Machine learning-based COVID-19 acute respiratory distress syndrome phenotyping and clinical outcomes: A systematic review.

COVID-19-related acute respiratory distress syndrome (CARDS) has been suggested to differ from the typical ARDS. While distinct phenotypes of ARDS have been identified through latent class analysis (LCA), it is unclear whether such phenotypes exist for CARDS and how they affect clinical outcomes. To address this question, we conducted a systematic review of the current evidence.We searched several, including PubMed, EBSCO Host, and Web of Science, from inception to July 1, 2022. Our exposure and outcome of interest were different CARDS phenotypes identified and their associated outcomes, such as 28-day, 90-day, 180-day mortality, ventilator-free days, and other relevant outcomes.We identified four studies comprising a total of 1776 CARDS patients.Of the four studies, three used LCA to identify subphenotypes (SPs) of CARDS. One study based on longitudinal data identified two SPs, with SP2 associated with worse ventilation and mechanical parameters than SP1. The other two studies based on baseline data also identified two SPs, with SP2 and SP1 were associated with hyperinflammatory and hypoinflammatory CARDS, respectively. The fourth study identified three SPs primarily stratified by comorbidities using multifactorial analysis.All studies identified a subphenotype associated with poorer outcomes, including mortality, ventilator-free days, multiple-organ injury, and pulmonary embolism. Two studies reported differential responses to corticosteroids among the SPs, with improved mortality in the hyperinflammatory and worse in the hypoinflammatory SPs.Overall, our review highlights the importance of phenotyping in understanding CARDS and its impact on disease management and prognostication. However, a consensus approach to phenotyping is necessary to ensure consistency and comparability across studies. We recommend that randomized clinical trials stratified by phenotype should only be initiated after such consensus is reached. Short title: COVID-19 ARDS subphenotypes and outcomes.

Case Report: Left atrial myxoma with confirmed Delta variant COVID-19 infection, "to treat or withhold".

Primary cardiac tumors (PCTs) are extremely rare entities. More than half of PCTs are benign, with myxoma being the most common tumor. Generally, simple tumor resection is the treatment of choice for benign PCTs since it has promising results that yield low complication and recurrence rates. However, in the COVID-19 pandemic era, the mitigation protocols and/or concurrent COVID-19 infection should be taken into account in patient management for the best overall outcome. To our knowledge, this is the first case report of a patient with a left atrial myxoma and systemic embolism complication in the form of an ischemic stroke, with a concurrent confirmed COVID-19 delta variant infection.

COVID-19 Associated Pulmonary Aspergillosis: A Case Series.

Coronavirus disease 2019 (COVID-19) has been a worldwide pandemic with several problems, one of which is the lack of definitive treatment. COVID-19-associated pulmonary aspergillosis (CAPA), the presence of invasive pulmonary aspergillosis (IPA) in COVID-19 patients, is one of the concerning secondary infections associated with higher mortality and worse clinical outcomes. Diagnosing CAPA may be challenging due to the possible absence of classic host factors and clinical symptoms or obscured radiological findings. We described two CAPA cases, which were suspected due to persistent respiratory failure despite standard treatment of COVID-19 with additional therapies and antimicrobial agents for secondary infections, eventually diagnosed with serum galactomannan testing. Clinical conditions of both patients improved significantly after the administration of voriconazole. This case series emphasizes the importance of being aware of clinical suspicions indicating CAPA followed by galactomannan testing as a relatively fast, noninvasive test for its diagnosis, which leads to appropriate antifungal treatment.

Lateral flow urine lipoarabinomannan assay for extrapulmonary tuberculosis diagnosis in adults who are HIV-positive.

BACKGROUND: The diagnosis of extrapulmonary tuberculosis (EPTB) in patients with HIV remains a challenge for clinicians. The World Health Organization recommends the detection of lipoarabinomannan (LAM) for diagnosing pulmonary tuberculosis in patients with HIV. A new generation of urine LAM tests (FujiLAM®) is available. However, studies regarding its accuracy are limited. OBJECTIVE: This study aimed to evaluate the accuracy of urine LAM tests using FujiLAM® for diagnosing EPTB in patients with HIV. METHODS: A cross-sectional study using urine samples of patients at Cipto Mangunkusumo Hospital, Indonesia, was performed from January 2020 to December 2020. Fresh urine was applied to the FujiLAM®. Patients were grouped into definitive, probable, and non-TB groups. The diagnostic accuracy of the urine LAM test was compared with other Mycobacterium tuberculosis specimen gold standard tests. RESULTS: Among 62 patients, 16 patients (25.8%) had definitive diagnosis of EPTB. Among those with definitive TB, an urine LAM test yielded a sensitivity of 75% (95% confidence interval [CI]: 47.62-92.73%) and specificity of 73.91% (95% CI: 87-85.73%). Meanwhile, compared with all diagnostic tests (definite + probable TB), FujiLAM® had a sensitivity value of 61% (95% CI 43.36-76.86%) and a specificity value of 92.31% (95% CI 74.87-99.05%). CONCLUSION: The FujiLAM® test is a feasible method for diagnosing EPTB in patients with HIV.

Prognostic Scoring System for Mortality of Hospitalized COVID-19 Patients in Resource-Limited Settings: A Multicenter Study from COVID-19 Referral Hospitals.

BACKGROUND: Many studies identified the risk factors and prognostic factors related to in-hospital COVID-19 mortality using sophisticated laboratory tests. Cost and the availability of supporting blood tests may be problematic in resource-limited settings. This multicenter cohort study was conducted to assess the factors associated with mortality of COVID-19 patients aged 18 years and older, based on history taking, physical examination, and simple blood tests to be used in resource-limited settings. METHODS: The study was conducted between July 2020 and January 2021 in five COVID-19 referral hospitals in Indonesia. Among 1048 confirmed cases of COVID-19, 160 (15%) died during hospitalization. RESULTS: Multivariate analysis showed eight predictors of in-hospital mortality, namely increased age, chronic kidney disease, chronic obstructive pulmonary disease, fatigue, dyspnea, altered mental status, neutrophil-lymphocyte ratio (NLR) ≥ 5.8, and severe-critical condition. This scoring system had an Area-under-the-curve (AUC) of 84.7%. With cut-off score of 6, the sensitivity was 76.3% and the specificity was 78.2%. CONCLUSION: The result of this practical prognostic scoring system may be a guide to decision making of physicians and help in the education of family members related to the possible outcome.

Effectiveness of Convalescent Plasma Therapy in Treating COVID-19: an Evidence-based Case Report.

BACKGROUND: Convalescent plasma is a potentially beneficial, tolerable, and available additional treatment option for COVID-19. This study aims to evaluate whether the administration of convalescent plasma therapy leads to improved clinical outcomes in COVID-19 patients compared to standard medical therapy. METHODS: We conducted a search of Pubmed, Cochrane, and EBSCO for studies assessing the clinical question using inclusion and exclusion criteria. Selected studies were critically appraised, and the results were summarized. RESULTS: A meta-analysis of 10 randomized clinical trials (RCTs), an RCT, a case-control clinical study were selected and assessed. Only the case-control clinical study showed that convalescent plasma administration improved the clinical outcomes of patients with COVID-19, including all-cause mortality, hospital length of stay, and the need for mechanical ventilation. On the contrary, the other two studies of a higher level of evidence showed no significant clinical outcome improvement with convalescent plasma therapy. CONCLUSION: The effectiveness of convalescent plasma therapy in improving clinical outcomes of patients with COVID-19 was still inconclusive due to several study limitations and other possible causes.

The Importance of Chest CT Scan in COVID-19.

The coronavirus disease 2019 (COVID-19) is a highly transmissible acute respiratory disease that is caused by the Severe Acute Respiratory Syndrome CoronaVirus-2 (SARS-CoV-2), a beta coronavirus first discovered in Wuhan, China, in late 2019. COVID-19 has been spreading swiftly globally, and as of March 2020, has been officially declared a pandemic by the World Health Organization (WHO). One of the challenges in managing COVID-19 is the identification of a swift, accessible, and reliable diagnostic modality that could serve as an alternative to a reverse-transcriptase polymerase chain reaction (RT-PCR). As of the writing of this paper, RT-PCR is still the recommended tool in diagnosing COVID-19, but the notion of a more prompt and accurate diagnostic tool is a possibility worth looking into. The objective of this case study is to investigate the importance and utility of chest computed tomography (CT) in the diagnosis of COVID-19, as increasing pieces of evidence suggest that chest CT could prove useful in the clinical pathway in diagnosing COVID-19.