COVID-Associated Pulmonary Aspergillosis and Its Related Outcomes: A Single-Center Prospective Observational Study.

Background and objective Invasive pulmonary aspergillosis (IPA) is a frequent complication among neutropenic patients. It is increasingly being reported in critical coronavirus disease 2019 (COVID-19) patients requiring ICU admission and invasive mechanical ventilation (IMV) and is known as COVID-associated pulmonary aspergillosis (CAPA). We conducted this large prospective observational study to determine the frequency of CAPA and its outcomes in the ICU population. Methodology This was a prospective observational study. We recruited 307 reverse transcription-polymerase chain reaction (RT-PCR)-confirmed cases of severe COVID-19 pneumonia requiring IMV. We excluded those who did not require IMV or had been transferred out to other hospitals. The Chi-square test was applied to find the association between categorical variables. A p-value of <0.05 was considered statistically significant. Results Out of the 307 cases of mechanically ventilated COVID-19 pneumonia, 61 had probable CAPA. The median age was 60 years. Malignancy and cirrhosis were significant risk factors associated with CAPA (p=<0.001, 0.001, respectively). Aspergillus fumigatus was detected in 78.7% of the cases. The median length of ICU stay was 11 days [interquartile range (IQR): 4-14]. Among CAPA cases, 70.5% developed septic shock and required ionotropic support. Among 61 probable cases of CAPA, 91.8% did not survive and there was a strong correlation between CAPA and ICU mortality (p=0.001). Conclusion We concluded that CAPA is a fatal complication of severe COVID-19 pneumonia and is associated with increased mortality.

Comparison of High-Resolution Computed Tomography and Real-Time Reverse Transcriptase Polymerase Chain Reaction in Diagnosis of COVID-19 Pneumonia in Intensive Care Unit Population.

Introduction The efficacy of high-resolution computed tomography (HRCT) chest in common respiratory infections is well-established; however, its use in the diagnosis of COVID-19 pneumonia is less popular. The previous studies have failed to establish the efficacy of HRCT in the diagnosis of COVID-19 pneumonia. Objective The current study aimed to assess the efficacy of HRCT as compared to a polymerase chain reaction (PCR) in diagnosing COVID-19 pneumonia in patients in our setting. Methodology A prospective observational study was conducted at the Department of Chest Medicine, Shifa International Hospital from April 2020 to December 2020. A total of 250 patients were admitted to medical intensive care units. Findings of HRCT and PCR were documented. The accuracy of HRCT compared with PCR was assessed. Data were analyzed using SPSS version 24 (IBM Corp., Armonk, NY). Results COVID-19 infection was more prevalent in male patients (62.8% vs 37.2%). The mean age was 60 years (interquartile range, IQR, 49-72). Sensitivity and specificity of HRCT segregated into typical, indeterminate, and atypical HRCT were (94.8%, 56.8%), (92.7%, 47.2%), and (91.7%, 76.8%), respectively. The positive predictive value for typical HRCT was 84.3% (p≤0.001). Conclusion We concluded that typical HRCT findings have diagnostic utility in the diagnosis of COVID pneumonia. Similarly, a negative HRCT chest reliably excludes the possibility of COVID pneumonia. HRCT chest is a reliable alternative to RT-PCR.

Diagnostic Utility of N-terminal pro-Brain Natriuretic Peptide and C-reactive Protein in Diagnosing Heart Failure in Patients with Acute Hypoxemic Respiratory Failure.

Introduction Shortness of breath is a leading cause of intensive care unit (ICU) admissions and is multifactorial. Acute hypoxemic respiratory failure due to heart failure is one of the leading causes of ICU admissions. N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by ventricles and carries a negative predictive value for heart failure (2). NT-proBNP can also be raised in sepsis (4). Changes in NT-proBNP strongly correlated with changes in C-reactive protein (CRP) and leukocytes levels (8). Objective This study was conducted to explore the diagnostic utility of NT-proBNP and CRP to diagnose heart failure in patients presenting with acute hypoxemic respiratory failure. Materials and methods After informed consent and approval from the institutional review board (IRB), patients of acute hypoxemic respiratory failure were included in the study. History and physical examination were done by a medical resident and recorded in the patients' files. Data were transferred to a structured proforma by the researcher. All tests were conducted within three hours of presentation. The diagnosis of heart failure was made by a panel of experts, including the consultant cardiologist and consultant intensivist in charge. The chest X-ray was reported by the radiologist. The cost of the test was afforded by the institution. Data were analyzed by SPSS version 15 (SPSS Inc., Chicago, Illinois). Analysis of variance (ANOVA), Pearson correlation and linear regression were applied to find out the relation between variables and significance. Results We studied 137 patients. Out of them, 72.9% were diagnosed as heart failure. Heart failure was more common in females (43.7%) as compared to males (29%). NT-proBNP was raised in 111 (81%) patients and out of them, 88 patients (79%) had heart failure. Sensitivity and specificity of NT-proBNP were found to be (95.56%) and (46.81%), respectively. Similarly, CRP was 90% sensitive and 25.53% specific for heart failure. The most common findings in chest X-rays of patients with heart failure were upper lobe diversion and enlarged cardiothoracic ratio (71%). Conclusion We concluded our study as NT-proBNP is a highly sensitive test to diagnose heart failure in settings of acute hypoxemic respiratory failure. CRP is also significantly raised in heart failure. Upper lobe diversion and an increased cardiothoracic ratio is a strong predictor of heart failure.

Comparison of CLIF-C ACLF Score and MELD Score in Predicting ICU Mortality in Patients with Acute-On-Chronic Liver Failure.

Introduction Acute-on-chronic liver failure (ACLF) is a serious complication of liver cirrhosis which presents with hepatic and/or extrahepatic organ failure and often needs admission to an Intensive Care Unit (ICU). This condition typically needs organ support and carries a high mortality rate. ICU care may not benefit these patients. There are many scores to assess prognosis in these patients, such as the Model for End-stage Liver Disease (MELD) score, the MELD score refined to take into account serum sodium level (MELD-Na), the chronic liver failure organ failure (CLIF-OF) score, the CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score and the Child-Turcotte-Pugh classification. This study was conducted to compare CLIF-C ACLF and MELD scores for selecting patients at risk of high mortality, as ICU care to these patients in the absence of liver transplantation may be of no value. Methods The data of 75 patients admitted to the ICU of Shifa International Hospital in Islamabad were prospectively analyzed. CLIF-C ACLF and MELD scores were calculated at admission and then at 24 and 48 hours after the ICU stay. Data were analyzed with the assistance of SPSS. Mortality was the primary outcome. Results Comparison of both scores showed that a CLIF-C ACLF score ≥ 70 at 48 hours predicts mortality more accurately, with an area under receiver operating curve (AUROC) of 0.643 (confidence interval [CI] 95% 0.505-0.781; p=0.046) which was significantly higher than MELD scores of 30,40 and 50 at 48 hours. Organ failure and the need for supportive care were strong predictors of mortality (p= < 0.05). Conclusion We concluded that a CLIF-C ACLF score ≥ 70 at 48 hours and organ failure are better predictors of mortality and that ICU care in these patients does not benefit them. Definitive therapy in the form of liver transplantation may have a promising role, if considered early.

Quantifying Serum Derived Differential Expressed and Low Molecular Weight Protein in Breast Cancer Patients.

BACKGROUND: Searching the biomarker from complex heterogeneous material for early detection of disease is a challenging task in the field of biomedical sciences. OBJECTIVE: The study has been arranged to explore the proteomics serum derived profiling of the differential expressed and low molecular weight protein in breast cancer patient. METHODS: Quantitative proteome was analyzed using the Nano LC/Mass and Bioinformatics tool. RESULTS: This quantification yields 239 total protein constituting 29% of differentially expressed protein, with 82% downregulated differential protein and 18% up-regulated differential protein. While 12% of total protein were found to be cancer inducing proteins. Gene Ontology (GO) described that the altered proteins with 0-60 kDa mass in nucleus, cytosol, ER, and mitochondria were abundant that chiefly controlled the RNA, DNA, ATP, Ca ion and receptor bindings. CONCLUSION: The study demonstrate that the organelle specific, low molecular weighted proteins are significantly important biomarker. That act as strong agents in the prognosis and diagnosis of breast cancer at early stage.