Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study.

Background: Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, clinically presenting with common symptoms of fever, dry cough, and breathlessness within 14 days of exposure. Its severity ranges from mild to severe, latter manifesting into severe acute respiratory syndrome. As a part of multidisciplinary team, physiotherapy along with medical management was administered to patients with COVID-19 in an acute care setup. This retrospective study aims to explore various patient characteristics and will aid in identifying the impairments associated with the disease, giving a direction to the physiotherapy community in planning future management strategy to improve quality of life. Patients and methods: The present study is a unicentric study wherein prospective analysis of retrospective data of patients referred for physiotherapy from May 13 to July 31, 2020, was performed. (i) Characteristics of patients, (ii) associated comorbidities, (iii) hospital course since the time of admission to discharge, (iv) mode of oxygen delivery, (v) pre- and post-physiotherapy treatment values of oxygen saturation and heart rate, and (vi) physiotherapy treatment were recorded. The archived data were analyzed using the commercially available SPSS software version 24. Wilcoxon's matched pair test was used to compare pre- and post-treatment oxygen saturation and heart rate, and McNemar's test was used to compare mode of oxygen delivery and pre- and post-physiotherapy treatment. Results: Descriptive analysis of data showed a better outcome in terms of grade of dyspnea and rate of discharge on day 14 of physiotherapy treatment. Hence, a comparative analysis of day 1 and day 14 was performed for mode of oxygen delivery, oxygen saturation, and heart rate. A statistically significant improvement was observed in the heart rate (p = 0.001) and oxygen delivery (p = 0.000). However, no significant difference in the level of oxygen saturation was found (p = 0.6433). Conclusion: Physiotherapy treatment in conjunction with medical treatment can be effectively administered in patients with COVID-19 in acute care setup taking into consideration the health status and the hemodynamic stability of the patients. It emphasizes the role of physiotherapy in the alleviation of symptoms, facilitating early weaning and recovery enabling early discharge from the hospital. How to cite this article: Verma CV, Arora RD, Mistry HM, Kubal SV, Kolwankar NS, Patil PC, et al. Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study. Indian J Crit Care Med 2021;25(3):317-321.

Effect of radiation dose and iterative reconstruction on lung lesion conspicuity at MDCT: does one size fit all?

OBJECTIVE: To evaluate the effect of different acquisition parameters and reconstruction algorithms in lung lesions conspicuity in chest MDCT. METHODS: An anthropomorphic chest phantom containing 6 models of lung disease (ground glass opacity, bronchial polyp, solid nodule, ground glass nodule, emphysema and tree-in-bud) was scanned using 80, 100 and 120 kVp, with fixed mAs ranging from 10 to 110. The scans were reconstructed using filtered back projection (FBP) and iterative reconstruction (IR) algorithms. Three blinded thoracic radiologists reviewed the images and scored lesions conspicuity and overall image quality. Image noise and radiation dose parameters were recorded. RESULTS: All acquisitions with 120 kVp received a score of 3 (acceptable) or higher for overall image quality. There was no significant difference between IR and FBP within each setting for overall image quality (p>0.05), even though image noise was significantly lower using IR (p<0.0001). When comparing specific lower radiation acquisition parameters 100 kVp/10 mAs [Effective Dose (ED): 0.238 mSv] vs 120 kVp/10 mAs (ED: 0.406 mSv) vs 80 kVp/40 mAs (ED: 0.434 mSv), we observed significant difference in lesions conspicuity (p<0.02), as well as significant difference in overall image quality, independent of the reconstruction algorithm (p<0.02), with higher scores on the 120 kV/10 mAs setting. Tree-in-bud pattern, ground glass nodule and ground glass opacity required lower radiation doses to get a diagnostic score using IR when compared to FBP. CONCLUSION: Designing protocols for specific lung pathologies using lower dose acquisition parameters is feasible, and by applying iterative reconstruction, radiologists may have better diagnostic confidence to evaluate some lesions in very low dose settings, preserving acceptable image quality.

Meigs syndrome revisited.

The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection is known as Meigs syndrome, and its importance was first emphasized by Meigs and Cass in 1937. The importance of Meigs syndrome is that the presence of ascites and pleural effusion does not necessarily indicate that a pelvic mass is malignant. The benign tumors in Meigs syndrome are usually fibromas or fibrothecomas and constitute 4% of all ovarian neoplasms. The authors present a case of Meigs syndrome with an ovarian fibroma. They focus on the evaluation of pleural fluid in the setting of an ovarian mass and then briefly discuss the imaging of ovarian fibromas and fibrothecomas.