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1.
Artigo em Inglês | MEDLINE | ID: mdl-34200028

RESUMO

BACKGROUND: The usefulness of Lung Ultrasound (LUS) for the diagnosis of interstitial syndrome caused by COVID-19 has been broadly described. The aim of this study was to evaluate if LUS may predict the complications (hospital admission) of COVID-19 pneumonia in primary care patients. METHODS: This observational study collects data from a cohort of 279 patients with clinical symptoms of COVID-19 pneumonia who attended the Balaguer Primary Health Care Area between 16 March 2020 and 30 September 2020. We collected the results of LUS scans reported by one general practitioner. We created a database and analysed the absolute and relative frequencies of LUS findings and their association with hospital admission. We found that different LUS patterns (diffuse, attenuated diffuse, and predominantly unilateral) were risk factors for hospital admission (p < 0.05). Additionally, an evolutionary pattern during the acute phase represented a risk factor (p = 0.0019). On the contrary, a normal ultrasound pattern was a protective factor (p = 0.0037). Finally, the presence of focal interstitial pattern was not associated with hospital admission (p = 0.4918). CONCLUSION: The lung ultrasound was useful to predict complications in COVID-19 pneumonia and to diagnose other lung diseases such as cancer, tuberculosis, pulmonary embolism, chronic interstitial pneumopathy, pleuropericarditis, pneumonia or heart failure.


Assuntos
COVID-19 , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Atenção Primária à Saúde , SARS-CoV-2 , Ultrassonografia
2.
Medicine (Baltimore) ; 100(27): e25938, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232165

RESUMO

ABSTRACT: 2019 Novel Coronavirus (COVID-19) is a new acute infectious disease of respiratory system, posed a great threat to human health because of its strong infectivity and rapid progress. This study aimed to assess the severity of COVID-19 Pneumonia by analyzing the change of CT manifestations and body temperature.This retrospective review included 22 patients with COVID-19 pneumonia. The imaging manifestations and clinical features were observed and evaluated.Most of the infected patients were men (13/22, 59%). Fever (>38°C) (17/22, 77%) and cough (6/22, 27%) were the main symptoms. Leukocytes count decreased in 23% of patients and lymphocyte decreased in 41%. Twenty-one patients with pneumonia had abnormal findings on chest CT. The special CT manifestations were observed at the first CT examination when the lesions progressed, including a single ground glass nodule with uneven density, multiple ground glass opacities distributed in subpleural, and the ground glass opacities confined in superior lobe. The special CT manifestations were observed at the first CT examination when the lesions resolved, including ground glass opacities with homogeneous density. The lesion involved in the bilateral lungs and the absorption of the lesions mainly occurred in bilateral inferior lobes. Three patients had normalized body temperature increased more than 1°C within 1 to 2 days after admission. Ten patients fluctuated more than 1°C within 1 to 7 days after admission and the second CT scans showed the disease was at the progressive stage.Dynamic analysis of CT manifestations and body temperature have the potential to predict the severity of COVID-19 pneumonia.


Assuntos
Temperatura Corporal/fisiologia , COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Pandemias , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/fisiopatologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
3.
J Med Case Rep ; 15(1): 359, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243811

RESUMO

BACKGROUND: We diagnosed a clinical case of pulmonary infection involving Mycobacterium tuberculosis and Tropheryma whipplei in a patient with acute respiratory distress syndrome. The diagnosis was assisted by metagenomic next-generation sequencing of bronchoalveolar lavage fluid. CASE PRESENTATION: A 44-year-old Han Chinese inmate was transferred to the emergency department because of dry cough, chest tightness, and shortness of breath. The patient's body temperature rose to 39.3 °C following empirical cephalosporin treatment for 1 week. The blood CD4+/CD8+ ratio was 0.7, suggesting immunodeficiency. Routine microbiological tests were performed, and tuberculosis interferon gamma release assays were positive. Mycobacterium tuberculosis polymerase chain reaction was also positive. Chest computed tomography scan revealed miliary nodules and ground-glass opacifications, which were in accordance with tuberculosis. To fully examine the etiology, we performed routine laboratory tests and metagenomic sequencing, the results of which indicated the presence of Mycobacterium tuberculosis and Tropheryma whipplei. We administered anti-tuberculosis regimen in combination with trimethoprim/sulfamethoxazole. The patient recovered, with chest computed tomography scan showing absorption of lesions. CONCLUSIONS: Compared with traditional diagnostic methods such as culture and serology, metagenomic next-generation sequencing has the advantage of detecting a wide array of microorganisms in a single test and therefore can be used for clinical diagnosis of rare pathogens and microbial coinfections. It is particularly useful for immunocompromised patients as they are more prone to infection by opportunistic microorganisms.


Assuntos
Coinfecção , Mycobacterium tuberculosis , Adulto , Líquido da Lavagem Broncoalveolar , Coinfecção/diagnóstico , Humanos , Pulmão/diagnóstico por imagem , Mycobacterium tuberculosis/genética , Tropheryma
4.
Medicina (Kaunas) ; 57(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: covidwho-1259541

RESUMO

Background and objective: According to the World Health Organization (WHO), more than 100 million people have already recovered from SARS-CoV-2 infection. Therefore, it is imperative to understand the possible outcomes of COVID-19. The aim of our study was to evaluate pulmonary function, exercise capacity, residual radiological changes, and health-related quality of life (HRQoL) at follow-up in a cohort of SARS-CoV-2 pneumonia survivors. Materials and Methods: Patients with SARS-CoV-2 infection and radiologically confirmed lung injury, with no chronic lung disease prior to this infection, were included in the study. Patients' evaluation 2 months after their discharge from hospital included spirometry (FVC, FEV1, FEV1/FVC), determination of lung volume (TLC, VC, RV) and diffusing capacity of lung for carbon monoxide (DLCO, adjusted for hemoglobin), 6-Minute Walk Test (6MWT), chest CT scan, and 36-Item Short Form General Health Survey (SF-36). Results: Fifty-one patients (25 men, 26 women) were included. The mean age was 56 years (SD-11,72). Eighteen patients (35.3%) had experienced moderate COVID-19, 21 (41.2%) severe COVID-19, and 12 (23.5%) were critically ill. The mean follow-up visit time after the discharge from hospital was 60 days (SD-17). Pulmonary function at follow-up was impaired in 24 (47.2%) patients. Reduced lung volume was observed in 15 (29.4%) patients, DLCO reduction in 15 (29.4%) patients, and only one patient displayed obstruction. Twelve patients out of 51 (12/51, 27.3%) showed reduced physical capacity in the 6 MWT, and 3/51 (9.1%) showed desaturation, with SO2 < 90%. Different levels of abnormality were found in 49/51 (96,1%) patients on follow-up chest CT; the median radiological score was 10.9 (SD ± 8.87, possible maximal score, 25). Ground-glass opacity was the most common radiological feature, found in 45 (88.2%) patients. The SF-36 scores demonstrated a reduction in health status across all domains, with the lowest scores for limitations in social activities because of physical problems, vitality, and general health. Conclusion: In the group of COVID-19 pneumonia survivors 2 months after hospital discharge, residual changes in the lungs on chest CT and in lung function and reduced physical and HRQoL status were found in a significant number of patients. To evaluate COVID-19 long-term consequences, a longer follow-up period is needed.


Assuntos
COVID-19 , Pneumonia , Tolerância ao Exercício , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , SARS-CoV-2
5.
Artigo em Inglês | MEDLINE | ID: covidwho-1259488

RESUMO

BACKGROUND: The usefulness of Lung Ultrasound (LUS) for the diagnosis of interstitial syndrome caused by COVID-19 has been broadly described. The aim of this study was to evaluate if LUS may predict the complications (hospital admission) of COVID-19 pneumonia in primary care patients. METHODS: This observational study collects data from a cohort of 279 patients with clinical symptoms of COVID-19 pneumonia who attended the Balaguer Primary Health Care Area between 16 March 2020 and 30 September 2020. We collected the results of LUS scans reported by one general practitioner. We created a database and analysed the absolute and relative frequencies of LUS findings and their association with hospital admission. We found that different LUS patterns (diffuse, attenuated diffuse, and predominantly unilateral) were risk factors for hospital admission (p < 0.05). Additionally, an evolutionary pattern during the acute phase represented a risk factor (p = 0.0019). On the contrary, a normal ultrasound pattern was a protective factor (p = 0.0037). Finally, the presence of focal interstitial pattern was not associated with hospital admission (p = 0.4918). CONCLUSION: The lung ultrasound was useful to predict complications in COVID-19 pneumonia and to diagnose other lung diseases such as cancer, tuberculosis, pulmonary embolism, chronic interstitial pneumopathy, pleuropericarditis, pneumonia or heart failure.


Assuntos
COVID-19 , Hospitalização , Humanos , Pulmão/diagnóstico por imagem , Atenção Primária à Saúde , SARS-CoV-2 , Ultrassonografia
6.
BMC Infect Dis ; 21(1): 629, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210287

RESUMO

BACKGROUND: Along with the medical development, organ transplant patients increase dramatically. Since these transplant patients take immunosuppressants for a long term, their immune functions are in a suppressed state, prone to all kinds of opportunistic infections and cancer. However, it is rarely reported that the kidney transplant recipients (KTRs) have pulmonary tuberculosis and lung cancer simultaneously. CASE PRESENTATION: A 60-year-old male was admitted because of persistent lung shadow for 2 years without any obvious symptom 8 years after renal transplant. T-SPOT test was positive but other etiological examinations for Mycobacterium tuberculosis were negative. Chest CT scan revealed two pulmonary lesions in the right upper and lower lobe respectively. 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) CT found FDG intake increased in both pulmonary consolidation lesions. CT-guided percutaneous transthoracic needle biopsy revealed lung adenocarcinoma and tuberculosis. The video-assisted thoracoscopic surgery was operated to resect the malignancy lesions. The patient received specific anti-tuberculosis therapy and was discharged. At the follow-up of 6 months post drug withdrawal, the patient was recovered very well. CONCLUSIONS: We for the first time reported co-existence of smear-negative pulmonary TB and lung adenocarcinoma in a KTR, which highlighted the clinical awareness of co-occurrence of TB and malignancy after renal transplant and emphasized the value of biopsy and 18F-FDG-PET in early diagnosis of TB and cancer.


Assuntos
Adenocarcinoma/complicações , Transplante de Rim , Neoplasias Pulmonares/complicações , Tuberculose Pulmonar/complicações , Adenocarcinoma/cirurgia , China/epidemiologia , Etambutol/uso terapêutico , Fluordesoxiglucose F18 , Humanos , Biópsia Guiada por Imagem , Isoniazida/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico
7.
Acta Biomed ; 92(3): e2021209, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212908

RESUMO

BACKGROUND AND AIM: Rheumatic Heart Disease (RHD) often evolves in congestive heart failure with development of pulmonary edema after a period of asymptomatic, latent phase. In the last years, Lung Ultrasound (LUS) has gained a primary role in the diagnosis and management of pleuropulmonary disorders, also in pediatric practice and in the diagnosis and follow-up of pulmonary edema through the qualitative analysis of ultrasound B-lines.Aim of this case report is that to keep high clinicians' attention to the diagnosis that of Rheumatic Heart Disease also in high-income countries and to deepen the role and importance of lung ultrasound, in clinical practice, in diagnosis and follow-up of pediatric lung diseases, especially in emergency settings as happened in our case. METHODS: We present the case of a 14-year-old Italian boy from a medium-low socio-economic and cultural class Italian family, who was diagnosed with severe and advanced stage RHD, which had remained undiagnosed until then. RESULTS AND CONCLUSIONS: In the diagnostic process of our case, LUS played a fundamental role because it quickly directed us, contextually to the clinical and anamnestic evaluation, towards the right diagnosis, in a Pediatric Emergency Department. In clinical practice, the only LUS findings and the only qualitative analysis of the B-lines, does not make clinicians able to make a clear characterization yet. Thus the study of cardiovascular function, laboratory parameters, anamnestic and clinical data continue to be useful tools to assist the LUS in the diagnostic processes of lung diseases, as was the case in our case.


Assuntos
Insuficiência Cardíaca , Edema Pulmonar , Adolescente , Criança , Serviço Hospitalar de Emergência , Humanos , Pulmão/diagnóstico por imagem , Masculino , Ultrassonografia
8.
Chin Med Sci J ; 36(2): 85-96, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34231456

RESUMO

ObjectiveTo describe the epidemiologic, clinical, laboratory, and radiological characteristics and prognoses of COVID-19 confirmed patients in a single center in Beijing, China. Methods The study retrospectively included 19 patients with nucleic acid-confirmed SARS-CoV-2 infection at our hospital from January 20 to March 5, 2020. The final follow-up date was March 14, 2020. The epidemiologic and clinical information was obtained through direct communication with the patients or their family members. Laboratory results retrieved from medical records and radiological images were analyzed both qualitatively by two senior chest radiologists as well as quantitatively via an artificial intelligence software. Results We identified 5 family clusters (13/19, 68.4%) from the study cohort. All cases had good clinical prognoses and were either mild (3/19) or moderate (16/19) clinical types. Fever (15/19, 78.9%) and dry cough (11/19, 57.9%) were common symptoms. Two patients received negative results for more than three consecutive viral nucleic acid tests. The longest interval between an initial CT abnormal finding and a confirmed diagnosis was 30 days. One patient's nucleic acid test turned positive on the follow-up examination after discharge. The presence of radiological abnormalities was non-specific for the diagnosis of COVID-19. Conclusions COVID-19 patients with mild or no clinical symptoms are common in Beijing, China. Radiological abnormalities are mostly non-specific and massive CT examinations for COVID-19 screening should be avoided. Analyses of the contact histories of diagnosed cases in combination with clinical, radiological and laboratory findings are crucial for the early detection of COVID-19. Close monitoring after discharge is also recommended.


Assuntos
Teste de Ácido Nucleico para COVID-19 , COVID-19 , Pulmão/diagnóstico por imagem , SARS-CoV-2 , Tomografia Computadorizada por Raios X , Adulto , COVID-19/diagnóstico , COVID-19/diagnóstico por imagem , Criança , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
IEEE J Transl Eng Health Med ; 9: 1800209, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34235005

RESUMO

Background: Accurate and fast diagnosis of COVID-19 is very important to manage the medical conditions of affected persons. The task is challenging owing to shortage and ineffectiveness of clinical testing kits. However, the existing problems can be improved by employing computational intelligent techniques on radiological images like CT-Scans (Computed Tomography) of lungs. Extensive research has been reported using deep learning models to diagnose the severity of COVID-19 from CT images. This has undoubtedly minimized the manual involvement in abnormality identification but reported detection accuracy is limited. Methods: The present work proposes an expert model based on deep features and Parameter Free BAT (PF-BAT) optimized Fuzzy K-nearest neighbor (PF-FKNN) classifier to diagnose novel coronavirus. In this proposed model, features are extracted from the fully connected layer of transfer learned MobileNetv2 followed by FKNN training. The hyperparameters of FKNN are fine-tuned using PF-BAT. Results: The experimental results on the benchmark COVID CT scan data reveal that the proposed algorithm attains a validation accuracy of 99.38% which is better than the existing state-of-the-art methods proposed in past. Conclusion: The proposed model will help in timely and accurate identification of the coronavirus at the various phases. Such kind of rapid diagnosis will assist clinicians to manage the healthcare condition of patients well and will help in speedy recovery from the diseases. Clinical and Translational Impact Statement - The proposed automated system can provide accurate and fast detection of COVID-19 signature from lung radiographs. Also, the usage of lighter MobileNetv2 architecture makes it practical for deployment in real-time.


Assuntos
COVID-19/diagnóstico por imagem , Aprendizado Profundo , Interpretação de Imagem Assistida por Computador/métodos , Algoritmos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , SARS-CoV-2 , Tomografia Computadorizada por Raios X
11.
Radiologia (Engl Ed) ; 63(4): 324-333, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34246423

RESUMO

BACKGROUND AND AIMS: We aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings. MATERIAL AND METHODS: This retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients' comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6A, 6B, and 8) to quantify lung involvement in each patient's initial pathological chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings. RESULTS: In the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (P = .009 in 6A, P = .001 in 6B, and P = .001 in 8) and with death (P = .02 in 6A, P = .01 in 6B, and P = .006 in 8). In the regression analysis, the most significant associations were 6B with alveolar involvement (OR 2.3; 95%CI 1.1.-4.7; P = .025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.-4.25; P = .046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe. CONCLUSION: Moderate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first pathologic X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.


Assuntos
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Tempo de Internação , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção Terciária , Raios X
12.
Int J Mol Sci ; 22(12)2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34204767

RESUMO

Increased airway wall thickness and remodeling of bronchial mucosa are characteristic of asthma and may arise from altered integrin signaling on airway cells. Here, we analyzed the expression of ß1-subfamily integrins on blood and airway cells (flow cytometry), inflammatory biomarkers in serum and bronchoalveolar lavage, reticular basement membrane (RBM) thickness and collagen deposits in the mucosa (histology), and airway geometry (CT-imaging) in 92 asthma patients (persistent airflow limitation subtype: n = 47) and 36 controls. Persistent airflow limitation was associated with type-2 inflammation, elevated soluble α2 integrin chain, and changes in the bronchial wall geometry. Both subtypes of asthma showed thicker RBM than control, but collagen deposition and epithelial α1 and α2 integrins staining were similar. Type-I collagen accumulation and RBM thickness were inversely related to the epithelial expression of the α2 integrin chain. Expression of α2ß1 integrin on T-cells and eosinophils was not altered in asthma. Collagen I deposits were, however, more abundant in patients with lower α2ß1 integrin on blood and airway CD8+ T-cells. Thicker airway walls in CT were associated with lower α2 integrin chain on blood CD4+ T-cells and airway eosinophils. Our data suggest that α2ß1 integrin on inflammatory and epithelial cells may protect against airway remodeling advancement in asthma.


Assuntos
Asma/metabolismo , Asma/patologia , Progressão da Doença , Integrina alfa2beta1/metabolismo , Pulmão/patologia , Substâncias Protetoras/metabolismo , Adulto , Idoso , Remodelação das Vias Aéreas , Asma/sangue , Asma/imunologia , Membrana Basal/patologia , Brônquios/diagnóstico por imagem , Brônquios/patologia , Brônquios/fisiopatologia , Lavagem Broncoalveolar , Feminino , Humanos , Inflamação/patologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Membrana Mucosa/patologia , Subunidades Proteicas/metabolismo , Ventilação Pulmonar , Solubilidade , Linfócitos T/metabolismo , Tomografia Computadorizada por Raios X
13.
J Healthc Eng ; 2021: 5513679, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34194681

RESUMO

The world is experiencing an unprecedented crisis due to the coronavirus disease (COVID-19) outbreak that has affected nearly 216 countries and territories across the globe. Since the pandemic outbreak, there is a growing interest in computational model-based diagnostic technologies to support the screening and diagnosis of COVID-19 cases using medical imaging such as chest X-ray (CXR) scans. It is discovered in initial studies that patients infected with COVID-19 show abnormalities in their CXR images that represent specific radiological patterns. Still, detection of these patterns is challenging and time-consuming even for skilled radiologists. In this study, we propose a novel convolutional neural network- (CNN-) based deep learning fusion framework using the transfer learning concept where parameters (weights) from different models are combined into a single model to extract features from images which are then fed to a custom classifier for prediction. We use gradient-weighted class activation mapping to visualize the infected areas of CXR images. Furthermore, we provide feature representation through visualization to gain a deeper understanding of the class separability of the studied models with respect to COVID-19 detection. Cross-validation studies are used to assess the performance of the proposed models using open-access datasets containing healthy and both COVID-19 and other pneumonia infected CXR images. Evaluation results show that the best performing fusion model can attain a classification accuracy of 95.49% with a high level of sensitivity and specificity.


Assuntos
COVID-19/diagnóstico por imagem , Aprendizado Profundo , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Torácica/métodos , Humanos , Pulmão/diagnóstico por imagem , SARS-CoV-2 , Sensibilidade e Especificidade
14.
J Investig Med High Impact Case Rep ; 9: 23247096211029787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34229469

RESUMO

We report the case of a 65-year-old man with COVID-19 (coronavirus disease-2019) post-infectious encephalitis who presented with delirium as an initial manifestation. He had severe COVID-19 pneumonia and recovered with dexamethasone and tocilizumab. One week after discharge, he developed abnormal behavior and delirium without fever and respiratory symptoms. Brain magnetic resonance imaging showed no abnormalities. Cerebrospinal fluid showed pleocytosis and elevated protein concentrations and was negative for severe acute respiratory syndrome-coronavirus-2 RNA. No anti-neuronal autoantibodies against intracellular and neuronal surface proteins were detected. The cerebrospinal fluid inflammatory changes compatible with post-infectious encephalitis, and the patient recovered with intravenous methylprednisolone and intravenous immunoglobulin therapy. Delirium could be an initial symptom of post-infectious encephalitis in older adults with COVID-19, and these patients may require immunosuppressive therapy.


Assuntos
COVID-19/complicações , Delírio/etiologia , Encefalite Viral/etiologia , Idoso , Encéfalo/diagnóstico por imagem , COVID-19/diagnóstico por imagem , Encefalite Viral/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , SARS-CoV-2/isolamento & purificação , Tomografia Computadorizada por Raios X
15.
PLoS One ; 16(7): e0252941, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34242213

RESUMO

Medical imaging as method to assess the longitudinal process of a SARS-CoV-2 infection in non-human primates is commonly used in research settings. Bronchoalveolar lavage (BAL) is regularly used to determine the local virus production and immune effects of SARS-CoV-2 in the lower respiratory tract. However, the potential interference of those two diagnostic modalities is unknown in non-human primates. The current study investigated the effect and duration of BAL on computed tomography (CT) in both healthy and experimentally SARS-CoV-2-infected female rhesus macaques (Macaca mulatta). In addition, the effect of subsequent BALs was reviewed. Thorax CTs and BALs were obtained from four healthy animals and 11 experimentally SARS-CoV-2-infected animals. From all animals, CTs were obtained just before BAL, and 24 hours post-BAL. Additionally, from the healthy animals, CTs immediately after, and four hours post-BAL were obtained. Thorax CTs were evaluated for alterations in lung density, measured in Hounsfield units, and a visual semi-quantitative scoring system. An increase in the lung density was observed on the immediately post-BAL CT but resolved within 24 hours in the healthy animals. In the infected animals, a significant difference in both the lung density and CT score was still found 24 hours after BAL. Furthermore, the differences between time points in CT score were increased for the second BAL. These results indicate that the effect of BAL on infected lungs is not resolved within the first 24 hours. Therefore, it is important to acknowledge the interference between BAL and CT in rhesus macaques.


Assuntos
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , SARS-CoV-2 , Tomografia Computadorizada por Raios X , Animais , Líquido da Lavagem Broncoalveolar , Modelos Animais de Doenças , Pulmão/virologia , Macaca mulatta , Tórax/diagnóstico por imagem , Tórax/virologia
17.
Tuberk Toraks ; 69(2): 177-186, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256508

RESUMO

Introduction: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can be confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). Materials and Methods: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. Result: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p<0.001). Fever, cough, and fatigue were found significantly higher in the COVID-19 pneumonia patients group (p<0.001). There was difference of lesions distribution between the two groups, centrally distributed lesions were found significantly higher in acute heart failure patients (p<0.001). Pleural effusion and cardiomegaly were found significantly higher in AHF patients (p<0.001, p<0.001). Counts of the white blood cells and lymphocytes were found significantly lower in COVID-19 pneumonia patients (p= 0.003, p= 0.009). COVID-19 pneumonia patients had significantly higher levels of CRP, ferritin, LDH and CK compared with AHF patients (p<0.001, p<0.001, p= 0.002, p= 0.013). However the level of NT-proBNP was found significantly higher in the AHF patients group (p<0.001). Conclusions: We believe that laboratory data and thorax CT findings can provide beneficial clinical information in differentiating COVID-19 pneumonia from AHF during the pandemic.


Assuntos
COVID-19/diagnóstico , Insuficiência Cardíaca/diagnóstico , Pulmão/diagnóstico por imagem , Pandemias , SARS-CoV-2 , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Idoso , COVID-19/epidemiologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
Tuberk Toraks ; 69(2): 187-195, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256509

RESUMO

Introduction: The aim of the study was to investigate the effects of radiological distribution on COVID-19 clinic and prognosis and to determine the relationship between laboratory parameters and thorax CT findings. Materials and Methods: Patients with COVID-19 were evaluated retrospectively. Laboratory parameters were obtained from medical records. Ground-glass opacities (GGO) and consolidation were evaluated on thorax CT. The presence of a single lobe lesion was considered as limited while multiple lobe lesions were considered as diffuse involvement for both GGO and consolidation. Result: A total 200 patients with COVID-19 were evaluated. 178 of them (89%) were discharged, 17 patients (8.5%) were transferred to the ICU and five patients died (2.5%). The ratios of mortality and transfer to the ICU in patients with diffused GGO were significantly higher compared to patients with limited GGOs. It was observed that troponin ≥0.06 µg/L, platelet <140 and fibrinogen ≥350 mg/dl were independent predictors of the presences of diffused GGOs in thorax CT. Conclusions: Diffused GGOs on thorax CT are correlated with the rate of mortality and transfer to the ICU in patients with COVID-19. Also, troponin, fibrinogen, and platelet levels can be used while predicting extensive parenchymal disease on thorax CT.


Assuntos
COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Estudos Retrospectivos , SARS-CoV-2
19.
Chest ; 160(1): e39-e44, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34246387

RESUMO

CASE PRESENTATION: A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. His medical history included hypertension, diabetes mellitus, chronic kidney disease, morbid obesity, paroxysmal atrial fibrillation, and tobacco use. He was taking amiodarone, carvedilol, furosemide, pregabalin, and insulin. The patient appeared to be in mild respiratory distress. He was afebrile and had saturation at 93% on 3 L of oxygen, heart rate of 105 beats/min, BP of 145/99 mm Hg, and respiratory rate of 18 breaths/min. On auscultation, there were crackles on bilateral lung bases and chronic bilateral leg swelling with hyperpigmented changes. His WBC count was 6.0 K/cumm (3.5 to 10.6 K/cumm) with absolute lymphocyte count 0.7 K/cumm (1.0 to 3.8 K/cumm); serum creatinine was 2.81 mg/dL (0.7 to 1.3 mg/dL). He had elevated inflammatory markers (serum ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and creatinine phosphokinase). Chest radiography showed bilateral pulmonary opacities that were suggestive of multifocal pneumonia (Fig 1). Nasopharyngeal swab for SARS-CoV-2 was positive. Therapy was started with ceftriaxone, doxycycline, hydroxychloroquine, and methylprednisolone 1 mg/kg IV for 3 days. By day 3 of hospitalization, he required endotracheal intubation, vasopressor support, and continuous renal replacement. Blood cultures were negative; respiratory cultures revealed only normal oral flora, so antibiotic therapy was discontinued. On day 10, WBC count increased to 28 K/cumm, and chest radiography showed persistent bilateral opacities with left lower lobe consolidation. Repeat respiratory cultures grew Pseudomonas aeruginosa (Table 1). Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.


Assuntos
Aspergillus niger/isolamento & purificação , COVID-19 , Hemoptise , Aspergilose Pulmonar Invasiva , Pseudomonas aeruginosa/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Superinfecção , Voriconazol/administração & dosagem , Idoso , Antifúngicos/administração & dosagem , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/fisiopatologia , COVID-19/terapia , Deterioração Clínica , Estado Terminal/terapia , Procedimentos Clínicos , Diagnóstico Diferencial , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/fisiopatologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Radiografia Torácica/métodos , Respiração Artificial/métodos , Superinfecção/diagnóstico , Superinfecção/microbiologia , Superinfecção/fisiopatologia , Superinfecção/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Khirurgiia (Mosk) ; (7): 84-89, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34270199

RESUMO

Differential diagnosis of pulmonary infiltrates is difficult due to the absence of specific clinical and radiological manifestations. Differential diagnosis of pulmonary infiltrates usually includes the following «triad¼: pneumonia, tuberculosis, lung cancer. Diagnosis of pulmonary tuberculosis is based on microbiological examination of sputum and bronchoscopic respiratory samples - bronchial washing and bronchoalveolar lavage. Efficiency of molecular genetic methods (including express tests) in detecting M. tuberculosis DNA can reach 91-98%. Therefore, treatment may be started without data of microbiological examination. Nevertheless, there are rare cases of false-positive results of PCR in patients with non-tuberculous lung lesions. This aspect often results false diagnosis and delayed verification of true cause of lung lesion. Another adverse effect is associated with anti-tuberculosis therapy. Endoscopic transbronchial lung biopsy and its modern version (transbronchial cryobiopsy) as a minimally invasive diagnostic procedure are performed in such patients. These methods require a sufficiently high experience and qualification of specialist and following such aspects as navigation techniques and balloon bronchial blocking. We present this clinical case as a demonstration of modern possibilities of multimodal navigational bronchoscopic diagnosis with transbronchial cryobiopsy for local pulmonary infiltrate.


Assuntos
Broncoscopia , Pneumopatias , Biópsia , Diagnóstico Diferencial , Endossonografia , Humanos , Pulmão/diagnóstico por imagem
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