Radiologic aspects of COVID-19 pneumonia: Outcomes and thoracic complications

Predictors of severity in severe respiratory infection in children with COVID-19 respiratory infection in a developing country

On March 11, 2020, the WHO declared the COVID-19 pandemic. This name was given to the disease caused by the SARS-CoV 2 virus at its outbreak in December 2019 in Wuhan, Hubei, China. In Colombia, a significant number of cases have been confirmed. The aim of this study was to evaluate children with respiratory symptoms caused by SARS-CoV2 infection, identifying independent predictors of risk of having a severe illness, thus leading to an early approach and intervention in our patients, especially in children with comorbidities. An analytical cross-sectional study was conducted between April 1, 2020 and March 31, 2021 at a fourth-level referral institution in Bogotá on patients under 18 years of age with respiratory symptoms and a COVID-19 diagnosis confirmed in the laboratory. An explanatory binary logistic regression model was performed with an outcome variable of admission to the intensive care unit. A total of 385 children were included in the study, with ages between 9 months and 17 years of age; 50.1% were male, and the ICR was 9.75 years. 41.6% had some comorbidity, 13.5% were admitted to the pediatric ICU, and 3.6% of the total number of patients died. The predictor variables were: use of antibiotics in the first 24 h, neurological comorbidity, and consolidation shown in the chest X-ray. This explains 38.7% of the variability of the variable. In this cohort of patients with COVID-19-associated respiratory symptoms, we identified predictors of severity, so we consider that these patients require a risk approach that allows timely and adequate care.

Pharmacotherapy consideration of thrombolytic medications in COVID-19-associated ARDS

BACKGROUND

In late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for coronavirus disease (COVID-19), was identified as the new pathogen to lead pneumonia in Wuhan, China, which has spread all over the world and developed into a pandemic. Despite the over 1 year of pandemic, due to the lack of an effective treatment plan, the morbidity and mortality of COVID-19 remains high. Efforts are underway to find the optimal management for this viral disease.

MAIN BODY

SARS-CoV-2 could simultaneously affect multiple organs with variable degrees of severity, from mild to critical disease. Overproduction of pro-inflammatory mediators, exacerbated cellular and humoral immune responses, and coagulopathy such as Pulmonary Intravascular Coagulopathy (PIC) contributes to cell injuries. Considering the pathophysiology of the disease and multiple microthrombi developments in COVID-19, thrombolytic medications seem to play a role in the management of the disease. Beyond the anticoagulation, the exact role of thrombolytic medications in the management of patients with COVID-19-associated acute respiratory distress syndrome (ARDS) is not explicit. This review focuses on current progress in underlying mechanisms of COVID-19-associated pulmonary intravascular coagulopathy, the historical use of thrombolytic drugs in the management of ARDS, and pharmacotherapy considerations of thrombolytic therapy, their possible benefits, and pitfalls in COVID-19-associated ARDS.

CONCLUSIONS

Inhaled or intravenous administration of thrombolytics appears to be a salvage therapy for severe ARDS associated with COVID-19 by prompt attenuation of lung injury. Considering the pathogenesis of COVID-19-related ARDS and mechanism of action of thrombolytic agents, thrombolytics appear attractive options in stable patients without contraindications.

SARS‐CoV ‐2, HIV , and Mycobacterium tuberculosis triple co‐infection

Tuberculosis (TB)‐related death has increased for the first time in a decade due to the coronavirus disease 2019 (COVID‐19), globally. People living with HIV (PLWHIV) might be at a higher risk of developing COVID‐19‐related complications. Herein, we describe the first case of a patient surviving from SARS‐CoV‐2‐TB‐HIV triple co‐infection in Cameroon. A 36‐year‐old Cameroonian woman presented at the emergency unit of the Jamot Hospital, Yaoundé with symptoms of anorexia, productive cough, weight loss, and fever. The SARS‐CoV‐2 rapid antigen test on nasopharyngeal sample was positive. Chest X‐ray showed bilateral parenchymal and tracheal calcifications most consistent with prior pulmonary histoplasmosis, varicella, or TB. She was tested HIV positive, and the sputum sample tested positive for TB on auramine staining. TB therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol) and COVID‐19 treatment were initiated, and the symptoms improved after 2 weeks of treatment. The SARS‐CoV‐2 rapid antigen and real‐time polymerase chain reaction tests were negative after 2 weeks. She was discharged home on antiretroviral therapy and TB therapy. Coinfection with both TB, HIV, and SARS‐CoV‐2 may be common in Cameroon but not reported. The similar clinical features of COVID‐19 and TB usually lead to misdiagnosis. Early diagnosis and initiation of appropriate treatment improve outcome.

COVID‐19, TB, and HIV are infectious diseases of global public health concern. Triple Co‐infection with these diseases can create a diagnostic and therapeutic dilemma. We present a 36‐year‐old Cameroonian woman who survived SARS‐CoV‐2 – HIV‐TB triple co‐infection. Timely diagnosis and appropriate management of these infections may improve outcomes and prevent complications.

An Analysis of New Feature Extraction Methods Based on Machine Learning Methods for Classification Radiological Images

The lungs are COVID-19's most important focus, as it induces inflammatory changes in the lungs that can lead to respiratory insufficiency. Reducing the supply of oxygen to human cells negatively impacts humans, and multiorgan failure with a high mortality rate may, in certain circumstances, occur. Radiological pulmonary evaluation is a vital part of patient therapy for the critically ill patient with COVID-19. The evaluation of radiological imagery is a specialized activity that requires a radiologist. Artificial intelligence to display radiological images is one of the essential topics. Using a deep machine learning technique to identify morphological differences in the lungs of COVID-19-infected patients could yield promising results on digital images of chest X-rays. Minor differences in digital images that are not detectable or apparent to the human eye may be detected using computer vision algorithms. This paper uses machine learning methods to diagnose COVID-19 on chest X-rays, and the findings have been very promising. The dataset includes COVID-19-enhanced X-ray images for disease detection using chest X-ray images. The data were gathered from two publicly accessible datasets. The feature extractions are done using the gray level co-occurrence matrix methods. K-nearest neighbor, support vector machine, linear discrimination analysis, naïve Bayes, and convolutional neural network methods are used for the classification of patients. According to the findings, convolutional neural networks' efficiency linked to imaging modalities with fewer human involvements outperforms other traditional machine learning approaches.

Coinfección de tuberculosis y COVID-19 asociado a tromboembolismo pulmonar: presentación de un caso

Contexto

En la actualidad, la infección por el virus SARS-CoV-2 genera predominantemente una infección respiratoria, que puede derivar complicaciones agudas y tardías, así como secuelas leves o graves. Una complicación que se ha evidenciado es el estado de hipercoagulabilidad, como tromboembolismo pulmonar (TEP) o trombosis venosa profunda (TVP).

Caso clínico

Se presenta una paciente con antecedente de infección reciente por COVID-19 que consulta por disnea y dolor en el hemitórax izquierdo, se toman imágenes complementarias evidenciando una gran caverna en la base pulmonar derecha y un electrocardiograma sugestivo de tromboembolismo pulmonar, se toma una TAC con el protocolo para TEP que lo confirma y baciloscopias que reportan positivo para la coinfección por tuberculosis pulmonar.

Discusión y conclusiones

La formación de fenómenos protrombóticos por COVID-19 se ha convertido en una complicación frecuente, sin embargo, es rara la coinfección de tuberculosis y COVID-19, esto se da por un proceso de amplificación de respuesta inmunológica desregulado denominado «tormenta de citoquinas», que activa infecciones latentes y ocultas, además el uso de medicamentos inmunosupresores en el COVID-19 pueden conducir a una expresión de tuberculosis.

Se debe sospechar una infección por tuberculosis en un medio endémico si persisten los síntomas tras la resolución de la infección vírica, en los casos sintomáticos antes del proceso vírico agudo o en los casos de hallazgos radiográficos atípicos. En estos casos se debe descartar infección por VIH u otra coinfección bacteriana.

High Flow Nasal Cannula Oxygenation Successfully Used as Bridge Therapy for Systemic Thrombolysis in COVID-19 Associated Intermediate-high Risk Pulmonary Embolism

The risk of venous thromboembolism (VTE) in COVID-19 patients is a growing problem. Thromboembolic complications are associated with the infection by SARSCoV-2, with an estimated incidence up to 25%-30% of VTE in patients with severe COVID-19 pneumonia. Here in, we present a case of a patient with severe pneumonia due to COVID-19 who is admitted with mild pneumothorax secondary to COVID-19 and high-intermediate-risk pulmonary embolism (PE), who underwent successfully a highflow nasal cannula (HFNC) oxygenation bridge with subsequent successful half-doses of systemic thrombolysis with intravenous alteplase. Prospective studies are warranted in this subset of patients with intermediate-high and high-risk PE, to further explore HFNC oxygenation with or without diverse reperfusion strategies, with the aim to identify the best individualized therapeutic approach in each patient with significant COVID-19 associated VTE and optimize outcomes.