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Lloyd-Jones G, Alcock R, Oudkerk M. COVID-19 lung disease is a pulmonary vasculopathy. Clin Radiol 2024; 79:e975-e978. [PMID: 38714395 DOI: 10.1016/j.crad.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/09/2024]
Affiliation(s)
- G Lloyd-Jones
- Department of Clinical Radiology, Salisbury NHS Foundation Trust, Salisbury, United Kingdom.
| | - R Alcock
- Department of Clinical Radiology, Salisbury NHS Foundation Trust, Salisbury, United Kingdom.
| | - M Oudkerk
- University of Groningen, Groningen, The Netherlands; Institute for Diagnostic Accuracy, Groningen, The Netherlands.
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2
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Moore J, Remy J, Altschul E, Chusid J, Flohr T, Raoof S, Remy-Jardin M. Thoracic Applications of Spectral CT Scan. Chest 2024; 165:417-430. [PMID: 37619663 DOI: 10.1016/j.chest.2023.07.4225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
TOPIC IMPORTANCE Thoracic imaging with CT scan has become an essential component in the evaluation of respiratory and thoracic diseases. Providers have historically used conventional single-energy CT; however, prevalence of dual-energy CT (DECT) is increasing, and as such, it is important for thoracic physicians to recognize the utility and limitations of this technology. REVIEW FINDINGS The technical aspects of DECT are presented, and practical approaches to using DECT are provided. Imaging at multiple energy spectra allows for postprocessing of the data and the possibility of creating multiple distinct image reconstructions based on the clinical question being asked. The data regarding utility of DECT in pulmonary vascular disorders, ventilatory defects, and thoracic oncology are presented. A pictorial essay is provided to give examples of the strengths associated with DECT. SUMMARY DECT has been most heavily studied in chronic thromboembolic pulmonary hypertension; however, it is increasingly being used across a wide spectrum of thoracic diseases. DECT combines morphologic and functional assessments in a single imaging acquisition, providing clinicians with a powerful diagnostic tool. Its role in the evaluation and treatment of thoracic diseases will likely continue to expand in the coming years as clinicians become more experienced with the technology.
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Affiliation(s)
- Jonathan Moore
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY
| | - Jacques Remy
- Univ Lille, Department of Thoracic Imaging, Lille, France
| | - Erica Altschul
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY
| | - Jesse Chusid
- Feinstein Institutes for Medical Research, and Imaging Services, Department of Radiology, Northwell Health, Manhasset, NY
| | - Thomas Flohr
- Department of Computed Tomography Research & Development, Siemens Healthineers, Forchheim, Germany
| | - Suhail Raoof
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health Physician Partners, New York, NY.
| | - Martine Remy-Jardin
- Univ Lille, Department of Thoracic Imaging, Lille, France; Univ Lille, CHU Lille, Evaluation des technologies de santé et des pratiques médicales, Lille, France
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3
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Bailey GL, Copley SJ. CT features of acute COVID-19 and long-term follow-up. Clin Radiol 2024; 79:1-9. [PMID: 37867078 DOI: 10.1016/j.crad.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023]
Abstract
Since the first few cases of pneumonia attributed to infection with the highly contagious novel coronavirus 2 (SARs-CoV-2) were detected in Wuhan, China, in December 2019, imaging has proven an invaluable diagnostic tool throughout the resulting global pandemic. This review describes the imaging features of severe pulmonary disease caused by SARs-CoV-2, named COVID-19 by the World Health Organization (WHO), particularly focussing on computed tomography (CT). CT plays an important role in understanding the pathology behind the progression of disease, as well as helping to identify the potential complications of COVID-19 pneumonia and recognising possible alternative or concurrent diagnoses. This review also focusses on follow-up imaging of survivors of COVID-19, which continues to contribute substantially to our understanding of the longer-term pulmonary changes in patients who have survived severe COVID-19 pneumonia.
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Affiliation(s)
- G L Bailey
- Radiology Department, Imperial College Healthcare NHS Trust, London, UK.
| | - S J Copley
- Radiology Department, Imperial College Healthcare NHS Trust, London, UK
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Moitra M, Alafeef M, Narasimhan A, Kakaria V, Moitra P, Pan D. Diagnosis of COVID-19 with simultaneous accurate prediction of cardiac abnormalities from chest computed tomographic images. PLoS One 2023; 18:e0290494. [PMID: 38096254 PMCID: PMC10721010 DOI: 10.1371/journal.pone.0290494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/09/2023] [Indexed: 12/17/2023] Open
Abstract
COVID-19 has potential consequences on the pulmonary and cardiovascular health of millions of infected people worldwide. Chest computed tomographic (CT) imaging has remained the first line of diagnosis for individuals infected with SARS-CoV-2. However, differentiating COVID-19 from other types of pneumonia and predicting associated cardiovascular complications from the same chest-CT images have remained challenging. In this study, we have first used transfer learning method to distinguish COVID-19 from other pneumonia and healthy cases with 99.2% accuracy. Next, we have developed another CNN-based deep learning approach to automatically predict the risk of cardiovascular disease (CVD) in COVID-19 patients compared to the normal subjects with 97.97% accuracy. Our model was further validated against cardiac CT-based markers including cardiac thoracic ratio (CTR), pulmonary artery to aorta ratio (PA/A), and presence of calcified plaque. Thus, we successfully demonstrate that CT-based deep learning algorithms can be employed as a dual screening diagnostic tool to diagnose COVID-19 and differentiate it from other pneumonia, and also predicts CVD risk associated with COVID-19 infection.
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Affiliation(s)
- Moumita Moitra
- Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County, Baltimore, Maryland, United States of America
| | - Maha Alafeef
- Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County, Baltimore, Maryland, United States of America
- Biomedical Engineering Department, Jordan University of Science and Technology, Irbid, Jordan
- Department of Nuclear Engineering, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Arjun Narasimhan
- Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
| | - Vikram Kakaria
- Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
| | - Parikshit Moitra
- Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
- Department of Nuclear Engineering, The Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Dipanjan Pan
- Center for Blood Oxygen Transport and Hemostasis, Department of Pediatrics, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, United States of America
- Department of Chemical, Biochemical and Environmental Engineering, University of Maryland Baltimore County, Baltimore, Maryland, United States of America
- Department of Nuclear Engineering, The Pennsylvania State University, State College, Pennsylvania, United States of America
- Department of Materials Science & Engineering, The Pennsylvania State University, State College, Pennsylvania, United States of America
- Huck Institutes of the Life Sciences, State College, Pennsylvania, United States of America
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5
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Salazar-Ardiles C, Asserella-Rebollo L, Cornejo C, Arias D, Vasquez-Muñoz M, Toledo C, Andrade DC. Molecular diagnostic approaches for SARS-CoV-2 detection and pathophysiological consequences. Mol Biol Rep 2023; 50:10367-10382. [PMID: 37817022 DOI: 10.1007/s11033-023-08844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023]
Abstract
SARS-CoV-2, a novel coronavirus within the Coronaviridae family, is the causative agent behind the respiratory ailment referred to as COVID-19. Operating on a global scale, COVID-19 has led to a substantial number of fatalities, exerting profound effects on both public health and the global economy. The most frequently reported symptoms encompass fever, cough, muscle or body aches, loss of taste or smell, headaches, and fatigue. Furthermore, a subset of individuals may manifest more severe symptoms, including those consistent with viral pneumonitis, which can be so profound as to result in fatalities. Consequently, this situation has spurred the rapid advancement of disease diagnostic technologies worldwide. Predominantly employed in diagnosing COVID-19, the real-time quantitative reverse transcription PCR has been the foremost diagnostic method, effectively detecting SARS-CoV-2 viral RNA. As the pandemic has evolved, antigen and serological tests have emerged as valuable diagnostic tools. Antigen tests pinpoint specific viral proteins of SARS-CoV-2, offering swift results, while serological tests identify the presence of antibodies in blood samples. Additionally, there have been notable strides in sample collection methods, notably with the introduction of saliva-based tests, presenting a non-invasive substitute to nasopharyngeal swabs. Given the ongoing mutations in SARS-CoV-2, there has been a continuous need for genomic surveillance, encompassing full genome sequencing and the identification of new variants through Illumina technology and, more recently, nanopore metagenomic sequencing (SMTN). Consequently, while diagnostic testing methods for COVID-19 have experienced remarkable progress, no test is flawless, and there exist limitations with each technique, including sensitivity, specificity, sample collection, and the minimum viral load necessary for accurate detection. These aspects are comprehensively addressed within this current review.
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Affiliation(s)
- Camila Salazar-Ardiles
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura (FIMEDALT), Biomedical Department, Faculty of Health Sciences, Universidad de Antofagasta, Av. Universidad de Antofagasta #02800, Antofagasta, Chile
| | | | - Carlos Cornejo
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura (FIMEDALT), Biomedical Department, Faculty of Health Sciences, Universidad de Antofagasta, Av. Universidad de Antofagasta #02800, Antofagasta, Chile
| | - Dayana Arias
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura (FIMEDALT), Biomedical Department, Faculty of Health Sciences, Universidad de Antofagasta, Av. Universidad de Antofagasta #02800, Antofagasta, Chile
| | - Manuel Vasquez-Muñoz
- Dirección de Docencia de Especialidades Médicas, Dirección de Postgrado, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | - Camilo Toledo
- Laboratory of Cardiorespiratory and Sleep Physiology, Institute of Physiology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
| | - David C Andrade
- Exercise Applied Physiology Laboratory, Centro de Investigación en Fisiología y Medicina de Altura (FIMEDALT), Biomedical Department, Faculty of Health Sciences, Universidad de Antofagasta, Av. Universidad de Antofagasta #02800, Antofagasta, Chile.
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6
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Chilosi M, Doglioni C, Ravaglia C, Piciucchi S, Dubini A, Stefanizzi L, Poletti V. COVID-19. Biology, pathophysiology, and immunology: a pathologist view. Pathologica 2023; 115:248-256. [PMID: 38054899 DOI: 10.32074/1591-951x-954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023] Open
Abstract
Even if the SARS-CoV-2 pandemic has been declared over, several risks and clinical problems remain to be faced, including long-COVID sequelae and possible outbreaks of pathogenic variants. Intense research on COVID-19 has provided in these few years a striking amount of data covering different fields and disciplines, which can help to provide a knowledge shield against new potential infective spreads, and may also potentially be applied to other fields of medicine, including oncology and neurology. Nevertheless, areas of uncertainty still remain regarding the pathogenic mechanisms that subtend the multifaceted manifestations of the disease. To better clarify the pathogenesis of the disease, a systematic multidisciplinary evaluation of the many mechanisms involved in COVID-19 is mandatory, including clinical, physiological, radiological, immunological and pathological studies. In COVID-19 syndrome the pathological studies have been mainly performed on autopsy cases, and only a few studies are available on biopsies. Nevertheless, these studies have provided relevant information that can substantially contribute to decipher the complex scenario characterizing the different forms of COVID-19 and long-COVID-19. In this review the data provided by pathological investigations are recapitulated and discussed, in the light of different hypothesis and data provided by clinical, physiological and immunological data.
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Affiliation(s)
- Marco Chilosi
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Claudio Doglioni
- Department of Pathology, San Raffaele Scientific Institute. Milan, Italy
| | - Claudia Ravaglia
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Sara Piciucchi
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | | | | | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
- Department of Pathology, Ospedale GB Morgagni, Forlì, Italy
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7
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Cengiz TB, Abdelrahman A, Rohren SA, Doucette J, Ghesani M. The diagnostic accuracy of perfusion-only scan in the diagnosis of pulmonary embolism in the era of COVID-19: A single-center study of 434 patients. Ann Thorac Med 2023; 18:199-205. [PMID: 38058788 PMCID: PMC10697306 DOI: 10.4103/atm.atm_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/25/2023] [Accepted: 03/09/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION There is a paucity of data in the literature regarding the diagnostic accuracy of perfusion (Q)-only studies in the absence of ventilation images. This study aims to assess the diagnostic accuracy of Q-only imaging in the pandemic era. METHODS Patients who underwent Q-only imaging for pulmonary embolism between March 2020 and February 2021 were analyzed. Patients who underwent lung quantification analysis were excluded. Q-only test results were reported as per modified PIOPED II criteria and single positron emission tomography/computed tomography (SPECT/CT) imaging was performed as needed. Patients were considered concordant or discordant by correlating the Q-only results with CT angiogram (CTA) or clinical diagnosis made through chart review. The diagnostic accuracy was calculated after excluding intermediate probability and nondiagnostic studies. RESULTS Four hundred and thirty-four patients were identified. One hundred and twenty-eight patients (29.4%) underwent ultrasound Doppler, 37 patients (8.5%) underwent CTA, and 16 patients (3.6%) underwent both. After excluding patients with intermediate probability or nondiagnostic studies and who did not have follow-up (a total of 87 patients [20%]), 347 patients were enrolled in the final analysis. The combined planar and SPECT/CT sensitivity and specificity were 85.4% (72.2%-93.9% confidence interval [CI]) and 98.7% (96.9%-98.6% CI), respectively. The positive predictive value (PPV) of the Q-only imaging was 89.1% (77.3%-95.1% CI) and the negative predictive value (NPV) was 98.2% (96.4%-99% CI). The sensitivity with SPECT/CT reached 100% (CI: 71.5%-100%) with a specificity of 92.3% (CI: 64%-99.8%). The PPV was 85.7% (CI: 62.1%-95.6%) and the NPV was 100%. CONCLUSION Q-only imaging provides clinically acceptable results. The sensitivity of the Q-only scan is increased when coupled with SPECT/CT.
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Affiliation(s)
- Turgut Bora Cengiz
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Ahmed Abdelrahman
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Scott A. Rohren
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - John Doucette
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Munir Ghesani
- Department of Diagnostic, Molecular and Interventional Radiology, Division of Nuclear Medicine, Mount Sinai Hospital, New York, NY, USA
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Saunders LC, Collier GJ, Chan HF, Hughes PJC, Smith LJ, Watson JGR, Meiring JE, Gabriel Z, Newman T, Plowright M, Wade P, Eaden JA, Thomas S, Strickland S, Gustafsson L, Bray J, Marshall H, Capener DA, Armstrong L, Rodgers J, Brook M, Biancardi AM, Rao MR, Norquay G, Rodgers O, Munro R, Ball JE, Stewart NJ, Lawrie A, Jenkins RG, Grist JT, Gleeson F, Schulte RF, Johnson KM, Wilson FJ, Cahn A, Swift AJ, Rajaram S, Mills GH, Watson L, Collini PJ, Lawson R, Thompson AAR, Wild JM. Longitudinal Lung Function Assessment of Patients Hospitalized With COVID-19 Using 1H and 129Xe Lung MRI. Chest 2023; 164:700-716. [PMID: 36965765 PMCID: PMC10036146 DOI: 10.1016/j.chest.2023.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Microvascular abnormalities and impaired gas transfer have been observed in patients with COVID-19. The progression of pulmonary changes in these patients remains unclear. RESEARCH QUESTION Do patients hospitalized with COVID-19 without evidence of architectural distortion on structural imaging exhibit longitudinal improvements in lung function measured by using 1H and 129Xe MRI between 6 and 52 weeks following hospitalization? STUDY DESIGN AND METHODS Patients who were hospitalized with COVID-19 pneumonia underwent a pulmonary 1H and 129Xe MRI protocol at 6, 12, 25, and 51 weeks following hospital admission in a prospective cohort study between November 2020 and February 2022. The imaging protocol was as follows: 1H ultra-short echo time, contrast-enhanced lung perfusion, 129Xe ventilation, 129Xe diffusion-weighted, and 129Xe spectroscopic imaging of gas exchange. RESULTS Nine patients were recruited (age 57 ± 14 [median ± interquartile range] years; six of nine patients were male). Patients underwent MRI at 6 (n = 9), 12 (n = 9), 25 (n = 6), and 51 (n = 8) weeks following hospital admission. Patients with signs of interstitial lung damage were excluded. At 6 weeks, patients exhibited impaired 129Xe gas transfer (RBC to membrane fraction), but lung microstructure was not increased (apparent diffusion coefficient and mean acinar airway dimensions). Minor ventilation abnormalities present in four patients were largely resolved in the 6- to 25-week period. At 12 weeks, all patients with lung perfusion data (n = 6) showed an increase in both pulmonary blood volume and flow compared with 6 weeks, although this was not statistically significant. At 12 weeks, significant improvements in 129Xe gas transfer were observed compared with 6-week examinations; however, 129Xe gas transfer remained abnormally low at weeks 12, 25, and 51. INTERPRETATION 129Xe gas transfer was impaired up to 1 year following hospitalization in patients who were hospitalized with COVID-19 pneumonia, without evidence of architectural distortion on structural imaging, whereas lung ventilation was normal at 52 weeks.
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Affiliation(s)
- Laura C Saunders
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Guilhem J Collier
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Ho-Fung Chan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Paul J C Hughes
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Laurie J Smith
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - J G R Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James E Meiring
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Zoë Gabriel
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Thomas Newman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Megan Plowright
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James A Eaden
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Siby Thomas
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | | | - Lotta Gustafsson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Jody Bray
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Helen Marshall
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - David A Capener
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Leanne Armstrong
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Jennifer Rodgers
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Martin Brook
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Alberto M Biancardi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Madhwesha R Rao
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Graham Norquay
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Oliver Rodgers
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Ryan Munro
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - James E Ball
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Neil J Stewart
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, England
| | - James T Grist
- Department of Radiology, Oxford University Hospitals, Oxford, England; Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, England; Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, England
| | - Fergus Gleeson
- Department of Oncology, University of Oxford, Oxford, England; Department of Radiology, Oxford University Hospitals, Oxford, England
| | | | - Kevin M Johnson
- Department of Medical Physics, University of Madison, Madison, WI, USA
| | | | | | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Smitha Rajaram
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Gary H Mills
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Lisa Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Paul J Collini
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England.
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9
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Trivedi S, Javed NB, Desai RS, Issar P. Diagnostic efficacy of chest CT imaging in diagnosis of COVID-19 cases based on duration of symptoms. Niger J Clin Pract 2023; 26:1171-1175. [PMID: 37635613 DOI: 10.4103/njcp.njcp_103_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Chest computed tomography (CT) imaging provides results more rapidly and with higher sensitivity than reverse transcription polymerase chain reaction in diagnosis of COVID-19. Aim To evaluate diagnostic efficacy of chest CT imaging in diagnosis of COVID-19 cases based on age and duration of symptoms. Materials and Methods A retrospective study conducted during December 2020 to June 2021 in a tertiary care hospital, India. Total 495 patients with typical clinical symptoms of COVID-19, reverse transcription polymerase chain reaction positive for COVID-19 and had undergone chest CT imaging were included. Descriptive statistical analysis was performed for all the variables. Receiver operating characteristic curve analysis was used to determine threshold value of chest CT severity score (CT_SS) based on duration of symptoms and age to diagnose COVID-19. Results Mean age of patients was 61.86 ± 10.77 years and 367 (71.4%) patients were male. Ground glass opacities were observed in 456 (92.1%) patients and in 332 (67.1%) patients, multilobes were affected. Total CT_SS showed positive correlation with age (r = 0.257) and duration of symptoms (r = 0.625). Total CT_SS >6 after a duration of 2 days of symptoms identified COVID-19 cases with sensitivity 90.8% (95% confidence interval [CI]: 87.5%-93.5%) and specificity 84.6% (95% CI: 76.2%-90.9%). Total CT_SS >11 in patients aged more than 60 years identified COVID-19 cases with sensitivity 47.4% (95% CI: 41.2%-53.6%) and specificity 87.3% (95% CI: 82.3%-91.4%). Conclusion Threshold value of CT_SS determined will help to expedite diagnosis of COVID-19 patients by the clinicians in an early stage especially in India and other developing countries which have a high patient volume and limited health resources.
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Affiliation(s)
- S Trivedi
- Department of Respiratory Medicine, Jawaharlal Nehru Hospital and Research Center, Bhilai Nagar, Chhattisgarh, India
| | - N B Javed
- Department of Public Health, College of Health Science, Saudi Electronic University, Dammam, Saudi Arabia
| | - R S Desai
- Department of Respiratory Medicine, Jawaharlal Nehru Hospital and Research Center, Bhilai Nagar, Chhattisgarh, India
| | - P Issar
- Department of Radiology, Jawaharlal Nehru Hospital and Research Center, Bhilai Nagar, Chhattisgarh, India
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Santamarina MG, Lomakin FM, Beddings I, Riscal DB, Chang Villacís J, Contreras R, Marambio JV, Labarca E, Torres J, Volpacchio M. COVID-19 pneumonia: Perfusion abnormalities shown on subtraction CT angiography in apparently well-ventilated lungs. A prospective cohort study. Heliyon 2023; 9:e18085. [PMID: 37519667 PMCID: PMC10375558 DOI: 10.1016/j.heliyon.2023.e18085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To evaluate whether a subtraction CT angiography (sCTA) perfusion score may have prognostic value in patients with COVID-19 pneumonia. Method This prospective cohort study included adult patients with RT-PCR-confirmed SARS-CoV-2 infection admitted to the ED and a sCTA performed within 24 h of admission between June and September 2020. Perfusion abnormalities (PA) in areas of apparently spared lung parenchyma on conventional CT images were assessed with sCTA perfusion score. Airspace disease extension was assessed with CT severity scores, which were then correlated with clinical outcomes (admission to ICU, requirement of IMV, and death). Inter-rater reliability (IRR) was assessed using Cohen's Kappa. Independent predictors of adverse outcomes were evaluated by multivariable logistic regression analyses using the Hosmer and Lemeshow's test. Results 191 patients were included: 112 males (58%), median age of 60.8 years (SD ± 16.0). The IRR was very high (median Kappa statistic: 0.95). No association was found between perfusion CT scores and D-dimer levels (Kendall's Tau-B coefficient = 0.08, p = 0.16) or between PaO2/FiO2 ratios and D-dimer levels (Kendall's Tau-B coefficient = -0.10, p = 0.07). Multivariate analyses adjusting for parenchymal disease extension, vascular beaded appearance, pulmonary embolism, sex, and age showed that severe PA remained a significant predictor for ICU admission (AOR: 6.25, 95% CI 2.10-18.7, p = 0.001). The overall diagnostic capacity of this model was adequate (ROC AUC: 0.83; 95% CI 0.77-0.89). Conclusions The assessment of pulmonary perfusion abnormalities in areas of apparently spared lung parenchyma on conventional CT images via sCTA perfusion scoring has prognostic value in COVID-19 pneumonia.
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Affiliation(s)
- Mario G. Santamarina
- Radiology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
- Radiology Department, Hospital Dr. Eduardo Pereira, Valparaiso, Chile
| | - Felipe Martinez Lomakin
- Intensive Care Unit, Hospital Naval Almirante Nef, Viña del Mar, Chile
- Universidad Andrés Bello, Viña del Mar, Escuela de Medicina, Facultad de Medicina Viña del Mar, Valparaiso, Chile
| | - Ignacio Beddings
- Radiology Department, Hospital Clínico San Borja Arriaran, Santiago, Chile
| | | | | | - Roberto Contreras
- Intensive Care Unit, Hospital San Martin de Quillota, Quillota, Chile
| | | | - Eduardo Labarca
- Intensive Care Unit, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Jorge Torres
- Radiology Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Mariano Volpacchio
- Radiology Department, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
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11
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Fahrni G, Rocha AC, Gudmundsson L, Pozzessere C, Qanadli SD, Rotzinger DC. Impact of COVID-19 pneumonia on pulmonary vascular volume. Front Med (Lausanne) 2023; 10:1117151. [PMID: 37035332 PMCID: PMC10073514 DOI: 10.3389/fmed.2023.1117151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Background Pulmonary manifestations of COVID-19 pneumonia are well known. However, COVID-19 is also associated with a range of vascular manifestations such as embolism, congestion, and perfusion changes. Regarding congestion, research from different groups has suggested arteriovenous anastomosis dysregulation as a contributing factor. In this study, we aim to better describe the changes in vascular volume in affected lung zones and to relate them to pathophysiological hypotheses. Methods We performed automatic vascular volume extraction in 10 chest CTs of patients, including 2 female and 8 male with a mean age of 63.5 ± 9.3 years, diagnosed with COVID-19 pneumonia. We compared the proportion of vascular volumes between manually segmented regions of lung parenchyma with and without signs of pneumonia. Results The proportion of vascular volume was significantly higher in COVID (CVasc) compared to non-COVID (NCVasc) areas. We found a mean difference (DVasc) of 5% and a mean ratio (RVasc) of 3.7 between the two compartments (p < 0.01). Conclusion Vascular volume in COVID-19 affected lung parenchyma is augmented relative to normal lung parenchyma, indicating venous congestion and supporting the hypothesis of pre-existing intra-pulmonary arteriovenous shunts.
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Affiliation(s)
- Guillaume Fahrni
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ana-Carolina Rocha
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Louis Gudmundsson
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chiara Pozzessere
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Riviera Chablais Hospital and University of Lausanne, Lausanne, Switzerland
| | - David C. Rotzinger
- Cardiothoracic and Vascular Division, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Jevnikar K, Meglič A, Lapajne L, Logar M, Vidovič Valentinčič N, Globočnik Petrovič M, Jaki Mekjavić P. The Comparison of Retinal Microvascular Findings in Acute COVID-19 and 1-Year after Hospital Discharge Assessed with Multimodal Imaging-A Prospective Longitudinal Cohort Study. Int J Mol Sci 2023; 24:ijms24044032. [PMID: 36835445 PMCID: PMC9966689 DOI: 10.3390/ijms24044032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
This study aimed to quantify possible long-term impairment of the retinal microcirculation and microvasculature by reassessing a cohort of patients with acute COVID-19 without other known comorbidities one year after their discharge from the hospital. Thirty patients in the acute phase of COVID-19 without known systemic comorbidities were enrolled in this prospective longitudinal cohort study. Fundus photography, SS-OCT, and SS-OCTA using swept-source OCT (SS-OCT, Topcon DRI OCT Triton; Topcon Corp., Tokyo, Japan) were performed in the COVID-19 unit and 1-year after hospital discharge. The cohort's median age was 60 years (range 28-65) and 18 (60%) were male. Mean vein diameter (MVD) significantly decreased over time, from 134.8 μm in the acute phase to 112.4 μm at a 1-year follow-up (p < 0.001). A significantly reduced retinal nerve fiber layer (RNFL) thickness was observed at follow-up in the inferior quadrant of the inner ring (mean diff. 0.80 95% CI 0.01-1.60, p = 0.047) and inferior (mean diff. 1.56 95% CI 0.50-2.61, p < 0.001), nasal (mean diff. 2.21 95% CI 1.16-3.27, p < 0.001), and superior (mean diff. 1.69 95% CI 0.63-2.74, p < 0.001) quadrants of the outer ring. There were no statistically significant differences between the groups regarding vessel density of the superior and deep capillary plexuses. The transient dilatation of the retinal vessels in the acute phase of COVID-19, as well as RNFL thickness changes, could become a biomarker of angiopathy in patients with severe COVID-19.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Meglič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Luka Lapajne
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Mateja Logar
- Department of Infectious Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Infectious Diseases, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Vidovič Valentinčič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mojca Globočnik Petrovič
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Ophthalmology, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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13
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Lung Injury in COVID-19 Has Pulmonary Edema as an Important Component and Treatment with Furosemide and Negative Fluid Balance (NEGBAL) Decreases Mortality. J Clin Med 2023; 12:jcm12041542. [PMID: 36836076 PMCID: PMC9966668 DOI: 10.3390/jcm12041542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023] Open
Abstract
The SARS-CoV2 promotes dysregulation of Renin-Angiotensin-Aldosterone. The result is excessive retention of water, producing a state of noxious hypervolemia. Consequently, in COVID-19 injury lung is pulmonary edema. Our report is a case-control study, retrospective. We included 116 patients with moderate-severe COVID-19 lung injury. A total of 58 patients received standard care (Control group). A total of 58 patients received a standard treatment with a more negative fluid balance (NEGBAL group), consisting of hydric restriction and diuretics. Analyzing the mortality of the population studied, it was observed that the NEGBAL group had lower mortality than the Control group, p = 0.001. Compared with Controls, the NEGBAL group had significantly fewer days of hospital stay (p < 0.001), fewer days of ICU stay (p < 0.001), and fewer days of IMV (p < 0.001). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p = 0.04). Compared with Controls, the NEGBAL group showed significant progressive improvement in PaO2/FiO2 (p < 0.001), CT score (p < 0.001). The multivariate model, the vaccination variables, and linear trends resulted in p = 0.671 and quadratic trends p = 0.723, whilst the accumulated fluid balance is p < 0.001. Although the study has limitations, the promising results encourage more research on this different therapeutic approach, since in our research it decreases mortality.
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14
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Nateghi S, Hesari E, Mansouri F, Akrami M, Pourian M, Khosravani A, Taghizadeh F, Akbarpour S, Faraji N. Evaluation of Blood Biochemistry and Cardiopulmonary status of Hospitalized Covid-19 Patients in 3 Months Post Discharged Follow up Survey. Clin Med Insights Circ Respir Pulm Med 2022; 16:11795484221119332. [PMID: 36579139 PMCID: PMC9791284 DOI: 10.1177/11795484221119332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/29/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The new coronavirus causes systemic inflammation and damage to various organs. So, this study aimed to follow up patients with COVID -19 after recovery for three months by performing cardiac, pulmonary and laboratory tests. MATERIALS AND METHODS This was a prospective cohort study of COVID-19 patients who were discharged from Baharloo Hospital. The diagnosis of COVID-19 was confirmed by PCR or long CT scan. Inclusion criteria were age over 18 years and patients with more than 50% of pulmonary involvement in lung CT scan. The patients were called to Baharloo hospital three months after recovery and were examined for cardiac, pulmonary and blood tests. RESULT Our study included 178 participants with mean age of 55.70, and 50.6% of them were male. Among pulmonary factors in the hospital, 71.9%, 15.7%,1.7%,19.1% and 53.4% had positive GGO, consolidation, reverse halo sign, traction bronchiectasis and vascular enlargement, respectively. After three months follow up, percentage of patients who had reticulation, honeycombing, fibrotic brand and bullae were 12%, 1.1%,8.4% and 0%, respectively. The Mean values of FVC and FEV1 were reported 4.21 and 3.01, respectively. Among Cardiac factors, positive PVC, PAC and mean Pap were decreased after three months. Only Growth in myalgia and Decreased sense of taste were statistically significant. Also, D dimer, UA protein, PMN, Ferritin CRP, PMN, LDH and HB amounts had decreased significantly. CONCLUSION Our study indicated that in addition to pulmonary changes, rapid damage to other organs and the occurrence of cardiac symptoms and changes in laboratory result were also reported in patients recovered from COVID-19.
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Affiliation(s)
- Saeed Nateghi
- Department of Cardiology, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Elahe Hesari
- School of public health, Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
| | - Fariba Mansouri
- Department of Respiratory, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Majid Akrami
- Department of Anesthesiology, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mandana Pourian
- Radiology, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Arezoo Khosravani
- Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | | | - Samaneh Akbarpour
- Occupational Sleep Research Center, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Neda Faraji
- Department of Internist, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran,Neda Faraji, Assistant professor of Internal Diseases, Department of Internist, Baharloo Hospital, Tehran University of Medical Science, Tehran, Iran.
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15
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Ketai L, Febbo J, Busby HK, Sheehan EB. Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19. Semin Respir Crit Care Med 2022; 43:924-935. [PMID: 36442476 DOI: 10.1055/s-0042-1755186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic upended our approach to imaging community-acquired pneumonia, and this will alter our diagnostic algorithms for years to come. In light of these changes, it is worthwhile to consider several postpandemic scenarios of community-acquired pneumonia: (1) patient with pneumonia and recent positive COVID-19 testing; (2) patient with air space opacities and history of prior COVID-19 pneumonia (weeks earlier); (3) multifocal pneumonia with negative or unknown COVID-19 status; and (4) lobar or sublobar pneumonia with negative or unknown COVID-19 status. In the setting of positive COVID-19 testing and typical radiologic findings, the diagnosis of COVID-19 pneumonia is generally secure. The diagnosis prompts vigilance for thromboembolic disease acutely and, in severely ill patients, for invasive fungal disease. Persistent or recurrent air space opacities following COVID-19 infection may more often represent organizing pneumonia than secondary infection. When COVID-19 status is unknown or negative, widespread airway-centric disease suggests infection with mycoplasma, Haemophilus influenzae, or several respiratory viruses. Necrotizing pneumonia favors infection with pneumococcus, Staphylococcus, Klebsiella, and anaerobes. Lobar or sublobar pneumonia will continue to suggest the diagnosis of pneumococcus or consideration of other pathogens in the setting of local outbreaks. A positive COVID-19 test accompanied by these imaging patterns may suggest coinfection with one of the above pathogens, or when the prevalence of COVID-19 is very low, a false positive COVID-19 test. Clinicians may still proceed with testing for COVID-19 when radiologic patterns are atypical for COVID-19, dependent on the patient's exposure history and the local epidemiology of the virus.
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Affiliation(s)
- Loren Ketai
- Department of Radiology, University of New Mexico HSC, Albuquerque, New Mexico
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico HSC, Albuquerque, New Mexico
| | - Hellen K Busby
- Department of Internal Medicine, Pulmonary Division, University of New Mexico HSC, Albuquerque, New Mexico
| | - Elyce B Sheehan
- Department of Internal Medicine, Pulmonary Division, University of New Mexico HSC, Albuquerque, New Mexico
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16
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Imaging of COVID-19 vasculopathy from head to toe: Egyptian collective experience after 2 years of the pandemic. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC9210343 DOI: 10.1186/s43055-022-00815-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
COVID-19 vasculopathy is a critical condition that impacts the disease prognosis including vasculitis and thromboembolic complications. This study aimed to provide the Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic and to collectively include the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial vascular complications.
Results
This is a multi-center retrospective analysis of 3500 PCR-proved COVID-19 infection between March 2020 and December 2021. A cohort of 282 consecutive patients with COVID-19 vasculopathy was considered for inclusion. They included 204 males and 78 females (72:28%). The mean age was 68 years, and age ranged from 48 to 90 years. Five radiologists evaluated the different imaging examinations in consensus including computed tomography (CT), CT-angiography (CTA), CT-perfusion (CTP), magnetic resonance imaging (MRI), MR-arteriography (MRA), and MR-venography (MRV). 244/282 (86.5%) patients suffered from non-hemorrhagic cerebral ischemic infarctions. 13/282 (4.6%) patients suffered from hemorrhagic cerebral infarctions. 5/282 (1.8%) patients suffered from cerebral vasculitis. Pulmonary vascular angiopathy was detected in 10/282 (3.5%) patients, including pulmonary embolism in 10/10 patients, pulmonary infarctions in 8/10 patients, pulmonary vascular enlargement in 5/10 patients, and vascular "tree-in-bud" sign in 2/10 patients. Intestinal ischemia and small bowel obstruction were detected in 3/282 patients (1%) while GIT bleeding was encountered in 4/282 patients (1.4%). Lower limb arterial ischemia was found in 3/282 patients (1%). Additionally; 39/282 (13.8%) patients developed peripheral deep venous thrombosis (DVT) due to prolonged ICU recumbence while 28/282 (10%) patients developed jugular vein thrombosis sequel to prolonged catheterization. A p value (0.002) and (r) = 0.8 statistically proved strong significant relation between COVID-19 vasculopathy and D-dimer levels.
Conclusions
Multi-system vasculopathy was a serious complication of COVID-19 which impacted the patients' morbidity and mortality. An Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic was provided. It encountered the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial COVID-19 vascular complications.
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17
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Enomoto N. Pathological Roles of Pulmonary Cells in Acute Lung Injury: Lessons from Clinical Practice. Int J Mol Sci 2022; 23:ijms232315027. [PMID: 36499351 PMCID: PMC9736972 DOI: 10.3390/ijms232315027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Interstitial lung diseases (ILD) are relatively rare and sometimes become life threatening. In particular, rapidly progressive ILD, which frequently presents as acute lung injury (ALI) on lung histopathology, shows poor prognosis if proper and immediate treatments are not initiated. These devastating conditions include acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF), clinically amyopathic dermatomyositis (CADM), epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI)-induced lung injury, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection named coronavirus disease 2019 (COVID-19). In this review, clinical information, physical findings, laboratory examinations, and findings on lung high-resolution computed tomography and lung histopathology are presented, focusing on majorly damaged cells in each disease. Furthermore, treatments that should be immediately initiated in clinical practice for each disease are illustrated to save patients with these diseases.
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Affiliation(s)
- Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; ; Tel.: +81-53-435-2263; Fax: +81-53-435-2354
- Health Administration Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
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18
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Jevnikar K, Meglič A, Lapajne L, Logar M, Vidovič Valentinčič N, Globočnik Petrovič M, Jaki Mekjavić P. The impact of acute COVID-19 on the retinal microvasculature assessed with multimodal imaging. Graefes Arch Clin Exp Ophthalmol 2022; 261:1115-1125. [PMID: 36334115 PMCID: PMC9638292 DOI: 10.1007/s00417-022-05887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/12/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To quantify retinal microvascular findings in the acute phase of COVID-19 using multimodal imaging and compare them with healthy, age-matched controls. METHODS Hospitalized patients in the acute phase of COVID-19 without known systemic comorbidities (n = 75) and healthy controls (n = 101) aged 18-65 were enrolled in this prospective cross-sectional study. The retinal microcirculation and microvasculature impairments were assessed using fundus photography, swept-source optical coherence tomography, and swept-source optical coherence tomography angiography in the COVID-19 unit and compared with healthy, age-matched controls. RESULTS Retinal findings were predominately observed in patients with severe disease (P = 0.006). Patients with severe disease were shown to have increased both mean vein diameter (Coef. = 19.28, 95% CI: 7.34-31.23, P = 0.002) and mean artery diameter (Coef. = 11.07, 95% CI: 0.84-21.67, P = 0.044). Neither blood vessel diameters were correlated with any confounding variables (age, sex, treatment with oxygen, LDH, or ferritin). Patients with severe COVID-19 were shown to have significantly increased retinal nerve fiber layer thickness in the superior and inferior quadrants both in the inner (S: P = 0.046; I: P = 0.016) and outer (S: P = 0.026; I: P = 0.014) ring and significantly increased GCL thickness in the outer temporal quadrant (P = 0.038). There were no statistically significant differences in vessel density or the foveal avascular zone area between the groups. CONCLUSION The severity of COVID-19 was significantly correlated with the presence of retinal microangiopathy, which could become a biomarker of angiopathy in patients with COVID-19.
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Affiliation(s)
- Kristina Jevnikar
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andrej Meglič
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Luka Lapajne
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia
| | - Mateja Logar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nataša Vidovič Valentinčič
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Globočnik Petrovič
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Polona Jaki Mekjavić
- Department of Ophthalmology, University Medical Centre Ljubljana, Grablovičeva 46, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. .,Jozef Stefan Institute, Ljubljana, Slovenia.
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19
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Ackermann M, Kamp JC, Werlein C, Walsh CL, Stark H, Prade V, Surabattula R, Wagner WL, Disney C, Bodey AJ, Illig T, Leeming DJ, Karsdal MA, Tzankov A, Boor P, Kühnel MP, Länger FP, Verleden SE, Kvasnicka HM, Kreipe HH, Haverich A, Black SM, Walch A, Tafforeau P, Lee PD, Hoeper MM, Welte T, Seeliger B, David S, Schuppan D, Mentzer SJ, Jonigk DD. The fatal trajectory of pulmonary COVID-19 is driven by lobular ischemia and fibrotic remodelling. EBioMedicine 2022; 85:104296. [PMID: 36206625 PMCID: PMC9535314 DOI: 10.1016/j.ebiom.2022.104296] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND COVID-19 is characterized by a heterogeneous clinical presentation, ranging from mild symptoms to severe courses of disease. 9-20% of hospitalized patients with severe lung disease die from COVID-19 and a substantial number of survivors develop long-COVID. Our objective was to provide comprehensive insights into the pathophysiology of severe COVID-19 and to identify liquid biomarkers for disease severity and therapy response. METHODS We studied a total of 85 lungs (n = 31 COVID autopsy samples; n = 7 influenza A autopsy samples; n = 18 interstitial lung disease explants; n = 24 healthy controls) using the highest resolution Synchrotron radiation-based hierarchical phase-contrast tomography, scanning electron microscopy of microvascular corrosion casts, immunohistochemistry, matrix-assisted laser desorption ionization mass spectrometry imaging, and analysis of mRNA expression and biological pathways. Plasma samples from all disease groups were used for liquid biomarker determination using ELISA. The anatomic/molecular data were analyzed as a function of patients' hospitalization time. FINDINGS The observed patchy/mosaic appearance of COVID-19 in conventional lung imaging resulted from microvascular occlusion and secondary lobular ischemia. The length of hospitalization was associated with increased intussusceptive angiogenesis. This was associated with enhanced angiogenic, and fibrotic gene expression demonstrated by molecular profiling and metabolomic analysis. Increased plasma fibrosis markers correlated with their pulmonary tissue transcript levels and predicted disease severity. Plasma analysis confirmed distinct fibrosis biomarkers (TSP2, GDF15, IGFBP7, Pro-C3) that predicted the fatal trajectory in COVID-19. INTERPRETATION Pulmonary severe COVID-19 is a consequence of secondary lobular microischemia and fibrotic remodelling, resulting in a distinctive form of fibrotic interstitial lung disease that contributes to long-COVID. FUNDING This project was made possible by a number of funders. The full list can be found within the Declaration of interests / Acknowledgements section at the end of the manuscript.
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Affiliation(s)
- Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Jan C. Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Christopher Werlein
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Claire L. Walsh
- Centre for Advanced Biomedical Imaging, University College London, UK
| | - Helge Stark
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Verena Prade
- Research Unit Analytical Pathology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Rambabu Surabattula
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Willi L. Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center Heidelberg (TLRC), Heidelberg, Germany
| | - Catherine Disney
- Department of Mechanical Engineering, University College London, UK
| | | | - Thomas Illig
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | - Diana J. Leeming
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | | | - Alexandar Tzankov
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Mark P. Kühnel
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Florian P. Länger
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Stijn E. Verleden
- Department of Thoracic Surgery, University Hospital Antwerp Edegem, Belgium
| | - Hans M. Kvasnicka
- Institute of Pathology and Molecular Pathology, Helios University Clinic Wuppertal, University of Witten/Herdecke, Germany
| | - Hans H. Kreipe
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Germany
| | - Stephen M. Black
- Department of Cellular Biology and Pharmacology, Center for Translational Research, Florida International University, USA
| | - Axel Walch
- Nordic Bioscience Biomarkers and Research, Herlev, Denmark
| | - Paul Tafforeau
- European Synchrotron Radiation Facility, Grenoble, France
| | - Peter D. Lee
- Hannover Unified Biobank, Hannover Medical School, Hannover Medical School, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Detlef Schuppan
- Institute of Translational Immunology and Research Center for Immune Therapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Steven J. Mentzer
- Laboratory of Adaptive and Regenerative Biology, Harvard Medical School, Brigham & Women's Hospital, Boston, United States
| | - Danny D. Jonigk
- Member of the German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
- Institute of Pathology, Hannover Medical School, Hannover, Germany
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20
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Parikh NI, Arowolo F, Durstenfeld MS, Nah G, Njoroge J, Vittinghoff E, Long CS, Ganz P, Pearce D, Hsue P, Wu AHS, Hajizadeh N, Liu KD, Lynch KL. Hospitalized Patients With COVID-19 Have Higher Plasma Aldosterone-Renin Ratio and Lower ACE Activity Than Controls. J Endocr Soc 2022; 6:bvac144. [PMID: 36338506 PMCID: PMC9619433 DOI: 10.1210/jendso/bvac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Indexed: 02/03/2023] Open
Abstract
Context SARS-CoV-2 infects cells via the angiotensin converting enzyme 2 (ACE2) receptor, whose downstream effects "counterbalance" the classical renin angiotensin aldosterone system (RAAS). Objective We aimed to determine to what extent circulating RAAS biomarker levels differ in persons with and without COVID-19 throughout the disease course. Methods We measured classical (renin, aldosterone, aldosterone/renin ratio [ARR], Ang2, ACE activity) and nonclassical (ACE2, Ang1,7) RAAS biomarkers in hospitalized COVID-19 patients vs SARS-CoV-2 negative controls. We compared biomarker levels in cases with contemporaneous samples from control patients with upper respiratory symptoms and a negative SARS-CoV-2 PCR test. To assess RAAS biomarker changes during the course of COVID-19 hospitalization, we studied cases at 2 different times points ∼ 12 days apart. We employed age- and sex-adjusted generalized linear models and paired/unpaired t tests. Results Mean age was 51 years for both cases (31% women) and controls (50% women). ARR was higher in the first sample among hospitalized COVID-19 patients vs controls (P = 0.02). ACE activity was lower among cases at their first sample vs controls (P = <0.001). ACE2 activity, Ang 1,7, and Ang2 did not differ at the 2 COVID-19 case time points and they did not differ in COVID-19 cases vs controls. Additional adjustment for body mass index (BMI) did not change our findings. Conclusions High ARR, independent of BMI, may be a risk marker for COVID-19 hospitalization. Serum ACE activity was lower in patients with COVID-19 vs controls at the beginning of their hospitalization and then increased to similar levels as controls, possibly due to lung injury, which improved with inpatient disease management.
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Affiliation(s)
- Nisha I Parikh
- Department of Medicine, University of California San Francisco, Division of Cardiology, San Francisco, CA 941432, USA
| | - Folagbayi Arowolo
- Department of Laboratory Medicine, University of California San Francisco, Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 941103, USA
| | - Matthew S Durstenfeld
- Department of Medicine, University of California San Francisco, Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 941104, USA
| | - Gregory Nah
- Department of Medicine, University of California San Francisco, Division of Cardiology, San Francisco, CA 941432, USA
| | - Joyce Njoroge
- Department of Medicine, University of California San Francisco, Division of Cardiology, San Francisco, CA 941432, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 941585, USA
| | - Carlin S Long
- Department of Medicine, University of California San Francisco, Division of Cardiology, San Francisco, CA 941432, USA
| | - Peter Ganz
- Department of Medicine, University of California San Francisco, Division of Cardiology, San Francisco, CA 941432, USA
| | - David Pearce
- Division of Nephrology, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA 941436, USA
| | - Priscilla Hsue
- Department of Medicine, University of California San Francisco, Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 941104, USA
| | - Alan H S Wu
- Department of Laboratory Medicine, University of California San Francisco, Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 941103, USA
| | - Negin Hajizadeh
- Hofstra Northwell School of Medicine, Department of Medicine,Manhasset, NY 110307, USA
| | - Kathleen D Liu
- Division of Nephrology, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA 941436, USA
- Division of Critical Care Medicine, Departments of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA 941431, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, University of California San Francisco, Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 941103, USA
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21
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Perchiazzi G, Larina A, Hansen T, Frithiof R, Hultström M, Lipcsey M, Pellegrini M. Chest dual-energy CT to assess the effects of steroids on lung function in severe COVID-19 patients. Crit Care 2022; 26:328. [PMID: 36284360 PMCID: PMC9595078 DOI: 10.1186/s13054-022-04200-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Steroids have been shown to reduce inflammation, hypoxic pulmonary vasoconstriction (HPV) and lung edema. Based on evidence from clinical trials, steroids are widely used in severe COVID-19. However, the effects of steroids on pulmonary gas volume and blood volume in this group of patients are unexplored. OBJECTIVE Profiting by dual-energy computed tomography (DECT), we investigated the relationship between the use of steroids in COVID-19 and distribution of blood volume as an index of impaired HPV. We also investigated whether the use of steroids influences lung weight, as index of lung edema, and how it affects gas distribution. METHODS Severe COVID-19 patients included in a single-center prospective observational study at the intensive care unit at Uppsala University Hospital who had undergone DECT were enrolled in the current study. Patients' cohort was divided into two groups depending on the administration of steroids. From each patient's DECT, 20 gas volume maps and the corresponding 20 blood volume maps, evenly distributed along the cranial-caudal axis, were analyzed. As a proxy for HPV, pulmonary blood volume distribution was analyzed in both the whole lung and the hypoinflated areas. Total lung weight, index of lung edema, was estimated. RESULTS Sixty patients were analyzed, whereof 43 received steroids. Patients not exposed to steroids showed a more extensive non-perfused area (19% vs 13%, p < 0.01) and less homogeneous pulmonary blood volume of hypoinflated areas (kurtosis: 1.91 vs 2.69, p < 0.01), suggesting a preserved HPV compared to patients treated with steroids. Moreover, patients exposed to steroids showed a significantly lower lung weight (953 gr vs 1140 gr, p = 0.01). A reduction in alveolar-arterial difference of oxygen followed the treatment with steroids (322 ± 106 mmHg at admission vs 267 ± 99 mmHg at DECT, p = 0.04). CONCLUSIONS The use of steroids might cause impaired HPV and might reduce lung edema in severe COVID-19. This is consistent with previous findings in other diseases. Moreover, a reduced lung weight, as index of decreased lung edema, and a more homogeneous distribution of gas within the lung were shown in patients treated with steroids. TRIAL REGISTRATION Clinical Trials ID: NCT04316884, Registered March 13, 2020.
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Affiliation(s)
- Gaetano Perchiazzi
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Aleksandra Larina
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Tomas Hansen
- grid.8993.b0000 0004 1936 9457Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Michael Hultström
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Mariangela Pellegrini
- grid.8993.b0000 0004 1936 9457Anesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden ,grid.8993.b0000 0004 1936 9457Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Akademiska Sjukhuset, Ing 40, 3 tr, 751 85 Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Anesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
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22
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Villalba JA, Hilburn CF, Garlin MA, Elliott GA, Li Y, Kunitoki K, Poli S, Alba GA, Madrigal E, Taso M, Price MC, Aviles AJ, Araujo-Medina M, Bonanno L, Boyraz B, Champion SN, Harris CK, Helland TL, Hutchison B, Jobbagy S, Marshall MS, Shepherd DJ, Barth JL, Hung YP, Ly A, Hariri LP, Turbett SE, Pierce VM, Branda JA, Rosenberg ES, Mendez-Pena J, Chebib I, Rosales IA, Smith RN, Miller MA, Rosas IO, Hardin CC, Baden LR, Medoff BD, Colvin RB, Little BP, Stone JR, Mino-Kenudson M, Shih AR. Vasculopathy and Increased Vascular Congestion in Fatal COVID-19 and Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2022; 206:857-873. [PMID: 35671465 PMCID: PMC9799276 DOI: 10.1164/rccm.202109-2150oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: The leading cause of death in coronavirus disease 2019 (COVID-19) is severe pneumonia, with many patients developing acute respiratory distress syndrome (ARDS) and diffuse alveolar damage (DAD). Whether DAD in fatal COVID-19 is distinct from other causes of DAD remains unknown. Objective: To compare lung parenchymal and vascular alterations between patients with fatal COVID-19 pneumonia and other DAD-causing etiologies using a multidimensional approach. Methods: This autopsy cohort consisted of consecutive patients with COVID-19 pneumonia (n = 20) and with respiratory failure and histologic DAD (n = 21; non-COVID-19 viral and nonviral etiologies). Premortem chest computed tomography (CT) scans were evaluated for vascular changes. Postmortem lung tissues were compared using histopathological and computational analyses. Machine-learning-derived morphometric analysis of the microvasculature was performed, with a random forest classifier quantifying vascular congestion (CVasc) in different microscopic compartments. Respiratory mechanics and gas-exchange parameters were evaluated longitudinally in patients with ARDS. Measurements and Main Results: In premortem CT, patients with COVID-19 showed more dilated vasculature when all lung segments were evaluated (P = 0.001) compared with controls with DAD. Histopathology revealed vasculopathic changes, including hemangiomatosis-like changes (P = 0.043), thromboemboli (P = 0.0038), pulmonary infarcts (P = 0.047), and perivascular inflammation (P < 0.001). Generalized estimating equations revealed significant regional differences in the lung microarchitecture among all DAD-causing entities. COVID-19 showed a larger overall CVasc range (P = 0.002). Alveolar-septal congestion was associated with a significantly shorter time to death from symptom onset (P = 0.03), length of hospital stay (P = 0.02), and increased ventilatory ratio [an estimate for pulmonary dead space fraction (Vd); p = 0.043] in all cases of ARDS. Conclusions: Severe COVID-19 pneumonia is characterized by significant vasculopathy and aberrant alveolar-septal congestion. Our findings also highlight the role that vascular alterations may play in Vd and clinical outcomes in ARDS in general.
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Affiliation(s)
- Julian A. Villalba
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Caroline F. Hilburn
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Michelle A. Garlin
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts;,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | | | - Yijia Li
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keiko Kunitoki
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts;,Department of Psychiatry
| | - Sergio Poli
- Department of Medicine, Mount Sinai Medical Center, Miami Beach, Florida
| | - George A. Alba
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Emilio Madrigal
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Melissa C. Price
- Division of Thoracic Imaging and Intervention, Department of Radiology
| | | | | | - Liana Bonanno
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Baris Boyraz
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Samantha N. Champion
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,C. S. Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital Charlestown HealthCare Center, Charlestown, Massachusetts;,Miami-Dade County Medical Examiner Department, Miami, Florida
| | - Cynthia K. Harris
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Timothy L. Helland
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Bailey Hutchison
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Soma Jobbagy
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Michael S. Marshall
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Daniel J. Shepherd
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | | | - Yin P. Hung
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Amy Ly
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Lida P. Hariri
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Sarah E. Turbett
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Virginia M. Pierce
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Pediatric Infectious Disease Unit, MassGeneral Hospital for Children, Boston, Massachusetts
| | - John A. Branda
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Eric S. Rosenberg
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ivan Chebib
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Ivy A. Rosales
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Immunopathology Research Laboratory, and
| | - Rex N. Smith
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Immunopathology Research Laboratory, and
| | - Miles A. Miller
- Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ivan O. Rosas
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Charles C. Hardin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Lindsey R. Baden
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin D. Medoff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Medicine
| | - Robert B. Colvin
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts;,Immunopathology Research Laboratory, and
| | - Brent P. Little
- Division of Thoracic Imaging and Intervention, Department of Radiology,,Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - James R. Stone
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Mari Mino-Kenudson
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Angela R. Shih
- James Homer Wright Pathology Laboratories,,Department of Pathology, Harvard Medical School, Boston, Massachusetts
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23
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Kanne JP, Little BP, Schulte JJ, Haramati A, Haramati LB. Long-term Lung Abnormalities Associated with COVID-19 Pneumonia. Radiology 2022; 306:e221806. [PMID: 36040336 PMCID: PMC9462591 DOI: 10.1148/radiol.221806] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the 3rd year of the SARS-CoV-2 pandemic, much has been learned about the long-term effects of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities at chest CT 1 year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS-CoV-2 infection are similar to those seen in patients with other causes of acute lung injury.
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24
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Khanna NN, Maindarkar M, Puvvula A, Paul S, Bhagawati M, Ahluwalia P, Ruzsa Z, Sharma A, Munjral S, Kolluri R, Krishnan PR, Singh IM, Laird JR, Fatemi M, Alizad A, Dhanjil SK, Saba L, Balestrieri A, Faa G, Paraskevas KI, Misra DP, Agarwal V, Sharma A, Teji J, Al-Maini M, Nicolaides A, Rathore V, Naidu S, Liblik K, Johri AM, Turk M, Sobel DW, Pareek G, Miner M, Viskovic K, Tsoulfas G, Protogerou AD, Mavrogeni S, Kitas GD, Fouda MM, Kalra MK, Suri JS. Vascular Implications of COVID-19: Role of Radiological Imaging, Artificial Intelligence, and Tissue Characterization: A Special Report. J Cardiovasc Dev Dis 2022; 9:jcdd9080268. [PMID: 36005433 PMCID: PMC9409845 DOI: 10.3390/jcdd9080268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/30/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS-CoV-2 virus has caused a pandemic, infecting nearly 80 million people worldwide, with mortality exceeding six million. The average survival span is just 14 days from the time the symptoms become aggressive. The present study delineates the deep-driven vascular damage in the pulmonary, renal, coronary, and carotid vessels due to SARS-CoV-2. This special report addresses an important gap in the literature in understanding (i) the pathophysiology of vascular damage and the role of medical imaging in the visualization of the damage caused by SARS-CoV-2, and (ii) further understanding the severity of COVID-19 using artificial intelligence (AI)-based tissue characterization (TC). PRISMA was used to select 296 studies for AI-based TC. Radiological imaging techniques such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were selected for imaging of the vasculature infected by COVID-19. Four kinds of hypotheses are presented for showing the vascular damage in radiological images due to COVID-19. Three kinds of AI models, namely, machine learning, deep learning, and transfer learning, are used for TC. Further, the study presents recommendations for improving AI-based architectures for vascular studies. We conclude that the process of vascular damage due to COVID-19 has similarities across vessel types, even though it results in multi-organ dysfunction. Although the mortality rate is ~2% of those infected, the long-term effect of COVID-19 needs monitoring to avoid deaths. AI seems to be penetrating the health care industry at warp speed, and we expect to see an emerging role in patient care, reduce the mortality and morbidity rate.
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Affiliation(s)
- Narendra N. Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi 110001, India
| | - Mahesh Maindarkar
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Anudeep Puvvula
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Annu’s Hospitals for Skin and Diabetes, Nellore 524101, India
| | - Sudip Paul
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Mrinalini Bhagawati
- Department of Biomedical Engineering, North Eastern Hill University, Shillong 793022, India
| | - Puneet Ahluwalia
- Max Institute of Cancer Care, Max Super Specialty Hospital, New Delhi 110017, India
| | - Zoltan Ruzsa
- Invasive Cardiology Division, Faculty of Medicine, University of Szeged, 6720 Szeged, Hungary
| | - Aditya Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA 22904, USA
| | - Smiksha Munjral
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Raghu Kolluri
- Ohio Health Heart and Vascular, Columbus, OH 43214, USA
| | | | - Inder M. Singh
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - John R. Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA 94574, USA
| | - Mostafa Fatemi
- Department of Physiology & Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Azra Alizad
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Surinder K. Dhanjil
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria, 40138 Cagliari, Italy
| | - Antonella Balestrieri
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gavino Faa
- Department of Pathology, Azienda Ospedaliero Universitaria, 09124 Cagliari, Italy
| | | | - Durga Prasanna Misra
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Vikas Agarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aman Sharma
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Jagjit Teji
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Mustafa Al-Maini
- Allergy, Clinical Immunology and Rheumatology Institute, Toronto, ON L4Z 4C4, Canada
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Vijay Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA 95119, USA
| | - Subbaram Naidu
- Electrical Engineering Department, University of Minnesota, Duluth, MN 55812, USA
| | - Kiera Liblik
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Amer M. Johri
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, 27753 Delmenhorst, Germany
| | - David W. Sobel
- Rheumatology Unit, National Kapodistrian University of Athens, 15772 Athens, Greece
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI 02912, USA
| | - Martin Miner
- Men’s Health Centre, Miriam Hospital Providence, Providence, RI 02906, USA
| | - Klaudija Viskovic
- Department of Radiology and Ultrasound, University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
| | - George Tsoulfas
- Department of Surgery, Aristoteleion University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Athanasios D. Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, 15772 Athens, Greece
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Centre, 17674 Athens, Greece
| | - George D. Kitas
- Academic Affairs, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
| | - Manudeep K. Kalra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Jasjit S. Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA 95661, USA
- Correspondence: ; Tel.: +1-916-749-5628
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25
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Asami‐Noyama M, Harada M, Hisamoto Y, Kobayashi T, Oishi K, Edakuni N, Hirano T, Kakugawa T, Matsunaga K. Platypnea‐orthodeoxia syndrome in a patient with ongoing
COVID
‐19. Respirol Case Rep 2022; 10:e01009. [PMID: 35865867 PMCID: PMC9296795 DOI: 10.1002/rcr2.1009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
SARS‐CoV‐2 infection of the vascular endothelium causes excessive vasodilation. It is important in the rehabilitation of patients with COVID‐19 to recognize that increased blood flow in lung lesions at the base of the lung due to vasodilation may cause V/Q mismatch and result in platypnea‐orthodeoxia syndrome.
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Affiliation(s)
- Maki Asami‐Noyama
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Misa Harada
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Yukari Hisamoto
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Taiga Kobayashi
- Department of Radiology Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Keiji Oishi
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Nobutaka Edakuni
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Tomoyuki Kakugawa
- Department of Pulmonary and Gerontology Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease Yamaguchi University School of Medicine Graduate School of Medicine Ube Japan
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Jonigk D, Werlein C, D. Lee P, Kauczor HU, Länger F, Ackermann M. Pulmonary and Systemic Pathology in COVID-19—Holistic Pathological Analyses. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:429-435. [PMID: 35698804 PMCID: PMC9549895 DOI: 10.3238/arztebl.m2022.0231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/22/2022] [Accepted: 05/10/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic is the third worldwide coronavirus-associated disease outbreak in the past 20 years. Lung involvement, with acute respiratory distress syndrome (ARDS) in severe cases, is the main clinical feature of this disease; the cardiovascular system, the central nervous system, and the gastrointestinal tract can also be affected. The pathophysiology of both pulmonary and extrapulmonary organ damage was almost completely unknown when the pandemic began. METHODS This review is based on pertinent publications retrieved by a selective search concerning the structural changes and pathophysiology of COVID-19, with a focus on imaging techniques. RESULTS Immunohistochemical, electron-microscopic and molecular pathological analyses of tissues obtained by autopsy have improved our understanding of COVID-19 pathophysiology, including molecular regulatory mechanisms. Intussusceptive angiogenesis (IA) has been found to be a prominent pattern of damage in the affected organs of COVID-19 patients. In IA, an existing vessel changes by invagination of the endothelium and formation of an intraluminal septum, ultimately giving rise to two new lumina. This alters hemodynamics within the vessel, leading to a loss of laminar flow and its replacement by turbulent, inhomogeneous flow. IA, which arises because of ischemia due to thrombosis, is itself a risk factor for the generation of further microthrombi; these have been detected in the lungs, heart, liver, kidneys, brain, and placenta of COVID-19 patients. CONCLUSION Studies of autopsy material from various tissues of COVID-19 patients have revealed ultrastructural evidence of altered microvascularity, IA, and multifocal thrombi. These changes may contribute to the pathophysiology of post-acute interstitial fibrotic organ changes as well as to the clinical picture of long COVID.
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Affiliation(s)
- Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover site, Hannover, Germany
- *Institut für Pathologie, Medizinische Hochschule Hannover Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | | | - Peter D. Lee
- Department of Mechanical Engineering, Faculty of Engineering Science, University College London, London, UK
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Heidelberg University Hospital, Heidelberg, Germany
| | - Florian Länger
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover site, Hannover, Germany
| | - Maximilian Ackermann
- Institute of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, University Hospital of Witten-Herdecke, Wuppertal, Germany
- Institute of Functional and Clinical Anatomy, University Medical Center Mainz, Mainz, Germany
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Ramasamy S, Kolloli A, Kumar R, Husain S, Soteropoulos P, Chang TL, Subbian S. Comprehensive Analysis of Disease Pathology in Immunocompetent and Immunocompromised Hosts following Pulmonary SARS-CoV-2 Infection. Biomedicines 2022; 10:biomedicines10061343. [PMID: 35740365 PMCID: PMC9219777 DOI: 10.3390/biomedicines10061343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic disproportionately affects immunocompetent and immunocompromised individuals, with the latter group being more vulnerable to severe disease and death. However, the differential pathogenesis of SARS-CoV-2 in the context of a specific immunological niche remains unknown. Similarly, systematic analysis of disease pathology in various extrapulmonary organs in immunocompetent and immunocompromised hosts during SARS-CoV-2 infection is not fully understood. We used a hamster model of SARS-CoV-2 infection, which recapitulates the pathophysiology of patients with mild-to-moderate COVID-19, to determine the dynamics of SARS-CoV-2 replication and histopathology at organ-level niches and map how COVID-19 symptoms vary in different immune contexts. Hamsters were intranasally infected with low (LD) or high (HD) inoculums of SARS-CoV-2, and the kinetics of disease pathology and viral load in multiple organs, antibody response, inflammatory cytokine expression, and genome-wide lung transcriptome by RNAseq analysis were determined and compared against corresponding responses from chemically induced immunocompromised hamsters. We observed transient body weight loss proportional to the SARS-CoV-2 infectious dose in immunocompetent hamsters. The kinetics of viral replication and peak viral loads were similar between LD and HD groups, although the latter developed more severe disease pathology in organs. Both groups generated a robust serum antibody response. In contrast, infected immunocompromised animals showed more prolonged body weight loss and mounted an inadequate SARS-CoV-2-neutralizing antibody response. The live virus was detected in the pulmonary and extrapulmonary organs for extended periods. These hamsters also had persistent inflammation with severe bronchiolar-alveolar hyperplasia/metaplasia. Consistent with the differential disease presentation, distinct changes in inflammation and immune cell response pathways and network gene expression were seen in the lungs of SARS-CoV-2-infected immunocompetent and immunocompromised animals.
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Affiliation(s)
- Santhamani Ramasamy
- Public Health Research Institute, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.R.); (A.K.); (R.K.); (T.L.C.)
| | - Afsal Kolloli
- Public Health Research Institute, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.R.); (A.K.); (R.K.); (T.L.C.)
| | - Ranjeet Kumar
- Public Health Research Institute, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.R.); (A.K.); (R.K.); (T.L.C.)
| | - Seema Husain
- The Genomics Center at Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.H.); (P.S.)
| | - Patricia Soteropoulos
- The Genomics Center at Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.H.); (P.S.)
| | - Theresa L. Chang
- Public Health Research Institute, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.R.); (A.K.); (R.K.); (T.L.C.)
| | - Selvakumar Subbian
- Public Health Research Institute, Rutgers-New Jersey Medical School, Newark, NJ 07103, USA; (S.R.); (A.K.); (R.K.); (T.L.C.)
- Correspondence: ; Tel.: +1-973-854-3226
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Acute Pulmonary Embolism in COVID-19: A Potential Connection between Venous Congestion and Thrombus Distribution. Biomedicines 2022; 10:biomedicines10061300. [PMID: 35740322 PMCID: PMC9219696 DOI: 10.3390/biomedicines10061300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Vascular abnormalities, including venous congestion (VC) and pulmonary embolism (PE), have been recognized as frequent COVID-19 imaging patterns and proposed as severity markers. However, the underlying pathophysiological mechanisms remain unclear. In this study, we aimed to characterize the relationship between VC, PE distribution, and alveolar opacities (AO). Methods: This multicenter observational registry (clinicaltrials.gov identifier NCT04824313) included 268 patients diagnosed with SARS-CoV-2 infection and subjected to contrast-enhanced CT between March and June 2020. Acute PE was diagnosed in 61 (22.8%) patients, including 17 females (27.9%), at a mean age of 61.7 ± 14.2 years. Demographic, laboratory, and outcome data were retrieved. We analyzed CT images at the segmental level regarding VC (qualitatively and quantitatively [diameter]), AO (semi-quantitatively as absent, <50%, or >50% involvement), clot location, and distribution related to VC and AO. Segments with vs. without PE were compared. Results: Out of 411 emboli, 82 (20%) were lobar or more proximal and 329 (80%) were segmental or subsegmental. Venous diameters were significantly higher in segments with AO (p = 0.031), unlike arteries (p = 0.138). At the segmental level, 77% of emboli were associated with VC. Overall, PE occurred in 28.2% of segments with AO vs. 21.8% without (p = 0.047). In the absence of VC, however, AO did not affect PE rates (p = 0.94). Conclusions: Vascular changes predominantly affected veins, and most PEs were located in segments with VC. In the absence of VC, AOs were not associated with the PE rate. VC might result from increased flow supported by the hypothesis of pulmonary arteriovenous anastomosis dysregulation as a relevant contributing factor.
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Ball L, Scaramuzzo G, Herrmann J, Cereda M. Lung aeration, ventilation, and perfusion imaging. Curr Opin Crit Care 2022; 28:302-307. [PMID: 35653251 PMCID: PMC9178949 DOI: 10.1097/mcc.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Lung imaging is a cornerstone of the management of patients admitted to the intensive care unit (ICU), providing anatomical and functional information on the respiratory system function. The aim of this review is to provide an overview of mechanisms and applications of conventional and emerging lung imaging techniques in critically ill patients. RECENT FINDINGS Chest radiographs provide information on lung structure and have several limitations in the ICU setting; however, scoring systems can be used to stratify patient severity and predict clinical outcomes. Computed tomography (CT) is the gold standard for assessment of lung aeration but requires moving the patients to the CT facility. Dual-energy CT has been recently applied to simultaneous study of lung aeration and perfusion in patients with respiratory failure. Lung ultrasound has an established role in the routine bedside assessment of ICU patients, but has poor spatial resolution and largely relies on the analysis of artifacts. Electrical impedance tomography is an emerging technique capable of depicting ventilation and perfusion at the bedside and at the regional level. SUMMARY Clinicians should be confident with the technical aspects, indications, and limitations of each lung imaging technique to improve patient care.
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Affiliation(s)
- Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, Genoa, Italy
| | - Gaetano Scaramuzzo
- Department of Translational medicine, University of Ferrara, Ferrara, Italy
- Anesthesia and intensive care, Arcispedale Sant’Anna, Ferrara, Italy
| | - Jake Herrmann
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, United States of America
| | - Maurizio Cereda
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Mehboob F, Rauf A, Jiang R, Saudagar AKJ, Malik KM, Khan MB, Hasnat MHA, AlTameem A, AlKhathami M. Towards robust diagnosis of COVID-19 using vision self-attention transformer. Sci Rep 2022; 12:8922. [PMID: 35618740 PMCID: PMC9134987 DOI: 10.1038/s41598-022-13039-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/16/2022] [Indexed: 01/31/2023] Open
Abstract
The outbreak of COVID-19, since its appearance, has affected about 200 countries and endangered millions of lives. COVID-19 is extremely contagious disease, and it can quickly incapacitate the healthcare systems if infected cases are not handled timely. Several Conventional Neural Networks (CNN) based techniques have been developed to diagnose the COVID-19. These techniques require a large, labelled dataset to train the algorithm fully, but there are not too many labelled datasets. To mitigate this problem and facilitate the diagnosis of COVID-19, we developed a self-attention transformer-based approach having self-attention mechanism using CT slices. The architecture of transformer can exploit the ample unlabelled datasets using pre-training. The paper aims to compare the performances of self-attention transformer-based approach with CNN and Ensemble classifiers for diagnosis of COVID-19 using binary Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and multi-class Hybrid-learning for UnbiaSed predicTion of COVID-19 (HUST-19) CT scan dataset. To perform this comparison, we have tested Deep learning-based classifiers and ensemble classifiers with proposed approach using CT scan images. Proposed approach is more effective in detection of COVID-19 with an accuracy of 99.7% on multi-class HUST-19, whereas 98% on binary class SARS-CoV-2 dataset. Cross corpus evaluation achieves accuracy of 93% by training the model with Hust19 dataset and testing using Brazilian COVID dataset.
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Affiliation(s)
| | | | - Richard Jiang
- LIRA Center, Lancaster University, Lancaster, LA1 4YW, UK
| | - Abdul Khader Jilani Saudagar
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia.
| | - Khalid Mahmood Malik
- Department of Computer Science and Engineering, Oakland University, Rochester, MI, USA
| | - Muhammad Badruddin Khan
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Mozaherul Hoque Abdul Hasnat
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Abdullah AlTameem
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Mohammed AlKhathami
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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31
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Brandi N, Ciccarese F, Rimondi MR, Balacchi C, Modolon C, Sportoletti C, Renzulli M, Coppola F, Golfieri R. An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review. Diagnostics (Basel) 2022; 12:846. [PMID: 35453894 PMCID: PMC9032937 DOI: 10.3390/diagnostics12040846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Maria Rita Rimondi
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Cecilia Modolon
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Camilla Sportoletti
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
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Sbirkov Y, Dzharov V, Todorova K, Hayrabedyan S, Sarafian V. Endothelial inflammation and dysfunction in COVID-19. VASA 2022; 51:62-70. [PMID: 35171039 DOI: 10.1024/0301-1526/a000991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The biggest challenge in the COVID-19 pandemic besides the spread of the SARS-CoV-2 virus is to reduce mortality rates. As the number of cases continues to rise and new variants, some with at least partial resistance to vaccines, emerge, the need for better understanding of the underlying pathology of the disease and for improved therapeutic strategies grows urgently. The endothelium is a main target of most viral infections in the body. The dysregulation of the normal functions of endothelial cells (ECs) contributes greatly to the thrombo-inflammatory storm and subsequent blood clot associated deaths in COVID-19 patients. Therefore, in this review we emphasize on the importance of ECs in healthy resting state and in inflammation. We summarize the current understanding of SARS-CoV-2 pathogenicity and the key contributions of in vitro cell culture models some of which have established the ACE2 (angiotensin-converting enzyme 2) receptors as the main gates for viral entry in the cell. Lastly, we focus on 3D biofabrication methods for the design of better in vitro models that mimic the host environment including interactions of multiple cell types, simulation of blood flow and real-time viral infections. The development and implementation of such experimental platforms are critical to elucidate host-pathogen interactions and to test new antiviral drugs and vaccines in a controlled, safe, and highly reproducible and predictive manner.
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Affiliation(s)
- Yordan Sbirkov
- Department of Medical Biology, Medical University-Plovdiv, Plovdiv, Bulgaria.,Research Institute, Medical University-Plovdiv, Plovdiv, Bulgaria
| | - Vasil Dzharov
- Department of Medical Biology, Medical University-Plovdiv, Plovdiv, Bulgaria
| | - Krassimira Todorova
- Laboratory of Reproductive OMICs Technologies, Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Soren Hayrabedyan
- Laboratory of Reproductive OMICs Technologies, Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Victoria Sarafian
- Department of Medical Biology, Medical University-Plovdiv, Plovdiv, Bulgaria.,Research Institute, Medical University-Plovdiv, Plovdiv, Bulgaria
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Air trapping in COVID-19 patients following hospital discharge: retrospective evaluation with paired inspiratory/expiratory thin-section CT. Eur Radiol 2022; 32:4427-4436. [PMID: 35226158 PMCID: PMC8884095 DOI: 10.1007/s00330-022-08580-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 12/13/2022]
Abstract
Objectives The study reports our experience with paired inspiration/expiration thin-section computed tomographic (CT) scans in the follow-up of COVID-19 patients with persistent respiratory symptoms. Methods From August 13, 2020, to May 31, 2021, 48 long-COVID patients with respiratory symptoms (27 men and 21 women; median age, 62.0 years; interquartile range: 54.0–69.0 years) underwent follow-up paired inspiration-expiration thin-section CT scans. Patient demographics, length of hospital stay, intensive care unit admission rate, and clinical and laboratory features of acute infection were also included. The scans were obtained on a median of 72.5 days after onset of symptoms (interquartile range: 58.5–86.5) and at least 30 days after hospital discharge. Thin-section CT findings included ground-glass opacity, mosaic attenuation pattern, consolidation, traction bronchiectasis, reticulation, parenchymal bands, bronchial wall thickening, and air trapping. We used a quantitative score to determine the degree of air trapping in the expiratory scans. Results Parenchymal abnormality was found in 50% (24/48) of patients and included air trapping (37/48, 77%), ground-glass opacities (19/48, 40%), reticulation (18/48, 38%), parenchymal bands (15/48, 31%), traction bronchiectasis (9/48, 19%), mosaic attenuation pattern (9/48, 19%), bronchial wall thickening (6/48, 13%), and consolidation (2/48, 4%). The absence of air trapping was observed in 11/48 (23%), mild air trapping in 20/48 (42%), moderate in 13/48 (27%), and severe in 4/48 (8%). Independent predictors of air trapping were, in decreasing order of importance, gender (p = 0.0085), and age (p = 0.0182). Conclusions Our results, in a limited number of patients, suggest that follow-up with paired inspiratory/expiratory CT in long-COVID patients with persistent respiratory symptoms commonly displays air trapping. Key Points • Our experience indicates that paired inspiratory/expiratory CT in long-COVID patients with persistent respiratory symptoms commonly displays air trapping. • Iterative reconstruction and dose-reduction options are recommended for demonstrating air trapping in long-COVID patients.
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Vascular findings in CTA body and extremity of critically ill COVID-19 patients: commonly encountered vascular complications with review of literature. Emerg Radiol 2022; 29:263-279. [PMID: 35064373 PMCID: PMC8782694 DOI: 10.1007/s10140-021-02013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 10/28/2022]
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35
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Luján M, Sayas J, Mediano O, Egea C. Non-invasive Respiratory Support in COVID-19: A Narrative Review. Front Med (Lausanne) 2022; 8:788190. [PMID: 35059415 PMCID: PMC8763700 DOI: 10.3389/fmed.2021.788190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
Acute respiratory failure secondary to COVID-19 pneumonia may require a variety of non-pharmacological strategies in addition to oxygen therapy to avoid endotracheal intubation. The response to all these strategies, which include high nasal flow, continuous positive pressure, non-invasive ventilation, or even prone positioning in awake patients, can be highly variable depending on the predominant phenotypic involvement. Deciding when to replace conventional oxygen therapy with non-invasive respiratory support, which to choose, the role of combined methods, definitions, and attitudes toward treatment failure, and improved case improvement procedures are directly relevant clinical questions for the daily care of critically ill COVID-19 patients. The experience accumulated after more than a year of the pandemic should lead to developing recommendations that give answers to all these questions.
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Affiliation(s)
- Manel Luján
- Pneumology Service, Hospital Universitari Parc Taulí, Sabadell, Spain.,Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain
| | - Javier Sayas
- Pneumology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Olga Mediano
- Pneumology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Carlos Egea
- Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain.,Hospital Universitario de Araba, Universidad País Vasco, Vitoria Gasteiz, Spain
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36
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Dalpiaz G, Gamberini L, Carnevale A, Spadaro S, Mazzoli CA, Piciucchi S, Allegri D, Capozzi C, Neziri E, Bartolucci M, Muratore F, Coppola F, Poerio A, Giampalma E, Baldini L, Tonetti T, Cappellini I, Colombo D, Zani G, Mellini L, Agnoletti V, Damiani F, Gordini G, Laici C, Gola G, Potalivo A, Montomoli J, Ranieri VM, Russo E, Taddei S, Volta CA, Scaramuzzo G. Clinical implications of microvascular CT scan signs in COVID-19 patients requiring invasive mechanical ventilation. Radiol Med 2022; 127:162-173. [PMID: 35034320 PMCID: PMC8761248 DOI: 10.1007/s11547-021-01444-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022]
Abstract
Purpose COVID-19-related acute respiratory distress syndrome (ARDS) is characterized by the presence of signs of microvascular involvement at the CT scan, such as the vascular tree in bud (TIB) and the vascular enlargement pattern (VEP). Recent evidence suggests that TIB could be associated with an increased duration of invasive mechanical ventilation (IMV) and intensive care unit (ICU) stay. The primary objective of this study was to evaluate whether microvascular involvement signs could have a prognostic significance concerning liberation from IMV. Material and methods All the COVID-19 patients requiring IMV admitted to 16 Italian ICUs and having a lung CT scan recorded within 3 days from intubation were enrolled in this secondary analysis. Radiologic, clinical and biochemical data were collected. Results A total of 139 patients affected by COVID-19 related ARDS were enrolled. After grouping based on TIB or VEP detection, we found no differences in terms of duration of IMV and mortality. Extension of VEP and TIB was significantly correlated with ground-glass opacities (GGOs) and crazy paving pattern extension. A parenchymal extent over 50% of GGO and crazy paving pattern was more frequently observed among non-survivors, while a VEP and TIB extent involving 3 or more lobes was significantly more frequent in non-responders to prone positioning. Conclusions The presence of early CT scan signs of microvascular involvement in COVID-19 patients does not appear to be associated with differences in duration of IMV and mortality. However, patients with a high extension of VEP and TIB may have a reduced oxygenation response to prone positioning. Trial Registration: NCT04411459 Supplementary Information The online version contains supplementary material available at 10.1007/s11547-021-01444-7.
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Affiliation(s)
| | - Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Aldo Carnevale
- Department of Radiology, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Sara Piciucchi
- Department of Radiology, G. B. Morgagni Hospital, Forlì, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Chiara Capozzi
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ersenad Neziri
- Radiology Department, SS. Trinità Hospital, ASL Novara, Borgomanero, Italy
| | | | | | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | | | | | - Luca Baldini
- Department of Radiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Iacopo Cappellini
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Davide Colombo
- Traslational Medicine Department, Eastern Piedmont University, Novara, Italy.,Anesthesiology Department, SS. Trinità Hospital, ASL Novara, Borgomanero, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Lorenzo Mellini
- Department of Radiology, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy, Imola Hospital, Imola, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Giuliano Gola
- Department of Radiology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Ospedale degli Infermi, Faenza, Italy
| | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Vito Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit, M. Bufalini Hospital, Cesena, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
| | - Gaetano Scaramuzzo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
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37
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Santamarina MG, Beddings I, Lomakin FM, Boisier Riscal D, Gutiérrez Claveria M, Vidal Marambio J, Retamal Báez N, Pavez Novoa C, Reyes Allende C, Ferreira Perey P, Gutiérrez Torres M, Villalobos Mazza C, Vergara Sagredo C, Ahumada Bermejo S, Labarca Mellado E, Barthel Munchmeyer E, Marchant Ramos S, Volpacchio M, Vega J. Sildenafil for treating patients with COVID-19 and perfusion mismatch: a pilot randomized trial. Crit Care 2022; 26:1. [PMID: 34980198 PMCID: PMC8721481 DOI: 10.1186/s13054-021-03885-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND SARS-CoV-2 seems to affect the regulation of pulmonary perfusion. Hypoperfusion in areas of well-aerated lung parenchyma results in a ventilation-perfusion mismatch that can be characterized using subtraction computed tomography angiography (sCTA). This study aims to evaluate the efficacy of oral sildenafil in treating COVID-19 inpatients showing perfusion abnormalities in sCTA. METHODS Triple-blinded, randomized, placebo-controlled trial was conducted in Chile in a tertiary-care hospital able to provide on-site sCTA scans and ventilatory support when needed between August 2020 and March 2021. In total, 82 eligible adults were admitted to the ED with RT-PCR-confirmed or highly probable SARS-COV-2 infection and sCTA performed within 24 h of admission showing perfusion abnormalities in areas of well-aerated lung parenchyma; 42 were excluded and 40 participants were enrolled and randomized (1:1 ratio) once hospitalized. The active intervention group received sildenafil (25 mg orally three times a day for seven days), and the control group received identical placebo capsules in the same way. Primary outcomes were differences in oxygenation parameters measured daily during follow-up (PaO2/FiO2 ratio and A-a gradient). Secondary outcomes included admission to the ICU, requirement of non-invasive ventilation, invasive mechanical ventilation (IMV), and mortality rates. Analysis was performed on an intention-to-treat basis. RESULTS Totally, 40 participants were enrolled (20 in the placebo group and 20 in the sildenafil group); 33 [82.5%] were male; and median age was 57 [IQR 41-68] years. No significant differences in mean PaO2/FiO2 ratios and A-a gradients were found between groups (repeated-measures ANOVA p = 0.67 and p = 0.69). IMV was required in 4 patients who received placebo and none in the sildenafil arm (logrank p = 0.04). Patients in the sildenafil arm showed a significantly shorter median length of hospital stay than the placebo group (9 IQR 7-12 days vs. 12 IQR 9-21 days, p = 0.04). CONCLUSIONS No statistically significant differences were found in the oxygenation parameters. Sildenafil treatment could have a potential therapeutic role regarding the need for IMV in COVID-19 patients with specific perfusion patterns in sCTA. A large-scale study is needed to confirm these results. TRIAL REGISTRATION Sildenafil for treating patients with COVID-19 and perfusion mismatch: a pilot randomized trial, NCT04489446, Registered 28 July 2020, https://clinicaltrials.gov/ct2/show/NCT04489446 .
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Affiliation(s)
- Mario G Santamarina
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., 254000, Viña del Mar, Provincia de Valparaíso, Chile. .,Radiology Department, Hospital Dr. Eduardo Pereira, Valparaiso, Chile.
| | - Ignacio Beddings
- Radiology Department, Hospital Clínico San Borja Arriarán, Santiago, Chile
| | - Felipe Martinez Lomakin
- Intensive Care Unit, Hospital Naval Almirante Nef, Viña del Mar, Chile.,Escuela de Medicina, Facultad de Medicina, Universidad Andres Bello, Viña del Mar, Chile
| | | | | | | | | | | | - César Reyes Allende
- Intensive Care Unit, Hospital Naval Almirante Nef, Viña del Mar, Chile.,Respiratory Department, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | | | | | | | | | | | | | | | | | - Mariano Volpacchio
- Radiology Department, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
| | - Jorge Vega
- General Internal Medicine Department, Hospital Naval Almirante Nef, Viña del Mar, Chile.,Departamento de Medicina, Escuela de Medicina, Universidad de Valparaíso, Viña del Mar, Chile
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38
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Farias LDPGD, Strabelli DG, Teles GBDS. COVID-19 pneumonia and target sign. EINSTEIN-SAO PAULO 2021; 19:eAI6564. [PMID: 34932755 PMCID: PMC8664281 DOI: 10.31744/einstein_journal/2021ai6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/24/2021] [Indexed: 11/22/2022] Open
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39
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Musat CA, Hadzhiivanov M, Durkowski V, Banerjee A, Chiphang A, Diwan M, Mahmood MS, Shami MN, Nune A. Observational study of clinico-radiological follow-up of COVID-19 pneumonia: a district general hospital experience in the UK. BMC Infect Dis 2021; 21:1233. [PMID: 34879817 PMCID: PMC8651500 DOI: 10.1186/s12879-021-06941-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The British Thoracic Society (BTS) recommends that all patients admitted with COVID-19 pneumonia should have a chest X-ray (CXR) and clinical follow-up at 6 or 12 weeks, depending on the disease severity. Little data is available on long-term CXR follow-up for moderate and severe COVID-19 pneumonia. This study aims to evaluate compliance with clinico-radiological follow-up of patients recovering from COVID-19 pneumonia at a local hospital in the UK, as per the BTS guidance, and to analyse radiological changes at clinical follow-up at 12 weeks, in order to risk-stratify and improve patient outcomes. METHODS This is a single-centre retrospective audit of 255 consecutive COVID-19 positive patients admitted to a local hospital in the UK over 5 months between May and October 2020. All CXRs and clinic follow-up at 12 ± 8 weeks were checked on an electronic database. RESULTS Over one in two (131/255) patients had CXR evidence of COVID-19 pneumonia during the initial hospital admission. Half of the patients (60/131) died before CXR or clinic follow-up. Fifty-eight percent (41/71) of the surviving patients had a follow-up CXR, and only two developed respiratory complications- one had residual lung fibrosis, another a pulmonary embolism. Eighty-eight percent (36/41) of the patients had either resolution or improved radiological changes at follow-up. Most patients who had abnormal follow-up CXR were symptomatic (6/8), and many asymptomatic patients at follow-up had a normal CXR (10/12). CONCLUSIONS Although there were concerns about interstitial lung disease (ILD) incidence in patients with COVID-19 pneumonia, most of our patients with COVID-19 pneumonia had no pulmonary complications at follow-up with CXR. This emphasises that CXR, a cost-effective investigation, can be used to risk-stratify patients for long term pulmonary complications following their COVID-19 pneumonia. However, we acknowledge the limitations of a low CXR and clinic follow-up rate in our cohort.
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Affiliation(s)
- C A Musat
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - M Hadzhiivanov
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - V Durkowski
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - A Banerjee
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - A Chiphang
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - M Diwan
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - M S Mahmood
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - M N Shami
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - A Nune
- Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK.
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40
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Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: a global perspective. Nat Rev Cardiol 2021; 19:314-331. [PMID: 34873286 PMCID: PMC8647069 DOI: 10.1038/s41569-021-00640-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
The lungs are the primary target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with severe hypoxia being the cause of death in the most critical cases. Coronavirus disease 2019 (COVID-19) is extremely heterogeneous in terms of severity, clinical phenotype and, importantly, global distribution. Although the majority of affected patients recover from the acute infection, many continue to suffer from late sequelae affecting various organs, including the lungs. The role of the pulmonary vascular system during the acute and chronic stages of COVID-19 has not been adequately studied. A thorough understanding of the origins and dynamic behaviour of the SARS-CoV-2 virus and the potential causes of heterogeneity in COVID-19 is essential for anticipating and treating the disease, in both the acute and the chronic stages, including the development of chronic pulmonary hypertension. Both COVID-19 and chronic pulmonary hypertension have assumed global dimensions, with potential complex interactions. In this Review, we present an update on the origins and behaviour of the SARS-CoV-2 virus and discuss the potential causes of the heterogeneity of COVID-19. In addition, we summarize the pathobiology of COVID-19, with an emphasis on the role of the pulmonary vasculature, both in the acute stage and in terms of the potential for developing chronic pulmonary hypertension. We hope that the information presented in this Review will help in the development of strategies for the prevention and treatment of the continuing COVID-19 pandemic. In this Review, the authors discuss the potential causes of the heterogeneity of COVID-19 and summarize the pathobiology of the disease, with an emphasis on the role of the pulmonary vasculature in the acute stage and the potential for developing chronic pulmonary hypertension. A thorough understanding of the dynamic behaviour of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential to understanding its heterogeneous effects on the pulmonary vasculature in patients with coronavirus disease 2019 (COVID-19). The severity and clinical phenotype of COVID-19 are influenced by host factors, including socioeconomic factors and genetics. Silent hypoxia is a major and independent cause of lung damage in COVID-19; the use of modern imaging techniques is proving to be very valuable in identifying silent hypoxia. The pulmonary vascular system has a major role in the pathobiology of COVID-19. Both COVID-19 and chronic pulmonary hypertension are global diseases with a complex interaction.
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41
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Evbuomwan O, Engelbrecht G. Incidental detection of a lung perfusion defect suspicious of pulmonary embolism on labelled white blood cell quality control imaging—case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8015745 DOI: 10.1186/s43055-021-00475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Incidental findings could be a very important observation in various nuclear medicine studies. There have been few cases of incidental findings of perfusion abnormalities on early quality control images of the lungs during radiolabeled white blood cell studies. This study is the first to detect perfusion defects on the early quality control images of the lungs during a labelled white blood cell study suspicious of pulmonary embolism in an unknown but treated COVID-19 patient.
Case presentation
We present a 40-year-old male who was referred to our department for a nuclear medicine 99mTc HMPAO-labelled white blood cell study to rule out osteomyelitis of his right foot. Early 5-min quality control images of his lungs revealed two perfusion defects in the right lung. A suspicion of pulmonary embolism was made, and a perfusion only SPECT/CT study the next day confirmed the suspicion of pulmonary embolism in one of the defects, with a possible fissure sign as a differential.
Conclusion
There has been an increase in the incidence of lung perfusion abnormalities and pulmonary embolism during the COVID-19 pandemic. Some of these may be detected as incidental findings on early lung quality control images of radiolabeled white blood cell studies.
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Pulmonary Edema in COVID-19 Treated with Furosemide and Negative Fluid Balance (NEGBAL): A Different and Promising Approach. J Clin Med 2021; 10:jcm10235599. [PMID: 34884300 PMCID: PMC8658626 DOI: 10.3390/jcm10235599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022] Open
Abstract
In COVID-19, pulmonary edema has been attributed to “cytokine storm”. However, it is known that SARS-CoV2 promotes angiotensin-converting enzyme 2 deficit, increases angiotensin II, and this triggers volume overload. Our report is based on COVID-19 patients with tomographic evidence of pulmonary edema and volume overload to whom established a standard treatment with diuretic (furosemide) guided by objectives: Negative Fluid Balance (NEGBAL approach). Retrospective observational study. We reviewed data from medical records: demographic, clinical, laboratory, blood gas, and chest tomography (CT) before and while undergoing NEGBAL, from 20 critically ill patients. Once the NEGBAL strategy was started, no patient required mechanical ventilation. All cases reverted to respiratory failure with NEGBAL, but subsequently two patients died from sepsis and acute myocardial infarction (AMI). The regressive analysis between PaO2/FiO2BAL and NEGBAL demonstrated correlation (p < 0.032). The results comparing the Pao2Fio2 between admission to NEGBAL to NEGBAL day 4, were statistically significant (p < 0.001). We noted between admission to NEGBAL and day 4 improvement in CT score (p < 0.001), decrease in the superior vena cava diameter (p < 0.001) and the decrease of cardiac axis (p < 0.001). Though our study has several limitations, we believe the promising results encourage further investigation of this different pathophysiological approach.
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43
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The "Target Sign" in a 46-Year-Old Patient with COVID-19 Pneumonia. Case Rep Radiol 2021; 2021:9956927. [PMID: 34721918 PMCID: PMC8556123 DOI: 10.1155/2021/9956927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 09/27/2021] [Accepted: 10/02/2021] [Indexed: 11/18/2022] Open
Abstract
COVID-19 has various imaging manifestations, most commonly peripheral ground-glass opacities with a basilar posterior predominance. Less common imaging manifestations include consolidations, findings typical of organizing pneumonia, such as “halo” or a “reverse halo” sign, and vascular enlargement. Our case describes a “target sign” on CT, which is uncommon but is increasingly being recognized. The target sign consists of a central nodular opacity with surrounding ground-glass opacity, then a surrounding relatively lucent ring, and a more peripheral ring of consolidation or ground-glass opacification. This may be the sequela of focal vascular enlargement, endothelial injury, microangiopathy, and perivascular inflammation. The case described involves a 46-year-old male who presented with subjective fevers, nonproductive cough, and hypoxia, subsequently diagnosed with COVID-19. CT imaging performed as part of initial work-up revealed multifocal ground-glass opacities scattered throughout the lung parenchyma, as well as multiple target sign lesions. Although it is a rare finding, the target sign, when present, may suggest the diagnosis of COVID-19.
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44
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Trunz LM, Lee P, Lange SM, Pomeranz CL, Needleman L, Ford RW, Karambelkar A, Sundaram B. Imaging approach to COVID-19 associated pulmonary embolism. Int J Clin Pract 2021; 75:e14340. [PMID: 33966326 PMCID: PMC8237008 DOI: 10.1111/ijcp.14340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
The novel coronavirus disease-2019 (COVID-19) illness and deaths, caused by the severe acute respiratory syndrome coronavirus-2, continue to increase. Multiple reports highlight the thromboembolic complications, such as pulmonary embolism (PE), in COVID-19. Imaging plays an essential role in the diagnosis and management of COVID-19 patients with PE. There continues to be a rapid evolution of knowledge related to COVID-19 associated PE. This review summarises the current understanding of prevalence, pathophysiology, role of diagnostic imaging modalities, and management, including catheter-directed therapy for COVID-19 associated PE. It also describes infection control considerations for the radiology department while providing care for patients with COVID-19 associated PE.
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Affiliation(s)
- Lukas M. Trunz
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Patrick Lee
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Steven M. Lange
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | | | | | - Robert W. Ford
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ajit Karambelkar
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
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Abstract
The pathophysiology of acute respiratory distress syndrome (ARDS) is marked by inflammation-mediated disruptions in alveolar-capillary permeability, edema formation, reduced alveolar clearance and collapse/derecruitment, reduced compliance, increased pulmonary vascular resistance, and resulting gas exchange abnormalities due to shunting and ventilation-perfusion mismatch. Mechanical ventilation, especially in the setting of regional disease heterogeneity, can propagate ventilator-associated injury patterns including barotrauma/volutrauma and atelectrauma. Lung injury due to the novel coronavirus SARS-CoV-2 resembles other causes of ARDS, though its initial clinical characteristics may include more profound hypoxemia and loss of dyspnea perception with less radiologically-evident lung injury, a pattern not described previously in ARDS.
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Affiliation(s)
- Kai Erik Swenson
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, 55 Fruit Street, BUL 148, Boston, MA 02114, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Erik Richard Swenson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA; Medical Service, Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way, Campus Box 358280 (S-111 Pulm), Seattle, WA 98108, USA
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Lysenkov SP, Muzhenya DV, Tuguz AR, Urakova TU, Shumilov DS, Thakushinov IA. Participation of nitrogen oxide and its metabolites in the genesis of hyperimmune inflammation in COVID-19. CHINESE J PHYSIOL 2021; 64:167-176. [PMID: 34472447 DOI: 10.4103/cjp.cjp_38_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Despite the success in the tactics of treating COVID-19, there are many unexplored issues related to the development and progression of the process in the lungs, brain, and other organs, as well as the role of individual elements, in particular, nitric oxide (NO), and in the pathogenesis of organ damage. Based on the analyzed literature data, we considered a possible pathophysiological mechanism of action of NO and its derivatives in COVID-19. It can be noted that hyperimmune systemic inflammation and "cytokine storm" are enhanced by the production of NO, products of its oxidation ("nitrosative stress"). It is noted in the work that as a result of the oxidation of NO, a large amount of the toxic compound peroxynitrite is formed, which is a powerful proinflammatory agent. Its presence significantly damages the endothelium of the vascular walls and also oxidizes lipids, hemoglobin, myoglobin, and cytochrome, binds SH-groups of proteins, and damages DNA in the target cells. This is confirmed by the picture of the vessels of the lungs on computed tomography and the data of biochemical studies. In case of peroxynitrite overproduction, inhibition of the synthesis of NO and its metabolic products seems to be justified. Another aspect considered in this work is the mechanism of damage by the virus to the central and peripheral nervous system, which remains poorly understood but may be important in understanding the consequences, as well as predicting brain functions in persons who have undergone COVID-19. According to the analyzed literature, it can be concluded that brain damage is possible due to the direct effect of the virus on the peripheral nerves and central structures, and indirectly through the effect on the endothelium of cerebral vessels. Disturbances in the central nervous regulation of immune responses may be associated with the insufficient function of the acetylcholine anti-inflammatory system. It is proposed to further study several approaches to influence various links of NO exchange, which are of interest for theoretical and practical medicine.
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Affiliation(s)
- Sergey Petrovich Lysenkov
- Department of Pathomorphology and Clinical Pathophysiology, Medical Institute, FSBEI HE "Maikop State Technological University", Maikop, Republic of Adygeya, Russia
| | - Dmitriy Vitalevich Muzhenya
- Department of Pathomorphology and Clinical Pathophysiology, Medical Institute, FSBEI HE "Maikop State Technological University", Maikop, Republic of Adygeya, Russia
| | - Aminat Ramazanovna Tuguz
- Immunogenetic Laboratory of the Research, Institute of Complex Problems, FSBEI HE "Adyghe State University", Maikop, Republic of Adygeya, Russia
| | - Tamara Ur'evna Urakova
- Department of Pathomorphology and Clinical Pathophysiology, Medical Institute, FSBEI HE "Maikop State Technological University", Maikop, Republic of Adygeya, Russia
| | - Dmitriy Sergeevich Shumilov
- Immunogenetic Laboratory of the Research, Institute of Complex Problems, FSBEI HE "Adyghe State University", Maikop, Republic of Adygeya, Russia
| | - Ibragim Askarbievich Thakushinov
- Department of Pathomorphology and Clinical Pathophysiology, Medical Institute, FSBEI HE "Maikop State Technological University", Maikop, Republic of Adygeya, Russia
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Febbo JA, Ketai L. Emerging Pulmonary Infections in Clinical Practice. ADVANCES IN CLINICAL RADIOLOGY 2021; 3:103-124. [PMID: 38620910 PMCID: PMC8169325 DOI: 10.1016/j.yacr.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Jennifer Ann Febbo
- Department of Radiology, University of New Mexico, 2211 Lomas Boulevard Northeast, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, University of New Mexico, 2211 Lomas Boulevard Northeast, Albuquerque, NM 87106, USA
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Aydin S, Kantarci M, Karavas E, Unver E, Yalcin S, Aydin F. Lung perfusion changes in COVID-19 pneumonia: a dual energy computerized tomography study. Br J Radiol 2021; 94:20201380. [PMID: 34415201 PMCID: PMC9327758 DOI: 10.1259/bjr.20201380] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings. METHODS Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant. RESULTS Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation. CONCLUSIONS Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity. ADVANCES IN KNOWLEDGE Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.
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Affiliation(s)
- Sonay Aydin
- Department of Radiology, Erzincan University, Erzincan, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University, Erzincan, Turkey.,Department of Radiology, Atatürk University, Erzurum, Turkey
| | - Erdal Karavas
- Department of Radiology, Erzincan University, Erzincan, Turkey
| | - Edhem Unver
- Department of Chest Disease, Erzincan University, Erzincan, Turkey
| | - Seven Yalcin
- Department of Chest Disease, Erzincan University, Erzincan, Turkey
| | - Fahri Aydin
- Department of Radiology, Atatürk University, Erzurum, Turkey
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Morris MF, Pershad Y, Kang P, Ridenour L, Lavon B, Lanclus M, Godon R, De Backer J, Glassberg MK. Altered pulmonary blood volume distribution as a biomarker for predicting outcomes in COVID-19 disease. Eur Respir J 2021; 58:2004133. [PMID: 33632795 PMCID: PMC7908189 DOI: 10.1183/13993003.04133-2020] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Evidence suggests that vascular inflammation and thrombosis may be important drivers of poor clinical outcomes in patients with COVID-19. We hypothesised that a significant decrease in the percentage of blood volume in vessels with a cross-sectional area between 1.25 and 5 mm2 relative to the total pulmonary blood volume (BV5%) on chest computed tomography (CT) in COVID-19 patients is predictive of adverse clinical outcomes. METHODS We performed a retrospective analysis of chest CT scans from 10 hospitals across two US states in 313 COVID-19-positive and 195 COVID-19-negative patients seeking acute medical care. RESULTS BV5% was predictive of outcomes in COVID-19 patients in a multivariate model, with a BV5% threshold below 25% associated with OR 5.58 for mortality, OR 3.20 for intubation and OR 2.54 for the composite of mortality or intubation. A model using age and BV5% had an area under the receiver operating characteristic curve of 0.85 to predict the composite of mortality or intubation in COVID-19 patients. BV5% was not predictive of clinical outcomes in patients without COVID-19. CONCLUSIONS The data suggest BV5% as a novel biomarker for predicting adverse outcomes in patients with COVID-19 seeking acute medical care.
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Affiliation(s)
- Michael F Morris
- Dept of Radiology, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
- Dept of Medicine, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | - Yash Pershad
- Dept of Bioengineering, Stanford University, Palo Alto, CA, USA
| | - Paul Kang
- Dept of Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA
| | - Lauren Ridenour
- Dept of Medicine, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
| | | | | | | | | | - Marilyn K Glassberg
- Dept of Medicine, Banner - University Medical Center Phoenix, Phoenix, AZ, USA
- Division of Pulmonary Medicine, Critical Care, and Sleep Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
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50
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Vanderboom PM, Mun DG, Madugundu AK, Mangalaparthi KK, Saraswat M, Garapati K, Chakraborty R, Ebihara H, Sun J, Pandey A. Proteomic Signature of Host Response to SARS-CoV-2 Infection in the Nasopharynx. Mol Cell Proteomics 2021; 20:100134. [PMID: 34400346 PMCID: PMC8363427 DOI: 10.1016/j.mcpro.2021.100134] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a global health pandemic. COVID-19 severity ranges from an asymptomatic infection to a severe multiorgan disease. Although the inflammatory response has been implicated in the pathogenesis of COVID-19, the exact nature of dysregulation in signaling pathways has not yet been elucidated, underscoring the need for further molecular characterization of SARS-CoV-2 infection in humans. Here, we characterize the host response directly at the point of viral entry through analysis of nasopharyngeal swabs. Multiplexed high-resolution MS-based proteomic analysis of confirmed COVID-19 cases and negative controls identified 7582 proteins and revealed significant upregulation of interferon-mediated antiviral signaling in addition to multiple other proteins that are not encoded by interferon-stimulated genes or well characterized during viral infections. Downregulation of several proteasomal subunits, E3 ubiquitin ligases, and components of protein synthesis machinery was significant upon SARS-CoV-2 infection. Targeted proteomics to measure abundance levels of MX1, ISG15, STAT1, RIG-I, and CXCL10 detected proteomic signatures of interferon-mediated antiviral signaling that differentiated COVID-19-positive from COVID-19-negative cases. Phosphoproteomic analysis revealed increased phosphorylation of several proteins with known antiviral properties as well as several proteins involved in ciliary function (CEP131 and CFAP57) that have not previously been implicated in the context of coronavirus infections. In addition, decreased phosphorylation levels of AKT and PKC, which have been shown to play varying roles in different viral infections, were observed in infected individuals relative to controls. These data provide novel insights that add depth to our understanding of SARS-CoV-2 infection in the upper airway and establish a proteomic signature for this viral infection.
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Affiliation(s)
- Patrick M Vanderboom
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dong-Gi Mun
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anil K Madugundu
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA; Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India; Manipal Academy of Higher Education, Manipal, Karnataka, India; Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Kiran K Mangalaparthi
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA; Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India; Amrita School of Biotechnology, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India
| | - Mayank Saraswat
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA; Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India; Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kishore Garapati
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA; Institute of Bioinformatics, International Technology Park, Bangalore, Karnataka, India; Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hideki Ebihara
- Department of Molecular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jie Sun
- The Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA; Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota, USA; Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India; Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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