Prevalence and risk factors for lung involvement on low-dose chest CT (LDCT) in a paucisymptomatic population of 247 patients affected by COVID-19

Lung ultrasound in the COVID-19 era: a lesson to be learned for the future

Lung Ultrasound (LUS) is a reliable, radiation free and bedside imaging technique to assess several pulmonary diseases. Although the diagnosis of COVID-19 is made with the nasopharyngeal swab, detection of pulmonary involvement is key for a safe patient management. LUS is a valid alternative to explore, in paucisymptomatic self-presenting patients, the presence and extension of pneumonia compared to High Resolution Computed Tomography (HRCT) that represent the gold standard. This is a single-centre prospective study with 131 patients enrolled. Twelve lung areas were explored reporting a semiquantitative assessment to obtain the LUS score. Each patient performed reverse-transcription polymerase chain reaction test (rRT-PCR), hemogasanalysis and HRCT. We observed an inverse correlation between LUSs and pO2, P/F, SpO2, AaDO2 (p value < 0.01), a direct correlation with LUSs and AaDO2 (p value < 0.01). Compared with HRCT, LUS showed sensitivity and specificity of 81.8% and 55.4%, respectively, and VPN 75%, VPP 65%. Therefore, LUS can represent an effective alternative tool to detect pulmonary involvement in COVID-19 compared to HRCT.

Olfactory dysfunction in COVID-19, new insights from a cohort of 353 patients: The ANOSVID study

Olfactory disorders (OD) pathogenesis, underlying conditions, and prognostic in coronavirus disease 2019 (COVID-19) remain partially described. ANOSVID is a retrospective study in Nord Franche-Comté Hospital (France) that included COVID-19 patients from March 1 2020 to May 31 2020. The aim was to compare COVID-19 patients with OD (OD group) and patients without OD (no-OD group). A second analysis compared patients with anosmia (high OD group) and patients with hyposmia or no OD (low or no-OD group). The OD group presented less cardiovascular and other respiratory diseases compared to the no-OD group (odds ratio [OR] = 0.536 [0.293-0.981], p = 0.041 and OR = 0.222 [0.056-0.874], p = 0.037 respectively). Moreover, history of malignancy was less present in the high OD group compared with the low or no-OD group (OR = 0.170 [0.064-0.455], p < 0.001). The main associated symptoms (OR > 5) with OD were loss of taste (OR = 24.059 [13.474-42.959], p = 0.000) and cacosmia (OR = 5.821 [2.246-15.085], p < 0.001). Most of all ORs decreased in the second analysis, especially for general, digestive, and ENT symptoms. Only two ORs increased: headache (OR = 2.697 [1.746-4.167], p < 0.001) and facial pain (OR = 2.901 [1.441-5.842], p = 0.002). The high OD group had a higher creatinine clearance CKD than the low or no-OD group (89.0 ± 21.1 vs. 81.0 ± 20.5, p = 0.040). No significant difference was found concerning the virological, radiological, and severity criteria. OD patients seem to have less comorbidity, especially better cardiovascular and renal function. Associated symptoms with OD were mostly neurological symptoms. We did not find a significant relationship between OD and less severity in COVID-19 possibly due to methodological bias.

Dose Descriptors and Assessment of Risk of Exposure-Induced Death in Patients Undergoing COVID-19 Related Chest Computed Tomography

For more than two years, coronavirus disease 19 (COVID-19) has represented a threat to global health and lifestyles. Computed tomography (CT) imaging provides useful information in patients with COVID-19 pneumonia. However, this diagnostic modality is based on exposure to ionizing radiation, which is associated with an increased risk of radiation-induced cancer. In this study, we evaluated the common dose descriptors, CTDIvol and DLP, for 1180 adult patients. This data was used to estimate the effective dose, and risk of exposure-induced death (REID). Awareness of the extensive use of CT as a diagnostic tool in the management of COVID-19 during the pandemic is vital for the evaluation of radiation exposure parameters, dose reduction methods development and radiation protection.

Multiple small pneumatoceles as a complication of a SARS-CoV-2 infection in a child from Myanmar

During the COVID-19 pandemic, pneumatoceles caused by 2019-nCoV are easily neglected, particularly in children. Which may potentially increase the risk of pneumothorax and pulmonary infection, we need to pay special attention to the management of population migration, especially for children.

Triaging of COVID-19 patients using low dose chest CT: Incidence and factor analysis of lung involvement on CT images

Introduction

Despite an increase in CT studies to evaluate patients with coronavirus disease 2019 (COVID-19), their indication in triage is not well-established. The purpose was to investigate the incidence of lung involvement and analyzed factors related to lung involvement on CT images for establishment of the indication for CT scans in the triaging of COVID-19 patients.

Methods

Included were 192 COVID-19 patients who had undergone CT scans and blood tests for triaging. Two radiologists reviewed the CT images and recorded the incidence of lung involvement. The prediction model for lung involvement on CT images using clinico-laboratory variables [age, gender, body mass index, oxygen saturation of the peripheral artery (SpO₂), comorbidities, symptoms, and blood data] were developed by multivariate logistic regression with cross-validation.

Results

In 120 of the 192 patients (62.5%), CT revealed lung involvement.

The patient age (odds ratio [OR]; 4.95, 95% confidence interval [CI]; 0.93–26.49), albumin (OR; 4.66, 95%CI; 1.37–15.84), lactate dehydrogenase (OR; 5.79, 95%CI; 1.43–23.38) and C-reactive protein (OR; 8.93, 95%CI; 4.13–19.29) were selected for the final prediction model for lung involvement on CT images. The cross-validated area under the receiver operating characteristics (ROC) curve was 0.83.

Conclusions

The high incidence of lung involvement (62.5%) was confirmed on CT images. The proposed prediction model that includes the patient age, albumin, lactate dehydrogenase, and C-reactive protein may be useful for predicting lung involvement on CT images and may assist in deciding whether triaged COVID-19 patients should undergo CT.

Low-dose radiation therapy (LDRT) for COVID-19 and its deadlier variants

Coronavirus variants are gaining strongholds throughout the globe. Despite early signals that SARS-CoV-2 coronavirus case numbers are easing up in the United States and during the middle of a (not so easy) vaccination roll out, the country has passed a grim landmark of 600,000 deaths. We contend that these numbers would have been much lower if the medical community undertook serious investigations into the potential of low doses of radiation (LDRT) as a mainstream treatment modality for COVID-19 pneumonia. LDRT has been posited to manifest anti-infectious and anti-inflammatory properties at doses of 0.3-1.0 Gy via the activation of the Nrf-2 pathway. Although some researchers are conducting well-designed clinical trials on the potential of LDRT, the deep-rooted, blind, and flawed acceptance of the Linear No-Threshold (LNT) model for ionizing radiation has led to sidelining of this promising therapy and thus unimaginable numbers of deaths in the United States.

Olfactory and gustatory dysfunctions in SARS-CoV-2 infection: A systematic review

BACKGROUND

Among Coronavirus Disease 2019 (COVID-19) manifestations, Olfactory (OD) and Gustatory (GD) Dysfunctions (OGD) have drawn considerable attention, becoming a sort of hallmark of the disease. Many have speculated on the pathogenesis and clinical characteristics of these disturbances; however, no definite answers have been produced on the topic. With this systematic review, we aimed to collect all the available evidence regarding the prevalence of OGD, the timing of their onset and their resolution, their rate of recovery and their role as diagnostic and prognostic tools for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection.

METHODS

A systematic review comprising all the observational studies that reported the prevalence and/or the longitudinal trajectories of OGD in COVID-19 patients, as self-reported by patients or measured through objective psychophysical tests.

RESULTS

After the selection process, 155 studies were included, with a total of 70,920 patients and 105,291 not-infected individuals. Prevalence reports were extremely variable across studies, with wide ranges for OD (0%-98%) and GD (0-89%) prevalence. OGD occurred early during the disease course and only rarely preceded other symptoms; out of 30 studies with a follow-up time of at least 20 days, only in 5 studies OGD fully resolved in more than 90% of patients. OGD had low sensitivity and high specificity for SARS-CoV-2 infection; accuracy of OD and GD for infection identification was higher than 80% in 10 out of 33 studies and in 8 out of 22 studies considered, respectively. 28 out of 30 studies that studied the association between OGD and disease severity found how OGD were associated with lower rates of severe pneumonia, hospitalization and mortality.

CONCLUSIONS

OGD seem to be highly prevalent in SARS-CoV-2 infection. They occur early, concomitantly with other symptoms and often persist after recovery, in some cases for months; whether a full recovery eventually occurs in all cases is not clear yet. OGD are good predictors of SARS-CoV-2 infection and are associated with a milder disease course.

COVID-19 Management at IHU Méditerranée Infection: A One-Year Experience

BACKGROUND

The Hospital-University Institute (IHU) Méditerranée Infection features a 27,000 square meter building hosting 700 employees and 75 hospitalized patients in the center of Marseille, France.

METHOD

Previous preparedness in contagious disease management allowed the IHU to manage the COVID-19 outbreak by continuing adaptation for optimal diagnosis, care and outcome. We report here the output of this management.

RESULTS

From 5 March 2020, and 26 April 2021, 608,313 PCR tests were provided for 424,919 patients and 44,089 returned positive. A total of 23,390 patients with COVID-19 were followed at IHU with an overall case fatality ratio of 1.7%. Of them 20,270 were followed as outpatients with an overall CFR of 0.17%. We performed 24,807 EKG, 5759 low dose CT Scanner, and 18,344 serology. Of the 7643 nasopharyngeal samples inoculated in cell cultures 3317 (43.3%) yielded SARS-Cov-2 isolates. Finally, 7370 SARS-Cov-2 genomes were analyzed, allowing description of the first genetic variants and their implication in the epidemiologic curves. Continuous clinical care quality evaluation provided the opportunity for 155 publications allowing a better understanding of the disease and improvement of care and 132 videos posted on the IHU Facebook network, totaling 60 million views and 390,000 followers, and dealing with COVID-19, outbreaks, epistemology, and ethics in medicine.

CONCLUSIONS

During this epidemic, IHU Méditerranée Infection played the role for which it has been created; useful clinical research to guarantee a high-quality diagnostic and care for patient and a recognized expertise.

Diagnostic performance of Radiological Society of North America structured reporting language for chest computed tomography findings in patients with COVID-19

PURPOSE

To evaluate the diagnostic performance of the RSNA structured reporting language for chest CT findings in patients with COVID-19.

MATERIAL AND METHODS

Patients with suspected COVID-19 who underwent chest CT and RT-PCR tests were enrolled consecutively in this retrospective study, regardless of symptoms. Imaging findings were categorized as "typical", "indeterminate", "atypical", or "negative" according to RSNA reporting language and compared to RT-PCR. "Single, round GGO" and "single, peripheral GGO," do not fit the reporting language, were also analyzed as "indeterminate" patterns.

RESULTS

Of the 1186 patients included in the analysis, the diagnosis of COVID-19 was confirmed in 388 patients. Of the 388 patients, CT findings were categorized as "typical" in 248, "indeterminate" in 77, and "negative" in 63. The sensitivity, specificity, and accuracy of "typical" findings were 63.9, 99.0, and 87.5% for COVID-19, respectively. In addition to the "typical" findings, the highest diagnostic accuracy of 92.2% was achieved when the "single, peripheral GGO" and "single, round GGO" were considered to be CT-positive.

CONCLUSION

The RSNA reporting language has significant diagnostic performance for identifying COVID-19 pneumonia. CT findings that do not exactly fit the RSNA reporting language, such as "single, round GGO" and "single, peripheral GGO" improve diagnostic performance.