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Caroselli C, Blaivas M, Tung Chen Y, Marcosignori M, Cherubini A, Longo D. A Modified Corona Score Using Lung Ultrasound to Identify COVID-19 Patients. Diagnostics (Basel) 2023; 14:51. [PMID: 38201360 PMCID: PMC10804308 DOI: 10.3390/diagnostics14010051] [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: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND COVID-19 continues to circulate around the world with multiple different strains being active at once. While diagnosis with antigen and molecular testing is more readily available, there is still room for alternative methods of diagnosis, particularly in out-of-hospital settings, e.g., home or nursing homes, and in low-medium income countries, where testing may not be readily available. STUDY OBJECTIVES To evaluate the performance of two modified corona score methods compared with a traditional corona score approach to identify patients with COVID-19. METHODS This was a retrospective multicenter study performed to compare the ability to predict SARS-CoV-2 test results on a nasopharyngeal swab between the corona scores and two novel corona scores (modified 1 corona score (M1CS) and modified 2 corona score (M2CS)). The M1CS included lung ultrasound (LUS) and chest X-ray (CXR) results, while the M2SC only utilized LUS findings without CXRs. Emergency physicians performed point-of-care LUS and a physical examination upon admission to the emergency department. RESULTS Subjects positive for SARS-CoV-2 were older and had higher ferritin levels and temperature and lower diastolic blood pressure and oxygen saturation. The two groups differed on corona score and modified corona scores (p < 0.001 for all). SARS-CoV-2-positive patients had fewer pleural line irregularities (p = 0.025) but presented more frequently with an interstitial pattern on CXRs (p < 0.001). CONCLUSIONS In our study, LUS alone provided a valuable contribution to the corona score and improved its performance more than when CXR results were included. These results suggest that resource-limited areas where CXRs may be unavailable or prohibitively expensive can utilize an ultrasound as the sole imaging modality without a loss of diagnostic performance for SARS-CoV-2 pneumonia diagnosis.
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Affiliation(s)
- Costantino Caroselli
- Acute Geriatric Unit, Geriatric Emergency Room and Aging Research Centre IRCCS INRCA, 60127 Ancona, Italy;
| | - Michael Blaivas
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, SC 29209, USA;
| | - Yale Tung Chen
- Internal Medicine Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - Matteo Marcosignori
- Emergency Department, Azienda Ospedaliero Universitaria, Ospedali Riuniti, 60123 Ancona, Italy;
| | - Antonio Cherubini
- Acute Geriatric Unit, Geriatric Emergency Room and Aging Research Centre IRCCS INRCA, 60127 Ancona, Italy;
| | - Daniele Longo
- Department of Prevention, APSS, 38123 Trento, Italy;
- Department of Diagnostics and Public Health, School of Medicine and Surgery, Università di Verona, 37124 Verona, Italy
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Li W, Li X, Kong Z, Chen B, Zhou H, Jiang Y, Li W, Zhong L, Zhang X, Zhang K, Zhang L, Zong X, Bai W, Zheng Y. Efficacy of low-intensity pulsed ultrasound in the treatment of COVID-19 pneumonia. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e274-e283. [PMID: 37467781 PMCID: PMC10695700 DOI: 10.1055/a-2133-0835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/13/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE As a public health emergency of international concern, coronavirus disease 2019 (COVID-19) still lacks specific antiviral drugs, and symptomatic treatment is currently the mainstay. The overactivated inflammatory response in COVID-19 patients is associated with a high risk of critical illness or even death. Low-intensity pulsed ultrasound (LIPUS) can mitigate inflammation and inhibit edema formation. We aimed to investigate the efficacy of LIPUS therapy for COVID-19 pneumonia. MATERIALS AND METHODS 62 patients were randomly assigned to a treatment group (LIPUS treatment area - Group 1; self-control area - Group 2) and an external control group (Group 3). The primary outcomes were the volume absorption rate (VAR) and the area absorption rate (AAR) of lung inflammation in CT images. RESULTS After an average duration of treatment 7.2 days, there were significant differences in AAR and VAR between Group 1 and Group 2 (AAR 0.25 vs 0.12, p=0.013; VAR 0.35 vs 0.11, p=0.005), and between Group 1 and Group 3 (AAR 0.25 vs 0.11, p=0.047; VAR 0.35 vs 0.19, p=0.042). Neither AAR nor VAR was statistically different between Group 2 and Group 3. After treatment, C-reactive protein, interleukin-6, leukocyte, and fingertip arterial oxygen saturation (SaO2) improved in Group 1, while in Group 3 only fingertip SaO2 increased. CONCLUSION LIPUS therapy reduced lung inflammation and serum inflammatory factor levels in hospitalized COVID-19 patients, which might be a major advancement in COVID-19 pneumonia therapy.
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Affiliation(s)
- Wen Li
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhibin Kong
- Respiratory Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Chen
- Cardiovascular Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongsheng Zhou
- Shanghai Acoustics Jiao Tong University, Shanghai, China
| | - Yimin Jiang
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weimei Li
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lichang Zhong
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyu Zhang
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaihua Zhang
- Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Zhang
- Cardiovascular Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyun Zong
- Breast Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenkun Bai
- Department of Ultrasound, Tong Ji Hospital Affiliated to Tong Ji University, Shanghai, China
| | - Yuanyi Zheng
- Department of Ultrasound, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Maggi L, De Fazio G, Guglielmi R, Coluzzi F, Fiorelli S, Rocco M. COVID-19 Lung Ultrasound Scores and Lessons from the Pandemic: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111972. [PMID: 37296825 DOI: 10.3390/diagnostics13111972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The WHO recently declared that COVID-19 no longer constitutes a public health emergency of international concern; however, lessons learned through the pandemic should not be left behind. Lung ultrasound was largely utilized as a diagnostic tool thanks to its feasibility, easy application, and the possibility to reduce the source of infection for health personnel. Lung ultrasound scores consist of grading systems used to guide diagnosis and medical decisions, owning a good prognostic value. In the emergency context of the pandemic, several lung ultrasound scores emerged either as new scores or as modifications of pre-existing ones. Our aim is to clarify the key aspects of lung ultrasound and lung ultrasound scores to standardize their clinical use in a non-pandemic context. The authors searched on PubMed for articles related to "COVID-19", "ultrasound", and "Score" until 5 May 2023; other keywords were "thoracic", "lung", "echography", and "diaphragm". A narrative summary of the results was made. Lung ultrasound scores are demonstrated to be an important tool for triage, prediction of severity, and aid in medical decisions. Ultimately, the existence of numerous scores leads to a lack of clarity, confusion, and an absence of standardization.
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Affiliation(s)
- Luigi Maggi
- Government of Italy Ministry of Interior, 00189 Rome, Italy
| | - Giulia De Fazio
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Riccardo Guglielmi
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
| | - Silvia Fiorelli
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
| | - Monica Rocco
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy
- Unit of Anaesthesia, Intensive Care and Pain Medicine, Sant'Andrea University Hospital, 00189 Rome, Italy
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Demi M, Soldati G. Lung Ultrasound: A Leading Diagnostic Tool. Diagnostics (Basel) 2023; 13:diagnostics13101710. [PMID: 37238195 DOI: 10.3390/diagnostics13101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Thoracic ultrasound is an important diagnostic tool employed by many clinicians in well-defined applications [...].
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Affiliation(s)
- Marcello Demi
- Department of Bioengineering, Fondazione Toscana Gabriele Monasterio, 56126 Pisa, Italy
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound Unit, Ippocrate Medical Center, 55032 Lucca, Italy
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Analysis of Chest X-ray for COVID-19 Diagnosis as a Use Case for an HPC-Enabled Data Analysis and Machine Learning Platform for Medical Diagnosis Support. Diagnostics (Basel) 2023; 13:diagnostics13030391. [PMID: 36766496 PMCID: PMC9914706 DOI: 10.3390/diagnostics13030391] [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] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
The COVID-19 pandemic shed light on the need for quick diagnosis tools in healthcare, leading to the development of several algorithmic models for disease detection. Though these models are relatively easy to build, their training requires a lot of data, storage, and resources, which may not be available for use by medical institutions or could be beyond the skillset of the people who most need these tools. This paper describes a data analysis and machine learning platform that takes advantage of high-performance computing infrastructure for medical diagnosis support applications. This platform is validated by re-training a previously published deep learning model (COVID-Net) on new data, where it is shown that the performance of the model is improved through large-scale hyperparameter optimisation that uncovered optimal training parameter combinations. The per-class accuracy of the model, especially for COVID-19 and pneumonia, is higher when using the tuned hyperparameters (healthy: 96.5%; pneumonia: 61.5%; COVID-19: 78.9%) as opposed to parameters chosen through traditional methods (healthy: 93.6%; pneumonia: 46.1%; COVID-19: 76.3%). Furthermore, training speed-up analysis shows a major decrease in training time as resources increase, from 207 min using 1 node to 54 min when distributed over 32 nodes, but highlights the presence of a cut-off point where the communication overhead begins to affect performance. The developed platform is intended to provide the medical field with a technical environment for developing novel portable artificial-intelligence-based tools for diagnosis support.
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B-Lines Lung Ultrasonography Simulation Using Finite Element Method. Diagnostics (Basel) 2022; 12:diagnostics12112751. [DOI: 10.3390/diagnostics12112751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Lung Ultrasonography (LUS) is a fast technique for the diagnosis of patients with respiratory syndromes. B-lines are seen in response to signal reverberations and amplifications into sites with peripheral lung fluid concentration or septal thickening. Mathematical models are commonly applied in biomedicine to predict biological responses to specific signal parameters. Objective: This study proposes a Finite-Element numerical model to simulate radio frequency ultrasonic lines propagated from normal and infiltrated lung structures. For tissue medium, a randomized inhomogeneous data method was used. The simulation implemented in COMSOL® used Acoustic Pressure and Time-Explicit models, which are based on the discontinuous Galerkin method (dG). Results: The RF signals, processed in MATLAB®, resulted in images of horizontal A-lines and vertical B-lines, which were reasonably similar to real images. Discussion: The use of inhomogeneous materials in the model was good enough to simulate the scattering response, similar to others in the literature. The model is useful to study the impact of the lung infiltration characteristics on the appearance of LUS images.
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