CT features of pulmonary embolism in patients with COVID-19 pneumonia

OBJECTIVE

The aim of this study was to describe the Computed Tomography (CT) features of pulmonary embolism in patients hospitalized for acute COVID-19 pneumonia and to evaluate the prognostic significance of these features.

PATIENTS AND METHODS

This retrospective study included 110 consecutive patients who were hospitalized for acute COVID-19 pneumonia and underwent pulmonary computed tomography angiography (BTPA) on the basis of clinical suspicion. The diagnosis of COVID-19 infection was determined by CT findings typical of COVID-19 pneumonia and/or a positive result of a reverse transcriptase-polymerase chain reaction test.

RESULTS

Of the 110 patients, 30 (27.3%) had acute pulmonary embolism and 71 (64.5%) had CT features of chronic pulmonary embolism. Of the 14 (12.7%) patients who died despite receiving therapeutic doses of heparin, 13 (92.9%) had CT features of chronic pulmonary embolism and 1 (7.1%) of acute pulmonary embolism. CT features of chronic pulmonary embolism were more common in deceased patients than in surviving patients (92.9% vs. 60.4%, p=0.01, respectively). Low oxygen saturation and high urine microalbumin creatinine ratio at admission in COVID-19 patients are important determinants of mortality after adjusting for sex and age in logistic procedures.

CONCLUSIONS

CT features of chronic pulmonary embolism are common in COVID-19 patients undergoing Computed Tomography Pulmonary Angiography (CTPA) in the hospital. The coexistence of albuminuria, low oxygen saturation and CT features of chronic pulmonary embolism at admission in COVID-19 patients may herald fatal outcomes.

Efficacy of povidone-iodine in preputial antisepsis

Wound infection after a surgical procedure is one of the main problems affecting the success of an operation. The prepuce is used in hypospadias surgery and in tissue defects in reconstructive surgery. The objective of this study is to determine the efficacy of povidone-iodine and surgical soap in preputial skin preparation. Ninety-four healthy children were divided into three groups. After obtaining preputial skin swabs, an application of povidone-iodine 10% was made and skin swabs were obtained after two and five minutes in group 1. An additional application of povidone-iodine after two minutes was made in group 2 and swabs taken. Group 3 received a local scrub with surgical soap and an application of povidone-iodine. Results showed that, despite painting with povidone-iodine and/or local cleaning with surgical soap, it is not possible totally to eradicate the micro-organisms in the prepuce. Surgical soap decreases the colony count, which can lead to increased effectiveness of povidone-iodine after painting. We recommend preoperative local cleaning with surgical soap before surgical painting.

Candida colonisation within a silicone tissue expander

The fungal contamination of tissue expanders is rarely reported. There are, however, occasional reports of fungi in association with inflatable mammary implants. We describe the colonisation of a tissue expander with Candida albicans, resulting in the fluid becoming a turbid brown colour. The possible modes of inoculation and survival of the microorganism within the expander shell were investigated by means of biochemical and microbiological analyses of the fluid. The colonisation of silicone implants by opportunistic fungi is probably more common than has been reported, and precautions that can be taken to avoid this complication are emphasised.

Endocarditis caused by Stenotrophomonas maltophilia

Stenotrophomonas maltophilia is frequently isolated from hospital environments. In recent years, it has been reported that this bacterium is causing hospital infections at increasing rates and is gaining importance because of its multiple resistance. Although it has been related to several infections, endocarditis caused by S. maltophilia is rarely encountered. In this case study, endocarditis in a 40-y-old man with a history of aortic valve replacement is presented. Blood cultures revealed S. maltophilia to be the aetiological agent, which showed multiresistance to various antibiotics. Ticarcillin-clavulanate and trimethoprim-sulfamethoxazole were used in the treatment.