scholarly journals Correlation of Computerized Tomography (CT) Severity Score for COVID-19 pneumonia with Clinical Outcomes

2021 ◽  
Author(s):  
Kiran Hilal ◽  
Jehanzeb Shahid ◽  
Abdullah Ameen ◽  
Russell Martins ◽  
Avinash Nankani ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Severity Score ◽  
Kappa Statistic ◽  
Observer Agreement ◽  
University Hospital ◽  
P Value ◽  
Observer Reliability ◽  
Severity Scores ◽  
Chi Squared ◽  
Chest Examination

ABSTRACTIntroductionVarious CT severity scores have already been described in literature since the start of this pandemic. One pertinent issue with all of the previously described severity scores is their relative challenging calculation and variance in inter-observer agreement. The severity score proposed in our study is relatively simpler, easier to calculate and apart from a trained radiologist, can easily be calculated even by physicians with good inter-observer agreement. Therefore, a rapid CT severity score calculation can give a clue to physician about possible clinical outcome without being dependent on radiologist who may not be readily available especially in third world countries.ObjectiveThe objective of this study is to develop a simple CT severity score (CT-SS) with good inter-observer agreement and access its correlation with clinical outcome.MethodsThis retrospective study was conducted by the Department of Radiology and Internal Medicine, at the Aga Khan University Hospital Karachi, from April 2020 to August 2020. Non-probability consecutive sampling was used to include all patients who were positive for COVID-19 on PCR, and underwent CT chest examination at AKUH. Severity of disease was calculated in each lobe on the basis of following proposed CT severity scoring system (CT-SS). For each lobe the percentage of involvement by disease was scored – 0% involvement was scored 0, <50% involvement was scored 1 and >50% involvement was scored 2. Maximum score for one lobe was 2 and hence total maximum overall score for all lobes was 10. Continuous data was represented using mean and standard deviation, and compared using independent sample t-tests. Categorical data was represented using frequencies and percentages, and compared using Chi-squared tests. Inter-observer reliability between radiologist and COVID intensivist for the 10 point CT-SS rated on 0-10 was assessed using the Kappa statistic. A p-value < 0.05 was considered significant for all analyses.ResultsA total of 73 patients were included, the majority male (58.9%) with mean age 55.8 ± 13.93 years. The CT-SS rated on 0-10 showed substantial inter-observer reliability between radiologist and intensivist with a Kappa statistic of 0.78. Patients with CT-SS 8-10 had a significantly higher ICU admission & intubation rate (53.8% vs. 23.5%) and mortality rate (35.9% vs. 11.8%; p = 0.017), as compared to those with CT-SS 0-7.ConclusionWe conclude that the described CT severity score (CT-SS) is a quick, effective and easily reproducible tool for prediction of adverse clinical outcome in patients with COVID 19 pneumonia. The tool shows good inter-observer agreement when calculated by radiologist and physician independently.

scholarly journals Recurrent Miscarriage and Consanguinity among Omani Women– A Cross Sectional Study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Fatma Al Hoqani ◽  
Wadha Al Ghafri ◽  
Saneya El tayeb ◽  
Yahya Al Farsi ◽  
Vaidyanathan Gowri
Keyword(s):  
Recurrent Miscarriage ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Control Group ◽  
P Value ◽  
Cross Sectional ◽  
Recurrent Miscarriages ◽  
Sultan Qaboos University ◽  
Chi Squared ◽  
History Of

Objective: to determine the prevalence of explained and unexplained recurrent miscarriages (RM) and to find out if there is a significant relationship between recurrent miscarriages and consanguinity. Methods: A cross sectional in which the cases group included all women with RM attending the outpatient clinic at Sultan Qaboos University Hospital from July 2006 to April 2012 and the controls group included women with no history of RM after matching them with cases for age (case to control ratio was 1:1). The main outcome measures were the prevalence of consanguinity in women with or without recurrent miscarriages. Results: During study period a total of 290 women with RM were seen. Of which, 150 (51.7%) women had unexplained RM. Control group with no history of RM were 300 women. Consanguinity rate among cases (49.5%) %) was less than the controls (52.7 %%). Both first cousin and second cousin marriages were more common in the controls than the cases and it was not statistically significant (p value 0.476, chi squared test). Conclusion: In this study we found that more than half of RM cases were unexplained and there was no significant association between RM and consanguinity.

Intra- and Inter-observer Reliability of the Distal Metatarsal Articular Angle in Adult Hallux Valgus

2002 ◽  
Vol 23 (8) ◽  
pp. 722-726 ◽  
Author(s):  
Thomas D. Chi ◽  
James Davitt ◽  
Alastair Younger ◽  
Sarah Holt ◽  
Bruce J. Sangeorzan
Keyword(s):  
Hallux Valgus ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
P Value ◽  
Hallux Valgus Angle ◽  
Joint Congruency ◽  
Observer Reliability ◽  
Valgus Angle ◽  
First Ray ◽  
Angular Measurements

There is some uncertainty as to whether the distal metatarsal articular angle (DMAA) is a real entity or just radiographic artifact and whether it can be reliably measured. If it is intrinsic to the bone, it should not change with bone position. If it is clinically useful, it should be reproducible. Pre-operative and post-operative radiographs of 32 patients undergoing a proximal bony procedure of the first ray were evaluated independently by three foot and ankle specialists in order to determine the intra and inter-observer reliability of the distal metatarsal articular angle (DMAA). In addition, the hallux valgus angle (HVA), intermetatarsal angle (IMA) and joint congruency/subluxation were determined. We used ANOVA (Scheffe's F-test) to determine reliability of the angular measurements; a p value of less than 0.05 indicates poor reliability and a p value of greater than 0.05 indicates reliability. Intra-observer reliability was good for all angular measurements (HVA, IMA, DMAA pre-op, and DMAA postop) with p values ranging from 0.33 to 0.95. Inter-observer reliability of the HVA and IMA was good (p = 0.63 and p = 0.32). Inter-observer reliability of the pre-op DMAA approached statistically poor reliability (p = 0.09) and the post-op DMAA reliability was poor (p = 0.002). The DMAA reduced after the proximal procedure as measured by all observers, and averaged a reduction of 3.9°. Weighted kappa analysis also revealed that there was poor agreement in the determination of congruency and subluxation (Kappa statistic ranged from 0.07 to 0.19). This study suggests that there may be limited value in the DMAA as a clinical measure as it varies with examiner and with the hallux valgus angle.

scholarly journals RADIOLOGICAL EVALUATION AND CORRELATION OF CT SEVERITY SCORING WITH THE CLINICAL OUTCOME IN RT-PCR CONFIRMED COVID-19 INFECTED PATIENTS

2021 ◽  
pp. 1-3
Author(s):  
Prem Anand E S ◽  
Ealai Athmarao Parthasarathy ◽  
Rajamani Anand
Keyword(s):  
Clinical Outcome ◽  
Severity Score ◽  
Laboratory Data ◽  
Chest Ct ◽  
Treatment Modalities ◽  
P Value ◽  
Radiological Evaluation ◽  
Rt Pcr ◽  
Positive Real ◽  
Severity Scoring

Background Radiological evaluation of the severity of lung inflammation in Covid-19 patients could provide an objective approach to rapidly identify the treatment modalities and to calculate the duration of hospitalization, need for intubation and ICU stay thereby analyzing and managing the clinical outcome of the patient. Purpose To identify the significant relationship between CT severity score and clinical outcome among RT-PCR confirmed Covid-19 infected patients Materials and Methods Inclusion of 40 patients with COVID-19 confirmed by positive real-time reverse transcriptase polymerase chain reaction on throat swabs underwent High resolution chest CT (7 men and 33 women).The CT-SS was defined by summing up individual scores from 20 lung regions; scores of 0, 1, and 2 were respectively assigned for each region if parenchymal opacification involved 0%, less than 50%, or equal or more than 50% of each region (theoretical range of CT-SS from 0 to 40). The clinical and laboratory data were collected and analyzed. Results All patients (n=16) who underwent intubation died invariably. The lung findings in all patients who died consist of co-existence of Consolidation and ground glass opacities in periphery and central region of lungs. Age is a predominant determinant factor for the course and outcome of disease as 17 patients with a mean age of 62 died when compared to 23 patients alive with a mean age of 47. This implies that mortality has a direct relationship with age. Out of 19 patients who had a CT –Severity score of >19 (Severe), 17 were shifted to ICU and 15 patients died. Only 4 patients recovered. Out of 5 patients whose CT-SS score were < 19, 5 patients were shifted to ICU and 2 cases died. 95 % of Covid-19 positive patients had Fever as their predominant complaint. The results are statistically significant with a p value of <0.01 and specificity of 82.6% and sensitivity of 88.2% Conclusion Along with RT-PCR, CT severity scoring is invariably a valuable modality for the management and planning of treatment for the patients by predicting the prognosis. Summary The chest CT severity score could be used to rapidly identify patients with severe forms of COVID-19 and clearly impacts the outcome of the patients.

scholarly journals To study heterogeneity in SARS-CoV-2 IgG response titre in patients recovered from COVID-19

2021 ◽  
Author(s):  
Avneet Garg ◽  
Rakendra Singh ◽  
Hariharan Iyer ◽  
Mansimranjit Kaur ◽  
Surbhi Surbhi ◽  
...  
Keyword(s):  
Antibody Response ◽  
Antibody Titre ◽  
Severity Score ◽  
Clinical Characteristics ◽  
Ventilatory Support ◽  
P Value ◽  
Age Group ◽  
Spearman Correlation ◽  
Severity Scores ◽  
Antibody Titres

The COVID-19 pandemic caused a serious health challenge to the entire mankind. The association between clinical characteristics of disease and formation of neutralizing antibodies have not well studied. A prospective study was conducted for patients recovered from confirmed SARS-CoV-2 infections from 1st August 2020 to 28th February 2021, to study the association between SARS-CoV-2 IgG antibody response titres and clinical characteristics of the disease. A total 92 patients were included in the study. Median age was 52 years; majority were male and middle or old aged.  About 48% patients required hospitalization and 38.3% had moderate CT severity score. Positive SARS-CoV-2-IgG was detected in all patients except one. On comparing the antibody titres among various sub-groups of COVID-19 recovered patients, old age was the only factor associated with statistically significant higher antibody response (28 AU/ml for age<35 years, 53 AU/ml for age group 35-60, and 71 AU/ml for age group >60 years, p value=0.01). Severity of infection, worse CT severity scores, need of hospitalization, oxygen or ventilatory support were associated with higher antibody titres but were not statistically significant. There was a strong correlation of antibody titres when analysed for age of study population (Spearman correlation=0.39, p value <0.001); whereas a weak correlation (Spearman correlation=0.03, p value 0.753) was seen when analysed for CT severity score. Elderly patients had higher antibody titre after recovery from Covid-19 infection. Severity of disease, need of hospitalisation or oxygen/mechanical ventilation did not influence the antibody titre.

scholarly journals A PROSPECTIVE STUDY ON THE INCIDENCE, MECHANISMS AND RISK FACTORS FOR SPORT RELATED CONCUSSIONS IN HIGH SCHOOL SOCCER PLAYERS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0018
Author(s):  
Timothy McGuine ◽  
Scott Hetzel ◽  
Alison Schwarz ◽  
Traci Snedden
Keyword(s):  
Risk Factors ◽  
High School ◽  
Symptom Score ◽  
Severity Score ◽  
Previous History ◽  
Cox Proportional Hazards ◽  
Soccer Players ◽  
P Value ◽  
Severity Scores ◽  
History Of

Background: There is a growing concern regarding the incidence of Sport Related Concussion (SRC) in high school soccer players. However, there is limited prospective data regarding the incidence, mechanism and risk factors for SRCs for this population. Hypothesis / Purpose: To prospectively document the incidence, mechanisms and risk factors for SRCs sustained by high school soccer players. Methods: High school soccer players from 32 high schools were invited to participate during academic years 2015/16 and 2016/17. Subjects completed a demographic form including their history of previous SRC and preseason PCSS symptom and severity scores from the SCAT3. Licensed Athletic trainers (ATs) and coaches recorded all (practice or competition) soccer exposures (SE). ATs reported the onset, mechanism, symptom resolution and days lost for each SRC sustained during the study. Descriptive statistics were calculated to describe the study population while Cox Proportional Hazards Ratios (HR: [95%], p-value) were used to compare the incidence of SRC among the baseline characteristics. Results: thousand eight hundred eighty-one subjects (Female = 62.8%, Age = 15.7+1.2 yrs.) participated in 96,947 SE (34.3% competition) during the study duration. Two hundred seventy subjects (14.4%) reported one, while 60 (3.2%) reported two previous SRCs. The median (IQR) preseason PCSS symptom score was 0.0 [0,3] while the severity score was 0.0 [0,4]. Eighty (4.3%) subjects sustained a SRC (0.825/1000 SE) during the study time period and reported a median PCSS symptom score of 10.0 [5.0,15.0] and PCSS severity score of 21.0 [14.0,41.0]. Concussion-related symptoms were reported for 6.0 [4.0,10.0] days and 13.0 [9.3, 20.0] soccer days were missed. SRCs occurred most often during competition (78.8%) and as the result of contact with another player (41.3%), the ball (35.0%) or playing surface (20.0%). Females were more likely to sustain a SRC than males (HR: 3.78 [2.00-7.14], p<0.001). Compared to subjects without a previous SRC, the rate was higher for subjects with one (HR: 2.70 (1.65-4.42), p<0.001) and two (HR: 3.71 (1.68-8.19), p=0.001) previous SRCs. Subjects with a preseason PCSS symptom and PCSS severity score > 0 had a higher rate of SRC (HR: 1.71 [1.10-2.65], p=0.017) than players who did not. Conclusions: This study provides details regarding the incidence, mechanisms and risk factors for SRCs in high school soccer players. Females, players with a previous history of SRC or those reporting a preseason PCSS symptom and severity score >0 were more likely to sustain a SRC playing soccer.

scholarly journals Loss of Consciousness in Injuries of the Extremities is an Alert to a Higher Probability of Death

2012 ◽  
Vol 6 (1) ◽  
pp. 590-592 ◽  
Author(s):  
José Eduardo Arantes Sanches ◽  
José Maria Pereira de Godoy ◽  
André Luciano Baitello ◽  
Alceu Gomes Chueire
Keyword(s):  
Relative Risk ◽  
Death Rate ◽  
University Hospital ◽  
P Value ◽  
Fisher Exact Test ◽  
Loss Of Consciousness ◽  
Exact Test ◽  
Chi Squared ◽  
Orthopedic Injuries ◽  
Minor Injuries

Background: There are many published studies about loss of consciousness related to general trauma however works on loss of consciousness in respect to orthopedic injuries are scarce. Aim: The aim of this study was to investigate whether loss of consciousness worsens the prognosis of patients with orthopedic injuries. Method: A retrospective cohort study of orthopedic traumas was performed in the university Hospital of Base in São José do Rio Preto. All accident victims with injuries of the extremities classified as Score 3 or 4 by the Abbreviated Injury Scale (AIS) were included in this observational quantitative study. Patients with minor injuries and injuries that did not involve the extremities were not included. The association of loss of consciousness at the scene of the accident with evolution to death was investigated. The t-test, chi-squared and Fisher exact tests, and relative risk were used for statistical analysis. An alpha error of 5% (p-value ≤ 0.05) was considered statistically significant. Results: A total of 245 patients with ages between 13 and 98 years old and a mean of 45.4 years had extremity AIS scores of 3 or 4. Of these, significantly more men (170 - p< 0.001) suffered this type of injury than women (71). Thirty-six (14.94%) of these patients lost consciousness compared to 205 (85.06%) who did not lose consciousness. The total death rate in this group of patients was 5.39%; 9 (25%) of the 36 patients who lost consciousness and 4 (1.95%) of the 205 who did not lose consciousness died (Fisher exact test: p-value = 0.0001 and relative risk = 12,813 – 95% confidence index: 4,166 to 39,408). Conclusion: Loss of consciousness in patients with orthopedic injuries of the extremities is associated to a higher death rate.

The Reliability of Ultrasound in the Assessment of Hyaline Cartilage in Rheumatoid Arthritis and Healthy Metacarpal Heads

2020 ◽  
Author(s):  
Edoardo Cipolletta ◽  
Emilio Filippucci ◽  
Andrea Di Matteo ◽  
Giulia Tesei ◽  
Micaela Ana Cosatti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Scoring System ◽  
Quantitative Assessment ◽  
Hyaline Cartilage ◽  
Scoring Systems ◽  
Thickness Measurement ◽  
Cartilage Thickness ◽  
Observer Agreement ◽  
Very High Frequency ◽  
Observer Reliability

Abstract Purpose i) To assess the inter- and intra-observer reliability of ultrasound (US) in the evaluation of the hyaline cartilage (HC) of the metacarpal head (MH) in patients with rheumatoid arthritis (RA) and in healthy subjects (HS) both qualitatively and quantitatively. ii) To calculate the smallest detectable difference (SDD) of the MH cartilage thickness measurement. iii) To correlate the qualitative scoring system and the quantitative assessment. Materials and Methods US examination was performed on 280 MHs of 20 patients with RA and 15 HS using a very high frequency probe (up to 22 MHz). HC status was evaluated both qualitatively (using a five-grade scoring system) and quantitatively (using the average value of the longitudinal and transverse measures). The HC of MHs from II to V metacarpophalangeal joint of both hands were scanned independently on the same day by two rheumatologists to assess inter-observer reliability. All subjects were re-examined using the same scanning protocol and the same US setting by one sonographer after a week to assess intra-observer reliability. Results The inter-observer agreement and intra-observer agreement were moderate to substantial (k = 0.66 and k = 0.73) for the qualitative scoring system and high (ICC = 0.93 and ICC = 0.94) for the quantitative assessment. The SDD of the MH cartilage thickness measurement was 0.09 mm. A significant correlation between the two scoring systems was found (r = –0.35; p < 0.001). Conclusion The present study describes the main methodological issues of HC assessment. Using a standardized protocol, both the qualitative and the quantitative scoring systems can be reliable.

scholarly journals Smart Health System to Detect Dementia Disorders Using Virtual Reality

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 810
Author(s):  
Areej Y. Bayahya ◽  
Wadee Alhalabi ◽  
Sultan H. AlAmri
Keyword(s):  
Virtual Reality ◽  
Clinical Diagnosis ◽  
Kappa Statistic ◽  
Weighted Kappa ◽  
Health Technology ◽  
P Value ◽  
Functional Evaluation ◽  
Medical Specialties ◽  
Weighted Kappa Statistic ◽  
Smart Health

Smart health technology includes physical sensors, intelligent sensors, and output advice to help monitor patients’ health and adjust their behavior. Virtual reality (VR) plays an increasingly larger role to improve health outcomes, being used in a variety of medical specialties including robotic surgery, diagnosis of some difficult diseases, and virtual reality pain distraction for severe burn patients. Smart VR health technology acts as a decision support system in the diseases diagnostic test of patients as they perform real world tasks in virtual reality (e.g., navigation). In this study, a non-invasive, cognitive computerized test based on 3D virtual environments for detecting the main symptoms of dementia (memory loss, visuospatial defects, and spatial navigation) is proposed. In a recent study, the system was tested on 115 real patients of which thirty had a dementia, sixty-five were cognitively healthy, and twenty had a mild cognitive impairment (MCI). The performance of the VR system was compared with Mini-Cog test, where the latter is used to measure cognitive impaired patients in the traditional diagnosis system at the clinic. It was observed that visuospatial and memory recall scores in both clinical diagnosis and VR system of dementia patients were less than those of MCI patients, and the scores of MCI patients were less than those of the control group. Furthermore, there is a perfect agreement between the standard methods in functional evaluation and navigational ability in our system where P-value in weighted Kappa statistic= 100% and between Mini-Cog-clinical diagnosis vs. VR scores where P-value in weighted Kappa statistic= 93%.

scholarly journals Short-Course Versus Long-Course Colistin for Treatment of Carbapenem-Resistant A.baumannii in Cancer Patient

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 484
Author(s):  
Wasan Katip ◽  
Suriyon Uitrakul ◽  
Peninnah Oberdorfer
Keyword(s):  
Clinical Response ◽  
Cancer Patients ◽  
Therapy Group ◽  
University Hospital ◽  
P Value ◽  
Chiang Mai ◽  
Carbapenem Resistant ◽  
Short Course ◽  
Significant Difference ◽  
Long Course

Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly reported nosocomial infections in cancer patients and could be fatal because of suboptimal immune defenses in these patients. We aimed to compare clinical response, microbiological response, nephrotoxicity, and 30-day mortality between cancer patients who received short (<14 days) and long (≥14 days) courses of colistin for treatment of CRAB infection. A retrospective cohort study was conducted in cancer patients with CRAB infection who received short or long courses of colistin between 2015 to 2017 at Chiang Mai University Hospital (CMUH). A total of 128 patients met the inclusion criteria. The results of this study show that patients who received long course of colistin therapy had a higher rate of clinical response; adjusted odds ratio (OR) was 3.16 times in patients receiving long-course colistin therapy (95%CI, 1.37–7.28; p value = 0.007). Microbiological response in patients with long course was 4.65 times (adjusted OR) higher than short course therapy (95%CI, 1.72–12.54; p value = 0.002). Moreover, there was no significant difference in nephrotoxicity (adjusted OR, 0.91, 95%CI, 0.39–2.11; p value = 0.826) between the two durations of therapy. Thirty-day mortality in the long-course therapy group was 0.11 times (adjusted OR) compared to the short-course therapy group (95%CI, 0.03–0.38; p value = 0.001). Propensity score analyses also demonstrated similar results. In conclusion, cancer patients who received a long course of colistin therapy presented greater clinical and microbiological responses and lower 30-day mortality but similar nephrotoxicity as compared with those who a received short course. Therefore, a long course of colistin therapy should be considered for management of CRAB infection in cancer patients.

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