Pulmonary fibrosis as an outcome of COVID-19 pneumonia

In this study, we report three cases of persistent severe respiratory failure and radiological signs of diffuse pulmonary fibrosis in patients after COVID-19 related pneumonia. Chest CT criteria for a diagnosis of pulmonary fibrosis include the presence of traction bronchiectasis and parenchymal bands (linear opacities), as well as numerous small subpleural cystic air spaces (honeycombing). The study found that all cases of fibrosis were associated with such risk factors as male gender, old age, and multicomorbidity. Chest CT of one patient with acute respiratory distress syndrome showed radiographic characteristics of pulmonary fibrosis together with the presence of ground glass opacities (GGO) – the main CT feature of COVID-19 pneumonia. In two other patients, CT features of pulmonary fibrosis appeared in about 2 months after the hospital stay.Thus, pulmonary fibrosis is severe and rapidly progressive complication of COVID-19 pneumonia with a poor prognosis, especially in patients with multiple risk factors.

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Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case–control study

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01086-5 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Paraskevi Stylianou-Riga ◽

Theodora Boutsikou ◽

Panayiotis Kouis ◽

Paraskevi Kinni ◽

Marina Krokou ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Caesarean Section ◽

Distress Syndrome ◽

Elective Caesarean Section ◽

Case Control ◽

Male Gender ◽

Term Neonates ◽

Systemic Hypotension ◽

Neonatal Respiratory Distress

Abstract Background Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. Methods In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017–October 2018. Clinical data were obtained from patients’ files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. Results During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03–18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80–78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (β:0.75, 95% CI: − 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). Conclusions This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care.

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Treatment of patients with locally advanced Merkel cell carcinoma: A multicenter study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21566 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21566-e21566

Author(s):

Monika Dudzisz-Śledź ◽

Pawel Sobczuk ◽

Katarzyna Kozak ◽

Tomasz Switaj ◽

Hanna Kosela-Paterczyk ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Poor Prognosis ◽

Locally Advanced ◽

Male Gender ◽

Merkel Cell ◽

Nodal Involvement ◽

Free Survival ◽

Independent Risk Factors ◽

Clinical Metastases

e21566 Background: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high risk of recurrence and poor prognosis. The treatment of locally advanced disease includes surgery (SUR) and radiotherapy (RTH) to achieve high locoregional control rates. The sentinel lymph node biopsy (SLNB) is recommended procedure in cases without clinical nodal involvement. In selected cases, chemotherapy (CHT) may also be considered, but its role is not confirmed. This study aimed to analyze outcomes for locally advanced MCC pts treated in routine clinical practice. Methods: We conducted the retrospective analysis of data from 156 MCC pts treated with curative surgery in four oncological centers, diagnosed between 01/2010 and 12/2019, with data cut-off on 31/12/2020. The data collected included epidemiological and clinical information. Survival analyses were performed using the Kaplan-Meier method, log-rank test and multivariate Cox regression. Results: The median patient age at diagnosis was 72 years (30-94); 50.6% were male. The primary tumor (PT) locations were lower limbs (33.3%), upper limbs (30.1%), and head and neck (28.2%). MCC with no PT was diagnosed in 3.9%. In 62.0% the PT was located in the sun-exposed skin. The median tumor size was 25 mm (4-170). Lymph node (LN) involvement (clinical or positive SLNB or LND) at diagnosis was found in 26.9% (n = 42). The scar excision was done in 50.0% (positive in 16.6%), SLNB in 36.5% (positive in 10.5 %), 51.9% of pts received perioperative treatment, including RTH- 86.4%, CHT- 21%. The relapse rate was 38.3% (35.8% local-regional, 11.1% distant). With the median follow-up of 2.2-years, the median disease-free survival (DFS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were not reached. The 1-year DFS, LRFS and DMFS rates were 65%, 68%, and 90%. The negative independent risk factors for DFS were male gender (HR 1.42, 95%CI 1.06-3.01), metastases in LN at diagnosis (HR 5.41, 95%CI 2.39-12.26), no SLNB in pts with no clinical metastases in LN (HR 5.45, 95%CI 2.41-12.3), and no perioperative RTH (HR 2.19, 95%CI 1.29-3.76). The median overall survival (OS) was 6.9 years (95%CI 4.64-9.15). The negative independent risk factors for OS were male gender (HR 1.95, 95%CI 1.16-3.27), age above 70 (HR 2.0, 95%CI 1.15-3.48), metastases in LN at diagnosis (HR 3.15, 95%CI 1.49-6.68), and no SLNB in pts with no clinical metastases in LN (HR 2.30, 95%CI 1.10-4.82). PT location, UV-exposure, and perioperative CHT or RTH were not independent risk factors for OS. Conclusions: Our results confirm that the MCC treatment should be done in an experienced multidisciplinary team. Male gender, nodal involvement at diagnosis, and no SLNB in pts without clinical metastases in LN are associated with poor prognosis in DFS and OS. The perioperative RTH improves the treatment outcomes and reduces disease progression risk but does not impact OS. Perioperative CHT does not affect pts survival.

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Risk Factors and Clinical Profile of Respiratory Distress in Newborn: A Hospital Based Study in Bangladesh Army

Bangladesh Medical Journal ◽

10.3329/bmj.v48i3.51793 ◽

2021 ◽

Vol 48 (3) ◽

pp. 21-27

Author(s):

Biplob Kumar Raha ◽

Md Julfikkar Alam ◽

Md Abdul Quddus Bhuiyan

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Caesarean Delivery ◽

Distress Syndrome ◽

Perinatal Asphyxia ◽

Fetal Distress ◽

Male Gender ◽

Care Visit

Neonatal respiratory distress (NRD) is a main cause of neonatal morbidity and mortality in developing countries. Early detection of its risk factors and early treatment of its causes are major challenges. There are many causes of respiratory distress, among them, transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS) and perinatal asphyxia are commonest causes. Timely and appropriate therapy is essential to prevent ongoing injury and improve outcome. The aim of this study was to determine the risk factors and to identify the causes of respiratory distress in neonatal intensive care unit (NICU) in Combined Military hospital (CMH) Sylhet and to observe the hospital outcome of these babies. Descriptive type of cross- sectional study was conducted in CMH Sylhet over a period of one year from April 2018 to March 2019. During the study period a total of 287 live newborns were found and included as study subjects to observe for development of respiratory distress. The overall prevalence of respiratory distress was 19.2%. There was male predominance (63.6%) and more than two third (71.1%) were born by cesarean section. Prematurity (38.2%), low birth weight (52.7%), male gender (63.6%), APGAR at 1 min <7 (10.9%), caesarean delivery (76.4%), less antenatal care visit (52.7%), more than 4 pervaginal examinations 49.1%, acute fetal distress 43.6% and gestational diabetes mellitus 34.5% were the most common risk factors for development of NRD. The main causes were transient tachypnea of newborn 47.3%, respiratory distress syndrome 29.1% and perinatal asphyxia 10.9%. All babies required high flow oxygen initially, subsequently Bubble Continuous Positive Airway Pressure (CPAP) and mechanical ventilation was required in 14.5% and 1(1.8%) cases respectively. Mortality was 1.8% in neonates with respiratory distress syndrome with pneumothorax with septicaemia requiring mechanical ventilation. NRD is a frequent emergency and causes high morbidity and mortality. Risk factors like prematurity, low birth weight, male gender, APGAR at 1 min <7, caesarean delivery, less antenatal care visit, more than 4 pervaginal examinations, acute fetal distress and gestational diabetes mellitus were associated with respiratory distress in newborns. Majority of cases are due to TTN followed by respiratory distress syndrome and perinatal asphyxia. Mortality was in RDS mainly related to pneumothorax with septicaemia. Better obstetrical care and timely intervention may improve the outcome of newborn respiratory distress. Bangladesh Med J. 2019 Sep; 48 (3): 21-27

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Multiple risk factors for the gastric dilatation-volvulus syndrome in dogs: a practitioner/owner case-control study

Journal of the American Animal Hospital Association ◽

10.5326/15473317-33-3-197 ◽

1997 ◽

Vol 33 (3) ◽

pp. 197-204 ◽

Cited By ~ 53

Author(s):

LT Glickman ◽

NW Glickman ◽

DB Schellenberg ◽

K Simpson ◽

GC Lantz

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Case Control ◽

Male Gender ◽

Predisposing Factors ◽

Gastric Dilatation ◽

Multiple Risk Factors ◽

Dog Food ◽

Usual Diet ◽

Control Study

A study was conducted of 101 dogs (i.e., case dogs) that had acute episodes of gastric dilatation-volvulus (GDV) and 101 dogs (i.e., control dogs) with nonGDV-related problems. The control dogs were matched individually to case dogs by breed or size, and age. Predisposing factors that significantly (p less than 0.10) increased a dog's risk of GDV were male gender, being underweight, eating one meal daily, eating rapidly, and a fearful temperament. Predisposing factors that decreased the risk of GDV significantly were a "happy" temperament and inclusion of table foods in a usual diet consisting primarily of dry dog food. The only factor that appeared to precipitate an acute episode of GDV was stress.

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Follow-Up Study of the Chest CT Characteristics of COVID-19 Survivors Seven Months After Recovery

Frontiers in Medicine ◽

10.3389/fmed.2021.636298 ◽

2021 ◽

Vol 8 ◽

Author(s):

Mengqi Liu ◽

Fajin Lv ◽

Yang Huang ◽

Kaihu Xiao

Keyword(s):

Pulmonary Fibrosis ◽

Cardiopulmonary Exercise Testing ◽

Lactic Dehydrogenase ◽

Chest Ct ◽

Characteristic Analysis ◽

Quantitative Ct ◽

Ventilatory Equivalent ◽

Radiological Model ◽

Traction Bronchiectasis

Background: It has remained a concern whether any long-term pulmonary sequelae exist for COVID-19 survivors.Methods: Forty-one patients (22 men and 19 women, 50 ± 14 years) confirmed with COVID-19 performed follow-up chest CT and cardiopulmonary exercise testing at 7 months after discharge. Patients were divided into fibrosis group and non-fibrosis group according to the evidence of fibrosis on follow-up CT. The clinical data and the CT findings were recorded and analyzed.Results: The predominant CT patterns of abnormalities observed at 7 months after discharge were parenchymal band (41%), interlobular septal thickening (32%), and traction bronchiectasis (29%). Sixty-one percent of the patients achieved complete radiological resolution, and 29% of patients developed pulmonary fibrosis. Compared with the patients in the non-fibrosis group, the patients in the fibrosis group were older, with a longer hospital stay, a higher rate of steroid and mechanical ventilation therapy, lower levels of lymphocyte and T cell count, higher levels of D-dimer and lactic dehydrogenase, and higher quantitative CT parameters (opacity score, volume of opacity, and percentage of opacity) at discharge. Besides, oxygen consumption and metabolic equations were decreased and ventilatory equivalent for carbon dioxide was increased in patients in the fibrosis group. Logistic regression analyses revealed that age, steroid therapy, presence of traction bronchiectasis on chest CT at discharge, and opacity score at discharge, were independent risk factors for developing pulmonary fibrosis at 7 months after discharge. Receiver operating characteristic analysis revealed that the combined clinical-radiological model was better than the clinical-only model in the prediction of pulmonary fibrosis.Conclusions: The chest CT lesions could be absorbed without any sequelae for most patients with COVID-19, whereas older patients with severe conditions are more prone to develop fibrosis, which may further lead to cardiopulmonary insufficiency. The combined clinical-radiological model may predict the formation of pulmonary fibrosis early.

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Prognostic factors of chest CT findings for ICU admission and mortality in patients with COVID-19 pneumonia

10.1101/2020.10.30.20223024 ◽

2020 ◽

Author(s):

Mohammad Ali Kazemi ◽

Hossein Ghanaati ◽

Behnaz Moradi ◽

Mohammadreza Chavoshi ◽

Hassan Hashemi ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Poor Prognosis ◽

Underlying Disease ◽

Good Prognosis ◽

Chest Ct ◽

Icu Admission ◽

Ct Findings ◽

Pattern Distribution ◽

Ct Features

AbstractBackgroundStudies have shown that CT could be valuable for prognostic issues in COVID-19Objectiveto investigate the prognostic factors of early chest CT findings in COVID-19 patients.Materials and MethodsThis retrospective study included 91 patients (34 women, and 57 men) of RT-PCR positive COVID-19 from 3 hospitals in Iran between February 25, 2020, to march 15, 2020. Patients were divided into two groups as good prognosis, discharged from the hospital and alive without symptoms (48 patients), and poor prognosis, died or needed ICU care (43 patients). The first CT images of both groups that were obtained during the first 8 days of the disease presentation were evaluated considering the pattern, distribution, and underlying disease. The total CT-score was calculated for each patient. Univariate and multivariate analysis with IBM SPSS Statistics v.26 was used to find the prognostic factors.ResultsThere was a significant correlation between poor prognosis and older ages, dyspnea, presence of comorbidities, especially cardiovascular and pulmonary. Considering CT features, peripheral and diffuse distribution, anterior and paracardiac involvement, crazy paving pattern, and pleural effusion were correlated with poor prognosis. There was a correlation between total CT-score and prognosis and an 11.5 score was suggested as a cut-off with 67.4% sensitivity and 68.7% specificity in differentiation of poor prognosis patients (patients who needed ICU admission or died. Multivariate analysis revealed that a model consisting of age, male gender, underlying comorbidity, diffused lesions, total CT-score, and dyspnea would predict the prognosis better.ConclusionTotal chest CT-score and chest CT features can be used as prognostic factors in COVID-19 patients. A multidisciplinary approach would be more accurate in predicting the prognosis.

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Prognostic Factors of Initial Chest CT Findings for ICU Admission and Mortality in Patients with COVID-19 Pneumonia

Iranian Journal of Radiology ◽

10.5812/iranjradiol.106879 ◽

2020 ◽

Vol In Press (In Press) ◽

Author(s):

Mohammad Ali Kazemi ◽

Hossein Ghanaati ◽

Behnaz Moradi ◽

Mohammadreza Chavoshi ◽

Hassan Hashemi ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Poor Prognosis ◽

Underlying Disease ◽

Good Prognosis ◽

Chest Ct ◽

Icu Admission ◽

Ct Findings ◽

Pattern Distribution ◽

Ct Features

Background: Studies have shown that CT could be valuable for prognostic issues in COVID-19. Objectives: To investigate the prognostic factors of early chest CT findings in COVID-19 patients. Methods: This retrospective study included 91 patients (34 women, and 57 men) of real-time reverse transcription polymerase chain reaction (RT-PCR) positive COVID-19 from three hospitals in Iran between February 25, 2020, to March 15, 2020. Patients were divided into two groups as good prognosis, discharged from the hospital and alive without symptoms (48 patients), and poor prognosis, died or needed ICU care (43 patients). The first CT images of both groups that were obtained during the first 8 days of the disease presentation were evaluated considering the pattern, distribution, and underlying disease. The total CT-score was calculated for each patient. Univariate and multivariate analysis with IBM SPSS Statistics v.26 was used to find the prognostic factors. Results: There was a significant correlation between poor prognosis and older ages, dyspnea, presence of comorbidities, especially cardiovascular and comorbidities. Considering CT features, peripheral and diffuse distribution, anterior and paracardiac involvement, crazy paving pattern, and pleural effusion were correlated with poor prognosis. There was a correlation between total CT-score and prognosis and an 11.5 score was suggested as a cut-off with 67.4% sensitivity and 68.7% specificity in differentiation of poor prognosis patients (patients who needed ICU admission or died). Multivariate analysis revealed that a model consisting of age, male gender, underlying comorbidity, diffused lesions, total CT-score, and dyspnea would predict the prognosis better. Conclusions: Total chest CT-score and chest CT features can be used as prognostic factors in COVID-19 patients. A multidisciplinary approach would be more accurate in predicting the prognosis.

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Analysis of Initial Clinical and CT Features of COVID-19 Pneumonia in Different Clinical Types

10.21203/rs.3.rs-30395/v1 ◽

2020 ◽

Author(s):

Wei Li ◽

Wenjun Yu ◽

Jianwei Liao ◽

Lin Yao ◽

Yijie Fang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Chest Ct ◽

Lower Body ◽

Clinical Classification ◽

Clinical Factors ◽

Factors Associated ◽

Critical Patients ◽

Ct Features

Abstract Background Different clinical classifications of COVID-19 pneumonia patients have different clinical and CT features, which is very important for the treatment after admission. As the epidemic situation in China continues to improve, it is particularly important to re-clarify the correlation between them.Methods 97 confirmed patients with COVID-19 pneumonia were enrolled from January 17, 2019 to February 21, 2020, including 75 mild/ordinary cases and 22 severe/critical cases. The clinical data and initial chest CT images of the patients were reviewed and compared. The risk factors associated with disease severity were analyzed.Results Compared with the mild/ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, first CT positive, CT always negative and fever. Mild/ordinary patients had lower body temperature than mild/ordinary patients. The incidences of large/multiple GGO in severe/critical patients were significantly higher than those of the mild/ordinary patients, furthermore, severe/critical patients showed higher incidences of 4-5 lobe infections than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P < 0.001). The clinical factors of age, sex, comorbidities, hypertension, diabetes mellitus, heart disease, pharyngeal discomfort, abdominal pain/diarrhea, temperature and CT score were risk factors for severe/critical COVID-19 pneumonia.Conclusion The initial clinical and CT characteristics have certain significance for the clinical classification of COVID-19 respiratory infection. Especially in terms of CT score, it can predict the trend of clinical classification of patients to a certain extent.

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