Lung Ultrasound Examination in Patients with SARS-CoV-2 Infection: Multicenter Study

Background: The COVID-19 pandemic has, by necessity, contributed to rapid advancements in medicine. Owing to the necessity of following strict anti-epidemic sanitary measures when taking care of infected patients, the accessibility of standard diagnostic methods may be limited. Consequently, the significance and potential of bedside diagnostic modalities increase, including lung ultrasound (LUS). Method: Multicenter registry study involving adult patients with confirmed COVID-19, for whom LUS was performed. Results: A total of 228 patients (61% males) qualified for the study. The average age was 60 years (±14), 40% were older than 65 years of age. In 130 from 173 hospitalized patients, HRCT (high-resolution computed tomography) was performed. In 80% of patients, LUS findings indicated interstitial pneumonia. In hospitalized patients multifocally located single B-lines, symmetrical B-lines, and areas of white lung were significantly more frequent as compared to ambulatory patients. LUS findings, both those indicating interstitial syndrome and consolidations, were positively correlated with HRCT images. As compared to HRCT, the sensitivity and specificity of LUS in detecting interstitial pneumonia were 97% and 100%, respectively. Conclusions: As compared to HRCT, LUS is characterized by a very high sensitivity and specificity in detecting interstitial pneumonia in COVID-19 patients. Potentially, LUS can be a particularly useful diagnostic modality for COVID-19 patients pneumonia.

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Trends in Diagnosis for Active Tuberculosis Using Nanomaterials

Current Medicinal Chemistry ◽

10.2174/0929867325666180912105617 ◽

2019 ◽

Vol 26 (11) ◽

pp. 1946-1959 ◽

Cited By ~ 3

Author(s):

Le Minh Tu Phan ◽

Lemma Teshome Tufa ◽

Hwa-Jung Kim ◽

Jaebeom Lee ◽

Tae Jung Park

Keyword(s):

Sensitivity And Specificity ◽

High Efficiency ◽

Point Of Care ◽

High Sensitivity ◽

Signs And Symptoms ◽

Diagnostic Methods ◽

Advantages And Disadvantages ◽

Treatment And Prevention ◽

Clinical Tools ◽

Diagnostic Applications

Background:Tuberculosis (TB), one of the leading causes of death worldwide, is difficult to diagnose based only on signs and symptoms. Methods for TB detection are continuously being researched to design novel effective clinical tools for the diagnosis of TB.Objective:This article reviews the methods to diagnose TB at the latent and active stages and to recognize prospective TB diagnostic methods based on nanomaterials.Methods:The current methods for TB diagnosis were reviewed by evaluating their advantages and disadvantages. Furthermore, the trends in TB detection using nanomaterials were discussed regarding their performance capacity for clinical diagnostic applications.Results:Current methods such as microscopy, culture, and tuberculin skin test are still being employed to diagnose TB, however, a highly sensitive point of care tool without false results is still needed. The utilization of nanomaterials to detect the specific TB biomarkers with high sensitivity and specificity can provide a possible strategy to rapidly diagnose TB. Although it is challenging for nanodiagnostic platforms to be assessed in clinical trials, active TB diagnosis using nanomaterials is highly expected to achieve clinical significance for regular application. In addition, aspects and future directions in developing the high-efficiency tools to diagnose active TB using advanced nanomaterials are expounded.Conclusion:This review suggests that nanomaterials have high potential as rapid, costeffective tools to enhance the diagnostic sensitivity and specificity for the accurate diagnosis, treatment, and prevention of TB. Hence, portable nanobiosensors can be alternative effective tests to be exploited globally after clinical trial execution.

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POS0842 LUNG ULTRASOUND TO ASSESS THE SEVERITY OF INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1350 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 675.1-675

Author(s):

C. Bruni ◽

L. Mattolini ◽

L. Tofani ◽

L. Gargani ◽

N. Landini ◽

...

Keyword(s):

Systemic Sclerosis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Quantitative Methods ◽

Lung Ultrasound ◽

Significant Negative Correlation ◽

High Resolution Computed Tomography ◽

Quantitative Score ◽

Quantitative Scoring ◽

B Lines

Background:Interstitial lung disease (ILD) is one of the most common complications and one of the main causes of morbidity and mortality in Systemic Sclerosis (SSc). High-resolution computed tomography (HRCT) is the gold standard for the diagnosis of ILD and it allows its quantification. Among semi-quantitative methods, Goh et al proposed a semi-quantitative scoring system to visually quantify ILD extent, with categorical cut-off of 20% to distinguish limited and extensive parenchymal involvement with prognostic implications. More recently, the use of radiomics has allowed the objective quantification of ILD through the use of dedicated software, which calculate different parameters of lung density.Given the exposure to ionizing radiation that the procedure entails, other methods of ILD evaluation are being studied, among which lung ultrasound (LUS) identifies the B-lines as a main feature of ILD. So far, different evidences have proposed the use of LUS for the screening of ILD, even in the early phases of the disease and in subclinical lung involvement.Objectives:the aim of this study is to test the role of LUS in quantifying the severity of SSc-ILD, evaluated with both semi-quantitative visual radiological and quantitative radiomic scores.Methods:Adult SSc patients classified according to the ACR/EULAR 2013 criteria patients were assessed with pulmonary function test (PFTs), lung ultrasound and HRCT over 60 days. CT images were analysed qualitatively (by presence/absence of ILD), semi-quantitatively (categorical Goh score <20% vs> 20% of extent and the continuous extent Goh score made from 5 levels’ assessment– 0 to 100%) and quantitatively [with the densitometric radiomic data obtained through the Horos software - Mean lung attenuation (MLA), Standard Deviation (SD), Kurtosis, Skewness and Lung volume (LV)]. LUS was used to quantify the B-lines detected in each patient by scanning a total of 13 intercostal spaces, on both anterior and posterior chest wall.Results:Among 59 SSc patients (81% women, mean age 48±14 years, 45% anti-Scl70 positive), 23 (39%) presented ILD on HRCT, of which 14 limited and 9 extensive. The mean visual semi-quantitative score was 6%, ranging from 0 to 66%. Our data showed a significantly different number of B-Lines in ILD vs non-ILD patients (median 38 vs 9, p <.005), a result which was further confirmed among non-ILD vs ILD> 20% (median 47 vs 9, p=.001) and ILD <20% (median 36 vs 9, p=.001) patients. Conversely, the number of B-lines was not statistically different between patients with ILD <20% and >20% (median 47 vs 36, p=.78). We observed a significant negative correlation between the number of B-lines and FVC (r=-.472, p<.05) TLC (r=-.436, p=.003), DLco (r=-.515, p<.001), DLCO/VA (r=.-306, p=.03). Finally, the number of B-lines showed a statistically significant correlation with the Goh score on 5 levels (r=.437, p=.001), MLA (r=.571, p<.001), kurtosis (r=-.285, p=.028), skewness (r=-.370, p = .004) and LV (r=-.277, p=.033). All data were confirmed analysing anterior and posterior B-Lines separately.Conclusion:Our study confirms that LUS represents a useful tool for the identification of SSc-ILD. In addition, we showed that LUS may be useful also for the quantification of the severity of SSc-ILD, by correlating with PFT parameters, radiomics parameters and visual radiological evaluation. Together with the PFTs, LUS could be used to increase the accuracy of the screening and, potentially, of the follow-up of SSc-ILD patients.Disclosure of Interests:Cosimo Bruni: None declared, Lavinia Mattolini: None declared, Lorenzo Tofani: None declared, Luna Gargani Consultant of: GE Healthcare, Philips Healthcare and Caption Health, Nicholas Landini: None declared, Gemma Lepri: None declared, Martina Orlandi: None declared, Serena Guiducci: None declared, Silvia Bellando Randone: None declared, Marco Matucci-Cerinic: None declared

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Algorithm of Screening and Monitoring of Hypertension in Rural Outpatient Clinics: the Realities of Practice Through the Prism of the Recommendations

Family Medicine ◽

10.30841/2307-5112.6.2016.249515 ◽

2016 ◽

pp. 88-93

Author(s):

Khrystyna Symchych ◽

Liubomyr Glushko ◽

Serhii Fedorov ◽

Irena Kozlova ◽

Viktoriia Rudnyk ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Outpatient Clinic ◽

Clinical Laboratory ◽

Blood Pressure Measurement ◽

Ankle Brachial Index ◽

High Sensitivity ◽

Home Blood Pressure ◽

Diagnostic Methods ◽

Vascular Pathology ◽

Continuous Control

The objective: of the study was a comparative analysis and identify the informativeness of diagnostic methods available in conditions of rural outpatient clinic and formulate the algorithm of screening and monitoring of hypertension in the practice of family doctors. Patients and methods: The study involved 62 patients with hypertension of the second-degree severity. In the first group diagnosis of AH was performed by the methods available in conditions of rural outpatient clinic, in the second group the reference methods were used. The clinical laboratory tests and instrumental examination were made. Informativeness of the methods available in conditions of rural outpatient clinic was defined on base of data of sensitivity, specificity and positive predictive value. Results. Home blood pressure measurement in terms of rural family medicine is the most justified because of the low cost of the survey, the possibility of continuous control of hypertension, the relative autonomy of the patient and results with data DMAT is approximate, high rates of sensitivity and specificity. Use ECG criteria for their relatively high sensitivity and specificity of the method proves informative and justifies its use in the village for early diagnosis of heart damage in patients with hypertension. Definition of ankle brachial index is informative, non-invasive, affordable method to detect the presence of vascular pathology, to evaluate dynamics during treatment. Determination of MAU is an affordable quality marker of kidney damage in hypertension, with high sensitivity and specificity. For a more accurate diagnosis be to calculate glomerular filtration rate. Lipid metabolism at clinic should be determined by the level of total cholesterol. Carbohydrate metabolism enough to carry on fasting glucose and glucose1tolerant test. Conclusion. It is proved the simple in performance, the cheap and routine methods that are used widely can to inform about cardiovascular risk and to determine the prognosis of illness in patients with hypertension.

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B‐lines by lung ultrasound predict heart failure in hospitalized patients with acute anterior wall STEMI

Echocardiography ◽

10.1111/echo.14420 ◽

2019 ◽

Author(s):

Xiao‐Jun Ye ◽

Nan Li ◽

Jia‐Hui Li ◽

Wen‐Jing Wu ◽

Ai‐Li Li ◽

...

Keyword(s):

Heart Failure ◽

Lung Ultrasound ◽

Anterior Wall ◽

Hospitalized Patients ◽

B Lines

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Emergency department ultrasound for the detection of B-lines in the early diagnosis of acute decompensated heart failure: a systematic review and meta-analysis

CJEM ◽

10.1017/cem.2018.27 ◽

2018 ◽

Vol 20 (3) ◽

pp. 343-352 ◽

Cited By ~ 11

Author(s):

Kyle McGivery ◽

Paul Atkinson ◽

David Lewis ◽

Luke Taylor ◽

Tim Harris ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Emergency Department ◽

Lung Ultrasound ◽

Acute Decompensated Heart Failure ◽

Meta Analysis ◽

Decompensated Heart Failure ◽

Diagnostic Methods ◽

Cochrane Library ◽

B Lines

AbstractObjectivesDyspnea is a common presenting problem that creates a diagnostic challenge for physicians in the emergency department (ED). While the differential diagnosis is broad, acute decompensated heart failure (ADHF) is a frequent cause that can be challenging to differentiate from other etiologies. Recent studies have suggested a potential diagnostic role for emergency lung ultrasound (US). The objective of this systematic review was to assess the accuracy of early bedside lung US in patients presenting to the ED with dyspnea.MethodsA systematic search of EMBASE, PubMed, and the Cochrane Library was performed in addition to a grey literature search. We selected prospective studies that reported on the sensitivity and specificity of B-lines from early lung ultrasound in dyspneic patients presenting to the ED. Selected studies underwent quality assessment using the Critical Appraisal and Skills Program (CASP) questionnaire.Data Extraction and SynthesisThe search yielded 3674 articles; seven studies met inclusion criteria and fulfilled CASP requirements for a total of 1861 patients. Summary statistics from the meta-analysis showed that as a diagnostic test for ADHF, bedside lung US had a pooled sensitivity of 82.5% (95% confidence interval [CI]=66.4% to 91.8%) and a pooled specificity of 83.6% (95% CI=72.4% to 90.8%).ConclusionsOur results suggest that in patients presenting to the ED with undifferentiated dyspnea, B-lines from early bedside lung US may be reliably used as an adjunct to current diagnostic methods. The incorporation of lung US may lead to more appropriate and timely diagnosis of patients with undifferentiated ADHF.

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P305 The evaluation of left ventricle filling pressure and lung ultrasound B-lines in the diagnosis of cardiogenic dyspnea

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.158 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

T Valova

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Lung Ultrasound ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Filling Pressure ◽

Diagnostic Methods ◽

Grey Zone ◽

X Ray ◽

B Lines

Abstract Introduction Dyspnea is the most frequent symptom of acute heart failure but it could also be a clinical presentation of some other noncardiogenic conditions. The differentiation of the origin of dyspnea could sometimes be a difficult task. The estimated elevation of left ventricle filling pressure with lung ultrasound proved positive B-lines score > 15 could be reliable as diagnostic methods for acute decompensated heart failure and proof of the cardiogenic origin of dyspnea. Purpose To evaluate the reliability of elevated left ventricle filling pressure and positive lung ultrasound B-lines score in differentiation of the origin of dyspnea. Methods Elevated E/e´>15 as a proof for elevated left ventricle filling pressure and multiple bilateral LUS B-lines (>15) were tested against conventional X-ray and NT-proBNP in 44 patients with cardiogenic dyspnea (23 NYHA III patients and 21 NYHA IV patients) and 42 patients with noncardiogenic dyspnea. Results Elevated left ventricle filling pressure detected with echocardography (E/e´>15) as a proof of acute decompensated heart failure was found in 18 NYHA IV patients and strongly correlated with multiple bilateral LUS B-lines > 15 (all 21 NYHA IV patients), alveolar edema from conventional X-ray (21 NYHA IV patients) and NTproBNP > 1000pg/ml in 17 NYHA IV patients. The results for NYHA III patients differ very much. Elevated filling pressure (E/e´ > 15) from echocardiography was found in 10 patients NYHA III. For the left 13 patients NYHA III E/e´ was in grey zone between 8-14. Multiple bilateral LUS B-lines >15 were found in 18 NYHA III patients. Interstitial pulmonary edema was found in 15 NYHA III patients and NTproBNP > 1000pg/ml was found in 16 NYHA III patients. E/e´ between 8-14 (grey zone) moderately correlated with NT-proBNP and strongly with pulmonary blood flow redistribution and interstitial edema from X-ray. Normal left ventricle filling pressure (E/e´ < 8) was found in 36 noncardiogenic patients. Only 6 patients with noncardiogenic dyspnea were with elevated left ventricle filling pressure (E/e´ > 15) which was explained with their overweight (BMI > 30) and hypervolemia and correlated with negative LUS B-lines. Only 1 patient with noncardiogenic dyspnea was with false positive B-lines score > 15 typical for pneumonia. Conclusions Elevated left ventricle filling pressure detected with Tissue Doppler echocardiography (E/e´>15) and positive LUS B-lines score > 15 are reliable modalities for the diagnosis of cardiogenic dyspnea in patients NYHA IV. In patient NYHA III with cardiogenic dyspnea the two presented modalities proved to be with moderate reliability and need references from conventional X-ray and NT-proBNP.

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Lung Ultrasound in the Screening of Pulmonary Interstitial Involvement Secondary to Systemic Connective Tissue Disease: A Prospective Pilot Study Involving 180 Patients

Journal of Clinical Medicine ◽

10.3390/jcm10184114 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4114

Author(s):

Natalia Buda ◽

Anna Wojteczek ◽

Anna Masiak ◽

Maciej Piskunowicz ◽

Wojciech Batko ◽

...

Keyword(s):

Connective Tissue ◽

Connective Tissue Disease ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Lung Ultrasound ◽

Imaging Modality ◽

Connective Tissue Diseases ◽

High Sensitivity ◽

Study Group ◽

A Prospective Study

Objectives: The aim of the study was the assessment of lung ultrasound (LUS) as a screening of pulmonary interstitial involvement secondary to systemic connective tissue diseases. Methods: A prospective study was conducted on the study group comprising 180 patients diagnosed with different systemic connective tissue diseases. Each patient underwent lung ultrasound (LUS), high-resolution chest computed tomography (HRCT), and echocardiography (ECHO). Each imaging examination was blinded and performed by an independent operator. LUS was conducted with convex and linear transducers. Results: The sensitivity and specificity of LUS as compared to HRCT in detecting pulmonary interstitial involvement in the study group were 99.3% and 96.4%, respectively; positive predictive value (PPV) 0.7, negative predictive value (NPV) 3.6. Abnormalities indicating interstitial lung disease (ILD) with fibrosis were most frequently localized bilaterally in the lower fields of the lungs, assessed in the dorsal view. Conclusions: LUS is an efficient imaging modality that can detect pulmonary interstitial involvement in patients with systemic connective tissue disease with a high sensitivity and specificity. Further prospective studies conducted on a larger population are deemed necessary.

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OP0167 THE ROLE OF LUNG ULTRASOUND IN THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASE IN CHILDREN WITH DERMATOMYOSISTIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4033 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 100.3-100

Author(s):

R. Dertkgil ◽

C. Cappello ◽

S. Dertkigil ◽

R. Marini ◽

S. Appenzeller

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Gold Standard ◽

Lung Ultrasound ◽

Pulmonary Involvement ◽

High Resolution Computed Tomography ◽

B Lines ◽

Transthoracic Ultrasound

Background:Dermatomyositis is a multi organ autoimmune disease wich is commonly complicated with interstitial lung disease. Chest high-resolution computed tomography (HRCT) is still considered the diagnostic gold standard for interstitial lung disease and is quantification, however he increasing use of lung ultrasound may play an important role in the future.Objectives:The aim of our study was to determine the diagnostic value of lung ultrasound in the detection and progression of interstitial pulmonary disease in patients with dermatomyositis.Methods:Twenty two subjects with dermatomyositis diagnosed according to the American College of Rheumatology criteria were enrolled (6 males, 16 females; mean age: 15,8 ± 8.8 years; range: 6 to 29 years). All subjects underwent high resolution computed tomography followed by transthoracic ultrasound for comet tail sign detection and pleural irregularity in order to predict the degree of interstitial lung disease. The modified transthoracic ultrasound assessment was performed at 06 thoracic regions each side. The Warrick score was calculated according standard high-resolution chest computed tomography images that were evaluated independently from each other by two thoracics radiologists.Results:A significantly positive correlation between transthoracic ultrasound and the severity of pulmonary involvement, as seen by the number of B lines (Spearman ‘s correlation coefficient = 0.80, p < 0.001), and the number of positive areas (regions wih more than 3 B lines) (Spearman ‘s correlation coefficient = 0.75, p < 0.001) were found. When compared with high-resolution chest computed tomography as the gold standard method, the sensitivity, specificity, of transthoracic ultrasound was 96.4%, 83,3% respectively. Addicionally the number of B lines (sum of 35 or more B lines) and a number of B lines positive areas (7 or more regions with at least 3 B lines) cut of allowed to discriminate the inflamatory pattern (ground glass) to those with structural pattern (honeycomb and pulmonary cysts).Conclusion:Our study showed that transthoracic ultrasound comet tails scoring system could be useful in the assessment of the pulmonary involvement in patients with dermatomyositis, and should be considered as a primary screening exam to exclude lung involvement, rather than routine chest CT scans in assimptomatic patients.Disclosure of Interests:None declared

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CHRONIC VULVAL SYMPTOMS: COMPARISON OF VARIOUS DIAGNOSTIC METHODS

International Journal of Advanced Research ◽

10.21474/ijar01/12448 ◽

2021 ◽

Vol 9 (02) ◽

pp. 310-314

Author(s):

Akanksha Sharma ◽

◽

Saritha Shamsunder ◽

Niti Khunger ◽

Geetika Khanna ◽

...

Keyword(s):

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Clinical Examination ◽

Predictive Value ◽

Diagnostic Methods ◽

Neoplastic Lesions ◽

High Negative Predictive Value ◽

Diagnostic Modalities ◽

Scrape Cytology

The aim of our study was to compare the various diagnostic modalities for evaluation of chronic vulval symptoms. We studied 100 women presenting with chronic vulval symptoms who underwent examination of vulva with low magnification, scrape cytology, colposcopy & directed biopsy. The overall sensitivity and specificity for detecting vulvar lesions was 29.87% and 100% with low magnification 58.44% and 13.04% with cytology 77.92 % and 17.39 % with colposcopy. We concluded that clinical examination with or without magnification can detect most of the neoplastic lesions. Colposcopy and cytology have high negative predictive value and provide reassurance in absence of disease.

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Correlation between Transthoracic Lung Ultrasound Score and HRCT Features in Patients with Interstitial Lung Diseases

Journal of Clinical Medicine ◽

10.3390/jcm8081199 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1199 ◽

Cited By ~ 7

Author(s):

Milena Adina Man ◽

Elena Dantes ◽

Bianca Domokos Hancu ◽

Cosmina Ioana Bondor ◽

Alina Ruscovan ◽

...

Keyword(s):

Computed Tomography ◽

Gold Standard ◽

Lung Diseases ◽

Lung Ultrasound ◽

Interstitial Lung Diseases ◽

High Resolution Computed Tomography ◽

Complementary Role ◽

Function Impairment ◽

Ultrasound Score ◽

B Lines

Chest high-resolution computed tomography (HRCT) is considered the “gold” standard radiological method in interstitial lung disease (ILD) patients. The objectives of our study were to evaluate the correlation between two transthoracic lung ultrasound (LUS) scores (total number of B-lines score = the total sum of B-lines in 10 predefined scanning sites and total number of positive chest areas score = intercostal spaces with ≥3 B-lines) and the features in HRCT simplified scores, in different interstitial disorders, between LUS scores and symptoms, as well as between LUS scores and pulmonary function impairment. We have evaluated 58 consecutive patients diagnosed with ILD. We demonstrated that there was a good correlation between the total number of B-lines score and the HRCT simplified score (r = 0.784, p < 0.001), and also a good correlation between the total number of positive chest areas score and the HRCT score (r = 0.805, p < 0.005). The results confirmed the value of using LUS as a diagnostic tool for the assessment of ILD compared to HRCT. The use of LUS in ILD patients can be a useful, cheap, accessible and radiation-free investigation and can play a complementary role in the diagnosis and monitoring of these patients.

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