scholarly journals Role of Lung Ultrasound in Predicting Clinical Severity and Fatality in COVID-19 Pneumonia

2021 ◽  
Vol 11 (8) ◽  
pp. 757
Author(s):  
Ivan Skopljanac ◽  
Mirela Pavicic Ivelja ◽  
Ognjen Barcot ◽  
Ivan Brdar ◽  
Kresimir Dolic ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Disease Severity ◽  
Predictive Power ◽  
Lung Ultrasound ◽  
Clinical Severity ◽  
Imaging Method ◽  
High Flow Nasal Cannula ◽  
Severity Of The Disease

Background: Lung ultrasound (LUS) is a useful imaging method for identifying COVID-19 pneumonia. The aim of this study was to explore the role of LUS in predicting the severity of the disease and fatality in patients with COVID-19. Methods: This was a single-center, follow-up study, conducted from 1 November 2020, to 22 March 2021. The LUS protocol was based on the assessment of 14 lung zones with a total score up to 42, which was compared to the disease severity and fatality. Results: A total of 133 patients with COVID-19 pneumonia confirmed by RT-PCR were enrolled, with a median time from hospital admission to lung ultrasound of one day. The LUS score was correlated with clinical severity at hospital admission (Spearman’s rho 0.40, 95% CI 0.24 to 0.53, p < 0.001). Patients with higher LUS scores were experiencing greater disease severity; a high flow nasal cannula had an odds ratio of 1.43 (5% CI 1.17–1.74) in patients with LUS score > 29; the same score also predicted the need for mechanical ventilation (1.25, [1.07–1.48]). An LUS score > 30 (1.41 [1.18–1.68]) and age over 68 (1.26 [1.11–1.43]) were significant predictors of fatality. Conclusions: LUS at hospital admission is shown to have a high predictive power of the severity and fatality of COVID-19 pneumonia.

Characterization of lung ultrasound imaging in preterm infants with bronchopulmonary dysplasia

2021 ◽  
pp. 1-13
Author(s):  
Ying-Hua Sun ◽  
Lin Yuan ◽  
Yang Du ◽  
Jian-Guo Zhou ◽  
Sam Bill Lin ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Intensive Care ◽  
Lung Ultrasound ◽  
Imaging Method ◽  
Chronic Lung Diseases ◽  
Pleural Line ◽  
Ultrasound Features

BACKGROUND: Lung ultrasound (LUS) is a bedside technique that can be used on diagnosis and follow-up of neonatal respiratory diseases. However, there are rare reports on the ultrasound features of bronchopulmonary dysplasia (BPD) which is one of the most common chronic lung diseases in preterm infants. OBJECTIVE: To describe the ultrasound features of different BPD levels, and to investigate the value of ultrasound in evaluating moderate-to-severe BPD. METHODS: In this prospective cohort study, newborns of less than 37 weeks’ gestational age in neonatal intensive care unit (NICU) were included. The LUS characteristics including pleural line, alveolar-interstitial syndrome (AIS), retrodiaphragmatic hyperechogenicity and diaphragmatic morphology were observed and recorded. The reliability of LUS in evaluating moderate and severe BPD were compared and calculated. RESULTS: A total of 108 infants were enrolled in our study: 39, 24, 29, 16 infants had non, mild, moderate and severe BPD. The median(IQR) pleura thickness in the moderate-to-severe BPD group was 1.7(1.6–1.85) mm, which was thicker than that in the none-to-mild BPD infants (P <  0.001), meanwhile the proportions of rough pleural lines, diffuse AIS, retrodiaphragmatic hyperechogenicity, small cysts above the diaphragm and rough diaphragm in the moderate-to-severe BPD group were also higher than those in none-to-mild BPD group (86.7% vs 36.5, 57.8% vs 7.9%, 37.8% vs 0, 33.3% vs 0, P <  0.001). In evaluating moderate-to-severe BPD, rough pleura had 91.1% (95% confidence interval [CI]: 0.793–0.965) in sensitivity, 91.3% (95% CI: 0.797–0.966) in negative predictive value (NPV), and 66.7% (95% CI: 0.544–0.771) in specificity. Small cysts had 100% (95% CI: 0.941-1) in specificity, 100% (95% CI: 0.816-1) in PPV, and 37.8% in sensitivity (95% CI: 0.251–0.524). Rough diaphragm had 100% (95% CI: 0.943-1) in sensitivity, 100% (95% CI: 0.796-1) in PPV and 33.3% (95% CI: 0.211–0.478) in specificity. CONCLUSIONS: Depending on its unique advantages such as convenient, no radiation and repeatable, LUS is a valuable imaging method in assessing the severity of BPD, especially in moderate and severe BPD.

scholarly journals Dissecting the role of genetic modifiers of hemoglobinopathies: A futuristic approach towards precision medicine

2021 ◽  
Author(s):  
Priya Hariharan ◽  
Manju Gorivale ◽  
Pratibha Sawant ◽  
Pallavi Mehta ◽  
Anita Nadkarni
Keyword(s):  
Disease Severity ◽  
Phenotypic Variability ◽  
Globin Gene ◽  
Gene Promoter ◽  
Clinical Severity ◽  
Genetic Modifiers ◽  
Promoter Polymorphisms ◽  
Cumulative Impact ◽  
Remarkable Result

Abstract Introduction: Hemoglobinopathies though a monogenic disorder, show phenotypic variability. Hence, understanding the genetics underlying the heritable sub-phenotypes of hemoglobinopathies, specific to each population, would be prognostically useful and could inform personalized therapeutics. This study aimed to evaluate the role of genetic modifiers leading to higher HbF production with cumulative impact of the modifiers on disease severity. Materials and methods:200 patients [100 β-thalassemia homozygotes,100 Sickle Cell Anemia], and 50 healthy controls were recruited. Primary screening followed with molecular analysis for confirming the β-hemoglobinopathy was performed. Co-existing α-thalassemia and the polymorphisms located in 3 genetic loci linked to HbF regulation were screened.Results: The most remarkable result was the association of SNPs with clinically relevant phenotypic groups. The γ-globin gene promoter polymorphisms [-158 C→T,+25 G→A],BCL11A rs1427407 G→T,-3 bp HBS1L-MYB rs66650371 and rs9399137 T→C polymorphisms were correlated with higher HbF, in group that has lower disease severity score (P<0.00001), milder clinical presentation, and a significant delay in the age of the first transfusion.Conclusion:Our study emphasizes the complex genetic interactions underlying the disease phenotype that may be a prognostic marker for predicting the clinical severity and assist in disease management.

scholarly journals Lung ultrasound in COVID-19: a useful diagnostic tool

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Gianmarco Secco ◽  
Marzia Delorenzo ◽  
Caterina Zattera ◽  
Bianca Giacomuzzi Moore ◽  
Lorenzo Demitry ◽  
...  
Keyword(s):  
Potential Role ◽  
Lung Ultrasound ◽  
Short Review ◽  
World Health ◽  
Emergency Setting ◽  
Inherent Risk ◽  
Therapeutic Protocols ◽  
Health Organization

Coronavirus disease 2019 (Covid-19), caused by a novel enveloped RNA betacoronavirus, has recently been declared a public health emergency by the World Health Organization (WHO). The lack of knowledge at the beginning of the pandemics, associated with the inherent risk of infective spreading, makes initial recognition and management particularly complex, in terms of defining effective diagnostic and therapeutic protocols. In the Emergency setting, Lung Ultrasound (LUS) can play an important role in the management of patients with SARS-CoV2-related pneumonia, expanding from the initial diagnosis to the subsequent monitoring and follow-up. Among many other potential advantages (such has the absence of ionizing radiation, its inherent costeffectiveness, and bedside repeatability), LUS provides immediate diagnostic response and might prevent the risk of spreading the infection by moving the patient from the Emergency Room to the Radiology facilities. Aim of this short review is to define the potential role of lung ultrasound in Covid-19 patients, according to the evidence in the medical literature

The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia

2012 ◽  
Vol 23 (5) ◽  
pp. 391-397 ◽  
Author(s):  
Angelika Reissig ◽  
Andrea Gramegna ◽  
Stefano Aliberti
Keyword(s):  
Lung Ultrasound ◽  
Community Acquired Pneumonia

scholarly journals Role of ROX Index in the first assessment of COVID-19 patients in the Emergency Department

2020 ◽  
Author(s):  
Alice Gianstefani ◽  
Gabriele Farina ◽  
Veronica Salvatore ◽  
Francesca Alvau ◽  
Maria Laura Artesiani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Healthcare Services ◽  
Clinical Findings ◽  
Clinical Severity ◽  
High Rate ◽  
Secondary Outcomes ◽  
Index Value ◽  
Suspected Diagnosis

Abstract Background: In Italy, since the first symptomatic cases of Coronavirus disease 2019 (COVID-19) appeared in late February 2020, 205.463 cases of Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) were reported as of April 30, causing an high rate of hospital admission through the Emergency Department (ED).Objectives: The aim of the study was to evaluate the accuracy of ROX index in predicting hospitalization and mortality in patients with suspected diagnosis of COVID-19 in the ED. Secondary outcomes were to assess the number of readmissions and the variations of ROX index between first and second admission.Methods: This is an observational prospective monocentric study, conducted in the ED of Policlinico Sant’Orsola-Malpighi in Bologna. We enrolled 1371 consecutive patients with suspected COVID-19 and ROX index was calculated in 554 patients. Patients were followed until hospital discharge or death. Results: ROX index value < 25.7 was associated with hospitalization (AUC=0.737, 95%CI 0.696–0.779, p<0.001). ROX index < 22.3 is statistically related with higher 30-days mortality (AUC= 0.764, 95%CI 0.708-0.820, p<0.001). 8 patients were discharged and returned in the ED within the following 7 days, their mean ROX index was 30.3 (6.2; range 21.9-39.4) at the first assessment and 24.6 (5.5; 14.5-29.5) at the second assessment, (p=0.012).Conclusion: ROX index, together with laboratory, imaging and clinical findings, can help discriminate patients suspected for COVID-19 requiring hospital admission, their clinical severity and their mortality risk. Furthermore, it can be useful to better manage these patients in territorial healthcare services, especially in the hypothesis of another pandemic.

scholarly journals Lung ultrasound in COVID-19 pregnancies: a literature review

2021 ◽  
Vol 12 (2) ◽  
pp. 26-34
Author(s):  
F. Moro ◽  
G. Beneduce ◽  
D. Buonsenso ◽  
Ch. Landolfo ◽  
F. Mascilini ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Search Strategy ◽  
Web Of Science ◽  
Lung Ultrasound ◽  
Scoring Systems ◽  
Clinical Applications ◽  
Imaging Method ◽  
Definition Of ◽  
Procedure Development

Lung ultrasound has been recognized as a valid imaging method for diagnosing and monitoring COVID-19 pneumonia in pregnant women. The present review aimed to summarize the main findings reported in the literature and international guidelines on the role of lung ultrasound in the care of pregnant women affected by COVID-19. A search strategy was developed and applied to PubMed, Scopus, Web of Science and EMBASE to identify previous papers reporting the utility of ultrasound in diagnosing and monitoring COVID-19 pneumonia. The search retrieved 369 articles and 23 of these were selected for analysis. The articles mainly focused on the definition of the procedure, development of training programs for obstetricians managing pregnant women with suspicion of COVID-19 and definition of scoring systems. The clinical applications of lung ultrasound in this setting have also been described. This review could encourage obstetricians to learn lung ultrasound to use during critical events like a pandemic.

scholarly journals Role of Lung Ultrasound in the Management of Patients with Suspected SARS-Cov-2 Infection in the Emergency Department

2021 ◽  
Author(s):  
Andrea Boccatonda ◽  
Alice Grignaschi ◽  
Antonella Lanotte ◽  
Fabrizio Giostra ◽  
Cosima Schiavone ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lung Ultrasound ◽  
Ultrasound Examination ◽  
Hospitalization Rate ◽  
Clinical Severity ◽  
A Value ◽  
Ultrasound Study ◽  
Increased Risk ◽  
Level Method

Abstract Background: the LUS score has been proposed as an optimal scheme for the ultrasound study of the patient with suspected / confirmed COVID-19 pneumonia. The aim of our study was to evaluate the use of lung ultrasound as a diagnostic tool for diagnosing SARS-CoV-2 pneumonia, and to examine the validity of LUS score for the diagnosis of COVID-19 pneumonia, and to correlate with hospitalization rate and 30-days mortality.Material & methods: a retrospective analysis was performed on all patients who were referred to the General Emergency Department of the S. Orsola-Malpighi Hospital from April 2020 to May 2020 for symptoms suspected for SARS-CoV-2 infection. The ultrasound examination was based on a common execution scheme called LUS score, as previously described.Results & Conclusions: LUS score correlates with the degree of clinical severity and respiratory failure (P/F ratio, Delta (A-a), Delta (A-a) increase). COVID-19 patients with a LUS score > 7 require the use of oxygen support; a value > 10 is associated with an increased risk of oro-tracheal intubation. The LUS score presents higher values in hospitalized patients, increasing according to the degree of care intensity. COVID-19 died patients were characterized by a mean LUS score of 11 at presentation to the emergency department. A LUS score value > 7.5 displays a sensitivity of 83% and specificity of 89% against 30-days mortality in COVID-19 patients. Lung ultrasound seems to be an optimal first level method for pneumonia detection in patients with suspected SARS-CoV-2 infection.

scholarly journals Pathophysiology of COVID-19: Mechanisms Underlying Disease Severity and Progression

Physiology ◽  
2020 ◽  
Vol 35 (5) ◽  
pp. 288-301 ◽  
Author(s):  
Mary Kathryn Bohn ◽  
Alexandra Hall ◽  
Lusia Sepiashvili ◽  
Benjamin Jung ◽  
Shannon Steele ◽  
...  
Keyword(s):  
Immune Response ◽  
Organ Failure ◽  
Disease Severity ◽  
Viral Entry ◽  
Wide Spectrum ◽  
Underlying Disease ◽  
Viral Clearance ◽  
Clinical Severity ◽  
Global Epidemiology

The global epidemiology of coronavirus disease 2019 (COVID-19) suggests a wide spectrum of clinical severity, ranging from asymptomatic to fatal. Although the clinical and laboratory characteristics of COVID-19 patients have been well characterized, the pathophysiological mechanisms underlying disease severity and progression remain unclear. This review highlights key mechanisms that have been proposed to contribute to COVID-19 progression from viral entry to multisystem organ failure, as well as the central role of the immune response in successful viral clearance or progression to death.

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