scholarly journals Lung Ultrasound Findings of Patients with Dengue Infection: A Prospective Observational Study

2021 ◽  
Author(s):  
Hiroshi Koyama ◽  
Wirongrong Chierakul ◽  
Prakaykaew Charunwatthana ◽  
Natpatou Sanguanwongse ◽  
Benjaluck Phonrat ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Dengue Infection ◽  
Severe Dengue ◽  
Pleural Effusions ◽  
Ultrasound Findings ◽  
Chest X Ray ◽  
Pulmonary Changes ◽  
Convalescence Phase

Lung ultrasound (LUS) is performed for several conditions and is a more sensitive method of detecting pathological pulmonary changes than chest X-ray. Therefore, LUS for individuals with dengue could be an important tool for the early detection of pleural effusions and pulmonary edema signifying capillary plasma leakage, which is the hallmark of severe dengue pathophysiology. We conducted a prospective observational study of pulmonary changes identifiable with LUS in dengue patients admitted to the Hospital for Tropical Diseases in Mahidol University, Bangkok, and the Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand. The LUS findings were described according to standard criteria, including the presence of A, B1, B2, and C patterns in eight chest regions and the presence of pleural effusions. From November 2017 to April 2018, 50 patients with dengue were included in the study. LUS was performed during the Shonna febrile phase for nine patients (18%) and during the critical-convalescence phase for 41 patients (82%). A total of 33 patients (66%) had at least one abnormality discovered using LUS. Abnormal LUS findings were observed more frequently during the critical-convalescence phase (N = 30/41; 73%) than during the febrile phase (N = 3/9; 33%) (P = 0.047). Abnormal aeration patterns were observed in 31 patients (62%). Only B patterns with only multiple B lines were observed in 21 patients (42%); of these patients, three had already exhibited these during the febrile phase (N = 3). C patterns (N = 10; 24%), pleural effusion (N = 10; 24%), and subpleural abnormalities (N = 11; 27%) were observed only during the critical-convalescence phase. LUS can detect signs of capillary leakage, including interstitial edema and pleural effusions, early during the course of dengue.

scholarly journals Sensitivity of lung ultrasound for the detection of pneumothorax one day after pulmonary resection—a prospective observational study

2020 ◽  
Author(s):  
Thomas Galetin ◽  
Mark Schieren ◽  
Benjamin Marks ◽  
Jerome Defosse ◽  
Erich Stoelben
Keyword(s):  
Observational Study ◽  
Thoracic Surgery ◽  
Test Performance ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Lung Resection ◽  
X Ray ◽  
Therapeutic Decisions ◽  
Chest X Ray ◽  
Diagnostic Test Performance

Summary Background Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions. Methods We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated. Results A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%. Conclusions Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.

scholarly journals A prospective observational study depicting role of lung ultrasound in pediatric pneumonias

2021 ◽  
Vol 8 (9) ◽  
pp. 1566
Author(s):  
Ashish Saklani ◽  
Ashwani Tomar ◽  
Sumala Kapila ◽  
Shyam Lal Kaushik ◽  
Anjali Mahajan
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Lung Ultrasound ◽  
Imaging Modality ◽  
High Sensitivity ◽  
Radiation Hazard ◽  
X Ray ◽  
Under Five ◽  
Lobar Pneumonia ◽  
Chest X Ray

Background: Pneumonia is a major cause of morbidity and mortality in children under five years of age. Chest x-ray poses radiation hazard to children and thus an alternative safe imaging modality must be explored for pediatric pneumonias.Methods: This prospective observational study included all children below 18 years of age. Majority of patients were below five years of age. All clinically suspicious patients were subjected to chest x-ray and lung ultrasound (LUS). Chest x-ray was considered as imaging diagnostic standard for pneumonia. Consolidation and dynamic air bronchogram were looked on LUS.Results: A total of 55 patients were included in study with 26 (47.2%) as infants and up to 47 (85.3%) as under five children. Out of 55 cases 32 cases (58.20%) were diagnosed as lobar pneumonia while 23 (41.8%) as bronchopneumonia on chest x-ray. LUS demonstrated high sensitivity and specificity of 90.63% and 100% for lobar pneumonia and 86.96 and 90.63% for bronchopneumonia respectively. Dynamic air bronchogram sign was found in all cases of lobar pneumonia on LUS and with sensitivity of 73.91% in bronchopneumonia.Conclusions: LUS proved itself as highly sensitive and specific modality for detecting consolidation and owing to safe non ionizing nature of ultrasound, it must be considered as an alternative to chest x-ray as an imaging diagnostic tool for pediatric pneumonia.

scholarly journals Can serum ferritin levels predict the severity of dengue early?: an observational study

2019 ◽  
Vol 7 (3) ◽  
pp. 876
Author(s):  
Velammal Petchiappan ◽  
Thaha Mohammed Hussain ◽  
Saravanan Thangavelu
Keyword(s):  
Platelet Count ◽  
Clinical Practice ◽  
Observational Study ◽  
Hospital Stay ◽  
Serum Ferritin ◽  
Early Recognition ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Severe Dengue ◽  
Elderly Subjects

Background: Dengue infection is a major public health threat; early recognition is crucial to improve the survival in severe dengue. Although there are various biomarkers to predict the severity of dengue, they are not routinely used in clinical practice for prognostication. We analyzed whether serum ferritin can be used to predict the severity at an earlier stage.Methods: A hospital based prospective observational study was done involving 119 dengue cases diagnosed by positive NS1 antigen or dengue specific serology (capture ELISA). Serum ferritin was measured in all at the time of diagnosis. Clinical and platelet count monitoring was done daily; classified as severe and non-severe according to 2009 WHO criteria.Results: Out of 119, 5 developed severe dengue; patients with severe dengue had significantly lower median platelet count (p<0.0001); higher ferritin levels (p=0.03) and hospital stay (p<0.0001) than non-severe group. Age had a significant negative co-relation with platelet count (r= -0.427; p<0.0001); positive correlation with ferritin levels (r=0.16; p=0.08) and hospital stay (r= 0.26; p=0.004) indicating that elderly subjects are at risk of severe disease. Serum ferritin levels negatively correlated with the platelet count (r= -0.51 p<0.001). High ferritin levels in severe cases are noted from day 4 of clinical illness.Conclusions: Elevated serum ferritin levels can be used as a potential early prognostic marker to predict the severity of dengue infection in clinical practice.

scholarly journals Predictors of Major Bleeding and Mortality in Dengue Infection: A Retrospective Observational Study in a Tertiary Care Centre in South India

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Kevin John John ◽  
Karthik Gunasekaran ◽  
John Davis Prasad ◽  
Divya Mathew ◽  
Sohini Das ◽  
...  
Keyword(s):  
Observational Study ◽  
Major Bleeding ◽  
South India ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Retrospective Observational Study ◽  
Total Leukocyte Count ◽  
Severe Dengue ◽  
Elderly Age ◽  
Tertiary Care Centre

We conducted a retrospective observational study to describe the clinical profile and outcomes of patients admitted with a diagnosis of dengue fever in a tertiary hospital in South India. A total of 159 patients admitted from April 2014 to October 2018 were included in the study. Vomiting (70.4%), myalgia (60.4%), headache (42.1%), abdominal pain (38.4%), bleeding (38%), and rash (37.1%) were the most common symptoms at presentation. The mean duration of hospital stay was 4.9 days (SD ± 2.4), and the median cost was INR 19,708 ($285) (IQR INR 12,968–32,056 ($188–$305)). Major bleeding was associated with elevated SGOT and SGPT, severe dengue, and secondary dengue. Mortality was associated with elderly age; elevated total leukocyte count, serum bilirubin, serum creatinine, SGOT, and SGPT; and high SOFA score. In view of these observations, we recommend stratifying patients according to the WHO classification of dengue and avoiding the use of thrombocytopenia as a single marker of the severity of the illness.

scholarly journals 2654. Myocarditis in Dengue: A Prospective Observational Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S928-S929
Author(s):  
Manish Soneja ◽  
Manasvini Bhatt ◽  
Faraz A Farooqui ◽  
Naval K Vikram ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Fluid Overload ◽  
Fluid Management ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Hemodynamic Instability ◽  
Warning Signs ◽  
Severe Dengue ◽  
Cardiac Enzymes

Abstract Background Cardiac involvement in dengue fever is underdiagnosed due to low index of suspicion and overlapping clinical manifestations of capillary leak associated with dengue. The frequency of subclinical dengue myocarditis and its relative contribution to the hemodynamic instability in severe dengue needs to be explored. We studied the prevalence of myocarditis and clinical outcomes among admitted patients with dengue. Methods A prospective observational study was carried out in admitted patients with age between 18 and 65 years having confirmed dengue (NS1/IgM ELISA). Patients with electrolyte abnormalities or on medications affecting heat rhythm/ rate, pre-existing heart disease were excluded. The baseline demographic, clinical and laboratory parameters were collected. A baseline ECG was done and repeated every second day. Trop-I and NT-proBNP were done at baseline and repeated only if elevated at baseline or there were ECG changes. The cardiac enzymes were measured using enzyme-linked fluorescent assay (VIDAS, bioMérieux, France). Patients with elevated enzymes underwent 2-dimensional echocardiography. Diagnosis of myocarditis was as per ESC 2013 criteria. Fluid management was as per WHO guidelines (2009). Results A total of 183 patients were recruited with median age of 29 years (IQR 21, 37) and 31% were females. Dengue with warning signs was present in 80 (44%) and severe dengue in 45 (25%) patients. Cardiac enzymes were elevated in 27 (15%) patients (cTnI in 25, NT-proBNP in 22). Among these 27 patients, 11 [6% (2.6–9.4, 95% CI)] had echo evidence and diagnosed as having myocarditis according to ESC 2013 criteria (Figure 1). Clinical features of fluid overload were more common in myocarditis group [8 (73%) vs 4 (2%), P = Overall, 5 (2.7%) patients expired, all of them had myocarditis (5/11 = 45%). These patients had severe dengue, 2 patients developed hospital-acquired pneumonia and 1 had malaria co-infection. Among patients with raised enzymes and normal echo (n = 16), 3 patients developed clinical signs of fluid overload compared with only 1 out of 156 patients without raised enzymes (P &lt; 0.01). Conclusion Myocarditis in admitted patients with dengue is not uncommon [6% (2.6–9.4, 95% CI)] and may lead to a complicated disease course. Disclosures All authors: No reported disclosures.

scholarly journals Unilateral Pleural Effusions with More Than One Apparent Etiology. A Prospective Observational Study

2016 ◽  
Vol 13 (7) ◽  
pp. 1050-1056 ◽  
Author(s):  
Oliver J. Bintcliffe ◽  
Clare E. Hooper ◽  
Iain J. Rider ◽  
Rhian S. Finn ◽  
Anna J. Morley ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Pleural Effusions
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