Demographic and Clinical Features Association With Mortality in Patients With COVID-19: A Cross-Sectional Study in the West of Iran

The coronavirus disease 2019 (COVID-19) pandemic as an emergency public health concern has caused hundreds of thousands of deaths in the world. Identifying predictors of death in COVID-19 patients is a key to improving survival and helping patients triage, better management, and assist physicians and health care. The present study was conducted on 512 positive COVID-19 patients confirmed by real-time PCR hospitalized in Sina Hospital, Hamadan, in 2020. The data of demographic characteristics, clinical manifestations, laboratory findings, chest examination, and disease outcome were collected. The logistic regression model was performed to explore the predictors of in-hospital mortality. Among 512 patients, 57 (11.1%) deaths have occurred. The adjusted odds ratios (OR) estimate of death in COVID-19 for patients with age more than 60 years versus those lower than 60 years was 3.15 (95% CI: 1.06, 9.37). The adjusted OR estimate of death in patients with hypertension comorbidity versus those with no comorbidity was 3.84 (95% CI: 1.27, 11.59). In addition, the adjusted OR estimate (95% CI) of death in patients with respiratory rate above 30 per minute, BUN >20 mg/dL, LDH >942 U/L and SGOT >45 U/L against lower than those values was respectively 10.72 (1.99, 57.68), 5.85 (2.19, 15.63), 13.42 (2.17, 83.22) and 2.86 (1.02, 8.05). The risk of death was higher among the patients with multiple comorbidity diseases, systolic BP lower than 90 mmHg, SPO2 lower than 88 and more than ten days hospitalization in comparison with COVID-19 patients with no comorbidity disease (P=0.002), systolic BP higher than 90 mmHg (P=0.002), SPO2 higher than 88 (P<0.001) and hospitalization for lower than ten days (P=0.012). Our findings suggest that older age, pre-existing hypertension and/or multiple co-morbidities, high respiratory rate, elevated BUN, LDH and SGOT, low systolic BP, and hypoxemia were independently associated with in-hospital mortality in COVID-19 patients. These results can be helpful for physicians and health care workers to improve clinical management and appropriate medical care of COVID-19 patients.

CT Pulmonary Manifestations in Patients with Rheumatoid Arthritis: Visual scoring versus pulmonary function

Background Pulmonary involvement is the most common extra-articular manifestation of Rheumatoid arthritis. Aim of the Work To highlight the role of HRCT in detection and characterization of variable pulmonary manifestations that can be encountered in patients with Rheumatoid Arthritis trying to correlate the CT pulmonary manifestations with pulmonary functions using CT scoring system. Patients and Methods This was a retrospective study that included 32 patients who were diagnosed to have Rheumatoid Arthritis either outpatients or referred from the Rheumatology Department at Ain Shams University Hospitals to the Radiodiagnosis Department for HRCT chest examination. An acceptance from the ethical committee of Faculty of Medicine - Ain Shams University was obtained to use the data stored on PACs system with the patient’s consent was waived being a retrospective study. All patients underwent HRCT image analysis regarding the CT features and CT score for disease severity. Also, all patients did spirometery for pulmonary function assessment. Results Analyzing the data showed a female sex predominance (90.6%). 87% of the patients were diagnosed to have RA for more than 2 years duration. The most common respiratory symptom was dyspnea and the restrictive pattern was the commonest PFT finding. Ground glass pattern was the most common 78.1% followed by reticular pattern which was seen in 68.8% of patients. PFT and HRCT showed a positive correlation regarding the severity. Conclusion HRCT is a modality of choice for detection of pulmonary manifestation of rheumatoid arthritis patients with CT scoring can be used to assess the severity of disease and degree of lung involvement which is correlated with pulmonary function test.

Estimating rotation angle from asymmetric projection of chest

BACKGROUND: Manual or machine-based analysis of chest radiographs needs the images acquired with technical adequacy. Currently, the equidistance between the medial end of clavicles and the center of spinous processes serves as the only criterion to assess whether a frontal PA chest radiograph is taken with any rotation. However, this measurement is normally difficult to implement because there exists overlapping of anatomies within the region. Moreover, there is no way available to predict exact rotating angles even the distances were correctly measured from PA chest radiographs. OBJECTIVE: To quantitatively assess positioning adequacy of PA chest examination, this study proposes and investigates a new method to estimate rotation angles from asymmetric projection of thoracic cage on radiographs. METHOD: By looking into the process of radiographic projection, generalized expressions have been established to correlate rotating angles of thorax with projection difference of left and right sides of thoracic cage. A trunk phantom with different positioning angles is employed to acquire radiographs as standard reference to verify the theoretical expressions. RESULTS: The angles estimated from asymmetric projections of thoracic cage yield good agreement with those actual rotated angles, and an approximate linear relationship exists between rotation angle and asymmetric projection of thoracic cage. Under the experimental projection settings, every degree of rotation corresponds to the width difference of two sides of thoracic cage around 13–14 pixels. CONCLUSION: The proposed new method may be used to quantify rotating angles of chest and assess image quality for thoracic radiographic examination.

Evaluation of Direct Chest Circumference Measurement as an Efficient Tool in the Reduction of Radiation Dose in Multi-Slice Computerized Tomography of Chest- A Suggestion for Radiographers

Non-contrast computerized tomography (NCCT) is in rampant use in daily practice for the diagnosis of various chest diseases. In the era of COVID-19 pandemic, the use of chest NCCT has increased many fold. The reason was because it will resolve many issues and quick diagnosis can be made. The same was also required to see the behavior of the disease as well as in the follow-up. Basically two parameter are in use to described the amount of radiation dose received by the patient in volumetric CT. These are, one is CT Dose Index (CTDIvol) & its unit is mGy, and the second is dose length product (DLP). With normal pitch factor i.e. 1, the CTDIw is use on the description of CTDIvol. Multiplication of scan length and CTDIvol parameter is known as Dose Length Product (DLP). There was much concern about the radiation dose received by the individual. A total of twenty-six individuals were studied. The measurement of direct chest circumference before each CT chest examination and correlation of CT chest protocol parameter in combination use was an effective tool to reduce the amount of radiation dose in patients. Chest circumference values can also be correlated with body mass index (BMI) values for more accuracy in the reduction of radiation dose. Lower chest circumference patients should be irradiated with the least amount of radiation dose and so on.

Recognition of phrenic paralysis as atypical presentation during CT chest examination of COVID-19 infection and its correlation with CT severity scoring: a local experience during pandemic era

Background Coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organization on March 11, 2020. COVID-19 infection is considered a multi-system disease with neurological, digestive, and cardiovascular symptoms and complications. It can trigger acute and diffuse endothelial dysfunction, resulting in a cytokine storm, most likely induced by the interleukin-6 (IL-6) amplifier. The peripheral and central neurological complications may explain some clinical manifestations such as vagus nerve palsy. The known main CT chest findings of COVID-19 pneumonia include ground glass patches, pulmonary consolidations, inter-lobar septal thickening, crazy paving appearance, and others. We presented our experience in the incidental discovery of phrenic nerve paralysis as atypical chest finding in patients with a known history of COVID-19-associated pneumonia, proved by RT-PCR and coming for evaluation of the lung changes. Patients with evidence of diaphragmatic paralysis underwent close follow-up with a re-evaluation of the phrenic nerve palsy at their routine follow-up for COVID-19 pneumonia. The association of the phrenic nerve palsy was correlated with the CT chest severity score. Results Among 1527 scanned patients with known COVID-19 pneumonia, we had recognized 23 patients (1.5%) with unilateral diaphragmatic paralysis, accidentally discovered during CT chest examination. Twenty-one patients had shown complete recovery of the associated diaphragmatic paralysis during their follow-up CT chest with regression or the near-total resolution of the pulmonary changes of COVID-19- pneumonia. No significant correlation between the incidence of unilateral diaphragmatic paralysis and CT severity score with p value = 0.28. Conclusion Phrenic paralysis is considered a serious but rare neurological complication of COVID-19 pneumonia. No significant correlation between the CT severity score and the incidental discovery of unilateral diaphragmatic paralysis. The majority of the cases show spontaneous recovery together with the improvement of the pulmonary changes of COVID-19 pneumonia. The association of phrenic paralysis with anosmia and dysgeusia could suggest a direct viral attack on the nerve cells.

Assessment of lung function and pulmonary disorders among women involved in palm kernel oil processing in Cape Coast, Ghana

Background: Does exposure to methods employed during local palm kernel oil processing affect lung function and increase pulmonary disorders in the women processors? Fifty test participants from palm kernel processing sites constantly exposed to processing hazards and fifty unexposed women from the general population in Cape Coast, Ghana were used for the study.Methods: Participants after filling questionnaires were subject to clinical chest examination, anthropometry and spirometry. Data were analyzed descriptively using percentages, means, standard deviation and inferentially using independent sample t-test and chi-square test.Results: Exposed participants complained of respiratory symptoms such as chest pain, phlegm production, burning and tearing of eyes and skin irritations. Chest examination also revealed significant reduced air entry and increase in bronchial and bronchovesicular sounds. Spirometry showed significant decreases in Forced Expiratory Volume in the first second (FEV1) and Forced Vital Capacity (FVC), with increase in restrictive lung disorders in the exposed participants (p<0.05). Chi-square analysis further showed association between length of exposure to emissions from processing and increased lung disorder.Conclusions: Our study shows that the methods employed in palm kernel processing sites coupled with lack of hazardous knowledge and use of protective equipment exposes the women extractors to pollutants which results in increased respiratory symptoms, decreased lung function and significant presence of lung disorders.

Évaluation de la dose aux patients lors de l’examen du thorax de face à Abidjan, Côte d’Ivoire

Our study aims to evaluate medical practices in order to reduce patient doses for frontal examination of the thorax in postero-anterior view. Thus, in five (5) radiological rooms of five (5) most frequented hospitals in Abidjan, thirty (30) patients per medical center, meaning a total of one hundred and fifty (150) patients, providing chest examination reports were followed. Using a DAP- meter consisting of an ionization chamber attached to the outlet of the tube and an electrometer, the dose in air (Dair) was measured. Then by calculating the entry dose (De) for each patient was determined. Thus, from the statistical method of the 75th percentile we determine the level of diagnostic references (DRL) in each room as well as in all the rooms of our study. The inlet dose averages (Dem) in each room and in all rooms were calculated. The couples (NRD, Dem) per room expressed in mGy (0.252, 0.226), (0.249, 0.213), (0.164, 0.159), (0.128, 0.117) and (0.234, 0.211) respectively at the CHU of Cocody, CHU of Yopougon, HMA, ICA and PISAM. By comparing the NRD value of De to that of Dem in each radiological room, we found Dem values lower than the NRD. This indicates that the doses are optimized in the rooms of our study, likewise, for all the rooms in Abidjan (0.220, 0.177). However, the average values of the voltage 104.04 kV and the load 4.55 mAs tell us that efforts can be made in the rooms of our study, increasing the voltage and reducing the load, to avoid unneeded doses of X-rays.

Standarisasi Indeks Eksposur untuk Memenuhi Kriteria Anatomi dan Aspek Teknis pada Radiografi Thorax Pediatrik

Background: Computed Radiography has an exposure index that used as an exposure indicator. But on radiographic examination, exposure index value sometimes ignored, and in the preliminary survey of pediatric chest examination resulting a large exposure index range. The aim of this study is to know the profile of exposure index value and the setting of the exposure factors, the assessment of anatomy criteria and technical aspect, and the right exposure factors such as kV and mAs on pediatric chest examination.Methods: The type of this research is descriptive quantitative. The research was done by collecting data related to pediatric chest radiograph (≤ 2 years) the value of exposure index was recorded, then the radiograph was assessed using questionnaires that filled by one respondent who is a radiologist. The data was analyzed by displaying the data of exposure index and anatomy criteria from questionnaires into the table form, and then conducted a descriptive analysis to be drawn conclusions.Results: The results showed the profile of exposure index value and the setting of the exposure factor has a fairly large exposure index range of 1084 – 2175, using 40 kV and 10 mAs and the collimation still often exceeds the object. Then for the assessment of the thorax anatomical criteria and the technical aspect overall was “Good Enough”, and the right exposure factors, that is: at 6 and 7 cm chest thickness was using 60 kV and 1,6 mAs; at 11 cm chest thickness was using 60 kV and 2 mAs, FFD 100 cm, and the setting of collimation as wide as object, the exposure index generated in the normal range that is 1251 – 1382.Conclusion: The right exposure factors on pediatric chest examination, that is: at 6 and 7 cm chest thickness was using 60 kV and 1,6 mAs; at 11 cm chest thickness was using 60 kV and 2 mAs, FFD 100 cm, and the setting of collimation as wide as object.

Recurrent croup in a young child: look beyond airways disease

We reported here a boy aged 5 years who presented for the evaluation of recurrent croup since infancy. On chest examination, breath sounds were reduced throughout the right lung field with a shifting of the trachea and cardiac apex to the right side. The chest radiograph showed a small right lung with decreased vascularity, hyperinflated left lung and mediastinum shifted towards the right side. Flexible bronchoscopy revealed tracheomalacia with left bronchomalacia due to external pulsatile compression. In CT angiogram, the right pulmonary artery (PA) was absent with dilated left PA. Echocardiography did not show any features of pulmonary arterial hypertension (PAH). Since the child was growing well, and there was no limitation of activity and evidence of PAH, he was managed conservatively and kept on follow-up. Though unilateral absent PA is a rare condition, it should be suspected in children with unilateral hypoplastic lung.

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

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.