Application of Mobile Helical Computed Tomography in Combatting COVID-19

Background: Chest computed tomography (CT) is a recommended screening and assessment tool for patients with suspected coronavirus disease (COVID-19). However, CT units are currently not available in many temporary hospitals and centralized isolation places. Objectives: To delineate the workflow of mobile CT unit and evaluate its role in screening for COVID-19 infection in temporary hospitals and centralized isolation locations. Patients and Methods: Two hundred and twenty-three patients under medical observation in temporary centralized isolation were enrolled in this study. All patients underwent reverse-transcription polymerase chain reaction (RT-PCR) testing and mobile CT chest examinations. Communication, storage, and browsing of CT data were performed with 4G and cloud technology. Image quality and radiation dose were evaluated and compared with a commercial conventional 64-row CT scanner. Additionally, the sensitivity of initial chest CT and the initial RT-PCR for COVID-19 were compared. Results: CT examination of 223 patients was completed within 19 work hours. Communication, storage, and browsing of CT data via 4G and cloud technology were seamless. There were no significant differences in subjective image quality scores between groups (P > 0.05). COVID-19 pneumonia was eventually confirmed in 49 patients (21.97%). The sensitivity of initial chest CT was greater than that of the initial RT-PCR (85.71% and 67.35%, respectively) (P < 0.05). Conclusion: Screening suspected patients for COVID-19 by mobile CT in temporary hospitals and isolation points is a simple, efficient, and highly sensitive technique for early diagnosis and control of COVID-19.

The SHARED Project: A Novel Approach to Engaging African American Men to Address Lung Cancer Disparities

Black men are disproportionately impacted by lung cancer morbidity and mortality. Low-dose helical computed tomography (LDCT) lung cancer screening has demonstrated benefits for reducing lung cancer deaths by identifying cancers at earlier, more treatable stages. Despite the known benefits, LDCT screening is underutilized in black men. Studies in racially heterogeneous populations have found correlations between screening behaviors and factors such as physician trust, physician referral, and a desire to reduce the uncertainty of not knowing if they had lung cancer; yet little is known about the factors that specifically contribute to screening behaviors in black men. Community engagement strategies are beneficial for understanding barriers to health-care engagement. One community engagement approach is the citizen scientist model. Citizen scientists are lay people who are trained in research methods; they have proven valuable in increasing communities’ knowledge of the importance of healthy behaviors such as screening, awareness of research, building trust in research, and improving study design and ethics. This paper proposes an intervention, grounded in community-based participatory research approaches and social network theory, to engage black men as citizen scientists in an effort to increase lung cancer screening in black men. This mixed-methods intervention will examine the attitudes, behaviors, and beliefs of black men related to uptake of evidence-based lung cancer screening.

The Effects of Multi-Slice Helical Computed Tomography and Phlebography on Edema Regression Nursing of Lower Limbs Varicosis

Objective: To explore the effects of multi-slice helical computed tomography (MSCT) and phlebography on edema regression nursing of lower limbs varicosis, and to analyze the values of MSCT and phlebography on the diagnosis and treatment of lower limb varicosis. Methods: A total of 193 patients with lower limb varicosis treated in the Vascular Surgery Department were included as the research objects. According to different examination methods, the included patients were divided into the MSCT group, and the MSCT combined with the phlebography group, Then, patients in both groups received joint treatment of high ligation and varicectomy. The Gabor filtering-based algorithm and the Mean-Variance Efficient Frontier (MVEF) algorithm were used to smoothen the obtained images. Also, the operation rates and contradiction compositions of patients in both groups were analyzed. Patients who received surgical treatment were followed up for three months to one year; whether the deep vein thrombosis (DVT) occurred in them were observed, as well as the edema regression. Results: As for gender, grading, disease history, duration of disease, and onset age of both groups, no statistical significance was found (P > 0.05). Compared to group A, the positive detection rate of postoperative DVT was lower in group B, so did the operation rate. In group A, 32 cases of edema regressed significantly, and the disease condition was relieved. In group B, 35 cases of edema were regressed. Conclusion: Compared with MSCT, phlebography had a higher screening rate for indications of lower limb varicosis, which could effectively reduce the probability of DVT after operations and relieve the symptoms of edema in patients. In addition, although the sensitivity of MSCT was relatively low, it could be used for the primary screening diagnosis of lower limb varicosis.

Pathogenetically-oriented therapy for novel coronavirus infection

Aim: to assess clinical efficacy of azoximer bromide in the complex inpatient treatment for COVID-19. Patients and Methods: the study included 20 patients aged 16–65 years with verified moderate novel coronavirus infection who received inpatient care. All patients were divided into two groups. Study group patients (n=10) received complex treatment that included azoximer bromide. Control group patients (n=10) received standard therapy only. The criterion of treatment efficacy was the improvement of major disease symptoms, radiographic manifestations, and pro-inflammatory laboratory tests. Results: azoximer bromide as a component of the treatment for novel coronavirus infection provides more rapid symptom relief (i.e., cough, sputum, fever, respiratory rate) compared to the standard therapy (p<0.05). azoximer bromide also provides more rapid radiographic improvement as demonstrated by helical computed tomography, i.e., by day 14, the percentage of lung parenchyma involved was 5% in the study group and 10–12% in the control group (p<0.05). In addition, the improvement of pro-inflammatory laboratory tests (i.e., normal WBC count, decrease in ESR) was revealed as well (p<0.05). Conclusion: azoximer bromide as a component of the complex treatment for novel coronavirus infection is associated with the clinical improvement that manifests with more rapid relief of inflammation and lung parenchyma involvement as compared with the standard therapy. No adverse reactions were reported. KEYWORDS: coronavirus infection, SARS-CoV2, COVID-19, pneumonia, immune correction, pathogenetically-oriented therapy, azoximer bromide. FOR CITATION: Mukhamadieva L.R., Mavzyutova G.A., Tyurina E.B., Kuzovkina O.Z. Pathogenetically-oriented therapy for novel coronavirus infection. Russian Medical Inquiry. 2020;4(4):192–198. DOI: 10.32364/2587-6821-2020-4-4-192-198.

Ischiofemoral syndrome as a mask of lesser trochanter apophysitis in a young athlete

Non-specific pelvic pain in young athletes can mask atypical disorders that are exceedingly rare among non-athletes. The diagnosis of this syndrome is very problematic, since it may concern different specialties, such as pediatric surgery, pediatrics, traumatology and orthopedics, neurology, gastroenterology, pediatric gynecology, etc. We report a case of lesser trochanter apophysitis in a 12-year-old female gymnast, who had been initially misdiagnosed and the disease had a mask of ischiofemoral syndrome. During the two-year diagnostic search, the athlete has undergone numerous instrumental examinations, some of them for several times (ultrasound, radiography, magnetic resonance imaging, helical computed tomography), as well as general clinical and laboratory examinations; however, many of them did not really narrow down, but expanded the range of diagnostic hypotheses. Treatment gave no positive dynamics. Laboratory and instrumental examinations performed within 2 years excluded a number of pathologies, but did not help to establish a correct diagnosis. Physical examination with the consideration of patient’s professional activity was a key method in the diagnosis of lesser trochanter apophysitis. The patient demonstrated positive dynamics in response to treatment, which confirmed the diagnosis. This case once again demonstrates possible atypical course of the diseases in young athletes and the importance of physical examination, which can significantly narrow down the diagnostic search. Key words: young athletes, pelvic pain syndrome, lesser trochanter apophysitis, ischiofemoral syndrome

Modern imaging modalities for diseases associated with obstructive jaundice syndrome

Obstructive jaundice (OJ) is a syndrome characterized by bile staining of the skin, mucous membranes, and sclera as a complication of pathological processes that lead to disruption of the bile ducts at various levels of the biliary tract. Obstructive jaundice represents various diseases with different onset, course, and outcome, as well as etiology, which implies the difficulties of the diagnostic process. Identification of a cholestasis cause and treatment of patients with OJ remain urgent and difficult tasks due to the steady rise in diseases of the hepatopancreatoduodenal zone (HPDZ) and the high frequency of diagnostic errors. The latter can lead to the progression of liver failure, as well as to the development of severe complications, which, in turn, are fatal. A significant role in detecting HPDZ pathology belongs to the radiological methods of studies, such as transabdominal ultrasonography (TUS), endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound (EUS), intraductal ultrasonography (IDUS), magnetic resonance cholangiopancreatography (MRCP), helical computed tomography (hCT), and helical CT cholangiography (hCT-CG). However, it should be noted that, as of today, there is no well-established conventional radiological algorithm for determining the causes of biliary obstruction. This, in turn, leads to repeated or sequential inefficient administration of all possible methods of visualization, complicating the diagnostic algorithm. In this regard, it is advisable to perform an in-depth study of the Russian and foreign literature sources, highlighting the problem of an early and highly effective diagnostics of the causes of biliary obstruction in patients with OJ.