Bilateral Lung Involvement Research Articles

Analysis of multiple organ function damage in patients with severe COVID-19 pneumonia.

This study aims to analyze the changes and significance of organ function indices in patients with severe Coronavirus Disease 2019 (COVID-19) pneumonia for prediction of major organ damages and guiding treatment schemes. 63 patients with severe COVID-19 pneumonia were selected as the severe group and 73 patients with mild syndromes were selected as the mild group. SAS9.4 software was used for statistical analysis of the data. Levels of ALT, AST, cTnI, Cr, PT, APTT and Ddimer of the severe group were significantly higher while PLT was lower than those of the mild group. The data of all quantitative variables were converted into categorical variables. Significantly higher levels of AST, ALB, D-dimer and higher proportion of bilateral lung involvement were observed from the severe group comparing to those in the mild group, while the difference in the other indices between the two groups was insignificant in statistical perspective. There are significant differences in the levels of multiple organ function indices between the severe group and the mild group of patients with COVID-19 pneumonia infection. Through examining the relevant indices, conditions of patients' multiple organ function damage could be predicted and used as guidance of treatment.

Chest X-Rays Findings and Correlation to Clinical Severity in COVID-19 Patients

Background: The manifestations of COVID-19 infection show a wide range of respiratory symptoms. Chest X-ray (CXR) is helpful for assessment, treatment, and monitoring hospitalization. Objective: To describe and distinguish CXR findings of patients confirming COVID-19 with correlation to clinical severity. Material and Methods: Between March and May 2020 all patients at Pattani provincial and field hospitals in Pattani Province with positive RTPCR results for COVID-19 were retrospectively reviewed. Patients’ demographics and clinical characteristics were evaluated and clustered in two groups based on clinical severity. Baseline CXRs were reviewed and correlated with clinical severity. Results: Forty-eight patients, including 31 males (64.6%) males and 17 females (35.4%), were admitted with confirmed COVID-19. Their age ranged from 3 to 91 years (48.7±18.4 years). Fifteen (31.3%) of the cases had comorbidities. Forty-eight baseline CXRs were obtained, in which 25.0% (12) of CXRs showed abnormalities. The most common pattern and distribution on CXRs was patchy and/or confluent ground-glass opacities and peripheral subpleural distribution in 10/12 (83.3%). The non-severe group showed predominance in the lower lung zone in 4/5 (80%), while in the severe group, they showed multiple zones of lung involvement in 6/7 (85.7%). Bilateral lung involvement in 5/7 (71.4%) was most frequent in the severe group (p<0.001). Conclusion: The most frequent abnormal pattern on CXRs in COVID-19 were patchy and/or confluent ground-glass opacities with peripheral subpleural distribution. The severe group showed bilateral and multiple lung zones involvement. The CXR findings of lung consolidation, perihilar distribution, bilateral, and multiple lower lung zone opacities, in conjunction with other zones of lung involvement suggested a higher risk of a patient developing severe manifestations of COVID-19. Keywords: Chest X-ray; Coronavirus; COVID-19; SARS-CoV-2; Severity

Correlation of Radiological Findings (High Resolution Computed Tomography Chest) with Anti-SARS-COV-2 Antibodies in Patients Visiting Tertiary Care Hospitals

Background: Coronavirus (COVID 19) pandemic has taken so many lives and has contributed to an increase in morbidity due to its complications. The research is still in infancy and much has yet to be investigated. Objective: To correlate the HRCT findings on chest with antibody testing in patients visiting tertiary care hospitals in Lahore. Methodology: Three hundred and thirty-two patients with mild, moderate and severe symptoms of COVID 19 were recruited. Those with raised CRP levels were sent for HRCT chest and PCR testing as protocol of the hospitals. All patients were tested with Rapid antibody kits for reactivity. Results: Showed that males were affected more than females. Similarly, non-health care workers were more affected. All patients with bilateral involvement of lungs on HRCT chest and positive PCR findings also tested reactive on antibody testing. However, a few people with bilateral lung involvement and negative on PCR testing got reactive results on Rapid antibody testing. Linear regression model shows significant correlation of HRCT chest findings with Ant-SARC- COV 2 antibodies. Conclusion: HRCT findings (Unilateral and bilateral lung infiltrates) correlated significantly with Anti SARC-COV 2 Antibodies.

Utility of the serial portable chest x-ray for the diagnosis and quantification of COVID-19 patients

ObjectiveTo determine the role of the serial portable chest X-ray in the diagnosis and quantification of patients with confirmed COVID-19 admitted to a tertiary care hospital. MethodsA retrospective study was conducted at Dow Institute of Radiology, Dow University of Health Sciences. Confirmed positive cases of COVID-19 from November 2020 to January 2021 were retrospectively studied. Patients' demographics and clinical characteristics, chest X-ray findings, and outcomes were retrieved through electronic medical records. Baseline and final follow-up chest X-rays findings were compared by using chest X-ray severity score. Multivariable logistic regression was used to evaluate the relationship between patients’ characteristics and patient outcomes. ResultsThe study included 329 patients with a mean age of 56.43 ± 13.10 years (range 16–85 years). Peripheral consolidation and ground glass opacities (89.4%) were the most common X-ray findings followed by bilateral lung involvement (79.0%) and perihilar consolidation/ground glass opacities (69.9%). Among the patients who were admitted, 61.4% were discharged, 49.5% had prolonged length of stay ≥10 days, and 37.7% died. After adjustment of all patients' characteristics, the multivariate model showed no significant difference in chest X-ray severity score in relation to the patient's outcome. Patients who were admitted to the intensive care unit, and received oxygen support, bilevel positive airway pressure, and a ventilator were significantly associated with the outcome of being discharged, prolonged hospital stay, and death. ConclusionPeripheral consolidation and ground glass opacities were the most common chest X-ray findings in admitted COVID-19 patients. No significant difference in chest X-ray severity score was noted in the primary outcome of being discharged, prolonged hospital stay, and death. There is no requirement for daily chest X-rays in hospitalized patients until required in the condition of worsening symptoms or significant intervention such as endotracheal intubation.

Low Dose Radiotherapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19): Final Results

Purpose/Objective(s)To evaluate the results of LD-RT to lungs in the management of patients with COVID-19 pneumonia.Materials/MethodsWe conducted a prospective phase I-II trial enrolling COVID-19 patients ≥50 years-old, with bilateral lung involvement at imaging study and oxygen requirement. Patients received 1 Gy to whole lungs in a single fraction. Primary outcome was radiological response assessed as severity and extension scores at days +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/ FiO2 index (SAFI), at day +3 and +7. Descriptive analyses were summarized as means with standard deviation (SD) and/or medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables.ResultsForty-one patients were included. Median age was 71 (IQR 60-84). Eighteen patients (47%) previously received any antiCOVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids during LD-RT. Extension score improved significantly (p=0.02) on day +7 and SAFI on day +3 and + 7 (p<0.01). Median SAFI on day 0 was 147 (IQR 118-264), 230 (IQR 120-343) on day +3 and 293 (IQR 121-353) on day +7. Significant decrease was found in C-reactive protein on day +7 (p=0.02) and in lymphocytes counts on day +3 and +7 (p=0.02). Median number of days in hospital after RT was 11 (range 4-78). With a median follow-up of 60 days after LD-RT, 26 (63%) patients were discharged, 11 (27%) died because of COVID respiratory failure and 4 (10%) died of other causes.ConclusionLD-RT is a feasible and well-tolerated treatment that may lead to rapid clinical improvement. Large randomized trials should be done to establish the efficacy of LD-RT to treat COVID-19 pneumonia.

Do COVID-19 CT features vary between patients from within and outside mainland China? Findings from a meta-analysis.

BackgroundChest computerized tomography (CT) plays an important role in detecting patients with suspected coronavirus disease 2019 (COVID-19), however, there are no systematic summaries on whether the chest CT findings of patients within mainland China are applicable to those found in patients outside.MethodsRelevant studies were retrieved comprehensively by searching PubMed, Embase, and Cochrane Library databases before 15 April 2022. Quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of the included studies, which were divided into two groups according to whether they were in mainland China or outside. Data on diagnostic performance, unilateral or bilateral lung involvement, and typical chest CT imaging appearances were extracted, and then, meta-analyses were performed with R software to compare the CT features of COVID-19 pneumonia between patients from within and outside mainland China.ResultsOf the 8,258 studies screened, 19 studies with 3,400 patients in mainland China and 14 studies with 554 outside mainland China were included. Overall, the risk of quality assessment and publication bias was low. The diagnostic value of chest CT is similar between patients from within and outside mainland China (93, 91%). The pooled incidence of unilateral lung involvement (15, 7%), the crazy-paving sign (31, 21%), mixed ground-glass opacities (GGO) and consolidations (51, 35%), air bronchogram (44, 25%), vascular engorgement (59, 33%), bronchial wall thickening (19, 12%), and septal thickening (39, 26%) in patients from mainland China were significantly higher than those from outside; however, the incidence rates of bilateral lung involvement (75, 84%), GGO (78, 87%), consolidations (45, 58%), nodules (12, 17%), and pleural effusion (9, 15%) were significantly lower.ConclusionConsidering that the chest CT features of patients in mainland China may not reflect those of the patients abroad, radiologists and clinicians should be familiar with various CT presentations suggestive of COVID-19 in different regions.

High Resolution Computed Tomography Chest Findings Among Post-COVID Patients

&#x0D; Background: HRCT chest has proven to be a helpful radiological modality to assess the course of disease. The main objective of the study was to analyze the pattern of lung involvement on HRCT chest among post-Covid patients.&#x0D; Methodology: This cross-sectional study was carried out in the post Covid patients (30 days after discharge) from Nov 2020 to July 2021 in Sahiwal Teaching Hospital, Pakistan. Total 180 patients were selected through non probability consecutive sampling technique. Whole body Multi Slice CT scan 128 Slices by GE discovery was used to get HRCT of chest and to document various patterns and stages of pulmonary fibrosis in the post-COVID patients. The data was analyzed using the IBM SPSS 28.0.0 2021. Various radiological findings were expressed in percentages.&#x0D; Results: A total of 77.8% patients had bilateral lung involvement, while 22.2% had unilateral lung involvement after one month of disease.&#x0D; Ground Glass Haze was the commonest radiological pattern, found in 140 (77.8%) cases. Other radiological patterns were Air Space Opacification (47.2%), Septal Thickening (20%) and Fibrotic Bands (26.1%). Traction Bronchiectasis (10%) and Honey Combing (7.8%) were among the lesser ones reported. About 62% patients had mixed findings on HRCT Chest. Diagnosis of Organizing Pneumonia was made in 166 (92.22%) patients while 14 (7.78%) patients were labelled as UIP (Usual Interstitial Pneumonia) with honey-combing in HRCT chest. The involvement of Right Lower Lobe was in 165 (91.7%) of cases. Right Middle Lobe remained fairly spared and was seen in 120 (66.7%) cases.&#x0D; Conclusion: Patchy ground glass haze seen bilaterally in lower lung lobes are the commonest abnormalities in HRCT chest of post-COVID patients.&#x0D; Keywords: Covid-19, Pneumonia, Radiology

P178 An unusual recurrent case of Cryptococcal sacroilitis in an immunocompetent elderly female in Rajasthan, India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMBackground Cryptococcus lives in the environment all over the globe. Although it spreads via inhalation route still most of the exposed individuals never get sick as the majority of cases are seen in immunocompromised. Objective of this clinical case report is to highlight the rare fungal etiology associated with iliac bone abscess to avoid incorrect diagnosis and prompt management of case.Case PresentationA 70-year-old elderly female presented with hip pain for a month duration, not relieved with analgesics in September, 2021. In MRI a well-defined irregularly marginated hyperintense focal lesion was found in left iliac bone with joint effusion suggestive of infective etiology, tubercular, or less likely metastasis.CT-guided biopsy reported occasional hyphae-like fragments giving an impression of acute on chronic osteomyelitis with suspicion of fungal infection. Culture reported Cryptococcus neoformans. Fungal markers and Beta-d glucan were indeterminate and Galactomannan was found negative for the sample. Extrapulmonary TB was ruled out by AFB staining, MGIT Culture, and GeneXpert MTB. Bone scan, tumor markers, and PET scan ruled out osteolytic lesion secondary to metastasis. Though PET Scan and HRCT thorax confirm pulmonary involvement giving a picture of bilateral interstitial lung disease along with multiple enlarged lymph nodes.Patient serum was found negative for HIV, HBV, and HCV. Liver and renal function tests were within normal range and in hematology, ESR was raised (50; normal range:0-20). Patient is hypertensive with HbA1c of 5.3. There was no history of travel, avian exposure, weight loss, and COVID-19 infection. Patient was started on voriconazole and considering generalized lymphadenopathy, a therapeutic trial of anti-tubercular therapy was started which was stopped within a week on patient non-compliance. Abscess resolved with voriconazole and patient was discharged.In February 2022, Patient presented with similar complaints. CT scan of this fluctuant nodule depicted hypoechoic lesion which was ultrasound-guided drained. Sections show many rounds of oval fungal organism which were found PAS positive with mucicarmine and alcian blue positive capsule. Budding yeast cells were seen on KOH mount and India ink preparation demonstrated capsule which was confirmed by Cryptococcal Antigen test giving an overall impression in favor of Cryptococcosis. Patient was started on oral fluconazole and Injection liposomal amphotericin B 250 mg for 14 days.Discussion and ConclusionThis is the first case of skeletal Cryptococcosis at our institution which was managed by antifungals without surgical debridement resulting in resolution of abscess. Isolated focal iliac bone cryptococcosis is unusual but may occur in immunocompetent with everyday exposure to the organism. Herein, Patient had bilateral lung involvement along with multiple lymphadenopathies with no evidence of TB bacilli which inferences that the isolate most likely originated from environmental bird droppings and has disseminated from pulmonary lesion to the iliac bone. The radiological findings of iliac cryptococcosis abscess were nonspecific. A definitive diagnosis was made on histopathological and fungal examinations of ultrasound-guided drained abscess. Patient will be followed in the near future for relapse or any other medical issues related to the case.

P262 Clinico- microbiological profile of post-COVID pulmonary fungal infections encountered during the second wave of COVID-19 pandemic at a tertiary care teaching hospital in the Himalayas

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectiveThe study aims to generate preliminary data about post-COVID pulmonary fungal infections in the Himalayas and analyze patients’ micro-radio-clinical profiles and outcomes.MethodologyWe conducted a retrospective study at a tertiary care teaching hospital in the Himalayas to generate preliminary post-COVID pulmonary fungal infection data. Sputum, Endotracheal Tube (ET), and Bronchoalveolar lavage (BAL) samples of patients sent to the Mycology laboratory were subjected to KOH mount and aerobic inoculation on Sabouraud dextrose agar plates at 37°C. The patients’ symptoms, diagnosis, clinical-radiological profile, and outcome were collected from the hospital database.ResultsAmong n = 16 cases of post-COVID pulmonary fungal infections aged 53 +/- 13.38 years, n = 7 (43.75%) had Pulmonary Aspergillosis (n = 5 A. fumigatus, n = 1 A. flavus, n = 1 A. niger), n = 5 (31.25%) had Pulmonary Mucormycosis (Rhizopus arrhizus), and n = 4 (25%) had mixed infection. In 2 of 4 mixed infection patients, R. arrhizus was identified on KOH microscopy and A. fumigatus on SDA Agar. Both A. fumigatus and R. arrhizus were identified on KOH Microscopy of the third patient, while only A. fumigatus was cultivated on his SDA Agar. Aspergillus flavus and R. arrhizus were isolated simultaneously from the sample of the last patient, but only R. arrhizus was identified on KOH Microscopy.Clinical symptoms were similar among Pulmonary Aspergillosis and Mucormycosis patients, but hemoptysis was reported only among Pulmonary Aspergillosis patients. Pre-existing co-morbid end-organ damage, AKI, CKD, CLD, COPD, and CAD was more common among Pulmonary Mucormycosis patients and rare among Pulmonary Aspergillosis patients. Treatment requirements and clinical outcomes of patients infected with either mold were similar. The clinical profile of mixed infection patients was notably different from the others. All the patients were males, none complained of chest pain or expectoration, and none had a history of PTB, AKI, CKD, CLD, COPD, or CAD. Only 2 (50%) mixed infection patients needed supplemental high flow oxygen, unlike all (100%) patients diagnosed with single mold infection. None of the mixed infection patients required steroids. Moreover, none of the mixed infection patients died, unlike 60% mortality in cases of single-species infections.On radiological investigation, n = 6 had typical thick-walled cavitary lesions with air-fluid levels and multiple centrilobular nodules giving a tree in bud appearance, of which n = 4 had bilateral lung involvement, and n = 2 had only one lung involved. n = 1 patient had a well-circumscribed lung abscess.ConclusionCOVID patients from the Himalayas had a higher prevalence of invasive pulmonary fungal infections, probably due to the dense surrounding vegetation. The immuno-compromised state following COVID-19 infection/treatment might be responsible for the progression of regular exposure to invasive pulmonary infection.

Pneumonia Frequency and Severity in Patients With Symptomatic COVID-19: Impact of mRNA and Adenovirus Vector Vaccines.

BACKGROUND. Additional evidence of the role of COVID-19 vaccination in reducing pneumonia frequency and severity in the setting of breakthrough infection could help combat ongoing vaccine hesitancy. OBJECTIVE. The purpose of this article was to compare the frequency and severity of pneumonia on chest CT in patients with confirmed COVID-19 between patients who are unvaccinated and those who are fully vaccinated by messenger RNA (mRNA) or adenovirus vector vaccines. METHODS. This retrospective single-center study included 467 patients (250 men, 217 women; mean age, 65 ± 17 [SD] years) who underwent chest CT between December 15, 2021, and February 18, 2022, during hospitalization for symptomatic COVID-19, confirmed by reverse transcriptase-polymerase chain reaction assay. A total of 216 patients were unvaccinated, and 167 and 84 patients were fully vaccinated (defined as receipt of the second dose at least 14 days before COVID-19 diagnosis) by the BNT162b2 mRNA vaccine or the ChAdOx1-S adenovirus vector vaccine, respectively. Semiquantitative CT severity scores (CT-SS; 0-25 scale) were determined; CT-SS of 0 indicated absence of pneumonia. Presence of bilateral involvement was assessed in patients with pneumonia. Associations were explored between vaccination status and CT findings. RESULTS. The frequency of the absence of pneumonia was 15% (32/216) in unvaccinated patients, 29% (24/84) in patients fully vaccinated with ChAdOx1-S vaccine, and 51% (85/167) in patients fully vaccinated with BNT162b2 vaccine (unvaccinated and ChAdOx1-S vs BNT162b2: p < .001; unvaccinated vs ChAdOx1-S: p = .08). Mean CT-SS was significantly higher in unvaccinated patients (9.7 ± 6.1) than in patients fully vaccinated with BNT162b2 (5.2 ± 6.1) or ChAdOx1-S (6.2 ± 5.9) vaccine (both p < .001). Full vaccination was significantly associated with CT-SS independent of patient age and sex (estimate = -4.46; p < .001). Frequency of bilateral lung involvement was significantly higher in unvaccinated patients (158/184, 86%) and in patients fully vaccinated with ChAdOx1-S vaccine (54/60, 90%) than in patients fully vaccinated with BNT162b2 vaccine (47/82, 57%) (both p < .001). CONCLUSION. Pneumonia frequency and severity were lower in patients with full vaccination by mRNA and adenovirus vector vaccines who experienced breakthrough infections in comparison with unvaccinated patients. CLINICAL IMPACT. The visual observation by radiologic imaging of the protective effect of vaccination on lung injury in patients with breakthrough infections provides additional evidence supporting the clinical benefit of vaccination.

Maternal mortality cases due to COVID-19 pandemic in a tertiary referral hospital

Objective: This study aimed to report the clinical prognoses, laboratory findings, treatment procedures, and neonatal outcomes, from hospitalization to death, of Coronavirus Disease 2019 (COVID-19)-related cases of maternal mortality at our clinic. Methods: Fifteen cases of COVID-19-related maternal mortality, between April 2020 and October 2021, in the Department of Obstetrics &amp; Gynecology of a Training and Research Hospital were retrospectively analyzed for the purpose of the study. Results: During the study period, a total of 501 symptomatic pregnant women received inpatient treatment for COVID-19. In our case group, 93.3% of maternal deaths due to COVID-19 occurred as a result of the worsening of the clinical condition of third-trimester pregnant women. In these patients whose clinical condition deteriorated, delivery was performed after the decision to give birth, and 86.6% of mortalities occurred in the postpartum period and 13.4% before delivery. There was at least one risk factor in 60% of the cases, with obesity being the most prevalent. In all mortality cases, there were pulmonary complaints (shortness of breath and cough) at admission, and bilateral lung involvement was observed during lung imaging; furthermore, there was a corresponding increase in the mean leukocytosis, AST, ALT, LDH, D-dimer, ferritin, procalcitonin, IL-6, and pro-BNP levels with the worsening of the clinical prognosis. The duration of hospitalization and intensive care unit stays were 6.87±3.18 and 5.33±3.27 days, respectively. The mean period of the delivery-to-mortality for mothers was 5.92±3.48 days and the mean period of the intubation-to-mortality for mothers was 3.33±3.15 days. Conclusion: The risks of severe illness and death associated with COVID-19 increased in the third trimester compared to the first and second trimesters. All mortality cases involved unvaccinated pregnant women, of which most had at least one risk factor, obesity being the most prevalent. There was no COVID-19-related mortality in the newborns, and it was found that prematurity rates increased due to maternal disease.

Clinical characteristics, radiological features, and disease severity of bronchiectasis according to the spirometric pattern

Bronchiectasis show various ventilatory disorders in pulmonary function. The characteristics and severity of patients with bronchiectasis according to these pulmonary dysfunctions are still very limited. This study aimed to evaluate the clinical, radiologic feature and the disease severity of patients with bronchiectasis according to spirometric patterns. We retrospectively evaluated 506 patients with bronchiectasis who underwent pulmonary lung function test (PFT) at a referral hospital between 2014 to 2021. The results showed that cylindrical type was the most common (70.8%) type of bronchiectasis on chest Computed tomography (CT), and 70% of patients had bilateral lung involvement. On the other hand, obstructive ventilatory disorder was the most common (51.6%), followed by normal ventilation (30%) and restrictive ventilatory disorder (18.4%). The modified Medical Research Council (mMRC) was highest in patients with obstructive ventilatory disorders, Modified Reiff score [median (interquartile range)] [6 (3–10), P < 0.001], FACED (FEV1, Age, Chronic colonization, Extension, and Dyspnea) score [3 (1–4), P < 0.001], and Bronchiectasis Severity (BSI) score [8 (5–11), P < 0.001] showed significantly highest values of obstructive ventilatory disorder rather than restrictive ventilatory disorder and normal ventilation. More than half of patients with bronchiectasis had obstructive ventilatory disorder. Bronchiectasis with obstructive ventilatory disorders has more dyspnea symptom, more disease severity and more radiologic severity. There was no significant association between spirometric pattern and radiologic type, but the more severe the radiologic severity, the more severe the lung function impairment.

HRCT Evaluation of Post Vaccinated RT-PCR Positive COVID-19 Patients at A Dedicated COVID-19 Hospital

Background: Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Large-scale vaccination of risk groups and later the general population is the single most effective public health measure for mitigation of the COVID-19 pandemic.&#x0D; Methods and Materials: This prospective cross sectional study was carried out at Dhaka North City Corporation dedicated COVID-19 hospital, Mohakhali, Dhaka, enrolling 50 (fifty) vaccinated RT-PCR positive COVID-19 patients.&#x0D; Results: Majority of the patients were &gt;50 years old. Most of the patients had bilateral lung involvement and ground glass was the predominant CT pattern. 20% patients had consolidation in HRCT scan. Most of the patients (46%) had mild disease and only 18% patients had severe disease. Severe cases were more common (77.8%) in older (&gt;50years) patients. 20% of the patients had 50-75% and only 6 % patients had more than 75% of total lung involvement. 52% patients had less than 25% lung involvement. Lung involvement was significantly higher in older patients. Patients had to stay an average of 6.2 days in hospital. Older patients had to stay more days in the hospital than younger patients. 2% (1) of COVID-19 patients died after admitting into our hospital.&#x0D; Conclusion: Vaccination can effectively reduce mortality and morbidity of COVID-19 patients by reducing the active number of cases as well as severity of the disease.

The Effect of Hesperidin on Laboratory Parameters of Patients with COVID 19: A Preliminary Report of a Clinical Trial Study

Background: Hesperidin is a secondary metabolite of the flavonoid group. Due to its antioxidant, anti-inflammatory and anti-viral properties, it can be helpful as a treatment option for patients with COVID 19.&#x0D; Methods: This study was conducted as a clinical trial in Masih Daneshvari Hospital in Tehran. After providing complete explanations and obtaining written consent, patients with new coronavirus (COVID-19) were included in the study if they met the inclusion criteria. 20 patients with the new coronavirus (COVID-19) were included in the study. Patients were then randomly divided into hesperidin and control groups. Patients in the hesperidin group received 1 mg of hesperidin orally intravenously every 6 hours for 5 days, whereas in the control group, they did not. Then, the desired variables were measured during the research period. Patients were monitored for adverse drug reactions based on clinical symptoms and signs. The results were evaluated with regard to the design of the questionnaire and its completion using t-test and SPSS16 software.&#x0D; Results: Patients with equal gender ratio were studied and diabetes mellitus with a prevalence of 60% had the highest prevalence among patients. On the other hand, 85% of these patients presented with bilateral lung involvement. Using hesperidin decreased lymphocytes, CRP, ESR, LDH, D-dimer, and IL-6 and increased WBC, Hb and Plt. None of the mentioned changes were significant (p&gt;0.05).&#x0D; Conclusion: Utilizing hesperidin could not cause significant changes in the level of immunological and inflammatory factors in patients with COVID 19.

Texture-based CT radiomics distinguishes radiation and immunotherapy induced pneumonitis in stage III NSCLC.

8555 Background: Recent changes to the standard of care for unresectable stage III NSCLC include chemoradiation followed by consolidative immunotherapy (IO). Pneumonitis is a well-known complication of radiotherapy (RT) and has been increasingly reported in association with IO. Although rare, pneumonitis can cause severe morbidity and possibly death in extreme cases. Differentiating RT and IO-induced pneumonitis (RTP vs IOP) is crucial for acute management and future considerations of individualized treatment. However, the clinical and radiological features of RTP and IOP may be similar and often indistinguishable on computed tomography (CT). Texture-based CT radiomics has previously been used to distinguish benign and malignant nodules on lung CT. In this study, we explore if radiomic features extracted from lung CT can distinguish between RTP and IOP. Methods: From 236 patients with stage III NSCLC who underwent chemoradiation followed by consolidative durvalumab, we identified 110 cases of treatment-related pneumonitis. IOP cases were identified through a retrospective review of electronic medical records and independently verified by a thoracic oncologist using features such as bilateral lung involvement, inflammatory changes outside the field of RT, temporal relationship to IO, and response to treatment. Inflammatory lesions were manually annotated using Slicer 3D. After excluding cases without discernible cause and non-identifiable lung lesions (n = 61), we included 49 cases in the study (RTP n = 20; IOP n = 29). A total of 555 features from Gabor, Laws, Laplace, and Haralick feature families were extracted on a pixel level from post-treatment CT images. A support vector machine (SVM) classifier was trained with the most discriminating features identified by Wilcoxon rank-sum test feature selection method. The classifier performance for distinguishing RTP vs. IOP was assessed by averaging the area under the receiver operating characteristic curve (AUC) values computed over 100 iterations of threefold cross-validation. Results: We identified the top 5 radiomic texture features distinguishing RTP from IOP including Haralick entropy, Haralick info, Laws median, and high- and low-frequency Gabor. Using 3-fold cross-validation, the SVM classifier model built on the radiomic features achieved an AUC of 0.83 (95% confidence interval, 0.78 - 0.86). Conclusions: Pneumonitis is a severe complication of both RT and IO that must be taken into consideration when evaluating future risks of IO-based therapies. The distinction between RTP and IOP remains challenging based on CT findings alone. Radiomic texture features analysis of post-treatment CT images can potentially differentiate RTP from IOP in stage III NSCLC patients who received RT followed by consolidative durvalumab. Additional multi-site independent validation of these quantitative image-based biomarkers is warranted.

P157 THE UNFORESEEABLE LINK: A CASE OF CORONARY–PULMONARY ARTERY FISTULA BRIDGING THE RIGHT CORONARY AND FIRST SEPTAL BRANCH OF THE LEFT ANTERIOR DESCENDING ARTERY

Abstract Coronary–pulmonary artery fistulas are a rare clinical entity with a variety of potential clinical manifestations. Albeit rare, such anomalies may in some instances involve multiple coronary arteries and go unnoticed until old age producing little to no clinical manifestations. We hereby present the case of an 83–year–old man, heavy smoker, with a history of cor pulmonale due to severe chronic obstructive pulmonary disease (COPD) who was recently diagnosed with metastatic lung adenocarcinoma. Incidentally, one of the ECGs performed revealed negative T waves in the precordial leads in the absence of symptoms and with a negative troponin curve. Echocardiography was thus performed and revealed severe left ventricular systolic dysfunction (EF 31%) with infero–postero–lateral akinesia. The patient underwent CT coronary angiogram, which ruled out any significant coronary stenosis but revealed a most surprising finding. An ectatic arterial branch running anteriorly and draining into the pulmonary artery connected the the proximal segment of the right coronary artery to the first septal branch of the left anterior descending (LAD) artery. Unfortunately, the severe left ventricular failure contraindicated any chemotherapy and the patient was discharged with a plan to start palliative radiotherapy. Three months later, the patient returned to our Hospital due to worsening weakness, cachexia and one episode of pre–sincope. During this hospital stay, he developed atypical chest pain with a significant troponin curve. A HRCT and pulmonary angiogram was performed, which revealed neoplastic progression with bilateral lung involvement and bone metastases, as well as bilateral segmental pulmonary emboli. Echocardiography demonstrated new segmental areas of akinesia (apical septum and mid–apical anteroseptal segment) suggestive of focal ischemic damage. Given the documented pulmonary embolism and the anomalous connection between pulmonary artery and coronary circulation, this event may have been caused by paradoxical embolism travelling from pulmonary to coronary circulation (most likely affecting the LAD artery territory). Due to the patient’s frailty however, this hypothesis could not be confirmed by coronary angiography. Despite their relative rarity, coronary–pulmonary artery fistulas involving multiple coronary arteries can occur in the elderly population with no previous clinical manifestations and may give rise to apparently unfathomable clinical constellations.

ATYPICAL MELANOMA MIMICKING A VASCULAR TUMOR : CLINICAL AND DERMOSCOPIC FINDINGS

Introduction: Completely amelanotic melanomas are rare and therefore often misdiagnosed. Analysis of dermoscopic features of the vascular pattern appears to be a reliable method to suggest these particular diagnosis. Case Presentation: we report a case of an atypical primary cutaneous melanoma of plantar localization which clinically mimicked an angiomatous tumor. Clinical examination showed an angiomatous lesion of 10 cm long axis, located on the lateral part of the left sole. The two adjacent nodules measured 3 cm each, one was angiomatous and the other erythematous. There were also multiple left inguinal adenopathies. Dermoscopic evaluation of the lesion revealed the lack of a pigmented network and a rich vascular bundle made of polymorphous linear vessels, dotted vessels, white lines and milky red areas. The patient underwent excision of an angiomatous nodule. The definitive diagnosis was provided by immunohistochemistry (tumor cells expressed S100 and Melan A). . Brain and thoracic-abdominal-pelvic CT scan showed bilateral nodular lung involvement and a segment VI liver lesion. We concluded to the diagnosis of a primary amelanotic metastatic melanoma stage 4. Clinical Discussion: The term amelanotic refers to tumors that have no pigmentation on visual and dermoscopic inspection. Amelanotic and hypomelanotic melanomas are rare. They could mimic many benign and malignant tumors. There are three forms of AM. The papulonodular form represents 58% and could be misdiagnosed as a vascular tumor, which was the case of our patient. The contribution of dermoscopy is valuable in the clinical orientation in case of amelanotic melanoma. There is a correlation between the stage of the melanoma and the vascular pattern(s) observed as well as their distribution. The prognosis of amelanotic melanoma is characterized with a lower survival rate and a high risk of recurrence. The treatment of amelanotic melanoma is similar to the pigmented counterpart. Conclusion: In order to avoid therapeutic delay, melanoma should be considered whenever there is a suspicious plantar lesion even in the absence of pigmentation. Dermoscopy is a non-invasive technique that could help in the diagnosis.

Epidemiologic and clinical characteristics of COVID-19 patients admitted in a tertiary care hospital in Khulna city

Background &amp; objective: The outbreak of coronavirus disease 2019 (COVID-19) has become a large threat to global health due to its high contagious nature and varied mortality. The number of infected cases and deaths are rising exponentially all over the world, including Bangladesh. This study aims to investigate the epidemiological and clinical features of COVID-19 patients admitted in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh. Methods: In this study, we included 110 RT-PCR positive COVID-19 cases at GMCH, Khulna, Bangladesh from 1 July, 2021 to 31 August, 2021. Demographic, clinical, laboratory and radiological data of the patients were recorded and analyzed. Results: Among 110 study subjects, 51.8% were male. The mean age was 52.6 years, with majority (43.6%) belonging to the age group of 40-59 years. Upon admission, the most frequent symptoms were fever (94.5%), cough (86.4%) and dyspnea (79.1%). Diabetes mellitus (42.7%) and hypertension (33.6%) were the most common comorbidities. Regarding laboratory parameters, neutrophilia and lymphocytopenia were observed in 72.7% and 58.2% cases, respectively. The mean D-dimer (2.9 mg/l) and CRP (61.7 mg/l) levels were above their normal limits. In high resolution CT scan of the chest (HRCT chest), bilateral lung involvement was present in 85.5% cases. Ground-glass appearance was the most frequent (89.1%) radiologic pattern. Among the study subjects, empirical antibiotic, antiviral (remdesivir) drug, and systemic glucocorticoid were given to 97.3%, 83.6% and 56.4% patients, respectively. Total 15 (13.6%) patients were severely affected with COVID-19 and admitted to the ICU, requiring mechanical ventilation. During our study, 12 patients (10.9%) died either due to multiple organ dysfunction syndrome or cardio-respiratory failure. Conclusion: The study provides key information about clinical characteristics and general management of COVID-19 patients, which may help physicians to identify the factors associated with adverse outcomes in this disease. Mediscope 2022;9(1): 9-15

Low-dose Radiation Therapy in the Management of COVID-19 Pneumonia (LOWRAD-Cov19). Final results of a prospective phase I–II trial

Background and purposeTo evaluate the results of low-dose radiation therapy (LD-RT) to lungs in the management of patients with COVID-19 pneumonia. Material and methodsWe conducted a prospective phase I–II trial enrolling COVID-19 patients ≥50 years-old, with bilateral lung involvement at imaging study and oxygen requirement (oxygen saturation ≤93% on room air). Patients received 1 Gy to whole lungs in a single fraction. Primary outcome was a radiological response assessed as severity and extension scores at days +3 and +7. Secondary outcomes were toxicity (CTCAE v5.0), days of hospitalization, changes in inflammatory blood parameters (ferritin, lymphocytes, C-reactive protein, d-dimer and LDH) and SatO2/FiO2 index (SAFI), at day +3 and +7. Descriptive analyses were summarized as means with standard deviation (SD) and/or medians with interquartile ranges (IQR). A Wilcoxon sign rank test for paired data was used to assess the CT scores and Chi Square was used to assess for comparison of categorical variables. ResultsForty-one patients were included. Median age was 71 (IQR 60–84). Eighteen patients (44%) previously received an anti-COVID treatment (tocilizumab, lopinavir/ritonavir, remdesivir) and thirty-two patients (84%) received steroids during LD-RT. The extension score improved significantly (p = 0.02) on day +7. Mean baseline extension score was 13.7 (SD ± 4.9) with a score of 12.2 (±5.2) at day 3, and 12.4 ± 4.7 at day 7. No differences were found in the severity score. SAFI improved significantly on day +3 and +7 (p < 0.01). Median SAFI on day 0 was 147 (IQR 118–264), 230 (IQR 120–343) on day +3 and 293 (IQR 121–353) on day +7. Significant decrease was found in C-reactive protein on day +7 (p = 0.02) and in lymphocytes counts on day +3 and +7 (p = 0.02). The median number of days in hospital after RT was 11 (range 4–78). With a median follow-up of 60 days after LD-RT, 26 (63%) patients were discharged, 11 (27%) died because of COVID respiratory failure and 4 (10%) died of other causes. ConclusionsLD-RT is a feasible and well-tolerated treatment that could lead to rapid clinical improvement. Large randomized trials would be required to establish the efficacy of LD-RT to treat COVID-19 pneumonia.

What Is COVID 19 Teaching Us about Pulmonary Ultrasound?

In lung ultrasound (LUS), the interactions between the acoustic pulse and the lung surface (including the pleura and a small subpleural layer of tissue) are crucial. Variations of the peripheral lung density and the subpleural alveolar shape and its configuration are typically connected to the presence of ultrasound artifacts and consolidations. COVID-19 pneumonia can give rise to a variety of pathological pulmonary changes ranging from mild diffuse alveolar damage (DAD) to severe acute respiratory distress syndrome (ARDS), characterized by peripheral bilateral patchy lung involvement. These findings are well described in CT imaging and in anatomopathological cases. Ultrasound artifacts and consolidations are therefore expected signs in COVID-19 pneumonia because edema, DAD, lung hemorrhage, interstitial thickening, hyaline membranes, and infiltrative lung diseases when they arise in a subpleural position, generate ultrasound findings. This review analyzes the structure of the ultrasound images in the normal and pathological lung given our current knowledge, and the role of LUS in the diagnosis and monitoring of patients with COVID-19 lung involvement.