Chest Scans Research Articles

HRCT imaging of pulmonary involvement in granulomatosis with polyangiitis and microscopic polyangiitis at disease onset and during follow-up

BackgroundThe pulmonary involvement in patients with microscopic polyangiitis (MPA) and granulomatosis with polyangiitis (GPA) is well known at disease onset but data during follow-up (after the induction regimen and when the first relapse occurs) are limited. Our goal was to analyze chest high-resolution computed tomography (HRCT) findings of (ANCA)-associated vasculitis patients. MethodAll consecutive unselected AAV patients over eighteen with positive ANCA status and with HRCT chest performed at the diagnosis were retrospectively enrolled between 2004 and 2019 at the Toulouse University Hospital (France). Two experienced pulmonologists and one expert respiratory radiologist reviewed independently HRCT chest scans. ResultsA total of 157 AAV patients were included in the study. Two-thirds of AAV patients had pulmonary involvement at diagnosis. Diffuse alveolar hemorrhage (DAH) was observed in 31.2 % of cases, nodules and masses in 18.5 %, bronchial airway involvement in 13.4 %, and interstitial involvement in 12.7 %. Following the induction regimen, chest HRCT scans over a two-year period demonstrated significant improvement in DAH and nodular manifestations, whereas bronchial airway involvement exhibited variability and half of cases of interstitial lung disease (ILD) had progressive course. Outcomes and survival rates are better for nodular and bronchial involvement. DAH was the most frequent cause of deaths. Progressive fibrotic changes in ILD over time could impact prognosis despite AAV remission. ConclusionEmploying a pattern-based approach with HRCT chest scans to assess lung involvement could be valuable in predicting treatment response, relapse, mortality, and could improved the management of AAV patients.

The Acute Inflammatory Biomarkers - Are They Cost Effective and Real Time Early Predictors of Mortality in Acute Pneumonia? - A Prospective Observational Study

Introduction: The CT chest and investigations like IL6 and TNFɑ are the most accurate blood biomarkers of inflammatory changes and can be used to stage the severity and outcome of acute pneumonia. . Getting all the above mentioned investigations in a financially poor patients is not always possible. There are not much studies to look for the association between early raise in serum acute inflammatory bio markers and the prediction of mortality in acute pneumonia. So this study is under taken to know the association between significant raise in serum acute inflammatory biomarkers like hs CRP, LDH, ferritin, NLR, WBCs count in predicting the mortality of acute pneumonia in comparison with the serum IL6,q-SOFA score and CT chest severity score. Materials & Method: All patients underwent standardized workup, including complete blood count, blood biochemistry, ferritin, hs-CRP, LDH,IL6,CT scan of chest ,q-SOFA score assessment and electrocardiogram. All the biochemical investigations were done on day 1 and day 5 of admission to the hospital. The patients were followed-up for the whole in hospital stay duration. Results: All the measured serum acute inflammatory bio markers, IL6, NLR, WBCs count, q-SOFA score and chest CT severity score were significantly elevated in patients with death due to acute pneumonia than the survived ones. [p value-0.01] Conclusion: This study proves that, the early raise in serum acute inflammatory biomarkers have got real and cost effective predictive value and are non-inferior to total WBCs count, NLR,IL6, q- SOFA score and chest CT severity score in assessing the mortality of acute pneumonia. Keywords: Acute Pneumonia, Acute inflammatory bio markers, CT scan of Chest, IL6, NLR (Neutrophils to Lymphocytes ratio), q-SOFA score, WBCs count

Impact of Immuno-Nutrition on the Nutritional Status, Inflammatory Response and Clinical Outcome of Clinic-Admitted Mild-Intensity-COVID-19 Patients: A Pilot, Perspective-Concluding Study.

The SARS-CoV-2 pandemic has impacted our lives since early 2020. Both malnutrition and an overweight status significantly correlate with worse patient outcomes and mortality. Immuno-nutrition (IN) has shown promising results in the inflammatory bowel disease (IBD) clinical course and the extubation time and mortality of patients admitted to intensive care units (ICUs). Thus, we wanted to assess the impact of a standardized IN oral formula on COVID-19 patients admitted to our mild-intensity clinic in late 2021. We prospectively enrolled patients admitted to the Internal Medicine COVID-19 Unit of San Benedetto General Hospital. All patients had biochemical, anthropometric, HRCT chest scan, and nutritional assessments at the time of admission and, after oral immuno-nutrition formula administration, at 15 days of the interval follow up. We enrolled 52 consecutive patients (mean age of 60.9 ± 5.4 years, 17 F, and BMI of 23.5 Kg/m2). The main comorbidities were diabetes (20%, type 2: 90%), hyperuricemia (15%), hypertension (38%), chronic ischemic heart disease (12%), COPD (13%), anxiety (10%), and depression (8%). Upon informed consent, 14 patients (mean age of 67.9 ± 5.4 years, 7 F, and BMI of 26.7 Kg/m2) were accepted to be administered IN. A moderate to severe overweight status was present in 59% of the patients; MNA test (4.4 ± 0.7) and phase angle (PA) values, suggestive of malnutrition, were present in 13% of the patients. After 15 days of admission, we recorded three deaths (mean age of 68.9 ± 4.1 years, 3 F, and BMI of 27.5 Kg/m2). An overweight status significantly correlated with the exitus occurrence (r = 0.65). One death was reported among the IN-treated patients. IN administration was followed by a significant decrease in inflammatory markers with a tendency to be higher than those of non-treated patients. IN prevented the worsening of BMI and PA vs. non-treated patients. In this overweight COVID-19 population, immuno-nutrition prevented malnutrition development with a significant decrease in inflammatory markers.

FRI311 GnRH Agonist Induced Pituitary Apoplexy In A Patient With Gonadotropinoma

Abstract Disclosure: I. Madahar: None. S. Khan: None. L. Hergenroeder: None. B. Skaff: None. A. Haider: None. Introduction: GnRH therapy is commonly employed in patients with advanced prostate cancer. It acts as an agonist that binds to pituitary GnRH receptors. It acts via desensitization, downregulating FSH and LH production, and ultimately decreasing testicular steroidogenesis. Initial administration leads to transient stimulation of the pituitary which leads to elevated FSH and LH levels and increased production of estrogen and testosterone with eventual downregulation of the overall pathway. Case description: 80-year-old male with a past history of atrial fibrillation and OA was diagnosed with prostate cancer. Prostate adenocarcinoma Gleason score 7 (4+3) grade 3 was diagnosed by needle core biopsy five months prior to presentation. CT chest, abdomen, pelvis, and bone scan did not show evidence of metastatic disease. A week prior to starting Lupron therapy he was started on bicalutamide therapy. He received a dose of leuprolide (Elligard) as part of his chemoradiation therapy for his cancer. The patient went golfing after the treatment and within four hours he started noticing headaches and retroorbital pain. Headaches were sharp in quality, intensity 9 out of 10, and associated with nausea and vomiting. He later developed right-sided ptosis and double vision which progressively worsened after the next few hours. An initial CT scan of the head showed an enlarging pituitary mass which was followed MRI of the brain with and without contrast showed an enlarged pituitary mass and right cavernous sinus effacement of the optic chiasm. Anterior pituitary hormone functions were ordered, and the patient was started on stress-dose steroids. Transsphenoidal pituitary resection was done which the patient tolerated well pathology showed pituitary adenoma with pituitary apoplexy and the immunoprofile was compatible with gonadotroph adenoma. The adenoma cells were positive for synaptophysin, cam 5.2, GATA3, and FSH. A repeat MRI of the Sella three months after surgery showed a 9 mm nodule in the right aspect of the Sella. Anterior pituitary hormone levels done prior to surgery showed an IGF- 1 level of 204 ng/ml (Z score 1.5 SD). TSH and free T4 were in the normal range. Hydrocortisone was tapered and stopped 6 weeks after transsphenoidal surgery. Discussion: Lupron levels reach maximum concentration four hours after intramuscular administration. Initial pituitary stimulation by leuprolide administration causes the increased metabolic activity of the underlying adenoma which outgrows its blood supply, thus developing ischemic necrosis and subsequent hemorrhage. The majority of pituitary apoplexy develops in patients with previous undiagnosed pituitary adenomas. Should patients get central imaging to screen for pituitary macroadenoma before Lupron treatments to prevent this potentially life-threatening complication? Presentation: Friday, June 16, 2023

Etiologic Investigation of Patients Diagnosed with Bacteriologically Unconfirmed Tuberculosis in Tanzania.

Globally, half of patients with pulmonary tuberculosis (PTB) are diagnosed clinically without bacteriologic confirmation. In clinically diagnosed PTB patients, we assessed both the proportion in whom PTB could be bacteriologically confirmed by reference standard diagnostic tests and the prevalence of diseases that mimic PTB. We recruited adult patients beginning treatment of bacteriologically unconfirmed PTB in Moshi, Tanzania, in 2019. We performed mycobacterial smear, Xpert MTB/RIF Ultra, and mycobacterial culture, fungal culture, and bacterial culture on two induced sputum samples: fungal serology and computed tomography chest scans. We followed participants for 2 months after enrollment. We enrolled 36 (63%) of 57 patients with bacteriologically unconfirmed PTB. The median (interquartile range) age was 55 (44-67) years. Six (17%) were HIV infected. We bacteriologically confirmed PTB in 2 (6%). We identified pneumonia in 11 of 23 (48%), bronchiectasis in 8 of 23 (35%), interstitial lung disease in 5 of 23 (22%), pleural collections in 5 of 23 (22%), lung malignancy in 1 of 23 (4%), and chronic pulmonary aspergillosis in 1 of 35 (3%). After 2 months, 4 (11%) were dead, 21 (58%) had persistent symptoms, 6 (17%) had recovered, and 5 (14%) were uncontactable. PTB could be bacteriologically confirmed in few patients with clinically diagnosed PTB and clinical outcomes were poor, suggesting that many did not have the disease. We identified a high prevalence of diseases other than tuberculosis that might be responsible for symptoms.

Prediction of the COVID disease using lung CT images by Deep Learning algorithm: DETS-optimized Resnet 101 classifier.

As a result of the COVID-19 (coronavirus) disease due to SARS-CoV2 becoming a pandemic, it has spread over the globe. It takes time to evaluate the results of the laboratory tests because of the rising number of cases each day. Therefore, there are restrictions in terms of both therapy and findings. A clinical decision-making system with predictive algorithms is needed to alleviate the pressure on healthcare systems via Deep Learning (DL) algorithms. With the use of DL and chest scans, this research intends to determine COVID-19 patients by utilizing the Transfer Learning (TL)-based Generative Adversarial Network (Pix 2 Pix-GAN). Moreover, the COVID-19 images are then classified as either positive or negative using a Duffing Equation Tuna Swarm (DETS)-optimized Resnet 101 classifier trained on synthetic and real images from the Kaggle lung CT Covid dataset. Implementation of the proposed technique is done using MATLAB simulations. Besides, is evaluated via accuracy, precision, F1-score, recall, and AUC. Experimental findings show that the proposed prediction model identifies COVID-19 patients with 97.2% accuracy, a recall of 95.9%, and a specificity of 95.5%, which suggests the proposed predictive model can be utilized to forecast COVID-19 infection by medical specialists for clinical prediction research and can be beneficial to them.

Raw data consistent deep learning-based field of view extension for dual-source dual-energy CT.

Due to technical constraints, dual-source dual-energy CT scans may lack spectral information in the periphery of thepatient. Here, we propose a deep learning-based iterative reconstruction to recover the missing spectral information outside the field of measurement (FOM) of the second source-detectorpair. In today's Siemens dual-source CT systems, one source-detector pair (referred to as A) typically has a FOM of about 50cm, while the FOM of the other pair (referred to as B) is limited by technical constraints to a diameter of about 35cm. As a result, dual-energy applications are currently only available within the small FOM, limiting their use for larger patients. To derive a reconstruction at B's energy for the entire patient cross-section, we propose a deep learning-based iterative reconstruction. Starting with A's reconstruction as initial estimate, it employs a neural network in each iteration to refine the current estimate according to a raw data fidelity measure. Here, the corresponding mapping is trained using simulated chest, abdomen, and pelvis scans based on a data set containing 70 full body CT scans. Finally, the proposed approach is tested on simulated and measured dual-source dual-energy scans and compared against existing referenceapproaches. For all test cases, the proposed approach was able to provide artifact-free CT reconstructions of B for the entire patient cross-section. Considering simulated data, the remaining error of the reconstructions is between 10 and 17HU on average, which is about half as low as the reference approaches. A similar performance with an average error of 8HU could be achieved for real phantommeasurements. The proposed approach is able to recover missing dual-energy information for patients exceeding the small 35cm FOM of dual-source CT systems. Therefore, it potentially allows to extend dual-energy applications to the entire-patient crosssection.

431. RARE CASE OF CONTAINED ESOPHAGEAL PERFORATION IN LONG STANDING ACHALASIA CARDIA AND ITS SUCCESSFUL MANAGEMENT

Abstract Background Esophageal perforation is the most feared complication after any intervention in achalasia cardia, especially after pneumatic dilation. We present a case of contained perforation after manometry in a long-standing case of achalasia cardia and its successful management. Methods A 64-year-old lady, known case of long-standing Rheumatoid arthritis on steroids and methotrexate, presented to us with complains of dysphagia to solids and liquids and 15 kgs weight loss in the past 3 years. On evaluation, she was dehydrated and cachexic. Upper GI endoscopy showed lot of food residue with erosions in body of esophagus and tight LES. Barium swallow showed sigmoid esophagus with typical bird beak appearance. Patient was admitted for hydration and nutritional optimization was done with nasojejunal feeding. She was further subjected to manometry to characterize the achalasia, which couldn’t be completed despite multiple forceful attempts. After 5 days, she was admitted for elective surgery. A CT scan of chest was done to evaluate the anatomy thoroughly before surgery, which showed contained mucosal perforation in lower esophagus on right side with minimal right pleural effusion. We planned for surgery next day. Results Laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication was done with thoracoscopic lavage. Intra-operatively, upper GI endoscopy with minimal insufflation was done to confirm adequate cardiomyotomy and to look for the site of perforation. The perforation was not found. Hence, right thoracoscopy was done, which showed reactive pleural effusion without any food contents. Lavage was given and ICD was placed. Feeding jejunostomy was done laparoscopically. Patient was kept NBM for 7 days and JT feeds were started on POD 1 and gradually increased. ICD removed on POD 7. Oral gastrograffin contrast study was done on POD 8, which showed delayed passage at 5 minutes and no extravasation. Oral liquids were started and escalated gradually. Supplemental high protein nutrition was given through JT feeding. Patient was discharged on POD 15. At 1 month follow up, patient had 2 kgs weight gain and tolerated semisoft diet adequately. Conclusion Successful management of contained perforation in long standing achalasia cardia was achieved by targeting the source pathology in an already immunocompromised patient.

Application of Deep Learning Techniques for Detection of Pneumothorax in Chest Radiographs.

With the advent of Artificial Intelligence (AI) and even more so recently in the field of Machine Learning (ML), there has been rapid progress across the field. One of the prominent examples is image recognition in the medical category, such as X-ray imaging, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). It has the potential to alleviate a doctor's heavy workload of sifting through large quantities of images. Due to the rising attention to lung-related diseases, such as pneumothorax and nodules, ML is being incorporated into the field in the hope of alleviating the already strained medical resources. In this study, we proposed a system that can detect pneumothorax diseases reliably. By comparing multiple models and hyperparameter configurations, we recommend a model for hospitals, as its focus on minimizing false positives aligns with the precision required by medical professionals. Through our cooperation with Poh-Ai Hospital, we acquired a total of over 8000 X-ray images, with more than 1000 of them from pneumothorax patients. We hope that by integrating AI systems into the automated process of scanning chest X-ray images with various diseases, more resources will be available in the already strained medical systems. Our proposed system showed that the best model that is used for transfer learning from our dataset performed with an AP of 51.57 and an AP75 of 61.40, with accuracy at 93.89%, a false positive of 1.12%, and a false negative of 4.99%. Based on the feedback from practicing doctors, they are more wary of false positives. For their use case, we recommend another model due to the lower false positive rate and higher accuracy compared with other models, which in our test shows a rate of only 0.88% and 95.68%, demonstrating the feasibility of the research. This promising result showed that it could be utilized in other types of diseases and expand to more hospitals and medical organizations, potentially benefitting more people.

Three to Six-Months Follow-Up Chest CT Findings after COVID-19 Pneumonitis, Incidence of Complications and Correlation to Different Risk Factors

Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, has become a global pandemic. As of November 19, 2020, World Health Organization stated that this disease has been found in more than 200 countries. Pathology studies have shown that COVID-19 causes injuries in multiple organs and tissues, with extensive pulmonary involvement similar to that found in other coronavirus infections (ie, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus infection). Aim of the Work to evaluate pulmonary changes on 3-6 months follow-up chest CT scans and to explore the risk factors for fibrotic-like changes in the lung in patients who recovered from COVID-19 pneumonia. Patients and Methods This was a retrospective and prospective study that included 50 patients who had Symptoms of variable degree of fever, cough, and dyspnea with RT-PCR confirmed COVID- 19 infection at Ain Shams University Hospitals referred to the Radiodiagnosis Department for HRCT chest examination. All patients were evaluated for: (I): Incidence of complications (residual fibrotic like changes in their follow up CT chest scans). (Il): Correlation to different risk factors such as (smoking, diabetes mellitus, hypertension, pre-existing pulmonary disease, pre-existing renal disease and steroid therapy). Results 56% of cases showed residual fibrotic like changes in their follow up chest CT scans while 44% of cases showed total resolution of the disease process. Smoking and old age were significant risk factors while steroid therapy decreased risk of fibrotic like change. Conclusion Twenty eight cases (56%) showed residual fibrotic like changes in their 3-6 months follow-up chest CT scan (CO-RADS III to V). Patients with older age and smokers have higher incidence of residual fibrotic like changes in their follow up chest CT scans, while patients on steroid therapy have less liability to develop fibrotic changes.

Evaluation of Anthropometric Scapula Indices in CT Scan Images for Gender Distinction in the Besat NAHAJA Hospital

Background: In forensic medicine, several bones are used to determine gender. The most important and widely used are the skull and pelvis. But in some cases, the mentioned bones may not be available, and other bones, such as the scapula bone, should be used. Objectives: This study aimed to investigate and locate the anthropometric indices of scapula bone in the Iranian population to determine gender. Methods: In this project, a study was performed on a chest scan of 259 Iranians referred to Besat NAHAJA Hospital in 2016. Pack software was used to measure the scapula's indices. The obtained data, including age, gender, and different scapula sizes of max width of glenoid (MWG), max length of glenoid (MLG), max width of scapula (MWS), and max length of scapula (MLS), were analyzed using appropriate statistical tests. Assessment of differential ability, sensitivity, and specificity of scapula anthropometric indices was used in determining gender. Results: Of 259 participants in this study, 133 (51.4%) were female, and 126 (48.6%) were male. Generally, the mean index of MWG, MLG, MWS, and MLS was higher in men than women in the studied population. The results of this study showed there is a significant difference among scapula features in men and women (P < 0.05). The highest accuracy in determining gender was assigned to MLS, with 88.9%, and the lowest was assigned to MLG, with 66.3%. Conclusions: Our study showed that measured anthropometric indices, including length and width of scapula bone and glenoid cavity, will help to predict gender and also can be used as an accurate and practical tool in gender determination.

Chest CT scan predictors of intensive care unit admission in hospitalized pregnant women with COVID-19: a case–control study

Purpose To investigate the role of chest computed tomography (CT) scan in the prediction of admission of pregnant women with COVID-19 into intensive care unit (ICU). Methods This was a single-center retrospective case–control study. We included pregnant women diagnosed with COVID-19 by reverse transcriptase polymerase chain reaction between February 2020 and July 2021, requiring hospital admission due to symptoms, who also had a CT chest scan at presentation. Patients admitted to the ICU (case group) were compared with patients who did not require ICU admission (control group). The CT scans were reported by an experienced radiologist, blinded to the patient’s course and outcome, aided by an artificial intelligence software. Total CT scan score, chest CT severity score (CT-SS), total lung volume (TLV), infected lung volume (ILV), and infected-to-total lung volume ratio (ILV/TLV) were calculated. Receiver operating characteristic curves were constructed to test the sensitivity and specificity of each parameter. Results 8/28 patients (28.6%) required ICU admission. These also had lower TLV, higher ILV, and ILV/TLV. The area under the curve (AUC) for these three parameters was 0.789, 0.775, and 0.763, respectively. TLV, ILV, and ILV/TLV had good sensitivity (62.5%, 87.5%, and 87.5%, respectively) and specificity (84.2%, 70%, and 73.7%, respectively) for predicting ICU admission at the following selected thresholds: 2255 mL, 319 mL, and 14%, respectively. The performance of CT-SS, CT scan score, and ILV/TLV in predicting ICU admission was comparable. Conclusion TLV, ILV, and ILV/TLV as measured by an artificial intelligence software on chest CT, may predict ICU admission in hospitalized pregnant women, symptomatic for COVID-19.

LA FISTULE COLO-BRONCHIQUE COMPLICATION EXCEPTIONNELLE DE LOESOPHAGOPLASTIE COLIQUE

Objective:Colonic interposition as an esophageal substitution is an accepted surgical approach for severe esophageal lesions especially after accidental caustic ingestion. Colobronchial fistula after coloesophageal interposition is a rare and a late complication. The bibliographical analysis showed very few cases of this complication. Material and Methods:A 37 yr old woman was admitted for recurrent right pneumonia. A 22 yr of age, she had developed a long esophageal stricture as a result of accidental caustic ingestion and a coloesophageal interposition was performed.The diagnostic of colobronchail fistula was suspected by chest scan and confirmed by digestive endoscopy.The patient was approached by thoracotomy,the evolution controlled by a thoracic scan and endoscopic is very satisfying.

CT Scan Imaging in Tuberculosis and Lung Cancer: A Case Report in Lung Hospital

Background: Tuberculosis is a contagious infectious disease that attacks various organs, especially the lungs. Chest CT scan modalities have a role in helping the diagnosis of tuberculosis and lung cancer. This case report presents a rare case of two women diagnosed with tuberculosis and lung cancer. Cases Presentation: Two women aged 43 and 42 years came to the radiology department with a history of chest pain, loss of appetite, and cough, and underwent tuberculosis therapy by taking medication for two months. The patient underwent chest x photo thorax, abdominal ultrasound, thoracic CT scan, and a biopsy was performed with CT scan guiding. Discussion: The findings of this case are consistent with previous studies which explained that radiological CT scans found tuberculosis with lung cancer. In the lung window, CT scan chest contrast found cystic bronchiectasis. Other results showed an encapsulated pleural effusion in the right hemithorax, compression atelectasis, and multiple lymphadenopathies. Conclusion: CT scan imaging simultaneously can show the occurrence of tuberculosis and lung cancer. Lung cancer that worsens can cause adenocarcinoma with metastasis spreading to other organs.

Management of COVID-19 Pneumonia: Experience in a Peripheral Tertiary Level Hospital in Bangladesh

Background: Since the detection of the first case of the novel SARS-CoV-2 virus in Wuhan, China, on December 31, 2019, the world stepped into an era of the pandemic as declared by WHO on March 11, 2020. With no prior knowledge regarding this new pandemic, the evidence-based practice of medical management was at stake. Experience sharing from different corners of the world played an essential role in building knowledge to save the world. Methods: The researchers collected data for this retrospective study, from hospital records of the COVID-19 dedicated unit of Sylhet Women’s Medical College, Sylhet, Bangladesh, that was formed temporarily in July 2020, in response to the pandemic situation in the country. This article includes data on 3408 admitted COVID-19 patients with moderate to severe symptoms, managed in the isolation unit including its intensive care unit (ICU) up to November 2021. Results: The mean age of the patients was 57.21±12.58 years and male to female ratio was 1:1.8. Fever (44.4%), cough (38.9), and fatigability (33.3%) were the common symptoms. Diabetes mellitus (67.7%), systemic hypertension (63.7%), asthma (8.65%), chronic obstructive pulmonary disease (21.94%), and, ischemic heart disease (31.2%) were the top co-morbid conditions. Of the study subjects, 68.2% were RT-PCR positive for COVID-19, 67.3% had an abnormal baseline chest X-ray, and 91.1% had a ground glass shadow on a high-resolution CT scan of chest. Average C-reactive protein, D-dimer, and serum ferritin values were 71.68±60.38, 1.16±2.11, and 839±748.57 respectively. Hypoxemia, which was a common problem among them, was managed with oxygen therapy with an appropriate delivery device, with or without supplementation by dexamethasone (78.3%), or methylprednisolone (18.8%). Eighteen (18) patients refused to receive any antiviral therapy, 61 received oral Favipiravir and the rest of them received injectable Remdesevir. Standard care was augmented with Baricitinib in 60 patients. Thirty-six (36) patients in the ICU, with poor response to standard care, were treated with Tocilizumab. Death rates were 9.46% in the non-ICU block, but they were 6-10 times higher in the ICU. Conclusion: Every medical professional learned from the initial two years of the COVID-19 pandemic. Lessons learnt from experience helped building up the knowledge pool necessary for generating effective protocols for COVID-19 pneumonia management.

Idiopathic pulmonary hemosiderosis as an occupational disease: a clinical case

BACKGROUND. Idiopathic pulmonary hemosiderosis (IPH) in adults is a rare pathology of unknown etiology. We did not find information about IPH in adults with occupational hazards in the available literary sources, which makes this work relevant.
 OBJECTIVE. To analyze the peculiarities of the IPH course in a patient with 23 years’ experience as a gas-electric welder at factories by our own clinical observation.
 RESULTS AND DISCUSSION. Changes in the form of heterogeneous pneumatization of the lung parenchyma due to the increased interstitial component were determined on the computer tomography of the chest cavity (CT of the chest cavity) 1.5 years before the patient’s visit, but no additional examination was prescribed, and only the diagnosis “Chronic obstructive pulmonary disease” (COPD) was made. Negative dynamics due to the increase of miliary nodular dissemination of the lungs was revealed on the CT scan of the chest after 1.5 years. IPH was already detected pathohistologically after videothoracoscopy of the right lung with biopsy. Shortness of breath and cough increased in the patient, but apart from treatment aimed at COPD treating, no other therapy was prescribed (this therapy did not have a positive effect). The patient underwent a comprehensive immunological examination: the indicators of the anti-neutrophil cytoplasmic antibodies (ANCA) profile and the complex immunological blood test were within the normal range, which ruled out pulmonary vasculitis and an immune-mediated process. Considering the positive Quantiferon test, the patient was examined and the tuberculosis was excluded. Patient have not been suffered from hemoptysis and anemia from the moment of detection of the first changes on the CT scan of chest up to the present time. Due to treatment, the clinical and radiological stabilization of the process was determined after 4 months: the clinical symptoms of the disease decreased; small nodular shadows with areas of fibrosis, which are characteristic of the period of remission, were determined on the CT scan of the chest.
 CONCLUSIONS. IPH course features in a patient with a professional route are: a long period of development with COPD manifestations (without effect of therapy), absence of hemoptysis and anemia, normal indicators of the ANCA profile and complex immunological examination, a positive Quantiferon test. Corticosteroid therapy in high doses has a positive effect, which is manifested in the clinical and radiological stabilization of the process. The mechanism of IPH development may have been a toxic mechanism (23 years of work experience as a gas-electric welder at factories). Timely detection of IPH and timely prescribed corticosteroid therapy will prevent the progression of the process and the development of complications, as well as reduce mortality from this disease. Patients with IPH should be under dynamic observation due to timely evaluation of CT-dynamics of the process in the lungs and correction of the dose of corticosteroids.

#5177 COVID-19 IN ELDERLY CHRONIC HEMODIALYSIS PATIENTS: PREDICTORS OF MORTALITY

Abstract Background and Aims Studies have shown that the incidence of severe COVID-19 pneumonia is higher in elderly patients and especially those with comorbidities including chronic kidney disease. The aim of our study was to determine risk factors for mortality in elderly chronic hemodialysis (HD) patients. Method We conducted a cross-sectional, observational, and analytical study, in the dialysis unit of the internal medicine department at Charles Nicolle Hospital over an 11-month period from September 2020 to August 2021. We studied the correlation between mortality and the different epidemiological, clinical and biological data via the SPSS software. Results We included 59 patients, with a mean age of 73 years [65-93] and a gender ratio of 1. All patients had confirmed COVID-19 infection, chronic kidney failure and required regular HD since at least 3 months. One on four patients had a coronary artery disease, 55% were diabetics and 72% had hypertension. From the 19 patients who underwent chest scan, 68% had severe lesions. Emergency HD had to be conducted for 25% of the patients, mainly because of hyperkalemia. At least one ongoing HD session was interrupted for neurologic, hemodynamic or respiratory instability in 26% of the patients. Mortality rate was 58%. Data that were associated with mortality in the univariate study were oxygen needs (p<10-3), COVID-19 infection severity (p=0.007), and interruption of HD session (p<10-3). Low blood pH levels and high pCo2 levels were also correlated to mortality (p=0.032 and p=0.020). Predictors of mortality in multivariate analysis were high oxygen needs (OR=1.368; 95% CI [1.081-1.732]; P = .009), interruption of HD session (OR=1.426; 95% CI [1.070-1.846]; P = .014) and severe form of COVID-19 infection (OR=1.770; 95% CI [1.062-2.980]; P = .029). Conclusion According to these results, high oxygen needs, severity of COVID-19 infection and interruption of HD session represented risk factors of death in elderly patients undergoing chronic hemodialysis. As highlighted in previous studies, mortality rate in COVID-19 seems to be higher among elderly patients. However, diabetes and cardiovascular diseases were not identified as predictors of mortality in this sample of patients.

Clinical, biochemical and pulmonary CT imaging features for hepatobiliary involvement in COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a viral disease with primary pulmonary involvement and systemic impact. This article aims to assess the importance of clinical, biological, demographic and radioimaging parameters in COVID-19 patients in characterizing the incidence and severity of the hepatobiliary involvement. We performed an observational cohort study on 132 consecutive patients, evaluating their demographics, hospitalization period, peripheral oxygen saturation (SpO2) in the ambient air, as well as biochemical markers of hepatobiliary involvement: aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TB), direct bilirubin (DB), gamma-glutamyl transferase (GGT), serum albumin, total serum proteins, D-dimers; coagulation tests such as prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR); inflammatory markers: fibrinogen, serum ferritin, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis alpha (TNF-α). Hepatobiliary involvement was further stratified by type of affection pattern: hepatocytolysis, cholestasis or mixed type. All patients received a computerized tomography (CT) chest scan in the first or second day of hospital admission. We observed lower SaO2 and longer hospitalization days in patients with hepatobiliary involvement, as well as longer coagulation times (PT and INR), lower serum albumin and higher serum ferritin (p<0.05). No significant correlations have been found between the degree or type of pattern of lung involvement as seen on CT scans performed and biochemical liver changes. Hepatobiliary involvement occurred in 72% of patients in the study group, associated with longer hospitalization period, prolonged coagulation parameters, lower serum albumin levels, raised serum ferritin and CRP levels. Cholestatic and mixed types of injury were associated with higher ferritin levels, while mixed type alone presented higher D-dimers levels compared with the cholestatic or hepatocytolysis groups. No significant correlation was found between lung involvement by CT evaluation and hepatobiliary involvement.

Preliminary results from the Female Asian Nonsmoker Screening Study (FANSS).

8510 Background: Lung cancer (LC) is the leading cause of cancer death in Asian Americans and unfortunately the majority are diagnosed at advanced or late stages. In Asia, approximately 60-80% of female LC patients are never smokers. Current screening in the U.S. with low-dose CT (LDCT) Chest scans is offered only to current or former smokers based on the National Lung Screening Trial (NLST). The LC detection rate in NLST was 1.1%. The TALENT study, a LC screening study for high-risk nonsmokers in Taiwan reported a LC detection rate of 2.6% which included invasive adenocarcinoma (adeno), adeno in situ, minimally invasive adeno and adenosquamous carcinoma. Invasive adeno detection rate was 1.52%. We are conducting the ongoing FANSS in the U.S. to screen female Asian nonsmokers with LDCT Chest scans to evaluate the feasibility of a LC screening program in this population. We report preliminary results here. Methods: This is an IRB-approved, prospective, multicenter study (NYU, MGH, UCI). Inclusion criteria are women, age between 40-74 years old (yo), never smoked or smoked &lt;100 cigarettes in one's lifetime and identify as from Asian descent (report ancestry or race from the continent of Asia). Participants (pts) with history of LC or treatment of any cancer &lt;5 years ago are excluded. Following informed consent, eligible pts undergo a shared-decision making discussion prior to obtaining a baseline LDCT Chest scan, read according to Lung-RADS 1.1 with plan for annual LDCT for two additional years. A plasma-based assay to analyze cell-free DNA (cfDNA) fragments for early detection of cancer by Delfi Diagnostics (Baltimore, MD) is sent at the time of each scan. A questionnaire regarding ethnicity, family history and environmental exposures is collected at baseline. Results: From 3/1/21 to 1/15/23, 222 pts signed consent and 201 had a baseline LDCT at NYU. Age range was 40-74 yo and median age of 56.8 yo. 83 (41%) reported a family history of LC. Of 201 pts who completed a baseline LDCT, 87 (43%) were Lung-RADS 1, 101 (50%) were Lung-RADS 2, 6 (3%) were Lung-RADS 3 and 7 (3.5%) were Lung-RADS 4. 5 pts with Lung-RADS 3 and 3 pts with Lung-RADS 4 have solid, subsolid or groundglass nodules &gt;6mm that remain in close follow-up. 3 pts were diagnosed with invasive lung adeno for a LC detection rate of 1.5%; 2 are stage IIB and 1 is stage IIIC. All pts were surgically resected, EGFR mutation positive and are receiving adjuvant osimertinib. Analysis of the cfDNA fragmentation profiles is ongoing. Conclusions: Our data shows that LC screening in Asian female nonsmokers is feasible. Preliminary results demonstrate an invasive adeno detection rate comparable with TALENT and higher than in NLST. Early detection brings new meaning with the recent FDA approval for adjuvant targeted therapy in early stage LC. The expansion of LC screening guidelines to other high-risk populations warrants further attention. FANSS is continuing to accrue at additional U.S. sites this year. Clinical trial information: NCT05164757 .

Computed Tomography scanning in patients with COVID-19: artificial intelligence analysis of lesions volume and outcome.

The aim of this study was to summarize the computed tomography (CT) chest scanning results of COVID-19 patients, and to assess the value of artificial intelligence (AI) dynamics and quantitative analysis of lesion volume change for the evaluation of the disease outcome. First chest CT and reexamination imaging data of 84 patients diagnosed with COVID-19 who were treated at Jiangshan Hospital of Guiyang, Guizhou Province from February 4, 2020, to February 22, 2020, were retrospectively analyzed. Distribution, location, and nature of lesions were analyzed according to the characteristics of CT imaging and COVID-19 diagnosis and treatment guidelines. Based on the results of the analysis, patients were divided into the group without abnormal pulmonary imaging, the early group, the rapid progression group, and the dissipation group. AI software was used to dynamically measure the lesion volume in the first examination and in the cases with more than two reexaminations. There were statistically significant differences in the age of patients between the groups (p<0.01). The first chest CT examination of the lung without abnormal imaging findings mainly occurred in young adults. Early and rapid progression was more common in the elderly, with a median age of 56 years. The ratio of the lesion to the total lung volume was 3.7 (1.4, 5.3) ml 0.1%, 15.4 (4.5, 36.8) ml 0.3%, 115.0 (44.5, 183.3) ml 3.33%, 32.6 (8.7, 98.0) ml 1.22% in the non-imaging group, early group, rapid progression group, and dissipation group, respectively. Pairwise comparison between the four groups was statistically significant (p<0.001). AI measured the total volume of pneumonia lesions and the proportion of the total volume of pneumonia lesions to predict the receiver operating characteristic (ROC) curve from early development to rapid progression, with a sensitivity of 92.10%, 96.83%, specificity of 100%, 80.56%, and the area under the curve of 0.789. Accurate measurement of lesion volume and volume changes by AI technology is helpful in assessing the severity and development trend of the disease. The increase in the lesion volume proportion indicates that the disease has entered a rapid progression period and is aggravated.