Chest Signs Research Articles

SURGICAL TREATMENT OF THORACIC AORTA TRANSECTION BY CONTUSIVE TRAUMA: CASE REPORT

Traumatic injuries to the thoracic aorta are rare events with high mortality. Several treatment modalities are described, including: conservative treatment, endovascular techniques, and conventional surgery. The objective of this work is to report the conventional surgical treatment and its evolution of a thoracic aorta transection injury. Case Report: Patient, F.R. 25 years old, victim of blunt motor trauma x shield, was admitted to the unit with chest pain plus signs of shock, a chest CT scan was performed and a grade IV blunt injury to the thoracic aorta and fracture of the right femur were identified, evolving with hypotension, tachycardia and anemia. A posterolateral thoracotomy was performed and, after control and exploration of the hematoma, a lesion with aortic transection was found, with an interposition using a Dacron prosthesis, with a satisfactory clamping time followed by chest drainage. External fixation of the D femur fracture was performed during the same surgery. Red blood cell concentrates were used during the operative period. The patient was admitted to the ICU, on mechanical ventilation, sedated and with amines and blood drains. He developed AKI due to rhabdomyolysis, requiring hemodialysis. A new CT scan showed hemothorax on the right side, and a thoracostomy on the right side was performed on the second day after the first surgery. The patient progressed with weaning from sedation and extubation 5 days after the first surgical procedure, but maintained anemia and mild hypoxia. A new CT scan showed a left hemothorax associated with a small pneumothorax, and a videothoracoscopy was performed on left with evacuation of the clot plus drainage. a good evolution of the condition, with improvement in hematic parameters and renal insufficiency, with gradual removal of the drains. Discharged from hospital without further complications.

Not So Transient Effusive-Constrictive Pericarditis

A 63-year-old male patient presented with chest pain and signs of volume overload. His work-up revealed a diagnosis of transient effusive constrictive pericarditis of idiopathic etiology. Despite treatment with optimal medical therapy, he continued to experience persistent symptoms eventually requiring radical pericardiectomy.

Antibiotics for lower respiratory tract infection in children presenting in primary care: ARTIC-PC RCT.

Antimicrobial resistance is a global health threat. Antibiotics are commonly prescribed for children with uncomplicated lower respiratory tract infections, but there is little randomised evidence to support the effectiveness of antibiotics in treating these infections, either overall or relating to key clinical subgroups in which antibiotic prescribing is common (chest signs; fever; physician rating of unwell; sputum/rattly chest; shortness of breath). To estimate the clinical effectiveness and cost-effectiveness of amoxicillin for uncomplicated lower respiratory tract infections in children both overall and in clinical subgroups. Placebo-controlled trial with qualitative, observational and cost-effectiveness studies. UK general practices. Children aged 1-12 years with acute uncomplicated lower respiratory tract infections. The primary outcome was the duration in days of symptoms rated moderately bad or worse (measured using a validated diary). Secondary outcomes were symptom severity on days 2-4 (0 = no problem to 6 = as bad as it could be); symptom duration until very little/no problem; reconsultations for new or worsening symptoms; complications; side effects; and resource use. Children were randomised to receive 50 mg/kg/day of oral amoxicillin in divided doses for 7 days, or placebo using pre-prepared packs, using computer-generated random numbers by an independent statistician. Children who were not randomised could participate in a parallel observational study. Semistructured telephone interviews explored the views of 16 parents and 14 clinicians, and the data were analysed using thematic analysis. Throat swabs were analysed using multiplex polymerase chain reaction. A total of 432 children were randomised (antibiotics, n = 221; placebo, n = 211). The primary analysis imputed missing data for 115 children. The duration of moderately bad symptoms was similar in the antibiotic and placebo groups overall (median of 5 and 6 days, respectively; hazard ratio 1.13, 95% confidence interval 0.90 to 1.42), with similar results for subgroups, and when including antibiotic prescription data from the 326 children in the observational study. Reconsultations for new or worsening symptoms (29.7% and 38.2%, respectively; risk ratio 0.80, 95% confidence interval 0.58 to 1.05), illness progression requiring hospital assessment or admission (2.4% vs. 2.0%) and side effects (38% vs. 34%) were similar in the two groups. Complete-case (n = 317) and per-protocol (n = 185) analyses were similar, and the presence of bacteria did not mediate antibiotic effectiveness. NHS costs per child were slightly higher (antibiotics, £29; placebo, £26), with no difference in non-NHS costs (antibiotics, £33; placebo, £33). A model predicting complications (with seven variables: baseline severity, difference in respiratory rate from normal for age, duration of prior illness, oxygen saturation, sputum/rattly chest, passing urine less often, and diarrhoea) had good discrimination (bootstrapped area under the receiver operator curve 0.83) and calibration. Parents found it difficult to interpret symptoms and signs, used the sounds of the child's cough to judge the severity of illness, and commonly consulted to receive a clinical examination and reassurance. Parents acknowledged that antibiotics should be used only when 'necessary', and clinicians noted a reduction in parents' expectations for antibiotics. The study was underpowered to detect small benefits in key subgroups. Amoxicillin for uncomplicated lower respiratory tract infections in children is unlikely to be clinically effective or to reduce health or societal costs. Parents need better access to information, as well as clear communication about the self-management of their child's illness and safety-netting. The data can be incorporated in the Cochrane review and individual patient data meta-analysis. This trial is registered as ISRCTN79914298. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 9. See the NIHR Journals Library website for further project information.

Chinese experts consensus statement: diagnosis and treatment of cystic fibrosis (2023)

Chinese experts consensus statement: diagnosis and treatment of cystic fibrosis (2023)

PORTABLE DEVICE AS A DIAGNOSTIC TOOL FOR MARFAN’S SYNDROME IN A REMOTE AREA

The Marfan’s syndrome is an autosomal dominant genetic disease that affects connective tissue, with an incidence of approximately one case for every 5000 individuals. Cardiovascular involvement often occurs in adulthood. As the most common manifestation of the syndrome, ascending aortic aneurysm frequently leads individuals to conditions of clinical emergencies, the emergency room and intensive care unit are a common sites for diagnosing cardiac disorders in patients with Marfan. In this article we find the case report of a 41-year-old patient with a history of chest pain, signs and symptoms of heart failure, admitted to the ICU, with phenotypic manifestations of the disease, whose aortic aneurysm was diagnosed during the initial examination of POCUS. As it is a relatively rare diagnosis, in a rural patient who until now was unaware of the diagnosis itself, the result of which was identified in a routine examination in the ICU, performed with a portable device, the ability to change the outcome of a disease with high morbidity and mortality with a simple exam, easy to access and with low training requirements in a highly complex unit, even in distant care units in a population with low socioeconomic status. This article aims to show how a simple examination, POCUS, performed with a handheld device, is able to identify complex, high-impact diseases.

Active screening of COVID-19-associated pulmonary aspergillosis with serum beta-glucan and endotracheal aspirates galactomannan and fungal culture.

Since February 2021 active screening of COVID-19-associated pulmonary aspergillosis (CAPA) has been implemented in our institution. To evaluate CAPA incidence in our centre and evaluate performance of our screening protocol. We screened once per week, collecting endotracheal aspirates for fungal culture and galactomannan (GM) and serum for 1,3-ß-D-glucan (BG). In case of positivity (GM more than 4.5, platelia assay, and/or BG >7pg/ml, wako and/or positive fungal culture), second-level investigations were performed to pursue CAPA diagnosis according to ECMM/ISHAM criteria: bronchoalveolar lavage (BAL) fungal culture and GM, chest computed tomography (CT), serum GM. A total of 102 patients were screened (median age 64 years, range 39-79; 28 (27.4%) females). Twenty-two patients were diagnosed with CAPA (21%). 12 patients were positive for serum BG, 17 patients were positive for endotracheal aspirates GM and 27 patients were positive for endotracheal aspirates fungal culture. Thirty-two BALs were performed, and 26 patients underwent CT chest. Following the second level investigations 61% of the patients with positive screening tests were diagnosed with CAPA. Serum BG above 20 pg/ml or positive serum GM were always associated with typical CT chest signs of aspergillosis. Compared with 1 single positive test, having 2 positive screening test was significantly more associated with CAPA diagnosis (p= .0004). Active CAPA screening with serum 1,3-ß-D-glucan and endotracheal aspirates galactomannan and fungal cultures and consequent second level investigations led to high number of CAPA diagnosis. Combining more positive fungal biomarkers was more predictive of CAPA diagnosis.

Management of Community Acquired Pneumonia in a Small Setting- A Case Report

Pneumonia is a potentially fatal infection and inflammation of the lower respiratory namely bronchioles and alveoli, usually caused by inhaled bacteria and viruses. The most common type of bacterial pneumonia in India is caused by the Streptococcus pneumoniae. The other organisms responsible for Pneumonia are, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. Pneumonia can occur at any age but is more common among young children and elderly in India. Fifty percent of world’s Pneumonia cases occur in India. However, it is not rare to occur among adults. Reliable estimates of disease burden are not available particularly for the adult population. Pneumonia that develops outside the hospital settings is commonly referred to as community acquired pneumonia (CAP) and that develops 48 hours after admission to the hospital is known as hospital acquired pneumonia. CAP is suspected by acute symptoms such as dyspnoea, cough with sputum and fever and presence of new focal chest signs without other obvious cause. New pulmonary infiltrate on a chest radiograph is required for a definite diagnosis. We present a case of CAP in adult male and its management in a sub-district hospital about 90 kms away from Bengaluru the capital of Karnataka State. A36-year male reported at a private hospital in a small town of Chintamani, in Kolar district of Karnataka with the complaints of cough with sputum, fever, vomiting, mild diarrhoea, for the last 3 days on 12/5/2021. Based on Chest Xray and other investigationshe was diagnosed as a case of pneumonia. His treatment consisted of multiple antibiotics that helped recover completely in 5 days.We feel that multiple antibiotics were against the Indian standard protocol of pneumonia management.

Клінічний випадок гігантської тимоліпоми в дитини віком 3 роки

Thymolipoma is a rare benign encapsulated tumor of anterior mediastinum. Overall, thymic neoplasms comprise only 4% of all mediastinal tumors. Only 2–9% of these are reported to be thymolipomas. Less than 200 cases have been published in the world literature and its incidence in both genders is equal and usually develops at any age. The youngest case in the literature was described in 6-month-old child. Thymolipoma can be associated with chronic lymphocytic leukemia, myasthenia graves, aplastic anemia, hyperthyroidism and Hodgkin’s disease. Half of the patients are asymptomatic, the neoplasm incidentally is discovered radiologically. The other half mostly represents shortness of breath, cough, chest pain and upper respiratory tract infection. The clinical case, diagnosis and treatment of gigantic thymolipoma in 3-year-old child is described in this article. A clinical case of giant thymolipoma in a 3-year-old child is presented. The child had several respiratory symptoms: episodes of choking, dry cough, groaning breathing during physical exertion and anxiety, chest deformity (enlarging the right half) and signs of type II respiratory failure. Radiographically - subtotal darkening of the right hemithorax with mediastinal shift to the contralateral side with compression of the left lung; laboratory results - hyperleukocytosis(39х109/l). Computed tomography showed a large hypovascular mass formation with inhomogeneous structure and areas of lipomatosis. Most likely, this is the case of congenital nature of thymolipoma, which manifested itself at the age of 3. Correct pathomorphological diagnosis was made with the help of open biopsy, since when performing the puncture method, there is a possibility of verification error due to insufficient amount of histological material given the inhomogeneity of the mass of the formation, as well as taking into account the suspicion of a lymphoproliferative process. Considering the mediastinal and intrathoracic compression syndrome, as well as the benign nature of these tumor, which is characterized by the absence of infiltrative growth, the only correct treatment tactic is radical surgery. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: neoplasms of anterior mediastinum, thymolipoma, children.

A comparison of Low Dose with Standard Dose Chest CT Scan in Diagnosis of COVID-19

Aim: Comparison of safety profile of low dose CT scan chest with standard dose CT scan in Covid 19. Study design: Prospective study Place and duration of study: Department of Radiology, Benazir Bhutto Hospital, Rawalpindi from -01-09-2020 to 31-03-2021. Methods After approval from ERB, 45 COVID-19 positive patients diagnosed by PCR, aged 55 years and above were selected. In the prospective study, these patients with normal CXR were advised for same day chest CT scan. Initially, a standard dose of chest CT scan of 150mAs was applied. After assessing the chest signs of Covid on scan, a low-dose CT of 30mAs was performed instantly. A comparison was made to check the diagnostic accuracy of standard-dose and low-dose CT for the identification of features of typical COVID19 pneumonia. Results: The mean age of patients was 58.27±7.23. An admirable intra-reader agreement was found between low- and standard-dose CT in identifying typical findings of COVID pneumonia (intraclass correlation coefficient [ICC] = 0.98–0.99 with A p value of less than 0.001 of all readers). Mean effective dose values of low and standard dose groups were 1.69±0.38 mSv and 7.21±1.23, correspondingly. Values of absolute cancer risk per mean cumulative effective dose of low & standard dose chest CT examinations were 0.68 × 10−4 and 2.41×10−4 respectively. Conclusions: The low dose CT chest protocol is better than standard dose for the identification of typical COVID-19 pneumonia features in routine practice with substantial decrease in dose of radiation as well as estimated cancer risk. Keywords: SARS CoV 2, Diagnosis, CT scan, Safety profile

Necrotizing Mediastinitis Following Dental Extraction: A Case Report.

IntroductionNecrotizing mediastinitis is a rare complication following a dental procedure. It is frequently lethal and requires prompt diagnosis with advanced imaging, administration of broad-spectrum antimicrobials, and early surgical consultation.Case ReportA 19-year-old, otherwise healthy male presented to the emergency department with chest pain, muffled voice, and facial and neck swelling six days following dental extraction. He was found to have a retropharyngeal abscess causing necrotizing mediastinitis and septic shock. The patient was started on broad-spectrum antimicrobials, required 10 surgical procedures, and experienced a prolonged hospitalization.ConclusionConsider necrotizing mediastinitis in patients presenting with chest pain and signs of retropharyngeal infection after dental procedures. Prompt imaging, antimicrobial therapy, and surgical consultation is critical in treating this frequently fatal disease.

MIS-A associated myocardial injury: The art of diagnosis and follow-up

Multisystem inflammatory syndrome in adults (MIS-A) is a rare but severe condition in adults with a clinical course similar to that described in children (MIS-C) following infection with the SARS-CoV-2 virus. Here we describe a case of a 21-year-old, otherwise healthy female who presented with chest pain and signs of sepsis six weeks after recovering from coronavirus disease 2019 (COVID-19). Early identification of MIS-A led to a favorable clinical course and full recovery. Given the highly variable disease presentation yet potentially deadly outcome, providers must remain vigilant to recognize and treat MIS-A early Keywords: MIS-A; myocardial inflammation; SARS-CoV-2; COVID-19 disease.

Antibiotics for lower respiratory tract infection in children presenting in primary care in England (ARTIC PC): a double-blind, randomised, placebo-controlled trial

SummaryBackgroundAntibiotic resistance is a global public health threat. Antibiotics are very commonly prescribed for children presenting with uncomplicated lower respiratory tract infections (LRTIs), but there is little evidence from randomised controlled trials of the effectiveness of antibiotics, both overall or among key clinical subgroups. In ARTIC PC, we assessed whether amoxicillin reduces the duration of moderately bad symptoms in children presenting with uncomplicated (non-pneumonic) LRTI in primary care, overall and in key clinical subgroups.MethodsARTIC PC was a double-blind, randomised, placebo-controlled trial done at 56 general practices in England. Eligible children were those aged 6 months to 12 years presenting in primary care with acute uncomplicated LRTI judged to be infective in origin, where pneumonia was not suspected clinically, with symptoms for less than 21 days. Patients were randomly assigned in a 1:1 ratio to receive amoxicillin 50 mg/kg per day or placebo oral suspension, in three divided doses orally for 7 days. Patients and investigators were masked to treatment assignment. The primary outcome was the duration of symptoms rated moderately bad or worse (measured using a validated diary) for up to 28 days or until symptoms resolved. The primary outcome and safety were assessed in the intention-to-treat population. The trial is registered with the ISRCTN Registry (ISRCTN79914298).FindingsBetween Nov 9, 2016, and March 17, 2020, 432 children (not including six who withdrew permission for use of their data after randomisation) were randomly assigned to the antibiotics group (n=221) or the placebo group (n=211). Complete data for symptom duration were available for 317 (73%) patients; missing data were imputed for the primary analysis. Median durations of moderately bad or worse symptoms were similar between the groups (5 days [IQR 4–11] in the antibiotics group vs 6 days [4–15] in the placebo group; hazard ratio [HR] 1·13 [95% CI 0·90–1·42]). No differences were seen for the primary outcome between the treatment groups in the five prespecified clinical subgroups (patients with chest signs, fever, physician rating of unwell, sputum or chest rattle, and short of breath). Estimates from complete-case analysis and a per-protocol analysis were similar to the imputed data analysis.InterpretationAmoxicillin for uncomplicated chest infections in children is unlikely to be clinically effective either overall or for key subgroups in whom antibiotics are commonly prescribed. Unless pneumonia is suspected, clinicians should provide safety-netting advice but not prescribe antibiotics for most children presenting with chest infections.FundingNational Institute for Health Research.

Acute Abdomen and Multisystem Inflammatory Syndrome in Children with COVID-19: A Case Report and Review of Pathophysiology, Gastrointestinal Symptoms and Abdominal Radiology

Introduction: Pediatric patients with coronavirus disease 2019 (COVID-19) account for less than 5% of the total incidence. The scientific literature reports that most patients are asymptomatic or present mild symptoms. However, they may only manifest gastrointestinal symptoms and even present an acute abdomen; a severe form of presentation has been reported, called multisystem inflammatory syndrome in children. Case Presentation: We report a 10-year-old girl who presents COVID-19 in the form of an acute abdomen because of severe sigmoiditis who developed multisystem inflammatory syndrome together with shock. The patient fully recovered without sequelae with medical treatment. We provide computed tomography and ultrasound images and review scientific information available on gastrointestinal COVID-19 pathophysiology from the pediatric point of view. Conclusion: A high index of suspicion is needed for diagnosing COVID-19 in the event of any pediatric acute abdomen during the pandemic, and screening should be undertaken even without an epidemiologic setting and in the absence of respiratory symptoms or radiologic chest signs because acute abdomen could be a clinical presentation of MIS-C in children.

Pharmacological treatment of the patients with croup

Background: Croup is a respiratory illness usually caused by acute viral infection of the larynx, trachea, and bronchi, and characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. Croup commonly affects children younger than 6 years of age, with peak incidence between 7 and 36 months. Although the disease is usually self-limited, it may occasionally become life threatening, and can, on rare occasion, lead to respiratory failure.Current Concepts: Treatment of viral croup depends on the severity of symptoms as denoted by Westley croup score (i.e., mild, moderate, or severe). A single dose of oral or intramuscular dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment for viral croup, irrespective of severity. A single dose of nebulized budesonide (2 mg) is equally effective as systemically administered dexamethasone, and is considered when a patient is unable to take a medicine orally. Nebulized L-epinephrine (1:1,000, 3-5 mL) causes vasoconstriction in the mucosa, rapidly reducing airway edema. Addition of nebulized L-epinephrine is indicated in the patients with croup of at least moderate severity, displaying chest retraction and signs of labored breathing.Discussion and Conclusion: The most effective pharmacological treatments for patients with viral croup are oral or intramuscular dexamethasone, and nebulized L-epinephrine. Especially, corticosteroids can significantly decrease the intensity of croup symptoms and reduce hospital admissions, return visits to emergency department and length of stay in the hospital.

High resolution computed tomography signs lead an early diagnosis of COVID-19

Introduction: The novel coronavirus disease 2019 (COVID-19) has huge impact on public health. RT-PCR of respiratory samples is generally accepted confirmatory test which can miss several cases due to various factors. Case description: A 32-years-old male without any co-morbidity presented with complaints of cough and fever was negative for Reverse Transcription Polymerase Chain Reaction (RT-PCR) on two separate occasions on two different centres died and the last sample sent on 30th day of admission tested positive for RT-PCR. Radiologist reported the CT Chest signs as highly likely case of COVID-19 on the day of admission. Clinical significance: Radiological signs on CT chest can contribute in the diagnostic workup of CIVID-19. Conclusion: Radiological signs reported in suspected COVID-19 should be noticed and given adequate weightage in conditions where the other laboratory tests are negative.

Acute Myocardial Infarction and Allergy, Causal or Casual Relationship?

A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque. LEARNING OBJECTIVE An exceptional clinical case is presented illustrating an acute myocardial infarction related to a severe allergic reaction. In addition, a review of the optimal management of this entity is carried out. We intend to make this entity known, which should be suspected in the appropriate clinical setting

Acute myocardial infarction and allergy, causal or casual relationship?

A 53-year-old man with a known allergy to metamizole presented for acute gonalgia, receiving metamizole by mistake. He suffers a severe allergy reaction accompanied by chest pain and signs of acute lower myocardial infarction, which subsides with treatment of anaphylactic shock and fibrinolysis, without observing intracoronary thrombus or signs of complication of atherosclerotic plaque. Keywords: Kounis syndrome; Allergic myocardial infarction; Myocardial infarction with normal coronary arteries.

Referral Bias in Coronary Micro vascular Dysfunction: a Retrospective Study

Obstructive coronary artery disease (CAD) is a well-defned condition and a signifcant cause of myocardial ischemia. Patients with angina typically undergo non-invasive cardiac investigations initially as a means of risk-stratifying. Coronary angiography is the diagnostic test of choice for patients with chest pain (angina) and signs of myocardial ischemia on noninvasive testing. Typically CAD is diagnosed based on the patency of the epicardial coronary arteries [1]. Approximately 30% of patients with angina have non-obstructive arteries on coronary angiogram and area diagnostic and management challenge for clinicians, contributing to signifcant social and economic burden [2]. They undergo multiple angiograms, experience a hospitalization rate 80% greater than patients with single vessel CAD and up to 50% have persistent symptoms leading to functional disability [3]. Historically, this population was given reassurance as long-term prognosis was believed to be benign [4]. We now know that a subset of these patients sui¬Â€er from coronary micro vascular dysfunction (MVD) [1] and are at increased risk for adverse cardiac events including congestive heart failure (CHF), myocardial infarction (MI), left ventricular (LV) dysfunction, and death [1,5]. The Cardiovascular Integrated Physiology (CVIP) program at Southlake Regional Health Centre (SRHC) investigates and manages patients with MVD. CVIP has received referrals for only a small fraction of patients with angina and non-obstructive angiograms at SRHC. It is unclear what factors promote referral. We hypothesized that referrals were not random and that the clinical characteristics of the referred patients dii¬Â€ered from the larger population of patients with angina and nonobstructive CAD. The primary objective of this study was to determine whether the patients referred to CVIP are an accurate representation of the overall population of patients with angina and non-obstructive coronary arteries.

Diagnostic cut-off value for Aspergillus fumigatus- and flavus-specific IgG with clinical relevance in chronic pulmonary Aspergillus infection: A pilot study in Taiwan.

The diagnostic cut-off value for chronic pulmonary Aspergillosis (CPA) by Aspergillus fumigatus-specific IgG has never been evaluated In Taiwan. The cut-off value for Aspergillus flavus-specific IgG has not been evaluated worldwide. Evaluate diagnostic cut-off value of Aspergillus IgG and its application characteristics. Blood from control groups and treatment-naïve patients with CPA infections was collected for Aspergillus-specific IgG measurements. Controls were patients who had chest radiographic abnormalities and signs of respiratory tract infection, but were negative for Aspergillus and resolved without anti-mould therapy. Confirmation and probability of CPA were defined according to radiological features and positivity for an Aspergillus or galactomannan index. Chest computer tomography patterns were recorded for the presence of aspergilloma or nodules, subacute invasive aspergillosis, chronic cavitary pulmonary aspergillosis and chronic fibrotic pulmonary aspergillosis. A total of 35 cases and 50 disease controls were included. The levels of A.fumigatus- and A.flavus-specific IgG correlated with CPA progression (P<.05) but not with the presence of Aspergillus species from clinical specimens (P>.05). The best cut-off value for A.fumigatus IgG was 21.7mg/L with area under curve (AUC) for receiver operating characteristic curve (ROC) 0.934 and had 85.7% sensitivity and 92.0% specificity. For A.flavus IgG, the best cut-off value was 22.1mgA/L and the AUC was 0.928 with 88.2% sensitivity and 94.1% specificity. The level of Aspergillus-specific IgG correlated with radiographic characteristics in patients with CPA and the best cut-off values compared to controls were 21.7mgA/L for A.fumigatus-specific IgG and 22.1mgA/L for A.flavus-specific IgG.

The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19

ObjectivesSofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2. This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with COVID-19.MethodsPatients with a positive nasopharyngeal swab for SARS-CoV-2 on RT–PCR or bilateral multi-lobar ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into two arms with one arm receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and single-dose hydroxychloroquine. The primary endpoint was time from starting the medication until discharge from hospital with secondary endpoints of duration of ICU stay and mortality.ResultsSixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27 in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95% CI 0.04–0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1–12.1, P < 0.01).ConclusionsGiven these encouraging initial results, and the current lack of treatments proven to decrease mortality in COVID-19, further investigation in larger-scale trials seems warranted.