Consolidation Score Research Articles

Chest CT Features of 182 Patients with Mild Coronavirus Disease 2019 (COVID-19) Pneumonia: A Longitudinal, Retrospective and Descriptive Study.

IntroductionThe evolution of computed tomography (CT) findings in patients with mild coronavirus disease 2019 (COVID-19) pneumonia has not been described in detail. A large-scale longitudinal study is urgently required.MethodsWe analyzed 606 CT scans of 182 patients. The dynamic evolution of CT scores was evaluated using two staging methods: one was divided into 10 periods based on decile intervals, and the other was one stage per week. Moreover, the latter was used to evaluate the dynamic evolution of imaging performance. A published severity scoring system was used to compare findings of the two methods.ResultsIn the dynamic evolution of 10 stages, the total lesion CT score peaked during stage 3 (9–11 days) and stage 6 (17–18 days), with scores = 7.19 ± 3.66 and 8.00 ± 4.57, respectively. The consolidation score peaked during stage 6 (17–18 days; score = 2.72 ± 3.07). In contrast, when a 1-week interval was used and time was divided into five stages, the total lesion score peaked during week 3 (score = 7.3 ± 4.15). The consolidation score peaked during week 2 (score = 2.54 ± 3.25). The predominant CT patterns differed significantly during each stage (P < 0.01). Ground-glass opacities (GGO), with an increased trend during week 3 and beyond, was the most common pattern in each stage (33–46%). The second most common patterns during week 1 were GGO and consolidation (24%). The linear opacity pattern with an increased trend was the second most common pattern during week 2 and beyond (21–32%).ConclusionsThe total lesion score of mild COVID-19 pneumonia peaked 17–18 days after disease onset. The consolidation scores objectively reflected the severity of the lung involvement compared with total lesion scores. Each temporal stage of mild COVID-19 pneumonia mainly manifested as GGO pattern. Moreover, good prognosis may be associated with increases in the proportions of the GGO and linear opacity patterns during the later stage of disease.

Cirugía de Preservación de Miembros en Tumores Músculo esqueléticos. Utilización de Nitrógeno Líquido. “Una novedosa y económica técnica de reconstrucción” Primera cohorte de pacientes en Uruguay

Introducción: La cirugía conservadora de miembros constituye el tratamiento estándar en el manejo de tumores músculo-esqueléticos. El problema al que se enfrenta el cirujano es la reconstrucción luego de una resección amplia. Existen diversas técnicas como endoprótesis, aloinjertos y autoinjertos, entre otras.&#x0D; En 1999 en Japón, Tsuchiya, et al desarrollaron la técnica de reconstrucción biológica utilizando nitrógeno líquido (NL). El objetivo del siguiente trabajo consiste en presentar la primera cohorte de pacientes tratados con dicha técnica en nuestro país. Además analizar los siguientes parámetros: recurrencia local, plazos de consolidación, sobrevida del autoinjerto y evaluación funcional al final del seguimiento.&#x0D; Metodología: Se realizó un estudio retrospectivo desde agosto 2015 hasta junio de 2019 de los pacientes tratados con autoinjerto congelado en NL. Todos fueron evaluados en equipo multidisciplinario y tratados por el mismo equipo quirúrgico. Se registraron un total de 19 casos, se incluyeron 13 para su evaluación, siendo excluidos el resto por tener menos de 6 meses de seguimiento. La técnica consiste en la resección tumoral con márgenes amplios, exposición de la pieza tumoral a un ciclo de inmersión en NL a -196 grados Celcius por 20 minutos, luego calentamiento progresivo por 15 minutos a temperatura ambiente y 10 minutos en agua destilada. Logrando erradicar las células tumorales por crioterapia. Seguido de la reimplantación del hueso congelado y fijación con material de osteosíntesis.&#x0D; En la evaluación, la recurrencia local fue evaluada clínica e imagenologicamente. La consolidación se evaluó según lo definido por Zekry et al: paciente sin dolor al deambular y líneas de osteotomías no son visibles o existe un callo evidente en 3 de las corticales en los enfoques antero posterior y lateral. La sobrevida del autoinjerto fue evaluada según si hubo necesidad o no de retirarlo.&#x0D; Resultados: Al final del seguimiento todos los pacientes se encuentran vivos, ninguno de los pacientes con enfermedad localizada ha desarrollado metástasis a distancia. Se registró un paciente con recurrencia local en partes blandas. Se logró la consolidación en un 83% de los pacientes, con una media de 6.7 meses. Fue necesario retirar el injerto en 3 casos, dos debido a una infección profunda y otro por colapso articular. La evaluación funcional según el score MSTS-ISOLS promedio fue de 73,8% (rango 13-100%). Dicho promedio fue de 89,9% (63-100%) en los 10 pacientes que se mantuvo el autoinjerto.&#x0D; Conclusiones: La técnica de autoinjerto congelado en NL constituye una muy buena opción de reconstrucción en tumores músculo-esqueléticos. Es una técnica de fácil acceso, bajo costo y mantiene las propiedades de osteoconducción y osteoinducción. Nuestra serie presenta resultados similares a los estudios publicados en cuanto a recurrencia local, consolidación y score funcional.

Feasibility of Lung Ultrasound to Monitor Aeration in Children Supported With Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome.

Feasibility of Lung Ultrasound to Monitor Aeration in Children Supported With Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome.

Clinical course and risk factors of mortality in Mycobacterium avium complex lung disease without initial treatment

PurposeMycobacterium avium complex-lung disease (MAC-LD) is increasing worldwide and may progress to cause mortality significantly. However, for patients without initial treatment at diagnosis, the survival outcomes and predictors of mortality remain unclear. MethodsFrom 2011 to 2017, MAC-LD patients at two medical centers in Taiwan were screened, and those who received MAC treatment at the initial were excluded. The clinical course and characteristics were recorded. Cox regression analysis and receiver operating characteristic (ROC) curves were performed to assess risk factors of mortality within 4 years. ResultsWe included 123 MAC-LD patients without initial MAC treatment. The mean follow-up period was 4.15 ± 2.52 years. Twenty-two (17.9%) patients died within four years. Multivariate analysis showed that four independent factors related to 4-year mortality were consolidation pattern (hazard ratio [HR] 6.0, 95% confidence interval [2.3–15.5]), radiographic score > 6 (HR:11.0 [4.0–31.1]), radiographic deterioration within two years (HR: 5.2 [2.1–13.1]) and no MAC treatment during follow up (HR: 6.5 [1.3–31.1]). The areas under the ROC curves for prediction of 4-year mortality for the combination of consolidation and radiographic score >6, the two factors plus radiographic progression, the two plus no MAC treatment, and the combination of the four factors were 0.702, 0.798, 0.758, and 0.835, respectively. ConclusionsThe four-year mortality rate in MAC-LD without initial treatment is high. Presence of consolidation pattern and radiographic score >6 at initial visit, radiographic deterioration and no treatment during follow-up were risk factors of 4-year mortality in initially untreated MAC-LD.

Clinical characteristics and changes of chest CT features in 307 patients with common COVID-19 pneumonia infected SARS-CoV-2: A multicenter study in Jiangsu, China

ObjectiveThe study was aimed to describe the clinical characteristics and evaluate the dynamic changes of chest CT features in the first three weeks in the common type fo COVID-19 pneumonia patients in Jiangsu Province. Methods307 patients infected SARS-CoV-2 classified as common type were enrolled in the study. 628 chest CT scans were divided into three groups based on the time interval between symptoms and chest CT scan. The clinical characteristics were descriptively analyzed.The chest CT features were quantitatively evaluated. Mann-Whitney U test was used to test the differences in three groups and between men and women. Spearman rank correlation was used to test the association between the arterial blood gas(ABG) analysis results and chest CT scores. ResultsFever (69.1%) and cough (62.8%) were common symptoms. 111(36.2%) patients were anorexia. GGO was the most common manifestation of COVID-19 pneumonia, which could be followed by consolidation and fibrosis. Lower lobe or subpleural region was the most common distribution form of lesion. More lung lobes were involved in the third week. Total chest CT scores in the second week were higher than the first week. Fibrosis Scores increased in the second and third week. Total CT score, GGO score and fibrosis score of male patients were significantly higher than female in the second week. Male patients had higher consolidation score and fibrosis score than female in the third week. Total CT score and GGO score had weak to moderate correlation with arterial blood gas indices. ConclusionChanges in chest CT were difficult to assess quantitatively in the first third weeks. Male patients recovered slower than female in the second week. Although CT score had correlations with arterial blood gas indices, long-term follow-up of pulmonary function test is needed to determine the recovery of lung.

Effect of regular alveolar recruitment on intraoperative atelectasis in paediatric patients ventilated in the prone position: a randomised controlled trial

BackgroundDesaturation frequently occurs in infants after general anaesthesia in the prone position. We aimed to evaluate the effect of regular alveolar recruitment in preventing atelectasis in infants and children after general anaesthesia in the prone position. MethodsChildren (<3 yr) undergoing general anaesthesia (>2 h) in the prone position were randomised to either receive regular alveolar recruitment or standardised care without recruitment. Ultrasound-guided alveolar recruitment was performed for both groups, and mechanical ventilation was started with a tidal volume of 6 ml kg−1 and PEEP of 7 cm H2O. During mechanical ventilation, the intervention (regular recruitment) group received alveolar recruitment once per hour. Lung ultrasound was performed after inducing anaesthesia and each position change. The primary outcome was the incidence of significant atelectasis (defined by consolidation score ≥2 in any region) before extubation, as evaluated by lung ultrasound undertaken by an investigator masked to trial allocation. ResultsSeventy-three children (regular recruitment: 37; standardised care: 36) were included in the analysis. Before the hourly intervention, atelectasis was similar between children randomised to regular alveolar recruitment or standardised care in both supine (83.3%, both groups; P>0.99) and prone positions (88.9% vs 91.9%; P=0.970). The incidence of atelectasis before extubation was lower in children receiving regular alveolar recruitment (8.1%), compared with 47.2% in children randomised to standardised care (absolute risk reduction: 39.1% [95% confidence interval: 20.6–57.6%); P<0.001). ConclusionsRegular alveolar recruitment reduced the incidence of atelectasis at the end of surgery in infants and children <3 yr undergoing general anaesthesia in the prone position. Clinical trial registrationNCT03486847.

Chest computed tomography semi-quantitative pleural effusion and pulmonary consolidation are early predictors of acute pancreatitis severity

To study the predictive value of semi-quantitative pleural effusion and pulmonary consolidation for acute pancreatitis (AP) severity. Thorax-abdominal computed tomography (CT) examinations were performed on 309 consecutive AP patients in a single center. Among them, 196 were male, and 113 were female, and the average age was 50±16 years. The etiology of AP was biliary in 43.7% (n=135), hyperlipidemia in 22.0% (n=68), alcoholic in 7.4% (n=23), trauma in 0.6% (n=2), and postoperative status in 1.6% (n=5) cases; 24.6% (n=76) of patients did not have specified etiologies. The prevalence of pleural effusion and pulmonary consolidation was noted. The pleural effusion volume was quantitatively derived from a CT volume evaluation software tool. The pulmonary consolidation score was based on the number of lobes involved in AP. Each patient's CT severity index (CTSI), acute physiology and chronic health evaluation II (APACHE II) scoring system, and bedside index for severity in acute pancreatitis (BISAP) scores were obtained. The semi-quantitative pleural effusion and pulmonary consolidation were compared to these scores and clinical outcomes by receiver operator characteristic (ROC) curve and area under the curve (AUC) analysis. In the 309 patients, 39.8% had pleural effusion, and 47.9% had pulmonary consolidation. The mean pleural effusion volume was 41.7±38.0 mL. The mean pulmonary consolidation score was 1.0±1.2 points. The mean CTSI was 3.7±1.8 points, the mean APACHE II score was 5.8±5.1 points, and the mean BISAP score was 1.3±1.0 points; 5.5% of patients developed severe AP, and 13.9% of patients developed organ failure. Pleural effusion volume and pulmonary consolidation scores correlated to the scores for the severity of AP. In predicting severe AP, the accuracy (AUC 0.839) of pleural effusion volume was similar to that of the CTSI score (P=0.961), APACHE II score (P=0.757), and BISAP score (P=0.906). The accuracy (AUC 0.805) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.503), APACHE II score (P=0.343), and BISAP score (P=0.669). In predicting organ failure, the accuracy (AUC 0.783) of pleural effusion volume was similar to that of the CTSI score (P=0.473), APACHE II score (P=0.119), and BISAP score (P=0.980), and the accuracy (AUC 0.808) of the pulmonary consolidation score was also similar to that of the CTSI score (P=0.236), APACHE II score (P=0.293), and BISAP score (P=0.612). Pleural effusion and pulmonary consolidation are common in AP and correlated to the severity of AP. Furthermore, the pleural effusion volume and pulmonary consolidation lobes can provide early prediction of severe AP and organ failure.

CT Quantitative Analysis and Its Relationship with Clinical Features for Assessing the Severity of Patients with COVID-19.

ObjectiveTo investigate the value of initial CT quantitative analysis of ground-glass opacity (GGO), consolidation, and total lesion volume and its relationship with clinical features for assessing the severity of coronavirus disease 2019 (COVID-19).Materials and MethodsA total of 84 patients with COVID-19 were retrospectively reviewed from January 23, 2020 to February 19, 2020. Patients were divided into two groups: severe group (n = 23) and non-severe group (n = 61). Clinical symptoms, laboratory data, and CT findings on admission were analyzed. CT quantitative parameters, including GGO, consolidation, total lesion score, percentage GGO, and percentage consolidation (both relative to total lesion volume) were calculated. Relationships between the CT findings and laboratory data were estimated. Finally, a discrimination model was established to assess the severity of COVID-19.ResultsPatients in the severe group had higher baseline neutrophil percentage, increased high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and lower baseline lymphocyte count and lymphocyte percentage (p < 0.001). The severe group also had higher GGO score (p < 0.001), consolidation score (p < 0.001), total lesion score (p < 0.001), and percentage consolidation (p = 0.002), but had a lower percentage GGO (p = 0.008). These CT quantitative parameters were significantly correlated with laboratory inflammatory marker levels, including neutrophil percentage, lymphocyte count, lymphocyte percentage, hs-CRP level, and procalcitonin level (p < 0.05). The total lesion score demonstrated the best performance when the data cut-off was 8.2%. Furthermore, the area under the curve, sensitivity, and specificity were 93.8% (confidence interval [CI]: 86.8–100%), 91.3% (CI: 69.6–100%), and 91.8% (CI: 23.0–98.4%), respectively.ConclusionCT quantitative parameters showed strong correlations with laboratory inflammatory markers, suggesting that CT quantitative analysis might be an effective and important method for assessing the severity of COVID-19, and may provide additional guidance for planning clinical treatment strategies.

Clinical characteristics and longitudinal chest CT features of healthcare workers hospitalized with coronavirus disease 2019 (COVID-19).

Rationale: The clinical data and corresponding dynamic CT findings were investigated in detail to describe the clinical and imaging profiles of COVID-19 pneumonia disease progression.Methods: Forty HCWs with COVID-19 were included in this study and 30 enrolled for imaging assessment. Disease was divided into four stages based on time from onset: stage 1 (1-6 days), stage 2 (7-13 days), stage 3 (14-22 days), and stage 4 (> 22 days). Clinical wand imaging data were analyzed retrospectively.Results: The cohort included 33 female and 7 male cases, with a median age of 40 years. Six had underlying comorbidities. More than half of the cases were nurses (22, 55%). Each stage included 39, 37, 34 and 32 CTs, respectively. Bilateral lesions, multifocal lesions and lesions with GGO pattern occurred in both lower lobes at all stages. The crazy-paving pattern (20, 54%), air bronchogram (13, 35%), and pleural effusion (2, 5%) were the most common CT features in stage 2. Consolidation score peaked in stage 2 whereas total lesions score peaked in stage 3.Conclusions: COVID-19 pneumonia in HCWs has a potential predilection for younger female workers. Stage 2 of COVID-19 pneumonia may be the key period for controlling progression of the disease, and consolidation scores may be an objective reflection of the severity of lung involvement.

Procalcitonin (PCT) Improves the Accuracy and Sensitivity of Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) Score in Predicting AECOPD Patients Admission to ICU.

The score of Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation (DECAF) can be used to predict the in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). It is worth noting that the DECAF score is the first scoring standard combining biomarkers and clinical variables. The application of biomarkers is helpful for improving the accuracy of the scoring system. In recent years, more and more reports and studies paid attentions to procalcitonin (PCT) in respiratory infectious diseases and its clinical value has attracted increasing attention. The study aimed at investigating the effectiveness of the DECAF score combined with PCT in predicting admission of AECOPD patients to intensive care unit (ICU). We conducted a retrospective study. We analyzed data from 171 non-immune individuals over the age of 40 in this study. All patients received blood routine measurement and DECAF score calculation on admission. The primary outcome used to assess the probability of an AECOPD patient was who would get a bed in general ward or ICU. Receiver operating characteristic curves (ROC) are used to assess the sensitivity and specificity of PCT, WBC, creatinine, and DECAF scores in predicting the risk of admissions to the ICU of COPD patients. We combined PCT, WBC, and creatinine with DECAF scores, observing the sensitivity and specificity of the different combinations in predicting COPD patients with regard to who should be admitted to ICU. After analyzing the data from 171 patients, we found that the probability of entering the ICU was 21.05% (36/171). The area under curve (AUC) of PCT, WBC, creatinine, and DECAF score in individually predicting the probability of entering the ICU of AECOPD patients were 0.71 (95% CI 0.61 - 0.81), 0.64 (95% CI 0.52 - 0.75), 0.74 (95% CI 0.63 - 0.84), and 0.88 (95% CI 0.81 - 0.94), respectively, with statistically significant differences (p = 0.00). The sensitivities of PCT, WBC, creatinine and DECAF scores were 0.61, 0.61, 0.56, and 0.91, respectively. The specificities of PCT, WBC, creatinine, and DECAF scores were 0.76, 0.67, 0.88 and 0.74, respectively. The AUC of Combination 1 (PCT&DECAF scores), Combination 2 (WBC&DECAF scores), and Combination 3 (creatinine&DECAF scores) for predicting AECOPD patients entering the ICU was 0.92 (95% CI 0.86 - 0.97), 0.89 (95% CI 0.84 - 0.94), and 0.91 (95% CI 0.85 - 0.96), respectively, with statistically significant differences (p = 0.00); the sensitivities were 0.92, 0.86, and 0.94, respectively, and the specificities were 0.97, 0.78, and 0.74, respectively. Procalcitonin improves the accuracy and sensitivity of the DECAF score in predicting the probability of AECOPD patients entering the ICU, and PCT was superior to other indexes to improve the sensitivity and specificity of the DECAF score.

Association between Initial Chest CT or Clinical Features and Clinical Course in Patients with Coronavirus Disease 2019 Pneumonia.

ObjectiveTo identify the initial chest computed tomography (CT) findings and clinical characteristics associated with the course of coronavirus disease 2019 (COVID-19) pneumonia.Materials and MethodsBaseline CT scans and clinical and laboratory data of 72 patients admitted with COVID-19 pneumonia (39 men, 46.2 ± 15.9 years) were retrospectively analyzed. Baseline CT findings including lobar distribution, presence of ground glass opacities, consolidation, linear opacities, and lung severity score were evaluated. The outcome event was recovery with hospital discharge. The time from symptom onset to discharge or the end of follow-up (for those remained hospitalized) was recorded. Data were censored in events such as death or discharge without recovery. Multivariable Cox proportional hazard regression was used to explore the association between initial CT, clinical or laboratory findings, and discharge with recovery, whereby hazard ratio (HR) values < 1 indicated a lower rate of discharge at four weeks and longer time until discharge.ResultsThirty-two patients recovered and were discharged during the study period with a median length of admission of 16 days (range, 9 to 25 days), while the rest remained hospitalized at the end of this study (median, 17.5 days; range, 4 to 27 days). None died during the study period. After controlling for age, onset time, lesion characteristics, number of lung lobes affected, and bilateral involvement, the lung severity score on baseline CT (> 4 vs. ≤ 4 [reference]: adjusted HR = 0.41 [95% confidence interval, CI = 0.18–0.92], p = 0.031) and initial lymphocyte count (reduced vs. normal or elevated [reference]: adjusted HR = 0.14 [95% CI = 0.03–0.60], p = 0.008) were two significant independent factors that influenced recovery and discharge.ConclusionLung severity score > 4 and reduced lymphocyte count at initial evaluation were independently associated with a significantly lower rate of recovery and discharge and extended hospitalization in patients admitted for COVID-19 pneumonia.

Predictors of mortality in acute exacerbations of chronic obstructive pulmonary disease using the dyspnea, eosinopenia, consolidation, acidemia and atrial fibrillation score.

Background:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common and often fatal; however, accurate prognosis of patients hospitalized with an exacerbation is difficult. The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score uses indices routinely available at the time of hospital admission and can accurately predict the inhospital mortality and outcomes in patients hospitalized with AECOPD.Methodology:A cross-sectional study was conducted in Jawaharlal Nehru Medical College, Belagavi, from January 2016 to June 2018. Consecutive patients hospitalized with an exacerbation of chronic obstructive pulmonary disease were included. DECAF indices and inhospital death rates were recorded. The prognostic value of DECAF was assessed by comparing the total score with the inhospital mortality. Statistical analysis was done using SPSS version 20.Results:Two hundred and twenty-eight patients were recruited. The mean (standard deviation) age was 61.09 ± 10.6 years; 73.68% were male and 48 patients (21.05%) died in hospital. One hundred and twelve patients were identified as low risk (DECAF: 0–1) with 6 (5.4%) patients dying in the hospital and 56 patients were identified as high risk (DECAF: 3–6) with an inhospital mortality of 60.1%. Length of stay for scores of 0–1, 2, and ≥3 was 6.42, 7.47, and 9.64 days, respectively, with P < 0.05. The receiver operating characteristic curve analysis showed P < 0.001, thereby proving that the DECAF is a significant predictor of mortality in AECOPD.Conclusion:This study proved that with an increase in the DECAF score, the mortality among patients in AECOPD increased. The DECAF score helps clinicians predict prognosis accurately by identifying low-risk patients potentially suitable for home-based care or early hospital discharge and high-risk patients requiring escalated palliation with high-level care to improve their outcome.

Energy and Migration Cost-Aware Dynamic Virtual Machine Consolidation in Heterogeneous Cloud Datacenters

Energy efficiency has become one of the major concerns for today's cloud datacenters. Dynamic virtual machine (VM) consolidation is a promising approach for improving the resource utilization and energy efficiency of datacenters. However, the live migration technology that VM consolidation relies on is costly in itself, and this migration cost is usually heterogeneous as well as the datacenter. This paper investigates the following bi-objective optimization problem: how to pay limited migration costs to save as much energy as possible via dynamic VM consolidation in a heterogeneous cloud datacenter. To capture these two conflicting objectives, a consolidation score function is designed for an overall evaluation on the basis of a migration cost estimation method and an upper bound estimation method for maximal saved power. To optimize the consolidation score, a greedy heuristic and a swap operation are introduced, and an improved grouping genetic algorithm (IGGA) based on them is proposed. Lastly, empirical studies are performed, and the evaluation results show that IGGA outperforms existing VM consolidation methods.

Role of the DECAF Score in Predicting In-hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

IntroductionAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be fatal. In 2012, a comprehensive score was developed to predict the risk of in-hospital mortality in AECOPD called the dyspnoea, eosinopenia, consolidation, acidemia, and atrial fibrillation (DECAF) score. We conducted this study to assess the value of the DECAF score as a clinical prediction tool that claims to stratify all patients with AECOPD by risk accurately.MethodsWe conducted a prospective study of patients admitted to the intensive care unit (ICU) of the Department of Pulmonology in Civil Hospital, Jamshoro, from January 2016 to December 2018. Our inclusion criteria were that the patient must be age 35 years or older, have a primary clinical diagnosis of AECOPD, spirometry consistent with airflow obstruction, and have a smoking history of ≥10 cigarette pack per year. We excluded patients who had domiciliary ventilation, survival-limiting comorbidities (such as metastatic malignancy), and a primary reason for admission other than AECOPD. All sociodemographic data were collected at the time of admission, including age, gender, co-morbidities, housebound status, and number of previous AECOPD. Clinical data collected included plain chest x-ray, spirometry, electrocardiogram, arterial blood gases analysis, complete blood count, kidney function test, liver function test, and serum electrolytes. A DECAF score was applied to each patient. We noted in-hospital mortality and compared the characteristics of survivors and non-survivors. Data were analyzed using IBM SPSS for Windows, version 19.0 (IBM Corp, Armonk, NY).ResultsA total of 162 patients were included in the study. The mortality rate was 13% (n=21). More survivors had a DECAF score from zero to three than non-survivors. The difference in the number of survivors vs. non-survivors was statistically significant for DECAF scores zero and one. For DECAF scores four and five, there were more patients in the “non-survivors” group, and the differences were statistically significant. None of the patients scored six on DECAF.ConclusionPatients with a DECAF score of four or higher have a significant risk of mortality. DECAF is a simple tool that predicts mortality that incorporates routinely available indices to stratify AECOPD patients into mortality risk categories.

What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial

ObjectiveHospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic...

Comparing severity scores in exacerbations of chronic obstructive pulmonary disease

Prognostic scores help identify patients at a high risk of mortality in exacerbations of chronic obstructive pulmonary disease (COPD). The Dyspnoea, Eosinopaenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score has been reported to perform better than other severity scores in predicting mortality from exacerbations of COPD in studies including patients with pneumonia. To compare the performance of DECAF with other prognostic scores: CURB-65, CRB-65 and BAP-65, in predicting 30-day mortality in patients hospitalised with exacerbations of COPD without pneumonia. Data from hospital admission of 423 patients from two cohorts of patients with exacerbations of COPD without consolidation on chest radiographs were used to compile the CURB-65, CRB-65, BAP-65 and DECAF scores. The performance of each prognostic score in predicting 30-day mortality was studied using receiver operating curve analysis. Thirty-one patients (7%) died within 30days of hospital admission. One hundred patients (24%) did not have DECAF scores because of the incomplete laboratory data, while all 423 patients had the other scores available for analysis. All scores predicted mortality with similar areas under the receiver operating characteristic curve (CURB-65=0.69, CRB-65=0.64, BAP-65=0.64, DECAF=0.65, P=0.186). In patients hospitalised with exacerbations of COPD without pneumonia, simple clinical scores that rely on fewer laboratory measures perform at least as well as DECAF in predicting early mortality.

Granulocyte-colony stimulating factor enhances bone fracture healing

BackgroundCirculating mesenchymal stem cells contribute to bone repair. Their incorporation in fracture callus is correlated to their bioavailability. In addition, Granulocyte-colony stimulating factor induces the release of vascular and mesenchymal progenitors. We hypothesized that this glycoprotein stimulates fracture healing, and analyzed the effects of its administration at low doses on bone healing. Methods27 adult male Sprague-Dawley rats underwent mid-femur osteotomy stabilized by centromedullar pinning. In a post (pre) operative group, rats were subcutaneously injected with 5 μg/kg per day of Granulocyte-colony stimulating factor for 5 days after (before) surgery. In a control group, rats were injected with saline solution for 5 days immediately after surgery. A radiographic consolidation score was calculated. At day 35, femurs were studied histologically and underwent biomechanical tests. Findings5 weeks after surgery, mean radiographic scores were significantly higher in the Preop group 7.75 (SD 0.42) and in the Postop group 7.67 (SD 0.52) than in the control group 6.75 (SD 0.69). Biomechanical tests showed femur stiffness to be more than three times higher in both the Preop 109.24 N/mm (SD 51.86) and Postop groups 100.05 N/mm (SD 60.24) than in control 32.01 N/mm (SD 15.78). Mean maximal failure force was twice as high in the Preop group 68.66 N (SD 27.78) as in the control group 34.21 N (SD 11.79). Histological results indicated a later consolidation process in control than in treated groups. InterpretationGranulocyte-colony stimulating factor injections strongly stimulated early femur fracture healing, indicating its potential utility in human clinical situations such as programmed osteotomy and fracture.

Haematology, bronchoalveolar cellular changes and pathology of swine pneumonia in Nigeria

Respiratory diseases are of considerable economic importance in pigs, and less emphasis is on the diagnostic approaches in porcine health in our environment. The aim of this study was to compare the diagnostic accuracy of haematology, gross, bronchoalveolar lavage (BAL) and histopathological changes of pneumonia in pigs. The study was conducted at a municipal abattoir for over three months. A total of 146 finished pigs were clinically examined. Blood samples were taken, while the plucks were examined for lung lesions. Lavage samples and lung sections were taken for BAL and histological examinations. Six breeds were slaughtered comprising Large White 112 (76.7%), Mixed Breed 15 (10.3%), Duroc 7 (4.8%), Local 6 (4.1%), Hampshire 4 (2.7%), and Large Black 2 (1.4%). Based on sex, 71 (48.6%) were males while, 75 (51.4%) were female. Grossly, there was pneumonia in 92 (63.0%) of the pigs and the mean pulmonary consolidation score was 9.6±1.2. The large white breed had the highest consolidation score. Also, the right and left caudal lobes had the highest consolidation scores. Clinically, there was mild anaemia and leukocytosis, and BAL fluid cellular differential showed increased lymphocytic and neutrophilic counts in the pigs with pneumonia (p&lt;0.05). Histologically, 91 (62.2%) of samples were normal, bronchointerstitial pneumonia was 31 (21.4%), bronchopneumonia was 18 (12.4%), granulomatous pneumonia was 1 (0.7%), bronchiolitis was 4 (2.7%), and verminous pneumonia was 1 (0.7%). Bronchointerstitial pneumonia was the most prevalent pattern. Porcine pneumonia is still important in our environment; the roles of different causal agents need to be elucidated for production of vaccines and control in Nigeria and other parts of West Africa.Keywords: Bronchoalveolar lavage, Cytology, Swine, Pneumonia, Diagnostics

Serum inflammatory biomarkers and clinical outcomes of COPD exacerbation caused by different pathogens.

Background and objectiveCOPD exacerbation is characterized by worsening of symptoms, warranting change in treatment. Systemic and airway inflammation play roles in the pathogenesis of COPD exacerbation. We hypothesized whether increased serum inflammatory biomarkers are associated with the clinical outcomes of COPD exacerbation caused by different infectious pathogens.MethodsCOPD patients with exacerbation were recruited from a hospital emergency department during 2014–2015. Serum procalcitonin (PCT) and C-reactive protein (CRP) were measured. Dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation (DECAF) score was calculated for predicting mortality. Multiplex polymerase chain reaction was carried out for respiratory viral assay from nasopharyngeal swabs, and sputum bacterial culture was also performed. Hospital mortality, invasive mechanical ventilation requirement, and length of hospital stay (LOS) were evaluated, and their associations with clinical characteristics, DECAF score, and serum biomarkers were examined.ResultsA total of 62 COPD patients were enrolled. These patients were classified as Global Initiative for Obstructive Lung Disease (GOLD) stage 2, 3, and 4 in 12.9%, 6.4%, and 80.7% of cases, respectively. Isolated bacterial exacerbation was recovered in 30.6% of exacerbation episodes: Klebsiella pneumoniae was the most commonly identified bacteria. Viral pathogens and coinfections were noted in 9.6% and 16.1% of exacerbated patients, respectively. Influenza was the most commonly detected viral pathogen. Serum biomarkers and DECAF score for viruses, bacteria, coinfection, and noninfectious causes of exacerbations were similar. Neither DECAF score nor serum biomarkers were able to differentiate patients with and without mortality or requiring mechanical ventilation. Increased serum PCT was noted in patients with LOS ≥7 days when compared with those with LOS <7 days (0.38 ng/mL vs 0.1 ng/mL; P=0.035).ConclusionIncreased serum PCT is associated with longer LOS in COPD exacerbation. However, CRP and DECAF score play limited roles in predicting clinical outcome and lack an association with causes of exacerbation.

Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation Score and BAP-65 Score, Tools for Prediction of Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Comparative Pilot Study.

Introduction:Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) being common and often fatal, prognostic tools in AECOPD are lacking.Materials and Methods:A prospective, observational study was carried out in fifty patients of AECOPD admitted in A and E department. Dyspnea, Eosinopenia, Consolidation, Acidemia and atrial Fibrillation (DECAF) score and elevated blood urea nitrogen, altered mental status, pulse >109, age >65 (BAP-65) score were calculated. Dyspnea was scored using extended Medical Research Council Dyspnoea score. Data were collected and analyzed using SPSS 17.0 software.Results:Forty-one patients were discharged and 9 (18%) died during treatment. Patients who were discharged and patients who died during hospital stay were compared. There was no significant difference in terms of sociodemographic variables, presence of comorbidities, and other markers of disease severity. A significant difference was found in blood counts, blood urea, serum creatinine, acidotic respiratory failure, and atrial fibrillation. A higher value of DECAF score and BAP-65 score was found more commonly in patients who died. Sensitivity for prediction of mortality for DECAF score and BAP-65 score was 100% and specificity was 34.1% and 63.4%, respectively. Sensitivity for prediction of need for invasive ventilation for DECAF score and BAP-65 score was 80% and 100%, respectively, and specificity was 80% and 60%, respectively.Conclusion:Both DECAF and BAP-65 scores were found to be good predictors of mortality and need for ventilation in this pilot study.