Severe Lung Involvement Research Articles

Genetically determined thymic function affects strength and duration of immune response in COVID patients with pneumonia.

Thymic activation improves the outcome of COVID-19 patients with severe pneumonia. The rs2204985 genetic polymorphism within the TCRA-TCRD locus, which affects thymic output in healthy individuals, was found here to modify SARS-CoV-2-specific immunity and disease severity in COVID-19 patients with severe pneumonia. Forty patients with severe COVID-19 pneumonia were investigated. The GG genotype at the rs2204985 locus was associated, independently of age and sex, with stronger and long-lasting anti-SARS-CoV-2 helper and cytotoxic T cell responses 6 months after recovery. The GG genotype was also associated with less severe lung involvement, higher thymic production, and higher counts of blood naïve T lymphocytes, including recent thymic emigrants, and a larger population of activated stem cell memory CD4+ T cells. Overall, GG patients developed a more robust and sustained immunity to SARS-CoV-2. Polymorphism at rs2204985 locus should be considered as an additional predictive marker of anti-SARS-CoV-2 immune response.

Prenatal transmission of severe acute respiratory syndrome coronavirus 2, resulting in neonatal severe acute pneumonia, from an asymptomatic mother: a case report

BackgroundWe report a case of prenatal coronavirus disease 2019, which evolved 6 days after birth into severe pneumonia with signs of multiple organ failure, in a mother with asymptomatic coronavirus disease 2019.Case presentationAt minute 11 of life, our patient from Afro-Caribbean had polypnea with mild signs of struggle; Silverman’s index was scored at three. Chest radiography showed bilateral opacities consistent with respiratory distress syndrome. On the 6th day of life, a thoracic computed tomography scan showed bilateral parenchymatous lesions (10–20%) in ground glass, compatible with coronavirus disease 2019-type infection. At the same time, the neonate showed signs of multiple organ failure (elevated liver and cardiac enzyme levels). She was treated with azithromycin (20 mg/kg/day) for 5 days. All the signs recovered fully by day 12. Real-time polymerase chain reaction results were positive in the first 30 min of life, suggesting prenatal transmission. Our patient has been followed until 2 years old and is developing well with no sequelae.ConclusionThis case report demonstrates the incompatibility between maternal asymptomatic coronavirus disease 2019 and severe neonatal lung involvement. We emphasize the need for vigilance to avoid missing the most severe forms of neonatal coronavirus disease 2019.

Assessment of lung involvement using HRCT among vaccinated and non-vaccinated elderly COVID-19 patients admitted in a designated hospital, Tamil Nadu - A retrospective study.

The COVID-19 pandemic is considered one of the most devastating situations globally, the worst affected were the senior citizens. A number of initiatives were carried out to control the COVID-19 pandemic; one such important measure is the development of COVID-19 vaccines to prevent the disease. But the continuous emergence of new SARS-COV2 variants (antigenic drift) and its demographic variation in virulence makes the vaccine's efficacy questionable. This study is intended to evaluate the association between the degree of lung involvement and the effectiveness of vaccination against the disease in cases admitted to a designated hospital in Tamil Nadu. A hospital records-based-retrospective research was conducted among COVID-19 patients admitted from the 1st of April 2021 to the 31st of May 2021, and information was gathered regarding their vaccination status, comorbid conditions, and CT severity score (CTSS) in the HRCT lung report. A consecutive sampling technique was used to choose the study participants; about 120 participants were included in the study. The Chi-square test and Fisher's extract test were used to evaluate the hypothesis. The relationship between a dependent variable and independent factors was estimated using multiple linear regression. Among 120 participants, about 60.2% were males and 39.8% were females. Vaccination status and comorbid conditions had a significant association with severe lung involvement in COVID-19 patients. Non-vaccinated patients had severe lung involvement based on the HRCT lung scan findings than the vaccinated patients. To reduce mortality, it is essential to ensure universal coverage of COVID-19 vaccination.

Vit D Assessment in Patients with Covid-19 Virus

Abstract Background vitamin D may potentially play an important role in preventing or ameliorating the multi-system consequences of COVID-19 infections. Aim of the Work The aims of this study is to assess that there is a potential association between mean levels of vitamin D in the cases and mortality caused by COVID-19. Patients and Methods This was a case control study that was conducted on 80 Egyptian Patients attending at El medani hospital, El Obour specialized hospital, and the outpatient clinics at Ain shams University hospitals through six months. Results Vitamin D deficiency has been found to contribute to acute respiratory distress syndrome, a major cause of death associated with COVID-19. Vitamin D plays a role in strengthening the body‟s immunity by inducing monocyte differentiation and inhibiting lymphocyte proliferation. Regarding to the laboratory investigations: We have found that the number and percentage of WBC, LYM and NEU were significantly different between positive and negative RT-PCR cases for COVID-19/or SARS-CoV-2. In comparison to the normal range, we found low WBC and LYM counts in patients with positive RT-PCR COVID-19. Regarding to vitamin D: Our study showed statistically significant positive correlation between vit D and lymphocytes, and there was statistically significant negative correlation between vit D, neutrophil-lymphocyte ratio, CRP, BUN, S. creatinine, AST, ALT, FERRITIN, LDH and D-DIMER. Conclusion Vitamin D deficiency is a risk factor for infections as well as for insufficient innate immune system reactivity, therefore the winter time testing for serum vitamin D status (lowest levels expected) should be mandatory as part of regular health check status. The test is even more mandatory in patients with chronic diseases, where we expect vitamin D deficiency during all the year and an increased burden of risk factors for further disease severity and even mortality. In conclusion, this study confirms that vitamin D deficiency is associated with more severe lung involvement, longer disease duration, in COVID-19 patients.

Role of statins in clinical evolution of octogenarian patients admitted due to COVID-19

Introduction and objectivesCOVID-19 (Coronavirus disease 2019) causes high mortality in elderly patients. Some studies have shown a benefit of statin treatment in the evolution of this disease. Since there are no similar publications in this population group, the aim of this study is to analyze in-hospital mortality in relation to preadmission treatment with statins in an exclusively elderly population of octogenarian patients. Materials and methodsA single-center retrospective cohort study was performed including a total of 258 patients ≥80 years with hospital admission for confirmed COVID-19 between March 1 and May 31, 2020. They were divided into two groups: taking statins prior to admission (n = 129) or not (n = 129). ResultsIn-hospital mortality due to COVID-19 in patients ≥80 years (86.13 ± 4.40) during the first wave was 35.7% (95% CI: 30.1%–41.7%). Mortality in patients previously taking statins was 25.6% while in those not taking statins was 45.7%. Female sex (RR 0.62 [0.44–0.89]; P = .008), diabetes (RR 0.61 [0.41–0.92]; P = .017) and pre-admission treatment with statins (RR 0.58 CI 95% [0.41–0.83]; P = .003) were associated with lower in-hospital mortality. Severe lung involvement was associated with increased in-hospital mortality (RR 1.45 IC95% [1.04–2.03]; P = .028). Hypertension, obesity, age, cardiovascular disease and a higher Charlson index did not, however, show influence on in-hospital mortality. ConclusionsIn octogenarian patients treated with statins prior to admission for COVID-19 in the first wave, lower in-hospital mortality was observed.

Assessing Role of HRCT Screening Policy among COVID-19 Test-Negative Symptomatic Patients in Ahmedabad, India

ntroduction: To effectively contain the disease and controlling the progression of the COVID19 pandemic, Ahmedabad Municipal Corporation (AMC) implemented a unique policy to screen symptomatic individuals with negative diagnostic tests using the High-Resolution Computed Tomography (HRCT) scan. Objective: To analyse the findings of the HRCT screening policy during the COVID19 pandemic situation. Method: During the period of HRCT Screening policy, i.e., 23rd July 2020 to 31st December 2020, a total of 41034 scan record from 25 CT scan centers were available. A retrospective analysis of these secondary data available with the health department of AMC was carried out after due permission from the local authority. Results: A total of 11337 [27.63%, 95% Confidence Interval (CI) 27.20-28.06] were reported as COVID positive. Males reported higher positivity (27.87%) than females (27.17%), however the difference was statistically not significant (Z=1.512, p=0.131). Age wise positivity shows increasing trend, while zone wise comparison shows positivity in line with the cases from respective zone. Analysis of CT severity score shows that 66.15% had Mild, 26.07% had moderate and 7.78% had severe lung involvement. Conclusion: HRCT screening policy identified additional cases of COVID19 and helped in isolation/admission of a large number of suspected cases which helped immensely in better control of the pandemic. HRCT, when used in combination with other diagnostic tests, plays a crucial role in controlling the pandemic situation.

Comparison of HRCT Chest Findings of COVID-19 Patients Having Clinical Co-morbid to Those Without Co-morbid Disease

Objective: To determine the severity of High-Resolution Computed Tomography Chest findings of COVID-19 patients having co-morbid in comparison to those without co-morbid.
 
 Study Design: Comparative cross sectional study.
 Place and Duration of the Study: Radiology Department Combined Military Hospital, Multan Pakistan, from Mar to Sep 2020.
 Methodology: Data was collected through the medical record system of positive COVID-19 tests. Patients were divided into patients with no co-morbidities and others having co-morbidities. Two radiologists interpreted High-Resolution Computed Tomography chests independently to assess the disease severity in these two Groups. Co-morbidities included diabetes mellitus, hypertension, chronic renal disease, heart disease, Chronic Obstructive Pulmonary Disease and liver diseases.
 Results: A total of 200 patients were included. Out of 121 male patients, 85 had co-morbidities (71 had moderate to severe lung involvement; 14 had mild lung involvement); while 36 had no co-morbidities (5 had moderate to severe lung involvement; 31 had mild lung involvement). Out of 79 female patients, 47 had co-morbidities (15 had moderate to severe lung involvement; 32 had mild lung involvement); while 32 had no co-morbidities (3 had moderate to severe lung involvement; 29 had mild lung involvement).
 Conclusion: The severity of lung involvement was remarkably higher in patients with associated co-morbidities compared to no co-morbidities. Older age male patients having co-morbidities pose a risk factor for the severity of disease progression as compared to younger age female patients having no co-morbidities

Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia

This study aims to examine the clinical characteristics and mortality-related factors of obstetric patients, who were taken to the intensive care unit due to Coronavirus Disease 2019 (COVID-19). This study included 31 patients in the peripartum period with COVID-19 pneumonia, followed up in the intensive care unit (ICU) from March 2020 to December 2020. Symptoms, laboratory values, intensive care unit duration of stay, complications, the requirement of non-invasive and invasive mechanical ventilation, and mortality were recorded. The mean age was 30.7 ± 6.2 years and the mean gestational age was 31.1 ± 6.4 weeks. Among the patients, 25.8% had a fever, 87.1% had a cough, 96.8% had dyspnoea and 77.4% had tachypnoea. Seventeen patients (54.8%) had mild, 6 (19.4%) had moderate and 8 (25.8%) had severe pulmonary involvement on computed tomography. Sixteen (51.6%) patients required high-frequency oscillatory ventilation, 6 (19.3%) patients required continuous positive airway pressure, and 5 (16.1%) patients required invasive mechanical ventilation. Sepsis complicated by septic shock and multiorgan failure occurred in 4 patients and all of them died. The ICU duration of stay was 4.9 ± 4.3 days. We have found that older maternal age, obesity, high LDH, AST, ALT, ferritin, leukocyte, CRP, and procalcitonin values, and severe lung involvement were mortality-related factors. Impact statement What is already known on this subject? Pregnant women are in the high-risk group for Covid-19 disease and its complications. Although most pregnant women are asymptomatic, severe infection-related hypoxia can cause serious foetal and maternal problems. What do the results of this study add? When we examined the literature, we found that the number of studies on pregnant women with severe Covid-19 infection was limited. For this reason, with our study results, we aim to contribute to the literature by determining the biochemical parameters and patient-related factors associated with severe infection and mortality in pregnant patients with severe Covid-19 infection. What are the implications of these findings for clinical practice and/or further research? With our study results, predisposing factors for the development of severe Covid-19 infection in the pregnant patient population and biochemical parameters that are early indicators of severe infection were determined. In this way, pregnant women in the high-risk group can be followed closely and the necessary treatments can be started quickly so disease-related complications and mortality can be reduced.

Pulmonary involvement in antineutrophil cytoplasmic antibody-associated vasculitides: A single center experience from Turkey.

Pulmonary involvement is an important cause of mortality and morbidity in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV). In this study, we aimed to evaluate the type and frequency of pulmonary involvement and investigate the potential relationship between thorax computed tomography (CT) signs and other systemic clinical findings in AAV. A total of 63 patients over the age of 18 and diagnosed with AAV were included in this study. Thoracic CT imaging findings and clinical features of the patients at the time of diagnosis were retrospectively evaluated. The frequency and distribution of detected pathological findings on imaging according to disease types, in addition to the relationship of these findings with other systemic findings and disease severity, were analyzed. Of 63 patients, 50 (79.4%) had pulmonary symptoms at the time of presentation. Most frequently observed pulmonary finding of thorax CT was nodular opacity. Consolidation, cavitary nodules, bronchiectasis, emphysema and fibrotic sequelae change were more common in the patients with diagnosis of granulomatosis with polyangiitis. Honeycomb, atelectasis, interstitial pneumonia, pulmonary venous congestion and pleural effusion were more common in the patients with diagnosis of microscopic polyangiitis. Ground-glass appearance, central airway disease, peribronchovascular nodules, pericardial effusion and lymphatic adenomegaly (>10 mm) were more common in the patients with diagnosis of eosinophilic granulomatosis with polyangiitis. Interstitial lung disease, pulmonary hemorrhage and severe lung involvement were found significantly increased in patients with myeloperoxidase antibody (MPO)-ANCA positivity (P < 0.05). Lung involvement was detected in almost all of the patients with AAV. Both interstitial lung disease and severe lung involvement were more frequently found in patients with MPO-ANCA positivity compared to other patients. Pulmonary examination by an imaging technique in all patients with AAV may be useful to determine the vasculitis subtype and to determine the extent of the disease. Pulmonary involvement is quite common in AAV. Every patient with suspected AAV should be examined with imaging for lung involvement, even in the absence of respiratory symptoms. Severe pulmonary involvement is associated with the presence of severe disease and MPO-ANCA positivity.

Changing Dynamics of Self-Harm by Attempted Suicidal Hanging during the COVID-19 Pandemic

ABSTRACT Background: The second wave of coronavirus disease (COVID-19) in 2021 was devastating for low- and middle-income countries (LMICs). This led to increased suicide rates among the young, economically productive age group. We analyzed the cohort of attempted suicidal hangings needing admission to the intensive care unit (ICU) and compared the data from the pre-COVID-19 era. Materials and Methods: We conducted a retrospective, observational, cohort study of suicidal hanging cases according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Six-month data of such cases admitted to the neurological ICU after the lockdown of the second wave of COVID-19 from July 2021 to January 2022 were collected. Demographic data along with the cause of attempted hanging, severity of sickness from hanging, and its outcome were gathered and compared with similar data acquired during 2003–2015 by the same authors in the same ICU. Results: There was a threefold increase in the incidence of suicidal hangings needing ICU care, from 9 to 27% in the pre- and post-COVID-19 era. A shift toward older aged males, in the third decade of life, was observed. The common cause of attempted suicide was a familial dispute (P = 0.03). Among the younger age group (18–25 years), increased screen time led to fights in the family. The cohort was also sicker with more severe lung involvement, longer ventilation, and hospital stay (P &lt; 0.001). Conclusion: The increased incidence of hanging among young adults, amid the socioeconomic effects of COVID-19, needs urgent attention. Suicide prevention measures need novel strategies aimed at de-addiction from electronic gadgets and reducing screen time.

Evaluation of Clinical Characteristics and Outcomes of Chest Trauma Patients with COVID-19 Infection Undergoing Emergency Surgeries.

This study aims to examine the clinical characteristics and prognosis of patients with chest trauma who were infected with COVID-19 and underwent emergency surgery. In light of the COVID-19 pandemic, this research investigates the impact of COVID-19 on patients with chest trauma who underwent emergency surgery. This retrospective cohort study was conducted on 56 patients with chest trauma in two groups with COVID-19, and no covid who underwent surgery in Shahid Madani Hospital. Among the trauma patients, 21 were infected with COVID-19, and 35 were not. The predominant causes of trauma were car and motorcycle accidents. Among COVID-19 patients, 3.3% exhibited symptoms of fever, chills, cough, shortness of breath, and gastrointestinal symptoms, while 5.9% had severe lung involvement confirmed by CT scan. Following surgery, 1.57% (12 individuals) of COVID-19 patients were transferred to the ICU, with an average hospitalization duration of 1.11 days. In contrast, the average hospitalization duration for non-COVID-19 chest trauma patients was 1.9 days (p =0.015). Patients with chest trauma who underwent surgery and were infected with COVID-19 demonstrated significant differences in average length of stay, ICU admissions, and pneumonia incidence. However, there was no significant distinction in the mortality rate between the two groups.

Prevalence of Methotrexate-Induced Lung Involvement in Psoriasis Patients

Background: Seventy five psoriasis patients who visited the Pakistani Institute of Medical Sciences in Islamabad from January 2021 to January 2022 were examined to assess the incidence of methotrexate-induced lung involvement. Long-term methotrexate therapy often results in lung involvement, which may present as pleuritis, pneumonia, fibrosis, and obliterative bronchiolitis. Clinical evaluations and case data were retrospectively reviewed. Out of the Seventy five individuals tested, the results indicate that 15 (15%) had mild to moderate lung involvement, while 4 (4%) had severe lung involvement. In 67% of the patients, there was no discernible lung involvement. The frequency of methotrexate-induced lung involvement at the Pakistani Institute of Medical Sciences is quite low, despite the fact that it is a possible side effect of long- term methotrexate usage for psoriasis patients. If long-term methotrexate usage raises the likelihood of lung involvement in psoriasis patients, further investigation is required. Objectives: Identifying the frequency of methotrexate-induced lung involvement in psoriasis patients seen at the Pakistani Institute of Medical Sciences in Islamabad from January 2021 to January 2022 is the goal of this research. Methods: Seventy five psoriasis patients who were seen between January 2021 and January 2022 at the Pakistani Institute of Medical Sciences (PIMS) in Islamabad were the subject of the research. Lung involvement was evaluated by a retrospective examination of the case files and clinical evaluation, which may have required pulmonary function tests, chest X-rays, or even chest CT scans. There was no discernible lung involvement, mild to moderate lung involvement, severe lung involvement, or no lung involvement at all. Results: Seventy-five individuals were examined; fifteen (15%) had mild to moderate lung involvement, four (4%) had severe lung involvement, and sixty-seven (67%) had no discernible lung involvement. Conclusion: According to the study's findings, although methotrexate-induced lung involvement is a possible side effect of long-term methotrexate usage for people with psoriasis, it is not very common at the Pakistani Institute of Medical Sciences. 67% of the individuals in the study had no observable lung involvement. If long-term methotrexate usage raises the likelihood of lung involvement in psoriasis patients, further investigation is required. Keyword: Methotrexate, Psoriasis, Lung Involvement, Prevalence, PIMS

Clinical Presentation of Connective Tissue Disease Patients with and without Interstitial Lung Disease: A Retrospective Study

Background: Connective tissue diseases (CTDs) are responsible for about 20% of interstitial lung disease (ILD) cases, but their diagnosis in a pulmonary unit (PU) is not always straightforward due to a heterogeneous clinical picture. Objectives: The aim of this study was to evaluate the clinical presentation of rheumatoid arthritis (RA) and CTD-ILD cases diagnosed in PU, compared to RA and CTD patients diagnosed in a rheumatologic unit (RU). Methods: Patients with RA, systemic sclerosis (SSc), primary Sjӧgren’s syndrome (pSS), and idiopathic inflammatory myopathy were retrospectively enrolled from an RU and a PU designated to manage ILD during a period from January 2017 to October 2022. The classification of CTD-PU was carried out in a multidisciplinary setting, including the same rheumatologists that diagnosed CTD in the RU. Results: ILD-CTD-PU patients were prevalently male and older. Progression from undifferentiated CTD to a specific condition was more common in ILD-CTD-PU, and those patients generally obtained a lower score on specific classification criteria. RA-PU patients resembled polymyalgia rheumatica in 47.6% of cases, also showing a greater proportion of typical joint deformities (p = 0.02). SSc-PU patients showed a usual interstitial pneumonia pattern in 76% of cases and, compared with SSc-RU, were more commonly seronegative (p = 0.03) and generally lacked fingertip lesions (p = 0.02). The majority of the diagnoses of pSS-PU were in patients with previously diagnosed ILD, in which seropositivity and sicca syndrome developed during follow-up. Conclusions: CTD-ILD patients diagnosed in the PU show severe lung involvement and a nuanced autoimmune clinical picture.

Pre-existing serum indoxyl sulfate and COVID-19 outcomes in patients undergoing hemodialysis: A retrospective cohort study

Patients undergoing hemodialysis (HD) are at increased risk of severe complications from COVID-19 due to compromised immune function and comorbidities. This retrospective study aimed to investigate the association between pre-existing serum indoxyl sulfate (IS) concentrations and COVID-19 outcomes in HD patients.&#x0D; Methods. Data on pre-existing IS and proinflammatory cytokines, such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-alpha (TNF-α) were extracted from an existing patient database. The patients were followed up for 1.5 years and compared according to median serum IS concentration: low-IS (&lt; 22.2 μg/mL) and high-IS (≥22.2 μg/mL) groups. The primary outcomes focused on assessing the risk and severity of COVID-19 infection.&#x0D; Results. A total of 56 patients aged 62 (56-67) years with a dialysis vintage of 37.5 (30-168) months were included in the analysis. Serum levels of IS were significantly correlated with Kt/V values (p = 0.043), arterial hypertension (p = 0.001), IL-6 (p = 0.023), MCP-1 (p = 0.023), and TNF-α (p = 0.033) concentrations. Elevated serum IS levels were significantly associated with an increased risk of COVID-19 infection (p &lt; 0.0001) and a higher likelihood of hospitalization (p = 0.03). Patients with higher IS levels exhibited more severe lung involvement (p &lt; 0.0001) and a greater need for respiratory support (p = 0.004). A serum IS concentration of 21.5 μg/mL was the optimal threshold for predicting COVID-19 infection in HD patients (sensitivity of 83.4% and specificity of 92.3%, p &lt; 0.0001).&#x0D; Conclusion: Our study highlights the detrimental impact of serum IS on COVID-19 infection and its clinical outcomes in patients undergoing HD. Further research is warranted to elucidate the underlying mechanisms and explore potential therapeutic strategies targeting IS in this population.

Papel de las estatinas en la evolución clínica de los pacientes octogenarios ingresados por COVID-19

Introduction and objectivescoronavirus disease 2019 (COVID-19) causes high mortality in elderly patients. Some studies have shown a benefit of statin treatment in the evolution of this disease. Since there are no similar publications in this population group, the aim of this study is to analyze in-hospital mortality in relation to preadmission treatment with statins in an exclusively elderly population of octogenarian patients. Materials and methodsA single-center retrospective cohort study was performed including a total of 258 patients ≥80 years with hospital admission for confirmed COVID-19 between March 1 and May 31, 2020. They were divided into two groups: taking statins prior to admission (n=129) or not (n=129). ResultsIn-hospital mortality due to COVID-19 in patients ≥80 years (86.13±4.40) during the first wave was 35.7% (95% CI: 30.1–41.7%). Mortality in patients previously taking statins was 25.6% while in those not taking statins was 45.7%. Female sex (RR 0.62 [0.44-0.89]; p=0.008), diabetes (RR 0.61 [0.41-0.92]; p=0.017) and pre-admission treatment with statins (RR 0.58 95% CI [0.41-0.83]; p=0.003) were associated with lower in-hospital mortality. Severe lung involvement was associated with increased in-hospital mortality (RR 1.45 95% CI [1.04-2.03]; p=0.028). Hypertension, obesity, age, cardiovascular disease and a higher Charlson index did not, however, show influence on in-hospital mortality. ConclusionsIn octogenarian patients treated with statins prior to admission for COVID-19 in the first wave, lower in-hospital mortality was observed.

ROLE OF CT PULMONARY ANGIOGRAPHY IN EVALUATION OF PULMONARY THROMBOEMBOLISM IN COVID-19 POSITIVE PATIENTS

Introduction- COVID-19 disease has been strongly associated with a pro thrombotic state and vascular endothelial damage resulting into wide range of thromboembolic phenomena including deep venous thrombosis involving extremeties, pulmonary artery thrombo-embolism and eventually pulmonary infarctions. Computed tomography pulmonary angiography (CTPA) was used at our hospital for assessment of patients with risk of pulmonary embolism. It plays a vital role in its establishing its diagnosis, defining its extent, stage and thereby guiding towards further management. Materials and Methods- A Retrospective study was performed in Sri Aurobindo Medical College and Post graduate Institute, Indore, Madhya Pradesh, India and was approved by the ethical committee. It was performed on 250 COVID-19 patients with clinically suspected pulmonary thromboembolism who underwent CTPA between the months of December 2021 and May 2021. The scans were analysed by skilled radiologists, having good experience in the field of CT reporting. Results- Our study demonstrated that approx. 14% of the patients had pulmonary thromboembolism and these cases were observed in patients with moderate to severe lung involvement. ConclusionIn this study, we have thoroughly tried to assess the presence of pulmonary thromboembolism using CTPA and establish its relationship with severity of lung involvement on HRCT

Patients with Diabetes Experienced More Serious and Protracted Sickness from the COVID-19 Infection: A Prospective Study

Background and Objectives: In December 2019, a flu-like illness began in the Chinese city of Wuhan. This sickness mainly affected the lungs, ranging from a minor respiratory tract infection to a severe lung involvement that mimicked the symptoms of Severe Acute Respiratory Syndrome (SARS). The World Health Organization (WHO) labelled this sickness as a pandemic in March 2020, after it quickly spread throughout the world population. It became clear, as the illness progressed, that people with concomitant illnesses, particularly diabetes mellitus (DM) and other immunocompromised states, were outmatched by this illness. This study was aimed to evaluate the correlation between Computed Tomographic Severity Score (CTSS) and underlying diabetes mellitus in coronavirus disease (COVID)-19 patients. Materials and Methods: This was a hospital-based prospective study in which a total of 152 patients with reverse transcriptase polymerase chain reaction (RT-PCR) positive COVID status who underwent high-resolution computed tomography (HRCT) of the chest were evaluated and categorized into mild, moderate and severe cases based on the extent of lung parenchymal involvement. A total score from 0-25 was given, based on the magnitude of lung involvement. Statistical analysis was used to derive a correlation between DM and CTSS, if any. Results: From our study, it was proven that patients with underlying diabetic status had more severe involvement of the lung as compared to non-diabetics, and it was found to be statistically significant (p = 0.024). Conclusions: On analysis of what we found based on the study, it can be concluded that patients with underlying diabetic status had a more prolonged and severe illness in comparison to non-diabetics, with higher CTSS in diabetics than in non-diabetics.

COVID-19 and Pre-existing Type 2 Diabetes Mellitus: A Retrospective Observational Study From Eastern India on the Association Between Glycaemic Control and Treatment Outcomes.

Diabetes has emerged as an important risk factor for causing severe illness and death from COVID-19. There is a paucity of structured data from the Indian subcontinent on the impact that glycaemic control (both immediate and remote) has on the degree of required medical intervention and mortality among hospitalized COVID-19 patients with type 2 diabetes mellitus (T2DM). To evaluate the differences in clinical characteristics and treatment outcomes between well-controlled and poorly controlled patients with T2DM and COVID-19. This was a retrospective observational study. Data on 177 patients who were hospitalized between February 2021 and July 2021 were categorized into four groups using a cut-off admission plasma glucose of <200 mg/dLand glycated hemoglobin (HbA1c) <7.5%. Patients with poorly controlled diabetes presented at a significantly older age than the other groups. Radiological findings suggested severe lung involvement in them. As a combined group patients with HbA1c ≥7.5% required more ventilatory requirement as compared with the group having HbA1c <7.5% irrespective of admission glucose. They also required prolonged hospitalization and intensive care unit(ICU) stays as compared with the well-controlled diabetes group. In this study, within similar ranges of HbA1cadmission glucose seemed to have a numerical impact on mortality without being able to achieve statistical significance. From the current study, it can be concluded that poor glycaemic control, particularly HbA1c ≥7.5%, is an important risk factor for the development of severe COVID-19and a predictor for the requirement of more intensive treatment and adverse treatment outcomes leading to increased hospital and ICU stay.

CT Severity Score in COVID-19 Patients and its Association with Diabetes Mellitus and Hypertension: A Retrospective Study

Introduction: The Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China, in December 2019. It is thought that, people who have Diabetes Mellitus (DM) and Hypertension (HTN) are more likely to get a severe COVID19 infection. High-resolution Chest Computed Tomography (HRCT) has been shown to provide immediate results with high sensitivity and specificity for determining the severity of COVID19 infection and lung involvement. Aim: To determine the association between chest CT Severity Scores (CTSS) and DM and HTN in COVID-19 patients. Materials and Methods: This retrospective observational study was conducted in the Department of Radiodiagnosis at, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. The duration of the study was 1 month, from July 2020 to August 2020. Based on the degree of lung involvement seen on HRCT chest scans, A total of 100 patients (68 males and 32 females) with COVID-19 infection were given a quantitative CTSS. The patients were divided into groups with mild, moderate, and severe lung involvement based on the CTSS. The Chi-square test was used to assess the relationship between DM, HTN, and CTSS. The data was analysed using Statistical Package for Social Sciences (SPSS) version 17.0. Results: The mean age of study participants was 45.7±15.95 years. A total of 72 (72%) of the participants were of normal weight, 8 (8%) were overweight or obese, and 20 (20%) were underweight. COVID19 patients with a co-diagnosis of DM (61.9%) or HTN (69.2%) had more severe lung involvement than COVID-19 patients without DM (19%) or HTN (21%). DM and HTN were found to be significantly associated with severe lung involvement (p-value&lt;0.01). Conclusion: Diabetic and hypertensive patients are more likely than non diabetic and non hypertensive patients to develop the severe form of COVID-19 and have a higher CT lung involvement score. DM and HTN should be considered as risk factors for the severity of COVID-19 disease.

COVID-19 chest CT and laboratory features of B.1.617.2 (Delta variant) vs B.1.1.7 (Alpha variant) surge: a single center case-control study.

To assess clinical, laboratory and radiological differences between Delta and Alpha SARS-CoV-2 variants. Twenty SARS-CoV-2 patients admitted from 30th of August to 30th of October 2021 (period with estimated highest prevalence of Delta variant circulation in Italy) were enrolled. Patients were matched in a 1:1 ratio with same gender and same age +/- 2 years controls admitted from 1st of September 2020 to 30th of January 2021 (predominant circulation of Alpha variant). Chest computed tomography (CT) were retrospectively evaluated. Main clinical parameters, radiological and laboratory findings were compared between two groups. Patients with probable Delta variant had significantly higher CT severity scores, lower PaO2/FiO2 ratio and higher C-reactive protein and lactate dehydrogenase levels at admission. On multivariate analysis, probable Delta variant infection was associated with higher CT severity score. Ground glass opacities and crazy paving patterns were more frequently noticed than consolidation, with the latter being more frequent in Delta cohort, even though not significantly. According to prevalent imaging pattern, the consolidation one was significantly associated with pregnancy (p=0.008). Patients admitted during predominance of Delta variant circulation had a more severe lung involvement compared to patients in infected when Alpha variant was predominant. Despite imaging pattern seems to be not influenced by viral variant and other clinical variables, the consolidative pattern was observed more frequently in pregnancy.