Search

Objective: To assess the association between Computerized Tomography severity score and oxygen saturation by pulse oximeter in patients of COVID-19. Study Design: Cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Apr 2021. Methodology: CT severity score was calculated for al patients who had undergone Chest CT scan. The oxygen saturation by pulse oximeter was noted at admission. Spearman rank correlation was calculated between the CT severity score and oxygen saturation on pulse oximeter. Results: There were 203 patients in this study. Among them, 124(61.1%) were male and 74(38.9%) females. The greater proportion of the patients, 138(68%) were between 36-55 years old, and 65(32%) were between 18-35 years old. There were 130(64%) patients who had low CT severity score, 73(36%) had high CT severity score. Among 73 patients who had high CT severity score, 67(91.7%) had shortness of breath (p-value<0.001), 48(66%) had fever (p-value=0.021), and 53(72.6%) belonged to the older age group of patients (p-value=0.0294). Statisticaly significant negative correlation between Computerized Tomography severity score and oxygen saturation was noted (rho=-0.264, p= 0.01). Conclusions: Our study provided evidence that there is a negative correlation between the Computerized Tomography severity score and oxygen saturation by pulse oximeter. [ABSTRACT FROM AUTHOR]

Background: Evaluations have shown that the severity of pulmonary involvement is very important in the mortality rate of patients with coronavirus disease 2019 (COVID‑19). The purpose of this study was to evaluate the value of chest CT severity score in assessment of COVID‑19 severity and short‑term prognosis. Materials and Methods: This study was a cross‑sectional study with a sample size of 197 patients, including all patients admitted to Rasoul Akram Hospital, with positive polymerase chain reaction, to investigate the relationship between computed tomography (CT) severity score and mortality. The demographic data and CT scan findings (including the pattern, side, and distribution of involvement), co‑morbidities, and lab data were collected. Finally, gathered data were analyzed by SPSS‑26. Results: 119 (60.4%) patients were male, and 78 (39.6%) were female. The mean age was 58.58 ± 17.3 years. Totally, 61 patients died; of those, 41 (67.2%) were admitted to the intensive care unit (ICU), so there was a significant relation between death and ICU admission (P value = 0.000). Diabetes was the most common co‑morbidity, followed by hypertension and IHD. There was no significant relation between co‑morbidities and death (P value = 0.13). The most common patterns of CTs were interlobular septal thickening and ground glass opacities, and a higher CT severity score was in the second week from the onset of symptoms, which was associated with more mortality (P value < 0.05). Conclusion: Our study showed that a patient with a higher CT severity score of the second week had a higher risk of mortality. Also, association of the CT severity score, laboratory data, and symptoms could be applicable in predicting the patient’s condition. [ABSTRACT FROM AUTHOR]

Background/Aim: In 2020, the World Health Organization declared the Coronavirus disease of 2019 (COVID-19) a pandemic due to its widespread nature. The severity of COVID-19 infections leading to patient deaths is influenced by various factors. Therefore, it is crucial to identify and address these contributing causes for effective treatment of COVID-19. Methods: This study was conducted between 23 January 2021 and 19 June 2021 at a hospital with 100 beds in Western Nepal. Patient demographic data and High-resolution computed tomography severity scores were recorded. Microsoft Excel and Statistical Package for the Social Sciences were used for statistical data analysis. Binomial regression and Chi-square tests were applied, setting the significance level at P<0.05 with a confidence interval of 95%. Results: The study found a significant association between computed tomography (CT) severity, gender, and age with the treatment outcome among COVID-19-infected patients admitted to the hospital. Patients with a CT severity score between 16 and 25 had an eightfold higher mortality rate (OR: -8.802; 95% CI: 3.506-18.491). Conclusion: The severity and mortality of COVID-19 infections are influenced by factors such as age, gender, and biomarkers indicated by CT severity scores. Identifying additional factors that worsen COVID-19 patient's conditions and increase the risk of mortality is essential. [ABSTRACT FROM AUTHOR]

Purpose: Coronavirus disease 2019 (COVID-19) is a highly formidable disease. Globally, multiple vaccines have been developed to prevent and manage this disease. However, the periodic mutations of severe acute respiratory syndrome coronavirus 2 variants cast doubt on the effectiveness of commonly used vaccines in mitigating severe disease in the Indian population. This study aimed to assess the effectiveness of the BBV152 vaccine and ChAdOx1-S vaccine in preventing severe forms of the disease. Materials and Methods: This retrospective study, based on hospital records, was conducted on 204 vaccinated COVID-19 patients using a consecutive sampling approach. Data on their vaccination status, comorbidities, and high-resolution computed tomography lung reports’ computed tomography severity scores were extracted from their medical records. Fisher’s exact test and binomial logistic regression analysis were employed to assess the independent associations of various factors with the dependent variables. Results: Of the 204 records, 57.9% represented males, with a mean age of 61.5±9.8 years. Both vaccines demonstrated effective protection against severe illness (90.2%), with BBV152 offering slightly better protection compared to ChAdOx1-S. Male gender, partial vaccination, comorbid conditions, and the type of vaccine were identified as independent predictors of severe lung involvement. Conclusion: This study indicates that both vaccines were highly effective (90%) in preventing severe forms of the disease in fully vaccinated individuals. When comparing the two vaccines, BBV152 was slightly more effective than ChAdOx1-S in preventing severe COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Corona virus disease 2019(COVID-19) is an infectious acute disease associated with significant morbidity and mortality. The disease threatened the whole world in 2020 and 2021 and new cases are reported till date. CT is invaluable in assessing no of bronchopulmonary segments involved in the lung as conventional chest X ray is not sensitive. Several cytokines are released during pathogenesis of the disease which play a pivotal role in dictating the disease outcome. In this study, we aimed to study the correlation between CT score, inflammatory markers with patient's outcome. Materials and Methods:A retrospective hospital based study conducted at Sri ManakulaVinayagar medical college and hospital(SMVMCH), tertiary care center located at Madagadipet in rural Puducherry, India. Adult patients who got admitted in SMVMCH with proven COVID 19 infection were chosen as study participants. The study was carried out after obtaining Institutional ethics committee (IEC)clearance. Data pertaining to CT severity score(CTSS), inflammatory markers, duration of hospital staytill discharge or death is collected from all such patients. Results:CT score was correlated using Pearson Correlation. Sample size(N) was taken as 117. CT score of 7 or less was classified as mild, was seen in 29 patients(24.8%). Moderate Covid was classifiedat a score of 8-17, was seen in 71 patients (60.7%). Severe Covid score of 18 or greater was seen in 17 out of the 117 patients (14.5%). Out of the 117 patients 51.3% of patients stayed in hospital for 7 days, 33.3% stayed in hospital for 14 days, 8.5% stayed in hospital for 21 days, 6.8% stayed in hospital for 31 days. Patients with increased values of CTSS and C reactive protein(CRP)had higher length of hospital stay and increased mortality compared to other patients.49 patients were observed in intensive care for an average duration of 3 days till their oxygen saturation got stabilized at 95% or more and were shifted to ward care. Conclusion: Increased CTSS was associated with increased duration of hospital stay and increased mortality. CRP was the marker which had a strong co relation with patient's outcome and CTSS. [ABSTRACT FROM AUTHOR]

Introduction: Corona virus disease 2019 (COVID-19) spread rapidly across the world with very high human to human transmission rate. It spread all over the world with approximately 66.4 crore cases, 64.40 crore recoveries and 67.1 lakh deaths till now. In India there were 4.46 crore cases of which 4.41 crore recovered and there were 5.30 lakh deaths till now (CSSE COVID-19 Data)1. Aims and objective: To study the Clinical, Radiological profile and inflammatory markers in Covid-19 patients Materials and method: The study was carried out in the Department of Respiratory Medicine of R.D. Gardi Medical College, Ujjain (MP). Result: A total of 107 patients with COVID-19 disease were evaluated, the patients had a median age of 52 years and a mean age of 50.79±16.81 years. The most common clinical presentation were the fever which was seen in 80(74.8%) cases, breathlessness in 84(78.5%), cough in 71(66.4%), weakness in 27.1%, loss of smell in 31.8% and loss of taste in 29.9%. The most common co-morbidity present in the study group was diabetes mellitus, which was present in 51(47.7%) cases. The chest radiograph of the patients revealed consolidation in 51(47.7%), GGOs in 29(27.1%), GGO with consolidation in 3(2.8%) and 23(21.5%) cases had normal pattern. Severity of disease was significantly associated with age of the patient. The typical findings of chest CT in the case of COVID-19 pneumonia include "bilateral, peripheral, and basal predominant ground-glass opacities with or without consolidation and broncho-vascular thickening, In addition, atypical findings are "cavitations, central upper lobe predominance, nodules, masses, tree-in bud sign and lymphadenopathy. A significant statistical correlation was found between CT severity score. In our study, out of 107 cases, 80.4% had raised CRP level, 69.2% had raised D-dimer level, 67.3% cases had raised LDH level and 55.1% had raised S.Ferritin level. Conclusions: Chest imaging played a very important part in the diagnosis and management of covid 19 patients during the pandemic. The typical presentation of chest radiographs and HRCT thorax helped in diagnosing cases even when the RTPCR, Rapid antigen tests were negative or not available along with clinical features and inflammatory markers especially the CRP, LDH, D-dimer and S.Ferritin. [ABSTRACT FROM AUTHOR]

Background A wide variety of computed tomography (CT) findings in COVID-19 have been reported in different studies, and the CT findings differ according to the stage of the disease and disease severity and associated co-morbidities. The study aimed to determine the role of HRCT chest in the evaluation of COVID 19 patients. Methods This is a retrospective study done at K.J. SOMAIYA MEDICAL COLLEGE & HOSPITAL SION, MUMBAI. The Present Study was on 160 hospitalized patients who underwent HRCT CHEST with symptoms of COVID 19. Results Most of the patients in the fifth and sixth decade of age group with a mean age of 58.36±15.36 years. There was a male preponderance (68.13% male and 31.88% female). Out of 160 patients, 145 patients (90.6%) were symptomatic, while 15 patients (9.4%) were asymptomatic. 53.8% of patients had some or the other underlying comorbid disease in the sample population. HRCT chest of the study population showed the variety of opacity characteristics. Out of 160 patients, 61 (38.13) patients had pure Ground glass opacities (GGO) while another 82 (51.25) patients had both mixed GGO. In early phase of the CT scan, 66.67% patients had GGO while in the intermediate phase high percentage of (56.1%) of the patients had mixed GGO & consolidation. The lobe involvement was measured using the Ct severity scoring system. In this study majority (59.38%) of the patients had a CT severity score between 1-7 indicating mild disease, 35.63% patients had CT score 8-15 indicating moderate disease while only 5.00% had CT severity score 16-20 indicating severe disease. Conclusion: HRCT chest in COVID-19 patients had significant diagnostic and prognostic importance as positive CT findings more prominent in symptomatic patients and comorbid patients. CT imaging was found to be useful in predicting a patient's clinical recovery or disease progression. [ABSTRACT FROM AUTHOR]

Introduction: 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. Materials and Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Background: COVID-19 infection requires an easily accessible yet precise variable for diagnosis and prognosis. This study aims to describe the predictive value of the Neutrophil-to-Lymphocyte Ratio (NL Ratio) for COVID-19 diagnosis and deteriorating clinical course, which has not been extensively demonstrated. Objective: To determine the correlation of the NL ratio and CT severity score(CTSS) with the lung injury severity in adult patients having COVID-19 infection. Materials and Methods: A retrospective study at a COVID centre included 123 hospitalized patients those who are COVID-19 positive by RT-PCR or Rapid Antigen Test. The study lasted six months (July 2020 - November 2020). In addition, the patient's demographics, chest CT findings, CRP, lymphocyte and neutrophil counts were documented. Results: The differences in NL Ratio were significant across the all grades of CT severity score groups, as well as within each group (p<0.001). There was an excellent correlation between the NL Ratio and the CTSS (r = 0.863, p<0.001). According to a ROC curve analysis, NL Ratio had diagnostic and prognostic relevance in COVID-19 subjects with negative or positive CT results. The AUC (area under curve) was 0.858 (95% CI: 0.728-0.903, p<0.001), the sensitivity was 69.9%, the specificity was 93.1%, and the optimum NL Ratio cut-off value was 3.734. Conclusion: NL ratio is a low-cost prognostic tool and a convenient, on-site alternative to a chest CT scan for determining the degree of lung injury in COVID-19 subjects, particularly in developing countries. [ABSTRACT FROM AUTHOR]

Aim: It has been reported that the increased neutrophil/lymphocyte ratio (NLR) is associated with a poor prognosis in Coronavirus disease-2019 (COVID-19) patients. We aimed to correlate three consecutive computed tomography severity score (CT-SS) values with simultaneous NLR and other laboratory parameters and investigate their temporal changes effects on the prognosis of COVID-19 patients. Methods: This single-center cross-sectional study included 99 (aged ≥18 years) COVID-19 patients hospitalized between March 1, 2021, and June 30, 2021. Demographic data, laboratory findings, and intensive care unit (ICU) admissions were obtained from electronic medical records. We divided patients into two groups: ICU and non-ICU patients A radiologist calculated three consecutive chest CT-SSs using a 25-point visually semiquantitative system. Spearman's rho correlation was used to evaluate correlations between CT-SSs and laboratory parameters in ICU and non-ICU patients. Results: The study population included 99 patients with a mean age of 61.17±14.36 years. Significant associations were found between the third-highest values of CRP (p=0.005), D-dimer (p=0.007), lactate dehydrogenase (p=0.027), and ICU admission. While there was no statistical significance between the first and second CT-SS and ICU admissions, there was a significant relationship between the third CT-SS and ICU admissions (p=0.013). Moderate positive correlations between the first NLR and CT-SS (p=0.025, r=0.488) and the second NLR and CT-SS (p=0.001, r=0.650) were found in ICU patients. Conclusion: Our results demonstrate the importance of late follow-up chest CT and laboratory parameters for the prognosis and ICU admissions of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: CT Severity Score (CT-SS) can be used to assess the extent of severe coronavirus disease 19 (COVID-19) pneumonia. Follow-up CT-SS in patients surviving COVID-19-associated hyperinflammation and its correlation with respiratory parameters remains unknown. This study aims to assess the association between CT-SS and respiratory outcomes, both in hospital and at three months after hospitalization. Methods: Patients from the COVID-19 High-intensity Immunosuppression in Cytokine storm Syndrome (CHIC) study surviving hospitalization due to COVID-19 associated hyperinflammation were invited for follow-up assessment at three months after hospitalization. Results of CT-SS three months after hospitalization were compared with CT-SS at hospital admission. CT-SS at admission and at 3-months were correlated with respiratory status during hospitalization and with patient reported outcomes as well as pulmonary- and exercise function tests at 3-months after hospitalization. Results: A total of 113 patients were included. Mean CT-SS decreased by 40.4% (SD 27.6) in three months (P < 0.001). CT-SS during hospitalization was higher in patients requiring more oxygen (P < 0.001). CT-SS at 3-months was higher in patients with more dyspnoea (CT-SS 8.31 (3.98) in patients with modified Medical Council Dyspnoea scale (mMRC) 0–2 vs. 11.03 (4.47) in those with mMRC 3–4). CT-SS at 3-months was also higher in patients with a more impaired pulmonary function (7.4 (3.6) in patients with diffusing capacity for carbon monoxide (DLCO) > 80%pred vs. 14.3 (3.2) in those with DLCO < 40%pred, P = 0.002). Conclusion: Patients surviving hospitalization for COVID-19-associated hyperinflammation with higher CT-SS have worse respiratory outcome, both in-hospital and at 3-months after hospitalization. Strict monitoring of patients with high CT-SS is therefore warranted. [ABSTRACT FROM AUTHOR]

In a prospective, observational, non-interventional, single-center study, we assessed various plasma and urinary biomarkers of kidney injury (neutrophil gelatinase-associated Lipocain [NGAL], kidney-injury molecule-1 [KIM-1], and interleukin-18 [IL-18]); inflammation (IL-6, C-reactive protein [CRP]); plus angiotensin converting enzyme 2 (ACE2) in 120 COVID-19 patients (of whom 70 had chronic kidney disease (CKD) at emergency-department (ED) admission). Our aim was to correlate the biomarkers with the outcomes (death, acute kidney injury [AKI]). All patients had received a chest-CT scan at admission to calculate the severity score (0–5). Biomarkers were also assessed in healthy volunteers and non-COVID-19-CKD patients. These biomarkers statistically differed across subgroups, i.e., they were significantly increased in COVID-19 patients, except for urinary (u)KIM1 and uIL-18. Amongst the biomarkers, only IL-6 was independently associated with mortality, along with AKI and not using remdesivir. Regarding the prediction of AKI, only IL-6 and uKIM1 were significantly elevated in patients presenting with AKI. However, AKI could not be predicted. Having high baseline IL-6 levels was associated with subsequent ventilation requirement and death. The mortality rate was almost 90% when the chest CT-scan severity score was 3 or 4 vs. 6.8% when the severity score was 0–2 (p < 0.0001). [ABSTRACT FROM AUTHOR]

Introduction: There is a great uncertainty on disease progression in COVID-19. Multiple factors play a role in progression of disease to severe form and these factors are not uniform in all patients. There are multiple ongoing researches for the early prediction of outcome using various prognostic factors. Aim: To study the association of Clinical parameters, Neutrophil-Lymphocyte Ratio and CT severity score of COVID-19 patients with Mortality. Material and Methods: This is a record based cross sectional analytical study conducted in ASRAM medical college and hospital in patients admitted with positive RT PCR report for COVID-19. In these patients clinical parameters like age, gender, SpO2, co-morbidities, laboratory parameter like Neutrophil lymphocyte ratio (NLR) and CT severity score were studied. Mortality was assessed with respect to all these parameters. Results: Out of 112 patients studied, 85 patients were discharged and 27(24.1%) patients died during the course in the hospital. Mortality was highest in the age group of 60 to 80 years(11.6%). Out of 70 males, 13 patients died(18.6%) and out of 42 females, 14 patients died(33.3%). 15 patients had comorbidities and mortality in this group was 66.7%. Patients with SpO2 <90% had higher mortality(35.2%). Patients with NLR > 3.5 were 92 and mortality in this group was 27.2%. Mortality was more in patients with high CT severity score (44.2%). Conclusion: Though CT severity score is a good predictor of mortality in patients with COVID-19, initial assessment of patients for clinical parameters like age, peripheral oxygen saturation, comorbidities and easily available laboratory parameter like NLR are also good and independent predictors of mortality and severe form of disease. [ABSTRACT FROM AUTHOR]

Background: Quantitative radiological scores for the extent and severity of pulmonary infiltrates based on chest radiography (CXR) and computed tomography (CT) scan are increasingly used in critically ill invasively ventilated patients. This study aimed to determine and compare the prognostic capacity of the Radiographic Assessment of Lung Edema (RALE) score and the chest CT Severity Score (CTSS) in a cohort of invasively ventilated patients with acute respiratory distress syndrome (ARDS) due to COVID-19. Methods: Two-center retrospective observational study, including consecutive invasively ventilated COVID-19 patients. Trained scorers calculated the RALE score of first available CXR and the CTSS of the first available CT scan. The primary outcome was ICU mortality; secondary outcomes were duration of ventilation in survivors, length of stay in ICU, and hospital-, 28-, and 90-day mortality. Prognostic accuracy for ICU death was expressed using odds ratios and Area Under the Receiver Operating Characteristic curves (AUROC). Results: A total of 82 patients were enrolled. The median RALE score (22 [15–37] vs. 26 [20–39]; p = 0.34) and the median CTSS (18 [16–21] vs. 21 [18–23]; p = 0.022) were both lower in ICU survivors compared to ICU non-survivors, although only the difference in CTSS reached statistical significance. While no association was observed between ICU mortality and RALE score (OR 1.35 [95%CI 0.64–2.84]; p = 0.417; AUC 0.50 [0.44–0.56], this was noticed with the CTSS (OR, 2.31 [1.22–4.38]; p = 0.010) although with poor prognostic capacity (AUC 0.64 [0.57–0.69]). The correlation between the RALE score and CTSS was weak (r2 = 0.075; p = 0.012). Conclusions: Despite poor prognostic capacity, only CTSS was associated with ICU mortality in our cohort of COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 global pandemic started in late 2019 with the first wave. In this cross‐sectional and observational study, we evaluated the associations between the biomarkers, COVID‐19 pneumonia severity and 1‐year mortality. Methods: A sample of 276 polymerase chain reaction (PCR)‐positive patients for SARS‐CoV‐2 was included. Computerized tomography severity score (CT‐SS) was used to assess the severity of COVID‐19 pneumonia in 222 cases. Multivariate analyses were performed to find the predictors of CT‐SS, severe CT‐SS (≥20) and 1‐year mortality. Biomarkers of ferritin, high‐sensitive C‐reactive protein (CRP), lactate dehydrogenase (LDH), cardiac troponin (cTn), neutrophil‐to‐lymphocyte ratio (NLR), uric acid (UA) and d‐dimer were routinely measured. Results: Severe CT‐SS (>20) was observed in 86 (31.2%) cases. Mortality was observed in 75 (27.2%) patients at 1 year. LDH displayed the highest predictive accuracy for severe CT‐SS (AUC 0.741, sensitivity = 81% and specificity = 68%, cut‐off value: 360 mg/dl). Linear regression analysis displayed that LDH predicted CT‐SS [B = 11 (95% CI for B = 5–17, p <.001)]. Age was the most significant parameter that was associated with severe CT‐SS (OR 0.96, 95% CI 0.92–0.99, p =.015). d‐dimer was the only biomarker that predicted with 1‐year mortality (OR 1.62, 95% CI 1.08–2.42, p =.020). Conclusion: LDH is a sensitive and specific biomarker to determine patients with severe lung injury in COVID‐19. d‐dimer is the only biomarker that predicts 1‐year mortality. Neither LDH nor CT‐SS is associated with 1‐year mortality. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused a serious health challenge to the entire mankind. The association between clinical characteristics of disease and formation of neutralizing antibodies have not well studied. A prospective study was conducted for patients recovered from confirmed SARS-CoV-2 infections from 1st August 2020 to 28th February 2021, to study the association between SARS-CoV-2 IgG antibody response titres and clinical characteristics of the disease. A total 92 patients were included in the study. Median age was 52 years; majority were male and middle or old aged. About 48% patients required hospitalization and 38.3% had moderate CT severity score. Positive SARS-CoV-2-IgG was detected in all patients except one. On comparing the antibody titres among various subgroups of COVID-19 recovered patients, old age was the only factor associated with statistically significant higher antibody response (28 AU/ml for age<35 years, 53 AU/ml for age group 35-60, and 71 AU/ml for age group >60 years, p=0.01). Severity of infection, worse CT severity scores, need of hospitalization, oxygen or ventilatory support were associated with higher antibody titres but were not statistically significant. There was a strong correlation of antibody titres when analysed for age of study population (Spearman correlation=0.39, p<0.001); whereas a weak correlation (Spearman correlation=0.03, p=0.753) was seen when analysed for CT severity score. Elderly patients had higher antibody titre after recovery from Covid-19 infection. Severity of disease, need of hospitalisation or oxygen/mechanical ventilation did not influence the antibody titre. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to find out the association of CT severity score with demographic and clinical characteristics as well as mortality in the patients who were confirmed to have COVID-19 disease in the second wave. Material and Methods: This retrospective study included collection and assessment of the demographic, clinical, laboratory data, and mortality of the patients, suspected with COVID-19 infection who underwent chest HRCT scan during March to April 2021. The findings of the chest HRCT were retrieved manually from the Medical Records section. Determination of the severity was done by the scoring system that involved the visual evaluation of the affected lobes. Results: CT severity score was mild, moderate, and severe in 21.94%, 41.60%, and 30.48% patients, respectively. Mortality rate was 5.70%. Age of the patients with mild, moderate, and severe CT severity score was significantly more than those with normal severity score (50 vs. 50 vs. 50 vs. 31, P=0.0009). When compared to patients with normal score, those with mild, moderate, and severe CT severity score had significantly higher dyspnoea (10.39% vs. 67.81% vs. 97.20% vs. 0%), significantly more cases with diabetes mellitus (16.88% vs. 25.34% vs. 31.78% vs. 9.52%, P=0.044), hypertension (27.27% vs. 21.23% vs. 32.71% vs. 4.76%, P=0.026), and obesity (6.49% vs. 8.90% vs. 23.36% vs. 0%, P=0.0005). Total leucocyte counts, absolute neutrophil counts, creatinine, serum glutamic pyruvic transaminase (SGPT), lactate dehydrogenase (LDH), ferritin, and D-dimer were deranged in significantly more patients of severe score (53.27%, 62.62%, 60.75%, 85.05%, 90.65%, 97.20%, and 95.35%, respectively). Interleukin-6 (IL-6) and C-reactive protein were deranged in significantly more patients with moderate disease (98.18% and 98.63%, respectively). Increasing severity scores were associated with increased mortality (mild vs. moderate vs. severe: 1.30% vs. 1.37 vs. 15.89%, P<.0001). Oxygen saturation (SpO2) was significantly lowest in severe score followed by moderate, mild and normal scores (87 vs. 90 vs. 96 vs. 97, P<.0001). Duration of non-rebreather mask (NRBM), noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), Venture/face mask, and intubation was also associated with increasing severity scores (P<0.0001). Conclusion: CT scans play an important role in guiding physicians with their management plans and can serve as a predictor of disease severity and outcomes. [ABSTRACT FROM AUTHOR]

Background: Treatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease. Methods: Patients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities. Findings: At the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups. Interpretation: LDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia. Funding: An intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India. Clinical Trial Registration: Clinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to explore the impact of smoking history on the severity of coronavirus disease 2019 radiologic findings. Therefore, we compared the computed tomography severity scores of smoking coronavirus disease 2019 patients with those of non-smoking coronavirus disease 2019 patients. MATERIAL AND METHODS: A total of 121 patients were included in our study group. We retrospectively reviewed 121 patients who underwent reverse transcription-polymerase chain reaction sampling and computed tomography examination in our hospital between April 1, 2020, and July 30, 2020. All computed tomography images were independently reviewed by 2 radiologists. RESULTS: There were 15 (12.4%) active smokers, 38 (31.4%) former smokers, and 68 (56.2%) never-smokers in this study. Among the 85 patients with evidence of pneumonia in thorax computed tomography, mean computed tomography severity scores were 8.02 and standard deviation 5.812. Computed tomography severity scores for patients with pathological computed tomography scans (n = 85) were performed for evaluating smoking status (never-smokers and smokers). We found a statistically significant relationship between computed tomography severity scores of never-smokers (n = 39) and smokers (n = 46) (Z = 2.243, P = .025). The computed tomography severity scores threshold for differentiating smokers in our study group was 8, with a sensitivity of 52.2% and a specificity of 79.5%. Among the 121 patients, 34 (28.1%) were in the asymptomatic group, 36 (29.75%) were in the mild group, 28 (23.14%) were in the common group, and 23 (19.0%) were in the severe group with severe pneumonia and respiratory distress. Five (1.47%), 16 (44.44%), 14 (50%), and 18 (78.26%) of the patients in these groups were smoking, respectively. CONCLUSION: Among coronavirus disease 2019 patients, smoking is associated with the progression of the disease and increased adverse effects. In our study, smoking status was significantly correlated with thorax computed tomography findings on admission. Computed tomography severity scores assessment helps to evaluate the disease extent in coronavirus disease 2019 patients. [ABSTRACT FROM AUTHOR]

In view of the rapid spread of COVID-19 and the high mortality rate of severe cases, reliable risk stratifying indicators of prognosis are necessary to decrease morbidity and mortality. The aim of the present study was to evaluate the value of serum amyloid A (SAA) and carcinoembryonic antigen (CEA) as prognostic biomarkers in comparison to other predictors, including C-reactive protein (CRP) and ferritin levels. This study included 124 patients diagnosed with COVID-19, and they were assigned to one of two groups: Mild and severe, based on the severity of the infection. Radiological and laboratory investigations were performed, including evaluation of CRP, ferritin, D-Dimer, SAA and CEA levels. Significantly higher levels of CRP, ferritin, D-Dimer, SAA and CEA were observed in severe cases. SAA was significantly correlated with CRP (r=0.422, P<0.001), ferritin (r=0.574, P<0.001), CEA (r=0.514, P<0.001) and computed tomography severity score (CT-SS; r=0.691, P<0.001). CEA was correlated with CRP (r=0.441, P<0.001), ferritin (r=0.349, P<0.001) and CT-SS (r=0.374, P<0.001). Receiver operator characteristic (ROC) curves for performance of SAA, CEA, ferritin, CRP and SAA showed the highest AUC value of 0.928, with a specificity of 93.1%, and a sensitivity of 98.5% at a cut-off of 16 mg/l. The multi-ROC curve for SAA and ferritin showed 100% specificity, 100% sensitivity and 100% efficiency, with an AUC of 1.000. Thus, combining SAA and ferritin may have guiding significance for predicting COVID-19 severity. SAA alone showed the highest prognostic significance. Both SAA and CEA were positively correlated with the CT-SS. Early monitoring of these laboratory markers may thus provide significant input for halting disease progression and reducing mortality rates. [ABSTRACT FROM AUTHOR]

Background: Endothelial dysfunction, inflammation, and hypercoagulability are hallmarks of severe COVID-19 related disease. Endothelial function can be measured non-invasively by flow-mediated dilatation in the brachial artery. We planned a study to measure it as a marker of the severity of COVID-19 disease. Objective: To evaluate the association of clinically recognizable endothelial dysfunction in COVID-19 disease and its usefulness as a marker of severe COVID-19-related disease. Methods: 20 COVID-19 patients being admitted to our unit were analyzed for endothelial dysfunction and correlated with disease severity as per computed tomography (CT) chest score. Patients with diabetes, atherosclerotic coronary artery disease, dyslipidemia, chronic renal disease, and infections other than COVID-19 were excluded. Endothelial dysfunction was measured by flow-mediated dilatation in the brachial artery. Results: The mean age was 46.4 ± 16.5 years; 70% were males. The mean CT severity score was 22 ± 8; 60% required supplemental oxygen and steroids. The incidence of endothelial dysfunction was more in patients with a computed tomography severity score of >19.5 or oxygen saturation of <93% at room air as compared to mild cases (P = 0.003). Endothelial dysfunction was more evident >7 days after onset of disease as compared to early (<7 days) disease (P = 0.016). There was negative correlation between % flow-mediated dilatation in brachial artery and severity of lung involvement and prolonged symptomatic phase. Conclusions: Endothelial dysfunction as measured by impaired brachial artery flow mediated dilatation correlates with disease severity. [ABSTRACT FROM AUTHOR]

Purpose: To analyze emergency department (ED) computerized tomography (CT) utilization in cancer patients with coronavirus disease 2019 (COVID-19). Methods: A retrospective chart review was performed to identify cancer patients who received COVID-19 diagnosis within the single healthcare system and presented to the ED within 30 days of COVID-19 positive date between May 1 and December 31, 2020. Results: In our 61 patients, the mean age was 72.5 years old, with 34% of patients (n = 21) on active cancer therapy and 66% (n = 40) on surveillance only. Most patients (n = 53) received their COVID-19 diagnosis within the ED, with 8 patients diagnosed prior to initial ED visit. The most common CT studies ordered within the ED were CT chest (n = 25), CT abdomen/pelvis (A/P) (n = 20), CT head (n = 8), and CT chest/abdomen/pelvis (C/A/P) (n = 7). COVID-19 findings were present on 33 scans, findings of worsening malignancy on 12 scans, and non-COVID non-cancer findings on 9 scans. Significant differences in CT severity score (p = 0.0001), indication for hospitalization (p = 0.026), length of hospitalization (p = 0.004), interventions (remdesivir, mechanical ventilation, and vasopressor support) while hospitalized (p < 0.05), and mortality (p = 0.042) were found between the prior diagnosis and ED diagnosis groups. No such differences were found between the active treatment and surveillance groups. Conclusion: ED CT imaging findings in patients with cancer and COVID-19 are predominantly related to COVID-19 infection, rather than cancer history or anti-cancer therapy status. [ABSTRACT FROM AUTHOR]

Context Computerized tomography (CT) is an invaluable imaging investigation for evaluating COVID-19 disease. CT detects early changes of COVID-19 pneumonia and predicts the disease prognosis based on a semiquantitative 25-point CT severity score (CT-SS). India launched its vaccination drive in January 2021 with two different vaccines being approved by the government. These vaccines are believed to prevent the disease itself, in majority of the cases and at least decrease disease severity, in the rest. Aim This study aims to evaluate the CT-SS in vaccinated and non-vaccinated subjects who have been diagnosed with COVID-pneumonia or are COVID suspects. Subjects and Methods A total of 3,235 patients with typical COVID-19 related imaging findings on HRCT thorax were included in the study. These subjects were divided into three age categories, 18–44, 45–59 and ≥60 years. The CT severity scores were allotted by experienced radiologists. Medians of the scores in different age groups were compared amongst vaccinated and non-vaccinated individuals using the Kruskal–Wallis H test. A p- value < 0.05 was considered significant. All results were shown with 95% confidence interval. Results The difference in the medians amongst the vaccinated and non-vaccinated groups was significant, p -values being < 0.001 in all age categories. Conclusion The mean CT-SS was less in vaccinated subjects and the difference in median CT-SS amongst vaccinated and non-vaccinated individuals was statistically significant, thus sending an important message that it is mandatory for the population at large to get vaccinated to reduce infection rate/disease severity. [ABSTRACT FROM AUTHOR]

Background: The novel coronavirus disease 2019 (COVID-19) continues to wreak havoc worldwide. This study assessed the ability of chest computed tomography (CT) severity score (CSS) to predict intensive care unit (ICU) admission and mortality in patients with COVID-19 pneumonia. Materials and Methods: A total of 192 consecutive patients with COVID-19 pneumonia aged more than 20 years and typical CT findings and reverse-transcription polymerase chain reaction positive admitted in a tertiary hospital were included. Clinical symptoms at admission and short-term outcome were obtained. A semi-quantitative scoring system was used to evaluate the parenchymal involvement. The association between CSS, disease severity, and outcomes were evaluated. Prediction of CSS was assessed with the area under the receiver-operating characteristic (ROC) curves. Results: The incidence of admission to ICU was 22.8% in men and 14.1% in women. CSS was related to ICU admission and mortality. Areas under the ROC curves were 0.764 for total CSS. Using a stepwise binary logistic regression model, gender, age, oxygen saturation, and CSS had a significant independent relationship with ICU admission and death. Patients with CSS ≥12.5 had about four-time risk of ICU admission and death (odds ratio 1.66, 95% confidence interval 1.66 – 9.25). The multivariate regression analysis showed the superiority of CSS over other clinical information and co-morbidities. Conclusion: CSS was a strong predictor of progression to ICU admission and death and there was a substantial role of non-contrast chest CT imaging in the presence of typical features for COVID-19 pneumonia as a reliable predictor of clinical severity and patient’s outcome. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pneumonia is responsible for the latest pandemics. Usage of pulmonary computed tomography (CT) scan is known to be an important method in the diagnosis of COVID-19. Here, we aimed to evaluate the relationship between CT severity score and capillary blood oxygen saturation in patients with COVID-19 infection. Patients and methods: This is a cross-sectional study performed in 2020 on patients with COVID-19 infection. All patients underwent pulmonary CT scan and CT severity score was calculated. The initial capillary oxygen saturation by the time of admission was also collected. Data were collected and analyzed. Results: A total number of 270 patients diagnosed with COVID-19 infection entered the study. The initial mean capillary oxygen saturation was 89.65 ± 8.09%. The mean score in patients was 15.16 ± 8.08. We also indicated that 27 patients had hypoxia by the time of admission and these patients had significantly higher CT severity scores (p = 0.001). Diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic obstructive pulmonary disease (COPD) (p = 0.03) and totally, having an underlying disease (p < 0.001) were significantly associated with decreased capillary oxygen saturation. Patients with hypertension (p = 0.001) and patients with the previous medical disease (p = 0.01) had significantly higher CT severity scores than others. There was a significant reverse relationship between CT severity score and capillary oxygen saturation (r = -0.44, p < 0.001). Conclusions: We showed that there was a significant reverse relationship between CT severity score and capillary oxygen saturation which has great clinical importance. Furthermore, we indicated that previous medical history could also play an important role in CT severity score. [ABSTRACT FROM AUTHOR]

Aims: To analyze the Chest CT Scan and association of the severity score with the serum biomarkers D-dimer, C-reactive protein (CRP), Lactate dehydrogenase (LDH) and Ferritin levels. Methods: This is a retrospective study done from the database of Department of Radiology and Department of Pathology at Nobel medical college and teaching hospital during the peak of the second wave of the pandemic from 1st April 2021 to 31st May 2021. Data for the Chest CT scan and lab parameters were analyzed and correlated. Ethical approval was obtained from the Institutional review committee of Nobel Medical College and Teaching Hospital. Descriptive statistical analysis was performed. Results: A total of 263 cases of Chest CT scan were done in 2 months period who were diagnosed as cases of COVID 19. In this study the severity and scores were taken from the database in the Radiology department. The lab parameters like D-dimer, CRP, LDH and Ferritin levels were studied from the database in the lab. Age of the patients ranged from 19 to 89 years with maximum cases 68 (25.8%) seen in the age group of 50-59 years. According to the chest CT Scan the severity score was in between 11-15 in 92 (48.3%) cases. Fifty six cases showed abnormal levels of D-dimer, Ferritin, CRP and LDH. Ddimer was raised in 26 (46.4%), LDH was raised in 48 (87.2%) while Ferritin and CRP was also raised in all 56 cases. Conclusions: There was a positive correlation between the biomarkers and the Chest CT severity score. The severity of the disease with involvement of the lungs can be estimated by correlating with the lab parameters. [ABSTRACT FROM AUTHOR]

The role of the adaptive microenvironment components in severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection is widely researched, but remains unclear. Studying the common dynamics of adaptive immune response changes can help understand the pathogenesis of coronavirus disease 2019 (COVID-19), especially in critical patients. The aim of the present study was to determine the cytokines concentration and leukocyte subpopulations profiles in the severe COVID-19 (n = 23) and critical (n = 18) COVID-19 group distinguished by the computed tomography (CT) severity score. We observed lower percentage of lymphocyte subpopulation, higher neutrophils to lymphocytes ratio (NLR) and higher IL-6 concentration in critical COVID-19 group than in severe group. CT severity score was negative correlated with proportion of lymphocytes, lymphocytes T, CD4+ cells, Treg cells and NK cells and positive correlated with neutrophils, NLR, and IL-6. In critical group more correlations between cytokines and lymphocytes were observed, mainly between TNF-α, IL-1β and lymphocyte subpopulations. The collective assessment of the cytokine profile, leukocyte subpopulations and the CT severity score can help to characterize and differentiate patient in advanced COVID-19 than the study of single parameters. We have shown that the interconnection of elements of the adaptive microenvironment can play an important role in critical COVID-19 cases. [ABSTRACT FROM AUTHOR]