CT Scan Finding Characteristics of Confirmed Covid-19 Patients Based on Clinical Symptom Onset Patterns

Chest computed tomography (CT) scan is one of the main modalities to detect COVID-19 infection. Several CT scan findings are the hallmark to rapidly detect suspected COVID-19 infection, therefore timely treatment could be administered. This study aims to describe chest CT scan findings of confirmed COVID-19 patients based on clinical symptom onset patterns. This study is a descriptive study with a retrospective design in confirmed COVID-19 patients. Data regarding characteristics of chest CT scan findings and the patient’s history including clinical symptoms onset were collected. There were 123 subjects in this study. The study data were categorized into modified clinical symptom onset patterns which were early, progressive, peak, absorption, and advanced phases. Most of male (57%) and female (43%) patients that were admitted to the hospital were in absorption phase of the disease with fever, cough, and dyspnea as the most prevalent symptoms. Chest CT scan findings of absorption phase included GGO (ground glass opacity) in 28 patients (76%), crazy paving pattern in 18 patients (49%), consolidation in 22 patients (59%), and fibrosis in 31 patients (84%). Chest CT scan findings of confirmed COVID-19 patients vary depending on the phase of the disease. Risk factors and secondary bacterial infection may contribute to long-term persistence of symptom

Association between chest X-ray score and clinical outcome in COVID-19 patients: A study on modified radiographic assessment of lung edema score (mRALE) in Indonesia

Radiological examinations such as chest X-rays (CXR) play a crucial role in the early diagnosis and determining disease severity in coronavirus disease 2019 (COVID-19). Various CXR scoring systems have been developed to quantitively assess lung abnormalities in COVID-19 patients, including CXR modified radiographic assessment of lung edema (mRALE). The aim of this study was to determine the relationship between mRALE scores and clinical outcome (mortality), as well as to identify the correlation between mRALE score and the severity of hypoxia (PaO2/FiO2 ratio). A retrospective cohort study was conducted among hospitalized COVID-19 patients at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from February to April 2022. All CXR data at initial admission were scored using the mRALE scoring system, and the clinical outcomes at the end of hospitalization were recorded. Of the total 178 COVID-19 patients, 62.9% survived after completing the treatment. Patients within non-survived had significantly higher quick sequential organ failure assessment (qSOFA) score (p<0.001), lower PaO2/FiO2 ratio (p=0.004), and higher blood urea nitrogen (p<0.001), serum creatinine (p<0.008) and serum glutamic oxaloacetic transaminase (p=0.001) levels. There was a significant relationship between mRALE score and clinical outcome (survived vs deceased) (p=0.024; contingency coefficient of 0.184); and mRALE score of ≥2.5 served as a risk factor for mortality among COVID-19 patients (relative risk of 1.624). There was a significant negative correlation between the mRALE score and PaO2/FiO2 ratio based on the Spearman correlation test (r=-0.346; p<0.001). The findings highlight that the initial mRALE score may serve as an independent predictor of mortality among hospitalized COVID-19 patients as well as proves its potential prognostic role in the management of COVID-19

The Role of ApOE, PSEN1, And Tnf-α as Predictor of COVID-19 Severity Evaluated Using Serial Thorax Radiograph

The high number of Covid-19 incidents is the main problem currently being faced, so how to reduce the number of incidents is a significant concern at this time. It is hoped that the risk factors and causes of mortality and how to detect the severity of Covid-19 can be a solution to reduce the morbidity of Covid-19 infection. This research is an analytical observational using the ApoE, Presenilin 1 (PSEN1), and TNF-α from the blood sample of Covid-19 patients; moreover, the thorax serial radiographs were evaluated by CARE score and were also used to determine the prognosis. All of the three indicators were examined using the ELISA Kit. Furthermore, the variables were analyzed using the SPSS 16.0 Ver. with Pearson and Spearman Rho data analysis. There is no correlation between ApoE, PSEN1, and TNF-α as Covid-19 severity predictors in this research regarding factors such as fewer geriatric samples, steroid usage as therapy, and fewer patients with comorbidities

Comparison of Chest X-Ray Findings Between Primary and Secondary Multidrug Resistant Pulmonary Tuberculosis

Abstract Introduction: Radiological imaging has a key role in multidrug-resistant (MDR) pulmonary tuberculosis (TB) screening and diagnosis. However, new cases of MDR pulmonary TB are often overlooked; therefore, its transmission might continue before its diagnosis. The most widely used and affordable radiological modality is a chest radiograph. This study aims to describe the characteristics of primary and secondary MDR pulmonary TB chest x-ray findings for differential diagnosis. Methods: This study was an analytic observational study with a retrospective design. Researchers evaluated medical record data of primary and secondary MDR pulmonary TB patients who underwent chest x-ray examinations. The patient's chest x-rays were then evaluated. Evaluated variables were lung, pleural, and mediastinal abnormalities and severity category. Results: The most common chest x-ray finding in primary MDR pulmonary TB was consolidation (96.2%), which was mostly unilateral (52.0%), accompanied by cavities (71.2%), most of which were multiple (83.8%) with a moderate category of severity. The most common chest x-ray finding in secondary MDR pulmonary TB was consolidation (100%), which was mostly bilateral (60.4%), accompanied by cavities (80.2%), most of which were multiple (90.1%) with severe category of severity. Pleural thickening (47.5%) was also found. Conclusion: There was a significant difference between primary and secondary MDR pulmonary TB in terms of mild severity category, and pleural thickening. Mild severity category is mostly found in primary MDR-TB and pleural thickening is mostly found in secondary TB

The relationship between Epidermal Growth Factor Receptor (EGFR) mutation and computed tomography findings in lung adenocarcinoma

Background: Adenocarcinoma is the highest histology subtype of lung cancer. Epidermal Growth Factor Receptor (EGFR) is a factor that can predict the prognosis or response to treatment in patients with lung adenocarcinoma. Adenocarcinomas with EGFR mutations generally have a component of Ground Glass Opacity (GGO), smaller size, oval shape, multiple nodal metastases, and distant metastases.  The aim of this study was to determine the relationship between EGFR mutations and CT scan images in pulmonary adenocarcinoma patients. Methods: This was a retrospective analytical study consisting of 92 samples, which were categorized into the mutation group (n = 62) and wild group (n = 30). This study was conducted at Dr. Soetomo General Hospital from January 2015 – December 2017. The assessed CT-Scan findings were tumor size, shape, density, lymph node size, pleural effusion, and metastasis presence. The relationship was analyzed using the chi-square test and considered significant if the p-value was < 0.05. Results: This study found a significant relationship between EGFR mutations status with tumor size ≤ 3 cm (p = 0.02), lymph node size < 1.5 cm (p = < 0.001) and metastasis (p = 0.026). However, tumor density, tumor form, and pleural effusion did not have significant relationship with EGFR mutation. Conclusion: Tumor size ≤ 3 cm, lymph node size < 1.5 cm and presence of metastasis can be found in EGFR mutations pulmonary adenocarcinoma patients

Pulmonary and intestinal tuberculosis with COVID-19 complicated with fluidopneumothorax and colovesical fistula: The importance of diagnosis complexity in line with clinical setting

The complication of hydropneumothorax and colovesical fistula is rare, especially in patients with tuberculosis (TB) and COVID-19. This particular situation poses a management difficulty, and can significantly threaten the patient's life without a clear diagnosis and timely treatment. We report a 28-year-old woman with pulmonary and intestinal TB with COVID-19 complicated with hydropneumothorax and colovesical fistula (CVF) which worsened her condition. Treatment for this patient was given according to the diagnosis. Her condition improved and she was discharged after 30 days of hospitalization, while elective surgery for CVF was not performed because there were no clinical symptoms complained of by this patient after completing TB treatment (9 months after hospital discharge). This case report highlights the importance of considering pulmonary and intestinal TB with COVID-19 as the cause of hydropneumothorax and CVF. Early and complex diagnosis is essential for proper management, as well as the efficacy of medical therapy and treatment for controlling such advanced stages of the disease. A complex condition with many symptoms can overlap with other diseases. Clinicians should consider the clinical symptoms, radiological imaging, and standard or supporting examination for accurate diagnosis to find the etiology of the diseases. Complete treatment for TB should be considered as the treatment choice (nonsurgical therapy) for CVF caused by TB before deciding on surgical intervention

Modified Chest X-Ray Scoring System in Evaluating Severity of COVID-19 Patient in Dr. Soetomo General Hospital Surabaya, Indonesia

Abstract Introduction The management of COVID-19 patients requires efficiency and accuracy in methods of detection, identification, monitoring, and treatment feasible in every hospital. Aside from clinical presentations and laboratory markers, chest x-ray imaging could also detect pneumonia caused by COVID-19. It is also a fast, simple, cheap, and safe modality used for the management of COVID-19 patients. Established scoring systems of COVID-19 chest x-ray imaging include Radiographic Assessment of Lung Edema (RALE) and Brixia classification. A modified scoring system has been adopted from BRIXIA and RALE scoring systems and has been made to adjust the scoring system needs at Dr. Soetomo General Hospital, Indonesia. This study aims to determine the value of scoring systems through chest x-ray imaging in evaluating the severity of COVID-19. Methods Data were collected from May to June of 2020 who underwent chest x-ray evaluation. Each image is then scored using three types of classifications: modified score, RALE score, and Brixia score. The scores are then analyzed and compared with the clinical conditions and laboratory markers to determine their value in evaluating the severity of COVID-19 infection in patients. Results A total of 115 patients were males (51.1%) and 110 were females (48.9%). All three scoring systems are significantly correlated with the clinical severity of the disease, with the strengths of correlation in order from the strongest to weakest as Brixia score (p<0.01, correlation coefficient 0.232), RALE score (p<0.01, correlation coefficient 0.209), and Dr. Soetomo General Hospital score (p<0.01, correlation coefficient 0.194). All three scoring systems correlate significantly with each other. Dr. Soetomo General Hospital score correlates more towards Brixia score (p<0.01, correlation coefficient 0.865) than RALE score (p<0.01, correlation coefficient 0.855). Brixia to RALE score correlates with a coefficient of 0.857 (p<0.01). Conclusion The modified scoring system can help determine the severity of the disease progression in COVID-19 patients especially in areas with shortages of facilities and specialists