Hospital trajectories and early predictors of clinical outcomes differ between SARS-CoV-2 and influenza pneumonia

BACKGROUND: A comparison of pneumonias due to SARS-CoV-2 and influenza, in terms of clinical course and predictors of outcomes, might inform prognosis and resource management. We aimed to compare clinical course and outcome predictors in SARS-CoV-2 and influenza pneumonia using multi-state modelling and supervised machine learning on clinical data among hospitalised patients. METHODS: This multicenter retrospective cohort study of patients hospitalised with SARS-CoV-2 (March-December 2020) or influenza (Jan 2015-March 2020) pneumonia had the composite of hospital mortality and hospice discharge as the primary outcome. Multi-state models compared differences in oxygenation/ventilatory utilisation between pneumonias longitudinally throughout hospitalisation. Differences in predictors of outcome were modelled using supervised machine learning classifiers. FINDINGS: Among 2,529 hospitalisations with SARS-CoV-2 and 2,256 with influenza pneumonia, the primary outcome occurred in 21% and 9%, respectively. Multi-state models differentiated oxygen requirement progression between viruses, with SARS-CoV-2 manifesting rapidly-escalating early hypoxemia. Highly contributory classifier variables for the primary outcome differed substantially between viruses. INTERPRETATION: SARS-CoV-2 and influenza pneumonia differ in presentation, hospital course, and outcome predictors. These pathogen-specific differential responses in viral pneumonias suggest distinct management approaches should be investigated. FUNDING: This project was supported by NIH/NCATS UL1 TR002345, NIH/NCATS KL2 TR002346 (PGL), the Doris Duke Charitable Foundation grant 2015215 (PGL), NIH/NHLBI R35 HL140026 (CSC), and a Big Ideas Award from the BJC HealthCare and Washington University School of Medicine Healthcare Innovation Lab and NIH/NIGMS R35 GM142992 (PS)

Cone beam computed tomography guided surgical stent: A preimplant planning procedure, a pilot study

Aim: The aim of the present study was to evaluate the efficacy of cone-beam computed tomography (CBCT)-based radiologic stent in guidance for preimplant placement procedures. Setting and Design: This study was a pilot study conducted among 5 patients who presented for dental implants and attending the department of Oral Medicine and Radiology, ITS Dental College, Muradnagar for CBCT volumetric scans. Materials and Methods: The dimensions of bone available for implants were measured from the scans. A radiologic stent was prepared on the study model using three radiopaque pins per implant site, which simulated the implant in the CBCT scan. The pin which was in the direction of the residual bone was identified and retained, and the remaining pins were removed. The retained pin was utilized and the final surgical stent was prepared. It was checked if the final implant placement could be accomplished surgically using the modified stent. Results: A total of 7 implants were inserted. The final implant placement was based on the CBCT data and was evaluated by postoperative radiographs. All the implant sites showed proper placement of the implants. Conclusion: The stent used in our study was cost effective and easy to fabricate. Apart from the anteroposterior direction, it was also possible to give buccolingual direction to the implant, reducing the chances of perforation