Impact of CT Scan Phenotypes in Clinical Manifestations, Management and Outcomes of Hospitalised Patients with COVID-19

COVID-19 is such a heterogeneous disease that a one-size-fits-all approach is not recommended, so the management of patients has been based on their clinical and laboratory characteristics. We therefore investigated possible homogeneous groups presenting similar features of lung involvement based on chest CT and laboratory results. We designed a study to identify a possible correlation between CT scan phenotypes, laboratory exams, and clinical outcomes. We retrospectively analysed 120 adult patients with COVID-19 5who underwent chest CT scan during hospitalisation, between March and December 2020 at our COVID-19 Hospital in two different wards: Respiratory Intensive Care Unit (RICU) and Intensive Care Unit (ICU). The analysis of CT scans resulted in the identification of three radiological phenotypes by two blinded pulmonologists (Cohen's κ = 0.9 for Phenotype 1, 0.9 for Phenotype 2 and 0.89 for Phenotype 3), in accordance with what previously described by Robba et al. “Phenotype 1” (PH1) is characterised by modest interstitial oedema with presentation on chest CT of diffuse ground glass opacities (GGO). “Phenotype 2” (PH2) shows predominant consolidation at lung lobes. “Phenotype 3” (PH3) shows a typical CT pattern of moderate-to-severe ARDS, with alveolar oedema. Based on our results, we could hypothesise that phenotype 2 shows a different trend from all the others and would seem to be more related to a coagulopathy, although we cannot exclude the hypothesis that one phenotype evolves from the other. Further studies might focus on the predictive role of D-dimer, and its cut-offs, in delineating the PH2 patients, that could require an early CT scan to avoid excessive pressure support and finally prevent VILI. To further understand the exact basis of the different CT scan phenotype, a longer longitudinal analysis of clinical and laboratory features (e.g., timing of weaning, pressures and FiO2 delivered) in each phenotype and a comparison among them is needed

Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

ObjectivesTo investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases.MethodsForty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0–3) and a continuous quantitative measurement (“VAS echogenicity,” 0–100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall’s Tau and Pearson’s Rho coefficients.ResultsThe semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57–0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68–0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. “VAS echogenicity” showed a high reliability both in the inter-observer [ICC = 0.80 (0.75–0.85)] and intra-observer [ICC = 0.88 (0.88–0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and “VAS echogenicity” [ICC = 0.52 (0.50–0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively).ConclusionThe results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases

A knowledge-based framework enabling decision support in RFID solutions for healthcare

The benefits of RFID technology in the healthcare sector are widely acknowledged. Nevertheless, the adoption of RFID as a means for pure item identification prevents adequate support to most knowledge-intensive medical tasks. Here an innovative Decision Support System for healthcare applications is presented, based on a semantic enhancement of RFID standard protocols. Semantically annotated descriptions of both medications and patient's case history are stored in RFID tags and used to help doctors in providing the correct therapy. The proposed system allows to discover possible incompatibilities in a therapy suggesting alternative treatments. © 2010 IEEE

Knowledge-Based Decision Support in Healthcare via Near Field Communication

The benefits of automatic identification technologies in healthcare have been largely recognized. Nevertheless, unlocking their potential to support the most knowledge-intensive medical tasks requires to go beyond mere item identification. This paper presents an innovative Decision Support System (DSS), based on a semantic enhancement of Near Field Communication (NFC) standard. Annotated descriptions of medications and patient’s case history are stored in NFC transponders and used to help caregivers providing the right therapy. The proposed framework includes a lightweight reasoning engine to infer possible incompatibilities in treatment, suggesting substitute therapies. A working prototype is presented in a rheumatology case study and preliminary performance tests are reported. The approach is independent from back-end infrastructures. The proposed DSS framework is validated in a limited but realistic case study, and performance evaluation of the prototype supports its practical feasibility. Automated reasoning on knowledge fragments extracted via NFC enables effective decision support not only in hospital centers, but also in pervasive IoT-based healthcare contexts such as first aid, ambulance transport, rehabilitation facilities and home care

[The treatment of recurrent uveitis with TNF-alpha inhibitors].

Objective. Uveitis is a severe manifestation of rheumatic diseases since it can lead to visual impairment and even blindness. Ocular involvement is frequently a clinical challenge because its occurrence often requires changes of the therapeutic strategy. There are growing evidence that tumor necrosis factor α (TNFα) inhibitors may be an effective treatment of refractory uveitis. Purpose of this study was to evaluate the efficacy and safety of TNFα blocking agents in patients with seronegative spondylo-arthropathies (SNSA) and Behcet disease (BD) associated relapsing uveitis. Methods. Five consecutive patients with chronic or relapsing uveitis were prospectively studied. Two patients with SNSA had recurrent anterior uveitis and three patients had BD associated uveitis (one anterior, two posterior uveitis). All of the patients were taking systemic and topical corticosteroids and three of them were also treated with DMARDS (methotrexate, cyclosporine, sulphasalazine) without clinical benefit. Four patients received infliximab, an anti- TNFα monoclonal antibody, at a dosage of 5 mg/kg body weight and one patient was treated with etanercept, a TNFα receptor p75-Fc fusion protein, at a dosage of 25 mg twice weekly. Results. Both infliximab and etanercept induced a marked improvement in uveitis and none relapse was observed throughout all the study. Systemic corticosteroids were progressively tapered and stopped in all patients. Also methotrexate and sulphasalazine were discontinued, while cyclosporine dose has been reduced by 30% until now. No side effects were observed. Conclusions. Therapy with TNFα blockers, infliximab and etanercept, was effective and safe in the treatment of rheumatic disease associated uveitis. A complete remission was achieved even in patients with severe steroid resistant uveitis. Further controlled studies on larger number of patients are needed to better define the different forms of ocular involvement that can benefit from the therapy with TNFα inhibitors

Obesity reduces the drug survival of second line biological drugs following a first TNF-α inhibitor in rheumatoid arthritis patients

tObjectives: The aim of this study was to assess whether body mass index (BMI) affects clinical outcomesin rheumatoid arthritis (RA) patients starting a second line biological drug after failure of a first TNF-blocker.Methods: From a longitudinal cohort, we analyzed 292 RA patients (66 obese, 109 overweight, and117 normal-weight) treated with a first ever anti-TNF- drug. Patients discontinuing the therapy werefollowed-up if began a second biological drug. Drug survival, by Kaplan-Meier life analysis, and 12 monthsdisease remission based on the 28-joint Disease Activity Score (DAS28) were assessed for either courseof biologics. The baseline predictors of clinical outcomes were assessed by Cox regression analysis.Results: Survival of the first anti-TNF- drug was lower in obese (39.4%) than in normal-weight (49.1%)patients, but the difference was not statistically significant. Obese patients had the highest hazard todiscontinue the first anti-TNF- drug (HR 1.64, 1.02–2.62 95% IC, P = 0.04), and the lowest percent-age of DAS28-based disease remission at 12 months (P = 0.04). In 97 (37 normal-weight, 36 overweight,24 obese) patients who started a second non-anti-TNF- biological drug, persistence on therapy wassignificantly lower in obese (43.5%) than in normal-weight (80%, P = 0.04) group, and again obesity sig-nificantly predicted drug discontinuation (HR 2.9, 1.08–8.45 95% IC, P = 0.04). Significantly, less obesepatients attained a disease remission (12%, P = 0.004) at 12 months.Conclusion: Our study provides evidence that obese RA patients poorly respond to second line non-anti-TNF- drugs after failure of a first TNF- inhibitor

Serum cartilage oligomeric matrix protein (COMP) following infliximab treatment in patients with rheumatoid arthritis: Analitical performances and clinical correlations

Background. Cartilage oligomeric matrix protein (COMP) is a biomarker for the cartilage turnover and is described as a valuable parameter for the assessment of therapy response in patients with rheumatoid arthritis (RA). This study evaluated the analytical performances and clinical correlations of an automated enzyme immunoassay for the detection of COMP (COMP R ELISA; AnaMar Medical AB, Lund, Sweden). Methods. Commercial controls and serum pool were used to evaluation of method precision and accuracy in accordance with the description in the NCCLS guideline EP15-A2. Twenty-eight patients with established RA were studied during a 6-month period from initiation of treatment with infliximab. COMP levels were correlated with clinical evaluation and laboratory tests (VES, C reactive protein) and compared before and after treatment. Results. The total imprecision (CV% within-laboratory) was 3.27%-5.50% for concentrations ranging between 7.09 and 14.69 U/L. The test was linear for concentrations ranging between 4 and 32 U/L. COMP levels decreased in ACR responders patients, remained unchanged or increased in ACR non responders. There was no significant correlation between COMP levels and laboratory test evaluated. Conclusions. The COMP assay we examined on a fully automated system showed a good analytical performances (precision and linearity) and can provide useful data for evaluating tissue effects of novel treatment in RA