Role of CXR and HRCT in diagnosing COVID-19, a descriptive cross-sectional study, at a tertiary care hospital in Pakistan

ABSTRACT Objectives: Objectives of this study are to do the analysis of chest X-ray and High-resolution CT scan findings in patients who are clinical suspects of COVID-19 infection. The other objective is to classify the radiological findings in mild, moderate or severe diseases according to BSTI criteria for chest X-ray and CTSS for high-resolution CT scan. Methods: This is a cross-sectional descriptive study. A group of 50 patients who were clinically suspected cases of COVID-19 infection, presented to Corona flu filter clinic of Holy Family Hospital (HFH) or admitted to corona isolation wards were included. The time duration of the study was from 15 May 2020 to 15 June 2020. Patients labelled as clinically suspected cases were having positive contact with confirmed positive (based upon positive PCR) patients. Recent travel history from the area having an outbreak. They were having clinical signs/symptoms of fever, cough, and shortness of breath, lethargy and loss of sense of smell or taste. CXR and HRCT was the investigation of choice for all the 50 patients.  I also did PCR to make a correlation with the other two tests. All radiological findings were analyzed based upon Fleischner society glossary of terms for thoracic imaging. Two radiologists then assessed CXRs findings based upon BSTI criteria. They marked those CXR findings as low, moderate and high probability for COVID-19 infection. HRCT findings were analyzed using CT-SS, and researchers labelled outcomes as mild, moderate and severe disease.  Results: Out of 50 patients, 33(66%) were males, and 17(34%) were females. Mean age was 51 with ages ranging from 30-72 years. Presenting complaints were fever in 42(84%) patients, cough in 37(74%), lethargy in 33(66%), shortness of breath in 41(82%) and loss of sense of smell and taste in 21(42%) patients. Out of these 50, 32(72%) were having positive PCR for COVID-19 infection. On CXR 5(10%) patients showed classic findings which were highly probable for COVID-19. 19(38%) patients showed intermediate results for COVID-19, 7(14%) patients had a low probability of COVID-19 infection on CXRS. Out of 50, 19(38%), patients showed normal CXR with no evidence of COVID-19 infection. We did HRCT of the same patients on the same day; it showed 21(42%)patients with mild disease,23(46%)patients with moderate disease and 6(12%)patients with the severe disease according to CTSI.HRCT of 3(6%)patients was ok with no evidence of illness in bilateral lungs.    Conclusion: The role of radiology is crucial in the diagnosis of this viral illness. CXR, with its ability to detect changes of COVID-19 in lungs, should be used as a first-line imaging modality in clinically suspected patients. Moreover, it should also be used for follow up of patients with COVID-19. HRCT is very sensitive in the diagnosis of COVID-19 infection in its milder forms. Due to lack of its widespread availability in countries with inadequate medical facilities, it was not the primary imaging tool/screening tool. Due to risk of infection to radiological staff as well as non-covid-19 patients due to surface contact, due to reduced infection control issues, due to increased burden of ionizing radiations in patients. All these factors limit the role of HRCT as a primary imaging modality for COVID-19 infectio

Perioperative registries in resource-limited settings: The way forward for Pakistan

Capable of improving surgical quality, perioperative registries can allow performance benchmarking, reliable reporting and the development of risk-prediction models. Well established in high-income countries, perioperative registries remain limited in lower- and middle-income countries due to several challenges. First, ensuring comprehensive data entry forums to power the registries is difficult because of limited electronic medical records requiring sustained efforts to develop and integrate these into practice. Second, lack of adequate expertise and resources to develop and maintain registry software necessitates the involvement of software developers and information technology personnel. Third, case ascertainment and item completion are challenging secondary to poor-quality medical records and high loss-to-follow-up rates, requiring telemedicine initiatives as an adjunct to existing care for the assessment of post-discharge outcomes. Lastly, standardised coding of clinical terminology is warranted for ensuring interoperability of the registries for which adaptation of the existing disease and procedural codes can be a sustainable and cost-effective alternative to the development of new codes

Chest X-ray findings in COVID-19: A Pictorial Review

Introduction: Chest X-ray and Computed tomography(CT) of chest play an important role in the diagnosis and management of the Coronavirus disease (COVID-19). As chest CT may not be readily available in most clinical setups X-ray Chest plays a pivotal role in such clinical scenarios and an irreplaceable initial radiological investigation of these patients. Objective: The objective of this article is to identify and elaborate the commonest appearances and patterns of lung changes on Chest X rays in COVID-19 positive patients confirmed on RT-PCR COVID testing. Materials and Methods: Cross-sectional descriptive-analytical study of Chest X-ray findings of 294  RT-PCR confirmed COVID-19 patients admitted across 3 hospitals (Rawalpindi institute of urology (RIU), Benazir Bhutto Hospital (BBH) and Holy Family Hospital (HFH)) from March 30th, 2020 till April 30th, 2020. CXR was analyzed for consolidation patches, ground-glass opacification (GGO), multi-lobe involvement, bilateral distribution, and pleural fluid. The chest X-ray with positive findings was graded into mild, moderate, and severe grades using BSTI (British Society of Thoracic imaging) guidelines. Results: Mean age of study patients was 45.5 years. Among the study population 230 (78.2 %) were male and 64 (21.8%) female. On baseline chest X rays, consolidations were the commonest finding (n=84, 28.5%), followed by ground-glass opacity (n=17, 5.7 %). The more common locations were peripheral and lower zones, and the majority had bilateral lung involvement (Table 1). Pleural effusions were found in only 5 of the study patients.  Among these patients, 187 (63.6%) had an initial normal chest X-ray. Moreover, 35, 34, and 38patients had mild, moderate, and severe diseases respectively. Conclusion: Chest X-ray is an important initial radiological investigation for COVID 19 patients and plays an important role in the management during the course of the disease

Malicious node detection using machine learning and distributed data storage using blockchain in WSNs

In the proposed work, blockchain is implemented on the Base Stations (BSs) and Cluster Heads (CHs) to register the nodes using their credentials and also to tackle various security issues. Moreover, a Machine Learning (ML) classifier, termed as Histogram Gradient Boost (HGB), is employed on the BSs to classify the nodes as malicious or legitimate. In case, the node is found to be malicious, its registration is revoked from the network. Whereas, if a node is found to be legitimate, then its data is stored in an Interplanetary File System (IPFS). IPFS stores the data in the form of chunks and generates hash for the data, which is then stored in blockchain. In addition, Verifiable Byzantine Fault Tolerance (VBFT) is used instead of Proof of Work (PoW) to perform consensus and validate transactions. Also, extensive simulations are performed using the Wireless Sensor Network (WSN) dataset, referred as WSN-DS. The proposed model is evaluated both on the original dataset and the balanced dataset. Furthermore, HGB is compared with other existing classifiers, Adaptive Boost (AdaBoost), Gradient Boost (GB), Linear Discriminant Analysis (LDA), Extreme Gradient Boost (XGB) and ridge, using different performance metrics like accuracy, precision, recall, micro-F1 score and macro-F1 score. The performance evaluation of HGB shows that it outperforms GB, AdaBoost, LDA, XGB and Ridge by 2-4%, 8-10%, 12-14%, 3-5% and 14-16%, respectively. Moreover, the results with balanced dataset are better than those with original dataset. Also, VBFT performs 20-30% better than PoW. Overall, the proposed model performs efficiently in terms of malicious node detection and secure data storage. © 2013 IEEE

The Diagnostic Accuracy Of Hyperbilirubinemia In Acute Appendicitis

Objective: To determine the diagnostic accuracy of serum Bilirubin in cases of acute appendicitis keeping the histopathological findings as Gold standard. Study Design: Cross sectional validation study. Place and Duration of the Study: Surgical Unit, Sheikh Khalifa Bin Zayed Al-Nayhan Hospital (Combined Military Hospital), Rawalakot, Azad Kashmir, from Jan 2022 to June 2022. Methodology: A total of 380 patients aged between 18 to 65 years, who matched the inclusion and exclusion criteria suspected of acute appendicitis were included. Serum Bilirubin level was noted. Appendectomy was done. Specimen of appendix was sent for histopathology for confirmation of the diagnosis. Results: In our study, mean age of the patients was 34.015 with a standard deviation of 13.32. 65% (n=247) of the patients were males and 35% (n=133) were females. Frequency of acute appendicitis on histopathology was 82.89% (n=315) while 17.1% (n=65) had no findings of the disease. Validity of serum Bilirubin in diagnosing appendicitis using histopathology showed 57.36% (n=218) were true positive, 2.1% (n=8) were false positive, 15% (n=57) were true negative and 25.52 %( n=97) were false negative. Specificity, sensitivity, negative predictive value, positive predictive value, accuracy rate, positive likelihood ratio and negative likelihood ratio were 87.69%, 69.20%, 37.01%, 96.46%, 72.36%, 5.62 and 0.35 respectively. Conclusion: Serum Bilirubin is a useful marker for diagnosing the acute appendicitis and can be used as a good alternative diagnostic modality in suspected cases of acute appendicitis

MORPHOLOGIC SPECTRUM AND CLINICO-PATHOLOGICAL CORRELATION OF GASTROINTESTINAL STROMAL TUMOURS: AN EXPERIENCE OF SIX YEARS AT A TERTIARY CARE HOSPITAL.

Objective: The objective of this study was to determine the morphologic spectrum and risk category of gastrointestinal stromal tumour (GIST) and compare with overall patient survival.Materials and Methods: It is a descriptive observational study. The study was carried at Shifa International Hospital, Islamabad. Duration of the study was from January 2009 to January 2015. A total of 31 patients with the diagnosis of GIST were included, irrespective of age and gender. Data were retrieved from laboratory information system. Results were analysed by statistical software, Statistical Package of the Social Sciences. Morphologic type, site of tumour, risk category and overall survival were determined and mean, standard deviation, frequencies and percentages were calculated for age site and risk category. Results: Of 31 patients, 21 (67.7%) were male and 10 (32.3%) were female. Site of tumour was as follows: Gastric 13 (41.9%), extra visceral 6 (19.4%), small intestine 9 (29.0%), rectum 2 (6.5%) and pancreas 1 (3.2%). According to risk categorisation, one was categorised as (3.2%) very low risk, 3 (9.7%) low risk, 5 (16.1%) intermediate risk and 22 (71%) high risk. Follow-up was available in 21 patients. 7 patients (22.5%) lost to follow-up. 8 (25%) had recurrence and 4 (12.9%) died. Conclusion: Majority of cases diagnosed at our centre were gastric in origin followed by small intestine, and as per risk categorisation, most were high risk. Patient survival with high-risk tumours was dismal. Key words: Gastrointestinal stromal tumour, immunohistochemistry, risk categorisation

Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients

Background: The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy andassess the severity of the infection. Objectives: The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. Methods: This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables. Results: Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results . However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificantfor other bronchopulmonary segments (p>0.05). Conclusion: CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patientsare needed. Keywords: Chest High resolution computed tomography (HRCT); COVID-19; Polymerase Chain Reaction (PCR)