COVID-19 outbreak in Italy: experimental chest X-ray scoring system for quantifying and monitoring disease progression
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new virus recently isolated from humans. SARS-CoV-2 was discovered to be the pathogen responsible for a cluster of pneumonia cases associated with severe respiratory disease that occurred in December 2019 in China. This CXR scoring system is a simple five-point grading tool that was proposed in 2015, and it was designed for non-radiologist clinicians. The goal of this scoring system was to facilitate the clinical grading of CXR reports into five different severity categories in hospitalized patients with acute respiratory infection. Our CXR scoring system for COVID-19 pneumonia (which we named Brixia score) includes two steps of image analysis. In the first step, the lungs are divided into six zones on frontal chest projection Upper zones (A and D): above the inferior wall of the aortic arch Middle zones (B and E): below the inferior wall of the aortic arch and above the inferior wall of the right inferior pulmonary vein (i.e., the hilar structures) Lower zones (C and F): below the inferior wall of the right inferior pulmonary vein (i.e., the lung bases) In the second step, a score (from 0 to 3) is assigned to each zone based on the lung abnormalities detected on frontal chest projection as follows Score 0 no lung abnormalities Score 1 interstitial infiltrates Score 2 interstitial and alveolar infiltrates (interstitial predominance) Score 3 interstitial and alveolar infiltrates (alveolar predominance) All statistical analyses were performed using commercial software (MedCalc Statistical Software version 19, Ostend, Belgium). P-values of less than 0.05 were considered statistically significant. In conclusion, we consider this scoring tool to be very promising due to its ability to provide, in a very clear and straightforward way, relevant information for clinicians by enhancing the role of radiologists in this long and tiring battle against this new viral pneumonia. To read more- https://link.springer.com/article/10.1007%2Fs11547-020-01200-3
"Latest news about Covid19. It seems that the disease is being attacked worldwide. Thanks to autopsies performed by the Italians ... it has been shown that it is not pneumonia ... but it is: disseminated intravascular coagulation (thrombosis). Therefore, the way to fight it is with antibiotics, antivirals, anti-inflammatories and anticoagulants. The protocols are being changed here since noon! According to valuable information from Italian pathologists, ventilators and intensive care units were never needed. If this is true for all cases, we are about to resolve it earlier than expected. Important and new about Coranovirus: Around the world, COVID-19 is being attacked wrongly due to a serious pathophysiological diagnosis error. The impressive case of a Mexican family in the United States who claimed they were cured with a home remedy was documented: three 500 mg aspirins dissolved in lemon juice boiled with honey, taken hot. The next day they woke up as if nothing had happened to them! Well, the scientific information that follows proves they are right! This information was released by a medical researcher from Italy: Thanks to 50 autopsies performed on patients who died of COVID-19, Italian pathologists have discovered that IT IS NOT PNEUMONIA, strictly speaking, because the virus does not only kill pneumocytes of this type, but uses an inflammatory storm to create an endothelial vascular thrombosis. As in disseminated intravascular coagulation, the lung is the most affected because it is the most inflamed, but there is also a heart attack, stroke and many other thromboembolic diseases. In fact, the protocols left antiviral therapies useless and focused on anti-inflammatory and anti-clotting therapies. These therapies should be done immediately, even at home, in which the treatment of patients responds very well. The later performed less effective. In resuscitation, they are almost useless. If the Chinese had denounced it, they would have invested in home therapy, not intensive care! DISSEMINATED INTRAVASCULAR COAGULATION (THROMBOSIS): So, the way to fight it is with antibiotics, anti-inflammatories and anticoagulants. An Italian pathologist reports that the hospital in Bergamo did a total of 50 autopsies and one in Milan, 20, that is, the Italian series is the highest in the world, the Chinese did only 3, which seems to fully confirm the information. Previously, in a nutshell, the disease is determined by a disseminated intravascular coagulation triggered by the virus; therefore, it is not pneumonia but pulmonary thrombosis, a major diagnostic error. We doubled the number of resuscitation places in the ICU, with unnecessary exorbitant costs. In retrospect, we have to rethink those chest X-rays that were discussed a month ago and were given as interstitial pneumonia; in fact, it may be entirely consistent with disseminated intravascular coagulation. Treatment in ICUs is useless if thromboembolism is not resolved first. If we ventilate a lung where blood does not circulate, it is useless, in fact, nine (9) patients out of ten (10) die. Because the problem is cardiovascular, not respiratory. It is venous microthrombosis, not pneumonia, that determines mortality. Why thrombi are formed❓ Because inflammation, according to the literature, induces thrombosis through a complex but well-known pathophysiological mechanism. Unfortunately what the scientific literature said, especially Chinese, until mid-March was that anti-inflammatory drugs should not be used. Now, the therapy being used in Italy is with anti-inflammatories and antibiotics, as in influenza, and the number of hospitalized patients has been reduced. Many deaths, even in their 40s, had a history of fever for 10 to 15 days, which were not treated properly. The inflammation did a great deal of tissue damage and created ground for thrombus formation, because the main problem is not the virus, but the immune hyperreaction that destroys the cell where the virus is installed. In fact, patients with rheumatoid arthritis have never needed to be admitted to the ICU because they are on corticosteroid therapy, which is a great anti-inflammatory. This is the main reason why hospitalizations in Italy are decreasing and becoming a treatable disease at home. By treating her well at home, not only is hospitalization avoided, but also the risk of thrombosis. It was not easy to understand, because the signs of microembolism disappeared! With this important discovery, it is possible to return to normal life and open closed deals due to the quarantine, not immediately, but it is time to publish this data, so that the health authorities of each country make their respective analysis of this information and prevent further deaths. useless! The vaccine may come later. Now we can wait. In Italy, as of today, protocols are changing. According to valuable information from Italian pathologists, ventilators and intensive care units are not necessary. Therefore, we need to rethink investments to properly deal with this disease. Não há (Translation by automatic device). LET'S PUBLISH URGENTLY! " How much it has authentic reasoning, remains a question
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Care for Critically Ill Patients With COVID-19 Initial reports suggest that COVID-19 is associated with severe disease that requires intensive care in approximately 5% of proven infections. Given how common the disease is becoming, as in prior major severe acute respiratory infection outbreaks—SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), avian influenza A(H7N9), and influenza A(H1N1)pdm09—critical care will be an integral component of the global response to this emerging infection. Management of severe COVID-19 is not different from management of most viral pneumonia causing respiratory failure. The principal feature of patients with severe disease is the development of ARDS: a syndrome characterized by acute onset of hypoxemic respiratory failure with bilateral infiltrates. Evidence-based treatment guidelines for ARDS should be followed, including conservative fluid strategies for patients without shock following initial resuscitation, empirical early antibiotics for suspected bacterial co-infection until a specific diagnosis is made, lung-protective ventilation, prone positioning, and consideration of extracorporeal membrane oxygenation for refractory hypoxemia. To read complete article- https://jamanetwork.com/journals/jama/fullarticle/2762996 Source- JAMA Authors- Srinivas Murthy, MD, CM, MHSc; Charles D. Gomersall, MBBS; Robert A. Fowler, MD, CM, MSc
Dr. Vivek Jain21 Likes19 Answers - Login to View the image
Patient in early 50s who has a history of SARS when it was going round. Presents with shortness of breath, oxygen saturation in high 80s despite no chronic pulmonary disease. The patient seems to be coping well, but when do you decide to proceed to intubation assuming this is COVID-19? Watch and observe until they begin to deteriorate, or intubate while still well?
Dr. Zaka Yusto M2 Likes20 Answers - Login to View the image
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. Methods Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. To read more- https://www.sciencedirect.com/science/article/pii/S0140673620303603 Source-sciencedirect
Dr. Pushker Mehra10 Likes15 Answers - Login to View the image
#its_time. x ray of Covid 19 patient 35yrs old taken in serial from day 1 to 7 trying to show pathological changes in the Lung. #Expert_opinion on this
Dr. Zaka Yusto M61 Likes30 Answers - Login to View the image
x-ray chest of first case of Corona virus pneumonia patient aged 61 years male who died during treatment in WUHAN city of China.
Dr. Ramesh Dutt Gautam39 Likes33 Answers
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