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Background: Critical COVID-19 patients account for 1.7 to 13% of all pregnant COVID-19 patients. Methods: Patients admitted to the COVID-19 intensive care unit of Elena Doamna Obstetrics and Gynecology University Hospital in Iasi between 1 January and 1 December 2021, with critical forms of the disease, were included and retrospectively studied. The patients’ age range was 25–44 years in the Alpha group (n = 12) and 27–52 years in the Delta group (n = 9). Results: Most critically ill pregnant COVID-19 patients in the Alpha group delivered when admitted to the intensive care unit, while less than half of those in the Delta group delivered when admitted; the rest were released home and continued their pregnancy normally. There was a significant difference regarding the number of patients released to home care and the number of days after admission when delivery occurred (p = 0.02 and 0.022, respectively). Conclusions: There was no significant difference in maternal and fetal outcomes between the two groups, except for the number of patients released to home care and the number of days after admission when delivery occurred. There was no correlation between any Brixia scores (H, L, A, E) and any maternal or fetal outcomes in both groups.

Objectives Identifying early markers of poor prognosis of coronavirus disease 2019 (COVID-19) is mandatory. Our purpose is to analyze by chest radiography if rapid worsening of COVID-19 pneumonia in the initial days has predictive value for ventilatory support (VS) need. Methods Ambispective observational ethically approved study in COVID-19 pneumonia inpatients, validated in a second outpatient sample. Brixia score (BS) was applied to the first and second chest radiography required for suspected COVID-19 pneumonia to determine the predictive capacity of BS worsening for VS need. Intraclass correlation coefficient (ICC) was previously analyzed among three radiologists. Sensitivity, specificity, likelihood ratios, AUC, and odds ratio were calculated using ROC curves and binary logistic regression analysis. A value of p 1.3 points within 10 days of the onset of symptoms doubles the risk for requiring VS in inpatients and 5 times in outpatients (p

COVID-19 has become a global health hazard and its high infectivity is worrying. This virus can infect anyone and can be more severe in people who have comorbid illnesses. One of the most common comorbidities in COVID-19 patients is type 2 diabetes mellitus. Chest radiography can be used to predict prognosis and mortality in COVID-19 patients. One of the scoring used is the Brixia score which serves to assess the severity of the lung based on certain indicators. There are not many studies that discuss the mortality rate of COVID-19 patients with comorbid diabetes mellitus based on the radiographic profile as measured by the Brixia score assessment. Therefore, this study aims to determine the correlation between the mortality rate of comorbid COVID-19 patients with type 2 diabetes mellitus with the severity of chest radiography using the Brixia score. This study used an analytic observational study with a cross-sectional approach. The subjects were 60 COVID-19 patients with type 2 diabetes mellitus who met the inclusion and exclusion criteria. Sampling was done by purposive sampling technique and the data obtained were analyzed using the contingency coefficient test. There was a significant relationship between the mortality rate of patients with COVID-19 comorbid type 2 diabetes mellitus and the severity of chest radiography using the Brixia score (p

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, over 103214008 cases have been reported, with more than 2231158 deaths as of January 31, 2021. Although the gold standard for diagnosis of this disease remains the reverse-transcription polymerase chain reaction of nasopharyngeal and oropharyngeal swabs, its false-negative rates have ignited the use of medical imaging as an important adjunct or alternative. Medical imaging assists in identifying the pathogenesis, the degree of pulmonary damage, and the characteristic features in each imaging modality. This literature review collates the characteristic radiographic findings of COVID-19 in various imaging modalities while keeping the preliminary focus on chest radiography, computed tomography (CT), and ultrasound scans. Given the higher sensitivity and greater proficiency in detecting characteristic findings during the early stages, CT scans are more reliable in diagnosis and serve as a practical method in following up the disease time course. As research rapidly expands, we have emphasized the CO-RADS classification system as a tool to aid in communicating the likelihood of COVID-19 suspicion among healthcare workers. Additionally, the utilization of other scoring systems such as MuLBSTA, Radiological Assessment of Lung Edema, and Brixia in this pandemic are reviewed as they integrate the radiographic findings into an objective scoring system to risk stratify the patients and predict the severity of disease. Furthermore, current progress in the utilization of artificial intelligence via radiomics is evaluated. Lastly, the lesson from the first wave and preparation for the second wave from the point of view of radiology are summarized.

COVID-19 can cause disturbances in insulin production and worsen the clinical condition of patients with comorbid diabetes mellitus. In patients with diabetes mellitus, one of the complications is heart disease. Therefore, a study was conducted to determine the relationship between hs-Troponin I levels, which is a biomarker of heart disease, with the severity of COVID-19 patients as measured by the Brixia score in COVID-19 patients with comorbid diabetes mellitus in the ICU (Intensive Care Unit) of Dr. Moewardi Hospital, Surakarta. The study was conducted with a cross-sectional approach, the sample was COVID-19 patients with comorbid diabetes mellitus in the ICU, chosen by purposive sampling method. The dependent variable of this study was the Brixia score, and hs-Troponin I would be the independent variable. Data were analyzed by contingency coefficient test with p0,05) and r=0,245 showed that there is no significant relationship between hs-Troponin I and Brixia score. Hs-Troponin I level is negatively correlated to Brixia score in COVID-19 patients with diabetes mellitus.

Rosy Setiawati,1 Anita Widyoningroem,1 Triwulan Handarini,1 Fierly Hayati,1 Agnes Triana Basja,1 Atrikha Rahma Dyana Surya Putri,1 Merlin Guntur Jaya,2 Jessica Andriani,2 Melina Rosita Tanadi,2 Imran Harsam Kamal2 1Department of Radiology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital Surabaya, Surabaya, Indonesia; 2Faculty of Medicine Universitas Airlangga, Surabaya, IndonesiaCorrespondence: Rosy Setiawati 60286 Tel +62 878 5330 0019Email rosy-s@fk.unair.ac.idIntroduction: 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.Keywords: Brixia score, chest radiographs, COVID-19, modified score, RALE score

Rosy Setiawati,1 Anita Widyoningroem,1 Triwulan Handarini,1 Fierly Hayati,1 Agnes Triana Basja,1 Atrikha Rahma Dyana Surya Putri,1 Merlin Guntur Jaya,2 Jessica Andriani,2 Melina Rosita Tanadi,2 Imran Harsam Kamal2 1Department of Radiology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital Surabaya, Surabaya, Indonesia; 2Faculty of Medicine Universitas Airlangga, Surabaya, IndonesiaCorrespondence: Rosy Setiawati 60286 Tel +62 878 5330 0019Email rosy-s@fk.unair.ac.idIntroduction: 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.Keywords: Brixia score, chest radiographs, COVID-19, modified score, RALE score

Purpose: To explore whether chest X-ray severity scoring (CX-SS) could be reliable to assess the severity of pulmonary parenchymal disease in COVID-19 patients. Material and methods: The study consisted of 325 patients whose COVID-19 was confirmed by RT-PCR test and who underwent chest X-ray and computed tomography (CT) studies to assess parenchymal disease severity. Only 195 cases included in the final analysis after exclusion of cases with previous chest disease and cases having more than 24 hours interval between their X-ray and CT chest studies. Both chest X-ray and CT severity scores (CT-SS) were recorded by 2 experienced radiologists and were compared to the clinical severity. Interobserver agreement was assessed for CX-SS and CT-SS. Results: In relation to the clinical severity, the sensitivity of the CX-SS for diagnosis of moderate to severe parenchymal disease was high (90.4% and 100%) and low for mild cases (66.2%), while the specificity was high for mild to moderate parenchymal disease (100%) compared to severe cases (86.7%). The sensitivity, specificity, and diagnostic accuracy of the CT-SS were higher than CX-SS. Pearson correlation coefficient demonstrated a strong positive correlation between CX-SS and CT-SS (rs = 0.88, p < 0.001). The inter-observer agreement for CX-SS was good (k = 0.79, p = 0.001), and it was excellent for CT-SS (k = 0.85, p = 0.001). Conclusions: CX-SS is reliable to assess the severity of COVID-19 pulmonary parenchymal disease, especially in moderate and severe cases, with the tendency of overestimation of severe cases.

Background:Covid-19 vaccination has reached more than 132 million people in Indonesia since its first outbreak in March 2020. However; its effects on immunity are still lack of evidence. Covid-19 cases reached a significant increase in June 2021 and decreased in November 2021. In early 2022; it again recorded an increase. Seeing this phenomenon; this study investigates the differences of Covid-19 Patients’ severity levels over their vaccination status. Objective:This study examines the differences of severity level of chest x-ray imaging in covid-19 patients treated at Dr. Moewardi Hospital in three periods of time. Methods:A total of 89 covid-19 cases were collected from 3 different vaccination status: (1) 30 non-vaccinated patients (group A); (2) 30 patients treated for covid-19 after 1-3 months post-vaccination (group B); (3) 29 treated for covid-19 after more than 6 months post-vaccination (group C). Patients with type-II diabetes mellitus; heart failure or autoimmune disease were excluded. Severity level is based on chest x-ray examination by calculating the Brixia score by 3 examiners. All assessment results were analysed using the Kruskall-Wallis test followed by the Mann-Whitney post-hoc test. Results:A total of 8 male (26.7%) and 22 female (73.3%) patients in group B had lower Brixia scores with mean score 2.94+0.25 compared to 29 patients (55% male and 45% female) in group C with mean score 4.90+0.27 with a significant difference (p= 0.001). The Brixia score with the highest average was found in group A (non-vaccinated) with mean value 5.77+0.31 showing a significant difference from groups B and C (p Conclusion:Vaccine administration status showed different Brixia scores; whereas longer duration from vaccination showed higher score. Unvaccinated patients recorded the most severe condition. Booster vaccination is strongly recommended to obtain the best immunity level.

Covid-19 is a global pandemic which currently becomes the world's concern. There were various studies to overcome the problem of high mortality due to the infection of the SARS Cov-2 virus. Vaccine is one of the solutions to lessen the global burden. Vaccine is expected to produce immunity for community health. The scientists are investigating the effectiveness of the vaccine. Some vaccinated Covid-19 patients can still be infected by the virus even with moderate or severe symptoms. Chest x-ray is one of the modalities to see clinical progress. This study aims to compare the chest x-ray of hospitalized patients who have been vaccinated and those who have not. There were two groups of 60 hospitalized patients aged 18-50 years, namely the vaccinated and non-vaccinated groups. Patients with type II diabetes mellitus, hypertension, heart failure or autoimmune disease were excluded from the sample. Assessment of severity level through chest x-ray was done by calculating Brixia score. The calculation of Brixia score was carried out by three researchers having parallel levels of competence with a tolerance of differences of less than 5%. Bivariate analysis was conducted to compare Brixia scores between the two groups. A total of 8 male (26,7%) and 22 female (73,3%) patients in the vaccinated group had lower Brixia scores with a mean score of 1,53 + 1,27 compared to 30 patients (60% male, 40% female) in the non-vaccinated group with a mean of 6,0 + 2,61 and p value of 0.001. There were no death cases in all samples. There is a difference in the average Brixia score with a lower tendency of severity in the vaccinated group compared to the non-vaccinated group. Vaccine is useful for raising immunity so that it avoids severe conditions due to the SARS Cov-2 virus infection

(1) Background: From the recent variants of concern of the SARS-CoV-2 virus, in which the delta variant generated more negative outcomes than the alpha, we hypothesized that lung involvement, clinical condition deterioration and blood alterations were also more severe in autumn infection, when the delta variant dominated (compared with spring infections, when the alpha variant dominated), in severely infected pregnant patients. (2) Methods: In a prospective study, all pregnant patients admitted to the ICU of the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection—spring group (n = 11) and autumn group (n = 7)—between 1 January 2021 and 1 December 2021 were included. Brixia scores were calculated for every patient: A score, upon admittance; H score, the highest score throughout hospitalization; and E score, at the end of hospitalization. For each day of Brixia A, H or E score, the qSOFA (quick sepsis-related organ failure assessment) score was calculated, and the blood values were also considered. (3) Results: Brixia E score, C-reactive protein, GGT and LDH were much higher, while neutrophil count was much lower in autumn compared with spring critical-form pregnant patients. (4) Conclusions: the autumn infection generated more dramatic alterations than the spring infection in pregnant patients with critical forms of COVID-19. Larger studies with more numerous participants are required to confirm these results.