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1. Artificial intelligence in clinical care amidst COVID-19 pandemic: A systematic review

Author

Konstantina S. Nikita, Eleni S. Adamidi, and Konstantinos Mitsis

Subjects
LR, Logistic Regression, APTT, Activated Partial Thromboplastin Time, DNN, Deep Neural Networks, GNB, Gaussian Naïve Bayes, RSV, Respiratory Syncytial Virus, SVM, Support Vector Machine, Review, Disease, Biochemistry, WBC, White Blood Cell count, 0302 clinical medicine, Multimodal data, DLC, Density Lipoprotein Cholesterol, Medicine, CPP, COVID-19 Positive Patients, Nadam optimizer, Nesterov Accelerated Adaptive Moment optimizer, 0303 health sciences, CRT, Classification and Regression Decision Tree, Prognosis, LDLC, Low Density Lipoprotein Cholesterol, CRP, C-Reactive Protein, GFS, Gradient boosted feature selection, LDA, Linear Discriminant Analysis, Systematic review, ADA, Adenosine Deaminase, ML, Machine Learning, CNN, Convolutional Neural Networks, 030220 oncology & carcinogenesis, GGT, Glutamyl Transpeptidase, RBP, Retinol Binding Protein, RF, Random Forest, NLP, Natural Language Processing, INR, International Normalized Ratio, LASSO, Least Absolute Shrinkage and Selection Operator, FCV, Fold Cross Validation, SEN, Sensitivity, Biophysics, ABG, Arterial Blood Gas, SRLSR, Sparse Rescaled Linear Square Regression, RBF, Radial Basis Function, AI, Artificial Intelligence, 03 medical and health sciences, PWD, Platelet Distribution Width, RFE, Recursive Feature Elimination, Genetics, OB, Occult Blood test, Paco2, Arterial Carbondioxide Tension, MLP, MultiLayer Perceptron, DL, Deep Learning, ED, Emergency Department, Guideline, CI, Confidence Interval, ANN, Artificial Neural Networks, GFR, Glomerular Filtration Rate, MPV, Mean Platelet Volume, TBA, Total Bile Acid, Adaboost, Adaptive Boosting, TP248.13-248.65, MCV, Mean corpuscular volume, ET, Extra Trees, Artificial intelligence, L1LR, L1 Regularized Logistic Regression, MCHC, Mean Corpuscular Hemoglobin Concentration, ARMED, Attribute Reduction with Multi-objective Decomposition Ensemble optimizer, CK-MB, Creatine Kinase isoenzyme, LSTM, Long-Short Term Memory, FL, Federated Learning, PCT, Thrombocytocrit, Structural Biology, Pandemic, Diagnosis, TTS, Training Test Split, HDLC, High Density Lipoprotein Cholesterol, PPV, Positive Predictive Values, k-NN, K-Nearest Neighbor, Computer Science Applications, BUN, Blood Urea Nitrogen, FiO2, Fraction of Inspiration O2, RBC, Red Blood Cell, SG, Specific Gravity, GDCNN, Genetic Deep Learning Convolutional Neural Network, Screening, XGB, eXtreme Gradient Boost, Apol B, Apolipoprotein B, GBDT, Gradient Boost Decision Tree, PaO2, Arterial Oxygen Tension, Biotechnology, NB, Naïve Bayes, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SMOTE, Synthetic Minority Oversampling Technique, Apol AI, Apolipoprotein AI, CoxPH, Cox Proportional Hazards, Acc, Accuracy, AUC, Area Under the Curve, ComputingMethodologies_COMPUTERGRAPHICS, 030304 developmental biology, ESR, Erythrocyte Sedimentation Rate, LDH, Lactate Dehydrogenase, BNB, Bernoulli Naïve Bayes, business.industry, RDW, Red blood cell Distribution Width, NPV, Negative Predictive Values, GBM light, Gradient Boosting Machine light, DCNN, Deep Convolutional Neural Networks, SPE, Specificity, COVID-19, Inception Resnet, Inception Residual Neural Network, DT, Decision Tree, MRMR, Maximum Relevance Minimum Redundancy, SaO2, Arterial Oxygen saturation, business, Predictive modelling
Abstract

Graphical abstract, The worldwide health crisis caused by the SARS-Cov-2 virus has resulted in>3 million deaths so far. Improving early screening, diagnosis and prognosis of the disease are critical steps in assisting healthcare professionals to save lives during this pandemic. Since WHO declared the COVID-19 outbreak as a pandemic, several studies have been conducted using Artificial Intelligence techniques to optimize these steps on clinical settings in terms of quality, accuracy and most importantly time. The objective of this study is to conduct a systematic literature review on published and preprint reports of Artificial Intelligence models developed and validated for screening, diagnosis and prognosis of the coronavirus disease 2019. We included 101 studies, published from January 1st, 2020 to December 30th, 2020, that developed AI prediction models which can be applied in the clinical setting. We identified in total 14 models for screening, 38 diagnostic models for detecting COVID-19 and 50 prognostic models for predicting ICU need, ventilator need, mortality risk, severity assessment or hospital length stay. Moreover, 43 studies were based on medical imaging and 58 studies on the use of clinical parameters, laboratory results or demographic features. Several heterogeneous predictors derived from multimodal data were identified. Analysis of these multimodal data, captured from various sources, in terms of prominence for each category of the included studies, was performed. Finally, Risk of Bias (RoB) analysis was also conducted to examine the applicability of the included studies in the clinical setting and assist healthcare providers, guideline developers, and policymakers.

Published
2021

2. Eleven routine clinical features predict COVID-19 severity uncovered by machine learning of longitudinal measurements

Author

Shigao Huang, Xindong Sun, Chunyu Tu, Haihong Zhao, Xuejun Dong, Baofu Chen, Lu Li, Hai Yang, Xiaomai Wu, Liang Yue, Bo Shen, Fangfei Zhang, Minfei Peng, Dongqing Lv, Luxiao Hong, Stan Z. Li, Tiannan Guo, Shiyong Chen, Hongguo Zhu, Qiushi Zhang, Zelin Zang, Chao Zhang, Yaoting Sun, Jing Wang, Yi Zhu, Jiaqin Xu, Zhehan Zhou, Junbo Liang, Weigang Ge, Jun Li, Hao Chen, Minghui Li, Haixiao Chen, and Kai Zhou

Subjects
Declaration, LOESS, locally estimated scatterplot smoothing, AST, aspartate aminotransferase, Research purpose, computer.software_genre, Biochemistry, AUC, area under the curve, 0302 clinical medicine, Informed consent, Structural Biology, SHAP, SHapley Additive exPlanations, GA, genetic algorithm, Medicine, Severity prediction, Predictive dynamics, TT, thrombin time, 0303 health sciences, LDH, lactate dehydrogenase, eGFR, estimated glomerular filtration rate, ROC, receiver operating characteristics, Subject (documents), Predictive value, PCT, procalcitonin, CT, computed tomography, Test (assessment), Computer Science Applications, NPV, negative predictive value, GGT, gamma glutamyl transpeptidase, 030220 oncology & carcinogenesis, Cohort, CRP, C-reactive protein, LOS, length of stay, Biotechnology, NETs, neutrophil extracellular traps, LAC, lactate, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Biophysics, Feature selection, Machine learning, Article, Mg, magnesium, 03 medical and health sciences, Text mining, Routine clinical test, Genetics, APTT, activated partial thromboplastin time, Normal range, ComputingMethodologies_COMPUTERGRAPHICS, 030304 developmental biology, HIS, hospital information system, ESR, erythrocyte sedimentation rate, SVM, support vector machine, SARS-CoV-2, business.industry, Disease progression, BASO#, basophil counts, COVID-19, Retrospective cohort study, CFDA, China Food and Drug Administration, PPV, positive predictive value, RT-PCR, reverse transcriptase -polymerase chain reaction, Family medicine, SaO2, oxygen saturation, ABG, arterial blood gas, Longitudinal dynamics, Artificial intelligence, business, computer, CK, creatine kinase, Medical ethics, TP248.13-248.65
Abstract

Graphical abstract, Severity prediction of COVID-19 remains one of the major clinical challenges for the ongoing pandemic. Here, we have recruited a 144 COVID-19 patient cohort, resulting in a data matrix containing 3,065 readings for 124 types of measurements over 52 days. A machine learning model was established to predict the disease progression based on the cohort consisting of training, validation, and internal test sets. A panel of eleven routine clinical factors constructed a classifier for COVID-19 severity prediction, achieving accuracy of over 98% in the discovery set. Validation of the model in an independent cohort containing 25 patients achieved accuracy of 80%. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.70, 0.99, 0.93, and 0.93, respectively. Our model captured predictive dynamics of lactate dehydrogenase (LDH) and creatine kinase (CK) while their levels were in the normal range. This model is accessible at https://www.guomics.com/covidAI/ for research purpose.

Published
2021
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3. Adult patient living 32 years with postduodenal remnant small bowel of only 35 cm in jejunocolic anastomosis type II weaned off parenteral nutrition. A case report

Author

Hassan Sabra, Mersad Alimoradi, Marwan M. Haddad, Georges Chahine, Etienne El-Helou, and Jessica Naccour

Subjects
medicine.medical_specialty, Abdominal pain, ER, emergency room, Intestinal adaptation, Physical examination, Anastomosis, Enteral administration, Article, IF, intestinal failure, 03 medical and health sciences, 0302 clinical medicine, Abdominal guarding, Case report, medicine, Bowel length, SBS, short bowel syndrome, medicine.diagnostic_test, BaFT, barium follow-through, business.industry, Short bowel syndrome, medicine.disease, Small bowel, Parenteral nutrition, ICU, intensive care unit, Surgery, CT, computed tomography, Mesenteric ischemia, 030220 oncology & carcinogenesis, DVT, deep venous thrombosis, CRP, C-reactive protein, TSBL, total small bowel length, ABG, arterial blood gas, 030211 gastroenterology & hepatology, medicine.symptom, VS, versus, business, IV, intravenous
Abstract

Highlights • The small intestine is an essential constituent of the digestive system and plays a major role in the absorption of nutrients. • Acute mesenteric ischemia remains an emergency case. • Failure to adapt and the inadequate nutritional supply result in Short bowel syndrome. • A minimal indispensable length is required for nutritional autonomy. • Parenteral Nutrition still presents a pertinent problem of complications, charges and impairment in quality of life., Introduction The small bowel is an essential organ for maintaining adequate nutrition. Decrease in length could be associated with malnutrition and may require that the patient receives parenteral nutritional support. We report a case of a 59-year-old man who survived32 years with a short bowel of 35 cm length without any parenteral nutrition. Case presentation A 59-year-old gentleman, with a history of hypercoagulable state, presented for severe abdominal pain and obstipation of one day's duration. Upon presentation, the patient was hemodynamically unstable, with abdominal guarding and tenderness upon physical examination. Laboratory studies showed metabolic acidosis with leukocytosis and electrolyte disturbances, and an abdominal CT scan showed thickening of the sigmoid and multiple air-fluid levels. The patient was operated urgently for suspicion of mesenteric ischemia, however, he was found intraoperatively to have a very short dilated small bowel with jejunotransverse anastomosis. Discussion The necessity for surgical resection of the small bowel can arise for a sum of reasons. However, the removal of a big amount of small bowel may not be adaptive and appropriate digestion will no more be possible. In the aftermath of the resection, patients require parenteral nutrition for a certain period after which they may switch to enteral and oral nutrition, and subsequently intestinal adaptation by thickening and growth of the remaining intestinal villi. Conclusion Patients with a short bowel, particularly those surgically removed, can survive even with a very short remaining bowel length, as a result of intestinal adaptation, nutrition enhancement, and elimination of parenteral nutrition.

Published
2020

4. Lung function and symptoms in post-COVID-19 patients: a single-center experience

Author

Nicola, Mumoli, Aldo, Bonaventura, Alessandra, Colombo, Alessandra, Vecchié, Marco, Cei, José, Vitale, Luca, Pavan, Antonino, Mazzone, and Francesco, Dentali

Subjects
chest CT scan, CVD, cardiovascular disease, Article, PaO2, arterial partial pressure of oxygen, PaCO2, arterial partial pressure of carbon dioxide, V/Q, ventilation/perfusion ratio, ARDS, acute respiratory distress syndrome, IQR, interquartile range, COVID-19, coronavirus disease 2019, SARS-CoV-2, DOE, dyspnea on exertion, COVID-19, SpO2, peripheral capillary oxygen saturation, respiratory tract diseases, CT, computed tomography, PFT, pulmonary function test, hypocapnia, GGO, ground-glass opacity, inflammation, CRP, C-reactive protein, ABG, arterial blood gas, CPAP, continuous positive airway pressure, PaO2/FiO2, ratio of arterial partial pressure of oxygen to fractional inspired oxygen, STROBE, Strengthening the Reporting of Observational Studies in Epidemiology, HRCT, high-resolution computed tomography, SD, standard deviation, SARS-CoV-2, severe acute respiratory syndrome coronavirus-2
Abstract

Objective To address the lack of information about clinical sequelae of coronavirus disease 2019 (COVID-19). Patients and Methods Previously hospitalized COVID-19 patients who were attending the outpatient clinic for post-COVID-19 patients (ASST Ovest Milanese, Magenta, Italy) were included in this retrospective study. They underwent blood draw for complete blood count, C-reactive protein (CRP), ferritin, D-dimer, and arterial blood gas analysis (ABG) and chest high-resolution computed tomography (HRCT) scan. The primary endpoint was the assessment of blood gas exchanges after 3 months. Other endpoints included the assessment of symptoms and chest HRCT scan abnormalities and changes in inflammatory biomarkers after 3 months from hospital admission. Results Eighty-eight patients (men 73.9%) were included. Admission arterial ABG analysis showed hypoxia and hypocapnia and a PaO2/FiO2 of 271.4 (238-304.7) mmHg, that greatly improved after 3 months (426.19 [395.24-461.90] mmHg, P

Published
2021

5. Variation in Early Management Practices in Moderate-to-Severe Acute Respiratory Distress Syndrome in the United States

Author

Nida, Qadir, Raquel R, Bartz, Mary L, Cooter, Catherine L, Hough, Michael J, Lanspa, Valerie M, Banner-Goodspeed, Jen-Ting, Chen, Shewit, Giovanni, Dina, Gomaa, Michael W, Sjoding, Negin, Hajizadeh, Jordan, Komisarow, Abhijit, Duggal, Ashish K, Khanna, Rahul, Kashyap, Akram, Khan, Steven Y, Chang, Joseph E, Tonna, Harry L, Anderson, Janice M, Liebler, Jarrod M, Mosier, Peter E, Morris, Alissa, Genthon, Irene K, Louh, Mark, Tidswell, R Scott, Stephens, Annette M, Esper, David J, Dries, Anthony, Martinez, Kraftin E, Schreyer, William, Bender, Anupama, Tiwari, Pramod K, Guru, Sinan, Hanna, Michelle N, Gong, and Pauline K, Park

Subjects
Male, ESRD, End stage renal disease, Vasodilator Agents, Ventilator-Induced Lung Injury, AIDS, Acquired immunodeficiency syndrome, Severity of Illness Index, US, United States, corticosteroids, Cohort Studies, Positive-Pressure Respiration, FiO2, Fraction of inspired oxygen, LPV, Lung protective ventilation, SOFA, Sequential organ failure assessment, SMR, Standardized mortality ratio, Hospital Mortality, Practice Patterns, Physicians', ABG, Arterial blood gas, Original Research, COVID-19, Coronavirus disease 2019, Respiratory Distress Syndrome, Acute respiratory distress syndrome, ARDS, Acute Respiratory Distress Syndrome, Middle Aged, prone positioning, ICU, Intensive care unit, Editorial, ECMO, Extracorporeal membrane oxygenation, Practice Guidelines as Topic, HD, Hemodialysis, Female, PVD, Pulmonary vasodilator, Guideline Adherence, PBW, Predicted body weight, Adult, UAB, Unassisted breathing, SAGE = Severe ARDS, Generating Evidence, BMI, Body mass index, mechanical ventilation, Patient Positioning, PEEP, Positive end-expiratory pressure, neuromuscular blockade, Early Medical Intervention, Prone Position, Humans, Glucocorticoids, VFD, Ventilator-free day, Aged, Quality of Health Care, CHF, Congestive heart failure, Tx, Transfusion, VT, Tidal volume, IQR, Interquartile range, extracorporeal membrane oxygenation, Respiration, Artificial, United States, CRF, Case report form, PaO2, Partial pressure of arterial oxygen, iNO, Inhaled nitric oxide
Abstract

Background While specific interventions have previously demonstrated benefit in patients with the Acute Respiratory Distress Syndrome (ARDS), use of these interventions is inconsistent, and patient mortality remains high. The impact of variability in center management practices on ARDS mortality rates remains unknown. Research Question What is the impact of treatment variability on mortality in patients with moderate-to-severe ARDS in the United States (US)? Study Design and Methods We conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and PaO2/FiO2< 150 on positive end expiratory pressure (PEEP) > 5 cm H2O, who were admitted to 29 US centers between October 1, 2016 and April 30, 2017. The primary outcome was 28-day in-hospital mortality. Center variation in ventilator management, adjunctive therapy use, and mortality were also assessed. Results A total of 2,466 patients were enrolled. Median baseline PaO2/FiO2 was 105 (IQR 78.0, 129.0). In-hospital 28-day mortality was 40.7%. Initial adherence to lung protective ventilation (tidal volume < 6.5 ml/kg predicted body weight, plateau pressure and/or peak inspiratory pressure < 30mm H2O) was 31.4% and varied between centers (0%-65%), as did rates of adjunctive therapy use (27.1%-96.4%), types of modalities used (neuromuscular blockade, prone positioning, systemic steroids, pulmonary vasodilators, and extracorporeal support), and mortality (16.7-73.3%). Center standardized mortality ratios (SMRs), calculated using baseline patient-level characteristics to derive expected mortality rate, ranged from 0.33 to 1.98. Of the treatment-level factors explored, only center adherence to early lung protective ventilation (LPV) was correlated with SMR. Interpretation Substantial center-to-center variability exists in ARDS management, suggesting that further opportunities for improving ARDS outcomes exist. Early adherence to LPV was associated with lower center mortality and may be a surrogate for overall quality of care processes. Future collaboration is needed to identify additional treatment-level factors influencing center-level outcomes. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT03021824

Published
2021

6. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae

Author

Michael Dreher, Christian Cornelissen, Ingmar Bergs, Paul Balfanz, Bojan Hartmann, Annegret Müller, Ayham Daher, Tobias Müller, Nikolaus Marx, and Dirk Müller-Wieland

Subjects
Lung Diseases, Male, medicine.medical_treatment, VTE, venous thromboembolism, Anxiety, Severity of Illness Index, FEV1, forced expiratory volume in 1 s, Pulmonary function testing, 0302 clinical medicine, Quality of life, DLCO, PaO2, partial pressure of oxygen, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Depression (differential diagnoses), Fatigue, COVID-19, coronavirus disease 2019, Depression, GAD-7, Generalized Anxiety Disorder 7, PHQ-9, Patient Health Questionnaire 9, Middle Aged, Patient Discharge, Respiratory Function Tests, Echocardiography, Anesthesia, Female, Pulmonary and Respiratory Medicine, Heart Diseases, SpO2, oxygen saturation on pulse oximeter, Walk Test, PFTs, pulmonary function tests, SARS-CoV-2, severe acute respiratory syndrome coronavirus 2, Article, 03 medical and health sciences, FEV1/FVC ratio, Thromboembolism, Severity of illness, medicine, Humans, PaCO2, partial pressure of carbon dioxide, DLco, diffusing capacity for carbon monoxide, Aged, Plethysmography, Whole Body, Mechanical ventilation, V/Q scan, ventilation/perfusion scan, business.industry, SARS-CoV-2, 6MWT, 6-min walk test, TLC, total lung capacity, COVID-19, Follow up, IQR, Interquartile range, Dyspnea, Pulmonary functions, 030228 respiratory system, Cough, SGRQ, St. George's Respiratory Questionnaire, FVC, forced vital capacity, VC, vital capacity, Quality of Life, ABG, arterial blood gas, Pulmonary Diffusing Capacity, Blood Gas Analysis, business, Follow-Up Studies
Abstract

Background Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID-19 after recovery from the acute disease are unknown. Material and methods Hospitalized COVID-19 patients not requiring mechanical ventilation were included and followed 6 weeks after discharge. Body plethysmography, lung diffusion capacity (DLco), blood gas analysis (ABG), 6-min walk test (6MWT), echocardiography, and laboratory tests were performed. Quality of life (QoL), depression, and anxiety were assessed using validated questionnaires. Results 33 patients with severe disease were included. Patients were discharged without prophylactic anticoagulation. At follow-up there were no thromboembolic complications in any patient. 11 patients (33%) had dyspnea, 11 (33%) had cough, and 15 (45%) suffered from symptoms of fatigue. Pulmonary function tests including ABG did not reveal any limitations (TLC: median = 94% of predicted [IQR:85–105]; VC: 93% [78–101]; FEV1: 95% [72–103]; FEV1/FVC 79% [76–85]; PaO2: 72 mmHg [67–79]; PaCO2: 38 mmHg (Xu et al., 2020; Tian et al., 2020; Huang et al., 2020; Ware, 2013) [35-38], except for slightly reduced DLco (77% [69–95]). There were no echocardiographic impairments. 6MWT distance was reduced in most patients without oxygen desaturation. According to standardized questionnaires, patients suffered from reduced QoL, mainly due to decreased mobility (SGRQ activity score: 54 [19–78]). There were no indicators for depression or anxiety (PHQ-9: 7 [4], [5], [6], [7], [8], [9], [10], [11]( Mizumoto et al., 2020; Kimball et al., 2020; Sakurai et al., 2020; Tabata et al., 2020; Wu and McGoogan, 2020; Richardson et al., 2020; Lewnard et al., 2020; Wang et al., 2020) [4], [5], [6], [7], [8], [9], [10], [11]4-11, GAD-7: 4 [1], [2], [3], [4], [5], [6], [7], [8], [9]( Lu et al., 2020; Zhou et al., 2020; Zhu et al., 2020; Mizumoto et al., 2020; Kimball et al., 2020; Sakurai et al., 2020; Tabata et al., 2020; Wu and McGoogan, 2020; Richardson et al., 2020) [1], [2], [3], [4], [5], [6], [7], [8], [9]1-9, respectively). Conclusions Hospitalized patients with severe COVID-19, who did not require mechanical ventilation, are unlikely to develop pulmonary long-term impairments, thromboembolic complications or cardiac impairments after discharge but frequently suffer from symptoms of fatigue., Highlights • Pulmonary impairment in hospitalized COVID-19 patients seems to be transient. • COVID-19 patients are unlikely to develop pulmonary impairments on follow-up. • Patients with COVID-19 often suffer from chronic fatigue following acute disease. • Exercise capacity is reduced 6 weeks after COVID-19.

Published
2020

7. Pharmacological safety of Plinia cauliflora (Mart.) Kausel in rabbits

Author

Paulo Vitor Moreira Romão, Arquimedes Gasparotto Junior, Denise Brentan Silva, Samara Requena Nocchi, Emerson Luiz Botelho Lourenço, Carlos Calixto dos Santos, Francielly Mourão Gasparotto, Lucas Pires Guarnier, and Rhanany Alan Calloi Palozi

Subjects
LL, Left leg, LC-DAD-MS, Liquid chromatography coupled to a diode array detector and mass spectrometer, ECG, Electrocardiography, Myrtaceae, Health, Toxicology and Mutagenesis, Irwin test, MAP, Mean arterial pressure, PO2, Partial pressure of oxygen, Plinia cauliflora, 010501 environmental sciences, Pharmacology, Cardiovascular, Toxicology, 01 natural sciences, chemistry.chemical_compound, 0302 clinical medicine, SO2, Level of hemoglobin-saturation by oxygen, EEPC, Ethanol extract of Plinia cauliflora, Medicine, Gallic acid, Respiratory system, ABG, Arterial blood gas, GAE, Gallic acid equivalent, DBP, Diastolic blood pressure, CNS, Central nervous system, HHb, Deoxyhemoglobin, Safety pharmacology, ctCO2 (B), Concentration of total carbon dioxide of whole blood, RA, Right arm, ANOVA, One-way analysis of variance, P50, Half of the maximum hemoglobin saturation, cHCO3, Bicarbonate concentration, Respiratory, Arterial blood, pH, Potential of hydrogen, ctCO2 (P), Concentration of total carbon dioxide in plasma, Na₂CO₃, Sodium carbonate, Ellagic acid, S.E.M, Standard error of the mean, food.ingredient, Na+, Sodium, Respiratory rate, Cl, Chloride, UFLC, Ultra fast liquid chromatograph, O2Hb, Oxyhemoglobin, Article, SBP, Systolic blood pressure, 03 medical and health sciences, food, BE, Base Excess, lcsh:RA1190-1270, RL, Right leg, Ca++, Calcium, ctO2, Concentration of total oxygen, ComputingMethodologies_COMPUTERGRAPHICS, PCO2, Partial pressure of carbon dioxide, lcsh:Toxicology. Poisons, 0105 earth and related environmental sciences, Hct, Hematocrit, business.industry, K+, Potassium, ASE, Accelerated solvent extraction, LA, Left arm, Blood pressure, chemistry, BEecf, Base excess in the extracellular fluid compartment, BB, Buffer Base, business, tHb, Hemoglobin, H+, Hydrogen ion dissociated, 030217 neurology & neurosurgery
Abstract

Graphical abstract, Highlights • Fruit peels of Plinia cauliflora are widely used in Brazilian traditional medicine. • No studies have proved the safety of its pharmacological effects. • We assessed the safety pharmacology of P. cauliflora extract (EEPC) in rabbits. • EEPC did not cause any significant changes in several physiological systems. • These data provide important safety data for its clinical use., Fruit peels of Plinia cauliflora (Mart.) Kausel are widely used in Brazilian traditional medicine, but no studies have proved the safety of its pharmacological effects on the respiratory, cardiovascular, and central nervous systems. The present study assessed the safety pharmacology of P. cauliflora in New Zealand rabbits. First, an ethanol extract (EEPC) was selected for the pharmacological experiments and chemical characterization. Then, different groups of rabbits were orally treated with EEPC (200 and 2000 mg/kg) or vehicle. Acute behavioral and physiological alterations in the modified Irwin test, respiratory rate, arterial blood gas, and various cardiovascular parameters (i.e., heart rate, blood pressure, and electrocardiography) were evaluated. The main secondary metabolites that were identified in EEPC were ellagic acid, gallic acid, O-deoxyhexosyl quercetin, and the anthocyanin O-hexosyl cyanidin. No significant behavioral or physiological changes were observed in any of the groups. None of the doses of EEPC affected respiratory rate or arterial blood gas, with no changes on blood pressure or electrocardiographic parameters. The present study showed that EEPC did not cause any significant changes in respiratory, cardiovascular, or central nervous system function. These data provide scientific evidence of the effects of this species and important safety data for its clinical use.

Published
2019
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8. Lung Ultrasound in Severe COVID-19 Pneumonia in the Sub-Intensive Care Unit: Beyond the Diagnostic Purpose

Author

Elisa Paolucci, Giovanni Magalotti, Luca Mattei, Chiara Praticò, Elena Magnani, Nicoletta Giacalone, Beniamino Praticò, and Maria Cristina Zani

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Case Report, ABG, Arterial Blood Gas, law.invention, 03 medical and health sciences, 0302 clinical medicine, HRTC, High-Resolution Computed Tomography, law, medicine, PEEP, Positive End Expiratory Pressure, Severe COVID-19 disease, P/F, ratio between arterial oxygen partial pressure (PaO2) and inspired oxygen fraction (FiO2), CPAP, Positive Airway Pressure, Stage (cooking), Intensive care medicine, COVID-19, coronavirus disease 2019, lcsh:RC705-779, Lung, Lung ultrasound, LUS, Lung Ultra Sound, business.industry, Pneumonia, lcsh:Diseases of the respiratory system, medicine.disease, Intensive care unit, respiratory tract diseases, medicine.anatomical_structure, 030228 respiratory system, 030220 oncology & carcinogenesis, Non-invasive ventilation, business
Abstract

Lung Ultra-Sound (LUS) can be very helpful at the diagnostic stage of COVID-19 pneumonia. We describe four clinical cases that summarize other helpful employment of LUS during the management of severe COVID-19 pneumonia with lung failure. LUS, together with clinical signs and arterial blood gases values, assists in guiding prompt clinical management of potential worsening of conditions. The monitoring of size and signs of aeration of consolidations is an important adjuvant in evaluating clinical evolution. The monitoring of LUS patterns can guide the management of non-invasive ventilation as well as the timing of CPAP weaning.

Published
2020

9. The Minnesota Mobile Extracorporeal Cardiopulmonary Resuscitation Consortium for Treatment of Out-of-Hospital Refractory Ventricular Fibrillation: Program Description, Performance, and Outcomes

Author

Casey Woster, Brandon Trigger, Keith Wesley, Jakub Tolar, Jason A. Bartos, Kari B. Haley, Lucinda Hodgson, Marc Conterato, Nik Vuljaj, Ralph J. Frascone, Demetris Yannopoulos, Aaron M. Burnett, Tom P. Aufderheide, Charles A. Bruen, Nicholas Simpson, Kim Harkins, Charles Lick, Joanna Moore, Marinos Kosmopoulos, Kevin Sipprell, Bjorn K. Peterson, and Kealy R. Ham

Subjects
medicine.medical_specialty, Resuscitation, medicine.medical_treatment, Return of spontaneous circulation, SEM, standard error of the mean, Ventricular tachycardia, 01 natural sciences, PaO2, arterial partial pressure of oxygen, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, medicine, Emergency medical services, Extracorporeal membrane oxygenation, OHCA, out-of-hospital cardiac arrest, Extracorporeal cardiopulmonary resuscitation, CPC, Cerebral Performance Category, 030212 general & internal medicine, Cardiopulmonary resuscitation, 0101 mathematics, CPR, cardiopulmonary resuscitation, ROSC, return of spontaneous circulation, business.industry, 010102 general mathematics, Advanced cardiac life support, CCL, cardiac catheterization laboratory, General Medicine, Emergency department, Cardiac arrest, medicine.disease, Intensive care unit, EMS, emergency medical services, Sudden cardiac death, VF/VT, ventricular fibrillation/ventricular tachycardia, Ventricular fibrillation, Emergency medicine, Refractory ventricular fibrillation, ABG, arterial blood gas, ACLS, advanced cardiac life support, business, ECMO, extracorporeal membrane oxygenation, Research Paper
Abstract

Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital (OH) cardiac arrest (CA). Methods: This observational cohort study analyzed 63 consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium’s ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University CA System (LUCAS™), and 5) estimated transfer time of < 30 minutes. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit. Results: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (92%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43%) were discharged from the hospital with CPC 1 or 2. Conclusions: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, good functionally favorable survival rates, safety, and appears potentially generalizable. Funding Statement: This community implementation program was made possible by a grant from the Leona M. and Harry B. Helmsley Charitable Trust Declaration of Interests: None of the authors have any financial or personal relationships with people or organizations that could have inappropriately influenced this study. Ethics Approval Statement: The Institutional Review Board at the University of Minnesota approved this study (No. 1703M11301) with waiver of informed consent.

Published
2020
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10. Hepatopulmonary syndrome.

Author

Raevens S, Boret M, and Fallon MB

Abstract

Hepatopulmonary syndrome (HPS) is a pulmonary vascular complication of liver disease, which adversely affects prognosis. The disease is characterised by intrapulmonary vascular dilatations and shunts, resulting in impaired gas exchange. A complex interaction between the liver, the gut and the lungs, predominately impacting pulmonary endothelial cells, immune cells and respiratory epithelial cells, is responsible for the development of typical pulmonary alterations seen in HPS. Liver transplantation is the only therapeutic option and generally reverses HPS. Since the implementation of the model for end-stage liver disease (MELD) standard exception policy, outcomes in patients with HPS have been significantly better than they were in the pre-MELD era. This review summarises current knowledge and highlights what's new regarding the diagnosis and management of HPS, and our understanding of pathogenesis based on experimental models and translational studies., Competing Interests: The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2022 The Authors.)

Published
2022
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11. A fulminant pneumonia due to Mycoplasma pneumoniae - Case report and literature review.

Author

Unni A, Hidayathulla PK, Kavitha KP, Paloth MN, Nair PR, Kumar P J, and Radhakrishnan C

Abstract

Fulminant pneumonia due to Mycoplasma pneumoniae [MP] is quite rare even though there is a high prevalence of Mycoplasma species infection in the general population. We report a case of an atypical pneumonia with Acute Respiratory Distress Syndrome (ARDS) due to Mycoplasma pneumoniae in a young female and the clinical challenges encountered along with the current literature review., Competing Interests: No Conflicts of interests., (© 2022 The Authors.)

Published
2022
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12. Severe COVID-19 during pregnancy treated with pulse corticosteroid therapy and mid-trimester termination: A case report.

Author

Bui TN, Huynh NM, Do-Tran NH, Ngo HA, Tran H, Nguyen NT, Pham TT, Le KD, and Nguyen TA

Abstract

Background: At the early stage of the pandemic, severe COVID-19 was thought to be rare among pregnant women. However, cumulating data showed that gestational state is a risk factor for severe pneumonia, particularly due to the hyperinflammatory state. Recent reports suggested the efficacy of pulse corticosteroids in stopping the cytokine storm in people infected with SARS-CoV-2, but limited data exists regarding its use in pregnant women. Moreover, pregnancy termination is a treatment option in this population, but it has been reported mainly in the third trimester and rarely in the second trimester., Case Presentation: A 37-year-old woman infected with SARS-CoV-2 at 23 weeks of gestation presented with fatigue and dyspnea but soon deteriorated to severely acute respiratory failure and cytokine storm requiring mechanical ventilation combined with hemodialysis just one day after hospitalization. Low-dose corticosteroids and antibiotics were initiated, followed by antiviral therapy, anticoagulant and high-dose corticosteroid therapy. On hospital day 3, a decision to terminate her pregnancy was made; termination led to significant improvement in her clinical condition and a gradual decrease in demand for oxygen supplementation as well as the corticosteroid dose. She was discharged two weeks after admission., Conclusions: Due to the specific immune response, pregnant women with COVID-19 may differ from others in their clinical presentation, especially the probability of classic acute respiratory distress syndrome (ARDS). This report provides evidence related to the efficacy of pulse corticosteroids on this group and the influence of the mid-trimester termination on recovery., (© 2022 The Authors.)

Published
2022
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13. Lung Function and Symptoms in Post-COVID-19 Patients: A Single-Center Experience.

Author

Mumoli N, Bonaventura A, Colombo A, Vecchié A, Cei M, Vitale J, Pavan L, Mazzone A, and Dentali F

Abstract

Objective: To address the lack of information about clinical sequelae of coronavirus disease 2019 (COVID-19)., Patients and Methods: Previously hospitalized COVID-19 patients who were attending the outpatient clinic for post-COVID-19 patients (ASST Ovest Milanese, Magenta, Italy) were included in this retrospective study. They underwent blood draw for complete blood count, C-reactive protein, ferritin, D-dimer, and arterial blood gas analysis and chest high-resolution computed tomography (HRCT) scan. The primary endpoint was the assessment of blood gas exchanges after 3 months. Other endpoints included the assessment of symptoms and chest HRCT scan abnormalities and changes in inflammatory biomarkers after 3 months from hospital admission., Results: Eighty-eight patients (n = 65 men; 73.9%) were included. Admission arterial blood gas analysis showed hypoxia and hypocapnia and an arterial partial pressure of oxygen/fractional inspired oxygen ratio of 271.4 (interquartile range [IQR]: 238-304.7) mm Hg that greatly improved after 3 months (426.19 [IQR: 395.2-461.9] mm Hg, P <.001). Forty percent of patients were still hypocapnic after 3 months. Inflammatory biomarkers dramatically improved after 3 months from hospitalization. Fever, resting dyspnea, and cough were common at hospital admission and improved after 3 months, when dyspnea on exertion and arthralgias arose. On chest HRCT scan, more than half of individuals still presented with interstitial involvement after 3 months. Positive correlations between the interstitial pattern at 3 months and dyspnea on admission were found. C-reactive protein at admission was positively associated with the presence of interstitial involvement at follow-up. The persistence of cough was associated with presence of bronchiectasis and consolidation on follow-up chest HRCT scan., Conclusion: Whereas inflammatory biomarker levels normalized after 3 months, signs of lung damage persisted for a longer period. These findings support the need for implementing post-COVID-19 outpatient clinics to closely follow-up COVID-19 patients after hospitalization., (© 2021 THE AUTHORS.)

Published
2021
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14. A case of severe acute exacerbation of Yokkaichi asthma treated with a vibrating mesh nebulizer

Author

Masahiko Taniguchi, Takeshi Yano, Tetsu Yonaha, Tomohiro Koshida, Koutaro Hidaka, Hiroshi Matsuoka, Isao Tsuneyoshi, and Masumi Nagahama

Subjects
0301 basic medicine, Pulmonary and Respiratory Medicine, Exacerbation, Procaterol, medicine.medical_treatment, Air pollution, Case Report, PEEP, positive end-expiratory pressure, Environmental pollution, Bronchospasm, 03 medical and health sciences, FiO2, fraction of inspired oxygen, Yokkaichi asthma, medicine, Montelukast, Asthma, Mechanical ventilation, PaCO2, partial arterial carbon dioxide pressure, business.industry, 030111 toxicology, medicine.disease, ICU, intensive care unit, respiratory tract diseases, P/F ratio, PaO2 /FiO2 ratio, Vibrating mesh nebulizer, Sulfur dioxide, Respiratory failure, Anesthesia, ABG, arterial blood gas, medicine.symptom, PaO2, partial pressure of arterial oxygen, business, medicine.drug
Abstract

Yokkaichi asthma was one of the most common environmental pollution diseases in Japan in the 1960s and 1970s. The problem of air pollution in Yokkaichi was solved in the 1970s. However, mortality and life expectancy were still affected by the late effects of air pollution in patients with Yokkaichi asthma even in the 2000s. In this case report, we described the experience of successful treatment of a patient with severe asthmatic status due to Yokkaichi asthma. A 40s-year-old man, who was officially certified as a patient with Yokkaichi asthma from his infancy, was admitted to hospital due to acute exacerbation of asthma. Mechanical ventilation, intravenous administration of aminophylline and dexamethasone, enteral administration of montelukast, and a transdermal patch of tulobuterol were started. However, because of the lack of improvement in clinical status, inhalation of procaterol using vibrating mesh nebulizer systems was started. Inhalation of procaterol was used three times a day. After using the vibrating mesh nebulizer, respiratory system compliance and hypercapnia rapidly improved. Bilateral expiratory wheezing was diminished. Weaning from mechanical ventilation was initiated, and on the eighth day of mechanical ventilation, the patient was extubated. Although intractable respiratory failure with decreased respiratory system compliance resulting from the late effects of air pollution and a long-time asthmatic inflammatory condition was observed, the use of a vibrating mesh nebulizer for the inhaled administration of procaterol was useful to relieve severe bronchospasm due to Yokkaichi asthma.

Published
2016
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15. Artificial intelligence in clinical care amidst COVID-19 pandemic: A systematic review.

Author

Adamidi ES, Mitsis K, and Nikita KS

Abstract

The worldwide health crisis caused by the SARS-Cov-2 virus has resulted in>3 million deaths so far. Improving early screening, diagnosis and prognosis of the disease are critical steps in assisting healthcare professionals to save lives during this pandemic. Since WHO declared the COVID-19 outbreak as a pandemic, several studies have been conducted using Artificial Intelligence techniques to optimize these steps on clinical settings in terms of quality, accuracy and most importantly time. The objective of this study is to conduct a systematic literature review on published and preprint reports of Artificial Intelligence models developed and validated for screening, diagnosis and prognosis of the coronavirus disease 2019. We included 101 studies, published from January 1st, 2020 to December 30th, 2020, that developed AI prediction models which can be applied in the clinical setting. We identified in total 14 models for screening, 38 diagnostic models for detecting COVID-19 and 50 prognostic models for predicting ICU need, ventilator need, mortality risk, severity assessment or hospital length stay. Moreover, 43 studies were based on medical imaging and 58 studies on the use of clinical parameters, laboratory results or demographic features. Several heterogeneous predictors derived from multimodal data were identified. Analysis of these multimodal data, captured from various sources, in terms of prominence for each category of the included studies, was performed. Finally, Risk of Bias (RoB) analysis was also conducted to examine the applicability of the included studies in the clinical setting and assist healthcare providers, guideline developers, and policymakers., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)

Published
2021
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16. The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes.

Author

Bartos JA, Frascone RJ, Conterato M, Wesley K, Lick C, Sipprell K, Vuljaj N, Burnett A, Peterson BK, Simpson N, Ham K, Bruen C, Woster C, Haley KB, Moore J, Trigger B, Hodgson L, Harkins K, Kosmopoulos M, Aufderheide TP, Tolar J, and Yannopoulos D

Abstract

Background: We describe implementation, evaluate performance, and report outcomes from the first program serving an entire metropolitan area designed to rapidly deliver extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to patients with refractory ventricular fibrillation/ventricular tachycardia (VF/VT) out-of-hospital cardiac arrest (OHCA)., Methods: This observational cohort study analyzed consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium's ECMO-facilitated resuscitation program. Entry criteria included: 1) adults (aged 18-75), 2) VF/VT OHCA, 3) no return of spontaneous circulation following 3 shocks, 4) automated cardiopulmonary resuscitation with a Lund University Cardiac Arrest System (LUCAS™), and 5) estimated transfer time of < 30 min. The primary endpoint was functionally favorable survival to hospital discharge with Cerebral Performance Category (CPC) 1 or 2. Secondary endpoints included 3-month functionally favorable survival, program benchmarks, ECMO cannulation rate, and safety. Essential program components included emergency medical services, 3 community ECMO Initiation Hospitals with emergency department ECMO cannulation sites and 24/7 cardiac catheterization laboratories, a 24/7 mobile ECMO cannulation team, and a single, centralized ECMO intensive care unit., Findings: From December 1, 2019 to April 1, 2020, 63 consecutive patients were transported and 58 (97%) met criteria and were treated by the mobile ECMO service. Mean age was 57 ± 1.8 years; 46/58 (79%) were male. Program benchmarks were variably met, 100% of patients were successfully cannulated, and no safety issues were identified. Of the 58 patients, 25/58 (43% [CI:31-56%]) were both discharged from the hospital and alive at 3 months with CPC 1 or 2., Interpretation: This first, community-wide ECMO-facilitated resuscitation program in the US demonstrated 100% successful cannulation, 43% functionally favorable survival rates at hospital discharge and 3 months, as well as safety. The program provides a potential model of this approach for other communities., Funding: The Helmsley Charitable Trust., Competing Interests: All authors report having received funding from the Leona M. and Harry B. Helmsley Charitable Trust. JAB, TPA, and DY also received funding from the National Heart, Lung, and Blood Institute., (© 2020 The Authors.)

Published
2020
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17. Lung Ultrasound in Severe COVID-19 Pneumonia in the Sub-Intensive Care Unit: Beyond the Diagnostic Purpose.

Author

Magnani E, Mattei L, Paolucci E, Magalotti G, Giacalone N, Praticò C, Praticò B, and Zani MC

Abstract

Lung Ultra-Sound (LUS) can be very helpful at the diagnostic stage of COVID-19 pneumonia. We describe four clinical cases that summarize other helpful employment of LUS during the management of severe COVID-19 pneumonia with lung failure. LUS, together with clinical signs and arterial blood gases values, assists in guiding prompt clinical management of potential worsening of conditions. The monitoring of size and signs of aeration of consolidations is an important adjuvant in evaluating clinical evolution. The monitoring of LUS patterns can guide the management of non-invasive ventilation as well as the timing of CPAP weaning., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors.)

Published
2020
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18. Surgery in a patient with liver disease.

Author

Rai R, Nagral S, and Nagral A

Abstract

Surgery is often needed in patients with concurrent liver disease. The multiple physiological roles of the liver places these patients at an increased risk of morbidity and mortality. Diseases necessitating surgery like gallstones and hernia are more common in patients with cirrhosis. Assessment of severity of liver dysfunction before surgery is important and the risk benefit of the procedure needs to be carefully assessed. The disease severity may vary from mild transaminase rise to decompensated cirrhosis. Surgery should be avoided if possible in the emergency setting, in the setting of acute and alcoholic hepatitis, in a patient of cirrhosis who is child class C or has a MELD score more than 15 or any patient with significant extrahepatic organ dysfunction. In this subset of patients, all possible means to manage these patients conservatively should be attempted. Modified Child-Pugh scores and model for end-stage liver disease (MELD) scores can predict mortality after surgery fairly reliably including nonhepatic abdominal surgery. Pre-operative optimization would include control of ascites, correction of electrolyte imbalance, improving renal dysfunction, cardiorespiratory assessment, and correction of coagulation. Tests of global hemostasis like thromboelastography and thrombin generation time may be more predictive of the risk of bleeding compared with the conventional tests of coagulation in patients with cirrhosis. Correction of international normalized ratio with fresh frozen plasma does not necessarily mean reduction of bleeding risk and may increase the risk of volume overload and lung injury. International normalized ratio liver may better reflect the coagulation status. Recombinant factor VIIa in patients with cirrhosis needing surgery needs further study. Intra-operatively, safe anesthetic agents like isoflurane and propofol with avoidance of hypotension are advised. In general, nonsteroidal anti-inflammatory drug (NSAIDs) and benzodiazepines should not be used. Intra-abdominal surgery in a patient with cirrhosis becomes more challenging in the presence of ascites, portal hypertension, and hepatomegaly. Uncontrolled hemorrhage due to coagulopathy and portal hypertension, sepsis, renal dysfunction, and worsening of liver failure contribute to the morbidity and mortality in these patients. Steps to reduce ascitic leaks and infections need to be taken. Any patient with cirrhosis undergoing major surgery should be referred to a specialist center with experience in managing liver disease.

Published
2012
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