Background: COVID-19 pandemic to date has recorded around 37 million cases across the world. This study was done to appraise the prognostic importance of portable chest X-ray (CXR) and the Brixia scoring was then used to predict the outcome variables like hypoxia, non-invasive ventilation, intubation, sepsis, multiple organ dysfunction syndrome (MODS), recovery, death and post corona sequalae.Methods: A 100 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 infection were included in the study, based on the inclusion and exclusion criteria. A CXR was done on admission and on day 3 following admission. The CXR Brixia score was calculated and was correlated with lab parameters, hypoxia, need for mechanical ventilator and clinical outcome variables. P value of <0.05 was taken as significant.Results: The mean Brixia score on admission were 2.52±1.505, 6.18±2.969 and 12.05±3.251 in mild, moderate and severe category respectively and the scores that were calculated 3 days after admission were 2.52±1.505, 6.18±2.969 and 12.14±3.306 in mild, moderate and severe category respectively, it was found that mean Brixia scores were higher in patients with moderate and severe category compared to mild category. There was a statistically significant correlation between lymphopenia, lactate dehydrogenase (LDH), d-dimer, C-reactive protein (CRP) and serum ferritin with Brixia score on admission.Conclusions: The simple and a bedside Brixia CXR score has shown that the higher scores predict a need for monitoring and management to prevent poor clinical outcome and mitigate complications and death. When this score is used along with other easily available biochemical parameters is useful in predicting clinical outcome and prognosis.
A case of diffuse nesidioblastosis in an adult patient is reported in this study. A 24-year-old female with no known comorbidities presented with multiple episodes of documented recurrent hypoglycaemia and Hypoglycaemia induced seizures both in fasting and postprandial state. Her blood investigations revealed low plasma glucose levels, high insulin and C-peptide levels with positive 72-hour fast test. Her transabdominal USG and CECT abdomen did not reveal any abnormality, 68Ga DOTANOC PET CT done showed ill-defined diffuse somatostatin receptor expression in the pancreatic head and tail suggestive of nesidioblastosis. As patient was not willing for surgical treatment, hence started on medical treatment with oral nifedipine. Nesidioblastosis is very rare in adults. It is an important differential diagnosis in adults with hyperinsulinemic hypoglycemia although the incidence is very rare in adults. PET SCAN was used to non-invasively diagnose nesidioblastosis in this case. Surgery being the preferred choice of treatment in nesidioblastosis, there is limited data on medical line of management in nesidioblastosis.
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