Objectives : Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has caused enormous strain on health-care systems worldwide. Early recognition of prognostic markers and appropriate management of patients with coronavirus disease 2019 (Covid-19) remains a major global health concern, particularly when resources are limited. We undertook a study to see if basic tests can inform frontline clinicians of disease trajectory in individual patients with COVID-19. Methods : We retrospectively assessed characteristics of the first 50 consecutive patients admitted to district general hospital in the United Kingdom with positive SARS-Cov-2 RNA swabs. Results : Our patient cohort shared broad similarities with previously published data on comorbidities and presenting features. We have found that chest radiographic assessment differed between survivors and non-survivors. Air space shadowing in middle zones were more prevalent in non-survivors (73.3% vs. 35.5% [p = 0.027]). Chest radiograph severity score was also found to be higher in non-survivors compared to survivors (3 vs. 1.5 [p = 0.007]). Conclusions : In this small retrospective study, our results suggest features of chest radiographs at presentation may provide a helpful tool for prognostication. In environments with constrained computed tomography (CT) imaging with serial chest radiographs could be a cost-effective tool in the assessment of Covid-19 patients.
IntroductionThe diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient.Case presentationA 9-year-old white boy presented to our institution with heel pain and an inability to weight bear. There was a 10-day delay in diagnosis of calcaneal osteomyelitis, with a total of three presentations to our emergency department. The condition was misdiagnosed as Sever’s disease on two separate occasions with discharge home. On his third presentation the diagnosis was finally clinched when he developed more definitive signs and symptoms, with pyrexia and signs of lymphangitis. Magnetic resonance imaging revealed diffuse osteomyelitis of his calcaneum. He underwent surgery and 2 weeks of antibiotics administered intravenously, followed by 4 weeks of oral therapy. We are happy to report a good recovery without any complications at his 12-month follow up.ConclusionsPhysicians should include calcaneal osteomyelitis as a differential in any child presenting with heel pain. Delays in the diagnosis can result in disastrous complications in the pediatric patient, such as growth arrest.
Purpose This study aims to systematically grade CXRs of COVID-19 patients to find associations between CXR (chest radiographs) characteristics and clinical outcomes. Methods A retrospective review and grading of CXRs in 161 COVID-19 positive patients was caried out in this single centre study. CXR changes primarily constituted that of presence or absence of ground glass opacification (GGO) or consolidation and their distribution across both lung fields. We used two grading systems normal/ mild/ moderate/ severe grading and a numeric 0−8 grading system. We defined mild severity as up to 25 % lung involvement, moderate as 25–62.5 % and severe as 62.5–100% lung involvement. Results Peripheral GGO in lower +/- mid zones of the lungs is the most common finding. Mid zone and perihilar GGO is associated with increased mortality. We additionally show that CXRs have a higher severity score in the non-survivor group and a CXR graded as severe has a relative risk ratio for mortality of 3.28. Finally, we describe the change in CXR severity with length of symptoms, finding 42.3 % of CXR were normal in the first 2 days of symptoms and 0% at 13 days. Conclusion Using a systematic approach to reviewing and grading CXRs in Covid-19 positive patients we clearly demonstrate that grading, location of airspace abnormalities and rate of CXR changes are related to clinical outcome.
Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England.
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