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This paper explores the impact of major unexpected public event on the survivability of technology-based small and medium-sized enterprises and the role of external support policies and internal adjustment strategies in mitigating the shock. Using data on Growth Enterprise Market listed companies for 2018–2021, we found that COVID-19 outbreaks caused severe survival pressure on technology-based SMEs, which we see mainly in the reduction of development capacity, operation capacity, profitability, and debt servicing capacity. Additionally, we find that both external support policies and internal adjustment strategies can effectively mitigate the negative impact of COVID-19 on the viability of technology-based SMEs. © 2023 Elsevier Inc.
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Background and Aim: Poor bowel preparation for colonoscopy leads to aborted procedures and reduced polyp and cancer detection rates, leading to increased risk for patients, inconvenience to families, and additional resource use in a burgeoning health care system. The UK's Joint Advisory Group on GI Endoscopy suggests that units have a > 90% rate of adequate preparation for successful accreditation. To improve patient education and poor preparation rates at our institution, the Project GEO - GE Online video platform was introduced in 2019. This consists of five Vimeo-hosted short educational videos to help prepare patients and their carers for their endoscopy and colonoscopy procedures, including diet and bowel preparation. We aimed to examine key performance indicators in colonoscopy, including bowel preparation, before and after the introduction of GEO. Method(s): We performed a retrospective audit in a metropolitan teaching hospital in Queensland that performs more than 6000 colonoscopies per year. A link to GEO, a set of culturally sensitive, patient-centered videos, was sent in a letter, an email, and SMS to patients preparing for endoscopy and colonoscopy. Previously, patients were required to attend the hospital and were given printed handouts for information. This audit obtained Provation MD data for a 6-month period in 2019, before the initiation of GEO, and a 6-month period after, in 2021. Incomplete colonoscopies or those without preparation reporting were excluded from the analysis. Statistics were performed with chi2 analysis, and significance was set as a P value of < 0.05. Result(s): In the 6 months of 2019, before the GEO videos, a total of 2798 colonoscopies were performed. After colonoscopies with missing data and incomplete procedures were removed, there were 2031 colonoscopies for analysis. A total of 2277 colonoscopies were included in the post-GEO dataset. Results for bowel preparation and sessile serrated adenoma (SSA) detection rate before and after GEO are shown in Table 1. Conclusion(s): Project GEO has shown a significant reduction in poor preparation rates in a high-performing center and reduced repeat procedures, while not compromising SSA detection rate. Poor preparation often leads to abandonment of procedures, waste of health resources, and significant risk and inconvenience for patients, carers, and the system provider. Project GEO has had excellent patient feedback that it is improving patient and carer education and understanding, is improving compliance, and is convenient. This has led to a massive reduction in face-to-face outpatient visits (> 10 000). GEO is also COVID-19-friendly, culturally sensitive, and reaches our patients in distant regional and rural Queensland.
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Background. The effectiveness of Severe Acute Respiratory Syndrome Coronavirus 2 vaccines after two doses needs to be demonstrated beyond clinical trials. Methods. In a retrospective cohort assembled from a cross-institution comprehensive data repository, established patients of the health care system were categorized as having received no doses, one dose or two doses of SARS-CoV-2 mRNA vaccine through April 4, 2021. Outcomes were COVID-19 related hospitalization and death. Results. Of 94,018 patients 27.7% had completed two doses and 3.1% had completed one dose of a COVID-19 mRNA vaccine. The two dose group was older with more comorbidities. 1.0% of the two dose group had a COVID-19 hospitalization, compared to 4.0% and 2.7% in the one dose and no dose groups respectively. The adjusted Cox proportional-hazards model based vaccine effectiveness after two doses (vs. no dose) was 96%(95% confidence interval(CI):95-97), compared to 78%(95%CI:76-82) after one dose. After two doses, vaccine effectiveness for COVID-19 mortality was 97.9%(95%CI:91.7-99.5), and 53.5%(95%CI:0.28-80.8) after one dose. Vaccine effectiveness at preventing hospitalization was conserved across age, race, ethnicity, Area Deprivation Index and Charlson Comorbidity Indices. Cohort Enrollment and Distribution by Immunization Status and Vaccine effectiveness against mortality Cohort members are described by their immunization status and hospitalization at the end of the study period ending April 4th, 2021. Percentages compare this population to the total established patients. Each group is then divided into when hospitalized events occurred across immunization status. These percentages compare the number of events to the population in the immunization status at the end of the analysis period. Odds ratios for mortality were calculated and vaccine effectiveness calculated as 1 minus odds ratio times 100%. Conclusion. In a large, diverse US cohort, receipt of two doses of an mRNA vaccine was highly effective in the real-world at preventing COVID-19 related hospitalizations and deaths with a substantive difference in effectiveness between one and two doses.
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Background: We evaluated the frequency and outcomes of Coronavirus Disease 2019 (COVID-19) associated stroke (ischemic and hemorrhagic) and myocardial infarction (MI) in a global research network. Methods: All adult (≥ 18 years) patients with ICD-10 diagnoses of COVID-19 were included and those with a stroke (ischemic stroke, intracerebral hemorrhage [ICH], transient ischemic attach [TIA] or subarachnoid hemorrhage [SAH]) or myocardial infarction (MI) ± 28 days from COVID-19 diagnosis were flagged. Individuals with a prior history of stroke / MI were excluded. COVID-19 associated stroke (CAS) and MI (CAM) frequencies were compared to prior AHA-reported population-based incidences. Severe COVID-19 disease (use of ventilator, intubation, or life support) and 90-day mortality were evaluated among no-stroke/MI and stroke/MI subgroups utilizing general linear models adjusted for age, sex, race/ethnicity, and Charlson Comorbidity Index scores. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported. Results: Between Jan 2020 and Jul 2021, we identified 637,820 COVID-19 patients of whom 4,559 (0.71%) had a CAS and 6,972 (1.09%) had a CAM. COVID-19 was associated with significantly higher stroke/MI rates compared to population based reported incidence (ORs, CI for CAS 1.99, 1.93 - 2.05 and CAM 3.09, 3.01 - 3.16). Severe COVID disease was observed among 1.07% of COVID-19 only patients, 11.25% of CAS patients (aOR, CI: 4.82, 4.35 - 5.34), and 14.81% of CAM patients (aOR, CI: 5.77, 5.34 - 5.22). 90-Day mortality was 1.92% for COVID-19 only patients, 14.35% for CAS patients (aOR, CI: 3.16, 2.87 - 3.46), and 20.52% for CAM patients (aOR, CI: 4.12, 3.85 - 4.41). Group specific demographic and outcome proportions are reported (Figure). Conclusion: The COVID-19 pandemic has tremendously exacerbated the burden of cerebrovascular and cardiovascular disease globally. Continued work is needed to understand drivers of poor outcomes among COVID-19 patients.
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Introduction: Vaccination of Healthcare workers (HCWs) is a crucial element of the strategy against COVID-19 to conduct an effective immunization campaign among general population. Objectives: A cross-sectional survey was conducted to assess attitudes, sources of information and practices among HCWs in relation to COVID-19 vaccination. Methods: From February 19th to April 23rd 2021 an anonymous voluntary questionnaire was sent to the mailing list of SIMPIOS and to the main National Health Service structures. Data collected through the Survey-Monkey platform was subjected to univariate and multivariate analysis to identify factors significantly and independently associated with the variables of interest. Results: 2137 HCWs answered. Hesitancy is greater in females, in those with lower concern about COVID-19, in nurses, auxiliary nurses (AN) and healthcare assistants. The most hesitant professionals are more likely not to recommend vaccination to either their patients or their relatives, while concern about COVID-19 increases the practice of recommending vaccination to family members, but not to patients. HCWs are mostly in favor of mandatory vaccination (61.22%). Female sex, a lower education level, greater hesitancy and refusal to adhere to flu vaccination campaigns are factors influencing the aversion to mandatory vaccination. Institutional source of information (eg. World Health Organization) are the most used by all categories. Scientific literature is more used by professionals working in the northern regions of Italy and by those dealing with infection control and hospital hygiene, infectious diseases, emergencies and critical area. HCWs working in south-central regions, nurses, AN, healthcare technicians, administrators and HCWs with a lower education level are more likely to choose internet, television, newspapers, family and friends' advice as sources of information. Conclusion: Communication in support of COVID-19 immunization campaigns should consider the differences between the various HCWs professional categories, to reach all professionals in a homogeneous way, involving even the most hesitant ones.
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Background: Cancer patients (pts) have higher risk of serious COVID-19 symptoms, morbidity and mortality than general population. SARS-CoV-2 vaccine trials excluded patients with metastatic cancer or undergoing immunosuppressive therapies;therefore, the effectiveness of vaccines are unknown in this population. Hence, there is an urgent need to understand the correlation between cancer type, its treatment and vaccine efficacy. Material and Methods: This is a prospective study conducted by the Oncology Unit of Cremona Hospital, enrolling pts from Oncology, Hematology, Radiotherapy and Palliative Care divisions. The trial aims to evaluate effectiveness of mRNA vaccines [BNT162b2 (Pfizer) and mRNA-1273 (Moderna)], incidence of symptomatic COVID-19 infection, antibodies (Abs) response in a consecutive population of 300 cancer pts, undergoing antiblastic therapies, starting from March 2021. Primary endpoint: Number of symptomatic pts affected by COVID-19, diagnosed 7-60 days after the 2nddose of vaccines. Secondary endpoints: Abs variation at different timepoints;duration of abs;correlation between effectiveness of vaccines and antiblastic treatments. Statistical Analysis: The primary objective will be tested by non-inferiority one-single proportion test, compared with the value of 95% observed in the vaccine registration trials. The hypothesis of vaccine inferiority in the trial population is rejected if a rate of protection conferred by the vaccine is observed in 89% of the sample size. Results: 356 patients received mRNA anti-COVID-19 vaccines. None of them reported symptomatic COVID-19 infection after vaccination. Whereas almost all patients (95.6%) with solid tumors developed an antibody response, only 77% of patients with hematological malignancy demonstrated anti-COVID-19 antibody production after vaccination. The different antiblastic treatments didn't have a significant impact on the antibody response. In particular, patients treated with immunotherapies and with chemotherapy developed antibodies against COVID-19 in 98% and 92% of cases, respectively. Conclusions: Vaccination against COVID-19 demonstrated to be effective and to prevent symptomatic COVID- 19 infection in patients with solid and hematological tumors during antiblastic treatment. The depth of antibody response resulted different between patients with solid and hematological malignancies. Different antiblastic therapies didn't significantly impact on the development of the antibody response.
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Background: Cancer patients (pts) have higher risk of serious COVID-19 symptoms, morbidity and mortality than general population. SARS-CoV-2 vaccine trials excluded patients with metastatic cancer or undergoing immunosuppressive therapies;therefore, the effectiveness of vaccines are unknown in this population. Hence, there is an urgent need to understand the correlation between cancer type, its treatment and vaccine efficacy. Trial design: Methods: This is a prospective study conducted by the Oncology Unit of Cremona (Cr) Hospital, enrolling pts from Oncology, Hematology, Radiotherapy (RT) and Palliative Care divisions. The trial aims to evaluate effectiveness of mRNA vaccines [BNT162b2 (Pfizer) and mRNA-1273 (Moderna)], incidence of symptomatic COVID-19 infection, antibodies (Abs) response and onset of adverse events (AEs) in a consecutive population of 300 cancer pts, undergoing antiblastic therapies, starting from March 2021. A vaccination point was set up by Cr Hospital, dedicated to cancer pts treated with chemotherapy (CT), TKIs, RT, hormones. Only pts in follow-up or treated with adjuvant hormone are excluded. CT was suspended at least 5 days before and 3 days after vaccination;targeted therapy, immunotherapy and RT are not interrupted. Primary endpoint: Number of symptomatic pts affected by COVID-19, diagnosed 7-60 days after the 2nddose of vaccines. The infection is defined according to the FDA criteria combined with a positive nasopharyngeal swab. Secondary endpoints: Abs variation at different timepoints compared to baseline;vaccine-related adverse events;duration of abs, up to 12 months after 2nd dose;correlation between effectiveness of vaccines and antiblastic treatments, tumor burden, PS ECOG. Statistical analysis: The primary objective will be tested by non-inferiority one-single proportion test, compared with the value of 95% observed in the vaccine registration trials. The hypothesis of vaccine inferiority in the trial population is rejected if a rate of protection conferred by the vaccine is observed in 89% of the sample size. Results Preliminary results will be available in July 2021. Clinical trial identification: NCT04878796. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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We describe the design and implementation of Protean - the Microsoft Azure service responsible for allocating Virtual Machines (VMs) to millions of servers around the globe. A single instance of Protean serves an entire availability zone (10-100k machines), facilitating seamless failover and scale-out to customers. The design has proven robust, enabling a substantial expansion of VM offerings and features with minimal changes to the core infrastructure. In particular, Protean preserves a clear separation between policy and mechanisms. From a policy perspective, a flexible rule-based Allocation Agent (AA) allows Protean to efficiently address multiple constraints and performance criteria, and adapt to different conditions. On the system side, a multi-layer caching mechanism expedites the allocation process, achieving turnaround times of few milliseconds. A slight compromise on allocation quality enables multiple AAs to run concurrently on the same inventory, resulting in increased throughput with negligible conflict rate. Our results from both simulations and production demonstrate that Protean achieves high throughput and utilization (85-90% on a key utilization metric), while satisfying user-specific requirements. We also demonstrate how Protean is adapted to handle capacity crunch conditions, by zooming in on spikes caused by COVID-19.
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Introduction: Neurotropism of the SARS-CoV-2 has been reported. We evaluated the risk of poor outcomes associated with preexisting neurological disease (PEND) among COVID-19 patients. Methods: We analyzed data from COVID-19 Outcomes Registry (CURATOR) at Houston Methodist. All adult (≥ 18 years) patients tested for SARS-CoV-2 RNA in nasopharyngeal specimens were included. Utilizing ICD-10 diagnoses codes, we classified PEND patients as those with documented history of ischemic or hemorrhagic stroke, transient ischemic attack, mild cognitive impairment, Alzheimer's disease and related dementias including vascular dementia, primary and metastatic brain tumors, epilepsy, motor neuron disease, amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, spinal cord injury, and traumatic brain injury. Logistic regression models were fitted to assess the odds of COVID-19 mortality associated with PEND. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported. Results: Between March 3 and August 10, 2020, 86,614 individuals were tested for SARS-CoV-2, of whom 14,233 (16.4%) tested positive, with 4,473 (31.4%) hospitalizations, and 431 (9.6%) deaths. Overall 11,473 (13.2%) individuals had PEND, of whom 1,458 (12.7%) tested positive, 966 (66.3%) were hospitalized and 165 (17.1%) died. Among positive cases, PEND (vs. non-PEND) patients were older (67.1 vs. 46.4 years) and had a higher overall comorbidity burden (median Charlson Comorbidity Index: 6 vs. 1). The proportion of PEND patients was significantly higher among COVID-19 patients who died (vs. those who were discharged alive) (38.3% vs. 19.8%, crude OR, CI: 2.51, 2.03 - 3.09). In the fully adjusted model for socio-demographic, comorbidity and clinical factors, PEND was independently associated with higher risk of COVID-19 mortality OR (CI): 1.42 (1.04, 1.95) (graphic). Conclusions: Biological mechanisms of higher COVID-19 mortality among patients with PEND need to be evaluated.
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Introduction: COVID-19 is associated with incident cerebrovascular disease (CVD). We evaluated the association between preexisting CVD and COVID-19 mortality. Methods: Utilizing deidentified pooled data from 40 healthcare organizations, adult (≥ 18 years) COVID-19 patients were identified based on ICD-10 diagnostic codes and documentation of laboratory positivity for SARS-CoV-2 RNA or antibodies. Among COVID-19 patients, those with documented ICD-10 diagnoses for cerebral infarction / ischemic stroke (IS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and transient ischemic attack (TIA) at least 30- days before the index COVID-19 event were classified as the CVD group. The CVD and non-CVD groups were propensity score (PS) matched on demographic and comorbidity variables. Pre and post-match risk ratios (RR) and 95% confidence intervals (CI) for 30 and 90-day mortality were calculated. Mortality rates for CVD subgroups (ICH, SAH, AIS, TIA) are also reported. Results: Among a total of 140,034 COVID-19 cases, 4,614 (3.3%) had prevalent CVD. CVD patients were significantly older and were predominantly males of either white or black race (vs. other). CVD patients also had a higher comorbidity burden (vs. non-CVD patients) (graphic). A 1:1 PS algorithm yielded an optimally matched sample of 8,218 COVID-19 patients (4,109 CVD and non-CVD patients each). In the matched sample, 30-day mortality was 8.4% among CVD patients and 7.0% among non-CVD patients RR (CI): 1.20 (1.03 - 1.39). 90-day mortality among CVD patients (vs. Non-CVD patients) remained significantly elevated (9.7% vs. 8.2%), RR (CI): 1.20 (1.04 - 1.37). Among CVD subgroups, 30 and 90-day mortality was higher for patients with preexisting ICH (11.8% and 13.7%, respectively) compared to IS (8.7% and 10.2%, respectively). Conclusion: Preexisting CVD significantly increases the mortality risk in COVID-19 patients. Mechanisms for poor COVID-19 outcomes among CVD patients need to be evaluated.
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Introduction: We evaluated the burden of SARS-CoV-2 susceptibility and COVID-19 mortality associated with Mild Cognitive Impairment (MCI) or Dementia (MCID). Methods: We analyzed data from COVID-19 Outcomes Registry (CURATOR) at Houston Methodist;a tertiary healthcare system in greater Houston. All adult (≥ 18 years) patients tested for SARS-CoV-2 RNA in nasopharyngeal swabs were included. Utilizing validated ICD-10 codes (MCI, Alzheimer's Disease, Vascular and Other Dementias) and use of MCID specific medications, we flagged patients with preexisting MCID. Logistic regression models were fitted to evaluate the odds of SARS-CoV-2 susceptibility and COVID-19 mortality associated with preexisting MCID. Odds ratios (OR) and 95% Confidence Intervals (CI) are reported. Results: Between March 3 and August 10, 2020;86,614 individuals were tested, of whom 14,233 (16.4%) tested positive, with 4,473 (31.4%) hospitalizations, and 431 (9.6%) deaths. Overall 3,069 individuals had preexisting MCID;among whom 518 (16.9%) tested positive. Among all SARS-CoV- 2 positive cases, MCID patients (vs. non MCID group) were older (79.9 vs. 47.3 years) and had higher overall comorbidity burden (median Charlson Comorbidity Index: 6 vs. 0), with higher proportion (%) of hypertension (90.3 vs. 39.0), heart failure (37.8 vs. 7.5), diabetes (69.3 vs. 28.2), and cancer (14.5 vs. 4.8). Mortality among MCID patients (vs. non MCID) was 22.3% vs. 8.6%. In fully adjusted models (demographics, comorbidities, clinical / laboratory parameters, complications, treatment and ICU admission), pre-existing MCID was independently associated with higher SARSCoV- 2 susceptibility, OR (CI) 1.62 (1.46-1.80) and in-hospital mortality OR (CI): 1.79 (1.23-2.61) among COVID-19 patients (graphic). Conclusions: Regardless of age, MCID is a potential risk factor for SARS-CoV-2 infection and COVID-19 mortality. Targeted prevention and management strategies are warranted for this highrisk group.
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Introduction: Overall poor COVID-19 outcomes have been reported among males. We evaluated sex differences in mortality among patients with stroke related to COVID-19. Methods: Utilizing pooled deidentified data from 30 healthcare organizations, we identified COVID- 19 patients via ICD-10 diagnosis or documented laboratory confirmation of SARS-CoV-2 RNA or antibodies. Patients with ICD-10 diagnoses of ischemic stroke or intracerebral hemorrhage within 30 days before or after the COVID-19 event were flagged. Male and female patients were propensity score (PS) matched on other demographic and comorbidity variables. Risk Ratio (RR) and 95% Confidence Interval (CI) for association between sex and 90-day mortality is reported. Kaplan-Meier analyses with log rank test (LRT) were conducted for time-to-death. As a sensitivity analysis, we only included a smaller sub-set with first instance of IS or ICH ± 30-days of COVID-19 diagnosis. Results: Among 149,410 COVID-19 patients, 1,618 (1.1%) had a stroke diagnosis ± 30-days of confirmed COVID-19. Of whom, 1,609 patients (847 males and 762 females) were included in primary analyses. Females were older (67.7 vs. 65.7 years) and were more likely to be of black race (34.1% vs. 27.6%). Females had a significantly higher proportion of chronic pulmonary disease (38.8% vs. 28.8%) and obesity (34.2% vs. 24.8%);whereas males had higher proportion of alcohol abuse (8.5% vs. 3.8%). A 1:1 PS algorithm yielded an optimally matched sample of 634 males and females each, balanced on all covariates. In the matched sample, 11.7% of females and 15.8% of males experienced 90-day mortality;RR (CI): 1.35 (1.02 - 1.78), LRT p value 0.04. Higher risk of 90- day mortality among males with COVID-19 and stroke was maintained in the sensitivity analyses, RR (CI): 1.47 (1.06 - 2.00), LRT p value = 0.03 (graphic). Conclusion: Future studies examining the socio-demographic and biological mechanisms for poor stroke outcomes among males with COVID-19 are needed.
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Background and Aim: In March 2020, the Gastroenterological Society of Australia released recommendations for endoscopic triaging during the coronavirus disease 2019 (COVID-19) pandemic. These unique circumstances resulted in diagnostic delays. In a Brisbane hospital, computed tomography (CT) colonography was used as a minimally invasive method to examine the colon, with the aim of identifying and expediting the diagnosis of patients with high-risk abnormalities. We aimed to explore the findings and outcomes of CT colonography. Methods: In April 2020, an experienced gastroenterologist reviewed and triaged about 645 category one waitlist colonoscopy patients. Of these, 130 patients were selected on clinical grounds and referred to three community radiology providers for CT colonography between April and June 2020. Data were retrospectively collected, including patient demographics, indication from referral source, and radiology reports. Colonoscopy reports were reviewed using ProVation software. Results: Of the 130 patients selected, 92 consented and 39 declined. After CTcolonography, 13 patients were referred for colonoscopy and 79 were referred to a gastroenterology outpatient clinic. The indication for referral addressed “red flag” symptoms of unexplained anemia, rectal bleeding, weight loss, or change in bowel habits in 54/92 patients (58.7%). The median time from referral to CT colonography was 20 days. Of the CT colonographies, 75 (81.5%) were recorded as being “good” or “satisfactory” quality. The significant colonic findings and outcomes of CT colonography are shown in Table 1. One patient had a significant extracolonic finding of a malignancy, consistent with renal cell carcinoma. This patient was reviewed in the urology outpatient clinic 9 days after CT colonography. Conclusion: This cohort of patients faced delays in the time to colonoscopy due to the COVID-19 pandemic. In using CT colonography, three patients were diagnosed with significant conditions that required urgent management and treatment. In 78/130 patients (60%), no high-risk radiological abnormalities were identified, and they were referred to an outpatient clinic. CTcolonography may be an appropriate tool to assist with risk stratification for patients facing long waitlists. This requires further study to assess outcomes after clinic consultation and colonoscopy procedures.
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Aim To analyze the clinical characteristics of patients of corona virus disease 2019 (COVID-19), and summarize the treatment experience, aiming to provide diagnostic and treatment reference for the front-line clinicians. Methods Seventy-nine patients with COVID-19 admitted to the Infectious Hospital of Anhui Provincial Hospital from January 22 to February 18, 2020 were selected as the research subjects. There were 55 cases in general group and 24 cases in severe and critical group. The clinical data of the two groups were collected and compared, including general conditions, clinical symptoms, signs, laboratory tests, computed tomography imaging of the lungs and complications. Results The average age of 79 COVID-19 patients was 45. 1 ± 16. 6 years, and forty-five of them are males. The severe and critical group was older than the general group. Besides, there were more males and comorbidities. In terms of laboratory tests, the lymphocyte (LYM) count and albumin (A L B) decreased more significantly in the severe and critical groups. Moreover, the percentage of neutrophils (N E U), c-reactive protein (CRP), D-dimer, lactate dehydrogenase (L D H), troponin I (cTnl) and urea nitrogen (BUN) increased significantly. Among all the patients, the types of antiviral drugs in severe and critical group were significantly more than those in general group;moreover, the glucocorticoids, gamma globulin and oxygen inhalation by nasal catheter were used more frequently in severe and critical patients. By the time of February 18, one patient died of acute large area cerebral infarction, 34 patients were discharged from hospital, and the rest were still receiving treatment. Conclusions The elderly patients with multiple cardiovascular diseases are more likely to get severe and critical COVID-19. They usually combine multiple organ or system abnormalities. Clinicians should make timely judgment and adjust the treatment plan according to the clinical symptoms, signs and laboratory examination results.
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BACKGROUND: Radiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them. METHODS: One hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis. RESULTS: COVID-19 patients had more distinct symptoms, tended to be younger (P<0.0001), male (P<0.0001), and had a higher body mass index (P=0.014). After 1:1 PSM, 121 matched pairs were identified. Regarding radiological characteristics, patients with a single lesion accounted for 17% in COVID-19 and 89% in lung cancer (P<0.0001). Most lesions were peripherally found in both groups. Lesions in COVID-19 involved more lobes (median 3.5 vs. 1; P<0.0001) and segments (median 6 vs. 1; P<0.0001) and tended to have multiple types (67%) with patchy form (54%). Early lung cancer was more likely to have a single type (92%) with oval form (66%). Also, COVID-19 and early lung cancer either had some distinctive features on computed tomography (CT) images. CONCLUSIONS: Both COVID-19 and early lung cancers showed GGOs, with similar but independent features. The imaging characteristics should be fully understood and combined with epidemiological history, pathogen detection, laboratory tests, short-term CT reexamination, and pathological results to aid differential diagnosis.