COVID-19 Pneumonia: Variation of Chest Computed Tomographic Findings at Different Phases of Disease

Objective: We determined the temporal changes on thoracic computed tomography (CT) in patients with Coronavirus disease-2019 (COVID-19) pneumonia, during the disease. Methods: Our sample included 55 patients (29 men, 26 women) who were admitted to our hospital between March 10 and May 10 2020 with COVID-19, diagnosed by reverse-transcription polymerase chain reaction, who underwent at least two CT examinations in our hospital. From the onset of the symptoms, the disease process was divided into six stages, and CT patterns at each stage were analyzed. Additionally, we calculated the CT score by using a semiquantitative method to measure the involvement in all five lung lobes. Results: The most common CT patterns in all stages were ground-glass opacification, crazy-paving pattern, and consolidation. The total CT scores were highest between the 10th and 21st days. This pattern continued similarly for a while later. Residual signs of disease were found in 92% of the patients who underwent CT after the 28th day. Conclusion: CT findings in COVID-19 pneumonia progress in a certain time-dependent pattern. CT findings of the disease is most severe between the 10th and 21st days. Residual disease findings are observed even after 28 days in most patients. [ FROM AUTHOR] Copyright of European Archives of Medical Research is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Can Serum ACE Level Be Used as a Prognostic Indicator in COVID-19?

BACKGROUND: SARS-COV-2 virus that causes COVID-19 binds to the host cell with angiotensin converting enzyme-2 causing acute respiratory distress syndrome (ARDS) and severe mortality and morbidity. There are studies in the literature conducted on the importance of serum angiotensin converting enzyme (ACE) and ACE-2 enzymes in ARDS pathogenesis. Serum ACE levels are higher in children and adolescents than in adults, and COVID-19 has a milder progression. All these reasons suggest that there may be a relationship between serum ACE levels and COVID-19 prognosis. METHODS: The serum ACE levels were determined at the time of hospitalization due to COVID-19 diagnosis in this single-centered, prospective study. According to discharge status, patients were divided into three groups as "Discharge with Healing", "Intensive Care Need" and "Mortality", and the effect of serum ACE levels on disease prognosis was investigated. RESULTS: The present study comprised a total of 103 patients, of whom 42.7% (n = 44) were female, and 57.3% (n = 59) were male. The mean age was 59.48 ± 16.47; 91.3% (n = 94) of them were discharged with healing, 5.8% (n = 6) needed intensive care, and 2.9% (n = 3) resulted in mortality. No differences were detected in terms of serum ACE levels between the groups. CONCLUSIONS: No relationships were detected between serum ACE levels at the time of hospitalization and COVID-19 prognosis.

Prediction of Clinical Results with the First Thoracic CT Findings in COVID-2019 Patients;Survey Study

Objective: This study aimed to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease-2019 (COVID-19) pneumonia. Methods: A total of 50 patients with critical COVID-19 pneumonia, receiving mechanical ventilation support in the intensive care unit (ICU) due to moderate-severe acute respiratory distress syndrome (ARDS), were included in this retrospective study. Chest CT, laboratory results, and clinical conditions of patients were concurrently identified. Only the first chest CT findings of patients were reviewed by 50 physicians and they were asked about their opinions on the laboratory results and clinical conditions of patients. Data were then compared with the real-time data. The efficacy of the first chest CT findings in diagnosis and treatment guidance was analyzed. Results: The simultaneous laboratory analyses of patients receiving mechanical ventilation support due to moderate-severe ARDS found a C-reactive protein of >40 mg/L in 72%, D-dimer was >1000 ng/mL and ferritin was >500 ng/mL in 57%, and lymphocyte count <800 μL in 50% of patients. While 53% of participants proposed that patients would be treated in the ICU, 28.2% suggested the patients be treated in inpatient care. A total of 60.2% of participants stated that the patients suffered from moderate-severe ARDS based on CT findings. Conclusion: A correlation was found between the clinical symptoms, laboratory analyses, and CT findings of patients presenting with severe COVID-19. The first chest CT alone may help a physician to determine the disease severity;however, additional laboratory data and clinical follow-up are needed to evaluate the prognosis and plan the treatment, as many factors are involved in determining the disease severity. [ FROM AUTHOR] Copyright of European Archives of Medical Research is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Relationships of the neutrophil-lymphocyte and CRP-albumin ratios with the duration of hospitalization and fatality in geriatric patients with COVID-19.

OBJECTIVE: The aim of this study was to determine the associations of the neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP)-albumin ratio (CAR) with the duration of hospital stay and fatality rate in geriatric patients with coronavirus disease 2019 (COVID-19). METHODS: Patients older than 65 years with polymerase chain reaction-positive COVID-19 were included. Neutrophil, lymphocyte, CRP, albumin, and demographic data and the duration of hospitalization were recorded. RESULTS: The mean length of stay was 15 days. NLR and CAR were significantly higher in patients who died than in those who survived. The cutoffs predictive of mortality were 4.02 (area under the curve [AUC] = 0.717) for NLR and 23 for CAR (AUC = 0.781). The fatality rate among patients who required inpatient treatment was 33%. CONCLUSION: NLR and CAR, which can be calculated inexpensively and quickly at the first admission to the hospital, are extremely useful for estimating the duration of hospitalization and risk of mortality in geriatric patients with COVID-19. Using these data, treatment can quickly be intensified when needed.

Tocilizumab treatment in severe COVID-19: a multicenter retrospective study with matched controls.

Coronavirus disease-2019 (COVID-19) associated pneumonia may progress into acute respiratory distress syndrome (ARDS). Some patients develop features of macrophage activation syndrome (MAS). Elevated levels of IL-6 were reported to be associated with severe disease, and anti-IL-6R tocilizumab has been shown to be effective in some patients. This retrospective multicenter case-control study aimed to evaluate the efficacy of tocilizumab in hospitalized COVID-19 patients, who received standard of care with or without tocilizumab. Primary outcome was the progression to intubation or death. PSMATCH (SAS) procedure was used to achieve exact propensity score (PS) matching. Data from 1289 patients were collected, and study population was reduced to 1073 based on inclusion-exclusion criteria. The composite outcome was observed more frequently in tocilizumab-users, but there was a significant imbalance between arms in all critical parameters. Primary analyses were carried out in 348 patients (174 in each arm) after exact PS matching according to gender, ferritin, and procalcitonin. Logistic regression models revealed that tocilizumab significantly reduced the intubation or death (OR 0.40, p = 0.0017). When intubation is considered alone, tocilizumab-users had > 60% reduction in odds of intubation. Multiple imputation approach, which increased the size of the matched patients up to 506, provided no significant difference between arms despite a similar trend for intubation alone group. Analysis of this retrospective cohort showed more frequent intubation or death in tocilizumab-users, but PS-matched analyses revealed significant results for supporting tocilizumab use overall in a subset of patients matched according to gender, ferritin and procalcitonin levels.

COVID-19 Associated Miller Fisher Syndrome and Rhombencephalitis with Magnetic Resonance Imaging Findings

Coronaviruses, including severe acute respiratory syndrome-coronavirus 2, are responsible for upper respiratory tract infections. However, recent studies have reported that patients with coronavirus disease-2019 (COVID-19) may manifest neurological symptoms. The involvement of the neurological system causes different clinical situations, including meningitis, encephalitis, acute necrotizing hemorrhagic encephalopathies, acute cerebrovascular events, and Guillain-Barre syndrome. Miller Fisher syndrome and rhombencephalitis were separately reported in few cases of COVID-19. In this report, we present the neuroimaging findings of a patient with Miller Fisher syndrome and rhombencephalitis due to COVID-19. [ABSTRACT FROM AUTHOR] Copyright of European Archives of Medical Research is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

CLINICAL FINDINGS AND PROGNOSIS OF HOSPITALIZED ELDERLY COVID-19 PATIENTS

Background: SARS-CoV-2 has caused an outbreak all over the World. Age is the most important factor for mortality. However, it is not known exactly why SARS-CoV-2 infections are more severe and fatal in the elderly population. We examined the clinical course and the causes of increasing mortality in all hospitalized patients diagnosed with COVID-19 over 65 years of age. Methods: Hospitalized elderly patients diagnosed with COVID-19 were examined in this retrospective observational study. The blood results, length of stay, comorbid diseases, admission symptoms, clinical results and demographic data of the patients were recorded. It was examined whether there was a significant difference between surviving and non-surviving patients in terms of comorbid diseases and symptoms. The effects of these parameters on the 30-day mortality alone were investigated. Results: A total of 263 patients (125 males) were included in the study. Cough (53.2%) followed by dyspnea (35.7%) were the two most common symptoms. There was no statistically significant difference age or sex distribution between survivor and nonsurvivor patients. Patients with dyspnea had a significantly lower survival rate compared to patients who did not have dyspnea at presentation and patients who have chronic obstructive pulmonary disease and cerebrovascular disease were associated with a significantly increased risk of mortality Conclusions: It has been shown that there is a significant increase in the risk of mortality in COVID-19 patients with chronic obstructive pulmonary disease and cerebrovascular diseases. Additionally, Dyspnea, as an admission symptom, were found to have an effect on mortality and clinical outcomes in our study.