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1.
Respir Med Case Rep ; 36: 101615, 2022.
Article in English | MEDLINE | ID: covidwho-1692918

ABSTRACT

A 70-year-old man diagnosed with idiopathic pulmonary fibrosis (IPF) one year earlier developed progressive exertional dyspnea 3 weeks after onset of coronavirus disease 2019 (COVID-19). High-resolution computed tomography showed new extensive ground-glass opacities with rapidly progressive honeycombing. Although he was diagnosed with acute exacerbation (AE) of IPF triggered by COVID-19 and received methylprednisolone pulse therapy twice within one month, there was no improvement of oxygenation and lung involvement. Three months after COVID-19 onset, it was decided to provide best supportive care. An AE of IPF as a sequela of COVID-19, which is recognized as macrophage activation syndrome, is fatal, and in this case, the measurement of serum heme oxygenase-1, which is a macrophage activation biomarker involved in pulmonary cellular protection against oxidative stress, was useful for tracking disease activity.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-317164

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with COVID-19 symptoms are suspected of disease. Computed tomography (CT) in patients with suspected COVID-19 may be reasonable for triaging, and CT-first triage strategies have been proposed. However, clinical evaluation of a CT-first triage protocol is lacking. The aim of this study is to investigate the real-world efficacy and limitations of a CT-first triage strategy in patients with suspected COVID-19. Methods: : This was a single-center cohort study evaluating outpatients with suspected COVID-19 who underwent a medical examination at Yokohama City University Hospital and who were prospectively registered between 9 February and 5 May 2020. We treated patients according to the CT-first triage protocol. CT findings were classified into five categories according to the COVID-19 Reporting and Data System (CO-RADS). With the CT-first triage protocol, patients with a suspicious clinical history, symptoms, or suspicious findings on chest CT were allocated to the COVID-19 suspected group. The primary outcome was efficacy of the CT-first triage protocol for outpatients with suspected COVID-19. We conducted additional analyses of the isolation time of outpatients with suspected COVID-19 and reached final diagnoses. Results: : In total, 108 outpatients with suspected COVID-19 were examined at our hospital. Forty-eight patients (44.9%) were categorized as CO-RADS 1, 26 patients (24.3%) as CO-RADS 2, 14 patients (13.1%) as CO-RADS 3, 6 patients (5.6%) as CO-RADS 4, and 13 patients (12.1%) as CO-RADS 5. One patient was excluded because of pregnancy. Using the CT-first triage protocol, 48 (44.9%) patients were suspected of having COVID-19. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction;no patients in the group not suspected of having COVID-19 were diagnosed with COVID-19 during follow up. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: : Our CT-first triage protocol was acceptable for triaging outpatients with suspected COVID-19. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is limited.

5.
Medicine (Baltimore) ; 100(22): e26161, 2021 Jun 04.
Article in English | MEDLINE | ID: covidwho-1258818

ABSTRACT

ABSTRACT: The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs 1037.0 minutes, P < .001).Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.


Subject(s)
COVID-19/diagnostic imaging , Tomography, X-Ray Computed/methods , Triage/methods , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Clinical Protocols , Comorbidity , Female , Humans , Japan , Male , Middle Aged , SARS-CoV-2 , Sensitivity and Specificity , Severity of Illness Index , Sex Factors , Young Adult
6.
J Thorac Dis ; 13(1): 202-212, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1079879

ABSTRACT

BACKGROUND: Although the US government approved hydroxychloroquine (HCQ) and chloroquine (CQ) for hospitalized coronavirus disease 19 (COVID-19) patients, some studies denied efficacy of HCQ and CQ. We aimed to evaluate HCQ/CQ treatment for COVID-19. METHODS: Five databases were searched on April 15, 2020, without publication date restriction. We followed both Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology statement reporting recommendations. A random-model meta-analysis was conducted to pool odds ratio (OR) and hazard ratio (HR). The quality of evidence for each outcome and the final recommendation was assessed using the GRADE guidelines of the American College of Chest Physicians. RESULTS: We identified four randomized controlled trials (RCTs) and four observational studies with 2,063 COVID-19 cases. All-cause mortality was not affected by the administration of HCQ/CQ [OR: 1.05, 95% confidence interval (CI): 0.53-2.09, P=0.89]. No improvement of viral clearance was found neither by time-to-event analysis (HR: 1.19, 95% CI: 0.74-1.94, P=0.47) nor frequency on day 7 (OR: 1.47, 95% CI: 0.33-6.63, P=0.62). HCQ/CQ treatment increased the risk of the any adverse event with OR of 3.56 (95% CI: 1.62-7.83, P=0.002). CONCLUSIONS: HCQ/CQ failed to decrease the all-cause mortality (very low quality evidence) and did not improve viral clearance (low or very low quality evidence) but increased the risk of any adverse event (moderate quality evidence). Routine administration of HCQ/CQ for COVID-19 patients is not recommended (weak recommendation, Grade 2C).

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