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1.
Diabetes Metab Res Rev ; : e3519, 2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1640696

ABSTRACT

AIM: To explore the association of obesity with the progression and outcome of coronavirus disease 2019 (COVID-19) at the acute period and 5-month follow-up from the perspectives of computed tomography (CT) imaging with artificial intelligence (AI) - based quantitative evaluation, which may help to predict the risk of obese COVID-19 patients progressing to severe and critical disease. MATERIALS AND METHODS: This retrospective cohort enrolled 213 hospitalized COVID-19 patients. Patients were classified into three groups according to their body mass index (BMI): normal weight (from 18.5 to < 24 kg/m2 ), overweight (from 24 to < 28 kg/m2 ), and obesity (≥ 28 kg/m2 ). RESULTS: Compared with normal weight patients, patients with higher BMI were associated with more lung involvements in lung CT examination [lung lesions volume (cm3 ), normal weight vs overweight vs obesity; 175.5(34.0-414.9) vs 261.7(73.3-576.2) vs 395.8(101.6-1135.6); P = .002], and were more inclined to deterioration at the acute period. At the 5-month follow-up, the lung residual lesion was more serious [residual total lung lesions volume (cm3 ), normal weight vs overweight vs obesity; 4.8(0.0-27.4) vs 10.7(0.0-55.5) vs 30.1(9.5-91.1); P = .015] and the absorption rates were lower for higher BMI patients [absorption rates of total lung lesions volume (%), normal weight vs overweight vs obesity; 99.6(94.0-100.0) vs 98.9(85.2-100.0) vs 88.5(66.5-95.2); P = .013]. The clinical-plus-AI parameter model was superior to the clinical-only parameter model in the prediction of disease deterioration [AUC (areas under the ROC curve), 0.884 vs 0.794, P < .05]. CONCLUSIONS: Obesity was associated with severe pneumonia lesions on CT and adverse clinical outcomes. The AI-based model with combinational use of clinical and CT parameters had incremental prognostic value over the clinical parameters alone. This article is protected by copyright. All rights reserved.

2.
Epidemiol Infect ; 148: e168, 2020 08 04.
Article in English | MEDLINE | ID: covidwho-1537262

ABSTRACT

This study aimed to identify clinical features for prognosing mortality risk using machine-learning methods in patients with coronavirus disease 2019 (COVID-19). A retrospective study of the inpatients with COVID-19 admitted from 15 January to 15 March 2020 in Wuhan is reported. The data of symptoms, comorbidity, demographic, vital sign, CT scans results and laboratory test results on admission were collected. Machine-learning methods (Random Forest and XGboost) were used to rank clinical features for mortality risk. Multivariate logistic regression models were applied to identify clinical features with statistical significance. The predictors of mortality were lactate dehydrogenase (LDH), C-reactive protein (CRP) and age based on 500 bootstrapped samples. A multivariate logistic regression model was formed to predict mortality 292 in-sample patients with area under the receiver operating characteristics (AUROC) of 0.9521, which was better than CURB-65 (AUROC of 0.8501) and the machine-learning-based model (AUROC of 0.4530). An out-sample data set of 13 patients was further tested to show our model (AUROC of 0.6061) was also better than CURB-65 (AUROC of 0.4608) and the machine-learning-based model (AUROC of 0.2292). LDH, CRP and age can be used to identify severe patients with COVID-19 on hospital admission.


Subject(s)
Coronavirus Infections/mortality , Coronavirus Infections/therapy , Logistic Models , Machine Learning , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Adolescent , Adult , Aged , COVID-19 , China/epidemiology , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Prognosis , ROC Curve , Reproducibility of Results , Retrospective Studies , Risk Assessment/methods , Young Adult
3.
Evid Based Complement Alternat Med ; 2021: 4303380, 2021.
Article in English | MEDLINE | ID: covidwho-1455773

ABSTRACT

Background: In view of the global efforts to develop effective treatments for the current worldwide coronavirus 2019 (COVID-19) pandemic, Qingfei Paidu decoction (QPD), a novel traditional Chinese medicine (TCM) prescription, was formulated as an optimized combination of constituents of classic prescriptions used to treat numerous febrile and respiratory-related diseases. This prescription has been used to treat patients with COVID-19 pneumonia in Wuhan, China. Hypothesis/Purpose. We hypothesized that QPD would have beneficial effects on patients with COVID-19. We aimed to prove this hypothesis by evaluating the efficacy of QPD in patients with COVID-19 pneumonia. Methods: In this single-center, retrospective, observational study, we identified eligible participants who received a laboratory diagnosis of COVID-19 between January 15 and March 15, 2020, in the west campus of Union Hospital in Wuhan, China. QPD was supplied as an oral liquid packaged in 200-mL containers, and patients were orally administered one package twice daily 40 minutes after a meal. The primary outcome was death, which was compared between patients who did and did not receive QPD (QPD and NoQPD groups, respectively). Propensity score matching (PSM) was used to identify cohorts. Results: In total, 239 and 522 participants were enrolled in the QPD and NoQPD groups, respectively. After PSM at a 1 : 1 ratio, 446 patients meeting the criteria were included in the analysis with 223 in each arm. In the QPD and NoQPD groups, 7 (3.2%) and 29 (13.0%) patients died, and those in the QPD group had a significantly lower risk of death (hazard ratio (HR) 0.29, 95% CI: 0.13-0.67) than those in the NoQPD group (p = 0.004). Furthermore, the survival time was significantly longer in the QPD group than in the NoQPD group (p < 0.001). Conclusion: The use of QPD may reduce the risk of death in patients with COVID-19 pneumonia.

4.
Atmos Environ (1994) ; 264: 118715, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1415204

ABSTRACT

In recent years, nitrate plays an increasingly important role in haze pollution and strict emission control seems ineffective in reducing nitrate pollution in China. In this study, observations of gaseous and particulate pollutants during the COVID-19 lockdown, as well as numerical modelling were integrated to explore the underlying causes of the nonlinear response of nitrate mitigation to nitric oxides (NOx) reduction. We found that, due to less NOx titration effect and the transition of ozone (O3) formation regime caused by NOx emissions reduction, a significant increase of O3 (by ∼ 69%) was observed during the lockdown period, leading to higher atmospheric oxidizing capacity and facilitating the conversion from NOx to oxidation products like nitric acid (HNO3). It is proven by the fact that 26-61% reduction of NOx emissions only lowered surface HNO3 by 2-3% in Hebi and Nanjing, eastern China. In addition, ammonia concentration in Hebi and Nanjing increased by 10% and 40% during the lockdown, respectively. Model results suggested that the increasing ammonia can promote the gas-particle partition and thus enhance the nitrate formation by up to 20%. The enhanced atmospheric oxidizing capacity together with increasing ammonia availability jointly promotes the nitrate formation, thereby partly offsetting the drop of NOx. This work sheds more lights on the side effects of a sharp NOx reduction and highlights the importance of a coordinated control strategy.

5.
Adv Mater ; 32(42): e2002940, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-743232

ABSTRACT

Recent years have seen enormous advances in nanovaccines for both prophylactic and therapeutic applications, but most of these technologies employ chemical or hybrid semi-biosynthetic production methods. Thus, production of nanovaccines has to date failed to exploit biology-only processes like complex sequential post-translational biochemical modifications and scalability, limiting the realization of the initial promise for offering major performance advantages and improved therapeutic outcomes over conventional vaccines. A Nano-B5 platform for in vivo production of fully protein-based, self-assembling, stable nanovaccines bearing diverse antigens including peptides and polysaccharides is presented here. Combined with the self-assembly capacities of pentamer domains from the bacterial AB5 toxin and unnatural trimer peptides, diverse nanovaccine structures can be produced in common Escherichia coli strains and in attenuated pathogenic strains. Notably, the chassis of these nanovaccines functions as an immunostimulant. After showing excellent lymph node targeting and immunoresponse elicitation and safety performance in both mouse and monkey models, the strong prophylactic effects of these nanovaccines against infection, as well as their efficient therapeutic effects against tumors are further demonstrated. Thus, the Nano-B5 platform can efficiently combine diverse modular components and antigen cargos to efficiently generate a potentially very large diversity of nanovaccine structures using many bacterial species.


Subject(s)
Nanoparticles , Proteins/chemistry , Proteins/immunology , Vaccination , Antigens/immunology , Proteins/metabolism
6.
Engineering (Beijing) ; 2021 Jul 13.
Article in English | MEDLINE | ID: covidwho-1306953

ABSTRACT

In 2020 and 2021, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, caused a global pandemic. Vaccines are expected to reduce the pressure of prevention and control, and have become the most effective strategy to solve the pandemic crisis. SARS-CoV-2 infects the host by binding to the cellular receptor angiotensin converting enzyme 2 (ACE2) via the receptor-binding domain (RBD) of the surface spike (S) glycoprotein. In this study, a candidate vaccine based on a RBD recombinant subunit was prepared by means of a novel glycoengineered yeast Pichia pastoris expression system with characteristics of glycosylation modification similar to those of mammalian cells. The candidate vaccine effectively stimulated mice to produce high-titer anti-RBD specific antibody. Furthermore, the specific antibody titer and virus-neutralizing antibody (NAb) titer induced by the vaccine were increased significantly by the combination of the double adjuvants Al(OH)3 and CpG. Our results showed that the virus-NAb lasted for more than 6 months in mice. To summarize, we have obtained a SARS-CoV-2 vaccine based on the RBD of the S glycoprotein expressed in glycoengineered Pichia pastoris, which stimulates neutralizing and protective antibody responses. A technical route for fucose-free complex-type N-glycosylation modified recombinant subunit vaccine preparation has been established.

7.
Medicine (Baltimore) ; 100(24): e26370, 2021 Jun 18.
Article in English | MEDLINE | ID: covidwho-1269624

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an epidemic infectious disease resulted from 2019 novel coronavirus (2019-nCoV). Up till now, COVID-19 has swept globally. Currently, due to many high-profiled benefits, clinical studies on Toujie Quwen granule (TJQW) have been increasing. The aim of the study is to assess the efficacy and safety of TJQW used with conventional western therapy for COVID-19. METHODS: Relevant randomized controlled trials (RCTs) were searched in Chinese and English databases, and the search time is January 2020 to May 2021. English databases include PubMed, Embase, Web of Science, and the Cochrane Library. Chinese databases include CNKI, WF, VIP, and CBM. The international clinical trial registration platform and the Chinese clinical trial registration platform of controlled trials will be searched by us from January 2020 to May 2021. According to the inclusion and exclusion criteria, screening literature, extraction data will be conducted by 2 researchers independently. Statistical analysis will be conducted using the RevMan 5.3.5 software. After screening the literature based on the inclusion and exclusion criteria, The Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to evaluate the quality of each result. RESULTS: This study will provide the evidence for TJQW to be used with conventional western therapy for COVID-19. CONCLUSION: The efficacy and safety of TJQW used with conventional western therapy for COVID-19 will be assessed. INPLASY REGISTRATION NUMBER: INPLASY202150038.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drugs, Chinese Herbal/therapeutic use , Meta-Analysis as Topic , Nutritional Support , Phytotherapy , Respiratory Therapy , Systematic Reviews as Topic , Antiviral Agents/adverse effects , Combined Modality Therapy , Drugs, Chinese Herbal/adverse effects , Humans , Pandemics , SARS-CoV-2
8.
Psychol Health Med ; : 1-6, 2021 May 11.
Article in English | MEDLINE | ID: covidwho-1223229

ABSTRACT

This study aimed to explore which age group out of the patients in quarantine wards with novel coronavirus pneumonia is the most susceptible to anxiety. The data of 32 Covid-19 patients isolated in the quarantine wards of the second Infectious Diseases Department of Baoding Hospital and 71 Covid-19 patients in Tangshan City Infectious Disease Hospital from January 24th to March 5th, 2020, a total of 103 patients, were analyzed. Among these patients, 97 isolated patients were scored with a self-rating anxiety scale (SAS) score seven days after quarantine, and the correlation between age and score was analyzed. These 97 isolated patients were then divided into three groups according to age: group A (up to 35 years old), group B (36-60 years), and group C (over 60 years). One-way analysis of variance was used to compare the scores among groups. The Q-test was used for pairwise comparison.P < 0.05 was considered statistically significant.There was a negative correlation between age and SAS score in isolated Covid-19 patients, and the differences in the score among groups were statistically significant. Patients under 35 years old were more prone to anxiety when they were isolated for seven days. Isolated patients aged up to 35 years old need more attention from quarantine medical staff, communication should be strengthened, and psychological intervention from psychotherapists should be given if necessary.

9.
ISPRS International Journal of Geo-Information ; 10(3):135, 2021.
Article in English | Academic Search Complete | ID: covidwho-1159819

ABSTRACT

Understanding sentiment changes in tourist flow is critical in designing exciting experiences for tourists and promoting sustainable tourism development. This paper proposes a novel analytical framework to investigate the tourist sentiment changes between different attractions based on geotagged social media data. Our framework mainly focuses on visualizing the detailed sentiment changes of tourists and exploring the valuable spatiotemporal pattern of the sentiment changes in tourist flow. The tourists were first identified from social media users. Then, we accurately evaluated the tourist sentiment by constructing a Chinese sentiment dictionary, grammatical rule, and sentiment score. Based on the location information of social media data, we built and visualized the tourist flow network. Last, to further reveal the impact of attractions on the sentiment of tourist flow, the positive and negative sentiment profiles were generated by mining social media texts. We took Beijing, a famous tourist destination in China, as a case study. Our results revealed the following: (1) the temporal trend of tourist sentiment has seasonal characteristics and is significantly influenced by government control policies against COVID-19;(2) due to the impact of the attraction's historical background, some tourist flows with highly decreased sentiment strength are linked to attractions;(3) on the long journey to the attraction, the sentiment strength of tourists decreases;and (4) bad traffic conditions can significantly decrease tourist sentiment. This study highlights the methodological implications of visualizing sentiment changes during collective tourist movement and provides comprehensive insight into the spatiotemporal pattern of tourist sentiment. [ABSTRACT FROM AUTHOR] Copyright of ISPRS International Journal of Geo-Information is the property of MDPI Publishing 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.)

10.
Epidemiol Infect ; 149: e61, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1124622

ABSTRACT

A fever clinic within a hospital plays a vital role in pandemic control because it serves as an outpost for pandemic discovery, monitoring and handling. As the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan was gradually brought under control, the fever clinic in the West Campus of Wuhan Union Hospital introduced a new model for construction and management of temporary mobile isolation wards. A traditional battlefield hospital model was combined with pandemic control regulations, to build a complex of mobile isolation wards that used adaptive design and construction for medical operational, medical waste management and water drainage systems. The mobile isolation wards allowed for the sharing of medical resources with the fever clinic. This increased the capacity and efficiency of receiving, screening, triaging and isolation and observation of patients with fever. The innovative mobile isolation wards also controlled new sudden outbreaks of COVID-19. We document the adaptive design and construction model of the novel complex of mobile isolation wards and explain its characteristics, functions and use.


Subject(s)
Fever/therapy , Models, Organizational , Patient Isolation/methods , COVID-19/complications , COVID-19/epidemiology , China/epidemiology , Fever/epidemiology , Humans , Infection Control/instrumentation , Infection Control/methods , Patient Isolation/trends
11.
J Infect Dis ; 223(4): 568-580, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1101847

ABSTRACT

BACKGROUND: The immune protective mechanisms during severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection remain to be deciphered for the development of an effective intervention approach. METHODS: We examined early responses of interleukin 37 (IL-37), a powerful anti-inflammatory cytokine, in 254 SARS-CoV-2-infected patients before any clinical intervention and determined its correlation with clinical prognosis. RESULTS: Our results demonstrated that SARS-CoV-2 infection causes elevation of plasma IL-37. Higher early IL-37 responses were correlated with earlier viral RNA negative conversion, chest computed tomographic improvement, and cough relief, consequently resulted in earlier hospital discharge. Further assays showed that higher IL-37 was associated with lower interleukin 6 and interleukin 8 (IL-8) and higher interferon α responses and facilitated biochemical homeostasis. Low IL-37 responses predicted severe clinical prognosis in combination with IL-8 and C-reactive protein. In addition, we observed that IL-37 administration was able to attenuate lung inflammation and alleviate respiratory tissue damage in human angiotensin-converting enzyme 2-transgenic mice infected with SARS-CoV-2. CONCLUSIONS: Overall, we found that IL-37 plays a protective role by antagonizing inflammatory responses while retaining type I interferon, thereby maintaining the functionalities of vital organs. IL-37, IL-8, and C-reactive protein might be formulated as a precise prediction model for screening severe clinical cases and have good value in clinical practice.


Subject(s)
COVID-19/immunology , Cytokine Release Syndrome/virology , Interleukin-1/blood , Adult , Animals , C-Reactive Protein/metabolism , COVID-19/blood , Female , Humans , Inflammation/immunology , Inflammation/virology , Interleukin-8/blood , Male , Mice , Mice, Transgenic , Middle Aged
12.
Preprint | SciFinder | ID: ppcovidwho-4150

ABSTRACT

the latest research progress of impact of COVID-19 on pregnancy is reviewed. It includes interaction of COVID-19 and pregnancy, impact of COVID-19 on pregnant women and fetals, diagnosis and treatment of COVID-19 during the pregnancy.

13.
Crit Care Med ; 48(11): e1004-e1011, 2020 11.
Article in English | MEDLINE | ID: covidwho-998501

ABSTRACT

OBJECTIVES: To evaluate and compare the efficacy of National Early Warning Score, National Early Warning Score 2, Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment on predicting in-hospital death in patients with coronavirus disease 2019. DESIGN: A retrospective, observational study. SETTING: Single center, West Campus of Wuhan Union hospital-a temporary center to manage critically ill patients with coronavirus disease 2019. PATIENTS: A total of 673 consecutive adult patients with coronavirus disease 2019 between January 30, 2020, and March 14, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data on demography, comorbidities, vital signs, mental status, oxygen saturation, and use of supplemental oxygen at admission to the ward were collected from medical records and used to score National Early Warning Score, National Early Warning Score 2, Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment. Total number of patients was 673 (51% male) and median (interquartile range) age was 61 years (50-69 yr). One-hundred twenty-one patients died (18%). For predicting in-hospital death, the area under the receiver operating characteristics (95% CI) for National Early Warning Score, National Early Warning Score 2, Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment were 0.882 (0.847-0.916), 0.880 (0.845-0.914), 0.839 (0.800-0.879), 0.766 (0.718-0.814), and 0.694 (0.641-0.746), respectively. Among the parameters of National Early Warning Score, the oxygen saturation score was found to be the most significant predictor of in-hospital death. The area under the receiver operating characteristic (95% CI) for oxygen saturation score was 0.875 (0.834-0.916). CONCLUSIONS: In this single-center study, the discrimination of National Early Warning Score/National Early Warning Score 2 for predicting mortality in patients with coronavirus disease 2019 admitted to the ward was found to be superior to Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment. Peripheral oxygen saturation could independently predict in-hospital death in these patients. Further validation of our finding in multiple settings is needed to determine its applicability for coronavirus disease 2019.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Critical Illness/mortality , Early Warning Score , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Aged , Blood Pressure , COVID-19 , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Middle Aged , Organ Dysfunction Scores , Pandemics , Prognosis , Retrospective Studies , Risk Assessment , SARS-CoV-2
14.
Small ; 16(46): e2004237, 2020 11.
Article in English | MEDLINE | ID: covidwho-891902

ABSTRACT

Prevention and intervention methods are urgently needed to curb the global pandemic of coronavirus disease-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Herein, a general pro-antigen strategy for subunit vaccine development based on the reversibly formulated receptor binding domain of SARS-CoV-2 spike protein (S-RBD) is reported. Since the poor lymph node targeting and uptake of S-RBD by antigen-presenting cells prevent effective immune responses, S-RBD protein is formulated into a reversible nanogel (S-RBD-NG), which serves as a pro-antigen with enhanced lymph node targeting and dendritic cell and macrophage accumulation. Synchronized release of S-RBD monomers from the internalized S-RBD-NG pro-antigen triggers more potent immune responses in vivo. In addition, by optimizing the adjuvant used, the potency of S-RBD-NG is further improved, which may provide a generally applicable, safer, and more effective strategy for subunit vaccine development against SARS-CoV-2 as well as other viruses.


Subject(s)
Antigens, Viral/immunology , COVID-19/immunology , COVID-19/prevention & control , Immunity , Nanogels/chemistry , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/metabolism , Animals , COVID-19/virology , Cell Line , Dendritic Cells/metabolism , Immunization , Lymph Nodes/immunology , Macrophages/metabolism , Mice , Nanogels/ultrastructure , Neutralization Tests , Protein Domains , Spike Glycoprotein, Coronavirus/chemistry
15.
Open Forum Infect Dis ; 7(7): ofaa283, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-846713

ABSTRACT

Background: Clinical manifestation and neonatal outcomes of pregnant women with coronavirus disease 2019 (COVID-19) were unclear in Wuhan, China. Methods: We retrospectively analyzed clinical characteristics of pregnant and nonpregnant women with COVID-19 aged from 20 to 40, admitted between January 15 and March 15, 2020 at Union Hospital, Wuhan, and symptoms of pregnant women with COVID-19 and compared the clinical characteristics and symptoms to historic data previously reported for H1N1. Results: Among 64 patients, 34 (53.13%) were pregnant, with higher proportion of exposure history (29.41% vs 6.67%) and more pulmonary infiltration on computed tomography test (50% vs 10%) compared to nonpregnant women. Of pregnant patients, 27 (79.41%) completed pregnancy, 5 (14.71%) had natural delivery, 18 (52.94%) had cesarean section, and 4 (11.76%) had abortion; 5 (14.71%) patients were asymptomatic. All 23 newborns had negative reverse-transcription polymerase chain results, and an average 1-minute Apgar score was 8-9 points. Pregnant and nonpregnant patients show differences in symptoms such as fever, expectoration, and fatigue and on laboratory tests such as neurophils, fibrinogen, D-dimer, and erythrocyte sedimentation rate. Pregnant patients with COVID-19 tend to have more milder symptoms than those with H1N1. Conclusions: Clinical characteristics of pregnant patients with COVID-19 are less serious than nonpregnant. No evidence indicated that pregnant women may have fetal infection through vertical transmission of COVID-19. Pregnant patients with H1N1 had more serious condition than those with COVID-19.

16.
Preprint | SSRN | ID: ppcovidwho-781

ABSTRACT

Background: WHO recently characterized Coronavirus disease 2019 (COVID-19) as a pandemic. We aimed to evaluate and compare the efficacy of a National Early Warni

17.
Radiology ; 295(3): 715-721, 2020 06.
Article in English | MEDLINE | ID: covidwho-399089

ABSTRACT

Background Chest CT is used to assess the severity of lung involvement in coronavirus disease 2019 (COVID-19). Purpose To determine the changes in chest CT findings associated with COVID-19 from initial diagnosis until patient recovery. Materials and Methods This retrospective review included patients with real-time polymerase chain reaction-confirmed COVID-19 who presented between January 12, 2020, and February 6, 2020. Patients with severe respiratory distress and/or oxygen requirement at any time during the disease course were excluded. Repeat chest CT was performed at approximately 4-day intervals. Each of the five lung lobes was visually scored on a scale of 0 to 5, with 0 indicating no involvement and 5 indicating more than 75% involvement. The total CT score was determined as the sum of lung involvement, ranging from 0 (no involvement) to 25 (maximum involvement). Results Twenty-one patients (six men and 15 women aged 25-63 years) with confirmed COVID-19 were evaluated. A total of 82 chest CT scans were obtained in these patients, with a mean interval (±standard deviation) of 4 days ± 1 (range, 1-8 days). All patients were discharged after a mean hospitalization period of 17 days ± 4 (range, 11-26 days). Maximum lung involved peaked at approximately 10 days (with a calculated total CT score of 6) from the onset of initial symptoms (R2 = 0.25, P < .001). Based on quartiles of chest CT scans from day 0 to day 26 involvement, four stages of lung CT findings were defined. CT scans obtained in stage 1 (0-4 days) showed ground-glass opacities (18 of 24 scans [75%]), with a mean total CT score of 2 ± 2; scans obtained in stage 2 (5-8 days) showed an increase in both the crazy-paving pattern (nine of 17 scans [53%]) and total CT score (mean, 6 ± 4; P = .002); scans obtained in stage 3 (9-13 days) showed consolidation (19 of 21 scans [91%]) and a peak in the total CT score (mean, 7 ± 4); and scans obtained in stage 4 (≥14 days) showed gradual resolution of consolidation (15 of 20 scans [75%]) and a decrease in the total CT score (mean, 6 ± 4) without crazy-paving pattern. Conclusion In patients recovering from coronavirus disease 2019 (without severe respiratory distress during the disease course), lung abnormalities on chest CT scans showed greatest severity approximately 10 days after initial onset of symptoms. © RSNA, 2020.


Subject(s)
Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Adult , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Lung/virology , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Radiography, Thoracic/methods , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methods
19.
Resuscitation ; 151: 18-23, 2020 06.
Article in English | MEDLINE | ID: covidwho-46293

ABSTRACT

OBJECTIVE: To describe the characteristics and outcomes of patients with severe COVID-19 and in-hospital cardiac arrest (IHCA) in Wuhan, China. METHODS: The outcomes of patients with severe COVID-19 pneumonia after IHCA over a 40-day period were retrospectively evaluated. Between January 15 and February 25, 2020, data for all cardiopulmonary resuscitation (CPR) attempts for IHCA that occurred in a tertiary teaching hospital in Wuhan, China were collected according to the Utstein style. The primary outcome was restoration of spontaneous circulation (ROSC), and the secondary outcomes were 30-day survival, and neurological outcome. RESULTS: Data from 136 patients showed 119 (87.5%) patients had a respiratory cause for their cardiac arrest, and 113 (83.1%) were resuscitated in a general ward. The initial rhythm was asystole in 89.7%, pulseless electrical activity (PEA) in 4.4%, and shockable in 5.9%. Most patients with IHCA were monitored (93.4%) and in most resuscitation (89%) was initiated <1 min. The average length of hospital stay was 7 days and the time from illness onset to hospital admission was 10 days. The most frequent comorbidity was hypertension (30.2%), and the most frequent symptom was shortness of breath (75%). Of the patients receiving CPR, ROSC was achieved in 18 (13.2%) patients, 4 (2.9%) patients survived for at least 30 days, and one patient achieved a favourable neurological outcome at 30 days. Cardiac arrest location and initial rhythm were associated with better outcomes. CONCLUSION: Survival of patients with severe COVID-19 pneumonia who had an in-hospital cardiac arrest was poor in Wuhan.


Subject(s)
Betacoronavirus , Cardiopulmonary Resuscitation/methods , Coronavirus Infections/complications , Heart Arrest/mortality , Hospital Mortality , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , COVID-19 , China , Cohort Studies , Female , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/etiology , Pneumonia, Viral/mortality , Prognosis , Retrospective Studies , Risk Assessment , SARS-CoV-2 , Survival Analysis , Treatment Outcome
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