COVID-19: comparison lung CT signs and biochemical parameters in the groups of patients with three-time positive RT-PCR and with triple negative RT-PCR test during the period of hospitalization.

Research goal. Comparative characteristics of the dynamics of CT semiotics and biochemical parameters of two groups of patients: with positive RT-PCR and with triple negative RT-PCR. Reflection of the results by comparing them with the data already available in the literature. The aim of the study is to compare the dynamics of CT semiotics and biochemical parameters of blood tests in two groups of patients: with positive RT-PCR and with triple negative RT-PCR. We also reflect the results by comparing them with the data already available in the literature. Materials and methods. We have performed a retrospective analysis of CT images of 66 patients: group I (n1 = 33) consists of patients who had three- time negative RT-PCR (nasopharyngeal swab for SARS-CoV-2 RNA) during hospitalization, and group II (n2 = 33) includes patients with triple positive RT-PCR. An important selection criterion is the presence of three CT examinations (primary, 1st CT and two dynamic examinations - 2nd CT and 3rd CT) and at least two results of biochemistry (C-reactive protein (CRP), fibrinogen, prothrombin time, procalcitonin) performed in a single time interval of +/- 5 days from 1st CT, upon admission, and +/- 5 days from 3st CT. A total of 198 CT examinations of the lungs were analyzed (3 examinations per patient). Results. The average age of patients in the first group was 58 +/- 14.4 years, in the second - 64.9 +/- 15.7 years. The number of days from the moment of illness to the primary CT scan 6.21 +/- 3.74 in group I, 7.0 (5.0-8.0) in group II, until the 2nd CT scan - 12.5 +/- 4, 87 and 12.0 (10.0-15.0), before the 3rd CT scan - 22.0 (19.0-26.0) and 22.0 (16.0-26.0), respectively. In both groups, all 66 patients (100%), the primary study identified the double-sided ground-glass opacity symptom and 36 of 66 (55%) patients showed consolidation of the lung tissue. Later on, a first follow-up CT defined GGO not in all the cases: it was presented in 22 of 33 (67%) patients with negative RT-PCR (group I) and in 28 of 33 (85%) patients with the positive one (group II). The percentage of studies showing consolidation increased significantly: up to 30 of 33 (91%) patients in group I, and up to 32 of 33 (97%) patients in group II. For the first time, radiological symptoms of "involutional changes" appeared: in 17 (52%) patients of the first group and in 5 (15%) patients of the second one. On second follow-up CT, GGO and consolidations were detected less often than on previous CT: in 1 and 27 patients of group I (3% and 82%, respectively) and in 6 and 30 patients of group II (18% and 91%, respectively), although the consolidation symptom still prevailed significantly . The peak of "involutional changes" occurred on last CT: 31 (94%) and 25 (76%) patients of groups I and II, respectively.So, in the groups studied, the dynamics of changes in lung CT were almost equal. After analyzing the biochemistry parameters, we found out that CRP significantly decreased in 93% of patients (p < 0.001) in group I;in group II, there was a statistically significant decrease in the values of C-reactive protein in 81% of patients (p = 0.005). With an increase in CT severity of coronavirus infection by one degree, an increase in CRP by 41.8 mg/ml should be expected. In group I, a statistically significant (p = 0.001) decrease in fibrinogen was recorded in 77% of patients;and a similar dynamic of this indicator was observed in group II: fibrinogen values decreased in 66% of patients (p = 0.002). Such parameters as procalcitonin and prothrombin time did not significantly change during inpatient treatment of the patients of the studied groups (p = 0.879 and p = 0.135), which may indicate that it is inappropriate to use these parameters in assessing dynamics of patients with a similar course of the disease. When comparing the outcomes of the studied groups, there was a statistically significant higher mortality in group II - 30.3%, in group I - 21.2% (p = 0.043). Conclusion. According to our data, a course of the disease does not significantly differ in the groups o patients with positive RT-PCR and three-time negative RT-PCR. A negative RT-PCR analysis may be associated with an individual peculiarity of a patient such as a low viral load of SARS-CoV-2 in the upper respiratory tract. Therefore, with repeated negative results on the RNA of the virus in the oro- and nasopharynx, one should take into account the clinic, the X-ray picture and biochemical indicators in dynamics and not be afraid to make a diagnosis of COVID-19.Copyright © 2021 ALIES. All rights reserved.

Late complications of the new coronavirus infection: a clinical case.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood. Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis. Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.Copyright © Chepurnenko S.A. et al., 2023.

Low-dose radiation therapy suppresses viral pneumonia by enhancing broad-spectrum anti-inflammatory responses via transforming growth factor-ß production.

Low-dose radiation therapy (LDRT) can suppress intractable inflammation, such as that in rheumatoid arthritis, and is used for treating more than 10,000 rheumatoid arthritis patients annually in Europe. Several recent clinical trials have reported that LDRT can effectively reduce the severity of coronavirus disease (COVID-19) and other cases of viral pneumonia. However, the therapeutic mechanism of LDRT remains unelucidated. Therefore, in the current study, we aimed to investigate the molecular mechanism underlying immunological alterations in influenza pneumonia after LDRT. Mice were irradiated to the whole lung 1 day post-infection. The changes in levels of inflammatory mediators (cytokines and chemokines) and immune cell populations in the bronchoalveolar lavage (BALF), lungs, and serum were examined. LDRT-treated mice displayed markedly increased survival rates and reduced lung edema and airway and vascular inflammation in the lung; however, the viral titers in the lungs were unaffected. Levels of primary inflammatory cytokines were reduced after LDRT, and transforming growth factor-ß (TGF-ß) levels increased significantly on day 1 following LDRT. Levels of chemokines increased from day 3 following LDRT. Additionally, M2 macrophage polarization or recruitment was increased following LDRT. We found that LDRT-induced TGF-ß reduced the levels of cytokines and polarized M2 cells and blocked immune cell infiltration, including neutrophils, in BALF. LDRT-induced early TGF-ß production was shown to be a key regulator involved in broad-spectrum anti-inflammatory activity in virus-infected lungs. Therefore, LDRT or TGF-ß may be an alternative therapy for viral pneumonia.

Viral Pneumonia during the COVID-19 Pandemic, 2019-2021 Evoking Needs for SARS-CoV-2 and Additional Vaccinations.

Coronaviruses can cause pneumonia, with clinical symptoms that may be similar to the symptoms of other viral pneumonias. To our knowledge, there have been no reports regarding cases of pneumonia caused by coronaviruses and other viruses among hospitalized patients in the past 3 years before and during coronavirus disease 2019 (COVID-19). Here, we analysed the causes of viral pneumonia among hospitalized patients during the coronavirus disease 2019 (COVID-19) pandemic (2019-2021). Between September 2019 and April 2021, patients hospitalized at Shuang Ho Hospital in north Taiwan with a diagnosis of pneumonia were enrolled in this study. Age, sex, onset date, and season of occurrence were recorded. Respiratory tract pathogens were identified with molecular detection using the FilmArray® platform from nasopharyngeal swabs. In total, 1147 patients (128 patients aged <18 years and 1019 patients aged ≥18 years) with pneumonia and identified respiratory tract pathogens were assessed. Among the 128 children with pneumonia, the dominant viral respiratory pathogen was rhinovirus (24.2%), followed by respiratory syncytial virus (RSV; 22.7%), parainfluenza virus (1 + 2 + 3 + 4) (17.2%), adenovirus (12.5%), metapneumovirus (9.4%), coronavirus (1.6%), and influenza virus (A + B) (1.6%). Among the 1019 adults with pneumonia, the dominant viral respiratory pathogen was rhinovirus (5.0%), followed by RSV (2.0%), coronavirus (2.0%), metapneumovirus (1.5%), parainfluenza virus (1 + 2 + 3 + 4) (1.1%), adenovirus (0.7%), and influenza virus (A + B) (0%). From 2019-2021, older patients (aged >65 years) with pneumonia tested positive for coronavirus most commonly in autumn. Coronavirus was not detected during summer in children or adults. Among children aged 0-6 years, RSV was the most common viral pathogen, and RSV infection occurred most often in autumn. Metapneumovirus infection occurred most often in spring in both children and adults. In contrast, influenza virus was not detected in patients with pneumonia in any season among children or adults from January 2020 to April 2021. Among all patients with pneumonia, the most common viral pathogens were rhinovirus in spring, adenovirus and rhinovirus in summer, RSV and rhinovirus in autumn, and parainfluenza virus in winter. Among children aged 0-6 years, RSV, rhinovirus, and adenovirus were detected in all seasons during the study period. In conclusion, the proportion of pneumonia cases caused by a viral pathogen was higher in children than the proportion in adults. The COVID-19 pandemic period evoked a need for SARS-CoV-2 (severe acute respiratory disease coronavirus 2) vaccination to prevent the severe complications of COVID-19. However, other viruses were also found. Vaccines for influenza were clinically applied. Active vaccines for other viral pathogens such as RSV, rhinovirus, metapneuomoccus, parainfluenza, and adenovirus may need to be developed for special groups in the future.

Efficacy of low-intensity pulsed ultrasound for the treatment of viral pneumonia: study protocol for a randomized controlled trial.

BACKGROUND: Viral pneumonia has always been a problem faced by clinicians because of its insidious onset, strong infectivity, and lack of effective drugs. Patients with advanced age or underlying diseases may experience more severe symptoms and are prone to severe ventilation dysfunction. Reducing pulmonary inflammation and improving clinical symptoms is the focus of current treatment. Low-intensity pulsed ultrasound (LIPUS) can mitigate inflammation and inhibit edema formation. We aimed to investigate the efficacy of therapeutic LIPUS in improving lung inflammation in hospitalized patients with viral pneumonia. METHODS: Sixty eligible participants with clinically confirmed viral pneumonia will be assigned to either (1) intervention group (LIPUS stimulus), (2) control group (null stimulus), or (3) self-control group (LIPUS stimulated areas versus non-stimulated areas). The primary outcome will be the difference in the extent of absorption and dissipation of lung inflammation on computed tomography. Secondary outcomes include changes in lung inflammation on ultrasonography images, pulmonary function, blood gas analysis, fingertip arterial oxygen saturation, serum inflammatory factor levels, the sputum excretion volume, time to the disappearance of pulmonary rales, pneumonia status score, and course of pneumonia. Adverse events will be recorded. DISCUSSION: This study is the first clinical study of the efficacy of therapeutic LIPUS in the treatment of viral pneumonia. Given that the current clinical recovery mainly depends on the body's self-limiting and conventional symptomatic treatment, LIPUS, as a new therapy method, might be a major advance in the treatment of viral pneumonia. TRIAL REGISTRATION: ChiCTR2200059550 Chinese Clinical Trial Registry, May 3, 2022.

Acute Fibrinous Organizing Pneumonia in a COVID-19 Patient: A Case Report

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has varied clinical and radiographic manifestations. Severe initial viral infection, cytokine release, opportunistic infection and post-viral inflammation may all contribute to progressive symptoms and severe lung injury. Acute fibrinous and organizing pneumonitis (AFOP), a rare pattern of acute lung injury characterized by intra-alveolar fibrin ball, has so far been reported associated with infections, connective tissue diseases, drugs and toxins, hematologic malignancy, altered immune status and inhalation injury. Case Report: The authors report a case of 26-year-old man with severe COVID-19 pneumonia that clinical and radiographic imaging worsened after episode of cytokine storm. The diagnosis of AFOP was confirmed by transbronchial biopsy, and the patient was successfully treated with high-dose corticosteroids. Conclusion(s): AFOP can be found in severe COVID-19 patients especially when clinical deterioration occurs later in disease course. Clinical suspicion is needed for prompt diagnosis and treatment. High-dose corticosteroid is an effective medication.Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.

Respiratory support for adult patients with COVID-19

The COVID-19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non-invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID-19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol-generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non-rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non-invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi-organ failure, or acute respiratory distress syndrome (ARDS).Copyright © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.

Fungal osteomyelitis of the skull in patients after COVID-19 associated pneumonia.

Purpose. To demonstrate possibilities of multispiral computed tomography in the detection of fungal osteomyelitis in two patients with second type of diabetes mellitus two and six months after COVID-19 associated pneumonia. Material and methods. We present two clinical observations of patients with second type of diabetes mellitus who complained about pain in the upper jaw, nasal purulent discharge, difficulty in nasal breathing which appeared two and six months after COVID-19 associated pneumonia. To identify pathological changes, patients were directed to the department of radiology for the purpose of performing MSCT of the skull. Results. In the presented clinical cases, using MSCT, the features of the radiological semiotics of skull bone changes were studied in patients with fungal infection on the background of type 2 diabetes mellitus, the use of corticosteroids and after the viral COVID-19 associated pneumonia. The diagnosis was verified by histological and cytological studies of biopsy (surgical) material. Discussion. Recently, there has been an increase in the number of cases of fungal osteomyelitis of the jaws and paranasal sinuses in patients after viral pneumonia caused by SARS-CoV-2. The most common fungal infection is mucormycosis, caused by fungi belonging to the order Mucorales. The rhinocerebral form of mucormycosis is common in patients with diabetes mellitus after treatment with corticosteroids with the background of immunosuppression. This form of mucormycosis contributes to the appearance of extensive bone-destructive changes in the middle and upper zones of the maxillofacial region, requiring further surgical treatment. Conclusion. The 2019 coronavirus infection (COVID-19) caused by SARS-CoV-2 and type 2 diabetes remain urgent healthcare problems worldwide. This combination in a patient after treatment of COVID-19 associated pneumonia with corticosteroids leads to immunosuppression and the development of concomitant infections, including fungal ones. Fungal osteomyelitis in such patients, as a rule, affects the skull and is characterized by an aggressive course and requires surgical treatment. The use of modern and high-tech methods of radiation imaging, such as MSCT, allows to obtain complete diagnostic information about the localization and prevalence of the lesion, which, in the future, determines the management tactics and surgical treatment of patients of this category.Copyright © 2022 Chinese Journal of Pediatric Surgery. All rights reserved.

Application Of Neural Network For The Detection Of Covid-19 Or Viral Pneumonia

A bacterial infection in the lungs can cause viral pneumonia, a disease. Later the middle of December 2019, there have been multiple episodes of pneumonia in Wuhan City, China, with no known cause;it has since been discovered that this pneumonia is actually a new respiratory condition brought on by coronavirus infection. Humans who have lung abnormalities are more likely to develop high-risk conditions;this risk can be decreased with much quicker and more effective therapy. The symptoms of Covid-19 pneumonia are similar to those of viral pneumonia;they are not distinctive. X-ray or Computed Tomography (CT) scan images are used to identify lung abnormalities. Even for a skilled radiologist, it might be challenging to identify Covid-19/Viral pneumonia by looking at the X-ray images. For prompt and effective treatment, accurate diagnosis is essential. In this epidemic condition, delayed diagnosis can cause the number of cases to double, hence a suitable tool is required is necessary for the early identification of Covid-19. This paper highlights various AI techniques as a part of our contribution to swift identification and curie Covid-19 to front-line corona. The safety of Covid-19 people who have viral pneumonia is a concern. Convolutional Neural Networks (CNN) and Recurrent Neural Networks (RNN), two AI technologies from Deep Learning (DL), were utilized to identify Covid-19/Viral pneumonia. The Algorithm is taught utilizing non-public local hospitals or Covid-19 wards, as well as X-ray images of healthy lungs, fake lungs from viral pneumonia, and ostentatious lungs from Covid-19 that are all publicly available. The model is also validated over a lengthy period of time using the transfer learning technique. The results correspond with clinically tested positive Covid-19 patients who underwent Swap testing conducted by medical professionals, giving us an accuracy of 78 to 82 percent. We discovered that each DL model has a unique expertise after testing the various models. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz 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.)

Covid-19 or Viral Pneumonia Detection Using AI Tools

Viral pneumonia is a disease which occurs in lungs due to bacterial infection. Since middle of December 2019, many cases of pneumonia with unknown cause were found in Wuhan City, China;at present, it has been confirmed that it is a new respiratory disorder caused due to coronavirus infection. Lungs abnormality is highly risky condition in humans;the reduction of the risk is done by enabling quick and efficient treatment. The Covid-19 pneumonia is mimicking viral pneumonia, that is, their symptoms are undistinguished. Lung's abnormality is detected by Computed Tomography (CT) scan images or X-ray images. By viewing the X-rays or CT scan images, even for a well-trained radiologist, it is difficult to detect Covid-19/viral pneumonia. For quick and efficient treatment, it is necessary that proper detection must take place and during this epidemic situation, late detection can lead to doubling of cases;hence, there is a need of proper tool for quick detection of Covid-19/viral pneumonia. This chapter is discussing various AI tools for quick detection as a part of our contribution for quick detection and cure of Covid-19 to front line corona worriers and safety of viral pneumonia patients from Covid-19. The two AI tools are from deep learning (DL), that is, Convolutional Neural Networks (CNN) and Recurrent Neural Network (RNN), which are used for the detection of Covid-19/viral pneumonia. The algorithm is trained using available X-ray images of health lungs, viral pneumonia-affected lungs, and Covid-19-affected lungs available through Kaggle and nondisclosed local hospitals or Covid-19 wards. Also transfer learning method is also used for long-lasting validation of the model. The results give us an accuracy for CNN 83.2 to 94.1% results which are also matched with practically tested positive Covid-19 patients using swab tests by doctors. After testing the various models, we also came through that every model of DL has its own specialty. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

CT chest findings in patients infected with COVID-19: review of literature

BackgroundCoronavirus disease 2019 (COVID-19) is a highly infectious disease causing severe respiratory distress syndrome that was first discovered by the end of 2019 in Wuhan, China.Main textA wide variety of CT findings in COVID-19 have been reported in different studies, and the CT findings differ according to the stage of the disease and disease severity and associated co-morbidities. We will discuss each sign separately and its importance in diagnosis and prognosis.ConclusionCT plays a pivotal role in the diagnosis and management of COVID-19 pneumonia. The typical appearance of COVID-19 pneumonia is bilateral patchy areas of ground glass infiltration, more in the lower lobes. The appearance of other signs like consolidation, air bronchogram, crazy pavement appearance, and air bubble signs appear during the course of the disease. In the context of pandemic, the CT chest can be used as a screening tool in symptomatic patients as it is cheaper, available, and time saving.

Therapeutic Effect of Gegentang Granules on Mouse Model with hCoV-229E Pneumonia and Hanshi Yidu Xifei Syndrome.

Objective:To determine the therapeutic effect of Gegentang granules on a disease-syndrome mouse model combining human coronavirus 229EhCoV-229Epneumonia with Hanshi Yidu Xifei syndrome in vivo. Method(s): Mice were randomly divided into normal group,infection group,cold-dampness group,model group,chloroquine phosphate group0.18 g.kg-1,interferon-alpha2bIFN-alpha2bgroup1.83x106 U.kg-1, Gegentang granules high-dose and low-dose groups6.6,3.3 g.kg-1with 10 mice in each group. Cold-dampness environment and hCoV-229E infection were used for modeling,and the general status and lung index of mice in each group were observed. The viral load in lung tissue was detected by real-time fluorescent quantitative polymerase chain reactionReal-time PCR,the pathological changes in lung tissue were evaluated by hematoxylin-eosinHEstaining,the levels of serum gastrointestinal hormones and inflammatory factors in lung tissue were detected by enzyme-linked immunosorbent assayELISA,and the percentage of peripheral blood lymphocytes was detected by flow cytometry. Result(s):Comparing with model group,Gegentang granules could significantly alleviate the physical signs of Hanshi Yidu Xifei syndrome,including listlessness,weakness of limbs,sticky stool,etc. Comparing with model group,Gegentang granules high-dose group significantly reduced lung index,histopathological score of interstitial lung and bronchus,and the level of serum motilinP< 0.05,P<0.01,two doses of Gegentang granules could significantly increase the level of serum gastrinP< 0.05,P<0.01,the percentage of CD4+ ,CD8+ T lymphocytes in peripheral bloodP<0.05,P<0.01,and the level of tumor necrosis factor-alphaTNF-alphain lung tissue was significantly decreasedP<0.01,and the level of interleukin-6IL-6showed decreasing tendency. Conclusion(s): Gegentang granules has therapeutic effect on model mice. It can improve the appearance and behavior characterization,regulate the level of gastrointestinal hormones,decrease lung index and histopathological score,and possibly play an immunomodulatory role by inhibiting the expression of inflammatory cytokines in lung tissue and restoring the percentage of peripheral blood lymphocytes.Copyright © 2022, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Late complications of the new coronavirus infection: a clinical case.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood. Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis. Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.Copyright © Chepurnenko S.A. et al., 2023.

A Real Time Method for Distinguishing COVID-19 Utilizing 2D-CNN and Transfer Learning.

Rapid identification of COVID-19 can assist in making decisions for effective treatment and epidemic prevention. The PCR-based test is expert-dependent, is time-consuming, and has limited sensitivity. By inspecting Chest R-ray (CXR) images, COVID-19, pneumonia, and other lung infections can be detected in real time. The current, state-of-the-art literature suggests that deep learning (DL) is highly advantageous in automatic disease classification utilizing the CXR images. The goal of this study is to develop models by employing DL models for identifying COVID-19 and other lung disorders more efficiently. For this study, a dataset of 18,564 CXR images with seven disease categories was created from multiple publicly available sources. Four DL architectures including the proposed CNN model and pretrained VGG-16, VGG-19, and Inception-v3 models were applied to identify healthy and six lung diseases (fibrosis, lung opacity, viral pneumonia, bacterial pneumonia, COVID-19, and tuberculosis). Accuracy, precision, recall, f1 score, area under the curve (AUC), and testing time were used to evaluate the performance of these four models. The results demonstrated that the proposed CNN model outperformed all other DL models employed for a seven-class classification with an accuracy of 93.15% and average values for precision, recall, f1-score, and AUC of 0.9343, 0.9443, 0.9386, and 0.9939. The CNN model equally performed well when other multiclass classifications including normal and COVID-19 as the common classes were considered, yielding accuracy values of 98%, 97.49%, 97.81%, 96%, and 96.75% for two, three, four, five, and six classes, respectively. The proposed model can also identify COVID-19 with shorter training and testing times compared to other transfer learning models.

Is there a relationship between the intensive care scores of patients and depression and anxiety?

OBJECTIVE: Coronaviruses that cause respiratory infections in people are known to be neuropathogenic. The purpose of this study is to determine whether there is an association between the severity of viral pneumonia and the anxiety and depression levels of patients in the intensive care unit (ICU). MATERIAL AND METHODS: 165 patients were included in the study prospectively, and 70 patients were intubated at follow-up. According to the intubation status, the patients were divided into two groups: intubated and non-intubated. RESULTS: The GAD-7 score was 10.37±3.75 (p<0.001) in patients who were intubated after the first 7 days. The length of stay in the ICU was 25±22.3/day (p<0.001), and the length of stay in the hospital was 28.28±23.37/day, which was longer than those who were not intubated (p<0.001). APACHE and SOFA scores, as well as GAD-7 and PHQ-9, were found to be positively related to ICU and hospital length of stay (p<0.01). CONCLUSION: The presence and exacerbation of anxiety and depression symptoms can provide information about the aggravation and progression of the underlying disease.

Analysis of risk factors of fungal superinfections in viral pneumonia patients: A systematic review and meta-analysis.

BACKGROUND: Infections with fungi, such as Aspergillus species, have been found as common complications of viral pneumonia. This study aims to determine the risk factors of fungal superinfections in viral pneumonia patients using meta-analysis. OBJECTIVE: This study aims to determine the risk factors of fungal infection s in viral pneumonia patients using meta-analysis. METHODS: We reviewed primary literature about fungal infection in viral pneumonia patients published between January 1, 2010 and September 30, 2020, in the Chinese Biomedical Literature, Chinese National Knowledge Infrastructure, Wanfang (China), Cochrane Central Library, Embase, PubMed, and Web of Science databases. These studies were subjected to an array of statistical analyses, including risk of bias and sensitivity analyses. RESULTS: In this study, we found a statistically significant difference in the incidence of fungal infections in viral pneumonia patients that received corticosteroid treatment as compared to those without corticosteroid treatment (p < .00001). Additionally, regarding the severity of fungal infections, we observed significant higher incidence of invasive pulmonary aspergillosis (IPA) in patients with high Acute Physiology and Chronic Health Evaluation (APACHE) II scores (p < .001), tumors (p = .005), or immunocompromised patients (p < .0001). CONCLUSIONS: Our research shows that corticosteroid treatment was an important risk factor for the development of fungal infection in patients with viral pneumonia. High APACHE II scores, tumors, and immunocompromised condition are also important risk factors of developing IPA. The diagnosis of fungal infection in viral pneumonia patients can be facilitated by early serum galactomannan (GM) testing, bronchoalveolar lavage fluid Aspergillus antigen testing, culture, and biopsy.

A Review of Crucial Radiological Investigations in the Management of COVID-19 Cases.

Chest X-ray, chest CT, and lung ultrasound are the most common radiological interventions used in the diagnosis and management of coronavirus disease 2019 (COVID-19) patients. The purpose of this literature review, which was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is to determine which radiological investigation is crucial for that purpose. PubMed, Medline, American Journal of Radiology (AJR), Public Library of Science (PLOS), Elsevier, National Center for Biotechnology Information (NCBI), and ScienceDirect were explored. Seventy-two articles were reviewed for potential inclusion, including 50 discussing chest CT, 15 discussing chest X-ray, five discussing lung ultrasound, and two discussing COVID-19 epidemiology. The reported sensitivities and specificities for chest CT ranged from 64 to 98% and 25 to 88%, respectively. The reported sensitivities and specificities for chest X-rays ranged from 33 to 89% and 11.1 to 88.9%, respectively. The reported sensitivities and specificities for lung ultrasound ranged from 93 to 96.8% and 21.3 to 95%, respectively. The most common findings on chest CT include ground glass opacities and consolidation. The most common findings on chest X-rays include opacities, consolidation, and pleural effusion. The data indicate that chest CT is the most effective radiological tool for the diagnosis and management of COVID-19 patients. The authors support the continued use of reverse transcription polymerase chain reaction (RT-PCR), along with physical examination and contact history, for such diagnosis. Chest CT could be more appropriate in emergency situations when quick triage of patients is necessary before RT-PCR results are available. CT can also be used to visualize the progression of COVID-19 pneumonia and to identify potential false positive RT-PCR results. Chest X-ray and lung ultrasound are acceptable in situations where chest CT is unavailable or contraindicated.

The Comprehensive Appraisal of COVID-19: Its' Clinical Panorama from Virology till Management and Beyond

Severe acute respiratory syndrome, caused by SARS-CoV-2 disease (COVID-19), was first reported in China, and has laid the entire globe at a standstill, with an uncertain future, and a possible economic disaster. The World Health Organization (WHO), on March 11th 2020, avowed COVID-19 a pandemic considering its global pervasiveness. The multi-dimensional challenges include the combat with present available treatment options while simultaneously hastening scientific research for the development of definitive therapeutics and vaccine for this pandemic. The research advancement related to earlier epidemics of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) by the same coronavirus family provides the understanding of basic and clinical virology, pathogenesis and therapeutics of SARS-CoV-2. The dearth of definitive therapeutics and vaccine ren-ders COVID-19 pandemic a public health challenge globally. This comprehensive review of virology, pathogenesis, and management will abet quarters of public health authorities and medical fraternity to better understand COVID-19.Copyright © 2020 Bentham Science Publishers.

Reporting and literature analysis of misdiagnosis and therapy of one case with tuberculous meningoencephalitis under the coronavirus disease 2019 epidemic

Objective To improve the diagnosis and treatment level for tuberculous meningitis (TBM) under the Coronavirus disease 2019 (COVID-19) epidemic. Methods The diagnosis and treatment course of a female patient under the COVID-19 epidemic was analyzed for high fever, vomiting for 23 days, headache, talk nonsense for 10 days, inability to stand, and double vision lasting 5 days. The patient was successively misdiagnosed to suffer from viral pneumonia and acute disseminated encephalomyelitis (ADEM) in other hospitals. The patient had a history of transit at Hankou railway station (wearing a mask without departing the station throughout the process) under the COVID-19 epidemic. The patient had a history of leukopenia and long-term medical therapy. The patient was diagnosed as TBM by applying the diagnostic scheme for the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines after physical examination, cerebrospinal fluid test, magnetic resonance imaging (MRI) plain scan and enhanced examination. The analysis on reasons for extramural hospital misdiagnosis showed it was related to the lack of careful physical examination and lack of scientific analysis of laboratory test results. Results The intracranial pressure reduction, anti-tuberculosis treatment, adrenal cortex hormone treatment and symptomatic treatment were immediately administered according to the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines. Intensive anti-tuberculosis treatment (4 months) was implemented firstly and followed by the anti-tuberculosis treatment (12 months) during the consolidation phase, clinically enabling the patient to be cured. Conclusion Careful inquiry of medical history, careful physical examination, timely cerebrospinal fluid examination and MRI examination and scientific analysis on clinical data are critical to confirmation of TBM. Standard anti-tuberculosis treatment, rational use of adrenal cortex hormones and lowering intracranial pressure are critical factors for curing. © 2023, Editorial Department of Medical Pest Control. All rights reserved.

Reporting and literature analysis of misdiagnosis and therapy of one case with tuberculous meningoencephalitis under the coronavirus disease 2019 epidemic

Objective To improve the diagnosis and treatment level for tuberculous meningitis (TBM) under the Coronavirus disease 2019 (COVID-19) epidemic. Methods The diagnosis and treatment course of a female patient under the COVID-19 epidemic was analyzed for high fever, vomiting for 23 days, headache, talk nonsense for 10 days, inability to stand, and double vision lasting 5 days. The patient was successively misdiagnosed to suffer from viral pneumonia and acute disseminated encephalomyelitis (ADEM) in other hospitals. The patient had a history of transit at Hankou railway station (wearing a mask without departing the station throughout the process) under the COVID-19 epidemic. The patient had a history of leukopenia and long-term medical therapy. The patient was diagnosed as TBM by applying the diagnostic scheme for the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines after physical examination, cerebrospinal fluid test, magnetic resonance imaging (MRI) plain scan and enhanced examination. The analysis on reasons for extramural hospital misdiagnosis showed it was related to the lack of careful physical examination and lack of scientific analysis of laboratory test results. Results The intracranial pressure reduction, anti-tuberculosis treatment, adrenal cortex hormone treatment and symptomatic treatment were immediately administered according to the 2019 China Central Nervous System Tuberculosis Diagnosis and Treatment Guidelines. Intensive anti-tuberculosis treatment (4 months) was implemented firstly and followed by the anti-tuberculosis treatment (12 months) during the consolidation phase, clinically enabling the patient to be cured. Conclusion Careful inquiry of medical history, careful physical examination, timely cerebrospinal fluid examination and MRI examination and scientific analysis on clinical data are critical to confirmation of TBM. Standard anti-tuberculosis treatment, rational use of adrenal cortex hormones and lowering intracranial pressure are critical factors for curing. © 2023, Editorial Department of Medical Pest Control. All rights reserved.