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1.
F1000Res ; 9: 1286, 2020.
Article in English | MEDLINE | ID: covidwho-1110755

ABSTRACT

Background: Case fatality rate of COVID-19 patients in Surabaya is higher than global cases. Thus, it is important to identify risk factors to reduce the mortality rate. This study aimed to assess the factors associated with hospital mortality of COVID-19 patients, and develop a prediction score based on these findings. Methods: We analyzed 111 patients, who were diagnosed with COVID-19 based on reverse-transcriptase polymerase chain reaction. The following patient characteristics were obtained from records: age, gender, type of symptoms, onset of symptoms, neutrophil lymphocyte ratio (NLR), absolute lymphocyte count, chest x-ray abnormalities, lung involvement, type of lesion, radiographic assessment of the quantity of lung edema (RALE) score, and mortality. Data were analyzed using SPSS 25.0. Results Multivariate analysis showed that age >50 years ( p=0.043), NLR score >5.8 ( p=0.016) and RALE score >2 ( p=0.002) can predict the mortality of COVID-19 patients in the hospital. ROC curve analysis of the score ability to predict mortality showed an area under the curve of 0.794. The cut-off point is 4.5, with a sensitivity of 96.7% and specificity of 49.4% to predict the mortality of COVID-19 patient in the hospital. Conclusions Age, NLR score and RALE score were associated with mortality of COVID-19 patients in the hospital and could be used as a predictor for discharge probability of COVID-19 patients in low health care resource setting. The prediction score may be useful for frontline physicians to effectively manage patients with a higher score to prevent mortality.


Subject(s)
Age Factors , Edema/diagnostic imaging , Hospital Mortality , Lymphocytes/cytology , Neutrophils/cytology , Adult , Aged , Female , Humans , Lung/diagnostic imaging , Lung/physiopathology , Male , Middle Aged , Respiratory Sounds , Retrospective Studies
2.
Intern Med ; 60(3): 457-461, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1110169

ABSTRACT

We herein report a case of severe coronavirus disease 2019 (COVID-19) in which high-dose intravenous immunoglobulin (IVIg) treatment achieved significant clinical improvement of deterioration of pulmonary inflammation after temporary clinical improvement. In the present case, clinical and radiological deterioration occurred despite a decrease in viral load, suggesting that deterioration was caused by reactivation of proinflammatory factors, such as tumor necrosis factor-α and interleukin-6, rather than direct viral effects. IVIg treatment may provide not only immunosuppressive effects but also inhibition of proinflammatory cytokines, indicating that treatment including IVIg may be effective by inhibiting cytokine storm in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection.


Subject(s)
/therapy , Immunoglobulins, Intravenous/administration & dosage , Respiratory Insufficiency/therapy , /isolation & purification , /complications , Cytokine Release Syndrome/prevention & control , Cytokines/drug effects , Humans , Ivermectin/therapeutic use , Lung/diagnostic imaging , Lung/pathology , Male , Middle Aged , Radiography, Thoracic , Viral Load
3.
BMC Infect Dis ; 21(1): 192, 2021 Feb 18.
Article in English | MEDLINE | ID: covidwho-1090689

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused a global pandemic that has raised worldwide concern. This study aims to investigate the correlation between the extent of lung infection and relevant clinical laboratory testing indicators in COVID-19 and to analyse its underlying mechanism. METHODS: Chest high-resolution computer tomography (CT) images and laboratory examination data of 31 patients with COVID-19 were extracted, and the lesion areas in CT images were quantitatively segmented and calculated using a deep learning (DL) system. A cross-sectional study method was carried out to explore the differences among the proportions of lung lobe infection and to correlate the percentage of infection (POI) of the whole lung in all patients with clinical laboratory examination values. RESULTS: No significant difference in the proportion of infection was noted among various lung lobes (P > 0.05). The POI of total lung was negatively correlated with the peripheral blood lymphocyte percentage (L%) (r = - 0.633, P < 0.001) and lymphocyte (LY) count (r = - 0.555, P = 0.001) but positively correlated with the neutrophil percentage (N%) (r = 0.565, P = 0.001). Otherwise, the POI was not significantly correlated with the peripheral blood white blood cell (WBC) count, monocyte percentage (M%) or haemoglobin (HGB) content. In some patients, as the infection progressed, the L% and LY count decreased progressively accompanied by a continuous increase in the N%. CONCLUSIONS: Lung lesions in COVID-19 patients are significantly correlated with the peripheral blood lymphocyte and neutrophil levels, both of which could serve as prognostic indicators that provide warning implications, and contribute to clinical interventions in patients.


Subject(s)
/diagnostic imaging , Lung/pathology , Machine Learning , Adult , Clinical Laboratory Techniques , Cross-Sectional Studies , Female , Humans , Lung/diagnostic imaging , Lung/virology , Lymphocyte Count , Lymphocytes/cytology , Male , Middle Aged , Neutrophils/cytology , Pandemics , Prognosis , Severity of Illness Index , Tomography, X-Ray Computed
4.
Medicine (Baltimore) ; 99(51): e23862, 2020 Dec 18.
Article in English | MEDLINE | ID: covidwho-1087851

ABSTRACT

ABSTRACT: Some evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center.We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records.Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 µg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2).This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.


Subject(s)
/complications , Subarachnoid Hemorrhage/virology , Adult , Aged , Angiography, Digital Subtraction , Female , Humans , Male , Middle Aged , Subarachnoid Hemorrhage/diagnostic imaging
5.
Eur Rev Med Pharmacol Sci ; 25(2): 1146-1157, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1084469

ABSTRACT

OBJECTIVE: Many studies have been published recently on the characteristics of the clinical manifestations of COVID-19 in children. The quality scores of literature are different, and the incidence of clinical manifestations and laboratory tests results vary greatly. Therefore, a systematic retrospective meta-analysis is needed to determine the incidence of the clinical manifestations of COVID-19 in children. MATERIALS AND METHODS: Data from databases, such as PubMed, Web of science, EMBASE, Johns Hopkins University, and Chinese databases were analysed from January 31, 2020 to October 20, 2020. High-quality articles were selected for analysis based on a quality standard score. A meta-analysis of random effects was used to determine the prevalence of comorbidities and subgroup meta-analysis to examine the changes in the estimated prevalence in different subgroups. RESULTS: Seventy-one articles involving 11,671 children were included in the study. The incidence of fever, respiratory symptoms, gastrointestinal symptoms, asymptomatic patients, nervous system symptoms, and chest tightness was 55.8%, 56.8%, 14.4%, 21.1%, 6.7%, and 6.1%, respectively. The incidence of multisystem inflammatory syndrome was 6.2%. Laboratory examination results showed that lymphocytes decreased in 12% and leukocytes decreased in 8.8% of patients, whereas white blood cells increased in 7.8% of patients. Imaging showed abnormalities in 66.5%, and ground-glass opacities were observed in 36.9% patients. Epidemiological history was present in 85.2% cases; severe disease rate was 3.33%. The mortality rate was 0.28%. CONCLUSIONS: The clinical symptoms of COVID-19 in children are mild, and laboratory indicators and imaging manifestations are atypical. While screening children for COVID-19, in addition to assessing patients for symptoms as the first step of screening, the epidemiological history of patients should be obtained.


Subject(s)
/blood , /diagnostic imaging , /complications , Child , Child, Preschool , Humans , Retrospective Studies , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/diagnostic imaging , Systemic Inflammatory Response Syndrome/etiology
7.
Eur Rev Med Pharmacol Sci ; 25(2): 1101-1108, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1082901

ABSTRACT

OBJECTIVE: The "Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)" disease caused a challenging and threating pandemic (COVID-19) worldwide with a great loss to life and the global economy. SARS-CoV-2 mainly involves the respiratory system, however, with Magnetic Resonance Imaging (MRI), neurological and special senses clinical manifestations have been reported rarely. The present study aims to investigate the MRI findings, clinical manifestations of neurological and special senses involvement in SARS-CoV-2 patients. MATERIALS AND METHODS: In this study, 284 articles from the databases "Pub-Med, Web of Science-Clarivate Analytics, Embase and Google Scholar" were identified. The keywords, coronavirus, SARS-CoV-2, COVID-19 pandemic, MRI, brain, special senses, neurological involvement were entered into the search engines and the concerned documents were selected and reviewed. The descriptive information was recorded from the particular studies; finally, we included 48 publications. RESULTS: The common neurological manifestations in SARS-CoV-2 patients were headache, impaired consciousness, acute cerebrovascular disease, ataxia, tremors, meningitis, encephalitis, cerebral bleeding, subarachnoid hemorrhage, frontal lobe, temporal lobe and intracerebral hematoma, hemiparesis and seizures. However, common special senses manifestations in SARS-CoV-2 patients were olfactory, auditory and gustatory disorders including red eyes, painless monocular visual disturbance, anosmia, ageusia, dysgeusia, dysosmia and hypoacusis. Moreover, the MRI findings identified in SARS-CoV-2 patients were isolated oval-shaped lesion in the corpus callosum, bilateral basal ganglia hemorrhage, ischemic lesions involving the corpus callosum, basal ganglia, cerebellum and vasogenic edema extending to the cerebral peduncles, pons and ventricles. CONCLUSIONS: The neurologic manifestations of SARS-CoV-2 patients are highly variable. The SARS-COV-2 exerts its damaging effects on the nervous system and special senses by developing determinant numerous neurological and special senses' clinical manifestations. Physicians with the help of MRI must rule out the neurological and special senses manifestations among SARS-CoV-2 patients.


Subject(s)
Brain/diagnostic imaging , /epidemiology , Magnetic Resonance Imaging/trends , Nervous System Diseases/diagnostic imaging , Nervous System Diseases/epidemiology , Humans , Magnetic Resonance Imaging/methods , Retrospective Studies
8.
J Clin Lab Anal ; 35(2): e23685, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1082686

ABSTRACT

BACKGROUND: Pneumonia caused by the 2019 novel Coronavirus (COVID-2019) shares overlapping signs and symptoms, laboratory findings, imaging features with influenza A pneumonia. We aimed to identify their clinical characteristics to help early diagnosis. METHODS: We retrospectively retrieved data for laboratory-confirmed patients admitted with COVID-19-induced or influenza A-induced pneumonia from electronic medical records in Ningbo First Hospital, China. We recorded patients' epidemiological and clinical features, as well as radiologic and laboratory findings. RESULTS: The median age of influenza A cohort was higher and it exhibited higher temperature and higher proportion of pleural effusion. COVID-19 cohort exhibited higher proportions of fatigue, diarrhea and ground-glass opacity and higher levels of lymphocyte percentage, absolute lymphocyte count, red-cell count, hemoglobin and albumin and presented lower levels of monocytes, c-reactive protein, aspartate aminotransferase, alkaline phosphatase, serum creatinine. Multivariate logistic regression analyses showed that fatigue, ground-glass opacity, and higher level of albumin were independent risk factors for COVID-19 pneumonia, while older age, higher temperature, and higher level of monocyte count were independent risk factors for influenza A pneumonia. CONCLUSIONS: In terms of COVID-19 pneumonia and influenza A pneumonia, fatigue, ground-glass opacity, and higher level of albumin tend to be helpful for diagnosis of COVID-19 pneumonia, while older age, higher temperature, and higher level of monocyte count tend to be helpful for the diagnosis of influenza A pneumonia.


Subject(s)
/diagnosis , Clinical Laboratory Techniques , Influenza A virus/physiology , Pneumonia/diagnosis , Pneumonia/virology , /physiology , /diagnostic imaging , Diagnosis, Differential , Female , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Pneumonia/diagnostic imaging , Risk Factors , Tomography, X-Ray Computed
10.
Eur Rev Med Pharmacol Sci ; 25(2): 1135-1145, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1082411

ABSTRACT

OBJECTIVE: To explore the different clinical and CT features distinguishing COVID-19 from H1N1 influenza pneumonia. PATIENTS AND METHODS: We compared two independent cohorts of COVID-19 pneumonia (n=405) and H1N1 influenza pneumonia (n=78), retrospectively. All patients were confirmed by RT-PCR. Four hundred and five cases of COVID-19 pneumonia were confirmed in nine hospitals of Zhejiang province, China from January 21 to February 20, 2020. Seventy-eight cases of H1N1 influenza pneumonia were confirmed in our hospital from January 1, 2017 to February 29, 2020. Their clinical manifestations, laboratory test results, and CT imaging characteristics were compared. RESULTS: COVID-19 pneumonia patients showed less proportions of underlying diseases, fever and respiratory symptoms than those of H1N1 pneumonia patients (p<0.01). White blood cell count, neutrophilic granulocyte percentage, C-reactive protein, procalcitonin, D-Dimer, and lactate dehydrogenase in H1N1 pneumonia patients were higher than those of COVID-19 pneumonia patients (p<0.05). H1N1 pneumonia was often symmetrically located in the dorsal part of inferior lung lobes, while COVID-19 pneumonia was unusually showed as a peripheral but non-specific lobe distribution. Ground glass opacity was more common in COVID-19 pneumonia and consolidation lesions were more common in H1N1 pneumonia (p<0.01). COVID-19 pneumonia lesions showed a relatively clear margin compared with H1N1 pneumonia. Crazy-paving pattern, thickening vessels, reversed halo sign and early fibrotic lesions were more common in COVID-19 pneumonia than H1N1 pneumonia (p<0.05). Pleural effusion in COVID-19 pneumonia was significantly less common than H1N1 pneumonia (p<0.01). CONCLUSIONS: Compared with H1N1 pneumonia in Zhejiang, China, the clinical manifestations of COVID-19 pneumonia were more concealed with less underlying diseases and slighter respiratory symptoms. The more common CT manifestations of COVID-19 pneumonia included ground-glass opacity with a relatively clear margin, crazy-paving pattern, thickening vessels, reversed halo sign, and early fibrotic lesions, while the less common CT manifestations of COVID-19 pneumonia included consolidation and pleural effusion.


Subject(s)
/diagnostic imaging , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/diagnostic imaging , Influenza, Human/epidemiology , Tomography, X-Ray Computed/methods , Adult , Aged , Case-Control Studies , China/epidemiology , Cohort Studies , Female , Humans , Male , Middle Aged , Retrospective Studies
11.
J Immunother Cancer ; 9(2)2021 02.
Article in English | MEDLINE | ID: covidwho-1081352

ABSTRACT

By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65-year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.


Subject(s)
/diagnosis , Lung Neoplasms/diagnosis , Pneumonia/diagnosis , Squamous Cell Carcinoma of Head and Neck/diagnosis , Aged , B7-H1 Antigen/antagonists & inhibitors , B7-H1 Antigen/immunology , /immunology , Diagnosis, Differential , Humans , /adverse effects , Immunotherapy/adverse effects , Lung Injury/diagnosis , Lung Injury/diagnostic imaging , Lung Injury/pathology , Lung Injury/virology , Lung Neoplasms/drug therapy , Lung Neoplasms/secondary , Lung Neoplasms/virology , Male , Nasopharynx/metabolism , Nasopharynx/pathology , Neoplasm Metastasis , Pandemics , Pneumonia/drug therapy , Pneumonia/immunology , Pneumonia/virology , Squamous Cell Carcinoma of Head and Neck/drug therapy , Squamous Cell Carcinoma of Head and Neck/immunology , Squamous Cell Carcinoma of Head and Neck/virology
12.
Eur Rev Med Pharmacol Sci ; 25(2): 1080-1086, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1081037

ABSTRACT

OBJECTIVE: This study aimed to explore the atypical imaging findings of the novel coronavirus pneumonia (COVID-19) and its evolution. MATERIALS AND METHODS: The atypical imaging data of ten patients in our hospital who tested positive for COVID-19 were analyzed retrospectively, and the distribution, morphology, and image evolution of the lesions were analyzed. High-resolution computed tomography (HRCT) was performed in all cases, and the imaging features were analyzed and summarized by two senior radiologists. RESULTS: Of these ten patients, three were male, and seven were female. The age of these patients ranged from 21-53 years, with an average age of 36.3 ± 3.6. The first symptom was fever in nine cases and dry cough in one case. A total of 17 lesions were detected in these ten patients. Five patients had a single lesion, and five patients had multiple lesions, for a total of 12 lesions. Ten lesions (58.82%) were located in the inferior lobe of the right lung, four lesions (23.53%) in the left inferior lobe, two lesions (11.76%) in the left upper lobe, and one lesion (5.88%) in the right middle lobe. Among the five single lesions, two were solid lesions, two were mixed ground-glass lesions, and one was a pure ground-glass lesion. Among the 12 multiple lesions, eight were solid lesions, two were mixed ground-glass lesions, and two were pure ground-glass lesions. Atypical manifestations in image signs: five lesions (29.41%) had single solid and sub-solid nodules, and four lesions (23.53%) had cavitary nodules. Typical manifestation (the presence of "white lung"): three lesions (17.65%) had an air bronchogram, two lesions (11.76%) had crazy-paving signs, two lesions (11.76%) had vascular thickening, and one lesion (5.88%) had halo signs. At reexamination 2-6 days later, 15 lesions (88.24%) had enlarged or increased, and two lesions (11.76%) had decreased or absorbed. CONCLUSIONS: Patients with COVID-19 may have atypical imaging findings. Radiologists should improve their understanding of the novel coronavirus pneumonia to avoid any missed diagnoses.


Subject(s)
/diagnostic imaging , Lung/diagnostic imaging , Tomography, X-Ray Computed/methods , Adult , Female , Humans , Lung/physiopathology , Male , Middle Aged , Tomography, X-Ray Computed/trends , Young Adult
13.
BMJ Case Rep ; 14(2)2021 Feb 11.
Article in English | MEDLINE | ID: covidwho-1080449

ABSTRACT

COVID-19 mainly causes pulmonary disease. Involvement of gastrointestinal and hepatobiliary systems, among other systems, has been reported. We report a case of acute pancreatitis in a patient with resolving COVID-19 pneumonia. History taking and investigations excluded other causes of pancreatitis. This case demonstrates the possibility of pancreatic injury in patients with COVID-19, in line with previously reported similar cases. We believe that it is imperative to screen patients presenting with acute pancreatitis for SARS-CoV-2. It is also important to take into consideration that patients with a complicated course who require an invasive procedure such as drainage might pose a risk of transmission to the operating surgeon or interventionist.


Subject(s)
/diagnosis , Pancreatitis/virology , /diagnostic imaging , Conservative Treatment , Diagnosis, Differential , Female , Humans , Lung/diagnostic imaging , Middle Aged , Pancreatitis/diagnostic imaging , Pancreatitis/therapy , Tomography, X-Ray Computed
14.
J Infect Dev Ctries ; 15(1): 69-72, 2021 Jan 31.
Article in English | MEDLINE | ID: covidwho-1079737

ABSTRACT

There is rising concern that patients who recover from COVID-19 may be at risk of recurrence. Increased rates of infection and recurrence in healthcare workers could cause the healthcare system collapse and a further worsening of the COVID-19 pandemic. Herein, we reported the clinically symptomatic recurrent COVID-19 cases in the two healthcare workers who treated and recovered from symptomatic and laboratory confirmed COVID-19. We discuss important questions in the COVID-19 pandemic waiting to be answered, such as the protection period of the acquired immunity, the severity of recurrence and how long after the first infection occurs. We aimed to emphasize that healthcare workers should continue to pay maximum attention to the measures without compromising.


Subject(s)
/diagnosis , Health Personnel , Female , Humans , Male , Middle Aged , Recurrence , Thorax/diagnostic imaging , Tomography, X-Ray Computed
15.
BMC Infect Dis ; 21(1): 167, 2021 Feb 10.
Article in English | MEDLINE | ID: covidwho-1079217

ABSTRACT

BACKGROUND: Characteristics of COVID-19 patients have mainly been reported within confirmed COVID-19 cohorts. By analyzing patients with respiratory infections in the emergency department during the first pandemic wave, we aim to assess differences in the characteristics of COVID-19 vs. Non-COVID-19 patients. This is particularly important regarding the second COVID-19 wave and the approaching influenza season. METHODS: We prospectively included 219 patients with suspected COVID-19 who received radiological imaging and RT-PCR for SARS-CoV-2. Demographic, clinical and laboratory parameters as well as RT-PCR results were used for subgroup analysis. Imaging data were reassessed using the following scoring system: 0 - not typical, 1 - possible, 2 - highly suspicious for COVID-19. RESULTS: COVID-19 was diagnosed in 72 (32,9%) patients. In three of them (4,2%) the initial RT-PCR was negative while initial CT scan revealed pneumonic findings. 111 (50,7%) patients, 61 of them (55,0%) COVID-19 positive, had evidence of pneumonia. Patients with COVID-19 pneumonia showed higher body temperature (37,7 ± 0,1 vs. 37,1 ± 0,1 °C; p = 0.0001) and LDH values (386,3 ± 27,1 vs. 310,4 ± 17,5 U/l; p = 0.012) as well as lower leukocytes (7,6 ± 0,5 vs. 10,1 ± 0,6G/l; p = 0.0003) than patients with other pneumonia. Among abnormal CT findings in COVID-19 patients, 57 (93,4%) were evaluated as highly suspicious or possible for COVID-19. In patients with negative RT-PCR and pneumonia, another third was evaluated as highly suspicious or possible for COVID-19 (14 out of 50; 28,0%). The sensitivity in the detection of patients requiring isolation was higher with initial chest CT than with initial RT-PCR (90,4% vs. 79,5%). CONCLUSIONS: COVID-19 patients show typical clinical, laboratory and imaging parameters which enable a sensitive detection of patients who demand isolation measures due to COVID-19.


Subject(s)
/diagnosis , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/physiopathology , Adult , Aged , Aged, 80 and over , Emergency Service, Hospital , Female , Germany/epidemiology , Hospitalization , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Prospective Studies , Respiratory Tract Infections/epidemiology , Tomography, X-Ray Computed , Young Adult
16.
J Med Internet Res ; 23(2): e23693, 2021 02 10.
Article in English | MEDLINE | ID: covidwho-1076386

ABSTRACT

BACKGROUND: COVID-19 has spread very rapidly, and it is important to build a system that can detect it in order to help an overwhelmed health care system. Many research studies on chest diseases rely on the strengths of deep learning techniques. Although some of these studies used state-of-the-art techniques and were able to deliver promising results, these techniques are not very useful if they can detect only one type of disease without detecting the others. OBJECTIVE: The main objective of this study was to achieve a fast and more accurate diagnosis of COVID-19. This study proposes a diagnostic technique that classifies COVID-19 x-ray images from normal x-ray images and those specific to 14 other chest diseases. METHODS: In this paper, we propose a novel, multilevel pipeline, based on deep learning models, to detect COVID-19 along with other chest diseases based on x-ray images. This pipeline reduces the burden of a single network to classify a large number of classes. The deep learning models used in this study were pretrained on the ImageNet dataset, and transfer learning was used for fast training. The lungs and heart were segmented from the whole x-ray images and passed onto the first classifier that checks whether the x-ray is normal, COVID-19 affected, or characteristic of another chest disease. If it is neither a COVID-19 x-ray image nor a normal one, then the second classifier comes into action and classifies the image as one of the other 14 diseases. RESULTS: We show how our model uses state-of-the-art deep neural networks to achieve classification accuracy for COVID-19 along with 14 other chest diseases and normal cases based on x-ray images, which is competitive with currently used state-of-the-art models. Due to the lack of data in some classes such as COVID-19, we applied 10-fold cross-validation through the ResNet50 model. Our classification technique thus achieved an average training accuracy of 96.04% and test accuracy of 92.52% for the first level of classification (ie, 3 classes). For the second level of classification (ie, 14 classes), our technique achieved a maximum training accuracy of 88.52% and test accuracy of 66.634% by using ResNet50. We also found that when all the 16 classes were classified at once, the overall accuracy for COVID-19 detection decreased, which in the case of ResNet50 was 88.92% for training data and 71.905% for test data. CONCLUSIONS: Our proposed pipeline can detect COVID-19 with a higher accuracy along with detecting 14 other chest diseases based on x-ray images. This is achieved by dividing the classification task into multiple steps rather than classifying them collectively.


Subject(s)
Algorithms , Deep Learning , Thoracic Diseases/diagnostic imaging , Humans , Neural Networks, Computer , Radiography, Thoracic , Thorax
17.
Viruses ; 13(1)2020 12 30.
Article in English | MEDLINE | ID: covidwho-1073492

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (COVID-19), a lung disease that may progress to systemic organ involvement and in some cases, death. The identification of the earliest predictors of progressive lung disease would allow for therapeutic intervention in those cases. In an earlier clinical study, individuals with moderate COVID-19 were treated with either arbidol (ARB) or inhaled interferon (IFN)-α2b +/-ARB. IFN treatment resulted in accelerated viral clearance from the upper airways and in a reduction in the circulating levels of the inflammatory biomarkers IL-6 and C-reactive protein (CRP). We have extended the analysis of this study cohort to determine whether IFN treatment had a direct effect on virus-induced lung abnormalities and also to ascertain whether any clinical or immune parameters are associated with worsening of lung abnormalities. Evidence is provided that IFN-α2b treatment limits the development of lung abnormalities associated with COVID-19, as assessed by CT images. Clinical predictors associated with worsening of lung abnormalities include low CD8+ T cell numbers, low levels of circulating albumin, high numbers of platelets, and higher levels of circulating interleukin (IL)-10, IL-6, and C-reactive protein (CRP). Notably, in this study cohort, IFN treatment resulted in a higher percentage of CD8+ T cells, lower tumor necrosis factor (TNF)-α levels and, as reported earlier, lower IL-6 levels. Independent of treatment, age and circulating levels of albumin and CRP emerged as the strongest predictors of the severity of lung abnormalities.


Subject(s)
Antiviral Agents/therapeutic use , Interferon-alpha/therapeutic use , Lung/abnormalities , Administration, Inhalation , Antiviral Agents/administration & dosage , Biomarkers/blood , C-Reactive Protein , CD8-Positive T-Lymphocytes , China , Cohort Studies , Cytokines/immunology , Drug Therapy, Combination , Humans , Indoles/administration & dosage , Indoles/therapeutic use , Interferon-alpha/administration & dosage , Interleukin-10 , Interleukin-6 , Lung/diagnostic imaging , Lung/pathology , /drug effects
18.
BMC Infect Dis ; 21(1): 157, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1069549

ABSTRACT

BACKGROUND: Laboratory data and computed tomography (CT) have been used during the COVID-19 pandemic, mainly to determine patient prognosis and guide clinical management. The aim of this study was to evaluate the association between CT findings and laboratory data in a cohort of COVID-19 patients. METHODS: This was an observational cross-sectional study including consecutive patients presenting to the Reggio Emilia (Italy) province emergency rooms for suspected COVID-19 for one month during the outbreak peak, who underwent chest CT scan and laboratory testing at presentation and resulted positive for SARS-CoV-2. RESULTS: Included were 866 patients. Total leukocytes, neutrophils, C-reactive protein (CRP), creatinine, AST, ALT and LDH increase with worsening parenchymal involvement; an increase in platelets was appreciable with the highest burden of lung involvement. A decrease in lymphocyte counts paralleled worsening parenchymal extension, along with reduced arterial oxygen partial pressure and saturation. After correcting for parenchymal extension, ground-glass opacities were associated with reduced platelets and increased procalcitonin, consolidation with increased CRP and reduced oxygen saturation. CONCLUSIONS: Pulmonary lesions induced by SARS-CoV-2 infection were associated with raised inflammatory response, impaired gas exchange and end-organ damage. These data suggest that lung lesions probably exert a central role in COVID-19 pathogenesis and clinical presentation.


Subject(s)
/diagnosis , Lung/diagnostic imaging , Adult , C-Reactive Protein/metabolism , Cross-Sectional Studies , Female , Humans , Italy , Lung/pathology , Lymphocyte Count , Male , Middle Aged , Oxygen/blood , Procalcitonin/blood , Prognosis , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
19.
BMC Infect Dis ; 21(1): 155, 2021 Feb 08.
Article in English | MEDLINE | ID: covidwho-1069544

ABSTRACT

BACKGROUND: The outbreak of COVID-19 has resulted in serious concerns in China and abroad. To investigate clinical features of confirmed and suspected patients with COVID-19 in west China, and to examine differences between severe versus non-severe patients. METHODS: Patients admitted for COVID-19 between January 21 and February 11 from fifteen hospitals in Sichuan Province, China were included. Experienced clinicians trained with methods abstracted data from medical records using pre-defined, pilot-tested forms. Clinical characteristics between severe and non-severe patients were compared. RESULTS: Of the 169 patients included, 147 were laboratory-confirmed, 22 were suspected. For confirmed cases, the most common symptoms from onset to admission were cough (70·7%), fever (70·5%) and sputum (33·3%), and the most common chest CT patterns were patchy or stripes shadowing (78·0%); throughout the course of disease, 19·0% had no fever, and 12·4% had no radiologic abnormality; twelve (8·2%) received mechanical ventilation, four (2·7%) were transferred to ICU, and no death occurred. Compared to non-severe cases, severe ones were more likely to have underlying comorbidities (62·5% vs 26·2%, P = 0·001), to present with cough (92·0% vs 66·4%, P = 0·02), sputum (60·0% vs 27·9%, P = 0·004) and shortness of breath (40·0% vs 8·2%, P <  0·0001), and to have more frequent lymphopenia (79·2% vs 43·7%, P = 0·003) and eosinopenia (84·2% vs 57·0%, P = 0·046). CONCLUSIONS: The symptoms of patients in west China were relatively mild, and an appreciable proportion of infected cases had no fever, warranting special attention.


Subject(s)
/physiopathology , Adult , Aged , Child, Preschool , China , Comorbidity , Cough , Disease Outbreaks , Female , Fever , Hospitalization , Humans , Infant , Lung/diagnostic imaging , Lymphopenia , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
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