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1.
Rev. Hosp. Ital. B. Aires (2004) ; 40(2): 53-55, jun. 2020. ilus
Article in Spanish | LILACS (Americas) | ID: covidwho-679083

ABSTRACT

Una de las características de la afección pulmonar por enfermedad por coronavirus (COVID-19) es la disociación entre la gravedad de la hipoxemia y el mantenimiento de una mecánica respiratoria relativamente conservada. En este contexto se ha establecido una teoría en relación con dos fenotipos de pacientes con síndrome de distrés respiratorio del adulto (SDRA): un fenotipo Low, caracterizado por baja elastancia y baja reclutabilidad, y un fenotipo High, con características de alta elastancia y alta reclutabilidad. Presentamos el caso de un paciente que cursó internación en la Unidad de Terapia Intensiva de Adultos de nuestro hospital, con clínica, mecánica ventilatoria y patrón tomográfico compatible con el fenotipo Low de SDRA por COVID-19. (AU)


Dissociation between severity of hypoxemia and relative preserved respiratory mechanics is a characteristic observed in lung impairment due to coronavirus disease (COVID-19). Patients with COVID-19 that present adult respiratory distress syndrome (ARDS) are identified for one of two phenotypes according to a theory recently established. The Low phenotype is distinguished by low elastance and low recruitability; and the High phenotype, by high elastance and high recruitability. The case describes a patient admitted in the adult Intensive Care Unit of Hospital Italiano de Buenos Aires with observed symptoms, ventilatory mechanics and tomographic pattern that are compatible with Low phenotype of ARDS due to COVID-19. (AU)


Subject(s)
Humans , Male , Middle Aged , Respiratory Distress Syndrome, Adult/microbiology , Coronavirus Infections/therapy , Phenotype , Respiratory Distress Syndrome, Adult/genetics , Respiratory Mechanics , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Hypertension/complications , Intensive Care Units , Hypoxia/physiopathology , Obesity/complications
2.
Medicine (Baltimore) ; 99(29): e21334, 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-676910

ABSTRACT

RATIONALE: The outbreak of coronavirus disease 2019 (COVID-19) in 2019 has become a global pandemic. It is not known whether the disease is associated with a higher risk of infection in pregnant women or whether intrauterine vertical transmission can occur. We report 2 cases of pregnant women diagnosed with COVID-19. PATIENT CONCERNS: In all of Yichang city from January 20, 2020, to April 9, 2020, only 2 pregnant women, who were in the late stage of pregnancy, were diagnosed with COVID-19; one patient was admitted for fever with limb asthenia, and the other patient was admitted for abnormal chest computed tomography results. DIAGNOSES: Both pregnant women were diagnosed with COVID-19. INTERVENTIONS: After the medical staff prepared for isolation and protection, the 2 pregnant women quickly underwent cesarean sections. A series of tests, such as laboratory, imaging, and SARS-CoV-2 nucleic acid examinations, were performed on the 2 women with COVID-19 and their newborns. OUTCOMES: One of the 2 infected pregnant women had severe COVID-19, and the other had mild disease. Both babies were delivered by cesarean section. Both of the women with COVID-19 worsened 3 to 6 days after delivery. Chest computed tomography suggested that the lesions due to SARS-CoV-2 infection increased. These women began to exhibit fever or reduced blood oxygen saturation again. One of the 2 newborns was born prematurely, and the other was born at full term. Neither infant was infected with COVID-19, but both had increased prothrombin time and fibrinogen, lactate dehydrogenase, phosphocreatine kinase, and creatine kinase isoenzyme contents. LESSONS: SARS-CoV-2 infection was not found in the newborns born to the 2 pregnant women with COVID-19, but transient coagulation dysfunction and myocardial damage occurred in the 2 newborns. Effective management strategies for pregnant women with COVID-19 will help to control the outbreak of COVID-19 among pregnant women.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Adult , Asthenia/etiology , Betacoronavirus/isolation & purification , Cesarean Section/methods , China/epidemiology , Coronavirus Infections/drug therapy , Disease Outbreaks/prevention & control , Female , Fever/etiology , Humans , Infant, Newborn/blood , Infant, Newborn/metabolism , Infectious Disease Transmission, Vertical/prevention & control , Pandemics , Pneumonia, Viral/drug therapy , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , Pregnancy Outcome/epidemiology , Premature Birth/epidemiology , Thorax/diagnostic imaging , Tomography, X-Ray Computed/methods
3.
Mol Med Rep ; 22(3): 2583-2587, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-675981

ABSTRACT

Since December 2019, an increasing number of cases associated with the 2019 novel coronavirus (2019­nCoV) have emerged in Wuhan, China, which has resulted in a rapid outbreak in China and worldwide. The present study aimed to describe the clinical, laboratory and radiological characteristics of 2019­nCoV pneumonia (NCP) in Zhejiang province, outside of Wuhan. A total of 74 patients with 2019­nCoV were continuously enrolled between January 22 and March 2, 2020 at Zhejiang Hospital. Diagnosis was confirmed at Zhejiang Hospital by reverse transcription­PCR (RT­PCR), which was approved by the Chinese government. Subsequently, the clinical features between positive­ and negative­NCP patients in Zhejiang were compared. Among the 74 hospitalized patients with suspected 2019­NCP, six patients (one male and five female patients) were confirmed to be infected with 2019­nCoV by RT­PCR. The average age of the confirmed patients was 40±13 years. There were three family clusters among the confirmed cases, one patient from each of these families had travel history or contact with patients from Wuhan within 2 weeks. Compared with non­NCP patients, the most common symptoms at onset for patients with NCP were fever (5/6; 83.3%) and cough (5/6; 83.3%), followed by dyspnea/pharyngalgia (2/6; 33.3%), whereas myalgia (1/6; 16.7%) and fatigue (1/6; 16.7%) were less common. All 74 patients with suspected NCP exhibited abnormal computerized tomography (CT) images. In total, 2/6 (33.3%) patients with confirmed NCP presented with bilateral pneumonia, and 21/68 (30.9%) non­NCP patients exhibited bilateral pneumonia, with bilateral distribution of patchy shadows or ground glass opacity. The present study revealed that epidemiological history was critical to the diagnosis of 2019­nCoV in low epidemic regions outside Hubei province. It was also identified that chest CT could not replace nucleic acid testing due to similar radiological manifestations.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Cough/etiology , Fatigue/etiology , Fever/etiology , Pneumonia, Viral/complications , Adult , China/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cough/pathology , Fatigue/pathology , Female , Fever/pathology , Humans , Incidence , Male , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology
4.
BMC Infect Dis ; 20(1): 517, 2020 Jul 16.
Article in English | MEDLINE | ID: covidwho-651422

ABSTRACT

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a public health emergency of major international concern. Real-time RT-PCR assays are recommended for diagnosis of COVID-19. Here we report a rare case of COVID-19 with multiple negative results for PCR assays outside Wuhan, China. CASE PRESENTATION: A 32-year old male was admitted to our hospital because of 6 days of unexplained fever on January 29, 2020. He had come from Wuhan city 10 days before admission. Five days before admission, no abnormality was noted in laboratory test, chest radiography, and nasopharyngeal swab test for the SARS-CoV-2 nucleic acid. The patient was treated with ibuprofen for alleviating fever. On admission, chest computed tomography showed multiple ground-glass opacities in right lower lung field. COVID-19 was suspected. Three times of nasopharyngeal swab specimens were collected after admission. However, none of the specimens were positive. The patient was confirmed with COVID-19 after fifth SARS-CoV-2 nucleic acid test. He was treated with lopinavir/ritonavir, recombinant human interferon alfa-2b inhalation, methylprednisolone. After 18 days of treatment, he was discharged with improved symptoms, lung lesions and negative results of nasopharyngeal swab. CONCLUSION: This case reminds clinician that a patient with high clinical suspicion of COVID-19 but multiple negative RT-PCR result should not be taken out of isolation. A combination of patient's exposure history, clinical manifestations, laboratory tests, and typical imaging findings plays a vital role in making preliminary diagnosis and guide early isolation and treatment. Repeat swab tests are helpful in diagnosis for this kind of patients.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Negative Results , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Adult , Betacoronavirus/genetics , China/epidemiology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Fever/etiology , Fever/virology , Hospitalization , Humans , Male , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Quarantine , Radiography , Real-Time Polymerase Chain Reaction , Sensitivity and Specificity , Tomography, X-Ray Computed , Uncertainty
5.
Cochrane Database Syst Rev ; 7: CD013665, 2020 07 07.
Article in English | MEDLINE | ID: covidwho-635734

ABSTRACT

BACKGROUND: Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or cough, and signs such as oxygen saturation or lung auscultation findings, are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19 disease, or select patients for further diagnostic testing. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19 disease or COVID-19 pneumonia. SEARCH METHODS: On 27 April 2020, we undertook electronic searches in the Cochrane COVID-19 Study Register and the University of Bern living search database, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with suspected COVID-19 disease, or if they recruited known cases with COVID-19 disease and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards including reverse transcription polymerase chain reaction (RT-PCR), clinical expertise, imaging, serology tests and World Health Organization (WHO) or other definitions of COVID-19. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the QUADAS-2 checklist. Analyses were descriptive, presenting sensitivity and specificity in paired forest plots, in ROC (receiver operating characteristic) space and in dumbbell plots. We did not attempt meta-analysis due to the small number of studies, heterogeneity across studies and the high risk of bias. MAIN RESULTS: We identified 16 studies including 7706 participants in total. Prevalence of COVID-19 disease varied from 5% to 38% with a median of 17%. There were no studies from primary care settings, although we did find seven studies in outpatient clinics (2172 participants), and four studies in the emergency department (1401 participants). We found data on 27 signs and symptoms, which fall into four different categories: systemic, respiratory, gastrointestinal and cardiovascular. No studies assessed combinations of different signs and symptoms and results were highly variable across studies. Most had very low sensitivity and high specificity; only six symptoms had a sensitivity of at least 50% in at least one study: cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache. Of these, fever, myalgia or arthralgia, fatigue, and headache could be considered red flags (defined as having a positive likelihood ratio of at least 5) for COVID-19 as their specificity was above 90%, meaning that they substantially increase the likelihood of COVID-19 disease when present. Seven studies carried a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional four studies, we were unable to assess the risk for selection bias. These factors make it very difficult to determine the diagnostic properties of these signs and symptoms from the included studies. We also had concerns about the applicability of these results, since most studies included participants who were already admitted to hospital or presenting to hospital settings. This makes these findings less applicable to people presenting to primary care, who may have less severe illness and a lower prevalence of COVID-19 disease. None of the studies included any data on children, and only one focused specifically on older adults. We hope that future updates of this review will be able to provide more information about the diagnostic properties of signs and symptoms in different settings and age groups. AUTHORS' CONCLUSIONS: The individual signs and symptoms included in this review appear to have very poor diagnostic properties, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19 disease, are urgently needed. Results from such studies could inform subsequent management decisions such as self-isolation or selecting patients for further diagnostic testing. We also need data on potentially more specific symptoms such as loss of sense of smell. Studies in older adults are especially important.


Subject(s)
Ambulatory Care , Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Primary Health Care , Symptom Assessment , Arthralgia/diagnosis , Arthralgia/etiology , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Fatigue/diagnosis , Fatigue/etiology , Fever/diagnosis , Fever/etiology , Headache/diagnosis , Humans , Myalgia/diagnosis , Myalgia/etiology , Outpatient Clinics, Hospital/statistics & numerical data , Pandemics , Physical Examination , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Selection Bias , Symptom Assessment/classification , Symptom Assessment/statistics & numerical data
6.
Eur Respir J ; 55(6)2020 06.
Article in English | MEDLINE | ID: covidwho-622479

ABSTRACT

BACKGROUND: During the outbreak of coronavirus disease 2019 (COVID-19), consistent and considerable differences in disease severity and mortality rate of patients treated in Hubei province compared to those in other parts of China have been observed. We sought to compare the clinical characteristics and outcomes of patients being treated inside and outside Hubei province, and explore the factors underlying these differences. METHODS: Collaborating with the National Health Commission, we established a retrospective cohort to study hospitalised COVID-19 cases in China. Clinical characteristics, the rate of severe events and deaths, and the time to critical illness (invasive ventilation or intensive care unit admission or death) were compared between patients within and outside Hubei. The impact of Wuhan-related exposure (a presumed key factor that drove the severe situation in Hubei, as Wuhan is the epicentre as well the administrative centre of Hubei province) and the duration between symptom onset and admission on prognosis were also determined. RESULTS: At the data cut-off (31 January 2020), 1590 cases from 575 hospitals in 31 provincial administrative regions were collected (core cohort). The overall rate of severe cases and mortality was 16.0% and 3.2%, respectively. Patients in Hubei (predominantly with Wuhan-related exposure, 597 (92.3%) out of 647) were older (mean age 49.7 versus 44.9 years), had more cases with comorbidity (32.9% versus 19.7%), higher symptomatic burden, abnormal radiologic manifestations and, especially, a longer waiting time between symptom onset and admission (5.7 versus 4.5 days) compared with patients outside Hubei. Patients in Hubei (severe event rate 23.0% versus 11.1%, death rate 7.3% versus 0.3%, HR (95% CI) for critical illness 1.59 (1.05-2.41)) have a poorer prognosis compared with patients outside Hubei after adjusting for age and comorbidity. However, among patients outside Hubei, the duration from symptom onset to hospitalisation (mean 4.4 versus 4.7 days) and prognosis (HR (95%) 0.84 (0.40-1.80)) were similar between patients with or without Wuhan-related exposure. In the overall population, the waiting time, but neither treated in Hubei nor Wuhan-related exposure, remained an independent prognostic factor (HR (95%) 1.05 (1.01-1.08)). CONCLUSION: There were more severe cases and poorer outcomes for COVID-19 patients treated in Hubei, which might be attributed to the prolonged duration of symptom onset to hospitalisation in the epicentre. Future studies to determine the reason for delaying hospitalisation are warranted.


Subject(s)
Coronavirus Infections/mortality , Hospitalization , Pneumonia, Viral/mortality , Adult , Aged , Betacoronavirus , Cardiovascular Diseases/epidemiology , China , Cohort Studies , Comorbidity , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Cough/etiology , Diabetes Mellitus/epidemiology , Disease Outbreaks , Dyspnea/etiology , Fatigue/etiology , Female , Fever/etiology , Geography , Humans , Hypertension/epidemiology , Intensive Care Units/statistics & numerical data , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Pharyngitis/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Prognosis , Proportional Hazards Models , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Severity of Illness Index , Time Factors , Time-to-Treatment/statistics & numerical data , Tomography, X-Ray Computed
7.
Ann Clin Lab Sci ; 50(3): 299-307, 2020 May.
Article in English | MEDLINE | ID: covidwho-614688

ABSTRACT

OBJECTIVE: An outbreak of pneumonia named COVID-19 caused by a novel coronavirus in Wuhan is rapidly spreading worldwide. The objective of the present study was to clarify further the clinical characteristics and blood parameters in COVID-19 patients. MATERIALS AND METHODS: Twenty-three suspected patients and 64 patients with laboratory-confirmed SARS-Cov-2 infection were admitted to a designated hospital. Epidemiological, clinical, laboratory, and treatment data were collected and analyzed. RESULTS: Of the 64 patients studied, 47 (73.4%) had been exposed to a confirmed source of COVID-19 transmission. On admission, the most common symptoms were fever (75%) and cough (76.6%). Twenty-eight (43.8%) COVID-19 patients showed leukopenia, 10 (15.6%) showed lymphopenia, 47 (73.4%) and 41 (64.1%) had elevated high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), respectively, and 30 (46.9%) had increased fibrinogen concentration. After the treatment, the counts of white blood cells and platelets, and the level of prealbumin increased significantly, while aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and hsCRP decreased. COVID-19 patients with the hospital stay longer than 12 days had higher body mass index (BMI) and increased levels of AST, LDH, fibrinogen, hsCRP, and ESR. CONCLUSIONS: Results of blood tests have potential clinical value in COVID-19 patients.


Subject(s)
Betacoronavirus/isolation & purification , Biomarkers/blood , Coronavirus Infections/complications , Cough/diagnosis , Fever/diagnosis , Leukopenia/diagnosis , Lymphopenia/diagnosis , Pneumonia, Viral/complications , Adult , Coronavirus Infections/virology , Cough/blood , Cough/etiology , Female , Fever/blood , Fever/etiology , Humans , Leukopenia/blood , Leukopenia/etiology , Lymphopenia/blood , Lymphopenia/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Prognosis
8.
BMC Med ; 18(1): 194, 2020 Jun 25.
Article in English | MEDLINE | ID: covidwho-614339

ABSTRACT

BACKGROUND: Data from the UK COVID-19 outbreak are emerging, and there are ongoing concerns about a disproportionate effect on ethnic minorities. There is very limited information on COVID-19 in the over-80s, and the rates of hospital-onset infections are unknown. METHODS: This was a retrospective cohort study from electronic case records of the first 450 patients admitted to our hospital with PCR-confirmed COVID-19, 77% of the total inpatient caseload to date. Demographic, clinical and biochemical data were extracted. The primary endpoint was death during the index hospital admission. The characteristics of all patients, those over 80 years of age and those with hospital-onset COVID-19 were examined. RESULTS: The median (IQR) age was 72 (56, 83), with 150 (33%) over 80 years old and 60% male. Presenting clinical and biochemical features were consistent with those reported elsewhere. The ethnic breakdown of patients admitted was similar to that of our underlying local population. Inpatient mortality was high at 38%. Patients over 80 presented earlier in their disease course and were significantly less likely to present with the typical features of cough, breathlessness and fever. Cardiac co-morbidity and markers of cardiac dysfunction were more common, but not those of bacterial infection. Mortality was significantly higher in this group (60% vs 28%, p < 0.001). Thirty-one (7%) patients acquired COVID-19 having continuously been in hospital for a median of 20 (14, 36) days. The peak of hospital-onset infections occurred at the same time as the overall peak of admitted infections. Despite being older and more frail than those with community-onset infection, their outcomes were no worse. CONCLUSIONS: Inpatient mortality was high, especially among the over-80s, who are more likely to present atypically. The ethnic composition of our caseload was similar to the underlying population. While a significant number of patients acquired COVID-19 while already in hospital, their outcomes were no worse.


Subject(s)
Coronavirus Infections/diagnosis , Hospitalization , Pneumonia, Viral/diagnosis , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Disease Progression , Dyspnea/etiology , Female , Fever/etiology , Humans , Inpatients , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Retrospective Studies
9.
JAMA Netw Open ; 3(6): e2012270, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-599358

ABSTRACT

Importance: In late December 2019, an outbreak caused by a novel severe acute respiratory syndrome coronavirus 2 emerged in Wuhan, China. Data on the clinical characteristics and outcomes of infected patients in urban communities in the US are limited. Objectives: To describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and to perform a comparative analysis of hospitalized and ambulatory patient populations. Design, Setting, and Participants: This study is a case series of 463 consecutive patients with COVID-19 evaluated at Henry Ford Health System in metropolitan Detroit, Michigan, from March 9 to March 27, 2020. Data analysis was performed from March to April 2020. Exposure: Laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Main Outcomes and Measures: Demographic data, underlying comorbidities, clinical presentation, complications, treatment, and outcomes were collected. Results: Of 463 patients with COVID-19 (mean [SD] age, 57.5 [16.8] years), 259 (55.9%) were female, and 334 (72.1%) were African American. Most patients (435 [94.0%]) had at least 1 comorbidity, including hypertension (295 patients [63.7%]), chronic kidney disease (182 patients [39.3%]), and diabetes (178 patients [38.4%]). Common symptoms at presentation were cough (347 patients [74.9%]), fever (315 patients [68.0%]), and dyspnea (282 patients [60.9%]). Three hundred fifty-five patients (76.7%) were hospitalized; 141 (39.7%) required intensive care unit management and 114 (80.8%) of those patients required invasive mechanical ventilation. Male sex (odds ratio [OR], 2.0; 95% CI, 1.3-3.2; P = .001), severe obesity (OR, 2.0; 95% CI, 1.4-3.6; P = .02), and chronic kidney disease (OR, 2.0; 95% CI, 1.3-3.3; P = .006) were independently associated with intensive care unit admission. Patients admitted to the intensive care unit had longer length of stay and higher incidence of respiratory failure and acute respiratory distress syndrome requiring invasive mechanical ventilation, acute kidney injury requiring dialysis, shock, and mortality (57 patients [40.4%] vs 15 patients [7.0%]) compared with patients in the general practice unit. Twenty-nine (11.2%) of those discharged from the hospital were readmitted and, overall, 20.0% died within 30 days. Male sex (OR, 1.8; 95% CI, 1.1-3.1; P = .03) and age older than 60 years (OR, 5.3; 95% CI, 2.9-9.7; P < .001) were significantly associated with mortality, whereas African American race was not (OR, 0.98; 95% CI, 0.54-1.8; P = .86). Conclusions and Relevance: In this review of urban metropolitan patients with COVID-19, most were African American with a high prevalence of comorbid conditions and high rates of hospitalization, intensive care unit admission, complications, and mortality due to COVID-19.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Acute Kidney Injury/epidemiology , Adult , African Americans/ethnology , African Americans/statistics & numerical data , Aged , Case-Control Studies , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/mortality , Cough/etiology , Dyspnea/etiology , Female , Fever/etiology , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Length of Stay/trends , Male , Michigan/epidemiology , Middle Aged , Obesity/epidemiology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/mortality , Prevalence , Respiration, Artificial/adverse effects , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/mortality , Retrospective Studies
11.
J Am Med Inform Assoc ; 27(7): 1067-1071, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-593321

ABSTRACT

OBJECTIVE: In December 2019, coronavirus disease 2019 (COVID-19) occurred in Wuhan, China. Online fever clinics were developed by hospitals, largely relieving the hospital's burden. Online fever clinics could help people stay out of crowded hospitals and prevent the risk of cross infections. The objective of our study was to describe the patient characteristics of an online fever clinic and explore the most important concerns and question of online patients. MATERIALS AND METHODS: Our study extracted data from fever clinic records in medical information systems from January 24 to February 18, 2020 in a tertiary hospital in Wuhan. We described the characteristics of patients in fever clinic, then we extracted and classified questions of patient consultations through the online fever clinic dataset. RESULTS: For the 64 487 patients who attended the online fever clinic, the average age was 30.4 years, and 37 665 (58.4%) were female patients. The current state of patients from online were home without isolation (52 360 [81.2%]), home isolated (11 152 [17.29%]), and outpatient observation (975 [1.51%]). From the 594 patient questions analyzed, confirming diagnosis and seeking medical treatment account for 60.61% and 38.05%, respectively, followed by treating (25.59%), preventing (4.38%), and relieving anxiety (1.68%). DISCUSSION: Online fever clinics can effectively relieve patients' mood of panic, and doctors can guide patients with suspected of COVID-19 to isolate and protect themselves through online fever clinic. Online fever clinics can also help to reduce the pressure of hospital fever clinics and prevent cross infection. CONCLUSIONS: This study indicated the importance of online fever clinics during the COVID-19 outbreak for prevention and control.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Fever/etiology , Pneumonia, Viral/diagnosis , Telemedicine , Adult , Aged , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Datasets as Topic , Diagnosis, Differential , Disease Outbreaks , Female , Humans , Male , Middle Aged , Outpatient Clinics, Hospital , Pandemics/prevention & control , Physicians , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Tertiary Care Centers , Young Adult
12.
Clin Nucl Med ; 45(8): 642-643, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-589934

ABSTRACT

An 85-year-old woman with history of melanoma is referred for a follow-up F-FDG PET/CT. F-FDG PET/CT scan showed bilateral and peripheral ground-glass opacities in upper and lower pulmonary lobes surrounded by consolidations of crescent shape with increased FDG uptake, findings compatible with organizing pneumonia. Following further inquiry, the patient reported low-grade fever, sore throat, and fatigue for the past 6 days. Because of the ongoing COVID-19 pandemic, the patient was tested for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which resulted positive.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Aged, 80 and over , Coronavirus Infections/complications , Female , Fever/etiology , Humans , Melanoma , Pandemics , Pneumonia, Viral/complications , Positron Emission Tomography Computed Tomography
13.
In Vivo ; 34(3 Suppl): 1675-1680, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-542896

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global pandemic. It is unclear to radiotherapy practitioners how to carry out radiotherapy during the epidemic. PATIENTS AND METHODS: After the outbreak of COVID-19, our Institute established measures for the prevention and control of COVID-19, and continues to treat patients according to these measures. The Radiotherapy Department has been divided into a clean zone and a semi-contaminated zone, and corresponding personal protective equipment is used in these zones. The temperature of patients and their escorts, and history of fever are assessed daily. Special procedures are performed during radiotherapy setup and intracavitary brachytherapy. RESULTS: Over a period of 2 months, 655 patients were treated in the Department. Sixteen patients with fever were identified and no patient undergoing radiotherapy or medical staff have been infected with COVID-19. CONCLUSION: Our protective measures were found to be effective and can be used as a reference in places where COVID-19 situations are not markedly serious.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Radiology Department, Hospital/organization & administration , Radiotherapy/methods , Adult , Beijing , Child , Clinical Laboratory Techniques/methods , Containment of Biohazards/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Disinfection , Equipment Contamination/prevention & control , Fever/etiology , Health Personnel/education , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Neoplasms/radiotherapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Procedures and Techniques Utilization , Protective Devices , Symptom Assessment , Thermometry
14.
Anaesthesiol Intensive Ther ; 52(1): 34-41, 2020.
Article in English | MEDLINE | ID: covidwho-621289

ABSTRACT

Over the past three months, the world has faced an unprecedented health hazard. The World Health Organization has announced a pandemic infection with an unknown species of coronavirus called SARS-CoV-2. Spreading mainly through the droplet route, the virus causes mild symptoms in the majority of cases, the most common being: fever (80%), dry cough (56%), fatigue (22%) and muscle pain (7%); less common symptoms include a sore throat, a runny nose, diarrhea, hemoptysis and chills. A life-threatening complication of SARS-CoV-2 infection is an acute respiratory distress syndrome (ARDS), which occurs more often in older adults, those with immune disorders and co-morbidities. Severe forms of the infection, being an indication for treatment in the intensive care unit, comprise acute lung inflammation, ARDS, sepsis and septic shock. The article presents basic information about etiology, pathogenesis and diagnostics (with particular emphasis on the importance of tomocomputer imaging), clinical picture, treatment and prevention of the infection. It goes on to emphasize the specific risks of providing anesthesiology and intensive care services. Due to the fact that effective causal treatment is not yet available and the number of infections and deaths increases day by day, infection prevention and strict adherence to recommendations of infection control organizations remain the basis for fighting the virus.


Subject(s)
Anesthesiologists/psychology , Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Age Factors , Coronavirus Infections/etiology , Coronavirus Infections/prevention & control , Cough/diagnosis , Cough/etiology , Disease Progression , Fever/diagnosis , Fever/etiology , Health Knowledge, Attitudes, Practice , Humans , Pneumonia, Viral/etiology , Pneumonia, Viral/prevention & control , Risk Factors
15.
Jpn J Radiol ; 38(7): 683-690, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-378255

ABSTRACT

PURPOSE: To summarize the chest CT imaging and clinical features of the initial COVID-19 patients and provide a clinical diagnostic method that is more effective and can be performed earlier. METHODS: This retrospective study investigated the clinical, laboratory and imaging information of 25 patients in the Luoyang area. There were 15 (60%) male and 10 (40%) female patients ranging from 24 to 88 years old (52 ± 19.30). Data were analyzed by Microsoft Excel and are expressed as the mean ± standard deviation or percentage. RESULTS: Thirteen (52%) patients had been in Wuhan or were in contact with people who had been in Wuhan, and ten (40%) patients were infected by their families or colleagues. The median time from initial symptoms to diagnosis was 7 days. Ninety-two percent of patients had respiratory symptoms, and 8% of them had digestive symptoms. Fever (92%), cough (60%) and fatigue (56%) were the most common symptoms. Most patients had a normal or reduced WBC (96%), reduced lymphocyte count (60%), increased CRP (48%) and increased ESR (44%). Ground glass opacity (GGO) was the typical radiological finding on chest CT. CONCLUSION: Characteristic chest CT imaging features could appear earlier than the viral nucleic acid assay results.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Lung/diagnostic imaging , Lung/pathology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , China , Coronavirus Infections/complications , Cough/etiology , Fatigue/etiology , Female , Fever/etiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Retrospective Studies , Young Adult
16.
Virulence ; 11(1): 482-485, 2020 12.
Article in English | MEDLINE | ID: covidwho-343283

ABSTRACT

Since its outbreak in Wuhan, Hubei Province China, 2019-coronavirus infected disease (COVID-19) had been widely spread all over the world, the control of which calls for a better understanding of its epidemiology and clinical characteristics. We included 12 confirmed cases of COVID-19 in First Affiliated Hospital of Jilin University from 23 January 2020 to 11 February 2020, which were retrospectively analyzed for epidemiological, demographic, clinical, laboratory, and radiological features. All the patients were confirmed by nucleic acid detection, the average age of whom was 45.25 years (range, 23-79 years). Most patients had a history of Wuhan traveling or had contact with Wuhan travelers or infected cases. Obvious family cluster was observed. Clinical manifestations included fever (12/12), fatigue (10/12), cough (6/12), sore throat (4/12), headache (3/12), and diarrhea (2/12). Only three out of eight patients had pneumonia manifestation on radiography. Most patients had a normal white blood cell (WBC) count and normal or reduced lymphocyte (LY) count. Pneumonia changes were observed in all the four patients who underwent a chest CT scan. Only one elderly patient developed severe pneumonia, while all the rest were mild disease and had a self-limiting course.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Adult , Aged , Betacoronavirus/isolation & purification , China/epidemiology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/virology , Cough/etiology , Diarrhea/etiology , Fatigue/etiology , Female , Fever/etiology , Headache/etiology , Humans , Leukocyte Count , Male , Middle Aged , Pandemics , Pharyngitis/etiology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/virology , Retrospective Studies , Tomography, X-Ray Computed , Young Adult
19.
Clin Nucl Med ; 45(8): 656-658, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-325587

ABSTRACT

A 56-year-old woman with high-grade neuroendocrine small cell carcinoma had known contact history of COVID-19 about 16 days prior to the restaging PET/CT. The patient was instructed to self-quarantine for 14 days, and no COVID-19 test was performed. Upon arrival, the patient had low-grade fever of 37.1°C, but did not meet infection control criteria for COVID-19 testing, and it was approved to proceed with PET/CT. The FDG PET/CT images revealed new multifocal hypermetabolic bilateral pulmonary ground-glass opacities that are suggestive of COVID-19 pneumonia. Meanwhile, the patient's symptoms worsened, and a blood test later confirmed COVID-19 infection.


Subject(s)
Betacoronavirus , Carcinoma, Neuroendocrine/complications , Carcinoma, Small Cell/complications , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Coronavirus Infections/complications , Female , Fever/etiology , Fluorodeoxyglucose F18 , Humans , Middle Aged , Pandemics , Pneumonia, Viral/complications , Positron Emission Tomography Computed Tomography
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