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1.
Egypt Heart J ; 72: 58, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-2098496

ABSTRACT

BACKGROUND: Wellens' syndrome is known to be associated with left anterior descending artery occlusion that could lead to an extensive anterior wall myocardial infarction. Thus, emergency cardiac catheterization is needed. However, during coronavirus disease 2019 (COVID-19) pandemic, it is recommended for hemodynamically stable acute coronary syndrome patients with COVID-19 infection to be treated conservatively in an isolated hospital ward. CASE PRESENTATION: We report an 85-year-old patient with chief complaints of typical, squeezing chest pain in the past 4 h. The patient had a high fever, dyspnea, sore throat, and fatigue for 3 days. He had previously come into contact with COVID-19 positive relatives. The patient was hemodynamically stable and pulmonary auscultation revealed coarse rales in the entire lung. Electrocardiography (ECG) evaluation during the pain episode showed non-specific ST-T changes in lead V2-V5. After sublingual nitrate was administered, ECG evaluation during the pain-free period revealed a biphasic T wave inversion in lead V2 and V3. Laboratory workup showed elevated cardiac marker and leucopenia with neutrophilia and lymphopenia. Rapid immunochromatographic test and initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) evaluation from nasopharyngeal swab showed negative results. However, radiographic evaluations suggest the diagnosis of COVID-19 infection. While waiting for the second RT-PCR evaluation, the patient was diagnosed with Wellens' syndrome with suspected COVID-19 infection. The patient was treated conservatively according to national guidelines and scheduled for elective cardiac catheterization. On the third day, the patient felt better and insisted on being discharged home. Ten days after discharged, the patient died of myocardial infarction. CONCLUSION: Emergency cardiac catheterization should be done for patient with Wellens' syndrome, regardless of the COVID-19 infection status.

2.
J Neurol ; 268(6): 2007-2012, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1342967

ABSTRACT

INTRODUCTION: The outbreak of coronavirus disease 2019 (COVID-19) has become one of the most serious pandemics of the recent times. Since this pandemic began, there have been numerous reports about the COVID-19 involvement of the nervous system. There have been reports of both direct and indirect involvement of the central and peripheral nervous system by the virus. OBJECTIVE: To review the neuropsychiatric manifestations along with corresponding pathophysiologic mechanisms of nervous system involvement by the COVID-19. BACKGROUND: Since the beginning of the disease in humans in the later part of 2019, the coronavirus disease 2019 (COVID-19) pandemic has rapidly spread across the world with over 2,719,000 reported cases in over 200 countries [World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-96.,]. While patients typically present with fever, shortness of breath, sore throat, and cough, neurologic manifestations have been reported, as well. These include the ones with both direct and indirect involvement of the nervous system. The reported manifestations include anosmia, ageusia, central respiratory failure, stroke, acute inflammatory demyelinating polyneuropathy (AIDP), acute necrotizing hemorrhagic encephalopathy, toxic-metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. These data were derived from the published clinical data in various journals and case reports. CONCLUSION: The neurological manifestations of the COVID-19 are varied and the data about this continue to evolve as the pandemic continues to progress.


Subject(s)
COVID-19 , Nervous System Diseases , Stroke , Humans , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Pandemics , SARS-CoV-2 , Stroke/epidemiology
3.
Int J Infect Dis ; 108: 382-390, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1297091

ABSTRACT

OBJECTIVE: Our study aimed to compare symptoms day by day for non-hospitalized individuals testing positive and negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: In total, 210 positive-test and 630 negative-test healthcare workers in the Central Denmark Region were followed for up to 90 days after testing, between April and June, 2020. Their daily reported COVID-19-related symptoms were compared graphically and by logistic regression. RESULTS: Thirty per cent of the positive-test and close to 0% of the negative-test participants reported a reduced sense of taste and smell during all 90 days (adjusted odds ratio [aOR] 86.07, 95% CI 22.86-323). Dyspnea was reported by an initial 20% of positive-test participants, declining to 5% after 30 days, without ever reaching the level of the negative-test participants (aOR 6.88, 95% CI 2.41-19.63). Cough, headache, sore throat, muscle pain, and fever were temporarily more prevalent among the positive-test participants; after 30 days, no increases were seen. Women and older participants were more susceptible to long-lasting COVID-19 symptoms. CONCLUSION: The prevalence of long-lasting reduced sense of taste and smell is highly increased in mild COVID-19 patients. This pattern is also seen for dyspnea at a low level, but not for cough, sore throat, headache, muscle pain, or fever.


Subject(s)
COVID-19 , SARS-CoV-2 , Female , Follow-Up Studies , Health Personnel , Humans , Polymerase Chain Reaction
4.
SAGE Open Med ; 9: 20503121211016965, 2021.
Article in English | MEDLINE | ID: covidwho-1255873

ABSTRACT

To detect, analyze, and discuss the different ear nose throat manifestations, those were reported in coronavirus disease-positive patients in the published and reviewed literature. Coronavirus disease has been reported to present with several symptoms. Common symptoms include new onset of fever, cough, fatigue, and myalgia. Other symptoms like sputum production, dyspnea, rhinorrhea, anosmia, nasal stuffiness, headache, and sore throat are less frequently reported, but the clinical presentation is highly variable among individuals. We review the otolaryngologic manifestations of coronavirus disease reported in the published literature to assess its importance in the early diagnosis of coronavirus disease. We searched PubMed database, MEDLINE, Web of Science, LILACS, SciELO, and Cochrane Library to find out relevant articles, using the following keywords: COVID-19, clinical features, characteristics, symptoms, clinical, manifestations, throat, cough, rhinorrhea, COVID-19 anosmia, headache, nasal, coronavirus, and coronavirus otolaryngologic. Article selection was based on their relevance to the research question. Totally, 14 articles and 2971 patients were recruited for our study. A wide variety of upper and lower airway manifestations were reported. Fever (34%-96.5%), cough (17.9%-83%), myalgia or fatigue (10%-31%), expectoration (20%-32.7%), dyspnea (7.6%-7.5%), rhinorrhea (1%-6.8%), sore throat (4%-61%), nasal congestion (3%-4.8%), and headache (3%-16.2%) were the most common symptoms reported. Our findings confirm that coronavirus disease infection presents with a wide spectrum of clinical presentation. The ear nose throat manifestations for coronavirus disease are not uncommon, but more attention should also be paid to patients with otolaryngologic symptoms which can appear early, as this could encourage an earlier diagnosis and treatment, which limits spread of the disease.

5.
Cureus ; 13(4): e14729, 2021 Apr 28.
Article in English | MEDLINE | ID: covidwho-1241336

ABSTRACT

Coronavirus disease 2019 (COVID-19) has swept the world with over hundred million of cases and millions of deaths. Upper respiratory tract symptoms including acute pharyngitis are the common symptoms of COVID-19, with a reported incidence of about 5%-17.4%. Group A Streptococcus (GAS) pharyngitis is a common cause of bacterial pharyngitis, with highest incidence between age 5 and 15, and it can still occur in adults with peak incidence at age 40. Herein, we report a case of co-occurrence of GAS and COVID-19 in a middle-aged man who presented with fever, sore throat, cough, and runny nose. To the best of our knowledge, we are the first to report this unique co-occurrence. Our case report aimed to raise the awareness among physician particularly in ambulatory and emergency department of not to have a singular focus on COVID-19 and forget to screen patient with acute pharyngitis for GAS.

6.
Surg Neurol Int ; 12: 187, 2021.
Article in English | MEDLINE | ID: covidwho-1209982

ABSTRACT

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 is responsible for over 83 million cases of infection and over 1.8 million deaths since the emergence of the COVID-19 pandemic. Because COVID-19 infection is associated with a devastating mortality rate and myriad complications, it is critical that clinicians better understand its pathophysiology to develop effective treatment. Cumulative evidence is suggestive of cerebral aneurysms being intertwined with the hyperinflammatory state and hypercytokinemia observed in severe COVID-19 infections. CASE DESCRIPTION: In case example 1, the patient presents with chills, a mild cough, and sore throat. The patient develops high-grade fever of 39.8° C, decreased oxygen saturation of 93% on room air, and an extensive spontaneous subarachnoid hemorrhage (SAH) in the basal cisterns from a ruptured left posterior communicating artery aneurysm. In case example 2, the patient presents with a positive PCR test for COVID-19 2 weeks prior with spontaneous SAH and found to have a large multilobulated bulbous ruptured aneurysm of the anterior communicating artery. Both patients' symptoms and high-grade fever are consistent with hypercytokinemia and a hyperinflammatory state, with elevated granulocyte colony-stimulating factor, inducible protein-10, monocyte chemoattractant protein-1, M1P1A, and tumor necrosis factor-α inflammatory mediators found to be elevated in COVID-19 intensive care unit admissions. CONCLUSION: COVID-19 effect on cerebral aneurysms requires future studies to clearly delineate correlation, however, hypercytokinemia and a hyperinflammatory state are strongly implicated to cause degenerative vascular changes that may predispose patients to cerebral aneurysm formation, change in size or morphology, and resultant aneurysm rupture.

7.
Indian J Otolaryngol Head Neck Surg ; : 1-6, 2021 Apr 27.
Article in English | MEDLINE | ID: covidwho-1206951

ABSTRACT

Corona virus also known as 2019 novel corona virus, a single stranded positive sense RNA virus is the causative agent of COVID 19 disease. It mainly spreads via the respiratory route by means of aerosols. The objectives of our study were. To know the prevalence of ENT presentations in COVID 19 patients and to know the relationship between the symptoms and category of the disease as well as to know the relation between the blood group and recovery from the disease. The first 500 patients who were tested positive for COVID 19 and getting treated in our hospital were included in the study after taking written informed consent from the patients who were willing to participate in the study. A detailed history was taken from all the patients and more stress was given on the ENT symptoms with respect to its onset, duration and time taken for the relief of symptoms. The ENT symptoms were compared with the category of the disease as well as the blood group of the patients. Statistical analysis was done using Chi square test and Statistical Package for Social Sciences [SPSS] for Windows Version 22.0 Released 2013. Armonk, NY: IBM Corp., was used to perform statistical analyses. In our study 310 (62.0%) were males and 190 (38.0%) patients were females (38%), of age group ranging from 2 years to 87 years. In our study 367 (73.3%) patients were symptomatic and the rest 133 (26.6%) were asymptomatic. There were 335 (67.0%) patients in category A, 140 (28.0%) in category B and 25 (5.0%) in category C. The most common ENT presentation was headache and its prevelance was more in category C and it was of statistical significance. On comparing the blood group and the ENT symptoms occurrence of sore throat was of statistical significance and its prevelance was more among the O blood group patients. In terms of recovery from the disease the patients with blood group O had good recovery rate. Covid 19 pandemic is still an on going problem and newer strains of the virus are arising as well hence. In our study we found out that isolated ENT symptoms such as aguesia and anosmia were the only presentation of the disease. Thus they can be considered as early marker of the disease and it will be helpful in early detection and isolation of the patient as well as prevention of further spread of the disease.

8.
J Med Virol ; 93(2): 1008-1012, 2021 02.
Article in English | MEDLINE | ID: covidwho-1206808

ABSTRACT

In the last months of 2019, an outbreak of fatal respiratory disease started in Wuhan, China, and quickly spread to other parts of the world. It was named COVID-19, and to date, thousands of cases of infection and death are reported worldwide. This disease is associated with a wide range of symptoms, which makes accurate diagnosis of it difficult. During previous severe acute respiratory syndrome (SARS) pandemic in 2003, researchers found that the patients with fever, cough, or sore throat had a 5% influenza virus-positive rate. This finding made us think that the wide range of symptoms and also relatively high prevalence of death in our patients may be due to the coinfection with other viruses. Thus, we evaluated the coinfection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with other respiratory viruses in dead patients in North Khorasan. We evaluated the presence of influenza A/B virus, human metapneumovirus, bocavirus, adenovirus, respiratory syncytial virus (RSV), and parainfluenza viruses in 105 SARS-CoV-2 positive dead patients, using polymerase chain reaction (PCR) and reverse transcription PCR tests. We found coinfection with influenza virus in 22.3%, RSV, and bocavirus in 9.7%, parainfluenza viruses in 3.9%, human metapneumovirus in 2.9%, and finally adenovirus in 1.9% of SARS-CoV-2 positive dead cases. Our findings highlight a high prevalence of coinfection with influenza A virus and the monopoly of coinfection with Human metapneumovirus in children.


Subject(s)
COVID-19/epidemiology , Coinfection/mortality , Coinfection/virology , Influenza, Human/epidemiology , Viruses/isolation & purification , Adolescent , Adult , Cadaver , Child , Child, Preschool , China/epidemiology , Coinfection/epidemiology , Female , Humans , Infant , Infant, Newborn , Iran/epidemiology , Male , Middle Aged , Orthomyxoviridae/isolation & purification , Prevalence , Respiratory Syncytial Virus, Human/isolation & purification , SARS-CoV-2/isolation & purification , Viruses/classification , Young Adult
9.
Int J Clin Pract ; 75(7): e14260, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1197146

ABSTRACT

INTRODUCTION: Coronavirus 2019 disease (COVID-19) has variable clinical, sinonasal, and smell/taste outcomes. METHODS: Observational study was conducted at a tertiary hospital in Amman, Jordan. Demographic data, clinical presentation and smoking status were collected. Sinonasal symptoms, using Sino-Nasal Outcome Test (SNOT-22) Questionnaire, were evaluated. Smell/taste dysfunction was followed for three months. RESULTS: Ninety-Seven patients had satisfactory responses. Eighty-six patients were symptomatic (41 at presentation, and 45 during admission). Among those patients, 59.3% had cough, 52.3% sore throat and 48.8% fever. The most common initial symptom was sore throat. Shortness of breath and smell/taste dysfunction were significantly higher in females. Surprisingly, shortness of breath was more common in non-smokers. Smell/taste dysfunction affected 25.6% of patients, but was the first symptom in only one patient. Fourteen of 22 symptoms in SNOT-22 had significant increase. The overall average of symptoms scores increased from 0.472 to 1.034, with smell/taste dysfunction to have the most increment. The latter symptom recovered completely in 81% and dysgeusia developed in 9.5% at three months, and it recovered completely in all patients at six months. CONCLUSION: Although COVID-19 may produce severe lower airways disease, it has modest effect on nose and paranasal sinuses. Moreover, smell/taste dysfunction is a prominent symptom, but it usually recovers dramatically.


Subject(s)
COVID-19 , Smell , Female , Humans , Jordan , SARS-CoV-2 , Taste
10.
eNeurologicalSci ; 23: 100338, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1191609

ABSTRACT

OBJECTIVE: To determine the prevalence and characteristics of the most common neurological manifestations in Peruvian patients with mild-to-moderate COVID-19. METHODS: We conducted a single-center prospective, cross-sectional study at an isolation center functioning as a public acute-care hospital during the COVID-19 pandemic in Lima, the capital city of Peru. This was a convenience sample of patients with acute COVID-19 infection and mild-to-moderate respiratory symptoms who presented for hospital admission between September 25 and November 25, 2020. We interviewed participants and collected demographic, medical history and clinical presentation data; all participants underwent a complete physical and neurological examination. Descriptive statistics and prevalence ratios (PR) with corresponding 95% confidence intervals and p-values were calculated to explore between-groups differences. RESULTS: Of 199 patients with mild-to-moderate COVID-19 enrolled in this study, 83% presented with at least one neurological symptom (mean symptom duration 8 +/- 6 days). The most common neurological symptoms were headache (72%), hypogeusia or ageusia (41%), hyposmia or anosmia (40%) and dizziness (34%). Only 2.5% of the cohort had an abnormal neurological examination. The majority (42%) had no prior comorbidities. Presence of at least 1 neurological symptom was independently associated with fever, dyspnea, cough, poor appetite, sore throat, chest tightness or diarrhea, but not with comorbid conditions. CONCLUSIONS: This cross-sectional study found that headaches, and smell and taste dysfunction are common among patients presenting with mild-to-moderate acute COVID-19 in Lima, Peru. International longitudinal studies are needed to determine the long-term neurological sequelae of COVID-19 during the acute and post-infectious period.

11.
J Infect Dev Ctries ; 15(2): 214-223, 2021 03 07.
Article in English | MEDLINE | ID: covidwho-1125213

ABSTRACT

INTRODUCTION: SARS-Cov-2 infection or COVID-19 is a global pandemic. In this manuscript, we investigated the primary symptoms and basic hematological presentations of SARS-CoV-2 infection among the Bangladeshi patients. METHODOLOGY: This was a multicentre cross-sectional study done on COVID-19 patients tested positive by RT PCR in Bangladesh. Clinical features of mild to moderate degree of COVID-19 patients; hematological and biochemical admission day laboratory findings of moderate to severe degree hospitalized COVID-19 patients were analyzed. RESULTS: COVID-19 patients in Bangladesh commonly presented with fever, cough, fatigue, shortness of breath, and sore throat. But symptoms like myalgia, diarrhea, skin rash, headache, Abdominal pain/cramp, nausea, vomiting, restlessness, and a higher temperature of >100°F have a greater presentation rate and more frequent than other published studies. CRP and Prothrombin time was found to increase in all the patients. Serum ferritin, ESR, SGPT, and D-Dimer were increased among 53.85%, 80.43, 44%, and 25% patients. 17.39% of the patients had leucocytosis and neutrophilia, 28.26% presented with lymphocytopenia, and 62.52% had mild erythrocytopenia. The difference between the decrease hemoglobin count (higher in the male) and increased SGPT (higher in female) against gender was significant. CONCLUSIONS: Our study had evaluated a different expression in presenting symptoms of COVID-19 patients in Bangladesh. CRP, Prothrombin time, serum ferritin, ESR, SGPT, D-Dimer, erythrocytopenia, and lymphocytopenia can be assessments for diagnosis and prognosis of COVID-19 disease. Decrease hemoglobin count (higher in the male) and increased SGPT (higher in female) establish these two markers as a good candidate for diagnostic value against gender.


Subject(s)
COVID-19/blood , COVID-19/etiology , Adolescent , Adult , Alanine Transaminase/blood , Bangladesh , COVID-19/epidemiology , Child , Comorbidity , Cough/virology , Cross-Sectional Studies , Fatigue/virology , Female , Fever/virology , Hematologic Tests , Hospitalization , Humans , Male , Middle Aged , Young Adult
12.
J Coll Physicians Surg Pak ; 30(1): S1-S6, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1112938

ABSTRACT

OBJECTIVE: To compare the diagnostic accuracies of HRCT chest and RT-PCR results in diagnosis of coronavirus disease (COVID-19) in a tertiary care hospital in Lahore. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Radiology and Central Research Lab, Lahore General Hospital, Lahore, from April to July, 2020. METHODOLOGY: Patients aged 18 to 83 years, who had clinically suspected symptoms of COVID-19 (fever, cough/sore throat or shortness of breath) presenting in outpatient or emergency department, were included. These patients had their HRCT chest conducted from Radiology Department and RT-PCR performed at Central Research Lab. These data were retrieved from electronic system of PACS. Results were categorised into positive and negative findings for COVID-19. Diagnostic accuracies of HRCT chest and first RT-PCR along with 95% confidence interval were calculated. RESULTS: A total of 94 patients, 55 (58.5%) males and 39 (41.5%) were females. Out of them, 83% patients had positive HRCT chest findings of COVID-19, 17% had negative HRCT chest findings; while 40.4% had positive and 59.6% had negative first PCR. Among the repeat second PCR, 19.6% had negative, 1.8% had positive PCR results; while 78.6% patients didn't undergo repeat PCR. The sensitivity, specificity, NPV, PPV and accuracy of HRCT chest was 92%, 23%, 81%, 45%, and 51%; while of first RT-PCR was 45%, 81%, 23%, 92% and 51%, respectively. CONCLUSION: The sensitivity of HRCT chest is higher (92%) as compared to first RT-PCR (45%). Key Words: COVID-19, RT-PCR, HRCT chest, Sensitivity, Specificity.


Subject(s)
COVID-19/diagnosis , Pandemics , Reverse Transcriptase Polymerase Chain Reaction/methods , SARS-CoV-2/genetics , Tomography, X-Ray Computed/methods , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Female , Humans , Male , Middle Aged , Pakistan/epidemiology , Retrospective Studies
13.
Endocrinol Diabetes Metab Case Rep ; 20212021 Jan 27.
Article in English | MEDLINE | ID: covidwho-1090513

ABSTRACT

SUMMARY: Comorbidities are a risk factor for patients with COVID-19 and the mechanisms of disease remain unclear. The aim of this paper is to present a case report of an COVID-19 patient with severe hypocalcaemia. This is a report of an 81-year-old female, suffered from myalgia and fatigue for more than 3-4 weeks. Fever and cough appear 2 days before she presented to the emergency room. On physical examination, she was febrile with a temperature of 38.8°C, accompanied by cough, sore throat, headache, fatigue, and muscle ache. Her past medical history was remarkable with no chronic disease. She had lymphopenia. Laboratory test revealed moderate liver dysfunction, hypoalbuminemia, and severe hypocalcaemia (serum corrected calcium level: 5.7 mg/dL). Parathyroid hormone (PTH) was 107.9 pg/mL (range: 15-65) and 25(OH)2D levels was 4.5 ng/mL (range: 25-80). Chest CT scan detected peripheral ground-glass opacity. Throat swab for coronavirus by RT-PCR assay tested positive for the virus. She was treated with lopinavir/ritonavir, third generation cephalosporin, anticoagulant, daily high-dose calcium acetate, vitamin D3, fresh frozen plasma and oxygen therapy. She was discharged after two negative throat swab tests for coronavirus by conventional RT-PCR. LEARNING POINTS: Comorbidities are a risk factor for patients with COVID-19. Laboratory findings are unspecific in COVID-19 patients; laboratory abnormalities include lymphopenia, elevated of LDH, CPK and the inflammatory markers, such as C reactive protein, ferritinemia and the erythrocyte sedimentation rate. In addition to inflammatory markers, in COVID-19 patients it is crucial to check the level of vitamin D and calcium. There may be a correlation between vitamin D deficiency and the severity of COVID-19 disease.

14.
Indian J Otolaryngol Head Neck Surg ; 73(2): 218-225, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1085622

ABSTRACT

Olfactory dysfunction (OD) and gustatory dysfunction (GD) has been reported as one of the presenting symptoms amongst COVID-19 patients. However the literature available is disjunct on this aspect. This study is conducted to identify the prevalence of olfactory and/or gustatory dysfunction in patients with coronavirus disease in Northern part of India. It's a cross-sectional observation study, conducted over 387 COVID-19 positive patients, at ENT dept of tertiary care hospital. A retrospective survey was conducted using a pre designed questionnaire and details of Olfactory and Gustatory dysfunction was collected. The patient's demographic details, disease course and recovery time for olfactory (OD) and/or gustatory dysfunctions (GD) were collected. A total of 387 patients with COVID-19 completed the study. 228 (58.9%) patients suffered from influenza like illness (ILI) (fever, sore throat, dry cough, malaise, and myalgia). There was significant positive association seen between with ILI and OD and / or GD. 167/387 (43.15%) patients reported OD, and 153/387 (39.53%) reported GD. 43.71% and 50.3% patients had mild OD & GD respectively. Recovery rates for both OD and GD are high and almost similar, with 161 (96.4%) and 148 (96.73%) patients had complete recovery of smell and taste. Maximum recovery was noticed between 4 and 6 weeks. COVID-19 patients with habits have significantly high probability of developing OD &/or GD. There is a significant correlation between OD and GD and there is high probability that patients who reported to have OD will also have GD or vice versa. Prevalence of OD and GD in Indian population may not be as high as mentioned in western literature, however, both are frequent and early symptoms of COVID-19. Recent onset of these should be considered as red flag symptoms for COVID-19.

15.
J Pain Res ; 14: 147-159, 2021.
Article in English | MEDLINE | ID: covidwho-1061204

ABSTRACT

PURPOSE: On 11 March, 2020, the coronavirus disease (COVID-19) outbreak was declared as a global pandemic by the World Health Organization. It brought substantial physical and psychological burden on individuals and financial loss across countries. Patients with COVID-19 may exhibit various symptoms, such as fever, cough, dyspnea, muscle pain, sore throat, headache, chest pain, and abdominal pain, at 2-14 days after exposure to the novel coronavirus (severe acute respiratory syndrome [SARS]-CoV-2). Pain symptoms present important challenge to clinicians' diagnosis when treating COVID-19 patients with mild symptoms. Considering the increasing number of confirmed COVID-19 cases, the pain symptoms should be systematically summarized. RESULTS: The virus can invade different tissues of the body and cause different pain manifestations. SARS-CoV-2 primarily invades the respiratory system, and patients develop sore throat, fever, cough, and other pneumonia-associated symptoms. Moreover, it infects the nervous system (eg, headache, dizziness, and confusion), digestive system (eg, abdominal pain, diarrhea), and cardiovascular system (eg, chest pain, palmus, and cardiac injury). The incidence rate is 1.7-33.9% for headache, 0.7-47.1% for sore throat, 1.5-61.0% for myalgia/arthralgia, 1.6-17.7% for chest pain, and 1.9-14.5% for abdominal pain. In comparison with chest and abdominal pain, COVID-19 patients are more likely to develop headache, sore throat, and myalgia/arthralgia. CONCLUSION: Different pain reflects the damage of different body systems. Therefore, the summary of pain symptoms for COVID-19 patients can help doctors improve the accuracy and efficiency of diagnosis when treating COVID-19 patients with atypical or mild symptoms and adopt more targeted treatment methods.

16.
Adv Clin Exp Med ; 30(1): 109-114, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1059687

ABSTRACT

BACKGROUND: This review focuses on the frequency of symptoms in COVID-19 in comparison to SARS, influenza and common cold. OBJECTIVES: To evaluate and compare the knowledge about the clinical features, symptoms and differences between patients with COVID-19, SARS, influenza, and common cold. The research can help ear, nose and throat specialists and other health practitioners manage patients during the COVID-19 pandemic. MATERIAL AND METHODS: The biomedical databases used in the study included PubMed and MEDLINE. Statistical analysis using the Z-score test assessed which symptoms were more characteristic of COVID-19 than other viral diseases. RESULTS: Among individuals with COVID-19, the most frequently reported symptoms were cough (70%), fever (45%), muscular pain (29%), and headache (21%), whereas sore throat (12%), and rhinorrhea (4%) were observed at lower rates. Fever was identified as most frequent in COVID-19 (74%), appearing at a higher rate in those cases than in influenza (68%) or the common cold (40%) (p < 0.05). In comparison to other viral diseases, sore throat was rarely reported in COVID-19 and SARS (12% and 18%, respectively) (p < 0.05). In influenza and common cold, a cough was identified in 93% and 80% of cases (p < 0.05). Headache, rhinorrhea, muscular pain, and sore throat were more common in influenza (91%, 91%, 94%, and 84%, respectively) and common cold (89%, 81%, 94%, and 84%, respectively) than in COVID-19 (21%, 4%, 29%, and 12%, respectively) and SARS (45%, 12%, 55%, and 18%, respectively) (p < 0.05). CONCLUSION: The results of the analysis show that a greater number of general symptoms should lead to a diagnosis of influenza or common cold rather than COVID-19.


Subject(s)
COVID-19 , Common Cold , Influenza, Human , Common Cold/diagnosis , Common Cold/epidemiology , Humans , Influenza, Human/diagnosis , Influenza, Human/epidemiology , Pandemics , SARS-CoV-2
17.
Int J Mol Sci ; 22(3)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1055067

ABSTRACT

The novel coronavirus disease (COVID-19) has many characteristics common to those in two other coronavirus acute respiratory diseases, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). They are all highly contagious and have severe pulmonary complications. Clinically, patients with COVID-19 run a rapidly progressive course of an acute respiratory tract infection with fever, sore throat, cough, headache and fatigue, complicated by severe pneumonia often leading to acute respiratory distress syndrome (ARDS). The infection also involves other organs throughout the body. In all three viral illnesses, the fibrinolytic system plays an active role in each phase of the pathogenesis. During transmission, the renin-aldosterone-angiotensin-system (RAAS) is involved with the spike protein of SARS-CoV-2, attaching to its natural receptor angiotensin-converting enzyme 2 (ACE 2) in host cells. Both tissue plasminogen activator (tPA) and plasminogen activator inhibitor 1 (PAI-1) are closely linked to the RAAS. In lesions in the lung, kidney and other organs, the two plasminogen activators urokinase-type plasminogen activator (uPA) and tissue plasminogen activator (tPA), along with their inhibitor, plasminogen activator 1 (PAI-1), are involved. The altered fibrinolytic balance enables the development of a hypercoagulable state. In this article, evidence for the central role of fibrinolysis is reviewed, and the possible drug targets at multiple sites in the fibrinolytic pathways are discussed.


Subject(s)
COVID-19/blood , COVID-19/drug therapy , Drug Discovery , Fibrinolysis , Animals , COVID-19/complications , Fibrinolysis/drug effects , Humans , Molecular Targeted Therapy , Renin-Angiotensin System/drug effects , SARS-CoV-2/drug effects , SARS-CoV-2/physiology , Thrombosis/blood , Thrombosis/drug therapy , Thrombosis/etiology
18.
Am J Emerg Med ; 38(11): 2492.e5-2492.e6, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-962170

ABSTRACT

Early reports of COVID-19 in pediatric populations emphasized a mild course of disease with severe cases disproportionately affecting infant and comorbid pediatric patients. After the peak of the epidemic in New York City, in late April to early May, cases of severe illness associated with COVID-19 were reported among mostly previously healthy children ages 5-19. Many of these cases feature a toxic shock-like syndrome or Kawasaki-like syndrome in the setting of SARS-CoV-2 positive diagnostic testing and the CDC has termed this presentation Multisystem Inflammatory Syndrome (MIS-C). It is essential to disseminate information among the medical community regarding severe and atypical presentations of COVID-19 as prior knowledge can help communities with increasing caseloads prepare to quickly identify and treat these patients as they present in the emergency department. We describe a case of MIS-C in a child who presented to our Emergency Department (ED) twice and on the second visit was found to have signs of distributive shock, multi-organ injury and systemic inflammation associated with COVID-19. The case describes two ED visits by an 11- year-old SARS-CoV-2-positive female who initially presented with fever, rash and pharyngitis and returned within 48 hours with evidence of cardiac and renal dysfunction and fluid-refractory hypotension requiring vasopressors and PICU admission.


Subject(s)
COVID-19/complications , Systemic Inflammatory Response Syndrome/diagnosis , COVID-19/diagnosis , COVID-19/virology , Child , Exanthema/virology , Female , Fever/virology , Humans , Pharyngitis/virology , Systemic Inflammatory Response Syndrome/virology
19.
BMC Fam Pract ; 21(1): 251, 2020 12 03.
Article in English | MEDLINE | ID: covidwho-958028

ABSTRACT

BACKGROUND: Combating the COVID-19 pandemic is a major challenge for health systems, citizens and policy makers worldwide. Early detection of affected patients within the large and heterogeneous group of patients with common cold symptoms is an important element of this effort, but often hindered by limited testing resources, false-negative test results and the lack of pathognomonic symptoms in COVID-19. Therefore, we aimed to identify anamnestic items with an increased/decreased odds ratio for a positive SARS-CoV-2 PCR (CovPCR) result in a primary care setting. METHODS: We performed a multi-center cross-sectional cohort study on predictive clinical characteristics for a positive CovPCR over a period of 4 weeks in primary care patients in Germany. RESULTS: In total, 374 patients in 14 primary care centers received CovPCR and were included in this analysis. The median age was 44.0 (IQR: 31.0-59.0) and a fraction of 10.7% (n = 40) tested positive for COVID-19. Patients who reported anosmia had a higher odds ratio (OR: 4.54; 95%-CI: 1.51-13.67) for a positive test result while patients with a sore throat had a lower OR (OR: 0.33; 95%-CI: 0.11-0.97). Furthermore, patients who had a first grade contact with an infected persons and showed symptoms themselves also had an increased OR for positive testing (OR: 5.16; 95% CI: 1.72-15.51). This correlation was also present when they themselves were still asymptomatic (OR: 12.55; 95% CI: 3.97-39.67). CONCLUSIONS: Several anamnestic criteria may be helpful to assess pre-test probability of COVID-19 in patients with common cold symptoms.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/diagnosis , Common Cold/diagnosis , SARS-CoV-2/isolation & purification , Adult , COVID-19/virology , Common Cold/virology , Cross-Sectional Studies , Female , Germany , Humans , Male , Middle Aged , Polymerase Chain Reaction , Primary Health Care , Retrospective Studies , Risk Factors
20.
BMC Infect Dis ; 20(1): 811, 2020 Nov 06.
Article in English | MEDLINE | ID: covidwho-914043

ABSTRACT

BACKGROUND: Covid-19 is causing a pandemic and forces physicians to restructure their work. We want to share our experience in the outpatient management of potentially-infected patients with special consideration of altered national test strategies during the crisis. METHODS: We analysed patients with respiratory symptoms reporting to our three rural general practitioner (GP) offices in North Rhine-Westphalia, Germany, from 27.01-20.04.2020 (n = 489 from a total of 6090 patients). A history of symptoms was taken at the doorstep following a specific questionnaire. Patients with respiratory symptoms were examined in a separated isolation area, while the others were allowed to enter the office. We applied the first recommended algorithm of the German Robert Koch Institute (RKI) to test suspected patients and compared our results with an adapted, more liberal version of the RKI, which is currently applied in Germany. RESULTS: Eighty patients (16.36%, mean age: 47.03 years+ - 18.08) were sent to a nasopharyngeal smear. Five patients (6.25%) proved to be positive, four of whom had established risk factors for COVID-19. Overall, the most common symptoms were cough (83.75%), sore throat (71.25%), as well as myalgia and fatigue (66.25%). The most common diagnoses were rhinopharyngitis (37.22%) and acute bronchitis (30.27%). A sore throat was more common in positively-tested patients (80% vs. 12%). Applying the first RKI test strategy yielded 6.25% of positive tests (n = 80), while the more liberal later RKI recommendation would have achieved 1.36% positive tests from 369 patients. No positive test was missed by applying the conservative strategy. None of our employees called in sick during this period, which emphasises the efficacy and safety of our screening methods. CONCLUSION: A clinical distinction between ordinary respiratory infections and COVID-19 is not possible in a low-prevalence population. Our model to prevent unprotected physical contact, screen patients in front of the office with protective equipment, and examine respiratory infections in separated areas works in the GP setting without overt health risks for employees. Thus, this approach should be used as a GP standard to uphold patient care without major health risks for the personnel. Large multi-centre studies are necessary to work out the most suitable test strategy.


Subject(s)
Ambulatory Care/methods , Betacoronavirus , Coronavirus Infections/therapy , General Practitioners , Pneumonia, Viral/therapy , Rural Health Services , Adult , Aged , COVID-19 , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Female , Germany/epidemiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Prevalence , Risk Factors , SARS-CoV-2 , Surveys and Questionnaires
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