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1.
Intern Med ; 60(3): 457-461, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1110169

RESUMEN

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.


Asunto(s)
/terapia , Inmunoglobulinas Intravenosas/administración & dosificación , Insuficiencia Respiratoria/terapia , /aislamiento & purificación , /complicaciones , Síndrome de Liberación de Citoquinas/prevención & control , Citocinas/efectos de los fármacos , Humanos , Ivermectina/uso terapéutico , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Radiografía Torácica , Carga Viral
2.
Medicine (Baltimore) ; 100(5): e23991, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: covidwho-1087853

RESUMEN

ABSTRACT: Since the first infected case of Coronavirus Disease 2019 (COVID-19) was reported in Wuhan, China in December 2019, the virus has spread swiftly, inflicting upon millions of people around the globe. The objective of the study is to investigate and analyze the clinical characteristics and outcomes of patients infected with COVID-19 in Wuxi, China.Cross-sectional study.The Fifth People's Hospital of Wuxi, China.A total of 48 COVID-19 patients were enrolled in the study from 23 January 2020 to 8 March 2020, and the clinical data of these subjects were collected.Epidemiological, clinical, laboratory, and radiologic characteristics, as well as treatment and outcome data, were collected and analyzed.Of these 48 patients with confirmed COVID-19, 3 were mild cases (6.3%), 44 were moderate cases (91.7%), 1 was severe case (2.1%). The median age of the subjects was 45 years (interquartile range [IQR], 24-59; range, 5-75 years). Twenty-five of the patients (52.1%) were male and 23 (47.9%) were female. Twenty-eight cases (58.3%) returned to Wuxi, Jiangsu Province. Thirty-four (70.8%) cases were infected due to clustering epidemic and 29 cases (85.3%) were attributable to family-clustering epidemic. No obvious clinical symptoms were observed in the cohort of patients, except for 3 mild cases. The most common symptoms include fever (41 [85.4%]), cough (28 [58.3%]), asthenia (13 [27.1%]), expectoration (11 [22.9%]), diarrhea (10 [20.8%]), and dyspnea (5 [10.4%]). Seventeen (35.4%) patients had lower lymphocyte values than baseline, 31 patients (64.6%) had higher d-dimers to exceed the normal range. The distribution of high-resolution computed tomography (HRCT)-positive lesions were as follows: left lung in 5 cases (10.4%), right lung in 9 cases (18.8%), and bilateral lungs in 31 cases (64.6%). In terms of density of lesions: 28 cases (58.3%) showed ground glass shadows in the lung, 7 cases (14.6%) showed solid density shadows, and 10 cases (20.8%) showed mixed density shadows. Extrapulmonary manifestations found that mediastinal lymph nodes were enlarged in 2 cases (4.2%) and that pleural effusion was present in 1 case (2.1%). All patients underwent treatment in quarantine. Forty-five (93.8%) patients received antiviral treatments, 22 (45.8%) patients received antibacterial treatments, 6 (12.5%) patients received glucocorticoid treatments, 2 (4.2%) patients received high flow oxygen inhalation treatments, and 6 (12.5%) patients received noninvasive ventilation treatments. As of 8 March 2020, all 48 patients included in this study were cured. The average time of hospitalization of the 48 patients was 18 ±â€Š6 (mean ±â€ŠSD) days, the average time of the lesion resorption was 11 ±â€Š4 days, and the average time taken to achieve negativity in the result of nucleic acid examination was (10 ±â€Š4) days.The epidemiological characteristics of 48 COVID-19 patients in Wuxi were mainly imported cases and clustered cases. The clinical manifestations of these patients were mainly fever and cough. Laboratory results showed that the lymphocytopenia and increased d-dimer are positively correlated with disease severity. Pulmonary imaging showed unilateral or bilateral ground glass infiltration. Most of the patients entered clinical recovery stage within 15 days after hospitalization.


Asunto(s)
Tos , Fiebre , Hospitalización/estadística & datos numéricos , Atención al Paciente , Evaluación de Síntomas/estadística & datos numéricos , /sangre , /fisiopatología , China/epidemiología , Análisis por Conglomerados , Tos/diagnóstico , Tos/etiología , Salud de la Familia/estadística & datos numéricos , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Linfopenia/diagnóstico , Linfopenia/etiología , Masculino , Persona de Mediana Edad , Atención al Paciente/métodos , Atención al Paciente/estadística & datos numéricos , Radiografía Torácica/estadística & datos numéricos , Tomografía Computarizada por Rayos X/métodos
3.
Medicine (Baltimore) ; 99(51): e23797, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1087850

RESUMEN

ABSTRACT: The coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 had resulted in a global pandemic. A comprehensive analysis of pediatric COVID-19 cases is essential to decipher the natural features of children under the risk of this disease.In the epidemic period, all the children infected with SARS-CoV-2 in Wuxi, a city with a stable medical system during the COVID-19 outbreak in China, were enrolled for comprehensive data documenting their clinical, prognosis, follow-up, treatment and various tests results. Combing their family cluster characteristics, the epidemiological, hospitalization, and transmission features of children with SARS-CoV-2 were analyzed and discussed.A total of 7 children were enrolled, including 4 mild cases, 1 moderate case, and 2 asymptomatic cases. The common symptoms were fever and dry cough. The length of viral nucleic acid duration in nasopharynx varied and was irrelevant to the severity of the symptom, whether symptomatic or asymptomatic. Two cases showed viral nucleic acid positive recurrence after discharge from the hospital. A child with type 1 diabetes was also focused, for the elevated blood sugar during hospitalization. All these children had close contacts with their family members, some of those were confirmed COVID-19 cases.We provided a holistic and detailed portrayal of the pediatric COVID-19 cases in a typical city of timely response to the epidemic. While the family cluster exhibits the major transmission mode, attention should be paid for the potential risk since the expanded social space of children in future.


Asunto(s)
/sangre , /aislamiento & purificación , Adolescente , Antivirales/uso terapéutico , Infecciones Asintomáticas , /tratamiento farmacológico , Niño , Preescolar , Femenino , Humanos , Masculino , Radiografía Torácica , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
4.
J Med Internet Res ; 23(2): e23693, 2021 02 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1076386

RESUMEN

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.


Asunto(s)
Algoritmos , Aprendizaje Profundo , Enfermedades Torácicas/diagnóstico por imagen , Humanos , Redes Neurales de la Computación , Radiografía Torácica , Tórax
6.
J Coll Physicians Surg Pak ; 31(1): 14-20, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1068267

RESUMEN

OBJECTIVE:   To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. STUDY DESIGN: Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. METHODOLOGY: Five hundred suspected COVID-19 cases referred for high resolution computed tomography - chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per 'Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection' recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. RESULTS: Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. CONCLUSION: In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. Key Words: COVID-19, COVID-19 pneumonia, CT-SS, High resolution computed tomography.


Asunto(s)
Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pakistán , Radiografía Torácica/métodos , Atención Terciaria de Salud , Adulto Joven
7.
Intern Med ; 60(3): 473-477, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1067517

RESUMEN

We experienced two cases of post-intubation laryngotracheal stenosis (PILS) occurring in patients after acute coronavirus disease (COVID)-19 in a relatively narrow time period. The patients required mechanical ventilation for 9 days in one and 28 days in the other. In both cases, the patients were discharged but later developed symptoms of cough and dyspnea, which were later diagnosed as PILS. Persistent cough and dyspnea are common symptoms in both PILS and the recovery phase of severe COVID-19. For this reason, PILS should be considered in the differential diagnosis post-COVID-19 patients. In addition, the prevalence of PILS may be greater than that of other critical diseases in severe COVID-19 patients.


Asunto(s)
/complicaciones , Intubación Intratraqueal/efectos adversos , Estenosis Traqueal/etiología , Adulto , Tos/etiología , Disnea/etiología , Femenino , Humanos , Laringoscopía , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Persona de Mediana Edad , Radiografía Torácica , Respiración Artificial , Tomografía Computarizada por Rayos X , Tráquea/diagnóstico por imagen , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/diagnóstico por imagen
8.
PLoS One ; 16(1): e0245547, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1067419

RESUMEN

Endemic human coronaviruses (HCoVs) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are members of the family Coronaviridae. Comparing the findings of the infections caused by these viruses would help reveal the novel characteristics of SARS-CoV-2 and provide insight into the unique pathogenesis of SARS-CoV-2 infection. This study aimed to compare the clinical and radiological characteristics of SARS-CoV-2 and endemic HCoVs infection in adult hospitalized patients with community-acquired pneumonia (CAP). This study was performed at a university-affiliated tertiary hospital in the Republic of Korea, between January 1, 2015, and July 31, 2020. A total of 109 consecutive patients who were over 18 years of age with confirmed SARS-CoV-2 and endemic HCoVs were enrolled. Finally, 19 patients with SARS-CoV-2 CAP were compared to 40 patients with endemic HCoV CAP. Flu-like symptoms such as cough, sore throat, headache, myalgia, and prolonged fever were more common in SARS-CoV-2 CAP, whereas clinical findings suggestive of bacterial pneumonia such as dyspnea, leukocytosis with left shift, and increased C-reactive protein were more common in endemic HCoV CAP. Bilateral peripherally distributed ground-glass opacities (GGOs) were typical radiologic findings in SARS-CoV-2 CAP, whereas mixed patterns of GGOs, consolidations, micronodules, and pleural effusion were observed in endemic HCoV CAP. Coinfection was not observed in patients with SARS-CoV-2 CAP, but was observed in more than half of the patients with endemic HCoV CAP. There were distinctive differences in the clinical and radiologic findings between SARS-CoV-2 and endemic HCoV CAP. Further investigations are required to elucidate the mechanism underlying this difference. Follow-up observations are needed to determine if the presentation of SARS-CoV-2 CAP changes with repeated infection.


Asunto(s)
/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Anciano , /patología , Estudios de Cohortes , Coinfección/diagnóstico por imagen , Coinfección/epidemiología , Coinfección/patología , Coinfección/virología , Infecciones Comunitarias Adquiridas , Coronavirus/aislamiento & purificación , Enfermedades Endémicas , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Coronavirus del Síndrome Respiratorio de Oriente Medio/aislamiento & purificación , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/patología , Neumonía Viral/virología , Radiografía Torácica/métodos , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tórax/diagnóstico por imagen
9.
PLoS One ; 16(1): e0245518, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1067418

RESUMEN

OBJECTIVES: High-risk CXR features in COVID-19 are not clearly defined. We aimed to identify CXR features that correlate with severe COVID-19. METHODS: All confirmed COVID-19 patients admitted within the study period were screened. Those with suboptimal baseline CXR were excluded. CXRs were reviewed by three independent radiologists and opacities recorded according to zones and laterality. The primary endpoint was defined as hypoxia requiring supplemental oxygen, and CXR features were assessed for association with this endpoint to identify high-risk features. These features were then used to define criteria for a high-risk CXR, and clinical features and outcomes of patients with and without baseline high-risk CXR were compared using logistic regression analysis. RESULTS: 109 patients were included. In the initial analysis of 40 patients (36.7%) with abnormal baseline CXR, presence of bilateral opacities, multifocal opacities, or any upper or middle zone opacity were associated with supplemental oxygen requirement. Of the entire cohort, 29 patients (26.6%) had a baseline CXR with at least one of these features. Having a high-risk baseline CXR was significantly associated with requiring supplemental oxygen in univariate (odds ratio 14.0, 95% confidence interval 3.90-55.60) and multivariate (adjusted odds ratio 8.38, 95% CI 2.43-28.97, P = 0.001) analyses. CONCLUSION: We identified several high-risk CXR features that are significantly associated with severe illness. The association of upper or middle zone opacities with severe illness has not been previously emphasized. Recognition of these specific high-risk CXR features is important to prioritize limited healthcare resources for sicker patients.


Asunto(s)
/diagnóstico por imagen , Adulto , /virología , Estudios de Cohortes , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica/métodos , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos
10.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1066837

RESUMEN

A previously healthy 37-year-old man presented with fevers and myalgias for a week with a minimal dry cough. Initial SARS-CoV-2 nasopharyngeal testing was negative, but in light of high community prevalence, he was diagnosed with COVID-19, treated with supportive care and self-quarantined at home. Three days after resolution of all symptoms, he developed sudden onset chest pain. Chest imaging revealed a large right-sided pneumothorax and patchy subpleural ground glass opacities. IgM and IgG antibodies for SARS-CoV-2 were positive. His pneumothorax resolved after placement of a small-bore chest tube, which was removed after 2 days.This case demonstrates that patients with COVID-19 can develop a significant pulmonary complication, a large pneumothorax, despite only minimal lower respiratory tract symptoms and after resolution of the original illness. Medical professionals should consider development of a pneumothorax in patients who have recovered from COVID-19 and present with new respiratory symptoms.


Asunto(s)
/complicaciones , Convalecencia , Neumotórax/etiología , Adulto , Dolor en el Pecho/fisiopatología , Tubos Torácicos , Tos/fisiopatología , Disnea/fisiopatología , Fiebre/fisiopatología , Humanos , Masculino , Mialgia/fisiopatología , Neumotórax/diagnóstico por imagen , Neumotórax/fisiopatología , Neumotórax/terapia , Radiografía Torácica , Índice de Severidad de la Enfermedad , Toracostomía , Tomografía Computarizada por Rayos X
11.
Int J Med Sci ; 18(5): 1277-1284, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1060234

RESUMEN

Rationale: To assess the longitudinal changes and relationships of clinical measures and extent of CT lung abnormalities in COVID-19. Methods: 81 patients with COVID-19 were prospectively enrolled and followed until discharge. CT scores were quantified on a basis of a CT scoring system where each lung was divided into 3 zones: upper (above the carina), middle, and lower (below the inferior pulmonary vein) zones; each zone was evaluated for percentage of lung involvement on a scale of 0-4 (0, 0%; 1, 0-24%; 2, 25% - 49%; 3, 50% -74%; 4, >74%).Temporal trends of CT scores and the laboratory parameters characteristic of COVID-19 were analyzed. Correlations between the two were determined at three milestones (initial presentation, worst CT manifestation, and recovery finding before discharge). Their correlations with duration to worst CT manifestation and discharge from symptom onset were evaluated. Results: CT scores peaked during illness days 6-11 (median: 5), and stayed steady. C-reactive protein and lactate dehydrogenase increased, peaked on illness days 6-8 and 8-11 (mean: 23.5 mg/L, 259.9 U/L), and gradually declined. Continual decrease and increase were observed in hemoglobin and lymphocyte count, respectively. Albumin reduced and remained at low levels with a nadir on illness days 12-15 (36.6 g/L). Both initial (r = 0.58, 0.64, p < 0.05) and worst CT scores (r = 0.47, 0.65, p < 0.05) were correlated with C-reactive protein and lactate dehydrogenase; and CT scores before discharge, only with albumin (r = -0.41, p < 0.05). Duration to worst CT manifestation was associated with initial and worst CT scores (r = 0.33, 0.29, p < 0.05). No parameters were related to timespan to discharge. Conclusion: Our results illustrated the temporal changes of characteristic clinical measures and extent of CT lung abnormalities in COVID-19. CT scores correlated with some important laboratory parameters, and might serve as prognostic factors.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Adulto , Proteína C-Reactiva/metabolismo , Femenino , Humanos , L-Lactato Deshidrogenasa/sangre , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía Torácica , Tomografía Computarizada por Rayos X
12.
PLoS One ; 16(1): e0244886, 2021.
Artículo en Inglés | MEDLINE | ID: covidwho-1059976

RESUMEN

INTRODUCTION: While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19. METHODS: All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0-8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1-8 being positive. The patients' initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0-4 and 5-8 being used to assess association with clinical outcomes. RESULTS: A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5-8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136-1.616]) and highest CXR-SS (1.390 [1.143-1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5-8 (2.532 [1.109-5.782]) and highest CXR-SS 5-8 (3.386 [1.405-8.159]). Lastly, age (1.060 [1.009-1.113]), initial CXR-SS (1.278 [1.010-1.617]) and ICU-Int (5.047 [1.731-14.710]), were found to be independent predictors of mortality in our patients. CONCLUSION: In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Radiografía Torácica/métodos , Adulto , Anciano , /mortalidad , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Tiempo de Internación , Pulmón/patología , Masculino , Persona de Mediana Edad , Pakistán/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria
13.
Eur Radiol Exp ; 5(1): 7, 2021 02 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1059693

RESUMEN

BACKGROUND: We aimed to train and test a deep learning classifier to support the diagnosis of coronavirus disease 2019 (COVID-19) using chest x-ray (CXR) on a cohort of subjects from two hospitals in Lombardy, Italy. METHODS: We used for training and validation an ensemble of ten convolutional neural networks (CNNs) with mainly bedside CXRs of 250 COVID-19 and 250 non-COVID-19 subjects from two hospitals (Centres 1 and 2). We then tested such system on bedside CXRs of an independent group of 110 patients (74 COVID-19, 36 non-COVID-19) from one of the two hospitals. A retrospective reading was performed by two radiologists in the absence of any clinical information, with the aim to differentiate COVID-19 from non-COVID-19 patients. Real-time polymerase chain reaction served as the reference standard. RESULTS: At 10-fold cross-validation, our deep learning model classified COVID-19 and non-COVID-19 patients with 0.78 sensitivity (95% confidence interval [CI] 0.74-0.81), 0.82 specificity (95% CI 0.78-0.85), and 0.89 area under the curve (AUC) (95% CI 0.86-0.91). For the independent dataset, deep learning showed 0.80 sensitivity (95% CI 0.72-0.86) (59/74), 0.81 specificity (29/36) (95% CI 0.73-0.87), and 0.81 AUC (95% CI 0.73-0.87). Radiologists' reading obtained 0.63 sensitivity (95% CI 0.52-0.74) and 0.78 specificity (95% CI 0.61-0.90) in Centre 1 and 0.64 sensitivity (95% CI 0.52-0.74) and 0.86 specificity (95% CI 0.71-0.95) in Centre 2. CONCLUSIONS: This preliminary experience based on ten CNNs trained on a limited training dataset shows an interesting potential of deep learning for COVID-19 diagnosis. Such tool is in training with new CXRs to further increase its performance.


Asunto(s)
Aprendizaje Automático , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Rayos X , Anciano , Femenino , Humanos , Italia , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía Torácica/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos
14.
BMC Pulm Med ; 21(1): 46, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: covidwho-1054817

RESUMEN

BACKGROUND: Sickle-cell anaemia is a widespread genetic disease prevalent worldwide among African and African-American populations. The pathogenesis is most often revealed by pulmonary conditions, including acute thoracic syndrome, which is affecting the life expectancy of these populations. The global spread of CoV2-SARS infection with a respiratory tropism, endothelial damages and procoagulant status endangers the SCD population. However, with only a few case reports, consequences of the Covid-19 pandemic on SCD population remain poorly known. CASE PRESENTATION: We report a case of a 33-year-old man with a history of homozygous SS homozygous sickle cell anemia who consulted on March 24, 2020 for febrile dyspnea 11 days after the onset of symptoms. A nasopharyngeal swab was positive for SARS-CoV-2. His respiratory status worsened rapidly in the emergency room and then in ICU leading to severe ARDS requiring intubation, curarization, and venovenous ECMO. Hematologically, severe hemolysis associated with major thrombocytopenia without documented spinal cord injury was noted. Several transfusion exchanges are performed. The evolution was finally slowly favorable and led to discharge from the intensive care unit and then from the hospital. CONCLUSIONS: This case recalls the importance of an increased prevention policy against COVID-19among the SCD population. In addition, from a therapeutic point of view, it advocates (1) a high preventive anticoagulation from the outset according to the level of D-dimers (2) the use of venovenous ECMO in this particular case, whereas this technique has had rather disappointing results in acute chest syndromes. (3) Unexpectedly, our patient did not develop pulmonary arterial hypertension (PAH) and acute cor pulmonale (ACP), whereas this is a common feature of ARDS during SCD. These last two observations suggest a different pathophysiology of pulmonary disorders in SCD patients in the case of SARS COv2. It could be associated with marked hypoxemia secondary to pulmonary vascular vasodilation.


Asunto(s)
Anemia de Células Falciformes/epidemiología , Oxigenación por Membrana Extracorpórea/métodos , Respiración Artificial/métodos , /etiología , Adulto , Anemia de Células Falciformes/terapia , /terapia , Humanos , Masculino , Pandemias , Radiografía Torácica , /terapia
15.
BMC Infect Dis ; 21(1): 127, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: covidwho-1054803

RESUMEN

BACKGROUND: To investigate the CT imaging and clinical features of three atypical presentations of coronavirus disease 2019 (COVID-19), namely (1) asymptomatic, (2) CT imaging-negative, and (3) re-detectable positive (RP), during all disease stages. METHODS: A consecutive cohort of 79 COVID-19 patients was retrospectively recruited from five independent institutions. For each presentation type, all patients were classified into atypical vs. typical groups (i.e., asymptomatic vs.symptomatic, CT imaging-negative vs. CT imaging-positive, and RP and non-RP,respectively). The chi-square test, Student's t test, and Kruskal-Wallis H test were performed to compare CT imaging and clinical features of atypical vs. typical patients for all three presentation categories. RESULTS: In our COVID-19 cohort, we found 12.7% asymptomatic patients, 13.9% CT imaging-negative patients, and 8.9% RP patients. The asymptomatic patients had fewer hospitalization days (P=0.043), lower total scores for bilateral lung involvement (P< 0.001), and fewer ground-glass opacities (GGOs) in the peripheral area (P< 0.001) than symptomatic patients. The CT imaging-negative patients were younger (P=0.002), had a higher lymphocyte count (P=0.038), had a higher lymphocyte rate (P=0.008), and had more asymptomatic infections (P=0.002) than the CT imaging-positive patients. The RP patients with moderate COVID-19 had lower total scores of for bilateral lung involvement (P=0.030) and a smaller portion of the left lung affected (P=0.024) than non-RP patients. Compared to their first hospitalization, RP patients had a shorter hospitalization period (P< 0.001) and fewer days from the onset of illness to last RNA negative conversion (P< 0.001) at readmission. CONCLUSIONS: Significant CT imaging and clinical feature differences were found between atypical and typical COVID-19 patients for all three atypical presentation categories investigated in this study, which may help provide complementary information for the effective management of COVID-19.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Radiografía Torácica , Tomografía Computarizada por Rayos X , Adulto , Infecciones Asintomáticas , China/epidemiología , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Estudios Retrospectivos
16.
Chest ; 159(2): e107-e113, 2021 02.
Artículo en Inglés | MEDLINE | ID: covidwho-1053266

RESUMEN

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Bacteriemia/complicaciones , /fisiopatología , Enfermedades Cerebelosas/complicaciones , Enfermedades Cerebelosas/diagnóstico por imagen , Tos/fisiopatología , Diarrea/fisiopatología , Progresión de la Enfermedad , Disnea/fisiopatología , Servicio de Urgencia en Hospital , Fiebre/fisiopatología , Cefalea/fisiopatología , Humanos , /diagnóstico por imagen , Linfopenia/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mialgia/fisiopatología , Oximetría , Neumonía Estafilocócica/complicaciones , Radiografía Torácica , Infecciones Estafilocócicas/complicaciones , Tomografía Computarizada por Rayos X
17.
Clin Med (Lond) ; 21(1): e14-e19, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1043992

RESUMEN

OBJECTIVE: The objective was to explore if chest X-ray severity, assessed using a validated scoring system, predicts patient outcome on admission and when starting continuous positive pressure ventilation (CPAP) for COVID-19. DESIGN: The study was a retrospective case-controlled study. PARTICIPANTS: There were 163 patients with COVID-19 deemed candidates for CPAP on admission, including 58 who subsequently required CPAP. OUTCOME MEASURES: On admission, we measured the proportion of patients meeting a composite 'negative' outcome of requiring CPAP, intubation or dying versus successful ward-based care. For those escalated to CPAP, 'negative' outcomes were intubation or death versus successful de-escalation of respiratory support. RESULTS: Our results were stratified into tertiles, those with 'moderate' or 'severe' X-rays on admission had significantly higher odds of negative outcome versus 'mild' (odds ratio (OR) 2.32; 95% confidence interval (CI) 1.121-4.803; p=0.023; and OR 3.600; 95% CI 1.681-7.708; p=0.001, respectively). This could not be demonstrated in those commencing CPAP (OR 0.976; 95% CI 0.754-1.264; p=0.856). CONCLUSIONS: We outline a scoring system to stratify X-rays by severity and directly link this to prognosis. However, we were unable to demonstrate this association in the patients commencing CPAP.


Asunto(s)
/diagnóstico , Presión de las Vías Aéreas Positiva Contínua/métodos , Pandemias , Admisión del Paciente , Radiografía Torácica/métodos , /epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
18.
Clin Med (Lond) ; 21(1): 79-80, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1043756

RESUMEN

We present the case of a 71-year-old woman with bilateral pneumonia who continued to deteriorate despite multiple courses of antibiotics. When dexamethasone was added to cover the possibility of COVID-19 pneumonia, she rapidly improved. Subsequently, she was found to have a strongly positive PR3 anti-nuclear cytoplasmic antibody (ANCA) and clinical features consistent with granulomatosis with polyangiitis (GPA) with upper respiratory tract and renal involvement. The case highlights how the COVID-19 pandemic can create new challenges in the diagnosis of GPA.


Asunto(s)
/epidemiología , Granulomatosis con Poliangitis/diagnóstico , Pulmón/diagnóstico por imagen , Radiografía Torácica/métodos , Anciano , Comorbilidad , Diagnóstico Diferencial , Femenino , Granulomatosis con Poliangitis/epidemiología , Humanos , Pandemias , Tomografía Computarizada por Rayos X
19.
Zhonghua Er Ke Za Zhi ; 58(4): 275-278, 2020 Apr 02.
Artículo en Chino | MEDLINE | ID: covidwho-1024679

RESUMEN

Objective: To explore imaging characteristics of children with 2019 novel coronavirus (2019-nCoV) infection. Methods: A retrospective analysis was performed on clinical data and chest CT images of 15 children diagnosed with 2019-nCoV infection. They were admitted to the Third People's Hospital of Shenzhen from January 16 to February 6, 2020. The distribution and morphology of pulmonary lesions on chest CT images were analyzed. Results: Among the 15 children, 5 were males and 10 females, aged from 4 to 14 years. Five of the 15 children were febrile and 10 were asymptomatic on the first visit. The first nasal or pharyngeal swab samples in all the 15 cases were positive for 2019-nCoV nucleic acid. For their first chest CT images, 6 patients had no lesions, while 9 patients had pulmonary inflammatory lesions. Seven cases had small nodular ground glass opacities and 2 cases had speckled ground glass opacities. After 3 to 5 days of treatment, 2019-nCoV nucleic acid in a second respiratory sample turned negative in 6 cases. Among them, chest CT images showed less lesions in 2 cases, no lesion in 3 cases, and no improvement in 1 case. The remaining 9 cases were still positive in a second nucleic acid test. Six patients showed similar chest CT inflammation, while 3 patients had new lesions, which were all small nodular ground glass opacities. Conclusions: The early chest CT images of children with 2019-nCoV infection are mostly small nodular ground glass opacities. The clinical symptoms of children with 2019-nCoV infection are nonspecific. Dynamic reexamination of chest CT and nucleic acid are important.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Niño , Preescolar , China , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Pulmón/patología , Masculino , Pandemias , ARN Viral/aislamiento & purificación , Radiografía Torácica , Estudios Retrospectivos
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