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1.
Korean J Radiol ; 21(10): 1150-1160, 2020 10.
Artículo en Inglés | MEDLINE | ID: covidwho-742717

RESUMEN

OBJECTIVE: To describe the experience of implementing a deep learning-based computer-aided detection (CAD) system for the interpretation of chest X-ray radiographs (CXR) of suspected coronavirus disease (COVID-19) patients and investigate the diagnostic performance of CXR interpretation with CAD assistance. MATERIALS AND METHODS: In this single-center retrospective study, initial CXR of patients with suspected or confirmed COVID-19 were investigated. A commercialized deep learning-based CAD system that can identify various abnormalities on CXR was implemented for the interpretation of CXR in daily practice. The diagnostic performance of radiologists with CAD assistance were evaluated based on two different reference standards: 1) real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) results for COVID-19 and 2) pulmonary abnormality suggesting pneumonia on chest CT. The turnaround times (TATs) of radiology reports for CXR and rRT-PCR results were also evaluated. RESULTS: Among 332 patients (male:female, 173:159; mean age, 57 years) with available rRT-PCR results, 16 patients (4.8%) were diagnosed with COVID-19. Using CXR, radiologists with CAD assistance identified rRT-PCR positive COVID-19 patients with sensitivity and specificity of 68.8% and 66.7%, respectively. Among 119 patients (male:female, 75:44; mean age, 69 years) with available chest CTs, radiologists assisted by CAD reported pneumonia on CXR with a sensitivity of 81.5% and a specificity of 72.3%. The TATs of CXR reports were significantly shorter than those of rRT-PCR results (median 51 vs. 507 minutes; p < 0.001). CONCLUSION: Radiologists with CAD assistance could identify patients with rRT-PCR-positive COVID-19 or pneumonia on CXR with a reasonably acceptable performance. In patients suspected with COVID-19, CXR had much faster TATs than rRT-PCRs.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Aprendizaje Profundo , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Radiografía Torácica/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodos
2.
Radiology ; 296(3): E166-E172, 2020 09.
Artículo en Inglés | MEDLINE | ID: covidwho-722986

RESUMEN

Background Chest radiography may play an important role in triage for coronavirus disease 2019 (COVID-19), particularly in low-resource settings. Purpose To evaluate the performance of an artificial intelligence (AI) system for detection of COVID-19 pneumonia on chest radiographs. Materials and Methods An AI system (CAD4COVID-XRay) was trained on 24 678 chest radiographs, including 1540 used only for validation while training. The test set consisted of a set of continuously acquired chest radiographs (n = 454) obtained in patients suspected of having COVID-19 pneumonia between March 4 and April 6, 2020, at one center (223 patients with positive reverse transcription polymerase chain reaction [RT-PCR] results, 231 with negative RT-PCR results). Radiographs were independently analyzed by six readers and by the AI system. Diagnostic performance was analyzed with the receiver operating characteristic curve. Results For the test set, the mean age of patients was 67 years ± 14.4 (standard deviation) (56% male). With RT-PCR test results as the reference standard, the AI system correctly classified chest radiographs as COVID-19 pneumonia with an area under the receiver operating characteristic curve of 0.81. The system significantly outperformed each reader (P < .001 using the McNemar test) at their highest possible sensitivities. At their lowest sensitivities, only one reader significantly outperformed the AI system (P = .04). Conclusion The performance of an artificial intelligence system in the detection of coronavirus disease 2019 on chest radiographs was comparable with that of six independent readers. © RSNA, 2020.


Asunto(s)
Inteligencia Artificial , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiografía Torácica/métodos , Anciano , Anciano de 80 o más Años , Betacoronavirus , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Curva ROC , Tomografía Computarizada por Rayos X
3.
Br J Radiol ; 93(1113): 20200643, 2020 Sep 01.
Artículo en Inglés | MEDLINE | ID: covidwho-721360

RESUMEN

OBJECTIVE: To investigate the diagnostic performance of chest CT in screening patients suspected of Coronavirus disease 2019 (COVID-19) in a Western population. METHODS: Consecutive patients who underwent chest CT because of clinical suspicion of COVID-19 were included. CT scans were prospectively evaluated by frontline general radiologists who were on duty at the time when the CT scan was performed and retrospectively assessed by a chest radiologist in an independent and blinded manner. Real-time reverse transcriptase-polymerase chain reaction was used as reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Sensitivity and specificity of the frontline general radiologists were compared to those of the chest radiologist using the McNemar test. RESULTS: 56 patients were included. Sensitivity, specificity, PPV, and NPV for the frontline general radiologists were 89.3% [95% confidence interval (CI): 71.8%, 97.7%], 32.1% (95% CI: 15.9%, 52.4%), 56.8% (95% CI: 41.0%, 71.7%), and 75.0% (95% CI: 42.8%, 94.5%), respectively. Sensitivity, specificity, PPV, and NPV for the chest radiologist were 89.3% (95% CI: 71.8%, 97.7%), 75.0% (95% CI: 55.1%, 89.3%), 78.1% (95% CI: 60.0%, 90.7%), and 87.5% (95% CI: 67.6%, 97.3%), respectively. Sensitivity was not significantly different (p = 1.000), but specificity was significantly higher for the chest radiologist (p = 0.001). CONCLUSION: Chest CT interpreted by frontline general radiologists achieves insufficient screening performance. Although specificity of a chest radiologist appears to be significantly higher, sensitivity did not improve. A negative chest CT result does not exclude COVID-19. ADVANCES IN KNOWLEDGE: Our study shows that chest CT interpreted by frontline general radiologists achieves insufficient diagnostic performance to use it as an independent screening tool for COVID-19. Although specificity of a chest radiologist appears to be significantly higher, sensitivity is still insufficiently high.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Radiografía Torácica/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad
4.
Medicine (Baltimore) ; 99(32): e21570, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: covidwho-706114

RESUMEN

RATIONALE: Macrophage activation syndrome (MAS) is a rare life-threatening condition characterized by cytokine-mediated tissue injury and multiorgan dysfunction. PATIENT CONCERNS: We describe the unique case of young man who developed MAS as the sole manifestation of an otherwise paucisymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DIAGNOSES: Clinical and biological criteria led to the diagnosis of MAS; cytokine profile was highly suggestive reverse transcription polymerase chain reaction for SARS-CoV-2 in nasopharyngeal swabs was negative, but serum anti-SARS-CoV-2 immunoglobulin A and immunoglobulin G resulted positive leading to the diagnosis of SARS-CoV-2 infection. INTERVENTIONS: The patient was treated with empiric antibiotic and hydroxychloroquine. OUTCOMES: Clinical improvement ensued. At follow-up, the patient is well. LESSON: SARS-CoV-2 infection may trigger develop life-threatening complications, like MAS. This can be independent from coronavirus disease 2019 gravity.


Asunto(s)
Ceftriaxona/administración & dosificación , Infecciones por Coronavirus/diagnóstico , Hospitalización , Hidroxicloroquina/administración & dosificación , Síndrome de Activación Macrofágica/diagnóstico , Neumonía Viral/diagnóstico , Adolescente , Análisis Químico de la Sangre , China , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/tratamiento farmacológico , ADN Viral/análisis , Diagnóstico Diferencial , Progresión de la Enfermedad , Quimioterapia Combinada , Electrocardiografía/métodos , Estudios de Seguimiento , Humanos , Síndrome de Activación Macrofágica/terapia , Masculino , Pandemias , Alta del Paciente , Neumonía Viral/tratamiento farmacológico , Radiografía Torácica/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
5.
Chest ; 158(1): 406-415, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-700492

RESUMEN

BACKGROUND: The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS: An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS: Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. CONCLUSIONS: There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Infecciones por Coronavirus , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples/diagnóstico , Pandemias , Neumonía Viral , Radiografía Torácica/métodos , Betacoronavirus/aislamiento & purificación , Consenso , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/normas , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Estadificación de Neoplasias , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Asignación de Recursos , Medición de Riesgo/métodos
6.
Eur J Cardiothorac Surg ; 58(3): 646-647, 2020 09 01.
Artículo en Inglés | MEDLINE | ID: covidwho-694782

RESUMEN

Pneumomediastinum is a rare clinical finding, but one which can be the source of significant concern for clinicians. By presenting 3 such cases, we highlight that pneumomediastinum can complicate the course of a severe coronavirus disease 2019 infection but emphasize that conservative management is the first-line method of treatment, with gradual resorption of the air from the tissues. It is important to be alert to the development of pneumothorax, which will require drainage.


Asunto(s)
Tratamiento Conservador , Infecciones por Coronavirus/complicaciones , Progresión de la Enfermedad , Enfisema Mediastínico/etiología , Enfisema Mediastínico/terapia , Neumonía Viral/complicaciones , Anciano , Antibacterianos/uso terapéutico , Análisis de los Gases de la Sangre , Técnicas de Laboratorio Clínico/métodos , Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus/diagnóstico , Estudios de Seguimiento , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagen , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Radiografía Torácica/métodos , Enfermedades Raras , Medición de Riesgo , Muestreo , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
7.
Cleve Clin J Med ; 87(8): 469-476, 2020 07 31.
Artículo en Inglés | MEDLINE | ID: covidwho-691294

RESUMEN

The typical findings of COVID-19 on chest radiography and computed tomography (CT) include bilateral, multifocal parenchymal opacities (ground-glass opacities with or without consolidation, and "crazy paving"). In most cases, the opacities are predominantly in the peripheral and lower lung zones, and several have rounded morphology. However, these imaging findings are not pathognomonic for COVID-19 pneumonia and can be seen in other viral and bacterial infections, as well as with noninfectious causes such as drug toxicity and connective tissue disease. Most radiology professional organizations and societies recommend against routine screening CT to diagnose or exclude COVID-19.


Asunto(s)
Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Humanos , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología
8.
Respir Res ; 21(1): 171, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: covidwho-655493

RESUMEN

BACKGROUND: There was much evidence suggesting that the serum lactate dehydrogenase (LDH) levels reflect the extent of various pathophysiological processes. However, the current information about dynamic change of LDH in COVID-19 pneumonia has not been well investigated. METHODS: Study was performed in 87 cases confirmed by COVID-19 infection. The serum LDH levels were determined at diagnosis and follow-up visits. The evaluation of clinical response to therapy was based on chest CT scan. We selected the value of LDH around the data of chest CT scan (- 1 ~ + 1 day). RESULTS: At diagnosis, significant differences in LDH levels were found between non-severe and severe group (P < 0.05). It was demonstrated that increase or decrease of LDH was indicative of radiographic progress or improvement (P < 0.05). The time to LDH normalization (5.67 ± 0.55, days) was positively correlated with the time to radiographic absorption (5.57 ± 0.65 days, r = 0.53, P < 0.05). Applying the cut-off value of the increase in LDH has good specificity to predict disease progression. CONCLUSIONS: Serum LDH was validated for its potential usefulness as markers for evaluating clinical severity and monitoring treatment response in COVID-19 pneumonia.


Asunto(s)
Infecciones por Coronavirus/sangre , Progresión de la Enfermedad , L-Lactato Deshidrogenasa/sangre , Neumonía Viral/sangre , Radiografía Torácica/métodos , Adulto , Anciano , Biomarcadores/sangre , China/epidemiología , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X/métodos
10.
Respir Res ; 21(1): 180, 2020 Jul 14.
Artículo en Inglés | MEDLINE | ID: covidwho-647137

RESUMEN

BACKGROUND: In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. OBJECTIVE: Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. METHODS: This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. RESULTS: All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. CONCLUSIONS: COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Tomografía Computarizada por Rayos X/métodos , Centros Médicos Académicos , Anciano , Anciano de 80 o más Años , Análisis Químico de la Sangre , Sedimentación Sanguínea , Proteína C-Reactiva/análisis , China/epidemiología , Estudios de Cohortes , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Polipéptido alfa Relacionado con Calcitonina/metabolismo , Radiografía Torácica/métodos , Síndrome de Dificultad Respiratoria del Adulto/fisiopatología , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia
11.
Medicine (Baltimore) ; 99(28): e21240, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: covidwho-646231

RESUMEN

RATIONALE: Chest computed tomography (CT) scans play a key role in diagnosing and managing of COVID-19 pneumonia. The typical manifestations of COVID-19 pneumonia on a chest CT scan are ground glass opacities, consolidation, nodules, and linear opacities. It can be accompanied by a "crazy-paving" pattern, air bronchograms, pleural hypertrophy, and pleural effusion. However, no literature has reported a case with cavities in the lungs. PATIENT CONCERNS: A 34-year-old male patient complained of fever, cough, fatigue, myalgia, diarrhea, headache, and dizziness for 2 weeks. This patient is living in Xiaogan, a city around Wuhan, and he had contact with a patient with COVID-19 pneumonia from Wuhan <14 days before he had fever. DIAGNOSIS: A nucleic acid test by rRT-PCR returned positive on a pharyngeal swab, confirming the diagnosis of COVID-19 pneumonia. INTERVENTIONS: Isolation antiviral treatment. OUTCOMES: After 19 days of isolation and antiviral treatment, his temperature returned to normal and the symptoms were relieved. The laboratory results also were returning to normal levels. The chest CT scan showed that the acute inflammation had subsided significantly. With 2 consecutive novel coronavirus nucleic acid tests had returned negative, the patient was discharged from the hospital and sent to a government designated hotel for quarantine observation. The unique chest CT manifestation in this case was the small cavities in both lungs during the absorption phase of this disease. These small cavities developed into consolidated nodules with clear edges and gradually shrank or disappeared. LESSONS: Although 2 consecutive nucleic acid tests returned negative in this patient, the small cavity changes in the lungs were observed, so the patient was quarantined for 14 days. However, follow-up CT after the first 14 days' quarantine showed new small cavity changes on the lungs, a further 14 days of quarantine was recommended. Therefore, in some COVID-19 cases, even if the nucleic acid tests turns negative, the disappearance of lung lesions may take a long time. The repeated chest CT scan plays an important role in the diagnosis and evaluation of the recovery of COVID-19.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/cirugía , Infecciones por Coronavirus/terapia , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Neumonía Viral/cirugía , Neumonía Viral/terapia , Cuarentena/métodos , Recuperación de la Función , Evaluación de Síntomas/métodos , Resultado del Tratamiento
12.
Int J Infect Dis ; 96: 157-162, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-644799

RESUMEN

OBJECTIVE: The study was aimed to describe the clinical characteristics and evaluate the dynamic changes of chest CT features in the first three weeks in the common type fo COVID-19 pneumonia patients in Jiangsu Province. METHODS: 307 patients infected SARS-CoV-2 classified as common type were enrolled in the study. 628 chest CT scans were divided into three groups based on the time interval between symptoms and chest CT scan. The clinical characteristics were descriptively analyzed.The chest CT features were quantitatively evaluated. Mann-Whitney U test was used to test the differences in three groups and between men and women. Spearman rank correlation was used to test the association between the arterial blood gas(ABG) analysis results and chest CT scores. RESULTS: Fever (69.1%) and cough (62.8%) were common symptoms. 111(36.2%) patients were anorexia. GGO was the most common manifestation of COVID-19 pneumonia, which could be followed by consolidation and fibrosis. Lower lobe or subpleural region was the most common distribution form of lesion. More lung lobes were involved in the third week. Total chest CT scores in the second week were higher than the first week. Fibrosis Scores increased in the second and third week. Total CT score, GGO score and fibrosis score of male patients were significantly higher than female in the second week. Male patients had higher consolidation score and fibrosis score than female in the third week. Total CT score and GGO score had weak to moderate correlation with arterial blood gas indices. CONCLUSION: Changes in chest CT were difficult to assess quantitatively in the first third weeks. Male patients recovered slower than female in the second week. Although CT score had correlations with arterial blood gas indices, long-term follow-up of pulmonary function test is needed to determine the recovery of lung.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias
14.
BMJ Case Rep ; 13(7)2020 Jul 08.
Artículo en Inglés | MEDLINE | ID: covidwho-639125

RESUMEN

Erythema nodosum (EN) is a common dermatological manifestation with many different aetiologies. Often however, the aetiology remains unidentified. We present here a 42-year-old male patient with an EN that is due to an acute COVID-19 infection. Most of the usual aetiologies were excluded by laboratory testing and imaging studies. This case is, to our knowledge, the first report of this cutaneous manifestation in the context of a COVID-19 infection. The EN was successfully treated with the disappearance of the COVID-19 infection and topical corticosteroids.


Asunto(s)
Analgésicos/administración & dosificación , Infecciones por Coronavirus , Eritema Nudoso , Glucocorticoides/administración & dosificación , Pandemias , Neumonía Viral , Tomografía Computarizada por Rayos X/métodos , Adulto , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Diagnóstico Diferencial , Eritema Nudoso/diagnóstico , Eritema Nudoso/etiología , Eritema Nudoso/terapia , Humanos , Masculino , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Radiografía Torácica/métodos , Crema para la Piel/administración & dosificación , Resultado del Tratamiento
15.
BMJ Case Rep ; 13(7)2020 Jul 07.
Artículo en Inglés | MEDLINE | ID: covidwho-638342

RESUMEN

We report on a patient with coronavirus disease 2019 (COVID-19) and decompensated cirrhosis who experienced a favourable outcome of severe immune thrombocytopaenic purpura (ITP) after administration of intravenous immunoglobulin and high-dose dexamethasone. The present case suggests that it is reasonable to evoke ITP in case of profound thrombocytopaenia in a patient with COVID-19.


Asunto(s)
Infecciones por Coronavirus , Glucocorticoides/administración & dosificación , Inmunoglobulinas Intravenosas/administración & dosificación , Cirrosis Hepática Alcohólica , Obesidad , Pandemias , Neumonía Viral , Púrpura Trombocitopénica Idiopática , Adulto , Betacoronavirus/aislamiento & purificación , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Humanos , Hipoxia/diagnóstico , Hipoxia/etiología , Factores Inmunológicos/administración & dosificación , Cirrosis Hepática Alcohólica/diagnóstico , Cirrosis Hepática Alcohólica/epidemiología , Masculino , Obesidad/diagnóstico , Obesidad/epidemiología , Terapia por Inhalación de Oxígeno/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Púrpura Trombocitopénica Idiopática/diagnóstico , Púrpura Trombocitopénica Idiopática/etiología , Púrpura Trombocitopénica Idiopática/fisiopatología , Púrpura Trombocitopénica Idiopática/terapia , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
16.
Chest ; 158(1): 106-116, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-634902

RESUMEN

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.


Asunto(s)
Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Manejo de Atención al Paciente , Neumonía Viral , Radiografía Torácica/métodos , Enfermedades Respiratorias , Tomografía Computarizada por Rayos X/métodos , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Diagnóstico Diferencial , Progresión de la Enfermedad , Diagnóstico Precoz , Humanos , Cooperación Internacional , Manejo de Atención al Paciente/métodos , Manejo de Atención al Paciente/normas , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/virología
17.
Chest ; 158(1): e9-e13, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-633839

RESUMEN

As of March 24, 2020, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for 379,661 infection cases with 16,428 deaths globally, and the number is still increasing rapidly. Herein, we present four critically ill patients with SARS-CoV-2 infection who received supportive care and convalescent plasma. Although all four patients (including a pregnant woman) recovered from SARS-CoV-2 infection eventually, randomized trials are needed to eliminate the effect of other treatments and investigate the safety and efficacy of convalescent plasma therapy.


Asunto(s)
Antivirales , Infecciones por Coronavirus , Enfermedad Crítica/terapia , Pandemias , Neumonía Viral , Complicaciones Infecciosas del Embarazo , Adulto , Anciano , Antifúngicos/administración & dosificación , Antivirales/administración & dosificación , Antivirales/clasificación , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Oxigenación por Membrana Extracorpórea/métodos , Femenino , Humanos , Inmunización Pasiva/métodos , Masculino , Persona de Mediana Edad , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/microbiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Embarazo , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/virología , Radiografía Torácica/métodos , Respiración Artificial/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
19.
Eur Respir J ; 56(2)2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-632571
20.
Respir Res ; 21(1): 163, 2020 Jun 29.
Artículo en Inglés | MEDLINE | ID: covidwho-617310

RESUMEN

OBJECTIVE: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. METHODS: A retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-min walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. RESULTS: Fifty-seven patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p = 0.019), higher lung total severity score (TSS) and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. CONCLUSION: Impaired diffusing-capacity, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Músculos Respiratorios/fisiopatología , Síndrome Respiratorio Agudo Grave/diagnóstico , Adulto , Anciano , Distribución de Chi-Cuadrado , China/epidemiología , Estudios de Cohortes , Convalecencia , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fuerza Muscular , Pandemias , Alta del Paciente , Radiografía Torácica/métodos , Pruebas de Función Respiratoria , Estudios Retrospectivos , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/epidemiología , Espirometría/métodos , Centros de Atención Terciaria , Tomografía Computarizada por Rayos X/métodos , Capacidad Vital/fisiología
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