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1.
Medicine (Baltimore) ; 100(7): e24668, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: covidwho-1091183

RESUMEN

ABSTRACT: We aimed to retrospectively analyze the clinical and computed tomography (CT) characteristics of young adults with Coronavirus Disease 2019 (COVID-19) pneumonia who were critically ill and to identify the features associated with non-survival.Thirty-eight COVID-19 patients (20-45 years old, 28 men) who had been admitted in the intensive care unit were included, including 18 non-survivors (group 1) and 20 survivors (group 2). Their clinical characteristics and initial and follow-up CT were compared between groups.In group 1, the days from illness onset to death were 21.1 ±â€Š10.3 days; 7 patients had underlying comorbidities. At admission, group 1 exhibited higher serum ferritin and interleukin-6 (IL-6) levels (1142.6 ±â€Š242.4 mg/L and 33.8 ±â€Š18.6 mmol/L) compared with group 2 (728.3 ±â€Š150.9 mg/L and 15.2 ±â€Š6.9 mmol/L, P < .01). Group 1 exhibited more rapidly progressive opacities and consolidation in follow-up CT (16.7 ±â€Š3.1 scores, 15.7 ±â€Š3.1 segments) than group 2 (11.4 ±â€Š4.0 scores, 10.3 ±â€Š4.6 segments, P < .01). The oxygenation index was lower (87.6 ±â€Š19.2 vs 99.1 ±â€Š20.4 mm Hg) and the mechanical ventilation duration was longer (14.7 ±â€Š6.9 vs 9.7 ±â€Š3.7 days) in group 1 compare with group 2 (P < .01).Compared with the survivors, the non-survivors showed higher serum ferritin and IL-6 levels, more rapidly progressive opacities in CT, lower oxygenation index, and longer mechanical ventilation durations. Special attention to ferritin/IL-6 levels and oxygenation index as well as early CT application and timely reexaminations are important to identify the individuals who may be at risk of becoming critically ill.


Asunto(s)
/diagnóstico , Neumonía Viral/diagnóstico , Neumonía Viral/inmunología , Neumonía Viral/mortalidad , Tomografía Computarizada por Rayos X/métodos , Adulto , Enfermedad Crítica , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Neumonía Viral/virología , Estudios Retrospectivos , Análisis de Supervivencia
2.
BMC Infect Dis ; 21(1): 192, 2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1090689

RESUMEN

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


Asunto(s)
/diagnóstico por imagen , Pulmón/patología , Aprendizaje Automático , Adulto , Técnicas de Laboratorio Clínico , Estudios Transversales , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/virología , Recuento de Linfocitos , Linfocitos/citología , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Pandemias , Pronóstico , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
3.
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
4.
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
5.
Sci Rep ; 11(1): 3938, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1087495

RESUMEN

Since its first outbreak, Coronavirus Disease 2019 (COVID-19) has been rapidly spreading worldwide and caused a global pandemic. Rapid and early detection is essential to contain COVID-19. Here, we first developed a deep learning (DL) integrated radiomics model for end-to-end identification of COVID-19 using CT scans and then validated its clinical feasibility. We retrospectively collected CT images of 386 patients (129 with COVID-19 and 257 with other community-acquired pneumonia) from three medical centers to train and externally validate the developed models. A pre-trained DL algorithm was utilized to automatically segment infected lesions (ROIs) on CT images which were used for feature extraction. Five feature selection methods and four machine learning algorithms were utilized to develop radiomics models. Trained with features selected by L1 regularized logistic regression, classifier multi-layer perceptron (MLP) demonstrated the optimal performance with AUC of 0.922 (95% CI 0.856-0.988) and 0.959 (95% CI 0.910-1.000), the same sensitivity of 0.879, and specificity of 0.900 and 0.887 on internal and external testing datasets, which was equivalent to the senior radiologist in a reader study. Additionally, diagnostic time of DL-MLP was more efficient than radiologists (38 s vs 5.15 min). With an adequate performance for identifying COVID-19, DL-MLP may help in screening of suspected cases.


Asunto(s)
/diagnóstico por imagen , Aprendizaje Profundo , Modelos Biológicos , Tomografía Computarizada por Rayos X , Adulto , Algoritmos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Radiólogos
6.
BMC Infect Dis ; 21(1): 176, 2021 Feb 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1085167

RESUMEN

BACKGROUND: Epidemiological and clinical features of patients with corona virus disease 2019 (COVID-19) were well delineated. However, no researches described the patients complicated with pleural effusion (PE). In the present study, we aimed to clinically characterize the COVID-19 patients complicated with PE and to create a predictive model on the basis of PE and other clinical features to identify COVID-19 patients who may progress to critical condition. METHODS: This retrospective study examined 476 COVID-19 inpatients, involving 153 patients with PE and 323 without PE. The data on patients' past history, clinical features, physical checkup findings, laboratory results and chest computed tomography (CT) findings were collected and analyzed. LASSO regression analysis was employed to identify risk factors associated with the severity of COVID-19. RESULTS: Laboratory findings showed that patients with PE had higher levels of white blood cells, neutrophils, lactic dehydrogenase, C-reactive protein and D-dimer, and lower levels of lymphocytes, platelets, hemoglobin, partial pressure of oxygen and oxygen saturation. Meanwhile, patients with PE had higher incidence of severe or critical illness and mortality rate, and longer hospital stay time compared to their counterparts without pleural effusion. Moreover, LASSO regression analysis exhibited that pleural effusion, lactic dehydrogenase (LDH), D-dimer and total bilirubin (TBIL) might be risk factors for critical COVID-19. CONCLUSIONS: Pleural effusion could serve as an indicator for severe inflammation and poor clinical outcomes, and might be a complementary risk factor for critical type of COVID-19.


Asunto(s)
/patología , Derrame Pleural/patología , Adulto , Proteína C-Reactiva/análisis , /fisiopatología , China , Exudados y Transudados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pleural/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
7.
Ann Med ; 53(1): 337-344, 2021 12.
Artículo en Inglés | MEDLINE | ID: covidwho-1084096

RESUMEN

BACKGROUND: To minimise the risk of COVID-19 transmission, an ambulant screening protocol for COVID-19 in patients before admission to the hospital was implemented, combining the SARS CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR) on a nasopharyngeal swab, a chest computed tomography (CT) and assessment of clinical symptoms. The aim of this study was to evaluatethe diagnostic yield and the proportionality of this pre-procedural screeningprotocol. METHODS: In this mono-centre, prospective, cross-sectional study, all patients admitted to the hospital between 22nd April 2020 until 14th May 2020 for semi-urgent surgery, haematological or oncological treatment, or electrophysiological investigationunderwent a COVID-19 screening 2 days before their procedure. At a 2-week follow-up, the presence of clinical symptoms was evaluated by telephone as a post-hoc evaluation of the screening approach.Combined positive RT-PCR assay and/or positive chest CT was used as gold standard. Post-procedural outcomes of all patients diagnosed positive for COVID-19 were assessed. RESULTS: In total,528 patients were included of which 20 (3.8%) were diagnosed as COVID-19 positive and 508 (96.2%) as COVID-19 negative. 11 (55.0%) of COVID-19 positive patients had only a positive RT-PCR assay, 3 (15.0%) had only a positive chest CT and 6 (30%) had both a positive RT-PCR assay and chest CT. 10 out of 20 (50.0%) COVID-19 positive patients reported no single clinical symptom at the screening. At 2 week follow-up, 50% of these patients were still asymptomatic. 37.5% of all COVID-19 negative patients were symptomatic at screening. In the COVID-19 negative group without symptoms at screening, 78 (29.3%) patients developed clinical symptoms at a 2-week follow-up. CONCLUSION: This study suggests that routine chest CT and assessment of self-reported symptoms have limited value in the preprocedural COVID-19 screening due to low sensitivity and/or specificity.


Asunto(s)
/métodos , Tamizaje Masivo/métodos , Admisión del Paciente , Adulto , Anciano , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X
8.
J Clin Lab Anal ; 35(2): e23685, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: covidwho-1082686

RESUMEN

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


Asunto(s)
/diagnóstico , Técnicas de Laboratorio Clínico , Virus de la Influenza A/fisiología , Neumonía/diagnóstico , Neumonía/virología , /fisiología , /diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Neumonía/diagnóstico por imagen , Factores de Riesgo , Tomografía Computarizada por Rayos X
9.
Eur Rev Med Pharmacol Sci ; 25(2): 1135-1145, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1082411

RESUMEN

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


Asunto(s)
/diagnóstico por imagen , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/diagnóstico por imagen , Gripe Humana/epidemiología , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Estudios de Casos y Controles , China/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
Eur Rev Med Pharmacol Sci ; 25(2): 1080-1086, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1081037

RESUMEN

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


Asunto(s)
/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/tendencias , Adulto Joven
11.
BMJ Case Rep ; 14(2)2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1080449

RESUMEN

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


Asunto(s)
/diagnóstico , Pancreatitis/virología , /diagnóstico por imagen , Tratamiento Conservador , Diagnóstico Diferencial , Femenino , Humanos , Pulmón/diagnóstico por imagen , Persona de Mediana Edad , Pancreatitis/diagnóstico por imagen , Pancreatitis/terapia , Tomografía Computarizada por Rayos X
12.
BMC Infect Dis ; 21(1): 167, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: covidwho-1079217

RESUMEN

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


Asunto(s)
/diagnóstico , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Alemania/epidemiología , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Tomografía Computarizada por Rayos X , Adulto Joven
13.
BMJ ; 372: n349, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1072744
14.
Pan Afr Med J ; 37(Suppl 1): 42, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1069975

RESUMEN

The aim of this study was to evaluate the main clinical and evolutionary features of SARS-CoV-2 infection in children aged 0-18 years who were suspected and diagnosed for COVID-19 during routine consultations in the pediatric ward of the Ignace Deen National Hospital in Conakry. This retrospective study targeted all children admitted to the Pediatrics Department during the study period and focused on children whose clinical examination and/or history indicated a suspicion of SARS-CoV-2 infection. Only children with a positive reverse transcriptase-polymerase chain reaction (RT-PCR) test were included. Clinical and paraclinical data were rigorously analyzed. Anonymity and respect for ethical rules were the norm. Medical records were used as the data source and a questionnaire was developed for collection. The analysis was done using STATA/SE version 11.2 software. The mean age of the patients observed was 9.66±1.32 years, with a sex ratio of 1.25. The history of the patients found that 36.11 had already been in contact with a COVID-19 positive subject, of which 8 or 22 had close relatives treated for COVID-19 and 5 had been with classmates treated for COVID-19. Fever and physical asthenia, runny nose and throat pain were respectively found in 58.33%, 50% and 30.55% of patients with irritability in 25%. Asymptomatic children were 30.55%. The diagnosis was confirmed after a positive RT-PCR test. Thoracic computed tomography (CT) scan was normal in 80.55% of the children. They were given mostly azithromycin 15mg/kg, zinc and chloroquine sulfate 5mg/kg. The mean age of the patients observed was 9.66 years, with a sex ratio of 1.25. The history of the patients found that 36.11 had already been in contact with a COVID-19 positive subject, of which 8 or 22 had close relatives treated for COVID-19 and 5 had been with classmates treated for COVID-19. Fever and physical asthenia, runny nose and throat pain were respectively found in 58.33%, 50% and 30.55% of patients with irritability in 25%. Asymptomatic children were 30.55%. The diagnosis was confirmed after a positive RT-PCR test. Thoracic computed tomography (CT) scan was normal in 80.55% of the children. They were given mostly azithromycin 15mg/kg, zinc and chloroquine sulfate 5mg/kg.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Hospitalización , Adolescente , Azitromicina/administración & dosificación , /fisiopatología , Niño , Preescolar , Cloroquina/administración & dosificación , Femenino , Guinea , Humanos , Lactante , Masculino , Estudios Retrospectivos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Tomografía Computarizada por Rayos X , Zinc/administración & dosificación
15.
BMC Med Imaging ; 21(1): 19, 2021 02 09.
Artículo en Inglés | MEDLINE | ID: covidwho-1069551

RESUMEN

BACKGROUND: Currently, there is an urgent need for efficient tools to assess the diagnosis of COVID-19 patients. In this paper, we present feasible solutions for detecting and labeling infected tissues on CT lung images of such patients. Two structurally-different deep learning techniques, SegNet and U-NET, are investigated for semantically segmenting infected tissue regions in CT lung images. METHODS: We propose to use two known deep learning networks, SegNet and U-NET, for image tissue classification. SegNet is characterized as a scene segmentation network and U-NET as a medical segmentation tool. Both networks were exploited as binary segmentors to discriminate between infected and healthy lung tissue, also as multi-class segmentors to learn the infection type on the lung. Each network is trained using seventy-two data images, validated on ten images, and tested against the left eighteen images. Several statistical scores are calculated for the results and tabulated accordingly. RESULTS: The results show the superior ability of SegNet in classifying infected/non-infected tissues compared to the other methods (with 0.95 mean accuracy), while the U-NET shows better results as a multi-class segmentor (with 0.91 mean accuracy). CONCLUSION: Semantically segmenting CT scan images of COVID-19 patients is a crucial goal because it would not only assist in disease diagnosis, also help in quantifying the severity of the illness, and hence, prioritize the population treatment accordingly. We propose computer-based techniques that prove to be reliable as detectors for infected tissue in lung CT scans. The availability of such a method in today's pandemic would help automate, prioritize, fasten, and broaden the treatment of COVID-19 patients globally.


Asunto(s)
/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Aprendizaje Profundo , Humanos , Tomografía Computarizada por Rayos X
16.
BMC Infect Dis ; 21(1): 157, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1069549

RESUMEN

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


Asunto(s)
/diagnóstico , Pulmón/diagnóstico por imagen , Adulto , Proteína C-Reactiva/metabolismo , Estudios Transversales , Femenino , Humanos , Italia , Pulmón/patología , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Oxígeno/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
17.
BMC Infect Dis ; 21(1): 155, 2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: covidwho-1069544

RESUMEN

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


Asunto(s)
/fisiopatología , Adulto , Anciano , Preescolar , China , Comorbilidad , Tos , Brotes de Enfermedades , Femenino , Fiebre , Hospitalización , Humanos , Lactante , Pulmón/diagnóstico por imagen , Linfopenia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X
18.
Ann Ital Chir ; 91: 563-567, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-1068445

RESUMEN

2019-nCoV currently named SARS-CoV-2 is a highly pathogenic Coronavirus identified in Wuhan China in December 2019. Turkey declared the first case relatively late compared to Asian and European countries on March 11, as the first SARS-CoV-2 infection in Turkey. In this study, we aimed to determine patients' outcomes in 50 surgeries done in the incubation period of SARS-CoV-2 in our hospital. METHODS: We retrospectively analyzed the clinical data of 50 patients who underwent surgeries during the incubation period of CoVid-19 at Istinye University Gaziosmanpasa Medical Park Hospital in Istanbul, from March 2 to April 11, 2020. RESULTS: The age of 50 patients range was 21 to 73, and the median age was 43.32 (64%) patients were women. The median length of hospital stay is 2.6 days (1-21). Operations at various difficulty levels were also performed on patients with co-morbidities. No complication or mortality was observed except for 1 patient, and the ICU requirement of that patient was also due to high energy trauma. CONCLUSION: Although contrary claims have been made in various studies; it is the primary duty of us surgeons to operate CoVid-19 positive/suspicious patients safely and without any contamination, and on the other hand, to continue their operations without victimizing negative patients. In this pilot study, we would like to emphasize with necessary and adequate measures these can be achieved. KEY WORDS: CoVid-19, SARS-CoV-2, Surgery.


Asunto(s)
/diagnóstico , Urgencias Médicas/epidemiología , Hospitales de Aislamiento/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Periodo de Incubación de Enfermedades Infecciosas , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Pandemias , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adulto , Anciano , /epidemiología , Comorbilidad , Procedimientos Quirúrgicos Electivos/mortalidad , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Contaminación de Equipos/prevención & control , Femenino , Mortalidad Hospitalaria , Humanos , Control de Infecciones/métodos , Masculino , Persona de Mediana Edad , Aislamiento de Pacientes , Proyectos Piloto , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/mortalidad , Tomografía Computarizada por Rayos X , Turquia/epidemiología , Adulto Joven
19.
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
20.
Anticancer Res ; 41(1): 335-340, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-1068194

RESUMEN

BACKGROUND/AIM: Large or bilateral multiple renal cell carcinoma (RCC) without/with tumor thrombus (TT) in the renal vein (RV) or inferior vena cava (IVC) poses a challenge to the surgeon due to the potential for massive hemorrhage, tumor thromboemboli and dialysis, and the situation is more critical due to Covid-19 pandemic. We report our experience and measures in dealing with challenging cases of large or multiple RCCs without/with TT during the ongoing Covid-19 pandemic. PATIENTS AND METHODS: Between 4/2020-10/2020, five patients underwent RCC resection with/without TT. Patients 1 and 2 had RCCs/TT in RV; Patient 3 had RCC/TT supradiaphragmatic below right atrium; Patient-4 had a 26 cm RCC; Patient-5 had multiple RCCS as part of Birt-Hogg-Dube syndrome. RESULTS: Patients were preoperatively tested negative for Covid-19. Operation times were 105, 85, 255, 200 and 247 minutes for Patients 1-5. Estimated blood loss was: 100, 50, 3,900,100 and 50 ml, respectively. Patient 3 underwent RCC resection en bloc with IVC/TT. Patients 1 and 2 underwent resections of RCC/TT in RV. Patient 4 underwent a 26 cm RCC resection. Patient 5 underwent laparoscopic bilateral radical nephrectomies. No immediate postoperative complications were reported. CONCLUSION: We successfully managed 5 challenging cases of RCCs despite the recommendations imposed by hospitals due to Covid-19 pandemic, with favorable outcomes.


Asunto(s)
/complicaciones , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/complicaciones , Neoplasias Renales/diagnóstico , Trombosis/diagnóstico , Trombosis/etiología , Anciano , Biopsia , Carcinoma de Células Renales/cirugía , Humanos , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Células Neoplásicas Circulantes , Nefrectomía , Venas Renales/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
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