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Azadbakht J, Khoramian D, Lajevardi ZS, Elikaii F, Aflatoonian AH, Farhood B, Najafi M, Bagheri H. A review on chest CT scanning parameters implemented in COVID-19 patients: bringing low-dose CT protocols into play. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC7784224 DOI: 10.1186/s43055-020-00400-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
This study aims to review chest computed tomography (CT) scanning parameters which are utilized to evaluate patients for COVID-19-induced pneumonia. Also, some of radiation dose reduction techniques in CT would be mentioned, because using these techniques or low-dose protocol can decrease the radiation burden on the population.
Main body
Chest CT scan can play a key diagnostic role in COVID-19 patients. Additionally, it can be useful to monitor imaging changes during treatment. However, CT scan overuse during the COVID-19 pandemic raises concerns about radiation-induced adverse effects, both in patients and healthcare workers.
Conclusion
By evaluating the CT scanning parameters used in several studies, one can find the necessity for optimizing these parameters. It has been found that chest CT scan taken using low-dose CT protocol is a reliable diagnostic tool to detect COVID-19 pneumonia in daily practice. Moreover, the low-dose chest CT protocol results in a remarkable reduction (up to 89%) in the radiation dose compared to the standard-dose protocol, not lowering diagnostic accuracy of COVID-19-induced pneumonia in CT images. Therefore, its employment in the era of the COVID-19 pandemic is highly recommended.
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Metwally MI, Basha MAA, Zaitoun MMA, Abdalla HM, Nofal HAE, Hendawy H, Manajrah E, Hijazy RF, Akbazli L, Negida A, Mosallam W. Clinical and radiological imaging as prognostic predictors in COVID-19 patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:100. [PMCID: PMC8033098 DOI: 10.1186/s43055-021-00470-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Background Since the announcement of COVID-19 as a pandemic infection, several studies have been performed to discuss the clinical picture, laboratory finding, and imaging features of this disease. The aim of this study is to demarcate the imaging features of novel coronavirus infected pneumonia (NCIP) in different age groups and outline the relation between radiological aspect, including CT severity, and clinical aspect, including age, oxygen saturation, and fatal outcome. We implemented a prospective observational study enrolled 299 laboratory-confirmed COVID-19 patients (169 males and 130 females; age range = 2–91 years; mean age = 38.4 ± 17.2). All patients were submitted to chest CT with multi-planar reconstruction. The imaging features of NCIP in different age groups were described. The relations between CT severity and age, oxygen saturation, and fatal outcome were evaluated. Results The most predominant CT features were bilateral (75.4%), posterior (66.3%), pleural-based (93.5%), lower lobe involvement (89.8%), and ground-glass opacity (94.7%). ROC curve analysis revealed that the optimal cutoff age that was highly exposed to moderate and severe stages of NCIP was 38 years old (AUC = 0.77, p < 0.001). NCIP was noted in 42.6% below 40-year-old age group compared to 84% above 40-year-old age group. The CT severity was significantly related to age and fatal outcome (p < 0.001). Anterior, centrilobular, hilar, apical, and middle lobe involvements had a significant relation to below 90% oxygen saturation. A significant negative correlation was found between CT severity and oxygen saturation (r = − 0.49, p < 0.001). Crazy-paving pattern, anterior aspect, hilar, centrilobular involvement, and moderate and severe stages had a statistically significant relation to higher mortality. Conclusion The current study confirmed the value of CT as a prognostic predictor in NCIP through demonstration of the strong relation between CT severity and age, oxygen saturation, and the fatal outcome. In the era of COVID-19 pandemic, this study is considered to be an extension to other studies discussing chest CT features of COVID-19 in different age groups with demarcation of the relation of chest CT severity to different pattern and distribution of NCIP, age, oxygen saturation, and mortality rate.
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Affiliation(s)
- Maha Ibrahim Metwally
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed M. A. Zaitoun
- Department of Radio-diagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Hanaa Abu Elazayem Nofal
- Department of Community and Occupational Medicine, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Hamdy Hendawy
- Department of Intensive Care, Faculty of Human Medicine, Suez Canal University, Esmaelia, Egypt
| | - Esaraa Manajrah
- Faculty of Human Medicine, Suez Canal University, Esmaelia, Egypt
| | | | - Loujain Akbazli
- Faculty of Human Medicine, Suez Canal University, Esmaelia, Egypt
| | - Ahmed Negida
- Zagazig University Hospitals, Zagazig University, Zagazig, Egypt
| | - Walid Mosallam
- Department of Radio-diagnosis, Faculty of Human Medicine, Suez Canal University, Esmaelia, Egypt
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153
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Esfehani RJ, Aelami MH, Kalat AR, Soleimanpour S, Pasdar Z, Khazaei M, Pasdar A, Avan A. SARS-CoV-2 Liability: The Hidden Mystery Behind Its Presentation in Children. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1353:225-241. [DOI: 10.1007/978-3-030-85113-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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154
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Farasani A. Genetic analysis of the 2019 coronavirus pandemic with from real-time reverse transcriptase polymerase chain reaction. Saudi J Biol Sci 2021; 28:911-916. [PMID: 33199970 PMCID: PMC7658593 DOI: 10.1016/j.sjbs.2020.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 12/17/2022] Open
Abstract
Corona viruses (CoV) are known to cause extreme pandemics in the globe. The year 2020 will be a pandemic with the spread of the novel coronavirus (SARS-CoV-2) across the globe. Coronavirus 2019 (COVID-19) has been a part of our scary life for more than a quarter of a year in 2020. The Wuhan market and China have been the most commonly used terms in the world for at least a quarter of 2020. A zoonotic coronavirus has entered organisms to affect organisms for the third season in several centuries. CoV is a global pandemic prompted a drastic and rapid reconfiguration of society. CoV have extraordinary broad genomes of about 30 kilobases of RNA. There is no genetic relationship between the SARS-CoV, MERS and SARS-CoV-2. For health care strategies and for anticipating and preventing potential outbreaks, adequate description of the international spread of COVID-19 virus is imperative. The WHO has declared COVID-19 as endemic to pandemic in the first trimester of 2020. The biggest issues for diagnosis COVID-19 is not established apart from Real-time reverse transcriptase polymerase chain reaction (RT-PCR). In order to monitor the COVID-19 pandemic, testing of active SARS-CoV-2 infections is a fundamental public health method. The vast use of SARS-CoV-2 RT-PCR tests around the world has led to increased availability of test kits, which is also a major bottleneck. The technique RT-PCR was generally agreed in the present scenario to detect SARS-CoV-2 in the human body. This review discusses about the importance of molecular technique for diagnosing the pandemic disease of 2019. In conclusion, RT-PCR was found to be an apt technique for identification of SARS-CoV-2.
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Affiliation(s)
- Abdullah Farasani
- Address: Biomedical Research Unit, Medical Research Center, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia.
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155
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Taverna G, Di Francesco S, Borroni EM, Yiu D, Toniato E, Milanesi S, Chiriva-Internati M, Bresalier RS, Zanoni M, Vota P, Maffei D, Justich M, Grizzi F. The kidney, COVID-19, and the chemokine network: an intriguing trio. Int Urol Nephrol 2021; 53:97-104. [PMID: 32720031 PMCID: PMC7384276 DOI: 10.1007/s11255-020-02579-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
On December 30th 2019, some patients with pneumonia of unknown etiology were reported in the Program for Monitoring Emerging Diseases (ProMED), a program run by the International Society for Infectious Diseases (ISID), hypothesized to be related to subjects who had had contact with the seafood market in Wuhan, China. Chinese authorities instituted an emergency agency aimed at identifying the source of infection and potential biological pathogens. It was subsequently named by the World Committee on Virus Classification as 2019-nCoV (2019-novel coronavirus) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A number of studies have demonstrated that 2019-nCoV and the SARS-CoV shared the same cell entry receptor named angiotensin-converting enzyme 2 (ACE2). This is expressed in human tissues, not only in the respiratory epithelia, but also in the small intestines, heart, liver, and kidneys. Here, we examine the most recent findings on the effects of SARS-CoV-2 infection on kidney diseases, mainly acute kidney injury, and the potential role of the chemokine network.
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Affiliation(s)
- Gianluigi Taverna
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
- Urology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- Humanitas University, Pieve Emanuele, Milan, Italy
| | - Simona Di Francesco
- Department of Urological Biomedical and Translational Sciences, Federiciana University, Rome, Italy
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University, Chieti, Pescara, Italy
| | - Elena Monica Borroni
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Daniel Yiu
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elena Toniato
- Department of Medical and Oral Sciences and Biotechnologies, G. D'Annunzio University, Chieti, Pescara, Italy
| | - Samantha Milanesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Maurizio Chiriva-Internati
- Division of Internal Medicine, Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Kiromic Biopharma, Inc., Houston, TX, USA
| | - Robert S Bresalier
- Division of Internal Medicine, Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matteo Zanoni
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Paolo Vota
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Davide Maffei
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Matteo Justich
- Urology Unit, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Fabio Grizzi
- Humanitas University, Pieve Emanuele, Milan, Italy.
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
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156
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Hong W, Chen Q, Qian S, Basharat Z, Zimmer V, Wang Y, Zippi M, Pan J. Critically Ill vs. Non-Critically Ill Patients With COVID-19 Pneumonia: Clinical Features, Laboratory Findings, and Prediction. Front Cell Infect Microbiol 2021; 11:550456. [PMID: 34327146 PMCID: PMC8313893 DOI: 10.3389/fcimb.2021.550456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/25/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The objective of this study was to investigate the clinical features and laboratory findings of patients with and without critical COVID-19 pneumonia and identify predictors for the critical form of the disease. METHODS Demographic, clinical, and laboratory data of 63 COVID-19 pneumonia patients were retrospectively reviewed. Laboratory parameters were also collected within 3-5 days, 7-9 days, and 11-14 days of hospitalization. Outcomes were followed up until March 12, 2020. RESULTS Twenty-two patients developed critically ill pneumonia; one of them died. Upon admission, older patients with critical illness were more likely to report cough and dyspnoea with higher respiration rates and had a greater possibility of abnormal laboratory parameters than patients without critical illness. When compared with the non-critically ill patients, patients with serious illness had a lower discharge rate and longer hospital stays, with a trend towards higher mortality. The interleukin-6 level in patients upon hospital admission was important in predicting disease severity and was associated with the length of hospitalization. CONCLUSIONS Many differences in clinical features and laboratory findings were observed between patients exhibiting non-critically ill and critically ill COVID-19 pneumonia. Non-critically ill COVID-19 pneumonia also needs aggressive treatments. Interleukin-6 was a superior predictor of disease severity.
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Affiliation(s)
- Wandong Hong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Wandong Hong, ; Jingye Pan,
| | - Qin Chen
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Songzan Qian
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Centre for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi-75270, Karachi, Pakistan
| | - Vincent Zimmer
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany
| | - Yumin Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Maddalena Zippi
- Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Rome, Italy
| | - Jingye Pan
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Wandong Hong, ; Jingye Pan,
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157
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Zhou J, Liao X, Cao J, Ling G, Ding X, Long Q. Differential diagnosis between the coronavirus disease 2019 and Streptococcus pneumoniae pneumonia by thin-slice CT features. Clin Imaging 2021; 69:318-323. [PMID: 33045476 PMCID: PMC7536592 DOI: 10.1016/j.clinimag.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The chest computed tomography (CT) features of coronavirus disease 2019 (COVID-19) and Streptococcus pneumoniae pneumonia (S. pneumoniae pneumonia) were compared to provide further evidence for the differential imaging diagnosis of patients with these two types of pneumonia. METHODS Clinical information and chest CT data of 149 COVID-19 patients between January 9, 2020 and March 15, 2020 and 97 patients with S. pneumoniae pneumonia between January 23, 2011 and March 18, 2020 in Zhongnan Hospital of Wuhan University were retrospectively analyzed. In addition, CT features were comparatively analyzed. RESULTS According to the chest CT images, the probability of lung segmental and lobar pneumonia in S. pneumoniae pneumonia was higher than that in COVID-19(P<0.001); the probabilities of ground-glass opacity (GGO), the "crazy paving" sign, and abnormally thickened interlobular septa in COVID-19 were higher than those in S. pneumoniae pneumonia(P = 0.005, P<0.001, P<0.001, respectively); and the probabilities of consolidation lesions, bronchial wall thickening, centrilobular nodules, and pleural effusion in S. pneumoniae pneumonia were higher than those in COVID-19 (P<0.001, P = 0.001, P = 0.003, P = 0.001, respectively). CONCLUSION The findings of GGO, the crazy paving sign, and abnormally thickened interlobular septa on chest CT were significantly higher in COVID-19 than S. pneumoniae pneumonia. The most important differential points on chest CT signs between COVID-19 and S. pneumoniae pneumonia were whether disease lesions were distributed in entire lung lobes and segments and whether the crazy paving sign, interlobular septal thickening, and consolidation lesions were found.
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Affiliation(s)
- Jun Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Xingnan Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Jia Cao
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Gonghao Ling
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - Xun Ding
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
| | - QingYun Long
- Department of Radiology, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuhan 430071, Hubei, PR China.
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158
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Yasar H, Ceylan M. A novel comparative study for detection of Covid-19 on CT lung images using texture analysis, machine learning, and deep learning methods. MULTIMEDIA TOOLS AND APPLICATIONS 2021; 80:5423-5447. [PMID: 33041635 PMCID: PMC7537375 DOI: 10.1007/s11042-020-09894-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/05/2020] [Accepted: 09/16/2020] [Indexed: 05/15/2023]
Abstract
The Covid-19 virus outbreak that emerged in China at the end of 2019 caused a huge and devastating effect worldwide. In patients with severe symptoms of the disease, pneumonia develops due to Covid-19 virus. This causes intense involvement and damage in lungs. Although the emergence of the disease occurred a short time ago, many literature studies have been carried out in which these effects of the disease on the lungs were revealed by the help of lung CT imaging. In this study, 1.396 lung CT images in total (386 Covid-19 and 1.010 Non-Covid-19) were subjected to automatic classification. In this study, Convolutional Neural Network (CNN), one of the deep learning methods, was used which suggested automatic classification of CT images of lungs for early diagnosis of Covid-19 disease. In addition, k-Nearest Neighbors (k-NN) and Support Vector Machine (SVM) was used to compare the classification successes of deep learning with machine learning. Within the scope of the study, a 23-layer CNN architecture was designed and used as a classifier. Also, training and testing processes were performed for Alexnet and Mobilenetv2 CNN architectures as well. The classification results were also calculated for the case of increasing the number of images used in training for the first 23-layer CNN architecture by 5, 10, and 20 times using data augmentation methods. To reveal the effect of the change in the number of images in the training and test clusters on the results, two different training and testing processes, 2-fold and 10-fold cross-validation, were performed and the results of the study were calculated. As a result, thanks to these detailed calculations performed within the scope of the study, a comprehensive comparison of the success of the texture analysis method, machine learning, and deep learning methods in Covid-19 classification from CT images was made. The highest mean sensitivity, specificity, accuracy, F-1 score, and AUC values obtained as a result of the study were 0,9197, 0,9891, 0,9473, 0,9058, 0,9888; respectively for 2-fold cross-validation, and they were 0,9404, 0,9901, 0,9599, 0,9284, 0,9903; respectively for 10-fold cross-validation.
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Affiliation(s)
- Huseyin Yasar
- Ministry of Health of Republic of Turkey, Ankara, Turkey
| | - Murat Ceylan
- Faculty of Engineering and Natural Sciences, Department of Electrical and Electronics Engineering, Konya Technical University, Konya, Turkey
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159
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CT Manifestations of Coronavirus Disease (COVID-19) Pneumonia and Influenza Virus Pneumonia: A Comparative Study. AJR Am J Roentgenol 2021; 216:71-79. [PMID: 32755175 DOI: 10.2214/ajr.20.23304] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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160
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Clinical laboratory characteristics of severe patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 9:184-190. [PMID: 32954048 PMCID: PMC7491425 DOI: 10.1016/j.cegh.2020.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/14/2020] [Accepted: 08/24/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To identify clinical characteristics of severe patients with COVID-19. METHODS The WHO database of publications on COVID-19 and PubMed were searched from inception to March 20, 2020 and all valuable studies were analyzed using Stata 15.0. RESULTS We selected forty-four studies with 13,497 patients. In the comparison of severe and non-severe groups, age over 50 (OR = 4.090; 95% CI = 2.422-6.907, P = 0.000) and underlying disease (OR = 3.992; 95% CI = 2.631-6.507, P = 0.000) are risk factors. Female gender (OR = 0.740; 95% CI = 0.622-0.881, P = 0.001) is a protective factor. Characteristics like dyspnea (OR = 4.914; 95% CI = 3.069-7.867, P = 0.000), lymphopenia (OR = 5.528; 95% CI = 3.484-8.772, P = 0.000), thrombocytopenia (OR = 3.623; 95% CI = 1.034-12.691, P = 0.044), elevated C-reactive protein (OR = 5.217; 95% CI = 2.459-11.070, P = 0.000) and D-dimer (OR = 3.780; 95% CI = 1.481-9.648, P = 0.005) were more frequently in severe cases. Diffuse lesions and consolidation (OR = 4.680; 95% CI = 3.183-6.881, P = 0.000) in imaging was considered reliable. CONCLUSIONS Men older than 50 with underlying disease are susceptible to develop severe pneumonia while female gender is protective. The typical symptom of severe pneumonia was dyspnea, but high fever, headache and diarrhea were not significantly different among patients with varying degrees of severity. Lymphopenia, thrombocytopenia, elevated C-reactive protein and D-dimer occurred more frequently in severe patients and yet leukopenia is not a characteristic laboratory indicator. Diffuse lesions and consolidation are important imaging features to distinguish severe pneumonia.
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161
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Rong Y, Wang F, Liu J, Zhou Y, Li X, Liang X, Zhang D, Zeng H, Wang J, Shi Y. Clinical characteristics and risk factors of mild-to-moderate COVID-19 patients with false-negative SARS-CoV-2 nucleic acid. J Med Virol 2021; 93:448-455. [PMID: 32603515 PMCID: PMC7362026 DOI: 10.1002/jmv.26242] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 02/01/2023]
Abstract
This study investigates the clinical and imaging characteristics of coronavirus disease 2019 (COVID-19) patients with false-negative nucleic acids. Mild-to-moderate COVID-19 patients, including 19 cases of nucleic acid false-negative patients and 31 cases of nucleic acid positive patients, were enrolled. Their epidemiological, clinical, and laboratory examination data and imaging characteristics were analyzed. Risk factors for false negatives were discussed. Compared with the nucleic acid positive group, the false-negative group had less epidemiological exposure (52.6% vs 83.9%; P = .025), less chest discomfort (5.3% vs 32.3%; P = .035), and faster recovery (10 [8, 13] vs 15 [11, 18.5] days; P = .005). The number of involved lung lobes was (2 [1, 2.5] vs 3 [2, 4] days; P = .004), and the lung damage severity score was (3 [2.5, 4.5] vs 5 [4, 9] days; P = .007), which was lighter in the nucleic acid false-negative group. Thus, the absence of epidemiological exposure may be a potential risk factor for false-negative nucleic acids. The false-negative cases of COVID-19 are worth noting because they have a risk of viral transmission without positive test results, lighter clinical manifestations, and less history of epidemiological exposure.
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Affiliation(s)
- Yan Rong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical MedicineSouthern Medical UniversityNanjingChina
- Department of Respiratory and Critical Care Medicine, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Fei Wang
- Department of OrthopaedicsThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Jing Liu
- Department of Health Management Center, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Yang Zhou
- Department of Respiratory and Critical Care Medicine, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Xiaoli Li
- Department of Respiratory and Critical Care Medicine, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Xinhua Liang
- Department of Nephrology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Dandan Zhang
- Department of Respiratory and Critical Care Medicine, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Huadong Zeng
- Department of Respiratory and Critical Care Medicine, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Jing Wang
- Department of Radiology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, The First School of Clinical MedicineSouthern Medical UniversityNanjingChina
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162
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Ikitimur H, Borku Uysal B, Cengiz M, Ikitimur B, Uysal H, Ozcan E, Islamoglu MS, Seyhan S, Yavuzer H, Yavuzer S. Determining host factors contributing to disease severity in a family cluster of 29 hospitalized SARS-CoV-2 patients: Could genetic factors be relevant in the clinical course of COVID-19? J Med Virol 2021; 93:357-365. [PMID: 32492209 PMCID: PMC7300487 DOI: 10.1002/jmv.26106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/31/2020] [Indexed: 02/02/2023]
Abstract
In this study, we report a large family cluster consisting of 29 genetically related patients hospitalized with coronavirus disease-2019 (COVID-19). We sought to determine the clinical characteristics relevant to the clinical course of COVID-19 by comparing the family cluster to unrelated patients with SARS-CoV-2 infection so that the presence of potential determinants of disease severity, other than traditional risk factors previously reported, could be investigated. Twenty-nine patient files were investigated in group 1 and group 2 was created with 52 consecutive patients with COVID-19 having age and gender compatibility. The virus was detected for diagnosis. The clinical, laboratory and imaging features of all patients were retrospectively screened. Disease course was assessed using records regarding outcome from patient files retrospectively. Groups were compared with respect to baseline characteristics, disease severity on presentation, and disease course. There was no difference between the two groups in terms of comorbidity and smoking history. In terms of inhospital treatment, use differed not significantly between two groups. We found that all 29 patients in the group 1 had severe pneumonia, 18 patients had severe pneumonia. Hospitalization rates, length of hospital stay, and transferred to intensive care unit were found to be statistically significantly higher in the group 1. In the present study, COVID-19 cases in the large family cluster were shown to have more severe disease and worse clinical course compared with consecutive patients with COVID-19 presenting to the same time. We believe further studies into potential genetic mechanisms of host susceptibility to COVID-19 should include such family clusters.
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Affiliation(s)
- Hande Ikitimur
- Department of Pulmonary DiseasesBiruni UniversityIstanbulTurkey
| | - Betul Borku Uysal
- Department of Internal Medicine, Medical FacultyBiruni UniversityIstanbulTurkey
| | - Mahir Cengiz
- Department of Internal Medicine, Medical FacultyBiruni UniversityIstanbulTurkey
| | - Barış Ikitimur
- Department of Cardiology, Cerrahpaşa School of MedicineIstanbul University‐CerrahpaşaIstanbulTurkey
| | - Harun Uysal
- Department of Anesthesiology and ReanimationBezmialem Vakif UniversityIstanbulTurkey
| | - Erkan Ozcan
- Department of Internal Medicine, Medical FacultyBiruni UniversityIstanbulTurkey
| | | | - Serhat Seyhan
- Department of Medical Genetics, Medical FacultyBiruni UniversityIstanbulTurkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, Cerrahpaşa School of MedicineIstanbul University‐CerrahpaşaIstanbulTurkey
| | - Serap Yavuzer
- Department of Internal Medicine, Medical FacultyBiruni UniversityIstanbulTurkey
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Kouhsari E, Azizian K, Sholeh M, Shayestehpour M, Hashemian M, Karamollahi S, Yaghoubi S, Sadeghiifard N. Clinical, epidemiological, laboratory, and radiological characteristics of novel Coronavirus (2019-nCoV) in retrospective studies: A systemic review and meta-analysis. Indian J Med Microbiol 2021; 39:104-115. [PMID: 33610239 PMCID: PMC7667392 DOI: 10.1016/j.ijmmb.2020.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND In December 2019, a novel pneumonia related to the 2019 coronavirus unexpectedly developed in Wuhan, China. We aimed to review data of the novel Coronavirus (2019-nCoV) by analyzing all the published retrospective studies on the clinical, epidemiological, laboratory, and radiological characteristics of patients with 2019-nCoV. METHODS We searched in four bibliographic databases PubMed, Scopus, Embase, and Web of Science) for studies March 10, 2020 focused on the clinical, epidemiological, laboratory, and radiological characteristics of patients with 2019-nCoV for meta-analysis. The Newcastle-Ottawa Scale was used to quality assessment, and publication bias was analyzed by Egger's test. In the meta-analysis, a random-effects model with Stata/SE software, v.14.1 (StataCorp, College Station, TX) was used to obtain a pooled incidence rate. RESULTS Fifty studies were included in this systematic review and meta-analysis with 8815 patients and the mean age was 46 years and 4647 (52.7%) were male. The pooled incidences rate of clinical symptoms were: fever (83%, 95% CI: 0.77, 0.89), cough (59%, 95% CI: 0.48, 0.69), myalgia or fatigue (31%, 95% CI: 0.23, 0.39), sputum production (29%, 95% CI: 0.21, 0.39), and dyspnea (19%, 95% CI: 0.12, 0.26). The pooled incidence rate of acute respiratory distress syndrome (ARDS) was (22%, 95% CI: 0.00, 0.60). CONCLUSION The results of this systemic review and meta-analysis present a quantitative pooled incidence rate of different characters of 2019-nCoV and has great potential to develop diagnosis and patient's stratification in 2019-nCoV. However, this conclusions of this study still requisite to be warranted by more careful design, larger sample size multivariate studies to corroborate the results of this meta-analysis.
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Affiliation(s)
- Ebrahim Kouhsari
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran; Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Khalil Azizian
- Department of Lab Science, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Mohammad Sholeh
- Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shayestehpour
- Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran; Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Marzieh Hashemian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Somayeh Karamollahi
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iranshahr, Iran.
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Wang Y, Zhang L, Wu GR, Zhou Q, Yue H, Rao LZ, Yuan T, Mo B, Wang FX, Chen LM, Sun F, Song J, Xiong F, Zhang S, Yu Q, Yang P, Xu Y, Zhao J, Zhang H, Xiong W, Wang CY. MBD2 serves as a viable target against pulmonary fibrosis by inhibiting macrophage M2 program. SCIENCE ADVANCES 2021; 7:sciadv.abb6075. [PMID: 33277324 PMCID: PMC7775789 DOI: 10.1126/sciadv.abb6075] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/29/2020] [Indexed: 05/22/2023]
Abstract
Despite past extensive studies, the mechanisms underlying pulmonary fibrosis (PF) still remain poorly understood. Here, we demonstrated that lungs originating from different types of patients with PF, including coronavirus disease 2019, systemic sclerosis-associated interstitial lung disease, and idiopathic PF, and from mice following bleomycin (BLM)-induced PF are characterized by the altered methyl-CpG-binding domain 2 (MBD2) expression in macrophages. Depletion of Mbd2 in macrophages protected mice against BLM-induced PF. Mbd2 deficiency significantly attenuated transforming growth factor-β1 (TGF-β1) production and reduced M2 macrophage accumulation in the lung following BLM induction. Mechanistically, Mbd2 selectively bound to the Ship promoter in macrophages, by which it repressed Ship expression and enhanced PI3K/Akt signaling to promote the macrophage M2 program. Therefore, intratracheal administration of liposomes loaded with Mbd2 siRNA protected mice from BLM-induced lung injuries and fibrosis. Together, our data support the possibility that MBD2 could be a viable target against PF in clinical settings.
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Affiliation(s)
- Yi Wang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Lei Zhang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Guo-Rao Wu
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Qing Zhou
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Huihui Yue
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Li-Zong Rao
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, 212 Renmin Road, Guilin 541000, China
| | - Ting Yuan
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, 212 Renmin Road, Guilin 541000, China
| | - Biwen Mo
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Guilin Medical University, 212 Renmin Road, Guilin 541000, China
| | - Fa-Xi Wang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Long-Min Chen
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Fei Sun
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Jia Song
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Fei Xiong
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Shu Zhang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Qilin Yu
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Ping Yang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Yongjian Xu
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Jianping Zhao
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China
| | - Huilan Zhang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China.
| | - Weining Xiong
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China.
- Department of Respiratory Medicine, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Lu, Shanghai 200011, China
| | - Cong-Yi Wang
- The Center for Biomedical Research, NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Sciences and Technology, 1095 Jiefang Ave., Wuhan 430030, China.
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Zheng KI, Feng G, Liu W, Targher G, Byrne CD, Zheng M. Extrapulmonary complications of COVID-19: A multisystem disease? J Med Virol 2021; 93:323-335. [PMID: 32648973 PMCID: PMC7405144 DOI: 10.1002/jmv.26294] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been recently declared a pandemic by the World Health Organization. In addition to its acute respiratory manifestations, SARS-CoV-2 may also adversely affect other organ systems. To date, however, there is a very limited understanding of the extent and management of COVID-19-related conditions outside of the pulmonary system. This narrative review provides an overview of the current literature about the extrapulmonary manifestations of COVID-19 that may affect the urinary, cardiovascular, gastrointestinal, hematological, hematopoietic, neurological, or reproductive systems. This review also describes the current understanding of the extrapulmonary complications caused by COVID-19 to improve the management and prognosis of patients with COVID-19.
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Affiliation(s)
- Kenneth I. Zheng
- MAFLD Research Center, Department of HepatologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | | | - Wen‐Yue Liu
- Department of EndocrinologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Giovanni Targher
- Section of Endocrinology, Diabetes, and Metabolism, Department of MedicineUniversity and Azienda Ospedaliera Universitaria Integrata of VeronaVeronaItaly
| | - Christopher D. Byrne
- Southampton National Institute for Health Research Biomedical Research Center, Southampton General HospitalUniversity Hospital SouthamptonSouthamptonUK
| | - Ming‐Hua Zheng
- MAFLD Research Center, Department of HepatologyThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
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166
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Mir JM, Maurya RC. Nitric oxide as a therapeutic option for COVID-19 treatment: a concise perspective. NEW J CHEM 2021. [DOI: 10.1039/d0nj03823g] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Among several possible therapies applicable for treating COVID-19, nitric oxide therapy has also gained considerable interest. This article describes the same with mechanistic details.
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Affiliation(s)
- Jan Mohammad Mir
- Coordination, Metallopharmaceutical and Computational Laboratory
- Department of PG Studies and Research in Chemistry and Pharmacy
- R. D. University
- Jabalpur
- India
| | - Ram Charitra Maurya
- Coordination, Metallopharmaceutical and Computational Laboratory
- Department of PG Studies and Research in Chemistry and Pharmacy
- R. D. University
- Jabalpur
- India
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167
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Meta-analysis investigating the relationship between clinical features, outcomes, and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Am J Infect Control 2021; 49:82-89. [PMID: 32540370 PMCID: PMC7292004 DOI: 10.1016/j.ajic.2020.06.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
Abstract
Objective We aimed to investigate the relationship between clinical characteristics, outcomes and the severity of severe acute respiratory syndrome coronavirus 2 pneumonia. Methods We performed a systematic review and meta-analysis using PubMed, Embase, and Cochrane Library databases to assess the clinical characteristics and outcomes of confirmed COVID-19 cases and compared severe (ICU) and nonsevere (non-ICU) groups. Results We included 12 cohort studies including 2,445 patients with COVID-19. Compared with nonsevere (non-ICU) patients, severe (ICU) disease was associated with a smoking history (P = .003) and comorbidities including chronic obstructive pulmonary disease (OR = 5.08, P < .001), diabetes (OR = 3.17, P < .001), hypertension (OR = 2.40, P < .001), coronary heart disease (OR = 2.66, P < .001), cerebrovascular diseases (OR = 2.68, P = .008), and malignancy (OR=2.21, P = .040). We found significant differences between the 2 groups for fever, dyspnea, decreased lymphocyte and platelet counts, and increased leukocyte count, C-creative protein, procalcitonin, lactose dehydrogenase, aspartate aminotransferase, alanine aminotransferase, creatinine kinase, and creatinine levels (P < .05). Significant differences were also observed for multiple treatments (P < .05). Patients in the severe (ICU) group were more likely to have complications and had a much higher mortality rate and lower discharge rate than those with nonsevere (non-ICU) disease (P < .05). Conclusions Investigation of clinical characteristics and outcomes of severe cases of COVID-19 will contribute to early prediction, accurate diagnosis, and treatment to improve the prognosis of patients with severe illness.
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Alharthy A, Bakirova GH, Bakheet H, Balhamar A, Brindley PG, Alqahtani SA, Memish ZA, Karakitsos D. COVID-19 with spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema in the intensive care unit: Two case reports. J Infect Public Health 2020; 14:290-292. [PMID: 33610937 PMCID: PMC7771902 DOI: 10.1016/j.jiph.2020.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/22/2020] [Accepted: 12/10/2020] [Indexed: 01/08/2023] Open
Abstract
Real-Time-reverse-transcription-Polymerase-Chain-Reaction from nasopharyngeal swabs and chest computed tomography (CT) depicting typically bilateral ground-glass opacities with a peripheral and/or posterior distribution are mandatory in the diagnosis of COVID-19. COVID-19 pneumonia may present though with atypical features such as pleural and pericardial effusions, lymphadenopathy, cavitations, and CT halo sign. In these two case-reports, COVID-19 presented as pneumothorax, pneumomediastinum and subcutaneous emphysema in critically ill patients. These disorders may require treatment or can be even self-limiting. Clinicians should be aware of their potential effects on the cardiorespiratory status of critically ill COVID-19 patients. Finally, pneumothorax can be promptly diagnosed by means of lung ultrasound. Although operator dependent, lung ultrasound is a useful bedside diagnostic tool that could alleviate the risk of cross-infection related to COVID-19 patient transport.
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Affiliation(s)
| | | | - Homaida Bakheet
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Abdullah Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Peter G Brindley
- Critical Care Department, The University of Alberta School of Medicine and Dentistry, Alberta, Canada.
| | - Saleh A Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, MD, USA.
| | - Ziad A Memish
- Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Critical Care Department. Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Li Z, Feng L, Cui W, Zhang J, Huang Y, Zhao Y, Teng F, Wu D, Wang H, Deng L, Yu Q. Sex differences in patients with COVID-19: a retrospective cohort study and meta-analysis. Open Access Maced J Med Sci 2020. [DOI: 10.3889/oamjms.2020.5380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND: Accumulated evidence revealed that male was much more likely to higher severity and fatality by SARS-CoV-2 infection than female patients, but few studies and meta-analyses have evaluated the sex differences of the infection and progression of COVID-19 patients.
AIM: We aimed to compare the sex differences of the epidemiological and clinical characteristics in COVID-19 patients; and to perform a meta-analysis evaluating the severe rate, fatality rate, and the sex differences of the infection and disease progression in COVID-19 patients.
METHODS: We analyzed clinical data of patients in Changchun Infectious Hospital and Center, Changchun, Northeast China; and searched PubMed, Embase, Web of Science, and Cochrane Library without any language restrictions for published articles that reported the data of sex-disaggregated, number of severe, and death patients on the confirmed diagnosis of adult COVID-19 patients.
RESULTS: The pooled severe rate and fatality rate of COVID-19 were 22.7% and 10.7%. Male incidence in the retrospective study was 58.1%, and the pooled incidence in male was 54.7%.
CONCLUSION: The pooled severe rate in male and female of COVID-19 was 28.2% and 18.8%, the risky of severe and death was about 1.6folds higher in male compared with female, especially for older patients (> 50 y).
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Di Girolamo M, Muscogiuri E, Zucchelli A, Laghi A. An Incidental Diagnosis of SARS-CoV-2 Pneumonia With Magnetic Resonance Imaging. Cureus 2020; 12:e12115. [PMID: 33489530 PMCID: PMC7810172 DOI: 10.7759/cureus.12115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
The Coronavirus disease 2019 (COVID-19) is caused by the human severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. The most common clinical findings related to COVID-19 are fever and cough, with the proportion of patients developing interstitial pneumonia. Other symptoms include dyspnea, expectoration, headache, anosmia, ageusia, myalgia and malaise. To date, the diagnostic criteria for COVID-19 include nasopharyngeal and oropharyngeal swabs. Computed tomography (CT) scans of the thorax showing signs of interstitial pneumonia are important in the management of respiratory disease and in the evaluation of lung involvement. In the literature, there are few cases of COVID-19 pneumonia diagnosis made using magnetic resonance imaging (MRI). In our report, we describe a case of accidental detection of findings related to interstitial pneumonia in a patient who underwent abdominal MRI for other clinical reasons. A 71-year-old woman was referred to our department for an MRI scan of the abdomen as her oncological follow-up. She was asymptomatic at the time of the examination and had passed the triage carried out on all the patients prior to diagnostic tests during the COVID-19 pandemic. The images acquired in the upper abdomen showed the presence of areas of altered signal intensity involving asymmetrically both pulmonary lower lobes, with a patchy appearance and a preferential peripheral subpleural distribution. We considered these features as highly suspicious for COVID-19 pneumonia. The nasopharyngeal swab later confirmed the diagnosis of SARS-CoV-2 infection. There are limited reports about MRI features of COVID-19 pneumonia, considering that high-resolution chest CT is the imaging technique of choice to diagnose pneumonia. Nevertheless, this clinical case confirmed that it is possible to detect MRI signs suggestive of COVID-19 pneumonia. The imaging features described could help in the evaluation of the lung parenchyma to assess the presence of signs suggestive of COVID-19 pneumonia, especially in asymptomatic patients during the pandemic phase of the disease.
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Affiliation(s)
- Marco Di Girolamo
- Department of Radiology, Sant'Andrea Hospital - Sapienza University of Rome, Roma, ITA
| | - Emanuele Muscogiuri
- Department of Radiology, Sant'Andrea Hospital - Sapienza University of Rome, Roma, ITA
| | - Alberto Zucchelli
- Department of Radiology, Sant'Andrea Hospital - Sapienza University of Rome, Roma, ITA
| | - Andrea Laghi
- Department of Radiology, Sant'Andrea Hospital - Sapienza University of Rome, Roma, ITA
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Saadat M, Manshadi MK, Mohammadi M, Zare MJ, Zarei M, Kamali R, Sanati-Nezhad A. Magnetic particle targeting for diagnosis and therapy of lung cancers. J Control Release 2020; 328:776-791. [PMID: 32920079 PMCID: PMC7484624 DOI: 10.1016/j.jconrel.2020.09.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
Over the past decade, the growing interest in targeted lung cancer therapy has guided researchers toward the cutting edge of controlled drug delivery, particularly magnetic particle targeting. Targeting of tissues by magnetic particles has tackled several limitations of traditional drug delivery methods for both cancer detection (e.g., using magnetic resonance imaging) and therapy. Delivery of magnetic particles offers the key advantage of high efficiency in the local deposition of drugs in the target tissue with the least harmful effect on other healthy tissues. This review first overviews clinical aspects of lung morphology and pathogenesis as well as clinical features of lung cancer. It is followed by reviewing the advances in using magnetic particles for diagnosis and therapy of lung cancers: (i) a combination of magnetic particle targeting with MRI imaging for diagnosis and screening of lung cancers, (ii) magnetic drug targeting (MDT) through either intravenous injection and pulmonary delivery for lung cancer therapy, and (iii) computational simulations that models new and effective approaches for magnetic particle drug delivery to the lung, all supporting improved lung cancer treatment. The review further discusses future opportunities to improve the clinical performance of MDT for diagnosis and treatment of lung cancer and highlights clinical therapy application of the MDT as a new horizon to cure with minimal side effects a wide variety of lung diseases and possibly other acute respiratory syndromes (COVID-19, MERS, and SARS).
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Affiliation(s)
- Mahsa Saadat
- Department of Chemical Engineering, College of Engineering, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mohammad K.D. Manshadi
- Department of Chemical Engineering, College of Engineering, Shahid Bahonar University of Kerman, Kerman, Iran,Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Mehdi Mohammadi
- Department of Chemical Engineering, College of Engineering, Shahid Bahonar University of Kerman, Kerman, Iran,Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada,Center for Bioengineering Research and Education, University of Calgary, Calgary, Alberta T2N 1N4, Canada,Department of Biological Science, University of Calgary, Alberta T2N 1N4, Canada
| | | | - Mohammad Zarei
- Mitochondrial and Epigenomic Medicine, and Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Reza Kamali
- Department of Mechanical Engineering, Shiraz University, 71345 Shiraz, Iran
| | - Amir Sanati-Nezhad
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada; Center for Bioengineering Research and Education, University of Calgary, Calgary, Alberta T2N 1N4, Canada.
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Biswas M, Rahaman S, Biswas TK, Haque Z, Ibrahim B. Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology 2020; 64:1-12. [PMID: 33296901 PMCID: PMC7801974 DOI: 10.1159/000512592] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Although severe acute respiratory syndrome coronavirus-2 infection is causing mortality in considerable proportion of coronavirus disease-2019 (COVID-19) patients, however, evidence for the association of sex, age, and comorbidities on the risk of mortality is not well-aggregated yet. It was aimed to assess the association of sex, age, and comorbidities with mortality in COVID-2019 patients. METHODS Literatures were searched using different keywords in various databases. Relative risks (RRs) were calculated by RevMan software where statistical significance was set as p < 0.05. RESULTS COVID-19 male patients were associated with significantly increased risk of mortality compared to females (RR 1.86: 95% confidence interval [CI] 1.67-2.07; p < 0.00001). Patients with age ≥50 years were associated with 15.4-folds significantly increased risk of mortality compared to patients with age <50 years (RR 15.44: 95% CI 13.02-18.31; p < 0.00001). Comorbidities were also associated with significantly increased risk of mortality; kidney disease (RR 4.90: 95% CI 3.04-7.88; p < 0.00001), cereborovascular disease (RR 4.78; 95% CI 3.39-6.76; p < 0.00001), cardiovascular disease (RR 3.05: 95% CI 2.20-4.25; p < 0.00001), respiratory disease (RR 2.74: 95% CI 2.04-3.67; p < 0.00001), diabetes (RR 1.97: 95% CI 1.48-2.64; p < 0.00001), hypertension (RR 1.95: 95% CI 1.58-2.40; p < 0.00001), and cancer (RR 1.89; 95% CI 1.25-2.84; p = 0.002) but not liver disease (RR 1.64: 95% CI 0.82-3.28; p= 0.16). CONCLUSION Implementation of adequate protection and interventions for COVID-19 patients in general and in particular male patients with age ≥50 years having comorbidities may significantly reduce risk of mortality associated with COVID-19.
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Affiliation(s)
- Mohitosh Biswas
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh,
| | - Shawonur Rahaman
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
| | - Tapash Kumar Biswas
- Department of Medicine, Faridpur Medical College Hospital, Faridpur, Bangladesh
| | - Zahirul Haque
- Department of Medicine, Rajshahi Medical College Hospital, Rajshahi, Bangladesh
| | - Baharudin Ibrahim
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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173
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Elhadedy MA, Marie Y, Halawa A. COVID-19 in Renal Transplant Recipients: Case Series and a Brief Review of Current Evidence. Nephron Clin Pract 2020; 145:192-198. [PMID: 33291120 PMCID: PMC7801980 DOI: 10.1159/000512329] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/14/2020] [Indexed: 01/06/2023] Open
Abstract
By April 26, 2020, infections related to coronavirus disease 2019 (COVID-19) affected people from 210 countries and caused 203,818 reported deaths worldwide. A few studies discussed the outcome of COVID-19 in kidney transplant recipients. This short series demonstrates our experience in managing COVID-19 disease in renal transplant patients in the absence of strong evidence. We report 8 cases of kidney transplant recipients infected with COVID-19 (median age = 48.5 years; range = 21–71 years), including 4 males and 4 females. The most frequently associated comorbidity was hypertension. The most common presenting features were fever and cough. The main radiological investigation was a portable chest X-ray. Other common features included lymphopenia, high C-reactive protein, and a very high ferritin level. Overall, 1 patient was managed as an outpatient, the remaining 7 required hospital admission, 1 of them referred to the intensive therapy unit. Management included supportive treatment (intravenous fluid therapy, monitoring renal function, and symptomatic treatment with or without ward-based oxygen therapy depending on oxygen saturation) and discontinuation of the antiproliferative immunosuppressive drugs. Seven patients recovered and discharged home to self-isolate. One patient required intensive care treatment and mechanical ventilation. Supportive treatment could be sufficient for the management or to be tried first. We also found that short hospital stay with self-isolation on discharge reduces the burden on the health service and protect the staff and the public.
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Affiliation(s)
- Muhammed Ahmed Elhadedy
- Nephrology Department, Sheffield Teaching Hospital, Sheffield, United Kingdom.,Transplantation unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yazin Marie
- Nephrology Department, Sheffield Teaching Hospital, Sheffield, United Kingdom
| | - Ahmed Halawa
- Nephrology Department, Sheffield Teaching Hospital, Sheffield, United Kingdom, .,Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom,
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174
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Goplen NP, Wu Y, Son YM, Li C, Wang Z, Cheon IS, Jiang L, Zhu B, Ayasoufi K, Chini EN, Johnson AJ, Vassallo R, Limper AH, Zhang N, Sun J. Tissue-resident CD8 + T cells drive age-associated chronic lung sequelae after viral pneumonia. Sci Immunol 2020; 5:5/53/eabc4557. [PMID: 33158975 DOI: 10.1126/sciimmunol.abc4557] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022]
Abstract
Lower respiratory viral infections, such as influenza virus and severe acute respiratory syndrome coronavirus 2 infections, often cause severe viral pneumonia in aged individuals. Here, we report that influenza viral pneumonia leads to chronic nonresolving lung pathology and exacerbated accumulation of CD8+ tissue-resident memory T cells (TRM) in the respiratory tract of aged hosts. TRM cell accumulation relies on elevated TGF-β present in aged tissues. Further, we show that TRM cells isolated from aged lungs lack a subpopulation characterized by expression of molecules involved in TCR signaling and effector function. Consequently, TRM cells from aged lungs were insufficient to provide heterologous protective immunity. The depletion of CD8+ TRM cells dampens persistent chronic lung inflammation and ameliorates tissue fibrosis in aged, but not young, animals. Collectively, our data demonstrate that age-associated TRM cell malfunction supports chronic lung inflammatory and fibrotic sequelae after viral pneumonia.
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Affiliation(s)
- Nick P Goplen
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,The Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA
| | - Yue Wu
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Young Min Son
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Chaofan Li
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Zheng Wang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - In Su Cheon
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Li Jiang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Bibo Zhu
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Eduardo N Chini
- The Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA.,Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Aaron J Johnson
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert Vassallo
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Andrew H Limper
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Nu Zhang
- Long School of Medicine, Departments of Microbiology, Immunology, and Molecular Genetics, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Jie Sun
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. .,The Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
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175
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Masaud SM, Szasz O, Szasz AM, Ejaz H, Anwar RA, Szasz A. A Potential Bioelectromagnetic Method to Slow Down the Progression and Prevent the Development of Ultimate Pulmonary Fibrosis by COVID-19. Front Immunol 2020; 11:556335. [PMID: 33343561 PMCID: PMC7746880 DOI: 10.3389/fimmu.2020.556335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction Right now, we are facing a global pandemic caused by the coronavirus SARS-CoV-2 that causes the highly contagious human disease COVID-19. The number of COVID-19 cases is increasing at an alarming rate, more and more people suffer from it, and the death toll is on the rise since December 2019, when COVID-19 has presumably appeared. We need an urgent solution for the prevention, treatment, and recovery of the involved patients. Methods Modulated electro-hyperthermia (mEHT) is known as an immuno-supportive therapy in oncology. Our proposal is to apply this method to prevent the progression of the disease after its identification, to provide treatment when necessary, and deliver rehabilitation to diminish the fibrotic-often fatal-consequences of the infection. Hypothesis The effects of mEHT, which are proven for oncological applications, could be utilized for the inactivation of the virus or for treating the fibrotic consequences. The hypothesized mEHT effects, which could have a role in the antiviral treatment, it could be applied for viral-specific immune-activation and for anti-fibrotic treatments.
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Affiliation(s)
| | - Oliver Szasz
- Biotechnics Department, St. Istvan University, Godollo, Hungary
| | - A. Marcell Szasz
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Huma Ejaz
- Department of Biochemistry, University of Turku, Turku, Finland
| | - Rana Attique Anwar
- Department of Oncology, Nishtar Medical College Multan, Multan, Pakistan
| | - Andras Szasz
- Biotechnics Department, St. Istvan University, Godollo, Hungary
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176
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Saburi A, Schoepf UJ, Ulversoy KA, Jafari R, Eghbal F, Ghanei M. From Radiological Manifestations to Pulmonary Pathogenesis of COVID-19: A Bench to Bedside Review. Radiol Res Pract 2020; 2020:8825761. [PMID: 33294226 PMCID: PMC7716750 DOI: 10.1155/2020/8825761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/16/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
In this review, we aim to assess previous radiologic studies in COVID-19 and suggest a pulmonary pathogenesis based on radiologic findings. Although radiologic features are not specific and there is heterogeneity in symptoms and radiologic and clinical manifestation, we suggest that the dominant pattern of computed tomography is consistent with limited pneumonia, followed by interstitial pneumonitis and organizing pneumonia.
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Affiliation(s)
- Amin Saburi
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - U. Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Kyle A. Ulversoy
- Augusta University/University of Georgia Medical Partnership, Athens, GA, USA
| | - Ramezan Jafari
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology & Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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177
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Adams HJA, Kwee TC, Yakar D, Hope MD, Kwee RM. Systematic Review and Meta-Analysis on the Value of Chest CT in the Diagnosis of Coronavirus Disease (COVID-19): Sol Scientiae, Illustra Nos. AJR Am J Roentgenol 2020; 215:1342-1350. [DOI: 10.2214/ajr.20.23391] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Hugo J. A. Adams
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas C. Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Derya Yakar
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Michael D. Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
- Radiology Service, Veterans Affairs Medical Center, San Francisco, CA
| | - Robert M. Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
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178
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Favas TT, Dev P, Chaurasia RN, Chakravarty K, Mishra R, Joshi D, Mishra VN, Kumar A, Singh VK, Pandey M, Pathak A. Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci 2020; 41:3437-3470. [PMID: 33089477 PMCID: PMC7577367 DOI: 10.1007/s10072-020-04801-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. METHODS We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. RESULTS Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4-50.2), taste disturbances (38.5%; 95%CI 24.0-53.0), myalgia (19.3%; 95% CI 15.1-23.6), headache (14.7%; 95% CI 10.4-18.9), dizziness (6.1%; 95% CI 3.1-9.2), and syncope (1.8%; 95% CI 0.9-4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0-3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9-3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2-0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1-0.6). CONCLUSIONS Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.
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Affiliation(s)
- T T Favas
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Priya Dev
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Rahul Mishra
- Department of Statistics, Institute of science, Banaras Hindu University, Varanasi, India
| | - Deepika Joshi
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vijay Nath Mishra
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Anand Kumar
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Varun Kumar Singh
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Manoj Pandey
- Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Abhishek Pathak
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
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179
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Faqihi F, Alharthy A, Alodat M, Kutsogiannis DJ, Brindley PG, Karakitsos D. Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study. J Crit Care 2020; 60:328-333. [PMID: 32763058 PMCID: PMC9629267 DOI: 10.1016/j.jcrc.2020.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE We investigated the effect of therapeutic plasma exchange (TPE) on life-threatening COVID-19; presenting as acute respiratory distress syndrome (ARDS) plus multi-system organ failure and cytokine release syndrome (CRS). MATERIALS AND METHODS We prospectively enrolled ten consecutive adult intensive care unit (ICU) subjects [7 males; median age: 51 interquartile range (IQR): 45.1-55.9 years old] with life-threatening COVID-19 infection. All had ARDS [PaO2/FiO2 ratio: 110 (IQR): 95.5-135.5], septic shock, CRS and deteriorated within 24 h of ICU admission despite fluid resuscitation, antibiotics, hydroxychloroquine, ARDS-net and prone position mechanical ventilation. All received 5-7 TPE sessions (dosed as 1.0 to 1.5 plasma volumes). RESULTS All of the following significantly normalized (p < 0.05) following the TPE completion, when compared to baseline: Sequential Organ Function Assessment score, PaO2/FiO2 ratio, levels of lymphocytes, total bilirubin, lactate dehydrogenase, ferritin, C-reactive protein and interleukin-6. No adverse effects from TPE were observed. Acute kidney injury and pulmonary embolism were observed in 10% and 20% of patients, respectively. The duration of mechanical ventilation was 9 (IQR: 7 to 12) days, the ICU length of stay was 15 (IQR: 13.2 to 19.6) days and the mortality on day-28 was 10%. CONCLUSION TPE demonstrates a potential survival benefit and low risk in life-threatening COVID-19, albeit in a small pilot study.
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Affiliation(s)
- Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Critical Care Department, Al Imam Abdulrahman Al Feisal Hospital, Riyadh, Saudi Arabia
| | | | - Mohammed Alodat
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Demetrios J Kutsogiannis
- Department of Critical Care, Faculty of Medicine and Dentistry, the University of Alberta, Alberta, Canada.
| | - Peter G Brindley
- Department of Critical Care, Faculty of Medicine and Dentistry, the University of Alberta, Alberta, Canada.
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Department of Internal Medicine, South Carolina University, School of Medicine, Columbia, SC, USA; Critical Care Department, Keck Medical School, USC, LA, CA, USA.
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180
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Waller JV, Allen IE, Lin KK, Diaz MJ, Henry TS, Hope MD. The Limited Sensitivity of Chest Computed Tomography Relative to Reverse Transcription Polymerase Chain Reaction for Severe Acute Respiratory Syndrome Coronavirus-2 Infection: A Systematic Review on COVID-19 Diagnostics. Invest Radiol 2020; 55:754-761. [PMID: 32554983 PMCID: PMC7314354 DOI: 10.1097/rli.0000000000000700] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Several studies suggest the sensitivity of chest computed tomography (CT) is far greater than that of reverse transcription polymerase chain reaction (RT-PCR) in diagnosing COVID-19 patients, and therefore, CT should be included as a primary diagnostic tool. This systematic review aims to stratify studies as high or low risk of bias to determine the true sensitivity of CT for severe acute respiratory syndrome coronavirus-2 infection according to the unbiased (low risk) studies, a topic of particular importance given the insufficient quantity of RT-PCR kits in many countries. We focus on sensitivity as that is the chief advantage perceived of CT. MATERIALS AND METHODS This systematic review involved searching the PubMed and Google Scholar databases for articles conducted and published between January 1 and April 15, 2020. The quality assessment tool QUADAS-2 was used to stratify studies according to their risk of bias, and exclusion criteria included not providing the information deemed relevant for such a stratification, such as not indicating if the patients were symptomatic or asymptomatic, or identifying the source of the specimen for the reference standard, RT-PCR (eg, nasal, oropharyngeal, etc). Sensitivity values were then extracted, and random effects meta-analyses were performed. RESULTS Of 641 search results, 37 studies (n = 9610 patients) were included in the analysis. The mean sensitivity of RT-PCR for COVID-19 reported by the biased studies was 70% (n = 5409/7 studies; 95% confidence interval [CI], 43-97; I = 99.1%), compared with 78% by unbiased studies (n = 534/4 studies; 95% CI, 69-87, I = 89.9%). For chest CT, the mean sensitivity reported by biased studies was 94% (n = 3371 patients/24 studies; 95% CI, 92-96; I = 93.1%), compared with 75% by unbiased studies (n = 957/10 studies; 95% CI, 67-83; I = 89.5%). CONCLUSIONS The difference between the sensitivities of CT and RT-PCR for severe acute respiratory syndrome coronavirus-2 infection is lower than previously thought, as after stratifying the studies, the true sensitivity for CT based on the unbiased studies is limited.
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Affiliation(s)
- Joseph V. Waller
- From the Drexel University College of Medicine, Philadelphia, PA
| | - Isabel E. Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Michael J. Diaz
- Department of Medical Engineering, USF College of Engineering, Tampa, FL
| | - Travis S. Henry
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Michael D. Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
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181
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Majidi H, Niksolat F. Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR. Am J Emerg Med 2020; 38:2730-2732. [PMID: 32312575 PMCID: PMC7141705 DOI: 10.1016/j.ajem.2020.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 02/08/2023] Open
Affiliation(s)
- Hadi Majidi
- Department of Radiology, Faculty of Medicine, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Fatemeh Niksolat
- Department of Internal Medicine and Rheumatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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182
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Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol 2020; 55:3252-3267. [PMID: 32965785 PMCID: PMC7646267 DOI: 10.1002/ppul.25087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. AIM To assess the characteristics of COVID-19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. SEARCH STRATEGY An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS-CoV-2, COVID-19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. RESULTS The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. CONCLUSIONS Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS-CoV-2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.
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Affiliation(s)
| | - Aggelos Tsalkidis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andrew Bush
- Departments of Pediatrics and Pediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Emmanouil Paraskakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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183
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Komolafe TE, Agbo J, Olaniyi EO, Komolafe K, Yang X. Prevalence of COVID-19 Diagnostic Output with Chest Computed Tomography: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:E1023. [PMID: 33260639 PMCID: PMC7759864 DOI: 10.3390/diagnostics10121023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/26/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The pooled prevalence of chest computed tomography (CT) abnormalities and other detailed analysis related to patients' biodata like gender and different age groups have not been previously described for patients with coronavirus disease 2019 (COVID-19), thus necessitating this study. Objectives: To perform a meta-analysis to evaluate the diagnostic performance of chest CT, common CT morphological abnormalities, disease prevalence, biodata information, and gender prevalence of patients. METHODS Studies were identified by searching PubMed and Science Direct libraries from 1 January 2020 to 30 April 2020. Pooled CT positive rate of COVID-19 and RT-PCR, CT-imaging features, history of exposure, and biodata information were estimated using the quality effect (QE) model. RESULTS Out of 36 studies included, the sensitivity was 89% (95% CI: 80-96%) and 98% (95% CI: 90-100%) for chest CT and reverse transcription-polymerase chain reaction (RT-PCR), respectively. The pooled prevalence across lesion distribution were 72% (95% CI: 62-80%), 92% (95% CI: 84-97%) for lung lobe, 88% (95% CI: 81-93%) for patients with history of exposure, and 91% (95% CI: 85-96%) for patients with all categories of symptoms. Seventy-six percent (95% CI: 67-83%) had age distribution across four age groups, while the pooled prevalence was higher in the male with 54% (95% CI: 50-57%) and 46% (95% CI: 43-50%) in the female. CONCLUSIONS The sensitivity of RT-PCR was higher than chest CT, and disease prevalence appears relatively higher in the elderly and males than children and females, respectively.
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Affiliation(s)
- Temitope Emmanuel Komolafe
- Division of Life Sciences and Medicine, School of Biomedical Engineering (Suzhou), University of Science and Technology of China, Hefei 230026, China;
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - John Agbo
- CAS Key Laboratory for Brain Function and Disease, Department of Neurobiology, University of Science and Technology of China, Hefei 230026, China;
- Department of Neuropharmacology, Faculty of Basic Medical Sciences, Abubakar Tafawa Balewa University, Bauchi 740272, Nigeria
| | - Ebenezer Obaloluwa Olaniyi
- Department of Biomedical Engineering, Shenzhen University, Shenzhen 518060, China;
- Department of Electrical and Electronic Engineering, Adeleke University, Ede 232103, Nigeria
| | - Kayode Komolafe
- Department of Biochemistry, Federal University of Oye Ekiti, Oye 371104, Nigeria;
| | - Xiaodong Yang
- Department of Medical Imaging, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- Jihua Laboratory, Foshan 528000, China
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184
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Tang L, Wang Y, Zhang Y, Zhang XY, Zeng XC, Song B. COVID-19: A review of what radiologists need to know. World J Clin Cases 2020; 8:5501-5512. [PMID: 33344540 PMCID: PMC7716304 DOI: 10.12998/wjcc.v8.i22.5501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease-2019 (COVID-19) is spreading throughout the world. Chest radiography and computed tomography play an important role in disease diagnosis, differential diagnosis, severity evaluation, prognosis prediction, therapeutic effects assessment and follow-up of patients with COVID-19. In this review, we summarize knowledge of COVID-19 pneumonia that may help improve the abilities of radiologists to diagnose and evaluate this highly infectious disease, which is essential for epidemic control and preventing new outbreaks in the short term.
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Affiliation(s)
- Lei Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang 550002, Guizhou Province, China
| | - Yi Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yun Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Yong Zhang
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang 550002, Guizhou Province, China
| | - Xian-Chun Zeng
- Department of Radiology, Guizhou Provincial People’s Hospital, Key Laboratory of Intelligent Medical Imaging Analysis and Accurate Diagnosis of Guizhou Province, International Exemplary Cooperation Base of Precision Imaging for Diagnosis and Treatment, Guiyang 550002, Guizhou Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Wang Z, Deng H, Ou C, Liang J, Wang Y, Jiang M, Li S. Clinical symptoms, comorbidities and complications in severe and non-severe patients with COVID-19: A systematic review and meta-analysis without cases duplication. Medicine (Baltimore) 2020; 99:e23327. [PMID: 33235096 PMCID: PMC7710213 DOI: 10.1097/md.0000000000023327] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/09/2020] [Accepted: 10/21/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The pandemic of COVID-19 poses a challenge to global healthcare. The mortality rates of severe cases range from 8.1% to 38%, and it is particularly important to identify risk factors that aggravate the disease. METHODS We performed a systematic review of the literature with meta-analysis, using 7 databases to identify studies reporting on clinical characteristics, comorbidities and complications in severe and non-severe patients with COVID-19. All the observational studies were included. We performed a random or fixed effects model meta-analysis to calculate the pooled proportion and 95% confidence interval (CI). Measure of heterogeneity was estimated by Cochran's Q statistic, I index and P value. RESULTS A total of 4881 cases from 25 studies related to COVID-19 were included. The most prevalent comorbidity was hypertension (severe: 33.4%, 95% CI: 25.4%-41.4%; non-severe 21.6%, 95% CI: 9.9%-33.3%), followed by diabetes (severe: 14.4%, 95% CI: 11.5%-17.3%; non-severe: 8.5%, 95% CI: 6.1%-11.0%). The prevalence of acute respiratory distress syndrome, acute kidney injury and shock were all higher in severe cases, with 41.1% (95% CI: 14.1%-68.2%), 16.4% (95% CI: 3.4%-29.5%) and 19.9% (95% CI: 5.5%-34.4%), rather than 3.0% (95% CI: 0.6%-5.5%), 2.2% (95% CI: 0.1%-4.2%) and 4.1% (95% CI: -4.8%-13.1%) in non-severe patients, respectively. The death rate was higher in severe cases (30.3%, 95% CI: 13.8%-46.8%) than non-severe cases (1.5%, 95% CI: 0.1%-2.8%). CONCLUSION Hypertension, diabetes and cardiovascular diseases may be risk factors for severe COVID-19.
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186
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Li J, Long X, Wang X, Fang F, Lv X, Zhang D, Sun Y, Hu S, Lin Z, Xiong N. Radiology indispensable for tracking COVID-19. Diagn Interv Imaging 2020; 102:69-75. [PMID: 33281082 PMCID: PMC7685040 DOI: 10.1016/j.diii.2020.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
Currently, chest computed tomography is recommended as the first-line imaging test for detecting COVID-19 pneumonia. The most typical CT imaging finding of COVID-19 patients is ground-glass opacity, combined with reticular and/or interlobular septal thickening and consolidation. CT is useful for monitoring patients with COVID-19, identifying associated vascular abnormalities and making differential diagnosis.
With the rapid spread of COVID-19 worldwide, early detection and efficient isolation of suspected patients are especially important to prevent the transmission. Although nucleic acid testing of SARS-CoV-2 is still the gold standard for diagnosis, there are well-recognized early-detection problems including time-consuming in the diagnosis process, noticeable false-negative rate in the early stage and lacking nucleic acid testing kits in some areas. Therefore, effective and rational applications of imaging technologies are critical in aiding the screen and helping the diagnosis of suspected patients. Currently, chest computed tomography is recommended as the first-line imaging test for detecting COVID-19 pneumonia, which could allow not only early detection of the typical chest manifestations, but also timely estimation of the disease severity and therapeutic effects. In addition, other radiological methods including chest X-ray, magnetic resonance imaging, and positron emission computed tomography also show significant advantages in the detection of COVID-19 pneumonia. This review summarizes the applications of radiology and nuclear medicine in detecting and diagnosing COVID-19. It highlights the importance for these technologies to curb the rapid transmission during the pandemic, considering findings from special groups such as children and pregnant women.
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Affiliation(s)
- Jingwen Li
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China
| | - Xi Long
- Department of Radiology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China
| | - Xinyi Wang
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China
| | - Fang Fang
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Xuefei Lv
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Dandan Zhang
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yu Sun
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Shaoping Hu
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Zhicheng Lin
- Harvard Medical School, Mclean Hospital, 02478 Belmont, MA, USA
| | - Nian Xiong
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China; Wuhan Red Cross Hospital, Wuhan, Hubei, China.
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187
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Lippi G, Mattiuzzi C, Bovo C, Henry BM. Headache is an important symptom in patients with coronavirus disease 2019 (COVID-19). Diagnosis (Berl) 2020; 7:409-411. [PMID: 32478675 DOI: 10.1515/dx-2020-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Piazzale LA Scuro, 37134, Verona, Italy
| | - Camilla Mattiuzzi
- Service of Clinical Governance, Provincial Agency for Social and Sanitary Services, Trento, Italy
| | - Chiara Bovo
- Medical Direction, University Hospital of Verona, Verona, Italy
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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188
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Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, Ceirano A, Espinosa F, Saavedra E, Sanguine V, Tassara A, Cid C, Catalano HN, Agarwal A, Foroutan F, Rada G. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One 2020; 15:e0241955. [PMID: 33201896 PMCID: PMC7671522 DOI: 10.1371/journal.pone.0241955] [Citation(s) in RCA: 366] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE The objective of our systematic review is to identify prognostic factors that may be used in decision-making related to the care of patients infected with COVID-19. DATA SOURCES We conducted highly sensitive searches in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The searches covered the period from the inception date of each database until April 28, 2020. No study design, publication status or language restriction were applied. STUDY SELECTION AND DATA EXTRACTION We included studies that assessed patients with confirmed or suspected SARS-CoV-2 infectious disease and examined one or more prognostic factors for mortality or disease severity. Reviewers working in pairs independently screened studies for eligibility, extracted data and assessed the risk of bias. We performed meta-analyses and used GRADE to assess the certainty of the evidence for each prognostic factor and outcome. RESULTS We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infectious disease: Demographic factors (age, male sex, smoking), patient history factors (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score (sequential organ failure assessment score). CONCLUSION Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infectious disease while researchers can utilise our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes. SYSTEMATIC REVIEW REGISTRATION Prospero registration number: CRD42020178802. Protocol available at: https://www.medrxiv.org/content/10.1101/2020.04.08.20056598v1.
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Affiliation(s)
- Ariel Izcovich
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | | | - Fernando Tortosa
- Departamento Médico, Hospital “Ramón Carrillo”, San Carlos de Bariloche, Argentina
| | | | - Camila Agnoletti
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Agustín Bengolea
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Agustina Ceirano
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Federico Espinosa
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Ezequiel Saavedra
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Verónica Sanguine
- Dirección Nacional de Calidad en Servicios de Salud y Regulación Sanitaria, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Alfredo Tassara
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Candelaria Cid
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | | | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Canada
| | - Gabriel Rada
- Fundación Epistemonikos, Santiago, Chile
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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189
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Panariello F, Cellini L, Speciani M, De Ronchi D, Atti AR. How Does SARS-CoV-2 Affect the Central Nervous System? A Working Hypothesis. Front Psychiatry 2020; 11:582345. [PMID: 33304284 PMCID: PMC7701095 DOI: 10.3389/fpsyt.2020.582345] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Interstitial pneumonia was the first manifestation to be recognized as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, in just a few weeks, it became clear that the coronavirus disease-2019 (COVID-19) overrun tissues and more body organs than just the lungs, so much so that it could be considered a systemic pathology. Several studies reported the involvement of the conjunctiva, the gut, the heart and its pace, and vascular injuries such as thromboembolic complications and Kawasaki disease in children and toddlers were also described. More recently, it was reported that in a sample of 214 SARS-CoV-2 positive patients, 36.4% complained of neurological symptoms ranging from non-specific manifestations (dizziness, headache, and seizures), to more specific symptoms such hyposmia or hypogeusia, and stroke. Older individuals, especially males with comorbidities, appear to be at the highest risk of developing such severe complications related to the Central Nervous System (CNS) involvement. Neuropsychiatric manifestations in COVID-19 appear to develop in patients with and without pre-existing neurological disorders. Growing evidence suggests that SARS-CoV-2 binds to the human Angiotensin-Converting Enzyme 2 (ACE2) for the attachment and entrance inside host cells. By describing ACE2 and the whole Renin Angiotensin Aldosterone System (RAAS) we may better understand whether specific cell types may be affected by SARS-CoV-2 and whether their functioning can be disrupted in case of an infection. Since clear evidences of neurological interest have already been shown, by clarifying the topographical distribution and density of ACE2, we will be able to speculate how SARS-CoV-2 may affect the CNS and what is the pathogenetic mechanism by which it contributes to the specific clinical manifestations of the disease. Based on such evidences, we finally hypothesize the process of SARS-CoV-2 invasion of the CNS and provide a possible explanation for the onset or the exacerbation of some common neuropsychiatric disorders in the elderly including cognitive impairment and Alzheimer disease.
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Affiliation(s)
- Fabio Panariello
- Department of Mental Health, Local Health Authorities, Bologna, Italy
| | - Lorenzo Cellini
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
| | - Maurizio Speciani
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, Psychiatry, Bologna University, Bologna, Italy
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190
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Xiang C, Huang L, Xia L. Mobile chest X-ray manifestations of 54 deceased patients with coronavirus disease 2019: Retrospective study. Medicine (Baltimore) 2020; 99:e23167. [PMID: 33181691 PMCID: PMC7668430 DOI: 10.1097/md.0000000000023167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To describe the mobile chest X-ray manifestations of deceased patients with coronavirus disease 2019 (COVID-19).In this retrospective study, we analyzed in patients with COVID-19 from Tongji Hospital (Wuhan, China), who had been died between February 18 and March 25, 2020. Two radiologists analyzed the radiologic characteristics of mobile chest X-ray, and analyzed the serial X-ray changes.Fifty-four deceased patients with COVID-19 were included in the study. We found that 50 (93%) patients with lesions occurred in the bilateral lung, 4 (7%) patients occurred in the right lung, 54 (100%) patients were multifocal involvement. The number of lung fields involved was 42 (78%) patients in 6 fields, 3 (6%) patients in 5 lung fields, 4 (7%) patients in 4 lung fields, and 5 (9%) patients in 3 lung fields. Fifty-three (98%) patients had patchy opacities, 3 (6%) patients had round or oval solid nodules, 9 (17%) patients had fibrous stripes, 13 (24%) patients had pleural effusion, 8 (15%) patients had pleural thickening, 6 (11%) patients had pneumothorax, 3 (6%) patients had subcutaneous emphysema. Among the 24 patients who had serial mobile chest X-rays, 16 (67%) patients had the progression of the lesions, 8 (33%) patients had no significant change of the lesions, and there was no case of reduction of the lesions.The mobile chest X-ray manifestations of deceased patients with COVID-19 were mostly bilateral lung, multifocal involvement, and extensive lung field, and pleural effusion, pleural thickening, and pneumothorax probably could be observed. The serial mobile chest X-ray showed that the chest lesions were progressive with a high probability.
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191
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Contribution of CT Features in the Diagnosis of COVID-19. Can Respir J 2020; 2020:1237418. [PMID: 33224361 PMCID: PMC7670585 DOI: 10.1155/2020/1237418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/19/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of novel coronavirus disease 2019 (COVID-19) first occurred in Wuhan, Hubei Province, China, and spread across the country and worldwide quickly. It has been defined as a major global health emergency by the World Health Organization (WHO). As this is a novel virus, its diagnosis is crucial to clinical treatment and management. To date, real-time reverse transcription-polymerase chain reaction (RT-PCR) has been recognized as the diagnostic criterion for COVID-19. However, the results of RT-PCR can be complemented by the features obtained in chest computed tomography (CT). In this review, we aim to discuss the diagnosis and main CT features of patients with COVID-19 based on the results of the published literature, in order to enhance the understanding of COVID-19 and provide more detailed information regarding treatment.
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192
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Mutiawati E, Syahrul S, Fahriani M, Fajar JK, Mamada SS, Maliga HA, Samsu N, Ilmawan M, Purnamasari Y, Asmiragani AA, Ichsan I, Emran TB, Rabaan AA, Masyeni S, Nainu F, Harapan H. Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis. F1000Res 2020; 9:1316. [PMID: 33953911 PMCID: PMC8063523 DOI: 10.12688/f1000research.27334.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 09/01/2023] Open
Abstract
Background: This study was conducted to determine the prevalence of headache in coronavirus disease 2019 (COVID-19) and to assess its association as a predictor for COVID-19. This study also aimed to discuss the possible pathogenesis of headache in COVID-19. Methods: Available articles from PubMed, Scopus, and Web of Science were searched as of September 2 nd, 2020. Data on characteristics of the study, headache and COVID-19 were extracted following the PRISMA guidelines. Biases were assessed using the Newcastle-Ottawa scale. The cumulative prevalence of headache was calculated for the general population (i.e. adults and children). The pooled odd ratio (OR) with 95% confidence intervals (95%CI) was calculated using the Z test to assess the association between headache and the presence of COVID-19 cases. Results: We included 104,751 COVID-19 cases from 78 eligible studies to calculate the global prevalence of headache in COVID-19 and 17 studies were included to calculate the association of headache and COVID-19. The cumulative prevalence of headache in COVID-19 was 25.2% (26,464 out of 104,751 cases). Headache was found to be more prevalent, approximately by two-fold, in COVID-19 patients than in non-COVID-19 patients with symptoms of other respiratory viral infections, OR: 1.73; 95% CI: 1.94, 2.5 with p=0.04. Conclusion: Headache is common among COVID-19 patients and seems to be more common in COVID-19 patients compared to those with the non-COVID-19 viral infection. No definitive mechanisms on how headache emerges in COVID-19 patients but several possible hypotheses have been proposed. However, extensive studies are warranted to elucidate the mechanisms. PROSPERO registration: CRD42020210332 (28/09/2020).
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Affiliation(s)
- Endang Mutiawati
- Department of Neurology, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
| | - Syahrul Syahrul
- Department of Neurology, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
| | - Marhami Fahriani
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
| | - Jonny Karunia Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Sukamto S. Mamada
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | | | - Nur Samsu
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Muhammad Ilmawan
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
| | - Yeni Purnamasari
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
| | | | - Ichsan Ichsan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
| | - Sri Masyeni
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Denpasar, Bali, 80235, Indonesia
- Department of Internal Medicine, Sanjiwani Hospital, Denpasar, Bali, 80235, Indonesia
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
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193
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Mutiawati E, Syahrul S, Fahriani M, Fajar JK, Mamada SS, Maliga HA, Samsu N, Ilmawan M, Purnamasari Y, Asmiragani AA, Ichsan I, Emran TB, Rabaan AA, Masyeni S, Nainu F, Harapan H. Global prevalence and pathogenesis of headache in COVID-19: A systematic review and meta-analysis. F1000Res 2020; 9:1316. [PMID: 33953911 PMCID: PMC8063523 DOI: 10.12688/f1000research.27334.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background: This study was conducted to determine the prevalence of headache in coronavirus disease 2019 (COVID-19) and to assess its association as a predictor for COVID-19. This study also aimed to discuss the possible pathogenesis of headache in COVID-19. Methods: Available articles from PubMed, Scopus, and Web of Science were searched as of September 2 nd, 2020. Data on characteristics of the study, headache and COVID-19 were extracted following the PRISMA guidelines. Biases were assessed using the Newcastle-Ottawa scale. The cumulative prevalence of headache was calculated for the general population (i.e. adults and children). The pooled odd ratio (OR) with 95% confidence intervals (95%CI) was calculated using the Z test to assess the association between headache and the presence of COVID-19 cases. Results: We included 104,751 COVID-19 cases from 78 eligible studies to calculate the global prevalence of headache in COVID-19 and 17 studies were included to calculate the association of headache and COVID-19. The cumulative prevalence of headache in COVID-19 was 25.2% (26,464 out of 104,751 cases). Headache was found to be more prevalent, approximately by two-fold, in COVID-19 patients than in non-COVID-19 patients (other respiratory viral infections), OR: 1.73; 95% CI: 1.94, 2.5 with p=0.04. Conclusion: Headache is common among COVID-19 patients and seems to be more common in COVID-19 patients compared to those with the non-COVID-19 viral infection. No definitive mechanisms on how headache emerges in COVID-19 patients but several possible hypotheses have been proposed. However, extensive studies are warranted to elucidate the mechanisms. PROSPERO registration: CRD42020210332 (28/09/2020).
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Affiliation(s)
- Endang Mutiawati
- Department of Neurology, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
| | - Syahrul Syahrul
- Department of Neurology, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
| | - Marhami Fahriani
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
| | - Jonny Karunia Fajar
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Sukamto S. Mamada
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | | | - Nur Samsu
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Muhammad Ilmawan
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
| | - Yeni Purnamasari
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
| | | | - Ichsan Ichsan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
| | - Sri Masyeni
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Universitas Warmadewa, Denpasar, Bali, 80235, Indonesia
- Department of Internal Medicine, Sanjiwani Hospital, Denpasar, Bali, 80235, Indonesia
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, 23111, Indonesia
- Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
- Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
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Abstract
Background Coronavirus disease 2019 (COVID-19) has become a global pandemic, affecting millions of people. However, the relationship between COVID-19 and acute cerebrovascular diseases is unclear. Aims We aimed to characterize the incidence, risk factors, clinical–radiological manifestations, and outcome of COVID-19-associated stroke. Methods Three medical databases were systematically reviewed for published articles on acute cerebrovascular diseases in COVID-19 (December 2019–September 2020). The review protocol was previously registered (PROSPERO ID = CRD42020185476). Data were extracted from articles reporting ≥5 stroke cases in COVID-19. We complied with the PRISMA guidelines and used the Newcastle–Ottawa Scale to assess data quality. Data were pooled using a random-effect model. Summary of review Of 2277 initially identified articles, 61 (2.7%) were entered in the meta-analysis. Out of 108,571 patients with COVID-19, acute CVD occurred in 1.4% (95%CI: 1.0–1.9). The most common manifestation was acute ischemic stroke (87.4%); intracerebral hemorrhage was less common (11.6%). Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not, were older (pooled median difference = 4.8 years; 95%CI: 1.7–22.4), more likely to have hypertension (OR = 7.35; 95%CI: 1.94–27.87), diabetes mellitus (OR = 5.56; 95%CI: 3.34–9.24), coronary artery disease (OR = 3.12; 95%CI: 1.61–6.02), and severe infection (OR = 5.10; 95%CI: 2.72–9.54). Compared to individuals who experienced a stroke without the infection, patients with COVID-19 and stroke were younger (pooled median difference = −6.0 years; 95%CI: −12.3 to −1.4), had higher NIHSS (pooled median difference = 5; 95%CI: 3–9), higher frequency of large vessel occlusion (OR = 2.73; 95%CI: 1.63–4.57), and higher in-hospital mortality rate (OR = 5.21; 95%CI: 3.43–7.90). Conclusions Acute cerebrovascular diseases are not uncommon in patients with COVID-19, especially in those whom are severely infected and have pre-existing vascular risk factors. The pattern of large vessel occlusion and multi-territory infarcts suggests that cerebral thrombosis and/or thromboembolism could be possible causative pathways for the disease.
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Affiliation(s)
- Stefania Nannoni
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Rosa de Groot
- Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Steven Bell
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
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195
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Akin H, Kurt R, Tufan F, Swi A, Ozaras R, Tahan V, Hammoud G. Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis. Diseases 2020; 8:E41. [PMID: 33182651 PMCID: PMC7709133 DOI: 10.3390/diseases8040041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIM Although constitutional and respiratory symptoms such as cough and fever are the most common symptoms in patients infected with COVID-19, gastrointestinal (GI) tract involvement has been observed by endoscopic biopsies. Multiple GI symptoms, including diarrhea, nausea or vomiting and abdominal pain, have also been reported. This review aims to present the currently available data regarding the GI symptoms of COVID-19 patients, and to compare the frequency of GI symptoms in early stage (Eastern) mostly Chinese data to the current stage (Western) non-Chinese data. METHODS We performed a systematic literature search to identify both published studies by using PubMed, Google Scholar, and CNKI (Chinese medical search engine), and yet unpublished studies through medRxiv and bioRxiv. We also reviewed the cross references of the detected articles. We conducted a Medical Subject Headings (MeSH) search up until 20 September 2020. We pooled the prevalence of symptoms of diarrhea, anorexia, nausea, vomiting, and abdominal pain by using the Freeman-Tukey's transforming random effect model. RESULTS A total of 118 studies were included in the systematic review and 44 of them were included in the meta-analysis. There was a significant heterogeneity between the studies; therefore, the random effects model was used. The pooled prevalence estimate of any GI symptoms reported was found to be 0.21 (95%CI, 0.16-0.27). Anorexia was the most commonly reported GI symptom at 18% (95%CI, 0.10-0.27) followed by diarrhea at 15% (95%CI, 0.12-0.19). Diarrhea, abdominal pain, nausea/vomiting, and respiratory symptoms were more common in non-Chinese studies. The prevalence of abdominal pain was lower in the "inpatient-only" studies when compared with studies that included outpatients only and those including both inpatients and outpatients. CONCLUSIONS In this comprehensive systematic review and meta-analysis study, we observed higher rates of diarrhea, nausea/vomiting, and abdominal pain in COVID-19 infected patients among non-Chinese studies compared to Chinese studies. We also observed a higher prevalence of GI symptoms in Chinese studies than was reported previously. Non-respiratory symptoms, including GI tract symptoms, should be more thoroughly and carefully evaluated and reported in future studies.
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Affiliation(s)
- Hakan Akin
- Birinci International Hospital, Istanbul 34525, Turkey;
| | - Ramazan Kurt
- Sondurak Medical Center, Istanbul 34764, Turkey;
| | - Fatih Tufan
- Independent Investigator, Istanbul 34107, Turkey;
| | - Ahmed Swi
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Resat Ozaras
- Medilife International Hospital, Istanbul 34523, Turkey;
| | - Veysel Tahan
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
| | - Ghassan Hammoud
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA; (A.S.); (G.H.)
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196
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Keyhanian K, Umeton RP, Mohit B, Davoudi V, Hajighasemi F, Ghasemi M. SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation. J Neuroimmunol 2020; 350:577436. [PMID: 33212316 PMCID: PMC7647896 DOI: 10.1016/j.jneuroim.2020.577436] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide.
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Affiliation(s)
- Kiandokht Keyhanian
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Raffaella Pizzolato Umeton
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Babak Mohit
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Vahid Davoudi
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Fatemeh Hajighasemi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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197
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Mair M, Singhavi H, Pai A, Singhavi J, Gandhi P, Conboy P, Baker A, Das S. A Meta-Analysis of 67 Studies with Presenting Symptoms and Laboratory Tests of COVID-19 Patients. Laryngoscope 2020; 131:1254-1265. [PMID: 33068023 DOI: 10.1002/lary.29207] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this meta-analysis was to look at the pooled prevalence of symptoms, laboratory tests, and imaging of all COVID-19 infected patients. This will allow better identification of potential COVID-19 patients and take appropriate precautions. STUDY DESIGN Meta analysis. METHODS We searched three databases, PubMed, EMBASE, and Ovid to identify studies published between Dec-2019 and May-2020. All studies reporting upper-aerodigestive symptoms of COVID-19 infection were included. The meta-analysis was conducted following meta-analyses of observational studies in epidemiology (MOOSE) guidelines, which have evaluated the pooled prevalence of 14 symptoms and nine laboratory investigations. RESULTS Based on inclusion criteria, 67 publications consisting of 8302 patients were included. Among adults, the pooled proportion of hypertensive and diabetic patients was 18% and 7%. Cough (53% [0.46-0.61]), anosmia (38% [0.19-0.58]), loss/distortion of taste (31% [0.17-0.45]), and nasal obstruction (26% [0.12-0.39]) were the most common ear, nose & throat (ENT) symptoms. Fever (69% [0.62-0.76]) and fatigue (31% [0.26-0.37]) were the commonest generalized symptoms. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were raised in 56% (0.41-0.71) and 49% (0.21-0.77), respectively. Interestingly, lymphopenia (41% [0.30-0.53]) and leucopenia (22% [0.16-0.29]) were more common than lymphocytosis (33% [0.02-0.64]) and leucocytosis (12% [0.09-0.16]). Fever (69% vs. 44%), cough (53% vs. 33%), and dyspnea (20% vs. 4%) were more common in adults as compared to the pediatric population. Diarrhea was more common among the pediatric cases (12%) versus (9%). The pooled estimate of fatality was 4%. CONCLUSIONS The most commonly experienced ENT symptom was cough followed by anosmia and dysguesia. Raised ESR and CRP with leukopenia and lymphopenia are common laboratory findings. Majority of the infected patients had abnormal computed tomography findings. COVID infection is less severe in pediatric patients. Laryngoscope, 131:1254-1265, 2021.
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Affiliation(s)
- Manish Mair
- Department of Otorhinolaryngology, University Hospitals of Leicester, United Kingdom
| | - Hitesh Singhavi
- Department of Head and Neck Services/Department of Medicine, Fortis Hospital, Mumbai, India
| | - Ameya Pai
- Head and Neck Services, Tata Memorial Hospital, Mumbai, India
| | - Jinesh Singhavi
- Department of Head and Neck Services/Department of Medicine, Fortis Hospital, Mumbai, India
| | - Prachi Gandhi
- Department of Neonatology, University Hospital of Leicester, United Kingdom
| | - Peter Conboy
- Department of Otorhinolaryngology, University Hospitals of Leicester, United Kingdom
| | - Andrew Baker
- Department of Otorhinolaryngology, University Hospitals of Leicester, United Kingdom
| | - Sudip Das
- Department of Otorhinolaryngology, University Hospitals of Leicester, United Kingdom
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198
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Borakati A, Perera A, Johnson J, Sood T. Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study. BMJ Open 2020; 10:e042946. [PMID: 33158840 PMCID: PMC7650091 DOI: 10.1136/bmjopen-2020-042946] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the association between imaging features and outcomes in these patients. DESIGN Retrospective analysis of electronic patient records. SETTING Tertiary academic health science centre and designated centre for high consequence infectious diseases in London, UK. PARTICIPANTS 1198 patients who attended the emergency department with paired reverse transcriptase PCR (RT-PCR) swabs for SARS-CoV-2 and CXR between 16 March and 16 April 2020. MAIN OUTCOME MEASURES Sensitivity and specificity of CXR and CT for diagnosis of COVID-19 using the British Society of Thoracic Imaging reporting templates. Reference standard was any RT-PCR positive naso-oropharyngeal swab within 30 days of attendance. ORs of CXR in association with vital signs, laboratory values and 30-day outcomes were calculated. RESULTS Sensitivity and specificity of CXR for COVID-19 diagnosis were 0.56 (95% CI 0.51 to 0.60) and 0.60 (95% CI 0.54 to 0.65), respectively. For CT scans, these were 0.85 (95% CI 0.79 to 0.90) and 0.50 (95% CI 0.41 to 0.60), respectively. This gave a statistically significant mean increase in sensitivity with CT of 29% (95% CI 19% to 38%, p<0.0001) compared with CXR. Specificity was not significantly different between the two modalities.CXR findings were not statistically significantly or clinically meaningfully associated with vital signs, laboratory parameters or 30-day outcomes. CONCLUSIONS CT has substantially improved diagnostic performance over CXR in COVID-19. CT should be strongly considered in the initial assessment for suspected COVID-19. This gives potential for increased sensitivity and considerably faster turnaround time, where capacity allows and balanced against excess radiation exposure risk.
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Affiliation(s)
- Aditya Borakati
- Division of Surgery and Interventional Science, University College London, London, London, UK
- Emergency Department, Royal Free Hospital, London, London, UK
| | - Adrian Perera
- Emergency Department, Royal Free Hospital, London, London, UK
| | - James Johnson
- Emergency Department, Royal Free Hospital, London, London, UK
| | - Tara Sood
- Emergency Department, Royal Free Hospital, London, London, UK
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199
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Aggarwal K, Agarwal A, Jaiswal N, Dahiya N, Ahuja A, Mahajan S, Tong L, Duggal M, Singh M, Agrawal R, Gupta V. Ocular surface manifestations of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One 2020; 15:e0241661. [PMID: 33151999 PMCID: PMC7643964 DOI: 10.1371/journal.pone.0241661] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose This study was performed to determine the occurrence of ocular surface manifestations in patients diagnosed with coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods A systematic search of electronic databases i.e. PubMed, Web of Science, CINAHL, OVID and Google scholar was performed using a comprehensive search strategy. The searches were current through 31st May 2020. Pooled data from cross-sectional studies was used for meta-analysis and a narrative synthesis was conducted for studies where a meta-analysis was not feasible. Results A total of 16 studies reporting 2347 confirmed COVID-19 cases were included. Pooled data showed that 11.64% of COVID-19 patients had ocular surface manifestations. Ocular pain (31.2%), discharge (19.2%), redness (10.8%), and follicular conjunctivitis (7.7%) were the main features. 6.9% patients with ocular manifestations had severe pneumonia. Viral RNA was detected from the ocular specimens in 3.5% patients. Conclusion The most common reported ocular presentations of COVID-19 included ocular pain, redness, discharge, and follicular conjunctivitis. A small proportion of patients had viral RNA in their conjunctival/tear samples. The available studies show significant publication bias and heterogeneity. Prospective studies with methodical collection and data reporting are needed for evaluation of ocular involvement in COVID-19.
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Affiliation(s)
- Kanika Aggarwal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nishant Jaiswal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neha Dahiya
- School of Medicine, St Joseph Mercy Hospital, Oakland, Pontiac, Michigan, United States of America
| | - Alka Ahuja
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sarakshi Mahajan
- School of Medicine, St Joseph Mercy Hospital, Oakland, Pontiac, Michigan, United States of America
| | - Louis Tong
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-Academic Clinical Program, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mona Duggal
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Meenu Singh
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rupesh Agrawal
- Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishali Gupta
- Advanced Eye Centre, Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- * E-mail: ,
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200
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Lakbar I, Luque-Paz D, Mege JL, Einav S, Leone M. COVID-19 gender susceptibility and outcomes: A systematic review. PLoS One 2020; 15:e0241827. [PMID: 33141872 PMCID: PMC7608911 DOI: 10.1371/journal.pone.0241827] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Epidemiological differences between men and women have been reported with regards to sepsis, influenza and severe coronavirus infections including SARS-CoV and MERS-CoV. AIM To systematically review the literature relating to men versus women on SARS-CoV-2 in order to seek differences in disease characteristics (e.g. infectivity, severity) and outcomes (e.g. mortality). METHODS We searched 3 electronic databases up or observational studies reporting differences between men and women in the SARS-CoV-2 disease characteristics stated. We identified and included 47 studies, reporting data for 21,454 patients mainly from China. RESULTS The unadjusted mortality rates of men were higher than those of women, with a mortality OR 0.51 [0.42, 0.61] (p<0.001) for women. The proportion of men presenting with severe disease and admitted to the intensive care unit (ICU) was also higher than that of women (OR 0.75 [0.60-0.93] p<0.001 and OR 0.45 [0.40-0.52] p<0.001 respectively). Adjusted analyses could not be conducted due to lack of data. CONCLUSION COVID-19 may be associated with worse outcomes in males than in females. However, until more detailed data are provided in further studies enabling adjusted analysis, this remains an unproven assumption.
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Affiliation(s)
- Ines Lakbar
- Department of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille University, Marseille, France
- MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
- Department of Anesthesiology and Intensive Care Unit, Toulouse, France
| | - David Luque-Paz
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
- University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR 1230, Rennes, France
| | - Jean-Louis Mege
- MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Sharon Einav
- Intensive Care Unit of the Shaare Zedek Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaire de Marseille, Aix Marseille University, Marseille, France
- MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
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