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Chavoshi M, Zamani S, Mirshahvalad SA. Diagnostic performance of deep learning models versus radiologists in COVID-19 pneumonia: A systematic review and meta-analysis. Clin Imaging 2024; 107:110092. [PMID: 38301371 DOI: 10.1016/j.clinimag.2024.110092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Although several studies have compared the performance of deep learning (DL) models and radiologists for the diagnosis of COVID-19 pneumonia on CT of the chest, these results have not been collectively evaluated. We performed a meta-analysis of original articles comparing the performance of DL models versus radiologists in detecting COVID-19 pneumonia. METHODS A systematic search was conducted on the three main medical literature databases, Scopus, Web of Science, and PubMed, for articles published as of February 1st, 2023. We included original scientific articles that compared DL models trained to detect COVID-19 pneumonia on CT to radiologists. Meta-analysis was performed to determine DL versus radiologist performance in terms of model sensitivity and specificity, taking into account inter and intra-study heterogeneity. RESULTS Twenty-two articles met the inclusion criteria. Based on the meta-analytic calculations, DL models had significantly higher pooled sensitivity (0.933 vs. 0.829, p < 0.001) compared to radiologists with similar pooled specificity (0.905 vs. 0.897, p = 0.746). In the differentiation of COVID-19 versus community-acquired pneumonia, the DL models had significantly higher sensitivity compared to radiologists (0.915 vs. 0.836, p = 0.001). CONCLUSIONS DL models have high performance for screening of COVID-19 pneumonia on chest CT, offering the possibility of these models for augmenting radiologists in clinical practice.
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Affiliation(s)
- Mohammadreza Chavoshi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Zamani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Ali Mirshahvalad
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Canada.
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2
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Trinh CD, Le VN, Le VNB, Pham NT, Le VD. Lung abnormalities on computed tomography of Vietnamese patients with COVID-19 and the association with medical variables. IJID REGIONS 2024; 10:183-190. [PMID: 38351902 PMCID: PMC10862005 DOI: 10.1016/j.ijregi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
Objectives Patients with COVID-19 may experience a lung injury without presenting clinical symptoms. Early detection of lung injury in patients with COVID-19 is required to enhance prediction and prevent severe progression. Methods Lung lesions in patients with COVID-19 were defined using the Fleischner Society terminology. Chest computed tomography lesions and their correlation with demographic characteristics and medical variables were identified. Results Patients with mild and moderate COVID-19 had up to 45% lung injuries, whereas critical patients had 55%. However, patients with mild and moderate COVID-19 typically had low-level lung injuries. Ground-glass (68.1%), consolidation (48.8%), opacity (36.3%), and nodular (6.9%) lung lesions were the most prevalent in patients with COVID-19. Patients with COVID-19 infected with the Delta variant had worse lung injury than those infected with the Alpha and Omicron. People vaccinated with ≥2 doses showed a lower risk of lung injury than those vaccinated with <1 dose. Patients <18 years old were less likely to have a lung injury than patients >18 years old. The treatment outcomes were unaffected by the severity of the lung injury. Conclusion Patients with mild COVID-19 had a similar risk of lung injury as patients with severe COVID-19. Thus, using chest computed tomography to detect lung injury can enhance the treatment outcomes and reduce the patient's risk of pulmonary complications.
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Affiliation(s)
- Cong Dien Trinh
- Departments of Infectious Disease, Military Hospital 103, Hanoi, Vietnam
| | - Van Nam Le
- Departments of Infectious Disease, Military Hospital 103, Hanoi, Vietnam
| | | | - Ngoc Thach Pham
- Micobiology and Molecular Biology Department, National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - Van Duyet Le
- Micobiology and Molecular Biology Department, National Hospital for Tropical Diseases, Hanoi, Vietnam
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3
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Alewaidat H, Bataineh Z, Bani-Ahmad M, Alali M, Almakhadmeh A. Investigation of the diagnostic importance and accuracy of CT in the chest compared to the RT-PCR test for suspected COVID-19 patients in Jordan. F1000Res 2023; 12:741. [PMID: 37822316 PMCID: PMC10562777 DOI: 10.12688/f1000research.130388.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 10/13/2023] Open
Abstract
This article aims to synthesize the existing literature on the implementation of public policies to incentivize the development of treatments for rare diseases, (diseases with very low prevalence and therefore with low commercial interest) otherwise known as orphan drugs. The implementation of these incentives in the United States (US), Japan, and in the European Union (EU) seems to be related to a substantial increase in treatments for these diseases, and has influenced the way the pharmaceutical research & development (R&D) system operates beyond this policy area. Despite the success of the Orphan Drug model, the academic literature also highlights the negative implications that these public policies have on affordability and access to orphan drugs, as well as on the prioritization of certain disease rare areas over others. The synthesis focuses mostly on the United States' Orphan Drug Act (ODA) as a model for subsequent policies in other regions and countries. It starts with a historical overview of the creation of the term "rare diseases", continues with a summary of the evidence available on the US ODA's positive and negative impacts, and provides a summary of the different proposals to reform these incentives in light of the negative outcomes described. Finally, it describes some key aspects of the Japanese and European policies, as well as some of the challenges captured in the literature related to their impact in Low- and Middle-Income Countries (LMICs).
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Affiliation(s)
- Haytham Alewaidat
- Applied Medical Sciences, Jordan University of Science and Technology, irbid, 22110, Jordan
| | - Ziad Bataineh
- Anatomy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad Bani-Ahmad
- Medical Laboratory Science, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Manar Alali
- Medical Laboratory Science, Zarqa University, Zarqa, Jordan
| | - Ali Almakhadmeh
- Radiologic Technology, Jordan University of Science and Technology, Irbid, 22110, Jordan
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4
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Zeinali-Rafsanjani B, Alavi A, Lotfi M, Haseli S, Saeedi-Moghadam M, Moradpour M. Is it necessary to define new diagnostic reference levels during pandemics like the Covid19-? Radiat Phys Chem Oxf Engl 1993 2023; 205:110739. [PMID: 36567703 PMCID: PMC9764089 DOI: 10.1016/j.radphyschem.2022.110739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Introduction This study intended to assess the dose length product (DLP), effective cumulative radiation dose (E.D.), and additional cancer risk (ACR) due to a chest CT scan to detect or follow up the Covid-19 disease in four university-affiliated hospitals that used different imaging protocols. Indeed, this study aimed to examine the differences in decision-making between different imaging centers in choosing chest CT imaging protocols during the pandemic, and to assess whether a new diagnostic reference level (DRL) is needed in pandemic situations. Methods This retrospective study assessed the E.D. of all chest imagings for Covid-19 for six months in four different hospitals in our country. Imaging parameters and DLP (mGy.cm) were recorded. The E.D.s and ACRs from chest CT scans were calculated using an online calculator. Results Thousand-six hundred patients were included in the study. The mean cumulative dose due to chest CT was 3.97 mSv which might cause 2.59 × 10-2 ACR. The mean cumulative E.D. in different hospitals was in the range of 1.96-9.51 mSv. Conclusions The variety of mean E.D.s shows that different hospitals used different imaging protocols. Since there is no defined DRL in the pandemic, some centers use routine protocols, and others try to reduce the dose but insufficiently.In pandemics such as Covid-19, when CT scan is used for screening or follow-up, DLPs can be significantly lower than in normal situations. Therefore, international regularized organizations such as the international atomic energy agency (IAEA) or the international commission on radiological protection (IRCP) should provide new DRL ranges.
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Affiliation(s)
| | - Azamalsadat Alavi
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Haseli
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Co-corresponding author
| | - Mahdi Saeedi-Moghadam
- Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author
| | - Moein Moradpour
- Radiology Department of Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Prakash J, Kumar N, Saran K, Yadav AK, Kumar A, Bhattacharya PK, Prasad A. Computed tomography severity score as a predictor of disease severity and mortality in COVID-19 patients: A systematic review and meta-analysis. J Med Imaging Radiat Sci 2023; 54:364-375. [PMID: 36907753 PMCID: PMC9933858 DOI: 10.1016/j.jmir.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Prediction of outcomes in severe COVID-19 patients using chest computed tomography severity score (CTSS) may enable more effective clinical management and early, timely ICU admission. We conducted a systematic review and meta-analysis to determine the predictive accuracy of the CTSS for disease severity and mortality in severe COVID-19 subjects. METHODS The electronic databases PubMed, Google Scholar, Web of Science, and the Cochrane Library were searched to find eligible studies that investigated the impact of CTSS on disease severity and mortality in COVID-19 patients between 7 January 2020 and 15 June 2021. Two independent authors looked into the risk of bias using the Quality in Prognosis Studies (QUIPS) tool. RESULTS Seventeen studies involving 2788 patients reported the predictive value of CTSS for disease severity. The pooled sensitivity, specificity, and summary area under the curve (sAUC) of CTSS were 0.85 (95% CI 0.78-0.90, I2 =83), 0.86 (95% CI 0.76-0.92, I2 =96) and 0.91 (95% CI 0.89-0.94), respectively. Six studies involving 1403 patients reported the predictive values of CTSS for COVID-19 mortality. The pooled sensitivity, specificity, and sAUC of CTSS were 0.77 (95% CI 0.69-0.83, I2 = 41), 0.79 (95% CI 0.72-0.85, I2 = 88), and 0.84 (95% CI 0.81-0.87), respectively. DISCUSSION Early prediction of prognosis is needed to deliver the better care to patients and stratify them as soon as possible. Because different CTSS thresholds have been reported in various studies, clinicians are still determining whether CTSS thresholds should be used to define disease severity and predict prognosis. CONCLUSION Early prediction of prognosis is needed to deliver optimal care and timely stratification of patients. CTSS has strong discriminating power for the prediction of disease severity and mortality in patients with COVID-19.
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Affiliation(s)
- Jay Prakash
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Naveen Kumar
- Department of Radiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Khushboo Saran
- Department of Pathology, Gandhi Nagar Hospital, Central Coalfields Limited, Kanke, Ranchi, Jharkhand, India.
| | - Arun Kumar Yadav
- Department of Community Medicine, Armed Force Medical College, Pune, Maharashtra, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Pradip Kumar Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Anupa Prasad
- Department of Biochemistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
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Topff L, Sánchez-García J, López-González R, Pastor AJ, Visser JJ, Huisman M, Guiot J, Beets-Tan RGH, Alberich-Bayarri A, Fuster-Matanzo A, Ranschaert ER. A deep learning-based application for COVID-19 diagnosis on CT: The Imaging COVID-19 AI initiative. PLoS One 2023; 18:e0285121. [PMID: 37130128 PMCID: PMC10153726 DOI: 10.1371/journal.pone.0285121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Recently, artificial intelligence (AI)-based applications for chest imaging have emerged as potential tools to assist clinicians in the diagnosis and management of patients with coronavirus disease 2019 (COVID-19). OBJECTIVES To develop a deep learning-based clinical decision support system for automatic diagnosis of COVID-19 on chest CT scans. Secondarily, to develop a complementary segmentation tool to assess the extent of lung involvement and measure disease severity. METHODS The Imaging COVID-19 AI initiative was formed to conduct a retrospective multicentre cohort study including 20 institutions from seven different European countries. Patients with suspected or known COVID-19 who underwent a chest CT were included. The dataset was split on the institution-level to allow external evaluation. Data annotation was performed by 34 radiologists/radiology residents and included quality control measures. A multi-class classification model was created using a custom 3D convolutional neural network. For the segmentation task, a UNET-like architecture with a backbone Residual Network (ResNet-34) was selected. RESULTS A total of 2,802 CT scans were included (2,667 unique patients, mean [standard deviation] age = 64.6 [16.2] years, male/female ratio 1.3:1). The distribution of classes (COVID-19/Other type of pulmonary infection/No imaging signs of infection) was 1,490 (53.2%), 402 (14.3%), and 910 (32.5%), respectively. On the external test dataset, the diagnostic multiclassification model yielded high micro-average and macro-average AUC values (0.93 and 0.91, respectively). The model provided the likelihood of COVID-19 vs other cases with a sensitivity of 87% and a specificity of 94%. The segmentation performance was moderate with Dice similarity coefficient (DSC) of 0.59. An imaging analysis pipeline was developed that returned a quantitative report to the user. CONCLUSION We developed a deep learning-based clinical decision support system that could become an efficient concurrent reading tool to assist clinicians, utilising a newly created European dataset including more than 2,800 CT scans.
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Affiliation(s)
- Laurens Topff
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | | | | | | | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merel Huisman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Julien Guiot
- Department of Pneumology, University Hospital of Liège (CHU Liège), Liège, Belgium
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | | | | | - Erik R Ranschaert
- Department of Radiology, St. Nikolaus Hospital, Eupen, Belgium
- Ghent University, Ghent, Belgium
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7
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COVID-19 diagnostics: Molecular biology to nanomaterials. Clin Chim Acta 2023; 538:139-156. [PMID: 36403665 PMCID: PMC9673061 DOI: 10.1016/j.cca.2022.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
The SARS-CoV-2 pandemic has claimed around 6.4 million lives worldwide. The disease symptoms range from mild flu-like infection to life-threatening complications. The widespread infection demands rapid, simple, and accurate diagnosis. Currently used methods include molecular biology-based approaches that consist of conventional amplification by RT-PCR, isothermal amplification-based techniques such as RT-LAMP, and gene editing tools like CRISPR-Cas. Other methods include immunological detection including ELISA, lateral flow immunoassay, chemiluminescence, etc. Radiological-based approaches are also being used. Despite good analytical performance of these current methods, there is an unmet need for less costly and simpler tests that may be performed at point of care. Accordingly, nanomaterial-based testing has been extensively pursued. In this review, we discuss the currently used diagnostic techniques for SARS-CoV-2, their usefulness, and limitations. In addition, nanoparticle-based approaches have been highlighted as another potential means of detection. The review provides a deep insight into the current diagnostic methods and future trends to combat this deadly menace.
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Saad MH, Hashima S, Sayed W, El-Shazly EH, Madian AH, Fouda MM. Early Diagnosis of COVID-19 Images Using Optimal CNN Hyperparameters. Diagnostics (Basel) 2022; 13:diagnostics13010076. [PMID: 36611368 PMCID: PMC9818649 DOI: 10.3390/diagnostics13010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Coronavirus disease (COVID-19) is a worldwide epidemic that poses substantial health hazards. However, COVID-19 diagnostic test sensitivity is still restricted due to abnormalities in specimen processing. Meanwhile, optimizing the highly defined number of convolutional neural network (CNN) hyperparameters (hundreds to thousands) is a useful direction to improve its overall performance and overcome its cons. Hence, this paper proposes an optimization strategy for obtaining the optimal learning rate and momentum of a CNN's hyperparameters using the grid search method to improve the network performance. Therefore, three alternative CNN architectures (GoogleNet, VGG16, and ResNet) were used to optimize hyperparameters utilizing two different COVID-19 radiography data sets (Kaggle (X-ray) and China national center for bio-information (CT)). These architectures were tested with/without optimizing the hyperparameters. The results confirm effective disease classification using the CNN structures with optimized hyperparameters. Experimental findings indicate that the new technique outperformed the previous in terms of accuracy, sensitivity, specificity, recall, F-score, false positive and negative rates, and error rate. At epoch 25, the optimized Resnet obtained high classification accuracy, reaching 98.98% for X-ray images and 98.78% for CT images.
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Affiliation(s)
- Mohamed H. Saad
- Radiation Engineering Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo 11787, Egypt
| | - Sherief Hashima
- Engineering Department, Nuclear Research Center (NRC), Egyptian Atomic Energy Authority, Cairo 13759, Egypt
- Correspondence: ; Tel.: +20-10-94230077
| | - Wessam Sayed
- Radiation Engineering Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo 11787, Egypt
| | - Ehab H. El-Shazly
- Radiation Engineering Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo 11787, Egypt
| | - Ahmed H. Madian
- Radiation Engineering Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority, Cairo 11787, Egypt
| | - Mostafa M. Fouda
- Department of Electrical and Computer Engineering, Idaho State University, Pocatello, ID 83209, USA
- Department of Electrical Engineering, Faculty of Engineering at Shoubra, Benha University, Cairo 11672, Egypt
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Hou N, Wang L, Li M, Xie B, He L, Guo M, Liu S, Wang M, Zhang R, Wang K. Do COVID-19 CT features vary between patients from within and outside mainland China? Findings from a meta-analysis. Front Public Health 2022; 10:939095. [PMID: 36311632 PMCID: PMC9616120 DOI: 10.3389/fpubh.2022.939095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023] Open
Abstract
Background Chest computerized tomography (CT) plays an important role in detecting patients with suspected coronavirus disease 2019 (COVID-19), however, there are no systematic summaries on whether the chest CT findings of patients within mainland China are applicable to those found in patients outside. Methods Relevant studies were retrieved comprehensively by searching PubMed, Embase, and Cochrane Library databases before 15 April 2022. Quality assessment of diagnostic accuracy studies (QUADAS) was used to evaluate the quality of the included studies, which were divided into two groups according to whether they were in mainland China or outside. Data on diagnostic performance, unilateral or bilateral lung involvement, and typical chest CT imaging appearances were extracted, and then, meta-analyses were performed with R software to compare the CT features of COVID-19 pneumonia between patients from within and outside mainland China. Results Of the 8,258 studies screened, 19 studies with 3,400 patients in mainland China and 14 studies with 554 outside mainland China were included. Overall, the risk of quality assessment and publication bias was low. The diagnostic value of chest CT is similar between patients from within and outside mainland China (93, 91%). The pooled incidence of unilateral lung involvement (15, 7%), the crazy-paving sign (31, 21%), mixed ground-glass opacities (GGO) and consolidations (51, 35%), air bronchogram (44, 25%), vascular engorgement (59, 33%), bronchial wall thickening (19, 12%), and septal thickening (39, 26%) in patients from mainland China were significantly higher than those from outside; however, the incidence rates of bilateral lung involvement (75, 84%), GGO (78, 87%), consolidations (45, 58%), nodules (12, 17%), and pleural effusion (9, 15%) were significantly lower. Conclusion Considering that the chest CT features of patients in mainland China may not reflect those of the patients abroad, radiologists and clinicians should be familiar with various CT presentations suggestive of COVID-19 in different regions.
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Affiliation(s)
- Nianzong Hou
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China,Department of Hand and Foot Surgery, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China
| | - Lin Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China
| | - Mingzhe Li
- School of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
| | - Bing Xie
- Department of Hand and Foot Surgery, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China
| | - Lu He
- Department of Urology, Dongfeng Hospital, Hubei University of Medicine, Shiyan, China
| | - Mingyu Guo
- Department of Hand and Foot Surgery, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China
| | - Shuo Liu
- Department of Hand and Foot Surgery, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China
| | - Meiyu Wang
- Department of Cardiology, The People's Hospital of Zhangdian District, Zibo, China
| | - Rumin Zhang
- Department of Critical Care Medicine, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China
| | - Kai Wang
- Department of Critical Care Medicine, Zibo Central Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Zibo, China,*Correspondence: Kai Wang
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10
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Shokri F, Rezapoor S, Najafi M, Asadi M, Karimi alavije M, Abolhassani M, Moieneddin MH, Ashrafi AM, Gholipour N, Naderi P, Charati JY, Alizadeh-Navaei R, Saeedi M, Heidary M, Rostamnezhad M. Efficacy of drug regimen with and without oseltamivir in hospitalized patients with COVID-19: A retrospective study. VACUNAS 2022; 24:141-149. [PMID: 36211984 PMCID: PMC9531663 DOI: 10.1016/j.vacun.2022.09.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
Abstract
Introduction Coronavirus disease 2019 (COVID-19) is the most critical issue in nowadays medicine. We aimed to evaluate the use and therapeutic outcomes of oseltamivir, an antiviral drug for patients with COVID-19. Materials and method In an observational study conducted at Imam Khomeini Hospital in Amol, Iran, data for 544 patients with laboratory and CT scan result confirmed COVID-19 were retrospectively collected between February 24th and April 13th 2020. To compare the characteristics of patients based on gender, the chi-square test was used. Logistic regression was used to evaluate the effect of oseltamivir on the outcome of treatment. Logrank test were used to compare the length of hospital stay in people treated with oseltamivir and drugs other than oseltamivir. Results Kaplan–Meier and logrank test showed no significant reduction in hospitalization time and survival rate following treatment with oseltamivir. However, a significant increase in lymphocytes count and reduction of C-reactive protein (CRP) level detected. Conclusion Administration of oseltamivir for patients with COVID-19 didn't show any improvement in hospitalization duration and survival rate.
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Affiliation(s)
- Fazlollah Shokri
- Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Rezapoor
- Department of Radiology, Imam Khomeini Hospital, Amol, Iran
| | - Masoud Najafi
- Medical Technology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran,Radiology and Nuclear Medicine Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Asadi
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Moussa Abolhassani
- International Federation of Inventors' Associations (IFIA), Geneva, Switzerland
| | | | - Amir Muhammad Ashrafi
- Student Research Committee, Amol Faculty of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Narges Gholipour
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Parisa Naderi
- Department of Biology, Faculty of Cellular and Molecular Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Jamshid Yazdani Charati
- Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Science, Sari, Iran
| | - Mohsen Heidary
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran,Corresponding authors
| | - Mostafa Rostamnezhad
- Department of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran,Corresponding authors
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11
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Freire de Melo F, Martins Oliveira Diniz L, Nélio Januário J, Fernando Gonçalves Ferreira J, Dórea RSDM, de Brito BB, Marques HS, Lemos FFB, Silva Luz M, Rocha Pinheiro SL, de Magalhães Queiroz DM. Performance of a serological IgM and IgG qualitative test for COVID-19 diagnosis: An experimental study in Brazil. World J Exp Med 2022; 12:100-103. [PMID: 36196438 PMCID: PMC9526998 DOI: 10.5493/wjem.v12.i5.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/27/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
Qualitative antibody tests are an easy, point-of-care diagnostic method that is useful in diagnosing coronavirus disease 2019, especially in situations where reverse transcription-polymerase chain reaction is negative. However, some factors are able to affect its sensitivity and accuracy, which may contribute to these tests not being used as a first-line diagnostic tool.
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Affiliation(s)
- Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - José Nélio Januário
- Núcleo de Ações e Pesquisa em Apoio Diagnóstico, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil
| | | | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45029-094, Brazil
| | - Fabian Fellipe Bueno Lemos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Marcel Silva Luz
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Samuel Luca Rocha Pinheiro
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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12
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Ahmadi Gohari M, Chegeni M, Haghdoost AA, Mirzaee F, White L, Kostoulas P, Mirzazadeh A, Karamouzian M, Jahani Y, Sharifi H. Excess deaths during the COVID-19 pandemic in Iran. Infect Dis (Lond) 2022; 54:909-917. [PMID: 36121798 DOI: 10.1080/23744235.2022.2122554] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The actual number of deaths during the COVID-19 pandemic is expected to be higher than the reported deaths. We aimed to estimate the number of deaths in Iran during the COVID-19 pandemic from December 22, 2019 to March 20, 2022. METHODS We compared the number of age- and sex-specific deaths reported by Iran's Bureau of Vital Statistics with the predicted deaths estimated using an improved Lee-Carter model. We estimated the number of all-cause excess deaths in three scenarios, including the baseline scenario (without any undercounting of deaths) and 4% and 8% undercounting of all-cause deaths. RESULTS We estimated 282,378 (95% confidence intervals [CI]: 225,439; 341,951) excess deaths in the baseline model. This number was 303,148 (95% CI: 246,417; 357,823) and 308,486 (95% CI: 250,607; 364,417) in the 4% and 8% scenarios, respectively. During the same period, Iran reported 139,610 deaths as being directly related to COVID-19. The ratio of reported COVID-19 deaths to total excess deaths ranged from 45.2% to 49.4% in the various scenarios. Most excess deaths occurred in the baseline scenario in males (157,552 [95% CI: 125,142; 191,265]) and those aged ≥75 years (102,369 [95% CI: 93,894; 111,188]). CONCLUSIONS The reported number of COVID-19 deaths was less than half of Iran's estimated number of excess deaths. The results of this study will be helpful for health policymakers' planning, and call for strengthening the timeliness and accuracy of Iran's death registration systems, planning for more accurate monitoring of epidemics, and planning to provide support services for survivors' families.
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Affiliation(s)
- Milad Ahmadi Gohari
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Chegeni
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
| | - Ali Akbar Haghdoost
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Firoozeh Mirzaee
- Department of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Lisa White
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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13
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Gempeler A, Griswold DP, Rosseau G, Johnson WD, Kaseje N, Kolias A, Hutchinson PJ, Rubiano AM. An Umbrella Review With Meta-Analysis of Chest Computed Tomography for Diagnosis of COVID-19: Considerations for Trauma Patient Management. Front Med (Lausanne) 2022; 9:900721. [PMID: 35957847 PMCID: PMC9360488 DOI: 10.3389/fmed.2022.900721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 12/01/2022] Open
Abstract
Background RT-PCR testing is the standard for diagnosis of COVID-19, although it has its suboptimal sensitivity. Chest computed tomography (CT) has been proposed as an additional tool with diagnostic value, and several reports from primary and secondary studies that assessed its diagnostic accuracy are already available. To inform recommendations and practice regarding the use of chest CT in the in the trauma setting, we sought to identify, appraise, and summarize the available evidence on the diagnostic accuracy of chest CT for diagnosis of COVID-19, and its application in emergency trauma surgery patients; overcoming limitations of previous reports regarding chest CT accuracy and discussing important considerations regarding its role in this setting. Methods We conducted an umbrella review using Living Overview of Evidence platform for COVID-19, which performs regular automated searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and more than 30 other sources. The review was conducted following the JBI methodology for systematic reviews. The Grading of Recommendations, Assessment, Development, and Evaluation approach for grading the certainty of the evidence is reported (registered in International Prospective Register of Systematic Reviews, CRD42020198267). Results Thirty studies that fulfilled selection criteria were included; 19 primary studies provided estimates of sensitivity (0.91, 95%CI = [0.88–0.93]) and specificity (0.73, 95%CI = [0.61; 0.82]) of chest CT for COVID-19. No correlation was found between sensitivities and specificities (ρ = 0.22, IC95% [–0.33; 0.66]). Diagnostic odds ratio was estimated at: DOR = 27.5, 95%CI (14.7; 48.5). Evidence for sensitivity estimates was graded as MODERATE, and for specificity estimates it was graded as LOW. Conclusion The value of chest CT appears to be that of an additional screening tool that can easily detect PCR false negatives, which are reportedly highly frequent. Upon the absence of PCR testing and impossibility to perform RT-PCR in trauma patients, chest CT can serve as a substitute with increased value and easy implementation. Systematic Review Registration [www.crd.york.ac.uk/prospero], identifier [CRD42020198267].
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Affiliation(s)
- Andrés Gempeler
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Dylan P. Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Walter D. Johnson
- School of Medicine and Public Health, Loma Linda University, Loma Linda, CA, United States
| | | | - Angelos Kolias
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter J. Hutchinson
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Andres M. Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia
- Neurological Surgery Service, Vallesalud Clinic, Cali, Colombia
- *Correspondence: Andres M. Rubiano,
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14
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Diagnostic Performance of Antigen Rapid Diagnostic Tests, Chest Computed Tomography, and Lung Point-of-Care-Ultrasonography for SARS-CoV-2 Compared with RT-PCR Testing: A Systematic Review and Network Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12061302. [PMID: 35741112 PMCID: PMC9222155 DOI: 10.3390/diagnostics12061302] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/04/2022] [Accepted: 05/20/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: The comparative performance of various diagnostic methods for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection remains unclear. This study aimed to investigate the comparison of the 3 index test performances of rapid antigen diagnostic tests (RDTs), chest computed tomography (CT), and lung point-of-care-ultrasonography (US) with reverse transcription-polymerase chain reaction (RT-PCR), the reference standard, to provide more evidence-based data on the appropriate use of these index tests. (2) Methods: We retrieved data from electronic literature searches of PubMed, Cochrane Library, and EMBASE from 1 January 2020, to 1 April 2021. Diagnostic performance was examined using bivariate random-effects diagnostic test accuracy (DTA) and Bayesian network meta-analysis (NMA) models. (3) Results: Of the 3992 studies identified in our search, 118 including 69,445 participants met our selection criteria. Among these, 69 RDT, 38 CT, and 15 US studies in the pairwise meta-analysis were included for DTA with NMA. CT and US had high sensitivity of 0.852 (95% credible interval (CrI), 0.791–0.914) and 0.879 (95% CrI, 0.784–0.973), respectively. RDT had high specificity, 0.978 (95% CrI, 0.960–0.996). In accuracy assessment, RDT and CT had a relatively higher than US. However, there was no significant difference in accuracy between the 3 index tests. (4) Conclusions: This meta-analysis suggests that, compared with the reference standard RT-PCR, the 3 index tests (RDTs, chest CT, and lung US) had similar and complementary performances for diagnosis of SARS-CoV-2 infection. To manage and control COVID-19 effectively, future large-scale prospective studies could be used to obtain an optimal timely diagnostic process that identifies the condition of the patient accurately.
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15
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Pence MC, Avdan Aslan A, Tunccan OG, Erbas G. Prognostic value of semi-quantitative CT-based score integrated with cardiovascular risk factors during the first peak of the COVID-19 pandemic: A new score to predict poor outcome. Eur J Radiol 2022; 150:110238. [PMID: 35278978 PMCID: PMC8900877 DOI: 10.1016/j.ejrad.2022.110238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 01/08/2023]
Abstract
Purpose Predicting the clinical course of COVID-19 pneumonia is of high clinical importance and may change treatment strategies. This study aimed to compare the semi-quantitative CT score (radiological score), mCHA2DS2-VASc score (clinical score), and R-mCHA2DS2-VASc score (clinical and radiological score) to predict the risk of ICU admission and mortality in COVID 19 pneumonia. Methods This study retrospectively evaluated 901 COVID-19 pneumonia cases with positive PCR results. The mCHA2DS2-VASc score was calculated based on clinical risk factors. CT images were evaluated, and the semi-quantitative CT scores were obtained. A new scoring method (R-mCHA2DS2-VASc score) was developed by combining these scores. The performance of the mCHA2DS2-VASc score, semi-quantitative CT score, and a combination of these scores (R-mCHA2DS2-VASc score) was evaluated using ROC analysis. Results The ROC curves of the semi-quantitative CT, mCHA2DS2-VASc, and R-mCHA2DS2-VASc scores were examined. The semi-quantitative CT, mCHA2DS2-VASc, and R-mCHA2DS2-VASc scores were significant in predicting intensive care unit (ICU) admission and mortality (p < 0.001). The R-mCHA2DS2-VASc score performed best in predicting a severe clinical course, and the cut-off value of 8 for the R-mCHA2DS2-VASc score had 83.9% sensitivity and 91.6% specificity for mortality. Conclusions The R-mCHA2DS2-VASc score includes both clinical and radiological parameters. It is a feasible scoring method for predicting a severe clinical course at an early stage with high sensitivity and specificity values. However, prospective studies with larger sample sizes are warranted.
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16
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Saad Menezes MC, Santinelli Pestana DV, Ferreira JC, Ribeiro de Carvalho CR, Felix MC, Marcilio IO, da Silva KR, Junior VC, Marchini JF, Alencar JC, Gomez LMG, Mauá DD, Souza HP. Distinct Outcomes in COVID-19 Patients with Positive or Negative RT-PCR Test. Viruses 2022; 14:v14020175. [PMID: 35215772 PMCID: PMC8874612 DOI: 10.3390/v14020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/08/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023] Open
Abstract
Identification of the SARS-CoV-2 virus by RT-PCR from a nasopharyngeal swab sample is a common test for diagnosing COVID-19. However, some patients present clinical, laboratorial, and radiological evidence of COVID-19 infection with negative RT-PCR result(s). Thus, we assessed whether positive results were associated with intubation and mortality. This study was conducted in a Brazilian tertiary hospital from March to August of 2020. All patients had clinical, laboratory, and radiological diagnosis of COVID-19. They were divided into two groups: positive (+) RT-PCR group, with 2292 participants, and negative (−) RT-PCR group, with 706 participants. Patients with negative RT-PCR testing and an alternative most probable diagnosis were excluded from the study. The RT-PCR(+) group presented increased risk of intensive care unit (ICU) admission, mechanical ventilation, length of hospital stay, and 28-day mortality, when compared to the RT-PCR(−) group. A positive SARS-CoV-2 RT-PCR result was independently associated with intubation and 28 day in-hospital mortality. Accordingly, we concluded that patients with a COVID-19 diagnosis based on clinical data, despite a negative RT-PCR test from nasopharyngeal samples, presented more favorable outcomes than patients with positive RT-PCR test(s).
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Affiliation(s)
- Maria Clara Saad Menezes
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
- Correspondence:
| | - Diego Vinicius Santinelli Pestana
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Juliana Carvalho Ferreira
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Carlos Roberto Ribeiro de Carvalho
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Marcelo Consorti Felix
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Izabel Oliva Marcilio
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Katia Regina da Silva
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Vilson Cobello Junior
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Julio Flavio Marchini
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Julio Cesar Alencar
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
| | - Luz Marina Gomez Gomez
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Denis Deratani Mauá
- Institute of Mathematics and Statistics, Universidade de São Paulo, São Paulo 05508-090, Brazil;
| | - Heraldo Possolo Souza
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - Emergency USP COVID-19 Group
- Emergency Medicine Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil; (D.V.S.P.); (L.M.G.G.); (H.P.S.)
| | - HCFMUSP COVID-19 Study Group
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903l, Brazil; (J.C.F.); (C.R.R.d.C.); (M.C.F.); (I.O.M.); (K.R.d.S.); (V.C.J.); (J.F.M.); (J.C.A.)
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17
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Marando M, Tamburello A, Gianella P, Taylor R, Bernasconi E, Fusi-Schmidhauser T. Diagnostic sensitivity of RT-PCR assays on nasopharyngeal specimens for detection of SARS-CoV-2 infection: A Systematic Review and Meta-Analysis. CASPIAN JOURNAL OF INTERNAL MEDICINE 2022; 13:139-147. [PMID: 35872685 PMCID: PMC9272971 DOI: 10.22088/cjim.13.0.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/14/2021] [Accepted: 08/22/2021] [Indexed: 10/31/2022]
Abstract
Background Reverse transcription polymerase chain reaction (RT-PCR) is the current standard of reference in the diagnosis of SARS-CoV-2 infection. In outpatient clinical practice, nasopharyngeal swab RT-PCR testing is still the most common procedure. The purpose of this systematic review and meta-analysis was to evaluate the sensitivity of RT-PCR nasopharyngeal assays. Methods We searched three databases, including PubMed/MEDLINE, EMBASE, and Cochrane Library, using a comprehensive strategy. Studies investigating the sensitivity of SARS-CoV-2 RT-PCR nasopharyngeal assays in adults were included. Two reviewers extracted data and assessed trial quality independently. Pooled sensitivity and its confidence interval were computed using the meta package in R. Results Thirteen studies were found eligible for the inclusion in the systematic review. Out of these, 25 different sub-studies were identified and included in the meta-analysis, which reported the sensitivities of 25 different nasopharyngeal RT-PCR assays. Finally, the overall pooled sensitivity resulted 89% (95% CI, 85.4 to 91.8%). Conclusion Our study suggests that RT-PCR assays on nasopharyngeal specimens have a substantial sensitivity for diagnosing SARS-CoV-2 infection.
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Affiliation(s)
- Marco Marando
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Adriana Tamburello
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Pietro Gianella
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland,Division of Pneumology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Rebecca Taylor
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Enos Bernasconi
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland,Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
| | - Tanja Fusi-Schmidhauser
- Internal Medicine Department, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Switzerland
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18
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Rocha CO, Prioste TAD, Faccin CS, Folador L, Tonetto MS, Knijnik PG, Mainardi NB, Borges RB, Garcia TS. Diagnostic performance of the RSNA-proposed classification for COVID-19 pneumonia versus pre-pandemic controls. Braz J Infect Dis 2021; 26:101665. [PMID: 34958741 PMCID: PMC8683265 DOI: 10.1016/j.bjid.2021.101665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the diagnostic accuracy of the Radiological Society of North America (RSNA) classification system for coronavirus disease 2019 (COVID-19) pneumonia compared to pre-pandemic chest computed tomography (CT) scan images to mitigate the risk of bias regarding the reference standard. Materials and methods This was a retrospective, cross-sectional, diagnostic test accuracy study. Chest CT scans, carried out from May 1 to June 30, 2020, and from May 1 to July 17, 2017, were consecutively selected for the COVID-19 (positive reverse transcription-polymerase chain reaction [RT-PCR] for severe acute respiratory syndrome coronavirus 2 result) and control (pre-pandemic) groups, respectively. Four expert thoracic radiologists blindly interpreted each CT scan image. Sensitivity and specificity were calculated. Results A total of 160 chest CT scan images were included: 79 in the COVID-19 group (56 [43.5–67] years old, 41 men) and 81 in the control group (62 [52–72] years old, 44 men). Typically, an estimated specificity of 98.5% (95% confidence interval [CI] 98.1%–98.4%) was obtained. For the indeterminate classification as a diagnostic threshold, an estimated sensitivity of 88.3% (95% CI 84.7%–91.7%) and a specificity of 79.0% (95% CI 74.5%–83.4%), with an area under the curve of 0.865 (95% CI 0.838–0.895), were obtained. Conclusion The RSNA classification system shows strong diagnostic accuracy for COVID-19 pneumonia, even against pre-pandemic controls. It can be an important aid in clinical decision-making, especially when a typical or indeterminate pattern is found, possibly advising retesting following an initial negative RT-PCR result and streamlining early management and isolation.
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Affiliation(s)
- Cauã O Rocha
- Radiology Department, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil; Graduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul, RS, Brazil.
| | - Tássia A D Prioste
- Radiology Department, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil
| | - Carlo S Faccin
- Radiology Department, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil
| | - Luciano Folador
- Radiology Department, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil
| | - Mateus S Tonetto
- Radiology Department, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil; Graduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Pedro G Knijnik
- School of Medicine, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Natalia B Mainardi
- School of Medicine, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Rogério B Borges
- Biostatistics Unit, Graduate Research Group (GPPG), Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Tiago S Garcia
- Radiology Department, Hospital de Clínicas de Porto Alegre (HCPA), RS, Brazil; Graduate Program in Pulmonary Sciences, Universidade Federal do Rio Grande do Sul, RS, Brazil
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19
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Ebrahimpour L, Marashi M, Zamanian H, Abedi M. Computed tomography findings in 3,557 COVID-19 infected children: a systematic review. Quant Imaging Med Surg 2021; 11:4644-4660. [PMID: 34737930 DOI: 10.21037/qims-20-1410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
Background Although it was assumed in the early stages of the coronavirus disease 2019 (COVID-19) outbreak that the novel coronavirus infection was uncommon among children, the number of infected children has since been increasing significantly. Real-time polymerase chain reaction (RT-PCR) is the gold standard modality for the diagnosis of COVID-19 infection. In adults, chest CT is performed as an adjunct for identifying suspected COVID-19 cases along with patients' management and follow-up. However, CT findings in COVID-19 children studies have shown a diverse incidence of abnormal CT and finding patterns that made CT scan necessity to have remained controversial. The aim of the present review was to comprehensively determine the imaging findings of chest CT scans of confirmed COVID-19-infected pediatric patients through a systematic review of the available published studies. Methods A systematic literature search was performed in the PubMed, Embase, Scopus, and Web of Science core collection databases (four databases including SSCI, SCIE, AHCI, and ESCI) to find original articles containing chest CT findings in children with COVID-19 through May 7, 2021. This review included 81 articles published in English that in total included 3,557 pediatric patients. Results This review included 81 articles published in English that in total included 3,557 pediatric patients. Among the total confirmed coronavirus-infected cases (via RT-PCR test), two-thirds had abnormal chest CT findings; among these patients, 549 (37.8%) had bilateral lung involvement, and 475 (32.7%) had unilateral disease. Regarding the types of lung lesions, ground glass opacities were observed in 794 (54.7%) of patients, and consolidation was observed in 10.2%; moreover, halo sign, discrete pulmonary nodules, interstitial abnormalities or reticulations, and vascular thickening shadows were reported in 7.4%, 2.6%, 9.7% and 1.7% of the patients, respectively. Discussion This review revealed that chest CT scan manifestations in majority of COVID-19 positive children are mild, so regarding the risk of radiation exposure, it is reasonable to confine CT scan to individual cases that its benefits outweigh the risks.
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Affiliation(s)
- Laleh Ebrahimpour
- Department of Radiology, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mahdis Marashi
- Department of Radiology, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hadi Zamanian
- School of Health, Qom University of Medical Sciences, Qom, Iran
| | - Mahboubeh Abedi
- Radiology Department, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kwon YS, Kim JY. Role of chest imaging in the diagnosis and treatment of COVID-19. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.10.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Thousands of new patients are diagnosed with coronavirus disease 2019 (COVID-19) daily worldwide. We reviewed the role of chest imaging in the diagnosis and treatment of patients with COVID-19.Current Concepts: Chest imaging is not recommended as a primary diagnostic tool for COVID-19. However, when real-time polymerase chain reaction is difficult to perform or when COVID-19 is strongly suspected, chest imaging can assist in the diagnosis. Thus, chest imaging is recommended for high-risk patients and patients with worsening respiratory symptoms, but not for asymptomatic patients. Bilateral peripheral pneumonia is a typical imaging finding in patients with COVID-19. However, there are cases where chest imaging shows atypical findings or appears normal. The extent of COVID-19 pneumonia on chest imaging is related to the severity of the disease. The presence and extent of pneumonia on chest imaging can help monitor patients, select appropriate treatment agents, determine whether the patient should be hospitalized, and predict the prognosis.Discussion and Conclusion: Appropriate use of chest imaging is needed for clinicians to help triage patients with COVID-19 and decide on the treatment plan.
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Aldika Akbar MI, Gumilar KE, Tjokroprawiro BA, Ulhaq RA. Successful management of a pregnant woman with COVID-19 and multiple severe complications. BMJ Case Rep 2021; 14:14/9/e243594. [PMID: 34531234 PMCID: PMC8449948 DOI: 10.1136/bcr-2021-243594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We report a case of a 36-year-old gravida 2 para 1 woman at 38 weeks of gestation. A caesarean section was performed for severe pre-eclampsia, intrauterine growth restriction and oligohydramnios. The patient suffered postoperative bleeding, and exploratory laparotomy was performed. Uterine atonia, Couvelaire uterus and left adnexal haematoma were found, requiring a supracervical hysterectomy. As COVID-19 pneumonia and superimposed bacterial infection developed, the patient was mechanically ventilated in the intensive care unit. Remdesivir and meropenem were initially administered, but were changed to levofloxacin and ciprofloxacin following antibiotic sensitivity tests. Blood culture grew Enterococcus galinarum. Meanwhile, bleeding of the incisional wound occurred, which was controlled by the cessation of heparin therapy and regular wound care. With intensive monitoring and multidisciplinary management, the patient’s condition improved, and she was discharged from the hospital on day 25 from admission.
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Affiliation(s)
| | - Khanisyah Erza Gumilar
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
| | | | - Renata Alya Ulhaq
- Midwifery Study Program, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia
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22
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Ruling Out Coronavirus Disease 2019 in Patients with Pneumonia: The Role of Blood Cell Count and Lung Ultrasound. J Clin Med 2021; 10:jcm10163481. [PMID: 34441777 PMCID: PMC8397060 DOI: 10.3390/jcm10163481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a distinctive blood leucocyte pattern and B-lines on lung ultrasound (LUS) as marker of alveolar-interstitial syndrome. We aimed to evaluate the accuracy of blood leucocyte count alone or in combination with LUS for COVID-19 diagnosis. We retrospectively enrolled consecutive patients diagnosed with community acquired pneumonia (CAP) at hospital admission to derive and validate cutoff values for blood cell count that could be predictive of COVID-19 before confirmation by the nucleic acid amplification test (NAAT). Cutoff values, generated and confirmed in inception (41/115, positive/negative patients) and validation (100/180, positive/negative patients) cohorts, were ≤17 and ≤10 cells/mm3 for basophils and eosinophils, respectively. Basophils and/or eosinophils below cutoff were associated with sensitivity of 98% (95%CI, 94–100) and negative likelihood ratio of 0.04 (95%CI, 0.01–0.11). In a subgroup of 265 subjects, the sensitivity of B-line on LUS was 15% lower (p < 0.001) than that of basophils and/or eosinophils below cutoff. The combination of B-lines with basophils and eosinophils below cutoff was associated with a moderate increase of the positive likelihood ratio: 5.0 (95%CI, 3.2–7.7). In conclusion, basophil and eosinophil counts above the generated cutoff virtually rule out COVID-19 in patients with CAP. Our findings can help optimize patient triage pending the NAAT results.
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Ghanei M, Keyvani H, Haghdoost A, Abolghasemi H, Janbabaei G, Reza Jamshidi H, Hosein Ghazale A, Hassan Saadat S, Gholami Fesharaki M, Raei M. The risk factors and related hospitalizations for cases with positive and negative COVID-19 tests: A case-control study. Int Immunopharmacol 2021; 98:107894. [PMID: 34186280 PMCID: PMC8205271 DOI: 10.1016/j.intimp.2021.107894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the risk factors for hospitalizations of cases with positive and negative COVID-19 tests. METHODS In this case-control study, the case and control groups consisted of 292 COVID-19 patients and 296 non-COVID-19 patients. Patients who referred to a reference laboratory in Tehran (Iran) in March 2020 were selected and interviewed. The patients were contacted by telephone and data were recorded through a questionnaire. RESULTS The sample of this study consisted of 588 patients (349 [59%] females, 239 [41%] males) with a mean age of 42 ± 15. The results of this study showed that comorbidities like diabetes (OR = 7.42), hypertension (OR = 4.85), asthma and respiratory diseases (OR = 5.64) in addition to symptoms including fever (OR = 6.67), chills (OR = 11.2), anorexia (OR = 11.3), dyspnea (OR = 4.8), weakness and lethargy (OR = 5.7) were the most predictive variables for hospitalization of non-COVID-19 cases. Furthermore, demographical variables like male gender (OR = 3.71), high age (>50; OR = 3.12), BMI (>25; OR = 2.37), travel (OR = 2.79), comorbidities including diabetes (OR = 5.26), hypertension (OR = 3.7) and underlying immunosuppressant patients receiving corticosteroid therapy (OR = 3.62) in addition to symptoms like anorexia [OR = 2.55] and dyspnea (OR = 6.99) tend to increase the risk of hospital admission in COVID-19 patients, suggesting their predictive values for hospitalization of COVID-19 patients. CONCLUSION Our results indicated that different factors tend to increase the odds of hospital admission in patients with positive and negative COVID-19 tests, suggesting their predictive values for hospitalization.
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Affiliation(s)
- Mostafa Ghanei
- Chemical Injuries Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Hossein Keyvani
- Department of Virology, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Aliakbar Haghdoost
- Associate Professor of Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Abolghasemi
- Chemical Injuries Research Center, Systems Biology and Poisoning Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran; Department of Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ghasem Janbabaei
- Gasterointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Amir Hosein Ghazale
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Hassan Saadat
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiatallah University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Raei
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052621. [PMID: 33807869 PMCID: PMC7967389 DOI: 10.3390/ijerph18052621] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
The pandemic of the coronavirus disease 2019 (COVID-19) has provoked a second pandemic, the "long-haulers", i.e., individuals presenting with post-COVID symptoms. We propose that to determine the presence of post-COVID symptoms, symptoms should appear after the diagnosis of SARS-CoV-2 infection; however, this situation has some problems due to the fact that not all people infected by SARS-CoV-2 receive such diagnosis. Based on relapsing/remitting nature of post-COVID symptoms, the following integrative classification is proposed: potentially infection related-symptoms (up to 4-5 weeks), acute post-COVID symptoms (from week 5 to week 12), long post-COVID symptoms (from week 12 to week 24), and persistent post-COVID symptoms (lasting more than 24 weeks). The most important topic is to establish the time reference points. The classification also integrates predisposing intrinsic and extrinsic factors and hospitalization data which could promote post-COVID symptoms. The plethora of symptoms affecting multiple systems exhibited by "long-haulers" suggests the presence of different underlying mechanisms.
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