Objective:To evaluate the clinical safety and efficacy of Lianhuaqingwen(LHQW)capsules in patients with high-risk common type COVID-19 pneumonia.Methods:A retrospective multicenter study on 383 high-risk common type C...Objective:To evaluate the clinical safety and efficacy of Lianhuaqingwen(LHQW)capsules in patients with high-risk common type COVID-19 pneumonia.Methods:A retrospective multicenter study on 383 high-risk common type COVID-19 pneumonia cases was conducted.Patients were categorized as the standard treatment(SDT)group(n=168)and the LHQW+SDT group(n=215).The primary endpoint was the rate of symptom(fever,fatigue,coughing)recovery and the secondary endpoints included the time to symptom recovery,the proportion of patients with improvement in chest CT images,the proportion of patients with clinical cure,the timing and rate of negative conversion of SARS-CoV-2 RNA assay.Results:The recovery rate was significantly higher in the LHQW+SDT group as compared with the SDT group(89.7%vs.72.0%,P<0.01).The combined use of LHQW+SDT also showed shorter time for symptom recovery,as well as shorter time for individual symptom of fever,fatigue and coughing recovery than use of SDT alone.A higher proportion of patients in the LHQW+SDT group with improvements in chest CT images and clinical cure(77.7%vs.57.1%,P<0.01)but the proportion of patients deteriorating to severe cases(1%vs.25%,P<0.01)in this group was significant lower than those in the SDT group.No significant difference in negative conversion rate of viral assay results was observed(76.8%vs.75.0%,P>0.05).No serious adverse events were reported.Conclusions:LHQW capsules could be recommended to ameliorate clinical symptoms and reduce the rate of deteriorating to severe cases for high-risk common type COVID-19 pneumonia.展开更多
Background: COVID-19 pneumonia increases the risk for pregnant women and the fetuses that often require intensive therapy. In addition to obvious therapeutic targets, ICU staff has to control the psycho-emotional cond...Background: COVID-19 pneumonia increases the risk for pregnant women and the fetuses that often require intensive therapy. In addition to obvious therapeutic targets, ICU staff has to control the psycho-emotional conditions of COVID-19 patients, e.g. intensive care unit syndrome and post-intensive care syndrome. Case presentation: Patient M., Uzbek, 24 years old, gravida 1 (27 weeks) was admitted to the Maternity Department of Zangiota hospital on 19.07.2021 with the diagnosis of extremely severe COVID-19 pneumonia and respiratory failure with psychomotor agitation. On day 4 her general condition deteriorated due to the progression of pneumonia and involvement of abdominal organs associated with 27-week pregnancy. On that day the fetus had no signs of life, and the caesarean delivery was performed;the child was stillborn. For the next two weeks the patient had been in medical coma due to the progression of respiratory and multi-organ failure. The patient had two separate cardiac arrests. Cardio-pulmonary resuscitation was successful. By day 20, the dynamics of her cardiac activity has been completely restored. The brain function restored to 15 on the Glasgow Coma Scale. Conclusion: Special measures of prevention and treatment of multi-organ failure, intensive care unit syndrome and post-intensive care syndrome should be taken in an ICU for pregnant women with COVID-19 pneumonia.展开更多
BACKGROUND The onset symptoms of people infected by Chlamydia psittaci can mimic the coronavirus disease 2019(COVID-19).However,the differences in laboratory tests and imaging features between psittacosis and COVID-19...BACKGROUND The onset symptoms of people infected by Chlamydia psittaci can mimic the coronavirus disease 2019(COVID-19).However,the differences in laboratory tests and imaging features between psittacosis and COVID-19 remain unknown.AIM To better understand the two diseases and then make an early diagnosis and treatment.METHODS Six patients from two institutions confirmed as psittacosis by high-throughput genetic testing and 31 patients confirmed as COVID-19 were retrospectively included.The epidemiology,clinical characteristics,laboratory tests and computed tomography(CT)imaging features were collected and compared between the two groups.The follow-up CT imaging findings of patients with psittacosis were also investigated.RESULTS The white blood cell count(WBC),neutrophil count and calcium were more likely to be decreased in patients with COVID-19 but were increased in patients with psittacosis(all P=0.000).Lymphocyte count and platelet count were higher in patients with psittacosis than in those with COVID-19(P=0.044,P=0.035,respectively).Lesions in patients with psittacosis were more likely to be unilateral(P=0.001),involve fewer lung lobes(P=0.006)and have pleural effusions(P=0.002).Vascular enlargement was more common in patients with COVID-19(P=0.003).Consolidation in lung CT images was absorbed in all 6 patients.CONCLUSION Psittacosis has the potential for human-to-human transmission.Patients with psittacosis present increased WBC count and neutrophil count and have specific CT imaging findings,including unilateral distribution,less involvement of lung lobes and pleural effusions,which might help us to differentiate it from COVID-19.展开更多
BACKGROUND Pneumonia is the main manifestation of coronavirus disease 2019(COVID-19)infection.Chest computed tomography is recommended for the initial evaluation of the disease;this technique can also be helpful to mo...BACKGROUND Pneumonia is the main manifestation of coronavirus disease 2019(COVID-19)infection.Chest computed tomography is recommended for the initial evaluation of the disease;this technique can also be helpful to monitor the disease progression and evaluate the therapeutic efficacy.AIM To review the currently available literature regarding the radiological follow-up of COVID-19-related lung alterations using the computed tomography scan,to describe the evidence about the dynamic evolution of COVID-19 pneumonia and verify the potential usefulness of the radiological follow-up.METHODS We used pertinent keywords on PubMed to select relevant studies;the articles we considered were published until October 30,2020.Through this selection,69 studies were identified,and 16 were finally included in the review.RESULTS Summarizing the included works’findings,we identified well-defined stages in the short follow-up time frame.A radiographic deterioration reaching a peak roughly within the first 2 wk;after the peak,an absorption process and repairing signs are observed.At later radiological follow-up,with the limitation of little evidence available,the lesions usually did not recover completely.CONCLUSION Following computed tomography scan evolution over time could help physicians better understand the clinical impact of COVID-19 pneumonia and manage the possible sequelae;a longer follow-up is advisable to verify the complete resolution or the presence of long-term damage.展开更多
Objective:To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia.Methods:We conduct...Objective:To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia.Methods:We conducted a single-centre retrospective cohort study on hospitalised patients with clinical,epidemiological,and/or radiologically confirmed and suspected COVID-19 at Bitlis Tatvan State Hospital in Turkey between December 1,2020 and June 1,2021.All data of the study participants were recorded,and all patients received intravenous high-dose corticosteroid pulse therapy.The Ordinal Scale for Clinical Improvement(OSCI),Charlson Comorbidity Index and Total Severity Score were calculated.Univariate and multivariate Cox regression models were performed to evaluate the clinical and laboratory parameters that may affect the 28-day mortality.Results:A total of 126 patients were included in the analysis.The 28-day mortality rate of the patients was 22.2%.Laboratory and clinical improvement were observed in 77.8%(98/126)of patients after high-dose corticosteroid pulse therapy.There was a statistically significant difference between the survivors and non-survivors in terms of age,platelet count,neutrophil/lymphocyte ratio,and OSCI,Charlson Comorbidity Index,and Total Severity Score(P<0.001).Multivariate Cox regression analysis revealed that age[HR 1.047(95%CI 1.01-1.08)],use of prophylactic anticoagulation[HR 0.838(95%CI 0.79-0.89)],and bacterial co-infection[HR 3.966(95%CI 1.40-11.21)]were significant determinants of mortality.Early C-reactive protein(CRP)response,decreased oxygen requirement,and improving respiratory rate/OSCI scores after administration of high-dose corticosteroid pulse therapy could contribute to clinical improvement.Conclusions:CRP response,needed oxygen and OSCI scores can be used as prognostic factors to select patients who will benefit from high-dose corticosteroid pulse therapy.展开更多
BACKGROUND Since December 2019,an outbreak of pneumonia caused by severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)has led to a life-threatening ongoing pandemic worldwide.A retrospective study by Chow et al...BACKGROUND Since December 2019,an outbreak of pneumonia caused by severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)has led to a life-threatening ongoing pandemic worldwide.A retrospective study by Chow et al showed aspirin use was associated with decreased intensive care unit(ICU)admissions in hospitalized coronavirus disease 2019(COVID-19)patients.Recently,the RECOVERY TRIAL showed no associated reductions in the 28-d mortality or the progression to mechanical ventilation of such patients.With these conflicting findings,our study was aimed at evaluating the impact of daily aspirin intake on the outcome of COVID-19 patients.AIM To study was aimed at evaluating the impact of daily aspirin intake on the outcome of COVID-19 patients.METHODS This retrospective cohort study was conducted on 125 COVID-19 positive patients.Subgroup analysis to evaluate the association of demographics and comorbidities was undertaken.The impact of chronic aspirin use was assessed on the survival outcomes,need for mechanical ventilation,and progression to ICU.Variables were evaluated using the chi-square test and multinomial logistic regression analysis.RESULTS 125 patients were studied,30.40%were on daily aspirin,and 69.60%were not.Cross-tabulation of the clinical parameters showed that hypertension(P=0.004),hyperlipidemia(0.016),and diabetes mellitus(P=0.022)were significantly associated with aspirin intake.Regression analysis for progression to the ICU,need for mechanical ventilation and survival outcomes against daily aspirin intake showed no statistical significance.CONCLUSION Our study suggests that daily aspirin intake has no protective impact on COVID-19 illnessassociated survival outcomes,mechanical ventilation,or progression to ICU level of care.展开更多
Under the epidemic situation of novel COVID-19 pneumonia, pregnant women belong to the susceptible population, and their physiological and psychological conditions are particularly worthy of attention. Diabetes patien...Under the epidemic situation of novel COVID-19 pneumonia, pregnant women belong to the susceptible population, and their physiological and psychological conditions are particularly worthy of attention. Diabetes patients during pregnancy may have a variety of complications, which can have a serious adverse impact on their own and fetal health. This article elaborates on home protection and diet and exercise guidance for pregnant women with diabetes in order to provide guidance for pregnant women with diabetes in a special period, and further prevent and control the pneumonia epidemic caused by novel COVID-19 infection in pregnant women.展开更多
Aims:During the COVID-19 epidemic,chest computed tomography(CT)has been highly recommended for screen-ing of patients with suspected COVID-19 because of an unclear contact history,overlapping clinical features,and an ...Aims:During the COVID-19 epidemic,chest computed tomography(CT)has been highly recommended for screen-ing of patients with suspected COVID-19 because of an unclear contact history,overlapping clinical features,and an overwhelmed health system.However,there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.Methods:Patients with heart failure(n=23)or COVID-19 pneumonia(n=23)and one patient with both diseases were retrospectively enrolled.Clinical information and chest CT images were obtained and analyzed.Results:There was no difference in ground-glass opacity,consolidation,crazy paving pattern,the lobes affected,and septal thickening between heart failure and COVID-19 pneumonia.However,a less rounded morphology(4%vs.70%,P=0.00092),more peribronchovascular thickening(70%vs.35%,P=0.018)and fi ssural thickening(43%vs.4%,P=0.002),and less peripheral distribution(30%vs.87%,P=0.00085)were found in the heart failure group than in the COVID-19 group.Importantly,there were also more patients with upper pulmonary vein enlargement(61%vs.4%,P=0.00087),subpleural effusion(50%vs.0%,P=0.00058),and cardiac enlargement(61%vs.4%,P=0.00075)in the heart failure group than in the COVID-19 group.Besides,more fi brous lesions were found in the COVID-19 group,although there was no statistical difference(22%vs.4%,P=0.080).Conclusions:Although there is some overlap of CT features between heart failure and COVID-19,CT is still a useful tool for differentiating COVID-19 pneumonia.展开更多
The coronavirus disease 2019(COVID-19)global pandemic can be a severe illness that leads to morbidity and mortality.With the increasing number of COVID-19 pneumonia survivors,several long-term changes may persist,incl...The coronavirus disease 2019(COVID-19)global pandemic can be a severe illness that leads to morbidity and mortality.With the increasing number of COVID-19 pneumonia survivors,several long-term changes may persist,including abnormal imaging of lung parenchyma.In addition to the clinical course,it is vital to follow up on pulmonary imaging during the post-infectious period,which is not routinely required in other common pulmonary diagnoses.Computed tomography(CT)scan of the chest is an effective and diagnostic tool for pneumonia which gives an insight into structural abnormalities within the lungs,complications,and possible progression of the disease.Several studies have monitored COVID-19 pneumonia and its complications using serial CT chest imaging from the initial phase of infection,hospitalization,and post-discharge.Nonetheless,long-term follow-up imaging data in post-COVID-19 is still limited.We have summarized the findings utilizing a systematic review of the literature regarding COVID-19 pneumonia imaging,including long-term follow-up.展开更多
BACKGROUND Diabetes mellitus is considered a leading contributor to severe coronavirus disease 2019(COVID-19).AIM To characterize differences between hospitalized diabetic patients with vs without COVID-19,and paramet...BACKGROUND Diabetes mellitus is considered a leading contributor to severe coronavirus disease 2019(COVID-19).AIM To characterize differences between hospitalized diabetic patients with vs without COVID-19,and parameters associated with COVID-19 severity for prediction.METHODS This case-control study included 209 patients with type 2 diabetic mellitus hospitalized at the Galilee Medical Center(Nahariya,Israel)and recruited between September 2020 and May 2021,65 patients with COVID-19 infection in dedicated wards and 144 COVID-19-negative patients in internal medicine wards hospitalized due to other reasons.Clinical parameters-including age,type of antiglycemic medications,presence of retinopathy,smoking history,body mass index(BMI),glycosylated hemoglobin,maximum neutrophil:lymphocyte ratio(NLR_(max)),C-reactive protein(CRP),estimated glomerular filtration rate(eGFR),and albumin(blood and urine)-were compared between the two primary patient groups,and then between COVID-19-negative patients hospitalized due to infectious vs non-infectious disease.Finally,we explored which parameters were associated with severe COVID-19 pneumonia.RESULTS COVID-19-negative patients were older(63.9±9.9 vs 59.8±9.2,P=0.005),and had longer duration of diabetes(P=0.031),lower eGFR(P=0.033),higher albumin(P=0.026),lower CRP(P<0.001),greater smoking prevalence(P<0.001),and more baseline albuminuria(54.9%vs 30.8%,P=0.005)at admission;70%of COVID-19 patients with albuminuria had moderate-range albuminuria(albumin:creatinine 30-300 mg/g).Most of the patients with albuminuria had chronic kidney disease stage II(CKD II).Oral antiglycemic therapies were not significantly different between the two groups.Multivariable logistic regression showed that higher BMI was significantly associated with severe COVID-19(OR 1.24,95%CI:1.01-1.53,P=0.04),as was higher NLR_(max)(OR 1.2,95%CI:1.06-1.37,P=0.005).Surprisingly,pre-hospitalization albuminuria,mostly moderate-range,was associated with reduced risk(OR 0.09,95%CI:0.01-0.62,P=0.015).Moderate-range albuminuria was not associated with bacterial infections.CONCLUSION Moderate-range albuminuria in COVID-19-positive diabetic patients with CKD II is associated with less severe COVID-19.Further studies should explore this potential biomarker for risk of COVID-19-related deterioration and early interventions.展开更多
BACKGROUND Procalcitonin(Pct)is a common biomarker in clinical practice,especially in the era of coronavirus disease 2019(COVID-19)infection.Although it is frequently used for the diagnosis and prognostication of bact...BACKGROUND Procalcitonin(Pct)is a common biomarker in clinical practice,especially in the era of coronavirus disease 2019(COVID-19)infection.Although it is frequently used for the diagnosis and prognostication of bacterial infections or sepsis,it is also elevated in a few other conditions,including medullary thyroid carcinoma(MTC).CASE SUMMARY A 43-year-old female presented with moderately severe COVID-19 pneumonia in April 2021.She gradually recovered clinically;however,despite normalization of other inflammatory markers,Pct levels remained persistently elevated.Further workup identified the cause as left lobe MTC with locoregional metastasis.Calcitonin levels were high,and carcinoembryonic antigen levels were normal.The patient underwent total thyroidectomy and neck dissection,which was followed by another radical neck dissection due to residual disease.Currently,she is doing well,nearly having completed her course of external beam radiotherapy with no recurrence.Pct is well documented as a screening tool for MTC,especially because of its stable nature compared to calcitonin in the community settings.It is important to keep in mind the differential diagnosis of MTC in patients with persistently elevated Pct levels despite normal levels of other acute phase reactants.To the best of our knowledge,this is the first report from Asia of such an incidental diagnosis of MTC due to persistently elevated Pct levels in a patient with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.CONCLUSION Persistently elevated Pct levels can occur in any pro-inflammatory state including infections,sepsis,or acute respiratory distress syndrome.In the current setting,SARS-CoV-2 infection is one such clinical scenario,and in rare situations of persistent elevation,MTC may need to be ruled out.展开更多
The early implementation of treatment therapies necessitates the swift and precise identification of COVID-19 pneumonia by the analysis of chest CT scans.This study aims to investigate the indispensable need for preci...The early implementation of treatment therapies necessitates the swift and precise identification of COVID-19 pneumonia by the analysis of chest CT scans.This study aims to investigate the indispensable need for precise and interpretable diagnostic tools for improving clinical decision-making for COVID-19 diagnosis.This paper proposes a novel deep learning approach,called Conformer Network,for explainable discrimination of viral pneumonia depending on the lung Region of Infections(ROI)within a single modality radiographic CT scan.Firstly,an efficient U-shaped transformer network is integrated for lung image segmentation.Then,a robust transfer learning technique is introduced to design a robust feature extractor based on pre-trained lightweight Big Transfer(BiT-L)and finetuned on medical data to effectively learn the patterns of infection in the input image.Secondly,this work presents a visual explanation method to guarantee clinical explainability for decisions made by Conformer Network.Experimental evaluation of real-world CT data demonstrated that the diagnostic accuracy of ourmodel outperforms cutting-edge studies with statistical significance.The Conformer Network achieves 97.40% of detection accuracy under cross-validation settings.Our model not only achieves high sensitivity and specificity but also affords visualizations of salient features contributing to each classification decision,enhancing the overall transparency and trustworthiness of our model.The findings provide obvious implications for the ability of our model to empower clinical staff by generating transparent intuitions about the features driving diagnostic decisions.展开更多
BACKGROUND A series of recent cases of pneumonia in Wuhan,Hubei Province,China,was caused by the 2019 novel coronavirus[2019-nCoV,also called severe acute respiratory syndrome(SARS)-CoV-2].The World Health Organizatio...BACKGROUND A series of recent cases of pneumonia in Wuhan,Hubei Province,China,was caused by the 2019 novel coronavirus[2019-nCoV,also called severe acute respiratory syndrome(SARS)-CoV-2].The World Health Organization officially named the disease as coronavirus disease 2019(COVID-19).With the global spread of COVID-19,similar cases have appeared in other areas of China,and there are a few reports of pediatric patients with COVID-19 pneumonia.CASE SUMMARY A 7-year-old girl was diagnosed with COVID-19 and presented with irregular fever,sore throat and diarrhea.Chest computed tomography revealed patchy consolidation and ground-glass opacities in multiple areas.The lesions were mainly distributed in the bronchial bundles or subpleural areas of both lungs,particularly in the right lower lobe.The patient also presented with diarrhea,mild kidney injury,and live coronavirus was found in her feces.She was given antiviral agents(lopinavir and ritonavir),and follow-up detection showed that these abnormalities were markedly decreased within 3 d.CONCLUSION The clinical symptoms and prognosis of COVID-19 in pediatric patients may be different from those in adult patients,and the fecal–oral transmission of SARSCoV-2 should be considered.展开更多
Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 20...Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.Methods:After obtaining approval from the Hospital Director,the data of COVID-19 patients including demographics,type of respiratory support(non-invasive ventilation or invasive ventilation),duration of ventilation,length of stay,discharge,and death were collected and analyzed.Results:Out of the 152 patients identified,134 patients were analyzed.The median intubation days were 10.0(Q1:3.5,Q3:13.5)in the IV group and 0.0(Q1:0.0,Q3:0.0)days in the NIV-only group.Out of the 101 patients who received NIV,43 patients were subsequently intubated due to failure of NIV.Of the 63 patients(47.01%)who died,22(66.66%)were from the IV group and 40(92.02%)were from the NIV-followed-by-intubation group,and 1(1.72%)were from the NIV-only group.Multivariate analysis showed that the presence of a respiratory comorbidity(OR=16.56,95%CI=1.56-175.48,P=0.02)was an independent predictor of survival.Conclusions:Respiratory co-morbidity is a significant adverse predictor of survival outcome.The decision on the type of respiratory support should be made on a patient-to-patient basis.展开更多
Coronavirus disease 2019(COVID-19)was first discovered after unusual cases of severe pneumonia emerged by the end of 2019 in Wuhan(China)and was declared a global public health emergency by the World Health Organizati...Coronavirus disease 2019(COVID-19)was first discovered after unusual cases of severe pneumonia emerged by the end of 2019 in Wuhan(China)and was declared a global public health emergency by the World Health Organization in January 2020.The new pathogen responsible for the infection,genetically similar to the beta-coronavirus family,is known as severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),and the current gold standard diagnostic tool for its detection in respiratory samples is the reverse transcription-polymerase chain reaction test.Imaging findings on COVID-19 have been widely described in studies published throughout last year,2020.In general,ground-glass opacities and consolidations,with a bilateral and peripheral distribution,are the most typical patterns found in COVID-19 pneumonia.Even though much of the literature focuses on chest computed tomography(CT)and X-ray imaging and their findings,other imaging modalities have also been useful in the assessment of COVID-19 patients.Lung ultrasonography is an emerging technique with a high sensitivity,and thus useful in the initial evaluation of SARS-CoV-2 infection.In addition,combined positron emission tomography-CT enables the identification of affected areas and follow-up treatment responses.This review intends to clarify the role of the imaging modalities available and identify the most common radiological manifestations of COVID-19.展开更多
BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible...BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.展开更多
Background: Diabetes is a known risk factor for susceptibility and severity of COVID-19 infection. It may also be a complication of COVID-19. Many hypotheses have been proposed to explain this condition. It may be due...Background: Diabetes is a known risk factor for susceptibility and severity of COVID-19 infection. It may also be a complication of COVID-19. Many hypotheses have been proposed to explain this condition. It may be due to the effect of SARS-CoV-2 on β cells or drug-related side effects. In children, there is a paucity of data on the burden of this complication. Objective: We aimed to report a case of secondary diabetes during COVID-19 in a pediatric unit. Case Presentation: A 16-year-old girl presented with severe respiratory distress. She was treated for COVID-19 infection with antibiotics and corticosteroids. On day 6 of treatment, she developed polyuria and polydipsia. A random blood glucose test showed hyperglycaemia. The diagnosis of secondary diabetes was maintained. Conclusion: Covid-19 infection can be complicated by diabetes in children. It is essential to monitor blood glucose levels regularly.展开更多
Objective:To validate a better scoring system between CURB-65 and the pneumonia severity index(PSI)to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.Methods...Objective:To validate a better scoring system between CURB-65 and the pneumonia severity index(PSI)to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.Methods:A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota,Rajasthan.Relevant data about history,and general and systemic examination with laboratory investigations was collected.Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI.Sensitivity,specificity,positive predictive value,negative predictive value,and area under the curve were calculated.Continuous variables,means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data.Results:100 patients who tested positive for SARS-CoV-2 by RT-PCR were included;67 were male and 33 were female.58 patients had severe disease(SpO2≤90%)and 30 patients died.CURB-65 had an area under the curve(AUC)of 0.81 for predicting ICU admission,with a sensitivity of 92%and a specificity of 54%for high risk patients.Meanwhile,PSI had an AUC of 0.88,with a sensitivity of 83%and a specificity of 73%in high risk patients.In addition,CURB-65 had an AUC of 0.79 for predicting 30-day mortality,with a sensitivity of 60%and a specificity of 89%in high risk patients.PSI had an AUC of 0.71 for predicting 30-day mortality,with a sensitivity of 90%and a specificity of 46%in high risk patients.Conclusions:This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality.However,PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.展开更多
Objective: To describe the CT findings and clinico-epidemiological aspects of coronavirus pulmonary lesions at the Radiology Department of Mother-Child Luxembourg’s Hospital in Bamako, West Africa. Materials and Meth...Objective: To describe the CT findings and clinico-epidemiological aspects of coronavirus pulmonary lesions at the Radiology Department of Mother-Child Luxembourg’s Hospital in Bamako, West Africa. Materials and Method: This was a cross-sectional descriptive study over a period of three months (November 2020-January 2021). The study involved all patients with a clinical suspicion of COVID-19 or confirmed cases with suggestive CT scan lesions during this period. No patients without suggestive CT lesions were not included. The variables were age, sex, clinical data, lungs lesions on CT scan and their severity. Results: Out of 202 patients enlisted, the age group 52 - 63 years was more frequent (30.2%), i.e. an average age of 60.43 years (range 23 and 95 years). Men represented 56.4% or a sex ratio of 1.3. Cough was the most common clinical manifestations (26.7%). Major findings were mixed appearance of the lung lesions (45.5%). The peripheral distribution was 57.4% and the bilateral topography was 98%. These lesions were extensive in the majority of our patients with 28.2%. Conclusion: Older people dominated the socio-demographic profile of our series with a predominance of men. Cough was the most observed clinical information. Mixed lesions with peripheral and bilateral distribution dominated the semiological tomodensitometric aspects. By severity, extensive lung lesions were the most commonly observed.展开更多
Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases ar...Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.展开更多
基金This project was supported by the Education Department of Hainan Province(grant No.:Hnky2022ZD-11)Hainan Provincial Natural Science Foundation of China(grant No.:822MS176)+1 种基金Hainan Provincial Natural Science Foundation of China(grant No.:GHYF2022011,ZDKJ2021036,ZDYF2020223 and 820CXTD448)the National Natural Science Foundation of China(grant No.82160012,82260001).
文摘Objective:To evaluate the clinical safety and efficacy of Lianhuaqingwen(LHQW)capsules in patients with high-risk common type COVID-19 pneumonia.Methods:A retrospective multicenter study on 383 high-risk common type COVID-19 pneumonia cases was conducted.Patients were categorized as the standard treatment(SDT)group(n=168)and the LHQW+SDT group(n=215).The primary endpoint was the rate of symptom(fever,fatigue,coughing)recovery and the secondary endpoints included the time to symptom recovery,the proportion of patients with improvement in chest CT images,the proportion of patients with clinical cure,the timing and rate of negative conversion of SARS-CoV-2 RNA assay.Results:The recovery rate was significantly higher in the LHQW+SDT group as compared with the SDT group(89.7%vs.72.0%,P<0.01).The combined use of LHQW+SDT also showed shorter time for symptom recovery,as well as shorter time for individual symptom of fever,fatigue and coughing recovery than use of SDT alone.A higher proportion of patients in the LHQW+SDT group with improvements in chest CT images and clinical cure(77.7%vs.57.1%,P<0.01)but the proportion of patients deteriorating to severe cases(1%vs.25%,P<0.01)in this group was significant lower than those in the SDT group.No significant difference in negative conversion rate of viral assay results was observed(76.8%vs.75.0%,P>0.05).No serious adverse events were reported.Conclusions:LHQW capsules could be recommended to ameliorate clinical symptoms and reduce the rate of deteriorating to severe cases for high-risk common type COVID-19 pneumonia.
文摘Background: COVID-19 pneumonia increases the risk for pregnant women and the fetuses that often require intensive therapy. In addition to obvious therapeutic targets, ICU staff has to control the psycho-emotional conditions of COVID-19 patients, e.g. intensive care unit syndrome and post-intensive care syndrome. Case presentation: Patient M., Uzbek, 24 years old, gravida 1 (27 weeks) was admitted to the Maternity Department of Zangiota hospital on 19.07.2021 with the diagnosis of extremely severe COVID-19 pneumonia and respiratory failure with psychomotor agitation. On day 4 her general condition deteriorated due to the progression of pneumonia and involvement of abdominal organs associated with 27-week pregnancy. On that day the fetus had no signs of life, and the caesarean delivery was performed;the child was stillborn. For the next two weeks the patient had been in medical coma due to the progression of respiratory and multi-organ failure. The patient had two separate cardiac arrests. Cardio-pulmonary resuscitation was successful. By day 20, the dynamics of her cardiac activity has been completely restored. The brain function restored to 15 on the Glasgow Coma Scale. Conclusion: Special measures of prevention and treatment of multi-organ failure, intensive care unit syndrome and post-intensive care syndrome should be taken in an ICU for pregnant women with COVID-19 pneumonia.
基金the National Natural Science Foundation of China,No.82102157Hunan Provincial Natural Science Foundation of China,No.2021JJ40895+1 种基金the Science and Technology Innovation Program of Hunan Province,No.2020SK53423the Clinical Research Center For Medical Imaging in Hunan Province,No.2020SK4001.
文摘BACKGROUND The onset symptoms of people infected by Chlamydia psittaci can mimic the coronavirus disease 2019(COVID-19).However,the differences in laboratory tests and imaging features between psittacosis and COVID-19 remain unknown.AIM To better understand the two diseases and then make an early diagnosis and treatment.METHODS Six patients from two institutions confirmed as psittacosis by high-throughput genetic testing and 31 patients confirmed as COVID-19 were retrospectively included.The epidemiology,clinical characteristics,laboratory tests and computed tomography(CT)imaging features were collected and compared between the two groups.The follow-up CT imaging findings of patients with psittacosis were also investigated.RESULTS The white blood cell count(WBC),neutrophil count and calcium were more likely to be decreased in patients with COVID-19 but were increased in patients with psittacosis(all P=0.000).Lymphocyte count and platelet count were higher in patients with psittacosis than in those with COVID-19(P=0.044,P=0.035,respectively).Lesions in patients with psittacosis were more likely to be unilateral(P=0.001),involve fewer lung lobes(P=0.006)and have pleural effusions(P=0.002).Vascular enlargement was more common in patients with COVID-19(P=0.003).Consolidation in lung CT images was absorbed in all 6 patients.CONCLUSION Psittacosis has the potential for human-to-human transmission.Patients with psittacosis present increased WBC count and neutrophil count and have specific CT imaging findings,including unilateral distribution,less involvement of lung lobes and pleural effusions,which might help us to differentiate it from COVID-19.
文摘BACKGROUND Pneumonia is the main manifestation of coronavirus disease 2019(COVID-19)infection.Chest computed tomography is recommended for the initial evaluation of the disease;this technique can also be helpful to monitor the disease progression and evaluate the therapeutic efficacy.AIM To review the currently available literature regarding the radiological follow-up of COVID-19-related lung alterations using the computed tomography scan,to describe the evidence about the dynamic evolution of COVID-19 pneumonia and verify the potential usefulness of the radiological follow-up.METHODS We used pertinent keywords on PubMed to select relevant studies;the articles we considered were published until October 30,2020.Through this selection,69 studies were identified,and 16 were finally included in the review.RESULTS Summarizing the included works’findings,we identified well-defined stages in the short follow-up time frame.A radiographic deterioration reaching a peak roughly within the first 2 wk;after the peak,an absorption process and repairing signs are observed.At later radiological follow-up,with the limitation of little evidence available,the lesions usually did not recover completely.CONCLUSION Following computed tomography scan evolution over time could help physicians better understand the clinical impact of COVID-19 pneumonia and manage the possible sequelae;a longer follow-up is advisable to verify the complete resolution or the presence of long-term damage.
文摘Objective:To assess the effectiveness of high-dose corticosteroid pulse therapy and evaluate possible factors associated with 28-day mortality in hospitalised patients with severe COVID-19 pneumonia.Methods:We conducted a single-centre retrospective cohort study on hospitalised patients with clinical,epidemiological,and/or radiologically confirmed and suspected COVID-19 at Bitlis Tatvan State Hospital in Turkey between December 1,2020 and June 1,2021.All data of the study participants were recorded,and all patients received intravenous high-dose corticosteroid pulse therapy.The Ordinal Scale for Clinical Improvement(OSCI),Charlson Comorbidity Index and Total Severity Score were calculated.Univariate and multivariate Cox regression models were performed to evaluate the clinical and laboratory parameters that may affect the 28-day mortality.Results:A total of 126 patients were included in the analysis.The 28-day mortality rate of the patients was 22.2%.Laboratory and clinical improvement were observed in 77.8%(98/126)of patients after high-dose corticosteroid pulse therapy.There was a statistically significant difference between the survivors and non-survivors in terms of age,platelet count,neutrophil/lymphocyte ratio,and OSCI,Charlson Comorbidity Index,and Total Severity Score(P<0.001).Multivariate Cox regression analysis revealed that age[HR 1.047(95%CI 1.01-1.08)],use of prophylactic anticoagulation[HR 0.838(95%CI 0.79-0.89)],and bacterial co-infection[HR 3.966(95%CI 1.40-11.21)]were significant determinants of mortality.Early C-reactive protein(CRP)response,decreased oxygen requirement,and improving respiratory rate/OSCI scores after administration of high-dose corticosteroid pulse therapy could contribute to clinical improvement.Conclusions:CRP response,needed oxygen and OSCI scores can be used as prognostic factors to select patients who will benefit from high-dose corticosteroid pulse therapy.
基金The study was reviewed and approved by the Saint Vincent-MetroWest Medical Center Institutional Review Board[(Approval No.2020-072)].
文摘BACKGROUND Since December 2019,an outbreak of pneumonia caused by severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2)has led to a life-threatening ongoing pandemic worldwide.A retrospective study by Chow et al showed aspirin use was associated with decreased intensive care unit(ICU)admissions in hospitalized coronavirus disease 2019(COVID-19)patients.Recently,the RECOVERY TRIAL showed no associated reductions in the 28-d mortality or the progression to mechanical ventilation of such patients.With these conflicting findings,our study was aimed at evaluating the impact of daily aspirin intake on the outcome of COVID-19 patients.AIM To study was aimed at evaluating the impact of daily aspirin intake on the outcome of COVID-19 patients.METHODS This retrospective cohort study was conducted on 125 COVID-19 positive patients.Subgroup analysis to evaluate the association of demographics and comorbidities was undertaken.The impact of chronic aspirin use was assessed on the survival outcomes,need for mechanical ventilation,and progression to ICU.Variables were evaluated using the chi-square test and multinomial logistic regression analysis.RESULTS 125 patients were studied,30.40%were on daily aspirin,and 69.60%were not.Cross-tabulation of the clinical parameters showed that hypertension(P=0.004),hyperlipidemia(0.016),and diabetes mellitus(P=0.022)were significantly associated with aspirin intake.Regression analysis for progression to the ICU,need for mechanical ventilation and survival outcomes against daily aspirin intake showed no statistical significance.CONCLUSION Our study suggests that daily aspirin intake has no protective impact on COVID-19 illnessassociated survival outcomes,mechanical ventilation,or progression to ICU level of care.
文摘Under the epidemic situation of novel COVID-19 pneumonia, pregnant women belong to the susceptible population, and their physiological and psychological conditions are particularly worthy of attention. Diabetes patients during pregnancy may have a variety of complications, which can have a serious adverse impact on their own and fetal health. This article elaborates on home protection and diet and exercise guidance for pregnant women with diabetes in order to provide guidance for pregnant women with diabetes in a special period, and further prevent and control the pneumonia epidemic caused by novel COVID-19 infection in pregnant women.
基金supported by a grant from the National Natural Science Foundation of China projects 81600248(to Z.Zhu)and 81670269(to S.Zhou).
文摘Aims:During the COVID-19 epidemic,chest computed tomography(CT)has been highly recommended for screen-ing of patients with suspected COVID-19 because of an unclear contact history,overlapping clinical features,and an overwhelmed health system.However,there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.Methods:Patients with heart failure(n=23)or COVID-19 pneumonia(n=23)and one patient with both diseases were retrospectively enrolled.Clinical information and chest CT images were obtained and analyzed.Results:There was no difference in ground-glass opacity,consolidation,crazy paving pattern,the lobes affected,and septal thickening between heart failure and COVID-19 pneumonia.However,a less rounded morphology(4%vs.70%,P=0.00092),more peribronchovascular thickening(70%vs.35%,P=0.018)and fi ssural thickening(43%vs.4%,P=0.002),and less peripheral distribution(30%vs.87%,P=0.00085)were found in the heart failure group than in the COVID-19 group.Importantly,there were also more patients with upper pulmonary vein enlargement(61%vs.4%,P=0.00087),subpleural effusion(50%vs.0%,P=0.00058),and cardiac enlargement(61%vs.4%,P=0.00075)in the heart failure group than in the COVID-19 group.Besides,more fi brous lesions were found in the COVID-19 group,although there was no statistical difference(22%vs.4%,P=0.080).Conclusions:Although there is some overlap of CT features between heart failure and COVID-19,CT is still a useful tool for differentiating COVID-19 pneumonia.
文摘The coronavirus disease 2019(COVID-19)global pandemic can be a severe illness that leads to morbidity and mortality.With the increasing number of COVID-19 pneumonia survivors,several long-term changes may persist,including abnormal imaging of lung parenchyma.In addition to the clinical course,it is vital to follow up on pulmonary imaging during the post-infectious period,which is not routinely required in other common pulmonary diagnoses.Computed tomography(CT)scan of the chest is an effective and diagnostic tool for pneumonia which gives an insight into structural abnormalities within the lungs,complications,and possible progression of the disease.Several studies have monitored COVID-19 pneumonia and its complications using serial CT chest imaging from the initial phase of infection,hospitalization,and post-discharge.Nonetheless,long-term follow-up imaging data in post-COVID-19 is still limited.We have summarized the findings utilizing a systematic review of the literature regarding COVID-19 pneumonia imaging,including long-term follow-up.
文摘BACKGROUND Diabetes mellitus is considered a leading contributor to severe coronavirus disease 2019(COVID-19).AIM To characterize differences between hospitalized diabetic patients with vs without COVID-19,and parameters associated with COVID-19 severity for prediction.METHODS This case-control study included 209 patients with type 2 diabetic mellitus hospitalized at the Galilee Medical Center(Nahariya,Israel)and recruited between September 2020 and May 2021,65 patients with COVID-19 infection in dedicated wards and 144 COVID-19-negative patients in internal medicine wards hospitalized due to other reasons.Clinical parameters-including age,type of antiglycemic medications,presence of retinopathy,smoking history,body mass index(BMI),glycosylated hemoglobin,maximum neutrophil:lymphocyte ratio(NLR_(max)),C-reactive protein(CRP),estimated glomerular filtration rate(eGFR),and albumin(blood and urine)-were compared between the two primary patient groups,and then between COVID-19-negative patients hospitalized due to infectious vs non-infectious disease.Finally,we explored which parameters were associated with severe COVID-19 pneumonia.RESULTS COVID-19-negative patients were older(63.9±9.9 vs 59.8±9.2,P=0.005),and had longer duration of diabetes(P=0.031),lower eGFR(P=0.033),higher albumin(P=0.026),lower CRP(P<0.001),greater smoking prevalence(P<0.001),and more baseline albuminuria(54.9%vs 30.8%,P=0.005)at admission;70%of COVID-19 patients with albuminuria had moderate-range albuminuria(albumin:creatinine 30-300 mg/g).Most of the patients with albuminuria had chronic kidney disease stage II(CKD II).Oral antiglycemic therapies were not significantly different between the two groups.Multivariable logistic regression showed that higher BMI was significantly associated with severe COVID-19(OR 1.24,95%CI:1.01-1.53,P=0.04),as was higher NLR_(max)(OR 1.2,95%CI:1.06-1.37,P=0.005).Surprisingly,pre-hospitalization albuminuria,mostly moderate-range,was associated with reduced risk(OR 0.09,95%CI:0.01-0.62,P=0.015).Moderate-range albuminuria was not associated with bacterial infections.CONCLUSION Moderate-range albuminuria in COVID-19-positive diabetic patients with CKD II is associated with less severe COVID-19.Further studies should explore this potential biomarker for risk of COVID-19-related deterioration and early interventions.
文摘BACKGROUND Procalcitonin(Pct)is a common biomarker in clinical practice,especially in the era of coronavirus disease 2019(COVID-19)infection.Although it is frequently used for the diagnosis and prognostication of bacterial infections or sepsis,it is also elevated in a few other conditions,including medullary thyroid carcinoma(MTC).CASE SUMMARY A 43-year-old female presented with moderately severe COVID-19 pneumonia in April 2021.She gradually recovered clinically;however,despite normalization of other inflammatory markers,Pct levels remained persistently elevated.Further workup identified the cause as left lobe MTC with locoregional metastasis.Calcitonin levels were high,and carcinoembryonic antigen levels were normal.The patient underwent total thyroidectomy and neck dissection,which was followed by another radical neck dissection due to residual disease.Currently,she is doing well,nearly having completed her course of external beam radiotherapy with no recurrence.Pct is well documented as a screening tool for MTC,especially because of its stable nature compared to calcitonin in the community settings.It is important to keep in mind the differential diagnosis of MTC in patients with persistently elevated Pct levels despite normal levels of other acute phase reactants.To the best of our knowledge,this is the first report from Asia of such an incidental diagnosis of MTC due to persistently elevated Pct levels in a patient with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.CONCLUSION Persistently elevated Pct levels can occur in any pro-inflammatory state including infections,sepsis,or acute respiratory distress syndrome.In the current setting,SARS-CoV-2 infection is one such clinical scenario,and in rare situations of persistent elevation,MTC may need to be ruled out.
基金funded by King Saud University,Riyadh,Saudi Arabia.Researchers Supporting Project Number(RSP2024R167),King Saud University,Riyadh,Saudi Arabia.
文摘The early implementation of treatment therapies necessitates the swift and precise identification of COVID-19 pneumonia by the analysis of chest CT scans.This study aims to investigate the indispensable need for precise and interpretable diagnostic tools for improving clinical decision-making for COVID-19 diagnosis.This paper proposes a novel deep learning approach,called Conformer Network,for explainable discrimination of viral pneumonia depending on the lung Region of Infections(ROI)within a single modality radiographic CT scan.Firstly,an efficient U-shaped transformer network is integrated for lung image segmentation.Then,a robust transfer learning technique is introduced to design a robust feature extractor based on pre-trained lightweight Big Transfer(BiT-L)and finetuned on medical data to effectively learn the patterns of infection in the input image.Secondly,this work presents a visual explanation method to guarantee clinical explainability for decisions made by Conformer Network.Experimental evaluation of real-world CT data demonstrated that the diagnostic accuracy of ourmodel outperforms cutting-edge studies with statistical significance.The Conformer Network achieves 97.40% of detection accuracy under cross-validation settings.Our model not only achieves high sensitivity and specificity but also affords visualizations of salient features contributing to each classification decision,enhancing the overall transparency and trustworthiness of our model.The findings provide obvious implications for the ability of our model to empower clinical staff by generating transparent intuitions about the features driving diagnostic decisions.
文摘BACKGROUND A series of recent cases of pneumonia in Wuhan,Hubei Province,China,was caused by the 2019 novel coronavirus[2019-nCoV,also called severe acute respiratory syndrome(SARS)-CoV-2].The World Health Organization officially named the disease as coronavirus disease 2019(COVID-19).With the global spread of COVID-19,similar cases have appeared in other areas of China,and there are a few reports of pediatric patients with COVID-19 pneumonia.CASE SUMMARY A 7-year-old girl was diagnosed with COVID-19 and presented with irregular fever,sore throat and diarrhea.Chest computed tomography revealed patchy consolidation and ground-glass opacities in multiple areas.The lesions were mainly distributed in the bronchial bundles or subpleural areas of both lungs,particularly in the right lower lobe.The patient also presented with diarrhea,mild kidney injury,and live coronavirus was found in her feces.She was given antiviral agents(lopinavir and ritonavir),and follow-up detection showed that these abnormalities were markedly decreased within 3 d.CONCLUSION The clinical symptoms and prognosis of COVID-19 in pediatric patients may be different from those in adult patients,and the fecal–oral transmission of SARSCoV-2 should be considered.
文摘Objective:To compare the survival and length of stay of invasive ventilation(IV)with those of non-invasive ventilation(NIV)in patients with COVID-19 acute respiratory distress syndrome in a single hospital from May 2020 to March 2021.Methods:After obtaining approval from the Hospital Director,the data of COVID-19 patients including demographics,type of respiratory support(non-invasive ventilation or invasive ventilation),duration of ventilation,length of stay,discharge,and death were collected and analyzed.Results:Out of the 152 patients identified,134 patients were analyzed.The median intubation days were 10.0(Q1:3.5,Q3:13.5)in the IV group and 0.0(Q1:0.0,Q3:0.0)days in the NIV-only group.Out of the 101 patients who received NIV,43 patients were subsequently intubated due to failure of NIV.Of the 63 patients(47.01%)who died,22(66.66%)were from the IV group and 40(92.02%)were from the NIV-followed-by-intubation group,and 1(1.72%)were from the NIV-only group.Multivariate analysis showed that the presence of a respiratory comorbidity(OR=16.56,95%CI=1.56-175.48,P=0.02)was an independent predictor of survival.Conclusions:Respiratory co-morbidity is a significant adverse predictor of survival outcome.The decision on the type of respiratory support should be made on a patient-to-patient basis.
文摘Coronavirus disease 2019(COVID-19)was first discovered after unusual cases of severe pneumonia emerged by the end of 2019 in Wuhan(China)and was declared a global public health emergency by the World Health Organization in January 2020.The new pathogen responsible for the infection,genetically similar to the beta-coronavirus family,is known as severe acute respiratory syndrome coronavirus-2(SARS-CoV-2),and the current gold standard diagnostic tool for its detection in respiratory samples is the reverse transcription-polymerase chain reaction test.Imaging findings on COVID-19 have been widely described in studies published throughout last year,2020.In general,ground-glass opacities and consolidations,with a bilateral and peripheral distribution,are the most typical patterns found in COVID-19 pneumonia.Even though much of the literature focuses on chest computed tomography(CT)and X-ray imaging and their findings,other imaging modalities have also been useful in the assessment of COVID-19 patients.Lung ultrasonography is an emerging technique with a high sensitivity,and thus useful in the initial evaluation of SARS-CoV-2 infection.In addition,combined positron emission tomography-CT enables the identification of affected areas and follow-up treatment responses.This review intends to clarify the role of the imaging modalities available and identify the most common radiological manifestations of COVID-19.
文摘BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.
文摘Background: Diabetes is a known risk factor for susceptibility and severity of COVID-19 infection. It may also be a complication of COVID-19. Many hypotheses have been proposed to explain this condition. It may be due to the effect of SARS-CoV-2 on β cells or drug-related side effects. In children, there is a paucity of data on the burden of this complication. Objective: We aimed to report a case of secondary diabetes during COVID-19 in a pediatric unit. Case Presentation: A 16-year-old girl presented with severe respiratory distress. She was treated for COVID-19 infection with antibiotics and corticosteroids. On day 6 of treatment, she developed polyuria and polydipsia. A random blood glucose test showed hyperglycaemia. The diagnosis of secondary diabetes was maintained. Conclusion: Covid-19 infection can be complicated by diabetes in children. It is essential to monitor blood glucose levels regularly.
文摘Objective:To validate a better scoring system between CURB-65 and the pneumonia severity index(PSI)to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia.Methods:A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota,Rajasthan.Relevant data about history,and general and systemic examination with laboratory investigations was collected.Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI.Sensitivity,specificity,positive predictive value,negative predictive value,and area under the curve were calculated.Continuous variables,means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data.Results:100 patients who tested positive for SARS-CoV-2 by RT-PCR were included;67 were male and 33 were female.58 patients had severe disease(SpO2≤90%)and 30 patients died.CURB-65 had an area under the curve(AUC)of 0.81 for predicting ICU admission,with a sensitivity of 92%and a specificity of 54%for high risk patients.Meanwhile,PSI had an AUC of 0.88,with a sensitivity of 83%and a specificity of 73%in high risk patients.In addition,CURB-65 had an AUC of 0.79 for predicting 30-day mortality,with a sensitivity of 60%and a specificity of 89%in high risk patients.PSI had an AUC of 0.71 for predicting 30-day mortality,with a sensitivity of 90%and a specificity of 46%in high risk patients.Conclusions:This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality.However,PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.
文摘Objective: To describe the CT findings and clinico-epidemiological aspects of coronavirus pulmonary lesions at the Radiology Department of Mother-Child Luxembourg’s Hospital in Bamako, West Africa. Materials and Method: This was a cross-sectional descriptive study over a period of three months (November 2020-January 2021). The study involved all patients with a clinical suspicion of COVID-19 or confirmed cases with suggestive CT scan lesions during this period. No patients without suggestive CT lesions were not included. The variables were age, sex, clinical data, lungs lesions on CT scan and their severity. Results: Out of 202 patients enlisted, the age group 52 - 63 years was more frequent (30.2%), i.e. an average age of 60.43 years (range 23 and 95 years). Men represented 56.4% or a sex ratio of 1.3. Cough was the most common clinical manifestations (26.7%). Major findings were mixed appearance of the lung lesions (45.5%). The peripheral distribution was 57.4% and the bilateral topography was 98%. These lesions were extensive in the majority of our patients with 28.2%. Conclusion: Older people dominated the socio-demographic profile of our series with a predominance of men. Cough was the most observed clinical information. Mixed lesions with peripheral and bilateral distribution dominated the semiological tomodensitometric aspects. By severity, extensive lung lesions were the most commonly observed.
文摘Benign laryngotracheal stenosis (LTS) is a debilitating and potentially life-threatening condition that is commonly caused by iatrogenic events as a result of endotracheal intubation or tracheostomy. Numerous cases are being published for patients with coronavirus disease 2019 (COVID-19) who end up with severe LTS after prolonged intubation or tracheostomy. Here, we presented two cases of LTS due to prolonged intubation after severe COVID-19 pneumonia. The characteristic of these two cases is that both of them needed second time intubation and were readmitted because of severe dyspnoea and all the workup for post-COVID-19 complications were investigated except the LTS which was later diagnosed after one month of suffering of these patients.
