March 9, 2020
Early Chest CT Features of Patients with 2019 Novel Coronavirus (COVID-19) Pneumonia: Relationship to Diagnosis and Prognosis
Fever (85%) and cough (79%) were most commonly seen. 10 (29%) patients demonstrated negative results on their first RT-PCR.22/34(65%) patients showed pure ground glass opacity (GGO). 17/34 (50%) patients had five lobes of lung involvement, while the 23(68%) patients had lower lobes were involved and 24/34 (71%) were subpleural. Lesions of 24 (71%) patients were distributed mainly in the subpleural. During follow-up, the initial CT lesions of ICU patients are distributed in both subpleural and parenchyma (80%) and the lesions are scattered. 60% of ICU patients had five lobes involved, while this was seen in only 25% discharged patients. Lesions of discharged patients are mainly in the subpleural (75%). 62.5% of discharged patients showed pure ground-glass opacity. 80% ICU demonstrated progressive stage on their first CT scan. 75 % discharged patients were at an early stage. CT score of ICU patients were significantly higher than that of the discharged patients.
March 8, 2020
The correlation Between Viral Clearance and Biochemical Outcomes of 94 Discharged Patients with COVID-19 Infection
COVID-19 mRNA clearance ratio was identified significantly correlated with the decline of serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels. Furthermore, COVID-19 mRNA clearance time was positively correlated with the length of hospital stay in patients treated with either IFN-α + lopinavir/ritonavir or IFN-α +lopinavir/ritonavir+ ribavirin.
March 8, 2020
Clinical and CT Characteristics of Medical Personnel with the Coronavirus Disease 2019 (COVID-19) in Wuhan
At admission, the main complaints of MP group, including fever (86.7%), fatigue (53.3%) and cough (43.3%), were similar to the non-MP group; the C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels of the non-MP group (55.6±45.9mg/L, 34.7±26.3mm/H and 321±117U/L) were higher than that of the MP group (17.8±19.9mg/L, 18.6±21.3mm/H and 219±54.2U/L, respectively, all p<0.05). Groundgrass opacities, consolidation, interstitial thickening were common CT features of both groups. The days from illness onset to the first CT exam, and the severity of opacities on initial CT were less in the MP group than that of the non-MP group (p<0.05). However, the days from onset to observation of the most obvious pulmonary opacities, according to CT findings, were similar in the MP group (11.5±5.9 days) and the non-MP group (12.2±3.1 days, p=0.55).
March 8, 2020
Clinical features of critically ill patients with COVID-19 infection in China
Fifty critically ill patients with SARS-CoV-2 infections were enrolled. Their median age was 62 (range, 29-92) [IQR,49.5-69.0] years, 68% were male, and 28 (56%) patients
had comorbidities, the most common being hypertension. In this cohort, 20(40%) patients survived ,16(32%) patients died, and the rest remained hospitalized. The invasive mechanical ventilator was used in 36(72%) patients with 15(30%) of them requiring prone positioning, and 17(34%) switched to ECMO. The compliance scores of lungs (Cstat)on the day of ICU admission among survivors were higher than those in non-survivors [42.0(18.0- 47.0), vs. 19.5(14.0-24.2), p=0.038].The blood IL-6 levels and neutrophils counts at the first day of ICU admission were significantly higher in non-survivors compared to survivors [123.7(85.3-228.8), vs. 20.2(6.8-67.2) ng/ml, p=0.025 for IL-6, and 20.2(6.8-67.2) vs. 4.01(1.99-7.05) × 10⁹/L, p=0.02 for neutrophils counts].The heart rates, PaCO2, lung injury scale (LIS), and positive end-expiratory pressure levels were constantly higher for 10 days in non-survivors than those who survived (p<0.05). The frequency of vasopressor uses and neuromuscular blockers was higher in non-survivors from day 1 to day 10 compared to survivors (p<0.05). In the whole cohort, the most common complications were ARDS (97%), shock (44%), arrhythmia (38%), acute cardiac injury (26%), and acute kidney injury (22%). A secondary bacterial infection was noted in 17(34%) patients. Univariate analysis indicated that lower lung complianceand higher neutrophil counts at the day of ICU admission were related to higher mortality (p-0.03, and 0.04, respectively).
March 8, 2020
A 49-year-old Woman Co-infected with SARS-COV-2 and Mycoplasma – A Case Report
Co-infection of SARS-COV-2 and Mycoplasma in COVID-19 patients appears to be uncommon. Computed tomography is an acceptive way to make primary diagnosis and treatment for patients as soon as possible. Combination therapy of antiviral, antiinflammatory, traditional Chinese medical herbal and supportive care may be a reference for further progress.
March 7, 2020
CT Scores Predict Mortality in 2019-nCoV Pneumonia
The major imaging feature of 2019-nCoV pneumonia is the ground glass opacity (GGO). Our study found that GGO was the main manifestation of the 2019-nCoV pneumonia. The intense immune response of the body could quickly enter the progressive stage and develop into pulmonary consolidation, but pleural effusion was less frequent. Lymph node enlargement was also absent or insignificant, and cavities were less frequent.
March 7, 2020
A Systematic Review Investigating The Effectiveness of Face Mask Use in Limiting the Spread of COVID-19 Among Medically Not
Diagnosed Individuals: Shedding Light on Current Recommendations Provided to Individuals Not Medically Diagnosed With COVID-19
There is a lack of scientific evidence on the effectiveness of face mask use in limiting the spread of COVID–19 among those who are not medically diagnosed with COVID–19.
March 7, 2020
Clinical Characteristics of 6 patients with SARS Cov-2 infected severe pneumonia in Zunyi, China
The most common symptoms at onset of illness were dry cough (4, 66%) and fever (4, 66%). Laboratory tests showed that white blood cell count, neutrophil count, C-reactive protein, IL-6, IL-10, and urea nitrogen elevated. The Total lymphocyte count and T lymphocyte count decreased. All patients received antiviral therapy, blood purification, immunomodulatory therapy, and Chinese herb treatments. One patient was discharged from the hospital, and 5 patients' condition improved significantly. T lymphocyte decreased significantly, IL-6 and IL-10 elevated in severe SARS-Cov-2 infected pneumonia patients. Elderly patients with comorbidities appear to be more severe and to recover more slowly. Blood purification can be tried for severe and critically ill patients. Early identification and timely treatment of critical cases is of crucial importance.
March 5, 2020
CT findings of patients infected with SARS-CoV-2
There are 54 patients with positive CT findings and 13 patients with negative CT findings. The common CT findings in hospitalized patients with SARS-CoV-2 infection were ground glass opacities (42/54), lesions located in the peripheral area (50/54), multiple lesions(46/54), and lesions located in the lower lobes (42/54). There were some less common CT findings: air bronchogram (n=18), pleural thickening or pleural effusion (14/54), consolidation (12/54), lesions in the upper lobes (12/54), interlobular septal thickening (11/54), reversed halo sign (9/54), single lesion (8/54), cavitaties (4/54), bronchial wall thickening (3/54), intrathoracic lymph node enlargement (2/54).
March 5, 2020
Correlation analysis between CT findings and duration of initial symptoms in young and middle aged patients with novel coronavirus pneumonia
Our study showed that the CT scores and length of maximum pulmonary inflammatory lesions in the young and middle-aged patients under 60 years old with COVID-19 was statistically different between the different duration time of initial symptoms groups. The duration of the initial symptom was found to be positively correlated with the CT score of pulmonary lesions and the length of the largest inflammatory lesions in the lungs. The longer the duration of the initial symptom was, the higher the CT score was, the more serious the CT manifestations of pulmonary lesions were, the larger the lesions were.
March 5, 2020
Evolution of CT Findings in Patients with COVID-19 Pneumonia
The most common symptoms were fever (84.1%) and cough (56.8%). The baseline CT was obtained on average 5 days from symptom onset. Four patients (4.5%) had negative initial CT. Significant differences were found among the time intervals in the proportion of pulmonary lesions that are 1) pure GGO, 2) mixed attenuation, 3) mixed attenuation with linear opacities, 4) consolidation with linear opacities, and 5) pure consolidation. The majority of patients had involvement of ≥ 3 lobes. Bilateral involvement was more prevalent than unilateral involvement. The proportions of patients observed to have pure GGO or GGO and consolidation decreased over time while proportion of patients with GGO and linear opacities increased. Total severity score showed an increasing trend in the first two weeks. While bilateral GGO are predominant features, CT findings changed during different time intervals in the three weeks after symptom onset in patients with COVID-19.
March 5, 2020
Clinical Features and Laboratory Inspection of Novel Coronavirus Pneumonia (COVID-19) in Xiangyang, Hubei
Fever (89.8%) and Cough (67.2%) were common clinical symptoms. The rate of patients with sore throats (14.1%) was rare. The rate of chest computed tomography scan showing ground glass opacity in overall, non-severe, severe groups were 63.3%, 60.7%, 76.2%, respectively. White blood cell counts in the normal range of overall patients, but severe group patients were increased significantly ( P < 0.01). Lymphocytes of overall patients were decreased. Alanine transaminase (ALT) and aspartate transaminase (AST) in the normal range of overall patients, but its were elevated in the severe group. Creatinine (CR) and blood urea nitrogen (BUN) of overall patients in the normal range. C-reactive protein (CRP) level of all patients were increased markedly, but it in the severe group was significantly higher than that in the non-severe group ( P < 0.01 ).
March 4, 2020
Host Susceptibility to Severe COVID-19: a Retrospective Analysis of 487 Case Outside Wuhan
On multivariate analysis, elder age, male and presence of hypertension are independently associated with severe disease at admission. A host risk score, incorporating age, sex and hypertension history, clearly stratifies risk of developing severe type of COVID-19 both in patients at admission and during in-hospital follow-up. Elder age, male and presence of hypertension are associated with host susceptibility to developing severe COVID-19.
March 3, 2020
Clinical Characteristics of Patients with 2019 Coronavirus disease in a non-Wuhan area of Hubei Province, China: A Retrospective Study
Of the 91 patients diagnosed with COVID-19, 30 (33.0%) cases were severe and two (2.2%) patients died. The severe patients tended to be older (50.5 vs 42.0, P=0.049), and have more chronic disease (40% vs 14.75%, P=0.009), compared to mild group. Only 67.0% of the patients were quantitative polymerase chain reaction (qPCR) positive on their first tests, while typical chest computed tomographic (CT) images were obtained for each patient. The most common complaints were cough (75, 82.4%), fever (59, 64.8%), fatigue (35, 38.5%), and diarrhea (14, 15.4%). Injuries outside the respiratory tract were identified by elevated levels of aspartate aminotransferase (18, 19.8%), creatinine (5, 5.5%) and creatine kinase (14, 15.4%) in laboratory tests. In sum, 28 (30.8%) cases suffered injuries outside the respiratory system, including 50% of the critically ill patients and 21.3% of the mild patients.
February 29, 2020
Evolution of CT Manifestations of 105 Novel Coronavirus Pneumonia Patients in Wuhan, China
CT images of 105 confirmed patients were collected. The patients underwent 2-7 chest CT examinations. M/F ratio: 49/56. The age range was 23-72 y, and the mean age was 48.6±13.1 y. The patients' chest CT examinations were divided into 5 groups according to the re-examination interval, group A (25 cases): ≤3 days, group B (70 cases): 4-7 days, group C (75 cases): 8-14 days, group D (29 cases): 15-21 days, group E (4 cases):> 21 days. There was significant difference in the improvement and progress rates between group B and C. Furthermore, the changes of ground glass nodules (GGO), consolidation and cord lesions in each group were recorded. The chest CT manifestations of the patients changed rapidly, and the reexamination of 7-14 days was of great significance in evaluating the prognosis of patients while minimizing the radiation dose.
February 29, 2020
Detectable Serum SARS-CoV-2 Viral Load (RNAaemia) Is Closely Associated With Drastically Elevated Interleukin 6 (IL-6) Level In Critically Ill COVID-19 Patients
Serum SARS-CoV-2 viral load (RNAaemia) is strongly associated with cytokine storm and can be used to predict the poor prognosis of COVID-19 patients. Moreover, our results strongly suggest that cytokine IL-6 should be considered as a therapeutic target in critically ill patients with excessive inflammatory response.
February 28, 2020
First Cured Patient With 2019 Novel Coronavirus in Changsha, China, A Case Report
A 57 year old woman developed cough and fever after returning from Wuhan to Changsha on January 9, 2020. She was tested positive for 2019-nCoV infection, which was supported by Chest CT. Lopinavir and ritonavir tablets and interferon alfa-2b injection were used for treatment. A small dose of glucocorticoids were used in a short period to control the immune response in bilateral lung and this patient avoided the occurrence of cytokine storms. The clinical condition of this patient improved and negative result was obtained for 2019-nCoV assay on January 25, 2020. This patient was recovered and discharged on January 30, 2020.
February 28, 2020
Clinical Implications of 37 Childhood Cases with 2019-nCoV Infection in Shenzhen, China
There were 9 mild cases, 20 common cases and 1 severe case and 7 cases with asymptomatic infection. The age ranged from 7 months to 18 years old and the median age was 7 years old. The common clinical features were fever (29.7%, 11/37) and cough (32.4%, 12/37). No death occurred among our patients. 86.5% (32/37) children were infected with 2019-nCoV after their family members (parents or grandparents). 1 child was identified with 2019-nCoV infection after 3 times testing. The majority (78.4%) of cases occurred in those children who travelled to Hubei Province. The percentage of cases in preschool and in schools was 21.6% and 54.1% (P<0.05) respectively.
February 28, 2020
Clinical Characteristics of Coronavirus Disease 2019 in China
The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings.
February 27, 2020
The Experience of High Flow Nasal Cannula in Hospitalized Patients with 2019 Novel Coronavirus–Infected Pneumonia in Chongqing, China
This study firstly provides the experience of how to use high flow nasal cannula (HFNC) in patients with (2019-nCoV)–infected pneumonia (NCIP). Patients with lower PaO2/FiO2 were more likely to experience HFNC failure. Among the failure patients, most of them can avoid intubation when they were ungraded to NIV.