Spontaneous Retroperitoneal Hematoma in COVID-19 Severe Pneumonia–Dual-phase Multidetector Computed Tomography (MDCT) Angiogram and Role of Radiologist

AbstractStudies available in the literature have shown alterations in blood coagulation tests in severe cases of COVID-19 pneumonia, with a significant risk of venous thromboembolism (VTE). Since microvascular thrombosis is a well-known fact in COVID-19 disease, requiring therapeutic anticoagulation, low-molecular weight heparin (LMWH) in prophylactic dose is a part of the clinical management of hospitalized COVID-19 patients. In this scenario, we describe three cases of abdominal spontaneous retroperitoneal hematoma (SRH) in hospitalized reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 patients.

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Immunothrombotic Dysregulation in COVID-19 Pneumonia Is Associated With Respiratory Failure and Coagulopathy

Circulation ◽

10.1161/circulationaha.120.048488 ◽

2020 ◽

Vol 142 (12) ◽

pp. 1176-1189 ◽

Cited By ~ 40

Author(s):

Leo Nicolai ◽

Alexander Leunig ◽

Sophia Brambs ◽

Rainer Kaiser ◽

Tobias Weinberger ◽

...

Keyword(s):

Respiratory Failure ◽

Severe Acute Respiratory Syndrome ◽

Disease Severity ◽

Severe Pneumonia ◽

Corona Virus ◽

Coagulation Tests ◽

Myocardial Involvement ◽

Platelet Aggregates ◽

Polymerase Chain

Background: Severe acute respiratory syndrome corona virus 2 infection causes severe pneumonia (coronavirus disease 2019 [COVID-19]), but the mechanisms of subsequent respiratory failure and complicating renal and myocardial involvement are poorly understood. In addition, a systemic prothrombotic phenotype has been reported in patients with COVID-19. Methods: A total of 62 subjects were included in our study (n=38 patients with reverse transcriptase polymerase chain reaction–confirmed COVID-19 and n=24 non–COVID-19 controls). We performed histopathologic assessment of autopsy cases, surface marker–based phenotyping of neutrophils and platelets, and functional assays for platelet, neutrophil functions, and coagulation tests, as well. Results: We provide evidence that organ involvement and prothrombotic features in COVID-19 are linked by immunothrombosis. We show that, in COVID-19, inflammatory microvascular thrombi are present in the lung, kidney, and heart, containing neutrophil extracellular traps associated with platelets and fibrin. Patients with COVID-19 also present with neutrophil-platelet aggregates and a distinct neutrophil and platelet activation pattern in blood, which changes with disease severity. Whereas cases of intermediate severity show an exhausted platelet and hyporeactive neutrophil phenotype, patients severely affected with COVID-19 are characterized by excessive platelet and neutrophil activation in comparison with healthy controls and non–COVID-19 pneumonia. Dysregulated immunothrombosis in severe acute respiratory syndrome corona virus 2 pneumonia is linked to both acute respiratory distress syndrome and systemic hypercoagulability. Conclusions: Taken together, our data point to immunothrombotic dysregulation as a key marker of disease severity in COVID-19. Further work is necessary to determine the role of immunothrombosis in COVID-19.

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Genomic Epidemiology of SARS-CoV-2 in Madrid, Spain, during the First Wave of the Pandemic: Fast Spread and Early Dominance by D614G Variants

Microorganisms ◽

10.3390/microorganisms9020454 ◽

2021 ◽

Vol 9 (2) ◽

pp. 454

Author(s):

Esther Viedma ◽

Elias Dahdouh ◽

José González-Alba ◽

Sara González-Bodi ◽

Laura Martínez-García ◽

...

Keyword(s):

Air Transportation ◽

European Population ◽

Viral Population ◽

Rt Pcr ◽

Viral Genomes ◽

Genomic Epidemiology ◽

International Transport ◽

Polymerase Chain ◽

Phylodynamic Analysis

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in Madrid, Spain, on 25 February 2020. It increased in frequency very fast and by the end of May more than 70,000 cases had been confirmed by reverse transcription-polymerase chain reaction (RT-PCR). To study the lineages and the diversity of the viral population during this first epidemic wave in Madrid we sequenced 224 SARS-CoV-2 viral genomes collected from three hospitals from February to May 2020. All the known major lineages were found in this set of samples, though B.1 and B.1.5 were the most frequent ones, accounting for more than 60% of the sequences. In parallel with the B lineages and sublineages, the D614G mutation in the Spike protein sequence was detected soon after the detection of the first coronavirus disease 19 (COVID-19) case in Madrid and in two weeks became dominant, being found in 80% of the samples and remaining at this level during all the study periods. The lineage composition of the viral population found in Madrid was more similar to the European population than to the publicly available Spanish data, underlining the role of Madrid as a national and international transport hub. In agreement with this, phylodynamic analysis suggested multiple independent entries before the national lockdown and air transportation restrictions.

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Chest CT texture-based radiomics analysis in differentiating COVID-19 from other interstitial pneumonia

La radiologia medica ◽

10.1007/s11547-021-01402-3 ◽

2021 ◽

Author(s):

Damiano Caruso ◽

Francesco Pucciarelli ◽

Marta Zerunian ◽

Balaji Ganeshan ◽

Domenico De Santis ◽

...

Keyword(s):

Interstitial Pneumonia ◽

Potential Role ◽

Texture Features ◽

Roc Curves ◽

Chest Ct ◽

Preliminary Evaluation ◽

Rt Pcr ◽

Mean Intensity ◽

Polymerase Chain

Abstract Purpose To evaluate the potential role of texture-based radiomics analysis in differentiating Coronavirus Disease-19 (COVID-19) pneumonia from pneumonia of other etiology on Chest CT. Materials and methods One hundred and twenty consecutive patients admitted to Emergency Department, from March 8, 2020, to April 25, 2020, with suspicious of COVID-19 that underwent Chest CT, were retrospectively analyzed. All patients presented CT findings indicative for interstitial pneumonia. Sixty patients with positive COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) and 60 patients with negative COVID-19 RT-PCR were enrolled. CT texture analysis (CTTA) was manually performed using dedicated software by two radiologists in consensus and textural features on filtered and unfiltered images were extracted as follows: mean intensity, standard deviation (SD), entropy, mean of positive pixels (MPP), skewness, and kurtosis. Nonparametric Mann–Whitney test assessed CTTA ability to differentiate positive from negative COVID-19 patients. Diagnostic criteria were obtained from receiver operating characteristic (ROC) curves. Results Unfiltered CTTA showed lower values of mean intensity, MPP, and kurtosis in COVID-19 positive patients compared to negative patients (p = 0.041, 0.004, and 0.002, respectively). On filtered images, fine and medium texture scales were significant differentiators; fine texture scale being most significant where COVID-19 positive patients had lower SD (p = 0.004) and MPP (p = 0.004) compared to COVID-19 negative patients. A combination of the significant texture features could identify the patients with positive COVID-19 from negative COVID-19 with a sensitivity of 60% and specificity of 80% (p = 0.001). Conclusions Preliminary evaluation suggests potential role of CTTA in distinguishing COVID-19 pneumonia from other interstitial pneumonia on Chest CT.

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Chest CT as a Complement to RT-PCR to Confirm and Follow-up COVID-19 Patients

Medicinus ◽

10.19166/med.v8i1.3122 ◽

2021 ◽

Vol 8 (1) ◽

pp. 31

Author(s):

Aziza Ghanie Icksan ◽

Muhammad Hafiz ◽

Annisa Dian Harlivasari

Keyword(s):

Chest Ct ◽

Rt Pcr ◽

High Resolution Computed Tomography ◽

X Ray ◽

First Case ◽

Chest X Ray ◽

Polymerase Chain

Background : The first case of COVID-19 in Indonesia was recorded in March 2020. Limitation of reverse-transcription polymerase chain reaction (RT-PCR) has put chest CT as an essential complementary tool in the diagnosis and follow up treatment for COVID-19. Literatures strongly suggested that High-Resolution Computed Tomography (HRCT) is essential in diagnosing typical symptoms of COVID-19 at the early phase of disease due to its superior sensitivity (97%) compared to chest x-ray (CXR).The two cases presented in this case study showed the crucial role of chest CT with HRCT to establish the working diagnosis and follow up COVID-19 patients as a complement to RT-PCR, currently deemed a gold standard.

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The role of DNA amplification and cultural growth in complicated acute appendicitis

Pediatric Reports ◽

10.4081/pr.2016.6487 ◽

2016 ◽

Vol 8 (3) ◽

Cited By ~ 1

Author(s):

Francesca Tocchioni ◽

Chiara Tani ◽

Laura Bartolini ◽

Maria Moriondo ◽

Francesco Nieddu ◽

...

Keyword(s):

Acute Appendicitis ◽

Bacterial Growth ◽

Peritoneal Fluid ◽

Dna Amplification ◽

Fusobacterium Necrophorum ◽

Rt Pcr ◽

Reactive Protein ◽

Polymerase Chain ◽

Surgical Setting

Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR) and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases), Pseudomonas aeruginosa (3), Fusobacterium necrophorum (3), Adenovirus (2), E.coli (1), Klebsiella pneumoniae (1), Serratia marcescens/Enterobacter cloacae (1). Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus). Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated.

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A study of genes involved in adipocyte differentiation

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2014-0002 ◽

2015 ◽

Vol 28 (1-2) ◽

Cited By ~ 5

Author(s):

Shunming Zhu ◽

Gong Cheng ◽

Huolan Zhu ◽

Gongchang Guan

Keyword(s):

Potential Role ◽

Adipocyte Differentiation ◽

Late Phase ◽

Redox Status ◽

Rt Pcr ◽

Chain Reaction ◽

Lipid Droplet Formation ◽

Polymerase Chain ◽

Microarray Technique

AbstractWith the use of the microarray technique, genes expressed in the late phase of adipocyte differentiation were investigated. These genes play an important role in stimulating adipocyte growth and lipid droplet formation. Therefore, they contribute a great deal to the onset of obesity.With the use of SW872 adipocytes and the microarray technique, genes related to adipocyte differentiation were tested and compared with undifferentiated preadipocytes 14 days after induction. Real-time reverse transcription polymerase chain reaction (RT-PCR) was used for confirmation.More than 21,329 transcriptors were expressed and determined, of which 1326 increased and 687 decreased undifferentiated adipocytes. Among them, 21 were highly expressed by more than 10-fold. With RT-PCR, 12 were confirmed, including apelin, CIDEC, PID1, LYRM1, ADD1, PPARγ2, ANGPTL4, ADIPOQ, ACOX1, FIP1L1, MAP3K2 and PEX14. Furthermore, genes involved in lipid metabolism, signal transduction, DNA replication, redox status and transcription factors were determined as well. Novel genes involved in adipogenesis (e.g., apelin) were detected.A variety of genes were discovered and validated with RT-PCR at the late phase of adipocyte differentiation. This may help us better understand the onset of obesity and the potential role of adipocytes in other organs.

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CO-RADS versus CT-SS scores in predicting severe COVID-19 patients: retrospective comparative study

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00060-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Niveen E. Zayed ◽

Manar A. Bessar ◽

Samah Lutfy

Keyword(s):

Comparative Study ◽

Severe Disease ◽

Scoring Systems ◽

Rt Pcr ◽

C Reactive Protein ◽

Reactive Protein ◽

Polymerase Chain ◽

Retrospective Comparative Study ◽

Rule Out

Abstract Background The role of CT in assessing and plotting viral pulmonary affection land marking is its potential among other investigation tools, and the aim of the study was to compare the ability of two different CT-based scoring systems in discriminating severe COVID-19 disease. Results Retrospective comparative study included 142 confirmed COVID-19 patients by real-time polymerase chain reaction (RT-PCR) test, with different degrees of disease (mild to severe), the data of patients collected from medical records, and patients with their first CT chest read for calculating CO-RADS and severity scoring system (CT-SS) score. The patients with severe COVID-19 disease were significantly older and had different comorbidities. The level of C-reactive protein, ESR, ferritin, and LDH were significantly higher in severe disease, P < 0.001. The ability of CT chest and its score bases (CT-SS and CO-RADS) were accurate in differentiation between mild/moderate and severe disease; AUC were 89% and 97%, respectively. The cutoff value of less than 7.5 and 4.5 for CT-SS and CO-RADS, respectively, can rule out severe COVID-19 by 90% and 97%, respectively. Conclusions CT chest play a segregate role in COVID-19 disease, add on an advantage in clinical data in triage, and highlight the decision of hospital admission.

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SPATIAL-TEMPORAL DISTRIBUTION AND SEQUENCE DIVERSITY OF GROUP A HUMAN RESPIRATORY SYNCYTIAL VIRUSES IN KENYA PRECEDING THE EMERGENCE OF ON1 GENOTYPE

10.22541/au.163871927.77682782/v1 ◽

2021 ◽

Author(s):

JULIA WANGUI ◽

David Nokes ◽

Victor Mobegi ◽

James Otieno ◽

Charles Agoti ◽

...

Keyword(s):

Temporal Distribution ◽

Severe Pneumonia ◽

Respiratory Illness ◽

Haplotype Network ◽

Rt Pcr ◽

Group A ◽

One Step ◽

Respiratory Syncytial Viruses ◽

Polymerase Chain ◽

Syncytial Virus

Background: Human respiratory syncytial virus (HRSV) is a major cause of severe viral acute respiratory illness and contributes significantly to severe pneumonia cases in Africa. Little is known about its spatial-temporal distribution as defined by its genetic diversity. Methods: A retrospective study conducted utilizing archived nasopharyngeal specimens from patients attending outpatient clinics in hospitals located in five demographically and climatically distinct regions of Kenya; Coast, Western, Highlands, Eastern and Nairobi. The viral total RNA was extracted and tested using multiplex real time RT-PCR (reverse transcriptase polymerase chain reaction). A segment of the G-gene was amplified using one-step RT-PCR and sequenced by Sanger di-deoxy method. Bayesian analysis of phylogeny was utilized and subsequently median joining methods for haplotype network reconstruction. Results: Three genotypes of HRSVA were detected; GA5 (14.0%), GA2 (33.1%) and NA1 (52.9%). HRSVA prevalence varied by location from 33% to 13.2% in the Highlands and the Eastern regions respectively. The mean nucleotide diversity (Pi(π)) varied by genotype: highest of 0.018 for GA5 and lowest of 0.005 for NA1. A total of 58 haplotypes were identified (GA5 10; GA2 20; NA1 28). These haplotypes were introduced into the population locally by single haplotypes and additional subsidiary seeds amongst the GA2 and the NA1 haplotypes. Conclusions: HRSVA was found across all the regions throughout the study period and comprised three genotypes; GA5, GA2 and NA1 genotypes. The genotypes were disproportionately distributed across the regions with GA5 gradually increasing towards the Western zones and decreasing towards the Eastern zones of the country.

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An atypical case: RT-PCR-negative, sero-positive covid-19 patient

Pneumologia ◽

10.2478/pneum-2020-0013 ◽

2020 ◽

Vol 69 (2) ◽

pp. 107-114

Author(s):

William Suriady ◽

Andika Chandra Putra ◽

Wiwien Heru Wiyono ◽

Mohammad Fahmi Alatas ◽

Bettia Bermawi ◽

...

Keyword(s):

False Negative ◽

Severe Pneumonia ◽

World Health ◽

Diagnostic Process ◽

The Novel ◽

Rt Pcr ◽

Atypical Case ◽

Polymerase Chain ◽

Novel Coronavirus ◽

Health Organization

Abstract The novel coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has become a public health emergency of international concern. The first confirmed COVID-19 case in Indonesia was announced on 2 March 2020, and later on, 11,192 confirmed cases were reported as of 3 May. The World Health Organization has stated that performing a real-time reverse transcription–polymerase chain reaction (RT-PCR) specific for SARS-CoV-2 on specimens from the upper and the lower respiratory tracts, especially nasopharyngeal and oropharyngeal swabs, is the standard diagnostic procedure for COVID-19. In Indonesia, we also use other diagnostic tests, such as rapid antibody tests specific for SARS-CoV-2. Herein, we report an atypical case of COVID-19 and describe the diagnostic process, the clinical course, with progression to severe pneumonia on Week 3 of illness and the case management. We also try to highlight the possibility of false-negative RT-PCR tests.

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False-Negative Nasopharyngeal Swab RT-PCR Assays in Typical COVID-19: Role of Ultra-low-dose Chest CT and Bronchoscopy in Diagnosis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001680 ◽

2020 ◽

Author(s):

Marco Marando ◽

Adriana Tamburello ◽

Pietro Gianella

Keyword(s):

Low Dose ◽

False Negative ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Oral Swab ◽

Negative Results ◽

False Negative Results ◽

Polymerase Chain ◽

Pcr Assays

On 11 March 2020, the WHO declared COVID-19 a pandemic and global health emergency. We describe the clinical features and role of ultra-low-dose chest computed tomography (CT) and bronchoscopy in the diagnosis of coronavirus disease (COVID-19). In our patient, who was highly suggestive clinically and radiologically for COVID-19, we had two false-negative results for nasopharyngeal and oral swab reverse-transcriptase polymerase chain reaction (RT-PCR) assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eventually, we confirmed the diagnosis using bronchoscopy and bronchoalveolar lavage (BAL).

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