Epidemiological investigation and intergenerational clinical characteristics of 24 coronavirus disease patients associated with a supermarket cluster: a retrospective study

Abstract Background In view of the ongoing coronavirus disease (COVID-19) pandemic, it remains unclear whether the severity of illness and time interval from symptom onset to release from quarantine differ between cases that originated from clusters and cases reported in other areas. This study aimed to assess epidemiological and intergenerational clinical characteristics of COVID-19 patients associated with cluster outbreaks to provide valuable data for the prevention and control of COVID-19. Methods We identified the first employee with COVID-19 at a supermarket and screened the close contacts of this index patient. Confirmed cases were divided into two groups according to the generation (first generation comprising supermarket employees [group A] and second or third generations comprising family members or friends of the supermarket employees [group B]). The epidemiological and clinical characteristics of the two groups were retrospectively compared. Results A total of 8437 people were screened, and 24 COVID-19 patients were identified. Seven patients (29.2%) were asymptomatic; three patients were responsible for six symptomatic cases. The interval from the confirmation of the first case to symptom onset in symptomatic patients was 5–11 days. The clinical manifestations of symptomatic patients upon admission were non-specific. All patients (including the seven asymptomatic patients) were admitted based on chest computed tomography features indicative of pneumonia. There were 11 cases in group A (first generation) and 13 cases in group B (second generation, 11 cases; third generation, 2 cases), with no significant differences in clinical and epidemiological characteristics between the two groups, except for sex, duration from symptom onset to hospitalization, and underlying disease (P > 0.05). Conclusions For cluster outbreaks, it is important to comprehensively screen close the contacts of the index patient. Special attention should be paid to asymptomatic cases. The clinical management of cluster patients is similar to that of other COVID-19 patients.

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Epidemiological investigation and intergenerational clinical characteristics of 24 COVID-19 patients associated with supermarket cluster

10.1101/2020.04.11.20058891 ◽

2020 ◽

Cited By ~ 5

Author(s):

Suochen Tian ◽

Min Wu ◽

Zhenqin Chang ◽

Yunxia Wang ◽

Guijie Zhou ◽

...

Keyword(s):

Lymphocyte Count ◽

Clinical Characteristics ◽

First Generation ◽

Antiviral Drug ◽

Gastrointestinal Symptoms ◽

Onset Time ◽

Third Generation ◽

Group A ◽

Group B ◽

Release Form

AbstractObjectiveTo analyze the epidemiological and intergenerational clinical characteristics of COVID-19 patients associated with cluster, so as to understand the rules of the patients associated with cluster of this outbreak and provide help for the prevention and control of COVID-19.MethodsAll close contacts of the patient were screened since the first supermarket employee with COVID-19 was identified. A retrospective analysis was made on the epidemiological and clinical characteristics of the confirmed cases admitted to the designated hospitals for centralized treatment. The patients were divided into two groups according to the first generation (supermarket employees, group A) and the second or third generation (family members or friends of supermarket employees, group B), and the similarities and differences between the two groups were compared.ResultsA total of 24 COVID-19 patients were diagnosed, with an average age of 48 ±1.73 years. The mean duration from onset to release form quarantine was 21.04± 6.77 days, and the onset time was concentrated in 5-11 days after the first patient was diagnosed. Among all the patients, 23 patients were moderate, among which 7 patients (29.17%) were asymptomatic. Symptoms of symptomatic patients were cough (75.00%), low fever (62.50%), shortness of breath (41.67%), sore throat (25.00%), gastrointestinal symptoms (25.00%), fatigue (20.83%), etc. Biochemical examination on admission showed that the white blood cell count < 4.0×109/L (29.17%) and the lymphocyte count <1.1×109/L (58.33%). The lymphocyte count of 50.00% of the patients was ≤ 0.6 × 109/L. On admission, chest CT showed pneumonia (100%) with bilateral infiltration (75.00%). Treatment: antiviral drug (100%), Chinese medicine (100%), common oxygen therapy (45.83%). There were 11 cases in group A (first generation, 11 cases) and 13 cases in group B (second generation, 11 cases; third generation, 2 cases). In group B, there were more males, from onset to admission later, more patients had underlying diseases, and more patients were treated with albumin (P<0.05). However, there was no statistical difference between the two groups in other clinical indicators, including the duration from onset to release form quarantine(P>0.05). There was no improvement in granulocyte count in all patients, as well as in groups A and B, between admission and release from quarantine(P>0.05).ConclusionThe clinical characteristics of COVID-19 patients associated with cluster were similar to those of other COVID-19 patients, but there were some special features. The severity of the disease was similar and there was intergenerational spread. There was no difference in clinical characteristics between generations. Asymptomatic infections occurred in a proportion of patients and could cause spread.

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Changes in clinical patterns of Chinese patients with primary hyperparathyroidism in recent 12 years: a single-center experience

Endocrine Connections ◽

10.1530/ec-21-0382 ◽

2021 ◽

Author(s):

Yuan Liu ◽

Siyi Guo ◽

Jinsong Wu ◽

Rongai Wang ◽

Jinbo Liu ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Chinese Patients ◽

Female Ratio ◽

Hydroxyvitamin D ◽

Single Center Experience ◽

Predominant Type ◽

Group A ◽

Group B

The clinical presentation of primary hyperparathyroidism (PHPT) differs between patients from developed and developing countries. In China, the clinical pattern has changed over the past few decades. Our aim was to elucidate general changes in the clinical characteristics of PHPT from 2010 to 2021. We enrolled 343 patients with PHPT at the Qilu Hospital of Shandong University, Jinan, China, from January 2010 to May 2021, including both surgical and non-surgical patients. Patients were divided into two subgroups, 2010–2016 (group A, n = 152) and 2017–2021 (group B, n = 191), based on the time span. We compared clinical manifestations and laboratory result data between these two groups. The mean patient age was 52.59 ± 13.55 years, and the male-to-female ratio was 1:2.54. Of the 343 patients, 183 (53.35%) had symptomatic PHPT; bone pain, urolithiasis, and fatigue were the most common symptoms. Postoperative pathology showed that 96.20% of the patients had parathyroid adenoma, whereas 2.41% had parathyroid carcinoma. Great changes occurred between 2010 and 2021; the percentage of patients with asymptomatic PHPT (aPHPT) increased from 36.18% in group A to 54.97% in group B. Moreover, patients in group B showed significantly lower serum calcium, alkaline phosphatase, parathyroid hormone, and urinary phosphate levels but higher serum 25-hydroxyvitamin D levels than those in group A. Clinical presentations in group B were also milder. In conclusion, the clinical characteristics of Chinese PHPT patients changed dramatically from 2010 to 2021, with asymptomatic PHPT (aPHPT) becoming the predominant type over the last 3 years.

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Clinical characteristics of Kawasaki disease in adolescents

Journal of International Medical Research ◽

10.1177/03000605211056839 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110568

Author(s):

Xiaoliang Liu ◽

Fang Wang ◽

Kaiyu Zhou ◽

Yimin Hua ◽

Mei Wu ◽

...

Keyword(s):

Kawasaki Disease ◽

Clinical Characteristics ◽

Community Health Center ◽

Clinical Manifestations ◽

Intermittent Fever ◽

Local Hospital ◽

High Incidence ◽

Group A ◽

Group B ◽

Ivig Administration

Objective Studies focusing on Kawasaki disease (KD) in adolescents are lacking in Southwest China. We systematically summarized the clinical characteristics of KD in adolescents to improve pediatricians’ recognition of this condition. Methods The clinical data of patients with adolescent-onset KD in our center were retrospectively analyzed. The patients were divided into Group A (n = 7), whose first hospitalization was at our hospital, and Group B (n = 10), who were transferred from their local hospital or community health center. Results Seventeen patients with adolescent-onset KD were identified (constituent ratio of 0.8%). Seven patients had an intermittent fever for >10 days. The incidence of incomplete KD was 52.9%. These patients had a high incidence of other atypical clinical manifestations. Fifteen patients were initially misdiagnosed with other infectious diseases. Although the incidence of typical KD was higher in Group B, the overall misdiagnosis rate at the initial stages was higher and the average fever duration on arrival and before IVIG administration were much longer in Group B than A. Conclusions KD in adolescents was frequently misdiagnosed, which might be associated with its atypical, diverse clinical features and pediatricians’ poor recognition. Pediatricians must be aware of the possibility of KD in adolescents.

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Outcome of endovascular treatment within and beyond 6 h without perfusion software

Scientific Reports ◽

10.1038/s41598-021-84857-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Zhen Jing ◽

Hao Li ◽

Shengming Huang ◽

Min Guan ◽

Yongxin Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Symptom Onset ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Group A ◽

Group B

AbstractEndovascular treatment (EVT) has been accepted as the standard of care for patients with acute ischemic stroke. The aim of the present study was to compare clinical outcomes of patients who received EVT within and beyond 6 h from symptom onset to groin puncture without perfusion software in Guangdong district, China. Between March 2017 and May 2018, acute ischemic stroke patients who received EVT from 6 comprehensive stroke centers, were enrolled into the registry study. In this subgroup study, we included all patients who had acute proximal large vessel occlusion in the anterior circulation. The demographic, clinical and neuroimaging data were collected from each center. A total of 192 patients were included in this subgroup study. They were divided into two groups: group A (n = 125), within 6 h; group B (n = 67), 6–24 h from symptom onset to groin puncture. There were no substantial differences between these two groups in terms of 90 days favorable outcome (modified Rankin scale [mRS] ≤ 2, P = 0.051) and mortality (P = 0.083), and the risk of symptomatic intracranial hemorrhage at 24 h (P = 0.425). The NIHSS (median 16, IQR12-20, group A; median 12, IQR8-18, group B; P = 0.009) and ASPECTS (median 10, IQR8-10, group A; median 9, IQR8-10, group B; P = 0.034) at baseline were higher in group A. The anesthesia method (general anesthesia, 21.3%, group A vs. 1.5% group B, P = 0.001) were also statistically different between the two groups. The NIHSS and ASPECTS were higher, and general anesthesia was also more widely used in group A. Clinical outcomes were not significantly different within 6 h versus 6–24 h from symptom onset to groin puncture in this real world study.

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369. Clinical Characteristics of the First 177 Patients Admitted with COVID-19 at a Bronx Community Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.564 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S254-S254

Author(s):

Victoria Bengualid ◽

Maria Martinez ◽

Zhenisa Hysenaj ◽

Debra M Willner ◽

Judith Berger

Keyword(s):

Oxygen Saturation ◽

Clinical Characteristics ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Altered Mental Status ◽

Channel Blockers ◽

First Case ◽

Overall Mortality

Abstract Background The first case of COVID-19 was admitted on March 15th 2020 to our community based hospital in the Bronx, NY. The aim of this study is to describe the clinical characteristics and outcome of these first COVID-19 patients. Patient Characteristics and Outcome Methods IRB approved retrospective chart review study of all COVID-19 patients admitted during March 2020 focusing on patient characteristics, co-morbidities, clinical manifestations and outcome. Results A total of 177 patients were admitted during March 2020: 57% African American 23.1% Hispanic and 16.9% White. 44.9% female, average age 60 years, and 90% had at least one comorbidity. Outcome was available on all patients except for one who was transferred to another institution for ECMO. Overall mortality was 33%. Clinical presentation: 69.4% presented with cough or shortness of breath, 15.8% with diarrhea, nausea, vomiting or abdominal pain, and 14.6% with myalgia, dizziness or altered mental status. 6.2% presented only with fever. However 59.8% of patients presented with fever and respiratory or gastrointestinal symptoms. Mortality The table compares patients who died vs discharged (either home or to a short term facility). Those that were 65 years or older, hypertensive or presented to the ER with an oxygen saturation of 94% or lower, were more likely to die. Ventilated patients: 31.6% of patients were intubated with a mortality rate of 77%. 22% of these patients were intubated in the first 24 hours. Compared to non-intubated patients, there was no difference in BMI, diabetes, hypertension, COPD/Asthma, use of statins, aspirin or calcium channel blockers. Intubated patients older than 64 years had significantly higher mortality rates (p=0.0001). Conclusion This cohort of COVID-19 patients is unique as almost all received Hydroxychloroquine and Azithromycin. Only 9% received steroids and even fewer received an interleukin-6 inhibitor, convalescent plasma or Remdesivir. African Americans and Hispanics accounted for 80% of patients. Greater than 90% received Medicaid. Overall mortality was 33%. The most common presentation was respiratory followed by gastrointestinal symptoms. The overall mortality was 33% but increased to 77% in intubated patients. Age, hypertension, and ER oxygen saturation correlated with mortality. Disclosures All Authors: No reported disclosures

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Palmoplantar psoriasis: a comparative therapeutic study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194668 ◽

2019 ◽

Vol 5 (4) ◽

pp. 779

Author(s):

Sathya Narayanan Rajendran ◽

Sukanya Mathupal Gurusamy

Keyword(s):

Treatment Options ◽

Clinical Manifestations ◽

Simple Random Sampling ◽

Inflammatory Dermatosis ◽

Duration Of Illness ◽

Erythrodermic Psoriasis ◽

Life Threatening ◽

Group A ◽

Group B ◽

Therapeutic Study

Background: Psoriasis is an immunologically mediated inflammatory dermatosis presenting with extremely variable clinical manifestations ranging from indolent lesions to life threatening forms of pustular and erythrodermic psoriasis. Palmoplantar psoriasis present as hyperkeratotic scaly plaques with fissures and can be managed with different treatment forms. This study was done to compare the efficacy between topical and systemic treatment options.Methods: The study was conducted in a tertiary level teaching hospital after ethical committee clearance. Fifty patients with palmoplantar psoriasis were allocated into the two groups using simple random sampling. PPPASI scoring was calculated to assess the extent of involvement. Patients in Group A were prescribed calcipotriol with clobetasol propionate ointment. Group B patients were given tablet methotrexate.Results: Twenty eight patients were males M: F of 1.27: 1. Mean age was 36. Mean duration of illness was eleven months. Most of these patients were manual laborers. 32 patients had lesions over both palms and soles, 9 over palms alone and 9 involving soles alone. Mean PASI reduction at 16 weeks was seen maximum with methotrexate. Compliance was comparatively good with methotrexate than topical. Though mean PASI reduction and compliance was good, relapse rates were higher with methotrexate in our study.Conclusions: There was no significant change in clinico-epidemiology and presentation of palmoplantar psoriasis. Methotrexate was observed to be the more efficacious modality in treating palmoplantar psoriasis.

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Genome-wide variations of SARS-CoV-2 infer evolution relationship and transmission route

10.1101/2020.04.27.20081349 ◽

2020 ◽

Cited By ~ 3

Author(s):

Lehai Zhang ◽

Shifu Wang ◽

Qian Ren ◽

Junjie Yang ◽

Yanqin Lu ◽

...

Keyword(s):

Molecular Detection ◽

Detection Efficiency ◽

Evolutionary Relationship ◽

Clinical Manifestations ◽

Coding Region ◽

Gene Coding ◽

Genome Wide ◽

Group A ◽

Group B ◽

Relationship Of

AbstractIn the epidemic evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the issues of mutation, origin, typing and the effect of mutation on molecular detection remain to be unrevealed. In order to identify the evolutionary relationship of SARS-CoV-2 and evaluate the detection efficiency of primers that are currently used in different countries, we retrieved genomic sequences of 373 SARS-CoV-2 strains from multiple databases and performed genome-wide variation analysis. According to the nucleotide C28144T variation, the SARS-CoV-2 can be divided into group A (117 strains) and group B (256 strains). The spike protein gene (S gene) coding region 1841 (total 23403) A1841G, formed a B1 subgroup (40 strains) in group B, of which 30 strains were from European and American countries in March (especially Washington, USA). These mutations are likely to be influenced by the environment or the immunization selection pressure of different populations. Although the mutation is not in the receptor binding region (RBD) and alkaline cleavage region, it may also affect the ability of transmission and pathogenicity; however, the significance is not yet clear. As the ratio of A / B strains in the epidemic months showed an increasing trend (0.35: 1 in January, 0.62: 1 in February and 0.76: 1 in March), it seems that the transmissibility of group A strains becomes stronger with time. Based on the variation of 11 nucleotide sites during the epidemic process, it is speculated that the Washington strain is more like an ancestor type, and the Wuhan strain is the offspring of the group A virus strain. By comparing the detection capabilities of primers in different countries, the SARS-CoV-2 nucleotide variation may only affect molecular detection of very few strains. The differences in the transmissibility, pathogenicity and clinical manifestations of different types of strains require further investigations.

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Abstract O.39: The Incidence Of Abnormal Electroencephalographic Findings And Mild Encephalitis/encephalopathy With A Reversible Splenial Lesion In Kawasaki Disease

Circulation ◽

10.1161/circ.131.suppl_2.o39 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Naomi Nakagawa ◽

Masahiro Kamada ◽

Yukiko Ishiguchi ◽

Yuji Moritoh ◽

Kengo Okamoto

Keyword(s):

Kawasaki Disease ◽

Therapy Response ◽

Ivig Therapy ◽

Liver Disorder ◽

Neurological Symptoms ◽

Splenial Lesion ◽

First Case ◽

Consciousness Disturbance ◽

Group A ◽

Group B

Background: Central nervous system inflammation sometimes occurs in Kawasaki disease (KD). In 2012, we reported the first case of KD complicated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a 14-year-old. Since then, similar cases have been reported. We studied the incidence of KD complicated with encephalitis/encephalopathy and MERS. Methods: We selected 36 patients (22 boys and 14 girls; age: range, 5-80 months; mean, 22 months) from 42 patients who had undergone electroencephalography (EEG) before intravenous immunoglobulin (IVIG) therapy between May 2013 and August 2014. Patients with and without abnormal EEG findings were assigned to groups A and B, respectively. Age; sex; time of diagnosis; neurological symptoms; N-terminal pro-brain natriuretic peptide, serum procalcitonin, serum sodium, serum albumin, and C-reactive protein (CRP) levels; liver disorder, coronary artery lesion, and IVIG therapy response were examined. Results: Group A comprised 6 patients (17%); and group B, 30 patients (83%). Consciousness disturbance was noted in 5 of 6 patients with abnormal EEG findings, without sequelae. Patients in group A were significantly older (56.5±16.8 vs 25.0±19.9 months ) and had higher CRP levels than those in group B (12.3±5.62 vs 6.56±3.47 mg/dL ). No other parameters showed significant differences. Magnetic resonance imaging revealed edema in 2 of 5 patients and MERS in the remaining patient in group A. Pleocytosis was noted in 1 of 4 patients in group A. Cytokine Il-6 and INF-γ levels were very high in the patient with MERS. Conclusion: EEG findings indicating central nerve disorders were noted in 17% patients, a lower incidence than that reported by Mitudome et al . We performed EEG early before IVIG therapy; thus, central nerve symptoms encountered may have occurred in the early stages of the disorders. MERS was noted in 1 of 6 patients with abnormal EEG findings, or 2 of 9 patients if past cases with neurological symptoms were included, suggesting that central nerve complications occur in a certain group of KD patients.

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Abstract TP52: Endovascular Therapy in Patients Over 80 Years of Age With Acute Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp52 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Janhavi M Modak ◽

Syed Daniyal Asad ◽

Jussie Lima ◽

Amre Nouh ◽

Ilene Staff ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Symptom Onset ◽

Time Window ◽

Extended Time ◽

Stroke Patients ◽

Stroke Outcomes ◽

Stroke Treatment ◽

Group A ◽

Group B

Introduction: Acute ischemic stroke treatment has undergone a paradigm shift, with patients being treated in the extended time window (6-24 hours post symptom onset). The purpose of this study is to assess outcomes in stroke patients above 80 years of age undergoing endovascular treatment (EVT) in the extended time window. Methods: Acute ischemic stroke patients presenting to Hartford Hospital between January 2017 to June 2019 were considered for the study. Stroke outcomes in patients above 80 years of age with anterior circulation ischemic strokes presenting in the extended time window (Group A, n=30) were compared to a younger cohort of patients below 80 years (Group B, n=31). Patients over 80 years treated in the traditional time window (within 6 hours of symptom onset) served as a second set of controls (Group C, n=40). Statistical analysis was performed with a significance level of 0.05 Results: For angiographic results, there were no statistically significant differences in terms of good outcomes (TICI 2b-3) among patients of Group A, when compared to Groups B or C (p>0.05). For the endovascular procedures, no significant differences were noted in the total fluoroscopy time (Median Group A 44.05, Group B 38.1, Group C 35.25 min), total intra-procedure time (Median Group A 144, Group B 143, Group C 126 min) or total radiation exposure (Median Group A 8308, Group B 8960, Group C 8318 uGy-m 2 ). For stroke outcomes, a good clinical outcome was defined as modified Rankin score of 0-2 at discharge. Significantly better outcomes were noted in the younger patients in Group B - 35.4%, when compared to 13.3% in Group A (p=0.03). Comparative outcomes differed in the elderly patients above 80 years, Group A -13.3% vs Group C - 25%, although not statistically significant (p=0.23). There was a significant difference in mortality in patients of Group A - 40% as compared to 12% in the younger cohort, Group B (p= 0.01). Conclusions: In the extended time window, patients above 80 years of age were noted to have a higher mortality, morbidity compared to the younger cohort of patients. No significant differences were noted in the stroke outcomes in patients above 80 years of age when comparing the traditional and the extended time window for stroke treatment.

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