Radiological and clinical characteristics of 22 suspected COVID-19 patients with multiple negative RT-PCR testing

Abstract This study aims to investigate radiological and clinical characteristics of suspected COVID-19 patients with negative RT-PCR testing. 22 suspected COVID-19 patients with 2-5 negative RT-PCR testing were enrolled. The most common symptoms at onset included fever (18[81.8%] patients), fatigue (16[72.7%]) and cough (12[54.5%]). 20(90.9%) patients were with normal or decreased Leukocyte count, 17 (77.3%) with decreased Lymphocyte count, 16 (72.7%) and 18 (81.8%) with increased level of C-reactive protein and D-dimers, respectively. Ground-glass opacity (GGO) (22[100]), reticular/interlobular septal thickening (11 [50%]) and consolidation (14 [63.6%)) with predominantly bilateral and peripheral distribution were typical findings at initial CT scan. The CT score of right lower lobe was significantly higher than right upper lobe (P=0.042). The total CT scores of group 2, 3, 4 (2nd week, 3rd week, 4th week and after) were significantly higher than group 1 (1st week) (P＜0.01,for all). After rapid progression at first week, the most extensive pulmonary involvement emerged at second week after symptom onset, then the involvement gradually decreased. Given the clinical symptoms, laboratory results and typical radiological manifestations, even suspected COVID-19 patients with multiple negative RT-PCR testing deserve great concern for active management.

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Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran

Archives of Iranian Medicine ◽

10.34172/aim.2020.102 ◽

2020 ◽

Vol 23 (11) ◽

pp. 766-775

Author(s):

Seyed Farshad Allameh ◽

Saeed Nemati ◽

Reza Ghalehtaki ◽

Esmaeil Mohammadnejad ◽

Seyed Mojtaba Aghili ◽

...

Keyword(s):

Clinical Characteristics ◽

Clinical Symptoms ◽

Risk Groups ◽

Severe Form ◽

Capital City ◽

Rt Pcr ◽

C Reactive Protein ◽

Reactive Protein ◽

History Of ◽

Elevated Lactate

Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters. Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63–38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06–10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00–8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64–3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07–2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study. Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups.

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CT features and artificial intelligence quantitative analysis of recovered COVID-19 patients with negative RT-PCR and clinical symptoms

10.21203/rs.3.rs-21021/v1 ◽

2020 ◽

Author(s):

Siyao Du ◽

Si Gao ◽

Guoliang Huang ◽

Shu Li ◽

Wei Chong ◽

...

Keyword(s):

Artificial Intelligence ◽

Quantitative Analysis ◽

Clinical Symptoms ◽

Lower Lobe ◽

Ground Glass Opacity ◽

Imaging Features ◽

Rt Pcr ◽

Ct Value ◽

Novel Coronavirus

Abstract Objectives: To evaluate imaging features and performed quantitative analysis for mild novel coronavirus pneumonia (COVID-19) cases ready for discharge.Methods: CT images of 125 patients (16-67 years, 63 males) recovering from COVID-19 were examined. We defined the double-negative period (DNp) as the period between the sampling days of two consecutive negative RT-PCR and three days thereafter. Lesion demonstrations and distributions on CT in DNp (CTDN) were evaluated by radiologists and artificial intelligence (AI) software. Major lesion transformations and the involvement range for patients with follow-up CT were analyzed.Results: Twenty (16.0%) patients exhibited normal CTDN; abnormal CTDN for 105 indicated ground-glass opacity (GGO) (99/125, 79.2%) and fibrosis (56/125, 44.8%) as the most frequent CT findings. Bilateral-lung involvement with mixed or random distribution was most common for GGO on CTDN. Fibrous lesions often affected both lungs, tending to distribute on the subpleura. Follow-up CT showed lesion improvement manifesting as GGO thinning (40/40, 100%), fibrosis reduction (17/26, 65.4%), and consolidation fading (9/11, 81.8%), with or without range reduction. AI analysis showed the highest proportions for right lower lobe involvement (volume, 12.01±35.87cm3; percentage; 1.45±4.58%) and CT-value ranging –570 to –470 HU (volume, 2.93±7.04cm3; percentage, 5.28±6.47%). Among cases with follow-up CT, most of lung lobes and CT-value ranges displayed a significant reduction after DNp.Conclusions: The main CT imaging manifestations were GGO and fibrosis in DNp, which weakened with or without volume reduction. AI analysis results were consistent with imaging features and changes, possibly serving as an objective indicator for disease monitoring and discharge.

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Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

BMC Infectious Diseases ◽

10.1186/s12879-021-06214-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Israel Júnior Borges do Nascimento ◽

Dónal P. O’Mathúna ◽

Thilo Caspar von Groote ◽

Hebatullah Mohamed Abdulazeem ◽

Ishanka Weerasekara ◽

...

Keyword(s):

Systematic Reviews ◽

Troponin I ◽

Clinical Symptoms ◽

Meta Analysis ◽

Severe Disease ◽

Ground Glass Opacity ◽

Cochrane Library ◽

Reactive Protein ◽

Overview Of Systematic Reviews ◽

The Impact

Abstract Background Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic. Methods Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes. Results Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%. Conclusions In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

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Clinical outcomes of hemodialysis patients infected with severe acute respiratory syndrome coronavirus 2 and impact of proactive chest computed tomography scans

Clinical Kidney Journal ◽

10.1093/ckj/sfaa086 ◽

2020 ◽

Vol 13 (3) ◽

pp. 328-333 ◽

Cited By ~ 3

Author(s):

Rui Wang ◽

Hong He ◽

Cong Liao ◽

Hongtao Hu ◽

Chun Hu ◽

...

Keyword(s):

Computed Tomography ◽

Invasive Mechanical Ventilation ◽

Case Series ◽

Ground Glass Opacity ◽

High Sensitivity ◽

Chest Ct ◽

Maintenance Hemodialysis ◽

Rt Pcr ◽

Chest Computed Tomography ◽

Reactive Protein

Abstract Background Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide. Methods We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans. Results Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead. Conclusions Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.

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A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias

Clinical Infectious Diseases ◽

10.1093/cid/ciaa247 ◽

2020 ◽

Vol 71 (15) ◽

pp. 756-761 ◽

Cited By ~ 95

Author(s):

Dahai Zhao ◽

Feifei Yao ◽

Lijie Wang ◽

Ling Zheng ◽

Yongjun Gao ◽

...

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Severe Pneumonia ◽

Ground Glass Opacity ◽

Chest Ct ◽

Rt Pcr ◽

Bilateral Involvement ◽

Radiological Features ◽

History Of ◽

Novel Coronavirus

Abstract Background A novel coronavirus (COVID-19) has raised world concern since it emerged in Wuhan, China in December 2019. The infection may result in severe pneumonia with clusters of illness onsets. Its impacts on public health make it paramount to clarify the clinical features with other pneumonias. Methods Nineteen COVID-19 and 15 other patients with pneumonia (non-COVID-19) in areas outside of Hubei were involved in this study. Both COVID-19 and non-COVID-19 patients were confirmed to be infected using throat swabs and/or sputa with/without COVID-2019 by real-time RT-PCR. We analyzed the demographic, epidemiological, clinical, and radiological features from those patients, and compared the differences between COVID-19 and non-COVID-19. Results All patients had a history of exposure to confirmed cases of COVID-19 or travel to Hubei before illness. The median (IQR) duration was 8 (6–11) and 5 (4–11) days from exposure to onset in COVID-19 and non-COVID-19 cases, respectively. The clinical symptoms were similar between COVID-19 and non-COVID-19. The most common symptoms were fever and cough. Fifteen (78.95%) COVID-19 but 4 (26.67%) non-COVID-19 patients had bilateral involvement while 17 COVID-19 patients (89.47%) but 1 non-COVID-19 patient (6.67%) had multiple mottling and ground-glass opacity on chest CT images. Compared with non-COVID-19, COVID-19 presents remarkably more abnormal laboratory tests, including AST, ALT, γ-GT, LDH, and α-HBDH. Conclusions The COVID-19 infection has onsets similar to other pneumonias. CT scan may be a reliable test for screening COVID-19 cases. Liver function damage is more frequent in COVID-19 than non-COVID-19 patients. LDH and α-HBDH may be considerable markers for evaluation of COVID-19.

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Changes in the Clinical Characteristics of 62 Patients Who Died from Coronavirus Disease 2019

BioMed Research International ◽

10.1155/2020/3280908 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Jingli Chen ◽

Jishi Ye ◽

Hui Li ◽

Zhongyuan Xia ◽

Hong Yan

Keyword(s):

Disease Progression ◽

Median Time ◽

Symptom Onset ◽

Clinical Characteristics ◽

Multiple Organ ◽

Rapid Progression ◽

Cytokine Storm ◽

Reactive Protein ◽

Clinical Changes

Background. Since the first reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in December 2019 in Wuhan, China, the virus has spread to other parts of China and across the world. Although a few studies have assessed the clinical course of coronavirus disease 2019 (COVID-19), the changes in clinical characteristics during disease progression remain unclear. Methods. We retrospectively analyzed the clinical characteristics of 62 patients who died from COVID-19 at the Central Hospital of Wuhan between January 26 and February 17, 2020. We compared the clinical features on admission and at the last follow-up before death. Results. Of the 62 patients with COVID-19, 41 (66%) patients were male, and 21 (34%) were female. The median age was 72 years (interquartile range (IQR), 54-88), and 45 (72.5%) patients had preexisting conditions. The median time from symptom onset to the first visit at the clinic was three days, while the median time from symptom onset to death was 18.5 days. During disease progression, the amounts of arterial gases worsened, and liver, renal, and heart dysfunction was observed. Due to the cytokine storm, infection-related biomarkers, including lactic acid, C-reactive protein, and interleukine-6, gradually worsened during hospitalization. Conclusion. Our findings suggest that during hospitalization, many COVID-19 patients experienced multiple organ dysfunction and cytokine storm. The time from symptom onset to death was only 18.5 days, highlighting the disease’s rapid progression. The better understanding of the clinical changes during disease progression might provide further insight into the COVID-19 pathophysiology.

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Clinical features and laboratory inspection of novel coronavirus pneumonia (COVID-19) in Xiangyang, Hubei

10.1101/2020.02.23.20026963 ◽

2020 ◽

Cited By ~ 14

Author(s):

Weiliang Cao ◽

Li Shi ◽

Lin Chen ◽

Xuemei Xu ◽

Zirong Wu

Keyword(s):

Risk Factor ◽

Clinical Symptoms ◽

White Blood Cells ◽

Ground Glass Opacity ◽

C Reactive Protein ◽

Normal Range ◽

Reactive Protein ◽

Cell Counts ◽

Severe Group ◽

Novel Coronavirus

AbstractBackgroundSince December 2019, a novel coronavirus pneumonia (COVID-19) rapidly spread in China, reached multiple continents currently.We aimed to reveal the infectious characteristics of COVID-19 that provide more information for the research of novel coronavirus.MethodsWe performed a retrospective study on the clinical characteristics of 128 COVID-19 cases with laboratory-confirmed from Xiangyang No 1 Hospitalad during January 2020 to 16 February 2020.ResultsFemale patients account for 53.1%. The aged below 20 years that accounts for 1.6% of overall patients. The aged in 21∼50, 51∼65, over 66 years were accounts for 44.5%, 35.1%,18.8%, respectively. In the difference age spectrum, all severe groups compared with non-severe groups were difference significantly (P < 0.01). 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).ConclusionsOur data provide more information that advanced age, lower lymphocytes levels at the diagnosed COVID-19 patients may be a risk factor for unfavourable prognosis. The white blood cells and C-reactive protein level elevated in severe COVID-19 patients may be accompanying bacterial infection. 2019-nCov may be carries a risk factor of impaired liver and kidney function.

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Clinical and CT manifestations of coronavirus disease 2019 (COVID-19): comparison of suspected cases of COVID-19 in isolation and non-COVID-19 pneumonia in a single-center study conducted in Beijing, China

10.21203/rs.3.rs-27288/v1 ◽

2020 ◽

Author(s):

Heng Liu ◽

Weihua Li ◽

Lei Zhang ◽

Bing Liu ◽

Chaoying Qi ◽

...

Keyword(s):

Clinical Symptoms ◽

Posterior Part ◽

Lower Lobe ◽

Imaging Features ◽

Group Iii ◽

Reactive Protein ◽

Group I ◽

Laboratory Test Results ◽

Single Center Study ◽

Centrilobular Nodule

Abstract Background: The clinical and CT manifestations of COVID-19 pneumonia and non-COVID-19 pneumonia in the same period have not been compared in detail. The purpose of this study is to analyze the clinical and CT manifestations of COVID-19 pneumonia and perform a comparison of those isolated patients for presumed COVID-19 infection and of non-COVID-19 pneumonia in the same period.Methods: 173 patients with pneumonia from January 1, 2020 to March 20, 2020 were retrospectively enrolled and classified into three groups: patients with COVID-19 pneumonia (Group I, N=4), patients in hospital-isolation for presumed COVID-19 pneumonia (Group Ⅱ, N=5), and patients with non-COVID-19 pneumonia (Group III, N=163). Clinical symptoms, laboratory test results and CT imaging features were compared among three groups.Results: Fever and cough were the most common clinical symptoms in the three groups. 30/163 (18.4%) patients were asymptomatic in Group III. Leukopenia, lymphocytopenia, and elevated C-reactive protein was identified in 1 (25%), 1 (25%), and 1 (25%) patient in Group I; 1 (20%), 1 (20%), and 2 (40%) patients in Group II; 10/157 (6.4%), 33/157(21.0%), and 94/136 (69.1%) patients in Group III. Demarcated GGO/mixed GGO, ill-defined GGO/mixed GGO, consolidation, centrilobular nodule, tree-in bud opacity, bilateral involvement, peripheral distribution, posterior part/lower lobe predilection was observed in 3/4 (75%), 2/4 (50%), 4/4 (100%), 2/4 (50%), 0, 3/4 (75%), 3/4 (75%), and 2/4 (50%) patients, respectively in Group I; 1/5 (20%), 5/5 (100%), 4/5 (80%), 4/5 (80%), 3/5 (60%), 4/5 (80%), 2/5 (40%), and 3/5 (60%) patients in Group Ⅱ; 1/163 (0.6%), 87/163 (54.3%), 115/163 (70.6%), 117/163 (71.8%), 95/163 (58.3%), 52/163 (31.9%), 9/163 (5.5%), and 9/163 (5.5%) patients in Group III, respectively.Conclusions: Demarcated GGO and consolidation prefer the diagnosis of COVID-19 pneumonia, whereas ill-defined GGO and consolidation, centrilobular nodule surrounded by GGO, and tree-in-bud opacity are preferred for non-COVID-19 pneumonia. chest CT has potential in early identification of COVID-19 and implementation of isolation for appropriate case.

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Chest CT changes in COVID-19 patients with hypertension comorbidities

10.21203/rs.3.rs-30394/v1 ◽

2020 ◽

Author(s):

Wei Li ◽

Wenjun Yu ◽

Jianwei Liao ◽

Yijie Fang ◽

Lin Yao ◽

...

Keyword(s):

Global Health ◽

Clinical Features ◽

Clinical Data ◽

Clinical Characteristics ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Relationship Of ◽

Pcr Test

Abstract AIMTo summarize the chest CT and clinical features of COVID-19 pneumonia patients with hypertension comorbidities.METHODSThe initial chest CT imaging and clinical data of 15 confirmed COVID-19 patients with hypertension comorbidities treated in our hospital were analyzed retrospectively from January 1, 2019 to February 14, 2020. The chest CT images and clinical data were reviewed and their relationship of the disease was analyzed.RESULTSTotally 15 COVID-19 patients diagnosed with hypertension comorbidities were included. In terms of clinical characteristics, 14/15 (93.3%) of patients had characteristics of clustering onset, and the positive rates of the first RT-PCR test and the initial CT were 80% and 93% respectively. The most frequent CT abnormality observed was ground glass opacity (GGO) (13/15, 86.7%), including patchy/ punctate GGO and large/multiple GGO. Most of the lesions were multiple, and 60% of them involved 4-5 lobes. Most patients present with bilateral CT onset (12,80.0%), and most present with subpleural distribution (10,66.7%). The average CT score is 13.7, and 40% of the patients exceeded 20 points.CONCLUSIONThe common chest CT findings in COVID-19 patients with hypertension comorbidities are GGO, most of which at present with bilateral CT onset and subpleural distribution. CT is indispensable in the diagnosis and evaluation of this global health emergency.

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COVID-19 in Iran, a comprehensive investigation from exposure to treatment outcomes

10.21203/rs.3.rs-26339/v1 ◽

2020 ◽

Cited By ~ 2

Author(s):

Mohammad Ali Ashraf ◽

Nasim Shokouhi ◽

Elham Shirali ◽

Fateme Davari-tanha ◽

Omeed Memar ◽

...

Keyword(s):

Clinical Symptoms ◽

Treatment Options ◽

Age Groups ◽

Clinical Manifestations ◽

Ground Glass Opacity ◽

Post Discharge ◽

Reactive Protein ◽

Presenting Symptoms ◽

Discharged Patients ◽

Symptom Relapse

Abstract Background There is a growing need for information regarding the recent coronavirus disease of 2019 (Covid-19). We present a comprehensive report of Covid-19 patients in Iran.Methods One hundred hospitalized patients with Covid-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and post-discharge follow-up were analyzed.Results The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), lymphocytopenia (74.2 %) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in CT scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom relapse, (8.6%) were readmitted to the hospital, and 3 patients (4.3%) died.Conclusions This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with Covid-19. The most common presenting symptoms are non-specific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom relapse.

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