scholarly journals Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

2021 ◽  
Author(s):  
Mei Zeng ◽  
Xiangdong Jian ◽  
Ning Zhong ◽  
Yu Li ◽  
Zhao Hu ◽  
...  
Keyword(s):  
Clinical Features ◽  
Early Stage ◽  
Extended Period ◽  
Chest Ct ◽  
Critical Group ◽  
Chest Computed Tomography ◽  
Lung Consolidation ◽  
Long Time ◽  
Bilateral Lesions ◽  
Over Time

Abstract Background: COVID-19 had caused more than 2.8 million deaths globally, and the epidemic will persist for an extended period of time. We analyzed clinical features of patients in the early stage of the epidemic, so as to deepen the understanding of the disease.Methods: In this retrospective study, we included 84 confirmed cases of COVID-19 during February 1, 2020 and March 31, 2020. Baseline data were used to classify patients as moderate (57%) or severe/critical based on Chinese protocol. We focused on analyzing the differences in chest computed tomography (CT) between the two groups. Results: Of the 84 cases, 50 were male and the median age was 69 years. 55 (65%) patients had comorbidities at admission, more in the severe/critical group (P=0.040). 94% patients had bilateral lesions on CT, up to 68% had lesions involving all lobes. Ground glass opacification (GGO) (96%), consolidation (44%), Linear opacities (50%) and Air bronchogram (23%) were the mainly lesions. The lesion was gradually absorbed over time, but imaging abnormalities can persist for a long time. Compared with moderate cases, the severe/critical group had more pulmonary consolidation changes (P=0.044) and significantly higher CT severity Score (CTSS) (P=0.040). Lymphocyte counts were significantly lower (P=0.011) and NLR were higher (P=0.029) in severe/critical cases. Conclusions: Chest CT showed bilateral and multiple GGO and consolidation mainly. After treatment, pulmonary lesions were gradually absorbed over time, and imaging abnormalities can be persistent for a long time. Lung consolidation, CTSS, comorbidity, lymphocyte counts, and NLR may be predictors of severe COVID-19.

scholarly journals The role of chest computed tomography in the management of COVID-19: A review of results and recommendations

2020 ◽  
Vol 245 (13) ◽  
pp. 1096-1103 ◽  
Author(s):  
Molly D Wong ◽  
Theresa Thai ◽  
Yuhua Li ◽  
Hong Liu
Keyword(s):  
Computed Tomography ◽  
Early Detection ◽  
Technology Development ◽  
Early Stage ◽  
Chest Ct ◽  
High Rate ◽  
Chest Computed Tomography ◽  
Severity Of The Disease ◽  
The Impact

The rapid and dramatic increase in confirmed cases of COVID-19 has led to a global pandemic. Early detection and containment are currently the most effective methods for controlling the outbreak. A positive diagnosis is determined by laboratory real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing, but the use of chest computed tomography (CT) has also been indicated as an important tool for detection and management of the disease. Numerous studies reviewed in this paper largely concur in their findings that the early hallmarks of COVID-19 infection are ground-glass opacities (GGOs), often with a bilateral and peripheral lung distribution. In addition, most studies demonstrated similar CT findings related to the progression of the disease, starting with GGOs in early disease, followed by the development of crazy paving in middle stages and finally increasing consolidation in the later stages of the disease. Studies have reported a low rate of misdiagnosis by chest CT, as well as a high rate of misdiagnosis by the rRT-PCR tests. Specifically, chest CT provides more accurate results in the early stages of COVID-19, when it is critical to begin treatment as well as isolate the patient to avoid the spread of the virus. While rRT-PCR will probably remain the definitive final test for COVID-19, until it is more readily available and can consistently provide higher sensitivity, the use of chest CT for early stage detection has proven valuable in avoiding misdiagnosis as well as monitoring the progression of the disease. With the understanding of the role of chest CT, researchers are beginning to apply deep learning and other algorithms to differentiate between COVID-19 and non-COVID-19 CT scans, determine the severity of the disease to guide the course of treatment, and investigate numerous additional COVID-19 applications. Impact statement The impact of the COVID-19 pandemic has been worldwide, and clinicians and researchers around the world have been working to develop effective and efficient methods for early detection as well as monitoring of the disease progression. This minireview compiles the various agency and expert recommendations, along with results from studies published in numerous countries, in an effort to facilitate the research in imaging technology development to benefit the detection and monitoring of COVID-19. To the best of our knowledge, this is the first review paper on the topic, and it provides a brief, yet comprehensive analysis.

scholarly journals Dynamic change in lymphocyte count in the early stage is a potential predictor of the severity of COVID-19

2020 ◽  
Author(s):  
Xi Zhang ◽  
Yonghao Du ◽  
Lei Shi ◽  
Tianyan Chen ◽  
Yingren Zhao ◽  
...  
Keyword(s):  
Lymphocyte Count ◽  
Early Stage ◽  
Dynamic Change ◽  
Severe Disease ◽  
Chest Ct ◽  
Dynamic Changes ◽  
Potential Predictor ◽  
Illness Onset ◽  
Over Time ◽  
Severe Patient

Abstract Background Lymphopenia is associated with COVID-19 severity. Herein we describe the dynamic changes in lymphocyte count during hospitalization and explore a possible association with the severity of COVID-19.Methods In this retrospective study, 13 non-severe COVID-19 patients diagnosed at admission were enrolled. One patient progressed to severe disease. Dynamic changes in lymphocyte count and CT score of all patients were analyzed.Results Lymphocyte count changed significantly in the non-severe patients over time (admission vs day 5, P=0.685; day 5 vs day 15, P<0.001). Lymphocyte count of the severe patient fluctuated, and even decreased within the first 12 days post-admission, before increasing gradually. Chest CT scores of nine (75%) non-severe patients on the 5th day of hospitalization were higher than at admission, but decreased gradually thereafter (admission vs day 5, P<0.001, day 5 vs day 15, P=0.004). In the severe patient, CT score continued to increase for 2 weeks after admission, before decreasing gradually.Conclusions Non-severe COVID-19 patients had significantly increased lymphocyte count and decreased CT score 1 week after illness onset. Dynamic change in lymphocyte count in the early stages of COVID-19 may be helpful to identify the patients who are more likely to develop severe or critical illness.

scholarly journals Evaluation of the long-term effect of polyhexamethylene guanidine phosphate in a rat lung model using conventional chest computed tomography with histopathologic analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256756
Author(s):  
Cherry Kim ◽  
Sang Hoon Jeong ◽  
Jaeyoung Kim ◽  
Ja Young Kang ◽  
Yoon Jeong Nam ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Rat Model ◽  
Chest Ct ◽  
P Value ◽  
Chest Computed Tomography ◽  
Polyhexamethylene Guanidine ◽  
Histopathologic Analysis ◽  
Guanidine Phosphate ◽  
Over Time

There have been no studies on the effects of polyhexamethylene guanidine phosphate (PHMG) after a long period of exposure in the rodent model. We aimed to evaluate long-term lung damage after PHMG exposure using conventional chest computed tomography (CT) and histopathologic analysis in a rat model. A PHMG solution was intratracheally administrated to 24 male rats. At 8, 26, and 52 weeks after PHMG instillation, conventional chest CT was performed in all rats and both lungs were extracted for histopathologic evaluation. At 52 weeks after PHMG instillation, four carcinomas had developed in three of the eight rats (37.5%). Bronchiolo-alveolar hyperplasia and adenoma were found in rats at 8, 26, and 52 weeks post-instillation. The number of bronchiolo-alveolar hyperplasia significantly increased over time (P-value for trend< 0.001). The severity of lung fibrosis and fibrosis scores significantly increased over time (P-values for trend = 0.002 and 0.023, respectively). Conventional chest CT analysis showed that bronchiectasis and linear density scores suggestive of fibrosis significantly increased over time (P-value for trend < 0.001). Our study revealed that one instillation of PHMG in a rat model resulted in lung carcinomas and progressive and irreversible fibrosis one year later based on conventional chest CT and histopathologic analysis. PHMG may be a lung carcinogen in the rat model.

scholarly journals The Clinical Manifestations and Chest Computed Tomography Findings of Coronavirus Disease 2019 (COVID-19) Patients in China: A Proportion Meta-Analysis

2020 ◽  
Vol 13 (2) ◽  
pp. 95-105 ◽  
Author(s):  
Joo-Hyun Park ◽  
Wook Jang ◽  
Sang-Woo Kim ◽  
Jeongjun Lee ◽  
Yun-Sung Lim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Features ◽  
Respiratory Infection ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Chest Ct ◽  
Common Symptom ◽  
Chest Computed Tomography ◽  
Screening Programs ◽  
Ct Findings

Objectives. The objectives of this study were to identify the clinical features and chest computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) patients and to compare the characteristics of patients diagnosed in Wuhan and in other areas of China by integrating the findings reported in previous studies.Methods. We conducted a proportion meta-analysis to integrate the results of previous studies identified in online databases, and subsequently compared the overlapping of 95% confidence intervals (CIs) between locations of diagnosis. The heterogeneity of the results of the included studies was also demonstrated.Results. Nine studies with level IV evidence were considered to be eligible for the meta-analysis, and a comparative analysis was only possible between patients diagnosed in Wuhan and outside of Wuhan in China. Fever (84.8%; 95% CI, 78.5% to 90.1%) was identified as the most common clinical manifestation in all COVID-19 patients, and signs of respiratory infection were also frequently present in these patients. When comparing the clinical features according to the location of diagnosis, fever and dyspnea were less frequent in patients diagnosed outside of Wuhan (fever: 78.1%; 95% CI, 73.2% to 82.7%; dyspnea: 3.80%; 95% CI, 0.13% to 12.22%) than in patients diagnosed in Wuhan (fever: 91.7%; 95% CI, 88.0% to 94.8%; dyspnea: 21.1%; 95% CI, 13.2% to 30.3%). The chest CT findings exhibited no significant differences between the groups.Conclusion. Fever was found to be the most common symptom in COVID-19, and respiratory infection signs were also commonly present. Fever and dyspnea were less frequently observed in the patients diagnosed outside of Wuhan, which should be considered in COVID-19 screening programs. These results may be attributable to the earlier diagnosis of the disease and the younger age of patients outside of Wuhan although further analysis is needed. The role of chest CT in COVID-19 diagnosis is inconclusive based on this study.

Continuous Decisions

2020 ◽  
Author(s):  
Seng Bum Michael Yoo ◽  
Benjamin Hayden ◽  
John Pearson
Keyword(s):  
Decision Making ◽  
Control Theory ◽  
Hierarchical Structure ◽  
Action Planning ◽  
Extended Period ◽  
Microeconomic Theory ◽  
Engineering Control ◽  
Over Time ◽  
Academic Study

Humans and other animals evolved to make decisions that extend over time with continuous and ever-changing options. Nonetheless, the academic study of decision-making is mostly limited to the simple case of choice between two options. Here we advocate that the study of choice should expand to include continuous decisions. Continuous decisions, by our definition, involve a continuum of possible responses and take place over an extended period of time during which the response is continuously subject to modification. In most continuous decisions, the range of options can fluctuate and is affected by recent responses, making consideration of reciprocal feedback between choices and the environment essential. The study of continuous decisions raises new questions, such as how abstract processes of valuation and comparison are co-implemented with action planning and execution, how we simulate the large number of possible futures our choices lead to, and how our brains employ hierarchical structure to make choices more efficiently. While microeconomic theory has proven invaluable for discrete decisions, we propose that engineering control theory may serve as a better foundation for continuous ones. And while the concept of value has proven foundational for discrete decisions, goal states and policies may prove more useful for continuous ones.

ADHD with Comorbid Bipolar Disorders: A Systematic Review of Neurobiological, Clinical and Pharmacological Aspects Across the Lifespan

2019 ◽  
Vol 26 (38) ◽  
pp. 6942-6969 ◽  
Author(s):  
Federico Mucci ◽  
Maria Teresa Avella ◽  
Donatella Marazziti
Keyword(s):  
Clinical Features ◽  
Adult Adhd ◽  
Neurodevelopmental Disorder ◽  
Bipolar Disorders ◽  
Mood Stabilizers ◽  
Disruptive Behaviour ◽  
Single Individual ◽  
Pharmacological Management ◽  
Long Time ◽  
The Individual

Background: Attention deficit hyperactivity (ADHD) disorder is a neurodevelopmental disorder characterized by inattention, hyperactivity, disruptive behaviour, and impulsivity. Despite considered typical of children for a long time, the persistence of ADHD symptoms in adulthood gained increasing interest during the last decades. Indeed, its diagnosis, albeit controversial, is rarely carried out even because ADHD is often comorbid with several other psychiatric diosrders, in particular with bipolar disorders (BDs), a condition that complicates the clinical picture, assessment and treatment. Aims: The aim of this paper was to systematically review the scientific literature on the neurobiological, clinical features and current pharmacological management of ADHD comorbid with BDs across the entire lifespan, with a major focus on the adulthood. Discussion: The pharmacology of ADHD-BD in adults is still empirical and influenced by the individual experience of the clinicians. Stimulants are endowed of a prompt efficacy and safety, whilst non-stimulants are useful when a substance abuse history is detected, although they require some weeks in order to be fully effective. In any case, an in-depth diagnostic and clinical evaluation of the single individual is mandatory. Conclusions: The comorbidity of ADHD with BD is still a controversial matter, as it is the notion of adult ADHD as a distinct nosological category. Indeed, some findings highlighted the presence of common neurobiological mechanisms and overlapping clinical features, although disagreement does exist. In any case, while expecting to disentangle this crucial question, a correct management of this comorbidity is essential, which requires the co-administration of mood stabilizers. Further controlled clinical studies in large samples of adult ADHD-BD patients appear extremely urgent in order to better define possible therapeutic guidelines, as well as alternative approaches for this potentially invalidating condition.

Hopf bifurcation for a discontinuous HTLV-1 model

Filomat ◽  
2017 ◽  
Vol 31 (20) ◽  
pp. 6247-6267 ◽  
Author(s):  
Elham Shamsara ◽  
Zahra Afsharnezhad ◽  
Reihaneh Mostolizadeh
Keyword(s):  
Hopf Bifurcation ◽  
Sliding Mode ◽  
Early Stage ◽  
Time Lag ◽  
Discontinuous System ◽  
Steady State Condition ◽  
Ctl Response ◽  
Optimal Drug ◽  
Long Time ◽  
Immunosuppressive Diseases

Developing accurate mathematical models for host immune response in immunosuppressive diseases such as HIV and HTLV-1 are essential to achieve an optimal drug therapy regime. Since for HTLV-1 specific CTL response typically occurs after a time lag, we consider a discontinuous response function to better describe this lagged response during the early stage of the infectious, thus the system of HTLV-1 model will be a discontinuous system. For analyzing the dynamic of the system we use Filippov theory and find conditions in which the Filippov system undergoes a Hopf bifurcation. The Hopf bifurcation help us to find stable and unstable periodic oscillations and can be used to predict whether the CTL response can return to a steady state condition. Also, Hopf bifurcation in sliding mode is investigated. In this case the solutions will remain in the hyper-surface of discontinuity and as a consequence the disease cannot progress, at least for a long time. Finally we use numerical simulations to demonstrate the results by example.

scholarly journals Risk Factors, and Clinical and Etiological Characteristics of Ischemic Strokes in COVID-19-Infected Patients: A Systematic Review of Literature

2021 ◽  
pp. 1-4
Author(s):  
Simone Vidale
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Clinical Features ◽  
Case Reports ◽  
Clinical Severity ◽  
Large Artery ◽  
Causal Association ◽  
Review Of Literature ◽  
Increased Risk ◽  
Long Time

<b><i>Background and Purpose:</i></b> Coronavirus disease 2019 (CO­VID-19) infection is an ongoing pandemic and worldwide health emergency that has caused important changes in healthcare systems. Previous studies reported an increased risk of thromboembolic events, including stroke. This systematic review aims to describe the clinical features and etiological characteristics of ischemic stroke patients with CO­VID-19 infection. <b><i>Method:</i></b> A literature search was performed in principal databases for studies and case reports containing data concerning risk factors, clinical features, and etiological characteristics of patients infected with COVID-19 and suffering from stroke. Descriptive and analytical statistics were applied. <b><i>Results:</i></b> Overall, 14 articles were included for a total of 93 patients. Median age was 65 (IQR: 55–75) years with prevalence in males. Stroke occurred after a median of 6 days from COVID-19 infection diagnosis. Median National of Institute of Health Stroke Scale (NIHSS) score was 19. Cryptogenic (Cry) strokes were more frequent (51.8%), followed by cardioembolic etiology, and they occurred a long time after COVID-19 diagnosis compared with large-artery atherosclerosis strokes (<i>p</i><sub>trend</sub>: 0.03). The clinical severity of stroke was significantly associated with the severity grade of COVID-19 infection (<i>p</i><sub>trend</sub>: 0.03). <b><i>Conclusions:</i></b> Ischemic strokes in COVID-19-infected patients were clinically severe, affecting younger patients mainly with Cry and cardioembolic etiologies. Further multicenter prospective registries are needed to better describe the causal association and the effect of COVID-19 infection on stroke.

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