Clinical Presentation, Laboratory Findings, Complications, and Mortality of Influenza During the Epidemic of October 2019-February 2020 in Iran

Background: Influenza is one of the most important viruses and causes millions of infections and 290-600 thousands deaths annually. We aimed to evaluate the hospitalization rates due to complications caused by the influenza virus (pneumonia, seizures, sinusitis, otitis, myositis and encephalitis), the frequency of clinical signs, and laboratory findings in children under 15 years of age infected with Influenza.Methods: We conducted a cross-sectional study during the Influenza epidemic in Qom, Iran, from October 2019 to February 2020. Children under 15 years of age with the definitive diagnosis of influenza obtained by polymerase chain reaction (PCR) test were included.Results: Out of 1225 patients who referred to us with flu-like symptoms; 1172 patients were referred by the emergency department and our hospital clinic but 53 patients were referred to us by other paediatricians. 375 patients (30.61%) who had a positive PCR test result for influenza and suffered from complications caused by the virus were hospitalized.The number of male hospitalized patients was 231 (61.6% of hospitalized patients) and the number of female hospitalized patients was 144 (38.4% of hospitalized patients) respectively.The highest age range of patients with pneumonia was of 13 months to 3 years with a hospitalization rate of 36.41% and the lowest hospitalization rate was of 12 years to 15 years with a hospitalization rate of 0.84%.The most serious complication observed in patients caused by the influenza virus was pneumonia; with 17 cases (4.53%) reported.89.6% of patients had fever at the time of referral causing it to be the most common clinical symptom among patients. Cough ranked second with 76.8%.Lymphopenia and leukopenia was recognized as the most common laboratory findings with a frequency of 26.33% and 21.85%.Conclusions: Complications of influenza was not uncommon in children and affected a fifth of the patients. The influenza epidemic of October 2019- February 2020 imposed a heavy burden on our hospital and the learned lessons should be implemented to further assist the physicians in future influenza epidemic.

Clinical determinants of coronavirus disease COVID-19 manifestation

The article presents the review of modern publications on the assessment of the factors which have impact on susceptibility, clinical course and outcomes of COVID-19 infection. Statistical data on rate of increased blood pressure and adverse clinical signs of infection disease in different populations are shown. The important role of angiotensin-converting enzyme 2 as functional cellular receptor for coronavirus and its participation in multiple systemic manifestations of COVID-19 are presented. The mechanisms of damage effects of cigarette smoking in virus pneumonia have been described. According to literature data, the relationship between metabolic disorders related to obesity and risk of severe coronavirus course is emphasized. From a pathophysiological point of view, an explanation is given for the occurrence of threatening complications in patients with a new coronavirus infection in the presence of diabetes mellitus — massive lung damage, acute respiratory distress syndrome, prothrombotic condition, venous and arterial thrombosis.

Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study

Background Thousands of Coronavirus Disease 2019 (COVID-19) patients have been discharged from hospitals Persistent follow-up studies are required to evaluate the prevalence of post-COVID-19 fibrosis. Methods This study involves 462 laboratory-confirmed patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital from January 11, 2020 to April 26, 2020. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 287 patients were followed up from 90 to 150 days after the onset of the disease, and lung function tests were conducted about three months after the onset. The risk factors affecting the persistence of pulmonary fibrosis were identified through regression analysis and the prediction model of the persistence of pulmonary fibrosis was established. Results Parenchymal bands, irregular interfaces, reticulation and traction bronchiectasis were the most common CT features in all COVID-19 patients. During the 0–30, 31–60, 61–90, 91–120 and > 120 days after onset, 86.87%, 74.40%, 79.56%, 68.12% and 62.03% patients developed with pulmonary fibrosis and 4.53%, 19.61%, 18.02%, 38.30% and 48.98% patients reversed pulmonary fibrosis, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. A predictive model of the persistence with pulmonary fibrosis was developed based-on the Logistic Regression method with an accuracy, PPV, NPV, Sensitivity and Specificity of the model of 76%, 71%, 79%, 67%, and 82%, respectively. More than half of the COVID-19 patients revealed abnormal conditions in lung function after 90 days from onset, and the ratio of abnormal lung function did not differ on a statistically significant level between the fibrotic and non-fibrotic groups. Conclusions Persistent pulmonary fibrosis was more likely to develop in patients with older age, higher BMI, severe/critical condition, fever, a longer viral clearance time, pre-existing disease and delayed hospitalization. Fibrosis developed in COVID-19 patients could be reversed in about a third of the patients after 120 days from onset. The pulmonary function of less than half of COVID-19 patients could turn to normal condition after three months from onset. An effective prediction model with an average area under the curve (AUC) of 0.84 was established to predict the persistence of pulmonary fibrosis in COVID-19 patients for early diagnosis.

Non-arteritic anterior ischaemic optic neuropathy sequential to SARS-CoV-2 virus pneumonia: preventable by endothelial protection?

We present a case of non-arteritic anterior ischaemic optic neuropathy (NAION) with no ocular or systemic risk factors in a patient who recovered from a recent SARS-CoV-2 pneumonia. NAION is the most common acute optic neuropathy among individuals over 50 years of age. It results from a transient hypoperfusion of the optic nerve head circulation, especially in patients with low vascular compliance due to ocular or systemic risk factors. We attribute the ophthalmological condition to a SARS-CoV-2 virus-associated endotheliopathy that can be prevented with timely protection of endothelial function with vitamins D and K2.