Novel coronavirus disease with conjunctivitis and conjunctivitis as first symptom: Two cases report

Since January 2020, as ophthalmologists working at the center of the novel coronavirus pneumonia (COVID-19) outbreak in Wuhan, China, we found 3 cases in 30 COVID-19 patients with binocular conjunctivitis.Of them, one case visited for conjunctivitis as a first symptom and then diagnosed as COVID-19 three days later, and two cases visited for binocular conjunctivitis during the COVID-19 onset.In 3 patients, conjunctivitis was manifested as signs of viral conjunctivitis from mild to moderate.The symptoms of two patients disappeared after treatment of antiviral eyedrops for 7 to 10 days and another patient died of COVID-19.Interestingly, although we detected positive viral nucleic acid in the conjunctiva sacs of 2 of other 27 COVID-19 patients by using swabs and RT-PCR technology, no conjunctivitis occurred in these two patients. Key words: Coronavirus; Infection; Novel coronavirus pneumonia; Conjunctivitis

Objective To investigate the CT and clinical features of 2019 novel coronavirus (NCP) pneumonia. Methods Chest CT and clinical data of confirmed 103 patients with 2019 novel coronavirus pneumonia in January 2020, retrospectively. According to diagnosis and treatment of NCP infected pneumonia (trial version 5), all the patients were classified into mild(n=58), severe (n=36) and very severe (n=9) type, and their clinical findings, laboratory examination and CT finding were analyzed. CT features included lesions’ distribution, location, size, shape, edge, number, density, percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations. The CT features of different clinical subtypes were compared using χ2test or Fisher's exact probability. Comparisons between the percentage of pneumonic lesions to total lung volume were computed by using analysis of variance (normal distribution) or Kruskal-Wallis rank sum test (non-normal distribution). Results In terms of clinical manifestations, the patients with severe NCP were more common in elderly men, with a median age of 65 years. Fever was the first symptom in 49 (84%) of 58 patients with NCP, and fever was the first symptom in both severe and critical NCP patients. The incidence of cough in severe (25 / 36, 69%) and critical (6 /9, 67%) NCP patients was higher than that in general (20 /58, 34%). All critical patients have dyspnea. In terms of CT findings, common NCP showed double lung (40/58,71%) multiple (40 / 58,69%) ground glass (31/58,52%) or mixed (25 / 58,43%) lesions (56 / 58,97%); severe and critical NCP showed double lung lesions, heavy NCP mainly showed multiple (34 / 36,96%) patches (33 / 36,92%) mixed density lesions (26 / 36,72%); 9 severe NCP lesions were more than 3 cm Mixed density lesions. The percentage of pneumonia focus in the whole lung volume: the common type (12.5% ± 6.1%) was significantly lower than the severe type (25.9% ± 10.7%) and the critical type (47.2% ± 19.2%) NCP, the difference was statistically significant (P values were < 0.001 and 0.002 respectively), and the severe type NCP was also significantly lower than the critical type (P = 0.032). Conclusions CT and clinical features of different clinical types of NCP pneumonia are different. Chest CT findings have unique characteristic, which can not only make early diagnosis, but also evaluate its clinical course and severity. Key words: Coronavirus infection; Pneumonia; Tomography, X-ray computed

Corona virus disease-19 (COVID-19) outbroke in the end of 2019 in Wuhan and is spreading worldwide, and its pathogeny is 2019 novel corona virus (2019-nCoV). 2019-nCoV mainly causes human respiratory infection and pulmonary inflammation, however, some COVID-19 patients are found to present viral conjunctivitis. Bilateral viral conjunctivitis is an initial symptom in some other cases. It is vital for us to know whether the eye can be directly infected by the virus and the consequence of the viral infection in ocular tissue. 2019-nCoV invades human cells primarily through binding to the angiotensin-converting enzyme 2 (ACE2) receptors. ACE2 expresses not only in lung, kidney, and cardiovascular system, but also in human cornea, conjunctiva, aqueous humor and retina. Therefore, it is crucial to expand our understanding of the infection mechanism and pathogenesis of COVID-19 comprehensively by clarifying the distribution of ACE2 in the eye. ACE2 is not only the receptor of 2019-nCoV, but also a key enzyme in renin-angiotensin system (RAS). RAS, which appears relatively independent in the eye, plays a modulate role in the eye and is associated with many common eye diseases. This article reviews the distribution and clinical significance of ACE2 in ocular tissues. Key words: Angiotensin-converting enzyme 2; Eye; Novel corona virus; Infection; Renin-angiotensin system

Little is known about the Covid-19 transmission through ocular tissue, and more research needs to be carried out in order to confirm its ability to infect ocular tissue and its pathogenic mechanisms. Covid-19 may be detected in the tears and conjunctival secretions in novel coronavirus pneumonia patients with conjunctivitis. This case report shows a severe viral conjunctivitis in a patient diagnosed with Covid-19 on the Diamond Princess ship, characterized by both red, irritated and swollen eyes, with transparent serous secretions, conjunctival chemosis, pseudomembranes of fibrin and inflammatory cells on the tarsal conjunctiva accompanied by preauricular lymph nodes and enlarged submaxillaries.

In the 21st century, human civilization has witnessed three major epidemics caused by Coronaviruses namely severe acute respiratory syndrome coronavirus (SARS CoV) in 2003, Middle East respiratory syndrome coronavirus (MERS CoV) in 2012 and 2019 novel coronavirus (2019 nCoV) or coronavirus disease (COVID 19) in 2019. Among these, COVID-19 has greater transmission and mortality rate. 2019 nCoV belongs to a large family of positive sense single-stranded RNA viruses (+ssRNA) that can be isolated in different animal species. The most communal symptoms of COVID-19 include fever, cough, and shortness of breath during the incubation period (2-14 days) of infection. COVID-19 transmission is occurring from infected humans to close contact with one another through respiratory droplets, coughs, and sneezes of infected person. Moreover, the virus containing surfaces may also transmit the infection. Diagnosis is being carried out by collecting a nasopharyngeal swab or sputum specimen for detection of SARS-CoV-2 RNA by reverse-transcription polymerase chain reaction (RT-PCR). Rapid diagnosing methods are also under development which can diagnose COVID 19 in few minutes to hours. Currently, there is no specific cure or preventive therapeutics available. Hence, based upon limited in-vitro and anecdotal data, Chloroquine, or Hydroxychloroquine, Remdesivir, Lopinavir and Ritonavir are being employed in the management. Search for new specific anti-viral drugs from natural/synthetic origins is under full swing and many of them are currently used as chemotherapeutic drugs under clinical investigation. Yet, there is a strong need for development of vaccine, which may take several months to few years for the development.

Corona virus disease (COVID-19) is an infectious disease caused by a newly discovered corona virus. Most people who fall sick with COVID-19 will experience mild to moderate symptoms and recover without special treatment. The virus that causes COVID-19 is mainly transmitted through droplets generated when an infected person coughs, sneezes, or exhales. These droplets are too heavy to hang in the air, and quickly fall on floors or surfaces. You can be infected by breathing in the virus if you are within close proximity of someone who has COVID-19, or by touching a contaminated surface and then your eyes, nose or mouth. The World Health Organization (WHO) in January 2020 declared outbreak of novel corona virus disease, COVID-19, an international public health emergency. It was stated that there was high COVID-19 spread risk to various other countries across world. According to WHO in March 2020, COVID-19 was characterized as pandemic. However, this sudden crisis is generating great deal of stress, anxiety, and depression throughout the world. Aim: The aim of this study was to assess the psychological impact and various associated factors during the developing COVID-19 situation among both the healthcare and non-healthcare working professionals in India. Materials and Methods: This was an observation-based cross-sectional study conducted during the lockdown period and following the lifting of the lockdown for a total of 3 months duration. A structured questionnaire was send via the (email) electronic mail system to a target population of 350 people. Out of which 300 responded. The questionnaire was comprised of study variables: (a) Gender; (b) age-group range which was categorized into- (i) Between 30 snf 50 years and (ii) More than 50 years; (c) Presence of any comorbid medical condition; psychological symptoms of- (d) insomnia; (e) anxiety; and (f) depression. Statistical analysis was performed using the Chi-square test for determining significance. Results: Mean ± SD values for age were found to be 35.54 ± 6.09; 33.84 ± 7.87; 32.16 ± 5.89 and 55.76 ± 8.98 for physicians, women Doctors, technical staff, and non-healthcare professionals while the percentages of male study participants was found to be 37.2%, 15%, 57%, and 65% and female study participants was 62.8%, 85%, 43%, and 35% for the physicians, nursing staff, technicians, and non-healthcare professionals. Depression, insomnia, and anxiety between healthcare and non-healthcare professional workers, demonstrated significant P values of 0.05, 0.03, and 0.02, respectively. Conclusion: The present study has shown a significant psychological impact arising from this crisis

Objective To investigate the epidemical characteristics and analyze the incidence trend of 2019 novel coronavirus diseases (COVID-19) in China. Methods The daily new confirmed cases of 2019 novel coronavirus diseases (COVID-19) in China from January 25 to February 8,2020 were collected for epidemiological descriptive analysis. Results During the period from January 25 to February 8, 2020, the number of daily new confirmed cases fell for five consecutive days, from 890 cases on February 3 to 509 cases on February 8. Conclusion The incidence of 2019 novel coronavirus diseases (COVID-19) slowed down in 30 provinces (autonomous regions and municipalities directly under the central government) except Hubei and Xinjiang production and construction corps , but the overall situation is still not optimistic. It is imperative to pay close attention to the origin and destination of migrant workers and the incidence of disease in various areas, and take targeted measures to strengthen prevention and control of the disease. Key words: 2019 novel coronavirus diseases (COVID-19); China; The prevention and control

Since the end of 2019, 2019 novel coronavirus disease (COVID-19) outbreaks and spreads in Wuhan and whole globe, which brings great challenge to the public health prevention and control work in our country and even in the world. Although the national medical staffs and Public Health Epidemic Prevention personnel to fight the epidemic, a large number of patients and long-term isolation measures have had a huge impact on people's life style. The development of the epidemic has currently been eased, but the blockade and quarantine in many cities have not been completely lifted. During the controls of the coronavirus, changes in living style caused by long-term isolation as well as the fear of disease and economic recession will bring people various negative emotions. These mental health issues may cause and aggravate occurrence and development dry eye. We explores the impact of mental health on dry eye during the epidemic and possible mechanism and puts forward relevant suggestions for the management related eye diseases during and after the epidemic. Key words: Novel coronavirus disease; Mental health; Dry eye; Depression; Stress

The epidemic situation of 2019 novel coronavirus disease (COVID-19) had been entered into the national prevention and control phase since its outbreak in China. Its main source of infection was the confirmed patients, but asymptomatic infections may also be source of this infection. Because pregnant women were in the state of immunosuppression, they were more susceptible to respiratory pathogens and inclined to develop into severe diseases. During the epidemic period, they still need to go to hospital for necessary prenatal examination or termination of pregnancy and other obstetric interventions. In view of the above particularity, Beijing Youan Hospital, Capital Medical University had formulated the diagnosis and treatment process of pregnant women under the epidemic situation, adjusted and optimized the outpatient inspection and inpatient treatment process, striving to minimize the impact of the epidemic situation on the diagnosis and treatment of pregnant women and ensure the health of mothers and infants. At the same time, the relevant protection process of medical staff should be formulated to effectively avoid nosocomial infection, so as to provide reference for the formulation of obstetric diagnosis and treatment plan during the epidemic. Key words: 2019 novel coronavirus disease; Pregnant woman; Diagnosis and treatment

An outbreak of a novel coronavirus disease-19 (nCoV-19) infection began in December 2019 in Wuhan, China, and now involved the whole word. Several health workers have been infected in different countries. We report the case of a young man with documented nCoV-19 infection evaluated with lung ultrasound and discuss potential applications of lung ultrasound in this setting. Lung ultrasound allowed the identification of nCoV-19 infection at bed-side. Moreover, lung ultrasound can have several other advantages, such as reduced health worker exposition to infected patients, repeatability during follow-up, low-costs and easier application in low-resource settings.

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care. Key words: 2019 Novel coronavirus pneumonia; Critical case; Treatment experience

Background: The novel coronavirus disease (COVID-19) which was identified in the month of December 2019 at Wuhan city of China and spread all over the world has now achieved pandemic status. It affects the physical and mental lives of millions of people and increases the mortality rate internationally. It also affects the mental well-being of the individuals and produces many psycho-social distresses and reduced adjustment mechanism and coping strategies to fight with coronavirus. Objectives: The prime objective of this present study was to find out the various psycho-social distresses associated with COVID-19 prevailing on different variables of socio-demographic details such as gender, their cultural background, age, education, marital status, and pre-existing medical conditions. Sample: A total of 120 samples were chosen through a purposive sampling technique that belonged to the urban and rural backgrounds of different parts of the country. Only those were selected who contacted the undersigned through telephonic communication related to their psycho-social distresses associated with COVID-19. There were no barriers to the age bar in the collection of data. Research design: This is a cross-sectional study. Those who were reported about psychosocial distress related to COVID-19 were included in the study. Variable: The independent variables are gender and different psycho-social variable like age, education, marital status, and pre-existing medical conditions. Their impact was examined on the dependent variable of expression and apprehension of psycho-social distress associated with COVID-19 symptoms such as fear, anxiety, depression, suicidal ideation, lack of sleep, lack of appetite, headache, irritation/ anger, lack of concentration and poor memory. Research tools: Data were collected through telephonic communication on the self-made questionnaire. Those who are anxious and apprehended about the symptoms of COVID-19 and used psychological support system through telephonic communication from 28th March 2020 to 20th Apr 2020 included in the study. Result: Fear and depression was most common psycho-social distresses (120, 100% on each) followed by anxiety (106, 88.34%), lack of sleep (54, 45%), headache (52, 43.34%), lack of appetite (38, 31.67%), irritation/ anger (36, 30%), lack of concentration/ poor memory (34, 28.34%). Suicidal ideation was found at least common psycho-social stresses related to COVID-19 which was found only in 33, 27.5% of cases. The contents of fear, anxiety, and depression were varied from the people of one socio-demographic domain to other. Those who don’t have a pre-existing medical history of any diseases were felt more psycho-social distresses (42, 35%) than those having the pre-existing medical history of any diseases such as hypertension (24, 20%), diabetes (27, 22.5%), heart problems (12, 10%) or any other medical conditions or psychiatric problems (15, 12.5%). Conclusion: Fear and depression were the most common and suicidal ideation were the least common psycho-social distresses related to COVID-19. Those who don’t have a pre-existing medical history of any diseases were felt more psycho-social distresses than those having the pre-existing medical history of any diseases such as hypertension diabetes, heart problems, or any other medical conditions or psychiatric problems.

The population is commonly susceptible to the 2019 novel coronavirus(2019-nCoV), especially the elderly with comorbidities. Elderly patients infected with 2019-nCoV tend to have higher rates of severe illnesses and mortality. Immunoaging is an important cause of severe novel coronavirus pneumonia(NCP)in the elderly.Due to the combination of underlying diseases, elderly patients may exhibit a typical manifestations in clinical symptoms, supplementary examinations and pulmonary imaging, deserving particular attention. The general condition of the elderly should be considered during diagnosis and treatment. In addition to routine care and measures such as oxygen therapy, antiviral therapy and respiratory support, treatment of underlying disease, nutritional support, sputum expectoration, complication prevention and psychological support should also be considered for elderly patients. Based on literature review and expert panel discussion, we drafted the Key Points for the Prevention and Treatment of the Novel Coronavirus Pneumonia in the elderly, aiming to provide help with the prevention and treatment of NCP and the reduction of harm to the elderly population. Key words: 2019 Novel coronavirus(2019-nCoV); Pneumonia; Prevention and treatment; The elderly

In December 2019, the outbreak of novel coronavirus (2019-nCoV) in Wuhan, China, attracting attention worldwidely. The novel coronavirus has the characteristics of rapid transmission, atypical clinical symptoms, and easy to affect both lungs, leading to missed diagnosis and misdiagnosis, as well as difficult to detection and assessment at early stage. Fever, cough, myalgia, weakness, dyspnea and imagings may be helpful for the early detection of novel coronavirus pneumonia. At the same time, the rate of disease progression, fever, CT manifestations, hypoxia degree, age, basic diseases, and laboratory indicators can also be used to evaluate the severity of the novel coronavirus pneumonia.

A male 23-year-old male received the Qingfei Paidu decoction(清肺排毒汤) orally 196 g /d once daily for the novel coronavirus pneumonia from the fourth day of admission. On the 14th day, 5.7 mmol/l of blood potassium was measured, hyperkalemia was diagnosed. And 5% glucose injection 250 ml plus 4 U insulin injection was given intravenously for continuous intravenous drip at 3.5 U/h. After administration, 5.4 mmol/l of blood potassium was immediately checked, and 5.0 mmol/l of blood potassium was rechecked at 21:41 p.m. On the 21th day, the patient's blood potassium was 5.4 mmol/L, 5% glucose injection plus 4 units of insulin injection were given for intravenous drip of 3.5 U/h. On the 23th day, blood potassium 5.2 mmol/l. On the 24th to 26th day, 5% glucose injection plus 4 units of insulin injection were given intravenously for continuous intravenous drip of 3.5U/h once daily. On the 25th day, blood potassium 4.9 mmol/l. On the 28th day of hospitalization, the three tests of nasopharynx swab were negative, and the symptoms of pulmonary infection improved and discharged. It was considered that the increase of blood potassium was related to Qingfei Paidu decoction(清肺排毒汤) . Key words: Coronavirus Infections; Hyperkalemia; Medicine, Chinese traditional; Qingfei Paidu decoction(清肺排毒汤)