Early Stage Of Coronavirus Disease 2019 Research Articles

Development and validation of a predicted nomogram for mortality of COVID-19: a multicenter retrospective cohort study of 4,711 cases in multiethnic.

Coronavirus disease 2019 (COVID-19) is an infectious disease spreading rapidly worldwide. As it quickly spreads and can cause severe disease, early detection and treatment may reduce mortality. Therefore, the study aims to construct a risk model and a nomogram for predicting the mortality of COVID-19. The original data of this study were from the article "Neurologic Syndromes Predict Higher In-Hospital Mortality in COVID-19." The database contained 4,711 multiethnic patients. In this secondary analysis, a statistical difference test was conducted for clinical demographics, clinical characteristics, and laboratory indexes. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis were applied to determine the independent predictors for the mortality of COVID-19. A nomogram was conducted and validated according to the independent predictors. The area under the curve (AUC), the calibration curve, and the decision curve analysis (DCA) were carried out to evaluate the nomogram. The mortality of COVID-19 is 24.4%. LASSO and multivariate logistic regression analysis suggested that risk factors for age, PCT, glucose, D-dimer, CRP, troponin, BUN, LOS, MAP, AST, temperature, O2Sats, platelets, Asian, and stroke were independent predictors of CTO. Using these independent predictors, a nomogram was constructed with good discrimination (0.860 in the C index) and internal validation (0.8479 in the C index), respectively. The calibration curves and the DCA showed a high degree of reliability and precision for this clinical prediction model. An early warning model based on accessible variates from routine clinical tests to predict the mortality of COVID-19 were conducted. This nomogram can be conveniently used to facilitate identifying patients who might develop severe disease at an early stage of COVID-19. Further studies are warranted to validate the prognostic ability of the nomogram.

Frontal QRS-T angle in patients with the suspicion of Coronavirus disease 2019 (COVID-19): could it be used as a predictive gravity sign even before the diagnosis by PCR?

Coronavirus disease 2019 (COVID-19) has been an ongoing global public health concern, causing serious challenges in diagnosing the disease timely. We investigated the value of the frontal QRS-T (fQRS-T) angle in patients visiting the emergency department with the suspicion of COVID-19. A hundred and thirty-seven patients with the complaint of dyspnea were evaluated retrospectively. The patients with a history of coronary artery disease, heart failure, pulmonary disease, hypertension, diabetes mellitus, or using any medication such as heart rate controllers or antiarrhythmic drugs were excluded from the study. The angle between frontal QRS- and T-wave axis was defined as the fQRS-T angle, and the patients were divided into two groups based on the fQRS-T angle (group 1, <90° and group 2, ≥90°). Demographic, clinical, electrocardiographic data and rRT-PCR results were compared between the groups. The mean value of the fQRS-T angle of all participants was 45.26°. There was no significant difference between the groups according to the demographic and clinical data. Subjects with wider fQRS-T angle (group 2) had higher heart rates (p = 0.018), higher corrected QT values (p = 0.017), and higher QRS axis (p = 0.001). The patients in group 2 had a higher number of positive COVID-19 rRT-PCR test results compared to subjects with the normal fQRS-T angle (p = 0.002). In multivariate regression analysis, fQRS-T angle (p = 0.027, OR: 1.013, 95% CI: 1.001-1.024) was found as an independent variable affecting the PCR test results. Prompt diagnosis, initiating preventive and protective measures in an early stage of COVID-19 are crucial. In suspected COVID-19 infection, the use of faster-resulting tests and diagnostic tools for COVID-19 allows patients to be diagnosed and treated in a timely manner for recovery, thereby optimizing patient management. Therefore, the fQRS-T angle can be used in patients with dyspnea as a part of diagnostic scores of COVID-19, even before the rRT-PCR test results and overt disease.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa.

Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI.Contribution:Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Gender-based depression factors of older adults living alone during the COVID-19 pandemic: A cross-sectional and secondary data approach

The coronavirus disease 2019 (COVID-19) pandemic negatively affected the mental health of older adults living alone. This study aimed to examine the differences in factors that influence depression among older adults based on gender. This study was a cross-sectional study employing the secondary data of 3581 older adults living alone at the early stage of COVID-19, collected from the 2020 Korea Community Health Survey, and used multiple linear regression analyses to identify factors associated with depression. We found that women had a higher level of depressive status than men. Low subjective health status was most significantly related to depression in both older men and older women. For women, body mass index and more changes in daily life due to COVID-19 were predictors of depression. Conversely, for men, a lower level of monthly income and smoking were significant predictors of depression. Depressive status caused by COVID-19 was likely to be frailer for older women who were living alone. There were differences in the factors related to depression due to COVID-19 by gender.

Efficacy and safety profile of corticosteroids and non-steroidal anti-inflammatory drugs in COVID-19 management: A narrative review.

Due to the fact that coronavirus disease 2019 (COVID-19) is still prevalent, and current reports show that some parts of the world have seen increase in incidence, it is relevant that health professionals and scientists know about recent or novel trends, especially drug treatments. Additionally, the safety profiles of these drug treatments need to be documented and shared with the public. Some studies have demonstrated the clinical benefits of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in COVID-19 treatment. On the contrary, others have also reported that NSAIDs and corticosteroids may worsen symptoms associated with COVID-19. While some researchers have suggested that corticosteroids may be helpful if used in the early stages of COVID-19, there are still some conflicting findings regarding the use of corticosteroids in certain viral infections. Our review suggests that methylprednisolone, dexamethasone, and ibuprofen have therapeutic potential in reducing mortality due to COVID-19 among hospitalized patients. This review also highlights the fact that the use of NSAIDs is not associated with adverse outcomes of COVID-19. In reality, evidence suggests that NSAIDs do not increase the risk of COVID-19 infections. Also, the literature reviewed suggests that corticosteroid treatment in COVID-19 was linked with a decrease in all-cause mortality and disease progression, without increase in adverse events when compared to no corticosteroid treatment.

Anticoagulation failure in pulmonary thromboembolism in COVID-19 pneumonia despite prolonged anticoagulation: A case series.

Moderate to severely ill patients diagnosed with Coronavirus disease 2019 (COVID-19) pneumonia develop a series of complications and less frequently, we might witness cases of Pulmonary Thromboembolism (PE)-refractory to the standard treatment with Low Molecular Weight Heparin (LMWH). The aim of this case series is to report the presentation and management of pulmonary thromboembolism secondary to COVID-19 pneumonia. We report a case series of seven cases aged 40-70 who were presented in Dhulikhel Hospital with COVID-19 symptoms in different stages. The case details were extracted from their medical reports of the hospital. The written informed ethical consents were obtained from all the cases and their voluntary participation was assured. The cases in the case series admitted with COVID-19 pneumonia, after diagnostic investigation (Chest x-ray, HRCT, CTPA) were suggestive of COVID-19 Pneumonia with ARDS and pulmonary thromboembolism. The cases received rivaroxaban, a newer anticoagulant-15 mg twice daily for 21 days and after discharge, they were asked to continue once daily doses for 9 weeks. Significant improvement was witnessed, with the presence of additional intervention including rehabilitative chest exercises. Pulmonary thromboembolism secondary to COVID-19 pneumonia is a life-threatening condition. Rivaroxaban is seen to be very effective in the management of this condition when an anticoagulation failure occurs even after the therapeutic dose of low molecular weight heparin. Future studies may require more scientific investigations to prevent complications even in the early stages of COVID-19.

CRISPR-Based Diagnostics and Microfluidics for COVID-19 Point-of-Care Testing: A Review of Main Applications.

An ongoing pandemic of coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). So far, there have been various approaches for SARS-CoV-2 detection, each having its pros and cons. The current gold-standard method for SARS-CoV-2 detection, which offers acceptable specificity and sensitivity, is the quantitative reverse transcription-PCR (qRT-PCR). However, this method requires considerable cost and time to transport samples to specialized laboratories and extract, amplify, and detect the viral genome. On the other hand, antigen and antibody testing approaches that bring rapidity and affordability into play have lower sensitivity and specificity during the early stages of COVID-19. Moreover, the immune response is variable depending on the individual. Methods based on clustered regularly interspaced short palindromic repeats (CRISPR) can be used as an alternative approach to controlling the spread of disease by a high-sensitive, specific, and low-cost molecular diagnostic system. CRISPR-based detection systems (CRISPR-Dx) target the desired sequences by specific CRISPR-RNA (crRNA)-pairing on a pre-amplified sample and a subsequent collateral cleavage. In the present article, we have reviewed different CRISPR-Dx methods and presented their benefits and drawbacks for point-of-care testing (POCT) of suspected SARS-CoV-2 infections at home or in small clinics.

Preventive Measures Against COVID-19 in Small- and Mid-sized Enterprises from an Early Stage of the Epidemic in Daegu and Gyeongsangbuk-do

BackgroundIn the early stage of the coronavirus disease 2019 (COVID-19) epidemic, small- and mid-sized enterprises (SMEs) may be an important transmission consideration. The study aimed to identify the pattern of COVID-19 prevention measures during the outbreaks in Daegu and Gyeongsangbuk-do at the early stage of COVID-19. Moreover, we investigated whether SME size and past experiences affected the preventive measures implemented in the region. MethodsA survey detailing the general characteristics and implementation of 12 preventive activities was conducted in 122 SMEs in Daegu and Gyeongsangbuk-do. The survey was analyzed by size and operation period. ResultsThe study subjects consisted of 53 (43.4%) workplaces with 1–5 employees, 50 (40.9%) workplaces with 6–30 employees, and 19 (15.6%) workplaces with 31–49 employees. The lowest three items among those surveyed were ‘symptomatic workers to stay home for 3–4 days’ (17.2%), ‘work remotely’ (18.9%), and ‘video meetings’ (20.5%). There were significant differences in the rate of several preventive measures implemented. The larger sized SMEs, the higher the number of implementations (p < 0.01). The operation period had no significant relationship with the implementation of preventive measures. The same pattern was observed in multiple generalized linear regression with covariate adjustment. ConclusionPreventive measures among SMEs with fewer than 50 employees were identified. Even within SMEs, a gap in preventive measures according to size was confirmed. To prevent the spread of infection and protect workers' right to health, different support for different sized SMEs is necessary.

Relationship Between Economic Loss and Anxiety During the Coronavirus Disease 2019 Pandemic: Moderating Effects of Knowledge, Gratitude, and Perceived Stress.

ObjectivesThe prolonged coronavirus disease 2019 (COVID-19) pandemic has caused individuals to suffer economic losses, in particular due to the implementation of intensive quarantine policies. Economic loss can cause anxiety and has a negative psychological impact on individuals, worsening their mental health and satisfaction with life. We examined the protective and risk factors that can influence the relationship between economic loss and anxiety during the COVID-19 pandemic.MethodsPanel data from 911 participants were collected in April and May 2020 and again 6 months later. We analyzed the relationship between economic loss and anxiety and investigated the moderating effects of knowledge about COVID-19, gratitude, and perceived stress. Moreover, we investigated whether there were any changes in moderating effects over time or in different demographic groups.ResultsIn the early stages of the spread of COVID-19, gratitude (B = –0.0211, F = 4.8130, p < 0.05) and perceived stress (B = 0.0278, F = 9.3139, p < 0.01) had moderating effects on the relationship between economic loss and anxiety. However, after 6 months, only perceived stress had a significant moderating effect (B = 0.0265, F = 7.8734, p < 0.01).ConclusionIn the early stages of COVID-19, lower levels of gratitude and higher perceived stress led to greater anxiety. In later stages of the prolonged pandemic, only perceived stress had a continued moderating effect on the relationship between economic loss and anxiety. This study suggests that psychological interventions to reduce perceived stress are needed to treat the possible adverse effects of the spread of infectious diseases on mental health.

Role of T Regulatory Cells and Myeloid-Derived Suppressor Cells in COVID-19.

Coronavirus disease 2019 (COVID-19) has been raised as a pandemic disease since December 2019. Immunosuppressive cells including T regulatory cells (Tregs) and myeloid-derived suppressor cells (MDSCs) are key players in immunological tolerance and immunoregulation; however, they contribute to the pathogenesis of different diseases including infections. Tregs have been shown to impair the protective role of CD8+ T lymphocytes against viral infections. In COVID-19 patients, most studies reported reduction, while few other studies found elevation in Treg levels. Moreover, Tregs have a dual role, depending on the different stages of COVID-19 disease. At early stages of COVID-19, Tregs have a critical role in decreasing antiviral immune responses, and consequently reducing the viral clearance. On the other side, during late stages, Tregs reduce inflammation-induced organ damage. Therefore, inhibition of Tregs in early stages and their expansion in late stages have potentials to improve clinical outcomes. In viral infections, MDSC levels are highly increased, and they have the potential to suppress T cell proliferation and reduce viral clearance. Some subsets of MDSCs are expanded in the blood of COVID-19 patients; however, there is a controversy whether this expansion has pathogenic or protective effects in COVID-19 patients. In conclusion, further studies are required to investigate the role and function of immunosuppressive cells and their potentials as prognostic biomarkers and therapeutic targets in COVID-19 patients.

Incidence of Olfactory and Gustatory Dysfunctions in the Early Stages of COVID-19: An Objective Evaluation

Introduction Coronavirus disease 2019 (COVID-19) is a dangerous infectious disease caused by a newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has various clinical presentations. Numerable cases with non-specific olfactory and gustatory dysfunctions in COVID-19 have been reported from all over the globe. This is important as awareness will let people to self-isolate and help in limiting disease spread. Objective To objectively evaluate the frequency of olfactory and gustatory dysfunction, which may occur independently or with other symptoms, in laboratory confirmed COVID-19 patients at an early stage of the disease. Methods Objective evaluation of olfactory and gustatory function of 322 COVID-19 patients treated at our hospital, (SMGS, Government Medical College, Jammu), from August 2020 until November 2020. Results Our study population included 127 (39.4%) males and 195 (60.6%) females. Two hundred and twenty-six (70.2%) COVID-19 patients experienced olfactory and gustatory disorders. One hundred and sixty-five (51.2%) cases experienced both olfactory and gustatory disorders. Isolated olfactory dysfunction was reported in 34 (10.6%) patients, while 27 (8.4%) patients experienced only gustatory dysfunction. Conclusion The olfactory and gustatory dysfunctions, without any nasal obstruction or rhinorrhea, are significant symptoms in the clinical presentation of early COVID-19 patients. This presentation can be recognized at the earliest one, and it can reduce the high communicability of the COVID-19 disease.

Photodynamic disinfection of SARS-CoV-2 clinical samples using a methylene blue formulation.

The amplitude of the coronavirus disease 2019 (COVID-19) pandemic motivated global efforts to find therapeutics that avert severe forms of this illness. The urgency of the medical needs privileged repositioning of approved medicines. Methylene blue (MB) has been in clinical use for a century and proved especially useful as a photosensitizer for photodynamic disinfection (PDI). We describe the use of MB to photo-inactivate SARS-CoV-2 in samples collected from COVID-19 patients. One minute of treatment can reduce the percentage inhibition of amplification by 99.99% under conditions of low cytotoxicity. We employed a pseudotyped lentiviral vector (LVs) encoding the luciferase reporter gene and exhibiting the S protein of SARS-CoV-2 at its surface, to infect human ACE2-expressing HEK293T cells. Pre-treatment of LVs with MB-PDI prevented infection at low micromolar MB concentrations and 1 min of illumination. These results reveal the potential of MB-PDI to reduce viral loads in the nasal cavity and oropharynx in the early stages of COVID-19, which may be employed to curb the transmission and severity of the disease.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1007/s43630-022-00202-6.

Machine-Learning Approaches for Predicting the Need of Oxygen Therapy in Early-Stage COVID-19 in Japan: Multicenter Retrospective Observational Study.

BackgroundEarly prediction of oxygen therapy in patients with coronavirus disease 2019 (COVID-19) is vital for triage. Several machine-learning prognostic models for COVID-19 are currently available. However, external validation of these models has rarely been performed. Therefore, most reported predictive performance is optimistic and has a high risk of bias. This study aimed to develop and validate a model that predicts oxygen therapy needs in the early stages of COVID-19 using a sizable multicenter dataset.MethodsThis multicenter retrospective study included consecutive COVID-19 hospitalized patients confirmed by a reverse transcription chain reaction in 11 medical institutions in Fukui, Japan. We developed and validated seven machine-learning models (e.g., penalized logistic regression model) using routinely collected data (e.g., demographics, simple blood test). The primary outcome was the need for oxygen therapy (≥1 L/min or SpO2 ≤ 94%) during hospitalization. C-statistics, calibration slope, and association measures (e.g., sensitivity) evaluated the performance of the model using the test set (randomly selected 20% of data for internal validation). Among these seven models, the machine-learning model that showed the best performance was re-evaluated using an external dataset. We compared the model performances using the A-DROP criteria (modified version of CURB-65) as a conventional method.ResultsOf the 396 patients with COVID-19 for the model development, 102 patients (26%) required oxygen therapy during hospitalization. For internal validation, machine-learning models, except for the k-point nearest neighbor, had a higher discrimination ability than the A-DORP criteria (P < 0.01). The XGboost had the highest c-statistic in the internal validation (0.92 vs. 0.69 in A-DROP criteria; P < 0.001). For the external validation with 728 temporal independent datasets (106 patients [15%] required oxygen therapy), the XG boost model had a higher c-statistic (0.88 vs. 0.69 in A-DROP criteria; P < 0.001).ConclusionsMachine-learning models demonstrated a more significant performance in predicting the need for oxygen therapy in the early stages of COVID-19.

Coping strategies among Ethiopian migrant returnees who were in quarantine in the time of COVID-19: a center-based cross-sectional study

BackgroundFollowing the coronavirus disease 2019 (COVID-19) outbreak, many numbers of Ethiopian migrant workers from the Middle East repatriated to their home country. Returnees who came back to Ethiopia during the early stages of COVID-19 went through difficult experiences of unplanned return and unfamiliar quarantine. Despite burgeoning studies on the coping strategies of the general population on stresses associated with the pandemic, there is lack of research on how returnees cope with challenges related to migration and quarantine experiences. The aim of this study was to examine the coping strategies used by returnees who were in mandatory quarantine in Addis Ababa, Ethiopia in the context of the COVID-19 pandemic.MethodsA center-based cross-sectional study was conducted with 405 migrant returnees who were in mandatory quarantine in Addis Ababa, Ethiopia. We developed a structured questionnaire to collect data about the socio-demographic, migration related, quarantine related and COVID-19 related characteristics of participants. We used the Brief COPE (Coping Orientation to Problems Experienced) scale to measure returnees coping strategies. Descriptive statistics and multiple regression analyses were used to determine extent of use of coping strategies and identify factors associated with them.ResultsEmotion-focused coping mainly religious coping was the most frequently used coping strategy in the study group. Dysfunctional coping, however, was the least frequently employed coping strategy. Higher scores on emotion-focused and problem-focused coping strategies were associated with absence of perceived support from family and relatives after the quarantine and with no history of contact with COVID-19 suspected or infected person.ConclusionsThe study shows that emotion-focused coping, particularly religious coping, was the most commonly used coping strategy among returnees who were in quarantine centers in the context of COVID-19. Returnees who perceived that they will not have support from family and relatives and those who were not exposed to the virus were more likely to use either emotion- or problem-focused coping strategies. Psychosocial reintegration efforts need to focus on enhancing returnees’ capacity to use adaptive coping strategies. We suggest in-depth qualitative studies for better understanding of returnees’ coping strategies and to facilitate reintegration activities.

Explore the Approaches to Corporate Social Responsibility Implemented by E-Commerce Platforms in China During the Early Stage of COVID-19: A Mixed-Methods Content Analysis.

The aim of this study was to explore (a) the approaches to corporate social responsibility (CSR) implemented by e-commerce platforms in China during the early stage of coronavirus disease 2019 (ESCOVID-19) and (b) the factors associated with the platforms' choice of these approaches. We collected the CSR data from the Internet during ESCOVID-19. Conventional content analysis was used to develop the targeted approaches. Finally, based on the frequency analysis of each approach, rank-based nonparametric testing was conducted to answer objective (b). Three main approaches (ie, donative CSR actions, responsive CSR actions, and strategic CSR actions) and 8 subapproaches were implemented. The strategic approach was the most frequently used approach. The platforms with higher market size implemented more donative and strategic CSR actions than did the platforms with lower market size. Donative CSR actions were significantly implemented in the earlier period, while strategic CSR actions were significantly implemented in the later period. Our research highlights the importance of e-commerce platforms to help the public survive and identifies that market size and time were associated with the platforms' CSR choice. The design of prevention and control policies should incorporate and support e-commerce platforms and evaluate the factors when confronting future public health crises.

Abstract 12007: RNA Sequencing Analysis Reveals A Novel Pathway Associated With The Exacerbation Of Covid-19

Introduction: The severity of Coronavirus disease 2019 (COVID-19) depends on the host immune cell response and dysregulation. Most COVID-19 patients had mild disease, however, 15-30 % of patients developed severe disease which could result in severe acute respiratory failure and death. Risk factors associated with severe disease such as age, smoking and comorbidities are well known, while molecular signatures to predict the disease progression are still emerging. Hypothesis: Severe COVID-19 have a unique gene expression profile in peripheral blood mononuclear cells (PBMCs) at early stage of disease compared to mild disease. Methods: We used RNA sequencing analysis and pathway analysis in PBMCs collected from COVID-19 patients at a median 4 days after the onset. Subsequent clinical course was evaluated by WHO definition (meet any of oxygen saturation &lt; 90 %, respiratory rate &gt; 30 breaths / min and signs of severe respiratory distress or not), and based on the severity, PBMCs obtained from mild (n=6) and severe (n=6) groups were analyzed. Results: At the sample collection, there was no significant difference in clinical characteristics between groups, but laboratory tests exhibited higher C-reactive protein and lactate dehydrogenase levels in severe group compared to mild group (Table). We identified 148 differentially expressed genes (DEGs, FDR &lt; 0.05) that are enriched for a pathway, HDACs deacetylate histone, as the top pathway using Metascape. This includes 15 genes in HIST1 cluster that has not only antimicrobial but also cytotoxic and blood coagulation effect once the proteins are released into circulation, which could result in acute lung injury. Conclusions: Our results suggest that the upregulation of HIST1 cluster genes expression in PBMCs at early stage of COVID-19 could predict the subsequent disease exacerbation. These findings may also link to the pathophysiology of COVID-19 in the context of histone protein mediated lung injury and respiratory failure.

Depression in public officials during the COVID-19 pandemic in Paraguay: a web-based study

BackgroundAccording to the World Health Organization, the coronavirus disease 2019 (COVID-19) pandemic has created situations that have a negative effect on people and threaten their mental health. Paraguay announced the Estado de Emergencia Sanitaria (Presidential Decree No. 3456) on March 16, 2020, which was followed by the imposition of a 24-h restriction on movement order on March 21. Self-quarantine at home may have been the most effective method of preventing the spread of infectious diseases; however, with the global pandemic becoming more prolonged and the consequent lengthening of the 24-h self-quarantine period, it is highly probable that both physical and psychological problems will arise.MethodsIn this study, a web-based cross-sectional method was used to analyze the factors influencing COVID-19-induced depressive feelings in Paraguayan public officials.ResultsPublic officials reported a high level of depressive symptoms with a high level of apprehension in early stage of COVID-19. In addition, this study identified that when the self-quarantine period increased, levels of depressive feelings also increased. Since self-quarantine is characterized by the requirement that individuals endure an undetermined period within a confined area, it may have caused stress and anxiety, as well as the consequent experience of depressive feelings.ConclusionsParaguayan government should develop a program for the delivery of mental health care and services to public officials in COVID-19 Pandemic period. Moreover, a program is required for people facing deteriorating mental health due to social isolation and loneliness caused by social distancing during the prolonged period of self-quarantine. Finally, mental health care programs should be organized in a community-focused way by utilizing online systems to enhance the effectiveness of mental health recovery.

Predictors of acute deep venous thrombosis in patients hospitalized for COVID-19.

Deep venous thrombosis (DVT) is associated with high mortality in coronavirus disease 2019 (COVID-19) but there remains uncertainty about the benefit of anti-coagulation prophylaxis and how to decide when ultrasound screening is indicated. We aimed to determine parameters predicting which COVID-19 patients are at risk of DVT and to assess the benefit of prophylactic anti-coagulation.Adult hospitalized patients with positive severe acute respiratory syndrome coronavirus-2 reverse transcription-polymerase chain reaction (RT-PCR) undergoing venous duplex ultrasound for DVT assessment (n = 451) were retrospectively reviewed. Clinical and laboratory data within 72 hours of ultrasound were collected. Using split sampling and a 10-fold cross-validation, a random forest model was developed to find the most important variables for predicting DVT. Different d-dimer cutoffs were examined for classification of DVT. We also compared the rate of DVT between the patients going and not going under thromboprophylaxis.DVT was found in 65 (14%) of 451 reverse transcription-polymerase chain reaction positive patients. The random forest model, trained and cross-validated on 2/3 of the original sample (n = 301), had area under the receiver operating characteristic curve = 0.91 (95% confidence interval [CI]: 0.85-0.97) for prediction of DVT in the test set (n = 150), with sensitivity = 93% (95%CI: 68%-99%) and specificity = 82% (95%CI: 75%-88%). The following variables had the highest importance: d-dimer, thromboprophylaxis, systolic blood pressure, admission to ultrasound interval, and platelets. Thromboprophylaxis reduced DVT risk 4-fold from 26% to 6% (P < .001), while anti-coagulation therapy led to hemorrhagic complications in 14 (22%) of 65 patients with DVT including 2 fatal intra-cranial hemorrhages. D-dimer was the most important predictor with area under curve = 0.79 (95%CI: 0.73-0.86) by itself, and a 5000 ng/mL threshold at 7 days postCOVID-19 symptom onset had 75% (95%CI: 53%-90%) sensitivity and 81% (95%CI: 72%-88%) specificity. In comparison with d-dimer alone, the random forest model showed 68% versus 32% specificity at 95% sensitivity, and 44% versus 23% sensitivity at 95% specificity.D-dimer >5000 ng/mL predicts DVT with high accuracy suggesting regular monitoring with d-dimer in the early stages of COVID-19 may be useful. A random forest model improved the prediction of DVT. Thromboprophylaxis reduced DVT in COVID-19 patients and should be considered in all patients. Full anti-coagulation therapy has a risk of life-threatening hemorrhage.

The Radiology of COVID-19 Pneumonia

Coronavirus disease 2019 (COVID-19) has reached a pandemic stage in March 2020 and currently more than 220 million patients worldwide are infected. The characteristic findings of COVID-19 pneumonia are bilateral, peripheral, rounded ground-glass opacities (GGO) which are dominantly located in the lower lobes and that may be accompanied by consolidation. The distribution of the parenchymal lesions was reported to be bilateral (88%), multi-lobar (78%) and peripheral (76%), with a tendency to involve the posterior regions of the lungs (80%). Several other chest CT findings, such as interlobular septal thickening, bronchiectasis, “crazy paving” and halo sign, have also been reported but with a lower frequency. &#x0D; RSNA has published consensus statements to reduce report variability among radiologists and defined 4 main categories: typical, indeterminate, atypical, and negative, to provide a relative likelihood that these findings are attributable to COVID-19 pneumonia. &#x0D; It is vital to understand that imaging may be normal in the early stages of COVID-19, and many conditions may present with imaging findings mimicking COVID-19 pneumonia. Chest CT may be also used as a useful tool for better identification of patients who will benefit from more aggressive therapy. In addition, CT may be used to evaluate patency of pulmonary and coronary vascular structures and myocardial damage. &#x0D; Although CT scan is not recommended as a diagnostic and screening tool, it can be helpful to clinician for a fast and accurate decision-making and has a crucial role in the diagnosis, risk stratifying, and follow-up of the progression of COVID-19 pneumonia.

The Role of Chest High Resolution CT and RT-PCR in Diagnosis of Different Stages of Coronavirus (COVID-19) Pneumonia

Purpose: The purpose of this study is to investigate how RT-PCR (real time–polymerase-chain-reaction) and chest High-Resolution Computed Tomography (HRCT) can detect COVID-19 (Coronavirus Disease 2019) disease in the early, progressive and severe stages, as well as patient’s outcome. Method: We perform a prospective study with chest HRCT on 206 patients with positive RT-PCR test. The patients were divided into three groups; early stage (100 patients), progressive stage (70 patients) and severe stage (36 patients). Results: The early stage involved typical category (COVID-19 Reporting and Data System, CO-RADS 5, 34 cases - 34%), indeterminate category (CORADS 3, six cases - 6%), atypical category (CO-RADS 4, ten cases - 10%) and normal chest HRCT imaging (CO-RADS 1, 50 cases - 50%). The progressive stage involved a typical category (CO-RADS 5, 70 cases, 100%), The severe stage involved a typical category (CO-RADS 5, 36 cases, 100%). Conclusion: RT-PCR is the gold standard and specific tool for confirming COVID-19 infection. Combination of RT-PCR and chest HRCT is used for the early diagnosis of COVID-19 pneumonia. Chest HRCT is positive in 50% of patients in the early stage of COVID-19. Chest HRCT is not only detecting pulmonary parenchymal changes but also determining patient’s outcome in the progressive and severe stages of COVID-19 (CO-RADS 5). Patients with progressive stage will not need ventilator and patients with severe stage should receive ventilator.