Findings In Coronavirus Disease 2019 Patients Research Articles

Role of CT-based body composition parameters in the course of COVID-19.

A significant correlation is observed between the course of coronavirus disease 2019 (COVID-19) and body composition parameters including visceral fat quantification, muscle mass, and hepatic attenuation. The aim of the study was to investigate the correlation between the extent of lung involvement and various computed tomography (CT) parameters, as well as laboratory findings in COVID-19 patients. A retrospective analysis was conducted on 72 adult patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who underwent two consecutive thorax CT scans at least 2 weeks apart. The patients were divided into two groups, as progressive and nonprogressive, based on the presence of two consecutive CT scans. Skeletal muscle area (SMA), subcutaneous fat area (SFA), visceral fat area (VFA), total fat area (TFA), liver-to-spleen (L/S) density ratio, and laboratory findings were compared between the groups. The correlation between the extent of lung involvement and CT parameters, as well as the laboratory findings were assessed. A total of 72 patients were included in the study, with 34 (47.2%) females and 38 (52.8%) males. Hemoglobin levels were significantly lower in the progressive group compared to the nonprogressive group. C-reactive protein (CRP) values were higher in the progressive group at follow-up. The nonprogressive group exhibited decreases in the SFA, VFA, and TFA, while liver density increased. The progressive group showed a decrease in the twelfth thoracic vertebra (T12) paravertebral muscle area and muscle index. In the comparison of the laboratory and radiological data in the course of COVID-19, white blood cell (WBC) and neutrophil counts increased, SMA T12, and the skeletal muscle index (SMI) decreased in the lung progressive group. Hemoglobin and CRP levels at admission may indicate disease progression. Future studies are warranted to increase the reliability with larger series.

Parallel electrophysiological abnormalities due to COVID-19 infection and to Alzheimer's disease and related dementia.

Many coronavirus disease 2019 (COVID-19) positive individuals exhibit abnormal electroencephalographic (EEG) activity reflecting "brain fog" and mild cognitive impairments even months after the acute phase of infection. Resting-state EEG abnormalities include EEG slowing (reduced alpha rhythm; increased slow waves) and epileptiform activity. An expert panel conducted a systematic review to present compelling evidence that cognitive deficits due to COVID-19 and to Alzheimer's disease and related dementia (ADRD) are driven by overlapping pathologies and neurophysiological abnormalities. EEG abnormalities seen in COVID-19 patients resemble those observed in early stages of neurodegenerative diseases, particularly ADRD. It is proposed that similar EEG abnormalities in Long COVID and ADRD are due to parallel neuroinflammation, astrocyte reactivity, hypoxia, and neurovascular injury. These neurophysiological abnormalities underpinning cognitive decline in COVID-19 can be detected by routine EEG exams. Future research will explore the value of EEG monitoring of COVID-19 patients for predicting long-term outcomes and monitoring efficacy of therapeutic interventions. HIGHLIGHTS: Abnormal intrinsic electrophysiological brain activity, such as slowing of EEG, reduced alpha wave, and epileptiform are characteristic findings in COVID-19 patients. EEG abnormalities have the potential as neural biomarkers to identify neurological complications at the early stage of the disease, to assist clinical assessment, and to assess cognitive decline risk in Long COVID patients. Similar slowing of intrinsic brain activity to that of COVID-19 patients is typically seen in patients with mild cognitive impairments, ADRD. Evidence presented supports the idea that cognitive deficits in Long COVID and ADRD are driven by overlapping neurophysiological abnormalities resulting, at least in part, from neuroinflammatory mechanisms and astrocyte reactivity. Identifying common biological mechanisms in Long COVID-19 and ADRD can highlight critical pathologies underlying brain disorders and cognitive decline. It elucidates research questions regarding cognitive EEG and mild cognitive impairment in Long COVID that have not yet been adequately investigated.

Comparison of Chest Computed Tomography (CT) Imaging Patterns and Severity among COVID-19 Patients during the First and Fourth Waves in Addis Ababa, Ethiopia

Background. Studies done globally had shown that chest imaging patterns of Corona virus disease 2019 (COVID-19) infection varied depending on the strains of the virus and the waves of the pandemic. There is no published literature done in Ethiopia to examine whether there is any difference in chest computed tomography (CT) findings of COVID-19 patients during the first and fourth waves. Thus, this study tries to fill the gap of knowledge in that regard. Objective. To describe and compare chest CT scan imaging pattern and assess the predictors of chest CT severity of the first and fourth wave of COVID-19 infection. Methods. An institution-based cross-sectional study was conducted on 200 polymerase chain reaction test confirmed COVID-19 patients who underwent chest CT scan imaging in two diagnostic centers in Addis Ababa city. Pioneer and Wudassie diagnostic centers were selected due to the high case load and availability of well-experienced cardiothoracic radiologists. Data were collected from July 1 to August 3, 2022, using a structured Google form sheet questionnaire. Binary logistic regression was performed, and statistical significance was assessed at a level of significance α = 0.05. Results. Comparatively higher proportion of patients from the first wave had positive chest CT finding than fourth wave (99% vs. 69%). Bilateral lung involvement and lower lobe predilection were seen for both waves of COVID-19. Ground glass opacity and consolidation were the most common CT features for both waves. Delayed chest CT features such as traction bronchiectasis were primarily seen among first-wave patients. Mean global CT severity score was higher for the first-wave patients (13.18 vs. 8.31), and the mean difference is statistically significant ( p < 0.001). Duration of symptoms was a statistically significant predictor of CT severity during the first wave of COVID-19, and patients that presented later than 14 days had 4.12 times higher odds of being in the severe CT score category than those that presented less than 7 days (AOR = 4.12, p = 0.011). There was no statistically significant predictor of CT severity for the fourth wave in this study. Conclusion. Chest CT positivity was comparatively higher for first wave patients. Common features included bilateral involvement, lower lobe involvement, ground glass opacity, and consolidation. Mean chest CT severity was comparatively higher for the first wave than the fourth wave, and the duration of symptoms was a statistically significant predictor of the CT severity for first wave.

Survey on chest CT findings in COVID-19 patients in Okinawa, Japan: differences between the delta and omicron variants

To investigate the frequency of pneumonia and chest computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) during the fifth Delta variant-predominant and sixth Omicron variant-predominant waves of the COVID-19 pandemic in Okinawa, Japan. A survey on chest CT examinations for patients with COVID-19 was conducted byhospitals with board-certified radiologists who provided treatment for COVID-19 pneumonia in Okinawa Prefecture. Data from 11 facilities were investigated. Indications for chest CT; number of COVID-19 patients undergoing chest CT; number of patients with late-onset pneumonia, tracheal intubation, and number of deaths; and COVID-19 Reporting and Data System classifications of initial chest CT scans were compared by the chi-squared test between the two pandemic waves (Delta vs. Omicron variants). A total of 1944 CT scans were performed during the fifth wave, and 1178 were performed during the sixth wave. CT implementation rates, which were the number of patients with COVID-19 undergoing CT examinations divided by the total number of COVID-19 cases in Okinawa Prefecture during the waves, were 7.1% for the fifth wave and 2.1% for the sixth wave. The rates of tracheal intubation and mortality were higher in the fifth wave. Differences between the distributions of the CO-RADS classifications were statistically significant for the fifth and sixth waves (p < 0.0001). In the fifth wave, CO-RADS 5 (typical of COVID-19) was most common (65%); in the sixth wave, CO-RADS 1 (no findings of pneumonia) was most common (50%). The finding of “typical for other infection but not COVID-19” was more frequent in the sixth than in the fifth wave (13.6% vs. 1.9%, respectively). The frequencies of pneumonia and typical CT findings were higher in the fifth Delta variant-predominant wave, and nontypical CT findings were more frequent in the sixth Omicron variant-predominant wave of the COVID-19 pandemic in Okinawa, Japan.

Knowledge about chest imaging findings in COVID-19 among healthcare workers in Goma, Democratic Republic of the Congo

Objectives: Chest imaging, particularly computed tomography, plays a crucial role in the evaluation of patients with Coronavirus disease 2019 (COVID-19) infection. This study aimed to assess physicians’ knowledge about chest imaging findings in COVID-19 patients in Goma, North Kivu Province (Democratic Republic of the Congo). Materials and Methods: This was a cross-sectional study involving 202 physicians who responded to the survey questionnaire. Performance was tested in terms of the mean score and proportions of correct answers for each questionnaire item. Multiple logistic regressions were used to identify factors associated with good knowledge. Results: The mean score obtained by respondents was 8.55 ± 2.49 out of 16 points. The proportion of physicians with more than 60% correct answers was 37.13%. There was no significant statistical association between good knowledge and the demographic and professional characteristics of the respondents (P &gt; 0.05). Conclusion: This study found that physicians’ knowledge about chest imaging findings in COVID-19 patients is poor. This lack of sufficient information on the part of healthcare workers indicates the need to develop continuing education programs.

Brain MRI findings in neurologically symptomatic COVID-19 patients: a systematic review and meta-analysis.

Coronavirus disease 2019 (COVID-19) has been associated with nervous system involvement, with more than one-third of COVID-19 patients experiencing neurological manifestations. Utilizing a systematic review, this study aims to summarize brain MRI findings in COVID-19 patients presenting with neurological symptoms. Systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE, Embase, Scopus, and Web of Science were systematically searched for literature addressing brain MRI findings in COVID-19 patients with neurological symptoms. 25 publications containing a total number of 3118 COVID-19 patients with neurological symptoms who underwent MRI were included. The most common MRI findings and the respective pooled incidences in decreasing order were acute/subacute infarct (22%), olfactory bulb abnormalities (22%), white matter abnormalities (20%), cerebral microbleeds (17%), grey matter abnormalities (12%), leptomeningeal enhancement (10%), ADEM (Acute Disseminated Encephalomyelitis) or ADEM-like lesions (10%), non-traumatic ICH (10%), cranial neuropathy (8%), cortical gray matter signal changes compatible with encephalitis (8%), basal ganglia abnormalities (5%), PRES (Posterior Reversible Encephalopathy Syndrome) (3%), hypoxic-ischemic lesions (4%), venous thrombosis (2%), and cytotoxic lesions of the corpus callosum (2%). The present study revealed that a considerable proportion of patients with COVID-19 might harbor neurological abnormalities detectable by MRI. Among various findings, the most common MRI alterations are acute/subacute infarction, olfactory bulb abnormalities, white matter abnormalities, and cerebral microbleeds.

Extension of Lung Damage at Chest Computed Tomography in Severely Ill COVID-19 Patients Treated with Interleukin-6 Receptor Blockers Correlates with Inflammatory Cytokines Production and Prognosis.

Elevated inflammatory markers are associated with severe coronavirus disease 2019 (COVID-19), and some patients benefit from Interleukin (IL)-6 pathway inhibitors. Different chest computed tomography (CT) scoring systems have shown a prognostic value in COVID-19, but not specifically in anti-IL-6-treated patients at high risk of respiratory failure. We aimed to explore the relationship between baseline CT findings and inflammatory conditions and to evaluate the prognostic value of chest CT scores and laboratory findings in COVID-19 patients specifically treated with anti-IL-6. Baseline CT lung involvement was assessed in 51 hospitalized COVID-19 patients naive to glucocorticoids and other immunosuppressants using four CT scoring systems. CT data were correlated with systemic inflammation and 30-day prognosis after anti-IL-6 treatment. All the considered CT scores showed a negative correlation with pulmonary function and a positive one with C-reactive protein (CRP), IL-6, IL-8, and Tumor Necrosis Factor α (TNF-α) serum levels. All the performed scores were prognostic factors, but the disease extension assessed by the six-lung-zone CT score (S24) was the only independently associated with intensive care unit (ICU) admission (p = 0.04). In conclusion, CT involvement correlates with laboratory inflammation markers and is an independent prognostic factor in COVID-19 patients representing a further tool to implement prognostic stratification in hospitalized patients.

Endoscopic findings are not different in patients with upper gastrointestinal bleeding with COVID-19

Background and Aims: Coronavirus disease-2019 is an emerging disease of global public health concern. We aimed to evaluate the demographic data, clinical properties, risk factors and endoscopy findings of coronavirus disease-2019 patients with upper gastrointestinal system bleeding. Materials and Method: Patients who underwent endoscopy for upper gastrointestinal bleeding between July 2, 2020 and January 29, 2021 and were diagnosed with severe acute respiratory syndrome coronavirus-2 confirmed by polymerase chain reaction were included in the study. In this retrospective study patients with gastrointestinal bleeding were compared as 1:2 case-control. Coronavirus disease-2019 patients who underwent endoscopy for upper gastrointestinal bleeding and the control group were compared retrospectively in terms of demographic data, comorbid diseases, bleeding symptom, drugs administered, laboratory parameters, time between bleeding symptom and endoscopy, endoscopy findings, gastrointestinal bleeding treatment, and mortality rates. Results: Forty Covid-19 patients (23 males, mean age ± SD, 65.92 ± 12.97) and 80 non-Covid-19 control patients (43 males, mean age ± SD, 66.17 ± 15.61) who underwent endoscopy for upper gastrointestinal bleeding were compared. The most common bleeding symptom was melena in both groups (50% vs 60%). Hospitalization in intensive care unit (47.5% vs 20%, P = 0.004) and need for mechanic ventilation (22.5% vs 5%, p = 0.006), use of corticosteroids were more common in coronavirus disease-2019 group (30% vs. 2.5%, p = 0.000). The need for erythrocyt replacement were not different between the groups [median (min - max) 1.5 (0 - 13) vs 0.5 (0 - 22), p = 0.397]. Use of low molecular weight heparin was statistically more common in coronavirus disease-2019 group (32.5% vs 5%, p=0.00). Time elapsed until the performance of endoscopy in terms of hours was significantly longer in coronavirus disease-2019 group (62.97 ± 84.59 vs. 21.85 ± 33.91, p = 0.006). The most common endoscopic finding was gastroduodenal ulcer in both groups. No significant differences were seen in terms of rebleeeding rates. Mortality rate was statistically higher in coronavirus disease-2019 group (37.5% vs 8.8%, p = 0.000). Conclusions: Until more precise guidelines for the management of gastrointestinal bleeding in COVID-19 patients are developed, a case-by-case decision should be made on whether to perform endoscopy and the timing of the procedure, after multidisciplinary assessments are made in terms of patient status, response to medical therapy, treatment resources, and assessment of risks.

The Extent of Lung Involvement Based on CT-Scores, Compared to Clinical Symptoms and Laboratory Findings in COVID-19 Patients

Novel coronavirus disease 2019 (COVID-19) has become a public health concern with over 6.5 million cases and 390,000 deaths around the world. This research aimed to find an association between computed tomography (CT) scores and clinical and laboratory findings to estimate the extent of lung infection in patients with COVID-19. The study sample enrolled 129 patients diagnosed with COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, images were segmented and scored by the degree of involvement from 0 to 4, and the relationship between them and clinical and laboratory findings were analyzed statistically. This study included 74 men and 59 women with a mean age of 55.08 years. Different abnormalities were observed; the mean CT score was 8.52 (7.83 to 9.21) and the most frequent lesions were GGO and consolidation. Our results revealed significant differences between groups categorized by dyspnea, sore throat, and low oxygen saturation concerning CT scores. There was also a significant correlation between CT scores and WBC counts and CRP levels (P&lt;0.05). The evidence from this study implies that clinical and laboratory data, such as CRP, dyspnea, lymphopenia, and symptom onset closely correspond to chest CT scores and may be employed as initial tools to estimate the extent of lung involvement in COVID-19 patients.

Electrodiagnostic findings in COVID-19 patients of an underserved population with neuromuscular complaints: case series

Introduction: Persistent neuromuscular symptoms have occurred in some patients after coronavirus disease 2019 (COVID-19) infection requiring hospitalization. Objective: This is a retrospective chart review of an underserved patient population referred to our electrodiagnostic [electromyography (EMG)] laboratory with persistent neuromuscular symptoms after COVID-19 infection hospitalization and recovery. Methods: A retrospective review of EMG charts from March 2020 to May 2022 was conducted in an underserved county hospital of a major urban city. History of COVID-19 infection with neuromuscular symptoms that began during hospitalization was included in the study. Demographic, neuromuscular symptoms, EMG data, and diagnosis are reported in this study. Results: Fifteen cases are included in this series. All the patients were hospitalized with COVID-19, most required intubation in the intensive care unit. Overall, 86.7% were Hispanic, 6.7% African American, and 6.7% Asian. This compares to 57% Hispanic in this county’s hospital population in general. EMG results diagnoses include sciatic neuropathies, brachial plexopathy, radiculopathy/polyradiculopathy, amyotrophy, and multiple proximal mononeuropathies. Conclusions: This case series reports EMG findings in patients post-COVID-19 infection in an underserved county hospital population. Interestingly, many neuropathies were not in the conventional compression sites seen with prolonged immobility in intensive care settings.

Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study).

PurposeSeverely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).MethodsRetrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Patients admitted to ICU who received at least one echocardiography between 1st February 2020 and 30th June 2021 were included. Clinical and echocardiographic data were uploaded using a secured web-based electronic database (REDCap).ResultsSix hundred and seventy-seven patients were included and the first echo was performed 2 [1, 4] days after ICU admission. The median age was 65 [56, 73] years, and 71% were male. Left ventricle (LV) and/or right ventricle (RV) systolic dysfunction were found in 234 (34.5%) patients. 149 (22%) patients had LV systolic dysfunction (with or without RV dysfunction) without LV dilatation and no elevation in filling pressure. 152 (22.5%) had RV systolic dysfunction. In 517 patients with information on both paradoxical septal motion and quantitative RV size, 90 (17.4%) had acute cor pulmonale (ACP). ACP was associated with mechanical ventilation (OR > 4), pulmonary embolism (OR > 5) and increased PaCO2. Exploratory analyses showed that patients with ACP and older age were more likely to die in hospital (including ICU).ConclusionAlmost one-third of this cohort of critically ill COVID-19 patients exhibited abnormal LV and/or RV systolic function in their first echocardiography assessment. While LV systolic dysfunction appears similar to septic cardiomyopathy, RV systolic dysfunction was related to pressure overload due to positive pressure ventilation, hypercapnia and pulmonary embolism. ACP and age seemed to be associated with mortality in this cohort.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00134-022-06685-2.

The red half-moon nail sign in a COVID-19 patient

Sir, Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Several cutaneous manifestations associated with COVID-19 have been reported, including chilblains or chilblain-like lesions, erythematous rash, viral exanthem, urticaria, livedo reticularis, acral ischemia, palpable purpura, and erythema multiforme. These were thought to be useful in the early diagnosis and triage of COVID-19 patients and their risk stratification [1]. However, there are limited reports on the nail manifestations of COVID-19, including several cases of Beau lines, leukonychia, orange discoloration, and onychomadesis [2]. An exceptionally rarely reported manifestation of COVID-19 is the red half-moon-nail sign [3,4]. A 46-year-old male presented to our outpatient clinic with transversal red bands surrounding the distal margin of the nail’s lunula on all of the fingernails, which the patient noticed a week previously (Fig. 1). One month before, with symptoms of fever, shortness of breath, and coughing present for three days, he had been given the diagnosis of COVID-19 following a positive nasopharyngeal swab polymerase chain reaction test. Computed tomography of the lungs revealed generalized ground-glass opacities and paraseptal emphysema in the upper lobes, and the patient was hospitalized for one week and treated with favipiravir for five days and was on oxygen therapy. He was discharged from the hospital one week later with partial remission of the respiratory symptoms. He also had hypertension, atherosclerotic heart disease, and Behçet’s disease, and had been using metoprolol, amlodipine, edoxaban, irbesartan, hydrochlorothiazide, and colchicine. After two weeks of follow-up, the bands remained present and became wider (Fig. 2). The red-half-moon sign was first described by Neri et al. as half-moon-shaped transversal red bands after SARS-CoV-2 infection. The patient was a sixty-year-old female and the bands appeared two weeks after the onset of symptoms of COVID-19. The patient was hospitalized and received oxygen therapy and several other treatments, including hydroxychloroquine and lopinavir/ritonavir. As in our patient, the bands remained present and became wider after one month of follow-up [3]. Mendez-Flores et al. reported a case of the red half-moon nail sign in a 37-year-old female with COVID-19. The patient noticed the changes two days after the COVID-19 symptoms appeared, and these lasted for one week before gradually returning to normal. The patient was managed at home and required no oxygen therapy [4]. The pathogenesis of the red half-moon sign is unknown. Neri et al. proposed that localized microvascular injury secondary to an inflammatory immune response and procoagulant state may play a role. It is thought that, because of the location, the distal subungual arcade’s capillary network may be affected in these cases [2,3]. We also agree that the red half-moon sign could be associated with microvascular injury or a procoagulant state connected to an inflammatory immune response. Recently, Natalello et al. reported nailfold capillaroscopy abnormalities in COVID-19 patients, including microvascular alterations in the nailfold capillary bed ranging from microthrombosis to altered capillary structures, according to the COVID-19 phase supporting this theory [5]. We also think that the persistence of the bands might be related to the severity of the disease, as both our and Neri et al.’s patients were hospitalized and had a more severe disease course than Mendez-Florez et al.’s patient. We think that, similarly to skin findings, nail findings may be a clue in the diagnosis and prognosis of COVID-19 as well as the pathogenesis of the disease, and clinicians should search for nail findings in COVID-19 patients.

Pulmonary Sequelae in Patients After Recovery From Coronavirus Disease 2019: A Follow-Up Study With Chest CT.

Objective: The pulmonary sequelae of coronavirus disease 2019 (COVID-19) have not been comprehensively evaluated. We performed a follow-up study analyzing chest computed tomography (CT) findings of COVID-19 patients at 3 and 6 months after hospital discharge.Methods: Between February 2020 and May 2020, a total of 273 patients with COVID-19 at the Shenzhen Third People's Hospital were recruited and followed for 6 months after discharge. Chest CT scanning was performed with the patient in the supine position at end-inspiration. A total of 957 chest CT scans was obtained at different timepoints. A semi-quantitative score was used to assess the degree of lung involvement.Results: Most chest CT scans showed bilateral lung involvement with peripheral location at 3 and 6 months follow-up. The most common CT findings were ground-glass opacity and parenchymal band, which were found in 136 (55.3%) and 94 (38.2%) of the 246 patients at 3 months follow-up, and 82 (48.2%) and 76 (44.7%) of 170 patients at 6 months follow-up, respectively. The number of lobes involved and the total CT severity score declined over time. The total CT score gradually increased with the increasement of disease severity at both 3 months follow-up (trend test P < 0.001) and 6 months follow-up (trend test P < 0.001). Patients with different disease severity represented diverse CT patterns over time.Conclusions: The most common CT findings were ground-glass opacity and parenchymal bands at the 3 and 6 months follow-up. Patients with different disease severity represent diverse CT manifestations, indicating the necessary for long-term follow-up monitoring of patients with severe and critical conditions.

Clinical and Endoscopic Outcomes in Coronavirus Disease-2019 Patients With Gastrointestinal Bleeding.

Background and AimsOver 404 million people worldwide have been infected with coronavirus disease–2019 (COVID-19), 145 million in the United States (77 million) and Europe (151 million) alone (as of February 10, 2022). This paper aims to analyze data from studies reporting gastrointestinal bleeding (GIB) and/or endoscopic findings in COVID-19 patients in Western countries.MethodsWe conducted a systematic review of articles on confirmed COVID-19 cases with GIB in Western countries published in PubMed and Google Scholar databases from June 20, 2020, to July 10, 2021.ResultsA total of 12 studies reporting GIB and/or endoscopic findings in 808 COVID-19 patients in Western countries were collected and analyzed. Outcomes and comorbidities were compared with 18,179 non-GIB COVID-19 patients from Italy and the United States. As per our study findings, the overall incidence of GIB in COVID-19 patients was found to be 0.06%. When compared to the non-GIB cohort, the death rate was significantly high in COVID-19 patients with GIB (16.4% vs 25.4%, P < .001, respectively). Endoscopic treatment was rarely necessary, and blood transfusion was the most common GIB treatment. The most common presentation in GIB patients is melena (n = 117, 47.5%). Peptic, esophageal, and rectal ulcers were the most common endoscopic findings in upper (48.4%) and lower (36.4%) endoscopies. The GIB cohort had worse outcomes and higher incidence of hypertension (61.1%), liver disease (11.2%), and cancer (13.6%) than the non-GIB cohort. Death was strongly associated with hypertension (P < .001, r = 0.814), hematochezia (P < .001, r = 0.646), and esophagogastroduodenoscopy (P < .001, r = 0.591) in COVID-19 patients with GIB.ConclusionOverall, the incidence of GIB in COVID-19 patients is similar to that estimated in the overall population, with melena being the most common presentation. The common endoscopic findings in GIB COVID-19 patients were ulcers, esophagitis, gastritis, and colitis. Patients with GIB were more prone to death than non-GIB COVID-19 patients.

The Evolving Role of Echocardiography During the Coronavirus Disease 2019 Pandemic.

Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has served as a valuable tool for triaging, diagnosing and managing patients with COVID-19. More recently, speckle-tracking echocardiography has been shown to be effective in demonstrating subclinical myocardial dysfunction that is often not detected in standard echocardiography. Echocardiographic findings in COVID-19 patients include left or right ventricular dysfunction, including abnormal longitudinal strain and focal wall motion abnormalities, valvular dysfunction and pericardial effusion. Additionally, some of these echocardiographic abnormalities have been shown to correlate with biomarkers and adverse clinical outcomes, suggesting an additional prognostic value of echocardiography. With increasing evidence of cardiac sequelae of COVID-19, the use of echocardiography has expanded to patients with cardiopulmonary symptoms after recovery from initial infection. This article aims to highlight the available echocardiographic tools and to summarize the echocardiographic findings across the full spectrum of COVID-19 disease and their correlations with biomarkers and mortality.

Local ocular surface findings in COVID-19 patients without ocular symptoms.

To investigate subjective ocular symptoms and objectively measure tear secretion in patients with a confirmed diagnosis of coronavirus disease-2019 (COVID-19). In this prospective cross-sectional study, 24 patients who had survived COVID-19 infection and 27 healthy controls were enrolled. Conjunctival impression cytology, the Schirmer test, tear-film break-up time, corneal staining scores were applied to all the participants. No significant difference was noted with regard to the gender and mean age between the two groups (p=0.484 and p=0.599, respectively). The conjunctival impression cytology analysis revealed that the density of the goblet cells was decreased, while the counts of lymphocytes and neutrophils were increased in the COVID-19 group patients when compared with ethe control group patients. When the Nelson classification was applied to the conjunctival impression cytology samples, 25% of the COVID-19 group patients and 14.8% of the control group patients exhibited changes consistent with ≥grade 2. The mean tear-film break-up time, Schirmer test, and corneal staining score results were determined to differ between the COVID-19 and control groups (p=0.02, p<0.001, and p=0.003, respectively). The present study revealed the pathological conjunctival alterations of patients with a confirmed diagnosis of COVID-19, indicating the possibility of the occurrence of pathological ocular surface alterations to even at the end of COVID-19 infection, without the occurrence of any significant clinical ocular manifestations.

COVID-19 is associated with a high prevalence of liver damage: a systematic review and meta-analysis

Introduction: The Coronavirus Disease 2019 (COVID-19) outbreak is a serious threat to humans, and the impact of COVID-19 on the liver remains unexplored. At present, no meta-analysis has summarized available findings of COVID-19 patients with liver injury in depth. Thus, we aimed to scrutinize the association of the liver in COVID-19 patients and approximate the prognosis of COVID-19 patients with liver injury thoroughly. Method: We searched different databases for qualified studies between December 2019 to May 2021. Finally, meta-analysis was carried out using fixed-effect or random-effect models based on the heterogeneity. Result: Our Meta-analysis includes 32 studies with a total of 6,933 COVID-19 patients. The pooled prevalence of chronic liver disease (CLD) was 3.5%. Overall, the rates of severity and mortality in COVID-19 patients with underlying CLD were 4.6% and 19.2%, respectively. Additionally, the incidence of acute on chronic failure (ACLF) among COVID-19 patients with CLD was 25.1%. The prevalence of an increase in serum ALT, AST, TBil, and LDH levels was 39.5%, 28.6%, 26.5%, and 55.5%, respectively. Similarly, PT was prolonged in 8.3% of cases, and albumin was decreased in 66.8% of cases. The pooled prevalence of liver injury among COVID-19 patients was 28.2%. Strikingly, the patients with liver injury had significantly more severe disease (42.3%) and a higher incidence of mortality (18.5%) than the patients without liver injury. Conclusion: In conclusion, more than one in five of the COVID-19 patients is at risk of developing a liver injury. Further, patients with liver injury have significantly more severe disease and a higher incidence of mortality than patients without liver injury. Thus, careful monitoring of liver function is advisable while treating COVID-19 patients.

Electrodiagnostic findings in COVID-19 patients: A single center experience

ObjectiveNeurological manifestations in patients with coronavirus disease 2019 (COVID-19) have been reported from early features of anosmia and dysgeusia to widespread involvement of the central nervous system, peripheral nervous system, as well as the neuromuscular junction and muscle. Our study objective is to evaluate the electromyography and nerve conduction study (EMG/NCS) findings among COVID-19 patients and look for possible correlations. MethodsThis is a hospital-based retrospective observational study. All COVID-19 patients between the period of 1st January 2020 to 31st December 2020 undergoing an EMG/NCS were included. ResultsEighteen patients (12 male and 6 female) were included. Mean age was 55 ± 12 years. 11 patients required intubation for a mean period of 18.6 days (range: 3–37 days). Electrodiagnostic findings were consistent with a myopathy in a majority of these patients (82%). Five of them also had a concurrent axonal neuropathy. In the remaining patients who did not require intubation (n = 7), three patients had myopathic EMG changes and one had Guillain Barre syndrome. ConclusionAt this time, there are no neuromuscular-specific recommendations for patients who contract COVID-19. Only time and additional data will unveil the varying nature and potential neurological sequelae of COVID-19. SignificanceMyopathic EMG changes are commonly seen in critically ill COVID-19 patients, especially with a prolonged hospital stay.

Radiological Findings From 101 Patients With Novel Coronavirus Disease 2019 (COVID-19) in Hamadan, West of Iran: Typical and Atypical Features

Background and aims: Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study, we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran. Methods: This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory, and chest CT findings of identified COVID-19 patients were assessed. Results: The mean age of the patients was 55.21 ± 14.08 years, and 54 (53.47%) of them were male. With regard to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea, and fever, respectively. The right lower lobe was the most commonly and severely involved lope (69%), followed by left lower lobe, right middle lobe, and lingual segment; however, the anterior segment of upper lobes showed the least involvement with abnormality in the late course of the disease. The most common pattern was ground glass opacity (GGO), but atypical patterns such as round pneumonia, moderate to severe pleural effusion, and segmental lobar consolidation were seen without evidence of mediastinal adenopathy, cavitation, or nodular lesion. Chest X-ray (CXR) was not a sensitive method as the first-line imaging method because 34.65% of them were normal. Conclusion: CXR is not a sensitive method as the first-line imaging method (34.65% normal first CXR), but chest CT is a very sensitive and nonspecific modality for diagnosis of COVID-19. The lower lobe and posterior basal segments of the lungs are the most involved sites in most cases. About 12% showed atypical chest CT findings.

Characteristic Electrocardiography Findings of COVID-19 Patients.

Determining a relationship between coronavirus disease 2019 (COVID-19) and the ECG findings of the patients with this disease can assist in early diagnosis and patient management based on these findings. This study aimed to investigate whether COVID-19 patients had characteristic ECG findings in the acute period. A total of 124 patients were divided into two groups as those diagnosed with COVID-19 and controls. The ECGs of these patients were evaluated in terms of rate, rhythm, presence of ST changes, PR interval, QRS width, QTc and QT interval, and presence of right and left bundle branch blocks. On the ECG, the median heart rate of the COVID-19 patients was 104/min (IQR: 99-114), and there was a significant difference compared to the control group (P<0.001). The median PR interval was 157/ms, the QRS width was 86 ± 9/ms in the COVID-19 patients, with no significant difference compared to the controls (P = 0.161 and P = 0.631, respectively). The median QT interval of the COVID-19 patients was normal (400/ms), but a significant difference was detected compared to the controls (P = 0.005). The QTc, ST change, AF, and presence of right and left bundle branch blocks were not significantly different between the two groups. Considering the importance of ECG findings in order to diagnose COVID-19 disease early, we can state that sinus tachycardia is very common in COVID-19 patients, but there is no characteristic ECG finding for COVID-19, including tachycardia.