Mild Type Research Articles

Epidemiological characteristics of 32 asymptomatic infections with COVID-19 in Liaoning

Objective To investigate the epidemiological characteristics, pathogenesis and clinical outcomes of asymptomatic patients with coronavirus disease 2019 (COVID-19), and we provide theoretical basis for the formulation of epidemic prevention and control strategies. Methods Follow-up survey of 32 asymptomatic carriers with COVID-19 were conducted in Liaoning Province. Demographic information, contact with confirmed cases, diagnosis time, clinical outcomes, etc were collected through the Chinese Disease Control and Prevention Information System-Infectious Disease Monitoring and Public Health Emergency Monitoring System. Results Of the 32 asymptomatic patients reported, 28 cases were the close contacts. 20 cases(62.5%) were confirmed, and the clinical outcomes were mainly general and mild type (95.0%); 27 cases (84.37%) were clustered in families. The median time from diagnosis to confirmed cases was 2 days, the longest interval was 11 days, the shortest was the very day; The duration of infection ranged from 5 to 27 days, with a median of 16 days. Epidemiological evidence of four chains of transmission suggests incubation period transmission. Conclusion The condition of asymptomatic carriers with COVID-19 in our province is mild after being converted to confirmed cases, but the communicable period is relatively long, and most of them are family clustering. It is urgent to monitor the close contacts through multiple nucleic acid screening to control the potential outbreaks. 摘要： 目的 探讨新冠肺炎无症状感染者流行病学特征、发病进程及临床结局，为制定疫情防控策略提供理论依 据。 方法 对辽宁省 32 例新冠肺炎无症状感染者追踪调查，通过中国疾病预防控制信息系统-传染病监测、突发公共 卫生事件监测系统及流行病学调查报告收集人口学信息、接触情况、诊断时间、临床转归情况等。 结果 累计报告的 32 例无症状感染者中，28 例为辽宁省报告确诊病例的密切接触者，20 例(62.5%)转为确诊病例，临床结局以普通型、轻 型为主(95.0%)；27 例(84.37%)为家庭聚集性发病。无症状感染者诊断至转为确诊病例的中位时间为 2 d，最长 11 d， 最短当日；传染期的范围 5~27 d，中位时间为 16 d。有 4 个传播链的流行病学证据提示为潜伏期传播。 结论 辽宁省 无症状感染者转为确诊病例病情轻微，但传染期较长，多为家庭聚集性发病。亟待通过核酸筛查严格监控密切接触 者，以控制潜在疫情暴发。

Epidemiological and clinical characteristics of 55 patients with COVID-19

Objective To explore the clinical and epidemiological characteristics of patients with coronavirus disease 2019, and we provide reference for the prevention and control of epidemic situation. Methods Fifty-five patients with COVID-19 diagnosed and admitted to the hospital were studied as the research object from January 23 to February 16, 2020, we collected epidemiological data, such as whether patients had been a recent travel to Hubei, ever come into contact with people from Hubei, whether recent contact with patients with respiratory diseases; and clinical features include fever, fatigue, dry cough, muscle pain, cough, sputum, etc, collected related laboratory tests and imaging examination index, analyzed clinical and epidemiology features of COVID-19 patients. Results Among the 55 cases, 27 were males and 28 were females, with an average age of (43.11 ± 17.91) years. Among them, there were 3 cases of mild type, 48 cases of normal type, 3 cases of severe type and 1 case of critical type. The common type was dominant, accounting for 87.27% of the total cases. There were 29 cases of family cluster (52.73%). There were 19 imported cases (34.55%), and 27 recent contacts with persons from Hubei (49.09%). The clinical symptoms were dry cough in 34 cases (61.82%), fever in 30 cases (54.55%), sputum in 19 cases (34.55%), and fatigue in 18 cases (32.73%), and asymptomatic in 6 cases (10.91%). The total number of white blood cells was normal or decreased in 52 cases (94.55%), and the lymphocyte count was decreased in 12 cases (21.82%).There were 46 cases (83.64%) with ground-glass changes in both lungs on CT 5 days after the onset of symptoms. Conclusion COVID-19 patients were mainly normal type, mainly imported and family cluster cases, but there were also asymptomatic patients. The prevention and control of COVID-19 should strictly prevent imported cases and personnel gathering, and strengthen the monitoring of body temperature.Strengthen COVID-19 nucleic acid testing of confirmed close contacts, we couldtimely detect asymptomatic cases and conduct isolation and treatment. 摘要： 目的 探讨新型冠状病毒肺炎(COVID-19)患者的临床和流行病学特征，为疫情的防控提供参考。 方法 以 2020 年 1 月 23 日—2 月 16 日在某院确诊并收治的 COVID-19 患者 55 例为研究对象，收集患者近期是否到湖 北出行，是否接触过来自湖北的人员，近期是否接触呼吸道疾病患者等流行病学资料，临床症状资料包括发热、乏力、 干咳、肌肉疼痛、咳痰等，收集相关的实验室检测和影像学检查指标，分析 COVID-19 患者临床和流行病学特征。 结果 55 例患者中男性 27 例，女性 28 例，平均年龄(43.11±17.91)岁。临床分型：轻型 3 例，普通型 48 例，重型 3 例，危重 型 1 例，以普通型为主(87.27%)。家庭聚集性病例 29 例(52.73%)，输入性病例 19 例(34.55%)，近期接触到过湖北的人 员 27 例(49.09%)。临床症状为干咳 34 例(61.82%)，发热 30 例(54.55%)，咳痰 19 例(34.55%)，乏力 18 例(32.73%)，无 症状者 6 例(10.91%)。首次住院检测白细胞总数正常或降低者 52 例(94.55%)，淋巴细胞计数减少 12 例(21.82%)。出 现症状后 5 d CT 双肺毛玻璃样变 46 例(83.64%)。 结论 COVID-19 患者以普通型为主，主要为输入性和家庭聚集性病 例，同时也存在着无症状感染者。对 COVID-19 防控要严防输入性病例和人员的聚集，加强体温的监测。加强对确诊 患者密切接触者的 COVID-19 核酸检测，及时发现无症状病例并进行隔离和治疗。

Comorbid depression and its associated factors in patients with epilepsy treated with single and multiple drug therapy: A cross-sectional study from Himalayan country

IntroductionDepressive disorder is the most common psychiatric comorbidity in individuals with epilepsy (IWE) and is associated with a significant negative impact with increased morbidity and mortality rate. However, the magnitude of comorbid depression in such patients in the Nepalese setting is still poorly understood. Therefore, we aimed to determine the magnitude of depression in individuals diagnosed as having epilepsy and further examine the influencing factors associated with it. MethodsThis cross-sectional observational study was conducted from April 2018 to September 2018 at Nepal Epilepsy Center, Lazimpat, Kathmandu, Nepal. One hundred and forty-two eligible subjects were enrolled for analysis. The core outcome variable evaluated in this study was depressive disorder, whereas age, gender, types of epilepsy, frequency of seizures, duration of epilepsy, and drug use were evaluated as covariates. The mean ages of the patients were 31.45 ± 12.05 years, and 87 (61.3%) were male. The prevalence of depression was found to be 31% (95% confidence interval [CI]; lower limit: 23.39% and upper limit: 38.60%), with majority subjects had a mild type of depression, and 63.63% (95% CI; lower limit: 55.05% and upper limit: 70.94%). The frequency of drug use remained a significant predictor for depression in individuals with epilepsy (P = 0.002), and the odds of having depression in individuals receiving polytherapy were 3.82 higher than in those receiving monotherapy (95%: 1.61–9.05, P = 0.002). ConclusionOur study indicated a high rate of depression in a substantial number of IWE in the Nepalese setting. Polytherapy emerged as an independent predictor for depression. The high coexistence of depression in this vulnerable population and an increased risk for comorbid in polytherapy necessitate incorporating depression screening and proper treatment into the existing epilepsy program. Furthermore, revising treatment guidelines on comorbid depression to reduce polytherapy and encouraging health education on epilepsy to reduce stigma may also be warranted.

Clinical characteristics of 132 healthcare workercases with COVID-19: A retrospective study from a single center in Wuhan, China.

Many healthcare workers (HCWs) have been confirmed to be infected with SARS-CoV-2 in China. A retrospective, single-center study was conducted. The median age of the 132 HCWs with COVID-19 was 32 years, with 92 (69.7%) beingfemales. There were 47 (35.6%) doctors, 72 (54.6%) nurses, and 13 (9.9%) other HCWs. Ten of the 132 patients (7.6%) had underlying diseases. The most common symptoms of illness onset were fever (70, 53.0%), cough (66, 50.0%), and fatigue (58, 43.9%). All patients were categorized into mild or moderate COVID-19 type on admission to hospital, and five (3.8%) progressed to the severe COVID-19 type. Sixty-six HCWs patients were included in both the early and later discharged group. In the logistic analysis, the later discharged patients had a longer time for illness onset to hospital admission (per 1 day; OR, 1.10; 95% CI, 1.03-1.18; p = .006), a higher proportion of>3 onset symptoms clustering (OR, 3.11; 95% CI, 1.27-7.62; p = .01), and a higher percentage of other HCWs (OR, 6.20; 95% CI, 1.49-25.80; p = .01). HCWpatients were youngfemalenurses with fewercomorbidities, and most were mild or moderate COVID-19 type. The later discharged patients exhibited characteristics of longer time for illness onset to hospitalization and clustering of onset symptoms.

Neuropsychology and differential diagnosis in cognitive declines and demoralprocesses in the elderly

In order to review the literature on cognitive decline in aging, normal and pathological and the role of neuropsychological evaluation in the differential diagnosis of these declines, a search was conducted in specialized textbooks, neuropsychological evaluation manuals and indexed scientific articles (in capes, lilacs, pubmed, mediline and scielo and academic Google journals), the review was conducted in November and December 2019. The study gathered information about cognitive deficits in normal aging, mild cognitive impairment (CLC) and different types of dementia, such as: Alzheimer's disease (AD); Frontotemporal dementia (FTD); Dementia with Lewy corpuscles (DCL); Vascular dementia (DV); Mixed dementia (AD/dv); dementias associated with other neurodegenerative disorders; infectious dementias and reversible dementias. The importance of neuropsychological evaluation was verified as a diagnostic tool, using resources such as: interviews, behavioral observations, batteries of screenings and specific tests (exclusive use of the psychologist). Neuropsychological evaluation characterizes dementia as a progressive deficit in cognitive function, with impaired memory from the initial phase, which impairs social and occupational activities. In addition, neuropsychological evaluation can identify situations in which there is the possibility of reversal, primary and sequelal conditions and also guide therapy and indicate prognosis.

NET PRIMARY PRODUCTIVITY OF A MOUNTAIN FOREST ECOSYSTEM AS AFFECTED BY CLIMATE AND TOPOGRAPHY

Response of terrestrial ecosystems to changing climate has become an issue of central importance for land managers and policymakers. Climate extremes and trends have a strong control on productivity of semi-arid mountain ecosystems. Located in a transition zone from continental type climate to relatively mild Black Sea type climate in Turkey, the Ilgaz Mountains with their rich biodiversity, provide a unique opportunity to evaluate vulnerability of a typical semi-arid mountain ecosystem to climate change. Therefore, we evaluated spatio-temporal variation of annual net primary productivity (NPP) of Ilgaz Mountains predicted by Moderate Resolution Imaging Spectroradiometer (MODIS), as affected by topography and climate between 2000 and 2010. The annual MODIS NPP ranged from 500 to 912 g.m-2.y-1. Elevation, slope aspect, and vegetation type were significantly correlated with MODIS NPP The MODIS NPP was highly sensitive to droughts, and the mean MODIS NPP generally decreased across the study pixels in the study period. The response of MODIS NPP to climate was highly site- and time-specific. Multiple interactions among climate, plant composition, and topography were the principal determinants of the temporal pattern as well as drought sensitivity of MODIS NPP to climate between 2000 and 2010. Quality control charts showed that MODIS NPP decreased sharply in 2003 and 2007 droughts. The results obtained in this study contributed to our understanding of the interactions among climate, topography, and vegetation composition in a typical mountain ecosystem.

Evolution of chest CT manifestations of COVID-19: a longitudinal study.

BackgroundThe aim of this study was to investigate the chest CT manifestations of COVID-19 and its CT evolving process to explore its inherent outcomes.MethodsInpatients diagnosed with COVID-19 at the Enze Hospital from January 17, 2020 to February 15, 2020 were included. The evolving characteristics of CT manifestations and treatment outcomes were analyzed.ResultsTwenty-two patients with COVID-19 were included in the study. Clinical symptoms at the time of onset included fever (n=19) and cough (n=8). The first CT findings mainly included ground-glass opacities (GGOs) (n=18), lung consolidation (n=7), interlobular septal thickening (n=5), and fibrosis-like stripes (n=4). Dynamic CT showed GGOs, lung consolidation, and fibrosis-like stripes, all of which demonstrated a trend that initially increased in number, and then gradually decreased in number or disappeared. According to the characteristics of CT evolution. COVID-19 could be divided into early stage, progressing stage, recovery stage, and dissipation stage. The median times of the respective stages were: early stage—3 days (1–8 days) after disease onset, progressing stage—7 days (4–17 days) after onset, recovery stage—10 days (8–14 days) after onset, and dissipation stage—19.5 days (11–25 days) after onset.ConclusionsCOVID-19 has an acute onset, with main imaging manifestations of different types of GGO with or without lung consolidation in the subpleural regions of the bilateral lungs. The CT manifestations of lung lesions change rapidly. The lung lesions of mild and ordinary types of COVID-19 may improve significantly or disappear in a short period after active treatment, with good prognosis. Moreover, fibrosis-like stripes may be a sign of atelectasis of sub-segment lung tissue of COVID-19 and may be a specific sign for the diagnosis of COVID-19.

Characteristics of alcohol use disorder patients based on MMPI-2 profile typology and comorbid disorder

This study investigated the clinical characteristics of alcohol use disorder (AUD) patients using a typology based on the MMPI-2 to compare patients with and without comorbid disorders. A total of 244 patients with AUD at an alcohol specialty hospital were categorized into the two groups. The noncomorbid group (n = 142) had three profile types: a “normal profile type,” with normal-range scores on clinical scales; a “depressive and worried profile type,” with elevated clinical scales 2, 7, and 4; and a “mild psychological discomfort type,” with scores within the normal range on clinical scales and relatively low on defensiveness scales. The comorbid group (n = 102) had two profile types: a “mild psychopathological type,” with higher scores on infrequency scales and clinical scales 2, 4, 6, 7, and 8 and relatively lower defensiveness scale scores than type 2; and a “normal profile type” with all scale scores within the normal range. In both groups, the profile types were significantly differentiated on the Addiction Admission Scale (AAS) in the supplemental scales for substance abuse.

Clinical Features of COVID-19 Patients with Diabetes and Secondary Hyperglycemia

People with diabetes have higher risks of various infections. Therefore, these diabetic patients might be at increased risk of COVID-19 and have a poorer prognosis. Up until now, little is known about critical role in the pathogenesis. This study aims to investigate the clinical characteristics of COVID-19 patients with diabetes and secondary hyperglycemia, as well as to explore the purported mechanisms. 80 confirmed COVID-19 subjects were classified into the euglycemia group, secondary hyperglycemia group, and diabetes group. Severity of COVID-19 was defined based on the diagnostic and treatment guideline for SARS-CoV-2 issued by Chinese National Health Committee. According to the severity of the disease, patients of the mild type and common type were registered as mild cases (patients with minimal symptoms and negative CT findings), while patients of the severe type and critical type were enrolled as severe cases (patients with positive CT findings and different extent of clinical manifestations). Patients in the diabetes group were older than those in the euglycemia group, and most of them were male. In the diabetes group, the proportion of severe cases was 57.14%, which was significantly higher than those in the other two groups, and 32% of the COVID-19 patients diagnosed as severe cases were with diabetes. The CD4+ cell counts in the diabetes group were lower than those in the other two groups, while the levels of LDH and hs-CRP were higher. Compared with the euglycemia group, the CD3+ cell counts and the CD4+/CD8+ ratio were decreased, whereas the levels of IL-6 were increased in the secondary hyperglycemia group and diabetes group, with the diversities in the diabetes group being especially more significant. The Spearman correlation analysis revealed that the presence of diabetes was positively correlated with age, hs-CRP, LDH, IL-6, CD8+ cells, and severity of COVID-19 and negatively correlated with CD3+ cell counts, CD4+ cell counts, and CD4+/CD8+ ratio. Compared with the other two groups, the diabetes group exhibited more diverse and multifocal features in CT imagings. Diabetes is a risk factor for influence of the progression and prognosis of COVID-19 due to ongoing inflammation and impaired immune response.

Water Quality Scenario of Kashmir Himalayan Springs—a Case Study of Baramulla District, Kashmir Valley

This article describes the water quality scenario of freshwater springs of Baramulla district of Kashmir Valley in light of pollution threats and predicted climate change consequences for Himalayan ecosystems. The study was designed to have insights to what extent the community is relying on the spring water and what policy initiatives and planning perspectives at the government level are currently in vogue for sustainable management of these freshwater springs. Our results indicated that the springs are mild hard water type with nitrate concentration, conductivity, and iron values ranging from 19 to 675 μg/L, 185 to 811 μS/cm, and 1 to 308 μg/L respectively. Water quality index (WQI) revealed that the majority of the springs have excellent to good water quality category, while as in few springs like Aboora (26), Harwan (27), Fugipora (29), and Goigam (30), it was falling under poor to very poor category. Principal component analysis (PCA) generated mainly three components (VF1, VF2, and VF3) with higher Eigen values of 2.0 or more (2.23–6) accounting for 56.92%, 28.85%, and 10.64% of the total variance respectively. The survey highlights revealed the dependence of a large proportion of population for drinking water besides other uses, but no signs of involvement from the government level. Keeping in view the importance of these springs, it is necessitated that this situation should catch the attention of government and policy makers for the management of freshwater springs which can play an important role in fulfilling the UN (United Nations) Sustainable Development Goal (SDG) of access to safe drinking water.

Clinical characteristics and corticosteroids application of different clinical types in patients with corona virus disease 2019

To describe the epidemiological and clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) in Beijing. To analyze the application of corticosteroids in patients with severe pneumonia. We collected information on demographic characteristics, exposure history, clinical characteristics, corticosteroids use, and outcomes of the 65 confirmed cases of COVID-19 at Fifth Medical Center of PLA General Hospital from Jan 20 to Feb 23, 2020. The final follow-up date observed was April 15th, 2020. The number of patients with mild, general, severe, and critical type were 10 (15.38%), 32 (49.23%), 8 (12.31%), and 15 (23.08%), respectively. The median incubation period was 6 days. Notable outliers were 1 patient at 16 days and 1 patient at 21 days. In lymphocyte subgroup analysis, decreases in total, T, CD4, and CD8 lymphocytes were more common as the disease worsened (All P < 0.05). Methylprednisolone (mPSL) was applied to 31 (47.69%) patients with pneumonia, including 10 (31.25%) general, 8 (100%) severe, and 13 (86.67%) critical patients, respectively. Corticosteroids inhibited Interleukin-6(IL-6) production (P = 0.0215) but did not affect T lymphocyte (P = 0.0796). There was no significant difference between patients using lower dose (≤ 2 mg/kg day) and higher dose (> 2 mg/kg day) mPSL in inhibiting IL-6 production (P = 0.5856). Thirty of 31 patients (96.77%) had stopped mPSL due to improvement of pneumonia. Virus RNA clearance time lengthened with disease progression (P = 0.0001). In general type, there was no significant difference in virus clearance time between patients with (15, 12–19 days) and without (14.5, 11–18 days) (P = 0.7372) mPSL use. Lymphocyte, especially T lymphocyte, in severe and critical patients showed a dramatic decrease. Application of lower dose corticosteroids (≤ 2 mg/kg day) could inhibit IL-6 production (a representative of cytokines) as effectively as a higher dose. Proper use corticosteroids in general type patients did not delay virus clearance.

Magnitude, Severity, and Associated Factors of Anemia among Under-Five Children Attending Hawassa University Teaching and Referral Hospital, Hawassa, Southern Ethiopia, 2016.

Background Anemia is a widespread public health problem associated with increased risk of morbidity and mortality. Infants, under-5-year-old children, and pregnant women have greater susceptibility to anemia. The magnitude and associated risk factors for anemia vary in different settings. The study aimed to assess the magnitude, severity, and associated factors of anemia at Hawassa University Teaching and Referral hospital, Hawassa, southern Ethiopia. Methods In a hospital-based cross-sectional study, a total of 422 under-five children were included. Sociodemographic data and other predisposing factors were collected by structured questionnaire. Venous blood samples were collected and analyzed for hemoglobin determination using a Cell-Dyn 1800 automated analyzer. Stool samples were collected and processed using direct wet mount and formol-ether concentration method to detect intestinal parasites. Data were entered and analyzed using SPSS version 20 statistical packages. Binary and multiple logistic regressions were computed to assess factors associated with anemia. p value less than 0.05 was taken as statistically significant. Result The overall prevalence of anemia was found to be 41.7%. The mean hemoglobin level was 10.59 g/dl. Anemia was of mild, moderate, and severe type in 6.6%, 19%, and 16.1% of the children, respectively. Children in the age group 6–23 months (AOR = 2.04 (95% CI: 1.13, 3.69)), and mothers having no formal education (AOR = 1.73 (95% CI: 0.99, 3.02)) were identified as associated factors for anemia. Conclusion The prevalence of anemia among the study subjects was 41.7% indicative of the fact that anemia is an important public health problem. It was associated with the child's age, residence, mother's education level, and intestinal parasite (Ascaris lumbricoides). It clearly indicates that there should be well integrated public health interventions to improve the health status that needs to be prioritized to prevent anemia among children under five years of age.

Prevalence of Psychological Effect of COVID-19 on Medical Professionals in a Tertiary Care Center.

COVID-19 is a pandemic disease first detected in Wuhan, China on last December 2019. Many doctors and nurses, were infected and lost their life by COVID-19 around the world. Therefore COVID-19 brought unbearable psychological pressure on doctors, and nurses. The objective of this study is to find the prevalence of anxiety among medical doctors and nurses. This is a descriptive cross-sectional study of 101 doctors and nurses carried out in a tertiary care center. Convenience sampling was done with the study period from April to May 2020. Ethical approval was taken from the institutional review board of NAMS (IRB reference no. 1076). The collected data stored and analyzed with statistical software (SPSS version 26.0). Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 101 participants prevalence of anxiety was found to be 74 (73.3%) (64.68-81.33 at 95% Confidence Interval). Among them, 9 (8.9%) of participants experienced sever types of generalized anxiety disorder, 23 (22.8%) moderate, and 42 (41.6%) mild type. Similarly, 18 (17.8%) and 10 (9.9%) of participants felt very difficult and extreme difficulty at the workplace and home respectively. The mental health of medical doctors and nurses is significantly affected during the COVID-19 pandemic. Hospital administration should conduct psychological preparedness training to the medical profession before posting on duty to provide quality health services to the patients.

A psychological investigation of coronavirus disease 2019 (COVID-19) patients in mobile cabin hospitals in Wuhan.

BackgroundThis study investigated the depression, anxiety, and insomnia levels of coronavirus disease 2019 (COVID-19) patients admitted to two mobile cabin hospitals in Jianghan District (Wuhan, China).MethodsThirty COVID-19 (eight mild type and twenty-two common type) patients were evaluated using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder 7 Questionnaire, the Insomnia Severity Index, and a semi-structured interview.ResultsAll 30 patients reported varying degrees of anxiety, depression, and insomnia. The levels of depression and anxiety in mild type COVID-19 patients were significantly lower than those in common type COVID-19 patients. Significant improvements in depression (P<0.001) and anxiety (P<0.001) levels were found in the COVID-19 patients at the second evaluation compared with the baseline (admittance to hospital). More than 80% patients agreed that medical security, support from other patients, and a better living environment were the main reasons for improvements to their adverse psychological states.ConclusionsVarying degrees of anxiety, depression, and insomnia frequently occur in patients with COVID-19. Standard treatment protocols and patient-centered care in the mobile cabin hospitals in this study provided the chance for COVID-19 patients to successfully improve their mental health during the outbreak of the pandemic.

Analysis of clinical features and imaging signs of COVID-19 with the assistance of artificial intelligence.

To explore the CT imaging features/signs of patients with different clinical types of Coronavirus Disease 2019 (COVID-19) via the application of artificial intelligence (AI), thus improving the understanding of COVID-19. Clinical data and chest CT imaging features of 58 patients confirmed with COVID-19 in the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. According to the Guidelines on Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (Provisional 6th Edition), COVID-19 patients were divided into mild type (7), common type (34), severe type (7) and critical type (10 patients). The CT imaging features of the patients with different clinical types of COVID-19 types were analyzed, and the volume percentage of pneumonia lesions with respect to the lung lobes (where the lesion was located) and to the whole lung was calculated with the use of AI software. SPSS 21.0 software was used for statistical analysis. Common clinical manifestations of COVID-19 patients: fever was found in 47 patients (81.0%), cough in 31 (53.4%) and weakness in 10 (17.2%). Laboratory examinations: normal or decreased white blood cell (WBC) counts were observed in 52 patients (89.7%), decreased lymphocyte counts (LCs) in 14 (24.1%) and increased C-reactive protein (CRP) levels in 18 (31.0%). CT imaging features: there were 48 patients (94.1%) with lesions distributed in both lungs and 46 patients (90.2%) had lesions most visible in the lower lungs; the primary manifestations in patients with common type COVID-19 were ground-glass opacities (GGOs) (23/34, 67.6%) or mixed type (17/34, 50.0%), with lesions mainly distributed in the periphery of the lungs (28/34, 82.4%); the primary manifestations of patients with severe/critical type COVID-19 were consolidations (13/17, 76.5%) or mixed type (14/17, 82.4%), with lesions distributed in both the peripheral and central areas of lungs (14/17,82.4%); other common signs, including pleural parallel signs, halo signs, vascular thickening signs, crazy-paving signs and air bronchogram signs, were visible in patients with different clinical types, and pleural effusion was found in 5 patients with severe/critical COVID-19. AI software was used to calculate the volume percentages of pneumonia lesions with respect to the lung lobes (where the lesion was located) and to the whole lung. There were significant differences in the volume percentages of pneumonia lesions for the superior lobe of the left lung, the inferior lobe of the left lung, the superior lobe of the right lung, the inferior lobe of the right lung and the whole lung among patients with different clinical types (p<0.05). The area under the ROC curve (AUC) of the volume percentage of pneumonia lesions for the whole lung for the diagnosis of severe/critical type COVID-19 was 0.740, with sensitivity and specificity of 91.2% and 58.8%, respectively. The clinical and CT imaging features of COVID-19 patients were characteristic to a certain degree; thus, the clinical course and severity of COVID-19 could be evaluated with a combination of an analysis of clinical features and CT imaging features and assistant diagnosis by AI software.

Clinico-Radiological Features and Outcomes in Pregnant Women with COVID-19 Pneumonia Compared with Age-Matched Non-Pregnant Women.

PurposeTo investigate the clinico-radiological findings and outcomes in pregnant women with COVID-19 pneumonia compared to age-matched non-pregnant women.MethodsA retrospective case-controlled study was conducted to review clinical and CT data of 21 pregnant and 19 age-matched non-pregnant women with COVID-19 pneumonia. Four stages of CT images were analyzed and compared based on the time interval from symptom onset: stage 1 (0–6 days), stage 2 (7–9 days), stage 3 (10–16 days), and stage 4 (>16 days). The initial and follow-up data were analyzed and compared.ResultsCompared with age-matched non-pregnant women, initial absence of fever (13/21, 62%) and normal lymphocyte count (11/21, 52%) were more frequent in pregnant group. The predominant patterns of lung lesions were pure ground-glass opacity (GGO), GGO with consolidation or reticulation, and pure consolidation in both groups. Pure consolidation on chest CT was more common at presentation in pregnant cases. Pregnant women progressed with a higher consolidation frequency compared with non-pregnant group in stage 2 (95% vs 82%). Improvement was identified in stages 3 and 4 for both groups, but consolidation was still more frequent for pregnant women in stage 4. Most patients (38/40, 95%) were grouped as mild or common type. The length of hospitalization between the two groups was similar.ConclusionPregnant women with COVID-19 pneumonia did not present typical clinical features, while developing a relatively more severe disease at imaging with a slower recovery course and experiencing similar outcomes compared with the non-pregnant women.

Morphological and Mechanistic Aspects of Thiourea-Induced Acute Lung Injury and Tolerance in the Rat.

Thiourea-based molecules cause pulmonary edema when administered to rats at relatively low doses. However, rats survive normally lethal doses after prior exposure to a lower, nonlethal dose; this phenomenon is known as tolerance. The present study investigated the morphological and functional aspects of acute lung injury (ALI) induced by methylphenylthiourea (MPTU) in the Wistar rat and the pulmonary response involved in prevention of the injury. We identified pulmonary endothelial cells as the main target of acute MPTU injury; they exhibited ultrastructural alterations that can result in increased vascular permeability. In tolerant rats, the lungs showed only transient endothelial changes, at 24-hour post dosing, and mild type II pneumocyte hyperplasia on day 7 post dosing. They exhibited glutathione levels similar to the controls and increased expression of flavin-containing monooxygenase 1 (FMO1), the enzyme responsible for bioactivation of small thioureas in the laboratory rat. Incubation of rat pulmonary microsomal preparations with MPTU inhibited FMO activity, indicating that tolerance is related to irreversible inhibition of FMOs. The rat model of thiourea-induced pulmonary toxicity and tolerance represents an interesting approach to investigate certain aspects of the pathogenesis of ALI and therapeutic approaches to lung diseases, such as acute respiratory distress syndrome.

An Analysis of High-Resolution Computed Tomography Chest Manifestations of COVID-19 Patients in Pakistan.

ObjectiveThe objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients presenting to a tertiary healthcare facility in Punjab, Pakistan, and to analyze the distribution of the disease in lung fields. Additionally, we assess the role of chest CT severity scoring (CT-SS) in determining the severity of pneumonia.MethodsIn this cross-sectional descriptive study conducted from March 30, 2020, to May 30, 2020, 87 confirmed COVID-19 patients undergoing HRCT scan in a tertiary care facility in Punjab, Pakistan were included. The HRCT chest was performed on the patients using a standard protocol. Each study was evaluated for the presence of ground-glass opacities (GGOs), consolidation, mixed pattern, distribution, crazy paving, reverse halo sign, nodules, pleural effusion, and other findings. Additionally, CT-SS was calculated by dividing each lung into 20 zones. Each zone was scored as 0, 1, and 2, representing no involvement, <50% involvement, and >50% involvement of one zone respectively (total score: 0-40 for each patient). The patients were classified into mild, moderate, and severe cases (mild: CT-SS of <20, moderate: CT-SS of 20-30, and severe: CT-SS of >30).ResultsGGO was the most common finding, as seen in 88.5% of the patients, followed by consolidations (52.8%) and crazy paving (33.3%). The majority of the patients showed the bilateral and peripheral distribution of the disease process. Vascular dilatation and bronchiectasis were seen in 10 patients; pleural effusions were observed in only two study patients, while no patient exhibited reverse halo sign or pulmonary nodules. The superior segment of lower lobes was the most commonly involved segment bilaterally. According to CT-SS, 78 (89.6%), six (6.9%), and three (3.45%) patients had mild, moderate, and severe disease respectively.ConclusionThe typical imaging findings of COVID-19 on HRCT are GGOs with multilobe involvement and bilateral, peripheral, and basal predominance. CT-SS is helpful in categorizing pneumonia into mild, moderate, and severe types, thereby helping to identify patients with severe disease. This is particularly helpful in settings where fast triage is required.

Clinical Characteristics and Immune Injury Mechanisms in 71 Patients with COVID-19.

The outbreak of coronavirus disease 2019 (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a threat to global health. The mortality rate of severely ill patients in the early stage is 32.5%. The exacerbation of the condition and death of patients are closely associated with inflammatory cytokine storms, which are caused by excessive activation of the immune and complement systems as well as the coinfection of other pathogens. However, the immunological characteristics and the mechanisms underlying inflammatory storms have not been well elucidated. Here, we analyzed the clinical and immunological characteristics of 71 confirmed COVID-19 patients. Based on the National Health Commission of China (NHCC) guidelines, patients were stratified into mild and severe types. We compared the clinical and laboratory data obtained from electronic medical records between the two types. In regard to the hematological parameters, COVID-19 patients showed decreased erythrocyte count, hemoglobin, hematocrit, lymphocyte count, eosinophil count, and complement C1q, whereas neutrophils, C-reactive protein, and procalcitonin were significantly increased, especially in severe cases. We also found that CD3+ CD4+ T lymphocytes, CD3+ CD8+ T lymphocytes, CD19+ B lymphocytes, and CD16+ CD56+ NK cells in the peripheral blood of all patients were decreased. In addition, CD3+ CD8+ T lymphocytes, CD16+ CD56+ NK cells, and complement C1q in severely ill patients decreased more significantly. Additionally, interleukin 6 (IL-6) elevation was particularly prominent in all patients, especially in severe cases. These results suggest that CD3+ CD8+ T lymphocytes, CD16+ CD56+ NK cells, C1q as well as IL-6 may play critical roles in the inflammatory cytokine storm. The dysregulation of these aforementioned immune parameters, along with bacterial coinfection, were the important causes of exacerbation of the patients' condition and death. This study improves our understanding of the immune dysregulation of COVID-19 and provides potential immunotherapeutic strategies.IMPORTANCE The dysregulation of CD3+ CD8+ T lymphocytes, CD16+ CD56+ NK cells, C1q as well as IL-6, along with bacterial coinfection, were important causes of exacerbation of the patients' condition and death.

Mitochondrial PCK2 Missense Variant in Shetland Sheepdogs with Paroxysmal Exercise-Induced Dyskinesia (PED).

Four female Shetland Sheepdogs with hypertonic paroxysmal dyskinesia, mainly triggered by exercise and stress, were investigated in a retrospective multi-center investigation aiming to characterize the clinical phenotype and its underlying molecular etiology. Three dogs were closely related and their pedigree suggested autosomal dominant inheritance. Laboratory diagnostic findings included mild lactic acidosis and lactaturia, mild intermittent serum creatine kinase (CK) elevation and hypoglycemia. Electrophysiological tests and magnetic resonance imaging of the brain were unremarkable. A muscle/nerve biopsy revealed a mild type II fiber predominant muscle atrophy. While treatment with phenobarbital, diazepam or levetiracetam did not alter the clinical course, treatment with a gluten-free, home-made fresh meat diet in three dogs or a tryptophan-rich, gluten-free, seafood-based diet, stress-reduction, and acetazolamide or zonisamide in the fourth dog correlated with a partial reduction in, or even a complete absence of, dystonic episodes. The genomes of two cases were sequenced and compared to 654 control genomes. The analysis revealed a case-specific missense variant, c.1658G>A or p.Arg553Gln, in the PCK2 gene encoding the mitochondrial phosphoenolpyruvate carboxykinase 2. Sanger sequencing confirmed that all four cases carried the mutant allele in a heterozygous state. The mutant allele was not found in 117 Shetland Sheepdog controls and more than 500 additionally genotyped dogs from various other breeds. The p.Arg553Gln substitution affects a highly conserved residue in close proximity to the GTP-binding site of PCK2. Taken together, we describe a new form of paroxysmal exercise-induced dyskinesia (PED) in dogs. The genetic findings suggest that PCK2:p.Arg553Gln should be further investigated as putative candidate causal variant.