Achados clínicos e radiológicos, perfil e evolução de pacientes internados com COVID-19 em uma enfermaria de referência em Salvador - BA / Clinical and radiological findings, profile and evolution of patients hospitalized for COVID-19 in a reference nurse in Salvador - BA

COVID-19 é a doença causada pelo coronavírus SARS-CoV-2. Esta doença foi responsável por uma pandemia no ano de 2020, que resultou em uma grande quantidade de óbitos. Nesse contexto, os exames radiológicos de pacientes com COVID-19 comumente demonstram distribuição bilateral de opacidades em vidro fosco, podendo existir consolidação periférica. Tais achados variam com a idade do paciente, progressão da doença, status da imunidade, comorbidades e intervenção médica inicial. Ademais, existem casos em que a sintomatologia do paciente não condiz com a gravidade das manifestações pulmonares. Objetivo: Analisar o perfil clínico radiológico e evolução de pacientes internados com diagnóstico de COVID-19, em uma enfermaria de um hospital de referência em Salvador-BA. Métodos: Estudo observacional, descritivo e analítico. Os dados foram coletados, por meio de análise de prontuário, acessados pelo computador (banco de dados) do Hospital Geral Ernesto Simões Filho (HGESF). Resultados: Foram coletados dados de um total de 70 pacientes. Destes, 29 (41,4%) participantes do sexo feminino e 41 (58,6%) do sexo masculino com idade variando entre menor que 60 anos (32,9%) e maior ou igual a 60 anos (67,1%), havendo 31 (44,3%) portadores de Diabetes Mellitus. Com relação aos sintomas apresentados, 59 (84,3%) pacientes cursaram com dispneia, 50 (71,4%) manifestaram tosse e 36 (51,4%) tiveram febre. Outros parâmetros clínicos como leucocitose foram evidenciados em 50 (71,4%) participantes, além da dessaturação (<90% spO2) presente em 25 (35,7%) participantes. Durante o internamento, 46 (65,7%) pacientes receberam tratamento com Azitromicina, 60(85,7%) pacientes foram transferidos para Unidade de Terapia Intensiva (UTI), 34 (48,6%) evoluíram com necessidade de intubação orotraqueal (IOT) e 32 (45,7%) foram a óbito. Tais variáveis foram analisadas junto ao percentual de acometimento pulmonar tomográfico que variou entre menor ou igual a 25% em 19 (27,1%) participantes, 26-49% em 19 (27,1%) participantes, 50-74% em 23 (32,9%) participantes e maior ou igual a 75% em 9 (12,9%) participantes. O envolvimento pulmonar foi preditor de óbito e acarretou mudança de conduta quanto ao tempo de internamento. Além disso, a presença de tosse foi constatada como um fator de alerta para o acometimento pulmonar mais grave. Ademais, o uso de azitromicina não predispôs menores percentuais de acometimento pulmonar.

COVID-19 is the disease caused by the coronavirus SARS-CoV-2. This disease was responsible for a pandemic in the year 2020, which resulted in a large number of deaths. In this context, it was noticed that the radiological examinations of patients with COVID-19 commonly demonstrate bilateral distribution of ground glass opacities, with the possibility of peripheral consolidation. Such findings vary with the patient's age, disease progression, immunity status, comorbidities and initial medical intervention. In addition, there are cases in which the patient's symptoms do not match the severity of the pulmonary manifestations. Objective: To analyze the clinical-radiological findings, profile and evolution of patients hospitalized with COVID-19 in a referral ward in Salvador-BA. MethodS: Observational, descriptive and analytical study. Data were collected through medical record analysis, accessed by the computer (database) of the Hospital Geral Ernesto Simões Filho (HGESF). Results: Data were collected from a total of 70 patients. Of these, 29 (41.4%) female participants and 41 (58.6%) male participants, aged between less than 60 years (32.9%) and greater than or equal to 60 years (67.1%), with 31 (44.3%) patients with Diabetes Mellitus. Regarding the symptoms presented, 59 (84.3%) patients had dyspnea, 50 (71.4%) had cough and 36 (51.4%) had fever. Other clinical parameters such as leukocytosis were evidenced in 50 (71.4%) participants, in addition to desaturation (<90% spO2) present in 25 (35.7%) participants. During hospitalization, 46 (65.7%) patients received treatment with Azithromycin, 60 (85.7%) patients were transferred to the intensive care unit (ICU), 34 (48.6%) envolved with the need for cheal intubation and 32 (45.7%) they died. These variables were analyzed along with the percentage of tomographic pulmonary involvement, which ranged from less than or equal to 25% in 19 (27.1%) participants, 26-49% in 19 (27.1%) participants, 50-74% in 23 (32.9%) participants and greater than or equal to 75% in 9 (12.9%) participants. Pulmonary involvement was a predictor of death and led to a change in conduct regarding the length of stay. In addition, the presence of cough was found to be an alert factor for the most severe pulmonary involvement. Furthermore, the use of azithromycin did not predispose lower percentages to pulmonary involvement

Relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a ventilación mecánica en pacientes COVID-19: un análisis preliminar / Relations of ventilatory mechanical and radiographic measures with the connection time to mechanical ventilation in patients COVID-19: a preliminary analysis

RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.

SUMMARY: The lungs are the predominant site of COVID-19 infection. This can lead to severe acute respiratory síndrome (ARDS). In view of its severe symptoms, mechanical ventilation (MV) and its ventilatory mechanics values appear as a fundamental tool. Chest radiography (CR) is a complement to analyze the state of progress of this pathology, although this sometimes depends on the experience of the health team. Thus, the aim of this research was to explore the relationship of ventilatory mechanics and radiographic measures with connection time to MV in COVID-19 patients. Retrospective study, which included 23 patients on MV. Information on ventilatory mechanics variables was collected; PEEP, plateau pressure, distension pressure and static compliance. And from CR, lung height and width, costodiaphragmatic angle and intercostal space were measured. The results indicated that ventilatory mechanics variables such as PEEP and plateau were significantly related to connection time to MV (r = 0.449; p = 0.035 and r = 0.472; p = 0.026), while the radiographic variables Constructed on the basis of the costodiaphragmatic angle and the intercostal space, they showed similar behaviors (r = 0.462; p = 0.046 and r = -0.543; p = 0.009). In conclusion, the pressure resulting from mechanical ventilator programming, together with the structural changes observed in CR, are related to the connection time to MV.

Habit Mimics the Illness: EVALI During the Era of the COVID-19 Pandemic.

Globally, health care providers have been challenged to provide adequate care during the coronavirus disease-2019 (COVID-19) pandemic. Due to the ever changing and rapidly evolving nature of the novel coronavirus, there is increased public anxiety and knowledge gaps that have created major dilemmas in health care delivery. In this environment, there is tremendous pressure on clinicians to diagnose each and every case of COVID-19. This has led to a situation in which clinicians are primed to suspect all respiratory illness is due to COVID-19 infection until proven otherwise. Because of this, providers may misdiagnose patients who have illnesses that are distinct from COVID-19 but present in a similar manner. In the current article, we present the case of e-cigarette- and vaping-associated acute lung injury (EVALI) mimicking pneumonia secondary to the novel coronavirus. It is unknown if vaping puts patients at higher risk of respiratory failure if coinfected with COVID-19. Therefore, exposure history in patients presenting with pneumonia-like syndrome is important. Physicians should be aware of the overlap between these conditions and should pay particular attention during history taking to distinguish EVALI from COVID-19 pneumonia.

Interest of the thoracic scanner in the diagnosis of COVID-19: study of 35 cases in the Republic of Guinea.

INTRODUCTION: the aim of this work is to evaluate the contribution of thoracic computed tomography (CT) in the diagnosis of COVID-19 in Guinea. METHODS: this was a retrospective study with data recorded over a 2 Month period. Records of patients who tested positive on chest CT without contrast injection on admission were included in this study. Not included are those who did or did not perform a chest CT scan after confirmation of the diagnosis by RT-PCR. The data were collected under the direction of the National Health Security Agency (ANSS) and analysed using STATA/SE version 11.2 software. RESULTS: all patients tested performed a chest CT scan without contrast injection while awaiting the RT-PCR test result. Eighty percent (80%) of patients had lesions characteristic of COVID-19 viral pneumonia on chest CT. The reverse transcriptase PCR (RT-PCR) test was later positive in 33 patients (94.28%) and negative in 2 (5.71%). CONCLUSION: it is noted from this study that chest computed tomography is a critical tool in the rapid diagnosis of COVID-19 infection. Its systematization in all patients suspected in our dispute, would facilitate diagnosis while waiting for confirmation by RT-PCR and would limit the loss of cases.

Clinical features of 17 patients with 2019-nCoV.

OBJECTIVE: This study aims to discuss the unique clinical features of patients with 2019-nCoV in Zhengzhou City to provide references for clinical diagnosis and treatment. PATIENTS AND METHODS: Seventeen patients with 2019-nCoV in Zhengzhou People's Hospital from February to March 2020 were collected. Their epidemiology, clinical symptoms, laboratory examinations, and chest CT images were reviewed. All 17 patients were aged between 12-83 years, with an average age of 47 years, and consisted of 10 males (58.8%) and 7 females (41.2%). Two patients had histories of living or traveling in Wuhan, and 9 patients were attacked locally. The 6 remaining patients were unknown about incidence reasons. RESULTS: The average incubation period was 10 days, and the average time of the course of the disease was 9 days. Among the participants, 12 patients had fever as the first symptoms and 5 patients had normal body temperature. One patient was symptom-free carrier, and one patient had serious symptoms. One patient developed from mild symptoms to severe symptoms, and 14 patients had mild symptoms. Moreover, 7 patients had complications of cardiovascular and cerebrovascular diseases and hypertension, 1 patient was in the advanced stage of squamous cell lung carcinoma, and 1 patient had diabetes mellitus, renal failure, and late-stage uremia. According to novel coronavirus nucleic acid test, 8 patients were positive, accounting for 47.1%. All patients were negative in the novel coronavirus IgM antibody test and negative in other common respiratory pathogen detection. All 17 patients had ground glass-like high-density shadow or stripped high-density shadow on lung CT images, accompanied with many affected lesions on two lungs. The average stay in hospital was 10 days, and the average time of the course of the disease was 9 days. After hospitalization, 15 patients were discharged from the hospital upon recovery, 1 patient was transferred to superior hospital for continuous treatment, and 1 patient died. Patients with 2019-nCoV in Zhengzhou People's Hospital were mainly attacked in local areas, and most of them had mild symptoms. The positive rate of the nucleic acid test was 47.1%. CONCLUSIONS: The main clinical characteristics are increased neutrophil granulocytes, increased C-reactive proteins, decreased lymphocytes, ground glass-like or stripped lesions on lung CT image, common complications of cardiovascular and cerebrovascular diseases, and favorable prognosis.

Incidental findings of COVID-19 in F18-FDG PET/CT from asymptomatic patients with cancer in two healthcare institutions in Bogotá, Colombia / [Hallazgos incidentales de COVID-19 en tomografías PET/CT 18F-FDG de pacientes asintomáticos con cáncer en dos instituciones de salud de Bogotá, Colombia].

COVID-19 is the viral infection caused by SARS-CoV-2 declared by the World Health Organization (WHO) as a pandemic. Patients with cancer have a higher risk to acquire the infection and worse prognosis as they have to attend more medical visits in healthcare institutions, receive medical and surgical treatments, and be subjected to diagnostic studies such as PET/CT in nuclear medicine services where the infection may be an incidental finding. We present here F18-FDG PET/CT (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose), images with findings of COVID-19 from patients with different oncological conditions but no respiratory symptoms.

La COVID-19 es la infección viral causada por el SARS-CoV-2 y declarada por la Organización Mundial de la Salud (OMS) como pandemia. Los pacientes con cáncer tienen un mayor riesgo de adquirir la infección y un peor pronóstico, ya que deben asistir a visitas médicas en diferentes centros hospitalarios, reciben tratamientos médicos y quirúrgicos y deben someterse a estudios diagnósticos como la PET/CT en servicios de medicina nuclear, lo que es ocasión para el hallazgo incidental de la infección. Se presentan las imágenes de tomografías computarizadas por emisión de positrones con 18-fluorodesoxiglucosa (F18) (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose, PET/CT F18-FDG) en las que se evidenció la COVID-19 en pacientes con diversas enfermedades oncológicas, pero sin sintomatología respiratoria.

Prognostic factors in hospitalized patients diagnosed with SARS-CoV-2 infection, Bogotá, Colombia / [Factores pronósticos en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2 en Bogotá, Colombia].

Introduction: Infection with the new SARS-Cov-2 coronavirus is a worldwide public health emergency; its diagnosis is based on molecular tests, while its prognosis depends on the patient's history and on some paraclinical tests. In Colombia, forecasts are not yet counted. Objective: To assess the factors associated with the development of severe disease in hospitalized patients diagnosed with SARS-CoV-2 infection, as well as the prognostic factors for the outcome of mortality. Materials and methods: We conducted an ambispective cohort study in hospitalized patients at the Fundación Cadioinfantil from March to June, 2020. Results: Of the 104 patients analyzed, 31.7% (n=33) had a severe presentation and 9.6% (n=10) had a mortality outcome. For mortality, the most important prognostic factor was the development of severe disease followed by age over 60 years and malnutrition. For the development of the severe disease, prognostic factors were a history of hemodialysis (HR=135), diabetes (HR=4.4), and an increased level of lactate dehydrogenase (LDH) (HR=1,004), while the lymphocyte count over 1,064 was a protective factor (HR=0.9). In the classification of patients, the National Early Warning Score (NEWS2) score in the high and low-risk categories corresponded to the best performance. There was no difference between the treatments administered. Conclusions: The most important prognostic factors for mortality were being over 60 years of age, hypertension, diabetes, and cirrhosis, while for the development of severe disease they were chronic kidney disease with hemodialysis, NEWS2 with high risk at admission, increased levels of LDH and C reactive protein (CRP), and leukocytosis.

Introducción. La infección por el nuevo coronavirus SARS-Cov-2 es una emergencia de salud pública en todo el mundo; su diagnóstico se basa en pruebas moleculares, en tanto que su pronóstico depende de los antecedentes del paciente y de algunos exámenes paraclínicos. En Colombia aún no se cuenta con datos de pronóstico en una población local. Objetivo. Evaluar los factores asociados con el desarrollo de la enfermedad grave en pacientes hospitalizados con diagnóstico de infección por SARS-CoV-2, así como los factores pronósticos de la mortalidad. Materiales y métodos. Se hizo un estudio de cohorte ambispectivo en pacientes hospitalizados en la Fundación Cardioinfantil entre marzo y junio de 2020. Resultados. De los 104 pacientes analizados, en el 31,7 % (n=33) la infección fue grave y en el 9,6 % (n=10) se produjo la muerte. El factor pronóstico más importante de la mortalidad fue el desarrollo de la enfermedad grave, seguido de una edad de más de 60 años y la desnutrición. Para el desarrollo de la enfermedad grave los factores pronósticos fueron los antecedentes de hemodiálisis (hazard ratio, HR=135), diabetes (HR=4,4) y el aumento en el nivel de la lactato deshidrogenasa (LDH) (HR=1,004), en tanto que un conteo de linfocitos superior a 1.064 fue un factor protector (HR=0,9). El puntaje del National Early Warning Score (NEWS2) correspondiente a las categorías de alto y bajo riesgo fue el que mejor rendimiento tuvo. No hubo diferencia entre los tratamientos administrados. Conclusiones. Los factores pronósticos más importantes para la mortalidad fueron tener más de 60 años, hipertensión, diabetes y cirrosis, en tanto que para el desarrollo de la enfermedad grave fueron la enfermedad renal crónica con hemodiálisis, un puntaje de NEWS2 de alto riesgo al ingreso, y aumento en los niveles de LDH y proteína C reactiva, y leucocitosis.

Chest computed tomography (CT) features in children with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19: A systematic review.

To describe the chest CT features reported in children with confirmed COVID-19 infection, published in English literature. A systematic review was completed on PubMed, Embase and Scopus databases on the 1st of June 2020 using the PICO strategy. The NIH Quality Assessment Tool was used to assess the quality of the selected articles. The systematic review was evaluated by Case Series Studies and the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA). The extracted data were assessed and compared with those reported in the adult population. Seventy-two articles were retrieved from the database search and screened by the title, abstract and keywords. Eleven articles were deemed eligible for full-text assessment. Nine articles were included for the data extraction and in the final analysis. Chest CT features in children with COVID-19 differ from those in adults. 'Ground-grass opacities' (GGOs) are the most commonly described abnormalities, but closely followed by a combination of GGO and consolidation, not usual in adults. Children tend to have a more variable involvement than the subpleural and posterior and basal topography described in adults. Interlobular thickening and air bronchogram found in adults with COVID-19 are not frequent in children. Pulmonary embolism reported in up to 30% of adults has not been yet reported in children. Original articles describing chest CT features in children with COVID-19 in the English literature are limited to small populations of Chinese children. Chest CT imaging features are very diverse across the selected studies and globally different from those reported in adults. Data from children of different countries would provide a more comprehensive description of chest CT features in children with COVID-19.

Chest CT-scan finding of asymptomatic COVID-19 pneumonia: a prospective 542 patients' single center study.

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.

Association of procalcitonin levels with the progression and prognosis of hospitalized patients with COVID-19.

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail. Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed. Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions (P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT (P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable. Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19.

Differential Diagnosis of COVID-19 Pneumonia in Cancer Patients Received Radiotherapy.

Background: During the outbreak period of COVID-19 pneumonia, cancer patients have been neglected and in greater danger. Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in cancer patients remains a challenge. This study determined their clinical presentations and radiological features in order to early diagnose and separate COVID-19 pneumonia from radiation pneumonitis patients promptly. Methods and Findings: From January 21, 2020 to February 18, 2020, 112 patients diagnosed with suspected COVID-19 were selected consecutively. A retrospective analysis including all patients' presenting was performed. Four patients from 112 suspected individals were selected, including 2 males and 2 females with a median age of 54 years (range 39-64 years). After repeated pharyngeal swab nucleic acid tests, 1 case was confirmed and 3 cases were excluded from COVID-19 pneumonia. Despite the comparable morphologic characteristics of lung CT imaging, the location, extent, and distribution of lung lesions between COVID-19 pneumonia and radiation pneumonitis differed significantly. Conclusions: Lung CT imaging combined with clinical and laboratory findings can facilitate early diagnosis and appropriate management of COVID-19 pneumonia with a history of malignancy and radiation therapy.

Multi-task deep learning based CT imaging analysis for COVID-19 pneumonia: Classification and segmentation.

This paper presents an automatic classification segmentation tool for helping screening COVID-19 pneumonia using chest CT imaging. The segmented lesions can help to assess the severity of pneumonia and follow-up the patients. In this work, we propose a new multitask deep learning model to jointly identify COVID-19 patient and segment COVID-19 lesion from chest CT images. Three learning tasks: segmentation, classification and reconstruction are jointly performed with different datasets. Our motivation is on the one hand to leverage useful information contained in multiple related tasks to improve both segmentation and classification performances, and on the other hand to deal with the problems of small data because each task can have a relatively small dataset. Our architecture is composed of a common encoder for disentangled feature representation with three tasks, and two decoders and a multi-layer perceptron for reconstruction, segmentation and classification respectively. The proposed model is evaluated and compared with other image segmentation techniques using a dataset of 1369 patients including 449 patients with COVID-19, 425 normal ones, 98 with lung cancer and 397 of different kinds of pathology. The obtained results show very encouraging performance of our method with a dice coefficient higher than 0.88 for the segmentation and an area under the ROC curve higher than 97% for the classification.

68Ga-PSMA PET/CT With Incidental Finding of COVID-19 in an Asymptomatic Patient.

A 70-year-old man with prostate adenocarcinoma was diagnosed by transrectal biopsy, with Gleason of 4 + 5 and initial PSA of 225 ng/mL since March 2020. Ga-PSMA PET/CT was performed as part of initial staging. The images showed an enlarged prostate with focal PSMA uptake in both lobes. Retroperitoneal and pelvic lymph nodes with moderate uptake of PSMA were shown. Another finding was a moderate PSMA uptake in the both lung parenchymas associated with opacities in CT. The patient denied any symptoms of coronavirus disease and was referred to the emergency department for RT-PCR COVID-19, and the result was positive.

The efficacy assessment of convalescent plasma therapy for COVID-19 patients: a multi-center case series.

Convalescent plasma (CP) transfusion has been indicated as a promising therapy in the treatment for other emerging viral infections. However, the quality control of CP and individual variation in patients in different studies make it rather difficult to evaluate the efficacy and risk of CP therapy for coronavirus disease 2019 (COVID-19). We aimed to explore the potential efficacy of CP therapy, and to assess the possible factors associated with its efficacy. We enrolled eight critical or severe COVID-19 patients from four centers. Each patient was transfused with 200-400 mL of CP from seven recovered donors. The primary indicators for clinical efficacy assessment were the changes of clinical symptoms, laboratory parameters, and radiological image after CP transfusion. CP donors had a wide range of antibody levels measured by serology tests which were to some degree correlated with the neutralizing antibody (NAb) level. No adverse events were observed during and after CP transfusion. Following CP transfusion, six out of eight patients showed improved oxygen support status; chest CT indicated varying degrees of absorption of pulmonary lesions in six patients within 8 days; the viral load was decreased to a negative level in five patients who had the previous viremia; other laboratory parameters also tended to improve, including increased lymphocyte counts, decreased C-reactive protein, procalcitonin, and indicators for liver function. The clinical efficacy might be associated with CP transfusion time, transfused dose, and the NAb levels of CP. This study indicated that CP might be a potential therapy for severe patients with COVID-19.

Early experiences of COVID-19 infected, middle-aged patients.

This case report describes our early radiological experiences of middle-aged patients with COVID-19 at Westmead Hospital, Sydney. We found limited relationship between initial CT imaging appearances and progression to severe disease. The most effective use of imaging in COVID-19 is yet to be determined.

Application of Critical Care Ultrasound in Patients With COVID-19: Our Experience and Perspective.

Up to April 4, 2020, the novel coronavirus disease-2019 COVID-19 has affected more than 1 099000 patients and has become a major global health concern. World Health Organization (WHO) has defined COVID-19 as a global pandemic. Critical care ultrasound (CCUS) can rapidly acquire the image of lung and other organs and demonstrate the pathophysiological changes to guide precise therapy in COVID-19 pneumonia without radiation or interfering with personal protective equipment. In addition, the application of CCUS can cover the whole courses from the fever clinic to the intensive care unit to improve the treatment. We would like to present the CCUS features about COVID-19 pneumonia and share the application experience of CCUS in Wuhan, China, and hope it works for physicians worldwide to solve the problem and improve the outcome.