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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(5): 859-861, 2021 Sep.
Artículo en Chino | MEDLINE | ID: mdl-34622606

RESUMEN

In this study, we report on three immunocompetent children with pulmonary cryptococcosis presenting mediastinal lymphadenopathy as the prominent manifestation. All three children were otherwise healthy previously. Two children had a history of exposure to pigeons and poultry. All three presented persistent fever accompanied by mild cough. There were no obvious positive signs in the lungs. One patient had enlarged cervical lymph nodes. All three had elevated levels of white blood cells, neutrophil count, and C-reactive protein (CRP). The levels of IgG, IgM, IgA, IgE and T cell subsets were normal in all cases, and they were all tested negative for HIV antibody. Two children were tested positive for serum cryptococcal antigen (sCRAG). The chest X-ray and pulmonary CT findings of the three patients all demonstrated marked enlargement of mediastinal lymph nodes, and one patient had nodules in the parenchyma. Surgical biopsies of mediastinal lymph nodes were performed in two children and large numbers of capsule spores were found in the histological examination. In the three cases, definitive diagnosis of pulmonary cryptococcosis were made in two patients, and clinical diagnosis was made in the third patient. Two patients were treated with fluconazole alone. The other patient whose condition was complicated with spleen infection was treated with fluconazole combined with amphotericin B for the first month, and was then given fluconazole for maintenance treatment. The overall treatment course lasted 5-9 months and all three were cured eventually. In conclusion, immunocompetent children with pulmonary cryptococcosis may present mediastinal lymphadenopathy as a prominent or isolated manifestation, which should be considered in differential diagnosis. Treatment with fluconazole alone or in combination with amphotericin B when it was necessary showed good therapeutic outcomes.


Asunto(s)
Criptococosis , Linfadenopatía , Niño , Tos , Criptococosis/complicaciones , Criptococosis/diagnóstico , Criptococosis/tratamiento farmacológico , Humanos , Pulmón , Ganglios Linfáticos
2.
Intern Med ; 60(19): 3081-3086, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34602522

RESUMEN

Objective This study aimed to elucidate the effects of early macrolide administration on genetically confirmed pertussis-induced cough in adolescents and adults. Methods This single-center, retrospective cohort study examined the effects of the early administration of macrolides and antitussive agents on cough secondary to pertussis. We divided the patients into two groups based on the median duration from the beginning of the cough to the initiation of macrolide administration: early macrolide administration group (EMAG) and non-early macrolide administration group (NEMAG). The clinical improvement of cough was defined as maintaining a cough awareness score of ≤3 points for 3 consecutive days. Patients The medical records of 40 patients diagnosed with pertussis (≥12 years old) who were able to maintain a cough diary and received no other antibiotics aside from macrolides were included in the study. A diagnosis of pertussis was made using the loop-mediated isothermal amplification (LAMP) test. Results The EMAG (24 patients) showed a significantly shorter total cough period than the NEMAG [16 patients; 20.0 (95% confidence interval (CI), 16-28) vs. 30.5 (95% CI, 27-40) days; log-rank test, p=0.002]. There was no significant difference in the post-administration cough periods between the EMAG and NEMAG [11.0 (95% CI, 7-19) vs. 13.0 (95% CI, 5-23) days; log-rank test, p=0.232]. Antitussive agents did not affect the cough. Conclusion The early administration of macrolides, but not antitussive agents, is effective for treating pertussis. Therefore, macrolides should be administered as soon as possible for this disease.


Asunto(s)
Tos Ferina , Adolescente , Adulto , Antibacterianos/uso terapéutico , Bordetella pertussis , Niño , Tos/tratamiento farmacológico , Humanos , Macrólidos , Técnicas de Diagnóstico Molecular , Técnicas de Amplificación de Ácido Nucleico , Estudios Retrospectivos , Tos Ferina/tratamiento farmacológico , Tos Ferina/epidemiología
4.
J Res Health Sci ; 21(2): e00512, 2021 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-34465636

RESUMEN

BACKGROUND: This study aimed to analyze the demographic and epidemiological features of identified COVID-19 cases in Kazakhstan. STUDY DESIGN: A cross-sectional study. METHODS: This cross-sectional study aimed to analyze COVID-19 cases (n=5116) collected from March 13 to June 6, 2020, in Kazakhstan. The data were obtained from a state official medical electronic database. The study investigated the geographic and demographic data of patients as well as the association of COVID-19 cases with gender and age. The prevalence of symptoms, the presence of comorbidities, complications, and COVID-19 mortality were determined for all patients. RESULTS: The mean±SD age of the patients in this study was 34.8±17.6 years, and the majority (55.7%) of COVID-19 cases were male and residents of cities (79.6%). In total, 80% of the cases had the asymptomatic/mild form of the disease. Cough (20.8 %) and sore throat (17.1%) were the most common symptoms among patients, and pneumonia was diagnosed in 1 out of 5 cases. Acute respiratory distress syndrome (ARDS) was recorded in 1.2% of the patients. The fatality rate was 1% in the study population and lethality was 2.6 times higher in males compared to females.  Each additional year in age increased the probability of COVID-19 infection by 1.06 times. The presence of cardiovascular, diabetes, respiratory, and kidney diseases affected the rate of mortality (P<0.05). CONCLUSION: The results demonstrated a high proportion (40%) of the asymptomatic type of coronavirus infection in the Kazakhstan population. The severity of COVID-19 symptoms and lethality were directly related to the age of patients and the presence of comorbidities.


Asunto(s)
COVID-19 , Portador Sano/virología , Tos/etiología , Pandemias , Faringitis/etiología , Adolescente , Adulto , Factores de Edad , Anciano , COVID-19/complicaciones , COVID-19/epidemiología , COVID-19/mortalidad , COVID-19/virología , Portador Sano/epidemiología , Niño , Comorbilidad , Tos/epidemiología , Estudios Transversales , Femenino , Humanos , Kazajstán/epidemiología , Masculino , Persona de Mediana Edad , Faringitis/epidemiología , Neumonía/epidemiología , Neumonía/etiología , Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Dificultad Respiratoria/etiología , Estudios Retrospectivos , SARS-CoV-2 , Factores Sexuales , Adulto Joven
5.
J Res Health Sci ; 21(2): e00514, 2021 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-34465637

RESUMEN

BACKGROUND: This study aimed to determine the secondary attack rate (SAR) and its determinants to describe the clinical features and epidemiological aspects of patients and determine the risk factors of COVID-19 among household contacts in Hamadan Province, west of Iran. STUDY DESIGN: A cohort study. METHODS: In this cohort study, a total of 323 index cases and 989 related close contacts ages more than 15 years old (family members, relatives, and co-workers) were enrolled using a manual contact tracing approach, and all participants were tested by reverse transcription polymerase chain reaction test. In this research, the frequency of symptoms was assessed, the SAR among contacts of index cases was calculated, and the risk factors of COVID-19 were evaluated by the logistic regression model. RESULTS: The secondary attack rate for total household members of index cases was estimated at 31.7% (95% CI: 28.8-34.7). It was found that among household contacts, the highest SARs were related to spouses 47.1% (95% CI: 38.7-55.7) and grandparents/parents 39.3% (95% CI: 29.4, 49.9) of index cases, who had also higher risks to become secondary cases (adjusted odds ratio [OR]=2.98, 95% CI: 1.31-6.75 and adjusted OR=2.76, 95% CI: 1.18-6.44, respectively). Considering the occupation of contacts, unemployed and retired people and housewives were most susceptible for transmission of COVID-19. It was revealed that cough was the most prevalent symptom among index and secondary cases. CONCLUSION: Our findings indicated that spouses and grandparents/parents of index cases were the most susceptible individuals for COVID-19 transmission. Prolonged exposure with index case before COVID-19 diagnosis raised the chance of infection among secondary cases.


Asunto(s)
COVID-19/transmisión , Trazado de Contacto , Composición Familiar , Familia , Pandemias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , Prueba de COVID-19 , Estudios de Cohortes , Tos/etiología , Empleo , Femenino , Humanos , Incidencia , Irán/epidemiología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , SARS-CoV-2 , Adulto Joven
6.
Front Public Health ; 9: 716421, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34485238

RESUMEN

Objective: Key to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test. Methods: In this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both samples. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present. Results: Participants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though, many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources. Conclusions: This study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with NHSTT. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a "wait and see" approach, and to address concerns around test accuracy to increase testing uptake.


Asunto(s)
COVID-19 , Actitud , Tos/diagnóstico , Femenino , Humanos , Masculino , SARS-CoV-2 , Reino Unido/epidemiología
7.
Ann Palliat Med ; 10(8): 8972-8981, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34488384

RESUMEN

BACKGROUND: The recent emergence of coronavirus disease 2019 (COVID-19) is a major global health threat. Monitoring viral transmission and disease characteristics as the disease spreads globally is vital. This study aimed to describe the clinical characteristics and source of infection in patients with secondary transmission of COVID-19 outside the outbreak area. METHODS: The epidemiological, demographic, clinical, laboratory, radiological, and treatment data of five patients with laboratory-confirmed COVID-19 who were treated in the General Hospital of Ningxia Medical University (Ningxia, China) from 1 January 2020 to 1 March 2020 were presented. The final follow-up evaluation was performed on 12 March 2020. RESULTS: The five participants included two couples and a young woman, none of whom had visited Hubei. It was likely that four of the participants had been infected by exposure to asymptomatic visitors from Wuhan. The other participant lived in a densely-populated community with potential COVID-19 cases. A variety of symptoms were presented by four participants, including cough, fevers, sputum, breathlessness, chest pain, fatigue, sore limbs, sore throats, headaches, and rhinorrhea. A severe infection, with dyspnea and decreased oxygen saturation, was experienced by one participant who had a history of chronic bronchitis. A single participant was asymptomatic, but had ground-glass opacities (GGOs) on chest imaging. Another two participants also displayed GGOs. Lymphopenia was noted in three participants. During the follow-up period, all participants were cured and discharged to their homes. CONCLUSIONS: This study included patients who had acquired infections of COVID-19 through local transmission. These findings will provide a better understanding of secondary transmission of COVID-19.


Asunto(s)
COVID-19 , Tos , Brotes de Enfermedades , Femenino , Fiebre , Humanos , Estudios Retrospectivos , SARS-CoV-2
8.
Nurs Open ; 8(3): 1077-1088, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-34482663

RESUMEN

OBJECTIVES: The aim of this analysis was to assess the prevalence of clinical features, comorbidities, complications and treatment options in the patients with COVID-19 and compare incidence of these clinical data in severe and non-severe patients. DESIGN: Systemic review and Meta-analysis. METHODS: PubMed, Embase, Scopus and Web of Sciences databases were searched to identify relevant papers until 20 July 2020. All studies comparing clinical data of severe and non-severe patients of COVID-19 were included. Heterogeneity across included studies was determined using Cochrane's Q test and the I2 statistic. Results were expressed as odds ratio with accompanying 95% confidence intervals. RESULTS: Twelve studies with 3,046 patients were included. The result showed the most prevalent clinical symptoms were fever 88.3%, cough 62.2%, fatigue 39.5% and dyspnoea 31.5%. Further meta-analysis showed incidence of fever, cough, fatigue and dyspnoea was higher in severe patients. The most prevalent comorbidities were hypertension 22.6%, diabetes 11.5%, cardiovascular disease 10.3% and cancer 2.5%. We found that compared with non-severe patients, the symptoms, existing comorbidities and complications are prevalent in severe COVID-19 patients. Future well-methodologically designed studies from other populations are strongly recommended.


Asunto(s)
COVID-19 , Diabetes Mellitus , Comorbilidad , Tos , Humanos , SARS-CoV-2
10.
J Coll Physicians Surg Pak ; 31(1): S83-S86, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-34530537

RESUMEN

The aim of this study was to determine overall morbidity and mortality of COVID-19 infection in children on cancer treatment. It was an observational study, carried at Shaukat Khanum Cancer Hospital from 1st April 2020 to 31st July 2020. A total of 165 children on active cancer treatment were tested for COVID-19 with PCR; out of these, 17 were detected positive. Twelve children were symptomatic having fever with or without cough, sore throat, body aches, rash or diarrhea. Two children had concurrent gram negative bacteremia. Ten children (58.8%) required hospitalisation, 23.5% required oxygen and two had intensive care unit admission. One death was reported in this study. Chemotherapy was modified in five children, while elective surgery, chemotherapy and radiotherapy schedule were affected in eight children. Overall, the spread of Covid-19 was limited, the course of disease was mild, and anticancer treatment was provided and continued as per standard protocols. Key Words: Covid -19, Cancer, Anticancer chemotherapy, Immunosuppression, Children.


Asunto(s)
COVID-19 , Neoplasias , Niño , Tos , Fiebre , Humanos , Morbilidad , Neoplasias/terapia , SARS-CoV-2
11.
Best Pract Res Clin Anaesthesiol ; 35(3): 269-292, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511219

RESUMEN

Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss coronavirus disease (COVID-19) biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.


Asunto(s)
Antivirales/administración & dosificación , COVID-19/epidemiología , COVID-19/terapia , SARS-CoV-2 , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/análogos & derivados , Corticoesteroides/administración & dosificación , Alanina/administración & dosificación , Alanina/análogos & derivados , Animales , COVID-19/diagnóstico , COVID-19/inmunología , Coronavirus/efectos de los fármacos , Coronavirus/inmunología , Tos/epidemiología , Tos/terapia , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Fatiga/epidemiología , Fatiga/terapia , Fiebre , Cardiopatías/epidemiología , Cardiopatías/terapia , Humanos , Respiración con Presión Positiva/métodos , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/terapia , SARS-CoV-2/efectos de los fármacos , SARS-CoV-2/inmunología , Resultado del Tratamiento
13.
N Z Med J ; 134(1542): 38-49, 2021 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-34531582

RESUMEN

AIMS: To review the demographic and clinical characteristics of confirmed COVID-19 cases within the Greater Wellington Region (GWR). METHODS: A retrospective, observational study of all 96 confirmed COVID-19 cases in the GWR. The primary outcome was time taken from onset to complete resolution of symptoms. Secondary outcomes were the epidemiological and clinical characteristics of cases. RESULTS: The mean (SD) time from symptom onset to complete resolution was 19.1 (1.1) days. The mean (SD) age was 43.1 (16.9). 51% were male. The majority were of European ethnicity (84%), resided in the top five decile neighbourhoods (76%) and had travelled to New Zealand (69%). The mean (SD) time from onset of symptoms to obtaining RT-PCR testing results was 5.3 (0.4) days. The most common symptoms at onset were cough (36%), sore throat (22%) and fatigue (21%); the overall most common symptoms were cough (65%), sore throat (43%), headache (43%) and fatigue (42%); many symptoms were late manifestations. The most common co-morbidity reported was asthma (20%), with no reported exacerbations. The rate of secondary infections within households was 0.05 per primary infection. CONCLUSION: The demography of COVID-19 cases reflected the imported nature of cases. The clinical presentation of COVID-19 was highly variable and there were no particular symptoms that could accurately predict infection.


Asunto(s)
COVID-19/diagnóstico , COVID-19/epidemiología , Examen Físico , Adulto , Causalidad , Tos/diagnóstico , Fatiga/diagnóstico , Cefalea/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Faringitis/diagnóstico , Estudios Retrospectivos
14.
Clin Med (Lond) ; 21(5): e526-e528, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34507938

RESUMEN

Despite distinct diagnostic criteria, several gastrointestinal pathologies can masquerade haemophagocytic lymphohistiocytosis (HLH) during the peripartum period. Acute fatty liver of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome, miliary tuberculosis, visceral leishmaniasis, abdominal surgical emergencies, haemolytic anaemias and haematological malignancies may have clinical and laboratory presentation similar to that of HLH. In this report, we present the case of a 26-year-old woman with 38-weeks' gestation and abdominal pain, vomiting, intermittent fever and non-productive cough for 1-2 months. A thorough investigation suggested HLH and the patient was successfully treated with corticosteroids. This patient demonstrates the importance of a focused investigation strategy and timely management to prevent mortality and morbidity to both the mother and fetus in this rare and fatal disease.


Asunto(s)
Linfohistiocitosis Hemofagocítica , Mujeres Embarazadas , Adulto , Tos , Femenino , Fiebre/etiología , Humanos , Embarazo
15.
PLoS Med ; 18(9): e1003777, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34582457

RESUMEN

BACKGROUND: Rapid detection, isolation, and contact tracing of community COVID-19 cases are essential measures to limit the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to identify a parsimonious set of symptoms that jointly predict COVID-19 and investigated whether predictive symptoms differ between the B.1.1.7 (Alpha) lineage (predominating as of April 2021 in the US, UK, and elsewhere) and wild type. METHODS AND FINDINGS: We obtained throat and nose swabs with valid SARS-CoV-2 PCR test results from 1,147,370 volunteers aged 5 years and above (6,450 positive cases) in the REal-time Assessment of Community Transmission-1 (REACT-1) study. This study involved repeated community-based random surveys of prevalence in England (study rounds 2 to 8, June 2020 to January 2021, response rates 22%-27%). Participants were asked about symptoms occurring in the week prior to testing. Viral genome sequencing was carried out for PCR-positive samples with N-gene cycle threshold value < 34 (N = 1,079) in round 8 (January 2021). In univariate analysis, all 26 surveyed symptoms were associated with PCR positivity compared with non-symptomatic people. Stability selection (1,000 penalized logistic regression models with 50% subsampling) among people reporting at least 1 symptom identified 7 symptoms as jointly and positively predictive of PCR positivity in rounds 2-7 (June to December 2020): loss or change of sense of smell, loss or change of sense of taste, fever, new persistent cough, chills, appetite loss, and muscle aches. The resulting model (rounds 2-7) predicted PCR positivity in round 8 with area under the curve (AUC) of 0.77. The same 7 symptoms were selected as jointly predictive of B.1.1.7 infection in round 8, although when comparing B.1.1.7 with wild type, new persistent cough and sore throat were more predictive of B.1.1.7 infection while loss or change of sense of smell was more predictive of the wild type. The main limitations of our study are (i) potential participation bias despite random sampling of named individuals from the National Health Service register and weighting designed to achieve a representative sample of the population of England and (ii) the necessary reliance on self-reported symptoms, which may be prone to recall bias and may therefore lead to biased estimates of symptom prevalence in England. CONCLUSIONS: Where testing capacity is limited, it is important to use tests in the most efficient way possible. We identified a set of 7 symptoms that, when considered together, maximize detection of COVID-19 in the community, including infection with the B.1.1.7 lineage.


Asunto(s)
COVID-19/complicaciones , COVID-19/diagnóstico , Modelos Biológicos , Ageusia/diagnóstico , Ageusia/etiología , Ageusia/virología , Anosmia/diagnóstico , Anosmia/etiología , Anosmia/virología , Apetito , Área Bajo la Curva , COVID-19/virología , Escalofríos/diagnóstico , Escalofríos/etiología , Escalofríos/virología , Control de Enfermedades Transmisibles , Tos/diagnóstico , Tos/etiología , Tos/virología , Inglaterra , Reacciones Falso Positivas , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Fiebre/virología , Humanos , Masculino , Tamizaje Masivo , Mialgia/diagnóstico , Mialgia/etiología , Mialgia/virología , Faringitis/diagnóstico , Faringitis/etiología , Faringitis/virología , Reacción en Cadena de la Polimerasa , SARS-CoV-2/genética , Medicina Estatal
16.
Pol J Microbiol ; 70(3): 401-404, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34584534

RESUMEN

SARS-CoV-2 was found in a recovered patient's stool specimen by combining quantitative reverse transcription PCR (qRT-PCR) and genome sequencing. The patient was virus positive in stool specimens for at least an additional 15 days after he was recovered, whereas respiratory tract specimens were negative. The discovery of the complete genome of SARS-CoV-2 in the stool sample of the recovered patient demonstrates a cautionary warning that the potential mode of the virus transmission cannot be excluded through the fecal-oral route after viral clearance in the respiratory tract.


Asunto(s)
COVID-19/virología , Convalecencia , Heces/virología , Genoma Viral , SARS-CoV-2/genética , Secuenciación Completa del Genoma , Adulto , COVID-19/diagnóstico por imagen , COVID-19/transmisión , China , Tos/virología , Fiebre/virología , Humanos , Masculino , SARS-CoV-2/aislamiento & purificación , Tomografía Computarizada por Rayos X
17.
J Trop Pediatr ; 67(4)2021 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-34471924

RESUMEN

Coronavirus disease (COVID-19) has been shown to affect all age groups. The data in the literature usually admit a milder form of disease in infants and newborns than adults. COVID-19 is rarely seen in newborns and an urgent diagnosis should be made in any suspicious situation. A 6-day-old female newborn was admitted to our hospital with fever and dyspnea without cough. A rapid reverse-transcription polymerase chain reaction COVID-19 showed a positive result. Chest computed tomography revealed bilateral and widespread pulmonary involvement. After support therapy, the newborn was successfully discharged. We should carefully consider the new type of coronavirus as an agent for pneumonia in newborns with fever and dyspnea together with non-symptomatic family history. Our case was one of the interesting reported cases of severe pneumonia presenting in the perinatal period.


Asunto(s)
COVID-19 , Adulto , Tos , Disnea , Femenino , Fiebre/etiología , Humanos , Lactante , Recién Nacido , Embarazo , SARS-CoV-2
18.
Sci Rep ; 11(1): 19149, 2021 09 27.
Artículo en Inglés | MEDLINE | ID: mdl-34580407

RESUMEN

Recently deep learning has attained a breakthrough in model accuracy for the classification of images due mainly to convolutional neural networks. In the present study, we attempted to investigate the presence of subclinical voice feature alteration in COVID-19 patients after the recent resolution of disease using deep learning. The study was a prospective study of 76 post COVID-19 patients and 40 healthy individuals. The diagnoses of post COVID-19 patients were based on more than the eighth week after onset of symptoms. Voice samples of an 'ah' sound, coughing sound and a polysyllabic sentence were collected and preprocessed to log-mel spectrogram. Transfer learning using the VGG19 pre-trained convolutional neural network was performed with all voice samples. The performance of the model using the polysyllabic sentence yielded the highest classification performance of all models. The coughing sound produced the lowest classification performance while the ability of the monosyllabic 'ah' sound to predict the recent COVID-19 fell between the other two vocalizations. The model using the polysyllabic sentence achieved 85% accuracy, 89% sensitivity, and 77% specificity. In conclusion, deep learning is able to detect the subtle change in voice features of COVID-19 patients after recent resolution of the disease.


Asunto(s)
COVID-19/diagnóstico , Tos/diagnóstico , Aprendizaje Profundo , Redes Neurales de la Computación , Sonido , Voz/fisiología , Adulto , COVID-19/fisiopatología , COVID-19/virología , Tos/fisiopatología , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Estudios Prospectivos , SARS-CoV-2/fisiología , Sensibilidad y Especificidad , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología
19.
BMC Infect Dis ; 21(1): 902, 2021 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-34479483

RESUMEN

BACKGROUND: Airway malacia is an important cause of noisy breathing, recurrent wheezing and respiratory infections, chronic coughing, and episodes of respiratory distress in young children. As the clinical manifestations of airway malacia are not common, many clinicians have insufficient understanding of this disease. So the purpose of this study is to summarize the pathogenic bacteria and clinical manifestations of airway softening complicated with pneumonia in children. METHODS: Children hospitalized with airway malacia complicated by pneumonia were eligible for enrollment from January 1, 2013 to December 31, 2019. Medical records of patients were reviewed for etiology, clinical characteristics, and laboratory examination results. RESULTS: A total of 164 pneumonia patients with airway malacia were admitted. The male-to-female ratio was 3:1. The age of patients ranged from 1 month to 4 years old. The median age was 6 (3-10) months. The most commonly detected pathogen were Mycoplasma pneumoniae (25/164, 15.24%), Streptococcus pneumoniae (18/164, 10.98%), and respiratory syncytial virus (16/164, 9.76%). Common signs among the 164 patients with confirmed airway malacia included cough (98.78%), wheezing (67.07%), fever (35.37%), intercostal retractions (23.17%), dyspnea (10.98%), cyanosis (11.11%), and crackles (50%). Compared with those without airway malacia, the incidence of premature delivery and mechanical ventilation was higher, and the duration of symptoms before admission (median, 13.5 d) and hospital stay (median 10.0 d) were longer. Of the children with pneumonia, 11.59% of those with airway malacia required supplemental oxygen compared with 4.88% of those without airway malacia (p < 0.05). CONCLUSION: The median age of children with airway malacia was 6 months. The most common pathogen in patients with airway malacia complicated by pneumonia was Mycoplasma pneumoniae. Patients with airway malacia complicated by pneumonia often presented with a longer disease course, more severe symptoms, and had delayed recovery.


Asunto(s)
Neumonía por Mycoplasma , Neumonía , Infecciones del Sistema Respiratorio , Niño , Preescolar , Tos , Femenino , Humanos , Lactante , Masculino , Mycoplasma pneumoniae , Neumonía por Mycoplasma/complicaciones , Neumonía por Mycoplasma/epidemiología , Ruidos Respiratorios
20.
Comput Methods Programs Biomed ; 210: 106395, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34525412

RESUMEN

BACKGROUND AND OBJECTIVE: Chronic cough (CC) affects approximately 10% of adults. Many disease states are associated with chronic cough, such as asthma, upper airway cough syndrome, bronchitis, and gastroesophageal reflux disease. The lack of an ICD code specific for chronic cough makes it challenging to identify such patients from electronic health records (EHRs). For clinical and research purposes, computational methods using EHR data are urgently needed to identify chronic cough cases. This research aims to investigate the data representations and deep learning algorithms for chronic cough prediction. METHODS: Utilizing real-world EHR data from a large academic healthcare system from October 2005 to September 2015, we investigated Natural Language Representation of the EHR data and systematically evaluated deep learning and traditional machine learning models to predict chronic cough patients. We built these machine learning models using structured data (medication and diagnosis) and unstructured data (clinical notes). RESULTS: The sensitivity and specificity of a transformer-based deep learning algorithm, specifically BERT with attention model, was 0.856 and 0.866, respectively, using structured data (medication and diagnosis). Sensitivity and specificity improved to 0.952 and 0.930 when we combined structured data with symptoms extracted from clinical notes. We further found that the attention mechanism of deep learning models can be used to extract important features that drive the prediction decisions. Compared with our previously published rule-based algorithm, the deep learning algorithm can identify more chronic cough patients with structured data. CONCLUSIONS: By applying deep learning models, chronic cough patients can be reliably identified for prospective or retrospective research through medication and diagnosis data, widely available in EHR and electronic claims data, thus improving the generalizability of the patient identification algorithm. Deep learning models can identify chronic cough patients with even higher sensitivity and specificity when structured and unstructured EHR data are utilized. We anticipate language-based data representation and deep learning models developed in this research could also be productively used for other disease prediction and case identification.


Asunto(s)
Aprendizaje Profundo , Adulto , Algoritmos , Tos/diagnóstico , Registros Electrónicos de Salud , Humanos , Aprendizaje Automático , Estudios Prospectivos , Estudios Retrospectivos
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