Saturday, April 4, 2020

COVID19 : Select Research Papers and Findings for easier access

I am going through some research papers on Covid 19 for some analysis purpose. I will be listing some of the interesting ones for reference to others who may be interested.
  • Clinical Features of 85 Fatal Cases of COVID-19 from Wuhan: A Retrospective Observational Study. 
    • The median age of the patients was 65.8 years and 72.9% were male. Common symptoms were fever (78 [91.8%]), shortness of breath (50 [58.8%]), fatigue (50 [58.8%]), dyspnea (60 [70.6%]). Hypertension, diabetes and coronary heart disease were the most common comorbidities. Notably, 81.2% patients had very low eosinophil counts at admission. Complications included respiratory failure (80 [94.1%]), shock (69 [81.2%]), ARDS (63 [74.1%]), arrhythmia (51 [60%]), etc. Most patients received antibiotic (77 [90.6%]), antiviral (78 [91.8%]) and glucocorticoids (65 [76.5%]) treatments. 38 patients [44.7%] and 33 [38.8%] received intravenous immunoglobulin and interferon α2b respectively
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  • Imaging and Clinical Features of Patients With 2019 Novel Coronavirus SARS-CoV-2: A systematic review and meta-analysis.
    • Overall, 31 articles and 46959 patients were included, including 10 English articles, 21 Chinese articles. The results of meta-analysis showed that the most common clinical manifestations were fever (87.3%, 0.838-0.909), cough (58.1%, 0.502-0.660), dyspnea (38.3%, 0.246-0.520), muscle soreness or fatigue (35.5%, 0.253-0.456), chest distress (31.2%, -0.024-0.648). The main imaging finding were bilateral pneumonia (75.7%, 0.639-0.871), and ground glass opacification (69.9%, 0.602-0.796). Among the patients, the incidence of required intensive care unit (ICU) was (29.3%, 0.190-0.395), the incidence of acute respiratory distress syndrome (ARDS) was (28.8%, 0.147-0.429), the multiple organ dysfunction syndrome (MODS) was (8.5%, -0.008-0.179), and and the case fatality rate of patients with COVID-19 was (6.8%, 0.044-0.093).
  • Comparison of clinical and pathological features between severe acute respiratory syndrome and coronavirus disease 2019
    • Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) shared similar pathogenetic, clinical and pathological features. Fever and cough were the most common symptoms of both diseases, while myalgia and diarrhea were less common in patients with COVID-19. Acute respiratory distress syndrome (ARDS) was the most severe pulmonary complication that caused high mortality rate. Histologically, diffuse alveolar damage (DAD) was the most characteristic finding in non-survivors with either SARS or COVID-19. Cases of patients died less than 10~14 days of disease duration demonstrated acute-phase DAD, while cases beyond 10~14 days of disease duration exhibited organizing-phase DAD in SARS. Meanwhile, organization and fibrosis were usually accompanied by exudation. Coronavirus was mostly detected in pneumocytes, while less in macrophages and bronchiolar epithelial cells. Hemorrhagic necrosis and lymphocytes depletion were found in lymph nodes and spleen in both SARS and COVID-19, indicating a pathological basis of lymphocytopenia. Thrombosis was commonly observed in small vessels and microvascular in lungs accompanying DAD. Microthrombosis was also found in extrapulmonary organs in COVID-19, that was less reported in SARS. Damages in multiple extrapulmonary organs were observed, but coronavirus was not detected in some of those organs, might indicating an alternative mechanism beyond viral infection, such as hypoxemia, ischemia and cytokine storm induced immunological injury. Diffuse alveolar damage due to viral infection and immunological injury, as well as multi-organ dysfunction and extensive microthrombus formation, brought huge challenge to the management of patients with severe SARS or COVID-19.

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