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Respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, lung cancer, and coronavirus pneumonia, present a major global health challenge. Current diagnostic and therapeutic options for these diseases are limited, necessitating the urgent development of novel biomarkers and therapeutic strategies. In recent years, microRNAs (miRNAs) within extracellular vesicles (EVs) have received considerable attention due to their crucial role in intercellular communication and disease progression. EVs are membrane-bound structures released by cells into the extracellular environment, encapsulating a variety of biomolecules such as DNA, RNA, lipids, and proteins. Specifically, miRNAs within EVs, known as EV-miRNAs, facilitate intercellular communication by regulating gene expression. The expression levels of these miRNAs can reflect distinct disease states and significantly influence immune cell function, chronic airway inflammation, airway remodeling, cell proliferation, angiogenesis, epithelial-mesenchymal transition, and other pathological processes. Consequently, EV-miRNAs have a profound impact on the onset, progression, and therapeutic responses of respiratory diseases, with great potential for disease management. Synthesizing the current understanding of EV-miRNAs in respiratory diseases such as COPD, asthma, lung cancer, and novel coronavirus pneumonia, this review aims to explore the potential of EV-miRNAs as biomarkers and therapeutic targets and examine their prospects in the diagnosis and treatment of these respiratory diseases. [ABSTRACT FROM AUTHOR]

Aim. To study the features of clinical manifestations and diagnosis of comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients with late stages of HIV infection with immunodeficiency. Materials and methods. The prospective study included 120 newly identified patients with disseminated pulmonary tuberculosis with Mycobacterium tuberculosis, stage IVB of HIV infection, in the phase of progression and in the absence of antiretroviral therapy, aged 2953 years, who were randomized into 1A and 2A main groups and 1B and 2B comparison groups. Group 1A included 29 patients with comorbidity and pneumocystis pneumonia and group 2A 31 patients with comorbidity of disseminated pulmonary tuberculosis, coronovirus pneumococcal pneumonia, and group 1B and 2B comprised 29 and 31 similar patients, but without coronovirus pneumonia. To diagnose coronavirus pneumonia, PCR of SARS-CoV-2 RNA was used in smears from the nasopharynx and oropharynx, in sputum or in endotracheal aspirate. To detect Pneumocystis jirovecii, the causative agent of pneumocystis pneumonia, a microscopic examination of diagnostic material from the respiratory tract with RomanovskyGiemse and GrokottGmri coloration was carried out, and to detect Streptococcus pneumoniae, the causative agent of pneumococcal pneumonia, the diagnostic material was seeded on special nutrient media with determination of the drug resistance of the resulting culture to broad-spectrum antibiotics. Statistical data processing was carried out using the Microsoft Office Excel 2019 program with the calculation of the average in the group and the standard error of the average, confidence interval. Results. The comorbidity of disseminated pulmonary tuberculosis, coronavirus, pneumocystis and pneumococcal pneumonia in patients in the late stages of HIV infection, in the phase of progression and in the absence of antiretroviral therapy was characterized by severe immunodeficiency, generalization of tuberculosis with multiple extrapulmonary lesions and severe pneumonia. This determines the similarity of clinical manifestations and respiratory symptoms, and also makes it difficult to visualize computed tomographic changes consisting of a complex simultaneous combination of four pathological syndromes: dissemination, pleural pathology, increased pulmonary pattern and adenopathy. Simultaneous layering of several pathologies with the same type of clinical manifestations and computed tomographic changes requires a comprehensive etiological diagnosis of specific diseases to prescribe timely comprehensive treatment and reduce the lethality of this heavy contingent of patients. Conclusion. Patients with disseminated pulmonary tuberculosis and HIV infection who are registered in the office of tuberculosis care for HIV-infected in the tuberculosis dispensary represent a high risk group of COVID-19 infection and the development of coronavirus pneumonia, and with severe immunodeficiency, pneumocystis and pneumococcal pneumonia, should be regularly subjected to preventive studies for timely detection of COVID-19, coronavirus, pneumocystis and pneumococcal pneumonia for the purpose of their emergency isolation and timely treatment.

In recent years, deep learning techniques have been widely used to diagnose diseases. However, in some tasks, such as the diagnosis of COVID-19 disease, due to insufficient data, the model is not properly trained and as a result, the generalizability of the model decreases. For example, if the model is trained on a CT scan dataset and tested on another CT scan dataset, it predicts near-random results. To address this, data from several different sources can be combined using transfer learning, taking into account the intrinsic and natural differences in existing datasets obtained with different medical imaging tools and approaches. In this paper, to improve the transfer learning technique and better generalizability between multiple data sources, we propose a multi-source adversarial transfer learning model, namely AMTLDC. In AMTLDC, representations are learned that are similar among the sources. In other words, extracted representations are general and not dependent on the particular dataset domain. We apply the AMTLDC to predict Covid-19 from medical images using a convolutional neural network. We show that accuracy can be improved using the AMTLDC framework, and surpass the results of current successful transfer learning approaches. In particular, we show that the AMTLDC works well when using different dataset domains, or when there is insufficient data. [ABSTRACT FROM AUTHOR]

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Abstract COVID-19 is a severe acute respiratory syndrome caused by coronavirus that has triggered acute respiratory infections in countries around the world. In the last 20 years, there have been several outbreaks of coronaviruses, which have had a tremendous impact on productive life and globalization. Since coronaviruses are mutagenic and highly susceptible to mutation, there are no specific drugs against coronaviruses. Medicines made from natural products gains worldwide attention, and the mechanism and effectiveness of natural products for the treatment of coronavirus-related diseases have received much attention after the global pandemic of COVID-19 in 2020. The vitro research results and clinical data from various countries have shown protective effects of good effects against coronaviruses. This review summarizes representative natural products for the treatment of coronavirus-related diseases in the past 20 years, and demonstrates the promising prospects of natural products against coronavirus-related diseases by listing herbal formulas, Chinese patent medicines and natural small molecule compounds and their therapeutic mechanisms, providing references for subsequent related studies.

COVID-19 is a severe acute respiratory syndrome caused by coronavirus that has triggered acute respiratory infections in countries around the world. In the last 20 years, there have been several outbreaks of coronaviruses, which have had a tremendous impact on productive life and globalization. Since coronaviruses are mutagenic and highly susceptible to mutation, there are no specific drugs against coronaviruses. Medicines made from natural products gains worldwide attention, and the mechanism and effectiveness of natural products for the treatment of coronavirus-related diseases have received much attention after the global pandemic of COVID-19 in 2020. The vitro research results and clinical data from various countries have shown protective effects of good effects against coronaviruses. This review summarizes representative natural products for the treatment of coronavirus-related diseases in the past 20 years, and demonstrates the promising prospects of natural products against coronavirus-related diseases by listing herbal formulas, Chinese patent medicines and natural small molecule compounds and their therapeutic mechanisms, providing references for subsequent related studies. [ABSTRACT FROM AUTHOR]

Aim: to assess the results of chest computer tomography (CT) of patients with novel coronavirus infection in correspondence with their outcomes, clinical and laboratory data. Methods: retrospective analysis of 962 chest CT scans, outcomes, clinical and laboratory data of all 354 COVID-19 patients hospitalized from April to June 2020. Results: Sensitivity and specificity of CT with polimerase chain reaction (PCR) as a reference were: 98.0 % and 5.7 % respectively; for PCR with CT as a reference: 54.6 % and 70.7 % respectively. Patients with positive and negative PCR tests had no significant differences in mean CT score and CO-RADS score. Cumulative survival was better in patients with lower CT score (significant only for maximal, not baseline scores). CT score changed during hospitalization in survived patients clinically insignificant (from 2 (1-2) to 2 (1-2), p=0.001), and increased in dead (from 2 (1,5-3) to 4 (4-4), p

Tong Liu,1,* Meng Feng,2,* Zexin Wen,3 Yijie He,1 Wei Lin,2 Min Zhang1 1Department of Medicine, Xizang Minzu University, Xianyang, Shaanxi, People’s Republic of China; 2School of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China; 3Department of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, People’s Republic of China*These authors contributed equally to this workCorrespondence: Min ZhangDepartment of Medicine, Xizang Minzu University, Xianyang, People’s Republic of ChinaTel +86 2918681997994Email zhangmin-wen@163.comWei LinSchool of Basic Medicine, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, People’s Republic of ChinaTel +86 53115098926353Email linw1978@163.comAbstract: Cytokine storm (CS) is a significant cause of death in patients with severe coronavirus pneumonia. Excessive immune–inflammatory reaction, many inflammatory cell infiltration, and extreme increase of proinflammatory cytokines and chemokines lead to acute lung injury and acute respiratory distress syndrome (ARDS). This review compares the characters of cytokine storms and immune responses caused by three highly pathogenic and infectious coronaviruses (HCoVs), including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome-coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and analyzes the possible mechanisms to guide clinical treatment in the future.Keywords: cytokines, coronavirus pneumonia, cytokine storm, immune evasion, interferon

Spontaneous pneumomediastinum is a rare complication of viral pneumonia. The prevalence of pneumomediastinum among coronavirus infection patients is unknown.Subjects and methods. Three cases of spontaneous pneumomediastinum among the COVID-19 pneumonia patients were analyzed. The researchers investigated and compared clinical, radiological and laboratory data.Results. According to the research results, no correlation was found between the development of pneumomediastinum and changes in values of blood laboratory tests. As well as there were no signs of correlation between drug treatment and pneumomediastinum frequency.Conclusion: The researchers suggest that the leading cause of spontaneous pneumomediastinum is viral pneumonia-associated severe alveolar damage.

Abstract Background Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI). Methods In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. Results A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P

In 2019, a novel pneumonia, called coronavirus disease 2019 (COVID-19), spread rapidly throughout the world. This novel global pandemic severely threatened public respiratory health and medical services. To date, except for the common respiratory symptoms, coagulation disorders, especially pulmonary thromboembolism (PTE), has been proven as an important complication in severe COVID-19 patients, and the incidence of PTE causes poor clinical outcome and increased fatality. Therefore, it is important that healthcare providers, including respiratory physicians, emergency medicine specialists, hematologists, cardiologists, infectious disease specialists, and other specialists, recognize that patients with COVID-19 are at increased risk of PTE, and ensure that appropriate prophylaxis is administered to the appropriate patients, and that they effectively manage PTE when it does occur. The mechanism of PTE in patients with coronavirus pneumonia consists of endothelial injury, activated platelet, cytokine storm, and a suppressed fibrinolytic system. Early prophylaxis, antiviral therapy, anticoagulation, and supportive treatment are beneficial to COVID-19 patients. In this review, we summarize the harm that coronavirus pneumonia wreaks and highlight the clinical relationship between PTE and coronavirus infection. The potential mechanism and the prophylaxis and therapeutic measures are also discussed to call for more effort and research to investigate the strategies for PTE in COVID-19.

In such a brief period, the recent coronavirus (COVID-19) already infected large populations worldwide. Diagnosing an infected individual requires a Real-Time Polymerase Chain Reaction (RT-PCR) test, which can become expensive and limited in most developing countries, making them rely on alternatives like Chest X-Rays (CXR) or Computerized Tomography (CT) scans. However, results from these imaging approaches radiated confusion for medical experts due to their similarities with other diseases like pneumonia. Other solutions based on Deep Convolutional Neural Network (DCNN) recently improved and automated the diagnosis of COVID-19 from CXRs and CT scans. However, upon examination, most proposed studies focused primarily on accuracy rather than deployment and reproduction, which may cause them to become difficult to reproduce and implement in locations with inadequate computing resources. Therefore, instead of focusing only on accuracy, this work investigated the effects of parameter reduction through a proposed truncation method and analyzed its effects. Various DCNNs had their architectures truncated, which retained only their initial core block, reducing their parameter sizes to <1 M. Once trained and validated, findings have shown that a DCNN with robust layer aggregations like the InceptionResNetV2 had less vulnerability to the adverse effects of the proposed truncation. The results also showed that from its full-length size of 55 M with 98.67% accuracy, the proposed truncation reduced its parameters to only 441 K and still attained an accuracy of 97.41%, outperforming other studies based on its size to performance ratio. [ABSTRACT FROM AUTHOR]

Background: computer tomography (CT) features of COVID-19, their temporal changes and differences from other pulmonary (viral and bacterial pneumonia) and non-pulmonary diseases are well described in recent publications. The prevalence and characteristics of signs of concomitant problems that could be identified at chest CT are less studied.Aim: to analyze the prevalence and characteristics of chest CT features of COVID-19, its complications and comorbidities.Methods: retrospective analysis of CT and clinical data of 354 patients hospitalized with suspected COVID at April and May of 2020.Results: 962 CT scans were analyzed (3 (2-3) scans per patient). First CT was performed at 8 (5-11) day of sickness. Several roentgenological scenarios could be highlighted: patients with coronavirus pneumonia (n=295; 83%); with combination of COVID-19 and another pathology (n=36; 10%); with complications of COVID-19 (n=12; 3%); with alternative pathology (n=2; 1%); without any pathological signs (n=9; 3%). Several cases, illustrating CT signs of coronavirus pneumonia, its complications and comorbidities are reported.Conclusion: CT possibilities are not limited to detect typical COVID-19 signs, it also helps to differentiate pulmonary and other thoracis pathology.

Abstract Background COVID-19 is a highly infectious respiratory disease. No therapeutics have yet been proven effective for treating severe COVID-19. Objectives To determine whether human umbilical cord mesenchymal stem cell infusion may be effective and safe for the treatment of severe COVID-19. Methods Patients with severe COVID-19 were randomly divided into 2 groups: the standard treatment group and the standard treatment plus hUC-MSC infusion group. The incidence of progression from severe to critical illness, 28-day mortality, clinical symptom improvement, time to clinical symptom improvement, hematologic indicators including C-reactive protein, lymphocyte number, and interleukin 6, and imaging changes were observed and compared between the two groups. Measurements and main results The incidence of progression from severe to critical illness and the 28-day mortality rate were 0 in the hUC-MSC treatment group, while 4 patients in the control group deteriorated to critical condition and received invasive ventilation; 3 of them died, and the 28-day mortality rate was 10.34%. In the hUC-MSC treatment group, the time to clinical improvement was shorter than that in the control group. Clinical symptoms of weakness and fatigue, shortness of breath, and low oxygen saturation obviously improved beginning on the third day of stem cell infusion and reached a significant difference on day 7. CRP and IL-6 levels were significantly lower from day 3 of infusion, the time for the lymphocyte count to return to the normal range was significantly faster, and lung inflammation absorption was significantly shorter on CT imaging in the hUC-MSC group than in the control group. Conclusions Intravenous transplantation of hUC-MSCs is a safe and effective method that can be considered a salvage and priority treatment option for severe COVID-19. Trial registration Chinese Clinical Trial Registration; ChiCTR2000031494; Registered on 2 April 2020; http:// www.medresman.org

In December 2019, novel coronavirus pneumonia-19 (COVID-19) was discovered in the viral pneumonia cases that occurred in Wuhan, China, and then quickly spread around the world. This report described the clinical course of two COVID-19 patients and the purpose of the study was to discuss the combination of chest CT and clinical features for diagnosis of COVID-19. The first case was a typical COVID-19 case. A 66-year-old female presented to our hospital with a 3-day history of fever. She had contact with a COVID-19 patient. Chest CT showed a typical COVID-19 appearance. She was diagnosed with COVID-19 by a positive nucleic acid test. The second case was a 50-year-old male with a 2-day history of fever. He denied having been to Wuhan. Chest CT also showed typical features of COVID-19 pneumonia. COVID-19 nucleic acid tests were repeated up to seven times and the results remained controversial. Eventually, he was diagnosed with COVID-19. Our study shows that chest CT has high sensitivity for diagnosis of COVID-19 in clinical practice, particularly when the nucleic acid test is negative. The chest CT should be considered as a diagnostic tool for the COVID-19 screening, comprehensive evaluation, and follow-up and patients would benefit from effective treatments in time.

The newly identified Coronavirus pneumonia, subsequently termed COVID-19, is highly transmittable and pathogenic with no clinically approved antiviral drug or vaccine available for treatment. Technological developments like edge computing, fog computing, Internet of Things (IoT), and Big Data have gained importance due to their robustness and ability to provide diverse response characteristics based on target application. In this paper, we present a novel Health-Fog framework universal system to automatically assist the early diagnosis, treatment, and preventive of people with COVID-19 in an efficient manner. Achieving an empirical of the proposed framework which mix between deep learning and Neutrosophic classifiers in the task of classifying COVID-19. There are some proposed applications based on the proposed COVID-X framework such as smart mask, smart medical suit, safe spacer, and Medical Mobile Learning (MML) will be presented. Computer-aided diagnosis systems could assist in the early detection of COVID-19 abnormalities and help to monitor the progression of the disease, potentially reduce mortality rates.

In the era of new coronavirus infection pulmonary embolism (PE) is a corollary manifestation that may aggravate the patient`s clinical status. In this setting of patients various coagulation abnormalities such as raised D-dimers and prolonged APTT have been reported previously in up to 65% and 45% of adults SARS patients respectively and multiple previously necropsy series of SARS patients showed that vascular thromboses were not uncommonly seen in lung specimens. During this period emergency rooms work is note of worthy in differentiation COVID from non-COVID patients due to separate admission procedure in the hospital. Accordingly, among the non-COVID population there exist a high percentage of patients with a typical radiologic pattern of COVID-19 but without a positive reverse transcription polymerase chain reaction (RT-PCR) resulting in naso-faringeal swamp. The above findings raise the suspicion of an occulted COVID-19 or a like-COVID-19 clinical presentation. In the last istance there is a need to pay more attention just to avoid further contamination. In this report we describe a case with high risk PE, as a first manifestation of a like- COVID-19 pneumonia. In the above case the patient in question, after careful CT angiography evaluation, has a clear COVID-19 pneumonia radiological findings in spite of three RT-PCR swamp negative for true COVID-19.

Background: At the beginning of the New Year 2020, China alerted the world health organization (WHO) to a cluster of unusual pneumonia cases in Wuhan. After extensive speculation, eventually a new species of coronavirus introduced as the causative pathogen of the disease. Coronavirus disease 2019 (COVID-19) is a name for the disease, and the virus that causes it is known SARS-CoV-2. The very rapid spread of the COVID-19 in China and in many other countries has caused fear among people across the world. The novel coronavirus outbreak declared a Public Health Emergency of International Concern on 30 January 2020. Materials and Methods: Several databases such as PubMed, Scopus, Google scholar, and BioRxiv were searched for publications reporting on the novel coronavirus up to 29 February 2020. Literature searches were performed using keywords including “Coronavirus 2019”, “2019-nCoV”, “COVID-19”, and “SARS-CoV-2”. Moreover, websites such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) were searched to retrieve updated data and statistics regarding the novel coronavirus. We extracted data on the epidemiology, pathogenesis, virology, clinical manifestations, transmission routes, diagnosis, treatment, and prevention measures. Results: From the 1416 articles identified in the initial search, 53 were remained after title and abstract screening. After full-text review, 37 articles were eligible to include in our study. Incubation period for COVID-19 is between 2-10 days, according to the World Health Organization (WHO). The case fatality rate in patients infected with SARC-CoV-2 is 4.3%, and the results indicate that the mortality is higher in elderly individuals and patients with chronic conditions including patients with coronary artery disease, diabetes, chronic pulmonary disease, and hypertension. The mortality rate in healthy subjects is less than 1%. Conclusion: The outbreak caused by the novel coronavirus is larger than the previous human coronaviruses, showing that the SARS-CoV-2 is an extremely contagious virus. However, the mortality rate of COVID-19 is lower than that of other coronaviruses diseases such as SARS or MERS and other viruses like HIV and Ebola. Currently, due to the lack of an effective treatment and vaccine, the best way to deal with the COVID-19 disease is to prevent transmission and spread of the virus and to execute personal protective measures.

Purpose: The aim of this study is to evaluate the frequency of cardiac involvement in patients with coronavirus disease 2019 (COVID-19), possible immune mechanisms of myocardial injury, and the place of cardiovascular pathology among other prognostic factors. Methods: The study included 86 patients (48 male, 60.2 ± 16.6 years) with COVID-19. In addition to common investigation, examination of troponin T (n = 18) and anti-heart antibodies (AHA, n = 34) were used. The average hospital period was 14 [12; 18] days. Results: The incidence of cardiovascular disease and symptoms was 45.3%. Arrhythmias, heart failure, low-QRS voltage, repolarization disorders, and pericardial effusion were the typical for coronavirus cardiac injury. The level of AHA was increased in 73.5%. Significant (p < 0.05) correlations of AHA level with inflammatory activity, pneumonia, respiratory failure, cardiac symptoms, and death were found. D-dimer >0.5 μg/mL had a sensitivity of 79.2% and specificity of 60% in the prediction of cardiovascular manifestations. Cardiac failure was one of the causes of death in 3/8 patients (37.5%). Lethality in the presence of cardiovascular pathology was 17.9 versus 2.2% without it, p < 0.05. The most powerful prognostic model includes age, diabetes, oxygen therapy volume, maximum leukocyte level, C-reactive protein, and D-dimer (correlation coefficient 0.871, p < 0.001). The model with only age, diabetes, and cardiovascular disease included also had predictive power (correlation coefficient 0.568, p < 0.001). Conclusions: The cardiovascular pathology is frequent in patients with COVID-19 and strong correlates with the D-dimer. It indicates the high significance of prothrombotic and ischemic mechanisms. High AHA levels may reflect an inflammatory heart injury. The cardiovascular pathology is associated with higher lethality. [ABSTRACT FROM AUTHOR]

The outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-caused pneumonia (Coronavirus disease −19, COVID-19), has resulted in a global health emergency. However, there is no vaccine or effective antiviral treatment against the newly emerged coronavirus and identifying the available therapeutics as soon as possible is critical for the response to the spread of SARS-CoV-2. Shufeng Jiedu Capsule (SFJDC), a well-known prescription of Traditional Chinese Medicine (TCM) in China, has been widely used in treating upper respiratory tract infections and acute lung injury, owing to its immunomodulatory and anti-inflammatory effects. Despite the definite evidence of effective use of SFJDC in the diagnosis and treatment of pneumonia caused by SARS-CoV-2, the underlying action mechanism remains unknown. Currently, a systematic study integrated with absorption, distribution, metabolism and excretion (ADME) evaluation, target prediction, network construction and functional bioinformatics analyses is proposed to illustrate the potential immune and anti-inflammatory mechanisms of SFJDC against SARS-CoV-2. Additionally, to further validate the reliability of the interactions and binding affinities between drugs and targets, docking, Molecular dynamics Simulations (MD) simulations and Molecular Mechanics/Poisson-Boltzmann Surface Area approach (MM-PBSA) calculations were carried out. The results demonstrate that SFJDC regulates the immunomodulatory and anti-inflammatory related targets on multiple pathways through its active ingredients, showing the potential anti-novel coronavirus effect. Overall, the work can provide a better understanding of the therapeutic mechanism of SFJDC for treating SARS-CoV-2 pneumonia from multi-scale perspectives, and may also offer a valuable clue for developing novel pharmaceutical strategies to control the current coronavirus.

Background: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients' data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards.Conclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992. [ABSTRACT FROM AUTHOR]

The rapid emergence of coronavirus disease 2019 (COVID‐19) has necessitated the implementation of diverse pandemic control strategies throughout the world. To effectively control the spread of this disease, it is essential that it be diagnosed at an early stage so that patients can be reliably quarantined such that disease spread will be slowed. At present, the diagnosis of this infectious form of coronavirus pneumonia is largely dependent upon a combination of laboratory testing and imaging analyses of variable diagnostic efficacy. In the present report, we reviewed prior literature pertaining to the diagnosis of different forms of pneumonia caused by coronaviruses (severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, and SARS‐CoV‐2) and assessed two different potential diagnostic approaches. We ultimately found that computed tomography was associated with a higher rate of diagnostic accuracy than was a real‐time quantitative polymerase chain reaction‐based approach (P =.0041), and chest radiography (P =.0100). Even so, it is important that clinicians utilize a combination of laboratory and radiological testing where possible to ensure that this virus is reliably and quickly detected such that it may be treated and patients may be isolated in a timely fashion, thereby effectively curbing the further progression of this pandemic. Highlights: 1.CT scan could be a better diagnosis method for COVID‐19 than RT‐PCR (P =.0041).2.The diagnosis rate of CT scan is higher than chest radiography (P =.0100).3.Combination diagnosis should be the main approach for disease control. [ABSTRACT FROM AUTHOR]

The newly identified Coronavirus pneumonia, subsequently termed COVID-19, is highly transmittable and pathogenic with no clinically approved antiviral drug or vaccine available for treatment. Technological developments like edge computing, fog computing, Internet of Things (IoT), and Big Data have gained importance due to their robustness and ability to provide diverse response characteristics based on target application. In this paper, we present a novel Health-Fog framework universal system to automatically assist the early diagnosis, treatment, and preventive of people with COVID-19 in an efficient manner. Achieving an empirical of the proposed framework which mix between deep learning and Neutrosophic classifiers in the task of classifying COVID-19. There are some proposed applications based on the proposed COVID-X framework such as smart mask, smart medical suit, safe spacer, and Medical Mobile Learning (MML) will be presented. Computer-aided diagnosis systems could assist in the early detection of COVID-19 abnormalities and help to monitor the progression of the disease, potentially reduce mortality rates. [ABSTRACT FROM AUTHOR]

Background: Delirium incidence and clinical correlates in coronavirus disease-19 (COVID-19) pneumonia are still poorly investigated. Aim: To describe the epidemiology of delirium in patients hospitalized for suspect COVID-19 pneumonia during the pandemic peak in an academic hospital of Northern Italy, identify its clinical correlations and evaluate the association with mortality. Methods: The clinical records of 852 patients admitted for suspect COVID-19 pneumonia, defined as respiratory symptoms or fever or certain history of contact with COVID-19 patients, plus chest CT imaging compatible with alveolar-interstitial pneumonia, were retrospectively analyzed. Delirium was defined after careful revision of daily clinical reports in accordance with the Confusion Assessment Method criteria. Data on age, clinical presentation, comorbidities, drugs, baseline lab tests and outcome were collected. The factors associated with delirium, and the association of delirium with mortality, were evaluated through binary logistic regression models. Results: Ninety-four patients (11%) developed delirium during stay. They were older (median age 82, interquartile range, IQR 78–89, vs 75, IQR 63–84, p < 0.001), had more neuropsychiatric comorbidities and worse respiratory exchanges at baseline. At multivariate models, delirium was independently and positively associated with age [odds ratio (OR) 1.093, 95% confidence interval (CI) 1.046–1.143, p < 0.001], use of antipsychotic drugs (OR 4.529, 95% CI 1.204–17.027, p = 0.025), serum urea and lactate-dehydrogenase at admission. Despite a higher mortality in patients with delirium (57% vs 30%), this association was not independent of age and respiratory parameters. Conclusions: Delirium represents a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity. [ABSTRACT FROM AUTHOR]

Taking the process of treating coronavirus disease 2019 (COVID-19) with Western medicine and traditional Chinese medicine (TCM) as the research object, this article compares the characteristics of Western medicine and TCM from the perspectives of aetiology, pathogenesis, diagnosis, and treatment. Western medicine and TCM each has its own theoretical system. Each has its own exposition in explaining the etiology and pathogenesis of the disease, and each has its own characteristics and advantages in diagnosis and treatment. Integrating TCM and Western medicine can improve the effect of treatment by forming a coordinated traditional Chinese and Western medicine treatment method. [ABSTRACT FROM AUTHOR]

Background: Lung ultrasound (LUS) is an accurate, safe, and cheap tool assisting in the diagnosis of several acute respiratory diseases. The diagnostic value of LUS in the workup of coronavirus disease-19 (COVID-19) in the hospital setting is still uncertain. Objectives: The aim of this observational study was to explore correlations of the LUS appearance of COVID-19-related pneumonia with CT findings. Methods: Twenty-six patients (14 males, age 64 ± 16 years) urgently hospitalized for COVID-19 pneumonia, who underwent chest CT and bedside LUS on the day of admission, were enrolled in this observational study. CT images were reviewed by expert chest radiologists, who calculated a visual CT score based on extension and distribution of ground-glass opacities and consolidations. LUS was performed by clinicians with certified competency in thoracic ultrasonography, blind to CT findings, following a systematic approach recommended by ultrasound guidelines. LUS score was calculated according to presence, distribution, and severity of abnormalities. Results: All participants had CT findings suggestive of bilateral COVID-19 pneumonia, with an average visual scoring of 43 ± 24%. LUS identified 4 different possible -abnormalities, with bilateral distribution (average LUS score 15 ± 5): focal areas of nonconfluent B lines, diffuse confluent B lines, small subpleural microconsolidations with pleural line irregularities, and large parenchymal consolidations with air bronchograms. LUS score was significantly correlated with CT visual scoring (r = 0.65, p < 0.001) and oxygen saturation in room air (r = –0.66, p < 0.001). Conclusion: When integrated with clinical data, LUS could represent a valid diagnostic aid in patients with suspect COVID-19 pneumonia, which reflects CT findings. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019.Data Sources: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible.Study Eligibility Criteria: All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included.Study Appraisal and Synthesis Methods: All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al.Results: Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported.Conclusion: Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario. [ABSTRACT FROM AUTHOR]

COVID-19 is an emerging infection caused by a novel coronavirus that is moving so rapidly that on 30 January 2020 the World Health Organization declared the outbreak a Public Health Emergency of International Concern and on 11 March 2020 as a pandemic. An early diagnosis of COVID-19 is crucial for disease treatment and control of the disease spread. Real-time reverse-transcription polymerase chain reaction (RT-PCR) demonstrated a low sensibility; therefore chest computed tomography (CT) plays a pivotal role not only in the early detection and diagnosis, especially for false negative RT-PCR tests, but also in monitoring the clinical course and in evaluating the disease severity. This paper reports the CT findings with some hints on the temporal changes over the course of the disease: the CT hallmarks of COVID-19 are bilateral distribution of ground glass opacities with or without consolidation in the posterior and peripheral lung, but the predominant findings in later phases include consolidations, linear opacities, "crazy-paving" pattern, "reversed halo" sign and vascular enlargement. The CT findings of COVID-19 overlap with the CT findings of other diseases, in particular the viral pneumonia including influenza viruses, parainfluenza virus, adenovirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, etc. There are differences as well as similarities in the CT features of COVID-19 compared with those of the severe acute respiratory syndrome. The aim of this article is to review the typical and atypical CT findings in COVID-19 patients in order to help radiologists and clinicians to become more familiar with the disease. [ABSTRACT FROM AUTHOR]

Coronavirus disease pandemic is a public health threat that affects the whole world. Most coronavirus infections are mild in humans. Severe acute respiratory syndrome coronavirus-2 causes coronavirus disease (COVID-19) and coronavirus pneumonia. Many results in coronavirus disease have been obtained in the studies conducted so far. Rapid and effective diagnosis of coronavirus disease is vital. Thus; infected people can be isolated earlier and the spread of the disease can be stopped, and treatment of patients in need of treatment can be started immediately. In this review; the classification of patients, laboratory findings and the causes and results of these findings are mentioned. It is thought that; this review could help clinicians and researchers for diagnosis, classification, treatment and prognosis of coronavirus disease. In addition, it is also thought that; this review helps to find out a biomarker that could be used in conjunction with computed tomography results for rapid and accurate diagnosis and classification of coronavirus disease. [ABSTRACT FROM AUTHOR]

In the era of new coronavirus infection pulmonary embolism (PE) is a corollary manifestation that may aggravate the patient's clinical status. In this setting of patients various coagulation abnormalities such as raised D-dimers and prolonged APTT have been reported previously in up to 65% and 45% of adults SARS patients respectively and multiple previously necropsy series of SARS patients showed that vascular thromboses were not uncommonly seen in lung specimens. During this period emergency rooms work is note of worthy in differentiation COVID from non-COVID patients due to separate admission procedure in the hospital. Accordingly, among the non-COVID population there exist a high percentage of patients with a typical radiologic pattern of COVID-19 but without a positive reverse transcription polymerase chain reaction (RT-PCR) resulting in naso-faringeal swamp. The above findings raise the suspicion of an occulted COVID-19 or a like-COVID-19 clinical presentation. In the last istance there is a need to pay more attention just to avoid further contamination. In this report we describe a case with high risk PE, as a first manifestation of a like-COVID-19 pneumonia. In the above case the patient in question, after careful CT angiography evaluation, has a clear COVID-19 pneumonia radiological findings in spite of three RT-PCR swamp negative for true COVID-19. [ABSTRACT FROM AUTHOR]

In December 2019, novel coronavirus pneumonia-19 (COVID-19) was discovered in the viral pneumonia cases that occurred in Wuhan, China, and then quickly spread around the world. This report described the clinical course of two COVID-19 patients and the purpose of the study was to discuss the combination of chest CT and clinical features for diagnosis of COVID-19. The first case was a typical COVID-19 case. A 66-year-old female presented to our hospital with a 3-day history of fever. She had contact with a COVID-19 patient. Chest CT showed a typical COVID-19 appearance. She was diagnosed with COVID19 by a positive nucleic acid test. The second case was a 50-year-old male with a 2-day history of fever. He denied having been to Wuhan. Chest CT also showed typical features of COVID-19 pneumonia. COVID-19 nucleic acid tests were repeated up to seven times and the results remained controversial. Eventually, he was diagnosed with COVID-19. Our study shows that chest CT has high sensitivity for diagnosis of COVID-19 in clinical practice, particularly when the nucleic acid test is negative. The chest CT should be considered as a diagnostic tool for the COVID-19 screening, comprehensive evaluation, and follow-up and patients would benefit from effective treatments in time. [ABSTRACT FROM AUTHOR]