Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Synergism of TNF-α and IFN-γ Triggers Inflammatory Cell Death, Tissue Damage, and Mortality in SARS-CoV-2 Infection and Cytokine Shock Syndromes

Initial studies found increased severity of coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients with diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals to hyperglycaemia. Interacting with other risk factors, hyperglycaemia might modulate immune and inflammatory responses, thus predisposing patients to severe COVID-19 and possible lethal outcomes. Angiotensin-converting enzyme 2 (ACE2), which is part of the renin-angiotensin-aldosterone system (RAAS), is the main entry receptor for SARS-CoV-2; although dipeptidyl peptidase 4 (DPP4) might also act as a binding target. Preliminary data, however, do not suggest a notable effect of glucose-lowering DPP4 inhibitors on SARS-CoV-2 susceptibility. Owing to their pharmacological characteristics, sodium-glucose cotransporter 2 (SGLT2) inhibitors might cause adverse effects in patients with COVID-19 and so cannot be recommended. Currently, insulin should be the main approach to the control of acute glycaemia. Most available evidence does not distinguish between the major types of diabetes mellitus and is related to type 2 diabetes mellitus owing to its high prevalence. However, some limited evidence is now available on type 1 diabetes mellitus and COVID-19. Most of these conclusions are preliminary, and further investigation of the optimal management in patients with diabetes mellitus is warranted.

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COVID-19 and diabetes mellitus: from pathophysiology to clinical management.

Within two decades, there have emerged three highly pathogenic and deadly human coronaviruses, namely SARS-CoV, MERS-CoV and SARS-CoV-2. The economic burden and health threats caused by these coronaviruses are extremely dreadful and getting more serious as the increasing number of global infections and attributed deaths of SARS-CoV-2 and MERS-CoV. Unfortunately, specific medical countermeasures for these hCoVs remain absent. Moreover, the fast spread of misinformation about the ongoing SARS-CoV-2 pandemic uniquely places the virus alongside an annoying infodemic and causes unnecessary worldwide panic. SARS-CoV-2 shares many similarities with SARS-CoV and MERS-CoV, certainly, obvious differences exist as well. Lessons learnt from SARS-CoV and MERS-CoV, timely updated information of SARS-CoV-2 and MERS-CoV, and summarized specific knowledge of these hCoVs are extremely invaluable for effectively and efficiently contain the outbreak of SARS-CoV-2 and MERS-CoV. By gaining a deeper understanding of hCoVs and the illnesses caused by them, we can bridge knowledge gaps, provide cultural weapons for fighting and controling the spread of MERS-CoV and SARS-CoV-2, and prepare effective and robust defense lines against hCoVs that may emerge or reemerge in the future. To this end, the state-of-the-art knowledge and comparing the biological features of these lethal hCoVs and the clinical characteristics of illnesses caused by them are systematically summarized in the review.

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From SARS and MERS to COVID-19: a brief summary and comparison of severe acute respiratory infections caused by three highly pathogenic human coronaviruses.

Although COVID-19 presents primarily as a lower respiratory tract infection transmitted via air droplets, increasing data suggest multiorgan involvement in patients that are infected. This systemic involvement is postulated to be mainly related to the SARS-CoV-2 virus binding on angiotensin-converting enzyme 2 (ACE2) receptors located on several different human cells. Lung involvement is the most common serious manifestation of the disease, ranging from asymptomatic disease or mild pneumonia, to severe disease associated with hypoxia, critical disease associated with shock, respiratory failure and multiorgan failure or death. Among patients with COVID-19, underlying cardiovascular comorbidities including hypertension, diabetes and especially cardiovascular disease, has been associated with adverse outcomes, whereas the emergence of cardiovascular complications, including myocardial injury, heart failure and arrhythmias, has been associated with poor survival. Gastrointestinal symptoms are also frequently encountered and may persist for several days. Haematological complications are frequent as well and have been associated with poor prognosis. Furthermore, recent studies have reported that over a third of infected patients develop a broad spectrum of neurological symptoms affecting the central nervous system, peripheral nervous system and skeletal muscles, including anosmia and ageusia. The skin, the kidneys, the liver, the endocrine organs and the eyes are also affected by the systemic COVID-19 disease. Herein, we provide a comprehensive overview of the organ-specific systemic manifestations of COVID-19.

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Organ-specific manifestations of COVID-19 infection.

COVID-19 is a rapidly spreading global threat that has been declared as a pandemic by the WHO COVID-19 is transmitted via droplets or direct contact and infects the respiratory tract resulting in pneumonia in most of the cases and acute respiratory distress syndrome (ARDS) in about 15 % of the cases Mortality in COVID-19 patients has been linked to the presence of the so-called "cytokine storm" induced by the virus Excessive production of proinflammatory cytokines leads to ARDS aggravation and widespread tissue damage resulting in multi-organ failure and death Targeting cytokines during the management of COVID-19 patients could improve survival rates and reduce mortality

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The COVID-19 Cytokine Storm; What We Know So Far.

Background: Magnetic resonance imaging (MRI) is used more commonly in evaluation of knee trauma compared to other modalities. It is an excellent diagnostic tool that may help clinicians in the evaluation of injuries to menisci and ligaments, osseous structures, articular surfaces, and tendon, it plays an important role in clinical decision-making.
Aim of the Work: The aim of the study was to determine the role of magnetic resonance imaging (MRI) in the assessment of injuries related to anterior cruciate ligament compared to arthroscopy.
Patients and Methods: This study included (20) ACL injury patients referred to the Radiology Department from the Orthopedics outpatient clinic department, Al-Demerdash Hospital, Faculty of Medicine, Ain Shams University from December of 2016 to August of 2017. Results: eighteen (90%) male and 2 (10%) female patients were enrolled in this study. We found that sensitivity, specificity, PPV, NPV and accuracy were (90%, 70%, 71.4% 100%, 80 %) respectively in partial ACL injury. And the sensitivity, specificity, PPV, NPV and accuracy in complete ACL injury were (78.4%, 100%, 100%, 71.4%, 82 %) respectively. And the sensitivity, specificity, NPV, PPV and accuracy of medial meniscal tear were 99.8 %, 91.7%, 92.3%, 100%, 94% respectively and the sensitivity, specificity, NPV, PPV of lateral meniscal tear were 95.4%, 97.3%, 99%,100%, 98% respectively. Conclusion: MRI is now commonly used before diagnostic arthroscopy in most settings as an effective screening tool with most patients because it is faster, non-invasive and does not involve morbidity associated with arthroscopy. MRI findings before arthroscopy help in the management of meniscal and ligament injuries, ultimately improving patient outcome.

https://ejhm.journals.ekb.eg/article_12292_74abb3e1cd3024b9239e480e7237b25d.pdf

Role of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Injuries

Background: T2 mapping of hyaline cartilage is an imaging technique for the qualitative and quantitative detection of thecartilage providing convincing color mapping and quantitative detection of the cartilage mainly regarding architecture and changes in water content, proteoglycan, and collagen matrix ultra-structure associated with early cartilage degeneration.Aim Of Work: This work aims at elucidating the role of MRI complementary T2 mapping in assessment of articular knee cartilage for improving sensitivity of early detection of Osteoarthritis. Also, compare the articular cartilage T2 relaxation values in normal subjects and patients with osteoarthritis. Patients And Methods: This prospective case-control study wasapproved by the Ethical Committee of Scientific Research in Ain Shams University, and the informed consent was obtained. The material of this study included sixty (60) subjects, divided into two groups, 50 patients (symptomatic group: 33 men and 17 women) with clinical evidence of osteoarthritis, and 10 normal control group (asymptomatic group 8 men and 2 women) were included in this study, with their ages ranged between 19-75 years. All patients and controls underwent MR imaging of the knee joint. MR imaging was performed at 1.5 Tesla by using a routine protocol with the addition of a sagittal, coronal, or axial T2 mapping sequence or all. The standard imaging planes of the knee were evaluated with articular cartilage assessment as intact or not. Thereafter, these standard planes were evaluated together with T2 maps and articular cartilage was again assessed as of normal (<48ms) or elevated (≥48ms) T2 value in terms of milliseconds. Generalized estimating equation models were used to compare the sensitivity and specificity of the routine MR imaging protocol and T2 maps. Results: Both sensitivities and specificities were 82% and 100%, respectively, for the routine MR protocol alone and 100% and 90% after the addition of the T2 mapping to the routine MR protocol. The addition of T2 maps to the routine MR imaging protocol significantly improved the sensitivity (Binary Diagnostic test, p = 0.01). AComparison between patients and controls as regards T2 values showed a highly statistically significant difference (Independent TTest, P<0 .001). Conclusion: A combination of both morphological and T2 mapping MRI, together with clinical evaluation represents a desirable multi-modal approach to the diagnosis of osteoarthritis. T2 mapping, as a biochemically sensitive MRI sequence of the knee improves sensitivity from 82% to 100% to detect early structural degeneration with better diagnostic information in the knee articular cartilage.

https://asmj.journals.ekb.eg/article_125675_ac283afed7b22c6e64b85428caeb557e.pdf

Role of mri t2 mapping in assessment of articular knee cartilage in osteoarthritis

Objective:Diagnosis of female pelvic congestion syndrome (PCS) is challenging. Although invasive venography is the gold-standard for diagnosis, however, CT and MRI are important in the assessment. ...

Female pelvic congestion syndrome: how can CT and MRI help in the management decision?

This study was aimed at validating the diagnostic accuracy of ultrasound (US) scans in pre-operative evaluation of flexor tendon injuries in the hand and to determine its value in the management of such injuries and in the prediction of patient outcome. This descriptive cross-sectional prospective study included 35 patients with penetrating trauma to the volar aspect of the hand or wrist with questionable clinical findings. They had 50 injured tendons and were candidates for exploratory surgery versus physiotherapy. They underwent pre-operative US to guide their management. Ultrasound results were compared with the operative findings as the gold standard test. Patients were followed up postoperatively, and functional outcome was assessed and correlated with pre-operative sonographic findings. Our results indicate that sonographic examination of hand tendon injury has high accuracy in diagnosing complete or partial flexor injuries, with 100% accuracy, sensitivity and specificity in diagnosing full-thickness tears as well as tenosynovitis of hand flexor tendons. Zonal II injury was the most frequent among our study population and correlated with poorest functional outcome after rehabilitation at 3 mo follow-up. US of the hand is a fast, inexpensive and potentially indispensable dynamic tool for accurate assessment of flexor tendon injuries. It provides data on the extent of injury that effectively helps both set up an appropriate operative plan and predict the patient's functional outcome post-operatively, which in turn will have a direct impact on the patient's rehabilitation plan and lifestyle. Thus, it should be a fundamental part of the management of patients with tendon injuries.

Rasha Tolba Khattab

Papers

The COVID-19 Cytokine Storm; What We Know So Far.

Role of Magnetic Resonance Imaging in Evaluation of Anterior Cruciate Ligament Injuries

Role of mri t2 mapping in assessment of articular knee cartilage in osteoarthritis

Female pelvic congestion syndrome: how can CT and MRI help in the management decision?

Role of Ultrasound in Flexor Tendon Injuries of the Hand: A New Insight