Showing papers in "Frontiers in Medicine in 2021"

Containing the Transmission of COVID-19: A Modeling Study in 160 Countries.

Abstract: Background: It is much valuable to evaluate the comparative effectiveness of the coronavirus disease 2019 (COVID-19) prevention and control in the non-pharmacological intervention phase of the pandemic across countries and identify useful experiences that could be generalized worldwide. Methods: In this study, we developed a susceptible – exposure – infectious – asymptomatic – removed (SEIAR) model to fit the daily reported COVID-19 cases in 160 countries. The time-varying reproduction number (Rt) that was estimated through fitting the mathematical model was adopted to quantify the transmissibility. We defined a synthetic index (IAC) based on the value of Rt to reflect the national capability to control COVID-19 was finally calculated by. Results: The goodness-of-fit tests showed that the SEIAR model fitted the data of the 160 countries well. At the beginning of the epidemic, the values of Rt of countries in the European region were generally higher than those in other regions. Among the 160 countries included in the study, all European countries had the ability to control the COVID-19 epidemic. The Western Pacific region did best in the managing of continuous control of the epidemic, with a total of 73.76% of countries can continuously controlled the COVID-19 epidemic, while only 43.63% of the countries in the European region continuously controlled the epidemic, followed by, the Region of Americas with 52.53% of countries, South-east Asia Region with 48% of countries, African region with 46.81% of countries, and Eastern Mediterranean Region with 40.48% of countries. Conclusion: Large variations in controlling the COVID-19 epidemic existed across countries. The world could benefit the experience of some countries that demonstrated the highest containment capabilities.

Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies.

Abstract: Extracorporeal membrane oxygenation (ECMO), a life-saving technique for patients with severe respiratory and cardiac diseases, is being increasingly utilized worldwide, particularly during the coronavirus disease 2019(COVID-19) pandemic, and there has been a sharp increase in the implementation of ECMO. However, due to the presence of various complications, the survival rate of patients undergoing ECMO remains low. Among the complications, the neurologic morbidity significantly associated with venoarterial and venovenous ECMO has received increasing attention. Generally, failure to recognize neurologic injury in time is reportedly associated with poor outcomes in patients on ECMO. Currently, multimodal monitoring is increasingly utilized in patients with devastating neurologic injuries and has been advocated as an important approach for early diagnosis. Here, we highlight the prevalence and outcomes, risk factors, current monitoring technologies, prevention, and treatment of neurologic complications in adult patients on ECMO. We believe that an improved understanding of neurologic complications presumably offers promising therapeutic solutions to prevent and treat neurologic morbidity.

The Differences and Changes of Semi-Quantitative and Quantitative CT Features of Coronavirus Disease 2019 Pneumonia in Patients With or Without Smoking History.

Abstract: Objective: To assess CT features of COVID-19 patients with different smoking status using quantitative and semi-quantitative technologies and to investigate changes of CT features in different disease states between the two groups. Methods: 30 COVID-19 patients with current smoking status (29 men, 1 woman) admitted in our database were enrolled as smoking group and 56 COVID-19 patients without smoking history (24 men, 32 women) admitted during the same period were enrolled as a control group. Twenty-seven smoking cases and 55 control cases reached recovery standard and were discharged. Initial and follow-up CT during hospitalization and follow-up CT after discharge were acquired. Thirty quantitative features, including the ratio of infection volume and visual-assessed interstitial changes score including total score, score of ground glass opacity, consolidation, septal thickening, reticulation and honeycombing sign, were analyzed. Results: Initial CT images of the smoking group showed higher scores of septal thickening [4.5 (0-5) vs. 0 (0-4), p = 0.001] and reticulation [0 (0-5.25) vs 0 (0-0), p = 0.001] as well as higher total score [7 (5-12.25) vs. 6 (5-7), p = 0.008] with statistical significance than in the control group. The score of reticulation was higher in the smoking group than in the control group when discharged [0.89 (0-0) vs. 0.09 (0-0), p = 0.02]. The score of septal thickening tended to be higher in the smoking group than the control group [4 (0-4) vs. 0 (0-4), p = 0.007] after being discharged. Quantitative CT features including infection ratio of whole lung and left lung as well as infection ratio within HU (-750, -300) and within HU (-300, 49) were higher in the control group of initial CT with statistical differences. The infection ratio of whole lung and left lung, infection ratio within HU (-750), and within HU (-750, -300) were higher in the control group with statistical differences when discharged. This trend turned adverse after discharge and the values of quantitative features were generally higher in the smoking group than in the control group without statistical differences. Conclusions: Patients with a history of smoking presented more severe interstitial manifestations and more residual lesion after being discharged. More support should be given for COVID-19 patients with a smoking history during hospitalization and after discharge.