Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study.
Luca Carsana,Aurelio Sonzogni,Ahmed Nasr,Roberta Simona Rossi,Alessandro Pellegrinelli,Pietro Zerbi,Roberto Rech,Riccardo Colombo,Spinello Antinori,Mario Corbellino,Massimo Galli,Emanuele Catena,Antonella Tosoni,Andrea Gianatti,Manuela Nebuloni +14 more
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TLDR
The predominant pattern of lung lesions in patients with COVID-19 patients is diffuse alveolar damage, as described in patients infected with severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses.Abstract:
Summary Background COVID-19 is characterised by respiratory symptoms, which deteriorate into respiratory failure in a substantial proportion of cases, requiring intensive care in up to a third of patients admitted to hospital. Analysis of the pathological features in the lung tissues of patients who have died with COVID-19 could help us to understand the disease pathogenesis and clinical outcomes. Methods We systematically analysed lung tissue samples from 38 patients who died from COVID-19 in two hospitals in northern Italy between Feb 29 and March 24, 2020. The most representative areas identified at macroscopic examination were selected, and tissue blocks (median seven, range five to nine) were taken from each lung and fixed in 10% buffered formalin for at least 48 h. Tissues were assessed with use of haematoxylin and eosin staining, immunohistochemical staining for inflammatory infiltrate and cellular components (including staining with antibodies against CD68, CD3, CD45, CD61, TTF1, p40, and Ki-67), and electron microscopy to identify virion localisation. Findings All cases showed features of the exudative and proliferative phases of diffuse alveolar damage, which included capillary congestion (in all cases), necrosis of pneumocytes (in all cases), hyaline membranes (in 33 cases), interstitial and intra-alveolar oedema (in 37 cases), type 2 pneumocyte hyperplasia (in all cases), squamous metaplasia with atypia (in 21 cases), and platelet–fibrin thrombi (in 33 cases). The inflammatory infiltrate, observed in all cases, was largely composed of macrophages in the alveolar lumina (in 24 cases) and lymphocytes in the interstitium (in 31 cases). Electron microscopy revealed that viral particles were predominantly located in the pneumocytes. Interpretation The predominant pattern of lung lesions in patients with COVID-19 patients is diffuse alveolar damage, as described in patients infected with severe acute respiratory syndrome and Middle East respiratory syndrome coronaviruses. Hyaline membrane formation and pneumocyte atypical hyperplasia are frequent. Importantly, the presence of platelet–fibrin thrombi in small arterial vessels is consistent with coagulopathy, which appears to be common in patients with COVID-19 and should be one of the main targets of therapy. Funding None.read more
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Dexamethasone in Hospitalized Patients with Covid-19
Peter Horby,Wei Shen Lim,Jonathan Emberson,M Mafham,Jennifer L Bell,Louise Linsell,Natalie Staplin,Christopher E. Brightling,Andrew Ustianowski,E Elmahi,B Prudon,Christopher A Green,Timothy Felton,David Chadwick,K Rege,C Fegan,Lucy C Chappell,Saul N. Faust,Thomas Jaki,Katie Jeffery,Alan A Montgomery,Kathryn M Rowan,Edmund Juszczak,J K Baillie,Richard Haynes,Martin J Landray +25 more
TL;DR: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Fei Zhou,Ting Yu,Ronghui Du,Guohui Fan,Ying Liu,Zhibo Liu,Jie Xiang,Yeming Wang,Bin Song,Xiaoying Gu,Xiaoying Gu,Lulu Guan,Yuan Wei,Li Hui,Xudong Wu,Jiuyang Xu,Shengjin Tu,Yi Zhang,Hua Chen,Bin Cao +19 more
TL;DR: Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Journal ArticleDOI
Post-acute COVID-19 syndrome.
Ani Nalbandian,Kartik Sehgal,Kartik Sehgal,Aakriti Gupta,Aakriti Gupta,Mahesh V. Madhavan,Claire McGroder,Jacob S. Stevens,Joshua R. Cook,Anna S. Nordvig,Daniel Shalev,Tejasav S. Sehrawat,Neha Ahluwalia,Behnood Bikdeli,Donald Dietz,Caroline Der-Nigoghossian,Nadia Liyanage-Don,Gregg F. Rosner,Elana J. Bernstein,Sumit Mohan,Akinpelumi A Beckley,David S. Seres,Toni K. Choueiri,Toni K. Choueiri,Nir Uriel,John C. Ausiello,Domenico Accili,Daniel E. Freedberg,Matthew R. Baldwin,Allan Schwartz,Daniel Brodie,Christine Kim Garcia,Mitchell S.V. Elkind,Jean M. Connors,Jean M. Connors,John P. Bilezikian,Donald W. Landry,Elaine Wan +37 more
TL;DR: A comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae is provided in this paper, where the authors discuss relevant considerations for the multidisciplinary care of COPD survivors and propose a framework for the identification of those at high risk for COPD and their coordinated management through dedicated COPD clinics.
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SARS-CoV-2 Reverse Genetics Reveals a Variable Infection Gradient in the Respiratory Tract.
Yixuan J. Hou,Kenichi Okuda,Caitlin E. Edwards,David R. Martinez,Takanori Asakura,Kenneth H. Dinnon,Takafumi Kato,Rhianna E. Lee,Boyd Yount,Teresa M. Mascenik,Gang Chen,Kenneth N. Olivier,Andrew J. Ghio,Longping V. Tse,Sarah R. Leist,Lisa E. Gralinski,Alexandra Schäfer,Hong Dang,Rodney C. Gilmore,Satoko Nakano,Ling Sun,M. Leslie Fulcher,Alessandra Livraghi-Butrico,Nathan I. Nicely,Mark J. Cameron,Cheryl M. Cameron,David J. Kelvin,David J. Kelvin,Aravinda M. de Silva,David M. Margolis,Alena J. Markmann,Luther A. Bartelt,Ross E. Zumwalt,Fernando J. Martinez,Steven P. Salvatore,Alain C. Borczuk,Purushothama Rao Tata,Vishwaraj Sontake,Adam J. Kimple,Ilona Jaspers,Wanda K. O'Neal,Scott H. Randell,Richard C. Boucher,Ralph S. Baric +43 more
TL;DR: The nasal susceptibility to SARS-CoV-2 with likely subsequent aspiration-mediated virus seeding to the lung in SARS/COVID-19 pathogenesis is highlighted and reagents provide a foundation for investigations into virus-host interactions in protective immunity, host susceptibility, and virus pathogenesis.
Posted ContentDOI
Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report
Peter Horby,Wei Shen Lim,Jonathan Emberson,Marion Mafham,Jennifer L Bell,Louise Linsell,Natalie Staplin,Christopher E. Brightling,Andrew Ustianowski,E Elmahi,B Prudon,Christopher A Green,Timothy Felton,David Chadwick,K Rege,Christopher Fegan,Lucy C Chappell,Saul N. Faust,Thomas Jaki,Katie Jeffery,Alan A Montgomery,Kathryn M Rowan,Edmund Juszczak,J Kenneth Baillie,Richard Haynes,Martin J Landray +25 more
TL;DR: In patients hospitalized with COVID-19, dexamethasone reduced 28-day mortality among those receiving invasive mechanical ventilation or oxygen at randomization, but not among patients not receiving respiratory support.
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TL;DR: Patients with coronavirus disease 2019 (COVID-19) requiring treatment in an intensive care unit (ICU) in the Lombardy region of Italy were characterized, including data on clinical management, respiratory failure, and patient mortality.
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Incidence of thrombotic complications in critically ill ICU patients with COVID-19.
Frederikus A. Klok,Marieke J. H. A. Kruip,N.J.M. van der Meer,M.S. Arbous,Diederik Gommers,K.M. Kant,F H J Kaptein,J. van Paassen,M A M Stals,Menno V. Huisman,Henrik Endeman +10 more
TL;DR: The findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophYLaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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