In a report of 72,314 cases in China, 81% of the cases were classified as mild, 14% were severe cases that required ventilation in an intensive care unit (ICU) and a 5% were critical (that is, the patients had respiratory failure, septic shock and/or multiple organ dysfunction or failure)9,86. On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT)13,60,80,81. Most patients also developed marked lymphopenia, similar to what was observed in patients with SARS and MERS, and non-survivors developed severer lymphopenia over time13,60,80,81. Compared with non-ICU patients, ICU patients had higher levels of plasma cytokines, which suggests an immunopathological process caused by a cytokine storm60,86,87. In this cohort of patient, around 2.3% people died within a median time of 16 days from disease onset9,86. Men older than 68 years had a higher risk of respiratory failure, acute cardiac injury and heart failure that led to death, regardless of a history of cardiovascular disease86 (Fig. 4). Most patients recovered enough to be released from hospital in 2 weeks9,80 (Fig. 4).
Early diagnosis is crucial for controlling the spread of COVID-19. Molecular detection of SARS-CoV-2 nucleic acid is the gold standard. Many viral nucleic acid detection kits targeting ORF1b (including RdRp), N, E or S genes are commercially available11,106,107,108,109. The detection time ranges from several minutes to hours depending on the technology106,107,109,110,111. The molecular detection can be affected by many factors. Although SARS-CoV-2 has been detected from a variety of respiratory sources, including throat swabs, posterior oropharyngeal saliva, nasopharyngeal swabs, sputum and bronchial fluid, the viral load is higher in lower respiratory tract samples11,96,112,113,114,115. In addition, viral nucleic acid was also found in samples from the intestinal tract or blood even when respiratory samples were negative116. Lastly, viral load may already drop from its peak level on disease onset96,97. Accordingly, false negatives can be common when oral swabs and used, and so multiple detection methods should be adopted to confirm a COVID-19 diagnosis117,118. Other detection methods were therefore used to overcome this problem. Chest CT was used to quickly identify a patient when the capacity of molecular detection was overloaded in Wuhan. Patients with COVID-19 showed typical features on initial CT, including bilateral multilobar ground-glass opacities with a peripheral or posterior distribution118,119. Thus, it has been suggested that CT scanning combined with repeated swab tests should be used for individuals with high clinical suspicion of COVID-19 but who test negative in initial nucleic acid screening118. Finally, SARS-CoV-2 serological tests detecting antibodies to N or S protein could complement molecular diagnosis, particularly in late phases after disease onset or for retrospective studies116,120,121. However, the extent and duration of immune responses are still unclear, and available serological tests differ in their sensitivity and specificity, all of which need to be taken into account when one is deciding on serological tests and interpreting their results or potentially in the future test for T cell responses.
Two Pages Philip Glass Pdf 19
Download File: https://shoxet.com/2vG1zu
2ff7e9595c
Comments