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The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum, and dyspnea. However, a significant proportion of patients initially manifested non-respiratory symptoms, such as fever, myalgia, and diarrhea. Here, we compared the different characteristics and outcomes between the patients with respiratory symptoms and non-respiratory symptoms at illness onset. The patients admitted to the respiratory departments from eight hospitals in Hunan and Guangxi Province with nucleic acid-positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens, and outcomes data were recorded and analyzed. The median age of the recruited 541 subjects was 43 years (IQR, 33–55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had non-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (8.7% vs 0.0%, P

BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic. Based on symptoms, COVID-19 cases can be classified as symptomatic or asymptomatic. However, there is limited information about the differences between COVID-19 patients with and without pneumonia. Our study aimed to further discuss the spectrum and clinical characteristics of symptomatic and asymptomatic COVID-19 patients with and without pneumonia. MethodsIn China, all COVID-19 cases are hospitalized in designated hospitals until two continuous negative oropharyngeal swabs obtained, which allows the professional monitoring of symptoms and clinical characteristics. We stratified all COVID-19 cases in our database, and evaluated clinical characteristics in different COVID-19 subgroups (symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia and asymptomatic without pneumonia). ResultsAccording to symptoms and laboratory and radiologic findings, COVID-19 cases were defined as symptomatic with pneumonia, symptomatic without pneumonia, asymptomatic with pneumonia or asymptomatic without pneumonia. There were differences in the clinical characteristics and prognosis among the four groups. Both noninvasive (18, 4.2%) and invasive mechanical ventilation (11, 2.6%) were applied in only the symptomatic with pneumonia group. Likewise, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were applied in only the symptomatic with pneumonia group. There were no differences in the durations of viral shedding and hospitalization among the four groups.ConclusionWe have defined a comprehensive spectrum of COVID-19 with and without pneumonia. The symptomatic with pneumonia group consumed more medical resources than the other groups, and extra caution and monitoring should be applied in this group. The asymptomatic COVID-19 group had a similar viral shedding duration as the symptomatic COVID-19 group.Trial registrationNot available

Objective: To deepen the understanding of clinical characteristics of pediatric patients with COVID-19. Methods: Retrospective analysis was executed among 21 children and their 38 families with laboratory-conformed novel coronavirus disease in five designated hospitals. Results: In total of 21 children (10 males and 11 females) aged from 1 to 17 years, 90.5% were from 18 family clusters and admitted to designated hospitals 2 days after illness onset, shorter than the adults. Besides 5 asymptomatic cases, pediatric patients mainly performed as fever (66.7%), cough (19.0%) and expectoration (14.3%). Among the 38 adult patients, the major symptoms included fever (63.2%), cough (63.2%), expectoration (44.7%), fatigue (6.8%), chill (15.8%) and dizziness (15.8%). Most cases had normal (76.2%, 68.4%) or decreased (19.0%, 26.3%) leucocytes, nearly half of children showed decreased neutrophils. 15 children and 32 adults had pulmonary involvement, consisted of ground-glass opacity (57.1%, 60.5%), spots (14.3%, 23.7%), stripes (14.3%, 7.9%) and patchy shadow (9.5%, 36.8%). All adults received antiviral therapy: lopinavir/ritonavir (92.1%), interferon (76.3%), arbidol (71.1%), chloroquine (18.4%) and ribavirin (10.5%). 16 children used interferon; 12 took lopinavir/ritonavir; 7 were given arbidol; two received ribavirin. All patients had been recovered and discharged with duration of admission 4-47 days (median 17 days). Conclusions: Pediatric patients with COVID-19 presented as milder symptoms and limited lung lesions than adults. Laboratory abnormalities were atypical in mild patients, neutropenia may be a potential characteristic of children. Efficiency of antiviral therapy need to be further investigated.

Background: The main clinical manifestations of coronavirus disease 2019 (COVID-19) onset are respiratory symptoms, including cough, sputum and dyspnea. However, a significant proportion of patients initially manifested extra-respiratory symptoms, such as fever, myalgia and diarrhea. Here we compared the different characteristics and outcomes between the patients with respiratory symptoms and extra-respiratory symptoms at illness onset.Methods: The patients admitted to the respiratory departments from eight hospitals out of Wuhan with nucleic acid-positive of severe acute respiratory syndrome coronavirus (SARS-CoV-2) were recruited. Epidemiological information, clinical manifestations, laboratory findings, and radiological characteristics, treatment regimens and outcomes data were recorded and analyzed.Results: The median age of the recruited 541 subjects was 43 years (IQR, 33-55). Of the 541 subjects, 404 (74.5%) subjects had initial symptom that were respiratory, while 137 (25.5%) subjects had extra-respiratory symptoms. Respiratory COVID-19 subjects had more secondary bacterial infections (pp = 0.01) dyspnea (OR = 4.91, p < 0.001) and secondary bacterial infection (OR = 19.8, p < 0.001) were independently associated with development of ARDS among COVID-19 patients.Conclusion: we identify COVID-19 subjects with dyspnea at disease onset have worse prognosis. We also demonstrate age and secondary bacterial infections to be independently associated with ARDS development in subjects with COVID-19.

To evaluate the correlation between three variables of neck circumference, body mass index (BMI) and Epworth sleepiness scale (ESS) and obstructive sleep apnea-hypopnea syndrome (OSAHS) and the value of three-variable screening tool among snorers in Guangxi region.From May 2009 to June 2014, 2 955 middle-aged consecutive patients with snoring were recruited from four hospitals of Guangxi Province. All subjects underwent polysomnography (PSG) and physical examinations including neck circumference, BMI and ESS. The diffrences of neck circumference, BMI and ESS were compared between OSAHS and non-OSAHS groups; the correlation between apnea-hypopnea index (AHI) and neck circumference, BMI and ESS were analyzed. The optimal cutoff point of three variables was selected by SPSS's Optimal Binning methods and screening score was assigned according to the Logistic regression coefficient. The recommended cutoff points were neck circumference ≥ 38.5 cm (3 points), BMI ≥ 25.7 kg/m(2) (5 points), ESS ≥ 9 points (1 point) for males and neck circumference ≥ 34.5 cm (5 points), BMI ≥ 24.5 kg/m(2) (2 points), ESS ≥ 7 points (1 points) for females. The best integral value was obtained through the receiver operating characteristic (ROC) curve.A total of 2 803 subjects fulfilled the study criteria. There were 2 366 males and 437 females. The average values of neck circumference, BMI and ESS were (38.7 ± 3.5) cm, (27.3 ± 3.6) kg/m(2) and (8.6 ± 5.4) score respectively. Both males and females had a positive association between AHI and neck circumference, BMI and ESS (r = 0.389, 0.485, 0.293, 0.386, 0.439 and 0.291 respectively, all P0.001). For males, at an integral value ≥ 6, the sensitivity was 71.4% in the diagnosis of OSAHS, specificity 65.5% and positive predictive value 91.1%. For females, at an integral value ≥ 3, the sensitivity was 73.3% in the diagnosis of OSAHS, specificity 63.6% and positive predictive value 66.3%.In middle-aged snorers in Guangxi, neck circumference, BMI and ESS are correlated with OSAHS. And a positive association exists between AHI and neck circumference, BMI and ESS. Simple three-variable screening tool is highly valuable for diagnosing OSAHS, especially among male snorers.