Chest imaging in COVID-19

Amin Mahsouli, Melissa Grillo, Nadia Amini, Souad Acid, Emmanuel Coche, Benoît Ghaye Published in the journal : May 2020 Category : Radiologie

In December 2019, a new type of coronavirus (SARS-CoV-2) spread from China to all around the world. Chest imaging has emerged as a valuable tool for the workup of COVID-19, notably for triaging symptomatic patients to COVID-19 or non-COVID-19 units in anticipation of the reverse transcription-polymerase chain reaction (RT-PCR) results. The findings observed on computed tomography (CT) in this context are highly sensitive, but they are not specific for this pathology. Chest CT most frequently reveals bilateral multilobar ground-glass opacities with a peripheral or posterior distribution. A correlation has been demonstrated between the radiological extent and evolution of chest findings and the clinical course of the disease. CT lesions may precede the onset of symptoms, which confirms the high sensitivity of this technique. This literature review was aimed at highlighting the usefulness of chest imaging in the diagnosis of COVID-19, which exhibits typical and less typical CT features, as well as radiological severity criteria, and in the triaging of patients.

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The big thread: COVID-19 infection and adolescent anxiety

Emmanuel de Becker Published in the journal : May 2020 Category : Psychiatrie infanto-juvénile

The current crisis is simultaneously disrupting and stabilizing adults, as well as children and adolescents, or maybe even grieving them. Along with the phenomenon’s scale, opinions of all kinds are multiplying, fueling more the feeling of insecurity and consequent anguish. In addition to the largely relayed physical concerns, our aim has been to draw attention to psychic and relational health, while focusing on the youngest society members. After recalling the notion and concept of anxiety disorder, we have proposed several therapeutic axes.

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Psychological interventions in COVID-19 units

Leila Rokbani, Julie Saussez, Pauline Chauvier, Céline Baurain, Nathalie Chatelle, Florence Chanteux, François Hocepied, Kevin Wagemans, Philippe de Timary, Geneviève Cool Published in the journal : May 2020 Category : Psychiatrie

In this article, we sought to describe and analyze the interventions and experiences of a subgroup of psychologists from the psychology department of the Saint-Luc University Hospital, who rapidly stepped in to support care units receiving COVID-19 patients during the COVID-19 pandemic. Besides the setting up of a call center and speech groups aimed at relieving staff members, psychologists collectively and voluntarily decided to immerse themselves into these care units in order to support staff members, patients, and families overwhelmed by the strength of the crisis. Behavioral and psychological alarm signs in care unit staff members and psychologists themselves need to be considered and cared for. At the end of the article, a testimony of the involved psychologists provides an insight into the reality of the crisis.

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The impact of the pandemic on psychiatry: did we step into war psychiatry?

Gérald Deschietere, Alain Luts, Wolfgang Schuller, Jean-Philippe Heymans, Nausica Germeau, Geneviève Cool, Philippe de Timary, Laurie Nizet Published in the journal : May 2020 Category : Psychiatrie

The COVID-19 pandemic (SARS-CoV-2) has changed the organization of care in psychiatry. After providing a brief overview of the links between the epidemic and psychiatry, this article details the methods used to organize psychiatric care at Saint-Luc University Clinics: overall reduction in activity, shift towards telephone or video consultations, allocation of psychiatric beds for patients suffering from mental disorders and COVID-19, significant increase of the mobile crisis team activity, etc. The changes in psychiatric practice induced by the use of telephone and mask wearing are discussed. As a conclusion, the article raises some questions about the future of psychiatry and the links between the pandemic and mental health reform. We end with an anthropological reflection on war psychiatry and the fate of death in our society

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Immunity and COVID-19: On the path towards precision medicine?

Thomas Planté-Bordeneuve, Antoine Froidure, Charles Pilette Published in the journal : May 2020 Category : Pneumology

COVID-19, which is caused by the SARS-CoV-2 virus, induces in 5 to 15% of cases a severe phenotype with bilateral pneumonia, sometimes complicated by an acute respiratory distress syndrome and respiratory failure. Patients present with lymphopenia and possibly neutrophilia, which are of prognostic relevance. In addition, some patients develop immune overactivation, which is associated with a cytokine storm and a poor prognosis. Although the underlying mechanisms remain poorly understood, the virus’ ability to escape immune mechanisms could play an important role. An improved understanding of the disease immunopathology should help defining a precision medicine to treat COVID-19 patients based on predictive (or early) biomarkers of severity.

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The SARS-CoV-2 pandemic in Sub-Saharan Africa, Questions, fears, and hopes

Ella Larissa Ndoricyimpaye, Joseph Tuyishimire, Sophie Vanwambeke, Léon Mutesa, Elias Nyandwi, Nadine Rujeni, Jean-Paul Coutelier Published in the journal : May 2020 Category : Pays émergents

The frequency of confirmed cases, along with subsequent deaths due to SARS-CoV-2 pandemic, appears to be lower in developing countries, especially Sub-Saharan Africa. This is most probably due to the delayed epidemic outbreak in this part of the world, where several local elements may modify the epidemic’s course. Indeed, the less favorable socio-economic conditions associated with promiscuity, along with health services already stretched to the utmost by several other diseases, as well as the frequency of aggravating diseases in some countries may at times induce a difficult health situation where it is difficult to be properly prepared in order to correctly respond to the outbreak. On the other hand, the populations’ age pyramid, as well as their potential genetic traits and co-infections’ immuno-regulatory mechanisms could effectively decrease the infection’s severity. To lessen the direct and indirect impacts of the epidemic in these countries, it is crucial to strengthen their diagnostic and treatment capacities, using a thorough scientific analysis of local risk factors most likely to be improve our understanding of this pandemic.

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ENT complaints associated with COVID-19 infection

Caroline Huart, Karl Le Bras, Caroline de Toeuf, Naima Deggouj, Philippe Rombaux Published in the journal : May 2020 Category : Otorhinolaryngology

Although fever, respiratory symptoms, cough, and fatigue were initially considered as the leading symptoms of COVID-19 infection, it has now become evident that patients often report ear, nose, and throat (ENT) symptoms. Notably, we are currently facing an outbreak of olfactory dysfunction along with the COVID-19 pandemic. Although the World Health Organization states that this symptom is less common, several studies have demonstrated that this symptom is often observed, and that anosmia may even constitute the only complaint of SARS-CoV-2 carriers in some cases. Consequently, it is now admitted that patients with isolated sudden anosmia and no nasal obstruction should be considered as potential COVID-19 patients. Hence, this symptom should motivate the initiation of quarantine and use of appropriate personal protective equipment for attending medical teams.

As SARS-CoV-2 has a tropism for ENT mucosa and given that ENT procedures may generate aerosolization, ENT examination is a procedure with a particularly high risk of transmission for medical doctors. Therefore, adequate personal protective equipment should be employed when performing ENT examination. Moreover, it is advised to limit procedures leading to aerosolization as much as possible, as well as to adapt ENT surgical techniques during the pandemic.

This paper has reviewed the ENT symptoms possibly related to COVID-19 infection, with a particular focus on anosmia. We have also provided a reminder concerning good clinical practice recommendations in the ENT setting.

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ONCOVID, or how not to harm

Alice Kalantari, Jean-Pascal Machiels, Cédric Van Marcke Published in the journal : May 2020 Category : Oncologie médicale

The management of oncology patients during a pandemic is a challenge on several levels. We have never faced before a pandemic of this magnitude, especially in the era of advanced medicine that uses many immunosuppressive or immunomodulating drugs.

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Pregnancy and COVID-19

Corinne Hubinont, Frédéric Debieve, Pierre Bernard Published in the journal : May 2020 Category : Obstétrique

The COVID-19 pandemia may affect pregnant women. Though the vast majority of infected pregnant patients are asymptomatic, about 9% exhibit symptoms of pneumonia, which must be diagnosed and appropriately treated. The first published papers suggested a management similar to that of non-pregnant patients in terms of diagnostic tests and therapies. Given the increased risk of preterm labor, corticosteroids for fetal lung maturation should be administrated in case of imminent labor. The delivery route should be chosen based on obstetrical data even if elective caesarian section was reported in most published patients. Loco-regional anesthesia is permitted. Only a few cases of maternal-fetal transmission have been reported to date, with transmission mainly occurring during and after delivery. Perinatal morbidity and mortality have been shown to be very low. Only one maternal death was reported so far. Breastfeeding is possible using specific hygiene measures, such as hand washing and surgical mask wearing. In conclusion, this up-to-date literature review suggests that COVID-19-infected pregnant women and their newborn face a good outcome. However, more information from large multicenter studies must be collected, in an effort to confirm these encouraging data.

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Neurological implications of SARS-CoV-2 infection

Pietro Maggi, Antoine Guilmot, Sofia Maldonado Slootjes, Caroline Huart, Bernard Hanseeuw, Thierry Duprez, Julien De Greef, Leila Belkhir, Jean Cyr Yombi, Adrian Ivanoiu, Vincent van Pesch Published in the journal : May 2020 Category : Neurology

A steadily increasing number of cases with neurological manifestations that are potentially related to COVID-19 are being reported in the literature. These most often include sudden anosmia, headache, encephalopathy, and stroke. The pathophysiological mechanisms underlying "Neuro-COVID" remain largely unknown, while the viral genome is very rarely detected in the cerebrospinal fluid. A study currently ongoing at the Cliniques universitaires Saint-Luc is aimed at investigating COVID-19 associated cerebrospinal fluid changes as well as immunohistochemical evidences of olfactory neuroepithelial cells direct viral infection and evidencing a direct infection of olfactory neuroepithelial cells.

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