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      Hemorrhagic Problem Among the Patients With COVID-19: Clinical Summary of 41 Thai Infected Patients

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      , PhD 1 , , MD 2
      Clinical and Applied Thrombosis/Hemostasis
      SAGE Publications

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          Abstract

          In late December 2019, a new emerging infectious disease, coronavirus disease 2019 (COVID-19), started in China. 1 The disease already spread to more than 40 countries at present (February 29, 2020). Thailand is the second country that was affected by this new disease. 2 Focusing on clinical presentation of this new coronavirus infection, the main clinical presentation is acute febrile illness with pulmonary complications. In clinical hematology, the effect of the infection is reported. Leukopenia is a common clinical blood picture. 3,4 Regarding the alteration of coagulation system, decreased platelet count and prothrombin time is observable. 3,4 In fact, this is similar observation to that seen in a previous emerging coronavirus infection, Middle East respiratory syndrome. 5 Nevertheless, there is still no report regarding hemorrhagic problem in the patients with COVID-19. Here, the authors would like to present observation from Thailand on 41 patients (4 males and 37 females, age between 7 and 74 years) with COVID-19 in Thailand (based on most update data at February 29, 2020). The diagnosis of COVID-19 was done by real-time polymerase chain reaction molecular diagnosis and reconfirmed for positive by 2 referencing molecular diagnosis laboratory. All presented with febrile illness and pneumonia within 14 days after history of exposure and the direct human to human contact is mode of transmission. Of these patients, there is no death case (at present, 28 are discharged after complete recovery from illness and 13 are still hospitalized). All of these patients received standard respiratory care in isolate clinical pulmonary unit. Of interest, there is a patient (2.44%) with bleeding presentation, petechiae. For this case, there is no specific additional treatment for hemorrhagic problem. This patient was firstly missed diagnosed to be dengue and cause local transmission to a medical worker. 6 It is recommended that the practitioner should recognize that hemorrhagic problem might be an initial presentation of COVID-19. Also, investigation and follow-up for possible hemorrhagic problem in patient with COVID-19 is recommended.

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          Most cited references6

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          Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

          Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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            Emerging new coronavirus infection in Wuhan, China:Situation in early 2020

            W Hsia (2020)
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              Editorial: Wuhan coronavirus outbreak and imported case

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                Author and article information

                Journal
                Clin Appl Thromb Hemost
                Clin. Appl. Thromb. Hemost
                CAT
                spcat
                Clinical and Applied Thrombosis/Hemostasis
                SAGE Publications (Sage CA: Los Angeles, CA )
                1076-0296
                1938-2723
                6 April 2020
                Jan-Dec 2020
                : 26
                : 1076029620918308
                Affiliations
                [1 ]Medical Academic Center, Bangkok, Thailand
                [2 ]DY Patil University, Pune, India
                Author notes
                [*]Beuy Joob, Medical Academic Center, Bangkok, Thailand. Email: beuyjoob@ 123456hotmail.com
                Author information
                https://orcid.org/0000-0002-5281-0369
                Article
                10.1177_1076029620918308
                10.1177/1076029620918308
                7289062
                32250159
                2902d476-7bae-4776-a039-b8f038bbc631
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 22 January 2020
                : 06 March 2020
                : 18 March 2020
                Categories
                Letter to the Editor
                Custom metadata
                January-December 2020
                ts3

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