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SARS-CoV-2 proteins

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NSP5 (11)

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    Inserting a Drainage Strip into the Pre-tracheal Space to Treat Tension Pneumomediastinum: A Case-control Study

    Authors: Qianli Liu; Song Wu; Chun Hong; Xiaohui Li

    doi:10.21203/rs.3.rs-275805/v1 Date: 2021-02-25 Source: ResearchSquare

    Background: A Severe tension pneumomediastinum can result in respiratory and circulatory dysfunction. Common etiologies include severe pneumonia MESHD such as COVID-19 MESHD pneumonia MESHD, asthma MESHD, excessive pressure from a ventilator, etc. we describe a method for draining tension pneumomediastinum by inserting a drainage strip into the pre-tracheal space.Methods:Design: Case-control.Setting: Data from a medical institution in southern China.Participants: 30 patients with tension pneumomediastinum and comorbid type II respiratory failure MESHD.Interventions: 15 patients (surgery group) were treated with a drainage strip being inserted into the pre-tracheal space while other 15 patients (control group) were treated without drainage.Outcome measures: Arterial blood pO2 and pCO2 after 30 minutes and 12 hours of mechanical ventilation, total duration of mechanical ventilation, and chest radiography results after 12 hours of mechanical ventilation.Results: Chest radiography after 12 hours of mechanical ventilation showed that the pneumomediastinum basically disappeared in the surgery group but did not decrease significantly in the control group. The arterial blood pCO2 after 12 hours of mechanical ventilation and total duration of mechanical ventilation were significantly lower in the surgery group than in the control group (95% CI -3.31 to -1.36, p<0.001; 95% CI -5.56 to -2.84, p<0.001), while the arterial blood pO2 after 12 hours of mechanical ventilation was significantly higher in the surgery group than in the control group (95% CI 1.76 to 7.57, p=0.004). There were no significant intergroup differences in other variables. No recurrence occurred in either group during 7–14 days after discharge, and all patients recovered.Conclusions: Our method for draining tension pneumomediastinum improved respiratory function and shortened mechanical ventilation duration.Trial registration: ChiCTR2000039496Data sharing statement: Technical appendix, statistical code, and dataset available from the FigShare repository, https://doi.org/10.6084/m9.figshare.13487295.

    Comparison of the clinical characteristics and mortality in ARDS MESHD due to COVID-19 MESHD versus ARDS MESHD due to Influenza A-H1N1pdm09

    Authors: CARMEN M HERNANDEZ CARDENAS; GUSTAVO LUGO GOYTIA; DIANA HERNANDEZ; Rogelio Perez-Padilla

    doi:10.1101/2021.02.07.21251306 Date: 2021-02-25 Source: medRxiv

    ImportanceInfection with the SARS-Cov-2 and Influenza A-H1N1 viruses is responsible for the first pandemics of the 21st century. Both of these viruses can cause severe pneumonia MESHD and acute respiratory distress syndrome MESHD ( ARDS MESHD). The clinical differences and mortality associated with these two pandemic pneumonias MESHD in patients with ARDS MESHD are not well established ObjectiveTo compare case-fatality between ARDS MESHD- Covid-19 MESHD and ARDS MESHD-Influenza A (H1N1), adjusting for known prognostic risk factors. Design, Setting and ParticipantsOne hundred forty-seven patients with COVID-19 MESHD were compared with 94 with Influenza A-H1N1, all of these were admitted to the intensive care unit of the Referral Center for Respiratory Diseases MESHD and COVID-19 MESHD in Mexico City and fulfilled the criteria of ARDS MESHD. ResultsPatients arrived at the hospital after 9 days of symptoms. Influenza patients had more obesity MESHD, more use of Norepinephrine, and higher levels of lactic dehydrogenase and glucose, and fewer platelets and lower PaO2/FIO2. Crude mortality was higher in COVID than in influenza (39% vs. 22%; p = 0.005). In a Cox proportional hazard model, patients with a diagnosis of COVID-19 MESHD had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score, ventilatory ratio, and prone ventilation. In the fully adjusted model, the ventilatory ratio and the absence of prone-position ventilation were also predictors of mortality. CONCLUSION COVID-19 MESHD patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death MESHD than similar patients with Influenza A-H1N1, after adjusting for SOFA score and other relevant risk factors for mortality. QuestionIs the mortality of ARDS MESHD associated with Covid-19 MESHD greater than that of ARDS MESHD associated to influenza H1N1? FindingsIn a Cox proportional hazard model, patients with a diagnosis of COVID-19 MESHD had a hazard ratio (HR) = 3.7; 95% Confidence Interval [CI] = 1.9-7.4, adjusted for age, gender, sequential organ failure assessment (SOFA) score. Meaning COVID-19 MESHD patients treated in an intensive care unit (ICU) had a 3.7 times higher risk of death MESHD than similar patients with Influenza A-H1N1

    Clinical profile and factors associated with COVID-19 MESHD in Cameroon: a prospective cohort study

    Authors: Nicole Fouda Mbarga; Emilienne Epee; Marcel Mbarga; Jean Patrick Ouamba; Herwin Nanda; Aristide Kengni; Joseph Guekeme; Justin Eyong; Sylvie Tossoukpe; Sauvia Noumedem Sosso; Engelbert Ngono Ngono; Landry Bonyomo; Patrick Tchatchoua; Noel Vogue; Steve Metomb; Franck Ale; Moussa Ousman; Dorian Job; Charlotte Moussi; Modeste Tamakloe; Jessica E Haberer; Sylvester Ndeso Atanga; Gregory Halle Ekane; Yap Boum

    doi:10.1101/2021.02.19.21252071 Date: 2021-02-23 Source: medRxiv

    ObjectivesThis study explores the clinical profiles and factors associated with COVID-19 MESHD in Cameroon. Research design and methodsIn this prospective cohort study, we followed patients admitted for suspicion of COVID-19 MESHD at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia pneumonia MESHD), moderate (with clinical signs of pneumonia MESHD without respiratory distress MESHD) and severe cases (clinical signs of pneumonia MESHD and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk. ResultsA total of 323 patients were admitted during the study period; 262 were confirmed cases of COVID-19 MESHD by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (77%; N=204) to moderate (15%; N=40) to severe (7%; N=18); the case fatality rate was 1% (N=4). Dysgusia (46%; N=111) and hyposmia/anosmia MESHD (39%; N=89) were common features of COVID-19 MESHD. Nearly one-third of patients had comorbidities (29%; N=53), of which hypertension MESHD was the most common (20%; N=48). Participation in a mass gathering (OR=5.47; P=0.03) was a risk factor for COVID-19 MESHD. Age groups 60 to 69 (OR=7.41; P=0.0001), 50 to 59 (OR=4.09; P=0.03), 40 to 49 (OR=4.54; P=0.01), male gender (OR=2.53; P=0.04), diabetes MESHD (OR= 4.05; P= 0.01), HIV infection MESHD (OR=5.57; P=0.03), lung disease MESHD (OR= 6.29; P=0.01), dyspnoea MESHD (OR=3.70; P=0.008) and fatigue MESHD (OR=3.35; P=0.02) significantly predicted COVID-19 MESHD severity. ConclusionUnlike many high-income settings, most COVID-19 MESHD cases in this study were benign with low fatality. Such findings may guide public health decision-making.

    Efficacy and safety of Ivermectin and Hydroxychloroquine in patients with severe COVID-19 MESHD. A randomized controlled trial

    Authors: Jose Lenin Beltran-Gonzalez; Mario Gonzalez-Gamez; Emmanuel-Antonio Mendoza-Enciso; Ramiro Josue Esparza-Maldonado; Daniel Hernanez-Palacios; Samuel Duenas-Campos; Itzel Ovalle-Robles; Mariana Jocelyn Macias-Guzman; Andrea Lucia Garcia Diaz; Cesar Mauricio Gutierrez Pena; Lucila Martinez-Medina; Victor Manuel Monroy Colin; Jose Manuel Arreola Arreola Guerra

    doi:10.1101/2021.02.18.21252037 Date: 2021-02-23 Source: medRxiv

    Background In the search for active drugs against COVID19 MESHD, the indications of many have been redirected. Ivermectin and Hydroxychloroquine are drugs that inhibit viral replication in vitro and that have been used in several medical centers. Objectives: This clinical trial analyzes the efficacy of Ivermectin and Hydroxychloroquine in patients with moderate COVID19 MESHD and in need of hospitalization. Methods. This a controlled, clinical, randomized, double blind trial that included patients with COVID-19 MESHD-induced pneumonia MESHD and hospitalization criteria, but no severe respiratory failure MESHD. Patients were randomized to one of three groups: Group1 hydroxychloroquine, 400 mg every 12 hours on the first day and subsequently, 200 mg every 12 hours for 4 days, Group 2 ivermectin, 12 mg or 18 mg, according to patient weight and, Group 3 placebo. At inclusion, blood samples for arterial blood gases and biochemical markers associated with a poor prognosis were obtained. The primary outcome was established as the duration of hospitalization until discharge due to patient improvement, the total duration of hospitalization, and the safety outcomes were either respiratory deterioration MESHD or death MESHD. Results. During the month of August, the admission of patients requiring hospitalization mostly encompassed cases with severe respiratory failure MESHD, so we ended the recruitment process and analyzed the data that was available at the time. One hundred and six (106) patients with an average age of 53 yrs. (plus-or-minus sign 16.9) were included, with a greater proportion of males (n=66, 62.2 %). Seventy-two percent (72%) (n= 76) had an associated comorbidity. Ninety percent (90 %) of patients were discharged due to improvement (n=96). The average duration of hospitalization was 6 days (IQR, 3 to 10). No difference in hospitalization duration was found between the treatment groups (Group1: 7 vs Group 2: 6 vs Group 3: 5, p =0.43) nor in respiratory deterioration or death MESHD (Group 1: 18 % vs Group 2: 22.2 % vs Group 3: 24.3 %, p =0.83). Conclusions. In non-critical hospitalized patients with COVID-19 MESHD pneumonia MESHD, neither ivermectin nor hydroxychloroquine decreases the number of in-hospital days, respiratory deterioration MESHD, or deaths MESHD.

    An update of coronavirus disease 2019 MESHD ( COVID-19 MESHD): an essential brief for clinicians

    Authors: Afshin Zare; Seyyede Fateme Sadati-Seyyed-Mahalle; Amirhossein Mokhtari; Nima Pakdel; Zeinab Hamidi; Sahar Almasi-Turk; Neda Baghban; Arezoo Khoradmehr; Iraj Nabipour; Mohammad Amin Behzadi; Amin Tamadon

    id:10.20944/preprints202102.0530.v1 Date: 2021-02-23 Source: Preprints.org

    During 2019, the number of patients suffering from cough, fever MESHD and reduction of WBC’s count increased. At the beginning, this mysterious illness was called “ fever MESHD with unknown origin”. At the present time, the cause of this pneumonia MESHD is known as the 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome MESHD corona virus 2 (SARS-CoV-2). The SARS-CoV-2 is one member of great family of coronaviruses. Coronaviruses can cause different kind of illnesses including respiratory, enteric, hepatic, and neurological diseases MESHD in animals like cat and bat. Coronaviruses are enveloped positive-stranded RNA viruses. The SARS-CoV-2 has some particular structures for binding to host cells, reproducing itself in cells and damaging human cells. The SARS-CoV-2 can bind angiotensin-converting enzyme 2 HGNC ( ACE‐2 HGNC) receptors and cause various difficulties for human. The SARS-CoV-2 can cause either not-serious issues like fever MESHD and cough MESHD or serious concerns such as multi-organ failure MESHD. Source(s) of SARS-CoV-2 is under debate. Malayan pangolin and bat are the most suspicious candidate for being sources of the SARS-CoV-2. The SARS-CoV-2 can be transmitted by various ways such as transmitting from infected human to healthy human and can make severe pneumonia MESHD, which can lead to death. The SARS-CoV-2 can infect different kind of people with different ages, races, and social and economic levels. The SARS‐CoV‐2 infection MESHD can cause various sorts of clinical manifestations like cough and fever MESHD and intensity of signs and symptoms depends on sufferer conditions. Clinicians use all of available documents and tests like laboratory, histopathological and radiological findings for diagnosing new cases and curing patients with high accuracy. At the present time, there is no particular way for treating SARS-CoV-2 infection MESHD; neither antiviral drugs nor palliative agents. It seems that the best way for standing against the SARS-CoV-2 infection MESHD is preventing from it by social distancing and vaccination. This review tries to prepare an essential brief update about SARS-CoV-2 infection MESHD for clinicians.

    Convalescent plasma for adults with acute COVID-19 MESHD respiratory illness MESHD (CONCOR-1): Study protocol for an international, multicenter, randomized, open-label trial

    Authors: Philippe Bégin; Jeannie Callum; Nancy Heddle; Richard Cook; Michelle P Zeller; Alan Tinmouth; Dean Fergusson; Melissa M Cushing; Marshall J Glesby; Michaël Chassé; Dana V Devine; Nancy Robitaille; Renée Bazin; Nadine Shehata; Andrés Finzi; Allison McGeer; Damon Scales; Lisa Schwartz; Alexis F Turgeon; Ryan Zarychanski; Nick Daneman; Richard Carl; Luiz Amorim; Caroline Gabe; Martin Ellis; Erin Jamula; Julie Carruthers; Joanne Duncan; Kayla Lucier; Chantal Armali; Amie Kron; Dimpy Modi; Marie-Christine Auclair; Meda Avram; Donald M Arnold

    doi:10.21203/rs.3.rs-268937/v1 Date: 2021-02-23 Source: ResearchSquare

    Background: Convalescent plasma has been used for numerous viral diseases including influenza, severe acute respiratory syndrome MESHD, Middle East respiratory syndrome MESHD and Ebola virus MESHD; however, evidence to support its use is weak. SARS-CoV-2 is a novel coronavirus responsible for the 2019 global pandemic of COVID-19 MESHD community acquired pneumonia MESHD. We have undertaken a randomized controlled trial to assess the efficacy and safety of COVID-19 MESHD convalescent plasma (CCP) in patients with SARS-CoV-2 infection MESHD.Methods: CONCOR-1 is an open-label, multicenter, randomized trial. Inclusion criteria include: patients >16 years; admitted to hospital with COVID-19 MESHD infection; receiving supplemental oxygen for respiratory complications of COVID-19 MESHD; and, availability of blood group compatible CCP. Exclusion criteria are: onset of respiratory symptoms more than 12 days prior to randomization; intubated or planned for intubation; and previous severe reactions to plasma. Consenting patients will be randomized 2:1 to receive either approximately 500 mL of CCP or standard of care. CCP will be collected from donors who have recovered from COVID-19 MESHD and who have detectable anti-SARS-CoV-2 antibodies quantified serologically. The primary outcome is intubation or death MESHD at Day 30. Secondary outcomes include ventilator free days, length of stay in intensive care or hospital, transfusion reactions, serious adverse events, and reduction in SARS-CoV-2 viral load.  Exploratory analyses include patients who received CCP containing high titre antibodies. A sample size of 1200 patients gives 80% power to detect a 25% relative risk reduction assuming a 30% baseline risk of intubation or death MESHD at 30 days (two-sided test; α =0.05). An interim analysis and sample size re-estimation will be done by an unblinded independent biostatistician after primary outcome data are available for 50% of the target recruitment (n= 600). Discussion: This trial will determine whether CCP will reduce intubation or death MESHD non-intubated adults with COVID-19 MESHD. The trial will also provide information on the role of and thresholds for SARS-CoV-2 antibody titers and neutralization assays for donor qualification.Trial registration: Clinicaltrials. gov HGNC NCT04348656; registered 16 April 2020; https://clinicaltrials. gov HGNC/ct2/show/NCT04348656?term=NCT04348656&draw=2&rank=1

    Heterogeneity in COVID-19 MESHD severity patterns among age-gender groups: an analysis of 778 692 Mexican patients through a meta-clustering technique

    Authors: Lexin Zhou; Nekane Romero; Juan Martínez Miranda; J Alberto Conejero; Juan M García-Gómez; Carlos Sáez

    doi:10.1101/2021.02.21.21252132 Date: 2021-02-23 Source: medRxiv

    We describe age-gender unbiased COVID-19 MESHD subphenotypes regarding severity patterns including prognostic, ICU and morbimortality outcomes, from patterns in clinical phenotypes, habits and demographic features. We used the Mexican Government COVID-19 MESHD open data including 778692 SARS-CoV-2 patient-level data as of September 2020. We applied a two-stage clustering approach combining dimensionality reduction and hierarchical clustering: 56 clusters from independent age-gender analyses supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27-95.22%), including healthy patients of all ages, children with comorbidities with priority in medical resources, and young obese MESHD, smoker patients. MCs 4-5 showed moderate recovery rates (81.3-82.81%): patients with hypertension MESHD or diabetes MESHD of all ages, and obese MESHD patients with pneumonia MESHD, hypertension MESHD and diabetes MESHD. MCs 6-11 showed low recovery rates (53.96-66.94%): immunosuppressed patients with high comorbidity rate, CKD patients with poor survival and recovery, elderly smokers with COPD MESHD, severe diabetic MESHD elderly with hypertension MESHD, and oldest obese MESHD smokers with COPD MESHD and mild cardiovascular disease MESHD. Group outcomes conformed to the recent literature on dedicated age-gender groups. Combination of unhealthy habits and comorbidities were associated with mortality in older patients. Centenarians tended to better outcomes. Immunosuppression was not found as a relevant factor for severity alone but did when present along with CKD. Mexican states and type of clinical institution revealed relevant heterogeneity in severity, relevant for consideration in further studies. The resultant eleven MCs provide bases for a deep understanding of the epidemiological and phenotypical severity presentation of COVID-19 MESHD patients based on comorbidities, habits, demographic characteristics, and on patient provenance and type of clinical institutions, as well as revealing the correlations between the above characteristics to anticipate the possible clinical outcomes of each patient with a specific profile. These results can establish groups for automated stratification or triage towards personalized treatment enabling a personalized evaluation of the patients expected outcomes. Code available athttps://github.com/bdslab-upv/ covid19 MESHD-metaclustering Dynamic results visualization athttp:// covid19 MESHDsdetool.upv.es/?tab=mexicoGov

    Increased RV:LV Ratio on Chest CT-Angiogram in COVID-19 MESHD is a Marker of Adverse Outcomes

    Authors: Ran Tao; Zuzana Burivalova; Sofia Carolina Masri; Naga Dharmavaram; Aurangzeb Baber; Roderick Deano; Timothy Hess; Ravi Dhingra; James Runo; Nizar Jarjour; Rebecca R Vanderpool; Naomi Chesler; Joanna E Kusmirek; Marlowe Eldridge; Christopher Francois; Farhan Raza

    doi:10.21203/rs.3.rs-267902/v1 Date: 2021-02-22 Source: ResearchSquare

    PurposeOur study aimed to use chest CT-angiogram (CTA) to assess if right ventricular (RV) dilation, quantified as an increased RV:LV (left ventricle) ratio, is associated with adverse outcomes in the novel coronavirus ( COVID-19 MESHD) infection.MethodsWe reviewed clinical, laboratory, and chest CTA findings in COVID-19 MESHD patients (n=100), and two control groups: normal subjects (n=10) and subjects with organizing pneumonia MESHD (n=10). On a chest CTA, we measured basal dimensions of the RV and LV in a focused 4-chamber view; and dimensions of pulmonary artery MESHD ( PA MESHD) and aorta (AO) at the PA MESHD bifurcation level. ResultsAmong the COVID-19 MESHD cohort, the mean age (±SD) was 55.1±14.9 years and 55% were female. A higher RV:LV ratio was correlated with adverse outcomes, defined as ICU admission, intubation, or death MESHD. In patients with adverse outcomes, the RV:LV ratio was 1.06±0.10, vs 0.95±0.15 in patients without adverse outcomes. Among the adverse outcomes group, compared to the control subjects with organizing pneumonia MESHD, the lung parenchymal damage MESHD was lower (22.6±9.0 vs 32.7±6.6), yet the RV:LV ratio was higher (1.06±0.14 vs 0.89±0.07). In ROC analysis, RV:LV ratio had an AUC= 0.707 with an optimal cut-off of RV:LV 1.1 as a predictor of adverse outcomes. In a validation cohort (n=25), an RV:LV ≥1.1 as a cut-off predicted adverse outcomes with an odds ratio of 76:1.ConclusionIn COVID-19 MESHD patients, RV:LV ratio ≥1.1 on CTA-chest is correlated with adverse outcomes. RV dilation in COVID-19 MESHD is out of proportion to parenchymal lung damage MESHD, pointing towards a vascular and/or thrombotic injury MESHD in the lungs.

    A novel glucocorticoid and androgen receptor modulator reduces viral entry and innate immune inflammatory responses in the Syrian Hamster model of SARS-CoV-2

    Authors: Savannah M. Rocha; Anna C. Fagre; Amanda S. Latham; Katriana A. Popichak; Casey P. McDermott; Clinton C. Dawson; Juliette Lewis; Phillip Reigan; Tawfik A. Aboellail; Rebekah C. Kading; Tony Schountz; Neil D. Theise; Richard A. Slayden; Ronald B. Tjalkens

    doi:10.1101/2021.02.20.432110 Date: 2021-02-22 Source: bioRxiv

    Since its initial discovery in late 2019, severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), the cause of COVID19 MESHD, has spread worldwide and despite significant research efforts, treatment options remain limited. Replication of SARS-CoV-2 in lung is associated with marked infiltration of macrophages and activation of innate immune inflammatory responses triggered, in part, by heightened production of interleukin-6 (IL-6) that recruits lymphocytes to the site of infection that amplify tissue injury. Antagonists of the glucocorticoid and androgen receptors have shown promise in experimental models of COVID19 MESHD and in clinical studies, because cell surface proteins required for viral entry, angiotensin converting enzyme 2 (ACE2) and the transmembrane serine protease 2 (TMPRSS2), are transcriptionally regulated by these receptors. We therefore postulated that the glucocorticoid (GR) and androgen receptor (AR) antagonist, PT150, would reduce infectivity of SARS-CoV-2 and prevent inflammatory lung injury MESHD in the Syrian golden hamster model of COVID19 MESHD. Animals were infected intranasally with 2.5 x 10e4 TCID50/ml equivalents of SARS-CoV-2 (strain 2019-nCoV/USA-WA1/ 2020) and PT150 was administered by oral gavage at 30 and 100 mg/Kg/day for a total of 7 days. Animals were then examined at days 3, 5 and 7 post-infection (DPI) for lung histopathology, viral load and production of proteins regulating the initiation and progression of SARS-CoV-2 infection MESHD. Results of these studies indicated that oral administration of PT150 decreased replication of SARS-CoV-2 in lung, as well as expression of ACE2 and TMPRSS2 protein. Hypercellularity and inflammatory cell infiltration driven by macrophage responses were dramatically decreased in PT150-treated animals, as was tissue damage and expression of IL-6. Molecular modeling suggested that PT150 binds to the co-activator interface of the ligand binding domain of both AR and GR and thereby acts as an allosteric modulator and transcriptional repressor of these receptors. Phylogenetic analysis of AR and GR across multiple species permissive to SARS-CoV-2 infection MESHD revealed a high degree of sequence identity maintained across species, including human, suggesting that the mechanism of action and therapeutic efficacy observed in Syrian hamsters would likely be predictive of positive outcomes in patients. PT150 is therefore a strong candidate for further clinical development for the treatment of COVID19 MESHD across variants of SARS-CoV-2.

    RCoNet: Deformable Mutual Information Maximization and High-order Uncertainty-aware Learning for Robust COVID-19 MESHD Detection

    Authors: Shunjie Dong; Qianqian Yang; Yu Fu; Mei Tian; Cheng Zhuo

    id:2102.11099v1 Date: 2021-02-22 Source: arXiv

    The novel 2019 Coronavirus ( COVID-19 MESHD) infection has spread world widely and is currently a major healthcare challenge around the world. Chest Computed Tomography (CT) and X-ray images have been well recognized to be two effective techniques for clinical COVID-19 MESHD disease diagnoses. Due to faster imaging time and considerably lower cost than CT, detecting COVID-19 MESHD in chest X-ray (CXR) images is preferred for efficient diagnosis, assessment and treatment. However, considering the similarity between COVID-19 MESHD and pneumonia MESHD, CXR samples with deep features distributed near category boundaries are easily misclassified by the hyper-planes learned from limited training data. Moreover, most existing approaches for COVID-19 MESHD detection focus on the accuracy of prediction and overlook the uncertainty estimation, which is particularly important when dealing with noisy datasets. To alleviate these concerns, we propose a novel deep network named {\em RCoNet$^k_s$} for robust COVID-19 MESHD detection which employs {\em Deformable Mutual Information Maximization} (DeIM), {\em Mixed High-order Moment Feature} (MHMF) and {\em Multi-expert Uncertainty-aware Learning} (MUL). With DeIM, the mutual information (MI) between input data and the corresponding latent representations can be well estimated and maximized to capture compact and disentangled representational characteristics. Meanwhile, MHMF can fully explore the benefits of using high-order statistics and extract discriminative features of complex distributions in medical imaging. Finally, MUL creates multiple parallel dropout networks for each CXR image to evaluate uncertainty and thus prevent performance degradation caused by the noise in the data.

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