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Id Subject Object Predicate Lexical cue
T1 0-58 Sentence denotes Pathological Findings and Management of COVID-19 Patients:
T2 59-98 Sentence denotes A Brief Overview of Modern-day Pandemic
T3 100-108 Sentence denotes Abstract
T4 109-185 Sentence denotes Today the world is facing one of the deadliest pandemics caused by COVID-19.
T5 186-259 Sentence denotes This highly transmissible virus has an incubation period of 2 to 14 days.
T6 260-391 Sentence denotes It acts by attaching to the angiotensin-converting enzyme (ACE2) with the help of glycoprotein spikes, which it uses as a receptor.
T7 392-564 Sentence denotes Real-time polymerase chain reaction (PCR; rt-PCR) is the gold standard diagnostic test, and chest X-ray and computed tomography (CT) scan are the other main investigations.
T8 565-644 Sentence denotes Several medications and passive immunization are in use to treat the condition.
T9 645-874 Sentence denotes We searched using PubMed and Google Scholar using keywords such as COVID-19, coronavirus, and their combination with pathological findings, clinical features, management, and treatment to search for relevant published literature.
T10 875-1028 Sentence denotes After the removal of duplications and the selection of only published English literature from the past five years, we had a total of 31 papers to review.
T11 1029-1147 Sentence denotes Most of the COVID-19 affected patients have mild pneumonia symptoms, and those with severe disease have comorbidities.
T12 1148-1330 Sentence denotes Patients with COVID-19 had pathological findings, like ground-glass opacities, consolidations, pleural effusion, lymphadenopathy, and interstitial infiltration of inflammatory cells.
T13 1331-1496 Sentence denotes Radiological changes show lung changes such as consolidations and opacities, and the pathological findings were infiltration of inflammatory cells and hyalinization.
T14 1497-1646 Sentence denotes Patients with mild symptoms should self-quarantine, whereas those with severe acute respiratory distress syndrome (ARDS) are treated in the hospital.
T15 1647-1747 Sentence denotes Medications under trial include antivirals, antibacterials, antimalarials, and passive immunization.
T16 1748-1870 Sentence denotes Supportive treatment such as oxygen therapy, extracorporeal membrane oxygenation, and ventilator support can also be used.
T17 1871-1934 Sentence denotes The symptoms shown by patients are very mild and self-limiting.
T18 1935-2163 Sentence denotes There is no definitive treatment, although a combination of hydroxychloroquine and azithromycin have shown good results, and passive immunization also shows promising results, their safety profile is yet to be studied in detail.
T19 2165-2192 Sentence denotes Introduction and background
T20 2193-2355 Sentence denotes As of April 16 2020, there are a total of 1,991,562 confirmed cases and 130,885 reported deaths due to this deadly virus, which is given the name of COVID-19 [1].
T21 2356-2399 Sentence denotes The fatality rate of the virus is 2.3% [2].
T22 2400-2555 Sentence denotes The death rate is higher in people of age above 80 and those having comorbid conditions like hypertension, diabetes, and chronic respiratory disorders [2].
T23 2556-2723 Sentence denotes Approximately 48% of the people who have had fatal outcomes had a comorbid condition, 30% were hypertensive, 19% were diabetics, and 8% had coronary heart disease [3].
T24 2724-2789 Sentence denotes This virus belongs to the family of viruses called Coronaviridae.
T25 2790-2986 Sentence denotes There are four genera of coronaviruses (ɑ,𝛃,ɣ,𝝳), COVID-19 belongs to the beta-coronaviruses as its genome matches 88% and 50% to the other coronaviruses which are SARS and MERS, respectively [4].
T26 2987-3135 Sentence denotes It is believed that initially, the virus transmitted from animals to humans, and among humans, the virus transmitted via respiratory droplets [3,5].
T27 3136-3230 Sentence denotes The virus has very high transmissibility as it has affected the whole world in a brief period.
T28 3231-3462 Sentence denotes When infected, there is an incubation period of 2-14 days after which the patient develops the symptoms of high fever, cough, shortness of breath, myalgias, and fatigue, and the virus is contagious during the incubation period [6].
T29 3463-3590 Sentence denotes The COVID-19 in susceptible patients causes pneumonia, which rapidly progresses to acute respiratory distress syndrome (ARDS). 
T30 3591-3824 Sentence denotes The exact pathogenesis is currently unknown; however, it is suggested that it is most likely to be similar to that of SARS CoV and MERS CoV, which attach to ACE 2 enzyme on the cell surface with the help of their glycoprotein spikes.
T31 3825-3963 Sentence denotes After the entry of the virus, its antigens are presented to major histocompatibility complex (MHC) via the antigen-presenting cells (APC).
T32 3964-4069 Sentence denotes Then these antigens are recognized by specific cytotoxic lymphocytes that destroy the infected cells [4].
T33 4070-4247 Sentence denotes On chest X-ray and chest computed tomography (CT), ground-glass opacities, patchy consolidation, and interstitial changes at the periphery of the lungs are typical findings [7].
T34 4248-4351 Sentence denotes Real-time polymerase chain reaction (RT-PCR) is used to make the diagnosis of the suspected cases [4]. 
T35 4352-4530 Sentence denotes There is currently no recommended treatment for COVID-19, only supportive care like oxygen, and mechanical ventilation is provided to patients in severe respiratory distress [2].
T36 4531-4725 Sentence denotes Two drugs, remdesevir and chloroquine, have shown some good results, but it is too soon to state their efficacy as there is limited data on the effectiveness of these drugs in COVID-19 patients.
T37 4726-4872 Sentence denotes Researchers are also considering the passive immunization of critical patients with the convalescent sera, and it has shown some good results [8].
T38 4873-4995 Sentence denotes As we know, currently, there is limited knowledge available on the pathophysiology and treatment options for the COVID-19.
T39 4996-5294 Sentence denotes And what little information is known is not well organized yet. In this review article, we aim to identify and highlight clinical features, pathological and radiological findings, and possible treatment options for COVID-19 patients and to organize the little information we have on this pathogen. 
T40 5296-5302 Sentence denotes Review
T41 5303-5310 Sentence denotes Methods
T42 5311-5328 Sentence denotes Research Strategy
T43 5329-5447 Sentence denotes We conducted this research to analyze and review the clinical and pathological findings in COVID-19 affected patients.
T44 5448-5549 Sentence denotes We used Pubmed and Google Scholar as our primary database research engines to find the relevant data.
T45 5550-5677 Sentence denotes Keywords used were novel coronavirus, COVID-19, pathological findings, antivirals, treatment, management, and passive immunity.
T46 5678-5717 Sentence denotes MeSH keyword coronavirus was also used.
T47 5718-5747 Sentence denotes Inclusion/Exclusion criteria 
T48 5748-5850 Sentence denotes We included papers from the past 5 years, they were mostly peer-reviewed, and full-text was available.
T49 5851-5950 Sentence denotes All selected articles were in the English language, and no geographical boundaries were considered.
T50 5951-5958 Sentence denotes Results
T51 5959-6052 Sentence denotes We extracted 1683 (PubMed), and 56400 (Google scholar) researches using the keyword COVID-19.
T52 6053-6222 Sentence denotes A combination of keywords coronavirus and pathological findings gave 1139 PubMed, and 22300 google scholar articles, and COVID-19 and treatment gave 385 PubMed articles.
T53 6223-6282 Sentence denotes COVID-19 and management gave 167 published research papers.
T54 6283-6339 Sentence denotes COVID19 and antivirals gave thirty-five PubMed articles.
T55 6340-6402 Sentence denotes Lastly, COVID-19 and passive immunization yielded 287 results.
T56 6403-6487 Sentence denotes Out of these results, a total of forty articles relevant to our topic were selected.
T57 6488-6620 Sentence denotes After applying the inclusion-exclusion criteria and removing the duplications, we finally got twenty-nine papers that were reviewed.
T58 6621-6807 Sentence denotes Among the selected papers, there were no clinical trials, most of the relevant papers were case reports which showed the clinical features and the effects of tried medical interventions.
T59 6808-6904 Sentence denotes Some of them were simple recommendations and guidelines about how the patient should be managed.
T60 6905-7028 Sentence denotes Three of these studies showed that a combination of lopinavir/Ritonavir combination was effective in decreasing viral load.
T61 7029-7159 Sentence denotes Five studies argued that convalescent plasma showed promising results but most of these studies were not of high-quality evidence.
T62 7160-7357 Sentence denotes Three other papers discussed the role of remdesivir, and five studies discussed the role of chloroquine in these patients which showed some positive effects however its safety profile is not clear.
T63 7358-7393 Sentence denotes Table 1 shows the studies included.
T64 7394-7445 Sentence denotes Table 1 Some of the studies included in the review
T65 7446-7487 Sentence denotes ARDS, acute respiratory distress syndrome
T66 7488-7494 Sentence denotes [9-13]
T67 7495-7577 Sentence denotes Author, Year of study Type of the study Purpose of the study Result/ Conclusion
T68 7578-7814 Sentence denotes Li T (2020) Recommendation To give comprehensive recommendations about Severe Acute Respiratory Syndrome Corona-virus 2 (COVID-19).   A combination of anti-virals Lopinavir/Ritonavir is useful in some cases and can be used as needed.
T69 7815-7978 Sentence denotes When a patient develops ARDS, A protective ventilation strategy should be used, and when it is severe, the authors recommended extracorporeal membrane oxygenation.
T70 7979-8352 Sentence denotes Arabi et al. (2020) Review article This review summarized the knowledge about management of adult acute respiratory infections and community-acquired viral pneumonia patients that needed ICU.   More research and studies are needed to test different antiviral therapies both alone and in combination, to find the best option in patients who develop serious complications.
T71 8353-8576 Sentence denotes Lu H. (2020) Review article This study reviewed the literature to identify which drug can be a suitable option in COVID -19 infection There are no specific antiviral drugs available and no vaccines for novel coronavirus.
T72 8577-8657 Sentence denotes Based on previous experience with SARS and MERS, some antivirals are being used.
T73 8658-8705 Sentence denotes However, their safety is yet to be established.
T74 8706-8761 Sentence denotes The mainstay of treatment still is symptomatic support.
T75 8762-9084 Sentence denotes Lim et al. (2020) Case Report This case report reviewed the clinical findings and management in one of the patients of COVID-19, who was the first case of the tertiary spread of the virus out of China.   COVID-19 symptoms can be mild, and the patient may recover when the symptoms are mild but can transmit the disease.
T76 9085-9213 Sentence denotes Lopinavir/Ritonavir combination reduced viral load and improved symptoms, so this combination can be used in high-risk patients.
T77 9214-9293 Sentence denotes However, more clinical evidence is needed to establish its safety and efficacy.
T78 9294-9578 Sentence denotes Wang, Chao, et al. (2020) Case series Four patients with mild or severe COVID-19 improved after using lopinavir/ritonavir combination.   Three out of four patients improved clinically, especially their pneumonia-related symptoms, whereas others also showed significant improvement.
T79 9579-9641 Sentence denotes More studies, however, are needed to establish their efficacy.
T80 9642-9652 Sentence denotes Discussion
T81 9653-9673 Sentence denotes Patient Presentation
T82 9674-9802 Sentence denotes COVID-19 may have produced intense effects worldwide due to rapid transmission and the fact that almost everyone is susceptible.
T83 9803-9892 Sentence denotes Still, mostly the disease is mild, especially in children and immunocompetent adults [6].
T84 9893-10017 Sentence denotes A research paper written by Jin YH et al. divided different groups of exposed individuals under various categories of cases.
T85 10018-10467 Sentence denotes These included the suspected cases (with two early clinical manifestations and an epidemiological risk), confirmed cases (with a positive RT-PCR result), close contacts (with contact history to a confirmed case of novel coronavirus without protection), clustered cases (one confirmed case + many cases showing symptoms in a small area within 14 days) and suspicious exposure [exposure to the contaminated environment without adequate protection [6].
T86 10468-10592 Sentence denotes This classification made it easy for a health professional to know what type of patient one is and how he should be managed.
T87 10593-10696 Sentence denotes A patient may present with clinical features of the disease depending upon the severity of the disease.
T88 10697-10754 Sentence denotes The different degrees are mild, severe, and critical [2].
T89 10755-10834 Sentence denotes Table 2 shows the clinical features of patients with varying degree of disease.
T90 10835-10906 Sentence denotes Table 2 Clinical features of patients with a varying degree of disease
T91 10907-10955 Sentence denotes Mild disease Severe disease  Critical disease 
T92 10956-10993 Sentence denotes Dry Cough Fever Respiratory failure
T93 10994-11017 Sentence denotes Fever Tachypnea Fever
T94 11018-11073 Sentence denotes Sour throat Dyspnea Decreases blood oxygen saturation
T95 11074-11123 Sentence denotes With or without nasal congestion   Septic shock
T96 11124-11173 Sentence denotes Generalized body aches   Multiple organ failure
T97 11174-11188 Sentence denotes Headache    
T98 11189-11367 Sentence denotes Malaise and fatigue     Patients with mild disease presented with dry cough, fever, sore throat, with or without nasal congestion, generalized body ache, headache, and fatigue.
T99 11368-11424 Sentence denotes In severe form, the symptoms were tachypnea and dyspnea.
T100 11425-11707 Sentence denotes In critical cases, patients complained of respiratory failure (severe dyspnea, respiratory distress >30/min, tachypnea and hypoxia), fever, decreased blood oxygen saturation of less than or equal to 93%, lung filtrates, shock, and multiple organ dysfunctions or even failure [2,14].
T101 11708-11878 Sentence denotes Research also showed that in severe conditions, patients showed signs of weakened breath sound, moist rales, dull percussion, and a decrease in tactile speech tremor [6].
T102 11879-11985 Sentence denotes The disease causes not only respiratory symptoms but also gastrointestinal symptoms such as diarrhea [15].
T103 11986-12150 Sentence denotes Laboratory complete blood count tests may show normal or reduced white blood cell count or reduced lymphocyte count in the early stages of the disease onset [6,15].
T104 12151-12210 Sentence denotes Patients also show elevated C-reactive protein levels [16].
T105 12211-12324 Sentence denotes Researchers from China studied the effect of infection on pregnant women suffering from COVID-19 on the neonates.
T106 12325-12552 Sentence denotes The study showed that the women that were confirmed cases during the prenatal stage had problems like premature rupture of membranes, intrauterine distress, abnormal amniotic fluid, umbilical cord, and position of the placenta.
T107 12553-12700 Sentence denotes The neonates born also presented with shortness of breath, fever, tachycardia, vomiting, inability to take proper feed, diarrhea, and bloating [5].
T108 12701-12793 Sentence denotes The complications are mostly seen in patients with an underlying chronic illness or are old.
T109 12794-12916 Sentence denotes Complications included acute respiratory distress syndrome (ARDS), RNAemia, acute cardiac injury, and secondary infection.
T110 12917-13004 Sentence denotes The patients with complications were admitted to the intensive care unit (ICU) [15-16].
T111 13005-13134 Sentence denotes These clinical features indicate that the absence of these symptoms in an individual does not rule out the diagnosis of COVID-19.
T112 13135-13324 Sentence denotes If a person has a history of exposure to the virus regardless of the symptoms that he shows, he should be kept under medical observation, isolated from others, and examined thoroughly [16].
T113 13325-13541 Sentence denotes The diagnosis should be made on history, examination, symptoms, and certain investigations that are necessary and gold standard in virus detection (RT-PCR, CT scan, POCT of IgG and IgM, ELISA, and blood culture) [4].
T114 13542-13782 Sentence denotes According to the reviewed data, patients had similar presenting features and progression of the disease with some minor differences according to the individual immune status of the subject and how they were treated in their health settings.
T115 13783-13922 Sentence denotes The majority recovers without complications;deaths involve the high-risk group like the geriatric age group or persons with co-morbidities.
T116 13923-14025 Sentence denotes The consistent findings were fever, dry cough, sore throat, myalgia, fatigue, and shortness of breath.
T117 14026-14158 Sentence denotes The distinct findings in different cases were tactile speech tremor, GI symptoms, hemoptysis, ARDS, and septic shock [2,6,15,17-18].
T118 14159-14218 Sentence denotes Pathological and Radiological Findings In COVID-19 Patients
T119 14219-14241 Sentence denotes Radiological findings:
T120 14242-14401 Sentence denotes A case review series by Lin X et al. showed that both patients had ground-glass opacities on CT scans, which later progressed to patchy consolidation of lungs.
T121 14402-14481 Sentence denotes The lesions were mostly distributed along the subpleural regions in both lungs.
T122 14482-14574 Sentence denotes No pleural effusion or lymphadenopathy was observed in subjects included in this study [19].
T123 14575-14738 Sentence denotes Another case report by Shi F et al. showed that in this subject initially, ground-glass opacities were seen on CT scan, which later on progressed to consolidation.
T124 14739-14851 Sentence denotes On the 18th day, the patient had increased consolidation, and the patient showed diffuse haziness in both lungs.
T125 14852-14940 Sentence denotes Other findings were bat wing appearance, crazy paving pattern, and air-bronchogram sign.
T126 14941-15008 Sentence denotes The lesions involved the peripheral regions of both the lungs [17].
T127 15009-15118 Sentence denotes Another study conducted by Xu X et al., which included 90 patients out of which 39 were males and 51 females.
T128 15119-15163 Sentence denotes The median age of the patients was 50 years.
T129 15164-15274 Sentence denotes More than 50% of the patients had bilateral multifocal lesions in their lungs distributed along the periphery.
T130 15275-15483 Sentence denotes Pneumonia in these patients presented with ground-glass opacities in 72%, consolidations in 13%, crazy paving pattern in 12%, interlobular thickening in 56% and adjacent pleural thickening in 56% of patients.
T131 15484-15561 Sentence denotes Twenty-three percent of the patients did not show any of these findings [16].
T132 15562-15613 Sentence denotes Figure 1 summarizes the findings of this research. 
T133 15614-15690 Sentence denotes Figure 1 Pathological findings of patients as per study done by Xu X et al.
T134 15691-15804 Sentence denotes Uncommon findings were pleural effusion, thoracic lymphadenopathy, pulmonary emphysema, and pericardial effusion.
T135 15805-15963 Sentence denotes CT scan of 52 patients was redone after six days, 19% of them showed no changes in CT scan while 4% had resolution of the disease, and 73% showed progression.
T136 15964-16097 Sentence denotes 6% of the patients who didn’t have any characteristic findings on a previous CT scan developed bilateral ground-glass opacities [16].
T137 16098-16200 Sentence denotes Another study carried out by Albarello F, et al. based on two cases showed somewhat uncommon findings.
T138 16201-16364 Sentence denotes The chest X-ray of the two patients showed interstitial involvement, lung opacities, pleural effusion and calcification, hilar enlargement, and cardiac silhouette.
T139 16365-16448 Sentence denotes Their CT findings were typical ones like ground-glass opacities with consolidation.
T140 16449-16586 Sentence denotes Some uncommon findings like pleural effusion, calcifications, mediastinal lymphadenopathy, and pericardial effusions were also seen [20].
T141 16587-16739 Sentence denotes A study carried out by Pan F et al. showed the different phases of recovery in patients, excluding the patients who developed ARDS and severe pneumonia.
T142 16740-16816 Sentence denotes The study included a total of 21 patients with confirmed COVID-19 diagnosis.
T143 16817-16904 Sentence denotes The study showed there are four stages in the disease progression based on CT findings.
T144 16905-17069 Sentence denotes Early-stage (0-4 days after the onset of initial symptoms) of the disease showed unilateral or bilateral ground-glass opacities, mostly in the lower lobes of lungs.
T145 17070-17226 Sentence denotes Progressive stage (5-8 days after the onset of initial symptoms) in this stage ground-glass opacities progressed to crazy paving patterns and consolidation.
T146 17227-17377 Sentence denotes Peak stage (9-13 days after the onset of initial symptoms) consolidations became denser and more prevalent, and there were residual parenchymal bands.
T147 17378-17589 Sentence denotes Absorption Stage (14 or more days after the onset of initial symptoms) consolidation gradually absorbed, there was no crazy paving pattern observed, but extensive ground-glass opacities were still observed [21].
T148 17590-17642 Sentence denotes Figure 2 shows the CT findings in COVID-19 patients.
T149 17643-17700 Sentence denotes Figure 2 Progression of CT findings in COVID-19 patients
T150 17701-17895 Sentence denotes CT, computed tomography Based on the studies reviewed, the findings on the CT scan of COVID-19 patients are ground-glass opacities, consolidation, crazy paving pattern, and air bronchogram sign.
T151 17896-18015 Sentence denotes These findings are consistent with the majority of the patients, and these are the characteristic findings of COVID-19.
T152 18016-18194 Sentence denotes In some patients, mediastinal lymphadenopathy, pleural effusion, pulmonary emphysema, and pericardial effusion are seen and are mostly in older patients and the high-risk groups.
T153 18195-18318 Sentence denotes CT scan findings of COVID-19 patients are also helpful in determining the severity of disease and the stage of the disease.
T154 18319-18443 Sentence denotes Also, in the areas where they have limited testing services, CT scan findings can be used as a diagnostic tool for COVID-19.
T155 18444-18641 Sentence denotes There is a specific pattern in which these findings present at the initial stages of the infection, ground-glass opacities are frequently bilateral and present in the lower lobes and the periphery.
T156 18642-18813 Sentence denotes They may then progress to develop consolidation and crazy paving patterns. Consolidation will start becoming denser, and parenchymal bands will appear, followed by a peak.
T157 18814-18915 Sentence denotes In most cases, consolidation starts resolving, and the CT scan becomes normal again within two weeks.
T158 18916-18991 Sentence denotes Therefore, a CT scan can be used to monitor the progression of the disease.
T159 18992-19014 Sentence denotes Pathological Findings:
T160 19015-19116 Sentence denotes A study conducted by Luo W, et al. based on the autopsy findings of the patient who died of COVID-19.
T161 19117-19280 Sentence denotes On gross examination of the lungs, the surface appears diffusely congested, hemorrhagic necrosis was evident and was more marked in the outer regions of the lungs.
T162 19281-19343 Sentence denotes Mucinous and hemorrhagic exudates were present in the bronchi.
T163 19344-19443 Sentence denotes On histopathology, extensive pulmonary interstitial fibrosis with hyaline degeneration was evident.
T164 19444-19486 Sentence denotes There were signs of a hemorrhagic infarct.
T165 19487-19645 Sentence denotes Small vessels showed severe congestion, thickening of walls and occlusion or stenosis of the blood vessel; lumen and microthrombi were present in the vessels.
T166 19646-19718 Sentence denotes Focal infiltration of lymphocytes, plasma cells, macrophages was marked.
T167 19719-19764 Sentence denotes There was marked necrosis of bronchial walls.
T168 19765-19866 Sentence denotes Mainly type 2 pneumocytes were affected, and various metaplastic changes of epithelium were observed.
T169 19867-19956 Sentence denotes Multinucleated giant cells and intracytoplasmic viral inclusions were also observed [22].
T170 19957-20143 Sentence denotes Another study conducted by Xu Z et al. based on the biopsy samples taken from the deceased COVID-19 patient showed diffuse alveolar damage bilaterally with cellular fibromyxoid exudates.
T171 20144-20244 Sentence denotes There was the formation of the hyaline membrane and interstitial infiltration of inflammatory cells.
T172 20245-20388 Sentence denotes Pneumocytes were atypically enlarged, having large nuclei, granular cytoplasm, and prominent nucleoli showing the viral cytopathic change [18].
T173 20389-20555 Sentence denotes Another study conducted by Zhang H et al. based on the biopsy findings of deceased COVID-19 patients showed diffuse alveolar damage and type 2 pneumocyte hyperplasia.
T174 20556-20639 Sentence denotes Fibrinous exudates were seen in the alveoli, and interstitial fibrosis was evident.
T175 20640-20711 Sentence denotes Interstitial infiltration of inflammatory cells was also observed [23].
T176 20712-20876 Sentence denotes Based on the studies reviewed, on gross examination, lungs were markedly congested, and hemorrhagic necrosis was seen, and several exudates were present in bronchi.
T177 20877-21006 Sentence denotes On the other hand, characteristic histopathological findings were severe pulmonary interstitial fibrosis, hemorrhagic infarction.
T178 21007-21113 Sentence denotes Small vessels were mainly affected, and they showed signs of congestion and were occluded by microthrombi.
T179 21114-21237 Sentence denotes Type 2 pneumocytes were the primary cells that affected their nuclei were atypically enlarged, and nucleoli were prominent.
T180 21238-21284 Sentence denotes Metaplastic change in the epithelium was seen.
T181 21285-21415 Sentence denotes Infiltration of inflammatory cells i-e lymphocytes, plasma cells, macrophages were marked, showing a severe inflammatory reaction.
T182 21416-21541 Sentence denotes Multinucleated giant cells were also seen, and some studies also suggested the presence of intracytoplasmic viral inclusions.
T183 21542-21577 Sentence denotes Prevention and Treatmentof COVID-19
T184 21578-21648 Sentence denotes Several options are in use and proposed to prevent COVID-19 infection.
T185 21649-21796 Sentence denotes Some are simple preventive measures suggested to the general public, like frequent hand washing, social distancing, self-isolating if feeling sick.
T186 21797-21953 Sentence denotes These measures proved to be effective in flattening the curve of COVID-19 infection and keeping the total cases within the healthcare system’s capabilities.
T187 21954-22106 Sentence denotes It is proposed that any person who is exposed to the confirmed case of COVID-19 or is suspected of having these symptoms should practice self-isolation.
T188 22107-22298 Sentence denotes This will prevent passing the virus to other healthy and vulnerable individuals; however, once they develop symptoms like fever or cough, it is advisable to consult a physician to get tested.
T189 22299-22569 Sentence denotes For mild symptoms the advice is different in different geographical regions, some advise the COVID-19-positive individuals with mild symptoms to quarantine at home, practice self-isolation, keep a check on their symptoms along with symptomatic measures like antipyretic.
T190 22570-22744 Sentence denotes Whereas in some regions where the healthcare system is not overwhelmed, they are being held in quarantine under supervision until they test negative to avoid it’s spread [9].
T191 22745-22850 Sentence denotes For moderate to severe symptoms, however, the patients are shifted to the hospital and are managed there.
T192 22851-22999 Sentence denotes Some of the patients do progress to severe form of the disease or ARDS and multi-organ failure and then need ICU care and other supportive measures.
T193 23000-23116 Sentence denotes Several factors cause the progression of the disease from mild symptoms to severe and poor prognosis of the disease.
T194 23117-23234 Sentence denotes One of these factors is old age, where comorbidities and polypharmacy make them vulnerable and worsen their symptoms.
T195 23235-23408 Sentence denotes Other factors include co-morbidities and status of the existing disease like increased d-dimer levels and high sepsis-related organ assessment score (SOFA score) for sepsis.
T196 23409-23595 Sentence denotes Although there is no definitive treatment available when the patient does develop symptoms, he is managed using one of the proposed treatment options along with other supportive options.
T197 23596-23719 Sentence denotes These proposed treatment options are based on the previous epidemics because of other coronaviruses like SARS and MERS CoV.
T198 23720-23757 Sentence denotes Figure 3 shows some of those options.
T199 23758-23810 Sentence denotes Figure 3 Treatment options for COVID-19 Antivirals:
T200 23811-23887 Sentence denotes One of the mainstays of treatment remains antivirals in any viral infection.
T201 23888-24029 Sentence denotes Among antivirals are the neuraminidase inhibitors which worked in SARS and MERS, Oseltamivir is one of those and is a widely used anti-viral.
T202 24030-24159 Sentence denotes Arabi et al. found zanamivir and Panamivir to be as effective as oseltamivir in patients with influenza and H1N1 infections [10].
T203 24160-24231 Sentence denotes However, these anti-virals are not that effective in COVID-19 patients.
T204 24232-24407 Sentence denotes Although there is not enough evidence to support their effectiveness in this latest outbreak, the combination of lopinavir/ritonavir is found to be effective in some patients.
T205 24408-24558 Sentence denotes A case report by Lim et al. showed that the combination of lopinavir and ritonavir significantly reduced the viral load in a 54-year-old patient [12].
T206 24559-24786 Sentence denotes Another case series by Wang Z et al. showed the results of this combination in four patients where severe pneumonia and respiratory symptoms significantly improved, and one patient tested negative and was discharged later [24].
T207 24787-24962 Sentence denotes Remdesivir, another broad-spectrum antiviral, is being used in these patients to find potential treatment and is among the ones that are relatively effective in COVID-19 [11].
T208 24963-25092 Sentence denotes Elfiky showed in a study that Sofosbuvir, Remdesivir, and Ribavirin showed that they could help manage and treat this virus [25].
T209 25093-25108 Sentence denotes Antibacterials:
T210 25109-25337 Sentence denotes Superimposed bacterial infections are common in patients with viral pneumonia, and use of antibacterial medications alongside as prophylaxis in moderate to severe infections or wherever there is suspected superimposed infection.
T211 25338-25456 Sentence denotes It is, however, recommended to avoid a combination of broad-spectrum antibiotics or their blind administration [6, 9].
T212 25457-25621 Sentence denotes The antibiotic treatment recommended for community-acquired pneumonia, like Azithromycin, fluoroquinolones can be administered to cover common bacterial pathogens. 
T213 25622-25645 Sentence denotes Immune modulator drugs:
T214 25646-25900 Sentence denotes Chloroquine and hydroxychloroquine, the immune modulator drugs used as antimalarials, and as a DMARD in Rheumatoid Arthritis and also in autoimmune diseases like Lupus were found effective in SARS infection and so were tried in COVID-19 patients as well.
T215 25901-25950 Sentence denotes They also act as a broad-spectrum antiviral drug.
T216 25951-26064 Sentence denotes Several clinical trials are in progress throughout the world to assess its efficacy and safety in these patients.
T217 26065-26294 Sentence denotes An in-vitro study testing the efficacy of broad-spectrum anti-virals like remdesivir, favipiravir, ribavirin penciclovir, and chloroquine showed that chloroquine and remdesivir were effective against COVID-19 virus in-vitro [13].
T218 26295-26576 Sentence denotes Another study involving 100 patients by Gao et al. also showed similar results; it showed an increased efficacy of chloroquine in preventing symptom exacerbation, preventing progression to severe pneumonia, and improving radiological findings without any serious side effects [26].
T219 26577-26726 Sentence denotes Chloroquine has both anti-viral and immune-modulating properties, which increase its effectiveness in stopping the viral replication in vivo [13,26].
T220 26727-26888 Sentence denotes Chloroquine, however, is associated with some uncommon but serious side-effects like QT interval prolongation, which may be severely harmful in cardiac patients.
T221 26889-26987 Sentence denotes Therefore, more clinical trials are needed to assess its safety profile in this group of patients.
T222 26988-27033 Sentence denotes Convalescent plasma and passive immunization:
T223 27034-27141 Sentence denotes Convalescent plasma has already been in use for some diseases; it was also effective in MERS-CoV infection.
T224 27142-27276 Sentence denotes Its safety and efficacy were tested by Arabi et al. and showed that it could be used as a potential treatment option in COVID-19 [27].
T225 27277-27539 Sentence denotes The WHO recently recommended its use as passive immunization in all serious patients because of the unavailability of active immunization in the form of vaccines [27].The plasma of recovered patients was used in different patients and had shown positive effects.
T226 27540-27690 Sentence denotes A case review series by Shen et al. discussed five critically ill patients having COVID-19 with ARDS who were given antibody-rich convalescent plasma.
T227 27691-27849 Sentence denotes They showed significant improvement in clinical status, their SOFA score improved, temperature improved, and they also were weaned off from a ventilator [28].
T228 27850-27952 Sentence denotes The results, however, cannot be considered as significantly reliable because of the small sample size.
T229 27953-28122 Sentence denotes Another case study showed significant improvement in symptoms and a decrease in viremia and viral load in seven out of 10 patients without any serious side effects [29].
T230 28123-28240 Sentence denotes Despite the positive results and considering that most of the studies had weak evidence, it can help manage patients.
T231 28241-28368 Sentence denotes Still, more studies are needed to assess its potential serious side-effects like transfusion-related acute lung injury (TRALI).
T232 28369-28390 Sentence denotes Supportive treatment:
T233 28391-28503 Sentence denotes Supportive treatment like oxygen therapy via mask is used if patients develop shortness of breath and hypoxemia.
T234 28504-28591 Sentence denotes In the case of resistant hypoxemia, Extracorporeal membrane oxygenation (ECMO) is used.
T235 28592-28814 Sentence denotes Patients with severe respiratory Distress may need ventilator support. Corticosteroids may be used as a supportive therapy, but its use and efficacy are controversial as they may make patients more prone to infections [9].
T236 28815-28826 Sentence denotes Limitations
T237 28827-28877 Sentence denotes Most of the clinical trials are currently ongoing.
T238 28878-28967 Sentence denotes Most of them involved fewer patients, which makes it difficult to make valid conclusions.
T239 28968-29057 Sentence denotes Only the papers that were published in the English language were selected for our review.
T240 29058-29236 Sentence denotes Most of the interventions are under trial; therefore, not much data was available about their safety in this population, and thus conclusions were hard to draw and are not valid.
T241 29237-29293 Sentence denotes A detailed quality appraisal of the papers was not done.
T242 29295-29306 Sentence denotes Conclusions
T243 29307-29447 Sentence denotes The research was oriented to identify clinical features, pathological and radiological findings, and possible treatment options of COVID-19.
T244 29448-29579 Sentence denotes The majority of the patients experience fever, cough, shortness of breath, and myalgia whereas some may develop pneumonia and ARDS.
T245 29580-30239 Sentence denotes Frequently seen radiological and pathological findings are bilateral ground-glass opacities in peripheries of lungs, consolidations, crazy paving pattern, air bronchogram sign, diffuse alveolar damage, fibrinous exudates in bronchi, formation of hyaline membrane, inflammatory cells infiltration, and metaplastic change in the alveolar epithelium. There is no definitive treatment, but the role of antivirals like remdesivir and lopinavir, azithromycin, hydroxychloroquine, and passive immunization like convalascent plasma is being researched. Currently, the focus is on the prevention of disease by practicing social distancing until a vaccine is developed.
T246 30240-30350 Sentence denotes There is a great need for more work on vaccine development and educating the medical community and the public.
T247 30351-30416 Sentence denotes Strict protocols are needed in the future to prevent such crises.
T248 30418-30478 Sentence denotes The authors have declared that no competing interests exist.