ABSTRACT
Currently, experience with COVID-19 in multiple myeloma (MM) is still very limited. Terefore, we conducted this analysis of MM patients infected by COVID-19 from two prominent hematology centers in Wuhan and Wurzburg (Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China and University Hospital of Wurzburg, Wurzburg, Germany) as of 9 June 2020. In total, we identifed fve Caucasian patients from Wurzburg and three Asian patients from Wuhan. The majority of the patients were male (n=5, 63%), and the median age at COVID-19 diagnosis was 57 (range 39-83 years). Tree patients had newly diagnosed (ND) MM, and two of them were therapy naive at diagnosis of COVID-19. One patient from Wuhan was receiving the second cycle of VTD (bortezomib, thalidomide, and dexamethasone) as the first line therapy. In Wuhan, a patient with extramedullary progression (No. 6) received leukapheresis to prepare for a salvage chimeric antigen receptor T-cell (CAR-T) therapy. Due to COVID-19 infection, systemic anti-MM treatment was discontinued in all eight patients. Notably, two patients in Wurzburg showed no COVID-19 symptoms, and the other three patients exhibited only mild symptoms such as fever, cough, and nausea, which did not require an intensive care unit (ICU) admission. Tree patients did not receive any COVID-19 treatment, and all fve patients in Wurzburg recovered. In contrast, two patients from Wuhan developed severe respiratory syndrome so that mechanical ventilation and circulatory support were needed. The patient who was receiving the frontline therapy with VTD also had an elevated procalcitonin value (30.05 ng/ml), suggesting an additional bacterial infection, and this patient died due to acute respiratory failure. In addition, two out of fve patients in our cohort did not show positive IgM or IgG for COVID-19 afer recovery. In summary, our observations showed that COVID-19 infection could be severe especially in NDMM, and also suggested inadequate humoral immune response in MM patients, probably due to secondary immune defciency caused by the treatments or the disease itself. Surprisingly, the MM patients in Wurzburg did not present any signs of severe COVID-19 infection. Other than Wuhan where COVID-19 was reported for the first time, in Europe, the pandemic had already been announced, and in Germany the lock-down came relatively early in comparison to other countries.
ABSTRACT
Environmental factors such as temperature and relative humidity can affect the inactivation and transmission of coronaviruses. By reviewing medical experiments on virus survival and virus transmission between infected and susceptible species in different temperature and humidity conditions, this study explores the influence of temperature and relative humidity on the survival and transmission of viruses, and provides suggestions, with experimental evidence, for the environmental control measures of Coronavirus Disease 2019. The results indicated that (1) virus viability and infectivity is increased at a low temperature of 5 â and reduced at higher temperatures. (2) Virus survival and transmission is highly efficient in a dry environment with low relative humidity, and also in a wet environment with high relative humidity, and it is minimal at intermediate relative humidity. Therefore, in indoor environments, the lack of heating in winter or overventilation, leading to low indoor temperature, can help virus survival and help susceptible people being infected. On the contrary, modulating the indoor relative humidity at an intermediate level is conducive to curb epidemic outbreaks.
ABSTRACT
Objective: Although coronavirus disease 2019(COVID-19) typically induced general and respiratory symptoms, digestive symptoms are also commonly companied symptoms. Doctors in fever clinic screened and treated suspect COVID-19 patients, while the possibility to reveal digestive symptoms may different according to their professional background. No previous reports have revealed prevalence of digestive symptoms in suspect COVID-19 cases. In this study, we sought to understand the feature of doctor's inquiry on digestive symptoms according to their professionals, and the prevalence of digestive symptoms among suspect COVID-19 cases. Methods: We reviewed records of two gastroenterologists and six physicians of other majors. Among CT identified COVID-19 patients, we analyzed and compared the difference of inquiry on digestive symptoms (diarrhea, vomit, low appetite, abdominal pain) between gastroenterologists and other physicians. Then we compared the digestive symptoms between identified patients and suspected cases who shared similar general and respiratory symptoms but were excluded from COVID-19. Results: Among all confirmed COVID-19 cases (254 by gastroenterologists and 241 by non- gastroenterologists), 22.83% cases from gastroenterologists experienced various digestive symptoms, while only 4.47% reported digestive symptoms by non-gastroenterologists (P < .0001). Among 611 suspect patients diagnosed by gastroenterologists, 254 patients were confirmed COVID-19 while 357 were excluded. Diagnosed cases presented far more frequency of digestive symptoms than excluded cases (58 vs 13, P < .0001). Furthermore, diagnosed patients reported more percentage of watery diarrhea(56% vs 36%, P < .0001) and higher frequent vomit (2.77 ± 0.97 vs 1.80 ± 0.45 per day, P = .04) than excluded cases. Conclusions: We described the feature for digestive symptoms of suspect COVID-19 patients in fever clinic. Gastroenterologists could discover more digestive symptoms of COVID-19 during inquiry than non-gastroenterologists. Moreover, COVID-19 patients are more likely to have digestive symptoms than suspect cases who share similar general and respiratory symptoms. Therefore, doctors should pay more attention on digestive symptoms of potential COVID-19.
ABSTRACT
Objective: Gut microbiota may be involved in the regulation of abnormal liver function during the period of SARS-COV-2 infection. We aimed to analyze the relationship between gut microbiota and liver dysfunction in patients with COVID-19 and explore the possible mechanism. Methods: Study design: A cross-sectional study was performed from 6th February to 31th March in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology. Diagnosis of COVID-19 was according to real-time reverse-transcriptase polymerase-chain-reaction assay for nasal and pharyngeal swab specimens. Liver dysfunction was determined by ALT (alanine aminotransferase), AST (aspartate aminotransferase), ALP (alkaline phosphatase), GGT (glutamate transpeptidase) and TBIL (total bilirubin). Normal liver function: all the five indexes <1 ULN (upper limit of normal). Mild liver dysfunction: TBIL <1 ULN and one or more of the other four indexes >1 ULN and <2 ULN. Significant liver dysfunction: TBIL >1 ULN and/or one or more of the other four indexes >2 ULN. The fecal specimen of the same period with the liver function test was collected. The primary outcome was the comparison of gut microbiota diversity among COVID-19 patients with different degrees of liver dysfunction. The secondary outcomes were the different abundance of specific genus. Results: Participants This study included 81 patients with COVID-19. Among them, 18 patients had normal liver function, 23 had mild liver dysfunction and the other 40 patients had significant liver dysfunction. Compared with patient with normal liver function, patients with liver dysfunction were more severe, longer in hospital duration, more elevated neutrophils and procalcitonin, and more decreased lymphocyte. No significant differences were found as for the gastrointestinal symptoms and the use of antibiotics among the patients with different degrees of liver dysfunction. Patients with elevated degree of liver dysfunction had higher C-reactive protein and serum interleukin-6 level. Primary outcome: As shown in Figure 1A, patients with elevated degree of liver dysfunction tend to have lower Shannon index level (1.67 vs 1.50 vs 1.33, respectively in normal liver function, mild liver dysfunction and significant liver dysfunction, P = .006). The PCoA plot in Figure 1B showed that, significant differences of beta-diversity were detected among patients with different degrees of liver dysfunction (P < .014). Secondary outcomes: As shown in Figure 1C, the abundance of four genus, including Butyrivibrio, Lachnospiraceae-noname, Megasphaera and Faecalibacterium, were found significant different among patients with different degrees of liver dysfunction. Further comparison showed that gut microbiota of patients with significant liver dysfunction had less abundance of Butyrivibrio (P = .004), Lachnospiraceae-noname(P = .001) and Megasphaera (P = .031) than that of patient with normal liver function. The abundance of Lachnospiraceae-noname in gut microbiota of patients with mild liver dysfunction was significantly lower than patients with normal liver function. And the abundance of Faecalibacterium in gut microbiota of patients with significant liver dysfunction was significantly lower than patients with mild liver function. Interestingly, both the inflammation index C-reactive protein and interleukin-6 negatively correlated with the Shannon indexes of fecal microbiota (Figure 1D). Besides, the four different abundance of bacteria genus negatively correlated with interleukin-6. We further analyzed the correlation between inflammation markers with liver function indexes as presented in Figure 1E,F. Significant correlations were found between C-reactive proteins/interleukin-6 and ALT/AST/ALP/GGT and between C-reactive proteins and TBIL. Conclusions: Our study found that the intestinal microbiota of COVID-19 is closely related to liver dysfunction, which may be due to the protective effect of microbiota on the intestinal epithelial barrier function.
ABSTRACT
The COVID-19 pandemic highlights the following problems: the balance between the private and the public within a liberal framework;the merits and the limits of a liberal democracy in governance;and the inadequacy of a nation-states-led global order. In light of these problems, I will offer some Confucian alternatives. © Philosophy Today