The Situation and Influencing Factors of Depression and Anxiety in Patients of Hemodialysis during the COVID-19 Pandemic in China.

OBJECTIVE: To investigate the incidence of depression and anxiety among maintenance hemodialysis (MHD) patients during the regular prevention and control stage of COVID-19 in China as well as the influencing factors. METHODS: A cross-sectional study including 180 patients under the treatment of hemodialysis was conducted in the hemodialysis center of the 8th Affiliated Hospital of Sun Yat-Sen University. The questionnaire regarding the subject's general information, Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) was completed by the patients, and the laboratory test results were recorded. RESULTS: The incidences of anxiety and depression were 35.6% and 38.9%, respectively, and the average scores of SAS and SDS were (48.03 ± 5.02) and (48.12 ± 5.42), respectively, in the subjects. The results showed that age, monthly income, vascular access of dialysis, feeling of pain and itching (within a week), worried about being infected by COVID-19, whether having health insurance and the levels of hemoglobin, parathyroid hormone, and phosphorus were the impact factors of both anxiety and depression in the MHD patients (p < 0.05 for all). CONCLUSION: The proportion of depression and anxiety is relatively high in the MHD patients during the regular prevention and control stage of COVID-19.

Perceived impact of the COVID-19 pandemic on infection containment training and mental state of dental residents in China: A longitudinal study.

Background: COVID-19 has presented a challenge for dental settings and dental schools: how to continue providing dental care and maintain education during the pandemic while remaining healthy. We highlight the necessity of infection containment control training for dental residents and rethink the tasks of safeguarding trainees' health and cultivating their abilities to deal with public health crises in the future. This paper may also serve as a health policy reference for policy makers. Objective: The study aimed to compare the formats, frequency, contents, emphasis, and test scores of infection containment control training pre- and post-pandemic. Besides, after the COVID-19 outbreak, we assessed the increased anxiety level, communication difficulties, and confidence of dental residents impacted by the pandemic. Methods: A total of 251 dental residents in Stomatological Hospital of Chongqing Medical University were recruited to complete a questionnaire of their routine involvement in infection control training before and after the COVID-19 outbreak. A self-designed 10-point Likert scale was used to assess the increased anxiety level, communication difficulties, and confidence in facing with the future public health crisis impacted by the pandemic. Results: After the outbreak, although more trainees chose online assessment than offline assessment, most of them (74.90%) still preferred in-person training rather than online training. Contents that trainees had been focusing on were affected by the COVID-19 outbreak. Thereafter, they were more inclined to learn crisis management. Over half of the participants (56.17%) participated in training more frequently after the outbreak. However, postgraduate students participated in training less frequently than others after the outbreak (p < 0.01). First-year trainees accounted for the majority in the population who emphasized considerably on infection control training and whose test scores had increased after the outbreak. In addition, the percentage of women scoring increasingly in post-pandemic assessment was significantly higher than that of men. In this study, the average increased anxiety level caused by COVID-19 was 5.51 ± 2.984, which was positively related to communication difficulties with patients caused by the pandemic. The trainees whose homes were located in Hubei Province showed higher increased anxiety levels (8.29 ± 2.93) impacted by the pandemic than the trainees from other provinces (p < 0.05). However, the former's confidence in coping with future public health crises was not significantly different from that of others (p > 0.05). Conclusions: Owing to the impact of COVID-19, the contents that the trainees focused on, frequency, emphasis, and test scores of infection containment control training were changed. Some recommendations have been provided for policy makers to attach importance to crisis-based training to cultivate dental residents in the post-pandemic era.

Prevention and control of hospital infection in the normalization of COVID-19 epidemic

OBJECTIVE: To introduce the measures to prevent and control the infection in a hospital in Qiqihaer. By formulating full-responsibility system and supervisor system of the hospital infection monitoring and management, it is not only optimize the management of the position of medical staff and reduce the exposure risk of all people in the hospital, but also provide references of prevention and control of Covid-19 for other medical institutions aiming to ensure the normalization and long-term effectiveness. METHODS: The epidemic prevention and control relevant systems, processes, measures, emergency plans for each department were formulated by combining the normative documents of the higher-level departments and the actual situation of our own institution. The hospital-responsibility system was established and improved based on the principle of different areas, contents, time periods and links, implement responsibility to everyone in each part, to form an effective supervision mechanism. RESULTS: All departments performed their duties and personnel responsibilities strictly, and established a reasonably and orderly work flows in the hospital during the COVID-19 epidemic. Besides, the ability of preventing and controlling the epidemic was improved continuously, which ensured normal medical activities that can be completed efficiently and orderly in the normalization of the epidemic. CONCLUSION: The scientific and effective hospital infection monitoring and management can not only enable the various departments to carry out daily work in an orderly manner, but also respond to the emergency situation of the epidemic. The most important thing is to implement the control work under the normalization of the epidemic.

Clinical characteristics and predictive value of lower CD4+T cell level in patients with moderate and severe COVID-19: a multicenter retrospective study.

BACKGROUND: In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. Moreover, it has become a global pandemic. This is of great value in describing the clinical symptoms of COVID-19 patients in detail and looking for markers which are significant to predict the prognosis of COVID-19 patients. METHODS: In this multicenter, retrospective study, 476 patients with COVID-19 were enrolled from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death. RESULTS: The main symptoms observed in the study included fever on admission, cough, fatigue, and shortness of breath. The most common comorbidities were hypertension and diabetes mellitus. Patients with lower CD4+T cell level were older and more often male compared to those with higher CD4+T cell level. Reduced CD8+T cell level was an indicator of the severity of COVID-19. Both decreased CD4+T [HR:13.659; 95%CI: 3.235-57.671] and CD8+T [HR: 10.883; 95%CI: 3.277-36.145] cell levels were associated with in-hospital death in COVID-19 patients, but only the decrease of CD4+T cell level was an independent predictor of in-hospital death in COVID-19 patients. CONCLUSIONS: Reductions in lymphocytes and lymphocyte subsets were common in COVID-19 patients, especially in severe cases of COVID-19. It was the CD8+T cell level, not the CD4+T cell level, that reflected the severity of the patient's disease. Only reduced CD4+T cell level was independently associated with increased in-hospital death in COVID-19 patients. TRIAL REGISTRATION: Prognostic Factors of Patients With COVID-19, NCT04292964 . Registered 03 March 2020. Retrospectively registered.

Clinical characteristics and fatal outcomes of hypertension in patients with severe COVID-19.

The aim of this study is to investigate clinical characteristics and fatal outcomes of hypertension as well as the role of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) use in patients with severe coronavirus disease 2019 (COVID-19). A total of 220 (female: 51.8%) patients with severe COVID-19 were included. The mean age of included patients was 59.5 years and 70 (31.8%) patients had a history of hypertension. There were 23 patients (32.9%) receiving ACEI/ARB therapy. Patients with hypertension were older and had more comorbidities, and were more likely to suffer from severe inflammatory response and acute cardiac injury. Moreover, patients with hypertension were associated with significantly higher risk of in-hospital mortality than patients without hypertension. After adjustment of potential confounders, the independent correlation was still observed. In addition, ACEI/ARB users were associated with lower level of high-sensitivity cardiac troponin I and creatinine kinase-myocardial band, and lower risk of acute cardiac injury than ACEI/ARB non-users. In conclusion, patients with hypertension were more likely to suffer from severe inflammatory response, acute cardiac injury and had high risk of in-hospital mortality in severe COVID-19. The use of ACEI/ARB may protect patients with COVID-19 from acute cardiac injury.

Efficacy of Traditional Chinese Medicine on COVID-19: Two Case Reports.

Severe acute respiratory syndrome coronavirus 2-infected pneumonia (novel coronavirus-infected pneumonia [NCIP]) is a new viral illness initially identified in the central Chinese city of Wuhan in December 2019. According to the daily report on the epidemic situation of coronavirus disease (COVID-19) issued by the National Health and Family Planning Commission of the People's Republic of China on March 23, 2020: COVID-19 is highly infectious, causing extremely high incidence of NCIP throughout Wuhan and has spread swiftly to 34 provinces within China and >100 other countries around the world between January and March 2020. Up to August 11, 2020, there have been 89,383 cases diagnosed as coronavirus-infected pneumonia; and 4,696 deaths in China (mortality rate of 5.25%) and worldwide reports have confirmed 19,936,210 cases and 732,499 deaths. These figures have been increasing daily. The treatment of viral conditions is well established within the context of Chinese Medicine. We report 2 successful cases in this study showing the patient's chest computed tomography scans and temperature charts made on before, during, and after treatment to demonstrate proof of the positive benefits achieved. Traditional Chinese Medicine (TCM) demonstrates a positive effect in the treatment for COVID-19. It is highly recommended that TCM be incorporated early on in the treatment schedule for COVID-19.

Prognostic value of NT-proBNP in patients with severe COVID-19.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China has been declared a public health emergency of international concern. The cardiac injury is a common condition among the hospitalized patients with COVID-19. However, whether N terminal pro B type natriuretic peptide (NT-proBNP) predicted outcome of severe COVID-19 patients was unknown. METHODS: The study initially enrolled 102 patients with severe COVID-19 from a continuous sample. After screening out the ineligible cases, 54 patients were analyzed in this study. The primary outcome was in-hospital death defined as the case fatality rate. Research information and following-up data were obtained from their medical records. RESULTS: The best cut-off value of NT-proBNP for predicting in-hospital death was 88.64 pg/mL with the sensitivity for 100% and the specificity for 66.67%. Patients with high NT-proBNP values (> 88.64 pg/mL) had a significantly increased risk of death during the days of following-up compared with those with low values (≤88.64 pg/mL). After adjustment for potential risk factors, NT-proBNP was independently correlated with in-hospital death. CONCLUSION: NT-proBNP might be an independent risk factor for in-hospital death in patients with severe COVID-19. TRIAL REGISTRATION: ClinicalTrials, NCT04292964. Registered 03 March 2020.

Incidence of novel coronavirus (2019-nCoV) infection among people under home quarantine in Shenzhen, China.

BACKGROUND: Since the outbreak of 2019-nCoV in December, Chinese government has implemented various measures including travel bans, centralized treatments, and home quarantines to slowing the transmission across the country. In this study, we aimed to estimate the incidence of 2019-nCoV infection among people under home quarantine in Shenzhen, China. METHODS: We used a stratified multistage random sampling method to recruit participants and collected demographic information and laboratory results of people under home quarantine. We conducted descriptive analysis to estimate the basic characteristics and to calculate the incidence in out study population. RESULTS: A total of 2004 people under home quarantine participated in this study, of which 1637 participants finished the questionnaire with a response rate of 81.7%. Mean age of the participants was 33.7 years, ranging from 0.3 to 80.2 years. Of people who provided clear travel history, 129 people have traveled to Wuhan city and 1,046 people have traveled to other cities in Hubei province within 14 days before the home quarantine. Few (less than 1%) participants reported contact history with confirmed or suspected cases during their trip and most of these arrived at Shenzhen between Jan 24, 2020 to Jan 27, 2020. The incidence of COVID-19 in the sample was 1.5‰ (95% CI: 0.31‰-4.37‰). CONCLUSION: Home quarantine has been effective in preventing the early transmission of COVID-19, but that more needs to be done to improve early detection of COVID-19 infection.