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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has impacted various aspects of healthcare, including the management of ST-elevation myocardial infarction (STEMI) patients. Our study investigates the in-hospital outcomes and the impact of transfer and COVID-19 infection status on mortality in STEMI patients. Methods: We conducted a retrospective cohort study to compare the inpatient outcomes of STEMI patients in 2020 with STEMI patients from 2016 to 2019 using the National Inpatient Sample database. We performed 1:1 greedy nearest neighbor matching and utilized logistic regression to compare mortality. Results: In our matched cohort, there was no difference in overall mortality between STEMI patients in 2020 and those from 2016 to 2019 (OR 1.00, 95% CI: 0.94-1.05; p = 0.87). When stratified by COVID-19 infection status, regularly admitted STEMI patients with concurrent COVID-19 infection in 2020 had 2.11 times higher odds of inpatient mortality compared to regularly admitted STEMI patients from 2016 to 2019 (OR 2.11, 95% CI: 1.55-2.87; p < 0.001). STEMI acute care transfers with concurrent COVID-19 infection in 2020 had 3.17 times higher odds of inpatient mortality than those from 2016 to 2019 (OR 3.17, 95% CI: 1.83-5.50; p < 0.001). STEMI non-acute care transfers with concurrent COVID-19 infection in 2020 had 5.13 times higher odds of inpatient mortality than those from 2016 to 2019 (OR 5.13, 95% CI: 1.87-14.06; p = 0.001). Conclusion: The COVID-19 pandemic exacerbated many longstanding disparities within our healthcare system. Moving forward, it is crucial to engage in further discussions addressing the national physician shortage, the patient transfer system and healthcare in underserved regions.
Subject(s)
COVID-19 , Myocardial InfarctionABSTRACT
BackgroundExisting clinical studies supported the potential efficacy of mesenchymal stromal cells as well as derived exosomes in the treatment of COVID-19. We aimed to explore the safety and efficiency of aerosol inhalation of the exosomes derived from human adipose-derived MSCs (haMSC-Exos) in patients with COVID-19.MethodsThe MEXCOVID trial is a phase 2a single-arm, open-labelled, interventional trial and patients were enrolled in Jinyintan Hospital, Wuhan, China. Eligible 7 patients were assigned to receive the daily dose of haMSCs-Exos (2.0×108 nano vesicles) for consecutively 5 days. The primary outcomes included the incidence of prespecified inhalation-associated events and serious adverse events. We also observed the demographic data, clinical characteristics, laboratory results including lymphocyte count, levels of D-dimer and IL-6 as well as chest imaging.ResultsSeven severe COVID-19 related pneumonia patients (4 males and 3 females) were enrolled and received nebulized haMSC-Exos. The median age was 57 year (IQR, 43 year to 70 year). The median time from onset of symptoms to hospital admission and administration of nebulized haMSC-Exos was 30 days (IQR, 15 days to 40 days) and 54 d (IQR, 34 d to 69 d), respectively. All COVID-19 patients tolerated the haMSC-Exos nebulization well, with no evidence of prespecified adverse events or clinical instability during the nebulization or during the immediate post-nebulization period. All patients presented a slight increase of serum lymphocyte counts (median as 1.61×109/L vs. 1.78×109/L). Different degrees of resolution of pulmonary lesions after aerosol inhalation of haMSC-Exos were observed among all patients, more obviously in 4 of 7 patients.ConclusionsOur trial shows that a consecutive 5 days inhalation dose of clinical grade haMSC-Exos up to a total amount of 2.0×109 nano vesicles was feasible and well tolerated in seven COVID-19 patients, with no evidence of prespecified adverse events, immediate clinical instability, or dose-relevant toxicity at any of the doses tested. This safety profile is seemingly followed by CT imaging improvement within 7 days. Further trials will have to confirm the long-term safety or efficacy in larger population.Trial RegistrationMEXCOVID, NCT04276987
Subject(s)
COVID-19ABSTRACT
Objective To study the mental health status of primary school students and the factors influencing the mental health status during the coronavirus disease 2019 (COVID-19) epidemic. Methods Online questionnaire surveys were conducted among 3 600 primary school students aged 6-12 years in Jilin Province, China in April, 2020 (during the epidemic) and 3 089 primary school students in September, 2020 (during the regular epidemic prevention and control). The general information and the data related to the Mental Health Scale for Child and Adolescent were collected by the questionnaire surveys. The multivariate logistic regression analysis was used to evaluate the factors influencing the mental health status of the students during the epidemic. Results The students during the epidemic had a significantly poorer mental health status in the emotional experience and volitional behavior than those during the regular epidemic prevention and control (P<0.05). The multivariate logistic regression analysis showed the risk of psychological problems of the students decreased with age (OR=0.895). The girls were at a higher risk of psychological problems than boys (OR=1.453). The students with father's and mother's charater between irritability and gentle were at a lower risk of psychological problems (OR=0.496 and 0.470 respectively). The students from a family with a parental education style of a combination of encouraging and scolding were at a lower risk of psychological problems (OR=0.263). The students from a single-parent family or an extended family were at a higher risk of psychological problems (OR=2.995 and 3.446 respectively). Conclusions The COVID-19 epidemic has a certain impact on emotional experience and volitional behavior of primary school students. During the epidemic, particular attention should be paid to the mental health of primary school students, especially girls, younger students, and students from single-parent families, extended families or families with impatient parents and improper parental education.
ABSTRACT
Background: Cancer patients are considered to be highly susceptible to viral infections, however, the comprehensive features of COVID-19 in these patients remained largely unknown. The present study aimed to assess the clinical characteristics and outcomes of COVID-19 in a large cohort of cancer patients. Design, Setting, and Participants: Data of consecutive cancer patients admitted to 33 designated hospitals for COVID-19 in Hubei province, China from December 17, 2019 to March 18, 2020 were retrospectively collected. The follow-up cutoff date was April 02, 2020. The clinical course and survival status of the cancer patients with COVID-19 were measured, and the potential risk factors of severe events and death were assessed through univariable and multivariable analyses. Results: A total of 283 laboratory confirmed COVID-19 patients (50% male; median age, 63.0 years [IQR, 55.0 to 70.0]) with more than 20 cancer types were included. The overall mortality rate was 18% (50/283), and the median hospitalization stay for the survivors was 26 days. Amongst all, 76 (27%) were former cancer patients with curative resections for over five years without recurrence. The current cancer patients exhibited worse outcomes versus former cancer patients (overall survival, HR=2.45, 95%CI 1.10 to 5.44, log-rank p=0.02; mortality rate, 21% vs 9%). Of the 207 current cancer patients, 95 (46%) have received recent anti-tumor treatment, and the highest mortality rate was observed in the patients receiving recent chemotherapy (33%), followed by surgery (26%), other anti-tumor treatments (19%), and no anti-tumor treatment (15%). In addition, a higher mortality rate was observed in patients with lymphohematopoietic malignancies (LHM) (53%, 9/17), and all seven LHM patients with recent chemotherapy died. Multivariable analysis indicated that LHM (p=0.001) was one of the independent factors associating with critical illness or death. Conclusions: This is the first systematic study comprehensively depicting COVID-19 in a large cancer cohort. Patients with tumors, especially LHM, may have poorer prognosis of COVID-19. Additional cares are warranted and non-emergency anti-tumor treatment should be cautiously used for these patients under the pandemic.