[Preliminary clinical analysis of direct renin inhibitor aliskiren in the treatment of severe coronavirus disease 2019 patients with hypertension].

Objective: To explore the feasibility of direct renin inhibitor aliskiren for the treatment of severe or critical coronavirus disease 2019 (COVID-19) patients with hypertension. Methods: The antihypertensive effects and safety of aliskiren was retrospectively analyzed in three severe and one critical COVID-19 patients with hypertension. Results: Four patients, two males and two females, with an average age of 78 years (66-87 years), were referred to hospital mainly because of respiratory symptoms. Three were diagnosed by positive novel coronavirus 2019 (2019-nCoV) nucleic acid or antibody, and the critical patient with cardiac insufficiency was clinically determined. Two patients were treated with calcium channel antagonist (CCB), one with angiotensin converting enzyme inhibitor (ACEI), and one with angiotensin Ⅱ receptor antagonist (ARB). After admission, ACEI and ARB were discontinued, one patient with heart failure was treated by aliskiren combined with diuretic.Three patients were treated with aliskiren combined with CCB among whom two withdrew CCB due to low blood pressure after 1 to 2 weeks. Based on comprehensive treatment including antiviral and oxygenation treatment, blood pressure was satisfactorily controlled by aliskiren after three to four weeks without serious adverse events. All patients were finally discharged. Conclusion: Our preliminary clinical data shows that antihypertensive effect of aliskiren is satisfactory and safe for severe COVID-19 patients complicated with hypertension.

Trends Of Diabetic Ketoacidosis During COVID-19 Pandemic In Large Urban Public Emergency Department

Study Objectives: Diabetic ketoacidosis (DKA) is a common and serious endocrine emergency. Common triggers for diabetic ketoacidosis include infection, cardiovascular events, drug use, medication non-adherence, and new onset diabetes. Early evidence suggests a correlation between COVID-19 infection and DKA. Based on the limited data, it is unclear at this time if increases in DKA are triggered by acute COVID-19 infection, or secondary factors from the pandemic such as lack of access to care or acute stress. In this study, we examine trends in DKA prevalence among patients at an underserved urban public ED within the context of the COVID-19 pandemic. Methods: This is a retrospective study using administrative report data of all ED encounters. Cases of DKA, found using top 5 ICD10 ED diagnoses, were identified from 2019 and 2020. COVID-19 infection was pulled from laboratory data and merged to create one data set. Poisson regression was utilized to compare incidence rates of DKA (1) between 2019 and 2020 and (2) among COVID positive and COVID negative patients with DKA for the year of 2020. Yearly trends were examined month by month. Results: There were 180,158 patient visits in 2019 and 138,012 in 2020. Compared to 2019, incidence rates of DKA increased by 23% in 2020 (95% CI 4% to 42%, p=0.017). Among all those tested for COVID in 2020 (n=25,867), patients with positive COVID-19 tests trended to higher DKA rate (37% higher (95% CI -6% to 81% increase, p=0.098) than patients with negative COVID-19 tests. The increase was most prominent from April 2020 onward, with the largest increase in December 2020, correlating with the COVID surge at our hospital. (Figure 1). In December 2019, 20 out of 14,324 visits (0.14%) were coded as DKA, while in December 2020, 37 out of 10,942 visits (0.34%) were coded DKA. In December 2020, 11 DKA cases were COVID-19 positive and 26 were COVID-19 negative. When excluding the 11 cases of DKA with positive COVID-19 tests, the rate of DKA in 12/2020 would be 0.24%. Conclusions: We found the incidence rate ratio of DKA in 2020 increased compared to 2019, with an almost doubling of DKA rates in the month of December, the peak months of our pandemic surge. Our findings suggest a correlation between COVID-19 positivity and DKA, but is limited by small numbers at a single site. There is also limited data to suggest secondary factors may also play a role in increased rates. When removing COVID positive DKA cases in December 2020, the prevalence that month continued to 0.10% higher than in December 2019. While small numbers prevent firm conclusions, itis possible factors outside of COVID infection are attributing to higher rates. Various studies have shown reduced access to care for conditions managed in ambulatory settings during the COVID pandemic. Given this, decreased access to care for medication refill and titration may also be contributing to the rise in DKA rates. As more data becomes available, further research is required to establish the role of access to care versus inflammation from COVID-19 infection in triggering DKA. [Formula presented]

A Privacy-Preserving and Overhead-Free Protocol for Direct Donations to People Impacted by COVID-19 Lockdowns

COVID-19 caused large-scale, long-lasting lockdowns in many parts of the world, which resulted in many people in need for financial or other aids. Governments, charities, and communities rushed to provide help. To complement these efforts and to provide direct assistance to individuals who may not get sufficient and/or timely assistance otherwise, we designed a privacy-preserving and overhead-free protocol named "Fireside Help" for matching donors and people-in-need. This protocol aims to provide maximum privacy protection. Only the assigned volunteer verifiers can know about details of the applications from people-in-need and the donations from the donors that they verified. No one else, including the Fireside Help system itself, can gain any knowledge beyond digital checksums and information intentionally made public. This protocol uses proven, free, and widely available hash functions such as SHA-256, SHA-1, or MD-5 to ensure the integrity of the system without revealing private information. The protocol was designed initially to help students in Wuhan, China, the very first city to lock down. Later, it was revised to help anyone around the world who has been impacted by COVID-19. Several real-world transactions were completed in the system that demonstrated its utility and robustness.

Nano Magnetic Beads Combined with Polymerase Chain Reaction Detection of 2019-nCoV and Analysis of the Epidemiological and Clinical Characteristics of 2019-nCoV Patients

The 2019 novel coronavirus (2019-nCoV) is extremely infectious and the human population globally is generally susceptible to it. Its spread poses a serious threat to public health. Analyzing the epidemiological and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) can more fully demonstrate its characteristics and evolution, and provide effective scientific strategies for preventing and controlling the epidemic. In this study, nucleic acid detection was performed on 228 suspected COVID-19 cases in Ningbo City from January 2020 to August 2020. The RNA of the virus was extracted by the nano magnetic bead method and was detected by real-time fluorescent quantitative PCR. Patients whose test results were positive were considered as research subjects. Clinical data of the patients were collected through a medical record system and the epidemiology and characteristics of COVID-19 were analyzed. Among the 228 suspected cases, 108 patients had a positive nucleic acid test result. The 108 confirmed patients were selected as research subjects, including 9 patients with mild symptoms, 85 patients with common symptoms, and 14 patients with severe symptoms. The age range of the patients was 17-82 years. Overall, 35 patients (32.40%) had complications. The median incubation period for patients was 7.5 days. Seventy patients (64.81%) had a contact history with a diseased individual. In terms of the clinical symptoms of the patients, the following symptoms were identified: fever in 92, cough in 62, fatigue in 34, sputum expectoration in 32, dry cough in 22, sore throat in 19, diarrhea in 8, headache in 8, shortness of breath in 7, nasal congestion in 5, and muscle ache in 5 cases. The results of chest CT imaging showed that 96 patients (88.89%) exhibited bilateral or unilateral pneumonia lesions of varying degrees, manifested as bilateral or unilateral lung patches, cloudy floccules, patches with an increased density shadow. The CT images of 12 patients (11.11%) showed no obvious abnormalities, while 24 cases (22.22%) had absolute white blood cell count of <4x10(9)/L, while 1 case had one of >10x10(9)/L. The absolute neutrophil count in 10 patients (9.26%) increased (>6.3x10(9/)L). The absolute lymphocyte count in 49 patients (45.37%) decreased (<1.1x10(9)/L). The hemoglobin, hematocrit, and platelet levels of the vast majority of patients were normal, while a few were low or high. Fifty-eight patients (53.70%) had elevated C-reactive protein (>10 mg/L);14 (12.96%) had elevated D-dimer (>256 mu g/L);14 (12.96%) had high levels of alanine aminotransferase (>40 U/L);9 (8.33%) had increased aspartate aminotransferase (>40 U/L);while 32 (29.6%) had increased lactate dehydrogenase (>250 U/L). COVID-19 in Ningbo is mainly transmitted in clusters, and elderly patients are more likely to develop severe symptoms. There is no significant difference in clinical characteristics between patients with severe conditions and those with mild and common ones.