A Case of Prolonged Shedding of SARS-Cov-2 with Rapid Decay of IgG Antibody (preprint)

BackgroundCoronavirus disease 2019 (COVID-19) epidemic is still spreading rapidly around the world. Recent cases with prolonged detection of SARS-CoV-2 RNA have been successively reported and the phenomenon of false-negative real-time polymerase chain reaction (RT-PCR) results of SARS-CoV-2 RNA or “repositive” was also described in patients with COVID-19.Case presentationA 69-year-old female with hypertension, total hysterectomy for hysteromyoma and suspected lung tumor presented with moderate COVID-19 symptoms was testing positive for SARS-CoV-2 RNA by RT-PCR when she travelled from USA to China. The patient required second and third re-hospitalization due to repositive SARS-CoV-2 test results of throat swaps during post-charge solitary isolation and observation. The serum SARS-CoV-2-IgG decayed rapidly and disappeared on illness day 139 when the throat swab was still positive for SARS-CoV-2 RNA. Finally the virus shedding lasted at least146 days (the last positive test result of throat swap on illness day 146 and the first true-negative test result on illness day 151) from her initial positive test.Conclusions Prolonged viral shedding of SARS-CoV RNA is prone to occur in an immunocompromised host. With the change of host immune status, SARS-CoV-2 detection can be repeatedly positive. The SARS-CoV-2-IgG may decrease rapidly and disappear before the virus removal, indicating there may be certain limitations on the protective effect of antibody against SARS-CoV-2 which deserves attention of clinicians. 

Learning burnout: evaluating the role of social support in medical students (preprint)

Background:Burnout is a stress-induced syndrome that is considered closely related to work. Although social support could reduce burnout syndrome, the effect of it on learning burnout in medical students remains unclear. The objectives of the study are to evaluate the association between learning burnout and social support in a cohort of Chinese medical students.Methods:A cross-sectional online survey was distributed to students who participated in online learning in a medical college in Wuhan during the COVID-19 epidemic. We used the Lian version of the Maslach Burnout Inventory (MBI) to assess learning burnout and the Social Support Rating Scale (SSRS) to assess social support.Results:A total of 684 students completed the survey (response rate of 30.9%), of which 315 (46.12%) met standard criteria for learning burnout. We found grade, family income, learning time, and the number of interactions with teachers or classmates had an effect on students’ learning burnout. After adjusting for the grade and residence, there was a significant and relevant association between the social support and learning burnout. (adjusted odds ratio, 0.93 for 1-point decrease in total SSRS score; 95% CI, 0.90 – 0.96; p < 0.001).Conclusions:Learning burnout was highly prevalent in medical students of our college. The social support especially subjective support and utilization of support played a protective role in reducing the risk of learning burnout.

COVID-19 patients with hypertension under potential risk of worsened organ injuries (preprint)

COVID -19 has rapidly spread from Wuhan to worldwide, and now has become a global health concern. Hypertension is the most common chronic illness in COVID-19, while the influence on those patients have not been well described. In this retrospective study, 82 confirmed patients with COVID-19 were enrolled, with epidemiological, demographic, clinical, laboratory, radiological, and therapies data analyzed and compared between COVID-19 patients with (29 cases) or without (53 cases) hypertension. Of all 82 patients with COVID-19, the median age of all patients was 60.5 years, including 49 females (59.8%) and 33 (40.2%) males. Hypertension (31[28.2%]) was the most chronic illness, followed by diabetes (16 [19.5%]) and cardiovascular disease (15 [18.3%]). Common symptoms included fatigue (55[67.1%]), dry cough (46 [56.1%]) and fever (≥37.3℃ (46 [56.1%]). The median time from illness onset to positive outcomes of RT-PCR analysis were 13.0 days, ranging from 3-25 days. In hypertension group, 6 (20.7%) patients died compared to 5 (9.4%) died in non-hypertension group. More hypertension patients with COVID-19 (8 [27.6%]) had at least one coexisting disease than those of non-hypertension patients (2 [3.8%]) (P=0.002). Compared with non-hypertension patients, higher levels of neutrophil counts, serum amyloid A, C-reactive protein, and NT-proBNP were observed in hypertension group, whereas levels of lymphocyte count and eGFR were decreased. Dynamic observations displayed more significant and worsened outcomes in hypertension group after hospital admission. COVID-19 patients with hypertension take more risks of severe inflammatory reactions, worsened internal organ injuries, and deteriorated progress.