The Attitude of the Medical Students in Professional Identity and Career Planning in China During COVID-19: A Cross-Sectional Survey (preprint)

Background: The outbreak of COVID-19 was an unprecedented health emergency, which affected everyone, including the medical students. We aimed to investigate the influence of COVID-19 on professional identity and career planning of clinical medical undergraduates, and propose strategies. Method: A cross-section survey was conducted via online questionnaire from January to March 2021 on clinical medical undergraduates in Hebei province. We collected the demographic information, the understanding status of the epidemic, the change of the attitude to professional identity and career planning after the epidemic. McNemar Tests were used to evaluate corresponding information. Findings: In 2754 respondents, over 80% students were aware about the transmission, incubation period, source, and first consultation department of COVID-19; however, the number of students knowing the name of the pathogen and therapy of this disease relatively fewer. Overall, the pandemic had a positive impact on their professional identity and career planning (all P <0·05, compared with the status before the epidemic). And the number of students who chose the department of infectious disease and respiration as the favorite after COVID-19 increased (184 (6·68%), vs 99 (3·59%), P <0·001). The number of students being willing to choose the above two departments after COVID-19 increased (956 (34·72%), vs 773 (28·07%), P <0·001). Interpretation: Overall, the pandemic had a positive impact on the professional identity and career planning of the students, but the number of students being willing to choose the department of infectious disease and respiration was still extremely low. In the future education, further attention should be paid to the cultivation of interest in above departments and the spirit of dedication.Funding Statement: None.Declaration of Interests: All authors declare that there are no conflicts of interest.Ethics Approval Statement: The study was approved by the medical ethics committee of the Third Hospital of Hebei Medical University. (Number: K 2021 -002-1)

Correlation of the renal function changes to prognosis in critical patients with COVID-19

Objective 　To get the message of kidney injury and its causes in patients with COVID-19, and analyze the correlation of kidney injury to COVID-19 typing and prognosis, so provide a reference for the treatment and prognosis evaluation of COVID-19. Methods　According to the retrospective cohort study protocol, the clinical data and prognosis of 319 confirmed patients with COVID-19, admitted in the General Hospital of Central Theater Command (Wuhan) from Jan. 1st to Mar. 14th, 2020, were collected. The correlation of COVID-19 patients' renal function changes to the classification and prognosis of diseases were analyzed using univariate and multivariate logistic regression analysis. Results　The mean age of the 319 confirmed patients with COVID-19 was (55.2±17.0) years. The proportion of non-critical group (mild+moderate type) and critical group (severe+critical type) were 62.1% (198/319) and 37.9% (121/319), respectively. The fatality rate of present study cohort was 5.6% (18/319). About 3.8% cases (12/319) were with elevated blood urea nitrogen (BUN) and serum creatinine (SCr) at admission, and about 5.6% cases (18/319) were with elevated BUN only at admission. Univariate logistic regression analysis revealed that the age, the levels of SCr and BUN at admission and one week after admission, the combination of diabetes mellitus, and chronic kidney disease were the risk factors associated with the death in critical group patients (P<0.05). Multivariate logistic regression analysis revealed that the elevated levels of BUN at admission and one week after admission were the independent risk factors of death in the critical group patients. Conclusions　The elevated levels of BUN at admission and one week after admission were the important clinical features and independent risk factors associated with the death of critical COVID-19 patients. More attention should be paid to all kinds of clinical factors that may lead to increase the level of BUN.

Environmental virus detection associated with asymptomatic SARS-CoV-2-infected individuals with positive anal swabs.

In the fight against the outbreak of COVID-19 in China, we treated some asymptomatic infected individuals. This study aimed to detect pathogens in biological and environmental samples of these asymptomatic infected individuals and analyse their association. Using a cross-sectional study design, we collected biological and environmental samples from 19 patients treated in the isolation ward of Nanjing No.2 Hospital. Biological samples included saliva, pharyngeal swabs, blood, anal swabs, and exhaled breath condensate. Swab samples from the ward environment included inside masks, outside masks, palm swabs, bedside handrails, bedside tables, cell phone screens, toilet cell phone shelves, toilet pads and toilet lids. We also obtained some samples from public areas. We used RT-PCR to detect pathogens and colloidal gold to detect antibodies. As results, 19 asymptomatic infected individuals participated in the survey, with 8 positives for pathogens and 11 positives only for antibodies. Three positive samples were detected from among 96 environmental samples, respectively, from a cell phone surface, a cell phone shelf and a bedside handrail. No positive samples were detected in the exhaled breath condensate in this work. All patients identified pathogens in the environment had positive anal swabs. There was a statistical association between positive anal swabs and positive environmental samples. The association of positive samples from the surrounding of asymptomatically infected patients with positive anal swabs suggested that patients might secrete the virus for a more extended period.

Toilets dominate environmental detection of severe acute respiratory syndrome coronavirus 2 in a hospital.

Respiratory and fecal aerosols play confirmed and suspected roles, respectively, in transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An extensive environmental sampling campaign of both toilet and non-toilet environments was performed in a dedicated hospital building for patients with coronavirus disease 2019 (COVID-19), and the associated environmental factors were analyzed. In total, 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected within and beyond four three-bed isolation rooms. The data of the COVID-19 patients were collected. The building environmental design and the cleaning routines were reviewed. Field measurements of airflow and CO2 concentrations were conducted. The 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms, and 36 from other surfaces outside the isolation rooms in the hospital. Four of these samples were positive, namely two ward door handles, one bathroom toilet seat cover, and one bathroom door handle. Three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever, and one bathroom ceiling exhaust louver. Of the 46 air samples, one collected from a corridor was weakly positive. The two exhaled condensate samples and the two expired air samples were negative. The fecal-derived aerosols in patients' toilets contained most of the detected SARS-CoV-2 in the hospital, highlighting the importance of surface and hand hygiene for intervention.

Changes in lipid metabolism in patients with severe COVID-19 (preprint)

Background: Dyslipidemia plays an important role in the pathogenesis and evolution of critical illness, but limited information exists regarding the lipid metabolism of severe coronavirus disease 2019 (COVID-19) patients. The aim of this study was to investigate role of dyslipidemia in patients with severe COVID-19Methods: We retrospectively reviewed 216 severe COVID-19 patients with clarified outcomes (discharged or deceased), admitted to the West Court of Union Hospital in Wuhan, China, between February 1 and March 31, 2020. The dynamic changes of lipid profiles and their relationships with disease severity and clinical outcomes were analyzed.Results: A total of 216 severe COVID-19 patients, including 24 non-survivors and 192 survivors, were included in the final analyses. The levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein AI (Apo-AI) on admission were significantly lower in non-survivors compared to survivors. During hospitalization, low-density lipoprotein cholesterol (LDL-C), total cholesterol(TC), HDL-C and Apo-AI were shown an increasing trend in survivors, but maintained lower levels or shown downward trend in non-survivors. The serum levels of HDL-C and Apo-AI were inversely correlated with C-reactive protein (CRP), length of hospital stay of survivors and disease severity. The receiver operating characteristic (ROC) curve analysis identified a CRP/ HDL-C ratio cut-off value of 62.54 as the predictor for in-hospital mortality (AUC=0.823, Sensitivity=83.3%, Specificity=70.8%). Logistic regression analysis demonstrated that hypertension, neutrophils-to-lymphocytes ratio(NLR), platelet count and high CRP/ HDL-C ratio (>62.54) were independent factors to predict in-hospital mortality.Conclusions: The results demonstrated that dyslipidemia was associated with the inflammatory response, disease severity and poor prognosis of COVID-19. High CRP/ HDL-C ratio may serve as an independently potential predictor for hospital mortality among patients with severe COVID-19.

Optimization of the intravenous infusion workflow in the isolation ward for patients with coronavirus disease 2019.

OBJECTIVE: This study aimed to evaluate the effect of optimization of the intravenous infusion workflow in isolation wards for patients with coronavirus disease 2019. METHODS: The infusion management group optimized the intravenous infusion workflow based on Hamer's Process Reengineering Theory and applied it to the treatment of patients with coronavirus disease 2019. The work efficiency, patients' satisfaction and economic indicators before and after optimization were compared. RESULTS: After the infusion workflow was optimized, average times for preparation drugs and intravenous admixture, and patients' waiting time decreased from 4.84 min, 4.03 min, and 34.33 min to 3.50 min, 2.60 min, and 30.87 min, respectively, patients' satisfaction increased from 66.7% to 93.3%, and the cost of personal protective equipment (PPE) decreased from 46.67 sets and 186.6 CNY per day to 36.17 sets and 144.6 CNY, with statistical significance. CONCLUSION: The optimization of the intravenous infusion workflow can effectively decrease the cost of PPE while improving the efficiency of infusion and patients' satisfaction.

Comorbid Diabetes Mellitus was Associated with Poorer Prognosis in Patients with COVID-19: A Retrospective Cohort Study (preprint)

Background The 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, Hubei province, China, and was characterized as pandemic by the World Health Organization. Diabetes mellitus is an established risk factor for poor clinical outcomes, but the association of diabetes with the prognosis of COVID-19 have not been reported yet. Methods In this cohort study, we retrospectively reviewed 258 consecutive hospitalized COVID-19 patients with or without diabetes at the West Court of Union Hospital of Huazhong University of Science and Technology in Wuhan, China, recruited from January 29 to February 12, 2020. The cases were confirmed by real-time PCR and the demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Prognosis was defined as hospitalization, discharged survivor and death, which was followed up until March 12, 2020. Results Of the 258 hospitalized patients (63 with diabetes) with COVID-19, the median age was 64 years (range 23-91), and 138 (53.5%) were male. No significant differences in age and sex were identified between patients with and without diabetes. Common symptoms included fever (82.2%), dry cough (67.1%), polypnea (48.1%), and fatigue (38%). Patients with diabetes had significantly higher leucocyte and neutrophil counts, and higher levels of fasting blood glucose, serum creatinine, urea nitrogen and creatine kinase isoenzyme MB at admission compared with those without diabetes. COVID-19 patients with diabetes were more likely to develop severe or critical disease condition with more complications at presentation, and had higher incidence rates of antibiotic therapy, non-invasive and invasive mechanical ventilation, and death (11.1% vs. 4.1%). Cox proportional hazard model showed that diabetes (adjusted hazard ratio [aHR]=3.64; 95% confidence interval [CI]: 1.09, 12.21) and fasting blood glucose (aHR=1.19; 95% CI: 1.08, 1.31) were associated with the fatality of COVID-19, adjusting for potential confounders. Conclusions Diabetes mellitus is associated with greater disease severity and a higher risk of mortality in patients with COVID-19. Primary and secondary prevention strategies are needed for COVID-19 patients with diabetes.

Reverse transcription loop-mediated isothermal amplification combined with nanoparticles-based biosensor for diagnosis of COVID-19 (preprint)

Given the scale and rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, known as 2019-nCov) infection (COVID-19), the ongoing global SARS-CoV-2 outbreak has become a huge public health issue. Rapid and precise diagnostic methods are thus immediately needed for diagnosing COVID-19, providing timely treatment and facilitating infection control. A one-step reverse transcription loop-mediated isothermal amplification (RT-LAMP) coupled with nanoparticles-based biosensor (NBS) assay (RT-LAMP-NBS) was successfully established for rapidly and accurately diagnosing COVID-19. A simple equipment (such as heating block) was required for maintaining a constant temperature (63 C) for only 40 min. Using two designed LAMP primer sets, F1ab (opening reading frame 1a/b) and np (nucleoprotein) genes of SARS-CoV-2 were simultaneously amplified and detected in a one-step and single-tube reaction, and the detection results were easily interpreted by NBS. The sensitivity of SARS-CoV-2 RT-LAMP-NBS was 12 copies (each of detection target) per reaction, and no cross-reactivity was generated from non-SARS-CoV-2 templates. Among clinically diagnosed COVID-19 patients, the analytical sensitivity of SARS-CoV-2 was 100% (33/33) in the oropharynx swab samples, and the assay's specificity was also 100% (96/96) when analyzed the clinical samples collected from non-COVID-19 patients. The total diagnosis test from sample collection to result interpretation only takes approximately 1 h. In sum, the RT-LAMP-NBS is a promising tool for diagnosing the current SARS-CoV-2 infection in first line field, public health and clinical laboratories, especially for resource-challenged regions.