Covid-19 Outcome in Patients with and without Cirrhosis

Background: Severe outcomes of COVID-19 are associated with advancing age, and multiple medical comorbidities. The impact of COVID-19 on the clinical course of patients with cirrhosis has not been well studied. We determined the effect of SARS-CoV-2 infection on the hospitalization and survival rates of patients with cirrhosis. Method(s): Using ICD-10-CM codes, we identified all Veterans with a diagnosis of cirrhosis in the VA Corporate Data Warehouse and COVID-19 Shared Data Resource. Study cohort included Veterans who were tested for SARS-CoV-2 and had no history of organ transplantation or malignancies. Each SARS-CoV-2 positive case was propensity-score matched by demographics and comorbidities with up to two SARS-CoV-2 negative controls. The primary endpoints were acute care hospitalization, admission to intensive care, respiratory support, or death. Result(s): Of 1,115,037 individuals tested for SARS-CoV-2, 31,680 were noted to have cirrhosis and among them 5,047 (16%) were SARS-CoV-2 positive. After exclusions and propensity-score matching, 5,047 SARS-CoV-2 positive and 9,913 propensity score matched SARS-CoV-2 negative individuals were included in the analysis cohort. Median age was 67 years, 95% were men and 25% were of black race. Median BMI was 30 and history of hypertension, diabetes, cardiovascular and chronic pulmonary disease was noted among 81%, 54%, 56% and 32% respectively. Among all cirrhotic individuals, SARS-CoV-2 positive individuals less frequently progressed to hepatic decompensation (3.1% vs 4.8%, P< 0.0001) or hospitalization (35.7% vs 38.2%, P=0.002), but more frequently required ICU admission 15% vs 12.2%, P< 0.0001) or respiratory support (7.3% vs 8.4%, P=0.01). Among those admitted, length of hospital stay was longer among SARS-CoV-2 positive individuals (7 vs 4 days, P< 0.0001). In Cox regression analysis, SARS-CoV-2 positivity was associated with a higher risk of all-cause mortality (HR 1.37, 95% CI 1.19,1.56). Conclusion(s): Although patients with cirrhosis and COVID-19 were less often hospitalized, they had longer duration of hospitalization and were at higher risk of severe or critical illness and death. (Figure Presented).

Clinical Efficacy of Modified Sanxiaoyin in Treatment of Mild or Moderate COVID-19 Patients:Based on Retrospective Analysis.

Objective: To retrospectively analyze the clinical data of 52 patients with coronavirus disease-2019 COVID-19 and explore the clinical efficacy of modified Sanxiaoyin on mild/moderate COVID-19 patients. Method(s): The propensity score matching method was used to collect the clinical data of mild or moderate COVID-19 patients enrolled in the designated hospital of the Second Hospital of Jingzhou from December 2019 to May 2020. A total of 26 eligible patients who were treated with modified Sanxiaoyin were included in the observation group,and the 26 patients treated with conventional method were the regarded as the control. The disappearance of clinical symptoms,disappearance time of main symptoms,efficacy on traditional Chinese medicineTCMsymptoms,hospitalization duration,laboratory test indicators,and CT imaging changes in the two groups were compared. Result(s): The general data in the two groups were insignificantly different and thus they were comparable. After 7 days of treatment,the disappearance rate of fever,cough, fatigue,dry throat,anorexia,poor mental state,and poor sleep quality in the observation group was higher than that in the control groupP<0.05,and the difference in the disappearance rate of expectoration and chest distress was insignificant. For the cases with the disappearance of symptoms,the main symptomsfever, cough,fatigue,dry throat,anorexia,chest distressdisappeared earlier in the observation group than in the control groupP<0.01. After 7 days of treatment,the scores of the TCM symptom scale of both groups decreasedP<0.01,and the decrease of the observation group was larger that of the control groupP<0.01. All patients in the two groups were cured and discharged. The average hospitalization duration in the observation group12.79+/-2.68dwas shorter than that in the control group15.27+/-3.11dP<0.01. The effective rate in the observation group92.31%,24/26was higher than that in the control group76.92%,20/26. After 7 days of treatment,the lymphocyteLYMcount increasedP<0.05,and white blood cellWBCcount and neutrophilNEUTcount decreased insignificantly in the two groups. Moreover,levels of C-reactive protein CRP,erythrocyte sedimentation rateESR,and procalcitoninPCTreduced in the two groups after treatmentP<0.01and the reduction in the observation group was larger than that in the control group P<0.01. Through 7 days of treatment,the total effective rate on pulmonary shadow in the observation group 90.00%,18/20was higher than that in the control group77.27%,17/22P>0.05and the improvement of lung shadow in the observation group was better than that in the control groupP<0.01. Conclusion(s):Modified Sanxiaoyin can significantly alleviate fever,cough,fatigue,anorexia,chest distress,poor sleep quality,and other symptoms of patients with mild or moderate COVID-19,improve biochemical indicators,and promote the recovery of lung function. This paper provides clinical evidence for the application of modified Sanxiaoyin in the treatment of mild or moderate COVID-19.Copyright © 2022, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Nirmatrelvir Use and Hospitalizations or Death in Individuals with Covid-19

Background: Nirmatrelvir/ritonavir (NMV/r) was granted Emergency Use Authorization in December 2021 for treatment of early symptomatic patients with mild to moderate COVID-19 at high risk of progression. However, its benefit is specific population subgroups remains unclear. Method(s): We used a matched cohort design to emulate a target trial within the VA COVID-19 Shared Data Resource database. Eligible individuals were those with at least two episodes of care in the VA in the last 2 years, who had a first confirmed SARS-CoV-2 infection between January 1 and August 31, 2022 and were free of hospitalization or death within 3 days of testing positive. Those hospitalized in the previous 60-days and those who received Molnupiravir after diagnosis were ineligible. Among the eligible individuals, we matched those prescribed NMV/r with those not prescribed NMV/r within 3 days of diagnosis. Controls were matched 1:1 on age (5-year blocks), race, sex, body mass index, Charlson Comorbidity Index, VA facility where NMV/r was prescribed, and vaccination status. Our primary outcome measure was hospitalization or death within 30 days of the index COVID-19 diagnosis date. Result(s): Among 90,432 persons with a confirmed first SARS-CoV-2 positive test, 68,236 persons met the eligibility criteria. Of those, 4,886 were prescribed NMV/r. Final primary analysis dataset included 4,148 matched pairs of NMV/r treated cases and controls. The incidence of hospitalization or death was significantly lower among those who were prescribed NMV/r overall (73 vs. 109 events;ARD [95% CI] -0.87 [-1.49 to -0.25]), for those older than 60 years (60 vs. 88 events;ARD [95% CI] -1.05 [-1.93 to -0.18]), for unvaccinated/incomplete primary series (ARD -1.88 [-3.54 to -0.22]), and those asymptomatic at baseline (ARD -1.96 [-3.00 to -0.92]). Those who were <60 years old, vaccinated with or without a booster, and those symptomatic at baseline did not experience a significant benefit. Conclusion(s): NMV/r use is associated with a modest but statistically significant reduction in hospitalization or death among previously uninfected, nonhospitalized population with COVID-19 who are at a high risk of progression to severe disease. The benefit is evident in older, unvaccinated, asymptomatic persons and those with certain comorbidities. But not in younger, vaccinated, and symptomatic persons.

Molnupavir in Previously Uninfected Nonhospitalized Persons with Covid-19

Background: Clinical benefit of Molnupiravir (MPV) in COVID-19 infected subpopulations is unclear. Method(s): We used a matched cohort design emulating a target trial to analyze the VA COVID-19 Shared Resource database to determine the association of MPV with hospitalization or death within 30 days compared with untreated controls in previously uninfected non-hospitalized persons. Incidence of hospitalization/ death and absolute risk difference (ARD) with 95% confidence intervals were calculated for the treated and untreated groups. Result(s): Among 1,459 matched pairs, the incidence of hospitalization/death was not different among MPV treated vs. untreated controls (48 vs. 44 cases;ARD [95% CI] 0.27 [-0.94,1.49]). No benefit was observed among those >60 or <60 years old (ARD 0.27 [-1.25,1.79] vs. -0.29 [-1.22,1.80]), those with specific comorbidities, or by vaccination status. A significant benefit was observed in asymptomatic but not in symptomatic persons (ARD -2.80 [-4.74,-0.87] vs. 1.12 [-0.31,2.55]). Kaplan-Meier curves did not show a significant reduction in proportion of persons who were hospitalized or died among those treated with MPV compared with untreated controls (logrank P=0.7). Conclusion(s): MPV was not associated with a significant reduction in hospitalization or death within 30 days of COVID-19 diagnosis overall. A subgroup of patients presenting without symptoms experienced a benefit.

Risk of Death in Remdesivir Treated and Untreated Patients with Covid-19 Infection

Background: The role of remdesivir in hospitalized patients with COVID-19 is not clear. Some studies have demonstrated improved clinical outcomes and reduced mortality, while others have failed to show a benefit. Method(s): We used the Department of Veterans Affairs' (VA) national COVID-19 Shared Data Resource database to identify confirmed SARS-CoV-2 infected Veterans between July 1, 2020 and December 31, 2021 who were hospitalized and received remdesivir and propensity-score matched controls who had not received remdesivir. Variables for propensity-score matching included demographics, comorbidities, time and location of diagnosis/admission, severity of illness, and use of other potential COVID-19 therapeutics. Primary outcome of interest was 28-day mortality in the entire matched cohort, and among subgroups stratified by use of supplemental oxygen. Result(s): Among 238,298 SARS-CoV-2 infected Veterans, 31,632 were hospitalized, and 13,147 received remdesivir. Our final dataset included 3,583 remdesivir recipients and 3,583 propensity-score matched controls. Probability of survival at 28 days overall was higher in those who had received remdesivir (P=0.032). Remdesivir recipients had better survival among the group who received supplemental oxygen but did not require mechanical ventilation (P=0.005). Conclusion(s): Remdesivir demonstrated a survival benefit among hospitalized patients with COVID-19 which was limited to those who received supplemental oxygen but did not require mechanical ventilation.

Clinical Efficacy of Modified Sanxiaoyin in Treatment of Mild or Moderate COVID-19 Patients：Based on Retrospective Analysis

［］ Objective： To retrospectively analyze the clinical data of 52 patients with coronavirus disease-2019 （COVID-19） and explore the clinical efficacy of modified Sanxiaoyin on mild/moderate COVID-19 patients. Method： The propensity score matching method was used to collect the clinical data of mild or moderate COVID-19 patients enrolled in the designated hospital of the Second Hospital of Jingzhou from December 2019 to May 2020. A total of 26 eligible patients who were treated with modified Sanxiaoyin were included in the observation group，and the 26 patients treated with conventional method were the regarded as the control. The disappearance of clinical symptoms，disappearance time of main symptoms，efficacy on traditional Chinese medicine（TCM）symptoms，hospitalization duration，laboratory test indicators，and CT imaging changes in the two groups were compared. Result： The general data in the two groups were insignificantly different and thus they were comparable. After 7 days of treatment，the disappearance rate of fever，cough， fatigue，dry throat，anorexia，poor mental state，and poor sleep quality in the observation group was higher than that in the control group（P<0.05），and the difference in the disappearance rate of expectoration and chest distress was insignificant. For the cases with the disappearance of symptoms，the main symptoms（fever， cough，fatigue，dry throat，anorexia，chest distress）disappeared earlier in the observation group than in the control group（P<0.01）. After 7 days of treatment，the scores of the TCM symptom scale of both groups decreased（P<0.01），and the decrease of the observation group was larger that of the control group（P<0.01）. All patients in the two groups were cured and discharged. The average hospitalization duration in the observation group［（12.79±2.68）d］was shorter than that in the control group［（15.27±3.11）d］（P<0.01）. The effective rate in the observation group（92.31%，24/26）was higher than that in the control group（76.92%，20/26）. After 7 days of treatment，the lymphocyte（LYM）count increased（P<0.05），and white blood cell（WBC）count and neutrophil（NEUT）count decreased insignificantly in the two groups. Moreover，levels of C-reactive protein （CRP），erythrocyte sedimentation rate（ESR），and procalcitonin（PCT）reduced in the two groups after treatment（P<0.01）and the reduction in the observation group was larger than that in the control group （P<0.01）. Through 7 days of treatment，the total effective rate on pulmonary shadow in the observation group （90.00%，18/20）was higher than that in the control group（77.27%，17/22）（P>0.05）and the improvement of lung shadow in the observation group was better than that in the control group（P<0.01）. Conclusion：Modified Sanxiaoyin can significantly alleviate fever，cough，fatigue，anorexia，chest distress，poor sleep quality，and other symptoms of patients with mild or moderate COVID-19，improve biochemical indicators，and promote the recovery of lung function. This paper provides clinical evidence for the application of modified Sanxiaoyin in the treatment of mild or moderate COVID-19. © 2022, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.

Convolutional Neural Network for Computer-aided Identification: Detection of Lung CT Images Using CNN for COVID-19 Identification

The angle of the photo, the size of the lung, and some occlusions make it difficult to control the accuracy when recognizing COVID-19 images, so recognition of related images is always a major problem. In our paper, we built a Convolutional Neural Network (CNN) model based on Keras, and ReLU function was employed in our model for hierarchical computation of image data, which aims to speed up the computation and improve the accuracy. To be more specific, the overall process of our method is to first convert the label set created during image reading into a specific format using one-hot labels and reduce it to a new label set, then apply the proposed CNN model to perform the hierarchical computation, and finally applied Adam optimizer to compile the neural network. The experimental results show that our proposed method has a very good accuracy rate, and it can be used in the field of COVID-19 identification. © 2022 IEEE.

Cardiovascular Disease Risk Improves COVID-19 Patient Outcome Prediction

The pandemic of coronavirus disease 2019 (COVID-19) has severely impacted the world. Several studies suggest an increased risk for COVID-19 patients with underlying cardiovascular diseases (CVD). However, it is challenging to quantify such risk factors and integrate them into patient condition evaluation. This paper presents machine learning methods to assess CVD risk scores from chest computed tomography together with laboratory data, demographics, and deep learning extracted lung imaging features to increase the outcome prediction accuracy for COVID-19 patients. The experimental results demonstrate an overall increase in prediction performance when the CVD severity score was added to the feature set. The machine learning methods obtained their best performance when all categories of the features were used for the patient outcome prediction. With the best attained area under the curve of 0.888, the presented research may assist physicians in clinical decision-making process on managing COVID-19 patients. © 2021, Springer Nature Switzerland AG.

Transmission of COVID-19 virus by cough-induced particles in an airliner cabin section

With airborne transmissions found as one of the major transmission routes of SARS-CoV-2, its transmission in airliner cabin environments drew special attention due to high number of imported cases and in-cabin transmissions. This study numerically investigated the transmission of COVID-19 by cough-induced particles in a cabin section of Boeing 737 model. One passenger was coughing in each case, while cough particles with measured size distributions were released during coughs and were tracked using the Lagrangian framework. Outcomes revealed that cough flow released by passengers could develop rapidly into a strong turbulent cough jet, breaking up the local airflow field. The released cough particles were largely dominated by the cough jet within 5 s, especially the first 1.5 s. Deposition of particles under 100 µm were relatively delayed when released from a window-seat location. Small particles (under 50 µm) released by a window-seat passenger were more likely to spread widely in the studied cabin section, which could lead to the highest exposure risks to nearby passengers. Also, due to ventilation design and seating arrangement, cough particles released by the middle-seat passenger were found easily trapped in his/her own local environment. Cough particles released from aisle-seat passengers had the least exposure risk to adjacent passengers. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Bibliometric analysis on global research trends of airborne microorganisms in recent ten years (2011-2020)

In recent years, exposure to bioaerosols—airborne particles of biological origin—has become a significant public health concern. Hence, this study aims to provide a bibliometric analysis of global trends in research on airborne microorganisms in the last ten years (2011–2020). Using the Web of Science (WoS) Core Collection database, a total of 1087 articles published during this period were selected for analysis. Firstly, we identified 11 co-citation clusters: potential pan microbiome, bioaerosol science, beneficial microbe, urban area, fungal microbiota, wastewater treatment plant, airborne microbial aerosol, modern practice, composting facilities— a review, airborne microbial biodiversity, and acidic electrolyzed water. Based on the co-occurrence between keywords in this literature, we concluded that particle-attached microorganisms, community structures of urban airborne microbes, and biological aerosols have inspired the hotspots in research during recent years, which suggests that bioaerosols are currently a popular topic in the field of air microbiology, with bacteria being the most frequently studied airborne microorganisms. We also discovered that interest in coronavirus disease 2019 (COVID-19) has continually risen during the past eight months, with the number of relevant articles exceeding 19,880, of which 106 have been frequently cited. Analyzing 500 recent publications on this topic, we found a high co-occurrence of COVID-19, pandemic, and coronavirus as well as of anxiety, depression, and stress. The greatest number of articles on airborne microorganisms in the last decade have been contributed by the USA, followed by China and France. Moreover, according to this metric, the leading institutions are Colorado State University and Peking University, and the top three journals are Applied and Environmental Microbiology, Atmospheric Environment, and Science of the Total Environment. The annual publication volume for this subject shows an increasing trend, indicating that interest in airborne microorganisms continues to grow. Our bibliometric analysis reveals the recent research hotspots and topic trends in air microbiology, thus offering potential clues for further examination. © The Author(s).

Analysis on the characteristics and contributing factors of ophthalmic online consultation during the COVID-19 epidemic

AIM: To analyze the demands, consultation patterns and contributing factors of the patients involved in the ophthalmic on-line consultation during the COVID-19 epidemic to provide reference for the optimization of the ophthalmic online health care system. METHODS: Prospective observational study. The patients using "expert online consultation" provided by the Zhongshan Ophthalmic Center from February 1 to March 15, 2020 were enrolled. The baseline characteristics were analyzed. For the patients with repeated consultation, we randomly selected the same amount of patients with single consultation as comparison. The baseline characteristics, consultation purposes, disease types, and number of combined eye diseases between the patients with single and repeated consultation were compared, and the contributing factors of patients'consultation pattern were analyzed with statistical test and regression model. RESULTS: The "expert online consultation" provided 9 831 consultations during the study, 3 919 of which were single consultation while 5 912 of which came from the repeated consultations of 1 967 patients. 1 967 patients with single consultation were randomly selected and compared with the repeated inquirers. The main consultation purposes in the both groups were "return visit" (59.7%, 64.9%). There was no significant difference in age and gender distribution between the patients with single online visit and repeated online visits(P=0.897, 0.482). Compared with the patients with single visit, the patients with repeated visit were less with the purpose of "new-onset discomfort", more with the purpose of "return visit" and "follow-up after surgery", more with ocular surface, fundus and uveal diseases, and more with two or more combined eye diseases. Regression analysis showed that the patients with ocular refractive issues tended to have a single consultation, while the patients inquired on previous eye disease and surgery, with fundus or uveal disease tended to have repeated consultations. The number of repeated visits for the patients with diagnosed ophthalmopathy and ophthalmic surgery was higher than that for the patients with new-onset discomfort;the number of repeated visits was lower for the patients with lens and anterior segment diseases, and was higher for the patients with ocular surface diseases. CONCLUSION: During the COVID-19 epidemic, the main purpose of on-line ophthalmic consultation was return visit for the diagnosed eye diseases. Type of eye disease, consultation purpose and number of combined ophthalmopathies all affected whether the patients repeated the consultation and the repeated times. The arrangement of ophthalmologists in different sub-specialties should be adjusted according to the patients' needs and their consultation patterns.

Importance and guidelines of postmortem examination on COVID-19 cases: An overview

Since the outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) occurred in December 2019, in Wuhan, China, the COVID-19 has spread to 216 countries, areas, and territories and killed more than 400,000 people worldwide. On March 11, the World Health Organization (WHO) declared COVID-19 a pandemic. The pathological findings of COVID-19 by postmortem biopsy were first reported in April 2020. Since then, there have been many publications regarding the postmortem pathological findings of different organs of COVID-19 patients. Well-performed systemic autopsy examination on patients with related diseases, acute respiratory distress syndrome coronavirus (SARS-CoV), and Middle East respiratory syndrome coronavirus has provided critical information for better understanding the pathogenesis of the emerging infectious diseases in the past. An overview on the importance and guidelines of postmortem examination on suspected or confirmed COVID-19 patients is presented. © 2020 MEDKNOW. All right reserved.

[Respiratory support for severe 2019-nCoV pneumonia suffering from acute respiratory failure: time and strategy].

Respiratory support is a very important technique for saving severe 2019-nCoV pneumonia patients who suffering respiratory failure, which can improve oxygenation, reduce mortality. Therefore, how to reasonable using respiratory support technique is the key point that relating success or failure. In this paper, the authors introduce their experience on treating severe 2019-nCoV pneumonia, it is hopeful for current fighting against 2019-nCoV in China.

Real-time forecasts of the COVID-19 epidemic in China from February 5th to February 24th, 2020.

The initial cluster of severe pneumonia cases that triggered the COVID-19 epidemic was identified in Wuhan, China in December 2019. While early cases of the disease were linked to a wet market, human-to-human transmission has driven the rapid spread of the virus throughout China. The Chinese government has implemented containment strategies of city-wide lockdowns, screening at airports and train stations, and isolation of suspected patients; however, the cumulative case count keeps growing every day. The ongoing outbreak presents a challenge for modelers, as limited data are available on the early growth trajectory, and the epidemiological characteristics of the novel coronavirus are yet to be fully elucidated. We use phenomenological models that have been validated during previous outbreaks to generate and assess short-term forecasts of the cumulative number of confirmed reported cases in Hubei province, the epicenter of the epidemic, and for the overall trajectory in China, excluding the province of Hubei. We collect daily reported cumulative confirmed cases for the 2019-nCoV outbreak for each Chinese province from the National Health Commission of China. Here, we provide 5, 10, and 15 day forecasts for five consecutive days, February 5th through February 9th, with quantified uncertainty based on a generalized logistic growth model, the Richards growth model, and a sub-epidemic wave model. Our most recent forecasts reported here, based on data up until February 9, 2020, largely agree across the three models presented and suggest an average range of 7409-7496 additional confirmed cases in Hubei and 1128-1929 additional cases in other provinces within the next five days. Models also predict an average total cumulative case count between 37,415 and 38,028 in Hubei and 11,588-13,499 in other provinces by February 24, 2020. Mean estimates and uncertainty bounds for both Hubei and other provinces have remained relatively stable in the last three reporting dates (February 7th - 9th). We also observe that each of the models predicts that the epidemic has reached saturation in both Hubei and other provinces. Our findings suggest that the containment strategies implemented in China are successfully reducing transmission and that the epidemic growth has slowed in recent days.