Concurrence of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura: a case report and review of the literature.

BACKGROUND: Immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura are both causes of thrombocytopenia. Recognizing thrombotic thrombocytopenic purpura is crucial for subsequent treatment and prognosis. In clinical practice, corticosteroids and rituximab can be used to treat both immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura; plasma exchange therapy is the first-line treatment in thrombotic thrombocytopenic purpura, while corticosteroids are strongly recommended as first-line treatment in immune thrombocytopenic purpura. The differential diagnosis of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura is essential in clinical practice. However, case reports have suggested that immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura can occur concurrently. CASE PRESENTATION: We report the case of a 32-year-old Asian female without previous disease who presented with pancytopenia, concurrent with immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura. The morphology of the megakaryocytes in the bone marrow indicated immune-mediated thrombocytopenia. The patient received glucocorticoid treatment, and her platelet count increased; however, schistocytes remained high during the course of the therapy. Further investigations revealed ADAMTS13 activity deficiency and positive ADAMTS13 antibodies. The high titer of antinuclear antibody and positive anti-U1-ribonucleoprotein/Smith antibody indicated a potential autoimmune disease. However, the patient did not fulfill the current criteria for systemic lupus erythematosus or mixed connective tissue disease. The patient responded well to plasma exchange therapy, and her platelet count remained normal on further follow-up. CONCLUSIONS: Concurrence of immune thrombocytopenic purpura and thrombotic thrombocytopenic purpura is rare, but clinicians should be aware of this entity to ensure prompt medical intervention. Most of the reported cases involve young women. Human immunodeficiency virus infection, pregnancy, and autoimmune disease are the most common underlying conditions.

An Analysis of the Effect of Personal Protective Equipment (PPE) Training Based on the Information-Motivation-Behavior Skills Model in the Practice of COVID-19 PPE Application.

Objective: The aim of this study is to improve the effectiveness of training in putting on and removing personal protective equipment (PPE) during COVID-19. Methods: An information-motivation-behavioral skills (IMB) model intervention team was established with the adoption of the IMB model to intervene in putting on and removing PPE by medical staff during COVID-19. Specifically, the information intervention was strengthened through the formulation of the hospital manual for PPE application. In the present study's five-stage motivational interview, the personal motivation and social motivation of medical staff were deeply understood, helping the medical staff to improve their belief in the importance of correct PPE application and to establish the correct attitude toward PPE application. In terms of behavioral skills, there are numerous issues that could interfere with the establishment of proper PPE application, including material supply, double duty, simultaneous supervision of entering and leaving, continuous supervision, video supervision, and nosocomial infection inspection. The scores relating to PPE application knowledge and self-efficacy as well as the PPE usage qualification rate were calculated in the control group and the IMB intervention group and subsequently compared. Results: For the control group and the IMB intervention group, the scores for PPE application knowledge were 87.78 ± 10.46 and 95.56 ± 9.06 points, respectively. For self-efficacy, the scores were 25.19 ± 0.97 and 33.79 ± 2.05 points, and the PPE usage qualification rates were 64.8% and 90.0%, respectively. The differences in all the scores were statistically significant between the two groups. Conclusion: The application of the IMB model could improve the relevant knowledge relating to PPE application, strengthen the belief in the importance of and motivation for correct PPE application, improve the qualification rate for PPE application, and provide a theoretical and practical basis for reducing the occurrence of nosocomial infection.

Interleukin-6 blocking therapy for COVID-19: From immune pathogenesis to clinical outcomes.

As a newly emerged infectious disease, the coronavirus disease 2019 (COVID-19) has caused millions of deaths, resulting in a global health challenge. Currently, several vaccines have been approved with significant benefits against disease transmission. However, effective therapies are still needed for the clinical management of infected COVID-19 patients. Available evidence has indicated elevated levels of proinflammatory cytokines, including interleukin-6 (IL-6), in COVID-19 patients, with cytokine storm involving excessive cytokine release being observed in some severe cases. Several clinical studies have shown the promising effects of IL-6-blocking strategy in treating severe COVID-19 patients, but some observational studies have reported that IL-6-blocking therapy has no effects in preventing disease progression or death among COVID-19 patients. Herein, we review recent findings on the immunopathogenesis of COVID-19, with specific emphasis on the proinflammatory function of IL-6 and discuss the therapeutic potential of IL-6-blocking therapy for the treatment of COVID-19 patients, especially those with rheumatic diseases.

Therapeutic Monitoring of Plasma Digoxin for COVID-19 Patients Using a Simple UPLC-MS/MS Method

Background: Cardiovascular diseases (CVD) have been reported in 8%-16% of patients with 2019 coronavirus disease (COVID-19). Digoxin is one of the main drugs to treat CVD. Objective: The clinician conducted therapeutic drug monitoring (TDM) of digoxin according to the drug usage on patients to monitor the concentration of digoxin, so as to avoid its toxic and side effects, and provide a theoretical reference for clinical usage of digoxin in patients with COVID-19. Methods: A method for quantifying digoxin concentration in plasma with ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) was developed. After simple protein precipitation of plasma with methanol, digoxin and its internal standard (digoxin-d3) were detected in the positive ion mode using multiple reaction monitoring. Results: Plasma digoxin in the range of 0.2 - 10 ng/mL had good linearity. The UPLC-MS/MS method was validated with inter-run accuracies ranging from 91.3% to 107.4% and precision less than 13%. Nine plasma samples (5 at valley concentration and 4 at follow-up after stopping dosing) from three patients with COVID-19 were tested. The mean plasma digoxin concentration was 0.73 ng/mL (ranged from 0 to 1.31 ng/mL). Digoxin was detected at the concentration of 0.93 ng/mL after stopping drug administration for 14 days. Conclusion: In this study, we established a simple UPLC-MS/MS method using protein-precipitation to perform TDM of digoxin in patients with COVID-19, and found that about 56% of digoxin plasma concentration was within the treatment window (0.8 - 2.0 ng/mL). Digoxin can be remained in the body for nearly 14 days in severe patients with COVID-19 after stopping dosing.

Influencing Factors of Environmental Risk Perception during the COVID-19 Epidemic in China.

The spread of COVID-19 is having a serious impact on socioeconomic development, and increased environmental risk perception (ERP). ERP provide new ideas for the orderly recovery of society. However, there have been studies that often pay attention to individual factors, and less concerned about the external environment. In fact, ERP will be affected by the external environment and individual factors. We used a Python script to collect 65,277 valid Weibo comments during the COVID-19 epidemic in China to assess urban residents' environmental risk perception (ERP). SnowNLP emotion analysis was used to measure the ERP of 366 urban in China, and the structural proportion characteristics and spatial-temporal differentiation of ERP were analyzed. Then, an order logistic regression model was used to investigate the relationship between economic level, social security, medical facilities and ERP. The study investigated the Chinese cities have a higher ERP during the COVID-19 period, and it shows marked fluctuations. As COVID-19 spreads, the ERP shows a distribution pattern of "high in the southeast and low in the northwest" with Hu line as the boundary and "from high to low" with Wuhan as the high value center. COVID-19 serves as catalysts for ERP, the impact of COVID-19 is enhanced after socioeconomic factors are considered. The economic level effectively regulates ERP, except the stage of accelerating diffusion. ERP is effectively stabilized by social security and medical facilities. After considering all the variables simultaneously, we found that the mitigation effect of social security and medical facilities on ERP has improved.

Clinical Significance of an IgM and IgG Test for Diagnosis of Highly Suspected COVID-19.

Background: Nucleic acid detection and CT scanning have been reported in COVID-19 diagnosis. Here, we aimed to investigate the clinical significance of IgM and IgG testing for the diagnosis of highly suspected COVID-19. Methods: A total of 63 patients with suspected COVID-19 were observed, 57 of whom were enrolled (24 males and 33 females). The selection was based on the diagnosis and treatment protocol for COVID-19 (trial Sixth Edition) released by the National Health Commission of the People's Republic of China. Patients were divided into positive and negative groups according to the first nucleic acid results from pharyngeal swab tests. Routine blood tests were detected on the second day after each patient was hospitalized. The remaining serum samples were used for detection of novel coronavirus-specific IgM/IgG antibodies. Results: The rate of COVID-19 nucleic acid positivity was 42.10%. The positive detection rates with a combination of IgM and IgG testing for patients with COVID-19 negative and positive nucleic acid test results were 72.73 and 87.50%, respectively. Conclusions: We report a rapid, simple, and accurate detection method for patients with suspected COVID-19 and for on-site screening for close contacts within the population. IgM and IgG antibody detection can identify COVID-19 after a negative nucleic acid test. Diagnostic accuracy of COVID-19 might be improved by nucleic acid testing in patients with a history of epidemic disease or with clinical symptoms, as well as CT scans when necessary, and serum-specific IgM and IgG antibody testing after the window period.

Prodrugs of a 1'-CN-4-Aza-7,9-dideazaadenosine C-Nucleoside Leading to the Discovery of Remdesivir (GS-5734) as a Potent Inhibitor of Respiratory Syncytial Virus with Efficacy in the African Green Monkey Model of RSV.

A discovery program targeting respiratory syncytial virus (RSV) identified C-nucleoside 4 (RSV A2 EC50 = 530 nM) as a phenotypic screening lead targeting the RSV RNA-dependent RNA polymerase (RdRp). Prodrug exploration resulted in the discovery of remdesivir (1, GS-5734) that is >30-fold more potent than 4 against RSV in HEp-2 and NHBE cells. Metabolism studies in vitro confirmed the rapid formation of the active triphosphate metabolite, 1-NTP, and in vivo studies in cynomolgus and African Green monkeys demonstrated a >10-fold higher lung tissue concentration of 1-NTP following molar normalized IV dosing of 1 compared to that of 4. A once daily 10 mg/kg IV administration of 1 in an African Green monkey RSV model demonstrated a >2-log10 reduction in the peak lung viral load. These early data following the discovery of 1 supported its potential as a novel treatment for RSV prior to its development for Ebola and approval for COVID-19 treatment.

Vitamin C supplementation is necessary for patients with coronavirus disease: An ultra-high-performance liquid chromatography-tandem mass spectrometry finding.

To administer vitamin C (VC) with precision to patients with the coronavirus disease (COVID-19), we developed an ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method to assess plasma VC concentrations. 31 patients with COVID-19 and 51 healthy volunteers were enrolled. VC stability was evaluated in blood, plasma, and precipitant-containing stabilizers. A proportion of 7.7 % of VC was degraded in blood at room temperature (RT) (approximately 20-25 °C) at 1.5 h post administration with respect to the proportion degraded at 0.5 h, but without statistical difference. VC was stable in plasma for 0.75 h at RT, 2 h at 4 °C, 5 days at -40 °C, and 4 h in precipitant-containing stabilizer (2 % oxalic acid) at RT. The mean plasma concentration of VC in patients with COVID-19 was 2.00 mg/L (0.5-4.90) (n = 8), which was almost 5-fold lower than that in healthy volunteers (9.23 mg/L (3.09. 35.30)) (n = 51). After high-dose VC treatment, the mean VC concentration increased to 13.46 mg/L (3.93. 34.70) (n = 36), higher than that in healthy volunteers, and was within the normal range (6-20 mg/L). In summary, we developed a simple UPLC-MS/MS method to quantify VC in plasma, and determined the duration for which the sample remained stable. VC levels in patients with COVID-19 were considerably low, and supplementation at 100 mg/kg/day is considered highly essential.

Epidemic control practices of an otolaryngology-head and neck surgery ward in an area with non-high incidence of COVID-19

The COVID-19 epidemic is still severe. As a non-high incidence area outside Hubei, the epidemic prevention and control of primary otolaryngology-head and neck surgery has its own characteristics. Daily diagnosis and treatment are performed in the ward to prevent cross infection by medical staff. This article combines our department's experience and the measures taken in this area with respect to ward diagnosis and treatment practices. We hope that our experience will be helpful to our otolaryngology-head and neck surgery colleagues in non-high incidence areas outside Hubei.

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.