Potential influence of COVID-19 and dexamethasone on the reproductive system: what we know and can expect.

Dexamethasone is the first and an important therapy that significantly reduces the risk of death in patients with severe COVID-19 disease. Nevertheless, a lot of studies have revealed that it has adverse impacts on multiple systems of the body especially the reproductive system, and dexamethasone exposure during the human foetal period may be associated with various diseases. In this paper, we reviewed the literature regarding the adverse effects of COVID-19 and dexamethasone administration on the reproductive system as well as related disease pathogenesis, in an attempt to clarify the potential harms of dexamethasone treatment in COVID-19 patients. Overall, we strongly support the application of dexamethasone as a pharmaceutical therapy in critical COVID-19 patients before a better therapy is developed, but the adverse side effects that may arise cannot be ignored. Our review will help medical professionals in the prognosis and follow-up of patients treated with dexamethasone. In addition, given that a considerable amount of uncertainty, confusion and even controversy that still remains, further studies and more clinical trials are urgently needed to improve the understanding of the parameters and the effects of dexamethasone on reproductive function of patients with severe acute respiratory syndrome coronavirus 2 infection.

Symptom Burden among Older COVID-19 Survivors Two Years after Hospital Discharge.

To study the long-term symptom burden among older COVID-19 survivors 2 years after hospital discharge and identify associated risk factors. The current cohort study included COVID-19 survivors aged 60 years and above, who were discharged between February 12 and April 10, 2020, from two designated hospitals in Wuhan, China. All patients were contacted via telephone and completed a standardized questionnaire assessing self-reported symptoms, the Checklist Individual Strength (CIS)-fatigue subscale, and two subscales of the Hospital Anxiety and Depression Scale (HADS). Of the 1,212 patients surveyed, the median (IQR) age was 68.0 (64.0-72.0), and 586 (48.3%) were male. At the two-year follow-up, 259 patients (21.4%) still reported at least one symptom. The most frequently self-reported symptoms were fatigue, anxiety, and dyspnea. Fatigue or myalgia, which was the most common symptom cluster (11.8%; 143/1212), often co-occurred with anxiety and chest symptoms. A total of 89 patients (7.7%) had CIS-fatigue scores ≥ 27, with older age (odds ratio [OR], 1.08; 95% CI: 1.05-1.11, P < 0.001) and oxygen therapy (OR, 2.19; 95% CI: 1.06-4.50, P= 0.03) being risk factors. A total of 43 patients (3.8%) had HADS-Anxiety scores ≥ 8, and 130 patients (11.5%) had HADS-Depression scores ≥ 8. For the 59 patients (5.2%) who had HADS total scores ≥ 16, older age, serious illness during hospitalization and coexisting cerebrovascular diseases were risk factors. Cooccurring fatigue, anxiety, and chest symptoms, as well as depression, were mainly responsible for long-term symptom burden among older COVID-19 survivors 2 years after discharge.

Effects of a online brief modified mindfulness-based stress reduction therapy for anxiety among Chinese adults: A randomized clinical trial

The COVID-19 pandemic has exacerbated anxiety and related symptoms among the general population. In order to cope with the mental health burden, we developed an online brief modified mindfulness-based stress reduction (mMBSR) therapy. We performed a parallel-group randomized controlled trial to evaluate the efficacy of the mMBSR for adult anxiety with cognitive-behavioral therapy (CBT) as an active control. Participants were randomized to mMBSR, CBT or waitlist group. Those in the intervention arms performed each therapy for 6 sections in 3 weeks. Measurements were conducted at baseline, post-treatment and 6 months post-treatment by Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Patient Health Questionnaire-15, reverse scored Cohen Perceived Stress scale, Insomnia Severity Index, and Snaith-Hamilton Pleasure Scale. 150 participants with anxiety symptoms were randomized to mMBSR, CBT or waitlist group. Post intervention assessments showed that mMBSR improved the scores of all the six mental problem dimensions (anxiety, depression, somatization, stress, insomnia, and the experience of pleasure) significantly compared to the waitlist group. During 6-month post treatment assessment, the scores of all six mental problem dimensions in the mMBSR group still showed improvement compared to baseline and showed no significant difference with the CBT group. Our results provide positive evidence for the efficacy and feasibility of an online brief modified MBSR program to alleviate anxiety and related symptoms of individuals from the general population, and the therapeutic benefits of mMBSR persisted for up to six months. This low resource-consuming intervention could facilitate the challenges of supplying psychological health therapy to large scale of population.

Effects of a online brief modified mindfulness-based stress reduction therapy for anxiety among Chinese adults: A randomized clinical trial.

The COVID-19 pandemic has exacerbated anxiety and related symptoms among the general population. In order to cope with the mental health burden, we developed an online brief modified mindfulness-based stress reduction (mMBSR) therapy. We performed a parallel-group randomized controlled trial to evaluate the efficacy of the mMBSR for adult anxiety with cognitive-behavioral therapy (CBT) as an active control. Participants were randomized to mMBSR, CBT or waitlist group. Those in the intervention arms performed each therapy for 6 sections in 3 weeks. Measurements were conducted at baseline, post-treatment and 6 months post-treatment by Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Patient Health Questionnaire-15, reverse scored Cohen Perceived Stress scale, Insomnia Severity Index, and Snaith-Hamilton Pleasure Scale. 150 participants with anxiety symptoms were randomized to mMBSR, CBT or waitlist group. Post intervention assessments showed that mMBSR improved the scores of all the six mental problem dimensions (anxiety, depression, somatization, stress, insomnia, and the experience of pleasure) significantly compared to the waitlist group. During 6-month post treatment assessment, the scores of all six mental problem dimensions in the mMBSR group still showed improvement compared to baseline and showed no significant difference with the CBT group. Our results provide positive evidence for the efficacy and feasibility of an online brief modified MBSR program to alleviate anxiety and related symptoms of individuals from the general population, and the therapeutic benefits of mMBSR persisted for up to six months. This low resource-consuming intervention could facilitate the challenges of supplying psychological health therapy to large scale of population.

Liver Injury in Patients with COVID-19: A Retrospective Study.

Objectives: The objective of this study is to explore the incidence, characteristics, risk factors, and prognosis of liver injury in patients with COVID-19. Methods: We collected clinical data of 384 cases of COVID-19 and retrospectively analyzed the incidence, characteristics, and risk factors of liver injury of the patients. In addition, we followed the patient two months after discharge. Results: A total of 23.7% of the patients with COVID-19 had liver injury, with higher serum AST (P < 0.001), ALT (P < 0.001), ALP (P = 0.004), GGT (P < 0.001), total bilirubin (P = 0.002), indirect bilirubin (P = 0.025) and direct bilirubin (P < 0.001) than the control group. The median serum AST and ALT of COVID-19 patients with liver injury were mildly elevated. Risk factors of liver injury in COVID-19 patients were age (P = 0.001), history of liver diseases (P = 0.002), alcoholic abuse (P = 0.036), body mass index (P = 0.037), severity of COVID-19 (P < 0.001), C-reactive protein (P < 0.001), erythrocyte sedimentation rate (P < 0.001), Qing-Fei-Pai-Du-Tang treatment (P = 0.032), mechanical ventilation (P < 0.001), and ICU admission (P < 0.001). Most of the patients (92.3%) with liver injury were treated with hepatoprotective drugs. 95.6% of the patients returned to normal liver function tests at 2 months after discharge. Conclusions: Liver injury was commen in COVID-19 patients with risk factors, most of them have mild elevations in transaminases, and conservative treatment has a good short-term prognosis.

Emergency methods, moral dilemma and coping styles among frontline nurses: an explorative study during the COVID-19 pandemic

Background: Coronavirus disease 2019 (COVID-19) pandemic has greatly impacted China, especially the emergency services since 2020. For many, it raises unique ethical dilemmas, including psychological, moral, social, and economic issues, especially among frontline health workers.

Mitochondrial dysfunction is associated with lipid metabolism disorder and upregulation of angiotensin-converting enzyme 2.

Thymidine kinase 2 (TK2) deficiency in humans leads to a myopathic form of mitochondrial DNA (mtDNA) deficiency. Here we present a skeletal and cardiac muscle specific TK2 knockout mouse (mTk2 KO). The mice showed dilated hearts and markedly reduced adipose tissue during week 12 to 16. A severe decrease of mtDNA was found only in skeletal muscle and heart tissue in mTk2 KO mice. Expression analysis of key metabolic genes of 16 weeks knockout mice showed significant changes of genes involved in lipid metabolism, with different patterns in heart and skeletal muscle. Our study further suggests that lipoprotein lipase (LPL) from liver supports the metabolism when heart and skeletal muscle were impaired due to mitochondrial dysfunction. The angiotensin-converting enzyme 2 (ACE2), which is involved in glucose homeostasis, was also affected by mtDNA deficiency in our study. Interestingly, both the gene and protein expression of ACE2 were increased in cardiac tissue of mTk2 KO mice. Since ACE2 is a receptor for the SARS-CoV-2 virus, its regulation in relation to mitochondrial function may have important clinical implications.

Hydro electroactive Cu/Zn coated cotton fiber nonwovens for antibacterial and antiviral applications.

In this study, Cu/Zn galvanic electrodes were sputtered on the two surfaces of hydrophilic cotton fiber nonwovens (Cotton) to prepare hydro electroactive Cu/Cotton/Zn composites. When the Cu/Cotton/Zn was used as a functional layer in the face mask, the Cu/Zn galvanic electrodes can be spontaneously activated by water vapor molecules exhaled by the human body and generate galvanic current. Based on this, the hydro electroactive Cu/Cotton/Zn demonstrated excellent antibacterial activity against Escherichia coli and Staphylococcus aureus and could deactivate Enterovirus 71 (EV71) virions transmitted through the respiratory tract by 97.72% after 15 min of contact. Moreover, the Cu/Cotton/Zn did not affect the particle filtration efficiency and breathability of the face mask's polypropylene (PP) melt-blown layer. Furthermore, the cytotoxicity assessment of Cu/Cotton/Zn showed no cytotoxicity, indicating good biological security. Overall, the Cu/Cotton/Zn may provide a new approach to increase the antibacterial and antiviral performance of current personnel protective equipment on the market.

Review and Thinking on Forensic Pathological Changes of Coronavirus-Infected Diseases.

Since the beginning of this century, three types of coronavirus have widely transmitted and caused severe diseases and deaths, which strongly indicates that severe infectious diseases caused by coronavirus infection are not accidental events. Coronavirus-infected diseases are mainly manifested by respiratory symptoms, with multiple organ dysfunctions. Precisely investigating the pathological process, characteristics and pathogenesis of coronavirus-infected diseases will be beneficial for us to understand clinical manifestations and provide targeted suggestions on prophylaxis and treatment. This paper briefly reviews the pathological findings of three known coronavirus-infected diseases, and attempts to construct the pathological spectrum of coronavirus-infected diseases, aiming to provide reference and thinking for autopsy, histopathological examination and animal infection model study of coronavirus-infected diseases.

Emergence of a young case infected with avian influenza A (H5N6) in Anhui Province, East China during the COVID-19 pandemic.

In the context of the coronavirus disease 2019 pandemic, we investigated the epidemiological and clinical characteristics of a young patient infected by avian influenza A (H5N6) virus in Anhui Province, East China, and analyzed genomic features of the pathogen in 2020. Through the cross-sectional investigation of external environment monitoring (December 29-31, 2020), 1909 samples were collected from Fuyang City. It was found that the positive rate of H5N6 was higher than other areas obviously in Tianma poultry market, where the case appeared. In addition, dual coinfections were detected with a 0.057% polymerase chain reaction positive rate the surveillance years. The virus was the clade 2.3.4.4, which was most likely formed by genetic reassortment between H5N6 and H9N2 viruses. This study found that the evolution rates of the hemagglutinin and neuraminidase genes of the virus were higher than those of common seasonal influenza viruses. The virus was still highly pathogenic to poultry and had a preference for avian receptor binding.

Laboratory Predictors of COVID-19 Pneumonia in Patients with Mild to Moderate Symptoms.

OBJECTIVE: This research aims to develop a laboratory model that can accurately distinguish pneumonia from nonpneumonia in patients with COVID-19 and to identify potential protective factors against lung infection. METHODS: We recruited 50 patients diagnosed with COVID-19 infection with or without pneumonia. We selected candidate predictors through group comparison and punitive least absolute shrinkage and selection operator (LASSO) analysis. A stepwise logistic regression model was used to distinguish patients with and without pneumonia. Finally, we used a decision-tree method and randomly selected 50% of the patients 1000 times from the same specimen to verify the effectiveness of the model. RESULTS: We found that the percentage of eosinophils, a high-fluorescence-reticulocyte ratio, and creatinine had better discriminatory power than other factors. Age and underlying diseases were not significant for discrimination. The model correctly discriminated 77.1% of patients. In the final validation step, we observed that the model had an overall predictive rate of 81.3%. CONCLUSION: We developed a laboratory model for COVID-19 pneumonia in patients with mild to moderate symptoms. In the clinical setting, the model will be able to predict and differentiate pneumonia vs nonpneumonia before any lung computed tomography findings. In addition, the percentage of eosinophils, a high-fluorescence-reticulocyte ratio, and creatinine were considered protective factors against lung infection in patients without pneumonia.

The UV/H2O2 Process Based on H2O2 In-situ Generation for Water Disinfection

Till now, the unprecedented global spread of novel coronavirus disease (nCOVID-19) threatened human health, economy as well as ecosystem services gravely. An efficient disinfection technology is highly demanded. Ultraviolet (UV)/H2O2 process seems like a potential candidate, in which H2O2 is an indispensable oxidant for HO· species production. In this work, UV/H2O2, which coupled with in-situ generated H2O2, was demonstrated as an effective process for disinfection than UV, which would play a significant role in sterilization and disinfection for water treatment. In addition, we investigated the effects of catalyst layer (CL) calcination on the performance of two-electron oxygen reduction reaction (ORR) for H2O2 generation. It is found that the two-electron ORR activity can be intensified by avoiding calcination of CL, which can be mainly due to much oxygen functional groups (C − O and C = O) as well as higher conductivity and reaction kinetics.

Acute psychological impact on COVID-19 patients in Hubei: a multicenter observational study.

We conducted a multicentre cross-sectional survey of COVID-19 patients to evaluate the acute psychological impact on the patients with coronavirus disease 2019 (COVID-19) during isolation treatment based on online questionnaires from 2 February to 5 March 2020. A total of 460 COVID-19 patients from 13 medical centers in Hubei province were investigated for their mental health status using online questionnaires (including Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Patient Health Questionnaire-15, and Insomnia Severity Index scales). Among all 460 COVID-19 patients, 187 (40.65%) of them were healthcare workers (HCWs). 297 (64.57%) of them were females. The most common psychological problems were somatization symptoms (66.09%, n = 304), followed by depression (53.48%, n = 246), anxiety (46.30%, n = 213), problems of insomnia (42.01%, n = 171), and then self-mutilating or suicidal thoughts (23.26%, n = 107). Of all the patients, 15.65% (n = 72) had severe somatization symptoms, and 2.83% (n = 13) had severe (almost every day) self-mutilating or suicidal thoughts. The most common psychological problems for HCWs were somatization symptoms (67.84%, n = 125), followed by depression (51.87%, n = 97), anxiety (44.92%, n = 84), problems of insomnia (36.18%, n = 55), and then self-mutilating or suicidal thoughts (20.86%, n = 39). Patients with lower education levels were found to be associated with higher incidence of self-mutilating or suicidal thoughts (odds ratio [OR], 2.68, 95% confidence interval [95% CI], 1.66-4.33 [P < 0.001]). Patients with abnormal body temperature were found to be associated with higher incidence of self-mutilating or suicidal thoughts (OR, 3.97, 95% CI, 2.07-7.63 [P < 0.001]), somatic symptoms (OR, 2.06, 95% CI, 1.20-3.55 [P = 0.009]) and insomnia (OR, 1.66, 95% CI, 1.04-2.65 [P = 0.033]). Those with suspected infected family members displayed a higher prevalence of anxiety than those without infected family members (OR, 1.61, 95% CI, 1.1-2.37 [P = 0.015]). Patients at the age of 18-44 years old had fewer somatic symptoms than those aged over 45 years old (OR, 1.91, 95% CI, 1.3-2.81 [P = 0.001]). In conclusion, COVID-19 patients tended to have a high prevalence of adverse psychological events. Early identification and intervention should be conducted to avoid extreme events such as self-mutilating or suicidal impulsivity for COVID-19 patients, especially for those with low education levels and females who have undergone divorce or bereavement.

[Clinical efficacy and safety of different antiviral regimens in patients with coronavirus disease 2019].

OBJECTIVE: To investigate the clinical efficacy and short-term and long-term adverse reactions for different antiviral regiments for coronavirus disease 2019 (COVID-19) in Ningxia Hui Autonomous Region during hospitalization and follow-up in 3 months. METHODS: A single-center retrospective study was conducted to enroll the COVID-19 patients in isolation ward of the only designated hospital to receive COVID-19 patients (the Fourth People's Hospital of Ningxia Hui Autonomous Region) when the authors were assigned by the Ningxia Health Commission as experts from January 20, 2020 to March 15, 2020. According to the antiviral regimen, the patients were divided into conventional antiviral group and unconventional antiviral group. The conventional antiviral group received α-interferon combined with Lopinavir/Ritonavir (LPV/R). The unconventional antiviral group was given α-interferon combined with LPV/R and Abidor or Ribavirin or Chloroquine. The patients were divided into mild (13 cases), ordinary (45 cases), severe (14 cases) and critical (1 case) types. The clinical data, length of hospital stay, the first 2019 novel coronavirus (2019-nCoV) nucleic acid negative recovery time, cost of hospitalization, 2019-nCoV nucleic acid positive reversal after 14 days of discharge, and the combination of hormones and antibiotics were collected. The differences in blood routine, liver function, blood lipid level and adverse reactions of antiviral drugs during hospitalization were compared between the two groups at 1, 3 and 7 days after admission and 1 and 3 months after discharge. RESULTS: (1) General information: a total of 75 patients with confirmed COVID-19 were admitted, and 73 patients were eventually enrolled, including 47 cases in the conventional antiviral group and 26 cases in the unconventional antiviral group. Patients with different clinical classification were analyzed, the higher the clinical classification and the patients' age, the higher the proportion of primary diseases and the cost of treatment, and the longer the length of hospital stay. Compared with conventional antiviral group, in unconventional antiviral group the percentage of severe and critical patients were higher [34.6% (9/26) vs. 10.6% (5/47), 3.8% (1/26) vs. 0 (0/47)], the length of hospital stay (days: 16.1±5.6 vs. 11.6±3.3), first nucleic acid negative recovery time (days: 12.4±4.5 vs. 10.0±3.5) were longer, and hospitalization cost was higher [Yuan: 11 984.2 (9 000.6, 24 424.7) vs. 8 140.4 (6 715.7,9 707.7)], with statistically significant differences (all P < 0.05). There were no significant differences in gender, age, proportion of patients with primary diseases and nucleic acid positive reversal rate after 14 days of discharge between the unconventional and conventional antiviral groups (all P > 0.05). (2) Laboratory tests: during the hospitalization, white blood cell count (WBC), platelet count (PLT), total bilirubin (TBil) and three acyl glycerin (TG) levels were first increased and then reduced, lymphocyte count (LYM) was first decreased and then increased in two groups. In the unconventional antiviral group, WBC [(6.53±2.78)×109/L], PLT [(250.77±96.12)×109/L], and TG [(1.94±0.96) µmol/L] all reached their peak values at 7 days after admission. TBil peaked at 3 days after admission, which was (23.69±12.14) µmol/L, and LYM reached the peak 1 month after discharge, which was (1.82±0.50)×109/L; however, there was no statistical significance among the above indicators between two groups. There were no statistically significant differences in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total cholesterol (TC) between the two groups at each time point. (3) The ratio of combined use of hormones in the non-antiviral group was significantly higher than that in the conventional antiviral group [26.9% (7/26) vs. 4.3% (2/47), P < 0.05]. CONCLUSIONS: Age and associated primary diseases are related to the severity of COVID-19 patients. Unconventional antiviral treatment regimens are mostly used for severe COVID-19 patients whose ucleic acid did not turn negative for a long time. Individual antiviral therapy can be used based on the patients' response and tolerance to drugs.

Prevalence of psychological disorders in the COVID-19 epidemic in China: A real world cross-sectional study.

OBJECTIVE: This study aimed to explore the prevalence of psychological disorders and associated factors at different stages of the COVID-19 epidemic in China. METHODS: The mental health status of respondents was assessed via the Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI) and the Generalized Anxiety Disorder 7 (GAD-7) scale. RESULTS: 5657 individuals participated in this study. History of chronic disease was a common risk factor for severe present depression (OR 2.2, 95% confidence interval [CI], 1.82-2.66, p < 0.001), anxiety (OR 2.41, 95% CI, 1.97-2.95, p < 0.001), and insomnia (OR 2.33, 95% CI, 1.83-2.95, p < 0.001) in the survey population. Female respondents had a higher risk of depression (OR 1.61, 95% CI, 1.39-1.87, p < 0.001) and anxiety (OR 1.35, 95% CI, 1.15-1.57, p < 0.001) than males. Among the medical workers, confirmed or suspected positive COVID-19 infection as associated with higher scores for depression (confirmed, OR 1.87; suspected, OR 4.13), anxiety (confirmed, OR 3.05; suspected, OR 3.07), and insomnia (confirmed, OR 3.46; suspected, OR 4.71). LIMITATION: The cross-sectional design of present study presents inference about causality. The present psychological assessment was based on an online survey and on self-report tools, albeit using established instruments. We cannot estimate the participation rate, since we cannot know how many potential subjects received and opened the link for the survey. CONCLUSIONS: Females, non-medical workers and those with a history of chronic diseases have had higher risks for depression, insomnia, and anxiety. Positive COVID-19 infection status was associated with higher risk of depression, insomnia, and anxiety in medical workers.