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1.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-334539

ABSTRACT

Aims: To evaluate the mortality of eight antihyperglycemics for COVID-19 patients with diabetes prior to diagnosis of COVID-19. Materials and Methods: We searched PubMed, Embase, Cochrane Central Register, Web of Science, and ClinicalTrials. gov through 21 March 2022. COVID-19 patients with diabetes while receiving glucose-lowering therapies for at least 14 days prior to COVID-19 confirmed were included. The Newcastle Ottawa scale was used to assess the risk of bias in nonrandomized studies. Bayesian network meta-analyses were performed. Results: Twenty nine distinct observational studies (3,665,644 COVID-19 patients with diabetes mellitus) were included. Compared with insulin, DPP4i, secretagogues, and glucosidase inhibitors, the incidence of adverse outcomes in patients with diabetes who took SGLT2i was relatively lower: OR 2.7 (95% CrI 1.9-3.9);2,0 (1.4-2.8);1.6 (1.1-2.4);1.8 (1.1-3.0);0.32 (0.16-0.70);0.47 (0.23-0.95). The SUCRA value of SGLT2i was the lowest (7%), followed by GLPIRA (13%) and biguanides (35%). Conclusion: The limitation of this study is that the differences in basic characteristics among therapies arms were not analyzed. SGLT2I may be an optimal choice for patients with diabetes before COVID-19 infection. GLP1RA and guanidine can also be a good choice for the protection of patients with diabetes during COVID-19 pandemic times.

2.
Vaccines ; 10(5):706, 2022.
Article in English | MDPI | ID: covidwho-1820443

ABSTRACT

The administration of COVID-19 vaccines has become increasingly essential to curb the pandemic. However, adverse events of acute kidney injury (AKI) emerge rapidly as the COVID-19 vaccination promotes. To investigate the intervenable risk factors of AKI, we searched the Vaccine Adverse Event Reporting System database and recorded adverse effects after COVID-19 vaccines from Dec 2020 to Jun 2021. We included 1149 AKI cases, of which 627 (54.6%) cases were reported following the Pfizer-BNT COVID-19 vaccine, and 433 (37.7%) were reported after the Moderna vaccine. A univariate analysis revealed that coexisting active illnesses (infections, uncontrolled hypertension, heart failure, etc.) have an unfavorable prognosis, with an increased risk of death (OR 2.35, 95% CI 1.70–3.25, p < 0.001). The other risk factors included older age and past disease histories. An adjusted regression analysis proved that coexisting active illnesses worsen AKI prognosis after COVID-19 vaccination, with a higher mortality risk (OR 2.19, 95% CI 1.48–3.25, p < 0.001). In subgroup analysis, we stratified different variables, and none revealed a significant effect modification on the association between coexisting active illnesses and AKI-associated death after vaccination (p-interaction >0.05). We found that coexisting active illnesses could complicate AKI after vaccines, but the potential causal relationship needed further investigation.

3.
Journal of Cleaner Production ; 358:131903, 2022.
Article in English | ScienceDirect | ID: covidwho-1819523

ABSTRACT

The disposal of medical waste has become an increasing environmental issue since the COVID-19 epidemic outbreaks. Conventional disposal methods have produced waste of fossil resources and environmental problems. In this study, the waste medical mask-derived materials were tested as viscosity reducer and pour point depressant to evaluate the possibility of being used as crude oil fluidity improver. The results show that the materials derived from the three parts of the waste medical mask can reduce the viscosity and pour point of each crude oil samples from different oilfields in China. The middle layer of the medical mask (PP-2) displays the highest efficiency, and the viscosity reduction rate and maximum pour point reduction reaches 81% and 8.3 °C at 500 ppm, respectively. A probable mechanism of improving rheological properties of the crude oil samples by the medical mask-derived materials was further proposed after the differential scanning calorimetry (DSC) analysis and the wax crystal morphology analysis. We hope this work could provide a way to solve the current environmental issues under COVID-19.

4.
Journal of Shandong University ; 58(4):1-6, 2020.
Article in English, Chinese | GIM | ID: covidwho-1813128

ABSTRACT

The National Health Commission of the People's Republic of China has classified coronavirus disease 2019(COVID-19) as category B infectious disease and taken preventive and control measures of category A infectious diseases. COVID-19 is highly contagious and all age groups are vulnerable. Therefore, medical institutions should strengthen preventive and control measures during COVID-19 epidemic to refrain from nosocomial infection. Other factors, such as mental status disturbances caused by psychological stress during COVID-19 outbreak, high population density of closed ward and poor behavioral control of psychiatric patients, may hinder the preventive and control measures of COVID-19. We propose the preventive and control strategy of psychiatric disorders during the COVID-19 epidemic to provide reference for various psychiatric institutions.

5.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-330781

ABSTRACT

Background: The negative emotions induced by the ongoing coronavirus disease 2019 (COVID-19) epidemic are affecting people's health. In order to identify emotional problems and promote early intervention to reduce the risk of disease, we studied the emotional states of Chinese people during the epidemic. Method: We adopted the Automated Neuropsychological Assessment Metrics mood scale and prepared an online questionnaire. Then, we conducted an exploratory factor analysis of the effective responses of 567 participants from 31 provinces and cities in China. Finally, we analyzed the characteristics of the distribution of different types of emotions and compared them via several statistical methods. Results: The original scale was modified to have six dimensions that yielded reliable internal consistency values ranging from 0.898 to 0.965 and explained 74.96% of the total variance. We found that a total of 33.9% of respondents felt negative emotions more strongly, were less happy and had less energy than other respondents (p<0.001). People with these traits had relatively serious emotional problems and were typically over 60 years old, doctoral degree holders, enterprise personnel and residents in an outbreak area. Conclusion: Thirty-three percent of people without COVID-19 had emotional problems. Psychotherapy should be provided as early as possible for people with emotional problems caused by the epidemic, and the modified scale could be used to survey the public's mood during public health events to detect problems and facilitate early intervention.

6.
World J Urol ; 40(2): 577-583, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1739309

ABSTRACT

PURPOSE: To balance epidemic prevention with the therapeutic needs of patients with urolithiasis during the COVID-19 pandemic, we developed a triage system to guide medical staff in making priority decisions. METHODS: The study began with a review of the literature to propose a theoretical framework. Then, focus groups were assembled to develop, supplement, refine and form a consensus on the indications of the triage system. Finally, the system was implemented in the clinic. The validity and reliability of the system were tested by a content validity index and the interrater reliability kappa coefficient. Changes in patient characteristics and waiting time before and after the epidemic were compared. RESULTS: The theoretical framework was based on disease pathophysiology, including obstruction, infection, kidney dysfunction, and other symptoms. With this guide, a 28-item triage system with categories of T1-5 (low priority to urgent) was developed. The content validity index and the interrater reliability coefficient were 0.833 and 0.812, respectively. During clinical application, although the total number of patients remained steady, the proportion of T1 decreased significantly; even though the overall waiting time of patients did not change significantly, it increased for T1 and decreased for T2-4 in 2020 compared with 2019 (P < 0.05). CONCLUSION: This triage tool based on the dimensions of obstruction, infection, kidney dysfunction, and other symptoms has good psychometric properties and significant utility for prioritizing patients with urolithiasis during times of crisis. With this system, patients of moderate to high priority were treated promptly during the COVID-19 pandemic.


Subject(s)
COVID-19 , Triage , Urolithiasis , COVID-19/epidemiology , Focus Groups , Humans , Pandemics , Reproducibility of Results , Triage/methods , Urolithiasis/complications , Urolithiasis/diagnosis , Urolithiasis/therapy
7.
iScience ; 25(4): 104046, 2022 Apr 15.
Article in English | MEDLINE | ID: covidwho-1734556

ABSTRACT

Mesenchymal stem cells (MSCs) have shown some efficacy in the COVID-19 treatment. We proposed that exogenous supplementation of ACE2 via MSCs (ACE2-MSCs) might have better therapeutic effects. We constructed SARS-CoV-2 spike glycoprotein stably transfected AT-II and Beas-2B cells and used SARS-CoV-2 spike pseudovirus to infect hACE2 transgenic mice. The results showed that spike glycoprotein transfection triggers the release of apoptotic bodies and formation of membrane pores in pyroptosis. Inflammatory factors and pyroptosis factors were highly upregulated by spike glycoprotein transfection. SARS-CoV-2 spike pseudovirus worsened lung injury and increased the main factors of cytokine storm and pyroptosis. Compared to using MSCs or rh-ACE2 alone, the administration of ACE2-MSCs could significantly reduce these factors better and alleviate lung injury in vivo and in vitro, which might be because of the increased activities of secretory ACE2. Our proposal is a promising therapeutic solution for preclinical or clinical research.

8.
China CDC Weekly ; 4:1-3, 2022.
Article in English | China CDC Weekly | ID: covidwho-1706780

ABSTRACT

On January 13, 2022, Zhuhai CDC received a notification that a coronavirus disease 2019 (COVID-19) case was found in the fever clinic in nearby Zhongshan City. Zhuhai CDC promptly carried out large-scale population screening in three nearby counties. A total of 4 COVID-19 cases were found in Nanping county. 34 cases were screened from close contacts, and 2 cases were reported from close contacts in other cities of Guangdong Province. The 20 cases were sequenced by Guangdong CDC and identified as the variant of concern (VOC)/Omicron variant BA.1. Since January 14, Zhuhai has carried out 8 rounds of nucleic acid screening for COVID-19 in the county where the cases occurred. Four large-scale nucleic acid screening tests for COVID-19 were conducted across the city, and no new community cases were reported after January 15.

9.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-325412

ABSTRACT

Deep learning models usually require a large amount of labeled data to achieve satisfactory performance. In multimedia analysis, domain adaptation studies the problem of cross-domain knowledge transfer from a label rich source domain to a label scarce target domain, thus potentially alleviates the annotation requirement for deep learning models. However, we find that contemporary domain adaptation methods for cross-domain image understanding perform poorly when source domain is noisy. Weakly Supervised Domain Adaptation (WSDA) studies the domain adaptation problem under the scenario where source data can be noisy. Prior methods on WSDA remove noisy source data and align the marginal distribution across domains without considering the fine-grained semantic structure in the embedding space, which have the problem of class misalignment, e.g., features of cats in the target domain might be mapped near features of dogs in the source domain. In this paper, we propose a novel method, termed Noise Tolerant Domain Adaptation, for WSDA. Specifically, we adopt the cluster assumption and learn cluster discriminatively with class prototypes in the embedding space. We propose to leverage the location information of the data points in the embedding space and model the location information with a Gaussian mixture model to identify noisy source data. We then design a network which incorporates the Gaussian mixture noise model as a sub-module for unsupervised noise removal and propose a novel cluster-level adversarial adaptation method which aligns unlabeled target data with the less noisy class prototypes for mapping the semantic structure across domains. We conduct extensive experiments to evaluate the effectiveness of our method on both general images and medical images from COVID-19 and e-commerce datasets. The results show that our method significantly outperforms state-of-the-art WSDA methods.

10.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-325099

ABSTRACT

Objectives: To analyze the findings of computed tomography (CT) imaging in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19). Methods: This retrospective study reviewed 60 critically ill patients (43 males and 17 females, mean age 64.4±11.0 years) with COVID-19 pneumonia who were admitted to two different clinical centers. Their clinical and medical records were analyzed, and the chest CT images were assessed to determine the involvement of lobes and the distribution of lesions in the lungs between the patients who recovered from the illness and those who died. Results: Patients were significantly older in the death group (10/60, 16.67%) than in the recovery group (50/60, 83.33%) (p=0.044). C-reactive protein (CRP) (67.9±50.5 mg/L) was significantly elevated in the death group as opposed to the recovery group (p<0.001). The neutrophil-to-lymphocyte ratio (NLR) was higher in the death group when compared with the recovery group (p=0.030). Involvement of five lung lobes was found in 98% of the patients, with medial or parahilar area involvement observed in all the death patients. Ground-glass opacities (97%), crazy-paving pattern (92%) and air bronchogram (93%) were the most common radiological findings. Presence of emphysema was more prevalent in the death group than in the recovery group (30% vs 2%, p=0.011). Conclusions: The degree of lung involvement and lesion distribution with dominance in the medial and parahilar pulmonary areas were more severe in the death patients than in those who recovered. Patient’s age, emphysema, CRP and NLR could be combined with CT to predict the disease outcomes.

11.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-324349

ABSTRACT

Background: The current double epidemic of non-communicable diseases (NCDs) and the 2019 coronavirus disease (COVID-19) and their vicious circle relationship causes adverse health effects at the population level and, at the same time, places a tremendous burden on the health care system. Our study aimed to investigate whether the metabolic indicators associated with NCDs in the general population have changed during the COVID-19 outbreak. Results We conducted a retrospective self-controlled study enrolling adult participants who received baseline test for metabolic indicators related to NCDs during January 1, 2019 and April 30, 2019 and were followed up on metabolic indicators in the same period in 2020. The follow-up total cholesterol was significantly increased than that of the baseline (4.73 (4.05, 5.46) mmol/L vs 4.71 (4.05, 5.43) mmol/L, p = 0.019;n = 3379). Similar results were observed in triglyceride (1.29 (0.91, 1.88) vs 1.25 (0.87, 1.81) mmol/L, p < 0.001;n = 3381), uric acid (330.0 (272.0, 397.0) vs 327.0 (271.0, 389.0) umol/L, p < 0.001;n = 3364), and glycosylated hemoglobin (6.50 (6.10, 7.30) vs 6.50 (6.10, 7.20) %, p = 0.013;n = 532). No significant difference was observed in low density lipoprotein, body mass index and blood pressure. Conclusions Metabolic indicators associated with non-communicable diseases deteriorated in the Coronavirus Disease 2019 outbreak. We should take action to prevent and control non-communicable diseases without delay.

12.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322231

ABSTRACT

The clinical features, molecular characteristics, and immune responses of COVID-19 patients with persistent SARS-CoV-2 infection are not yet well described. In this study, we investigated the differences in clinical parameters, laboratory indexes, plasma cytokines, and peripheral blood mononuclear cell responses, which were assessed using single-cell RNA-sequencing in patients with non-critical COVID-19 with long durations (LDs) and short durations (SDs) of viral shedding. Our results revealed that clinical parameters and laboratory indexes, such as c-reactive protein (CRP) and D-dimer, were comparable between SDs and LDs. Most inflammatory cytokines/chemokines, such as IL-2, IL2R, TNFα/β, IL1β, and CCL5 were present at low levels in LDs. Our single-cell RNA-sequencing revealed a reconfiguration of the peripheral immune cell phenotype in LDs, including decreases in natural killer (NK) cells and CD14 + monocytes and an increase in regulatory T cells (Tregs). Furthermore, most cell subsets in LDs consistently exhibited reduced expression of ribosomal protein (RP) genes, indicating dysfunctions in cytokine/chemokine synthesis, folding, modification, and assembly. Accordingly, the negative correlation between the RP levels and viral shedding duration was validated in an independent cohort of bulk-RNA-sequencing data from 103 non-critical patients, which may help guide clinical management and resource allocation. Moreover, peripheral T and NK cells and memory B cells in LDs likely failed to activate, which contributed to the persistence of viral shedding.

13.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-319493

ABSTRACT

Objective: Few studies have investigated the psychological impact throughout a major epidemic, such as COVID-19. This study aimed to evaluate the psychological state of individuals experienced quarantine and to provide evidence to reduce the impact of quarantine after COVID-19. Methods: : A questionnaire-based survey conducted by using an internet site using 631 individuals who lived in China in the year 2020. Spearman rank correlation analysis was used for the data analysis. Results: : Approximately 9.97% of the study participants reported that they did not feel good about his or her health condition. Approximately 50.16% of participants had experienced various levels of anxious and nervous feelings. Approximately 5.91% of participants reported anxious or nervous feelings almost every day. By using the spearman rank correlation analysis, we observed that anxious and nervous feelings appeared to be correlated with the frequency of receiving negative news, current health situation and time spent on receiving information related to COVID-19. Conclusion: A long-term quarantine is likely to have some level of impact on health conditions among relatively healthy individuals. The survey study may suggest that government and hospital workers should pay close attention to the psychological change experienced by quarantined individuals.

14.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-318622

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is currently widespread in the world. This study aimed to access the characteristics of the publications involving COVID-19 by using a bibliometric analysis. Methods: : COVID-19 publications published between 1 January 2020 and 31 July 2020 was searched from the Web of Science database on 1 August 2020.The database retrieval was done on the same day. Analysis parameters mainly include publication month, research institutions, authors, journals, countries and cooperation networks among them. Results: : A total of 14186 COVID-19 associated articles were retrieved from the Web of Science database, and the quantity of articles increased rapidly month by month. The authors of the top ten manuscripts per number of citations and the most productive institution were both from China. The total publication number of China was as high as 3,029,second only to the United States. Moreover, China ranks first in the number of total citations of articles and the average article citations. The United States has the highest number of total publications and ranks second only to China in terms of the influence of individual articles. Authors, institutions and Countries established a network of close cooperation for research on COVID-19. Conclusion: There was a growing number of articles on COVID-19 around the world, China and the United States are the two most influential countries.

15.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-318616

ABSTRACT

Corticosteroids have been widely applied in the treatment of various diseases, and patients exposed to corticosteroid therapy are at higher risk of infections, including the influenza, than others. Influenza vaccination are recommended for patients treated with steroids, while its efficacy and safety may be influenced by the immunosuppression induced by steroids. Therefore, we conducted an updated literature review of immune responses against influenza virus on patients treated with systemic corticosteroids to assess whether patients receiving long-term glucocorticoid therapy have developed an adequate antibody response. Findings from this review assume that influenza vaccine works safely and efficiently among patients with long-term systemic corticosteroid therapy at a low dose, 10mg/day might be a boundary value. Further studies are needed.

16.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-316406

ABSTRACT

BACKGROUND: Most studies have shown that diabetic patients with COVID-19 have a higher proportion of mortality and poor prognosis. However, there are still many controversial issue about the relationship between diabetes and COVID-19.PURPOSE: The purpose of this study is to summarize the clinical characteristics, disease prognosis and the risk factors for death of COVID-19 patients with diabetes.DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang databases were searched for relevant articles.STUDY SELECTION: We included retrospective or prospective original articles comparing the characteristics of diabetic and non-diabetic patients with COVID-19.DATA EXTRACTION: We collected data on demographic characteristics, clinical symptoms and signs, treatments and prognosis, etc.DATA SYNTHESIS: A total of 17 articles met the conditions of this systematic review and meta-analysis, including 1310 diabetic patients. Our research found that elderly male diabetic patients with high body mass index were more susceptible to COVID-19 infection than non-diabetic patients. Besides, COVID-19 patients with diabetes had more underlying comorbidities, were more likely to have various complications and usually need more treatments of mechanical ventilation and intensive care. In addition, male and dyspnea may be risk factors for in-hospital death.LIMITATIONS: There are still a lack of articles on the characteristics of diabetic patients with COVID-19, and further research is needed in a large sample.CONCLUSIONS: Diabetes was associated with poor outcomes and mortality in patients with COVID-19. More closely attention should be paid to the treatment and prevention for diabetic patients.Funding Statement: None.Declaration of Interests: The authors declare that they have no conflicts of interest for this work.Ethics Approval Statement: Since the study is a systematic review of the literature, informed consent and institutional review board approval were not obtained.

17.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315502

ABSTRACT

Background: The spread of coronavirus disease 2019 (COVID-19) has posed great threat to the global population’s health and nearly every medical school throughout the world suspended classes as a precaution against the virus. The aim of this research is to explore the most suitable teaching and learning pattern in medical school during COVID-19 Outbreak. Methods: : This was a case-control study which conducted in a medical school. We applied a new blended teaching model based on 5G network that combined team-based learning (TBL) and online interaction to the students before the outbreak and when universities responded to the COVID-19 outbreak by closing campuses, they shifted to different forms of distance learning. Fifty fourth-year medical students receiving the “5+3” pattern courses regarding internal medicine were enrolled in the study. A five-point Likert scale questionnaire that contains 20 items was used to compare the effect of the two kinds of teaching patterns. It evaluated the indicators of core competencies of students including professionalism, attitude towards learning, knowledge and learning skills, teamwork skills, motivation in learning, adaptability and acceptance of the courses and network environment. Results: : According to the descriptive statistical analysis of the first part of the questionnaire (question 1-16), the average score of adaptability and acceptance of the courses is 2.60 less than 3, indicating that students are more adapted to other forms of distance learning during COVID-19 outbreak;the average score of the rest of the questions is greater than 3, indicating that blended teaching model based on 5G network is superior to other forms of distance learning. The number of male students who are inclined to the blended teaching model based on 5G network is 0.13 times as much as that of female students (95%CI:0.028~0.602, p=0.009). Conclusion: The results that medical education based on 5G network that combined team-based learning (TBL) and online interaction is a more suitable option to teach medical students.

18.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315501

ABSTRACT

Background: The spread of coronavirus disease 2019 (COVID-19) has posed great threat to the global population’s health and nearly every medical school throughout the world suspended classes as a precaution against the virus. This study is aimed at exploring a more advanced online teaching and learning pattern for medical school in the future especially during a Public Health Emergency of International Concern (PHEIC) and to evaluate the efficacy of the teaching methods in improving students’ professionalism, knowledge and learning skills including problem analyzing and solving, teamwork skills, self-directed learning, as well as adaptability and acceptance to the courses. Methods: : Fifty fourth-year medical students receiving the “5+3” pattern courses regarding internal medicine were enrolled in the study. A five-point Likert scale questionnaire that contains 20 items was used to compare the effect between online TBL via 5G network (hereinafter referred as blended teaching model) and home-based online learning which is not based on TBL via other prevalent forms of wireless internet connection(hereinafter referred as traditional online teaching model). It evaluated the network environment and indices of students’ competencies we put forward based on six core competencies Results: : According to the descriptive statistical analysis of the first part of the questionnaire (question 1-16), the average score of adaptability and acceptance of the courses is 2.60 less than 3, indicating that students are more adapted to traditional online teaching model;the average score of the rest of the questions is greater than 3, indicating that blended teaching model is superior to traditional online teaching model. The number of male students who are inclined to blended teaching model is 0.13 times as much as that of female students (95%CI:0.028~0.602, p=0.009). Conclusion: Online TBL via 5G network is a more advanced online teaching and learning pattern for medical school and may be a more suitable method during PHEIC in the future.

19.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-315319

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is an emerging global medical challenge and glucocorticoids remain the most promising therapy. Osteonecrosis (ON) is a disease caused by reduced blood flow to bones in the joints, which will rapidly induce joint destroy. ON had been frequently identified among convalescent patients after Severe Acute Respiratory Syndrome (SARS). Considering the similarity of SARS and COVID-19 on their pathogen, clinical characteristics and therapeutic strategies, it is particularly worrying whether ON will be a common sequela among convalescent COVID-19 patient.Methods: This multi-strategy study integrating different research methods, such as meta-analysis, systematic review and cross-sectional investigation. At first, two meta-analyses were performed on the incidence of osteonecrosis among SARS patients and the clinical data of glucocorticoid exposure among COVID-19 patients. Then, a systematic review of low-dosage glucocorticoid associated osteonecrosis and a real-world cross-sectional investigation of glucocorticoid exposure of COVID-19 patients in China Wuhan were also provided. Moreover, the pathogenesis, diagnosis, prevention, and treatment options for osteonecrosis after COVID-19 infection were further described.Findings: Our meta-analysis showed that 32% of SARS patients had developed ON after receiving glucocorticoid treatment with high dose, and our system review also supported that low level glucocorticoid exposure may lead to the occurrence of ON. Similarly, 40% of COVID-19 patients had undergone glucocorticoid treatment according to our meta-analysis. The cross-sectional investigation in China Wuhan found that the average of cumulative glucocorticoid exposure level was 504 mg calculated by the dosage of methylprednisolone. Notably, a confirmed osteonecrosis case after COVID-19 was identified during our investigation. Preventive management of ON shall better start with regular clinical followup observation.Interpretation: Growing evidence of the glucocorticoid therapy for COVID-19 patients prompts us to put forward the risk-classification-based early screening and early prevention protocol of ON, which may be of clinical significance in favorable prognosis of this disease.Registration Details: PROSPERO, registration number CRD42020203536.Funding Information: This study was supported by the Special Project For COVID-19 Prevention and Management of Ministry of Education of China (2020-JYB-YJ-023), the National Key Research and Development Program of China (2019ZX09731-002) and the State Key Program of National Natural Science Foundation of China (82030122).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The protocol for the investigation study has been registered in the Chinese Clinical Trial Registry (ChiCTR), (URL: http://www.chictr.org.cn/showproj.aspx?proj=61769, No. ChiCTR2000038333). This study was approved by the Ethics Institutional Review Board of the Third Affiliated Hospital of Beijing University of Chinese Medicine (No. BZYSY-2020KYKTPJ-06), and informed consent was obtained from every participant patient.

20.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315199

ABSTRACT

Background: The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome Coronavirus-2 has spread rapidly worldwide and disease spread is currently increasing. The clinical picture of transplant recipients and the effect of the anti-rejection immunosuppressive regimens on the clinical course of COVID-19 are lacking. Case presentation: We report two cases of COVID-19infection in renal transplant recipients with variable clinical presentations. The first patient presented with mild respiratory symptoms and a stableclinical course. The second patient had more severe clinical characteristics and presented with severe pneumonia and multi-organ failure. Both patients received a combination therapy including antiviral treatment and reducedimmunosuppressiontherapy and finally recovered. Conclusions: : We report COVID-19 infectionin two renal transplant recipients with a favorable outcome but different clinical courses, which may provide a reference valuefor treating such patients. Additional data are needed to gain a better understanding of the impact of immunosuppressive therapy on the clinical presentation, severity, and outcome of COVID-19in solid organ transplant recipients.

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