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1.
BMC Infect Dis ; 21(1): 365, 2021 Apr 17.
Article in English | MEDLINE | ID: covidwho-1190058

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) share similar symptoms with influenza A (IA), but it is more worthwhile to understand the disparities of the two infections regarding their clinical characteristics on admission. METHODS: A total of 71 age-matched pediatric IA and COVID-19 patient pairs were formed and their clinical data on admission were compared. RESULTS: Fever, cough, nasal congestion and nausea/vomiting were the most common symptoms on admission for both infections but occurred less often in COVID-19. The IA patients were more likely to have lower-than-normal levels of lymphocyte count and percentage and to have higher-than-normal levels of activated partial thromboplastin time, prothrombin time, serum C-reactive protein, and serum procalcitonin, while the COVID-19 patients had higher odds of having lower-than-normal levels of neutrophil count and percentage. CONCLUSIONS: This study suggests that influenza A is more symptomatic than COVID-19 for children and might be an overall more severe infection at the time of admission.


Subject(s)
/diagnosis , Diagnosis, Differential , Influenza, Human/diagnosis , Symptom Assessment , Adolescent , C-Reactive Protein , Child , Child, Preschool , China , Cough , Female , Fever , Hospitalization , Humans , Infant , Infant, Newborn , Influenza, Human/pathology , Leukocyte Count , Male , Nausea , Neutrophils , Partial Thromboplastin Time , Procalcitonin , Retrospective Studies , Vomiting
2.
Psychiatr Danub ; 33(1): 86-94, 2021.
Article in English | MEDLINE | ID: covidwho-1187230

ABSTRACT

BACKGROUND: The World Health Organization has declared the Corona Virus Disease 2019 (COVID-19) epidemic as a public health emergency of international concern. Given the sudden infection from and extensive dispersion of COVID-19 and the absence of specific drugs, those infected are in danger if they are not treated in time. Consequently, COVID-19 has become an important factor influencing adolescents' mental health. The purpose of this study is to explore the intervention effect of the integration model on the negative emotions of adolescents during the COVID-19 epidemic. SUBJECTS AND METHODS: Adolescents were randomly selected from five middle schools in Zhejiang Province of China from May 2020 to July 2020. First, the Self-rating Anxiety Scale, Positive and Negative Affect Scale, and Psychological Well-Being Scale were used for measurement. Then, 72 patients with moderate and severe anxiety symptoms were chosen as the research objects, and the intervention and comparison time was determined to be eight weeks. The subjects were randomly divided into the experiment group (35 members) and the control group (34 members). The integration model was employed on the experiment group. RESULTS: Grade, physical condition, and sleep time are important factors influencing the anxiety level of adolescents during the COVID-19 period, and the anxiety risk of adolescents is higher during their third year of junior high school. After the intervention, the SAS score of the experiment group is lower than that of the control group, and the decrease in the SAS score is higher in the experiment group than in the control group (P<0.01). Moreover, the positive emotion score of the experiment group is higher than that of the control group, and the negative emotion score of the former is lower than that of the latter. The variances in the positive and negative emotion scores are higher in the experiment group than in the control group (P<0.01). The variance in the overall well-being index is also greater in the experiment group than in the control group (P<0.01). CONCLUSION: The intervention using the integrated model can significantly reduce negative emotions such as anxiety, increase positive emotions, and improve the overall well-being of adolescents during the epidemic period.


Subject(s)
Adolescent , Anxiety/epidemiology , China , Disease Outbreaks , Emotions , Humans , Surveys and Questionnaires
3.
Virol Sin ; 2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1182321

ABSTRACT

Genome sequencing has shown strong capabilities in the initial stages of the COVID-19 pandemic such as pathogen identification and virus preliminary tracing. While the rapid acquisition of SARS-CoV-2 genome from clinical specimens is limited by their low nucleic acid load and the complexity of the nucleic acid background. To address this issue, we modified and evaluated an approach by utilizing SARS-CoV-2-specific amplicon amplification and Oxford Nanopore PromethION platform. This workflow started with the throat swab of the COVID-19 patient, combined reverse transcript PCR, and multi-amplification in one-step to shorten the experiment time, then can quickly and steadily obtain high-quality SARS-CoV-2 genome within 24 h. A comprehensive evaluation of the method was conducted in 42 samples: the sequencing quality of the method was correlated well with the viral load of the samples; high-quality SARS-CoV-2 genome could be obtained stably in the samples with Ct value up to 39.14; data yielding for different Ct values were assessed and the recommended sequencing time was 8 h for samples with Ct value of less than 20; variation analysis indicated that the method can detect the existing and emerging genomic mutations as well; Illumina sequencing verified that ultra-deep sequencing can greatly improve the single read error rate of Nanopore sequencing, making it as low as 0.4/10,000 bp. In summary, high-quality SARS-CoV-2 genome can be acquired by utilizing the amplicon amplification and it is an effective method in accelerating the acquisition of genetic resources and tracking the genome diversity of SARS-CoV-2.

4.
Biosci Trends ; 15(2): 126-128, 2021 May 11.
Article in English | MEDLINE | ID: covidwho-1140772

ABSTRACT

Despite strict control measures implemented worldwide, the COVID-19 pandemic continues to rage. Several drugs, including lopinavir/ritonavir, hydroxychloroquine, dexamethasone, and remdesivir, have been evaluated for the treatment of COVID-19 during the past year. While most of the drugs failed to display efficacy in treating COVID-19, scientists have encouraged herd immunity to control the pandemic. Immunity generated after natural infection with SARS-CoV-2 is precarious, as indicated by real-world evidence in the form of epidemiological data from Manaus, Brazil. Vaccines using different platforms are therefore the most promising approach to help us return to normality. Although several vaccines have been authorized for emergency use, there are still many concerns regarding their accessibility, the vaccination rate, and most importantly, their efficacy in preventing infection with emerging virus variants. Continued virus surveillance and rapid redesign of new vaccines to counter new variants are crucial to fighting COVID-19. Rapid production and extensive vaccination are also essential to preventing the emergence of new variants. Nevertheless, antivirals including monoclonal antibodies and oral medicines need to be developed in light of uncertainties with regard to vaccination. In the battle between humans and SARS-CoV-2, the speed with which we fight the virus, and especially its emerging variants, is the key to winning.

5.
Front Immunol ; 12: 625881, 2021.
Article in English | MEDLINE | ID: covidwho-1133910

ABSTRACT

T cells play a critical role in coronavirus diseases. How they do so in COVID-19 may be revealed by analyzing the epigenetic chromatin accessibility of cis- and trans-regulatory elements and creating transcriptomic immune profiles. We performed single-cell assay for transposase-accessible chromatin (scATAC) and single-cell RNA (scRNA) sequencing (seq) on the peripheral blood mononuclear cells (PBMCs) of severely ill/critical patients (SCPs) infected with COVID-19, moderate patients (MPs), and healthy volunteer controls (HCs). About 76,570 and 107,862 single cells were used, respectively, for analyzing the characteristics of chromatin accessibility and transcriptomic immune profiles by the application of scATAC-seq (nine cases) and scRNA-seq (15 cases). The scATAC-seq detected 28,535 different peaks in the three groups; among these peaks, 41.6 and 10.7% were located in the promoter and enhancer regions, respectively. Compared to HCs, among the peak-located genes in the total T cells and its subsets, CD4+ T and CD8+ T cells, from SCPs and MPs were enriched with inflammatory pathways, such as mitogen-activated protein kinase (MAPK) signaling pathway and tumor necrosis factor (TNF) signaling pathway. The motifs of TBX21 were less accessible in the CD4+ T cells of SCPs compared with those in MPs. Furthermore, the scRNA-seq showed that the proportion of T cells, especially the CD4+ T cells, was decreased in SCPs and MPs compared with those in HCs. Transcriptomic results revealed that histone-related genes, and inflammatory genes, such as NFKBIA, S100A9, and PIK3R1, were highly expressed in the total T cells, CD4+ T and CD8+ T cells, both in the cases of SCPs and MPs. In the CD4+ T cells, decreased T helper-1 (Th1) cells were observed in SCPs and MPs. In the CD8+T cells, activation markers, such as CD69 and HLA class II genes (HLA-DRA, HLA-DRB1, and HLA-DRB5), were significantly upregulated in SCPs. An integrated analysis of the data from scATAC-seq and scRNA-seq showed some consistency between the approaches. Cumulatively, we have generated a landscape of chromatin epigenetic status and transcriptomic immune profiles of T cells in patients with COVID-19. This has provided a deeper dissection of the characteristics of the T cells involved at a higher resolution than from previously obtained data merely by the scRNA-seq analysis. Our data led us to suggest that the T-cell inflammatory states accompanied with defective functions in the CD4+ T cells of SCPs may be the key factors for determining the pathogenesis of and recovery from COVID-19.


Subject(s)
CD4-Positive T-Lymphocytes/physiology , CD8-Positive T-Lymphocytes/physiology , Chromatin/metabolism , /physiology , /genetics , Calgranulin B/genetics , Chromatin/genetics , Class Ia Phosphatidylinositol 3-Kinase/genetics , Epigenome/immunology , Gene Expression Profiling , Humans , Immunity, Cellular/genetics , Inflammation/genetics , Lymphocyte Activation , NF-KappaB Inhibitor alpha/genetics , Sequence Analysis, RNA , Single-Cell Analysis , Transposases/metabolism , Up-Regulation
6.
Zhongguo Bingdubing Zazhi = Chinese Journal of Viral Diseases ; - (6):455, 2020.
Article | WHO COVID | ID: covidwho-1126072

ABSTRACT

Objective To explore the risk factors of 43 patients with severe coronavirus disease 2019 pneumonia(COVID-19) in Hangzhou Methods The clinical and epidemiological data of COVID-19 confirmed patients during 1 st January 2020 and 20 th March 2020 in Hangzhou were collected The risk factors of the severe cases were analyzed by univariate and multivariate logistic regression Results Up to 20 th March 2020,a total of 169 patients were reported in Hangzhou, among which, 43(25 44%) were severe cases The analysis showed that over 60 years old[χ~2=6 16,P=0 01;OR(95%CI)=3 35(1 29-8 69)],hypertension[χ~2=6 91,P<0 001;OR(95%CI)=3 80(1 40-10 28)],headache as initial onset symptom [χ~2=4 80,P=0 03;OR(95%CI)=3 02(1 12-8 09)] and delayed hospitalization(Z=-2 21,P=0 03) were statistically significant Conclusions Age over 60 years, hypertension, headache as initial onset symptom are risk factors and delayed hospitalization is influencing factor of severe COVID-19 patients It is necessary to monitor COVID-19 patients′ condition and take effective treatment timely

7.
Front Med ; 2021 Mar 09.
Article in English | MEDLINE | ID: covidwho-1122810

ABSTRACT

Tocilizumab has been reported to attenuate the "cytokine storm" in COVID-19 patients. We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment. We conducted a randomized, controlled, open-label multicenter trial among COVID-19 patients. The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone. The cure rate, changes of oxygen saturation and interference, and inflammation biomarkers were observed. Thirty-three patients were randomized to the tocilizumab group, and 32 patients to the control group. The cure rate in the tocilizumab group was higher than that in the control group, but the difference was not statistically significant (94.12% vs. 87.10%, rate difference 95% CI-7.19%-21.23%, P = 0.4133). The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12 (P = 0.0359). In moderate disease patients with bilateral pulmonary lesions, the hypoxia ameliorated earlier after tocilizumab treatment, and less patients (1/12, 8.33%) needed an increase of inhaled oxygen concentration compared with the controls (4/6, 66.67%; rate difference 95% CI-99.17% to-17.50%, P = 0.0217). No severe adverse events occurred. More mild temporary adverse events were recorded in tocilizumab recipients (20/34, 58.82%) than the controls (4/31, 12.90%). Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative. For patients with bilateral pulmonary lesions and elevated IL-6 levels, tocilizumab could be recommended to improve outcome.

8.
Zhongguo Jishui Paishui = China Water & Wastewater ; - (2):42, 2021.
Article | WHO COVID | ID: covidwho-1117870

ABSTRACT

The Huoshenshan hospital and Leishenshan hospital are special infectious diseases hospitals that were designed to focus on the treatment of patients infected by new Coronavirus pneumonia( COVID-19) The design of sewage treatment system was "pre-disinfection contact tank + septic tank + lifting pump station( including crushed grille) + regulating tank + MBBR biochemical tank +coagulation sedimentation tank + contact disinfection tank " MBBR process could achieve efficient removal of pollutants in sewage at low temperature Two-stage disinfection process guaranteed 100% virus elimination At the same time,HDPE membrane was laid under the sewage station according to the landfill standard to ensure the full collection,disinfection and discharge of rainwater and sewage The sludge was collected and transported as hazardous waste after disinfection and dehydration The waste gas was collected,deodorized and disinfected in a unified way,so as to realize the full collection and treatment of rainwater,sewage,sludge and waste gas At present,the operations of the sewage stations of Huoshenshan and Leishenshan hospitals had kept stable,and the relevant effluent indexes met the design requirements COD concentration was stable below 50 mg/L,ammonia nitrogen was stable below 2 mg/L,residual chlorine was stable near 13 mg/L Therefore,the pollutant removal and disinfection effect were stable during the whole operation

9.
China Tropical Medicine ; 20(12):1167-1171, 2020.
Article in Chinese | WHO COVID | ID: covidwho-1106542

ABSTRACT

Objective: To investigate the psychological changes of 84 patients with common type of coronavirus disease 2019 (COVID-19) in Jingzhou City, Hubei, and we aim to guide their psychological rehabilitation training

10.
iScience ; : 102187, 2021 Feb 12.
Article in English | MEDLINE | ID: covidwho-1093067

ABSTRACT

Dysregulated immune cell responses have been linked to the severity of coronavirus disease 2019 (COVID-19), but the specific viral factors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were currently unknown. Herein, we reveal that the Ig-like fold ectodomain of the viral protein SARS-CoV-2 ORF7a interacts with high efficiency to CD14+ monocytes in human peripheral blood, compared to pathogenic protein SARS-CoV ORF7a. The crystal structure of SARS-CoV-2 ORF7a at 2.2 Å resolution reveals three remarkable changes on the amphipathic side of the four-stranded ß-sheet, implying a potential functional interface of the viral protein. Importantly, SARS-CoV-2 ORF7a coincubation with CD14+ monocytes ex vivo triggered a decrease in HLA-DR/DP/DQ expression levels and upregulated significant production of proinflammatory cytokines, including IL-6, IL-1ß, IL-8, and TNF-α. Our work demonstrates that SARS-CoV-2 ORF7a is an immunomodulating factor for immune cell binding and triggers dramatic inflammatory responses, providing promising therapeutic drug targets for pandemic COVID-19.

12.
Curr Med Sci ; 41(1): 1-13, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1081528

ABSTRACT

Currently, little in-depth evidence is known about the application of extracorporeal membrane oxygenation (ECMO) therapy in coronavirus disease 2019 (COVID-19) patients. This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan, China. The patients were followed up until June 30, 2020. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning. Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation (IMV)-only therapy. Of 88 patients receiving ECMO therapy, 27 and 61 patients were and were not successfully weaned from ECMO, respectively. Additionally, 15, 15, and 65 patients were further weaned from IMV, discharged from hospital, or died during hospitalization, respectively. In the multivariate logistic regression analysis, a lymphocyte count ≤0.5×109/L and D-dimer concentration >4× the upper limit of normal level at ICU admission, a peak PaCO2 >60 mmHg at 24 h before ECMO initiation, and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning. In the propensity score-matched analysis, a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group. The presence of lymphocytopenia, higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis. Tracheotomy could facilitate weaning from ECMO. ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.


Subject(s)
/therapy , Extracorporeal Membrane Oxygenation/methods , Adult , Aged , Case-Control Studies , China , Critical Illness , Extracorporeal Membrane Oxygenation/statistics & numerical data , Humans , Male , Middle Aged , Prognosis , Propensity Score , Retrospective Studies , Risk Factors , Survival Analysis , Treatment Outcome , Young Adult
13.
Nat Commun ; 12(1): 814, 2021 02 05.
Article in English | MEDLINE | ID: covidwho-1065864

ABSTRACT

On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesize that the anti-vascular endothelial growth factor (VEGF) drug bevacizumab might be beneficial for treating Covid-19 patients. From Feb 15 to April 5, 2020, we conducted a single-arm trial (NCT04275414) and recruited 26 patients from 2-centers (China and Italy) with severe Covid-19, with respiratory rate ≥30 times/min, oxygen saturation ≤93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100 mmHg and ≤300 mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO2/FiO2 ratios at days 1 and 7. By day 28, 24 (92%) patients show improvement in oxygen-support status, 17 (65%) patients are discharged, and none show worsen oxygen-support status nor die. Significant reduction of lesion areas/ratios are shown in chest computed tomography (CT) or X-ray within 7 days. Of 14 patients with fever, body temperature normalizes within 72 h in 13 (93%) patients. Relative to comparable controls, bevacizumab shows clinical efficacy by improving oxygenation and shortening oxygen-support duration. Our findings suggest bevacizumab plus standard care is highly beneficial for patients with severe Covid-19. Randomized controlled trial is warranted.


Subject(s)
Bevacizumab/therapeutic use , /drug effects , Aged , Angiogenesis Inhibitors/therapeutic use , Body Temperature/drug effects , China , Female , Fever/prevention & control , Humans , Italy , Male , Middle Aged , Treatment Outcome
15.
EClinicalMedicine ; 25: 100478, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-1047557

ABSTRACT

Background: The outbreak of a new coronavirus (SARS-CoV-2) poses a great challenge to global public health. New and effective intervention strategies are urgently needed to combat the disease. Methods: We conducted an open-label, non-randomized, clinical trial involving moderate COVID-19 patients according to study protocol. Patients were assigned in a 1:2 ratio to receive either aerosol inhalation treatment with IFN-κ and TFF2, every 48 h for three consecutive dosages, in addition to standard treatment (experimental group), or standard treatment alone (control group). The end point was the time to discharge from the hospital. This study is registered with chictr.org.cn, ChiCTR2000030262. Findings: A total of thirty-three eligible COVID-19 patients were enrolled from February 1, 2020 to April 6, 2020, eleven were assigned to the IFN-κ plus TFF2 group, and twenty-two to the control group. Safety and efficacy were evaluated for both groups. No treatment-associated severe adverse effects (SAE) were observed in the group treated with aerosol inhalation of IFN-κ plus TFF2, and no significant differences in the safety evaluations were observed between experimental and control groups. CT imaging was performed in all patients with the median improvement time of 5.0 days (IQR 3.0-9.0) in the experimental group versus 8.5 days (IQR 3.0-17.0) in the control group (p<0.05). In addition, the experimental group had a significant shorten median time in cough relief (4.5 days [IQR 2.0-7.0]) than the control group did (10.0 days [IQR 6.0-21.0])(p<0.005), in viral RNA reversion of 6.0 days (IQR 2.0-13.0) in the experimental group vs 9.5 days (IQR 3.0-23.0) in the control group (p < 0.05), and in the median hospitalization stays of 12.0 days (IQR 7.0-20.0) in the experimental group vs 15.0 days (IQR 10.0-25.0) in the control group (p<0.001), respectively. Interpretation: Aerosol inhalation of IFN-κ plus TFF2 is a safe treatment and is likely to significantly facilitate clinical improvement, including cough relief, CT imaging improvement, and viral RNA reversion, thereby achieves an early release from hospitalization. These data support to explore a scale-up trial with IFN-κ plus TFF2. Funding: National Major Project for Control and Prevention of Infectious Disease in China, Shanghai Science and Technology Commission, Shanghai Municipal Health Commission.

16.
Clin Lab ; 67(1)2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1045294

ABSTRACT

BACKGROUND: Since December 2019, a series of pneumonia cases caused by COVID-19 emerged in Wuhan, Hubei Province, China. People are generally susceptible to COVID-19 because people lack immunity to this new virus. With the spread of this epidemic disease from Wuhan, a national outbreak soon appeared, and now many countries have this disease. Unfortunately, no effective drug for COVID-19 treatment has been found so far. METHODS: We designed a retrospective study based on patients admitted to The Affiliated Infectious Hospital of Soochow University from January 22, 2020, to February 25, 2020, with diagnosed COVID-19. We analyzed correlations between RT-PCR negative time and laboratory indicators, then divided all cases into 2 groups according to oxygenation index, data of RT-PCR negative time and related laboratory indicators of the two groups were com-pared. RESULTS: We collected 84 confirmed patients whose RT-PCR had turned negative, including 23 patients with the lowest oxygenation index ≤ 300 mmHg and 61 patients had > 300 mmHg. There was a positive correlation between the RT-PCR negative time and age, WBC count, LDH, SCr. There were statistically significant differences in fever numbers, WBC count, lymphocyte count, CRP, ALT, AST, albumin, LDH, SCr, D-dimer, and fibrinogen between the two groups based on the oxygenation index. CONCLUSIONS: Age, WBC count, LDH, and SCr may be related to the duration of COVID-19 disease. Fever, WBC count, lymphocyte count, CRP, ALT, AST, albumin, LDH, SCr, D-dimer, and fibrinogen are related to the severity of acute lung injury.


Subject(s)
Acute Lung Injury/diagnosis , Blood Chemical Analysis , /complications , Acute Lung Injury/blood , Acute Lung Injury/virology , Adolescent , Adult , Aged , Aged, 80 and over , Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Biomarkers/blood , C-Reactive Protein/analysis , /virology , Child , Child, Preschool , China , Creatinine/blood , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infant , Infant, Newborn , L-Lactate Dehydrogenase/blood , Leukocyte Count , Male , Middle Aged , Oxygen/blood , Predictive Value of Tests , Prognosis , Real-Time Polymerase Chain Reaction , Retrospective Studies , Serum Albumin, Human/analysis , Severity of Illness Index , Time Factors , Young Adult
17.
Archives of Clinical Infectious Diseases ; 15(5), 2020.
Article in English | WHO COVID | ID: covidwho-1044895

ABSTRACT

Introduction: The early diagnosis of coronavirus disease 2019 (COVID-19) is important for disease treatment and control Chest CT has a high sensitivity for the diagnosis of COVID-19, and it is considered an important tool for COVID-19 detection in epidemics Case Presentation: We report two cases of suspected patients Due to the special nature of the patient's work, the patients were suspected of having COVID-19 infection Chest CT images showed multiple ground-glass opacities in the bilateral lungs However, the final diagnosis was not COVID-19 infection Conclusions: The CT scan plays an important role in the early detection of COVID-19, but imaging manifestations of viral pneumonia have similar CT findings This reminds us to avoid overdiagnosis during clinical procedures

18.
Respiration ; 100(2): 116-126, 2021.
Article in English | MEDLINE | ID: covidwho-1044350

ABSTRACT

BACKGROUND: There is still no clinical evidence available to support or to oppose corticosteroid treatment for coronavirus disease 2019 (COVID-19) pneumonia. OBJECTIVE: To investigate the efficacy and safety of corticosteroid given to the hospitalized patients with COVID-19 pneumonia. METHODS: This was a prospective, multicenter, single-blind, randomized control trial. Adult patients with COVID-19 pneumonia who were admitted to the general ward were randomly assigned to either receive methylprednisolone or not for 7 days. The primary end point was the incidence of clinical deterioration 14 days after randomization. RESULTS: We terminated this trial early because the number of patients with COVID-19 pneumonia in all the centers decreased in late March. Finally, a total of 86 COVID-19 patients underwent randomization. There was no difference of the incidence of clinical deterioration between the methylprednisolone group and control group (4.8 vs. 4.8%, p = 1.000). The duration of throat viral RNA detectability in the methylprednisolone group was 11 days (interquartile range, 6-16 days), which was significantly longer than that in the control group (8 days [2-12 days], p = 0.030). There were no significant differences between the 2 groups in other secondary outcomes. Mass cytometry discovered CD3+ T cells, CD8+ T cells, and NK cells in the methylprednisolone group which were significantly lower than those in the control group after randomization (p < 0.05). CONCLUSIONS: From this prematurely closed trial, we found that the short-term early use of corticosteroid could suppress the immune cells, which may prolong severe acute respiratory syndrome coronavirus 2 shedding in patients with COVID-19 pneumonia. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04273321.


Subject(s)
/drug therapy , Glucocorticoids/therapeutic use , Hospitalization , Methylprednisolone/therapeutic use , Pharynx/chemistry , RNA, Viral/isolation & purification , Virus Shedding , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , CD3 Complex , CD8-Positive T-Lymphocytes , /therapy , Disease Progression , Early Medical Intervention , Extracorporeal Membrane Oxygenation , Female , Humans , Killer Cells, Natural , Lymphocyte Count , Male , Middle Aged , Oxygen Inhalation Therapy , Patients' Rooms , Pharynx/virology , Proportional Hazards Models , Respiration, Artificial , Single-Blind Method , T-Lymphocyte Subsets , T-Lymphocytes , Time Factors , Treatment Outcome
19.
Front Immunol ; 11: 586073, 2020.
Article in English | MEDLINE | ID: covidwho-1021888

ABSTRACT

Since the December 2019 outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, the infection has spread locally and globally resulting in a pandemic. As the numbers of confirmed diagnoses and deaths continue to rise, COVID-19 has become the focus of international public health. COVID-19 is highly contagious, and there is no effective treatment yet. New treatment strategies are urgently needed to improve the treatment success rate of severe and critically ill patients. Increasing evidence has shown that a cytokine storm plays an important role in the progression of COVID-19. The artificial-liver blood-purification system (ALS) is expected to improve the outcome of the cytokine storm. In the present study, the levels of cytokines were detected in 12 COVID-19 patients pre- and post-ALS with promising results. The present study shows promising evidence that ALS can block the cytokine storm, rapidly remove the inflammatory mediators, and hopefully, suppress the progression of the disease, thereby providing a new strategy for the clinical treatment of COVID-19.


Subject(s)
/therapy , Cytokine Release Syndrome/therapy , Cytokines/blood , Hemoperfusion , Liver/metabolism , Plasma Exchange , Adult , Aged , Aged, 80 and over , Cytokine Release Syndrome/etiology , Female , Humans , Male , Middle Aged
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