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2.
Int J Clin Pract ; : e13654, 2020 Aug 08.
Article in English | MEDLINE | ID: covidwho-696760

ABSTRACT

PURPOSE: Severe coronavirus disease 2019 (COVID-19) pneumonia is associated with a high mortality. However, the evolution of computed tomography (CT) manifestations of severe COVID-19 pneumonia remains unclear, more evidence regarding its evolution process is urgent needed. METHOD: The clinical, laboratory and imaging data of eleven patients with severe COVID-19 pneumonia were collected to investigate the evolution process of severe COVID-19 cases. RESULTS: The main initial CT manifestations of severe COVID-19 pneumonia were multiple ground-glass opacities and/or consolidation. Evolution of CT manifestations showed that acute exudative lesions of severe COVID-19 pneumonia could be gradually resolved after active intervention. CONCLUSIONS: Most of patients with severe COVID-19 pneumonia showed marked improvement of acute exudative lesions on chest imagings, and satisfactory prognosis of severe COVID-19 pneumonia could be achieved after active treatment.

3.
Sci Adv ; 6(27)2020 07.
Article in English | MEDLINE | ID: covidwho-692265

ABSTRACT

COVID-19 has become a global pandemic caused by the novel coronavirus SARS-CoV-2. Understanding the origins of SARS-CoV-2 is critical for deterring future zoonosis, discovering new drugs, and developing a vaccine. We show evidence of strong purifying selection around the receptor binding motif (RBM) in the spike and other genes among bat, pangolin, and human coronaviruses, suggesting similar evolutionary constraints in different host species. We also demonstrate that SARS-CoV-2's entire RBM was introduced through recombination with coronaviruses from pangolins, possibly a critical step in the evolution of SARS-CoV-2's ability to infect humans. Similar purifying selection in different host species, together with frequent recombination among coronaviruses, suggests a common evolutionary mechanism that could lead to new emerging human coronaviruses.

6.
J Infect Dis ; 221(12): 1948-1952, 2020 06 11.
Article in English | MEDLINE | ID: covidwho-599716

ABSTRACT

Data concerning the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic and paucisymptomatic patients are lacking. We report a 3-family cluster of infections involving asymptomatic and paucisymptomatic transmission. Eight of 15 (53%) members from 3 families were confirmed with SARS-CoV-2 infection. Of 8 patients, 3 were asymptomatic and 1 was paucisymptomatic. An asymptomatic mother transmitted the virus to her son, and a paucisymptomatic father transmitted the virus to his 3-month-old daughter. SARS-CoV-2 was detected in the environment of 1 household. The complete genomes of SARS-CoV-2 from the patients were > 99.9% identical and were clustered with other SARS-CoV-2 sequences reported from China and other countries.


Subject(s)
Asymptomatic Infections , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Adult , Aged , Betacoronavirus/genetics , China/epidemiology , Contact Tracing , Coronavirus Infections/epidemiology , Family Health , Female , Humans , Infant , Male , Middle Aged , Pandemics , Phylogeny , Pneumonia, Viral/epidemiology , Quarantine
10.
J Gastroenterol Hepatol ; 2020 May 21.
Article in English | MEDLINE | ID: covidwho-327199

ABSTRACT

BACKGROUND AND AIM: Coronavirus disease 2019 (COVID-19) has attracted increasing worldwide attention. While diabetes is known to aggravate COVID-19 severity, it is not known whether nondiabetic patients with metabolic dysfunction are also more prone to more severe disease. The association of metabolic associated fatty liver disease (MAFLD) with COVID-19 severity in nondiabetic patients was investigated here. METHODS: The study cohort comprised 65 patients with (i.e. cases) and 65 patients without MAFLD (i.e. controls). Each case was randomly matched with one control by sex (1:1) and age (±5 years). The association between the presence of MAFLD (as exposure) and COVID-19 severity (as the outcome) was assessed by binary logistic regression analysis. RESULTS: In nondiabetic patients with COVID-19, the presence of MAFLD was associated with a four-fold increased risk of severe COVID-19; the risk increased with increasing numbers of metabolic risk factors. The association with COVID-19 severity persisted after adjusting for age, sex, and coexisting morbid conditions. CONCLUSION: Health-care professionals caring for nondiabetic patients with COVID-19 should be cognizant of the increased likelihood of severe COVID-19 in patients with MAFLD.

12.
Science ; 368(6496): 1274-1278, 2020 06 12.
Article in English | MEDLINE | ID: covidwho-260594

ABSTRACT

Neutralizing antibodies could potentially be used as antivirals against the coronavirus disease 2019 (COVID-19) pandemic. Here, we report isolation of four human-origin monoclonal antibodies from a convalescent patient, all of which display neutralization abilities. The antibodies B38 and H4 block binding between the spike glycoprotein receptor binding domain (RBD) of the virus and the cellular receptor angiotensin-converting enzyme 2 (ACE2). A competition assay indicated different epitopes on the RBD for these two antibodies, making them a potentially promising virus-targeting monoclonal antibody pair for avoiding immune escape in future clinical applications. Moreover, a therapeutic study in a mouse model validated that these antibodies can reduce virus titers in infected lungs. The RBD-B38 complex structure revealed that most residues on the epitope overlap with the RBD-ACE2 binding interface, explaining the blocking effect and neutralizing capacity. Our results highlight the promise of antibody-based therapeutics and provide a structural basis for rational vaccine design.


Subject(s)
Antibodies, Neutralizing/therapeutic use , Antibodies, Viral/therapeutic use , Coronavirus Infections/therapy , Peptidyl-Dipeptidase A/immunology , Pneumonia, Viral/therapy , Receptors, Virus/immunology , Spike Glycoprotein, Coronavirus/immunology , Animals , Antibodies, Monoclonal/immunology , Antibodies, Monoclonal/isolation & purification , Antibodies, Monoclonal/therapeutic use , Antibodies, Neutralizing/immunology , Antibodies, Neutralizing/isolation & purification , Antibodies, Viral/immunology , Antibodies, Viral/isolation & purification , Disease Models, Animal , Humans , Immunodominant Epitopes/chemistry , Immunodominant Epitopes/immunology , Lung/immunology , Lung/virology , Mice , Neutralization Tests , Pandemics , Protein Domains , Viral Load/immunology
13.
J Infect Dis ; 221(12): 1948-1952, 2020 06 11.
Article in English | MEDLINE | ID: covidwho-102311

ABSTRACT

Data concerning the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic and paucisymptomatic patients are lacking. We report a 3-family cluster of infections involving asymptomatic and paucisymptomatic transmission. Eight of 15 (53%) members from 3 families were confirmed with SARS-CoV-2 infection. Of 8 patients, 3 were asymptomatic and 1 was paucisymptomatic. An asymptomatic mother transmitted the virus to her son, and a paucisymptomatic father transmitted the virus to his 3-month-old daughter. SARS-CoV-2 was detected in the environment of 1 household. The complete genomes of SARS-CoV-2 from the patients were > 99.9% identical and were clustered with other SARS-CoV-2 sequences reported from China and other countries.


Subject(s)
Asymptomatic Infections , Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Adult , Aged , Betacoronavirus/genetics , China/epidemiology , Contact Tracing , Coronavirus Infections/epidemiology , Family Health , Female , Humans , Infant , Male , Middle Aged , Pandemics , Phylogeny , Pneumonia, Viral/epidemiology , Quarantine
16.
Br J Anaesth ; 125(1): e28-e37, 2020 07.
Article in English | MEDLINE | ID: covidwho-45870

ABSTRACT

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (Sao2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (Sao2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Intubation, Intratracheal/methods , Personal Protective Equipment , Pneumonia, Viral/therapy , Aged , China , Coronavirus Infections/complications , Coronavirus Infections/prevention & control , Female , Humans , Hypotension/etiology , Hypoxia/etiology , Male , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumothorax/etiology , Practice Guidelines as Topic , Retrospective Studies
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