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1.
Alzheimer's & Dementia: Translational Research & Clinical Interventions ; 8(1):e12236, 2022.
Article in English | Wiley | ID: covidwho-1819398

ABSTRACT

Introduction COVID-19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life. Methods In a UK cohort study, pre- and post-pandemic data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life. Results Carers reported significant decline in quality of life, although no change was demonstrated by people with dementia. In multivariable analyses, higher levels of cognitive impairment, deprivation, study site, and lower number of memory clinic contacts were associated with greater decline in carer quality of life. Discussion Maintaining life quality for people with dementia during the pandemic appears to have come at the expense of their family carers. This inequity has fallen hardest on those caring for people with more severe dementia, in deprived areas, and with least support from memory services. These effects may be prevented or reversed by post-diagnostic care.

2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-329774

ABSTRACT

Background Vaccination plays an imperative role in protecting public health and preventing avoidable mortality. Yet, the reasons for vaccine hesitancy are not well understood. This study investigates the factors associated with the acceptability of COVID-19 vaccine in Mozambique. Methods The data came from the three waves of the COVID-19 Knowledge, Attitudes and Practices (KAP) survey which followed a cohort of 1,371 adults in Mozambique over three months (N=3,809). Data collection was through a structured questionnaire using telephone interviewing (CAPI). Multilevel regression analysis was conducted to identify the trajectories of, and the factors associated with COVID-19 vaccine acceptability. Results There was great volatility in COVID-19 vaccine acceptability over time. Institutional trust was consistently and strongly correlated with different measures of vaccine acceptability. There was a greater decline in vaccine acceptability in people with lower institutional trust. The positive correlation between institutional trust and vaccine acceptability was stronger in younger than older adults. Vaccine acceptability also varied by gender and marital status. Conclusions Vaccine acceptability is sensitive to news and information circulated in the public domain. Institutional trust is a central driver of vaccine acceptability and contributes to the resilience of the health system. Our study highlights the importance of health communication and building a trustful relationship between the general public and public institutions in the context of a global pandemic.

3.
J Allergy Clin Immunol Pract ; 10(3): 742-750.e14, 2022 03.
Article in English | MEDLINE | ID: covidwho-1729872

ABSTRACT

BACKGROUND: In addition to their proinflammatory effect, eosinophils have antiviral properties. Similarly, inhaled corticosteroids (ICS) were found to suppress coronavirus replication in vitro and were associated with improved outcomes in coronavirus disease 2019 (COVID-19). However, the interplay between the two and its effect on COVID-19 needs further evaluation. OBJECTIVE: To determine the associations among preexisting blood absolute eosinophil counts, ICS, and COVID-19-related outcomes. METHODS: We analyzed data from the Cleveland Clinic COVID-19 Research Registry (April 1, 2020 to March 31, 2021). Of the 82,096 individuals who tested positive, 46,397 had blood differential cell counts obtained before severe acute respiratory syndrome coronavirus 2 testing dates. Our end points included the need for hospitalization, admission to the intensive care unit (ICU), and in-hospital mortality. The effect of eosinophilia on outcomes was estimated after propensity weighting and adjustment. RESULTS: Of the 46,397 patients included in the final analyses, 19,506 had preexisting eosinophilia (>0.15 × 103 cells/µL), 5,011 received ICS, 9,096 (19.6%) were hospitalized, 2,129 required ICU admission (4.6%) and 1,402 died during index hospitalization (3.0%). Adjusted analysis associated eosinophilia with lower odds for hospitalization (odds ratio [OR] [95% confidence interval (CI)]: 0.86 [0.79-0.93]), ICU admission (OR [95% CI]: 0.79 [0.69-0.90]), and mortality (OR [95% CI]: 0.80 [0.68-0.95]) among ICS-treated patients but not untreated ones. The correlation between absolute eosinophil count and the estimated probability of hospitalization, ICU admission, and death was nonlinear (U-shaped) among patients not treated with ICS, and negative in treated patients. CONCLUSIONS: The association between eosinophilia and improved COVID-19 outcomes depends on ICS. Future randomized controlled trials are needed to determine the role of ICS and its interaction with eosinophilia in COVID-19 therapy.


Subject(s)
COVID-19 , Eosinophilia , Pulmonary Disease, Chronic Obstructive , Adrenal Cortex Hormones , COVID-19 Testing , Eosinophilia/chemically induced , Eosinophilia/drug therapy , Eosinophilia/epidemiology , Humans , Pulmonary Disease, Chronic Obstructive/complications , SARS-CoV-2
4.
Ann Palliat Med ; 11(2): 544-550, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1727123

ABSTRACT

BACKGROUND: Under the current epidemic of the coronavirus disease of 2019 (COVID-19), there is a need to distinguish the differences between the laboratory examinations of COVID-19-infected patients, tumor patients with fever, and those with normal fever patients. We aimed to investigate the temperature of tumor patients with different tumor burdens, stages, and cancer types. METHODS: We recruited 3 groups of patients to this study: fever patients with malignant tumors, ordinary fever patients, and confirmed cases of COVID-19, with 31, 55, and 28 cases in each group, respectively. RESULTS: The levels of leukocytes and neutrophils were the highest among non-tumor patients, and the count of COVID-19 was the lowest, with a P value of 0.000. Among the leukocytosis group, non-tumor patients had the highest proportion (43.6%), while that of COVID-19 was only 3.6% (P=0.000). Similarly, there were significant differences in the grading of neutrophils, where most of the infected patients were in the normal group and the P value was 0.000. The lymphocyte count of the tumor group was significantly reduced, with an average of (0.97±0.66) ×109/L (P=0.004). In the lymphocyte grades, most of the infected patients were the normal group (71.4%), while tumor patients in the lymphocytopenia group accounted for 63.1% (P=0.006). There were also significant differences in the neutrophil to lymphocyte ratio (NLR) (P=0.006). There was a significant difference in temperature between different tumor burden groups (P=0.014). CONCLUSIONS: The normal fever group had the highest count of leukocyte and neutrophils, whereas the infected group had the lowest relative count. The NLR was the lowest in the infected group. The NLR was higher in the bigger tumor load group.


Subject(s)
COVID-19 , Neoplasms , Humans , Lymphocytes , Neoplasms/complications , Prognosis , Retrospective Studies , SARS-CoV-2
5.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323560

ABSTRACT

Background: In December 2019, Coronavirus Disease 2019 (COVID-19) outbreak was reported from Wuhan, China. Information on the clinical course and prognosis of COVID-19 was not thoroughly described. We described the clinical courses and prognosis in COVID-19 patients. Methods Retrospective case series of COVID-19 patients from Zhongnan Hospital of Wuhan University in Wuhan, and Xi-shui Hospital, Hubei Province, China, up to February 10, 2020. Epidemiological, demographic and clinical data were collected. Clinical course of survivors and non-survivors were compared. Risk factors for death were analyzed. Results A total of 107 discharged patients with COVID-19 were enrolled. The clinical course of COVID-19 presented as a tri-phasic pattern. Week 1 after illness onset was characterized by fever, cough, dyspnea, lymphopenia and radiological multilobar pulmonary infiltrates. In severe cases, thrombocytopenia, acute kidney injury, acute myocardial injury or adult respiratory distress syndrome were observed. During week 2, in mild cases, fever, cough and systemic symptoms began to resolve and platelet count rose to normal range, but lymphopenia persisted. In severe cases, leukocytosis, neutrophilia and deteriorating multi-organ dysfunction were dominant. By week 3, mild cases had clinically resolved except for lymphopenia. However, severe cases showed persistent lymphopenia, severe acute respiratory dyspnea syndrome , refractory shock, anuric acute kidney injury, coagulopathy, thrombocytopenia and death. Older age and male sex were independent risk factors for poor outcome of the illness. Conclusions A period of 7–13 days after illness onset is the critical stage in COVID-19 course. Age and male gender were independent risk factors for death of COVID-19.

6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322526

ABSTRACT

The aim of our study was to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. We investigated all COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei Province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3-27.0] days. Most tracheotomies were performed by ICU physicians (62 (77.5%)) and using percutaneous techniques (63 (78.8%)) at the ICU bedside (76 (95.0%)). At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from the ventilator, 17 (21.2%) patients were discharged from the ICU, and 43 (53.8%) patients had died. Higher 60-day mortality (22 (73.3%) vs 21 (42.0%)) was identified in patients who underwent early tracheostomy. In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physicians at bedside with few major complications. However, tracheostomies within 14 days of endotracheal intubation should be avoided.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322503

ABSTRACT

Background: The Corona Virus Disease 2019 (COVID-19) is spreading globally now. However, the clinical presentation that predict prognosis of the patients are still largely unknow. Methods: We enrolled 393 patients infected with COVID-19 and 30 patients with common pulmonary bulla and reviewed their clinical features to evaluate the potential prognostic value of pulmonary vesicles, especially in the patients with severe symptoms. One COVID-19 patient with vesicles was treated by bullectomy for last resort, and its characteristics of the patient’s perioperative laboratory tests was analyzed. The pathological findings of bullectomy were described and compared with those of common bulla cases. Results: Patients infected with COVID-19 showed more dependence on ventilator, occurrence of super resistant bacteria, and prone to vesicle formation than common bulla (p<0.05). Disease severity is associated with age, sex, and usage of ventilator, ECMO and antibiotics, super resistance bacteria and vesicle formation (p<0.05). The average mortality rate of COVID-19 patients was 4.10% (25.4% in severe patients, 0.00% in mild patients). Interestingly, the mortality rate further increased in severe patients with pulmonary vesicles than those without pulmonary vesicles (35.7% vs 22.4%, p=0.0442). One COVID-19 patient with vesicles underwent bullectomy and had a poor prognosis, who showed diffuse alveolar damage and extensive necrosis in bullectomy specimen. Conclusions: Patients infected with COVID-19 are more prone to form pulmonary vesicles showed on chest CT scans, as an important poor prognosis factor, especially in the severe patients.

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315618

ABSTRACT

Objective: Coronavirus disease 2019 (COVID-19) is currently the most serious infectious disease in the world. An accurate diagnosis of this disease in the clinic is very important. This study aims to improve the differential ability of computed tomography (CT) to diagnose COVID-19 and other community-acquired pneumonias (CAPs) and evaluate the short-term prognosis of these patients. Methods: The clinical and imaging data of 165 COVID-19 and 118 CAP patients diagnosed in seven hospitals in Anhui Province, China from January 21 to February 28, 2020 were retrospectively analysed. The CT manifestations of the two groups were recorded and compared. A correlation analysis was used to examine the relationship between COVID-19 and age, size of lung lesions, number of involved lobes, and CT findings of patients. The factors that were helpful in diagnosing the two groups of patients were identified based on specificity and sensitivity. Results : The typical CT findings of COVID-19 are simple ground-glass opacities (GGO), GGO with consolidation or grid-like changes. The sensitivity and specificity of the combination of age, white blood cell count, and ground-glass opacity in the diagnosis of COVID-19 were 92.7% and 66.1%, respectively. Pulmonary consolidation, fibrous cords, and bronchial wall thickening were used as indicators to exclude COVID-19. The sensitivity and specificity of the combination of these findings were 78.0% and 63.6%, respectively. The follow-up results showed that 67.8% (112/165) of COVID-19 patients had abnormal changes in their lung parameters, and the severity of the pulmonary sequelae of patients over 60 years of age worsened with age. Conclusions : Age, white blood cell count and ground-glass opacity have high accuracy in the early diagnosis of COVID-19 and the differential diagnosis from CAP. Patients aged over 60 years with COVID-19 have a poor prognosis. This result provides certain significant guidance for the diagnosis and treatment of new coronavirus pneumonia.

9.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312621

ABSTRACT

Importance: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections outbreak in China is now a global issue. There is only a limited understanding of the clinical characteristics of patients with SARS-CoV-2 infections is available. Objective: To describe the characteristics, management strategies, and outcomes of critically ill patients with SARS-CoV-2 infection. Design: , Setting, and Patients: This is aretrospective, multi-center case series of 50 critically ill patients with confirmed SARS-CoV-2 infection who were admitted at Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital in Wuhan, China, from January 8 to February 9, 2020. Exposures: Documented Corona Virus Disease, 2019 (COVID-19). Main Outcome Measures: Demographic, clinical, laboratory, imaging data were collected along with management strategies, complications and outcomes of enrolled individuals. Results: Fifty critically ill patients with SARS-CoV-2 infections were enrolled. Their median age was 62 (range, 29-92) [IQR,49.5-69.0] years, 68% were male, and 28 (56%) patients had comorbidities, the most common being hypertension. In this cohort, 20(40%) patients survived ,16(32%) patients died, and the rest remained hospitalized. The invasive mechanical ventilator was used in 36(72%) patients with 15(30%) of them requiring prone positioning, and 17(34%) switched to ECMO. The compliance scores of lungs (Cstat)on the day of ICU admission among survivors were higher than those in non-survivors [42.0(18.0-47.0), vs. 19.5(14.0-24.2), p=0.038].The blood IL-6 levels and neutrophils counts at the first day of ICU admission were significantly higher in non-survivors compared to survivors [123.7(85.3-228.8), vs. 20.2(6.8-67.2) ng/ml, p=0.025 for IL-6, and 20.2(6.8-67.2) vs. 4.01(1.99-7.05) × 10⁹/L, p=0.02 for neutrophils counts].The heart rates, PaCO2, lung injury scale (LIS), and positive end-expiratory pressure levels were constantly higher for 10 days in non-survivors than those who survived (p<0.05). The frequency of vasopressor uses and neuromuscular blockers was higher in non-survivors from day 1 to day 10 compared to survivors (p<0.05). In the whole cohort, the most common complications were ARDS (97%), shock (44%), arrhythmia (38%), acute cardiac injury (26%), and acute kidney injury (22%). A secondary bacterial infection was noted in 17(34%) patients. Univariate analysis indicated that lower lung complianceand higher neutrophil counts at the day of ICU admission were related to higher mortality (p-0.03, and 0.04, respectively) Conclusion: We demonstrated that SARS-CoV-2 infection-related critical illness predominantly affected old individuals with comorbidities and characterized by severe hypoxemic respiratory failure, often requiring prolonged mechanical ventilation and rescue therapies. Low lung compliance and persistently elevated PaCO2 indicated poor outcomes.

10.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-311711

ABSTRACT

P2Y receptors (P2YRs), a δ group of rhodopsin-like G protein-coupled receptors (GPCRs), have many essential functions in physiology and pathology, such as platelet aggregation, immune responses, neuroprotective effects, inflammation, and cellular proliferation;thus, they are among the most researched therapeutic targets for use in the clinical treatment of diseases (e.g., clopidogrel, an antithrombotic drug, and Prolacria, a treatment for dry eye). Over the past two decades, GPCRs have been revealed to transmit signals as dimers to increase the diversity of signalling pathways or pharmacological activities. Many studies have frequently confirmed dimerization between P2YRs and other GPCRs due to their functions in cardiovascular and cerebrovascular processes in vivo and in vitro. Recently, some P2YR dimers that dynamically balance physiological functions in the body were shown to be involved in effective signal transduction and exert pathological pharmacological effects. In this review, we summarize the types, pharmacological changes, and active regulators of P2YR-related dimerization. In summary, our review delineates that P2YR-related dimers have new functions and pharmacological activities and maybe a novel direction to improve the effectiveness of medications such as thrombotic events associated with COVID-19.

11.
J Affect Disord ; 304: 12-19, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1683225

ABSTRACT

BACKGROUND: Trauma experience increases the risk of suicidal ideation, but little is known about potentially psychological mechanisms underlying this relationship. This study aims to examine the relationship between coronavirus disease 2019 (COVID-19)-related traumatic event (CTE) exposure and suicidal ideation among hospital workers, and identify mediating roles of sleep disturbances in this relationship. METHODS: Workers in seven designated hospitals in Wuhan, China, were invited to participate in an online survey from May 27, 2020, to July 31, 2020. Participants completed a self-report questionnaire to evaluate demographic characteristics, level of CTE exposures, nightmare frequency, insomnia severity, symptoms of depression and anxiety, and suicidal ideation. A series of correlation analyses were performed, and a mediation model was generated to examine correlations between CTE exposure, sleep disturbances, and suicidal ideation. RESULTS: A total of 16,220 hospital workers were included in the final analysis, 13.3% of them reported suicidal ideation in the past month. CTE exposure was significantly associated with insomnia severity, nightmare frequency, and suicidal ideation. After controlling potential confounders, nightmares but not insomnia, depression, or anxiety were shown to be independent risk factors for suicidal ideation. Pathway analyses showed that the relationship between CTE exposure and suicidal ideation was fully mediated by nightmares (proportion mediated 66.4%) after adjusting for demographic characteristics and psychological confounders. LIMITATIONS: Cross-sectional design precluded the investigation of causal relationships. CONCLUSIONS: CTE exposure increases risk of hospital workers' suicidal ideation that is mediated by nightmares, suggesting nightmares intervention might be considered as a component when developing suicide prevention strategies.


Subject(s)
COVID-19 , Sleep Initiation and Maintenance Disorders , Cross-Sectional Studies , Dreams/psychology , Humans , Sleep Initiation and Maintenance Disorders/epidemiology , Suicidal Ideation
12.
Journal of Intensive Medicine ; 2022.
Article in English | ScienceDirect | ID: covidwho-1665214

ABSTRACT

Background The coronavirus disease 2019 (COVID-19) is an ongoing pandemic since December 2019. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods In this retrospective, single-center, case series, 46 patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8, 2020, to March 24, 2020, with the final follow-up date of April 20, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results The median age of the 46 patients with COVID-19-associated ARDS requiring IMV was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR], 6.0–27.3) days, and the median respiratory support decision score was 11.0 (IQR, 7.8–16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3–17.0] vs. 8.5 (6.0–10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657–0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P < 0.001). Conclusions For severe COVID-19-associated ARDS with IMV, following the respiratory support decision and assessing completion would improve the progress of ventilation. With a decision score of >11.5, the mortality at 28 days after ICU admission showed an obvious decrease.

13.
JAMA Netw Open ; 4(11): e2131455, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1520138

ABSTRACT

Importance: This randomized clinical trial examines the feasibility and acceptability of a decision-making tool for increasing patient interest in individualized recommendations for preventive care services. Objective: To pilot a tool to help patients compare life expectancy gains from evidence-based preventive services. Design, Setting, and Participants: This randomized clinical trial examined patient and physician responses to a pilot decision tool incorporating personalized risk factors at 3 US primary care clinics between 2017 and 2020. Eligible patients were between ages 45 to 70 years with 2 or more high-risk factors. Patients were followed-up after 1 year. Interventions: The gain in life expectancy associated with guideline adherence to each recommended preventive service was estimated. Personalized estimates incorporating risk factors in electronic health records were displayed in a physician-distributed visual aid. During development, physicians discussed individualized results with patients using shared decision-making (SDM). During the trial, patients were randomized to receive individualized recommendations or usual care (nonmasked, parallel, 1:1 ratio). Main Outcomes and Measures: Primary outcome was patient interest in individualized recommendations, assessed by survey. Secondary outcomes were use of SDM, decisional comfort, readiness to change, and preventive services received within 1 year. Results: The study enrolled 104 patients (31 development, 39 intervention, 34 control), of whom 101 were included in analysis (mean [SD] age, 56.5 [5.3] years; 73 [72.3%] women; 80 [79.2%] Black patients) and 20 physicians. Intervention patients found the tool helpful and wanted to use it again, rating it a median 9 of 10 (IQR, 8-10) and 10 of 10 (8-10), respectively. Compared with the control group, intervention patients more often correctly identified the service least likely (18 [46%] vs 0; P = .03) to improve their life expectancy. A greater number of patients also identified the service most likely to improve their life expectancy (26 [69%] vs 10 [30%]; P = .07), although this result was not statistically significant. Intervention patients reported greater mean [SD] improvement in SDM (4.7 [6.9] points) and near-term readiness to change (13.8 points for top-3-ranked recommendations). Point estimates indicated that patients in the intervention group experienced greater, although non-statistically significant, reductions in percentage of body weight (-2.96%; 95% CI, -8.18% to 2.28%), systolic blood pressure (-6.42 mm Hg; 95% CI, -16.12 to 3.27 mm Hg), hemoglobin A1c (-0.68%; 95% CI, -1.82% to 0.45%), 10-year atherosclerotic cardiovascular disease risk score (-1.20%; 95% CI, -3.65% to 1.26%), and low-density lipoprotein cholesterol (-8.46 mg/dL; 95% CI, -26.63 to 9.70 mg/dL) than the control group. Nineteen of 20 physicians wanted to continue using the decision tool in the future. Conclusions and Relevance: In this clinical trial, an individualized preventive care decision support tool improved patient understanding of primary prevention and demonstrated promise for improved shared decision-making and preventive care utilization. Trial Registration: ClinicalTrials.gov Identifier: NCT03023813.


Subject(s)
Decision Making , Decision Support Techniques , Physician-Patient Relations , Preventive Medicine/methods , Aged , Attitude of Health Personnel , Evidence-Based Medicine , Female , Guideline Adherence , Humans , Life Expectancy , Male , Middle Aged , Physicians/psychology , Pilot Projects
14.
J Allergy Clin Immunol Pract ; 9(11): 3934-3940.e9, 2021 11.
Article in English | MEDLINE | ID: covidwho-1504841

ABSTRACT

BACKGROUND: Sites of entry for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are highly expressed in nasal epithelial cells; however, little is known about the impact of intranasal corticosteroids (INCS) on coronavirus disease 2019 (COVID-19)-related outcomes. OBJECTIVE: To determine the association between baseline INCS use and COVID-19-related outcomes. METHODS: Using the Cleveland Clinic COVID-19 Research Registry, we performed a propensity score matching for treatment with INCS before SARS-CoV-2 infection (April 1, 2020, to March 31, 2021). Of the 82,096 individuals who tested positive, 72,147 met inclusion criteria. Our endpoints included the need for hospitalization, admission to the intensive care unit (ICU), or in-hospital mortality. RESULTS: Of the 12,608 (17.5%) who were hospitalized, 2935 (4.1%) required ICU admission and 1880 (2.6%) died during hospitalization. A significant proportion (n = 10,187; 14.1%) were using INCS before SARS-CoV-2 infection. Compared with nonusers, INCS users demonstrated lower risk for hospitalization (adjusted odds ratio [OR] [95% confidence interval (CI)]: 0.78 [0.72; 0.85]), ICU admission (adjusted OR [95% CI]: 0.77 [0.65; 0.92]), and in-hospital mortality (adjusted OR [95% CI]: 0.76 [0.61; 0.94]). These findings were replicated in sensitivity analyses where patients on inhaled corticosteroids and those with allergic rhinitis were excluded. The beneficial effect of INCS was significant after adjustment for baseline blood eosinophil count (measured before SARS-CoV-2 testing) in a subset of 30,289 individuals. CONCLUSION: INCS therapy is associated with a lower risk for COVID-19-related hospitalization, ICU admission, or death. Future randomized control trials are needed to determine if INCS reduces the risk for severe outcomes related to COVID-19.


Subject(s)
COVID-19 , Adrenal Cortex Hormones/therapeutic use , COVID-19 Testing , Humans , Intensive Care Units , SARS-CoV-2
15.
Chinese Journal of Virology ; 36(4):692-693, 2020.
Article in Chinese | CAB Abstracts | ID: covidwho-1407612

ABSTRACT

In December 2019, an outbreak of a respiratory illness took place in Wuhan, Hubei Province, China, and spread throughout China and other countries. A beta genus coronavirus, SARS-CoV-2 was isolated and identified as a cause of the outbreak. Currently, the main infectious sources(host)of SARS-CoV-2 have not been identified. It has been reported that SARS-CoV-2 was possibly originated from wild animals, for example, bats. However, there are no reports on the traceability of SARS-CoV-2 to fur animals, such as minks, foxes and raccoon dogs, which are widely farmed in Northern China. Therefore, it is necessary to investigate the epidemiology of SARS-CoV-2 in fur animals. In this study, we detected SARS-CoV-2 in 625 tissue specimens collected from farmed minks, foxes and raccoon dogs of unknown death cases in 14 regions of China from 2016 to 2019 and 150 fecal samples collected from farmed minks, foxes and raccoon dogs in Jilin Province, China from August to December in 2019 using the Real-time RT-PCR method recommended by WHO. The results showed that SARS-CoV-2 was not detected in all the 775 samples.

16.
Remote Sensing ; 13(18):3664, 2021.
Article in English | MDPI | ID: covidwho-1410789

ABSTRACT

Air pollutant transport plays an important role in local air quality, but field observations of transport fluxes, especially their vertical distributions, are very limited. We characterized the vertical structures of transport fluxes in central Luoyang, Fen-Wei Plain, China, in winter based on observations of vertical air pollutant and wind profiles using multi-axis differential optical absorption spectroscopy (MAX-DOAS) and Doppler wind lidar, respectively. The northwest and the northeast are the two privileged wind directions. The wind direction and total transport scenarios were dominantly the northwest during clear days, turning to the northeast during the polluted days. Increased transport flux intensities of aerosol were found at altitudes below 400 m on heavily polluted days from the northeast to the southwest over the city. Considering pollution dependence on wind directions and speeds, surface-dominated northeast transport may contribute to local haze events. Northwest winds transporting clean air masses were dominant during clean periods and flux profiles characterized by high altitudes between 200 and 600 m in Luoyang. During the COVID-19 lockdown period in late January and February, clear reductions in transport flux were found for NO2 from the northeast and for HCHO from the northwest, while the corresponding main transport altitude remained unchanged. Our findings provide better understandings of regional transport characteristics, especially at different altitudes.

17.
Front Cardiovasc Med ; 8: 604736, 2021.
Article in English | MEDLINE | ID: covidwho-1403460

ABSTRACT

Low-density lipoprotein cholesterol (LDL-C) is a well-known risk factor for coronary heart disease but protects against infection and sepsis. We aimed to disclose the exact association between LDL-C and severe 2019 novel coronavirus disease (COVID-19). Baseline data were retrospectively collected for 601 non-severe COVID-19 patients from two centers in Guangzhou and one center in Shenzhen, and patients on admission were medically observed for at least 15 days to determine the final outcome, including the non-severe group (n = 460) and the severe group (severe and critical cases) (n = 141). Among 601 cases, 76 (12.65%) received lipid-lowering therapy; the proportion of patients taking lipid-lowering drugs in the severe group was higher than that in the non-severe group (22.7 vs. 9.6%). We found a U-shaped association between LDL-C level and risk of severe COVID-19 using restricted cubic splines. Using univariate logistic regression analysis, odds ratios for severe COVID-19 for patients with LDL-C ≤1.6 mmol/L (61.9 mg/dL) and above 3.4 mmol/L (131.4 mg/dL) were 2.29 (95% confidence interval 1.12-4.68; p = 0.023) and 2.02 (1.04-3.94; p = 0.039), respectively, compared to those with LDL-C of 2.81-3.40 mmol/L (108.6-131.4 mg/dL); following multifactorial adjustment, odds ratios were 2.61 (1.07-6.37; p = 0.035) and 2.36 (1.09-5.14; p = 0.030). Similar results were yielded using 0.3 and 0.5 mmol/L categories of LDL-C and sensitivity analyses. Both low and high LDL-C levels were significantly associated with higher risk of severe COVID-19. Although our findings do not necessarily imply causality, they suggest that clinicians should pay more attention to lipid-lowering therapy in COVID-19 patients to improve clinical prognosis.

18.
Front Psychiatry ; 12: 710515, 2021.
Article in English | MEDLINE | ID: covidwho-1399179

ABSTRACT

Long-term home isolation has had a certain impact on adolescents' enthusiasm for interpersonal communication and desire for self-disclosure during COVID-19. The purpose of this study was to explore the relationship between adolescents' self-disclosure and loneliness during COVID-19, and to analyze the mediating role of peer relationship in it. We conducted a cross-sectional study involving 830 Chinese adolescents (males: 47.5%, Mage14.25 years; females: 52.05%, Mage 14.19 years; Age range 12-15). Participants completed a self-reported survey that included sociodemographic, Jourard Self-Disclosure Scale, UCLA, and Peer Relationship Scale. The results showed that in the period of COVID-19, adolescents' self-disclosure affects loneliness through peer relationship, that is, the level of self-disclosure can significantly predict loneliness through peer relationship, and peer relationship plays a complete mediating role.

19.
Stroke Vasc Neurol ; 5(3): 279-284, 2020 09.
Article in English | MEDLINE | ID: covidwho-1318202

ABSTRACT

BACKGROUND AND PURPOSE: COVID-19 is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Apart from respiratory complications, acute cerebrovascular disease (CVD) has been observed in some patients with COVID-19. Therefore, we described the clinical characteristics, laboratory features, treatment and outcomes of CVD complicating SARS-CoV-2 infection. MATERIALS AND METHODS: Demographic and clinical characteristics, laboratory findings, treatments and clinical outcomes were collected and analysed. Clinical characteristics and laboratory findings of patients with COVID-19 with or without new-onset CVD were compared. RESULTS: Of 219 patients with COVID-19, 10 (4.6%) developed acute ischaemic stroke and 1 (0.5%) had intracerebral haemorrhage. COVID-19 with new onset of CVD were significantly older (75.7±10.8 years vs 52.1±15.3 years, p<0.001), more likely to present with severe COVID-19 (81.8% vs 39.9%, p<0.01) and were more likely to have cardiovascular risk factors, including hypertension, diabetes and medical history of CVD (all p<0.05). In addition, they were more likely to have increased inflammatory response and hypercoagulable state as reflected in C reactive protein (51.1 (1.3-127.9) vs 12.1 (0.1-212.0) mg/L, p<0.05) and D-dimer (6.9 (0.3-20.0) vs 0.5 (0.1-20.0) mg/L, p<0.001). Of 10 patients with ischemic stroke; 6 received antiplatelet treatment with aspirin or clopidogrel; and 3 of them died. The other four patients received anticoagulant treatment with enoxaparin and 2 of them died. As of 24 March 2020, six patients with CVD died (54.5%). CONCLUSION: Acute CVD is not uncommon in COVID-19. Our findings suggest that older patients with risk factors are more likely to develop CVD. The development of CVD is an important negative prognostic factor which requires further study to identify optimal management strategy to combat the COVID-19 outbreak.


Subject(s)
Betacoronavirus/pathogenicity , Cerebrovascular Disorders/virology , Coronavirus Infections/virology , Pneumonia, Viral/virology , Acute Disease , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , COVID-19 , Cerebrovascular Disorders/diagnosis , Cerebrovascular Disorders/drug therapy , Cerebrovascular Disorders/mortality , China , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Female , Host-Pathogen Interactions , Humans , Male , Middle Aged , Pandemics , Platelet Aggregation Inhibitors/therapeutic use , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Treatment Outcome
20.
Stroke Vasc Neurol ; 5(2): 146-151, 2020 06.
Article in English | MEDLINE | ID: covidwho-1318197

ABSTRACT

Coronavirus disease 2019 (COVID-19) has become a pandemic disease globally. Although COVID-19 directly invades lungs, it also involves the nervous system. Therefore, patients with nervous system involvement as the presenting symptoms in the early stage of infection may easily be misdiagnosed and their treatment delayed. They become silent contagious sources or 'virus spreaders'. In order to help neurologists to better understand the occurrence, development and prognosis, we have developed this consensus of prevention and management of COVID-19. It can also assist other healthcare providers to be familiar with and recognise COVID-19 in their evaluation of patients in the clinic and hospital environment.


Subject(s)
Betacoronavirus/pathogenicity , Central Nervous System Infections/therapy , Central Nervous System/virology , Clinical Laboratory Techniques/standards , Coronavirus Infections/therapy , Neurologists/standards , Pneumonia, Viral/therapy , COVID-19 , COVID-19 Testing , Central Nervous System/physiopathology , Central Nervous System Infections/diagnosis , Central Nervous System Infections/physiopathology , Central Nervous System Infections/virology , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Early Diagnosis , Host-Pathogen Interactions , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , Predictive Value of Tests , Prognosis , SARS-CoV-2
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