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1.
Am J Respir Crit Care Med ; 2022 May 25.
Article in English | MEDLINE | ID: covidwho-1864199
2.
JAMA Intern Med ; 182(6): 624-633, 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1801976

ABSTRACT

Importance: The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined. Objective: To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission. Design, Setting, and Participants: This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states. Exposure: Having a family member in the ICU with COVID-19. Main Outcomes and Measures: Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6). Results: A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients' child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners. Conclusions and Relevance: In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , COVID-19/epidemiology , Child , Cohort Studies , Family/psychology , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Prospective Studies , Stress Disorders, Post-Traumatic/psychology
3.
J Formos Med Assoc ; 2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1739928

ABSTRACT

Psychiatric and neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are common. Psychiatric symptoms are so common that they are easily misinterpreted as an affective disorder induced by SARSCoV-2 infection. However, psychiatric symptoms, such as acute delirium, though rarely seen, can be the initial manifestations of acute ischemic stroke (AIS). These psychiatric symptoms may confuse the diagnosis of acute stroke, which needs correct and timely management. We report two hospitalized cases with SARS-CoV-2 infection and elevated serum D-dimer levels having acute delirium as the initial manifestation of AIS. The diagnostic processes were challenging and time-consuming, so reperfusion therapy could not be given in the therapeutic time window. The diagnoses of AIS were finally made by brain magnetic resonance imaging which showed diffusion restriction at the right middle cerebral artery territory in both cases. Features of psychiatric complications and stroke in coronavirus disease 2019 (COVID-19) patients are reviewed. For the hospitalized COVID-19 patients with elevated levels of serum Ddimer and acute delirium, acute stroke with neuropsychiatric manifestations should beconsidered.

5.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-315402

ABSTRACT

Background: Awareness of the association between coronavirus disease 2019 (COVID-19) and airway diseases can effectively help in the treatment during the coronavirus pandemic. Case presentation : Herein, we present a COVID-19 case who confirmed to coexist with asthma. BGF was used as sequential medicine to systemic glucocorticoidsfor his persisted symptoms related to bronchospasms. Conclusion: Our case suggests patients with long-term airway diseases like asthma probably attribute to COVID-19 instead of primary diseases, which make it more difficult in the treatment.BGF is able to be an effective and convenient choiceas sequential medicine to systemic glucocorticoidsin some refractoryasthmatic patients complicated with COVID-19.

6.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312747

ABSTRACT

Objective: This study investigated the influence of Coronavirus Disease 2019 (COVID-19) on lung function in early convalescence phase. Methods: A prospective retrospective study of COVID-19 patients at the Fifth Affiliated Hospital of Sun Yat-sen University were conducted, with serial assessments including lung volumes (TLC), spirometry (FVC, FEV1), lung diffusing capacity for carbon monoxide (DLCO),respiratory muscle strength, 6-minute walking distance (6MWD) and high resolution CT being collected at 30 days after discharged. Results: 57 patients completed the serial assessments. There were 40 non-severe cases and 17 severe cases. Thirty-one patients (54.3%) had abnormal CT findings. Abnormalities were detected in the pulmonary function tests in 43 (75.4%) of the patients. Six (10.5%), 5(8.7%), 25(43.8%) 7(12.3%), and 30 (52.6%) patients had FVC, FEV1, FEV1/FVC ratio, TLC, and DLCO values less than 80% of predicted values, respectively. 28 (49.1%) and 13 (22.8%) patients had PImax and PEmax values less than 80% of the corresponding predicted values. Compared with non-severe cases, severe patients showed higher incidence of DLCO impairment (75.6%vs42.5%, p=0.019), higher lung total severity score(TSS)and R20, and significantly lower percentage of predicted TLC and 6MWD. No significant correlation between TSS and pulmonary function parameters was found during follow-up visit. Conclusion: Impaired diffusing-capacityDeclining DLCO, lower respiratory muscle strength, and lung imaging abnormalities were detected in more than half of the COVID-19 patients in early convalescence phase. Compared with non-severe cases, severe patients had a higher incidence of DLCO impairment and encountered more TLC decrease and 6MWD decline.

7.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-312708

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) epidemic is still spreading rapidly around the world. Recent cases with prolonged detection of SARS-CoV-2 RNA have been successively reported and the phenomenon of false-negative real-time polymerase chain reaction (RT-PCR) results of SARS-CoV-2 RNA or “repositive” was also described in patients with COVID-19. Case presentation A 69-year-old female with hypertension, total hysterectomy for hysteromyoma and suspected lung tumor presented with moderate COVID-19 symptoms was testing positive for SARS-CoV-2 RNA by RT-PCR when she travelled from USA to China. The patient required second and third re-hospitalization due to repositive SARS-CoV-2 test results of throat swaps during post-charge solitary isolation and observation. The serum SARS-CoV-2-IgG decayed rapidly and disappeared on illness day 139 when the throat swab was still positive for SARS-CoV-2 RNA. Finally the virus shedding lasted at least146 days (the last positive test result of throat swap on illness day 146 and the first true-negative test result on illness day 151) from her initial positive test. Conclusions: Prolonged viral shedding of SARS-CoV RNA is prone to occur in an immunocompromised host. With the change of host immune status, SARS-CoV-2 detection can be repeatedly positive. The SARS-CoV-2-IgG may decrease rapidly and disappear before the virus removal, indicating there may be certain limitations on the protective effect of antibody against SARS-CoV-2 which deserves attention of clinicians.

8.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312703

ABSTRACT

Background: In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and has since rapidly spread throughout China. The mortality rates of novel coronavirus pneumonia (NCP) in severe and critical cases are very high. In this public-health emergency, a high-efficiency administrative emergency-response mode in designated hospitals is needed. Method: As an affiliated hospital of Sun Yat-sen University, ours, the Fifth Affiliated Hospital, is the only one designated for the diagnosis and treatment of COVID-19 in Zhuhai, a mid-sized city. The NCP department, for which the president of the hospital is also the direct administrative lead, was established at an early stage of the epidemic at our hospital. This department includes core members of the pulmonary and critical-care medicine (PCCM) specialist and multidisciplinary team. Rather than adhering to national guidelines on NCP, we have focused on individualized treatment, timely adjustment thereof and management strategies in working with COVID-19 patients based on the professional opinions of a professor of respiratory medicine and an expert group. Results: (1) High working efficiency: As of March 2, 2020, we have completed 2974 citywide consultations and treatment of 366 inpatients, including 101 who were diagnosed with COVID-19. (2) Excellent therapeutic effect: Of the 101 patients hospitalized with confirmed COVID-19, only 1 has died, and the rest were all cured and discharged. No secondary hospital infection, pipeline infection or pressure sores were found in any patient. (3) Finding and confirming person-to-person transmission characteristic of COVID-19 prior to the official press conference: Strengthened protection is key to zero infection among the healthcare providers and medical faculty, as well as to a lower rate of second-generation infectious patients. (4) Timely adjustment of management and treatment strategy prior to guideline updates: The first evidence of digestive-tract involvement in COVID-19 has been found, and the earliest clinical trial of chloroquine in the treatment of the disease was carried out at our hospital. Conclusions: At our hospital, establishment of an NCP department, which is directly administered by the hospital president and specialized operation guided by a professor of respiratory medicine, has been key to our success in managing and treating COVID-19 patients. Our hospital’s emergency-response mode could provide a reference for other hospitals and cities in this epidemic situation.

9.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322986

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a worldwide public health pandemic with a high mortality rate, among severe cases. The disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. It is important to ensure early detection of the virus to curb disease progression to severe COVID-19. This study aimed to establish a clinical-nomogram model to predict the progression to severe COVID-19 in a timely, efficient manner. Methods This retrospective study included 202 patients with COVID-19 who were admitted to the Fifth Affiliated Hospital of Sun Yat-sen University and Shiyan Taihe Hospital from January 17 to April 30, 2020. The patients were randomly assigned to the training dataset (n = 163, with 43 progressing to severe COVID-19) or the validation dataset (n = 39, with 10 progressing to severe COVID-19) at a ratio of 8:2. The optimal subset algorithm was applied to filter for the clinical factors most relevant to the disease progression. Based on these factors, the logistic regression model was fit to distinguish severe (including severe and critical cases) from non-severe (including mild and moderate cases) COVID-19. Sensitivity, specificity, and area under the curve (AUC) were calculated using the R software package to evaluate prediction performance. A clinical nomogram was established and performance assessed with the discrimination curve. Results Risk factors, including demographics data, symptoms, laboratory and image findings were recorded for the 202 patients. Eight of the 52 variables that were entered into the selection process were selected via the best subset algorithm to establish the predictive model;they included gender, age, BMI, CRP, D-dimer, TP, ALB, and involved-lobe. Sensitivity, specificity and AUC were 0.91, 0.84 and 0.86 for the training dataset, and 0.87, 0.66, and 0.80 for the validation dataset. Conclusions We established an efficient and reliable clinical nomogram model which showed that gender, age, and initial indexes including BMI, CRP, D-dimer, involved-lobe, TP, and ALB could predict the risk of progression to severe COVID-19.

10.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322985

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the leading cause of a public health emergency in the world, accompanying with high mortality in severe corona virus disease 2019(COVID-19 ), thereby early detection and stopping the progress to severe COVID-19 is important. Our aim is to establish a clinical nomogram model to calculate and predict the progress to severe COVID-19 timely and efficiently. Methods: In this study, 65 patients with COVID-19 had been included retrospectively in the Fifth Affiliated Hospital of Sun Yat-sen University from January 17, to February 11, 2020. Patients were randomly assigned to train dataset (n=51 with 15 progressing to severe COVID-19) and test dataset (n=14 with 4 progressing to severe COVID-19). Lasso algorithm was applied to filter the most classification relevant clinical factors. Based on selected factors, logistic regression model was fit to predict the severe from mild/common. Meanwhile in nomogram sensitivity, specificity, AUC (Area under Curve), and calibration curve were depicted and calculated by R language, to evaluate the prediction performance to severe COVID-19. Results: High ratio of sever COVID-19 patients (26.5%) had been found in our retrospective study, and 84% of these cases progress to severe or critical after 5 days from their first clinical examination. In these 65 patients with COVID-19, 77 clinical characteristics in first examination were collected and analyzed, and 37 ones had been found different between non-severe and severe COVID-19. But when all these factors were analyzed in establishment of prediction model, six factors are crucial for predicting progress of severe COVID-19 via Lasso algorithm. Based on these six factors, including increased fibrinogen, hyponatremia, decreased PaO2,multiple lung lobes involved, down-regulated CD3(+)T-lymphocyte and fever, a logistic regression model was fit to discriminate severe and common COVID-19 patients. The sensitivity, specificity and AUC were 0.93, 0.86, 0.96 in the train dataset and 0.9, 1.0, 1.0 in test dataset respectively. Nomogram-predicted probability was more consistent with actual probability by R language. Conclusions: In summary, an efficient and reliable clinical nomogram model had been established, which indicate increased fibrinogen, hyponatremia, decreased PaO2, multiple lung lobes involved, down-regulated CD3(+)T-lymphocyte and fever at the first clinical examination, could predict progress of patients to severe COVID-19.

11.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-322455

ABSTRACT

Deaths attributed to Coronavirus Disease 2019 (COVID-19) are mainly due to severe hypoxemic respiratory failure. Although the inflammatory storm has been considered main pathogenesis of severe COVID-19, hypersensitivity may be another important mechanism involved in severe cases, which have perfect response to corticosteroids (CS). We detected the presence of anti-SARS-CoV-2–spike S1 protein specific IgE (SP- IgE)and SARS-CoV-2 nucleocapsid protein specific IgE (NP- IgE)in all COVID-19 patients’ serum, while it was rarely detected in healthy controls. Additionally, the levels of serum SP- IgE and NP- IgE were significantly higher in severe cases, and which were correlations with the total lung severity scores (TLSS) and the PaO 2 /PAO 2 ratio. In both airway and intestinal tissues obtained from severe COVID-patients via endoscopy, NP could be stained and detected in activated mast cells, which binded with IgE. After application of CS in severe COVID-19, SP- IgE and NP- IgE decreased, but maintained at high level in early convalescence, which were maybe reason of airway hyperresponsiveness (AHR) in these patients partly. Overall, our study revealed that the chief mechanism of severe COVID-19–related hypoxemic respiratory failure is likely hypersensitivity reactions directly involving SARS-CoV-2 antigens, anti-SARS-CoV-2–specific IgE, and mast cells. Moreover, in our cohort of COVID-19 patients, severe COVID-19 patients with increased SP- IgE and NP-IgE and hypoxemic respiratory failure were treated with pulse methylprednisolone and achieved an excellent response. In conclusion, hypersensitivity may be involved in severe COVID-19.Funding Information: Guangdong Basic and Applied Basic Research Foundation (2020A1515011147) Zhuhai Science and Technology Project (ZH22036302200021PWC).Declaration of Interests: The authors of this manuscript declare no relationships with any companies whose products or services might be related to the subject matter of the article.Ethics Approval Statement: Our study was approved by the Research Ethics Committee of the Fifth Affiliated Hospital of Sun Yat-sen University. Written informed consent was obtained from all participants.

13.
Biomass Convers Biorefin ; : 1-12, 2021 Sep 25.
Article in English | MEDLINE | ID: covidwho-1446260

ABSTRACT

Currently, the enormous generation of contaminated disposed face masks raises many environmental concerns. The present study provides a novel route for efficient crude bio-oil production from disposed masks through co-hydrothermal liquefaction (Co-HTL) with Spirulina platensis grown in wastewater. Ultimate and proximate analysis confirmed that S. platensis contains relatively high nitrogen content (9.13%dw), which decreased by increasing the mask blend ratio. However, carbon and hydrogen contents were higher in masks (83.84 and 13.77%dw, respectively). In addition, masks showed 29.6% higher volatiles than S. platensis, which resulted in 94.2% lower ash content. Thermal decomposition of masks started at a higher temperature (≈330 °C) comparing to S. platensis (≈208 °C). The highest bio-oil yield was recorded by HTL of S. platensis and Co-HTL with 25% (w/w) masks at 300 °C, which showed insignificant differences with each other. GC/MS analysis of the bio-oil produced from HTL of algal biomass showed a high proportion of nitrogen- and oxygen-containing compounds (3.6% and 11.9%, respectively), with relatively low hydrocarbons (17.4%). Mask blend ratio at 25% reduced the nitrogen-containing compounds by 55.6% and enhanced the hydrocarbons by 43.7%. Moreover, blending of masks with S. platensis enhanced the compounds within the diesel range in favor of gasoline and heavy oil. Overall, the present study provides an innovative route for enhanced bio-oil production through mask recycling coupled with wastewater treatment. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13399-021-01891-2.

14.
Clin Exp Allergy ; 52(2): 324-333, 2022 02.
Article in English | MEDLINE | ID: covidwho-1437986

ABSTRACT

BACKGROUND: Deaths attributed to Coronavirus Disease 2019 (COVID-19) are mainly due to severe hypoxemic respiratory failure. Although the inflammatory storm has been considered the main pathogenesis of severe COVID-19, hypersensitivity may be another important mechanism involved in severe cases, which have a perfect response to corticosteroids (CS). METHOD: We detected the serum level of anti-SARS-CoV-2-spike S1 protein-specific IgE (SP-IgE) and anti-SARS-CoV-2 nucleocapsid protein-specific IgE (NP-IgE) in COVID-19. Correlation of levels of specific IgE and clinical severity were analysed. Pulmonary function test and bronchial provocation test were conducted in early convalescence of COVID-19. We also obtained histological samples via endoscopy to detect the evidence of mast cell activation. RESULT: The levels of serum SP-IgE and NP-IgE were significantly higher in severe cases, and were correlated with the total lung severity scores (TLSS) and the PaO2 /FiO2 ratio. Nucleocapsid protein could be detected in both airway and intestinal tissues, which was stained positive together with activated mast cells, binded with IgE. Airway hyperresponsiveness (AHR) exists in the early convalescence of COVID-19. After the application of CS in severe COVID-19, SP-IgE and NP-IgE decreased, but maintained at a high level. CONCLUSION: Hypersensitivity may be involved in severe COVID-19.


Subject(s)
Bronchi/immunology , COVID-19/immunology , Coronavirus Nucleocapsid Proteins/immunology , Duodenum/immunology , Hypersensitivity/immunology , Immunoglobulin E/immunology , Mast Cells/immunology , Spike Glycoprotein, Coronavirus/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Bronchi/metabolism , Bronchi/pathology , COVID-19/metabolism , COVID-19/pathology , COVID-19/physiopathology , Case-Control Studies , Coronavirus Nucleocapsid Proteins/metabolism , Duodenum/metabolism , Duodenum/pathology , Female , Humans , Hypersensitivity/metabolism , Hypersensitivity/pathology , Hypersensitivity/physiopathology , Lung/physiopathology , Male , Mast Cells/metabolism , Mast Cells/pathology , Middle Aged , Mucous Membrane/immunology , Mucous Membrane/metabolism , Mucous Membrane/pathology , Phosphoproteins/immunology , Phosphoproteins/metabolism , Recovery of Function , Respiratory Hypersensitivity/physiopathology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Spike Glycoprotein, Coronavirus/metabolism , Young Adult
15.
Front Immunol ; 12: 717461, 2021.
Article in English | MEDLINE | ID: covidwho-1435990

ABSTRACT

Data on the impact of lymphocytes and neutrophils on the incidence of liver dysfunction in COVID-19 patients are limited. This study aimed to investigate the lateral and longitudinal associations of lymphocyte ratio (LR) and neutrophil ratio (NR) on liver dysfunction in COVID-19 patients. We tested 1,409 blood samples from 245 COVID-19 patients in China between January 2020 and June 2021. The lateral U-shaped relationships, determined by smooth curve fitting and the piecewise-linear mixed-effect model, were observed between LR, NR, and AST and the incidence of AST-linked liver dysfunction, with the threshold cutoffs of 26.1 and 62.0, respectively. Over the 1,409 tests, the LR ≤ 26.1 and NR ≥ 62.0 related to the occurrence of mild liver dysfunction (HR: 1.36; 95% CI: 1.01, 1.82), moderate liver dysfunction (HR: 1.37; 95% CI: 1.01, 1.85), and severe liver dysfunction (HR: 1.72; 95% CI: 1.02, 2.90). For the patients with preexisting AST ≥ 35 U/L, the baseline LR ≤ 26.1 and NR ≥ 62.0 (b.LLCHN) groups had a fully adjusted 8.85-, 7.88-, and 5.97-fold increased risk of mild and moderate liver dysfunction after being hospitalized of 3, 6, and 9 days compared to the baseline LR > 26.1 and NR < 62.0 (b.normal) groups. Severe liver dysfunction only presents significant differences after being adjusted for age, sex, and BMI. Consistently, Kaplan-Meier analyses showed that b.LLCHN reflects a better predictive value for different subsequent magnitude liver dysfunctions after admission of 3 and 6 days. To improve liver function in patients with preexisting AST ≥35 U/L, future management strategies should pay more attention to baseline LR ≤ 26.1 and NR ≥ 62.0 patients.


Subject(s)
COVID-19/physiopathology , Liver/physiopathology , Lymphocytes/pathology , Neutrophils/pathology , Adult , Aspartate Aminotransferases/blood , Biomarkers/blood , COVID-19/blood , China/epidemiology , Female , Humans , Leukocyte Count , Longitudinal Studies , Male , Middle Aged , Proportional Hazards Models , SARS-CoV-2
16.
J Clin Med ; 10(17)2021 Aug 30.
Article in English | MEDLINE | ID: covidwho-1390661

ABSTRACT

Thromboembolism is a critical event in patients with coronavirus disease (COVID)-19 infection and highly associated with neutrophil extracellular traps. D-dimer has been found to be an essential thromboembolism-associated biomarker; however, the association between absolute neutrophil count (ANC) and level of D-dimer in patients with COVID-19 infection remains unclear. In this study, we enrolled consecutive patients with COVID-19 admitted to Taichung Veterans General Hospital (TCVGH), a referral center in central Taiwan with 20 airborne infection isolation rooms. Spearman correlation was used to determine the association between ANC and level of D-dimer in distinct time periods. A total of 28 consecutive patients with COVID-19 infection were enrolled, and 32.1% (9/28) of them required mechanical ventilation. Patients requiring mechanical ventilation had a higher ANC (8225 vs. 3427/µL, p < 0.01) and levels of D-dimer (6.0 vs. 0.6 mg/L, p < 0.01) compared with those without mechanical ventilation. Notably, we identified five patients with image-proven thromboembolic events during the hospital course, with the number of patients with pulmonary embolism, venous thrombosis and acute ischemic stroke were 2, 1, and 2, respectively. We found that ANC within 4 days correlated with the level of D-dimer to a moderate level (r = 0.71, p < 0.05), and the association between ANC and D-dimer no longer exist after day 5. In conclusion, we found highly prevalent thromboembolic events among patients with severe COVID-19 infection in central Taiwan and identified the association between early ANC and D-dimer. More studies are warranted to elucidate the underlying mechanism.

17.
Clin Transl Allergy ; 11(7): e12056, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1372706

ABSTRACT

BACKGROUND: COVID-19 is a highly contagious respiratory disease caused by the SARS-CoV-2 virus. Patients with severe disease have a high fatality rate and face a huge medical burden due to the need for invasive mechanical ventilation. Hypoxic respiratory failure is the major cause of death in these patients. There are currently no specific anti-SARS-CoV-2 drugs, and the effect of corticosteroids is still controversial. METHODS: The clinical data of 102 COVID-19 patients, including 27 patients with severe disease, were analyzed. The serum levels of total IgE and anti-SARS-CoV-2 specific IgE were compared in healthy controls and COVID-19 patients, changes in the level of anti-SARS-CoV-2 specific IgE and clinical response to methylprednisolone (MP) treatment were analyzed, and the effect of high-dose/short-term MP therapy for patients with critical illness and respiratory failure was determined. RESULTS: COVID-19 patients had elevated serum levels of anti-SARS-CoV-2 specific IgE, and patients with severe disease, especially critical illness, had even higher levels. Application of short-term/high-dose MP significantly reduced the level of these IgE antibodies and also blocked the progression of hypoxic respiratory failure. Hypoxic respiratory failure in patients with COVID-19 is related to pulmonary hypersensitivity. CONCLUSIONS: Hypersensitivity in the lungs is responsible for acute respiratory failure in COVID-19 patients. Application of high-dose/short-term MP appears to be an effective life-saving method for COVID-19 patients who have hypoxic respiratory failure.

18.
Front Oncol ; 11: 650766, 2021.
Article in English | MEDLINE | ID: covidwho-1354878

ABSTRACT

OBJECTIVE: The outbreak of COVID-19 pandemic has greatly impacted on radiotherapy (RT) strategy for breast cancer patients, which might lead to increased distressing psychological symptoms. We performed a multi-center cross-section survey to investigate prevalence of fear of cancer recurrence (FCR) and predictors for FCR in patients referred to RT during pandemic. METHODS: 542 patients were consecutively enrolled from three regions in China including Yangtze Delta River Region, Guangdong and Shanxi province. Patients' characteristics were collected using an information sheet, Fear of progression questionnaire-short form, Hospital Anxiety/Depression Scale and EORTC QLQ-C30. The hierarchical multiple regression models were performed. RESULTS: 488 patients with complete data were eligible. The RT strategy was affected in 265 (54.3%) patients, including 143 with delayed RT initiation, 66 believing to have delayed RT initiation but actually not, 24 with RT interruptions, 19 shifting to local hospitals for RT and the remaining 13 influenced on both RT schedule and hospital level. The model explained 59.7% of observed variances in FCR (p<0.001) and showed that influence of RT strategy had significantly impacted on FCR (△R2 = 0.01, △F=2.966, p=0.019). Hospitals in Shanxi province (ß=-0.117, p=0.001), emotional function (ß=-0.19, p<0.001), social function (ß=-0.111, p=0.006), anxiety (ß=0.434, p<0.001) and RT interruption (ß=0.071, p=0.035) were independent predictors. CONCLUSIONS: RT strategy for breast cancer patients was greatly influenced during pandemic. RT interruption is an independent predictor for high FCR. Our findings emphasize the necessity to ensure continuum of RT, and efforts should be taken to alleviate FCR through psychological interventions.

19.
Org Biomol Chem ; 19(30): 6650-6656, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-1343477

ABSTRACT

The exquisite chemodiversity of terpenoids is the product of the large diverse terpene synthase (TPS) superfamily. Here, by using structural and phylogenetic analyses and site-directed mutagenesis, we identified a residue (Cys440 in Nicotiana tabacum 5-epi-aristolochene synthase) proximal to an ion-binding motif common to all TPSs and named the preNSE/DTE residue, which determines the product specificity of sesquiterpene synthases from different plant species. In sesquiterpene synthases catalyzing 1,10-cyclization (1,10-cyclases) of farnesyl diphosphate, mutation of the residue in both specific and promiscuous 1,10-cyclases from different lineages leads to the accumulation of monocyclic germacrene A-11-ol, which is "short-circuited" from complex cyclization cascades, suggesting a key role of this residue in generating the first common intermediate of 1,10-cyclization. Altering this residue in a specific 1,11-cyclase results in alternative 1,10-cyclization products. Moreover, the preNSE/DTE residue can be harnessed to engineer highly specific sesquiterpene synthases for an improved proportion of high-value terpenoids, such as patchoulol, a main constituent of several traditional Chinese medicines that could treat SARS-CoV-2.


Subject(s)
Alkyl and Aryl Transferases/chemistry , Alkyl and Aryl Transferases/metabolism , Biocatalysis , Alkyl and Aryl Transferases/genetics , Catalytic Domain , Cyclization , Models, Molecular , Mutagenesis, Site-Directed , Phylogeny , Tobacco/enzymology
20.
Front Public Health ; 9: 622707, 2021.
Article in English | MEDLINE | ID: covidwho-1325581

ABSTRACT

Background: Integrated Chinese and Western medicine (integrated medicine) is routinely used in the treatment of coronavirus disease 2019 (COVID-19) in China. In this study, we undertook a systematic review and meta-analysis of published randomized controlled trials (RCTs) to evaluate the efficacy of integrated medicine therapy for patients with COVID-19. Methods: In this meta-analysis, we searched PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), and Wanfang databases from inception to April 12, 2021, to identify RCTs of integrated medicine in the treatment of COVID-19. The quality of RCTs was assessed by the Cochrane risk of bias tool. RevMan v5.3 and Stata software packages were used for statistical analysis. Results: Nineteen RCTs involving 1,853 patients met our inclusion criteria. Compared with patients treated by conventional Western medicine (CWM), patients treated by integrated medicine have a higher overall effective rate [RR = 1.17, 95% CI: (1.10, 1.26), p < 0.00001], fever disappearance rate [RR = 1.25, 95% CI: (1.04, 1.50), p = 0.02], fatigue disappearance rate [RR = 1.28, 95% CI: (1.00, 1.63), p = 0.05], and chest CT improvement rate [RR = 1.24, 95% CI: (1.14, 1.34), p < 00001]. Beneficial effects of the integrated medicine therapy were also seen in C-reactive protein (CRP) level [WMD = -4.14, 95% CI: (-6.38, -1.91), p = 0.0003] and white blood cell (WBC) count [WMD = 0.35, 95% CI: (0.11, 0.58), p = 0.004]. Subgroup analyses showed that, when the treatment time is <2 weeks, the effect of integrated medicine treatment is more obvious in improving the overall effective rate, clinical symptoms (fever, fatigue, and cough), the CRP level, and WBC count compared with that of the CWM treatment. For patients with severe and non-severe COVID-19, integrated medicine is more effective in improving fever and cough symptoms and WBC count than using CWM alone. Conclusion: The results of the current meta-analysis suggested that the integrated medicine can improve the clinical symptoms, chest CT and infection indicators of COVID-19 patients. Even if the treatment time is <2 weeks, the effect of integrated medicine in improving symptoms is more obvious compared with the treatment of CWM. However, the results should be interpreted cautiously due to the heterogeneity among the studies.


Subject(s)
COVID-19 , Drugs, Chinese Herbal , Integrative Medicine , China , Humans , Randomized Controlled Trials as Topic , SARS-CoV-2
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