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1.
Front Med (Lausanne) ; 8: 785496, 2021.
Article in English | MEDLINE | ID: covidwho-1638923

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has plunged the world into a major crisis. The disease is characterized by strong infectivity, high morbidity, and high mortality. It is still spreading in some countries. Microbiota and their metabolites affect human physiological health and diseases by participating in host digestion and nutrition, promoting metabolic function, and regulating the immune system. Studies have shown that human microecology is associated with many diseases, including COVID-19. In this research, we first reviewed the microbial characteristics of COVID-19 from the aspects of gut microbiome, lung microbime, and oral microbiome. We found that significant changes take place in both the gut microbiome and airway microbiome in patients with COVID-19 and are characterized by an increase in conditional pathogenic bacteria and a decrease in beneficial bacteria. Then, we summarized the possible microecological mechanisms involved in the progression of COVID-19. Intestinal microecological disorders in individuals may be involved in the occurrence and development of COVID-19 in the host through interaction with ACE2, mitochondria, and the lung-gut axis. In addition, fecal bacteria transplantation (FMT), prebiotics, and probiotics may play a positive role in the treatment of COVID-19 and reduce the fatal consequences of the disease.

2.
FlatChem ; : 100336, 2022.
Article in English | ScienceDirect | ID: covidwho-1620663

ABSTRACT

Discovered in December 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (aka SARS-CoV-2 or 2019-nCoV) has attracted worldwide attention and concerns due to its high transmissibility and the severe health consequences experienced upon its infection, particularly by elderly people. Over 272 million people have been infected till date and over 5.33 million people could not survive the respiratory illness known as COVID-19 syndrome. Rapid and low-cost detection methods are of utmost importance to monitor the diffusion of the virus and to aid in the global fight against the pandemic. We propose here the use of graphene oxide nanocolloids (GONC) as an electroactive nanocarbon material that can act simultaneously as a transducing platform as well as the electroactive label for the detection of 2019-nCoV genomic sequences. The ability of GONC to provide an intrinsic electrochemical signal arising from the reduction of the electrochemically reducible oxygen functionalities present on its surface, allows GONC to be used as a simple and sensitive biosensing platform. Different intrinsic electroactivity of the material was obtained at each step of the genosensing process, starting from the immobilization of a short-stranded DNA probe and followed by the incubation with different concentrations of the target 2019-nCoV DNA strand. Monitoring such variations enabled the quantification of the target analyte over a wide dynamic range between 10−10 and 10−5 M. All in all, this proof-of-concept system serves as a stepping stone for the development of a rapid, sensitive and selective analytical tool for the detection of 2019-nCoV as well as other similar viral vectors. The use of cost-effective electrochemical detection methods coupled with the vast availability and suitability of carbon-based nanomaterials make this sensing system a valid candidate for low-cost and point-of-care analysis.

3.
Frontiers in medicine ; 8, 2021.
Article in English | EuropePMC | ID: covidwho-1602618

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has plunged the world into a major crisis. The disease is characterized by strong infectivity, high morbidity, and high mortality. It is still spreading in some countries. Microbiota and their metabolites affect human physiological health and diseases by participating in host digestion and nutrition, promoting metabolic function, and regulating the immune system. Studies have shown that human microecology is associated with many diseases, including COVID-19. In this research, we first reviewed the microbial characteristics of COVID-19 from the aspects of gut microbiome, lung microbime, and oral microbiome. We found that significant changes take place in both the gut microbiome and airway microbiome in patients with COVID-19 and are characterized by an increase in conditional pathogenic bacteria and a decrease in beneficial bacteria. Then, we summarized the possible microecological mechanisms involved in the progression of COVID-19. Intestinal microecological disorders in individuals may be involved in the occurrence and development of COVID-19 in the host through interaction with ACE2, mitochondria, and the lung-gut axis. In addition, fecal bacteria transplantation (FMT), prebiotics, and probiotics may play a positive role in the treatment of COVID-19 and reduce the fatal consequences of the disease.

4.
Blood ; 138(19):4997-4997, 2021.
Article in English | EuropePMC | ID: covidwho-1602496

ABSTRACT

Background : Patients (pts) with COVID-19 are reported to have increased risk of venous thromboembolism yet bleeding has been an under recognized complication. Rates of bleeding remain unexamined in all patients especially in pts with cancer and COVID-19. Aim: To estimate the incidence of bleeding complication in patients with cancer and COVID 19 Methods: The CCC19 international registry (NCT04354701) aims to investigate complications of COVID-19 in pts with cancer. Our aim was to investigate the frequency of bleeding in hospitalized adult pts with cancer andCOVID-19, enrolled between March 16, 2020 and Feb 8, 2021. The incidence of bleeding complications was captured as defined by CCC19 and included both major and non major bleeding . Associated baseline clinic-pathologic prognostic factors and outcomes such as need for mechanical ventilation, intensive care unit (ICU) admission and mortality rates were assessed Results :3849 pts met analysis inclusion criteria. Bleeding was reported in 276 (7%) pts with median age of 70years;incidence was 6.6 % in females and 7.6 % in males, 6.5% in non-Hispanic white pts, 8.2 % in non-Hispanic Black pts, and 7.8 % in Hispanic pts. 74% had solid cancer and 29% had hematologic malignancies, 33% had received anti-cancer therapy in preceding 30 days, and 8% had surgery within 4weeks. In pts taking antiplatelet or anticoagulant medications at baseline, 7.2% developed bleeding. Need for mechanical ventilation, ICU admission, 30-day mortality, and total mortality were significantly higher in those with bleeding complications compared to those without, p<0.05 Conclusion : We describe the incidence of bleeding in a large cohort of pts with cancer and COVID-19. Bleeding events were observed in those with adverse outcomes including mechanical ventilation, ICU admission, and high mortality;the overall mortality of 43% in patients with bleeding complications is especially notable. This important complication may reflect underlying COVID-19 pathophysiology as well as iatrogenic causes. Figure 1 Disclosures Kumar:  Diagnostica Stago: Honoraria. Zon:  AMAGMA AND RLZ: Consultancy, Current holder of individual stocks in a privately-held company. Byeff:  Pfizer, BMS, Takeda,Teva, Merck, United health: Consultancy, Current equity holder in publicly-traded company, Current holder of stock options in a privately-held company. Nagaraj:  Novartis: Research Funding. Hwang:  astrazaneca,Merck,bayer, Genentech: Consultancy, Research Funding. McKay:  Myovant: Consultancy;Bayer: Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees;Exelixis: Consultancy, Membership on an entity's Board of Directors or advisory committees;Calithera: Membership on an entity's Board of Directors or advisory committees;Tempus: Research Funding;Merck: Consultancy, Membership on an entity's Board of Directors or advisory committees;Tempus: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees, Research Funding;Janssen: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees;Sanofi: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Dendreon: Consultancy;Caris: Other: Serves as a molecular tumor board ;Vividion: Consultancy;Sorrento Therapeutics: Consultancy;Bayer: Research Funding. Warner:  Westat, Hemonc.org: Consultancy, Current holder of stock options in a privately-held company. Connors:  Pfizer: Honoraria;CSL Behring: Research Funding;Alnylam: Consultancy;Bristol-Myers Squibb: Honoraria;takeda: Honoraria;Abbott: Consultancy. Rosovsky:  Janssen: Consultancy, Research Funding;BMS: Consultancy, Research Funding;Inari: Consultancy, Membership on an entity's Board of Directors r advisory committees;Dova: Consultancy, Membership on an entity's Board of Directors or advisory committees.

5.
Preprint | EuropePMC | ID: ppcovidwho-296793

ABSTRACT

Purpose: This study aimed to explore the influences of online support of an Internet plus Shared Care diabetes management model on metabolic indicators and the differences before and after the coronavirus disease 2019 (COVID-19) pandemic. Method: Type 2 diabetes patients who visited the Peking University First Hospital Internet plus Shared Care clinic from May 18, 2020 to June 20, 2020 (after the COVID-19 pandemic subsided) were enrolled in the study. The age, gender, usage of insulin, and duration of diabetes of the patients were collected. The glycosylated hemoglobin (HbA1c), interval between two consecutive visits, communication frequencies with online diabetes educators through an app, online self-monitoring of blood glucose (SMBG) and upload count and SMBG pairing count (before–after meal) were collected before (prior to January 20, 2020) and after (from May 18, 2020 to June 20, 2020) the COVID-19 pandemic for logistic regression analysis. The R-3.4.4 and TWANG programs were used for analysis. The group of patients whose HbA1c did not change during the pandemic was the control group, while the group of patients with improved HbA1c was the dependent variable. Independent variables included age, gender, duration of disease, insulin usage, online communication amount, SMBG count, and SMBG pairing count. Propensity score matching (PSM) was applied with age, duration, gender, body mass index (BMI), HbA1c, low density lipoprotein- cholesterol (LDL-C), and blood pressure (BP) at baseline as the concomitant variable. After the PSM weighting, the average treatment effect (ATE) of post-pandemic BMI, HbA1c, LDL-C, and BP was compared with the baseline. Results: A total of 387 patients were enrolled in the study including 184 female (47.5%). The baseline values were the following: age, 61.7±9.4 year;, duration of diabetes, 11.7±8.2 years;BMI, 25.9±3.8Kg/m 2 ;HbA1c, 7.2±1.3%;LDL-C, 2.49±0.85mmol/L;systolic BP, 130.8±14.9 mmHg;and diastolic BP, 81.1±40.9 mmHg. Among variables, online communication amounted to a statistically significant contribution to the HbA1c improvement after the COVID-19 pandemic (OR=2.178, p=0.003). During the pandemic, each patient received 18 (3, 56) times online communication support per quarter. Patients were divided into four groups by quartiles: Q1 (more than 56 times/quarter, n=95), Q2 (18–56 times/quarter, n=97), Q3 (3–18 times/quarter, n=93), and Q4 (0–3 times/quarter, n=102). After PSM, post-pandemic data showed significant differences. Between-group variance was found in HbA1c (Q1 vs. Q3, -0.42±0.16%, p=0.009;Q1 vs. Q4, -0.53±0.15%, p=0.0009) and BMI (Q1 vs. Q3, -1.2±0.5, p=0.02;Q1 vs. Q4 -1.5±0.7, p=0.01) of patients. Conclusion: During the COVID-19 pandemic, high-quality online support of the Internet plus Shared Care diabetes management model can significantly improve the HbA1c and BMI of type 2 diabetes patients.

6.
BMC Public Health ; 21(1): 1958, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1561729

ABSTRACT

BACKGROUND: Stigma associated with infectious diseases is common and causes various negative effects on stigmatized people. With Wuhan as the center of the COVID-19 outbreak in China, its people were likely to be the target of stigmatization. To evaluate the severity of stigmatization toward Wuhan people and provide necessary information for stigma mitigation, this study aimed to identify the stigmatizing attitudes toward Wuhan people and trace their changes as COVID-19 progresses in China by analyzing related posts on social media. METHODS: We collected 19,780 Weibo posts containing the keyword 'Wuhan people' and performed a content analysis to identify stigmatizing attitudes in the posts. Then, we divided our observation time into three periods and performed repeated-measures ANOVA to compare the differences in attitudes during the three periods. RESULTS: The results showed that stigma was mild, with 2.46% of related posts being stigmatizing. The percentages of stigmatizing posts differed significantly during the three periods. The percentages of 'Infectious' posts and 'Stupid' posts were significantly different for the three periods. The percentage of 'Irresponsible' posts was not significantly different for the three periods. After government interventions, stigma did not decrease significantly, and stigma with the 'Infectious' attitude even increased. It was not until the government interventions took effect that stigma significantly reduced. CONCLUSIONS: This study found that stigma toward Wuhan people included diverse attitudes and changed at different periods. After government interventions but before they took effect, stigma with the 'Infectious' attitude increased. After government interventions took effect, general stigma and stigmas with 'Infectious' and 'Stupid' attitudes decreased. This study constituted an important endeavor to understand the stigma toward Wuhan people in China during the COVID-19 epidemic. Implications for stigma reduction and improvement of the public's perception during different periods of epidemic control are discussed.


Subject(s)
COVID-19 , Epidemics , Social Media , Humans , SARS-CoV-2 , Social Stigma
7.
JMIR Serious Games ; 9(4): e13124, 2021 Nov 22.
Article in English | MEDLINE | ID: covidwho-1547099

ABSTRACT

BACKGROUND: Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. OBJECTIVE: The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. METHODS: This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. RESULTS: All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. CONCLUSIONS: Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules. TRIAL REGISTRATION: ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.

8.
Medicine ; 100(25), 2021.
Article in English | CAB Abstracts | ID: covidwho-1410299

ABSTRACT

Rationale: The COVID-19 pandemic is spreading around the world and the leading cause of death is rapidly progressive respiratory failure because of lung damage and consolidation. Lung transplantation is the last line of treatment for chronic end-stage lung diseases. There were several cases of lung transplantation reported in patients with COVID-19 pneumonia. However, anesthetic management of lung transplantation in this subpopulation is rare. We report the anesthetic and perioperative management of lung transplantation in a patient with COVID-19 pneumonia. Patient concerns: A 70-year-old man with a 7-day history of fever was diagnosed with COVID-19 pneumonia. His throat swab was positive for COVID-19, but negative for other common viruses. Chest radiography showed multiple inflammatory foci in both lungs. By day 5, he presented respiratory distress. Computed tomography (CT) scan showed progressive deterioration of both lungs. Starting on day 7, SARS-CoV-2 RNA in bronchoalveolar lavage samples were continuously negative. However, his lung condition deteriorated. By day 17, a veno-venous extracorporeal membrane oxygenation (ECMO) was initiated. After 10 days of ECMO support, the patient's lung condition did not improve. CT scan revealed bilateral parenchymal consolidation with pulmonary fibrosis and hydrothorax. Diagnosis: Irreversible lung function loss induced by COVID-19 pneumonia. Interventions: Bilateral transplantation was performed because the patient's lung condition did not improve and CT scan revealed parenchymal consolidation with pulmonary fibrosis after 10 days of ECMO support. Thirty-six hours after the surgery, ECMO was discontinued. A percutaneous transluminal coronary angioplasty and a stent implantation were performed because of acute coronary syndrome and myocardial ischemia 4 days postoperatively. Outcomes: The patient remained hospitalized because of requirements for intermittent assisted ventilation via tracheostomy. Lessons: This case further supports the consideration that lung transplantation can potentially be the successful therapy for these patients who have developed irreversible lung function lose due to COVID-19 pneumonia. However, most critical patients with COVID-19 are older individuals with various comorbidities, which present new anesthetic challenges.

9.
BMC Infect Dis ; 21(1): 885, 2021 Aug 30.
Article in English | MEDLINE | ID: covidwho-1379783

ABSTRACT

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) posed an enormous threat to public health. The use of antiviral drugs in patients with this disease have triggered people's attentions. Whether interferon alfa-2b or lopinavir/ritonavir (LPV/r) plus interferon alfa-2b treatment can against SARS-CoV-2 was unknown. The objectives of this study was to evaluate the efficacy and safety of interferon alfa-2b and LPV/r plus interferon alfa-2b for SARS-CoV-2 infection in adult patients hospitalized with COVID-19. METHODS: This is a retrospective cohort study of 123 patients confirmed SARS-CoV-2 infection by PCR on nasopharyngeal swab and symptoms between Jan. 13 and Apr. 23, 2020. All patients received standard supportive care and regular clinical monitoring. Patients were assigned to standard care group (n = 12), interferon alfa-2b group (n = 44), and combination LPV/r plus interferon alfa-2b group (n = 67). The primary endpoints were duration of required oxygen support and virus clearance time. Associations between therapies and these outcomes were assessed by Cox proportional hazards regression. RESULTS: Baseline clinical characteristics were not significantly different among the three groups (P > 0.05). No significant associations were observed between LPV/r/interferon alfa-2b and faster SARS-CoV-2 RNA clearance (HR, 0.85 [95% confidence interval (CI) 0.45-1.61]; P = 0.61 in interferon alfa-2b group vs HR, 0.59 [95% CI 0.32-1.11]; P = 0.10 in LPV/r plus interferon alfa-2b group). Individual therapy groups also showed no significant association with duration of required oxygen support. There were no significant differences among the three groups in the incidence of adverse events (P > 0.05). CONCLUSIONS: In patients with confirmed SARS-CoV-2 infection, no benefit was observed from interferon alfa-2b or LPV/r plus interferon alfa-2b treatment. The findings may provide references for treatment guidelines of patients with SARS-CoV-2 infection.


Subject(s)
COVID-19 , Ritonavir , Adult , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drug Combinations , Humans , Interferon alpha-2 , Lopinavir/therapeutic use , RNA, Viral , Retrospective Studies , Ritonavir/therapeutic use , SARS-CoV-2
10.
JAC Antimicrob Resist ; 3(3): dlab133, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1371735

ABSTRACT

Background: Procalcitonin is a biomarker that may be able to identify patients with COVID-19 pneumonia who do not require antimicrobials for bacterial respiratory tract co-infections. Objectives: To evaluate the safety and effectiveness of a procalcitonin-guided algorithm in rationalizing empirical antimicrobial prescriptions in non-critically ill patients with COVID-19 pneumonia. Methods: Retrospective, single-site, cohort study in adults hospitalized with confirmed or suspected COVID-19 pneumonia and receiving empirical antimicrobials for potential bacterial respiratory tract co-infection. Regression models were used to compare the following outcomes in patients with and without procalcitonin testing within 72 h of starting antimicrobials: antimicrobial consumption (DDD); antimicrobial duration; a composite safety outcome of death, admission to HDU/ICU or readmission to hospital within 30 days; and length of admission. Procalcitonin levels of ≤0.25 ng/L were interpreted as negatively predictive of bacterial co-infection. Effects were expressed as ratios of means (ROM) or prevalence ratios (PR) accordingly. Results: 259 patients were included in the final analysis. Antimicrobial use was lower in patients who had procalcitonin measured within 72 h of starting antimicrobials: mean antimicrobial duration 4.4 versus 5.4 days, adjusted ROM 0.7 (95% CI 0.6-0.9); mean antimicrobial consumption 6.8 versus 8.4 DDD, adjusted ROM 0.7 (95% CI 0.6-0.8). Both groups had similar composite safety outcomes (adjusted PR 0.9; 95% CI 0.6-1.3) and lengths of admission (adjusted ROM 1.3; 95% CI 0.9-1.6). Conclusions: A procalcitonin-guided algorithm may allow for the safe reduction of antimicrobial usage in hospitalized non-critically ill patients with COVID-19 pneumonia.

11.
Blood ; 136(Supplement 1):56-58, 2020.
Article in English | PMC | ID: covidwho-1338999

ABSTRACT

Introduction: Hospitalized patients with COVID-19 may have increased risk of venous thromboembolism (VTE) and pulmonary embolism (PE). Cancer and anti-cancer therapies are well-known additional risk factors for VTE. Nonetheless, the VTE risk in patients with both cancer and COVID-19 infection remains unknown as recent studies have not found an association due to sample size limitations. We report the incidence of and risk factors for VTE and PE among hospitalized patients with cancer and COVID-19.Methods: The COVID-19 and Cancer Consortium (CCC19) developed an international retrospective cohort study (NCT04354701) to investigate the clinical course and complications of COVID-19 among adult patients with an active or previous history of cancer. For the current study, cumulative incidences of clinically detected VTE and PE were analyzed among hospitalized patients with laboratory confirmed SARS-CoV-2. Pre-specified subgroup analysis was performed to examine the interaction between intensive care unit (ICU) admission and recent anti-cancer therapy on VTE outcomes. Bivariable logistic regression analyses were conducted to assess the association between baseline variables and VTE;unadjusted odds ratios (OR) and 95% confidence interval (CI) were reported. These variables included age, sex, obesity (BMI>30), race/ethnicity, performance status, comorbidities, blood type, history of VTE, recent surgery, recent anti-cancer therapy, cancer subtype VTE risk grouping (adapted from Khorana Score), pre-admission anticoagulant or antiplatelet use, and ICU admission status.Results: From March 17, 2020 to July 31, 2020, 3914 patients were enrolled in the CCC19 registry. For the present analysis, patients were excluded if they had inadequate follow-up <4 weeks (n=950), were not admitted to the hospital (n=1008), or had unknown VTE outcomes (n=327). Among the 1629 hospitalized patients, the median follow-up was 35 days. Patients were comprised from 3 countries (92% US, 6% Canada, 2% Spain), with a median age of 70, 45% female, and a median comorbidity score of 3. Racial/ethnic breakdown included 44% White, 26% Black, 14% Hispanic, and 13% Other. A past history of VTE was reported in 9% of patients;pre-admission anticoagulant use and antiplatelet use were reported in 25% and 35% of patients, respectively. The most common cancer types included prostate (18%), breast (15%), and lymphoma (14%). Based on the VTE risk grouping adapted from the original Khorana Score, 34% were low-risk, 29% were high-risk, and 6% were very high-risk. The receipt of anti-cancer therapy within 3 months of diagnosis was observed in 39% of patients (17% cytotoxic chemotherapy, 11% targeted therapy, 7% endocrine therapy, and 5% immunotherapy).The overall incidence of inhospital VTE and PE was 9.3% and 5.2%, respectively. The corresponding estimates were 13.4% and 7.9% among the ICU subgroup. On bivariable analysis, significant predictors of VTE included ICU admission, recent anti-cancer therapy, active cancer status, cancer subtype VTE risk grouping, and pre-admission antiplatelet use (Table 1). Pre-admission anticoagulant use had significant associations with PE but not VTE. Multivariable adjustment is ongoing to identify independent risk factor for VTE and clarify the impact of pre-admission anticoagulant/antiplatelet use controlled for other potential confounders.Both ICU admission status and anti-cancer therapy increased the risk of VTE independently. Non-ICU patients not on anti-cancer therapy had the lowest incidence of VTE (4.5%), whose estimate was similar to that reported in the non-cancer hospitalized population with COVID-19 infection. Patients with either ICU admission or recent anti-cancer therapy had the intermediate risk (11.0%), whereas ICU patients with recent anti-cancer therapy had the highest risk (16.7%). We did not observe confounding or effect modification by the ICU subgroup on the association between anti-cancer therapy and VTE.Conclusion: In this cohort study of hospitalized patients with cancer and COVID-19, recent anti-cancer t erapy, active disease, high-risk VTE cancer subtypes, and ICU admission have increased risk of VTE and PE, while pre-admission anticoagulant/antiplatelet therapy may reduce the risk. This information will aid in developing a risk prediction tool for VTE in hospitalized patients with cancer and COVID-19.

12.
Emerg Microbes Infect ; 10(1): 1507-1514, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1310873

ABSTRACT

Severe respiratory disease coronavirus-2 (SARS-CoV-2) has been the most devastating disease COVID-19 in the century. One of the unsolved scientific questions of SARS-CoV-2 is the animal origin of this virus. Bats and pangolins are recognized as the most probable reservoir hosts that harbour highly similar SARS-CoV-2 related viruses (SARSr-CoV-2). This study identified a novel lineage of SARSr-CoVs, including RaTG15 and seven other viruses, from bats at the same location where we found RaTG13 in 2015. Although RaTG15 and the related viruses share 97.2% amino acid sequence identities with SARS-CoV-2 in the conserved ORF1b region, it only shows less than 77.6% nucleotide identity to all known SARSr-CoVs at the genome level, thus forming a distinct lineage in the Sarbecovirus phylogenetic tree. We found that the RaTG15 receptor-binding domain (RBD) can bind to ACE2 from Rhinolophus affinis, Malayan pangolin, and use it as an entry receptor, except for ACE2 from humans. However, it contains a short deletion and has different key residues responsible for ACE2 binding. In addition, we showed that none of the known viruses in bat SARSr-CoV-2 lineage discovered uses human ACE2 as efficiently as the pangolin-derived SARSr-CoV-2 or some viruses in the SARSr-CoV-1 lineage. Therefore, further systematic and longitudinal studies in bats are needed to prevent future spillover events caused by SARSr-CoVs or to understand the origin of SARS-CoV-2 better.


Subject(s)
Angiotensin-Converting Enzyme 2/physiology , Cell Lineage , Chiroptera/virology , SARS Virus/isolation & purification , SARS-CoV-2/classification , Animals , Host Specificity , Phylogeny , SARS Virus/classification
13.
J Thromb Haemost ; 19(10): 2522-2532, 2021 10.
Article in English | MEDLINE | ID: covidwho-1309788

ABSTRACT

BACKGROUND: Hospitalized patients with COVID-19 have increased risks of venous (VTE) and arterial thromboembolism (ATE). Active cancer diagnosis and treatment are well-known risk factors; however, a risk assessment model (RAM) for VTE in patients with both cancer and COVID-19 is lacking. OBJECTIVES: To assess the incidence of and risk factors for thrombosis in hospitalized patients with cancer and COVID-19. METHODS: Among patients with cancer in the COVID-19 and Cancer Consortium registry (CCC19) cohort study, we assessed the incidence of VTE and ATE within 90 days of COVID-19-associated hospitalization. A multivariable logistic regression model specifically for VTE was built using a priori determined clinical risk factors. A simplified RAM was derived and internally validated using bootstrap. RESULTS: From March 17, 2020 to November 30, 2020, 2804 hospitalized patients were analyzed. The incidence of VTE and ATE was 7.6% and 3.9%, respectively. The incidence of VTE, but not ATE, was higher in patients receiving recent anti-cancer therapy. A simplified RAM for VTE was derived and named CoVID-TE (Cancer subtype high to very-high risk by original Khorana score +1, VTE history +2, ICU admission +2, D-dimer elevation +1, recent systemic anti-cancer Therapy +1, and non-Hispanic Ethnicity +1). The RAM stratified patients into two cohorts (low-risk, 0-2 points, n = 1423 vs. high-risk, 3+ points, n = 1034) where VTE occurred in 4.1% low-risk and 11.3% high-risk patients (c statistic 0.67, 95% confidence interval 0.63-0.71). The RAM performed similarly well in subgroups of patients not on anticoagulant prior to admission and moderately ill patients not requiring direct ICU admission. CONCLUSIONS: Hospitalized patients with cancer and COVID-19 have elevated thrombotic risks. The CoVID-TE RAM for VTE prediction may help real-time data-driven decisions in this vulnerable population.


Subject(s)
COVID-19 , Neoplasms , Venous Thromboembolism , Cohort Studies , Humans , Neoplasms/complications , Neoplasms/epidemiology , Risk Assessment , SARS-CoV-2 , Venous Thromboembolism/diagnosis , Venous Thromboembolism/epidemiology
14.
Dis Markers ; 2021: 5598824, 2021.
Article in English | MEDLINE | ID: covidwho-1262420

ABSTRACT

Assessing the length of hospital stay (LOS) in patients with coronavirus disease 2019 (COVID-19) pneumonia is helpful in optimizing the use efficiency of hospital beds and medical resources and relieving medical resource shortages. This retrospective cohort study of 97 patients was conducted at Beijing You'An Hospital between January 21, 2020, and March 21, 2020. A multivariate Cox proportional hazards regression based on the smallest Akaike information criterion value was used to select demographic and clinical variables to construct a nomogram. Discrimination, area under the receiver operating characteristic curve (AUC), calibration, and Kaplan-Meier curves with the log-rank test were used to assess the nomogram model. The median LOS was 13 days (interquartile range [IQR]: 10-18). Age, alanine aminotransferase, pneumonia, platelet count, and PF ratio (PaO2/FiO2) were included in the final model. The C-index of the nomogram was 0.76 (95%confidence interval [CI] = 0.69-0.83), and the AUC was 0.88 (95%CI = 0.82-0.95). The adjusted C-index was 0.75 (95%CI = 0.67-0.82) and adjusted AUC 0.86 (95%CI = 0.73-0.95), both after 1000 bootstrap cross internal validations. A Brier score of 0.11 (95%CI = 0.07-0.15) and adjusted Brier score of 0.130 (95%CI = 0.07-0.20) for the calibration curve showed good agreement. The AUC values for the nomogram at LOS of 10, 20, and 30 days were 0.79 (95%CI = 0.69-0.89), 0.89 (95%CI = 0.83-0.96), and 0.96 (95%CI = 0.92-1.00), respectively, and the high fit score of the nomogram model indicated a high probability of hospital stay. These results confirmed that the nomogram model accurately predicted the LOS of patients with COVID-19. We developed and validated a nomogram that incorporated five independent predictors of LOS. If validated in a future large cohort study, the model may help to optimize discharge strategies and, thus, shorten LOS in patients with COVID-19.


Subject(s)
COVID-19/therapy , Length of Stay , Nomograms , SARS-CoV-2 , Adult , Aged , Female , Humans , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies
15.
Am J Clin Oncol ; 44(8): 409-412, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1262256

ABSTRACT

OBJECTIVES: Current coronavirus disease 2019 (COVID-19) guidelines recommend delaying clinical care for all affected cancer patients, including incidentally diagnosed asymptomatic infections. This retrospective study conducted in a safety-net hospital in Houston examines the care delivery of asymptomatic COVID-19 cancer patients and how their diagnosis affected their care. METHODS: A retrospective chart review was conducted on cancer patients with a documented positive SARS-CoV-2 laboratory result in the Harris Health System in Houston, Texas. Patient demographics, treatment delays, and patient outcomes were analyzed. RESULTS: Thirteen percent (n=24) of all patients with cancer and COVID-19 diagnosis (n=181) were asymptomatic and 96% had a solid organ malignancy. Among asymptomatic patients, 44% (n=11) of them experienced a median treatment delay of 33 days and 21% (n=5) transitioned to hospice. No patients had progression of disease at first evaluation after recovering from COVID-19 diagnosis. Asymptomatic patients were more likely to have a worse ECOG performance status, metastatic disease, and charity insurance as compared with symptomatic patients. CONCLUSIONS: This study supports the safety of our current isolation guidelines for all COVID-19 asymptomatic cancer patients. While treatment delays occurred, they did not appear to significantly impact overall care. Differences in care delivery and health care usage patterns between symptomatic and asymptomatic patients demonstrate the need for continued studies in vulnerable populations.


Subject(s)
COVID-19/etiology , Delivery of Health Care/methods , Neoplasms/therapy , Neoplasms/virology , Adult , Aged , Aged, 80 and over , Asymptomatic Infections/epidemiology , COVID-19/epidemiology , COVID-19 Testing , Delivery of Health Care/organization & administration , Female , Humans , Male , Middle Aged , Patient Safety , Safety-net Providers , Tertiary Care Centers , Texas/epidemiology , Time-to-Treatment
17.
Gut ; 70(7): 1253-1265, 2021 07.
Article in English | MEDLINE | ID: covidwho-1166535

ABSTRACT

OBJECTIVE: To characterise the oral microbiome, gut microbiome and serum lipid profiles in patients with active COVID-19 and recovered patients; evaluate the potential of the microbiome as a non-invasive biomarker for COVID-19; and explore correlations between the microbiome and lipid profile. DESIGN: We collected and sequenced 392 tongue-coating samples, 172 faecal samples and 155 serum samples from Central China and East China. We characterised microbiome and lipid molecules, constructed microbial classifiers in discovery cohort and verified their diagnostic potential in 74 confirmed patients (CPs) from East China and 37 suspected patients (SPs) with IgG positivity. RESULTS: Oral and faecal microbial diversity was significantly decreased in CPs versus healthy controls (HCs). Compared with HCs, butyric acid-producing bacteria were decreased and lipopolysaccharide-producing bacteria were increased in CPs in oral cavity. The classifiers based on 8 optimal oral microbial markers (7 faecal microbial markers) achieved good diagnostic efficiency in different cohorts. Importantly, diagnostic efficacy reached 87.24% in the cross-regional cohort. Moreover, the classifiers successfully diagnosed SPs with IgG antibody positivity as CPs, and diagnostic efficacy reached 92.11% (98.01% of faecal microbiome). Compared with CPs, 47 lipid molecules, including sphingomyelin (SM)(d40:4), SM(d38:5) and monoglyceride(33:5), were depleted, and 122 lipid molecules, including phosphatidylcholine(36:4p), phosphatidylethanolamine (PE)(16:0p/20:5) and diglyceride(20:1/18:2), were enriched in confirmed patients recovery. CONCLUSION: This study is the first to characterise the oral microbiome in COVID-19, and oral microbiomes and lipid alterations in recovered patients, to explore their correlations and to report the successful establishment and validation of a diagnostic model for COVID-19.


Subject(s)
COVID-19/blood , COVID-19/microbiology , Feces/microbiology , Lipids/blood , Mouth/microbiology , Adult , COVID-19/diagnosis , Case-Control Studies , China , Cohort Studies , Female , Gastrointestinal Microbiome , Humans , Lipidomics , Male , Middle Aged
18.
J Racial Ethn Health Disparities ; 2021 Mar 10.
Article in English | MEDLINE | ID: covidwho-1126646

ABSTRACT

IMPORTANCE: Recent reports indicate differences in COVID-19-related care and outcomes between Black and White Americans. OBJECTIVE: We examine the COVID-19-related healthcare utilization and mortality by race and ethnicity of patients tested for SARS-CoV-2 in the Veterans Health Administration (VHA). DESIGN: A retrospective cohort study. SETTING: We used the VHA COVID-19 shared data resources between February 1 and June 30, 2020. PARTICIPANTS: Veterans tested for SARS-CoV-2 virus by VHA. EXPOSURE(S): Three racial-ethnicity groups of Black, Hispanic, and White (as reference) veterans. MAIN OUTCOME(S) AND MEASURE(S): Main outcomes are testing rate, positivity rate, hospitalization rate, ICU admission rate, and in-hospital mortality. Controlling for sex, age, and Elixhauser comorbidity index, we report adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) from logistic regression models. RESULTS: Of the 8,667,996 active veteran enrollees, 252,702 were tested by VHA from February to June, 2020, with 20,500 positive results and 4,790 hospitalizations. The testing rate was 4.4% among Black and 4.7% among Hispanic veterans compared to White veterans, 2.8%. The testing positivity rate was similarly elevated among Black (12.2%) and Hispanic (11.6%) veterans compared to White veterans (6.0%). The aORs of hospitalization in Black veterans (1.88; 95% CI 1.74, 2.03) and Hispanic veterans (1.41; 95% CI 1.25, 1.60) were higher compared to White veterans. No significant differences by race and ethnicity were observed in OR or aOR of ICU admission and in-hospital death among hospitalized patients. CONCLUSIONS AND RELEVANCE: On a national level, the VHA was more likely to test and hospitalize Black and Hispanic veterans compared to White veterans, but there were no significant differences in ICU admission or in-hospital mortality among those hospitalized. This pattern of differences may relate to social determinants of health, factors affecting access to non-VHA care, or preferences for VHA care affecting initial care seeking, but not in-hospital outcomes.

19.
J Infect Dis ; 223(4): 568-580, 2021 02 24.
Article in English | MEDLINE | ID: covidwho-1101847

ABSTRACT

BACKGROUND: The immune protective mechanisms during severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection remain to be deciphered for the development of an effective intervention approach. METHODS: We examined early responses of interleukin 37 (IL-37), a powerful anti-inflammatory cytokine, in 254 SARS-CoV-2-infected patients before any clinical intervention and determined its correlation with clinical prognosis. RESULTS: Our results demonstrated that SARS-CoV-2 infection causes elevation of plasma IL-37. Higher early IL-37 responses were correlated with earlier viral RNA negative conversion, chest computed tomographic improvement, and cough relief, consequently resulted in earlier hospital discharge. Further assays showed that higher IL-37 was associated with lower interleukin 6 and interleukin 8 (IL-8) and higher interferon α responses and facilitated biochemical homeostasis. Low IL-37 responses predicted severe clinical prognosis in combination with IL-8 and C-reactive protein. In addition, we observed that IL-37 administration was able to attenuate lung inflammation and alleviate respiratory tissue damage in human angiotensin-converting enzyme 2-transgenic mice infected with SARS-CoV-2. CONCLUSIONS: Overall, we found that IL-37 plays a protective role by antagonizing inflammatory responses while retaining type I interferon, thereby maintaining the functionalities of vital organs. IL-37, IL-8, and C-reactive protein might be formulated as a precise prediction model for screening severe clinical cases and have good value in clinical practice.


Subject(s)
COVID-19/immunology , Cytokine Release Syndrome/virology , Interleukin-1/blood , Adult , Animals , C-Reactive Protein/metabolism , COVID-19/blood , Female , Humans , Inflammation/immunology , Inflammation/virology , Interleukin-8/blood , Male , Mice , Mice, Transgenic , Middle Aged
20.
Crit Care ; 25(1): 51, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1069580

ABSTRACT

BACKGROUND: Thrombosis and coagulopathy are highly prevalent in critically ill patients with COVID-19 and increase the risk of death. Immunothrombosis has recently been demonstrated to contribute to the thrombotic events in COVID-19 patients with coagulopathy. As the primary components of immunothrombosis, neutrophil extracellular traps (NETs) could be induced by complement cascade components and other proinflammatory mediators. We aimed to explore the clinical roles of NETs and the regulation of complement on the NET formation in COVID-19. METHODS: We recruited 135 COVID-19 patients and measured plasma levels of C5, C3, cell-free DNA and myeloperoxidase (MPO)-DNA. Besides, the formation of NETs was detected by immunofluorescent staining and the cytotoxicity to vascular endothelial HUVEC cells was evaluated by CCK-8 assay. RESULTS: We found that the plasma levels of complements C3 and MPO-DNA were positively related to coagulation indicator fibrin(-ogen) degradation products (C3: r = 0.300, p = 0.005; MPO-DNA: r = 0.316, p = 0.002) in COVID-19 patients. Besides, C3 was positively related to direct bilirubin (r = 0.303, p = 0.004) and total bilirubin (r = 0.304, p = 0.005), MPO-DNA was positively related to lactate dehydrogenase (r = 0.306, p = 0.003) and creatine kinase (r = 0.308, p = 0.004). By using anti-C3a and anti-C5a antibodies, we revealed that the complement component anaphylatoxins in the plasma of COVID-19 patients strongly induced NET formation. The pathological effect of the anaphylatoxin-NET axis on the damage of vascular endothelial cells could be relieved by recombinant carboxypeptidase B (CPB), a stable homolog of enzyme CPB2 which can degrade anaphylatoxins to inactive products. CONCLUSIONS: Over-activation in anaphylatoxin-NET axis plays a pathological role in COVID-19. Early intervention in anaphylatoxins might help prevent thrombosis and disease progression in COVID-19 patients.


Subject(s)
Anaphylatoxins/metabolism , COVID-19/drug therapy , COVID-19/immunology , Carboxypeptidase B/metabolism , Carboxypeptidase B/therapeutic use , Extracellular Traps/drug effects , Neutrophils/drug effects , Thrombosis/prevention & control , Adult , Aged , COVID-19/physiopathology , Extracellular Traps/immunology , Female , Humans , Male , Middle Aged , Neutrophils/immunology , Thrombosis/immunology
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