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1.
Molecules ; 27(7)2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1785841

ABSTRACT

Nanomaterial technology has attracted much attention because of its antibacterial and drug delivery properties, among other applications. Metal-organic frameworks (MOFs) have advantages, such as their pore structure, large specific surface area, open metal sites, and chemical stability, over other nanomaterials, enabling better drug encapsulation and adsorption. In two examples, we used the common pathogenic bacterium Staphylococcus aureus and highly infectious influenza A virus. A novel complex MIL-101(Fe)-T705 was formed by synthesizing MOF material MIL-101(Fe) with the drug favipiravir (T-705), and a hot solvent synthesis method was applied to investigate the in vitro antibacterial and antiviral activities. The results showed that MIL-101(Fe)-T705 combined the advantages of nanomaterials and drugs and could inhibit the growth of Staphylococcus aureus at a concentration of 0.0032 g/mL. Regarding the inhibition of influenza A virus, MIL-101(Fe)-T705 showed good biosafety at 12, 24, 48, and 72 h in addition to a good antiviral effect at concentrations of 0.1, 0.2, 0.4, 0.8, 1.6, and 3 µg/mL, which were higher than MIL-101(Fe) and T-705.


Subject(s)
Metal-Organic Frameworks , Amides , Anti-Bacterial Agents , Antiviral Agents/pharmacology , Metal-Organic Frameworks/chemistry , Metal-Organic Frameworks/pharmacology , Pyrazines
2.
Front Public Health ; 10: 861072, 2022.
Article in English | MEDLINE | ID: covidwho-1776093

ABSTRACT

Rural communities have become a hot topic in academic circles because of their graceful natural environment and great healing potential. However, existing research still lacks attention to the street space in rural communities and rarely considers its integrated visual and soundscape design in terms of their effect on public health. As a result, the healing potential of rural community streets cannot be fully used in design practice. Relevant audiovisual materials were collected from a field investigation in four rural communities in southwestern China. Based on these data, the subjective and objective healing index data of subjects under comprehensive audiovisual conditions were collected and analyzed through laboratory experiments. The results revealed that type of street space affects healing potential, and the artificial-natural enclosed and natural semi-enclosed streets are the street types with the best healing effect. When the total sound pressure level was 55dB(A), the sound combination with birdsong accounting for 70% had a significant positive effect on improving the healing effect of rural community streets. In contrast, the sound combination with birdsong accounting for 50% or less had no significant effect on improving healing. The subjective healing perception of street space in rural communities was significantly positively correlated with aesthetic preferences. There was also a significant correlation between subjective healing perception and physiological index data in the audiovisual combination. This research explored the impact of different types of street space and sound combinations on the healing effect of rural community streets in an integrated audiovisual environment and provided a scientific basis for the healing landscape design of rural community streets in an integrated audiovisual environment. It was expected to provide new ideas for the construction of rural community landscapes, including acoustic landscapes, to promote physical and mental healing.


Subject(s)
Built Environment , Rural Population , China , Humans
3.
Front Psychol ; 13: 822208, 2022.
Article in English | MEDLINE | ID: covidwho-1731839

ABSTRACT

Individuals' capacity to participate in leisure activities is contingent upon their ability to overcome obstacles. It is worthwhile to investigate how individuals perceive constraints on their leisure activities participation during the COVID-19 pandemic. This study demonstrates that the connotation of leisure constraints during pandemic includes personal health concerns, shock on economic revenue, reduced freedom of travel, and inconvenience associated with epidemic prevention. Reduced travel freedom is the most influential factor on participation intentions, followed by personal health concerns. Significant differences in perceptions of constraints are observed between groups with different characteristics.

4.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-322231

ABSTRACT

The clinical features, molecular characteristics, and immune responses of COVID-19 patients with persistent SARS-CoV-2 infection are not yet well described. In this study, we investigated the differences in clinical parameters, laboratory indexes, plasma cytokines, and peripheral blood mononuclear cell responses, which were assessed using single-cell RNA-sequencing in patients with non-critical COVID-19 with long durations (LDs) and short durations (SDs) of viral shedding. Our results revealed that clinical parameters and laboratory indexes, such as c-reactive protein (CRP) and D-dimer, were comparable between SDs and LDs. Most inflammatory cytokines/chemokines, such as IL-2, IL2R, TNFα/β, IL1β, and CCL5 were present at low levels in LDs. Our single-cell RNA-sequencing revealed a reconfiguration of the peripheral immune cell phenotype in LDs, including decreases in natural killer (NK) cells and CD14 + monocytes and an increase in regulatory T cells (Tregs). Furthermore, most cell subsets in LDs consistently exhibited reduced expression of ribosomal protein (RP) genes, indicating dysfunctions in cytokine/chemokine synthesis, folding, modification, and assembly. Accordingly, the negative correlation between the RP levels and viral shedding duration was validated in an independent cohort of bulk-RNA-sequencing data from 103 non-critical patients, which may help guide clinical management and resource allocation. Moreover, peripheral T and NK cells and memory B cells in LDs likely failed to activate, which contributed to the persistence of viral shedding.

5.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-308158

ABSTRACT

Abstract Background: The aim of this study was to investigate the prevalence of anxiety and depression in neurological doctors and nurses in Hunan Province, China, during the Coronavirus Disease 2019 (COVID-19) outbreak.Methods: A cross-sectional study was conducted among neurological doctors and nurses in Hunan Province. Symptoms of anxiety and depression were assessed by the Zung Self-Rating Anxiety scale (SAS) and Zung Self-Rating Depression Scale (SDS).Results: The average SAS standard scores of neurological physicians were 41.33 ± 8.98, higher than Chinese national norms. The prevalence of anxiety (defined as a total score ≥50 on the SAS) and depression (defined as a total score ≥53 on the SDS) in nurses (20.3%, 30.2%) was higher than in doctors (12.6%, 20.2%). Logistic regression analysis showed that attitude toward the risk of infection due to the shortage of protective equipment was independently associated with anxiety among neurological staff (OR = 2.004, 95% CI: 1.257 - 3.193).Conclusions: Symptoms of anxiety and depression were more prevalent among neurological nurses than doctors in Hunan Province. The shortage of protective equipment led to anxiety in the medical staff of neurology departments, which merits attention during the battle against COVID-19.

6.
Aging (Albany NY) ; 13(23): 24943-24962, 2021 12 04.
Article in English | MEDLINE | ID: covidwho-1622953

ABSTRACT

Ongoing pandemic and potential resurgence of Coronavirus disease 2019 (COVID-19) has prompted urgent efforts to investigate the immunological memory of convalescent patients, especially in patients with active cancers. Here we performed single-cell RNA sequencing in peripheral blood samples of 3 healthy donors (HDs), 4 COVID-19 patients (Covs) and 4 COVID-19 patients with active gynecological tumor (TCs) pre- and post- anti-tumor treatment. All Covs patients had recovered from their acute infection. Interestingly, the molecular features of PBMCs in TCs are similar to that in Covs, suggesting that convalescent COVID-19 with gynecologic tumors do not have major immunological changes and may be protected against reinfection similar to COVID-19 patients without tumors. Moreover, the chemotherapy given to these patients mainly caused neutropenia, while having little effect on the proportion and functional phenotype of T and B cells, and T cell clonal expansion. Notably, anti-PD-L1 treatment massively increased cytotoxic scores of NK cells, and T cells, and facilitated clonal expansion of T cells in these patients. It is likely that T cells could protect patients from SARS-CoV-2 virus reinfection and anti-PD-L1 treatment can enhance the anti-viral activity of the T cells.


Subject(s)
COVID-19/complications , Genital Neoplasms, Female/complications , Genital Neoplasms, Female/therapy , Immune Checkpoint Inhibitors/therapeutic use , Immunotherapy , Antibodies, Viral/immunology , B-Lymphocytes/drug effects , B-Lymphocytes/immunology , COVID-19/immunology , COVID-19/prevention & control , Female , Genital Neoplasms, Female/immunology , Humans , Immune Checkpoint Inhibitors/pharmacology , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , Single-Cell Analysis , T-Lymphocytes/drug effects , T-Lymphocytes/immunology
7.
Zhongguo Huanjing Kexue = China Environmental Science ; 41(10):4703, 2021.
Article in English | ProQuest Central | ID: covidwho-1619209

ABSTRACT

Using the method of sewage epidemiology, the occurrence characteristics and changes of two typical psychoactive drugs methamphetamine and ketamine in the domestic sewage of a city in Guangdong Province during and before and after the new crown epidemic in 2020 were studied, and the mobile phone signaling data was used to analyze The total population, structural characteristics and their change laws were combined to analyze the changes in the consumption of the two drugs during the epidemic and before and after the epidemic. The results show that the actual population of the city during the epidemic decreased by about 45% compared with before the epidemic. The total consumption of various drugs has dropped by about 75% compared to before the epidemic. The significant decline in total consumption was largely caused by the actual population decline during the epidemic. In fact, the per capita consumption levels of methamphetamine and ketamine in the city during the epidemic Compared with the pre-epidemic drop of less than 50%. Taking into account the strict control measures during the epidemic, this decline shows that the abuse of these two psychotropic substances is extremely stubborn;after the epidemic, the consumption of the two drugs and their concentrations in the environment have increased significantly. It has basically returned to the level before the epidemic, which further proves the stubbornness of psychotropic substance abuse.

8.
MMWR Morb Mortal Wkly Rep ; 70(45): 1563-1569, 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1513269

ABSTRACT

In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan,* with the objective of eliminating measles† in five of the six World Health Organization (WHO) regions by 2020 (1). The Immunization Agenda 2021-2030 (IA2030)§ uses measles incidence as an indicator of the strength of immunization systems. The Measles-Rubella Strategic Framework 2021-2030¶ and the Measles Outbreaks Strategic Response Plan 2021-2023** are aligned with the IA2030 and highlight robust measles surveillance systems to document immunity gaps, identify root causes of undervaccination, and develop locally tailored solutions to ensure administration of 2 doses of measles-containing vaccine (MCV) to all children. This report describes progress toward World Health Assembly milestones and measles elimination objectives during 2000-2020 and updates a previous report (2). During 2000-2010, estimated MCV first dose (MCV1) coverage increased globally from 72% to 84%, peaked at 86% in 2019, but declined to 84% in 2020 during the COVID-19 pandemic. All countries conducted measles surveillance, although fewer than one third achieved the sensitivity indicator target of ≥2 discarded†† cases per 100,000 population in 2020. Annual reported measles incidence decreased 88% during 2000-2016, from 145 to 18 cases per 1 million population, rebounded to 120 in 2019, before falling to 22 in 2020. During 2000-2020, the annual number of estimated measles deaths decreased 94%, from 1,072,800 to 60,700, averting an estimated 31.7 million measles deaths. To achieve regional measles elimination targets, enhanced efforts are needed to reach all children with 2 MCV doses, implement robust surveillance, and identify and close immunity gaps.


Subject(s)
Disease Eradication , Global Health/statistics & numerical data , Measles/prevention & control , Child , Humans , Immunization Programs , Incidence , Infant , Measles/epidemiology , Measles Vaccine/administration & dosage , World Health Organization
9.
Mil Med Res ; 8(1): 57, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1496239

ABSTRACT

BACKGROUND: Mitochondria have been shown to play vital roles during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) development. Currently, it is unclear whether mitochondrial DNA (mtDNA) variants, which define mtDNA haplogroups and determine oxidative phosphorylation performance and reactive oxygen species production, are associated with COVID-19 risk. METHODS: A population-based case-control study was conducted to compare the distribution of mtDNA variations defining mtDNA haplogroups between healthy controls (n = 615) and COVID-19 patients (n = 536). COVID-19 patients were diagnosed based on molecular diagnostics of the viral genome by qPCR and chest X-ray or computed tomography scanning. The exclusion criteria for the healthy controls were any history of disease in the month preceding the study assessment. MtDNA variants defining mtDNA haplogroups were identified by PCR-RFLPs and HVS-I sequencing and determined based on mtDNA phylogenetic analysis using Mitomap Phylogeny. Student's t-test was used for continuous variables, and Pearson's chi-squared test or Fisher's exact test was used for categorical variables. To assess the independent effect of each mtDNA variant defining mtDNA haplogroups, multivariate logistic regression analyses were performed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) with adjustments for possible confounding factors of age, sex, smoking and diseases (including cardiopulmonary diseases, diabetes, obesity and hypertension) as determined through clinical and radiographic examinations. RESULTS: Multivariate logistic regression analyses revealed that the most common investigated mtDNA variations (> 10% in the control population) at C5178a (in NADH dehydrogenase subunit 2 gene, ND2) and A249d (in the displacement loop region, D-loop)/T6392C (in cytochrome c oxidase I gene, CO1)/G10310A (in ND3) were associated with a reduced risk of severe COVID-19 (OR = 0.590, 95% CI 0.428-0.814, P = 0.001; and OR = 0.654, 95% CI 0.457-0.936, P = 0.020, respectively), while A4833G (ND2), A4715G (ND2), T3394C (ND1) and G5417A (ND2)/C16257a (D-loop)/C16261T (D-loop) were related to an increased risk of severe COVID-19 (OR = 2.336, 95% CI 1.179-4.608, P = 0.015; OR = 2.033, 95% CI 1.242-3.322, P = 0.005; OR = 3.040, 95% CI 1.522-6.061, P = 0.002; and OR = 2.890, 95% CI 1.199-6.993, P = 0.018, respectively). CONCLUSIONS: This is the first study to explore the association of mtDNA variants with individual's risk of developing severe COVID-19. Based on the case-control study, we concluded that the common mtDNA variants at C5178a and A249d/T6392C/G10310A might contribute to an individual's resistance to developing severe COVID-19, whereas A4833G, A4715G, T3394C and G5417A/C16257a/C16261T might increase an individual's risk of developing severe COVID-19.


Subject(s)
COVID-19 , DNA, Mitochondrial , COVID-19/genetics , Case-Control Studies , China , DNA, Mitochondrial/genetics , Humans , Mitochondria/genetics , Phylogeny , Risk Factors
10.
Elife ; 102021 07 13.
Article in English | MEDLINE | ID: covidwho-1308531

ABSTRACT

Background: Vaccination is one of the most effective public health interventions. We investigate the impact of vaccination activities for Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae, and yellow fever over the years 2000-2030 across 112 countries. Methods: Twenty-one mathematical models estimated disease burden using standardised demographic and immunisation data. Impact was attributed to the year of vaccination through vaccine-activity-stratified impact ratios. Results: We estimate 97 (95%CrI[80, 120]) million deaths would be averted due to vaccination activities over 2000-2030, with 50 (95%CrI[41, 62]) million deaths averted by activities between 2000 and 2019. For children under-5 born between 2000 and 2030, we estimate 52 (95%CrI[41, 69]) million more deaths would occur over their lifetimes without vaccination against these diseases. Conclusions: This study represents the largest assessment of vaccine impact before COVID-19-related disruptions and provides motivation for sustaining and improving global vaccination coverage in the future. Funding: VIMC is jointly funded by Gavi, the Vaccine Alliance, and the Bill and Melinda Gates Foundation (BMGF) (BMGF grant number: OPP1157270 / INV-009125). Funding from Gavi is channelled via VIMC to the Consortium's modelling groups (VIMC-funded institutions represented in this paper: Imperial College London, London School of Hygiene and Tropical Medicine, Oxford University Clinical Research Unit, Public Health England, Johns Hopkins University, The Pennsylvania State University, Center for Disease Analysis Foundation, Kaiser Permanente Washington, University of Cambridge, University of Notre Dame, Harvard University, Conservatoire National des Arts et Métiers, Emory University, National University of Singapore). Funding from BMGF was used for salaries of the Consortium secretariat (authors represented here: TBH, MJ, XL, SE-L, JT, KW, NMF, KAMG); and channelled via VIMC for travel and subsistence costs of all Consortium members (all authors). We also acknowledge funding from the UK Medical Research Council and Department for International Development, which supported aspects of VIMC's work (MRC grant number: MR/R015600/1).JHH acknowledges funding from National Science Foundation Graduate Research Fellowship; Richard and Peggy Notebaert Premier Fellowship from the University of Notre Dame. BAL acknowledges funding from NIH/NIGMS (grant number R01 GM124280) and NIH/NIAID (grant number R01 AI112970). The Lives Saved Tool (LiST) receives funding support from the Bill and Melinda Gates Foundation.This paper was compiled by all coauthors, including two coauthors from Gavi. Other funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.


Subject(s)
Bacterial Infections/prevention & control , Bacterial Vaccines/therapeutic use , COVID-19 , Global Health , Models, Biological , SARS-CoV-2 , Bacterial Infections/epidemiology , Humans
11.
International Journal of Applied Earth Observation and Geoinformation ; : 102421, 2021.
Article in English | ScienceDirect | ID: covidwho-1293892

ABSTRACT

The lockdown of cities to against the COVID-19 epidemic directly decreases urban socioeconomic activities. Remotely sensed night-time light (NTL) provides a macro perspective to capture these variations. Here, taking 20 global megacities as examples, we adopted the NASA’s Black Marble NTL data with a daily resolution to investigate their spatio-temporal changes. We collected daily NTL products for four weeks (one month) before and after the date of lockdown in each city, which were then summarized as weekly and monthly averaged NTL images after pre-processing (cloud removing, outlier detection, etc.). Results show that NTL overall decreased after the lockdown of cities, but with regional disparities and varying spatial patterns. Asian cities experienced the most obvious reduction of NTL. Particularly, the monthly averaged NTL in Mumbai, India, decreased by nearly 20% compared to one month before. However, there were no significant decline in NTL in European cities. African cities also experienced stable changes of NTL. Spatially, city centers darkened more obviously than the urban periphery. Facing emergencies, NTL data has broad applications in monitoring socioeconomic dynamics and assessing public policies in a near real-time manner.

12.
Nat Commun ; 12(1): 3501, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-1263489

ABSTRACT

The characteristics of COVID-19 patients with persistent SARS-CoV-2 infection are not yet well described. Here, we compare the clinical and molecular features of patients with long duration of viral shedding (LDs) with those from patients with short duration patients (SDs), and healthy donors (HDs). We find that several cytokines and chemokines, such as interleukin (IL)-2, tumor necrosis factor (TNF) and lymphotoxin α (LT-α) are present at lower levels in LDs than SDs. Single-cell RNA sequencing shows that natural killer (NK) cells and CD14+ monocytes are reduced, while regulatory T cells are increased in LDs; moreover, T and NK cells in LDs are less activated than in SDs. Importantly, most cells in LDs show reduced expression of ribosomal protein (RP) genes and related pathways, with this inversed correlation between RP levels and infection duration further validated in 103 independent patients. Our results thus indicate that immunosuppression and low RP expression may be related to the persistence of the viral infection in COVID-19 patients.


Subject(s)
COVID-19/immunology , SARS-CoV-2/pathogenicity , B-Lymphocytes/metabolism , B-Lymphocytes/pathology , COVID-19/virology , Cytokines/blood , Gene Expression Profiling , Humans , Killer Cells, Natural/metabolism , Killer Cells, Natural/pathology , Leukocytes, Mononuclear/pathology , Lymphocyte Activation/genetics , Lymphocyte Subsets/metabolism , Lymphocyte Subsets/pathology , Ribosomal Proteins/genetics , SARS-CoV-2/isolation & purification , Signal Transduction/genetics , T-Lymphocytes/metabolism , T-Lymphocytes/pathology , Virus Shedding
13.
Pattern Recognit ; 118: 108006, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1230705

ABSTRACT

The fast pandemics of coronavirus disease (COVID-19) has led to a devastating influence on global public health. In order to treat the disease, medical imaging emerges as a useful tool for diagnosis. However, the computed tomography (CT) diagnosis of COVID-19 requires experts' extensive clinical experience. Therefore, it is essential to achieve rapid and accurate segmentation and detection of COVID-19. This paper proposes a simple yet efficient and general-purpose network, called Sequential Region Generation Network (SRGNet), to jointly detect and segment the lesion areas of COVID-19. SRGNet can make full use of the supervised segmentation information and then outputs multi-scale segmentation predictions. Through this, high-quality lesion-areas suggestions can be generated on the predicted segmentation maps, reducing the diagnosis cost. Simultaneously, the detection results conversely refine the segmentation map by a post-processing procedure, which significantly improves the segmentation accuracy. The superiorities of our SRGNet over the state-of-the-art methods are validated through extensive experiments on the built COVID-19 database.

14.
JAMA Netw Open ; 4(3): e212574, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1126330

ABSTRACT

Importance: Face masks are recommended to prevent transmission of coronavirus disease 2019 (COVID-19); however, there is scarce evidence on their protection efficacy and ways to improve it. Objective: To determine the proportion of improper face mask use, the factors associated with face mask protection efficacy, and ways to improve efficacy. Design, Setting, and Participants: This population-based cross-sectional study was conducted in China from July to August 2020 in 5 kinds of public places. Participants included convenience samples of individuals wearing face masks and able to taste the check solution. Exposures: Demographic and socioeconomic characteristics, including sex, age, and education level; information on face mask model and the worn duration was recorded. Main Outcomes and Measures: The main outcome as airtightness, assessed by detecting face-to-face mask gaps, movement of cotton fiber placed at the face mask edges, and using a qualitative fit test with a bitter solution spray. Masks were further assessed for whether sealing the upper face mask edge with an adhesive tape strip was associated with improved face mask airtightness. Results: Among 6003 face mask wearers enrolled, the mean (SD) age of participants was 31.1 (13.7) years, and 3047 participants (50.8%) were female. The first qualitative fit test found air leakage in 2754 participants (45.9%; 95% CI, 44.6%-47.1%), which was mostly attributable to gaps at the upper face mask edge. After sealing the upper face mask edge with an adhesive tape strip, 69.7% (95% CI, 68.0%-71.5%) of masks that had exhibited leakage became airtight in the second qualitative fit test, and the rate of airtightness reached 96.2% (95% CI, 95.4%-96.8%) in a third qualitative fit test after new surgical face masks with tape on the upper edge were provided to those who had not converted initially. The tape was well tolerated; overall, 6 participants (1.2%) reported a rash and 24 participants (5.8%) reported significant discomfort. Conclusions and Relevance: In this study of face mask fit among participants in China, although most people used face masks in public places, compromised protection due to suboptimal airtightness was common. The simple approach of sealing the upper edge of the face mask with an adhesive tape strip was associated with substantially improved its airtightness.


Subject(s)
COVID-19/prevention & control , Cotton Fiber , Disposable Equipment , Masks , N95 Respirators , Adult , COVID-19/transmission , China , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , Young Adult
15.
Phytomedicine ; 85: 153531, 2021 May.
Article in English | MEDLINE | ID: covidwho-1104217

ABSTRACT

BACKGROUND: Qingfei Paidu Tang (QPT), a formula of traditional Chinese medicine, which was suggested to be able to ease symptoms in patients with Coronavirus Disease 2019 (COVID-19), has been recommended by clinical guidelines and widely used to treat COVID-19 in China. However, whether it decreases mortality remains unknown. PURPOSE: We aimed to explore the association between QPT use and in-hospital mortality among patients hospitalized for COVID-19. STUDY DESIGN: A retrospective study based on a real-world database was conducted. METHODS: We identified patients consecutively hospitalized with COVID-19 in 15 hospitals from a national retrospective registry in China, from January through May 2020. Data on patients' characteristics, treatments, and outcomes were extracted from the electronic medical records. The association of QPT use with COVID-19 related mortality was evaluated using Cox proportional hazards models based on propensity score analysis. RESULTS: Of the 8939 patients included, 28.7% received QPT. The COVID-19 related mortality was 1.2% (95% confidence interval [CI] 0.8% to 1.7%) among the patients receiving QPT and 4.8% (95% CI 4.3% to 5.3%) among those not receiving QPT. After adjustment for patient characteristics and concomitant treatments, QPT use was associated with a relative reduction of 50% in-hospital COVID-19 related mortality (hazard ratio, 0.50; 95% CI, 0.37 to 0.66 p < 0.001). This association was consistent across subgroups by sex and age. Meanwhile, the incidences of acute liver injury (8.9% [95% CI, 7.8% to 10.1%] vs. 9.9% [95% CI, 9.2% to 10.7%]; odds ratio, 0.96 [95% CI, 0.81% to 1.14%], p = 0.658) and acute kidney injury (1.6% [95% CI, 1.2% to 2.2%] vs. 3.0% [95% CI, 2.6% to 3.5%]; odds ratio, 0.85 [95% CI, 0.62 to 1.17], p = 0.318) were comparable between patients receiving QPT and those not receiving QPT. The major study limitations included that the study was an observational study based on real-world data rather than a randomized control trial, and the quality of data could be affected by the accuracy and completeness of medical records. CONCLUSIONS: QPT was associated with a substantially lower risk of in-hospital mortality, without extra risk of acute liver injury or acute kidney injury among patients hospitalized with COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/mortality , Drugs, Chinese Herbal/therapeutic use , Acute Kidney Injury , Adult , Aged , Chemical and Drug Induced Liver Injury , China , Female , Hospital Mortality , Humans , Incidence , Male , Medicine, Chinese Traditional , Middle Aged , Proportional Hazards Models , Registries , Retrospective Studies
16.
BMC Psychiatry ; 20(1): 436, 2020 09 05.
Article in English | MEDLINE | ID: covidwho-745684

ABSTRACT

BACKGROUND: Neurological symptoms are increasingly being noted among COVID-19 patients. Currently, there is little data on the mental health of neurological healthcare workers. The aim of this study was to identify the prevalence and influencing factors on anxiety and depression in neurological healthcare workers in Hunan Province, China during the early stage of the Coronavirus Disease 2019 (COVID-19) outbreak. METHODS: An online cross-sectional study was conducted among neurological doctors and nurses in early February 2020 in Hunan Province. Symptoms of anxiety and depression were assessed by the Chinese version of the Self-Rating Anxiety Scale (SAS) (defined as a total score ≥ 50) and Self-Rating Depression Scale (SDS) (defined as a total score ≥ 53). The prevalences of probable anxiety and depression were compared between different groups, and multivariate logistic regression analysis was used to understand the independent influencing factors on anxiety and depression. RESULTS: The prevalence of probable anxiety and depression in neurological nurses (20.3 and 30.2%, respectively) was higher than that in doctors (12.6 and 20.2%, respectively). Female healthcare workers (18.4%) had a higher proportion of anxiety than males (10.8%). Probable anxiety and depression were more prevalent among nurses, younger workers (≤ 40 years), and medical staff with junior titles. Logistic regression analysis showed that a shortage of protective equipment was independently associated with probable anxiety (OR = 1.980, 95% CI: 1.241-3.160, P = 0.004), while young age was a risk factor for probable depression (OR = 2.293, 95% CI: 1.137-4.623, P = 0.020) among neurological healthcare workers. CONCLUSIONS: Probable anxiety and depression were more prevalent among neurological nurses than doctors in Hunan Province. The shortage of protective equipment led to probable anxiety, and young age led to probable depression in healthcare workers in neurology departments, which merits attention during the battle against COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections , Depressive Disorder/epidemiology , Nurses/psychology , Pandemics , Physicians/psychology , Pneumonia, Viral , Adult , COVID-19 , China/epidemiology , Cross-Sectional Studies , Depressive Disorder/psychology , Disease Outbreaks , Female , Hospital Units , Humans , Male , Neurology , Prevalence , SARS-CoV-2 , Surveys and Questionnaires
17.
J. Xi'An Jiaotong Univ. Med. Sci. ; 4(41): 488-491, 20200705.
Article in Chinese | WHO COVID, ELSEVIER | ID: covidwho-683576

ABSTRACT

Coronavirus disease 2019 (COVID-19) is highly infectious and seriously harmful to human health. According to the clinical characteristics of COVID-19, it can be classified into mild, moderate, severe and critical ones. The treatment for critical cases is an important factor of reducing the mortality rate of the disease and is always dependent on the intensive care unit (ICU). The ICU therapy strategies involve not only curing the critical cases, but also avoiding cross infection in the same ward. Therefore, we have formulated detailed response management strategies, including the establishment of core groups, standardization of diagnosis and treatment process, strengthening personnel management, multimodal training assessment, and overall allocation of protection materials. We hope the strategies can provide reference for relevant ICUs.

18.
JCI Insight ; 5(12)2020 06 18.
Article in English | MEDLINE | ID: covidwho-611544

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has become a pandemic. This study addresses the clinical and immunopathological characteristics of severe COVID-19. METHODS: Sixty-nine patients with COVID-19 were classified into severe and nonsevere groups to analyze their clinical and laboratory characteristics. A panel of blood cytokines was quantified over time. Biopsy specimens from 2 deceased cases were obtained for immunopathological, ultrastructural, and in situ hybridization examinations. RESULTS: Circulating cytokines, including IL-8, IL-6, TNF-α, IP10, MCP1, and RANTES, were significantly elevated in patients with severe COVID-19. Dynamic IL-6 and IL-8 were associated with disease progression. SARS-CoV-2 was demonstrated to infect type II and type I pneumocytes and endothelial cells, leading to severe lung damage through cell pyroptosis and apoptosis. In severe cases, lymphopenia, neutrophilia, depletion of CD4+ and CD8+ T lymphocytes, and massive macrophage and neutrophil infiltrates were observed in both blood and lung tissues. CONCLUSIONS: A panel of circulating cytokines could be used to predict disease deterioration and inform clinical interventions. Severe pulmonary damage was predominantly attributed to both cytopathy caused by SARS-CoV-2 and immunopathologic damage. Strategies that prohibit pulmonary recruitment and overactivation of inflammatory cells by suppressing cytokine storm might improve the outcomes of patients with severe COVID-19.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/pathology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/pathology , Adult , Aged , Betacoronavirus/isolation & purification , Biopsy , CD8-Positive T-Lymphocytes , COVID-19 , Chemokine CCL2/blood , Chemokine CCL5/blood , China/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/epidemiology , Cytokines/blood , Disease Progression , Endothelial Cells/pathology , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Lymphocyte Count , Lymphopenia/pathology , Lymphopenia/virology , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/epidemiology , SARS-CoV-2
19.
Lancet ; 395(10239): 1802-1812, 2020 06 06.
Article in English | MEDLINE | ID: covidwho-548644

ABSTRACT

China has substantially increased financial investment and introduced favourable policies for strengthening its primary health care system with core responsibilities in preventing and managing chronic diseases such as hypertension and emerging infectious diseases such as coronavirus disease 2019 (COVID-19). However, widespread gaps in the quality of primary health care still exist. In this Review, we aim to identify the causes for this poor quality, and provide policy recommendations. System challenges include: the suboptimal education and training of primary health-care practitioners, a fee-for-service payment system that incentivises testing and treatments over prevention, fragmentation of clinical care and public health service, and insufficient continuity of care throughout the entire health-care system. The following recommendations merit consideration: (1) enhancement of the quality of training for primary health-care physicians, (2) establishment of performance accountability to incentivise high-quality and high-value care; (3) integration of clinical care with the basic public health services, and (4) strengthening of the coordination between primary health-care institutions and hospitals. Additionally, China should consider modernising its primary health-care system through the establishment of a learning health system built on digital data and innovative technologies.


Subject(s)
Primary Health Care/standards , Quality of Health Care , COVID-19 , China , Continuity of Patient Care , Coronavirus Infections , Fee-for-Service Plans , Humans , Pandemics , Physicians, Primary Care/education , Physicians, Primary Care/standards , Pneumonia, Viral , Primary Health Care/organization & administration
20.
J Hepatol ; 73(4): 807-816, 2020 10.
Article in English | MEDLINE | ID: covidwho-345685

ABSTRACT

Background & Aims: Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). Whether or not severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to liver damage per se remains unknown. Herein, we reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with liver enzyme abnormalities. Methods: We analyzed 156 patients diagnosed with COVID-19 from 2 designated centers in China and compared clinical features between patients with or without elevated aminotransferases. Postmortem liver biopsies were obtained from 2 cases who had elevated aminotransferases. We investigated the patterns of liver impairment by electron microscopy, immunohistochemistry, TUNEL assay and pathological studies. Results: Sixty-four out of 156 (41.0%) patients with COVID-19 had elevated aminotransferases. The median levels of alanine aminotransferase were 50 U/L vs. 19 U/L, respectively, aspartate aminotransferase were 45.5 U/L vs. 24 U/L, respectively in abnormal and normal aminotransferase groups. Liver enzyme abnormalities were associated with disease severity, as well as a series of laboratory tests including higher alveolar-arterial oxygen partial pressure difference, higher gamma-glutamyltransferase, lower albumin, decreased CD4+ T cells and B lymphocytes. Ultrastructural examination identified typical coronavirus particles, characterized by spike structures, in the cytoplasm of hepatocytes in 2 COVID-19 cases. SARS-CoV-2-infected hepatocytes displayed conspicuous mitochondrial swelling, endoplasmic reticulum dilatation and glycogen granule decrease. Histologically, massive hepatic apoptosis and some binuclear hepatocytes were observed. Taken together, both ultrastructural and histological evidence indicated a typical lesion of viral infection. Immunohistochemical results showed scarce CD4+ and CD8+ lymphocytes. No obvious eosinophil infiltration, cholestasis, fibrin deposition, granuloma, massive central necrosis, or interface hepatitis were observed. Conclusions: SARS-CoV-2 infection in the liver directly contributes to hepatic impairment in patients with COVID-19. Hence, a surveillance of viral clearance in liver and long-term outcome of COVID-19 is required. Lay summary: Liver enzyme abnormalities are common in patients with coronavirus disease 2019 (COVID-19). We reported the clinical characteristics and liver pathological manifestations of COVID-19 patients with elevated liver enzymes. Our findings suggested that SARS-CoV-2 infection of the liver is a crucial factor contributing to hepatic impairment in patients with COVID-19.


Subject(s)
Alanine Transaminase/blood , Aspartate Aminotransferases/blood , Coronavirus Infections , Liver Diseases , Liver , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Correlation of Data , Humans , Immunohistochemistry , Liver/metabolism , Liver/pathology , Liver/virology , Liver Diseases/blood , Liver Diseases/diagnosis , Liver Diseases/etiology , Liver Function Tests/methods , Male , Microscopy, Electron , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , SARS-CoV-2 , Severity of Illness Index
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