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1.
Cochrane Database Syst Rev ; 8: CD010168, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1813437

ABSTRACT

BACKGROUND: This is the second update of a Cochrane Review first published in 2015 and last updated in 2018. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. Patients who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial. OBJECTIVES: To assess the safety and efficacy of abdominal drainage to prevent intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid Embase, Web of Science, the World Health Organization International Trials Registry Platform, ClinicalTrials.gov, Chinese Biomedical Literature Database, and three trials registers on 24 February 2020, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that compared abdominal drainage versus no drainage in people undergoing emergency open or laparoscopic appendectomy for complicated appendicitis. We also included RCTs that compared different types of drains and different schedules for drain removal in people undergoing appendectomy for complicated appendicitis. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently identified the trials for inclusion, collected the data, and assessed the risk of bias. We used the GRADE approach to assess evidence certainty. We included intraperitoneal abscess as the primary outcome. Secondary outcomes were wound infection, morbidity, mortality, hospital stay, hospital costs, pain, and quality of life. MAIN RESULTS: Use of drain versus no drain We included six RCTs (521 participants) comparing abdominal drainage and no drainage in participants undergoing emergency open appendectomy for complicated appendicitis. The studies were conducted in North America, Asia, and Africa. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open appendectomy. None of the trials was assessed as at low risk of bias. The evidence is very uncertain regarding the effects of abdominal drainage versus no drainage on intraperitoneal abscess at 30 days (risk ratio (RR) 1.23, 95% confidence interval (CI) 0.47 to 3.21; 5 RCTs; 453 participants; very low-certainty evidence) or wound infection at 30 days (RR 2.01, 95% CI 0.88 to 4.56; 5 RCTs; 478 participants; very low-certainty evidence). There were seven deaths in the drainage group (N = 183) compared to one in the no-drainage group (N = 180), equating to an increase in the risk of 30-day mortality from 0.6% to 2.7% (Peto odds ratio 4.88, 95% CI 1.18 to 20.09; 4 RCTs; 363 participants; low-certainty evidence). Abdominal drainage may increase 30-day overall complication rate (morbidity; RR 6.67, 95% CI 2.13 to 20.87; 1 RCT; 90 participants; low-certainty evidence) and hospital stay by 2.17 days (95% CI 1.76 to 2.58; 3 RCTs; 298 participants; low-certainty evidence) compared to no drainage. The outcomes hospital costs, pain, and quality of life were not reported in any of the included studies. There were no RCTs comparing the use of drain versus no drain in participants undergoing emergency laparoscopic appendectomy for complicated appendicitis. Open drain versus closed drain There were no RCTs comparing open drain versus closed drain for complicated appendicitis. Early versus late drain removal There were no RCTs comparing early versus late drain removal for complicated appendicitis. AUTHORS' CONCLUSIONS: The certainty of the currently available evidence is low to very low. The effect of abdominal drainage on the prevention of intraperitoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to the no-drainage group are based on low-certainty evidence. Consequently, there is no evidence for any clinical improvement with the use of abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths observed in just under 400 recruited participants. Larger studies are needed to more reliably determine the effects of drainage on morbidity and mortality outcomes.


Subject(s)
Abscess/prevention & control , Appendectomy/adverse effects , Appendicitis/surgery , Drainage/methods , Peritonitis/prevention & control , Postoperative Complications/prevention & control , Humans
2.
Stem Cell Rev Rep ; 18(3): 1193-1206, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1620352

ABSTRACT

Type 2 diabetes mellitus (T2DM), one of the most common carbohydrate metabolism disorders, is characterized by chronic hyperglycemia and insulin resistance (IR), and has become an urgent global health challenge. Mesenchymal stem cells (MSCs) originating from perinatal tissues such as umbilical cord (UC) and amniotic membrane (AM) serve as ideal candidates for the treatment of T2DM due to their great advantages in terms of abundant source, proliferation capacity, immunomodulation and plasticity for insulin-producing cell differentiation. However, the optimally perinatal MSC source to treat T2DM remains elusive. This study aims to compare the therapeutic efficacy of MSCs derived from AM and UC (AMMSCs and UCMSCs) of the same donor in the alleviation of T2DM symptoms and explore the underlying mechanisms. Our results showed that AMMSCs and UCMSCs displayed indistinguishable immunophenotype and multi-lineage differentiation potential, but UCMSCs had a much higher expansion capacity than AMMSCs. Moreover, we uncovered that single-dose intravenous injection of either AMMSCs or UCMSCs could comparably reduce hyperglycemia and improve IR in T2DM db/db mice. Mechanistic investigations revealed that either AMMSC or UCMSC infusion could greatly improve glycolipid metabolism in the liver of db/db mice, which was evidenced by decreased liver to body weight ratio, reduced lipid accumulation, upregulated glycogen synthesis, and increased Akt phosphorylation. Taken together, these data indicate that the same donor-derived AMMSCs and UCMSCs possessed comparable effects and shared a similar hepatoprotective mechanism on the alleviation of T2DM symptoms.

3.
Cell Res ; 31(12): 1244-1262, 2021 12.
Article in English | MEDLINE | ID: covidwho-1493090

ABSTRACT

The infusion of coronavirus disease 2019 (COVID-19) patients with mesenchymal stem cells (MSCs) potentially improves clinical symptoms, but the underlying mechanism remains unclear. We conducted a randomized, single-blind, placebo-controlled (29 patients/group) phase II clinical trial to validate previous findings and explore the potential mechanisms. Patients treated with umbilical cord-derived MSCs exhibited a shorter hospital stay (P = 0.0198) and less time required for symptoms remission (P = 0.0194) than those who received placebo. Based on chest images, both severe and critical patients treated with MSCs showed improvement by day 7 (P = 0.0099) and day 21 (P = 0.0084). MSC-treated patients had fewer adverse events. MSC infusion reduced the levels of C-reactive protein, proinflammatory cytokines, and neutrophil extracellular traps (NETs) and promoted the maintenance of SARS-CoV-2-specific antibodies. To explore how MSCs modulate the immune system, we employed single-cell RNA sequencing analysis on peripheral blood. Our analysis identified a novel subpopulation of VNN2+ hematopoietic stem/progenitor-like (HSPC-like) cells expressing CSF3R and PTPRE that were mobilized following MSC infusion. Genes encoding chemotaxis factors - CX3CR1 and L-selectin - were upregulated in various immune cells. MSC treatment also regulated B cell subsets and increased the expression of costimulatory CD28 in T cells in vivo and in vitro. In addition, an in vivo mouse study confirmed that MSCs suppressed NET release and reduced venous thrombosis by upregulating kindlin-3 signaling. Together, our results underscore the role of MSCs in improving COVID-19 patient outcomes via maintenance of immune homeostasis.


Subject(s)
COVID-19/therapy , Immunomodulation , Mesenchymal Stem Cell Transplantation , Aged , Animals , Antibodies, Viral/blood , B-Lymphocyte Subsets/cytology , B-Lymphocyte Subsets/immunology , B-Lymphocyte Subsets/metabolism , C-Reactive Protein/analysis , COVID-19/immunology , COVID-19/virology , Cytokines/genetics , Cytokines/metabolism , Cytoskeletal Proteins/metabolism , Disease Models, Animal , Extracellular Traps/metabolism , Female , Humans , Leukocytes, Mononuclear/cytology , Leukocytes, Mononuclear/metabolism , Male , Mice , Mice, Inbred C57BL , Middle Aged , SARS-CoV-2/isolation & purification , T-Lymphocytes/cytology , T-Lymphocytes/immunology , T-Lymphocytes/metabolism , Venous Thrombosis/metabolism , Venous Thrombosis/pathology
5.
Healthcare (Basel) ; 9(9)2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1390595

ABSTRACT

In this paper, we utilize the Internet big data tool, namely Baidu Index, to predict the development trend of the new coronavirus pneumonia epidemic to obtain further data. By selecting appropriate keywords, we can collect the data of COVID-19 cases in China between 1 January 2020 and 1 April 2020. After preprocessing the data set, the optimal sub-data set can be obtained by using random forest feature selection method. The optimization results of the seven hyperparameters of the LightGBM model by grid search, random search and Bayesian optimization algorithms are compared. The experimental results show that applying the data set obtained from the Baidu Index to the Bayesian-optimized LightGBM model can better predict the growth of the number of patients with new coronary pneumonias, and also help people to make accurate judgments to the development trend of the new coronary pneumonia.

6.
Journal of Physics: Conference Series ; 1992(4), 2021.
Article in English | ProQuest Central | ID: covidwho-1379417

ABSTRACT

Up to now, COVID-19 has been diagnosed in the world as many as about sixty million, which has caused tremendous pressure and burden to hospitals and medical systems. The number of chest X-rays required to be reviewed by doctors of relevant specialties is more than ever before. Besides, in the process of recognition, there are many difficulties for human identification of chest X-ray images, such as the naked eye is difficult to find tiny abnormalities, the chest X-ray images researchers have is limited and doctors is unfamiliar with this new disease. In this case, it is very necessary to use deep learning to help doctors diagnose pneumonia and solve some urgent difficulties. In the field of deep learning, transfer learning focuses on saving solution model of previous problems, and takes advantage of it on other different but related problems. Therefore, we can use the existed Imagenet model to help us train the dataset of COVID-19 and pneumonia. Moreover, deep learning depends on a large amount of data, but when the data is few, data augmentation is able to increase data by some methods, so it is a effective way to overcome the lack of train data. In terms of the good function of these two ways, we use them to improve performance and help doctors improve diagnosis so as to relieve the current tense medical situation.

8.
Front Psychiatry ; 12: 664808, 2021.
Article in English | MEDLINE | ID: covidwho-1278460

ABSTRACT

Background: The COVID-19 pandemic has had impact that may contribute to a rise in mental health problems. The present study was aimed to better understand psychological status among medical staff and medical students during the early epidemic and to explore the influence factors of psychological distress. Methods: A cross-sectional survey was conducted online from February 2-14, 2020. We collected general information related to the COVID-19 outbreak. Respondents were assessed using the Kessler-6 Psychological Distress Scale (K6), Social Support Rating Scale (SSRS), Perceived Stress Scale (PSS) and Simplified Coping Style Questionnaire (SCSQ). Stepwise multiple linear regression was performed to identify factors influencing psychological distress. Results: Five hundred and twenty-eight respondents returned valid questionnaires. Medical staff and Medical students scored averages of 6.77 ± 5.04, 15.48 ± 8.66 on the K6, 37.22 ± 11.39, 22.62 ± 11.25 on the SSRS and 18.52 ± 7.54, 28.49 ± 11.17 on the PSS, respectively. Most medical staff (279, 91.77%) and 148 medical students (66.07%) showed a positive coping style. Social support, perceived stress, hours spent watching epidemic-related information per day and frequency of epidemic-related dreams were identified as factors influencing psychological distress among medical staff and medical students. Coping style emerged as a determinant of psychological distress among medical staff. Conclusions: In the early stages of the COVID-19 epidemic in China, medical staff and medical students were at moderate to high risk of psychological distress. Our results suggest that psychological interventions designed to strengthen social support, reduce perceived stress and adopt a positive coping style may be effective at improving the mental health of medical staff and medical students.

10.
Journal of Clinical Hepatology ; 37(3):554-555, 2021.
Article in Chinese | GIM | ID: covidwho-1154604
11.
Ann Transl Med ; 8(24): 1654, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1041387

ABSTRACT

BACKGROUND: The global outbreak of COVID-19 is a significant threat to public health. Among COVID-19 cases, critically ill patients account for most in-hospital deaths. Given the pressing clinical needs, identification of potential prognostic factors that would assist clinicians to determine appropriate therapeutic interventions is urgently needed. METHODS: A retrospective analysis of 171 critically ill COVID-19 patients from two medical centers in Wuhan was conducted. The training and validation cohorts were comprised of 77 and 94 patients, respectively. Univariate and multivariate Logistic regression analyses were used to identify independent prognostic factors, and the linear prediction index was established and externally validated. RESULTS: Blood urine nitrogen (BUN) and high-sensitive C-reactive protein (hs-CRP) were independent factors negatively correlated with patient survival in the training cohort. A linear prediction model, named as the CB index (hs-CRP combined with BUN), was established and logistic regression analysis showed that this was associated with a 13% increase in death rate, with high sensitivity (86.7%) and specificity (89.7%). Patients were then divided into a high-risk group (CB index >32) and low-risk group (CB index <32) and the high-risk group showed a 56.3-fold risk of death compared with the low-risk group. Importantly, these findings were readily recaptured in the validation cohort. The efficacy of the CB index in predicting prognosis in real-world patients was then determined, which showed that patients with a higher CB index had an increased risk of death in comparison to those with a lower CB index. CONCLUSIONS: The CB index may be an important prognostic factor in critically ill COVID-19 patients.

12.
Med Res Rev ; 41(3): 1775-1797, 2021 05.
Article in English | MEDLINE | ID: covidwho-1001951

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has become a global crisis. As of November 9, COVID-19 has already spread to more than 190 countries with 50,000,000 infections and 1,250,000 deaths. Effective therapeutics and drugs are in high demand. The structure of SARS-CoV-2 is highly conserved with those of SARS-CoV and Middle East respiratory syndrome-CoV. Enzymes, including RdRp, Mpro /3CLpro , and PLpro , which play important roles in viral transcription and replication, have been regarded as key targets for therapies against coronaviruses, including SARS-CoV-2. The identification of readily available drugs for repositioning in COVID-19 therapy is a relatively rapid approach for clinical treatment, and a series of approved or candidate drugs have been proven to be efficient against COVID-19 in preclinical or clinical studies. This review summarizes recent progress in the development of drugs against SARS-CoV-2 and the targets involved.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/virology , Humans , SARS-CoV-2/isolation & purification
13.
Ann Palliat Med ; 9(6): 4156-4165, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-961974

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is a once-in-century crisis to public health. Although the pathogen for COVID-19, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been identified, the pandemic is still ongoing. The critically ill COVID-19 patients account for most disease-associated death; thus, there is an urgent need to identify prognostic factors that would help determine therapeutic approaches. METHODS: In this study, we retrospectively analyzed the clinical and laboratory findings in 100 critically ill COVID-19 patients in Hubei Women & Children Healthcare Hospital (Guanggu District), of whom 22 patients died in hospital, and 78 patients survived. RESULTS: We found that age, lymphocyte count, and total bilirubin concentration were an independent prognostic factor for critically ill COVID-19 patients. Of particular importance, we observed a significant elevation of myocardium injury biomarkers, including CK-MB, high-sensitivity cardiac troponini I (hs-cTnI), and Mb, in the non-survivor group. These myocardium injury biomarkers appeared to correlate with the time of survival, and two multivariate models have suggested hs-cTnI was a novel prognostic factor with a sensitivity of 75.0% and a specificity of 84.9%. CONCLUSIONS: Altogether, our study highlighted the prognostic significance of myocardium injury biomarkers in critically ill COVID-19 patients. Monitoring myocardium injury biomarkers would predict patient survival and guide therapeutic strategy.


Subject(s)
COVID-19/pathology , Cardiomyopathies/metabolism , Critical Illness , Aged , Aged, 80 and over , Biomarkers/metabolism , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/virology , Cardiomyopathies/complications , China/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Prognosis , Retrospective Studies , SARS-CoV-2/isolation & purification
14.
PLoS One ; 15(12): e0243605, 2020.
Article in English | MEDLINE | ID: covidwho-961465

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an acute respiratory infection caused by novel coronavirus 2019. Many individuals suffered psychological symptoms in the early stage when the epidemic was uncertain. We explored the perceived psychological stress and associated factors in the early stage of COVID-19 epidemic. METHOD: The Perceived Stress Scale, Simplified Coping Style Questionnaire, Social Support Rating Scale and a general information questionnaire were integrated in an on-line survey conducted from February 1, 2020 until February 4, 2020. Multiple linear regression analysis was performed to explore whether coping style, social support or other factors contributed to psychological stress. RESULTS: A total of 1638 participants were included, of whom 44.3% showed moderate psychological stress. Individuals who were younger, female, unmarried, spent more time on the disease, felt more concern about it, reported lower social support (Subjective Social support; Objective social support; Utilization social support), or showed a negative coping style were more likely to suffer higher psychological stress in the early stages of the COVID-19 epidemic. CONCLUSION: Psychological interventions may be targeted to individuals with the risk characteristics identified in this study. It may be helpful to promote social support and positive coping style in the early stage of infectious disease epidemics. This initial evidence from the general Chinese population may be relevant to interventions in other countries for dealing with the COVID-19 and other epidemics.


Subject(s)
/psychology , COVID-19/psychology , Stress, Psychological/psychology , Adaptation, Psychological , Adult , Anxiety/epidemiology , COVID-19/epidemiology , China/epidemiology , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Emotions , Female , Humans , Male , Mental Health , Middle Aged , Pandemics/prevention & control , SARS-CoV-2/pathogenicity , Social Support , Stress, Psychological/epidemiology , Surveys and Questionnaires
15.
Disaster Med Public Health Prep ; 14(3): e25-e26, 2020 06.
Article in English | MEDLINE | ID: covidwho-950866

ABSTRACT

We investigated the adoption of World Health Organization (WHO) naming of COVID-19 into the respective languages among the Group of Twenty (G20) countries, and the variation of COVID-19 naming in the Chinese language across different health authorities. On May 7, 2020, we identified the websites of the national health authorities of the G20 countries to identify naming of COVID-19 in their respective languages, and the websites of the health authorities in mainland China, Hong Kong, Macau, Taiwan and Singapore and identify their Chinese name for COVID-19. Among the G20 nations, Argentina, China, Italy, Japan, Mexico, Saudi Arabia and Turkey do not use the literal translation of COVID-19 in their official language(s) to refer to COVID-19, as they retain "novel" in the naming of this disease. China is the only G20 nation that names COVID-19 a pneumonia. Among Chinese-speaking jurisdictions, Hong Kong and Singapore governments follow the WHO's recommendation and adopt the literal translation of COVID-19 in Chinese. In contrast, mainland China, Macau, and Taiwan refer to COVID-19 as a type of pneumonia in Chinese. We urge health authorities worldwide to adopt naming in their native languages that are consistent with WHO's naming of COVID-19.


Subject(s)
Betacoronavirus/classification , Coronavirus Infections/classification , Internationality , Language , Names , Pandemics/classification , Pneumonia, Viral/classification , COVID-19 , Humans , SARS-CoV-2
16.
Proc Natl Acad Sci U S A ; 117(44): 27381-27387, 2020 11 03.
Article in English | MEDLINE | ID: covidwho-867659

ABSTRACT

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global crisis. There is no therapeutic treatment specific for COVID-19. It is highly desirable to identify potential antiviral agents against SARS-CoV-2 from existing drugs available for other diseases and thus repurpose them for treatment of COVID-19. In general, a drug repurposing effort for treatment of a new disease, such as COVID-19, usually starts from a virtual screening of existing drugs, followed by experimental validation, but the actual hit rate is generally rather low with traditional computational methods. Here we report a virtual screening approach with accelerated free energy perturbation-based absolute binding free energy (FEP-ABFE) predictions and its use in identifying drugs targeting SARS-CoV-2 main protease (Mpro). The accurate FEP-ABFE predictions were based on the use of a restraint energy distribution (RED) function, making the practical FEP-ABFE-based virtual screening of the existing drug library possible. As a result, out of 25 drugs predicted, 15 were confirmed as potent inhibitors of SARS-CoV-2 Mpro The most potent one is dipyridamole (inhibitory constant Ki = 0.04 µM) which has shown promising therapeutic effects in subsequently conducted clinical studies for treatment of patients with COVID-19. Additionally, hydroxychloroquine (Ki = 0.36 µM) and chloroquine (Ki = 0.56 µM) were also found to potently inhibit SARS-CoV-2 Mpro We anticipate that the FEP-ABFE prediction-based virtual screening approach will be useful in many other drug repurposing or discovery efforts.


Subject(s)
Antiviral Agents/pharmacology , Betacoronavirus/drug effects , Drug Repositioning , Protease Inhibitors/pharmacology , Viral Nonstructural Proteins/antagonists & inhibitors , COVID-19 , Chloroquine/pharmacology , Coronavirus 3C Proteases , Coronavirus Infections/drug therapy , Cysteine Endopeptidases , Dipyridamole/pharmacology , Humans , Hydroxychloroquine/pharmacology , Molecular Docking Simulation , Molecular Structure , Pandemics , Pneumonia, Viral/drug therapy , SARS-CoV-2
17.
J Clin Pharm Ther ; 45(1): 199-203, 2020 Feb.
Article in English | MEDLINE | ID: covidwho-838508

ABSTRACT

WHAT IS KNOWN AND OBJECTIVE: Some patients with refractory depression who fail to respond to rapid injection of standard-dose ketamine are injected with high doses, but the safety and efficacy of this practice are unclear. CASE DESCRIPTION: A 57-year-old woman with refractory depression whose symptoms did not improve after 20-seconds intravenous injection of 0.5 mg/kg ketamine went into remission following eight, 1-minute intravenous injections of 1 mg/kg ketamine delivered over a 4-week period. By 6-month follow-up, no significant adverse events had occurred and cognitive function had improved. WHAT IS NEW AND CONCLUSION: High-dose intravenous injections of ketamine may stably improve depressive symptoms and cognitive function in patients with refractory depression who do not respond to rapid intravenous injection of standard-dose ketamine. The high-dose treatment appears to be associated with only mild side effects.


Subject(s)
Antidepressive Agents/administration & dosage , Depressive Disorder, Major/drug therapy , Depressive Disorder, Treatment-Resistant/drug therapy , Ketamine/administration & dosage , Antidepressive Agents/adverse effects , COVID-19/drug therapy , Coronavirus Infections/drug therapy , Depressive Disorder, Major/physiopathology , Depressive Disorder, Treatment-Resistant/physiopathology , Drug Synergism , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Injections, Intravenous , Ketamine/adverse effects , Middle Aged , Remission Induction
18.
SSRN; 2020.
Preprint | SSRN | ID: ppcovidwho-717

ABSTRACT

Background: The purpose of this study was to investigate the psychological status of the general population in mainland China during the outbreak of coronavirus

19.
Med Sci Monit ; 26: e926651, 2020 Sep 24.
Article in English | MEDLINE | ID: covidwho-793806

ABSTRACT

BACKGROUND Use of renin-angiotensin-aldosterone system inhibitors in coronavirus disease 2019 (COVID-19) patients lacks evidence and is still controversial. This study was designed to investigate effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on clinical outcomes of COVID-19 patients and to assess the safety of ACEIs/ARBs medication. MATERIAL AND METHODS COVID-19 patients with hypertension from 2 hospitals in Wuhan, China, from 17 Feb to 18 Mar 2020 were retrospectively screened and grouped according to in-hospital medication. We performed 1: 1 propensity score matching (PSM) analysis to adjust for confounding factors. RESULTS We included 210 patients and allocated them to ACEIs/ARBs (n=81; 46.91% males) or non-ACEIs/ARBs (n=129; 48.06% males) groups. The median age was 68 [interquartile range (IQR) 61.5-76] and 66 (IQR 59-72.5) years, respectively. General comparison showed mortality in the ACEIs/ARBs group was higher (8.64% vs. 3.88%) but the difference was not significant (P=0.148). ACEIs/ARBs was associated with significantly more cases 7-categorical ordinal scale >2 at discharge, more cases requiring Intensive Care Unit (ICU) stay, and increased values and ratio of days that blood pressure (BP) was above normal range (P<0.05). PSM analysis showed no significant difference in mortality, cumulative survival rate, or other clinical outcomes such as length of in-hospital/ICU stay, BP fluctuations, or ratio of adverse events between groups after adjustment for confounding parameters on admission. CONCLUSIONS We found no association between ACEIs/ARBs and clinical outcomes or adverse events, thus indicating no evidence for discontinuing use of ACEIs/ARBs in the COVID-19 pandemic.


Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Betacoronavirus , Coronavirus Infections/complications , Hypertension/complications , Pandemics , Pneumonia, Viral/complications , Aged , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Antihypertensive Agents/adverse effects , COVID-19 , China , Comorbidity , Female , Hospital Mortality , Humans , Hypertension/drug therapy , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Peptidyl-Dipeptidase A/biosynthesis , Peptidyl-Dipeptidase A/drug effects , Propensity Score , Retrospective Studies , SARS-CoV-2 , Survival Rate , Treatment Outcome
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(7): 790-796, 2020 Jul 28.
Article in English, Chinese | MEDLINE | ID: covidwho-745313

ABSTRACT

OBJECTIVES: To analyze the clinical characteristics of 71 patients with coronavirus disease 2019 (COVID-19). METHODS: The general data, epidemiological data, laboratory tests, imaging examinations, and treatment of 71 patients with COVID-19 admitted to the Sixth People's Hospital of Zhengzhou from January 19, 2020 to March 3, 2020 were retrospectively analyzed. RESULTS: Of the 71 COVID-19 patients, the ages were 4-84 (41.29±15.21) years, 38 (53.5%) patients were male, 33 (46.5%) were female, and 52 (73.2%) were in 22 clusters. The main clinical manifestations were fever (78.9%), cough (64.8%), and sputum (38.0%). The fever was mainly low and moderate, with 49 patients (69.0%) at 37.3-39.0 ℃. Most of the leukocytes, neutrophils, and lymphocytes were normal, accounting for 47 (66.2%), 51 (71.8%), and 51 (71.8%) patients, respectively; a few of them were decreased, accounting for 21 (29.6%), 16 (22.5%), and 20 (28.2%) patients, respectively. There were 38 (53.5%) and 31 (43.7%) patients with the decreased CD4+ and CD8+ T cell counts, respectively. There were 41 (57.7%), 38 (53.5%), 32 (45.1%), 26(36.6%), 22 (31.0%), 20 (28.2%), 14 (19.7%), 14 (19.7%), and 9 (12.7%) patients with the increased levels of C-reactive protein, erythrocyte sedimentation rate, procalcitonin, fibrinogen,interleukin 6, lactate dehydrogenase,D-dimer,alanine aminotransferase, and aspartate aminotransferase, respectively. Of the 71 patients, the lung was involved in 60 (84.5%) patients, the double lung was involved in 47 (66.2%) patients, and the single lung was involved in 13 (18.3%) patients. The course of the disease was long, and the time from symptom onset to the second severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid negative transformation was (17.22±6.34) days.There were no significant differences in the incubation period (t=-0.453, P>0.05), the complicates (χ2=0.042, P>0.05), and the time from symptom onset to diagnosis (t=-1.330, P>0.05) in patients between the non-severe group and the severe group. The onset age, gender, SARS-CoV-2 nucleic acid negative time, lymphocyte count, D-dimer, C-reactive protein, total bilirubin, direct bilirubin, lactate dehydrogenase, calcium ion, CD4+ T cell count, CD8+ T cell count, calcitonin, procalcitonin, and troponin were significantly different between the severe group and the non-severe group (all P<0.05). Among the 71 patients, 4 (5.6%) patients were mild, 59 (83.1%) were normal, and 8 (11.3%) were severe or critical. CONCLUSIONS: The aggregation phenomenon of COVID-19 is obvious. Fever and cough are the main clinical manifestations. White blood cells, neutrophils, and lymphocytes in the most patients in the early onset are normal. Most COVID-19 patients are light and ordinary type, with good prognosis.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Child , Child, Preschool , China , Cough/virology , Female , Fever/virology , Humans , Leukocyte Count , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
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