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1.
Chinesische Med. ; 3(35): 143-150, 20200901.
Article in German | ELSEVIER | ID: covidwho-763360

ABSTRACT

The article looks at Covid-19 from the perspective of classical Chinese Medicine. On the strength of their clinical experience with the illness, the authors assign it to the category of epidemic febrile diseases characterised by dampness (humor) (shiwen 濕瘟) within the group of “warm diseases” (wenbing). They explain the nomenclature used in the classical medical works for epidemic diseases and describe the mechanisms of the disease in which dampness (humor, shi) plays a prominent role. Describing the symptoms occurring in the four different stages of the disease, they explain the pathogenesis of each stage.

2.
Chinesische Med. ; 3(35): 143-150, 20200901.
Article in German | ELSEVIER | ID: covidwho-746452

ABSTRACT

The article looks at Covid-19 from the perspective of classical Chinese Medicine. On the strength of their clinical experience with the illness, the authors assign it to the category of epidemic febrile diseases characterised by dampness (humor) (shiwen 濕瘟) within the group of “warm diseases” (wenbing). They explain the nomenclature used in the classical medical works for epidemic diseases and describe the mechanisms of the disease in which dampness (humor, shi) plays a prominent role. Describing the symptoms occurring in the four different stages of the disease, they explain the pathogenesis of each stage.

4.
Am J Respir Crit Care Med ; 201(11): 1380-1388, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-436947

ABSTRACT

Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern.Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China.Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China.Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients >75 years old had a significantly lower survival rate than younger patients.Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (≥75 yr) was a risk factor for mortality.


Subject(s)
Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Adult , Age Factors , Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Betacoronavirus , China/epidemiology , Comorbidity , Coronavirus Infections/mortality , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Lung/pathology , Male , Middle Aged , Multiple Organ Failure/virology , Pandemics , Pleural Effusion/virology , Pneumonia, Viral/mortality , Tomography, X-Ray Computed
5.
Brain Behav Immun ; 88: 17-27, 2020 08.
Article in English | MEDLINE | ID: covidwho-270288

ABSTRACT

Since the end of 2019, Corona Virus Disease 2019 (COVID-19) has been the cause of a worldwide pandemic. The mental status of patients with COVID-19 who have been quarantined and the interactions between their psychological distress and physiological levels of inflammation have yet to be analyzed. Using a mixed-method triangulation design (QUAN + QUAL), this study investigated and compared the mental status and inflammatory markers of 103 patients who, while hospitalized with mild symptoms, tested positive with COVID-19 and 103 matched controls that were COVID-19 negative. The severity of depression, anxiety, and post-traumatic stress symptoms (PTSS) was measured via an on-line survey. Using a convenience sampling technique, qualitative data were collected until the point of data saturation. In addition, a semi-structured interview was conducted among five patients with COVID-19. Peripheral inflammatory markers were also collected in patients, both at baseline and within ± three days of completing the on-line survey. Results revealed that COVID-19 patients, when compared to non-COVID controls, manifested higher levels of depression (P < 0.001), anxiety (P < 0.001), and post-traumatic stress symptoms (P < 0.001). A gender effect was observed in the score of "Perceived Helplessness", the subscale of PSS-10, with female patients showing higher scores compared to male patients (Z = 2.56, P = 0.010), female (Z = 2.37, P = 0.018) and male controls (Z = 2.87, P = 0.004). Levels of CRP, a peripheral inflammatory indicator, correlated positively with the PHQ-9 total score (R = 0.37, P = 0.003, Spearman's correlation) of patients who presented symptoms of depression. Moreover, the change of CRP level from baseline inversely correlated with the PHQ-9 total score (R = -0.31, P = 0.002), indicative of improvement of depression symptoms. Qualitative analysis revealed similar results with respect to patient reports of negative feelings, including fear, guilt, and helplessness. Stigma and uncertainty of viral disease progression were two main concerns expressed by COVID-19 patients. Our results indicate that significant psychological distress was experienced by hospitalized COVID-19 patients and that levels of depressive features may be related to the inflammation markers in these patients. Thus, we recommend that necessary measures should be provided to address depression and other psychiatric symptoms for COVID-19 patients and attention should be paid to patient perceived stigma and coping strategies when delivering psychological interventions.


Subject(s)
Anxiety/psychology , C-Reactive Protein/immunology , Coronavirus Infections/psychology , Depression/psychology , Inflammation/immunology , Pneumonia, Viral/psychology , Psychological Distress , Quarantine/psychology , Stress, Psychological/psychology , Adult , Aged , Anxiety/immunology , Betacoronavirus , Blood Sedimentation , Case-Control Studies , Coronavirus Infections/immunology , Cross-Sectional Studies , Depression/immunology , Female , Hospitalization , Humans , Leukocyte Count , Male , Middle Aged , Pandemics , Patient Health Questionnaire , Pneumonia, Viral/immunology , Procalcitonin/immunology , Sex Factors , Stress Disorders, Post-Traumatic/immunology , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/immunology
6.
ASAIO J ; 66(5): 475-481, 2020 05.
Article in English | MEDLINE | ID: covidwho-142784

ABSTRACT

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , China , Female , Humans , Male , Middle Aged , Pandemics , Respiration, Artificial , Retrospective Studies , Treatment Outcome
7.
ASAIO J ; 66(5): 475-481, 2020 05.
Article in English | MEDLINE | ID: covidwho-115779

ABSTRACT

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Adult , Aged , Aged, 80 and over , China , Female , Humans , Male , Middle Aged , Pandemics , Respiration, Artificial , Retrospective Studies , Treatment Outcome
8.
Aging (Albany NY) ; 12(7): 6037-6048, 2020 04 10.
Article in English | MEDLINE | ID: covidwho-45873

ABSTRACT

OBJECTIVE: This study aimed to investigate the potential parameters associated with imaging progression on chest CT from coronavirus disease 19 (COVID-19) patients. RESULTS: The average age of 273 COVID-19 patients enrolled with imaging progression were older than those without imaging progression (p = 0.006). The white blood cells, platelets, neutrophils and acid glycoprotein were all decreased in imaging progression patients (all p < 0.05), and monocytes were increased (p = 0.025). The parameters including homocysteine, urea, creatinine and serum cystatin C were significantly higher in imaging progression patients (all p < 0.05), while eGFR decreased (p < 0.001). Monocyte-lymphocyte ratio (MLR) was significantly higher in imaging progression patients compared to that in imaging progression-free ones (p < 0.001). Logistic models revealed that age, MLR, homocysteine and period from onset to admission were factors for predicting imaging progression on chest CT at first week from COVID-19 patients (all p < 0.05). CONCLUSION: Age, MLR, homocysteine and period from onset to admission could predict imaging progression on chest CT from COVID-19 patients. METHODS: The primary outcome was imaging progression on chest CT. Baseline parameters were collected at the first day of admission. Imaging manifestations on chest CT were followed-up at (6±1) days.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Coronavirus Infections/virology , Disease Progression , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Thorax/diagnostic imaging , Thorax/virology , Tomography, X-Ray Computed
9.
Am J Respir Crit Care Med ; 201(11): 1380-1388, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-47397

ABSTRACT

Rationale: The coronavirus disease (COVID-19) pandemic is now a global health concern.Objectives: We compared the clinical characteristics, laboratory examinations, computed tomography images, and treatments of patients with COVID-19 from three different cities in China.Methods: A total of 476 patients were recruited from January 1, 2020, to February 15, 2020, at three hospitals in Wuhan, Shanghai, and Anhui. The patients were divided into four groups according to age and into three groups (moderate, severe, and critical) according to the fifth edition of the Guidelines on the Diagnosis and Treatment of COVID-19 issued by the National Health Commission of China.Measurements and Main Results: The incidence of comorbidities was higher in the severe (46.3%) and critical (67.1%) groups than in the moderate group (37.8%). More patients were taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in the moderate group than in the severe and critical groups. More patients had multiple lung lobe involvement and pleural effusion in the critical group than in the moderate group. More patients received antiviral agents within the first 4 days in the moderate group than in the severe group, and more patients received antibiotics and corticosteroids in the critical and severe groups. Patients >75 years old had a significantly lower survival rate than younger patients.Conclusions: Multiple organ dysfunction and impaired immune function were the typical characteristics of patients with severe or critical illness. There was a significant difference in the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers among patients with different severities of disease. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (≥75 yr) was a risk factor for mortality.


Subject(s)
Coronavirus Infections/physiopathology , Pneumonia, Viral/physiopathology , Adult , Age Factors , Aged , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Betacoronavirus , China/epidemiology , Comorbidity , Coronavirus Infections/mortality , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Lung/pathology , Male , Middle Aged , Multiple Organ Failure/virology , Pandemics , Pleural Effusion/virology , Pneumonia, Viral/mortality , Tomography, X-Ray Computed
10.
Biosci Trends ; 14(1): 64-68, 2020 Mar 16.
Article in English | MEDLINE | ID: covidwho-8517

ABSTRACT

Pneumonia associated with the 2019 novel coronavirus (2019-nCoV) is continuously and rapidly circulating at present. No effective antiviral treatment has been verified thus far. We report here the clinical characteristics and therapeutic procedure for four patients with mild or severe 2019-nCoV pneumonia admitted to Shanghai Public Health Clinical Center. All the patients were given antiviral treatment including lopinavir/ritonavir (Kaletra®), arbidol, and Shufeng Jiedu Capsule (SFJDC, a traditional Chinese medicine) and other necessary support care. After treatment, three patients gained significant improvement in pneumonia associated symptoms, two of whom were confirmed 2019-nCoV negative and discharged, and one of whom was virus negative at the first test. The remaining patient with severe pneumonia had shown signs of improvement by the cutoff date for data collection. Results obtained in the current study may provide clues for treatment of 2019-nCoV pneumonia. The efficacy of antiviral treatment including lopinavir/ritonavir, arbidol, and SFJDC warrants further verification in future study.


Subject(s)
Antiviral Agents/therapeutic use , Betacoronavirus , Coronavirus Infections/drug therapy , Drugs, Chinese Herbal/therapeutic use , Indoles/therapeutic use , Lopinavir/therapeutic use , Pneumonia, Viral/drug therapy , Ritonavir/therapeutic use , Adult , China , Drug Combinations , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
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