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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-325222

ABSTRACT

BACKGROUND: Previous study suggested that Chinese Herbal Medicine (CHM) Formula Huashibaidu granule might shorten disease course of Corona Virus Disease 2019 (COVID-19) patients. Our research aims to investigate the early treatment effect of Huashibaidu granule in mild COVID-19 patients under well clinical management.METHODS: An unblended cluster-randomized clinical trial was conducted at the Dongxihu FangCang hospital. 2 cabins were randomly allocated to CHM or control group, with 204 randomly sampled mild COVID-19 patients in each cabin. All participants received a 7-day conventional treatment, and CHM group cabin used additional Huashibaidu granule 10g twice daily. Participants were followed up until they met clinical endpoint. The primary outcome was patient become worsening before clinical endpoint occurred. The secondary outcomes was discharge with cure before clinical endpoint occurred and relief of composite symptoms after 7 days treatment.FINDINGS: All 408 participants were followed up to meet clinical endpoint and included in statistical analysis. The baseline characteristics were comparable between 2 groups. The number of worsening patients in the CHM group was 5 (2.5%), and that in the control group was 16 (7.8%). There was a significant difference between groups (P=0.014). 8 foreseeable mild adverse events occurred without statistical difference between groups.INTERPRETATION: 7-day early treatment with Huashibaidu granule reduced worsening conversion of mild COVID-19 patients. Our study supports Huashibaidu Granule as an active option for early treatment of mild COVID-19 in similar medical locations with well management.TRIAL REGISTRATION: The Chinese Clinical Trial Registry: ChiCTR2000029763.FUNDING: This study was supported by “National Key R&D Program of China” (No.2020YFC0841500).DECLARATION OF INTERESTS: The authors guaranteed that there existed no competing interest in this paper.ETHICS APPROVAL STATEMENT: Ethics Review Committee of Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences Approval of Ethical Review Acceptance Number: S2020-001;Approval Number: P20001/PJ01.

2.
J Evid Based Med ; 14(4): 313-332, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1462829

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) has turned into a pandemic and resulted in huge death tolls and burdens. Integrating Chinese and western medicine has played an important role in the fight against the COVID-19 pandemic. PURPOSE: We aimed to develop a living evidence-based guideline of integrating Chinese and western medicine for COVID-19. STUDY DESIGN: Living evidence-based guideline. METHODS: This living guideline was developed using internationally recognized and accepted guideline standards, dynamically monitoring the release of new clinical evidence, and quickly updating the linked living systematic review, evidence summary tables, and recommendations. Modified Delphi method was used to reach consensus for all recommendations. The certainty of the evidence, resources, and other factors were fully considered, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of evidence and the strength of recommendations. RESULTS: The first version of this living guidance focuses on patients who are mild or moderate COVID-19. A multidisciplinary guideline development panel was established. Ten clinical questions were identified based on the status of evidence and a face-to-face experts' consensus. Finally, nine recommendations were reached consensus, and were formulated from systematic reviews of the benefits and harms, certainty of evidence, public accessibility, policy supports, feedback on proposed recommendations from multidisciplinary experts, and consensus meetings. CONCLUSION: This guideline panel made nine recommendations, which covered five traditional Chinese medicine (TCM) prescription granules/decoction (MXXFJD, QFPD, XFBD, TJQW, and JWDY), three Chinese patent medicines (LHQW granules/capsule, JHQG granules, and LHQK granules), and one Chinese herbal injection (XBJ injection). Of them, two were strongly recommended (LHQW granules/capsule and QFPD decoction), and five were weakly recommended (MXXFJD decoction, XFBD decoction, JHQG granules, TJQW granules, and JWDY decoction) for the treatment of mild and moderate COVID-19; two were weakly recommended against (XBJ injection and LHQK granules) the treatment of mild and moderate COVID-19. The users of this living guideline are most likely to be clinicians, patients, governments, ministries, and health administrators.


Subject(s)
COVID-19 , Drugs, Chinese Herbal , China , Humans , Medicine, Chinese Traditional , Pandemics , Practice Guidelines as Topic , SARS-CoV-2
3.
Front Med (Lausanne) ; 8: 696976, 2021.
Article in English | MEDLINE | ID: covidwho-1450816

ABSTRACT

Background: Previous research suggested that Chinese Medicine (CM) Formula Huashibaidu granule might shorten the disease course in coronavirus disease 2019 (COVID-19) patients. This research aimed to investigate the early treatment effect of Huashibaidu granule in well-managed patients with mild COVID-19. Methods: An unblinded cluster-randomized clinical trial was conducted at the Dongxihu FangCang hospital. Two cabins were randomly allocated to a CM or control group, with 204 mild COVID-19 participants in each cabin. All participants received conventional treatment over a 7 day period, while the ones in CM group were additionally given Huashibaidu granule 10 g twice daily. Participants were followed up to their clinical endpoint. The primary outcome was worsening symptoms before the clinical endpoint. The secondary outcomes were cure and discharge before the clinical endpoint and alleviation of composite symptoms after the 7 days of treatment. Results: All 408 participants were followed up to their clinical endpoint and included in statistical analysis. Baseline characteristics were comparable between the two groups (P > 0.05). The number of worsening patients in the CM group was 5 (2.5%), and that in the control group was 16 (7.8%) with a significant difference between groups (P = 0.014). Eight foreseeable mild adverse events occurred without statistical difference between groups (P = 0.151). Conclusion: Seven days of early treatment with Huashibaidu granule reduced the likelihood of worsening symptoms in patients with mild COVID-19. Our study supports Huashibaidu granule as an active option for early treatment of mild COVID-19 in similar well-managed medical environments. Clinical Trial Registration:www.chictr.org.cn/showproj.aspx?proj=49408, identifier: ChiCTR2000029763.

4.
Phytomedicine ; 91: 153671, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1313371

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of Hua Shi Bai Du Granule (Q-14) plus standard care compared with standard care alone in adults with coronavirus disease (COVID-19). STUDY DESIGN: A single-center, open-label, randomized controlled trial. SETTING: Wuhan Jinyintan Hospital, Wuhan, China, February 27 to March 27, 2020. PARTICIPANTS: A total of 204 patients with laboratory-confirmed COVID-19 were randomized into the treatment group and control group, consisting of 102 patients in each group. INTERVENTIONS: In the treatment group, Q-14 was administered at 10 g (granules) twice daily for 14 days, plus standard care. In the control group, patients were provided standard care alone for 14 days. MAIN OUTCOME MEASURE: The primary outcome was the conversion time for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral assay. Adverse events were analyzed in the safety population. RESULTS: Among the 204 patients, 195 were analyzed according to the intention-to-treat principle. A total of 149 patients (71 vs. 78 in the treatment and control groups, respectively) tested negative via the SARS-CoV-2 viral assay. There was no statistical significance in the conversion time between the treatment group and control group (Full analysis set: Median [interquartile range]: 10.00 [9.00-11.00] vs. 10.00 [9.00-11.00]; Mean rank: 67.92 vs. 81.44; P = 0.051). The recovery time for fever was shorter in the treatment group than in the control group. The disappearance rate of symptoms like cough, fatigue, and chest discomfort was significantly higher in the treatment group. In chest computed tomography (CT) examinations, the overall evaluation of chest CT examination after treatment compared with baseline showed that more patients improved in the treatment group. There were no significant differences in the other outcomes. CONCLUSION: The combination of Q-14 and standard care for COVID-19 was useful for the improvement of symptoms (such as fever, cough, fatigue, and chest discomfort), but did not result in a significantly higher probability of negative conversion in the SARS-CoV-2 viral assay. No serious adverse events were observed. TRIAL REGISTRATION: ChiCTR2000030288.


Subject(s)
COVID-19 , Drugs, Chinese Herbal/therapeutic use , COVID-19/therapy , China , Female , Humans , Male , Middle Aged , Treatment Outcome
6.
J Microbiol Immunol Infect ; 54(5): 808-815, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1164098

ABSTRACT

BACKGROUND: In COVID-19 patients, information regarding superinfection, antimicrobial assessment, and the value of metagenomic sequencing (MS) could help develop antimicrobial stewardship. METHOD: This retrospective study analyzed 323 laboratory-confirmed COVID-19 patients for co-infection rate and antimicrobial usage in the Shanghai Public Health Clinical Center (SPHCC) from January 23rd to March 14th 2020. The microbiota composition was also investigated in patients with critically severe COVID-19. RESULTS: The total population co-infection rate was 17/323 (5.3%) and 0/229 (0), 4/78 (5.1%), and 13/16 (81.3%) for the mild, severe, and critically severe subgroups, respectively. Proven fungal infection was significantly associated with a higher mortality rate (p = 0.029). In critically severe patients, the rate of antimicrobials and carbapenem usage were 16/16 (100%) and 13/16 (81.3%), respectively, in which the preemptive and empiric antimicrobial days accounted for 51.6% and 30.1%, respectively. Targeted therapy only accounted for 18.3%. MS was implemented to detect non-COVID-19 virus co-existence and the semi-quantitative surveillance of bacteremia, with clear clinical benefit seen in cases with MS-based precision antimicrobial management. Airway microbiome analysis suggested that the microbiota compositions in critically severe COVID-19 patients were likely due to intubation and mechanical ventilation. CONCLUSIONS: In the SPHCC cohort, we observed a non-negligible rate of super-infection, especially for the critically ill COVID-19 patients. Fungal co-infection requires intensive attention due to the high risk of mortality, and the clinical benefit of MS in guiding antimicrobial management warrants further investigation.


Subject(s)
Anti-Bacterial Agents/therapeutic use , COVID-19 , Metagenomics , Microbiota/physiology , Respiratory System/microbiology , Superinfection/drug therapy , Adult , Aged , Aged, 80 and over , Antimicrobial Stewardship , China , Cohort Studies , Coinfection/drug therapy , Critical Illness , Female , High-Throughput Nucleotide Sequencing , Humans , Male , Microbiota/genetics , Middle Aged , Mycoses/drug therapy , Retrospective Studies , SARS-CoV-2
7.
SciFinder; 2020.
Preprint | SciFinder | ID: ppcovidwho-4354

ABSTRACT

The present study relates to anal. of medical cases of corona virus disease 2019 treated with traditional Chinese medicine Haoqin Qingdan decoction. Corona virus disease-2019 (COVID-19), which broke out in Wuhan, is highly contagious, and belongs to the category of "damp toxin epidemic" in traditional Chinese medicine. In this study, Haoqin Qingdan decoction was used to clear dampness and heat, reconcile Shaoyang channel and reach Sanjiao channel, detoxify the dampness fever epidemic toxin, and block the toxin inside, with a good efficacy. This prescription focuses on smoothing the Shaoyang gallbladder channel and Sanjiao channel, and regards the spleen and stomach as the acquired essence. In the prescription, Erchen decoction reconciles the spleen and stomach, elevates clear qi and lower turbid qi;Radix Bupleuri is added to increase its detoxification function;and Radix Paeoniae Rubra is added to circulate the blood and prevent pathogen from the blood. When the condition improves, Sweet Wormwood Herb and talc are often withdrawn, and Codonopsis is added to nourish the spleen and stomach, to strengthen the healthy qi and eliminate evil. Based on the cases of COVID-19 treated in Wuhan Jinyintan Hospital, this paper summarized some experience of applying Haoqin Qingdan decoction.

8.
Environ Pollut ; 271: 116298, 2021 Feb 15.
Article in English | MEDLINE | ID: covidwho-987653

ABSTRACT

To control the spread of the 2019 novel coronavirus (COVID-19), China imposed rigorous restrictions, which resulted in great reductions in pollutant emissions. This study examines the characteristics of air pollutants, including PM2.5 (particles with aerodynamic diameters < 2.5 µm), gas pollutants, water-soluble ions (WSIs), black carbon (BC) and elements, as well as the source apportionment of PM2.5 in Suzhou before, during and after the Chinese New Year (CNY) holiday of 2020 (when China was under an unprecedented state of lockdown to restrict the COVID-19 outbreak). Compared to those before CNY, PM2.5, BC, SNA (sulfate, nitrate and ammonium), other ions, elements, and NO2 and CO mass concentrations decreased by 9.9%-64.0% during CNY. The lockdown policy had strong (weak) effects on the diurnal variations in aerosol chemical compositions (gas pollutants). Compared to those before CNY, source concentrations and contributions of vehicle exhaust during CNY decreased by 72.9% and 21.7%, respectively. In contrast, increased contributions from coal combustion and industry were observed during CNY, which were recorded to be 2.9 and 1.7 times higher than those before CNY, respectively. This study highlights that the lockdown policy that was imposed in Suzhou during CNY not only reduced the mass concentrations of air pollutants but also modified their diurnal variations and the source contributions of PM2.5, which revealed the complex responses of PM2.5 sources to the rare, low emissions of anthropogenic pollutants that occurred during the COVID-19 lockdown.


Subject(s)
Air Pollutants , COVID-19 , Aerosols/analysis , Air Pollutants/analysis , China , Communicable Disease Control , Environmental Monitoring , Humans , Particulate Matter/analysis , SARS-CoV-2 , Vehicle Emissions/analysis
9.
Biosci Trends ; 14(6): 408-414, 2021 Jan 23.
Article in English | MEDLINE | ID: covidwho-979798

ABSTRACT

The aim of this study is to assess the efficacy of multiple treatments, especially hydroxychloroquine, used in different disease stages of coronavirus disease 2019 (COVID-19). All consecutive patients with COVID-19 admitted to Shanghai Public Health Clinical Center (Shanghai, China) between January 20, 2020, and April 30, 2020, were enrolled, and their clinical data were retrospectively collected. Binary logistic regression was used to screen the factors associated with disease aggravation, and multivariable analyses with the Cox proportional hazards model were used to estimate the effects of prognostic factors on the improvement time and PCR conversion days in throat swabs and stool swabs. A total of 616 patients, including 50 (8.11%) severe and 18 (2.92%) critical patients, were enrolled in our retrospective cohort study. The early use of hydroxychloroquine was a protective factor associated with disease aggravation (95% CI: 0.040-0.575, p = 0.006). Clinical improvement by 20 days was significantly different between patients with hydroxychloroquine used early and those with hydroxychloroquine not used (p = 0.016, 95% CI: 1.052-1.647). The median time to clinical improvement was 6 days in the hydroxychloroquine used early group, compared with 9 days in the without hydroxychloroquine used group and 8 days in the with hydroxychloroquine not used early group (p < 0.001). Hydroxychloroquine used early was associated with earlier PCR conversion in both throat swabs (HR = 1.558, p = 0.001) and stool swabs (HR = 1.400, p = 0.028). The use of hydroxychloroquine at an early stage is a potential therapeutic strategy for treating patients before irreversible severe respiratory complications occur. The early use of hydroxychloroquine decreased the improvement time and the duration of COVID-19 detection in throat and stool swabs.


Subject(s)
Antimalarials/administration & dosage , COVID-19/drug therapy , Hydroxychloroquine/administration & dosage , Adult , Aged , China , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
10.
Phytomedicine ; 81: 153367, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-837550

ABSTRACT

BACKGROUND: Treatments for coronavirus disease 2019 (COVID-19) are limited by suboptimal efficacy. METHODS: From January 30, 2020 to March 23, 2020, we conducted a non-randomised controlled trial, in which all adult patients with laboratory-confirmed COVID-19 were assigned to three groups non-randomly and given supportive treatments: Group A, Lopinavir-Ritonavir; Group B, Huashi Baidu Formula (a Chinese medicineformula made by the China Academy of Chinese Medical Sciences to treat COVID-19, which is now in the clinical trial period) and Lopinavir-Ritonavir; and Group C, Huashi Baidu Formula. The use of antibiotics, antiviruses, and corticosteroids was permitted in Group A and B. Traditional Chinese medicine injections were permitted in Group C. The primary outcomes were clinical remission time (interval from admission to the first time the patient tested negatively for novel coronavirus or an obvious improvement was observed from chest CT) and clinical remission rate (number of patients whose clinical time was within 16 days/total number of patients). RESULTS: A total of 60 adult patients with COVID-19 were enrolled at sites in Wuhan, China, and the sample size of each group was 20. In Groups A, B and C, the clinical remission rates were 95.0%%(19/20), 100.0%%(20/20) and 100.0%%(20/20), respectively. Compared with Groups A and B, the clinical remission time of Group C was significantly shorter (5.9 days vs. 10.8 days, p < 0.05; 5.9 days vs. 9.7 days, p < 0.05). There was no significant difference among Groups A, B, and C in terms of the time taken to be released from quarantine. The clinical biochemical indicators and safety indexes showed no significant differences among the three groups. CONCLUSIONS: Our findings suggest that Lopinavir-Ritonavir has some efficacy in the treatment of COVID-19, and the Huashi Baidu Formula might enhance this effect to an extent. In addition, superiority was displayed in the treatment of COVID-19 through a combination of the Huashi Baidu Formula and traditional Chinese medicine injection. In future, well-designed prospective double-blinded randomised control trials are required to confirm our findings.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drugs, Chinese Herbal/therapeutic use , Lopinavir/therapeutic use , Ritonavir/therapeutic use , Adult , Aged , Aged, 80 and over , Antiviral Agents/adverse effects , COVID-19/diagnostic imaging , Drug Combinations , Drug Therapy, Combination , Drugs, Chinese Herbal/adverse effects , Female , Humans , Lopinavir/adverse effects , Male , Medicine, Chinese Traditional , Middle Aged , Patient Safety , Prospective Studies , Ritonavir/adverse effects , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome
11.
SSRN; 2020.
Preprint | SSRN | ID: ppcovidwho-740

ABSTRACT

Importance: An ongoing outbreak of COVID-19 has exhibited significant threats around the world. We found a significant decrease of T lymphocyte subsets and an i

12.
J Environ Sci (China) ; 102: 110-122, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-779238

ABSTRACT

To control the spread of COVID-19, rigorous restrictions have been implemented in China, resulting in a great reduction in pollutant emissions. In this study, we evaluated the air quality in the Yangtze River Delta during the COVID-19 lockdown period using satellite and ground-based data, including particle matter (PM), trace gases, water-soluble ions (WSIs) and black carbon (BC). We found that the impacts of lockdown policy on air quality cannot be accurately assessed using MODIS aerosol optical depth (AOD) data, whereas the tropospheric nitrogen dioxide (NO2) vertical column density can well reflect the influences of these restrictions on human activities. Compared to the pre-COVID period, the PM2.5, PM10, NO2, carbon monoxide (CO), BC and WSIs during the lockdown in Suzhou were observed to decrease by 37.2%, 38.3%, 64.5%, 26.1%, 53.3% and 58.6%, respectively, while the sulfur dioxide (SO2) and ozone (O3) increased by 1.5% and 104.7%. The WSIs ranked in the order of NO3- > NH4+ > SO42- > Cl- > Ca2+ > K+ > Mg2+ > Na+ during the lockdown period. By comparisons with the ion concentrations during the pre-COVID period, we found that the ions NO3-, NH4+, SO42-, Cl-, Ca2+, K+ and Na+ decreased by 66.3%, 48.8%, 52.9%, 56.9%, 57.9% and 76.3%, respectively, during the lockdown, in contrast to Mg2+, which increased by 30.2%. The lockdown policy was found to have great impacts on the diurnal variations of Cl-, SO42-, Na+ and Ca2+.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Aerosols/analysis , Air Pollutants/analysis , Air Pollution/analysis , China , Communicable Disease Control , Environmental Monitoring , Humans , Particulate Matter/analysis , Rivers , SARS-CoV-2
13.
World Dev ; 137: 105128, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-696276

ABSTRACT

The COVID-19 pandemic created a critical need for citizen volunteers working with government to protect public health and to augment overwhelmed public services. Our research examines the crucial role of community volunteers and their effective deployment during a crisis. We analyze individual and collaborative service activities based on usage data from 85,699 COVID-19 volunteers gathered through China's leading digital volunteering platform, as well as a survey conducted among a sample of 2,270 of these COVID-19 volunteers using the platform and interviews with 14 civil society leaders in charge of coordinating service activities. Several results emerge: the value of collaboration among local citizens, civil society including community-based groups, and regional government to fill gaps in public services; the key role of experienced local volunteers, who rapidly shifted to COVID-19 from other causes as the pandemic peaked; and an example of state-led coproduction based on long-term relationships. Our analysis provides insight into the role of volunteerism and coproduction in China's response to the pandemic, laying groundwork for future research. The findings can help support the response to COVID-19 and future crises by more effectively leveraging human capital and technology in community service delivery.

14.
J Infect ; 81(1): e51-e60, 2020 07.
Article in English | MEDLINE | ID: covidwho-71722

ABSTRACT

IMPORTANCE: An ongoing outbreak of COVID-19 has exhibited significant threats around the world. We found a significant decrease of T lymphocyte subsets and an increase of inflammatory cytokines of hospitalized patients with COVID-19 in clinical practice. METHODS: We conducted a retrospective, single-center observational study of in-hospital adult patients with confirmed COVID-19 in Hubei Provincial Hospital of traditional Chinese and Western medicine (Wuhan, China) by Mar 1, 2020. Demographic, clinical, laboratory information, especially T lymphocyte subsets and inflammatory cytokines were reported. For patients who died or discharge from hospital, the associations of T lymphocyte subsets on admission were evaluated by univariate logistic regression with odds ratios (ORs) and 95% confidence intervals (CIs), warning values to predict in-hospital death were assessed by Receiver Operator Characteristic (ROC) curves. RESULTS: A total of 187 patients were enrolled in our study from Dec 26, 2019 to Mar 1, 2020, of whom 145 were survivors (discharge = 117) or non-survivors (in-hospital death ==28). All patients exhibited a significant drop of T lymphocyte subsets counts with remarkably increasing concentrations of SAA, CRP, IL-6, and IL-10 compared to normal values. The median concentrations of SAA and CRP in critically-ill patients were nearly 4- and 10-fold than those of mild-ill patients, respectively. As the severity of COVID-19 getting worse, the counts of T lymphocyte drop lower.28 patients died in hospital, the median lymphocyte, CD3+ T-cell, CD4+ T-cell, CD8+ T-cell and B-cell were significantly lower than other patients. Lower counts (/uL) of T lymphocyte subsets lymphocyte (<500), CD3+T-cell (<200), CD4+ T-cell (<100), CD8+ T-cell (<100) and B-cell (<50) were associated with higher risks of in-hospital death of CIVID-19. The warning values to predict in-hospital death of lymphocyte, CD3+ T-cell, CD4+ T-cell, CD8+ T-cell, and B-cell were 559, 235, 104, 85 and 82, respectively. CONCLUSION: We find a significant decrease of T lymphocyte subset is positively correlated with in-hospital death and severity of illness. The decreased levels of T lymphocyte subsets reported in our study were similar with SARS but not common among other virus infection, which may be possible biomarkers for early diagnosis of COVID-19. Our findings may shed light on early warning of high risks of mortality and help early intervention and treatment of COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Immunity, Cellular , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , Adult , Aged , COVID-19 , China/epidemiology , Female , Humans , Lymphocyte Count , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , T-Lymphocyte Subsets
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