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1.
Frontiers in Microbiology ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2043499

ABSTRACT

Although the FDA has given emergency use authorization (EUA) for some antiviral drugs for the treatment of COVID-19, no direct antiviral drugs have been identified for the treatment of critically ill patients, the most important treatment is suppression of the hyperinflammation. The purpose of this study was to evaluate the role of corticosteroids in hospitalized severe or critical patients positive for COVID-19. This is a retrospective single-center descriptive study. Patients classified as having severe or critical COVID-19 infections with acute respiratory dysfunction syndrome in Shenzhen Third People’s Hospital were enrolled from January 11th to March 30th, 2020. Ninety patients were classified as having severe or critical COVID-19 infections. The patients were treated with methylprednisolone with a low-to-moderate dosage and short duration. The days from the symptom onset to methylprednisolone were about 8 days. Eighteen patients were treated with invasive ventilation and intensive care unit (ICU) care. All the patients in the severe group and ten in the critical group recovered and were discharged. Three critical cases with invasive ventilation died. Although cases were much more severe in the corticosteroid-treated group, the mortality was not significantly increased. Early use of low-to-moderate dosage and short duration of corticosteroid may be the more accurate immune-modulatory treatment and brings more benefits to severe patients with COVID-19.

2.
Smart Biomedical and Physiological Sensor Technology Xix ; 12123, 2022.
Article in English | Web of Science | ID: covidwho-2005290

ABSTRACT

Rapid, simple, inexpensive, and sensitive self-testing for SARS-CoV-2 is expected to be an important element of controlling the ongoing COVID pandemic. We report a novel approach in which saliva is mixed at room temperature with a Designer DNA Nanostructure (DDN) engineered to create a net-like structure that positions an array of highly specific nucleic acid aptamer-quencher locks at the locations of the trimeric spike proteins. When the spike proteins selectively unlock aptamers on the DDN, fluorescent reporter molecules are unquenched, generating an intense and easily measured optical signal. The fluorescence intensity, proportional to the virus concentration, is detected by a battery-powered palmsized fluorimeter, whose functions are managed wirelessly with a Bluetooth-linked smartphone. Because the single-step, room temperature, test is performed in a conventional 0.2 mL PCR tube that is inserted into the fluorimeter, which resembles an Apple AirPodsT headphone case, we call the technology (DDN+fluorimeter+App) a "V-Pod." We show that DDNs are highly specific only for detection of SARS-CoV-2 in both its initial form as well as common variants. The approach achieves a detection limit of 10,000 genome copies/mL, consistent with laboratory-based PCR, while requiring only one reagent and a 5-10 minute incubation time with saliva. Because DDNs are inexpensively synthesized, structurally stable nucleic acid constructs, and the V-Pod instrument is comprised of inexpensive electronic and photonic components, the approach offers potential for rapid self-monitoring of viral infection with integrated capability for contact tracing and interaction with health services.

3.
Radiology: Artificial Intelligence ; 4(4), 2022.
Article in English | EMBASE | ID: covidwho-1968372

ABSTRACT

Purpose: To conduct a prospective observational study across 12 U.S. hospitals to evaluate real-time performance of an interpretable artificial intelligence (AI) model to detect COVID-19 on chest radiographs. Materials and Methods: A total of 95 363 chest radiographs were included in model training, external validation, and real-time validation. The model was deployed as a clinical decision support system, and performance was prospectively evaluated. There were 5335 total real-time predictions and a COVID-19 prevalence of 4.8% (258 of 5335). Model performance was assessed with use of receiver operating characteristic analysis, precision-recall curves, and F1 score. Logistic regression was used to evaluate the association of race and sex with AI model diagnostic accuracy. To compare model accuracy with the performance of board-certified radiologists, a third dataset of 1638 images was read independently by two radiologists. Results: Participants positive for COVID-19 had higher COVID-19 diagnostic scores than participants negative for COVID-19 (me-dian, 0.1 [IQR, 0.0–0.8] vs 0.0 [IQR, 0.0–0.1], respectively;P, .001). Real-time model performance was unchanged over 19 weeks of implementation (area under the receiver operating characteristic curve, 0.70;95% CI: 0.66, 0.73). Model sensitivity was higher in men than women (P = .01), whereas model specificity was higher in women (P = .001). Sensitivity was higher for Asian (P = .002) and Black (P = .046) participants compared with White participants. The COVID-19 AI diagnostic system had worse accuracy (63.5% correct) compared with radiologist predictions (radiologist 1 = 67.8% correct, radiologist 2 = 68.6% correct;McNemar P, .001 for both). Conclusion: AI-based tools have not yet reached full diagnostic potential for COVID-19 and underperform compared with radiologist prediction.

4.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-333745

ABSTRACT

The potential emergence of SARS-CoV-2 Spike (S) escape mutants is a threat to reduce the efficacy of existing vaccines and neutralizing antibody (nAb) therapies. An understanding of the antibody/S escape mutations landscape is urgently needed to preemptively address this threat. Here we describe a rapid method to identify escape mutants for nAbs targeting the S receptor binding site. We identified escape mutants for five nAbs, including three from the public germline class VH3-53 elicited by natural COVID-19 infection. Escape mutations predominantly mapped to the periphery of the ACE2 recognition site on the RBD with K417, D420, Y421, F486, and Q493 as notable hotspots. We provide libraries, methods, and software as an openly available community resource to accelerate new therapeutic strategies against SARS-CoV-2. ONE SENTENCE SUMMARY: We present a facile method to identify antibody escape mutants on SARS-CoV-2 S RBD.

5.
Non-conventional in English | National Technical Information Service, Grey literature | ID: grc-753724

ABSTRACT

The recurrent zoonotic spillover of coronaviruses (CoVs) into the human population underscores the need for broadly active countermeasures. We employed a directed evolution approach to engineer three SARS-CoV-2 antibodies for enhanced neutralization breadth and potency. One of the affinity-matured variants, ADG-2, displays strong binding activity to a large panel of sarbecovirus receptor binding domains (RBDs) and neutralizes representative epidemic sarbecoviruses with high potency. Structural and biochemical studies demonstrate that ADG-2 employs a distinct angle of approach to recognize a highly conserved epitope overlapping the receptor binding site. In immunocompetent mouse models of SARS and COVID-19, prophylactic administration of ADG-2 provided complete protection against respiratory burden, viral replication in the lungs, and lung pathology. Altogether, ADG-2 represents a promising broad-spectrum therapeutic candidate against clade 1 sarbecoviruses.

6.
6th International Conference on Electromechanical Control Technology and Transportation, ICECTT 2021 ; 12081, 2022.
Article in English | Scopus | ID: covidwho-1731248

ABSTRACT

With the promotion of electrification of transportation, fuel cell electric vehicles (FCEVs) begin to flourish in recent years. FCEVs operate with zero emission and excellent fuel economy, but high cost and incomplete infrastructure hinder the popularization further. Targeting resources are poured into this area by some governments worldwide. To foster the development, it is essential to study the use of FCEVs. Based on the Service and Management center for EVs (SMC-EV), this work conducts a statistical analysis of the market scales, the operation conditions, such as user login statistics, driving distance and refueling behavior and the impact of the occurrence of the Covid-19 pandemic. The analysis results provide essential support to predict the subsequent development of FCEVs and guide the policymaking and the construction of hydrogen refueling stations. © 2022 SPIE. All rights reserved.

7.
PubMed; 2022.
Preprint in English | PubMed | ID: ppcovidwho-329416

ABSTRACT

The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has high transmissibility and recently swept the globe. Due to the extensive number of mutations, this variant has high level of immune evasion, which drastically reduced the efficacy of existing antibodies and vaccines. Thus, it is important to test an Omicron-specific vaccine, evaluate its immune response against Omicron and other variants, and compare its immunogenicity as boosters with existing vaccine designed against the reference wildtype virus (WT). Here, we generated an Omicron-specific lipid nanoparticle (LNP) mRNA vaccine candidate, and tested its activity in animals, both alone and as a heterologous booster to existing WT mRNA vaccine. Our Omicron-specific LNP-mRNA vaccine elicited strong and specific antibody response in vaccination-naive mice. Mice that received two-dose WT LNP-mRNA, the one mimicking the commonly used Pfizer/Moderna mRNA vaccine, showed a >40-fold reduction in neutralization potency against Omicron variant than that against WT two weeks post second dose, which further reduced to background level >3 months post second dose. As a booster shot for two-dose WT mRNA vaccinated mice, a single dose of either a homologous booster with WT LNP-mRNA or a heterologous booster with Omicron LNP-mRNA restored the waning antibody response against Omicron, with over 40-fold increase at two weeks post injection as compared to right before booster. Interestingly, the heterologous Omicron LNP-mRNA booster elicited neutralizing titers 10-20 fold higher than the homologous WT booster against the Omicron variant, with comparable titers against the Delta variant. All three types of vaccination, including Omicron mRNA alone, WT mRNA homologous booster, and Omicron heterologous booster, elicited broad binding antibody responses against SARS-CoV-2 WA-1, Beta, and Delta variants, as well as other Betacoronavirus species such as SARS-CoV, but not Middle East respiratory syndrome coronavirus (MERS-CoV). These data provided direct proof-of-concept assessments of an Omicron-specific mRNA vaccination in vivo, both alone and as a heterologous booster to the existing widely-used WT mRNA vaccine form.

8.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326943

ABSTRACT

COVID-19 pathogen SARS-CoV-2 has infected hundreds of millions and caused over 5 million deaths to date. Although multiple vaccines are available, breakthrough infections occur especially by emerging variants. Effective therapeutic options such as monoclonal antibodies (mAbs) are still critical. Here, we report the development, cryo-EM structures, and functional analyses of mAbs that potently neutralize SARS-CoV-2 variants of concern. By high-throughput single cell sequencing of B cells from spike receptor binding domain (RBD) immunized animals, we identified two highly potent SARS-CoV-2 neutralizing mAb clones that have single-digit nanomolar affinity and low-picomolar avidity, and generated a bispecific antibody. Lead antibodies showed strong inhibitory activity against historical SARS-CoV-2 and several emerging variants of concern. We solved several cryo-EM structures at ~3 Å resolution of these neutralizing antibodies in complex with prefusion spike trimer ectodomain, and revealed distinct epitopes, binding patterns, and conformations. The lead clones also showed potent efficacy in vivo against authentic SARS-CoV-2 in both prophylactic and therapeutic settings. We also generated and characterized a humanized antibody to facilitate translation and drug development. The humanized clone also has strong potency against both the original virus and the B.1.617.2 Delta variant. These mAbs expand the repertoire of therapeutics against SARS-CoV-2 and emerging variants.

9.
Embase;
Preprint in English | EMBASE | ID: ppcovidwho-326814

ABSTRACT

The outbreak of SARS-CoV-2 continues to pose a serious threat to human health and social and economic stability. In this study, we established an anti-coronavirus drug screening platform based on the Homogeneous Time Resolved Fluorescence (HTRF) technology and the interaction between the coronavirus S protein and its host receptor ACE2. This platform is a rapid, sensitive, specific, and high throughput system. With this platform, we screened two compound libraries of 2,864 molecules and identified three potential anti-coronavirus compounds: tannic acid (TA), TS-1276 (anthraquinone), and TS-984 (9-Methoxycanthin-6-one). Our in vitro validation experiments indicated that TS-984 strongly inhibits the interaction of the coronavirus S-protein and the human cell ACE2 receptor. This data suggests that TS-984 is a potent blocker of the interaction between the S-protein and ACE2, which might have the potential to be developed into an effective anti-coronavirus drug.

10.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326636

ABSTRACT

Broadly neutralizing antibodies (bnAbs) to coronaviruses (CoVs) are valuable in their own right as prophylactic and therapeutic reagents to treat diverse CoVs and, importantly, as templates for rational pan-CoV vaccine design. We recently described a bnAb, CC40.8, from a coronavirus disease 2019 (COVID-19)-convalescent donor that exhibits broad reactivity with human beta-coronaviruses (beta-CoVs). Here, we showed that CC40.8 targets the conserved S2 stem-helix region of the coronavirus spike fusion machinery. We determined a crystal structure of CC40.8 Fab with a SARS-CoV-2 S2 stem-peptide at 1.6 A resolution and found that the peptide adopted a mainly helical structure. Conserved residues in beta-CoVs interacted with CC40.8 antibody, thereby providing a molecular basis for its broad reactivity. CC40.8 exhibited in vivo protective efficacy against SARS-CoV-2 challenge in two animal models. In both models, CC40.8-treated animals exhibited less weight loss and reduced lung viral titers compared to controls. Furthermore, we noted CC40.8-like bnAbs are relatively rare in human COVID-19 infection and therefore their elicitation may require rational structure-based vaccine design strategies. Overall, our study describes a target on beta-CoV spike proteins for protective antibodies that may facilitate the development of pan-beta-CoV vaccines. SUMMARY: A human mAb isolated from a COVID-19 donor defines a protective cross-neutralizing epitope for pan-beta-CoV vaccine design strategies.

12.
American Journal of Gastroenterology ; 116(SUPPL):S1091, 2021.
Article in English | EMBASE | ID: covidwho-1534814

ABSTRACT

Introduction: It is established that COVID-19 predisposes patients to arterial and venous thrombotic disease,1 though the exact mechanism is unknown. Cases of PE and DVT are well described, while arterial and multi-vessel thromboses are rare.2 We report COVID-19 associated hepatic artery thrombosis (HAT) and portal and superior mesenteric vein (PV;SMV) thrombosis, both resulting in compromised liver function. Case Description/Methods: A 47-year-old man with a history of remote orthotopic liver transplantation (OLT) for HBV cirrhosis presented to the ED with two days of RUQ pain and vomiting. Physical exam revealed tenderness to palpation in the RUQ. Labs were normal, including liver synthetic function. COVID-19 nasopharyngeal swab was positive. CT of the abdomen and pelvis with IV contrast revealed complete acute thrombosis of the aortohepatic conduit near its origin, new from imaging six months prior. He received remdesivir and methylprednisolone and was discharged on a DOAC. A 57-year-old man with a history of Lynch syndrome and decompensated alcoholic cirrhosis presented to the ED with 3 days of LUQ pain, melena, coffee ground emesis and subjective fever. Physical exam and vital signs were normal. Labs showed Hgb 5.4 and WBC 15.2. COVID-19 nasopharyngeal swab was positive. CT of the abdomen and pelvis with IV contrast revealed extensive PV and SMV thrombosis. The patient was treated with pRBC, PPI, octreotide, and empiric antibiotics. He was given IV heparin and bridged to warfarin. Discussion: Thrombosis is a serious complication of COVID-19 infection. While there are known macrovascular thrombotic events associated with COVID-19, there are no reports of HAT, and one reported case of PV and SMV thrombosis. It is important to evaluate for thromboses in patients with cirrhosis or prior OLT and COVID-19 due to elevated thrombotic risk. Thromboses in these patients can compromise blood supply and further worsen liver function.

13.
American Journal of Translational Research ; 13(9):9983-9992, 2021.
Article in English | EMBASE | ID: covidwho-1456892

ABSTRACT

The novel coronavirus 2019 (2019 nCoV), appeared in Wuhan in December 2019, can cause a novel coronavirus pneumonia (Corona Virus Disease 2019, COVID-19). COVID-19 is highly infectious and easy to infect people. The epidemic has gradually spread to all parts of the country. In order to provide a basis for clinical diagnosis, this study retrospectively analyzed the imaging characteristics, evolution and related imaging manifestations of COVID-19 patients in different stages of the disease. The results suggest that the imaging findings of 48 COVID-19 patients from Hengyang, Hunan Province are comparable in different stages of the disease. Chest CT showed no pneumonia in one mild patient. Chest CT findings of moderate type (n=38) and severe type (n=9) had comparable characteristics. The main manifestations were ground-glass opacity (GGO) (18/38, 47.37%;1/9, 11.11%), and GGO with consolidation (16/38, 42.11%;5/9, 55.56%), which respectively presented in bilateral lungs (34/38, 89.47%;9/9, 100.00%), and multi-lobe distribution (involving 5 lobes) (17/38, 44.74%;8/9, 88.89%). After treatment, 28 patients were isolated for 14 days and returned to the hospital for re-examination;among them, the pulmonary lesion was completely absorbed in 15 moderate patients, while 13 patients mainly manifested as GGO. The CT imaging findings of patients with COVID-19 can detect the lesions early, observe the scope of the lesions, evaluate the severity of the lesions, and assist the clinician in completing rapid isolation, diagnosis and treatment. At the same time, it can help to understand the performance of COVID-19 in different stages and dynamically detect changes in the patient's condition.

14.
South African Journal of Clinical Nutrition ; 34(3):181, 2021.
Article in English | EMBASE | ID: covidwho-1447527

ABSTRACT

Introduction: The coronavirus (COVID-19) pandemic has affected income levels, employment status, and food intakes globally. In the United States (US), many university students work to fund their studies. The objective of this study was to assess the number of students whose work hours and income were affected by COVID-19 and to investigate if these factors were associated with dietary intake. Methods: An online questionnaire was administered using Qualtrics to 280 students at a public research university in Texas between November 2020 and March 2021. Chi-square tests of independence were performed on R version 4.0.3. Results: Preliminary analysis found that 45.2% had a change in income or employment status that was related to COVID-19 and 36.9% of the students had experienced a COVID-19 related reduction in working hours. There was an association between reduced working hours and fast-food intake (X2 =12.494, p = 0.014). Additionally, COVID-related changes in income/ employment status were associated with snack and dessert consumption (X2 = 21.06, p = 0.021). No significant associations were found between either income/employment status or reduced working hours, and home-cooked meals or fruit and vegetable intake. Conclusion: The results suggest that employment challenges related to COVID-19 have an association with students' dietary intake, specifically in relation to higher calorie foods such as snacks, desserts, and fast food.

15.
Systematic Reviews in Pharmacy ; 11(11):1087-1090, 2020.
Article in English | EMBASE | ID: covidwho-1224426

ABSTRACT

Introduction: Overweight and obesity in children is a global health problem among children of all ages. Based on the Indonesia Basic Health Research, overweight problems in children aged 5 12 years was still high, 18.8% were overweight and 8.8% were obese. In developing countries, the rate increased obesity and overweight in children 30% higher than developed countries. Aims: Our study aims to identify the relationship between gadgets use and pocket money with school children s nutritional status. Methods: This research was a cross-sectional study involving 672 schoolchildren randomly selected from ten elementary schools in Surabaya City, Indonesia. Data about duration of gadget use, pocket money, and snacking habit were assessed using structured questionnaire. Body weight and height were directly measured to calculate the subject s nutritional status using digital weight scale and stadiometer. Statistical analysis done in this study was Chi-square test to assess the relationship between variable tested. Results: The results showed that 38.8% of participants were overweight. 71.9% children were having gadget use for more than 2 hours/day, exceeding the recommended time use. Duration of gadget use and pocket money were significantly correlated with the nutritional status of school children (p 0.001). Snacking habits at home (p=0.302) and school (p=0.933) were not significantly correlated with nutritional status. Conclusions: Gadget use duration and pocket money proved to be correlated with the increase of nutritional status among schoolchildren. Thus, parents should pay more attention to control gadget use and pocket money to prevent overweight.

17.
Chinese General Practice ; 23(35):4419-4424, 2020.
Article in Chinese | Scopus | ID: covidwho-891672

ABSTRACT

Background: The COVID-19 has become a global epidemic.How to effectively treat it and reduce the fatality rate is still at exploratory stage.Identification of risk factors for death is critical to optimize treatment strategies for COVID-19.Objective: To investigate risk factors for COVID-19 death, and based on this, to develop a COVID-19 death predictive scoring system.Methods: Two hundred and seventy patients, who discharged or deceased with confirmed COVID-19 in Zhongnan Hospital of Wuhan University during January 1 to February 29, 2020, were reviewed.Baseline data were obtained, including demographics, admission symptoms and vital signs, complications and laboratory test results.According to the clinical outcome, i.e.discharged and deceased, the patients were divided into recovery group and death group.Risk factors of death were explored by using multivariate logistic regression analysis, and used for the development of a predictive scoring system for death.Results Two hundred and forty-five cases were finally included, including 212 discharged and 33 deceased during hospitalization.Factors independently associated with death were age ≥ 65 years〔OR=7.177, 95%CI(1.715, 30.038), P<0.05〕, SpO2≤93%〔OR=15.456, 95%CI(3.343, 71.450), P<0.05〕, BUN≥7 mmol/L〔OR=7.115, 95%CI(1.550, 32.652), P<0.05〕, PCT≥0.1 μg/L〔OR=23.895, 95%CI(4.209, 135.639), P<0.05〕.In predicting death due to COVID-19, the AUC of ASBP(A: age, S: SpO2, B: BUN, P: PCT) scoring system was 0.967〔95%CI(0.931, 0.987)〕, and that of CURB-65 scoring system was 0.885〔95%CI(0.831, 0.926)〕, showing a significant difference(Z=2.816, P<0.01).5 was the maximal Youden Index for ASBP scoring system and was chosen as the cut-off value, with 0.871 sensitivity and 0.957 specificity.And 2 was the maximal Youden Index for CURB-65 scoring system and was chosen as the cut-off value, with 0.903 sensitivity and 0.735 specificity.Conclusion: Older age, lower SpO2, higher levels of BUN and PCT were independent risk factors for COVID-19 death, and the ASBP scoring system developed based these factors might be available for the assessment of death risk of COVID-19. Copyright © 2020 by the Chinese General Practice.

18.
Academic Journal of Second Military Medical University ; 41(6):612-615, 2020.
Article in Chinese | EMBASE | ID: covidwho-743071

ABSTRACT

Objective To evaluate the clinical efficacy and safety of hydroxychloroquine sulfate combined with azithromycin in the treatment of refractory common coronavirus disease 2019 (COVID-19) patients. Methods The clinical data of 11 refractory common COVID-19 patients, who were admitted to Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province from Mar. 22 to 25, 2020, were retrospectively collected. The patients all received combined treatment regimens: hydroxychloroquine sulfate orally 200 mg three times daily for 7 days;and azithromycin orally 500 mg once daily on day 1 and then 250 mg once daily from day 2 to day 4. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test of throat swab was performed once daily from day 4 to day 10 after combined administration, and the blood routine and other laboratory indicators were tested within 3 days before administration and on the 8th days after administration. Results All the 11 patients had common COVID-19, seven of them were consistently positive for SARSCoV- 2 nucleic acid test, and four were positive again after negative results. The average course of disease of 11 patients before combined administration was 50.2 days. The treatment process was uneventful. Zero case of SARS-CoV-2 nucleic acid test result turned negative on day 4 after administration, two cases on day 5, two cases on day 6, two cases on day 7, one case on day 8 and one case on day 9. No patients progressed to severe or critical illness, and no severe side effects were found. Conclusion Hydroxychloroquine sulfate combined with azithromycin is safe and effective in the treatment of refractory common COVID-19 patients who have ailed in other treatments and are consistently positive for SARS-CoV-2 nucleic acid.

19.
Zhonghua Bing Li Xue Za Zhi ; 49(6): 568-575, 2020 Jun 08.
Article in Chinese | MEDLINE | ID: covidwho-505562

ABSTRACT

Objectives: To observe the pulmonary changes with coronavirus disease 2019 (COVID-19) in postmortem needle specimens, to detect the presence of 2019 novel coronavirus(2019-nCoV) in the lung tissues, and to analyze the clinicopathological characteristics. Methods: For 10 decedents with 2019-nCoV infection in Wuhan, bilateral lungs underwent ultrasound-guided percutaneous multi-point puncture autopsy, and pulmonary pathological changes were described in routine hematoxylin-eosin staining (HE) slides. Electron microscopy was also performed. The reverse transcription polymerase chain reaction (RT-PCR) was employed to detect 2019-nCoV nucleic acid in lung tissue, and the pathological characteristics were demonstrated in combination with clinical data analysis. Results: Of the 10 deaths associated with COVID-19, 7 were male and 3 were female. The average age was 70 (39-87) years. Medical record showed that 7 patients had underlying diseases. The average course of disease was 30 (16-36) days. Nine cases showed fibrinous and suppurative exudation in the alveolar cavity accompanied by the formation of hyaline membrane, and fibroblastic proliferation of alveolar septum. Type Ⅱ alveolar epithelial cells showed reactive hyperplasia and desquamation. Many macrophages accumulated in the alveolar cavity. Capillary hyaline thrombus and intravascular mixed thrombus were noted. In some cases, acute bronchiolitis with mucous membrane exfoliation, accumulation of bronchiolar secretions, and bronchiolar epithelial metaplasia occurred. In the cohort, a large number of bacteria (cocci) were detected in 1 case and a large number of fungi (yeast type) were detected in 1 case. Nine cases were positive for the nucleic acids of 2019-nCoV while one case remained negative by RT-PCR. Coronavirus particles were detected in the cytoplasm of type Ⅱ alveolar epithelium. Conclusions: The pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage (DAD), mainly in the acute exudative stage and the organic proliferative stage. There are fibrinous exudate aggregation in alveolar cavity with hyaline membrane formation, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries with reactive hyperplasia and desquamation of type Ⅱ alveolar epithelial cells. A large amount of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious bacterial or fungal infection secondary to the DAD.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Adult , Aged , Aged, 80 and over , Autopsy , COVID-19 , Female , Humans , Lung , Male , Middle Aged , SARS-CoV-2
20.
Ann Oncol ; 31(7): 894-901, 2020 07.
Article in English | MEDLINE | ID: covidwho-16011

ABSTRACT

BACKGROUND: Cancer patients are regarded as a highly vulnerable group in the current Coronavirus Disease 2019 (COVID-19) pandemic. To date, the clinical characteristics of COVID-19-infected cancer patients remain largely unknown. PATIENTS AND METHODS: In this retrospective cohort study, we included cancer patients with laboratory-confirmed COVID-19 from three designated hospitals in Wuhan, China. Clinical data were collected from medical records from 13 January 2020 to 26 February 2020. Univariate and multivariate analyses were carried out to assess the risk factors associated with severe events defined as a condition requiring admission to an intensive care unit, the use of mechanical ventilation, or death. RESULTS: A total of 28 COVID-19-infected cancer patients were included; 17 (60.7%) patients were male. Median (interquartile range) age was 65.0 (56.0-70.0) years. Lung cancer was the most frequent cancer type (n = 7; 25.0%). Eight (28.6%) patients were suspected to have hospital-associated transmission. The following clinical features were shown in our cohort: fever (n = 23, 82.1%), dry cough (n = 22, 81%), and dyspnoea (n = 14, 50.0%), along with lymphopaenia (n = 23, 82.1%), high level of high-sensitivity C-reactive protein (n = 23, 82.1%), anaemia (n = 21, 75.0%), and hypoproteinaemia (n = 25, 89.3%). The common chest computed tomography (CT) findings were ground-glass opacity (n = 21, 75.0%) and patchy consolidation (n = 13, 46.3%). A total of 15 (53.6%) patients had severe events and the mortality rate was 28.6%. If the last antitumour treatment was within 14 days, it significantly increased the risk of developing severe events [hazard ratio (HR) = 4.079, 95% confidence interval (CI) 1.086-15.322, P = 0.037]. Furthermore, patchy consolidation on CT on admission was associated with a higher risk of developing severe events (HR = 5.438, 95% CI 1.498-19.748, P = 0.010). CONCLUSIONS: Cancer patients show deteriorating conditions and poor outcomes from the COVID-19 infection. It is recommended that cancer patients receiving antitumour treatments should have vigorous screening for COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19 coinfection.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Hospitalization/trends , Neoplasms/diagnostic imaging , Neoplasms/epidemiology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Aged , COVID-19 , China/epidemiology , Cohort Studies , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Neoplasms/therapy , Pandemics , Pneumonia, Viral/therapy , Retrospective Studies , SARS-CoV-2
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