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1.
Front Pharmacol ; 13: 764305, 2022.
Article in English | MEDLINE | ID: covidwho-1785389

ABSTRACT

Background: To explore the effect of combining traditional Chinese medicine (TCM) and Western medicine in hemodialysis patients with coronavirus disease 2019 (COVID-19). Methods: This study was conducted from 27 January 2020 to 17 March 2020 in Wuhan Third Hospital Guanggu Branch, Wuhan, China. Fifty-three patients were included and divided into a control group (CG), which received Western medicine and a combined treatment group, which received TCM and Western medicine (TG). Clinical and laboratory data, TCM symptom scores, and chest computed tomography results were extracted and compared between the two groups. Results: The TG included 21 (67.7%) men and 10 (32.3%) women with a mean age of 61.02 (standard deviation [SD] 15.07, range 26-89) years. The mean dialysis duration in the TG was 49 (SD 31) months. Of all patients in the TG, 27 (87.1%) had fatigue, 18 (58.1%) had dry cough, 16 (51.6%) had anorexia, 11 (35.5%) had dyspnea, and 11 (35.5%) had fever. The CG included 14 (63.6%) men and 8 (36.4%) women with a mean age of 61.45 (SD 13.78, range 36-84) years. The mean dialysis duration in the CG was 63 (SD 46) months. Of all patients in the CG, 21 (95.5%) had fatigue, 12 (54.5%) had dry cough, 17 (77.3%) had anorexia, 12 (54.5%) had dyspnea, and 7 (31.8%) had fever. After treatment, the TCM symptom scores of the two groups decreased; the anorexia scores were lower in the TG than in the CG (p < 0.05). After treatment, albumin increased and D-dimer, C-reactive protein, and lactate dehydrogenase levels decreased in the TG. The d-dimer levels were lower and the albumin level was higher in the TG than in the CG after treatment (p < 0.05). The cure rate was higher, and the mortality rate was lower in the TG than in the CG (p < 0.05). Conclusion: A combination of TCM and Western medicine in hemodialysis patients with COVID-19 could relieve symptoms and help recovery. Further evidence from larger randomized controlled trials is needed to confirm our results.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-296736

ABSTRACT

Background: Ventilatory ratio is a simple bedside index of impaired efficiency of ventilation and correlates well with physiological dead space fraction in patients with ARDS. So it was regarded as a dead-space marker associated with mortality in mechanically ventilated adults with ARDS. However, the association between VR and outcome of patients with ARDS remains largely unknown. Methods: : We searched articles in three electronic databases including PubMed, EMBASE and Web of Science. All the English publications up to 1 st Oct. 2021 will be searched without any restriction of countries. All the observational study that investigated the association between ventilatory ratio and the mortality of ARDS patients were identified in this meta-analysis. The main outcome was mortality. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes with accompanying 95% confidence interval (CI) were expressed. Results: : A total of 9 trials enrolling 5638 patients were finally included in this meta-analysis. The results revealed that the use of ventilatory ratio could be significantly related to the mortality in adult ARDS (OR=1.27;95% CI 1.10 to 1.47;P=0.001). Ventilatory ratio may have the capability of predicting the mortality of NON- COVID-related patients (OR 1.39, 95% CI 1.12 to 1.73 P = 0.003) while it has no predictable significance in patients with COVID (OR 1.18, 95% CI 0.94 to 1.48 P = 0.16). Importantly, the dynamic changes of VR adds more predictable value (OR 1.21 vs 1.19). Conclusion: Our study suggests that ventilatory ratio can be regarded as a valuable marker to predict the mortality of adult patients with ARDS. Compared to patients with COVID, ventilatory ratio is more predictable in patients with NON-COVID. What’s more, the dynamic changes of VR may have the potential to improve the prognostic value.

4.
Am J Chin Med ; 49(5): 1063-1092, 2021.
Article in English | MEDLINE | ID: covidwho-1263933

ABSTRACT

Coronavirus disease (COVID-19) is a new infectious disease associated with high mortality, and traditional Chinese medicine decoctions (TCMDs) have been widely used for the treatment of patients with COVID-19 in China; however, the impact of these decoctions on severe and critical COVID-19-related mortality has not been evaluated. Therefore, we aimed to address this gap. In this retrospective cohort study, we included inpatients diagnosed with severe/critical COVID-19 at the Tongren Hospital of Wuhan University and grouped them depending on the recipience of TCMDs (TCMD and non-TCMD groups). We conducted a propensity score-matched analysis to adjust the imbalanced variables and treatments and used logistic regression methods to explore the risk factors associated with in-hospital death. Among 282 patients with COVID-19 who were discharged or died, 186 patients (66.0%) received TCMD treatment (TCMD cohort) and 96 (34.0%) did not (non-TCMD cohort). After propensity score matching at a 1:1 ratio, 94 TCMD users were matched to 94 non-users, and there were no significant differences in baseline clinical variables between the two groups of patients. The all-cause mortality was significantly lower in the TCMD group than in the non-TCMD group, and this trend remained valid even after matching (21.3% [20/94] vs. 39.4% [37/94]). Multivariable logistic regression model showed that disease severity (odds ratio: 0.010; 95% CI: 0.003, 0.037; [Formula: see text]¡ 0.001) was associated with increased odds of death and that TCMD treatment significantly decreased the odds of in-hospital death (odds ratio: 0.115; 95% CI: 0.035, 0.383; [Formula: see text]¡ 0.001), which was related to the duration of TCMD treatment. Our findings show that TCMD treatment may reduce the mortality in patients with severe/critical COVID-19.


Subject(s)
COVID-19/drug therapy , COVID-19/mortality , Drugs, Chinese Herbal/administration & dosage , Aged , COVID-19/pathology , Critical Illness , Female , Humans , Male , Medicine, Chinese Traditional , Middle Aged , Retrospective Studies , Severity of Illness Index
5.
Clin Infect Dis ; 71(16): 2109-2113, 2020 11 19.
Article in English | MEDLINE | ID: covidwho-1153167

ABSTRACT

BACKGROUND: Healthcare workers (HCWs) at the frontline are facing a substantial risk of infection during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: We acquired information and data on general information on and infection and death status of HCWs in Wuhan during the COVID-19 outbreak and completed statistical analyses. RESULTS: We obtained the data on 2457 infected cases among HCWs in Wuhan, China. More than half of the infected individuals were nurses (52.06%), whereas 33.62% of infected cases were doctors and 14.33% of cases were medical staff. In particular, the case infection rate of nurses (2.22%) was remarkably higher than that of doctors (1.92%). Most infected cases among HCWs were female (72.28%). A majority of the infected HCWs (89.26%) came from general hospitals, followed by specialized hospitals (5.70%) and community hospitals (5.05%). The case infection rate of HCWs (2.10%) was dramatically higher than that of non-HCWs (0.43%). The case fatality rate of HCWs (0.69%) was significantly lower than that of non-HCWs (5.30%). CONCLUSIONS: The infection risk of HCWs is clearly higher than that of non-HCWs. HCWs play an essential role in fighting the pandemic. The analysis of the infection status of HCWs is essential to attract enough attention from the public, provide effective suggestions for government agencies, and improve protective measures for HCWs.


Subject(s)
COVID-19/epidemiology , China/epidemiology , Cross-Sectional Studies , Disease Outbreaks/statistics & numerical data , Female , Health Personnel/statistics & numerical data , Humans , Male , Pandemics
6.
Front Pharmacol ; 11: 589714, 2020.
Article in English | MEDLINE | ID: covidwho-1083588

ABSTRACT

Since the sudden epidemic of coronavirus disease 2019 (COVID-19), the State Administration of Traditional Chinese Medicine immediately organized experts to formulate and screen the effective prescriptions of traditional Chinese medicine according to the characteristics of the novel coronavirus infection. Qingfei Paidu decoction (QFPDD) has been proven to be effective in multi-provincial clinical trials, and has been selected as a general prescription for the treatment of COVID-19 in different stages that was later promoted to be used nationwide. This review highlights the latest advances of QFPDD, focusing on the TCM theory, mechanism analysis, clinical application of QFPDD and its future perspectives. Moreover, an in-depth discussion of some valuable issues and possible development for future research on QFPDD is also discussed, aiming to provide a novel guide to combat the global epidemic COVID-19.

7.
Int Immunopharmacol ; 90: 107143, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1084141

ABSTRACT

BACKGROUND: Thymosin α1 therapy was commonly used in patients with coronavirus disease 2019 (COVID-19), while its impact on outcomes and which patients could benefit from thymosin α1 therapy were uncertain. STUDY DESIGN AND METHODS: Patients with COVID-19 from 19 designated hospitals between January 1 to February 29, 2020 were included, and the main exposure of interest was administration of thymosin α1. The primary outcome was 28-day mortality. Propensity score matching (PSM) was used to account for baseline confounders, cluster analysis and Cox proportional hazard model was used to account for subgroup analysis. RESULTS: A total of 771 patients were included, and 327/771 (42.4%) patients received thymosin α1 therapy. The 28-day mortality in thymosin group was significantly lower than that in control group (41.3% vs. 60.6%, p < 0.001). After PSM 522 patients were included in analysis and the 28-day mortality in thymosin α1 group and control group were 51.0% and 52.9% respectively, with no significant difference. In subgroup analyses, the association between thymosin α1 therapy and 28-day mortality appeared to be stronger among male patients (HR 0.673, 95% CI 0.454-0.998; p = 0.049). There were no benefits of thymosin α1 in 28-day mortality in other subgroups. There were two phenotypes after cluster analysis, but no benefits of thymosin α1 were shown in phenotype 1 (HR 0.823 95% CI 0.581-1.166; p = 0.273) and phenotype 2 (HR 1.148 95% CI 0.710-1.895; p = 0.442). CONCLUSION: There was no association between use of thymosin α1 and decreased mortality in critically ill COVID-19 patients. Subgroups analysis and phenotype analysis also showed no differences on mortality after thymosin α1 therapy.


Subject(s)
Adjuvants, Immunologic/therapeutic use , COVID-19/drug therapy , COVID-19/mortality , SARS-CoV-2 , Thymalfasin/therapeutic use , Aged , Critical Illness , Female , Humans , Male , Middle Aged , Retrospective Studies , Survival Analysis
8.
Biomed Pharmacother ; 137: 111310, 2021 May.
Article in English | MEDLINE | ID: covidwho-1062247

ABSTRACT

BACKGROUND: Currently, the number of confirmed cases and deaths of COVID-19 worldwide continues to rise, receiving great concern from the international community. However, there is no specific and widely accepted effective vaccines. The experience in controlling the outbreak in China has proven the effectiveness of traditional Chinese medicine (TCM). OBJECTIVES: This review aims to evaluate the role of TCM in COVID-19 treatment, hoping to provide references for prevention and control of global pandemic. DATA SOURCES: China National Knowledge Infrastructure, Web of Science, Baidu Scholar, ScienceDirect, Elsevier and PubMed were used to search literatures published from December 2019 to December 2020 by entering the keywords "Traditional Chinese medicine", "COVID-19″, "Severe acute respiratory syndrome coronavirus 2″, "Pathogenesis", "Syndrome differentiation", "Prescriptions" and their combinations. Hence, we have performed an extensive review of research articles, reviews and primary scientific studies to identify TCM against COVID-19. RESULTS: Among clinical treatments of COVID-19, several TCM prescriptions and characteristic therapies have been effectively suggested, the underlying mechanisms of which are mainly involved in antiviral, anti-inflammatory, immunomodulatory and organ-protective effects of multi-components acting on multi-targets at multi-pathways. CONCLUSIONS: This review may provide meaningful and feasible information that can be considered for the treatment of COVID-19 pandemic globally.


Subject(s)
Antiviral Agents/administration & dosage , COVID-19/drug therapy , Drugs, Chinese Herbal/administration & dosage , COVID-19/epidemiology , China/epidemiology , Humans , Medicine, Chinese Traditional , Prescription Drugs , SARS-CoV-2/isolation & purification
9.
Chest ; 159(5): 1793-1802, 2021 05.
Article in English | MEDLINE | ID: covidwho-1046526

ABSTRACT

BACKGROUND: Corticosteroid therapy is used commonly in patients with COVID-19, although its impact on outcomes and which patients could benefit from corticosteroid therapy are uncertain. RESEARCH QUESTION: Are clinical phenotypes of COVID-19 associated with differential response to corticosteroid therapy? STUDY DESIGN AND METHODS: Critically ill patients with COVID-19 from Tongji Hospital treated between January and February 2020 were included, and the main exposure of interest was the administration of IV corticosteroids. The primary outcome was 28-day mortality. Marginal structural modeling was used to account for baseline and time-dependent confounders. An unsupervised machine learning approach was carried out to identify phenotypes of COVID-19. RESULTS: A total of 428 patients were included; 280 of 428 patients (65.4%) received corticosteroid therapy. The 28-day mortality was significantly higher in patients who received corticosteroid therapy than in those who did not (53.9% vs 19.6%; P < .0001). After marginal structural modeling, corticosteroid therapy was not associated significantly with 28-day mortality (hazard ratio [HR], 0.80; 95% CI, 0.54-1.18; P = .26). Our analysis identified two phenotypes of COVID-19, and compared with the hypoinflammatory phenotype, the hyperinflammatory phenotype was characterized by elevated levels of proinflammatory cytokines, higher Sequential Organ Failure Assessment scores, and higher rates of complications. Corticosteroid therapy was associated with a reduced 28-day mortality (HR, 0.45; 95% CI, 0.25-0.80; P = .0062) in patients with the hyperinflammatory phenotype. INTERPRETATION: For critically ill patients with COVID-19, corticosteroid therapy was not associated with 28-day mortality, but the use of corticosteroids showed significant survival benefits in patients with the hyperinflammatory phenotype.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19 , Critical Illness , Inflammation , Aged , COVID-19/complications , COVID-19/immunology , COVID-19/mortality , COVID-19/therapy , China/epidemiology , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness/mortality , Critical Illness/therapy , Female , Humans , Inflammation/mortality , Inflammation/therapy , Male , Middle Aged , Mortality , Organ Dysfunction Scores , Outcome and Process Assessment, Health Care , SARS-CoV-2 , Severity of Illness Index
10.
Clin Epidemiol Glob Health ; 9: 184-190, 2021.
Article in English | MEDLINE | ID: covidwho-758648

ABSTRACT

OBJECTIVES: To identify clinical characteristics of severe patients with COVID-19. METHODS: The WHO database of publications on COVID-19 and PubMed were searched from inception to March 20, 2020 and all valuable studies were analyzed using Stata 15.0. RESULTS: We selected forty-four studies with 13,497 patients. In the comparison of severe and non-severe groups, age over 50 (OR = 4.090; 95% CI = 2.422-6.907, P = 0.000) and underlying disease (OR = 3.992; 95% CI = 2.631-6.507, P = 0.000) are risk factors. Female gender (OR = 0.740; 95% CI = 0.622-0.881, P = 0.001) is a protective factor. Characteristics like dyspnea (OR = 4.914; 95% CI = 3.069-7.867, P = 0.000), lymphopenia (OR = 5.528; 95% CI = 3.484-8.772, P = 0.000), thrombocytopenia (OR = 3.623; 95% CI = 1.034-12.691, P = 0.044), elevated C-reactive protein (OR = 5.217; 95% CI = 2.459-11.070, P = 0.000) and D-dimer (OR = 3.780; 95% CI = 1.481-9.648, P = 0.005) were more frequently in severe cases. Diffuse lesions and consolidation (OR = 4.680; 95% CI = 3.183-6.881, P = 0.000) in imaging was considered reliable. CONCLUSIONS: Men older than 50 with underlying disease are susceptible to develop severe pneumonia while female gender is protective. The typical symptom of severe pneumonia was dyspnea, but high fever, headache and diarrhea were not significantly different among patients with varying degrees of severity. Lymphopenia, thrombocytopenia, elevated C-reactive protein and D-dimer occurred more frequently in severe patients and yet leukopenia is not a characteristic laboratory indicator. Diffuse lesions and consolidation are important imaging features to distinguish severe pneumonia.

11.
World J Clin Cases ; 8(16): 3465-3473, 2020 Aug 26.
Article in English | MEDLINE | ID: covidwho-743039

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak began in China at the end of 2019. The disease is highly infectious. In order to prevent and control the epidemic situation, the state has issued a series of measures to guide the prevention and control of the epidemic. At the same time, it also introduced the measure of home isolation for children with fever. However, due to the nature of children, the implementation of the home isolation turned out to be quite difficult, and questions regarding the home isolation were brought out by parents when seeing doctors. For this reason, we decided to conduct this study. AIM: To study factors that influence home quarantine compliance in children with fever during the COVID-19 epidemic. METHODS: A total of 495 paediatric patients with respiratory tract infection and fever were selected from the general fever clinic at Xiamen Children's Hospital from February 6-27, 2020. On day 8 after the hospital visit, follow-up was conducted by telephone to evaluate the compliance of home quarantine. RESULTS: Among the ten quarantine measures, the proportion of families adhering to keeping 1.5 m distance, proper hand hygiene, wearing masks at home, and proper cough etiquette was very low (< 30% for each measure). Our analysis showed that compliance was related to gender and age of children, gender and age of primary caregiver, number of children in the family, and intensity of information on quarantine measures. We observed that compliance increased with the age of children. Compared with children whose caregivers were young adults, children with elderly caregivers were 2.461 times more likely to show poor compliance. Furthermore, children who received intensive information on quarantine measures had significantly better compliance. CONCLUSION: Compliance of children with fever to quarantine measures at home is low during the COVID-19 epidemic. Strengthening education on the quarantine measures is critical to improve compliance, in particular in young children with elderly caregivers.

12.
Chin. Trad. Herbal Drugs ; 6(51): 1450-1454, 20200328.
Article in Chinese | WHO COVID, ELSEVIER | ID: covidwho-380429

ABSTRACT

Objective: To analyze the influencing factors of death in patients with coronavirus disease 2019 (COVID-19) and provide a reference for clinically reducing the mortality of patients with COVID-19. Methods: Based on the retrospective analysis of the case data of all patients with COVID-19 admitted in our hospital from January 17th to February 25th, 2020, and the sex, age, whether or not to take Chinese medicine preparations during hospitalization, clinical classification, comorbidities, nucleic acid test results, admission time, discharge and other relevant indicators were collected for statistical analysis. Results: During the period of COVID-19, the number of patients of COVID-19 in our hospital gradually increased. At the epidemic peak period, 904 patients with COVID-19 were treated simultaneously. From January 17th to February 25th, 2020, a total of 1 305 patients with COVID-19 were treated in our hospital, including 632 males and 673 females, and the male to female ratio was 1:1.06. The age distribution ranged from 7 to 111 years, with a median of 63 (51, 70) years old. There was no significant difference in the age distribution of patients between different genders (Z = 1.217, P = 0.224). The results of univariate analysis showed that the patient's gender, age, whether to take Chinese medicine preparations during treatment, clinical classification, whether combined with underlying diseases (hypertension, coronary heart disease, diabetes, tumors and uremia) and nucleic acid test results all could affect patients fatality rate. Logistics multivariate regression analysis found that taking traditional Chinese medicine preparations, clinical classification, and whether combined with underlying diseases were independent risk factors for death in patients with COVID-19. Conclusion: The death of patients with COVID-19 is related to various factors. Reducing the occurrence of critical illness, controlling underlying diseases, stabilizing blood pressure and blood sugar, actively improving cardio-cerebral vascular conditions, and stabilizing renal function are main measures to improve the therapeutic effect, and early application of traditional Chinese medicine treatment also plays a very important role in reducing the mortality of patients with COVID-19.

13.
Ann Intensive Care ; 10(1): 33, 2020 Mar 18.
Article in English | MEDLINE | ID: covidwho-9967
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