Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 33
Filter
1.
IEEE Trans Med Imaging ; 39(8): 2572-2583, 2020 08.
Article in English | MEDLINE | ID: covidwho-691241

ABSTRACT

We propose a conceptually simple framework for fast COVID-19 screening in 3D chest CT images. The framework can efficiently predict whether or not a CT scan contains pneumonia while simultaneously identifying pneumonia types between COVID-19 and Interstitial Lung Disease (ILD) caused by other viruses. In the proposed method, two 3D-ResNets are coupled together into a single model for the two above-mentioned tasks via a novel prior-attention strategy. We extend residual learning with the proposed prior-attention mechanism and design a new so-called prior-attention residual learning (PARL) block. The model can be easily built by stacking the PARL blocks and trained end-to-end using multi-task losses. More specifically, one 3D-ResNet branch is trained as a binary classifier using lung images with and without pneumonia so that it can highlight the lesion areas within the lungs. Simultaneously, inside the PARL blocks, prior-attention maps are generated from this branch and used to guide another branch to learn more discriminative representations for the pneumonia-type classification. Experimental results demonstrate that the proposed framework can significantly improve the performance of COVID-19 screening. Compared to other methods, it achieves a state-of-the-art result. Moreover, the proposed method can be easily extended to other similar clinical applications such as computer-aided detection and diagnosis of pulmonary nodules in CT images, glaucoma lesions in Retina fundus images, etc.

2.
Frontiers in molecular biosciences ; 7:157-157, 2020.
Article | WHO COVID | ID: covidwho-689155

ABSTRACT

Introduction: A recently emerging respiratory disease named coronavirus disease 2019 (COVID-19) has quickly spread across the world This disease is initiated by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and uncontrolled cytokine storm, but it remains unknown as to whether a robust antibody response is related to clinical deterioration and poor outcome in COVID-19 patients Methods: Anti-SARS-CoV-2 IgG and IgM antibodies were determined by chemiluminescence analysis (CLIA) in COVID-19 patients at a single center in Wuhan Median IgG and IgM levels in acute and convalescent-phase sera (within 35 days) for all included patients were calculated and compared between severe and non-severe patients Immune response phenotyping based on the late IgG levels and neutrophil-to-lymphocyte ratio (NLR) was characterized to stratified patients into different disease severities and outcomes Results: A total of 222 patients were included in this study IgG was first detected on day 4 of illness, and its peak levels occurred in the fourth week Severe cases were more frequently found in patients with high IgG levels, compared to those with low IgG levels (51 8 vs 32 3%;p = 0 008) Severity rates for patients with NLR(hi)IgG(hi), NLR(hi)IgG(lo), NLR(lo)IgG(hi), and NLR(lo)IgG(lo) phenotype were 72 3, 48 5, 33 3, and 15 6%, respectively (p < 0 0001) Furthermore, severe patients with NLR(hi)IgG(hi), NLR(hi)IgG(lo) had higher inflammatory cytokines levels including IL-2, IL-6 and IL-10, and decreased CD4+ T cell count compared to those with NLR(lo)IgG(lo) phenotype (p < 0 05) Recovery rates for severe patients with NLR(hi)IgG(hi), NLR(hi)IgG(lo), NLR(lo)IgG(hi), and NLR(lo)IgG(lo) phenotype were 58 8% (20/34), 68 8% (11/16), 80 0% (4/5), and 100% (12/12), respectively (p = 0 0592) Dead cases only occurred in NLR(hi)IgG(hi) and NLR(hi)IgG(lo) phenotypes Conclusions: COVID-19 severity is associated with increased IgG response, and an immune response phenotyping based on the late IgG response and NLR could act as a simple complementary tool to discriminate between severe and non-severe COVID-19 patients, and further predict their clinical outcome

3.
Zhongguo Zhong Yao Za Zhi ; 45(13): 2993-3000, 2020 Jul.
Article in Chinese | MEDLINE | ID: covidwho-679286

ABSTRACT

To scientifically evaluate the intervention effect of Chinese medicine preventive administration(combined use of Huo-xiang Zhengqi Oral Liquid and Jinhao Jiere Granules) on community population in the case of coronavirus disease 2019(COVID-19), a large cohort, prospective, randomized, and parallel-controlled clinical study was conducted. Total 22 065 subjects were included and randomly divided into 2 groups. The non-intervention group was given health guidance only, while the traditional Chinese medicine(TCM) intervention group was given two coordinated TCM in addition to health guidance. The medical instructions were as follows. Huoxiang Zhengqi Oral Liquid: oral before meals, 10 mL/time, 2 times/day, a course of 5 days. Jinhao Jiere Granules: dissolve in boiling water and take after meals, 8 g/time, 2 times/day, a course of 5 days, followed up for 14 days, respectively. The study found that with the intake of medication, the incidence rate of TCM intervention group was basically maintained at a low and continuous stable level(0.01%-0.02%), while the non-intervention group showed an overall trend of continuous growth(0.02%-0.18%) from 3 to 14 days. No suspected or confirmed COVID-19 case occurred in either group. There were 2 cases of colds in the TCM intervention group and 26 cases in the non-intervention group. The incidence of colds in the TCM intervention group was significantly lower(P<0.05) than that in the non-intervention group. In the population of 16-60 years old, the incidence rate of non-intervention and intervention groups were 0.01% and 0.25%, respectively. The difference of colds incidence between the two groups was statistically significant(P<0.05). In the population older than 60 years old, they were 0.04% and 0.21%, respectively. The incidence of colds in the non-intervention group was higher than that in the intervention group, but not reaching statistical difference. The protection rate of TCM for the whole population was 91.8%, especially for the population of age 16-60(95.0%). It was suggested that TCM intervention(combined use of Huoxiang Zhengqi Oral Liquid and Jinhao Jiere Granules) could effectively protect community residents against respiratory diseases, such as colds, which was worthy of promotion in the community. In addition, in terms of safety, the incidence of adverse events and adverse reactions in the TCM intervention group was relatively low, which was basically consistent with the drug instructions.

4.
Medicine in Drug Discovery ; 2020.
Article | WHO COVID | ID: covidwho-670913

ABSTRACT

Background Until June 23th 2020, 9,195,635 laboratory-confirmed cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection have been reported worldwide, including 473,127 deaths Bacterial infection is the main cause of sepsis, however, sepsis caused by virus is often ignored Increased awareness, early recognition of viral sepsis, rapid administration of appropriate antiviral drugs, and urgent treatment can significantly reduce deaths of viral sepsis Objectives Given the rapid global spread of novel Corona Virus Disease (COVID-19), coupled with the high rate of missed diagnosis of viral sepsis caused by SARS-CoV-2 infection, it is urgent to evaluate the multiple organ failure score and viral sepsis in COVID-19 patients, so as to determine the clinical characteristics of viral sepsis more accurately and reveal the risk factors related to mortality Methods Here we provide a full description of three cases of viral sepsis and subsequent multiple organ dysfunction (MODS) caused by SARS-CoV-2 infection imported to Guiyang from Wuhan Results We analyzed complete laboratory examination, imaging data and treatment methods for the patients and assessed Sepsis-related Organ Failure Assessment score (SOFA score) and Multiple organ dysfunction scores (MOD score) daily, aimed to elucidate the clinical feature of viral sepsis and MODS and to attract enough attention by clinicians Conclusions Therefore, we strongly suggest to daily evaluate SOFA score and MOD score in severe and critically-ill COVID-19 patients, so as to early diagnose and prevention of sepsis and MODS Given the rapid global spread of novel Corona Virus Disease (COVID-19), coupled with the high rate of missed diagnosis of viral sepsis caused by SARS-CoV-2 infection, it is urgent to evaluate the multiple organ failure score and viral sepsis in COVID-19 patients, so as to determine the clinical characteristics of viral sepsis more accurately and reveal the risk factors related to mortality Here we provide a full description of three cases of viral sepsis and subsequent multiple organ dysfunction (MODS) caused by SARS-CoV-2 infection imported to Guiyang from Wuhan We analyzed complete laboratory examination, imaging data and treatment methods for the patients and assessed Sepsis-related Organ Failure Assessment score (SOFA score) and Multiple organ dysfunction scores (MOD score) daily, aimed to elucidate the clinical feature of viral sepsis and MODS and to attract enough attention by clinicians Therefore, we strongly suggest to daily evaluate SOFA score and MOD score in severe and critically-ill COVID-19 patients, so as to early diagnose and prevention of sepsis and MODS

5.
Respir Res ; 21(1): 194, 2020 Jul 22.
Article in English | MEDLINE | ID: covidwho-670959

ABSTRACT

RATIONALE: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been described as potential predictor of poor outcome for COVID-19, without considering its time-varying behavior though. METHODS: Prognostic value of SpO2/FiO2 was evaluated by jointly modeling the longitudinal responses of SpO2/FiO2 and time-to-event data retrieved from 280 severe and critically ill (intensive care) patients with COVID-19. RESULTS: A sharply decrease of SpO2/FiO2 from the first to second measurement for non-survivors was observed, and a strong association between square root SpO2/FiO2 and mortality risk was demonstrated, with a unit decrease in the marker corresponding to 1.82-fold increase in mortality risk (95% CI: 1.56-2.13). CONCLUSIONS: The current study suggested that SpO2/FiO2 could serve as a non-invasive prognostic marker to facilitate early adjustment for treatment, thus improving overall survival.

6.
Asian Journal of Surgery ; 2020.
Article | WHO COVID | ID: covidwho-663156

ABSTRACT

COVID-19 patients with preexisting diseases are at high risk of worse clinical outcomes There is little data about patients with different comorbidities and how to deal with them We reported a case of a patient with severe aplastic anemia complicated with COVID-19 who improved but turned worse rapidly and died in septic shock

7.
Respir Res ; 21(1): 194, 2020 Jul 22.
Article in English | MEDLINE | ID: covidwho-662459

ABSTRACT

RATIONALE: Oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) has been described as potential predictor of poor outcome for COVID-19, without considering its time-varying behavior though. METHODS: Prognostic value of SpO2/FiO2 was evaluated by jointly modeling the longitudinal responses of SpO2/FiO2 and time-to-event data retrieved from 280 severe and critically ill (intensive care) patients with COVID-19. RESULTS: A sharply decrease of SpO2/FiO2 from the first to second measurement for non-survivors was observed, and a strong association between square root SpO2/FiO2 and mortality risk was demonstrated, with a unit decrease in the marker corresponding to 1.82-fold increase in mortality risk (95% CI: 1.56-2.13). CONCLUSIONS: The current study suggested that SpO2/FiO2 could serve as a non-invasive prognostic marker to facilitate early adjustment for treatment, thus improving overall survival.

8.
Anesth Analg ; 131(2): 326-334, 2020 08.
Article in English | MEDLINE | ID: covidwho-650425

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide. During the ongoing COVID-19 epidemic, most hospitals have postponed elective surgeries. However, some emergency surgeries, especially for trauma patients, are inevitable. For patients with suspected or confirmed COVID-19, a standard protocol addressing preoperative preparation, intraoperative management, and postoperative surveillance should be implemented to avoid nosocomial infection and ensure the safety of patients and the health care workforce. With reference to the guidelines and recommendations issued by the National Health Commission and Chinese Society of Anesthesiology, this article provides recommendations for anesthesia management of trauma and emergency surgery cases during the COVID-19 pandemic.


Subject(s)
Anesthesia , Anesthesiology , Coronavirus Infections , Coronavirus , Pandemics , Pneumonia, Viral , Betacoronavirus , Humans
10.
American Journal of Orthodontics and Dentofacial Orthopedics ; 2020.
Article | WHO COVID | ID: covidwho-643339

ABSTRACT

Introduction The ongoing coronavirus disease 2019 (COVID-19) outbreak impacts the mental health of patients, health workers and the public The level of impact on the mental health of orthodontic patients in treatment is unknown The objective of the study was to evaluate the mental health of orthodontic patients in China during the early stage of the pandemic Methods An online questionnaire type of survey was conducted on a convenien ce sample of anonymous participants The questionnaire, in Chinese (Mandarin), comprised 5 sections Sections 1 to 3 included demographic, epidemical, and orthodontic status of the patients Section 4 assessed the mental health related to orthodontics Section 5 was the Kessler-10 mental distress scale A total of 48 orthodontists were invited to distribute the questionnaires to their patients Descriptive statistics, principle component analysis, k-means cluster analysis and bivariate logistics regression analysis were performed with statistical significance set at P<0 05 Result s: Questionnaires were collected from 558 patients (104 males, 354 females;age 24 78 ± 6 33 years [mean ± standard deviation]) The prevalence of mental distress was 38% (174/458) Higher odds ratios were associated with female participants, missed appointments and Hubei residence Types of orthodontic appliance were associated with anxiety of prolonged treatment duration The manner of communication with patients regarding the postponement of appointments was associated with patients' concern of prolonged treatment duration Frequency of contact from dentists was associated with patients' independence Conclusion s: Over one third of orthodontic patients experienced mental distress during the pandemic Multiple factors affected the level of anxiety of orthodontic patients, such as the type of orthodontic appliance, interval from the last dental visit, manner of communication with the orthodontist, and the localities of the pandemic progression

11.
PLoS One ; 15(7): e0235458, 2020.
Article in English | MEDLINE | ID: covidwho-638588

ABSTRACT

A recently developed pneumonia caused by SARS-CoV-2 bursting in Wuhan, China, has quickly spread across the world. We report the clinical characteristics of 82 cases of death from COVID-19 in a single center. Clinical data on 82 death cases laboratory-confirmed as SARS-CoV-2 infection were obtained from a Wuhan local hospital's electronic medical records according to previously designed standardized data collection forms. All patients were local residents of Wuhan, and a large proportion of them were diagnosed with severe illness when admitted. Due to the overwhelming of our system, a total of 14 patients (17.1%) were treated in the ICU, 83% of deaths never received Critical Care Support, only 40% had mechanical ventilation support despite 100% needing oxygen and the leading cause of death being pulmonary. Most of the patients who died were male (65.9%). More than half of the patients who died were older than 60 years (80.5%), and the median age was 72.5 years. The bulk of the patients who died had comorbidities (76.8%), including hypertension (56.1%), heart disease (20.7%), diabetes (18.3%), cerebrovascular disease (12.2%), and cancer (7.3%). Respiratory failure remained the leading cause of death (69.5%), followed by sepsis/MOF (28.0%), cardiac failure (14.6%), hemorrhage (6.1%), and renal failure (3.7%). Furthermore, respiratory, cardiac, hemorrhagic, hepatic, and renal damage were found in 100%, 89%, 80.5%, 78.0%, and 31.7% of patients, respectively. On admission, lymphopenia (89.2%), neutrophilia (74.3%), and thrombocytopenia (24.3%) were usually observed. Most patients had a high neutrophil-to-lymphocyte ratio of >5 (94.5%), high systemic immune-inflammation index of >500 (89.2%), and increased C-reactive protein (100%), lactate dehydrogenase (93.2%), and D-dimer (97.1%) levels. A high level of IL-6 (>10 pg/ml) was observed in all detected patients. The median time from initial symptoms to death was 15 days (IQR 11-20), and a significant association between aspartate aminotransferase (p = 0.002), alanine aminotransferase (p = 0.037) and time from initial symptoms to death was remarkably observed. Older males with comorbidities are more likely to develop severe disease and even die from SARS-CoV-2 infection. Respiratory failure is the main cause of COVID-19, but the virus itself and cytokine release syndrome-mediated damage to other organs, including cardiac, renal, hepatic, and hemorrhagic damage, should be taken seriously as well.


Subject(s)
Coronavirus Infections/mortality , Coronavirus Infections/pathology , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , Adult , Age Factors , Aged , Betacoronavirus , Cause of Death , China/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Respiratory Insufficiency/pathology , Retrospective Studies
13.
Horm Metab Res ; 2020 Jul 06.
Article in English | MEDLINE | ID: covidwho-634513

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was originated in November-December 2019 in Wuhan, China, and has rapidly spread around the world causing severe health and socioeconomical damage to the entire civilization. The key feature of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is upper respiratory tract infection, which may be complicated by bilateral pneumonia. Angiotensin converting enzyme 2 (ACE2) has been identified as a key host factor, required for virus entry into cells. Interestingly, ACE2 is expressed not only in the respiratory system, but also in the other organs and systems including adrenal glands. Here we provide the first description of the pathomorphological changes in adrenal glands in patients with severe COVID-19 characterized by perivascular infiltration of CD3+ and CD8+ T-lymphocytes. Due to the central role of the adrenals in the stress response of the organism, this finding is of potential clinical relevance, because infection with the SARS-CoV-2 virus might critically impair adrenal function under pathophysiological conditions.

14.
Disaster Med Public Health Prep ; : 1-17, 2020 Jun 25.
Article in English | MEDLINE | ID: covidwho-615235

ABSTRACT

OBJECTIVE: This study aims to explore factors associated with the intention to work of hospital workers in the early stages of the COVID-19 outbreak in South Korea. METHODS: An online self-reported survey was conducted in a tertiary hospital. Respondents were asked to report their perceived threat, perceived risk of infection, evaluation of hospital response, demographics, and job-related factors. Descriptive statistics and multivariate regression analyses were performed. RESULTS: A total of 441 employees participated in this study. Of respondents, 60% were willing to accept their work during an infectious disease outbreak and 12.5% were unwilling to accept the work. In addition, 8% of respondents reported that they had considered quitting their job, 54.4% reported their job was dangerous, and 50.1% of respondents perceived the severity of COVID-19 as high. Perceived threat and effectiveness of hospital response were associated with hospital employees' intention to work. CONCLUSIONS: Hospital workers are at the front line of the COVID-19 outbreak. This study highlighted hospital workers' perceived effectiveness of organizational response to the outbreak, and perceived threats were found to be important factors for whether they continue to work or not in the fight against the outbreak.

15.
Cell Res ; 30(8): 678-692, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-599672

ABSTRACT

A new coronavirus SARS-CoV-2, also called novel coronavirus 2019 (2019-nCoV), started to circulate among humans around December 2019, and it is now widespread as a global pandemic. The disease caused by SARS-CoV-2 virus is called COVID-19, which is highly contagious and has an overall mortality rate of 6.35% as of May 26, 2020. There is no vaccine or antiviral available for SARS-CoV-2. In this study, we report our discovery of inhibitors targeting the SARS-CoV-2 main protease (Mpro). Using the FRET-based enzymatic assay, several inhibitors including boceprevir, GC-376, and calpain inhibitors II, and XII were identified to have potent activity with single-digit to submicromolar IC50 values in the enzymatic assay. The mechanism of action of the hits was further characterized using enzyme kinetic studies, thermal shift binding assays, and native mass spectrometry. Significantly, four compounds (boceprevir, GC-376, calpain inhibitors II and XII) inhibit SARS-CoV-2 viral replication in cell culture with EC50 values ranging from 0.49 to 3.37 µM. Notably, boceprevir, calpain inhibitors II and XII represent novel chemotypes that are distinct from known substrate-based peptidomimetic Mpro inhibitors. A complex crystal structure of SARS-CoV-2 Mpro with GC-376, determined at 2.15 Å resolution with three protomers per asymmetric unit, revealed two unique binding configurations, shedding light on the molecular interactions and protein conformational flexibility underlying substrate and inhibitor binding by Mpro. Overall, the compounds identified herein provide promising starting points for the further development of SARS-CoV-2 therapeutics.

16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 430-434, 2020 Apr.
Article in Chinese | MEDLINE | ID: covidwho-594902

ABSTRACT

OBJECTIVE: To provide a reference for extracorporeal membrane oxygenation (ECMO) inter-hospital transport during coronavirus disease 2019 (COVID-19), based on the transport experience of 6 patients with severe H1N1 influenza virus pneumonia using ECMO. METHODS: Clinical data of patients with severe H1N1 influenza virus pneumonia implemented by ECMO in the First Affiliated Hospital of Wannan Medical College from October 2018 to December 2019 were retrospective analyzed, including general information, ECMO transport distance, time, clinical parameters before and after ECMO, including the patients' oxygenation index (PaO2/FiO2), respiratory rate (RR), pulse blood oxygen saturation (SpO2), arterial blood carbon dioxide partial pressure (PaCO2), and pH value, various complications during transport, mechanical ventilation time, patients' prognosis and other indicators. Experience from the aspects of personal protection, transport process and equipment, team cooperation, mid-transit monitoring, quality control, etc., was summarized to provide suggestions for patients with severe COVID-19 using ECMO during inter-hospital transport and protection. RESULTS: A total of 6 patients with severe H1N1 influenza virus pneumonia were transported on ECMO. All patients were transported to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College by the ECMO transport team after the establishment of ECMO in the local hospital. The transfer distance was 11 to 197 km, with an average of (93.8±58.6) km; the transfer time was 30 to 150 minutes, with an average of (79.2±40.6) minutes. Two patients experienced a drop in ECMO flow and SpO2 during the process, and the main reason was insufficient volume, which was improved after fluid resuscitation and posture adjustment. All patients maintained SpO2 above 0.93. Six patients survived and were discharged. ECMO assisted time was 4-9 days, with an average of (6.5±1.5) days; mechanical ventilation time was 7-24 days, and median time was 10.0 (8.0, 14.5) days. No H1N1 transmission occurred in medical personnel. To achieve good therapeutic effect, the main experience was to choose the proper timing and mode of ECMO; intact transportation vehicles and equipment to reduce or avoid mechanical complications; the effective management of respiration and circulation during the transportation to avoid ventilation-associated lung injury (VALI) and serious hypoxemia; the appropriate space for the transfer team to quickly handle various critical situations; and personal protection to avoid infection. CONCLUSIONS: With an experienced ECMO transport team, good transport equipment, comprehensive protection measures, reasonable transport procedures, and a perfect emergency plan, it is safe to use ECMO transport for COVID-19 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Extracorporeal Membrane Oxygenation , Influenza A Virus, H1N1 Subtype , Influenza, Human , Pneumonia, Viral/epidemiology , Pneumonia/therapy , Respiratory Distress Syndrome, Adult , Humans , Pandemics , Retrospective Studies , Treatment Outcome
17.
Korean J Intern Med ; 35(4): 758-764, 2020 07.
Article in English | MEDLINE | ID: covidwho-574597

ABSTRACT

BACKGROUND/AIMS: As the global impact of the novel coronavirus disease 2019 (COVID-19) has been severe, many countries have intensified containment activities to eliminate virus transmission, through early detection and isolation strategies. To establish a proper quarantine strategy, it is essential to understand how easily the virus can spread in the communities. METHODS: In this study, we collected detailed information on the circumstances in which human-to-human transmission occurred in the tertiary transmission cases of COVID-19 in the community. RESULTS: On January 26, 2020, an imported case of COVID-19 was confirmed, and by February 10, 2020, one secondary transmission and three tertiary transmissions were identified. Secondary transmission occurred on the first day of illness of the infector, and his symptoms were suggestive of a common cold. The transmission occurred during a 90-minute long meal together in a restaurant. The people were sitting within one meter of each other, and had no direct contact. The tertiary transmission also occurred on the first-day illness of the other infector, and his only symptom was slight chills. The transmission occurred at a church during 2-hour-long worship, and two rows separated them. CONCLUSION: Our findings suggest that mildly symptomatic patients with COVID-19 could transmit the virus from the first day of illness through daily activities in the community. Early detection and isolation of patients with COVID-19 may be challenging.


Subject(s)
Coronavirus Infections/transmission , Pneumonia, Viral/transmission , Betacoronavirus , Coronavirus Infections/diagnostic imaging , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic , Young Adult
18.
JAMA Netw Open ; 3(6): e2010895, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-505563

ABSTRACT

Importance: The epidemiologic and clinical characteristics of pediatric patients with coronavirus disease 2019 (COVID-19) have been reported, but information on immune features associated with disease severity is scarce. Objective: To delineate and compare the immunologic features of mild and moderate COVID-19 in pediatric patients. Design, Setting, and Participants: This single-center case series included 157 pediatric patients admitted to Wuhan Children's Hospital with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data were collected from January 25 to April 18, 2020. Exposures: Documented SARS-CoV-2 infection. Main Outcomes and Measures: Clinical and immunologic characteristics were collected and analyzed. Outcomes were observed until April 18, 2020. Results: Of the 157 pediatric patients with COVID-19, 60 (38.2%) had mild clinical type with pneumonia, 88 (56.1%) had moderate cases, 6 (3.8%) had severe cases, and 3 (1.9%) were critically ill. The 148 children with mild or moderate disease had a median (interquartile range [IQR]) age of 84 (18-123) months, and 88 (59.5%) were girls. The most common laboratory abnormalities were increased levels of alanine aminotransferase (ALT) (median [IQR], 16.0 [12.0-26.0] U/L), aspartate aminotransferase (AST) (median [IQR], 30.0 [23.0-41.8] U/L), creatine kinase MB (CK-MB) activity (median [IQR], 24.0 [18.0-34.0] U/L), and lactate dehydrogenase (LDH) (median [IQR], 243.0 [203.0-297.0] U/L), which are associated with liver and myocardial injury. Compared with mild cases, levels of inflammatory cytokines including interleukin 6, tumor necrosis factor α, and interferon γ were unchanged, whereas the level of immune suppressive interleukin 10 was markedly increased in moderate cases compared with mild cases (median [IQR], 3.96 [3.34-5.29] pg/mL vs 3.58 [3.10-4.36] pg/mL; P = .048). There was no statistically significant difference in absolute number of lymphocytes (including T cells and B cells) between mild and moderate cases, but moderate cases were associated with a decrease in neutrophil levels compared with mild cases (median [IQR], 2310/µL [1680/µL-3510/µL] vs 3120/µL [2040/µL-4170/µL]; P = .01). Immunoglobin G and the neutrophil to lymphocyte ratio were negatively associated with biochemical indices related to liver and myocardial injury (immunoglobulin G, ALT: r, -0.3579; AST: r, -0.5280; CK-MB activity: r, -0.4786; LDH: r, -0.4984; and neutrophil to lymphocyte ratio, ALT: r, -0.1893; AST: r, -0.3912; CK-MB activity: r, -0.3428; LDH: r, -0.3234), while counts of lymphocytes, CD4+ T cells, and interleukin 10 showed positive associations (lymphocytes, ALT: r, 0.2055; AST: r, 0.3615; CK-MB activity: r, 0.338; LDH: r, 0.3309; CD4+ T cells, AST: r, 0.4701; CK-MB activity: r, 0.4151; LDH: r, 0.4418; interleukin 10, ALT: r, 0.2595; AST: r, 0.3386; CK-MB activity: r, 0.3948; LDH: r, 0.3794). Conclusions and Relevance: In this case series, systemic inflammation rarely occurred in pediatric patients with COVID-19, in contrast with the lymphopenia and aggravated inflammatory responses frequently observed in adults with COVID-19. Gaining a deeper understanding of the role of neutrophils, CD4+ T cells, and B cells in the pathogenesis of SARS-CoV-2 infection could be important for the clinical management of COVID-19.


Subject(s)
Coronavirus Infections/immunology , Cytokines/immunology , Neutrophils/immunology , Pneumonia, Viral/immunology , Age Distribution , Alanine Transaminase/metabolism , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Aspartate Aminotransferases/metabolism , B-Lymphocytes/immunology , C-Reactive Protein/immunology , CD4-Positive T-Lymphocytes/immunology , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/therapy , Creatine Kinase, MB Form/metabolism , Critical Illness , Female , Hospitals, Pediatric , Humans , Infant , Interferon-gamma/immunology , Interleukin-10/immunology , Interleukin-2/immunology , Interleukin-4/immunology , Interleukin-6/immunology , Killer Cells, Natural/immunology , L-Lactate Dehydrogenase/metabolism , Leukocyte Count , Lymphocyte Count , Male , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/therapy , Severity of Illness Index , Sex Distribution , Tumor Necrosis Factor-alpha/immunology
19.
Horm Metab Res ; 52(7): 540-546, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-618763

ABSTRACT

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic affects people around the world. However, there have been striking differences in the number of infected individuals and deaths in different countries. Particularly, within Central Europe in countries that are similar in ethnicity, age, and medical standards and have performed similar steps of containment, such differences in mortality rates remain inexplicable. We suggest to consider and explore environmental factors to explain these intriguing variations. Countries like Northern Italy, France, Spain, and UK have suffered from 5 times more deaths from the corona virus infection than neighboring countries like Germany, Switzerland, Austria, and Denmark related to the size of their respective populations. There is a striking correlation between the level of environmental pollutants including pesticides, dioxins, and air pollution such as NO2 known to affect immune function and healthy metabolism with the rate of mortality in COVID-19 pandemic in these European countries. There is also a correlation with the use of chlorination of drinking water in these regions. In addition to the improvement of environmental protective programs, there are possibilities to lower the blood levels of these pollutants by therapeutic apheresis. Furthermore, therapeutic apheresis might be an effective method to improve metabolic inflammation, altered vascular perfusion, and neurodegeneration observed as long-term complications of COVID-19 disease.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Environment , Environmental Pollution/adverse effects , Halogenation , Metabolism , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Water Supply , Disease Susceptibility , Humans , Pandemics
SELECTION OF CITATIONS
SEARCH DETAIL