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2.
J Neural Transm (Vienna) ; 128(1): 37-48, 2021 01.
Article in English | MEDLINE | ID: covidwho-1064510

ABSTRACT

Information about Parkinson's disease (PD) patients with severe COVID-19 is scarce. We aimed to analyze the clinical characteristics, outcomes, and risk factors affecting the prognosis of PD patients with severe COVID-19 infection. Clinical data of severe COVID-19 patients admitted at the Union Hospital, Wuhan between 28th January and 29th February 2020 were collected and analyzed. 10 patients (1.96%) had a medical history of PD with a mean (SD) age of 72.10 (± 11.46) years. The clinical characteristics and outcomes of severe COVID-19 with and without PD patients were then compared. There was no significant difference in overall mortality between the PD and non-PD patients with severe COVID-19 (p > 0.05). In PD patients with severe COVID-19, the proportion of patients with critical type, disturbance of consciousness, incidence of complications, white blood cells count and neutrophils counts on admission seem higher in the non-survivors. PD patients with older age, longer PD duration, and late stage PD may be highly susceptible to critical COVID-19 infection and bad outcome. The PD patients with consciousness disorders and complications that progressed rapidly are at increased risk of death.


Subject(s)
/epidemiology , Consciousness Disorders/epidemiology , Parkinson Disease/epidemiology , Aged , Aged, 80 and over , /mortality , China/epidemiology , Comorbidity , Consciousness Disorders/etiology , Female , Humans , Male , Middle Aged , Parkinson Disease/mortality , Retrospective Studies , Risk Factors , Severity of Illness Index
4.
Life Sci ; 269: 119046, 2021 Mar 15.
Article in English | MEDLINE | ID: covidwho-1030918

ABSTRACT

BACKGROUND: The pandemic of the coronavirus disease 2019 (COVID-19) has brought a global public health crisis. However, the pathogenesis underlying COVID-19 are barely understood. METHODS: In this study, we performed proteomic analyses of airway mucus obtained by bronchoscopy from severe COVID-19 patients. In total, 2351 and 2073 proteins were identified and quantified in COVID-19 patients and healthy controls, respectively. RESULTS: Among them, 92 differentiated expressed proteins (DEPs) (46 up-regulated and 46 down-regulated) were found with a fold change >1.5 or <0.67 and a p-value <0.05, and 375 proteins were uniquely present in airway mucus from COVID-19 patients. Pathway and network enrichment analyses revealed that the 92 DEPs were mostly associated with metabolic, complement and coagulation cascades, lysosome, and cholesterol metabolism pathways, and the 375 COVID-19 only proteins were mainly enriched in amino acid degradation (Valine, Leucine and Isoleucine degradation), amino acid metabolism (beta-Alanine, Tryptophan, Cysteine and Methionine metabolism), oxidative phosphorylation, phagosome, and cholesterol metabolism pathways. CONCLUSIONS: This study aims to provide fundamental data for elucidating proteomic changes of COVID-19, which may implicate further investigation of molecular targets directing at specific therapy.


Subject(s)
Amino Acids/metabolism , Mucus/virology , Proteins/metabolism , Aged , Bronchoscopy , Case-Control Studies , Cholesterol/metabolism , Critical Illness , Female , Humans , Male , Middle Aged , Proteomics , Severity of Illness Index
5.
Eur J Clin Microbiol Infect Dis ; 2021 Jan 15.
Article in English | MEDLINE | ID: covidwho-1030727

ABSTRACT

At present, it has been noticed that some patients recovered from COVID-19 present a recurrent positive RNA test of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) after being discharged from hospitals. The purpose of the current study was to characterize the clinical features of re-hospitalized patients with recurrent SARS-CoV-2 positive results. From January 12 to April 1 of 2020, our retrospective study was conducted in China. The exposure history, baseline data, laboratory findings, therapeutic schedule, and clinical endpoints of the patients were collected. All the patients were followed until April 10, 2020. Among all COVID-19 patients included in the current study, there were 14 re-hospitalized patients due to recurrent positive tests of SARS-CoV-2 RNA. Fever (11 [78.6%]), cough (10 [71.4%]), and fatigue (7 [50.0%]) were the most common symptoms on the patient's first admission, and less symptoms were found on their second admission. The average duration from the onset of symptoms to admission to hospital was found to be 8.4 days for the first admission and 2.6 days for the second admission (P = 0.002). The average time from the detection of RNA (+) to hospitalization was 1.9 days for the first admission and 2.6 days for the second admission (P = 0.479), and the average time from RNA (+) to RNA (-) was 11.1 days for the first admission and 6.3 days for the second admission (P = 0.030). Moreover, the total time in hospital was 18.6 days for the first admission and 8.0 days for the second admission (P = 0.000). It may be necessary to increase the isolation observation time and RT-PCR tests should be timely performed on multiple samples as soon as possible.

6.
Preprint | SciFinder | ID: ppcovidwho-3787

ABSTRACT

A review In order to effectively prevent, timely control and eliminate the hazards of emergent public health events and eventually protect and promote public health The special review program is currently applicable for research and development (R&D) for drugs on COVID-19 during epidemic There are some new and practical difficulties in safety surveillance for drug clin trials, so investigators, sponsors and regulators are now exchanging opinions and facilitating new drug R&D together On the condition of ensuring subject′s safety and sponsors′ responsibilities, some specific measures for safety surveillance have been explored and taken This article introduces the main contents of safety surveillance for clin trials during epidemic and propose some considerations for future

7.
Ann Clin Microbiol Antimicrob ; 20(1): 3, 2021 Jan 06.
Article in English | MEDLINE | ID: covidwho-1013151

ABSTRACT

BACKGROUND AND OBJECTIVE: Little is yet known whether pathogenesis of COVID-19 is different between young and elder patients. Our study aimed to investigate the clinical characteristics and provide predictors of mortality for young adults with severe COVID-19. METHODS: A total of 77 young adults with confirmed severe COVID-19 were recruited retrospectively at Tongji Hospital. Clinical characteristics, laboratory findings, treatment and outcomes were obtained from electronic medical records. The prognostic effects of variables were analyzed using logistic regression model. RESULTS: In this retrospective cohort, non-survivors showed higher incidence of dyspnea and co-existing laboratory abnormalities, compared with young survivals in severe COVID-19. Multivariate logistic regression analysis showed that lymphopenia, elevated level of d-dimer, hypersensitive cardiac troponin I (hs-CTnI) and high sensitivity C-reactive protein (hs-CRP) were independent predictors of mortality in young adults with severe COVID-19. Further analysis showed that severely young adults with two or more factors abnormalities above would be more prone to death. The similar predictive effect of above four factors had been observed in all-age patients with severe COVID-19. CONCLUSION: Lymphopenia, elevated level of d-dimer, hs-CTnI and hs-CRP predicted clinical outcomes of young adults with severe COVID-19.


Subject(s)
/mortality , /physiopathology , /therapy , China/epidemiology , Cohort Studies , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Pandemics , Regression Analysis , Retrospective Studies , Risk Factors , Treatment Outcome , Young Adult
8.
Chest ; 158(1): 97-105, 2020 07.
Article in English | MEDLINE | ID: covidwho-980155

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) has become a global health emergency. The cumulative number of new confirmed cases and deaths are still increasing out of China. Independent predicted factors associated with fatal outcomes remain uncertain. RESEARCH QUESTION: The goal of the current study was to investigate the potential risk factors associated with fatal outcomes from COVID-19 through a multivariate Cox regression analysis and a nomogram model. STUDY DESIGN AND METHODS: A retrospective cohort of 1,590 hospitalized patients with COVID-19 throughout China was established. The prognostic effects of variables, including clinical features and laboratory findings, were analyzed by using Kaplan-Meier methods and a Cox proportional hazards model. A prognostic nomogram was formulated to predict the survival of patients with COVID-19. RESULTS: In this nationwide cohort, nonsurvivors included a higher incidence of elderly people and subjects with coexisting chronic illness, dyspnea, and laboratory abnormalities on admission compared with survivors. Multivariate Cox regression analysis showed that age ≥ 75 years (hazard ratio [HR], 7.86; 95% CI, 2.44-25.35), age between 65 and 74 years (HR, 3.43; 95% CI, 1.24-9.5), coronary heart disease (HR, 4.28; 95% CI, 1.14-16.13), cerebrovascular disease (HR, 3.1; 95% CI, 1.07-8.94), dyspnea (HR, 3.96; 95% CI, 1.42-11), procalcitonin level > 0.5 ng/mL (HR, 8.72; 95% CI, 3.42-22.28), and aspartate aminotransferase level > 40 U/L (HR, 2.2; 95% CI, 1.1-6.73) were independent risk factors associated with fatal outcome. A nomogram was established based on the results of multivariate analysis. The internal bootstrap resampling approach suggested the nomogram has sufficient discriminatory power with a C-index of 0.91 (95% CI, 0.85-0.97). The calibration plots also showed good consistency between the prediction and the observation. INTERPRETATION: The proposed nomogram accurately predicted clinical outcomes of patients with COVID-19 based on individual characteristics. Earlier identification, more intensive surveillance, and appropriate therapy should be considered in patients at high risk.


Subject(s)
Aspartate Aminotransferases/blood , Cardiovascular Diseases/epidemiology , Coronavirus Infections , Dyspnea , Pandemics , Pneumonia, Viral , Procalcitonin/blood , Aged , Betacoronavirus/isolation & purification , China/epidemiology , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Correlation of Data , Dyspnea/epidemiology , Dyspnea/etiology , Female , Humans , Male , Nomograms , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Prognosis , Risk Assessment/methods , Risk Factors , Survival Analysis
9.
J Cardiothorac Surg ; 15(1): 335, 2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-979807

ABSTRACT

BACKGROUND: A newly infectious diseases named coronavirus disease 2019 (COVID-19) emerged in China and now has spread in many countries, and constituted a public health emergency of international concern. Extracorporeal membrane oxygenation (ECMO) is used as salvage therapies in critical COVID-19 patients with respiratory/cardiac failure. CASE PRESENTATION: A 49-year-old female patient was diagnosed with COVID-19 and progressed to critical cases, she was successfully treated with the application of awake extracorporeal membrane oxygenation. This case is the first reported successfully treatment of application awake ECMO in critical COVID-19 patient in China. CONCLUSIONS: Here we present the first reported successfully treatment of application awake ECMO in critical COVID-19 patient, however, whether awake ECMO can be widely used in the treatment of critical COVID-19 patients need more practice.


Subject(s)
/therapy , Extracorporeal Membrane Oxygenation , Respiratory Insufficiency/therapy , /complications , Extracorporeal Membrane Oxygenation/methods , Female , Humans , Middle Aged , Respiratory Insufficiency/virology , Wakefulness
10.
11.
Adv Funct Mater ; : 2008452, 2020 Nov 25.
Article in English | MEDLINE | ID: covidwho-967839

ABSTRACT

The world-wide spreading of coronavirus disease (COVID-19) has greatly shaken human society, thus effective and fast-speed methods of non-daily-life-disturbance sterilization have become extremely significant. In this work, by fully benefitting from high-quality AlN template (with threading dislocation density as low as ≈6×108 cm-2) as well as outstanding deep ultraviolet (UVC-less than 280 nm) light-emitting diodes (LEDs) structure design and epitaxy optimization, high power UVC LEDs and ultra-high-power sterilization irradiation source are achieved. Moreover, for the first time, a result in which a fast and complete elimination of SARS-CoV-2 (the virus causes COVID-19) within only 1 s is achieved by the nearly whole industry-chain-covered product. These results advance the promising potential in UVC-LED disinfection particularly in the shadow of COVID-19.

13.
BMJ Open ; 10(11): e041471, 2020 11 30.
Article in English | MEDLINE | ID: covidwho-951588

ABSTRACT

OBJECTIVE: To delineate the characteristics and clinical significance of plasma inflammatory cytokines altered in COVID-19. DESIGN: Retrospective, single-centre cohort study. SETTING: Tongji Hospital in Wuhan, China. PARTICIPANTS: Among a cohort of 308 patients with a diagnosis of COVID-19, 138 patients died while 170 patients recovered and were discharged from the hospital. The data were collected until 27 February 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Clinical characteristics and laboratory findings were obtained from electronic medical records using data collection forms. RESULTS: The percentage of patients with elevated interleukin 2 receptor (IL-2R), IL-6, IL-8, IL-10 and tumour necrosis factor (TNF) increased with severity of disease (p<0.0001 for all). IL-2R (p<0.0001), IL-6 (p<0.0001), IL-8 (p=0.0001), IL-10 (p<0.0001) and TNF (p<0.0001) were also twofold to 20-fold higher in patients who died compared with those who recovered. Also, IL-6 and IL-10 increased in both the progressive patient groups: moderate (p=0.0026) and severe (p<0.0001). In multivariate analysis, higher levels of IL-2R (OR 1.001, 95% CI 1.000 to 1.002, p=0.031) and IL-6 (OR 1.013, 95% CI 1.003 to 1.024, p=0.015) on admission were associated with increasing odds of in-hospital death, independent of other covariates, including severity of disease and lymphocyte count. CONCLUSION: Increased proinflammatory and anti-inflammatory cytokines, including IL-2R, IL-6, IL-8, TNF and IL-10, showed an obvious association with both COVID-19 severity and in-hospital mortality. Thus, our study indicates that cytokines are valuable in predicting the severity of COVID-19 and helps in distinguishing critically ill patients from the less affected ones.

14.
Expert Rev Respir Med ; 2020 Nov 28.
Article in English | MEDLINE | ID: covidwho-949527

ABSTRACT

OBJECTIVES: To explore the efficacy of corticosteroid treatment in patients with severe COVID-19 pneumonia and the association between corticosteroid use and patient mortality. METHODS: A retrospective investigation was made on the medical records of the patients with severe and critical patients with COVID-19 pneumonia from January to February 2020. First, the patients who received corticosteroid treatment were compared with patients without given corticosteroid treatment. Then a propensity score matching method was used to control confounding factors. Cox survival regression analysis was used to evaluate the effect of corticosteroid therapy on the mortality of severe and critical patients with COVID-19. RESULTS: A total of 371 severe and critical patients were included in our analyses. 209 patients were treated with corticosteroid therapy. Most of them were treated with methylprednisolone (197[94.3%]). The median corticosteroid therapy was applied 3(IQR 2-6) days after admission, 13(IQR 10-17) days after symptoms appeared. Temperature on admission(OR=1.255,[95%CI 1.021-1.547],p=0.032), ventilation(OR=1.926,[95%CI 1.148-3.269],p=0.014) and ICU admission(OR=3.713, [95%CI 1.776-8.277],p<0.001) were significantly associated with corticosteroids use. After PS matching, the cox regression survival analysis showed that corticosteroid use was significantly associated with a lower mortality rate (HR=0.592, [95%CI 0.406-0.862], p=0.006). CONCLUSION: Corticosteroid therapy use in severe and critical patients with COVID-19 pneumonia leads to lower mortality but may cause other side effects. Corticosteroid therapy should be used carefully.

15.
Atmos Pollut Res ; 2020 Nov 28.
Article in English | MEDLINE | ID: covidwho-947111

ABSTRACT

The COVID-19 virus outbreak has been declared a "global pandemic". Therefore, "lockdown" was issued in affected countries to control the spread of the virus. To assess air pollution during and after lockdowns, this study selected pandemic hotspots in China (Wuhan), Japan (Tokyo), the Republic of Korea (Daegu), and India (Mumbai) and compared the Air Quality Index (AQI) in these areas for the past three years. The results indicated that air pollution levels were positively correlated with a reduction in pollutant levels during and after lockdowns in these cities. In Tokyo, low levels of air pollution, no significant change in the distribution of "good" and "moderate" days was observed during lockdown. In Daegu, mid-level air pollution, the percentage of "unhealthy" days (AQI>100) markedly reduced during lockdown; however, this reverted after lockdown was lifted. In Wuhan and Mumbai, high air pollution levels, the percentage of unhealthy days remarkably decreased during lockdown and continued to reduce after lockdown. It was found that PM2.5 was the critical pollutant for all cities because its sub-AQI was the largest of the six pollutant species for the majority of days. In addition, PM10 dominated the overall AQI for 2.2-9.6% of the period in Wuhan and Mumbai, and its sub-AQI reduced during lockdown. The mean sub-AQI for NO2, SO2, CO, and O3 was within the "good" category for all cities. In conclusion, the lockdown policy reduced air pollution in general and this reduction was more significant for regions with high air pollution levels.

16.
Nat Biomed Eng ; 4(12): 1208-1220, 2020 12.
Article in English | MEDLINE | ID: covidwho-933690

ABSTRACT

Consumer wearable devices that continuously measure vital signs have been used to monitor the onset of infectious disease. Here, we show that data from consumer smartwatches can be used for the pre-symptomatic detection of coronavirus disease 2019 (COVID-19). We analysed physiological and activity data from 32 individuals infected with COVID-19, identified from a cohort of nearly 5,300 participants, and found that 26 of them (81%) had alterations in their heart rate, number of daily steps or time asleep. Of the 25 cases of COVID-19 with detected physiological alterations for which we had symptom information, 22 were detected before (or at) symptom onset, with four cases detected at least nine days earlier. Using retrospective smartwatch data, we show that 63% of the COVID-19 cases could have been detected before symptom onset in real time via a two-tiered warning system based on the occurrence of extreme elevations in resting heart rate relative to the individual baseline. Our findings suggest that activity tracking and health monitoring via consumer wearable devices may be used for the large-scale, real-time detection of respiratory infections, often pre-symptomatically.

17.
Nat Commun ; 11(1): 5874, 2020 11 18.
Article in English | MEDLINE | ID: covidwho-933688

ABSTRACT

Non-structural proteins (nsp) constitute the SARS-CoV-2 replication and transcription complex (RTC) to play a pivotal role in the virus life cycle. Here we determine the atomic structure of a SARS-CoV-2 mini RTC, assembled by viral RNA-dependent RNA polymerase (RdRp, nsp12) with a template-primer RNA, nsp7 and nsp8, and two helicase molecules (nsp13-1 and nsp13-2), by cryo-electron microscopy. Two groups of mini RTCs with different conformations of nsp13-1 are identified. In both of them, nsp13-1 stabilizes overall architecture of the mini RTC by contacting with nsp13-2, which anchors the 5'-extension of RNA template, as well as interacting with nsp7-nsp8-nsp12-RNA. Orientation shifts of nsp13-1 results in its variable interactions with other components in two forms of mini RTC. The mutations on nsp13-1:nsp12 and nsp13-1:nsp13-2 interfaces prohibit the enhancement of helicase activity achieved by mini RTCs. These results provide an insight into how helicase couples with polymerase to facilitate its function in virus replication and transcription.


Subject(s)
Betacoronavirus/chemistry , Betacoronavirus/physiology , Virus Replication , Betacoronavirus/genetics , Betacoronavirus/metabolism , Binding Sites , Cryoelectron Microscopy , Humans , Methyltransferases/chemistry , Methyltransferases/genetics , Methyltransferases/metabolism , Models, Molecular , Mutation , Protein Binding , Protein Conformation , RNA Helicases/chemistry , RNA Helicases/genetics , RNA Helicases/metabolism , RNA, Viral/metabolism , Structure-Activity Relationship , Transcription, Genetic , Viral Nonstructural Proteins/chemistry , Viral Nonstructural Proteins/genetics , Viral Nonstructural Proteins/metabolism
18.
Biomed Pharmacother ; 133: 111035, 2020 Nov 17.
Article in English | MEDLINE | ID: covidwho-927110

ABSTRACT

Outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 have produced high pathogenicity and mortality rates in human populations. However, to meet the increasing demand for treatment of these pathogenic coronaviruses, accelerating novel antiviral drug development as much as possible has become a public concern. Target-based drug development may be a promising approach to achieve this goal. In this review, the relevant features of potential molecular targets in human coronaviruses (HCoVs) are highlighted, including the viral protease, RNA-dependent RNA polymerase, and methyltransferases. Additionally, recent advances in the development of antivirals based on these targets are summarized. This review is expected to provide new insights and potential strategies for the development of novel antiviral drugs to treat SARS-CoV-2 infection.

19.
Cell ; 2020 Nov 14.
Article in English | MEDLINE | ID: covidwho-921846

ABSTRACT

Transcription of SARS-CoV-2 mRNA requires sequential reactions facilitated by the replication and transcription complex (RTC). Here, we present a structural snapshot of SARS-CoV-2 RTC as it transitions toward cap structure synthesis. We determine the atomic cryo-EM structure of an extended RTC assembled by nsp7-nsp82-nsp12-nsp132-RNA and a single RNA-binding protein, nsp9. Nsp9 binds tightly to nsp12 (RdRp) NiRAN, allowing nsp9 N terminus inserting into the catalytic center of nsp12 NiRAN, which then inhibits activity. We also show that nsp12 NiRAN possesses guanylyltransferase activity, catalyzing the formation of cap core structure (GpppA). The orientation of nsp13 that anchors the 5' extension of template RNA shows a remarkable conformational shift, resulting in zinc finger 3 of its ZBD inserting into a minor groove of paired template-primer RNA. These results reason an intermediate state of RTC toward mRNA synthesis, pave a way to understand the RTC architecture, and provide a target for antiviral development.

20.
Andrology ; 2020 Nov 04.
Article in English | MEDLINE | ID: covidwho-910378

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been spreading all over the world since December 2019. However, medical information regarding the urogenital involvement in recovered COVID-19 patients is limited or unknown. OBJECTIVES: To comprehensively evaluate urogenital involvement in recovered COVID-19 patients. MATERIALS AND METHODS: Men aged between 20 years and 50 years who were diagnosed with SARS-CoV-2 infection and recovered when the study was conducted were enrolled in our study. Demographic and clinical characteristics, and history of hospitalization were collected and analyzed. Urine, expressed prostatic secretions (EPSs), and semen samples were collected for SARS-CoV-2 RNA detection. Semen quality and hormonal profiles were analyzed. RESULTS: Among 74 male recovered COVID-19 patients, 11 (14.9%) were asymptomatic, classified into mild type, and 31 (41.9%) were classified into moderate type. The remaining patients (32/74, 43.2%) had severe pneumonia. No critically ill recovered COVID-19 patient was recruited in our cohort. The median interval between last positive pharyngeal swab RT-PCR test and semen samples collection was 80 days (IQR, 64-93). The median age was 31 years (IQR, 27-36; range, 21-49), and the median body mass index (BMI) was 24.40 (IQR, 22.55-27.30). Forty-five (61.6%) men were married, and 28 (38.4%) were unmarried. Fifty-three (72.6%) patients denied cigarette smoking, 18 (24.7%) were active smokers, and 2 of them were past smokers. The majority of our participants (53/74, 72.6%) did not consume alcohol. Fever occurred in most of the patients (75.3%), and 63 of them had abnormal chest CT images. Only one patient complained of scrotal discomfort during the course of COVID-19, which was ruled out orchitis by MRI (data not shown). A total of 205 samples were collected for SARS-CoV-2 detection (74 urine samples, 70 semen samples, and 61 EPS samples). However, viral nucleic acid was not detected in body fluids from the urogenital system. In terms of hormonal profiles, the levels of FSH, LH, testosterone, and estradiol were 5.20 [4.23] mIU/mL, 3.95 [1.63] mIU/mL, 3.65 [1.19] ng/mL, and 39.48 [12.51] pg/mL, respectively. And these values were within the normal limits. The overall semen quality of recovered COVID-19 patients was above the lower reference limit released by the WHO. While compared with healthy control, sperm concentration, total sperm count, and total motility were significantly declined. In addition, different clinical types of COVID-19 have no significant difference in semen parameters, but total sperm count showed a descending trend. Interestingly, subjects with a longer recovery time showed worse data for sperm quality. Small sample size and lacking semen parameters before the infection are the major limitations of our study. DISCUSSION AND CONCLUSIONS: To the best of our knowledge, it is the largest cohort study with longest follow-up for urogenital evaluation comprehensively so far. Direct urogenital involvement was not found in the recovered COVID-19 male patients. SARS-CoV-2 RNA was undetectable in the urogenital secretions, and semen quality declined slightly, while hormonal profiles remained normal. Moreover, patients with a long time (≥90 days) since recovery had lower total sperm count. Great attention and further study should be conducted and follow-up on the reproductive function in the following months.

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