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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324766

ABSTRACT

Background: The global spread of the 2019 coronavirus disease (COVID-19) has lasted more than half a year. Except for the gene sequence and viral structure of SARS-CoV-2, its clinical characteristics, pathological mechanisms and corresponding measures have not been fully revealed. We aimed to speculate about the possible pathological mechanism from the early clinical manifestations of patients with COVID-19. Methods: : The onset symptoms, laboratory examinations and CT findings on admission of 300 patients in two wards of Wuhan Third Hospital from January 28 to March 15 were analyzed retrospectively. Results: : There was no difference in incidence between men and women, but women were hospitalized later after onset. Upper respiratory symptoms and sputum were rare. The incidence of fever was 71%. Blood lymphocyte counts were decreased significantly on admission and were related to the severity of the disease. In moderate patients without hypoxia, thrombocytopenia occurred in 12.37%, CRP rose in 64.43%, BUN was elevated in 20.62%, creatinine rose in 17.53%, D-dimer was elevated in 74.74%, and creatine kinase and α-hydroxybutyrate dehydrogenase were elevated in 45.36% and 54.12% of patients, respectively. Early CT showed a small amount of infiltration in the subpleural and lateral zones of the lung and thickening of the interlobular septum. Approximately 5 days later, infiltration was worse in some of the patients, and the proportion of involvement of the affected lung was negatively correlated with the lymphocyte count. Conclusions: : There was no sex difference in patients with SARS-CoV-2 infection. Alveolar cells and T lymphocytes may be the main targets of the virus, and apoptosis may be the primary mechanism of pathogenesis. The virus entering the lung may be transmitted through lymph or blood vessels rather than directly dispersing through the respiratory tract. Early damage to multiple organs may be caused by the immune response.

2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-324765

ABSTRACT

The global spread of COVID-19 has been lasted more than half a year. Except for the gene sequence and virus structure of SARS-CoV-2, its clinical characteristics, pathological mechanism and corresponding measures have not been fully revealed. Objective: To speculate the possible pathological mechanism from the early clinical manifestations of the patients with COVID-19. Methods: The onset symptoms, laboratory examination and CT findings on admission of 300 cases in two wards of Wuhan Third Hospital from January 28 to March 15 were analyzed retrospectively. Results: There was no difference in incidence between men and women, but women were hospitalized later after onset. Upper respiratory symptoms and sputum were seldom. The incidence of fever was 71%. Blood lymphocytes count decreased significantly on admission, which was related to the severity of the disease. In the moderate type of patients, who without hypoxia, thrombocytopenia occurred in 12.37%, CRP rose in 64.43 %, BUN elevated in 20.62 %, creatinine rose in 17.53 %, D-dimer elevated in 74.74%, creatine kinase and α-hydroxybutyrate dehydrogenase elevated in 45.36% and 54.12% patients respectively. The early CT showed a small amount of infiltration in the subpleural, the lateral zone of the lung and thickening of the interlobular septum. About 5 days later, infiltration had been worse in a part of the patients, and the affected lung was negatively correlated with the lymphocyte count. Conclusion: There was no gender difference in patients with SARS-CoV-2 invasion. Alveolar cells and T lymphocytes maybe main targets of the virus and apoptosis maybe primary pathogenesis. The virus entering the lung maybe transmitted through lymph or blood channels, rather than direct diffused in the respiratory tract. Early damage of multiple organs maybe caused by immune response.

3.
BMJ ; 369: m1849, 2020 05 14.
Article in English | MEDLINE | ID: covidwho-1495142

ABSTRACT

OBJECTIVE: To assess the efficacy and safety of hydroxychloroquine plus standard of care compared with standard of care alone in adults with coronavirus disease 2019 (covid-19). DESIGN: Multicentre, open label, randomised controlled trial. SETTING: 16 government designated covid-19 treatment centres in China, 11 to 29 February 2020. PARTICIPANTS: 150 patients admitted to hospital with laboratory confirmed covid-19 were included in the intention to treat analysis (75 patients assigned to hydroxychloroquine plus standard of care, 75 to standard of care alone). INTERVENTIONS: Hydroxychloroquine administrated at a loading dose of 1200 mg daily for three days followed by a maintenance dose of 800 mg daily (total treatment duration: two or three weeks for patients with mild to moderate or severe disease, respectively). MAIN OUTCOME MEASURE: Negative conversion of severe acute respiratory syndrome coronavirus 2 by 28 days, analysed according to the intention to treat principle. Adverse events were analysed in the safety population in which hydroxychloroquine recipients were participants who received at least one dose of hydroxychloroquine and hydroxychloroquine non-recipients were those managed with standard of care alone. RESULTS: Of 150 patients, 148 had mild to moderate disease and two had severe disease. The mean duration from symptom onset to randomisation was 16.6 (SD 10.5; range 3-41) days. A total of 109 (73%) patients (56 standard of care; 53 standard of care plus hydroxychloroquine) had negative conversion well before 28 days, and the remaining 41 (27%) patients (19 standard of care; 22 standard of care plus hydroxychloroquine) were censored as they did not reach negative conversion of virus. The probability of negative conversion by 28 days in the standard of care plus hydroxychloroquine group was 85.4% (95% confidence interval 73.8% to 93.8%), similar to that in the standard of care group (81.3%, 71.2% to 89.6%). The difference between groups was 4.1% (95% confidence interval -10.3% to 18.5%). In the safety population, adverse events were recorded in 7/80 (9%) hydroxychloroquine non-recipients and in 21/70 (30%) hydroxychloroquine recipients. The most common adverse event in the hydroxychloroquine recipients was diarrhoea, reported in 7/70 (10%) patients. Two hydroxychloroquine recipients reported serious adverse events. CONCLUSIONS: Administration of hydroxychloroquine did not result in a significantly higher probability of negative conversion than standard of care alone in patients admitted to hospital with mainly persistent mild to moderate covid-19. Adverse events were higher in hydroxychloroquine recipients than in non-recipients. TRIAL REGISTRATION: ChiCTR2000029868.


Subject(s)
Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Adult , COVID-19 , China , Female , Humans , Male , Middle Aged , Pandemics , Treatment Outcome
4.
Magnes Res ; 34(3): 103-113, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1468228

ABSTRACT

The aim of the study was to evaluate the significance of hypomagnesemia in patients with coronavirus disease 2019 (COVID-19) and clarify its possible pathogenesis. A retrospective cohort study was conducted by reviewing 83 patients hospitalized in Guanggu district, Wuhan Third Hospital, China. Clinical histories, laboratory findings and outcome data were collected. Eighteen patients had hypomagnesemia during hospitalization. Fourteen patients were in the critical group and six died. In the critical group, serum magnesium (0.72 ± 0.15 mmol/L) was much lower than that in the moderate and severe groups. At the same time, we also found that several indicators are correlated with the level of magnesium. The level of magnesium was positively associated with the lymphocyte count (r = 0.203, P = 0.004) and platelet count (r = 0.217, P = 0.002) but negatively related to the levels of CRP (r = -0.277, P = 0.000), LDH (r = -0.185, P = 0.011) and α-hydroxybutyrate dehydrogenase (r = -0.198, P = 0.008) in the critical group. Hypomagnesemia might increase symptoms and may be associated with mortality in COVID-19 by affecting enzyme activity and activating the inflammatory response. Thus, magnesium might play a key role in the pathogenesis of COVID-19.


Subject(s)
COVID-19/blood , COVID-19/complications , Magnesium Deficiency/blood , Magnesium Deficiency/complications , Magnesium/blood , Adult , Aged , Aged, 80 and over , C-Reactive Protein/biosynthesis , China/epidemiology , Female , Hospitalization , Humans , Hydroxybutyrate Dehydrogenase/blood , Inflammation , L-Lactate Dehydrogenase/blood , Lymphocyte Count , Lymphocytes/cytology , Male , Middle Aged , Platelet Count , Retrospective Studies , Risk Factors , SARS-CoV-2 , Temperature , Treatment Outcome
5.
Clinical eHealth ; 3:7-15, 2020.
Article in English | PMC | ID: covidwho-822402

ABSTRACT

The aim is to diagnose COVID-19 earlier and to improve its treatment by applying medical technology, the “COVID-19 Intelligent Diagnosis and Treatment Assistant Program (nCapp)” based on the Internet of Things. Terminal eight functions can be implemented in real-time online communication with the “cloud” through the page selection key. According to existing data, questionnaires, and check results, the diagnosis is automatically generated as confirmed, suspected, or suspicious of 2019 novel coronavirus (2019-nCoV) infection. It classifies patients into mild, moderate, severe or critical pneumonia. nCapp can also establish an online COVID-19 real-time update database, and it updates the model of diagnosis in real time based on the latest real-world case data to improve diagnostic accuracy. Additionally, nCapp can guide treatment. Front-line physicians, experts, and managers are linked to perform consultation and prevention. nCapp also contributes to the long-term follow-up of patients with COVID-19. The ultimate goal is to enable different levels of COVID-19 diagnosis and treatment among different doctors from different hospitals to upgrade to the national and international through the intelligent assistance of the nCapp system. In this way, we can block disease transmission, avoid physician infection, and epidemic prevention and control as soon as possible.

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