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2.
BMJ Open ; 11(10): e052609, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1484032

ABSTRACT

OBJECTIVE: This study aimed to describe the epidemiological and clinical features and potential factors related to the time to return negative reverse transcriptase (RT)-PCR in discharged paediatric patients with COVID-19. DESIGN: Retrospective cohort study. SETTING: Unscheduled admissions to 12 tertiary hospitals in China. PARTICIPANTS: Two hundred and thirty-three clinical charts of paediatric patients with confirmed diagnosis of COVID-19 admitted from 1 January 2020 to 17 April 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures: factors associated with the time to return negative RT-PCR from COVID-19 in paediatric patients. SECONDARY OUTCOME MEASURES: epidemiological and clinical features and laboratory results in paediatric patients. RESULTS: The median age of patients in our cohort was 7.50 (IQR: 2.92-12.17) years, and 133 (57.1%) patients were male. 42 (18.0%) patients were evaluated as asymptomatic, while 162 (69.5%) and 25 (10.7%) patients were classified as mild or moderate, respectively. In Cox regression analysis, longer time to negative RT-PCR was associated with the presence of confirmed infection in family members (HR (95% CI): 0.56 (0.41 to 0.79)). Paediatric patients with emesis symptom had a longer time to return negative (HR (95% CI): 0.33 (0.14 to 0.78)). During hospitalisation, the use of traditional Chinese medicine (TCM) and antiviral drugs at the same time is less conducive to return negative than antiviral drugs alone (HR (95% CI): 0.85 (0.64 to 1.13)). CONCLUSIONS: The mode of transmission might be a critical factor determining the disease severity of COVID-19. Patients with emesis symptom, complications or confirmed infection in family members may have longer healing time than others. However, there were no significant favourable effects from TCM when the patients have received antiviral treatment.


Subject(s)
COVID-19 , Child , Child, Preschool , Cohort Studies , Humans , Male , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2
3.
Pediatr Pulmonol ; 57(1): 49-56, 2022 01.
Article in English | MEDLINE | ID: covidwho-1437078

ABSTRACT

OBJECTIVE: Few studies have explored the clinical features in children infected with SARS-CoV-2 and other common respiratory viruses, including respiratory syncytial virus (RSV), Influenza virus (IV), and adenovirus (ADV). Herein, we reported the clinical characteristics and cytokine profiling in children with COVID-19 or other acute respiratory tract infections (ARTI). METHODS: We enrolled 20 hospitalized children confirmed as COVID-19 positive, 58 patients with ARTI, and 20 age and sex-matched healthy children. The clinical information and blood test results were collected. A total of 27 cytokines and chemokines were measured and analyzed. RESULTS: The median age in the COVID-19 positive group was 14.5 years, which was higher than that of the ARTI groups. Around one-third of patients in the COVID-19 group experienced moderate fever, with a peak temperature of 38.27°C. None of the patients displayed wheezing or dyspnea. In addition, patients in the COVID-19 group had lower white blood cells, platelet counts as well as a neutrophil-lymphocyte ratio. Lower serum concentrations of 14 out of 27 cytokines were observed in the COVID-19 group than in healthy individuals. Seven cytokines (IL-1Ra, IL-1ß, IL-9, IL-10, TNF-α, MIP-1α, and VEGF) changed serum concentration in COVID-19 compared with other ARTI groups. CONCLUSION: Patients with COVID-19 were older and showed milder symptoms and a favorable prognosis than ARTI caused by RSV, IV, and ADV. There was a low grade or constrained innate immune reaction in children with mild COVID-19.


Subject(s)
COVID-19 , Respiratory Syncytial Virus Infections , Respiratory Syncytial Virus, Human , Respiratory Tract Infections , Adolescent , China/epidemiology , Humans , Infant , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Tract Infections/diagnosis , SARS-CoV-2
4.
BMC Infect Dis ; 21(1): 737, 2021 Aug 03.
Article in English | MEDLINE | ID: covidwho-1435227

ABSTRACT

BACKGROUND: The serum surfactant protein D (SP-D) level is suggested to be a useful biomarker for acute lung injuries and acute respiratory distress syndrome. Whether the serum SP-D level could identify the severity of coronavirus disease 2019 (COVID-19) in the early stage has not been elucidated. METHODS: We performed an observational study on 39 laboratory-confirmed COVID-19 patients from The Fourth People's Hospital of Yiyang, Hunan, China. Receiver operating characteristic (ROC) curve analysis, correlation analysis, and multivariate logistic regression model analysis were performed. RESULTS: In the acute phase, the serum levels of SP-D were elevated significantly in severe COVID-19 patients than in mild cases (mean value ± standard deviation (SD), 449.7 ± 125.8 vs 245.9 ± 90.0 ng/mL, P<0.001), while the serum levels of SP-D in the recovery period were decreased dramatically than that in the acute phase (mean value ± SD, 129.5 ± 51.7 vs 292.9 ± 130.7 ng/ml, P<0.001), and so were for the stratified patients. The chest CT imaging scores were considerably higher in the severe group compared with those in the mild group (median value, 10.0 vs 9.0, P = 0.011), while markedly lower in the recovery period than those in the acute phase (median value, 2.0 vs 9.0, P<0.001), and so were for the stratified patients. ROC curve analysis revealed that areas under the curve of lymphocyte counts (LYM), C-reaction protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), and SP-D for severe COVID-19 were 0.719, 0.833, 0.817, 0.837, and 0.922, respectively. Correlation analysis showed that the SP-D levels were negatively correlated with LYM (r = - 0.320, P = 0.047), while positively correlated with CRP (r = 0.658, P<0.001), IL-6 (r = 0.471, P = 0.002), the duration of nucleic acid of throat swab turning negative (r = 0.668, P<0.001), chest CT imaging score on admission (r = 0.695, P<0.001) and length of stay (r = 0.420, P = 0.008). Multivariate logistic regression model analysis showed that age (P = 0.041, OR = 1.093) and SP-D (P = 0.008, OR = 1.018) were risk factors for severe COVID-19. CONCLUSIONS: Elevated serum SP-D level was a potential biomarker for the severity of COVID-19; this may be useful in identifying patients whose condition worsens at an early stage.


Subject(s)
COVID-19 , Pulmonary Surfactant-Associated Protein D , Humans , Prognosis , ROC Curve , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
5.
Ann Palliat Med ; 10(8): 9233-9238, 2021 08.
Article in English | MEDLINE | ID: covidwho-1399728

ABSTRACT

BACKGROUND: The optimal duration of treatment for intestinal tuberculosis (TB), which remains a common disease worldwide, has not yet been established. The proposed randomized controlled study will aim to compare the efficacy of short-term six-month with nine-month anti-TB therapy for treating intestinal TB. METHODS: This multicenter, open-label, double-blinded, randomized controlled trial conducted in the Affiliated Hangzhou Chest Hospital of Zhejiang University will include a total of 80 patients. Patients who meet the inclusion criteria will be randomly assigned to either the six-month (n=40) or nine-month (n=40) treatment group. The primary outcome will be complete response, which is defined as endoscopy displaying active lesion healing at the end of treatment. Participants will be scheduled for follow-up visits once a month in the first three months, then once every three months until the end of the treatment. The last follow-up will be one year after the treatment. Recurrence will be assessed one year after the end of treatment, which is defined as endoscopy displaying recurrent lesions after complete response. DISCUSSION: In addition to the reports of tuberculous lymphadenitis and spinal TB, there are few appropriate randomized trials for the treatment of extrapulmonary TB with appropriate clinical endpoints. We believe that the proposed randomized controlled trial will provide further data on the efficacy of short-term six-month anti-TB therapy in intestinal TB patients. TRIAL REGISTRATION: This trial will be registered on ClinicalTrial.gov.


Subject(s)
COVID-19 , Tuberculosis, Lymph Node , Humans , Multicenter Studies as Topic , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome
6.
Jpn J Infect Dis ; 74(4): 359-366, 2021 Jul 21.
Article in English | MEDLINE | ID: covidwho-1380104

ABSTRACT

This study aimed to develop and validate a bedside risk analysis system for predicting the clinical severity and prognosis of patients with coronavirus disease 2019 (COVID-19). In total, 444 COVID-19 patients were included and randomly assigned in a 2:1 ratio to 2 groups: derivation group and validation group. The new scoring system comprised of the following 8 variables: history of malignant diseases, history of diabetes mellitus, dyspnea, respiratory rate >24 breaths/min, C-reactive protein level >14 mg/L, white blood cell count >8×109/L, platelets count <180 × 1012/L, and lymphocyte count <1 × 109/L. The sensitivity analysis revealed that this new scoring system was more efficient than the sequential organ failure assessment scoring system on the first day of admission. The receiver characteristic curve analysis revealed that the new risk scoring predicted the severe cases of COVID-19 infection with an area under the curve of 0.831 (95% confidence interval [CI]: 0.783-0.879) and 0.798 (95% CI: 0.727-0.869) in the derivation and validation groups, respectively. This proposed risk score system is a fairly reliable and robust tool for evaluating the severity and prognosis of patients with COVID-19. This may help in the early identification of severe COVID-19 patients with poor prognosis, requiring more intense interventions.


Subject(s)
COVID-19/pathology , COVID-19/virology , Risk Assessment/methods , Aged , Female , Hospitalization , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness Index
7.
Front Psychiatry ; 12: 680202, 2021.
Article in English | MEDLINE | ID: covidwho-1285351

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a plethora of psychological problems worldwide since its onset in December 2019. In the upheaval period, compared with medical college students, nonmedical students' psychological state deserves additional concern due to their lack of medical knowledge. Although the epidemic in China has been largely controlled for several months, the mental health problems resulting from the COVID-19 epidemic persist to this day. In this study, we assessed the mental health problems and associated risk factors experienced by nonmedical vs. medical college students in universities of Shandong Province during the COVID-19 epidemic recovery period. Methods: An online survey was conducted over the period from 17 to 19 December 2020. A total of 954 Chinese college students (486 nonmedical and 468 medical students) from three universities of Shandong Province participated in the survey. Mental health variables were assessed with use of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Insomnia Severity Index (ISI). Results: Compared with medical students, nonmedical college students had higher prevalence rates of depression (53.9 vs. 46.4%; p = 0.020) and insomnia (28.0 vs. 22.4%, p = 0.049), as well as higher total scores on the PHQ-9 (p = 0.03) and ISI (p < 0.01). Among nonmedical college students, being female and native of non-Shandong were risk factors for anxiety and depression (p < 0.01), while only native of non-Shandong for insomnia (p < 0.01). Among medical students, age (p < 0.01) and living in rural areas (p = 0.04) were risk factors for depression, while only age (p < 0.05) was a risk factor for anxiety and insomnia. Conclusion: Nonmedical college students in the universities of Shandong Province had more mental health problems and more risk factors for developing them during the COVID-19 epidemic recovery period than medical students. These nonmedical students require additional attention and recovery programs to alleviate the increased incidence of psychological problems related to COVID-19.

8.
J Am Med Dir Assoc ; 22(8): 1565-1573.e4, 2021 08.
Article in English | MEDLINE | ID: covidwho-1267722

ABSTRACT

OBJECTIVE: To describe temporal changes in treatment, care, and short-term mortality outcomes of geriatric patients during the first wave of the COVID-19 pandemic. DESIGN: Observational study. SETTING AND PARTICIPANTS: Altogether 1785 patients diagnosed with COVID-19 and 6744 hospitalized for non-COVID-19 causes at 7 geriatric clinics in Stockholm from March 6 to July 31, 2020, were included. METHODS: Across admission month, patient vital signs and pharmacological treatment in relationship to risk for in-hospital death were analyzed using the Poisson regression model. Incidence rates (IRs) and incidence rate ratios (IRRs) of death are presented. RESULTS: In patients with COVID-19, the IR of mortality were 27%, 17%, 10%, 8%, and 2% from March to July, respectively, after standardization for demographics and vital signs. Compared with patients admitted in March, the risk of in-hospital death decreased by 29% [IRR 0.71, 95% confidence interval (CI) 0.51-0.99] in April, 61% (0.39, 0.26-0.58) in May, 68% (0.32, 0.19-0.55) in June, and 86% (0.14, 0.03-0.58) in July. The proportion of patients admitted for geriatric care with oxygen saturation <90% decreased from 13% to 1%, which partly explains the improvement of COVID-19 patient survival. In non-COVID-19 patients during the pandemic, mortality rates remained relatively stable (IR 1.3%-2.3%). Compared with non-COVID-19 geriatric patients, the IRR of death declined from 11 times higher (IRR 11.7, 95% CI 6.11-22.3) to 1.6 times (2.61, 0.50-13.7) between March and July in patients with COVID-19. CONCLUSIONS AND IMPLICATIONS: Mortality risk in geriatric patients from the Stockholm region declined over time throughout the first pandemic wave of COVID-19. The improved survival rate over time was only partly related to improvement in saturation status at the admission of the patients hospitalized later throughout the pandemic. Lower incidence during the later months could have led to less severe hospitalized cases driving down mortality.


Subject(s)
COVID-19 , Pandemics , Aged , Hospital Mortality , Hospitalization , Humans , SARS-CoV-2
10.
Ann Work Expo Health ; 65(8): 1004-1008, 2021 10 09.
Article in English | MEDLINE | ID: covidwho-1205525

ABSTRACT

OBJECTIVES: The aim of the present study was to investigate changes in the psychological state of medical personnel in the Department of Radiotherapy during the COVID-19 epidemic. METHODS: Psychological state was evaluated using the Pittsburgh Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). All three questionnaires were first completed by medical personnel on 17-18 February 2020 and were repeated every 3 months thereafter until 17-18 August. The number and intentions of patients receiving radiotherapy (RT) in our department were also collected. RESULTS: Twenty medical personnel participated in the present study. The global PSQI score recorded in August was significantly lower than that recorded in February (P = 0.045). Among the seven components of the PSQI, sleep quality (P = 0.048) and daytime dysfunction (P = 0.006) in August were significantly improved compared with February, whereas SDS and SAS did not significantly differ among the three different time points. The proportion of patients who received palliative radiotherapy was significantly higher on 18 May than on 17 February (P = 0.005). CONCLUSIONS: Medical personnel in the Department of Radiotherapy experienced a significantly elevated incidence of sleeping problems during the early COVID-19 outbreak period. Multiple combinations of protective measures to avoid infection could improve sleep quality and ensure the safe delivery of RT to cancer patients.


Subject(s)
COVID-19 , Epidemics , Occupational Exposure , China/epidemiology , Cross-Sectional Studies , Hospitals, Teaching , Humans , SARS-CoV-2 , Tertiary Healthcare
11.
Hum Vaccin Immunother ; 17(9): 2863-2867, 2021 09 02.
Article in English | MEDLINE | ID: covidwho-1196955

ABSTRACT

This study explored the safety of COVID-19 vaccine (Aikewei) and the role of clinical pharmacists in the implementation of COVID-19 vaccination. A total of 2305 hospital employees in Children's Hospital of Fudan University in Shanghai, China received the COVID-19 vaccine. The whole process of vaccination was monitored by clinical pharmacists, and the occurrence, types, severity of adverse reactions were recorded in detail. Through the investigation and analysis on the safety of COVID-19 vaccination of the 2305 people, the important role and value of clinical pharmacists in the vaccination process was elaborated. Common adverse reactions included local pain, dizziness and fatigue, with the incidence rates of 2.09%, 0.67% and 0.49%, respectively. Others such as headache, nausea, skin itching, cough, palpitation, dry mouth, hand anesthesia, local induration, muscle soreness, local rash, and chill had incidence rates of less than 0.30%. Three cases of serious adverse events that occurred in this vaccination returned to normal after treatment, with no subsequent discomfort. Clinical pharmacists played an important role in the safety monitoring of COVID-19 vaccination. The safety of the inactivated COVID-19 vaccine is good. Most of the common adverse reactions were mild and tolerable, with generally low incidence. The work of clinical pharmacists is important and can be expanded in the future to ensure the safety of vaccination and to provide better health care service.


Subject(s)
COVID-19 Vaccines , COVID-19 , Child , China/epidemiology , Humans , Pharmacists , SARS-CoV-2 , Vaccination
12.
Top Curr Chem (Cham) ; 379(3): 23, 2021 Apr 22.
Article in English | MEDLINE | ID: covidwho-1196651

ABSTRACT

Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is still a pandemic around the world. Currently, specific antiviral drugs to control the epidemic remain deficient. Understanding the details of SARS-CoV-2 structural biology is extremely important for development of antiviral agents that will enable regulation of its life cycle. This review focuses on the structural biology and medicinal chemistry of various key proteins (Spike, ACE2, TMPRSS2, RdRp and Mpro) in the life cycle of SARS-CoV-2, as well as their inhibitors/drug candidates. Representative broad-spectrum antiviral drugs, especially those against the homologous virus SARS-CoV, are summarized with the expectation they will drive the development of effective, broad-spectrum inhibitors against coronaviruses. We are hopeful that this review will be a useful aid for discovery of novel, potent anti-SARS-CoV-2 drugs with excellent therapeutic results in the near future.


Subject(s)
Antiviral Agents/chemistry , SARS-CoV-2/metabolism , Spike Glycoprotein, Coronavirus/chemistry , Viral Matrix Proteins/chemistry , Angiotensin-Converting Enzyme 2/antagonists & inhibitors , Angiotensin-Converting Enzyme 2/metabolism , Antiviral Agents/metabolism , Antiviral Agents/pharmacology , Antiviral Agents/therapeutic use , COVID-19/drug therapy , COVID-19/pathology , COVID-19/virology , Drug Repositioning , Humans , SARS-CoV-2/isolation & purification , Serine Endopeptidases/chemistry , Serine Endopeptidases/metabolism , Spike Glycoprotein, Coronavirus/metabolism , Viral Matrix Proteins/metabolism , Virus Internalization/drug effects
13.
Jie Fang Jun Yi Xue Za Zhi ; 46(3):267-273, 2021.
Article in Chinese | ProQuest Central | ID: covidwho-1187153

ABSTRACT

Objective To investigate the clinical characteristics of severe coronavirus disease 2019 (COVID-19) and explore the relevant risk factors that affect outcomes of the patients. Methods A retrospective analysis was performed on the data of the patients with severe COVID-19 admitted to the ICU of Huoshenshan Hospital of Wuhan City during the period from February to April, 2019. The patients were classified into survival group and death group. The general data, clinical manifestations, laboratory examinations, and treatments were compared between the 2 groups. Results A total of 122 severe COVID-19 patients were included in the study, 56 died and the fatality rate was 45.9%. The proportion of comorbidities of coronary heart disease in death group was significantly higher than that in the survival group [19.6%(11/56) vs. 7.6%(5/66), P=0.049]. Compared with patients in the survival group, the platelet count in the death group decreased [190.1(132.3, 245.0)×109/L vs. 217.0(176.0, 262.3)×109/L, P=0.015] and the levels of C-reactive protein and brain natriuretic peptide in the death group increased [37.4(4.3, 125.6) mg/L vs. 8.9(2.7, 51.4) mg/L, P=0.027 and 65.17(18.84, 167.71) pg/ml vs. 16.60(0.01, 67.68) pg/ml, P=0.007]. The prothrombin time and thrombin time in the death group were longer than those in the survival group [14.20(13.22, 15.86) s vs. 13.27(12.16, 14.27) s, P<0.01 and 16.32(15.11, 18.02) s vs. 15.75(14.81, 16.62) s, P=0.037]. Dynamic observation data showed that there were significant differences in neutrophil count, lymphocyte count, neutrophil/lymphocyte ratio and levels of both lactate dehydrogenase and α-hydroxybutyrate dehydrogenase (α-HBDH) between the two groups. ROC curve analysis showed that LDH and α-HBDH were of high value in predicting outcome, and the area under the curve was more than 0.7. Conclusions We should pay close attention to the changes of blood routine, LDH, and α-HBDH for older patients with underlying diseases. This will help us to identify the patients with high risk of death in the early stage, and take effective treatment measures as early as possible to improve the prognosis.

14.
Transl Pediatr ; 10(3): 560-568, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1184108

ABSTRACT

Background: Telemedicine is becoming an emerging innovative supplement to the traditional medical system in China. In the present study, we described the rapid implementation of the telemedicine in pediatrics during the coronavirus disease 2019 (COVID-19) outbreak and explored its value in response to the demand for pediatric medical services during the epidemic. Methods: An Internet-based platform for multidisciplinary online medical consultation was established on February 8, 2020, by a national children's medical center in China. The medical data of the traditional hospital visits and novel online visits from the first two months (February 8 to March 31) after the establishment of the platform were collected and analyzed. The demographic features, changes in the disease spectrum and characteristics of online medical services were described. Results: The total number of visits was significantly lower (by 75.3%) than that of in the same period in the previous year. The disease spectrum was different with a significant decrease of >95% in the number of patients with infectious or contagious diseases. The online visits accounted for 14.7% of all visits. Online patients came from all over the country, covering 91% of the administrative regions of China, and the largest proportion of inquiries were for infants (33.7%) (P<0.01). The response rate of experts to requests for online consultations was 100%. During the study period, 266 experts from 25 pediatric specialties completed 12,318 effective consultations, proving different degrees of online supplementation for various specialties (4.3-168.4%). Online consultations mainly addressed two types of problems: (I) accessibility of the traditional hospital visits and (II) consultations regarding an illness. Data from pediatric nephrology showed that 96% of the patients with stable chronic kidney disease successfully received follow-up medication adjustment guidance through the online platform. Conclusions: The traditional hospital medical services have been affected by the COVID-19 outbreak. The multidisciplinary online medical consultation system is a strategy to actively respond to the medical needs of children during unique periods.

15.
Health Qual Life Outcomes ; 19(1): 103, 2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1147072

ABSTRACT

BACKGROUND: More than 210,000 medical workers have fought against the outbreak of Coronavirus Disease 2019 (COVID-19) in Hubei in China since December 2019. However, the prevalence of mental health problems in frontline medical staff after fighting COVID-19 is still unknown. METHODS: Medical workers in Wuhan and other cities in Hubei Province were invited to participate a cross-sectional and convenience sampling online survey, which assessed the prevalence of anxiety, insomnia, depression, and post-traumatic stress disorder (PTSD). RESULTS: A total of 1,091 responses (33% male and 67% female) were valid for statistical analysis. The prevalence was anxiety 53%, insomnia 79%, depression 56%, and PTSD 11%. Healthcare workers in Wuhan were more likely to face risks of anxiety (56% vs. 52%, P = 0.03) and PTSD (15% vs. 9%, P = 0.03) than those in other cities of Hubei. In terms of educational attainment, those with doctoral and masters' (D/M) degrees may experience more anxiety (median of 7.0, [interquartile range (IQR) 2.0-8.5] vs. median 5.0 [IQR 5.0-8.0], P = 0.02) and PTSD (median 26.0 [IQR 19.5-33.0] vs. median 23.0 [IQR 19.0-31.0], P = 0.04) than those with lower educational degrees. CONCLUSIONS: The mental problems were an important issue for the healthcare workers after COVID-19. Thus, an early intervention on such mental problems is necessary for healthcare workers.


Subject(s)
COVID-19 , Depressive Disorder/epidemiology , Disease Outbreaks , Health Personnel/psychology , Occupational Diseases/epidemiology , SARS-CoV-2 , Adult , China/epidemiology , Cross-Sectional Studies , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Occupational Diseases/psychology , Prevalence , Psychometrics , Quality of Life , Surveys and Questionnaires , Young Adult
16.
J Nephrol ; 34(2): 295-304, 2021 04.
Article in English | MEDLINE | ID: covidwho-1144428

ABSTRACT

BACKGROUND: Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. METHODS: Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression. RESULTS: Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04-2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48-7.05), for eGFR 30 to < 60 mL/min, and 20.3 (9.95-41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11-2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3-235.6)], followed by COVID-19 without AKI [16.3 (6.28-42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66-28.2)]. CONCLUSIONS: Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Pandemics , Risk Assessment/methods , Acute Kidney Injury/mortality , Aged, 80 and over , COVID-19/epidemiology , Female , Hospital Mortality/trends , Humans , Incidence , Male , Retrospective Studies , Risk Factors , Survival Rate/trends , Sweden/epidemiology
17.
Medicine (Baltimore) ; 100(10): e24919, 2021 Mar 12.
Article in English | MEDLINE | ID: covidwho-1138017

ABSTRACT

INTRODUCTION: Hydroxychloroquine (HCQ) has received much attention in the treatment of coronavirus disease 2019 recently. However, it can cause irreversible vision loss. Few cases have been reported in pediatric patient with HCQ-related adverse reactions. Appropriate administration and early disease recognition are important for reducing the adverse drug reactions of HCQ. PATIENT CONCERNS: We report a case of a 14-year-old Chinese girl who sought treatment for rapidly decreasing vision in the left eye over 3 days. The simulation results of the population pharmacokinetic model of HCQ revealed that the plasma concentration of HCQ abnormally increased before the visual acuity of the eye decreased. DIAGNOSIS: She was diagnosed as HCQ related drug adverse reaction. INTERVENTIONS: The daily dose of HCQ for this patient was adjusted from 100 mg/d to 50 mg/d. OUTCOMES: Follow-up for 6 months showed no more vision loss recurrence. However, the existing decreased visual acuity of the eye did not recover either. CONCLUSION: Although decreased visual acuity is an infrequent symptom, ophthalmologists should be aware of the possibility of HCQ concentration enrichment and consider minimizing HCQ use when a child with renal hypofunction seeks treatment for shortsightedness.


Subject(s)
Hydroxychloroquine/adverse effects , Vision, Low/chemically induced , Adolescent , Female , Humans , Hydroxychloroquine/pharmacokinetics , Hydroxychloroquine/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Visual Acuity
18.
Transl Pediatr ; 10(1): 44-53, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1106650

ABSTRACT

Background: To evaluate the effectiveness of training on knowledge and practice of infection prevention and control (IPC) among pediatric health care workers (HCW) in Shanghai, China, in the context of COVID-19 pandemic. Methods: An online training program was designed by the Shanghai Pediatric Clinical Quality Control Center (SPQCC) during the early phase of COVID-19 pandemic on disease knowledge and practice of IPC. Training took place in the 81 partner hospitals affiliated with SPQCC. A multicenter, cross-sectional questionnaire survey was designed with a 25-item self-administered questionnaire to evaluate the knowledge gained from the training. Stratified-random sampling was used to select HCW according to three professionals (i.e., pediatricians, nurses and administrators) within each partner hospital. Awareness and knowledge of COVID-19 and its related infection control and practice were assessed by comparing survey results between different types of hospitals, professionals and professional ranks. A higher survey score meant that the respondent was more prepared and knowledgeable about COVID-19 and its infection control measures. Results: Completed questionnaires were returned from 1,062 subjects (385 pediatricians, 410 nurses, and 267 administrators), giving a response rate of 96.5%. Overall, awareness of clinical information related to COVID-19, importance of personal hygiene and isolation policy was high among the respondents. No statistical difference of scores on knowledge of COVID-19, IPC and relevant practice between the tertiary and peripheral hospitals. Among all respondents, middle-ranked health care personnel were most knowledgeable and achieved the highest score. Conclusions: Majority of pediatric HCW showed good recognition and practice in infection protection and control measures. The online training was able to achieve its aim to enhance knowledge and awareness and could have contributed to the zero infection rate among HCW caring for confirmed COVID-19 cases in Shanghai.

20.
Biomed Environ Sci ; 33(12): 893-905, 2020 Dec 20.
Article in English | MEDLINE | ID: covidwho-1060079

ABSTRACT

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( OR) and 95% confidence interval (95% CI) of the associations between comorbidities (cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19. Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion: Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.


Subject(s)
COVID-19/complications , Adult , Aged , COVID-19/epidemiology , COVID-19/therapy , COVID-19/virology , China/epidemiology , Comorbidity , Female , Humans , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Treatment Outcome
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