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1.
Curr Med Sci ; 2020 Aug 07.
Article in English | MEDLINE | ID: covidwho-695683

ABSTRACT

In late December 2019, COVID-19 was firstly recognized in Wuhan, China and spread rapidly to all of the provinces of China. The West Campus of Wuhan Union Hospital, the designated hospital to admit and treat the severe and critically ill COVID-19 cases, has treated a large number of such patients with great success and obtained lots of valuable experiences based on the Chinese guideline (V7.0). To standardize and share the treatment procedures of severe and critically ill cases, Wuhan Union Hospital has established a working group and formulated an operational recommendation, including the monitoring, early warning indicators, and several treatment principles for severe and critically ill cases. The treatment experiences may provide some constructive suggestions for treating the severe and critically ill COVID-19 cases all over the world.

2.
Chinese Journal of Integrative Medicine ; 2020.
Article | WHO COVID | ID: covidwho-694806

ABSTRACT

COVID-19 has globally spread and has become a new pandemic, but there is still no effective drugs or vaccines to treat or prevent this disease SARS-Cov-2 invades human cells through its spike proteins interacting with human ACE2 receptors One strategy to prevent the virus from entering cells is the interruption of the viral spike protein interacting with ACE2 In such an emergent situation, drug repurposing is a promising method for rapid drug development Here, we selected around 15000 molecular candidates including FDA-approved drugs from DrugBank and natural compounds from TCMSP to perform virtual screening for potential molecules that can target viral spike protein based on its crystal structure In this article, we present the top 20 molecules with high binding affinity with spike protein, of which, digitoxin, a cardiac glycoside in DrugBank and bisindigotin in TCMSP, extracted from indigo naturalis and polygoni tinctorii foliu, have the highest docking scores In addition, we also found that raltegravir, an HIV integrase inhibitor, has a relatively high binding score Those molecules with high binding capacity to spike glycoprotein might be used by other researchers for further anti-COVID-19 drug development

3.
Chin J Integr Med ; 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-691259

ABSTRACT

OBJECTIVE: To select potential molecules that can target viral spike proteins, which may potentially interrupt the interaction between the human angiotension-converting enzyme 2 (ACE2) receptor and viral spike protein by virtual screening. METHODS: The three-dimensional (3D)-coordinate file of the receptor-binding domain (RBD)-ACE2 complex for searching a suitable docking pocket was firstly downloaded and prepared. Secondly, approximately 15,000 molecular candidates were prepared, including US Food and Drug Administration (FDA)-approved drugs from DrugBank and natural compounds from Traditional Chinese Medicine Systems Pharmacology (TCMSP), for the docking process. Then, virtual screening was performed and the binding energy in Autodock Vina was calculated. Finally, the top 20 molecules with high binding energy and their Chinese medicine (CM) herb sources were listed in this paper. RESULTS: It was found that digitoxin, a cardiac glycoside in DrugBank and bisindigotin in TCMSP had the highest docking scores. Interestingly, two of the CM herbs containing the natural compounds that had relatively high binding scores, Forsythiae fructus and Isatidis radix, are components of Lianhua Qingwen (), a CM formula reportedly exerting activity against severe acute respiratory syndrome (SARS)-Cov-2. Moreover, raltegravir, an HIV integrase inhibitor, was found to have a relatively high binding score. CONCLUSIONS: A class of compounds, which are from FDA-approved drugs and CM natural compounds, that had high binding energy with RBD of the viral spike protein. Our work provides potential candidates for other researchers to identify inhibitors to prevent SARS-CoV-2 infection, and highlights the importance of CM and integrative application of CM and Western medicine on treating COVID-19.

4.
Nutrients ; 12(8)2020 Jul 28.
Article in English | MEDLINE | ID: covidwho-680581

ABSTRACT

Reproductive health is a significant public health issue during pandemics; however, the impacts of the novel 2019 coronavirus disease (COVID-19) on noninfected pregnant women are still unknown. This study intends (1) to examine whether emotional eating (EE) occurred during the pandemic triggered by disease concerns and (2) to explore the associations among EE, dietary changes, and gestational weight gain (GWG). Based on an online survey, 640 new mothers who experienced the lockdown in their third trimester were recruited from seven provinces in China. EE was evaluated with the Chinese version of the Dutch Eating Behavior Questionnaire, EE domain. A self-designed e-questionnaire was used to collect the data of participants on the sociodemographic characteristics, concerns about the COVID-19 pandemic, maternity information, physical activities, and dietary changes during lockdown. The results show that the average EE score was 26.5 ± 8.3, and women living in a severely affected area, who are very worried about the pandemic and who had less physical activity had a higher tendency of EE. Although there is a dietary pattern changed during pandemic, the average GWG in the studied group was in the normal range. However, a higher EE score was associated with a significant excess of GWG in women not from Wuhan (EE score 33-65 vs. 13-22: adjusted Odd Ratio (OR), 95% Confidence Interval (CI) = 1.90, 1.08-3.32). The sensitivity analysis that additionally adjusted for the pregestational body mass index and gestational metabolic disease was consistent with this result. The mediation model was also examined and showed that, after adjusting for living area and exercise, EE was associated with significantly increased consumption of cereals (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 2.22, 1.29-3.82) and oil (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 3.03, 1.06-8.69) but decreased consumption of fish and seafood (EE score 33-65 vs. 13-22: adjusted OR, 95% CI = 1.88, 1.14-3.11; 23-32 vs. 13-22: adjusted OR, 95% CI = 1.79, 1.20-2.66). In conclusion, this study indicated that EE occurred in a proportional number of pregnant women during the COVID-19 pandemic and is associated with excess GWG mediated by increased intake of certain foods. The findings suggest the need for psychosocial and nutritional education and interventions during pregnancy checkups. Further studies are needed to determine modifiable psychosocial predictors and potential nutritional concerns in pregnant women during disease outbreaks.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Diet , Feeding Behavior/psychology , Gestational Weight Gain , Pandemics , Pneumonia, Viral/epidemiology , Adult , China/epidemiology , Emotions , Female , Humans , Maternal Health/statistics & numerical data , Maternal Nutritional Physiological Phenomena/physiology , Pregnancy , Pregnancy Trimester, Third , Retrospective Studies , Surveys and Questionnaires
5.
Diabetes Obes Metab ; 22(8): 1443-1454, 2020 08.
Article in English | MEDLINE | ID: covidwho-647644

ABSTRACT

AIM: To explore whether coronavirus disease 2019 (COVID-19) patients with diabetes and secondary hyperglycaemia have different clinical characteristics and prognoses than those without significantly abnormal glucose metabolism. MATERIALS AND METHODS: We retrospectively analysed 166 COVID-19 patients at Tongji Hospital (Wuhan) from 8 February to 21 March 2020. Clinical characteristics and outcomes (as of 4 April 2020) were compared among control (group 1), secondary hyperglycaemia (group 2: no diabetes history, fasting plasma glucose levels of ≥7.0 mmol/L once and HbA1c values <6.5%) and patients with diabetes (group 3). RESULTS: Compared with group 1, groups 2 and 3 had higher rates of leukocytosis, neutrophilia, lymphocytopenia, eosinopenia and levels of hypersensitive C-reactive protein, ferritin and d-dimer (P < .05 for all). Group 2 patients had higher levels of lactate dehydrogenase, prevalence of liver dysfunction and increased interleukin-8 (IL-8) than those in group 1, and a higher prevalence of increased IL-8 was found in group 2 than in group 3 (P < .05 for all). The proportions of critical patients in groups 2 and 3 were significantly higher compared with group 1 (38.1%, 32.8% vs. 9.5%, P < .05 for both). Groups 2 and 3 had significantly longer hospital stays than group 1, which was nearly 1 week longer. The composite outcomes risks were 5.47 (1.56-19.82) and 2.61 (0.86-7.88) times greater in groups 2 and 3 than in group 1. CONCLUSIONS: Hyperglycaemia in both diabetes and secondary hyperglycaemia patients with COVID-19 may indicate poor prognoses. There were differences between patients with secondary hyperglycaemia and those with diabetes. We recommend that clinicians pay more attention to the blood glucose status of COVID-19 patients, even those not diagnosed with diabetes before admission.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Diabetes Mellitus/virology , Hyperglycemia/virology , Pneumonia, Viral/blood , Adult , Aged , Blood Glucose/analysis , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/mortality , Diabetes Mellitus/blood , Diabetes Mellitus/mortality , Female , Glycated Hemoglobin A/analysis , Hospitalization/statistics & numerical data , Humans , Hyperglycemia/blood , Hyperglycemia/mortality , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Prognosis , Retrospective Studies
6.
Infect Dis Poverty ; 9(1): 78, 2020 Jun 29.
Article in English | MEDLINE | ID: covidwho-617375

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now a global public threat. Given the pandemic of COVID-19, the economic impact of COVID-19 is essential to add value to the policy-making process. We retrospectively conducted a cost and affordability analysis to determine the medical costs of COVID-19 patients in China, and also assess the factors affecting their costs. METHODS: This analysis was retrospectively conducted in Shandong Provincial Chest Hospital between 24 January and 16 March 2020. The total direct medical expenditures were analyzed by cost factors. We also assessed affordability by comparing the simulated out-of-pocket expenditure of COVID-19 cases relative to the per capita disposable income. Differences between groups were tested by student t test and Mann-Whitney test when appropriate. A multiple logistic regression model was built to determine the risk factors associated with high cost. RESULTS: A total of 70 COVID-19 patients were included in the analysis. The overall mean cost was USD 6827 per treated episode. The highest mean cost was observed in drug acquisition, accounting for 45.1% of the overall cost. Total mean cost was significantly higher in patients with pre-existing diseases compared to those without pre-existing diseases. Pre-existing diseases and the advanced disease severity were strongly associated with higher cost. Around USD 0.49 billion were expected for clinical manage of COVID-19 in China. Among rural households, the proportions of health insurance coverage should be increased to 70% for severe cases, and 80% for critically ill cases to avoid catastrophic health expenditure. CONCLUSIONS: Our data demonstrate that clinical management of COVID-19 patients incurs a great financial burden to national health insurance. The cost for drug acquisition is the major contributor to the medical cost, whereas the risk factors for higher cost are pre-existing diseases and severity of COVID-19. Improvement of insurance coverage will need to address the barriers of rural patients to avoid the occurrence of catastrophic health expenditure.


Subject(s)
Betacoronavirus , Coronavirus Infections , Health Care Costs/statistics & numerical data , Health Expenditures/statistics & numerical data , Pandemics , Pneumonia, Viral , Adolescent , Adult , Aged , Child , Child, Preschool , China , Coronavirus Infections/economics , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Models, Economic , National Health Programs/economics , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Retrospective Studies , Rural Population , Young Adult
7.
World J Pediatr ; 16(4): 326-332, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-613534

ABSTRACT

During the COVID-19 epidemic, it is important for ensuring infection prevention and control in the pediatric respiratory clinics. Herein, we introduced the practice of infection prevention and control in pediatric respiratory clinics in China. Triage measures for patients who visit respiratory clinics, quality control for pediatric respiratory clinics and other preventive measures for related examinations and treatment have been introduced in this review article.


Subject(s)
Ambulatory Care/organization & administration , Communicable Disease Control/organization & administration , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Respiratory Tract Diseases/therapy , Adolescent , Ambulatory Care Facilities/organization & administration , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/epidemiology , Female , Humans , Infection Control/organization & administration , Male , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/epidemiology
8.
Clin Gastroenterol Hepatol ; 18(8): 1753-1759.e2, 2020 07.
Article in English | MEDLINE | ID: covidwho-613156

ABSTRACT

BACKGROUND & AIMS: We compared clinical, laboratory, radiological, and outcome features of patients with SARS-CoV-2 infection (COVID-19) with pneumonia, with vs without diarrhea. METHODS: We performed a retrospective, single-center analysis of 84 patients with SARS-CoV-2 pneumonia in Wuhan Union Hospital, China, from January 19 through February 7, 2020. Cases were confirmed by real-time reverse-transcriptase PCR of nasal and pharyngeal swab specimens for SARS-CoV-2 RNA. Blood samples were analyzed for white blood cell count, lymphocyte count, alanine aminotransferase, creatine kinase, lactate dehydrogenase, D-dimer, C-reactive protein, and in some cases, immunoglobulins, complement, lymphocyte subsets, and cytokines. Virus RNA was detected in stool samples by real-time PCR. RESULTS: Of the 84 patients with SARS-CoV-2 pneumonia, 26 (31%) had diarrhea. The duration of fever and dyspnea in patients with diarrhea was significantly longer than those without diarrhea (all P < .05). Stool samples from a higher proportion of patients with diarrhea tested positive for virus RNA (69%) than from patients without diarrhea (17%) (P < .001). As of February 19, a lower proportion of patients with diarrhea had a negative result from the latest throat swab for SARS-CoV-2 (77%) than patients without diarrhea (97%) (P = .010), during these patients' hospitalization. Of 76 patients with a negative result from their latest throat swab test during hospitalization, a significantly higher proportion of patients with diarrhea had a positive result from the retest for SARS-CoV-2 in stool (45%) than patients without diarrhea (20%) (P = .039). CONCLUSIONS: At a single center in Wuhan, China, 31% of patients with SARS-CoV-2 pneumonia had diarrhea. A significantly higher proportion of patients with diarrhea have virus RNA in stool than patients without diarrhea. Elimination of SARS-CoV-2 from stool takes longer than elimination from the nose and throat.


Subject(s)
Betacoronavirus/isolation & purification , Carrier State/virology , Coronavirus Infections/complications , Coronavirus Infections/pathology , Diarrhea/epidemiology , Diarrhea/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Adult , Aged , Blood Cell Count , Blood Chemical Analysis , China , Diarrhea/pathology , Feces/virology , Female , Hospitals , Humans , Male , Middle Aged , Nasal Mucosa/virology , Pandemics , Pharynx/virology , RNA, Viral/analysis , Real-Time Polymerase Chain Reaction , Retrospective Studies , Young Adult
9.
Travel Med Infect Dis ; : 101803, 2020 Jun 24.
Article in English | MEDLINE | ID: covidwho-612833

ABSTRACT

OBJECTIVES: Pandemic COVID-19 has become a seriously public health priority worldwide. Comprehensive strategies including travel restrictions and mask-wearing have been implemented to mitigate the virus circulation. However, detail information on community transmission is unavailable yet. METHODS: From January 23 to March 1, 2020, 127 patients (median age: 46 years; range: 11-80) with 71 male and 56 female, were confirmed to be infected with the SARS-CoV-2 in Taizhou, Zhejiang, China. Epidemiological trajectory and clinical features of these COVID-19 cases were retrospectively retrieved from electronic medical records and valid individual questionnaire. RESULTS: The disease onset was between January 9 to February 14, 2020. Among them, 64 patients are local residents, and 63 patients were back home from Wuhan from January 10 to 24, 2020 before travel restriction. 197 local residents had definite close-contact with 41 pre-symptomatic patients back from Wuhan. 123 and 74 of them contact with mask-wearing or with no mask-wearing pre-symptomatic patients back from Wuhan, respectively. Data showed that incidence of COVID-19 was significantly higher for local residents close-contact with no mask-wearing Wuhan returned pre-symptomatic patients (19.0% vs. 8.1%, p < 0.001). Among 57 close-contact individuals, 21 sequential local COVID-19 patients originated from a pre-symptomatic Wuhan returned couple, indicated dense gathering in congested spaces is a high risk for SARS-CoV-2 transmission. CONCLUSIONS: Our findings provided valuable details of pre-symptomatic patient mask-wearing and restriction of mass gathering in congested spaces particularly, are important interventions to mitigate the SARS-CoV-2 transmission.

10.
Nutrients ; 12(6)2020 Jun 06.
Article in English | MEDLINE | ID: covidwho-548252

ABSTRACT

COVID-19, a Public Health Emergency of International Concern, has imposed enormous challenges on the health system, economy, and food supply and has substantially modified people's lifestyles. This study aimed to (1) explore the dietary diversity during the lockdown time in China and (2) examine factors associated with dietary diversity including socio-economic characteristics, sources for food and food purchases, and specific dietary behaviors responding to COVID-19 and isolation. A cross-sectional questionnaire-based survey was conducted online in March 2020. Multi-stage sampling was used to recruit participants living in Hubei Province and other parts of China. Dietary diversity was assessed using the Household Dietary Diversity Score (HDDS) and clustering analysis was used to categorize people with different propensities of methods for purchasing or obtaining foods. Logistic regression was used to model the associations among HDDS, participants' characteristics, approaches to purchase or obtain food, and behaviors adopted to cope with COVID-19. Results: A total of 1938 participants were included in the analysis. The overall mean HDDS was 9.7 ± 2.1, and the median (25th, 75th) was 10 (8, 12). There were relatively low consumptions of fish, legumes, and miscellaneous foods (e.g., processed food like snacks and beverages). After adjusting for age, family income, and geographic regions, people living in places where laboratory confirmed COVID-19 cases were above 500 (ORadjusted = 0.79, 95%CI 0.65, 0.96), or living in Hubei Province (ORadjusted = 0.60, 95%CI 0.39, 0.93) had a lower HDDS. During isolation time, the most common sources for food and food purchases were in-house storage and in person grocery shopping. More than half of the participants (55.9%) purchased food at least once via online ordering and delivery services. There was no significant difference in HDDS among people with distinct dependences on different ways to obtain or purchase food (i.e., dependence on in-person grocery shopping, dependence on both in-house storage and in-person grocery shopping, or dependence on online food purchasing). We also identified a total of 37.7% participants who consumed certain foods or nutritional supplements to cope with COVID-19, which included vitamin C, probiotics, other dietary supplements, alcohol, and vinegar. People who reported these specific dietary behaviors had a significantly higher HDDS (ORadjusted = 1.23, 95%CI 1.02, 1.45) than those who did not do so. This study revealed an overall good dietary diversity among the studied Chinese residents during the COVID-19 pandemic. However, we observed a lower dietary diversity among people living in areas with a high number of confirmed COVID-19 cases. Online ordering and delivery services were popular and could serve as a feasible method to obtain and purchase food, contributing to ensure diversified diets during the time of lockdown. Certain dietary behaviors associated with COVID-19 were also identified and had significant impacts on HDDS.


Subject(s)
Coronavirus Infections/epidemiology , Diet/classification , Disease Outbreaks , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , China/epidemiology , Coronavirus Infections/physiopathology , Cross-Sectional Studies , Diet/standards , Diet/trends , Dietary Supplements/statistics & numerical data , Drugs, Chinese Herbal/administration & dosage , Female , Food Supply/methods , Food Supply/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Rural Population , Surveys and Questionnaires , Urban Population , Young Adult
11.
Eur Heart J ; 41(22): 2109-2117, 2020 06 07.
Article in English | MEDLINE | ID: covidwho-526858

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has important implications for the safety of participants in clinical trials and the research staff caring for them and, consequently, for the trials themselves. Patients with heart failure may be at greater risk of infection with COVID-19 and the consequences might also be more serious, but they are also at risk of adverse outcomes if their clinical care is compromised. As physicians and clinical trialists, it is our responsibility to ensure safe and effective care is delivered to trial participants without affecting the integrity of the trial. The social contract with our patients demands no less. Many regulatory authorities from different world regions have issued guidance statements regarding the conduct of clinical trials during this COVID-19 crisis. However, international trials may benefit from expert guidance from a global panel of experts to supplement local advice and regulations, thereby enhancing the safety of participants and the integrity of the trial. Accordingly, the Heart Failure Association of the European Society of Cardiology on 21 and 22 March 2020 conducted web-based meetings with expert clinical trialists in Europe, North America, South America, Australia, and Asia. The main objectives of this Expert Position Paper are to highlight the challenges that this pandemic poses for the conduct of clinical trials in heart failure and to offer advice on how they might be overcome, with some practical examples. While this panel of experts are focused on heart failure clinical trials, these discussions and recommendations may apply to clinical trials in other therapeutic areas.


Subject(s)
Betacoronavirus , Clinical Trials as Topic/methods , Coronavirus Infections , Heart Failure , Pandemics , Pneumonia, Viral , Research Design/standards , Clinical Trials as Topic/ethics , Clinical Trials as Topic/standards , Europe , Heart Failure/complications , Heart Failure/therapy , Humans , Informed Consent/ethics , Informed Consent/standards , Patient Safety , Patient Selection/ethics
12.
Zhonghua Shiyan Yanke Zazhi Chin. J. Exp. Ophthalmol. ; 4(38): 305-310, 20200410.
Article in Chinese | ELSEVIER | ID: covidwho-456364

ABSTRACT

Objective: Due to the circumstances where people being required to home quarantine and eye hospitals being unable to receive patient normally, The application of internet plus technology is explored to build Remote Dedicated Doctor Platform of Ophthalmology (RDDPO) for online consultation, accessing to medication, medical services and advises orderly, and to help to further develop and apply the platform. Methods: In 2018, RDDPO was jointly developed.It has been modified and improved to the formulation of national medical policy and medical insurance policy and the outbreak of COVID-19 at the end of 2019, and it has been carried out comprehensive application verification during the prevention and control of COVID-19 epidemic.With a B/S structure, platform docks the official accounts of Wechat platform.On the server side, three J2EE frameworks of the integrated development, including Struts2, Spring and Hibernate are adopted; on the mobile client side, a combination of development tools including React-Native and Redux is used.Meanwhile, a micro-services Architecture (msA) of RESTful WebAPI is chosen at the business logic layer.The terminal data information is used to summarize the results of the platform's functional services for ophthalmic patients, such as remote diagnosis and treatment, online prescription, medicine delivery and health education, etc., and to make statistics on all kinds of data during the epidemic prevention and control period, so as to verify the operations management capabilities of the platform's functions. Results: During the period of COVID-19 epidemic prevention and control, the number of monthly visits of RDDPO increased from 1063 person times from September 1, 2019 to the end of September to 30 002 person times from February 1, 2020 to February 28, 2020.The proportion of diagnosis and treatment person times of this platform in the total number of diagnosis and treatment person times increased from 19.1% (203/1 063) to 92.3% (277/3 002), which can effectively avoid the risk of personal contact infection and meet the patients' medical needs.95.8% of the patients were very satisfied.95.8% of the patients were very satisfied. Conclusions: The RDDPO establishes a channel for doctor-patient communication during the epidemic, which can be considered as an important way to effectively address the needs of patients for medical treatment.

13.
Eur J Heart Fail ; 22(6): 941-956, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-401833

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is causing considerable morbidity and mortality worldwide. Multiple reports have suggested that patients with heart failure (HF) are at a higher risk of severe disease and mortality with COVID-19. Moreover, evaluating and treating HF patients with comorbid COVID-19 represents a formidable clinical challenge as symptoms of both conditions may overlap and they may potentiate each other. Limited data exist regarding comprehensive management of HF patients with concomitant COVID-19. Since these issues pose serious new challenges for clinicians worldwide, HF specialists must develop a structured approach to the care of patients with COVID-19 and be included early in the care of these patients. Therefore, the Heart Failure Association of the European Society of Cardiology and the Chinese Heart Failure Association & National Heart Failure Committee conducted web-based meetings to discuss these unique clinical challenges and reach a consensus opinion to help providers worldwide deliver better patient care. The main objective of this position paper is to outline the management of HF patients with concomitant COVID-19 based on the available data and personal experiences of physicians from Asia, Europe and the United States.

14.
JMIR Public Health Surveill ; 6(2): e18928, 2020 06 23.
Article in English | MEDLINE | ID: covidwho-260485

ABSTRACT

BACKGROUND: The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. OBJECTIVE: We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. METHODS: We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. RESULTS: The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. CONCLUSIONS: There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO2 deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment.


Subject(s)
Coronavirus Infections/transmission , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy/adverse effects , Pneumonia, Viral/transmission , Clinical Trials as Topic , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Review Literature as Topic , Risk Assessment
15.
Clin. Transl. Immunology ; 5(9)20200501.
Article in English | ELSEVIER | ID: covidwho-209400

ABSTRACT

Objectives: Host immune responses are indispensable to combat the disease. We report the dynamics of peripheral immune cells, cytokines, and human leucocyte antigen-G (HLA-G) and its receptor expressions in a patient suffering from critical COVID-19 pneumonia to convalescence. Methods: Clinical data of the patient were collected from medical records. The expressions of HLA-G and receptors ILT2, ILT4 and KIR2DL4 in peripheral immune cells were measured with flow cytometry. Results: From critical COVID-19 to the convalescent stage, early lymphopenia was improved (median: 0.6 × 109 L−1vs. 0.9 × 109 L−1, P = 0.009), and an obvious fluctuation in WBC and neutrophil counts was observed. Initially, low levels of CD4+T cells (from 120 to 528 μL−1) and CD8+T cells (from 68 to 362 μL−1) gradually increased to normal levels. Meanwhile, high IL-6 (from 251.8 to 6.32 pg mL−1), IL-10 (from 39.53 to 5.21 pg mL−1) and IFN-γ (from 13.55 to 3.16 pg mL−1) levels decreased, and IL-4 (from 2.36 to 3.19 pg mL−1) and TNF-α (from 2.27 to 20.2 pg mL−1) levels increased quickly when the viral RNA returned negative. Moreover, the percentage of HLA-G+T cells, B cells and monocytes follows high–low–high pattern, while the percentage of receptors ILT2-, ILT4- and KIR2DL4-expressing cells remained relatively stable. Conclusion: Our findings provide valuable information on the dynamics of early peripheral immunological responses in SARS-CoV-2 infection. CD4+and CD8+T cells, cytokines and HLA-G+immune cells are associated with the natural history of the critical COVID-19 patient; however, future studies are necessary.

16.
J Microbiol Immunol Infect ; 2020 Apr 27.
Article in English | MEDLINE | ID: covidwho-125502

ABSTRACT

BACKGROUND: The current outbreak of coronavirus disease 2019 (COVID-19) caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, Hubei, China, spreads across national and international borders. METHODS: We prospectively collected medical records of 14 health care workers (HCWs) who were infected with SARS-CoV-2, in neurosurgery department of Wuhan Union Hospital, China. RESULTS: Among the 14 HCWs, 12 were conformed cases, the other 2 were suspected cases. Most of them were either exposed to the two index patients or infected coworkers, without knowing they were COVID-19 patients. There were 4 male and 10 female infected HCWs in this cohort, whose mean age was 36 years (SD, 6 years). The main symptoms included myalgia or fatigue (100%), fever (86%) and dry cough (71%). On admission, 79% of infected HCWs showed leucopenia and 43% lymphopenia. Reduced complement C3 could be seen in 57% of the infected HCWs and IL-6 was significantly elevated in 86% of them. The proportion of lymphocytes subsets, concentrations of immunoglobulins, complement C4, IL-2, IL-4, IL-10, TNF-α and IFN-γ were within normal range in these 14 infected HCWs. The most frequent findings on pulmonary computed tomographic images were bilateral multifocal ground-glass opacifications (86%). CONCLUSIONS: Human-to-human transmission of COVID-19 pneumonia has occurred among HCWs, and most of these infected HCWs with confirmed COVID-19 are mild cases. Our data suggest that in the epidemic area of COVID-19, stringent and urgent surveillance and infection-control measures should be implemented to protect doctors and nurses from COVID-19 infection.

17.
Clin Infect Dis ; 2020 Apr 27.
Article in English | MEDLINE | ID: covidwho-125363

ABSTRACT

BACKGROUND: Pneumonia COVID-19 has became a pandemic. However, information on early risk factors for the duration of SARS-CoV-2 viral positivity is unavailable yet. METHODS: In this prospective study, a cohort of 137 patients with confirmed SARS-CoV-2 infection were enrolled. Clinical information and laboratory data were retrieved from electronic medical records. Viral positivity duration was calculated by an interval from the day SARS-CoV-2 positive confirmed to the day SARS-CoV-2 returned to negative in these 137 COVID-19 patients. Early risk factors for the duration of SARS-CoV-2 viral positivity were evaluated. FINDINGS: The median SARS-CoV-2 viral positivity duration is 12 days (range: 4 days ~ 45 days) for this cohort. Cox regression results showed a significantly shorter viral positivity duration was related to younger [hazard ratio (HR) = 0.658, p = 0.017], not severe patient (HR = 0.653, p = 0.076), higher count of lymphocytes (HR = 1.464, p = 0.033), eosinophils (HR = 1.514, p = 0.020) and CD8+ T cells (HR=1.745, p=0.033), and lower IL-6 (HR = 0.664, p = 0.036) and IL-10 (HR = 0.631, p = 0.021). Multivariate analysis with covariables adjusted results showed that the count of CD8+ T cells (HR=2.376, p=0.114) was a predominant risk factor for the SARS-CoV-2 viral positivity duration. INTERPRETATION: Our findings firstly provided early laboratory parameters such as count of CD8+ T cells, as risk factors for the duration of SARS-CoV-2 viral positivity, which have significance in control and prevention of the disease.

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Chronic Dis Transl Med ; 2020 Mar 27.
Article in English | MEDLINE | ID: covidwho-23282

ABSTRACT

Since December 2019, increasing attention has been paid to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Wuhan, China. SARS-CoV-2 primarily invades the respiratory tract and lungs, leading to pneumonia and other systemic disorders. The effect of SARS-CoV-2 in transplant recipients has raised significant concerns, especially because there is a large population of transplant recipients in China. Based on the current epidemic situation, this study reviewed publications on this virus and coronavirus disease 2019 (COVID-19), analyzed common features of respiratory viral pneumonias, and presented the currently reported clinical characteristics of COVID-19 in transplant recipients to improve strategies regarding the diagnosis and treatment of COVID-19 in this special population.

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