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1.
Jpn J Infect Dis ; 2020 Aug 01.
Article in English | MEDLINE | ID: covidwho-693646

ABSTRACT

We report a hospitalized patient with COVID-19 whose fecal samples turned negative 22 days later than the respiratory samples. It highlights that the duration of virus release from patients is longer than previously expected. Current clinical examinations for treatment and discharge standard are limited to respiratory samples. However, we believe that nucleic acid testing of both respiratory and fecal samples is necessary for discharged patients. Further studies are needed to confirm the potential for fecal-oral transmission or fecal-respiratory transmission via aerosols.

2.
Front. Med. ; (7)20200710.
Article in English | ELSEVIER | ID: covidwho-689650

ABSTRACT

Objective: The aim of the study was to analyze the characteristics of renal function in patients diagnosed with COVID-19. Methods: In this retrospective, single-center study, we included all confirmed cases of COVID-19 in a tertiary hospital in Guangdong, China from January 20, 2020 to March 20, 2020. Blood and urine laboratory findings related to renal function were summarized, and the estimated glomerular filtration rate (eGFR) and endogenous creatinine clearance (Ccr) were also calculated to assess the renal function. Results: A total of 12 admitted hospital patients were diagnosed with COVID-19, included 3 severe cases, and 9 common cases. Serum creatinine (Scr) was not abnormally elevated in all of the patients, and blood urea nitrogen (BUN) was abnormally elevated in only 25.0% of the patients. However, compared with the recovery period, the patient's Scr and BUN increased significantly in peak of disease (p-scr = 0.002 & p-bun < 0.001). By observing the fluctuations in Scr and BUN from admission to recovery, it was found that the peak of Scr and BUN appeared within the first 14 day of the course of the disease. Urinary microprotein detection indicated that the abnormally elevated rates of urine microalbumin (UMA), α1-microglobulin (A1M), urine immunoglobulin-G (IGU), and urine transferring (TRU) standardized by urinary creatinine in peak of disease were 41.7, 41.7, 50.0, and 16.7%, respectively. The abnormal rates of the calculated eGFR and Ccr were 66.7 and 41.7%. Conclusion: Scr and BUN were generally increased during the course of COVID-19. Detection of urinary microproteins and application of multiple indicators assessment could be helpful for discovering abnormal renal function in patients with COVID-19. However, the evidence is limited due to the small sample size and observational nature. Additional studies, especially large prospective cohort studies, are required to confirm these findings.

3.
Medicine ; 99(30):e21404, 2020.
Article | WHO COVID | ID: covidwho-684117

ABSTRACT

Background: The novel coronavirus pneumonia (COVID-19) has spread to >200 countries and regions There is no effective antiviral drug for COVID-19 Traditional Chinese medicine, such as Lianhua Qingwen, has achieved some curative effect in many countries, but its effect is not clear We aim to assess the efficacy and safety of Lianhua Qingwen combined with Conventional antiviral Western Medicine in Clinical treatment of COVID-19 or asymptomatic infection Methods: The following electronic bibliographic databases will be searched to identify relevant studies: CNKI, CBM, VIP and Wanfang databases, PubMed, EMBASE, MEDLINE, Cochrane central, and clinical trial registration centers, such as China Clinical Trial Registration Center (ChiCTR), Netherlands National Trial Registration Center (NTR) and clinical trials gov In addition, Manual retrieval of articles, conference papers, ongoing experiments, internal reports, among others, to supplement electronic retrieval Select all eligible studies published before May 8, 2020 According to the Cochrane Handbook “bias risk” assessment tool, bias risk is independently assessed The independent Newcastle Ottawa scale was used to conduct methodological quality assessment of nonrandomized trials STATA15 1 and RevMan5 3 software were used to analyze meta outcomes of different intervention measures for the treatment of new crown pneumonia and the control group (conventional antiviral western medicine treatment) clinical efficacy Results: This study will provide a relatively high-quality synthesis of current evidence of Lianhua Qingwen combined with Conventional antiviral Western Medicine in the treatment of COVID-19 from several aspects including the Clinical effective rate, CT improvement rate, severe conversion rate, antipyretic time, disappearance rate of fever symptoms, disappearance rate of cough symptoms, disappearance rate of asthenia symptoms, and adverse drug events Conclusion: The conclusion of this review will provide evidence to judge whether Lianhua Qingwen combined with Conventional antiviral Western Medicine is an effective and safe intervention for COVID-19 Ethics and dissemination: This systemic review will evaluate the efficacy and safety of Lianhua Qingwen combined with Conventional antiviral Western Medicine in the treatment of COVID-19 Since all the data included are published, the systematic review does not need ethical approval INPLASY registration number: INPLASY202060067

4.
Nursing Outlook ; 2020.
Article | WHO COVID | ID: covidwho-663963

ABSTRACT

Background During an epidemic of a novel infectious disease, frontline nurses suffer from unprecedented psychological stress This study aimed to assess the immediate psychological impact on frontline nurses in China Methods A multi-center, cross-sectional survey of frontline nurses was conducted via online questionnaires Symptoms of depression, anxiety, somatic disorders and suicidal ideation were evaluated Demographic, stress and support variables were entered into logistic regression analysis to identify the impact factors Results Of the 4692 nurses who completed the survey, 9 4% (n=442) were considered to have depressive symptoms, 8 1% (n=379) represented anxiety, and 42 7% (n=2005) had somatic symptom 6 5% (n=306) respondents had suicidal ideation Conclusions The study showed that the overall mental health of frontline nurses was generally poor during COVID-19 outbreak, and several impact factors associated with nurses’ psychological health were identified Further research is needed to ascertain whether training and support strategies are indeed able to mitigate psychological morbidities

5.
CMAJ ; 192(27): E734-E744, 2020 07 06.
Article in English | MEDLINE | ID: covidwho-661875

ABSTRACT

BACKGROUND: Antiviral medications are being given empirically to some patients with coronavirus disease 2019 (COVID-19). To support the development of a COVID-19 management guideline, we conducted a systematic review that addressed the benefits and harms of 7 antiviral treatments for COVID-19. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PubMed and 3 Chinese databases (CNKI, WANFANG and SinoMed) through Apr. 19, medRxiv and Chinaxiv through Apr. 27, and Chongqing VIP through Apr. 30, 2020. We included studies of ribavirin, chloroquine, hydroxychloroquine, umifenovir (arbidol), favipravir, interferon and lopinavir/ritonavir. If direct evidence from COVID-19 studies was not available, we included indirect evidence from studies of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) for efficacy outcomes and other acute respiratory viral infections for safety outcomes. RESULTS: In patients with nonsevere COVID-19 illness, the death rate was extremely low, precluding an important effect on mortality. We found only very low-quality evidence with little or no suggestion of benefit for most treatments and outcomes in both nonsevere and severe COVID-19. An exception was treatment with lopinavir/ritonavir, for which we found low-quality evidence for a decrease in length of stay in the intensive care unit (risk difference 5 d shorter, 95% confidence interval [CI] 0 to 9 d) and hospital stay (risk difference 1 d shorter, 95% CI 0 to 2 d). For safety outcomes, evidence was of low or very low quality, with the exception of treatment with lopinavir/ritonavir for which moderate-quality evidence suggested likely increases in diarrhea, nausea and vomiting. INTERPRETATION: To date, persuasive evidence of important benefit in COVID-19 does not exist for any antiviral treatments, although for each treatment evidence has not excluded important benefit. Additional randomized controlled trials involving patients with COVID-19 will be needed before such treatments can be administered with confidence.


Subject(s)
Antiviral Agents , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Influenza, Human/drug therapy , Lopinavir/pharmacology , Pneumonia, Viral/drug therapy , Amides , Antiviral Agents/pharmacology , Chloroquine , Evidence-Based Medicine , Humans , Hydroxychloroquine , Indoles , Observational Studies as Topic , Pandemics , Pyrazines , Ribavirin , Ritonavir
6.
J Urol ; : 101097JU0000000000001289, 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-659886

ABSTRACT

PURPOSE: The first case of coronavirus disease 2019 (COVID-19) was identified and confirmed in December 2019 in Wuhan, China. COVID-19 is gradually posing a serious threat to global public health. In this review, the characteristics and mechanism of kidney injury caused by SARS-CoV, MERS-CoV, and SARS-CoV-2 infection are summarized and contrasted. Especially, urine-oral transmission, prevention and management of the kidney injury caused by SARS-CoV-2 were emphasized. MATERIALS AND METHODS: We searched PubMed for English language articles published since 2003 with the keywords "SARS", "MERS", "COVID-19" or "kidney injury". ClinicalTrials.gov was queried for ongoing studies. We also used relevant data from websites, including Centers for Disease Control and Prevention (CDC) and European Centre for Disease Prevention and Control (ECDC). RESULTS: Similar to two other coronaviruses including SARS-CoV and MERS-CoV, SARS-CoV-2 caused severe respiratory syndrome with rapid progression and kidney injury. The infection process of SARS-CoV-2 is mediated by specifically binding to ACE2. The COVID-19 patients combined with kidney impairment are associated with a higher risk of mortality, compared with those without comorbidities. The pathological changes of the kidney are mainly due to local SARS-CoV-2 replication or indirectly by pro-inflammatory cytokine response. Besides, studies have confirmed the isolation of infectious SARS-CoV-2 in urine, raising the possibility of urine-oral transmission. Thus, it is significant for preventing possible potential urine-oral transmission and improving the cure rate of acute kidney injury of COVID-19. CONCLUSIONS: Emerging evidence supports that in patients with SARS-CoV-2 infections, the prevalence of kidney injury is high and usually leads to a poor prognosis. The optimal prevention, management of kidney injury will benefit for COVID-19 patients.

7.
Journal of Scholarly Publishing ; 51(4):273-273–291, 2020.
Article | WHO COVID | ID: covidwho-656461

ABSTRACT

In this brief article, the author speculates on the possible negative impacts of the COVID-19 pandemic on scholarship and scholarly output for academics who may already experience discrimination in the workplace

8.
Cell ; 2020 Jul 17.
Article in English | MEDLINE | ID: covidwho-652603

ABSTRACT

The spike protein of SARS-CoV-2 has been undergoing mutations and is highly glycosylated. It is critically important to investigate the biological significance of these mutations. Here, we investigated 80 variants and 26 glycosylation site modifications for the infectivity and reactivity to a panel of neutralizing antibodies and sera from convalescent patients. D614G, along with several variants containing both D614G and another amino acid change, were significantly more infectious. Most variants with amino acid change at receptor binding domain were less infectious, but variants including A475V, L452R, V483A, and F490L became resistant to some neutralizing antibodies. Moreover, the majority of glycosylation deletions were less infectious, whereas deletion of both N331 and N343 glycosylation drastically reduced infectivity, revealing the importance of glycosylation for viral infectivity. Interestingly, N234Q was markedly resistant to neutralizing antibodies, whereas N165Q became more sensitive. These findings could be of value in the development of vaccine and therapeutic antibodies.

9.
Emerg Infect Dis ; 26(11)2020 Jul 15.
Article in English | MEDLINE | ID: covidwho-647120

ABSTRACT

During January-February 2020, coronavirus disease (COVID-19) and tuberculosis were diagnosed for 3 patients in Wuhan, China. All 3 patients had COVID-19 pneumonia. One severely ill patient died after acute respiratory distress syndrome developed. Clinicians and public health officials should be aware of underlying chronic infections such as tuberculosis in COVID-19 patients.

11.
Injury ; 51(8): 1698-1704, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-598715

ABSTRACT

PURPOSE: Amid the outbreak of coronavirus disease 2019 (COVID-19), effective measures have been taken in China to suggest people wearing masks and staying at home. The majority of the people stayed at home, which had an obvious impact on the occurrence of traumatic fractures. This study aimed to describe the epidemiologic characteristics of traumatic fractures during the COVID-19, and provide reference for targeted control measures for the whole world by proposing China's experiences. METHODS: This was a retrospective & comparative multi-center study with data obtained from 11 hospitals in five provinces of China. Patients were enrolled into this study, who sustained fractures from 20 January to 19 February 2020 and the same period in 2019 (based on Chinese lunar calendar). All patients were divided into two groups: epidemic group (admitted in 2020) and control group (admitted in 2019). The data of patients' demographics (age and gender), injury related data (fracture type, fractured site, osteoporosis fracture, concurrent fractures, injury mechanism, places where fracture occurred, ISS score, Gustilo-Anderson Classification for open fracture), mortality and treatment modality were compared between the two groups. RESULTS: A total of 2,489 patients with 2,590 fractures were included. In the epidemic group, there were 865 patients, including 483 (55.8%) males and 382 (44.2%) females with an average age of 53.1 ± 23.1 years (range, 1 to 105). In the control group, there were 1,624 patients, including 876 (53.9%) males and 748 (46.1%) females with an average age of 51.2 ± 21.5 years (range, 1 to 98). Patients in the epidemic group was significantly older than those in the control group (t=-2.046, P = 0.045). For epidemic group, the mostly commonly involved age group was elderly patients, whereas it was middle-aged adults for the control group (χ2 = 14.642, P = 0.002). For epidemic group, a total of 576 (66.6%) patients had their fracture occurring at home, while in the control group there was 183 (11.3%). The proportion rates of low energy injuries (79.1%, 684/865), osteoporotic fractures (32.5%, 294/906) and closed fractures (94.5%, 817/865) in the epidemic group were significantly higher when compared to the control group, respectively (34.4%, 559/1624; 26.9%, 453/1684; 91.9%, 1,493/1692; all P<0.05). The proportion rates of Gustilo-Anderson classification (5.5%, 16/865), concurrent fractures (2.3%, 20/865), and injury severity score (15.6 ± 6.7) in epidemic group were significantly lower than those in the control group, respectively (52.8%, 199/1624; 3.9%, 63/1624; 20.1 ± 8.7; all P<0.05). No positive case with COVID-19 was diagnosed in the epidemic group. The mortality rate in the epidemic group (0.46%) was similar with that in the control group (0.43%). CONCLUSIONS: Our findings confirmed the importance of the measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19. The epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically, and more attempts should be focused on the prevention of low energy injuries of elderly population.

12.
Medicine (Baltimore) ; 99(24): e20613, 2020 Jun 12.
Article in English | MEDLINE | ID: covidwho-593900

ABSTRACT

BACKGROUND: The 2019 novel coronavirus disease has caused a global pandemic with substantial morbidity and mortality. Chinese medicine has been extensively employed in the coronavirus-related pandemic in China. We aim to assess the efficacy and safety of Chinese medicine in treatment of coronavirus-related pneumonia with the updated results of relevant clinical trials. METHODS: Six electronic databases including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and SinoMed will be searched to identify randomized controlled trials up to May 2020. Patients diagnosed with coronavirus-related pneumonia including severe acute respiratory syndrome, Middle East respiratory syndrome, and 2019 novel coronavirus disease and administrated with Chinese medicine will be included. The primary outcome is the all cause mortality at the longest follow up available. The second outcomes include the length of stay in hospital and intensive care units, the duration of mechanical ventilation, and adverse events. The pooled effects will be analyzed and reported as risk ratios for dichotomous data using the Mantel-Haenszel method or mean differences for continuous data using the inverse-variance method. Sensitivity and subgroup analyses will be performed to test the robustness of the results and to explore the potential sources of heterogeneities. The Egger test and/or funnel plots will be used for the examination of publication bias. The grades of recommendation assessment, development, and evaluation methodology will be used to summarize the quality of evidence. The trial sequential analysis will be conducted to test whether the meta-analysis has a sufficient sample size after adjustment of the increased type I and II error risks. RESULTS: The evidence to date of Chinese medicine in treatment of coronavirus-related pneumonia will be systematically reviewed and meta-analyzed. CONCLUSION: The relevant studies will be summarized and further evidence will be provided.PROSPERO registration number: CRD42020178879.


Subject(s)
Coronavirus Infections/drug therapy , Drugs, Chinese Herbal/therapeutic use , Meta-Analysis as Topic , Phytotherapy , Pneumonia, Viral/drug therapy , Research Design , Systematic Reviews as Topic , Humans , Pandemics , Randomized Controlled Trials as Topic
13.
Theranostics ; 10(14): 6372-6383, 2020.
Article in English | MEDLINE | ID: covidwho-494062

ABSTRACT

Background: The risk factors for adverse events of Coronavirus Disease-19 (COVID-19) have not been well described. We aimed to explore the predictive value of clinical, laboratory and CT imaging characteristics on admission for short-term outcomes of COVID-19 patients. Methods: This multicenter, retrospective, observation study enrolled 703 laboratory-confirmed COVID-19 patients admitted to 16 tertiary hospitals from 8 provinces in China between January 10, 2020 and March 13, 2020. Demographic, clinical, laboratory data, CT imaging findings on admission and clinical outcomes were collected and compared. The primary endpoint was in-hospital death, the secondary endpoints were composite clinical adverse outcomes including in-hospital death, admission to intensive care unit (ICU) and requiring invasive mechanical ventilation support (IMV). Multivariable Cox regression, Kaplan-Meier plots and log-rank test were used to explore risk factors related to in-hospital death and in-hospital adverse outcomes. Results: Of 703 patients, 55 (8%) developed adverse outcomes (including 33 deceased), 648 (92%) discharged without any adverse outcome. Multivariable regression analysis showed risk factors associated with in-hospital death included ≥ 2 comorbidities (hazard ratio [HR], 6.734; 95% CI; 3.239-14.003, p < 0.001), leukocytosis (HR, 9.639; 95% CI, 4.572-20.321, p < 0.001), lymphopenia (HR, 4.579; 95% CI, 1.334-15.715, p = 0.016) and CT severity score > 14 (HR, 2.915; 95% CI, 1.376-6.177, p = 0.005) on admission, while older age (HR, 2.231; 95% CI, 1.124-4.427, p = 0.022), ≥ 2 comorbidities (HR, 4.778; 95% CI; 2.451-9.315, p < 0.001), leukocytosis (HR, 6.349; 95% CI; 3.330-12.108, p < 0.001), lymphopenia (HR, 3.014; 95% CI; 1.356-6.697, p = 0.007) and CT severity score > 14 (HR, 1.946; 95% CI; 1.095-3.459, p = 0.023) were associated with increased odds of composite adverse outcomes. Conclusion: The risk factors of older age, multiple comorbidities, leukocytosis, lymphopenia and higher CT severity score could help clinicians identify patients with potential adverse events.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , China/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/mortality , Female , Hospital Mortality , Humans , Infant , Kaplan-Meier Estimate , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Theranostic Nanomedicine , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Young Adult
14.
Nature ; 2020 May 26.
Article in English | MEDLINE | ID: covidwho-381745

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents a global health emergency that is in urgent need of intervention1-3. The entry of SARS-CoV-2 into its target cells depends on binding between the receptor-binding domain (RBD) of the viral spike protein and its cellular receptor, angiotensin-converting enzyme 2 (ACE2)2,4-6. Here we report the isolation and characterization of 206 RBD-specific monoclonal antibodies derived from single B cells from 8 individuals infected with SARS-CoV-2. We identified antibodies that potently neutralize SARS-CoV-2; this activity correlates with competition with ACE2 for binding to RBD. Unexpectedly, the anti-SARS-CoV-2 antibodies and the infected plasma did not cross-react with the RBDs of SARS-CoV or Middle East respiratory syndrome-related coronavirus (MERS-CoV), although there was substantial plasma cross-reactivity to their trimeric spike proteins. Analysis of the crystal structure of RBD-bound antibody revealed that steric hindrance inhibits viral engagement with ACE2, thereby blocking viral entry. These findings suggest that anti-RBD antibodies are largely viral-species-specific inhibitors. The antibodies identified here may be candidates for development of clinical interventions against SARS-CoV-2.

15.
Sleep Med ; 72: 1-4, 2020 May 23.
Article in English | MEDLINE | ID: covidwho-342920

ABSTRACT

OBJECTIVE: To evaluate sleep disturbances of Chinese frontline medical workers (FMW) under the outbreak of coronavirus disease 2019 (COVID-19), and make a comparison with non-FMW. METHODS: The medical workers from multiple hospitals in Hubei Province, China, volunteered to participate in this cross-sectional study. An online questionnaire, including Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS) and Visual Analogue Scale (VAS), was used to evaluate sleep disturbances and mental status. Sleep disturbances were defined as PSQI>6 points or/and AIS>6 points. We compared the scores of PSQI, AIS, anxiety and depression VAS, as well as prevalence of sleep disturbances between FMW and non-FMW. RESULTS: A total of 1306 subjects (801 FMW and 505 non-FMW) were enrolled. Compared to non-FMW, FMW had significantly higher scores of PSQI (9.3 ± 3.8 vs 7.5 ± 3.7; P < 0.001; Cohen's d = 0.47), AIS (6.9 ± 4.3 vs 5.3 ± 3.8; P < 0.001; Cohen's d = 0.38), anxiety (4.9 ± 2.7 vs 4.3 ± 2.6; P < 0.001; Cohen's d = 0.22) and depression (4.1 ± 2.5 vs 3.6 ± 2.4; P = 0.001; Cohen's d = 0.21), as well as higher prevalence of sleep disturbances according to PSQI > 6 points (78.4% vs 61.0%; relative risk [RR] = 1.29; P < 0.001) and AIS > 6 points (51.7% vs 35.6%; RR = 1.45; P < 0.001). CONCLUSION: FMW have higher prevalence of sleep disturbances and worse sleep quality than non-FMW. Further interventions should be administrated for FMW, aiming to maintain their healthy condition and guarantee their professional performance in the battle against COVID-19.

16.
Emerg Microbes Infect ; 9(1): 1259-1268, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-342833

ABSTRACT

Quantitative real time PCR (RT-PCR) is widely used as the gold standard for clinical detection of SARS-CoV-2. However, due to the low viral load specimens and the limitations of RT-PCR, significant numbers of false negative reports are inevitable, which results in failure to timely diagnose, cut off transmission, and assess discharge criteria. To improve this situation, an optimized droplet digital PCR (ddPCR) was used for detection of SARS-CoV-2, which showed that the limit of detection of ddPCR is significantly lower than that of RT-PCR. We further explored the feasibility of ddPCR to detect SARS-CoV-2 RNA from 77 patients, and compared with RT-PCR in terms of the diagnostic accuracy based on the results of follow-up survey. 26 patients of COVID-19 with negative RT-PCR reports were reported as positive by ddPCR. The sensitivity, specificity, PPV, NPV, negative likelihood ratio (NLR) and accuracy were improved from 40% (95% CI: 27-55%), 100% (95% CI: 54-100%), 100%, 16% (95% CI: 13-19%), 0.6 (95% CI: 0.48-0.75) and 47% (95% CI: 33-60%) for RT-PCR to 94% (95% CI: 83-99%), 100% (95% CI: 48-100%), 100%, 63% (95% CI: 36-83%), 0.06 (95% CI: 0.02-0.18), and 95% (95% CI: 84-99%) for ddPCR, respectively. Moreover, 6/14 (42.9%) convalescents were detected as positive by ddPCR at 5-12 days post discharge. Overall, ddPCR shows superiority for clinical diagnosis of SARS-CoV-2 to reduce the false negative reports, which could be a powerful complement to the RT-PCR.


Subject(s)
Betacoronavirus/genetics , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Real-Time Polymerase Chain Reaction/methods , False Negative Reactions , Humans , Limit of Detection , Pandemics , RNA, Viral/genetics , Viral Load/methods
17.
Intensive Care Med ; 46(8): 1627-1629, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-209805
18.
Theranostics ; 10(12): 5613-5622, 2020.
Article in English | MEDLINE | ID: covidwho-203318

ABSTRACT

Rationale: Some patients with coronavirus disease 2019 (COVID-19) rapidly develop respiratory failure or even die, underscoring the need for early identification of patients at elevated risk of severe illness. This study aims to quantify pneumonia lesions by computed tomography (CT) in the early days to predict progression to severe illness in a cohort of COVID-19 patients. Methods: This retrospective cohort study included confirmed COVID-19 patients. Three quantitative CT features of pneumonia lesions were automatically calculated using artificial intelligence algorithms, representing the percentages of ground-glass opacity volume (PGV), semi-consolidation volume (PSV), and consolidation volume (PCV) in both lungs. CT features, acute physiology and chronic health evaluation II (APACHE-II) score, neutrophil-to-lymphocyte ratio (NLR), and d-dimer, on day 0 (hospital admission) and day 4, were collected to predict the occurrence of severe illness within a 28-day follow-up using both logistic regression and Cox proportional hazard models. Results: We included 134 patients, of whom 19 (14.2%) developed any severe illness. CT features on day 0 and day 4, as well as their changes from day 0 to day 4, showed predictive capability. Changes in CT features from day 0 to day 4 performed the best in the prediction (area under the receiver operating characteristic curve = 0.93, 95% confidence interval [CI] 0.87~0.99; C-index=0.88, 95% CI 0.81~0.95). The hazard ratios of PGV and PCV were 1.39 (95% CI 1.05~1.84, P=0.023) and 1.67 (95% CI 1.17~2.38, P=0.005), respectively. CT features, adjusted for age and gender, on day 4 and in terms of changes from day 0 to day 4 outperformed APACHE-II, NLR, and d-dimer. Conclusions: CT quantification of pneumonia lesions can early and non-invasively predict the progression to severe illness, providing a promising prognostic indicator for clinical management of COVID-19.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Lung/pathology , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Adult , Aged , Algorithms , Artificial Intelligence , Betacoronavirus , China , Disease Progression , Female , Humans , Image Processing, Computer-Assisted , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Prognosis , Retrospective Studies , Tomography, X-Ray Computed
19.
J Med Virol ; 92(6): 540-545, 2020 06.
Article in English | MEDLINE | ID: covidwho-153831

ABSTRACT

So far, there is a lack of effective drugs for the new coronavirus pneumonia. With more and more patients diagnosed, China has carried out more than 100 clinical studies of new coronavirus infection, including antiviral drugs, antimalarial drugs, glucocorticoids, plasma therapy, virus vaccine, and other Western drugs, while Chinese medicine research accounted for half of the studies. Most of the trials were initiated by investigators and the study period would last for 1 to 11 months. The primary endpoints included symptom improvement and virus nucleic acid turning negative, but the optimal endpoint has not been determined. Although the final results of studies will take a long time to complete, the interim research data may provide some help for the current urgent demand for drug treatment. Compared with that of during SARS period in 2003, China has the stronger capability to carry out clinical trials of new drugs in emergency period.


Subject(s)
Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Disease Outbreaks , Drugs, Chinese Herbal/therapeutic use , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Amides/therapeutic use , Betacoronavirus/drug effects , Betacoronavirus/genetics , Betacoronavirus/pathogenicity , China/epidemiology , Chloroquine/analogs & derivatives , Chloroquine/therapeutic use , Clinical Trials as Topic , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Disease Management , Humans , Medicine, Chinese Traditional/methods , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Practice Guidelines as Topic , Pyrazines/therapeutic use
20.
Emerg Microbes Infect ; 9(1): 761-770, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-29222

ABSTRACT

Circulating in China and 158 other countries and areas, the ongoing COVID-19 outbreak has caused devastating mortality and posed a great threat to public health. However, efforts to identify effectively supportive therapeutic drugs and treatments has been hampered by our limited understanding of host immune response for this fatal disease. To characterize the transcriptional signatures of host inflammatory response to SARS-CoV-2 (HCoV-19) infection, we carried out transcriptome sequencing of the RNAs isolated from the bronchoalveolar lavage fluid (BALF) and peripheral blood mononuclear cells (PBMC) specimens of COVID-19 patients. Our results reveal distinct host inflammatory cytokine profiles to SARS-CoV-2 infection in patients, and highlight the association between COVID-19 pathogenesis and excessive cytokine release such as CCL2/MCP-1, CXCL10/IP-10, CCL3/MIP-1A, and CCL4/MIP1B. Furthermore, SARS-CoV-2 induced activation of apoptosis and P53 signalling pathway in lymphocytes may be the cause of patients' lymphopenia. The transcriptome dataset of COVID-19 patients would be a valuable resource for clinical guidance on anti-inflammatory medication and understanding the molecular mechansims of host response.


Subject(s)
Bronchoalveolar Lavage Fluid , Chemokines/analysis , Coronavirus Infections/genetics , Cytokines/analysis , Leukocytes, Mononuclear , Pneumonia, Viral/genetics , Transcriptome , Apoptosis , Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/immunology , Humans , Lymphopenia , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/immunology , RNA-Seq , Signal Transduction , Tumor Suppressor Protein p53
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