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1.
J Trauma Acute Care Surg ; 2020 Sep 09.
Article in English | MEDLINE | ID: covidwho-760082

ABSTRACT

Invasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving IMV in Wuhan and to discuss the timing of IMV in these patients. METHODS: Data of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020 were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge. RESULTS: Among 40 COVID-19 patients with IMV, 31 died, 9 survived and discharged. The median age was 70 years (IQR 62-76), and non-survivors were older than survivors. The median period from the non-invasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR 2-42) in IMV survivors and 54 hours (IQR 28-143) in IMV non-survivors. We observed that when the time interval from NIV/HFNC to intubation less than 50 hours (about 2 calendar days), together with APACHE II score less than 10, or PSI score less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation as well as high levels of APACHE II and PSI prior to intubation was associated with higher mortality in critically ill patients. Multiple organ damage was common among these non-survivors in the course of treatment. CONCLUSION: Early initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI score might help physicians in decision-making about timing of intubation for curbing subsequent mortality. LEVEL OF EVIDENCE: level Vtherapeutic.

2.
J. Cancer ; 21(11): 6243-6247, 2020.
Article in English | ELSEVIER | ID: covidwho-750443

ABSTRACT

Background: The Coronavirus disease 2019 (COVID-19) global pandemic has posed unprecedented challenges to the health-care systems all over the world. Among the booming literatures about COVID-19, there is yet a paucity of study addressing the association between COVID-19 and cancer, which is a rare comorbidity of COVID-19, as well as consensus for treatment of cancer in this pandemic. Methods: In this retrospective, single-center cohort study, information of all inpatient cases with laboratory-confirmed COVID-19 who had treatment outcome were collected from the designated departments in Zhongnan Hospital of Wuhan University, Wuhan, China on March 10, 2020. Demographic data, clinical information, and treatment outcomes were extracted from electronic medical records. Severe events were defined as admission to intensive care unit (ICU), the use of mechanical ventilation, or death. Result: A total of 716 patients with laboratory-confirmed COVID-19 infection were identified. Among them, a total of 12 cases (1.7%, 95% CI: 0.7%-2.6%) had history of cancer with 4 cases (33%) experienced severe events. Compared with cases without cancer, patients with cancer have higher risks of severe events (33% vs 7.7%, p=0.012) and deaths (25% vs 3.6%, p=0.009). Multivariable logistic regression model showed that cancer was independently associated with increased odds of severe events after adjusting for other risk factors (OR 6.51, 95% CI 1.72-24.64; p=0.006). Among COVID-19 patients with cancer, we found that patients older than 60 years (75%), with other comorbidities (50%), or experiencing anticancer treatment in past month (42.9%) had a numerically higher incidence of severe events. Conclusion: Cancer is a rare comorbidity of patients with COVID-19; however, it cannot be overemphasized due to its poorer outcomes. We propose that personalized treatment recommendation for cancer patients should be addressed during COVID-19 pandemic, along with meticulous personal protective protocols for them to mitigate the risk of SARS-CoV-2 infection.

3.
Engineering ; 2020.
Article | WHO COVID | ID: covidwho-743961

ABSTRACT

Fast and accurate diagnosis and the immediate isolation of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are regarded as the most effective measures to restrain the coronavirus disease 2019 (COVID-19) pandemic Here, we present a high-throughput, multi-index nucleic acid isothermal amplification analyzer (RTisochipTM-W) employing a centrifugal microfluidic chip to detect 19 common respiratory viruses, including SARS-CoV-2, from 16 samples in a single run within 90 min The limits of detection of all the viruses analyzed by the RTisochipTM-W system were equal to or less than 50 copies per microliter, which is comparable to those of conventional reverse-transcription polymerase chain reaction We also demonstrate that the RTisochipTM-W system possesses the advantages of good repeatability, strong robustness, and high specificity Finally, we analyzed 201 cases of preclinical samples, 14 cases of COVID-19-positive samples, 25 cases of clinically diagnosed samples, and 614 cases of clinical samples from patients or suspected patients with respiratory tract infections using the RTisochipTM-W system The test results matched the referenced results well and reflected the epidemic characteristics of the respiratory infectious diseases The coincidence rate of the RTisochipTM-W with the referenced kits was 98 15% for the detection of SARS-CoV-2 Based on these extensive trials, we believe that the RTisochipTM-W system provides a powerful platform for fighting the COVID-19 pandemic

4.
Global Health ; 16(1): 75, 2020 08 19.
Article in English | MEDLINE | ID: covidwho-721311

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) has been found in more than 200 countries worldwide since December, 2019. In China, a major reason for the rapid transmission of the COVID-19 in early stage of the outbreak is the huge numbers of passengers boarding their "last train home" to meet family members during the Spring Festival. Most of these travelers were internal migrant workers. In order to reduce the risk of the COVID-19 transmission, public transportation networks were suspended, and many migrant workers who returned to their hometowns needed to be quarantined for 2 weeks, which led to the delay of returning back to cities to work. Many businesses have temporarily closed because of the risk of COVID-19 transmission, leading to unemployment of many workers. Sudden loss of income and further quarantine enforcement in cities can exacerbate existing mental health problems or trigger new mental disorders among affected migrant workers. However, to date no specific guidelines or strategies about mental health services of migrant workers have been released. Health authorities and professionals should pay more attention to this vulnerable group and provide timely mental health service support for those in need.


Subject(s)
Coronavirus Infections/epidemiology , Disease Outbreaks , Emergency Services, Psychiatric , Health Services Needs and Demand , Pneumonia, Viral/epidemiology , Transients and Migrants/psychology , China/epidemiology , Humans , Pandemics
5.
Int J Biol Sci ; 16(13): 2265-2270, 2020.
Article in English | MEDLINE | ID: covidwho-689141

ABSTRACT

The 2019 novel coronavirus disease (COVID-19) epidemic in China has presented substantial challenges to traditional forms of mental health service delivery. This review summarizes the expert consensus on the mental health treatment and services for severe psychiatric disorders during the COVID-19 outbreak developed by the Chinese Society of Psychiatry and other academic associations. The Expert Recommendations on Managing Patients with Mental Disorders during a Serious Infectious Disease Outbreak (COVID-19) outline the appropriate measures for psychiatric hospitals or psychiatric units in general hospitals, including the delivery of outpatient, inpatient, and community mental health services. The Expert Recommendations on Internet and Telehealth in Psychiatry during Major Public Health Crises (COVID-19) describe the assessment and treatment issues of internet-based mental health services during the COVID-19 outbreak. The expert consensus recommendations provide guidance for mental health professionals in managing psychiatric services during the COVID-19 outbreak in China. The experiences from China in addressing the challenges in the management of major psychiatric disorders may be useful and relevant to other countries who are combating the COVID-19 pandemic.


Subject(s)
Community Mental Health Services/organization & administration , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Mental Disorders/psychology , Mental Disorders/therapy , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Betacoronavirus , China/epidemiology , Consensus , Humans , Inpatients , Internet , Mental Health Services/organization & administration , Outpatients , Pandemics , Telemedicine
6.
J Ultrasound Med ; 2020 Jul 29.
Article in English | MEDLINE | ID: covidwho-684709

ABSTRACT

To date, coronavirus disease 2019 (COVID-19) has infected millions of people worldwide. Ultrasound plays an indispensable role in the diagnosis, monitoring, and follow-up of patients with COVID-19. In this study, we used a robotic tele-echography system based on a 5G communication network for remote diagnosis. The system has great potential for lung, heart, and vasculature information, medical staff protection, and resource sharing, can be a valuable tool for treating patients during the pandemic, and can be expected to expand to more specialized fields.

7.
Chest ; 2020 Jul 09.
Article in English | MEDLINE | ID: covidwho-640948

ABSTRACT

BACKGROUND: Traditional methods for cardiopulmonary assessment of patients with coronavirus disease 2019 (COVID-19) pose risks to both patients and examiners. This necessitates a remote examination of such patients without sacrificing information quality. RESEARCH QUESTION: The goal of this study was to assess the feasibility of a 5G-based robot-assisted remote ultrasound system in examining patients with COVID-19 and to establish an examination protocol for telerobotic ultrasound scanning. STUDY DESIGN AND METHODS: Twenty-three patients with COVID-19 were included and divided into two groups. Twelve were nonsevere cases, and 11 were severe cases. All patients underwent a 5G-based robot-assisted remote ultrasound system examination of the lungs and heart following an established protocol. Distribution characteristics and morphology of the lung and surrounding tissue lesions, left ventricular ejection fraction, ventricular area ratio, pericardial effusion, and examination-related complications were recorded. Bilateral lung lesions were evaluated by using a lung ultrasound score. RESULTS: The remote ultrasound system successfully and safely performed cardiopulmonary examinations of all patients. Peripheral lung lesions were clearly evaluated. Severe cases of COVID-19 had significantly more diseased regions (median [interquartile range], 6.0 [2.0-11.0] vs 1.0 [0.0-2.8]) and higher lung ultrasound scores (12.0 [4.0-24.0] vs 2.0 [0.0-4.0]) than nonsevere cases of COVID-19 (both, P < .05). One nonsevere case (8.3%; 95% CI, 1.5-35.4) and three severe cases (27.3%; 95% CI, 9.7-56.6) were complicated by pleural effusions. Four severe cases (36.4%; 95% CI, 15.2-64.6) were complicated by pericardial effusions (vs 0% of nonsevere cases, P < .05). No patients had significant examination-related complications. INTERPRETATION: Use of the 5G-based robot-assisted remote ultrasound system is feasible and effectively obtains ultrasound characteristics for cardiopulmonary assessment of patients with COVID-19. By following established protocols and considering medical history, clinical manifestations, and laboratory markers, this system might help to evaluate the severity of COVID-19 remotely.

8.
Cardiovasc Res ; 116(10): 1733-1741, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-637912

ABSTRACT

AIMS: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) directly binds to ACE2 (angiotensin-converting enzyme 2) to facilitate cellular entry. Compared with the lung or respiratory tract, the human heart exhibits greater ACE2 expression. However, little substantial damage was found in the heart tissue, and no viral particles were observed in the cardiac myocytes. This study aims to analyse ACE2 and SARS-CoV-2 spike (S) protein proteases at the single-cell level, to explore the cardiac involvement in COVID-19 and improve our understanding of the potential cardiovascular implications of COVID-19. METHODS AND RESULTS: With meta-analysis, the prevalence of cardiac injury in COVID-19 patients varies from 2% [95% confidence interval (CI) 0-5%, I2 = 0%] in non-ICU patients to 59% (95% CI 48-71%, I2 = 85%) in non-survivors. With public single-cell sequence data analysis, ACE2 expression in the adult human heart is higher than that in the lung (adjusted P < 0.0001). Inversely, the most important S protein cleavage protease TMPRSS2 (transmembrane protease serine protease-2) in the heart exhibits an extremely lower expression than that in the lung (adjusted P < 0.0001), which may restrict entry of SARS-CoV-2 into cardiac cells. Furthermore, we discovered that other S protein proteases, CTSL (cathepsin L) and FURIN (furin, paired basic amino acid cleaving enzyme), were expressed in the adult heart at a similar level to that in the lung, which may compensate for TMPRSS2, mediating cardiac involvement in COVID-19. CONCLUSION: Compared with the lung, ACE2 is relatively more highly expressed in the human heart, while the key S protein priming protease, TMPRSS2, is rarely expressed. The low percentage of ACE2+/TMPRSS2+ cells reduced heart vulnerability to SARS-CoV-2 to some degree. CTSL and FURIN may compensate for S protein priming to mediate SARS-CoV-2 infection of the heart.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/metabolism , Myocardium/enzymology , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/metabolism , Single-Cell Analysis , Spike Glycoprotein, Coronavirus/metabolism , Humans , Lung/metabolism , Lung/virology , Pandemics , Peptide Hydrolases/metabolism , Proteolysis
9.
World Neurosurg ; 140: e381-e386, 2020 08.
Article in English | MEDLINE | ID: covidwho-624489

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on the healthcare system. Owing to restrictions in elective surgery and social distancing guidelines, the training curriculum for neurosurgical trainees has been rapidly evolving. This evolution could have significant long-term effects on the training of neurosurgery residents. The objective of the present study was to assess the effects of COVID-19 on neurosurgical training programs and residents. METHODS: A survey consisting of 31 questions assessing changes to resident clinical and educational workload and their sentiment regarding how these changes might affect their careers was distributed electronically to neurosurgery residents in the United States and Canada. RESULTS: The survey respondents were from 29 states and Canada and were relatively evenly spread across all levels of residency. Nearly 82% reported that the inpatient and outpatient volumes had been either greatly (44.0%) or moderately (37.8%) reduced. Greater than 91% reported that their work responsibilities or access to the hospital had been reduced, with a significant reduction in work hours and a significant increase in resident didactics (P < 0.001). Senior residents expressed concern about their educational experience and their future career prospects as a result of the pandemic. CONCLUSION: Universally, residents have experienced reduced work hours and a reduction in their operative case volumes. Programs have adapted by increasing didactic time and using electronic platforms. It is quite possible that this remarkable period will prompt a critical reappraisal of the pre-COVID-19 adequacy of educational content in our training programs and that the enhanced educational efforts driven by this pandemic could be lasting.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections , Education, Medical, Continuing , Neurosurgery/education , Pandemics , Pneumonia, Viral , Surveys and Questionnaires , Canada , Curriculum , Humans , Internship and Residency , Workload
10.
Front Cell Infect Microbiol ; 10: 318, 2020.
Article in English | MEDLINE | ID: covidwho-615471

ABSTRACT

Background: A novel enveloped RNA beta coronavirus, Corona Virus Disease 2019 (COVID-19) caused severe and even fetal pneumonia in China and other countries from December 2019. Early detection of severe patients with COVID-19 is of great significance to shorten the disease course and reduce mortality. Methods: We assembled a retrospective cohort of 80 patients (including 56 mild and 24 severe) with COVID-19 infection treated at Beijing You'an Hospital. We used univariable and multivariable logistic regression analyses to select the risk factors of severe and even fetal pneumonia and build scoring system for prediction, which was validated later on in a group of 22 COVID-19 patients. Results: Age, white blood cell count, neutrophil, glomerular filtration rate, and myoglobin were selected by multivariate analysis as candidates of scoring system for prediction of disease severity in COVID-19. The scoring system was applied to calculate the predictive value and found that the percentage of ICU admission (20%, 6/30) and ventilation (16.7%, 5/30) in patients with high risk was much higher than those (2%, 1/50; 2%, 1/50) in patients with low risk (p = 0.009; p = 0.026). The AUC of scoring system was 0.906, sensitivity of prediction is 70.8%, and the specificity is 89.3%. According to scoring system, the probability of patients in high risk group developing severe disease was 20.24 times than that in low risk group. Conclusions: The possibility of severity in COVID-19 infection predicted by scoring system could help patients to receiving different therapy strategies at a very early stage. Topic: COVID-19, severe and fetal pneumonia, logistic regression, scoring system, prediction.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/pathology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/pathology , Severity of Illness Index , Aged , Aged, 80 and over , Betacoronavirus/pathogenicity , China , Comorbidity , Disease Progression , Female , Glomerular Filtration Rate/physiology , Humans , Leukocyte Count , Male , Middle Aged , Myoglobin/analysis , Neutrophil Infiltration/immunology , Neutrophils/immunology , Pandemics , Prognosis , Retrospective Studies
11.
Cell Metab ; 32(2): 176-187.e4, 2020 08 04.
Article in English | MEDLINE | ID: covidwho-612919

ABSTRACT

Statins are lipid-lowering therapeutics with favorable anti-inflammatory profiles and have been proposed as an adjunct therapy for COVID-19. However, statins may increase the risk of SARS-CoV-2 viral entry by inducing ACE2 expression. Here, we performed a retrospective study on 13,981 patients with COVID-19 in Hubei Province, China, among which 1,219 received statins. Based on a mixed-effect Cox model after propensity score-matching, we found that the risk for 28-day all-cause mortality was 5.2% and 9.4% in the matched statin and non-statin groups, respectively, with an adjusted hazard ratio of 0.58. The statin use-associated lower risk of mortality was also observed in the Cox time-varying model and marginal structural model analysis. These results give support for the completion of ongoing prospective studies and randomized controlled trials involving statin treatment for COVID-19, which are needed to further validate the utility of this class of drugs to combat the mortality of this pandemic.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Coronavirus Infections/drug therapy , Drug Repositioning/methods , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Pneumonia, Viral/drug therapy , Aged , Betacoronavirus/drug effects , Comorbidity , Coronavirus Infections/mortality , Cytokine Release Syndrome/drug therapy , Drug Therapy, Combination , Female , Humans , Hypertension/drug therapy , Male , Middle Aged , Pandemics , Peptidyl-Dipeptidase A/drug effects , Pneumonia, Viral/mortality , Retrospective Studies
12.
J Infect Dis ; 222(1): 34-37, 2020 06 16.
Article in English | MEDLINE | ID: covidwho-599711

ABSTRACT

A major unanswered question in the current global coronavirus disease 2019 (COVID-19) outbreak is why severe disease develops in a small minority of infected individuals. In the current article, we report that homozygosity for the C allele of rs12252 in the interferon-induced transmembrane protein 3 (IFITM3) gene is associated with more severe disease in an age-dependent manner. This supports a role for IFITM3 in disease pathogenesis and the opportunity for early targeted intervention in at-risk individuals.


Subject(s)
Alleles , Betacoronavirus/genetics , Coronavirus Infections/genetics , Membrane Proteins/genetics , Pneumonia, Viral/genetics , Polymorphism, Single Nucleotide , RNA-Binding Proteins/genetics , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Cohort Studies , Coronavirus Infections/virology , Female , Genotype , High-Throughput Nucleotide Sequencing , Homozygote , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Real-Time Polymerase Chain Reaction
13.
JCI Insight ; 5(13)2020 07 09.
Article in English | MEDLINE | ID: covidwho-541270

ABSTRACT

BACKGROUND: Identifying immune correlates of COVID-19 disease severity is an urgent need for clinical management, vaccine evaluation, and drug development. Here, we present a temporal analysis of key immune mediators, cytokines, and chemokines in blood of hospitalized COVID-19 patients from serial sampling and follow-up over 4 weeks. METHODS: A total of 71 patients with laboratory-confirmed COVID-19 admitted to Beijing You'an Hospital in China with either mild (53 patients) or severe (18 patients) disease were enrolled with 18 healthy volunteers. We measured 34 immune mediators, cytokines, and chemokines in peripheral blood every 4-7 days over 1 month per patient using a bioplex multiplex immunoassay. RESULTS: We found that the chemokine RANTES (CCL5) was significantly elevated, from an early stage of the infection, in patients with mild but not severe disease. We also found that early production of inhibitory mediators including IL-10 and IL-1RA were significantly associated with disease severity, and a combination of CCL5, IL-1 receptor antagonist (IL-1RA), and IL-10 at week 1 may predict patient outcomes. The majority of cytokines that are known to be associated with the cytokine storm in virus infections such as IL-6 and IFN-γ were only significantly elevated in the late stage of severe COVID-19 illness. TNF-α and GM-CSF showed no significant differences between severe and mild cases. CONCLUSION: Together, our data suggest that early intervention to increase expression of CCL5 may prevent patients from developing severe illness. Our data also suggest that measurement of levels of CCL5, as well as IL-1RA and IL-10 in blood individually and in combination, might be useful prognostic biomarkers to guide treatment strategies.


Subject(s)
Chemokine CCL5/immunology , Coronavirus Infections/immunology , Interleukin 1 Receptor Antagonist Protein/immunology , Interleukin-10/immunology , Pneumonia, Viral/immunology , Adult , Aged , Betacoronavirus , Case-Control Studies , Coronavirus Infections/physiopathology , Cytokine Release Syndrome/immunology , Female , Granulocyte-Macrophage Colony-Stimulating Factor/immunology , Hospitalization , Humans , Immunoassay , Interferon-gamma/immunology , Interleukin-6/immunology , Longitudinal Studies , Male , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Severity of Illness Index , Tumor Necrosis Factor-alpha/immunology
14.
The American Journal of Emergency Medicine ; 2020.
Article | WHO COVID | ID: covidwho-401492

ABSTRACT

Objectives N95 mask is essential for healthcare workers dealing with the coronavirus disease 2019 (COVID-19) However, N95 mask causes discomfort breathing with marked reduction in air exchange This study was designed to investigate whether the use of N95 mask affects rescuer's fatigue and chest compression quality during cardiopulmonary resuscitation (CPR) Methods After a brief review of CPR, each participant performed a 2-minute continuous chest compression on a manikin wearing N95 (N95 group, n = 40) or surgical mask (SM group, n = 40) Compression rate and depth, the proportions of correct compression rate, depth, complete chest recoil and hand position were documented Participants' fatigue was assessed using Borg score Results Significantly lower mean chest compression rate and depth were both achieved in the N95 group than in the SM group (p < 0 05, respectively) In addition, the proportion of correct compression rate (61 ± 19 vs 75 ± 195, p = 0 0067), depth (67 ± 16 vs 90 ± 14, p < 0 0001) and complete recoil (91 ± 16 vs 98 ± 5%, p = 0 0248) were significantly decreased in the N95 group as compared to the SM group At the end of compression, the Borg score in the N95 group was significantly higher than that in the SM group (p = 0 027) Conclusion Wearing a N95 mask increases rescuer's fatigue and decreases chest compression quality during CPR Therefore, the exchange of rescuers during CPR should be more frequent than that recommended in current guidelines when N95 masks are applied

15.
Crit Care Med ; 48(9): 1289-1295, 2020 09.
Article in English | MEDLINE | ID: covidwho-317610

ABSTRACT

OBJECTIVES: Severe acute respiratory distress syndrome is complicated with coronavirus disease 2019 and extracorporeal membrane oxygenation support may be necessary in severe cases. This study is to summarize the clinical features, extracorporeal membrane oxygenation characteristics, and outcomes of patients with severe acute respiratory syndrome coronavirus 2 pneumonia received extracorporeal membrane oxygenation. DESIGN: Descriptive study from two hospitals. SETTING: The ICUs from university hospitals. PATIENTS: Patients with severe acute respiratory syndrome coronavirus 2 pneumonia received mechanical ventilation, including those underwent extracorporeal membrane oxygenation from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8, 2020, to March 31, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical records, laboratory results, ventilator parameters, and extracorporeal membrane oxygenation-related data were abstracted from the medical records. One-hundred twenty-nine critically ill patients with severe acute respiratory syndrome coronavirus 2 pneumonia were admitted to ICU of the two referral hospitals. Fifty-nine patients received mechanical ventilation and 21 of them received extracorporeal membrane oxygenation support (fourteen from Zhongnan hospital and seven from Wuhan pulmonary hospital). Compared to mechanical ventilation patients without extracorporeal membrane oxygenation support, there was a tendency of decline in mortality but with no significant difference (no-extracorporeal membrane oxygenation group 24/38 [63.2%] vs extracorporeal membrane oxygenation group 12/21 [57.1%]; p = 0.782). For those patients with extracorporeal membrane oxygenation, 12 patients died and nine survived by April 7, 2020. Among extracorporeal membrane oxygenation patients, the PaCO2 prior to extracorporeal membrane oxygenation was lower (54.40 mm Hg [29.20-57.50 mm Hg] vs 63.20 mm Hg [55.40-72.12 mm Hg]; p = 0.006), and pH prior to extracorporeal membrane oxygenation was higher (7.38 [7.28-7.48] vs 7.23 [7.16-7.33]; p = 0.023) in survivors than nonsurvivors. CONCLUSIONS: Extracorporeal membrane oxygenation might be an effective salvage treatment for patients with severe acute respiratory syndrome coronavirus 2 pneumonia associated with severe acute respiratory distress syndrome. Severe CO2 retention and acidosis prior to extracorporeal membrane oxygenation indicated a poor prognosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/therapy , Aged , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/mortality , Female , Hospitals, University , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Prognosis , Respiration, Artificial , Respiratory Distress Syndrome, Adult/etiology , Respiratory Function Tests
17.
J Ethnopharmacol ; 258: 112932, 2020 Aug 10.
Article in English | MEDLINE | ID: covidwho-165277

ABSTRACT

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Chinese Medicine (TCM) has been widely used as an approach worldwide. Chinese Medicines (CMs) had been used to treat and prevent viral infection pneumonia diseases for thousands of years and had accumulated a large number of clinical experiences and effective prescriptions. AIM OF THE STUDY: This research aimed to systematically excavate the classical prescriptions of Chinese Medicine (CM), which have been used to prevent and treat Pestilence (Wenbing, Wenyi, Shiyi or Yibing) for long history in China, to obtain the potential prescriptions and ingredients to alternatively treat COVID-19. MATERIALS AND METHODS: We developed the screening system based on data mining, molecular docking and network pharmacology. Data mining and association network were used to mine the high-frequency herbs and formulas from ancient prescriptions. Virtual screening for the effective components of high frequency CMs and compatibility Chinese Medicine was explored by a molecular docking approach. Furthermore, network pharmacology method was used to preliminarily uncover the molecule mechanism. RESULTS: 574 prescriptions were obtained from 96,606 classical prescriptions with the key words to treat "Warm diseases (Wenbing)", "Pestilence (Wenyi or Yibing)" or "Epidemic diseases (Shiyi)". Meanwhile, 40 kinds of CMs, 36 CMs-pairs, 6 triple-CMs-groups existed with high frequency among the 574 prescriptions. Additionally, the key targets of SARS-COV-2, namely 3CL hydrolase (Mpro) and angiotensin-converting enzyme 2(ACE2), were used to dock the main ingredients from the 40 kinds by the LigandFitDock method. A total of 66 compounds components with higher frequency were docked with the COVID-19 targets, which were distributed in 26 kinds of CMs, among which Gancao (Glycyrrhizae Radix Et Rhizoma), HuangQin (Scutellariae Radix), Dahuang (Rhei Radix Et Rhizome) and Chaihu (Bupleuri Radix) contain more potential compounds. Network pharmacology results showed that Gancao (Glycyrrhizae Radix Et Rhizoma) and HuangQin (Scutellariae Radix) CMs-pairs could also interact with the targets involving in immune and inflammation diseases. CONCLUSIONS: These results we obtained probably provided potential candidate CMs formulas or active ingredients to overcome COVID-19. Prospectively, animal experiment and rigorous clinic studies are needed to confirm the potential preventive and treat effect of these CMs and compounds.


Subject(s)
Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Drugs, Chinese Herbal/pharmacology , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese Traditional , Pneumonia, Viral/drug therapy , Coronavirus Infections/virology , Data Mining , Humans , Models, Molecular , Pandemics , Plant Extracts , Pneumonia, Viral/virology , Protein Conformation , Viral Proteins
18.
Virus Res ; 285: 198002, 2020 08.
Article in English | MEDLINE | ID: covidwho-165136

ABSTRACT

In the present study, an IBV strain I0305/19 was isolated from a diseased commercial broiler flock in 2019 in China with high morbidity and mortality. The isolate I0305/19 was clustered together with viruses in sublineage D of GI-19 lineage on the basis of the complete S1 sequence analysis. Isolate I0305/19 and other GI-19 viruses isolated in China have the amino acid sequence MIA at positions 110-112 in the S protein. Further analysis based on the complete genomic sequence showed that the isolate emerged through at least four recombination events between GI-19 ck/CH/LJS/120848- and GI-13 4/91-like strains, in which the S gene was found to be similar to that of the GI-19 ck/CH/LJS/120848-like strain. Pathological assessment showed the isolate was a nephropathogenic IBV strain that caused high morbidity of 100 % and mortality of 80 % in 1-day-old specific-pathogen-free (SPF) chicks. The isolate I0305/19 exhibited broader tropisms in different tissues, including tracheas, lungs, bursa of Fabricius, spleen, liver, kidneys, proventriculus, small intestines, large intestines, cecum, and cecal tonsils. Furthermore, subpopulations of the virus were found in tissues of infected chickens; this finding is important in understanding how the virulent IBV strains can potentially replicate and evolve to cause disease. This information is also valuable for understanding the mechanisms of replication and evolution of other coronaviruses such as the newly emerged SARS-CoV-2.


Subject(s)
Chickens/virology , Coronavirus Infections/veterinary , Infectious bronchitis virus/genetics , Infectious bronchitis virus/pathogenicity , Poultry Diseases/virology , Recombination, Genetic , Viral Tropism , Animals , China , Coronavirus Infections/virology , Genome, Viral , Infectious bronchitis virus/classification , Infectious bronchitis virus/physiology , Phylogeny , Specific Pathogen-Free Organisms , Spike Glycoprotein, Coronavirus/genetics , Virus Replication
20.
J Infect Dis ; 222(1): 34-37, 2020 06 16.
Article in English | MEDLINE | ID: covidwho-141798

ABSTRACT

A major unanswered question in the current global coronavirus disease 2019 (COVID-19) outbreak is why severe disease develops in a small minority of infected individuals. In the current article, we report that homozygosity for the C allele of rs12252 in the interferon-induced transmembrane protein 3 (IFITM3) gene is associated with more severe disease in an age-dependent manner. This supports a role for IFITM3 in disease pathogenesis and the opportunity for early targeted intervention in at-risk individuals.


Subject(s)
Alleles , Betacoronavirus/genetics , Coronavirus Infections/genetics , Membrane Proteins/genetics , Pneumonia, Viral/genetics , Polymorphism, Single Nucleotide , RNA-Binding Proteins/genetics , Severity of Illness Index , Adult , Aged , Aged, 80 and over , Cohort Studies , Coronavirus Infections/virology , Female , Genotype , High-Throughput Nucleotide Sequencing , Homozygote , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Real-Time Polymerase Chain Reaction
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