Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
Lancet Diabetes Endocrinol ; 9(5): 293-303, 2021 05.
Article in English | MEDLINE | ID: covidwho-1531930

ABSTRACT

BACKGROUND: In patients with type 2 diabetes, hyperglycaemia is an independent risk factor for COVID-19-related mortality. Associations between pre-infection prescription for glucose-lowering drugs and COVID-19-related mortality in people with type 2 diabetes have been postulated but only investigated in small studies and limited to a few agents. We investigated whether there are associations between prescription of different classes of glucose-lowering drugs and risk of COVID-19-related mortality in people with type 2 diabetes. METHODS: This was a nationwide observational cohort study done with data from the National Diabetes Audit for people with type 2 diabetes and registered with a general practice in England since 2003. Cox regression was used to estimate the hazard ratio (HR) of COVID-19-related mortality in people prescribed each class of glucose-lowering drug, with covariate adjustment with a propensity score to address confounding by demographic, socioeconomic, and clinical factors. FINDINGS: Among the 2 851 465 people with type 2 diabetes included in our analyses, 13 479 (0·5%) COVID-19-related deaths occurred during the study period (Feb 16 to Aug 31, 2020), corresponding to a rate of 8·9 per 1000 person-years (95% CI 8·7-9·0). The adjusted HR associated with recorded versus no recorded prescription was 0·77 (95% CI 0·73-0·81) for metformin and 1·42 (1·35-1·49) for insulin. Adjusted HRs for prescription of other individual classes of glucose-lowering treatment were as follows: 0·75 (0·48-1·17) for meglitinides, 0·82 (0·74-0·91) for SGLT2 inhibitors, 0·94 (0·82-1·07) for thiazolidinediones, 0·94 (0·89-0·99) for sulfonylureas, 0·94 (0·83-1·07) for GLP-1 receptor agonists, 1·07 (1·01-1·13) for DPP-4 inhibitors, and 1·26 (0·76-2·09) for α-glucosidase inhibitors. INTERPRETATION: Our results provide evidence of associations between prescription of some glucose-lowering drugs and COVID-19-related mortality, although the differences in risk are small and these findings are likely to be due to confounding by indication, in view of the use of different drug classes at different stages of type 2 diabetes disease progression. In the context of the COVID-19 pandemic, there is no clear indication to change prescribing of glucose-lowering drugs in people with type 2 diabetes. FUNDING: None.


Subject(s)
COVID-19/mortality , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/adverse effects , Aged , COVID-19/complications , Cohort Studies , England , Female , Humans , Male , Middle Aged , Proportional Hazards Models
2.
J Med Virol ; 93(10): 5768-5776, 2021 10.
Article in English | MEDLINE | ID: covidwho-1432407

ABSTRACT

Though it is widely believed that chronic immunosuppressive medications increase the severity of coronavirus disease 2019 (COVID-19) illness, there is little data to support this. We performed a retrospective study of COVID-19 positive patients diagnosed at a single academic medical center between March 10, 2020 and October 13, 2020. A total of 835 patients diagnosed with COVID-19 by polymerase chain reaction were included (median age 64 years; 52% female). Of these, 46 (5.5%) had a prescription for an immunosuppressive therapy before diagnosis, most commonly oral steroids (20, 43%), mycophenolate (12, 26%), or tacrolimus (11, 24%). Patients on immunosuppressive therapy with COVID-19 had increased mortality (30% vs. 17%, p = 0.036; odds ratio 2.1, 95% confidence interval 1.11-4.04), which remained significant (p = 0.040) after performing multivariate logistic regression controlling for gender, age, race, and comorbidity status. Laboratory markers of inflammation were uniformly elevated in both patients on or not on immunosuppressive therapies who died, but lymphocytes and neutrophils were decreased in both COVID-19 patients on immunosuppressive therapies who died and who remained alive. These findings demonstrate that COVID-19 disease is more severe in patients taking prior immunosuppressive medications. This finding emphasizes the need for aggressive monitoring and supportive care for immunosuppressed patients who are diagnosed with COVID-19.


Subject(s)
COVID-19/mortality , /adverse effects , Aged , COVID-19/diagnosis , Female , Humans , Immunosuppressive Agents/adverse effects , Length of Stay , Male , Middle Aged , Risk Factors , SARS-CoV-2 , Severity of Illness Index
3.
Am J Chin Med ; 48(5): 1035-1049, 2020.
Article in English | MEDLINE | ID: covidwho-1352580

ABSTRACT

In December 2019, coronavirus disease-2019 (COVID-19) broke out in Wuhan and other places. Seven versions of the Diagnosis and Treatment Program for Coronavirus Disease-2019 successively issued by the Chinese government have designated traditional Chinese medicine (TCM) as a necessary medical strategy. Based on the changes in TCM diagnosis and treatment strategies in these seven versions of Diagnosis and Treatment Program for Coronavirus Disease-2019, this paper collected data reported by the Chinese government media; analyzed the understanding of the etiology, pathogenesis, syndrome differentiation, treatment methods, and prescriptions of COVID-19 by TCM and evaluated the clinical efficacy of TCM strategies. COVID-19 is associated with TCM disease of pestilence, and its pathogenesis can be summarized as an "epidemic pathogen invading the body, followed by entering the internal organs and transforming into heat, resulting in pathogen trapping in the interior and healthy qi collapsing, and deficiency of qi and yin". Pathological processes should be emphasized in syndrome differentiation. The manifestations of qi deficiency and yin deficiency are exhibited during the recovery period. TCM strategies represented by Qing Fei Pai Du Tang have shown apparent advantages in improving symptoms, promoting virus clearance, and shortening hospitalization, as well as surprising efficacy of zero patient progressing from mild to severe cases in a TCM cabin hospital. Clinical data illustrate the effectiveness of TCM strategies proposed by the Chinese government. This major epidemic may bring new opportunities for TCM development.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Medicine, Chinese Traditional/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Animals , Betacoronavirus , COVID-19 , China , Coronavirus Infections/drug therapy , Coronavirus Infections/virology , Drugs, Chinese Herbal/administration & dosage , Humans , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , SARS-CoV-2
4.
J Med Virol ; 93(10): 5768-5776, 2021 10.
Article in English | MEDLINE | ID: covidwho-1245504

ABSTRACT

Though it is widely believed that chronic immunosuppressive medications increase the severity of coronavirus disease 2019 (COVID-19) illness, there is little data to support this. We performed a retrospective study of COVID-19 positive patients diagnosed at a single academic medical center between March 10, 2020 and October 13, 2020. A total of 835 patients diagnosed with COVID-19 by polymerase chain reaction were included (median age 64 years; 52% female). Of these, 46 (5.5%) had a prescription for an immunosuppressive therapy before diagnosis, most commonly oral steroids (20, 43%), mycophenolate (12, 26%), or tacrolimus (11, 24%). Patients on immunosuppressive therapy with COVID-19 had increased mortality (30% vs. 17%, p = 0.036; odds ratio 2.1, 95% confidence interval 1.11-4.04), which remained significant (p = 0.040) after performing multivariate logistic regression controlling for gender, age, race, and comorbidity status. Laboratory markers of inflammation were uniformly elevated in both patients on or not on immunosuppressive therapies who died, but lymphocytes and neutrophils were decreased in both COVID-19 patients on immunosuppressive therapies who died and who remained alive. These findings demonstrate that COVID-19 disease is more severe in patients taking prior immunosuppressive medications. This finding emphasizes the need for aggressive monitoring and supportive care for immunosuppressed patients who are diagnosed with COVID-19.


Subject(s)
COVID-19/mortality , /adverse effects , Aged , COVID-19/diagnosis , Female , Humans , Immunosuppressive Agents/adverse effects , Length of Stay , Male , Middle Aged , Risk Factors , SARS-CoV-2 , Severity of Illness Index
5.
J Comp Eff Res ; 10(2): 119-126, 2021 02.
Article in English | MEDLINE | ID: covidwho-1195988

ABSTRACT

Objective: To assess the patient-related barriers to access of some virtual healthcare tools among cancer patients in the USA in a population-based cohort. Materials & methods: National Health Interview Survey datasets (2011-2018) were reviewed and adult participants (≥18 years old) with a history of cancer diagnosis and complete information about virtual healthcare utilization (defined by [a] filling a prescription on the internet in the past 12 months and/or [b] communicating with a healthcare provider through email in the past 12 months) were included. Information about video-conferenced phone calls and telephone calls are not available in the National Health Interview Survey datasets; and thus, they were not examined in this study. Multivariable logistic regression analysis was used to evaluate factors associated with the utilization of virtual care tools. Results: A total of 25,121 participants were included in the current analysis; including 4499 participants (17.9%) who utilized virtual care in the past 12 months and 20,622 participants (82.1%) who did not utilize virtual care in the past 12 months. The following factors were associated with less utilization of virtual healthcare tools in multivariable logistic regression: older age (continuous odds ratio [OR] with increasing age: 0.987; 95% CI: 0.984-0.990), African-American race (OR for African American vs white race: 0.608; 95% CI: 0.517-0.715), unmarried status (OR for unmarried compared with married status: 0.689; 95% CI: 0.642-0.739), lower level of education (OR for education ≤high school vs >high school: 0.284; 95% CI: 0.259-0.311), weaker English proficiency (OR for no proficiency vs very good proficiency: 0.224; 95% CI: 0.091-0.552) and lower yearly earnings (OR for earnings <$45,000 vs earnings >$45,000: 0.582; 95% CI: 0.523-0.647). Conclusion: Older patients, those with African-American race, lower education, lower earnings and weak English proficiency are less likely to access the above studied virtual healthcare tools. Further efforts are needed to tackle disparities in telemedicine access.


Subject(s)
Neoplasms , Telemedicine , Adolescent , Adult , African Americans , Aged , Health Services , Health Services Accessibility , Healthcare Disparities , Humans , Income , Infant , Neoplasms/therapy , United States
6.
J Med Internet Res ; 23(3): e23662, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1194536

ABSTRACT

BACKGROUND: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. OBJECTIVE: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. METHODS: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ≥18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. RESULTS: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. CONCLUSIONS: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions.


Subject(s)
Pharmacies , Adolescent , Adult , Aged , Drug Prescriptions , Female , Humans , Internet , Logistic Models , Middle Aged , Prevalence , United States
7.
Eur Geriatr Med ; 12(3): 609-617, 2021 06.
Article in English | MEDLINE | ID: covidwho-1144432

ABSTRACT

PURPOSE: We share our strategies for preventing the COVID-19 outbreak in a nursing home in Taiwan. METHODS: We compared the number of outpatient department visits, the days of prescription from the outpatient department, the number of emergency department visits of the nursing home residents and staff, the number of admissions, and the days of admission of the residents for respiratory tract infection treatment between 2019 and 2020 to examine the effect of our preventive measures in the nursing home. Residents and staff who continuously lived and worked in the nursing home from 2019 to 2020 were included. The differences in outcomes between 2019 and 2020 were examined using paired sample t tests. The multivariate analyses were presented through generalized estimating equation analysis. RESULTS: A cohort of 183 residents and 127 staff was included and their electronic medical documentation was analyzed in two periods: January-September 2019 and January-September 2020. These residents had lower numbers of outpatient department visits (P < 0.001), days of prescription from the outpatient department (P < 0.001), number of emergency department visits (P < 0.001), number of admissions (P < 0.001), and days of admission (P < 0.001) to treat respiratory tract infections from January-September 2020 than January-September 2019. These staff members had lower numbers of outpatient department visits (P = 0.015) and days of prescription from the outpatient department (P = 0.009) to treat respiratory tract infections from January-September 2020 than January-September 2019. CONCLUSION: The association between our preventive measures and decreasing the risk of respiratory tract infection in nursing home residents and staff could be found. Sharing these experiences is valuable, as they provide important insights related to clinical practice during the COVID-19 pandemic.


Subject(s)
COVID-19 , Infection Control , Nursing Homes , Respiratory Tract Infections , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , Female , Health Personnel/statistics & numerical data , Homes for the Aged , Hospitalization/statistics & numerical data , Humans , Infection Control/methods , Infection Control/statistics & numerical data , Male , Middle Aged , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/prevention & control , Retrospective Studies , SARS-CoV-2 , Taiwan
8.
J Infect Public Health ; 14(6): 685-688, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1118564

ABSTRACT

Reinfection with SARS-CoV-2 is a rare phenomenon. To date, there has been some cases reported from countries such as United States, Ecuador, Hong Kong, the Netherlands and Belgium. This case report presents the first case of reinfection from Saudi Arabia, and probably the first dental student to have been re-infected with COVID-19. A 24-year-old male dental student presents with reinfection after a period of three months since he was first infected with COVID-19. The signs and symptoms reported by the patient were similar in both instances, except that he developed fever only at the time of reinfection. The infection and reinfection were confirmed with a RT-PCR test reports. This report highlights how it is necessary to continue to observe all the prescriptions recently indicated in the literature in order to avoid new contagion for all health workers after healed from covid-19 or asymptomatic positive, since as seen sometimes the infection does not ensures complete immunity in 100% of cases.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Belgium , Ecuador , Health Personnel , Humans , Male , Netherlands , Reinfection , Saudi Arabia , Young Adult
9.
Int J Antimicrob Agents ; 56(6): 106214, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-893921

ABSTRACT

The aim of this study was to describe the outcomes of patients with coronavirus disease 2019 (COVID-19) in the outpatient setting after early treatment with zinc, low-dose hydroxychloroquine and azithromycin (triple therapy) dependent on risk stratification. This was a retrospective case series study in the general practice setting. A total of 141 COVID-19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the year 2020 were included. The main outcome measures were risk-stratified treatment decision and rates of hospitalisation and all-cause death. A median of 4 days [interquartile range (IQR) 3-6 days; available for n = 66/141 patients] after the onset of symptoms, 141 patients (median age 58 years, IQR 40-67 years; 73.0% male) received a prescription for triple therapy for 5 days. Independent public reference data from 377 confirmed COVID-19 patients in the same community were used as untreated controls. Of 141 treated patients, 4 (2.8%) were hospitalised, which was significantly fewer (P < 0.001) compared with 58 (15.4%) of 377 untreated patients [odds ratio (OR) = 0.16, 95% confidence interval (CI) 0.06-0.5]. One patient (0.7%) in the treatment group died versus 13 patients (3.4%) in the untreated group (OR = 0.2, 95% CI 0.03-1.5; P = 0.12). No cardiac side effects were observed. Risk stratification-based treatment of COVID-19 outpatients as early as possible after symptom onset using triple therapy, including the combination of zinc with low-dose hydroxychloroquine, was associated with significantly fewer hospitalisations.


Subject(s)
Azithromycin/administration & dosage , COVID-19/drug therapy , Hydroxychloroquine/administration & dosage , SARS-CoV-2 , Zinc/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Azithromycin/adverse effects , Drug Therapy, Combination , Female , Humans , Hydroxychloroquine/adverse effects , Male , Middle Aged , Outpatients , Retrospective Studies , Young Adult , Zinc/adverse effects
10.
J Med Virol ; 92(10): 2200-2204, 2020 10.
Article in English | MEDLINE | ID: covidwho-763196

ABSTRACT

SARS-CoV-2 is highly infectious, and infection by this virus results in COVID-19, manifesting predominantly symptoms in the lower respiratory system. Detection of viral genomic materials by RT-PCR is the gold standard for diagnosis. Suspected COVID-19 patients who had a documented history of exposure and exhibited symptoms, but did not have positive PCR test results, were generally self-quarantined with prescriptions aiming to help attenuate their symptoms. These prescriptions are however neither specific nor highly effective for COVID-19 treatment. Given the rapidly growing pandemic and the overwhelmed medical system, the number of self-quarantined patients is increasing. There is an urgent need of alternative medicine to help patients relieve symptoms during self-quarantine, and to potentially help increase their chances of survival and recovery from the infection. We report here a case of severe COVID-19 that never had a positive PCR test result during disease progression but was confirmed with antibody test post recovery. This patient was self-quarantined and received diammonium glycyrrhizinate (DG), a steroid-like molecule, in combination with vitamin C as alternative medicine. This patient went through severe COVID-19 but eventually recovered upon the implementation of this treatment regimen, suggesting potential therapeutic effects of DG as alternative medicine to help relieve COVID-19 symptoms.


Subject(s)
COVID-19/drug therapy , Glycyrrhetinic Acid/therapeutic use , Ascorbic Acid/therapeutic use , Complementary Therapies/methods , Female , Humans , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , SARS-CoV-2/drug effects
12.
Zhongguo Zhong Yao Za Zhi ; 45(13): 3007-3012, 2020 Jul.
Article in Chinese | MEDLINE | ID: covidwho-679285

ABSTRACT

The coronavirus disease 2019(COVID-19) is developing rapidly and posing great threat to public health. There is no effective intervention for the severe patients, and their prognosis is poor. It is worth noting that in the fight against COVID-19, China has always put equal emphasis on both Chinese and Western medicine. Traditional Chinese medicine has played an important role in the whole process. It is of great significance to discuss the rules and characteristics of the prescription of traditional Chinese medicine in the treatment of COVID-19. In this study, information was collected from 444 severe COVID-19 patients who were admitted to a hospital designated to treat patients with severe COVID-19 in Wuhan before March 20, 2020. We collected traditional Chinese medicine prescriptions for patients with severe COVID-19, referred to Chinese Pharmacopoeia to standardize the names of traditional Chinese medicine, and extract the property, flavor and channel tropism of traditional Chinese medicines to analyze the rules of the prescriptions. IBM SPSS Modeler 18.0 software was used to conduct correlation analysis of traditional Chinese medicine. Effective traditional Chinese medicines against COVID-19 was identified by the TCMATCOV platform. In the end, 1 532 effective prescriptions were included. Among them, the high-frequency drugs are Poria, Astragali Radix, Pogostemonis Herba, Armeniacae Semen Amarum, Atractylodis Macrocephalae Rhizoma, Pinelliae Rhizoma, Glycyrrhizae Radix et Rhizoma, Magnoliae Officinalis Cortex, Ephedrae Herba, Cinna-momi Ramulus. Most of the drugs have the following functions: resolving dampness, replenishing deficiency, resolving phlegm, cough, and asthma. The core combinations are Pogostemonis Herba-Poria, Astragali Radix-Pogostemonis Herba-Poria, Amomi Fructus-Poria, Amomi Fructus-Pogostemonis Herba, Amomi Fructus-Astragali Radix. The majority of the medicines are with cold and warm properties, and the proportions are 41.03% and 38.46%, respectively. The medicinal flavors are mainly concentrated in sweet and bitter, and the proportions are 34.71% and 30.58%, respectively. The meridian of the drug is more into the lung, stomach and spleen, with lung accounting for 22.87%. From the analysis of high-frequency drugs to the core combinations, one can see that the main treatment principle for severe COVID-19 is to remove internal and external dampness, protect the spleen and stomach, remove evil energy, and support righteousness. TCMATCOV platform was used to calculate the network disturbances of the high-frequency drugs. It was found that the traditional Chinese medicine with a high disturbance score accounted for a high proportion of the classic anti-COVID-19 prescriptions used by clinicians. Among them, the drugs with top scores are Ephedrae Herba, Citri Reticulatae Pericarpium, Eupatorii Herba, Platycodonis Radix, Cinnamomi Ramulus, Astragali Radix, Magnoliae Officinalis Cortex, Atractylodis Macrocephalae Rhizoma, Pogostemonis Herba, Scutellariae Radix. After a further exploration of the action targets, it was showed that disease-specific factor TNF was the target of the above ten drugs, and traditional Chinese medicine can exert anti-inflammatory and immune-modulating effects.


Subject(s)
Betacoronavirus , Coronavirus Infections , Drugs, Chinese Herbal , Medicine, Chinese Traditional , Pandemics , Pneumonia, Viral , COVID-19 , China , Coronavirus Infections/drug therapy , Humans , Pneumonia, Viral/drug therapy , SARS-CoV-2
13.
Blood Purif ; 50(2): 150-160, 2021.
Article in English | MEDLINE | ID: covidwho-646291

ABSTRACT

Children seem to be less severely affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as compared to adults. Little is known about the prevalence and pathogenesis of acute kidney injury (AKI) in children affected by SARS-CoV-2. Dehydration seems to be the most common trigger factor, and meticulous attention to fluid status is imperative. The principles of initiation, prescription, and complications related to renal replacement therapy are the same for coronavirus disease (COVID) patients as for non-COVID patients. Continuous renal replacement therapy (CRRT) remains the most common modality of treatment. When to initiate and what modality to use are dependent on the available resources. Though children are less often and less severely affected, diversion of all hospital resources to manage the adult surge might lead to limited CRRT resources. We describe how these shortages might be mitigated. Where machines are limited, one CRRT machine can be used for multiple patients, providing a limited number of hours of CRRT per day. In this case, increased exchange rates can be used to compensate for the decreased duration of CRRT. If consumables are limited, lower doses of CRRT (15-20 mL/kg/h) for 24 h may be feasible. Hypercoagulability leading to frequent filter clotting is an important issue in these children. Increased doses of unfractionated heparin, combination of heparin and regional citrate anticoagulation, or combination of prostacyclin and heparin might be used. If infusion pumps to deliver anticoagulants are limited, the administration of low-molecular-weight heparin might be considered. Alternatively in children, acute peritoneal dialysis can successfully control both fluid and metabolic disturbances. Intermittent hemodialysis can also be used in patients who are hemodynamically stable. The keys to successfully managing pediatric AKI in a pandemic are flexible use of resources, good understanding of dialysis techniques, and teamwork.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/epidemiology , Continuous Renal Replacement Therapy/methods , Critical Care/methods , SARS-CoV-2 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Anticoagulants/therapeutic use , COVID-19/prevention & control , Child , Citrates/therapeutic use , Comorbidity , Continuous Renal Replacement Therapy/instrumentation , Disease Management , Disinfection , Equipment Contamination/prevention & control , Fluid Therapy , Health Services Accessibility , Hemodynamics , Heparin/therapeutic use , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Nephrology/organization & administration , Patient Care Team , Peritoneal Dialysis , Prostaglandins I/therapeutic use , Resource Allocation , Time Factors
14.
Zhongguo Zhong Yao Za Zhi ; 45(7): 1521-1525, 2020 Apr.
Article in Chinese | MEDLINE | ID: covidwho-324708

ABSTRACT

The global outbreak of coronavirus disease 2019(COVID-19) has further spread, and there is an increasing number of confirmed cases in many countries. On February 28, 2020 of Geneva time, the World Health Organization has raised global risk level to the very high level in view of outbreak of COVID-19. Since some patients' condition appeared to deteriorate rapidly after infection of this 2019 novel coronavirus(2019-nCoV), a variety of treatments should be considered. Holistic view and syndrome differentiation are the two characteristics of traditional Chinese medicine(TCM). Therefore, under the guidance of the holistic view, syndrome diffe-rentiation of TCM has achieved good effects in the treatment of COVID-19. This treatment mainly aimed at eliminating pathogens and strengthening overall health, regulating the balance of body and coordinating various of functions of Zangfu organs. In addition, modern medical proposes host-directed therapy(HDT), a strategy aims to interfere with host cell mechanism, enhance immune responses, and reduce exacerbated inflammation. To some extent, the combined application of HDT and antiviral therapy is highly consistent with the therapeutic concept of the holistic view of TCM. Therefore, under the guidance of the holistic view, syndrome differentiation of TCM uses treatments, such as clearing heat, detoxification, relieving asthma, clearing damp and phlegm, together with Lianhua Qingwen Capsules, Maxing Shigan Decoction, and Haoqin Qingdan Decoction under the guidance of these therapeutic methods. These therapeutic methods and prescriptions intervened with both virus and host at the same time in the treatment of COVID-19, which has important implications for the effective clinical treatment of COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/drug therapy , Medicine, Chinese Traditional , Pneumonia, Viral/drug therapy , COVID-19 , Humans , Pandemics , SARS-CoV-2
15.
Trials ; 21(1): 394, 2020 May 12.
Article in English | MEDLINE | ID: covidwho-244906

ABSTRACT

BACKGROUND: Inappropriate prescribing of antibiotics for acute respiratory infections at the primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China's primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages. METHODS: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: (1) training using new operational guidelines, (2) improved management and peer-review of antibiotic prescribing, (3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months' post-trial long-term follow-up. DISCUSSION: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All interventional activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN96892547. Registered on 18 August 2019.


Subject(s)
Antimicrobial Stewardship/methods , Inappropriate Prescribing/prevention & control , Primary Health Care/statistics & numerical data , Respiratory Tract Infections/drug therapy , Acute Disease , Ambulatory Care Facilities/statistics & numerical data , Caregivers/education , China/epidemiology , Cost-Benefit Analysis , Drug Resistance, Microbial , Follow-Up Studies , Humans , Mobile Applications , Patient Education as Topic/methods , Physicians, Family/education , Qualitative Research , Rural Population , Smartphone/instrumentation
16.
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 , COVID-19 , Coronavirus Infections/virology , Data Mining , Humans , Models, Molecular , Pandemics , Plant Extracts , Pneumonia, Viral/virology , Protein Conformation , SARS-CoV-2 , Viral Proteins
17.
Zhongguo Zhong Yao Za Zhi ; 45(6): 1253-1258, 2020 Mar.
Article in Chinese | MEDLINE | ID: covidwho-56094

ABSTRACT

Coronavirus disease 2019(COVID-19) triggered a severe and complicated epidemic situation, and it is of great significance to discuss the rules and characteristics of the prescription of COVID-19 in traditional Chinese medicine. This study collected prevention and treatment approaches of traditional Chinese medicine for COVID-19 released from the National Health Committee of China, 7 provinces and municipal health committees, the Chinese Medicine Administration and Handbook of Traditional Chinese Medicine Diagnosis and Treatment of COVID-19 between January 1 and February 18, 2020, and prescriptions prepared by 3 masters of Chinese medicine and 4 well-known Chinese medicine experts. These information were selected according to the inclusion and exclusion criteria, and EpiData 3.0 software was used to establish the "Traditional Chinese Medicine Prescription Library for the Prevention and Treatment of COVID-19" and the "Common Database of Traditional Chinese Medicine for the Prevention and Treatment of COVID-19". A total of 93 effective Chinese medicine prescriptions and a total of 157 kinds of constituent medicines were collected. Data analysis was performed by SPSS 18.0 software. The results showed that: ①most of the medicines are with cold and warm properties, 69 with cold medicines, accounting for 43.95%, 57 with warm medicines, accounting for 36.31%, and less with hot medicines, taking up 1.27%; ②there are many pungent, bitter and sweet medicines, and the distribution of medicinal flavors is different at different disease stage. The pungent medicines are mostly found in the early stage, the bitter drugs are the main flavor in the middle and severe stage, and the sweet medicines are mostly used in the recovery stage; ③the meridian of the drug is more concentrated at the lung, stomach, and heart, and most of drugs are into the lung meridian, accounting for 24.55%; these medicines are mostly into the lungs and stomach in the initial and middle stages, and into the heart and kidney in severe stages; ④oral drugs are mostly non-toxic, among which only 6 kinds are toxic, namely Armeniacae Semen Amarum, Dryopteridis Crassirhizomatis Rhizoma, Paridis Rhizoma, Pinelliae Rhizoma, Aconiti Lateralis Radix Praeparaia; ⑤most of the drugs have five types of functions: treating exterior syndromes, resolving dampness, clearing heat, replenishing deficiency, resolving phlegm, cough, and asthma. In the early stage, both drugs for treating exterior syndromes and heat clearing drugs were equally used, accounting for 18.81% each. In the middle stage, drugs resolving phlegm, cough, and asthma drugs are more often used, accounting for 29.61%. In the severe stage, heat clearing drugs are mostly used, accounting for 33.33%. During the recovery period, tonic deficiency drugs are used the most, accounting for 36.47%. The medical characteristics and efficacy of Chinese medicine in preventing and treating COVID-19 are closely related to the understanding of the etiology of Chinese medicine and the location and pathogenesis of the disease. Staged medication and local conditions need attention during the identification and treatment of COVID-19 clinical syndromes.


Subject(s)
Coronavirus Infections/drug therapy , Drugs, Chinese Herbal/therapeutic use , Medicine, Chinese Traditional , Pneumonia, Viral/drug therapy , Betacoronavirus , COVID-19 , China , Humans , Pandemics , SARS-CoV-2
18.
J Toxicol Environ Health B Crit Rev ; 23(4): 177-181, 2020 05 18.
Article in English | MEDLINE | ID: covidwho-46381

ABSTRACT

As a result of the 2019 coronavirus disease pandemic (COVID-19), there has been an urgent worldwide demand for treatments. Due to factors such as history of prescription for other infectious diseases, availability, and relatively low cost, the use of chloroquine (CQ) and hydroxychloroquine (HCQ) has been tested in vivo and in vitro for the ability to inhibit the causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, even though investigators noted the therapeutic potential of these drugs, it is important to consider the toxicological risks and necessary care for rational use of CQ and HCQ. This study provides information on the main toxicological and epidemiological aspects to be considered for prophylaxis or treatment of COVID-19 using CQ but mainly HCQ, which is a less toxic derivative than CQ, and was shown to produce better results in inhibiting proliferation of SARS-CoV-2 based upon preliminary tests.


Subject(s)
Antimalarials/therapeutic use , Antirheumatic Agents/therapeutic use , Antiviral Agents , Betacoronavirus , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Pneumonia, Viral/drug therapy , Antimalarials/adverse effects , Antirheumatic Agents/adverse effects , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use , Betacoronavirus/drug effects , COVID-19 , Humans , Hydroxychloroquine/adverse effects , Pandemics , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL