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BackgroundA recently developing pneumonia caused by SARS-CoV-2 was originated in Wuhan, China, and has quickly spread across the world. We reported the clinical characteristics of 82 death cases with COVID-19 in a single center. MethodsClinical data on 82 death cases laboratory-confirmed as SARS-CoV-2 infection were obtained from a Wuhan local hospitals electronic medical records according to previously designed standardized data collection forms. ResultsAll patients were local residents of Wuhan, and the great proportion of them were diagnosed as severe illness when admitted. Most of the death cases were male (65.9%). More than half of dead patients were older than 60 years (80.5%) and the median age was 72.5 years. The bulk of death cases had comorbidity (76.8%), including hypertension (56.1%), heart disease (20.7%), diabetes (18.3%), cerebrovascular disease (12.2%), and cancer (7.3%). Respiratory failure remained the leading cause of death (69.5%), following by sepsis syndrome/MOF (28.0%), cardiac failure (14.6%), hemorrhage (6.1%), and renal failure (3.7%). Furthermore, respiratory, cardiac, hemorrhage, hepatic, and renal damage were found in 100%, 89%, 80.5%, 78.0%, and 31.7% of patients, respectively. On the admission, lymphopenia (89.2%), neutrophilia (74.3%), and thrombocytopenia (24.3%) were usually observed. Most patients had a high neutrophil-to-lymphocyte ratio of >5 (94.5%), high systemic immune-inflammation index of >500 (89.2%), increased C-reactive protein level (100%), lactate dehydrogenase (93.2%), and D-dimer (97.1%). A high level of IL-6 (>10 pg/ml) was observed in all detected patients. Median time from initial symptom to death was 15 days (IQR 11-20), and a significant association between aspartate aminotransferase (p=0.002), alanine aminotransferase (p=0.037) and time from initial symptom to death were interestingly observed. ConclusionOlder males with comorbidities are more likely to develop severe disease, even die from SARS-CoV-2 infection. Respiratory failure is the main cause of COVID-19, but either virus itself or cytokine release storm mediated damage to other organ including cardiac, renal, hepatic, and hemorrhage should be taken seriously as well. FundingNo founding. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSAs the seventh member of enveloped RNA coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV)-2 causes a cluster of severe respiratory disease which is similar to another two fatal coronavirus infection caused by SARS-CoV and Middle Eastern respiratory syndrome coronavirus (MERS-CoV). Through searching PubMed and the China National knowledge infrastructure databases up to February 20, 2020, no published article focusing on hospitalized dead patients was identified. Added value of this studyWe conducted a single-center investigation involving 82 hospitalized death patients with COVID-19 and focused on their epidemiological and clinical characteristics. 66 of 82 (80.5%) of patients were older than 60 years and the median age was 72.5 years. The bulk of death cases had comorbidity (76.8%). Respiratory failure remained the leading cause of death, following by sepsis syndrome/MOF, cardiac failure, hemorrhage, and renal failure. Most patients had a high neutrophil-to-lymphocyte ratio, high systemic immune-inflammation index, and increased levels of proinflammatory cytokines. Implications of all the available evidenceSARS-CoV-2 causes a cluster of severe respiratory illness which is similar to another two fatal coronavirus infection caused by SARS-CoV and MERS-CoV. Death is more likely to occur in older male patients with comorbidity. Infected patients might develop acute respiratory distress and respiratory failure which was the leading cause of death, but damages of other organs and systems, including cardiac, hemorrhage, hepatic, and renal also contribute to the death. These damages might be attributable to indirect cytokines storm initiated by immune system and direct attack from SARS-CoV-2 itself.
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Objective:To study the effect of COVID-19 on pregnancy outcomes and neonatal prognosis in Hubei Province.Method:s A retrospective comparison of the pregnancy outcomes was done between 16 women with COVID-19 and 45 women without COVID-19. Also, the results of laboratory tests, imaging examinations, and the 2019 novel coronavirus (2019-nCoV) nucleic acid test were performed in 10 cases of neonatal delivered from women with COVID-19.Result:s (1) Of the 16 pregnant women with COVID-19, 15 cases were ordinary type and 1 case was severe type. No one has progressed to critical pneumonia.The delivery method of the two groups was cesarean section, and the gestational age were (38.7±1.4) and (37.9±1.6) weeks,there was no significant difference between the two groups ( P>0.05). Also, there wee no significant differences in the intraoperative blood loss and birth weight of the newborn between the two groups (all P>0.05). (2) Ten cases of neonates delivered from pregnant women with COVID-19 were collected. The 2019-nCoV nucleic acid test were all negative.There were no significant differences in fetal distress, meconium-stained amniotic fluid, preterm birth, and neonatal asphyxia between the two groups (all P>0.05).(3) In the treatment of uterine contraction fatigue, carbetocin or carboprost tromethamine was used more in cesarean section for pregnant women with COVID-19 (1.3±0.6), compared with Non-COVID-19 group (0.5±0.7),the difference was statistically significant ( P=0.001). Conclusions:If there is an indication for obstetric surgery or critical illness of COVID-19 in pregnant women, timely termination of pregnancy will not increase the risk of premature birth and asphyxia of the newborn, but it is beneficial to the treatment and rehabilitation of maternal pneumonia. Preventive use of long-acting uterotonic agents could reduce the incidence of postpartum hemorrhage during surgery. 2019-nCoV infection has not been found in neonates delivered from pregnant women with COVID-19.
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Objective:To analyze the clinical data of corona virus disease 2019 (COVID-19) in pregnant women, and to study the characteristics of disease onset, diagnosis and treatment in pregnant women complicated with COVID-19.Methods:The clinical data of 29 pregnant women with COVID-19 hospitalized in Renmin Hospital of Wuhan University from January 30 to February 23, 2020 were retrospectively analyzed. The disease characteristics and experiences of diagnosis and treatment were concluded. The first day of onset was defined as the day when respiratory symptoms such as fever, cough, fatigue, and chest tightness occurred. Group one was admitted to the hospital within the first week of onset, and group two was hospitalized during the second week of onset. Statistical analysis was conducted by t test and Mann-Whitney U test. Results:The age of 29 patients ranged from 24 to 40 years old, with fever, cough and fatigue as the initial symptoms. There were five cases in the first trimester of pregnancy, five cases in the second trimester and 19 cases in the third trimester of pregnancy. There were 28 ordinary patients and one severe patient. Among the 29 patients, 14 were hospitalized in the first week of onset (group one), nine in the second week of onset (group two), and the remaining six were asymptomatic. On the day of admission, 22 patients showed lymphocytopenia in complete blood count and all the indicators of cellular immunity (CD3 + , CD4 + , CD8 + , CD19 + , CD16 + CD56 + T lymphocytes) were reduced in two patients. There were no significant differences between patients in group one and group two (all P>0.05). The levels of IgE and complement 3 were 28.45(18.30, 51.70) IU/mL and (1.219±0.320) g/L in group one, and 20.30(18.30, 75.80) IU/mL and (1.170±0.147) g/L in group two. The differences were statistical significance ( U=67 222.000, t=0.442, P=0.024、0.028). Primary chest computed tomography revealed ground-glass opacity in all 29 cases, which was considered as the diagnostic marker of viral pneumonia. Conventional therapy such as oxygen inhalation, antiviral, anti-infection was the main regimen for COVID-19 in pregnant women. Methylprednisolone and gamma globulin could be used for severe patients or ordinary patients with disease progression and slow recovery. No abortion or premature delivery occurred in patients in the first and second trimester of pregnancy. But in the third trimester of pregnancy patients, three cases of preterm labor and 13 cases of full-term pregnancy were all given emergency cesarean section after admission. One patient admitted to the hospital at gestation of 35 weeks underwent expectant management and then was given cesarean section at 37 weeks + 6 gestation. 2019 novel coronavirus nucleic acid detection in 17 neonatal nasal and pharyngeal swabs were all negative. Nineteen patients were cured and discharged, and the course of the patients was (19.60±5.38) days. The remaining 10 patients in hospital were mild. Conclusions:The COVID-19 patients with pregnancy generally exhibit mild symptoms and a favorable recovery. Concurrent damages to heart, liver and kidney and vertical transmission rarely occur. Most of the patients could be cured under routine treatment.
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To explore the effect of [Ca2+]i and neuronal mitochondria transmembrane potentials in hippocampus of murine cytomegalovirus (MCMV) infected mice, newborn Balb/c mice were randomly divided into two groups: a virus inoculated group and a control group. After 56 days, single cell of hippocampus was isolated, and mitochondria transmembrane potentials and the intracellular free calcium level [Ca2+]i in hippocampus were measured by means of flow cytometry (FCM). Compared with the control group, the mitochondria transmembrane potentials was decreased (P<0.01) and the intracellular free calcium level [Ca2+]i was increased (P<0.01) in inoculated group. The dysfunction of [Ca2+]i and mitochondria transmembrane potentials in hippocampus may play an important role in the functional disorders in CMV-infected CNS.
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To explore the effect of [Ca2+]I and neuronal mitochondria transmembrane potentials in hippocampus of murine cytomegalovirus (MCMV) infected mice, newborn Balb/c mice were randomly divided into two groups: a virus inoculated group and a control group. After 56 days, single cell of hippocampus was isolated, and mitochondria transmembrane potentials and the intracellular free calcium level [Ca2+ ]I in hippocampus were measured by means of flow cytometry (FCM).Compared with the control group, the mitochondria transmembrane potentials was decreased (P＜0.01) and the intracellular free calcium level [Ca2+]I was increased (P＜0.01) in inoculated group.The dysfunction of [Ca2+ ]I and mitochondria transmembrane potentials in hippocampus may play an important role in the functional disorders in CMV-infected CNS.
