451
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Gupta I, Rizeq B, Elkord E, Vranic S, Al Moustafa AE. SARS-CoV-2 Infection and Lung Cancer: Potential Therapeutic Modalities. Cancers (Basel) 2020; 12:E2186. [PMID: 32764454 PMCID: PMC7464614 DOI: 10.3390/cancers12082186] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Human coronaviruses, especially SARS-CoV-2, are emerging pandemic infectious diseases with high morbidity and mortality in certain group of patients. In general, SARS-CoV-2 causes symptoms ranging from the common cold to severe conditions accompanied by lung injury, acute respiratory distress syndrome in addition to other organs' destruction. The main impact upon SARS-CoV-2 infection is damage to alveolar and acute respiratory failure. Thus, lung cancer patients are identified as a particularly high-risk group for SARS-CoV-2 infection and its complications. On the other hand, it has been reported that SARS-CoV-2 spike (S) protein binds to angiotensin-converting enzyme 2 (ACE-2), that promotes cellular entry of this virus in concert with host proteases, principally transmembrane serine protease 2 (TMPRSS2). Today, there are no vaccines and/or effective drugs against the SARS-CoV-2 coronavirus. Thus, manipulation of key entry genes of this virus especially in lung cancer patients could be one of the best approaches to manage SARS-CoV-2 infection in this group of patients. We herein provide a comprehensive and up-to-date overview of the role of ACE-2 and TMPRSS2 genes, as key entry elements as well as therapeutic targets for SARS-CoV-2 infection, which can help to better understand the applications and capacities of various remedial approaches for infected individuals, especially those with lung cancer.
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Affiliation(s)
- Ishita Gupta
- College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar; (I.G.); (B.R.); (S.V.)
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar
| | - Balsam Rizeq
- College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar; (I.G.); (B.R.); (S.V.)
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar
| | - Eyad Elkord
- Qatar Biomedical Research Institute & 4Hamad Bin Khalifa University, 34110 Doha, Qatar;
- Biomedical Research Center, School of Science, Engineering and Environment, University of Salford, Manchester M5 4WT, UK
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar; (I.G.); (B.R.); (S.V.)
| | - Ala-Eddin Al Moustafa
- College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar; (I.G.); (B.R.); (S.V.)
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar
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452
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Habas K, Nganwuchu C, Shahzad F, Gopalan R, Haque M, Rahman S, Majumder AA, Nasim T. Resolution of coronavirus disease 2019 (COVID-19). Expert Rev Anti Infect Ther 2020; 18:1201-1211. [PMID: 32749914 DOI: 10.1080/14787210.2020.1797487] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) was first detected in China in December, 2019, and declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. The current management of COVID-19 is based generally on supportive therapy and treatment to prevent respiratory failure. The effective option of antiviral therapy and vaccination are currently under evaluation and development. AREAS COVERED A literature search was performed using PubMed between December 1, 2019-June 23, 2020. This review highlights the current state of knowledge on the viral replication and pathogenicity, diagnostic and therapeutic strategies, and management of COVID-19. This review will be of interest to scientists and clinicians and make a significant contribution toward development of vaccines and targeted therapies to contain the pandemic. EXPERT OPINION The exit strategy for a path back to normal life is required, which should involve a multi-prong effort toward development of new treatment and a successful vaccine to protect public health worldwide and prevent future COVID-19 outbreaks. Therefore, the bench to bedside translational research as well as reverse translational works focusing bedside to bench is very important and would provide the foundation for the development of targeted drugs and vaccines for COVID-19 infections.
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Affiliation(s)
- Khaled Habas
- Faculty of Life Sciences, University of Bradford , West Yorkshire, UK
| | - Chioma Nganwuchu
- Faculty of Life Sciences, University of Bradford , West Yorkshire, UK
| | - Fanila Shahzad
- Faculty of Life Sciences, University of Bradford , West Yorkshire, UK
| | - Rajendran Gopalan
- Faculty of Life Sciences, University of Bradford , West Yorkshire, UK
| | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia) , Kuala Lumpur, Malaysia
| | - Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences , Bridgetown, Barbados, West Indies
| | - Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus , Bridgetown, Barbados, West Indies
| | - Talat Nasim
- Faculty of Life Sciences, University of Bradford , West Yorkshire, UK.,Research Division, Centre for Health, Agriculture and Socio-economic Advancements (CHASA) , Lalmonirhat, Bangladesh
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453
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Wu R, Ai S, Cai J, Zhang S, Qian ZM, Zhang Y, Wu Y, Chen L, Tian F, Li H, Li M, Lin H. Predictive Model and Risk Factors for Case Fatality of COVID-19: A Cohort of 21,392 Cases in Hubei, China. Innovation (N Y) 2020; 1:100022. [PMID: 33521759 PMCID: PMC7832941 DOI: 10.1016/j.xinn.2020.100022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023] Open
Abstract
An increasing number of patients are being killed by coronavirus disease 2019 (COVID-19), however, risk factors for the fatality of COVID-19 remain unclear. A total of 21,392 COVID-19 cases were recruited in the Hubei Province of China between December 2019 and February 2020, and followed up until March 18, 2020. We adopted Cox regression models to investigate the risk factors for case fatality and predicted the death probability under specific combinations of key predictors. Among the 21,392 patients, 1,020 (4.77%) died of COVID-19. Multivariable analyses showed that factors, including age (≥60 versus <45 years, hazard ratio [HR] = 7.32; 95% confidence interval [CI], 5.42, 9.89), sex (male versus female, HR = 1.31; 95% CI, 1.15, 1.50), severity of the disease (critical versus mild, HR = 39.98; 95% CI, 29.52, 48.86), comorbidity (HR = 1.40; 95% CI, 1.23, 1.60), highest body temperature (>39°C versus <39°C, HR = 1.28; 95% CI, 1.09, 1.49), white blood cell counts (>10 × 109/L versus (4–10) × 109/L, HR = 1.69; 95% CI, 1.35, 2.13), and lymphocyte counts (<0.8 × 109/L versus (0.8–4) × 109/L, HR = 1.26; 95% CI, 1.06, 1.50) were significantly associated with case fatality of COVID-19 patients. Individuals of an older age, who were male, with comorbidities, and had a critical illness had the highest death probability, with 21%, 36%, 46%, and 54% within 1–4 weeks after the symptom onset. Risk factors, including demographic characteristics, clinical symptoms, and laboratory factors were confirmed to be important determinants of fatality of COVID-19. Our predictive model can provide scientific evidence for a more rational, evidence-driven allocation of scarce medical resources to reduce the fatality of COVID-19. 21,392 COVID-19 patients constituted one of the largest cohort studies to date Elderly male patients with critical illness and comorbidities had higher death rate The death probability increased with time, which was evident for critically ill patients The highest death probability within 1 month can reach 54% by the predictive model The predictive model could guide the allocation of medical resources
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Affiliation(s)
- Ran Wu
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, Hubei 430079, China
| | - Siqi Ai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
| | - Jing Cai
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, Hubei 430079, China
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
| | - Zhengmin Min Qian
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Yunquan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yinglin Wu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
| | - Lan Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
| | - Fei Tian
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
| | - Huan Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
| | - Mingyan Li
- Institute of Preventive Medicine Information, Hubei Provincial Center for Disease Control and Prevention, 6 Zhuodaoquan North Road, Wuhan, Hubei 430079, China
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong 510080, China
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454
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Turriziani O, Sciandra I, Mazzuti L, Di Carlo D, Bitossi C, Calabretto M, Guerrizio G, Oliveto G, Riveros Cabral RJ, Viscido A, Falasca F, Gentile M, Pietropaolo V, Rodio DM, Carattoli A, Antonelli G. SARS-CoV-2 diagnostics in the virology laboratory of a University Hospital in Rome during the lockdown period. J Med Virol 2020; 93:886-891. [PMID: 32697357 PMCID: PMC7405396 DOI: 10.1002/jmv.26332] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/08/2023]
Abstract
Italy was one of the most affected nations by coronavirus disease 2019 outside China. The infections, initially limited to Northern Italy, spread to all other Italian regions. This study aims to provide a snapshot of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) epidemiology based on a single‐center laboratory experience in Rome. The study retrospectively included 6565 subjects tested for SARS‐CoV‐2 at the Laboratory of Virology of Sapienza University Hospital in Rome from 6 March to 4 May. A total of 9995 clinical specimens were analyzed, including nasopharyngeal swabs, bronchoalveolar lavage fluids, gargle lavages, stools, pleural fluids, and cerebrospinal fluids. Positivity to SARS‐CoV‐2 was detected in 8% (527/6565) of individuals, increased with age, and was higher in male patients (P < .001). The number of new confirmed cases reached a peak on 18 March and then decreased. The virus was detected in respiratory samples, in stool and in pleural fluids, while none of gargle lavage or cerebrospinal fluid samples gave a positive result. This analysis allowed to gather comprehensive information on SARS‐CoV‐2 epidemiology in our area, highlighting positivity variations over time and in different sex and age group and the need for a continuous surveillance of the infection, mostly because the pandemic evolution remains unknown. This is the first study reporting an epidemiological insight for the SARS‐CoV‐2 infection in Rome. The containing measures have been effective to flatten epidemiological curve. Gender and age are important contributor to lethality.
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Affiliation(s)
- Ombretta Turriziani
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Ilaria Sciandra
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Laura Mazzuti
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Daniele Di Carlo
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Camilla Bitossi
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Marianna Calabretto
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Giuliana Guerrizio
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Giuseppe Oliveto
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Rodolfo J Riveros Cabral
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Agnese Viscido
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Francesca Falasca
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Massimo Gentile
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Valeria Pietropaolo
- Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy.,Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy
| | - Donatella M Rodio
- Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Alessandra Carattoli
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Guido Antonelli
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, Sapienza University, Rome, Italy.,Microbiology and Virology Unit, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
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455
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Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D'Agnano V, Komici K, Mazzarella G, Parrella R, Bianco A. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res 2020; 32:1599-1608. [PMID: 32557332 PMCID: PMC7298699 DOI: 10.1007/s40520-020-01631-y] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
The elderly may represent a specific cluster of high-risk patients for developing COVID-19 with rapidly progressive clinical deterioration. Indeed, in older individuals, immunosenescence and comorbid disorders are more likely to promote viral-induced cytokine storm resulting in life-threatening respiratory failure and multisystemic involvement. Early diagnosis and individualized therapeutic management should be developed for elderly subjects based on personal medical history and polypharmacotherapy. Our review examines the pathogenesis and clinical implications of ageing in COVID-19 patients; finally, we discuss the evidence and controversies in the management in the long-stay residential care homes and aspects of end-of-life care for elderly patients with COVID-19.
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Affiliation(s)
- Fabio Perrotta
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Grazia Mazzeo
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
| | - Matilde Boccia
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Luigi Aronne
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Vito D'Agnano
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, "Vincenzo Tiberio", University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy
- Italian Society of Gerontology and Geriatrics (SIGG), Florence, Italy
| | - Gennaro Mazzarella
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
| | - Roberto Parrella
- COVID Unit D, Department of Infectious Diseases, Cotugno Hospital, A.O.R.N. dei Colli, Naples, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli"/Hosp. Monaldi, 80131, Naples, Italy
- COVID-19 Unit, Infectious Disease Department, University of Campania "L. Vanvitelli", 80131, Naples, Italy
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456
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Rozenberg S, Vandromme J, Martin C. Are we equal in adversity? Does Covid-19 affect women and men differently? Maturitas 2020; 138:62-68. [PMID: 32425315 PMCID: PMC7227588 DOI: 10.1016/j.maturitas.2020.05.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & OBJECTIVES This article examines whether women are less prone than men to Covid-19 infections and their complications. DATA SOURCES We reviewed available databases and searched systematically for publications. To be taken into account, data had to be broken down by gender. There was no study evaluation nor quantification synthesis, due to the large heterogeneity of the studies. Nineteen databases were selected. 73 publications were considered and 33 were selected, to which 12 more were added. RESULTS Globally, the proportion of men and women who tested positive is comparable. However, men are about 60 % more likely to be severely ill or to die from the complications of Covid-19 than are women. LIMITATIONS The study was hampered by a large heterogeneity in testing and reporting of the data. CONCLUSIONS Although in the pandemic men die more frequently than women from Covid-19, it is not clear whether this is due to biological differences between men and women, differences in behavioral habits, or differences in the rates of co-morbidities. IMPLICATIONS OF KEY FINDINGS Countries and studies should report their data by age, gender and co-morbidities. This may have implications in terms of vaccination strategies, the choice of treatments and future consequences for long-term health issues concerning gender equality.
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Affiliation(s)
- Serge Rozenberg
- Department of Gynaecology-Obstetrics, CHU St Pierre, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Jean Vandromme
- Department of Gynaecology-Obstetrics, CHU St Pierre, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium
| | - Charlotte Martin
- Department of Infectious diseases, CHU St Pierre. Université Libre de Bruxelles, Brussels, Belgium
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457
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Wang C, Huang P, Wang L, Shen Z, Lin B, Wang Q, Zhao T, Zheng H, Ji W, Gao Y, Xia J, Cheng J, Ma J, Liu J, Liu Y, Su M, Ruan G, Shu J, Ren D, Zhao Z, Yao W, Yang Y, Liu B, Zhang M. Temporal changes of COVID-19 pneumonia by mass evaluation using CT: a retrospective multi-center study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:935. [PMID: 32953735 PMCID: PMC7475384 DOI: 10.21037/atm-20-4004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has widely spread worldwide and caused a pandemic. Chest CT has been found to play an important role in the diagnosis and management of COVID-19. However, quantitatively assessing temporal changes of COVID-19 pneumonia over time using CT has still not been fully elucidated. The purpose of this study was to perform a longitudinal study to quantitatively assess temporal changes of COVID-19 pneumonia. Methods This retrospective and multi-center study included patients with laboratory-confirmed COVID-19 infection from 16 hospitals between January 19 and March 27, 2020. Mass was used as an approach to quantitatively measure dynamic changes of pulmonary involvement in patients with COVID-19. Artificial intelligence (AI) was employed as image segmentation and analysis tool for calculating the mass of pulmonary involvement. Results A total of 581 confirmed patients with 1,309 chest CT examinations were included in this study. The median age was 46 years (IQR, 35–55; range, 4–87 years), and 311 (53.5%) patients were male. The mass of pulmonary involvement peaked on day 10 after the onset of initial symptoms. Furthermore, the mass of pulmonary involvement of older patients (>45 years) was significantly severer (P<0.001) and peaked later (day 11 vs. day 8) than that of younger patients (≤45 years). In addition, there were no significant differences in the peak time (day 10 vs. day 10) and median mass (P=0.679) of pulmonary involvement between male and female. Conclusions Pulmonary involvement peaked on day 10 after the onset of initial symptoms in patients with COVID-19. Further, pulmonary involvement of older patients was severer and peaked later than that of younger patients. These findings suggest that AI-based quantitative mass evaluation of COVID-19 pneumonia hold great potential for monitoring the disease progression.
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Affiliation(s)
- Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihua Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhujing Shen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Lin
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiyuan Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tongtong Zhao
- Department of Radiology, The Second People's Hospital of Fuyang, Fuyang, China
| | - Hanpeng Zheng
- Department of Radiology, Yueqing People's Hospital, Yueqing, Wenzhou, China
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Yuantong Gao
- Department of Radiology, Ruian People's Hospital, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, China
| | - Junli Xia
- Bozhou Bone Trauma Hospital Image Center, Bozhou, China
| | - Jianmin Cheng
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianbing Ma
- Department of Radiology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yongqiang Liu
- Department of Radiology, Kecheng People's Hospital, Quzhou, China
| | - Miaoguang Su
- Department of Radiology, The People's Hospital of Pingyang, Pingyang Hospital Affiliated to Wenzhou Medical University, Pingyang, China
| | - Guixiang Ruan
- Department of Radiology, The First People's Hospital of Yuhang District, Hangzhou, China
| | - Jiner Shu
- Department of Radiology, Jinhua Hospital of Zhejiang University, Jinhua Municipal Central Hospital, Jinhua, China
| | - Dawei Ren
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital, Shaoxing, China
| | - Weigen Yao
- Department of Radiology, Yuyao People's Hospital, The Affiliated Yangming Hospital of Ningbo University, Ningbo, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Liu
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China.,YITU AI Research Institute for Healthcare, Shanghai, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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458
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Mukherjee V, Toth AT, Fenianos M, Martell S, Karpel HC, Postelnicu R, Bhatt A, Deshwal H, Kreiger-Benson E, Brill K, Goldlust S, Nair S, Walsh BC, Ellenberg D, Magda G, Pradhan D, Uppal A, Hena K, Chitkara N, Alviar CL, Basavaraj A, Luoma K, Link N, Bails D, Addrizzo-Harris D, Sterman DH. Clinical Outcomes in Critically Ill Coronavirus Disease 2019 Patients: A Unique New York City Public Hospital Experience. Crit Care Explor 2020; 2:e0188. [PMID: 32885172 PMCID: PMC7437795 DOI: 10.1097/cce.0000000000000188] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To explore demographics, comorbidities, transfers, and mortality in critically ill patients with confirmed severe acute respiratory syndrome coronavirus 2. DESIGN Retrospective cohort study. SETTING Data were collected from a large tertiary care public hospital ICU that is part of the largest public healthcare network in the United States. PATIENTS One-hundred thirty-seven adult (≥ 18 yr old) ICU patients admitted between March 10, 2020, and April 7, 2020, with follow-up collected through May 18, 2020. INTERVENTIONS None. MEASUREMENTS Demographic, clinical, laboratory, treatment, and outcome data extracted from electronic medical records. MAIN RESULTS The majority of patients were male (99/137; 72.3%) and older than 50 years old (108/137; 78.9%). The most reported ethnicity and race were Hispanic (61/137; 44.5%) and Black (23/137; 16.7%). One-hundred six of 137 patients had at least one comorbidity (77.4%). One-hundred twenty-one of 137 (78.1%) required mechanical ventilation of whom 30 (24.8%) moved to tracheostomy and 46 of 137 (33.6%) required new onset renal replacement therapy. Eighty-two of 137 patients (59.9%) died after a median of 8 days (interquartile range 5-15 d) in the ICU. Male sex had a trend toward a higher hazard of death (hazard ratio, 2.1 [1.1-4.0]) in the multivariable Cox model. CONCLUSIONS We report a mortality rate of 59.9% in a predominantly Hispanic and Black patient population. A significant association between comorbidities and mortality was not found in multivariable regression, and further research is needed to study factors that impact mortality in critical coronavirus disease 2019 patients. We also describe how a public hospital developed innovative approaches to safely manage a large volume of interhospital transfers and admitted patients.
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Affiliation(s)
- Vikramjit Mukherjee
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Alexander T Toth
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Madelin Fenianos
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | | | | | - Radu Postelnicu
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Alok Bhatt
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | - Himanshu Deshwal
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | | | | | | | - Sunil Nair
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | - B Corbett Walsh
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | - David Ellenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | - Gabriela Magda
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
| | - Deepak Pradhan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Amit Uppal
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Kerry Hena
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Nishay Chitkara
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Carlos L Alviar
- NYU Grossman School of Medicine, New York, NY
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York City, NY
| | - Ashwin Basavaraj
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Kelsey Luoma
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY
| | - Nathan Link
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY
| | - Douglas Bails
- Department of Medicine, New York University Grossman School of Medicine, New York City, NY
| | - Doreen Addrizzo-Harris
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
| | - Daniel H Sterman
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine, New York City, NY
- NYU Grossman School of Medicine, New York, NY
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459
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Kabeerdoss J, Danda D. Understanding immunopathological fallout of human coronavirus infections including COVID-19: Will they cross the path of rheumatologists? Int J Rheum Dis 2020; 23:998-1008. [PMID: 32779341 PMCID: PMC7436450 DOI: 10.1111/1756-185x.13909] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19) is the biggest pandemic of our lifetime to date. No effective treatment is yet in sight for this catastrophic illness. Several antiviral agents and vaccines are in clinical trials, and drug repurposings as immediate and alternative choices are also under consideration. Immunomodulatory agents like hydroxychloroquine (HCQ) as well as biological disease-modifying anti-rheumatic drugs (bDMARDs) such as tocilizumab and anakinra received worldwide attention for treatment of critical patients with COVID-19. This is of interest to rheumatologists, who are well versed with rational use of these agents. This brief review addresses the understandings of some of the common immunopathogenetic mechanisms in the context of autoimmune rheumatic diseases like systemic lupus erythematosus (SLE) and COVID-19. Apart from demographic comparisons, the role of type I interferons (IFN), presence of antiphospholipid antibodies and finally mechanism of action of HCQ in both the scenarios are discussed here. High risks for fatal disease in COVID-19 include older age, metabolic syndrome, male gender, and individuals who develop delayed type I IFN response. HCQ acts by different mechanisms including prevention of cellular entry of SARS-CoV-2 and inhibition of type I IFN signaling. Recent controversies regarding efficacy of HCQ in management of COVID-19 warrant more studies in that direction. Autoantibodies were also reported in severe acute respiratory syndrome (SARS) as well as in COVID-19. Rheumatologists need to wait and see whether SARS-CoV-2 infection triggers development of autoimmunity in patients with COVID-19 infection in the long run.
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Affiliation(s)
| | - Debashish Danda
- Department of Clinical Immunology and RheumatologyChristian Medical CollegeVelloreIndia
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Al-Lami RA, Urban RJ, Volpi E, Algburi AMA, Baillargeon J. Sex Hormones and Novel Corona Virus Infectious Disease (COVID-19). Mayo Clin Proc 2020; 95:1710-1714. [PMID: 32753145 PMCID: PMC7256539 DOI: 10.1016/j.mayocp.2020.05.013] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Abstract
Given the rapid spread of the coronavirus disease 2019 (COVID-19) pandemic and its overwhelming effect on health care systems and the global economy, innovative therapeutic strategies are urgently needed. The proposed primary culprit of COVID-19 is the intense inflammatory response-an augmented immune response and cytokine storm-severely damaging the lung tissue and rendering some patients' conditions severe enough to require assisted ventilation. Sex differences in the response to inflammation have been documented and can be attributed, at least in part, to sex steroid hormones. Moreover, age-associated decreases in sex steroid hormones, namely, estrogen and testosterone, may mediate proinflammatory increases in older adults that could increase their risk of COVID-19 adverse outcomes. Sex hormones can mitigate the inflammation response and might provide promising therapeutic potential for patients with COVID-19. In this article, we explore the possible anti-inflammatory effects of estrogen and testosterone and the anabolic effect of testosterone, with particular attention to the potential therapeutic role of hormone replacement therapy in older men and women with COVID-19.
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Affiliation(s)
- Rasha A Al-Lami
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston.
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Elena Volpi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | | | - Jacques Baillargeon
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
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461
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Clark A, Jit M, Warren-Gash C, Guthrie B, Wang HHX, Mercer SW, Sanderson C, McKee M, Troeger C, Ong KL, Checchi F, Perel P, Joseph S, Gibbs HP, Banerjee A, Eggo RM. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health 2020; 8:e1003-e1017. [PMID: 32553130 PMCID: PMC7295519 DOI: 10.1016/s2214-109x(20)30264-3] [Citation(s) in RCA: 608] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The risk of severe COVID-19 if an individual becomes infected is known to be higher in older individuals and those with underlying health conditions. Understanding the number of individuals at increased risk of severe COVID-19 and how this varies between countries should inform the design of possible strategies to shield or vaccinate those at highest risk. METHODS We estimated the number of individuals at increased risk of severe disease (defined as those with at least one condition listed as "at increased risk of severe COVID-19" in current guidelines) by age (5-year age groups), sex, and country for 188 countries using prevalence data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 and UN population estimates for 2020. The list of underlying conditions relevant to COVID-19 was determined by mapping the conditions listed in GBD 2017 to those listed in guidelines published by WHO and public health agencies in the UK and the USA. We analysed data from two large multimorbidity studies to determine appropriate adjustment factors for clustering and multimorbidity. To help interpretation of the degree of risk among those at increased risk, we also estimated the number of individuals at high risk (defined as those that would require hospital admission if infected) using age-specific infection-hospitalisation ratios for COVID-19 estimated for mainland China and making adjustments to reflect country-specific differences in the prevalence of underlying conditions and frailty. We assumed males were twice at likely as females to be at high risk. We also calculated the number of individuals without an underlying condition that could be considered at increased risk because of their age, using minimum ages from 50 to 70 years. We generated uncertainty intervals (UIs) for our estimates by running low and high scenarios using the lower and upper 95% confidence limits for country population size, disease prevalences, multimorbidity fractions, and infection-hospitalisation ratios, and plausible low and high estimates for the degree of clustering, informed by multimorbidity studies. FINDINGS We estimated that 1·7 billion (UI 1·0-2·4) people, comprising 22% (UI 15-28) of the global population, have at least one underlying condition that puts them at increased risk of severe COVID-19 if infected (ranging from <5% of those younger than 20 years to >66% of those aged 70 years or older). We estimated that 349 million (186-787) people (4% [3-9] of the global population) are at high risk of severe COVID-19 and would require hospital admission if infected (ranging from <1% of those younger than 20 years to approximately 20% of those aged 70 years or older). We estimated 6% (3-12) of males to be at high risk compared with 3% (2-7) of females. The share of the population at increased risk was highest in countries with older populations, African countries with high HIV/AIDS prevalence, and small island nations with high diabetes prevalence. Estimates of the number of individuals at increased risk were most sensitive to the prevalence of chronic kidney disease, diabetes, cardiovascular disease, and chronic respiratory disease. INTERPRETATION About one in five individuals worldwide could be at increased risk of severe COVID-19, should they become infected, due to underlying health conditions, but this risk varies considerably by age. Our estimates are uncertain, and focus on underlying conditions rather than other risk factors such as ethnicity, socioeconomic deprivation, and obesity, but provide a starting point for considering the number of individuals that might need to be shielded or vaccinated as the global pandemic unfolds. FUNDING UK Department for International Development, Wellcome Trust, Health Data Research UK, Medical Research Council, and National Institute for Health Research.
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Affiliation(s)
- Andrew Clark
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte Warren-Gash
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Bruce Guthrie
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Colin Sanderson
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kanyin L Ong
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Joseph
- IAVI Human Immunology Laboratory, Imperial College London, London, UK
| | - Hamish P Gibbs
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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462
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Maleki Dana P, Sadoughi F, Hallajzadeh J, Asemi Z, Mansournia MA, Yousefi B, Momen-Heravi M. An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes? Prehosp Disaster Med 2020; 35:438-441. [PMID: 32600476 PMCID: PMC7327162 DOI: 10.1017/s1049023x20000837] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Studies have reported a sex bias in case fatalities of COVID-19 patients. Moreover, it is observed that men have a higher risk of developing a severe form of the disease compared to women, highlighting the importance of disaggregated data of male and female COVID-19 patients. On the other hand, other factors (eg, hormonal levels and immune functions) also need to be addressed due to the effects of sex differences on the outcomes of COVID-19 patients. An insight into the underlying causes of sex differences in COVID-19 patients may provide an opportunity for better care of the patients or prevention of the disease. The current study reviews the reports concerning with the sex differences in COVID-19 patients. It is explained how sex can affect angiotensin converting enzyme-2 (ACE2), that is a key component for the pathogenesis of COVID-19, and summarized the gender differences in immune responses and how sex hormones are involved in immune processes. Furthermore, the available data about the impact of sex hormones on the immune functions of COVID-19 cases are looked into.
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Affiliation(s)
- Parisa Maleki Dana
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Fatemeh Sadoughi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Jamal Hallajzadeh
- Department of Biochemistry and Nutrition, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, school of medicine, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
- Infections Diseases Research Center, Kashan University of Medical Sciences, Kashan, Islamic Republic of Iran
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463
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Avcı H, Karabulut B, Farasoglu A, Boldaz E, Evman M. Relationship between anosmia and hospitalisation in patients with coronavirus disease 2019: an otolaryngological perspective. J Laryngol Otol 2020; 134:710-716. [PMID: 32838819 PMCID: PMC7468686 DOI: 10.1017/s0022215120001851] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A study was carried out to evaluate the relationship between anosmia and hospital admission in coronavirus disease 2019 patients. METHODS The clinical data of 1534 patients with confirmed coronavirus disease 2019 virus were analysed. The study was conducted with medical records of 1197 patients (78 per cent). The basic characteristics of patients and symptoms related to otolaryngology practice were examined. The patients were divided into two groups according to their follow up: an out-patient group and an in-patient group. RESULTS The majority of patients presented with anosmia (44.2 per cent), dysgeusia (43.9 per cent) and fever (38.7 per cent). Anosmia was observed in 462 patients (47 per cent) in the out-patient group, and in only 67 patients (31.2 per cent) in the in-patient group. Younger age (odds ratio = 1.05, 95 per cent confidence interval = 1.03-1.06) and the presence of anosmia (odds ratio = 2.04, 95 per cent confidence interval = 1.39-3) were significantly related to out-patient treatment. CONCLUSION Anosmia could be a symptom in the clinical presentation of the coronavirus disease 2019 infection.
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Affiliation(s)
- H Avcı
- Department of Ear, Nose and Throat Diseases, Istanbul Kartal Dr Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Turkey
| | - B Karabulut
- Department of Ear, Nose and Throat Diseases, Istanbul Kartal Dr Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Turkey
| | - A Farasoglu
- Department of Ear, Nose and Throat Diseases, Istanbul Kartal Dr Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Turkey
| | - E Boldaz
- Department of Ear, Nose and Throat Diseases, Istanbul Kartal Dr Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Turkey
| | - M Evman
- Department of Ear, Nose and Throat Diseases, Istanbul Kartal Dr Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Turkey
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464
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Madewell ZJ, Yang Y, Longini IM, Halloran ME, Dean NE. Household transmission of SARS-CoV-2: a systematic review and meta-analysis of secondary attack rate. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.07.29.20164590. [PMID: 32766596 PMCID: PMC7402051 DOI: 10.1101/2020.07.29.20164590] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spread by direct, indirect, or close contact with infected people via infected respiratory droplets or saliva. Crowded indoor environments with sustained close contact and conversations are a particularly high-risk setting. METHODS We performed a meta-analysis through July 29, 2020 of SARS-CoV-2 household secondary attack rate (SAR), disaggregating by several covariates (contact type, symptom status, adult/child contacts, contact sex, relationship to index case, index case sex, number of contacts in household, coronavirus). FINDINGS We identified 40 relevant published studies that report household secondary transmission. The estimated overall household SAR was 18.8% (95% confidence interval [CI]: 15.4%-22.2%), which is higher than previously observed SARs for SARS-CoV and MERS-CoV. We observed that household SARs were significantly higher from symptomatic index cases than asymptomatic index cases, to adult contacts than children contacts, to spouses than other family contacts, and in households with one contact than households with three or more contacts. INTERPRETATION To prevent the spread of SARS-CoV-2, people are being asked to stay at home worldwide. With suspected or confirmed infections referred to isolate at home, household transmission will continue to be a significant source of transmission.
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Affiliation(s)
| | - Yang Yang
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Ira M. Longini
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - M. Elizabeth Halloran
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Natalie E. Dean
- Department of Biostatistics, University of Florida, Gainesville, FL
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465
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White A, Kirby M. COVID‐19: biological factors in men's vulnerability. TRENDS IN UROLOGY & MENS HEALTH 2020. [DOI: 10.1002/tre.757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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466
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Zeng JH, Wu WB, Qu JX, Wang Y, Dong CF, Luo YF, Zhou D, Feng WX, Feng C. Cardiac manifestations of COVID-19 in Shenzhen, China. Infection 2020; 48:861-870. [PMID: 32725595 PMCID: PMC7386384 DOI: 10.1007/s15010-020-01473-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/28/2020] [Indexed: 12/18/2022]
Abstract
Purpose The coronavirus disease 2019 (COVID-19) outbreak has become a global public health concern; however, relatively few detailed reports of related cardiac injury are available. The aims of this study were to compare the clinical and echocardiographic characteristics of inpatients in the intensive-care unit (ICU) and non-ICU patients. Methods We recruited 416 patients diagnosed with COVID-19 and divided them into two groups: ICU (n = 35) and non-ICU (n = 381). Medical histories, laboratory findings, and echocardiography data were compared. Results The levels of myocardial injury markers in ICU vs non-ICU patients were as follows: troponin I (0.029 ng/mL [0.007–0.063] vs 0.006 ng/mL [0.006–0.006]) and myoglobin (65.45 μg/L [39.77–130.57] vs 37.00 μg/L [26.40–53.54]). Echocardiographic findings included ventricular wall thickening (12 [39%] vs 1 [4%]), pulmonary hypertension (9 [29%] vs 0 [0%]), and reduced left-ventricular ejection fraction (5 [16%] vs 0 [0%]). Overall, 10% of the ICU patients presented with right heart enlargement, thickened right-ventricular wall, decreased right heart function, and pericardial effusion. Cardiac complications were more common in ICU patients, including acute cardiac injury (21 [60%] vs 13 [3%]) (including 2 cases of fulminant myocarditis), atrial or ventricular tachyarrhythmia (3 [9%] vs 3 [1%]), and acute heart failure (5 [14%] vs 0 [0%]). Conclusion Myocardial injury marker elevation, ventricular wall thickening, pulmonary artery hypertension, and cardiac complications including acute myocardial injury, arrhythmia, and acute heart failure are more common in ICU patients with COVID-19. Cardiac injury in COVID-19 patients may be related more to the systemic response after infection rather than direct damage by coronavirus.
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Affiliation(s)
- Jia-Hui Zeng
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Wei-Bo Wu
- Department of Infectious Disease, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Jiu-Xin Qu
- Department of Clinical Laboratory, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Yao Wang
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Chang-Feng Dong
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Yong-Fang Luo
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Dan Zhou
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Wen-Xia Feng
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China
| | - Cheng Feng
- Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.
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467
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Xu X, Yu MQ, Shen Q, Wang LZ, Yan RD, Zhang MY, Liu JY, Qu YQ. Analysis of inflammatory parameters and disease severity for 88 hospitalized COVID-19 patients in Wuhan, China. Int J Med Sci 2020; 17:2052-2062. [PMID: 32788884 PMCID: PMC7415392 DOI: 10.7150/ijms.47935] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background and aim: The outbreak of coronavirus disease 2019 (COVID-19) is quickly turning into a pandemic. We aimed to further clarify the clinical characteristics and the relationship between these features and disease severity. Methods: In this retrospective single-center study, demographic, clinical and laboratory data were collected and analyzed among moderate, severe and critically ill group patients. Results: 88 hospitalization patients confirmed COVID-19 were enrolled in this study. The average age of the patients was 57.11 years (SD, ±15.39). Of these 88 patients, the median body mass index (BMI) was 24.03 (IQR, 21.64-26.61; range 15.05-32.39), the median duration from disease onset to hospital admission were 11 days (IQR, 6.50-14.50). 46.59% patients had one or more comorbidities, with hypertension being the most common (26.14%), followed by diabetes mellitus (12.50%) and coronary atherosclerotic heart disease (CAD) (7.95%). Common symptoms at onset of disease were fever (71.59%), cough (59.09%), dyspnea (38.64%) and fatigue (29.55%). 88 patients were divided into moderate (47 [53.41%]), severe (32 [36.36%]) and critically ill (9 [10.23%]) groups. Compared with severe and moderate patients, lymphocytopenia occurred in 85.71% critically ill patients, and serum IL-2R, IL-6, IL-8, TNF-α, LDH, and cTnI were also increased in 71.42%, 83.33%, 57.14%, 71.43%, 100% and 42.86% in critically ill patients. Through our analysis, the age, comorbidities, lymphocyte count, eosinophil count, ferritin, CRP, LDH, PT and inflammatory cytokines were statistically significant along with the disease severity. Conclusion: We found some clinical characteristic and inflammatory cytokines could reveal the severity of COVID-19 during the outbreak phage. Our research could assist the clinicians recognize severe and critically ill patients timely and focus on the expectant treatment for each patient.
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Affiliation(s)
- Xia Xu
- Department of Geriatric Medicine, Qilu Hospital of Shandong University
| | - Mu-Qing Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Qian Shen
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
| | - Lian-Zhong Wang
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of TCM
| | - Rong-Di Yan
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Shandong University of TCM
| | - Meng-Yu Zhang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Jian-Yu Liu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Yi-Qing Qu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University
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468
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Ebinger JE, Achamallah N, Ji H, Claggett BL, Sun N, Botting P, Nguyen TT, Luong E, Kim EH, Park E, Liu Y, Rosenberry R, Matusov Y, Zhao S, Pedraza I, Zaman T, Thompson M, Raedschelders K, Berg AH, Grein JD, Noble PW, Chugh SS, Bairey Merz CN, Marbán E, Van Eyk JE, Solomon SD, Albert CM, Chen P, Cheng S. Pre-existing traits associated with Covid-19 illness severity. PLoS One 2020; 15:e0236240. [PMID: 32702044 PMCID: PMC7377468 DOI: 10.1371/journal.pone.0236240] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/01/2020] [Indexed: 01/08/2023] Open
Abstract
Importance Certain individuals, when infected by SARS-CoV-2, tend to develop the more severe forms of Covid-19 illness for reasons that remain unclear. Objective To determine the demographic and clinical characteristics associated with increased severity of Covid-19 infection. Design Retrospective observational study. We curated data from the electronic health record, and used multivariable logistic regression to examine the association of pre-existing traits with a Covid-19 illness severity defined by level of required care: need for hospital admission, need for intensive care, and need for intubation. Setting A large, multihospital healthcare system in Southern California. Participants All patients with confirmed Covid-19 infection (N = 442). Results Of all patients studied, 48% required hospitalization, 17% required intensive care, and 12% required intubation. In multivariable-adjusted analyses, patients requiring a higher levels of care were more likely to be older (OR 1.5 per 10 years, P<0.001), male (OR 2.0, P = 0.001), African American (OR 2.1, P = 0.011), obese (OR 2.0, P = 0.021), with diabetes mellitus (OR 1.8, P = 0.037), and with a higher comorbidity index (OR 1.8 per SD, P<0.001). Several clinical associations were more pronounced in younger compared to older patients (Pinteraction<0.05). Of all hospitalized patients, males required higher levels of care (OR 2.5, P = 0.003) irrespective of age, race, or morbidity profile. Conclusions and relevance In our healthcare system, greater Covid-19 illness severity is seen in patients who are older, male, African American, obese, with diabetes, and with greater overall comorbidity burden. Certain comorbidities paradoxically augment risk to a greater extent in younger patients. In hospitalized patients, male sex is the main determinant of needing more intensive care. Further investigation is needed to understand the mechanisms underlying these findings.
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Affiliation(s)
- Joseph E. Ebinger
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Natalie Achamallah
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Hongwei Ji
- Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Brian L. Claggett
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Nancy Sun
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Patrick Botting
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Trevor-Trung Nguyen
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Eric Luong
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Elizabeth H. Kim
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Eunice Park
- Enterprise Information Systems Data Intelligence Team, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Yunxian Liu
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Ryan Rosenberry
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Yuri Matusov
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Steven Zhao
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Isabel Pedraza
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Tanzira Zaman
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Michael Thompson
- Enterprise Information Systems Data Intelligence Team, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Koen Raedschelders
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Advanced Clinical Biosystems Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Anders H. Berg
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Jonathan D. Grein
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Department of Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Paul W. Noble
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Sumeet S. Chugh
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - C. Noel Bairey Merz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Eduardo Marbán
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Jennifer E. Van Eyk
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Advanced Clinical Biosystems Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Christine M. Albert
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Peter Chen
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Women’s Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- * E-mail: (PC); (SC)
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
- * E-mail: (PC); (SC)
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469
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Nasiri MJ, Haddadi S, Tahvildari A, Farsi Y, Arbabi M, Hasanzadeh S, Jamshidi P, Murthi M, Mirsaeidi M. COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2020; 7:459. [PMID: 32793620 PMCID: PMC7385184 DOI: 10.3389/fmed.2020.00459] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023] Open
Abstract
Background: The rapidly evolving coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization on March 11, 2020. It was first detected in the Wuhan city of China and has spread globally resulting in a substantial health and economic crisis in many countries. Observational studies have partially identified different aspects of this disease. There have been no published systematic reviews that combine clinical, laboratory, epidemiologic, and mortality findings. Also, the effect of gender on the outcomes of COVID-19 has not been well-defined. Methods: We reviewed the scientific literature published from January 1, 2019 to May 29, 2020. Statistical analyses were performed with STATA (version 14, IC; Stata Corporation, College Station, TX, USA). The pooled frequency with 95% confidence intervals (CI) was assessed using random effect model. P < 0.05 was considered a statistically significant publication bias. Results: Out of 1,223 studies, 34 satisfied the inclusion criteria. A total of 5,057 patients with a mean age of 49 years were evaluated. Fever (83.0%, CI 77.5–87.6) and cough (65.2%, CI 58.6–71.2) were the most common symptoms. The most prevalent comorbidities were hypertension (18.5%, CI 12.7–24.4) and Cardiovascular disease (14.9%, CI 6.0–23.8). Among the laboratory abnormalities, elevated C-Reactive Protein (CRP) (72.0%, CI 54.3–84.6) and lymphopenia (50.1%, CI 38.0–62.4) were the most common. Bilateral ground-glass opacities (66.0%, CI 51.1–78.0) was the most common CT scan presentation. The pooled mortality rate was 6.6%, with males having significantly higher mortality compared to females (OR 3.4; 95% CI 1.2–9.1, P = 0.01). Conclusion: COVID-19 has caused a significant number of hospitalization and mortality worldwide. Mortality associated with COVID-19 was higher in our study compared to the previous reports from China. The mortality was significantly higher among the hospitalized male group. Further studies are required to evaluate the effect of different variables resulting in sex disparity in COVID-19 mortality.
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Affiliation(s)
- Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Haddadi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Azin Tahvildari
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yeganeh Farsi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahta Arbabi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Hasanzadeh
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parnian Jamshidi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mukunthan Murthi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States.,Department of Pulmonary and Critical Care, Miami VA Medical Center, Miami, FL, United States
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470
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Pancrazzi A, Magliocca P, Lorubbio M, Vaggelli G, Galano A, Mafucci M, Duranti D, Cortesi M, Mazzeschi E, Fabbroni S, Viti G, Tartaglia Polcini A, Tripodo E, Sanchini P, Gervino S, Tacconi D, Dei S, Mazzierli M, D'Urso A, Ognibene A. Comparison of serologic and molecular SARS-CoV 2 results in a large cohort in Southern Tuscany demonstrates a role for serologic testing to increase diagnostic sensitivity. Clin Biochem 2020; 84:87-92. [PMID: 32702365 PMCID: PMC7371578 DOI: 10.1016/j.clinbiochem.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023]
Abstract
Background Since February 2020, Italian hospitals registered COVID-19 (COronaVIrus Disease 19) cases more often than the rest of the Europe. During this epidemic, health authorities requested swab tests, while seeking new patient paths. Methods A dual laboratory approach was evaluated, consisting of patient care reports for viral RNA detection on swabs and rapid serological tests in 516 patients (192 symptomatic or paucisymptomatic and 324 asymptomatic). Results We found the molecular positive fraction equal to 12% (23/192) among symptomatic/paucisymptomatic (S/P) and 15.4% (50/324) in asymptomatic (As) sets. Among subsets, we observed serologically positive results, corresponding to 35% (8/23) for S/P and 38% (19/50) for As. Among molecular negative cases, we detected specific Immunoglobulin G or M (Ig G or Ig M) positivity in the S/P cohort equal to 6.6% (11/167) and 6% (15/246) in As cases. For indeterminate molecular results, we found S/P serological positivity equal to 100% (1/1) and 54% (13/24) in As patients. We found higher (p < 0.05) seropositivity in older patients (n = 8) among symptomatic and positives for viral RNA (n.23). Conclusions It has been observed that a dual approach of serological and molecular tests detects a higher absolute number of disease cases in a pandemic context,which could improve monitoring and health surveillance efficacy. The age-related seropositivity frequency in this study, if confirmed, could enhance the validity of serological tests, especially in older patients.In these subjects, molecular positivity accompanied by serological positivity (distinct for M and G immunoglobulins) should help determine disease status and support decisions related to patient management.
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Affiliation(s)
- Alessandro Pancrazzi
- Laboratory Medicine Department, Molecular and Clinical Pathology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy.
| | - Pasqualino Magliocca
- Laboratory Medicine Department, Serology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Maria Lorubbio
- Laboratory Medicine Department, Hematology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Guendalina Vaggelli
- Laboratory Medicine Department, Microbiology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Angelo Galano
- Laboratory Medicine Department, Microbiology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Manuela Mafucci
- Laboratory Medicine Department, Serology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Diletta Duranti
- Laboratory Medicine Department, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Monica Cortesi
- Laboratory Medicine Department, Serology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Erica Mazzeschi
- Laboratory Medicine Department, Serology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Sara Fabbroni
- Laboratory Medicine Department, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Gianluca Viti
- Laboratory Medicine Department, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Alessandro Tartaglia Polcini
- Laboratory Medicine Department, Microbiology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Emanuela Tripodo
- Laboratory Medicine Department, Quality Control Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Paola Sanchini
- Laboratory Medicine Department, Quality Control Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Silvana Gervino
- Laboratory Medicine Department, Molecular and Clinical Pathology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Danilo Tacconi
- Internal Medicine Department, Infection Disease Section, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Simona Dei
- Health Management, Azienda USL Toscana Sudest, Tuscany, Italy
| | - Monica Mazzierli
- Laboratory Medicine Department, Serology Sector, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
| | - Antonio D'Urso
- General Direction, Azienda USL Toscana Sudest, Tuscany, Italy
| | - Agostino Ognibene
- Laboratory Medicine Department, Azienda USL Toscana Sudest, Ospedale San Donato, Arezzo, Italy
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471
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Reifer J, Hayum N, Heszkel B, Klagsbald I, Streva VA. SARS-CoV-2 IgG antibody responses in New York City. Diagn Microbiol Infect Dis 2020; 98:115128. [PMID: 32777699 PMCID: PMC7372255 DOI: 10.1016/j.diagmicrobio.2020.115128] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023]
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a strain of coronavirus that causes coronavirus disease 2019 (Covid-19) and has been declared a global pandemic by the World Health Organization. Total cases of SARS-CoV-2 worldwide exceed 10.2 million, with over 503,000 deaths recorded. Little is known about the body's immune response to SARS-CoV-2 infection. In this paper, we describe SARS-CoV-2 IgG antibody responses in 28,523 patients from the New York City metropolitan area and report a SARS-CoV-2 IgG positivity rate of 44%, indicating the widespread nature of the pandemic in the city and state of New York. Additionally, for a subset of patients, we report on the correlation between SARS-CoV-2 patient symptom severity and level of SARS-CoV-2 IgG antibody found in the patient sample.
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Affiliation(s)
- Josh Reifer
- Sherman Abrams Laboratory, Brooklyn, NY 11205
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472
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Calderone A, Menichetti F, Santini F, Colangelo L, Lucenteforte E, Calderone V. Selective Estrogen Receptor Modulators in COVID-19: A Possible Therapeutic Option? Front Pharmacol 2020; 11:1085. [PMID: 32765279 PMCID: PMC7381128 DOI: 10.3389/fphar.2020.01085] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/03/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Alba Calderone
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ferruccio Santini
- Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luciano Colangelo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Department of Clinical, Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Ersilia Lucenteforte
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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473
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Abstract
OBJECTIVES The novel coronavirus disease 2019 (COVID-19) pandemic has spread to over 213 countries and territories. We sought to describe the clinical features of fatalities in patients with severe COVID-19. METHODS We conducted an Internet-based retrospective cohort study through retrieving the clinical information of 100 COVID-19 deaths from nonduplicating incidental reports in Chinese provincial and other governmental websites between January 23 and March 10, 2020. RESULTS Approximately 6 of 10 COVID-19 deaths were males (64.0%). The average age was 70.7 ± 13.5 y, and 84% of patients were elderly (over age 60 y). The mean duration from admission to diagnosis was 2.2 ± 3.8 d (median: 1 d). The mean duration from diagnosis to death was 9.9 ± 7.0 d (median: 9 d). Approximately 3 of 4 cases (76.0%) were complicated by 1 or more chronic diseases, including hypertension (41.0%), diabetes (29.0%) and coronary heart disease (27.0%), respiratory disorders (23.0%), and cerebrovascular disease (12.0%). Fever (46.0%), cough (33.0%), and shortness of breath (9.0%) were the most common first symptoms. Multiple organ failure (67.9%), circulatory failure (20.2%), and respiratory failure (11.9%) are the top 3 direct causes of death. CONCLUSIONS COVID-19 deaths are mainly elderly and patients with chronic diseases especially cardiovascular disorders and diabetes. Multiple organ failure is the most common direct cause of death.
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474
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Raisi-Estabragh Z, McCracken C, Ardissino M, Bethell MS, Cooper J, Cooper C, Harvey NC, Petersen SE. Renin-Angiotensin-Aldosterone System Blockers Are Not Associated With Coronavirus Disease 2019 (COVID-19) Hospitalization: Study of 1,439 UK Biobank Cases. Front Cardiovasc Med 2020; 7:138. [PMID: 32766285 PMCID: PMC7381180 DOI: 10.3389/fcvm.2020.00138] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Cardiometabolic morbidity and medications, specifically Angiotensin Converting Enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs), have been linked with adverse outcomes from coronavirus disease 2019 (COVID-19). This study aims to investigate, factors associated with COVID-19 positivity in hospital for 1,436 UK Biobank participants; compared with individuals who tested negative, and with the untested, presumed negative, rest of the cohort. Methods: We studied 7,099 participants from the UK Biobank who had been tested for COVID-19 in hospital. We considered the following exposures: age, sex, ethnicity, body mass index (BMI), diabetes, hypertension, hypercholesterolaemia, ACEi/ARB use, prior myocardial infarction (MI), and smoking. We undertook comparisons between (1) COVID-19 positive and COVID-19 negative tested participants; and (2) COVID-19 tested positive and the remaining participants (tested negative plus untested, n = 494,838). Logistic regression models were used to investigate univariate and mutually adjusted associations. Results: Among participants tested for COVID-19, Black, Asian, and Minority ethnic (BAME) ethnicity, male sex, and higher BMI were independently associated with a positive result. BAME ethnicity, male sex, greater BMI, diabetes, hypertension, and smoking were independently associated with COVID-19 positivity compared to the remaining cohort (test negatives plus untested). However, similar associations were observed when comparing those who tested negative for COVID-19 with the untested cohort; suggesting that these factors associate with general hospitalization rather than specifically with COVID-19. Conclusions: Among participants tested for COVID-19 with presumed moderate to severe symptoms in a hospital setting, BAME ethnicity, male sex, and higher BMI are associated with a positive result. Other cardiometabolic morbidities confer increased risk of hospitalization, without specificity for COVID-19. ACE/ARB use did not associate with COVID-19 status.
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Affiliation(s)
- Zahra Raisi-Estabragh
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Celeste McCracken
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Maddalena Ardissino
- Sir Alexander Fleming Building, Imperial College London, London, United Kingdom
| | - Mae S Bethell
- North West Anglia NHS Foundation Trust, Hinchingbrooke Hospital, Huntingdon, United Kingdom
| | - Jackie Cooper
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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475
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Zheng H, Tan J, Ma K, Meng W. Changes in RT-PCR test results and symptoms during the menstrual cycle of female individuals infected with SARS-CoV-2: Report of two cases. J Med Virol 2020; 93:541-545. [PMID: 32639581 PMCID: PMC7361390 DOI: 10.1002/jmv.26275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
The implications of the menstrual cycle for disease susceptibility, development, and severity of acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection are largely unknown. Here, we describe two women infected with SARS‐CoV‐2 whose real‐time reverse transcriptase‐polymerase chain reaction (RT‐PCR) test results and symptoms changed during the menstrual cycle. The first patient developed a fever on the first day of her menstrual period, and again on the first day of her next menstrual period after hospital discharge. RT‐PCR test results were positive during the first menstrual period before admission, but turned negative during hospitalization, and then were positive again during the second menstrual period after hospital discharge. Another one also developed a fever again on the first day of her menstrual period after hospital discharge. RT‐PCR test results were negative before admission and during hospitalization, but turned positive during the first menstrual period after hospital discharge. The cases indicate sex hormones may play an important role in SARS‐CoV‐2 infection. For women with history of exposure to SARS‐CoV‐2, the management protocol should include assessment of the menstrual status.
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Affiliation(s)
- Hua Zheng
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Juan Tan
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Ma
- Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Meng
- Division of Population Health Sciences, School of Medicine, University of Dundee, Dundee, UK
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476
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Li Y, Jerkic M, Slutsky AS, Zhang H. Molecular mechanisms of sex bias differences in COVID-19 mortality. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:405. [PMID: 32646459 PMCID: PMC7347256 DOI: 10.1186/s13054-020-03118-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
More men than women have died from COVID-19. Genes encoded on X chromosomes, and sex hormones may explain the decreased fatality of COVID-19 in women. The angiotensin-converting enzyme 2 gene is located on X chromosomes. Men, with a single X chromosome, may lack the alternative mechanism for cellular protection after exposure to SARS-CoV-2. Some Toll-like receptors encoded on the X chromosomes can sense SARS-CoV-2 nucleic acids, leading to a stronger innate immunity response in women. Both estrogen and estrogen receptor-α contribute to T cell activation. Interventional approaches including estrogen-related compounds and androgen receptor antagonists may be considered in patients with COVID-19.
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Affiliation(s)
- Yuchong Li
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mirjana Jerkic
- The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Arthur S Slutsky
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Haibo Zhang
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China. .,The Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Ontario, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. .,Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. .,Department of Physiology, University of Toronto, Toronto, Ontario, Canada.
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477
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Jiang RD, Liu MQ, Chen Y, Shan C, Zhou YW, Shen XR, Li Q, Zhang L, Zhu Y, Si HR, Wang Q, Min J, Wang X, Zhang W, Li B, Zhang HJ, Baric RS, Zhou P, Yang XL, Shi ZL. Pathogenesis of SARS-CoV-2 in Transgenic Mice Expressing Human Angiotensin-Converting Enzyme 2. Cell 2020; 182:50-58.e8. [PMID: 32516571 PMCID: PMC7241398 DOI: 10.1016/j.cell.2020.05.027] [Citation(s) in RCA: 425] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/27/2020] [Accepted: 05/14/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 has spread worldwide since 2019 and is now a severe threat to public health. We previously identified the causative agent as a novel SARS-related coronavirus (SARS-CoV-2) that uses human angiotensin-converting enzyme 2 (hACE2) as the entry receptor. Here, we successfully developed a SARS-CoV-2 hACE2 transgenic mouse (HFH4-hACE2 in C3B6 mice) infection model. The infected mice generated typical interstitial pneumonia and pathology that were similar to those of COVID-19 patients. Viral quantification revealed the lungs as the major site of infection, although viral RNA could also be found in the eye, heart, and brain in some mice. Virus identical to SARS-CoV-2 in full-genome sequences was isolated from the infected lung and brain tissues. Last, we showed that pre-exposure to SARS-CoV-2 could protect mice from severe pneumonia. Our results show that the hACE2 mouse would be a valuable tool for testing potential vaccines and therapeutics.
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Affiliation(s)
- Ren-Di Jiang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Mei-Qin Liu
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Ying Chen
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Chao Shan
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Yi-Wu Zhou
- Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xu-Rui Shen
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Qian Li
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Lei Zhang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Yan Zhu
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Hao-Rui Si
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Qi Wang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Juan Min
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Xi Wang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China; University of Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Wei Zhang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Bei Li
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Hua-Jun Zhang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Ralph S Baric
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Peng Zhou
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China
| | - Xing-Lou Yang
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China.
| | - Zheng-Li Shi
- CAS Key Laboratory of Special Pathogens, Wuhan Institute of Virology, Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, People's Republic of China.
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478
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Chakravarty D, Nair SS, Hammouda N, Ratnani P, Gharib Y, Wagaskar V, Mohamed N, Lundon D, Dovey Z, Kyprianou N, Tewari AK. Sex differences in SARS-CoV-2 infection rates and the potential link to prostate cancer. Commun Biol 2020; 3:374. [PMID: 32641750 PMCID: PMC7343823 DOI: 10.1038/s42003-020-1088-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
The recent outbreak of infections and the pandemic caused by SARS-CoV-2 represent one of the most severe threats to human health in more than a century. Emerging data from the United States and elsewhere suggest that the disease is more severe in men. Knowledge gained, and lessons learned, from studies of the biological interactions and molecular links that may explain the reasons for the greater severity of disease in men, and specifically in the age group at risk for prostate cancer, will lead to better management of COVID-19 in prostate cancer patients. Such information will be indispensable in the current and post-pandemic scenarios.
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Affiliation(s)
- Dimple Chakravarty
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Sujit S Nair
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
| | - Nada Hammouda
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Parita Ratnani
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Yasmine Gharib
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vinayak Wagaskar
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nihal Mohamed
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dara Lundon
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zachary Dovey
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Natasha Kyprianou
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ashutosh K Tewari
- Department of Urology and The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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479
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Bischof E, Wolfe J, Klein SL. Clinical trials for COVID-19 should include sex as a variable. J Clin Invest 2020; 130:3350-3352. [PMID: 32392184 DOI: 10.1172/jci139306] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Evelyne Bischof
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.,College of Clinical Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Jeannette Wolfe
- Department of Emergency Medicine, UMass Medical School - Baystate Campus, Springfield, Massachusetts, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology and.,Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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480
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Kragholm K, Andersen MP, Gerds TA, Butt JH, Østergaard L, Polcwiartek C, Phelps M, Andersson C, Gislason GH, Torp-Pedersen C, Køber L, Schou M, Fosbøl EL. Association between male sex and outcomes of Coronavirus Disease 2019 (Covid-19) - a Danish nationwide, register-based study. Clin Infect Dis 2020; 73:e4025-e4030. [PMID: 32634827 PMCID: PMC7454435 DOI: 10.1093/cid/ciaa924] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Male sex has been associated with severe Coronavirus disease 2019 (Covid-19) infection. We examined the association between male sex and severe Covid-19 infection and if an increased risk remains after adjustment for age and comorbidities. METHODS Nationwide register-based follow-up study of Covid-19 patients in Denmark until May 16, 2020. Average risk ratio comparing 30-day composite outcome of all-cause death, severe Covid-19 diagnosis or intensive care unit (ICU) admission for men versus women standardized to the age and comorbidity distribution of all patients were derived from multivariable Cox regression. Included covariates were age, hypertension, diagnoses including obesity, alcohol, sleep apnea, diabetes, chronic obstructive pulmonary disease, previous myocardial infarction (MI), ischemic heart disease (IHD), heart failure (HF), atrial fibrillation (AF), stroke, peripheral artery disease, cancer, liver-, rheumatic-, and chronic kidney disease (CKD). RESULTS Of 4,842 Covid-19 patients, 2,281 (47.1%) were men. Median age was 57 [25%-75% 43-73] for men versus 52 [38-71] for women (P<0.001); however, octogenarians had equal sex distribution. Alcohol diagnosis, diabetes, hypertension, sleep apnea, prior MI and IHD (all P<0.001) as well as AF, stroke and HF (all P=0.01) were more often seen in men, and so was CKD (P=0.03). Obesity diagnosis (P<0.001) were more often seen in women. Other comorbidity differences were insignificant (P>0.05). The fully adjusted average risk ratio was 1.63 [95% CI 1.44-1.84]. CONCLUSIONS Men with Covid-19 infection have >50% higher risk of all-cause death, severe Covid-19 infection, or ICU admission than women. The excess risk was not explained by age and comorbidities.
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Affiliation(s)
- Kristian Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Denmark.,Department of Cardiology, North Denmark Regional Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
| | | | - Thomas A Gerds
- Department of Biostatistics, Copenhagen University, Denmark
| | - Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | - Charlotte Andersson
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Copenhagen, Denmark
| | - Gunnar H Gislason
- The Danish Heart Foundation, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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481
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Michaud V, Deodhar M, Arwood M, Al Rihani SB, Dow P, Turgeon J. ACE2 as a Therapeutic Target for COVID-19; its Role in Infectious Processes and Regulation by Modulators of the RAAS System. J Clin Med 2020; 9:E2096. [PMID: 32635289 PMCID: PMC7408699 DOI: 10.3390/jcm9072096] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 01/08/2023] Open
Abstract
Angiotensin converting enzyme 2 (ACE2) is the recognized host cell receptor responsiblefor mediating infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ACE2bound to tissue facilitates infectivity of SARS-CoV-2; thus, one could argue that decreasing ACE2tissue expression would be beneficial. However, ACE2 catalytic activity towards angiotensin I (AngI) and II (Ang II) mitigates deleterious effects associated with activation of the renin-angiotensinaldosteronesystem (RAAS) on several organs, including a pro-inflammatory status. At the tissuelevel, SARS-CoV-2 (a) binds to ACE2, leading to its internalization, and (b) favors ACE2 cleavage toform soluble ACE2: these actions result in decreased ACE2 tissue levels. Preserving tissue ACE2activity while preventing ACE2 shredding is expected to circumvent unrestrained inflammatoryresponse. Concerns have been raised around RAAS modulators and their effects on ACE2expression or catalytic activity. Various cellular and animal models report conflicting results invarious tissues. However, recent data from observational and meta-analysis studies in SARS-CoV-2-infected patients have concluded that RAAS modulators do not increase plasma ACE2 levels orsusceptibility to infection and are not associated with more severe diseases. This review presentsour current but evolving knowledge of the complex interplay between SARS-CoV-2 infection, ACE2levels, modulators of RAAS activity and the effects of RAAS modulators on ACE2 expression.
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Affiliation(s)
- Veronique Michaud
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (V.M.); (M.D.); (M.A.); (S.B.A.R.); (P.D.)
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3C 3J7, Canada
| | - Malavika Deodhar
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (V.M.); (M.D.); (M.A.); (S.B.A.R.); (P.D.)
| | - Meghan Arwood
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (V.M.); (M.D.); (M.A.); (S.B.A.R.); (P.D.)
| | - Sweilem B Al Rihani
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (V.M.); (M.D.); (M.A.); (S.B.A.R.); (P.D.)
| | - Pamela Dow
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (V.M.); (M.D.); (M.A.); (S.B.A.R.); (P.D.)
| | - Jacques Turgeon
- Tabula Rasa HealthCare Precision Pharmacotherapy Research & Development Institute, Orlando, FL 32827, USA; (V.M.); (M.D.); (M.A.); (S.B.A.R.); (P.D.)
- Faculty of Pharmacy, Université de Montréal, Montreal, QC H3C 3J7, Canada
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482
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Alsufyani HA, Docherty JR. The renin angiotensin aldosterone system and COVID-19. Saudi Pharm J 2020; 28:977-984. [PMID: 32788834 PMCID: PMC7332203 DOI: 10.1016/j.jsps.2020.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
The ongoing pandemic has stimulated study of the Renin Angiotensin Aldosterone System (RAAS), and how it can be manipulated to treat COVID-19. Studies are examining whether drugs that act on the RAAS system might be useful to treat COVID-19. COVID-19 and the RAAS are closely linked both in infection and in possible post-infection inflammatory cascades. We detail the Physiology and Pharmacology of the RAAS including the effects of aldosterone and atrial natriuretic peptide. It is appropriate that the theoretical benefits of modulation of the RAAS should be considered based on available knowledge of the complexity of the system. In this short review we have tried to explain the actions of the angiotensin family of peptides and produce a relatively simple model and diagrammatic summary of the RAAS and the possible sites of intervention.
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Affiliation(s)
- Hadeel A Alsufyani
- Department of Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James R Docherty
- Department of Physiology, Royal College of Surgeons in Ireland, 123, St. Stephen's Green, Dublin 2, Ireland
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483
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Qian GQ, Yang NB, Ding F, Ma AHY, Wang ZY, Shen YF, Shi CW, Lian X, Chu JG, Chen L, Wang ZY, Ren DW, Li GX, Chen XQ, Shen HJ, Chen XM. Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: a retrospective, multi-centre case series. QJM 2020; 113:474-481. [PMID: 32181807 PMCID: PMC7184349 DOI: 10.1093/qjmed/hcaa089] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recent studies have focused on initial clinical and epidemiological characteristics of the coronavirus disease 2019 (COVID-19), which is the mainly revealing situation in Wuhan, Hubei. AIM This study aims to reveal more data on the epidemiological and clinical characteristics of COVID-19 patients outside of Wuhan, Zhejiang, China. DESIGN This study was a retrospective case series. METHODS Eighty-eight cases of laboratory-confirmed and three cases of clinically confirmed COVID-19 were admitted to five hospitals in Zhejiang province, China. Data were collected from 20 January 2020 to 11 February 2020. RESULTS AND DISCUSSION Of all 91 patients, 88 (96.70%) were laboratory-confirmed COVID-19 with throat swab samples that tested positive for SARS-Cov-2, three (3.30%) cases were clinically diagnosed. The median age of the patients was 50 (36.5-57) years, and female accounted for 59.34%. In this sample, 40 (43.96%) patients had contracted the disease from local cases, 31 (34.07%) patients had been to Wuhan/Hubei, eight (8.79%) patients had contacted with people from Wuhan, and 11 (12.09%) patients were diagnosed after having flown together in the same flight with no passenger that could later be identified as the source of infection. In particular within the city of Ningbo, 60.52% cases can be traced back to an event held in a temple. The most common symptoms were fever (71.43%), cough (60.44%) and fatigue (43.96%). The median of incubation period was 6 (interquartile range 3-8) days and the median time from the first visit to a doctor to the confirmed diagnosis was 1 (1-2) days. According to the chest computed tomography scans, 67.03% cases had bilateral pneumonia. CONCLUSIONS Social activity cluster, family cluster and flying alongside with persons already infected with COVID-19 were how people got infected with COVID-19 in Zhejiang.
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Affiliation(s)
- G -Q Qian
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - N -B Yang
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - F Ding
- Department of Infectious Disease, Affiliated Hospital of Shaoxing University/Shaoxing Municipal Hospital, Yuecheng District, Shaoxing City, Zhejiang Province 312000
| | - A H Y Ma
- Department of Finance, Nottingham University Business School, University of Nottingham Ningbo China, Yinzhou District, Ningbo, Zhejiang Province 315100
| | - Z -Y Wang
- Department of Infectious Disease, Ninghai County First Hospital, Ninghai County, Ningbo City, Zhejiang Province 315600
| | - Y -F Shen
- Department of Infectious Disease, Xiaoshan District People’s Hospital, Xiaoshan District, Hangzhou City, Zhejiang Province 311200
| | - C -W Shi
- Department of Infectious Disease, Xiaoshan District People’s Hospital, Xiaoshan District, Hangzhou City, Zhejiang Province 311200
| | - X Lian
- Department of Infectious Disease, Xiangshan County People’s First Hospital, Xiangshan County, Ningbo City, Zhejiang Province 315700
| | - J -G Chu
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - L Chen
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - Z -Y Wang
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - D -W Ren
- Department of Radiology, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - G -X Li
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
| | - X -Q Chen
- Department of Chinese Traditional Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000, China
| | - H -J Shen
- Department of Infectious Disease, Affiliated Hospital of Shaoxing University/Shaoxing Municipal Hospital, Yuecheng District, Shaoxing City, Zhejiang Province 312000
| | - X -M Chen
- Department of General Internal Medicine, Ningbo City First Hospital, Haishu District, Ningbo, Zhejiang Province 315000
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484
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Shekhar S, Wurth R, Kamilaris CDC, Eisenhofer G, Barrera FJ, Hajdenberg M, Tonleu J, Hall JE, Schiffrin EL, Porter F, Stratakis CA, Hannah-Shmouni F. Endocrine Conditions and COVID-19. Horm Metab Res 2020; 52:471-484. [PMID: 32512611 PMCID: PMC7417289 DOI: 10.1055/a-1172-1352] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023]
Abstract
COVID-19 was declared a global pandemic by the WHO and has affected millions of patients around the world. COVID-19 disproportionately affects persons with endocrine conditions, thus putting them at an increased risk for severe disease. We discuss the mechanisms that place persons with endocrine conditions at an additional risk for severe COVID-19 and review the evidence. We also suggest precautions and management of endocrine conditions in the setting of global curfews being imposed and offer practical tips for uninterrupted endocrine care.
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Affiliation(s)
- Skand Shekhar
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health (NIH), Bethesda, Maryland, USA
- Clinical Research Branch, National Institute of Environmental Health
Sciences, NIH, North Carolina, USA
| | - Rachel Wurth
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health (NIH), Bethesda, Maryland, USA
| | - Crystal D. C. Kamilaris
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health (NIH), Bethesda, Maryland, USA
| | - Graeme Eisenhofer
- Institute of Clinical Chemistry and Laboratory Medicine, and Department
of Medicine III, University Hospital Carl Gustav Carus, Technische
Universität Dresden, Dresden, Germany
| | - Francisco J. Barrera
- Endocrinology Division, Internal Medicine Department, University
Hospital “Dr. Jose E. Gonzalez”, Universidad Autonoma de Nuevo
Leon, Monterrey, Mexico
- Plataforma INVEST-KER Unit Mayo Clinic, School of Medicine, Universidad
Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Michelle Hajdenberg
- College of Arts and Sciences at Washington University in St. Louis,
Saint Louis, Missouri, USA
| | - Joselyne Tonleu
- Clinical Research Branch, National Institute of Environmental Health
Sciences, NIH, North Carolina, USA
| | - Janet E. Hall
- Clinical Research Branch, National Institute of Environmental Health
Sciences, NIH, North Carolina, USA
| | - Ernesto L. Schiffrin
- Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital,
McGill University, Montreal, Quebec, Canada
| | - Forbes Porter
- Division of Translational Medicine, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, NIH, Bethesda, Maryland,
USA
| | - Constantine A. Stratakis
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health (NIH), Bethesda, Maryland, USA
| | - Fady Hannah-Shmouni
- Section on Endocrinology & Genetics, Eunice Kennedy Shriver
National Institute of Child Health and Human Development, National Institutes of
Health (NIH), Bethesda, Maryland, USA
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485
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Merza MA, Haleem Al Mezori AA, Mohammed HM, Abdulah DM. COVID-19 outbreak in Iraqi Kurdistan: The first report characterizing epidemiological, clinical, laboratory, and radiological findings of the disease. Diabetes Metab Syndr 2020; 14:547-554. [PMID: 32408119 PMCID: PMC7199697 DOI: 10.1016/j.dsx.2020.04.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 01/12/2023]
Abstract
INTRODUCTION On March 11, 2020, the novel coronavirus was declared a global pandemic. The disease was named COVID-19 standing for coronavirus disease 2019. The objectives were to determine the epidemiological, clinical, laboratory, and radiological characteristics of COVID-19 patients. METHODS In this prospective descriptive study, 15 confirmed hospitalized cases of COVID-19 between 18th March and April 7, 2020 were followed-up till discharge. RESULTS There were 15 reported patients infected by 3 imported index cases from Europe. The mean age of the patients was 28.06 (SD: 16.42 years). The patients' age stratification was as follows: 0-5 (2, 13.3%); 6-18 (2, 13.3); 19-50 (10, 66.7%), and 51-64 years (1, 6.7%). The patients were male (9, 60.0%) and female (6, 40.0%). Most of the patients had mild disease severity (13, 86.7%), followed by mild-moderate (1, 6.7%) and moderate-severe (1, 6.7%). The study revealed that 6 patients were asymptomatic, and 9 patients were symptomatic. The most common symptoms were: fever (n = 8; 53.3%), cough (n = 7; 46.7%), shortness of breath (n = 3; 20.0%), fatigue (n = 3; 20.0%), and taste and smell disorders (n = 4; 26.7%). All patients were recovered and discharged over a median of 8 between 8 and 21 days. The mean and Std. deviation values of the hematological were: WBC: 6.57 (1.86); neutrophil count: 3.75 (1.26); lymphocyte count: 1.87 (0.41); Hb: 13.89 (1.26); platelet count: 207.67 (52.21). CONCLUSION All COVID-19 cases were linked to foreign visits with few local transmissions to close contacts without community transmission. The majority of cases were mild illnesses with full recovery.
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Affiliation(s)
- Muayad A Merza
- Department of Internal Medicine, Azadi Teaching Hospital, College of Pharmacy, University of Duhok, Iraqi Kurdistan, Iraq.
| | | | - Hakar Mustafa Mohammed
- Department of Internal Medicine, Azadi Teaching Hospital, Duhok General Directoarte of Health, Iraqi Kurdistan, Iraq.
| | - Deldar Morad Abdulah
- Community and Maternity Nursing Unit, College of Nursing, University of Duhok, Iraqi Kurdistan, Iraq.
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486
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Pal R, Banerjee M. COVID-19 and the endocrine system: exploring the unexplored. J Endocrinol Invest 2020; 43:1027-1031. [PMID: 32361826 PMCID: PMC7195612 DOI: 10.1007/s40618-020-01276-8] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Affiliation(s)
- R Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - M Banerjee
- Department of Endocrinology, Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, 700007, India
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487
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Chen J, Jiang Q, Xia X, Liu K, Yu Z, Tao W, Gong W, Han JJ. Individual variation of the SARS-CoV-2 receptor ACE2 gene expression and regulation. Aging Cell 2020; 19:e13168. [PMID: 32558150 PMCID: PMC7323071 DOI: 10.1111/acel.13168] [Citation(s) in RCA: 273] [Impact Index Per Article: 68.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 coronavirus is now spreading worldwide. Its pathogen, SARS-CoV-2, has been shown to use angiotensin-converting enzyme 2 (ACE2) as its host cell receptor, same as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003. Epidemiology studies found males although only slightly more likely to be infected than females account for the majority of the severely ill and fatality, which also bias for people older than 60 years or with metabolic and cardiovascular diseases. Here by analyzing GTEx and other public data in 30 tissues across thousands of individuals, we found a significantly higher level in Asian females, an age-dependent decrease in all ethnic groups, and a highly significant decrease in type II diabetic patients of ACE2 expression. Consistently, the most significant expression quantitative loci (eQTLs) contributing to high ACE2 expression are close to 100% in East Asians, >30% higher than other ethnic groups. A shockingly common enrichment of viral infection pathways was found among ACE2 anti-expressed genes, and multiple binding sites of virus infection related transcription factors and sex hormone receptors locate at ACE2 regulatory regions. Human and mice data analysis further revealed ACE2 expression is reduced in T2D patients and with inflammatory cytokine treatment and upregulated by estrogen and androgen (both decrease with age). Our findings revealed a negative correlation between ACE2 expression and COVID-19 fatality at both population and molecular levels. These results will be instrumental when designing potential prevention and treatment strategies for ACE2 binding coronaviruses in general.
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Affiliation(s)
- Jiawei Chen
- Peking‐Tsinghua Center for Life SciencesAcademy for Advanced Interdisciplinary StudiesCenter for Quantitative Biology (CQB)Peking UniversityBeijingChina
| | - Quanlong Jiang
- CAS Key Laboratory of Computational BiologyCAS‐MPG Partner Institute for Computational BiologyShanghai Institute of Nutrition and HealthChinese Academy of Sciences Center for Excellence in Molecular Cell ScienceCollaborative Innovation Center for Genetics and Developmental BiologyShanghai Institutes for Biological SciencesChinese Academy of SciencesShanghaiChina
| | - Xian Xia
- CAS Key Laboratory of Computational BiologyCAS‐MPG Partner Institute for Computational BiologyShanghai Institute of Nutrition and HealthChinese Academy of Sciences Center for Excellence in Molecular Cell ScienceCollaborative Innovation Center for Genetics and Developmental BiologyShanghai Institutes for Biological SciencesChinese Academy of SciencesShanghaiChina
| | - Kangping Liu
- Peking‐Tsinghua Center for Life SciencesAcademy for Advanced Interdisciplinary StudiesCenter for Quantitative Biology (CQB)Peking UniversityBeijingChina
| | - Zhengqing Yu
- Peking‐Tsinghua Center for Life SciencesAcademy for Advanced Interdisciplinary StudiesCenter for Quantitative Biology (CQB)Peking UniversityBeijingChina
| | - Wanyu Tao
- Peking‐Tsinghua Center for Life SciencesAcademy for Advanced Interdisciplinary StudiesCenter for Quantitative Biology (CQB)Peking UniversityBeijingChina
| | - Wenxuan Gong
- CAS Key Laboratory of Computational BiologyCAS‐MPG Partner Institute for Computational BiologyShanghai Institute of Nutrition and HealthChinese Academy of Sciences Center for Excellence in Molecular Cell ScienceCollaborative Innovation Center for Genetics and Developmental BiologyShanghai Institutes for Biological SciencesChinese Academy of SciencesShanghaiChina
| | - Jing‐Dong J. Han
- Peking‐Tsinghua Center for Life SciencesAcademy for Advanced Interdisciplinary StudiesCenter for Quantitative Biology (CQB)Peking UniversityBeijingChina
- CAS Key Laboratory of Computational BiologyCAS‐MPG Partner Institute for Computational BiologyShanghai Institute of Nutrition and HealthChinese Academy of Sciences Center for Excellence in Molecular Cell ScienceCollaborative Innovation Center for Genetics and Developmental BiologyShanghai Institutes for Biological SciencesChinese Academy of SciencesShanghaiChina
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488
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Manning JT, Fink B. Understanding COVID-19: Digit ratio (2D:4D) and sex differences in national case fatality rates. Early Hum Dev 2020; 146:105074. [PMID: 32419720 PMCID: PMC7224643 DOI: 10.1016/j.earlhumdev.2020.105074] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The reported national case fatality rates (CFRs) for coronavirus disease 2019 (COVID-19) shows a sex bias with males > females. The relative lengths of the index (2D) and ring (4D) fingers (digit ratio; 2D:4D) is a sexually dimorphic (males < females) proxy of fetal sex steroids (low 2D:4D indicates high prenatal testosterone/low prenatal estrogen). AIM To examine sex-specific relationships of 2D:4D per nation with national values of COVID-19 CFRs. STUDY DESIGN COVID-19 CFRs and the percent of male deaths were related to mean national (self-reported) 2D:4D by sex and hand from a large online survey (the BBC Internet Study). SUBJECTS 103,482 men and 83,366 women. OUTCOME MEASURES Relationships of mean national 2D:4D with CFRs from 41 countries and with national male death rates from 16 countries. RESULTS Male right and left hand 2D:4D showed positive relationships with CFR. These relationships remained significant after removing the influence of female 2D:4D. A positive association of male right and left 2D:4D was detected with the percentage of male deaths. CONCLUSIONS At the national level, high mean 2D:4D (indicating low prenatal testosterone/high prenatal estrogen) is associated with high CFRs and percent male mortality. At the individual level, high 2D:4D may be a risk factor for severity of COVID-19 in males. We speculate that male 2D:4D is a negative correlate for expression of the SARS-CoV2 receptor (ACE2).
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Affiliation(s)
- John T Manning
- Applied Sports, Technology, Exercise, and Medicine (A-STEM), Swansea University, Swansea, United Kingdom
| | - Bernhard Fink
- Biosocial Science Information, Biedermannsdorf, Austria.
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489
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Zheng Y, Xiong C, Liu Y, Qian X, Tang Y, Liu L, Leung ELH, Wang M. Epidemiological and clinical characteristics analysis of COVID-19 in the surrounding areas of Wuhan, Hubei Province in 2020. Pharmacol Res 2020; 157:104821. [PMID: 32360481 PMCID: PMC7191275 DOI: 10.1016/j.phrs.2020.104821] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/31/2020] [Accepted: 04/08/2020] [Indexed: 12/20/2022]
Abstract
AIM Since December 2019, new COVID-19 outbreaks have occurred and spread around the world. However, the clinical characteristics of patients in other areas around Wuhan, Hubei Province are still unclear. In this study, we performed epidemiological and clinical characteristics analysis on these regional cases. METHODS We retrospectively investigated COVID-19 patients positively confirmed by nucleic acid Q-PCR at Taihe Hospital from January 16 to February 4, 2020. Their epidemiological, clinical manifestations, and imaging characteristics were analysed. RESULTS Among the 73 patients studied, 12.3 % developed symptoms after returning to Shiyan from Wuhan, and 71.2 % had a history of close contact with Wuhan personnel or confirmed cases. Among these patients, 9 cases were associated with family clustering. The first main symptoms presented by these patients were fever (84.9 %) and cough (21.9 %). The longest incubation period was 26 days, and the median interval from the first symptoms to admission was 5 days. Of the patients, 67.1 % were originally healthy people with no underlying diseases, others mostly had common comorbidities including hypertension (12.3 %) and diabetes (5.5 %), 10.9 % were current smokers, 30.1 % had low white blood cell counts and 45.2 % showed decreased lymphocytes at the first time of diagnosis. CT scans showed that multiple patchy ground glass shadows outside of the patient lungs were commonly observed, and a single sub-pleural sheet of ground glass shadow with enhanced vascular bundles was also found located under the pleura. Patient follow-up to February 14 presented 38.4 % severe cases and 2.7 % critical cases. After follow-up, the parameter of lymphocyte counts below 0.8 × 109/L cannot be used to predict severe and critical groups from the ordinary group, and a lower proportion of smokers and higher proportion of diabetes patients occur in the poor outcome group. Other co-morbidities are observed but did not lead to poor outcomes. CONCLUSION The epidemiological characteristics of patients in the area around Wuhan, such as Shiyan, at first diagnosis are described as follows: Patients had histories of Wuhan residences in the early stage and family clustering in the later period. The incubation period was relatively long, and the incidence was relatively hidden, but the virulence was relatively low. The initial diagnosis of the patients was mostly ordinary, and the percentage of critical patients who evolved into the ICU during follow-up is 2.7 %, which is lower than the 26.1 % reported by Wuhan city. According to the Shiyan experience, early diagnosis with multiple swaps of the Q-PCR test and timely treatment can reduce the death rate. Diabetes could be one of the risk factors for progression to severe/critical outcomes. No evidence exists that smoking protects COVID-19 patients from developing to severe/critical cases, and the absolute number of lymphocytes at initial diagnosis could not predict the progression risk from severe to critical condition. Multivariate regression analysis should be used to further guide the allocation of clinical resources.
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Affiliation(s)
- Yi Zheng
- Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Chang Xiong
- Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Yuquan Liu
- Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Xin Qian
- Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Yijun Tang
- Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Liang Liu
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau (SAR), China
| | - Elaine Lai-Han Leung
- State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau (SAR), China.
| | - Meifang Wang
- Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China.
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490
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Biagi A, Rossi L, Malagoli A, Zanni A, Sticozzi C, Comastri G, Gandolfi S, Villani GQ. Clinical and epidemiological characteristics of 320 deceased patients with COVID-19 in an Italian Province: A retrospective observational study. J Med Virol 2020; 92:2718-2724. [PMID: 32515500 PMCID: PMC7300458 DOI: 10.1002/jmv.26147] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 01/16/2023]
Abstract
Studies have described clinical features of patients with coronavirus disease (COVID‐19). However, limited data concerning the clinical characteristics of the Italian deaths are available. We aim to describe the clinical and epidemiological characteristics of 320 deceased from the Italian experience. We retrospectively collected all consecutive non‐survivor patients with laboratory‐confirmed COVID‐19 infection admitted to the Emergency Rooms (ERs) Piacenza Hospital Network during the first month of COVID‐19 pandemic in Italy. Clinical history, comorbidities, laboratory findings and treatment were recorded for each patient. A total of 1050 patients with confirmed COVID‐19 pneumonia were admitted to the ERs between 24 February and 22 March 2020. Three hundred and twenty (30.5%) patients died with a median age of 78.0 years, 205 (64%) non‐survivors were above 65 years old, 230 (71.9%) were male. Non‐survivor patients showed frequently several coexisting medical conditions, with hypertension being the most common comorbidity (235 patients, 73.4%). The in‐hospital mortality did not change during the progression of the pandemic. In this retrospective Italian study, most of COVID‐19 deceased patients were elderly male aged over than 65 years. Hypertension was the most common coexisting disease. In‐hospital mortality was high and showed no variation during the first month of the COVID‐19 italian epidemic. This work highlights the clinical and epidemiological characteristics of COVID‐19 deceased patients in an Italian province with high in‐hospital mortality.
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Affiliation(s)
- Andrea Biagi
- Division of Cardiology, Department of Cardiovascular and Emergency, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Luca Rossi
- Division of Cardiology, Department of Cardiovascular and Emergency, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Alessandro Malagoli
- Division of Cardiology, Department of Nephro-Cardiovascular, "S. Agostino-Estense" Public Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Zanni
- Division of Cardiology, Department of Cardiovascular and Emergency, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Concetta Sticozzi
- Division of Cardiology, Department of Cardiovascular and Emergency, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Greta Comastri
- Division of Cardiology, Department of Cardiovascular and Emergency, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Stefano Gandolfi
- Health Management, Department of Health Administration, Guglielmo da Saliceto Hospital, ASL Piacenza, Piacenza, Italy
| | - Giovanni Quinto Villani
- Division of Cardiology, Department of Cardiovascular and Emergency, Guglielmo da Saliceto Hospital, Piacenza, Italy
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491
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Wu Y, Guo W, Liu H, Qi B, Liang K, Xu H, Peng Z, Xiao SY. Clinical outcomes of 402 patients with COVID-2019 from a single center in Wuhan, China. J Med Virol 2020; 92:2751-2757. [PMID: 32530494 PMCID: PMC7307018 DOI: 10.1002/jmv.26168] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of SARS‐CoV‐2 has become a pandemic with significant mortality. Published studies described clinical characteristics of the disease contain small cohorts from individual centers or larger series consisting of mixed series from multiple different hospitals. We report here analyses of mortality and disease severity among 402 patients from a single hospital. The cohort includes 297 patients with confirmed and 105 with clinical diagnosis. The latter group consists of cases with inconclusive nucleic acid test but meeting the criteria for clinical diagnosis. Data are compared between sexes and among different age groups. The overall case fatality is 5.2%. However, age at 70 years or older is associated with a significantly higher mortality (17.8%) and higher rate of severe and critical illness (57.5%). Case fatality is 8% in patients 50 years of age or older, and 1.2% in those younger than 50 years. In addition, case fatality is 7.6% in male patients, as opposed to 2.9% in females, demonstrating a clear sex difference. Mortality and disease severity were examined among 402 consecutive COVID‐19 patients from a single hospital. Age 50 years or older is associated with higher case fatality (8%) than age younger than 50 years (1.2%). Age 70 years or older is associated with a significantly higher case fatality (17.8%) and higher rate of severe or critical illness (57.5%). Male gender is linked to higher case fatality than female.
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Affiliation(s)
- Yingjie Wu
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Guo
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Pathology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
| | - Huan Liu
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bei Qi
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shu-Yuan Xiao
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Pathology, University of Chicago Medicine, Chicago, Illinois
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492
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Shen Q, Xiao X, Aierken A, Yue W, Wu X, Liao M, Hua J. The ACE2 expression in Sertoli cells and germ cells may cause male reproductive disorder after SARS-CoV-2 infection. J Cell Mol Med 2020; 24:9472-9477. [PMID: 32594644 PMCID: PMC7361928 DOI: 10.1111/jcmm.15541] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
The serious coronavirus disease‐2019 (COVID‐19) was first reported in December 2019 in Wuhan, China. COVID‐19 is an infectious disease caused by severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2). Angiotensin converting enzyme 2(ACE2) is the cellular receptor for SARS‐CoV‐2. Considering the critical roles of testicular cells for the transmission of genetic information between generations, we analyzed single‐cell RNA‐sequencing (scRNA‐seq) data of adult human testis. The mRNA expression of ACE2 was expressed in both germ cells and somatic cells. Moreover, the positive rate of ACE2 in testes of infertile men was higher than normal, which indicates that SARS‐CoV‐2 may cause reproductive disorders through pathway activated by ACE2 and the men with reproductive disorder may easily to be infected by SARS‐CoV‐2. The expression level of ACE2 was related to the age, and the mid‐aged with higher positive rate than young men testicular cells. Taken together, this research provides a biological background of the potential route for infection of SARS‐CoV‐2 and may enable rapid deciphering male‐related reproductive disorders induced by COVID‐19.
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Affiliation(s)
- Qiaoyan Shen
- College of Veterinary Medicine, Shaanxi Centre of Stem Cells Engineering & Technology, Northwest A&F University, Yangling, China
| | - Xia Xiao
- College of LifeSciences, Northwest A&F University, Yangling, China
| | - Aili Aierken
- College of Veterinary Medicine, Shaanxi Centre of Stem Cells Engineering & Technology, Northwest A&F University, Yangling, China
| | - Wei Yue
- College of Veterinary Medicine, Shaanxi Centre of Stem Cells Engineering & Technology, Northwest A&F University, Yangling, China
| | - Xiaojie Wu
- College of Veterinary Medicine, Shaanxi Centre of Stem Cells Engineering & Technology, Northwest A&F University, Yangling, China
| | - Mingzhi Liao
- College of LifeSciences, Northwest A&F University, Yangling, China
| | - Jinlian Hua
- College of Veterinary Medicine, Shaanxi Centre of Stem Cells Engineering & Technology, Northwest A&F University, Yangling, China
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493
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Affiliation(s)
- Sandra Pellegrini
- Institut Pasteur, Department of Immunology, Cytokine Signaling Unit, Inserm U1221, Paris, France
| | - Gilles Uzé
- CNRS UMR 5235, University of Montpellier, Montpellier, France
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494
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Zeng QL, Li GM, Ji F, Ma SH, Zhang GF, Xu JH, Lin WB, Xu GH, Zhang GQ, Li GT, Cui GL, Liu N, Zeng FJ, Ai ZG, Xu GF, Liu N, Liang J, Zhang MM, Li C, Zhang ZH, Wang ZS, Li Z, Yu ZJ. Clinical course and treatment efficacy of COVID-19 near Hubei Province, China: A multicentre, retrospective study. Transbound Emerg Dis 2020; 67:2971-2982. [PMID: 32531138 PMCID: PMC7307118 DOI: 10.1111/tbed.13674] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/31/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Currently, COVID‐19 has been reported in nearly all countries globally. To date, little is known about the viral shedding duration, clinical course and treatment efficacy of COVID‐19 near Hubei Province, China. This multicentre, retrospective study was performed in 12 hospitals in Henan and Shaanxi Provinces from 20 January to 8 February 2020. Clinical outcomes were followed up until 26 March 2020. The viral shedding duration, full clinical course and treatment efficacy were analysed in different subgroups of patients. A total of 149 COVID‐19 patients were enrolled. The median age was 42 years, and 61.1% (91) were males. Of them, 133 (89.3%) had fever, 131 of 144 (91%) had pneumonia, 27 (18.1%) required intensive care unit (ICU) management, 3 (2%) were pregnant, and 3 (2%) died. Two premature newborns were negative for SARS‐CoV‐2. In total, the median SARS‐CoV‐2 shedding period and clinical course were 12 (IQR: 9–17; mean: 13.4, 95% CI: 12.5, 14.2) and 20 (IQR: 16–24; mean: 21.2, 95% CI: 20.1, 22.3) days, respectively, and ICU patients had longer median viral shedding periods (21 [17–24] versus 11 [9–15]) and clinical courses (30 [22–33] vs. 19 [15.8–22]) than non‐ICU patients (both p < .0001). SARS‐CoV‐2 clearances occurred at least 2 days before fatality in 3 non‐survivors. Current treatment with any anti‐viral agent or combination did not present the benefit of shortening viral shedding period and clinical course (all p > .05) in real‐life settings. In conclusion, the viral shedding duration and clinical course in Henan and Shaanxi Provinces were shorter than those in Hubei Province, and current anti‐viral therapies were ineffective for shortening viral shedding duration and clinical course in real‐world settings. These findings expand our knowledge of the SARS‐CoV‐2 infection and may be helpful for management of the epidemic outbreak of COVID‐19 worldwide. Further studies concerning effective anti‐viral agents and vaccines are urgently needed.
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Affiliation(s)
- Qing-Lei Zeng
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Guang-Ming Li
- Department of Infectious Diseases, The Sixth People's Hospital of Zhengzhou City, Zhengzhou, Henan Province, China
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of China, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Shu-Huan Ma
- Department of Infectious Diseases, The Sixth People's Hospital of Zhengzhou City, Zhengzhou, Henan Province, China
| | - Guo-Fan Zhang
- The Department of Infectious Diseases, The First Affiliated Hospital of Nanyang Medical College, Nanyang, Henan Province, China
| | - Jiang-Hai Xu
- The Department of Infectious Diseases, The Fifth People's Hospital of Anyang City, Anyang, Henan Province, China
| | - Wan-Bao Lin
- The Department of Infectious Diseases, Xinyang Central Hospital, Xinyang, Henan Province, China
| | - Guang-Hua Xu
- The Department of Infectious Diseases, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi Province, China
| | - Guo-Qiang Zhang
- The Department of Infectious Diseases, Luoyang Central Hospital, Luoyang, Henan Province, China
| | - Guo-Tao Li
- The Department of Infectious Diseases, Luoyang Central Hospital, Luoyang, Henan Province, China
| | - Guang-Lin Cui
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Na Liu
- The Department of Infectious Diseases, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi Province, China
| | - Fan-Jun Zeng
- The Department of Infectious Diseases, Shangcheng People's Hospital, Shangcheng, Henan Province, China
| | - Zhi-Guo Ai
- The Department of Infectious Diseases, Shangcheng People's Hospital, Shangcheng, Henan Province, China
| | - Guang-Feng Xu
- The Department of Infectious Diseases, Xiayi People's Hospital, Xiayi, Henan Province, China
| | - Na Liu
- The Department of Infectious Diseases, Sheqi People's Hospital, Sheqi, Henan Province, China
| | - Jie Liang
- The Department of Infectious Diseases, Qixian People's Hospital, Qixian, Henan Province, China
| | - Min-Min Zhang
- Department of Infectious Diseases, The Sixth People's Hospital of Zhengzhou City, Zhengzhou, Henan Province, China
| | - Cheng Li
- Department of Infectious Diseases, The Sixth People's Hospital of Zhengzhou City, Zhengzhou, Henan Province, China
| | - Zhi-Hao Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ze-Shuai Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zongfang Li
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education of China, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.,National and Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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495
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Sun D, Zhu F, Wang C, Wu J, Liu J, Chen X, Liu Z, Wu Z, Lu X, Ma J, Peng H, Xiao H. Children Infected With SARS-CoV-2 From Family Clusters. Front Pediatr 2020; 8:386. [PMID: 32656172 PMCID: PMC7324777 DOI: 10.3389/fped.2020.00386] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/08/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is ongoing globally. Limited data are available for children with SARS-CoV-2 infection. Methods: A retrospective case study was conducted in one designated hospital for children with SARS-CoV-2 infection in Wuhan. Results: Out of the 74 children with laboratory-confirmed SARS-CoV-2 infection, the median age was 5.8 years, with no notable variation based on gender. All of the children had had direct exposure to at least one family member with confirmed SARS-CoV-2 infection. The most common symptoms were cough in 41 (55.4%) and fever in 38 (51.4%). Typical CT patterns of viral pneumonia were exhibited in 40 (54.1%) children, including ground-glass opacity and interstitial abnormalities. However, 17 (23.0%) children were classified as asymptomatic carriers, with neither symptoms nor radiological findings. Also, 68 (91.9%) children recovered fully and showed negative results on RT-PCR assay by nasopharyngeal swabs during our observation period. In contrast to the negative result for nasopharyngeal swab, 34% of the anal swabs showed a continued positive result. The mean hospitalization days of the children discharged after full recovery was 10.0 days. Conclusion: Within family clusters that had SARS-CoV-2 infection, children had mild or even asymptomatic illness. Although CT is highly sensitive, it should be avoided in follow-up of the disease in consideration of the radiological hazards and limited clinical benefits for mild illness in children. Furthermore, it is advocated that both nasopharyngeal and anal swabs should be confirmed negative for viral load prior to declaring full recovery so as to avoid oral-fecal transmission. Asymptomatic children with family clusters are potentially a little-known source of COVID-19. This therefore warrants an urgent reassessment of the transmission dynamics of the current outbreak.
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Affiliation(s)
- Dan Sun
- Department of Neurology, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Zhu
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Wang
- Clinic Center of Human Gene Research, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Cardiology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Liu
- Pediatric Department, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xue Chen
- Department of Neurology, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhisheng Liu
- Department of Neurology, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zubo Wu
- Pediatric Department, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoxia Lu
- Department of Respiratory, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jiehui Ma
- Department of Neurology, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Peng
- Pediatric Department, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Han Xiao
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
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496
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Galbadage T, Peterson BM, Awada J, Buck AS, Ramirez DA, Wilson J, Gunasekera RS. Systematic Review and Meta-Analysis of Sex-Specific COVID-19 Clinical Outcomes. Front Med (Lausanne) 2020; 7:348. [PMID: 32671082 PMCID: PMC7331754 DOI: 10.3389/fmed.2020.00348] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
To successfully mitigate the extraordinary devastation caused by the Coronavirus disease 2019 (COVID-19) pandemic, it is crucial to identify important risk factors for this disease. One such neglected health determinant is the sex of the patient. This is an essential clinical characteristic, as it can factor into a patient's clinical management and preventative measures. Some clinical studies have shown disparities in the proportion between males and females that have more severe clinical outcomes or, subsequently, die from this disease. However, this association has not been unequivocally established. Thus, the purpose of this investigation was to examine the association between male sex and COVID-19 severity. We systematically reviewed the literature, identified studies that matched predetermined selection criteria, and performed a meta-analysis to evaluate the proportion of males among four disease severity categories. Appropriate assessment strategies were implemented to assess and minimize potential biases. The results of this meta-analysis indicated that males constituted a significantly higher proportion of those who had adverse clinical outcomes and died from COVID-19. As the coronavirus spread from the East to the West, male sex remained a consistent risk factor. Our results support the establishment of the male sex as an important risk factor for this disease. Early identification and appropriate medical care for males with lab-confirmed COVID-19 may substantially change the course of clinical prognosis, resulting in greater numbers of lives saved.
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Affiliation(s)
- Thushara Galbadage
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Brent M Peterson
- Department of Kinesiology and Health Science, Biola University, La Mirada, CA, United States
| | - Joseph Awada
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - Alison S Buck
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - Danny A Ramirez
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
| | - Jason Wilson
- Department of Mathematics and Computer Science, Biola University, La Mirada, CA, United States
| | - Richard S Gunasekera
- Department of Chemistry, Physics, and Engineering, Biola University, La Mirada, CA, United States
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497
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Espinosa OA, Zanetti ADS, Antunes EF, Longhi FG, Matos TAD, Battaglini PF. Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis. Rev Inst Med Trop Sao Paulo 2020; 62:e43. [PMID: 32578683 PMCID: PMC7310609 DOI: 10.1590/s1678-9946202062043] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
The new coronavirus, COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020. Risk factors associated with this disease are age, sex, and the presence of comorbidities, the most common being hypertension, diabetes, and heart disease. The aim of this meta-analysis was to calculate the prevalence and geographical distribution of comorbidities in all patients admitted to intensive care units (ICUs), and the mortality rate of COVID-19. We selected studies based upon epidemiological and clinical descriptions of the patients and mortality from the disease to determine the pooled prevalence of comorbidities in all patients and in mortality cases due to COVID-19. The pooled prevalence was estimated using the random effects model, and odds ratios were used to measure the probability of death for a patient with a comorbidity. The total prevalence of comorbidities in patients with COVID-19 was 42% (95% CI: 25-60), 61% (95% CI: 42-80) in those admitted to the ICU, and 77% (95% CI: 68-86) among death cases; males were the most affected. Hypertension was the most prevalent comorbidity in all three groups studied, accounting for 32%, 26%, and 35%, respectively. The odds ratio of death for a patient with a comorbidity compared to one with no comorbidity was 2.4 (P < 0.0001). The higher the prevalence of comorbidities the higher the odds that the COVID-19 patient will need intensive care or will die, especially if the pre-existing disease is hypertension, heart disease, or diabetes.
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Affiliation(s)
| | - Andernice Dos Santos Zanetti
- Universidade do Estado de Mato Grosso, Faculdade de Ciências Agrárias e Biológicas, Programa de Pós-Graduação em Ciências Ambientais. Cáceres, Mato Grosso, Brazil
| | | | - Fabiana Gulin Longhi
- Centro de Excelência do Instituto Joanna Briggs, Centro Brasileiro para o Cuidado à Saúde Informado por Evidências, São Paulo, São Paulo, Brazil
| | - Tatiane Amorim de Matos
- Universidade do Estado de Mato Grosso, Faculdade de Ciências Agrárias e Biológicas, Programa de Pós-Graduação em Ciências Ambientais. Cáceres, Mato Grosso, Brazil
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498
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Lechowicz K, Drożdżal S, Machaj F, Rosik J, Szostak B, Zegan-Barańska M, Biernawska J, Dabrowski W, Rotter I, Kotfis K. COVID-19: The Potential Treatment of Pulmonary Fibrosis Associated with SARS-CoV-2 Infection. J Clin Med 2020; 9:E1917. [PMID: 32575380 PMCID: PMC7356800 DOI: 10.3390/jcm9061917] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
In December 2019, a novel coronavirus, SARS-CoV-2, appeared, causing a wide range of symptoms, mainly respiratory infection. In March 2020, the World Health Organization (WHO) declared Coronavirus Disease 2019 (COVID-19) a pandemic, therefore the efforts of scientists around the world are focused on finding the right treatment and vaccine for the novel disease. COVID-19 has spread rapidly over several months, affecting patients across all age groups and geographic areas. The disease has a diverse course; patients may range from asymptomatic to those with respiratory failure, complicated by acute respiratory distress syndrome (ARDS). One possible complication of pulmonary involvement in COVID-19 is pulmonary fibrosis, which leads to chronic breathing difficulties, long-term disability and affects patients' quality of life. There are no specific mechanisms that lead to this phenomenon in COVID-19, but some information arises from previous severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS) epidemics. The aim of this narrative review is to present the possible causes and pathophysiology of pulmonary fibrosis associated with COVID-19 based on the mechanisms of the immune response, to suggest possible ways of prevention and treatment.
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Affiliation(s)
- Kacper Lechowicz
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (M.Z.-B.)
| | - Sylwester Drożdżal
- Department of Pharmacokinetics and Monitored Therapy, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Filip Machaj
- Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (F.M.); (J.R.); (B.S.)
| | - Jakub Rosik
- Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (F.M.); (J.R.); (B.S.)
| | - Bartosz Szostak
- Department of Physiology, Pomeranian Medical University, 70-111 Szczecin, Poland; (F.M.); (J.R.); (B.S.)
| | - Małgorzata Zegan-Barańska
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (M.Z.-B.)
| | - Jowita Biernawska
- Department of Anaesthesiology and Intensive Therapy, Pomeranian Medical University, 71-242 Szczecin, Poland;
| | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Care, Medical University, 20-090 Lublin, Poland;
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, 71-210 Szczecin, Poland;
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.L.); (M.Z.-B.)
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499
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Borrás A, Guimerà M, Barral Y, Agustí I, Manau Trullàs MD. [SARS-CoV-2 pandemic and assisted reproduction]. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020; 47:96-105. [PMID: 32834306 PMCID: PMC7303616 DOI: 10.1016/j.gine.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023]
Abstract
La pandemia por el nuevo virus SARS-CoV-2 ha provocado un proceso de adaptación a la nueva situación por parte de toda de la sociedad y, con ello, los centros de reproducción asistida. Tras la fase aguda de la crisis sanitaria, en la que se redujo de forma drástica la actividad, se han reanudado los ciclos, guiados por las recomendaciones de las sociedades científicas. En este artículo revisamos toda la información publicada respecto al virus y el sistema reproductivo, señalando la presencia de enzima convertidora de angiotensina tipo ii(angiotensin-converting enzyme 2, ACE2) en el sistema reproductivo femenino y masculino, a nivel testicular, ovárico, endometrial y a nivel embrionario. Además, realizamos un análisis comparativo entre las recomendaciones de las sociedades científicas en cuanto al cribado de la infección, las normas de funcionamiento y las medidas generales de laboratorio.
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Affiliation(s)
- A Borrás
- Unidad de Reproducción Humana Asistida, Servicio de Ginecología, Institut Clínic de Ginecología, Obtetricia i Neonatologia (ICGON), Hospital Clínic de Barcelona, Barcelona, España
| | - M Guimerà
- Unidad de Reproducción Humana Asistida, Servicio de Ginecología, Institut Clínic de Ginecología, Obtetricia i Neonatologia (ICGON), Hospital Clínic de Barcelona, Barcelona, España
| | - Y Barral
- Unidad de Reproducción Humana Asistida, Servicio de Ginecología, Institut Clínic de Ginecología, Obtetricia i Neonatologia (ICGON), Hospital Clínic de Barcelona, Barcelona, España
| | - I Agustí
- Unidad de Reproducción Humana Asistida, Servicio de Ginecología, Institut Clínic de Ginecología, Obtetricia i Neonatologia (ICGON), Hospital Clínic de Barcelona, Barcelona, España
| | - M D Manau Trullàs
- Unidad de Reproducción Humana Asistida, Servicio de Ginecología, Institut Clínic de Ginecología, Obtetricia i Neonatologia (ICGON), Hospital Clínic de Barcelona, Barcelona, España
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500
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Qin L, Li X, Shi J, Yu M, Wang K, Tao Y, Zhou Y, Zhou M, Xu S, Wu B, Yang Z, Zhang C, Yue J, Cheng C, Liu X, Xie M. Gendered effects on inflammation reaction and outcome of COVID-19 patients in Wuhan. J Med Virol 2020; 92:2684-2692. [PMID: 32497297 PMCID: PMC7300463 DOI: 10.1002/jmv.26137] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The rapid outbreak of coronavirus disease 2019 (COVID-19) has turned into a public health emergency of international concern. Epidemiological research has shown that sex is associated with the severity of COVID-19, but the underlying mechanism of sex predisposition remains poorly understood. We aim to study the gendered differences in inflammation reaction, and the association with severity and mortality of COVID-19. METHODS In this retrospective study, we enrolled 548 COVID-19 inpatients from Tongji Hospital from 26 January to 5 February 2020, and followed up to 3 March 2020. Epidemiological, demographic and clinical features, and inflammatory indexes were collected and compared between males and females. The Cox proportional hazard regression model was applied to identify the gendered effect on mortality of COVID-19 after adjusting for age, comorbidity, and smoking history. The multiple linear regression method was used to explore the influence of sex on inflammation reaction. RESULTS Males had higher mortality than females did (22.2% vs 10.4%), with an hazard ratio of 1.923 (95% confidence interval, 1.181-3.130); elder age and comorbidity were significantly associated with decease of COVID-19 patients. Excess inflammation reaction was related to severity of COVID-19. Male patients had greater inflammation reaction, with higher levels of interleukin 10, tumor necrosis factor-α, lactose dehydrogenase, ferritin, and hyper-sensitive C-reactive protein, but a lower lymphocyte count than females adjusted by age and comorbidity. CONCLUSIONS Sex, age, and comorbidity are critical risk factors for mortality of COVID-19. Excess innate immunity and proinflammation activity, and deficiency in adaptive immunity response promote males, especially elder males, to develop a cytokine storm, causing potential acute respiratory distressed syndrome, multiple organ failure and decease.
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Affiliation(s)
- Lu Qin
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Xiaochen Li
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Jing Shi
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Muqing Yu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Ke Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Yu Tao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Ying Zhou
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Shuyun Xu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Bo Wu
- United Imaging Healthcare Co, Ltd, Wuhan, China
| | - Zhenyu Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Cong Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Junqing Yue
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Chongsheng Cheng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Xiansheng Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Respiratory Diseases, National Ministry of Health of the People's Republic of China and National Clinical Research Center for Respiratory Disease, Wuhan, China
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