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The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect 2020; 148:e98. [PMID: 32430088 PMCID: PMC7251286 DOI: 10.1017/s0950268820001107] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2 virus) has been sustained in China since December 2019, and has become a pandemic. The mental health of frontline medical staff is a concern. In this study, we aimed to identify the factors influencing medical worker anxiety in China during the COVID-19 outbreak. We conducted a cross-sectional study to estimate the prevalence of anxiety among medical staff in China from 10 February 2020 to 20 February 2020 using the Zung Self-rating Anxiety Scale (SAS) to assess anxiety, with the criteria of normal (⩽49), mild (50–59), moderate (60–70) and severe anxiety (⩾70). We used multivariable linear regression to determine the factors (e.g. having direct contact when treating infected patients, being a medical staff worker from Hubei province, being a suspect case) for anxiety. We also used adjusted models to confirm independent factors for anxiety after adjusting for gender, age, education and marital status. Of 512 medical staff in China, 164 (32.03%) had had direct contact treating infected patients. The prevalence of anxiety was 12.5%, with 53 workers suffering from mild (10.35%), seven workers suffering from moderate (1.36%) and four workers suffering from severe anxiety (0.78%). After adjusting for sociodemographic characteristics (gender, age, education and marital status), medical staff who had had direct contact treating infected patients experienced higher anxiety scores than those who had not had direct contact (β value = 2.33, confidence interval (CI) 0.65–4.00; P = 0.0068). A similar trend was observed in medical staff from Hubei province, compared with those from other parts of China (β value = 3.67, CI 1.44–5.89; P = 0.0013). The most important variable was suspect cases with high anxiety scores, compared to non-suspect cases (β value = 4.44, CI 1.55–7.33; P = 0.0028). In this survey of hospital medical workers during the COVID-19 outbreak in China, we found that study participants experienced anxiety symptoms, especially those who had direct clinical contact with infected patients; as did those in the worst affected areas, including Hubei province; and those who were suspect cases. Governments and healthcare authorities should proactively implement appropriate psychological intervention programmes, to prevent, alleviate or treat increased anxiety.
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652
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Wang J, Li Z, Cheng X, Hu H, Liao C, Li P, Lu J, Chen Z. Epidemiologic Characteristics, Transmission Chain, and Risk Factors of Severe Infection of COVID-19 in Tianjin, a Representative Municipality City of China. Front Public Health 2020; 8:198. [PMID: 32671007 PMCID: PMC7326095 DOI: 10.3389/fpubh.2020.00198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/30/2020] [Indexed: 01/22/2023] Open
Abstract
This study was performed to describe the epidemiologic characteristics of coronavirus disease 2019 (COVID-19) and explore risk factors for severe infection. Data of all 131 confirmed cases in Tianjin before February 20 were collected. By February 20, a total of 14/16 districts reported COVID-19 cases, with Baodi district reporting the most cases (n = 56). A total of 22 (16.8%) cases had a Wuhan-related exposure. Fever was the most common symptom (82.4%). The median duration of symptom onset to treatment was [1.0 (0.0–4.0) days], the duration of symptom onset to isolation [2.0 (0.0–6.0) days], and the duration of symptom onset to diagnosis [5.0 (2.0–8.0) days]. The analysis of the transmission chain showed two cluster infections with 62 cases infected. Transmission from a family member constituted 42%, usually at the end of transmission chain. Compared with patients with non-severe infections, patients with severe infections were more likely to be male (46.2 vs. 77.3%, P = 0.009) and had a Wuhan-related exposure (14.0 vs. 40.9%, P = 0.004). Multivariate logistic regression showed that male (OR 3.913, 95% CI 1.206, 12.696; P = 0.023) was an independent risk factor for severe infection. This study provides evidence on the epidemic of COVID-19 by analyzing the epidemiological characteristics of confirmed cases in Tianjin. Self-quarantine at an outbreak's early stage, especially for those with high-risk exposures, is conducive to prevent the transmission of infection. Further investigation is needed to confirm the risk factors for severe COVID-19 infection and investigate the mechanisms involved.
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Affiliation(s)
- Jin Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhihui Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaomin Cheng
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Huan Hu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Conghui Liao
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Pengyuan Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiahai Lu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zeliang Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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653
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Cecconi M, Piovani D, Brunetta E, Aghemo A, Greco M, Ciccarelli M, Angelini C, Voza A, Omodei P, Vespa E, Pugliese N, Parigi TL, Folci M, Danese S, Bonovas S. Early Predictors of Clinical Deterioration in a Cohort of 239 Patients Hospitalized for Covid-19 Infection in Lombardy, Italy. J Clin Med 2020; 9:jcm9051548. [PMID: 32443899 PMCID: PMC7290833 DOI: 10.3390/jcm9051548] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023] Open
Abstract
We described features of hospitalized Covid-19 patients and identified predictors of clinical deterioration. We included patients consecutively admitted at Humanitas Research Hospital (Rozzano, Milan, Italy); retrospectively extracted demographic; clinical; laboratory and imaging findings at admission; used survival methods to identify factors associated with clinical deterioration (defined as intensive care unit (ICU) transfer or death), and developed a prognostic index. Overall; we analyzed 239 patients (29.3% females) with a mean age of 63.9 (standard deviation [SD]; 14.0) years. Clinical deterioration occurred in 70 patients (29.3%), including 41 (17.2%) ICU transfers and 36 (15.1%) deaths. The most common symptoms and signs at admission were cough (77.8%) and elevated respiratory rate (34.1%), while 66.5% of patients had at least one coexisting medical condition. Imaging frequently revealed ground-glass opacity (68.9%) and consolidation (23.8%). Age; increased respiratory rate; abnormal blood gas parameters and imaging findings; coexisting coronary heart disease; leukocytosis; lymphocytopenia; and several laboratory parameters (elevated procalcitonin; interleukin-6; serum ferritin; C-reactive protein; aspartate aminotransferase; lactate dehydrogenase; creatinine; fibrinogen; troponin-I; and D-dimer) were significant predictors of clinical deterioration. We suggested a prognostic index to assist risk-stratification (C-statistic; 0.845; 95% CI; 0.802–0.887). These results could aid early identification and management of patients at risk, who should therefore receive additional monitoring and aggressive supportive care.
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Affiliation(s)
- Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
- Correspondence: ; Tel.: +39-34-0366-5193
| | - Enrico Brunetta
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Michele Ciccarelli
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Claudio Angelini
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Paolo Omodei
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Edoardo Vespa
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Marco Folci
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; (M.C.); (E.B.); (A.A.); (M.G.); (M.C.); (C.A.); (A.V.); (P.O.); (E.V.); (N.P.); (T.L.P.); (M.F.); (S.D.); (S.B.)
- Humanitas Clinical and Research Center—IRCCS, 20089 Rozzano, Milan, Italy
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654
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Pan A, Liu L, Wang C, Guo H, Hao X, Wang Q, Huang J, He N, Yu H, Lin X, Wei S, Wu T. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA 2020; 323:1915-1923. [PMID: 32275295 PMCID: PMC7149375 DOI: 10.1001/jama.2020.6130] [Citation(s) in RCA: 1023] [Impact Index Per Article: 255.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/03/2020] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Coronavirus disease 2019 (COVID-19) has become a pandemic, and it is unknown whether a combination of public health interventions can improve control of the outbreak. OBJECTIVE To evaluate the association of public health interventions with the epidemiological features of the COVID-19 outbreak in Wuhan by 5 periods according to key events and interventions. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, individual-level data on 32 583 laboratory-confirmed COVID-19 cases reported between December 8, 2019, and March 8, 2020, were extracted from the municipal Notifiable Disease Report System, including patients' age, sex, residential location, occupation, and severity classification. EXPOSURES Nonpharmaceutical public health interventions including cordons sanitaire, traffic restriction, social distancing, home confinement, centralized quarantine, and universal symptom survey. MAIN OUTCOMES AND MEASURES Rates of laboratory-confirmed COVID-19 infections (defined as the number of cases per day per million people), across age, sex, and geographic locations were calculated across 5 periods: December 8 to January 9 (no intervention), January 10 to 22 (massive human movement due to the Chinese New Year holiday), January 23 to February 1 (cordons sanitaire, traffic restriction and home quarantine), February 2 to 16 (centralized quarantine and treatment), and February 17 to March 8 (universal symptom survey). The effective reproduction number of SARS-CoV-2 (an indicator of secondary transmission) was also calculated over the periods. RESULTS Among 32 583 laboratory-confirmed COVID-19 cases, the median patient age was 56.7 years (range, 0-103; interquartile range, 43.4-66.8) and 16 817 (51.6%) were women. The daily confirmed case rate peaked in the third period and declined afterward across geographic regions and sex and age groups, except for children and adolescents, whose rate of confirmed cases continued to increase. The daily confirmed case rate over the whole period in local health care workers (130.5 per million people [95% CI, 123.9-137.2]) was higher than that in the general population (41.5 per million people [95% CI, 41.0-41.9]). The proportion of severe and critical cases decreased from 53.1% to 10.3% over the 5 periods. The severity risk increased with age: compared with those aged 20 to 39 years (proportion of severe and critical cases, 12.1%), elderly people (≥80 years) had a higher risk of having severe or critical disease (proportion, 41.3%; risk ratio, 3.61 [95% CI, 3.31-3.95]) while younger people (<20 years) had a lower risk (proportion, 4.1%; risk ratio, 0.47 [95% CI, 0.31-0.70]). The effective reproduction number fluctuated above 3.0 before January 26, decreased to below 1.0 after February 6, and decreased further to less than 0.3 after March 1. CONCLUSIONS AND RELEVANCE A series of multifaceted public health interventions was temporally associated with improved control of the COVID-19 outbreak in Wuhan, China. These findings may inform public health policy in other countries and regions.
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Affiliation(s)
- An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chaolong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Guo
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingjie Hao
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Na He
- School of Public Health, Ministry of Education Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Hongjie Yu
- School of Public Health, Ministry of Education Key Laboratory of Public Health Safety, Fudan University, Shanghai, China
| | - Xihong Lin
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Statistics, Harvard University, Boston, Massachusetts
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tangchun Wu
- Department of Occupational and Environmental Health, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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655
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Lv Z, Cheng S, Le J, Huang J, Feng L, Zhang B, Li Y. Clinical characteristics and co-infections of 354 hospitalized patients with COVID-19 in Wuhan, China: a retrospective cohort study. Microbes Infect 2020; 22:195-199. [PMID: 32425649 PMCID: PMC7233257 DOI: 10.1016/j.micinf.2020.05.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Abstract
From December 2019, a novel coronavirus, SARS-CoV-2, caused an outbreak of pneumonia in Wuhan city and rapidly spread throughout China and globally. However, the clinical characteristics and co-infection with other respiratory pathogens of patients with COVID-19 and the factors associated with severity of COVID-19 are still limited. In this retrospective cohort study, we included 354 inpatients with COVID-19 admitted to Renmin Hospital of Wuhan University from February 4, 2020 to February 28, 2020. We found levels of interleukin-6, interleukin-10, C-reactive protein, D-dimer, white blood cell count and neutrophil count were clearly elevated in males and critical cases compared with females and severe and mild cases, respectively. However, lymphopenia was more severe in males than females and levels of tumor necrosis factor alpha were reduced significantly in critical cases than severe and mild cases. 23.5% of severe cases and 24.4% of critical cases were co-infected with other respiratory pathogens. Additionally, stepwise multivariable regression analysis suggested that co-infection, lymphocyte count and levels of D-dimer were associated with severity of COVID-19.These findings provide crucial clues for further identification of the mechanisms, characteristics and treatments of patients with COVID-19.
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Affiliation(s)
- Zhihua Lv
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Shaohua Cheng
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Juan Le
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jingtao Huang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Lina Feng
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Binghong Zhang
- Department of Orthopedic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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656
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Cuadrado-Payán E, Montagud-Marrahi E, Torres-Elorza M, Bodro M, Blasco M, Poch E, Soriano A, Piñeiro GJ. SARS-CoV-2 and influenza virus co-infection. Lancet 2020; 395:e84. [PMID: 32423586 PMCID: PMC7200126 DOI: 10.1016/s0140-6736(20)31052-7] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | - Marta Bodro
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Miquel Blasco
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Esteban Poch
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
| | - Alex Soriano
- Hospital Clinic of Barcelona, Barcelona 08036, Spain
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657
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Nanda KDS, Nanda J. Recommendations and Management in Dental Practice during Corona Virus COVID-19. Open Dent J 2020. [DOI: 10.2174/1874210602014010191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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658
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Lee YH, Auh QS. Strategies for prevention of coronavirus disease 2019 in the dental field. Oral Dis 2020; 27 Suppl 3:740-741. [PMID: 32306496 PMCID: PMC7264497 DOI: 10.1111/odi.13361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/11/2020] [Accepted: 04/11/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Seoul, Korea
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659
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Sun DW, Zhang D, Tian RH, Li Y, Wang YS, Cao J, Tang Y, Zhang N, Zan T, Gao L, Huang YZ, Cui CL, Wang DX, Zheng Y, Lv GY. The underlying changes and predicting role of peripheral blood inflammatory cells in severe COVID-19 patients: A sentinel? Clin Chim Acta 2020; 508:122-129. [PMID: 32417210 PMCID: PMC7224669 DOI: 10.1016/j.cca.2020.05.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Abstract
Lymphopenia and eosinopenia might be predictors of disease severity in COVID-19. Lymphopenia and eosinopenia might be predictors of disease progression in COVID-19. Clinical classification-severe type is the dependently risk factor for alteration of PBICs. PBICs might be a sentinel, and it deserves attention during COVID-19 management.
Background The underlying changes of peripheral blood inflammatory cells (PBICs) in COVID-19 patients are little known. Moreover, the risk factors for the underlying changes of PBICs and their predicting role in severe COVID-19 patients remain uncertain. Material and methods This retrospective study including two cohorts: the main cohort enrolling 45 patients of severe type serving as study group, and the secondary cohort enrolling 12 patients of no-severe type serving as control group. The PBICs analysis was based on blood routine and lymphocyte subsets. The inflammatory cell levels were compared among patients according to clinical classifications, disease-associated phases, as well as one-month outcomes. Results Compared with patients of non-severe type, the patients of severe type suffered from significantly decreased counts of lymphocytes, eosinophils, basophils, but increased counts of neutrophils. These PBICs alterations got improved in recovery phase, but persisted or got worse in aggravated phase. Compared with patients in discharged group, the patients in un-discharged/died group suffered from decreased counts of total T lymphocytes, CD4 + T lymphocytes, CD8 + T lymphocytes, as well as NK cells at 2 weeks after treatment. Clinical classification-critically severe was the independently risk factor for lymphopenia (OR = 7.701, 95%CI:1.265–46.893, P = 0.027), eosinopenia (OR = 5.595, 95%CI:1.008–31.054, P = 0.049), and worse one-month outcome (OR = 8.984; 95%CI:1.021–79.061, P = 0.048). Conclusion Lymphopenia and eosinopenia may serve as predictors of disease severity and disease progression in COVID-19 patients, and enhancing the cellular immunity may contribute to COVID-19 treatment. Thus, PBICs might become a sentinel of COVID-19, and it deserves attention during COVID-19 treatment.
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Affiliation(s)
- Da-Wei Sun
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Dong Zhang
- Department of Intensive Care Unit, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Run-Hui Tian
- Department of Psychology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Yang Li
- Department of Thoracic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Yu-Shi Wang
- Department of Cardiology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China
| | - Jie Cao
- Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Ying Tang
- Department of Respiration, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Nan Zhang
- Department of Gastroenterology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Tao Zan
- Department of Intensive Care Unit, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Lan Gao
- Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Yan-Zhu Huang
- Department of Neurology, Tongji Hospital Affiliated to Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Chang-Lei Cui
- Department of Anesthesiology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Dong-Xuan Wang
- Department of Ultrasound, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Yang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
| | - Guo-Yue Lv
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Jilin University, Changchun 130021, Jilin, China.
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660
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Catalá Gonzalo A, Galván Casas C. COVID-19 and the Skin. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:447-449. [PMID: 32401723 PMCID: PMC7219358 DOI: 10.1016/j.ad.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - C Galván Casas
- Servicio de Dermatología, Hospital Universitario de Móstoles, Madrid, España.
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661
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Radbel J, Jagpal S, Roy J, Brooks A, Tischfield J, Sheldon M, Bixby C, Witt D, Gennaro ML, Horton DB, Barrett ES, Carson JL, Panettieri RA, Blaser MJ. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Is Comparable in Clinical Samples Preserved in Saline or Viral Transport Medium. J Mol Diagn 2020; 22:871-875. [PMID: 32405270 PMCID: PMC7219422 DOI: 10.1016/j.jmoldx.2020.04.209] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/28/2020] [Indexed: 12/22/2022] Open
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic sweeps across the world, the availability of viral transport medium (VTM) has become severely limited, contributing to delays in diagnosis and rationing of diagnostic testing. Given that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA has demonstrated stability, we posited that phosphate-buffered saline (PBS) may be a viable transport medium, as an alternative to VTM, for clinical real-time quantitative PCR (qPCR) testing. The intra-individual reliability and interindividual reliability of SARS-CoV-2 qPCR were assessed in clinical endotracheal secretion samples transported in VTM or PBS to evaluate the stability of the qPCR signal for three viral targets (N gene, ORF1ab, and S gene) when samples were stored in these media at room temperature for up to 18 hours. We report that the use of PBS as a transport medium allows high intra-individual and interindividual reliability, maintains viral stability, and compares with VTM in the detection of the three SARS-CoV-2 genes through 18 hours of storage. This study establishes PBS as a clinically useful medium that can be readily deployed for transporting and short-term preservation of specimens containing SARS-CoV-2. Use of PBS as a transport medium has the potential to increase testing capacity for SARS-CoV-2, aiding more widespread screening and early diagnosis of COVID-19.
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Affiliation(s)
- Jared Radbel
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey
| | - Sugeet Jagpal
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jason Roy
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrew Brooks
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey; Rutgers University Cell and DNA Repository Infinite Biologics and Human Genetics Institute of New Jersey and Department of Genetics, Rutgers University, Piscataway, New Jersey
| | - Jay Tischfield
- Rutgers University Cell and DNA Repository Infinite Biologics and Human Genetics Institute of New Jersey and Department of Genetics, Rutgers University, Piscataway, New Jersey; Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael Sheldon
- Rutgers University Cell and DNA Repository Infinite Biologics and Human Genetics Institute of New Jersey and Department of Genetics, Rutgers University, Piscataway, New Jersey
| | - Christian Bixby
- Rutgers University Cell and DNA Repository Infinite Biologics and Human Genetics Institute of New Jersey and Department of Genetics, Rutgers University, Piscataway, New Jersey
| | - Dana Witt
- Rutgers University Cell and DNA Repository Infinite Biologics and Human Genetics Institute of New Jersey and Department of Genetics, Rutgers University, Piscataway, New Jersey
| | - Maria L Gennaro
- Public Health Research Institute, Department of Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Daniel B Horton
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey; Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
| | - Emily S Barrett
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Jeffrey L Carson
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Reynold A Panettieri
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Rutgers Institute for Translational Medicine and Science, New Brunswick, New Jersey
| | - Martin J Blaser
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, New Jersey.
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662
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Puliatti S, Eissa A, Eissa R, Amato M, Mazzone E, Dell'Oglio P, Sighinolfi MC, Zoeir A, Micali S, Bianchi G, Patel V, Wiklund P, Coelho RF, Bernhard JC, Dasgupta P, Mottrie A, Rocco B. COVID-19 and urology: a comprehensive review of the literature. BJU Int 2020; 125:E7-E14. [PMID: 32249538 DOI: 10.1111/bju.15071] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To discuss the impact of COVID-19 on global health, particularly on urological practice and to review some of the available recommendations reported in the literature. MATERIAL AND METHODS In the current narrative review the PubMed database was searched to identify all the related reports discussing the impact of COVID-19 on the urological field. RESULTS The COVID-19 pandemic is the latest and biggest global health threat. Medical and surgical priorities have changed dramatically to cope with the current challenge. These changes include postponements of all elective outpatient visits and surgical procedures to save facilities and resources for urgent cases and patients with COVID-19 patients. This review discuss some of the related changes in urology. CONCLUSIONS Over the coming weeks, healthcare workers including urologists will be facing increasingly difficult challenges, and consequently, they should adopt triage strategy to avoid wasting of medical resources and they should endorse sufficient protection policies to guard against infection when dealing with COVID-19 patients.
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Affiliation(s)
- Stefano Puliatti
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Ahmed Eissa
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Radwa Eissa
- Microbiology and Virology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Marco Amato
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy.,ORSI Academy, Melle, Belgium
| | - Elio Mazzone
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Ahmed Zoeir
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Salvatore Micali
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
| | - Vipul Patel
- Global Robotics Institute, Florida Hospital-Celebration Health Celebration, University of Central Florida School of Medicine, Orlando, FL, USA
| | - Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Rafael F Coelho
- Department of urology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil
| | | | - Prokar Dasgupta
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners, London, UK.,MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Alexandre Mottrie
- ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Bernardo Rocco
- Urology Department, University of Modena and Reggio Emilia, Modena, Italy
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663
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Kukla M, Skonieczna-Żydecka K, Kotfis K, Maciejewska D, Łoniewski I, Lara LF, Pazgan-Simon M, Stachowska E, Kaczmarczyk M, Koulaouzidis A, Marlicz W. COVID-19, MERS and SARS with Concomitant Liver Injury-Systematic Review of the Existing Literature. J Clin Med 2020; 9:E1420. [PMID: 32403255 PMCID: PMC7290752 DOI: 10.3390/jcm9051420] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/10/2023] Open
Abstract
The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.
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Affiliation(s)
- Michał Kukla
- Department of Internal Medicine and Geriatrics, Jagiellonian University Medical College, 2 Jakubowskiego St., 30-688 Cracow, Poland;
- Department of Endoscopy, University Hospital in Cracow, 2 Jakubowskiego St., 30-688 Cracow, Poland
- 1st Infectious Diseases Ward, Gromkowski Regional Specialist Hospital, Wroclaw, 5 Koszarowa St., 50-149 Wroclaw, Poland;
| | - Karolina Skonieczna-Żydecka
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Dominika Maciejewska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Igor Łoniewski
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Luis. F. Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Monika Pazgan-Simon
- 1st Infectious Diseases Ward, Gromkowski Regional Specialist Hospital, Wroclaw, 5 Koszarowa St., 50-149 Wroclaw, Poland;
- Department of Infectious Diseases, Wroclaw Medical University, 5 Koszarowa St., 50-149 Wroclaw, Poland
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland; (K.S.-Ż.); (D.M.); (I.Ł.); (E.S.)
| | - Mariusz Kaczmarczyk
- Department of Clinical and Molecular Biochemistry, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK;
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, 71-252 Szczecin, Poland
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664
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[Estimated Effect of COVID-19 Lockdown on Skin Tumor Size and Survival: An Exponential Growth Model]. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:629-638. [PMID: 32513393 PMCID: PMC7211725 DOI: 10.1016/j.ad.2020.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 01/17/2023] Open
Abstract
Antecedentes y objetivos La pandemia del coronavirus SARS-CoV-2 ha provocado un confinamiento indefinido. Una posible consecuencia de esta situación es un retraso en los procedimientos asistenciales de las enfermedades oncológicas. El objetivo de este estudio es estimar el hipotético impacto en la supervivencia que tendría el aumento del tamaño tanto para los carcinomas de células escamosas (CCE) como de los melanomas. Material y método Estudio observacional retrospectivo de cohorte multicéntrico. Se desarrolló un modelo de crecimiento exponencial para cada tumor basado en el tiempo de evolución que refiere el paciente. Resultados Se incluyeron un total de 200 pacientes con CCE localizados en la cabeza y el cuello y 1.000 pacientes con melanoma cutáneo. Se calculó una curva de crecimiento exponencial para cada tumor y se estimó el tamaño del tumor tras 1, 2 y 3 meses tras el diagnóstico. En la muestra, los CCE mayores de 4 cm o > 6 mm de grosor (definidos como T3) pasaron de 83 (41,5%) en el grupo de estudio real a una estimación del 58,5, 70,5 y 72% tras 1, 2 y 3 meses de retraso quirúrgico estimado, respectivamente. Se estimó una disminución de la supervivencia específica de enfermedad (SEE) de un 6,2, 8,2 y 5,2% a los 2, 5 y 10 años, respectivamente, tras 3 meses de retraso. Para los melanomas ultragruesos (> 6 mm de Breslow) pasaron del 6,9% en el grupo de estudio al 21,9, 30,2 y 30,2% tras 1, 2 y 3 meses de demora. La SEE a los 5 y 10 años del grupo de estudio descendió un 14,4% en ambos tiempos. Conclusiones En ausencia de un adecuado diagnóstico y tratamiento de los pacientes con CCE y melanoma en la actual situación de confinamiento en España, podemos llegar a asistir a un considerable aumento de los casos de CCE y melanomas gruesos y de gran tamaño. Se deben fomentar los esfuerzos para promocionar la autoexploración y facilitar el acceso a los dermatólogos para no aumentar la demora de estos pacientes.
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665
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Jajodia A, Ebner L, Heidinger B, Chaturvedi A, Prosch H. Imaging in corona virus disease 2019 (COVID-19)-A Scoping review. Eur J Radiol Open 2020; 7:100237. [PMID: 32395567 PMCID: PMC7211691 DOI: 10.1016/j.ejro.2020.100237] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
Coronavirus Disease-2019 (COVID-19) originated in the Wuhan, Hubei Province, China in November 2019 and has since been declared a pandemic by the WHO. COVID-19 is an acute infectious disease, primarily affecting the respiratory system. Currently, real-time reverse transcription polymerase chain reaction (RT-PCR) performed on respiratory specimens is considered the reference by which to diagnose COVID-19. However, the limitations of RT-PCR, specifically, the fact that it is time-consuming and inadequate for the assessment of disease severity, have affected the process of epidemiological disease containment and has taken a toll on the healthcare management chain. As the risk of infection for other patients and personnel must be kept to a minimum, the indications for imaging have to be carefully considered. Imaging is primarily performed in patients with a negative RT-PCR, but a high clinical suspicion of COVID-19, or, in patients with diagnosed COVID-19 who are suffering from moderate to severe symptoms. In this article, we review the typical imaging findings in COVID-19, the differential diagnoses, and common complications.
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Affiliation(s)
- Ankush Jajodia
- Dep. of Radiology, Rajiv Gandhi Cancer Institute and Research Centre -Delhi, India
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital University Hospital Bern, Switzerland
| | - Benedikt Heidinger
- Dept. Of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Arvind Chaturvedi
- Dep. of Radiology, Rajiv Gandhi Cancer Institute and Research Centre -Delhi, India
| | - Helmut Prosch
- Dept. Of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
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666
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Zhang S, Gan J, Chen BG, Zheng D, Zhang JG, Lin RH, Zhou YP, Yang WY, Lin A, Yan WH. Dynamics of peripheral immune cells and their HLA-G and receptor expressions in a patient suffering from critical COVID-19 pneumonia to convalescence. Clin Transl Immunology 2020; 9:e1128. [PMID: 32399213 PMCID: PMC7211507 DOI: 10.1002/cti2.1128] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Host immune responses are indispensable to combat the disease. We report the dynamics of peripheral immune cells, cytokines, and human leucocyte antigen-G (HLA-G) and its receptor expressions in a patient suffering from critical COVID-19 pneumonia to convalescence. Methods Clinical data of the patient were collected from medical records. The expressions of HLA-G and receptors ILT2, ILT4 and KIR2DL4 in peripheral immune cells were measured with flow cytometry. Results From critical COVID-19 to the convalescent stage, early lymphopenia was improved (median: 0.6 × 109 L-1 vs. 0.9 × 109 L-1, P = 0.009), and an obvious fluctuation in WBC and neutrophil counts was observed. Initially, low levels of CD4+ T cells (from 120 to 528 μL-1) and CD8+ T cells (from 68 to 362 μL-1) gradually increased to normal levels. Meanwhile, high IL-6 (from 251.8 to 6.32 pg mL-1), IL-10 (from 39.53 to 5.21 pg mL-1) and IFN-γ (from 13.55 to 3.16 pg mL-1) levels decreased, and IL-4 (from 2.36 to 3.19 pg mL-1) and TNF-α (from 2.27 to 20.2 pg mL-1) levels increased quickly when the viral RNA returned negative. Moreover, the percentage of HLA-G+ T cells, B cells and monocytes follows high-low-high pattern, while the percentage of receptors ILT2-, ILT4- and KIR2DL4-expressing cells remained relatively stable. Conclusion Our findings provide valuable information on the dynamics of early peripheral immunological responses in SARS-CoV-2 infection. CD4+ and CD8+ T cells, cytokines and HLA-G+ immune cells are associated with the natural history of the critical COVID-19 patient; however, future studies are necessary.
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Affiliation(s)
- Sheng Zhang
- Department of Intensive Care Unit TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Jun Gan
- Medical Research Center TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Bao-Guo Chen
- Medical Research Center TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Dan Zheng
- Department of Intensive Care Unit TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Jian-Gang Zhang
- Biological Resource Center TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Rong-Hai Lin
- Department of Intensive Care Unit TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Yi-Ping Zhou
- Department of Intensive Care Unit TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Wei-Ying Yang
- Department of Intensive Care Unit TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Aifen Lin
- Biological Resource Center TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
| | - Wei-Hua Yan
- Medical Research Center TaiZhou Hospital of Zhejiang Province Wenzhou Medical University LinHai Zhejiang China
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667
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What's new in lung ultrasound during the COVID-19 pandemic. Intensive Care Med 2020; 46:1445-1448. [PMID: 32367169 PMCID: PMC7196717 DOI: 10.1007/s00134-020-06048-9] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 12/23/2022]
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668
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Ni L, Ye F, Cheng ML, Feng Y, Deng YQ, Zhao H, Wei P, Ge J, Gou M, Li X, Sun L, Cao T, Wang P, Zhou C, Zhang R, Liang P, Guo H, Wang X, Qin CF, Chen F, Dong C. Detection of SARS-CoV-2-Specific Humoral and Cellular Immunity in COVID-19 Convalescent Individuals. Immunity 2020; 52:971-977.e3. [PMID: 32413330 PMCID: PMC7196424 DOI: 10.1016/j.immuni.2020.04.023] [Citation(s) in RCA: 781] [Impact Index Per Article: 195.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
The World Health Organization has declared SARS-CoV-2 virus outbreak a worldwide pandemic. However, there is very limited understanding on the immune responses, especially adaptive immune responses to SARS-CoV-2 infection. Here, we collected blood from COVID-19 patients who have recently become virus-free, and therefore were discharged, and detected SARS-CoV-2-specific humoral and cellular immunity in eight newly discharged patients. Follow-up analysis on another cohort of six patients 2 weeks post discharge also revealed high titers of immunoglobulin G (IgG) antibodies. In all 14 patients tested, 13 displayed serum-neutralizing activities in a pseudotype entry assay. Notably, there was a strong correlation between neutralization antibody titers and the numbers of virus-specific T cells. Our work provides a basis for further analysis of protective immunity to SARS-CoV-2, and understanding the pathogenesis of COVID-19, especially in the severe cases. It also has implications in developing an effective vaccine to SARS-CoV-2 infection.
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Affiliation(s)
- Ling Ni
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China; Center for Human Disease Immuno-monitoring, Beijing Friendship Hospital, 100050 Beijing, China
| | - Fang Ye
- Department of Hematology, Chui Yang Liu Hospital affiliated to Tsinghua University, 100022 Beijing, China
| | - Meng-Li Cheng
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China
| | - Yu Feng
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Yong-Qiang Deng
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China
| | - Hui Zhao
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China
| | - Peng Wei
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Jiwan Ge
- School of Life Sciences, Tsinghua University, 100022 Beijing, China
| | - Mengting Gou
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Xiaoli Li
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Lin Sun
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Tianshu Cao
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China
| | - Pengzhi Wang
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China
| | - Chao Zhou
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China
| | - Rongrong Zhang
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China
| | - Peng Liang
- Department of Cardiology, Chui Yang Liu Hospital affiliated to Tsinghua University, 100022 Beijing, China
| | - Han Guo
- Department of Orthopedics, Chui Yang Liu Hospital affiliated to Tsinghua University, 100022 Beijing, China
| | - Xinquan Wang
- School of Life Sciences, Tsinghua University, 100022 Beijing, China
| | - Cheng-Feng Qin
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, 100071 Beijing, China.
| | - Fang Chen
- Department of Cardiology, Chui Yang Liu Hospital affiliated to Tsinghua University, 100022 Beijing, China.
| | - Chen Dong
- Institute for Immunology and School of Medicine, Tsinghua University, 100084 Beijing, China; Center for Human Disease Immuno-monitoring, Beijing Friendship Hospital, 100050 Beijing, China; Beijing Key Lab for Immunological Research on Chronic Diseases, 100084 Beijing, China.
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Khubchandani J, Jordan TR, Yang YT. Ebola, Zika, Corona…What Is Next for Our World? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093171. [PMID: 32370141 PMCID: PMC7246487 DOI: 10.3390/ijerph17093171] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
Abstract
In the past century, there have been several pandemics. Within the context of global health, these pandemics have often been viewed from the lens of determinants such as population, poverty, and pollution. With an ever-changing world and the COVID-19 pandemic, the current global determinants of public health need to be expanded. In this editorial, we explore and redefine the major determinants of global public health to prevent future pandemics. Policymakers and global leaders should keep at heart the determinants suggested hereby in any planning, implementation, and evaluation of efforts to improve global public health and prevent pandemics.
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Affiliation(s)
| | - Timothy R. Jordan
- College of Health and Human Services, University of Toledo, Toledo, OH 43606, USA;
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC 20006, USA;
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670
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Tadros BJ, Black J, Dhinsa BS. COVID-19 outbreak: The early response of a UK orthopaedic department. J Clin Orthop Trauma 2020; 11:S301-S303. [PMID: 32398916 PMCID: PMC7217071 DOI: 10.1016/j.jcot.2020.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Baha John Tadros
- Trauma & Orthopaedics Department, William Harvey Hospital, Ashford, Kent, UK
| | - Jonathon Black
- Trauma & Orthopaedics Department, William Harvey Hospital, Ashford, Kent, UK
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671
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Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis 2020; 94:44-48. [PMID: 32171952 PMCID: PMC7102543 DOI: 10.1016/j.ijid.2020.03.004] [Citation(s) in RCA: 654] [Impact Index Per Article: 163.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 01/08/2023] Open
Abstract
There is a current worldwide outbreak of the novel coronavirus Covid-19 (coronavirus disease 2019; the pathogen called SARS-CoV-2; previously 2019-nCoV), which originated from Wuhan in China and has now spread to 6 continents including 66 countries, as of 24:00 on March 2, 2020. Governments are under increased pressure to stop the outbreak from spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak site and from laboratories supporting the investigation. This paper aggregates and consolidates the epidemiology, clinical manifestations, diagnosis, treatments and preventions of this new type of coronavirus.
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Affiliation(s)
- Di Wu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
| | - Tiantian Wu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
| | - Qun Liu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
| | - Zhicong Yang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China.
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672
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Xu H, Liu E, Xie J, Smyth RL, Zhou Q, Zhao R, Zang N, Long X, Tang Y, Estill J, Yang S, Zhu J, Yan X, Gong F, Tian W, Zhou X, Mo Y, Xiao H, Tang Z, Chen Y, Wang Y, Cui Y, Fang X, Li F, Tian Y, Li P, Deng Q, Ren C, He R, Li Y, Qin H, Wang A, Deng H, Wu J, Meng W, Li W, Zhao Y, Luo Z, Wang Z, Chen Y, Wong GWK, Li Q. A follow-up study of children infected with SARS-CoV-2 from western China. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:623. [PMID: 32566560 PMCID: PMC7290618 DOI: 10.21037/atm-20-3192] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background To clarify the characteristic and the duration of positive nucleic acid in children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including asymptomatic children. Methods A total of 32 children confirmed with SARS-CoV-2 infection between January 24 and February 12, 2020 from four provinces in western China were enrolled in this study and followed up until discharge and quarantine 14 days later. Results Eleven children (34%) were asymptomatic, among whom six children had normal computed tomographic (CT) scan images. Age and gender were not associated with clinical symptoms or the results of CT scan in children infected with SARS-CoV-2. The concentrations of white blood cells and neutrophils were higher in children with asymptomatic infection than in children with clinical symptoms or CT abnormalities. Patients who presented with CT abnormalities had lower D-dimer or lower total bilirubin than those who had normal CT scan but clinical symptoms. All children recovered and no one died or was admitted to the pediatric intensive care unit (PICU). The mean duration of positive SARS-CoV-2 nucleic acid was 15.4 (SD =7.2) days and similar for both asymptomatic children and children with symptoms or CT abnormalities. We found a significant negative correlation between the lymphocyte count and the duration of positive nucleic acid test. Conclusions Children with asymptomatic infection should be quarantined for the same duration as symptomatic patients infected with SARS-CoV-2. The clinical significance and mechanism behind the negative correlation between the number of lymphocytes and the duration of positive SARS-CoV-2 needs further study.
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Affiliation(s)
- Hongmei Xu
- Department of Infection, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Enmei Liu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Jun Xie
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Rosalind L Smyth
- UCL Great Ormond St Institute of Child Health, Great Ormond Street Hospital, London, UK
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Ruiqiu Zhao
- Department of Infection, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Na Zang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Xiaoru Long
- Department of Infection, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yuyi Tang
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Shu Yang
- College of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jing Zhu
- Department of Infection, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xiaofeng Yan
- Department of Infection, Chongqing Public Health Medical Center, Chongqing 400036, China
| | - Fang Gong
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing 402460, China
| | - Wenguang Tian
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing 402460, China
| | - Xiaqia Zhou
- Department of Pediatrics, Yongchuan Hospital of Chongqing Medical University, Chongqing 402460, China
| | - Yunbo Mo
- Department of Pediatrics, Three Gorges Hospital, Chongqing University, Chongqing 404100, China
| | - Hongzhou Xiao
- Department of Pediatrics, Three Gorges Hospital, Chongqing University, Chongqing 404100, China
| | - Zhengzhen Tang
- Department of Pediatrics, Third Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Yanni Chen
- Department of Infection, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi 710003, China
| | - Yi Wang
- Department of Infection, Xi'an Children's Hospital, the Affiliated Children's Hospital of Xi'an Jiaotong University, Shaanxi 710003, China
| | - Yuxia Cui
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Xiuling Fang
- Department of Pediatrics, Tongchuan Mining Bureau Central Hospital, Tongchuan 727000, China
| | - Feiyu Li
- Department of Pediatrics, Xi'an Eighth Hospital, Xi'an 710065, China
| | - Yong Tian
- Department of Pediatrics, The People's Hospital of Xiushan County, Chongqing 409900, China
| | - Peibo Li
- Department of Pediatrics, The People's Hospital of Xiushan County, Chongqing 409900, China
| | - Quanmin Deng
- Department of Pediatrics, The People's Hospital of Deyang City, Deyang 618000, China
| | - Chongsong Ren
- Department of Pediatrics, Nanchong Central Hospital, Nanchong 637000, China
| | - Ronghui He
- Department of Pediatrics, Nanchong Central Hospital, Nanchong 637000, China
| | - Yi Li
- Department of Pediatrics, Suining Central Hospital, Suining 629000, China
| | - Hong Qin
- Department of Pediatrics, The People's Hospital of Fengdu County, Chongqing 408200, China
| | - Aiguo Wang
- Department of Pediatrics, The People's Hospital of Kaizhou District, Chongqing 405400, China
| | - Hongli Deng
- Department of Pediatrics, The People's Hospital of Hechuan District, Chongqing 401520, China
| | - Jianguo Wu
- Department of Pediatrics, The People's Hospital of Fengjie County, Chongqing 404600, China
| | - Wenbo Meng
- Special Minimally Invasive Surgery Department, the First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Weiguo Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Yao Zhao
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Zhengxiu Luo
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Zijun Wang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Gary Wing Kin Wong
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.,Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
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673
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Abstract
En diciembre de 2019, en Wuhan, provincia de Hubei en China, se reportó un grupo de 27 pacientes con neumonÃa de etiologÃa desconocida, vinculados con exposición al mercado de mariscos, pescado y animales vivos. El 7 de enero de 2020, se identificó una nueva sepa de coronavirus aislada en estos pacientes (SARS-CoV-2); la enfermedad producida por este virus ha sido denominada COVID-19. Durante las etapas iniciales de la pandemia y dados los pocos estudios publicados al respecto, se creÃa que este coronavirus causaba sÃntomas netamente respiratorios; sin embargo, a medida que el número de pacientes aumentó, se observó que la enfermedad cardiovascular tenÃa un papel fundamental en el desarrollo y pronóstico de la infección. Los factores de riesgo más importantes relacionados con mortalidad son la edad y la presencia de comorbilidades, especialmente de tipo cardiovascular. El incremento en niveles de troponina, péptidos natriuréticos y dÃmero-D tiene valor pronóstico en pacientes con infección por SARS-CoV-2. Los pacientes con COVID-19 tienen un aumento en el riesgo de infarto agudo del miocardio, miocarditis, insuficiencia cardiaca, choque, arritmias y muerte súbita, en relación con la respuesta sistémica al virus y a los tratamientos necesarios en la fase aguda. En este documento se revisa el compromiso cardiovascular por SARS-CoV-2 (COVID-19).
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674
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Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, Li P, Hu B, Wang J, Hu C, Jin Y, Niu X, Ping R, Du Y, Li T, Xu G, Hu Q, Tu L. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J Gastroenterol 2020; 115:766-773. [PMID: 32287140 PMCID: PMC7172492 DOI: 10.14309/ajg.0000000000000620] [Citation(s) in RCA: 1147] [Impact Index Per Article: 286.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, various digestive symptoms have been frequently reported in patients infected with the virus. In this study, we aimed to further investigate the prevalence and outcomes of COVID-19 patients with digestive symptoms. METHODS In this descriptive, cross-sectional, multicenter study, we enrolled confirmed patients with COVID-19 who presented to 3 hospitals from January 18, 2020, to February 28, 2020. All patients were confirmed by real-time polymerase chain reaction and were analyzed for clinical characteristics, laboratory data, and treatment. Data were followed up until March 18, 2020. RESULTS In the present study, 204 patients with COVID-19 and full laboratory, imaging, and historical data were analyzed. The average age was 52.9 years (SD ± 16), including 107 men and 97 women. Although most patients presented to the hospital with fever or respiratory symptoms, we found that 103 patients (50.5%) reported a digestive symptom, including lack of appetite (81 [78.6%] cases), diarrhea (35 [34%] cases), vomiting (4 [3.9%] cases), and abdominal pain (2 [1.9%] cases). If lack of appetite is excluded from the analysis (because it is less specific for the gastrointestinal tract), there were 38 total cases (18.6%) where patients presented with a gastrointestinal-specific symptom, including diarrhea, vomiting, or abdominal pain. Patients with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9.0 days vs 7.3 days). In 6 cases, there were digestive symptoms, but no respiratory symptoms. As the severity of the disease increased, digestive symptoms became more pronounced. Patients with digestive symptoms had higher mean liver enzyme levels, lower monocyte count, longer prothrombin time, and received more antimicrobial treatment than those without digestive symptoms. DISCUSSION We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission, evidence of longer coagulation, and higher liver enzyme levels. Clinicians should recognize that digestive symptoms, such as diarrhea, are commonly among the presenting features of COVID-19 and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms. However, further large sample studies are needed to confirm these findings.
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Affiliation(s)
- Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China;
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China;
| | - Mi Mu
- Medical College of PLA, Chinese PLA General Hospital, Beijing, China;
- Department of Respiratory Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China;
| | - Pengcheng Yang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China;
| | - Yu Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Runsheng Wang
- Department of Respiratory Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Medical College of PLA, Chinese PLA General Hospital, Beijing, China;
| | - Junhong Yan
- Department of Ultrasound, Binzhou Medical University Hospital, Binzhou, China;
| | - Pibao Li
- Department of Critical Care Medicine, Shandong Provincial Third Hospital, Jinan, China;
| | - Baoguang Hu
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, China;
| | - Jing Wang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China;
| | - Chao Hu
- Department of Respiratory Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Medical College of PLA, Chinese PLA General Hospital, Beijing, China;
| | - Yuan Jin
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Xun Niu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Rongyu Ping
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China;
| | - Yingzhen Du
- Department of Respiratory Medicine, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Medical College of PLA, Chinese PLA General Hospital, Beijing, China;
| | - Tianzhi Li
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China;
| | - Guogang Xu
- The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China;
| | - Qinyong Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China;
| | - Lei Tu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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675
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Shi Q, Zhou Q, Wang X, Liao J, Yu Y, Wang Z, Lu S, Ma Y, Xun Y, Luo X, Li W, Fukuoka T, Ahn HS, Lee MS, Luo Z, Liu E, Chen Y, Li Q, Yang K, Guan Q. Potential effectiveness and safety of antiviral agents in children with coronavirus disease 2019: a rapid review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:624. [PMID: 32566561 PMCID: PMC7290634 DOI: 10.21037/atm-20-3301] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The COVID-19 outbreak presents a new, life-threatening disease. Our aim was to assess the potential effectiveness and safety of antiviral agents for COVID-19 in children. Methods Electronic databases (MEDLINE, Embase, Web of Science, the Cochrane library, CBM, CNKI, and Wanfang Data) from their inception to March 31, 2020 were searched for randomized controlled trials (RCTs), clinical controlled trials and cohort studies of interventions with antiviral agents for children (less than 18 years of age) with COVID-19. Results A total of 23 studies with 6,008 patients were included. There was no direct evidence and all of evidence were indirect. The risks of bias in all studies were moderate to high in general. The effectiveness and safety of antiviral agents for children with COVID-19 is uncertain: For adults with COVID-19, lopinavir/ritonavir had no effect on mortality [risk ratio (RR) =0.77; 95% confidence interval (CI), 0.45 to 1.30]. Arbidol and hydroxychloroquine (HCQ) had no benefit on probability of negative PCR test (RR =1.27; 95% CI, 0.93 to 1.73; RR =0.93; 95% CI, 0.73 to 1.18) respectively. For adults with SARS, interferon was associated with reduced corticosteroid dose [weighted mean difference (WMD) = −0.14 g; 95% CI, −0.21 to −0.07] but had no effect on mortality (RR =0.72; 95% CI, 0.28 to 1.88); ribavirin did not reduce mortality (RR =0.68; 95% CI, 0.43 to 1.06) and was associated with high risk of severe adverse reactions; and oseltamivir had no effect on mortality (RR =0.87; 95% CI, 0.55 to 1.38). Ribavirin combined with interferon was also not effective in adults with MERS and associated with adverse reactions. Conclusions There is no evidence showing the effectiveness of antiviral agents for children with COVID-19, and the clinical efficacy of existing antiviral agents is still uncertain. We do not suggest clinical routine use of antivirals for COVID-19 in children, with the exception of clinical trials.
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Affiliation(s)
- Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xia Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Jing Liao
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yang Yu
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Zijun Wang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Shuya Lu
- Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
| | - Yanfang Ma
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Yangqin Xun
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xufei Luo
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Weiguo Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Toshio Fukuoka
- Emergency and Critical Care Center, Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan.,Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.,Korea Cochrane Centre, Seoul, Korea
| | - Myeong Soo Lee
- Korea Institute of Oriental Medicine, Daejeon, Korea.,University of Science and Technology, Daejeon, Korea
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,Lanzhou University, An Affiliate of the Cochrane China Network, Lanzhou 730000, China.,Chinese GRADE Center, Lanzhou 730000, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Qubei Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Kehu Yang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.,Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Quanlin Guan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.,Department of Oncology Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, China
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676
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Lu S, Zhou Q, Huang L, Shi Q, Zhao S, Wang Z, Li W, Tang Y, Ma Y, Luo X, Fukuoka T, Ahn HS, Lee MS, Luo Z, Liu E, Chen Y, Zhou C, Peng D. Effectiveness and safety of glucocorticoids to treat COVID-19: a rapid review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:627. [PMID: 32566564 PMCID: PMC7290628 DOI: 10.21037/atm-20-3307] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Glucocorticoids are widely used in the treatment of various pulmonary inflammatory diseases, but they are also often accompanied by significant adverse reactions. Published guidelines point out that low dose and short duration systemic glucocorticoid therapy may be considered for patients with rapidly progressing coronavirus disease 2019 (COVID-19) while the evidence is still limited. METHODS We comprehensively searched electronic databases and supplemented the screening by conducting a manual search. We included randomized controlled trials (RCTs) and cohort studies evaluating the effectiveness and safety of glucocorticoids in children and adults with COVID-19, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and conducted meta-analyses of the main indicators that were identified in the studies. RESULTS Our search retrieved 23 studies, including one RCT and 22 cohort studies, with a total of 13,815 patients. In adults with COVID-19, the use of systemic glucocorticoid did not reduce mortality [risk ratio (RR) =2.00, 95% confidence interval (CI): 0.69 to 5.75, I2=90.9%] or the duration of lung inflammation [weighted mean difference (WMD) =-1 days, 95% CI: -2.91 to 0.91], while a significant reduction was found in the duration of fever (WMD =-3.23 days, 95% CI: -3.56 to -2.90). In patients with SARS, glucocorticoids also did not reduce the mortality (RR =1.52, 95% CI: 0.89 to 2.60, I2=84.6%), duration of fever (WMD =0.82 days, 95% CI: -2.88 to 4.52, I2=97.9%) or duration of lung inflammation absorption (WMD =0.95 days, 95% CI: -7.57 to 9.48, I2=94.6%). The use of systemic glucocorticoid therapy prolonged the duration of hospital stay in all patients (COVID-19, SARS and MERS). CONCLUSIONS Glucocorticoid therapy was found to reduce the duration of fever, but not mortality, duration of hospitalization or lung inflammation absorption. Long-term use of high-dose glucocorticoids increased the risk of adverse reactions such as coinfections, so routine use of systemic glucocorticoids for patients with COVID-19 cannot be recommend.
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Affiliation(s)
- Shuya Lu
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Qi Zhou
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Liping Huang
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Qianling Shi
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Siya Zhao
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Zijun Wang
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Weiguo Li
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yuyi Tang
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yanfang Ma
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Xufei Luo
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- School of Public Health, Lanzhou University, Lanzhou 730000, China
| | - Toshio Fukuoka
- Emergency and Critical Care Center, the Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan
- Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Korea Cochrane Centre, Seoul, Korea
| | - Myeong Soo Lee
- Korea Institute of Oriental Medicine, Daejeon, Korea
- University of Science and Technology, Daejeon, Korea
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou 730000, China
- Chinese GRADE Center, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Chenyan Zhou
- Department of Pediatric, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China
| | - Donghong Peng
- Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Liu E, Smyth RL, Luo Z, Qaseem A, Mathew JL, Lu Q, Fu Z, Zhao X, Zhao S, Estill J, Chan ESY, Liu L, Qian Y, Xu H, Wang Q, Fukuoka T, Luo X, Wong GWK, Lei J, Nurdiati D, Tu W, Zhang X, Zheng X, Ahn HS, Wang M, Dong X, Wu L, Lee MS, Li G, Yang S, Feng X, Zhao R, Lu X, He Z, Liu S, Li W, Zhou Q, Ren L, Chen Y, Li Q. Rapid advice guidelines for management of children with COVID-19. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:617. [PMID: 32566554 PMCID: PMC7290610 DOI: 10.21037/atm-20-3754] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Enmei Liu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Rosalind L Smyth
- UCL Great Ormond St Institute of Child Health, London, UK.,Great Ormond Street Hospital, London, UK
| | - Zhengxiu Luo
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Amir Qaseem
- Clinical Policy and Center for Evidence Reviews, American College of Physicians, Philadelphia, USA
| | - Joseph L Mathew
- Advanced Pediatrics Centre, PGIMER Chandigarh, Chandigarh, India
| | - Quan Lu
- Shanghai Children's Hospital affiliated to Shanghai Jiaotong University, Shanghai 200240, China
| | - Zhou Fu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xiaodong Zhao
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | | | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland.,Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Edwin Shih-Yen Chan
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Medical School, Singapore.,Singapore Clinical Research Institute, Singapore
| | - Lei Liu
- National Clinical Research Center for Infectious Disease, Shenzhen 518020, China.,Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Yuan Qian
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Beijing 100020, China
| | - Hongmei Xu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Qi Wang
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.,McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Toshio Fukuoka
- Emergency and Critical Care Center, the Department of General Medicine, Department of Research and Medical Education, Kurashiki Central Hospital, Okayama, Japan.,Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Gary Wing-Kin Wong
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Detty Nurdiati
- Clinical Epidemiology & Biostatistics Unit, Department of Obstetrics & Gynaecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wenwei Tu
- Department of Pediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Xiaobo Zhang
- Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xianlan Zheng
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University, Seoul, Korea.,Korea Cochrane Centre, Seoul, Korea.,Evidence Based Medicine, Seoul, Korea.,Korea University School of Medicine, Seoul, Korea
| | - Mengshu Wang
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Xiaoyan Dong
- Shanghai Children's Hospital, Shanghai 200040, China
| | - Liqun Wu
- Shenzhen Health Development Research Center, Shenzhen 518028, China
| | - Myeong Soo Lee
- Korea Institute of Oriental Medicine, Daejeon, Korea.,University of Science and Technology, Daejeon, Korea.,London Southbank University, London, UK.,Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China
| | - Guobao Li
- National Clinical Research Center for Infectious Disease, Shenzhen 518020, China.,Shenzhen Third People's Hospital, Shenzhen 518112, China
| | - Shu Yang
- College of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China.,Digital Institute of Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xixi Feng
- Department of Public Health, Chengdu Medical College, Chengdu 610500, China
| | - Ruiqiu Zhao
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Xiaoxia Lu
- Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Zhihui He
- Chongqing Ninth People's Hospital, Chongqing 400700, China
| | - Shihui Liu
- Beijing Jishuitan Hospital, Beijing 100035, China
| | - Weiguo Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Qi Zhou
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Luo Ren
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China.,GIN Asia, Lanzhou 730000, China.,Chinese GRADE Centre, Lanzhou 730000, China.,Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou 730000, China.,Key Laboratory of Evidence Based Medicine & Knowledge Translation of Gansu Province, Lanzhou 730000, China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Children's Hospital of Chongqing Medical University, Chongqing 400014, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
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Abstract
Severe acute respiratory syndrome (SARS) is a pandemic that has shocked the world twice over the last two decades caused by a highly transmissible and pathogenic coronavirus (CoV). It causes disease in the lower respiratory tract in humans that was first reported in late 2002 in Guangdong province, China, and later on in December 2019 in Wuhan, China. The two viruses designated as SARS-CoV and SARS-CoV-2, respectively, originated probably from the bat and infected humans via carrier animals. The constant recombination and evolution in the CoV genome may have facilitated their cross-species transmission resulting in recurrent emergence as a pandemic. This chapter intends to accumulate recent findings related to CoV transmission and tentative molecular mechanisms governing the process.
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679
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COVID-19 Pandemic: Prevention and Protection Measures to Be Adopted at the Workplace. SUSTAINABILITY 2020. [DOI: 10.3390/su12093603] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
SARS-CoV-2, identified in Wuhan, China, for the first time in December 2019, is a new viral strain, which has not been previously identified in humans; it can be transmitted both by air and via direct and indirect contact; however, the most frequent way it spreads is via droplets. Like the other viruses belonging to the same family of coronaviruses, it can cause from mild flu-like symptoms, such as cold, sore throat, cough and fever, to more severe ones such as pneumonia and breathing difficulties, and it can even lead to death. Since no effective specific drug therapy has been found yet, nor any vaccine capable of limiting the spread of this pathogen, it is important for ways of preventing the spread of this infection to be established. The purpose of our research was to provide a protocol to prevent the spread of SARS-CoV-2 infection in light of the limited information related to this coronavirus. In detail, we analysed and searched targeted evidence-based guidelines issued in the various countries affected by this epidemic up till now. In addition, we analyzed the recommendations for the prevention and control of other epidemics caused by other pathogens belonging to the same family of coronaviruses or others that present the same mechanisms of transmission. General organizational measures regarding the containment and management of the epidemiological emergency of COVID-19 have been imposed by the competent authorities for an adequate and proportionate management of the evolution of the epidemiological situation. The prevention and protection organizational measures therefore aim to minimize the probability of being exposed to SARS-CoV-2. For this purpose, measures must also be taken at work to avoid new infections or even the spread of the virus where it has already been present. Furthermore, environmental measures are aimed at reducing the risk of transmission of SARS-CoV-2 to individuals through contact with infected subjects, objects, equipment, or contaminated environmental surfaces. Protective devices must be used whenever there is potentially close contact with a suspect case, especially when the potentially infected person does not wear a surgical mask that could reduce the spread of viruses in the environment. By adopting this specific prevention and protection measures recommended in the workplace, it will be possible to help overcome this COVID-19 pandemic.
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680
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Ali H, Daoud A, Mohamed MM, Salim SA, Yessayan L, Baharani J, Murtaza A, Rao V, Soliman KM. Survival rate in acute kidney injury superimposed COVID-19 patients: a systematic review and meta-analysis. Ren Fail 2020; 42:393-397. [PMID: 32340507 PMCID: PMC7241495 DOI: 10.1080/0886022x.2020.1756323] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hatem Ali
- Department of Medicine, Division of Nephrology, University Hospitals of Birmingham, UK
| | - Ahmed Daoud
- Department of Medicine, Division of Nephrology, Faculty of Medicine, Cairo University, Egypt
| | - Mahmoud M Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee, USA
| | - Sohail Abdul Salim
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lenar Yessayan
- Department of Medicine, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Jyoti Baharani
- Department of Medicine, Division of Nephrology, University Hospitals of Birmingham, UK
| | - Asam Murtaza
- Department of Medicine, Division of Nephrology, Walsall Manor Hospital, UK
| | - Vinaya Rao
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, USA
| | - Karim M Soliman
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, USA
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681
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Dousa KM, Malavade SS, Furin J, Gripshover B, Hatszegi M, Hojat L, Saade E, Salata RA. SARS-CoV-2 infection in a patient on chronic hydroxychloroquine therapy: Implications for prophylaxis. IDCases 2020; 20:e00778. [PMID: 32341910 PMCID: PMC7185003 DOI: 10.1016/j.idcr.2020.e00778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
People exposed to COVID-19 have a risk of developing disease, and health care workers are at risk at a time when they are badly needed during a health care crisis. Hydroxychloroquine and chloroquine have been used as treatment and are being considered as prophylaxis. Our patient developed COVID-19 while on hydroxychloroquine and although more work is needed, this calls into question the role of these medications as preventive therapy.
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Affiliation(s)
- Khalid M. Dousa
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sharad S. Malavade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Jennifer Furin
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Gripshover
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Marjorie Hatszegi
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Roe Green Center for Travel Medicine and Global Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Leila Hojat
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Elie Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Robert A. Salata
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Roe Green Center for Travel Medicine and Global Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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682
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Chen LR, Chen ZX, Liu YC, Peng L, Zhang Y, Xu Q, Lin Q, Tao YM, Wu H, Yin S, Hu YJ. Pulmonary contusion mimicking COVID-19: A case report. World J Clin Cases 2020; 8:1554-1560. [PMID: 32368550 PMCID: PMC7190958 DOI: 10.12998/wjcc.v8.i8.1554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a major public health emergency with obvious characteristics of human-to-human transmission, and there are infective asymptomatic carriers. Early identification and proper management of patients with COVID-19 are important. Features in chest computed tomography (CT) can facilitate identifying newly infected individuals. However, CT findings of some lung contusions are similar to those of COVID-19, as shown in the present case.
CASE SUMMARY A 46-year-old woman was admitted to hospital for backache and foot pain caused by a fall injury 1 d before hospitalization. She was suspected of having COVID-19, since there was a confirmed COVID-19 case near her residence. But she had no fever, cough, chest tightness, difficult breathing, nausea, vomiting, or diarrhea, etc. On physical examination, the lower posterior chest of both sides showed dullness on percussion and moist rales at the end of inspiration on auscultation. The white blood cell count and lymphocyte count were 10.88 × 109/L and 1.04 × 109/L, respectively. CT performed on February 7, 2020 revealed that both lungs were scattered with patchy ground-glass opacity. The patient was diagnosed with pulmonary contusion with thoracic spinal fracture (T12), calcaneal fracture, and pelvic fracture. On day 9 after conservative treatment, her condition was alleviated. On review of the chest CT, the previous shadows were significantly reduced.
CONCLUSION Differential diagnosis of lung contusion and COVID-19 must be emphasized. Both conditions require effective prompt actions, especially COVID-19.
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Affiliation(s)
- Li-Ru Chen
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Zheng-Xin Chen
- Department of Surgery, Yongxin County People's Hospital, Ji’an 343400, Jiangxi Province, China
| | - Yang-Chun Liu
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Lei Peng
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ye Zhang
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Quan Xu
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qing Lin
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yun-Ming Tao
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hao Wu
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Sui Yin
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ye-Ji Hu
- Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang 330006, Jiangxi Province, China
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683
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Landa N, Mendieta-Eckert M, Fonda-Pascual P, Aguirre T. Chilblain-like lesions on feet and hands during the COVID-19 Pandemic. Int J Dermatol 2020; 59:739-743. [PMID: 32329897 PMCID: PMC7264591 DOI: 10.1111/ijd.14937] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Nerea Landa
- Department of Dermatology, Dermitek Clinic - Grupo stop, Bilbao, Spain
| | | | | | - Teresa Aguirre
- Primary Care Physician, Centro Bombero Echaniz, Bilbao, Spain
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684
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Heerfordt C, Heerfordt IM. Has there been an increased interest in smoking cessation during the first months of the COVID-19 pandemic? A Google Trends study. Public Health 2020; 183:6-7. [PMID: 32388011 PMCID: PMC7167577 DOI: 10.1016/j.puhe.2020.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 01/06/2023]
Affiliation(s)
- C Heerfordt
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - I M Heerfordt
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark.
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685
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Mei X, Lee HC, Diao K, Huang M, Lin B, Liu C, Xie Z, Ma Y, Robson PM, Chung M, Bernheim A, Mani V, Calcagno C, Li K, Li S, Shan H, Lv J, Zhao T, Xia J, Long Q, Steinberger S, Jacobi A, Deyer T, Luksza M, Liu F, Little BP, Fayad ZA, Yang Y. Artificial intelligence-enabled rapid diagnosis of COVID-19 patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.04.12.20062661. [PMID: 32511559 PMCID: PMC7274240 DOI: 10.1101/2020.04.12.20062661] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
For diagnosis of COVID-19, a SARS-CoV-2 virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) test is routinely used. However, this test can take up to two days to complete, serial testing may be required to rule out the possibility of false negative results, and there is currently a shortage of RT-PCR test kits, underscoring the urgent need for alternative methods for rapid and accurate diagnosis of COVID-19 patients. Chest computed tomography (CT) is a valuable component in the evaluation of patients with suspected SARS-CoV-2 infection. Nevertheless, CT alone may have limited negative predictive value for ruling out SARS-CoV-2 infection, as some patients may have normal radiologic findings at early stages of the disease. In this study, we used artificial intelligence (AI) algorithms to integrate chest CT findings with clinical symptoms, exposure history, and laboratory testing to rapidly diagnose COVID-19 positive patients. Among a total of 905 patients tested by real-time RT-PCR assay and next-generation sequencing RT-PCR, 419 (46.3%) tested positive for SARS-CoV-2. In a test set of 279 patients, the AI system achieved an AUC of 0.92 and had equal sensitivity as compared to a senior thoracic radiologist. The AI system also improved the detection of RT-PCR positive COVID-19 patients who presented with normal CT scans, correctly identifying 17 of 25 (68%) patients, whereas radiologists classified all of these patients as COVID-19 negative. When CT scans and associated clinical history are available, the proposed AI system can help to rapidly diagnose COVID-19 patients.
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686
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Mungroo MR, Khan NA, Siddiqui R. Novel Coronavirus: Current Understanding of Clinical Features, Diagnosis, Pathogenesis, and Treatment Options. Pathogens 2020; 9:E297. [PMID: 32316618 PMCID: PMC7238102 DOI: 10.3390/pathogens9040297] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 01/08/2023] Open
Abstract
Since December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in devastating consequences worldwide and infected more than 350,000 individuals and killed more than 16,000 people. SARS-CoV-2 is the seventh member of the coronavirus family to affect humans. Symptoms of COVID-19 include fever (88%), cough (68%), vomiting (5%) and diarrhoea (3.7%), and transmission of SARS-CoV-2 is thought to occur from human to human via respiratory secretions released by the infected individuals when coughing and sneezing. COVID-19 can be detected through computed tomography scans and confirmed through molecular diagnostics tools such as polymerase chain reaction. Currently, there are no effective treatments against SARS-CoV-2, hence antiviral drugs have been used to reduce the development of respiratory complications by reducing viral load. The purpose of this review is to provide a comprehensive update on the pathogenesis, clinical aspects, diagnosis, challenges and treatment of SARS-CoV-2 infections.
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Affiliation(s)
| | - Naveed Ahmed Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah 26666, UAE; (M.R.M.); (R.S.)
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687
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Jotz GP, Voegels RL, Bento RF. Otorhinolaryngologists and Coronavirus Disease 2019 (COVID-19). Int Arch Otorhinolaryngol 2020; 24:e125-e128. [PMID: 32296468 PMCID: PMC7153919 DOI: 10.1055/s-0040-1709724] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Geraldo Pereira Jotz
- Morphological Sciences Department, Instituto de Ciências Básicas da Saúde (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Richard Louis Voegels
- Otorhinolaryngology and Ophthalmology Department, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Ricardo Ferreira Bento
- Otorhinolaryngology and Ophthalmology Department, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
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688
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Zhang J, Lin G, Zeng J, Lin J, Tian J, Li G. Challenges of SARS-CoV-2 and lessons learnt from SARS in Guangdong Province, China. J Clin Virol 2020; 126:104341. [PMID: 32278300 PMCID: PMC7194575 DOI: 10.1016/j.jcv.2020.104341] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023]
Abstract
‘Early detection, early reporting, early isolation, and early treatment’ is the primary principle for the combat of SARS-CoV-2 outbreak. The rapider and stricter the control measures are, the lower day-on-day ratio in the early stage is. Guangdong is taking multiple strict regulations in combination with effective healthcare provision to bring COVID-19 under control.
With lessons learnt from the SARS outbreak in 2003, Guangdong Province is taking the lead in bringing COVID-19 under control by multiple strict regulations in combination with effective healthcare provision.
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Affiliation(s)
- Junguo Zhang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guanwen Lin
- Department of Infection Management, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jie Zeng
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jianguo Lin
- P3 Biosafety Level Laboratory, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Junzhang Tian
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China; Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.
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689
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Khan S, Khan M, Maqsood K, Hussain T, Noor-Ul-Huda, Zeeshan M. Is Pakistan prepared for the COVID-19 epidemic? A questionnaire-based survey. J Med Virol 2020; 92:824-832. [PMID: 32237161 PMCID: PMC7228297 DOI: 10.1002/jmv.25814] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 01/17/2023]
Abstract
COVID‐19 is a pandemic that began in China in December 2019. World health organization (WHO) has expressed fears that Pakistan might emerge as the next epicenter of this pandemic. We hypothesize that at present the Pakistani masses are not prepared to face any threat of a looming epidemic. The main aim of this study was to evaluate the basic knowledge of educational and health care workers (HCWs) regarding COVID‐19, its control, and prevention. Knowledge about origin, symptoms, and spread of viral infection was assessed. In this cross‐sectional survey, a self‐designed questionnaire was distributed among 302 HCWs including physicians (10.9%), nurses (1.32%), lab staff (1.65%), and academic individuals including faculty and students (86.42%) of different organizations. Results were analyzed using the χ2 test. Obtained results validate our null hypothesis that Pakistani masses are not well aware of the COVID‐19 and strategies for the prevention and control of infection. The study concluded that individuals belonging to the front‐line workers and high literacy groups are not prepared for the alarming situation in the country. Effectual implementation of infection control programs should be practiced, and it depends on awareness, training, and cooperation of individuals. Pakistan is facing a looming threat of COVID‐19 epidemic. Strict measures need to be taken to avert the threat of COVID‐19. Vigilant training sessions should be carried out for front‐line workers.
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Affiliation(s)
- Samea Khan
- Department of Molecular Biology, Virtual University of Pakistan, Lahore, Pakistan
| | - Mahjabeen Khan
- School of Optometry and Vision Science University of New South Wales, Sydney, Australia
| | - Khizra Maqsood
- Department of Bioinformatics and Computational Biology, Virtual University of Pakistan, Lahore, Pakistan
| | - Tanveer Hussain
- Department of Molecular Biology, Virtual University of Pakistan, Lahore, Pakistan
| | - Noor-Ul-Huda
- Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
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690
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In Vitro Diagnostic Assays for COVID-19: Recent Advances and Emerging Trends. Diagnostics (Basel) 2020; 10:diagnostics10040202. [PMID: 32260471 PMCID: PMC7235801 DOI: 10.3390/diagnostics10040202] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
There have been tremendous advances in in vitro diagnostic (IVD) assays for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main IVD assays used for COVID-19 employ real-time reverse transcriptase polymerase chain reaction (RT-PCR) that takes a few hours. But the assay duration has been shortened to 45 min by Cepheid. Of interest is the point-of-care (POC) molecular assay by Abbott that decreased the assay duration to just 5 min. Most molecular tests have been approved by the United States Food and Drug Administration (FDA) under emergency use authorization (EUA) and are Conformité Européenne (CE) marked. A wide range of serology immunoassays (IAs) have also been developed that complement the molecular assays for the diagnosis of COVID-19. The most prominent IAs are automated chemiluminescent IA (CLIA), manual ELISA, and rapid lateral flow IA (LFIA), which detect the immunoglobulin M (IgM) and immunoglobulin G (IgG) produced in persons in response to SARS-CoV-2 infection. The ongoing research efforts and advances in complementary technologies will pave the way to new POC IVD assays in the coming months. However, the performance of IVD assays needs to be critically evaluated before they are employed for the clinical diagnosis of COVID-19.
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691
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Zhou M, Zhang X, Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front Med 2020; 14:126-135. [PMID: 32240462 PMCID: PMC7115348 DOI: 10.1007/s11684-020-0767-8] [Citation(s) in RCA: 229] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed a significant threat to global health. It caused a total of 80 868 confirmed cases and 3101 deaths in Chinese mainland until March 8, 2020. This novel virus spread mainly through respiratory droplets and close contact. As disease progressed, a series of complications tend to develop, especially in critically ill patients. Pathological findings showed representative features of acute respiratory distress syndrome and involvement of multiple organs. Apart from supportive care, no specific treatment has been established for COVID-19. The efficacy of some promising antivirals, convalescent plasma transfusion, and tocilizumab needs to be investigated by ongoing clinical trials.
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Affiliation(s)
- Min Zhou
- National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xinxin Zhang
- National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Research Laboratory of Clinical Virology, Ruijin Hospital and Ruijin Hospital North Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jieming Qu
- National Research Center for Translational Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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692
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Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, Iosifidis C, Agha R. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020; 76:71-76. [PMID: 32112977 PMCID: PMC7105032 DOI: 10.1016/j.ijsu.2020.02.034] [Citation(s) in RCA: 2525] [Impact Index Per Article: 631.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
An unprecedented outbreak of pneumonia of unknown aetiology in Wuhan City, Hubei province in China emerged in December 2019. A novel coronavirus was identified as the causative agent and was subsequently termed COVID-19 by the World Health Organization (WHO). Considered a relative of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), COVID-19 is caused by a betacoronavirus named SARS-CoV-2 that affects the lower respiratory tract and manifests as pneumonia in humans. Despite rigorous global containment and quarantine efforts, the incidence of COVID-19 continues to rise, with 90,870 laboratory-confirmed cases and over 3,000 deaths worldwide. In response to this global outbreak, we summarise the current state of knowledge surrounding COVID-19.
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Affiliation(s)
- Catrin Sohrabi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Zaid Alsafi
- UCL Medical School, University College London, United Kingdom
| | - Niamh O'Neill
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
| | - Mehdi Khan
- UCL Medical School, University College London, United Kingdom
| | - Ahmed Kerwan
- GKT School of Medical Education, King's College London, United Kingdom
| | - Ahmed Al-Jabir
- GKT School of Medical Education, King's College London, United Kingdom
| | - Christos Iosifidis
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Riaz Agha
- Barts Health NHS Trust, London, United Kingdom
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693
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Sorbello M, El-Boghdadly K, Di Giacinto I, Cataldo R, Esposito C, Falcetta S, Merli G, Cortese G, Corso RM, Bressan F, Pintaudi S, Greif R, Donati A, Petrini F. The Italian coronavirus disease 2019 outbreak: recommendations from clinical practice. Anaesthesia 2020; 75:724-732. [PMID: 32221973 DOI: 10.1111/anae.15049] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. We report the impact of the coronavirus disease 2019 outbreak on regional and national healthcare infrastructure. We also report on recommendations based on clinical experiences of managing patients throughout Italy. In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.
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Affiliation(s)
- M Sorbello
- Anesthesia and Intensive Care, AOU Policlinico San Marco University Hospital, Catania, Italy
| | - K El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - I Di Giacinto
- Anesthesia and Intensive Care, Anestesia e Terapia Intensiva Polivalente, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi - Alma Mater Studiorum, Bologna, Italy
| | - R Cataldo
- Anesthesia and Intensive Care, Anestesia, Terapia Intensiva e Terapia del Dolore, Università Campus, Bio-Medico, Roma, Italy
| | - C Esposito
- Anesthesia and Intensive Care, Dipartimento di Area Critica Ospedale Monaldi, Ospedali dei Colli, Napoli, Italy
| | - S Falcetta
- Anesthesia and Intensive Care, Clinica di Anestesia e Rianimazione Ospedali Riuniti Ancona, Ancona, Italy
| | - G Merli
- Anesthesia and Intensive Care, Dipartimento di Anestesia e Terapia Intensiva, Ospedale Maggiore Crema, Milano, Italy
| | - G Cortese
- Anesthesia and Intensive Care, Dipartimento di Anestesia, Rianimazione ed Emergenze AOU Città della salute e della scienza Torino, Italy
| | - R M Corso
- Anesthesia and Intensive Care, Dipartimento di Chirurgia, Anestesia e Rianimazione, Ospedale GB Morgagni-L. Pierantoni, Forlì, Italy
| | - F Bressan
- Anesthesia and Intensive Care, Anestesia e Rianimazione Ospedale Santo Stefano di Prato, Prato, Italy
| | - S Pintaudi
- Anesthesia and Intensive Care, Past Head of Dipartimento di Emergenza, ARNAS Garibaldi Catania, Past Bio-containment coordinator for Sicily, Italian Military Navy scientific consultant, Italy
| | - R Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Switzerland
| | - A Donati
- Università Politecnica delle Marche, Ancona, Italy
| | - F Petrini
- Anesthesia and Intensive Care Dipartimento di Medicina Perioperatoria, Dolore, Terapia Intensiva e Rapid Response System, Ospedale di Chieti, Università di Chieti Pescara, Chieti, Italy
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694
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054-1062. [PMID: 32171076 PMCID: PMC7270627 DOI: 10.1016/s0140-6736(20)30566-3] [Citation(s) in RCA: 17403] [Impact Index Per Article: 4350.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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Affiliation(s)
- Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ting Yu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Ronghui Du
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ying Liu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Xiang
- Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Lulu Guan
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuan Wei
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xudong Wu
- GCP Center, Jinyintan Hospital, Wuhan, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Shengjin Tu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China.
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695
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054-1062. [PMID: 32171076 DOI: 10.1016/s0140-6736(20)30566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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Affiliation(s)
- Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ting Yu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Ronghui Du
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ying Liu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Xiang
- Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Lulu Guan
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuan Wei
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xudong Wu
- GCP Center, Jinyintan Hospital, Wuhan, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Shengjin Tu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China.
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696
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Nie J, Li Q, Wu J, Zhao C, Hao H, Liu H, Zhang L, Nie L, Qin H, Wang M, Lu Q, Li X, Sun Q, Liu J, Fan C, Huang W, Xu M, Wang Y. Establishment and validation of a pseudovirus neutralization assay for SARS-CoV-2. Emerg Microbes Infect 2020; 9:680-686. [PMID: 32207377 PMCID: PMC7144318 DOI: 10.1080/22221751.2020.1743767] [Citation(s) in RCA: 514] [Impact Index Per Article: 128.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pseudoviruses are useful virological tools because of their safety and versatility, especially for emerging and re-emerging viruses. Due to its high pathogenicity and infectivity and the lack of effective vaccines and therapeutics, live SARS-CoV-2 has to be handled under biosafety level 3 conditions, which has hindered the development of vaccines and therapeutics. Based on a VSV pseudovirus production system, a pseudovirus-based neutralization assay has been developed for evaluating neutralizing antibodies against SARS-CoV-2 in biosafety level 2 facilities. The key parameters for this assay were optimized, including cell types, cell numbers, virus inoculum. When tested against the SARS-CoV-2 pseudovirus, SARS-CoV-2 convalescent patient sera showed high neutralizing potency, which underscore its potential as therapeutics. The limit of detection for this assay was determined as 22.1 and 43.2 for human and mouse serum samples respectively using a panel of 120 negative samples. The cutoff values were set as 30 and 50 for human and mouse serum samples, respectively. This assay showed relatively low coefficient of variations with 15.9% and 16.2% for the intra- and inter-assay analyses respectively. Taken together, we established a robust pseudovirus-based neutralization assay for SARS-CoV-2 and are glad to share pseudoviruses and related protocols with the developers of vaccines or therapeutics to fight against this lethal virus.
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Affiliation(s)
- Jianhui Nie
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Qianqian Li
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China.,Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Jiajing Wu
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China.,Wuhan Institute of Biological Products, Wuhan, People's Republic of China
| | - Chenyan Zhao
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Huan Hao
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Huan Liu
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Li Zhang
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Lingling Nie
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Haiyang Qin
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Meng Wang
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Qiong Lu
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Xiaoyu Li
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Qiyu Sun
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Junkai Liu
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Changfa Fan
- Division of Animal Model Research, Institute for Laboratory Animal Resources, National Institutes for Food and Drug Control, Beijing, People's Republic of China
| | - Weijin Huang
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China
| | - Miao Xu
- Institute for Biological Product Control, National Institutes for Food and Drug Control, Beijing, People's Republic of China
| | - Youchun Wang
- Division of HIV/AIDS and Sex-transmitted Virus Vaccines, Institute for Biological Product Control, National Institutes for Food and Drug Control (NIFDC), Beijing, People's Republic of China.,Graduate School of Peking Union Medical College, Beijing, People's Republic of China
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697
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2020 year of the nurse and midwife: Meeting new challenges. Int Emerg Nurs 2020; 49:100848. [PMID: 32184067 PMCID: PMC7269972 DOI: 10.1016/j.ienj.2020.100848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/23/2020] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
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698
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Affiliation(s)
- Carlos Del Rio
- Division of Infectious Diseases, Department of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
- Associate Editor
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699
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Meng L, Hua F, Bian Z. Coronavirus Disease 2019 (COVID-19): Emerging and Future Challenges for Dental and Oral Medicine. J Dent Res 2020; 99:481-487. [PMID: 32162995 PMCID: PMC7140973 DOI: 10.1177/0022034520914246] [Citation(s) in RCA: 855] [Impact Index Per Article: 213.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The epidemic of coronavirus disease 2019 (COVID-19), originating in Wuhan, China, has become a major public health challenge for not only China but also countries around the world. The World Health Organization announced that the outbreaks of the novel coronavirus have constituted a public health emergency of international concern. As of February 26, 2020, COVID-19 has been recognized in 34 countries, with a total of 80,239 laboratory-confirmed cases and 2,700 deaths. Infection control measures are necessary to prevent the virus from further spreading and to help control the epidemic situation. Due to the characteristics of dental settings, the risk of cross infection can be high between patients and dental practitioners. For dental practices and hospitals in areas that are (potentially) affected with COVID-19, strict and effective infection control protocols are urgently needed. This article, based on our experience and relevant guidelines and research, introduces essential knowledge about COVID-19 and nosocomial infection in dental settings and provides recommended management protocols for dental practitioners and students in (potentially) affected areas.
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Affiliation(s)
- L Meng
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - F Hua
- Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Z Bian
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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700
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. LANCET (LONDON, ENGLAND) 2020. [PMID: 32171076 DOI: 10.1016/s0140-6736(20)30566-3,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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Affiliation(s)
- Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ting Yu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Ronghui Du
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ying Liu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Xiang
- Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Lulu Guan
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuan Wei
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xudong Wu
- GCP Center, Jinyintan Hospital, Wuhan, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Shengjin Tu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China.
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