重症病毒性肺炎的病理形态学特征

2019年新型冠状病毒疫情全球暴发,其主要病变为新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)。目前,对COVID-19的认识已取得不菲成绩,但对最能直观反应其疾病特性的病理形态学特征却知之甚少。该文根据病毒性肺炎的病理变化及形成机制,总结了各种重症病毒性肺炎病理形态学特征的共性:急性间质性肺炎伴不同程度的弥漫性肺泡损伤;并对严重急性呼吸综合征、COVID-19、中东呼吸综合征冠状病毒、甲型H1N1流感病毒性肺炎的病理特征进行阐述和比较。充分了解重症病毒性肺炎的临床病理形态学特征,有助于更好地认识疾病、协助指导临床诊治。     

从SARS尸体解剖发现, 浅析新型冠状病毒感染疾病(COVID-19)的若干问题

国际病毒分类委员会的冠状病毒研究小组通过系统进化分析, 认为新型冠状病毒是SARS冠状病毒(SARS-CoV)的姊妹病毒, 同属于SARS相关冠状病毒(SARSr-CoV), 将新型冠状病毒命名为"SARS-CoV-2", 同时, 世界卫生组织也将"新型冠状病毒肺炎"重新命名为冠状病毒病-19(COVID-19), 我们分析其病理变化及发病机制可能与SARS有相似之处。因此, 根据我们的4例SARS尸体解剖发现及研究结果对COVID-19的病理变化及其发病机制等问题进行初步探讨, 供病理及临床工作者参考。     

95例COVID-19患者合并细菌及真菌感染的临床分析

目的:回顾性分析新型冠状病毒肺炎(COVID-19)患者合并细菌及真菌感染的临床特点和耐药情况。方法:收集同济医院2020年2月10日至3月31日血液、尿液、痰液和纤支镜冲洗液培养阳性的COVID-19患者的临床资料,采用WHONET5.6分析统计药敏数据。结果:共收集病原菌培养阳性COVID-19患者95例,非危重型...     

药物临床试验在新型冠状病毒肺炎疫情防控期间的运行管理

2019 年 12 月以来,新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情迅速蔓延,我国 30 个省市自治区相继启动重大突发公共卫生事件一级响应.为做好 COVID-19 疫情防控,我国多个部门根据新型冠状病毒病原体的特点及 COVID-19 临床诊疗经验发布了一系列诊疗与...     

新型冠状病毒肺炎病例血清中和抗体动态变化及影响因素

目的:了解新型冠状病毒肺炎(Coronavirus Disease 2019, COVID-19)确诊病例血清抗新型冠状病毒(2019 novel Coronavirus, 2019-nCoV)中和抗体动态变化规律及可能的影响因素。方法:采用微量中和试验检测COVID-19确诊病例血清中和抗体,采用Excel 2007...     

武汉市511例新型冠状病毒肺炎病例临床特征分析

目的:分析511例新型冠状病毒肺炎（corona virus disease 2019,COVID-19）病例临床特征,为本病的临床诊治提供参考。方法:对本院收治511例COVID-19病例临床资料进行回顾性分析。结果:511例患者平均年龄为（60.8±15.9）岁,痊愈组（440例）和死亡组（71例）的平均年龄分别为...     

COVID-19患者嗅觉功能障碍治疗的研究进展

嗅觉障碍是新型冠状病毒肺炎(Coronavirus disease 2019,COVID-19)患者常见的症状之一,嗅觉障碍影响患者的正常社交及日常生活.本文通过对COVID-19 嗅觉障碍的流行病学研究、发病机制、临床评估、治疗手段等进行综述,以期为COVID-19嗅觉障碍患者的诊疗提供理论依据.     

82例COVID-19零死亡患者的临床特征分析

目的 探讨新型冠状病毒肺炎(coronavirus disease2019,COVID-19)患者的临床特征。方法 收集82例COVID-19患者的胸部影像学特征、血常规、尿常规及心肌酶谱相关检查指标,观察其可能存在的相关性。除1例重型患者外,将81例COVID-19患者分为轻型及普通型两组,进行相关实验室检查并进行比较分析。结果 81例COVID-19患者中胸部影像学表现为双肺多发磨玻璃影多见,其次为右肺病灶,近1/2的患者均合并淋巴细胞减少,1/3的患者尿蛋白阳性,仅8例患者出现不同程度心肌损害。通过比较分析发现,轻型及普通型组在上述指标中均未见明显差异(P0.05)。结论 轻型及普通型COVID-19患者预后佳,针对疑似COVID-19患者,早诊断、早治疗可减少向重型/危重型COVID-19发展。     

骨质疏松症与新型冠状病毒感染的研究进展

新型冠状病毒感染(COVID-19)对神经、肺、肾、血管和心脏均会产生负面影响, 但对肌肉骨骼的作用仍缺乏关注。新近的研究表明COVID-19与骨质疏松症(OP)存在紧密关联。COVID-19本身及其治疗、患者自身因素等都与OP的发生有关, 同时骨密度(BMD)降低与COVID-19患者的临床病程及预后也密切相关。此外, 抗OP治疗与COVID-19之间的关系尚未得到深入研究。因此, 本文就COVID-19与OP的相互关系进行总结分析, 以期为COVID-19患者以及未来疫情下治疗OP、加强骨健康管理提供新思路和指导。     

国内外儿童新型冠状病毒感染流行病学及临床特征进展

新型冠状病毒疫情自2020年初至今仍在世界范围广泛流行。目前国际防疫形势依然严峻, 儿童作为特殊群体, 其流行病学、临床表现特征等与成人存在不同。儿童的发病率逐渐升高, 住院率和病死率较成人偏低, 临床表现以无症状或轻症病例常见, 重症病例多合并基础疾病, 但大多数MIS-C患儿既往体健, 心血管受累最常见, 经临床积极治疗, 多数预后良好, 少数病例出现死亡。本文通过对国内外COVID-19儿童的流行病学特征及临床特征进行综述, 以期为儿童新型冠状病毒感染预防和诊疗提供参考。     

Tocilizumab treatment in COVID-19: A single center experience

Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), emerged as an alternative treatment for COVID-19 patients with a risk of cytokine storms recently. In the present study, we aimed to discuss the treatment response of TCZ therapy in COVID-19 infected patients. The demographic, treatment, laboratory parameters of C-reactive protein (CRP) and IL-6 before and after TCZ therapy and clinical outcome in the 15 COVID-19 patients were retrospectively assessed. Totally 15 patients with COVID-19 were included in this study. Two of them were moderately ill, six were seriously ill and seven were critically ill. The TCZ was used in combination with methylprednisolone in eight patients. Five patients received the TCZ administration twice or more. Although TCZ treatment ameliorated the increased CRP in all patients rapidly, for the four critically ill patients who received an only single dose of TCZ, three of them (No. 1, 2, and 3) still dead and the CRP level in the rest one patient (No. 7) failed to return to normal range with a clinical outcome of disease aggravation. Serum IL-6 level tended to further spiked firstly and then decreased after TCZ therapy in 10 patients. A persistent and dramatic increase of IL-6 was observed in these four patients who failed treatment. TCZ appears to be an effective treatment option in COVID-19 patients with a risk of cytokine storms. And for these critically ill patients with elevated IL-6, the repeated dose of the TCZ is recommended.     

Evaluating the efficacy of extracted squalene from seed oil in the form of microemulsion for the treatment of COVID-19: A clinical study

This study investigates the effect of the nanostructure of squalene in the form of microemulsion on COVID-19 patients. In this blinded clinical trial, a comparison was made between the efficacy of squalene treatment and controls. A total of 30 COVID-19 patients admitted to the emergency department, and the infection ward was equally allocated to case (n = 15) and control (n = 15) groups according to their age and underlying diseases. The baseline characteristics of subjects, including age, gender, time of treatment onset, underlying condition, white blood cells count, and lymphocyte count were similar (p < 0.05). Baseline laboratory tests and computed tomography (CT) scans were performed for the study groups. The treatment group received 5 mg of intravenous squalene twice a day and standard treatment for 6 days, while controls received only standard treatment. After 6 days of treatment, clinical and CT scan changes were evaluated and compared in intervention and control groups. The need for oxygen therapy (p = 0.020), 2 days of no fever (p = 0.025), cough alleviation (p = 0.010), and lung high-resolution computed tomography improvement (p = 0.033) were significantly different between cases and controls within 7 days of admission. No adverse effects were observed in the treatment group. Our data suggest that squalene could be considered as a potential treatment for COVID-19, and further studies are required to confirm the results.     

Epidemiological characteristics,baseline clinical features,and outcomes of critically ill patients treated in a coronavirus disease 2019 tertiary center in continental Croatia

AimTo describe epidemiological characteristics and baseline clinical features, laboratory findings at intensive care unit (ICU) admission, and survival rates of critically ill coronavirus disease 2019 (COVID-19) patients treated at a tertiary institution specialized for COVID-19 patients.MethodsThis retrospective study recruited 692 patients (67.1% men). Baseline demographic data, major comorbidities, anthropometric measurements, clinical features, and laboratory findings at admission were compared between survivors and non-survivors.ResultsThe median age was 72 (64-78) years. The median body mass index was 29.1 kg/m². The most relevant comorbidities were diabetes mellitus (32.6%), arterial hypertension (71.2%), congestive heart failure (19.1%), chronic kidney disease (12.6%), and hematological disorders (10.3%). The median number of comorbidities was 3 and median Charlson Comorbidity Index (CCI) was 5. A total of 61.8% patients received high-flow nasal oxygen therapy (HFNO) and 80.5% received mechanical ventilation (MV). Median duration of HFNO was 3, and that of MV was 7 days. ICU mortality rate was 72.7%. Survivors had significantly lower age, number of comorbidities, CCI, sequential organ failure assessment score, serum ferritin, C-reactive protein, D-dimer, and procalcitonin, interleukin-6, lactate, white blood cell, and neutrophil counts. They also had higher lymphocyte counts, PaO₂/FiO₂ ratio, and glomerular filtration rate at admission. Length of ICU stay was 9 days. The median survival was 11 days for mechanically ventilated patients, and 24 days for patients who were not mechanically ventilated.ConclusionThe parameters that differentiate survivors from non-survivors are in agreement with published data. Further multivariate analyses are warranted to identify individual mortality risk factors.

The first case of coronavirus disease 2019 (COVID-19) in Croatia was confirmed on February 25, 2020 (1). Very soon, on March 11, the World Health Organization (WHO) declared a COVID-19 pandemic (2). As of February 25, 2021, there were more than 240 000 confirmed cases and 5489 deaths in Croatia.As a part of the national strategy against COVID-19 pandemic, the Ministry of Health and Civil Protection Headquarters decided that University Hospital Dubrava (UH) is to be repurposed into a Primary Respiratory Center for patients with confirmed COVID-19 infection. The intensive center of primary respiratory intensive center (PRIC-IC) is a subunit of UH Dubrava reserved for the treatment of patients with severe symptoms of COVID-19 who require mechanical ventilation, vasoactive hemodynamic support, continuous renal replacement therapy, and other aspects of intensive care (3). UH Dubrava became a COVID-19 tertiary center treating a third of all COVID-19 positive ICU patients in the country.As the pandemic was surging through Europe, the number of critically ill COVID-19 patients in UH Dubrava continued to grow, and ICU capacities needed expansion. During winter months, six intensive care units in PRIC were operating at the same time: Three were run by intensivists from UH Dubrava and three by intensivists from other hospitals in Zagreb, including University Hospital Center Zagreb, University Hospital Center Sestre Milosrdnice, University Hospital Sveti Duh, University Hospital Merkur, and Children''s Hospital Zagreb. The outcomes of critically ill patients treated in PRIC-IC therefore represent the work of intensivists from all hospitals in Zagreb.Although scientific knowledge of COVID-19 increases daily, limited information is available regarding early identification of individuals who are at risk of developing severe symptoms. Previous studies reported certain demographic features and clinical characteristics of patients who were likely to develop severe symptoms of COVID-19 and thus require mechanical ventilation (4-7). Studies worldwide reported high mortality rates for patients requiring mechanical ventilation, ranging from 40% to 97% (4,8-10). Unfortunately, some of these reports were preliminary and included patients without a completed ICU stay. The aim of our cohort retrospective study is to describe the demographic characteristic, clinical features, laboratory values, and outcomes among critically ill COVID-19 patients treated in PRIC-IC, UH Dubrava.     

Clinical,radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients

Background

The coronavirus disease 2019 (COVID-19) has become a global pandemic, with 10%-20% of severe cases and over 508 000 deaths worldwide.

Objective

This study aims to address the risk factors associated with the severity of COVID-19 patients and the mortality of severe patients.

Methods

289 hospitalized laboratory-confirmed COVID-19 patients were included in this study. Electronic medical records, including patient demographics, clinical manifestation, comorbidities, laboratory tests results, and radiological materials, were collected and analyzed. According to the severity and outcomes of the patients, they were divided into three groups: nonsurvived (n = 49), survived severe (n = 78), and nonsevere (n = 162) groups. Clinical, laboratory, and radiological data were compared among these groups. Principal component analysis (PCA) was applied to reduce the dimensionality and visualize the patients on a low-dimensional space. Correlations between clinical, radiological, and laboratory parameters were investigated. Univariate and multivariate logistic regression methods were used to determine the risk factors associated with mortality in severe patients. Longitudinal changes of laboratory findings of survived severe cases and nonsurvived cases during hospital stay were also collected.

Results

Of the 289 patients, the median age was 57 years (range, 22-88) and 155 (53.4%) patients were male. As of the final follow-up date of this study, 240 (83.0%) patients were discharged from the hospital and 49 (17.0%) patients died. Elder age, underlying comorbidities, and increased laboratory variables, such as leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and blood urea nitrogen (BUN) on admission, were found in survived severe cases compared to nonsevere cases. According to the multivariate logistic regression analysis, elder age, a higher number of affected lobes, elevated CRP levels on admission, increased prevalence of chest tightness/dyspnea, and smoking history were independent risk factors for death of severe patients. A trajectory in PCA was observed from "nonsevere" toward "nonsurvived" via "severe and survived" patients. Strong correlations between the age of patients, the affected lobe numbers, and laboratory variables were identified. Dynamic changes of laboratory findings of survived severe cases and nonsurvived cases during hospital stay showed that continuing increase of leukocytes and neutrophil count, sustained lymphopenia and eosinopenia, progressing decrease in platelet count, as well as high levels of NLR, CRP, PCT, AST, BUN, and serum creatinine were associated with in-hospital death.

Conclusions

Survived severe and nonsurvived COVID-19 patients had distinct clinical and laboratory characteristics, which were separated by principle component analysis. Elder age, increased number of affected lobes, higher levels of serum CRP, chest tightness/dyspnea, and smoking history were risk factors for mortality of severe COVID-19 patients. Longitudinal changes of laboratory findings may be helpful in predicting disease progression and clinical outcome of severe patients.

     

Clinical features of patients with coronavirus disease 2019 from a designated hospital in Beijing,China

Clinical and laboratory data on patients with coronavirus disease 2019 (COVID-19) in Beijing, China, remain extremely limited. In this study, we summarized the clinical characteristics of patients with COVID-19 from a designated hospital in Beijing. In total, 55 patients with laboratory-confirmed SARS-CoV-2 infection in Beijing 302 Hospital were enrolled in this study. Demographic data, symptoms, comorbidities, laboratory values, treatments, and clinical outcomes were all collected and retrospectively analyzed. A total of 15 (27.3%) patients had severe symptoms, the mean age was 44.0 years (interquartile range [IQR], 34.0-56.0), and the median incubation period was 7.5 days (IQR, 5.0-11.8). A total of 26 (47.3%) patients had exposure history in Wuhan of less than 2 weeks, whereas 20 (36.4%) patients were associated with familial clusters. Also, eighteen (32.7%) patients had underlying comorbidities including hypertension. The most common symptom of illness was fever (45; 81.8%); 51 (92.7%) patients had abnormal findings on chest computed tomography. Laboratory findings showed that neutrophil count, percentage of lymphocyte, percentage of eosinophil, eosinophil count, erythrocyte sedimentation rate, albumin, and serum ferritin are potential risk factors for patients with a poor prognosis. A total of 26 patients (47.3%) were still hospitalized, whereas 29 (52.7%) patients had been discharged. Compared with patients in Wuhan, China, the symptoms of patients in Beijing are relatively mild. Older age, more comorbidities, and more abnormal prominent laboratory markers were associated with a severe condition. On the basis of antiviral drugs, it is observed that antibiotics treatment, appropriate dosage of corticosteroid, and gamma globulin therapy significantly improve patients' outcomes. Early identification and timely medical treatment are important to reduce the severity of patients with COVID-19.     

Melatonin effects on sleep quality and outcomes of COVID-19 patients: An open-label,randomized, controlled trial

This trial aims to evaluate the effectiveness of adding melatonin to the treatment protocol of hospitalized coronavirus disease 2019 (COVID-19) patients. This was an open-label, randomized controlled clinical trial in hospitalized COVID-19 patients. Patients were randomized into a treatment arm receiving melatonin plus standard care or a control arm receiving standard care alone. The trial's primary endpoint was sleep quality examined by the Leeds Sleep Evaluation Questionnaire (LSEQ). The trial's secondary endpoints were symptoms alleviation by Day 7, intensive care unit admission, 10-day mortality, white blood cell count, lymphocyte count, C-reactive protein status, and peripheral capillary oxygen saturation. Ninety-six patients were recruited and allocated to either the melatonin arm (n = 48) or control arm (n = 48). Baseline characteristics were similar across treatment arms. There was no significant difference in symptoms on Day 7. The mean of the LSEQ scores was significantly higher in the melatonin group (p < 0.001). There was no significant difference in laboratory data, except for blood oxygen saturation, which has improved significantly in the melatonin group compared with the control group (95.81% vs. 93.65% respectively, p = 0.003). This clinical trial study showed that the combination of oral melatonin tablets and standard treatment could substantially improve sleep quality and blood oxygen saturation in hospitalized COVID-19 patients.     

HLA-B*15 predicts survival in Egyptian patients with COVID-19

Genetic differences among individuals could affect the clinical presentations and outcomes of COVID-19. Human Leukocyte Antigens are associated with COVID-19 susceptibility, severity, and prognosis. This study aimed to identify HLA-B and -C genotypes among 69 Egyptian patients with COVID-19 and correlate them with disease outcomes and other clinical and laboratory data. HLA-B and -C typing was performed using Luminex-based HLA typing kits. Forty patients (58%) had severe COVID-19; 55% of these patients died, without reported mortality in the moderate group. The alleles associated with severe COVID-19 were HLA-B*41, -B*42, -C*16, and -C*17, whereas HLA-B*15, -C*7, and -C*12 were significantly associated with protection against mortality. Regression analysis showed that HLA-B*15 was the only allele associated with predicted protection against mortality, where the likelihood of survival increased with HLA-B*15 (P < 0.001). Patient survival was less likely to occur with higher total leukocytic count, ferritin, and creatinine levels. This study provides interesting insights into the association between HLA class I alleles and protection from or severity of COVID-19 through immune response modulation. This is the first study to investigate this relationship in Egyptian patients. More studies are needed to understand how HLA class I alleles interact and affect Cytotoxic T lymphocytes and natural killer cell function.     

Children with coronavirus disease 2019: A review of demographic,clinical, laboratory,and imaging features in pediatric patients

There is a current outbreak of coronavirus disease 2019 (COVID-19), with a global spread. With the rapid increase in the number of infections, an increase is observed in the number of children with COVID-19. Most research findings are regarding adult cases, which are not always transferrable to children. Evidence-based studies are still expected to formulate clinical decisions for pediatric patients. In this review, we included 2597 pediatric patients that reported recently and evaluated the demographic, clinical, laboratory, and imaging features of children with COVID-19. We found that even lymphopenia was the most common lab finding in adults; it infrequently occurred in children (9.8%). Moreover, elevated creatine kinase MB isoenzyme was much more commonly observed in children (27.0%) than that in adults, suggesting that heart injury would be more likely to occur in pediatric patients. Our analysis may contribute to determine the spectrum of disease in children and to develop strategies to control the disease transmission.