1) The study found that 14.5% (25/172) of discharged COVID-19 patients in China later tested positive again for the virus based on RT-PCR testing after being discharged from the hospital.
2) These patients met criteria for discharge but tested positive again within 2-13 days without worsening symptoms.
3) The study suggests that more than two negative RT-PCR tests separated by 48 hours or combining RT-PCR tests with antibody and other immunological markers may be needed to confirm viral clearance before discharge.
A trial of Lopinavir-Ritonavir in Adults Hospitalized with Sever COVID-19Valentina Corona
This randomized controlled trial studied 199 hospitalized adult patients with severe Covid-19 in Wuhan, China to evaluate if the drug combination lopinavir-ritonavir provided benefits beyond standard care. Patients received either lopinavir-ritonavir plus standard care or standard care alone. Treatment with lopinavir-ritonavir did not significantly reduce time to clinical improvement or mortality at 28 days compared to standard care. Gastrointestinal side effects were more common with lopinavir-ritonavir. The study found no clinical benefit to using lopinavir-ritonavir for severe Covid-19.
Baseline characteristics and outcomes of 1591 patients infected with sars co ...Valentina Corona
This case series describes 1591 critically ill patients with COVID-19 admitted to ICUs in Lombardy, Italy between February 20th and March 18th. The median age was 63 years and 82% were male. Of those with available data, 68% had at least one comorbidity and 49% had hypertension. Among those with respiratory support data, 99% required support including 88% who received mechanical ventilation. ICU mortality was 26% as of March 25th and older patients had higher mortality than younger patients.
CONVID-19: consider cytokine storm syndromes and immunosuppressionValentina Corona
This correspondence discusses the potential benefits of immunosuppression to treat hyperinflammation in severe cases of COVID-19. It recommends screening COVID-19 patients for hyperinflammation using markers like elevated ferritin and platelet counts. Therapies already approved for safety like IL-6 receptor blockade may help reduce rising mortality from hyperinflammation-induced lung injury and multiple organ failure. Early identification of hyperinflammation and treatment with immunosuppression therapies could improve outcomes for severely ill COVID-19 patients.
1. The document summarizes the current state of knowledge about COVID-19, including its origin, pathophysiology, epidemiology, clinical presentation, diagnosis, and management.
2. Key points include that SARS-CoV-2 likely evolved through natural selection in an animal host before transferring to humans, its optimal binding to the human ACE2 receptor, and viral shedding occurring for up to 37 days including in asymptomatic cases.
3. Clinical presentation varies from mild to critical illness, with risk factors for severe disease including older age and comorbidities. Lymphopenia and elevated inflammatory markers are common lab findings.
- 84 of the 201 patients with COVID-19 pneumonia (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84 patients, 44 (52.4%) died.
- Risk factors for developing ARDS included older age, pre-existing comorbidities like hypertension and diabetes, and signs of disease severity like dyspnea.
- Risk factors for progression from ARDS to death included older age, signs of immune system overactivation and organ dysfunction like neutrophilia and elevated lactate dehydrogenase and D-dimer levels.
- Treatment with the corticosteroid methylprednisolone was associated with decreased risk of death among patients with ARDS.
Respiratory virus shedding in exhaled breath and efficacy of face masksValentina Corona
1) The study identified seasonal human coronaviruses, influenza viruses, and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness.
2) Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols. There was also a trend toward reduced detection of coronavirus RNA in respiratory droplets.
3) The results indicate that surgical face masks could help prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
A trial of Lopinavir-Ritonavir in Adults Hospitalized with Sever COVID-19Valentina Corona
This randomized controlled trial studied 199 hospitalized adult patients with severe Covid-19 in Wuhan, China to evaluate if the drug combination lopinavir-ritonavir provided benefits beyond standard care. Patients received either lopinavir-ritonavir plus standard care or standard care alone. Treatment with lopinavir-ritonavir did not significantly reduce time to clinical improvement or mortality at 28 days compared to standard care. Gastrointestinal side effects were more common with lopinavir-ritonavir. The study found no clinical benefit to using lopinavir-ritonavir for severe Covid-19.
Baseline characteristics and outcomes of 1591 patients infected with sars co ...Valentina Corona
This case series describes 1591 critically ill patients with COVID-19 admitted to ICUs in Lombardy, Italy between February 20th and March 18th. The median age was 63 years and 82% were male. Of those with available data, 68% had at least one comorbidity and 49% had hypertension. Among those with respiratory support data, 99% required support including 88% who received mechanical ventilation. ICU mortality was 26% as of March 25th and older patients had higher mortality than younger patients.
CONVID-19: consider cytokine storm syndromes and immunosuppressionValentina Corona
This correspondence discusses the potential benefits of immunosuppression to treat hyperinflammation in severe cases of COVID-19. It recommends screening COVID-19 patients for hyperinflammation using markers like elevated ferritin and platelet counts. Therapies already approved for safety like IL-6 receptor blockade may help reduce rising mortality from hyperinflammation-induced lung injury and multiple organ failure. Early identification of hyperinflammation and treatment with immunosuppression therapies could improve outcomes for severely ill COVID-19 patients.
1. The document summarizes the current state of knowledge about COVID-19, including its origin, pathophysiology, epidemiology, clinical presentation, diagnosis, and management.
2. Key points include that SARS-CoV-2 likely evolved through natural selection in an animal host before transferring to humans, its optimal binding to the human ACE2 receptor, and viral shedding occurring for up to 37 days including in asymptomatic cases.
3. Clinical presentation varies from mild to critical illness, with risk factors for severe disease including older age and comorbidities. Lymphopenia and elevated inflammatory markers are common lab findings.
- 84 of the 201 patients with COVID-19 pneumonia (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84 patients, 44 (52.4%) died.
- Risk factors for developing ARDS included older age, pre-existing comorbidities like hypertension and diabetes, and signs of disease severity like dyspnea.
- Risk factors for progression from ARDS to death included older age, signs of immune system overactivation and organ dysfunction like neutrophilia and elevated lactate dehydrogenase and D-dimer levels.
- Treatment with the corticosteroid methylprednisolone was associated with decreased risk of death among patients with ARDS.
Respiratory virus shedding in exhaled breath and efficacy of face masksValentina Corona
1) The study identified seasonal human coronaviruses, influenza viruses, and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness.
2) Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols. There was also a trend toward reduced detection of coronavirus RNA in respiratory droplets.
3) The results indicate that surgical face masks could help prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
COVID-19: in gastroenterology a clinical perspectiveValentina Corona
This document discusses gastrointestinal symptoms and liver involvement in COVID-19. It notes that while fever and cough are the most commonly reported COVID-19 symptoms, diarrhea is reported in 17% of cases in Singapore. SARS-CoV-2 RNA has been detected in stool samples. Abnormal liver function tests occurred in around 50% of COVID-19 patients in Chinese studies. The causes of diarrhea and liver abnormalities in COVID-19 are likely multifactorial and may involve the virus binding to ACE2 receptors in the gut and bile ducts. Gastroenterologists need to be aware of atypical COVID-19 presentations that can mimic other gastrointestinal or liver conditions.
This document discusses how telemedicine can help address challenges posed by the COVID-19 pandemic. It describes how telemedicine allows for efficient screening of patients through direct-to-consumer access to physicians via video calls or online intake forms. It also discusses how telemedicine can be used to monitor hospitalized patients remotely and allow specialists to consult on cases virtually. The barriers to increased telemedicine use include reimbursement policies, licensing issues, and the need for coordinated testing. However, health systems that already utilize telemedicine are well positioned to leverage these resources to treat COVID-19 patients while limiting exposure.
Treatment for severe acute respiratory distress syndrome from covid 19Valentina Corona
The document discusses treatment recommendations for patients experiencing severe acute respiratory distress syndrome (ARDS) from COVID-19. It provides guidance on use of extracorporeal membrane oxygenation (ECMO) and other evidence-based options for managing hypoxemia and respiratory failure in COVID-19 patients, including high-flow nasal oxygen, mechanical ventilation strategies, prone positioning, neuromuscular blockade, inhaled nitric oxide, fluid management, and antibiotics. It acknowledges challenges in scaling up ECMO globally and emphasizes optimizing other established treatment protocols.
crp as a prognostic indicator in hospitalized patient with covid 19tanjinamuntakim1
C-reactive protein (CRP) levels were measured in 268 hospitalized COVID-19 patients to evaluate its utility as a prognostic indicator. Higher peak and slope of CRP in the first week, and median CRP levels throughout hospitalization correlated with worse outcomes including mortality, intubation and shorter hospital stay. Optimal CRP thresholds for predicting mortality were a maximum value of 250 mg/L in the first week and a slope greater than 10 mg/L. Elevated CRP thus serves as a sensitive marker for disease progression and severity in COVID-19 patients.
Renin - Angiotensin - Aldosterone System Inhibitors in Patients with Covid-19Valentina Corona
This document summarizes the current understanding of how medications that inhibit the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors and angiotensin receptor blockers (ARBs), may impact COVID-19. It notes that while animal studies have found mixed results on how these drugs affect ACE2 levels, human studies provide little evidence they increase ACE2. It also raises the possibility that ACE2 may be beneficial rather than harmful for lung injury in COVID-19. The document concludes more research is needed to understand the complex interactions between SARS-CoV-2 and the RAAS system in humans before making recommendations about RAAS inhibitor use in COVID-19 patients.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
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.
This document discusses the importance of urologists being aware of the clinical presentation of COVID-19. It notes that some early cases of COVID-19 in Italy were initially attributed to urosepsis by internal medicine physicians due to fever in patients with urological devices. However, these cases were later determined to be pneumonia. The document emphasizes that the symptoms of COVID-19 can overlap with urosepsis, so urologists evaluating patients with fever should consider COVID-19 to avoid missed or delayed diagnoses and unnecessary exposure. Laboratory findings like procalcitonin levels can help differentiate between viral COVID-19 infection and bacterial urosepsis.
The document discusses the difficult decisions cancer doctors face in treating patients during the COVID-19 pandemic. It describes the risks cancer patients face from both COVID-19 infection and delays or reductions in cancer treatment. Doctors must carefully consider the risks of cancer progression if treatment is stopped or reduced against the risks patients face from immunosuppression and side effects from chemotherapy during the pandemic. The pandemic has added further complexity to the already difficult task of weighing benefits and risks of cancer treatment.
The editorial discusses the Covid-19 outbreak caused by a novel coronavirus. It summarizes a study describing the first 425 cases in Wuhan, China, noting the median age was 59 and higher mortality in the elderly and those with preexisting conditions. While the current fatality rate is around 2%, it may ultimately be closer to seasonal flu if asymptomatic cases are accounted for. The virus has an estimated reproduction number of 2.2, indicating rapid spread. Countries have implemented travel restrictions and should prepare for broader community spread, potentially using social distancing and isolation measures. Research efforts are underway to develop treatments and a vaccine.
Dr. D, a chief of cardiology in northern Italy, developed a fever and suspected he had Covid-19 but could not get a test. His hospital's ICU was at half capacity treating Covid-19 patients. Physicians in northern Italy described the rapid deterioration of patients, both young and old. With limited resources, doctors were forced to decide which patients could receive life-saving treatment like ventilators. The healthcare system was overwhelmed, and difficult decisions around rationing care had to be made.
Undertstanding unreported cases in the 2019-nCov epidemicValentina Corona
This document develops a mathematical model to analyze the 2019-nCov epidemic in Wuhan, China. The model accounts for unreported cases and uses reported case data up to January 31, 2020 to parameterize the model. The model is then used to project the epidemic forward under varying levels of public health interventions. The model estimates that there were a significant number of unreported cases and emphasizes that major public health interventions are important for controlling the outbreak.
The document summarizes the link between hypertension (HTN) and COVID-19. It finds that approximately 22.5% of COVID-19 patients have HTN, making it the most common comorbidity. Patients with HTN who contract COVID-19 have a higher risk of severe outcomes like intensive care unit admission and death. The document also discusses how the renin-angiotensin-aldosterone system, which HTN medications target, may impact the interaction of the COVID-19 virus with the body. Specifically, angiotensin-converting enzyme 2 is utilized by the COVID-19 virus to enter cells and HTN medications like ACE inhibitors may alter ACE2 expression levels.
The study found that Ivermectin, an FDA-approved anti-parasitic drug, is able to inhibit the replication of SARS-CoV-2, the virus that causes COVID-19, in vitro. A single dose of Ivermectin resulted in a 5000-fold reduction in viral RNA at 48 hours in infected Vero-hSLAM cells. The authors hypothesize that Ivermectin acts by inhibiting the nuclear import of viral proteins through interaction with importin proteins. They conclude that Ivermectin warrants further investigation for potential benefits against COVID-19 in humans.
Γρηγόριος Γεροτζιάφας, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση:“Artificial intelligence and personalised medicine for patients at high risk of severe COVID-19”
Γρηγόριος Γεροτζιάφας, Καθηγητής Αιματολογίας, Ιατρική σχολή της Σορβόνης, Υπεύθυνος, Τμήμα Θρόμβωσης, Νοσοκομείο Tenon, Παρίσι & Διευθυντής, Ερευνητική Ομάδα Καρκίνος και Θρόμβωση INSERM U938
Insignt from nono medicine into chloroquine efficacy against COVID-19Valentina Corona
Chloroquine, an approved malaria drug, may have potential therapeutic effects against COVID-19 based on preliminary clinical trials and studies. Chloroquine is known to inhibit endocytosis and increase lysosomal pH, which could interfere with SARS-CoV-2 cellular entry and fusion. Specifically, chloroquine may suppress the protein PICALM, reducing clathrin-mediated endocytosis of SARS-CoV-2. However, more clinical trial data is still needed to verify chloroquine's efficacy against COVID-19, and further studies aim to better understand chloroquine's mechanisms of action and optimal dosing protocols.
Considerations in the triage of urologic surgeries during the covid 19 pandemicValentina Corona
This document provides preliminary recommendations for prioritizing urologic surgeries during the COVID-19 pandemic. It suggests prioritizing surgeries where delays may affect patient survival, such as for aggressive urologic cancers. It also suggests alternatives to surgeries that may spare ventilator use, and considers how common urologic treatments may impact patients during an outbreak. The recommendations are meant to help decrease demands on critical hospital resources while avoiding compromised patient outcomes whenever possible. Local tailoring is still needed based on available resources and situations.
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...hivlifeinfo
Вопросы, связанные с АРТ первого ряда, смена арв-стратегии для пациентов с вирусной супрессией, акцентом на возрастающую роль новыхантиретровирусных стратегий.
COVID-19: in gastroenterology a clinical perspectiveValentina Corona
This document discusses gastrointestinal symptoms and liver involvement in COVID-19. It notes that while fever and cough are the most commonly reported COVID-19 symptoms, diarrhea is reported in 17% of cases in Singapore. SARS-CoV-2 RNA has been detected in stool samples. Abnormal liver function tests occurred in around 50% of COVID-19 patients in Chinese studies. The causes of diarrhea and liver abnormalities in COVID-19 are likely multifactorial and may involve the virus binding to ACE2 receptors in the gut and bile ducts. Gastroenterologists need to be aware of atypical COVID-19 presentations that can mimic other gastrointestinal or liver conditions.
This document discusses how telemedicine can help address challenges posed by the COVID-19 pandemic. It describes how telemedicine allows for efficient screening of patients through direct-to-consumer access to physicians via video calls or online intake forms. It also discusses how telemedicine can be used to monitor hospitalized patients remotely and allow specialists to consult on cases virtually. The barriers to increased telemedicine use include reimbursement policies, licensing issues, and the need for coordinated testing. However, health systems that already utilize telemedicine are well positioned to leverage these resources to treat COVID-19 patients while limiting exposure.
Treatment for severe acute respiratory distress syndrome from covid 19Valentina Corona
The document discusses treatment recommendations for patients experiencing severe acute respiratory distress syndrome (ARDS) from COVID-19. It provides guidance on use of extracorporeal membrane oxygenation (ECMO) and other evidence-based options for managing hypoxemia and respiratory failure in COVID-19 patients, including high-flow nasal oxygen, mechanical ventilation strategies, prone positioning, neuromuscular blockade, inhaled nitric oxide, fluid management, and antibiotics. It acknowledges challenges in scaling up ECMO globally and emphasizes optimizing other established treatment protocols.
crp as a prognostic indicator in hospitalized patient with covid 19tanjinamuntakim1
C-reactive protein (CRP) levels were measured in 268 hospitalized COVID-19 patients to evaluate its utility as a prognostic indicator. Higher peak and slope of CRP in the first week, and median CRP levels throughout hospitalization correlated with worse outcomes including mortality, intubation and shorter hospital stay. Optimal CRP thresholds for predicting mortality were a maximum value of 250 mg/L in the first week and a slope greater than 10 mg/L. Elevated CRP thus serves as a sensitive marker for disease progression and severity in COVID-19 patients.
Renin - Angiotensin - Aldosterone System Inhibitors in Patients with Covid-19Valentina Corona
This document summarizes the current understanding of how medications that inhibit the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors and angiotensin receptor blockers (ARBs), may impact COVID-19. It notes that while animal studies have found mixed results on how these drugs affect ACE2 levels, human studies provide little evidence they increase ACE2. It also raises the possibility that ACE2 may be beneficial rather than harmful for lung injury in COVID-19. The document concludes more research is needed to understand the complex interactions between SARS-CoV-2 and the RAAS system in humans before making recommendations about RAAS inhibitor use in COVID-19 patients.
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
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.
This document discusses the importance of urologists being aware of the clinical presentation of COVID-19. It notes that some early cases of COVID-19 in Italy were initially attributed to urosepsis by internal medicine physicians due to fever in patients with urological devices. However, these cases were later determined to be pneumonia. The document emphasizes that the symptoms of COVID-19 can overlap with urosepsis, so urologists evaluating patients with fever should consider COVID-19 to avoid missed or delayed diagnoses and unnecessary exposure. Laboratory findings like procalcitonin levels can help differentiate between viral COVID-19 infection and bacterial urosepsis.
The document discusses the difficult decisions cancer doctors face in treating patients during the COVID-19 pandemic. It describes the risks cancer patients face from both COVID-19 infection and delays or reductions in cancer treatment. Doctors must carefully consider the risks of cancer progression if treatment is stopped or reduced against the risks patients face from immunosuppression and side effects from chemotherapy during the pandemic. The pandemic has added further complexity to the already difficult task of weighing benefits and risks of cancer treatment.
The editorial discusses the Covid-19 outbreak caused by a novel coronavirus. It summarizes a study describing the first 425 cases in Wuhan, China, noting the median age was 59 and higher mortality in the elderly and those with preexisting conditions. While the current fatality rate is around 2%, it may ultimately be closer to seasonal flu if asymptomatic cases are accounted for. The virus has an estimated reproduction number of 2.2, indicating rapid spread. Countries have implemented travel restrictions and should prepare for broader community spread, potentially using social distancing and isolation measures. Research efforts are underway to develop treatments and a vaccine.
Dr. D, a chief of cardiology in northern Italy, developed a fever and suspected he had Covid-19 but could not get a test. His hospital's ICU was at half capacity treating Covid-19 patients. Physicians in northern Italy described the rapid deterioration of patients, both young and old. With limited resources, doctors were forced to decide which patients could receive life-saving treatment like ventilators. The healthcare system was overwhelmed, and difficult decisions around rationing care had to be made.
Undertstanding unreported cases in the 2019-nCov epidemicValentina Corona
This document develops a mathematical model to analyze the 2019-nCov epidemic in Wuhan, China. The model accounts for unreported cases and uses reported case data up to January 31, 2020 to parameterize the model. The model is then used to project the epidemic forward under varying levels of public health interventions. The model estimates that there were a significant number of unreported cases and emphasizes that major public health interventions are important for controlling the outbreak.
The document summarizes the link between hypertension (HTN) and COVID-19. It finds that approximately 22.5% of COVID-19 patients have HTN, making it the most common comorbidity. Patients with HTN who contract COVID-19 have a higher risk of severe outcomes like intensive care unit admission and death. The document also discusses how the renin-angiotensin-aldosterone system, which HTN medications target, may impact the interaction of the COVID-19 virus with the body. Specifically, angiotensin-converting enzyme 2 is utilized by the COVID-19 virus to enter cells and HTN medications like ACE inhibitors may alter ACE2 expression levels.
The study found that Ivermectin, an FDA-approved anti-parasitic drug, is able to inhibit the replication of SARS-CoV-2, the virus that causes COVID-19, in vitro. A single dose of Ivermectin resulted in a 5000-fold reduction in viral RNA at 48 hours in infected Vero-hSLAM cells. The authors hypothesize that Ivermectin acts by inhibiting the nuclear import of viral proteins through interaction with importin proteins. They conclude that Ivermectin warrants further investigation for potential benefits against COVID-19 in humans.
Γρηγόριος Γεροτζιάφας, Health Innovation Conference 2021Starttech Ventures
Ομιλία – Παρουσίαση:“Artificial intelligence and personalised medicine for patients at high risk of severe COVID-19”
Γρηγόριος Γεροτζιάφας, Καθηγητής Αιματολογίας, Ιατρική σχολή της Σορβόνης, Υπεύθυνος, Τμήμα Θρόμβωσης, Νοσοκομείο Tenon, Παρίσι & Διευθυντής, Ερευνητική Ομάδα Καρκίνος και Θρόμβωση INSERM U938
Insignt from nono medicine into chloroquine efficacy against COVID-19Valentina Corona
Chloroquine, an approved malaria drug, may have potential therapeutic effects against COVID-19 based on preliminary clinical trials and studies. Chloroquine is known to inhibit endocytosis and increase lysosomal pH, which could interfere with SARS-CoV-2 cellular entry and fusion. Specifically, chloroquine may suppress the protein PICALM, reducing clathrin-mediated endocytosis of SARS-CoV-2. However, more clinical trial data is still needed to verify chloroquine's efficacy against COVID-19, and further studies aim to better understand chloroquine's mechanisms of action and optimal dosing protocols.
Considerations in the triage of urologic surgeries during the covid 19 pandemicValentina Corona
This document provides preliminary recommendations for prioritizing urologic surgeries during the COVID-19 pandemic. It suggests prioritizing surgeries where delays may affect patient survival, such as for aggressive urologic cancers. It also suggests alternatives to surgeries that may spare ventilator use, and considers how common urologic treatments may impact patients during an outbreak. The recommendations are meant to help decrease demands on critical hospital resources while avoiding compromised patient outcomes whenever possible. Local tailoring is still needed based on available resources and situations.
Современное лечение ВИЧ: новые подходы к оптимизации АРТ/Contemporary Managem...hivlifeinfo
Вопросы, связанные с АРТ первого ряда, смена арв-стратегии для пациентов с вирусной супрессией, акцентом на возрастающую роль новыхантиретровирусных стратегий.
Nejm clinical outcomes of hydroxychlorquine in patients with covid19.pdf.pdfgisa_legal
This study evaluated the effects of hydroxychloroquine treatment in 63 hospitalized patients with COVID-19. Patients were divided into a hydroxychloroquine treatment group (32 patients) and a supportive care only group (31 patients). The primary outcomes measured were need for escalation of respiratory support, change in lymphocyte count, and change in neutrophil-to-lymphocyte ratio. The results showed that hydroxychloroquine treatment was associated with a higher need for escalation of respiratory support compared to the supportive care only group. There were no significant benefits of hydroxychloroquine treatment on lymphocyte counts or neutrophil-to-lymphocyte ratios. The study concludes that hydroxychloroquine did not provide benefits and
Factores de riesgo para reingreso temprano despues de hospitalizacion por cov...MelendiNavarro
The study assessed the incidence and risk factors for early readmission (within 60 days) in patients hospitalized for COVID-19. Of the 629 patients followed, 34 (5.4%) were readmitted, with a median time to readmission of 12 days. Main reasons for readmission were respiratory worsening (38.2%), decompensation of a previous disease (35.3%), or infectious complications (17.6%). Prior diagnosis of heart failure, length of stay over 13 days, treatment with corticosteroids, and developing pulmonary thromboembolism were identified as risk factors statistically associated with early readmission.
Investigation of Long term Hazards and Multi organ Impact of SARS COV-2 in Po...Jagruti Marathe
Introduction
Background
Burden of COVID 19
Need of the study
Rationale of the study
Review of literature
Epidemiology
Hypothesis
Aim and objective
Material and Method
Criteria
Study design
Outcome
Result
Analysis
Discussion
Coronavirus are a large family of viruses that causes illness ranging from the common cold to more serve disease such as middle east respiratory syndrome(MERS-COV) and sever acute respiratory syndrome (SARS-COV).
A novel corona virus (nCOV) is a new strain that has not been previously identified in humans.
SARS-CoV-2 belongs to the Single Standing RNA Viruses class of coronaviruses, but the infection had been rapidly spreading around the world and World Health Organization (WHO) declared a pandemic .
Post covid pulmonary fibrosis , atypical covid19 sequeleDr-Ajay Tripathi
1) COVID-19 can cause persistent radiological changes and lung function abnormalities even after discharge from the hospital. Regular follow-up is recommended, especially for severe cases.
2) COVID-19 has been shown to cause multi-system involvement beyond the lungs, including cardiovascular, neurological, renal and other organ systems. It can present atypically without respiratory symptoms.
3) Post-COVID care including pulmonary rehabilitation is important as many patients have long-term effects. Emerging treatments like anti-fibrotics are being studied to prevent long-term pulmonary fibrosis in severe cases.
Современное лечение ВИЧ: новые парадигмы в АРТ / Contemporary Management of H...hivlifeinfo
Набор слайдов c рассмотрением важных вопросов об АРТ первого ряда, арв-препаратами пролонгированного действия и схемами АРТ с двумя препаратами, акцент в публикации на роль новых стратегий.
Constance Benson, MD
Professor of Medicine and Director of the UC San Diego
AntiViral Research Center
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
This document discusses diagnostic testing for COVID-19. It outlines that RT-PCR tests on respiratory samples are the reference standard, but point-of-care tests and serology are emerging. It recommends testing symptomatic individuals, healthcare workers, and those with recent exposure. Rapid antibody tests are not recommended for diagnosis but can indicate exposure. Specimens include respiratory and blood samples. Saliva samples may be a sensitive alternative to nasal swabs. Validation of diagnostic tests is important.
COVID 19 radiology.ppt human education systemssuserb52e6c
1) The document discusses the chest CT findings of COVID-19 pneumonia based on a review of 1014 patient cases in Wuhan, China. 2) Key findings on CT included ground-glass opacities in 97% of positive cases as well as consolidations. 3) CT was found to have a sensitivity of 97% in detecting COVID-19 compared to PCR testing, and found positive findings in 75% of PCR-negative cases, suggesting CT may detect COVID-19 earlier than tests.
This study analyzed clinical data from 1099 patients with confirmed COVID-19 in China. It found that the median age was 47 years and the most common symptoms were fever (88.7% developing during hospitalization) and cough (67.8%). Lymphocytopenia was present in 83.2% of patients. The primary endpoint of ICU admission, mechanical ventilation or death occurred in 6.1% of patients. While most cases had contact with Wuhan residents, only 1.9% reported direct contact with wildlife. The study concludes that COVID-19 spread rapidly in China and caused illness of varying severity, with some patients presenting without fever or abnormal radiology.
Journal club on Hydrcortisone for Severe Community acquired pneumoniaWondwosenMulatu
This study aimed to evaluate whether early treatment with hydrocortisone reduces mortality among patients admitted to the ICU for severe community-acquired pneumonia. The randomized controlled trial assigned 800 patients to receive either hydrocortisone or placebo within 24 hours of meeting severity criteria. The primary outcome was death from any cause by day 28. Treatment with hydrocortisone resulted in lower 28-day mortality compared to placebo (11.9% vs 18.0%), fewer patients requiring invasive mechanical ventilation or vasopressors, and no increase in safety outcomes. The results provide evidence that early hydrocortisone treatment reduces mortality for patients with severe community-acquired pneumonia admitted to the ICU.
1. The document summarizes data on COVID-19 from various sources, including rates of COVID-19 hospitalization by age group in the US, racial/ethnic disparities in reported COVID-19 cases, proposed routes of SARS-CoV-2 transmission, and the impact of personal protective equipment on risk of infection in frontline healthcare workers.
2. It also reviews considerations around SARS-CoV-2 transmission, the concept of herd immunity, temporal profiles of viral load and opportunities for diagnosis, chest CT findings consistent with COVID-19, and the varying clinical presentation and natural history of COVID-19 by factors like age and sex.
3. Key findings include that the highest rates of COVID-19 hospitalization
Four Unique Laboratory Characteristics Applied to Assess the Severity of COVI...semualkaira
The sudden outbreaking of COVID-19 worldwide has
brought into sharp increased burden of economic and treatment.
How to simply, quickly and accurately assess the severity of patients with COVID-19 in the early stage after hospital admission is
essential for healthcare systems
Four Unique Laboratory Characteristics Applied to Assess the Severity of COVI...komalicarol
The sudden outbreaking of COVID-19 worldwide has
brought into sharp increased burden of economic and treatment.
How to simply, quickly and accurately assess the severity of patients with COVID-19 in the early stage after hospital admission is
essential for healthcare systems.
Application of ordinal logistic=China.pdfHenokBuno
This study aimed to identify determinants of illness severity for COVID-19 patients in China. Medical records from 598 COVID-19 patients admitted to four hospitals in China between January and March 2020 were analyzed. Patients were divided into moderate (n=400), severe (n=85), and critical (n=113) illness groups based on their condition. Ordinal logistic regression was used to identify predictors of more severe illness. The analysis found that older age, hypertension, abnormal liver enzymes and cardiac markers, longer time from illness onset to diagnosis and admission were associated with increased risk of more severe illness.
Triple combination of
interferon beta-1b, lopinavir – ritonavir, and ribavirin
in the treatment of patients admitted to hospital with COVID-19:
an open-label, randomized, phase 2 trial
The T2 magnetic resonance (T2MR) assay demonstrated high sensitivity and specificity for rapid diagnosis of candidemia directly from whole blood. In a multicenter clinical trial of 1801 patients, T2MR had an overall sensitivity of 91.1% and specificity of 99.4% for detecting five Candida species, with results available in an average of 4.4 hours. Subgroup analysis showed sensitivities ranging from 88.1-94.2% for individual species and specificities of 98.9-99.9%. The assay has the potential to improve outcomes for candidemia by enabling earlier targeted antifungal treatment.
1) A randomized controlled trial of 72 COVID-19 patients in Bangladesh investigated the effects of a 5-day course of ivermectin alone or ivermectin combined with doxycycline on viral clearance time and safety.
2) The study found that viral clearance time was significantly reduced in the ivermectin-only group compared to the placebo group, taking 9.7 days versus 12.7 days on average.
3) No severe adverse drug events occurred, and a 5-day course of ivermectin appeared to be safe and effective for treating mild COVID-19 based on this preliminary study. However, larger trials are still needed to confirm these results.
Telehealth in Urology: A Systematic Review of the Literature.Valentina Corona
This systematic review identified 45 studies evaluating telehealth applications in urology. The studies covered prostate cancer (11 studies), hematuria management (3 studies), urinary stones (6 studies), urinary incontinence (14 studies), urinary tract infections (5 studies), and other conditions (6 studies). The available evidence indicates that telehealth has been successfully used for decision-making in prostate cancer, follow-up care of prostate cancer and urinary incontinence patients, initial diagnosis of hematuria and urinary tract infections, and management of uncomplicated urinary stones. However, more robust data on long-term outcomes, safety, and cost-effectiveness are still needed. The COVID-19 pandemic is likely
This randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of the antiviral remdesivir in 1062 hospitalized adults with COVID-19 and evidence of lower respiratory tract infection. Patients received either intravenous remdesivir (200 mg loading dose on day 1, then 100 mg daily for up to 9 more days) or placebo for up to 10 days. The primary outcome was time to recovery, defined as hospital discharge or hospitalization for non-infectious reasons only. Patients who received remdesivir had a median recovery time of 10 days compared to 15 days for placebo patients, and were more likely to have clinical improvement at day 15. Mortality by day 29 was 11.4% for rem
Avoidng disruption of timely surgical management of genitourinary cancers ...Valentina Corona
This article describes the experience of a large cancer center in Southern Italy in continuing timely surgical treatment of genitourinary cancers during the early phase of the COVID-19 pandemic. The center established a multidisciplinary team to prioritize urgent cancer cases and implemented screening, safety protocols, and transfer agreements to identify and manage any COVID-19 positive patients while maintaining surgical volume. Through regional healthcare reorganization designating the center as "COVID-free" and other measures, the hospital was able to safely perform a similar number and mix of cancer surgeries compared to the previous year without major disruption of care.
Avoiding disruption of surgical treatment of genitourinary cancers...Valentina Corona
The document discusses surgical treatment of genitourinary cancers during the COVID-19 pandemic at a high-volume cancer center in Southern Italy. Through careful patient selection, strict safety protocols, and hospital reorganization, the center was able to maintain surgical treatment flow for urological cancers. A multidisciplinary team prioritized 93 cancer surgeries from March-April 2020, performing 40.8% robotically. Outcomes were similar to the prior year. One patient developed postoperative COVID-19 but recovered. The experience shows timely cancer treatment can continue safely during pandemics with appropriate measures.
A systematic review on COVID-1: urological manifestations...Valentina Corona
1) Acute kidney injury leading to mortality is common amongst COVID-19 patients, occurring in 7.58% of patients with a mortality rate of 93.27% amongst those developing acute kidney injury. This is likely due to direct viral toxicity as the virus interacts with receptors in the kidneys.
2) While urinary symptoms are not a presenting symptom of COVID-19, 5.74% of COVID-19 patients had positive viral RNA detected in urine samples.
3) Viral RNA was also detected in stool samples of 65.82% of COVID-19 patients, detected from 2 to 47 days from symptom onset. This suggests precautions are needed when performing transurethral or transrectal
Urology in the time of Coronavirus: Reduced Acmes to Urgent and Emergent Care...Valentina Corona
- Urologists in Italy reported data on urgent/emergent urological cases seen before and during the COVID-19 outbreak.
- There was a significant decrease in the number of total urgent/emergent cases seen each week, dropping from 956 patients/week before the outbreak to 291 patients/week by the end of the study period.
- Specific conditions like hematuria, urinary retention, UTI, scrotal pain, renal colic, and trauma all saw significant decreases in patients presenting each week as hospitals restructured to focus on COVID-19.
The COVID-19 pandemic led to a 55% decrease in urological consultations in emergency departments in Italy between March 2019 and March 2020. Hospitals in northern Italy, which was hit hardest by the pandemic, saw a 64% decrease, while southern Italy saw an 82% decrease. Patients in 2020 tended to be older and had conditions like gross hematuria and acute urinary retention that required urgent treatment. There was more aggressive early treatment for some conditions to reduce hospital visits and risk of infection. The study suggests emergency departments need to prepare for around half the usual urological caseload during the pandemic.
Accessing the Burden of Nondeferrable Major Uro-oncologic Surgery to Guide Pr...Valentina Corona
The COVID-19 pandemic has led to unprecedented strain on healthcare resources including urology services. This study assessed the proportion of high-priority major uro-oncologic surgeries at three large Italian hospitals to help guide prioritization strategies. Of 2387 major cancer surgeries performed in 2018-2019, 32.3% were considered high priority. Approximately two-thirds of elective major urologic cancer surgeries could be safely postponed. Of high-priority surgeries, 26.4% involved patients at higher perioperative risk who may require alternative treatment. The findings provide insights into balancing cancer care needs while optimizing limited resources during the pandemic.
A Global Survey on the Impact of COVID-19 on Urological ServicesValentina Corona
1. A global survey of 1004 urology healthcare professionals found that COVID-19 profoundly impacted urological care worldwide.
2. 41% reported their hospital staff being diagnosed with COVID-19, and 26% had to be deployed to care for COVID-19 patients. Only 33% felt they had adequate protective equipment.
3. COVID-19 reduced urological services globally, including outpatient clinics (28% delay), investigations and procedures (30% delay), and surgeries (31% delay over 8 weeks). Reductions were greater for benign than malignant conditions and in areas with more COVID-19 cases.
4. While 47% believed the backlog could be addressed, 50%
Since January Elsevier has created a COVID-19 resource center with...Valentina Corona
The document summarizes recommendations from 13 urological associations/societies (UASs) regarding prioritization of urological procedures during the COVID-19 pandemic. Four UASs were international and nine were European national associations. There was broad consensus that prostate biopsies for suspected lower-risk prostate cancer and elective procedures for benign conditions should be deferred. Most UASs also recommended deferring elective surgeries for lower-risk prostate cancer and kidney cancer, non-obstructing kidney stones, and benign prostatic hyperplasia. The expected changes are likely to significantly increase urologists' workload regarding consultations, surgical waitlists, and resource allocation in the future.
Since January Elsevier has created a COVID-19 resource center with...Valentina Corona
Elsevier has created a COVID-19 resource center since January 2020 that provides free information about the novel coronavirus in English and Mandarin. This resource center allows all COVID-19 research available on the site, including the content in this document, to be made immediately available in public repositories without restrictions for research reuse. These permissions are granted by Elsevier as long as the COVID-19 resource center remains active.
Simulated Sunlight Rapidly Inactivates SARS-CoV-2 on SurfacesValentina Corona
This study investigated how sunlight inactivates SARS-CoV-2 on non-porous surfaces. The virus was suspended in simulated saliva or culture media and dried on stainless steel coupons. When exposed to simulated sunlight, 90% of infectious virus was inactivated every 6.8 minutes in simulated saliva and every 14.3 minutes in culture media. Significant inactivation also occurred under lower sunlight levels, though at a slower rate. This provides evidence that sunlight can rapidly inactivate SARS-CoV-2 on surfaces, suggesting the risk of exposure varies between indoor and outdoor environments, with natural sunlight being an effective disinfectant.
Chloroquine or hydroxychloroquine for Covid-19: why might they be hazardous?Valentina Corona
This document summarizes a large observational study on the effects of chloroquine or hydroxychloroquine, with or without macrolides, in treating COVID-19 patients. The study found these treatments increased the risk of in-hospital mortality and ventricular arrhythmias in COVID-19 patients compared to controls. Specifically, it observed a significant increase in the hazard ratios for in-hospital mortality for patients treated with these drugs. It also observed a higher incidence of ventricular arrhythmias in patients treated with 4-aminoquinolines. While the study had limitations as an observational one, its large sample size across many hospitals indicates these treatments do not benefit and may harm hospitalized COVID-19 patients.
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This study examined autopsy lung tissue from 7 patients who died from COVID-19 and compared it to lung tissue from 7 patients who died from influenza A(H1N1) and 10 control lungs. The key findings were:
1) Lungs from COVID-19 patients showed diffuse alveolar damage similar to influenza, but also showed distinctive vascular features including severe endothelial injury, intracellular virus within endothelial cells, and disrupted cell membranes.
2) Histological analysis found widespread thrombosis and microangiopathy in pulmonary vessels of COVID-19 patients, with microthrombi being 9 times more prevalent than in influenza patients.
3) Lungs from COVID-19 patients showed significantly more new vessel growth, predominantly
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The document compares COVID-19 deaths to seasonal influenza deaths in the United States. It finds that comparing the total estimated influenza deaths reported by the CDC to the current COVID-19 death count is an "apples to oranges" comparison. A more valid comparison is between weekly counted COVID-19 deaths and historical weekly counted seasonal influenza deaths. Based on this comparison, COVID-19 deaths were 9.5-44 times higher than the peak weekly influenza deaths in recent seasons. The document concludes that COVID-19 poses a much greater public health threat than seasonal influenza based on comparing "apples to apples" death counting methods.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Abstract:
We report the observation that 14.5% of COVID-19 patients had positive RT-PCR testing again after
discharge. We describe correlations between laboratory parameters and treatment duration (r= -0.637;
p=0.002) and time to virus recrudescence (r= 0.52; p=0.008) respectively, suggesting the need for
additional measures to confirm illness resolution in COVID-19 patients.
Keywords: coronavirus, COVID-19, discharged patients, recurrent viral activity, D-dimer
level.
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3. Introduction
Since Dec 8th
2019, many cases has been reported by investigators who described the clinical
characteristics of hospitalized patients with COVID-19 infection1-3
. We noticed the recent report4
from Lan et al. that 4 medical staff were still virus carriers after recovery from COVID-19 infection.
Here we gave a report on 25 discharged patients with their medical record review and further analysis.
Methods
Enrolled from Jan 23th 2020 to Feb 21th 2020, total 172 COVID-19 infected patients were discharged
from Shenzhen Third People’s Hospital. They all met the following criteria of hospital discharge in
China: (1) Normal body temperature for more than 3 consecutive days. (2) Significant reduction of
respiratory symptoms evaluated by following indicators: cough and expectoration disappeared,
normal ranges for inflammatory markers IL-6 and CRP, as well as oxygenation index ≥350. (3)
Substantial improvement over conventional chest radiography detection. (4) At least two
consecutively negative results of RT-PCR testing separated by at least 24-hour interval. Considering
the risk of reinfection, all discharged patients were required another 14 days of self-segregating at
home for further observation. The cloacal swab and nasopharyngeal swab samples were both
collected from these discharged patients each three days for RT-PCR detection of COVID-19 in the
same way as they were in hospital. Among them, 25 discharged patients were identified with positive
results again. COVID-19 RNA Detection Kits (Real-time fluorescent PCR method) approved by the
National Medical Products Administration were used for virus testing as described previously5
.
Conditions for the amplifications include reverse transcription at 50°C for 15min, pre-denaturation at
95°C for 15 min, followed by 45 cycles of 94°C for 15 s and 55°C for 45 s for fluoresce detection.
The receiver operating characteristic (ROC) curve analysis was used to determine the optimal
threshold cut-off value. And a cycle threshold (Ct) value ≤40 was defined as a positive test. Other
demographic, clinical, radiologic and laboratory findings were extracted from the electronic medical
records of the patients. The anti-viral compound ritonavir/lopinavir (Kaletra ®) combined with
interferon alpha (IFN-α) was used as the potential antiviral therapy for all these patients during their
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4. first hospitalization. Ritonavir/lopinavir table was administrated with 500 mg once daily while 50 μg
IFN-α was aerosolized 2 times a day. Besides, Chinese herbal medicines were widely recommended
by the Chinese Clinical Guideline for the Diagnosis and Treatment of Novel Coronavirus Pneumonia
(On Trials) issued by National Health Commission of China. The herbal formula of Lung Cleansing
and Detoxifying Decoction was used for these 25 patients during their second hospital stay. The study
was approved by Shenzhen Third People’s Hospital Ethics Committee and the informed consent was
waived.
Results
The study population included 172 discharged COVID-19 patients from Jan 23th 2020 to Feb 21th
2020. These were 25 of discharged patients (total 14.5%) sent to hospital again because of the positive
RT-PCR results on virus again. With the median age of 28 years (IQR: 16.25-42), 17 of them were
females, including 6 children under 12 years old. According to their previous medical records, these
patients had experienced an average of 15.36±3.81 days of hospital stay, as well as 13.33±3.93 days
of potential antivirus therapy with ritonavir/lopinavir and IFN-α, no obvious differences with other
discharged patients. Before discharging from the hospital, these patients all showed improvements on
chest computed tomography (CT) evidence and exhibited with two consecutive negative results (24
hours of interval) on virus mRNA by RT-PCR assays.
After leaving the hospital to self-quarantine at home, the discharged patients hadn’t taken drug any
longer but just monitored at home by RT-PCR detection of COVID-19 with both cloacal swab and
nasopharyngeal swab samples in each three days. Unexpectedly, cloacal swab samples of 14 patients
turned positive on virus mRNA and another 11 patients showed positive results of nasopharyngeal
swab sample testing. Overall, the mean duration from their final negative PCR result to hospital
discharge was 2.71±1.88 days. While the average period from positive again to previous discharge
lasted for 5.23±4.13 days. Thereby, these 25 patients experienced an average of 7.32±3.86 days
from their last negative RT-PCR result to turning positive again.
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5. Notably, these patients once represented with the common symptoms of fever (68%) and cough (60%)
and 24 of them were non-severe types at the first onset. At this time of hospital readmission, only 8
patients (32%) had mild cough. Besides, CT scan results indicated that 12 of them were characterized
by improvement of original lesions compared with images before leaving the hospital, while another 8
patients showed no worsening than previous results. When they readmitted to hospital, the formula of
Lung Cleansing and Detoxifying Decoction was used for these 25 patients. Within an average of 2.73
days of hospital stay, the RT-PCR results of virus mRNA detection were all turning to negative in
both nasopharyngeal swab and cloacal swab samples. These patient were all stayed for a prolonged
observation.
On the other hand, previous clinical and laboratory outcomes were compared between these 25
patients (with conversion of RT-PCR results from negative to positive after being discharged from the
hospital) and rest 147 patients (continuously represented negative for the virus after discharge). They
showed no distinguished differences on the levels of laboratory parameters before leaving the
hospital. Subsequently, correlation analysis indicated that there was a significant inverse correlation
existed between serum D-Dimer level before discharging and the duration of treatment in these 25
patients (r=-0.637, p=0.002), instead of the rest 147 patients. Furthermore, lymphocyte concentrations
before these 25 patient leaving the hospital were significantly positively correlated (r=0.52, p=0.008)
with the time interval for virus reappearing.
Discussion
These 25 patients with COVID-19 infection all met the criteria for hospital release from quarantine,
while the RT-PCR testing then conversed to positive without aggravation on symptoms after 2 to 13
days. It seems that there was a fluctuating period between of seeming improvement in clinics and full
recovery from virus. These less symptomatic carriers brought more challenges to the management and
control of COVID-19 epidemic in China and any other affected countries. According to our study, it
is probably that two negative RT-PCR tests 24 hours apart may not be sufficient for viral clearance
evaluation. Repeated viral RT-PCR testing separated by prolonged duration like 48 hours is essential
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6. to assure that virus has actually cleared and the discharged patients no longer transmitted the virus. On
the other hand, we suggested that some immunological parameters such as D-dimer and absolute
lymphocyte count, and even antibody test should be combined with RT-PCR negative test as
additional measures to assure that infected patients have completely recovered and can be released
from quarantine. Besides, the RT-PCR results then turning to negative within an average of 2.73 days
of hospital stay. Even the Chinese herbal medicine was used for these readmitted patients, it is hard to
assess the effect on virus clearance. Further case-control study and cohort study will be needed to
pursue that.
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7. Author Contributions: Dr. Yanchao Pan and Lei Liu had full access to all of the data in the study
and take responsibility for the integrity of the data and the accuracy of the data analysis. Jing Yuan
and Shanglong Kou contributed equally to this work. Acquisition, analysis, or interpretation of data:
Jing Yuan, Yanhua Liang, Jianfeng Zeng. Concept and design: Jing Yuan, Lei Liu. Drafting of the
manuscript: Yanchao Pan, Shanglong Kou. Statistical analysis: Yanchao Pan, Shanglong Kou.
Funding: This work was supported by Sanming Project of Medicine in Shenzhen (SZSM201512005).
Conflict of Interest Disclosures: All authors declare that they have no conflict of interest exists.
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8. Reference:
1. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel
Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020.
2. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-
Infected Pneumonia. N Engl J Med 2020.
3. Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel
coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-23.
4. Lan L, Xu D, Ye G, et al. Positive RT-PCR Test Results in Patients Recovered From COVID-19.
JAMA 2020.
5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in
Wuhan, China. Lancet 2020;395:497-506.
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9. Table. Baseline Characteristics of 25 Discharged Patients with positive results of RT-PCR again.
Groups by age range, case number ≤14, N=6
20-40,
N=13
41-60,
N=6
Total,
N=25
p
valu
e
Sex (numbers) (male, female) 1, 5 4, 9 3, 3 8, 17 NS
Symptom of first admission to hospital
Fever (number (percentage))
3 (50%) 9 (69.23%) 5
(83.33%)
17 (68%) NS
Cough (number percentage)
2 (33.33) 9 (69.23%) 4
(66.67%)
15 (60%) NS
Symptom of second admission to hospital
Mild cough (number (percentage)) 2 (33.33%) 3 (18.75%) 3 (50%) 8 (32%)
Laboratory parameters before discharge (mean, (SD))
lymphocyte count (10^9/L)
3.61 (1.52) 1.62 (0.46)
1.51
(0.43)
2.07
(1.19)
0.00
1
LDH level (U/L) 218.40
(49.85)
156.50
(29.74)
188
(40.42)
180.24
(44.5)
0.02
5
CRP level (mg/L)
0.84 (0.85) 6.77 (5.05)
5.30
(4.78)
4.90
(4.79)
NS
IL-6 level (pg/ml)
2.49 (0.93) 3.3.0 (1.94)
3.41
(0.81)
3.19
(1.40)
NS
D-Dimer level (μg/ml)
0.29 (0.14) 0.36 (0.29)
0.43
(0.27)
0.37
(0.26)
NS
Clinical features (mean, (SD)) (days)
Length of first hospital stay 15 (2.83)
15.23
(3.35) 16 (5.83)
15.36
(3.81)
NS
antivirus treatment durations
13.33
(3.93)
13.46
(4.31)
13.5
(4.46)
13.44
(4.08)
NS
Time from negative PCR test to
discharge 3.67 (2.50) 2.17 (1.53)
2.83
(1.72)
2.71
(1.88)
NS
Time from positive again to last negative 8.33 (5.61) 6.77 (3.40)
7.5
(3.21)
7.32
(3.86)
NS
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10. Time from positive again to last
discharge 4.67 (4.23) 5.92 (4.72)
4.67
(2.94)
5.32
(4.13)
NS
Time from positive again to second
hospitalization 1.33 (1.51) 1.85 (2.12)
2.67
(2.07)
1.92
(1.96)
NS
Time from readmission to negative again 1 (0) 2 .69 (2.06)
3.67
(2.07)
2.73
(2.03)
NS
Data are given as mean ± standard deviation (SD). Determined using one-way analysis of variance.
Abbreviations: LDH, lactate dehydrogenase; CRP, C-reactive protein; IL-6, interleukin-6.
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11. Figure. Correlation analysis for serum D-Dimer level and duration of treatment, as well as
lymphocyte count and time interval for virus reappearing.
Correlation analysis on serum D-Dimer level and the duration of treatment (r=-0.637, p=0.002) (A),
as well as correlation between lymphocyte concentration and the time interval for virus reappearing
(r=0.52, p=0.008) (B). The D-Dimer values and lymphocyte counts were collected from the last
measurements before their first hospital discharge. The duration of treatment was derived from their
previous records. The time interval for virus reappearing was calculated from last negative before
previously leaving the hospital to turning positive again of RT-PCR testing on COVID-19.
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