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Objective:To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).Methods:A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.Results:A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change. Conclusions:The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.
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Objective:To retrospective analyze the epidemiology, clinical characteristics, treatment and prognosis in patients with coronavirus disease 2019 (COVID-19).Methods:A total of 278 patients with COVID-19 admitted to Guangzhou Eighth People′s Hospital from January 20 to February 10, 2020 were selected. The general demographic data, epidemiological data, clinical symptoms, laboratory examinations, lung CT imaging, treatment and prognosis were analyzed.Results:There were 130 male patients (46.8%) and 148 females (53.2%) with age (48.1±17.0) years and 88.8% patients between 20-69 years. Two hundred and thirty-six (84.9%) patients had comorbidities. Two hundred and eleven cases (75.9%) were common type. The in-hospital mortality was 0.4% (1/278). The majority (201, 72.3%) were imported cases mainly from Wuhan (89, 44.3%). The most common clinical manifestations were fever (70.9%) and dry cough (61.5%). In some patients, hemoglobin (10.4%), platelets (12.6%) and albumin (55.4%) were lower than the normal range. Other biochemical tests according to liver and function were normal, while lactic dehydrogenase (LDH) was elevated in 61 patients (21.9%), creatine kinase increased in 26 patients (9.4%). Prolonged activated partial thromboplastin time (APTT) was seen in 52 patients (18.7%), D-dimer higher than normal in 140 patients (50.4%), while 117 patients (42.1%) had elevated high-sensitivity C-reactive protein. Typical CT manifestations included single or multiple ground glass shadows especially in lung periphery in early disease which infiltrated and enlarged during progressive stage. Diffuse consolidation with multiple patchy density in severe/critical cases and even "white lung" presented in a few patients. Two hundred and forty-two patients (87.1%) received one or more antiviral agents, 242 (87.1%) combined with antibacterials, 191 (68.7%) with oxygen therapy. There were 198 patients (71.2%) treated with traditional Chinese medicine.Conclusions:COVID-19 could attack patients in all ages with majority of common type and low mortality rate. Clinical manifestations involve multiple organs or systems. Progression of the disease results in critical status which should be paid much attention.
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Objective:To investigate the immunological features of 135 patients with corona virus disease 2019 (COVID-19), and to provide reference for the pathogenesis of the disease.Methods:The clinical and laboratory data of 135 confirmed COVID-19 patients in Guangzhou Eighth People′s Hospital from January 23 to February 29, 2020 were collected. The features of lymphocytes (CD4 + and CD8 + T lymphocytes, B lymphocytes, natural killer cells and natural killer T cells), and cytokines (interleukin (IL)-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)-α and interferon (IFN)-γ) of patients at a median of 19 (14, 27) days of admission were analyzed. Kruskal-Wallis test, Mann-Whitney U test, chi-square test and Spearman rank correlation were used for statistical analysis. Results:Patients were divided into three groups according to the relevant diagnostic criteria, including mild group (14 cases), ordinary group (92 cases) and severe group (29 cases). Decreased CD4 + T lymphocytes were found in 44.4% (60/135) patients, while decreased CD8 + T lymphocytes were found in 42.2%(57/135) patients. Compared to mild group and ordinary group, level of CD4 + T lymphocytes in severe group was significant lower ( Z=4.379 and 3.799, respectively, both P<0.01), and level of CD8 + T lymphocytes was also significant lower ( Z=2.684 and 3.306, respectively, P=0.022 and 0.003, respectively). Decreased B lymphocytes were found in 25.3% (24/95) patients and significant different among the three groups, with the lowest levels ((88(56, 189)/μL; Z=6.199, P=0.045) and most frequency of decreased levels ((52.2%(12/23); χ2=11.723, P=0.003) in the severe group. Compared to the mild group and the ordinary group, IL-6 level in severe group was significant higher ( Z=-4.022 and -4.108, respectively, both P<0.01) and IL-10 level was also significant higher ( Z=-3.261 and -4.006, respectively, both P<0.01). Similar levels of IL-2, IL-4, TNF-α and IFN-γ were found among three groups (all P>0.05). The IL-6 level was positively correlated with the persistence of viral shedding ( r=0.301, P=0.007). Conclusion:The immune-mediated inflammation may be the important cause of disease deterioration of COVID-19, which might be the key target of the treatment of severe cases.
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Objective To analyze the characteristics of opportunistic infection (OI) in patients with HIV/AIDS in Guangdong and the relationship between OI and the change in blood CD4+ T lymphocyte count (CD4+ ).Methods Seven hundred and sixty two patients with HIV/AIDS admitted were analyzed. Results Among all the 762 patients, 704 (92.39% ) had more than one kind of OI, with 1428 episodes totally.Etiologically, fungus infection (38.38% ) was most common, followed by bacteria (36.20% ), and virus (7.77% ) infection. Most OI occurred in the lungs (33.05% ), mouth (26.89% ), skin (10.29% ) and gastro-intestine (8.96% ).Septicemia and other systemic disseminated diseases accounted for 6.58% and 9.94% respectively.The incidence of OI in patients with CD4+= 200/μ1 (103/136, 75.74%) was significantly lower than that in patients with CD4+ <200/μ1 (601/626, 96.01%), P<0.01.All the AIDS defining OI were found in patients with CD4+ <200/μ1 Among them, 81.97% of patients with pneumonia carinii pneumonia (PCP), 71.43% of patients with cytomegalovirus retinitis and all the patients with cryptococcal meningitis, disseminated cryptococosis, disseminated histoplasmosis, mycobacterium avium intracellular complex (MAC), disseminated penicilliosis mameffei and toxoplasma cerebritis had the CD4+ less than 50/ μ1.Conclusions The most common OI in patients with AIDS in Guangdong area are fungi, bacterial and viral infections.Lung, mouth, skin, gastro-intestine and systemic disseminated infections are the most prevalent infections.As the CD4+ decreased, the incidence of OI especially AIDS defining OI increased. Dynamic detection of CD4+ will be of great help for the prediction, prevention, early diagnosis and treatment of OI in patients with AIDS.
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Objective To analyse the effect of antivirus treatment on the survival time of chronic severe hepatitis B retrospectively.Methods one hundred and twenty-one patients with chronic severe hepatitis B and positive HBV DNA were divided into 3 groups:42 patients in entecavir(ETV)group,34 patients in lamivudine(LVD)group and 45 patients in control group.The primary data were recorded and followed.The survival curve was described using Kaolain-Maier method.The comparison of survival rate among groups was done using Logrank test.Results The baseline characteristics were well balanced among 3 groups.When the follow-up ended,the mean survival time of ETV group,LVD group and control group was(49.4±5.8)weeks,(51.6±6.7)weeks,(32.8±5.7)weeks;the total survival rate was 0.567,0.557,0.318 respectively,there was a statistical difference between ETV group and control grouP(χ2=5.742,P<0.05),or between LVD group and control group (χ2=5.472,P<0.05).There was not statistical difference between ETV group and LVD group in the week of 2,4,8,12,24,48.Conclusion ETV and LVD can improve the survival rate of chronic severe heoatitis B,and ETV iS not different from LVD.
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OBJECTIVE To explore the effect of the measures of protection and control of nosocomial infection in the period of H1N1 Influenza prevalence.METHODS Established emergency plan and concrete working procedure,enhanced training.Strictly disinfection and isolation and personal protection,supervising and checking were carried out.RESULTS No nosocomial infection happened in our hospital in the diagnosis and treatment of H1N1 Influenza.CONCLUSIONS Carried out general measures of protection and management are the key to provent nosocomial infection.
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Objective To evaluate the efficacy and safety of adefovir dipivoxil(ADV)in treating patients with hepatitis B e antigen(HBeAg)positive chronic hepatitis B.Methods In this randomized,double blind,placebo-controlled,multicenter trial,210 eligible patients with HBeAg positive chronic hepatitis B were recruited and randomized(randomization ratio was 2:1)receiving ADV 10 mg/d for 48 weeks(ADV+ADV group,n=142)or placebo for 24 weeks followed by ADV 10 mg/d for 24 weeks(PLB+ADV group,n=68).The primary endpoint was virological response. The secondary endpoint was serologic response(HBeAg loss rate and HBeAg seroconversion rate) and alanine aminotransferase normalization rate.Results After 24 weeks therapy,mean reduction of hepatitis B virus(HBV)DNA level comparing with that of baseline was 3.12 log_(10)copy/mL in ADV +ADV group while it was 0.95 log_(10)copy/mL in PLB+ADV group.The percentages of patients with HBV DNA clearance(HBV DNA level
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Objective To illustrate the relationship between the serum viral load, clinical types and the G1896A in precore, A1762T/G1764A in basal core promoter (BCP) or united mutation of them of HBV from patients with HBeAg-negative hepatitis. Methods Sera from 240 HBeAg-negative, 60 HBeAg-positive patients, and 40 negative controls were collected. Mutations of G1896A and A1762T/G1764A were detected using CD-PCR. Viral load in sera was demonstrated using real-time quantification PCR. Results The mutations of G1896A were detected in 57.6% and 6.7% in HBeAg-negative and HBeAg-positive patients respectively. The mutations of A1762T/G1764A were detected in 37.9% and 31.7% in the same patients respectively. The united mutations were detected in 13.5% of HBeAg-negative patients. G1896A was associated with low viral load, and A1762T/G1764A did not have any special relation viral load in sera from HBeAg-negative patients. The united mutations often occurred in patients with severe chronic hepatitis B, and been not related to the viral load. Conclusions The replication capability of G1896A variant decreased without HBeAg production as usual. For A1762T/G1764A variant, the situation of its replication activity was complicated. Its HBeAg production was less influenced than that of G1896A variant. The united variant might has higher pathogenicity and replication activity, and to which much attention should be paid in the future.