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Resumen Introducción: La inmunoterapia pasiva es una alternativa terapéutica para los pacientes con COVID-19. Métodos: Se tomó la decisión de realizar una base de datos prospectiva de los pacientes con diagnóstico de neumonía por SARS-CoV-2, no hipoxémica, tratados de forma ambulatoria en el Hospital de Bolívar, Dr. Miguel Capredoni, provincia de Buenos Aires, Argentina, con el objetivo de evaluar la eficacia del tratamiento con suero equino hiperinmune en la reducción de casos graves e internaciones. Realizamos un análisis retrospectivo del período comprendido entre el 26/05/2021 al 28/08/2021, se incluyeron 151 pacientes. Las opciones fueron meprednisona y colchicina asociadas a dos infusiones de suero equino (n = 92) o me prednisona y colchicina durante 10 días por vía oral (n = 59). Resultados: No se observaron diferencias en las características poblacionales y comorbilidades entre ambos grupos. El 46% (69) de los pacientes había recibido por lo menos una dosis de vacuna contra COVID-19. Durante el seguimiento el 23% (35) requirió internación, sin diferencias entre el grupo suero equino y el grupo control (p = 0.89). Se observó una tendencia no significa tiva al riesgo de internación prolongada del 15.7%. (Grupo suero equino 38.1% vs. grupo control 53.8%, Fisher Exact test p = 0.41). La mortalidad en el grupo suero equino fue del 3.97% (4), sin observarse diferencias entre ambos grupos. Se observaron diferencias entre los pacientes vacunados y no vacunados, en puntos duros como necesidad de ARM (0% vs. 8% p = 0.001) y muerte (0% vs. 8% p = 0.001). Discusión: Si bien las tasas de internación y muerte fueron menores de lo esperado, la utilización de suero equino hiperinmune en el escenario ambulatorio impresiona no aportar beneficio clínico.
Abstract Introduction: Passive immunotherapy is a therapeutic alternative for patients with COVID-19. Methods: The decision was made to create a prospective database of patients diagnosed with SARS-CoV-2 pneumonia, non-hypoxemic, treated on an outpatient basis at the Hospital de Bolívar, Dr. Miguel Capredoni, province of Buenos Aires, Argentina, with the aim of evaluating the efficacy in reducing severe cases and hospitalizations of treatment with hyperimmune equine serum in this subgroup of patients. We performed a retrospective analysis of the period from 05/26/2021 to 08/28/2021, where a total of 151 patients were included. The options were meprednisone plus colchicine associated with two equine serum infusions (n = 92) or oral meprednisone and colchicine for 10 days (59). Results: No differences were observed between the population characteristics and comorbidities between both groups. A 46% (69) of the patients had received at least one dose of vaccine against COVID-19. During follow-up, 23% (35) required hospitalization, with no differences between the equine serum group and the control group (p = 0.89). A non-significant trend of 15.7% was observed for the risk of prolonged hospitalization. (Equine serum group 38.1% vs. control group 53.8%, Fisher Exact test p = 0.41). Mortality between the equine serum group was 3.97% (4), with no differences between the two groups. Differences were observed between vaccinated and unvaccinated patients in hard points such as the need for MRA (0% vs. 8% p = 0.001) and death (0% vs. 8% p = 0.001). Discussion: Although the rate of hospitalization and death were lower than expected, the use of hyperimmune equine serum in the outpatient setting impresses as not providing clinical benefit.
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ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.
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Lung transplantation has been advanced for nearly half a century around the globe, and it has been developed rapidly for over 20 years in China. The field of lung transplantation in China has been gradually integrated into the international community. The outbreak of novel coronavirus pneumonia (COVID-19) in 2020 brought big challenges, as well as diverted the worldwide attention to the development of lung transplantation in China, accelerating international communication and cooperation. With the steadily deepening of clinical and basic research on lung transplantation for severe cases of COVID-19, organ transplant physicians have deepened the understanding and thinking of the maintenance of donors, selection of elderly and pediatric candidates, and perioperative management of recipients, as the future perspective of lung transplantation in China. For interdisciplinary research related to lung transplantation, it is necessary to carry out multi-center clinical trials with qualified study design and constantly promote the theoretic and practical innovation.
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In December 2019, a number of cases of pneumonia with unknown causes were successively reported in multiple hospitals in Wuhan City, Hubei Province, China. The pathogen is a novel coronavirus, which can lead to novel coronavirus pneumonia (COVID-19) and even threaten the patients' lives. In the following, the COVID-19 epidemic is spreading rapidly in many provinces and cities. It is particularly important to summarize and analyze the clinical characteristics of COVID-19 in solid organ transplantation (SOT) recipients and to optimize the prevention, early diagnosis and treatment strategies. Therefore, we organized Chinese experts in the field of organ transplantation to draft this article according to the characteristics of lung infection of SOT recipients and the characteristics of current COVID-19 by referring to relevant guidelines and specifications at home and abroad, aiming to provide reference for transplant physicians in China. This management strategy will be revised at any time with the deepening understanding of the COVID-19 infection.
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In December 2019, a novel coronavirus pneumonia outbreak in Hubei Province spread rapidly to many provinces and cities. As organ transplantation is in the stage of high-quality development in China, how to carry out organ donation and transplantation in a scientific and orderly manner during the severe epidemic, summarize and analyze the clinical characteristics of COVID-19 on organ transplant recipients, and optimize the prevention, early diagnosis and treatment strategies of COVID-19 to ensure medical safety is essential to the development of organ transplantation and the treatment of the patients with end-stage organ failure as well as the overall situation of the prevention and control of COVID-19 epidemic. Thus, based on the instructions of the National Health Committee, the guidelines are issued by several experts organized by Branch of Organ Transplantation of Chinese Medical Association, providing help to the workers and managers of organ donation and transplantation in China. Approved by the Standing Committee of Branch of Organ Transplantation of Chinese Medical Association, the guidelines adopt the 'expert advice', 'prevention and control strategies' and 'guidance' published in China for reference, and will be revised upon changes of the further understanding of COVID-19 and epidemic control situation.
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The outbreak of the novel coronavirus pneumonia (NCP), an acute infectious respiratory disease in Wuhan, China in December 2019, which was officially named COVID-19 by WHO, has caused enormous burden on society and health services. To ensure safe rehabilitation practice during the epidemic, the Chinese Association of Rehabilitation Medicine formed an expert group to develop a consensus statement for rehabilitation practice. The consensus statement provides guidance on: (1) safeguarding medical staff, patients, caregivers and visitors; and (2) timing and methods of effective rehabilitation interventions for treatment of COVID-19 patients. It also emphasizes that non-COVID-19 patients still require rehabilitation intervention during the epidemic outbreak, bearing in mind the safety of staff and patients and making adaptations according to the individual conditions and the patients′ actual environment. This expert consensus statement applies to departments of rehabilitation medicine and related disciplines in general hospitals as well as to specialized rehabilitation facilities, and it provides valuable reference for rehabilitation professionals working with infectious respiratory diseases in the future.
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Objective To summarize the experience of organ donation after citizen' s death during the novel coronavirus pneumonia (COVID-19) epidemic. Methods Eleven cases of potential donors of organ donation after citizen' s death during the COVID-19 epidemic were retrospectively analyzed, and the workflow and key points of infectionprevention and control were summarized. Results Among 11 cases of potential donors, 6 cases failed to implement organ donation. Five donors who were successfully performed organ donation had no respiratory symptoms before the onset of encephalopathy. CT scan of the lungs upon the onset of encephalopathy showed that one case was diagnosed with aspiration pneumonia, and the remaining four cases obtained negative results. During hospitalization, all of the 5 donors showed fever symptom and repeated chest CT scan detected lung inflammation. Bronchoalveolar lavage fluid or blood samples tested for novel coronavirus nucleic acids were all negative. No confirmed or suspected cases appeared among all staff and recipients who were in close contact with organ donors. Conclusions Targeted formulation of the workflow and prevention and control measures, in combination with selection and implementation of infection risk classification can effectivelyreduce the risk of COVID-19 infection and carry out organ donation after citizen' s death in a safe and organized manner.
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Novel coronavirus pneumonia (COVID-19) is currently raging worldwide, and the prevention and control situation is very grim. Gratifying achievements of organ donation have been made in China since its implementation. Due to the characteristics of potential donors, such as complicated personnel structure, sudden onset and critical illness, it is necessary for multi-department to contact with the donors and their families during the work link of donor evaluation, family communication, donor transportation, organ function maintenance and organ procurement, which raises higher requirement for the screening and management of potential donors under COVID-19 epidemic. During the outbreak, Beijing Youan Hospital, Capital Medical University has completed 9 cases of organ donation, formulated the relevant screening process, established the prevention and control requirements, and gained certain experience and effects, which benefits the orderly and smooth development of organ donation under the COVID-19 epidemic.
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This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.
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@#Objective To investigate CT image features of ground glass opacity (GGO)-like 2019 novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) and early-stage lung carcinoma for control and therapy of this acute severe respiratory disease. Methods We retrospectively analyzed the clinical data of 71 GGO-like COVID-19 patients who received therapy in Tongji Hospital of Huazhong University of Science and Technology between January 17th and February 13th, 2020. These 71 GGO-like COVID-19 patients were as a COVID-19 group. And 80 GGO-like early-stage lung carcinoma patients who underwent resection were as a lung carcinoma group. Clinical features such as sex, age, symptoms including fever, cough, fatigue, myalgia and dyspnea, detailed exposure history, confirmatory test (SARS-CoV-2 quantitative RT-PCR) and pathologic diagnosis were analyzed. Results Significantly different symptoms and exposure history between the two groups were detected (P<0.001). More lesions (61 patients at percentage of 85.92%, P<0.001), relative peripheral locations (69 patients at percentage of 97.18%, P<0.001) and larger opacities (65 patients at percentage of 91.55%, P<0.001) were found in chest radiographs of GGO-like COVID-19 compared with GGO-like early-stage lung carcinoma. Similar features appeared in early-stage of COVID-19 and lung carcinoma, while pneumonia developed into more extensive and basal predominant lung consolidation. Coexistence of GGO-like COVID-19 and early-stage lung carcinoma might occur. Conclusion Considering these similar and unique features of GGO-like COVID-19 and early-stage lung carcinoma, it is necessary to understand short time re-examination of chest radiographs and other diagnostic methods of these two diseases. We believe that the findings reported here are important for diagnosis and control of COVID-19 in China.
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Objective:To observe the therapeutic effect of Kesuting syrups and Keqing capsules, which have the function of promoting lung and resolving phlegm, on a mouse model combining disease and syndrome of human coronavirus pneumonia with cold-dampness pestilence attacking lung. Method:The therapeutic effects of Kesuting syrups (the doses of 22, 11 mL·kg-1) and Keqing capsules (the doses of 1.155, 0.577 5 g·kg-1) on this model were evaluated by the inflammatory changes of lung tissue, the expression of viral nucleic acid, the contents of inflammatory factors [interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α and interferon-γ (IFN-γ)], and the percentages of immune cells in peripheral blood (CD4+ T cells, CD8+ T cells and B cells). Result:Compared with the model group, high- and low-dose groups of Keqing capsules and Kesuting syrups could significantly reduce the inflammatory damage in the lung tissues of mice, Keqing capsules could significantly increase the percentages of CD4+ T cells, CD8+ T cells and B cells in peripheral blood, Keqing capsules and Kesuting syrups could reduce the expression levels of IL-6, IL-10, TNF-α and IFN-γ, inhibit the viral load in lung tissue, as well as improve the pathogenic manifestations of lung tissue. Conclusion:As the first-line drugs for novel coronavirus pneumonia, Keqing capsules and Kesuting syrups have significant therapeutic effect on the mouse model combining disease and syndrome of human coronavirus pneumonia with cold-dampness pestilence attacking lung, and the mechanism may be related to regulating immune function and reducing cytokine storm.
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Objective:To study the clinical medication regulation for the prevention and treatment of new coronavirus pneumonia with traditional Chinese medicine（TCM），especially prescriptions，on the basis of "treatment in accordance with seasonal conditions". Method:The guidelines and suggestions on novel coronavirus pneumonia formulated and published by national，provincial and municipal governments and experts before February 17，2020, were retrieved and summarized. Data was recorded in stages according to "prevention period，clinical observation period，pre-clinical period，middle clinical period，late clinical period and recovery period". The frequency analysis of TCM and its efficacy，prescription and proprietary Chinese medicine was carried out，and then the factor analysis and cluster analysis of TCM were carried out to obtain rational drug combinations. Result:Totally 172 suggestions on combined structure of drugs，50 suggestions on prescriptions and 31 suggestions on proprietary Chinese medicine were involved in the study，and provided by 24 official agencies and 24 medical experts， 147 kinds of herbs，44 prescriptions and 16 proprietary Chinese medicines were collected. No matter for the drug category or for the specific drug selection，the law of drug use in different stages was not the same. Huoxiang Zhengqi capsule，Shufeng Jiedu capsule，Lianhua Qingwen capsule and Jinhua Qinggan capsule can be used in the observation period. Xuanbai Chengqitang can be used in the middle of the disease. Angong Niuhuangwan，Suhexiangwan or Zixuedan, and Angong Niuhuangwan can be selected in the middle of the disease. And Qingfei Paidu decoction can be used in all stages of the disease. Conclusion:Doctors need to adjust their prescriptions along with the progress of the disease，because the law of medication in each stage of the new coronavirus pneumonia is different.
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The outbreak of new coronavirus pneumonia (COVID-19) in Wuhan and surrounding areas has brought huge challenges to China. As a new infectious disease, there are questions and confusion about its epidemiological characteristics and clinical treatment. Therefore, it is urgent to figure out how to achieve effective prevention, higher success rate of treatment and scientific management.