Duration of SARS-CoV-2 RNA shedding and factors associated with prolonged viral shedding in patients with COVID-19.

To investigate the factors associated with the duration of severe acute respiratory syndrome coronavirus 2 RNA shedding in patients with coronavirus disease 2019 (COVID-19). A retrospective cohort of COVID-19 patients admitted to a designated hospital in Beijing was analyzed to study the factors affecting the duration of viral shedding. The median duration of viral shedding was 11 days (IQR, 8-14.3 days) as measured from illness onset. Univariate regression analysis showed that disease severity, corticosteroid therapy, fever (temperature>38.5°C), and time from onset to hospitalization were associated with prolonged duration of viral shedding (P < .05). Multivariate regression analysis showed that fever (temperature>38.5°C) (OR, 5.1, 95%CI: 1.5-18.1), corticosteroid therapy (OR, 6.3, 95%CI: 1.5-27.8), and time from onset to hospitalization (OR, 1.8, 95%CI: 1.19-2.7) were associated with increased odds of prolonged duration of viral shedding. Corticosteroid treatment, fever (temperature>38.5°C), and longer time from onset to hospitalization were associated with prolonged viral shedding in COVID-19 patients.

A new factor influencing pathogen detection by molecular assay in children with both mild and severe hand, foot, and mouth disease.

This study aimed to find novel information concerning pathogen detection and some probable coinfection factors in hand, foot, and mouth disease (HFMD). In this study, 1104 clinically diagnosed HFMD patients were included. Enterovirus 71 (EV71), coxsackievirus A16 (CA16), and 14 different respiratory pathogens were examined from nasopharyngeal swabs using polymerase chain reaction (PCR) or reverse transcriptase PCR (RT-PCR). To evaluate the immune activation in HFMD patients, 8 cytokines and IgM antibodies to EV71 and CA16 from mild and severe patients were detected. Our results indicated that the severity of HFMD may affect the pathogen detection. The lower positive rates of enterovirus and respiratory viruses in severe HFMD cases by RT-PCR were probably related to stronger immune response. Therefore, immunological tests such as ELISA are essential supplements to PCR or RT-PCR in order to increase pathogen diagnosis in HFMD, especially in severe cases.

Natural herbal medicine Lianhuaqingwen capsule anti-influenza A (H1N1) trial: a randomized, double blind, positive controlled clinical trial.

BACKGROUND: The 2009 influenza A (H1N1) virus infection is associated with the high risk of severe complications and is spreading more rapidly throughout the world than other reported seasonal influenzas. This study aimed to evaluate the efficacy and safety of the nature herbal medicine Lianhuaqingwen capsule (LHC) in patients infected with influenza A (H1N1) virus. METHODS: A total of 244 patients aged 16 - 65 years confirmed with influenza A (H1N1) virus infection by the real time RT-PCR were randomized to one of two treatment groups of 122 patients each. Each group assigned to receive either LHC or Oseltamivir for five days and observation for seven days. The patients were enrolled within 36 hours of illness onset if they had an axillary temperature of ≥ 37.4°C and with at least one of the following symptoms: nasal obstruction, runny nose, cough, sore throat, fatigue, headache, myalgia, chills and sweating. The primary end point was the duration of illness. RESULTS: Of 244 patients, 240 (98.36%) patients with a median age 21 years completed the study between October 24, 2009 and November 23, 2009. There were no significant overall differences between LHC treated and Oseltamivir treated patients in the median duration of illness (LHC 69 hours vs. Oseltamivir 85 hours P > 0.05) or the median duration of viral shedding (LHC 103 hours vs. Oseltamivir 96 hours, P > 0.05). However, it was worthwhile to note that LHC significantly reduced the severity of illness and the duration of symptoms including fever, cough, sore throat, and fatigue (P < 0.05). Both study medications were well tolerated. No drug related serious adverse events occurred during the study. CONCLUSIONS: Compared with Oseltamivir, LHC achieved a similar therapeutic effectiveness reduction of the duration of illness and duration of viral shedding. Therefore, LHC might be an alternative therapeutic measure for influenza A (H1N1) virus infections.

[The analysis of clinical character in different age patients suffered from A-H1N1].

OBJECTIVE: To describe the feature of different age patients with A-H1N1. METHODS: Cross-sectional study was performed in 95 patients who were confirmed to be infected with A-H1N1 from May, 2009 to July, 2009, in according to their age. RESULTS: The average age of patients with A-H1N1 infection was 23.44 +/- 14.73. Accumulative prevalence in children and young adult reached 74.7% of total patients. There was a trend that the subclinical infection rate raised gradually from 0-15 years group to over 45 years group. The percent of lymphocyte in 0-15 years group was significantly higher than other age groups, P = 0.039. The average time of virus shedding were 6.5 +/- 2.10 days (from 2 days to 12 days) , and there were no significant difference in diverse age groups, P = 0.272. 13 out of 95 (13.7%) patients presented complications related with A-H1N1 infection, and 4 of 6 patients complicated with pneumonia were in the 0-15 years group. CONCLUSION: The distribution of age in A-H1N1 infection is markedly different from seasonal influenza, with more cases in school children and young adults and fewer cases in older adults. Flu-like symptoms in children were apparent and pneumonia was the major complication in children.

[A clinical analysis of 137 cases of influenza A(H1N1)].

OBJECTIVE: To analyze the epidemiology and clinical characteristics of influenza A (H1N1). METHODS: A retrospective analysis was performed on the clinical data of 137 cases of influenza A (H1N1) admitted into our hospital during May to August 2009. RESULTS: In the early stage, most cases were imported from the US, Australia, Canada and the UK. While in the later stage, most of them were secondary. The patients were mainly children and youngsters. And the most common clinical manifestations were fever (n = 108), cough (n = 93) and sore throat (n = 67) while the most common signs congestive throat (n = 99) and swelling tonsil (n = 46). The average fever period was 3.3 ± 1.5 days. The clinical symptoms vanished in 4.4 ± 1.9 days. And the average length of stay was 5.5 ± 2.1 days. Laboratory tests: the count of leukocytes declined while that of lymphocytes increased in 39 cases (39.5%). The test of influenza A (H1N1) nucleic acid was positive. The chest radiograph showed intensive pulmonary markings or patchy pneumonia-like signs. TREATMENTS: the groups of patients using Chinese herbs, western medicine plus Chinese herbs, symptomatic relief and placebo showed no significant difference in fever period, recovery time and the negative-converting period of influenza A (H1N1) nucleic acid tests became negative. CONCLUSION: Influenza A (H1N1) may be recessive or dominant. Despite a strong infectivity, the clinical symptoms are mild and the clinical course is self-limited, similar to the seasonal influenza.

[E2F1 upregulates endogenous XRCC1 expression].

OBJECTIVE: To investigate the regulatory effect and significance of transcription factor E2F1 on X-ray repair cross2 complementing 1 (XRCC1). METHODS: Saos2 cells were transfected with the E2F1 expression vectors (tet-E2F1) and mutated E2F1 expression vectors (tet-132E). XRCC1 promotor luciferase reporter vector was constructed and transfected into Saos2 cells together with E2F1, E2F2, E2F3 and E2F4 expression vectors at different amount. The cells were collected 36 hours post-transfection for luciferase assays and absorbance was read at 570 nm. RESULTS: Cotransfection of increasing amounts of E2F1 expression vector with the XRCC1 promoter-luciferase reporter caused a dose-dependent increase in luciferase activation. In contrast, DNA binding incompetent E2F1 (132E) could not activate the XRCC1 promoter-luciferase reporter. CONCLUSION: E2F1 could upregulate endogenous XRCC1 expression and stimulate the XRCC1 promoter.

[Expression of K18, Ser-33 and Ser-52 phosphorylated K18 in HBV infected human liver disease and its significance].

OBJECTIVE: To investigate the expression of K18, Ser-33 and Ser-52 phosphorylated K18 in HBV infected human liver disease and its significance. METHODS: The expression and localization of K18 and Ser-33, Ser-52 phosphorylated K18 in healthy liver tissue, in liver tissues of patients with post-HBV infection cirrhosis and severe chronic hepatitis were detected by histochemistry. RESULTS: K18, Ser-33 and Ser-52 phosphorylated K18 were expressed in normal liver cells, in liver tissues of cirrhosis patients and severe chronic hepatitis cases. The expression of K18 in the liver cells from the 3 different sources had no significant difference in levels. Ser-33 and Ser-52 phosphorylated K18 were expressed in normal liver cells, in liver tissues of cirrhosis patients chronicity HBV hepatitis and severe chronic hepatitis cases. Ser-33 and Ser-52 located around cytoplasmic membrane, diffused into cytoplasm and expressed at a higher levels in cirrhosis and severe chronic hepatitis. CONCLUSION: The expression levels of Ser-33 and Ser-52 phosphorylated K18 increased along with the progression of HBV infected human liver disease. The phosphorylation of K18 could be a marker of progression of HBV infected human liver disease.

[Changes and significance of peripheral blood fibrinogen level in patients with severe acute respiratory syndrome].

OBJECTIVE: To investigate variations and significance of plasma fibrinogen in patients with severe acute respiratory syndrome (SARS). METHODS: Totally 148 patients with SARS were divided into the following groups: initial stage group (44 cases) and after the initial stage group (104 cases), common type group (87 cases) and severe type group (61 cases), unilobar lung involvement group (49 cases), bilobar lung involvement group (53 cases) and diffuse lung involvement group (46 cases). The values of plasma fibrinogen of the 148 SARS patients were analyzed and compared among the different groups. RESULTS: The mean value of plasma fibrinogen (x +/- SD, 522.29 +/- 154.87 mg/dl) of the 148 cases was higher than the normal value (p less than 0.01). There were significant differences between the initial stage and after initial stage groups, between the common and severe type groups, and among the unilobar, bilobar and diffuse lung involvement groups (p less than 0.05). CONCLUSION: theses results suggested that elevation of peripheral blood fibrinogen in SARS patients may play an important role in development and progress of the disease and its treatment.

[The characteristics of opportunistic infections in 181 HIV/AIDS patients in China].

OBJECTIVE: To investigate the spectra of opportunistic infections (OIs) in HIV/AIDS patients in China and evaluate the relation between OIs and CD(4)(+), CD(8)(+) T cell counts so as to suggest when the prophylaxis for OIs should begin. METHODS: The clinical and immunological characteristics of 181 patients with HIV/AIDS admitted into the Department of Infectious Disease, Beijing Youan Hospital from 2002 to 2005 were retrospectively analyzed. RESULTS: One hundred and four of the 181 HIV-positive patients experienced at least one HIV-related opportunistic infection. The most common opportunistic infections were as follows: oral candidal pharyngitis (52.9%), Pneumocystis carinii pneumonia (PCP) (31.7%), tuberculosis (21.2%), systemic mycosis (15.4%), viral herpes (12.5%) and other respiratory infections (6.7%), etc. The medians of CD(4)(+), CD(8)(+) T cell counts and CD(4)/CD(8) ratios in the patients with OIs were lower as compared with those in the patients without OIs. The patients who experienced OIs had similar CD(4)(+) T cell count with no statistical difference, no matter there was one or more than one OIs. The CD(+)(4) T cell counts lowered in accordance with increase of the number of OIs. The similar results were found in the CD(4)/CD(8) ratios. There was significant difference between CD(4)/CD(8) in patients with tuberculosis and those with PCP. CONCLUSIONS: HIV-related OIs are easily encountered in digestive and respiratory systems of HIV/AIDS patients and it is shown that a close correlation exists between CD(4)(+) T cell count, CD(4)/CD(8) ratio and opportunistic infections. Patients with CD(4)(+) T cell count below 200 cells/microl, CD(4)/CD(8) less than 0.20 especially are at higher risk of developing opportunistic infections and they generally have diverse OIs. Our findings are helpful to predict the initiation both primary and secondary prophylaxis for OIs in HIV/AIDS patients in China.

[Use of glucocorticoid in treatment of severe acute respiratory syndrome cases].

OBJECTIVE: To explore the effect of glucocorticoid in the treatment for severe acute respiratory syndrome (SARS). METHODS: Clinical data of 70 patients with SARS admitted to Youan Hospital in Beijing during March to May, 2003 were analyzed. RESULTS: (1) Sixty-three of 70 cases of SARS recovered and seven cases died, with a case-fatality ratio of 10%. (2) Average length of hospital stay was 16.9 days for the all 70 cases, and 16.8 days for the 11 cases without glucocorticoid treatment, without statistical significance (F = 1.018, P = 0.39). (3) The other 59 cases were administered with 40 mg to 640 mg of methylprednisolone daily. (4) Average hospital stay was 15 days for the 23 cases with lower dose of 40 mg to 80 mg methylprednisolone daily, 18.5 days for the 27 cases with medium dose of 120 mg to 240 mg daily, and 17.9 days for the nine cases with higher dose of 320 mg to 640 mg daily (F = 1.018, P = 0.39). CONCLUSIONS: Earlier use of glucocorticoid therapy with suitable doses could alleviate their clinical symptoms, improve their clinical courses, and promote the absorbance of infiltration in their lungs on chest-X-ray films for the cases with SARS. However, current clinical data showed that glucocorticoid therapy could not shorten the length of hospitalization for the cases with SARS.

[Clinical features of severe acute respiratory syndrome in forty-one confirmed health care workers].

OBJECTIVE: To investigate the clinical features of severe acute respiratory syndrome (SARS). METHODS: Forty-one medical care workers (aged 23 - 55 years, with a average of 32 years; men/women = 8/32) who were admitted to our hospital and diagnosed with SARS during March and April, 2003 were retrospectively analyzed. RESULTS: Thirteen of all the patients were physicians and the rest were nurses. The disease was mainly transmitted through air droplet in a short distance, and overwork induced tiredness was involved in disease stimulation. Seventy-three percent of the patients presented fever as their first symptom. Ten patients complained inertia and myalgia. One patient showed no clinical symptoms, and bilateral infiltrates was found in his chest X-ray. Among the 41 cases, 6 (15%) were diagnosed as severe type. At the first week, the counts of white blood cells (WBCs), lymphocyte and platelets were (4.4 +/- 1.5) x 10(9)/L, 0.22 +/- 0.12 and (143 +/- 37) x 10(9)/L, which were significantly lower when compared with those at the 2nd to 4th week. Abnormal liver function was found in 27 cases (mostly with elevated serum ALT), with 70% occurred at the 3rd or 4th week. In terms of CT, 30 patients (73%) showed pathological changes in lungs, and bilateral lung involvement was found in 35.59%. Of 36 cases treated with steroids, 86% received middle or low dosage (80 - 240 mg/d). Artificial ventilation was used for twenty-seven patients, and air pipe mechanical ventilation was used for 1 case. Mortality in this study was 5%. CONCLUSIONS: Inertia and myalgia may be the earlier symptoms of health care workers with SARS include, which are parallel to CT manifestations. There is no objective index for the assessment of the severity of the disease at early stage. The medicine associated toxicities may be the main reason of liver lesions. damages. Middle or low dosage of steroid was reasonable to be used as early as possible.