Early kidney injury during long-term adefovir dipivoxil therapy for chronic hepatitis B

AIM: To evaluate urine β2-microglobulin(β2-M), retinol-binding protein(RBP) excretion, and renal impairment with adefovir dipivoxil(ADV) for chronic hepatitis B. METHODS: We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy(n = 90) or ADV plus lamivudine combination therapy(n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate(e GFR) at the initiation of antiviral therapy and every 6 mo for a period of five years. RESULTS: Urine β2-M abnormalities were observed in patients during the first(n = 3), second(n = 7), third(n = 11), fourth(n = 16), and fifth(n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first(n = 2), second(n = 8), third(n = 12), fourth(n = 15), and fifth(n = 22) year of ADV treatment. e GFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in e GFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and e GFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment. CONCLUSION: Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.

Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS-CoV-2 Omicron strain infection in China:A national multicenter survey of 35,566 individuals

Objective:This cross-sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID-19 in China.Methods:This study was conducted by 45 tertiary Grade-A hospitals in China.Online and offline questionnaire data were obtained from patients infected with COVID-19 between December 28,2022,and February 21,2023.The collected information included basic demographics,medical history,smoking and drinking history,vaccination history,changes in olfactory and gustatory functions before and after infection,and other postinfection symptoms,as well as the duration and improvement status of olfactory and gustatory disorders.Results:Complete questionnaires were obtained from 35,566 subjects.The overall incidence of olfactory and taste dysfunction was 67.75%.Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction.Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction.Before infection,the average olfactory and taste VAS scores were 8.41 and 8.51,respectively;after infection,they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey.The median duration of dysosmia and dysgeusia was 15 and 12 days,respectively,with 0.5%of patients having symptoms lasting for more than 28 days.The overall self-reported improvement rate was 59.16%.Recovery was higher in males,never smokers,those who received two or three vaccine doses,and those that had never experienced dental health issues,or chronic accompanying symptoms.Conclusions:The incidence of dysosmia and dysgeusia following infection with the SARS-CoV-2 virus is high in China.Incidence and prognosis are influenced by several factors,including sex,SARS-CoV-2 vaccination,history of head-facial trauma,nasal and oral health status,smoking and drinking history,and the persistence of accompanying symptoms.

干扰素-α2b喷雾吸入未缩短住院患者的SARS-CoV-2的脱落时间:一项初步的配对病例对照研究

目的:分析干扰素-α2b(IFN-α2b)喷雾吸入治疗对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)在呼吸道病毒脱落时间的影响。创新点:IFN在2019冠状病毒病(COVID-19)中的治疗价值尚未得到验证。方法:我们进行了一项回顾性研究,纳入2020年1月19日至2月19日在中国杭州浙江大学医学院附属第一医院住院的104例确诊的COVID-19患者。根据入院时是否接受了初始IFN-α2b喷雾吸入治疗,将患者分为IFN组和对照组。采用倾向性得分匹配方法平衡混杂因素后,比较两组间住院时间和病毒脱落时间的差异。结论:IFN-α2b喷雾吸入不能缩短COVID-19住院患者的住院时间和SARS-CoV-2的病毒脱毒时间。

浙江省有无武汉暴露史新型冠状肺炎患者的流行病学和临床特征的比较研究

目的:调查浙江省有武汉暴露史和无武汉暴露史的新型冠状肺炎患者的流行病学和临床特征。创新点:探索新型冠状病毒从武汉市向浙江省传播过程中是否会发生流行病学和临床特征的变化。方法:我们进行了一项回顾性研究。收集了2020年1月17日至2月7日浙江省确诊的新型冠状肺炎患者的流行病学和临床资料,并比较分析了有武汉暴露史和无武汉暴露史患者的流行病学和临床特征。结论:从流行病学和临床特征的角度来看,有武汉暴露史和无武汉暴露史的新型冠状肺炎患者之间没有显著差异。

Clinical characteristics of different subtypes and risk factors for the severity of illness in patients with COVID-19 in Zhejiang, China

Background The outbreak of coronavirus disease 2019(COVID-19)is now becoming an enormous threat to public health.The clinical spectrum of COVID-19 is extensive,of which critical cases are with rapid disease progression and high mortality.The aim of our study is to summarize the characteristics of different subtypes and explore risk factors of illness severity for early identification and prompt treatment.Methods In this retrospective study,we collected data of patients confirmed COVID-19 in Zhejiang Province from 17 January to 12 February 2020.According to the definition of clinical classification,we divided confirmed cases into four types,and summarize epidemiological and clinical characteristics,laboratory and radiograph findings,treatments,and outcomes,respectively.Moreover,we used univariate and multivariate ordinal logistic regression models to explore risk factors for the severity of illness in patients with COVID-19.Results A total of 788 patients were enrolled in our study,of whom 52 cases(6.6%)were mild type,658 cases(83.5%)were common type,61 cases(7.2%)were severe type,and 17 cases(2.2%)were critical type.Multivariate ordinal logistic regression demonstrated increasing odds of the severity of illness in patients with COVID-19 associated with male(odds ratio[OR]=1.7,95%confidence interval[CI]:1.2–2.6 P=0.008),fever(OR=3.6,95%CI:2.1–6.3,P<0.001),cough(OR=1.7,95%CI:1.0–2.9,P=0.041),hemoptysis(OR=3.4,95%CI:1.1–10.3,P=0.032),gastrointestinal symptoms(OR=1.9,95%CI:1.0–3.5,P=0.047),hypertension(OR=2.6,95%CI:1.2–5.6,P=0.013).With the increase of age-grading,risk for the severity of illness was gradually higher(≤18 years[OR=1.0],19–40 years[OR=12.7,95%CI:4.5–36.0,P<0.001],41–65 years[OR=14.8,95%CI:5.2–42.1,P<0.001],≥66 years[OR=56.5,95%CI:17.1–186.5,P<0.001]).Conclusions Clinicians should pay close attention to these features in patients with COVID-19 including older age,male,fever,cough,hemoptysis,gastrointestinal symptoms and hypertension to identify the severity of illness as early as possible.