Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019:protocol of a randomized controlled trial

Background:At the end of 2019,a novel coronavirus outbreak causative organism has been subsequently designated the 2019 novel coronavirus(2019-nCoV).The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear,and warrants further investigation.Methods:The present study will be conducted as an open-labeled,randomized,controlled trial.We will enrol 48 subjects from Chongqing Public Health Medical Center.Each eligible subject will be assigned to an intervention group(methylprednisolone via intravenous injection at a dose of 1-2 mg/kg/day for 3 days)or a control group(no glucocorticoid use)randomly,at a 1:1 ratio.Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points.We will use the clinical improvement rate as our primary endpoint.Secondary endpoints include the timing of clinical improvement after intervention,duration of mechanical ventilation,duration of hospitalization,overall incidence of adverse events,as well as rate of adverse events at each visit,and mortality at 2 and 4 weeks.Discussion:The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades.Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past.However,there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease,or indeed in other types of severe respiratory disease.In this study,we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019.

Changes of human immunodeficiency virus (HIV) burden globally and in China over three decades: a secondary analysis of global HIV statistics

Background: A more comprehensive understanding of the trends of incidence, prevalence, and mortality in human immunodeficiency virus (HIV), and their complex interrelationships, may provide important evidence for decision-making related to HIV prevention and control. The variances in these indices between different population groups, genders, and ages are critical to decipher evolving patterns of the HIV epidemic in specific populations.Methods: A secondary analysis of relevant data was conducted using data extracted from the Global Burden of Disease study of 2019. HIV/acquired immune deficiency syndrome (AIDS) incidence, prevalence, AIDS-related mortality, and mortality-to-prevalence ratio (MPR) for annual percentage change, average annual percentage change (AAPC), and corresponding 95% confidence intervals (CIs) were calculated using joinpoint regression statistical analysis.Results: The AAPC of HIV/AIDS incidence, prevalence, AIDS-related mortality rate, and MPR were -1.4 (95% CI: -1.6, -1.2), 4.1 (95% CI: 4.0, 4.3), 2.0 (95% CI: 1.7, 2.3), and -2.1 (95% CI: -2.3, -1.8) between 1990 and 2019 globally, and were 3.5 (95% CI: 2.2, 4.8), 6.9 (95% CI: 6.8, 7.0), 8.1 (95% CI: 7.1, 9.1), and 1.2 (95% CI: 0.1, 2.3) in China during the same period. In terms of differences in the preceding indicators by gender, we observed a similar pattern of trends for male and female genders both globally and in China during the entire study period. Each specific age group exhibits a distinct pattern in terms of incidence, prevalence, mortality rate, and MPR both globally and in China.Conclusions: Prevalence and mortality rates of HIV/AIDS have increased between 1990 and 2019 globally and in China. While the incidence rate and MPR have declined globally over the past three decades, these two indicators are observed to present an increasing trend in China. There is a high HIV burden among young and middle-aged adults globally;however, the elderly have a high HIV burden in China. HIV screening at older age should be scaled up, and patients with advanced HIV disease should be provided early with additional care and health resources.

Asymptomatic cryptococcal antigenemia in HIV-infected patients:a review of recent studies

The prevalence of asymptomatic cryptococcal antigenemia(ACA)in human immunodeficiency virus(HIV)infected individuals has been observed to be elevated.The prevalence of ACA ranges from 1.3%to 13%,with different rates of prevalence in various regions of the world.We reviewed studies conducted internationally,and also referred to two established expert consensus guideline documents published in China,and we have concluded that Chinese HIV-infected patients should undergo cryptococcal antigen screening when CD4+T-cell counts fall below 200 cells/μL and that the recommended treatment regimen for these patients follow current World Health Organization guidelines,although it is likely that this recommendation may change in the future.Early screening and optimized preemptive treatment for ACA is likely to help decrease the incidence of cryptococcosis,and is lifesaving.Further studies are warranted to explore issues related to the optimal management of ACA.

Six weeks into the 2019 coronavirus disease outbreak:it is time to consider strategies to impede the emergence of new zoonotic infections

Coronaviruses have in the past been known to be the etiologic agents of mild upper respiratory infections in humans,similar to the ubiquitous and relatively benign"common cold"-type upper respiratory illnesses induced by the human rhinoviruses in adults and children.Subsequent to the severe acute respiratory syndrome(SARS)outbreak in China 2003,and the Middle East respiratory syndrome(MERS)outbreak in the Middle East in 2012,global concerns regarding the pathogenicity and epidemic/pandemic potential of novel human coronaviruses began to emerge,with some experts predicting that novel coronaviruses could likely again cross the species barrier and present humans with future pandemic-potential infections.[1]These concerns have proven prescient with the emergence,late in 2019,of the 2019 coronavirus disease(COVID-19)or novel coronavirus pneumonia.

Comparative effectiveness and safety of ribavirin plus interferon-alpha,lopinavir/ritonavir plus interferon-alpha,and ribavirin plus lopinavir/ritonavir plus interferon-alpha in patients with mild to moderate novel coronavirus disease 2019:study protocol

To the Editor:At the end of 2019,an outbreak of novel coronavirus disease 2019(COVID-19),caused by 2019-nCov,causing widespread novel coronavirus disease.This outbreak of COVID-19 occurred during the period of the 2020 Spring Festival in China,a period known for massive population movements within China.This has resulted in large numbers of infected patients as a consequence of multiple human contact episodes in individual travelers.