Symptomatic and optimal supportive care of critical COVID-19:A case report and literature review

BACKGROUND Coronavirus disease 2019(COVID-19)severity is classified as asymptomatic,mild,moderate,severe,and critical.Mild cases account for a large percentage of cases in the epidemic and typically exhibit a favorable prognosis.However,a 49%-67%mortality is noted in critical cases.No COVID-19-specific drug has been reported to date,and symptomatic and optimal supportive care,including oxygenation,anti-coinfection treatments,and ventilation,represent the mainstay of treatment for this disease,especially in critical patients.CASE SUMMARY In the above-mentioned context,we share our experience with the treatment of one critical COVID-19 case and review the relevant literature.CONCLUSION Timely tracheal intubation,reasonable mechanical ventilation support,appropriate anti-infection treatment,and early anticoagulation and immunity support are key factors in the successful treatment of this case.

Factors Affecting Treatment Interruption among TB Patients in Lagos Nigeria: Is There Any Need for Treatment Supporters?

Background: This study assessed treatment interruption of tuberculosis (TB) patients managed by treatment supporters and health care workers and other predictors of treatment interruption. Methods: A descriptive cross-sectional study was conducted. Four hundred and seventy new smear positive TB patients above 14 years of age were consecutively recruited between October 1 and December 31 2012 from 34 (23 public and 11 private) directly observed treatment short course (DOTS) facilities that offered TB treatment and microscopy services. They were followed up till treatment was completed. Logistic regression was used to assess the predictors of treatment interruption. Results: A significantly higher proportion of smokers (58.6% vs 38.3%, p = 0.030), patients supervised by treatment supporters (44.4% vs 34.7%, p = 0.032), patients not counselled before initiation of treatment (55.6% vs 38.2%, p = 0.041), patients managed at private DOTS facilities (50% vs 36.3%, p = 0.010) and TB/HIV co-infected patients (54.2% vs 38.6%, p = 0.038) had treatment interruption. Predictors of treatment interruption were supervision by treatment supporters, smoking, lack of pre-treatment counselling and TB/HIV co-infection. Conclusion: A higher proportion of patients supervised by treatment supporters had treatment interruption than those supervised by health care workers. There may be a need to review the concept of treatment supervision by treatment supporters in Lagos state Nigeria.

Clinical features of elderly patients with COVID-19 in Wuhan,China

BACKGROUND Elderly patients with coronavirus disease 2019(COVID-19)who have comorbidities,frailty or profound disabilities experience poor outcomes.We analyzed the clinical characteristics of elderly patients from Wuhan who had COVID-19 during the early stages of the pandemic.AIM To identify factors affecting the early mortality of elderly patients with COVID-19.METHODS The records of 234 patients who were 65-years-old or more and were hospitalized in Wuhan Huoshenshan Hospital from February 4 to March 4,2020 were reviewed.All patients had confirmed COVID-19 and the final date of follow-up was April 4,2020.RESULTS There were 163 cases of mild disease(69.66%),39 cases of severe disease(16.67%)and 32 cases of critical disease(13.68%).Twenty-nine patients died within 1 mo(12.40%),all of whom had critical disease.Surviving patients and deceased patients had no significant differences in age or chronic diseases.Overall,the most common symptoms were fever(65.4%),dry cough(57.3%),fatigue(47.4%)and shortness of breath(41%).The deceased patients had higher levels of multiple disease markers(C-reactive protein,D-dimer,lactate dehydrogenase,alanine amino transferase,aspartate aminotransferase,creatinine kinase and creatinine kinase-MB)and higher incidences of lymphocytopenia and hypoproteinemia.CONCLUSION This single-center study of elderly patients from Wuhan,China who were hospitalized with COVID-19 indicated that age and chronic diseases were not associated with mortality.Hypertension,diabetes and cardiovascular disease were the most common comorbidities and the most common symptoms were fever,dry cough,fatigue and shortness of breath.Lymphocytopenia,increased levels of D-dimer and other markers indicative of damage to the heart,kidneys or liver were associated with an increased risk of death.

Changes of High Mobility Group box 1 in Serum of Pig Acute Hepatic Failure Model and Significance

The role of the high mobility group box 1 （HMGB-1） in acute hepatic failure and the effect of artificial liver support system treatment on HMGB-1 level were investigated. Pig models of acute hepatic failure were induced by D-galactosamine and randomly divided into two groups with or without artificial liver support system treatment. Tumor necrosis factor-α （TNF-α） and interleukin-1β （IL-1β） levels were detected by the enzyme linked immunosorbent assay （ELISA）, the expression of HMGB-1 by Western blot, and serum levels of HMGB-1, liver function and hepatic pathology were observed after artificial liver support system treatment. The levels of TNF-α and IL-1β were increased and reached the peak at 24th h in the acute hepatic failure group, then quickly decreased. The serum level of HMGB-1 was increased at 24th h in the acute hepatic failure group and reached the peak at 48th h, then kept a stable high level. Significant liver injury appeared at 24th h and was continuously getting worse in the pig models of acute hepatic failure. In contrast, the liver injury was significantly alleviated and serum level of HMGB-1 was significantly decreased in the group treated with artificial liver support system （P〈0.05）. It was suggested that HMGB-1 may participate in the inflammatory response and liver injury in the late stage of the acute liver failure. Artificial liver support system treatment can reduce serum HMGB-1 level and relieve liver pathological damage.

Elimination of Surfactants and Small Dyes from Water with Silicasupported Dendritic Amphiphiles

Silica-supported branched polyethylenimine（Sil@PEI） is a conventional adsorbent and shows a limited affinity to anionic surfactants and small dyes（K = 106？107 L/mol）. If the PEI is alkylated with cetyl groups（C16）, the K of the resulting adsorbents（Sil@PEI@C16-x, where x is the fraction of PEI units being alkylated） is significantly improved. Optimization shows that Sil@PEI@C16-0.15 can best reduce aqueous surfactants to a residue around 10？10 mol/L; while Sil@PEI@C16-0.6 can reduce even small aqueous dyes to a residue below 10？10 mol/L, nearly 105-fold lower than that by Sil@PEI. The adsorbents are well recyclable. It is believed that in the case of dyes, the dense cetyl shell can isolate the PEI from the bulky water and thus suppress the competitive binding by water; while in the case of surfactants, the semiclosed cetyl shell can simultaneously meet electrostatic complement and hydrophobic complement to the surfactants.