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      A Digital Health Platform for Assisting the Diagnosis and Monitoring of COVID-19 Progression: An Adjuvant Approach for Augmenting the Antiviral Response and Mitigating the Immune-mediated Target Organ Damage

      research-article
      a , a , a , b , c , b , b , a , *
      Biomedicine & Pharmacotherapy
      The Author(s). Published by Elsevier Masson SAS.
      COVID-19, coronavirus disease 2019, CoV, coronavirus, ARDS, acute respiratory distress syndrome, SARS, severe acute respiratory syndrome, MERS, Middle East respiratory syndrome, RT-PCR, reverse transcriptase polymerase chain reaction, IFNβ, interferon-beta, RNA, ribonucleic acid, dsRNA, double-stranded RNA, TLR, toll-like receptors, RIG-I, retinoic acid-inducible gene I, NF-κB, nuclear factor kappa-light-chain, IRF, interferon regulatory factor, IFN, interferon, JAK-STAT, Janus kinase signal transducer and activation of transcription, IFNR, type I IFN receptor, PRM, patterns recognition molecules, IL, interleukin, NK cells, natural killer cells, Th cells, T helper cells, APC, antigen-presenting cells, CTL, cytotoxic T cells, ICU, intensive care unit, IP-10, IFN gamma-induced protein 10, MCP, monocyte chemoattractant protein, TNF, tumor necrosis factor, NLR, neutrophil-lymphocyte ratio, Tregs, regulatory T cells, CD, cluster of differentiation, NKT, NK T cells, HLH, hemophagocytic lymphohistiocytosis, S-1P, sphingosine-1-phosphate, GC, glucosylceramide, HCC, hepatocellular carcinoma, SphK, sphingosine kinase, MT, microtubules, HBC, hyperimmune bovine colostrum, IG, immunoglobulin, HRV, heart rate variability, SK1, sphingokinase 1, COVID-19, coronavirus, digital health, antiviral therapy, antiviral response, ARDS

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          Abstract

          Coronavirus disease 2019 (COVID-19), which is a respiratory illness associated with high mortality, has been classified as a pandemic. The major obstacles for the clinicians to contain the disease are limited information availability, difficulty in disease diagnosis, predicting disease prognosis, and lack of disease monitoring tools. Additionally, the lack of valid therapies has further contributed to the difficulties in containing the pandemic. Recent studies have reported that the dysregulation of the immune system leads to an ineffective antiviral response and promotes pathological immune response, which manifests as ARDS, myocarditis, and hepatitis. In this study, a novel platform has been described for disseminating information to physicians for the diagnosis and monitoring of patients with COVID-19. An adjuvant approach using compounds that can potentiate antiviral immune response and mitigate COVID-19-induced immune-mediated target organ damage has been presented. A prolonged beneficial effect is achieved by implementing algorithm-based individualized variability measures in the treatment regimen.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

              Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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                Author and article information

                Journal
                Biomed Pharmacother
                Biomed Pharmacother
                Biomedicine & Pharmacotherapy
                The Author(s). Published by Elsevier Masson SAS.
                0753-3322
                1950-6007
                22 September 2021
                22 September 2021
                : 112228
                Affiliations
                [a ]Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
                [b ]Altus Care powered by Oberon Sciences, Denmark, Israel
                [c ]Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford, USA
                Author notes
                [* ]Correspondance to: Department of Medicine.Hebrew University-Hadassah Medical Center.Ein-Kerem, Jerusalem, Israel.POB 1200, IL91120. Tel.: +972 2 6778231.
                Article
                S0753-3322(21)01012-X 112228
                10.1016/j.biopha.2021.112228
                8455249
                34649354
                b9c22546-dced-4208-9ece-89ba4b469d00
                © 2021 The Author(s). Published by Elsevier Masson SAS.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 9 December 2020
                : 17 September 2021
                : 18 September 2021
                Categories
                Article

                covid-19, coronavirus disease 2019,cov, coronavirus,ards, acute respiratory distress syndrome,sars, severe acute respiratory syndrome,mers, middle east respiratory syndrome,rt-pcr, reverse transcriptase polymerase chain reaction,ifnβ, interferon-beta,rna, ribonucleic acid,dsrna, double-stranded rna,tlr, toll-like receptors,rig-i, retinoic acid-inducible gene i,nf-κb, nuclear factor kappa-light-chain,irf, interferon regulatory factor,ifn, interferon,jak-stat, janus kinase signal transducer and activation of transcription,ifnr, type i ifn receptor,prm, patterns recognition molecules,il, interleukin,nk cells, natural killer cells,th cells, t helper cells,apc, antigen-presenting cells,ctl, cytotoxic t cells,icu, intensive care unit,ip-10, ifn gamma-induced protein 10,mcp, monocyte chemoattractant protein,tnf, tumor necrosis factor,nlr, neutrophil-lymphocyte ratio,tregs, regulatory t cells,cd, cluster of differentiation,nkt, nk t cells,hlh, hemophagocytic lymphohistiocytosis,s-1p, sphingosine-1-phosphate,gc, glucosylceramide,hcc, hepatocellular carcinoma,sphk, sphingosine kinase,mt, microtubules,hbc, hyperimmune bovine colostrum,ig, immunoglobulin,hrv, heart rate variability,sk1, sphingokinase 1,covid-19,coronavirus,digital health,antiviral therapy,antiviral response,ards

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