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      Pregnancy and COVID-19

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          Abstract

          Abstract

          There are many unknowns for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Clinical experience of pregnancies complicated with infection by other coronaviruses e.g., Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome, has led to pregnant woman being considered potentially vulnerable to severe SARS-CoV-2 infection. Physiological changes during pregnancy have a significant impact on the immune system, respiratory system, cardiovascular function, and coagulation. These may have positive or negative effects on COVID-19 disease progression. The impact of SARS-CoV-2 in pregnancy remains to be determined, and a concerted, global effort is required to determine the effects on implantation, fetal growth and development, labor, and neonatal health. Asymptomatic infection presents a further challenge regarding service provision, prevention, and management. Besides the direct impacts of the disease, a plethora of indirect consequences of the pandemic adversely affect maternal health, including reduced access to reproductive health services, increased mental health strain, and increased socioeconomic deprivation. In this review, we explore the current knowledge of COVID-19 in pregnancy and highlight areas for further research to minimize its impact for women and their children.

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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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            SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor

            Summary The recent emergence of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in China and its rapid national and international spread pose a global health emergency. Cell entry of coronaviruses depends on binding of the viral spike (S) proteins to cellular receptors and on S protein priming by host cell proteases. Unravelling which cellular factors are used by SARS-CoV-2 for entry might provide insights into viral transmission and reveal therapeutic targets. Here, we demonstrate that SARS-CoV-2 uses the SARS-CoV receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. A TMPRSS2 inhibitor approved for clinical use blocked entry and might constitute a treatment option. Finally, we show that the sera from convalescent SARS patients cross-neutralized SARS-2-S-driven entry. Our results reveal important commonalities between SARS-CoV-2 and SARS-CoV infection and identify a potential target for antiviral intervention.
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              Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

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                Author and article information

                Journal
                Physiol Rev
                Physiol Rev
                physrev
                Physiol Rev
                PHYSREV
                Physiological Reviews
                American Physiological Society (Bethesda, MD )
                0031-9333
                1522-1210
                1 January 2021
                24 September 2020
                24 September 2020
                : 101
                : 1
                : 303-318
                Affiliations
                [1]Tommy’s Centre for Maternal Health, Medical Research Council (MRC)Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh , Edinburgh, United Kingdom; Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh , Edinburgh, United Kingdom; Usher Institute, University of Edinburgh , Edinburgh, United Kingdom; MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh , Edinburgh, United Kingdom
                Article
                PRV-00024-2020 PRV-00024-2020
                10.1152/physrev.00024.2020
                7686875
                32969772
                e4a001b7-7412-43ba-affe-3bb02a2bbb78
                Copyright © 2021 the American Physiological Society
                History
                : 16 June 2020
                : 24 August 2020
                : 22 September 2020
                Funding
                Funded by: The Wellcome Trust
                Award ID: 209560/Z/17/Z
                Funded by: The Wellcome Trust
                Award ID: 209589/Z/17/Z
                Funded by: Medical Research Council (MRC) 10.13039/501100000265
                Award ID: MR/N022556/1
                Funded by: British Heart Foundation (BHF) 10.13039/501100000274
                Award ID: RE/18/5/34216
                Award Recipient : Hilary OD Critchley
                Funded by: Tommy's Baby Charity 10.13039/501100000306
                Categories
                Review

                covid-19,neonatal outcomes,pathophysiology,placenta,pregnancy

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