The data related signs of ocular fundus associated with COVID-19 published in this journal collected from December 2022, while the pandemic of COVID-19 was in a clustering occurrence. The signs of ocular fundus including acute macular neuroretinopathy (AMN), cotton wool spots or Purtscher-like retinopathy, central retinal vein occlusion (CRVO) and macular edema of unknown etiology. The different lesions can be concurrent existence in some cases is one of the clinical characteristics of COVID-19, other characteristics including both eye involved, predominated affected more women, aged from 13 to 56 years. AMN was mentioned recently in most papers on COVID-19, it has been known as deep capillary ischemia. Cotton wool spots is sign infarct in superficial capillary. Retina dots indicated retinal infarct in the outer plexiform layer. CRVO was demonstrated that the blood clot blocks the flow of blood at the level of the lamina cribro, optic disc edema with macular subretinal fluid showed the retina tissue as well as optic head affected. Eye is part of the body, lesions of ocular fundus are identical with body system. Several study proposed different hypothesis for these alterations in acute phase of COVID-19: direct viral endothelial injury, activation of the immune response by a cytokine storm leading to a procoagulant state or transient hypercoagulability. Retina lesions demonstrated a vasculature impairment in several layers of retina and edema in retina and optic disk. We should monitor in the acute phase of COVID-19 the prothrombotic markers and the treatment should consider anti-virus and preventing thrombosis formation.
ObjectiveTo systematically review the economic evaluation research of anti-novel coronavirus infection drugs at home and abroad, so as to promote clinical rational drug use. MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, INAHTA, SinoMed, WanFang Data, and CNKI databases were systematically searched from January 1, 2020 to March 25, 2023, to collect economic evaluation studies related to anti-novel coronavirus infection drugs. ResultsA total of 22 articles were included, among which 11 studies were conducted from the perspective of health system, and most of the studies performed cost estimation on direct medical costs. The overall compliance rate of the included studies ranged from 42% to 70%, with deficiencies in model setting, incomplete uncertainty analysis, and lack of stakeholder participation. The results showed that immunotherapy drugs (Dexamethasone, Tocilizumab), neutralizing antibody (REGEN-COV antibody), small molecule drugs (Baricitinib, Nirmatrelvir/Ritonavir, Molnupiravir, Favipiravir) and statin were cost-effective. There was some variation in the results of the economic evaluation of Remdesivir. ConclusionAt present, there are few studies on the economic evaluation of drug interventions in COVID-19. Existing studies have pointed out that most drug interventions are cost-effective. It is suggested that more standardized pharmacoeconomic evaluation studies based on the actual situation of China epidemic should be carried out in the future.
ObjectiveTo observe the clinical and fundus imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA retrospective case study. A total of 32 eyes of 18 patients diagnosed of AMN associated with COVID-19 at Chengdu Aidi Eye Hospital from December 2022 to February 2023 were included. All patients had a history of fever 1 to 5 days prior to ocular onset and tested positive for SARS CoV-2 antigen. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, scanning laser ophthalmoscope (SLO), infrared fundus photography (IR), and optical coherence tomography (OCT); OCT angiography, visual field and multifocal electroretinogram (mf-ERG) were performed in 6 patients (11 eyes), 3 patients (6 eyes) and 1 patient (2 eyes), respectively. Follow-up time was 8-10 weeks. The clinical and fundus imaging features were observed and analyzed.ResultsThere were 6 males (12 eyes) and 12 females (20 eyes), aged from 15 to 36 years, with the mean age of (28.00±5.86) years. Fourteen patients were bilateral and 4 patients were unilateral. The time from the onset of eye symptoms to seeing a doctor was ranged from 1 day to 8 weeks. Among them, 6 patients (10 eyes) visited the doctor within 3 days of onset, while 12 patients (22 eyes) visited the doctor after 3 days of onset. The BCVA was 0.80±0.29. Fundus color photography and SLO examination showed that only 2 patients (4 eyes) showed sheet or petal-like dark red lesions in the macular area, and no obvious abnormal changes were observed in other patients. No obvious abnormalities were found in AF examination of all patients. IR examination showed no significant abnormality in 6 cases which came to hospital within 3 days after the onset, but irregular hyporeflective dark shadow lesions in the macular region of patients with more than 3-day course of disease was observed. OCT examinations of all eyes showed hyperreflective band or patchy lesion on the outer plexiform layer (OPL) and outer nuclear layer (ONL) and affect the ellipsoid zone (EZ) and interdigitation zone (IZ). In 11 eyes of 6 patients undergoing OCTA examination, the blood flow density of the choroidal capillary layer in the focal area decreased. In 6 eyes of 3 patients who underwent visual field examination, the physiologic scotoma was slightly enlarged. One patient (2 eyes) receiving mf-ERG showed a concave reduction in macular center amplitude. The hyperreflective band lesion on OPL and ONL disappear rapidly within 2 weeks, while the continuity of EZ recovered slowly, and the disruption of IZ kept existing for more than 10 weeks. ConclusionsMost AMN associated with COVID-19 are young women; IR showed irregular weak reflex in the lesion area. OCT showed strong OPL and ONL reflection. OCTA was characterized by decreased blood flow density in the choroidal capillary layer of the focal area.
ObjectiveTo construct a lentiviral vector carrying rat sirt1 gene and observe the expression of sirt1 in retinal ganglion cell (RGC) of rat. MethodsRat sirt1 cDNA was inserted into pLV5 vector. After identification by sequencing analysis and PCR, the recombinant sirt1expressinglentivirus vector was packaged by cotransfecting 293T cells with packaged plasmid.Then pLV5-sirt1 was used to infect the cultured Sprague-Dawley rat RGC cell in vitro.The expressions of sirt1 protein and mRNA in infected rat RGC were detected by quantitative real-time PCR and Western blot. ResultsThe sirt1 expression vector pLV5 was successful constructed and sequence was proved to be correct. The expression of sirt1 protein and mRNA in RGC was significantly increased than that in cells infected with control lentiviruses(P < 0.05). ConclusionWe have successful constructed a sirt1 expression lentivirus vector pLV5-sirt1 and it can increase the expression of sirt1 protein and mRNA in the rat retinal ganglion cells.
COVID-19 associated fundus lesions are mostly vascular occlusion or inflammatory changes. The affected vessels include both retinal macrovessels and microvessels, and the inflammatory changes are mainly autoimmune lesions. Clinically, the different lesions present as various fundus diseases, with varying degrees of impact on visual function. The mechanism of these lesions is considered to be related to direct injury of SARS-CoV-2, abnormal coagulation or inflammatory response caused by SARS-CoV-2. Awareness of fundus lesions associated to COVID-19 is helpful to figure out the pathophysiological mechanism of COVID-19 and promote in-depth studies for a deeper and complete understanding of the occurrence and full impact of COVID-19, emphasizing the importance of early prevention and control of the disease, and highlighting the significance of early intervention of the fundus diseases caused by COVID-19.
As an important tool for nucleic acid detection of variant strains of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), the mobile air capsule construction laboratory is a key medical resource in the prevention and control of COVID-19. Medical staff, security guards, cleaners, maintenance workers and volunteers in the mobile air capsule construction laboratory have high contact frequency with the samples, so they have a high risk of infection with COVID-19. In order to reduce this risk, this article discusses the infection management measures in the aspects of wearing and taking off personal protective equipment, environmental health management, post use goods management, medical waste management, staff training management and disposal process after occupational exposure, and analyzed the common problems in operation, based on the operation process of Nanchong mobile air capsule construction laboratory. The purpose is to provide a reference for the construction and management of other mobile air capsule construction laboratory.
Objective To observe the imaging features of fundus lesions associated with COVID-19. MethodsA observational case series study. Twenty eyes of 10 patients with fundus lesions associated with COVID-19 at Xiamen Eye Center of Xiamen University from December 10, 2022 to January 20, 2023 were included in this study. There were 1 males and 9 females, aged from 17 to 49 years, with the median age of 26 years. The time of ocular symptoms after the diagnosis of COVID-19 was 0-2 days. The time from the onset of ocular symptoms to seeing a doctor was 1-14 days. All patients were examined by best-corrected visual acuity (BCVA), intraocular pressure, color fundus photography, infra-red fundus photography (IR), optical coherence tomography (OCT). Serum D-dimer examination was performed in 3 patients. The median BCVA was 0.4. There was no abnormalities in intraocular pressure and anterior segment examination. Among 20 eyes of 10 patients, there were 10 eyes of 5 patients with acute macular neuroretinopathy (AMN), 6 eyes of 3 patients with Purtscher-like retinopathy (PLR), 4 eyes of 2 patients with central retinal vein occlusion (CRVO). The imaging features of fundus were observed and analyzed. ResultsRetinal lesions included AMN, paramacular central medial retinopathy (PAMM), PLR, cotton wool spots, hemorrhage, optic disc edema, macular edema. AMN was found in 10 eyes, with reddish-brown and wedge-shaped lesion in the fovea, dark area in IR and hyper reflectivity in outer nuclear layer and outer plexiform layer by OCT. The cotton wool spot showed hyper reflectivity on retinal nerve fiber layer whereas PAMM showed band-shape hyper reflectivity in inner nuclear layer by OCT. The Purtscher spot was seen at the posterior pole and/or peripapillary in 6 eyes of PLR. By OCT examination, the retinal nerve fiber layer corresponding to Purtscher flecken was significantly thickened and the reflex was enhanced. Among 6 eyes of PLR, there were 4 eyes combined with AMN, 1 eye with PAMM and macular edema. In 4 eyes of CRVO, vitreous cells, optic disc edema, retinal flame, spot hemorrhage, and atypical cotton wool spots were seen in 2 eyes. ConclusionsThe manifestations of fundus lesions associated with COVID-19 are varied. The multilayer structure of retina is involved, and the microvessels of retina and choroidal capillary layer are damaged.
Objective To determine the independent influencing factors of intraoperative choking during painless gastrointestinal endoscopy (PGIE) after coronavirus disease 2019 (COVID-19). Methods The data of patients undergoing PGIE with COVID-19 in Northern Jiangsu People’s Hospital between December 2022 and April 2023 were retrospectively collected. Multiple logistic regression analysis was used to screen the influencing factors of intraoperative coughing events that occurred during the diagnosis and treatment process. Results A total of 948 patients were included, with 93 (9.8%) cases of choking. The results of the multiple logistic regression analysis showed that smoking and unresolved cough were independent risk factors for coughing (P<0.05), while colonoscopy and infection duration beyond 14 days between diagnosis and treatment were independent protective factors for coughing (P<0.05). ConclusionsWhen patients with COVID-19 undergoing PGIE, special attention should be paid to high-risk groups such as smoking and unresolved cough. It is necessary to strengthen intraoperative monitoring and implementation of prevention and control measures to reduce the incidence of coughing and improve the safety of diagnosis and treatment for patients.
Objective To investigate the causal effect of coronavirus disease 2019 (COVID-19) on idiopathic pulmonary fibrosis (IPF). Methods Genome-wide association studies (GWAS) data were sourced from the COVID-19 Host Genetics Initiative and published research. We employed: ① linkage disequilibrium score regression to estimate heritability of individual traits and genetic correlations between COVID-19 and IPF; ② multi-trait analysis of GWAS to identify genetic loci associated with COVID-19 and IPF; ③ Mendelian randomization (MR) to assess causal effect of COVID-19 on IPF; ④ colocalization analysis to identify shared causal variants. Results ① Three COVID-19 phenotypes showed significant positive genetic correlations with IPF (P<0.05); ② Multi-trait analysis of GWAS identified loci jointly associated with COVID-19 and IPF; ③ MR indicated that COVID-19 hospitalization may increase IPF risk (P=0.006); ④ Two causal variants were identified: rs12585036 (posterior probability>0.8, mapped to ATP11A) and rs12610495 (posterior probability>0.8, mapped to DPP9). Conclusions COVID-19 hospitalization may increase IPF risk through inflammatory pathways, providing new insights for managing COVID-19-related pulmonary diseases.
Objective To investigate the impact of COVID-19 infection on the early clinical outcomes of patients undergoing valve replacement. MethodsPerioperative data of patients who underwent single valve replacement at the Second Affiliated Hospital of Chinese People's Liberation Army Medical University from January to February 2023 were consecutively collected. Based on COVID-19 infection status, patients were divided into a COVID-19 group and a non-COVID-19 group. The perioperative data were compared between the two groups. ResultsA total of 136 patients were included, comprising 53 males and 83 females, with a mean age of (53.4±10.2) years. There were 32 patients receiving aortic valve replacements, 102 mitral valve replacements, and 2 tricuspid valve replacements. The COVID-19 group comprised 70 patients, and the non-COVID-19 group included 66 patients. No statistical difference was observed in the incidence of postoperative complications between the two groups [9.09% (6/66) vs. 11.43% (8/70), P=0.654]. However, the COVID-19 group had longer postoperative mechanical ventilation duration [1 201.00 (1 003.75, 1 347.75) min vs. 913.50 (465.50, 1 251.00) min, P=0.001] and ICU stay [3 (2, 3) days vs. 2 (2, 3) days, P<0.001] compared to the non-COVID-19 group. Additionally, troponin I [4.76 (2.55, 7.93) ng/mL vs. 2.66 (1.19, 5.65) ng/mL, P=0.001] and brain natriuretic peptide [608.50 (249.75, 1 150.00) pg/mL vs. 192.00 (100.93, 314.75) pg/mL, P<0.001] levels were significantly higher in the COVID-19 group. ConclusionFor patients with single valve disease undergoing elective surgery, short-term outcomes after recovery from COVID-19 infection are favorable, with no significant increase in in-hospital mortality or postoperative complication rates.