Transcriptase-polymerase Chain Reaction Assay Research Articles

Clinical Characteristics and Predictors of 28-Day Mortality in 352 Critically Ill Patients with COVID-19: A Retrospective Study

BackgroundSince the first COVID-19 patient in Saudi Arabia (March, 2020) more than 338,539 cases and approximately 4996 dead were reported. We present the main characteristics and outcomes of critically ill COVID-19 patients that were admitted in the largest Ministry of Health Intensive Care Unit (ICU) in Saudi Arabia.MethodsThis retrospective study, analyzed routine epidemiologic, clinical, and laboratory data of COVID-19 critically ill patients in King Saud Medical City (KSMC), Riyadh, Saudi Arabia, between March 20, 2020 and May 31, 2020. Severe acute respiratory syndrome coronavirus-2 infection was confirmed by real-time reverse transcriptase polymerase chain reaction assays performed on nasopharyngeal swabs in all enrolled cases. Outcome measures such as 28-days mortality, duration of mechanical ventilation, and ICU length of stay were analyzed.ResultsThree-hundred-and-fifty-two critically ill COVID-19 patients were included in the study. Patients had a mean age of 50.63 ± 13.3 years, 87.2% were males, and 49.4% were active smokers. Upon ICU admission, 56.8% of patients were mechanically ventilated with peripheral oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) ratio of 158 ± 32. No co-infections with other endemic viruses were observed. Duration of mechanical ventilation was 16 (IQR: 8–28) days; ICU length of stay was 18 (IQR: 9–29) days, and 28-day mortality was 32.1%. Multivariate regression analysis showed that old age [Odds Ratio (OR): 1.15, 95% Confidence Intervals (CI): 1.03–1.21], active smoking [OR: 3, 95% CI: 2.51–3.66], pulmonary embolism [OR: 2.91, 95% CI: 2.65–3.36), decreased SpO2/FiO2 ratio [OR: 0.94, 95% CI: 0.91–0.97], and increased lactate [OR: 3.9, 95% CI: 2.4–4.9], and d-dimers [OR: 2.54, 95% CI: 1.57–3.12] were mortality predictors.ConclusionOld age, active smoking, pulmonary embolism, decreased SpO2/FiO2 ratio, and increased lactate and d-dimers were predictors of 28-day mortality in critically ill COVID-19 patients.

Case Report: Survival of A Coronavirus Disease-2019 (Covid-19) Patient with Acute Respiratory Distress Syndrome (ARDS) in Dr. Soetomo Hospital, Surabaya, Indonesia

An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that began in Wuhan, China has spread rapidly in multiple countries of the world and has become a pandemic. Currently, there is no vaccine or specific antiviral for COVID-19. A study reported 7.3% of critical patients admitted to ICU, 71% of them required mechanical ventilation, and 38.5% of them were survived. Herein, we reported a 54-year-old man with Acute Respiratory Distress Syndrome (ARDS) of COVID-19 who survived the disease. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasopharyngeal and oropharingeal swabs were positive for SARS-CoV-2. Diagnosis of ARDS was also according to clinical symptoms, laboratory, chest radiograph, and chest CT scan. Alcaligenes faecalis and Candida albicans were also identified from sputum culture. Treatment for this patient was causal and supportive therapy, including antibiotic, antiviral, and antifungal therapy according to the culture results, fluid resuscitation, and oxygen supply from the mechanical ventilator. This patient was survived and discharged on hospital day-29. A fibrosis in parenchyma pulmonary and sensory peripheral neuropathy occurred after survived from ARDS. Monitoring of clinical, laboratory, and chest radiograph were continued after the patient discharged from the hospital. This case highlights the importance of early diagnosis and effective treatment to the care of COVID-19 patient.

ISOLATION OF NOVEL CORONAVIRUS IN TEARS AND CONJUNCTIVAL SECRETIONS FROM COVID-19 PATIENTS PRESENTING WITH KERATOCONJUNTIVITIS

This study aimed to assess the isolation of novel coronavirus in tears and conjunctival secretions by reverse transcriptase polymerase chain reaction (RT-PCR) assay from novel coronavirus disease 2019 (COVID-19) patients presenting with keratoconjunctivitis.

Absence of SARS-CoV-2 in the effluent of peritoneal dialysis patients.

The pandemic of respiratory disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is life-threatening in peritoneal dialysis (PD) patients. In PD patients with systemic viral infections, peritoneal effluent may be theoretically contaminated. We searched for the presence of SARS-CoV-2 genetic material by real-time reverse transcriptase-polymerase chain reaction assays in serial PD effluents of three PD infected patients. Nasopharyngeal swabs obtained at admission showed high viral load in all three patients, whereas none of the PD effluent specimen tested positive, even after dialysate concentration. Those results support at most a very low SARS-CoV-2 dissemination risk by the peritoneal effluent of PD patients. Imposing special disposal procedures, such as the instillation of hypochlorite in the drainage bags to prevent viral spread to health-care workers, are probably not required.

Author response: Miller Fisher syndrome and polyneuritis cranialis in COVID-19.

We thank Drs. Ni and Xu for their letter on our study.1 We think that our 2 patients developed Miller Fisher syndrome and polyneuritis cranialis because of an aberrant immunologic response to COVID-19. As we previously commented in the article, oropharyngeal swab test for SARS-CoV-2 by qualitative real-time reverse transcriptase polymerase chain reaction (PCR) assay was positive in both patients and negative in the CSF. We did not examine the presence of antibodies for SARS-CoV-2 in CSF because that technique had not been validated. In the patient who acutely presented with Miller Fisher syndrome, CSF PCR for enterovirus, herpes simplex virus type 1 and 2, and varicella zoster virus were negative as well as CSF-VDRL test. On the other hand, in the patient with polyneuritis cranialis, these tests could not be performed because of the extreme circumstances of the University Hospital “Príncipe de Asturias,” Alcala de Henares, Madrid, at the peak of this pandemic. Notwithstanding, considering the temporal relationship, we feel that SARS-CoV-2 infection was responsible for the development of these 2 neurologic pictures.

Circular RNA cir-ITCH Is a Potential Therapeutic Target for the Treatment of Castration-Resistant Prostate Cancer.

cir-ITCH, a well-known tumor-suppressive circular RNA, plays a critical role in different cancers. However, its expression and functional role in prostate cancer (PCa) are unclear. Herein, we explored the potential mechanism and tumor-inhibiting role of cir-ITCH in PCa. Using reverse transcriptase polymerase chain reaction assay, we analyzed the expression of cir-ITCH in PCa and paired adjacent nontumor tissue samples resected during surgical operation, as well as in two cell lines of human PCa (LNCaP and PC-3) and the immortalized normal prostate epithelial cell line (RWPE-1). Cell viability and migration of PCa cell lines were evaluated using CCK-8 and wound-healing assays. Expression of key proteins of the Wnt/β-catenin and PI3K/AKT/mTOR pathways was detected using western blotting. We found that cir-ITCH expression was typically downregulated in the tissues and cell lines of PCa compared to that in the peritumoral tissue and in RWPE-1 cells, respectively. The results showed that cir-ITCH overexpression significantly inhibits the proliferation, migration, and invasion of human PCa cells and that reciprocal inhibition of expression occurred between cir-ITCH and miR-17. Proteins in the Wnt/β-catenin and PI3K/AKT/mTOR pathways were downregulated by overexpression of cir-ITCH both in androgen receptor-positive LNCaP cells and androgen receptor-negative PC-3 cells. Taken together, these data demonstrated that cir-ITCH plays a tumor-suppressive role in human PCa cells, partly through the Wnt/β-catenin and PI3K/AKT/mTOR pathways. Thus, cir-ITCH may serve as a novel therapeutic target for the treatment of PCa, especially castration-resistant prostate cancer.

Transmission of infection from non-isolated patients with COVID-19 to healthcare workers

Insufficiently protected healthcare workers (HCWs), defined as high-risk contacts of patients with coronavirus disease 2019 (COVID-19), are routinely quarantined. This study evaluated the transmission of infection from a symptomatic patient with COVID-19 to 60 HCWs exposed at ≤2 m for ≥15 min or during aerosol-generating procedures. Following ≥106 unique high-risk contacts, none of the HCWs tested positive for severe acute respiratory syndrome coronavirus-2 RNA or developed antibodies. The HCWs reported adherence to basic infection control procedures. These results are in accordance with other reports, and should reassure HCWs and further stimulate broader evaluation of the foundation for the current practice of home quarantining non-symptomatic HCWs.

Clinical significance of circPVT1 in patients with non-small cell lung cancer who received cisplatin combined with gemcitabine chemotherapy.

CircPVT1 was identified as a tumor-promoted circRNA that is upregulated in several cancers. We researched clinical significance of circPVT1 in patients with non-small cell lung cancer (NSCLC) who received cisplatin combined with gemcitabine chemotherapy. Reverse transcriptase polymerase chain reaction assays were performed to detect circPVT1 expression in 96 patients with NSCLC. In addition, Kaplan-Meier methods were performed to analyze survival of patients with NSCLC. There is no significant difference between circPVT1 and age, sex, histologic type, lymphatic invasion, or vascular invasion in patients with NSCLC and there is significant difference between circPVT1 and differentiation or p-TNM stage in patients with NSCLC. In addition, after cisplatin combined with gemcitabine chemotherapy, circPVT1 expression was decreased, and circPVT1 expression in the chemotherapy-resistant group was higher than in the chemotherapy-sensitive group. Survival of patients with NSCLC was associated with high circPVT1 expression. Our study revealed the clinical significance of circPVT1 in NSCLC after cisplatin combined with gemcitabine chemotherapy. After treatment, circPVT1 expression was decreased and circPVT1 expression in chemotherapy-resistant patients was higher than in chemotherapy-sensitive patients. Decreased circPVT1 expression in chemotherapy-sensitive patients is more notable than in chemotherapy-resistant patients. Therefore, it is possible to determine the effect of therapy after receiving chemotherapy by detecting the expression of circRNA in serum.

Brief Report: Retrospective Evaluation on the Efficacy of Lopinavir/Ritonavir and Chloroquine to Treat Nonsevere COVID-19 Patients.

Background:The effectiveness of lopinavir/ritonavir (LPV/r) and chloroquine treatment for COVID-19 has not been verified.Methods:We conducted a retrospective study to summarize the clinical practices of nonsevere patients with COVID-19 receiving the standard care, LPV/r or chloroquine in Beijing Ditan Hospital from January 20 to March 26, 2020. The main outcome measurements include the changes of cycle threshold values of open reading frame 1 ab (ORF1ab) and nucleocapsid (N) genes by reverse transcriptase–polymerase chain reaction assay from day 1 to 7 after admission for patients receiving standard care or after treatment being initiated for patients receiving either LPV/r or chloroquine. The proportion of developing severe illness, fever duration and the time from symptom onset to chest computer tomography improvement, and negative conversion of nucleic acid were compared.Results:Of the 129 patients included in the study, 59 received the standard care, 51 received LPV/r, and 19 received chloroquine. The demographics and baseline characteristics were comparable among the 3 groups. The median duration of fever, median time from symptom onset to chest computer tomography improvement, and negative conversion of the nucleic acid were similar among the 3 groups. The median increase in cycle threshold values of N and ORF1ab gene for patients receiving LPV/r or chloroquine or the standard care during the treatment course was 7.0 and 8.5, 8.0, and 7.6, 5.0, and 4.0, respectively. These figures were not found significantly different among the 3 groups.Conclusions:Antiviral therapy using LPV/r or chloroquine seemed not to improve the prognosis or shorten the clinical course of COVID-19.

Effects of Rubus coreanus Miquel extracts on the proliferation and differentiation of mouse osteoblast-like MC3T3-E1 cells

Rubus coreanus Miquel (RCM), one a type of edible red raspberry, grows wild in Korea and China and its unripe fruit has been used as a folk medicine for the treatment of impotence and as a diuretic agent. The goal of this study was to investigate the effects of RCM on the proliferation and differentiation of mouse osteoblast-like MC3T3-E1 cells. In this study, RCM extract (1-10 μg/mL) enhanced the viability of osteoblast cell. RCM extract also increased alkaline phosphatase (ALP) activity and osteocalcin secretion of MC3T3-E1 cells (significant at 1-10 μg/mL). Especially, at a concentration of 10 μg/mL ALP activity was increased by approximately 4.3 times in comparison with the control. Alizarin red staining and osteocalcin secretion assay showed that RCM extract stimulates differentiation of osteoblast cells by inducing the activation of mineralization. Moreover, reverse transcriptase polymerase chain reaction and western blotting assay indicated that RCM extract induced the differentiation at mRNA and protein level. These results suggest that RCM extract enhanced the osteoblast function by increasing the proliferation and differentiation of osteoblast like MC3T3-E1 cells.

Role of Ultrasound-Guided Evaluation of Dyspnea in the Coronavirus Disease 2019 Pandemic

Role of Ultrasound-Guided Evaluation of Dyspnea in the Coronavirus Disease 2019 Pandemic

Clinicopathological significance of common genetic alterations in patients with acute promyelocytic leukemia

Objective/BackgroundAcute myeloid leukemia (AML) is one of the common forms of hematological malignancy and acute promyelocytic leukemia (APL) is a unique subtype of AML conferring favorable prognosis. We aimed to determine the prevalence and prognostic impact of Fms-like tyrosine kinase 3 (FLT3), nucleophosmin 1 (NPM1) mutation, epidermal growth factor receptor (EGFR), and flow marker’s expression in patients with APL. MethodsIn the present study, 165 de novo APL patients were molecularly characterized for promyelocytic leukemia (PML) breakpoint and additional genetic alterations. Reverse transcriptase polymerase chain reaction (PCR) and real-time PCR assays were used to detect genetic alterations. ResultsPML/RARα was detected in 29/165 (17.5%) samples with breakpoint cluster region 1 (bcr1) in 17/29 (58.5%) and bcr3 in 12/29 (41.5%) samples. The prevalence of FLT3-ITD, NPM1, and EGFR were detected in 5/29 (17.5%), 11/29 (38%), and 5/29 (17.5%) patients, respectively. Patients expressing bcr-3 hybrid transcript had lower overall survival compared with bcr1 (p = .254). White blood cell (WBC) count was significantly higher in bcr3 in comparison with bcr1 patients (p = .002). Patients with positive EGFR expression (p = .042) and higher WBC (p = .002) were significantly associated with poor survival (p < .05). ConclusionsWe documented the higher prevalence of bcr1 and confirmed that the association of FLT3-ITD significantly reduced the chances of survival in APL. The mortality rate of bcr3 was comparatively higher than that of bcr1. Higher WBC count and EGFR expression were significantly associated with poor survival.

Chest CT Evaluation of 11 Persistent Asymptomatic Patients with SARS-CoV-2 Infection.

In total, 11 asymptomatic carriers who underwent nasal or oropharyngeal swab tests for SARS-CoV-2 after being in close contact with patients who developed symptomatic 2019 coronavirus disease (COVID-19) were enrolled in this study. The chest multidetector computed tomography (CT) images of the enrolled patients were qualitatively and quantitatively analyzed. The findings of the first chest CT were normal in 3 (27.3%) patients, 2 of whom were aged below 15 years. The lesions of 2 (18.2%) patients involved 1 lobe with unifocal presence. Subpleural lesions were observed in 7 (63.6%) patients. Ground glass opacity (GGO) was the most common sign observed in 7 (63.6%) patients. Crazy-paving pattern and consolidation were detected in 2 (18.2%) and 4 (36.4%) patients, respectively. Based on deep learning and quantitative analysis, the mean volume of intrapulmonary lesions in the first CT image was 85.73 ± 84.46 cm3. In patients with positive findings on CT images, the average interval between positive real-time reverse transcriptase polymerase chain reaction assay and peak volume on CT images was 5.1 ± 3.1 days. In conclusion, typical CT findings can be detected in over 70% of asymptomatic SARS-CoV-2 carriers. The initial presentation is typically GGO along the subpleural regions and bronchi, which absorbs in approximately 5 days.

Active surveillance for acute respiratory infections among pediatric long-term care facility staff

Transmission of respiratory viruses between staff and residents of pediatric long-term care facilities (pLTCFs) can occur. We assessed the feasibility of using text or email messages to perform surveillance for acute respiratory infections (ARIs) among staff. From December 7, 2016 to May 7, 2017, 50 staff participants from 2 pLTCFs received weekly text or email requests to report the presence or absence of ARI symptoms. Those who fulfilled the ARI case definition (≥2 symptoms) had respiratory specimens collected to detect viruses by reverse transcriptase polymerase chain reaction assays. Pre- and postsurveillance respiratory specimens were collected to assess subclinical viral shedding. The response rate to weekly electronic messages was 93%. Twenty-one ARIs reported from 20 (40%) participants fulfilled the case definition. Respiratory viruses were detected in 29% (5/17) of specimens collected at symptom onset (influenza B, respiratory syncytial virus, coronavirus [CoV] 229E, rhinovirus [RV], and dual detection of CoV OC43 and bocavirus). Four participants had positive presurveillance (4 RV), and 6 had positive postsurveillance specimens (3 RV, 2 CoV NL63, and 1 adenovirus). Electronic messaging to conduct ARI surveillance among pLTCF staff was feasible.

Neurological Manifestations in Mild SARS-CoV-2 Infected Patients at a Tertiary Health Center in India: A Prospective Cohort Study

Background: The outbreak of novel corona virus Wuhan, China in December 2019 with rapid spread in various corner of world, has prominently respiratory system involvement with varied manifestation of other systems as well. The objective of the study was to study the neurological manifestation in the patients with mild coronavirus disease 2019 (COVID-19). Method: Demographic and clinical data of 109 SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) real time reverse transcriptase polymerase chain reaction (RT-PCR) assay confirmed adult patients was collected prospectively. Patients who were unable to cooperate and/or required mechanical ventilation were excluded. Questionnaire based assessment pertaining to most prevalent symptoms and neurological symptoms were done. The prevalence of neurological manifestation in SARS-Cov 2 infected patients and their correlation with severity of disease was assessed. Results: We enrolled 109 patients between 1st April 2020 to 20th April 2020. Patients who were intubated were excluded. The mean age of patients was 38.2 (13.4) years and majority were males (86.2%). More than half of the patients (58.7%) were symptomatic and 24.8% of the patients had at least one neurological symptom. Cough was the commonest symptom (46.8%) followed by fever (31.2%). Amongst the neurological symptoms, the commonest was headache (15.6%), and anosmia (9.2%). In addition, patients had increased thirst (9.2%), myalgia (8.3%), weakness (8.3%), decreased taste (8.3%), and decreased sleep (5.5%). Conclusion: SARS-CoV-2 may have neurological manifestations in addition to respiratory tract symptoms. Commonest symptoms like headache, anosmia, and increased thirst may be enquired in doubtful cases with high index of suspicion. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The study was approved by the institute ethics committee. The study was performed in accordance with the principles of the Declaration of Helsinki.

Performance of Oropharyngeal Swab Testing Compared With Nasopharyngeal Swab Testing for Diagnosis of Coronavirus Disease 2019-United States, January 2020-February 2020.

Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected ≤7 days after illness onset, Real-Time Reverse Transcriptase Polymerase Chain Reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 RT-PCR) diagnostic results were 95.2% concordant. However, NP swab cycle threshold values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect the amount of SARS-CoV-2.

Factors Associated With Surgical Mortality and Complications Among Patients With and Without Coronavirus Disease 2019 (COVID-19) in Italy

There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery. To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties. This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score. Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase-polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations. The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors. Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]; mean [SD] age, 76.6 [14.4] years), 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR, 4.98; 95% CI, 1.81-16.07); pulmonary complications were the most common (OR, 35.62; 95% CI, 9.34-205.55), but thrombotic complications were also significantly associated with COVID-19 (OR, 13.2; 95% CI, 1.48-∞). Different models (cumulative link model and classification tree) identified COVID-19 as the main variable associated with complications. In this matched cohort study, surgical mortality and complications were higher in patients with COVID-19 compared with patients without COVID-19. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.

Human coronaviruses in persons with acute respiratory infections in Ghana

Background: Acute respiratory infections (ARI) remain a leading cause of morbidity, mortality, and economic loss globally. Until recently, human coronaviruses (HCoVs) have been mainly associated with mild respiratory tract infections. The 2003 outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV) and cases of Middle East respiratory syndrome coronavirus (MERS-CoV), since 2012, illustrate the potential of coronaviruses to cause severe disease. Objective: This study investigated the presence of human coronaviruses in acute respiratory illness in Ghana. Methods: As part of routine influenza surveillance, nasopharyngeal and oropharyngeal (NP/OP) swabs obtained from 200 patients (100 hospital inpatients and 100 outpatients) with Influenza-like-illness from sentinel health facilities in Ghana from January 2013 to March 2014, were screened for the presence of HCoVs at the National Influenza Center using real-time reverse transcriptase polymerase chain reaction assays. Results: Human CoVs were detected in 7(3.5%) out of 200 cases investigated: HCo V HKU1 in 3 patient, HCo V 229E in 2 patients, HCo V OC43 in 1patient, and HCo V NL63 in 1 patient. No co-infection with HCoV types was detected. Out of 7 patients with HCoV infections, 6 were aged 5 yr. or greater.Also, HCoVs were detected more frequently in outpatients (5/100) than in hospitalized patients (2/100) with acute respiratory tract infections, though statistically insignificant (p&gt;0.005). None of the respiratory specimens tested were positive for MERS-CoV, indicating the absence of MERS-CoV infection in Ghana between January 2013 and March 2014. Conclusion: This work provides an important reference point for coronavirus infections in humans in Ghana noting the current concern on the 2019 novel coronavirus.

Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series.

ObjectiveTo characterize patients with coronavirus disease 2019 (covid-19) in a large New York City medical center and describe their clinical course across the emergency department, hospital wards, and intensive care units.DesignRetrospective manual medical record review.SettingNewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical center in New York City.ParticipantsThe first 1000 consecutive patients with a positive result on the reverse transcriptase polymerase chain reaction assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented to the emergency department or were admitted to hospital between 1 March and 5 April 2020. Patient data were manually abstracted from electronic medical records.Main outcome measuresCharacterization of patients, including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.ResultsOf the first 1000 patients, 150 presented to the emergency department, 614 were admitted to hospital (not intensive care units), and 236 were admitted or transferred to intensive care units. The most common presenting symptoms were cough (732/1000), fever (728/1000), and dyspnea (631/1000). Patients in hospital, particularly those treated in intensive care units, often had baseline comorbidities including hypertension, diabetes, and obesity. Patients admitted to intensive care units were older, predominantly male (158/236, 66.9%), and had long lengths of stay (median 23 days, interquartile range 12-32 days); 78.0% (184/236) developed acute kidney injury and 35.2% (83/236) needed dialysis. Only 4.4% (6/136) of patients who required mechanical ventilation were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at three to four days, and at nine days. As of 30 April, 90 patients remained in hospital and 211 had died in hospital.ConclusionsPatients admitted to hospital with covid-19 at this medical center faced major morbidity and mortality, with high rates of acute kidney injury and inpatient dialysis, prolonged intubations, and a bimodal distribution of time to intubation from symptom onset.

Identification of Novel Candidate Biomarkers for Oral Squamous Cell Carcinoma Based on Whole Gene Expression Profiling.

This study aimed to determine the whole gene expression profiles and to ascertain potential biomarkers for 22 oral squamous cell carcinoma (OSCC) among Thai patients using the Illumina Human HT-12, V4.0 Expression BeadChip array. Result indicated 2,724 differential expressed genes composed of 1,560 up-regulated and 1,164 down-regulated genes (unpaired t-test, p-value <0.05; fold change ≥2.0 and ≤2.0). The top 9 up-regulated genes were validated in 39 OSCC cases using TaqMan real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) assay. Among these, the up-regulation of peptidase inhibitor 3 (PI3) and keratin 17 (KRT17) genes was harbored in all 39 OSCC patients (100%). Likewise, statistical analysis indicated that gene expression in 8 selective genes including keratin 16 (KRT16), keratin 14 (KRT14), keratinocyte differentiation-associated protein (KRTDAP), keratin 6B (KRT6B), PI3, S100 calcium binding protein A7 (S100A7), stratifin (SFN) and keratin 5 (KRT5) was significantly associated with well differentiated OSCC (p-value <0.05). Moreover, high level of KRT17 protein was significantly associated with well differentiated OSCC compared to moderately OSCC (p-value = 0.041). Notably, using nested-PCR analysis indicated all OSCC cases in this study were HPV-free. Especially, KRTDAP, PI3, SFN mRNA expression were first reported among patients with OSCC. Conclusion, the whole transcript expression study and TaqMan real-time qRT-PCR assay were relevant regarding the increase in gene expression in OSCC. In addition, the up-regulation of PI3 and KRT17 might constitute potential candidate molecular biomarkers to diagnose patients with OSCC.