Not Only High Number and Specific Comorbidities but Also Age Are Closely Related to Progression and Poor Prognosis in Patients With COVID-19

Background: Some patients with comorbidities and rapid disease progression have a poor prognosis.Aim: We aimed to investigate the characteristics of comorbidities and their relationship with disease progression and outcomes of COVID-19 patients.Methods: A total of 718 COVID-19 patients were divided into five clinical type groups and eight age-interval groups. The characteristics of comorbidities were compared between the different clinical type groups and between the different age-interval groups, and their relationships with disease progression and outcomes of COVID-19 patients were assessed.Results: Approximately 91.23% (655/718) of COVID-19 patients were younger than 60 years old. Approximately 64.76% (465/718) had one or more comorbidities, and common comorbidities included non-alcoholic fatty liver disease (NAFLD), hyperlipidaemia, hypertension, diabetes mellitus (DM), chronic hepatitis B (CHB), hyperuricaemia, and gout. COVID-19 patients with comorbidities were older, especially those with chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). Hypertension, DM, COPD, chronic kidney disease (CKD) and CVD were mainly found in severe COVID-19 patients. According to spearman correlation analysis the number of comorbidities was correlated positively with disease severity, the number of comorbidities and NAFLD were correlated positively with virus negative conversion time, hypertension, CKD and CVD were primarily associated with those who died, and the above-mentioned correlation existed independently of age. Risk factors included age, the number of comorbidities and hyperlipidaemia for disease severity, the number of comorbidities, hyperlipidaemia, NAFLD and COPD for the virus negative conversion time, and the number of comorbidities and CKD for prognosis. Number of comorbidities and age played a predictive role in disease progression and outcomes.Conclusion: Not only high number and specific comorbidities but also age are closely related to progression and poor prognosis in patients with COVID-19. These findings provide a reference for clinicians to focus on not only the number and specific comorbidities but also age in COVID-19 patients to predict disease progression and prognosis.Clinical Trial Registry: Chinese Clinical Trial Register ChiCTR2000034563.

Factors Affecting Generalization of Ocular Myasthenia Gravis in Palembang

Introduction. Ocular myasthenia gravis (OMG) is an autoimmune disease which is characterized by weakness of extraocular muscles, levator palpebrae and orbicularis oculi, resulting in ptosis and binocular diplopia. Nearly all patients present with eyelid and extra ocular muscles involvement. Approximately 30% to 80% of patients with OMG experience a conversion to generalized myasthenia gravis (GMG) within 2 years. There are not only have ptosis and diplopia but also limb weakness,bulbar symptoms, or even respiratory failure. This study was aimed to observe the clinical features of OMG to GMG and risk factors and median time to conversion of OMG to GMG of myasthenia gravis patients in Mohammad Hoesin General Hospital Palembang. Method. This study is a cohort retrospective study and the data were collected from the medical records of 91 patients who were registered as myasthenia gravis patients during September 2018 to March 2020. Sosiodemographic and clinical characteristics, including onset of OMG to GMG, history of smoking, presence of thymic abnormalities, and medications received were reviewed retrospectively. Result. A total of 91 OMG patients were observed in this study with 32 (35,2%) patients converted from ocular myastenia gravis to general myastenia gravis. Median conversion time to GMG was 34 months. Risk factor for convertion cases of OMG to MGG was receiving immunosupressive agents (Risk: 14.7, 95% CI 4.83, 44.7), thymus hyperplasia (Risk: 3.36, CI 95% 0.33, 33.6), Female (Risk: 2.41, 95% CI 0.94, 6.17), Smoking (Risk: 1.56, 95% CI 0.31, 7.81). Conclusion. Ptosis was the definitive sign for OMG in this study, with all patients had ptosis, thus it needs the colaboration from neuroophthalmologist and neurologist to diagnose and manage this case. Most of converted case was female and those who receive an immunosupressive agent therapy.

Fast Improvement of TEM Images with Low-Dose Electrons by Deep Learning

Low electron dose observation is indispensable for observing various samples using a transmission electron microscope; consequently, image processing has been used to improve transmission electron microscopy (TEM) images. To apply such image processing to in situ observations, we here apply a convolutional neural network to TEM imaging. Using a dataset that includes short-exposure images and long-exposure images, we develop a pipeline for processed short-exposure images, based on end-to-end training. The quality of images acquired with a total dose of approximately $5$ $e^{-}$ per pixel becomes comparable to that of images acquired with a total dose of approximately $1{,}000$ $e^{-}$ per pixel. Because the conversion time is approximately 8 ms, in situ observation at 125 fps is possible. This imaging technique enables in situ observation of electron-beam-sensitive specimens.

Unjuk Kerja GPIO, PWM, ADC dan Timer pada Mikrokontroler STM32F103, ESP32S dan ATMega328

Perangkat embedded system pada masa sekarang memiliki banyak pilihan terhadap jenis mikrokontroler yang sesuai dengan kebutuhan. Hal ini menjadi tantangan tersendiri bagi pengguna ketika diharuskan untuk memilih salah satu jenis mikrokontroler tersebut. Sebagai contoh permasalahan apakah mikrokontroler yang telah dipilih tersebut memiliki sejumlah pin GPIO yang diinginkan, dengan frekuensi switching yang tinggi, berapakah jumlah kanal, resolusi, linieritas dan durasi konversi ADC, bagaimana kemampuan peripheral internal DAC, Timer dan PWM yang bisa dibangkitkan dari mikrokontroler tersebut. Penelitian ini telah membandingkan setidaknya 4 peripheral internal utama yang dimiliki oleh 3 jenis mikrokontroler. Metode yang dilakukan adalah dengan menguji karakteristik GPIO, PWM, TIMER dan ADC pada 3 jenis mikrokontroler yaitu Arduino ATMega328, STM32F103C8 dan ESP32. Eksperiment dilakukan dengan mengevaluasi frekuensi switching digital ouput, mengevaluasi resolusi sinyal hasil konversi ADC, mengevaluasi ketepatan hasil instruksi delay berkaitan dengan timer program dan waktu konversi sinyal DAC semuanya dilakukan pada masing-masing mikrokontroler. Hasil akhir dari penelitian ini menunjukkan, mikrokontroler ESP32 memiliki unjuk kerja GPIO, PWM, TIMER dan ADC terbaik apabila dibandingkan dengan jenis lainnya. Penelitian ini juga membuktikan integrasi FreeRTOS pada Framework Arduino bisa berfungsi dengan optimal meskipun mikrokontroler berjalan pada 2 task yang berbeda di 2 core CPU yang bekerja secara pararel. Frekuensi switching digital output pada ESP32 mampu mencapai 3MHz, waktu konversi ADC hanya 5,7us dan DAC hanya 3,7us. Today's embedded systems have many choices for the type of microcontroller that suits the needs. This is a challenge in itself for users when required to choose one type of microcontroller. For example, the problem of whether the selected microcontroller has the desired number of GPIO pins, with a high switching frequency, what is the number of channels, resolution, linearity, and duration of the ADC conversion, what is the ability of the internal DAC, Timer and PWM peripherals that can be generated from the microcontroller. This study has compared at least 4 main internal peripherals owned by 3 types of microcontrollers. The method used is to test the characteristics of the GPIO, PWM, TIMER, and ADC on 3 types of microcontrollers, namely Arduino ATMega328, STM32F103C8, and ESP32. The experiment was carried out by evaluating the digital output switching frequency, evaluating the signal resolution of the ADC conversion result, evaluating the accuracy of the delay instruction results related to the program timer and DAC signal conversion time, all of which were carried out on each microcontroller. The final results of this study indicate that the ESP32 microcontroller has the best GPIO, PWM, TIMER, and ADC performance when compared to other types. This research also proves that the FreeRTOS integration on the Arduino Framework can function optimally even though the microcontroller runs on 2 different tasks on 2 CPU cores that work in parallel. The digital output switching frequency on the ESP32 is capable of reaching 3MHz, the ADC conversion time is only 5.7us and the DAC is the only 3.7us.

Synergic Role of Dexamethasone And Lianhua Qingwen Capsule Accelerate Nucleic Acid Negative Conversion In Severe COVID-19 Patients

Background:Corticosteroids were recommended by guidelines in severe or critical COVID -19 patients likely to have acute respiratory distress syndrome. In the treatment strategies of COVID -19 in China, corticosteroids were generally combined with some traditional Chinese medicine, especially Lianhua Qingwen Capsule (LHQW). We aimed to investigate the correlation between dexamethasone with or without LHQW and the nucleic acid negative conversion in severe patients with COVID-19.Methods:The clinical course and nucleic acid negative conversion time of 452 consecutive symptomatic COVID-19 patients admitted to the west campus of Union Hospital in Wuhan from January 31, 2020, to March 13, 2020, were evaluated retrospectively. Results:The duration of virus RNA from positive to negative in the participants was 28 days (interquartile range 21-34 days). Of the 452 patients, 105 (23.23%) subjects received dexamethasone, and 347 (76.77%) did not. Among patients receiving LHQW treatment, the nucleic acid negative conversion time in the dexamethasone group was shorter than that in the no dexamethasone group (𝛽, -4.77; 95% CI, -9.41, -0.12). Although among those who were receiving no LHQW treatment, the effect on shortening nucleic acid negative conversion time of dexamethasone was not observed (𝛽, 5.37; 95% CI,-4.88, 15.62; p interaction = 0.038). Additional multivariable propensity-score analyses yielded consistent results with the unmatched participants (β, -8.61; 95% CI, -16.73, -0.50).Conclusions：In patients hospitalized with COVID-19, the use of dexamethasone resulted in shortening nucleic acid negative conversion time among those who were receiving LHQW, suggesting that LHQW synergic with dexamethasone accelerated the SARS-CoV-2 clearance in severe patients. Trial registration：ECUH 2020-0212, a retrospective study.

Median Nucleic Acid Conversion Time and The Clinical and Laboratory Parameters Affecting It in Patients with COVID-19

Background: The time for PCR positivity to negativity is defined as nucleic acid conversion time (NCT) and is very important in terminating the isolation of patients and determining infectiousness in patients with COVID-19. Objective: The aim of this study is to determine the median NCT and to evaluate the clinical and laboratory parameters affecting it in patients with COVID-19. Methods: This study included 318 mild to moderate patients with COVID-19 diagnosed with PCR positivity retrospectively. Results: The median NCT was 11 days. Patients were divided into 2 groups as early (<11 days) and late conversion (>=11 days). Older age, sore throat, onset fever, fever 72 hours after hospitalization, history of exposure to SARS-CoV-2 virus without a mask and moderated disease were significantly more common in the late conversion group. In addition, favipiravir use was higher in early conversion group and hydroxychloroquine use was higher in late conversion group. In multivariate analysis, sore throat (OR = 2.570; 95% CI: 1.051-6.284) and hydroxychloroquine use (OR = 3.518, 95% CI: 1.163-10.635) were independent risk factors for late conversion. Favipiravir use (OR = 0.062, 95% CI: 0.021-0.184) negatively affected the late conversion. Conclusion: NCT was longer in patients with COVID-19 who had sore throat at admission and were treated with hydroxychloroquine instead of favipiravir. Keywords: COVID-19, Nucleic Acids, Polymerase Chain Reaction, SARS-CoV-2.

The value of early positive nucleic acid test and negative conversion time of SARS-CoV-2 RNA in the clinical outcome of COVID-19 patients

Background The outbreak of coronavirus disease (COVID-19) poses a great threat to the global public health. At present, the number of new confirmed COVID-19 cases and new deaths is increasing worldwide. The strategy of comprehensive and scientific detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes COVID-19) through real-time reverse transcriptase polymerase chain reaction (RT-PCR) for special populations and environments provides great support for the prevention and control of this pandemic in China. Our study focused on determining the factors associated with the length of time from symptom onset to the first positive nucleic acid test of throat swabs in COVID-19 patients, evaluating the effect of early positive nucleic acid detection on the disease severity and its significance in prognosis, and predicting the factors associated with the time from positive SARS-CoV-2 RNA test to negative conversion in COVID-19 patients. Methods This study included 116 hospitalized patients with COVID-19 from January 30, 2020 to March 4, 2020 in Wuhan, China. Throat swabs samples were collected for real-time reverse transcriptase polymerase chain reaction (RT-PCR) test of SARS-CoV-2 RNA, and all patients included in this study were positive for this test. Results Multivariate Cox proportional hazards model showed that disease severity and the duration of disease before admission to hospitals were protective factors for the time from symptom onset to positive nucleic acid detection, and the time from positive nucleic acid test to negative conversion was a risk factor for the time from symptom onset to positive nucleic acid detection. Meanwhile, the time from symptom onset to positive nucleic acid detection was an independent risk factor for the prolonged negative conversion of SARS-CoV-2 virus. Conclusions Patients with more severe disease and longer duration of disease before admission to hospitals had a shorter time from symptom onset to positive nucleic acid test. Prolonged time from symptom onset to positive nucleic acid test was an independent risk factor for the prolonged negative conversion time of SARS-CoV-2 virus, and the severity of the disease had no correlation with negative conversion time of SARS-CoV-2 virus.

Safety and Efficacy of Ibutilide for Acute Pharmacological Cardioversion of Rheumatic Atrial Fibrillation

<b><i>Introduction:</i></b> Ibutilide is indicated for acute cardioversion of nonvalvular atrial fibrillation (AF). However, its efficacy and safety in the pharmacological cardioversion of rheumatic AF are unknown. <b><i>Methods:</i></b> Patients with mild-to-moderate rheumatic mitral valve (MV) disease with symptomatic, paroxysmal, or persistent AF were included in the analysis. Intravenous ibutilide was administered at doses tailored to body weight (0.5–2.0 mg) for over 10 min. The primary end point was efficacy, assessed as the rate of conversion of AF to sinus rhythm. The secondary end point was safety, including arrhythmic events and death within 24 h of drug initiation. <b><i>Results:</i></b> From June 2016 to October 2018, 165 patients (94 with mitral stenosis, 23 with mitral regurgitation, 11 with mixed MV disease, and 37 with MV replacement) received ibutilide (mean dose 0.90 ± 0.54 mg). Ibutilide successfully converted AF to sinus rhythm in 127/165 (76.9%) patients, with a conversion time of 7.9 ± 4.1 min. The QTc increased from 419.9 ± 15.8 to 487.5 ± 34 ms after ibutilide administration (<i>p</i> &#x3c; 0.001). The mean change in QTc after ibutilide administration (∆QTc) was 72.01 ± 36.03. There were no deaths, but 3 patients (1.8%) developed torsades de pointes (TdP) requiring defibrillation 55 ± 37 min after infusion. <b><i>Conclusion:</i></b> Ibutilide cardioverted 77% of rheumatic AF to sinus rhythm, indicating its potential as a clinically useful option for pharmacological cardioversion of rheumatic AF. TdP is a potentially serious adverse event that requires careful monitoring.