Hepatitis and Novel Wuhan Coronavirus Infection: Observation

A recent epidemic of pneumonia cases in Wuhan China was caused by a novel coronavirus with strong infectivity, the 2019 novel coronavirus (2019-nCoV). The article provides the pulmonary rehabilitation (PR) methods in the principle of 4S (simple, safe, satisfy, save) for patients with pneumonia caused by the novel coronavirus, shows how to establish a ventilative and convectional PR environment to prevent the spread of virus through droplets, how to guide the patients to carry out PR, how to carry out respiratory muscle training, effective cough, expectoration, sneeze, general exercise, digestive function rehabilitation and psychological rehabilitation, and how to clean and disinfect the PR environment.

In December 2019, the outbreak of novel coronavirus (2019-nCoV) in Wuhan, China, attracting attention worldwidely. The novel coronavirus has the characteristics of rapid transmission, atypical clinical symptoms, and easy to affect both lungs, leading to missed diagnosis and misdiagnosis, as well as difficult to detection and assessment at early stage. Fever, cough, myalgia, weakness, dyspnea and imagings may be helpful for the early detection of novel coronavirus pneumonia. At the same time, the rate of disease progression, fever, CT manifestations, hypoxia degree, age, basic diseases, and laboratory indicators can also be used to evaluate the severity of the novel coronavirus pneumonia.

Objective To investigate the effective regimen and security to treat the hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT).Methods The clinical data of 9 cases of HCV related end-stage hepatopathy after liver transplantation were retrospectively analyzed.Five patients with recurrent HCV after OLT were selected for treatment,and all of them were given pygylated interferon αα-2a and ribavirin.The treatment course was 48 weeks.The changes in hemoglobin,white blood cells,transaminase,and HCV RNA copies were observed before and after treatment.The early viral response (EVR),sustained viral response (SVR) and adverse reactions were assessed.Results Three cases out of 5 cases of HCV recurrence after OLT obtained EVR within 12 weeks,all of them obtained SVR after the treatment,and the function of the transplanted liver returned to normal; In one case,HCV RNA was declined by less than 102 copies after 12 weeks of treatment,and the treatment was terminated; In one case,HCV RNA was declined by greater than 102 copies after 12 weeks of treatment,and at 24th week,HCV RNA was still positive and the treatment was terminated,but HCV RNA remained at a low level at 48th week.Side effects occurred in all 5 cases after antiviral treatment,and alleviated after symptomatic treatment.Conclusion To treat the recurrence of HCV timely after OLT by pygylated interferon (in combination with ribavirin was safe,and the majority of patients could achieved sustained virological response. Key words: Liver transplantation; Hepatitis C; Therapy

The novel coronavirus pneumonia (NCP) has spread from Wuhan to all parts of China since December 2019, and the prevention and control of NCP is a top priority for medical staff. Now report three cases of NCP patients, whose viral nucleic acids still positive in stool after throat swab detection turned negative. In view of the highly homologous and similar clinical manifestations between the 2019 novel coronavirus (2019-nCoV) and the severe acute respiratory syndrome(SARS) related coronaviruses, it is recommended to attach great importance to the detection of the viral nucleic acids in stool, with the reference of SARS prevention and control experience. In order to minimize the risks of gastrointestinal spread, the detection of 2019-nCoV nucleic acids in stool may be recommended as the reference standard of disisolation and discharge. Key words: Novel coronavirus pneumonia; Stool; Throat swab; Prevention and control

A flare-up of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) started in the city of Wuhan in China and is viewed as another strain that has not been distinguished earlier in people. SARS-COV-2 dominatingly causes sickness that ranges from the basic virus to progressively SARS. Clinical highlights of the disease involve respiratory side effects as fever, hack, brevity of breath, and sore throat. Assessment and treatment of patients during COVID-19 pandemic is a test for the dental experts because of close face to face contact with the patients, thus implicating the requirement of prudent disease control measures. This article reviews the dental contemplations during COVID-19 flare-up in dental settings and prescribed administration conventions to dental experts in influenced territories.

Objective To study the clinical characteristics of 2019 coronavirus (2019-nCoV) pneumonia patients and make a feasible screening process in fever clinic. Methods Epidemiologic features, clinical presentation, laboratory findings and image features of the screened patients were retrospectively collected and analyzed. Results Totally, 46 patients were screened, 9 of them were laboratory-confirmed 2019-nCoV infection, and others were defined as laboratory-excluded patients. Laboratory-confirmed patients had higher frequency of travelling or residence in Wuhan within two weeks of onset (P 0.05). The most common feature of the laboratory-confirmed patients was fever (100%), but the symptoms showed no differences between the two groups (P>0.05). Laboratory-confirmed patients had lower white blood cell count than the laboratory-excluded patients (P<0.05), and all of them had pneumonia in chest CT scan. None of the patients with normal chest CT had positive 2019-nCoV nucleic acid test. Conclusions No specific symptom was helpful in the diagnosis of 2019-nCoV infection. However, patients without chest CT scan changes had a very low risk of 2019-nCoV infection despite of the epidemiologic history and fever. We recommended a screening procedure that might be helpful to reduce the rate of miss diagnosis and improve screening efficiency. Key words: 2019-nCoV; pneumonia; fever; chest CT

The clinical spectrum of 2019 novel coronavirus (2019-nCoV) infection is still being defined. Now, investigators describe the characteristics of 99

It is stated that the acute phase protein levels increased during the inflammatory reactions such as trauma ,aseptic necrosis and infections. Present study is to study the levels of acute phase protein synthesis in the liver disorders like cirrhosis of liver and infective hepatitis. Materials And Methods: 50 cases of liver disorders and 10 normal individuals were chosen for the present study. Determination of serum ceruloplasmin, transferrin, A/G ratio, serum total bilirubin, alanine amino transferase, alkaline phosphatase, HDL cholesterol, total cholesterol is done. Results: when compared with controls, a significant increase (P 0.001) decrease in total proteins and albumin is observerd in cases of cirrhosis of liver . A significant increase (P 0.5) decrease in total proteins and albumin is observerd in cases of infective hepatitis . Discussion: Elevated ceruloplasmin levels are characteristically present in acute infections and various inflammatory states. Many pathological conditions are accompanied by a marked increase in plasma copper and ceruloplasmin levels. Serum ceruloplasmin levels increased both in cirrhosis of liver and viral hepatitis in this study. An increase in transferrin levels is seen in hemochromatosis and infective hepatitis. In this study there is decrease in albumin levels in all cases of liver diseases more so in cirrhosis of liver is seen. Conclusion: Increased levels of serum ceruloplasmin and transferrin levels indicates the liver disorders with tissue lesions accompanied by inflammatory process. The acute phase proteins in liver disorders may play a role in the process of regeneration of damaged tissues. I. Introduction It is stated that the acute phase protein levels increased during the inflammatory reactions such as trauma ,aseptic necrosis and infections. Acute phase proteins are synthesized in liver.To establish the variations in acute phase protein synthesis in the liver disorders like cirrhosis of liver and infective hepatitis. (1)This work is done..The diagnosis of cirrhosis of liver is established by the other parameters like serum bilirubin , alanine amino transferase , alkaline phosphatase . Acute phase proteins which show marked increase in concentration during the early stages of disorders with tissue lesions accompanied by inflammation such as trauma , aseptic necrosis and infections. The term acute phase protein is imprecise as the same proteins also show up with high plasma concentration and high rate of synthesis in conditions accompanied by sub-acute or chronic inflammation. The difference between the plasma protein pattern in acute and in chronic inflammation mainly concerns the immunoglobulins and not the acute phase proteins. An increase in plasma concentrations of acute phase proteins is a regular part of inflammatory response. Ceruloplasmin and transferrin are included in the group of acute phase proteins, but their increase during most acute inflammation is less pronounced that of the other proteins. The other acute phase proteins that are changed in liver disorders are alpha-1 antitrypsin, c- reactive protein and fibrinogen etc. In viral hepatitis and cirrhosis, the serum albumin levels bear a close relation to the clinical state and are helpful in prognosis and treatment of the disease.(2)

Chairmen:Prof. Y.T. Xiong, Wuhan University, China;Prof. G.X. You, Wuhan University, China;Prof. Z.B. You, Wuhan University of Technology, China;Members:Prof. H. Davis, Boya Century Publishing Ltd., Hong Kong;Prof. K. Georgiou, University of Waterloo, Canada;Prof. W.L. Xiao, Wuhan University of Science and Technology, China;Prof. H.W. Hua, Wuhan University of Technology, China;Prof. J.X. Zhang, Wuhan University of Technology, China;Prof. J.Y. Zhong, Huazhong University of Science and Technology, China;Prof. J.D. Wang, Wuhan University of Science and Technology, China;Prof. T. Cui, Guizhou Institute of Technology, China;Prof. W.L. Su, China University of Geosciences, China;Prof. H.F. Liu, Jiangsu University, China;Prof. H.Y. Zhu, Chongqing University, China;Prof. X.J. Gao, Hefei University of Technology, China;Prof. X.P. Han, Jiangsu University of Science and Technology, China;Prof. H. Chen, Shanghai University of Engineering Science, China;Dr. J. Hu, Ohio State University, USA;Dr. W. Zhong, New York State University at Stony Brook, USA;Dr. C.W. Yang, Wuhan University of Science and Technology, China;Dr. W.M. Luo, Wuhan University of Science and Technology, China;Dr. G.W. Yang, Shanghai University, China;Dr. H.T. Zhang, South China University of Technology, China;Mr. Q. Yun, Chi Shun Chemical Co., Ltd., China.Organizing Committee:Prof. Z.B. You, Wuhan University of Technology, China;Prof. S. Hu, Wuhan University of Technology, China;Prof. D.G. Yang, Wuhan University, China;Prof. T. Liu, Wuhan University of Science and Technology, China;Dr. C.W. Yang, Wuhan University of Science and Technology, China;Dr. S.F. Zhao, Wuhan University of Science and Technology, China;Dr. W.M. Luo, Wuhan University of Science and Technology, China;Dr. G.L. Liu, Wuhan University of Technology, China;Dr. X. Xiao, Wuhan University of Technology, China;Ms. Y.F. Ma, Hubei New Wen Sheng Conference Co., Ltd., China;Mr. Z.P. Ma, Hubei New Wen Sheng Conference Co., Ltd., China;Mr. B.T. Zhou, Hubei New Wen Sheng Conference Co., Ltd., China;Mr. H.T. Ke, Hubei New Wen Sheng Conference Co., Ltd., China;Mr. X.L. Jiang, Hubei New Wen Sheng Conference Co., Ltd., China;Mr. Y.J. Shi, Hubei New Wen Sheng Conference Co., Ltd., China;Ms. W.H. Qin, Hubei New Wen Sheng Conference Co., Ltd., China;Ms. D.W. Liu, Hubei New Wen Sheng Conference Co., Ltd., China.

Background: In the outbreak of infectious diseases, non-pharmacological intervention might be the only available protection tools.The aim of this systematic review is to investigate whether it is or is not necessary to wear masks in new corona virus (COVID-19) outbreaks in the community.Methods: On February, 28, 2020, related databases were searched with the following keywords: "COVID-19"; "COVID 19"; 2019-nCoV; 2019-CoV; coronavirus; mask* and facemask.We updated the search in March 13, 2020.A total of 982 relevant reports were identified after removing duplicates.Of these, 71 references were screened based on titles and abstracts.After excluding unrelated studies, 36 studies were included in the full-text review and were assessed for eligibility.Finally, 3 articles met our inclusion criteria. Results:In three wards of hospital with more exposure to infected patients, wearing the N95 respirator while using regular disinfectants and hand hygiene, was a better way to prevent COVID-19 transmission from patients to nurses and physicians when compared to non-users of masks.Another study on family members with a history of travelling to Wuhan, showed that those who had worn a surgical mask only during the hospital visit, were infected.However, the 7 years old child of the family who wore a surgical mask, was not found to be infected by COVID-19.Finally, none of eleven healthcare workers who had unprotected exposure with confirmed cases were infected. Conclusion:Due to the newness of the COVID-19 virus, no clinical trials have been found regarding the use of the masks in the prevention of the disease, and the level of evidence were low.

Hepatitis C virus (HCV) is one of leading causes for chronic liver diseases, the treatment area has been changed rapidly since direct acting antiviral agents (DAAs) were approved to treat patients with chronic HCV infection. To cure hepatitis in 2030 is the goal set by World Health Organization. However, globally, especially in China, there are still many difficulties needing to be resolved on the cure road of chronic hepatitis C, such as large patient population, high percentage of untreated patients, nonstandard DAA treatment, low efficacy of special groups, and resistance-associated variants in baseline, etc. This comment will focus on the new demands for HCV related clinical examinations for DAA treatment, so as to improve the treatment effectiveness and to help achieve the goal of eliminating viral hepatitis. Key words: Hepacivirus; Hepatitis C; Antiviral agents; Clinical laboratory techniques

\nIn December 2019, a novel coronavirus (2019-nCoV) was detected in Wuhan Hubei province, China. The virus has caused a global concern because of its high potential for transmission, high morbidity and mortality. COVID-19 spreads so rapidly across an increasing number of countries worldwide that it has been found in more than 200 countries so far. The World Health Organization (WHO) has declared COVID-19 a pandemic and public health threat. In general, COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A case fatality rate of approximately 2.3% has been reported for COVID-19. New fever, cough, lymphopenia and bilateral lung infiltrations are characteristic but not diagnostic for COVID-19. Sore throat, dyspnea, myalgia, diarrhea, and abdominal pain are other presentations of COVID-19. We should also be attentive to the probability of atypical presentations in patients who are immunocompromised. While the majority of cases result in mild respiratory tract symptoms like acute bronchitis, severe cases might end in severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and death due to multiorgan damage, so early recognition of patients with suspected COVID-19 infection is crucial. The burden of the virus is not limited to physical damage, but it also has a significant impact on the mental health of the public. It can lead to generalized anxiety disorders and depression during COVID-19 pandemic. Now many countries are in a state of crisis worldwide. Whenever the living environment changes, people feel unsafe. People's fear of COVID-19 makes them refrain from going to medical centers, which significantly impacts their access to medical care while they require acute treatment. COVID-19 outbreak in countries has pulled essential medical resources away from regular procedures. This has caused complications for patients who need treatment for other medical conditions that require timely and appropriate care. Cancer patients especially still require attention in curative or palliative settings, and women will still be delivering their infants. How can we care for these patients without exposing them to COVID-19?\n

Background: The novel coronavirus disease (COVID-19) which was identified in the month of December 2019 at Wuhan city of China and spread all over the world has now achieved pandemic status. It affects the physical and mental lives of millions of people and increases the mortality rate internationally. It also affects the mental well-being of the individuals and produces many psycho-social distresses and reduced adjustment mechanism and coping strategies to fight with coronavirus. Objectives: The prime objective of this present study was to find out the various psycho-social distresses associated with COVID-19 prevailing on different variables of socio-demographic details such as gender, their cultural background, age, education, marital status, and pre-existing medical conditions. Sample: A total of 120 samples were chosen through a purposive sampling technique that belonged to the urban and rural backgrounds of different parts of the country. Only those were selected who contacted the undersigned through telephonic communication related to their psycho-social distresses associated with COVID-19. There were no barriers to the age bar in the collection of data. Research design: This is a cross-sectional study. Those who were reported about psychosocial distress related to COVID-19 were included in the study. Variable: The independent variables are gender and different psycho-social variable like age, education, marital status, and pre-existing medical conditions. Their impact was examined on the dependent variable of expression and apprehension of psycho-social distress associated with COVID-19 symptoms such as fear, anxiety, depression, suicidal ideation, lack of sleep, lack of appetite, headache, irritation/ anger, lack of concentration and poor memory. Research tools: Data were collected through telephonic communication on the self-made questionnaire. Those who are anxious and apprehended about the symptoms of COVID-19 and used psychological support system through telephonic communication from 28th March 2020 to 20th Apr 2020 included in the study. Result: Fear and depression was most common psycho-social distresses (120, 100% on each) followed by anxiety (106, 88.34%), lack of sleep (54, 45%), headache (52, 43.34%), lack of appetite (38, 31.67%), irritation/ anger (36, 30%), lack of concentration/ poor memory (34, 28.34%). Suicidal ideation was found at least common psycho-social stresses related to COVID-19 which was found only in 33, 27.5% of cases. The contents of fear, anxiety, and depression were varied from the people of one socio-demographic domain to other. Those who don’t have a pre-existing medical history of any diseases were felt more psycho-social distresses (42, 35%) than those having the pre-existing medical history of any diseases such as hypertension (24, 20%), diabetes (27, 22.5%), heart problems (12, 10%) or any other medical conditions or psychiatric problems (15, 12.5%). Conclusion: Fear and depression were the most common and suicidal ideation were the least common psycho-social distresses related to COVID-19. Those who don’t have a pre-existing medical history of any diseases were felt more psycho-social distresses than those having the pre-existing medical history of any diseases such as hypertension diabetes, heart problems, or any other medical conditions or psychiatric problems.

Objective To analyze the characteristics of dry eye syndrome in viral hepatitis patients.Methods Two hundred and ninety-two patients with viral hepatitis,including 253 cases of hepatitis B,39 cases of hepatitis C visited our department of ophthalmology and were enrolled in this study.All patients received eye examination and liver function tests,including medical history,slit lamp examination,corneal fluorescein staining,tear film break-up time (BUT) and schirmer test,alanine aminotransferase (ALT),total bilirubin (TBil),albumin (ALB).Results In the 292 cases of viral hepatitis,there were 208 dry eye cases and 84 non-dry eye cases.In 169 male cases,119 cases had dry eyes; in 123 femalecases,89 cases were with dry eyes.In the dry eyes group and non-dry eyes group,the ages were 47 ± 12 and 44 ± 13 years old,respectively.The median values of alanine aminotransferase was 37.61U l-1 and 27.3U l-1; the median values of total bilirubin were 25.26umol· l-1 and 15.35umolⅠ·l-1 and albumin values were 41.81 ±6.49g l-1,43.56 ± 4.59g l-1.There were statistics difference in age,total bilirubin and albumin values between dry eye and non-dry eye groups.In the 208 hepatitis B patients,85.10％ showed dry eye (177 cases) ; 14.90％ of the 31 hepatitis C cases had dry eyes.There was no significant difference between the prevalence of dry eye syndrome in hepatitis B and hepatitis C viral hepatitis patients.There was no significant difference in Schirmer I test and BUT between different types of viral hepatitis.Ages and total bilirubin values were the correlation factors in viral hepatitis and dry eye.Conclusions Viral hepatitis patients with dry eye syndrome has its own characteristics,including high incidence of dry eyes in patients with viral hepatitis.Dry eye has no correlation with gender.There was no significant difference of dry eye syndrome in hepatitis B and hepatitis C patients.Age and total bilirubin values correlated with viral hepatitis and dry eye. Key words: Dry eye syndrome; Viral hepatitis; Hepatitis B; Hepatitis C; Correlation factor

Objective To study the manifestations of digestive system of hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and to provide a reference for disease control and treatment. Methods The data of hospitalized patients with COVID-19 in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 27 to February 14, 2020 were retrospectively analyzed, which included general information, positive rate of nucleic acid test, severity of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected Chi-square test and independent sample median Chi-square test were used for statistical analysis. Results Among the 305 patients, there were 146 males (47.9%) and 159 females (52.1%), and the median age was 57 years old. Nucleic acid assay of nasopharyngeal swabs or pharyngeal swabs were positive in 84.1% (228/271) patients including 46 patients (15.1%) of critical group and 259 patients (84.9%) of non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms were mainly fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, with a median time of 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. After excluding possible drug-related diarrhea, the incidence of diarrhea was still 22.2%. Only 6.9% (4/58) of patients had positive fecal leukocytes or fecal occult blood test. Alanine aminotrans ferase (ALT), aspartate aminotransferase (AST), or total bilirubin (TBil) increased in 39.1% (119/304) of patients on admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased TBil level, and the average level was (37.4±21.1) μmol/L. The median age of critical group was older than that of non-critical group (65 years vs. 56 years), the proportion of patients with abnormal liver function and slightly increased AST (40- 0.05). Conclusions The manifestation of digestive system of hospitalized COVID-19 patients in Wuhan is significant, the proportion of patients with diarrhea and abnormal aminotransferase level is high. And on admission the proportion of patients with abnormal liver function of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of COVID-19. Key words: 2019-nCoV; COVID-19; Diarrhea; Liver function; Gastrointestinal tract