Objective To evaluate the risk factors associated with in-hospital death in patients co-infected with human immunodeficiency virus and Mycobacterium tuberculosis (HIV-TB). Methods A retrospective case-control study was performed in patients admitted to Shanghai Public Health Clinical Center from November 2004 to May 2009. Fifty-three HIV-TB patients who died during hospitalization were matched with 79 HIV-TB co-infected patients who survived during hospitalization.Clinical, demographic, and radiological characteristics of the two groups were compared by the retrospective case-control study method. Multivariate Logistic stepwise regression analysis was performed to explore the risk factors contributing to death in HIV-TB co-infected patients. Results Among the 459 co-infected patients, 53 (11.5%) cases died during hospitalization and 25 cases died during the first week in hospital. Sixty-four point two percent dead patients (34/53) died from tuberculosis. Several factors were associated with worse prognosis in the death group compared to the survival group, which included body weight≤50 kg (χ2 = 7.50), positive for acid-fast bacilli in sputum smear or culture exam (χ2= 4. 04, 14. 27), drug-resistant/multi-drug resistant Mycobacterium tuberculosis infection (χ2 =9.00,6.39), extra-pulmonary tuberculosis infection (χ2 =6.99), retreated tuberculosis (χ2 = 5. 92), non-standardized anti-tuberculosis treatment (χ2 = 12. 07), extensive pulmonary TB infection (lesions ≥50% of lung fields, χ2 = 20. 21), co-infection with fungi (χ2 =3.46), respiratory failure (χ2 = 4.27), non-pulmonary organ impairment (χ2 = 3.46), HIV infection longer than 5 years (χ2 = 7. 19), non-standardized highly active antiretroviral therary treatment (χ2 =5.16) and CD4+ T lymphocyte count ≤ 200 × 106/L (χ2= 12.99) (all P＜0. 05). Multivariate Logistic regression analysis showed that non-standardized anti-TB treatment, extensive pulmonary TB infection, multi-drug resistant TB infection and CD4+ T lymphocyte count ≤ 200 × 106/L were the major risk factors related to in-hospital mortality. Conclusions Non-standardized anti-TB treatment,extensive pulmonary TB infection, multi-drug resistant TB infection and CD4+ T lymphocyte count ≤200 × 106/L are the major risk factors related to in-hospital mortality in the patients co-infected with TB and HIV.

H7N9 avian influenza is the latest subtype of influenza virus to emerge in the world. By April 17, 2013 in Shanghai, a total of 31 confirmed cases were reported, and 11 of these patients died. The epidemiological characteristics and the clinical progress of this new human flu infection are still not clear. Thirteen confirmed patients have now been treated in Shanghai Public Health Clinical Center. Among the first batch of patients, hospitalised at the beginning of April 2013, two who were admitted with the same estimated date of onset of disease had very different outcomes. After active treatment at the Centre, one recovered by April 18, 2013, but one patient entered critical condition and died on April 11, 2013. The clinical and laboratory characteristics in hospital are here analysed and compared to learn more about H7N9 avian influenza. Confirmation that the observed differences are valuable for prognosis and treatment decisions for H7N9 patients awaits authentication by analysis of more patients.
Influenza in Birds ; Influenza A Virus, H7N9 Subtype ; Communicable Diseases ; Laboratories

Objective:To analyze the effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) on coronavirus disease 2019 (COVID-19) patients with hypertension, and to provide an evidence for selecting antihypertensive drugs in those patients.Methods:Clinical data were retrospectively analyzed in 58 COVID-19 patients with hypertension admitted to Shanghai Public Health Clinical Center from January 20 to February 22, 2020, including epidemiological history, clinical manifestations, laboratory findings, chest CT and outcome. Patients were divided into ACEI/ARB group and non-ACEI/ARB group.Results:Twenty-six patients were in ACEI/ARB group and the other 32 patients in non-ACEI/ARB group, with median age 64.0 (49.5, 72.0) years and 64.0 (57.0, 68.8) years respectively. The median time to onset was 5(3, 8) days in ACEI/ARB group and 4 (3, 7) days in non-ACEI/ARB group, the proportion of patients with severe or critical illness was 19.2% and 15.6% respectively. The main clinical symptoms in two groups were fever (80.8% vs. 84.4%) and cough (23.1% vs. 31.3%). The following parameters were comparable including lymphocyte counts, C-reactive protein, lactate dehydrogenase, D-dimer, bilateral involvement in chest CT (76.9% vs. 71.9%), worsening of COVID-19 (15.4% vs. 9.4%), favorable outcome (92.3% vs. 96.9%) between ACEI/ARB group and non-ACEI/ARB group respectively (all P>0.05). However, compared with non-ACEI/ARB group, serum creatinine [80.49 (68.72, 95.30) μmol/L vs. 71.29 (50.98, 76.98) μmol/L, P=0.007] was higher significantly in ACEI/ARB group. Conclusions:ACEI/ARB drugs have no significant effects on baseline clinical parameters (serum creatine and myoglobin excluded) , outcome, and prognosis of COVID-19 patients with hypertension. Antihypertensive drugs are not suggested to adjust in those patients, but the potential impairment of renal function as elevation of serum creatinine should be paid attention in patients administrating ACEI/ARB drugs.

Administration, Intravenous ; Ascorbic Acid/therapeutic use* ; COVID-19 ; Humans ; Pneumonia ; SARS-CoV-2

Tuberculosis (TB) is an ancient infectious disease. Before the availability of effective drug therapy, it had high morbidity and mortality. In the past 100 years, the discovery of revolutionary anti-TB drugs such as streptomycin, isoniazid, pyrazinamide, ethambutol and rifampicin, along with drug combination treatment, has greatly improved TB control globally. As anti-TB drugs were widely used, multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis emerged due to acquired genetic mutations, and this now presents a major problem for effective treatment. Genes associated with drug resistance have been identified, including katG mutations in isoniazid resistance, rpoB mutations in rifampin resistance, pncA mutations in pyrazinamide resistance, and gyrA mutations in quinolone resistance. The major mechanisms of drug resistance include loss of enzyme activity in prodrug activation, drug target alteration, overexpression of drug target, and overexpression of the efflux pump. During the disease process, Mycobacterium tuberculosis may reside in different microenvironments where it is expose to acidic pH, low oxygen, reactive oxygen species and anti-TB drugs, which can facilitate the development of non-replicating persisters and promote bacterial survival. The mechanisms of persister formation may include toxin-antitoxin (TA) modules, DNA protection and repair, protein degradation such as trans-translation, efflux, and altered metabolism. In recent years, the use of new anti-TB drugs, repurposed drugs, and their drug combinations has greatly improved treatment outcomes in patients with both drug-susceptible TB and MDR/XDR-TB. The importance of developing more effective drugs targeting persisters of Mycobacterium tuberculosis is emphasized. In addition, host-directed therapeutics using both conventional drugs and herbal medicines for more effective TB treatment should also be explored. In this article, we review historical aspects of the research on anti-TB drugs and discuss the current understanding and treatments of drug resistant and persistent tuberculosis to inform future therapeutic development.
Humans ; Pyrazinamide/therapeutic use* ; Isoniazid/therapeutic use* ; Antitubercular Agents/therapeutic use* ; Tuberculosis, Multidrug-Resistant/microbiology* ; Mycobacterium tuberculosis/genetics* ; Tuberculosis/drug therapy* ; Rifampin/therapeutic use* ; Mutation ; Drug Resistance, Multiple, Bacterial/genetics*