The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnos...The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.展开更多
Background:The urbanization and industrialization of East and Southeast Asia in decades past has significantly altered living environment and lifestyles,which may have complicated effects on the burden of asthma.We ai...Background:The urbanization and industrialization of East and Southeast Asia in decades past has significantly altered living environment and lifestyles,which may have complicated effects on the burden of asthma.We aim to examine the patterns and trends of asthma incidence rates in six major East and Southeast Asian countries as well as five major Western countries,and predict the numbers of new cases attributed to various factors.Methods:Data on annual asthma incident cases and corresponding population by age group were drawn from 6 major selected East and Southeast Asian countries available in the Global Burden of Disease database,including China,Japan,Korea,Singapore,Philippines,and Thailand.We also collected data of five major high-income Western countries for comparative purposes.Two separate Bayesian age–period–cohort models,representing pre-COVID(model 1)and post-COVID(model 2)scenarios,were constructed to predict the asthma incidence until 2030.Results:In model 1,the age-standardized incidence rate of asthma will be the highest in the US(1970.07 per 100,000,95%confidence interval[CI]533.05–4455.03),while the lowest incidence rate will be found in Singapore(296.72 per 100,000,95%CI 135.16–899.55)in 2030.Between 1990 and 2030,the incidence of asthma is projected to increase in China and Thailand,with average annual percentages changes(AAPC)ranging from 0.70%to 1.80%.The remaining four Asian countries show a declining trend,with AAPC ranging from-0.51%to-2.00%.In model 2,the US is estimated to have the highest age-standardized incidence rate(902.71 per 100,000,95%CI 375.44–2277.24),while Korea will have the lowest incidence rate(176.46 per 100,000,95%CI 58.77–512.09)in 2030.A decrease in asthma incidence was observed in all countries with the overall AAPC ranging from-3.42%to-0.42%.Notably,a turning point was found around 2020,after which the incidence rates dropped significantly.Conclusions:Pandemic-related factors may temporarily lower the incidence of asthma.The expected increasing asthma incidence in pre-COVID scenario(model 1)should still warrant attention from public health practitioners and call for efforts to reduce the burden of asthma.展开更多
基金supported(in part)by the National Key Research and Development Program of China(2020YFC0845500)the Special Project for Emergency of Hubei Province(2020FCA008)the First Level Funding of the Second Medical Leading Talent Project in Hubei Province。
文摘The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.
文摘Background:The urbanization and industrialization of East and Southeast Asia in decades past has significantly altered living environment and lifestyles,which may have complicated effects on the burden of asthma.We aim to examine the patterns and trends of asthma incidence rates in six major East and Southeast Asian countries as well as five major Western countries,and predict the numbers of new cases attributed to various factors.Methods:Data on annual asthma incident cases and corresponding population by age group were drawn from 6 major selected East and Southeast Asian countries available in the Global Burden of Disease database,including China,Japan,Korea,Singapore,Philippines,and Thailand.We also collected data of five major high-income Western countries for comparative purposes.Two separate Bayesian age–period–cohort models,representing pre-COVID(model 1)and post-COVID(model 2)scenarios,were constructed to predict the asthma incidence until 2030.Results:In model 1,the age-standardized incidence rate of asthma will be the highest in the US(1970.07 per 100,000,95%confidence interval[CI]533.05–4455.03),while the lowest incidence rate will be found in Singapore(296.72 per 100,000,95%CI 135.16–899.55)in 2030.Between 1990 and 2030,the incidence of asthma is projected to increase in China and Thailand,with average annual percentages changes(AAPC)ranging from 0.70%to 1.80%.The remaining four Asian countries show a declining trend,with AAPC ranging from-0.51%to-2.00%.In model 2,the US is estimated to have the highest age-standardized incidence rate(902.71 per 100,000,95%CI 375.44–2277.24),while Korea will have the lowest incidence rate(176.46 per 100,000,95%CI 58.77–512.09)in 2030.A decrease in asthma incidence was observed in all countries with the overall AAPC ranging from-3.42%to-0.42%.Notably,a turning point was found around 2020,after which the incidence rates dropped significantly.Conclusions:Pandemic-related factors may temporarily lower the incidence of asthma.The expected increasing asthma incidence in pre-COVID scenario(model 1)should still warrant attention from public health practitioners and call for efforts to reduce the burden of asthma.
