Hepatobiliary system and intestinal injury in new coronavirus infection(COVID-19):A retrospective study

BACKGROUND An important area of effective control of the coronavirus disease 19(COVID-19)pandemic is the study of the pathogenic features of severe acute respiratory syndrome coronavirus 2 infection,including those based on assessing the state of the intestinal microbiota and permeability.AIM To study the clinical features of the new COVID-19 in patients with mild and moderate severity at the stage of hospitalization,to determine the role of hepatobiliary injury,intestinal permeability disorders,and changes in the qualitative and quantitative composition of the microbiota in the development of systemic inflammation in patients with COVID-19.METHODS The study was performed in 80 patients with COVID-19,with an average age of 45 years,19 of whom had mild disease,and 61 had moderate disease severity.The scope of the examination included traditional clinical,laboratory,biochemical,instrumental,and radiation studies,as well as original methods for studying microbiota and intestinal permeability.RESULTS The clinical course of COVID-19 was studied,and the clinical and biochemical features,manifestations of systemic inflammation,and intestinal microbiome changes in patients with mild and moderate severity were identified.Intestinal permeability characteristics against the background of COVID-19 were evaluated by measuring levels of proinflammatory cytokines,insulin,faecal calprotectin,and zonulin.CONCLUSION This study highlights the role of intestinal permeability and microbiota as the main drivers of gastroenterological manifestations and increased COVID-19 severity.

Decoding the evolution and transmissions of the novel pneumonia coronavirus(SARS-CoV-2/HCoV-19)using whole genomic data

The outbreak of COVID-19 started in mid-December2019 in Wuhan, China. Up to 29 February 2020,SARS-CoV-2(HCoV-19/2019-nCoV) had infected more than 85 000 people in the world. In this study,we used 93 complete genomes of SARS-CoV-2 from the GISAID EpiFlu TM database to investigate the evolution and human-to-human transmissions of SARS-CoV-2 in the first two months of the outbreak.We constructed haplotypes of the SARS-CoV-2 genomes, performed phylogenomic analyses and estimated the potential population size changes of the virus. The date of population expansion was calculated based on the expansion parameter tau(τ)using the formula t=τ/2 u. A total of 120 substitution sites with 119 codons, including 79 non-synonymous and 40 synonymous substitutions, were found in eight coding-regions in the SARS-CoV-2 genomes.Forty non-synonymous substitutions are potentially associated with virus adaptation. No combinations were detected. The 58 haplotypes(31 found in samples from China and 31 from outside China)were identified in 93 viral genomes under study and could be classified into five groups. By applying the reported bat coronavirus genome(bat-RaTG13-CoV)as the outgroup, we found that haplotypes H13 and H38 might be considered as ancestral haplotypes,and later H1 was derived from the intermediate haplotype H3. The population size of the SARS-CoV-2 was estimated to have undergone a recent expansion on 06 January 2020, and an early expansion on 08 December 2019. Furthermore,phyloepidemiologic approaches have recovered specific directions of human-to-human transmissions and the potential sources for international infected cases.

Electron beam irradiation on novel coronavirus(COVID-19):A Monte-Carlo simulation

The novel coronavirus pneumonia triggered by COVID-19 is now raging the whole world.As a rapid and reliable killing COVID-19 method in industry,electron beam irradiation can interact with virus molecules and destroy their activity.With the unexpected appearance and quickly spreading of the virus,it is urgently necessary to figure out the mechanism of electron beam irradiation on COVID-19.In this study,we establish a virus structure and molecule model based on the detected gene sequence of Wuhan patient,and calculate irradiated electron interaction with virus atoms via a Monte Carlo simulation that track each elastic and inelastic collision of all electrons.The characteristics of irradiation damage on COVID-19,atoms’ionizations and electron energy losses are calculated and analyzed with regions.We simulate the different situations of incident electron energy for evaluating the influence of incident energy on virus damage.It is found that under the major protecting of an envelope protein layer,the inner RNA suffers the minimal damage.The damage for a^100-nm-diameter virus molecule is not always enhanced by irradiation energy monotonicity,for COVID-19,the irradiation electron energy of the strongest energy loss damage is 2 keV.

低频脉冲磁场诱导TRPC1改善COVID-19患者康复期下肢的肌肉无力症状

背景:肌肉无力是新型冠状病毒(COVID-19)感染后的常见症状,影响康复期人体日常活动能力。在强度1.5 mT,频率3300 Hz的低频脉冲磁场刺激下可通过诱导和激活经典瞬时感受器电位通1(classical transient receptor potential channel 1,TRPC1),提升人体骨骼肌的最大自主收缩力与力量耐力,对肌肉组织产生一系列生理支持效应,该手段是否会改善新型冠状病毒肺炎患者康复期的肌无力症状尚无研究。目的:选用低频脉冲磁场对新型冠状病毒肺炎患者下肢肌群进行磁刺激,以观察该刺激对新型冠状病毒肺炎患者康复期下肢肌群肌无力改善的影响。方法:招募胶体金法抗原检测试剂(COVID-19)为阳性并伴有肌肉无力症状的新型冠状病毒(奥密克戎毒株)感染患者14例,将所有受试者随机分成2组,分别为接受磁场刺激的试验组和接受假治疗的对照组。试验总时长3周,试验组每隔48 h对腿部进行低频脉冲磁刺激,对照组与试验组干预流程一致但给予假刺激,两组患者均不被告知磁刺激仪器是否运行,两组患者共进行9次操作,随后观察两组患者下肢局部肌群最大自主收缩力、腿部爆发力与力量耐力的变化情况。结果与结论:①在采集的8个局部肌群中,试验组患者7个局部肌群在经过3周的低频脉冲磁场刺激,最大自主收缩力值均增长。对照组除3个肌群最大自主收缩力自行增长改善以外,其他肌群肌力无提升。②试验组的左腿前群与双腿后群提升率显著高于对照组。③两组的纵跳摸高高度与膝关节峰值角速度相比试验前测均提升,试验组摸高高度提升率高于对照组。④在疲劳状态下,试验组膝关节峰值角速度下降率显著下降,对照组膝关节峰值角速度下降率无显著性变化;试验组摸高高度下降率显著下降,而对照组摸高高度下降率无显著性变化。⑤上述数据证实,在强度1.5 mT,频率3300 Hz的低频脉冲磁场刺激方案下,新型冠状病毒肺炎患者在康复期经过3周的低频脉冲磁场刺激相比人体自愈过程可使更多的下肢局部肌群肌力获得提升,对基于腿部爆发力的全身协调发力能力及功能状态明显改善。因此,低频脉冲磁场刺激可作为一种改善新冠感染患者下肢肌肉无力症状的有效、非运动的康复手段。

Increased alcohol consumption during the COVID-19 pandemic:A cross-sectional study

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has significantly impacted health,mental well-being,and societal functioning,particularly for individuals with psychiatric conditions and substance use disorders.Recent evidence highlights a concerning increase in alcohol consumption during the pandemic,with a study spanning 2015-2020 indicating heightened usage,especially among young and middle-aged adults,for relaxation and tension relief.Additionally,addressing challenges exacerbated by the pandemic,another study underscored persistent barriers to healthcare access,resulting in increased alcohol and tobacco use rates and limited healthcare options.These findings shed light on the unique vulnerabilities exposed by the pandemic,emphasizing the need to investigate further its impact on alcohol consumption in diverse non-urban American communities.AIM To investigate the impact of the COVID-19 pandemic on alcohol abuse using socioeconomic and medical parameters in diverse non-urban community in America.METHODS Based on a cross-sectional analysis of 416 participants the United States in 2021,the study utilized The Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria to categorize alcohol consumption levels.Participants aged 21 years and above were surveyed through an online platform due to COVID-19 challenges.The survey was conducted from January 14 to January 31,2022,recruiting participants via social media and ensuring anonymity.Informed consent was secured,emphasizing the voluntary nature of participation,and participants could only take the survey once.RESULTS Out of 416 survey respondents,396 met eligibility criteria,with 62.9%reporting increased alcohol consumption during COVID-19.Males(68.8%)and ages 21-29 years(34.6%)predominated.Low alcohol consumption decreased by 2.8%(P=0.237),moderate by 21.4%(P<0.001),and heavy increased by 14.9%(P<0.001).Alcohol abuse rose by 6.5%(P=0.0439),with a 7%increase in self-identified alcohol abusers/alcoholics.Seeking treatment during COVID-19 rose by 6.9%.Easier alcohol access(76.0%)was reported,while 80.7%found it harder to access medical care for alcohol-related issues.These findings highlight the pandemic's impact on alcohol consumption and healthcare access,emphasizing the need for targeted interventions during public health crises.CONCLUSION The COVID-19 pandemic exacerbated alcoholism and abuse,with increased heavy consumption(P<0.001)and abuse(P=0.0439).Access to medical programs for addressing alcohol abuse declined,highlighting the need for targeted intervention.

Subdural effusion associated with COVID-19 encephalopathy: A case report

BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.

TCM theoretical analysis and modern pharmacological mechanism of Huashi Baidu decoction in treating severe novel coronavirus pneumonia

The main symptom elements of the severe novel coronavirus pneumonia epidemic virus closed lung syndrome are cold, damp, poisonous, heat, dryness, blood stasis, and deficiency, which mainly involve the lung and spleen, and are closely related to the heart, liver, kidney, and large intestine. Chinese medicine has accumulated rich academic theories and clinical experience in the prevention and treatment of infectious diseases. The treatment of lung syndrome recommends the use of Huashibaidu formula in the treatment of novel coronavirus pneumonia with integrated traditional Chinese and western medicine. The prescription for removing dampness and detoxification is composed of Maxingshigan formula in "Treatise on Febrile Diseases", "Tingli Dazao Xiefei formula" in "An Outline of Jinkui", Xuanbai Chengqi formula in "Diagnosis of Warm Diseases", "Medical Source Moisture" The combination of four prescriptions of Huopu Xialing formula in "On" is made according to the specific requirements. Through the composition of the prescription of Huashibaidu formula and the pharmacological research involving drugs, the mechanism of the novel coronavirus pneumonia severe epidemic closed lung syndrome may be combined with the blocking of cytokine inflammation storm, immune regulation, antispasmodic and asthma, and improvement Related to hemodynamics.

CT Imaging Evolution of Novel Coronavirus Pneumonia during Hospitalization

Object: To evaluate CT Features on serial thin-section computed tomographic (CT) scans in patients with conventional Novel Coronavirus Pneumonia (COVID-19) for the period during which they remained hospitalized. Methods: In this Retrospective study, we collected clinical information including Laboratory investigations and more importantly we focused on collecting imaging data of these 15 selected patients (8 men and 7 women, 22 - 70 years old, average age (45 ± 15)) with COVID-19 disease. The mean time between the initial and repeat thin-section CT scans was 3.3 ± 2.1 days, 7.9 ± 2.1 days, 14.2 ± 1.3 days after onset of symptoms in these 15 patients. Three experienced Radiologists reviewed the CT images independently and also in collaboration with each other for complicated or unique cases, for the Imaging characteristics like number and site of lesions, distribution of lesions whether it is lobular, lobar, unilateral or bilateral, and comparing the severity of disease in relation to the CT findings. The CT features were compared using the χ2 test and Fisher’s exact probability. Results: All of 15 patients had a history of visit to the endemic center i.e. Wuhan city or came in direct contact with an infected individual. Fever (93.3%) was the most common symptom. Majority of patients had a normal white blood cell count, and normal lymphocyte count although there were patients with leucopenia and lymphocytopenia. CT images showed predominate Ground-Glass opacities in the initial and repeat CT scans with a percentage of 90.6%, 53.9%, 44.2% respectively during the three spaced CT examinations;most patients had bilateral lung involvement (60%, 93.3%, 93.3%), the lesions predominantly involved the posterior (87.5%, 71.9%, 76.6%) and peripheral (90.6%, 84.3%, 85.7%) part of the lungs. There were more consolidation and mixed patterns in repeat CT scan Versus initial CT scan, the difference was statistically significant (P-values were < 0.001). The total lung severity score in the three aforementioned timely spaced CT scans were 36 (3.3 ± 2.1 days) 63 (7.9 ± 2.1 days), and 57 (14.2 ± 1.3 days) respectively. The median percentage of pneumonia lesions of the whole lung volume in three times CT scan was 1.69% (4.59), 3.47% (5.46), 2.33% (4.75) respectively. Besides, “Tree-in-bud” sign, lung cavitation, and lymphadenopathy were absent. Conclusion: The Thin-slice Section CT Imaging features show uniquely different characteristics, each time the scans are taken. The most common findings in our study were bilateral multiple peripheral and mostly posterior ground-glass opacities (GGO), however the CT scan images that were taken in a timely manner to follow up demonstrated some remarkable changes, which undoubtedly play an important role in the diagnosis and management of the patient with COVID-19 disease.

Radiation and Differential Diagnosis of Computed Tomography (CT) Data for Coronavirus Infection “COVID-19” with Clinical Examples

This article is presenting data from a retrospective analysis of medical records and computed tomography (CT) scans of patients’ chests with coronavirus infection “COVID-19” who applied to the diagnostic center of URFA in Osh during the first wave of the pandemic in the Kyrgyz Republic, with a description of individual clinical cases and their differential diagnosis. Chest computed tomography is one of the main methods in visual diagnosis of pneumonia in COVID-19 in hospitalized patients, which allows determining signs, symptoms for effective treatment.

Retrospective analysis of the efficacy of traditional Chinese medicine Lianhua Qingwen Capsule for the treatment of novel coronavirus-infected pneumonia

Objective:The aim of this study was to evaluate the clinical efficacy of traditional Chinese medicine Lianhua Qingwen Capsule(LQC)for the treatment of novel coronavirus-infected pneumonia by a retrospective analysis of confirmed COVID-19 cases,thereby providing a reference for clinical treatment.Methods:We retrospectively analyzed the clinical data of patients with confirmed NCIP treated at the Hanchuan Hospital of People’s Hospital of Wuhan University of China between January 21 and January 30,2020.A total of 32 patients were included in the treatment group,who received routine treatment plus LQC(1 packet,tid),and 32 patients were included in the control group,who received routine treatment alone.The data about response rate of respiratory symptoms were compared and analyzed between the two groups.Results:No significant between-group difference was observed in baseline data.The response rates for fever were 84.4%in the treatment group and 56.3%in the control group;for cough,the response rates were 47.8%and 7.4%in the treatment group and the control group,respectively(P<0.05).The response rates for expectoration were 71.4%in the treatment group and 11.8%in the control group;for shortness of breath,the response rates were 78.6%and 0%in the treatment group and the control group,respectively(P<0.05).The average duration of symptoms like fever,cough,fatigue and expectoration in the treatment group were shorter than that in the control group(P<0.05).There was no significant difference in the incidence rate between LQC and control group.Conclusion:Traditional Chinese medicine LQC significantly improved fever,cough,expectoration,and shortness of breath in patients with confirmed COVID-19,thereby providing preliminary evidence for clinical treatment.

Advances in the mechanism of liver injury caused by COVID-19

In addition to the performance of the respiratory system,COVID-19 can also have different degrees of abnormal liver function,and even liver injury and liver failure may occur in serious cases.In addition,infection with novel coronavirus will aggravate the liver damage of patients with chronic liver disease,resulting in a significant increase in severe morbidity and mortality.Based on this,this paper briefly reviews the mechanism of liver injury caused by COVID-19 and its impact on patients with chronic liver disease,in order to provide a theoretical basis for the prevention and treatment of COVID-19.

COVID-19疫情对台湾地区旅游业的影响

旅游业对政治、经济、社会、文化以及国际关系都会产生一定的影响。随着跨地域流动渐趋频繁,旅游业成为了地方化与全球化连结的重要指标。2020年伊始,新冠肺炎(COVID-19)疫情全球肆虐,台湾地区的旅游业也饱受考验。疫情影响下旅游产业发生巨变,旅游业复苏需更具弹性、重视可持续性性及包容性。在全球追求可持续性风潮、倡议气候变迁治理政策与COVID-19疫情影响之下,台湾地区旅游产业的发展可实施以下策略:1)创新旅游产业,升级核心业务:因疫情不确定性,调整并升级服务或产品;2)加速科技应用与导入:应用多元科技,解决无法面对面服务的痛点;3)转型旅游产业,吸引国际及在地游客:重新定位品牌在地化,调整商品销售与营销模式;4)转变个人化旅客消费模式,带动旅宿产业转型:数字游民(Digital Nomad)带动居家度假Staycation(stay+vacation)与工作度假Workation(work+vacation),实行生活、工作、旅游界线模糊模式,结合深度文化或自然体验;5)由环境可持续性转变为可持续旅游模式:可持续性的理念是实施环境可持续性的基石,在疫情影响下,将旅游景点与生态休养生息相结合,为动植物与环境增加新生机,提供旅客深度旅游体验规划。

Clinical features and potential mechanism of coronavirus disease 2019-associated liver injury

Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2,has posed a serious threat to global public health security.With the increase in the number of confirmed cases globally,the World Health Organization has declared the outbreak of COVID-19 an international public health emergency.Despite atypical pneumonia as the primary symptom,liver dysfunction has also been observed in many clinical cases and is associated with the mortality risk in patients with COVID-19,like severe acute respiratory syndrome and Middle East respiratory syndrome.Here we will provide a schematic overview of the clinical characteristics and the possible mechanisms of liver injury caused by severe acute respiratory syndrome coronavirus 2 infection,which may provide help for optimizing the management of liver injury and reducing mortality in COVID-19 patients.

COVID-19 or non-COVID viral pneumonia:How to differentiate based on the radiologic findings?

Influenza viruses were responsible for most adult viral pneumonia.Presently,coronavirus disease 2019(COVID-19)has evolved into serious global pandemic.COVID-19 outbreak is expected to persist in months to come that will be synchronous with the influenza season.The management,prognosis,and protection for these two viral pneumonias differ considerably and differentiating between them has a high impact on the patient outcome.Reverse transcriptase polymerase chain reaction is highly specific but has suboptimal sensitivity.Chest computed tomography(CT)has a high sensitivity for detection of pulmonary disease manifestations and can play a key-role in diagnosing COVID-19.We reviewed 47 studies and delineated CT findings of COVID-19 and influenza pneumonia.The differences observed in the chest CT scan can be helpful in differentiation.For instance,ground glass opacities(GGOs),as the most frequent imaging finding in both diseases,can differ in the pattern of distribution.Peripheral and posterior distribution,multilobular distribution,pure or clear margin GGOs were more commonly reported in COVID-19,whereas central or peri-bronchovascular GGOs and pure consolidations were more seen in influenza A(H1N1).In review of other imaging findings,further differences were noticed.Subpleural curvilinear lines,sugar melted sign,intra-lesional vascular enlargement,reverse halo sign,and fibrotic bands were more reported in COVID-19 than H1N1,while air space nodule,tree-in-bud,bronchiectasia,pleural effusion,and cavitation were more seen in H1N1.This delineation,when combined with clinical manifestations and laboratory results may help to differentiate these two viral infections.

Mechanism prediction analysis of an epidemic prevention sachet in preventing new coronavirus pneumonia

Objective:To explore the prevention mechanism of an anti-epidemic sachet on the new coronavirus pneumonia(COVID-19)based on the network pharmacology and molecular docking method.Methods:The chemical constituents and action targets of wormwood leaves,white peony,borneol,Rhizoma atracylodis,and Herba pogostemonis in the epidemic-preventive sachet were retrieved in TCMSP database.Query the genes of targets through the Uniprot database,and then use Cytoscape 3.7.2 software to build a medicinal drugs-active ingredients-targets(genes)network for visualization.Then we used DAVID to perform gene ontology(GO)function enrichment analysis and genome encyclopedia(KEGG)pathway analysis to predict the mechanisms of action.Draw histograms and bubble charts for visualization with Excel software and Omicshare database.The crystal structure of ACE2 was searched in the RCSB PDB database,and the compounds and proteins were molecularly docked with the help of PyMOL,AutoDockTool,and Vina software.Results:Sixty-seven effective chemical components in the anti-epidemic sachet were screened and a drugs-chemical components-targets network was constructed to obtain 948 targets,and 18 core targets and 28 core target pathways were predicted.6 compounds in Folium artemisiae argyi,13 compounds in Radix angelicae dahuricae,3 compounds in Rhizoma atracylodis,4 compounds in Fructus tsaoko,8 compounds in Herba pogostemonis,and 3 compounds in Rhizoma acori talarinowii have less binding energy with 1R42 than the ligand.Conclusion:It is predicted that the anti-epidemic sachet has prevention effects on new coronavirus pneumonia.

Secondary Bacterial Organizing Pneumonia in a Patient Recovered from COVID-19 Disease: A Case Report

COVID-19 disease is a global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) that mainly presents with pneumonia, but has variable multi-systemic manifestations. Concomitant bacterial infections associated with the acute stage of COVID-19 disease have been rarely reported in the literature. However, to our knowledge, post viral organizing pneumonia (OP) secondary to bacterial infection after recovery from SARS-CoV2 infection has not been noted before. We report a 27-year-old male patient with Type 1 Diabetes Mellitus who presented with fever post recovery from COVID-19 disease for seven weeks and was found to have OP secondary to Klebsiella pneumoniae. Furthermore, the bronchoalveolar lavage was positive for SARS-CoV2 by RT-PCR despite multiple negative nasopharyngeal RT-PCR. The patient was successfully treated with antibiotics only. Therefore, we conclude that early recognition of OP secondary to bacterial infection in patients with COVID-19 disease and prompt antibiotic treatment could avoid the use of a prolonged course of steroids.

CT征象及动态变化对COVID-19疑似病例鉴别诊断的价值

目的:探讨CT征象及动态变化对COVID-19疑似病例鉴别诊断的价值。方法:回顾性分析2020年1月20日至2020年2月25日收治的54例COVID-19疑似病例的资料。最终COVID-19确诊病例25例,患者年龄3~94岁,≤50岁16例(64%)。排除病例(非COVID-19)29例。54例均行CT平扫,首次检查后间隔3~6 d复查。结果:COVID-19病灶多分布于双肺胸膜下,主要征象为磨玻璃密度改变并小叶内间隔增厚,伴血管影增粗;进展期13例呈胸膜下融合改变,好转消散期15例密度增高,边缘平直及出现纤维条索。非COVID-19病灶多沿支气管血管束分布,树芽征及腺泡结节7例,均见于细菌性肺炎及支原体肺炎患者;进展期9例沿支气管血管束扩散,好转消散期27例表现为整体密度浅淡。两组以上征象检出率差异均有统计学意义(P<0.05)。结论:精准CT征象分析可以用于COVID-19和非COVID-19的鉴别,有助于缩小疑诊范围,减轻临床排查压力。

生命伦理视阈下新型冠状病毒肺炎(COVID-19)疫情的反思

病毒丰富的遗传多样性使其具有进化上的优势,并已成为人类面临的最具威胁力的对手之一。人类直立行走至今,其文明不断发展与壮大,特别是科学与技术的发展日新月异,但对病毒所引发的疫情危害仍然措手不及。频频发生的疫情,一次次地考验着人类的灵魂与智慧,也一次次呼唤我们对生命伦理的全新认知。本文在生命伦理视阈下,对当前我国正在经历的大规模新冠肺炎(COVID-19)疫情进行反思,期待人们对自然与生命、科学研究与应用,特别是对人类自身与自然的关系,有更深刻和清醒的认识。

新型冠状病毒(COVID-19)感染性肺炎现代中医诊疗建议方案与探讨

自2019年12月以来,以我国湖北武汉地区为中心,以人群集散辐射传播为特点,全国各地病例陆续出现增加。疫情发源地罹患患者早期以身热不扬、干咳气促、身楚乏力为主要症状,以脉濡缓、舌苔厚腻、胸部X线检查显示炎性反应性改变为特征的新型冠状病毒(COVID-19)感染性肺炎为主的新型传染病。疫情传入地的患者早期症状由于地域的不同,有所差异。各地传统中医、现代医学先后集体或个人出台了相关诊疗方法和建议方案。作为现代中医,按照习近平主席:“遵循中医发展规律,传承精华,守正创新”和“中西并重”的指示精神。为规范这一新型传染病“瘟疫”的认知和诊疗,综合相关资料,根据疫情演变规律,结合个人经验与体会,特此探讨COVID-19感染性肺炎的诊疗建议方案。

COVID-19不同临床分型患者病例资料回顾性分析

目的分析不同临床分型的新型冠状病毒性肺炎(COVID-19)确诊病例的特征。方法收集江汉大学附属湖北省第三人民医院2020年1月24日至2月8日确诊COVID-19患者54例,分为普通组,重症组及死亡组。比较3组患者流行病学、临床症状、检验结果、影像资料及用药情况。结果COVID-19确诊患者的核酸检测阳性率为45.5%;普通组、重症组、死亡组患者中位年龄分别为49岁、60岁、70岁,差异有统计学意义(P<0.05);合并基础疾病比率分别为13.0%,80.0%,66.7%,差异有统计学意义(P<0.01);潜在并发症比率分别为4.4%,40.0%,100.0%,差异有统计学意义(P<0.01);死亡组患者住院时间为6.5 d,低于普通组(11 d,P=0.026)和重症组(21 d,P=0.045);临床症状主要为发热47例(87.0%)、咳嗽41例(75.9%)、乏力29例(53.7%)、肌肉酸痛25例(46.3%);患者入院当天中位淋巴细胞计数为0.7×109·L-1(IQR0.6~1.2),C反应蛋白为46.4 mg·L-1(IQR12.7~84.3),血清淀粉样蛋白为373.5 ng·mL^-1(IQR57.1~961.7)及红细胞沉降率为42.7 mm·h-1(IQR17.3~74.5);死亡组中位肌钙蛋白为0.6μg·L-1(IQR0.5~0.6),乳酸脱氢酶为842.0 U·L-1(IQR556.5~1127.5);影像学检查提示68.5%患者肺部出现斑片状影;抗病毒药物、抗菌药物、提高免疫力药物及皮质类固醇药物使用率分别为100.0%,100.0%,51.9%,85.2%。结论核酸检测结果存在一定的假阴性,患者临床症状、实验室指标中淋巴细胞计数、C反应蛋白、血清淀粉样蛋白、红细胞沉降率及影像资料具有一定参考意义。重症患者多为老年患者且合并基础性疾病。COVID-19患者使用抗菌药物、皮质类固醇药物比率较高。