“An integrated system,three separated responsibilities”,a new fever clinic management model,in prevention and control of novel coronavirus pneumonia

BACKGROUND Since December 2019,there have been many new cases of coronavirus pneumonia in Wuhan,Hubei Province,which has gradually spread throughout the country.AIM To explore our hospital’s innovative management system to ensure the efficient operation of fever clinics during the epidemic,since controlling the spread of disease is an important way to prevent and control the epidemic.METHODS In total,200 outpatients with fever at our hospital between November 2019 and July 2020 were selected and allocated into two groups.RESULTS The fever clinic in our hospital operated smoothly,and infection with the novel coronavirus disease(COVID-19)has not been reported in our hospital.Additionally,we did not have any cases of missed diagnosis.The awareness regarding COVID-19 infection sources,transmission routes,early symptoms,and preventive measures was significantly higher in our fever clinic than in those of the pre-management group.CONCLUSION"An integrated system,three separate responsibilities"ensured the efficient functioning of our fever outpatient clinic and early screening of COVID-19 cases,which effectively curbed the transmission of COVID-19 and hence prevented COVID-19 pneumonia epidemic in our hospital,ultimately achieving the maximum effect of epidemic prevention and control.

Clinical Presentations of Lassa Fever in Non-Endemic Parts of the World: A Systematic Review

Background: Lassa fever cases outside Africa are seen as imported cases of Lassa fever. Timely diagnosis of imported Lassa fever is important for timely intervention necessary to reduce the morbidity and mortality associated with Lassa fever, and this requires the knowledge of the clinical manifestations of Lassa fever. Purpose: This review was done to see how clinical diagnosis of imported Lassa fever can be facilitated based on the clinical presentations of imported cases of Lassa fever in Lassa fever non-endemic region. Methods: The relevant articles for the review were obtained from the databases of PubMed and Google Scholar. Results: The clinical presentations of the imported Lassa fever cases consisted of multisystem involvement and were similar to those of Lassa fever patients who were treated in the Lassa fever endemic region. Conclusions: History of recent travel to, or residence in, Lassa fever endemic region is an important clue for clinical diagnosis of Lassa fever. The 2011 CDC surveillance case definition and the modified Khan case definition for Lassa fever may aid clinical diagnosis of Lassa fever. Any clinically suspected case of Lassa fever should have a laboratory confirmation.

Relationship between the Clinical Features and the Viral Antigen in the Extremity Blood of the Patients with Hemorrhagic Fever with Renal Syndrome

Summary: The direct immunogold silver staining (D IGSS) method was used to detect the viral antigen in the extremity blood of 67 cases of hemorrhagic fever with renal syndrome. The positive rate of viral antigen was the highest during the fever, hypotension and oligouria phrase; and the rate dropped gradually during the polyuria and convalescent phase. It is suggested that clinical staging was positively related with the percentage of the viral antigen positive cells (P<0.001). It is concluded that the positive rate was related to the extent of the injuries by direct viral attack and immune reaction. The D IGSS was proved to be fast, simple, economical, with high sensitivity and specificity.

Relationship between fever and early clinical diagnosis and treatment in mild COVID-2019 patients

Objective:To investigate the relationship between clinical manifestations,blood testing,chest CT,treatment and fever of 457mild cases of COVID-19.Methods:A tatal of 457cases of mild COVID-19 diagnosed in Wuhan Jianghan module Hospital from February 6,2020 to February 26,2020 were gathered,and the cases with/without fever were retrospectively analyzed in epidemiology,clinical manifestation,blood routing,hypersensitive C-reactive protein(hs-CRP),pathogens serological testing,chest CT and drugs treatment.Results:For 312 fever cases,the average age was(47.6±10.9)years old,male was 128 cases(41%),the mean peak fever was 38(36.8,38.6)℃,fever lasting was 2(0,3)days,131cases(28.7%)had Huanan seafood market exposure history,90 cases(28.8%)had closely contact with COVID-19 patients,20cases(6.4%)had hypertension history,10 cases(3.2%)had diabetes,5cases(1.6%)had coronary heart disease.Main symptoms of fever group including dry cough of 260cases(83.3%),of 104cases(33.3%),blood sputum of 9cases(2.9%),chest tightness 20cases(19.6%),shortness of breath of 87cases(27.9%),weak of 105cases(33.7%),diarrhea of 43cases(13.8%),sleep disorders of 61cases(19.6%),among fever cases with sputum and shortness of breath more rather without fever,and two groups were statistically significantly difference(P<0.05).In fever group,WBC(109/L)[4.34(3.69,5.26)than 5.11(4.22,6.22),P<0.001],NEUT(109/L)[2.67(2.1,3.49)than 2.88(2.37,3.9),P<0.05],LYM(109/L)[0.9(0.8,1.1)than 1.36(1.03,1.85),P<0.001),PLT(109/L)/(106,188)134-189(132,224),P<0.001)were lower than normal group,while WBC<4.0×109/L[108(34.6%)than 24(16.6%),P<0.001)],LYM<1.0×109/L[189(60.6%)than 31(21.4%),P<0.001)],PLT<100×109/L[45(14.4%)than in 2(1.4%),P<0.001)and hs-CRP(mg/L)[14(6.83,32)than 3.4(0.96,10.75),P<0.001)were higher than normal group,and pathogens serological examination of 36cases shown influenzaⅠ/Ⅱvirus IgM antibody positive in 3cases(8.3%),respiratory syncytial virus IgM antibody positive in 2 cases(5.6%),mycoplasma pneumoniae IgM antibody positive(11.1%),4 cases of adenovirus IgM antibody positive(11.1%),but 4 pathogens of fever group and normal group were no statistical difference(P>0.05).According to early onset of chest CT examination,there were no change of 11cases(2.4%),unilateral lung lesions of 93cases(20.4%),bilateral lung lesions of 353 cases(77.2%),ground glass shadow of 228 cases(73.1%),high density shadow patch of 65 cases(20.8%),consolidation shadow of 6 cases(1.9%),while fever group compared with normal group,there were no statistically significant difference(P>0.05).Logistic regression analysis showed that LYM(OR=0.24,95%CI=0.139~0.415,P<0.001),LYM<1.0 x 109/L(OR=5.12,95%CI=3.07~8.65,P<0.001),PLT<100×109/L(OR=6.1,95%CI=1.36~27.33,P<0.05),and the hs-CRP(OR=1.03,95%CI=1.02~1.05,P<0.001)were fever independent impact factors in mild COVID-19.Aiming at COVID-19 treatment,Chinese medicine usage had 416cases(91%),antiviral drugs had 328cases(71.8%),and antibiotics had 172cases(37.6%),furthermore,fever group using antiviral and antibiotic drugs was higher than normal group(P<0.05),and compared to low fever group,high fever group used more antibiotic drugs(P<0.05).Conclusions:Mild COVID-19 patients with early onset had epidemiological characteristics,and fever,dry cough,expectoration and shortness of breath were main symptoms,and chest CT often involved bilateral lung lesions,ground glass shadow and patch density shadow.The fever patients in WBC,LYM,PLT,hs-CRP index changed significantly and could affect on anti-infective therapy selection.

Epidemic Hemorrhagic Fever in Hubei Frovince,The Peoples Repulic of China: A Clinical and Serological Study

Between July 1975 and April 1980, 71 patients were admitted to the 2ndAttached Hospital of Hubei Provincial Medical College in Wuchang withthe diagnosis of Epidemic Hemorrhagic Fever (EHF). The clinical courseamong these patients was similar to that described for patients with KoreanHemorrhagic Fever, Nephropathica Epidemica of Scandanavia and Hemor-rhagic Fever with Renal Syndrome of the U.S.S.R. The overall mortalitywas 11.2％. Sera obtaincd from some of these patients as well as frompatients admitted to the First Attached Hospital of Hubei Provincial Me-dical College were tested against an antigen associated with Korean He-morrhagic Fever and showed exceedingly high antibody titers. We concludethat EHF in Centfal China represents the same disease process as KoreanHemorrhagic Fever.

Electrocardiographic changes in dengue fever

Dengue fever(DF)is one of the most commonly prevalent viral diseases in the world,primarily affecting tropical countries.It is transmitted by the bite of female Aedes(Ae.)aegypti mainly and Ae.albopictus mosquito infected with the virus.Dengue virus is a flavivirus,arbovirus.There are four strains of dengue virus(DENV1,DENV2,DENV3,DENV4).The clinical spectrum of the disease ranges from mild to severe forms with complications.

A Single Blind Comparative Randomized Non-Inferior Multicenter Study for Efficacy and Safety of Levofloxacin versus Ciprofloxacin in the Treatment of Uncomplicated Typhoid Fever

Ciprofloxacin is currently the drug of choice for typhoid fever, but Salmonella typhi resistance to ciprofloxacin is increasing, while levofloxacin has been shown to be very effective in a few open studies. This study aimed to compare the efficacy, and safety of levofloxacin and ciprofloxacin for typhoid fever. From 110 patients with confirmed typhoid fever, 54 patients received oral levofloxacin 500 mg once daily with one drop out, while 56 received ciprofloxacin 500 mg twice daily for 7 days with two drop outs. Defervescence of fever was achieved on an average of 3 days after initiating levofloxacin and 5 days after starting ciprofloxacin and one microbiologically non confirmed typhoid fever relapse occurred in the levofloxacin group while two relapses with positive Salmonella microorganism occurred in the ciprofloxacin group. No carrier of Salmonella typhi was found in both groups at day 30. Adverse reactions were more pronounced in the ciprofloxacin group compared to the levofloxacin group. In conclusion, oral levofloxacin 500 mg once daily for one week showed faster fever clearance compared to ciprofloxacin 500 mg twice daily in typhoid fever in Indonesia, and less adverse reactions occurred with levofloxacin compared to ciprofloxacin. This electronic document is a “live” template. The various components of your paper (title, text, heads, etc.) are already defined on the style sheet, as illustrated by the portions given in this document.

Low-grade fever during COVID-19 convalescence:A report of 3 cases

BACKGROUND Low-grade fever during convalescence is an atypical symptom of coronavirus disease 2019(COVID-19).Reports of such cases are rare,and the mechanism and outcome of low-grade fever during COVID-19 convalescence are not completely clear.We report 3 cases with low-grade fever during COVID-19 convalescence and highlight the main clinical,radiographic,and laboratory characteristics,thereby increasing the level of expertise in the clinical management of COVID-19 during convalescence and facilitating individualized decision-making.CASE SUMMARY We describe 3 patients with COVID-19,two females aged 62 and 66 years and a male 55 years,who had low-grade fever during COVID-19 convalescence.All 3 patients had no other discomfort or comorbidities during low-grade process.Lesions on computed tomography in all 3 patients had resolved during this period.Two patients tested negative on two consecutive severe acute respiratory syndrome coronavirus 2 tests with an interval of at least 24 h between tests.Body temperature in all 3 patients returned to normal after several days without treatment,and fever recurrence was not observed.CONCLUSION Enhancing the knowledge of low-grade fever during COVID-19 convalescence may increase the expertise in the delivery of optimal healthcare services.

View Point on Severe Fever with Thrombocytopenia Syndrome

Severe fever with thrombocytopenia syndrome (SFTS), a new disease of zoonotic natural foci has been increasing in recent years. In this review, the disease of human granulocytic anaplasmosis infection due to tick-borne and new Bunia virus infection, have similar clinical symptoms. Total of 11 articles were retrieved. The emergence, etiology, nomenclature and pathogenic mechanisms, clinical diagnosis and genotyping of SFTS were summarized, and the current situation of treatment was also evaluated. In conclusion, early detection, identiifcation and treatment are the key points to SFTS, but how to reduce the mortality of critically ill patients is still the focus in the future.

6例急性Q热的临床特征分析

目的分析急性Q热的流行病学、临床特征和诊治方法,以期为该病诊治提供参考。方法收集2022年5月至2023年8月南通市第三人民医院确诊的6例急性Q热患者的流行病学史、既往病史、临床表现、实验室检查、宏基因组学二代测序(metagenomic next-generation sequencing,mNGS)结果、影像学表现及诊治过程等资料,对其进行回顾性分析。结果6例急性Q热患者均为男性,年龄为45~59岁。4例患者发病前有多次野外钓鱼史,1例发病前有掏鸟窝史,1例居住地周围有羊群。发病时间呈全年散发。所有患者临床表现均有高热,热型以弛张热为主(5例),其他主要伴随症状有乏力(6例)、畏寒(5例)、肌肉酸痛(5例)、纳差(4例)。实验室检查中2例患者外周血白细胞计数减少,3例患者血小板计数减少;所有患者谷丙转氨酶、谷草转氨酶和乳酸脱氢酶均升高,4例患者肌酸激酶升高;所有患者C反应蛋白、降钙素原、铁蛋白、D-二聚体均明显升高;3例患者红细胞沉降率轻度升高。6例患者均行胸部CT检查,未见肺炎;5例患者行心脏超声检查,未见心内膜炎。6例患者的血液或骨髓标本均通过m NGS检出贝纳柯克斯体(Coxiella burnetii,Cb),确诊为急性Q热后,给予多西环素单药(2例)或多西环素联合莫西沙星(4例)治疗,所有患者好转出院。结论急性Q热的临床表现、影像学及实验室检测缺乏特异性,部分患者缺乏明确的流行病学史,对可疑患者行mNGS可以快速明确诊断,多西环素、莫西沙星治疗效果明显。

临床药师参与3例外科术后发热患者的会诊分析

目的通过临床药师参与外科术后发热患者的会诊,探讨临床药师在会诊工作中如何建立有效的会诊思维。方法临床药师对3例术后发热患者从诊疗方案适宜性、药物的不良反应及抗生素的药代动力学达标情况等方面进行分析,帮助临床寻找患者发热的可能原因,并向临床医师提供调整治疗方案的建议。结果临床药师对3例会诊患者提出的调整抗生素治疗方案、停药观察及调整药物给药剂量等建议被医师采纳,患者的发热问题得到解决。结论临床药师可通过对患者个体化用药方案的调整,协助医生解决患者术后发热的常见问题,提高治疗效果。

基于发热门诊留观数据的大连市新型冠状病毒感染本地暴发疫情预警3种方法比较

目的以发热门诊留观病例为基础数据,筛选出应用于大连市新型冠状病毒感染本地暴发疫情预警的最佳方法。方法分别采用Poisson分布、累计和控制图、指数加权移动平均法3种方法建立新型冠状病毒感染本地暴发疫情预警模型,并以灵敏度、特异度、约登指数、阳性预测值、阴性预测值等指标为评价指标,从中选择最优预警模型。结果以2021年7月1日—12月19日和2022年2月24日—7月21日期间大连市28家医疗机构上报的发热门诊留观病例为基础数据,建立了3种预警模型。结果显示,Poisson分布预警模型中,当检验水准取值为0.03时,预警灵敏度可达94.59%,特异度为41.38%,阳性预测值为33.98%,阴性预测值为96.00%,在2021年7月1日—12月19日和2022年2月24日—7月21日期间的3起本地暴发疫情中,均最早提前6 d提出预警信号;累计和控制图预警模型中,当允偏量设置为1.5和判定值设置为2时,模型的约登指数最大(0.17),模型的预警灵敏度为21.67%,特异度为95.12%,阳性预测值为52.00%,阴性预测值为83.27%,并在2021年的11月份疫情中分别提前2 d和1 d提出预警信号;指数加权移动平均法预警模型中,当权重因子λ设置为0.6和0.7,标准差系数设置为1时约登指数最大(0.16),模型的预警灵敏度为35.48%,特异度为80.33%,阳性预测值为31.43%,阴性预测值为83.05%,并在2021年11月和2022年4月疫情中分别最早6 d和5 d提出预警信号。结论以发热门诊留观病例作为基础数据,采用Poisson分布建立新型冠状病毒感染暴发疫情预警模型,相对于累计和控制图法和指数加权移动平均法可获得较理想的预警效果。

基于信息平台的发热门诊就诊模式优化实践

通过医院信息化建设整合患者诊疗数据,并用于智能服务设备、信息自动采集、信息区域共享。实现基于医院信息平台的发热门诊就诊模式,优化资源配置,减少患者候诊时长,提高患者满意度,同时强化发热门诊在新型病毒监测方面的哨点作用。该模式为发热门诊的整体诊疗流程提供了有力的支持,在改善患者就医体验、节约医院成本、院感防控方面均具有一定意义。

枣庄市27例发热伴血小板减少综合征患者流行病学及临床特征分析

目的了解枣庄市发热伴血小板减少综合征(SFTS)患者的流行病学及临床特征,为该疾病的科学诊疗提供依据。方法采用回顾性分析方法,收集2018—2022年枣庄市立医院收治的27例发热伴血小板减少综合征患者流行病学特征、临床表现、实验室检查结果、药物治疗与疾病转归情况进行统计分析。结果在27例发热伴血小板减少综合征患者中,男性11例,女性16例,平均年龄为(62.56±9.61)岁;职业分布以农民为主,占81.48%(22/27);发病时间集中在4—10月;地区分布以山亭区为主,占48.15%(13/27);12例明确有蜱虫咬伤史。所有患者均有发热,其他主要症状为淋巴结肿大85.19%(23/27),头痛70.37%(19/27),胃肠道不适66.67%(18/27),全身乏力44.44%(12/27)。实验室检查结果主要表现为血小板减少27例,白细胞减少21例,D-二聚体升高15例,粒细胞缺乏13例,凝血功能异常13例,肝功能异常10例,降钙素原升高9例,尿蛋白阳性7例。治疗主要采用抗病毒药物联合人血白蛋白,平均住院天数为(10.15±4.22)d,治愈率为92.59%(25/27)。结论发热伴血小板减少综合征在春夏季高发,采用抗病毒药物联合人血白蛋白治疗效果较好。

发热伴淋巴结肿大初诊 163 例病因及临床特征分析

目的探讨以发热伴淋巴结肿大为特征疾病初诊病人的病因分布及临床特征,提高临床对该疾病的认知和诊断能力。方法收集2020年1月至2022年10月在山西白求恩医院初次收治的经淋巴结活检及病理检查诊断明确的163例发热伴淋巴结肿大病人,根据病因分为感染性疾病组(感染组)、非感染性炎症性疾病组(非感染组)、肿瘤性疾病及造血系统疾病组(肿瘤及造血组)、其他类疾病组(其他组),对其性别、年龄、热程、淋巴结肿大特征、伴随症状、实验室资料、淋巴结病理等资料进行分析。结果163例病人中,感染组63例(38.7%)、非感染组32例(19.6%)、肿瘤及造血组31例(19.0%)、其他组37例(22.7%)。临床特征中,四组间性别、年龄、淋巴结压痛、淋巴结肿大部位(头颈部/胸部/腹部)、合并全身性淋巴结肿大、半年内体质量下降≥10%均差异有统计学意义(均P<0.05)。实验室检查结果中,四组间白细胞计数、中性粒细胞百分比、血小板计数、总胆红素、C反应蛋白、降钙素原、红细胞沉降率、抗核抗体阳性均差异有统计学意义(均P<0.05)。结论发热伴淋巴结肿大主要病因是感染性疾病,其次为其他类疾病,前者病毒感染多见,后者以组织坏死性淋巴结炎为主。临床可通过病人基本情况、临床特征、实验室检查进行初步鉴别诊断,淋巴结活检对诊疗有一定帮助。

中国部分大型牧场产后瘫痪和临床型酮病的发病特征分析

以奶牛酮病和产后低血钙作为代表的群发性营养代谢病,对我国奶业的生产效益造成了显著影响,为了应对这一挑战,本试验对10个规模化牧场进行了流行病学调查,分析其发病特征。试验于2022年11月—2023年10月收集了我国10个大型牧场(存栏量>4 000头)产后瘫痪和临床型酮病奶牛的发病数据,分析季节性因素和奶牛个体因素(泌乳天数、体况和胎次)与这2种疾病的关系,揭示疾病发生规律。结果显示,秋季是产后瘫痪的高发季节,发病率达到1.87%(400/21 379);临床型酮病则在夏季发病率最高,为0.93%(326/35 010);产后瘫痪的发病高峰集中在泌乳天数1~3 d,而临床型酮病的发病高峰则集中在泌乳天数3~15 d;所调查牧场中,产后瘫痪和临床型酮病奶牛干奶时和分娩时体况评分主要集中在3.25和3.50分(5分制)。5胎以上奶牛2种疾病的发病率均较高。本试验结果不仅为识别和监测高风险牛群、制定针对性的预防措施提供了重要的参考信息,还有助于提高奶牛群的健康水平和生产效率。

非洲猪瘟病毒的感染与排毒研究进展

非洲猪瘟(African swine fever,ASF)是由非洲猪瘟病毒(African swine fever virus,ASFV)引起的急性、热性传染病,发病快,病死率高。目前并无安全有效的商业化疫苗和抗病毒药物,只能对感染动物进行扑杀,要减少经济损失,必然要求尽早扑灭疫情,掌握感染宿主的传播途径、临床症状与带毒排毒规律有助于疫情早发现。ASFV的感染途径多样,主要包括直接接触、间接接触以及通过钝缘软蜱等传播。临床中ASF表现为急性、亚急性、慢性症状,不同临床症状表现导致排毒时间、带毒持续时间及病毒载量的差异。研究病毒传播途径、临床症状与所感染毒株毒力关系,不同宿主感染性差异有助于全面认识ASF,有助于ASF防控。本文主要针对ASF的感染途径、不同毒株感染后的临床表现以及带毒排毒规律等方面进行综述,对病毒早期的诊断、监测具有参考意义。

北京某三甲中医院发热门诊患者病原体感染变化趋势分析

目的分析发热门诊患者就诊人数及呼吸道病原体变化趋势,为合理安排发热门诊医疗资源分配提供依据。方法收集并分析北京某三甲中医院2023年1月至2023年12月发热门诊患者相关信息。对就诊人数、年龄分布及感染情况进行描述性分析。结果2023年1月至2023年12月北京某三甲中医院发热门诊共就诊16707人次。其中男性7498人次,女性9209人次。女性患者高于男性患者。20岁以下患者1156人次,21~40岁区间患者8495人次,41~60岁区间患者3801人次,61岁以上患者3255人次。21~40岁患者为主要感染人群。就诊高峰季节为3月;次高峰为11月、12月。甲型流感病毒抗原检测阳性率11%,乙型流感病毒抗原检测阳性率9%。甲型流感病毒核酸检测阳性率24.4%,乙型流感病毒核酸检测阳性率7.8%。肺炎支原体IgM检测阳性率11%。结论北京某三甲中医院发热门诊患者就诊高峰阶段为春季3月、冬季11月、12月。以甲型流感病毒,乙型流感病毒及肺炎支原体为主要感染源,21~40岁患者为主要易感人群。因此应在此时段增加医疗资源分配比重,保护易感人群。

临床药师参与1例万古霉素致药物性肝损伤及药物热临床实践

目的促进临床合理使用万古霉素。方法临床药师参与1例万古霉素致药物性肝损伤(DILI)及药物热的救治过程,为患者提供药学服务,结合文献及患者每日检查指标的变化,及时发现导致DILI及药物热的线索,及时停药并对症处理。结果通过DILI因果关系评估量表(RUCAM)评分发现导致DILI的药物,通过排除性诊断发现导致药物热的药物,查阅文献并结合患者的检查指标,推断万古霉素致DILI和药物热同时发生,与体液免疫的超敏反应有关。结论临床使用万古霉素时除要关注患者的肾功能不良反应外,还需关注患者的肝功能、体温变化,若出现肝功能损伤、体温升高等,则需警惕万古霉素诱发的药品不良反应。

“中”“阳”视域下“红山医派”《伤寒论》解经与中医临床教育刍议

2023年6月至10月,北京中医药大学“红山医派”《伤寒论》解经研究课题组、北京扶阳国际中医科学研究院持续开展了“红山医派”《伤寒论》解经暨临床教育相关研讨。综合纳入院校与民间中医学者和北京中医药大学研究生、本科生群体,以求在瞄准临床的经典学习、解读中可集“庙堂之上”与“江湖之远”之长。选定《伤寒论》为主要学习研讨对象,以“红山医派”的重“阳”和重“中”的理念,为相对“中规中矩”的院校经典教育及基于教育的临床实践注入“一剂活水”。在传统院校教育基础上,提升了中医学习者在古今语境差异下从相对碎片化的行文论述中把握经典中心思想的能力。文章将“红山医派”《伤寒论》解经与中医临床教育研讨成果进行整理,以求对于临床经典教学有所借鉴及参考。