床旁超声评估COVID-19重症患者心肺损伤的价值

目的总结新型冠状病毒肺炎(COVID-19)重症患者心肺超声表现,探讨床旁超声评估COVID-19重症患者心肺损伤的价值。方法纳入31例COVID-19患者,包括16例重症患者和15例非重症患者,所有患者均行肺部超声(LUS)评分及心脏超声检查,进行组间比较,并分析重症患者LUS评分与肺动脉收缩压(PASP)的相关性。结果 COVID-19重症患者肺部超声主要表现为B线融合(15/16,93.8%)、肺实变(10/16,62.5%)及肺部合并症,LUS评分显著高于非重症患者(P0.05),更易于累及双肺。重症患者左房内径(LA)、左室内径(LVDD)、右房左右径(RA)、右室左右径(RV)、右室流出道(RVOT)及肺动脉内径(PA)均明显增大(P0.05),出现三尖瓣反流(16/16,100%)及肺动脉高压(6/16,37.5%)的比例更高。重症患者LUS评分与PASP之间呈正相关(r=0.746,P=0.002)。结论 COVID-19重症患者心肺损伤的超声表现具有一定特征性,床旁超声在其病情评估中具有较大价值。     

新冠肺炎患者死亡率相关因素的回顾性分析

目的：评估流行早期COVID-19患者的人口统计学和临床特征与30天死亡率的关系。方法：本研究纳入2020年1月1日至2020年3月10日武汉市金银潭医院1008例出院或30天死亡的COVID-19患者。结果：1008名患者的中位年龄为55岁，56.4%的患者为男性；43.5%的患者有一种或多种合并症；10.5%的患者为当前吸烟者（541名报告吸烟状态）。共有211例（20.9%）患者30天内死亡。与出院患者相比，死亡患者年龄更大、性别倾向于男性、吸烟、有合并症、中性粒细胞与淋巴细胞比值（NLR）水平更高。40岁以上的患者院内死亡率随年龄增加而增加，但40岁以下的患者死亡率相对较低且稳定。NLR水平越高，死亡风险越大。多元cox回归显示死亡率分别与男性，老年，吸烟，慢性病合并症，NLR水平高低有关。结论：年龄较大（尤其是>60岁的人群）、男性、合并症、吸烟、高NLR分别不同程度地导致了流行早期COVID-19死亡风险增加。我们的研究结果将为临床和公共卫生决策提供依据，以减少COVID-19死亡率。     

维持性血液透析患者新型冠状病毒感染重症的相关危险因素

目的 分析维持性血液透析患者新型冠状病毒感染(COVID-19)重症的危险因素,为患者的早期风险识别提供参考。方法 回顾性收集2022年3月至4月吉林省人民医院收治的73例确诊COVID-19的维持性血液透析患者的临床资料,根据患者临床分型分为MC组(轻型及普通型,61例)与SC组(重型及危重型,12例),收集患者基线资料[年龄、性别、COVID-19疫苗接种情况、年龄校正Charlson合并症指数(aCCI)、原发性高血压、糖尿病、冠心病、恶性肿瘤、透析时间]、首发临床症状(发热、干咳、乏力、咽痛、腹泻、呼吸困难)、入院24 h内实验室检查指标(白细胞总数、中性粒细胞总数、淋巴细胞总数、C反应蛋白、降钙素原、D-二聚体、白蛋白),采用多因素logistic回归分析维持性血液透析患者COVID-19重症的危险因素。结果 两组年龄、aCCI、淋巴细胞总数、C反应蛋白及D-二聚体差异有统计学意义(P<0.01);多因素logistic回归分析显示,年龄大及C反应蛋白水平高为维持性血液透析患者COVID-19重症的独立危险因素(OR=1.256, 95%CI:1.016～1.553,P...     

新型冠状病毒肺炎重症、危重症患者院内转运专家共识

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者中,重症及危重症患者占5%~10%。此类患者在治疗与康复过程中,院内转运是必不可少的环节,为保障患者在转运过程中的安全,提高转运效率,COVID-19重症、危重症患者院内转运专家共识编写组在回顾已有证据基础上,通过多次讨论制定了《新型冠状病毒肺炎重症、危重症患者院内转运专家共识》,以期为COVID-19重症、危重症患者院内转运提供参考。     

NLR、CRP、PCT、DD、NT-proBNP在重症COVID-19中的诊断价值

目的 探讨中性粒细胞/淋巴细胞比值(NLR)、C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体(DD)、氨基末端B型钠尿肽原(NT-proBNP)对重症新型冠状病毒肺炎(COVID-19)的诊断价值.方法 选取105例COVID-19患者,根据COVID-19诊断标准将患者分成轻症组(83例)、重症组(22例).以...     

基于国际健康分类架构构建新型冠状病毒病重症病区配对康复治疗模式及其效果

目的 基于国际健康分类架构探讨构建新型冠状病毒病(COVID-19)配对康复治疗模式,并观察其对重症病区COVID-19危重患者的治疗效果.方法 基于国际健康分类架构建立配对康复治疗模式:两名康复治疗师在危重病房实施康复,一名实施治疗,另一名辅助治疗并进行防疫工作.选择重症病区住院的COVID-19重症肺炎患者11例,...     

重症监护病房新型冠状病毒感染患者物理治疗实践建议

自新型冠状病毒感染（coronavirus disease 2019, COVID-19）疫情暴发以来，已有大量研究证实物理治疗是住院期间COVID-19患者综合治疗中必不可少的一部分，能促进该类患者恢复。但专门针对重症监护病房中COVID-19患者的物理治疗规范仍然空白。该文围绕对COVID-19患者物理治疗安全防护的建议、评估和干预的建议以及未来的工作进行了文献回顾和实践经验总结，以期为在重症监护病房工作的物理治疗师诊治COVID-19患者过程中提供一份实践建议。     

血常规和凝血常规联合检测对重症新型冠状病毒肺炎的诊断价值

目的 探讨血常规和凝血常规联合检测对重症新型冠状病毒肺炎(COVID-19)的诊断价值.方法 选取2020年1月21日至3月1日在该院住院治疗的53例COVID-19患者为研究对象,其中轻型和普通型患者35例纳入非重症组,重型和危重型患者18例纳入重症组.比较非重症组和重症组血常规和凝血常规指标的差异,建立Fisher...     

2019冠状病毒病患者危重症临床风险评分系统的外部验证

目的 评价2019冠状病毒病(COVID-19)危重症风险预测评分模型对医疗资源充足地区患者的适用性.方法 纳入2020年1月11日—2月22日深圳市第三人民医院COVID-19定点收治医院的病例,并进行严重程度分型.危重症COVID-19患者被定义为入住ICU、有创机械通气或死亡的患者.使用COVID-19危重症风险...     

新型冠状病毒肺炎临床护理管理实践研究

目的探讨新型冠状病毒肺炎(COVID-19)临床护理管理模式的实践。方法通过成立COVID-19专业护理小组、重症救治小组、建立合理的病区环境布局与流程、规范穿脱防护服流程、制定各组岗位职责、保障医疗队护理工作顺利开展。结果接诊136例COVID-19患者,治愈出院135例,死亡1例。结论此次护理管理实践保障了医疗队临床护理工作的顺利开展,确保了护理救治成功率,实现了医务人员"零感染"的既定目标,为COVID-19的护理救护提供了借鉴。     

新型冠状病毒肺炎后时代：基础疾病带来的巨大挑战

新型冠状病毒流行已经造成全球超五亿人次感染。由于病毒变异等原因，我国基础疾病导致的高龄重症患者明显增加，给临床诊疗带来了巨大的挑战。高龄合并基础疾病患者进展为新型冠状病毒肺炎（简称新冠肺炎）重症或基础疾病重型，预后不佳，采用早期筛查和早期干预，预防高危患者重症化；强调重症规范管理和基础疾病的专科化诊疗，关注肺与肺外器官保护；同时加强营养支持和康复治疗，是降低患者重症率和病死率的关键。     

Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages

OBJECTIVEDiabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission.RESULTSAmong 373,963 adults with COVID-19, 16.1% (95% CI 16.0–16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6–39.2) for patients with diabetes only and 42.9% (42.2–43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3–12.7) and 17.5% (14.5–20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization.CONCLUSIONSSocial vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.     

Obesity Management in Primary Care During and Beyond the COVID-19 Pandemic

With 6.1 million United States cases as of early September 2020, the coronavirus disease 2019 (COVID-19) pandemic is presenting unprecedented challenges to primary care. As a complex multifactorial chronic disease, obesity is a significant risk for severe COVID-19 complications associated with high morbidity and mortality. Sustainable lifestyle changes and weight loss can be effective to address obesity and its complications. With COVID-19 expected to persist for the foreseeable future, treatment and prevention of obesity is more imperative than ever. This report summarizes how obesity management and lifestyle counseling can be incorporated and applied in primary care during and beyond the COVID-19 pandemic.     

Diabetes and Overweight/Obesity Are Independent,Nonadditive Risk Factors for In-Hospital Severity of COVID-19: An International,Multicenter Retrospective Meta-analysis

OBJECTIVEObesity is an established risk factor for severe coronavirus disease 2019 (COVID-19), but the contribution of overweight and/or diabetes remains unclear. In a multicenter, international study, we investigated if overweight, obesity, and diabetes were independently associated with COVID-19 severity and whether the BMI-associated risk was increased among those with diabetes.RESEARCH DESIGN AND METHODSWe retrospectively extracted data from health care records and regional databases of hospitalized adult patients with COVID-19 from 18 sites in 11 countries. We used standardized definitions and analyses to generate site-specific estimates, modeling the odds of each outcome (supplemental oxygen/noninvasive ventilatory support, invasive mechanical ventilatory support, and in-hospital mortality) by BMI category (reference, overweight, obese), adjusting for age, sex, and prespecified comorbidities. Subgroup analysis was performed on patients with preexisting diabetes. Site-specific estimates were combined in a meta-analysis.RESULTSAmong 7,244 patients (65.6% overweight/obese), those with overweight were more likely to require oxygen/noninvasive ventilatory support (random effects adjusted odds ratio [aOR], 1.44; 95% CI 1.15–1.80) and invasive mechanical ventilatory support (aOR, 1.22; 95% CI 1.03–1.46). There was no association between overweight and in-hospital mortality (aOR, 0.88; 95% CI 0.74–1.04). Similar effects were observed in patients with obesity or diabetes. In the subgroup analysis, the aOR for any outcome was not additionally increased in those with diabetes and overweight or obesity.CONCLUSIONSIn adults hospitalized with COVID-19, overweight, obesity, and diabetes were associated with increased odds of requiring respiratory support but were not associated with death. In patients with diabetes, the odds of severe COVID-19 were not increased above the BMI-associated risk.     

Clinical,demographic and oxidative profile of patients with COVID-19 and disease severity

This study aimed to profile the clinical progression, demographics, and oxidative status of COVID-19 patients, correlating with disease severity. The study included 143 participants: 93 patients with COVID-19 (28 outpatients, 65 inpatients), and 50 control participants. Thiobarbituric acid reactive substance (TBARS) was used as an oxidative damage marker. Antioxidant activity was assessed via quantification of Vitamin C, sulfhydryl groups, ferric reduction ability of plasma (FRAP), Uric acid (UA), and evaluation of delta-aminolevulinate dehydratase (δ-ALA-D) enzymatic activity. Geriatric patients, especially men, with comorbidities such as obesity and/or chronic diseases were more likely to develop the most severe form of COVID-19. The activity of the δ-ALA-D was lower in inpatients, and there was no significant difference with the outpatient. Antioxidants decreased in COVID-19 groups, while lipid peroxidation increased. FRAP and Vitamin C decreased with evolution of the disease. Oxidative stress could be used as a predictor of worsening clinical condition.     

Are Migraine Patients at Increased Risk for Symptomatic Coronavirus Disease 2019 Due to Shared Comorbidities?

The coronavirus disease 2019 (COVID-19) pandemic has rapidly transformed the whole world and forced us to look through comorbid diseases and risk factors from a different perspective. COVID-19 shows some inherent risk factors like cardiovascular comorbidities independent from age, gender, and geographic location. One of the most peculiar features of the COVID-19 pandemic is that severe acute respiratory syndrome coronavirus 2 respiratory infections disproportionately impact patients with hypertension, diabetes, and other cardiovascular comorbidities rather than those with allergic respiratory diseases and immune-compromised conditions. Migraine is a complex neuro-vasculo-inflammatory disorder that is also packed frequently with certain medical conditions including vascular disorders, hypertension, allergic diseases such as asthma and systemic inflammatory disorders. Accordingly, 2 different questions arise during the pandemic: (1) Do share comorbidities of cardiovascular diseases and hypertension increase the risk of symptomatic COVID-19 for migraine patients? (2) Do comorbid allergic and atopic diseases, including asthma act as opposite influencers alongside with female gender? This paper focuses on the co-existence of comorbidities of COVID-19, in comparison with migraine, based on a wide clinical dataset and available reports. Discussed mechanisms include potential strategic roles of angiotensin-converting enzyme 2, angiotensin-II, and nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 inflammasome, playing remarkable parts in the pathogenesis of COVID-19 and migraine. There are also some clues about the importance of endothelial and pericyte dysfunction and neuroinflammation in COVID-19 infection, related to complications and survival of the patients. The large epidemiological studies as well as basic research, focusing on migraine patients with COVID-19 will clarify these vital questions during the upcoming periods.     

Polycystic ovary syndrome: Pathways and mechanisms for possible increased susceptibility to COVID-19

In 75% of women with polycystic ovary syndrome (PCOS), insulin action is impaired. In obesity, visceral adipose tissue becomes dysfunctional: Chronic inflammation is favored over storage, contributing to the development of metabolic complications. PCOS, metabolic syndrome (MetSy) and non-alcoholic fatty liver disease (NAFLD) apparently share common pathogenic factors; these include abdominal adiposity, excess body weight and insulin resistance. Alterations in the gut microbiome have been noted in women with PCOS compared to controls; these may lead to deterioration of the intestinal barrier, increased gut mucosal permeability and immune system activation, hyperinsulinemia and glucose intolerance, which hamper normal ovarian function and follicular development (all being hallmarks of PCOS). It has been proposed that PCOS may entail higher susceptibility to coronavirus disease 2019 (COVID-19) via its associated comorbidities (NAFLD, obesity, MetSy and alterations in the gut microbiome). Studies have found an association between acute respiratory distress syndrome (seen in severe cases of COVID-19) and the intestinal microbiome. Furthermore, apparently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can gain entry to the gastrointestinal tract via locally-expressed angiotensin converting enzyme type 2 receptors. Excess body weight is associated with more severe COVID-19 and increased mortality. Although robust links between SARS-CoV-2 infection and PCOS/NAFLD/gut microbiome/metabolic consequences are yet to be confirmed, it seems that strategies for adapting the intestinal microbiome could help reduce the severity of COVID-19 in women with PCOS with or without NAFLD, MetSy or obesity.     

Non-pulmonary involvement in COVID-19: A systemic disease rather than a pure respiratory infection

During the early phase of the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), diagnosis was difficult due to the diversity in symptoms and imaging findings and the variability of disease presentation. Pulmonary manifestations are reportedly the main clinical presentations of COVID-19 patients. Scientists are working hard on a myriad of clinical, epidemiological, and biological aspects to better understand SARS-CoV-2 infection, aiming to mitigate the ongoing disaster. Many reports have documented the involvement of various body systems and organs apart from the respiratory tract including the gastrointestinal, liver, immune system, renal, and neurological systems. Such involvement will result in diverse presentations related to effects on these systems. Other presentations such as coagulation defects and cutaneous manifestation may also occur. Patients with specific comorbidities including obesity, diabetes, and hypertension have increased morbidity and mortality risks with COVID-19.     

Diagnosis,treatment protocols,and outcomes of liver transplant recipients infected with COVID-19

Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019(COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention hav...     

Nonalcoholic fatty liver disease and COVID-19: An epidemic that begets pandemic

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic, affecting all the individuals across the planet. COVID-19 has gained significant attention due to its high prevalence among individuals with diabetes, nonalcoholic fatty liver disease (NAFLD), and metabolic syndrome. NAFLD is the hepatic manifestation of metabolic syndrome and can be associated with a high risk of developing type 2 diabetes. The association of COVID-19 and NAFLD has also gained more attention because NAFLD is highly associated with the epidemic of obesity. NAFLD is a potential risk factor for SARS-CoV-2 infection and severe COVID-19, independent of metabolic syndrome. Importantly, it is not yet clear whether the epidemics of obesity and NAFLD have perpetuated the current pandemic of COVID-19. Further research is urgently needed to assess the following: (1) Whether NAFLD is a high risk factor for SARS-CoV-2 infection; (2) Whether NAFLD is associated with the severe form of COVID-19; and (3) Whether the presence of NAFLD can explain the racial variation in the morbidity and mortality associated with COVID-19. This review summarizes the interactions between COVID-19 and NAFLD, mechanism of liver injury by COVID-19, and effect of lockdown due to COVID- 19 on patients with NAFLD.