At present, there are few studies on patients with epilepsy (PWE) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the results of many studies are inconsistent. SARS-CoV-2 may cause new seizures through a variety of mechanisms, and the susceptibility and mortality of PWE to SARS-CoV-2 remains controversial. During the SARS-CoV-2 pandemic, anxiety, depression and other psychological problems were common among epileptic patients. Clinicians providing telemedicine, telephone chat and video call can effectively reduce the risk of psychological disorders in PWE patients. At the same time, there are many interactions between antiepileptic drugs and various antiviral drugs, which should be carefully considered when using. Considering that the research results are few and many studies contradict each other, PWE and SARS-CoV-2 deserve further exploration in future studies.
Objective To explore the shortcomings of the traditional clinical probation teaching mode, propose and implement the interactive teaching mode, so as to stimulate the students’ interest in knowledge and achieve better teaching effects. Methods The students of Grade 2017 who had clinical probation in the Orthopaedic Trauma Center of West China Hospital of Sichuan University from September 2020 to December 2021 were selected. Students were randomly divided into traditional clinical probation teaching mode group and interactive teaching mode group according to random number table method. Wechat mini program anonymous questionnaire survey was used to evaluate students’ satisfaction with the interactive teaching model of orthopaedic trauma and the teaching effect. Results A total of 110 students were enrolled, 55 in the traditional clinical probation teaching mode group and 55 in the interactive teaching mode group. There was no significant difference in gender or age between the two groups (P>0.05). The students in the interactive teaching mode group were better than those in the traditional clinical probation teaching mode group in orthopedic theory test (90.13±3.65 vs. 88.39±3.74; t=2.469, P=0.015) in the orthopedic theory test, teacher evaluation (89.15±2.94 vs. 87.56±3.12; t=2.751, P=0.007) and student self-evaluation (89.07±3.18 vs. 87.41±2.89; t=2.865, P=0.005). The teaching satisfaction of the interactive teaching group was higher than that of the traditional teaching group (96.36% vs. 87.27%; Z=−2.159, P=0.031). Conclusion Interactive teaching mode can effectively stimulate students’ interest in knowledge seeking, improve the enthusiasm and interaction of clinical probation, and effectively improve the satisfaction of undergraduate orthopaedic trauma clinical probation teaching.
ObjectiveTo analyze the clinical characteristics and epidemiological characteristics of patients with coronavirus disease 2019 treated early in Jiangxi province.MethodsFour-night patients with coronavirus disease 2019 treated in this hospital from January 21st to 27th, 2020 were included in this study. The epidemiological and clinical data of patients after admission were collected, and laboratory tests such as blood routine, urine routine, stool routine, liver and kidney function, electrolytes, myocardial enzymes, erythrocyte sedimentation (ESR), C-reactive protein (CRP), calcitonin, coagulation, T cell subset and Chest CT were reviewed. The clinical results of common and severe/critically ill patients were compared.ResultsOf the 49 patients, 40 were common and 9 were severe/critical. Fourty-six patients had a clear history of contact with Wuhan or other areas of Hubei. The sex ratio was 2.06∶1, and the average age was 42.9 years. The symptoms were mainly fever (78.7%), cough (38.8%), and fatigue (18.4%). 28.6% (14 cases) of patients had hypertension and diabetes. Serum lymphocyte count and calcium concentration of the patients were decreased, but lactate dehydrogenase, ESR, CRP and serum amyloid A were increased in these patients. T lymphocyte subsets (CD3+, CD4+, CD8+) decreased significantly in these patients. Forty-seven patients (95.9%) had single or scattered patchy ground glass density shadows on the chest CT. Compared with common patients, the patients with severe/critical patients were older (P=0.023), hospitalized later (P=0.002), and had higher comorbidities (P=0.017). ESR (P=0.001）, CRP (P=0.010) and the serum amyloid A (P=0.040) increased significantly, while CD3+ (P<0.001), CD4+ (P=0.012), CD8+ (P=0.006) decreased significantly in severe/critical patients.ConclusionsThe patients with coronavirus disease 2019 in Jiangxi province are commonly imported from Wuhan. Severe/critical patients are older, hospitalized later, and have more medical complications and more severe systemic inflammatory reactions than common patients.
Objective To investigate the clinical characteristics of patients with COVID-19 associated pulmonary aspergillosis (CAPA). Methods The clinical data of patients diagnosed with CAPA admitted to the First Affiliated Hospital of Soochow University from December 16, 2022 to February 2, 2023 were collected and analyzed. Results Among the 43 enrolled patients,16 patients required invasive mechanical ventilation, 44.19% (19/43) of them with critical novel coronavirus pneumonia, and 86.05% (37/43) had underlying diseases. The peak period of CAPA was 14 - 28 days after SARS-CoV-2 infection (48.84%, 21/43). In the laboratory results, 86.05% (37/43) of patients had varying degrees of lymphocyte reduction, with a lymphocyte count of 0.63 (0.33, 0.96) × 109/L, the median levels of procalcitonin, CRP, and erythrocyte sedimentation rate were all higher than the reference values. 38.89% (14/36) of patients tested positive for serum GM test, and 75.00% (9/12) of patients tested positive for bronchoalveolar lavage fluid GM test. Aspergillus fumigatus is the most common strain. Voriconazole is the most commonly used antifungal drug (86.05%), and other drugs used include caspofungin, posaconazole, isavuconazonium, and amphotericin B. Two patients received local treatment with amphotericin B under bronchoscopy. After treatment, 27 patients improved and were discharged. Conclusions The symptoms, signs, and imaging manifestations of CAPA are not significantly specific, and are prone to misdiagnosis and missed diagnosis. The mortality rate is high. For patients suspected of CAPA and those with CAPA risk factors, relevant examinations should be promptly improved to improve diagnosis and treatment efficiency.
ObjectiveTo explore the epidemiological characteristics, clinical manifestations, laboratory examination and imaging findings of patients with coronavirus disease 2019 (COVID-19) outside Hubei Province in 2019.MethodsFrom January 21, 2020 to February 18, 2020, 17 patients with COVID-19 diagnosed by SARS-CoV-2 nucleic acid test in Xianyang Central Hospital of Shaanxi Province and 23 patients in Liaocheng Infectious Disease Hospital of Shandong Province were collected. The information of epidemiology, age, time of onset, first symptom, white blood cell, lymphocyte count, procalcitonin (PCT), serum amyloid protein A (SAA), C-reactive protein (CRP) and chest CT were collected and analyzed.Results40.0% of the 40 patients had a clear history of contact with Wuhan or other areas of Hubei, 60.0% had no clear exposure history, 60.0% were aggregative diseases, 40.0% were imported patients; the average visit time was (4.9±3.5) d, 35% of the patients had underlying diseases; 75.0% of the patients had fever, 7.5% of the initial symptoms were cough, 5.0% pharyngitis, 2.5% headache, and 10.0% were asymptomatic. In the laboratory examination, 77.5% of the patients' white blood cells were normal, 45.0% of the patients' lymphocyte count could be decreased, 72.5% and 55.0% of the patients' SAA and CRP increased respectively, 92.5% of the patients' PCT was normal, 92.5% of the patients were positive for the first nucleic acid test, and 72.5% of the patients' chest CT showed multiple ground glass lesions in one or both lungs, and the positive coincidence rate between the initial nucleic acid test and the chest CT test was 92.5%. 90% of the patients in the group were common type, and all patients were treated with aerosol inhalation of α-interferon combined with lopinavir/ritonavir tablets, 62.5% were treated with antibiotics and 15.0% were treated with glucocorticoid. All patients were improved and 14 patients were cured and discharged from hospital.ConclusionsSARS-COV-2 is highly contagious, family aggregation infection and asymptomatic infection may be the main mode of transmission outside Hubei Province, mild and common types are common, there are no specific changes in laboratory examination, and the condition is stable after treatment.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
The diagnosis of coronavirus disease 2019 should not only depend on nucleic acid test, but also be based on clinical information such as medical history and radiographic findings. It’s critical to identify patients with high risk of rapid progression. Treatment of coronavirus disease 2019 should be individualized according to the underlying diseases and progression manner. For severely ill patients, oxygen and nutrition supplementation need to be strengthened, and for some highly selected cases, administration of glucocorticoids might be beneficial.
ObjectiveTo systematically review the application of extracorporeal membrane oxygenation (ECMO) in patients with coronavirus disease 2019 (COVID-19).MethodsPubMed, The Cochrane Library, EMbase, CBM, WanFang Data and CNKI databases were searched for studies on ECMO for COVID-19 from December 1st, 2019 to December 31st, 2020. Two researchers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 24 studies were included, involving 1 576 acute respiratory distress syndrome (ARDS) patients with COVID-19. The overall mortality of patients was 27.3% (430/1 576). The rate of ECMO treatment was 4.68% (379/1576), and the survival rate was 69.4% (263/379). The mean duration of mechanical ventilation prior to ECMO treatment for ARDS patients ranged from 2.07±0.40 to 15.89±13.0 days, compared with 1.64±0.78 days and 29.9±3.60 days for ECMO treatment. Of the 11 studies included in the meta-analysis, 84.0% (405/482) patients with ARDS received conventional treatment with COVID-19, and 16.0% (77/482) received ECMO treatment on the basis of conventional treatment with ARDS. Results of meta-analysis showed that there was statistically significant difference in the survival rate of ARDS patients with COVID-19 treated with conventional therapy combined with ECMO or with conventional therapy alone (RR=1.27, 95%CI 1.00 to 1.62, P=0.05).ConclusionsThis study suggests that the survival rate of COVID-19 patients after ECMO treatment has a tendency to improve. Due to the limitation of quantity and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
At present, coronavirus disease 2019 has become the most serious public health emergency in the world. The disease is still spreading around the world. The disease progresses rapidly and is highly contagious, causing great harm to the public health security of the world. Based on the research evidence published at home and abroad, this article systematically summarizes the biological structure of severe acute respiratory syndrome coronavirus 2, and the pathogenesis, transmission routes and susceptible populations, clinical features and treatment methods of coronavirus disease 2019. It aims to help medical workers understand coronavirus disease 2019 in order to better diagnose and treat the disease, and provide references for future research.