Rapid and accurate laboratory diagnosis of SARS-CoV-2 infection is crucial for the management of COVID-19 patients and control of the spread of the virus. At the start of the COVID-19 pandemic, Bangladesh had only one...Rapid and accurate laboratory diagnosis of SARS-CoV-2 infection is crucial for the management of COVID-19 patients and control of the spread of the virus. At the start of the COVID-19 pandemic, Bangladesh had only one government molecular laboratory where real-time RT-PCR would be performed to diagnose SARS-CoV-2 infection. With the increasing number of suspected cases requiring confirmation diagnostic testing, there is a requirement to expand capacity for large-scale testing quickly. The government of Bangladesh established over 100 molecular laboratories within one year to test COVID-19. To expand the testing capacity, the government was compelled to recruit laboratory staff with limited experience and technical expertise, especially in molecular assays, to process specimens, interpret results, troubleshoot. As a result, the risk of diagnostic errors, such as cross-contamination, increased, potentially undermining the efficacy of public health policies, public health response, surveillance programs, and restrictive measures aimed toward containing the outbreak. In this piece, we discuss the different sources of cross-contamination in the COVID-19 RT-PCR laboratories and proffer practical preventive measures to avoid them.展开更多
The infection of SARS-CoV-2 has triggered the COVID-19 pandemic. In addition to the fever and respiratory symptoms in the process of coronavirus infections, gastrointestinal symptoms, especially diarrhea, are prominen...The infection of SARS-CoV-2 has triggered the COVID-19 pandemic. In addition to the fever and respiratory symptoms in the process of coronavirus infections, gastrointestinal symptoms, especially diarrhea, are prominent features of its acute infection and long COVID. The associations between the lung and large intestine have been demonstrated by Western medicine in aspects such as tissue origin, microflora homeostasis, mucosal immunity, renin-angiotensin system(RAS) and autonomic nervous system as well, which are considered as the evidence of material basis and potential regulatory mechanisms for “gutlung crosstalk(肺肠串扰)” in COVID-19. We have noticed that probiotics and other preparations can regulate the intestines, and further treat COVID-19 with effective and gratifying results. In the system of traditional Chinese medicine(TCM), there's a term of “exterior-interior pairing of the lung and large intestine(肺与大肠相表里)”, showing an interconnection of the lung and the bowels. “Exterior-interior pairing of the lung and large intestine” is an important part of the theory of visceral activities proposed by ancient physicians through a long-term observation and practice. It's considered that “lung” and “large intestine” are interconnected and mutually exterior-interior in the normal physical activities and the disease development, providing a theoretical basis for treating lung diseases and bowel diseases from the perspective of overall concept. The study aims to compare the term of “exterior-interior pairing of the lung and large intestine” in TCM and “gut-lung crosstalk” in Western medicine regarding the development of COVID-19 and its intestinal symptoms, and provide more ideas for diagnosing and treating lung and bowel related diseases.展开更多
目的观察温针灸联合刺络拔罐治疗轻型新型冠状病毒(corona virus disease 2019,COVID-19)感染患者的临床疗效。方法将82例COVID-19轻型患者随机分为治疗组和对照组,每组41例。对照组予连花清瘟颗粒口服,治疗组在对照组基础上给予温针灸...目的观察温针灸联合刺络拔罐治疗轻型新型冠状病毒(corona virus disease 2019,COVID-19)感染患者的临床疗效。方法将82例COVID-19轻型患者随机分为治疗组和对照组,每组41例。对照组予连花清瘟颗粒口服,治疗组在对照组基础上给予温针灸联合刺络拔罐治疗。比较两组退热时间,两组治疗前后咳嗽视觉模拟量表(visual analog scale,VAS)、中文版莱塞斯特咳嗽生命质量问卷(Mandarin Chinese version of the Leicester cough questionnaire,LCQ-MC)、咽干/痛缓解程度,并比较两组安全性情况,追踪观察两组患者是否出现“长新冠综合征”和COVID-19二次感染情况。结果两组退热时间比较差异有统计学意义(P<0.05)。两组治疗后咳嗽VAS评分低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。两组治疗后LCQ-MC评分低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。两组治疗后咽干/痛程度分布优于治疗前,且治疗组优于对照组,差异有统计学意义(P<0.05)。两组“长新冠综合征”发生率比较差异无统计学意义(P>0.05)。两组COVID-19二次感染率比较差异无统计学意义(P>0.05)。两组疗法安全性均可。结论在口服中成药的基础上,温针灸联合刺络拔罐治疗COVID-19轻型患者在急性期临床疗效显著,安全性高。展开更多
BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms(PTSSs)among university students during the coronavirus disease 2019(COVID-19)pandemic as well as understanding the mental health help-seeking beh...BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms(PTSSs)among university students during the coronavirus disease 2019(COVID-19)pandemic as well as understanding the mental health help-seeking behavior of individuals with PTSSs has critical implications for public mental health strategies in future medical pandemics.AIM To investigate the prevalence and correlates of PTSSs among university students during the first wave of the COVID-19 pandemic in China and to examine mental health help-seeking behaviors among these students.METHODS A total of 2507 Chinese university students were recruited via snowball sampling.The students completed the Seven-item Screening Scale for Post-traumatic Stress Disorder during the first wave of the COVID-19 pandemic in China.Sociodemo-graphic characteristics,pandemic-related characteristics,and mental health help-seeking behaviors of students with PTSSs were also collected.RESULTS The prevalence of PTSSs among the participants was 28.0%.Seven significant correlates of PTSSs were identified(odds ratio=1.23-3.65,P≤0.024):Female sex,being 19 years old or older,living with others or alone,a low level of family economic status,fair or poor interpersonal relationships,severe or very severe local pandemic,and having family members diagnosed with COVID-19.However,only 3.28%of the students with PTSSs reported seeking help from mental health specialists.Among the 23 students who sought help from mental health specialists,13 opted for online or telephone-based psychological consultation.CONCLUSION Our data suggest that there was a high risk of PTSSs among university students and a high level of unmet mental health needs during the COVID-19 pandemic.The delivery of mental health services online or via telephone is a promising approach to address these unmet needs.展开更多
BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for...BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for assessing this risk.In Gabon,early implementation of anticoagulation therapy and D-dimer testing has been crucial in managing COVID-19.This study hypothesizes that elevated Ddimer levels are linked to increased COVID-19 severity.AIM To determine the impact of D-dimer levels on COVID-19 severity and their role in guiding clinical decisions.METHODS This retrospective study analyzed COVID-19 patients admitted to two hospitals in Gabon between March 2020 and December 2023.The study included patients with confirmed COVID-19 diagnoses and available D-dimer measurements at admission.Data on demographics,clinical outcomes,D-dimer levels,and healthcare costs were collected.COVID-19 severity was classified as non-severe(outpatients)or severe(inpatients).A multivariable logistic regression model was used to assess the relationship between D-dimer levels and disease severity,with adjusted odds ratios(OR)and 95%CI.RESULTS A total of 3004 patients were included,with a mean age of 50.17 years,and the majority were female(53.43%).Elevated D-dimer levels were found in 65.81%of patients,and 57.21%of these experienced severe COVID-19.Univariate analysis showed that patients with elevated D-dimer levels had 3.33 times higher odds of severe COVID-19(OR=3.33,95%CI:2.84-3.92,P<0.001),and this association remained significant in the multivariable analysis,adjusted for age,sex,and year of collection.The financial analysis revealed a substantial burden,particularly for uninsured patients.CONCLUSION D-dimer predicts COVID-19 severity and guides treatment,but the high cost of anticoagulant therapy highlights the need for policies ensuring affordable access in resource-limited settings like Gabon.展开更多
BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpfu...BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.展开更多
The ongoing coronavirus disease 2019(COVID-19)pandemic has necessitated rapid advancements in therapeutic strategies,with dexamethasone emerging as a key treatment for severe cases.This editorial discusses the systema...The ongoing coronavirus disease 2019(COVID-19)pandemic has necessitated rapid advancements in therapeutic strategies,with dexamethasone emerging as a key treatment for severe cases.This editorial discusses the systematic review conducted by Sethi et al,published in the World Journal of Virology.The review critically examines the efficacy and safety of varying dosages of dexamethasone in severe COVID-19 patients,providing a comprehensive meta-analysis that underscores the current clinical recommendations favoring a low-dose regimen.Despite these findings,the review highlights the potential benefits of tailored dosages for specific patient subgroups,suggesting a need for personalized treatment approaches.This editorial expands on the implications of these findings,advocating for the integration of evolving clinical data into treatment protocols and calling for further research into patient-specific responses to therapy.It emphasizes the importance of adaptability and precision in pandemic response,urging the medical community to consider both the robustness of existing evidence and the potential for innovative approaches to enhance patient outcomes in the face of global health challenges.展开更多
Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI)...Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI),can result in significant morbidity and mortality,particularly in the context of coronavirus disease 2019(COVID-19).This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI.The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers,such as Creactive protein,ferritin,and procalcitonin,and experienced worse clinical outcomes compared to those with other causes of AKI.The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)pla...BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)plays a role in both immune support and inflammation control,especially in immunocompromised patients.This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.CASE SUMMARY A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations.Postoperatively,he developed COVID-19 pneumonia,severe septic shock,and ARDS.He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation,in addition to IVIG and pulse steroids.CONCLUSION IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection.We aim,for the first time,to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting.With further investigations,this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.展开更多
BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial st...BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.展开更多
This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National ...This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.展开更多
BACKGROUND Many patients with coronavirus disease 2019(COVID-19)may experience emotional issues and cognitive impairment.However,it remains unclear whether the brain mediates the impact of COVID-19 on the emergence of...BACKGROUND Many patients with coronavirus disease 2019(COVID-19)may experience emotional issues and cognitive impairment.However,it remains unclear whether the brain mediates the impact of COVID-19 on the emergence of psychopathological symptoms.It remains unclear whether anxiety and depression are caused by stressors or viral infection.AIM To use functional near-infrared spectroscopy(fNIRS)to detect cortical hemodynamic changes in patients with COVID-19 and their relationship with mental symptoms(mainly depression and anxiety),to investigate whether COVID-19 causes these changes by affecting brain function.METHODS A total of 58 subjects,comprising 29 patients with first acute COVID-19 infection and 29 healthy controls without COVID-19 infection and without anxiety or depression were recruited.Then cortical activation during the performance of the verbal fluency test(VFT)and brain connectivity during the resting state(rs)were evaluated by 53-channel fNIRS.For the COVID-19-infected group,Patient Health Questionnaire-9(PHQ-9)and General Anxiety Disorder-7(GAD-7)were used to assess the emotional state before fNIRS measures.RESULTS For the rs,compared to the uninfected group,the infected group exhibited lower rs functional connectivity(FC)in the dorsolateral prefrontal cortex(DLPFC),which was correlated with both the PHQ score and GAD score.During the VFT,the infected group exhibited significantly lower cortical activation than the uninfected group in both Broca-left and Broca-right.Besides,the integral value in the DLPFC-L showed a significant negative correlation with the PHQ-9 score during the VFT in the infected group.CONCLUSION There were significant differences in the bilateral Broca area and DLPFC between the COVID-19-infected and uninfected groups,which may be the reason why COVID-19 infection impairs cognitive function and language function and leads to psychiatric symptoms.In addition,the rsFC in patients with COVID-19 was positively correlated with the severity of depression and anxiety,which may be related to the fact that the mental symptoms of patients with COVID-19 are characterized by depression and anxiety,rather than depression or anxiety alone.Our study provides evidence that the psychological and emotional issues caused by COVID-19 are not only due to external social factors but also involve more direct brain neural mechanisms and abnormal neural circuits,which also provide insights into the future treatment and prognosis of individuals with COVID-19.展开更多
The study aims to investigate county-level variations of the COVID-19 disease and vaccination rate. The COVID-19 data was acquired from usafact.org, and the vaccination records were acquired from the Ohio vaccination ...The study aims to investigate county-level variations of the COVID-19 disease and vaccination rate. The COVID-19 data was acquired from usafact.org, and the vaccination records were acquired from the Ohio vaccination tracker dashboard. GIS-based exploratory analysis was conducted to select four variables (poverty, black race, population density, and vaccination) to explain COVID-19 occurrence during the study period. Consequently, spatial statistical techniques such as Moran’s I, Hot Spot Analysis, Spatial Lag Model (SLM), and Spatial Error Model (SEM) were used to explain the COVID-19 occurrence and vaccination rate across the 88 counties in Ohio. The result of the Local Moran’s I analysis reveals that the epicenters of COVID-19 and vaccination followed the same patterns. Indeed, counties like Summit, Franklin, Fairfield, Hamilton, and Medina were categorized as epicenters for both COVID-19 occurrence and vaccination rate. The SEM seems to be the best model for both COVID-19 and vaccination rates, with R2 values of 0.68 and 0.70, respectively. The GWR analysis proves to be better than Ordinary Least Squares (OLS), and the distribution of R2 in the GWR is uneven throughout the study area for both COVID-19 cases and vaccinations. Some counties have a high R2 of up to 0.70 for both COVID-19 cases and vaccinations. The outcomes of the regression analyses show that the SEM models can explain 68% - 70% of COVID-19 cases and vaccination across the entire counties within the study period. COVID-19 cases and vaccination rates exhibited significant positive associations with black race and poverty throughout the study area.展开更多
文摘Rapid and accurate laboratory diagnosis of SARS-CoV-2 infection is crucial for the management of COVID-19 patients and control of the spread of the virus. At the start of the COVID-19 pandemic, Bangladesh had only one government molecular laboratory where real-time RT-PCR would be performed to diagnose SARS-CoV-2 infection. With the increasing number of suspected cases requiring confirmation diagnostic testing, there is a requirement to expand capacity for large-scale testing quickly. The government of Bangladesh established over 100 molecular laboratories within one year to test COVID-19. To expand the testing capacity, the government was compelled to recruit laboratory staff with limited experience and technical expertise, especially in molecular assays, to process specimens, interpret results, troubleshoot. As a result, the risk of diagnostic errors, such as cross-contamination, increased, potentially undermining the efficacy of public health policies, public health response, surveillance programs, and restrictive measures aimed toward containing the outbreak. In this piece, we discuss the different sources of cross-contamination in the COVID-19 RT-PCR laboratories and proffer practical preventive measures to avoid them.
基金financed by the grant from the Fundamental Research Funds for the Central Universities (No. 2019-JYB-TD004)。
文摘The infection of SARS-CoV-2 has triggered the COVID-19 pandemic. In addition to the fever and respiratory symptoms in the process of coronavirus infections, gastrointestinal symptoms, especially diarrhea, are prominent features of its acute infection and long COVID. The associations between the lung and large intestine have been demonstrated by Western medicine in aspects such as tissue origin, microflora homeostasis, mucosal immunity, renin-angiotensin system(RAS) and autonomic nervous system as well, which are considered as the evidence of material basis and potential regulatory mechanisms for “gutlung crosstalk(肺肠串扰)” in COVID-19. We have noticed that probiotics and other preparations can regulate the intestines, and further treat COVID-19 with effective and gratifying results. In the system of traditional Chinese medicine(TCM), there's a term of “exterior-interior pairing of the lung and large intestine(肺与大肠相表里)”, showing an interconnection of the lung and the bowels. “Exterior-interior pairing of the lung and large intestine” is an important part of the theory of visceral activities proposed by ancient physicians through a long-term observation and practice. It's considered that “lung” and “large intestine” are interconnected and mutually exterior-interior in the normal physical activities and the disease development, providing a theoretical basis for treating lung diseases and bowel diseases from the perspective of overall concept. The study aims to compare the term of “exterior-interior pairing of the lung and large intestine” in TCM and “gut-lung crosstalk” in Western medicine regarding the development of COVID-19 and its intestinal symptoms, and provide more ideas for diagnosing and treating lung and bowel related diseases.
文摘目的观察温针灸联合刺络拔罐治疗轻型新型冠状病毒(corona virus disease 2019,COVID-19)感染患者的临床疗效。方法将82例COVID-19轻型患者随机分为治疗组和对照组,每组41例。对照组予连花清瘟颗粒口服,治疗组在对照组基础上给予温针灸联合刺络拔罐治疗。比较两组退热时间,两组治疗前后咳嗽视觉模拟量表(visual analog scale,VAS)、中文版莱塞斯特咳嗽生命质量问卷(Mandarin Chinese version of the Leicester cough questionnaire,LCQ-MC)、咽干/痛缓解程度,并比较两组安全性情况,追踪观察两组患者是否出现“长新冠综合征”和COVID-19二次感染情况。结果两组退热时间比较差异有统计学意义(P<0.05)。两组治疗后咳嗽VAS评分低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。两组治疗后LCQ-MC评分低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。两组治疗后咽干/痛程度分布优于治疗前,且治疗组优于对照组,差异有统计学意义(P<0.05)。两组“长新冠综合征”发生率比较差异无统计学意义(P>0.05)。两组COVID-19二次感染率比较差异无统计学意义(P>0.05)。两组疗法安全性均可。结论在口服中成药的基础上,温针灸联合刺络拔罐治疗COVID-19轻型患者在急性期临床疗效显著,安全性高。
文摘BACKGROUND Revisiting the epidemiology of posttraumatic stress symptoms(PTSSs)among university students during the coronavirus disease 2019(COVID-19)pandemic as well as understanding the mental health help-seeking behavior of individuals with PTSSs has critical implications for public mental health strategies in future medical pandemics.AIM To investigate the prevalence and correlates of PTSSs among university students during the first wave of the COVID-19 pandemic in China and to examine mental health help-seeking behaviors among these students.METHODS A total of 2507 Chinese university students were recruited via snowball sampling.The students completed the Seven-item Screening Scale for Post-traumatic Stress Disorder during the first wave of the COVID-19 pandemic in China.Sociodemo-graphic characteristics,pandemic-related characteristics,and mental health help-seeking behaviors of students with PTSSs were also collected.RESULTS The prevalence of PTSSs among the participants was 28.0%.Seven significant correlates of PTSSs were identified(odds ratio=1.23-3.65,P≤0.024):Female sex,being 19 years old or older,living with others or alone,a low level of family economic status,fair or poor interpersonal relationships,severe or very severe local pandemic,and having family members diagnosed with COVID-19.However,only 3.28%of the students with PTSSs reported seeking help from mental health specialists.Among the 23 students who sought help from mental health specialists,13 opted for online or telephone-based psychological consultation.CONCLUSION Our data suggest that there was a high risk of PTSSs among university students and a high level of unmet mental health needs during the COVID-19 pandemic.The delivery of mental health services online or via telephone is a promising approach to address these unmet needs.
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)is strongly associated with an increased risk of thrombotic events,including severe outcomes such as pulmonary embolism.Elevated D-dimer levels are a critical biomarker for assessing this risk.In Gabon,early implementation of anticoagulation therapy and D-dimer testing has been crucial in managing COVID-19.This study hypothesizes that elevated Ddimer levels are linked to increased COVID-19 severity.AIM To determine the impact of D-dimer levels on COVID-19 severity and their role in guiding clinical decisions.METHODS This retrospective study analyzed COVID-19 patients admitted to two hospitals in Gabon between March 2020 and December 2023.The study included patients with confirmed COVID-19 diagnoses and available D-dimer measurements at admission.Data on demographics,clinical outcomes,D-dimer levels,and healthcare costs were collected.COVID-19 severity was classified as non-severe(outpatients)or severe(inpatients).A multivariable logistic regression model was used to assess the relationship between D-dimer levels and disease severity,with adjusted odds ratios(OR)and 95%CI.RESULTS A total of 3004 patients were included,with a mean age of 50.17 years,and the majority were female(53.43%).Elevated D-dimer levels were found in 65.81%of patients,and 57.21%of these experienced severe COVID-19.Univariate analysis showed that patients with elevated D-dimer levels had 3.33 times higher odds of severe COVID-19(OR=3.33,95%CI:2.84-3.92,P<0.001),and this association remained significant in the multivariable analysis,adjusted for age,sex,and year of collection.The financial analysis revealed a substantial burden,particularly for uninsured patients.CONCLUSION D-dimer predicts COVID-19 severity and guides treatment,but the high cost of anticoagulant therapy highlights the need for policies ensuring affordable access in resource-limited settings like Gabon.
文摘BACKGROUND Understanding a patient's clinical status and setting priorities for their care are two aspects of the constantly changing process of clinical decision-making.One analytical technique that can be helpful in uncertain situations is clinical judgment.Clinicians must deal with contradictory information,lack of time to make decisions,and long-term factors when emergencies occur.AIM To examine the ethical issues healthcare professionals faced during the coronavirus disease 2019(COVID-19)pandemic and the factors affecting clinical decision-making.METHODS This pilot study,which means it was a preliminary investigation to gather information and test the feasibility of a larger investigation was conducted over 6 months and we invited responses from clinicians worldwide who managed patients with COVID-19.The survey focused on topics related to their professional roles and personal relationships.We examined five core areas influencing critical care decision-making:Patients'personal factors,family-related factors,informed consent,communication and media,and hospital administrative policies on clinical decision-making.The collected data were analyzed using the χ^(2) test for categorical variables.RESULTS A total of 102 clinicians from 23 specialties and 17 countries responded to the survey.Age was a significant factor in treatment planning(n=88)and ventilator access(n=78).Sex had no bearing on how decisions were made.Most doctors reported maintaining patient confidentiality regarding privacy and informed consent.Approximately 50%of clinicians reported a moderate influence of clinical work,with many citing it as one of the most important factors affecting their health and relationships.Clinicians from developing countries had a significantly higher score for considering a patient's financial status when creating a treatment plan than their counterparts from developed countries.Regarding personal experiences,some respondents noted that treatment plans and preferences changed from wave to wave,and that there was a rapid turnover of studies and evidence.Hospital and government policies also played a role in critical decision-making.Rather than assessing the appropriateness of treatment,some doctors observed that hospital policies regarding medications were driven by patient demand.CONCLUSION Factors other than medical considerations frequently affect management choices.The disparity in treatment choices,became more apparent during the pandemic.We highlight the difficulties and contradictions between moral standards and the realities physicians encountered during this medical emergency.False information,large patient populations,and limited resources caused problems for clinicians.These factors impacted decision-making,which,in turn,affected patient care and healthcare staff well-being.
文摘The ongoing coronavirus disease 2019(COVID-19)pandemic has necessitated rapid advancements in therapeutic strategies,with dexamethasone emerging as a key treatment for severe cases.This editorial discusses the systematic review conducted by Sethi et al,published in the World Journal of Virology.The review critically examines the efficacy and safety of varying dosages of dexamethasone in severe COVID-19 patients,providing a comprehensive meta-analysis that underscores the current clinical recommendations favoring a low-dose regimen.Despite these findings,the review highlights the potential benefits of tailored dosages for specific patient subgroups,suggesting a need for personalized treatment approaches.This editorial expands on the implications of these findings,advocating for the integration of evolving clinical data into treatment protocols and calling for further research into patient-specific responses to therapy.It emphasizes the importance of adaptability and precision in pandemic response,urging the medical community to consider both the robustness of existing evidence and the potential for innovative approaches to enhance patient outcomes in the face of global health challenges.
文摘Rhabdomyolysis is a severe condition characterized by the breakdown of muscle tissue leading to the release of intracellular components into the bloodstream.This condition,when associated with acute kidney injury(AKI),can result in significant morbidity and mortality,particularly in the context of coronavirus disease 2019(COVID-19).This editorial discusses a retrospective study on patients with COVID-19 who developed rhabdomyolysis-related AKI.The study highlights that patients with rhabdomyolysis exhibited higher inflammatory markers,such as Creactive protein,ferritin,and procalcitonin,and experienced worse clinical outcomes compared to those with other causes of AKI.The findings underscore the importance of early recognition and management of rhabdomyolysis in COVID-19 patients to improve prognosis and reduce mortality rates.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)pneumonia with severe septic shock and acute respiratory distress syndrome(ARDS)are critical illnesses for patients following transplant.Intravenous immunoglobulin(IVIG)plays a role in both immune support and inflammation control,especially in immunocompromised patients.This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.CASE SUMMARY A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations.Postoperatively,he developed COVID-19 pneumonia,severe septic shock,and ARDS.He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation,in addition to IVIG and pulse steroids.CONCLUSION IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection.We aim,for the first time,to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting.With further investigations,this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.
文摘BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.
文摘This editorial comments on the article by Desai et al,which investigates the impact of coronavirus disease 2019(COVID-19)on in-hospital mortality among patients with recurrent stroke using data from the 2020 National Inpatient Sample.The findings reveal significantly higher mortality rates in COVID-19-positive patients compared to non-COVID-19 patients,particularly among middle-aged individuals,males,and ethnic minorities.This editorial explores the underlying mechanisms contributing to these outcomes and discusses the clinical implications for targeted management strategies in high-risk groups.The results emphasize the need for comprehensive approaches to mitigate the heightened risks faced by recurrent stroke patients during the COVID-19 pandemic.
基金Supported by Hunan Provincial Scientific Research Plan Project of Traditional Chinese MedicineNational Natural Science Foundation of China,No.82371521Special Tasks for the Construction of Hunan Innovative Province,No.2023SK4002.
文摘BACKGROUND Many patients with coronavirus disease 2019(COVID-19)may experience emotional issues and cognitive impairment.However,it remains unclear whether the brain mediates the impact of COVID-19 on the emergence of psychopathological symptoms.It remains unclear whether anxiety and depression are caused by stressors or viral infection.AIM To use functional near-infrared spectroscopy(fNIRS)to detect cortical hemodynamic changes in patients with COVID-19 and their relationship with mental symptoms(mainly depression and anxiety),to investigate whether COVID-19 causes these changes by affecting brain function.METHODS A total of 58 subjects,comprising 29 patients with first acute COVID-19 infection and 29 healthy controls without COVID-19 infection and without anxiety or depression were recruited.Then cortical activation during the performance of the verbal fluency test(VFT)and brain connectivity during the resting state(rs)were evaluated by 53-channel fNIRS.For the COVID-19-infected group,Patient Health Questionnaire-9(PHQ-9)and General Anxiety Disorder-7(GAD-7)were used to assess the emotional state before fNIRS measures.RESULTS For the rs,compared to the uninfected group,the infected group exhibited lower rs functional connectivity(FC)in the dorsolateral prefrontal cortex(DLPFC),which was correlated with both the PHQ score and GAD score.During the VFT,the infected group exhibited significantly lower cortical activation than the uninfected group in both Broca-left and Broca-right.Besides,the integral value in the DLPFC-L showed a significant negative correlation with the PHQ-9 score during the VFT in the infected group.CONCLUSION There were significant differences in the bilateral Broca area and DLPFC between the COVID-19-infected and uninfected groups,which may be the reason why COVID-19 infection impairs cognitive function and language function and leads to psychiatric symptoms.In addition,the rsFC in patients with COVID-19 was positively correlated with the severity of depression and anxiety,which may be related to the fact that the mental symptoms of patients with COVID-19 are characterized by depression and anxiety,rather than depression or anxiety alone.Our study provides evidence that the psychological and emotional issues caused by COVID-19 are not only due to external social factors but also involve more direct brain neural mechanisms and abnormal neural circuits,which also provide insights into the future treatment and prognosis of individuals with COVID-19.
文摘The study aims to investigate county-level variations of the COVID-19 disease and vaccination rate. The COVID-19 data was acquired from usafact.org, and the vaccination records were acquired from the Ohio vaccination tracker dashboard. GIS-based exploratory analysis was conducted to select four variables (poverty, black race, population density, and vaccination) to explain COVID-19 occurrence during the study period. Consequently, spatial statistical techniques such as Moran’s I, Hot Spot Analysis, Spatial Lag Model (SLM), and Spatial Error Model (SEM) were used to explain the COVID-19 occurrence and vaccination rate across the 88 counties in Ohio. The result of the Local Moran’s I analysis reveals that the epicenters of COVID-19 and vaccination followed the same patterns. Indeed, counties like Summit, Franklin, Fairfield, Hamilton, and Medina were categorized as epicenters for both COVID-19 occurrence and vaccination rate. The SEM seems to be the best model for both COVID-19 and vaccination rates, with R2 values of 0.68 and 0.70, respectively. The GWR analysis proves to be better than Ordinary Least Squares (OLS), and the distribution of R2 in the GWR is uneven throughout the study area for both COVID-19 cases and vaccinations. Some counties have a high R2 of up to 0.70 for both COVID-19 cases and vaccinations. The outcomes of the regression analyses show that the SEM models can explain 68% - 70% of COVID-19 cases and vaccination across the entire counties within the study period. COVID-19 cases and vaccination rates exhibited significant positive associations with black race and poverty throughout the study area.
