新型冠状病毒肺炎疫情期间心理应激障碍及应对措施

新型冠状病毒肺炎(COVID-19)疫情暴发和流行期间,由于其病原体新型冠状病毒(SARS-CoV-2)具有强的传染性、可致死性及难预测性等特点,给全社会民众包括正常人群、确诊病例及疑似病例带来了巨大的心理冲击。不良的心理应激往往对社会造成恐慌,对个人不仅可导致心理应激障碍如焦虑、抑郁,甚至诱发创伤后应激障碍(PTSD),更不利于COVID-19患者的康复,所以早期对疫情期间心理应激干预非常必要。本文通过分析此次COVID-19疫情期间不同人群心理应激障碍,并探讨其应对措施,有助于及时对个体进行心理疏导,避免心理应激障碍的发生,有利于COVID-19患者的康复。     

新型冠状病毒肺炎患者的骨科急诊处理经验分享(附2例报告)

目的 探讨在新型冠状病毒肺炎(COVID-19)疫情期间,合并新冠肺炎的骨科急诊患者的合理化接诊、处置流程和规范化的防护措施。方法 在新冠肺炎疫情早期接诊2例合并新冠肺炎的骨科急诊创伤患者:1例重型新冠肺炎合并股骨颈骨折,1例轻型新冠肺炎合并开放性踝关节骨折、脱位。从入院急诊开始,医务人员、患者及其家属均采取全程规范化防护措施,并将患者的新冠肺炎病情程度和骨科创伤特点有机结合、综合分析,并经院内多学科讨论后,制定出人性化、规范化的接诊、处置和防护措施:第1例患者为新冠肺炎重型,为手术的禁忌证,故采取保守治疗,即“患肢牵引制动+止痛+抗骨质疏松”;第2例患者为新冠肺炎轻型,且为开放性骨折、关节脱位,必须急诊手术,即在全程防护下行“关节复位、清创缝合术+石膏外固定”。结果 第1例患者治疗2周后,症状减轻,肺部炎性病灶已有部分吸收,最近一次核酸检测呈阴性,现持续患肢皮牵引并拟行第二次核酸检测。第2例患者已在全麻下行“关节复位、清创缝合术+石膏外固定”,伤口愈合良好,持续石膏外固定,现2次核酸检测均呈阴性,肺部炎性病灶已完全吸收,新冠肺炎也已治愈。结论 新冠肺炎疫情期间,诊治合并新冠肺炎的骨科急诊患者时,应将患者的新冠肺炎病情程度和骨科创伤特点有机结合、综合分析,以防控疫情扩散为第一原则,并经院内多学科讨论后,制定出人性化、规范化的接诊、处置流程和防护措施;有效地避免新冠肺炎院内交叉感染和聚集性扩散。     

新型冠状病毒肺炎疫情期间定点医院缓冲隔离病区的建立与运行

目的新型冠状病毒肺炎(COVID-19)疫情期间,通过建立与运行定点医院缓冲隔离病区,确保新入院非COVID-19的其他传染性疾病患者得到精准救治,防止发生交叉感染。方法结合宜昌市第三人民医院传染病患者收治实际情况,设置缓冲隔离病区,制定门急诊患者诊疗管理流程,通过门诊预检分诊及各专科门诊筛查,初步识别非COVID-19患者与COVID-19患者,并对新入院非COVID-19的普通传染病患者单间收治,集中管理,通过为期6 d的健康监测及规范筛查,再分流到各专科传染病区。结果在COVID-19流行期间,缓冲隔离病区的建立及运行可确保非COVID-19的其他传染性疾病患者也能得到最大限度的及时高效救治,防止医务人员与患者之间、患者与患者之间发生交叉感染。同时通过缓冲隔离病区集中收治,可减少人力资源及防护物资的投入,更利于规范管理。结论设置缓冲隔离病区集中管理,确保了新入院的非COVID-19的其他传染性疾病患者得以精准救治且无交叉感染发生。     

COVID-19流行区域外科收治全流程防护决策对骨科创伤患者处置能力影响探讨

目的 提出一种在新型冠状病毒肺炎(COVID-19)流行区域对疑似及确诊病例合并骨创伤患者的外科流程化分区收治处置对策,研究在COVID-19疫情中心区域实施相应诊疗行动对骨科住院择期及限期手术患者的影响。方法 回顾性分析本院2020年1月20日至2020年3月15日收治的湖北省武汉市COVID-19疫情中心区域骨科择期及限期手术患者共计40例,按门急诊处理及分流、医院综合缓冲病区隔离筛查、专科病房及手术处置3个阶段分区诊疗处理决策进行救治。记录平均院前待床时间、住院后平均手术前准备时间、术后平均住院时间,与2019年度同期收治患者进行比较分析。同时进行治疗优良度的临床评估。结果 COVID-19疫情下手术患者平均手术前准备时间和2019年同期相比存在较大幅度增长,术后平均住院时间及总住院时间则有所缩短。因平均院前待床时间延长,陈旧性骨折发生率有所升高,但手术优良率在评估时未见明显下降。结论 COVID-19流行区域采用外科流程化分区收治诊疗处理可以有效对骨科患者进行快速处置,在控制院内感染风险的基础上,维持医院周转能力。     

1例疑似新型冠状病毒肺炎患者的手术管理策略

回顾1例疑似新型冠状病毒肺炎(COVID-19)患者的急诊手术管理,医护团队根据COVID-19的感染特点,参照核应急演习及手术室特殊感染手术的防控要求,提出严密的隔离措施和管理计划策略,从患者的病情评估、术前准备、手术间及器材设备准备、手术人员管控、麻醉防护特点、术中护理关键点及术后环境、器械、用物处置的特殊性进行积极探索,以期为保障手术顺利进行及制定疑似/确诊COVID-19患者手术管理流程和感染防控规范提供依据。     

北京某三甲医院在COVID-19疫情期间血液供给模式及效果分析

目的 探讨通过采取一系列应急措施,在COVID-19疫情期间医院血液供给模式及效果分析.方法 选择2019年1月21日至3月23日与2020年1月21日至3月23日期间,我站全血采集量与血小板采集量之间进行比对;红细胞、血浆及血小板临床用量之间进行比对.结果 在COVID-19疫情期间,我站调整无偿献血模式、加大宣传力度、严格把控临床用血.保障了无偿献血者及临床用血工作的安全、顺利展开.结论 面对突发公共事件,在保证人员安全的基础上,及时调整无偿献血模式、加大宣传力度、严格规范化临床用血,多方面结合才能有效、安全保证COVID-19疫情期间临床用血供应.     

新型冠状病毒肺炎疫情下医学生的参与及其启示

新型冠状病毒肺炎(COVID-19)疫情流行期间,医学教育受到了很大的影响。关于医学生是否应该以及通过何种方式参与疫情防控,全球争议不断。本文对COVID-19疫情期间医学生所面临的困境以及实际的参与情况进行回顾与总结,为医学教育对重大公共卫生事件的应对提供参考。     

2020-2021重庆某高校口腔医学生知觉压力状况变化

目的:了解突发公共卫生事件新型冠状病毒肺炎(COVID-19)疫情及常态化疫情防控期间重庆某高校口腔医学生知觉压力状况变化.方法:抽取重庆某高校口腔医学生作为调查对象,采用知觉压力量表(PSS-14)等,采取在线调查问卷方式对COVID-19疫情及常态化疫情防控期间口腔医学生知觉压力状况,知觉压力水平与睡眠时间、焦虑状况相关性进行调查.结果:口腔医学生知觉压力COVID-19疫情期平均得分22.49±9.38,常态化疫情防控期21.83±9.49.常态化疫情防控期间,男女生(t=-3.770,P＜0.01),是否在毕业班(t=5.559,P＜0.01)知觉压力状况水平有显著统计学差异.知觉压力检出率COVID-19疫情期24.06％,常态化疫情防控期22.80％.常态化疫情防控期知觉压力女性高于男性,有统计学差异(X2=5.942,P＜0.05);毕业班口腔医学生较非毕业班高,且有显著统计学差异(X2=8.568,P＜0.01).2021年较2020年知觉压力平均得分、检出率都稍低,但无统计学差异.COVID-19疫情及常态化疫情防控期间,调查对象知觉压力水平与焦虑得分呈显著正相关(r=0.583,0.707;P＜0.01),与每日睡眠时间呈显著负相关(r=-0.115,-0.162;P＜0.05).结论:常态化疫情防控期间,女生比男生更有更高的压力,毕业班学生比非毕业班学生具有更高的压力;口腔医学生知觉压力水平与焦虑呈正相关,与睡眠呈负相关.     

新冠肺炎疫情下结直肠癌标本采集和处理的对策

正2019年12月以来,新型冠状病毒肺炎(新冠肺炎,COVID-19/2019-nCoV)在我国武汉暴发,并迅速向全世界蔓延~([1])。2020年1月20日,国家卫生健康委员会将该疾病纳入乙类传染病并按照甲类传染病进行防治~([2])。在疫情的影响下,我国的各行各业均受到很大影响,尤其是医疗卫生事业。相关卫生部门在疫情影响下制定了各种应对策略。COVID-19病毒对紫外线和热敏感(56℃30 min),乙醚、75%乙醇和过氧乙酸等条件下均可有效灭活病毒~([3])。COVID-19的主要传播途径包括呼吸道飞沫和密切接触,在相对封闭的环境中长时间暴露于高浓度气溶胶情况下还可能存在气溶胶传播~([4])。疫情期间,医院中患者来源结构复杂、     

新型冠状病毒肺炎期间方舱CT感染防控经验（英文）

新型冠状病毒肺炎(COVID-19)爆发后,胸部CT迅速成为COVID-19诊断、治疗、随访等必不可少的检查手段,但影像科内交叉感染的风险也随之升高。为降低此风险,方舱CT被专门用于疑似和确诊患者的CT检查。本研究结合实际工作经验,从方舱CT的安装环境及功能划分及操作步骤、患者检查次序、技师的排班管理及感控措施、CT设备与机房内物表消毒等方面,介绍疫情期间方舱CT的检查流程及防控策略。     

Hyperpyrexia in patients with COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health emergency, in which its effective treatment and prevention remain obscured. Hyperpyrexia is an elevation of body temperature above 106.7°F (41.5°C) due to an abnormally increased hypothalamic-thermoregulatory set. The pathophysiology, impact, and outcomes of hyperpyrexia in patients with COVID-19 have not yet been studied. Herein, we present clinical features and outcomes of six patients with COVID-19 who had developed hyperpyrexia during hospitalization. All patients expired shortly after the onset of hyperpyrexia. Hyperpyrexia seems to adversely impact the outcomes and mortality in patients with COVID-19. The underlying mechanisms of developing hyperpyrexia in COVID-19 are mysterious. We propose it may be caused by SARS-CoV-2-related brain injury, exuberant immune response, and thrombus formation. More research is needed to verify our results. Understanding the association between hyperpyrexia and SARS-CoV-2 will help to elucidate the COVID-19 pathogenesis, which is mandatory for developing effective treatment strategies.     

Impact of COVID-19 on liver disease: From the experimental to the clinic perspective

Coronavirus disease 2019 (COVID-19) has caused a global pandemic unprecedented in over a century. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a predominantly respiratory infection, various degrees of liver function abnormalities have been reported. Pre-existing liver disease in patients with SARS-CoV-2 infection has not been comprehensively evaluated in most studies, but it can critically compromise survival and trigger hepatic decompensation. The collapse of the healthcare services has negatively impacted the diagnosis, monitoring, and treatment of liver diseases in non-COVID-19 patients. In this review, we aim to discuss the impact of COVID-19 on liver disease from the experimental to the clinic perspective.     

Are nucleotide inhibitors,already used for treating hepatitis C virus infection,a potential option for the treatment of COVID-19 compared with standard of care? A literature review

Coronavirus disease 2019 (COVID-19) is global pandemic with various clinical presentations, ranging from cold to sometimes unrecoverable acute respiratory distress syndrome. Although urgently needed, currently there are no specific treatments for COVID-19. Repurposing existing pharmaceuticals to treat COVID-19 is crucial to control the pandemic. In silico and in vitro studies suggest that a nucleotide inhibitor called Sofosbuvir, has also antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), apart from suppressing other positive-strand ribonucleic Acid viruses with conserved polymerase (hepatitis C virus). The aim of this study was to assess if Sofosbuvir improves clinical outcomes in patients with moderate or severe COVID-19. A compre-hensive overview of scientific literature has been made. Terms searched in PubMed were: COVID-19, SARS-CoV-2, nucleotide inhibitors, pandemic, Sofosbuvir. Results clinical trials conducted among adults with moderate or severe COVID-19 were analyzed. Patients were divided in treatment and control arms, receiving Sofosbuvir plus standard care and standard care alone respectively. The addition of Sofosbuvir to standard care significantly reduced the duration of hospital stay compared with standard care alone in clinical trials examined. If efficacy of these repurposed, cheap and easily available drug against SARS-CoV-2 is further demonstrated, it could be essential to refine the treatment of COVID-19.     

Trends in the management of infectious disease under SARS-CoV-2 era: From pathophysiological comparison of COVID-19 and influenza

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), has become a historic pandemic, and dealing with it is one of the most important aspects of infectious disease treatment today. SARS-CoV-2 has been found to have characteristic and powerful infectivity (ability to propagate) and lethality (severity). With influenza, primary influenza pneumonia from the virus itself is known to exist in addition to secondary bacterial pneumonia. With COVID-19, on the other hand, it is important to provide diagnosis and treatment while keeping acute respiratory distress syndrome and pulmonary edema (alveolar flood) from a similar cytokine storm, as well as severe angiopathy, in mind. The importance of complying with hand hygiene and masks in infection control remains the same as in previous general infection control measures and responses to influenza virus infections and others, but in the future, vaccination will likely be the key to infection control in the community.     

Management of SARS-CoV-2 infection is a major challenge in patients with lymphoid malignancies: Warrants a clear therapeutic strategy

Patients with lymphoid malignancies are at a higher risk of coronavirus disease 2019 (COVID-19) infection due to their immunocompromised state and results in higher mortality rates in these patients. Anti-CD 20 therapy is one of the leading causes of immunosuppression that worsens in COVID-19 cases. COVID-19 vaccines, on the other hand, appear to be less beneficial to these patients. App-ropriate treatment and recommendations are required for these COVID-19 patients with lymphoid malignancies.     

An overview of COVID-19 in solid organ transplantation

BackgroundThe COVID-19 pandemic has influenced the field of solid organ transplantation (SOT) in many ways. COVID-19 has led to programmatic impacts and changes in donor and recipient selection. Several studies have evaluated the course, optimal treatment, and prevention of COVID-19 in SOT recipients.ObjectivesTo review the literature on COVID-19 in SOT recipients.SourcesPubMed, Web of Science, and Google Scholar were searched. The search was restricted to articles published between January 1, 2019 and December 1, 2021.ContentThe COVID-19 pandemic initially led to a decreased volume of solid organ transplants. However, transplant volumes at most centres have rebounded. Donor selection remains an incompletely defined issue. Several reports suggest that donor-derived SARS-CoV-2 infections occur only in lung transplant recipients and that other organs from SARS-CoV-2 PCR-positive donors could potentially be safely used. However, these data are limited to case series. Transplantation for end-stage lung disease after COVID-19 infection is increasingly common and has been performed with acceptable outcomes. In acute COVID-19 in a transplant candidate, transplantation should be delayed when feasible. After adjustment, mortality after COVID-19 appear similar in SOT recipients compared to the general population, with notable increased use of antiviral and anti-inflammatory treatment options. Prevention of COVID-19 is key in SOT recipients. Vaccination of SOT recipients and anyone who is in contact with SOT recipients is one of the cornerstones of prevention. Nonpharmacological interventions such as face coverings, hand hygiene, and physical distancing remain ever important as well.ImplicationsThe COVID-19 pandemic continues to have an important impact on SOT candidates and recipients. Prevention of infection is the most important measure and requires careful attention to approaches to vaccination and messaging of the ongoing need for face coverings, physical distancing, and hand hygiene.     

Hepatic complications of COVID-19 and its treatment

Coronavirus disease 2019 (COVID-19) is highly contagious and has a variety of clinical manifestations, it can affect a number of other organs in addition to the lungs, and liver injury may occur. Severe acute respiratory syndrome coronavirus 2 can cause liver injury through systemic inflammatory response syndrome, cytokine storms, ischemia-reperfusion injury, side effects of treatment drugs, and underlying liver disease and can attack liver cells directly via angiotensin-converting enzyme 2. Clinical studies have found that liver injury in COVID-19 patients mainly manifests as abnormal liver biochemical indicators, but there have been no reports of liver failure caused by this disease. The number of COVID-19 patients with liver injury is increasing, and the incidence of liver injury in COVID-19 patients with severe disease are higher than in patients with mild disease. Liver injury may be a risk factor, which worsens in patients with COVID-19, and hence it is necessary to pay attention to the occurrence of liver injury in the diagnosis and treatment of COVID-19.