新型冠状病毒肺炎诊治

2019年12月在武汉市爆发新型冠状病毒肺炎新型冠状病毒肺炎(COVID-19)中国引起严重疫情并在世界多个国家引起疫情,疫情来势凶猛及传染性强。我们对引起此次疫情的病原体-2019新型冠状病毒知之甚少,我们在此结合近期在新冠肺炎方面发表相关的研究,介绍新冠肺炎的诊断与治疗体会。     

新型冠状病毒肺炎疫情期间糖尿病基层管理专家建议

自2019年12月以来,我国发生新型冠状病毒肺炎(COVID-19)疫情。糖尿病患者COVID-19感染风险增高,且预后差。COVID-19疫情期间,基层医疗在糖尿病预防和血糖控制管理方面面临严峻挑战。中国糖尿病专家、基层医疗服务提供者和公共卫生管理者提出专家建议,旨在提高全国基层医疗卫生机构在COVID-19疫情期间的临床诊治能力并提供标准化的基本公共卫生和医疗服务。本建议的主要内容包括管理的基本要求、健康管理的工作流程、转诊、治疗和长期随访。     

新型冠状病毒肺炎流行期间神经急诊流程专家建议

在新型冠状病毒肺炎(COVID-19)疫情防控的关键时期,神经急诊面临各种挑战,既负责着疫情防控的重任,又面临接诊急性脑血管病和神经疾病的压力,中国人体健康科技促进会神经急诊重症监护专业委员会会同有关专家在前期疫情防控经验的基础上,分别在神经急诊接诊、抢救、外出转运、绿色通道等工作流程给予专家建议,供广大同行参考并在实践中改进,旨在为全国各级医院神经急诊重症医师在做好防护工作的同时,坚持神经急诊患者的救治提供参考。     

新型冠状病毒肺炎疫情防控期间非疫区急性心肌梗死患者救治策略

急性心肌梗死发病急、最佳救治窗口期短,患者死亡率高,预后差,需要积极救治。新型冠状病毒人群普遍易感,目前全国各地医疗机构都把防控疫情作为重中之重,特殊时期的隔离措施对疫情防控发挥了重要作用,但急性心肌梗死患者的救治不可避免地受到一定影响。该文在新型冠状病毒肺炎防控指南基础上,结合现有胸痛中心区域协同救治急性心肌梗死的模式,对已发布的心血管危重症中急性心肌梗死救治策略要点进行梳理,供非疫区医院参考。     

新型冠状病毒肺炎疫情期间普通科室医务人员院内感染的防控

自2019年12月湖北武汉市出现新型冠状病毒肺炎以来,全国其他地区和境外也相继出现了疫情,严重影响广大人民的生命健康。据报道,除发热门诊、感染科等,一些普通科室医务人员也出现了新冠肺炎院内感染的发生。针对此疫情,在国家卫生健康委员会制定的新型冠状病毒感染的肺炎诊疗方案指导下,普通科室通过严格的个人防护,细致的环境管理,严谨的工作流程,科学的工作安排,以及充分的人文关怀,做好院内感染的防控,避免医务人员新型冠状病毒院内感染的发生。     

新型冠状病毒肺炎疫情期间慢性心力衰竭患者临床管理策略

在新型冠状病毒肺炎疫情时期,慢性心衰患者因免疫力低下,合并感染后症状重、进展快,是疫情防治中的重点对象,需对患者病情进行动态及综合评估,并进行精细化和个体化的管理,最大程度地保护患者健康。本文就此作一综述,旨在为当前新冠肺炎疫情期间慢性心力衰竭患者防控工作提供新的思路和方案。     

冠状病毒及新型冠状病毒肺炎防控策略

随着科学技术的发展和医学研究不断取得新进步,人们认识到病毒引发的传染性疾病仍然对人类健康构成巨大威胁,据世界卫生组织(World Health Organization,WHO)宣布,地球上对人类危害最大的有九大病毒:(1)克里米亚-刚果出血热病毒(Crimean-Congo haemorrhagic fever virus,CCHFV);(2)埃博拉病毒(Ebola virus,EBOV);(3)马尔堡病毒(Marburg virus,MBV);(4)艾滋病病毒(Human immunodeficiency virus,HIV);(5)寨卡病毒(Zika virus,ZKV);(6)狂犬病毒(rabies virus,RBV);(7)流感病毒(influenza virus,FLV);(8)尼帕病毒和裂谷热病毒(Nipah virus and riftvelley fever virus,NV-RFV);(9)冠状病毒(coronavirus,CoV),其中包括中东呼吸综合征(Middle East respiratory syndrome,MERS)和重症急性呼吸综合征(severe acute respiratory syndrome,SARS)等。特别是EBOV和CoV传播较快,病死率高,造成了严重公共健康危机[1-3]。     

新型冠状病毒肺炎疫情对急性心肌梗死诊治的影响

新型冠状病毒肺炎成为世界卫生体系的严峻挑战,国内外均采取了前所未有的严格防控措施,肺炎疫情对急性心肌梗死的急诊救治流程产生了深刻的影响,国内外制定了一系列的相关文件以指导疫情期间急性心肌梗死的救治工作,本文对此进行综述。     

新型冠状病毒肺炎疫情防控时期主动脉急症患者诊治的建议

近期新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情爆发,恰逢主动脉急症高发的冬春时节,而主动脉急症大多起病急骤,病情危重,死亡率高,需紧急处理。在国家"重大突发公共卫生事件一级响应机制"之下,疫期主动脉急症患者的诊疗需制订全新的流程。如何在这一特殊时期增强医护人员的防护和正确救治意识,既让主动脉急症患者获得及时、有效的治疗,又能避免救治期间可能发生的院内疫情传播,是急诊科、心外科、血管外科等相关学科当前面临的重大课题。本文呼吁各医疗单位在严格遵守政府和医院感控部门规章制度的基础上开展医疗实践,在"疫情防控为重,严防院内感染,确诊COVID-19患者首选保守"的前提下,提倡"择期手术适当推迟,限期手术术前隔离排查,急诊手术严格防护"的诊治原则,同时针对COVID-19疫期主动脉急症患者的急诊科接诊、病房收治、术前准备、术中防护、术后处理等方面提出了建议。     

湖北省新型冠状病毒肺炎疫情下心血管病治疗与管理专家建议

在湖北省新冠肺炎疫情下,心血管病管理原则:加强隔离、减少转运、网络咨询、自我管理;高血压和慢性心力衰竭治疗原则:就地购药、同类替代、剂量足够、治疗达标、减少住院;急性心肌梗死救治原则:急性ST段抬高型心肌梗死(STEMI)患者就地溶栓,溶栓后转运PCI暂时不宜运行,降低心血管病发病率和病死率。     

Redefining diabetic foot disease management service during COVID-19 pandemic

Background & aimsDiabetic Foot Disease (DFD) management had to be redefined during COVID-19. We aim to evaluate the impact of this on diabetic foot care services and the strategies adopted to mitigate them.MethodsWe have performed a comprehensive review of the literature using suitable keywords on the Search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first two weeks of May 2020. We have reviewed how the diabetic foot service in the hospital and community setting has been affected by the current Coronavirus outbreak.ResultsWe found considerable disruption in diabetic foot service provisions both in the primary care and in the hospital settings. Social distancing and shielding public health guidelines have impacted the delivery of diabetic foot services.ConclusionAs the COVID-19 pandemic spreads worldwide, health care systems are facing the tough challenges in delivering diabetic foot service to patients. Public health guidelines and the risk of virus transmission have resulted in reconfiguration of methods to support and manage diabetic foot patients including remote consultations.     

新型冠状病毒肺炎疫情防控期间儿童及青少年糖尿病居家管理指导建议

本管理建议的主旨是以预防为主,希望提高居家看护者、社区以及基层医生,包括因疫情开展的网络就诊平台医生对儿童及青少年糖尿病患儿新型冠状病毒肺炎(COVID-19)疫情期间居家防护、血糖管理以及糖尿病急性并发症的科学管理能力,便于患儿居家或就近治疗,避免交叉感染。对于糖尿病患儿,建议加强自我血糖管理,避免发生糖尿病酮症酸中毒和严重低血糖。为减少交叉感染的风险,对具备基本条件的家庭及社区诊所提供轻中度糖尿病酮症及酮症酸中毒初步处理方案。     

Surgical treatment of diabetic foot ulcers during the COVID-19 pandemic in China

Diabetic foot ulcers are among the most serious complications of diabetes. If left untreated, these ulcers can lead to severe infection and gangrene; in some instances, they may result in death. Thus, timely treatment of diabetic foot ulcers is extremely important. However, timely patient treatment during the COVID-19 pandemic is particularly challenging, because of the higher volume of patients and the need to ensure safety of medical personnel. This article describes a proposed strategy for diagnosis and treatment of diabetic foot ulcers, based on experiences with infection and control strategies during the COVID-19 pandemic in China.     

新型冠状病毒肺炎诊治要点浅析

当前新型冠状病毒肺炎(简称"新冠肺炎")在中国引起严重疫情,而且对世界公共卫生造成巨大压力。截至发稿之日,全国确诊人数已逾8万例,全球超过10万例。为更好地增强临床医师对新冠肺炎的认识,我们结合新冠肺炎临床一线的救治体会、相关发表的研究文献和最近的诊疗方案,给大家简要概述新冠肺炎的诊治要点。期望能给临床医生提供一定的参考作用。     

Insights on defeating coronavirus disease (COVID-19) outbreak and predicting tourist arrival on the Chinese Hainan Leisure Island during the COVID-19 pandemic

Background:Hainan province is a very popular leisure tourist arriving city in China. Coronavirus disease 2019 (COVID-19) emerged in China and rapidly in early 2020, and due to its rapid worldwide spread, the World Health Organization declared COVID-19 as a global emergency. During the COVID-19 pandemic in Hainan province, many businesses and economies were influenced in this unexpected event, especially in tourism.Methods:This study used 2 classical forecasting methods to predict the number of tourists on Hainan Leisure Island from September to December in the second half of 2020 and to summarize the COVID-19 fighting experience during the pandemic. In addition, the Hainan government implemented epidemic control measures to resume production and work, and promote new tourism measures to acquire superior COVID-19 protection.Results:Winter''s method provides a statistical model for predicting the number of visitors to Hainan under normal conditions. The trend analysis method considers the impact of the black swan event, an irregular event, and only uses the data under the influence of the event to predict according to the trend.Conclusion:If the impact of the black swan event (COVID-19) continues, the prediction can be made using this method. In addition, the Hainan government has undertaken timely and effective measures against COVID-19 to promote leisure tourism development.     

Our future: Experiencing the coronavirus disease 2019 (COVID-19) outbreak and pandemic

Outbreaks of the novel coronavirus disease (severe acute respiratory syndrome coronavirus 2: SARS-CoV-2) (coronavirus disease 2019; COVID-19) remind us once again of the mechanisms of zoonotic outbreaks. Climate change and the expansion of agricultural lands and infrastructures due to population growth will ultimately reduce or eliminate wildlife and avian habitats and increase opportunities for wildlife and birds to come into contact with livestock and humans. Consequently, infectious pathogens are transmitted from wildlife and birds to livestock and humans, promoting zoonotic diseases. In addition, the spread of diseases has been associated with air pollution and social inequities, such as racial discrimination, gender inequality, and racial, economic, and educational disparities. The COVID-19 pandemic is a fresh reminder of the significance of excessive greenhouse gas excretion and air pollution, highlighting social inequities and distortions. This provides us with an opportunity to reflect on the appropriateness of our trajectory. Therefore, this review glances through the COVID-19 pandemic and discusses our future.     

新型冠状病毒肺炎疫情对我国消除疟疾工作的挑战及应对策略

2019年底以来,一种新型冠状病毒病肺炎（COVID-19）在我国大范围流行,不仅严重威胁人民群众的生命安全和身体健康,同时也给其他传染病防控带来了严峻挑战。目前,我国每年仍有近3 000例境外输入性疟疾病例,如不能及时开展病例诊治和疫点调查处置,不仅有可能危及患者生命,还可能引起继发传播而威胁我国消除疟疾成果。新型冠状病毒肺炎流行范围广、传播能力强,不仅疟疾患者在就医过程中有可能被感染,而且医务人员在开展临床诊治、样本检测和流行学调查时也面临感染风险。本文分析新型冠状病毒肺炎流行对我国消除疟疾工作的挑战,并探讨相应的应对策略和措施,从而为医务工作者提供参考。     

Six month assessment of low dose rituximab in the treatment of rheumatoid arthritis during coronavirus disease 2019 (COVID-19) pandemic

Aim of the workTo evaluate the 6-month treatment responses to low dose rituximab (LDR) compared to standard dose rituximab (SDR) in rheumatoid arthritis (RA) patients whose treatments were disrupted due to the pandemic with increased disease activity and to examine the effect of LDR treatment on serum immunoglobulin (Ig) levels.Patients and methodsRecords were retrospectively analysed for 80 patients on SDR not admitted to the hospital due to fear of infection during pandemic, with increased disease activity and were resumed on LDR (500 mg intravenous RTX-infusion twice with 15 days intervals, and repeated for the second time in all patients after 6 months). Disease activity score (DAS-28) values were obtained. The Ig levels of the patients before and after rituximab treatment were calculated.ResultsThe mean age of patients was 55.1 ± 13.1 years. They were 46 (57.5%) female and 34 (42.5%) male (F:M 1.4:1) with median disease duration of 13 (0.5–50) years. After the second dose of LDR, there was a significant decrease in the disease activity DAS28 (6.5 ± 1.01 to 3.2 ± 1.2, p < 0.0001) and acute phase reactants with a tendency to decrease in Ig levels. After LDR, 6 (7.5%) patients developed COVID-19 infection that did not require hospitalization. There was no difference between the Ig levels of patients with and without COVID-19 infection.ConclusionsLDR is an effective treatment option in the treatment of RA. In our study, none of our patients developed severe COVID-19 infection requiring hospitalization, and LDR may be preferred during the COVID-19 pandemic period.