Comparison between SARS-CoV-2 positive and negative pneumonia in children: A retrospective analysis at the beginning of the pandemic

BACKGROUNDEven though coronavirus 2019 disease (COVID-19) clinical course in children is much milder than in adults, pneumonia can occur in the pediatric population as well. Here, we reported a single-center pediatric case series of COVID-19 from Kazakhstan during the first wave of pandemic.AIMTo analyze the main clinical and laboratory aspects in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive and negative children diagnosed with pneumonia. METHODSThis is a retrospective analysis of 54 children, who were medically assessed as close contacts of COVID-19 adults in their family setting, between June and September 2020. These children were all hospitalized: We compared the clinical and laboratory characteristics of children affected with pneumonia in the presence (group 1) or absence (group 2) of SARS-CoV-2 infection.RESULTSOverall, the main clinical manifestations at the admission were fever, cough, loss of appetite, fatigue/weakness, nasal congestion and/or rhinorrhea, and dyspnea. Based on the SARS-CoV-2 polymerase chain reaction (PCR) test, 24 positive children with pneumonia (group 1) and 20 negative children with pneumonia (group 2) were identified; 10 positive children did not show any radiological findings of pneumonia. No significant differences were found between the two pneumonia study groups for any clinical and laboratory parameters, except for C-reactive protein (CRP). Of course, both pneumonia groups showed increased CRP values; however, the COVID-19 pneumonia group 1 showed a significantly higher increase of CRP compared to group 2.CONCLUSIONIn our case series of children assessed for SARS-CoV-2 infection based on contact tracing, the acute inflammatory response and, in detail, CRP increase resulted to be more pronounced in COVID-19 children with pneumonia than in children with SARS-CoV-2-unrelated pneumonia. However, because of multiple limitations of this study, larger, controlled and more complete clinical studies are needed to verify this finding.     

Algorithm for Individual Prediction of COVID-19–Related Hospitalization Based on Symptoms: Development and Implementation Study

BackgroundThe COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes.ObjectiveThis study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization.MethodsA predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed.ResultsThe predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept –0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients.ConclusionsA simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.     

Epidemiological,imaging, laboratory,and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study

ObjectivesCoronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.MethodsWe established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.ResultsIn total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.ConclusionComorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.     

The clinical data from 19 critically ill patients with coronavirus disease 2019: a single-centered,retrospective, observational study

Background

The objectives of this study were to analyze the clinical features of coronavirus disease 2019 (COVID-19) and evaluate the diagnosis and treatment.

Methods

A retrospective analysis of the clinical manifestation and auxiliary examination of 19 patients with COVID-19 from the Liyuan Hospital intensive care unit (ICU) between January 16, 2020 and February 20, 2020 was undertaken.

Results

There were 11 male and 8 female cases among the patients. The median (range) age was 73 (38–91) years. Of these patients, 8 (42.1%) had died and the median duration from ICU admission to death was 2 (interquartile range (IQR): 1–10.75) days. Seven of these 8 patients had underlying diseases. The auxiliary examination showed fever (68.4%), dry cough (15.8%), dyspnea (10.5%), and diarrhea (5.3%). All 19 cases showed ground-glass changes on chest computed tomography. Serum hypersensitive C-reactive protein (hs-CRP) and serum amylase A (SAA) were clearly increased in all of the cases. Among the 19 cases, there were 16 (84.2%) cases in which the total number of lymphocytes decreased, 12 cases (63%) had reduced liver function, and 11 cases (58%) had deviant results for fibrinogen (FIB) and D-dimer, in particular, the D-dimer level was significantly higher in the non-survivors compared with the survivors.

Conclusion

There were more men than women among critically ill patients. All of the cases showed ground-glass changes on chest computed tomography and the vast majority of patients displayed fever and dry cough. The clinical laboratory indices change significantly, especially the D-dimer level among non-survivors.

     

Factors Associated With COVID-19 Hospitalizations and Deaths in French Nursing Homes

ObjectivesTo describe the clinical characteristics and management of residents in French nursing homes with suspected or confirmed coronavirus disease 2019 (COVID-19) and to determine the risk factors for COVID-19–related hospitalization and death in this population.DesignA retrospective multicenter cohort study.Setting and ParticipantsFour hundred eighty nursing home residents with suspected or confirmed COVID-19 between March 1 and May 20, 2020, were enrolled and followed until June 2, 2020, in 15 nursing homes in Marseille’s greater metropolitan area.MethodsDemographic, clinical, laboratory, treatment type, and clinical outcome data were collected from patients’ medical records. Multivariable analysis was used to determine factors associated with COVID-19–related hospitalization and death. For the former, the competing risk analysis—based on Fine and Gray’s model—took death into account.ResultsA total of 480 residents were included. Median age was 88 years (IQR 80-93), and 330 residents were women. A total of 371 residents were symptomatic (77.3%), the most common symptoms being asthenia (47.9%), fever or hypothermia (48.1%), and dyspnea (35.6%). One hundred twenty-three patients (25.6%) were hospitalized and 96 (20%) died. Male gender [specific hazard ratio (sHR) 1.63, 95% confidence interval (CI) 1.12-2.35], diabetes (sHR 1.69, 95% CI 1.15-2.50), an altered level of consciousness (sHR 2.36, 95% CI 1.40-3.98), and dyspnea (sHR 1.69, 95% CI 1.09-2.62) were all associated with a greater risk of COVID-19–related hospitalization. Male gender [odds ratio (OR) 6.63, 95% CI 1.04-42.39], thermal dysregulation (OR 2.64, 95% CI 1.60-4.38), falls (2.21 95% CI 1.02-4.75), and being aged >85 years (OR 2.36, 95% CI 1.32-4.24) were all associated with increased COVID-19–related mortality risk, whereas polymedication (OR 0.46, 95% CI 0.27-0.77) and preventive anticoagulation (OR 0.46, 95% CI 0.27-0.79) were protective prognostic factors.Conclusions and ImplicationsMale gender, being aged >85 years old, diabetes, dyspnea, thermal dysregulation, an altered level of consciousness, and falls must all be considered when identifying and protecting nursing home residents who are at greatest risk of COVID-19–related hospitalization and death.     

15例嗜血细胞综合征合并肝损伤的临床分析

目的 分析嗜血细胞综合征(HPS)合并肝损伤的临床特点.方法 对我院2006年1月至2010年12月就诊的15例HPS合并肝损伤患者的病因、临床特点及转归进行分析.结果 本组病例发病以持续高热(100.0%)、浆膜腔积液(80.0%)、黄疸(80.0%)、脾肿大(73.3%)、肝肿大(66.7%)、淋巴结肿大(60.0...     

Prevalence and Predictors of Persistence of COVID-19 Symptoms in Older Adults: A Single-Center Study

ObjectivesSymptom persistence weeks after laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clearance is a relatively common long-term complication of Coronavirus disease 2019 (COVID-19). Little is known about this phenomenon in older adults. The present study aimed at determining the prevalence of persistent symptoms among older COVID-19 survivors and identifying symptom patterns.DesignCross-sectional study.Setting and ParticipantsWe analyzed data collected in people 65 years and older (n = 165) who were hospitalized for COVID-19 and then admitted to the Day Hospital Post-COVID 19 of the Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS (Rome, Italy) between April and December 2020. All patients tested negative for SARS-CoV-2 and met the World Health Organization criteria for quarantine discontinuation.MeasuresPatients were offered multidisciplinary individualized assessments. The persistence of symptoms was evaluated on admission using a standardized questionnaire.ResultsThe mean age was 73.1 ± 6.2 years (median 72, interquartile range 27), and 63 (38.4%) were women. The average time elapsed from hospital discharge was 76.8 ± 20.3 days (range 25−109 days). On admission, 137 (83%) patients reported at least 1 persistent symptom. Of these, more than one-third reported 1 or 2 symptoms and 46.3% had 3 or more symptoms. The rate of symptom persistence was not significantly different when patients were stratified according to median age. Compared with those with no persistent symptoms, patients with symptom persistence reported a greater number of symptoms during acute COVID-19 (5.3 ± 3.0 vs 3.3 ± 2.0; P < .001). The most common persistent symptoms were fatigue (53.1%), dyspnea (51.5%), joint pain (22.2%), and cough (16.7%). The likelihood of symptom persistence was higher in those who had experienced fatigue during acute COVID-19.Conclusions and ImplicationsPersistent symptoms are frequently experienced by older adults who have been hospitalized for COVID-19. Follow-up programs should be implemented to monitor and care for long-term COVID-19–related health issues.     

Clinical Manifestations,Imaging Procedures and Laboratory Parameters among Hospitalized Patients with COVID-19 in Ilam Province,Western Iran

BackgroundCOVID-19 is the last global threat which WHO confirmed it as a pandemic on March 11, 2020. In the Middle East, Iran was the first country where the SARS-Cov-2 was detected. The epidemiological and economic challenges of Iran make this country a particularly relevant subject of study. In the current study, we aimed to evaluate the clinical, radiological and laboratory findings in hospitalized COVID-19 confirmed cases in Ilam province, western of Iran.MethodsOverall, 2204 hospitalized RT-PCR confirmed patients with COVID-19 were considered in this study. Electronic medical records, including clinical symptoms, radiological images, laboratory findings, and the comorbidities of patients with COVID-19 were collected and analyzed. In addition, the medication regimens used in these patients were evaluated. The patients were classified in discharged and died groups according to their outcomes. Then, clinical, radiological and laboratory findings as well as treatment regimens and underlying diseases were compared in these two groups.ResultsAmong the patients, 1209 (54.85%) were male and 995 (45.14%) were female. Pneumonia, dyspnea and cough, were the most common clinical data in both discharged and died groups. Among the comorbidities, COPD, and cancer were significantly more common in the dead patients than in the living. The results of laboratory tests showed that blood creatinine, BUN, ESR, Na+, WBC, and neutrophil count have increased in deceased group compared to the survivors. However, the lymphocyte count decreased in deceased patients. The evaluation of radiographs demonstrated that there were significant correlations between bilateral pneumonia, ground glass opacity, bilateral patchy shadowing, and pleural effusion with death.ConclusionThe current investigation indicated the special profile of COVID-19 in west of Iran. Discharged and dead patients with COVID-19 had distinct clinical, radiological and laboratory features, which were separated by principal component analysis. Identifying these characteristics of the disease would translate into the implementation of practical measures to improve results.     

COVID-19 in the New York City Jail System: Epidemiology and Health Care Response,March–April 2020

ObjectivesPeople detained in correctional facilities are at high risk for infection with severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). We described the epidemiology of the COVID-19 outbreak in a large urban jail system, including signs and symptoms at time of testing and risk factors for hospitalization.MethodsThis retrospective observational cohort study included all patients aged ≥18 years who were tested for COVID-19 during March 11–April 28, 2020, while in custody in the New York City jail system (N = 978). We described demographic characteristics and signs and symptoms at the time of testing and performed Cox regression analysis to identify factors associated with hospitalization among those with a positive test result.ResultsOf 978 people tested for COVID-19, 568 received a positive test result. Among symptomatic patients, the most common symptoms among those who received a positive test result were cough (n = 293 of 510, 57%) and objective fever (n = 288 of 510, 56%). Of 257 asymptomatic patients who were tested, 58 (23%) received a positive test result. Forty-five (8%) people who received a positive test result were hospitalized for COVID-19. Older age (aged ≥55 vs 18-34) (adjusted hazard ratio [aHR] = 13.41; 95% CI, 3.80-47.33) and diabetes mellitus (aHR = 1.99; 95% CI, 1.00-3.95) were significantly associated with hospitalization.ConclusionsA substantial proportion of people tested in New York City jails received a positive test result for COVID-19, including a large proportion of people tested while asymptomatic. During periods of ongoing transmission, asymptomatic screening should complement symptom-driven COVID-19 testing in correctional facilities. Older patients and people with diabetes mellitus should be closely monitored after COVID-19 diagnosis because of their increased risk for hospitalization.     

云南省新型冠状病毒肺炎临床及流行病学特征

目的 探讨云南省新型冠状病毒肺炎（简称新冠肺炎）确诊病例的临床及流行病学特征。方法 采用回顾性研究对云南省公开发布的新冠肺炎确诊病例的一般流行病学资料及临床检查资料进行分析。结果 确诊病例174例,年龄3~85岁,平均（41.7±18.1）岁,男性89例（51.1%）,女性85例（48.9%）。全省14个地州市均有确诊病例;入院后病情评估轻型占21.3%,普通型占68.8%,重型占9.2%,危重型占0.7%;出院98.9%、死亡1.1%。确诊病例中湖北籍47.4%,云南籍42.9%。51.1%从武汉到云南,11.5%曾到武汉,11.5%密切接触新冠肺炎病例,24.7%为不明确流行病学史。首发和临床症状中,以发热、咳嗽、咳痰、乏力为主要表现。实验室检查95.5%病例白细胞正常或减少,41.3%患者淋巴细胞计数降低,29.2%患者淋巴细胞百分比降低;少部分病例谷草转氨酶（AST）、谷丙转氨酶（ALT）升高;轻/普通型和重/危重型患者首发症状中,发热所占比例差异有统计学意义（48.2%比78.6%,P<0.05）。结论 云南省新冠肺炎大部分病例有明确的流行病学史,人群中普遍易感,且在性别间无差异。临床分型大多患者为普通型,主要表现为发热、咳嗽、咳痰、乏力,预后较好。     

新生儿黄疸TRF、CRP和肝功指标变化意义分析

目的 观察血清转铁蛋白(TRF)、C反应蛋白(CRP)水平在新生儿黄疸中的变化,并分析其临床意义.方法 以2012年3月至2015年6月在临海市第二人民医院接受治疗的黄疸新生儿为观察对象.根据其黄疸程度分为高危组(48例)、中危组(60)和低危组(78例),同时选取50例母婴同室病房内的健康新生儿作为对照组.观察四组新生儿TRF、CRP水平及肝功能指标的差异,分析TRF、CRP水平与肝功能指标的相关性.结果 四组新生儿的TRF和CRP水平分别比较差异均具有统计学意义(F值分别为-39.265、75.956,均P<0.05).四组新生儿的ALT、AST、DBIL和TBIL水平分别比较差异均具有统计学意义(F值分别为22.356、28.932、18.253、25.266,均P<0.05).新生儿黄疸者的TRF水平与ALT、AST呈显著负相关(r值分别为-0.542、-0.431,均P<0.05);CRP水平与ALT、AST和DBIL呈显著正相关(r值分别为0.423、0.382、0.346,均P<0.05).结论 TRF在新生儿黄疸患者中较低,而CRP水平较高,且可作为临床观察指标.     

不发热COVID-19患者临床特征及胸部薄层CT筛查价值评估

 目的 分析20例不发热新型冠状病毒肺炎（COVID-19）患者临床及胸部薄层CT影像特征。方法 回顾性分析某院20例临床确诊为COVID-19不发热患者首次入院临床特征，主要包括呼吸道、消化道等症状及白细胞计数、淋巴细胞计数、C反应蛋白等试验室指标，同时对胸部薄层CT扫描资料进行分析。结果 临床症状分为完全无症状、不发热有呼吸道或消化道症状，后者症状均轻微，主要症状为干咳，实验室以白细胞计数及淋巴结细胞计数减少多见。不发热COVID-19患者胸部薄层CT以早期、恢复期影像表现为主，少数表现为进展期：（1）早期呈单肺段或多肺段斑片状、结节状、不规则形磨玻璃密度影（GGO），以肺外周或胸膜下分布为主，常见血管增粗穿行，部分出现长短不一细线状高密度影；（2）进展期病灶融合成不规则片状，可累及多个肺段、肺叶，可见小叶间隔增厚或呈"铺路石"征，部分可见局灶性实变影；（3）恢复期病灶范围缩小、变淡，通常吸收较完全，少见纤维残留灶。结论 不发热COVID-19患者临床特征隐匿，但胸部影像表现具有特征性，胸部薄层CT对COVID-19的早期诊断和评估有重要价值。     

血常规及肝肾功能检测在新型冠状病毒肺炎病情预判中的应用

目的探讨血常规和肝肾功能等常规指标对新型冠状病毒肺炎(COVID-19)患者的辅助诊断和病情预测的临床价值。方法回顾性研究,收集2020年1月28日至2月14日中南大学湘雅医院的COVID-19患者30例、其他病毒性肺炎29例、甲型/乙型流感患者35例及往期健康体检者25名,采用SNK-q等方法分析4组人群及COVID-19各亚组间血常规、肝肾功能及其他炎性指标的差异。结果中性粒细胞计数在COVID-19组、甲乙流组和其他类型病毒性肺炎组中逐步递增,且COVID-19组与其他病毒性肺炎组间差异具有统计学意义(H=-19.064,P<0.05);而淋巴细胞计数则在对照组、甲乙流组、其他病毒性肺炎组及COVID-19组中逐步递减,此外DB、UA及GLU在各组间也存在一定差异;亚组分析显示COVID-19患者肺部累及范围+~++者与肺部累及范围+++~++++者组间N(F=9.581,t=-0.152,P<0.05)、N%(F=5.723,t=-0.600,P<0.05)、NLR(F=4.773,t=-1.161,P<0.05)、PCT(F=17.464,t=-1.477,P<0.05)及CRP(F=7.656,t=-1.973,P<0.05)差异具有统计学意义,COVID-19临床分型中轻型、普通型患者与重型、危重型患者组间NLR(F=63.931,t=-2.815,P<0.01)、AST(F=15.704,t=-1.930,P<0.01)、ALT(F=35.551,t=-2.199,P<0.01)、LDH(F=7.715,t=-2.703,P<0.05)及GLU(F=6.306,t=-5.116,P<0.05)差异具有统计学意义;相关分析显示临床分型与影像学分期均与NLR(r=0.406,P=0.026;r=0.397,P=0.030)、ALT(r=0.403,P=0.049;r=0.418,P=0.047)、LDH(r=0.543,P<0.01;r=0.643,P<0.01)及GLU(r=0.750,P<0.01;r=0.471,P=0.042)显著相关;从所有纳入指标中共提取出5个主成分,综合信息提取率为82.86%,其中载荷量较大者有Ur、PCT和CRP(PC1);ALT、AST和GLU(PC2);N%、L%、L和NLR(PC3),表明急性感染指标、肝功能和血常规对疾病监测具有一定的提示作用。ROC曲线分析结果表明,N+TB+Urea的联合检测为区分COVID-19与其他病毒性肺炎的最佳方案;N+L+UA的联合检测则为区分COVID-19与甲乙流患者的最佳方案;在评估病情方面,NLR+LDH+GLU+ALT的联合检测为区分临床分型轻型、普通型患者与重型、危重型患者的最佳方案,其AUC(ROC)可达到0.904,此时cut-off值为0.477,敏感度为75%,特异度为100%。结论除了病原学和影像学检查外,医生还可以通过完善血常规、肝肾功能等实验室常规检测对呼吸道感染患者进行疾病的辅助诊断和病情预估。     

血清腺苷脱氨酶在监测慢性肝病进展中的临床意义

目的探讨血清腺苷脱氨酶在评估慢性肝病进展中的意义。方法观察组为慢性乙型肝炎患者168例,对照组选自社区健康人群,共50例研究对象,分别检测血清ADA、ALT、AST及ALP。结果观察组患者ADA水平显著高于对照组的健康观察对象(P<0.05),ADA随病情进展显著升高,分析ADA与ALT、AST及ALP相关性,ADA与三者显著正相关(P<0.05)。结论 ADA有助于检测慢性肝病的进展及预后。     

4种血清酶在三硝基甲苯染毒致大鼠肝损伤中的变化及意义

[目的]观察三硝基甲苯(TNT)染毒致大鼠肝损伤时血清乳酸脱氢酶(LDH)、谷氨酸氨基移换酶(ALT)、天门冬酸氨基移换酶(AST)和碱性磷酸酶(ALP)的活力变化情况,并探讨其意义。[方法]以50、100和200mg/kg体重剂量的TNT对大鼠每天一次经口染毒,分别于染毒2、4、6和8周后处死,测定血和肝组织TNT代谢产物2,6-二硝基-4-氨基甲苯(DNAT)水平、血靛青绿(ICG)10min滞留率(ICG_(R10))和血清LDH、ALT、AST、ALP的变化情况。[结果]TNT染毒大鼠血和肝组织DNAT均比对照组有明显升高,TNT染毒剂量与大鼠血清或肝组织DNAT呈显著性相关(P<0.01),血清与肝组织DNAT呈显著性相关(P<0.01);各TNT染毒组大鼠血清ICG_(R10)明显高于对照组。TNT高剂量染毒组大鼠血清LDH、ALT、AST和ALP活力有所降低,其他剂量组与对照组相比未见显著性变化;血清或肝组织DNAT与血清LDH呈显著性负相关(P<0.05或0.01),与ALT、AST和ALP均负相关,但未见显著性(P>0.05)。[结论]血清LDH、ALT、AST和ALP指标对TNT染毒诱导的大鼠肝损伤的反应并不敏感,似与TNT代谢产物DNAT对血清4种酶活力可能具有的一定抑制作用有关。     

锰接触对大鼠肝脏的影响

目的探讨锰接触对大鼠肝脏功能和病理组织学的影响。方法SD大鼠36只随机分为3组,每组12只。高、低剂量染锰组分别给予含二氯化锰5.0g/L和0.5g/L的水溶液自由饮食,对照组给予蒸馏水。持续60天后,每组取9只动物应用荧光分光光度法测定各组动物肝脏匀浆的丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)活性和蛋白质含量;另3只动物作肝组织切片,HE法染色,光镜下检测肝组织病理学的变化。结果(1)与对照组相比,高、低剂量染锰组肝脏匀浆ALT、AST、ALP的活性明显升高,高剂量组为(60.79±9.88)、(49.77±8.36)和(49.43±8.88)U/ml,P<0.01;低剂量组为(47.35±8.11)、(37.31±6.77)和(32.34±4.53)U/ml,上述各项变化均呈现显著的量-效关系(P<0.05);而PRO含量各组间无显著差异(P>0.0)。(2)高、低剂量染锰组肝脏组织学损害主要表现为不同程度的肝小叶结构紊乱、肝细胞索松散、肝细胞脂肪变性和粒细胞浸润。结论锰接触对大鼠肝脏功能和组织学产生了明显的损害。     

咽拭子新型冠状病毒核酸检测的临床价值

 目的 了解某院新型冠状病毒肺炎（COVID-19）患者的临床资料及咽拭子检查结果,评价咽拭子新型冠状病毒（SARS-CoV-2）核酸检测的临床价值,为临床诊断COVID-19提供参考。方法 回顾性收集中南大学湘雅医院2020年1月23日—2月18日经SARS-CoV-2核酸检测确诊COVID-19患者病历资料,分析患者临床资料、病毒核酸检测的取样次数、取样方法、标本类型、检测手段等信息。结果 28例确诊患者平均年龄（43.78±14.46）岁,男女比例为2.5∶1,46.42%的患者有武汉/湖北旅居史,14.29%的患者与确诊COVID-19患者有密切接触史。患者临床表现以发热（78.57%）、咳嗽（53.57%）为主,实验室检查可见白细胞计数正常（71.43%）,淋巴细胞计数下降（53.57%）,肺部CT呈多发磨玻璃影（92.59%）及斑片影（70.37%）。28例确诊病例中,发病至确诊的中位时间为5.5 d。首次采集标本SARS-CoV-2检测阳性者18例（64.29%）,首次可疑阳性1例;首次阴性（包括可疑阳性）,第二次采集阳性者5例（17.86%）;前两次采集阴性,第三次采集阳性者2例（7.14%）;经四次检测阳性者1例（3.57%）;经五次检测后阳性者2例（7.14%）。鼻/口咽拭子采样26例（92.86%）,诱导排痰2例（7.14%）,经鼻咽拭子、咽拭子、痰标本RT-PCR确诊27例（96.43%）,痰标本NGS测序确诊1例（3.57%）。结论 COVID-19临床常表现有发热及干咳,但无特异性,仍需依赖SARS-CoV-2核酸检测才能确诊。咽拭子作为发热门诊首选的SARS-CoV-2核酸采集方式具有简便易行的优势,但检测结果呈阴性并不能排除SARS-CoV-2感染。     

Epidemiological and clinical characteristics of early COVID-19 cases,United Kingdom of Great Britain and Northern Ireland

ObjectiveTo describe the clinical presentation, course of disease and health-care seeking behaviour of the first few hundred cases of coronavirus disease 2019 (COVID-19) in the United Kingdom of Great Britain and Northern Ireland.MethodsWe implemented the World Health Organization’s First Few X cases and contacts investigation protocol for COVID-19. Trained public health professionals collected information on 381 virologically confirmed COVID-19 cases from 31 January 2020 to 9 April 2020. We actively followed up cases to identify exposure to infection, symptoms and outcomes. We also collected limited data on 752 symptomatic people testing negative for COVID-19, as a control group for analyses of the sensitivity, specificity and predictive value of symptoms.FindingsApproximately half of the COVID-19 cases were imported (196 cases; 51.4%), of whom the majority had recent travel to Italy (140 cases; 71.4%). Of the 94 (24.7%) secondary cases, almost all reported close contact with a confirmed case (93 cases; 98.9%), many through household contact (37 cases; 39.8%). By age, a lower proportion of children had COVID-19. Most cases presented with cough, fever and fatigue. The sensitivity and specificity of symptoms varied by age, with nonlinear relationships with age. Although the proportion of COVID-19 cases with fever increased with age, for those with other respiratory infections the occurrence of fever decreased with age. The occurrence of shortness of breath also increased with age in a greater proportion of COVID-19 cases.ConclusionThe study has provided useful evidence for generating case definitions and has informed modelling studies of the likely burden of COVID-19.     

三氯乙烯药疹样皮炎患者肝功能动态变化

目的 观察职业性三氯乙烯( trichloroethylene,TCE)药疹样皮炎患者血清肝功能指标动态变化,为TCE药疹样皮炎肝损害的治疗提供依据.方法 收集10例职业性TCE药疹样皮炎并发肝损害患者不同时间点血清,采用全自动生化分析仪测定血清总蛋白(TP)、白蛋白( ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、AST/ALT比值、白蛋白/球蛋白比值(A/G)等11项指标,分析各指标动态变化.结果 10例TCE药疹样皮炎患者11项肝功能指标变化范围是TP:43.2～74.2 g/L,ALB:24.6～44.6 g/L,A/G:0.77～2.10,TBIL:3.7～268.2 μmol/L,DBIL:1.0～166.0 μmol/L,IBIL:2.4～167.5 μmol/L,ALT:11～5985 U/L,AST:14～5586 U/L,GGT:15～1500 U/L,ALP:35～309 U/L,S/L:0.07～1.94.TBIL、DBIL、ALT、AST、GGT、ALP浓度明显升高,尤以ALT、AST、GGT变化最明显;ALT最高达5985U/L,AST最高达5586 U/L,GGT最高达1500 U/L.TP、ALB、S/L明显降低,TP最低降到43.2g/L,S/L最低至0.07.A/G基本保持不变,IBIL变化不规律.结论 TCE药疹样皮炎患者早期肝损害严重,病情易反复发作.     

恩替卡韦联合护肝药物治疗慢性乙肝肝硬化的价值分析

目的 探究恩替卡韦联合护肝药物治疗慢性乙肝肝硬化的临床效果及对肝功能的影响.方法 以2020年1月—2021年1月80例慢性乙肝肝硬化患者为研究对象,应用随机数字表法分组,对照组采用护肝药物治疗,试验组采用恩替卡韦与护肝药物联合治疗,分析两组治疗结果的差异性.结果 试验组总有效率为92.50％,高于对照组总有效率72....