Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.     

Mental health outcomes among patients from Fangcang shelter hospitals exposed to coronavirus disease 2019: An observational cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) is not only attacking physical health, but it is also increasing psychological suffering. This study aimed to observe the impact of the COVID-19 pandemic on mental health outcomes among patients with mild to moderate illness in Fangcang shelter hospitals.Methods: We conducted an observational, cross-sectional study of 129 patients with mild to moderate illness from Jiangxia Fangcang shelter hospitals in Wuhan, China. The participants were assessed by quantifying their symptoms of depression, anxiety, insomnia, and stressful life events and analyzing potential risk factors associated with these symptoms. Using correlation analysis, we examined associations between exposure to COVID-19 and subsequent psychological distress in response to the outbreak.Results: In total, 49.6% of participants had depressive or anxiety symptoms. The depressive and anxiety symptoms were highly related to sleep disturbances and hypochondriasis (allr > 0.50,P < 0.01). The impact of the event was positively related to depressive symptoms, anxiety symptoms, sleep disturbances, hypochondriasis and life events (allr > 0.35,P < 0.01) but was negatively related to psychological resilience (r = -0.41,P < 0.01). The presence of the COVID-19 infection in this setting was associated with increased anxiety, depression and stress levels, and decreased sleep quality, and seriously affected patients’ quality of life as well as adversely affecting the course and prognosis of physical diseases.Conclusion: The sleep quality, anxiety, and depression of COVID-19 patients in Fangcang shelter hospitals were significantly related to the impact of the epidemic.     

Renewed vision on pulmonary rehabilitation service delivery for chronic obstructive pulmonary disease management beyond COVID-19

Pulmonary rehabilitation (PR) is a cornerstone management for chronic obstructive pulmonary disease (COPD). International respiratory societies defined PR is more than “just an exercise program”; it is a comprehensive care delivered by a team of dedicated healthcare professionals with a strong emphasis on long-term health-enhancing Behaviors. However, “Uncertainty” exists with varied reasons for the political and geographical barriers of referral, uptake, attendance, and completion of PR in both primary and secondary care. Besides, COVID-19 pandemic has sparked many global controversies and challenges on pulmonary rehabilitation service delivery. Post-COVID-19 guidelines emphasize on integrated care rehabilitation for patients with COPD. Thus, this concise review intends to understand the gaps in United Kingdom healthcare policies, practices, and PR services resources. To date, there is no clear consensus on PR integrated care model pathway to address the unmet needs, measure the health and social care disparities; adds to the disease burden of COPD. Based on the culmination of evidence, this perspective offers a theoretical framework of PR integrated service model, a pathway to deliver high-value personalized care to patients with COPD.     

Recommendations for prevention and management of COVID-19 in peritoneal dialysis patients

The World Health Organization characterized coronavirus disease (COVID-19) as a pandemic on March 11, 2020. Peritoneal dialysis patients have a weakened immune system that is associated with a high morbidity of infection. Thus, COVID-19 prevention measures and management for patients on peritoneal dialysis are urgent and critical. Based on published research on COVID-19 and previous clinical practices for similar coronavirus outbreaks, we aimed to make recommendations to manage patients undergoing peritoneal dialysis.     

Expert recommendations on blood purification treatment protocol for patients with severe COVID-19

Coronavirus disease (COVID-19) was first diagnosed in Wuhan in December 2019. The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern. Epidemiological data indicate that at least 20% of COVID-19 patients have severe disease. In addition to impairment of the respiratory system, acute kidney injury (AKI) is a major complication. Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis. Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice, we developed a blood purification protocol for patients with severe COVID-19. This protocol is divided into four major steps. The first step is to assess whether patients with severe COVID-19 require blood purification. The second step is to prescribe a blood purification treatment for patients with COVID-19. The third step is to monitor and adjust parameters of blood purification. The fourth step is to evaluate the timing of discontinuation of blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.     

Pulmonary embolism with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The incidence of COPD is growing annually in China, and it is a significant and growing public health burden. Multivariate analysis showed that COPD was one of the independent risk factors for the occurrence of pulmonary embolism (PE), and the incidence of PE was significantly higher in COPD patients than in normal subjects. However, PE is often overlooked in patients with acute exacerbation of COPD (AECOPD) because there are many similarities in clinical symptoms between PE and AECOPD, which are difficult to distinguish, resulting in the failure of timely treatment and poor prognosis. Therefore, it is of great significance to understand the clinical manifestations, diagnosis, and treatment of COPD combined with PE for making a more accurate diagnosis, providing timely and effective treatment, and improving the prognosis of such patients.     

互动达标理论指导下的肺康复护理对COPD患者的干预效果

目的 探讨互动达标理论指导下的肺康复护理对慢性阻塞性肺疾病(COPD)的干预效果。方法 随机选取2020年6月～12月浙江中医药大学附属第三医院收治的180例COPD患者为研究对象。按照随机数字表法将180例患者分为试验组和对照组,每组90例患者。试验组患者在常规护理的基础上给予互动达标理论指导下的肺康复护理,对照组患者给予常规护理。实施干预3个月后,通过肺功能、运动耐力、生活质量和自我护理能力等指标比较两组患者的干预效果。结果 实施干预3个月后,试验组患者第1秒最大呼气量(FEV1)、FEV1/用力肺活量(FVC)、6 min步行试验距离(6WMTD)均高于对照组患者,圣乔治呼吸问卷(SGRQ)3个维度上的评分均低于对照组患者(均P<0.05),自我护理能力测定量表(ESCA)4个维度上的评分均高于对照组患者(均P<0.05),各项比较差异均具有统计学意义(均P<0.05)。结论 互动达标理论指导下的肺康复护理对改善COPD患者的肺功能、提高患者的生活质量和自我护理能力等具有积极的促进作用。     

疫情期间直播/在线平台实施M BBS口腔教学的实践与思考

2020年初的新冠肺炎疫情给高校教学工作造成了一定程度的干扰,尤其是留学生医学教育受疫情全球持续扩散的影响,面临诸多挑战.我们根据疫情期间MBBS留学生口腔科学课程教学的特点,采用了以直播/在线平台为主的教学方式.实践结果表明MBBS留学生对直播/在线教学课程的参与度高,教学达到了预期效果.     

老年冠心病患者介入术后联用氯吡格雷及质子泵抑制剂的安全性和有效性研究

目的评估老年冠心病患者经皮冠状动脉介入治疗（PCI）后联合使用质子泵抑制剂（PPI）及氯吡咯雷是否安全、有效。方法回顾本院PCI术后并有复查冠状动脉造影的老年患者（≥60岁）,共317例,并根据联合使用PPI情况,分无PPI组（69例）,PPI低暴露组（142例）及PPI高暴露组（106例）,观察各组支架内再狭窄率及临床事件。结果平均随访时间为（14±6.5）个月,PPI高暴露组支架内再狭窄率比无PPI组显著增加（P＜0.05）,总的临床不良事件无显著性差异（P＞0.05）。PPI低暴露组支架内再狭窄及心血管事件增加无显著性差异（P＞0.05）,出血事件明显减少（P＜0.05）。结论对老年患者PCI术后长期使用PPI可增加支架内再狭窄及心血管风险,但总体是安全的,短期使用则更加安全有效。     

探讨心超和心电图在高血压性心脏病诊断中的临床价值

目的研究分析心脏B超以及心电图应用在高血压性心脏病临床诊断中的价值。方法抽取48例高血压性心脏病患者,将其按照每组24例划分为对照组和观察组,对照组通过心电图进行临床检查诊断,观察组则实施心脏B超检查诊断。结果观察组取得的诊断准确率为68.2%,显著高于对照组的38.7%(P0.05)。结论针对高血压性心脏病患者,采用心脏B超手段进行临床检查能够发挥良好的诊断效果,诊断准确性明显高于采用心电图检查。     

2型糖尿病合并冠心病患者心血管危险因素控制的临床分析

目的探讨心血管危险因素控制在2型糖尿病合并冠心病患者中的意义。方法筛选2型糖尿病合并冠心病患者140例,行问卷调查,对比心血管危险因素控制良好、差者血糖控制水平、近2年心血管事件发生情况。结果心血管危险因素控制水平良好93人、差者47人,心血管危险因素控制良好者血糖控制59.14%、一般34.41%、不佳6.45%,优于心血管危险因素控制者10.64%、53.19%、36.1%,急诊8.60%、门诊16.13%、医疗资源获取例次率24.73%,低于差者19.15%、104.26%、123.40%,心肌梗死4.30%、心衰3.23%、心绞痛37.63%、心血管事件合计发生例次率45.16%,低于差者14.89%、23.40%、93.62%、131.91%,差异具有统计学意义(P0.05)。结论对于2型糖尿病合并冠心病患者而言,积极控制心血管病危险因素,有助于提高血糖控制水平,降低心血管事件发生风险,进而改善预后。     

吡格列酮对2型糖尿病合并冠心病患者动脉粥样硬化相关危险因素及预后的影响

目的探讨吡格列酮治疗2型糖尿病合并冠心病患者对其动脉粥样硬化相关危险因素及预后的影响。方法选取2010年8月至2012年1月在本院进行治疗的2型糖尿病合并冠心病患者202例,随机分为治疗组和对照组,两组均给予常规治疗;在此基础上,治疗组(101例)加用吡格列酮(15mg/次,1次/天)治疗,期间定期随访,1年后比较2组血液动脉粥样硬化相关危险因素及心血管不良事件发生率。结果治疗组血清PAI-1(纤溶酶原激活物抑制物-1)水平为(4.15±0.47)ng/ml,P-选择素水平为(12.38±3.56)ng/ml,对照组血清PAI-1水平为(7.46±1.73)ng/ml,P-选择素水平为(15.84±6.32)ng/ml,两组比较差异显著(P<0.05);治疗组空腹血糖、餐后血糖、空腹胰岛素、糖化血红蛋白水平和胰岛素抵抗指数及急性冠脉综合征、不稳定性心绞痛和靶血管重建发生率显著低于对照组,(P<0.05)。结论吡格列酮用于治疗2型糖尿病合并冠心病,能降低其动脉粥样硬化相关危险因素从而改善预后。