COVID-19的临床特征和CT表现

目的探讨COVID-19的临床特征和CT表现特点。方法回顾性分析我院核酸检测确诊的13例COVID-19患者的临床和CT资料。CT重点观察病灶的密度、数目、分布、位置和形态,以及有无胸膜增厚、胸腔积液、纵膈淋巴结肿大或其他伴随征象。结果确诊患者包括男性9例,女性4例,年龄31~67岁（49±12岁）。常见临床症状包括发热（8例）,干咳或咳嗽（3例）,伴有腹泻、恶心呕吐（1例）。2例出现外周淋巴细胞计数减低,5例出现C-反应蛋白增加。CT表现:病灶多发10例,双肺下叶背段或后基底段累及者共11例,以周围性分布（位于胸膜下或叶间裂胸膜下区）为主12例,沿支气管树分布10例,形态以团片状和斑片状为主10例,伴网格状影9例,密度以磨玻璃密度病灶为主11例,病灶临近支气管血管束增粗9例,伴有胸膜增厚或牵拉变形（包括叶间裂扭曲）8例,无胸腔积液和纵膈淋巴结增大。结论COVID-19临床特征常表现为发热和C-反应蛋白的增加,影像表现为肺部外周性磨玻璃影,胸部高分辨率CT扫描能早期发现COVID-19患者的肺部改变。      

48例伤寒患者的心脏损害

本文报导48例血培养或肥达氏阳性伤寒患者的血清谷草转氨酶(ALT)、磷酸肌酸激酶(CPK)、乳酸脱氢酶(LDH)、心电图及血压、心脏听诊等变化。结果44／48例有1～3项血清酶异常，以本病极期最明显；心电图有27／48例异常，15例为典型心肌损害；胸片3／48例有心脏改变；14例作心动超声的8例有心包积液；38／48例有血压和心音改变。提示伤寒患者大多(91．6％)并有心肌损害，少数同时伴有心包炎。     

台州市COVID-19患者临床及随访情况分析

目的 分析台州市COVID-19患者的临床特征及出院后随访情况。方法 回顾性分析101例COVID-19确诊患者的一般情况、实验室检查指标、胸部CT等,并比较重型和普通型COVID-19患者间的临床指标。追踪出院后患者2周、4周复诊情况。结果 101例COVID-19确诊病例中重型28例(27.72%)、普通型73例(72.28%);39例(38.61%)有湖北疫区接触史,55例有家属患病,平均潜伏期6.90 d,平均确诊时间4.51 d,平均年龄(48.28±13.88)岁,男性多于女性(3∶2)。重型患者更多的出现发热、咳嗽、咳痰、肌肉酸痛、气促,差异有统计学意义(χ²分别=10.61、10.61、4.63、7.25、15.30,P均<0.05),重型患者CD⁴⁺、CD⁸⁺、CD⁴⁺/CD⁸⁺、CD³⁺T细胞均低于普通型,差异有统计学意义(Z分别=-3.33、-1.99、-2.87、-3.79,P均<0.05),IL-6、IL-10则高于普...     

COVID-19患者胸部CT变化规律及转归

目的探讨临床普通型COVID-19患者病程中胸部CT表现的变化规律及最终转归。方法选择临床普通型COVID-19患者33例,其中男性17例,女性16例,年龄18~74岁(48.60±11.85岁)。住院期间主要采用抗病毒治疗和相关基础疾病对症治疗,根据病情变化,间隔2~10 d复查胸部CT,出院14 d后再次复查。收集患者的临床及影像学资料,主要观察病变的位置、数目、形态、密度及有无胸膜增厚、胸腔积液等征象,并统计首诊、历次复查的病灶特征和间隔时间,分析病程中病变的CT动态变化规律及转归与时间相关性。结果首诊时3例CT显示阴性,其余30例中75.8%为双肺多发磨玻璃影,45.5%伴有亚实变或实变,病灶主要位于胸膜下。33例患者在住院期间进行了1~4次复查,21例在病程中病变出现加重或此消彼长现象,最终均明显吸收。17例出院后复查病灶完全吸收,10例有少量残留,其中60%合并基础病,另有6例暂未复查。33例患者在出现症状或核酸检测为阳性后15.79±3.79 d进入恢复期,17例完全吸收患者恢复期为21.70±5.61 d,总病程37.89±7.15 d。结论临床普通型COVID-19预后良好,影像表现的动态变化及与时间相关性具有一定规律,对指导临床治疗有一定价值。     

强直性脊柱炎的心脏损害

强直性脊柱炎（ＡＳ）心脏损害为ＡＳ的一种并发症,最常见损害是主动脉瓣关闭不全（ＡＩ）和心脏传导系统阻滞,其他包括二尖瓣关闭不全（ＭＶＩ）,心包炎,心肌病。作者对１９９４～１９９７年８５例ＡＳ住院患者进行心电图、彩色多普勒超声心动图检查,发现１３例心脏...     

肢端肥大症患者心脏损害的超声表现

目的 通过超声心动图检查，观察肢端肥大症患者心脏结构和功能的改变，以及出现高血压并发症后对心脏的影响。方法 研究对象为56例确诊为肢端肥大症的患者，其中17例合并高血压，定为亚组病例。对照组34例。两组均行超声心动图检查，测定心脏结构及功能并对结果进行分析。结果 （1）患病组心肌重量（LVM）及心肌重量指数（LVMi）较对照组明显增加，LVMi达到左室肥厚（LVH）的比例为46．7％，高血压亚组增高更为明显；（2）反映心脏收缩功能的参数射血分数（EF）两组比较，差异无显著性；（3）反映心脏舒张功能的参数左室等容舒张时间（IRT）和二尖瓣减速时间（MDT），患病组较对照组明显延长，说明心肌松弛性受损。结论 肢端肥大症患者超声心动图表现为明显的心肌肥厚和心肌重量的增加，伴发高血压的患者心肌肥厚有加重的趋势。心脏功能的改变以舒张功能损害为主，反映心肌松弛性减低；而收缩功能则可在较长时间内维持在正常范围。     

COVID-19患者嗅觉和味觉功能障碍研究进展

<正>自2019年12月报告首例新型冠状病毒(COVID-19)感染患者以来,全球已有6亿多人口被COVID-19感染,并有650万人死亡^[1]。其中嗅觉功能障碍(olfactory dysfunction)和味觉功能障碍(gustatory dysfunction)是COVID-19常见的相关症状之一,其发生率明显高于流行性感冒等其他上呼吸道感染疾病,并且可通过嗅觉和味觉障碍来预测和诊断COVID-19。大多数研究^[2-3]报告,嗅觉和味觉障碍在发病后1个月内康复,但症状也可持续至2年甚至更久,且转阴后仍持续存在。     

新冠肺炎(COVID-19)的临床特征及CT表现

目的:分析新冠肺炎(COVID-19)的临床特征与CT表现,探讨CT在COVID-19的临床诊断及病情评估中的应用价值.方法:回顾性分析多家医院42例经RT-PCR检测COVID-19阳性病例的临床资料及CT表现,运用SPSS 25.0软件对病灶分布范围及密度等数据进行统计学分析.结果:在首次CT扫描中,31例(73....     

糖尿病对心脏损害的早期检测

近年来糖尿病的发病率有逐年升高的趋势,这在中老年知识分子中表现尤为突出。据统计我国糖尿病的发病率约为1％,40岁以上者约为2.5％,而北京大学调查退离休教工中患病率为12％。糖尿病性心脏病发病年龄较轻,发病较早,发展较快,并发症多,病情较重,患病率与病死率高,是糖尿病人的主要致死原因之一,是中老年健康的大敌。故认真开展糖尿病的普查和监测是医疗保健的重要课题。     

COVID-19 and gastroenteric manifestations

Coronavirus disease 2019 (COVID-19), caused by the infection of a novel coronavirus [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)], has become a pandemic. The infection has resulted in about one hundred million COVID-19 cases and millions of deaths. Although SARS-CoV-2 mainly spreads through the air and impairs the function of the respiratory system, it also attacks the gastrointestinal epithelial cells through the same receptor, angiotensin converting enzyme 2 receptor, which results in gastroenteric symptoms and potential fecal-oral transmission. Besides the infection of SARS-CoV-2, the treatments of COVID-19 also contribute to the gastroenteric manifestations due to the adverse drug reactions of anti-COVID-19 drugs. In this review, we update the clinical features, basic studies, and clinical practices of COVID-19-associated gastroenteric manifestations.     

Electrocardiographic manifestations of COVID-19

IntroductionCoronavirus disease of 2019 (COVID-19) is a lower respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease can impact the cardiovascular system and lead to abnormal electrocardiographic (ECG) findings. Emergency clinicians must be aware of the ECG manifestations of COVID-19.ObjectiveThis narrative review outlines the pathophysiology and electrocardiographic findings associated with COVID-19.DiscussionCOVID-19 is a potentially critical illness associated with a variety of ECG abnormalities, with up to 90% of critically ill patients demonstrating at least one abnormality. The ECG abnormalities in COVID-19 may be due to cytokine storm, hypoxic injury, electrolyte abnormalities, plaque rupture, coronary spasm, microthrombi, or direct endothelial or myocardial injury. While sinus tachycardia is the most common abnormality, others include supraventricular tachycardias such as atrial fibrillation or flutter, ventricular arrhythmias such as ventricular tachycardia or fibrillation, various bradycardias, interval and axis changes, and ST segment and T wave changes. Several ECG presentations are associated with poor outcome, including atrial fibrillation, QT interval prolongation, ST segment and T wave changes, and ventricular tachycardia/fibrillation.ConclusionsThis review summarizes the relevant ECG findings associated with COVID-19. Knowledge of these findings in COVID-19-related electrocardiographic presentations may assist emergency clinicians in the evaluation and management of potentially infected and infected patients.     

Dermatologic manifestations and complications of COVID-19

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. While much of the focus has been on the cardiac and pulmonary complications, there are several important dermatologic components that clinicians must be aware of.ObjectiveThis brief report summarizes the dermatologic manifestations and complications associated with COVID-19 with an emphasis on Emergency Medicine clinicians.DiscussionDermatologic manifestations of COVID-19 are increasingly recognized within the literature. The primary etiologies include vasculitis versus direct viral involvement. There are several types of skin findings described in association with COVID-19. These include maculopapular rashes, urticaria, vesicles, petechiae, purpura, chilblains, livedo racemosa, and distal limb ischemia. While most of these dermatologic findings are self-resolving, they can help increase one's suspicion for COVID-19.ConclusionIt is important to be aware of the dermatologic manifestations and complications of COVID-19. Knowledge of the components is important to help identify potential COVID-19 patients and properly treat complications.     

输入性COVID-19的临床表现及CT分布特征

目的分析上海市浦东新区输入性COVID-19的临床表现及CT分布特征。方法回顾性分析经病毒核酸检查阳性的12例输入性COVID-19患者的临床及影像学资料,CT主要观察病变的数量、分布、形态、密度、边界、纵隔及胸膜等情况。结果11例有疫区接触史,1例不详;10例有发热,9例有咳嗽;10例白细胞计数、中性粒细胞计数、淋巴细胞计数正常,7例单核细胞计数升高,10例嗜酸性粒细胞减低,2例C反应蛋白升高,3例血清淀粉样蛋白升高。CT分布特征：12例均为多发病灶,3例累及单个肺叶,3例累及两个肺叶,6例累及多个肺叶;肺下叶累及为主,有10例累及肺下叶;5例肺外周分布,7例肺外周及中心同时分布;胸膜受累11例,12例患者均未见胸腔积液和纵隔淋巴结增大;伴随征象为晕征1例,小叶间隔增厚2例,铺路石征1例,病变内支气管壁增厚、血管增粗7例,充气支气管征3例。结论COVID-19患者临床表现主要为发热、咳嗽;实验室检查白细胞计数、中性粒细胞计数、淋巴细胞计数多正常,嗜酸性粒细胞计数减低;CT分布特征以肺下叶外周多发磨玻璃样影为主要表现。     

Persistent hiccups as an atypical presenting complaint of COVID-19

Hiccups (singultus) are reflex inspiratory movements that involve the swallowing reflex arc and can be classified as acute (<48 h) or persistent (>48 h). A 62-year-old man with no history of malignancy or pulmonary disease presented to the Emergency Department with a four-day history of persistent hiccups. Other than episodic hiccupping, his physical examination was otherwise unremarkable. An abnormal chest X-ray led to a CT scan of the chest with IV contrast, which demonstrated regional, peripheral groundglass opacities of the upper lobes with small focal groundglass opacities scattered throughout the lungs. He was tested for COVID-19 per admission protocol, started on hydroxychloroquine, his hiccups improved, and he was discharged to home after 3 days. An emergency medicine physician should keep COVID-19 on the differential and be vigilant of exposure in atypical presentations.     

COVID-19: Gastrointestinal manifestations,liver injury and recommendations

Coronavirus disease 2019 (COVID-19) has caused a pandemic that affected all countries with nearly 270 million patients and 5 million deaths, as of as of December, 2021. The severe acute respiratory syndrome coronavirus 2 virus targets the receptor, angiotensin-converting enzyme 2, which is frequently found in human intestinal epithelial cells, bile duct epithelial cells, and liver cells, and all gastrointestinal system organs are affected by COVID-19 infection. The aim of this study is to review the gastrointestinal manifestations and liver damage of COVID-19 infection and investigate the severe COVID-19 infection risk in patients that have chronic gastrointestinal disease, along with current treatment guidelines. A literature search was conducted on electronic databases of PubMed, Scopus, and Cochran Library, consisting of COVID-19, liver injury, gastrointestinal system findings, and treatment. Liver and intestinal involvements are the most common manifestations. Diarrhea, anorexia, nausea/vomiting, abdominal pain are the most frequent symptoms seen in intestinal involvement. Mild hepatitis occurs with elevated levels of transaminases. Gastrointestinal involvement is associated with long hospital stay, severity of the disease, and intensive care unit necessity. Treatments and follow-up of patients with inflammatory bowel diseases, cirrhosis, hepatocellular carcinoma, or liver transplant have been negatively affected during the pandemic. Patients with cirrhosis, hepatocellular carcinoma, auto-immune diseases, or liver transplantation may have a greater risk for severe COVID-19. Diagnostic or therapeutic procedures should be restricted with specific conditions. Telemedicine should be used in non-urgent periodic patient follow up. COVID-19 treatment should not be delayed in patients at the risk group. COVID-19 vaccination should be prioritized in this group.     

新型冠状病毒肺炎患者HRCT影像学表现及动态分析

[目的]探讨新型冠状病毒肺炎(COVID-19)的高分辨CT扫描(HRCT)表现及动态影像变化.[方法]回顾本院及周边地区经核酸检测确诊的46例COVID-19患者完整的临床及HRCT扫描资料,每例患者于首次CT检查后每隔4?5 d复查,动态观察不同时期胸部CT影像变化特点.[结果]46例患者中入院时发热38例,干咳2...     

外伤性视神经损伤的HRCT及MRI表现

目的 探讨外伤性视神经损伤的HRCT及MRI表现。 方法 对19例外伤致盲患者的HRCT及MRI表现进行回顾性分析。 结果 ①19例患者均接受HRCT检查。19例中,16例存在34处视神经管壁骨折,以神经管内侧壁及下壁骨折多见,3例无骨折;视神经管邻近结构骨折共77处,包括眶尖部眼眶骨折23处,蝶骨大翼近眶上裂、眶下裂处骨折15处;蝶骨平台近视交叉沟处骨折11处,蝶窦侧壁骨折2处,眶壁前部、额窦及上颌窦窦壁骨折26处;13例患侧视神经局部较对侧增粗。②10例患者接受MR检查,14处视神经局部信号增高,其中眶内段6处、管内段5处、颅内段3处。③19例患者均接受视神经管减压术治疗,13例在术后7天内即出现不同程度的视力改善。 结论 外伤后行视神经管HRCT检查可明确视神经管与邻近结构的骨折情况,而MRI对显示视神经具有优势,尤其对无视神经管骨折的外伤性视神经损伤患者,MRI有利于病变的及早检出。