一起海陆边境城市新型冠状病毒肺炎疫情暴发溯源调查

目的 分析2021年12月广西海陆边境城市（D市）一起新型冠状病毒肺炎（新冠肺炎）疫情暴发的流行特征及溯源过程,为今后类似疫情应急处置及科学溯源提供科学依据。方法 按照《新型冠状病毒感染的肺炎病例流行病学调查方案（第八版）》对病例开展流行病学调查,用实时荧光定量(RT-PCR)法对标本进行新冠病毒核酸检测,阳性标本进行新冠病毒全基因组二代测序和系统发育分析。采用R4.1.3统计软件进行数据统计分析。结果 本次疫情累计感染病例20例,波及6个家庭,平均潜伏期（4.6±2.2） d。获得19例病例新冠病毒基因组有效序列,与武汉参考株（NC＿045512）序列相比,本起疫情病例新冠病毒基因组序列存在35～36个核苷酸突变位点,属于德尔塔（VOC/Delta）变异株（AY.57进化分支）,新冠病毒刺突（S）蛋白均存在相同的11个氨基酸突变位点,与全球新冠病毒基因组数据库（GISAID）中邻国上传的2条新冠病毒基因组序列高度同源。结论 本起疫情是一起由渔民外出作业接触邻国境外人员感染导致本地社区传播,今后应加强边境村民管理和边境流行株监测,尽早发现并处置疫情。     

新型冠状病毒肺炎流行期间综合医院发热门诊管理实践

发热门诊是防控急性传染病期间专门用于排查疑似传染病患者、治疗发热患者所启动的预防预警机制。为了积极配合做好新型冠状病毒肺炎疫情防控工作,本院迅速完善发热门诊管理,规范医务人员个人防护,严格患者筛查管理,避免交叉感染,确保医患安全,遏制新型冠状病毒在院内传播。本文从发热门诊的布局、医务人员管理及工作制度和工作流程管理等方面阐述了新型冠状病毒肺炎流行期间发热门诊的管理现状。     

新型冠状病毒肺炎疫情期间非定点救治医院血液透析室防控措施探讨

新型冠状病毒肺炎流行期间,医院应制定科学可行的制度和流程,采取有效的防控措施,避免新型冠状病毒肺炎院内感染和疫情扩散。本文总结了非定点救治医院血液透析室应对新型冠状病毒肺炎疫情的防控措施,通过成立防控小组,制定相关制度和流程;强化全员培训,多途径宣传教育;科学排班,分级管理;对全体员工、患者及家属严格筛查,严格落实个人防护和消毒隔离措施。此外,医院应高度重视新型冠状病毒肺炎的诊疗及防控。在组织管理、制度修订、人员培训、工作和人员分配安排、患者及家属管理和健康教育等方面,要基于科室实际情况迅速作出部署,全面加强对疫情防控的集中统一领导,保障科室所有工作人员、患者及其家属的身心健康和安全。     

D-Dimer as a potential biomarker for disease severity in COVID-19

IntroductionThis study seeks to determine the utility of D-dimer levels as a biomarker in determining disease severity and prognosis in COVID-19.MethodsClinical, imaging and laboratory data of 120 patients whose COVID-19 diagnosis based on RT-PCR were evaluated retrospectively. Clinically, the severity of COVID-19 was classified as noncomplicated or mild or severe pneumonia. Radiologically, the area of affected lungs compatible with viral pneumonia in each patient's computed tomography was classified as either 0–30% or ≥ 31% of the total lung area. The D-dimer values and laboratory data of patients with COVID-19 were compared with inpatient status, duration of hospitalization, and lung involvement during treatment and follow-up. To assess the predictive value of D-dimer, receiver operating characteristic (ROC) analysis was conducted.ResultsD-dimer elevation (> 243 ng/ml) was detected in 63.3% (76/120) of the patients. The mean D-dimer value was calculated as 3144.50 ± 1709.4 ng/ml (1643–8548) for inpatients with severe pneumonia in the intensive care unit. D-Dimer values showed positive correlations with age, duration of stay, lung involvement, fibrinogen, neutrophil count, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR). When the threshold D-dimer value was 370 ng/ml in the ROC analysis, this value was calculated to have 77% specificity and 74% sensitivity for lung involvement in patients with COVID-19.ConclusionD-Dimer levels in patients with COVID-19 correlate with outcome, but further studies are needed to see how useful they are in determining prognosis.     

In vitro and in silico studies on clinically important enzymes inhibitory activities of flavonoids isolated from Euphorbia pulcherrima

Introduction: The genus Euphorbia is known to contain diterpenoids, and several isolated compounds which exhibited biological activities including significant multidrug resistance reversal effects. This work is focused on the isolation, in vitro and in silico studies of two natural bio-active flavonoids (1 & 2) isolated from Euphorbia pulcherrima bark for the very first time.Methods: The phytochemical investigation resulted in the identification of two flavonoids: 3,5,7-trihydroxy-2-(4-hydroxy-3-methoxyphenyl)-6-methoxy-4H-chromen-4-one (1) and 2-(3,4-dihydroxyphenyl)-3,5,7-trihydroxy-6-methoxy-4H-chromen-4-one (2), which were isolated for the first time from Euphorbia pulcherrima.Results: The chemical structures of the two isolated compounds were confirmed by ¹H NMR, ¹³C NMR, and ESI-HRMS spectral data. The Bioactivity activity of these compounds was evaluated; results revealed that compounds 1 & 2 exhibit promising urease inhibitory potential with IC50 values of 15.3 ± 2.13 μM and 19.0 ± 2.43 μM, respectively, whereas the positive control thiourea had an IC₅₀ of 21.0 ± 0.23 μM. Similarly, these compounds were also evaluated against the tyrosinase enzyme; results showed that compound 1 displays significant inhibitory activity with an IC₅₀ value of 48.7 ± 2.19 μM, whereas compound 2 exhibited a moderate effect with an IC50 value of 74.8 ± 1.79 μM, when compared with the standard (alpha-kojic acid, IC₅₀ = 47.6 ± 0.67 μM). Additionally, compounds 1 and 2 also exhibited anti-glycation and phosphodiesterase inhibitory activities.Conclusion: Studies dealing with the drug like properties such as in silico screening (docking study) was also carried out to discover the structural features of both compounds 1 and 2. Results indicated that the docking scores of compounds 1 and 2 are in agreement with their IC₅₀ values.

Key messages

• Isolation and characterization of two bioactive flavonoids (1 and 2) from Euphorbia pulcherrima.
• In silico and in vitro enzyme inhibition studies were conducted to identify the therapeutic potential of flavonoids 1 and 2.
• Drug-like properties were calculated to discover important pharmacophoric features.

     

新型冠状病毒肺炎疫情期间基层医院发热门诊护理管理实践

本文主要介绍了新型冠状病毒肺炎疫情防控期间基层医院发热门诊的建设和管理,包括就诊流程、人员调配、防控措施、人文关怀、人员培训等,以期为进一步完善新型冠状病毒肺炎疫情期间基层医院发热门诊的工作流程提供参考。     

Transfusion practices during the COVID-19 pandemic: An experience from a hematology daycare in India

The Coronavirus disease-19 (COVID-19) pandemic has in multiple ways affected healthcare delivery to non?COVID patients throughout the world. Adequate transfusion services are fundamental in ongoing therapy of patients with hematological ailments. We present the transfusion services in the hematology daycare under the department of Hematology and supported by the Blood Bank at our institution for the period 12th April 2020?30th June 2020, which saw the stringent lockdown and unlocking Phase I in India, declared in lieu of the pandemic. A 56 % reduction in total transfusion sessions was observed in 2020 (588 sessions given to 176 patients) compared to 1336 sessions in 516 patients over the same period in 2019. The reductions were seen across the different blood components (packed red blood cells [PRBC]: 585 vs. 1840, platelet rich plasma: 372 vs. 1313, single donor platelet 18 vs. 16), with a significant reduction in the mean PRBC transfused per PRBC transfusion session (1.11 vs 1.99, p<0.001) in 2020, compared to 2019. There were however no major differences in the transfusion practices across the different phases of the lockdown. Our study highlights the detrimental reduction in transfusion services due to the COVID-19 pandemic and related lockdown and showcases the remedial strategies taken to maximize transfusion support to patients during this period. Our observations might help to provide insights to adequately combat possible similar adverse situations in the future.     

新型冠状病毒肺炎疫情期间中医院发热门诊管理实践

本文以总结了新型冠状病毒疫情防控期间发热门诊管理、转运流程管理、医护人员管理等方面的实践经验,以期为提高疫情期间救治水平,同时保障医护自身安全提供参考。     

Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population’s mental health, given the lack of mental health professionals. AIMTo investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders. METHODSIn this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire. RESULTSThe participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen’s d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen’s d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen’s d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen''s d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen’s d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen’s d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group. CONCLUSIONThis study’s findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.     

Impact of temporary closures of emergency departments during the COVID-19 outbreak on clinical outcomes for emergency patients in a metropolitan area

BackgroundDuring the early phase of the coronavirus disease 2019 (COVID-19) outbreak, many emergency departments (EDs) were exposed to COVID-19 and were temporarily closed according to national protocol of Korea. We aimed to evaluate the effect of concurrent and recurrent temporary closures of EDs on the clinical outcomes of patients who visited EDs during the COVID-19 outbreak.MethodsThis cross-sectional study used a nationwide emergency patient database. Patients who visited one of the 46 EDs in Daegu and Gyeongbuk between January 21 and April 14, 2020 were included. The main exposure variable was the first medical contact (ED visit or 119 call to emergency medical services (EMS)) during closure of at least one ED. There were 25 temporary closures of six Level-1 and Level-2 EDs between February 18 and March 17, 2020. We constructed a dataset by performing bidirectional crossover matching and conducted a conditional logistic regression analysis where the primary outcome was in-hospital mortality.ResultsOf the 94,360 eligible study participants, 36,327 were classified into the non-EMS-use group and 10,116 were classified into the EMS-use group. In-hospital mortality rates were 2.0% and 1.6% for the temporary-closure and no-closure groups in the non-EMS-use group (p-value, 0.03) and 8.7% and 7.4% in the EMS-use group (p-value, 0.02), respectively. In the conditional logistic analysis for in-hospital mortality, the odds ratios (95% confidence intervals) of the temporary-closure group compared the no-closure group were 1.22 (1.03–1.44) among the non-EMS-use group and 1.23 (1.04–1.46) among the EMS-use group.ConclusionThe temporary closures of EDs due to the unpredicted COVID-19 exposure resulted in an increase in emergency patients' in-hospital mortality rates irrespective of whether they used EMS. Preparing regional EMS systems to cope with new outbreaks is essential to protect the safety of all citizens.     

1例新冠肺炎康复患者行心脏移植术后护理

通过对1例新冠肺炎康复患者行心脏移植术,术后给予主动脉内球囊反搏(intra-aortic balloon pump IABP)辅助,气管切开间断呼吸机辅助呼吸,纤维支气管镜治疗,连续性血液净化治疗(continuous renal replacement therapy,CRRT).密 切监护护理、康复护理、消毒隔离...     

新冠肺炎疫情期间定点医院急诊应急体系的管理实践

本研究详细介绍了定点医院急诊科在新型冠状病毒肺炎疫情期间应急体系的构成与实践经验,应急体系的构成包括全院协同联动机制、人员配置和培训、应急预案演练、物资配置及管理以及科室环境管理.此应急体系通过临床实践实现医护人员零感染、疑似及确诊病例有效隔离,疫情期间应急管理工作有序开展,对新型冠状病毒肺炎疫情的防控具有重要意义.     

Do Patients With COVID-19 Benefit from Rehabilitation? Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit

ObjectiveTo determine the benefits associated with brief inpatient rehabilitation for coronavirus 2019 (COVID-19) patients.DesignRetrospective chart review.SettingA newly created specialized rehabilitation unit in a tertiary care medical center.ParticipantsConsecutive sample of patients (N=100) with COVID-19 infection admitted to rehabilitation.InterventionInpatient rehabilitation for postacute care COVID-19 patients.Main Outcome MeasuresMeasurements at admission and discharge comprised a Barthel Activities of Daily Living Index (including baseline value before COVID-19 infection), time to perform 10 sit-to-stands with associated cardiorespiratory changes, and grip strength (dynamometry). Correlations between these outcomes and the time spent in the intensive care unit (ICU) were explored.ResultsUpon admission to rehabilitation, 66% of the patients were men, the age was 66±22 years, mean delay from symptom onset was 20.4±10.0 days, body mass index was 26.0±5.4 kg/m², 49% had hypertension, 29% had diabetes, and 26% had more than 50% pulmonary damage on computed tomographic scans. The mean length of rehabilitation stay was 9.8±5.6 days. From admission to discharge, the Barthel index increased from 77.3±26.7 to 88.8±24.5 (P<.001), without recovering baseline values (94.5±16.2; P<.001). There was a 37% improvement in sit-to-stand frequency (0.27±0.16 to 0.37±0.16 Hz; P<.001), a 13% decrease in post-test respiratory rate (30.7±12.6 to 26.6±6.1; P=.03), and a 15% increase in grip strength (18.1±9.2 to 20.9±8.9 kg; P<.001). At both admission and discharge, Barthel score correlated with grip strength (ρ=0.39-0.66; P<.01), which negatively correlated with time spent in the ICU (ρ=–0.57 to –0.49; P<.05).ConclusionsInpatient rehabilitation for COVID-19 patients was associated with substantial motor, respiratory, and functional improvement, especially in severe cases, although there remained mild persistent autonomy loss upon discharge. After acute stages, COVID-19, primarily a respiratory disease, might convert into a motor impairment correlated with the time spent in intensive care.     

Evaluation of physical and psychological status of health care workers infected with COVID-19 during a hospital outbreak in Japan

PurposeCOVID-19 causes physical and psychological impacts on health care workers (HCWs), especially when it occurs during an outbreak. As there are few reports on outcomes of HCWs infected with COVID-19 during a hospital outbreak, we investigated the physical and psychological impacts on HCWs infected with COVID-19 during an outbreak in our hospital.MethodsDuring the outbreak in our hospital, 231 people were infected with COVID-19 including patients, HCWs and their families. Among them, 83 HCWs were enrolled in this study. Current quality of life (QOL) was assessed with the EuroQol-visual analogue scales (EQ-VAS), and motivation to keep on working was evaluated by a 10-point analogue scale. Physiological recovery rates including return to work (RTW) period were also analyzed.ResultsOne nurse quit work due to anxiety regarding re-infection with COVID-19. The median period to RTW from the diagnosis was 14.0 (12.0–17.0) days. Motivation to keep on working was slightly reduced, and the EQ-VAS was 75.0 (65.0–83.6). There were no significant differences in QOL and motivation between male and female HCWs, nurses and other HCWs, treatment and non-treatment group, and supplemental and non-supplemental oxygen group. The most frequent persistent symptoms at 1,3 and 6 months after infection were anosmia followed by fatigue.ConclusionAlthough QOL and motivation to keep on working were slightly reduced, only one HCW quit work. No severe persistent symptoms were observed, and the RTW period was relatively short.     

新冠肺炎疫情期间某中医院一线驻场护士心理状况调查及干预对策分析

目的 了解Delta新冠疫情突发期间,一线驻场护理人员的心理状况,并提供相应干预对策。 方法 采用横断面调查,使用广泛性焦虑量表(GAD-7)和心理健康自评问卷(SRQ-20)对某三甲中医院外派驻场护士进行调查,并根据结果,选择部分人员进行远程视频访谈。 结果 外派护理人员出现心理应激反应者达15.64%,出现焦虑反应者达38.55%;护士工作年限与焦虑、应激反应的发生率差异均具有统计学意义(p＜0.05),其中工作5年以上人员焦虑和应激反应发生率高于工作5年护士。 结论 支援抗疫一线的驻场护理人员可出现焦虑和应激反应,且工作5年以上人员发生率更高。管理者需给予护理人员个性化心理辅导与支持,保障抗疫工作的顺利完成。