新型冠状病毒肺炎与甲状腺疾病

自新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)疫情暴发以来, 出现了若干COVID-19相关甲状腺疾病的报道, 包括亚急性甲状腺炎、自身免疫性甲状腺疾病、非甲状腺疾病综合征以及原因未明的甲状腺功能异常。本综述旨在对COVID-19相关甲状腺疾病的临床特点进行总结, 并探究可能的发生机制。     

新型冠状病毒IgM/IgG抗体在病程监测中的临床意义

目的评价新型冠状病毒(SARS-CoV-2)IgM/IgG抗体检测(化学发光法)在新型冠状病毒肺炎(COVID-19)病程监测和转归方面的临床意义。方法回顾性研究。收集2020年1月20日至2020年3月1日在天津市疾病预防控制中心核酸检测阳性的COVID-19确诊患者88例(115例血清样本)作为疾病组,排除COVID-19(核酸检测阴性)的其他疾病患者245例(245例血清样本)作为对照组。用化学发光法检测SARS-CoV-2 IgM和IgG抗体。结果 SARS-CoV-2 IgM抗体检测的敏感性、特异性分别为90.91%、100%;SARS-CoV-2 IgG抗体检测的敏感性、特异性分别为88.64%、100%;IgM和IgG抗体联合检测敏感性显著提高至96.59%,特异性为100%,与核酸检测的总符合率高达99.10%。SARS-CoV-2 IgM抗体水平在COVID-19病程中呈现先升高后降低的趋势,IgG抗体水平随着病程的进展逐渐升高。结论 SARS-CoV-2 IgM和IgG抗体化学发光法联合检测敏感性高,可作为COVID-19一种有效的辅助诊断,在病程监测和转归方面有一定的意义。     

结核病对2019冠状病毒病患者病情和病毒核酸转阴影响的初步分析

目的通过比较2019冠状病毒病(COVID-19)患者合并与不合并结核病两组的临床特征、实验室检查结果及病毒核酸转阴时间,明确结核病是否会加重COVID-19患者病情和延长病毒核酸转阴时间。方法收集2020年10月—2021年1月青岛市明确诊断为COVID-19感染患者的人口学特征和临床变量。按COVID-19患者是否合并结核病进行分组,比较两组患者的人口学特征、实验室检查结果及核酸转阴时间等临床变量,分析结核病对COVID-19患者病情和核酸转阴的影响。结果共纳入COVID-19患者42例,其中合并结核病患者共8例。COVID-19患者合并结核病所占比例较合并高血压、糖尿病等慢性基础疾病高(19.0%对16.7%对14.3%)。所有患者中常见的症状为咳嗽(33.3%)和发热(28.6%),且咳嗽和发热在COVID-19合并结核病组患者中更常见,差异均具有统计学意义(P<0.05)。COVID-19合并结核病组的淋巴细胞计数、辅助T细胞数(CD3、CD4)及CD4/CD8均较COVID-19组低,差异均具有统计学意义(P<0.05)。重症患者在COVID-19合并结核病组中所占比率(27.5%)明显高于无结核病组(2.9%),且差异具有统计学意义(P<0.05)。COVID-19合并结核病患者的核酸转阴时间比无结核病患者明显延长(23.5 d对16.5 d),差异具有统计学意义(P<0.05)。结论结核病加重了COVID-19患者病情,延长了患者核酸转阴时间。因此,在COVID-19大流行时期应加强对COVID-19患者结核感染的筛查,加强对结核病患者的管理和治疗。     

新型冠状病毒肺炎临床实验室相关检测现状

正近来,由新型冠状病毒(SARS-CoV-2)引起的新型冠状病毒肺炎(COVID-19)仍全球持续蔓延,形势极其严峻,影响不容小觑~([1-3])。对COVID-19的实验室相关检测已有了诸多报道,已知COVID-19患者发病早期外周血白细胞总数正常或减低,淋巴细胞计数减少,部分患者出现肌酸激酶(CK)、乳酸脱氢酶     

中医药防治新型冠状病毒感染的研究进展

严重急性呼吸系统综合征冠状病毒2 (SARS-COV-2)引发的新型冠状病毒感染(COVID-19)自2019年底暴发以来,已致全球数亿人感染和数百万人死亡。SARS-COV-2极易快速突变导致疫苗失效。药物治疗是目前防治COVID-19的有效手段,针对疾病临床特征辨证施治的中医药疗法在中国疫情防治中发挥了极其重要的作用。鉴于此,笔者依据中国中医药防治COVID-19的临床经验,对临床用于治疗COVID-19的清热药、解表药、芳香化湿药和补虚药等方药特点及其多途径、多靶点发挥综合治疗COVID-19作用的药效机制进行综述,以期为临床随症组方治疗此类疾病提供参考。     

新型冠状病毒肺炎普通型患者血清淀粉样蛋白A水平变化特点及其临床意义

目的:观察新型冠状病毒感染的肺炎(COVID-19)普通型患者血清淀粉样蛋白A(SAA)水平变化特点并探讨其临床意义.方法:选取2020年1月29日～2月13日期间就诊于合肥市第二人民医院隔离病区的26例COVID-19普通型患者,通过院内电子病例系统记录其入、出院时炎症标志物包括白细胞数(WBC)及其分类计数、C反应...     

北京市海淀区新型冠状病毒肺炎患者及其家庭成员呼吸道病原谱研究

目的 分析北京市海淀区新型冠状病毒肺炎(COVID-19)患者及其家庭成员中常见呼吸道病原体的流行情况,比较混合感染患者与只感染新型冠状病毒(SARS-CoV-2)患者的疾病严重程度差异.方法 使用多重荧光定量PCR方法对2020年1-6月北京市海淀区疾病预防控制中心检测的所有COVID-19患者及其家庭成员同期采集的...     

2020年湖北省荆州市新型冠状病毒肺炎疫情流行特征分析

目的 探讨湖北省荆州市新型冠状病毒肺炎(COVID-19)确诊病例流行病学特征,为今后类似疫情防控提供科学依据.方法 通过中国疾病预防控制信息系统收集2020年荆州市COVID-19病例资料,描述病例的流行病学特征.结果 2020年荆州市累计报告COVID-19病例1 550例,重症病例占22.71％(352/1 55...     

2例新型冠状病毒肺炎粪便SARS-CoV-2核酸阳性临床启示

目前中国新型冠状病毒肺炎(COVID-19)疫情仍十分严峻,及时、早期地识别COVID-19患者是控制疫情的关键步骤。而新型冠状病毒(SARS-CoV-2)核酸检测作为诊断COVID-19的金标准,不但对检测技术提出更高的要求,同时对不同病程患者如何选择标本类型也是一个挑战。本文报道2例COVID-19确诊病例的诊疗经过,并分析采用不同类型标本检测SARS-CoV-2核酸的检出情况,为临床诊断COVID-19时如何选择标本类型和如何提高核酸检出率提供参考。     

细胞因子在评估新型冠状病毒肺炎患者疾病严重程度及预后中的价值

目的 研究细胞因子在评估新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者疾病严重程度及预后中的价值.方法 回顾性分析武汉市雷神山医院205例COVID-19患者资料,根据疾病严重程度分为普通型组(n=117)、重型组(n=69)和危重型组(n=19).收集患者的基本情况和细胞因子相关参数,比较3组间差异并分析其在评估COVID-19患者疾病严重程度及预后中的价值.结果 3组患者的年龄、新型冠状病毒核酸检测结果、白细胞介素(interleukin,IL)-6、IL-10、IL-2受体、IL-8、肿瘤坏死因子-α差异有统计学意义(P＜0.05).相关性分析显示,年龄、新型冠状病毒核酸检测结果持续20 d阳性、IL-6水平、IL-10水平、IL-2受体水平、IL-8水平、肿瘤坏死因子-α水平与COVID-19分型具有相关性(相关系数rs分别为0.354、0.187、0.366、0.327、0.329、0.273、0.157,P＜0.05).死亡COVID-19患者的IL-6、IL-10、IL-2受体、IL-8、肿瘤坏死因子-α水平高于存活患者(P＜0.05).多因素分析显示,年龄[比值比(odds ratio,OR) =1.034,95％置信区间(confidence interval,CI) (1.006,1.063),P=0.016]、IL-6水平[OR=1.030,95％CI (1.006,1.055),P=0.015]、IL-10水平[OR=1.088,95％CI(1.003,1.179),P=0.042]和IL-2受体水平[OR=1.003,95％CI (1.001,1.005),P=0.001]是普通型COVID-19患者转成重型/危重型的独立风险因素.结论 COVID-19患者体内的细胞因子水平与疾病的严重程度及预后密切相关.     

非器质性睡眠障碍的ICD疾病分类编码

本文探讨了非器质性睡眠障碍编码的ICD疾病分类编码,提出了提升编码质量的重要性。编码人员需认真查阅病案信息,编码过程中遇到问题及时与临床医师进行沟通,深入剖析产生睡眠障碍的病因,结合患者的病情,按ICD-10的编码规则,对非器质性睡眠障碍进行疾病区分和分类编码,结合患者的临床表现、病因等进行准确地疾病分类编码,保证病案首页信息以及分值付费的准确性,此外,本文还提出了非器质性睡眠障碍的ICD疾病分类编码的修改建议,旨在为ICD准确编码提供参考依据。     

Comparison and validity of procedures coded With ICD-9-CM and ICD-10-CA/CCI

BACKGROUND: The use of health administrative data in health services research is facilitated by standardized classification systems, such as the International Classification of Diseases (ICD). Canada, among other countries, recently introduced the tenth version of ICD and its accompanying Canadian Classification of Interventions (CCI). It is imperative to assess errors that could occur in administrative data due to the introduction of the new coding system. OBJECTIVE: To evaluate the validity of procedure coding in hospital discharge data, comparing CCI with ICD-9-CM. RESEARCH DESIGN: Trained reviewers examined 4008 randomly selected charts from 4 teaching hospitals in Alberta, Canada, for the presence of 30 procedures. The charts, already coded using CCI, were recoded using ICD-9-CM. Comprehensive lists of procedure codes in both systems were identified using literature, health records technicians, surgeons and online resources. MEASURES: Three databases were created for the same hospital discharge record, including CCI, ICD-9-CM, and chart review data. Sensitivity, specificity, positive predictive value, negative predictive value and kappa scores were calculated. RESULTS: Compared with the chart review data, ICD-9-CM data under-reported 17 procedures, over-reported 12, and equivalently reported 1. CCI data under-reported 19 procedures, over-reported 9, and equivalently reported 2. Kappa value was within 0.1 difference between ICD-9-CM and CCI for 14 procedures. CONCLUSIONS: Both ICD-9-CM and CCI coded the more major or invasive procedures reasonably well, but were not valid for less invasive or minor procedures. CCI can be used by health services and population health researchers with as much confidence as ICD-9-CM.     

The implementation of ICD-10 in Germany - tools and information on the Internet

ICD-10 was implemented for morbidity coding in Germany in January 2000. The electronic versions of ICD-10 are introduced. For everyday work with the classification and for epidemiological research further tools are provided by DIMDI: ICD-10 meta files, ICD conversion tables, ICD-10 thesaurus of diagnostic terms. All files are available free of charge via the INTERNET.     

Utility of Point-of-Care Lung Ultrasound for Clinical Classification of COVID-19

In this study, the utility of point-of-care lung ultrasound for clinical classification of coronavirus disease (COVID-19) was prospectively assessed. Twenty-seven adult patients with COVID-19 underwent bedside lung ultrasonography (LUS) examinations three times each within the first 2 wk of admission to the isolation ward. We divided the 81 exams into three groups (moderate, severe and critically ill). Lung scores were calculated as the sum of points. A rank sum test and bivariate correlation analysis were carried out to determine the correlation between LUS on admission and clinical classification of COVID-19. There were dramatic differences in LUS (p < 0.001) among the three groups, and LUS scores (r = 0.754) correlated positively with clinical severity (p < 0.01). In addition, moderate, severe and critically ill patients were more likely to have low (≤9), medium (9–15) and high scores (≥15), respectively. This study provides stratification criteria of LUS scores to assist in quantitatively evaluating COVID-19 patients.     

PS1-43: ICD9 to ICD10 Migration and Impact to Reporting

Background/Aims The International Classification of Diseases (ICD) is a classification system developed and maintained by the World Health Organization. The 10th revision of ICD (ICD-10) was created in 1994. The U.S. is the only industrialized nation still using ICD-9. On January 16, 2009, the Department of Health and Human Services released the Final HIPAA Administrative Mandate to Adopt ICD-10. The compliance date for implementation of the ICD-10 Coding System is October 1, 2013. Complying with new federal regulations to implement ICD-10 by October 1, 2013 will have an enormous impact on the people, processes, and technology throughout KP and other Health Care Organizations. ICD-9 is running out f codes. Hundreds of new diagnosis codes are submitted annually. ICD-10 will allow not only for more codes, but also for greater specificity and thus better epidemiological tracking. How will this change impact data? Where do analysts find the new codes and what process should they follow to get ready for this conversion. What Clarity tables and columns will carry the new codes and how should the mapping be done? This presentation will provide tools for the programmers and guide them to make this conversion less painful.     

Limitations of Tachycardia Confirmation and Rate Classification Algorithms in a Third-Generation Implantable Cardioverter Defibrillator

Newer ICDs provide antitachycardia (ATP) and bradycardia pacing and cardioversion and defibrillaiion shocks based on sensed interval criteria. The objectives of this investigation were to determine the algorithm related errors in tachycardia confirmation and rate classification that occurred in patients with a third-generation, noncommitted, tiered ICD therapy. Forty-three consecutive patients with the Guardian ATP 4210 ICD, which uses an X out of Y sensed interval counting algorithm for tachycardia detection, confirmation, and classification were studied. Surface ECGs, intracardiac electrograms, stored data logs, and sense histories were reviewed to diagnose errors due to these algorithms that resulted in delivery of inappropriate therapy or inhibition of appropriate therapy. Sixty-eight classification or confirmation algorithm errors from 7,610 tachycardia detections (< 1 %) were diagnosed in 23 (53%) of 43 patients. Three types of errors not related to device or sensing lead malfunction or programming mistakes were seen. In 26 episodes, the confirmation algorithm failed to detect late tachycardia reversion of nonsustained tachyarrhythmias, on the last or next to last sensed interval, and did not inhibit ATP (n = 17) or shocks (n = 9). In 28 episodes, inaccurate classification of tachycardia rate resulted in inappropriate ATP (n = 23) or shock (n = 5) therapy. In 14 episodes, the posttherapy reconfirmation algorithm produced inhibition of VVI pacing and prolonged asystole following shock therapy. These errors in tachycardia confirmation and rate classification were due to the inherent limitations of the X out of Y counting algorithm.     

The concept of mood disorder in ICD-10

The classification of 'Manic-depressive illness(MDI)' has been changing in this several years greatly. MDI is recently named as a 'mood(affective) disorder' according to the ICD and DSM diagnostic system. Since 1990, with ICD-10(WHO), and 1994, with DSM-IV(APA), practitioners have had at their disposal two(practically compatible) classifications of mental disorders containing operational criteria for diagnosis, and helpful in guiding clinical and therapeutic approach. In ICD-10, mood disorder belongs to the F3 category, and there are seven subcategories which were divided in to subclasses. The two other subclasses of 'F06.3 organic mood disorder' 'F41.2 mixed anxiety and depressive disorders' were set up additionally.     

新型冠状病毒相关研究的文献计量学分析——基于Web of Science核心合集

  目的  从文献计量学角度了解新型冠状病毒（以下简称“新冠”）相关文献的研究现状、进展和热点趋势,为构建以新冠文献为基础的细致分类体系提供数据支撑。   方法  以Web of Science平台为数据来源,利用VOSviewer、CiteSpace等工具的分析和可视化功能,检索2020年1月1日至2022年1月5日期间发表的新冠相关的英文文献,对其发表时间、国家、关键词、机构、学科类别等进行分析。  结果  共检索到158413篇新冠相关的英文,高频关键词有Mental health, COVID-19 infection, Risk factors, Health-care, COVID-19 vaccine等,主要呈现5个聚类。 影响力最大的4个研究领域为普通内科学、公共卫生,环境卫生与职业卫生、传染病。 发文量最多的机构为哈佛医学院,发文被引量最多的机构为华中科技大学。 在所有国家中,美国和中国的发文量和被引量、基金资助频次处于领先水平,中国国家自然科学基金委员会对于新冠文献的资助频次最高,排名前10位的基金中有4项来源于中国。  结论  新冠的研究热点从公共卫生领域、临床医学领域逐渐发展到到社会环境、经济、教育和生活等方面,影响逐步扩大。 此外,对于新冠文献研究领域和学科的具体分类需要进一步细化。     

COVID-19患者血浆凝血指标及D-二聚体水平检测对临床分型的鉴别价值

目的　探讨新型冠状病毒肺炎(COVID-19)患者疾病分型中血浆凝血指标及D-二聚体的鉴别价值。方法 　选取2020年1月25日～2月24日在荆州市中心医院诊断为COVID-19的52例患者住院期间检查的101份血凝标本,将样本按采血时患者的疾病分期分为轻症（n=31）和重症（n=70）。应用非配对t检验和受试者工作曲线（ROC 曲线）分析探讨凝血指标以及D-二聚体水平与患者疾病严重程度的关系,其中凝血指标包括活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、凝血酶原时间（PT）和血浆纤维蛋白原（Fg）。结果　101份血凝标本中,重症组凝血指标中的APTT,TT和PT以及D-二聚体水平显著高于轻症组,差异均具有统计学意义（P<0.05）。而Fg含量差异无统计学意义（P>0.05）。APTT,TT,PT,D-二聚体,APTT+TT,APTT+PT和TT+PT的ROC曲线下面积（AUC）分别为0.605,0.749,0.760,0.949,0.764,0.758和0.865。结论　单独D-二聚体、凝血指标联合使用对COVID-19疾病分型有很好的诊断价值,可辅助临床诊疗,进一步推广于临床。