An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study

BackgroundSince the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll.ObjectiveThe aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan.MethodsA retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020).ResultsAntibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%).ConclusionsGuidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19.     

不同方法预防儿童第一恒磨牙龋坏的效果评价

采用窝沟封闭、氟凝胶、含氟泡沫、口腔卫生宣教(OHI)对泉州市二年级儿童(7~8岁)第一恒磨牙龋坏的预防效果进行评价,尝试寻找最适合群体儿童的第一恒磨牙龋坏预防方法。方法 2017年采用整群随机抽样的方法在泉州市区选取5所学校的二年级儿童1 768名,检查第一恒磨牙萌出情况及患龋情况,分为5组,分别为空白对照组(n=313)、口腔卫生宣教组(n=421)、氟保护漆组(n=267)、含氟泡沫组(n=438)、窝沟封闭组(n=329),观察两年后五组学生防龋效果。结果 五所小学共有1 748名儿童完成两年的观察研究,随访率为98.87%。干预两年后,氟保护漆组新增龋均及龋面均高于其他四组,窝沟封闭组新增龋均及龋面均低于其他四组,差异有统计学意义(P<0.05)。 结论 4种预防方法对7~8岁儿童第一恒磨牙防龋效果不同,窝沟封闭对龋齿预防效果最好。     

孕早期外周血中lnc-C17orf64-1:1对子痫前期的预测价值

目的 探究孕早期孕妇外周血中lnc-C17orf64-1∶1的表达及其在子痫前期发病中的预测价值。方法 选择2018年9月至2019年9月于上海交通大学医学院附属国际和平妇幼保健院就诊分娩的孕妇,留取其孕早期(11~13周)外周血样本。根据妊娠结局是否为子痫前期分组:正常孕妇29例为对照组,子痫前期孕妇20例为子痫前期组。收集孕产妇相关临床资料,采用实时荧光定量PCR(qRT-PCR)检测孕早期外周血中lnc-C17orf64-1∶1的表达水平(ΔCT值),分析其与病情相关临床指标的相关性,并通过受试者工作特征(receiver operating characteristi, ROC)曲线分析其预测价值。结果 子痫前期组孕妇孕早期外周血中lnc-C17orf64-1∶1表达升高(ΔCT值降低);ROC曲线分析发现孕早期外周血lnc-C17orf64-1∶1预测子痫前期发病的曲线下面积(area under the curve, AUC)为0.9172(95%置信区间:0.8445-0.9899),敏感度80.00%,特异度86.21%,最大约登指数0.6621,最佳截断点13.71(ΔCT值),阳性预测值80.00%,阴性预测值86.21%;Spearman相关性分析发现孕早期外周血lnc-C17orf64-1∶1的ΔCT值与收缩压及舒张压均呈负相关。结论 孕早期外周血lnc-C17orf64-1∶1高表达与子痫前期密切相关,且对子痫前期早期诊断有一定预测价值。     

《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》解读

药物流产(MA)是早孕期避孕失败的补救措施,主要药物为米非司酮和米索前列醇,二者联合使用,可使早孕期孕妇完全终止妊娠率达到90%。但是,MA导致的患者阴道流血时间长、量多,甚至阴道大流血,而需采取急诊刮宫术治疗等,尚未被彻底解决。如何安全、有效终止早孕期妊娠,保护女性生殖健康是目前国内外该领域的研究重点。美国妇产科医师学学会(ACOG)发布的《2020 ACOG实践简报:孕龄≤70 d药物流产(No.225)》对早孕期孕妇终止妊娠,具有重要指导作用。笔者拟就该简报对MA用于孕龄≤70 d孕妇的临床效果评估,MA用药方案、禁忌证、适应证,MA前咨询和检查,MA疼痛管理,MA后观察、预防性抗菌药物使用、随访管理、避孕措施9个方面基于循证医学推荐进行解读。     

皮肤撕脱伤39例Ⅰ期治愈分析

目的 总结皮肤撕脱伤修复后Ⅰ期愈合的治疗效果。方法 早期彻底创面清创,清除所有失去活力的皮肤组织、异物、积血和死腔;根据创面部位、受伤程度选择缝合、皮片、皮瓣移位等不同修复方法修复;早期足量的抗生素应用。结果 1例失败38例成活。Ⅰ期愈合率达97.5%,术后效果满意。结论 本组治疗方法治疗时间短致残率低,Ⅰ期愈合率高,效果满意。     

灌洗法一期叻除吻合术在左侧梗阻性结肠癌中的应用

目的：探讨左半结肠癌并梗阻一期切除吻合的可行性。方法：术中灌洗肠内容物,术后吻合口减压。结果：1995年至1999年所遇左侧梗阻性大肠癌中选择5例用此方法吻合成功。结论：左侧梗阻性大肠癌,只要掌握好手术指针。术中充分灌洗肠内容物,术后扩肛可一期切除吻合。     

首发甲状腺癌病人认知功能特征及影响因素研究

目的 了解首发甲状腺癌病人认知功能水平,探讨影响其认知功能的相关因素。方法 选取2020年6~12月安徽医科大学第一附属医院耳鼻咽喉头颈外科147例住院的首发甲状腺癌病人为观察组（甲状腺癌组）,同期选取在该医院进行健康体检的147名健康人群为对照组,采用一般情况调查表、长沙版蒙特利尔认知评估量表及匹兹堡睡眠质量指数量表进行调查。结果 首发甲状腺癌病人认知功能损害的发生率为53.1%,除命名功能得分两组比较差异无统计学意义外,甲状腺癌组在视空间或执行功能、注意、语言、抽象、延迟记忆、定向领域得分及认知功能总分均低于对照组（P<0.05）。不同年龄、受教育程度、婚姻状况、睡眠状况、癌症分期的甲状腺癌病人认知功能损害发生率差异均有统计学意义（P<0.05）。二元Logistic回归分析显示,高龄、睡眠障碍、癌症分期是甲状腺癌病人认知功能损害的危险因素,高文化程度是甲状腺癌病人认知功能损害的保护因素,P均<0.05。结论 首发甲状腺癌病人认知功能损害发生率较高,年龄、睡眠状况、癌症分期、受教育程度是甲状腺癌病人认知功能损害的影响因素。     

Functional paraganglioma with tumor thrombus in the inferior vena cava,first case report

Pheochromocytoma (PHEO) is a rare neuroendocrine that tumor originated from the adrenal medulla that secrets catecholamines. Tumors from extra-adrenal chromaffin tissues are called extra-adrenal PHEO or paraganglioma (PGL). To our knowledge, adrenal PHEO and subclinical PGL with inferior vena cava (IVC) invasion had been sporadically reported, while functional PGL with IVC tumor thrombus has not been publicly reported yet. Perioperative management of those diseases is less well established because of their multidisciplinary nature and rarity. We herein present a case of primary malignant PGL with IVC invasion. A 16-year-old female patient with a history of severe paroxysmal hypertension was admitted to Peking Union Medical College Hospital on suspicion of retroperitoneal mass. In-house diagnostic work-up revealed a malignant PGL with IVC invasion, inferior mesenteric artery encasement and, aorta engagement. Multi-disciplinary discussions were held and careful preoperative preparation plans were made. After everything was ready, the functional PGL and tumor thrombus were completely resected, then a reconstruction of IVC was performed. The patient was discharged on postoperative day 14 and all her clinical symptoms disappeared afterward. No evidence of tumor residual or metastasis was found in the subsequent six months of follow-up. Gene tests were made for her and her family. Albeit its rarity, functional PGL with IVC invasion is not unresectable, a multi-disciplinary task force should be established to settle down every detail. We recommended 3-dimensional imaging reconstruction for gaining a better anatomic understanding. Literature reviews showed that complete resection is the premise of a good prognosis. In particular cases, complementary or alternative therapy like chemotherapy and ¹³¹I-metaiodobenzylguanidine might help, family hereditary genetic tests are advised as well.     

第一趾蹼皮瓣修复虎口挛缩

目的：探讨吻合血管的第一趾蹼皮瓣修复虎口挛缩的方法和疗效。方法：供区为第一趾蹼皮瓣,将皮瓣所携带的第一跖背动脉、大隐静及犀利腓深神经分别与受区桡动脉腕背支,头静脉及桡神经浅支吻合。结果：本组32例皮瓣全部成活,经1.0-3.5年随访,第一趾蹼游离皮瓣能满足保留虎口深度、展开度、良好感觉和美观外形的要求,临床效果较好。结论：第一趾蹼皮瓣与虎口皮肤组织结构伯厚薄及功用方面相似,是再造虎口的理想组织皮瓣。     

精神分裂症及其健康一级亲属全血11种微量元素的测定与分析

目的：探讨精神分裂症患者及其健康一级亲属全血微量元素含量与精神分裂症之间的关系。方法：采用等离子发光法测定了６６例精神分裂症病人、２４例精神分裂症患者的健康一级亲属、５０例正常对照３组人群全血１１种微量元素的含量。结果：精神分裂症病人 Ａｌ、 Ｃｕ、 Ｚｎ、 Ｂａ、 Ｃｒ 的含量显著低于正常对照组（ Ｐ＜ ００５）, Ｆｅ、 Ｍ ｇ、 Ｂ 含量显著高于对照组（ Ｐ＜ ００５）,一级亲属组 Ｆｅ、 Ｍ ｇ、 Ｂ含量显著高于对照组（ Ｐ＜ ００５）,同时 Ｃｕ、 Ｃａ、 Ｂａ 低于对照组（ Ｐ＜ ００５）;精神分裂症患者与其健康一级亲属相比微量元素含量无明显差异（ Ｐ＞ ００５）。结论：微量元素的代谢异常可能是精神分裂症病理过程的表现,同时遗传因素在精神分裂症的发病过程中有一定作用。