At present, coronavirus disease 2019 has become the most serious public health emergency in the world. The disease is still spreading around the world. The disease progresses rapidly and is highly contagious, causing great harm to the public health security of the world. Based on the research evidence published at home and abroad, this article systematically summarizes the biological structure of severe acute respiratory syndrome coronavirus 2, and the pathogenesis, transmission routes and susceptible populations, clinical features and treatment methods of coronavirus disease 2019. It aims to help medical workers understand coronavirus disease 2019 in order to better diagnose and treat the disease, and provide references for future research.
ObjectiveTo analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
Targeted initiatives of West China Hospital of Sichuan University to cope with coronavirus disease 2019 epidemic in three stages were summarized, including “three reconstructions” to mobilize in pre-epidemic stage, “three earlies” strategy to precisely treat critically ill patients in epidemic stage, and “three orderlies” to resume hospital operation in post-epidemic stage. The development of comprehensive hospitals in China after the epidemic was also discussed. It’s recommended to continuously strengthen the role of emergency response, early warning, comprehensive treatment, high-level talent training, international exchange, regional leadership, and collaborative innovation, in response to the shortcomings exposed in the epidemic.
Coronavirus disease 2019 has been widespread in Hubei province since the beginning of 2020. Many medical teams went to aid Hubei from the whole country. The medical team of West China Hospital of Sichuan University arrived in Jianghan district of Wuhan on January 25, 2020. As one of the earliest teams arriving Hubei, we explored the measures for infection prevention and control of resident, in order to reduce the risk for infection of medical team. The infection prevention and control experiences on the establishment of infection control team, process management, behavior management, clean disinfection, infection monitoring and emergency response and emergency response to exposure of the medical team of West China Hospital were summarized in this article.
ObjectiveTo compile the information overload severity scale in the situation of coronavirus disease 2019 epidemic, and evaluate the reliability and validity.MethodsFrom February to March 2020, according to the procedures of literature analysis, semi-structured interview, and expert consultation, an initial scale was formed; and then the online scale was measured, and the scale items were screened based on the measured results of the scale. The reliability was evaluated by Cronbach’s α coefficient, and the validity was tested by exploratory factor analysis.ResultsThere were 8 items in the initial scale. The scale items were screened based on the degree of dispersion, the correlation coefficient with the total score, and the factor-load-related indicators, and finally a 7-item scale was formed. The factor analysis results of the scale showed that one component could be extracted from the scale, and the reliability analysis showed that the total Cronbach’s α coefficient of the scale was 0.863.ConclusionThe information overload severity scale has good reliability and validity, which can provide strong support for related research after the outbreak of coronavirus disease 2019 and other major public events.
In December 2019, an outbreak of pneumonia associated with the coronavirus disease 2019 (COVID-19) occurred in Wuhan, China. The lung imaging finding is like that of the lung cancer immune checkpoint inhibitors (ICI) associated pneumonia. Therefore, we speculated that they may have similar pathogenesis and treatment strategies, which is reviewed in this article in order to provide some reference to timely and effectively reduce the fatality rate of COVID-19.
ObjectiveTo explore the application effect of the new in-hospital blood glucose management model for patients with stroke and diabetes mellitus during the epidemic of coronavirus disease 2019.MethodsA total of 120 patients with stroke and diabetes mellitus who were admitted to Mianyang Central Hospital and were consulted by the Department of Endocrinology between October 1st 2019 and April 12th 2020 were recruited. Patients who used the traditional consultation model for blood glucose management between October 1st 2019 and January 19th 2020 were classified as the control group (60 cases). Patients who were managed by the virtual ward of remote blood glucose management combined with the video consultation mode between January 20th 2020 and April 12th 2020 were classified as the observation group (60 cases). The basic conditions, the time to reach target blood glucose, the completion time of the consultation, the accuracy of blood glucose related data, the satisfaction rate of the consultation, the rate of reaching target blood glucose, the incidence of hypoglycemia, the blood glucose fluctuation (standard deviation of blood glucose level, maximum blood glucose fluctuation range), the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, and average hospitalization expenses of the two groups were compared.ResultsThere was no significant difference in the basic conditions between the two groups of patients (P>0.05). The time to reach target blood glucose [(5.38±2.16) vs. (8.18±2.63) d], completion time ofthe consultation [(4.33±1.51) vs. (17.97±3.23) h], incidence of hypoglycemia (6.67% vs. 21.67%), standard deviation of blood glucose level [(2.16±0.34) vs. (2.52±0.34) mmol/L] and maximum blood glucose fluctuation range [(5.72±1.36) vs. (6.34±1.51) mmol/L] of the observation group were lower than those of the control group, the accuracy rate of blood glucose related data (100.00% vs. 83.33%), satisfaction rate of the consultation (93.33% vs. 73.33%) and rate of reaching target blood glucose (88.33% vs. 70.00%) of the observation group were higher than those of the control group, and the differences were statistically significant (P<0.05). There was no significant difference in the incidence of nosocomial infections, diabetes mellitus diagnosis and treatment related expenses, or average hospitalization expenses between the two groups of patients (P>0.05).ConclusionDuring the epidemic of coronavirus disease 2019, the combined video consultation model of remote blood glucose virtual ward for patients with stroke and diabetes mellitus has a good application effect, which has certain feasibility and clinical promotion value.
ObjectiveTo analyze the epidemiological and clinical characteristics of severe cases of coronavirus disease 2019 (COVID-19) in order to provide reference for clinical diagnosis and treatment.MethodThe epidemiological histories, clinical characteristics, laboratory examinations, chest images, and treatment outcomes of 20 confirmed cases of severe COVID-19 admitted to Public Health Clinical Center of Chengdu from January 16th to February 5th, 2020 were retrospectively analyzed.ResultsAmong the 20 patients with severe COVID-19, 12 were male and 8 were female. The age ranged from 34 to 84 years old, with an average of (57.4±16.5) years old. Thirteen patients (65.0%) had one or more co-existing diseases, such as hypertension (9 cases), diabetes (6 cases), and coronary atherosclerotic heart disease (4 cases). Eleven cases (55.0%) had a history of living or traveling in Wuhan, 4 cases (20.0%) had a history of living in non-Wuhan areas of Hubei Province, 3 cases (15.0%) had a history of contact with confirmed COVID-19 patients, while 2 cases had no above-mentioned epidemiological history, but had a history of traveling in non-epidemic areas. The main symptoms were fever (100.0%), cough (100.0%), shortness of breath (75.0%), and fatigue (65.0). Some patients developed into acute respiratory distress syndrome in 3-10 d after onset. The white blood cell count of the patients was normal or decreased, the hypersensitive C-reactive protein and serum amyloid protein significantly increased, while the CD4+ T lymphocyte count and CD56+ natural killer cell count significantly decreased. Sixteen patients (80.0%) were given transnasal hyperbaric oxygenation [among whom 6 patients (30.0%) were transferred to non-invasive ventilator after no improvement], 3 patients (15.0%) were given tracheal intubated ventilator, and 1 patient (5.0%) was treated by tracheal intubated ventilator combined with extracorporeal membrane oxygenation to support breathing. By April 8th, 2020, 3 patients died and the remaining 17 had been cured and discharged, with an average length of hospital stay of 21.4 d. The 3 death cases were all elderly with underlying diseases such as heart disease and pulmonary disease.ConclusionsSevere COVID-19 is associated with hypertension, diabetes, heart disease, and other basic diseases, and some patients develope acute respiratory distress syndrome. Respiratory support may help to improve prognosis.
ObjectiveTo explore the effects of corticosteroid on peripheral blood T lymphocyte subsets in patients with coronavirus disease 2019 (COVID-19).MethodsThis was a retrospective study and 376 patients were included in the study. The patients were classified into three type: moderate type (118 patients), severe type (215 patients), critical type (43 patients). Six critical patients died. T lymphocyte subsets were analyzed and compared among these patients. In severe patients, T lymphocyte subsets were compared between no corticosteroid therapy patients (178 patients) and patients who were treated with corticosteroid for 3 to 5 days (37 patients).Results(1) In contrast with those in moderate patients, in severe patients total lymphocytes [(1359.2±597.9)×106 vs. (1703.7±702.4)×106/L, LSD-t=4.786, P<0.001], total T lymphocytes [(949.2±454.0)×106 vs. (1235.5±555.7)×106/L, LSD-t=5.175, P<0.001] and CD8+ T cells [(336.8±189.8)×106 vs. (461.7±242.8)×106/L, LSD-t=5.332, P<0.001] decreased significantly, and CD4+/CD8+ ratio (1.81±0.92 vs. 1.64±0.74, LSD-t=1.574, P=0.116) was increased. In contrast with those in severe patients, in critical patients CD4+/CD8+ ratio (2.23±1.24 vs. 1.81±0.92, LSD-t=2.627, P=0.009) increased and CD8+ T cells [(232.5±159.8)×106/L vs. (336.8±189.8)×106/L, LSD-t=2.867, P=0.004] decreased significantly, total lymphocytes [(1161.1±583.7)×106/L vs. (1359.2±597.9)×106/L, LSD-t=1.772, P=0.077], total T lymphocytes [(790.5±419.3)×106/L vs. (949.2±454.0)×106/L, LSD-t=1.846, P=0.066] also decreased but without significant difference. There was no significant difference between dead and survived critical patients. (2) In severe type, in contrast with no corticosteroid therapy patients, 37 patients were therapy with corticosteroid for 3 to 5 days, and their total T lymphocytes [(770.6±480.3)×106 vs. (986.3±440.7)×106/L, t=2.666, P=0.008] and CD4+/CD8+ ratio (1.30±0.73 vs. 1.91±0.92, t=3.771, P<0.001) were decreased significantly.ConclusionsIn COVID-19 patients, lymphocytes, T lymphocytes and CD8+ T cells are decreased, but CD4+/CD8+ ratio is increased, and these changes are positively related to the severity of the disease. After corticosteroid therapy, the increase of CD4+/CD8+ ratio is relieved, but T lymphocytes are decreased further.
Since January 2020, due to the epidemic of coronavirus disease 2019, all universities in China have postponed their studies or even suspend their studies. In response to the teaching policy of “suspending class, but keeping teaching and learning” , college teachers have rapidly changed into online teaching mode. However, how to ensure the quality and effect of online teaching still needs further exploration. Through analyzing the course characteristics of medical imaging diagnostics and students’ learning situations, this study discusses how to design detailed online teaching projects and improve the teaching quality and how to select online software suitable for the course. A questionnaire survey was conducted to evaluate the effect of online teaching during the spring course in 2020, selecting a total of 297 clinical and other undergraduate students of grade 2017 from West China School of Medicine of Sichuan University. The results showed that the detailed online teaching programs including “video learning” “distance teaching” “periodic examination” “weakness tutorial” were helpful to the learning process agreed by the majority of students. During the epidemic period, online teaching method can help students master the content of medical imaging diagnosis. In the era of Internet, the “online+offline” teaching mode is expected to be popularized in the future.