Peripheral lymphocyte subset alteration in patients with COVID-19 having differential clinical manifestations

Background & objectives: The COVID-19 disease profile in Indian patients has been found to be different from the Western world. Changes in lymphocyte compartment have been correlated with disease course, illness severity and clinical outcome. This study was aimed to assess the peripheral lymphocyte phenotype and subset distribution in patients with COVID-19 disease from India with differential clinical manifestations. Methods: Percentages of peripheral lymphocyte subsets were measured by flow cytometry in hospitalized asymptomatic (n=53), mild symptomatic (n=36), moderate and severe (n=30) patients with SARS-CoV-2 infection, recovered individuals (n=40) and uninfected controls (n=56) from Pune, Maharashtra, India. Results: Percentages of CD4+Th cells were significantly high in asymptomatic, mild symptomatic, moderate and severe patients and recovered individuals compared to controls. Percentages of Th memory (CD3+CD4+CD45RO+), Tc memory (CD3+CD8+CD45RO+) and B memory (CD19+CD27+) cells were significantly higher in the recovered group compared to both asymptomatic, mild symptomatic patient and uninfected control groups. NK cell (CD56+CD3-) percentages were comparable among moderate +severe patient and uninfected control groups. Interpretation & conclusions: The observed lower CD4+Th cells in moderate+severe group requiring oxygen support compared to asymptomatic+mild symptomatic group not requiring oxygen support could be indicative of poor prognosis. Higher Th memory, Tc memory and B memory cells in the recovered group compared to mild symptomatic patient groups might be markers of recovery from mild infection; however, it remains to be established if the persistence of any of these cells could be considered as a correlate of protection.

Expert consensus for diagnosis and treatment of coagulation dysfunction in COVID-19 / 解放军医学杂志

Since December 2019, a novel type of coronavirus disease (COVID-19) in Wuhan led to an outbreak throughout the world. To date, there have been more than 1,260,000 COVID-19 patients, with a mortality rate of approximately 5.44%. Studies have shown that coagulation dysfunction is a major cause of death in patients with severe COVID-19. Therefore, the People's Liberation Army Professional Committee of Critical Care Medicine and Chinese Thrombosis and Hemostasis Committee grouped experts from the frontline of the Wuhan epidemic to come together and develop an expert consensus on diagnosis and treatment of coagulation dysfunction associated with severe COVID-19 infection. This consensus includes an overview of COVID-19-related coagulation dysfunction, tests for coagulation, anticoagulation therapy, replacement therapy, supportive therapy and prevention. The consensus produced 18 recommendations which are being used to guide clinical work.

Application of enteral nutrition feeding procedure in severe patients in ICU / 中国实用护理杂志

Objective@#To investigate the effect of enteral nutrition feeding procedure in ICU in severe patients in order to reduce complications and promote rehabilitation of patients.@*Methods@#A total of 184 severe patients admitted to ICU from January to October 2018 were selected as the subjects of the study. 90 patients admitted to the family from January to May were the control group, and 94 patients admitted to the family from June to October were the observation group. The control group adopted routine nutritional support and nursing, and the observation group carried out intensive enteral nutrition feeding process. The nutritional status, immunity, gastrointestinal dysfunction, complications of nosocomial infection and outcome of patients in two groups were compared between the two groups.@*Results@#The nutritional indicators of hemoglobin, serum total protein and serum albumin after a week of treatment were (119.73 ± 9.96), (58.88 ± 2.65), (29.09 ± 1.42) g/L, immunization indicators IgA, IgG, IgM were (2.56±0.10), (2.98±0.36), (1.65±0.15) g/L in the observation group. The control groups were (108.02±9.21), (51.90±2.74), (27.80±1.59), (2.09±0.18), (2.01±0.24), (1.41±0.13)g/L, the difference between the two groups was statistically significant (t=5.81-22.48, P<0.01). The incidence of gastrointestinal dysfunction (gastric retention, diarrhea) in the observation group were 11.70%(11/94), 8.51%(8/94), the incidence of nosocomial infections (ventilator associated pneumonia, catheter related blood stream infection, catheter-associated urinary tract infections) were 6.12‰(5/817), 1.53‰(1/650), 0, the outcome indicators of patients (nutritional standard time, ICU hospitalization time, and mortality rate) were (6.12±1.03) d, (10.98±2.03) d, 13.82%(13/94), all were lower than the control group′s 23.33%(21/90), 20.00%(18/90), 13.06‰(11/842), 11.28‰(8/709), 2.88 ‰(2/694), (7.98 ± 1.54) d, (12.21 ± 1.87) d, 26.67%(24/90), the difference between the two groups was statistically significant (χ2=4.33-8.22, t=6.19, 2.26, P<0.05).@*Conclusions@#The procedure of enteral nutrition feeding in patients with severe illness can effectively reduce enteral nutrition complications and enable patients to obtain effective nutrition early.

Application value of individualized nursing care in intensive care unit patients with mind mapping as a guide / 中国中西医结合急救杂志

Objective To study the therapeutic value of using mind map (MM) as a basis for developing individualized nursing scheme for patients in Intensive Care Unit (ICU). Methods Seventy severe patients admitted to the Department of Transplant ICU of Tianjin First Center Hospital from December 2015 to February 2017 were enrolled, and they were divided into a control group and an observation group by different nursing methods, each group 35 cases. The observation group was treated with individualized nursing based on MM; while the control group followed the doctor's instruction. After nursing, the changes of acute physiology and chronic health evaluationⅡ(APACHEⅡ), predictive mortality, complication situations and quality of life were observed in the two groups. Results After nursing, the APACHE Ⅱ scores and predictive mortalities in the two groups were significantly lower than those before nursing [control group: APACHEⅡ scores was 29.5±7.5 vs. 37.8±9.2, predict of mortality was (40.6±9.9)% vs. (63.1±11.5)%;observation group: APACHEⅡscores was 25.9±6.3 vs. 38.4±9.6, predict of mortality was (33.2±10.8)% vs. (40.6±9.9)%], and in the observation group, after nursing the above indicators were significantly lower than those in the control group [APACHEⅡscores: 25.9±6.3 vs. 29.5±7.5, predictive mortality: (33.2±10.8)% vs. (40.6±9.9)%, both P < 0.05]. The complication rate of the observation group was obviously lower than that of the control group [8.57% (7/35) vs. 20.00% (3/35), P < 0.05]. After intervention, the indexes of life quality such as social function, psychological function, physical function and material life scores in the observation group were all significantly higher than those of the control group (social function scores: 23.1±3.1 vs. 19.0±2.5, psychological function scores: 23.6±5.1 vs. 20.1±5.7, physical function scores: 25.2±3.2 vs. 21.1±3.7, material life scores: 25.8±3.1 vs. 20.1±3.3, all P < 0.05). Conclusion MM can transform complex and tedious nursing information into intuitive content, which may facilitate understanding, effectively reduce the pressure of ICU nursing work, improve nursing efficiency and patients' quality of life, and decrease their mortality.

The effect of daily quality checklist on intensive care unit severe patients with hospital associated infection / 中国中西医结合急救杂志

Objective To investigate the effect of daily quality checklist on intensive care unit (ICU) the incidence of severe patients with hospital associated infection (HAI). Methods A historical control study was conducted. In Tianjin Fifth Center Hospital from June 2016 to May 2017, 286 severe patients with mechanical ventilation (MV) and using ICU daily quality checklist were assigned as the experimental group, and from June 2015 to May 2016, 291 severe patients who did not use the daily quality checklist were selected as the control group. In the control group, the routine treatment, nursing care and ward rounds were the daily ordinary work; in the experimental group, the severe disease ICU quality checklist system was strictly carried out, and every day the doctor and nurse on duty applied the checklist to assess and verify the medical quality given to the patient, including sedation, analgesia, MV, glycemic control, nutrition, etc 16 items. The incidences of ventilation associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), catheter-associated urinary tract infection (CAUTI), 28-day mortality, time of MV and the length of ICU stay were compared between the two groups. Results Compared with the control group, the incidences of VAP, CRBSI and CAUTI of experimental group were obviously decreased (VAP: 1.78‰ vs. 5.09‰, CRBSI: 1.46‰vs. 5.21‰; CAUTI: 1.39‰ vs. 4.41‰, all P ＜ 0.05), the time of MV and the length of ICU stay in experimental group were significantly shorter than those in the control group [the time of MV (days): 7.81±2.74 vs. 10.62±3.67, the length of ICU stay (days): 8.40±1.94 vs. 11.35±2.47, both P ＜ 0.05]; there was a decreasing tendency of 28-day mortality in experimental group compared with that in control group [5.24% (15/286) vs. 6.19% (18/291)], but no statistical significant difference was seen (P ＞ 0.05). Conclusion Implementation of daily quality checklist can effectively decrease the incidence of HAI in ICU patients, reduce the time of MV and the length of ICU stay.

Practice and Experience of Clinical Pharmacist in Participating in the Anti-infective Treatment of Severe Patients in Urology Department / 中国药师

Objective: To investigate the role of clinical pharmacist in the treatment of patients with severe infections in urology department.Methods: An objective analysis of the important roles of clinical pharmacists was carried out by making and adjusting the anti-infective treatment plan of two patients in urology department.Results: During the participation in the treatment of two patients with severe infections in urology department, clinical pharmacists played important roles in the treatment of the diseases through observing the clinical symptoms,analyzing the conditions of the patients and giving the pharmaceutical opinions and suggestions, and finally the infections were controlled successfully.Conclusion: Clinical pharmacists should participate in the therapy strategy adjustment in urology department using their professional knowledge to play important roles in the management of anti-infection strategy for severe patients.

Effect of traditional Chinese herbal packet combined with Zusanli (ST 36) injection therapy on gastrointestinal dysfunction in severe patients / 现代临床护理

Objective To explore the curative effect of traditional Chinese herbal packet combined with ST 36 injection therapy on gastrointestinal dysfunction in severe patients. Methods Sixty severe patients with gastrointestinal dysfunction were randomly divided into the control group and treatment group with random digital number, 30 cases in each group. The control group received conventional care and besides conventional care , the treatment group was treated with traditional Chinese herbal packet combined with ST 36 injection. The two groups were compared 7 days after treatment in terms of scores by (acute physiology and chronic health evaluationⅡ, APACHEⅡ) and improvement of gastrointestinal dysfunction. Result After treatment, the APACHE II score and improvement of gastrointestinal dysfunction of the treatment group were significantly higher and better than those of the control group (P<0.05). Conclusion The traditional Chinese herbal packet combined with ST 36 injection can promote the recovery of gastrointestinal dysfunctional in severe patients.

Comparative analysis of two patients with severe drug resistance of urinary tractnosocomial infection in the department of urology of Enterococcus induced / 国际检验医学杂志

Objective Research of Enterococcus faecalis and Enterococcus faecium to our hospital in patients with severeurinary tract infection status and to compare the resistance ,to provide a basis for clinical rational use of antimicrobial agents .Methods From 2011 January -2014 December in our hospital with severe urinary tract infections in patients with isolated 172 strains of En‐terococcus were analyzed ,with the French bioMerieux ATB microorganism identification instrument identification of Enterococcus , using the disc diffusion method (K‐B) was used in drug sensitivity test ,by using WHONET 5 .6 software test data analysis and processing .Results A total of 172 strains of Enterococcus ,the separation of Enterococcus faecalis and Enterococcus faecium rates were 68 .0% (117 strains) and 32 .0% (55 strains);drug sensitive test showed that two kinds of Enterococcus to Linezolid、vanco‐mycin、Ti Koa Laing、tigecycline are more sensitive (resistance rate < 5% ) ,in addition to these 4 drugs ,for the other 12 kinds of antimicrobial resistance has significant difference (P< 0 .05);there were 5 strains of vancomycin resistant Enterococcus ,the 3 strains of Enterococcus faecalis ,2 strains of Enterococcus faecium ,Nailinai temozolomide of 3 strains of Enterococcus faecalis ,En‐terococcus faecium strain .Conclusion Multi drug resistant Enterococcus isolated from our hospital in patients with severe in urine samples of serious ,there are two kinds of resistance strain differences in Enterococcus ,we should strengthen the monitoring of clini‐cal bacteria ,Linezolid、vancomycin、Ti Koa Laing、tigecycline preferred treatment of Enterococcus infections .

Changes and clinical significance of serum thyroid hormone and TNF-αin severe patients / 局解手术学杂志

Objective To explore the changes of thyroid hormone and TNF-α in severe patients which occurring under critical illness and to explore the interrelation of these endocrine factors in order to direct clinical therapy. Methods Serum thyroid hormone and TNF-αin 102 severe patients and 80 healthy volunteers were detected by radioimmunoassay and enzymoimmunoassay. The results were analyzed and compared with normal subjects,groups of different prognosis,MODS group and no MODS group. Results TT3,FT4,FT3 levels in severe pa-tients were lower than that in normal subjects(P <0. 01),By contrast,TNF-α level were significantly higher than that of control group (P<0. 01). As the situation became worse,the above changes were more obvious in severe patients as compared with normal subjects. For TT3 and TNF-α level,the differences in the early stages of the disease (3 ~7rd) in the survival group and death group were significant (P<0. 05). Compared with non-MODS group,TT3,FT4,FT3 and TNF-α changed significantly in MODS group(P<0. 05). Conclusion TNF-α and thyroid hormone levels play important roles in the severe patients. The changes of TNF-αand thyroid hormone levels can be used for severe patients prediction and treatment.

Application of PBL teaching method in the discussion of severe cardiac patients / 中国实用护理杂志

ObjectiveTo investigate the best pattern of the discussion on nursing cases of severe cardiac patients and improve the quality of the clinical nursing activity.Methods90 nurses from six cardiac units were divided into the control group and the experimental group with 45 nurses in each group. The experimental group adopted PBL teaching method, the control group adopted conventional teaching method. The discussion of severe cardiac patients was proceeded twice every month for one year.Results The experimental group was better than the control group in master and application of the basic cardiac knowledge, nursing quality of serious patients and effectiveness of nurse-patient communication.ConclusionsDiscussion with PBL teaching method is superior to the conventional method. This method can widen the nurses'thread, improve the nurses' ability to solve problem, so it is worthy of wide application.

Study on systemic inflammatory response syndrome score and APACHE Ⅱ score predicting outcome in severe patients of emergency department / 中国医师进修杂志

Objective To study effect and significance of systemic inflammatory response syndrome(SIRS) score and APACHE Ⅱ score in prognosis in severe patients of emergency department.Methods Data of 114 patients were collected at admission.SIRS score and APACHEⅡ score were calculated in 24 hours.To analyze mortality of patients in different score,to estimate dependability of them.Result With SIRS score increasing,mortality rate increased as well and patients with SIRS score ≥2 or APACHE Ⅱ score ≥25 had significantly higher mortality rate.Conclusions SIRS score is a simple,useful predictor of outcome in patients of emergency department.It can be used in clinical generally.

Clinical experience of PICC in the acute and severe patients / 肠外与肠内营养

Objective:To review clinical experience of PICC parenteral nutritoin in the acute and severe patients.Methods:Basilic vein,median vein and brachiocephalic vein were selected for PICC.Results:Insertion and use of PICC were successful in 56 cases with success rate of 93.33%.The parenteral nutrition was carriedout in 32 cases.There was no infection and phlebitis.2 cases failed in puncture. Conclusion:There was important clinical significance with the use of PICC in acute and severe patients.

Peripheral Nerve Block during Lower Limb Procedures for Severe Patients with Vascular Diseases / 中国微创外科杂志

0.1), but duration of sensory and motor block in S group was longer than that in C group (P