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Liver transplant patients require lifelong immunotherapy， and if they are infected by SARS-Cov-2， their immune function will face double whammy. This report described the integrated approach of traditional Chinese and western medicine in the treatment of a liver transplant patient with severe COVID-19. The treatment was involved with western medicine such as antiviral， immunosuppressive， focusing on maintaining immune balance. Traditional Chinese medicine was given based on the differentiation of syndromes， targeting at the core pathogenesis and using methods such as promoting qi circulation， clearing heat and resolving dampness， draining lung and relieving panting. Following the treatment， the patient exhibited notable improvement in clinical symptoms and liver function， leading to the effective cessation of disease progression and a shortened recovery period.
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There is currently no drug or therapy that can cure the coronavirus disease 2019 (COVID-19), which is highly contagious and can be life-threatening in severe cases. Therefore, seeking potential effective therapies is an urgent task. An older female at the Leishenshan Hospital in Wuhan, China, with a severe case of COVID-19 with significant shortness of breath and decrease in peripheral oxygen saturation (SpO
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Female , Humans , Acupuncture Therapy , COVID-19/therapy , Drugs, Chinese Herbal , Treatment OutcomeABSTRACT
Objective @#To compare the clinical characteristics of ordinary and severe coronavirus disease 2019 ( COVID-19 ) cases, so as to provide basis for the diagnosis, treatment and prognosis. @*Methods @#We recruited 77 COVID-19 cases in Wenzhou Central Hospital from January 15 to February 29, 2020, collected their general information, clinical symptoms, laboratory test and CT scan results, and compared the clinical features of ordinary and severe cases.@*Results@# There were 50 ordinary cases and 27 severe cases. The age, prevalence of hypertension and other baseline diseases of severe cases were higher than those of ordinary cases ( P<0.05 ) . The maximum body temperature during 1-3 days of hospitalization, proportion of body temperature rising, prevalence of cough, yellow phlegm, hemoptysis, chest tightness and shortness of breath of severe cases were higher than those of ordinary cases ( all P<0.05 ) . The proportion of pulmonary consolidation, glazing and patch shadow, the number of solid changes and the cumulative number of lesions of severe cases were higher than those of ordinary cases ( all P<0.05 ) . The values of LYM during 1-10 days of hospitalization, total T-lymphocyte percentage, CD4 count and percentage, CD8 count, Hb and oxygenation index of severe cases were lower than those of ordinary cases; while the values of LDH and NLR during 1-10 days of hospitalization, N8R, AST, ferritin, CRP during 1-7 days of hospitalization and D-dimer of severe cases were higher than those of ordinary cases ( all P<0.05 ). @*Conclusions@#Severe COVID-19 cases have older age, higher prevalence of baseline diseases, fever, shortness of breath symptoms, more lung consolidation and lesions, significantly decreased lymphocyte level ( especially CD4 ) , and increased LDH, NLR, ferritin and CRP.
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@#【Objective】To explore the clinical manifestation of COVID- 19 severe cases.【Methods】Clinical data of one severe case with COVID-19 including the clinical characteristic ，laboratory testing results，radiography，treatment，complication and outcome of the patient were retrospectively collected and analyzed.【Results】 The patient with COVID-19 was a 61-year old male，He suffered with underlying disease. His symptoms included fever，cough，myalgia， fatigue，and dyspnea. Laboratory testing results included normal WBC count，decreased lymphocyte cells，elevated LDH and hypoxemia. Radiography findings showed bilateral lung infiltration. His condition deteriorated after intensive treatment for one week. He was intubated and treated with mechanical ventilation because of complicating with severe acute respiratory distress syndrome（ARDS）.【Conclusion】COVID-19 is an emerging acute communicable disease，which lack specific and effective treatment. Most patients have a good prognosis but mortality in severe cases is high. More attention should be paid on the high risk of progression in COVID-19 cases.
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Objective To analyze the clinical features of patients with coronavirus disease 2019 (COVID-19) in Shanghai and to investigate the risk factors for disease progression to severe cases. Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20, 2020 to February 10, 2020 were retrospectively analyzed, including 21 severe patients and 271 mild patients. The demographic characteristics, epidemiological history, history of underlying diseases and laboratory examinations were compared between the two groups. Measurement data were compared using t test or Mann-Whitney U test. The count data were compared using hi-square test. The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases. Results Among the 292 patients, 21 were severe cases with the rate of 7.2% (21/292). One patient died, and the mortality rate was 4.8% in severe patients. The severe patients aged (65.0±15.7) years old, 19 (90.5%) were male, 11 (52.4%) had underlying diseases, 7 (33.3%) had close relatives diagnosed with COVID-19. The mild patients aged (48.7±15.7) years old, 135 (49.8%) were male, 74 (27.3%) had underlying diseases, 36 (13.3%) had close relatives diagnosed with COVID-19. The differences between two groups were all significant statistically ( t =-4.730, χ 2 =12.930, 5.938 and 4.744, respectively, all P <0.05). Compared with the mild patients, the levels of absolute numbers of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine, serum cystatin C, C reactive protein (CRP), procalcitonin , D -dimer, pro-B-type natriuretic peptide (proBNP), serum myoglobin, creatine kinase (CK), creatine kinase isoenzyme (CK-MB), serum troponin I (cTnI) in severe patients were all significantly higher ( U =2 091.5, 1 928.0, 1 215.5, 729.0, 1 580.5, 1 375.5, 917.5, 789.5, 1 209.0, 1 434.0, 638.0, 964.5, 1 258.0 and 1 747.5, respectively, all P <0.05), while the levels of lymphocyte count, albumin, transferrin, CD3 + T lymphocyte count, CD8 + T lymphocyte count and CD4 + T lymphocyte count in severe patients were all significantly lower ( U =1 263.5, t =4.716, U =1 214.0, 962.0, 1 167.5 and 988.0, respectively, all P <0.05). Further logistic regression analysis showed that the albumin (odds ratio ( OR )=0.806, 95% CI 0.675-0.961), CRP ( OR =1.016, 95% CI 1.000-1.032), serum myoglobin ( OR =1.010, 95% CI 1.004-1.016), CD3 + T lymphocyte count ( OR =0.996, 95% CI 0.991-1.000) and CD8 + T lymphocyte count ( OR =1.006, 95% CI 1.001-1.010) at admission were independent risk factors for the progression of COVID-19 patients to severe illness (all P <0.05). Conclusions Severe cases of patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases. Albumin, CRP, serum myoglobin, CD3 + T lymphocyte count and CD8 + T lymphocyte count could be used as early warning indicators for severe cases, which deserve more clinical attention.
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Objective To analyze the genetic characteristics of VP1-VP4 genes carried by cox-sackievirus A6 (CVA6) strains isolated from severe cases of hand, foot, and mouth disease (HFMD) in Shenzhen during 2012 to 2015. -ethods The VP1-VP4 genes of CVA6 strains isolated from severe HFMD cases in Shenzhen during 2012 to 2015 were amplified and sequenced. Phylogenetic analysis was performed to analyze the VP1-VP4 genes of CVA6 isolates and sequences downloaded from GenBank by using DNASTAR6. 0 and MEGA6. 02 software packages. Results Four cases of severe HFMD were caused by CVA6 in Shenzhen during 2012 to 2015. All of the patients had the symptom of fever, skin rash and aseptic encephalitis. The CVA6 strain causing severe HFMD in 2013 shared 98. 8％-98. 9％ homology in nucleotide sequences and 99. 3％-99. 8％ in amino acid sequences with the strains isolated in 2012. Two amino acid mutations were found in the CVA6 strain isolated in 2013, which were G73E in VP2 region and S13G in VP1 region. However, the CVA6 strain isolated in 2015 only shared 95. 0％ homology in nucleotide sequences and 99. 3％ homology in amino acid sequences with the strain isolated in 2013. Six amino acid mutations were identified including E73G in VP2 region and T5A, S27N, A30V, N137S and V242I in VP1 region. The phylogenetic analysis revealed that the four CVA6 strains belong to D3 sub-genotype. The CVA6 strains causing severe cases in 2012 had the nearest genetic relationship with the strain isolated in Changsha in 2012 (KJ156349). The CVA6 strain isolated in Shenzhen in 2013 had the nearest genetic relationship with the strain isolated in Shanghai in 2013 (KJ612513). The Shenzhen CVA6 isolate in 2015 showed high similarity to Weifang CVA6 isolate in 2014 (KX752785). Conclusions All CVA6 strains causing severe HFMD ca-ses in Shenzhen during 2012 to 2015 belongs to D3 sub-genotype. Mutations of S27N and A30V in the VP1 region of the CVA6 isolate in 2015 are located in the B cell epitopes. In addition, the VP1-V242I mutation in the CVA6 strain isolated in 2015 is located in the binding site of PSGL-1 receptor. These mutations may affect the binding of CVA6 strains to the cellular receptors and their infectivity to people.
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Bronchiolitis mainly occurs in infants under 2 years old. The infection is mainly caused by respiratory syncytial virus. Bronchiolitis is self-limited in clinic. The treatment is mainly symptomatic and supportive treatment,including monitoring the change of disease,oxygen supply and maintaining the stability of water and electrolyte environment. Other measures should be taken to treat children with severe infection when routine oxygen inhalation,sputum aspiration and atomization are not effective. Including giving epinephrine,glucocorticoid,hypertonic saline atomization inhalation and active anti-infection treatment. More and more attention has been paid to the application of noninvasive ventilation in children with severe bronchiolitis,and early use of continuous positive airway pressure ventilation can reduce the rate of invasive tracheal intubation,effectively improve respiratory distress,reduce respiratory work and shorten hospitalization time. For children with risk factors,the changes of children's condition should be closely monitored,and the aggravation and deterioration of the disease should be dealt with in time.
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Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.
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Objective To analyze the epidemiological characteristics of imported malaria cases and investigate the influenc-ing factors of severe cases in Anhui Province,so as to provide the evidence for improving the control strategy. Methods The ep-idemiological data of imported malaria cases in Anhui Province from January 1st,2012 to April 18th,2017 were collected and analyzed. Results The imported malaria cases in Anhui Province were mainly young men of migrant workers. There were im-ported malaria cases in 79％(83/105)of counties(districts)in Anhui Province. . Totally 686 imported malaria cases were re-corded,in which there were 62 severe cases(9.04％),and four death cases with the mortality rate of 0.58％. The age,educa-tion,initial diagnosed departments,initial diagnosed results,time from onset to seeing a doctor,and time from seeing a doctor to diagnosis were the influencing factors for the severe cases. Conclusion The proportion of severe imported malaria cases is high in Anhui Province. The monitoring sensitivity,clinician's awareness of malaria diagnosis,and health education for migrant workers should be improved.
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Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand,foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease.Methods According to factors as geographical location,economic and epidemic levels,five provinces (Henan,Shandong,Yunnan,Zhejiang and Sichuan provinces) were selected.Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces.Basic epidemiological information,clinical data,and pathogen testing results in the involved hospitals were collected.Clinical stages on all the patients were decided in accordance with "the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)".Data were analyzed using SPSS software 18.0 and other epidemiological methods.Results A total of 657 severe HFMD cases were investigated,with 326 cases positive of EV71,accounting for 91.3％ (326/357) among all the laboratory-confirmed cases.Of the 657 cases,542 cases (82.5％,95％CI:79.4％-85.3％) were diagnosed as in stage 2 (with nervous system involvement),99 cases (15.1％,95％CI:12.4％-18.0％) in stage 3 (early phase of function failure on heart and lung),and 16 cases (2.4％,95％CI:1.4％-3.9％) were in stage 4 (function failure of heart and lung).11 cases (1.7％,95％CI:0.9％-3.0％) were with squeal when discharged from hospital with 8 cases (1.2％,95％CI:0.6％-2.3％) died.When comparing the proportions among stage 2,stage 3 and stage 4,significant differences were found between age groups (x2=22.632,P=0.012).The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared.When comparing the proportions of clinical stages among the five provinces,significant differences (x2=41.481,P =0.000) were noticed.Proportions of different clinical stages in gender,ethnicity,occupation,place of residence types and the type of pathogen appeared no significant differences,respectively.However,the proportions of squeal and death in stage 2,stage 3 and stage 4 showed significant differences (sequela:x2=12.960,P=0.001;Death:x 2=16.850,P=0.001),respectively.Conclusions The pcrccntage of clinical stages of severe HFMD patients related to the rate of squeal and death.Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment,of HFMD.
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Objective To analyze the epidemiological characteristics of the severe cases of hand , foot and mouth disease ( HFMD) in Danzhou and to provide a scientific evidence for the prevention of severe HFMD.Methods Descriptive epidemiological analysis was used to analyze the characteristics of severe ca -ses of HFMD occurred from 2010 to 2014 .Results A total of 18 960 cases of HFMD were reported in Danzhou City from 2010 to 2014.The death rate (annual deaths/1000 persons) was 0.13%.One hundred and eighty-eight cases (0.99%) were diagnosed as severe HFMD with a male to female ratio of 2.4 :1 and 96.28%of them were scattered inhabiting children .Six cases were died from severe HFMD and all of them were under 2 years of age.In total 87.77%of the severe cases were occurred in children under 2 years of age.The severe cases were mainly occurred in June and July .Children form the countryside showed higher rates of severe HFMD than those from cities and towns .No significant differences in the time between the in-itial diagnosis and treatment for children with HFMD in countryside and urban areas were found .However , the differences in the duration from initial diagnosis to severe HFMD between children in countryside and ur -ban areas were statistically significant (M-W test, P<0.05).Among the 188 severe cases, 82.44% were initially diagnosed as common HFMD cases by the county-level medical institutions and 90.96%were diag-nosed as severe cases by the municipal and above medical institutions .The cases positive for EV71 strains accounted for 44.15%.Conclusion Most of the severe HFMD were developed in scattered inhabiting chil-dren under 2 years of age in the countryside of Danzhou during 2010 to 2014.In order to decrease the mor-bidity and mortality of severe HFMD in children , it is necessary to implement health education for residents , to improve the professional skills of medical staffs in the early diagnosis of HFMD , and to strengthen etiologi-cal surveillances and warning system for HFMD .
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Objective To ivestigate integrative medicine therapy for severe systemic lupus erythematosus.Methods In 2005,we successfully salvaged a severe SLE patient,who was an inpatient from the TCM Rheumatology department of China-Japan relationship hospital.The mainly clinic manifestations included severe pulmonary hypertension,gangrene and pancytopenia.We analyzed this ease.Results By integrative medicine therapy,we successfully salvaged this patient.Conclusion The key points for integrative medicine therapy for severe systemic lupus erythematosus included:1.Using strong measures to control the disease progress,including hormones,immunosuppressive agents; 2.Positive and effective symptomatic treatment aiming at pulmonary hypertension and severe gangrene; 3.Emphasizing the effect of Chinese medicine,using integrative medicine therapy.In sum,in this case,we applied integrative medicine therapy and got very perfect clinic effect at last.
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<b>Background:</b> Taking a good history is important for the diagnosis of abdominal pain. We investigated questionnaire items that were significantly correlated with causes of abdominal pain requiring hospitalization. We also studied the combination of responses that could exclude severe disease.<br><b>Method:</b> Between February 2006 and December 2007, 296 of 317 patients with abdominal pain who attended our Outpatient Department completed a questionnaire for their abdominal pain. They included 32 patients requiring hospitalization (severe group) and 264 other patients (mild group). The percentage of positive responses to each questionnaire item was compared between the two groups, and those showing a significant difference were employed for logistic regression analysis.<br><b>Results:</b> The following 4 responses were selected: “It is less than 7 days since the onset of pain” (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.2-6.4); “The pain is exacerbated by walking” (OR, 2.8; 95% CI, 1.3-6.2); “The pain is accompanied by weight loss” (OR, 3.8; 95% CI, 1.5-9.8); and “The pain wakes me at night” (OR, 2.3; 95% CI, 1.1-5.2). If a patient had none of these responses, the predictive value was 0.03 for severe disease.<br><b>Conclusions:</b> Our findings suggested that pain reported within 7 days, exacerbation by walking, nocturnal awakening, and associated weight loss are features of abdominal pain that predict severe disease. Conversely, severe disease can be almost completely excluded in patients negative for all 4 features.
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Objective To explore the factors associated with severe hand-food-mouth disease (HFMD) case in Shanghai.Methods A total of 105 severe HFMD cases diagnosed from May to July,2011 in Shanghai were enrolled as case group while another 210 mild HFMD cases were randomly selected as control group in the same period.All subject' s parents or babysitters were asked to fill in the questionnaire in which including demography,ways of babysitting,behavior and the like.All HFMD cases were diagnosed by both clinical symptom and nuclear acid testing.Data was processed by EpiData (V3.0) and analyzed by SPSS (V17.0).Results Factors as age,gender,Diaspora pattern,migrant,size of house,numbers of family member,numbers of children,frequency of seeing doctor,dishware that sharing with babysitter,food chewed by babysitter,dirty hand,EV71 virus type and diagnosis on HFMD in the fist visit to hospital were found associated with severe HFMD by univariate analysis.Results through multivariate logistic regression showed that factors including:being the only male kid,more than 3 children in the family,dirty hands,unable to be diagnosed as HFMD in the first visit to the hospital,visiting doctor during the past 6 months for 2 and 3 times etc.could be kept in the model with statistical threshold of 0.05.Adjusted ORs and confidence intervals of them were 2.431 ( 1.317-4.487),2.661 (1.332-5.315),3.403 ( 1.871-6.191 ),6.607 (3.011-14.500),2.431 ( 1.111-5.321 ),2.628 ( 1.137-6.071 ) respectively.Being Infected by EV71 was also found a very important risk factor compared with CoxA16 or other enteroviruses,and its adjusted OR was 5.614 (2.409-13.082).Conclusion It was necessary to implement molecular diagnosis for identifying the virus type of HFMD,together with improvement on the capacity of clinical diagnosis in order to diagnose the HFMD cases earlier.More attention should be paid to these HFMD cases with EV71 infection as well as prompting frequent visits to hospitals on those families with more children.
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Objective To study the effect of partial parenterai nutrition support in severe cases of general surgery.Methods Treated 170 severe cases from January 2001 to September 2008,ran two sets, 80 cases of ex-perimental group and 90 cases of the control group.Results The exaltation of hemoglobin, albumin, lymphocytes and weight in experimental group were better than those in the control group (P < 0.05).The level of glycemic control was also better than that in the control group (P < 0.05).Conclusions The effection of partial parenteral nutrition support is reliable, practical and low-cost.
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The academic thinking of WU Pei-heng derived from the theory of thinking highly of yang-qi in Inner Canon of Huangdi and the theory of waming yang to support vital qi in Treatise on Febrile Diseases. He considered that the yang-qi was the essence of the life, warming yang and assisting yang was the core of his academic thinking. He was good at using Radix Aconiti Lateralis Preparata with hige dosage. The 4 cases in this article proved the science and practicality of warming yang and assisting yang.