Epidemiological investigation and intergenerational clinical characteristics of 24 COVID-19 patients associated with supermarket cluster

ObjectiveTo analyze the epidemiological and intergenerational clinical characteristics of COVID-19 patients associated with cluster, so as to understand the rules of the patients associated with cluster of this outbreak and provide help for the prevention and control of COVID-19. MethodsAll close contacts of the patient were screened since the first supermarket employee with COVID-19 was identified. A retrospective analysis was made on the epidemiological and clinical characteristics of the confirmed cases admitted to the designated hospitals for centralized treatment. The patients were divided into two groups according to the first generation (supermarket employees, group A) and the second or third generation (family members or friends of supermarket employees, group B), and the similarities and differences between the two groups were compared. ResultsA total of 24 COVID-19 patients were diagnosed, with an average age of 48 {+/-}1.73 years. The mean duration from onset to release form quarantine was 21.04{+/-} 6.77 days, and the onset time was concentrated in 5-11 days after the first patient was diagnosed. Among all the patients, 23 patients were moderate, among which 7 patients (29.17%) were asymptomatic. Symptoms of symptomatic patients were cough (75.00%), low fever (62.50%), shortness of breath (41.67%), sore throat (25.00%), gastrointestinal symptoms (25.00%), fatigue (20.83%), etc. Biochemical examination on admission showed that the white blood cell count < 4.0x109/L (29.17%) and the lymphocyte count <1.1x109/L (58.33%). The lymphocyte count of 50.00% of the patients was [≤] 0.6 x 109/L. On admission, chest CT showed pneumonia (100%) with bilateral infiltration (75.00%). Treatment: antiviral drug (100%), Chinese medicine (100%), common oxygen therapy (45.83%). There were 11 cases in group A (first generation, 11 cases) and 13 cases in group B (second generation, 11 cases; third generation, 2 cases). In group B, there were more males, from onset to admission later, more patients had underlying diseases, and more patients were treated with albumin (P<0.05). However, there was no statistical difference between the two groups in other clinical indicators, including the duration from onset to release form quarantine(P>0.05). There was no improvement in granulocyte count in all patients, as well as in groups A and B, between admission and release from quarantine(P>0.05). ConclusionThe clinical characteristics of COVID-19 patients associated with cluster were similar to those of other COVID-19 patients, but there were some special features. The severity of the disease was similar and there was intergenerational spread. There was no difference in clinical characteristics between generations. Asymptomatic infections occurred in a proportion of patients and could cause spread.

Clinical characteristics and reasons of different duration from onset to release from quarantine for patients with COVID-19 Outside Hubei province, China.

ObjectiveTo find out more characteristics and rules of COVID-19 by analyzing the clinical course of COVID-19 patients in a region outside Hubei province. Methods37 cases diagnosed adult COVID-19 cases of general characteristics, history of epidemiology, chronic underlying diseases, clinical symptoms and complications, chest CT, biochemical monitoring, severity assessment, treatment and outcome were retrospectively analyzed, and according to the duration from onset to release from quarantine were divided into [≤]20 -day group and > 20 -day group, compare the similarities and differences between the two groups. ResultsAmong the 37 patients, 5 were mild, 30 were moderate, 1 was severe and 1 was critical. All the patients were released from quarantine without death. The average duration from onset to release from quarantine was 20.2{+/-}6.6 days, The average length of stay from onset to hospitalization was 4.1{+/-}3.7 days, and hospitalization duration average 16.1 {+/-}6.2 days. The average age was 44.3{+/-}1.67 years. 78.4% of cases were caused by exposure to a confirmed patient or the workplace of a confirmed patient. The main symptoms were cough (67.6%), fever (62.2%), shortness of breath (32.4%), fatigue (24.3%), sore throat (21.6%,) vomiting or diarrhea (21.6%). The white blood cell count was decreased in 27.0% of the patients, and the lymphocyte count was decreased in 62.2% of the patients, of which 43.5% patients were [≤]0.6x109/L. On admission, 86.5% of patients with chest CT showed pneumonia, including some asymptomatic patients. 68.8% of patients showed bilateral infiltration. In the > 20-day group, the average age was 49.9{+/-}1.38 years old, and the duration from onset to hospitalization was 5.5{+/-}3.9 days. Compared with the [≤] 20-day group, the age was older and duration was longer, P < 0.05. All the 7 asymptomatic patients were [≤]20 -day group. When 37 patients were released from quarantine, the white blood cell count of 16.2% patients was < 4.0x109/L, and the lymphocyte count of 59.5% patients was <1.1x109/L, and the absolute count of white blood cells and lymphocytes was 5.02{+/-}1.3 4x109/L and 1.03{+/-}0.34x109/L respectively, compared with those on admission, P > 0.05. ConclusionThe majority of COVID-19 cases in the study area were mild and moderate, with good clinical outcomes. There were some special characteristics in the clinical process. The reasons of duration from onset to release from quarantine were complex. There was no significant change in the number of granulocytes at the time of release from quarantine compared to the time of admission.

Diagnostic value of procalcitonin in distinguishing Gram-negative bacterial blood stream infection from Gram-positive bacterial infection in early stage of sepsis / 中华急诊医学杂志

Objective To investigate the diagnostic values of procalcitonin (PCT),high sensitive C-reactive protein (hs-CRP),white blood cell (WBC)and percentage of neutrocyte (NEU％)in Gramnegative and Gram-positive bacterial blood stream infection in early stage of sepsis in order to investigate the correlation between PCT and APACHE lⅡ score as well as between PCT and SOFA score,and the prognostic value in assessment of Gram-negative and Gram-positive bacterial blood stream infection.Methods Clinical data of patients admitted to ICU from January 2012 through December 2014 were retrospectively analyzed.A total of 124 sepsis patients with blood stream infection were checked with PCT,hs-CRP,WBC and NEU％ tests,and APACHE Ⅱ score and SOFA score were calculated.The differences in APACHE Ⅱ score and SOFA score were compared between Gram-negative group (n =41) and Gram-positive group (n =83).The correlation between PCT and APACHE Ⅱ score as well as between PCT and SOFA score was analyzed.The differences in diagnostic values of PCT,hs-CRP,WBC and NEU％ between Gram-negative group and Grampositive group were analyzed by using receiver operating characteristic (ROC) curve and it was plotted to assess the prognostic values of PCT,hs-CRP,WBC and NEU％ for septic patients with blood stream infection.Results Compared with Gram-positive group,the levels of PCT [.55.32 (22.01,97.11) vs.2.13 (0.27,5.27)] (P ＜0.01),hs-CRP [105.09 (69.97,186.12) vs.70.54 (42.37,138.63)] (P=0.508),NEU％ [88.30 (75.79,93.52) vs.55.32 (22.01,97.11)] (P=0.302) were higher but WBC was lower [13.59 (10.74,17.58) vs.13.73 (11.32,20.90)] (P=0.058) in Gram-negative group.The ROC curve analysis of PCT showed the area under the curve (AUC) was 0.867 (95％ CI:0.789-0.946).When the optimal cutoff point of PCT was 17.48 ng/mL,the largest Youden's index was found to be 0.661 with 76.9％ sensitivity and 89.2％ specificity.Between two groups,there were significant differences in APACHE Ⅱ score and SOFA score (27.46 ± 9.60 vs.23.67 ± 7.74,P =0.020;8.05 ±3.38 vs.6.59-±3.45,P =0.028).There was significant difference in diagnostic value between PCT and SOFA (r =0.536,P =0.036) in Gram-negative group but no significant difference in Gram-positive group.Conclusions Higher PCT levels are found in Gram-negative group and it can play a role in differntiation between the Gram-negative group and Gram-positive group rather than hs-CRP,WBC and NEU％.PCT can be a better indicator for evaluation of severity of sepsis as well as for prognosis of sepsis patients with Gram-negative bacterium infection.

Clinical significance of point-of-care testing of N-terminal pro-brain natriuretic peptide in pregnant patients complicated by hypertensive disorders / 中华危重病急救医学

Objective To observe the features of the changes in the whole blood N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in pregnant patients with complication of hypertensive disorders,its correlation to the severity of the illness,and to investigate the diagnostic value of point-of-care testing of NT-proBNP in patients with hypertensive disorders complicating pregnancy.Methods A prospective observation was conducted.Sixty-nine patients with hypertensive disorders complicating pregnancy admitted to Department of Critical Care Medicine of Liaocheng People's Hospital in Shandong Province from April 2013 to April 2015 were enrolled.All patients were divided into gestational hypertension group (n =16),preeclampsia group (n =30) and eclampsia group (n =23).At the same time,30 age-matched normal pregnant women were enrolled as the control group.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of all patients with hypertensive disorders complicating pregnancy were calculated within 24 hours after intensive care unit (ICU) admission.NT-proBNP in venous blood at 1,3,5 days after ICU admission was determined with point-of-care testing,in order to analyze the correlation of changes in NT-proBNP value in each group and the severity of the disorder.Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of NT-proBNP in the whole blood in hypertensive disorder complicating pregnancy.Results The APACHE Ⅱ score of the eclampsia group was significantly higher than that of the preeclampsia group,and it was higher than that of gestational hypertension group (15.91 ± 1.06,13.73 ± 1.09,10.31 ± 1.10,all P ＜ 0.01).The NT-proBNP in normal pregnancy group was lower than 125.00 ng/L,with a mean of 90.00 (79.75,100.00) ng/L.With the aggravation of the disease,NT-proBNP was gradually increased.On the first day in ICU,the NT-proBNP of the eclampsia gronp was significantly higher than that of the preeclampsia group,and it was higher in preeclampsia group than that of gestational hypertension group [ng/L:1960.00 (1 226.00,3 229.00),859.50 (626.75,2439.00),505.00 (171.25,604.05),P ＜ 0.05 or P ＜ 0.01].With the extension of duration of treatment,the levels of NT-proBNP (ng/L) in the eclampsia group,preeclampsia group,and gestational hypertension group was gradually decreased,and had a statistically significant difference on the fifth day as compared with that of the first day [310.00 (210.00,430.00) vs.1 960.00 (1 226.00,3 229.00) in eclampsia group,265.00 (229.50,333.25) vs.859.50 (626.75,2439.00) in preeclampsia group,and 203.00 (115.50,259.25) vs.505.00 (171.25,604.05) in gestational hypertension group,all P ＜ 0.01].APACHE Ⅱ score of the patient with hypertensive disorders complicating pregnancy was positively correlated with the level of NT-proBNP on the first day in ICU (r =0.795,P =0.000).It was shown by ROC curve analysis that the area under the ROC curve (AUC) of NT-proBNP in the whole blood for the diagnosis of the patient with hypertensive disorder complicating pregnancy was 0.986 [95％ confidence interval (95％C/) =0.753-0.924].When the cutoff value was 122.50 ng/L,the sensitivity was 97.1％,and the specificity was 100.0％.No patient died,all the 69 patients recovered and discharged.Conclusions The levels of NT-proBNP in the whole blood in the patients with hypertensive disorder complicating pregnancy,especially those with eclampsia,were significantly higher,and it was correlated with the severity of illness.After treatment,the levels were gradually lowered with the improvement of the disease.Therefore,it is concluded that the point-of-care testing of NT-proBNP in the whole blood has an excellent value for the diagnosis and evaluation of hypertensive disorder complication pregnancy.

Monitoring of nosocomial infection in intensive care unit / 中华全科医师杂志

The data on nosocomial infection of 4060 patients who were stayed in intensive care unit (ICU) more than 48 h from January 1997 to August 2008 were reviewed.From Jan 2004 the target monitoring of hospital-acquired infection was implemented in ICU.The nosocomial infection rates before and after target monitoring were 35.25% (871/2471) and 30.77% (489/1589) respectively (P ＜ 0.01);however there was no significant difference in case infection rate before and after target monitor were practiced (47.67% vs.45.25%,χ~2 = 2.2836,P ＞0.05).The incidence of Acinetobacter infection was increased after target monitoring.Targeted monitoring can decrease the nosocomial infection rate in ICU,and also reduce the cost of medical care.

Nosocomial Infection in Intensive Care Unit with Target and Environmental Monitoring:A Correlation Analysis / 中华医院感染学杂志

OBJECTIVE Through nosocomial infection targeted surveillance in intensive care unit(ICU),to evaluate the characteristics of nosocomical infection and their its correlation with the results of environmental monitoring at the same period.METHODS Nosocomial infection monitoring was explored on patients who were in ICU more than 48 h from Jan 1997 to Jun 2008.Correlation analysis was conducted between the rate of nosocomial infection in ICU and the same period environmental monitoring results.Data were analyzed with the SPSS10.34 software.RESULTS There was significant difference(P0.05)in the rate of infection cases before and after target monitoring was practiced.The site of infection was mainly in respiratory tract,followed by the gastrointestinal tract and urinary tract;The full-time personnel in duty for nosocomial infection surveillance monitored the indoor air,object surface,medical personnel's hands in ICU,their qualified rate was 78.28%,90.94% and 95.83%,respectively.CONCLUSIONS There are many risk factors in patients in ICU,ICU should be looked as one of the important nosocomial infection monitoring department.The target monitoring of nosocomial infection is an effective method;the nosocomial infection rate in ICU and the environmental result at the same period don't show relevance,the environmental hygiene monitoring should be scientific and practical.

Effects of fat emulsion made of fish oil for total parenteral nutrition on patients with systemic inflammatory response syndrome / 中华急诊医学杂志

Objective To explore the effects of fat emulsion made of fish oil for total parenteml nutrition on patients with systemic inflammatory response syndrome(SIRS).Methos Forty patients with SIRS in the intensive care unit(ICU),Liaocheng People's Hospital,from January to June 2007 were randomly divided into conventional total parenteral nutrition(TPN)group(group A,n=20)and fish oil emulsion+TIN group(group B,n=20).Patients of both groups received equal amount of nitrogen and calories.The energy give.Was 20 kcal/(kg·d),and nitrogen 0.2 g/(kg·d)for 7 days and the fish oil emulsion given was 1-2 ml/(kg·d)(Commoditieds:Omegaven,No.UK 1580,Wuxi,China SINO-SWEO Pharmaceutical CORP.Ltd.).The levels of serurn TNF-α,IL-1 and IL-6 were checked before TPN and 1 d,3 d and 7 d after TPN.The davs of ICU stay,the incidence of MODS and the mortality within 28 aays of two groups were also recorded.Data were analyzed wotj inde pent-saraples t test and paired-sarnples t test using the SPSS 10.34 software.Results There wsa no significant difference in APACHF-Ⅱ score between two groups of patients.Compared with group A,the levels of serum TNF-α,IL-1 and IL-6 in group B decreased markedly at different intervals(P<0.05,P<0.01).The duration of ICU slay shortened obviously in group B than that in group A[(11.5±2.4)days vs.(15.8±2.3)days,P<0.05].Conclusions The fat emulsion made of fish oil has protective effects on patients with SIRS by the mechanism of decrease in the levek of Serum TNF-α,IL-1 and IL-6,and thereby reduees the incidence of MODS,shortens the duration of ICU stay,increasing the survival rote of seriously ill patients.