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Since the outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, a series of confirmed cases of COVID-19 were found on the Qinghai-Tibet plateau. We aimed to describe the epidemiological, clinical characteristics, and outcomes of all confirmed cases in Qinghai, a province at high altitude. With efficient measures to stop the spread of coronavirus, no new cases were found in Qinghai Province for 60 consecutive days between Feb 6 and April 6, 2020. Of all 18 patients with confirmed SARS-CoV-2 infection, 15 patients comprising 4 transmission clusters were identified. Three patients were infected by direct contact without travel history to Wuhan. Seven patients were asymptomatic on admission. Of 18 patients, 10 patients showed bilateral pneumonia and 2 patients showed no abnormalities. Three patients with comorbidities such as hypertension, liver diseases or diabetes developed severe illness. High C-reactive protein levels and elevations of both ALT and AST were observed in 3 severely ill patients on admission. All 18 patients were eventually discharged, including the 3 severe patients who recovered after treatment with non-invasive mechanical ventilation, convalescent plasma and other therapies. Our findings confirmed human-to-human transmission of SARS-CoV-2 in clusters. The strategies of early diagnosis, early isolation, and early treatment are important to prevent the spread of COVID-19 and improve the cure rate. Patients with comorbidities are more likely to develop severe illness and could benefit from convalescent plasma transfusion.
RESUMO
<p><b>OBJECTIVE</b>Application of real-time shear wave elastography (SWE) measurement of patients with Chronic severe hepatitis B and liver cirrhosis of the liver stiffness, aimed to explore SWE can evaluate the existence of liver cirrhosis patients with esophageal varices (EV) and its severity.</p><p><b>METHODS</b>According to the results of gastroscope, 256 cases of patients with chronic liver disease and cirrhosis of the liver can be divided into no EV group,mild EV group,moderate to severe EV group,analysis between groups in patients with liver stiffness, portal vein,spleen vein diameter, the correlation of liver fibrosis indexes and the degree of esophageal varices.Using receives operating characteristic curve (ROC) and area under curve of ROC to evaluate each index prediction ability.</p><p><b>RESULTS</b>Compare the liver stiffiness, portal vein,spleen vein diameter had statistically significant difference in the no EV group, mild EV group,moderate to severe EV group, (F values are respectively 137.86,44.77,73.88, P < 0.05), Patients age, type IV collagen, larninin, hyaluronic acid had no statistically significant difference in the no EV group and mild EV group (P > 0.05) and had statistically significant difference in the other two groups (P < 0.05). Patients with gender, pro-collagen type III N-terminal peptide (PC III NP) had no statistically significant difference in the three groups (P > 0.05). Correlation analysis showed that portal vein, spleen vein diameter, type IV collagen, laminin, hyaluronic acid showed significant positive correlation (P < 0.05),highest correlation was liver stiffness and the degree of esophageal varices, correlation coefficient of 0.689 (P < 0.01). PC III NP and the degree of esophageal varices, liver stiffness showed no correlation (P > 0.05). Liver stiffness area under the ROC curve is 0.923, with a strong ability to predict than the portal vein and splenic vein diameter, LN, IV-C, HA, PCIII NP. Liver stiffness more than 7.55 kPa, diagnose mild EV sensitivity 90.5%, specificity 60%.Liver stiffness more than 18.85 kPa,the sensitivity of the diagnosis of severe EV 82.4%, specificity of 90.5%.</p><p><b>CONCLUSIONS</b>SWE liver stiffness measurement was predicted the existence of the EV and the severity of liver disease patients and effective inspection method, can be used as evaluation of liver disease patients with esophageal varices non-invasive indicator of the initial screening.</p>
