Inpatients after COVID-19 infection, especially those admitted to intensive care unit (ICU), may encounter a series of coagulation dysfunction, which may lead to thrombosis, such as pulmonary embolism (PE), deep vein thrombosis (DVT) or arterial thrombosis (AT). Although there are many literatures on the incidence rate, prevention and treatment of venous thromboembolism (VTE) in hospitalized patients with COVID-19 infection, there are few data on the symptomatic and subclinical incidence rate of VTE after COVID-19 infection discharge. Therefore, there are no specific recommendations or guidelines for the prevention of VTE after discharge from hospital due to COVID-19 infection, and the current guidelines are controversial. In this study, we reviewed and summarized the existing literature on the incidence rate, prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19 infection, in order to provide guidance for VTE prevention in patients with COVID-19 infection after discharge.
Objective To investigate the status of frailty in patients with coronavirus disease 2019 (COVID-19), and to analyze the influence of COVID-19 disease on the prevalence of frailty. Methods This study was conducted using a cross-sectional survey method. COVID-19 patients admitted to a centralized isolation point in Guangzhou were selected for an questionnaire survey by “questionnaire star”, between November and December 2022. The questionnaire included the general information questionnaire, Tilburg Frailty Indicator (TFI), the COVID-19 symptom scale and Mental Resilience Scale (RS-11). Multi-model logistic regression analysis was used to explore the influence of COVID-19 on the occurrence of debilitation. Results A total of 667 questionnaires were distributed, of which 594 were valid, with an effective rate of 89.1%. There were 150 patients (25.3%) were frail, 444 patients (74.7%) were non-frail, and 51 patients (8.6%) were newly frail after infected COVID-19. The median TFI score before COVID-19 was 3 (2, 4) points, 16.7% (99/594) were in a weak state. The median TFI score after COVID-19 was 3 (2, 5) points, 25.3% (150/594) were in a weak state. There were statistically significant differences in TFI scores (Z=?6.596, P＜0.001) and the incidence of debilitation (χ2=351.648, P＜0.001) before and after COVID-19. The results of multivariate logistic regression analysis showed that after controlling disease factors, demographic factors and psychosocial factors, the score of the COVID-19 symptom score was always the influencing factor of COVID-19 patients. The overall change trend of COVID-19 symptom score was statistically significant (P<0.001). Conclusions The COVID-19 symptom score is an important risk factor or predictor of frailty in patients with COVID-19. As the level of COVID-19 symptom score increases, the risk of frailty in COVID-19 patients increases.
Objective To discuss the epidemiological characteristics of young and middle-aged people infected with COVID-19 in Gansu province under the new epidemic policy. Methods A total of 1800 people were collected from two tertiary hospitals in Gansu province from November 8, 2022 to January 28, 2023. The vaccination status, nucleic acid antigen detection, the specific time of infection, main symptoms and severity of the disease were investigated. Results Among 1800 participants, 1685 (93.6%) were vaccinated and 1565 (86.9%) were infected with COVID-19. Among the 1565 infected persons, 523 (33.4%) completed both nucleic acid and antigen testing, 382 (24.4%) completed nucleic acid testing, 490 (31.3%) completed antigen testing, 170 (10.9%) received IgG testing. 1490 (95.2%) were slight ill, 75 (4.8%) were critical ill, and 96 (6.1%) were hospitalized, and no one died. In 2022, 92 cases (5.9%) were infected in the first half of November, 141 cases (9.1%) in the second half of November, 630 cases (40.3%) in the first half of December, and 553 cases (35.4%) in the second half of December. 109 cases (7.0%) were infected in the first half of January, 38 cases (2.2%) in the second half of January, and 2 cases (0.1%) in the first half of February of 2023. and no cases in the second half of February. Among the 1565 infected persons, 825 (52.7%) had respiratory symptoms, 293 (18.7%) had gastrointestinal symptoms, 257 (16.4%) had autonomic disorders, 140 (8.9%) had other symptoms such as decreased smell and taste, and 48 (3.3%) had no symptoms after infection. Conclusions The vaccination rate of young and middle-aged people in Lanzhou city of Gansu Province is high. Since the new policy, the infection rate of the novel coronavirus among young and middle-aged people is high, the number of antigen tests is more than nucleic acid tests, most of the infected patients are slight, with fewer critical patients, and the hospitalization rate is low. The peak of infection occurred in early December 2022, and the infection rate was basically zero by February 2023. The main symptoms of COVID-19 infection are mainly respiratory tract, followed by digestive tract and autonomic nervous system disorders, and few patients are completely asymptomatic.
ObjectiveTo systematically review the correlation between adenoviral infection and encephalitis in children.
MethodsStudies on the correlation between adenoviral infection and encephalitis among children were retrieved in the databases of CHKD, CNKI, WanFang Data, CMCC, PubMed, Ovid, EBSCO, and Science New during 1978-2013. According to our inclusion and exclusion criteria, literature was screened. After data extraction, meta-analysis was conducted using Comprehensive Meta Analysis 2.0.
ResultsA total of 18 studies were enrolled. The results of meta-analysis indicated that:the prevalence of infection of human adenovirus in children with encephalitis was p1=10.8% (95%CI 6.5% to 15.2%, P < 0.000 01). The incidence of encephalitis in children with adenoviral infection was p2=31.4% (95%CI 14.1% to 48.6%, P < 0.000 01). The results of two studies showed that, the correlation coefficients between adenoviral infection and encephalitis were OR1=2.22 (95%CI 0.32 to 14.79, P > 0.05), and OR2=1.12 (95%CI 0.14 to 9.10, P > 0.05), respectively, both with no significant difference. In addition, the subgenus B adenoviruses, including type 3 and type 7 were more associated with encephalitis, followed by type 1 and type 2 in subgenus C and type 8 in subgenus D.
ConclusionCurrent evidence shows that no correlation exists between adenoviral infection and encephalitis in children. However, the above conclusion needs to be verified by conducting more rationally-designed studies so as to clarify the correlation.
ObjectiveIn order to summarize the best evidence, evaluate the efficacy and safety of interventions for the treatment of COVID-19, and provide practical guidance for medical workers, public health workers, and COVID-19 patients, we formulated the evidence-based practice points. MethodsWe followed the "Evidence-based practice points: methods and processes of development", with comprehensively considering the pros and cons of evidence, quality of evidence, public and patient preferences and values, cost of interventions, acceptability, and feasibility based on systematic reviews. Practice points Finally, 12 practice points were formed for non-severe, severe and critical COVID-19 patients. Non-severe: ① Consider Hanshiyi formula or Gegenqinlian pills for patients with nausea, vomiting and diarrhea; ② Consider Huashibaidu granules (decoration), Jinyinhua oral liquid, Jinhuaqinggan granules, Xuanfeibaidu granules (decoration), Lianhuaqingwen capsules (granules), or Reyanning mixture for patients with sore throat, fever, muscle aches or cough; ③ Consider Qingfeipaidu granules (decoration) for patients with nasal congestion, runny nose, cough, low-grade fever, aversion to wind and cold, and fatigue; ④ Consider Toujiequwen granules for patients with fever, chills, itchy throat, cough, dry mouth and throat, and constipation; ⑤ Consider Reduning injection or Xiyanping injection for patients with high fever, mild aversion to wind and cold, headache and body pain, cough, and yellow phlegm; ⑥ Consider molnupiravir, nirmatrelvir–ritonavir (Paxlovid), remdesivir or VV116 for patients within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease. Severe: ① Consider Shenhuang granules or Xuebijing injection for patients with high fever, irritability, and thirst; ② Consider remdesivir used as soon as possible for patients with severe symptoms. Critical severe: Consider corticosteroids, IL-6 receptor inhibitors, and baricitinib for patients 7 days after the onset of symptoms.
Since the outbreak of coronavirus disease 2019 (COVID-19), there have been numerous studies confirming that physiotherapy is an essential part of the comprehensive treatment during hospitalization and can facilitate recovery in COVID-19 patients. However, physiotherapy protocols for COVID-19 patients in intensive care units are still lacking. This article reviews the literature and incorporates practical experience around recommendations for the safe protection during physiotherapy, recommendations for evaluation criteria and intervention of physiotherapy, and future work for COVID-19 patients, so as to provide a standardized recommendation for physiotherapists working in intensive care units.
Objective To describe the development trend of clinical symptoms, pulmonary function and chest imaging examination of COVID-19 discharged from Xinyang from January 2020 to June 2020, and analyze the related risk factors. Methods This study was a prospective, longitudinal and cohort study. The survivors of COVID-19 hospitalized in Xinyang Fifth People's Hospital and Xinyang Central Hospital from January to June, 2020 were prospectively followed up 12 months and 24 months after discharge. Patients who refused to participate in the study and suffered from cancer and chronic respiratory diseases, including asthma or chronic obstructive pulmonary disease, were excluded. During the follow-up period, the patients who meet the research conditions were asked about clinical symptoms, routine and biochemical blood tests, pulmonary function and chest high-resolution CT (HRCT) and 6-minute walking distance test, and were evaluated with the Dyspnea Scale (mMRC). Results It was found that from January to June, 2020, among 207 eligible patients, 169 patients participated in this study, including 126 cases of mild and ordinary type (74.6%) and 43 cases of severe and critical type (25.4%). There were 100 males (59.2%) and 69 females (40.8%), aged 20 - 78 years old (50±15). It was found that more than half of COVID-19 patients had one or more symptoms at the end of 12 months after rehabilitation, including fatigue (90 cases, 53.3%), insomnia (43 cases, 25.4%), anxiety (24 cases, 14.2%), chest tightness (29 cases, 17.2%) and alopecia (35 cases, 20.7%). Two years after discharge, 52 patients (30.8%) still had at least one clinical symptom. The quality of life, cardiopulmonary function and exercise ability of COVID-19 patients in rehabilitation period decreased to varying degrees. Most patients' lung function and CT results returned to normal, but a few patients still had persistent lung function and imaging abnormalities 12 months and 24 months after discharge. Pulmonary function was mainly manifested as diffuse function injury, and the predicted value of carbon monoxide diffusion capacity (DLCO) was less than 80% in 44 cases (26.0%). Pulmonary HRCT mainly showed chronic inflammation in one lung/both lungs (28 cases, 41.2%), multiple nodules in one lung/both lungs (23 cases, 33.8%) and ground glass shadow (10 cases, 14.7%), etc. Multivariate logistic regression analysis showed that female COVID-19 patients with old age were more likely to have anxiety symptoms after discharge, which had nothing to do with the severity of acute disease. Older female patients with severe COVID-19 were more likely to have symptoms of DLCO damage during the recovery period, and their lung function gradually recovered with time. Conclusions Most of COVID-19 patients in Xinyang recovered well during the rehabilitation period, but some patients still had clinical symptoms such as fatigue, insomnia, anxiety, etc. The absorption of lung lesions was slow and some patients were accompanied by impaired pulmonary diffusion function. With the extension of rehabilitation time, the above symptoms have been significantly improved.
ObjectiveTo summarize the clinical features of cytomegalovirus infection after severe pneumonia in immunocompetent subjects.
MethodsTwo cases of cytomegalovirus infection after severe pneumonia in immunocompetent subjects were reported and the literatures were reviewed.
ResultsTwo elderly patients were admitted to our Respiratory Intensive Care Unit for severe pneumonia and typeⅠrespiratory failure. After treatment of invasive mechanical ventilation, broad-spectrum antibiotics and steroids, their body temperature became normal with improvement of oxygenation and lung infiltrates on chest radiograph. After extubation, their oxygenation deteriorated, with extensive lung infiltrates on chest X ray. Coincidently, their blood cytomegalovirus DNA became positive and then they were treated with parenteral ganciclovir for more than 2 weeks. After that, their oxygenation and chest radiograph returned to normal. Combined with the results of the related literature, invasive mechanical ventilation and use of corticosteroids could be the risk factors of immunocompetent subjects to develop cytomegalovirus infection after severe pneumonia. The clinical characteristics include deterioration of oxygenation and extensive lung infiltrates without positive pathogenic findings of bacteria and fungi. Quantitive nucleic acid amplification tests for blood cytomegalovirus DNA, cytomegalovirus pp65 antigenemia test and histology/immunohistochemistry are recommended diagnostic tools. Valganciclovir or intravenous ganciclovir are recommended as first-line treatment for at least 2 weeks.
ConclusionsCytomegalovirus infection occurs frequently in immunocompe-tent subjects with critical illness. Cytomegalovirus pneumonia should especially be considered in patients with severe pneumonia, receiving mechanical ventilation and steroids. Early diagnosis and treatment may help improve the prognosis of these patients.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
Objective To understand the new characteristics of clinical symptoms of patients with mild COVID-19 during the prevalence of SARS-CoV-2 Omicron, and provide basis for better prevention and treatment of COVID-19.Methods A cross-sectional retrospective study was conducted with WeChat questionnaire among medical staff with COVID-19 recently, who come from the Third Affiliated Hospital of Chongqing Medical University and The Second Affiliated Hospital of Army Medical University.Results A total of 630 valid questionnaires was received. 99.2% of infected people had been vaccinated against COVID-19. 2.4% of infected persons developed pneumonia and 2.1% were hospitalized. The most common symptoms after infection were coughing (89.7%), fever (83.0%), fatigue (84.1%), headache and dizziness (75.7%), muscle soreness (72.7%), sore throat (62.1%), nasal congestion and runny nose (60.6%), expectoration (71.6%), anorexia (58.0%) and taste loss (40.2%). The incidence of gastrointestinal symptoms and cardiovascular symptoms was relatively low (17.8% and 31.0% respectively). The severity of self-reported symptoms of most infected persons was moderate or severe. The proportion of serious symptoms reported was coughing (23.8%), sore throat (27.0%), headache and dizziness (17.9%). The severity of symptoms reported by young group (<35 years old) was significantly higher than that of older group (>35 years old). Fever was the highest at 38 to 39 ℃ (52.4%). 77.0% of fever sustained for 1 to 3 days. At the time of investigation, the viral detection turned negative in 60.6% of infected people, and the time of turning negative was mostly 7 to 10 days. More than half of the infected persons still had different symptoms, among which cough (43.7%) and fatigue (23.8%) were the most common.Conclusions Most subjects with mild COVID-19 infection have obvious upper respiratory tract and systemic symptoms, the most prominent is the high incidence of cough, which has become a new feature of omicron infection. And most of the infected people have moderate to severe symptoms, and the younger ones have more severer symptoms.
