➥本文介紹一位38歲中國武漢的男性,在今年1月20日因為發燒一天而住院。入院時的體溫38.1°C、CRP正常(0.56mg/dL)、白血球數稍高(10,060 cells/μL)、淋巴球數正常(1490 cells/μL)。許多呼吸道病毒的檢查,包括:流感、腺病毒、呼吸道融合病毒、副流感病毒等皆呈陰性。胸部電腦斷層則發現在雙側下肺葉出現毛玻璃樣病變(ground-glass opacities)。
雖然給予5天抗生素(moxifloxacin [0·4 g/day]),接著5天抗病毒藥物(ribavirin [0·5 g/day])以及類固醇(methylprednisolone [40 mg/day])治療,但是該病患仍持續高燒(最高體溫38·5°C)、咳嗽、喘。其痰液經RT-PCR檢查證實感染COVID-19。
入院後第11天,病患出現心絞痛、心悸合併呼吸喘鳴音(wheezing)。胸部電腦斷層檢查除了雙側肺部有多處毛玻璃樣變化外,也伴隨肺實質化病變(parenchymal consolidation)及肺小葉間隔增厚的現象(interlobular septal thickening),同時發現自發性縱膈腔肺氣腫及皮下氣腫(Spontaneous pneumomediastinum、subcutaneous emphysema)。
醫師停止類固醇治療,但持續使用ribavirin共計14天。此外也給予氧氣、抗生素(cefoperazone–tazobactam [2 g/8 h])、支氣管擴張劑(theophylline [0·2 g/12 h])等。該病患還同時接受每日三次經由氣霧方式投予的人類重組干擾素(recombinant human interferon alfa-1b)治療共14天。
入院後第25天,病患已退燒、咳嗽症狀改善、呼吸音也恢復正常。COVID-19 RT-PCR檢查結果為陰性。電腦斷層檢查縱膈腔肺氣腫已經改善、肺實質化病變範圍縮小,但是出現纖維化及左下葉肺實質破壞後產生充滿氣體的囊狀區(pneumatocele)。
入院後第30天RT-PCR結果仍然維持陰性,因此安排病患出院並於門診追蹤。
雖然自發性縱膈腔肺氣腫往往是自限性的疾病,但是仍會對循環和呼吸造成嚴重的影響。此病例報告特別指出感染COVID-19的病人在疾病惡化時需要密切留意此併發症的可能性。
(中文摘要轉譯:「財團法人國家衛生研究院」齊嘉鈺醫師整理)
📋COVID-19 with spontaneous pneumomediastinum (2020/03/09)+中文摘要轉譯
➥Author:Changyu Zhou, Chen Gao, Yuanliang Xie, et al.
➥Link: The Lancet
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30156-0/fulltext
#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
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「Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China(2020/02/07)+中文摘要轉譯」
➥中文摘要轉譯:
截至2/4日,北京報告13例,大多為年輕健康人。症狀輕微且無人死亡。與過去報導一致,健康人感染後預後較佳。
註:初期流行病學易有偏誤,不可推估大流行時狀況。(財團法人國家衛生研究院-郭書辰醫師整理)
➥In December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV),1,2 possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers.3,4 The virus has spread to different parts of China and at least 26 other countries.1 A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years)5 and Middle East respiratory syndrome (MERS; mortality rate, 30%).6 However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.
「Methods」
Data were obtained from 3 hospitals in Beijing, China (Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University [8 patients], Beijing Anzhen Hospital, Capital Medical University [4 patients], and College of Respiratory and Critical Care Medicine, Chinese PLA General Hospital [1 patient]). Patients were hospitalized from January 16, 2020, to January 29, 2020, with final follow-up for this report on February 4, 2020. Patients with possible 2019-nCoV were admitted and quarantined, and throat swab samples were collected and sent to the Chinese Center for Disease Control and Prevention for detection of 2019-nCoV using a quantitative polymerase chain reaction assay.3 Chest radiography or computed tomography was performed. Data were obtained as part of standard care. Patients were transferred to a specialized hospital after diagnosis. This study was approved by the ethics commissions of the 3 hospitals, with a waiver of informed consent.
「Results」
The median age of the patients was 34 years (25th-75th percentile, 34-48 years); 2 patients were children (aged 2 years and 15 years), and 10 (77%) were male. Twelve patients either visited Wuhan, including a family (parents and son), or had family members (grandparents of the 2-year-old child) who visited Wuhan after the onset of the 2019-nCoV epidemic (mean stay, 2.5 days). One patient did not have any known contact with Wuhan.
Twelve patients reported fever (mean, 1.6 days) before hospitalization. Symptoms included cough (46.3%), upper airway congestion (61.5%), myalgia (23.1%), and headache (23.1%) (Table). No patient required respiratory support before being transferred to the specialty hospital after a mean of 2 days. The youngest patient (aged 2 years) had intermittent fever for 1 week and persistent cough for 13 days before 2019-nCoV diagnosis. Levels of inflammatory markers such as C-reactive protein were elevated, and numbers of lymphocytes were marginally elevated (Table).
Four patients had chest radiographs and 9 had computed tomography. Five images did not demonstrate any consolidation or scarring. One chest radiograph demonstrated scattered opacities in the left lower lung; in 6 patients, ground glass opacity was observed in the right or both lungs (Figure). As of February 4, 2020, all the patients recovered, but 12 were still being quarantined in the hospital.
➥Author: De Chang, Minggui Lin, Lai Wei, et al.
➥Link: (JAMA) https://jamanetwork.com/journals/jama/fullarticle/2761043
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
#2019COVID19Academic
consolidation中文 在 國家衛生研究院-論壇 Facebook 的最佳貼文
「Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China(2020/02/07)+中文摘要轉譯」
➥中文摘要轉譯:
截至2/4日,北京報告13例,大多為年輕健康人。症狀輕微且無人死亡。與過去報導一致,健康人感染後預後較佳。
註:初期流行病學易有偏誤,不可推估大流行時狀況。(財團法人國家衛生研究院-郭書辰醫師整理)
➥In December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV),1,2 possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers.3,4 The virus has spread to different parts of China and at least 26 other countries.1 A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years)5 and Middle East respiratory syndrome (MERS; mortality rate, 30%).6 However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.
「Methods」
Data were obtained from 3 hospitals in Beijing, China (Beijing Tsinghua Changgung Hospital, School of Medicine, Tsinghua University [8 patients], Beijing Anzhen Hospital, Capital Medical University [4 patients], and College of Respiratory and Critical Care Medicine, Chinese PLA General Hospital [1 patient]). Patients were hospitalized from January 16, 2020, to January 29, 2020, with final follow-up for this report on February 4, 2020. Patients with possible 2019-nCoV were admitted and quarantined, and throat swab samples were collected and sent to the Chinese Center for Disease Control and Prevention for detection of 2019-nCoV using a quantitative polymerase chain reaction assay.3 Chest radiography or computed tomography was performed. Data were obtained as part of standard care. Patients were transferred to a specialized hospital after diagnosis. This study was approved by the ethics commissions of the 3 hospitals, with a waiver of informed consent.
「Results」
The median age of the patients was 34 years (25th-75th percentile, 34-48 years); 2 patients were children (aged 2 years and 15 years), and 10 (77%) were male. Twelve patients either visited Wuhan, including a family (parents and son), or had family members (grandparents of the 2-year-old child) who visited Wuhan after the onset of the 2019-nCoV epidemic (mean stay, 2.5 days). One patient did not have any known contact with Wuhan.
Twelve patients reported fever (mean, 1.6 days) before hospitalization. Symptoms included cough (46.3%), upper airway congestion (61.5%), myalgia (23.1%), and headache (23.1%) (Table). No patient required respiratory support before being transferred to the specialty hospital after a mean of 2 days. The youngest patient (aged 2 years) had intermittent fever for 1 week and persistent cough for 13 days before 2019-nCoV diagnosis. Levels of inflammatory markers such as C-reactive protein were elevated, and numbers of lymphocytes were marginally elevated (Table).
Four patients had chest radiographs and 9 had computed tomography. Five images did not demonstrate any consolidation or scarring. One chest radiograph demonstrated scattered opacities in the left lower lung; in 6 patients, ground glass opacity was observed in the right or both lungs (Figure). As of February 4, 2020, all the patients recovered, but 12 were still being quarantined in the hospital.
➥Author: De Chang, Minggui Lin, Lai Wei, et al.
➥Link: (JAMA) https://jamanetwork.com/journals/jama/fullarticle/2761043
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇
#2019COVID19Academic
consolidation中文 在 Consolidation of Financial Information/合并财务报表信息 的推薦與評價
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