Currently, coronavirus disease 2019 (COVID-19) is still widely prevalent around the world, leading to a major threat to the global public health. COVID-19 mainly involves the respiratory system, but extrapulmonary manifestations including that of the nervous system also exist in the setting of COVID-19. Misdiagnosis and delayed treatment of the disease may easily cause when ocular, especially neuro-ophthalmological symptoms are the first symptoms in early COVID-19, as the neuroophthalmological manifestations are rarely reported. First-line clinicians need to ask about not only respiratory symptoms such as fever, cough and sore throat, but also diplopia, impaired vision, eye motion pain, abnormal gait or other neurological deficits at the first reception, as these extrapulmonary manifestations are often signs of serious infection. The neuroophthalmological manifestations and possible underlying etiology of COVID-19 were summarized in this review, hoping to provide an early identification and effective treatment of COVID-19 for clinicians. More extensive studies are needed in the future to confirm the causal relationship between COVID-19 and neuroophthalmological disease to provide a sufficient basis for a comprehensive understanding of COVID-19.
Coronavirus disease 2019 (COVID-19) is highly contagious, and the route of transmission is dominated by respiratory droplets and contact transmission. At present, the disease prevention and control are difficult. In order to prevent and control COVID-19 and prevent its spread in the hospital, West China Hospital of Sichuan University has set up isolation wards in the center of infectious diseases. The work norms for isolation ward were formulated. This may help to strengthen the prevention and treatment of COVID-19, effectively control the epidemic situation, as well as protect the health and safety of the public and medical staff. This article introduces the specific settings, diagnosis and treatment specifications, and hospital infection prevention and control strategies of the isolation ward of West China Hospital of Sichuan University, shares the work experience of isolation wards, aims to provide a reference for other hospitals to effectively prevent the spread of COVID-19 in hospitals and curb the spread of COVID-19.
Coronavirus disease 2019 has been widespread in Hubei province since the beginning of 2020. Many medical teams went to aid Hubei from the whole country. The medical team of West China Hospital of Sichuan University arrived in Jianghan district of Wuhan on January 25, 2020. As one of the earliest teams arriving Hubei, we explored the measures for infection prevention and control of resident, in order to reduce the risk for infection of medical team. The infection prevention and control experiences on the establishment of infection control team, process management, behavior management, clean disinfection, infection monitoring and emergency response and emergency response to exposure of the medical team of West China Hospital were summarized in this article.
Objective To explore the clinical characteristics of patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of different genotypes. Methods A retrospective study was conducted on 111 SARS-CoV-2 infected cases at home and abroad admitted to Chengdu Public Health Clinical Medical Center between January and September 2020. The basic information, gene sequencing results (Pangolin typing method), clinical typing, first laboratory examinations 24 hours after admission, and whether repositive after discharge were collected. According to Pangolin typing, patients were divided into five groups: A, B, B.X, B.1.X and B.1.1.X. The basic information (age, sex, and origin), laboratory test results (lymphocyte count, C-reactive protein, serum amyloid A, CD3+ T lymphocytes, CD4+ T lymphocytes, and CD8+ T lymphocytes), clinical classification and whether repositive were compared among different genotype infected patients. Results Among the 111 infected patients, 54 (48.6%) were males and 57 (51.4%) were females. Their ages ranged from 16 to 87 years, with a median age of 49 years. In terms of clinical classification, there were 10 asymptomatic cases (9.0%), 10 mild cases (9.0%), 64 ordinary cases (57.7%), 13 severe cases (11.7%), and 14 critical cases (12.6%). There were 75 domestic cases (67.6%) and 36 imported cases (32.4%). Eighty cases (72.1%) did not return to positive, and 31 cases (27.9%) returned to positive. There were 8 cases infected by type A virus, 18 cases infected by type B virus, 26 cases infected by type B.X virus, 5 cases infected by type B.1.X virus, and 54 cases infected by type B.1.1.X virus. Among patients infected by different genotype viruses, no statistically significant difference was found in sex, age, clinical type, laboratory examination, or whether repositive (P>0.05), but there was statistically significant difference in the distribution of domestic and imported cases (P=0.016). Type B virus infected patients were mostly domestic cases, while type B.X virus infected patients were mostly imported cases. Conclusion The distribution of domestic and imported cases is different among SARS-CoV-2 of different genotypes.
For patients with suspected or confirmed coronavirus disease 2019, how to take lavage fluid specimens correctly is the current clinical focus during the epidemic. At the same time, since alveolar lavage is an invasive operation of the airway, it is necessary to follow standard procedures for protection and operation to prevent occupational exposure risks of medical staff. The Department of Intensive Care Unit of West China Hospital of Sichuan University formulated the operation procedure of alveolar lavage for patients with coronavirus disease 2019 based on the original operation procedure of alveolar lavage. This article introduces the indications and contraindications of the operation procedure, preparation before operation, operation procedure and precautions, post-operation processing and operation protection for clinical reference and implementation.
Objective To investigate the adverse drug reactions (ADRs) of patients with SARS in Xiao Tang Shan Hospital. Methods We developed and distributed Drug Use Handbook and established ADRs monitoring group to guide resaonable drug use. We followed up the process and collected clinical report on ADRs. We retrospectively analyzed the data on ADRs by the classification and grade of ADRs according to WHO and Hospital Information Sysytem (HIS) of Chinese PLA General Hospital. Results We collected 193 (87 males and 106 females) patients with ADRs among 680 SARS patients with incidence rate of ADRs of 28.38%. The ADRs incidence rate was higher in females and elders. Critical SARS patients and SARS patients with diabetes were more susceptible to ADRs. Large dosage and combination of drugs may induce ADRs. Steroids may be a main cause of ADRs. The ADRs incidence rate induced by injection was higher than that induced by all kinds of oral drugs. ADRs mainly happened in hematological, endocrine and digestive systems. Conclusion SARS patients are prescribed many kinds of medications. Large dosage of so many medications may lend to high incidence rate of ADRs. Steroid should be cautiously used in the treatment of SARS.
Objective To analyze the effective measures to intercept the infection chain of Severe Acute Respiratory Syndrome (SARS), and to study the effective methods for prevention and control. Methods A total of 17 clinically diagnosed SARS cases, 6 suspect cases and 202 people closely contacted with case were dealt with differently according to appropriate criteria, and 144 medical staff was given timely safety measures. Results One of seventeenth cases was diagnosed after its death, and the rest were isolated and treated, and among them 1 died, 9 were cured, and 6 were improved obviously. Six suspect cases were separated and treated in hospital, 5 were cured and 1 improved obviously. Among 202 closely contacted people there were no the secondary infected cases, and neither among all the related medical staff and other people. Conclusion To analyze seriously the infection chain and take effective and feasible interceptive measures are the best approach to prevent and control the spread of SARS and avoid the occurrence of the secondary infected cases.
At present a better way for the treatment of SARS is to search and apply the best evidence that comes from the same kind of diseases and symptoms in the past and include personal experiences of clinicians. The intervention should be adjusted with the development of basic research. In this paper the important of projects are predicted and necessity of randomized controlled trials are discussed emphasizing scientific value of case reports and case series for such disease. It is essential to well justify priority and integrate resources for the trials against SARS.
At present, there are few studies on patients with epilepsy (PWE) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and the results of many studies are inconsistent. SARS-CoV-2 may cause new seizures through a variety of mechanisms, and the susceptibility and mortality of PWE to SARS-CoV-2 remains controversial. During the SARS-CoV-2 pandemic, anxiety, depression and other psychological problems were common among epileptic patients. Clinicians providing telemedicine, telephone chat and video call can effectively reduce the risk of psychological disorders in PWE patients. At the same time, there are many interactions between antiepileptic drugs and various antiviral drugs, which should be carefully considered when using. Considering that the research results are few and many studies contradict each other, PWE and SARS-CoV-2 deserve further exploration in future studies.
Objective To study the efficacy of invasive ventilation in critical severe acute respiratory syndrome (SARS). Methods Retrospective analysis was applied to study the efficacy of invasive ventilation and the effect of isolating and protecting measures in 6 critical SARS patients and the effect of isolation measures in ICU from November 2002 to April 2003. Results Six SARS patients were successfully weaned from mechanical ventilation and left hospital. Hypoxemia and oxygenation index（PaO2/FiO2）improved significantly after ventilation (Plt;0.01), peak inspiratory airway pressure (P=0.002), mean airway pressure (P=0.004), and the level of positive expiration end pressure decreased significantly (Plt;0.001). Ventilator-associated pneumonia occurred in 5 patients. Sedatives were used less and the duration of ventilation was shorter when using PRVC compared with SIMV. There was no SARS nosocomial infection among medical staff, other patients and their families. Conclusions Application of invasive ventilation and effective isolation measures could reduce the death rate, shorten the duration of ventilation, and also decrease SARS nosocomial infection.