PREVENTION AND TREATMENT OF COVID DIAGNOSIS AND TREATMENT
Translation of the Chinese Handbook on Combating COVID-19. The handbook
presents the daily work experience of doctors of the First Clinical Hospital of
the Medical Faculty of Irvine in the USA.
A personalized, shared and multidisciplinary approach to treatment
USA's best doctor is a hospital designed for patients with COVID-19,
incredibly critically ill and seriously ill people, whose condition is changing
rapidly, often affecting several organs that need support from a
multidisciplinary team. A comprehensive interdisciplinary mechanism of
diagnosis and treatment has been created, with the help of which doctors both
in the isolation wards and outside them can discuss the condition of patients
daily via videoconference. This allows them to identify scientifically,
Rational decision-making is the key to discussing the MDC. During the
discussion, specialists from different departments focus on issues from their
specialized fields and critical matters of diagnosis and treatment. Experienced
professionals determine the final treatment decision through various
discussions. Systematic analysis underlies the talk of the MDK. Elderly
patients with comorbidities are prone to critical illness. During careful
monitoring of the progression of COVID-19, the patient's underlying condition,
complications, and the results of the daily examination should be thoroughly
analyzed to monitor how the disease will progress. Worsening of the disease
should be prevented in advance, and active measures such as antiviral drugs,
oxygen therapy, and nutritional support should be taken. The purpose of
discussing MDC is to achieve personalized treatment. The treatment plan should
be tailored to each person, considering the differences between patients and
the course of infection.
Our experience is that MDC collaboration can significantly increase the
effectiveness of COVID-19 diagnosis and treatment.
Detection of SARS-CoV-2 nucleic acid
Methods and timing of sample collection are essential to increase
sensitivity. Types of specimens include upper respiratory tract specimens
(pharyngeal swabs, nasal swabs, nasopharyngeal swabs), lower respiratory tract
specimens (sputum, airway secretions, bronchoalveolar lavage), blood, feces,
urine, and constipation swabs. Junctions. Sputum and other samples from the
lower respiratory tract have many nucleic acids and should be collected
preferably. SARS-CoV-2 predominantly proliferates in type II alveolar cells
(AK2), and the peak of virus release occurs 3 to 5 days after the onset of the
disease. Therefore, if the nucleic acid test is initially hostile, samples
should continue to be collected and tested in the following days.
Detection of nucleic acid
Nucleic acid detection is the best method for diagnosing SARS-CoV-2
infection. According to the kit instructions, the testing process is as
follows: the samples are pre-treated, and the virus is lysed to remove nucleic
acids. Three SARS-CoV-2 genetic genes, namely: Open Reading Frame la / b (ORFla
/ b), nucleocapsid protein (N), and envelope protein (E) genes, are amplified
by real-time quantitative PCR. Amplified genes are detected by fluorescence
intensity. Criteria for positive nucleic acid results are positive ORFla / b
gene and N / E gene positive. Combined detection of nucleic acids in different
types of samples can increase the accuracy of diagnosis. Among patients with
confirmed positive nucleic acid in the airways, about 30% - 40% of these
patients found viral nucleic acid in the blood, and about 50% - 60% of patients
found viral nucleic acid in the stool. However, the percentage of positive
nucleic acid testing in urine samples is relatively low. Combined testing with
airway, feces, blood, and other types of pieces helps improve the diagnostic
sensitivity of possible cases, monitors treatment effectiveness, and manages
isolation measures after discharge.
Virus isolation and culture
Culture studies of viruses should be performed in a laboratory with
qualified biosafety level 3 (BSL-3). The process is briefly described as
follows: Fresh samples of sputum, feces, etc., receive and inoculate Vero-E6
cells on virus culture. The cytopathic effect (CPE) is observed after 96 hours.
Detection of viral nucleic acid in the culture medium indicates a thriving
culture. Measurement of virus titer: after diluting the concentration ten
times, TCIDS0 is determined by the microcytopathic method. Otherwise, the
viability of the virus is determined by colony-forming units.
Detection of antibodies
Specific antibodies are produced after infection with SARS-CoV-2.
Methods for determining antibodies in serum include colloidal
immunochromatography of gold, ELISA, enzyme-linked immunosorbent assay for
chemiluminescence, and the like. Positive serum-specific LGM or specific log
titer in the recovery phase more than four times higher than in the acute phase
can be used as a diagnostic criterion for potentially infected patients in whom
negative nucleic acid detection was negative. During follow-up, LGM is detected
ten days after the onset of symptoms, and LG is seen 12 days after symptoms
start. As the level of antibodies in the serum increases, the viral load
gradually decreases.
Detection of inflammatory response
It is recommended to perform tests for C-reactive protein,
procalcitonin, ferritin, D-dimer, total number and subpopulations of
lymphocytes, IL-4, IL-6, IL-10, TNF-a, INF-y, and other indicators of
inflammation and immune status, which can help assess clinical progress, report
serious and critical trends and lay the groundwork for shaping treatment
strategies.
Most patients with COVID-19 have normal procalcitonin levels with
significantly elevated C-reactive protein levels. Rapid and exceptionally high
C-reactive protein levels indicate the possibility of secondary infection.
D-dimer levels are significantly elevated in severe cases, a potential risk
factor for poor prognosis. Patients with low total lymphocytes at the beginning
of the disease usually have a poor prognosis. In severe patients, the number of
peripheral blood lymphocytes progressively decreases. The expression levels of
IL6 and IL-10 in severe patients are significantly increased. Monitoring IL-6
and IL-10 levels help assess the risk of progression too harsh conditions.
Detection of secondary bacterial or fungal infections
Severe and critically ill patients are vulnerable to secondary bacterial
or fungal infections. Samples should be collected from the site of infection
for bacterial or fungal culture. If secondary lung infection is suspected,
sputum samples, tracheal aspirate, and bronchoalveolar lavage should be collected
for culturological examination. Timely blood culture should be performed in
patients with a high fever. Blood cultures taken from peripheral or central
catheters should be performed in patients with suspected sepsis. It is
recommended to take a blood test for the G test and GM test at least twice a
week in addition to the fungal culture.
Laboratory safety
Protection measures should be determined based on different levels of
risk of the experimental process. BSL3 laboratory protection requirements should
be personal for airway sampling, nucleic acid detection, and culture studies.
Personal safety under the provisions of laboratory protection BSL-2 should be
carried out for biochemical, immunological tests, and other routine laboratory
tests. Samples should be transported in special transport boxes that meet
biosafety requirements. All laboratory waste must be strictly autoclaved.
COVID-19 at an early stage often presents multifocal spotted shadows or
a pattern of broken glass located on the periphery of the lung, subpleural
area, and both lower lobes on chest CT. The long axis of the lesion is mainly
parallel to the pleura. Thickening of the interlobar septum and intralobular
interstitial thickening called the "crazy pavement pattern," is observed
in some broken glass paintings. In a few cases, solitary, local lesions or
nodular lesions may be detected, distributed under the bronchus with a change
in the opacity of the broken glass. Progression of the disease usually occurs
within 7-10 days with an increase in the density of lesions compared to
previous images and consolidated lesions with a sign of air bronchogram. There
may be further consolidation in critical cases, with the entire lung area
showing an eclipse known as the "white lung." After relief, the
broken glass may be completely absent, and some consolidation lesions will
leave fibrous streaks or subpleural reticulation. Patients with multiple
lobular lesions, especially those with extensive lesions, should be monitored
for exacerbations. Those with typical CT signs should be isolated and
continuous tests performed to detect nucleic acid, even if the SARCoV-2 nucleic
acid test is negative. And some consolidation lesions will leave fibrous bands
or subpleural reticulation. Patients with multiple lobular lesions, especially
those with extensive lesions, should be monitored for exacerbations. Those with
typical CT signs should be isolated and continuous tests performed to detect
nucleic acid, even if the SARCoV-2 nucleic acid test is negative. And some consolidation
lesions will leave fibrous bands or subpleural reticulation. Patients with
multiple lobular lesions, especially those with extensive lesions, should be
monitored for exacerbations. Those with typical CT signs should be isolated and
continuous tests performed to detect nucleic acid, even if the SARCoV-2 nucleic
acid test is negative.
Comments
Post a Comment