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Improved Kidney Function Following Physiologic Insulin Resensitization Treatment Modality 生理性胰岛素脱敏治疗方式改善肾功能
Pub Date : 2021-08-18 DOI: 10.31579/2640-1045/080
Jonathan RT Lakey, Zach Villaverde, Tori R. Tucker, M. Alexander, Scott A. Hepford
Diabetes affects millions of people worldwide and is a leading cause of amputation, blindness, neuropathy, and chronic kidney disease. Chronic kidney disease results in the prolonged impairment of kidney function. Common medications and lifestyle modifications do not eliminate the long-term complications of diabetes, because they lack the ability to restore the periodic cycle of insulin that exists in healthy physiology. Our study used a precise administration of exogenous insulin, mimicking the physiologic profile of insulin secretion, which is more effective at stabilizing cellular blood glucose uptake and reducing diabetic complications than current drug and lifestyle modifications alone. In this case study report, we evaluated three diabetic or pre-diabetic patients who showed improvements in kidney function after beginning this treatment modality. We monitored their chronic kidney disease symptoms before and after the physiological insulin resensitization (PIR) process. We showed that the patients improved in kidney function after several months based on their laboratory metrics and CKD stage classification.
糖尿病影响着全世界数百万人,是截肢、失明、神经病变和慢性肾脏疾病的主要原因。慢性肾脏疾病会导致肾功能长期受损。常见的药物和生活方式的改变并不能消除糖尿病的长期并发症,因为它们缺乏恢复健康生理中存在的胰岛素周期的能力。我们的研究使用了精确的外源性胰岛素给药,模拟了胰岛素分泌的生理特征,这在稳定细胞血糖摄取和减少糖尿病并发症方面比目前单独改变药物和生活方式更有效。在本病例研究报告中,我们评估了三名糖尿病或糖尿病前期患者,他们在开始这种治疗模式后肾功能有所改善。我们监测了他们在生理性胰岛素再敏感(PIR)过程前后的慢性肾脏疾病症状。根据实验室指标和CKD分期分类,我们发现患者在几个月后肾功能有所改善。
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引用次数: 2
Re-Print Cell Impact: Pathophysiological Mechanism of Sars-Cov-2 in the Olfactory and Gustatory System 重印细胞影响:嗅觉和味觉系统中Sars-Cov-2的病理生理机制
Pub Date : 2021-07-30 DOI: 10.31579/2640-1045/082
Juan Esteban Tafur Delgado, Geovanny Jesús Bravo Diz, Katherine Stella Humanes Moreno
Smell and taste alterations are very common in patients with COVID 19, even when we are in an asymptomatic phase of the disease, it is reported that up to 80 to 90% of patients present anosmia and ageusia as a cardinal symptom of the disease. In this manuscript we will mention the alterations and the mode of action of the Sars-cov-2 virus at the level of the nasal and buccal fossae, taking into account the alterations at the cellular level as a result of this, based on current evidence, remembering that it is still unknown. A lot about this disease and the way this virus works.
嗅觉和味觉改变在新冠肺炎患者中非常常见,即使我们处于该疾病的无症状阶段,据报道,高达80%至90%的患者将嗅觉缺失和味觉丧失作为该疾病的主要症状。在这篇手稿中,我们将提到严重急性呼吸系统综合征冠状病毒2型病毒在鼻窝和颊窝水平上的改变和作用模式,考虑到由此在细胞水平上的变化,基于目前的证据,记住这仍然是未知的。很多关于这种疾病和这种病毒的工作方式。
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引用次数: 0
Thyroid Gland Abscess: Uncommon complication 甲状腺脓肿:罕见并发症
Pub Date : 2021-06-09 DOI: 10.31579/2692-9759/075
I. Boumendil
The thyroid gland is naturally resistant to infectious processes, which explains the rarity of thyroid abscess. It represent about 0.1% of the surgical thyroid pathology. We report in this article a case of thyroid gland abscess in a 61 year-old man who was followed for diabetes and hypothyroidism with poor adherence, who consulted in emergency department for acute neck swelling. CT scan showed a fluid collection of the left thyroid lobe. The patient was operated, and histopathological examination concluded of laryngeal carcinoma associated to thyroid papillary carcinoma.
甲状腺对感染过程具有天然抵抗力,这解释了甲状腺脓肿罕见的原因。它约占甲状腺手术病理的0.1%。我们在这篇文章中报告了一个61岁男性甲状腺脓肿的病例,他被跟踪诊断为糖尿病和甲状腺功能减退,依从性差,他在急诊科咨询急性颈部肿胀。CT扫描显示左侧甲状腺叶积液。手术后病理检查为喉癌合并甲状腺乳头状癌。
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引用次数: 0
Effects of Metformin on Clinical outcomes in Patients with Type 2 Diabetes and Covid-19 二甲双胍对2型糖尿病合并新冠肺炎患者临床结局的影响
Pub Date : 2021-06-09 DOI: 10.31579/2692-9759/072
N. Mikhail
Background: The effects of metformin therapy on the prognosis of patients with coronavirus disease 2019 (COVID-19) are unclear. Objective: To review effects of metformin on clinical outcomes, particularly mortality, in patients with type 2 diabetes and COVID-19. Methods: Review of English literature by PUBMED search until April 20, 2021. Search terms included diabetes, COVID-19, metformin, Retrospective studies, meta-analyses, pertinent reviews, and consensus guidelines are reviewed. Results: All available studies in this area are retrospective. Two population-based studies did not find significant association between metformin use and susceptibility to COVID-19. Most, but not all studies, suggest that metformin use prior to hospital admission might be associated with significant decrease in mortality in patients with type 2 diabetes and COVID-19. Continuing metformin use after hospital admission did not have significant impact on COVID-19 related death but may decrease risk of acute respiratory distress syndrome (ARDS). Meanwhile, in-hospital metformin administration may be associated with approximately 4.6 times increase risk of lactic acidosis in patients with severe symptoms of COVID-19, patients taking ≥2 gm/d of metformin, and patients with estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 kg/m2. Conclusions: Although most retrospective studies suggest that metformin administration may be associated with decreased risk of COVID-19 mortality, these data should be confirmed by randomized trials. In patients with type 2 diabetes and COVID-19 admitted to the hospital, metformin use should be avoided in presence of severe symptoms of COVID-19, kidney dysfunction (eGFR < 60 ml/min/1.73m2), and in daily doses of ≥ 2 gm due to increased risk of lactic acidosis.
背景:二甲双胍治疗对2019冠状病毒病(COVID-19)患者预后的影响尚不清楚。目的:回顾二甲双胍对2型糖尿病合并COVID-19患者临床结局,特别是死亡率的影响。方法:通过PUBMED检索到2021年4月20日的英文文献。检索词包括糖尿病、COVID-19、二甲双胍、回顾性研究、荟萃分析、相关评论和共识指南。结果:该领域的所有研究均为回顾性研究。两项基于人群的研究未发现二甲双胍使用与COVID-19易感性之间存在显著关联。大多数(但不是所有)研究表明,入院前使用二甲双胍可能与2型糖尿病和COVID-19患者死亡率的显著降低有关。入院后继续使用二甲双胍对COVID-19相关死亡没有显著影响,但可能降低急性呼吸窘迫综合征(ARDS)的风险。同时,院内给药二甲双胍可能与COVID-19严重症状患者、二甲双胍服用≥2 gm/d的患者、肾小球滤过率(eGFR)估计小于60 ml/min/1.73 kg/m2的患者发生乳酸性酸中毒的风险增加约4.6倍相关。结论:尽管大多数回顾性研究表明,使用二甲双胍可能与COVID-19死亡风险降低有关,但这些数据应通过随机试验加以证实。对于入院的2型糖尿病合并COVID-19患者,如果出现严重的COVID-19症状、肾功能不全(eGFR < 60 ml/min/1.73m2),以及由于乳酸酸中毒风险增加,每日剂量≥2 gm,应避免使用二甲双胍。
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引用次数: 0
Atypical genotype in a typical phenotype 典型表型中的非典型基因型
Pub Date : 2021-06-09 DOI: 10.31579/2692-9759/068
D. Shirodkar
Introduction: Usually, onset of thelarche heralds puberty. Delayed puberty is worrisome and needs medical attention. Our patient in her late adolescence presented with primary amenorrhea, whose evaluation left us surprised. Case report: An eighteen-year-old scholastically backward girl, presented with complaints of not attaining menarche. Physical examination included a height of 156 cm(10th-25thcentile),weight 51 kg(50th centile), wide carrying angle, multiple nevi and a broad chest, however no other Turner stigmata was noted. Her sexual maturity rating (SMR) was A2P2B1 Laboratory investigations revealed increased gonadotropins (FSH:77mIU/ml; LH:25.4mIU/ml), low estradiol (14 pg/ml) and vitamin-D deficiency (21ng/ml). Ultrasonography of abdomen-pelvis showed small infantile uterus with streak ovaries. Karyotype (50 metaphases) demonstrated mosaicism [47,XXX (29)/45,X(19)/46,XX(2)]. Hormone replacement therapy and vitamin D replacement was initiated. Conclusion: 30-40% of the Turner syndrome are mosaics, the most common being 45,X/46,XX. Mosaicism is the presence of 2 or more cell lines with different chromosomal constitutions. The cell lines are derived due mostly to postzygotic mitotic nondisjunction. X/XX/XXX can present with or without classical turner stigmata. Trisomy X has a spectrum of presentation from normal menses and fertility to recurrent abortions and primary/secondary amenorrhea (primary ovarian insufficiency). Varied clinical phenotype due to three cell lines in a Turner mosaic makes this case unique.
导读:通常,青春期的开始预示着青春期的到来。青春期延迟是令人担忧的,需要医疗照顾。我们的患者在青春期晚期表现为原发性闭经,其评估结果让我们感到惊讶。病例报告:一名十八岁学习落后的女孩,因未到月经初潮而抱怨。体格检查包括身高156厘米(10 -25百分位),体重51公斤(50百分位),携带角度宽,多痣,胸部宽,但未发现其他特纳柱头。性成熟评分(SMR)为A2P2B1,实验室检查显示促性腺激素升高(FSH:77mIU/ml;LH:25.4mIU/ml),低雌二醇(14pg /ml)和维生素d缺乏(21ng/ml)。腹部-骨盆超声示小婴儿子宫伴条纹卵巢。核型(50个中期)显示嵌合[47,XXX (29)/45,X(19)/46,XX(2)]。开始了激素替代疗法和维生素D替代疗法。结论:30-40%的特纳综合征为嵌合体,以45、X/46、XX最为常见。镶嵌现象是指存在2个或更多具有不同染色体结构的细胞系。细胞系主要是由于受精卵后有丝分裂不分离而产生的。X/XX/XXX可以有或没有经典特纳柱头。X三体的表现范围从正常月经和生育到反复流产和原发性/继发性闭经(原发性卵巢功能不全)。不同的临床表型由于三个细胞系在特纳马赛克使这种情况独特。
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引用次数: 0
Relative Fat Mass, a new tool for measuring obesity, could predict the complications of type 2 diabetes 相对脂肪量是一种测量肥胖的新工具,可以预测2型糖尿病的并发症
Pub Date : 2021-06-09 DOI: 10.31579/2692-9759/074
Isabelle Jambart
Aim/background: Obesity is a chronic disease contributing to many metabolic illnesses, in particular type 2 diabetes. The Relative Fat Mass (RFM) is a tool recently introduced for obesity which better predicts the level of visceral fat than the Body Mass Index (BMI). The aim of this study is to determine whether RFM is a better predictor of the cardiometabolic risk factors and the complications of type 2 diabetes than BMI. Materials and methods: This is a cross sectional study. A list of information was collected from endocrinologists treating type 2 diabetic patients in a primary healthcare clinic and a tertiary hospital in Beirut. This list allowed us to evaluate the micro and macro vascular complications of type 2 diabetic patients, to assess their risk factors and to calculate their RFM and BMI. Results: We analyzed the data of 359 patients. Higher RFM was associated with higher systolic blood pressure (p < 0.05), and both RFM and BMI were significantly correlated to higher CRP, triglyceride levels and liver enzymes. However, the BMI was better associated with other cardiometabolic risk factors such as the total cholesterol (p = 0,003), LDL cholesterol (p = 0,002) and HbA1c (p = 0,01) than RFM. Both RFM and BMI were correlated with higher microalbuminuria (p < 0.001) but unlike BMI, higher RFM was associated with higher creatinine level (p = 0.317 versus 0.047 respectively) and therefore better linked to diabetic nephropathy than BMI. More importantly, we observed an unprecedented result, associating RFM to diabetic neuropathy: a normal RFM excludes diabetic neuropathy with a high probability of 82.5%. Furthermore, a RFM cutoff value of 30.76 in men and 43.31 in women showed an increased risk of developing diabetic neuropathy by 2.464. No association was observed between RFM and diabetic retinopathy. Conclusion: The RFM better predicts microvascular complications of diabetes than BMI except for retinopathy. It is also associated with a worse profile of metabolic syndrome. This study is unique in its discovery of the potential role of RFM as a tool which could rule out neuropathy in diabetic patients.
目的/背景:肥胖是一种慢性疾病,会导致许多代谢性疾病,尤其是2型糖尿病。相对脂肪量(RFM)是最近引入的一种针对肥胖的工具,它比身体质量指数(BMI)更能预测内脏脂肪的水平。本研究的目的是确定RFM是否比BMI更能预测心脏代谢危险因素和2型糖尿病并发症。材料与方法:这是一项横断面研究。从贝鲁特一家初级保健诊所和一家三级医院治疗2型糖尿病患者的内分泌学家那里收集了一份信息清单。该列表使我们能够评估2型糖尿病患者的微血管和大血管并发症,评估其危险因素,并计算其RFM和BMI。结果:我们分析了359例患者的资料。较高的RFM与较高的收缩压相关(p < 0.05), RFM和BMI与较高的CRP、甘油三酯水平和肝酶水平显著相关。然而,与RFM相比,BMI与其他心脏代谢危险因素如总胆固醇(p = 0.003)、低密度脂蛋白胆固醇(p = 0.002)和HbA1c (p = 0.01)的相关性更好。RFM和BMI均与较高的微量白蛋白尿相关(p < 0.001),但与BMI不同的是,较高的RFM与较高的肌酐水平相关(p分别为0.317和0.047),因此与BMI相比,RFM与糖尿病肾病的关系更好。更重要的是,我们观察到一个前所未有的结果,将RFM与糖尿病神经病变联系起来:正常的RFM排除糖尿病神经病变的概率高达82.5%。此外,男性的RFM临界值为30.76,女性为43.31,这表明糖尿病神经病变的风险增加了2.464。RFM与糖尿病视网膜病变之间无关联。结论:除视网膜病变外,RFM比BMI更能预测糖尿病微血管并发症。它还与更严重的代谢综合征有关。这项研究的独特之处在于它发现了RFM作为一种可以排除糖尿病患者神经病变的工具的潜在作用。
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引用次数: 0
Mechanistic Insights into Immunological Therapy for Targeting Diabetic Retinopathy 针对糖尿病视网膜病变的免疫治疗机制研究
Pub Date : 2021-06-09 DOI: 10.31579/2692-9759/073
I. Qamar
Diabetic retinopathy (DR) is a common complication amongst patients that have diabetes. It is a leading cause of blindness in middle age people. A large proportion of patients who have diabetes develop retinopathy. There are several immunological reasons associated with the pathophysiology of this disease. Role of several mediators that increase the oxidative stress and have a pro-inflammatory effect which leads to capillary occlusion and neovascularization (NV). Increased vasopermeability due to disruption of the blood-retinal barrier (BRB) leading to diabetic macular edema (DME). Immunotherapies utilise different compounds and target various inflammatory molecules like TNF-α and pathways such as PPARγ for treatment of this progressive disease. Inflammatory and pro-inflammatory pathways are found to have an essential role in promoting DR; therefore, targeting them provides a useful technique for curing DR.
糖尿病视网膜病变(DR)是糖尿病患者中常见的并发症。它是导致中年人失明的主要原因。糖尿病患者中有很大一部分会发展为视网膜病变。有几个免疫学原因与这种疾病的病理生理学有关。几种介质的作用,增加氧化应激并具有促炎作用,导致毛细血管闭塞和新生血管形成(NV)。血液-视网膜屏障(BRB)破裂导致血管通透性增加,导致糖尿病黄斑水肿(DME)。免疫疗法利用不同的化合物,靶向TNF-α等各种炎症分子和PPARγ等途径来治疗这种进行性疾病。炎症和促炎途径被发现在促进DR中具有重要作用;因此,靶向它们为治疗DR提供了一种有用的技术。
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引用次数: 0
Therapeutic and evolutionary characteristics of Diabetic ketosis decompensations after a decade at the University Hospital of Cotonou, Benin 在贝宁科托努大学医院十年后糖尿病酮症失代偿的治疗和进化特征
Pub Date : 2021-04-30 DOI: 10.31579/2640-1045/067
G. Jules
Aim: To evaluate the therapeutic and evolutionary aspects of diabetic ketosis decompensation, a decade after its previous report in our center. Materials and Method: This was a 3-year retrospective study, including all patients admitted from June 1, 2016 to May 31, 2019 for DKA at the Endocrinology and Metabolic Diseases Department of the National and University Hospital Hubert Koutoukou Maga (CNHU-HKM). Ketosis was defined by the presence of at least 2 acetone crosses on the urine strip. Results: A total of 196 patients were included. The mean age was 43.73 years ± 16.2 years with a sex ratio of 0.96. The prevalence of DKA was 28.99%. The main precipitating factors of DKA were infections (67.86%) and non-compliance to the treatment (29.59%). The most common infections were urogenital (23.30%), respiratory (18.04%) and malaria (32.33%). The mortality was 2.55%. Male subjects (84.36%) had blood glucose levels above 3g/L with a higher mean dose of insulin used (84.71 IU versus 54.29 IU for women p=0.008). Duration of recovery (p=0.008) and length of hospitalization (p=0.006) were statistically longer for men. Conclusion: The prevalence of ketosis decompensations remains high. The main decompensation factors found were infections and non-compliance to treatment. Improving patient care over the past decade had produced a positive impact on mortality, recovery time and length of hospitalization.
目的:评估糖尿病酮症酸中毒失代偿的治疗和进化方面,这是在我们中心上一次报道十年后。材料和方法:这是一项为期3年的回顾性研究,包括2016年6月1日至2019年5月31日在国立和大学医院Hubert Koutoukou Maga(CNHU-HKM)内分泌和代谢疾病科因DKA入院的所有患者。酮症酸中毒的定义是尿条上存在至少2个丙酮交叉。结果:共纳入196例患者。平均年龄43.73岁±16.2岁,性别比0.96。DKA的发病率为28.99%。DKA的主要诱因是感染(67.86%)和不遵守治疗(29.59%)。最常见的感染是泌尿生殖道感染(23.30%),呼吸系统(18.04%)和疟疾(32.33%)。死亡率为2.55%。男性受试者(84.36%)血糖水平高于3g/L,平均使用胰岛素剂量较高(84.71 IU,女性54.29 IU,p=0.008)。男性的恢复时间(p=0.008)和住院时间(p=0.006)在统计学上更长。结论:酮症失代偿的患病率仍然很高。发现的主要失代偿因素是感染和不遵守治疗。在过去十年中,改善患者护理对死亡率、恢复时间和住院时间产生了积极影响。
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引用次数: 0
Sonographic Abnormalities of Thyroid Gland in Post-Menopausal Women with and without Hormone Replacement Therapy 绝经后妇女接受和不接受激素替代治疗的甲状腺超声异常
Pub Date : 2021-04-30 DOI: 10.31579/2640-1045/061
Namra Adnan
Background: Thyroid dysfunction is common especially in women over the age of 50 years. The prevalence of thyroid abnormalities is more in postmenopausal women using hormone replacement therapy. The prevalence of biochemical (or subclinical) hypothyroidism in women increases steadily with age, rising from 10% to 20% in the postmenopausal. The study results clearly indicate an increase in the activities of TSH among the older-aged post-menopausal women. Objective: To compare the sonographic findings of thyroid gland in post-menopausal women with and without hormone replacement therapy. Material and Method: A review of scientific literature concerning the correlation of Sonographic abnormalities of thyroid gland in post-menopausal women with and without hormone replacement therapy was done. Different platforms including medical journals, books and online resources(e.g., PubMed, Google Scholar & Medline) were explored to find the relevant data using the mesh Terms: Thyroid gland, postmenopausal women, Hormone Replacement Therapy etc. The main focus was given to the latest data published in the last 10 years.
背景:甲状腺功能障碍是常见的,特别是在50岁以上的妇女。在使用激素替代疗法的绝经后妇女中,甲状腺异常的患病率更高。随着年龄的增长,女性生化(或亚临床)甲状腺功能减退的患病率稳步上升,在绝经后从10%上升到20%。研究结果清楚地表明,老年绝经后妇女的TSH活性增加。目的:比较绝经后妇女激素替代治疗前后甲状腺声像图表现。材料和方法:回顾有关绝经后妇女接受和不接受激素替代治疗的甲状腺超声异常相关性的科学文献。不同的平台,包括医学期刊、书籍和在线资源(例如:, PubMed,谷歌Scholar & Medline),使用网格术语:甲状腺,绝经后妇女,激素替代疗法等来查找相关数据。主要关注的是过去10年公布的最新数据。
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引用次数: 0
Sex hormones as an emerging weapon to combat COVID-19 性激素是对抗COVID-19的新武器
Pub Date : 2021-04-27 DOI: 10.31579/2640-1045/069
Q. Mehmood, Priyanka Chahal, Parth A Patel, Prasant Upadhyay, Arisha Nawaz, Debraj Mukhopadhyay, A. Corriero, D. Mukherjee, Usman Garba Kurmi, Hadiza Abubakar Balkore, Vikas Jaiswal
Coronavirus disease 2019 (COVID-19) started as an epidemic in Wuhan in 2019 and was declared pandemic by WHO in March 2020. The virus has been identified and named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This novel coronavirus strain is the causative agent of COVID-19, and continues to rapidly spread worldwide. SARS-CoV-2 is a highly pathogenic and transmissible coronavirus that spreads through respiratory droplets and unprotected close contact. “COVID‑19 outbreak, which has caused >95 million confirmed infections and >2 million coronavirus related deaths, is one of the most disastrous worldwide crises in recent years. Several methods have been used to examine SARS-CoV-2 infections.” i.e. RT-qPCR for viral RNA detection, and rapid screening procedures for antibody or virus detection. COVID-19 shows an incubation period of 3–7 days globally. Approximately 80% of the cases remain mild or asymptomatic, 15% are severe and 5% infectious cases turn to critical, requiring ventilation [2]. Several clinical trials have been proposed for its treatment and management with supportive aim of mortality reduction [1]. By glancing a view on fig 1, it can be evidently seen that COVID-19 cases have started to rise significantly since last few months. Furthermore, as per World Health Organization (WHO), there have been 131,020,967 confirmed cases of COVID-19 at a global level recently.
2019冠状病毒病(新冠肺炎)于2019年在武汉开始流行,并于2020年3月被世界卫生组织宣布为大流行。该病毒已被确认并命名为严重急性呼吸综合征冠状病毒2型(严重急性呼吸系统综合征冠状病毒-2)。这种新型冠状病毒毒株是新冠肺炎的病原体,并继续在全球迅速传播。严重急性呼吸系统综合征冠状病毒2型是一种高致病性和传染性的冠状病毒,通过呼吸道飞沫和无保护的密切接触传播。“新冠肺炎疫情已导致9500多万确诊感染和200多万冠状病毒相关死亡,是近年来全球最灾难性的危机之一。已经使用了几种方法来检测严重急性呼吸系统综合征冠状病毒2型感染。”即用于病毒RNA检测的RT-qPCR,以及用于抗体或病毒检测的快速筛查程序。新冠肺炎的潜伏期为3-7 天。大约80%的病例仍为轻度或无症状,15%为重度,5%的感染病例转为危重病例,需要通气[2]。已经提出了几项临床试验来治疗和管理它,以降低死亡率为支持目标[1]。通过浏览图1,可以明显看出,自过去几个月以来,新冠肺炎病例开始显著上升。此外,根据世界卫生组织(世界卫生组织)的数据,最近全球共有131020967例新冠肺炎确诊病例。
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引用次数: 1
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Endocrinology and disorders : open access
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