(Original Title: Dean of Jinyintan Hospital: Anti-Medical Clizhi has a promising future, and the clinical effect of Radixivir is obvious)
Suffering from icy fever, his wife was infected, and he was on the front line of treatment. It was difficult for Zhang Dingyu to get out. However, both for doctors and the general public, the clinical medication and treatment after infection are extremely valuable experiences to be exchanged.
Jinyintan Hospital is a specialist hospital for infectious diseases in Wuhan. As the director, Zhang Dingyu led the team to conduct an epidemiological investigation on the first 7 patients with unknown pneumonia transferred on December 29, 2019, and collected bronchoalveolar lavage fluid samples for inspection . He also used the anti-AIDS drug clizar for the treatment of severe cases of the new coronavirus pneumonia.
Recently, the North American Chinese doctor group invited Dean Zhang Dingyu to share the medicine and treatment experience of New Crown. "Mr. Sai" was compiled and slightly edited based on the shared recording. The content has not been reviewed by me.
abstract:
1. Kelizhi is the main drug that many first-line doctors like, which can reduce the conversion rate from severe to critical illness.
The main side effects of Kelizhi are gastrointestinal, nausea, vomiting, and diarrhea; this drug does not respond so strongly in the treatment of AIDS, but patients with neocoronary pneumonia respond very strongly. The other is that the heart rate slows down, so be careful of taking beta blockers, and interact with certain antihypertensive drugs and hypoglycemic drugs.
People with AIDS who took this medicine had a lower infection rate of new crown pneumonia; more than a thousand cases were tracked, and only 3-5 cases were infected with new crown pneumonia.
2. The clinical trial of Redecide is still in progress, and it is administered in a ratio of 2: 1, which means that twice as many people in the experiment are given to placebo patients. Although it is double-blind, it can be seen that the obvious effect is to reduce the deterioration of the severe group to the critical group.
3. Once in critically ill patients, ECMO is rarely extubated (high mortality). Unlike bird flu, the latter can be extubated within 3-5 days.
4. Plasma therapy: It is effective for critically ill patients, and critically ill patients can maintain a longer blood oxygen concentration.
5. Some patients found that the throat swab was negative, but the anal swab was still positive.
6. The course of patients with new coronary pneumonia is from bottom to top, that is, the disease starts from the bottom of the lung and then progresses upward (this may be why there are no upper respiratory symptoms in the early stage), mainly the exudation of the interstitial, and then the consolidation of the lungs.
Anti-AIDS drug Cleeve has promise, but beware of adverse reactions
The main thing I want to introduce is the clinical research of medicines that we carry out. After the patient comes, the key is that there is no medicine available.
The earliest we came into contact with Kelizhi (Lopinavir / Ritonavir) came from Professor Cao Bin of the China-Japan Friendship Hospital. He recommended this product to us. It happens that we are another "anti-AIDS" hospital. We have Cleeve in hand. Later, after our hospital passed the ethical review of the hospital, we initiated a clinical study, which was to compare the use of clef and no clef, because there was no placebo to use, so an open the study.
So far, nearly 202 cases have been enrolled, two or three cases have "shedded", and only 198 cases have been enrolled. It seems that (Kelizhi) can still reduce mortality and reduce the incidence of critical cases.
During the study, we collected anus swabs, throat swabs, and blood samples from patients. The collection time was before medication, 5 days and 10 days after medication, and 15 days and 24 days follow-up if the patient was not discharged. Some tests on anal swabs, throat swabs, and blood samples have not yet been started. It is estimated that we will discuss a test plan for these tests tomorrow. We leave these samples mainly to see some changes in viral load and blood antibodies.
We are quite confident in the use of Climax, although at the beginning we had great hopes for it, and when it was used in the middle, there were some doubts about it because of some adverse reactions. Until now, it feels like it is a very promising medicine against new coronary pneumonia.
Its main adverse reaction is still gastrointestinal.
Gastrointestinal reactions, followed by diarrhea, nausea, and vomiting. I don't know why there are so many gastrointestinal reactions in patients with new coronary pneumonia. In fact, this medicine is used in people with AIDS. There are not so many serious gastrointestinal reactions. Although there are some, the patients are basically tolerable. Many patients in this case could not tolerate gastrointestinal reactions.
Another problem with this medicine is the interactions it causes.
Some hypoglycemic drugs or beta blockers and other antihypertensive drugs, these drugs cause some blood concentrations to increase (problems). For example, beta blockers increase blood concentrations and slow down heart rate. One of my clerks was eating clef and beta-blockers at the same time. One day my heart rate suddenly dropped to 30-40 times. I was frightened so we were especially vigilant. Some (adverse reactions).
Be particularly alert to its adverse effects. Adverse reactions include gastrointestinal reactions, and the drug itself can cause heart rate to slow down because it prolongs the QT interval (refers to the time between q wave and t wave in the ECG, which is usually between 0.32 and 0.44s, Greater than 0.44s is the extension of the qt interval) or for other reasons, this section may require special care.
This is also two weeks after using (Creature), I also reminded on different occasions that our colleagues must be careful when using drugs.
Less HIV infection
There is another very important reason for paying attention to clitoris, which is our observation during the epidemic of new crown pneumonia.
More than 5,000 people in Wuhan are taking anti-AIDS drugs, because Kelly is used as a second-line drug for AIDS, and only more than 600 of these people have taken Kelly.
We followed up nearly 1,000 HIV-infected people, only 3 to 5 of the 1,000 people. The exact number, I do n’t remember right now, we are still doing it. Among these people, there are currently only 3 to 5 people with HIV infection, at least Less than 10 people have the infection, which is far lower than that of ordinary citizens.
In addition, the reason I admire Kelizhi is related to my own experience. Because I have a icing disease, after taking Dotti Abalavi, I have not been infected. It happened because my wife was infected, and I had very close contact with her, but I was not infected, so I believe that anti-AIDS drugs may have the effect of inhibiting virus replication.
We are currently planning to complete the follow-up of more than 5,000 people living with HIV. 1,000 have been done, and after the follow-up work of more than 4,000 HIV-infected people is completed, there will be more detailed evidence to prove the combined use of anti-AIDS, anti-reverse transcriptase inhibitors and protease inhibitors, In fact, it can prevent the replication of the new crown virus.
Regarding Abidol, we have no experience in using it, but experts are promoting it in the media and admiring this product, so we do n’t have much say in this matter. We don't know much about it.
Clinical Studies of Redecide
Redecive has conducted clinical research based on our hospital.
Our overall target enrollment is about 400 cases of severe cases and 300 cases of mild cases. The current enrollment situation is a 2: 1 ratio of administration, which means that the number of people in the active drug group is slightly larger and the number of people in the placebo group is smaller. However, the clinical doctor can actually feel which medicine is a placebo and which medicine is an active medicine. The overall effect of Radixivir is still relatively obvious, and it can prevent the serious condition from sliding to the critical condition.
Treatment of severe and critical illness
The key to current clinical treatment is the critical illness.
Critically ill so far, there should be no good way. In fact, as far as patients who have been tracheally intubated have rarely been able to successfully extubate. Therefore, the treatment of critical illness is a huge bottleneck. Patients who have been treated with ECMO (Extracorporeal Membrane Oxygenation, commonly known as "Yeke Membrane" and "Artificial Lungs"), they just heard that Professor Peng Zhiyong of Central South Hospital had a patient who had survived, and the others did not see alive Of patients, especially looking forward to a medicine that can prevent slipping to critically ill.
Kelizhi's words seem to have such a role. We have a few very typical cases, although the evidence is not strong. In a typical case, after using Kelizhi, his entire course was relatively long, and the entire lung was very damaged. Until now, the patient could not escape from oxygen, but could survive. His entire lung injury was very serious, and he is now in the absorption stage of fibrosis. Until now, he can only meet the respiratory exchange under the state of inhaling oxygen. We speculate that if this kind of patient did not use Kelizhi, he would probably have died.
During the same period, a control patient of ours actually recommended him to use Clevis because of his gastrointestinal reaction, and he did not insist on taking it for only two days. Later, this patient also had an endotracheal intubation and had an artificial lung, but the patient eventually died.
Regarding the case fatality rate, the overall data (of our hospital) should be higher than the current case fatality rate of Wuhan as a whole, which is more related to the critically ill patients we treat.
Plasma treatment was started at this time.
Our longest patient use is only 5 days. A total of 6 patients have been used, 4 of them are critically ill, and two are critically ill. The overall feeling is okay, how to call it okay? One is that the blood oxygen condition has been improved; the other is that the lymphocytes have recovered. Spontaneous symptoms of critically ill patients feel better, and they can also see their mental state better. After the use of recovery plasma in critically ill patients, the situation also improved slightly, that is, the blood oxygen can be maintained when the same breathing parameters are used. Because in fact, many patients who have undergone tracheal intubation, we can see that it is sliding down the abyss step by step, and it is an irreversible process.
Nucleic acid false negatives may be a problem with sampling
The standard of rehabilitation is still the national fifth edition of the diagnosis and treatment program, which is twice nucleic acid negative, the patient has no fever for three days, and the symptoms of spontaneous improvement, even if rehabilitation. In these patients, throat swabs were negative after recovery, but anal swabs (us) did not.
Earlier we did a group of patient's anal swabs and throat swabs. Not for discharged patients, but for discharged patients.
Those patients are more than ten days after onset, 10 to 15 days, or even 25 days. They are patients after 10 days of hospitalization. At this time we found that his throat swab was negative, but his anal swab was positive.
Actually very early, when we did nucleic acid and antibody (detection) on January 10 and January 15, so this data should be relatively complete. We also recommend this data to others. Now some experts are beginning to pay attention to the problem of anal swabs. In fact, this phenomenon has existed very early.
One of our earliest critically ill patients was also a famous patient of ours. After he was transferred, because he had been intubated, we obtained the secretion of his hood and performed a few throat swabs. Nucleic acid in the secretions of the respiratory tract was negative, but his anal swab detected high copy number nucleic acid in his stool. These early tests were conducted in conjunction with the Wuhan Institute of Virology, Chinese Academy of Sciences, which was carried out in another laboratory under Researcher Shi Zhengli and in Researcher Zhou Peng's laboratory.
Regarding the problem of low PCR positive rate, I think it should be the problem of sampling. This goes back to the problem found in our earliest case.
In our first group of 7 patients, it was at that time that I learned that the Wuhan CDC had performed nucleic acid tests on these patients with throat swabs, and all of them were negative. At the time, it was Wuhan CDC that had the ability to detect nucleic acids. This nucleic acid was a nucleic acid covering SARS coronavirus at the time, and actually detected SARS coronavirus. If the nucleic acid of SARS coronavirus was detected at that time, it should also be partially positive.
So I heard at the time that after the nucleic acid was not found in the throat swab, we all performed alveolar lavage on all 7 patients. As a result of alveolar lavage, there were two in Wuhan CDC and one in Wuhan Virus, and two patients were detected at the same time, all of which were positive. Later, the Wuhan Institute of Virology detected another three SARS coronavirus positive.
A little bit later, other adjusted detection methods used by Wuhan Virus, in fact, all seven patients, that is, all patients were positive for nucleic acid. So I believe that (these false negatives) should be a matter of sampling.
The lesion starts at the bottom of the lung
But we can't do all patients with alveolar lavage. The patient's infection, the coronavirus infection, seems to reach the bottom of the lung first, from the end of the lung, the infection in the alveoli, and the infected virus will not reach the upper respiratory tract until it reaches the pharynx, not from top to bottom. . It feels like bottom to top.
This feeling is also a feeling of Professor Zhao Jianping of Wuhan Tongji Hospital. He also felt the same when he read the radiograph. It feels that these patients in the early stage only had such an infection with a few viruses on the bottom of the lungs, and changed into frost-like glass. Later, they reinfected one by one, and gradually became a so-called white lung. .
The white lung is different from other exudative changes in the past, it is mainly some interstitial changes, which causes the patient to have a dry cough. If there is no bacterial infection, all patients have a dry cough, it has no sputum, and it does not produce sputum. The change of white lung is mainly a consolidation process caused by some exudates of the interstitial, rather than a change of true exudation.
This has to go back to the critical patient rescue we just said. In 17 years, our hospital also treated a large number of avian flu patients. The secretions of avian flu patients were very large. After you gave him a membrane lung, many patients could quickly withdraw from the hospital within 3-5 days. After the use of upper membrane lungs, the patient's change is one change a day. It quickly starts to become white lungs, and the lungs will soon become translucent. After the end, they gradually absorb. After 5 days, 6 days, or even a week, many patients will Machine, are able to retract the membrane lung.
