Dentists; Diabetes; Sensitivity of COVID-19 Antibody Tests (Lecture 72)
Welcome to another MedCram Covid-19 update. I wanted to take a look at India. We’ve got definitely rising total cases, and that’s because the number of daily new cases is also increasing. It also looks as though the daily new deaths in India are increasing. But despite that, the death rate is remaining relatively low and the recovery rate is relatively high.
欢迎收听MedCram Covid-19的最新课程。我想看看印度，病例总数肯定在上升，这是因为每天新病例的数量也在增加。看起来印度每天的新死亡人数正在增加。但是尽管如此，死亡率仍然相对较低，恢复率也较高。
If you look at the list of nations here where we have the United States at the top of this list at least in terms of total cases, we can see the total deaths per million population listed at 252. For India, we’re looking at around two deaths per million population. And even though India has more than three times the amount of people in this country, over a billion, the number of total tests is a fraction and the number of total tests that have been done in the United States. So it’s really unclear exactly what to make of those numbers.
如果大家看一下国家列表，至少在总病例数方面美国居首，我们可以看到每百万人口总死亡人数是252。对于印度，我们看到每百万人口约有两人死亡。尽管印度的人口数量是我们的三倍多，超过了十亿，但总测试数量只是美国的一小部分。因此，目前还不清楚究竟该如何理解那些数字。
Again, let’s look at Australia with the number of daily new cases, still very low. And this is important because Australia is headed into the winter season, and so we’ll see whether or not coronavirus makes a resurgence during that time.
我们再来看一下澳大利亚每天新病例的数量仍然非常低。这很重要，因为澳大利亚即将进入冬季，因此我们将看到在此期间冠状病毒是否会重新流行。
Things have started to open up very slowly in the United States. We can see here that the daily new cases in the United States overall is slowly drifting down and the daily deaths are also seemingly taking a similar course, but we have to remember that what we do today is not going to show up in these statistics for at least another week or two. So, let’s keep vigilant.
在美国，情况开始好转。我们可以在这里看到，美国总体上每天的新发病例正在缓慢下降，每天的死亡人数似乎也在沿着类似的方向发展，但是我们必须记住，我们今天所做的工作不会在这些统计数据中显示，至少再过一两个星期才能显示。所以，让我们保持警惕。
In Sweden, we see that the daily new cases are slowly drifting down. And the daily death seem to be taking a similar course as well.
在瑞典，我们看到每天的新病例正在缓慢下降。每天的死亡似乎也在缓慢下降。
There was an article recently in the Business Insider titled “Texas reported its highest single day increase in new COVID-19 cases as restaurants, salons and cinemas open to the public”. If you read down here, it’s unclear exactly whether or not this is related to opening up or just more testing. Abbott, the governor of Texas, expects the number of new cases to continue to see increases as the state plans to increase the amount of testing in the most high-risk areas: nursing homes, meat-packing plants, and jails. And specifically these large cases that popped up here have to do with these meat–packing facilities in the Amarillo region of the panhandle of Texas. So again, we have to watch and wait and be vigilant.
最近在《商业内幕》上有一篇文章，标题为“德州报告说，由于餐馆，沙龙和电影院向公众开放，新的COVID-19病例单日增幅最高”。如果你从这往下看，目前还不清楚这是否与开放或更多测试有关。德克萨斯州州长雅培（Abbott）预计，随着该州计划增加最高风险地区（养老院、肉品加工厂和监狱）的检测数量，新病例数将继续增加。特别是在这里突然冒出的病例，与德克萨斯州Amarillo狭长地区的这些肉类包装厂有关。再说一次，我们必须观察并保持警惕。
There’s been a lot of discussion about the sensitivity and specificity of the antibody tests. And we’ve talked about antibody test before. These are blood tests, either finger pricks or sample that is sent off for a blood test to see whether or not you have the antibody against SARS-CoV2. Well, here’s an article that was just published on April 29th in the journal of clinical virology that was comparing the four different commercially available serological assays for their sensitivity and their specificity.
关于抗体测试的敏感性和特殊性，已经进行了很多讨论。我们之前已经讨论过抗体测试。这些是验血，刺手指或者采样，确定是否具有抗SARS-CoV2的抗体。这是一篇于4月29日发表在《临床病毒学》杂志上的文章，该文章比较了四种不同的商业血清学检测方法的敏感性和特殊性。
And again, I have no relationship with any of these companies, but in this study, they took 75 sera from patients testing positive or negative by SARS-CoV2 PCR to find whether or not this was specific or sensitive and they found the different companies. There is one called Euroimmun from Germany. There’s Epitope diagnostics from the United States. There’s Mikrogen from Germany and also Viramed from Germany. And they found that the sensitivity was 86.4%, 100%, 86.4% and 77.3% respectively and they found a specificity of 96.2%, 88.7%, 100% and 100% respectively.
再说一次，我与这些公司都没有关系，但是在这项研究中，他们从SARS-CoV2 PCR检测阳性或阴性的患者中提取了75份血清，以发现这是特异性还是敏感性，他们找到了不同的公司。一个来自德国的Euroimmun公司，一个来自美国的Epitope公司，一个来自德国的Mikrogen公司，还有一个来自德国的Viramed公司。他们发现敏感性分别为86.4％，100％，86.4％和77.3％，特异性分别为96.2％，88.7％，100％和100％。
Now remember if you have a high sensitivity and the test comes out negative then you can practically rule it out. On the other hand, if you have a high specificity and the test comes back positive, then you can practically rule it in. And you can see that the second one listed, the one from the United States, the Epitope had a 100% sensitivity and that the two last ones, Mikrogen, and Viramed from Germany, had 100% specificity. I will put a link in the description below.
如果你具有很高的敏感性并且测试结果为阴性，那么实际上可以排除它。另一方面，如果你具有很高的特异性，并且测试返回阳性，那么你实际上可以将其考虑在内。你可以看到排在第二，来自美国的公司Epitope敏感性为100％，最后两个是Mikrogen和来自德国的Viramed有100％的特异性。我会在下面的说明中放置一个链接。
Here’s another interesting article that was published on May 13 in diabetes research and clinical practice. And basically what it’s looking at is something called a hemoglobin (HbA1c), which is a measure of glycosylated hemoglobin. What happens here is as the blood sugar in someone’s body is elevated for a long period of time sugar gets attached to the hemoglobin molecule. In a sense, it’s glycolated and this can be measured.
这是另一篇有趣的文章，于5月13日发表在《糖尿病研究和临床实践》杂志上。这篇文章研究一种血红蛋白（HbA1c）的物质，它测量糖基化血红蛋白。发生这种情况的原因是，人体中的血糖长时间升高后，糖会附着在血红蛋白分子上。从某种意义上说，它是糖基化的，可以测量。
Now, normally this number should be down to around five or six in somebody who does not have diabetes, but in somebody who does have diabetes and they have it uncontrolled, this number could go up to as high as 10 11 12 and even higher in some patients. And so somebody with an elevated hemoglobin A1c may have more oxidative stress and may have worse diabetes in terms of control.
通常这个数字在没有糖尿病的人中应该降至五到六个左右，但是在患有糖尿病并且他们无法控制的人中，这个数字可能会上升到10 11 12甚至更高。一些病人。因此，血红蛋白A1c升高的人在控制方面可能具有更大的氧化应激，并且糖尿病可能会恶化。
What this study seems to indicate is that what we imagine might be associated with hemoglobin A1c is truly the case. In other words, as the hemoglobin A1c goes up, the saturation of that patient goes down, which is not a good thing, serum ferritin levels, which are an indication of inflammation C-reactive protein, which is a indication of inflammation as well as the ESR or the erythrocyte sedimentation rate and fibrinogen, IL-6. All these things go up and are worse.
这项研究似乎表明，我们想象的可能与血红蛋白A1c有关。换句话说，随着血红蛋白A1c升高，该患者的饱和度降低，这可不是好事，血清铁蛋白水平，这反映炎症C反应蛋白，反映炎症、ESR或红细胞沉降率和纤维蛋白原，IL-6。所有这些事情都变得越来越糟。
And they are directly correlated with hemoglobin A1c. They also noticed that hypercoagulability is also associated with an elevated hemoglobin A1c. Not only that but the mortality rate in these patients with COVID-19 is associated with that as well. And so the conclusion that they came up with is that the hemoglobin A1c level after hospital admission is helpful in assessing inflammation hypercoagulability and prognosis of COVID-19 patients.
它们与血红蛋白A1c直接相关。他们还注意到，高凝性也与血红蛋白A1c升高有关。不仅如此，这些COVID-19患者的死亡率也与此相关。因此，他们得出的结论是，住院后的血红蛋白A1c水平有助于评估COVID-19患者的炎症高凝性和预后。
I also want to draw your attention to this article that was published in Market Watch, regarding if you need to see a dentist and what happens if you are a dentist and you want to open up, what do you need to do to make sure that you’re complying with all the laws?
我还想让大家关注一下《市场观察》上发表的这篇文章，该文章涉及是否需要看牙医以及如果你是牙医并且想要开业，你需要做什么以确保你遵守所有法律吗？
Well, this is a great article to take a look at because it goes through exactly what the issues are. The ADA is looking to the CDC for advice on exactly what needs to be done. And as of the printing of this article there really is not much from the CDC in terms of dentistry or dental visits.
这是一篇值得一看的好文章，因为它恰好解决了问题所在。 ADA正在向CDC寻求确切的建议。从本文印刷之日起，疾病预防控制中心在牙科或牙科访问方面确实没有提供多少建议。
For instance here, it says although dentist in 31 states are allowed to reopen and perform elective procedures, the CDC recommends dentists only provide emergency services. As it stands, the agency does not have any published protocol on how to safely offer non-emergency services. But even for emergency services the CDC says, “that if a surgical mask and a full face shield are not available, do not perform any emergency dental care. Refer the patient to a clinician who has the appropriate PPE.“
例如，它说，尽管允许31个州的牙医重新开放并执行选拔程序，但CDC建议牙医仅提供紧急服务。就目前而言，该机构尚未发布有关如何安全提供非紧急服务的方案。但是，即使对于急救服务，疾病预防控制中心也表示：“如果没有手术口罩和全面罩，不要进行任何急诊牙科护理。将患者转给具有适当PPE的临床医生。”
Of course, this is really important for a lot of dentist because they don’t want to have even one patient get COVID-19 from them. And that’s understandable, especially when you look at the history of HIV and how it was spread potentially back in 1993, when there was a New York Times article on this topic. And according to the story during the AIDS crisis, dentists were seen by some people as a mechanism for transmitting the deadly disease. We certainly don’t want a repeat of that.
当然，这对于许多牙医来说确实很重要，因为他们甚至不想让一个患者从他们那里染上COVID-19。这是可以理解的，尤其是当你回顾艾滋病的历史以及它在1993年的传播方式时，当时《纽约时报》发表了一篇有关该主题的文章。根据艾滋病危机期间的故事，有人把牙医视为传播致命疾病的一个途径。我们当然不希望再出现这种情况。
Now because of this vacuum in terms of the American Dental Association and the CDC, a lot of dentists have been relying on groups composed of, for instance, New York city-based periodontists, oral surgeons and general dentists like the one here in the story because they need information on what they need to do to open up their dental office.
由于美国牙科协会和疾病预防控制中心的真空，许多牙医一直依赖由例如纽约市的牙周病医生，口腔外科医生和普通牙医组成的小组因为他们需要有关开设牙科诊所所需的信息。
And as the article says there’s a number of people who are employed by dental offices and they are being furloughed or no longer employed and says here that the number of Americans working in dental offices has plunged by more than 53 percent since February.
正如文章所说，有很多人在牙科诊所工作，他们正在休假或不再工作，这里还说，自2月份以来，在牙科诊所工作的美国人数量暴跌了53％以上。
And so there’s less patients coming in the dentist have to pay more money for the PPE that is going to keep them in business and keep their patients safe. And all at the same time, there’s going to be more and more patients that aren’t going to seek dental care. And as they say here in the article, “that’s the last thing I want to see,” he said. “They could easily cause an oral health crisis if everyone stops seeing their dentists.”
由于患者人数减少了，牙医需要为PPE支付更多的钱，来使他们保持业务正常并确保患者安全。而且同时，将有越来越多的患者不再寻求牙科护理。正如他们在文章中所说的那样，“这是我最不想看到的情况，”他说。 “如果每个人都停止看牙医，他们很容易造成口腔健康危机。”
The mouth and the teeth are not detached from the body and when the teeth become inflamed, this leads to a number of problems. It can increase the risk of pneumonia and as we’ve already talked about oxidative stress is the result of infections and things of that nature. Coronary disease is connected with periodontal disease as well. So you can’t have good medical health unless you have good dental health as well.
口腔和牙齿与身体健康息息相关，当牙齿发炎时，这会导致许多问题。它会增加肺炎的风险，正如我们已经谈到的，氧化应激是感染和此类疾病的结果。冠状动脉疾病也与牙周疾病有关。因此，除非你也拥有良好的牙齿健康，否则就无法拥有良好的健康。
And I believe a problem that we have in this country is that dentistry is seen as a luxury. I mean it’s carved out. There’s a different dental insurance plan. And it seems as though that decision makers feel that it’s not essential to have good dental health and while I know that the CDC have a lot of things on their hands, I really do hope that they come up with recommendations fairly quickly that they can give to the American Dental Association to get dental offices back open because if we wait for everyone have a toothache we’re waiting way too long. Thanks for joining us.
我相信在这个国家，我们面临的一个问题是牙科被视为一种奢侈。我是说它被细化了。牙科有单独的保险计划。似乎决策者认为保持良好的牙齿健康并不重要，尽管我知道CDC手上有很多东西，但我确实希望他们能尽快提出建议，使美国牙科协会重新开放牙科诊所，因为如果我们等待所有人牙痛，我们等待的时间就太长了。感谢大家收听。
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