ABSTRACT
Objective To explore the characteristics of pathogenic bacteria and risk factors for stroke‐associated pneumonia (SAP) in senile patients in order to privide basis for early clinical intervention .Methods A retrospective study was carried out to review the clinical data of 689 SAP patients treated at a university hospital between January 1 ,2011 and December 12 ,2013 . The pathogens from sputum and their antibiotic resistance profiles were analyzed .Multivariate Logistic regression model was used to screen relevant factors for stroke‐associated pneumonia (SAP) in a case‐control analysis at 1∶1 ratio .Results Of the 684 bacterial strains isolated from sputum , 545 (79 .7% ) were gram‐negative bacteria . The top bacterial species were Pseudomonasaeruginosa,Klebsiellapneumoniae,Acinetobacterbaumannii,and Enterobacterspp.Gram‐negativebacteria were highly resistant to most of the antimicrobial agents . About 31 .8% of the Acinetobacter strains were resistant to imipenem .A total of 139 (20 .3% ) gram‐positive strains were isolated . Staphylococcus aureus was the most frequently isolated gram‐positive pathogen (51 .8% ) , of which 63 .9% were resistant to methicillin (MRSA) .Most gram‐positive bacteria were sensitive to vancomycin , teicoplanin and linezolid . Multivariate Logistic regression suggested that age ( OR = 5 .632 ) , NIH stroke scale (NIHSS) score (OR= 4 .126) ,dysphagia (OR= 3 .481) , totally bedridden (OR=3 .431) ,mechanical ventilation (OR=4 .214) ,hyperglycemia (OR=2 .076) ,hypoalbuminemia (OR=2 .008) ,and high serum cortisol (OR=1 .825) were the major risk factors for SAP in senile patients .Conclusions Multiple antibiotic‐resistant pathogens are usually identified in the senile SAP patients .Early intervention to control the risk factors of SAP is important for prevention of SAP in senile patients .
ABSTRACT
Objective To investigate the effect of plasma homocysteine (Hcy) levels and cognitive dysfunction on patients with type 2 diabetes and explore the other factors that affect cognitive function.Methods 80 patients with type 2 diabetes were selected as our subjects and they were divided into cognitive impairment group (38 cases),cognitive normal group (42 cases) according to a simple mental state scale(MMSE) score.The plasma Hcy,glycosylated hemoglobin,blood lipid,uric acid,24 h urine trace albumin were measured.Results Plasma Hcy concentration in diabetic cognitive dysfunction,non cognitive impairment group and normal control group respectively were(19.56 ± 5.23),(16.21 ± 3.27),(14.67 ± 4.27) tmol/L,and there was statistically significant difference(F =3.76,P ＜0.05).The plasma Hcy levels in diabetic cognitive impairment group was higher than that non-cognitive impairment group(P ＜ 0.05) and normal control group (P ＜ 0.01),The factors impaired cognitive function in patients with other factors included age,glycosylated hemoglobin,body mass index,diabetes duration and plasma Hcy levels,and there were negative correlation with MMSE score (r =-0.336,-0.285,-0.226,-0.392,-0.312 ; all P values were less than 0.05).Conclusion Patient's age,duration of diabetes,glycosylated hemoglobin and BMI can affect cognitive function in patients.Higher Hcy levels in patients with type 2 diabetes is a risk factor for cognitive impairment.