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Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.
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Objective To observe the influencing factors of polysomnography (PSG) monitoring and to evaluate the efficacy of preventive measures.Methods We selected 205 patients with sleep apnea syndrome (SAS) who accepted PSG from May 2011 to April 2012 in our hospital as the intervention group.They were administered preventive measures,including psychological counseling,intensive grease dispelling of patient skin,arrangement of sensor and electrode.One hundred and fifty-two SAS patients who were administered PSG from May 2010 to April 2011 were selected as the control group.The monitoring successful rates between groups were compared and influencing factors were investigated.Results The monitoring successful rates of control group and the intervention group were 92.1％ and 97.1％ respectively; there was a statistically significant difference between the successful rates of the two groups (x2 =4.499,P ＜ 0.05).The main causes for unsuccessful monitoring were difficulty falling asleep,electrode distortion and high impedance of electrode.Conclusion PSG monitoring has a complex operating procedure and is time-consuming and effective preventive measures can improve the successful rate of PSG.
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Objective To reveal the differences in clinical characteristics between health care associated pneumonia (HCAP) and community acquired pneumonia (CAP) in elderly patients.Methods A total of 282 elderly patients were evaluated,including 69 patients with HCAP (25.5％) and 213 with CAP (75.5％).A retrospective observational study was conducted.The baseline characteristics,comorbidities,pathogen distribution,antibiotics,and clinical outcomes between HCAP and CAP patients were compared.Results The incidence of chronic obstructive pulmonary diseases and cerebrovascular diseases were higher in HCAP group (49 cases,71.0％; 36 cases,52.2％) than in CAP group (93 cases,43.7％; 57 cases,26.8％) (x2 =15.598,15.229,all P＜0.001).The infection of Pseudomonas aeruginosa (29 cases,51.8％),Staphylococcus aureus (19cases,34.0％) and Acinetobacter baumannii (18 cases,32.1％) in HCAP group were more than in CAP group [(26 cases,27.7％),(12 cases,2.8％),(8 cases,8.5％),(x2 =8.796,9.586,13.678,all P＜0.05)],respectively.While the infection of Streptococcus pneumoniae (38 cases,40.4％) in CAP group was much more than in HCAP group (4 cases,7.1％)(x2 =19.283,P＜0.001).Initial inappropriate antibiotics treatment failure was more frequent in HCAP group (24 cases,34.8％) than in CAP group (37 cases,17.3％)(x2=9.321,P＜0.05).The mortality was higher in HCAP group (19 cases,27.5％) than in CAP group (29 cases,13.6％)(x2 =7.151,P＜0.05).Conclusions HCAP should be distinguished from CAP in elderly,which is helpful to choose appropriate empirical anti-infective regimen and improve the effect of HCAP treatment.
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@#ObjectiveTo investigate the change of the level of testosterone and CD4+/CD8+ T cell in long-term mechanical ventilation patients with chronic obstructive pulmonary disease (COPD) and their correlation.MethodsThe level of testosterone, count of CD4+ and CD8+ T cell were measured in 42 COPD patients accepted long-term mechanical ventilation and other 34 stable COPD patients. The ratio of CD4+/CD8+ was calculated.The correlation between testosterone and CD4+/CD8+ was analyzed.ResultsCompared with the stabel COPD, there were significantly differences in the level of testosterone and the ratio of CD4+/CD8+ in long-term mechanical ventilation COPD group(P<0.05), but there was not relationship between them.ConclusionThe level of testosterone and the ratio of CD4+/CD8+ were significantly decreased in COPD patients with long-term mechanical ventilation. There is no correlation between the level of testosterone and the ratio of CD4+/CD8+.
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0.05).The prognosis was worse with increase in Dukes stage,negative expression of gene nm23,and positive expression of gene p53 and C-erb-2.Reverse expressions had better prognosis.Conclusions It can be likely to get a more reliable prognosis predication if a combine examination together with p53,C-erb-2,nm23 and their clinical pathology such as Dukes stages,was done in colorectal cancer patients.
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The widely application of the radio knife alleviates the patient's pain and improve the medical quality.The radio knife is high frequency power equipment based on the theory that electricity concentrates on the skin.It can directly cut the tissue,homeostasis and cauterize.The safety requirement of this equipment is very strict because unsafe operation will burn the tissue,cause temporal unaware hurt and even endanger the patient's life.If the safety support system is imperfect,disastrous loss or medical conflict will be caused.Users must be cautious in using and familiar with the safety and protection of the radio knife.[Chinese Medical Equipment Journal,2008,29(2):96-98,104]
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Objective To find out the distribution and changing trend of pathogens in positive blood cultures. Methods To analyze 183 isolates from 2010 blood specimens then the results were compared with the relative clinical data. Results A total of 183 strains were isolated from all blood specimens, of which 139 strains (76.0%) were identified as pathogens, where 69 strains (49.6%)being Gram-positive cocci, 57 strains (41.0%) gram-negative bacilli, and 13 strains (9.4%) fungi, respectively. The other 44 strains (24.0%) were contaminated. The major pathogens in 139 strains were Coagulase-negative staphylococci (40 strains, 28.8%), Pseudomonas aeruginosa (17 strains, 12.2%), Escherichia coli (15 strains, 10.8%), fungi 13 strains (9.4%) and Staphylococcus aureus (9 strains, 6.5%). Conclusion The dominant pathogens in positive blood cultures were gram-positive cocci, while gram-negative bacilli cultures were becoming less.