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Resumen: Objetivo: Determinar los costos directos e indirectos en la Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia «Lomas Verdes¼ de la patología del trauma complejo de mano calificado como riesgo de trabajo. Material y métodos: Se analizaron 50 expedientes clínicos completos con diagnóstico de trauma complejo de mano de Enero de 2019 a Agosto de 2020. La perspectiva del estudio es determinar los costos de la atención médica del trauma complejo de mano en trabajadores activos. Resultados: Se revisaron 50 expedientes clínicos de pacientes con diagnóstico clínico y radiológico de trauma severo de mano, trabajadores asegurados con dictamen de riesgo de trabajo. Conclusión: La presencia de estas lesiones en la edad activa de nuestros pacientes nos habla de la gran importancia que conlleva una atención oportuna y adecuada del trauma severo de mano, que impacta de manera importante en la economía del país. De ahí de la gran necesidad de establecer métodos de prevención de dichas lesiones en las empresas y la necesidad de establecer protocolos de atención médica para estas lesiones y buscar disminuir los procedimientos quirúrgicos para resolver esta patología.
Abstract: Objective: To determine the direct and indirect costs in the High Specialty Medical Unit Hospital de Traumatology y Orthopedic «Lomas Verdes¼ of the pathology of complex hand trauma classified as occupational risk. Material and methods: 50 complete clinical records with a diagnosis of complex hand trauma were analyzed from January 2019 to August 2020. The perspective of the study is to determine the costs of medical care for complex hand trauma in active workers. Results: 50 clinical records of patients with clinical and radiological diagnosis of trauma severe de mano, insured workers with a work risk opinion, were reviewed. Conclusion: The presence of these injuries in the active age of our patients speaks to us of the great importance of timely and adequate care for severe hand trauma, which has a significant impact on the country's economy. Hence the great need to establish methods of prevention of such injuries in companies and the need to establish medical care protocols for these injuries and seek to reduce surgical procedures to resolve this pathology.
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@#Abstract: Objective To observe the expression of peripheral blood stimulating molecules CD80 and CD86 in children with severe hand, foot, and mouth disease (HFMD), and to analyze the relationship between them and the therapeutic effects of children. Methods The clinical data of 252 children with severe HFMD treated in Wuhan Hospital of Traditional Chinese Medicine from March 2017 to March 2021 were collected retrospectively. All children were treated with standardized treatment and the therapeutic effects was evaluated. The baseline data and laboratory test results of children were recorded, and the positive rates of CD80 and CD86 cells in peripheral blood were detected by flow cytometry. Logistic regression was used to analyze the relationship between the above indexes and the therapeutic effects of children. The receiver operating curve (ROC) was drawn to evaluate the value of the above indicators in predicting the therapeutic effects of children. Results After standardized treatment, 48 children were ineffective, and 204 children were effective; the levels of serum CD80 [(2.28±0.84)% vs (2.12±0.33 )%] and CD86 [(3.35±0.96)% vs (2.23±0.41)%] in children were significantly lower than those at admission (t=2.851, 16.991; P<0.05). The levels of blood lactic acid, serum C-reactive protein (CRP), matrix metalloproteinase-9 (MMP-9), CD80 and CD86 at admission in the ineffective group were significantly higher than those of the effective group (P<0.05). Logistic regression analysis showed that the overexpression of serum CRP (OR=10.929), MMP-9 (OR=1.926), CD80 (OR=3.943) and CD86 (OR=1.947) at admission might be the risk factors of ineffective (all P<0.05). The results of the goodness of fit test for the model showed that, the goodness of fit was high (χ2=6.245, P=0.620); the model collinearity results showed that the variance inflation factors (VIF) values of each variable were <2, and there was no collinearity among the main indicators; the results of the individual independence test for the model showed that Durbin-Watson statistics (D-W)=0.279 and there was poor mutual independence among main indicators. ROC curve analysis showed that the area under the curve(AUC) of serum CD80 at admission in predicting the therapeutic effects of children was 0.762, the cut-off value was 2.390%, and the specificity, sensitivity and Youden index were 0.598, 0792 and 0.390 respectively; the AUC predicted by CD86 was 0.739, the cut-off value was 3.280%, and the specificity, sensitivity and Youden index were 0.510, 0.896 and 0.406 respectively; the AUC by combined prediction was 0.823, and the specificity, sensitivity and Youden index were 0.696, 0.833 and 0.529 respectively. Conclusions Peripheral blood stimulating molecules CD80 and CD86 are involved in the progression of HFMD. Their overexpression may suggest a high risk of treatment ineffectiveness in children with severe HFMD. Early dynamic monitoring of the expression of serum CD80 and CD86 has a certain predictive value for the therapeutic effect of children.
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Objective:To explore the clinical significance of serum Chromogranin A (CGA) level in predicting the prognosis of children with severe hand, foot, and mouth disease (HFMD) and complicating neurogenic pulmonary edema (NPE).Methods:A total of 162 patients with HFMD admitted in our hospital from January 2017 to December 2019 were enrolled in the study; and 40 age-matched healthy children were selected as controls. According to the disease severity and complication the patients were divided into three groups: mild group ( n=88), severe without NPE group ( n=46) and severe with NPE group ( n=28). In 72 severe HFMD patients 16 cases died (fatal group) and 56 cases survived (survival group) within 28 days of hospitalization. The serum CGA, LAC, GLU, WBC, PCT, IL-6, cTnT were measured in all subjects. SPSS 23.0 software was used for data analysis, and the receiver operating characteristic (ROC) curve was used to evaluate the various indicators for predicting the prognosis of severe HFMD combined with NPE. Results:The serum CGA, GLU, LAC, IL-6 and cTnT levels in severe HFMD group with NPE significantly higher than those in the other three group ( H=61.554, 79.031, 86.994, 36.477, 75.021, all P<0.05 ). The serum CGA, LAC, GLU and IL-6 levels in the fatal group were significantly higher than those in survival group ( Z=-6.094, -4.621, -4.283, -5.504, all P<0.05). There was no significant difference in the levels of WBC, PCT and cTnT between the survival group and the fatal group ( P>0.05). The area under the receiver operating curve (AUC) of serum CGA was 0.890 (95% CI: 0.833-0.947) for predicting the prognosis of patients and the best cut-off value was 120.59 μg/L. Conclusion:The detection of serum CGA levels may be beneficial for the early diagnosis of severe HFMD with NPE, and can be used as one of the predictors of death from severe HFMD.
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Objective@#To analyze the predictive value of the mortality risk score for severe hand, foot and mouth disease(MRSHFMD) system for the complications and mortality risk of severe hand, foot and mouth disease(HFMD) in children.@*Methods@#This study included 354 children with severe HFMD who admitted in the pediatric intensive care unit(PICU) of Hunan Provincial Children′s Hospital from March 2012 to March 2014.The patients were grouped according to whether they had complicated nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure in the course of disease, and the prognosis was grouped according to their 28 d survival.The worst values of white blood cell count, blood glucose, blood lactic acid, N-terminal pro-brain natriuretic peptide, within 24 hours after admission were used to score MRSHFMD.The predictive value of MRSHFMD for nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure, and prognosis were evaluated using the receiver operating characteristic(ROC)curve.@*Results@#The blood glucose, white blood cell count, blood lactic acid value, N-terminal pro-brain natriuretic peptide and MRSHFMD score of the children with HFMD complicated with nervous system damage, pulmonary edema, pulmonary hemorrhage and circulatory failure were significantly higher than those in the non-complicated groups(P<0.01). When the cut-off value of MRSHFMD score was 3, the area (95%CI) under the ROC curve were 0.723 (0.643-0.804), 0.870 (0.793-0.946), 0.921 (0.85-0.992), 0.944 (0.867-1.000) and 0.954 (0.000-1.000) of nervous system damage, pulmonary edema, pulmonary hemorrhage, circulation failure and death in children with HFMD, respectively.The specificity and sensitivity of predicting nervous system damage, pulmonary edema, pulmonary hemorrhage, circulatory failure and death were 44.6% and 95.8%; 67.5% and 95.5%; 83.3% and 95.1%; 89.3% and 95.1%; 90.9% and 93.7%, respectively.@*Conclusion@#MRSHFMD system is an effective tool to predict HFMD complications of pulmonary hemorrhage, circulatory failure, and death, which is worthy of clinical promotion.
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OBJECTIVE@#To observe the effect of acupuncture combined with conventional symptomatic and supportive treatments on swallowing function and nutritional status in children with severe hand foot and mouth disease complicated with dysphagia.@*METHODS@#A total of 68 children with severe hand foot and mouth disease complicated with dysphagia were randomized into an observation group and a control group, 34 cases in each one. Symptomatic and supportive treatments such as lowering temperature, tranquilizing and mechanical ventilation were adopted in the control group. On the basis of the treatments in the control group, acupuncture was applied at Lianquan (CV 23), Jialianquan (Extra), cervical Jiaji (EX-B 2), Fengfu (GV 16), Fengchi (GB 20), Yamen (GV 15), scalp motor and sensory areas in the observation group, once a day, 6 times a week, one month as a course and totally 3 courses were required. Time spent on restoring swallowing function was observed in both groups. Besides, score of dysphagia disorder survey (DDS) and nutritional status were evaluated before and after treatment, and the clinical effects were compared.@*RESULTS@#The total effective rate was 91.2% (31/34) in the observation group, which was superior to 73.5% (25/34) in the control group (<0.05). The time of restoring swallowing function in the observation group was advanced than the control group (<0.05). Compared before treatment, the DDS scores after treatment were decreased in both groups, and the reduction in the observation group was larger than the control group (all <0.05). After the treatment, the normal rate of nutritional status was 61.8% (21/34) in the observation group, which was superior to 32.4% (11/34) in the control group (<0.05).@*CONCLUSION@#On the basis of conventional treatment, acupuncture can effectively treat the severe hand foot and mouth disease complicated with dysphagia, improve the swallowing function and nutritional status.
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Child , Humans , Acupuncture Points , Acupuncture Therapy , Deglutition Disorders , Therapeutics , Hand, Foot and Mouth Disease , Therapeutics , Treatment OutcomeABSTRACT
Objective To observe the neuro-protective effect of Levocarnitine on severe hand,foot and mouth disease (HFMD) after enterovirus 71 (EV71) infection,to preliminarily explore the possible mechanism preliminarily.Methods One hundred and thirty-two children with EV71 infection and HFMD combined with serum S100 protein and neuronspecific enolase (NSE) abnormalities who were admitted to Chihlren's Hospital Affiliated to Zhengzhou University from March 2015 to July 2016 were enrolled in the study.They were divided into the routine group and the Levocarnitine group by the random number grouping method.The routine group (66 cases,including 32 males and 34 females,median age of 2 years and 3 months) was given symptomatic treatment such as antiviral therapy while the Levocarnitine group (66 cases,including 36 males and 30 females,median age of 2 years and 5 months) was treated with Levocarnitine for neuroprotection on the basis of routine group.Forty healthy children (23 males and 17 females,median age of 2 years and 6 months) who were examined at the Children's Hospital Affiliated to Zhengzhou University during the same period were selected as the healthy control group.The levels of S100,NSE,soluble apoptosis-related factors (sFas),soluble apoptosis-related factor l igands (sFasL),malondialdehyde (MDA),superoxide dismutase (SOD) in serum were compared between the healthy control group and children with HFMD.The levels of above-mentioned indexes in cerebrospinal fluid and serum,efficacy-related indicators such as duration of fever,white blood cell count on the 3rd day of treatment,time to remission of nervous system symptoms,time of disease progression and critical conversion rate were compared between 2 groups of children with HFMD.The correlation between sFas,sFasL,MDA,SOD and S100,NSEwas performed Results (1) The levels of S100 [(0.38:±:0.16) μg/Lvs.(0.06:±:0.23) μg/L],NSE [(43.70±8.80) μg/Lvs.10.10±3.60) μg/L],sFas [(6.61 ±1.86) μg/Lvs.(3.88±1.22) μg/L],sFasL [(101.40±20.7) μg/Lvs.(54.4±13.3) μg/L] and MDA[(11.98±2.54) nmol/Lvs.(4.08±1.45) nmol/L]in serum of HFMD group were significantly higher than those of the healthy control group (t =-12.245,-22.895,-8.273,-12.803,-17.960,all P ＜0.05),while the SOD level [(57.10 ± 10.40) kU/L vs.(70.3 ±14.4) kU/L] was significantly lower (t =5.457,P ＜ 0.05).(2) With the extension of treatment time for HFMD children in the two groups,S100 and NSE in cerebrospinal fluid,S100,NSE,sFas,sFasL and MDA in serum decreased,while SOD level increased.On the 3rd and 7th day after treatment,S100 (t3 =3.491,t7 =14.434),NSE (t3 =2.920,t7 =23.490) in cerebrospinal fluid,S100 (t3 =5.277,t7 =3.614),NSE (t3 =4.652,t7 =10.525),sFas (t3 =6.399,t7 =7.514),sFasL (t3 =11.155,t7 =8.804) and MDA (t3 =6.348,t7 =7.499) in serum of Levocarnitine group were significantly lower than those of routine group (all P ＜ O.05),while SOD (t3 =3.162,t7 =-3.529) was significantly higher than that of routine group (P ＜0.05).(3) The relief time of neurological symptom in levocarnitine group was significantly shorter than that in the routine group [(1.23 ± 0.65) d vs.(1.84 ± 0.47) d],and WBC on the 3rd day after treatment [(9.14 ± 2.93) × 109/L vs.(7.12 ± 2.58) × 109/L] and the progression time of the disease [(29.74 ± 7.85) h vs.(17.36 ± 8.73) h] were significantly better than the those in the routine group (t =-6.178,4.204,8.567,all P ＜ 0.05).The critical conversion rates of Levocarnitine group and the routine group were 7.58％ and 18.18％,respectively,and the difference in critical conversion rate was not statistically significant (x2 =2.316,P ＞0.05).(4)There was a positive correlation between S100 and sFas,sFasL,MDA in children with HFMD (r =0.373,0.735,0.334,P ＜ 0.05).NSE was positively correlated with sFas and sFasL (r =0.479,0.601,all P ＜0.05),while SOD and S100 were negatively correlated with NSE (r =-0.425,-0.460,all P ＜ 0.05).Conclusions Levocarnitine has good curative effect on severe HFMD in children infected by enterovirus EV71,which can effectively protect the cranial nerves.The mechanism may be related to scavenging oxygen free radicals and blocking nerve cell apoptosis.
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Objective@#To understand the etiological and clinical characteristics of children with severe hand, foot and mouth disease (HFMD) in Xi′an in 2018, and to provide the evidence for clinical diagnosis and treatment.@*Methods@#The children with severe HFMD admitted at Xi′an Children′s Hospital from January to December 2018 were selected as the research objects.Clinical data were collected, and the anal swab were detected by adopting real time(RT)-polymerase chain reaction(PCR).@*Results@#Ninety-five cases of HFMD were treated in Xi′an Children′s Hospital in 2018, of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid, 30 cases were enterovirus 71(EV71)(31.6%), 39 cases were coxsackievirus A6(CA6) (41.0%), 3 cases were CA16(3.2%), 2 cases were CA10(2.1%) and 13 cases were other enteroviruses (13.7%). Among 95 patients, the ratio of male to female was 1.1∶1.0; the peak period of incidence of HFMD was from May to July, and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation, vomiting, irritability, lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash, and demethylation may occur in recovery period.The rash in EV71 cases was small, thick, hard and few.After active treatment, only one child with EV71 infection died because of severe cerebral dysfunction, frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital.@*Conclusions@#In 2018, CA6 was the main pathogen of severe HFMD in Xi′an, with bullae was the main manifestation of skin rash, and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.
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Hand, foot and mouth disease is a common acute fever and rash disease in pediatrics, which seriously affects children′s health.It is still an important public health problem for children in China.Now, a comprehensive review of early identification and standardized diagnosis and treatment of severe cases, especially critical hand, foot and mouth disease is performed, in order to improve the success rate of severe hand, foot and mouth disease.
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Objective@#To observe the neuro-protective effect of Levocarnitine on severe hand, foot and mouth disease (HFMD) after enterovirus 71(EV71) infection, to preliminarily explore the possible mechanism preliminarily.@*Methods@#One hundred and thirty-two children with EV71 infection and HFMD combined with serum S100 protein and neuronspecific enolase (NSE) abnormalities who were admitted to Children′s Hospital Affiliated to Zhengzhou University from March 2015 to July 2016 were enrolled in the study.They were divided into the routine group and the Levocarnitine group by the random number grouping method.The routine group (66 cases, including 32 males and 34 females, median age of 2 years and 3 months) was given symptomatic treatment such as antiviral therapy while the Levo-carnitine group (66 cases, including 36 males and 30 females, median age of 2 years and 5 months) was treated with Levocarnitine for neuroprotection on the basis of routine group.Forty healthy children (23 males and 17 females, median age of 2 years and 6 months) who were examined at the Children′s Hospital Affiliated to Zhengzhou University during the same period were selected as the healthy control group.The levels of S100, NSE, soluble apoptosis-related factors (sFas), soluble apoptosis-related factor ligands (sFasL), malondialdehyde (MDA), superoxide dismutase (SOD) in serum were compared between the healthy control group and children with HFMD.The levels of above-mentioned indexes in cerebrospinal fluid and serum, efficacy-related indicators such as duration of fever, white blood cell count on the 3rd day of treatment, time to remission of nervous system symptoms, time of disease progression and critical conversion rate were compared between 2 groups of children with HFMD.The correlation between sFas, sFasL, MDA, SOD and S100, NSE was performed@*Results@#(1) The levels of S100 [(0.38±0.16) μg/L vs. (0.06±0.23) μg/L], NSE [(43.70±8.80) μg/L vs. 10.10±3.60) μg/L], sFas [(6.61±1.86) μg/L vs. (3.88±1.22) μg/L], sFasL[(101.40±20.7) μg/L vs. (54.4±13.3) μg/L] and MDA[(11.98±2.54) nmol/L vs. (4.08±1.45) nmol/L] in serum of HFMD group were significantly higher than those of the healthy control group (t=-12.245, -22.895, -8.273, -12.803, -17.960, all P<0.05), while the SOD level [(57.10±10.40) kU/L vs. (70.3±14.4) kU/L] was significantly lower (t=5.457, P<0.05). (2) With the extension of treatment time for HFMD children in the two groups, S100 and NSE in cerebrospinal fluid, S100, NSE, sFas, sFasL and MDA in serum decreased, while SOD level increased.On the 3rd and 7th day after treatment, S100 (t3=3.491, t7=14.434), NSE (t3=2.920, t7=23.490) in cerebrospinal fluid, S100 (t3=5.277, t7=3.614), NSE (t3=4.652, t7=10.525), sFas (t3=6.399, t7=7.514), sFasL (t3=11.155, t7=8.804) and MDA (t3=6.348, t7=7.499) in serum of Levocarnitine group were significantly lower than those of routine group (all P<0.05), while SOD (t3=3.162, t7=-3.529) was significantly higher than that of routine group (P<0.05). (3) The relief time of neurological symptom in levocarnitine group was significantly shorter than that in the routine group [(1.23±0.65) d vs. (1.84±0.47) d], and WBC on the 3rd day after treatment [(9.14±2.93)×109/L vs. (7.12±2.58)×109/L] and the progression time of the disease [(29.74±7.85) h vs. (17.36±8.73) h] were significantly better than the those in the routine group (t=-6.178, 4.204, 8.567, all P<0.05). The critical conversion rates of Levocarnitine group and the routine group were 7.58% and 18.18%, respectively, and the difference in critical conversion rate was not statistically significant (χ2=2.316, P>0.05). (4)There was a positive correlation between S100 and sFas, sFasL, MDA in children with HFMD (r=0.373, 0.735, 0.334, P<0.05). NSE was positively correlated with sFas and sFasL (r=0.479, 0.601, all P<0.05), while SOD and S100 were negatively correlated with NSE (r=-0.425, -0.460, all P<0.05).@*Conclusions@#Levocarnitine has good curative effect on severe HFMD in children infected by enterovirus EV71, which can effectively protect the cranial nerves.The mechanism may be related to scavenging oxygen free radicals and blocking nerve cell apoptosis.
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Objective To understand the etiological and clinical characteristics of children with severe hand,foot and mouth disease (HFMD) in Xi'an in 2018,and to provide the evidence for clinical diagnosis and treatment.Methods The children with severe HFMD admitted at Xi'an Children's Hospital from January to December 2018 were selected as the research objects.Clinical data were collected,and the anal swab were detected by adopting real time (RT)-polymerase chain reaction(PCR).Results Ninety-five cases of HFMD were treated in Xi'an Children's Hospital in 2018,of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid,30 cases were enterovirus 71 (EV71) (31.6％),39 cases were coxsackievirus A6 (CA6) (41.0％),3 cases were CA16 (3.2 ％),2 cases were CA 10 (2.1％) and 13 cases were other enteroviruses (13.7 ％).Among 95 patients,the ratio of male to female was 1.1 ∶ 1.0;the peak period of incidence of HFMD was from May to July,and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation,vomiting,irritability,lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash,and demethylation may occur in recovery period.The rash in EV71 cases was small,thick,hard and few.After active treatment,only one child with EV71 infection died because of severe cerebral dysfunction,frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital.Conclusions In 2018,CA6 was the main pathogen of severe HFMD in Xi'an,with bullae was the main manifestation of skin rash,and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.
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Hand,foot and mouth disease is a common acute fever and rash disease in pediatrics,which seriously affects children's health.It is still an important public health problem for children in China.Now,a comprehensive review of early identification and standardized diagnosis and treatment of severe cases,especially critical hand,foot and mouth disease is performed,in order to improve the success rate of severe hand,foot and mouth disease.
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Objective To study the levels of plasma catecholamine( norepinephrine,epinephrine and dopamine) in children with severe hand,foot and mouth disease( HFMD) ,and to assess the influence of cate-cholamine on the pathogenesis of severe HFMD. Methods A collaborative study group was established, including Children′s Hospital of Fudan University, Jiangxi Provincial Children′s Hospital, Anhui Provincial Children′s Hospital,Linyi People′s Hospital and No. 2 People′s Hospital of Fuyang City. Blood samples from children with severe HFMD were collected from April 2014 to October 2016. The levels of blood epineph-rine,norepinephrine,dopamine were measured at 2 h,24 h and 48 h after diagnosis for HFMD. Results The level of epinephrine at 24 h after diagnosis was ( 213. 0 ± 139. 8 ) ng/L in children with pulmonary edema, which was significantly higher than that of children without pulmonary edema[(137. 8 ± 45. 5)ng/L)](P=0. 022). The level of epinephrine at 24 h after diagnosis was (373. 2 ± 298. 1)ng/L in the dead children,and was (144. 2 ± 42. 5)ng/L in the survival children. The concentration of norepinephrine at 24 h after diagnosis was (1935. 7 ± 1824. 1)ng/L in the dead children,and was (858. 3 ± 212. 7)ng/L in the survival children. The levels of epinephrine and norepinephrine of those who died from HFMD were significantly higher than those of survival children at 24 h after diagnosis. There were no significant differences in catecholamine con-centrations among stage 2,3,4 HFMDs at 2 h,24 h and 48 h after diagnosis. Sex and enterovirus 71 virus infection had no significant influences on plasma catecholamine concentrations in children with severe HFMD. Conclusion Plasma epinephrine levels increase in children with HFMD complicated with pulmonary edema. Epinephrine and norepinephrine may play an important role in the death of children with severe HFMD.
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Objective To investigate the clinical features of severe hand,foot and mouth disease (HFMD) in recent three years,and to analyse the risk factors of severe HFMD.Methods A multicenter collaborative research group was set up,including five children's hospitals(pediatric department)with high incidence of HFMD.Prospective epidemiologic approaches were adopted.After training,staffs from the col-laborative center executed the study by filling up the record forms.Results We collected 114 HFMD cases in stage 2,75 cases of HFMD in stage 3,37 cases of HFMD in stage 4 from April 2014 to October 2016.The age ranged from 2 months to 13 years old,the median age was 2 years old,younger than 3 years accounted for 86.3%.Fever was observed in all the severe HFMD,mean temperature was (39.2 ± 0.7) ℃,fever lasted for (4.54 ± 2.89)d.The mean heart rates in stage 2,3,4 were (128.2 ± 13.3,176.1 ± 22.2,184.2 ± 27.5) times/min,respectively.The mean arterial pressure was (84.4 ± 14.6) mmHg(1 mmHg=0.133 kPa),the mean respiratory rate was (39.0 ± 8.4)times/min,the mean respiratory rates in stage 2,3,4 were (37.8 ± 7.36,38.7 ± 8.13,43.4 ± 10.7) times/min,respectively. Respiratory rhythm abnormality in stage 2,3,4 were 9.6%,14.9% and 56.8%,respectively.The blood glucose increased gradually in 2,3 and 4 stages,the mean blood glucose in stage 4 was(12.4 ± 4.74)mmol/L.The incidence of coma in stage 4 was higher than those in stage 2 and 3. Multivariate Logistic regression analysis found that tachycardia,drowsiness,coma, respiratory rate increase,respiratory rhythm abnormality,capillary refilling time more than 3 seconds were risk factors for severe HFMD.Conclusion The incidence of severe HFMD is still high in children under 3 years of age in last three years.The severe patients have obvious changes in the nervous,respiratory and circulatory system. Tachycardia,drowsiness,coma,respiratory rate increase,respiratoy rhythm abnormality,capillary refilling time more than 3 seconds are risk factors for severe HFMD.
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Objective To discuss the change trends of pathogen of severe hand,foot and mouth dis-ease(HFMD) in Chaoshan area during 2011 to 2015. Methods All 1410 throat swabs of cases who were diagnosed as HFMD were collected from children hospitalized in our hospital during May 2011 to August 2015. Enterovirus were detected by nest RT-PCR,and the results of these positive cases diagnosed as severe HFMD were analyzed. Results (1) There were 216 positive cases(67. 29％,216/321) diagnosed as severe HFMD,including 53. 70％ ( 116/216 ) enterovirus 71 ( EV71 ), 19. 91％ ( 43/216 ) coxsackievirus A16 (CA16),12. 04％(26/216) CA6,8. 80％(19/216) CA10,3. 24％(7/216) CA4,0. 93％(2/216) coxsack-ievirus B5, 0. 46％ ( 1/216 ) enteric cytopathogenic human orphan virus and 0. 93％ ( 2/216 ) unclassified samples were unclassified to species. (2) Five cases of critical HFMD were all caused by EV71. (3) The EV71 positive samples were given priority to severe cases ( 51. 79％,116/224 ) and the non EV71 positive samples were given priority to mild cases ( 82. 08％, 458/558 ) , the difference was statistically significant (χ2 =91. 68,P<0. 001). (4) The change trends of severe HFMD year by year were consistent with the change trends of EV71 composition,and were highly correlated(Rs=0. 9,P=0. 037). (5) Severe HFMD caused by non EV71 virus gradually increased. Conclusion Severe HFMD in Chaoshan area during 2011 to 2015 were mainly caused by EV71,non EV71 viruses including CA16,CA6,CA10,CA4,coxsackievirus B5, enteric cytopathogenic human orphan virus 6 could also develop to severe HFMD. The composition ratio of severe HFMD increased accordingly in the year of EV71 as the dominant pathogen. The proportion of severe HFMD caused by non EV71 virus gradually increased after 2013 year.
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Objective To investigate the molecular characteristics of coxsackievirus A12 ( CV-A12) and to understand the clinical manifestations of severe hand, foot and mouth disease (HFMD) caused by CV-A12 in Qingdao. Methods Throat swabs of HFMD, herpangina and influenza-like cases from 2011 to 2016 were detected for enteroviruses ( EVs) in Qingdao. Human rhabdomyosarcoma ( RD) and human la-ryngeal carcinoma (Hep-2) cells were used for virus proliferation and CV-A12 strains were identified through a semi-nest RT-PCR. The full-length of VP1 gene of CV-A12 strains was sequenced and phylogenetically an-alyzed using MEGA7. 0 software package. Clinical data of severe HFMD cases positive for CV-A12 were col-lected and analyzed. Results CV-A12-positive HFMD, herpangina and influenza-like cases accounted for 0. 3％(18/6798), 1. 2％(2/169) and 0. 1％(1/676) in Qingdao, respectively. Most of the HFMD caused by CV-A12 in children were mild before 2013 (84. 6％, 11/13), while hospitalized severe cases with neurological symptoms (100％, 5/5) became more common after 2013. Phylogenetic analysis of the VP1 region revealed that CV-A12 strains worldwide could be divided into two genotypes, A and B. All of the CV-A12 strains successfully sequenced in Qingdao from 2011 to 2016 belonged to genotype B, and 88. 9％(16/18) of them belonged to subgenotype B2. All hospitalized severe cases of CV-A12-caused HFMD after 2013 were associated with strains in branch B2b of subgenotype B2. Conclusion CV-A12 was one of the pathogens causing HFMD, herpangina and influenza-like illness in children in Qingdao. Strains of genotype B2 were the predominant CV-A12 strains circulating in Qingdao in recent years. CV-A12-caused HFMD might complicated by nervous system damage.
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Objective To compare the clinical effect of different doses of methylprednisolone in the treatment of children with severe hand foot mouth disease research and analysis. Methods 100 patients in our hospital from January 2014 to August 2016 were selected and randomly divided into the control group and the experimental group, with 50 patients in each group. The control group were treated with small doses of methylprednisolone, 2 mg/ (kg?d), intravenous injection. The experimental group was treated with large dose of methylprednisolone, 10～15 mg/(kg?d) intravenous infusion. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results after the corresponding treatment, the number of adverse reactions in the experimental group was 31, the adverse reaction rate was 62.0％, and the adverse reaction rate in the control group was 60.0％. There was no significant difference in the incidence of adverse reactions between the two groups. The upper respiratory rate and critical illness in the experimental group were 26.0％ and 32.0％, significantly lower than that of the control group (P<0.05). The average remission time of the patients in the experimental group was (2.19±1.01) days. The symptomatic remission time in the control group was (4.19±1.89) days. The remission time of the control group was significantly longer than that of the experimental group, with statistical difference (P<0.05). Conclusion The short term large dose of methylprednisolone in treatment of children with severe HFMD clinical effect is ideal, can be reduced to critical illness rate, less symptom remission time, with the further promotion of the clinical significance.
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The severe hand,foot and mouth disease(HFMD) caused by Enterovirus 71 (EV71) has become a serious threat to children's health.It is an important issues which need to be faced and resolved by pediatrician and disease prevention and control system,especially pediatric critical care specialist.The pathogenesis of severe HFMD caused by EV71 has not been clearly defined so far,and the clinical treatmnent is controversial.So,to further explore the mechanism of EV71 infection in severe HFMD and explore new effective prevention and control methods,have important significance in reducing the mortality and improve the quality of life of patients with severe HFMD.
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Objective To investigate the effect of mouse nerve growth factor on humoral immunity in children with severe hand foot mouth disease. Methods 92 patients with severe hand foot mouth disease were selected from June 2010 to September 2012 in the hospital, and randomly divided into two groups.The indexes of blood cell analysis, humoral immunity, cytokines and T lymphocyte subsets were compared after treatment.Results After treatment, compared with control group, the numeration white blood cell, neutrophil and lymphocyte of observation group were lower (P<0.05), IgM, IgG and IgA were higher (P<0.05), IL-1, IL-6 and IL-10 were lower (P<0.05), CD4 +and CD8 +were higher (P<0.05).Conclusion Mouse nerve growth factor can significantly improve the each index of humoral immunity cytokines and T lymphocyte subsets level in children with hand foot mouth disease, which has the great significance in clinical.
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ObjectiveTo explore the clinical feature of severe hand, foot and mouth disease (HFMD) in pediatric patients, and to observe the hemodynamic changes in those with acute pulmonary edema.Methods A prospective observation study was conducted. Thirty-five severe HFMD pediatric patients with acute pulmonary edema admitted to the intensive care unit (ICU) and Department of Pediatric of First People's Hospital of Foshan from May 2008 to September 2014 were enrolled. The clinical features were thoroughly investigated. Hemodynamic data were monitored by pulse-indicated continuous cardiac output (PiCCO) in 5 cases, and the changes in PiCCO parameters were observed at ICU admission (0 hour), and 24, 48, 96 hours after treatment.Results Thirty-five patients who met the diagnostic standard of severe HFMD were enrolled, including 22 male and 13 female, aged from 7 months to 4 years. Six patients were younger than 1 year, 13 1-2 years, 12 2-3 years, and 4 patients 3-4 years old. The most common time of occurrence of pulmonary edema was 3-4 days after the onset of the disease. Fever and central nervous system symptoms were found in all the patients, and examination of the cerebral spinal fluid (CSF) revealed non-bacterial inflammatory changes. PiCCO results showed a tendency of lowering of heart rate (HR), systemic vascular resistance index (SVRI), and extravascular lung water index (EVLWI) after the treatment, and the values obtained at 96 hours were significantly lower than those at 0 hour [HR (bpm): 119.0±14.7 vs. 200.8±19.7, SVRI (kPa·s·L-1·m-2):148.9±14.6 vs. 209.6±58.7, EVLWI (mL/kg): 10.5±1.9 vs. 34.8±10.8,P< 0.05 orP< 0.01], global end-diastolic volume index (GEDVI) was also gradually decreased without significant differences among all the time points, together with a tendency of increase in stroke volume index (SI) and cardiac index (CI). The values of the parameters at 96 hours were significantly higher than those at 0 hour [SI (mL/m2): 38.5±6.5 vs. 17.4±2.8, CI (mL·s-1·m-2): 75.0±8.0 vs. 55.5±8.5, bothP< 0.01]. Left atrium was found to be enlarged, and left ventricular systolic function decreased in two patients by cardiac ultrasonic. Four out of 35 patients died, and functional disability of extremities was found in 1 patient. Other patients were cured and discharged without any sequelae.Conclusions Severe HFMD complicated by acute pulmonary edema is a perilous condition in children, accompanied commonly by pathologic changes in central nervous system and systolic dysfunction of left ventricle. According to the results with PiCCO monitoring, HFMD patients suffering from acute pulmonary edema may be of cardiac origin in addition to neurogenic origin.
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Objective To comment the severity of severe hand,foot and mouth disease(HFMD)by pediatric risk of mortality score(PRISM),and assess the performance of PRISM in predicting mortality or complication probability in HFMD.Methods Four hundred and twenty-four severe HFMD pediatric patients were recruited in the study from 1th Jan 2010 to 31th June 2013.Information on the outcome and the varia-bles required to calculate PRISM score were collected.The logistic regression model developed in the learning sample was evaluated in the test sample by calculating the area under the receiver operating characteristic (ROC)curve to assess discrimination pneumorrhagia and death.Calibration across deciles of risk was evalua-ted using the Hosmer-Lemeshow goodness-of-fit χ2 test.Results The area under the ROC curve were 0.87 (95%CI 0.80~0.94 )for PRISM in predicting pneumorrhagia probability.The area under the ROC curve were 0.87(95%CI 0.80~0.95)for PRISM in predicting mortality probability.The PRISM in observed and expected pneumorrhagia did not demonstrate good calibration at ten mortality risk intervals (χ2 =36.66, P<0.001 ).The PRISM in observed and expected mortality did not demonstrate good calibration at ten mortali-ty risk intervals(χ2 =41.11,P<0.001).Conclusion The PRISM score is demonstrated good discrimination of pneumorrhagia and death in HFMD pediatric patients,but the performance of calibration is not good.