ABSTRACT
Background@#Since early December 2019, the 2019 novel coronavirus disease (COVID-19) has caused pneumonia epidemic in Wuhan, Hubei province of China. This study aims to investigate the factors affecting the progression of pneumonia in COVID-19 patients. Associated results will be used to evaluate the prognosis and to find the optimal treatment regimens for COVID-19 pneumonia.@*Methods@#Patients tested positive for the COVID-19 based on nucleic acid detection were included in this study. Patients were admitted to three tertiary hospitals in Wuhan between December 30, 2019, and January 15, 2020. Individual data, laboratory indices, imaging characteristics, and clinical data were collected, and statistical analysis was performed. Based on clinical typing results, the patients were divided into a progression group or an improvement/stabilization group. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. Categorical variables were analyzed using chi-squared test or Fisher’s exact test. Logistic regression analysis was performed to explore the risk factors for disease progression.@*Results@#Seventy-eight patients with COVID-19-induced pneumonia met the inclusion criteria and were included in this study. Efficacy evaluation at 2 weeks after hospitalization indicated that 11 patients (14.1%) had deteriorated, and 67 patients (85.9%) had improved/stabilized. The patients in the progression group were significantly older than those in the disease improvement/stabilization group (66 [51, 70] years vs. 37 [32, 41] years, U =4.932, P =0.001). The progression group had a significantly higher proportion of patients with a history of smoking than the improvement/stabilization group (27.3% vs. 3.0%, χ2=9.291, P =0.018). For all the 78 patients, fever was the most common initial symptom, and the maximum body temperature at admission was significantly higher in the progression group than in the improvement/stabilization group (38.2 [37.8, 38.6]℃ vs. 37.5 [37.0, 38.4]℃, U=2.057, P =0.027). Moreover, the proportion of patients with respiratory failure (54.5% vs. 20.9%, χ2=5.611, P=0.028) and respiratory rate (34 [18, 48] breaths/min vs. 24 [16, 60] breaths/min, U=4.030, P=0.004) were significantly higher in the progression group than in the improvement/stabilization group. C-reactive protein was significantly elevated in the progression group compared to the improvement/stabilization group (38.9 [14.3, 64.8] mg/L vs. 10.6 [1.9, 33.1] mg/L, U=1.315, P=0.024). Albumin was significantly lower in the progression group than in the improvement/stabilization group (36.62±6.60 g/L vs. 41.27±4.55 g/L, U =2.843, P =0.006). Patients in the progression group were more likely to receive high-level respiratory support than in the improvement/stabilization group (χ2=16.01, P=0.001). Multivariate logistic analysis indicated that age (OR, 8.546; 95% CI: 1.628-44.864; P = 0.011), history of smoking (OR, 14.285; 95% CI: 1.577-25.000; P = 0.018), maximum body temperature at admission (OR, 8.999; 95% CI: 1.036-78.147, P = 0.046), respiratory failure (OR, 8.772, 95% CI: 1.942-40.000; P = 0.016), albumin (OR, 7.353, 95% CI: 1.098-50.000; P = 0.003) and C-reactive protein (OR, 10.530; 95% CI: 1.224-34.701, P = 0.028) were risk factors for disease progression.@*Conclusions@#Several factors that led to the progression of COVID-19 pneumonia were identified, including age, history of smoking, maximum body temperature on admission, respiratory failure, albumin, C-reactive protein. These results can be used to further enhance the ability of management of COVID-19 pneumonia.
ABSTRACT
Although the occurrence of tuberculous meningitis (TBM) in children is relatively rare, but it is associated with higher rates of mortality and severe morbidity. The peak incidence of TBM occurs in younger children who are less than five years of age, and most children present with late-stage disease. Confirmation of diagnosis is often difficult, and other infectious causes such as bacterial, viral and fungal causes must be ruled out. Bacteriological confirmation of diagnosis is ideal but is often difficult because of its paucibacillary nature as well as decreased sensitivity and specificity of diagnostic tests. Early diagnosis and management of the disease, though difficult, is essential to avoid death or neurologic disability. Hence, a high degree of suspicion and a combined battery of tests including clinical, bacteriological and neuroimaging help in diagnosis of TBM. Children diagnosed with TBM should be managed with antituberculosis therapy (ATT) and steroids. There are studies reporting low concentrations of ATT, especially of rifampicin and ethambutol in cerebrospinal fluid (CSF), and very young children are at higher risk of low ATT drug concentrations. Further studies are needed to identify appropriate regimens with adequate dosing of ATT for the management of paediatric TBM to improve treatment outcomes. This review describes the clinical presentation, investigations, management and outcome of TBM in children and also discusses various studies conducted among children with TBM.
ABSTRACT
Objective To investigate the epidemiological characteristics of inpatients with acute cerebral hemorrhage, and to observe the different influencing factors on the outcome of the disease, so as to provide a reference for formulating prevention and treatment measures. Methods Four hundred in-patients with acute cerebral hemorrhage admitted to Haikou People's Hospital from May 2016 to May 2018 were enrolled, and their diagnoses were confirmed by magnetic resonance imaging (MRI), the CT, digital subtraction angiography (DSA). The patients' relevant information, including gender, age, occupation, life habits (drinking alcohol, smoking), onset season, hemorrhagic site, past medical history and complication (hypertension, cardiovascular disease, diabetes), blood glucose, first episode and recurrence, etc clinical data were collected from the self-designed case information table, the epidemiological characteristics of patients with acute cerebral hemorrhage were analyzed, and the indexes with statistical significance obtained from univariate analysis were included in the multivariate Logistics regression analysis, and the risk factors affecting the 28-day disease outcome of patients with cerebral hemorrhage were screened out. Results Among the 400 in-patients with acute cerebral hemorrhage, the patients with age ≥ 70 years old, being workers, winter onset, hemorrhage mainly in the cerebral lobe and having history of hypertension were the highest [35.00% (140/400), 36.00% (144/400), 36.75% (147/400), 27.00% (108/400), 58.75% (235/400)], and the proportion of males was significantly higher than that of females [68.25% (273/400) vs. 31.75% (127/400)]. Among the 400 inpatients, 88 died after admission, accounting for 22.00%, and 312 patients were discharged, accounting for 78.00%. Univariate analysis showed that workers [odds ratio (OR) = 2.416, 95% confidence interval (95%CI) = 0.258-6.859, P = 0.011], unhealthy living habits:smoking [OR = 1.792, 95%CI = 1.107-2.895, P = 0.015], drinking alcohol (OR = 1.664, 95%CI = 1.024-2.713, P = 0.040), hypertension (OR = 1.730, 95%CI = 0.701-4.266, P = 0.031), fasting blood glucose ≥ 7.0 mmol/L (OR = 8.112, 95%CI = 3.631-20.183, P = 0.000) could be the influencing factors of the cerebral hemorrhage;multivariate Logistic regression analysis showed: occupation being worker (OR = 3.427, 95%CI = 0.221-0.815, P = 0.010), hypertension (OR = 2.974, 95%CI = 1.182-7.489, P = 0.022), fasting blood glucose ≥ 7.0 mmol/L (OR = 8.974, 95%CI = 3.677-21.936, P = 0.000) were the main risk factors affecting the outcome of acute cerebral hemorrhage, effective first aid is a protective factor. Conclusion The age of patients with acute cerebral hemorrhage is mainly ≥ 70 years old, and the males are more than females; the incidence is high in winter, and the cerebral lobe is the main hemorrhagic site; from single and multiple factors analyses, workers, hypertension history, hyperglycemia and unhealthy habits (smoking, drinking) are the risk factors for the disease outcome, effective first aid is a protective factor.
ABSTRACT
Objective To investigate the demographical data,clinical data and outcomes of patients with Hydatid disease. Methods The data of 493 Hydatid disease patients collected from January 2013 to June 2017 in Qinghai Province were treated with the Epi Data 3.02 to record the data in duplicate and establish Hydatid disease database,which was then analyzed with SPSS 17.0 for statistical analysis.Results There were 409 cases of Cystic Echinococcosis and 84 cases of Bursal Echinococcosis. The male patients accounted for 42%,and the female for 58%.The curative rate of CE2 and CE4 patients was higher than that of patients with CE1,CE3 and CE5,with sig-nificant differences(χ2=3.502,Р=0.835).The cure rate of patients with cystic echinococcosis was significantly higher than that of Bursa edulis(χ2=30.275,Р=<0.01).The difference was statistically significant in view of the affected position(χ2= 17.521,Р = 0.020). In view of Child-Pugh classification and immunological examination on the outcome of the disease,the difference was statistically significant(χ2= 17.521,Р = 0.020;χ2= 15.731,Р < 0.022). In view of the operation method,the different was statistically significant(χ2= 57.389,Р < 0.01). Conclusion The data of Hydatid disease patients in Qinghai province were establisheded,which provides scientif-ic and detailed and clinical data on Hydatid disease.
ABSTRACT
Objective To induce and analysis the death relative factors of peritoneal dialysis patients over the past five years in fourth ward of qiandongnan from guizhou province guiyang medical college affiliated people's hospital in endocrinology and to improve the effect of nursing intervention.Methods 492 peritoneal dialysis patients were retrospective analyzed from Mar 2009 to Mar 2014,in order to conclude the causes of the patients that ending with death (n =89) and to formulate targeted nursing measures.Results The primary disease for death of maintained peritoneal patients was cardiovascular events [41.6％(37/89)],and the second factor was infection [32.6％(29/89)].The risk factors for mortality were age (≥70 years old),diabetes,endogenous creinine clearance rate declined [＜50 L·week-1 ·m-2],change of hemodialysis to peritoneal dialysis and higher peritoneal transport status.Conclusions It's important to strengthen the nursing intervention for the peritoneal dialysis patients with coronary heart disease,and to formulate targeted nursing measures for risk factors,so as to avoid the death.
ABSTRACT
Objective To discuss the clinical effect of pulmonary surfactant in the treatment of preterm children respiratory distress syndrome (RDS).Methods 86 RDS premature children were randomly divided into two groups by digital number table methods,43 cases were in each group,the control group was given nasal continuous positive airway pressure (NCPAP) treatment,while the observation group was given intratracheal instillation PS on the basis of the control group.The arterial blood gases,outcome indicators of changes in circumstances were compared between the two groups.Results After treatment,the PaO2 and PaO2/FiO2 of the observation group were (67.10 ±3.88) mmHg and (191.30 ± 10.72) higher than (43.81 ± 3.78) mmHg and (81.71 ± 5.34) of pre-treatment and (53.35 ± 3.86) mmHg and (126.88 ± 8.50) of the control group (t =9.35,9.50,7.34,7.20,all P ＜ 0.05) ; while PaCO2 was (37.38 ± 3.65) mmHg significantly lower than (59.15 ± 4.27) mmHg of pre-treatment and (58.76 ±3.86) mmHg of the control group,the differences were statistically significance (t =10.15,7.62,all P ＜0.05);after treatment,the IVH and ROP incidence of the observation group were 4.65％ and 6.98％,which were significantly lower than 13.95％ and 16.28％ of the control group (x2 =7.68,7.39,all P ＜ 0.05) ; while the two groups showed no significant difference in incidence of BPD (P ＞ 0.05).Conclusion Pulmonary surfactant in the treatment of respiratory distress syndrome in premature children has significant effect,and it can improve lung function in children with disease outcome and prognosis.
ABSTRACT
Leishmania tropica is one of the causative agents of leishmaniasis in humans. Routes of infection have been reported to be an important variable for some species of Leishmania parasites. The role of this variable is not clear for L. tropica infection. The aim of this study was to explore the effects of route of L. tropica infection on the disease outcome and immunologic parameters in BALB/c mice. Two routes were used; subcutaneous in the footpad and intradermal in the ear. Mice were challenged by Leishmani major, after establishment of the L. tropica infection, to evaluate the level of protective immunity. Immune responses were assayed at week 1 and week 4 after challenge. The subcutaneous route in the footpad in comparison to the intradermal route in the ear induced significantly more protective immunity against L. major challenge, including higher delayed-type hypersensitivity responses, more rapid lesion resolution, lower parasite loads, and lower levels of IL-10. Our data showed that the route of infection in BALB/c model of L. tropica infection is an important variable and should be considered in developing an appropriate experimental model for L. tropica infections.
Subject(s)
Animals , Female , Mice , Disease Models, Animal , Leishmania major/immunology , Leishmania tropica/immunology , Leishmaniasis/immunology , Mice, Inbred BALB C , Treatment OutcomeABSTRACT
Objective To identify the diseases outcome of inpatients of prefectural hospital in Xinjiang,through analyzing the diseases outcome of inpatients of a prefectural hospital in Xinjiang from 2006 to 2008.Methods To analyze the diseases outcome of inpatients(20 533 cases)randomly selectedin hospital from 2006 to 2008 the date were aralgzed.according to year,gender,ethnicity,disease systems.Results The overall cured rate,improved rate,healed rate,fatality rate of inpatients was 42.10％(8663 cases),51.10％(10 463 cases),6.00％(1242 cases),0.80％(165 cases)respectively.The fatality rate of inpatients of above 60 years old,45 ～59 years old,15 ～44 years old is higher in inpatients of various age groups; The fatality rate of inpatients of tumor,circulatory system diseases,symptoms of menopause with the experimental and clinical body seen to be kind to the suffering of its is higher in inpatients of various systemic diseases,binary multinomial logistic regression shows that the disease outcome is influenced by gender,age,disease systems,hospital annual,four single factors,but not influenced by ethnicity.Conclusion The cured rate adding improved rate is over 90％ of common and frequently-occurring diseases in the prefectural hospital of Xinjiang province.The fatality rate is higher in inpatients who suffered from tumor or circulatory system diseases or symptoms of menopause with the experimental and clinical body seen to be kind to the suffering of its and the fatality rate of all age groups over 15 years old is higher.
ABSTRACT
ObjectiveTo investigate the effect of nursing intervention on clinical outcomes and recurrence rate of patients with pulmonary tuberculosis hemoptysis. Methods120 patients with hemoptysis of tuberculosis from October 2008 to October 2009 in our hospital were chosen as research object.They were randomly divided into the observation group and the control group.The control group was treated with conventional methods of nursing care,and the observation group was taken nursing intervention based on routine care.The outcome of the treatment,recurrence rate and medication compliance during 1-year follow- up after discharge for the two groups were compared. ResultsAfter treatment,the outcome of the situation was compared.There were 54 patients cured,1 died,5 patients abandoned treatment and were discharged automatically in the observation group.47 patients were cured,4 died,9 patients abandoned treatment and were discharged automatically in the control group.The cure rate in the observation group was better than the control group.The mortahty rate was significantly lower than the control group.The relapse rate during one-year follow-up were compared.There were 4 cases with recurrence in the observation group,accounted for 6.8％.There were 15 cases with recurrence in the control group,the recurrence rate was 26.8％.The medication compliance of the observation group was significantly better than the control group during 1-year follow-up. ConclusionsNursing intervention can improve patients' medical compliance,enhance treatment effect,and obtain better outcomes.It can improve medication compliance,help establish healthy habits,and reduce the relapse rate post-discharge.
ABSTRACT
Background Multiple drug therapy for leprosy has been in use in Malaysia since 1985. The SBAMDT is a modified WHO-MDT with an initial intensive phase and a longer duration of treatment. Objective The aim of the study is to compare the efficacy and safety of SBA-MDT against WHOMDT in the Treatment of Leprosy in Malaysia. Methodology A retrospective study was conducted between 1985 and 2009 in thirteen Malaysian dermatology centres. Data collected were analysed for comparison of relapse rates, compliance rates and adverse drug effects between the 2 regimes. Results A total of 1113 patients were included, of which 966 patients completed the SBA-MDT and 147 patients completed the WHO-MDT. Both the MDT regimes had a treatment failure rate of less than 2%. The relapse rate was 1.7% with SBA-MDT and 1.4% with WHO-MDT (p = 0.79). For multibacillary leprosy, the relapse rates were 0.9% with the former and 0 with the latter (p = 0.32). For paucibacillary leprosy, it was 3.1% and 5.0% respectively (p = 0.52). Patients on SBA-MDT had higher type 1 (16.1% vs. 8.8%, p = 0.03) and type 2 lepra reactions (19.2% vs. 6.1%, p < 0.001). Similarly, those on SBA-MDT also had higher rate of severe adverse drug reactions (11.1% vs. 5.6%, p = 0.01). Conclusion Both the SBA-MDT and the WHO-MDT regimes were effective in inducing clinical remission. Incidence of lepra reactions and severe adverse drug reactions were higher in patients with SBA-MDT.