Famotidina en el tratamiento de pacientes hospitalizados con COVID-19. Revisión sistemática y metaanálisis / Famotidine in the treatment of hospitalized patients with COVID-19. Systematic review and meta-analysis

Introducción: El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2), de alta morbimortalidad, carece a la fecha de preparar esta revisión, de una terapia específica altamente eficaz. Famotidina se ha postulado como una opción terapéutica viable, basado en trabajos de cohorte retrospectiva y modelos computacionales guiados por inteligencia artificial. Objetivo: Recopilar la mejor evidencia científica disponible para determinar la efectividad y eficacia de famotidina en el tratamiento de pacientes hospitalizados con COVID-19, para reducir el riesgo de progresión de la enfermedad, intubación, muerte y tiempo de estancia hospitalaria. Material y Métodos: Se realizó una búsqueda en PubMed, EBSCO, Scopus, Web of Science y Cochrane Central, de artículos originales que reporten las variables de interés asociadas al uso de famotidina en pacientes hospitalizados con COVID- 19. Los investigadores independientemente evaluaron y seleccionaron los estudios, se extrajeron los datos expuestos para las asociaciones de interés y se procesaron con el software Revman 5.3. Resultados: En la búsqueda se obtuvo un total de 126 artículos potenciales para la revisión, de los cuales 14 fueron seleccionados para el análisis. En el metaanálisis se incluyeron un total de 47.044 pacientes, de los cuales 6.647 fueron los usuarios de famotidina. El riesgo de intubación se vio reducido en el grupo no expuesto a famotidina, aunque sin significancia estadística, (RR 1,43 IC95% 0,42-4,83), en cuanto a la mortalidad no se evidenció reducción significativa en el grupo de famotidina (RR 0,95 IC 95% 0,70-1,29). Se observó reducción en el tiempo de estancia hospitalaria (DM -1,60 -2,89, -0,31) y finalmente se mostró que no hay presencia de asociación entre el uso de famotidina y el desenlace compuesto de reducción del riesgo de ingreso a UCI, intubación y muerte (RR 1,03 IC 95% 0,46-2,34). Conclusión: Famotidina no presenta efectividad ni eficacia en la reducción de riesgo de intubación o ingreso a UCI ni de mortalidad en pacientes hospitalizados por COVID-19. La eficacia en la reducción de la estancia hospitalaria no es consistente y se necesitan más ensayos clínicos con buena calidad metodológica para definirla.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with high morbidity and mortality, lacks, at the time of preparing this review, a highly effective specific therapy. Famotidine has been postulated as a viable therapeutic option, based on retrospective cohort investigations and computational models guided by artificial intelligence. Aim: The objective of this study was to compile the best scientific evidence available to determine the effectiveness and efficacy of famotidine in the treatment of hospitalized patients with COVID-19, to reduce the risk of disease progression, intubation, death, and time to hospital stay. Methods: A search was carried out in PubMed, EBSCO, Scopus, Web of Science, and Central Cochrane, for original articles that report the variables of interest associated with the use of famotidine in hospitalized patients with COVID-19. The investigators independently evaluated and selected the studies, the exposed data for the associations of interest were extracted and processed with Revman 5.3 software. Results: The search yielded a total of 126 potential articles for the review, of which 14 were selected for analysis. A total of 47,044 patients were included in the meta-analysis of which 6,647 were famotidine users. The risk of intubation was reduced in the group not exposed to famotidine, although without statistical significance (RR 1.43 IC95% 0.42 - 4.83), regarding mortality there was no significant reduction in the famotidine group (RR 0.95 IC 95 % 0.70-1.29). A reduction in the length of hospital stay was observed (MD -1.60 -2.89, -0.31) and finally it was shown that there is no association between the use of famotidine and the composite outcome of reduced risk of ICU admission, intubation and death. (RR 1.03 95% CI 0.46-2.34). Conclusion: Famotidine does not show effectiveness or efficacy in reducing the risk of intubation or ICU admission or mortality in patients hospitalized for COVID-19. The efficacy in reducing hospital stay is not consistent and more clinical trials with good methodological quality are needed to define it.

Clinical characteristics and risk factors for severe disease of hemorrhagic fever with renal syndrome in underage patients / 中华传染病杂志

Objective:To analyze the clinical characteristics and risk factors for severe disease of hemorrhagic fever with renal syndrome (HFRS) in underage patients, and to construct the severe disease risk model.Methods:A total of 170 HFRS patients (<18 years old) from the Second Affiliated Hospital of Air Force Medical University (153 cases) and the Second Affiliated Hospital of Xi′an Jiaotong University (17 cases) from January 2009 to December 2021 were included. According to the severity of the disease, the patients were divided into mild and severe groups. Baseline demographic data, symptoms, signs, laboratory examination on admission and prognosis were analyzed between the two groups. Statistical comparisons were performed using the Mann-Whitney U test and chi-square test.Binary logistic regression was used to analyze the independent risk factors of patients with severe disease, and the severe disease risk model was built.The receiver operator characteristic curve was used to analyze the value of the risk model in predicting severity of disease. Results:Among the 170 underage patients, 132 (77.6%) were males, aged (14.9±3.1) years, including 124 cases in mild group and 46 cases in severe group. One hundred and sixty-nine cases (99.4%) had fever, 119 cases (70.0%) had headache, 106 cases (62.4%) had lumbago, 158 cases (92.9%) had skin and mucous congestion, and 101 cases (59.4%) had nausea and vomiting. Renal percussive pain was found in 139(81.8%) patients. The incidence of nausea and vomiting and bleeding of skin and mucosa in the severe group were 71.7%(33/46) and 67.4%(31/46), respectively, which were both higher than those in the mild group (54.8%(68/124) and 44.4%(55/124), respectively), and the differences were statistically significant ( χ2=3.97 and 7.12, respectively, both P<0.05). There were significant differences in platelet count, activated partial thromboplastin time (APTT), serum creatinine (SCr), aspartate aminotransferase, alanine aminotransferase, leukocyte count, total bilirubin and albumin levels between the two groups ( Z=-4.14, -4.04, -4.87, -3.90, -4.07, -2.60, -2.78 and t=2.50, respectively, all P<0.05). Binary logistic regression analysis showed that chemosis (odds ratio ( OR)=8.035, 95% confidence interval (95% CI) 2.946 to 21.916), SCr ( OR=1.010, 95% CI 1.006 to 1.015) and APTT ( OR=1.049, 95% CI 1.003 to 1.098) were the independent risk factors for severe HFRS in the underage patients. The risk model was constructed as: Logit(P)=-10.323+ 2.084×chemosis (no=0, grade Ⅰ=1, grade Ⅱ=2, grade Ⅲ=3)+ 0.010×SCr (μmol/L)+ 0.048×APTT (s). The area under the curve to predict severity of disease in underage HFRS patients was 0.868, with an optimal cut-off value of -4.39, with a sensitivity of 73.90% and a specificity of 91.10%. According to the internal verification of the data of the study based on the severe disease risk model, 34 out of 46 patients with severe disease were severe (sensitivity, 73.91%), 113 out of 124 patients with mild disease were mild (specificity, 91.13%). Conclusions:The clinical manifestations of the underage HFRS patients are not typical.The main manifestations are fever, headache and lumbago, nausea and vomiting, and the incidences of skin and mucous congestion and renal percussive pain are high.Chemosis, SCr and APTT are independent risk factors for severe disease in underage patients with HFRS. The severe disease risk model could effectively predict the severity of disease.

Asociación del umbral de ciclos (Ct) en prueba RT-PCR para SARS-CoV-2 y severidad de la COVID-19 en pacientes de un hospital de referencia en Paraguay

RESUMEN Algunos estudios han encontrado que la severidad de la COVID-19 se asocia con una alta carga viral determinada por los números de ciclos (Ct) de amplificación de ADN de SARS-CoV-2. El objetivo fue determinar la relación entre el umbral de ciclos de PCR de SARS-CoV-2 y la severidad de la infección por el virus SARS-COV-2 en pacientes internados y ambulatorios en un hospital de referencia entre marzo a junio del 2021. Estudio retrospectivo observacional analítico de corte trasverso de pacientes adultos con COVID-19, ambulatorios e internados en el Hospital Nacional. Se incluyeron los pacientes cuya infección fue confirmada por RT-PCR para SARS-CoV-2, se consideró un punto de corte para Ct60 años (36,6%), estuvieron hospitalizados (69,8%), internados en sala (57,1%), y admitidos en cuidados intensivos (12,8%), tiempo medio de enfermedad 8,48 ± 4,2 días. La mortalidad fue de 22,2%. Se encontró mayor riesgo de fallecer para los pacientes con Ct 60 años (OR: 3,69; IC95%: 2,39-5,68). Estos dos factores permanecieron asociados con el óbito en el análisis multivariado. Hubo mayor riesgo de hospitalizarse y fallecer en los pacientes con Ct<25. El valor Ct podría ser útil para la predicción del curso clínico y el pronóstico de los pacientes con COVID-19.

ABSTRACT Some studies have found that severity of COVID-19 is associated with a high viral load determined by the number of cycles (Ct) of SARS-CoV-2 DNA amplification. The objective was to determine the relationship between the Ct value and the severity of the SARS-COV-2 virus infection in inpatients and outpatients at a reference hospital in Paraguay between March and June 2021. Cross-sectional retrospective study of adult patients with COVID-19, ambulatory and hospitalized admitted to the National Hospital. Patients whose infection was confirmed by RT-PCR for SARS-CoV-2 were included, a cut off point of Ct 60 years (36.6%), hospitalized (69.8%), admitted to ward (57.1%), and admitted to intensive care (12.8%), mean time of illness 8.48 ± 4.2 days and mortality was 22.2%. A higher risk of death was found for patients with Ct 60 years (OR: 3.69; 95% CI: 2.39-5.68). These two factors remained associated with death in the multivariate analysis. There was a higher risk of hospitalization and death in patients with TC <25. Ct value could be useful for predicting clinical course and prognosis of COVID-19 patients.

Advances in the surgical management of severe acute pancreatitis / 国际外科学杂志

Severe acute pancreatitis is one of the most common surgical emergencies with rapid onset, rapid progression, multiple complications, poor prognosis, and high morbidity and mortality, and it still faces many challenges in treatment. Surgical interventions are crucial in many complications of SAP mainly infected pancreatic necrosis in the late course of the disease, and there is a basic consensus on delayed intervention and trauma ascending treatment model, but over-emphasis on delay may cause patients to miss the best treatment period, and following a single treatment model may delay the patient′s condition. Therefore, it is of great significance for surgeons to grasp the correct indications and timing of surgical intervention and to develop appropriate surgical intervention strategies to reduce the morbidity and mortality of severe acute pancreatitis and improve the clinical prognosis of patients. In this paper, we review the progress of surgical treatment of severe acute pancreatitis with domestic and international literature.

Clinical application of remifentanil in children with critical diseases / 中国小儿急救医学

Analgesia and sedation are important for children with acute critical diseases.With the new development of the concept of analgesia and sedation, new analgesics and sedatives are constantly introduced.Remifentanil has the characteristics of short half-life, no accumulation, less impact on important organs of patients, better controllability, better analgesic effect and quick onset, and has been widely used in children with critical diseases.This paper discussed the application advantages of remifentanil in children with critical diseases.

Analysis of clinical features of 153 patients with novel coronavirus pneumonia in Chongqing / 中华临床感染病杂志

Objective@#To analyze the clinical data of 153 patients with novel coronavirus pneumonia (COVID-19) in chongqing ,and provide reference and thinking for the diagnosis and treatment.@*Methods@#Analyze the clinical data, laboratory examination and chest imaging characteristics of 153 COVID-19 patients in Chongqing Public Health Medical Center from January 26 to February 5, 2020. According to the relevant diagnostic criteria ,patients were divided into non-severe group(n=132) and severe group(n=21),and analyze the correlation between serum index changes and disease severity.@*Results@#Combined with diabetes and chronic respiratory diseases, the severity of the disease was statistically significant (χ2=11.04和6.94, P<0.05). No symptoms were found in patients with mild illness (χ2=4.09, P<0.05) .The proportion of fever and muscle soreness in the severe group was higher than that in the non-severe group (χ2=4.40 and 22.67,P<0.05).Among the concomitant symptoms, the proportion of cough and shortness of breath in the severe group was higher than that in the non-severe group (χ2=8.46 and 4.80,P<0.05).C-reactive protein and d-dimer were higher in the severe group than in the non-severe group (t=43.44 and 37.13, P<0.05), and the number of CD3+T lymphocyte cells, CD4+T lymphocyte cells and CD8+T lymphocyte cells in the severe group was lower than that in the non-severe group (Z=27.25, 20.60 and 17.36, P<0.05).Compared with the non-severe group, both lungs and the right lung lower lobe were more susceptible to involved (χ2=6.95和20.39, P<0.05) .@*Conclusion@#Severity of COVID-19 was associated with underlying disease, symptoms, site of involvement, C-reactive protein, d-dimer, CD3+T lymphocyte count, CD4+T lymphocyte count, and CD8+T lymphocyte count. 

Observation on therapeutic effect of hemoperfusion on patients with critical severe organophosphorus poisoning / 中国中西医结合急救杂志

Objective To observe the clinical effect of hemoperfusion in the treatment of patients with critical severe organophosphorus poisoning. Methods Sixty-two patients with critical severe organophosphorus poisoning admitted to the Department of Critical Care Medicine of Jincheng People's Hospital from August 2016 to August 2018 were enrolled, and they were divided into a routine treatment group and a hemoperfusion group according to whether hemoperfusion or not, 31 cases in each group. The routine treatment group was treated with western drugs combined with continuous gastric lavage, while the hemoperfusion group was additionally treated with hemoperfusion for consecutive 3 days on the basis of the routine emergency regimen. The changes of the dosage of penehyclidine hydrochloride used, recovery time of consciousness, recovery time of cholinesterase (ChE) activity, off-line time of mechanical ventilation, hospitalization time, poisoning rebound and mortality were observed in the two groups after treatment; Glasgow coma scale (GCS) was used to assess the prognosis of patients. Results The dosage of penehyclidine hydrochloride used in hemoperfusion group was less than that in the routine treatment group (mg: 3.1±1.2 vs. 5.8±1.3), and the time of consciousness recovery (hours: 3.3±1.7 vs. 13.4±2.4), recovery time of ChE activity (days: 7.7±1.5 vs. 17.9±3.3), off-line time (days: 2.1±0.9 vs. 7.5±2.6), hospitalization time (days: 12.3±1.5 vs. 19.8±3.6) in hemoperfusion group were shorter than those in the routine treatment group (all P < 0.05); poisoning rebound [3.23% (1/31) vs. 16.13% (5/31)] and mortality [9.68% (3/31) vs. 25.81% (8/31)] in hemoperfusion group were lower than those in the routine treatment group (both P < 0.05). The Glasgow coma score (GCS) of the hemoperfusion group on 3, 4 and 5 days after treatment were all higher than those of the routine treatment group (9.9±2.9 vs. 5.7±2.6, 13.3±2.7 vs.7.8±3.2, 13.3±1.5 vs.9.3±2.6, all P < 0.05). Conclusion The conventional treatment, western drug and gastric lavage, combined with hemoperfusion in patients with critical severe organophosphorus poisoning can further reduce the hospital stay, improve the quality of life and reduce the mortality of such patients, therefore.

Clinical research of target guided treatment of patients with severe heart failure under the guidance of pulse indicator continuous cardiac output / 中华危重病急救医学

Objective@#To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure.@*Methods@#Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups.@*Results@#Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s-1·m-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m2): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L-1·m-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0% vs. 80.0%), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05).@*Conclusion@#PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.

Progress in diagnosis and treatment of severe hand, foot and mouth disease / 中华实用儿科临床杂志

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.

Progress in diagnosis and treatment of severe hand, foot and mouth disease / 中华实用儿科临床杂志

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.

Clinical research of target guided treatment of patients with severe heart failure under the guidance of pulse indicator continuous cardiac output / 中华危重病急救医学

Objective To investigate the value of pulse indicator continuous cardiac output (PiCCO) monitoring in the treatment management of patients with severe heart failure. Methods Sixty patients of severe heart failure admitted to intensive care unit (ICU) of Fujian Provincial Hospital from August 2017 to February 2019 were enrolled, and they were divided into control group and treatment group according to random number table method, with 30 in each group. The treatment group used bedside PiCCO to carry out minimally invasive hemodynamics monitoring, according to the monitoring data target guidance for vasoactive drugs and liquid management. The control group was based only on traditional electrocardiogram (ECG) monitoring and lung sound, urine volume of vasoactive drugs and liquid management. The changes of cardiac index (CI), global end diastolic volume index (GEDVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), invasive mean arterial pressure (MAP) and central venous pressure (CVP) were observed before and 72 hours after treatment in the treatment group. The 7-day total effective rate, the length of ICU stay and 28-day mortality were compared between the two groups. Results Compared with before treatment, CI and MAP in the treatment group were significantly increased after treatment [CI (mL·s-1·m-2): 53.34±16.67 vs. 35.01±13.34, MAP (mmHg, 1 mmHg = 0.133 kPa): 72.6±10.6 vs. 62.5±10.3, both P < 0.05], GEDVI, EVLWI, SVRI, CVP were significantly decreased [GEDVI (mL/m2): 760.3±90.2 vs. 960.2±110.3, EVLWI (mL/kg): 6.5±1.3 vs. 12.5±6.2, SVRI (kPa·s·L-1·m-2): 297.3±35.1 vs. 434.1±58.8, CVP (mmHg): 10.1±2.6 vs. 12.2±3.4, all P < 0.05]. Compared with the control group, the 7-day total effective rate of the treatment group was significantly higher (90.0％ vs. 80.0％), the length of ICU stay was significantly shorter (days: 8.2±4.5 vs. 10.3±2.5), and the 28-day mortality was significantly lower, with statistically significant difference (all P < 0.05). Conclusion PiCCO monitoring is a goal-oriented treatment management for patients with severe heart failure, which is helpful to individualized accurate treatment, shorten the length of ICU stay and improve short-term prognosis.

Early clinical experience of transcatheter aortic valve implantation via apical approach for high-risk aortic valve disease in single-center / 中国胸心血管外科临床杂志

@#Objective    To summarize the clinical experience in the treatment of high-risk patients with severe aortic valve disease by transcatheter aortic valve implantation (TAVI) via heart apex approach and to evaluate the early efficacy. Method    Five patients who underwent TAVI via heart apex approach from September 2017 to February 2019 in Henan Thoracic Hospital were retrospectively analyzed, including 3 males and 2 females, aged 65-84 (74.6±4.5) years. Result    All operations were performed through a small left incision into the thoracic cavity (3-5 cm), and then through the J-Valve transport system, the aortic valve was successfully released via heart apex after precise positioning under digital subtraction angiography. One patient developed ventricular fibrillation during the operation, and the operation was completed with the assistance of emergency femoral arteriovenous catheterization cardiopulmonary bypass; one patient underwent percutaneous coronary intervention first because of severe coronary stenosis; one patient had paroxysmal atrial fibrillation during the perioperative period, and had hepatorenal insufficiency and thrombocytopenia after the operation, and was improved after medical treatment; one patient had perivalvular leak during the operation, and was improved after re-implantation of the valve; one patient was in stable condition during operation and recovered smoothly after operation. Surgery was successful in all 5 patients. The follow-up time was 2-19 months, and the early clinical effect was good. Conclusion    The short-term clinical efficacy of TAVI via heart apex approach in the treatment of high-risk severe aortic valve disease is definite and safe, but the long-term and medium-term effects need to be further evaluated.

Effects of nutritional support under energy metabolic monitoring on nutritional indexes and clinical prognosis of elderly patients with critical severe diseases / 中国中西医结合急救杂志

Objective To investigate the effects of nutritional therapy under energy metabolic monitoring on nutrition indicators and clinical prognosis of elderly patients with critical severe diseases in the department of Intensive Care Unit (ICU).Methods One hundred and twenty elderly patients admitted to the Department of ICU of Integrate Traditional Chinese Medicine Hospital of Ningbo, from January 2013 to December 2016 were enrolled, and they were divided into a control group (62 cases) and an observation group (58 cases) by randomized block method. The patients in observation group received nutritional support treatment under the guidance of energy metabolic monitoring, the amount of nitrogen needed was measured every day, and appropriate energy was provided according to the amount of nitrogen and the ratio of heat to nitrogen; the patients in the control group were given the nutritional support program according to experience. The clinical efficacy was evaluated after 7 days of treatment in the two groups, the differences in hemoglobin (Hb), serum albumin (Alb), prealbumin (PA), weaning success rate within 7 days, duration of mechanical ventilation, length of stay in ICU, the standard rate of enteral nutrition (EN) in 7 days, parenteral nutrition support rate, reaching EN target calorie time, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score on the 7th day after admission and at discharge, the incidence of complications such as abdominal distention, stress ulcer, ventilator associator pneumonia (VAP), heart failure during nutritional treatment and mortality were observed and compared after EN support between the two groups.Results Compared with control group, after treatment Hb (g/L: 136.5±2.5 vs. 90.4±2.3), Alb (g/L: 35.7±4.6 vs. 32.8±4.2), PA contents (g/L: 211.0±20.8 vs. 190.9±30.7), weaning success rate within 7 days [55.2% (32/58) vs. 33.9% (21/62)], the standard rate of EN in 7 days in the observation group were obviously higher [82.8% (48/58) vs. 51.61% (32/62) allP < 0.05], but duration of mechanical ventilation (days: 8.8±3.5 vs. 11.1±4.0), length of stay in ICU (days: 21.2±5.0 vs. 25.9±6.5), parenteral nutrition support rate [29.3% (17/58) vs. 51.6% (32/62)], reaching EN target calorie time (days: 4.4±2.1 vs. 6.2±2.9), APECHE Ⅱ score 7 days after admission (18.7±5.8 vs. 20.8±8.1), APACHEⅡscore at discharge (13.0±5.2 vs. 15.6±4.5) and the incidence of complications such as abdominal distension [10.3% (6/58) vs. 41.9% (26/62)], stress ulcer [3.4% (2/58) vs. 12.9%(8/62)], VAP [22.4% (13/58) vs. 25.8% (16/62)], heart failure [15.5% (9/58) vs. 24.2% (15/62)] etc, were all lower in observation group (allP < 0.05), and 2 weeks later the mortality was significantly lower in the observation group than that in the control group [13.79% (8/58) vs. 22.58% (14/62),P < 0.05].Conclusions Nitrogen required in elderly patients critically ill patients with early determination, the supply of nutrients to guide empirical method is more accurate compared to the nutritional therapy. Nutritional support under energy metabolism monitoring can shorten clinical course, improve nutritional indicators and help reduce the risk of complications and death.

Clinical analysis of extubation failure in critically ill patients with tracheotomy / 中国中西医结合急救杂志

Objective To analyze the clinical features of extubation failure in critically ill patients with tracheotomy in order to improve the success rate of tracheal extubation.Methods The clinical data of 52 critically ill patients with tracheotomy admitted to the Department of Emergency Internal Medicine of Chizhou People's Hospital of Anhui Province from January 2014 to January 2017 were retrospectively analyzed; there were 14 cases in failed extubation group (extubation failure: unable to plug the pipe, necessary to be cut or intubated again), and 38 cases were in successful extubation group (success criteria: after trying plugging the pipe for 24 - 48 hours, pulling out sleeving tube of tracheal incision, the incision healed well, within 3 months no dyspnea or pulmonary infection necessary to again performing tracheal intubation or incision). The differences in gender, age, within 3 days before plugging the pipe the consciousness, cough condition, the levels of serum albumin (Alb), serum potassium and serum sodium, brain natriuretic peptide (BNP), hemoglobin (Hb) were compared between the two groups, the clinical characteristics of extubation failure were analyzed, and the descriptions and their numbers for all diseases resulting in extubation failure were carried out.Results The number of conscious patients (24 cases vs. 4 cases), and the number of patients with good cough function (38 cases vs. 3 cases) were obviously more in successful extubation group than those in the failed extubation group, and the levels of serum Alb (g/L: 35.13±3.13 vs. 27.50±5.53), Hb (g/L: 112.18±13.62 vs. 94.14±17.03) in successful extubation group were significantly higher than those in failed extubation group (allP< 0.05). BNP was significantly lower in successful extubation group than that in failed extubation group (ng/L: 344.03±152.85 vs. 5887.80±2695.97,P < 0.05). The common diseases in extubation failure group were as follows: stroke in 7 cases, special severe craniocerebral injury 3 cases, respiratory failure 3 cases, after cardiac pulmonary resuscitation (CPR) operation 1 case.Conclusions The patients are fully assessed before extubation, countermeasures are taken as soon as possible in cases with coma, cough capability poor, hypoproteinemia, heart dysfunction and anemia in order to improve the successful rate of extubation.

Effect of moist healing therapy on severe pressure ulcers and nursing measures / 现代临床护理

Objective To explore the effect of moist healing therapy on severe pressure ulcers in stage III-IV and summarize the nursing points. Methods Forty-five patients with stage III-IV pressure ulcers (62 cases) were randomly divided into 23 patients of control group (30 cases) and 23 patients of observation group (32 cases). The control group was treated with conventional pressure ulcer care. The observation group was treated with alderate dressing, hydrocolloid dressing and recombinant human epidermal growth factor gel. The wound healing time and wound healing effect were compared between the two groups. Result The total effective rate of the observation group was significantly higher than that of the control group (P<0.01). Conclusion The clinical effect of moist healing therapy combined with wet dressing in the treatment of severe pressure ulcer wound in stage III-IV is superior to that of traditional pressure sore treatment, for it can shorten the healing time and increase the healing rate.

Effect of moist healing therapy on severe pressure ulcers and nursing measures / 现代临床护理

Objective To explore the effect of moist healing therapy on severe pressure ulcers in stage III-IV and summarize the nursing points. Methods Forty-five patients with stage III-IV pressure ulcers (62 cases) were randomly divided into 23 patients of control group (30 cases) and 23 patients of observation group (32 cases). The control group was treated with conventional pressure ulcer care. The observation group was treated with alderate dressing, hydrocolloid dressing and recombinant human epidermal growth factor gel. The wound healing time and wound healing effect were compared between the two groups. Result The total effective rate of the observation group was significantly higher than that of the control group (P<0.01). Conclusion The clinical effect of moist healing therapy combined with wet dressing in the treatment of severe pressure ulcer wound in stage III-IV is superior to that of traditional pressure sore treatment, for it can shorten the healing time and increase the healing rate.

Value of cardiopulmonary resuscitation and tracheal intubation in emergency care / 中国生化药物杂志

Objective To analyze the value of cardiopulmonary resuscitation and tracheal intubation in emergency care. Methods A total of 286 acute critical patients from April 2014 to April 2017 were selected and divided into control group and observation group randomly, which were treated by common emergency nursing staff and excellent staff, respectively. The emergency care quality and effectiveness of each group were then compared. Results The rescuing time and the time required for cardiopulmonary resuscitation, resumed breathing and intubation of observation group were less than control group(P<0.05). The ratio of successful rescue and the survival rate of observation group were higher than control group(P<0.05), while the adverse event rate of observation group was lower(P<0.05). The cases from observation group who are satisfied with the rescue techniques and emergency care were more than contrast group. Conclusion Improving the CPR and endotracheal intubation technique level of nursing staff can increase the ratio of successful rescue, reduce the occurrence of adverse events and improve the rescue nursing quality. This paper recommend the emergency department to enhance the quality of emergency nursing staff.

Value of cardiopulmonary resuscitation and tracheal intubation in emergency care / 中国生化药物杂志

Objective To analyze the value of cardiopulmonary resuscitation and tracheal intubation in emergency care. Methods A total of 286 acute critical patients from April 2014 to April 2017 were selected and divided into control group and observation group randomly, which were treated by common emergency nursing staff and excellent staff, respectively. The emergency care quality and effectiveness of each group were then compared. Results The rescuing time and the time required for cardiopulmonary resuscitation, resumed breathing and intubation of observation group were less than control group(P<0.05). The ratio of successful rescue and the survival rate of observation group were higher than control group(P<0.05), while the adverse event rate of observation group was lower(P<0.05). The cases from observation group who are satisfied with the rescue techniques and emergency care were more than contrast group. Conclusion Improving the CPR and endotracheal intubation technique level of nursing staff can increase the ratio of successful rescue, reduce the occurrence of adverse events and improve the rescue nursing quality. This paper recommend the emergency department to enhance the quality of emergency nursing staff.

Disease Severity and Common Etiology of Diarrhea among Children Under-five in Mirzapur, Rural Bangladesh.

Aim: There is lack of information on the severity of diarrheal disease with etiology. Thus the study aimed to compare the etiology of under-five children with moderate-to-severe disease (MSD) and mild disease (MD). Study Design: Diarrheal disease surveillance. Place and Duration of Study: Mirzapur Kumudini Hospital, Tangail, rural Bangladesh, January 2010 – December 2011. Methodology: Overall, 2,324 under-5 diarrhea children were enrolled in the hospital who came from the demographic surveillance system (DSS) catchment area. Whole stool samples were collected from each enrolled child to detect rotavirus, Shigella, ETEC and V. cholerae. Information on socio-demographic and clinical characteristics was also collected. Results: Among all the study children, 1,098 (47%) were aged 0-11 months; 789 (34%) were 12-23 months, and 437 (19%) were 24-59 months. Rotavirus (33%) was mainly responsible for diarrhea amongst children under-5 and 90% of them were less than 2 years. Shigella represented 14%; of which, 45% were 24-59 months old. However, ETEC and V. cholerae represented only 3% and 2% respectively. Shigella was the most commonly detected pathogen (27%) for MSD followed by rotavirus (16%). Conversely, rotavirus (43%) was responsible for MD. MSD were most likely to be infected with Shigella flexneri [OR-9.81; 95% CI (6.38, 15.18)] and Shigella sonnei [6.29; (3.67, 10.87)] compared to their counterparts with MD. In logistic regression analysis, Shigella was responsible for a 2.25 times higher risk for MSD. Children with Shigella were 3.28 times at higher risk for bloody stool and 2.45 times more likely to have fever. However, rotavirus diarrhea was more likely to be presented with vomiting (OR-2.46) and fever (OR-1.28), and Vibrio cholerae, most often with watery diarrhea (OR-4.35). None of the clinical features were significantly associated with ETEC. Conclusion: Shigella was the leading pathogen that was detected most often in MSD, whereas rotavirus was often associated with MD.

Analysis of the clinical diagnosis and treatment of neonatal severe disease complicated with hyponatremia / 中国基层医药

Objective To explore the best scheme of clinical diagnosis and treatment of neonatal severe disease complicated with hyponatremia.Methods 120 severe disease neonatal with hyponatremia were randomly divided into observation group and control group,60 cases in each group.The observation group was given special care and treatment for the cause,the control group was given conventional treatment in intensive care and conventional sodium.The incidence rate of severe disease and the treatment effect of hyponatremia were compared.Results After treatment,the total incidence rate of severe disease of the observation group was 8.3％,that was 23.3％ in the control group,there was significant difference between two groups (x2 =3.858,P ＜ 0.05).In observation group,the markedly effective rate of hyponatremia was 83.3％,that was 63.3％ in the control group,there was significant difference between two groups (x2 =10.231,P ＜ 0.05).Conclusion Special intensive care and aimed at pathogeny cure can obviously reduce the probability of hyponatremia complicated with severe disease,and it can significantly improve the treatment effect of hyponatremia,it has fairly well clinical value.