Evolución y factores de riesgo de mortalidad en una cohorte pediátrica con enfermedad renal crónica en Paraguay: estudio multicéntrico

Contexto: la enfermedad renal crónica (ERC) tiene una alta morbimortalidad y un alto costo de tratamiento. Entre sus causas principales en Pediatría se describen las anomalías congénitas del riñón y las vías urinarias (CAKUT, por sus siglas en inglés) Objetivo: determinar la evolución y los factores asociados a mortalidad de una cohorte pediátrica atendida en dos hospitales de referencia nacional, con el fin de elaborar estrategias para el manejo precoz y multidisciplinario de esta enfermedad y, de esa manera, optimizar los recursos para reducir la morbimortalidad de la enfermedad. Metodología: estudio de cohorte retrospectivo de pacientes de dos hospitales de referencia entre enero del 2000 y diciembre del 2020, en el cual se estudiaron: edad, sexo, seguro social, ingreso fijo, causa de la ERC, estadio de la ERC al ingreso y al final de estudio, requerimiento y tipo de diálisis, trasplante y óbito, donde el estadio de la ERC se clasificó según las guías K/DOQI (Kidney Disease Quality Iniciative). Por su parte, se relacionó óbito con edad, sexo, ingreso fijo, seguro social, estadio de ERC y requerimiento de diálisis. Se destaca que el análisis se realizó con el programa Epi Info (Atlanta), el cual usa estadística descriptiva y la prueba de chi cuadrado para establecer asociaciones con óbito a un nivel de significancia de 0,05. Resultados: se estudió a 187 pacientes de entre 2 y 17 años de edad, 96 mujeres y 91 varones, donde la mayoría eran mayores de10 años (44,9 %). Entre las causas de ERC más frecuentes se encuentran las anomalías congénitas (CAKUT) (54,5 %) y las indeterminadas (16,6 %); el estadio de ERC al ingreso estuvo repartido entre I (2,1 %), II (16 %), III (25,7 %), IV (8 %), y V (48,1 %); además, el 59,4 % requirió diálisis, el 87,3 % hemodiálisis, el 12,6 % diálisis peritoneal y 13,3 % recibieron un trasplante; por último, la mortalidad fue del 24,5 %, lo cual se asoció con el estadio de ERC al ingreso y el requerimiento de diálisis. Conclusiones: este estudio de cohorte demostró mejores resultados en la evolución de los niños con ERC diagnosticados en estadios tempranos. El diagnóstico y tratamiento precoces ayudan a mejorar la morbimortalidad.

Background: Chronic kidney disease (CKD) has high morbidity and mortality and high cost of treatment. Among the main causes are congenital anomalies of the kidney and urinary tract (CAKUT). Purpose: To determine the evolution and factors associated with mortality in a pediatric cohort attended in two national referral hospitals, in order to develop strategies for early and multidisciplinary management of this disease and, thus, optimize resources to reduce morbidity and mortality of the disease. Methodology: Retrospective cohort study of patients in two reference hospitals between January 2000 and December 2020. Age, sex, social security, fixed income, cause of CKD, CKD stage at admission and at the end of study, requirement and type of dialysis, transplant and death were studied. CKD stage was classified according to the K/DOQI (Kidney Disease Quality Initiative) guidelines. Death was related to age, sex, fixed income, social security, CKD stage, and dialysis requirement. Data analysis was performed with the Epi Info program (CDC, Atlanta), using descriptive statistics, and the chi-square test to establish associations with death at a significance level of 0.05. Results: 187 patients between 2 and 17 years of age 96 women and 91 men, were studied. Most of the patients were older than 10 years (44.9%). Among the most frequent causes of CKD are congenital anomalies (CAKUT) (54.5%) and undetermined (16,6%). CKD stage at admission was I (2,1%), II (16%), III (25,7%), IV (8%), and V (48.1%). 59.4% required dialysis, hemodialysis (87.3%), peritoneal dialysis (12.7%), 13.3% underwent kidney transplant. Mortality rate was 24.5%, which was associated with CKD stage at admission and dialysis requirement. Conclusions: This cohort study demonstrated better outcomes in children with CKD diagnoses at its early stages. The early diagnosis and treatment help to improve the morbidity and mortality.

Esquizofrenia resistente al tratamiento. I, concepto e impacto clínico / Treatment resistant schizophrenia. I, concept and clinical impact

La esquizofrenia es una psicosis crónica que se caracteriza por tres dominios sintomáticos: síntomas positivos, síntomas negativos y síntomas cognitivos. Se estima que afecta al 1 % de la población. El desarrollo de la psicofarmacología y del tratamiento de la esquizofrenia ha permitido distinguir genios evolutivos según la respuesta terapéutica. En este sentido es que se delinea el concepto de esquizofrenia resistente al tratamiento (ERT). Se estima ERT en un 30 % aproximadamente de los sujetos que padecen esquizofrenia. La identificación temprana y adecuada de este subgrupo de individuos se relaciona con una mejor respuesta. Este artículo es una narrativa sobre el concepto de ERT y su impacto clínico.

Schizophrenia is a chronic psychosis characterized by three symptom domains: positive symptoms, negative symptoms and cognitive symptoms. Its prevalence is about 1 % of the general population. The development of psychopharmacology and schizophrenia treatment have made possible the distinction between different clinical courses and outcomes according to treatment response. This is the basis for the concept of treatment resistant schizophrenia (TRS), which can be present in 30 % of schizophrenic patients. Early and adequate identification of this subgroup is related to better outcomes. Authors analyze the previously mentioned concept and its clinical impact.

Feasibility study on developing clinical pediatrics curriculum for medical students engaged in long schooling system in the pre-clinical stage / 中华医学教育探索杂志

Objective:To analyze the feasibility of developing clinical pediatrics curriculum for pediatric students at the pre-clinical stage, and to provide a basis for the subsequent curriculum construction.Methods:A total of 90 pediatric medical students were enrolled, including pre-clinical group (G1, third semester of the second year, n=47) and the clinical clerkship group (G2, seventh semester of the fourth year, n=43). A questionnaire survey was conducted to compare the two groups from three aspects: clinical interest, learning methods and learning ability. And 24 and 20 students were randomly selected from the two groups to participate a clinical course respectively. Both of the formative evaluation and in-class test were carried out to compare the learning performance and learning effect between G1 and G2. SPSS 22.0 was used for data analysis. The counting data were described by case number and rate, and the frequency between groups was compared by chi-square test. When the chi-square test condition is not met, Fisher's exact test was performed. Normal distribution test was carried out for measurement data. Two independent sample t test was conducted for the comparison between groups of normal distribution data and Mann-Whitney U test for the comparison between groups of skewed distribution respectively. Results:There was no significant difference in clinical interest and pre-clinical interest between the two groups (Fisher's exact probability method, P=0.252, 1.000). There were partial differences in learning methods: G1 spent more time learning after class ( Z=-2.36, P=0.018), learned more in spare time ( Z=2.53, P=0.011), learned more on the homework ( P=0.020), and had a higher preview rate ( Z=-5.07, P < 0.001). There were also partial differences in learning ability: G2 had better literature retrieval ability ( χ2=10.57, P=0.001); G2 had higher scores on class and extended class performance ( t=-3.18, P=0.004; t=-10.14, P<0.001). In terms of learning effect, G2 scored higher scores on only one multiple choice question ( t=-2.46, P=0.022). Conclusion:The pediatrics students at the pre-clinical stage have certain interest and ability to receive clinical pediatrics courses. Sufficient pre-class preparation and appropriate curriculum design are helpful to the early cultivation of student's clinical thinking.

Hematoma subdural crónico / Chronic subdural hematoma

El hematoma subdural crónico (HSC) es una patología neuroquirúrgica frecuente, que se reconoce como consecuencia de traumatismos craneoencefálicos de poca magnitud que habitualmente se diagnostican en pacientes seniles, aunque puede presentarse en pacientes jóvenes y sin antecedentes de traumas.El objetivo que persigue este trabajo es la presentación de una paciente con un HSC bilateral, con características poco usuales.Caso clínico: se presenta una paciente del sexo femenino, de 46 años de edad, sin antecedente de traumatismo craneal ni de otra patología concomitante, que consulta por una cefalea de 15 días de evolución. El examen físico constató midriasis, pupila de Hutchinson, papiledema bilateral y exoforia del ojo derecho, parálisis del tercer par craneal y ataxia de tronco, fue catalogada con Glasgow 13. Se realizó tratamiento anti edema cerebral temprano y las manifestaciones desaparecieron en gran medida. En la Tomografía axial computarizada se diagnosticó un hematoma subdural frontotemporal bilateral con desplazamiento de las estructuras de la línea media a la izquierda. Fue operada de urgencia y dada de alta completamente recuperada tres días después.Conclusión: el HSC puede presentarse con distintas formas clínicas, simulando procesos expansivos tumorales, ataques cerebrovasculares, demencias o entidades neurológicas de otra índole. El manejo del caso por clínicos y neurocirujanos fue rápido y efectivo, lo que explica que la paciente tuvo una recuperación temprana y total. En estos casos la actuación médica es decisiva en el éxito del tratamiento.

Chronic subdural hematoma (CSH) is a common neurosurgical pathology that is recognized as a consequence of minor head injuries that are usually diagnosed in senile patients, although it can occur in young patients without a history of trauma.The objective of this work is the presentation of a patient with a bilateral CSH, with unusual characteristics.Clinical case: a 46-year-old female patient with no history of head trauma or other concomitant pathology is presented, who consulted for a 15-day-old headache. Physical examination confirmed mydriasis, Hutchinson's pupil, bilateral papilledema and exophoria of the right eye, third cranial nerve palsy, and trunk ataxia. She was cataloged with Glasgow 13. Early anti-cerebral edema treatment was performed and the manifestations largely disappeared. A computed tomography scan diagnosed a bilateral fronto temporal subdural hematoma with displacement of the midline structures to the left. She underwent emergency surgery and was discharged completely recovered three days later. Conclusion: HSC can present with different clinical forms, simulating expansive tumor processes, cerebrovascular attacks, dementias or neurological entities of another nature. The case management by clinicians and neurosurgeons was quick and effective, which explains that the patient had an early and complete recovery. In these cases, medical action is decisive in the success of the treatment.

Cambios en el patrón epidemiológico de la colitis ulcerosa crónica idiopática en México en un hospital de tercer nivel de atención / Changes in chronic idiopathic ulcerative colitis epidemiological pattern in Mexico in a tertiary care hospital

Resumen Antecedentes: La colitis ulcerosa crónica idiopática (CUCI) es una enfermedad con inflamación crónica de la mucosa del colon de origen multifactorial. El objetivo de este trabajo es identificar posibles cambios en el comportamiento de la CUCI en un hospital de referencia. Métodos: Se incluyeron nuevos casos de CUCI confirmados por histopatología de enero del 2007 a diciembre del 2014. Resultados: Se incluyeron un total de 189 pacientes. La media de nuevos casos anuales de CUCI fue de 23.6. Este estudio incorpora 95 pacientes de sexo masculino (50 %) y 94 de sexo femenino (50 %), con una edad promedio al diagnóstico de 44.6 años. La frecuencia de pancolitis fue del 77 %, en comparación con el 59 % en el periodo anterior. Las manifestaciones extraintestinales (MEI) estuvieron presentes en el 55.8 % y las colectomías en el 5.2 %. Conclusión: Algunas características de la enfermedad han cambiado con el tiempo: aumento de la frecuencia de pancolitis y MEI, así como disminución de la tasa de colectomías.

Abstract Background: Chronic idiopathic ulcerative colitis (CIUC) is a disease with multifactorial chronic inflammation of the colonic mucosa. In Mexico, there are studies that show an increase in the frequency of new cases. The purpose of this work was to identify possible changes in CIUC behavior in a referral hospital. Methods: New ulcerative colitis (UC) cases confirmed by histopathology from January 2007 to December 2014 were included. Results: A total of 189 patients were included. Mean number of UC annual new cases was 23.6. The study included 95 male patients (50 %) and 94 female patients (50 %), with an average age of 44.6 years at diagnosis. The frequency of pancolitis was 77 %, in comparison with 59 % in the previous period. Extra-intestinal manifestations (EIM) were present in 55.8 % and colectomies in 5.2 %. Conclusion: Some characteristics of the disease have changed over time: there is an increased frequency of pancolitis and EIM, as well as a decrease in the rate of colectomies.

De vuelta a la clínica. Métodos II. Arquitectura de la investigación clínica. Interacción sujeto, maniobras y enfermedad a través del tiempo / Back to the clinic. Methods II. Architecture of clinical research. Subject interaction, maneuvers and disease throughout time

Resumen La medicina se caracteriza por la aplicación del método científico a través del juicio clínico, por la correcta interpretación y el uso del curso clínico o historia natural de la enfermedad; su descripción más lograda la observamos en la arquitectura de la investigación clínica. A través de una secuencia temporal, este modelo explica el fenómeno de causalidad con tres apartados: estado basal, maniobra y desenlace. En el estado basal se evalúa quién es el paciente, de donde proviene, sus condiciones generales, el diagnóstico, el estadio y la agresividad de la patología, las complicaciones, terapias previas, nivel socioeconómico-cultural, hábitos, indicaciones o contraindicaciones terapéuticas y se prevé la evolución esperada. De la maniobra se pueden evaluar los factores de riesgo o pronóstico, tratamiento específico, sintomático y medidas generales. En el desenlace se vigila la evolución temprana y tardía. El modelo también permite determinar las causas de pérdida de seguimiento. Anticipar la evolución del paciente al reconocer su condición, enfermedad y efecto esperado de la decisiones médicas permite actuar anticipadamente, ya que esperar las manifestaciones del proceso evolutivo de la enfermedad resulta en detrimento del paciente.

Abstract Medicine is characterized by the application of the scientific method through clinical judgment, by correct interpretation and use of the clinical course and/or natural history of the disease; its best description is observed in the architecture of clinical research. Through a temporal sequence, this model explains the phenomenon of causality with three sections: baseline status, maneuver, and outcome. The baseline status assesses who the patient is, where does he come from, his general conditions, the diagnosis, stage and aggressiveness of the pathology, complications, previous therapies, socioeconomic-cultural level, habits, therapeutic indications or contraindications and the expected evolution is anticipated. In the maneuver, risk or prognostic factors, specific or symptom treatment, and general measures could be evaluated. In the outcome, early and late evolution are monitored. The model also allows the causes of follow-up loss to be determined. Anticipating patient evolution by recognizing his condition, disease, and expected effect of medical decisions allows acting in advance, since waiting for the manifestations of the evolutionary process of disease results in detriment to the patient.

Cattle rabies: the effect of clinical evolution, viral genetic lineage, and viral load on the severity of histological lesions / Raiva bovina: relação do curso clínico, da linhagem genética do vírus e carga viral com a intensidade de lesões histológicas

Our objective was the characterization and staging of histological lesions in different anatomical sites of the central nervous system (CNS) of rabid cattle. The severity of the lesions was compared with the clinical stages of the disease, the variants of viral isolates, and with the load of virus. Thirty-one spontaneously affected rabid cattle the state of Santa Catarina underwent clinical follow-up and were eventually necropsied. CNS tissues were sampled and submitted to direct fluorescent antibody technique (DFAT), immunohistochemistry (IHC), routine histopathology with hematoxylin and eosin stain (HE), reverse transcriptase polymerase chain reaction (RT-PCR), and polymerase chain reaction in quantitative reverse transcriptase in real time (qRT-PCR). Affected cattle were allotted in four groups according to their clinical stage when euthanized: G1, euthanized while standing; G2, euthanized when in sternal recumbence; G3, euthanized when in lateral recumbence; and G4, affected cattle with natural death. In order to evaluate the degree of severity of the lesions and the presence of Negri bodies (NBs), the brain was sectioned at 9 sites. Additionally, spinal cord and trigeminal ganglion sections were examined. The intensity of the lesions was graded as either absent, mild, moderate, or marked, and the presence or absence of the NBs was noted. Histological lesions were characterized by lymphocytic and monocytic meningoencephalitis with NBs in 28 cases. In all analyzed groups, intensities of histological lesions ranging from mild to severe were observed. Brain regions with the highest inflammatory lesion intensity were the medulla at the level of obex, followed by the colliculus and thalamus. NBs were observed in a higher percentage in the cerebellum, followed by medulla at the obex level, striatum complex, and frontal telencephalon. The duration of the clinical course of the disease did not influence the intensity of the inflammatory lesion, but it did influence the presence of NBs, with a higher percentage of these inclusions in cattle that died naturally than in euthanized cattle. All isolated rhabdovirus included in this study were genetically compatible with samples from hematophagous bats Desmodus rotundus. The evaluation by qRT-PCR did not demonstrate a correlation between lesion intensity and the amount of virus.(AU)

Nosso objetivo foi a caracterização e estadiamento de lesões histológicas em diferentes locais anatômicos do sistema nervoso central (SNC) de bovinos raivosos. A gravidade das lesões foi comparada com os estágios clínicos da doença, as variantes dos isolados virais e com a quantidade de vírus. Trinta e um bovinos do estado de Santa Catarina, afetados naturalmente por raiva, foram acompanhados clinicalmente e, ao final, necropsiados. Os tecidos do SNC foram amostrados e submetidos a imunofluorescência direta, imunohistoquímica, histopatologia de rotina, reação em cadeia da polimerase via transcriptase reversa (RT-PCR) e reação em cadeia da polimerase em transcriptase reversa quantitativa em tempo real (qRT-PCR). Os bovinos afetados foram distribuídos em quatro grupos, de acordo com sua fase clínica: G1, eutanasiados quando ainda se mantinham em pé; G2, eutanasiados quando em decúbito esternal; G3, eutanasiados quando em decúbito lateral; e G4, bovinos afetados com morte natural. Para avaliar o grau de gravidade das lesões e a presença de corpúsculos de Negri (CNs), o cérebro foi seccionado em 9 locais. Além disso, seções da medula espinhal e do gânglio trigêmeo foram examinadas. A intensidade das lesões foi graduada como ausente, leve, moderada ou acentuada, e a presença ou ausência dos CNs foi anotada. Lesões histológicas foram caracterizadas por meningoencefalite linfocítica e monocítica com CNs em 28 casos. Em todos os grupos analisados foram observadas intensidades de lesões histológicas variando de leve a grave. As regiões cerebrais com maior intensidade de lesão inflamatória foram o bulbo no nível do obex, seguido do colículo e tálamo. CNs foram mais prevalentes no cerebelo, seguido pelo bulbo ao nível do óbex, corpo estriado e telencéfalo frontal. A duração do curso clínico da raiva não influenciou a intensidade da lesão inflamatória, mas influenciou a presença de CNs, com maior porcentagem dessas inclusões em bovinos que morreram naturalmente do que em bovinos sacrificados. Todos os isolados rabdovírus obtidos neste estudo eram geneticamente compatíveis com amostras provenientes de morcegos hematófagos Desmodus rotundus.(AU)

Effects of Inflammatory Disease on Clinical Progression and Treatment of Ischiogluteal Bursitis: A Retrospective Observational Study

@#Introduction: The symptoms of Ischiogluteal Bursitis (IGB) are often nonspecific and atypical, and its diagnosis is more challenging. Moreover, it is difficult to predict cases of chronic progression or poor treatment response. Therefore, the aim of this study was to investigate the clinical course of IGB patients and identify factors that are predictive of failure of conservative treatment. Materials and Methods: Our study consisted of IGB patients diagnosed between 2010 March and 2016 December who had been followed-up for at least one year. Structured questionnaires and medical records were reviewed to analyse demographic characteristics, lifestyle patterns, blood tests, and imaging studies. We categorized the cases into two groups based on the response to conservative treatment and the need for surgical intervention. Results: The most common initial chief symptoms were buttock pains in 24 patients (37.5%). Physical examinations showed the tenderness of ischial tuberosity area in 59 (92.2%) patients, but no specific findings were confirmed in 5 patients (7.8%). 51 patients (79.7%) responded well to the conservative management, 11 patients (17.2%) needed injection, and 2 patients (3.1%) had surgical treatment performed due to continuous recurrence. There was no difference in demographic and blood lab data between the two groups. However, the incidence of inflammatory diseases (response group: 10.3% vs non-response group: 66.7%, p=0.004) was significantly different between the two groups. Conclusion: The diagnosis of IGB can be missed due to variations in clinical symptoms, and cautions should be exercised in patients with inflammatory diseases as conservative treatment is less effective in them, leading to chronic progression of IGB.

Correlation between the atypical presentation of myasthenia gravis and radio-pathological classification of the thymus – A retrospective cohort study

@#Myasthenia gravis (MG) is a disease of neuromuscular junction and mainly autoimmune in aetiology. The state of thymus is a critical determinant for the prognosis. In this retrospective review study, we aimed at clarifying the relationship between the mode of clinical presentation of MG and the radiopathological classification of the thymus. We identified patients with MG from the database of our medical center from 1988 – 2017. The patients were classified into two groups according to their clinical presentation: those with a typical presentation with diurnal variation, and those with an atypical presentation of persistent weakness or respiratory failure from the beginning. The underlying thymic state was categorized into six groups: normal, abnormal by imaging (if no operation was performed), hyperplasia, benign thymoma, cortical type thymoma, and malignant thymoma. In total, 227 patients (133 females and 94 males) were included in the analysis, of whom 68% were classified into the typical presentation group. The atypical presentation correlated significantly with thymic categories (p = 0.014) and sex (p = 0.026) but not age at onset (p = 0.232). The atypical presentation was more common in the male patients and in those with thymic carcinoma.

Reform of clinical courses examination based on Deming cycle theory: An exploration of explanation and evaluation system for examination papers / 中华医学教育探索杂志

Deming cycle theory, namely the plan-do-check-act (PDCA) cycle theory, is a relatively advanced and widely used theory of quality management system in foreign countries, with both scientific and systematic features. The research group introduced the PDCA quality control theory into the eight-year clinical course assessment for the first time to carry out the reform of clinical course examination and actively promote the explanation and evaluation system for examination papers. After four years of follow-up research, the management means based on the PDCA cycle was continuously used to optimize the explanation and evaluation system for examination papers and improved the efficiency of clinical course examination. At present, certain achievements have been made, which include urging students to reflect on learning, promoting the implementation of the student-centered teaching philosophy, enhancing teachers' teaching input, and improving the management quality of teaching departments.

Reform of clinical courses examination based on Deming cycle theory:An exploration of explanation and evaluation system for examination papers / 中华医学教育探索杂志

Deming cycle theory, namely the plan-do-check-act (PDCA) cycle theory, is a relatively advanced and widely used theory of quality management system in foreign countries, with both scientific and systematic features. The research group introduced the PDCA quality control theory into the eight-year clinical course assessment for the first time to carry out the reform of clinical course examination and actively promote the explanation and evaluation system for examination papers. After four years of follow-up research , the management means based on the PDCA cycle was continuously used to optimize the explanation and evaluation system for examination papers and improved the efficiency of clinical course examination. At present, certain achievements have been made, which include urging students to reflect on learning, promoting the implementation of the student-centered teaching philosophy, enhancing teachers' teaching input, and improving the management quality of teaching departments.

Clinical Course of Chronic Spontaneous Urticaria in the Korean Adult Population

Knowledge of the clinical course of chronic spontaneous urticaria (CSU) remains unclear. The purpose of our study was to investigate the clinical course of CSU in the Korean adult population. Each patient in the CSU group who was defined by disease codes between 2003 and 2007 was tracked whether he or she went into remission or not until 2013. Kaplan-Meier survival analysis was carried out to analyze remission, and log-rank tests were performed for between-group comparisons. Demographic differences between subjects who went into remission 1 year after the initial diagnosis and those who did not were analyzed using χ² tests. A total of 13,969 subjects were included in the CSU group. The 1-, 2-, 3-, 4-, and 5-year remission rates of CSU were 21.5%, 33.0%, 38.9%, 42.6%, and 44.6%, respectively. The proportion of subjects in the 65+ age group (P=0.050) and with male gender (P=0.002) was significantly higher among subjects who did not go into remission 1 year after the initial diagnosis. Our study indicates that CSU could have a more persistent course than previously reported.

Clinical Courses and Outcome of Newly Diagnosed Immune Thrombocytopenia in Infants / 임상소아혈액종양

BACKGROUND: Infants with immune thrombocytopenia (ITP) are at increased risk of high risk bleeding and vaccination-associated ITP. Infants with ITP respond favorably to treatment and are less likely to develop chronic ITP compared to older children. However the characteristics of this entity in infants have rarely been analyzed. We investigated the clinical characteristics and response to treatment of newly diagnosed ITP in infants under 1 year of age. METHODS: We retrospectively reviewed the medical records of newly diagnosed ITP infants between 1 month to 11 months of age at Chonbuk National University Hospital from 2002 to 2017. The demographics, complete blood count, absolute lymphocyte count (ALC), absolute neutrophil count, vaccination history, upper respiratory infection, viral study (cytomegalovirus) and treatment of patients with ITP were reviewed. RESULTS: A total of 85 patients satisfied the criteria for newly diagnosed ITP. Of these patients, 83 were in complete remission, 6 were in persistent remission, and 2 progressed to chronic ITP. As a result of the study, 57 patients (67%) were male. 71 patients (83.5%) were secondary ITP. Among secondary ITP, vaccination related ITP was the most common cause with 60 patients (84.5%). The mean at diagnosis was 4.3±3.2 month. There was no statistically significant difference in ALC between the time of diagnosis and treatment. Hemoglobin was 10.8 g/dL at diagnosis and increased significantly to 12.3 g/dL after treatment. CONCLUSION: Ninety-seven percent of ITP patients diagnosed under 1 year of age were in remission.

Related factors for the development of subdural haematoma in patients with spontaneous intracranial hypotension / 中华神经科杂志

Objective To investigate related factors for subdural haematoma (SDH) in patients with spontaneous intracranial hypotension (SIH),and to provide clinical evidence for the prevention and treatment of the disease.Methods The clinical and imaging data of 177 patients with SIH from Sir Run Run Shaw Hospital during April 2008 to May 2014 were retrospectively analyzed,145 patients of whom were selected as study subjects and divided into SDH group and non-SDH (NSDH) group.And then the univariate analysis and further multiple Logistic regression analysis were performed to identify the potential risk factors,including gender,age,clinical course,blood pressure,cerebrospinal fluid pressure,lesions,for the development of SDH.Results In 29 of 145 patients with the development of SDH (20.0％),male patients accounted for the majority (62.1％,18/29).The mean age was (44.72 ± 11.03) years and the mean clinical course was (50.41 ±30.42) days in the SDH group,which were (39.96 ±9.35) years and (31.70 ± 24.39) days in the NSDH group.The univariate analysis showed that advanced age,male gender and longer clinical course were associated with the development of SDH.However,multivariate analysis only included male (Exp(B) =3.636,95％ CI 1.559-8.482,P=0.003) and longer clinical course (Exp(B) =1.021,95％ CI 1.006-1.036,P =0.005).When the clinical course has been exceeded 18 days,the probability of the development of SDH was significantly higher,with the incidence of SDH increased to 24.3％ (26/107),obviously higher than that in patients with clinical course ≤ 18 days (7.9％ (3/38);x2=4.716,P =0.030).Conclusions The male gender and the longer clinical course were found to be the potential risk factors for the development of SDH.When the clinical course duration exceeds 18 days,there will be a greater potential for the development of SDH comparing with other factors.

The role of teaching feedback in improvingthe quality of eight-year program clinical medical students' surgery courses / 基础医学与临床

Feedback for teaching refers to the mutual transmission and interaction of various information between teaching and learning in teaching process,and is an inevitable result and objective existence of teaching in which teachers and students participate.Effective feedback for teaching is characterized by timely,comprehensive and authentic.Teachers can continuously modify teaching per formance through the feedback of students;the feedback of teaching by students is reflected in examination performance,which really reflects the idea that teaching benefits teachers as well as students.Clinical comprehensive course of eight-year program students is an important bridge between basic medicine and clinical medicine,and the foundation of teaching clinical medicine.Feedback for teaching was applied in students of academic year 2011 from the Department of Surgery of Clinical College in Pekjing Union Medical College,and teaching approach was adjusted in time,contributing to good teaching effectiveness.

Modest Improvement of Untreated Severe Sleep-Disordered Breathing in the Middle-Aged and Elderly

OBJECTIVE: It has been reported that untreated sleep-disordered breathing (SDB) deteriorates over time, however this remains contentious. The aim of the present study is to evaluate the clinical course of SDB in middle-aged and older SDB patients, and to identify how relevant factors contribute to the change in SDB severity. METHODS: Baseline and follow-up polysomnographic data of 56 untreated SDB patients (mean age, 61.2±5.71) were obtained retrospectively and the mean interval was 62.4±22.0 months. Subgroup analysis was performed based on the baseline severity, and the factors associated with the course of SDB were analyzed. RESULTS: At the baseline, 13 subjects were simple snorers, 15 had mild to moderate SDB, and 28 were severe SDB patients. While there was no significant change in apnea-hypopnea index (AHI) as a whole, subgroup analysis showed decrease of AHI in severe SDB patients (43.9±10.6 to 35.6±20.0, p=0.009). The change in supine time percent and baseline AHI were associated with the change in AHI (β=0.387, p=0.003; β=-0.272, p=0.037). CONCLUSION: Untreated SDB did not deteriorate over time with modest improvement in severe SDB. A proportion of severe SDB patients might expect decrease in SDB severity irrespective of changes in sleep position or body weight.

"The assessment and analysis of the graduation papers of ""3+2"" assistant general practitioners training ""comprehensive clinical course""" / 中华医学教育探索杂志

Objective Based on the objective test (A type) results of the 2014 comprehensive clinical course graduation test of 3+2 assistant general practitioners training,this article analyzed the differences between different teaching units,so as to provide objective basis for improving the teaching level of each unit.Method We established a database with EXCEL 2000,and put each question's ID and points,and the score of each student into the computer,so we could get the difficulty coefficient,distinction degree and reliability of the test paper,and calculate the difficulty coefficient and difference of each question.Then we analyzed the difficulty coefficient,the difference and the reliability of the 122 students' testing results,and compared the accuracy to the same question of the 6 teaching units.Result The objective test's (A type) difficulty coefficient is 0.77,distinction degree is 0.19,and reliability is 0.99.The highest score of the 122 students is 47 points,and the lowest score is 28 points,the average score is (38.5 ± 3.9) points.In the 50 questions,3 questions' difficulty coefficient is less than 0.4,14 questions' difficulty coefficient is between 0.4-0.7,33 questions' difficulty coefficient is above 0.7,so the difficulty degree of the paper is relatively low.In the 50 questions,23 questions' distinction degree is less than 0.15,17 questions' distinction degree is between 0.15-0.30,10 questions' distinction degree is above 0.30,so the distinction degree of the paper is relatively high.In the 50 questions,20 questions' accuracy appears larger differences between each unit:9 questions' accuracy has decreased significantly among 1-2 units,4 questions' accuracy decreased significantly among 3 units,3 questions' accuracy decreased significantly among 4 units,only 1 unit has high accuracy among 2 questions,and 2 questions' accuracy decreased significantly among all units.These problems are related to the teachers' teaching ability,the difficulty in mastering the key points of the curriculum,the lack of the concept of the general practitioners training.Conclusion The design of the examination paper is basically in line with the study purpose and the objectives of the training course.This examination paper was highly reliable,and suitable for the professional theory and ability test.There are site differences between each unit,which can provide an objective basis for improving the teaching level of different teaching unit,and we will solve the problems in the form of collective preparation next step.

Disease Phenotype, Activity and Clinical Course Prediction Based on C-Reactive Protein Levels at Diagnosis in Patients with Crohn's Disease: Results from the CONNECT Study

BACKGROUND/AIMS: C-reactive protein (CRP) is an easily measured index of disease activity, but its ability to predict clinical course is controversial. We therefore designed a study to determine whether the CRP level at Crohn's disease (CD) diagnosis is a valuable indicator of the disease phenotype, activity, and clinical course. METHODS: We retrospectively analyzed 705 CD patients from 32 institutions. The patients were classified into two groups according to CRP level. The patients' demographic and clinical characteristics and their use of immunosuppressive or biological agents were recorded. Disease location and behavior, hospitalization, and surgery were analyzed. RESULTS: A high CRP was associated with younger age, steroid use, colonic or ileocolonic location, high CD activity index, and active inflammation at colonoscopy (p<0.001). As the disease progressed, patients with high CRP were more likely to exhibit strictures (p=0.027). There were significant differences in the use of 5-aminosalicylic acid, antibiotics, corticosteroids, azathioprine, and infliximab (p<0.001, p<0.001, p<0.001, p<0.001, and p=0.023, respectively). Hospitalization was also more frequent in patients with high CRP. CONCLUSIONS: The CRP level at diagnosis is useful for evaluating the phenotype, activity, and clinical course of CD. Closer follow-up strategies, with early aggressive treatment, could be considered for patients with high CRP.

Clinical Course of Consecutive Esotropia after Surgery to Correct Recurrent Intermittent Exotropia

PURPOSE: To analyze the clinical aspects of consecutive esotropia after intermittent exotropia reoperation and study the prognosis and associated risk factors. METHODS: The present study included 34 patients with intermittent exotropia who underwent reoperation; incidence rate, risk factors, treatment methods and prognosis of the postoperative consecutive esotropia were analyzed. RESULTS: Of the 34 patients, 12 developed consecutive esotropia that persisted longer than a month after the reoperation; a higher incidence rate was observed in patients with esodeviation greater than 16 prism diopter (PD) on postoperative day 1 and in patients who received unilateral lateral muscle recession and medial muscle resection during the operation (p < 0.05). Conversely, factors such as age, deviation angle, refractive power, anisometropia, lateral incomitance and oblique muscle dysfunction prior to the reoperation did not affect the incidence of consecutive esotropia. The patients who developed consecutive esotropia received conservative treatments such as alternative occlusion therapy and fresnel prism wearing; 10 of 12 patients showed significant clinical improvements. CONCLUSIONS: Consecutive esotropia frequently occurs after intermittent exotropia reoperation if the patient had esodeviation greater than 16 PD on postoperative day 1 or received unilateral lateral muscle recession and medial muscle resection. The conservative treatments of the consecutive esotropia showed good clinical response and improved prognosis.

Middle East Respiratory Syndrome-Coronavirus Infection: A Case Report of Serial Computed Tomographic Findings in a Young Male Patient

Radiologic findings of Middle East respiratory syndrome (MERS), a novel coronavirus infection, have been rarely reported. We report a 30-year-old male presented with fever, abdominal pain, and diarrhea, who was diagnosed with MERS. A chest computed tomographic scan revealed rapidly developed multifocal nodular consolidations with ground-glass opacity halo and mixed consolidation, mainly in the dependent and peripheral areas. After treatment, follow-up imaging showed that these abnormalities markedly decreased but fibrotic changes developed.