Risk factors analysis of blood type unexpected antibody in large sample of inpatients / 中国输血杂志

【Objective】 To observe and analyze the detection results of blood type unexpected antibody and its risk factors in inpatients, so as to provide reference for promoting the safety of clinical blood transfusion. 【Methods】 Clinical data of 22 800 inpatients were collected retrospectively and unexpected antibody screening was performed by microcolumn gel method and saline method. According to the screening results, the inpatients were divided into positive group (n = 62) and negative group (n = 22 738). Clinical data of the two groups were collected and analized by univariate analysis, and specificity identification of unexpected antibody was performed in the positive group. The specific distribution characteristics of antibody were statistically analyzed, and the risk factors of unexpected antibody were analyzed by binary logistic regression. 【Results】 Among the 22 800 inpatients, the yield rate of unexpected antibody was 0.27% (62/22 800), with Rh, MNS, Lewis, Kidd blood group antibody, mixed antibody, autoantibodies and others accounted for 40.32% (25/62), 14.52% (9/62), 6.45%(4/62), 1.61%(1/62), 20.97%(13/62), 6.45%(4/62) and 9.68%(6/62), respectively. Univariate analysis showed that there were significant differences in gender, age, pregnancy history, blood transfusion history, blood transfusion frequency and disease type between the positive group and the negative group by chi-square test (χ2 = 11.142, 6.994, 12.453, 4.762, 5.493, 92.381, all P<0.05), while there was no significant difference in nationality (χ2 = 3.719, P>0.05 ) . Binary logistic regression analysis showed that female, age >60 years old, with history of blood transfusion, number of blood transfusion >3 times, history of pregnancy, solid tumor and blood diseases, severe internal medical diseases were independent risk factors for unexpected antibody(P<0.05) . 【Conclusion】 For patients who need blood transfusion, especially those with the above risk factors, conducting unexpected antibodies screening and identification before transfusion, avoiding corresponding antibodies and selecting antigen-negative blood for cross-matching were suggested to ensure the effectiveness and safety of clinical blood transfusion.

Predictors determining the duration of hospital stay among patients admitted with singlefractures / Predictores que determinan la duración de la estancia hospitalaria en pacientes ingresados con fracturasúnicas

Introduction: Fractures pose a tremendous burden on the health care systems due to the prolonged duration of admission. Addressing various determinants that prolong hospital stay will help minimize the cost of treatment. Objective: To study the determinants associated with the duration of hospital stay among patients admitted with fractures. Methods: This was a retrospective observational study conducted at a private tertiary care hospital in Mangalore. A semi-structured proforma was used for collecting data from the medical records. Results: The mean age of the 124 patients were 48.3±21.4 years. The majority were males [69(55.6 por ciento)] and were from urban areas [86(69.3 por ciento)]. Co-morbidities were present among 69(55.6 por ciento) patients. Out of the total patients, 8(6.4 por ciento) were alcoholics, and 10(8.1 por ciento) were tobacco smokers. The majority [50(40.3 por ciento)] had fracture of the femur. Five (4 por ciento) patients developed complications during the post-operative period. Seventy-eight (62.9 por ciento) patients had medical insurance facilities. The mean duration of hospital stay was 9.6±3.2 days among the patients. The mean duration of hospital stay among patients (n=115) before surgery was 2.4±1.6 days. Increased pre-operative stay, increasing age, rural residential status, open type of fracture, and being given general anaesthesia for the operative procedure were significant predictors determining the period of stay among patients in the hospitals. Alcoholic status independently influenced the period of stay in the pre-operative period. Conclusion: Both patient and treatment characteristics were important determinants associated with the duration of hospital stay. Targeting these predictors will help to manage in-patients better and shorten their duration of hospital stay(AU)

Introducción: Las fracturas suponen una enorme carga para los sistemas sanitarios debido a la duración prolongada del ingreso. Abordar varios determinantes que prolongan la estadía en el hospital ayudará a minimizar el costo del tratamiento. Objetivo: Estudiar los determinantes asociados a la duración de la estancia hospitalaria en pacientes ingresados con fracturas. Métodos: Este es un estudio observacional retrospectivo realizado en un hospital privado de atención terciaria en Mangalore. Se utilizó una proforma semiestructurada para la recolección de datos de las historias clínicas. Resultados: La edad media de los 124 pacientes fue de 48,3±21,4 años. La mayoría eran hombres [69 (55,6 percent)] y de áreas urbanas [86 (69,3 percent)]. Las comorbilidades estuvieron presentes en 69 (55,6 percent) pacientes. Del total de pacientes, 8 (6,4 percent) eran alcohólicos y 10 (8,1 percent) fumadores. La mayoría [50 (40,3 percent)] tenía fractura de fémur. Cinco (4 percent) pacientes desarrollaron complicaciones durante el postoperatorio. Setenta y ocho (62,9 percent) pacientes tenían seguro médico. La duración media de la estancia hospitalaria fue de 9,6±3,2 días entre los pacientes. La duración media de la estancia hospitalaria de los pacientes (n=115) antes de la cirugía fue de 2,4±1,6 días. El aumento de la estancia preoperatoria, el aumento de la edad, el estado residencial rural, el tipo de fractura abierta y la anestesia general para el procedimiento quirúrgico fueron predictores significativos que determinaron el período de estancia entre los pacientes en los hospitales. El estado alcohólico influyó de forma independiente en el tiempo de estancia en el preoperatorio. Conclusión: Tanto las características del paciente como las del tratamiento fueron determinantes importantes asociadas con la duración de la estancia hospitalaria. Abordar estos predictores ayudará a manejar mejor a los pacientes hospitalizados y acortar la duración de su estadía en el hospital(AU)

Prevalence of Subclinical Hypothyroidism of Patients with Acute Coronary Syndrome at a Tertiary Care Hospital

Background: Cardiovascular diseases (CVDs) have nowbecome the leading cause of mortality in India. Acute coronarysyndrome (ACS) describes the range of myocardial ischemicstates that includes unstable angina, non-ST elevatedmyocardial infarction (MI), or ST-elevated MI. Hence; thepresent study was undertaken for assessing the prevalence ofsubclinical hypothyroidism of patients with acute coronarysyndrome.Materials & Methods: A total of 50 patients who wereadmitted due to acute coronary syndrome were enrolled in thepresent study. Blood samples were obtained and were sent tofor assessment of thyroid profile. Complete haematological andbiochemical profile of all the patients was also obtained. Forserum thyroid hormone profile was measured by Enzymelinked immunosorbent assay (ELISA) technique.Results: Subclinical hypothyroidism was found to be present in5 patients (10 percent of the patients). Non-significant resultswere obtained while correlating the presence of subclinicalhypothyroidism with age and gender-wise distribution ofpatients.Conclusion: Thyroid profile is altered significantly in patientswith acute coronary syndrome.

Smoking cessation practices and perspectives among in-patients in a tertiary teaching hospital setting

Background: The objective of the present study was to assess the in-patient’s perspectives about smoking cessation and the services they received.Methods: A descriptive study was carried out in a hospital attached to a Medical College. An interview schedule was administered in person to in-patients to assess their perspectives towards smoking cessation and services received.Results: Of the 141 in-patients interviewed, 40% were active smokers. Almost 3/4th of active smokers had moderate to high nicotine dependence. About 92% of active smokers reported being asked about smoking status and being advised to quit, but only 23% received assistance, and 8% had a follow-up arranged. Health was the top reason for the willingness to quit. Around 90% of study participants had no awareness about tobacco cessation centres and services.Conclusions: An in-patient setting has a higher proportion of smokers than the general population. These in-patients should be a prime target for cessation programs as there are relatable health reasons and opportunity for the delivery of comprehensive smoking cessation services based on 5 A’s protocol, which is currently lacking. Creating better awareness regarding smoking cessation centres and services available is necessary.

A study on prescribing errors in in-patients of a corporate tertiary care hospital in North India

Background: Prescribing errors are a subset of medication errors which have a potential for grave harm to the patient. Identification and acknowledgement of such errors can ameliorate much of this danger. Studies of prescribing errors are sparse in India. Such studies, whatever have been conducted, mainly focus on the out-patients or the patients on discharge. Hence, this study was undertaken to study the prescribing errors in prescriptions generated for patients admitted in wards of a corporate hospital in North India.Methods: The prescriptions for in-patients admitted in wards were analyzed for different types of prescribing errors in individual drug orders and prescription as a whole.Results: The prescribing error rate was found to be 3.3% in this study. Of all errors, errors leading to delays in patient care (i.e. Errors of prescription writing) (54.54%) and erroneous copying of the prescription to the drug chart by junior/ resident doctors (Transcription errors) (31.31%) were found to be the major causes of prescribing errors in this study. Of the former category, prescribing a wrong strength (24.24%) and illegible drug orders (12.12%) were the most numerous error subtypes. Errors leading to sub-optimal patient care (i.e. Errors of decision making) were least identified of which Therapeutic duplication (12.12%) was the most common subtype.Conclusions: The error rate found in this study is comparable to the data available from developed countries. However, there are significant differences in the occurrences of error subtypes found in this study as compared to the studies of the west.

Role of hypofractionated palliative radiotherapy in patients with stage four head-and-neck squamous cell carcinoma

Background: Large number of patients with head-and-neck cancer presents with factors such as advanced disease, poor general condition, and associated comorbidities due to which radical treatment is not recommended in these patients. In this scenario, the aim of the present study is to assess the role and feasibility of hypofractionated palliative radiotherapy in these patients. Subjects and Methods: This study was conducted on patients with histopathologically proven cases of squamous cell carcinoma of the head-and-neck region who were surgically unresectable. The quality of life (QOL) was assessed before and after 1 month of radiotherapy using University of Washington Quality of Life questionnaire version 4. All patients received 40 Gy in 10 fractions, twice weekly by two lateral fields covering primary and secondary disease. Response evaluation criteria in solid tumor criteria were used to assess the tumor response. Toxicity was assessed weekly using radiation therapy oncology group criteria. Results: A total of 50 patients were enrolled in this study, out of which 46 completed the planned treatment of 40 Gy in 10 fractions. Common complaints were distressing pain at the primary site (42%), neck swelling (30%), difficult in swallowing (18%), and change in voice (10%). Statistically significant improvements were observed in overall QOL (26.9 ± 9.63 to 55.65 ± 19.28) and none of them experienced Grade IV mucositis or skin toxicity. Good objective response was seen in 82.6% and 84.7% of patients at primary and nodal sites, respectively. Conclusions: This hypofractionated palliative radiotherapy regimen is a good treatment option in patients with Stage IV head-and-neck cancer, who are not fit for treatment with curative intent.

Hyperuricemia as an Early Marker in Predicting the Mortality and Morbidity in Patients with Sepsis

Introduction: Serum uric acid can be used as a marker ofoxidative stress, and poor prognosis in patients with sepsis,since high levels of oxy radicals, lower oxidant level in sepsispatients result in multi organ failure. Raised uric acid isassociated with chronic diseases and is used as a prognosticindicator of severe infection as it acutely activates varioustranscription factors. Aim: This study aims to understandthe correlation between hyperuricemia and the mortality andmorbidity rate in patients with clinically suspected sepsis(based on Qsofa Criteria - Quick sepsis related organ failure).The secondary end points of the study are to understandcorrelation between hyperuricemia in clinically suspectedsepsis patients and Acute kidney injury, acute respiratorydistress syndrome, and duration of stay in the hospital.Material and methods: We conducted a prospective cohortstudy in clinically suspected sepsis patients {based on theQsofa Criteria} between September2017-2018 in a tertiarycare center in AJ Institute Of Medical Sciences in South India.Patients or their medical power of attorneys provided writteninformed consent. A total no of 60 patients were enrolled basedon the inclusion criteria, clinically suspected sepsis patientsaged more than 18 years. All pregnant female, patients fromoutside facility admitted in the medical intensive care unit formore than 24 hours were excluded. For the purpose of ourstudy we defined hyperuricemia as greater than or equal to7 mg/ dl in both males and females. Patients were divided intwo groups based on the uric acid levels. The first group hadclinically suspected sepsis patients with uric acid levels morethan 7 and the second group had clinically suspected sepsispatients with uric acid level less than 7.Results: More than half of the patients, 55%, with high uricacid were found to be males. The overall mortality rate inpatients with high uric acid levels was found to be 90%. Theprobability of having hyperuricemia with acute kidney injurywas around 92.9%.Conclusion: Hyperuricemia was associated with poorprognosis in clinically suspected sepsis patients

Analysis of mortality trend and related factors for aged in-patients with diabetes mellitus / 中国实用内科杂志

OBJECTIVE: To find out the mortality trend and related factors in aged hospitalized patients with diabetes mellitus(DM). METHODS: The case information diabetic in patients who died during the period from 2005 to 2014 were collected and the mortality and causes of death were analyzed. RESULTS: From 2005 to 2014, 1297 diabetic patients died, and the mortality of elderly DM inpatients was 4.44%(1162 cases), significantly higher than that of the non-elderly of 0.94%(P<0.001). The death rate of elderly diabetic patients was significantly higher in males than in females(5.22% vs. 3.47%, P<0.001). The mortality of the aged diabetic patients decreased within 10 years(P<0.001), decreasing from 4.75% in 2005 to 3.01% in 2009(P<0.001) in the year of 2005-2009, while there were no differences in the year of 2010-2014. The main death causes of the aged diabetic in-patients were as follows: infections(27.71%), cardiovascular diseases(25.22%), tumor(21.34%), cerebral vascular diseases(10.41%) and diabetic complications(5.51%). The first death cause in the 60-79 yrs group was cardiovascular diseases, while in the ≥80 yrs group, it was infections. The constituent ratio of infection as death cause in the aged during 2010-2014 significantly increased(22.60% vs. 32.50%, P<0.001), increasing by 43.81%, and it became the first cause of death in 2010. CONCLUSION: The death rate of the elderly DM in-patients has decreased significantly within 10 years, from 2005 to 2014, while the rate has kept steady from 2010. Infections and cardiovascular diseases are the main cause of death. So it's important to prevent the elderly hospitalized DM patients from infection, in addition to cardiovascular diseases, and to control in time.

Clinical characteristics analysis of 1 808 rheumatism in-patients with oral candidiasis / 中华口腔医学杂志

Objective@#To analyze the clinical characteristics of oral candidiasis (OC) in in-patients with rheumatism, in order to provide theoretical basis for the prevention and treatment of OC in rheumatism patients.@*Methods@#One thousand eight hundred and eight in-patients were recruited in the Department of Rheumatology, the Second Hospital of Shanxi Medical University from January 2017 to December 2017. The patients included 607 males and 1 201 females. Their average age was (49.5±15.5) years old with a ranging from 14 to 81 years. According to occurrence of OC or not, the patients were divided into OC group and non-OC group. The differences of general data, primary diseases, laboratory examinations, usage of glucocorticoid and immunosuppressant therapy were compared between the two groups, and the risk factors of OC occurrence were analyzed.@*Results@#Two hundred and sixty-nine patients had OC and 1 539 patients had no OC. Age [(54.9±14.7) years], duration of illness [(9.4±4.4) years] and hospital stay [(15.3±5.7) d] in OC group were significantly longer than those in non-OC group. OC incidence in patients with connective tissue disease (CTD) [17.40% (193/1 109)] was higher than that in non-CTD patients [10.87% (75/699)] (P<0.001). OC most likely occurred in patients with such CTD as Sjögren syndrome (SS) and Behcet syndrome. OC incidence in non-CTD patients with osteoarthritis (OA) was highest. The salivary flow rate in OC group [(0.65±0.45) ml/min] was significantly lower than that in non-OC group [(0.78± 0.39) ml/min] (t=2.394, P=0.017). There was no statistical differences in other laboratory examinations between the two groups, including white blood cells (WBC), lymphocyte, platelet count, liver function, renal function, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, immunoglobulin G, immunoglobulin M, immunoglobulin A, C3, C4 and so on. OC incidence in patients using prednisone≥15 mg/d [17.16% (133/775)] was higher than that in patients using prednisone<15 mg/d [12.53% (94/750)] and patients not using prednisone [14.84% (42/283)] (P<0.05). The incidence of OC in patients with immunosuppressant therapy [16.11% (226/1 403)] was statistically higher than that in non-immunosuppressant patients [10.62% (43/405)] (P<0.01). Logistic regression analysis showed that the risk factors of OC occurrence included primary diseases (P<0.001), age (P<0.001), duration of illness (P=0.001) and duration of hospitalization (P=0.002).@*Conclusions@#OC occurred commonly in rheumatism in-patients, especially in elder patients, patients with long duration of illness and hospital stay. OC incidence in CTD patients is significantly higher than that in non-CTD patients. Glucocorticoid and immunosuppressant therapy might significantly reduce the anti-fungal immunity of the patients.

Analyses on causes of disease condition changes for patients discharged from intensive care unit / 中国中西医结合急救杂志

Objective To investigate the causes of disease condition changes after the patients' transfer from intensive care unit (ICU) into the general wards. Methods From January 2013 to December 2018, the patients with improvement of disease condition in comprehensive ICU were transferred into the general wards of the First People's Hospital of Lianyungang and their clinical data were retrospectively analyzed. The general information of patients was collected, such as gender, age, underlying diseases, heavy smoking, acute physiology and chronic health evaluationⅡ(APACHEⅡ) and Glasgow coma score (GCS) in 24 hours, length of stay in ICU, average levels of oxygenation index and respiratory rates during the stay in ICU and on the day transfer from ICU, GCS score on the day of transfer from ICU, presence or absence of invasive ventilation,the time of invasive ventilation, sepsis or its absence, the situation of community or hospital acquired pneumonia, etc, and the classification of the disease changes after transfer. The patients were divided into a disease situation change group (change group) and a disease situation stable group (stable group) according to whether there was any change in the disease situation in the general ward or not, the patients were divided into respiratory complications group and non-respiratory complications group. The risk factors that may influence the change of the disease condition were analyzed by multiple-factor Logistic regression. Results From January 2013 to December 2018, there were 2 451 patients treated in comprehensive ICU, of that 1 293 were transferred into the general wards for further treatment. Among the patients transferred to the general ward, 628 cases' conditions were changed.① The respiratory complications were the most common changes (345 cases, 54.9%) in patients after the transfer from ICU, followed by cardiovascular complications (118 cases, 18.8%) and surgery-related complications (96 cases, 15.3%).② The proportions of underlying diseases and heavy smoking in the change group were significantly higher than those in the stable group [24.4% (153/628) vs. 7.8% (52/665), 40.3% (253/628) vs. 24.2% (161/665), all P < 0.05]. Compared with the stable group, the average oxygenation index [mmHg (1 mmHg = 0.133 kPa): 238.91±71.14 vs. 291.74±63.64], and the turn-out day oxygenation index (mmHg: 261.23±58.11 vs. 301.00 ±58.25) were lower in the change group, while the proportion of applying invasive ventilation [64.2% (403/628) vs. 47.4% (315/665)], and the duration of invasive ventilation [days: 5 (2-9) vs. 3 (2-7)] were higher in the change group, the differences being all statistical significant (all P < 0.05). ③ Compared with the non-respiratory complications group, the average oxygenation index in the respiratory complications group was lower (mmHg: 216.43±67.17 vs. 264.85±78.46), the turn-out day oxygenation index was lower (mmHg: 250.72±74.93 vs. 274.87±81.79), and invasive ventilation ratio was higher [77.4% (267/345) vs. 48.1% (136/283)], the differences being statistically significant (all P < 0.05).④ Logistic regression analysis showed that the underlying diseases [odds ratio (OR) = 1.522], heavy smoking (OR = 2.314), and average oxygenation index (OR = 1.821) were the independent risk factors for patients in the general wards occurring disease situation changes after transfer from ICU (all P < 0.05). Conclusions The patients with following factors: underlying diseases, heavy smoking, low average oxygenation index during ICU stay, low oxygenation level on the day of transfer, application of invasive ventilation and long ventilation time are more easily to occur complications of respiratory system in the general wards after transfer from ICU; among the above related factors, the underlying diseases, heavy smoking and average oxygenation index are the independent risk factors for patients' occurrence of disease situation changes after transfer from ICU. Therefore, the patients with these risk factors, the evaluation and monitoring of the disease situation should be strengthened before and after patients' transfer from ICU. and the changes of patients' condition are mostly respiratory complications. Among them, combined underlying diseases, severe smoking and average oxygenation index are the independent risk factors for patients who have condition changes transferred from ICU. For patients with these risk factors, evaluation and monitoring should be strengthened before and after patients are transferred from ICU.

A Concept of "Transition of Care" in Japan -Focusing on Care Transition of Patients Who are Discharged from a Hospital and Treated at Another Clinic as an Outpatient- / 日本プライマリ・ケア連合学会誌

Recently in Japan, "transition of care" cases, in which patients are transferred from a medical institution that had once provided medical care to a new one and the medical care provider is therefore changed, are increasing. However, the concept of "transition of care" and "undesirable outcomes in patients accompanied by care transition" have been studied very little in Japan. The concept of "transition of care" consists of factors such as patient background (age, underlying disease, and family's caregiving ability), transfer of clinical information, and tools to transfer clinical information. In Europe and the USA, undesirable outcomes accompanied by care transition, such as "medicamentous adverse events", "clinical examination data taken during hospitalization are not confirmed", and "medical care planned for a patient is not implemented", are reported to have occurred for 19% to 50% of patients who had been discharged from hospitals and transferred to clinics. It is also necessary to understand the state of care transition in Japan and investigate countermeasures compatible with the Japanese medical care system.

Increase of 10% in the rate of adverse drug reactions for each drug administered in hospitalized patients

OBJECTIVE: To assess the risk factors, incidence and severity of adverse drug reactions in in-patients. METHODS: This prospective study evaluated 472 patients treated at a teaching hospital in Brazil between 2010 and 2013 by five medical specialties: Internal Medicine, General Surgery, Geriatrics, Neurology, and Clinical Immunology and Allergy. The following variables were assessed: patient age, gender, comorbidities, family history of hypersensitivity, personal and family history of atopy, number of prescribed drugs before and during hospitalization, hospital diagnoses, days of hospitalization. The patients were visited every other day, and medical records were reviewed by the investigators to detect adverse drug reactions. RESULTS: There were a total of 94 adverse drug reactions in 75 patients. Most reactions were predictable and of moderate severity. The incidence of adverse drug reactions was 16.2%, and the incidence varied, according to the medical specialty; it was higher in Internal Medicine (30%). Antibiotics were the most commonly involved medication. Chronic renal failure, longer hospital stay, greater number of diagnoses and greater number of medications upon admission were risk factors. For each medication introduced during hospitalization, there was a 10% increase in the rate of adverse drug reaction. In the present study, the probability of observing an adverse drug reaction was 1 in 104 patients per day. CONCLUSIONS: Adverse drug reactions are frequent and potentially serious and should be better monitored in patients with chronic renal failure or prolonged hospitalization and especially in those on 'polypharmacy' regimens. The rational use of medications plays an important role in preventing adverse drug reactions.

Diabetes mellitus e insuficiencia cardíaca en pacientes hospitalizados / Diabetes and heart failure in impatients

INTRODUCCIÓN: existe asociación entre diabetes mellitus(DM) e insuficiencia cardiaca (IC), planteándose una miocardiopatía inducida por DM, sin embargo, se desconoce la fisiopatología exacta. OBJETIVO: describir la población de pacientes hospitalizados por insuficiencia cardiaca descompensada (ICD). MÉTODOS: estudio descriptivo de cohorte transversal en pacientes hospitalizados con diagnóstico de ICD.Se obtuvieron datos delingreso de la Unidad de Emergencias, anamnesis y epicrisis. Las variables estudiadas fueron: edad, sexo, duración de la hospitalización, comorbilidades, causa de la IC y de su descompensación, evolución clínica y complicaciones adyacentes, realización de ecocardiograma y hospitalizaciones previas por ICD. Se comparó descriptivamente entre subgrupo de pacientes diabéticos y no diabéticos. RESULTADOS: se obtuvo 31 pacientes,todos con diagnóstico previo de IC, 10 de ellos diabéticos.La etiología isquémica fuemásfrecuente en los diabéticos y éstos presentaban mayores hospitalizaciones previas por ICD y mayores complicaciones durante la hospitalización. Los no diabéticos tuvieron más días de hospitalización y fracción de eyección (FE) más baja. Fallecieron 2 pacientes, ninguno diabético. Los pacientes diabéticos tenían un inadecuado control metabólico según valor de hemoglobina glicada. CONCLUSIONES: la población diabética presentó mayor proporción de insuficiencia cardiaca de etiología isquémica y mayores complicaciones durante la hospitalización. Se encontró diferencias a lo descrito en la literatura, en cuanto a días de hospitalización y mortalidad,lo que probablemente se explica por la muestra pequeña y laFE menor en no diabéticos. La DM mal controladaparecióser unfactorinfluyente enla rehospitalización porICD.

INTRODUCTION: diabetes mellitus and heart failure are associated, possibly through a diabetes-induced myocardiopathy, however the precise pathophysiology remains unknown. OBJECTIVE: to describe a population of patients hospitalized for heart failure. METHODS: a descriptive study of a transversal cohort of inpatients diagnosed with heart failure. Data were taken from Aand E admissions, patient histories and discharge papers. The variables studied were: age, sex, length of stay, co-morbidities, cause of heart failure and its exacerbation, clinical course and complications, heart ultrasound findings, and prior hospitalizations for heart failure. The sub-groups diabetic and non-diabetic were compared descriptively. RESULTS: We describe 31 patients already diagnosed with heart failure, 10 being diabetic. Ischemic etiology was more frequent in the diabetic patients and these had had more hospitalizations and presented more complications. The non-diabetics had longer hospital stays and a lower ejection fraction. Two patients died. Neither was diabetic. Glycated hemoglobin levels showed that the diabetics had poor metabolic control. CONCLUSIONS: the diabetic group had a higher incidence of ischemic heart failure and more complications during their stay. Our values for length of stay and mortality differ from those found in the literature, probably because of the small sample size and the low ejection fraction found in non-diabetics. Poorly controlled diabetes seems to be a factor in re-admission for heart failure

Effect of intravitreal injection of Ranibizumab on choroid in patients with severe NPDR with macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the changes of choroidal thickness in patients with severe non-proliferative diabetic retinopathy (NPDR) after vitreous injection of ranibizumab,and to analyze the relationship between the thickness of choroid and the visual acuity of the patients.METHODS:Eighty patients with severe non-proliferative diabetic retinopathy were selected from January 1,2014 to January 1,2017.All patients were divided into observation group and control group according to the random number table,40 cases in each group.The control group was treated in a conventional manner,and the observation group was injected with ranibizumab in the vitreous.The thickness of the choroid in the macular area and the thickness of the retinal neuroepithelium in the macular area were compared between the two groups before and after treatment.The changes of the corrected visual acuity were analyzed at 1mo before and after treatment.The relationship between the thickness of the choroid and the thickness of the retinal neuroepithelium and the best corrected visual acuity were compared.The complications and adverse events were compared between the two groups after 6wk of treatment.RESULTS:The thickness of the choroid and the retinal neuroepithelium in the macular area before were 219.57± 51.24μm and 474.76 ± 95.56μm,respectively,in the observation group and the control group,217.56± 50.36μm and 473.27 ± 96.48μm,respectively.The thickness of the choroid and the thickness of the retinal neuroepithelium in the macular area after treatment were 180.15±42.06μm and 382.18±84.26,202.48±48.28μm and 407.88± 44.25μm,respectively.The difference between the two groups was statistically significant (P＜0.05).The best corrected visual acuity in the observation group and the control group were 0.47±0.19 and 0.53±0.25 respectively (P＜0.05).There was a positive correlation between the choroidal thickness and the best corrected visual acuity in the macular fovea (regression coefficient=1.12,S=0.48,OR=1.376,P＜ 0.05).There was a positive correlation between retinal neuroepithelial thickness and best corrected visual acuity in the macular area (regression coefficient =0.95,S=0.27,OR=1.020,P＜ 0.05).There were 2 eyes (5％) with subconjunctival hemorrhage,1 eyes (2.5％) of glaucoma,1 eyes (2.5％) of vitreous hemorrhage,0 of choroidal detachment,retinal detachment in 0 in observation group at 6wk after treatment.There were 4 eyes (10％) with subconjunctival hemorrhage,2 eyes (5％) of glaucoma,2 eyes of vitreous hemorrhage (5％),2 eyes of choroidal detachment (5％),retinal detachment in 2 eyes (5％) in the control group,and the difference between the two groups on the complications and adverse reactions was statistically significant (P＜0.05).CONCLUSION:The choroidal thickness of patients with macular edema in severe non-proliferative diabetic retinopathy is correlated with the best corrected visual acuity.Intravitreal injection of ranibizumab can effectively reduce the macular fovea choroidal thickness,reduce macular edema and improve vision,and less complications.

Pathophysiological basis of portal hypertension and the new concept of acute kidney injury in patients with liver cirrhosis / 中华肝脏病杂志

Recently, the International Club of Ascites (ICA) has developed a new expert consensus on the diagnosis and treatment of acute kidney injury (AKI) in patients with liver cirrhosis, which reflects the new concept of AKI management in patients with liver cirrhosis. This consensus emphasizes the increase in the absolute value of serum creatinine (SCr) and establishes a new staging system for AKI, which may help to evaluate disease progression and recovery. In addition, the new management concept also emphasizes that when AKI progresses to stage 2/3 or still progresses after comprehensive treatment, a diagnosis can be made and vasoconstrictors and albumin can be used as long as the patient meets the other diagnostic criteria for hepatorenal syndrome, regardless of SCr level.

Curative effect of compound Xuesaitong combined with Conbercept in the treatment of choroidal neovascularization in pathological myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effect of compound xuesaitong combined with conbercept on central macular retinal thickness (CMT), fluorescein fundus angiography and best corrected visual acuity(BCVA) in pathological patients with choroidal neovascularization (CNV).METHODS:A total of 60 cases (60 eyes) with pathological myopia and CNV who were admitted to our hospital during January to October 2016 were enrolled in the study.They were divided into observation group and control group, 30 cases in each group.Observation group was treated with compound xuesaitong combined with conbercept.Control group was treated with conbercept only.Changes of CMT, intraocular pressure (IOP), area of CNV, BCVA and serum vascular endothelial growth factor (VEGF) before surgery, 4 and 12wk after surgery were compared.Complications during follow-up were statistically analyzed.RESULTS: At 12wk after surgery, the total effective rate was 97% in observation group, 80% in control group and the difference was significant (P<0.01).The CMT, IOP, area of CNV and serum VEGF levels were significantly lower or smaller than those before surgery while BCVA was significantly higher than that before surgery (P<0.01).There were no local complications of systematic severe complications.CONCLUSION: Compound xuesaitong combined with conbercept can effectively reduce CMT and IOP, reduce the area of CNV and significantly improve visual acuity.Its anti-VEGF effect is obvious, safe and feasible.

A design of dynamic intelligent management system for patients in mental hospital based on RFID technique / 中国医学装备

Objective: To implement dynamic intelligent management system for patients in mental hospital based on RFID technique so as to achieve safe management for patients and contribute to grasp the patient's status in real time. Methods: The hardware of the designed dynamic intelligent management system was consisted of patient's wristbands (electronic tags), locator, reader and the server. The architecture, hardware and function modules of the system were procedural designed. Results: The new design has changed the traditional supervised situation for psychopath which need many manpower and material resources, and reduced the burden of paramedical staff, and decreased the pressure of management for psychopath and enhanced the management level of modernization in hospital. Conclusion: The dynamic intelligent management system based on RFID technique can enhance the management level of hospital, and accelerate the construction of informatization for hospital and improve the image of hospital.

Clinical study of zoledronic acid in the treatment of bone metastasis in patients with lung cancer / 中国生化药物杂志

Objective To study and analyze the clinical effect of zoledronic acid in the treatment of bone metastasis in patients with lung cancer.Methods 50 cases of lung cancer patients with bone metastasis from January 2015 to December 2016 in our hospital were selected and randomLy divided into two groups, the control group and the experimental group, with 25 patients in each group.The control group was treated with pamidronate intravenous drug treatment, patients in the experimental group of zoledronic acid monotherapy in the treatment of.After treatment for a period of time, the relative clinical indicators of the experimental group and the control group were compared and analyzed.Results After the corresponding treatment, 3 patients in the experimental group had complications, the proportion was 12%, and 2 cases in the control group had adverse reactions, the incidence was 8%.The incidence of adverse reactions and the effectiveness of pain treatment in the experimental group were not significantly different from those in the control group, and there was no statistical significance.After treatment, the quality of life scores and general status scores of the experimental group and the control group were significantly higher than those before treatment, with statistical difference(P<0.05).There was no significant difference in the quality of life score and general condition score between the experimental group and the control group, and there was no statistical significance.Conclusion Zoledronic acid monotherapy in the treatment of metastasis corresponds largely to pamidronate treatment for lung cancer patients with bone, can improve the treatment effect and quality of life in a large extent, help the patients to relieve pain, with further clinical promotion and application significance.

Catarata posuveítis: algunas consideraciones / Some considerations about cataract after uveitis

La catarata constituye una causa frecuente y obligada de consulta en los pacientes con enfermedades inflamatorias por la mala visión que produce y para la evaluación del tratamiento quirúrgico. En estos pacientes la cirugía es más complicada. Realizamos una revisión actualizada del tema en los últimos diez años. Se plantean algunas consideraciones sobre los protocolos de tratamiento pre, trans y posquirúrgicos para la cirugía de la catarata, las dificultades y los elementos a tener en cuenta para el mejor tratamiento e implante de lente intraocular. Las opciones de tratamiento, el control pre y posquirúrgico, así como de evitar las complicaciones transquirúrgicas, son fundamentales para el mejor pronóstico de pacientes con uveítis. Nos propusimos realizar una revisión del tema en la literatura publicada en los últimos diez años, así como exponer nuestras experiencias y los elementos a tener en cuenta para el mejor resultado de la cirugía de catarata(AU)

Cataract represents a common cause of medical consultation in patients with inflammatory illnesses because of the visual problems it brings about and the evaluation of the surgical treatment. Surgery is more complicated to be performed in these patients. A literature review on this topic in the last ten years was made. Some considerations were put forward about the treatment protocols before, during and after cataract surgery, the difficulties and elements to be taken into account for best treatment and implantation of the intraocular lens. The treatment choices, the preoperative and postoperative control as well as the prevention of transoperative complications are fundamental for better prognosis of patients with uveitis. We intended to make a literature review on this topic using the articles published in the last ten years as well as to present our experiences and the elements to take into account to achieve best results in the cataract surgery(AU)

The burden of infectious and cardiovascular diseases in India from 2004 to 2014 / 한국역학회지

OBJECTIVES: In India, both communicable and non-communicable diseases have been argued to disproportionately affect certain socioeconomic strata of the population. Using the 60th (2004) and 71st (2014) rounds of the National Sample Survey, this study assessed the balance between infectious diseases and cardiovascular diseases (CVD) from 2004 to 2014, as well as changes in the disease burden in various socioeconomic and demographic subpopulations. METHODS: Prevalence rates, hospitalization rates, case fatality rates, and share of in-patients deaths were estimated to compare the disease burdens at these time points. Logistic regression and multivariate decomposition were used to evaluate changes in disease burden across various socio-demographic and socioeconomic groups. RESULTS: Evidence of stagnation in the infectious disease burden and rapid increase in the CVD burden was observed. Along with the drastic increase in case fatality rate, share of in-patients deaths became more skewed towards CVD from 2004 to 2014. Logistic regression analysis demonstrated a significant shift of the chance of succumbing to CVD from the privileged class, comprising non-Scheduled Castes and Tribes, more highly educated individuals, and households with higher monthly expenditures, towards the underprivileged population. Decomposition indicated that a change in the probability of suffering from CVD among the subcategories of age, social groups, educational status, and monthly household expenditures contributed to the increase in CVD prevalence more than compositional changes of the population from 2004 to 2014. CONCLUSIONS: This study provides evidence of the ongoing tendency of CVD to occur in older population segments, and also confirms the theory of diffusion, according to which an increased probability of suffering from CVD has trickled down the socioeconomic gradient.