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Objective:To investigate the influencing factors of hospitalization for pregnant women with influenza A.Methods:From December 2018 to February 2019, 261 pregnant women with influenza A were admitted to Beijing Ditan Hospital, Capital Medical University. The clinical data of age, gestational period, underlying diseases, time from onset to treatment, white blood cell count and lymphocyte count of these patients were collected. Data of out-patients were compared with those of inpatients. Chi-square test and multivariate logistic regression were used to analyze the influencing factors of hospitalization in pregnant women with influenza A.Results:Among the 261 cases of pregnancy with influenza A, 36 cases (13.79%) were hospitalized, of which 10 (27.78%) were hospitalized due to severe influenza complications, the other 26 cases (72.22%) were hospitalized due to pregnancy related adverse events. The proportions of hospitalized patients with age ≥30 years old, gestational period ≥28 weeks, combined with underlying diseases and lymphocyte count <1×10 9/L were 75.00%(27/36), 83.33%(30/36), 16.67%(6/36) and 50.00%(18/36), respectively, which were significantly higher than those of out-patients (47.11%(106/225), 35.56%(80/225), 0.89%(2/225) and 13.22%(16/121), respectively; χ2=9.66, 29.05, 26.00 and 22.12, respectively, all P<0.05). The proportions of inpatients and out-patients with white blood cell count ≥4×10 9/L were 97.22%(35/36) and 97.52%(118/121), respectively, and there was no significant difference ( χ2=0.01, P=0.921). Multivariate logistic regression analysis showed that age ≥30 years (odds ratio ( OR)=5.181, 95% confidence interval ( CI) 1.628-16.489, P=0.005), gestational period ≥28 weeks ( OR=11.054, 95% CI 3.233-37.796, P<0.01), lymphocyte count <1×10 9/L ( OR=6.864, 95% CI 2.237-20.729, P=0.001), and time from onset to treatment <24 h ( OR=0.076, 95% CI 0.012-0.468, P=0.005) were the influencing factors for hospitalization of pregnant women with influenza A. Conclusion:Age ≥30 years old, gestational period ≥28 weeks, lymphocyte count <1×10 9/L and time from onset to treatment <24 h are the influencing factors for hospitalization of pregnant women with influenza A.
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Objective:To analyze the epidemiological and clinical characteristics of patients with imported corona virus disease 2019 (COVID-19) in Beijing City.Methods:A case-control study was performed to retrospectively analyze 69 cases of imported COVID-19 from abroad and 147 cases of domestic confirmed COVID-19 from China as a control group from January 20 to March 20, 2020 admitted to Beijing Ditan Hospital, Capital Medical University.The epidemiological and clinical characteristics were compared.Statistical analysis were performed by t test, Mann-Whitney U test, chi-square test and Fisher exact test. Results:The main sources of the cases in the import group were from the United Kingdom, Italy, Spain and other European countries, with 44.9%(31/69) of the overseas students entering the country by air. The age of the imported group (27(21, 40) years) was lower than the domestic group (43 (32, 59)years), the difference between the two groups was statistically significant ( U=2 828.500, P<0.01). Compared with the domestic group, the proportion of cases with contact history of confirmed cases in the imported group was lower (30.4%(21/69) vs 68.0%(100/147)), the interval between onset and admission ≤seven days was higher (81.2%(56/69) vs 66.0%(97/147)), the proportion of cases with underlying diseases was lower (21.7%(15/69) vs 44.2%(65/147)). The differences between the two groups were all statistically significant ( χ2=26.935, 5.233 and 10.175, respectively, all P<0.05). The proportion of mild cases in the imported group was higher than that in the domestic group (42.0%(29/69) vs 10.9%(16/147)). Seventeen cases with olfactory abnormality and 12 cases with taste abnormality were found in the imported group, while no olfactory and taste abnormality was found in the domestic group. The proportions of fever, weakness, muscle soreness and dyspnea were all lower than those of the domestic group, the differences between the two groups were all statistically significant ( χ2=13.851, 8.118, 9.730 and 16.255, respectively, all P<0.01). The proportions of cases with decreased lymphocyte absolute numbers (37.7%(26/69) vs 67.3%(99/147)) and increased C reactive protein level (15.9%(11/69) vs 51.8%(72/139)) were both lower than the domestic group, and the differences between the two groups were both statistically significant ( χ2=18.015 and 24.722, respectively, both P<0.01). The proportions of cases with ground glass shadow and consolidation of chest computed tomography were lower than those of the domestic group and the differences between the two groups were all statistically significant ( χ2=11.961 and 5.099, respectively, all P<0.05). In terms of complications, the proportions of cases with acute respiratory distress syndrome and acute myocardial injury were lower (2.9%(2/69) vs 10.9%(16/147) and 4.3%(3/69) vs 14.0%(16/114), respectively), and there were statistically significant differences between the two groups ( χ2=4.017 and 4.335, respectively, both P<0.05). There were no cases received mechanical ventilation and extracorporeal membrane oxygenation in the imported group, and the proportions of patients received oxygen therapy and antibiotic treatment were significantly lower than those in the domestic group (13.0%(9/69) vs 26.5%(39/147) and 13.0%(9/69) vs 39.5%(58/147), respectively) and the differences between the two groups were statistically significant ( χ2=4.942 and 15.797, respectively, both P<0.05). Conclusions:The majority of imported COVID-19 cases are mainly from European countries, mostly young and middle-aged, and mostly mild and ordinary types.The symptoms of olfactory and taste abnormality are found for the first time.
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Yersiniosis is one of the "other infectious diarrhea" of the notifiable infectious diseases and also an important food-borne disease. However, it lacked the basis or standard for diagnosis. The Chinese Preventive Medicine Association coordinated experienced researchers from National Institute for Communicable Disease Control and Prevention, China CDC and other institutes to produce the group standard entitled "Diagnosis of Yersiniosis" (T/CPMA 005-2019). Based on the principle of "legality, scientificity, advancement, and feasibility" , the standard gives a clear definition for Yerisiniosis, stipulates diagnosis basis, principles and main differential diagnosis and provides two informative appendixes for epidemiological and clinical characteristics and a normative appendix for laboratory detection. The standard provides accurate basis and methods of Yersiniosis diagnosis for hospitals and CDCs at all levels in China. It will solve the problems that Yersiniosis cannot be clearly diagnosed for clinical cases and in the outbreaks.
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Objective To analyze the diagnostic sensitivity and related impact factors of T cell spot test of tuberculosis (T‐SPOT .TB ) test in acquired immunodeficiency syndrome (AIDS )/tuberculosis (TB) patients .Methods Ninety‐two confirmed cases with AIDS/TB coinfection were tested by T‐SPOT . TB ,and the impact of CD4+ T cells counts on the diagnostic sensitivity was analyzed .Multivariate Logistic analysis was used for the analysis of impact factors of T‐SPOT .TB sensitivity .Blood samples of 19 cases with advanced stage AIDS/TB from January 2015 to January 2016 were collected ,and peripheral blood mononuclear cell (PBMC ) were isolated by Ficoll method , and lymphocytes were isolated by Percoll method .McNemar test was used for the comparison of these two methods .Results Among the 92 patients with AIDS/TB ,T‐SPOT .TB tests were positive in 51 cases ,with positive rate of 55 .4% .The sensitivity was 26 .3% (10/38) when CD4+ T cell count less than 20/μL ,and that was 92 .9% (13/14) when CD4+ T cell more than 200/μL .In Logistic analysis ,the sensitivity of T‐SPOT .TB test in patients with extra‐pulmonary tuberculosis was better than that in pulmonary tuberculosis patients (OR=3 .042 , P=0 .038) .The sensitivity of T‐SPOT .TB was positively correlated with CD4+ T cell count ,and the sensitivity increased by 2 .889 times when CD4+ T cells increasing 100/μL (OR=3 .889 ,P=0 .016) .The percentage of lymphocytes in PBMC was also positively correlated with T‐SPOT .TB positivity ,and the sensitivity increased by 1 .393 times when the percentage increasing 30% (OR=2 .393 ,P=0 .045) .When Percoll was used for lymphocytes isolation ,the T‐SPOT .TB sensitivity was 52 .6% (10/19) ,and when Ficoll was used for PBMC isolation ,the sensitivity was 36 .8% (7/19) .The difference was not statistically significant (P=0 .375) .Conclusion The sensitivity of T‐SPOT .TB test based on lymphocytes is higher than that based on PBMC .
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Objective To investigate the clinical features of varicella and the prognosis in pregnant women and their newborns .Methods Clinical data of pregnant women with varicella zoster virus (VZV) infection (n= 25) and their newborns hospitalized in Beijing Ditan Hospital from 1st Jan .2008 to 31st Dec .2014 were retrospectively analyzed and randomly compared to non‐pregnant women with VZV infection (n=50) .Clinical features and prognosis of varicella in pregnant women and their infants were analyzed .Chi‐square test was used for categorical data and t test was used for quantitative data .Results Time to rash scab of varicella in pregnant women was longer than non‐pregnant women ([10 .1 ± 2 .1] d vs [5 .6 ± 1 .4] d ,t=10 .941 ,P<0 .05) .The rate of bacterial infection in pregnant women was higher than non‐pregnant varicella women (72 .0% [18/25] vs 32 .0% [16/50] ,χ2 = 10 .761 , P < 0 .05) , with statistical significance .Among 25 cases of varicella pregnant women ,the pregnancy complications were observed in 3 cases of diabetes ,2 cases of premature rupture of membranes ,5 cases of anemia and 1 case of oligoamnios .Seven cases out of 25 pregnant women underwent parturition during fever and varicella period ,and 3 cases (12 .0% ) were complicated with intrapartum hemorrhage . Twenty five varicella pregnant women were all cured after antiviral and supportive treatment and gave birth to their babies ,with no abortion ,stillbirth or birth defects .No congenital varicella was observed in newborns .Of the 25 infants ,4 developed (16 .0% ) varicella within 2 weeks after birth and they were all born from mothers who developed varicella around delivery time .The clinical features of neonatal varicella presented with classic rash with no fever .The time to rash scab was longer (11 .0 ± 2 .1) d and antibody test for VZV was negative .All neonates were cured after antiviral and immunoglobulin treatment .Conclusions Longer duration of skin rash scab and higher rate of bacterial infections are the features of varicella in pregnant women .Intrapartum hemorrhage occurrs more commonly in pregnant women with varicella onset around delivery time .Varicella occurring during mid‐pregnancy may not increase the risk of neonatal birth defects after treatment .The newborns whose mothers with varicella onset during perinatal time especially around delivery time may suffer from varicella .The prognosis of neonatal period varicella is good after treatment .
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Objective To investigate the risk factors of delayed hemolysis after treatment in patients with malaria .Methods Eighty-nine cases of malaria were retrospectively analyzed .The incidence rate , time from treatment to delayed hemolysis and clinical features of delayed hemolysis after treatment in patients with malaria were investigated .The characteristics of demography ,etiology and laboratory data were compared between delayed hemolysis group and non-delayed hemolysis group .The t test ,χ2 test and Fisher exact test were used for comparison between groups .Results A total of 89 cases of malaria infection were included and 8 cases were diagnosed with delayed hemolysis after treatment among them , with incidence rate of 8 .99% .Patients developed delayed hemolysis after anti-malarial treatment with a median of 7 .5 d and patients recovered from hemolysis after the usage of glucocorticoid with a median of 2 .5 d .The 8 cases were all infected with Plasmodium f alciparum ,and 4 of which had high parasitemia . None of the patients with delayed hemolysis came from epidemic area ,while 28 of the patients without non-delayed hemolysis came from epidemic area .The difference was statistically significant (P=0 .042 , Fisher unilateral exact test) .The average level of minimum hemoglobin was (44 .87 ± 11 .58) g/L in patients with delayed hemolysis ,which was significantly lower than that of non-delayed hemolysis group (108 .35 ± 19 .72) g/L (t= -8 .923 , P< 0 .01) .Conclusion Plasmodium falciparum infection , hyperparasitemia and having no immunity against malaria may be risk factors of delayed hemolysis after treatment .
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Objective To evaluate the dynamic changes of T lymphocyte subsets in children with hand-foot-and-mouth disease(HFMD)and to provide new evidence for the therapy and prognosis.Methods Peripheral venous blood samples of 346 HFMD cases in acute stage who were hospitalized in Beijing Ditan Hospital from May 1,2008 to August 31,2008 were collected and T lymphocyte subsets were assayed by flow cytometer.Meanwhile,T lymphocyte subsets of 67 HFMD cases in recovery phase were also detected.The pathogens were determined by reverse transcriptionpolymerase chain reaction(RT-PCR)using pharynx swab samples from 99 cases.Different samples were compared by independent-sample t test,paired t test or variance analysis.Results The average levels of T lymphocyte subsets of HFMD children in different agc groups were all lower than reference levels of healthy children in according age groups.In severe cases.T lymphocyte(TL)/lymphocyte (L)ratio in all age groups,helper T cell(Th)/L ratio in children older than 1 year,TL,Th and Th/suppressor T cell(Ts)ratio in children of 1-2 years old were all lower than those in common eases (P＜0.05).The Th/L ratio tended to increase with the disease progression.Ratios of TL/L and Th/L in common cases were increased in recovery phase(TL/L:56.3±8.6 vs 61.1±9.1,t=2.56,P＜0.05;Th/L:30.2±7.2 vs 34.9±7.9,t=2.90,P＜0.05)and all indices of severe cases except Ts/Lratio and Th/Ts ratio increased apparently in recovery phase(P＜0.01).TL[(1.738±0.976)×10~6/Lvs(2.696±1.946)×10~6/L,t=2.17,P＜0.05],Th/L ratio(25.9±7.0 vs 30.2±7.2,t=2.34,P＜0.05),Th[(0.864±0.550)×10~6/L vs(1.459±0.879)×10~6/L,t=2.90,P＜0.01]and L[(3.352±1.458)×10~6/L vs(4.664±2.435)×10~6/L,t=2.32,P＜0.05]of severe cases in acute phase were all lower than those of common cases(P＜0.05),while those were not significantly different in recovery phase between two groups(P＞0.05).The T lymphocyte subsets of enterovirus(EV)71 positive cases were lower than EVT1 negative cases,but there was no significant difference between these two groups(P＞0.05).Conclusion T lymphocyte immune responses may be correlated with HFMD onset and progression.
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Objective To review the clinical characteristics of H1N1 influenza A, and suggest the clinical practices for the diagnosis and treatment of H1N1 influenza A in the future. Methods Thirty-three cases of H1N1 influenza A hospitalized in Beijing Ditan Hospital from May 15 to June 22, 2009 were studied and the clinical data were statistically analyzed with SPSS 11.0 for Windows. Results Twenty-five of the 33 patients had a history of travelling in America, Canada, Japan etc within a week; the latent period was between 1 and 6 days in 12 close contact patients. The main symptoms of H1N1 influenza A are fever (66.7%), dry cough (60.6%), cough with sputum (42.4%) and sore throat (36.4%). The laboratory tests in 24 cases(72.7%) were normal, while mild abnormal results were found in the remaining patients.All of the 33 cases were discharged according to the Standard of Diagnosis and Treatment of H1N1 Influenza A published by The Minister of Health, China. The period between 2-consecutive negative results in viral nucleic acid RT-PCR detection and the presenting symptom was 2 to 16 days and the period of hospitalization was 3 to 16 days. Conclusion The new type of H1N1 influenza A is characterised by mild symptoms, short period of hospitalization and good prognosis. All the patients can be cured, if they do not suffer from other severe chronic disease.
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Objective To discuss the clinical characteristics and prognosis of 15 children with hand foot and mouth disease (HFMD) and acute flaccid paralysis (AFP) who were admitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008. Method The epidemiology, clinical manifestations, cerebrospinal fluid (CSF),magnetic resonance imaging and prognosis of 15 children with HFMD and AFP were retrospectively reviewed. The recovery of the patients' affected extremities were monitored for 4 weeks. Results The mean age of these patients was (22.47 ± 20.68) months (range: 5～72 months). Acute paralysis developed (3.47 ± 1.68) days after the onset of fever and progressed to maximum severity within (1～2) days. Poliomyelitis-like syndrome was observed in all cases. Of the 15 cases, 10 had monoplegia of lower limbs, two had paraplegia, one had monoplegia of upper limbs and two had quadriplegia. In these cases, the muscle power varied from level 0 to level 4, and six even showed no muscle power in their affected extremities. Thirteen cases developed neurologic complications (encephalitis, meningitis or ataxia) and three had transient urinary retention. Cerebrospinal MRI examination in eight cases showed hyperintense lesions on T2-weighted images, predominantly in the impaired anterior horn regions of the spinal cord (C2～C7 for cases with upper extremity impairments and T12～L1 for cases with lower extremity impairments), and displayed long T1 signals and long T2 signals. In addition, the midbrain, brain-stem or medulla was also involved in four cases who also contracted encephalitis or meningitis. The muscle strength in 11 patients with single lower extremity impairment showed improvements in the distal limb muscles within 4～8 days, and the other cases showed recovery 2～3 weeks later. Conclusions HFMD in combination with AFP most commonly occurs in children aged less than 2 years old. Acute paralysis develops during the early stage of infection and progresses to a maximum severity within 2 days. In most cases described here, paralysis occurred in a single lower extremity and recovered more rapidly than those with all four limbs affected or with single upper extremity impairment . MRI examination is particularly valuable for the diagnosis and prognosis of AFP because of its high sensitivity and accuracy.