Retrospective analysis of 201 clinical isolates of Aspergillus fumigatus from a hospital in Nanjing: clinical characteristics of infected patients and azole resistance / 中华皮肤科杂志

Objective:To summarize clinical characteristics of patients with Aspergillus fumigatus infection in a hospital in Nanjing, to preliminarily assess azole resistance in clinical isolates of Aspergillus fumigatus, and to investigate risk factors for the emergence of azole-resistant Aspergillus fumigatus. Methods:Clinical isolates of Aspergillus fumigatus were collected from inpatients in Department of Laboratory, Nanjing Drum Tower Hospital from March 2017 to February 2021. Clinical data on these infected patients were analyzed, azole sensitivity testing and mutation analysis of the cyp51A gene and its promoter region were performed for these Aspergillus fumigatus isolates. Results:A total of 201 strains of Aspergillus fumigatus were collected, and mainly isolated from sputum specimens. Among the infected patients, there were 131 males and 70 females, and their age were 64.2 ± 15.8 years. The patients were mainly collected from department of respiratory medicine (79 cases), department of intensive medicine (34 cases), department of rheumatology (19 cases), etc. Among these patients, common underlying diseases included interstitial pneumonia (32 cases), malignant tumors (18 cases), pneumonia (13 cases), trauma (12 cases), systemic lupus erythematosus (8 cases), etc. Drug susceptibility testing showed that 6 (2.99%) strains of Aspergillus fumigatus were resistant to itraconazole and posaconazole, and 3 patients infected with azole-resistant Aspergillus fumigatus had used antifungal drugs before testing. Sequencing was performed on the cyp51A gene and its promoter region in the 6 strains of azole-resistant Aspergillus fumigatus, and showed TR34/L98H/S297T/F495I mutation in 5 strains and TR34/L98H mutation in 1 strain. Conclusion:Compared with previously published data about azole resistance in China during 2010 -2015, the resistance of Aspergillus fumigatus to azoles in Nanjing Drum Tower Hospital did not increase from 2017 to 2021, and the mechanism of azole resistance was mostly associated with TR34/L98H/S297T/F495I mutation in the cyp51A gene and its promoter region.

Características epidemiológicas de los pacientes atendidos en el sector de reanimación de un servicio de emergencia en un hospital de tercer nivel de Argentina / Epidemiological features of patients admitted to the resuscitation unit at an emergency department of a third level hospital in Argentina

Introducción. Conocer las características epidemiológicas (CE) de una población resulta primordial para la definición de estrategias sanitarias. Nuestro objetivo es describir las características de pacientes críticos ingresados al sector reanimación (SR). Materiales y métodos. Estudio descriptivo y retrospectivo realizado en un servicio de urgencias de un hospital de tercer nivel entre 2/7/2018 y 1/7/2019. Se incluyeron todos los pacientes ingresados a SR. Se registró edad, sexo, motivo de ingreso, condición crónica, procedimientos diagnósticos y terapéuticos efectuados. Los datos fueron obtenidos del libro de registro y la historia clínica informatizada, y analizados con software Redcap Versión 8.9.2. Las variables categóricas se expresaron como frecuencias y porcentajes y las continuas con mediana y rango intercuartílico. Resultados. Ingresaron 2292 pacientes. El 94% fueron menores de 16 años. El 56,5% presentaba condiciones crónicas (CC), siendo más frecuentes las enfermedades neurológicas (29%), endocrino/metabólicas (15,5%) y cardiovasculares (11%). Los motivos de ingreso más habituales: enfermedad respiratoria aguda baja (31%), estado epiléptico (13%), sepsis (13%) y deshidratación grave (7%). Estudios complementarios más utilizados: laboratorio (54%), radiografía (28%), hemocultivos (23%). Los procedimientos realizados con más frecuencia fueron la colocación de acceso venoso periférico (67%), cánula nasal de alto flujo (6%) y ventilación mecánica (5%). Las drogas más indicadas: oxígeno (42%), fluidos (34%), antibióticos (22%). El 14% ingresó a cuidados intensivos. Hubo 11 paros cardiorrespiratorios y 6 óbitos. Conclusiones. En el SR se asisten pacientes críticos con patologías de alta prevalencia como también pacientes con enfermedades crónicas complejas. La evaluación periódica de CE resulta una herramienta fundamental para detectar dificultades y elaborar estrategias de mejora (AU)

Introduction. Knowledge on the epidemiological characteristics (EC) of a population is essential to define healthcare strategies. Our aim was to describe the characteristics of critical patients admitted to the resuscitation unit (RU). Materials and methods. A descriptive and retrospective study was conducted at an emergency department of a third-level hospital between 2/7/2018 and 1/7/2019. All patients admitted to the RU were included. Age, sex, reason for admission, underlying disease, and diagnostic and therapeutic procedures performed were recorded. The data were obtained from the logbook and electronic records, and analyzed using Redcap software Version 8.9.2. Categorical variables were expressed as frequencies and percentages and continuous variables as median and interquartile range. Results. 2292 patients were admitted; 94% were younger than 16 years of age. Overall, 56.5% had underlying diseases (UD), the most common of which were neurological (29%), endocrine/metabolic (15.5%), and cardiovascular (11%) disorders. The most common reasons for admission were acute lower respiratory tract disease (31%), status epilepticus (13%), sepsis (13%), and severe dehydration (7%). The most frequently used complementary studies were laboratory tests (54%), x-rays (28%), and hemocultures (23%). The most frequently performed procedures were peripheral venous line (67%), high-flow nasal cannula (6%), and mechanical ventilation (5%) placement. The most frequently indicated medications were oxygen (42%), fluids (34%), and antibiotics (22%). Overall, 14% required admission to the intensive care unit. There were 11 cardiorespiratory arrests and six deaths. Conclusions. Critical patients with highly prevalent diseases as well as patients with complex underlying diseases are seen at the RU. Periodic EC evaluation is a key tool for detecting difficulties and developing improvement strategies (AU)

Attention should be paid to the exposure risk of patients with chronic wounds on the way to hospital during corona virus disease 2019 epidemic prevention and control / 中华烧伤杂志

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

Comparative study on deep venous thrombosis onset in hospitalized patients with different underlying diseases / 中华内科杂志

Objective To improve the understanding of deep venous thrombosis (DVT),the present study was conducted to investigate the difference of DVT onset in hospitalized patients with different underlying diseases.Methods This is a single-center retrospective study from Beijing Shijitan Hospital.Clinical data from hospital onset DVT patients from 2007 to 2016 were collected.DVT was confirmed with compression ultrasonography (CUS),color Doppler flow imaging (CDFI),CT venography (CTV),magnetic resonance venography (MRV),lower extremities radionuclide venography(RDV) or conventional venography (CV).The risk factors of DVT in hospital were analyzed with a Chi-square analysis.Results A total of 5 063 patients (1.65％) with DVT involving 5 024 veins were identified from 305 922 inpatients admitted without DVT during ten years.Among DVT patients,2 752 were males (54.36％) and 2 311 were females (45.64％) with age of (74.1±15.9) years (range from 1 to 103 years).Patients with DVT were elder and longer inhospital than those without DVT (P＜ 0.001).Patients with respiratory diseases had higher incidence of DVT (6.83％,OR=5.498,95％CI 5.151-5.868) than those with other system diseases,in which patients with respiratory failure had the highest incidence of DVT (9.53％,95％CI 6.912-8.018) among all patients.The risks of having DVT were higher in patients with serious internal medicine diseases than those in patients with trauma,or cataclasis / operations,or invasive manipulations.Among all DVT patients,71.54％ of them were with inflammation diseases,55.56％ were with hypertension and 54.93％ were with structural heart disease.DVT often occurred in inferior extremities (83.78％,4 360/5 063) in patients irrespective of underlying diseases.Conclusions There is an association between underlying diseases of hospitalized patients and the development of DVT.Patients with internal medicine diseases had higher risk to develop DVT than those with trauma or cataclasis / operations or invasive manipulations.To prevent the development of DVT,its screening should be emphasized in patients with serious internal diseases.

Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave / Endogenous endophthalmitis: case report and brief review of a serious ocular disease

Endogenous endophthalmitis (EE) is a prevalent but serious disease. Our aim was to describe cases of EE, with emphasis in the risk factors and the improvement of the prognosis. Methods: A review of EE cases was done between 1996-2011 in a secondary care hospital in Spain. The reported variables were: comorbidities, isolated microorganisms, susceptibility to antimicrobial treatment and visual prognosis. Results: 9 cases of EE were analyzed. All had some underlying disease, diabetes mellitus being the most frequent. Seven of the nine cases had a history of eye injury. Extraocular source of infection was identified in 7 cases, with predominantly gastrointestinal disease. Most microorganisms were isolated from blood cultures. The visual prognosis was unfavorable in five patients and was associated with virulent microorganisms and delayed treatment. Conclusions: EE is a rare disease that involve immunocompromised patients with ophthalmic disease. To improve prognosis, appropriate diagnosis and early treatment is require. Therefore, we recommend funduscopy examination in patients with sepsis, risk factors and prior history of ocular disease.

La endoftalmitis endógena (EE) es una patología poco prevalente aunque grave. Nuestro objetivo es describir los casos de EE diagnosticados en un hospital secundario español, con particular atención a los factores de riesgo y la posible mejora del pronóstico. Material y Métodos: Revisamos las historias clínicas de los pacientes diagnosticados de EE entre 1996-2011. Las variables recogidas fueron: co-morbilidades, microorganismo/s aislados y su susceptibilidad a los antimicrobianos, tratamiento administrado y pronóstico visual. Resultados: Se estudiaron nueve casos de EE. Todos presentaban alguna enfermedad de base, siendo diabetes mellitus la más frecuente. Siete de los nueve casos presentaron antecedentes de lesión ocular. La probable fuente extraocular se identificó en siete casos, predominando el foco gastrointestinal. La mayoría de microorganismos se aisló de hemocultivos. El pronóstico visual fue desfavorable en cinco pacientes, asociándose a microorganismos virulentos y al retraso terapéutico. Conclusiones: La EE es una enfermedad inusual que afecta a pacientes con inmunidad disminuida y antecedentes oftalmológicos. Para mejorar el pronóstico se requiere un diagnóstico acertado y un tratamiento precoz, todo un reto para médicos clínicos y microbiólogos. Por ello, recomendamos realizar un fondo de ojo a los pacientes con sepsis, factores de riesgo de EE y antecedentes de patología ocular.

Charlson'S weighted index of comorbidities in assessing prognosis of septic patients / 第二军医大学学报

Objective To investigate the value of Charlson's weighted index of comorbidities (WIC) in predicting the prognosis of patientswith sepsis. Methods The clinical data of 234 septic patients in the last three years were retrospectively analyzed. The scores of WIC and acute physiology and chronic health evaluation II (APACHE II) were calculated. The patients were divided into two groups according to death or survival outcome 28 days later, and the value of WIC score in predicting prognosis was analyzed. Results It was found that 77 (32. 9%) of the 234 patients died. Increasing WIC score was associated with increased mortality. Multiple logistic regression analysis revealed that WIC was a risk factor of prognosis of septic patients (QR = 1. 434, 95% CI:1. 097-1. 875, P = 0. 008). The areas under the ROC curves in predicting the mortality of the septic patients were 0. 670 (0.591-0.748) for the WIC score, 0.770 (0.703-0.837) for APACHE II score and0. 821 (0. 757-0.885) for the combination of both. Conclusion WIC score can satisfactorily predict the influence of underlying diseases on the prognosis of septic patients.

Clinical analysis of 45 cases of hemophagocytic syndrome / 基础医学与临床

Objective To analize the clinical features of patients with hemophagocytic syndrome (HI'S). Methods The underlying diseases, clinical characteristics, laboratory findings, responses to therapy as well as their outcomes of 45 patients with HPS were analyzed retrospectively. Results The underlying diseases included virus infection (n = 9) , tuberculosis (n =2), rheumatic fever (n =4) , malignancies (n =22) , unknown diseases (n =8). HPS was clinically characterized by high fever(93. 3% ) , hepatomegaly (77. 8% ) , splenomegaly(80% ) , lymphadenopathy (55. 6% ) , skin rash(24.4% ), gastrointestinal hemorrhage(22. 2% ) , renal (35. 6% ) and central nervous systern involvement( 15. 6% ) , five patients presented with disseminated intravascular coagulation( DIC) (11. 1% ). Laboratory data mainly manifested with cytopenia ( 100% ) , liver dysfunction ( 77. 8% ) , hypofibrinogenemia (62. 8% ), hypertriglyceridemia (71. 1% ) , serum ferritin >500 p,g/L(87. 5% ) , low NK-cell activity(92. 9% ) and hemophagocytosis in bone marrow (100% ). Based on treating underlying diseases and use of corticosteroids and immunosuppressive agents in combination with intravenous immunoglobulins(IVIG) therapy, 14 patients recovered , 19 patients died in the hospital, and other 12 cases give up treatment be cause of exacerbation of the disease.Conclusion There are various underlying diseases and clinical manifestations for HPS. HPS is always extremely dangerous with high mortality. Treatment of underlying diseases, corticosteroids, immunodepressant and IVIG may improve the prognosis of HPS.

Antibiotic Susceptibility of Clinical Isolates from Lower Respiratory Tract Infection Patients in Respiratory Ward / 中华医院感染学杂志

OBJECTIVE To investigate the pathogenic bacteria distribution and susceptibility of lower respiratory tract infection in patients in our respiratory ward.METHODS All the clinical isolates from sputum or secretion of lower respiratory tract from 2003 to 2007 were analyzed retrospectively.RESULTS A total of 1529 clinical isolates were collected,including 1326 strains of Gram-negative bacilli(86.7%) and 203 strains of Gram-positive cocci(13.3%).The proportion of Gram-negative bacilli was higher in lung underlying diseases group when compared with non-lung underlying diseases.Haemophilus parainfluenzae and H.influenzae were susceptible to spectinonycin,doxycycline and third-generation cephalosporins.Pseudomonas aeruginosa and Acinetobacter baumanni were susceptible to meropenem,cefoperazone/sulbactam and cefepime.Klebsiella pneumoniae and Escherichia coli were susceptible to meropenem,cefoperazone/sulbactam and amikacin.The major Gram-positive isolates were highly resistant to azithromycin,erythromycin,penicillin.All Staphylococcus aureus isolates were susceptible to vancomycin.Streptococcus pneumoniae isolates were highly susceptible to meropenem,levofloxacin,cefazolin and vancomycin.CONCLUSIONS Infection caused by Gram-negative bacilli are predominant in lower respiratory tract infection patients,especially in the patients with lung underlying diseases.Antibiotics resistance of some pathogens become increasingly severe.Therefore,the rational use of antibiotics is important for the containment of bacterial resistance.

Clinical Study on Relation Between Herpes Zoster and Underlying Diseases / 대한피부과학회지

This study was designed to observe more closely about clinical course, complication, predilection site of skin eruption and associated diseases with herpes zoster. Total 122 cases of herpes zoster were prospectively observed from April 1986 to July 1987. The results obtained were as follows : 1. The ineidence of herpes zoster versus the total number of outpatients was 20.6%. There was no difference in sex ratio of male(52.5%) to female(47.5%). 2. Herpes zoster was observed most frequently in the 50-59 year age group (25.4%). 3. There were no marked monthly or seasonal difference in herpes zoster without an explosive outbreak or an epidemic cycle. 4, We found that 68 cases(55.7%) were associated with underlying diseases : the most common disease was hypertension(23 cases), the next one was malignsncy(10 cases), namely, lung cancer, Hodgkin's lymphoma, other malignant lymphoma, leukemia and mediastinal mass, and the other diseases were tuberculosis of intenal organs, diabetes mellitus, hepatic diseases, cardiac diseases, chronic pulmonary diseases, cord injury, gastric ulcer, brain damage, burn, renal diseases, rheumatoid arthritis, and measles. 5. It was suggested that the distributuon of skin lesion were related to dermatome. The incidence of skin lesion was distributuon in the following region in order : T5-T8(25.4%), C6-T4(24.6%), Cl-C5(20.5%), Ll-S3(13.9%), Vl-V3 (12.3%), and T9-T12(3.3%), there was involvement of the entire thoracic dermatome(C6-T12) in 65 cases(53.3%). A great many cases of malignancy, chronic pulmonary disease, cardiac disease, tuberculosis and gastric ulcer were most frequently distributed in the thoracie dermatome, but the involvement of ophthalmic dermatome was found only in the patients with hypertension. 6. The most common complication was postherpetic neuralgia for 31 cases(25.4%) with the highest frequency in 60's(32.3%). Other complications were ophthalmic complication, Ramsay-Hunt syndrome, secondary bacterial infection, moter nerve involvement, difficulty of urination, and recurrent herpes zoster.