Follow-up and retrospective investigation of pneumoconiosis cases in a county of Ningbo City from 1974 to 2019 / 环境与职业医学

Background Pneumoconiosis is one of the most common and widespread prescribed occupational diseases in China, and there is no cure for it at present. The Healthy China 2030 underlines that the prevention and treatment of pneumoconiosis are the critical element of promoting occupational health. Objective To understand the basic characteristics, social security, and death causes of pneumoconiosis cases in Ninghai County, and to provide a basis for scientific prevention and treatment of pneumoconiosis. Methods Information on pneumoconiosis cases in Ninghai County from 1974 to 2019 was obtained by consulting occupational disease and occupational health information monitoring systems, occupational disease diagnosis institutions, and employers, which may retain original data on occupational pneumoconiosis diagnosis, as well as specialized epidemiological survey projects on pneumoconiosis. Telephone or face-to-face follow-up visits were conducted based on relevant information to complete or verify relevant information such as length of service with dust exposure, type, stage, and diagnosis date of pneumoconiosis. ANOVA, chi-square test, and rank-sum test were used to analyze age of diagnosis and age of death, entitlement to social security and mortality rate of cases/length of service. Results As of the end of 2019, a total of 420 cases of pneumoconiosis were diagnosed among workers exposed to dust in Ninghai County, with 409 cases (97.38%) followed up and 11 cases (2.62%) lost to follow-up. Since the first case of pneumoconiosis was reported in 1974, 39 cases, 278 cases, and 101 cases of pneumoconiosis were reported before 2000, from 2000 to 2009, and from 2010 to 2019, respectively. Two other cases of pneumoconiosis were diagnosed with an unknown year, one as a dead case and one as a lost case. There were 294 surviving pneumoconiosis cases, who mainly lived in Sangzhou Town. The mean age of diagnosis was (58.68±15.37) years old, and the median length of service with exposure to dust was 8.0 (4.0, 15.7) years. The age of diagnosing stage III pneumoconiosis was less than that of stage I and stage II, and the difference between the age of diagnosing stage III and stage II pneumoconiosis was significant (P <0.05). There were 231 cases (78.57%) aged ≥ 60 years, while there were 74 cases aged ≥ 80 years (25.17%). There were 160 cases (54.42%) whose length of service was < 10 years. There were 12.59% and 7.82% of the total cases compensated by work injury insurance and civil compensation by employers, respectively. From the perspective of diagnosis period, the proportion of patients who collected work-related injury insurance and civil compensation from employers in the 2010—2019 year group was higher than that in the <2000 year group or the 2000—2009 year group (P<0.01). There were 115 fatal pneumoconiosis cases, and the fatality rates of stage I, II , and III pneumoconiosis were 23.86%, 18.18%, and 50.75%, respectively. The fatality rate of stage III pneumoconiosis was higher than that of stage I or II (P <0.05). The age of diagnosis and age of death of stage III pneumoconiosis cases were lower than those of stage I and II (P <0.05). The cause of death was definite in 65 patients, including 25 cases (38.46%) of respiratory diseases (except lung cancer) and 28 cases (43.07%) of tumors, and lung cancer accounted for 1/2 of the pneumoconiosis cases that died due to tumors. Conclusion The surviving pneumoconiosis cases in Ninghai are mainly older than 60 years old and largely live in Sangzhou Town. Constructing local rehabilitation stations should be taken as an opportunity to actively prevent and treat pneumoconiosis complications, further improving the quality of life of pneumoconiosis patients.

Case analysis of antithyroid drug-induced agranulocytosis combined with fatal complications / 西安交通大学学报(医学版)

Objective: To investigate the clinical characteristics of patients with antithyroid drug (ATD)-induced agranulocytosis in the treatment of hyperthyroidism and analyze factors associated with the death rate of patients with fatal outcomes. Methods:Patients diagnosed with ATD-induced agranulocytosis in Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2018, were included in this study and their medical records were reviewed retrospectively. We compared the clinical characteristics of patients in death group and survival group. Results: We recruited 70 patients with ATD-induced agranulocytosis in the study. Five of them died. All fatal cases were females, aged between 33 to 54 years. Three patients also had hyperthyroidism crisis, and two had hyperthyroid heart disease. Compared with the survival cases of ATD-induced agranulocytosis, patients with fatal agranulocytosis were elderly [47.00±8.12)years vs. (35.58±11.10) years, P=0.028] and had a longer duration of hyperthyroidism [1 800 (315-2 880)d vs. 60(40-120)d, P=0.002]. The interval days between symptoms and the diagnosis of agranulocytosis were significantly longer in patients with fatal cases than the survival ones[5.0(3.5-11.0)d vs. 0(0-2.5) d, P=0.002]. In addition, the proportion of patients with hyperthyroid crisis was greater in the death group (60% vs. 0%, P<0.001). Conclusion: Age, duration of hyperthyroidism, and timely diagnosis of agranulocytosis could affect the mortality of agranulocytosis. Mortality in patients with hyperthyroidism was significantly increased. It is recommended that patients with hyperthyroidism should be reminded to monitor routine blood cells immediately. In the event of agranulocytosis, other methods should be chosen as soon as possible to treat hyperthyroidism and avoid serious outcomes.

Analysis of eight fatal cases of severe influenza A (H1N1) in children / 中国小儿急救医学

Objective To analyze the clinical characteristics of fatal cases with confirmed influenza A ( H1N1) in children in order to improve the diagnosis and treatment. Methods The fatal cases of influenza A (H1N1) admitted to Pediatric Intensive Care Unit of Beijing Children′s Hospital from December 2017 to March 2018 were collected,whose clinical features,diagnosis,treatment,and the causes of death were ana-lyzed retrospectively. Results A total of eight children were enrolled. The age ranged from 3 months to 9 years,and six cases were less than 5 years old. Four cases had underlying diseases. All patients had fever, cough,dyspnea,cyanosis,flaring nares and three depressions sign. Four cases had coma. On admission,the average score of pediatric index of mortality was 58. 8％. Blood routine test showed that lymphocyte predomi-nance in six cases, three cases had leukopenia. C-reactive protein elevated in five patients. Procalcitonin increased in all cases. P/F ratio (PaO2/FiO2) were less than 100 mmHg(1 mmHg =0. 133 kPa) in four cases who were diagnosed as severe acute respiratory distress syndrome. The pulmonary imaging showed mul-tiple parenchymal or mixed lesions. Three cases had air leakage syndrome,and one had pleural effusion. Bac-terial culture was performed on the day of admission. Four cases were complicated with bacterial infection. Three cases had Gram-positive cocci infection,and multidrug-resistant bacteria were predominant. The aver-age time from onset to definitive diagnosis was 8 days. Neuraminidase inhibitors were used in all patients,and the average time from onset to the first dose was 8 days. Mechanical ventilation were performed in all patients in this group. Extracorporeal membrane oxygenation was applied in one case. Four cases in this group died of severe acute respiratory distress syndrome. Three cases died of influenza associated encephalopathy,and one died of septic shock with multiple organ failure. Conclusion Fatal influenza A (H1N1) mostly appeares in children under 5 years old or with underlying diseases. Acute respiratory distress syndrome and influenza associ-ated encephalopathy are the main causes of death. Delayed diagnosis and delayed use of anti-influenza drugs may be an important factors leading to death,and bacteria infection may be another important cause of death.

Analysis of 19 fatal cases of influenza virus infection in children / 中华实用儿科临床杂志

Objective To analyze the cause of fatal cases in children with confirmed influenza virus infection,and in order to improve the level of diagnosis and treatment.Methods Deaths in critical illness of influenza were collected from November 2017 to April 2018 in Pediatric Intensive Care Unit of Beijing Children's Hospital,Capital Medical University.The clinical characteristics and causes of death were retrospectively analyzed according to the different virus types.Results A total of 19 cases were included.Fifteen cases (78.95％) were less than 5 years old and 9 cases (47.37％) were less than 2 years old.On admission,the median score of pediatric index of mortality 2 was 72.7％.There were 11 cases of influenza H1N1 and 8 cases of influenza B.Six cases had underlying diseases.All patients had fever,cough and dyspnea.Thirteen patients had coma.Seventeen cases had pneumonia,11 cases had severe acute respiratory distress syndrome(ARDS),3 cases had air leakage syndrome and 8 cases had influenza-related encephalopathy(IAE).Ten cases (52.63％) died of severe ARDS,7 cases (36.84％) died of IAE,1 case(5.26％) died of multiple organ dysfunction,and 1 case(5.26％)died of severe myocarditis and cardiogenic shock.There was statistical difference in the time from onset to death between the ARDS group and IAE group[15(4,22) d vs.3(2,8) d] (Z =-2.063,P =0.039).Among the children who died of severe ARDS,most patients in influenza H1 N1 group ＜ 2 years old,while those influenza B group ≥ 2 years old.All children who died of IAE were all ≥ 1 years old.Six cases (31.58％) had bacterial infection,mainly gram-positive cocci.All patients were treated with neuraminidase inhibitors.The average time from onset to the first time of medication was 5 days.Conclusions Severe ARDS and IAE are the main causes of death in children with influenza virus infection.Compared with ARDS,the condition of children with IAE worsened more rapidly.

Parvovirus B19 1A complete genome from a fatal case in Brazil

Parvovirus B19 (B19V) infects individuals worldwide and is associated with an ample range of pathologies and clinical manifestations. B19V is classified into three distinct genotypes, all identified in Brazil. Here, we report a complete sequence of a B19V genotype 1A that was obtained by high-throughput metagenomic sequencing. This genome provides information that will contribute to the studies on B19V epidemiology and evolution.

A Fatal Case of Naegleria fowleri Meningoencephalitis in Taiwan

After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later.