Epidemiology, clinical and imaging features of pediatric patients with COVID-19: analysis of 14 cases / 中华全科医师杂志

Epidemiologic, clinical and imaging data were collected from 14 children with confirmed coronavirus disease 2019 (COVID-19) admitted in Beijing Ditan Hospital from January 27, 2020 to February 12, 2020. There were 6 boys and 8 girls with a median age of 3.5 years (6 months-9.4 years). Four patients had a history of travel to Wuhan City or Hubei Province and 2 patients had contacted with people from Wuhan; 13 patients were familial cluster of infection. The incubation period was 4 to 16 days. The clinical manifestations were fever in 8 cases, cough in 5 cases, diarrhea in 1 case; and 2 cases were asymptomatic. Four patients had abnormal peripheral blood routine, including 1 had lymphocytosis, 3 had lymphocytopenia; 3 patients had a slightly elevated CRP, and 3 patients had hepatic dysfunction. Thirteen patients underwent chest CT; and 1 case showed bilateral lung glass exudation, 1 case showed multiple patchy high density shadows of bilateral lung. One patient underwent chest X-ray examination, which was showed no abnormal findings. The pediatric patients with COVID-19 in this series generally have a traceable epidemiological history. The clinical manifestations are fever, cough and diarrhea. Peripheral white blood cell counts were most normal. Chest CT reveals less severe changes than those in adults, most child patients show no manifestation of pneumonia.

Clinical analysis of 10 cases of idiopathic portal hypertension / 中华全科医师杂志

Objective To review the clinical characteristics of idiopathic portal hypertension (IPH).Methods The clinical and pathological data of 10 patients with idiopathic portal hypertension admitted from December 2008 to December 2014 were retrospectively analyzed.Results Among 10 patients 5 were males and 5 females with averaged age of (38.6 ± 16.1) years.There were splenomegaly and esophageal varices in all 10 cases,upper gastrointestinal bleeding in 3 cases,thrombocytopenia in 9 cases and anemia in 6 cases.Liver function was normal in 7 cases,mild abnormality in 3 cases.Ten cases underwent ultrasound examination and 7 cases had CT scan,cirrhosis was suggested with ultrasound/CT scan in 6 cases.Liver histology showed lobular architecture in existence,no false flocculus to form,variable degree of portal fibrosis appeared.Eight cases were misdiagnosed as liver cirrhosis,the duration of misdiagnosis varied from 1 month to 15 years.Conclusions The clinical manifestation of IPH is similar as cirrhosis caused portal hypertension.Liver histopathological examination can exclude liver cirrhosis,and portal fibrosis and liver terminal portal branch occlusion in histopathology is helpful to the diagnosis of IPH.

Awareness of diagnosis and treatment for chronic hepatitis B among general practitioners at communities and effectiveness of its intervention / 中华全科医师杂志

Totally, 102 general practitioners (GPs) from 40 community health-care service centers in a district of Beijing were investigated for their awareness of diagnosis, treatment and prevention for chronic hepatitis B and evaluating effectiveness of their training with self-designed questionnaire before and after professional training.Before training, higher awareness of knowledge about prevention for hepatitis B had been achieved in GPs, such as "hepatitis C is communicable" (78/102, 76.5% ), "hepatitis B can be prevented by protective antibody" ( 76/102, 74.5% ), whereas only 3.9% ( 4/102 ) of GPs knew indications of antiviral therapy for chronic hepatitis B, 4.9% (5/102) could describe complications of decompensated cirrhosis and 19.6% (20/102) knew methods for screening primary hepatocellular carcinoma.After training, their awareness increased significantly to 93.1% (95/102), 49.0% (50/102)and 86.3% (88/102), respectively (all P ＜0.01 ).Now, GPs' knowledge about diagnosis and treatment for hepatitis B is still insufficient at community health-care centers and professional training can improve their awareness.It is an important assurance for patients with chronic hepatitis B to be better managed in both of specialized hospitals and community health-care centers by enhancing professional training for GPs indiagnosis and treatment for hepatitis B.

Clinical study on peripheral T lymphocyte subsets in children with hand-foot-and-mouth disease / 中华传染病杂志

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.