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Objective:To investigate the clinical characteristics of central nervous system tuberculosis in adults and the possible factors affecting the mortality and disability of the patients.Methods:The clinical data of patients diagnosed as "tuberculous meningitis" "tuberculous meningoencephalitis" "tuberculous cerebrospinal meningitis" or "tuberculous brain ubscess" in Huashan Hospital, Fudan University and Jing′an Branch, Huashan Hospital, Fudan University in Shanghai from January 1, 2010 to December 31, 2017 were collected, and a retrospective cohort was established. The clinical characteristics were analyzed, Medical Research Council (MRC) grade system was used to assess the severity of meningitis, and the modified Rankin Scale was used to assess the impairment of self-care. Survival rate and disability rate of the cohort were analyzed. Binary logistic regression was used for multivariate analysis. Kaplan-Meier survival curve was used for survival analysis.Results:A total of 161 patients with central nervous system tuberculosis were enrolled. Among the 161 patients, 55 cases (34.2%) were confirmed, 72 cases (44.7%) were highly suspected and 34 cases (21.1%) were suspected diagnosis. There were 56 cases (34.8%) with MRC grade Ⅰ, 76 cases (47.2%) with MRC grade Ⅱ and 29 cases (18.0%) patients with MRC grade Ⅲ before treatment. Up to January 1, 2019, ten (6.2%) patients died, 32 (19.9%) patients lost to follow-up, 119 (73.9%) patients survived. The five-year survival rate was 92.83%. There were 72 patients with no impact on life, 34 patients with moderate impact and 13 patients with severe impact. The disability rate was 39.5% (47/119). Binary logistic regression analysis showed that increasing age (odds ratio ( OR)=1.06, 95%confidence interval ( CI) 1.00 to 1.13, P=0.032) and deterioration of MRC grade during anti-tuberculosis treatment ( OR=89.00, 95% CI4.46 to 1 779.00, P=0.003) were independent risk factors for death. When severe disability and death were used as adverse outcomes, logistic regression analysis showed increasing age ( OR=1.07, 95% CI 1.01 to 1.13, P=0.035) and deterioration of MRC grade during anti-tuberculosis treatment ( OR=77.17, 95% CI4.45 to 1 337.00, P=0.003) were still independent risk factors for adverse outcomes. Conclusions:The mortality of central nervous system tuberculosis in adults in this cohort is relatively low, but the disability rate is still high. Increasing age and deterioration of MRC grade during anti-tuberculosis treatment are independent risk factors for death and disability.
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Objective To construct and apply resuscitation and transfer modules in the field medical unit.Methods Two modules of resuscitation and transfer were developed according to the objective,principle and method of resuscitation and transfer modularity.Totally 3 modes were used during the application of the modules,including independent deployment,combined deployment by brigade and regiment treatment facilities as well as separate deployment.Studies were executed on classification of professional equipment,generalization,integration,portability and etc.The efficacy of establishing the modules was verified in the practical application.Resultd The modules enhanced the efficiency of the field medical unit while saved medical resources.Conclusion The resuscitation and transfer modules and their equipment systems in the field medical unit meet the requirements for rapid deployment,supply,withdrawal and etc of emergency mobile medical unit,and thus raise the medical service support ability.
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Objective To understand the present situation and the changes on causes of physical disabilities among children aged 0-14 years for the past 20 years in China. Methods Data on children with physical disabilities aged 0-14 years from The China National Sample Survey on Disability in 2006 and 1987,were analyzed and compared. Results The categories on the causes of children with physical disabilities aged 0-14 could be grouped as: congenital diseases and eccyliosis, with injury factors, other factors and disease factors. The specific causing-disability rates were 0. 257%, 0.066%, 0.055% and0.041% respectively. Cerebral palsy rated the highest specific causing-disability as 0.129% in all of the causes. Compared with 1987, the specific causing-disability rate of congenital diseases and eccyliosis had an obvious increase while the rates of disease factors and other factors showed a substantial decrease. The top five causes of children with physical disabilities aged 0-14 years in China were cerebral palsy, deformity,other kinds of traumas, congenital diseases and eecyliosis in 2006. Other causes, postpoliomyelitis muscularatrophy,deformity,other kinds of traumas and unknown causes were the top five in 1987. The age-specific top five causes were basically the same as the total top five causes of children aged 0-14 years with physical disabilities in 1987 and 2006,so as the same relationship between sex-specific top five causes and total top five. Conclusion Congenital diseases and eccyliosis were the main causes of 0-14 year-old children with physical disabilities, and cerebral palsy had the highest specific causing-disability rate while injury factors gradually became the major one.
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Objective To observe the influence of Zhenweifang on the muscle tension in flaccid paralysis period and prognosis of stroke.Methods One hundred and eighty patients were randomly divided into basic group,Buyanghuanwutang group and Zhenweifang group.Basic group was treated with usual medical treatment with nerve rehabitilation and acupuncture.Buyanghuanwutang group and Zhenweifang group were given the corresponding traditional Chinese medicine.Patients in Buyanghuanwutang group and Zhenweifang group stop taking the traditional Chinese medicine when their muscle tension reach the level of Ashworth Grade Ⅱ,and continued their basic treatment.The defect of neurological and daily life ability were evaluated after three-week and six-week treatment,and the prognosis was evaluated according to clinical efficacy.Results The time that patients muscle tension in Zhenweifang group need to reach Ashworth Grade Ⅱ was much shorter than that in Buyanghuanwutang group and basic group(P
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In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Grading of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 14 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The advantage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s' of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical impairment could be compared in 167 out of total 312 cases and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AMA method. 6. When disability rate was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.