[Clinical characteristics and short-term prognosis of 22 cases with SARS-CoV-2 infection associated acute encephalopathy].

Objective: To investigate the clinical features and short-term prognosis of patients with SARS-CoV-2 infection associated acute encephalopathy (AE). Methods: Retrospective cohort study. The clinical data, radiological features and short-term follow-up of 22 cases diagnosed with SARS-CoV-2 infection associated AE in the Department of Neurology, Beijing Children's Hospital from December 2022 to January 2023 were retrospectively analyzed. The patients were divided into cytokine storm group, excitotoxic brain damage group and unclassified encephalopathy group according to the the clinicopathological features and the imaging features. The clinical characteristics of each group were analyzed descriptively. Patients were divided into good prognosis group (≤2 scores) and poor prognosis group (>2 scores) based on the modified Rankin scale (mRS) score of the last follow-up. Fisher exact test or Mann-Whitney U test was used to compare the two groups. Results: A total of 22 cases (12 females, 10 males) were included. The age of onset was 3.3 (1.7, 8.6) years. There were 11 cases (50%) with abnormal medical history, and 4 cases with abnormal family history. All the enrolled patients had fever as the initial clinical symptom, and 21 cases (95%) developed neurological symptoms within 24 hours after fever. The onset of neurological symptoms included convulsions (17 cases) and disturbance of consciousness (5 cases). There were 22 cases of encephalopathy, 20 cases of convulsions, 14 cases of speech disorders, 8 cases of involuntary movements and 3 cases of ataxia during the course of the disease. Clinical classification included 3 cases in the cytokine storm group, all with acute necrotizing encephalopathy (ANE); 9 cases in the excitotoxicity group, 8 cases with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and 1 case with hemiconvulsion-hemiplegia syndrome; and 10 cases of unclassified encephalopathy. Laboratory studies revealed elevated glutathione transaminase in 9 cases, elevated glutamic alanine transaminase in 4 cases, elevated blood glucose in 3 cases, and elevated D-dimer in 3 cases. Serum ferritin was elevated in 3 of 5 cases, serum and cerebrospinal fluid (CSF) neurofilament light chain protein was elevated in 5 of 9 cases, serum cytokines were elevated in 7 of 18 cases, and CSF cytokines were elevated in 7 of 8 cases. Cranial imaging abnormalities were noted in 18 cases, including bilateral symmetric lesions in 3 ANE cases and "bright tree appearance" in 8 AESD cases. All 22 cases received symptomatic treatment and immunotherapy (intravenous immunoglobulin or glucocorticosteroids), and 1 ANE patient received tocilizumab. The follow-up time was 50 (43, 53) d, and 10 patients had a good prognosis and 12 patients had a poor prognosis. No statistically significant differences were found between the two groups in terms of epidemiology, clinical manifestations, biochemical indices, and duration of illness to initiate immunotherapy (all P>0.05). Conclusions: SARS-CoV-2 infection is also a major cause of AE. AESD and ANE are the common AE syndromes. Therefore, it is crucial to identify AE patients with fever, convulsions, and impaired consciousness, and apply aggressive therapy as early as possible.

The Effect of Feedforward Nursing Quality Management Control on the Sterilization Qualification Rate and Nosocomial Infection Rate

To study the effect of feedforward nursing quality management control in the disinfection supply room in improving the sterilization qualification rate and reducing the nosocomial infection rate under the coronavirus disease 2019 (COVID-19),the feedforward control of nursing quality management in disinfection supply room were implemented when the COVID-19 occurred.Through the summary analysis of nursing quality factors in disinfection supply room and the analysis of the reasons for nursing quality,the feedforward control management scheme in disinfection supply room was established.Moreover,the qualified rate of sterilization and nosocomial infection rate before and after the implementation of feedforward control of nursing quality management in disinfection supply room were counted respectively.Furthermore,the self-designed questionnaire was used to investigate the satisfaction of clinical medical staff on the use of device before and after the implementation of feedforward control of nursing quality management in disinfection supply room.In that case,the effect of feedforward control of nursing quality management in disinfection supply room was evaluated.The qualification rate of device sterilization,the nosocomial infection rate and the satisfaction rate of clinical medical staff were 95.20%,4.20% and 83.00%,respectively,before the implementation of feedforward nursing quality management control in disinfection supply room.While,the qualification rate of device sterilization,the nosocomial infection rate and the satisfaction rate of clinical medical staff were changed to 99.10%,0.40% and 98.00%,respectively,after the implementation of feedforward nursing quality management control in disinfection supply room,which have statistical differences (P<0.05).The application of feedforward nursing quality management control in the disinfection supply room under the COVID-19 could effectively prevent the spread of the virus through non-disposable medical devices in hospitals,increase the qualification rate of device sterilization,reduce the nosocomial infection rate,and improve the satisfaction of clinical care staff. © 2021, Editorial Board of Pharmaceutical Biotechnology. All right reserved.