ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.
ObjectiveTo investigate the clinical characteristics of tracheobronchial stenosis due to tracheobronchial tuberculosis (TBTB).MethodsWe recruited all patients diagnosed as TBTB within one year from four centers of Guangdong province, southern China. The prevalence, risk factors and bronchoscopy characteristics of tracheobronchial stenosis were analyzed. The location and pathological type of stenosis were also compared between different genders.ResultsA total of 345 patients were diagnosed with TBTB, 206 cases (59.7%) of which were concomitant with varying degrees of tracheobronchial stenosis. The stenosis was mainly located at upper lobe (50.0%) and gave priority to unilateral infiltration. The proportion of left and right-side stenosis were 53.9% and 44.2%, respectively. Forty-nine cases (23.8%) with tracheobronchia stenosis developed severe airway narrowing, the proportion of which was similar between left and right-side lung (49% vs. 51%). Severe stenosis in the left-side lung mainly involved in upper lobe (37.5%), main bronchus (37.5%) and the right-side mainly involved in upper lobe (44.0%), middle lobe or intermediate bronchus (40.0%). Among the TBTB patients, females, those with age ≥18 years, non-smokers, and those with symptom duration ≥4 weeks were more likely to be with tracheobronchial stenosis (P<0.05). The differences in gender between the patients with airway stenosis were as follows: the median age of female tracheobronchial stenosis patients was smaller than that of male patients (31 years vs. 43 years, P<0.05); stenosis were more likely involved in left side and main bronchus in female patients; ulceration necrosis of stenosis was more frequently seen in the female patients (P<0.05).ConclusionsTracheobronchial stenosis due to tracheobronchial tuberculosis is more frequently seen in young and middle-aged female patients. There are different stenosis location and lesion types between different genders.
ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.
ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
ObjectivesTo investigate the epidemiological and clinical characteristics of first diagnosed human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in a general hospital, so as to improve early recognition and diagnosis of HIV/AIDS.MethodsWe retrospectively analyzed the data of HIV/AIDS patients who were diagnosed for the first time and had medical records in West China Hospital of Sichuan University from January 2015 to December 2016. Epidemiological information, clinical characteristics and opportunistic infection of these patients were analyzed.ResultsThe 1 036 HIV/AIDS patients were mainly from other regions of Sichuan Province except Chengdu. The overall ratio of male to female was 3.26∶1, and the ages of the patients were mainly between 15 and 59 years old (83.20%). In the occupational distribution, household or unemployed accounted for the largest proportion (36.39%). In terms of education level, junior high school accounted for the largest proportion (27.70%). Among marital status, married accounted for the largest proportion (52.41%). Among ethnic groups, the Han nationality accounted for the largest proportion (87.64%). The main infection route was sexual transmission (82.05%), of which heterosexual transmission accounted for 65.64% and homosexual transmission accounted for 16.41%. The clinical departments of confirmed patients had a wide range of sources, the top five of which were General Outpatient Clinic, Infection Center, Department of Emergency, Department of Dermatology & Venerology and Department of Neurology. Of the patients, 66.99% reported asymptomatic, and 33.01% had one or more symptoms. The most common symptoms were systemic symptoms such as fever, fatigue and lymphadenopathy, as well as clinical manifestations of respiratory system, nervous system and gastrointestinal system. The clinical stage of HIV/AIDS patients were mainly asymptomatic phase and AIDS phase, accounting for 98.65%. Among the HIV/AIDS patients, there were obviously more medical patients than surgical patients. The most common symptoms of the medical patients were fever, cough and expectoration, headache, fatigue and abdominal pain. The main symptoms of the surgical patients were headache, abdominal pain and lymphadenopathy. Compared with the surgical HIV/AIDS patients, the medical patients were younger (Z=−2.647, P=0.008), and the platelet counts (t=−2.110, P=0.036) and CD4+ T lymphocyte counts (Z=−4.639, P<0.001) were lower, the differences were statistically significant. Compared with the homosexually transmitted HIV/AIDS patients, the heterosexually transmitted patients were older (t=25.477, P<0.001), and had lower CD4+ T lymphocyte counts (Z=−2.779, P=0.005). And in males, the red blood cell count and hemoglobin content were lower. There were 214 patients (20.66%) with opportunistic infections, and 50 patients (4.83%) with tumors.ConclusionsHIV/AIDS patients in this general hospital come from different clinic departments, and were mainly Han nationality and married men. Sexual transmission is the main transmission route. Common clinical presentations of HIV/AIDS include fever, fatigue, cough and expectoration, headache, abdominal pain and lymphadenopathy. The diagnosis and treatment of HIV/AIDS patients combined with opportunistic infections and tumors need more attention.
ObjectiveTo analyze the clinical and epidemiological characteristics of hospitalized avian influenza A (H7N9) virus infections in Hunan province from 2013 to 2017, and provide evidences for control, diagnosis and treatment of this disease.MethodsNinety-one hospitalized patients were confirmed with H7N9 infection in Hunan. Excluding 2 patients less than 18 years old and 10 with missing data, 79 patients with H7N9 infection were analyzed.ResultsMost confirmed cases were affected in the second and fifth epidemic wave and number of patients in the fifth wave was more than the sum in prior 4 waves. Epidemiological characteristics, clinical symptoms and case fatality did not change significantly. Administration of antiviral drugs was more active in the fifth wave [from illness onset to antiviral drug: (6.3±2.4)d vs. (7.6±2.4)d, P=0.047]. Multiple logistic regression analysis showed that shock (OR=4.683, 95%CI 1.136–19.301, P=0.033) was the independent risk factor of H7N9 infections. There were no significant differences in case fatality among group oseltamivir, group oseltamivir+peramivir, and group peramivir.ConclusionsPatients with avian influenza A (H7N9) increased in the fifth wave but clinical characteristics changed little. Antiviral treatment should be more active. Shock is an independent risk factor of H7N9 infections. Oseltamivir-peramivir biotherapy can not reduce case fatality compared with oseltamivir or peramivir monotherapy.
Objective To summarize the cl inical characteristics of 596 patients with fracture in Wenchuan earthquake and to investigate the therapeutic methods and effects of early treatment. Methods From May 12th 2008 to May 21st 2008, 596 patients with fracture caused by Wenchuan earthquake were treated, including 283 males and 313 females aged1.9-102 years (median 43 years). The time from injury to hospital ization varied from 12 minutes to 4 days. There were 132 cases of upper extremity fracture, 496 cases lower extremity fracture, 10 cases clavicular fracture, 16 cases scapular fracture, 23 cases pelvis fracture, and 59 cases spinal fracture. Among them, 183 cases were open fracture and 413 cases were closed fracture. And 214 cases had multiple fracture (35.9%) and 68 cases had crush injury in l imbs which scored (6.84 ± 2.48) points according to the mangled extremity severity score (MESS). Thirty-six cases were combined with neurovascular injury. The wound of the open fracture was contaminated at different degrees, but no gas gangrene was observed. Open fracture was treated with suturing or no suturing after debridement, open reduction and internal or external fixation. Closed fracture was fixed with spl ints, cast and traction. Forty-nine patients whom were highly suspected as osseous fascia compartment syndrome received incision decompression timely, and 34 patients whose MESS were above 7.0 points or suffering from crush injury of l ifethreatening systemic symptoms received amputation. Results Apart from 34 patients receiving amputation, 460 patients achieved functional reduction of fracture after manipulative reduction and 102 cases got satisfactory reduction after surgery. Postoperatively, 289 patients were transferred to other hospitals. Among the rest 307 patients, 34 with severe wound infection were healed after multiple debridement, anti-infection, and skin flap transplantation (16 cases healed by first intention and 18 cases healed by second intention), 42 cases with crush syndrome were treated with open decompression and amputation, and nodeep venous thrombosis of lower l imb, stress ulcer and death were observed after operation (29 cases healed by first intention and 13 cases healed by second intention). Conclusion By aiming at the features of fracture caused by earthquake, the prompt and professional treatment can achieve good therapeutic effects.
ObjectiveTo analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
ObjectiveTo systematically review the clinical and genetic features of permanent neonatal diabetes mellitus (PNDM) case reports. MethodsThe PubMed, Embase, Scopus, SinoMed, Web of Science, CINAHL, Medrxiv, VIP, CNKI and WanFang Data databases were electronically searched to collect PNDM case reports from inception to June 2023. Two reviewers independently screened literature, extracted data and assessed the reporting quality of the included studies. Descriptive analysis was performed. ResultsA total of 105 case reports were finally included. Typical clinical manifestations of PNDM were early onset of persistent hyperglycemia, developmental delay and low birth weight. The results of genetic testing showed that mutations in the KCNJ11, INS, EIF2AK3, GCK, ABCC8, PTF1A, GATA6, IER3IP1, SLC19A2, NEUROG3, PDX1, and 6q24 genes were closely associated with the development of PNDM. In addition, there may be different clinical manifestations and prognosis of PNDM in different genotypes. ConclusionThis study reveales the clinical characteristics and genetic pattern of PNDM, and provides a direction for further research on the mechanism of PNDM.
ObjectiveTo observe the clinical characteristics and treatment prognosis of patients with ocular toxocariasis (OT). MethodsA retrospective clinical trial. From March 2018 to September 2021, 40 eyes of 40 OT patients diagnosed by ophthalmic examination in the First Affiliated Hospital of Zhengzhou University were included in the study. All patients underwent best corrected visual acuity (BCVA) and scanning laser ophthalmoscope (SLO) examination. Color Doppler ultrasound flow imaging (CDFI), fluorescein fundus angiography (FFA) and optical coherence tomography (OCT) were performed in 25, 26 and 26 eyes, respectively. Among the 40 patients, there were 23 males (57.5%, 23/40) and 17 females (42.5%, 17/40). All patients were monocular. Thirty patients (75.0%, 30/40) were younger than 18 years old, with the mean age of (9.60±0.60) years. Ten patients (25.0%, 10/40) were great than or equal to 18 years old, with the mean age of (34.60±4.52) years. Thirty-three patients (82.5%, 33/40) lived in rural areas for a long time. There were 27 patients (67.5%, 27/40) with a history of contact with dogs and cats. In 40 eyes, peripheral granuloma (peripheral type), posterior pole granuloma (posterior pole type), vitreous opacity similar to endophthalmitis (turbid type) and hybrid type were 18(45.0%, 18/40), 11(27.5%, 11/40), 6(15.0%, 6/40) ang 5(12.5%,5/40), respectively. All patients were treated with drugs and/or surgery after definite diagnosis. There were 28 eyes of peripheral type, posterior pole type and hybrid type, 17 eyes were treated with surgery and 11 eyes with drug treatment, respectively. Five eyes with turbid type were only treated with drugs. In 40 patients, 33 patients participated in follow-up. The follow-up time after treatment was (18.78±9.44) months. The improvement of BCVA was observed. The number of eyes with different BCVA before and after treatment was compared by χ2 test or Fisher's test. ResultsAt the first visit, the BCVA ranged from light perception to 0.6, including 20 eyes with BCVA ＜0.1, 13 eyes with BCVA 0.1-0.3, and 7 eyes with BCVA ＞0.3. The posterior vitreous anterior limiting membrane was thickened in 24 eyes (60.0%, 24/40). There were 27 eyes (67.5%, 27/40) with lamellar vitreous opacity and 22 eyes (55.0%, 22/40) with peripheral/posterior pole granulomas. Among 25 eyes examined by CDFI, 14 eyes (56.0%, 14/25) showed characteristic stratified or diffuse opacity in vitreous body. Of the 26 eyes examined by FFA, 15 eyes (57.7%, 15/26) had "fern-like" leakage of retinal capillaries, and the lesion had a patchy non-perfused area. In 26 eyes examined by OCT, epiretinal membrane, cystoid macular edema and vitreoretinal traction were 8 (30.8%, 8/26), 5 (19.2%, 5/26) and 2 (7.7%, 2/26) eyes, respectively. At the last follow-up, compared with before treatment, the BCVA of 5 eyes with turbid type increased, and the difference was statistically significant (P＜0.05). In 28 eyes with peripheral type, posterior pole type and hybrid type, 17 eyes with surgical treatment improved BCVA, and the difference was statistically significant (χ2=6.258, P＜0.05). In 11 eyes only treated with drugs, BCVA remained unchanged, and the difference was not statistically significant (χ2=0.594, P＞0.05). ConclusionsOT patients are mostly children; retinal granulomas, gray-white hyperplastic membrane behind lens or vitreous stratified opacity are specific characteristics. OT is mainly treated by glucocorticoid drugs and vitrectomy.