目的探讨早期胱抑素C(Cys-C)联合凝血酶原时间(PT)在发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者病情严重程度及预后中的评估价值。方法回顾性收集2021年4月至2023年8月安徽医科大学附属巢湖医院诊...目的探讨早期胱抑素C(Cys-C)联合凝血酶原时间(PT)在发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者病情严重程度及预后中的评估价值。方法回顾性收集2021年4月至2023年8月安徽医科大学附属巢湖医院诊治的101例SFTS患者资料,按患者病情严重程度分为普通组和重症组,按治疗结局分为生存组和死亡组。分析各组临床表现及早期实验室指标差异,采用logistic回归分析影响预后的因素,并采用受试者工作特征(ROC)曲线评估早期Cys-C水平及PT单独及联合检测对预测生存及死亡结局的效能。结果早期患者血清Cys-C、尿素氮、肌酐、尿酸、肌酸激酶、肌酸激酶同工酶水平、PT、活化部分凝血活酶时间在重症组及死亡组高于普通组及生存组,而淋巴细胞计数低于后两组,差异具有统计学意义(P<0.05)。多因素二元logistic回归分析结果提示,患者年龄(OR=1.146,95%CI:1.036~1.267)、PT(OR=2.643,95%CI:1.323~5.281)、Cys-C(OR=5.039,95%CI:1.548~16.395)是SFTS患者预后的独立危险因素。血清Cys-C作为预测生存者与死亡者的指标具有较高评估价值,ROC曲线下面积为0.831;而联合Cys-C、PT和患者年龄,曲线下面积高达0.930。结论SFTS多发生于农民及老年人群,患者入院早期血清PT和Cys-C水平可有效预估患者预后,两者有望成为预测生存和死亡的生物标志物。展开更多
肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)是我国重点防治的乙类传染病,曾在我国广泛流行,给人民群众健康带来严重威胁。多年来,在政府主导多部门通力协作全面落实综合防控措施的背景下,HFRS得到有效控制,发病总体...肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)是我国重点防治的乙类传染病,曾在我国广泛流行,给人民群众健康带来严重威胁。多年来,在政府主导多部门通力协作全面落实综合防控措施的背景下,HFRS得到有效控制,发病总体上进入低水平波动期,但累及地区却在扩大,新的疫源地仍在出现,部分疫源地疫情时有反复,防控工作面临新的形势。进一步巩固防控成果,降低发病率和病死率,仍是当前公共卫生系统亟待解决的挑战之一。为此,本文介绍了HFRS的病原学特征,结合既往疫情资料分析了我国当前HFRS的流行特点,总结了我国HFRS的防控策略与措施,以期为新形势下我国HFRS的防控工作提供有益参考。展开更多
Objective:To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles.Methods:This study included pediatric cases evaluat...Objective:To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles.Methods:This study included pediatric cases evaluated with a presumed diagnosis of measles between December 2022 and June 2023,at Marmara University Pendik Training and Research Hospital.The effects of vaccination status and underlying disease on the clinical course,treatments,and complications were evaluated.Results:In total,117 patients were enrolled in the study with a median age of 80 months(IQR:32.5-125.0).Twelve patients with contact history were asymptomatic and had an underlying disorder,and intravenous immunoglobulin was given to them for post-exposure prophylaxis.Fifty-one patients had confirmed measles diagnosis.Ribavirin treatment was given to three patients(a newborn,a girl with rhabdomyosarcoma,and a healthy boy)with respiratory distress.Seventy-eight percent of confirmed measles cases were unvaccinated,and all hospitalized cases were unvaccinated or under-vaccinated.Four full-vaccinated children had confirmed measles infection.Measles PCR from nasopharyngeal swabs was negative in all of them,and their diagnosis was established with anti-measles IgM positivity.Conclusions:The measles vaccine is the most effective way to protect from measles and measles-related complications.Although measles can also occur in fully vaccinated patients,the disease is milder than in unvaccinated patients.Using ELISA and RT-PCR tests together may be beneficial in patients with high clinical suspicion for early diagnosis.展开更多
目的探究发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者预后的影响因素,构建列线图预测模型并验证评价。方法回顾性分析2019年4月至2024年5月于安徽医科大学第二附属医院住院治疗SFTS成人患者的临床资...目的探究发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者预后的影响因素,构建列线图预测模型并验证评价。方法回顾性分析2019年4月至2024年5月于安徽医科大学第二附属医院住院治疗SFTS成人患者的临床资料,根据院内生存情况分为生存组和死亡组。采用二元Logistic回归分析确定SFTS患者预后不良的独立危险因素并构建列线图预测模型,使用Bootstrap法重复抽样1000次进行验证,采用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)、校准曲线和决策曲线评估列线图模型的区分度、校准度和临床适用性。结果共纳入271例SFTS患者,其中生存组215例,死亡组56例。二元Logistic回归分析显示年龄[OR=1.089,95%CI(1.018,1.166)]、病毒载量[OR=2.047,95%CI(1.192,3.514)]、消化道出血[OR=5.368,95%CI(1.635,17.625)]、肺部真菌感染[OR=6.446,95%CI(2.115,19.645)]、血清铁蛋白[OR=8.198,95%CI(1.850,36.340)]是SFTS患者院内死亡的影响因素。列线图预测模型AUC值为0.936[95%CI(0.906,0.965)],Bootstrap法重复抽样1000次后的AUC为0.928[95%CI(0.898,0.960)],校准曲线、决策曲线显示模型具有较好的一致性和净收益。结论年龄、病毒载量、消化道出血、肺部真菌感染、血清铁蛋白是SFTS院内死亡的影响因素,本研究构建的SFTS患者院内死亡风险的列线图预测模型可辅助临床识别高危患者,具有一定的临床使用价值。展开更多
肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)又称流行性出血热,是由汉坦病毒(Hantavirus,HV)引起的以啮齿类动物为主要传染源的人畜共患病,病死率较高,中国是HFRS的高发地区之一[1]。人类免疫缺陷病毒(human immunodef...肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)又称流行性出血热,是由汉坦病毒(Hantavirus,HV)引起的以啮齿类动物为主要传染源的人畜共患病,病死率较高,中国是HFRS的高发地区之一[1]。人类免疫缺陷病毒(human immunodeficiency virus,HIV)是全球范围内广泛流行的传染性疾病,其感染的主要特征是进行性免疫缺陷,极易合并其他病原体感染。HIV合并乙型肝炎病毒和丙型肝炎病毒(hepatitis C virus,HCV)感染较为常见[2,3],在这2种病毒感染基础上合并HV导致的重症HFRS罕见报道。展开更多
Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods...Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods:This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals.The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR.Results:Based on the emerging themes from the qualitative data,the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits,encompassing a diverse patient population with various healthcare needs.However,it faces challenges such as the lack of outcome monitoring,formal training,and workforce constraints.Despite these hurdles,there is a pressing need for the expansion of this service to better serve the community,and collaboration with community pharmacists holds potential to broaden its scope.Ultimately,the findings suggest that pharmacist-led HMR is both warranted and feasible within the Malaysian healthcare context.In order to optimize medicine-use among older people living in the community,approaches for expanding geriatric HMR services in Malaysia must be developed.Conclusions:This study holds profound implications as it attempts to illuminate policy makers in developing countries,enabling them to formulate effective HMR plans.By considering the challenges highlighted within this research,policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.展开更多
Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on child...Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.展开更多
Rationale:Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens,resulting in complement-mediated hemolysis,leading to intravascular hemolysis and hemo...Rationale:Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens,resulting in complement-mediated hemolysis,leading to intravascular hemolysis and hemoglobinuria.Patient’s concern:A 12-year-old male patient who recovered from dengue fever a week ago had red blood cell agglutination,spherocytes,and engulfment of red blood cells(erythrophagocytosis)by monocytes and neutrophils on routine hematological peripheral blood smear.The unexpected blood smear results prompted the lab physicians to investigate autoimmune hemolytic anemia,which revealed a monospecific positive direct antiglobulin test for complement(C3d,C3b)and the presence of Donath-Landsteiner antibody.Diagnosis:Paroxysmal cold hemoglobinuria(PCH),secondary to dengue fever.Interventions:Oxygen supplements,antibiotics,intravenous immunoglobulins,steroid therapy,and packed cell transfusions were administered.Outcomes:The patient’s condition was improved following the therapy.Lessons:Post-dengue PCH is a rare complication that requires a thorough peripheral smear examination for erythrophagocytosis,as advanced hematology analyzers fail to detect such findings.展开更多
文摘目的探讨早期胱抑素C(Cys-C)联合凝血酶原时间(PT)在发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者病情严重程度及预后中的评估价值。方法回顾性收集2021年4月至2023年8月安徽医科大学附属巢湖医院诊治的101例SFTS患者资料,按患者病情严重程度分为普通组和重症组,按治疗结局分为生存组和死亡组。分析各组临床表现及早期实验室指标差异,采用logistic回归分析影响预后的因素,并采用受试者工作特征(ROC)曲线评估早期Cys-C水平及PT单独及联合检测对预测生存及死亡结局的效能。结果早期患者血清Cys-C、尿素氮、肌酐、尿酸、肌酸激酶、肌酸激酶同工酶水平、PT、活化部分凝血活酶时间在重症组及死亡组高于普通组及生存组,而淋巴细胞计数低于后两组,差异具有统计学意义(P<0.05)。多因素二元logistic回归分析结果提示,患者年龄(OR=1.146,95%CI:1.036~1.267)、PT(OR=2.643,95%CI:1.323~5.281)、Cys-C(OR=5.039,95%CI:1.548~16.395)是SFTS患者预后的独立危险因素。血清Cys-C作为预测生存者与死亡者的指标具有较高评估价值,ROC曲线下面积为0.831;而联合Cys-C、PT和患者年龄,曲线下面积高达0.930。结论SFTS多发生于农民及老年人群,患者入院早期血清PT和Cys-C水平可有效预估患者预后,两者有望成为预测生存和死亡的生物标志物。
文摘肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)是我国重点防治的乙类传染病,曾在我国广泛流行,给人民群众健康带来严重威胁。多年来,在政府主导多部门通力协作全面落实综合防控措施的背景下,HFRS得到有效控制,发病总体上进入低水平波动期,但累及地区却在扩大,新的疫源地仍在出现,部分疫源地疫情时有反复,防控工作面临新的形势。进一步巩固防控成果,降低发病率和病死率,仍是当前公共卫生系统亟待解决的挑战之一。为此,本文介绍了HFRS的病原学特征,结合既往疫情资料分析了我国当前HFRS的流行特点,总结了我国HFRS的防控策略与措施,以期为新形势下我国HFRS的防控工作提供有益参考。
文摘Objective:To investigate the importance of immunization in preventing measles infection and to determine the most useful laboratory tests for confirmation of measles.Methods:This study included pediatric cases evaluated with a presumed diagnosis of measles between December 2022 and June 2023,at Marmara University Pendik Training and Research Hospital.The effects of vaccination status and underlying disease on the clinical course,treatments,and complications were evaluated.Results:In total,117 patients were enrolled in the study with a median age of 80 months(IQR:32.5-125.0).Twelve patients with contact history were asymptomatic and had an underlying disorder,and intravenous immunoglobulin was given to them for post-exposure prophylaxis.Fifty-one patients had confirmed measles diagnosis.Ribavirin treatment was given to three patients(a newborn,a girl with rhabdomyosarcoma,and a healthy boy)with respiratory distress.Seventy-eight percent of confirmed measles cases were unvaccinated,and all hospitalized cases were unvaccinated or under-vaccinated.Four full-vaccinated children had confirmed measles infection.Measles PCR from nasopharyngeal swabs was negative in all of them,and their diagnosis was established with anti-measles IgM positivity.Conclusions:The measles vaccine is the most effective way to protect from measles and measles-related complications.Although measles can also occur in fully vaccinated patients,the disease is milder than in unvaccinated patients.Using ELISA and RT-PCR tests together may be beneficial in patients with high clinical suspicion for early diagnosis.
文摘目的探究发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)患者预后的影响因素,构建列线图预测模型并验证评价。方法回顾性分析2019年4月至2024年5月于安徽医科大学第二附属医院住院治疗SFTS成人患者的临床资料,根据院内生存情况分为生存组和死亡组。采用二元Logistic回归分析确定SFTS患者预后不良的独立危险因素并构建列线图预测模型,使用Bootstrap法重复抽样1000次进行验证,采用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)、校准曲线和决策曲线评估列线图模型的区分度、校准度和临床适用性。结果共纳入271例SFTS患者,其中生存组215例,死亡组56例。二元Logistic回归分析显示年龄[OR=1.089,95%CI(1.018,1.166)]、病毒载量[OR=2.047,95%CI(1.192,3.514)]、消化道出血[OR=5.368,95%CI(1.635,17.625)]、肺部真菌感染[OR=6.446,95%CI(2.115,19.645)]、血清铁蛋白[OR=8.198,95%CI(1.850,36.340)]是SFTS患者院内死亡的影响因素。列线图预测模型AUC值为0.936[95%CI(0.906,0.965)],Bootstrap法重复抽样1000次后的AUC为0.928[95%CI(0.898,0.960)],校准曲线、决策曲线显示模型具有较好的一致性和净收益。结论年龄、病毒载量、消化道出血、肺部真菌感染、血清铁蛋白是SFTS院内死亡的影响因素,本研究构建的SFTS患者院内死亡风险的列线图预测模型可辅助临床识别高危患者,具有一定的临床使用价值。
文摘肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)又称流行性出血热,是由汉坦病毒(Hantavirus,HV)引起的以啮齿类动物为主要传染源的人畜共患病,病死率较高,中国是HFRS的高发地区之一[1]。人类免疫缺陷病毒(human immunodeficiency virus,HIV)是全球范围内广泛流行的传染性疾病,其感染的主要特征是进行性免疫缺陷,极易合并其他病原体感染。HIV合并乙型肝炎病毒和丙型肝炎病毒(hepatitis C virus,HCV)感染较为常见[2,3],在这2种病毒感染基础上合并HV导致的重症HFRS罕见报道。
基金funded by the Taylor’s University Flagship Research Grant(TUFR/2017/002/03).
文摘Objective:To explore existing practices and challenges in the delivery of geriatric home medication review(HMR).The study was part of a larger study aimed to offer solution to expand the range of geriatric HMR.Methods:This study employed qualitative exploratory design through semi-structured individual in-depth interviews with the public pharmacists involved in the delivery of geriatric HMR at public hospitals.The purpose of the interviews was to explore challenges faced by them in the delivery of geriatric HMR.Results:Based on the emerging themes from the qualitative data,the study reveals that geriatric HMR in Malaysia is integrated as part of multidisciplinary home care visits,encompassing a diverse patient population with various healthcare needs.However,it faces challenges such as the lack of outcome monitoring,formal training,and workforce constraints.Despite these hurdles,there is a pressing need for the expansion of this service to better serve the community,and collaboration with community pharmacists holds potential to broaden its scope.Ultimately,the findings suggest that pharmacist-led HMR is both warranted and feasible within the Malaysian healthcare context.In order to optimize medicine-use among older people living in the community,approaches for expanding geriatric HMR services in Malaysia must be developed.Conclusions:This study holds profound implications as it attempts to illuminate policy makers in developing countries,enabling them to formulate effective HMR plans.By considering the challenges highlighted within this research,policy makers can design a comprehensive HMR service that caters adeptly to the healthcare needs of the mass population.
文摘Objective:To investigate the contribution of N-terminal pro B-type natriuretic peptide(NT-pro BNP)and troponin Ⅰ to mortality in children with dengue shock syndrome.Methods:A longitudinal study was conducted on children with dengue shock syndrome in a hospital in southern Vietnam.Detailed clinical histories,physical examinations,and laboratory parameters,including NT-pro BNP and troponin Ⅰ,were recorded.A comparison between survival and non-survival was carried out to identify factors influencing mortality.Results:A total of 107 patients with a median age of 9 years were included in the study.Among them,63.6%(68/107)presented with compensated shock,36.4%(39/107)had hypotensive shock,23.4%(25/107)required mechanical ventilation,and 12.1%(13/107)died.The NT-pro BNP levels were 3.9 pmol/L(IQR:1.9,10.3)and 15.2 pmol/L(5.8,46.3),while the median high sensitivity troponin Ⅰ levels were 20 pg/L(6,95)and 62 pg/L(12,325)at the first and second measurements,respectively.The mortality group exhibited higher rates of hypotensive shock,prolonged shock,lactate levels,liver damage,NT-pro BNP,and troponin Ⅰ levels.Hypotensive shock(OR 12.96,95%CI 2.70-62.30,P=0.004),prolonged shock(OR 39.40,95%CI 6.68-232.70,P<0.001),AST>1000 IU/L(OR 9.50,95%CI 2.63-34.34,P=0.041),and NT-pro BNP>7 pmol/L(OR 44.40,95%CI 5.44-362.20,P=0.001)were identified as predictive factors for mortality in dengue shock syndrome.Conclusions:The NT-pro BNP level could serve as a potential biomarker for predicting mortality in children with dengue shock syndrome.
文摘Rationale:Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens,resulting in complement-mediated hemolysis,leading to intravascular hemolysis and hemoglobinuria.Patient’s concern:A 12-year-old male patient who recovered from dengue fever a week ago had red blood cell agglutination,spherocytes,and engulfment of red blood cells(erythrophagocytosis)by monocytes and neutrophils on routine hematological peripheral blood smear.The unexpected blood smear results prompted the lab physicians to investigate autoimmune hemolytic anemia,which revealed a monospecific positive direct antiglobulin test for complement(C3d,C3b)and the presence of Donath-Landsteiner antibody.Diagnosis:Paroxysmal cold hemoglobinuria(PCH),secondary to dengue fever.Interventions:Oxygen supplements,antibiotics,intravenous immunoglobulins,steroid therapy,and packed cell transfusions were administered.Outcomes:The patient’s condition was improved following the therapy.Lessons:Post-dengue PCH is a rare complication that requires a thorough peripheral smear examination for erythrophagocytosis,as advanced hematology analyzers fail to detect such findings.
