Nocardia farcinica cerebral abscess: A systematic review of treatment strategies

PurposeNocardia farcinica is an opportunistic pathogen causing mainly pneumonia in immunocompromised patients, complicated in almost one-third of the cases by a thick-walled multiloculated cerebral abscess which induces significant morbidity and mortality. This review aims to assess the optimal treatment strategy for N. farcinica cerebral abscess.MethodsReport of a case. Medline database was used to conduct a systematic review from inception to January 2020 looking for English-language articles focused on N. farcinica cerebral abscess, in accordance with the PRISMA guidelines.ResultsThe research yielded 54 articles for a total of 58 patients. N. farcinica cerebral abscess displayed three different neuroimaging patterns: a single multiloculated abscess in half of the cases, multiple cerebral abscesses, or a small paraventricular abscess with meningitis. The patients who benefited from surgical excision of the abscess showed a trend towards a lower risk of surgical revision (8% versus 31%, P = 0.06) and a lower mortality rate (8% versus 23%, P = 0.18) than patients who benefited from needle aspiration. Twenty-two percent of the patients benefited from microbiological documentation from another site with a mortality rate of 23%.ConclusionUrgent multimodal MRI is necessary in face with clinical suspicion of cerebral nocardiosis. In case of single or multiple small cerebral abscesses, microbiological documentation can be obtained with puncture of pseudotumoral visceral lesions. In case of large or symptomatic cerebral abscess, an aggressive surgical excision seems a reliable option and can be preferred over needle aspiration. Long-term antibiotic therapy with cotrimoxazole is necessary thereafter.     

长沙市HIV感染者/AIDS病人对随访管理及治疗服务依从性调查

目的 了解HIV感染者/AIDS病人对随访管理及治疗服务的依从现状并探讨其相关因素。 方法 以长沙市疾病预防控制中心和艾滋病定点治疗医院为调查现场,将在2013年3月1日－2015年8月31日期间开始接受抗病毒治疗的HIV感染者/AIDS病人(治疗时长为3~6个月)作为连续样本征募入组,获得有效样本207例。采用“美国社区艾滋病临床研究抗逆转录病毒用药自陈式问卷”及自编的一般情况问卷进行调查;CD4检测和常规随访数据来源于艾滋病综合防治信息系统。 结果 样本对随访管理的依从率为96.6%,抗病毒治疗服药量依从率为87.0%;随访管理及治疗服务依从率为75.4%。多因素分析显示,有稳定工作(OR=2.30,95%CI:1.06~4.98)、治疗方案为“其他组合”(OR=5.49,95%CI:2.15~14.02)的样本依从更差。 结论 长沙市HIV感染者/AIDS病人对随访管理服务的依从性较好,但其服药依从性有待提高。在管理及治疗服务中,应及时为该人群提供服药指导及心理支持。     

Development and Validation of a Nomogram for Predicting Sarcopenia in Community-Dwelling Older Adults

ObjectiveTo establish and validate a nomogram that predicts the risk of sarcopenia for community-dwelling older residents.DesignRetrospective study.Setting and ParticipantsA total of 1050 community-dwelling older adults.MethodsData from a survey of community-dwelling older residents (≥60 years old) in Hunan, China, from June to September 2019 were retrospectively analyzed. The survey included general demographic information, diet, and exercise habits. Sarcopenia diagnosis was according to 2019 Asian Working Group for Sarcopenia criteria. Participants were randomly divided into the development group and validation groups. Independent risk factors were screened by multivariate logistic regression analysis. Based on the independent risk factors, a nomogram model was developed to predict the risk of sarcopenia for community-dwelling older adults. Both in the development and validation sets, the discrimination, calibration, and clinical practicability of the nomogram were verified using receiver operating characteristic curve analysis, Hosmer-Lemeshow test, and decision curve analysis, respectively.ResultsSarcopenia was identified in 263 (25.0%) participants. Age, body mass index, marital status, regular physical activity habit, uninterrupted sedentary time, and dietary diversity score were significant contributors to sarcopenia risk. A nomogram for predicting sarcopenia in community-dwelling older adults was developed using these factors. Receiver operating characteristic curve analysis showed that the area under the curve was 0.827 (95% CI 0.792-0.860) and 0.755 (95% CI 0.680-0.837) in the development and validation sets, respectively. The Hosmer-Lemeshow test yielded P values of .609 and .565, respectively, for the 2 sets. The nomogram demonstrated a high net benefit in the clinical decision curve in both sets.Conclusions and ImplicationsThis study developed and validated a risk prediction nomogram for sarcopenia among community-dwelling older adults. Sarcopenia risk was classified as low (<11%), moderate (11%-70%), and high (>70%). This nomogram provides an accurate visual tool to medical staff, caregivers, and older adults for prediction, early intervention, and graded management of sarcopenia.     

Immune responses following meningococcal serogroups A,C, Y and W polysaccharide vaccination in C2-deficient persons: Evidence for increased levels of serum bactericidal antibodies

Complement C2 deficiency (C2D) is associated with immunological diseases and increased susceptibility to invasive infections caused by encapsulated bacteria such as Neisseria menigitidis. In this study we evaluate the immunogenicity of vaccination against N. menigitidis in C2D.C2D patients (n = 22) and controls (n = 52) were given a tetravalent meningococcal polysaccharide vaccine. Serum bactericidal antibody (SBA) titres (serogroups A, C, Y and W) were analysed using a rabbit complement source. Levels of IgG, IgM, and IgA, factor B, and factor H, polymorphisms of MBL and Fc-gamma receptors were determined.The C2D patients responded with an increased SBA titre to all four serogroups (p < 0.001). The response rates define as SBA titres ≥8 were found to be between 85.7% and 92.5%. The post-vaccination titres for serogroups C, Y and W were equal to healthy controls. C2D patients with a history of invasive infection had a lower post-vaccination SBA titres both compared to healthy C2D persons (p = 0.03) and compared to controls (p < 0.0001). We found that the G2M*n/G2M*n genotype were associated with a higher SBA titres after immunization (p = 0.03). None of the other investigated immunological factors appear to be important in influencing the vaccine responses. Autoimmune diseases in C2D did not affect the vaccine response.In general, vaccination against meningococci gave rise to antibody responses in the C2D patients that equal healthy controls. The response rate was lower to serogroup A and among C2D patients with history of invasive infections. The presence of G2M*n/G2M*n genotype was associated with higher SBA titres after immunization.     

家庭中心式护理对癫痫儿童家长心理状况的影响

目的探讨家庭中心式护理对癫痫儿童家长心理状况的影响。方法将62例癫痫患儿家长随机分为对照组与实验组,每组各31例。对照组予以普通护理干预,实验组予以家庭中心式护理干预。采用中文版Zung焦虑自评量表（SAS）及抑郁自评量表（SDS）分别于干预前、干预2个月评定两组家长的焦虑、抑郁情况。结果两组的焦虑、抑郁评分均高于全国常模（P〈0．01）;干预前,两组的SAS及SDS评分比较,差异无统计学意义（P〉0．05）;干预2个月,SAS、SDS评分比较,差异有统计学意义（P〈0．01）。结论家庭中心式护理能够显著改善患儿家长的焦虑、抑郁情绪。     

雨花区村卫生室和个体诊所消毒质量监测分析

目的掌握长沙市雨花区村卫生室及个体诊所消毒质量情况，查找消毒薄弱环节，为加强医院感染控制工作提供依据。方法按《消毒技术规范》和《医院消毒卫生标准》对雨花区村卫生室及个体诊所消毒质量进行监测。结果两种医疗机构消毒总合格率为76．8％，其中村卫生室为68．1％，个体诊所为85．6％，经卡方检验，差异有显著性。结论雨花区村卫生室和个体诊所消毒工作存在着相当大的问题，尤其是村卫生室消毒效果更差，应切实引起有关部门的高度重视，加强管理、监督和基层医务人员的培训工作。     

国内首例人感染高致病性禽流感病例流行病学调查

目的了解国内首例人禽流感病例的流行病学特征，以预防高致病性禽流感病毒在人间传播。方法采用病例流行病学调查方法，在实验室对痛原体和患者急性期、恢复期双份血清进行检测，同时对与患者密切接触者进行严密的医学观察。结果患者家中于10月6日出现家禽大批死亡，10月10日发病，H5、H7流感病毒核酸、M5流感病毒HA抗原、流感病毒A、B抗原和RSV病毒抗原检查皆为阴性。急性期和恢复期双份血清H5特异性抗体呈4倍以上增高，与患者密切接触者中均未发现异常临床表现。结论经卫生部和WHO专家组鉴定为人感染高致病性禽流感H5N1确诊病例。     

一例急性非淋巴细胞性白血病的职业病诊断分析

目的探讨职业性苯致白血病的接触时间、潜隐期在职业病诊断中的应用问题。方法依据职业性肿瘤的诊断标准针对急性非淋巴细胞性白血病的诊断过程中职业史采信、接触时间、潜隐期应用等问题进行分析和探讨。结果认为《职业性肿瘤诊断标准》标准中的累计工龄计算、潜隐期的概念存在不适宜性。结论建议对《职业性肿瘤诊断标准》中工龄计算、亚急性苯致白血病诊断标准、潜隐期的概念等内容进行补充和完善。