黔南地区人体隐孢子虫病流行病学调查

目的:了解黔南地区隐孢子虫病的感染情况及其流行特征。方法:对1946份人粪和48份动物粪便标本用改良抗酸染色法查隐孢子虫卵囊。结果:黔南地区隐孢子虫病感染率为2.11％;农村居民感染率为2.50％,城市居民感染率为0.29％;12岁以下儿童感染率为5.55％,成人仅0.95％;婴幼儿患者占总病例数的46.34％。结论:首次报道黔南地区隐孢子虫病并非少见,应引起足够的重视。     

建德市肾综合征出血热Ⅰ型灭活疫苗试验现场对照组人群隐性感染定群研究

用定群血清流行病学方法观察ＨＦＲＳ疫苗效果考核现场对照组人群隐性感染情况。采用ＩＦＡＴ检则血清中ＨＦＲＳＩｇＧ抗体,分析不同性别和年龄人群的隐性感染及感染后抗体水平变化情况。结果,ＨＦＲＳ年感染率为２２９％,在不同性别和年龄组中未见显著差异;３２名隐性感染者ＨＦＲＳ抗体转阴率４６８８％,ＨＦＲＳ抗体上升率达２５００％,在不同ＨＦＲＳ抗体滴度、性别和年龄组中未见显著差异。此观察结果为疫苗现场效果评价提供一些背景资料。     

中俄,中哈边境地区莱姆病自然疫源地调查研究

目的：调查边境地区莱杂姆病和自然疫源地的状况。方法;对血清学、病原学、宿主、媒介,病例和地理景观方面进行调查。结果：用ＩＦＡ和ＥＬＩＳＡ法共检测人畜血清１５０１份,从１９９份人血清中检出抗体阳性１８份,阳性率为９．０５％,并发现莱姆病典型患者１５例;检查马血清２０份,阳性５份,阳性率为２５．００％;检查牛血清３９９份,阳性６９份,阳性率１７．２９％;检查羊血清８８３份,阳性１９９份,阳性率２２．５     

妇幼保健机构的医院感染管理

随着妇幼保健机构功能的多元化,医院感染问题也日益突出,与综合医院相比,妇幼保健机构的医院感染管理与综合医院有其共性也有自身特点。主要表现有三个方面：建立健全监控网络;建立适合妇幼保健机构特点的控制感染机制（包括住院前宣教、住院时各项控制措施、出院后随访等）;指导、监控下级妇幼保健机构的医院感染工作     

儿童白血病患者医院感染的临床分析

目的:探讨儿童白血病患者医院感染的临床特点、严重程度及原因。方法:本文对1989 年～1995 年儿童白血病住院病人发生医院感染情况进行回顾性分析。结果:本组儿童白血病的医院感染( 例次) 率达47-3 % ,以呼吸道感染最多见,病原菌以革兰阴性杆菌占首位,病死率较高。结论:儿童白血病住院病人是医院感染的易感人群,尤其在粒细胞减少期,应加强对这部分病人的管理及合理用药。     

A single technique to correct various degrees of upper lid retraction in patients with Graves' orbitopathy

BACKGROUND: Several lengthening techniques have been proposed for upper eyelid retraction in patients with Graves' orbitopathy and variable rates of success have been reported. Most authors recommend different procedures for different degrees of retraction, but cannot prevent residual temporal retraction in a significant number of cases. The modified levator aponeurosis recession described by Harvey and colleagues, in which the lateral horn is cut completely, seems to be an exception to this rule, but was evaluated in a limited number of cases only. METHOD: The authors further modified Harvey's technique by dissecting the aponeurosis together with Müller's muscle of the tarsus and the conjunctiva medially only to the extent necessary to achieve an acceptable position and contour of the eyelid in upright position. They also used an Ethilon 6.0 suture, instead of Vicryl, on a loop. It is placed between the tarsal plate and the detached aponeurosis to prevent spontaneous disinsertion. This modification was used in 50 Graves' patients (78 eyelids) with a upper lid margin-limbus distance ranging from 1 to 7 mm and evaluated using strict criteria. RESULTS: A perfect or acceptable result was obtained in 23 of 28 patients (82%) with bilateral retraction and in 18 of 22 patients (82%) with unilateral retraction. Seven eyelids were overcorrected (too low) and three undercorrected, necessitating reoperation. All other eyelids had an almond-like contour and a lid crease of 10 mm or less. No complications except subcutaneous haematomas were seen. Two patients showed a recurrence of lid retraction 9 months after the operation. CONCLUSION: This technique is safe and efficacious and can be used for all degrees of eyelid retraction.     

A predictive model to estimate the risk of serious bacterial infections in febrile infants

Low risk criteria have been defined to identify febrile infants unlikely to have serious bacterial infection (SBI). Using these criteria approximately 40% of all febrile infants can be defined as being at low risk. Of the remaining infants (60%) only 10%–20% have an SBI. No adequate criteria exist to identify these infants. All infants aged 2 weeks-1 year, presenting during a 1-year-period with rectal temperature 38.0°C to the Sophia Children's Hospital were included in a prospective study. Infants with a history of prematurity, perinatal complications, known underlying disease, antibiotic treatment or vaccination during the preceding 48 h were excluded. Clinical and laboratory variables at presentation were evaluated by a multivariate logistic regression model using SBI as the dependent variable. By using likelihood ratios a predictive model was derived, providing a post test probability of SBI for every individual patient. Of the 138 infants included in the study, 33 (24%) had SBI. Logistic regression analysis defined C-reactive protein (CRP), duration of fever, a standardized clinical impression score, a history of diarrhoea and focal signs of infection as independent predictors of SBI.Conclusion CRP, duration of fever, the standardized clinical impression score, a history of diarrhoea and focal signs of infection were the independent, most powerful predictors of SBI in febrile infants, identified by logistic regression analysis. Although the predictive model is not validated for direct clinical use, it illustrates the clinical potential of the used technique. This technique offers the advantage to assess the probability of SBI in every individual infant. This probability will form the best basis for well-founded decisions in the management of the individual febrile infant.     

Méningite à pneumocoque résistant à la pénicilline et transmission nosocomiale en milieu hospitalier pédiatrique confirmée par analyse génomique

Background.

Careful epidemiological studies and sophisticated diagnostic procedures are necessary to prove that bacterial infection is nosocomial in origin. DNA finger printing method can be useful with this aim in view.

Case reports.

A 11 month-old girl suffered from a febrile pneumonia. She developed acute meningitis 15 days later; culture of CSF grew Streptococcus pneumoniae, serotype 23 F, resistant to β-lactamines, erythromycin and cotrimoxazole. She died 24 hours later. Five days after this death, a 5 month-old infant hospitalized in the next bed developed an acute pulmonary infection due to the same strain with the same bacterial characteristics; this patient was cured with cefotaxime plus vancomycin and gentamicin. Randomly amplified polymorphic DNA analysis showed an identical profile of both strains.

Conclusion.

This is the first case of meningitis due to penicillin-resistant Streptococcus pneumoniae (PRSP) associated with nosocomial spread between two children in adjacent beds. This case suggests that it is necessary to isolate patients with PRSP infection during hospitalization.     

Practical approach to recurrent respiratory infections

Respiratory diseases are a major cause of morbidity and mortality in developing countries. Recurrent respiratory infections in children pose a great challenge to the pediatrician where he has to exercise his clinical acumen and methodical, approach, for correct diagnosis and treatment. It is a fact that children should suffer 7 to 8 upper respiratory infections per year until they are 5 years of age when their immune status reaches adult level. In this situation, it is essential to find out whether the frequencies are abnormal. Whenever a child has the following, problems, then only it needs to be investigated.—(a) repeated bacterial pneumonias; (b) a child less than 3 months old having repeated respiratory infections; (c) a child of 9 months old without a history of exposure infections; (d) infections, complicating into bronchiectasis and; (e) in a child where there is no history of allergy or asthma. Once the problem is established as a true recurrent respiratory infection, the clinician should pose questions—whether it is chronic, acute or recurrent, to find out the site of pathology, seriousness of the problem, response to previous medications, to establish the possible diagnosis which fall into six categories—congenital anamolies, aspiration syndrome, genital disorders, immunological, diseases, immune deficiency disorders and allergic diseases. The author discusses quoting some examples for various categories avoiding non pulmonary causes for recurrent respiratory infections in children.     

Preventing nosocomial infection in paediatric wards

• Nosocomial infection is potentially a major problem in paediatric wards. However, there are methodological difficulties which hinder researchers in identifying the true extent of nosocomial infection.
• Respiratory infections pose the greatest challenge, with the respiratory syncytial virus (RSV) being particularly problematic. However, RSV can be contained by strict implementation of isolation procedures.
• Other major pathogens such as enteric bacteria and viruses can similarly be controlled through vigorous attention to hand-washing and isolation.
• Health-care staff are implicated in the nosocomial spread of many other infectious agents, and should pay particular care to personal practice.