A prediction rule for clinical diagnosis of severe acute respiratory syndrome.

A prospective study was undertaken to identify clinical, radiographical, haematological and biochemical profiles of severe acute respiratory syndrome (SARS) patients. A prediction rule, which demarcates low from high risk patients for SARS in an outbreak situation was developed. A total of 295 patients with unexplained respiratory illnesses, admitted to Queen Mary Hospital, Hong Kong SAR, China, in March to July 2003, were evaluated for clinical, radiological, haematological and alanine transaminase (ALT) data daily for 3 days after hospitalisation. In total, 44 cases were subsequently confirmed to have SARS by RT-PCR (68.2%) and serology (100%). The scoring system of attributing 11, 10, 3, 3 and 3 points to the presence of independent risk factors, namely: epidemiological link, radiographical deterioration, myalgia, lymphopenia and elevated ALT respectively, generated high and low-risk (total score 11-30 and 0-10, respectively) groups for SARS. The sensitivity and specificity of this prediction rule in positively identifying a SARS patient were 97.7 and 81.3%, respectively. The positive and negative predictive values were 47.8 and 99.5%, respectively. The prediction rule appears to be helpful in assessing suspected patients with severe acute respiratory syndrome at the bedside, and should be further validated in other severe acute respiratory syndrome cohorts.     

Using the emergency department clinical decision unit for acute decompensated heart failure

Acute decompensated heart failure (ADHF) is a complex disease of epidemic proportions.In the United States, it accounts for more than 1 million hospitalizations annually,and heart failure represents the single greatest cost to the Centers for Medicaid and Medicare Studies. Half of the annual costs are estimated to be the result of hospitalization.Compared with other pathology, heart failure has a very high hospitalization rate, with 80% of emergency department ADHF patients being admitted. This high rate has resulted from the lack of successful management predictors available to the emergency physician and the lack of any disposition option other than hospitalization for the ADHF patient. The emergency department observation unit offers an alternative to hospitalization for patients with ADHF. Validated protocols have demonstrated that in ADHF, intensive short-term therapeutic, diagnostic, and educational protocols result in a marked improvement in hospitalization rates, while at the same time decreasing costs. New risk stratification data can aid in the identification of the appropriate candidate. The observation unit now represents a nonhospitalization disposition option for patients presenting to the emergency department with ADHF.viii CO     

重症急性呼吸综合征的临床特点与分期

目的 通过分析重症急性呼吸综合征(SARS)患者的临床特点,制订SARS的临床分期。方法 回顾性分析1170例SARS患者症状体征、实验室检查、影像学结果在病程不同时期的特点。结果 发热为SARS患者的首发症状,自然热程14d左右。呼吸道症状和感染中毒症状在病程第2周出现或维持一个高峰,3周后恢复正常。低氧血症是其特点之一,动脉血氧分压、脉搏血氧饱和度在病程前2周明显下降,2周后逐渐恢复。100％患者X线胸片异常,病程第1天即可出现,前2周明显加重,2周后开始恢复。淋巴细胞亚群计数在发病初期全面下降,2～3周后恢复正常。结论 典型SARS病程约4周,1～7d为早期,8～14d为极期,15～28d为恢复期。     

Advances in clinical diagnosis and treatment of severe acute respiratory syndrome

It has been proved that severe acute respiratory syndrome(SARS) is caused by SARS-associated coronavirus, a novel coronavirus. SARS originated in Guangdong Province, the People‘s Republic of China at the end of 2002. At present,it has spread to more than 33 countries or regions all over the world and affected 8 360 people and killed 764 by May 31,2003. Identification of the SARS causative agent and development of a diagnostic test are important. Detecting disease in its early stage, understanding its pathways of transmission and implementing specific prevention measures for the disease are dependent upon swift progress. Due to the efforts of the WHO-led network of laboratodes testing for SARS, tests for the novel coronavirus have been developed with unprecedented speed. The genome sequence reveals that this coronavirus is only moderately related to other known coronaviruses. WHO established the definitions of suspected and confirmed and probable cases. But the laboratory tests and definitions are limited. Until now, the primary measures include disolation, ribavirin and corticosteroid therapy, mechanical ventilation, etc. Other therapies such as convalescent plasma are being explored. It is necessary to find more effective therapy. There still are many problems to be solved in the course of conquering SARS.     

重症急性呼吸综合征影像学变化和临床分期的研究

目的分析重症急性呼吸综合征(SARS)患者临床特点、实验室检测结果和胸部影像学变化,提出临床分期.方法对2003年3～5月间有完整胸部影像学动态变化和实验室检测数据的45例SARS患者进行分析.结果 (1)影像学变化普通型23例肺部出现一侧片状阴影为病程的2～5(2.9±1.0) d;发展到双侧2～11(6.9±2.5) d;出现双肺广泛磨玻璃样变、实变6～19(11.0±2.0) d;开始吸收为10～21(15.0±4.1) d;胸部影像学改变完全吸收为18～46(25.9±7.2) d.重型患者22例发展到双肺广泛磨玻璃样变、实变(9.0±3.2) d,与普通型相比,差异无显著性(P>0.05);开始吸收为(19.0±4.6) d, P=0.009, 胸部影像学改变完全吸收为(36.0±8.1) d, P=0.001, 其中7例死亡患者胸部影像学表现均在7 d内进展到双肺广泛实变.(2)实验室检测早期SARS患者T细胞亚群和淋巴细胞明显降低,38例存活组患者在10～15 d恢复;但7例死亡患者T细胞亚群和淋巴细胞未见恢复.结论 SARS患者可分5期潜伏期2～10 d,前驱期1～3 d,进展期4～7 d,极期8～15 d,恢复期16～24 d.从发病到胸部影像学改变初步吸收时间为10～15 d.1周之内进展到双肺广泛实变且2周左右T细胞亚群和淋巴细胞不能恢复的患者,可能预后极差.     

关于严重急性呼吸综合征的反思

20 0 3年 6月 2 4日 ,北京终于以 2 50 0余人患病 ,1 91人死亡的代价迎来了“双解除”。我们在庆幸有效控制严重急性呼吸综合征 (SARS)流行的同时 ,也应及时总结经验与教训 ,为有朝一日SARS卷土重来或其他重大公共卫生事件的发生做好准备。一、防治的成功与科研的缺憾2 0 0 3年 4月 2 0日以来 ,政府采取了果断的措施 ,充分发挥了“群众运动”的优势 ,仅用 2个月的时间就使SARS在全国范围内得到有效控制 ,避免了更大的损失 ,不能不说这是一个巨大的成就 ,是一奇迹 ,也是其他国家无法效仿的。但是 ,有关部门如果从开始阶段就能对SARS的…     

严重急性呼吸道综合征研究动态

世界卫生组织 (WHO)和美国疾病预防与控制中心 (CDC)正致力于研究在许多国家流行的严重呼吸道综合征。流行病学与实验室研究仍在继续。一种新的冠状病毒已被确定为本病的致病因子。CDC暂行的可疑病例标准着重临床表现和与患者的接触史和疫区旅行史。医务人员、患者家属及社区的感染控制应遵循消毒隔离措施