广州市儿童医院传染病住院情况分析

目的了解1999—2008年广州地区儿童传染病的变化规律和主要传染病的发病情况,为医院儿科临床及传染病管理提供参考。方法对1999—2008年广州市儿童医院传染科住院所有法定传染病进行分类、统计,应用Excel软件进行统计学分析。结果传染病发病居前10位的依次为麻疹、水痘、流行性腮腺炎、病毒性肝炎、流行性感冒、感染性腹泻、细菌性痢疾、猩红热、恙虫病、伤寒副伤寒。呼吸道传染病居发病首位,占79．82％,其次为肠道传染病,占16．97％,再次为自然疫源性传染病,占1．74％。传染病发病以麻疹居首位,占49．67％,其次为水痘,占14．50％。年龄最大分布在1～6岁,占72．16％。人均住院8．13d。10年来儿童传染病发病趋势有所下降,肠道传染病发病降低,呼吸道传染病发病上升,以麻疹、水痘、流行性腮腺炎居发病前三位,出现梅毒、艾滋病新发传染病。结论广州市儿童传染病的防控应采取以呼吸道传染病、肠道传染病为防控工作的重点．同时。新发传染病应高度重视。     

777例住院小儿烧伤特点及治疗

目的探寻小儿烧伤的发病规律、特点，以期减少或者预防小儿烧伤的发生。方法回顾性分析777例小儿烧伤住院患者的发病率、致伤原因、发病的年龄特点、性别比、致伤部位、发病的季节分布、致伤程度等特征，揭示小儿烧伤的特点。结果777例小儿烧伤占同期住院患者（2271例）的比例为34．26％，其中男470例，女307例，比例为1．5：1；年龄段以1—3岁发病率最高，达到73．36％；受伤场所以家中为主，777例患儿中在家中发病760例，97．69％的患儿在家中受伤；致伤的部位以下肢这些暴露部位最为常见。结论小儿烧伤重在预防，应注重家庭中的预防，对1—3年龄段小儿的监护和照顾，重点加强外来人员儿童的安全防护教育。     

鹤山市恙虫病流行病学特征分析

目的了解鹤山市恙虫病的流行病学特征。为疫情防控提供依据。方法回顾性分析了2008—2012年在鹤山市人民医院住院的75例恙虫病病例资料,分析其流行病学特征。结果恙虫病的发生季节性明显,病例分布于2-11月,5～10月为发病高峰期,病例数占88．00％,近2年发病例数较前上升,尤其是2012年病例数明显增加,较2011年增加了113％。发病年龄以50～70岁年龄段最多,占53．33％。宅梧镇为发病例数最多的地区,病例数27例,占36．00％。职业构成以农民最多,占73．33％。结论鹤山市恙虫病发病呈现上升趋势。在恙虫病流行季节,尤其是高发地区,需做好高危人群的健康教育,以减少恙虫病的发生及流行。     

婴幼儿肠套叠与轮状病毒性腹泻分布特征分析

目的 了解苏州市婴幼儿肠套叠的发病状况及肠套叠与轮状病毒性腹泻是否存在关联.方法 采用回顾调查的方法 ,以<2岁的婴幼儿为对象,统计1999-2003年在门诊和住院的肠套叠病例.采用ELISA法对2001年9月至2003年8月2岁以下的腹泻住院患者的粪便标本进行病毒抗原测定.结果 苏州市2岁以下的肠套叠患儿1101例,1999-2003年1岁以下肠套叠的发病率分别为:275.3/10万、338.2/10万、547.0/10万、515.3/10万、425.4/10万,平均年发病率为418.1/10万.肠套叠以4-10个月最常见.共692例(62.85%).平均年龄(9.62±5.65)月.轮状病毒性腹泻是以5~16个月最常见,共252例(76.13%).平均年龄(11.42±5.14)月.两组间发病年龄经比较,z=-15.52,P<0.01.肠套叠的发病高峰季节在4~8月份,共595例(54.04%).而轮状病毒性腹泻的发病的高峰季节在10月至次年1月,共232例(70.09%).两组问发病的季节的分布进行统计学检验,X2=226.06,P<0.001.结论 流行病学的资料显示肠套叠与轮状病毒性腹泻的相关性有待进一步研究.     

小儿轮状病毒肠炎患者的流行及临床调查

目的探讨小儿腹泻轮状病毒（RV）感染的发生率、影响因素和临床特征。方法对我院2006年6月至2010年10月临床诊断为dxJL腹泻病的住院患儿634例行胶体金免疫层析双抗体夹心法直接检测轮状病毒抗原,对确诊病例从发病年龄、发病季节、临床特点及多器官损害等方面进行总结分析。结果634例标本中阳性308例,阳性率48．6％,6～12月龄阳性197例占66．3％,全年均可检出轮状病毒,第一季度63．8％、第四季度62．6％,阳性率较高,68．6％伴有心肌损害,41．2％伴有下呼吸道感染,13．3％伴有肝功损害,14．9％伴有肾脏损害,9．4％伴有惊厥,4．9％伴有血液系统损害。结论轮状病毒是引起小儿腹泻的主要病原,6～12月龄的婴幼儿感染率最高,第一、第四季度是高发季节。轮状病毒感染可引起多器官功能损害。     

新生儿黄疸82例临床分析

本文通过对８２例黄疸患儿的病因、病程、治疗等临床资料的分析总结，旨在了解黄疸在我院住院病儿的发病情况、特点，结果发现新生儿黄疸发生率占总住院人数的３５％，以高胆红素血症为主（６６／８２），病因主要为Ｇ６ＰＤ缺陷症２４例，占２９．３％，感染（肺炎、败血症）１６例，占１９．５％，ＡＢＯ溶血１０例，占１２．２％以及窒息、缺氧、出血等非感染因素４例，占４．８％。经光疗以及药物退黄治疗、病因治疗，大部分痊愈，治愈率为９８．８％。     

新生儿G6PD缺陷病和晚发性维生素K缺乏症的特点与预防

目的 探讨新生儿C6PD缺陷病和晚发性维生素K缺乏症的危害与预防措施。方法 回顾分析1995-2000年儿内科住院的1周-2月(不含2月)的婴儿3104例次，其中病死56例。结果 1周-2月的小婴儿占住院患儿的19．34％，其中新生儿G6PD缺陷病239例，占7．70％；晚发性维生素K缺乏症92例，占2．96％。死因的第2、3位分别是晚发性维生素K缺乏症(13例，占23．21％)和新生儿C6PD缺陷病(12例，占21．43％)，两者的病死率分别为14．13％和5．02％，极显著高于(x^2＝17．59，P＜0．01)或相近于(x^2＝0．88，P＞0．05)肺炎的3．57％。新生儿G6PD缺陷病合并感染占38．49％、低氧血症占23．35％、低血糖占19．25％、酸中毒占15．90％，继发胆红素脑病占13．81％。晚发性维生素K缺乏症出现抽搐占90．22％、胃肠、注射部位出血占60．89％；CT证实颅内出血占98．91％。结论 1周-2月的小婴儿约占住院患儿的两成，新生儿G6PD缺陷病和晚发性维生素K缺乏症的病死率均很高，两者是除肺炎外最主要的死因。提议制定并推广预防这2种疾病的常规措施，并参照国内外相应的现状拟出其具体内容。     

海南地区6160例小儿烧伤发病规律的分析

目的 分析海南地区12岁以下小儿烧伤的发病规律。方法 对6160例小儿烧伤的年龄分布、烧伤原因、烧伤程度及季节分布进行统计分析。结果 年龄以1～3岁居多，占39．31％；烧伤原因以热液烫伤为主，占68．76％；烧伤程度以中度烧伤为主，占41．56％；季节分布，从高到低依次为第二、四、三、一季度。结论 要高度重视幼儿烧伤的防治，特别要预防热液烫伤。     

小儿烧伤并发症原因分析

小儿烧伤较常见，其发病率约占同期烧伤住院患者的50％，致伤原因以热液为主，笔者单位2003年1月至2008年1月共收治≤5岁的烧伤患儿1060例，其中死亡29例，占2．74％，先将其并发症分析如下。     

225例妊娠期肝内胆汁瘀积症临床分析

1999年1月至2002年6月间我院住院分娩孕妇5178例，其中妊娠期肝内胆汁瘀积症(ICP)占225例，其发生率为4．35％。ICP主要表现为皮肤瘙瘁，黄疸，血TBA、血ALT、AST升高。225例中发生早产38例，早产发生率为16．89％；死胎2例，新生儿死亡1例，其围产儿死亡率为13．33‰；新生儿Apgar评分≤7分者10例，占4．44％；产后出血6例．占2．67%。本文认为：早期诊断，加强孕期监护，产时严密观察产程进展、胎心变化、羊水情况，积极处理产程是降低ICP并发症的有效措施。     

How frequent is varicella-associated pneumonia in children?

Varicella is a frequent though mild infection in children, but it can cause important morbidity in adults. The most frequent complication in adults is varicella pneumonia. However, lower airway complications associated to varicella have been scarcely studied in children. We retrospectively reviewed the clinical records of the children hospitalized for varicella-associated pneumonia in the three public hospitals on the Island of Mallorca. We discovered that 17/213 (8%) children hospitalized for varicella were diagnosed of pneumonia. The rate of hospitalization for varicella complication due to pneumonia was 4.3 cases per 10,000 varicella infections. Only one patient was diagnosed of varicella pneumonia, which accounts for 0.3 cases per 10,000 varicella infections. Nine of 17 (53%) cases were classified as bacterial pneumonia. Statistical differences (p < 0.05) in the median time from rash (5.9 vs. 2.4 days) and fever (4.1 vs. 2.2 days) to admission were observed between bacterial and viral pneumonia. However, outcome differences measured by the median length of stay, need for oxygen, and admission to the intensive care unit were not observed. Varicella pneumonia is a very rare complication of varicella in children. Most of the lower airway infections in the course of varicella are associated to other co-infections.     

一起学校水痘暴发的现场流行病学调查

目的核实疫情,确定J学校水痘暴发的存在并描述疫情三间分布特征和流行强度,探讨发病危险因素。方法按照病例定义,开展病例搜索,描述其三间分布后,结合现场流行病学调查情况,形成假设,再采用回顾性队列研究方法验证假设。结果 2009年3月1日至4月28日搜索到符合病例定义的病例共45例。首例病例于4月2日发病,全校分别于4月8日、16日、21～27日出现3个发病高峰。二（4）班和二（5）班罹患率最高,分别为33.3%和27.1%。45例病例均为学生,男生罹患率为7.2%,女生罹患率为4.8%。7～10岁组38人,占84.44%。在全校学生中乘坐校车者发生水痘的危险是不乘坐校车者的2.3倍（RR=2.36,95%CI=1.29～4.32）。按不同年级进行的Mantel-Haenszel分层分析表明：乘车与不乘车2个队列之间罹患率差异有统计学意义（χ2=4.32,P〈0.05）。结论根据病例临床表现、三间分布特征,确定J学校存在水痘暴发;年级不是混杂因素,乘坐校车会增加水痘发病的危险性。     

Factors Associated with Complications and Mortality in Adult Patients Hospitalized for Infectious Cellulitis

The aim of this study was to analyze medical outcomes, including risks for complications and mortality, in 332 adult patients hospitalized for cellulitis. The infection was documented microbiologically in 128 cases (39%). Staphylococcus aureus (46 cases) and Streptococcus pyogenes (22 cases) were the most frequent causative pathogens. Overall, 63 patients (19%) were discharged early (≤4 days) and 166 patients (50%) were hospitalized for more than 4 days without developing any complications. One hundred three patients (31%) had one or more complications or died. Of these, 78 required surgical debridement, 10 required plastic surgery, 7 underwent amputation, and 15 had shock on presentation. When comparing the three study groups (patients discharged early, patients hospitalized for ≤4 days without complications, and patients who developed 1 or more complication or who died), patients who were discharged early (low risk) were more frequently female and were less likely to have multiple comorbid conditions, hypoalbuminemia, renal insufficiency, and/or cutaneous necrosis at presentation. Overall mortality (<30 days) was 5% (16/332 patients). Factors associated with death were male sex, presence of multiple comorbid conditions, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency, shock, and Pseudomonas aeruginosa cellulitis. These findings can be used to stratify patients with acute cellulitis according to risks for complications and mortality and may be helpful when deciding the most appropriate means of care, i.e. outpatient treatment or hospitalization. Electronic Publication     

Definite Streptococcus bovis endocarditis: characteristics in 20 patients

Objective   To determine the specific characteristics of Streptococcus bovis infective endocarditis (IE) by reviewing our own experience of S. bovis IE.
Methods   Twenty episodes of definite S. bovis IE were reviewed in 20 patients hospitalized from 1980 to 1996.
Results   The mean age was 62 ± 14 years, and 14 (70%) patients had no known predisposing cardiac condition. The principal antimicrobials used were penicillin G ( N  = 10) and amoxycillin ( N  = 8). Surgery was required in four (20%) patients. Neurologic complications occurred in eight (40%) patients, after initiation of therapy in six (75%) (mean time: 14 days). An unfavorable outcome was observed in four of 20 patients and tended to be more frequent in patients who had had neurologic complications ( P  = 0.10). Colonic tumors were present in 11 of 16 (69%) patients.
Conclusions   Advanced age, occurrence of IE on presumably normal valves, high rate of neurologic complications, associated gastrointestinal diseases and low mortality rate during initial follow-up are characteristic features of S. bovis IE observed in this study.     

Respiratory viral infections among pediatric inpatients and outpatients in Taiwan from 1997 to 1999

The present study examined the association of specific virus infections with acute respiratory tract conditions among hospitalized and outpatient children in a subtropical country. A total of 2,295 virus infections were detected in 6,986 patients between 1997 and 1999, including infections caused by respiratory syncytial virus (RSV) (1.7%), parainfluenza virus (2.0%), influenza B virus (2.6%), adenovirus (4.0%), herpes simplex virus type 1 (4. 4%), influenza A virus (5.5%), and enterovirus (12.7%). There were 61 mixed infections, and no consistent seasonal variation was found. One or more viruses were detected among 24.8% of hospitalized patients and 35.0% of outpatients. The frequencies and profiles of detection of various viruses among in- and outpatients were different. The occurrence of enterovirus infections exceeded that of other viral infections detected in 1998 and 1999 due to outbreaks of enterovirus 71 and coxsackievirus A10. RSV was the most prevalent virus detected among hospitalized children, whereas influenza virus was the most frequently isolated virus in the outpatient group. Most respiratory viral infections (39.3%) occurred in children between 1 and 3 years old. RSV (P < 0.025) and influenza A virus (P < 0.05) infections were dominant in the male inpatient group. In addition, most pneumonia and bronchiolitis (48.4%) was caused by RSV among hospitalized children less than 6 months old. Adenovirus was the most common agent associated with pharyngitis and tonsilitis (45.5%). These data expand our understanding of the etiology of acute respiratory tract viral infections among in- and outpatients in a subtropical country and may contribute to the prevention and control of viral respiratory tract infections.     

Osmotic demyelination syndrome in Intensive Care Unit

Dyselectrolytemia, especially hyponatremia is a common occurrence in hospitalized patients, and a number of dreaded complications arise out of the disorder itself and its treatment. Osmotic demyelination syndrome develops secondary to rapid correction of hyponatremia. As the disease is rare and available literature from Intensive Care Units are limited, we report our retrospective observation over 5 years. Overall incidence was 2.5% with altered sensorium and hypokalemia as most common symptom and associated factor respectively. Isolated pontine involvement was in 41% and combined pontine, and extra-pontine lesions were found in 23% of cases. All patients received supportive therapy; out of which 2 died and complete neurological recovery was seen in 24% of patients. Our findings suggest that a well organized supportive therapy and multidisciplinary approach is of more concern than many available therapeutic modalities which are still to be proved.     

Infections in patients after thoracic surgery

Purpose of this paper was estimation of occurrence of postoperative complications caused by most common infection agents. Research covered 1662 hospitalised patients during 2000-2001. Clinical records of patients and results from bacteriological research were analysed. Analysis of etiological agents were based on 779 clinical samples. In postoperative period infection was observed in 138 patients (9.2%). Among them 158 episodes of infection occurred. Totally for 138 patients, 158 infections were observed in postoperative period. 9% of all (1662)-operated patients had postoperative infections. In that number were: 98 (6.5%)--bronchopulmonary infection, 25 (1.7%)--empyema, 21 (1.4%)--wound infections, 10 (0.7%)--urinary tract infection, 4 (0.3%)--sepsis. All those complications caused 14 deaths. CONCLUSIONS: 1. Thoracic surgeries were connected with quite high risk of postoperative infections. 2. The most common postoperative complication was bronchopneumonia. 3. The most common etiological agent in thoracic surgery infections was Pseudomonas aeruginosa.     

Iatrogenic femoral pseudoaneurysms - a simple solution of inconvenient problem?

PurposeA femoral artery pseudoaneurysm - is the most common complication associated with invasive coronary interventions. The aim of the study was to analyze the effectiveness of various methods used for femoral pseudoaneurysm treatment and to assess how routine use of radial approach leads to reduction of these site complications.MethodsThe study comprised 1854 consecutive patients who were hospitalized in years 2005–2008 and underwent coronary angiography (with or without angioplasty) via femoral artery access. Since 2009 routine radial approach has been introduced for both coronary angiography and angioplasty. In patients with symptoms suggesting entry site complications Doppler ultrasound was performed.ResultsFemoral access site complications requiring additional procedures were observed in 63 patients (3.4%): in 56 femoral pseudoaneurysms (88.8%) and in 7 arteriovenous fistulas (11.1%) were diagnosed (all appeared after coronary angioplasty). The patients were treated in following ways: standard compression with an elastic bandage prolonged to 12 hours - in 14 cases (25%), ultrasound guided compression - in 13 patients (23.2%), finger compression followed by standard compression with an elastic bandage prolonged to 12 hours or ice compress - in 10 patients (17.8%), surgical treatment - in 3 patients (5.3%). Only 2 patients required thrombin injection (3.6%). Since the time routine radial approach was introduced extreme reduction in the rate of local complications was registered.ConclusionAlthough iatrogenic femoral pseudoaneurysms following invasive percutaneous coronary interventions are still important complications, most of them can be treated conservatively. It seems that radial access completely eliminates the risk of this complication.     

Bronchial ulceration as a prognostic indicator for varicella pneumonia: Case report and systematic literature review

Adult varicella pneumonia is a common and serious complication of varicella zoster virus (VZV) infection in pregnant woman and immunocompromised individuals, with mortality rates of 30–50%. The poor prognosis is attributable to very aggressive disease progression and delayed onset of treatment. Here, we present a case of varicella pneumonia in a 69-year-old woman following long-term immunosuppressive treatment for kidney transplant. Respiratory failure developed within 3 d after admission for skin rash, and the patient died 28 d later despite acyclovir and foscarnet treatment. The autopsy showed extensive mucosal airway ulcerations from the pharynx to the main bronchi and numerous VZV-infected cells. We searched PubMed, Web of Science, and EMBASE (1980 through February 2012), as well as several medical report databases created by Japanese healthcare professionals, for all reported cases of varicella pneumonia for which bronchoscopy findings were documented. Twenty-four cases were included and we found that patients with limited or shallow ulcers had favorable outcomes, whereas patients with vast and deep ulcerations had fatal outcomes. These findings indicate that bronchoscopy findings, particularly those showing bronchial involvement, may be useful for evaluating varicella pneumonia.