广东地区1316例急性胰腺炎的临床流行病学特征

目的探讨广东地区急性胰腺炎（AP）的临床特点和发病规律。方法总结分析中山大学附属第二医院及广东省人民医院1986—2005年AP住院患者共1316例临床资料,并对结果进行统计分析。结果1986—1990年间病例数占同期内、外科住院总人数的0．19％,1991—1995年间上升为0．36％,1996—2000年间升至0．54％,而2001—2005年间则高达为0．71％。1316例患者中胆源性胰腺炎占60．48％,其余依次为高脂血症胰腺炎、特发性胰腺炎。临床症状以上腹部疼痛为主,伴或不伴腰背部放射痛,多数伴有恶心、呕吐等消化道症状。动态增强CT扫描是明确诊断、严重度分级及发现并发症的准确影像学方法。非手术治疗1104例,死亡24例;手术治疗212例,死亡48例。结论AP发病例数逐年增多,AP发病因素多而复杂,胆道疾病仍为主要病因。影像学检查有助于早期诊断及严重度分级,早期治疗可采用中西医结合的非手术疗法,严格掌握手术指征,合理使用内镜技术,均能取得理想的治疗效果。     

177例急性乙型肝炎流行病学及临床特征分析

目的探讨近年来急性乙型肝炎的流行病学及临床特点,为更好地诊断、治疗及预防急性乙型肝炎提供依据。方法回顾性分析哈尔滨医科大学附属第一医院2005年1月-2011年2月确诊的177例急性乙型肝炎患者的临床资料。结果急性乙型肝炎发病以男性多见,高发年龄段为20-49岁,以工人和农民为主,多数患者传播途径不详,发病无明显季节性;起病急,76．84％为黄疸型,大多数患者出现乏力和消化道症状,部分患者出现低到中度发热,少数患者出现皮疹、关节痛,个别患者出现肾功能衰竭等罕见的肝外损害表现;绝大多数急性乙型肝炎患者能得到及时正确的诊断,个别患者曾被误诊为慢性乙型肝炎、发热原因待查、糖尿病酮症及多发性肌炎等;急性乙型肝炎预后较好,临床治愈好转率较高达93．78％,5．08％的患者进展为暴发性肝炎,半年内随访92．44％的患者HBsAg阴转,95．80％的患者HBVDNA阴转,7．56％患者转变为慢性乙型肝炎;3例口服核苷类似物抗病毒治疗的暴发性肝炎患者病情均出现了好转,4例未抗病毒治疗者死亡3例,放弃治疗2例。结论急性乙型肝炎的发病年龄及传播途径发生了明显的变化;个别患者出现了罕见的肝外损害表现;少部分患者存在误诊现象,临床医师应加强对本病的认识以减少误诊;急性乙型肝炎的预后较好,但仍有部分会发生慢性化,少部分进展为暴发型肝炎,甚至死亡;重型肝炎或有重症倾向的患者应及时使用核苷类似物抗病毒治疗。     

The microfilarial periodicity of Wuchereria bancrofti in north-eastern Brazil

The periodicity of Wuchereria bancrofti microfilariae (mff) in peripheral blood was analysed in 42 microfilaraemics living in Maceió, in Alagoas state, north-eastern Brazil. Nine blood samples were collected from each subject, over a 24-h period, and two quantitative (60-microliter) thick smears were prepared from each sample. Although all the subjects had detectable microfilaraemias from 23.00 hours to 06.00 hours, no mff could be detected in most (71.4%) of the smears prepared from samples collected at 15.00 hours. Samples collected during the day, at 15.00 hours, contained 170 times fewer mff/microliter than those collected at 01.00 hours, when microfilaraemias were generally most intense. For diagnosis of bancroftian filariasis in Maceió, blood samples should be collected between 22.00 and 03.00 hours, when microfilarial counts will be at least 90% of the peak counts. The circadian variation observed was independent of the subject's gender and microfilarial density. Mathematical analysis, using a simple harmonic-wave model, indicated a periodicity index of 127.6 and that maximum microfilarial densities occurred at 00.51 hours, confirming the nocturnal pattern of microfilaraemia in the study area.     

Epidemiology of Schistosoma mansoni infection in a low-endemic area in Brazil: clinical and nutritional characteristics.

A cross-sectional case-control study designed to evaluate the role of malnutrition in the association between the intensity of Schistosoma mansoni infection and clinical schistosomiasis, was conducted in an area with both low frequency of infection and low morbidity of schistosomiasis in Brazil. Cases (256) were patients with a positive stool examination for S. mansoni; their geometrical mean number of eggs/gram of feces was 90. Controls (256) were a random sample of the negative participants paired to the cases by age, sex and length of residence in the area. The clinical signs and symptoms found to be associated with S. mansoni infection, comparing cases and controls, were blood in stools and presence of a palpable liver. A linear trend in the relative odds of these signs and symptoms with increasing levels of infection was detected. Adjusting by the level of egg excretion, the existence of an interaction between palpable liver and ethnic group (white) was suggested. No differences in the nutritional status of infected and non-infected participants were found.     

Childhood diarrhoea in Ankara, Turkey: epidemiological and clinical features of rotavirus-positive versus rotavirus-negative cases

Published reports dealing with rotavirus infections in Turkey are very scarce. This study included 1099 consecutive paediatric patients with diarrhoea, who sought care at 3 hospitals in Ankara, Turkey between 1999 and 2002 and were investigated for the presence of rotavirus antigen in faeces. Rotavirus antigen was detected by an immunochromatographic test, Simple Rotavirus (Operon, Spain). Other clinical and laboratory data were extracted from patient journals. A total of 404 (36.8%) patients were positive for rotavirus antigen. Rotavirus antigen was more frequently detected in boys than girls (40.8 vs 31.8%) and in children younger than 2 y (62.7%). The proportion of rotavirus-positive children was higher in the winter season (49.6%; November to April) and the highest proportion was observed in December (55.4%). Rotavirus-associated diarrhoea had a more severe clinical presentation than non-rotaviral diarrhoea; 55.3% of all patients who required hospitalization were rotavirus-positive. The seasonal and epidemiological characteristics of rotavirus diarrhoea in Ankara were similar to those in the USA and Europe. For reliable nationwide information about the epidemiology of rotavirus-associated disease in Turkey, more individual studies and reliable official statistics of gastroenteritis cases are needed.     

成人麻疹112例流行病学和临床特征

目的对2005年1月至6月上海交通大学附属第六人民医院、附属第三人民医院收治的112例成人麻疹患者临床资料进行分析,探讨本次成人麻疹流行病学特点及临床特征.方法对收治的112例麻疹患者的临床资料进行回顾性分析.结果112例患者（男63例,女49例）,男女比为1.3：1,平均年龄约32岁,非上海户籍人员占40.18%,发病集中于4～5月份,血清麻疹IgM抗体阳性率为96.43%,热峰高于39℃97例（86.61%）,并发麻疹病毒性肝炎36例（32.14%）.结论可能与麻疹疫苗接种不规范或接种疫苗抗体滴度下降等因素有关,临床特征具有较重的病毒血症以及肝脏损害.     

Clinical, histologic and serologic evaluation of patients with acute non-A-E hepatitis in north-eastern Brazil: is it an infectious disease?

Non-A-E hepatitis and acute cryptogenic hepatitis are the names given to the disease of patients with clinical hepatitis, but in whom serologic evidence of A-E hepatitis has not been found. Over a period of 8 years, we evaluated in Brazil 32 patients who fulfilled the criteria for this diagnosis in order to determine patterns of the clinical illness, laboratory parameters, or histologic features. Each patient was subjected to virologic tests to exclude A-E hepatitis and cytomegalovirus/Epstein-Barr virus infection. Drug-induced hepatitis and autoimmune disease were also excluded. Wilson's disease was excluded in young patients. The course of the disease was clinical/biochemical recovery in 3 months in 25 patients and persistent alanine aminotransferase (ALT) elevation in 7 patients. Three of these had chronic hepatitis, and one had severe fibrosis on liver biopsy. During the acute illness, mean peak ALT was 1267 IU/L, bilirubin was 4.0 mg/dL, and ferritin was 1393 IU/mL. GB virus type C (GBV-C) was found in six patients, and TT virus (TTV) in five patients. We conclude that, in Brazil, non-A-E hepatitis probably originates from still unidentified viruses. The course of the disease and the histologic patterns are similar to those recorded for known viruses. Continuous survey for the specific etiologic agents is needed.     

Sex differences in epidemiological, clinical and pathological characteristics of colorectal cancer

Sex significantly influences the clinical and pathological characteristics of colorectal cancer (CRC). These include differences in incidence and mortality rates, clinical presentations including age, emergency surgery for complications from CRC, screening participation rates, site, stage and treatment utilization, histopathology and survival. Environmental, behavioral and biological factors contribute to the differential risk. Recent advances in the molecular biology of CRC, specifically in microsatellite status, estrogen hormone and estrogen receptor β, have led to greater understanding of the effect of estrogen in colorectal carcinogenesis. Estrogen may preferentially protect against microsatellite unstable cancers through its effect on selected molecular targets; however, the exact pathways have not been elucidated. Recognition of important sex disparities in these areas may lead to the implementation of specific measures to diminish these differences and facilitate equitable distribution of health resources. Identifying specific molecular targets on CRC that interact with estrogen may stimulate research to improve the overall outcomes of all patients with CRC.     

Frequency and characteristics of diarrhoeagenic Escherichia coli strains isolated from children with and without diarrhoea in Rio de Janeiro, Brazil

The frequency of diarrhoeagenic Escherichia coli (DEC) strains was investigated in 253 children up to 3 years old, with (patient group, PG, 199 children) and without (control group, CG, 54 children) diarrhoea, living in Rio de Janeiro, Brazil. DEC strains were detected in 70 (27.6%) children, including 54 (27.1%) with diarrhoea and 16 (29.6%) without diarrhoea. Enteroaggregative E. coli (EAEC) was the most frequent DEC category, accounting for 14.6% of the isolates in the PG and for 11.1% in the CG. E. coli strains carrying enteropathogenic E. coli (EPEC) virulence markers showed higher incidence in the CG (12.9%) than in the PG (8.0%). E. coli strains belonging to non-classical EPEC groups that carried eae only or eae and bfpA, designated as attaching-effacing E. coli (AEEC) were the most frequent (79.1%). Simultaneous presence of multiple EPEC virulence factors (EAF/eae/bfpA) were only detected among strains isolated from the PG. Enterotoxigenic E. coli (ETEC) strains were isolated from 5.5% of the children in the CG and from 3.5% of those in the PG. Most of the ETEC isolates were LT-probe positive (70%) and none carried both LT-I and ST-I probe sequences. One enteroinvasive E. coli (EIEC) strain was recovered from a child with diarrhoea. No stx-probe positive E. coli strains were detected. Overall, DEC strains were not found to be significantly associated with diarrhoea (p>0.05). However, the higher incidence of EAEC, the most frequent DEC category, among children with diarrhoea, suggests a potential role of EAEC as an important enteric pathogen in the community investigated.     

Enteropathogens associated with acute diarrheal disease in urban infants in S?o Paulo, Brazil

To determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhea, 500 infants less than or equal to 12 months of age with diarrhea and 500 age-matched control subjects coming to a S?o Paulo emergency room were studied. Enteropathogens were identified in 55% of case infants and 10% of controls; enteropathogenic Escherichia coli (EPEC) of classic EPEC serotypes producing EPEC adherence factor (EAF) (26% of case infants), rotavirus (14%), Salmonella species (8%), enterotoxigenic E. coli (7%), and Shigella species (5%) were associated with diarrhea. Isolation of EAF+ classic EPEC decreased with increasing age of cases and peaked in spring, whereas rotavirus was least common in early infancy and peaked in fall and winter. Bloody stool had a 36% positive predictive value for Shigella infection, EAF+ classic EPEC were highly resistant to antimicrobial drugs. Among poor S?o Paulo infants, EAF+ classic EPEC equaled or exceeded rotavirus throughout the year as a cause of diarrhea bringing children to medical attention.     

The feasibility of conducting clinical trials in infants and children with acute respiratory failure

Designing robust clinical trials in critically ill, mechanically ventilated children requires an understanding of the epidemiology and course of pediatric respiratory failure. As part of a clinical trial, we screened all mechanically ventilated children in nine large pediatric intensive care units (ICUs) across North America for 6 consecutive months. Of 6,403 total ICU admissions, 1,096 (17.1%) required mechanical ventilator support for a minimum of 24 hours. Of these, 701 (64%) met one or more exclusion criteria for trial enrollment. Common reasons for exclusion were upper airway obstruction (13.5%) and cyanotic congenital heart disease (11.5%). Life support interventions were restricted for 9.7% of patients, and 5.5% were chronically ventilator dependent. In the patients who were eligible for respiratory failure studies, 62.4% had an acute primary diagnosis of pulmonary disease, 14.2% neurologic disease, and 8.9% cardiac disease. Chronic underlying conditions were present in 43.2% of the patients. The most common acute diagnosis was bronchiolitis in infants (43.6%) and pneumonia in children 1 year old and older (24.5%). Mortality was rare (1.6%), and the median duration of ventilation was 7 days. The design of clinical trials in critically ill children is feasible but must account for the diverse population, infrequent mortality, and short duration of mechanical ventilation.     

Changing epidemiological characteristics of acute viral hepatitis in Greece

Summary We have studied the epidemiological characteristics of acute viral hepatitis (AVH) in adult patients admitted to the Infectious Diseases Hospital of Athens in 1980. Commercially available radioimmunoassays were used for the detection of the hepatitis B surface antigen, its antibody, the antibody to the core of the hepatitis B virus (HBV) and the IgG and IgM antibody to the hepatitis A virus (HAV). HBV was responsible for 59.9%, HAV for 20.4% and hepatitis non-A, non-B virus for the remaining 19.7% of the cases studied. The results show that the relative frequency of AVH type B has declined considerably in the last four years (from 80.6% to 59.9%). In contrast, AVH type A (from 10.8% to 20.4%) and non-A, non-B (from 8.6% to 19.7%) have increased substantially. The incidence of AVH type A declined rapidly with age; the incidence of type B was higher in the 20–29 year-old group, while non-A, non-B continued to occur in older people. Seasonal variation was not observed, except for a slight increase during the winter months. These changes in the epidemiological characteristics of AVH can be attributed to the improvements in socioeconomic, sanitary and hygienic conditions, as well as to the obligatory screening of blood donors for HBsAg and the increased awareness of medical and paramedical personnel regarding the risk of transmitting the disease iatrogenically.

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Veränderte Epidemiologie der akuten Virushepatitis in Griechenland

Zusammenfassung Die epidemiologischen Charakteristika der akuten Virushepatitis (AVH) wurden an erwachsenen Patienten analysiert, die im Jahre 1980 in das Krankenhaus für Infektionskrankheiten in Athen eingewiesen wurden. Zum Nachweis des Hepatitis-B-Virus Oberflächenantigens, seines Antikörpers, des Hepatitis-B-Virus (HBV) Core-Antikörpers und der IgG und IgM Antikörper gegen Hepatitis-A-Virus (HAV) wurden kommerziell erhältliche Radioimmunassays verwendet. 59,9% der untersuchten Fälle wurden durch HBV, 20,4% durch HAV und die restlichen 19,7% durch Nicht-A-, Nicht-B-Hepatitis-Virus ausgelöst. Aus den Ergebnissen läßt sich ableiten, daß die relative Häufigkeit von AVH Typ B in den letzten vier Jahren erheblich abgenommen hat (von 80,6% auf 59,9%). Dagegen ist für AVH Typ A und Nicht-A-, Nicht-B-Hepatitis ein beträchtlicher Anstieg von 10,8% auf 20,4% bzw. 8,6% auf 19,7% zu verzeichnen. Mit zunehmendem Alter ging die Inzidenz der AVH Typ A rasch zurück, eine erhöhte Inzidenz von Hepatitis B zeichnete sich in der Gruppe der 20- bis 29jährigen ab; die Nicht-A-, Nicht-B-Hepatitis war auch bei älteren Personen zu finden. Saisonale Schwankungen waren mit Ausnahme eines leichten Anstiegs der Erkrankungszahl in den Wintermonaten nicht festzustellen. Die Veränderungen der epidemiologischen Merkmale der AVH lassen auf Verbesserungen im sanitären und hygienischen Bereich schließen, doch dürfte auch das obligate Screening der Blutspender auf HBsAg und die erhöhte Wachsamkeit der Ärzte und des medizinischen Assistenzpersonals bezüglich der Risiken einer iatrogenen Übertragung der Krankheit eine Rolle spielen.

     

布氏菌病86例临床分析

目的研究急性期布氏菌病患者的流行病学和临床特征。方法对我院2002至2004年收治的86例布氏菌病患者的流行病学资料、临床表现、实验室检查、治疗情况进行回顾性分析。结果51例患者有与牛、羊密切接触史，27例患者曾饮牛奶或进食涮羊肉，8例患者传播途径不明。86例患者均有发热，以低热为主，热型以不规则热55例、间歇热20例为主．乏力63例．多汗43例，关节疼痛68例，睾丸炎7例，肝肿大8例，脾肿大7例，头痛18例。合并肝损害47例；PLT减少17例。经利福平、复方磺胺甲嚼唑和第三代喹诺酮联合治疗，80例痊愈，6例复发。结论急性期布氏菌病在流行病学和临床特征发生了变化，不典型病例明显增多，症状轻，给诊断增加了难度。     

The US capitol bioterrorism anthrax exposures: clinical epidemiological and immunological characteristics

BACKGROUND: Bioterrorism-related anthrax exposures occurred at the US Capitol in 2001. Exposed individuals received antibiotics and anthrax vaccine adsorbed immunization. METHODS: A prospective longitudinal study of 124 subjects--stratified on the basis of spore exposure, nasopharyngeal culture results, and immunization status from inside and outside an epidemiologically defined exposure zone--was performed to describe clinical outcome and immune responses after Bacillus anthracis exposure. Antibody and cell-mediated immune (CMI) responses to protective antigen (PA) and lethal factor were assayed by enzyme-linked immunosorbent assay and fluorescence-activated cell sorting. RESULTS: Antibody and CMI dose-exposure responses, albeit generally of low magnitude, were seen for unimmunized subjects from inside, within the perimeter, and outside the exposure zone and in nonexposed control subjects. Anti-PA antibody and CMI responses were detected in 94% and 86% of immunized subjects. No associations were seen between symptoms and exposure levels or immune responses. CONCLUSIONS: Anthrax spores primed cellular and possibly antibody immune responses in a dose-dependent manner and may have enhanced vaccine boost and recall responses. Immune responses were detected inside the perimeter and outside the exposure zone, which implies more-extensive spore exposure than was predicted. Despite postexposure prophylaxis with antibiotics, inhalation of B. anthracis spores resulted in stimulation of the immune system and possibly subclinical infection, and the greater the exposure, the more complete the immune response. The significance of low-level exposure should not be underestimated.     

小儿肺炎克雷伯杆菌肺炎临床特点与治疗策略

目的探讨婴幼儿肺炎克雷伯杆菌肺炎临床特点及治疗策略。方法分析132例婴幼儿肺炎克雷伯杆菌肺炎临床特点、药敏结果及治疗情况。结果婴幼儿肺炎克雷伯杆菌肺炎临床主要症状为咳嗽,咳白色粘痰,喘息,呼吸困难;胸片双侧实质病变多见,易并发肺不张,重症肺炎发生率42.4%。产ESBLs菌株占53.0%,药敏显示对青霉素类、头孢菌素类耐药率83%~100%;碳青霉烯类耐药率6%~30%,较无ESBLs菌株有显著差异。结论婴幼儿肺炎克雷伯杆菌肺炎多见于有基础疾病患儿,耐药率高,重症肺炎发生率高。符合重症肺炎标准治疗建议首选碳青霉烯类药物抗感染。     

急性心肌梗死并发急性脑梗死危险因素及临床特点

目的 分析急性心肌梗死（AMI）并发急性脑梗死（AIS）的危险因素及临床特点。 方法 回顾性分析2010年1月~2015年4月我院收治住院的75例AMI并发AIS患者为病例组,随机选择同期住院的单纯AMI和单纯AIS患者各80例为对照组,对比分析3组临床资料。 结果 单因素分析显示,AMI并发AIS组与单纯AMI组比较,既往脑梗死病史、外周血管病史、血肌酐水平显著高于对照组,高密度脂蛋白胆固醇（HDL-C）显著低于对照组,差异有统计学意义（P<0.05）;与单纯AIS组比较,男性、既往心肌梗死病史、外周血管病史、血肌酐水平显著高于对照组,入院收缩压与舒张压显著低于对照组,差异有统计学意义（P<0.05）;多因素Logistic回归分析表明,男性、既往脑梗病史、血肌酐为AMI并发AIS的独立危险因素（P<0.05,OR>1）,入院舒张压为其保护性因素（P<0.01,OR<1）。临床特点分析表明,KILLIP分级≥Ⅱ级高于两对照组（44% vs. 16% vs. 1%,P<0.01）,多发脑梗死高于单纯AIS 组（46% vs. 16%,P<0.01）,PCI患者冠状动脉3支病变显著高于单纯AMI组（76% vs. 52%,P<0.05）。 结论 男性、入院舒张压降低、既往脑梗病史、血肌酐水平升高为AMI并发AIS的独立危险因素,心功能不全、多发脑梗死为其临床特点,冠状动脉3支病变为PCI术后并发急性脑梗死患者的临床特点。     

Non-travel-associated hepatitis E in England and Wales: demographic, clinical, and molecular epidemiological characteristics

Between 1996 and 2003, 186 cases of hepatitis E were serologically diagnosed. Of these, 17 (9%) were not associated with recent travel abroad. Patients were >55 years old (range, 56-82 years old) and tended to be male (76%). Two patients presented with fulminant hepatitis. A total of 129 (69%) cases were associated with recent travel to countries where hepatitis E virus (HEV) is hyperendemic. Compared with patients with travel-associated disease, patients with non-travel-associated disease were more likely to be older, living in coastal or estuarine areas, not of South Asian ethnicity, and infected by genotype 3 strains of HEV. The genotype 3 subgenomic nucleotide sequences were unique and closely related to those from British pigs. Patients infected by HEV indigenous to England and Wales tended to belong to a distinct demographic group, there were multiple sources of infection, and pigs might have been a viral reservoir.