Hypophosphatemia in hospitalized patients.

Hypophosphatemia is common in hospitalized patients and occurs under a variety of circumstances other than parathyroid hormone excess. Charts of 100 inpatients with hypophosphatemia were reviewed and the patients divided into five groups on the basis of serum phosphate level: 18, 2.1 to 2.4 mg/dL; 49, 1.6 to 2.0 mg/dL; 20, 1.1 to 1.5 mg/dL; 12, 0.6 to 1.0 mg/dL; 1, 0.1 to 0.5 mg/dL. The effect of glucose ingestion on serum phosphate level was shown in one normal patient. Whenever carbohydrate was administered intravenously (45 cases), this was considered the primary cause of the hypophosphatemia. Other causes were as follows: diuretics, hyperalimentation, alcoholism, respiratory alkalosis, dialysis, insulin, corticosteroids, diabetic ketoacidosis, vomiting, phosphate-binding antacid, Gram-negative sepsis, primary hyperparathyroidism, saline, epinephrine, gastrointestinal malabsorption, and unknown. Hypophosphatemia in hospitalized patients may have multiple causes.     

低钠血症398例临床特征分析

目的：分析低钠血症的病因、转归及特点,为本地低钠血症的临床流行病学研究提供初步资料。方法收集2012年6月-2013年12月于大连医科大学附属第一医院住院的低钠血症患者临床资料,按照血清钠离子（Na＋）浓度分为轻度低钠血症组（130≤Na＋＜135 mmol/L）,中度低钠血症组（120≤Na＋＜130 mmol/L）以及重度低钠血症组（ Na＋＜120 mmol/L）,分析病因、各组转归、合并症情况及血钠水平的影响因素等。结果398例低钠血症在住院患者中的发病率0．03％,根据基础疾病进行分析,其中以肺部疾病103例（占25．88％）,中枢神经系统疾病74例（占18．59％）,恶性肿瘤56例（占14．07％）,消化系统疾病53例（占13．32％）居多。重度组死亡率高于轻、中度组（ P＜0．05）。年龄、肾小球滤过率与血Na＋呈负相关;血Cl-、血渗透压与血Na＋呈正相关,差异有显著性意义（ P＜0．05）。结论低钠血症是住院患者常见的并发症,主要原因是肺部疾病、中枢神经系统疾病、恶性肿瘤;随着年龄增长、肾小球滤过率升高时容易合并低钠血症。早期识别、正确处理能降低低钠血症的发生率和病死率。     

Fractional excretion of potassium in normal subjects and in patients with hypokalaemia.

The aim of our study was the determination of fractional excretion of potassium (FEK+) in both normal subjects and hypokalaemic patients. Three hundred and twelve normal subjects aged 21-69 years and 84 hypokalaemic patients aged 36-72 years were studied. The mean FEK+ in normal subjects was 8% (range 4-16%). FEK+ was positively correlated with serum potassium (r = 0.74, p < 0.0001) and inversely with serum creatinine (r = -0.51, p < 0.001). The mean FEK+ in patients with hypokalaemia of external origin was 2.8% (range 1.5-6.4%). On the contrary, the mean FEK+ in hypokalaemic patients in whom renal potassium loss was the main aetiologic factor for the pathogenesis of hypokalaemia was 15% (range 9.5-24%).     

Drug-related superinfection in hospitalized patients.

In a series of 14,077 hospitalized medical patients receiving antibiotics, superinfection developed in 95 (0.7%) during drug therapy. The majority were yeast and fungal infections, and serious infections occurred with a frequency of less than one per 1,000 patients treated. Concurrent immunosuppression and impaired renal function increased the risk of new infections.     

Epidemiology of adverse cutaneous drug reactions. A prospective study in hospitalized patients

BACKGROUND: Drug reactions are commonly present in the skin; however, their frequency in our setting is unknown. METHODS: A 10-month prospective cohort study including all hospitalized patients was designed. Those with adverse cutaneous drug reactions (ACDR) were clinically identified. RESULTS: Thirty five drug reactions (prevalence of 0.7%) were seen among 4785 (2713 females, 2072 males) discharged patients. According to Begaud's imputability criteria, the reactions were most likely attributed to a drug in 4.87%, likely in 41.46% and possible in 53.65%. The most commonly seen dermatoses were morbilliform rash 51.2%, urticaria 12.2% and erythema multiforme 4.9%. Drugs most frequently associated with ACDR were amoxicillin clavulanate (8), amphotericin B (2) and metamizole (4). Expressed as risk by 1000 day-doses (Dd: the risk a patient has of developing an ACDR after receiving 1 day of treatment with the drug): amoxicillin clavulanate Dd 7.7, amphotericin B Dd 4.8 and metamizole Dd 3.7. Immunosuppressed patients were most frequently affected. Notably, patients with systemic lupus erythematosus (SLE) had a 4.68 higher risk (CI 95% 1.794-12.186 p <0.001) of developing an ACDR. AIDS patients showed a risk of 8.68 (CI 95% 2.18-33.19 p <0.001). Non-Hodgkin's lymphoma patients also had an increased risk of developing an ACDR. Six of the 35 identified cases were patients who had been hospitalized due to a severe drug reaction (1.3/1000 patients); one died from complications directly related to the ACDR, representing a 16.6% mortality rate among those admitted for an ACDR and 0.02% among the global mortality. CONCLUSIONS: We have a low prevalence of drug reactions compared to data reported in the literature. Pharmacovigilance with special attention to immunosuppressed SLE or AIDS patients is stressed.     

Handicap and rehabilitation in hospitalized hemodialized patients: study of 20 patients

Twenty hemodialyzed patients, received rehabilitation while they were hospitalized. They were all handicapped in the beginning; when they left the hospital, 10 patients were completely independent, six needed help at home and 4 were completely dependent. The authors search, from their own practice, the etiologies of handicap with hemodialyzed patients and how to prevent this handicap, with the target of giving to their patients the best quality of life. The rehabilitation is very important in the strategies of global care of these patients.     

住院抑郁症患者梦的内容研究

目的探讨抑郁症患者梦的特点以及其内容是否与疾病演变有关。方法根据CalvinHall的＂梦的内容分析（thecon-tent analysis of dreams）＂方法,分别记录住院抑郁症患者病前印象最深的梦、入院前1个月内、住院治疗2周内、住院2周后到4周内及出院前的梦,然后对其进行相关分析。结果共收集30例患者不同阶段的梦112个,平均每个梦（68.8±8.13）个字;患者在抑郁症病重期梦到友好行为的梦和不幸事件的梦较少,经治疗抑郁好转后梦中友好行为增加,自我负性评价减少。结论住院抑郁症患者的梦较为简短;梦的内容随病情的变化而有所不同。     

Transient atrial fibrillation in hypertensive patients with thiazide induced hypokalaemia

During the previous 34 months, 3 hypertensive patients on long-term thiazide therapy were admitted to the medical department, Mubarak Hospital, Kuwait, with atrial fibrillation (AF) and hypokalaemia. They received potassium chloride by intravenous infusion, followed by oral therapy with reversion to sinus rhythm. There were no clinical, electrocardiographic, radiological, or echocardiographic signs of cardiac or pericardial disease, and the other usual cases of AF were also excluded. The contribution of thiazide-induced hypokalaemia to the occurrence of AF in our patients is discussed.     

住院精神分裂症患者抽象色彩偏好实验研究

目的探讨不同性别、年龄、受教育程度住院精神分裂症患者抽象色彩偏好差异。方法纳入1320名住院精神分裂症患者及1005名正常人群作为研究对象,采用对偶比较法进行色彩偏好实验。结果(1)精神分裂症患者最偏爱蓝色、绿色等冷色,与对照组色彩偏好顺序倾向一致,对紫色、黑色的偏好程度高于对照组,差异具有统计学意义(P0.05)。(2)不同性别、年龄、受教育程度精神分裂症患者色彩偏好顺序均倾向一致。男女均最偏好蓝色;女性对橙色、灰色更为偏好,而男性更偏好绿色、蓝色,差异有统计学意义(P0.05)。不同年龄患者在红色、白色、黑色上偏好程度上存在统计学差异(P0.05)。不同受教育程度患者在红色、蓝色、白色、黑色、灰色偏好程度上存在统计学差异(P0.05)。结论住院精神分裂症患者偏爱蓝色、绿色、紫色、黑色等冷色调;不同性别、年龄、受教育程度患者抽象色彩偏好顺序倾向一致,但其偏好程度存在明显差异。     

Food asphyxiation in hospitalized patients

During a five-year period, food asphyxiation caused 1.3% of all deaths of patients who came to autopsy at a hospital for chronic diseases. Patients died suddendly, during or shortly after meals. Acute myocardial infarction was mistakenly diagnosed in eight of the 14 patients until autopsy was performed. Sedation, old age, and poor dentition predisposed to aspiration. Food asphyxiation is a common problem whenever and wherever people eat. To minimize its occurrence in hospitalized patients, sedatives should be prescribed judiciously, and diets ordered appropriately. Physicians should learn the simple methods of extracting inhaled food.     

Thiazides and hypokalaemia in diabetic ketoacidosis

In a series of forty-one episodes of diabetic coma or pre-coma, three patients had plasma potassium values of less than 3.0 mEq/l. All three had been taking thiazide diuretics with only one receiving oral potassium supplements. None was previously known to be diabetic, representing 18% of the new diabetics in the series. The mean plasma potassium for the other new diabetics was 4·7 ± 0·2 mEq/l. These findings emphasize that adequate potassium supplements should be given with thiazide diuretics to diabetic subjects and to those with an increased risk of developing the disease.     

Invasive candidiasis in immunocompromised hospitalized patients

The frequency of infections by Candida species is increasing worldwide, with candidemia representing the fourth most common bloodstream infection in the U.S. The risk of infection is especially high in the immunocompromised, hospitalized patient. The treatment of and prophylaxis for Candida infection have led to the emergence of resistant species and the acquisition of resistance in previously susceptible species. Current therapeutic options include amphotericin B and its lipid compounds, fluconazole, itraconazole, voriconazole, and caspofungin. Research is focusing on better diagnostics and the evaluation of strategies such as prophylaxis in high-risk hosts and pre-emptive therapy.     

Skin and soft tissue infections in hospitalized cancer patients: A retrospective study

Objectives:To assess the clinical and epidemiological characteristics of hospitalized cancer patients with skin and soft-tissue infections (SSTIs).Methods:An observational retrospective study was conducted between March 2016 and December 2020 at the Oncology Department of King Saudi Medical City, Riyadh, Saudi Arabia. Patients with complicated and uncomplicated SSTIs were included.Results:A total of 204 cancer patients with SSTIs were evaluated. The incidence of SSTIs was 1.67% (204/12,203). Breast cancer (39%) was the most common solid tumor in all patients with SSTIs. Exit site infection (n=84, 41.2%) was the most common SSTI in cancer patients, followed by wound infection (n=72, 35.3%), and cellulitis (n=44, 21.5%). The majority of patients received appropriate antimicrobial therapy (n=150, 73.5%).Conclusion:This study has shown a modest incidence of SSTIs in hospitalized cancer patients, with many of the patients received appropriate antimicrobial therapy.