Epidemiology of bacteraemia in Hamad general hospital, Qatar: a one year hospital-based study

We conducted a one-year observational study from July 2007 to June 2008 to describe the epidemiology of bacteraemia at Hamad general hospital. During this period, a total of 452 episodes of bacteraemia occurred, which corresponds to a rate of 19/1000 hospital admissions. Most patients 58.8% (266/452) had community acquired bacteraemia, and primary bacteraemia accounted for 62.2% (281/452) of the cases. The most common source of bacteraemia was intravenous catheterization in 19.2% (87/452) but no source was identified in 42.9% (194/452) of the episodes. Gram-negative organisms were isolated in 63.1% (285/452) episodes with Escherichia coli being the most frequent 21.5% (97/452). Multidrug resistance was observed in 33.3% (7/21) of all Pseudomonas aeruginosa isolates, 50% (6/12) of Acinetobacter isolates and 28.6% (6/21) of Enterobacter isolates, whereas all ESBL producing Klebsiella spp. and E. coli were multiresistant. The percentages of oxacillin resistant coagulase negative Staphylococci isolates and methicillin-resistant Staphylococcus aureus isolates were 81.8% (27/33) and 13.2% (7/53) respectively. In hospital mortality was 22.5% (102/452), and inadequate treatment and septic shock were found to be independent predictors of mortality. Therefore, bloodstream infection surveillance is crucial to produce meaningful guidelines for prevention (e.g., catheter-related) and empirical treatment of bacteraemia in Qatar.     

Characteristics of patients with definite septic arthritis at Hamad General Hospital, Qatar: a hospital-based study from 2006 to 2011

The aim of this retrospective study was to determine the epidemiological and clinical characteristics, coexisting conditions, causative organisms, and outcomes of all adult patients 15 years of age or older who had definite septic arthritis at Hamad General Hospital, Qatar, from 2006 to 2011. During this period, 56 patients were diagnosed with septic arthritis (mean age ± SD, 49.0?±?16.6 years). In 53 of 56 (94.6 %) patients, arthritis was diagnosed in a single joint, while polyarthritis was diagnosed in 3 of 56 (5.4 %) patients; the most commonly involved joint was the knee (40 of 59 joints, 67.7 %). The most frequent coexisting condition was diabetes mellitus (24 of 56 patients, 42.8 %). Joint pain and restriction of movement were reported by all patients. Gram-positive bacteria accounted for 36 of all 57 (63.0 %) isolated microorganisms, and Staphylococcus aureus was the most common pathogen (20 of 57 microorganisms, 35.0 %). Three cases of tuberculous arthritis were seen. The most favored antibiotic combinations were cloxacillin/ciprofloxacin, cefazolin/ciprofloxacin, and vancomycin/ciprofloxacin. Repeated needle aspiration, open joint drainage, and arthroscopic techniques were performed in 18 (32.1 %), 22 (39.3 %), and 11 (19.6 %) of the 56 patients, respectively. The 30-day mortality was 3.6 %, and the remaining patients showed clinical improvement upon discharge. In conclusion, there was no specific sign or symptom for diagnosing septic arthritis. Isolation of bacteria from the synovial fluid confirmed the diagnosis, and S. aureus and streptococci were the most common pathogens isolated. Prompt treatment with appropriate antibiotics and synovial drainage are mandatory to improve the outcome.     

2005～2009年新疆喀什地区结核病防治工作探析

目的回顾分析2005～2009年新疆喀什地区疫情报告数据,旨在发现存在的问题。方法对比分析病人的登记、治疗转归和转诊、追踪情况。结果该地区平均发现活动性肺结核病人占全疆的27.74%、涂阳占31.09%;初、复治涂阳患者的平均治愈率和新发涂阴完成疗程率分别为97.8%、97.5%和94.7%,其他地州为90.04%、83.89%和74.38%;转诊到位率、追踪率、追踪到位率、总到位率为7.35%、74.94%、43.75%、36.67%,其他地州为35.65%、96.25%、55.93%、68.80%。结论喀什地区是新疆结核病高发区之一。在缺乏严格全程督导管理下,长期、大量、大范围高治愈率报表与疫情失控显然有悖;病人转报存在＂高报、低转、高追、低到＂情况;当务之急是提高认识、加强培训、严格管理、科学统计。     

Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study

Background  

Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients.     

2005—2009年北京市平谷区肺结核患者的发现与治疗管理分析

目的 通过回顾分析2005-2009年北京市平谷区肺结核患者的发现登记和治疗管理情况,探索适合农村山区传染性肺结核患者的发现方式和治疗管理模式。 方法 采用描述流行病学方法, 对平谷区2005-2009年563例肺结核患者发现方式、登记数据、管理模式和治疗转归进行分析。2005-2009年北京结核病控制研究所下达新涂阳发现任务指标总数为280例。 结果 2005-2009年全区共登记治疗管理户籍人口活动性肺结核患者563例,山区、半山区肺结核患者381例,占67.7%,新登肺结核年均登记率为32.86/10万;平原地区新登肺结核患者182例,占32.3%,新登肺结核年均登记率为22.12/10万。山区、半山区肺结核患者登记率明显高于平原地区（χ²=19.562,P＜0.001）。2005-2009年年平均涂阳肺结核登记率为13.27/10万,发现方式以转诊和因症就诊的被动发现方式为主,达94.1%（530/563）,新涂阳发现任务指标平均完成率为83.9%（235/280）。金海湖镇为我区肺结核的高发地区,2005-2009年新登活动性肺结核患者118例,占全区的21.0%,其中合并有矽肺的涂阳肺结核患者22例,占金海湖镇新发涂阳肺结核患者的37.9%（22/58）。563例患者100％实施现代结核病控制策略（DOTS）,全部采用家庭成员为督导员的全程督导管理方式,新涂阳患者强化期末平均痰菌转阴率为79.6%（187/235）,新涂阳患者治愈率88.9%（209/235）。 结论 将结核病控制工作的重点放到农村边远山区,及时主动发现新涂阳肺结核患者,并给予彻底、规范化的治疗,有效控制肺结核病在人群中传播。     

Seroprevalence of HIV infection among paediatric tuberculosis patients in Agra, India: a hospital-based study

In this study which was carried over a period of 2 years, from 2003 to 2004, 270 paediatric patients with active Tuberculosis (TB) disease attending the OPD of S.N. Medical College, Agra were screened for Human Immunodeficiency Virus (HIV)-1/2 antibodies. Of these, 23 were found to be HIV-positive. Seroprevalence of HIV infection among paediatric TB patients in Agra is 8.51% (23/270). The HIV infection was found to be significantly higher, i.e. 82.61% in male children than in female children, i.e. 17.39%. Among the age groups, which were divided into < or =1, 2-5, 6-10 and 11-15 years, maximum cases of HIV-positivity, i.e. 65.22% was observed in the age group, 2-5 years of age. Among the HIV-positive children with TB, 86.75% were of pulmonary and 13.04% were of extra-pulmonary type. Among the vaccinated children, 65.22% were found to be HIV-positive, while 34.78% of the HIV-positive children were not BCG vaccinated. HIV-positive children are more likely to suffer from prolonged fever, weight loss, failure to thrive, developmental delay, stunted growth, cough, anorexia, lethargy, lower respiratory tract infections (LRTI) and hepatosplenomegaly while HIV negative are more likely to suffer from fever, diarrhoea, lymphadenitis, pallor and LRTI. 82.60% (19/23) of these TB patients had a history of positive contact with HIV, i.e. one of the parents was HIV-infected. The mode of transmission of HIV infection among paediatric TB patients was perinatal as revealed during the counselling sessions (pre-test and post-test) of both the parents.     

Clinical characteristics of pulmonary tuberculosis patients from a southern Taiwan hospital-based survey

This study aimed to identify the clinical characteristics of culture-positive pulmonary tuberculosis (TB) patients from a southern Taiwan hospital-based survey between August 1, 2003 and July 31, 2006. Demographics, symptoms, susceptibility patterns, sputum acid-fast bacilli (AFB) stain status and treatment outcomes were recorded. The medical records of 154 patients who presented to the Kaohsiung Municipal Hsiao-Kang Hospital were analyzed retrospectively. The mean age of patients was 59.5 years; 115 patients were male and 39 were female. Diabetes mellitus (48/154; 31.2%) was the most frequent risk factor for pulmonary TB infection. Nearly all patients (139/154; 90.3%) had a cough. Fever was only seen in 27.9% and hemoptysis in 14.9% of patients. The combined resistance rates of Mycobacterium tuberculosis to the tested first-line agents were as follows: isoniazid, 3.2%; rifampin, 7.8%; ethambutol, 5.8%; and streptomycin, 2.6%. The combined resistance rate to any one of four first-line drugs was 12.3%. The combined resistance rate to ofloxacin was 3.9%. The combined resistance rate of multidrug resistant-TB was 1.9%. Sputum AFB stains were positive in 68.2% of cases. Analysis of treatment outcomes showed overall treatment success at 76.6%. The proportions of patients who died, defaulted treatment or in whom treatment failed were 16.2%, 3.9% and 0.0%, respectively. In conclusion, our study showed: (1) a higher frequency of pulmonary TB in male subjects than in other areas of Taiwan; (2) a higher frequency of cough and lower frequency of fever and hemoptysis than previous studies; (3) that the combined resistance rates to isoniazid and streptomycin were lower than both average levels in Taiwan and the global combined drug resistance rate; and (4) a higher proportion of patients responding to treatment and lower proportions of patients suffering mortality, defaulting treatment or not responding to treatment compared with other areas of Taiwan. With regard to resistance rates, the combined resistance rate to ethambutol was similar to the average level in Taiwan and higher than the global combined drug resistance rate. However, the combined resistance rate to rifampin was higher than both the average level in Taiwan and the global combined drug resistance rate. The combined resistance rates to at least any one of four first-line drugs and multidrug resistant-TB were lower than the average levels in Taiwan and higher than the global combined drug resistance rate. Our results may help to identify local variations in the disease and improve the effectiveness of TB infection control programs.     

Encephalitis in Taiwan: a prospective hospital-based study

To investigate encephalitis in Taiwan, a multicenter study was conducted with patients who had acute severe neurological dysfunction and suspected encephalitis from May 2000 to December 2001. Demographic data such as age, sex, and seasons were analyzed. Polymerase chain reaction analyses were performed to determine the microbiologic diagnosis. The patients included 73 males and 54 females, with a peak age of 10-40 years old. Microbiologic diagnoses in 86 (69%) of 124 cases involved herpes simplex virus (HSV, 45 cases), varicella zoster (16 cases), Mycobacterium tuberculosis (10 cases), cytomegalovirus (8 cases), adenovirus (5 cases), influenza (1 case), and enterovirus (1 case). Pathogens were found in 69% of the cases. Encephalitis was most likely to occur in June and July. Based on the results, HSV is still the major viral cause of encephalitis in Taiwan.     

Benign joint hypermobility syndrome: a hospital-based study from northern India

ObjectivesTo study the frequency, demography, clinical features and response to treatment of benign joint hypermobility syndrome (BJHS) in a rheumatology clinic at a tertiary referral centre in India and to ascertain the association of hypermobility with musculoskeletal symptoms.MethodsConsecutive adult patients with Beighton score of 5 or more and conforming to Brighton criteria were recruited from the rheumatology clinic over 18 months. Detailed clinical and laboratory work-up was carried out including ophthalmologic and echocardiographic evaluation. Treatment comprised reassurance, physiotherapy and nonsteroidal anti-inflammatory drugs/analgesics. Pain score and patient global assessment were measured at 0, 2 and 12 weeks. The association of hypermobility with musculoskeletal symptoms was ascertained in a case-control study performed separately.ResultsHypermobility (Beighton score ≥ 5) was observed in about 20% (405/2050) of rheumatology referrals. However, only about half of them (204/2050) met the Brighton criteria for BJHS. One hundred BJHS patients (mean age 30 ± 9.4 years, female : male = 2.2 : 1) were recruited for detailed study. All had gross hypermobility and knee was the commonest joint involved. Rheumatoid distribution of painful joints often raised suspicion of rheumatoid arthritis (RA) but objective clinical and laboratory findings of RA were lacking. Sixty-one had received a wrong diagnosis before referral (RA, ankylosing spondylitis, rheumatic fever) and 22 had been taking long-term penicillin prophylaxis for suspected rheumatic fever. About 40% had negligible symptoms after 12 weeks while others continued to suffer from mild to moderate symptoms with no synovitis or joint damage. Case-control study showed greater likelihood of presence of hypermobility amongst the patients referred to the rheumatology clinic with odds ratio = 3.23 (CI = 1.86–5.63, P= 0.000).Conclusions BJHS is common in Indians and is often mistaken for other rheumatic disorders. There is 3.2 times more likelihood of finding joint hypermobility amongst patients referred to a rheumatology clinic, thereby confirming its association with musculoskeletal complaints.     

Survey of deaths in hong kong attributed to tuberculosis during a five-year period

For the 12-month period from September 1st 1975 to August 31st 1976, and for the years 1979 and 1980, records were obtained for patients certified on part I of the death certificate as having died from tuberculosis in Hong Kong. In addition, records were obtained for patients in whom tuberculosis was a contributory cause of death (part 11 certifications) in 1979 and in 1980. The records for each survey were reviewed by an independent assessor. In the assessor's opinion, the diagnosis of tuberculosis was adequately established in 93%, 92%, and 92% of the patients in the 3 periods respectively, but among the part I certifications tuberculosis had in fact been the direct cause of death in only 74%, 78%, and 76%, active disease being the cause in 53%, 48% and 42%, and the late results of previous disease, inactive at the time of death, in 21%, 30% and 35%, respectively. Among the part II certifications, 39% in 1979 and 45% in 1980 should have been part I certifications, and only 32% and 24% respectively had been correctly certified in part II.If all the patients certified in part I had really died from tuberculosis, the death rates would have been 13.1 per 100 000 population in 1975/76, 9.7 in 1979, and 10.3 in 1980. According to the assessor's classification these should have been 9.7, 7.5, and 7.9 respectively, the rates from active disease declining from 6.9 in 1975/76, to 4.6 in 1979, and 4.3 in 1980. Among both part I and part II certifications there was a marked preponderance of males, and the death rates were particularly high in patients of both sexes aged 55 years or over.     

Seasonal influenza virus strains circulating in Malaysia from 2005 to 2009

From 2005 to 2009, the Institute for Medical Research (IMR), Kuala Lumpur received a total of 7,117 respiratory specimens from patients with influenza-like illness (ILI) for influenza screening. Seasonal influenza virus was isolated from 17.3% of patients with ILI in 2005, 31.6% in 2006, 12.8% in 2007, 10.2% in 2008 and 13.5% in 2009. There were one or more influenza A and B virus strains circulating in Malaysia throughout the year, with distinctly a peak in May to August. The predominant circulating strains of seasonal influenza A were A/California/7/2004-like (H3N2) in 2005, A/New Caledonia/20/99-like (H1N1) in 2006, A/ Brisbane/10/2007-like (H3N2) in 2007 and 2008, and A/Perth/16/2009-like (H3N2) virus in 2009. The predominant circulating strains of influenza B were B/Hong Kong/330/2001-like in 2005, B/Malaysia/2506/2004-like in 2006, B/Florida/4/2006-like in 2007 and 2008, and B/Brisbane/60/2008-like in 2009.     

2005—2009年部队献血员检测项目结果分析

目的：分析献血员体检项目不合格人数占当年献血总人数和不合格人数百分率,并观察其分布规律,确定部队献血员筛查重点,为部队征兵提供参考指标。方法：统计2005-2009年的部队献血员的检测资料,计算阳性百分率,分析变化趋势。结果：ALT阳性率以2007年最高,2009年最低,总体呈正态分布;HBsAg和抗-HCV阳性率呈增高趋势,且抗-HCV阳性率明显高于HBsAg;TP阳性率呈下降趋势,5年内无抗-HIV确诊阳性标本检出。结论：部队献血员检测项目阳性率明显低于地方献血员,HBsAg和抗-HCV阳性率高低与地方献血员比例分布呈倒置状态。建议在以后的征兵体检时,应重视应征者抗-HCV的检测。     

溃疡性结肠炎住院患者525例临床特征分析

目的 探讨近16年解放军总医院溃疡性结肠炎(UC)的临床特征的变化特点.方法 总结分析解放军总医院1994至2009年期间确诊并住院治疗的UC患者的临床资料.结果 自1994-2009年共有525例患者诊断为UC,中位发病年龄42岁.在发病部位中,12.4%(65/525)为直肠,25.7%(135/525)为直乙状结...     

天津市2005—2007年结核病流行病学分析

目的了解天津市结核病发病水平及流行特点,探讨预防与控制策略。方法采用Excel 2003对2005～2007年来我院就诊的结核病例进行统计和分析。结果涂阳病人呈上升趋势,构成比中从24．41％增长到28．50％,男性发病明显高于女性,而发病年龄主要集中在中年,无明显的季节性,流行呈散发,主要结核病人还是本地人。结论肺结核病疫情依然较重,应继续作重点控制,加大投入,落实结核病防治管理措施。     

Seroprevalence of HIV infection among tuberculosis patients in Agra, India--a hospital-based study

In this study which was carried over a period of 4 years, from 2001 to 2004, 600 adult patients with active TB disease attending the OPD of TBDTC, Agra, were screened for HIV-1/2 antibodies. Of these, 26 were found to be HIV-positive. Seroprevalence of HIV infection among adult TB patients in Agra is 4.3% (26/600). The HIV infection was found to be more in females, i.e. 7.95% (7/88) than in males, 3.71% (19/512). HIV-positivity of 5% was observed in the age groups, 15-24 and 25-34 years, i.e. 3/60 and 13/260, respectively. Among HIV-positive TB patients, 4.2% (22/524) were of pulmonary and 5.3% (4/76) were of extra-pulmonary type. A total of 3.04% (6/197) of HIV-positive TB patients were PPD positive and 4.96% (20/403) were PPD negative and bacillary positivity was 4.4% (15/340) and bacillary negativity was 4.2% (11/260). A total of 3.5% (18/515) of TB patients had a history of positive contact, i.e. spouse or one of the family members was HIV-infected. The difference in signs and symptoms among the HIV positive and HIV negative TB patients was found to be statistically significant.