121例成人55型腺病毒肺炎胸部CT影像分析

目的回顾性分析121例成人55型腺病毒肺炎的胸部CT影像学表现,为该病的影像学诊断提供参考。方法总结2012年2月某单位暴发的55型腺病毒感染疫情,选择其中121例经肺部CT确诊的肺炎患者为研究对象,分析其临床表现及胸部CT特点。结果 121例体温为(39.22±0.77)℃,热程为(7.12±2.23)d,所有患者均有咳嗽、咳痰、咽痛及咽充血,其中87.60%扁桃体肿大,64.46%颈部淋巴结肿大。90例表现为肺部单叶或多叶段少许渗出性病变,22例为多叶段片状团簇状影,8例为肺部单叶条索状影,1例为支气管扩张伴感染。单肺叶病变组热程短于多肺叶病变组(P0.05),但2组间最高体温、白细胞计数、中性粒细胞比例及CRP差异无统计学意义。结论成人55型腺病毒感染与普通上呼吸道病毒感染临床表现类似,胸部CT提示多数患者存在肺部影像学异常,肺外表现较少;多肺叶受累者并未表现出明显的重症倾向。     

非免疫缺陷成人重症腺病毒B组55型肺炎1例

人类腺病毒(HAdV)是双链DNA病毒,其血清型、病毒毒力、入侵机体的部位和宿主因素不同,引起的临床症状不同。呼吸道腺病毒感染常见于婴幼儿,非免疫缺陷的成年人出现腺病毒肺炎的几率较小,且早期的临床表现缺乏特异性,多以发热、咳嗽、气促等症状起病。引起非免疫缺陷成人腺病毒肺炎的血清型包括B组的3型、7型、11型、14型、35型,C组的1型,E组的4型,现报道1例非免疫缺陷重症腺病毒肺炎罕见基因型,并相关文献复习。     

潮汕地区呼吸道感染患儿腺病毒流行情况及临床分析

目的 了解潮汕地区呼吸道感染患儿腺病毒流行情况及临床特征.方法 收集2012年7月至2016年6月因呼吸道感染入住汕头大学医学院第二附属医院儿科患儿的咽拭子标本2 668份,应用多重聚合酶链反应(PCR)技术,对咽拭子标本行腺病毒、呼吸道合胞病毒、人鼻病毒、WU多瘤病毒、人博卡病毒、流感病毒A、B型、副流感病毒1、3型、人类偏肺病毒共10种(型)病毒检测,并对腺病毒阳性病例进行临床资料分析.结果 2 668份咽拭子标本中,病毒阳性1 388份(52.02%),其中腺病毒95例(3.53%);腺病毒感染呈全年散发,年龄主要集中发生在6岁以下,尤其是3岁以下;主要临床症状表现为发热、咳嗽、喘息、气促,其中混合感染组中,随着合并感染病毒数增加,咳嗽、喘息症状越明显,95例中仅4例(4.21%)患儿符合重症肺炎诊断.结论 腺病毒2012年7月至2016年6月腺病毒在潮汕地区没有发生规模以上的流行和暴发;腺病毒与其他病毒混合感染普遍存在;呼吸道腺病毒感染的临床表现和实验室检查及影像学检查均无特异性特征,但随着合并感染病毒种类数目的增加,咳嗽、喘息、气促发生率更高;近4年来潮汕地区腺病毒呼吸道感染临床症状普遍较轻,重症肺炎发生率低.     

儿童重症博卡病毒与腺病毒肺炎临床比较

目的 通过对比临床常见的重症腺病毒肺炎的临床特点，更好的了解重症博卡病毒(HBoV)肺炎的临床特征，指导临床工作。方法 收集2017年1月-2019年12月苏州大学附属儿童医院重症医学科42例重症博卡病毒(HBoV)肺炎及30例重症腺病毒(ADV)肺炎患儿临床资料，进行比较分析。结果 重症HBoV肺炎和ADV肺炎发生率分别为1.93%(42/2178)和4.85%(30/619),两者中位年龄分别为1.33(1.00,1.89)岁、1.25(0.96,2.77)岁，差异无统计学意义(P=0.587)。重症HBoV肺炎全年均可发生，以春季偏低，为7.14%(3/42)。而重症ADV肺炎以冬季高发。78.57%(33/42)重症HBoV肺炎患儿有喘息，显著高于重症ADV肺炎的30.00%(9/30)(P<0.001)。30.95%(13/42)重症HBoV肺炎有发热，显著低于重症ADV肺炎的80.00%(24/30)(P<0.001);重症HBoV肺炎组影像学以肺纹理增粗模糊、小斑片状影多见，存在絮片状影、胸腔积液表现显著低于重症ADV肺炎组(P<0.05)。2.38%(...     

儿童肺炎支原体肺炎的临床及影像学特征分析

目的 回顾性分析儿童肺炎支原体肺炎的临床表现和影像学特征,为临床诊治提供依据。方法 回顾性分析2023年11月至2024年1月在清华大学第一附属医院和首都儿科研究所附属儿童医院门诊就诊及住院的肺炎支原体肺炎患儿200例的临床资料、胸部CT影像学资料和病原学检查结果。胸部CT影像观察指标包括病灶在肺内的分布范围、支气管壁增厚、肺内病灶的影像表现形式、有无塑形性支气管炎、有无胸腔积液等。结果 共纳入200例肺炎支原体肺炎患儿,年龄范围1月龄至15岁,平均年龄(8.29±2.81)岁,其中男107例(53.5%),女93例(46.5%)。临床症状主要为发热165例(66.0%),发热病程1～30d,中位数7d;其次是咳嗽162例(64.8%),咳嗽病程2～60d,中位数7d;其他症状按频率依次为咳痰、喘息、流涕、咽痛、呕吐、头痛、胸痛、呼吸困难、荨麻疹等。肺部病灶累及最多为左肺下叶,其次是右肺下叶;影像学表现依次是支气管壁增厚、树芽征和肺实变。儿童肺炎支原体肺炎合并感染腺病毒最多见。发生塑形性支气管炎与非塑形性支气管炎的患儿在合并呼吸道合胞病毒感染、树芽征、腺泡结节、肺实变、肺不张、胸腔积液...     

腺病毒7型致呼吸道感染暴发流行的临床特点与治疗探讨

目的:分析一起腺病毒7型呼吸道感染暴发流行的临床特点和治疗经验。方法:首发病例及其陪护咽拭子行RT-PCR检测及序列测定鉴别病原体类型及变异情况。密切接触者53例取鼻咽拭子标本行甲型流感病毒和腺病毒核酸抗原检测,腺病毒核酸阳性者取隔离初期及解除隔离前双份血清标本,行腺病毒Ig M抗体测定,隔离初期抽血检测淋巴细胞亚群。并对临床资料进行回顾性分析。结果:53例密切接触者中17例腺病毒阳性,其中隐性感染者9例,急性上呼吸道感染4例,腺病毒性肺炎4例,其中重症肺炎3例,腺病毒阳性患者采用静脉滴注利巴韦林及中西医结合抗病毒治疗,重症腺病毒肺炎给予甲泼尼龙抗炎治疗及提高免疫力等综合治疗,除首发病例死亡外,均治愈。结论:早诊断、早隔离、早治疗是控制腺病毒呼吸道感染暴发流行和改善预后的关键。     

群体性人55型腺病毒感染的临床特征分析

目的:回顾性分析既往发生的群体性人55型腺病毒(human adenovirus 55,HAdV-55)感染的临床特征和诊治过程,为类似疫情处置和临床诊疗提供借鉴。方法:收集2011—2018年发生的7起HAdV-55感染疫情资料中1 074例患者的临床资料,总结分析其临床表现、实验室检查指标、胸部影像学特点和临床转归。结果:677例患者资料完整。HAdV感染潜伏期3～8 d,具有发热(100.0%)、咳嗽(86.0%)、咽痛(70.0%)等症状。常见的体征是咽部充血(100.0%)和扁桃体增大(27.6%)。血常规显示白细胞减少(18.1%)、淋巴细胞减少(75.8%)、单核细胞增多(36.2%)。肺部感染占50.1%,最常见的异常表现为肺部单侧或双侧的结节状、斑片状、小片状或大片斑片状高密度影。心率(≥100次/min)、体温(39℃且持续3 d以上)、呼吸频率(≥30次/min)和干咳(3 d)是HAdV-55感染并发严重呼吸衰竭的危险因素。结论:HAdV-55易引起群体性呼吸道感染暴发流行,约半数患者可发展为肺炎。入院初即进行实验室与影像学检查以筛查重症病例,及时观察和分析心率、体温和呼吸频率等生命体征的改变对预测疾病临床转归、评估预后具有重要意义。     

肺炎型肺癌的影像诊断与病理对照分析研究

目的探讨肺炎型肺癌的特征与病理对照及诊断价值。方法分析32例经病理证明的肺炎型肺癌的临床、病理、影像资料。结果 32例肺炎型肺癌中,支气管肺泡癌25例,7例腺癌。影像学分为6型:单纯磨玻璃影肿块6例,磨玻璃伴结节影响9例,6例为肺叶及肺段分布实变影,5例为肺叶及肺段实变伴空泡及蜂窝状影,5例为肺炎变并纤维化及肿块,1例为混合阴影。影像学特点:病变范围逐渐增大及病变形态由磨玻璃或实变影逐渐进展为结节、纤维化、蜂窝及肿块,以及出现淋巴及远处转移。结论肺炎性肺癌影像学表现多样性,动态观察影像学具有一定特征性。     

16例肺炎性假瘤的诊断与外科治疗

目的探讨肺炎性假瘤的临床表现、诊断及外科治疗。方法总结分析16例肺炎性假瘤的临床诊治情况。结果全组术前仅4例（25.0%）诊断正确,5例（31.3%）误诊肺癌,7例（43.7%）误诊为良性肿瘤,均行手术治疗,肺叶切除11例,肺楔形切除4例,假瘤摘除1例,术后无并发症和死亡。结论该病从临床症状和影像学上很难与肺癌鉴别,术前纤维支气管镜和CT引导经皮肺穿刺检查十分重要,必要时给予诊断性抗炎或抗结核治疗,术中冰冻切片明确病理诊断,决定手术方式,术式以局部切除和肺叶切除为主,尽量多保留正常肺组织。     

老年院内获得性肺炎的影像学特征分析

目的 探讨老年院内获得性肺炎的影像学特征.方法 回顾性收集临床确诊的老年院内获得性肺炎67例的临床及影像学资料,分析其病原分布及CT表现.结果 老年院内肺部感染的病原体中细菌31例(46％),支原体或衣原体6例(9％),病毒感染7例(10％),结核9例(13％),各种真菌14例(22％).67例中有47例为混合感染(71％).肺CT表现多种多样,基本表现为肺内实质和间质同时受累,呈小点状、小片状、结节状、磨玻璃、小空洞阴影多种混合存在;不按肺叶和支气管纹理的散在分布.结论 老年院内获得性肺炎的CT表现与感染的病原有关,在结核或COPD等基础疾病基础上合并真菌感染是老年院内肺部感染的特点,其影像学表现特征性不明显.     

Effects of inspiratory muscle training in patients with heart failure

Aim

To investigate the effects of inspiratory muscle training (IMT) on functional capacity and balance, respiratory and peripheral muscle strength, pulmonary function, dyspnea, fatigue, depression, and quality of life in heart failure patients.

Methods

A prospective, randomized controlled, double-blinded study. Thirty patients with heart failure (NYHA II-III, LVEF<40%) were included. Sixteen patients received IMT at 40% of maximal inspiratory pressure (MIP), and 14 patients received sham therapy (15% of MIP) for 6 weeks. Functional capacity and balance, respiratory muscle strength, quadriceps femoris muscle strength, pulmonary function, dyspnea, fatigue, quality of life, and depression were evaluated.

Results

Functional capacity and balance, respiratory and peripheral muscle strength, dyspnea, depression were significantly improved in the treatment group compared with controls; quality of life and fatigue were similarly improved within groups (p < 0.05). Functional capacity (418.59 ± 123.32 to 478.56 ± 131.58 m, p < 0.001), respiratory (MIP = 62.00 ± 33.57 to 97.13 ± 32.63 cmH₂O, p < 0.001) and quadriceps femoris muscle strength (240.91 ± 106.08 to 301.82 ± 111.86 N, p < 0.001), FEV₁%, FVC% and PEF%, functional balance (52.73 ± 3.15 to 54.25 ± 2.34, p < 0.001), functional dyspnea (2.27 ± 0.88 to 1.07 ± 0.79, p < 0.001), depression (11.47 ± 7.50 to 3.20 ± 4.09, p < 0.001), quality of life, fatigue (42.73 ± 11.75 to 29.07 ± 13.96, p < 0.001) were significantly improved in the treatment group. Respiratory muscle strength (MIP = 78.64 ± 35.95 to 90.86 ± 30.23 cmH₂O, p = 0.001), FVC%, depression (14.36 ± 9.04 to 9.50 ± 10.42, p = 0.011), quality of life and fatigue (42.86 ± 12.67 to 32.93 ± 15.87, p = 0.008) were significantly improved in the control group.

Conclusion

The IMT improves functional capacity and balance, respiratory and peripheral muscle strength; decreases depression and dyspnea perception in patients with heart failure. IMT should be included effectively in pulmonary rehabilitation programs.     

Cardiac arrhythmias and sudden cardiac death in women

Zusammenfassung. Hintergrund: Geschlechtsspezifische Unterschiede bei Herzrhythmusstörungen sind seit Jahrzehnten bekannt. Einflüsse von Sexualsteroiden auf das autonome Nervensystem und die zelluläre Elektrophysiologie des Erregungsbildungs- und -leitungssystems werden ebenso diskutiert wie direkte genetische Dispositionen auf zellulärer, funktioneller oder metabolischer Ebene. Zudem gilt es, die alters- und geschlechtsspezifischen Unterschiede im Hinblick auf unterschiedliche kardiale Grunderkrankungen zu berücksichtigen, die ihrerseits Häufigkeit, Form und Schwere maßgeblich mitbestimmen. Herzrhythmusstörungen bei Frauen: Eine im Vergleich zu Männern höhere Ruhefrequenz und ein längeres QTc-Intervall, beginnend nach der Pubertät, sind die auffälligsten EKG-Veränderungen bei Frauen und weisen eine enge Beziehung zu konstitutionellen und hormonellen Einflüssen auf. Supraventrikuläre Herzrhythmusstörungen, bei Frauen prädestiniert Sinus- und AV-Knoten-Reentry-Tachykardien, seltener Wolff-Parkinson-White-Tachykardien, können zyklusabhängigen Häufigkeitsschwankungen unterliegen. Vorhofflimmern ist bei Frauen ebenfalls häufiger als bei Männern, meist typischerweise symptomatisch, und die Therapie erweist sich als problematischer. Ventrikuläre Herzrhythmusstörungen, in der gesunden Allgemeinbevölkerung gleich häufig, weisen bei Männern eine enge und prognostisch bedeutsame Beziehung zur KHK auf, während diese bei Frauen weniger ausgeprägt ist und arrhythmogene Kofaktoren eine größere Rolle spielen. Frauen leiden häufiger an erworbenem und kongenitalem Long-QT-Syndrom, in deren Folge häufiger Torsade de pointes-Tachykardien auftreten (u. a. durch ausgeprägtere medikamentös induzierte QT-Verlängerung, häufigere Kurz-Lang-Sequenzen, Unterschiede der Ikr-Sensitivität), die allerdings seltener als bei Männern in Kammerflimmern degenerieren. Frauen sind von einem plötzlichen Herztod etwa dreimal seltener betroffen. Er ereignet sich etwa zehn Jahre später; die zugrunde liegende Ursache ist deutlich heterogener als bei Männern, und die Prognose, ein solches Ereignis zu überleben, ist deutlich schlechter. Frauen sind in Studien zu Primär- und Sekundärprävention deutlich unterrepräsentiert, wenngleich der Nutzen dieser Therapie sogar den bei Männern zu übersteigen scheint. Schlussfolgerungen: Auch wenn die Genese der geschlechtsspezifischen Unterschiede von kardialen Arrhythmien in einer Reihe von Punkten noch offen ist, implizieren die dargestellten Befunde die besondere Notwendigkeit eines entsprechend ausgerichteten Forschungsansatzes, da sich nur so geschlechtsspezifische Risikostratifikations- und Therapieansätze für die Zukunft entwickeln lassen.     

Gut microbiota changes in patients with hypertension: A systematic review and meta-analysis

Hypertension is a major public health issue worldwide. The imbalance of gut microbiota is thought to play an important role in the pathogenesis of hypertension. The authors conducted the systematic review and meta-analysis to clarify the relationship between gut microbiota and hypertension through conducting an electronic search in six databases. Our meta-analysis included 19 studies and the results showed that compared with healthy controls, Shannon significantly decreased in hypertension [SMD = −0.13, 95%CI (−0.22, −0.04), p = .007]; however, Simpson [SMD = −0.01, 95%CI (−0.14, 0.12), p = .87], ACE [SMD = 0.18, 95%CI (−0.06, 0.43), p = .14], and Chao1 [SMD = 0.11, 95%CI (−0.01, 0.23), p = .08] did not differ significantly between hypertension and healthy controls. The F/B ratio significantly increased in hypertension [SMD = 0.84, 95%CI (0.10, 1.58), p = .03]. In addition, Shannon index was negatively correlated with hypertension [r = −0.12, 95%CI (−0.19, −0.05)], but had no significant correlation with SBP [r = 0.10, 95%CI (−0.19, 0.37)] and DBP [r = −0.39, 95%CI (−0.73, 0.12)]. At the phylum level, the relative abundance of Firmicutes [SMD = −0.01, 95%CI (−0.37, 0.34), p = .94], Bacteroidetes [SMD = −0.15, 95%CI (−0.44, 0.14), p = .30], Proteobacteria [SMD = 0.25, 95%CI (−0.01, 0.51), p = .06], and Actinobacteria [SMD = 0.21, 95%CI (−0.11, 0.53), p = .21] did not differ significantly between hypertension and healthy controls. At the genus level, compared with healthy controls, the relative abundance of Faecalibacterium decreased significantly [SMD = −0.16, 95%CI (−0.28, −0.04), p = .01], while the Streptococcus [SMD = 0.20, 95%CI (0.08, 0.32), p = .001] and Enterococcus [SMD = 0.20, 95%CI (0.08, 0.33), p = .002] significantly increased in hypertension. Available evidence suggests that hypertensive patients may have an imbalance of gut microbiota. However, it still needs further validation by large sample size studies of high quality.     

Clinical characteristics of non‐small cell lung cancer patients with EGFR mutations and ALK&ROS1 fusions

ObjectiveTo study the relationship between clinical characteristics and anaplastic lymphoma kinase (ALK) fusions, c‐ros oncogene 1, receptor tyrosine kinase (ROS1) gene fusions, and epidermic growth factor receptor (EGFR) mutations in non‐small cell lung cancer (NSCLC) patients to distinguish these different types.MethodsBoth ALK, ROS1 gene rearrangements and EGFR mutations testing were performed. The clinical characteristics and associated pulmonary abnormalities were investigated.ResultsFour hundred fifty‐three NSCLC patients were included for analysis. One hundred seventy (37.5%), 32 (7.1%), and 9 cases (2.0%) with EGFR mutations, ALK gene fusions, and ROS1 gene fusions were identified, respectively. The EGFR‐positive and ALK&ROS1‐positive were more common in female (χ ² = 61.934, P < 0.001 and χ ² = 28.152, P < 0.001), non‐smoking (χ ² = 59.315, P < 0.001 and χ ² = 11.080, P = 0.001), and adenocarcinoma (χ ² = 44.864, P < 0.001 and χ ² = 12.318, P = 0.002) patients; proportion of patients with emphysema was lower (χ ² = 35.494, P < 0.001 and χ ² = 15.770, P < 0.001) than the wild‐type patients. The results of logistic regression analysis indicated that female (adjusted odds ratio [OR] 1.834, 95% confidence interval [CI] 1.069–3.144, P = 0.028), non‐smoking (adjusted OR 2.504, 95% CI 1.456–4.306, P = 0.001), lung adenocarcinoma (adjusted OR 4.512, 95% CI 2.465–8.260, P < 0.001), stage III–IV (adjusted OR 2.232, 95% CI 1.066–4.676, P = 0.033), and no symptoms of emphysema (adjusted OR 2.139, 95% CI 1.221–3.747, P = 0.008) were independent variables associated with EGFR mutations. Young (adjusted OR 3.947, 95% CI 1.873–8.314, P < 0.001) and lung adenocarcinoma (adjusted OR 2.950, 95% CI 0.998–8.719, P = 0.050) were associated with ALK/ROS1 fusions.Conclusions EGFR mutations were more likely to occur in non‐smoking, stage III–IV, and female patients with lung adenocarcinoma, whereas ALK&ROS1 gene fusions were more likely to occur in young patients with lung adenocarcinoma. Emphysema was less common in patients with EGFR mutations.     

Arterial blood pressure and serum lipids in a population of children and adolescents from Southern Italy: The Calabrian Sierras Community Study (CSCS)

Background

Lipid standards in Italy are lacking in children and adolescents whereas those for blood pressure (BP) were derived from US surveys.

Methods

In a 14-town community in Southern Italy 1657 (64%) of 2594 children aged 6–14 years were enrolled and anthropometric, BP, lipid and glucose serum levels were obtained.

Results

Average systolic BP was 101 ± 11 (60–150) mm Hg and cholesterol (CholT) level was 156 ± 28 (57–264) mg/dl. There were positive (p < 0.00001) age-trends for systolic BP and body mass index (BMI) in both genders whereas age-trends for CholT and heart rate were negative (p < 0.00001). A negative age-trend in both genders was also seen for non-HDL cholesterol (p < 0.03). Based on 95% percentile gender and age distributions, there were 177 (10.68%) hypertensive (HT) and 82 (4.94%) hypercholesterolemic (HC) children or adolescents. Univariately, HT had higher (p < 0.00001) height, weight, BMI, arm circumference, hips, waist, diastolic BP and waist/height, whereas HC had higher LDL-, HDL and non-HDL-cholesterol and triglycerides (p < 0.01). Systolic BP was predicted (r² = 0.2810, p = 0.00001) by age (t = 2.319, p < 0.0205), male gender (t = 3.179, p < 0.0015), glucose (t = 2.357, p < 0.0186), height (t = 2.473, p < 0.0135), arm circumference (t = 3.313, p < 0.0009) and heart rate (t = 4.161, p < 0.00001). CholT was related inversely (r² = 0.1399, p = 0.00001) to height (t = − 3.928, p < 0.0001), weight (t = − 3.922, p < 0.0001) and waist/height (t = − 4.797, p < 0.00001) and directly to BMI (t = 3.064, p < 0.0022), waist (t = 5.149, p < 0.0000), triglycerides (t = 11.332, p < 0.00001) and female gender (t = − 2.041, p < 0.0414).

Conclusion

In these Southern Italian children and adolescents systolic BP and CholT are related with anthropometric and other variables, not confined to height. BP is lower than previously reported.     

Quality of life in young fibromyalgia patients and effect of depression

Aim: The purpose of this study was to compare the depression and quality of life (QOL) scores of fibromyalgia (FM) patients and control subjects. We also aimed to detect relationships between different QOL scales, depression and clinical symptoms. Method: Ninety‐eight fibromyalgia patients and 48 healthy volunteers were included in the study. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rating Scale and Diagnostic and Statistical Manual for Mental Disorders Edition 4 (DSM‐IV) criteria. QOL of the FM patients was assessed according to the Nottingham Health Profile (NHP), Health Assessment Questionnaire (HAQ), and Fibromyalgia Impact Questionnaire (FIQ). Results: We found significantly higher scores of depression, NHP, FIQ and HAQ in FM patients compared with controls (P < 0.000). Pain, tender point count (TPC), pain intensity, skinfold tenderness, FIQ, HAQ, and NHP scores were higher in patients with depression than in those without depression. Depression scores correlated with FIQ (r = 0.39, P < 0.01), HAQ (r = 0.35, P < 0.01), NHP (r = 0.55, P < 0.01) scores, TPC (r = 0.34, P < 0.01) and duration of disease (r = 0.21, P < 0.05). Fibromyalgia Impact Questionnaire scores correlated with HAQ scores (r = 0.45, P < 0.01), NHP scores (r = 0.49, P < 0.01) and TPC (r = 0.21, P < 0.05). HAQ scores correlated with NHP scores (r = 0.40, P < 0.01) and TPC (r = 0.29, P < 0.05). Nottingham Health Profile scores correlated with TPC (r = 0.43, P < 0.01) and duration of disease (r = 0.22, P < 0.05). Conclusion: We found higher scores of TPC, pain intensity, skinfold tenderness, NHP, FIQ, and HAQ in depressive FM patients as compared with non‐depressive FM patients. Our study indicates that there is an important relationship between pain, depression and QOL scales in young FM patients. Therefore; these patients should be managed using a multidisciplinary approach including psychiatric support.     

Diabetes and pregnancy

Summary Pregnancy raises insulin requirement, lowers the renal threshold for glucose, increases the tendency to infection of the urinary tract and to renal insufficiency. Diabetic women are more prone to hydramnios, toxemia, stillbirths and neonatal deaths. Their infants, in contrast to their appearance (macrosomia), are immature and of low vitality. Congenital abnormalities, hyaline membrane disease, cardiac dilatation, hyperbilirubinemia, hypocalcemic tetany make their adaptation to extrauterine life difficult during the first few days. Good cooperation between internist, obstetrician, anesthesiologist and pediatrician considerably improves the prognosis of diabetic pregnancies.

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Zusammenfassung Schwangerschaft erhöht den Insulinbedarf, senkt die Nierenschwelle für Traubenzucker, steigert die Neigung zu Infektionen der Harnwege und zu Niereninsuffizienz. Diabetikerinnen neigen zu Hydramnion, Spättoxikose, Totgeburt und Neugeborenen-Todesfällen. Die Kinder zuckerkranker Mütter sind trotz ihrer Makrosomie unreif und lebensschwach. Missbildungen, hyaline Membranen, Herzerweiterung, Hyperbilirubinämie, hypokalzämische Tetanie erschweren während der ersten Tage die Anpassung an das extrauterine Leben. Gute Zusammenarbeit von Internist, Geburtshelfer, Narkosearzt und Pädiater verbessern die Prognose der Schwangerschaft bei zuckerkranken Frauen in wesentlichem Masse.

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Resumen El embarazo aumenta la necesidad de insulina, disminuye el dintel renal de la glucosa, aumenta la tendencia a las infecciones de las vias urinarias y a la insuficiencia renal. En las mujeres diabéticas son más frecuentes el hidramnios, la toxiemia, la natimortalidad y las muertes neonatales. Los recién nacidos de madre diabética, contrariamente a su aspecto (macrosomia), son inmaturos y escasamente vitales. Su adaptación a la vida extrauterina en los primeros días de vida se hace difícil a causa de anomalías congénitas, membranas hialinas, dilatación cardiaca, hiperbilirrubinemia y tetania hipocalcémica. Una buena collaboración entre internista, obstétrico, anestesista y pediatra mejora considerablemente el pronóstico de los embarazos diabéticos.

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Résumé La grossesse augmente le besoin en insuline, descend le seuil rénal pour glucose et agrandit la tendance à l'infection des voies urinaires et à l'insuffisance rénale. Chez les femmes diabétiques l'hydramnie est fréquente; elles sont disposées à la toxémie, aux mort-nés et à une mortalité exagérée des nouveau-nés. Les nouveau-nés des mères diabétiques sont immatures et de vitalité réduite malgré leur apparence macrosomique. Des malformations congénitales, des membranes hyalines, une dilatation aiguë du coeur, l'hyperbilirubinémie, une tétanie hypocalcémique rendent difficile l'adaptation à la vie extrautérine, surtout pendant les premiers jours. Une étroite coopération entre interniste, accoucheur, narcotiseur et pédiatre améliore considérablement le pronostic de la grossesse des diabétiques.

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Riassunto La gravidanza accresce il fabbisogno insulinico, abbassa la soglia renale per il glucosio, aumenta la disposizione alle infezioni delle vie urinarie e all'insufficienza renale. Nelle donne diabetiche sono più frequenti l'idramnios, la tossiemia, la natimortalità e le morti neonatali. I neonati di madre diabetica, contrariamente al loro aspetto (macrosomia), sono immaturi e scarsamente vitali. Il loro adattamento alla vita extrauterina nei primi giorni di vita è reso difficile da anomalie congenite, membrane ialine, dilatazione cardiaca, iperbilirubinemia e tetania ipocalcemica. Una buona cooperazione tra internista, ostetrico, anestesista e pediatra migliora considerevolmente la prognosi delle gravidanze diabetiche.

     

Predictive Factors of Severe Behçet's disease: A Longitudinal,Prospective Cohort Followed Between 1981–2020

IntroductionBehçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described.ObjectivesTo evaluate clinical factors associated with manifestations of severe disease in a single-center cohort.MethodsA longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points.ResultsWe included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N = 243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR = 2.004, p = 0.024), increasing with age (OR = 1.021 per year, p = 0.037), in the presence of skin manifestations (OR = 4.711, p < 0.001), specifically erythema nodosum (OR = 8.381, p < 0.001), and pseudofolliculitis (OR = 2.910, p < 0.001).In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR = 1.961, p = 0.047), erythema nodosum (Adjusted OR = 8.561, p < 0.001) and pseudofolliculitis (Adjusted OR = 2.372, p = 0.007).DiscussionMale gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.     

Doppler parameters of ophthalmic artery in women with preeclampsia: A meta-analysis

Preeclampsia is a progressive and severe cardiovascular disorder in pregnant women. To determine the potential significance of ophthalmic Doppler parameters in preeclamptic women and to provide evidence-based hints for clinical practice and scientific investigation. We searched PubMed, Embase, Web of Science, and the Cochrane Library till July 31, 2022. Pooled standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated using the random effects model. Heterogeneity across included studies was evaluated utilizing the Q test and I² statistic. We identified 8 observational studies that met the inclusion criteria. The pooled SMD for peak systolic velocities (PSV) was .12 (95% CI: −.82, 1.06, p = .8071; I² = 94%, p < .0001). The overall SMD for time-averaged mean peak velocities (MV) was 1.79 (95% CI: .87, 2.71, p = .0001; I² = 60%, p = .1152). Regarding the pulsatility index (PI), the pooled SMD was −2.05 (95% CI: −3.12, −.98, p = .0002; I² = 92%, p < .0001). Overall SMD for end-diastolic velocities (EDV) was 1.11 (95% CI: .23, 1.98, p = .0136; I² = 92%, p < .0001). The pooled SMDs for resistance index (RI) and peak ratio (PR) was −.18 (95% CI: −1.90, 1.53, p = .8333; I² = 96%, p < .0001) and 1.46 (95% CI: −1.30, 4.22, p = .2994; I² = 99%, p < .0001), respectively. Publication bias was not identified. MV, PI, and EDV showed significant differences between patients with preeclampsia and non-hypertensive pregnant participants. Studies on the predictive performance of ophthalmic artery Doppler parameters are warranted.     

Inpatientvs. outpatient bowel preparation for elective colorectal surgery

BACKGROUND: Recent pressures to decrease the cost of medical care have mandated preoperative outpatient bowel preparation (OBP) for elective colorectal surgery without any data documenting equivalent quality of care. This study examined the safety and efficacy of OBP compared with inpatient bowel preparation (IBP). METHODS: Records of all patients who underwent OBP for elective colorectal resection since the inception of the OBP program from July 1993 to June 1994 were compared with records of all patients who received IBP for elective procedures from January to June 1993. RESULTS: The two groups, 90 patients who underwent OBP and 98 patient who had IBP, were well matched for age, sex, diagnosis, and operations performed. The OBP group had a shorter length of hospital stay (median, 7 vs. 9 days; P < 0.0001; chi-squared analysis), whereas the complication rate was similar (19 percent in the OBP group vs. 18 percent in the IBP group), including infectious complications (10 percent in the OBP group vs. 7 percent in the IBP group). Although operating time was similar (mean, 199 vs. 213 minutes) and estimated blood loss (mean, 528 vs. 536 ml), the OBP group had significantly higher perioperative fluid requirements: intraoperative fluids (median, 4300 vs. 3700 ml; P < 0.05; Student's t-test), intraoperative colloid administration (48 vs. 29 percent; P < 0.0002; chi-squared), 24-hour postoperative fluids (3224 vs. 2700 ml; P < 0.0001; Student's t-test), and postoperative fluid challenges (50 vs. 20 percent; P <0.0001; chi-squared analysis). CONCLUSION: Outpatient bowel preparation for elective colorectal surgery is safe and effective. It offers shorter hospital stay, and, therefore, potentially reduces medical care cost. Patients with multiple medical problems may not tolerate extensive fluid shifts; therefore, other preoperative arrangements, such as inpatient or outpatient intravenous fluid therapy, need to be considered to minimize complications that may outweigh potential cost savings.Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.