Recommendations for reducing risks of infection associated with suction collection procedures.

It is recognized that risks are incurred when health care workers contact various body fluids. The handling of suction collection equipment poses a risk because it is one way workers may come in contact with these fluids. Minimizing the risks associated with suction procedures can be accomplished if appropriate policies and procedures can be developed in health care facilities.     

皮肌炎合并感染106例临床分析

目的探讨皮肌炎合并感染患者的临床特征及其与其他并发症的关系。方法对武汉市皮肤病防治研究所和华中科技大学同济医学院附属同济医院2000～2009年间收治的106例皮肌炎初诊患者的住院资料进行回顾性分析,分析比较合并感染病例（34例）与未合并感染病例（72例）的临床特征和辅助检查资料。结果皮肌炎合并感染组的肌无力、吞咽困难、抗核抗体阳性（ANA〉1：100）率及伴发问质性肺炎的发生率分别为85．29％、50。00％、62．07％和35．29％,非感染组上述分别为65．28％、16．67％、48．65％和2．78％,两组比较差异有统计学意义（P值分别为〈0．05、〈0．01、〈0．01和〈0．01）,感染组与非感染组的面部红斑、V区红斑、Gottron征、肌痛、肌电图呈肌源性改变及伴发恶性肿瘤等比较差异则无统计学意义。皮肌炎合并感染组患者的丙氨酸氨基转移酶、AST、肌酸激酶、乳酸脱氢酶水平分别为（124．67±86．27）IU／L、（213．41±153．01）IU／L、（1614．06±617．26）IU／L和（578．88±578．88）IU／L）,非感染组分别为（52．75±31．02）IU／L、（81．17±58．73）IU／L、（348．5±129．45）IU／L和（314．19±187．21）IU／L,两组比较差异有统计学意义（P值分别为〈0．001、〈0．001、〈0．01和〈0．001）。结论皮肌炎患者出现明显肌酶升高、肌无力、吞咽困难、抗核抗体（ANA）阳性及伴发间质性肺炎时应密切注意合并感染的发生。     

Presence of Helicobacter pylori in drinking water is associated with clinical infection.

Helicobacter pylori was detected using molecular methods in untreated well water. The presence of H. pylori in the wells correlated with infection in consumers and with the presence of Escherichia coli, indicating fecal contamination. Consumption of untreated well water should be considered a risk factor for H. pylori infection.     

The occurrence and prevention of infections associated with gastrointestinal endoscopy

In the four decades since the introduction of flexible endoscopy into medical practice, nearly 300 cases of human infections or pseudoinfections involving bacteria, fungi, parasites, and viruses have been linked to endoscopic procedures. In the majority of such cases, inadequate cleaning and disinfection techniques during the reprocessing of the instruments or their accessories have been likely contributing factors. Working groups from major gastroenterology societies and infection control organizations have established standards of care for the routine maintenance of endoscopic equipment in order to decrease the rates of infection even further. Since the institution of these standards, rates of transmission of infections to patients have decreased, though have not been completely resolved. This article reviews the available literature on transmission of pathogenic agents through endoscopic procedures, summarizes the current guidelines for the care of endoscopic equipment, and discusses available preventive measures aimed at decreasing the risk of endoscopy-related infections.     

Gastrointestinal endoscopy: infection and disinfection.

The past decade has seen the development of an array of complex flexible fibreoptic instruments for gastrointestinal (GI) endoscopy, and an increasing use of these for diagnostic and therapeutic purposes. It has been recognised more recently that the use of contaminated endoscopic equipment can lead to serious and occasionally fatal infections. Infection with a wide variety of micro-organisms has been reported following oesophago-gastroduodenoscopy (OGD) and endoscopic retrograde cholangio-pancreatography (ERCP).     

Myocarditis associated with Campylobacter infection.

We describe the case of a young man with fever, chest pain and enteric symptoms. He developed myocarditis and Campylobacter was isolated in faeces.     

Human immunodeficiency virus infection associated arthritis: clinical characteristics.

OBJECTIVE: To define the frequency and characteristics of human immunodeficiency virus (HIV) associated arthritis. METHODS: A total of 270 patients with HIV infection were prospectively evaluated for the presence of rheumatic complaints. Diagnosis of HIV infection was performed by ELISA and confirmed by Western blot, and all HIV patients were classified according to the US Centers for Disease Control criteria. RESULTS: Twenty-one (7.8%) patients presented with HIV associated arthritis. Other arthritides including HLA-B27 related, such as Reiter's syndrome, psoriatic arthritis, and rheumatoid arthritis, were excluded. Seventeen were men and 4 women, with a mean age of 34.8 years (SD 11.1). Fourteen (66%) were homosexuals, 4 (19%) intravenous drug users, and 3 (14%) heterosexuals. Twelve (57%) were in stage IV, 5 (23%) in stage III, and 4 (9%) in stage II. Ten (47%) patients had oligoarticular involvement, 8 (38%) monoarticular, 2 (9%) asymmetric polyarthritis, and one (4%) symmetric polyarthritis. Rheumatoid factor and HLA-B27 antigen were negative in all (15) patients studied. The mean duration of arthritis was 2 weeks (1-24). No differences in duration of arthritis were found among the different risk factors (p = 0.811), HIV stages (p = 0.205), and type of articular involvement (p = 0.252). There was, however, a trend between the number of involved joints and stages of HIV infection (p = 0.13). CONCLUSION: The pattern of joint involvement of HIV associated arthritis is similar to that of other viral disorders: acute onset, short duration, no recurrences, and no erosive changes.     

67例肝门部胆管癌内镜下治疗的临床分析

目的 探讨肝门部胆管癌患者内镜下支架治疗的临床效果,为置人支架方式的选择提供依据.方法 选择67例肝门部胆管癌患者,根据磁共振胰胆管造影(MRCP)和逆行胰胆管造影(ERCP)对患者Bismuth分型进行比较.ERCP下胆管狭窄部分别置人金属和塑料支架,观察患者术前、术后临床表现及肝功能指标.随访1年观察患者生存情况.结果 MRCP与ERCP对患者Bismuth分型结果基本相似,仅对Ⅰ型与Ⅳ型判断略有偏差.所有患者中置入金属支架21例,双侧塑料支架10例,单侧塑料支架36例.术后1周腹痛、发热及消化不良症状的发生率较术前显著降低(P＜0.05),术后1个月黄疸发生率均较术前显著降低(P＜0.01).术后1个月血清总胆红素、直接胆红素、丙氨酸转氨酶、碱性磷酸酶和γ-谷氨酰转肽酶值均较术前显著降低(P＜0.05).ERCP术后1个月,单侧金属支架组与双侧塑料支架组患者血清总胆红素、直接胆红素及碱性磷酸酶值较单侧塑料支架组显著降低(P＜0.05),而金属支架组与双侧塑料支架组患者间肝功能差异无统计学意义(P＞0.05).结论 内镜下支架置入术能显著缓解肝门部胆管癌患者,尤其是出现阻塞性黄疸者的临床症状.     

The clinical spectrum of ascites associated with maintenance dialysis.

Among 197 patients being treated with maintenance dialysis, six were found to have ascites. Unlike previous reported series, the cause of ascites and the clinical course were variable. Two patients responded to definitive therapy directed against the specific cause. No consistent association was found with the etiology of renal disease or therapy of uremia including the duration of hemodialysis or prior peritoneal dialysis. Nonspecific therapy attempting to alleviate ascites was unsatisfactory. Severe hypertension was not characteristic and bilateral nephrectomy did not influence the course. An extensive diagnostic evaluation is recommended along with skepticism before declaring that idiopathic, refractory ascites exists signaling progressive deterioration.     

Factors associated with non-attendance at outpatient endoscopy

OBJECTIVE: Non-attendance at endoscopy procedures leads to wasted resources and increased costs. The purpose of this study was to investigate the factors associated with non-attendance. MATERIAL AND METHODS: All patients who attended the outpatient clinic for gastroscopy or colonoscopy examinations were included in the study. Patients who missed their appointment were identified and their data were collected prospectively. Patients who kept their appointment in the same period of time served as controls. RESULTS: Between August 2002 and February 2003, 1051 gastroscopies and 756 colonoscopies were scheduled. A total of 265 patients (14.7%) missed their appointment. No significant differences were found between attendees and non-attendees for mean age, gender, type of examination and day of the week on which the examination was scheduled. The time on the waiting list was longer in patients who did not keep their appointment than in those who did. Fewer appointments were missed in patients with a preferent referral, and among patients referred by their general practitioner a higher percentage failed to keep their appointment compared with those referred by a specialist. In the multivariate analysis, length of time on the waiting list and the source of referral were the only two independent predictive factors for non-attendance. CONCLUSIONS: A longer time on the waiting list and referral by a general practitioner are factors associated with patients failing to keep their endoscopy appointment.     

OMOM胶囊内镜临床应用的初步评价

目的探讨0MOM胶囊内镜系统的性能及在临床应用中的价值。方法总结分析65例OMOM胶囊内镜检查的临床资料。结果在疑有消化道疾病的65例患者检查中，l例在胶囊有效时间未能通过幽门，总结其余64例患者，共检出病变47例，包括小肠炎2l例(其中克鲁恩病3例)，胃及小肠息肉8例(其中1例Peutz-Jeghers综合征)，血管粗大或畸形9例，回肠憩室3例，钩虫症3例，小肠黏膜下占位3例(其中1例手术及病理证实为平滑肌肉瘤)。未见异常17例。阳性检出率为73．4％。胶囊检查时间平均为473min(360～630min)，排出时间平均为1723min(690～2370min)。结论OMOM胶囊内镜对于小肠病变的检出率较高，对于不明原因的消化道出血患者可作为常规检查手段。     

The epidemiology of polycystic ovary syndrome. Prevalence and associated disease risks.

Polycystic ovary syndrome is a common problem affecting approximately 5% of women of reproductive age when defined by clinical features of anovulation and hyperandrogenism. Metabolic derangements associated with this condition may predispose to a range of diseases with attendant morbidity and mortality risks. In general, available data support significantly increased rates of type II diabetes mellitus, dyslipidemia, and endometrial cancer in PCOS that are not completely explained by obesity; data also suggest that rates of hypertension, gestational diabetes, and pregnancy-induced hypertension may likewise be increased, although the extent to which obesity mediates these risks is not clear. The increased prevalence of several cardiovascular risk factors in PCOS and limited cross-sectional data suggest that cardiovascular disease should be more likely in PCOS, but prospective data are lacking to confirm this supposition. Limited data have suggested an association between PCOS and ovarian cancer risk and require further study. The present data do not support an increased risk for breast cancer in this condition. Long-term prospective data are clearly needed to better delineate the nature and magnitude of disease risks associated with PCOS, with appropriate adjustment for associated obesity. Such information is a necessary background for understanding the role of established and emerging PCOS therapies, including oral contraceptives, intermittent progesterone, ovulation induction agents, and insulin sensitizers, in modifying such risks. In the meantime, close follow-up of women with PCOS and encouragement of lifestyle practices likely to reduce disease risks, such as regular exercise and weight control, should be standard practice.     

Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa

Health policy making in developing countries requires estimates of the (global) burden of disease. At present, most of the available data on schistosomiasis is limited to numbers of individuals harbouring the infection. We explored the relationship between the presence of schistosome infection and clinical morbidity, in order to estimate numbers of individuals with disease-specific morbidity for Schistosoma haematobium and Schistosoma mansoni infection in sub-Saharan Africa. We searched the literature for cross-sectional data from field studies reporting both schistosome infection and morbidity. This was used to derive a functional relationship between morbidity and infection. After standardisation for diagnostic method, the number of individuals with specific types of clinical morbidity or pathology was predicted. As only aggregated prevalences of infection were available for countries or areas, we adjusted for heterogeneity in infection levels within communities in those countries. In total, 70 million individuals out of 682 million (2000 estimate) in sub-Saharan Africa were estimated to experience haematuria in the last 2 weeks associated with S. haematobium infection, and 32 million dysuria. Ultrasound detected serious consequences of S. haematobium, major bladder wall pathology and major hydronephrosis, were predicted at 18 and 10 million, respectively. Infection with S. mansoni was estimated to cause diarrhoea in 0.78 million individuals, blood in stool in 4.4 million and hepatomegaly in 8.5 million. As the associations between prevalence of S. mansoni infection and prevalence of diarrhoea and blood in stool were not very clear, the resulting estimates may be underestimations. Using the very limited data available, we estimated the mortality rates due to non-functioning kidney (from S. haematobium) and haematemesis (from S. mansoni) at 150000 and 130000 per year. Given the overall high number of cases with schistosomiasis-related disease and associated death, we conclude that schistosomiasis remains an important public health problem in sub-Saharan Africa.