艾滋病合并隐球菌脑膜炎临床特征及预后影响因素

目的探讨艾滋病合并隐球菌脑膜炎临床特征及预后影响因素。方法回顾性分析2012年1月-2018年7月在武汉大学中南医院住院治疗的90例艾滋病合并隐球菌脑膜炎患者的临床数据,分析患者临床特征及影响预后的相关因素。结果艾滋病合并隐球菌脑膜炎患者最常见的临床表现是发热90.00%(81/90)、头晕头痛83.33%(75/90)和恶心呕吐58.89%(53/90);脑脊液中隐球菌抗原、墨汁染色及培养的阳性率分别为92.59%(50/54)、78.89%(71/90)和51.11%(46/90);经系统抗真菌治疗后总病死率为25.56%(23/90);影响艾滋病合并隐球菌脑膜炎患者12周预后单因素分析显示:病死组患者联合抗逆转录病毒治疗(cART)、意识障碍、痫性发作、颈项强直、低CD_4~+T细胞计数患者例数及全身播散性隐球菌感染发生率较生存组高,差异有统计学意义(P0.05);多因素Logistic回归分析显示:意识障碍、颈项强直及痫性发作是影响患者12周预后的危险因素。结论艾滋病合并隐球菌脑膜炎患者常伴播散性感染,意识障碍、颈项强直及痫性发作是艾滋病合并隐球菌脑膜炎患者预后不良的危险因素,对CD_4~+T细胞计数100个/μl的患者开始cART前应常规筛查隐球菌抗原,早诊断治疗,可能进一步降低病死率。     

艾滋病的隐球菌脑膜炎:在两性霉素B治疗无效后使用氟康唑治疗获得成功

隐球菌脑膜炎是艾滋病常见的并发症,常伴有高病死率,而且必需长期使用两性霉素 B 治疗。氟康唑(Fluconazole)是最近发现的一种三吡咯化合物,在体外对新型隐球菌有抗菌作用。据表明,此药对隐球菌脑膜炎的动物模型有效,而且容易穿透入脑脊液。本文报道1例艾滋病患者的隐球菌脑膜炎因两性霉索 B 治疗无效后使用氟康唑治疗获得成功。患者男性,40岁。1985年8月因隐球菌脑膜炎首次入院,最初给予静注两性霉素 B7周,同时加用5-氟胞嘧啶4周。后曾有     

支气管肺泡灌洗液培养在肺部感染监测中的应用研究

目的:探讨支气管肺泡灌洗液(BALF)培养在肺部感染中的应用价值。方法:对152例肺部感染患者BALF培养结果进行病原菌种类及药敏分析。结果:培养阳性标本78例,阳性率51.3%,共分离出病原菌94株,其中革兰阳性球菌占11.7%,以金黄色葡萄球菌为主;革兰阴性杆菌占64.9%,以鲍曼不动杆菌为主,其次为铜绿假单胞菌;真菌占23.4%,以白色念珠菌为主。阳性球菌对万古霉素、替考拉丁最敏感;阴性杆菌对亚胺培南、美罗培南耐药率低;念珠菌对两性霉素B的敏感率高。结论:肺部感染患者行支气管肺泡灌洗液培养,对明确病原、指导抗生素的合理应用有重要临床意义。     

艾滋病合并血液感染的病原体分布、耐药性及预后影响因素

目的分析艾滋病合并血液感染的病原体分布、耐药性及患者预后的影响因素。方法选取2017年9月至2020年9月本院收治的109例艾滋病合并血流感染患者为研究对象,采集患者的血液标本进行细菌培养和药敏实验,分析患者病原菌分布特征及耐药性。依据患者的预后情况将患者分为预后良好组67例和预后不良组42例,分析影响预后的危险因素。结果 109例患者血液样本共分离出病原菌株127株,其中真菌58株(45.67%)、革兰阳性菌44株(34.65%)、革兰阴性菌25株(19.69%)。以马尔尼菲篮状菌、新型隐球菌、大肠埃希菌、凝固酶阴性葡萄球菌占比较高。多因素Logistic回归分析显示BMI、Hb、Alb、CRP是患者预后不良的影响因素(均P0.05)。结论艾滋病合并血液感染病原体以真菌为主,对伏立康唑、两性霉素B、氟胞嘧啶、氟康唑耐药率较低;患者预后受多种因素影响,临床工作中应结合药敏实验结果和预后影响因素进行针对性用药及适当干预。     

应用肺泡灌洗液荚膜多糖抗原早期诊断肺隐球菌病一例

 报道1例应用胶体金免疫层析法（LFA）检测肺泡灌洗液（BALF）隐球菌荚膜多糖抗原早期诊断肺隐球菌病的病例，为肺隐球菌病的诊断提供参考。本例患者仅存在隐球菌肺部感染，入院时LFA对血清荚膜多糖抗原检测结果为阴性，但对BALF荚膜多糖抗原检测结果为阳性，考虑相比血清，BALF中可检测的荚膜多糖抗原较早出现阳性。故LFA检测BALF荚膜多糖抗原对肺隐球菌病早期诊断更有意义。     

儿童新型隐球菌脑膜炎10例

目的：探讨儿童新型隐球菌性脑膜炎的临床特点、诊断及治疗方法.方法：对本院经过病原学确诊的10例新型隐球菌性脑膜炎患儿的临床资料、影像学表现、诊断方法、治疗和转归进行回顾性分析.结果：10例均起病较缓慢、病史长.确诊依据脑脊液真菌涂片、培养或隐球菌抗原检查.症状以发热、头痛为主,头部影像学检查以脑室扩大、脑积水为主.治疗采用两性霉素B静滴,5-氟胞嘧啶口服,辅以两性霉素B鞘内注射等药物治疗.10例患儿痊愈4例,病情明显好转4例,放弃治疗1例,死亡1例.结论：儿童新型隐球脑膜炎起病缓慢,其临床和影像学表现无特异性,可发生于免疫功能正常的儿童,对怀疑中枢神经系统感染疾病时,应该积极新型隐球菌相关辅助检查,尤其是脑脊液检查.儿童新型隐球菌脑炎预后不良、病死率较高.     

艾滋病并新型隐球菌性脑膜炎40例临床分析

目的通过对艾滋病并发新型隐球菌性脑膜炎进行临床分析,提高诊治水平。方法对2004年至2010年收治的40例患者进行回顾性分析。结果 40例患者临床症状消失时间为（38.03±24.274）d,病原阴转时间为（48.18±31.906）d,病死率15%。结论新型隐球菌性脑膜炎常发生在艾滋病期患者,CD4细胞较低,在合并其他机会性感染时治疗疗程延长,病死率可能增加。早期发现艾滋病病毒感染并及时治疗是预防隐球菌性脑膜炎、降低病死率的有效途径。     

艾滋病合并隐球菌脑膜炎16例分析

目的提高对艾滋病合并隐球菌脑膜炎患者临床特征的认识,为临床诊断、治疗提供参考。方法对近4年收治的16例艾滋病合并隐球菌脑膜炎患者的病历资料进行回顾性分析。结果治愈2例（12．50％）,好转10例（62．50％）,未愈3例（18．75％）,死亡1例（6．25％）。结论艾滋病合并隐球菌脑膜炎患者,病情复杂、病势凶险、预后差,早期诊断、及时综合治疗可以改善艾滋病合并隐球菌脑膜炎患者的预后。     

两性霉素B治疗AIDS合并新型隐球菌脑膜脑炎的观察及护理

目的:探讨了两性霉素B治疗AIDS合并新型隐球菌脑膜脑炎的观察及护理.方法:回顾性分析了我科2008年至2011年4月期间住院的艾滋病合并新型隐球菌脑膜脑炎患者16例的临床资料,并实施了相应的护理对策.结果:16例患者中性途径感染者15例,输血感染者1例,在抗菌治疗前已经进行高效联合抗逆转录病毒治疗(HAART)9例,4例抗菌治疗2周后开始HAART.结论:采取适当的护理措施,才能最大限度减少两性霉素B的不良反应,充分发挥其疗效.     

隐球菌感染的检测方法比较

目的 :研究胶体金法隐球菌抗原检测与传统检测方法的灵敏度差异,探讨其在早期检出隐球菌感染中的价值。方法 :回顾性分析了浙江大学医学院附属第二医院的28例隐球菌感染患者,比较了墨汁染色法、真菌培养法和胶体金法隐球菌抗原检测的结果,评价各自的灵敏度,并比较了不同标本类型对检测结果的影响。结果 :墨汁染色法、真菌培养法和胶体金法隐球菌抗原检测法的灵敏度分别为17.6%,2.1%和86.7%,在隐球菌性脑膜炎组,血液标本和脑脊液标本对于胶体金法隐球菌抗原检测的灵敏度分别为83.3%和100%,在隐球菌性肺炎组,血液标本和肺泡灌洗液标本对于胶体金法隐球菌抗原检测的灵敏度分别为94.7%和83.3%。结论 :胶体金法隐球菌抗原检测灵敏度高,可作为早期检出隐球菌感染的方法。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.