HIV serostatus and recovery from severe childhood malnutrition. A retrospective matched case-control study

The world-wide epidemic of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has led to an increase in the number of HIV positive children, mainly through perinatal transmission. HIV/AIDS can lead to severe childhood malnutrition (SCM) and has been noted as an increasingly common cause of secondary SCM. In this context, it is important to make assessments of the appropriateness of current approaches to treatment of severe malnutrition in HIV positive children. A retrospective matched case-control study of ten HIV positive children admitted to the Tropical Metabolism Research Unit (TMRU) was conducted. There were few differences between cases and matched controls on admission to the ward. Oral candidiasis and lower respiratory tract infections appeared to occur more frequently, and serum globulin concentrations were significantly higher among HIV positive cases when compared to their controls. Despite the fact that the differences between cases and controls appeared to be small, four cases died; there were no deaths among the controls. The duration of the maintenance phase was approximately five days longer (p = 0.024) among cases than controls but the time between the end of the maintenance phase and discharge from the ward was not significantly longer for the cases. The results of this matched case-control study suggest that there are likely to be important differences between HIV positive and negative patients with SCM that influence risk of mortality and morbidity, particularly in the maintenance phase of treatment. Prospective studies will be required in order to explore these differences and to develop better approaches to the care of HIV positive children with SCM.     

The impact of HIV infection on the clinical presentation of severe malnutrition in children at QECH

A study was undertaken in a central nutritional rehabilitation unit (NRU) in southern Malawi to assess the impact of HIV infection on clinical presentation and case fatality rate. The HIV seroprevalence for 250 severely malnourished children over 1 year of age was 34.4% and the overall mortality was 28%. HIV infection was significantly more associated with marasmus (62.2%) than with kwashiorkor (21.7%) [p<0.0001]. Clinical and radiological features were not helpful in distinguishing HIV infected from non HIV infected children. The in-hospital case fatality rate was significantly higher for HIV infected children (38.4%) compared to severely malnourished children without HIV infection (22.7%) [p<0.05]. Though HIV infection contributes to the high mortality experienced in NRU''s in Malawi, we argue that more remediable contributing factors still need to be addressed.     

Crystalluria in HIV/AIDS patients on highly active anti-retroviral therapy in the Kumasi metropolis; a cross sectional study

Background:

Crystalluria is associated with some highly active anti-retroviral therapies (HAART''s) used in the management of HIV/AIDS. Aims: This study used light microscopy to establish the prevalence of crystalluria among HIV/AIDS patients on HAART and identified the routine crystals present in their urine.

Materials and Methods:

In this simple randomised cross-sectional study, 200 HIV/AIDS participants, comprising 150 on HAART and 50 HAART-naïve were recruited from the HIV clinic at the Komfo Anokye Teaching Hospital (KATH). Urine and blood samples were collected, for urinalysis and the determination of the CD4 count, respectively. A well-structured pre-tested questionnaire was used to obtain socio-demographic data and clinical history of the participants.

Results:

The prevalence of crystalluria was higher among HIV-infected persons on HAART than those not on HAART (6.7% vs 4%; P = 0.733). Calcium oxalate and triple phosphate crystals were the crystal types present in their urine (3.5% and 2.5%, respectively) and was present only in HIV subjects on first line of treatment (without protease inhibitors). Participants aged between 40-50 years and those with hypersthenuria and acidic urine had the highest amount of crystalluria (41.6%, 83.3%, and 58.3%, respectively).

Conclusion:

HAART is associated with crystalluria in HIV patients. Light microscopy will be of disgnostic value in resource limited settings.     

环境因素与儿童急性白血病发病风险的病例对照研究

目的 探讨儿童急性白血病发病的室内外环境危险因素.方法 2007年9月～2008年8月,对115例0～15岁新发急性白血病患儿(急性淋巴细胞白血病87例,急性髓细胞白血病28例)进行相同性别和年龄及入住相同医院的1∶1配对病例对照研究.对患儿父母采用面对面问卷调查一般情况和可能的危险因素(室内和室外相关环境因素).运用Logistic模型对数据进行单因素和多因素回归分析,计算比值比(OR)和95%置信区间(CI).结果 母亲孕前和(或)孕期化学物质接触史(OR=2.68, 95%CI 1.22～5.90)、父亲既往医源性放射性物质接触史(OR＝2.78, 95%CI 1.24～6.23)、居室周围高压变电器和(或)电线分布(OR＝3.35, 95%CI 1.38～8.17)、居室内非实木地板装修(OR＝1.91, 95%CI 1.04～3.51)、儿童冬季睡眠时门窗关闭(OR＝3.30, 95%CI 1.80～6.06)和儿童经常使用解热镇痛药和(或)抗生素(β＝-1.011,OR＝0.36, 95%CI 0.19～0.72)与儿童急性白血病发病相关.亚型分析中,上述6项因素除居室内非实木地板装修外均与急性淋巴细胞白血病发病相关;而急性髓细胞白血病发病的危险因素为母亲孕前和(或)孕期化学物质接触史、居室周围有工业三废、儿童冬季睡眠时门窗关闭.结论 室内外环境因素是儿童急性白血病发病相关的危险因素,对不同亚型急性白血病发病的影响作用可能不同.     

环境因素与儿童急性白血病发病风险的病例对照研究

目的 探讨儿童急性白血病发病的室内外环境危险因素.方法 2007年9月～2008年8月,对115例0～15岁新发急性白血病患儿(急性淋巴细胞白血病87例,急性髓细胞白血病28例)进行相同性别和年龄及入住相同医院的1∶1配对病例对照研究.对患儿父母采用面对面问卷调查一般情况和可能的危险因素(室内和室外相关环境因素).运用Logistic模型对数据进行单因素和多因素回归分析,计算比值比(OR)和95%置信区间(CI).结果 母亲孕前和(或)孕期化学物质接触史(OR=2.68, 95%CI 1.22～5.90)、父亲既往医源性放射性物质接触史(OR＝2.78, 95%CI 1.24～6.23)、居室周围高压变电器和(或)电线分布(OR＝3.35, 95%CI 1.38～8.17)、居室内非实木地板装修(OR＝1.91, 95%CI 1.04～3.51)、儿童冬季睡眠时门窗关闭(OR＝3.30, 95%CI 1.80～6.06)和儿童经常使用解热镇痛药和(或)抗生素(β＝-1.011,OR＝0.36, 95%CI 0.19～0.72)与儿童急性白血病发病相关.亚型分析中,上述6项因素除居室内非实木地板装修外均与急性淋巴细胞白血病发病相关;而急性髓细胞白血病发病的危险因素为母亲孕前和(或)孕期化学物质接触史、居室周围有工业三废、儿童冬季睡眠时门窗关闭.结论 室内外环境因素是儿童急性白血病发病相关的危险因素,对不同亚型急性白血病发病的影响作用可能不同.     

重症急性胰腺炎早期低白蛋白血症的临床研究

目的:探讨重症急性胰腺炎(severe acute pancreatitis, SAP)早期低白蛋白血症的发生机制和临床特点,及其对预后的影响和防治措施.方法:2003年8月1日～2004年12月31日收治的SAP早期并发低白蛋白血症患者138例,分成轻度低白蛋白血症组(血浆白蛋白30～35 g/L)54例和重度低白蛋白血症组(血浆白蛋白＜30 g/L)84例,比较分析两组的早期并发症、相关参数、后期感染及病死率.结果:重度低白蛋白血症组肾功能衰竭、休克、心衰及消化道出血的发生率高于轻度低白蛋白血症组(P＜0.01),肝功能衰竭发生率两组比较无统计学差异;Ranson评分及Balthazar CT评分两组间比较,差异无统计学意义(P＞0.05);重度低白蛋白血症组的急性生理和慢性健康评价指标Ⅱ(acute physiology and chronic health evaluationⅡ, APACHEⅡ)评分、脉搏和呼吸频率均明显高于轻度低白蛋白血症组(P＜0.05或P＜0.01);重度低白蛋白血症组后期感染发生率及病死率均高于轻度低白蛋白血症组(P＜0.01).结论:SAP早期低白蛋白血症对SAP的病理生理过程起着促进作用,血浆白蛋白水平越低,则并发症越多,后期感染发生率及病死率也越高.减轻SAP早期的炎性反应,及时足量补充白蛋白、氨基酸及脂肪等营养物质,是防止低白蛋白血症发生和发展的关键.     

伴有或不伴有1型糖尿病少女的进食障碍：横断面调查

目标 :确定 1型糖尿病少女进食障碍的患病率 ,并与非糖尿病少女进行比较。研究设计 :横剖面病例对照调查数据来源 :加拿大 3个城市的糖尿病门诊和学校。研究对象 :年龄在 1 2～ 1 9岁的 3 56例 1型糖尿病少女 ,以及年龄与之相匹配的 1 0 98名非糖尿病的对照人群。主要结果指标 :符合精神病诊断与统计手册 (ＤｉａｇｎｏｓｔｉｃａｎｄＳｔａｔｉｓｔｉｃａｌＭａｎｕａｌｏｆＭｅｎｔａｌＤｉｓｏｒｄｅｒｓ,ＤＳＭ ＩＶ)标准的进食障碍。结果 :糖尿病患者达ＤＳＭ ＩＶ标准的进食障碍患病率 ( 3 6例 ,1 0 % )高于非糖尿病对照人群的患病率 …     

在初级保健中口头提问两项问题筛查抑郁症：横断面研究

目的 确定口头提问两项问题筛查抑郁症的诊断准确性。设计 标准的横断面确认研究。设置 新西兰15家全科诊所。对象 未服用精神药物的421例病人。主要结果的测量与计算机辅助的复合国际诊断访谈比较，两项问题的敏感性、特异性和似然比。结果 两项筛查问题的敏感性和特异性分别是97％(95％可信区间：83％～99％)和67％(62%～72％)，阳性检验似然比为2．9(2．5～3．4)，阴性检验似然比为0．05(0．01～0．35)。病人抑郁症筛查的总阳性率为37％(157／421)。结论 口头提问两项筛查抑郁症的问题能检出全科诊所中的多数抑郁症病例，优点是问题简洁明了。如果医师诊断后，使病人得到治疗的可能性增加，这些问题的效用会更大。     

Identification of bacterial antigens and super antigens in synovial fluid of patients with arthritis: a cross sectional study

Background

An accurate and prompt diagnosis of bacterial arthritis is essential for earlier treatment and a good outcome. Superantigens produced by Staph. Aureus are among the most lethal toxins. The paper objective was Identification of common bacterial antigens and S.aureus superantigens in synovial fluid (SF) of children with negative culture and direct smear for other bacteria except for S.aureus.

Methods

In this cross-sectional study a total of 62 patients with a mean age of 11 ± 3.8 years (range: 5 months-16 years) with acute arthritis in pediatric and orthopedic wards of Rasoul Hospital (2008-2010) were studied. Three common bacterial antigens (e.g. S.pneumonia, H.influenza, N. meningitis) using LPA (latex particle antigen) and Staphylococcal superantigens (TSST1; Enterotoxin A; B; C) using ELISA method (ABcam; USA) were identified in 60 adequate SF samples with negative culture and negative direct smears) for other bacteria except for S.aureus. Staphylococcal superantigens were compared with S.aureus infection (positive culture or direct smear).

Results

Positive bacterial antigens (LPA test) were found in 4 cases including two S. Pneumonia, one N.meningitis, and one H.influenza. S.aureus was diagnosed in 7 cases including 4 positive cultures and 3 positive smears. Staphylococcal superantigens (toxins) were found in 73% of SF samples. Some cases had 2 or 3 types of toxins. S.aureus toxins were reported in 47% of culture negative SF samples. Positive TSST1, Enterotoxin B, Enterotoxin A, and Enterotoxin C were found in 47% (n= 28), 18% (n= 10), 39% (n= 22), and 39% (n = 21) of cases respectively. The most common type of superantigens was TSST1; and Enterotoxin A was the less common type. Except for Enterotoxin A, no relation between positive S.aureus culture and positive tests for superantigens in SF was found.

Conclusion

S.aureus has a prominent role in septic arthritis. S.aureus toxins might have a prominent role in arthritis with negative SF culture. Rapid identification of bacterial antigens (LPA) or S.aureus superantigens (toxins) are valuable for diagnosis in cases with negative cultures. We recommend usage of complementary methods (e.g. antigen detection tests) in children. Those tests are cheaper and easier in comparison with PCR as a complex and time-taking method. Identification of S.aureus superantigens in SF of all cases with negative culture, or treatment with antagonist drugs needs further clinical trial studies.     

广东人群亚健康状态与健康促进生活方式的相关性

目的探讨广东人群亚健康状态与健康促进生活方式的相关性。方法对2012~2013年进行了24 159人（12~80岁）的大 样本、多中心的横断面调查;生活方式的评估使用《健康促进生活方式量表》,健康状况的判定主要结合被调查者的体检报告及 《亚健康评定量表》。结果在24 159名调查对象中,亚健康（46.0%）及疾病（35.2%）人群所占的比例远高于健康者（18.8%）;回 归分析发现健康促进生活方式对健康状态有显著影响（P<0.001）,不良的生活方式是亚健康和疾病的危险因素,且其对亚健康 状态的影响比对疾病的影响更大;在校正一般人口学资料的模型中,相对于优秀的促进健康生活方式（最小暴露者）,差的生活 方式（最高暴露者）发生亚健康的危险性高达43倍（OR：42.825,95% CI：30.567~59.997）,一般的生活方式（较高暴露者）发生亚 健康的危险性高达21 倍（OR：21.072,95% CI：17.258~25.729）,次优的生活方式发生亚健康的危险性为4 倍（OR：4.085,95% CI：3.352~4.979）。且在一般人群中,压力管理差、自我实现差、运动锻炼少、人际关系差是亚健康状态的最主要危险因素。结 论亚健康状态与不良生活方式密切相关;对可改变的生活方式危险因素的组合进行干预,是健康促进的有效方法;将慢性管理 的窗口前移,加强对亚健康状态“窗口”的健康管理至关重要。     

重庆市绝经期妇女生殖健康状况的现状调查

目的初步了解我市妇女的绝经期生殖健康保健情况,为进一步开展妇女健康保健工作提供依据.方法我们对2003年6月～2004年6月在我院门诊就诊的重庆地区502名绝经期妇女进行了调查.结果重庆市绝经妇女中自然的平均绝经年龄为48.18岁,自然绝经占94.02%,手术绝经占5.98%.其中在围绝经期和/或绝经期妇女52.99%有潮热、汗多,32.87%有失眠等围绝经期综合征.因有围绝经期症状而使用激素治疗者占28.29%.结论围绝经期和绝经期妇女的健康保健工作应引起高度重视,指导并采取积极有效的措施使中老年妇女的生活质量得到提高.     

1999年1月瑞典药房处方药中的潜在性药物相互作用：横断面研究

随着药物制剂的广泛使用 ,药物间的相互作用也愈来愈受到公共卫生界的广泛关注1 。对于药物间潜在性相互作用的监测有助于提高药物处方及配方的质量 ,也可为合理处方用药方面的教育奠定基础。　　研究对象、方法和结果在抽样研究中 ,我们于 1 999年 1月对瑞典88 5家药房中为瑞典居民 (人口共 72 1 4 50 9人 ,年龄范围 1 5～ 95岁 )配发的两种以上药物处方 (共计 962 0 1 3张 )进行了分析。本文涉及数据均取自瑞典卫生保健数据库 ,该数据库收录有瑞典所有药房配发的药品配方 ,该数据库因建立有严格的登记程序以及内控系统 ,所以可以确保数据…     

Re-licensing of general practitioners using the current UK revalidation proposals: a cross sectional study

Objective To explore the views of general practitioners (GPs) on the feasibility of collecting supporting information for the Royal College of General Practitioners (RCGP) revalidation portfolio and mapping of this evidence to the General Medical Practice framework for proposed UK medical re-licensing. Design Cross sectional study with a questionnaire. Setting One inner city and one mixed urban/rural primary care organisation in the West Midlands, England and one rural primary care organisation in Wales. Participants 51/69 GPs who submitted a revalidation portfolio from November 2009 to February 2010. Results The majority of GPs considered the majority of work based supporting information was feasible to collect within a 5 year revalidation cycle; most concerns were expressed about providing evidence for extended practice, learning credits, and patient satisfaction and colleague feedback surveys (59%, 63%, 72%, and 77%, respectively, of GPs considered it feasible to collect this evidence) due to workload time constraints and lack of automatic access to evidence from others, which differed by GP work role. Two-thirds of participants (65%) stated that the submission of a portfolio of evidence was a feasible component of GP revalidation, reporting reservations on the appropriateness of patient and colleague feedback surveys and extended practice (55%, 57%, and 59% respectively) to provide objective evidence. GPs requested further clarity on the evidence mapping process. Conclusion Overall, GPs reported a positive response to the RCGP revalidation proposals. Concerns were focused on collecting the newer types of supporting information and the ability of GPs non-principals to collect this evidence. GP revalidation training and preparation is required.     

重症急性胰腺炎与脏器功能衰竭

目的:探讨重症急性胰腺炎与脏器功能衰竭的关系.方法:回顾性分析我院1993年1月～2002年12月收治的74例重症急性胰腺炎的临床资料,分析脏器功能衰竭与病人的年龄、性别、胆石性胰腺炎、胰腺坏死的范围、感染与否及与死亡率的关系.结果:74例重症急性胰腺炎脏器功能衰竭的发生率为63.5%(47/74),其中多脏器功能衰竭的发生率为27.0%(20/74),单脏器功能衰竭的发生率为36.5%(27/74),呼吸功能衰竭是最常见的单个脏器功能衰竭(23.0%);脏器功能衰竭的发生与病人的年龄、性别、胆石性胰腺炎、坏死组织是否感染及胰腺坏死的范围无关;合并脏器功能衰竭者死亡率比无脏器功能衰竭者明显增高;重症急性胰腺炎病人的死亡与多脏器功能衰竭、呼吸功能衰竭、心血管功能衰竭及胃肠功能衰竭有关.结论:脏器功能衰竭在重症急性胰腺炎的发病中常见,对病人威胁最大的是多脏器功能衰竭及呼吸功能衰竭,预防并积极治疗脏器功能衰竭能够改善病人的预后.     

Tracheostomy without mechanical ventilation in patients with traumatic brain injury at a tertiary referral hospital in Malawi: a cross sectional study

BackgroundTracheostomy alone, without mechanical ventilation, has been advocated to maintain a free airway in patients with traumatic brain injury in low-income settings with minimal critical care capacity. However, no reports exist on the outcomes of this strategy. We examine the results of this practice at a central hospital in Malawi.MethodsThis is a retrospective review of medical records and prospectively gathered trauma surveillance data of patients admitted to Kamuzu Central Hospital, with traumatic brain injury from January 2010 to December 2015. In-hospital mortality rates were examined according to registered traumatic brain injury severity and airway management.ResultsIn our analysis, 1875 of 2051 registered traumatic brain injury patients were included; 83.3% were male, mean age 32.6 (SD 12.9) years. 14.2% (n=267) of the patients had invasive airway management (endotracheal tube or tracheostomy) with or without mechanical ventilation. Mortality in severe traumatic brain injury treated with tracheostomy without mechanical ventilation was 42% (10/24) compared to 21% (14/68) in patients treated without intubation or tracheostomy (p= 0.043). Tracheostomies had an overall complication rate of 11%.ConclusionTracheostomy without mechanical ventilation in severe traumatic brain injury did not improve survival outcomes in our setting. Tracheostomy for severe traumatic brain injury cannot be recommended when mechanical ventilation is not available unless there are sufficient specialized human resources for follow up in the ward. Efforts to improve critical care facilities and human resource capacity to allow proper use of mechanical ventilation in severe traumatic brain injury should be a high priority in low-income countries where the burden of trauma is high.