Prevalence and risk factors of asymptomatic hepatitis C virus infection in Egyptian children

AIM: To identify the prevalence, risk factors and manifestations of asymptomatic hepatitis C virus (HCV) infection in Egyptian children. METHODS: Children at the age of 1-9 years were screened for HCV antibodies and alanine aminotransferase (ALT) levels. Every child with elevated ALT and/or detectable HCV antibodies was tested for HCV RNA by RT-PCR and compared with two negative controls for risk factors and signs and symptoms of liver disease.RESULTS: We screened 1042 children, six of them had elevated ALT, negative HCV antibody and positive RNA, likely representing acute hepatitis C cases. Fifteen children were HCV seropositive, 5 of them were HCV RNA positive. Asymptomatic HCV infection was present in 2.02% (positive results for either HCV antibodies or HCV-RNA or both). Symptoms such as diarrhea, abdominal pain, history of fatigue and school absence because of illness and risk factors such as dental care were significantly more common among HCV positive cases than among controls. None of the HCV positive children was diagnosed as having signs of advanced liver disease upon clinical or ultrasonographic examination. CONCLUSION: Asymptomatic HCV infection is detectable in 2.02% Egyptian children.     

Study of concentration of amniotic fluid Alpha-fetal protein in thalassemia fetus

Objective:To test the hypothesis that concentration of amniotic fluid alpha-fetal protein(AFAFP) is increased in thalassemia fetus.Methods:A total of 135 cases of amniocentesis admitted from July 2013 to December 2014 were included in this study.Among them 98 cases of normal fetuses were assigned into control group and 37 cases of thalassemia fetus were included as thalassemia fetus group.Alpha-fetoprotein levels detected by enzyme linked immunosorbent assay and the alpha-fetoprotein concentration were compared between the two groups.There is no significant difference in gestrational age between the two groups.Results:1.AFP concentration in thalassemia fetus group was significantly higher than that of normal control group [(1541.65±734.78) μg/mL vs.(2728.84± 1539.97) μg/mL ],and amniotic fluid AFP concentration was related to fetal thalassemia.2.AFAFP concentration in pureα-thalassemia fetus was higher than that of β thalassemia fetus or mixed αand was not significant.Conclusions:Concentration of a β thalassemia fetus,but the difference mniotic fluid alpha-fetal protein is increased in thalassemia fetus.AFP concentration inα-thalassemia fetus was higher than that of β thalassemia or mixed αand lore β thalassemia fetus but difference was not significance.Further studies are needed to exp the possible correlation between Down syndrome and biochemical markers of Thalassemia.     

Childhood inflammatory bowel disease： Parental concerns and expectations

AIM: To document the concerns and expectations of parents of children with inflammatory bowel disease (IBD) within the context of a multidisciplinary IBD clinic, and to highlight the importance of a holistic approach to the care of these children. METHODS: The parents of 60 children with IBD were surveyed by mailed questionnaire. Parents were asked to provide details of their concerns regarding their child's condition and to express their expectations of medical care. In addition, enquiry was made in respect to the respondents' learning about IBD. RESULTS: Forty-six questionnaires (77%) returned. Fiftytwo percent of the patients were male. Patients were aged a mean of 10.9 (±4.1) years and diagnosed at an average age of 2.1 (±1.8) years previously. The most common concerns expressed by the parents related to the side- effects of medications and the future prospects for their child. Overall, parents were satisfied with aspects of care within the IBD clinic but many suggested additional personnel such as counselors or educators should be available. Parents also reported the need for continuing education and easy access to up-to-date information. CONCLUSION: Parents of children and adolescents with IBD have many common concerns regarding their child's condition. On-going attention to holistic care, including psychosocial and educational elements for patients and families, is appropriate in the context of the chronic and unpredictable nature of IBD.     

Spectrum of thalassemia mutations in fetuses of Han and Li ethinicities in Hainan province,China

Objective: To analyze the frequency and spectrum of thalassemia mutations in amniotic fluid samples collected from Han and Li people in Hainan province of China.Methods: We carried out a retrospective analysis on prenatal diagnosis of amniotic fluid samples collected from pregnant women who may have next generation with high risks of medium or severe thalassemia between 2005 and 2016. Diverse fetal thalassemia genotypes and mutated alleles in Han and Li people were analyzed and cmpared. Results: We examined 536 amniotic fluid samples from Han people and 588 from Li people, among which 406 Han and 500 Li samples were found to carry at least one thalassemia gene mutation, with a detection rate of 75.75% and 85.03%, respectively. Among all α-and β-thalassemia mutant alleles detected, the most frequently found mutations in Han and Li samples were SEA-type of α-thalassemia and 41/42(–CTTT) of β-thalassemia, respectively. A total of 75 severe thalassemia cases were identified in Han samples and 53 in Li samples. In most of these severe cases, parents chose to terminate pregnancy after being informed of thalassemia-related risks. Conclusions: The thalassemia mutations shows ethnic and area specificity, and that prenatal diagnosis for high-risk thalassemia carrier pregnant women is an efficient approach to prevent and control the occurrence of severe thalassemia in the high-prevalence areas.     

Classification therapy in 405 children with immune thrombocytopenia

<正>Objective To explore the efficiency and safety of immune thrombocytopenia(ITP)in children through classification treatment.Methods 405 newly diagnosed ITP patients were enrolled in this study from January 1st2013 to August 31st2014.The cases were divided into observation group and therapy group according to the initial platelet count of less than 20×109/L or the cases of     

Current treatment options and response rates in children with chronic hepatitis C

Vertical transmission has become the most common mode of transmission of hepatitis C virus (HCV) in children.The rate of perinatal transmission from an HCVinfected mother to her child ranges from 2% to 5% and the prevalence of HCV in children in developed countries ranges between 0.1% and 0.4%.Spontaneous viral clearance seems to be dependent on the genotype and has been reported between 2.4%-25%.For chronically infected patients,treatment with recombinant polyethylene glycol (PEG)-interferon α-2b and daily ribavirin has now been approved as standard treatment for children 2-17 years of age.In five large prospective studies,a total of 318 children and adolescents aged 3-17 years were treated either with subcutaneous PEG-interferon α-2b at a dose of 1-1.5 μg/kg or 60 μg/m2 once a week in combination with oral ribavirin (15 mg/kg per day) or PEG-interferon α-2a with ribavirin.Subjects with genotype 1 and 4 received the medication for 48 wk and individuals with genotype 2 and 3 mainly for 24 wk.Overall sustained viral response (SVR) was achieved in 193/318 (60.7%) of treated patients.Stratified for genotype;120/234 (51%) with genotype 1,68/73 (93%) with genotype 2/3,and 6/11 (55%) with genotype 4 showed SVR.Relapse rate was between 7.7% and 17%.Overall,treatment was well tolerated;how-ever,notable side effects were present in approximately 20%.According to recent experiences in the treatment of chronic hepatitis C in children and adolescents,a combination of PEG-interferon α with ribavirin has been found to be well tolerated and highly efficacious,particularly in individuals with genotype 2/3.Thus,this treatment can be recommended as standard of care until more effective treatment options will become available for genotype 1 patients.     

CLINICAL AND LABORATORY OBSERVATION ON 31 CHILDREN WITH APLASTIC ANEMIA TREATED BY SPATHOLOBUS SUBERECTUS COMPOSITA

To investigate the effect of Spatholobus Suberectus Composita (SSC) on bone marrow hematopoiesis in child aplastic anemia (AA).Methods 31 cases of AA children were treated with SSC for 24 months. The pathological changes of bone marrow and the amount of CD_(34) positive cells before or after treatment were compared. 14 cases of normal volunteers were enrolled as control.Results The overall response rate was 87.1% (27 in 31 patients). The volume of nucleated cell in bone marrow (27.4±9.9vol% before treatment vs 44.6±31.5 vol% after treatment), granulocytes (36.0±9.9% vs 46.2±12.9%), megakaryocytes(3.3±7.2 vs 28.5±40.5 cells in bone marrow sections) and CD_(34)~ cells (0.9±0.5% vs 2.0±0.7%) significantly increased after treatment compared with those before treatment (P<0.01 or P<0.05).Conclusion SSC has stimulative effect, which possibly acts at the level of stem/progenitor cells, on the bone marrow hematopoesis.     

内镜下大肠支架置入术在老年结直肠癌并急性肠梗阻患者中的应用

目的 探讨内镜下大肠支架置入在老年人结直肠癌并急性肠梗阻的临床应用价值.方法 65岁以上结直肠癌并急性肠梗阻患者82例,分为大肠支架组41例,行Niti-S肠道支架置入;以及急诊手术组41例,根据术中探查结果分别行肿瘤切除及结肠造瘘.比较两组的平均住院日,平均住院费用,中位生存时间,1年生存率,围手术期病死率,手术并发症等情况.结果 大肠支架组平均住院日(17.9±6.7)d,平均住院费用40 047元,中位生存时间(9.4±4.4)个月,1年生存率43.9%.急诊手术组平均住院日(24.4±4.6)d,平均住院费用61 867元,中位生存时间(8.8±4.8)个月,1年生存率36.6%.结论 大肠内支架对于结直肠癌合并肠梗阻的老年患者是一种安全、经济、有效的治疗方式.

Abstract：

Objective To evaluate the clinica1 value of endoscopic placement of colorectal metal stents for malignant colonic obstruction in aged patients. Methods The 82 cases who were older than 65 years with malignant colonic obstruction were randomly divided into colorectal metal stenting group who were treated with endoscopic Niti-S colorectal metal stenting and emergency surgery group who were treated with tumor resection or colostomy. The average length of stay, average hospitalization charge, median survival time, one-year survival rate, perioperative mortality, and the complications such as anastomotic leakage, incision infection were analyzed. Results In colorectal metal stenting group, in 39 of 41 patients, metal stents were successfully inserted, without complications of hemorrhage, perforation and so on. And the symptoms of obstruction were effectively relieved within 2 days. The 17 cases underwent subsequent elective radical resection of colorectal carcinoma after 1 week, without complications of anastomotic leakage. The 22 cases were treated with colorectal metal stenting for palliative treatment. There were 4 cases of stent migration and 5 cases of stent obstruction again. The average length of inhospital stay was (17.9±6.7) days, the average hospitalization charge was 40 047 yuan, the median survival time was (9.4±4.4) months, and one-year survival rate was 43.9%. In emergency surgery group, 13 cases underwent tumor resection and 28 cases received colostomy. The 14 cases presented with multiple organ dysfunction, 8 cases died preoperatively, 4 cases presented with anastigmatic leakage. The average length of stay was (24.4±4.6) day, the average hospitalization charge was 61 867 yuan, the median survival time was (8.8±4.8) months, and one-year survival rate was 36.6%. Conclusions Endoscopic colorectal metal stenting is a safe, economic and effective treatment for malignant colonic obstruction in aged patients, especially reduces the risk of surgical complications, improves the aged patient's quality of life.     

Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment

AIM: To evaluate the utility of local tumor therapy combined with percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive biliary disease. METHODS: A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients accepted brachytherapy or extra-radiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis. RESULTS: Twenty-two patients underwent chemotherapy (11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy), and 14 patients received radiotherapy (10 cases of cholan-giocarcinoma, 4 cases of pancreatic carcinoma), and 13 patients accepted brachytherapy (7 cases of cholangio-carcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy). The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively, longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%, 80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group. CONCLUSION: Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.     

Immunization status and hospitalization for vaccine-preventable and non-vaccine-preventable infections in liver-transplanted children

BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children.Immunization strategies to prevent vaccine-preventable infections(VPIs) can effectively minimize this infection burden.However,data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited.AIM To evaluate the immunization status,VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant.METHODS The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital(Bangkok,Thailand) were retrospectively reviewed.Immunization status was evaluated via their vaccination books.Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated,and divided into VPIs and non-VPIs.Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded.Severity of infection,length of hospital stay,ventilator support,intensive care unit requirement,and mortality were assessed.RESULTS Seventy-seven children with a mean age of 3.29±4.17 years were included in the study,of whom 41(53.2 %) were female.The mean follow-up duration was 3.68±1.45 years.Fortyeight children(62.3%) had vaccination records.There was a significant difference in the proportion of children with incomplete vaccination according to Thailand's Expanded Program on Immunization(52.0%) and accelerated vaccine from Infectious Diseases Society of America(89.5%)(P 0.001).Post-liver transplant,47.9% of the children did not catch up with ageappropriate immunizations.There were 237 infections requiring hospitalization during the 5 years of follow-up.There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations.The risk of serious infection was high in the first year after receiving a liver transplant,and two children died.Respiratory and gastrointestinal systems were common sites of infection.The most common pathogens that caused VPIs were rotavirus,influenza virus,and varicella-zoster virus.CONCLUSION Incomplete immunization was common pre-and post-transplant,and nearly all children required hospitalization for non-VPIs or VPIs within 5 years posttransplant.Infection severity was high in the first year post-transplant.     

湖南省农村结核病对家庭经济影响的研究

目的 分析湖南省农村结核病对家庭经济的影响,构建肺结核家庭经济负担指数。 方法 以2005年7-9月在6个样本县（区）结核病防治所就诊并确诊的连续登记的354例新发活动性肺结核患者为调查对象,354例患者分布在354户家庭,<30岁、30～岁、45～岁和60~岁组分别有78、121、89和66例,采用自制的结核病社会经济学调查问卷,在知情同意的前提下,分别在确诊时和疗程结束后2次入户访谈,收集患者病后医疗费用及患病前、后1年个人和家庭经济收入、支出等相关资料和信息。 结果 患病后354户患者家庭总经济收入总共减少了437.4万元,户均减少1235.6元（中位625元）;患者本人年收入占家庭年收入1/2及以上者由患病前的48.9%（173/354）减少到患病后的27.1%（96/354）;对患病前、后家庭总收入和总支出情况进行比较,收不抵支的家庭由患病前的26.3%（93/354）增加到患病后的69.5%（246/354）。患病后,肺结核患者平均医疗费占家庭经济开支的（20.4±15.1）%;<30岁、30～岁、45～岁和60~岁4个年龄组的肺结核患者平均医疗费占家庭经济开支的比率分别为（16.5±10.1）%、（17.9±12.4）%、（19.5±13.7）%和（30.6±21.2）%,随着患者年龄组的年龄增大,医疗费用占家庭总开支的比率逐渐增高（H=26.788,P=0.0001）;肺结核患者医疗费用平均占家庭总医疗费用的（89.6±18.9）%;其中45～岁年龄组肺结核患者平均医疗费占家庭总医疗费用的（84.9±24.6）%,低于其他年龄组,<30岁、30～岁、60~岁3个年龄组的肺结核患者平均医疗费占家庭总医疗费用的比率分别为（90.3±18.4）%、（90.5±15.9）%和（93.6±14.5）%（F=2.982,P=0.031）。肺结核患者户均家庭经济负担指数为0.33年,中位负担指数为0.16年（0.14～10.3年）。 结论 罹患肺结核减少了患者和家庭的收入,不仅导致约70%的家庭收不抵支、因病致贫,也使一些贫困的家庭变得更加穷困。     

Family Planning Practices in Families with Children Affected by β-Thalassemia Major in Southern Iran

Preventing the birth of children with β-thalassemia major (β-TM) is an important health issue. We investigated family planning practices and related factors among families with affected children. We selected a total of 569 parents from the parents of patients with β-TM who were registered at thalassemia referral clinics in southern Iran. Information was recorded regarding demographic variables, socioeconomic status and family planning practices. The correlations between family planning practice and related factors were evaluated. Approximately 96.0% of the parents (546) were practicing contraception at the time of the study. Only 12.8% of the families whose first child had β-TM decided to have no more children. The most frequent contraceptive method was tubal ligation (TL) (37.5%) followed by oral contraceptive pills (OCP) (31.5%). Higher education level of the mothers and higher economic status of the families were found to be related with the lower numbers of children with β-TM (p = 0.001). We found a high percentage of safe contraception being used by at-risk couples. It seems that educational programs have been effective in influencing family planning practices. Further attention should be devoted to increasing the knowledge of at-risk couples with a greater focus on parents of low socioeconomic status. Because of cultural factors in Iran, many of these at-risk couples opted to achieve the desired family size, so implementation of a well-organized prenatal diagnostic system seems necessary.     

重庆市四区县肺结核患者经济负担分析

目的: 了解重庆市经济欠发达(简称“欠发达”)区县肺结核患者的经济负担,为优化肺结核患者医疗保险政策提供数据支持。 方法: 采用横断面的研究,选择重庆市黔江区、丰都县、开州区和巫山县结核病定点医院2019年6月至2020年6月间登记治疗的326例活动性肺结核患者,通过问卷调查,以及收集《医院信息系统》中的诊疗信息和费用信息,对患者因病发生的各项费用及个人负担进行分析。 结果: 326例患者平均疗程为180.0(178.0,210.0)d,确诊前的直接医疗费用为1600.0(920.0,3500.0)元,确诊后的直接医疗费用为2479.0(1218.9,5709.6)元。患病后的直接非医疗费用为1300.0(400.0,3000.0)元,因治疗肺结核损失的间接费用为3850.0(500.0,15000.0)元,总费用为14156.8(6904.7,28133.9)元。80.98%(264/326)的患者因治疗肺结核发生家庭灾难性支出。 结论: 重庆市欠发达地区的肺结核患者经济负担较重,现行医疗保险报销政策不能完全缓解患者经济负担,应考虑进一步完善重庆市结核病医疗保险报销政策,降低家庭灾难性支出。     

小儿糖尿病酮症酸中毒临床急救措施与护理研究

目的 研究小儿糖尿病酮症酸中毒的临床急救措施与护理方法.方法 选取2017年12月—2019年12月期间内该院收治的60例小儿糖尿病酮症酸中毒患儿,先随机抽取出30例设为A组,实施常规护理,将剩余的30例设为B组,开展综合护理,护理后,对两组患儿的血糖指标与护理满意度进行比较分析.结果 治疗后,B组患儿的空腹血糖(9....     

临床路径在小儿社区获得性肺炎中的应用

目的探讨临床路径管理在小儿社区获得性肺炎中应用效果。方法回顾性分析我院儿科住院治疗的社区获得性肺炎患儿860例。常规治疗组438例,采用传统的医疗模式,按经验进行治疗、护理及相关检查。临床路径组422例,依据临床路径流程实施检查、治疗及护理。比较两组间住院天数,总住院费用,抗生素的费用。结果两组间比较,临床路径组住院时间[(8±1.2)d]、总住院费用[(4472.28±524.30)元]和抗生素费用[(86.43±25.80)元]均低于常规治疗组[(9.5±1.5)d、(5182.07±467.54)元和(176.68±18.62)元],差异均有统计学意义(P0.05)。结论临床路径应用于小儿社区获得性肺炎管理中,诊疗过程更加规范,缩短住院时间,住院费用、抗生素费用降低,而不影响临床疗效。     

Comparison of perceived needs of family members between registered nurses and family members of critically ill patients in intensive care and neonatal intensive care units

Using the Norris and Grove (1986) questionnaire of perceived needs of families of critically ill patients, 11 registered nurses working in the neonatal intensive care unit and 19 registered nurses working in the intensive care unit of two mid-northern community hospitals provided their perceptions of family needs. Their responses were compared with responses of family members of patients in the intensive care unit (n = 25) and the (n = 24). Results suggest that regardless of unit, registered nurses' perceptions of family needs are congruent. Family members collectively and by unit ranked their needs consistently higher and in some areas differently than did the registered nurses.     

慢性阻塞性肺疾病对中国部分城市患者生命质量和经济负担的影响

目的 了解COPD对城市患者牛命质量的影响,以及COPD造成的经济负担.方法 于2006年7-10月采用横断面调查方法 ,对北京、上海、广州、成都、沈阳和西安等6个城市24家医院723例确诊的COPD患者进行面对面访问,调查内容包括患者的社会人口学信息、目前患病情况、生命质最(采用圣乔治呼吸问卷)、过去1年医疗资源利用情况,以及其他相关费用.对调查所获得信息主要采用描述性分析.结果 被调查COPD患者男性占73%(526/723),平均年龄(67±10)岁.COPD患者圣乔治呼吸问卷症状平均得分为(49±24)分,活动部分得分为(57±23)分,影响部分得分为(46±23)分,总分平均为(50±21)分,均明显高于健康人群得分.COPD患者的年人均直接医疗费用(包括门诊费用、住院费用和自我购药费用)为11744元,直接非医疗费用为1570元.在职COPD患者每人每年因病平均误工17 d,家属冈照顾COPD患者平均每年误工14 d.结论 COPD严重影响城市患者的生命质量,并给患者的家庭和社会造成沉重的经济负担.应大力加强对COPD的干预,特别是对稳定期COPD的干预,以减少COPD的发病和急性加重.     

Family quality of life in families affected by HIV: the perspective of HIV-positive mothers

The HIV infection of a family member can impact family quality of life (FQoL). The objectives of this study are to (1) describe patterns of FQoL among mothers living with HIV (MLHIV) and (2) identify key factors associated with FQoL in families affected by HIV. Recruitment took place in HIV-specialized clinics and community organizations. A 100 MLHIV and 67 of their children participated in this study. Mothers were on average 40.8 years old and reported having an average of two dependent children at home (M = 2.1, SD = 1.0). Participating children were 16.2 years old, on average. Half of the children were boys (50.8%). More than half were aware of their mother's positive HIV status (68.2%) and 19.7% were diagnosed with HIV. All HIV-positive children were aware of their status. A latent profile analysis was performed on the five continuous indicators of FQoL, and three main profiles of self-reported FQoL among MLHIV were established: high FQoL (33%), moderate FQoL (58%), and low FQoL (9%). Among the mothers' characteristics, education, physical functioning, social support, and resilience increased FQoL, while anxiety and irritability decreased FQoL. Among the children's characteristics, resilience followed the FQoL profile. A trend was observed toward children's greater awareness of the mother's HIV status in high and low FQoL profiles. Additionally, irritability tended to be higher within the lower FQoL profile. FQoL profiles can be used to identify families needing special care, particularly for family interventions with both parents and children. Other relevant indicators must be studied (e.g., closeness and support between family members, availability and accessibility of care, family structure, father–child relationships, and medical condition of the mother) and longitudinal research conducted to estimate the direction of causality between FQoL profile and individual family member characteristics.     

西安市养老机构入住人员医养结合现状调查

目的调查西安市养老机构内入住老年人医养结合的现状。 方法于2017年9月至2018年1月对西安市不同区划内12家养老机构的111例老年人进行问卷调查,调查内容包括老年人基本情况、养老支持情况和医养结合相关需求。 结果入住老年人主要以80～89岁的老年人为主（占44.5%）,受教育程度多为小学及以下水平（占40.2%）;月收入1 500～4 000元者最多（占43.4%）,养老月花费为1 000～3 000元者最多（占78.2%）;89例（80.4%）处于丧偶状态;76例（68.4%）老年人不了解、也不曾听说医养结合的相关知识和政策;48.5%的老年人因需要照护而入住养老院。大部分[71例（63.9%）]老年人对服务满意。 结论目前的养老机构医护水平参差不齐,无法满足日增增多的老年人的医疗和照护需求,政府指导下的社会养老亟待进一步完善和快速发展。