学生作为标准化病人用于临床技能考核的初步研究

培养 32名四年级医学生成为标准化病人 ,分别对住院医师、毕业生和转科的实习生进行临床技能考核 ,考核后通过对考生和学生标准化病人进行问卷调查分析 ,证明 :学生经过正规标准化病人培训后能够满足临床技能考核的要求 ,学生在接受培训和用于对其他学生的考核过程中能够增长专业知识和提高技能水平。我们认为 ,学生标准化病人培训花费时间少、支出费用低、易推广应用。     

Children with learning disabilities in the paediatric clinic, Hospital Tuanku Ja'afar Seremban: an overview

The aim of the study was to document the prevalence of learning disability among the children attending the Paediatric Clinic in Hospital Tuanku Ja'afar Seremban. The demographic distribution of these patients; the age of detection of the problem; the associated medical conditions and types of intervention received by these patients were documented. Patients who were between the ages of five to twelve years were included in the study. Learning disability was divided into three categories: speech and articulation problems, academic skills disorder and other categories which included developmental delay. Children with cerebral palsy were excluded from the study. Out of 1320 patients screened, 355 were found to have learning disorders. Majority were Malays, with the male to female ratio of 1.9:1. Most of the patients stayed in Seremban. The learning problem was most commonly detected at the age of 4 years and below. The commonest type of learning disorder was developmental delay, followed by academic skills disorder, speech and academic skills problems and speech disorders. Problems that were detected early were speech problems and developmental delay. Majority of the children had associated medical conditions. Most of the patients received some form of intervention but 11.3% did not attend any intervention program at all. A strategy should be formulated and implemented to help this group of children.     

A 3 year case study of alcohol related psychotic disorders at Hospital Seremban

This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.     

Microbial keratitis: aetiological diagnosis and clinical features in patients admitted to Hospital Universiti Sains Malaysia

INTRODUCTION: Corneal ulceration remains one of the major causes of blindness in developing countries, including Malaysia. Our objective is to determine the epidemiological characteristics, clinical features, risk factors and the aetiology of microbial keratitis in patients admitted to Hospital Universiti Sains Malaysia (HUSM). METHODS: All patients with microbial keratitis admitted to our hospital over a 16-month period from January 2004 to April 2005 were included in the study. Sociodemographic data and information pertaining to risk factors were recorded. All patients underwent examination with slit lamp biomicroscopy and corneal scrapings were sent for microbiological diagnosis. RESULTS: 42 patients were included in the study; 26 were male and 16 were female, with mean age of 44.5 (+/- 20.9) years. History of previous corneal trauma was present in 26 (61.9 percent) patients. Central location ulcers were more predominant (69 percent) than peripheral ulcers. Cultures from corneal scrapings were positive in 29 cases (69 percent). Of those individuals with positive cultures, 23 (79.3 percent) had pure bacterial infection, four (13.8 percent) had pure fungal infection and two (6.9 percent) had mixed growth. The most common bacterial pathogen isolated was Pseudomonas aeruginosa (40.5 percent), followed by Streptococcus pneumoniae (7.5 percent). Fungal pathogens which were isolated include Fusarium spp. (4.7 percent) and Aspergillus spp. (2.4 percent). CONCLUSION: Central corneal ulceration is a problem among patients presenting with microbial keratitis in HUSM. It often occurs after corneal trauma. These findings have important public health implications for the treatment and prevention of visual morbidity due to an infective cause.     

寻常型银屑病患者血清S100A12水平的测定及临床意义

目的了解寻常型银屑病患者血清中S100A12水平及其临床意义。方法 ELISA法检测50例寻常型银屑病患者和50例健康对照组血清S100A12水平,并计算患者银屑病面积和严重程度指数(psoriasis area and severity index,PASI)。使用Pearson分析法分析S100A12水平与PASI相关性。结果寻常型银屑病组血清S100A12水平为(154.4±114.9)ng/mL;对照组血清S100A12水平为(72.6±62.8)ng/mL。寻常型银屑病组S100A12水平高于对照组,差异有统计学意义(P0.05)。Pearson分析结果显示寻常型银屑病组S100A12水平与PASI评分之间呈正相关性(r=0.436,P0.05)。结论银屑病患者血清S100A12水平明显高于健康人,与疾病严重程度相关,可作为判断银屑病严重程度的指标。     

Upper gastrointestinal bleeding in Kuala Lumpur Hospital, Malaysia

Despite advancements in endoscopy and pharmacology in the treatment of peptic ulcer disease the overall mortality has remained constant at 10% for the past four decades. The aim of this study was to determine the age, gender, racial distribution, incidence and causes of endoscopically diagnosed cases of upper gastrointestinal (UGI) bleeding to summarise treatments undertaken and to report their outcome. A prospective study of UGI bleeding in 128 patients was performed in two surgical wards of Kuala Lumpur Hospital, involving both elective and emergency admissions. The study group comprised of 113 (88.2%) males and 15 (11.7%) females. The mean age was 51.9 years (range 14 to 85 years) and 37.5% (48 of 128 patients) were older than 60 years. The Indian race was over-represented in all disease categories. Smoking (50.1%), alcohol consumption (37.5%), non-steroidal anti-inflammatory drugs (NSAIDs) (17.2%), traditional remedies (5.5%), anti-coagulants (2.3%) and steroids (0.8%) were among the risk factors reported. Common presenting symptoms and signs included malaena (68.8%), haematemesis (59.4%) and fresh per rectal bleeding (33.6%). The commonest causes of UGI bleeding were duodenal ulcer (32%), gastric ulcer (29.7%), erosions (duodenal and gastric) (21.9%), oesophageal varices (10.9%) and malignancy (3.9%). UGI bleeding was treated non-surgically in 90.6% of cases. Blood transfusions were required in 62.6% (67/107) of peptic ulcer disease patients. Surgical intervention for bleeding peptic ulcer occurred in around 10% of cases and involved under-running of the bleeding vessel in most high risk duodenal and gastric ulcer patients. The overall mortality from bleeding peptic ulcer disease was 4.7%. Six patients died from torrential UGI haemorrhage soon after presentation, without the establishment of a cause. Active resuscitative protocols, early endoscopy, more aggressive interventional therapy, early surgery by more senior surgeons, increasing intensive care unit beds and more active participation of multidisciplinary teams in co-ordinating management are among remedial measures advocated. Broader educational preventive strategies should target the causes of UGI bleeding.     

Red cell autoantibodies among thalassaemia patients in Hospital Universiti Sains Malaysia

INTRODUCTION: Thalassaemia is one of the major public health problems in Malaysia. Regular monthly blood transfusion remains the main treatment for severe thalassaemia patients. One of the complications of blood transfusion is the formation by the recipients of alloantibodies and autoantibodies against red blood cell (RBC) antigen. The purpose of this study was to determine the prevalence of RBC autoantibodies among multiple-transfused thalassaemic patients in our institution and factors that contribute to its development. METHODS: A prospective study was conducted in Haematology Laboratory, Hospital Universiti Sains Malaysia between January 2004 and December 2004. A total of 63 thalassaemia patients, who received regular blood transfusion were included in this study. Clinical and serological data were collected and analysed prospectively. Blood samples were subjected to standard blood bank procedures for screening of antibodies and their subsequent identification using reagent of Diamed-ID Gel microtyping system. RESULTS: There were 49 (77.8 percent) patients with Hb E/beta-thalassaemia, ten (15.9 percent) beta-thalassaemia major, three (4.7 percent) Hb H Constant Spring and one (1.6 percent) Hb H disease. Only one (1.6 percent) patient had autoantibodies. There were no statistical associations found between the formation of autoantibodies with age at the start of transfusion, number of packed cell transfused and splenectomy. CONCLUSION: Our data showed a low autoimmunisation rate in multiple-transfused thalassaemia patients in our hospital.     

银屑病患者血清层粘连蛋白水平与临床意义

目的探讨血清层粘连蛋白（Ｌａｍｉｎｉｎ,ＬＮ）含量与银屑病病情活动的关系。方法用放射免疫法测定２５例进行期和 静止期银屑病患者血清ＬＮ含量并与２５例健康正常者作对照。结果银屑病进行期组、静止期组、对照组血清ＬＮ水 平分别为（９２．６６±９．８６） μｇ／Ｌ、（８７．５９±６．４０）μｇ／Ｌ和（８０．９７±６．２５）μｇ／Ｌ。 ３组中两两之间均存在显著性差异（Ｐ＜０．０１）,且银 屑病进行期与静止期组血清ＬＮ水平呈正相关。结论ＬＮ是反映银屑病病情活动的可靠指标之一。     

银屑病患者血液学检验指标特点及临床意义

目的探讨银屑病患者血液学检验指标特点及临床意义。方法选择2015年1月~2016年12月在我院就诊的银屑病患者380例为研究对象。另选择同期健康体检者100例为对照组。比较两组血常规、血生化指标、细胞因子水平、免疫指标等。结果 (1)血常规结果比较:银屑病组WBC、N%、N、EO%、EO、PLT、MPV显著高于对照组,差异有统计学意义(P0.05);银屑病组LYMPH、MONO%、PDW显著低于对照组,差异有统计学意义(P0.05)。(2)血生化指标比较:银屑病组TP、ALB、HDL、Apo A1、CA显著低于对照组,TG、LDL、L(a)、Apo B、UA显著高于对照组,差异有统计学意义(P0.05)。(3)免疫指标比较:银屑病组Ig G、CRP、ESR显著高于对照组,差异有统计学意义(P0.05)。(4)细胞因子水平比较:银屑病组s IL-2R、IL-2、IL-4、IL-10、IL-12水平均显著高于对照组,差异有统计学意义(P0.05)。结论银屑病的发病机制复杂,患者存在炎症反应增强、血细胞计数异常、细胞因子水平异常、免疫功能紊乱、低蛋白血症倾向、高脂血症、高尿酸血症倾向等。     

A review of burns patients admitted to the Burns Unit of Hospital Universiti Kebangsaan Malaysia

This is a retrospective review of 110 patients admitted to the Burns Units between October 1999 and November 2001. The aim was to determine the burns pattern of patients admitted to hospital UKM. There was an increasing trend for patients admitted. Female to male ratio was 1:2. Children consisted 34% of the total admission. Children had significant higher number of scald burns as compare to adult (p < 0.01). Domestic burns were consist of 75% overall admission. Mean percentage of TBSA (total body surface area) burns was 19%. Thirty percent of patients sustained more than 20% of TBSA. Sixty percent of patients had scald burns. Ninety percents of patients with second degree burns that were treated with biologic membrane dressing or split skin graft. Mean duration of hospital stay was 10 days. Over 70% of patients were discharged within 15 days. Overall mortality rate was 6.3%. The patients who died had significantly larger area of burns of more than 20% TBSA (p < 0.05) and a higher incidence of inhalation injury (p < 0.02). Hence, this study suggests a need for better preventive measures by the authority to prevent burns related accident and the expansion of the service provided by the Burns Unit.     

综合医院精神心理障碍患者的心理咨询方法研究(附11例患者临床资料分析)

目的 探讨综合医院精神心理障碍患者的心理咨询方法.方法 对在全科医学科住院的11例精神心理障碍患者给予药物治疗与心理咨询,结合"心身一体"理论,采用认知行为疗法和认识领悟疗法进行干预.结果 经主观和客观评价11例患者均有不同程度恢复,治疗后SAS、SDS评分与治疗前比较,差异均有统计学意义(P＜0.01);治疗后SCL-90躯体化、人际关系、恐惧、强迫、抑郁、焦虑、敌对及其他各因子分与治疗前比较差异均有统计学意义(P＜0.05).结论 认知行为疗法和认识领悟疗法简单、通俗易懂,容易被患者接受,医生容易掌握.     

阿立哌唑与喹硫平治疗首发精神分裂症的临床对照研究

目的探讨阿立哌唑与喹硫平治疗首发精神分裂症的临床疗效。方法 63例首发精神分裂症患者,符合CCMD-3精神分裂症诊断标准,随机分成两组,分别使用阿立哌唑和喹硫平治疗,疗程共8周。采用阳性和阴性症状量表(PANSS)和不良反应症状量表(TESS)进行副反应评定。结果阿立哌唑组总有效率为93.55%,喹硫平组总有效率为90.63%,差异无统计学意义(P>0.05)。阿立哌唑组和喹硫平组两组患者治疗前后PANSS量表评分,差异无统计学意义(P>0.05);阿立哌唑组治疗前后相比,瘦素和三酰甘油水平升高,差异有统计学意义(P<0.05),喹硫平组治疗前后瘦素、催乳素、血糖和三酰甘油水平升高,差异有统计学意义(P<0.05)。结论阿立哌唑和喹硫平对首发精神分裂症疗效相当,但副反应表现有差异,前者优于后者。     

穿孔素、颗粒酶、颗粒溶素在银屑病患者中的表达及临床意义

目的 探讨穿孔素(PF)、颗粒酶B(GrB)、颗粒溶素(GNLY)在银屑病患者外周血单个核细胞中的表达及临床意义.方法 收集30例银屑病患者和30例健康体检者全血,分离出单个核细胞,采用荧光定量PCR(FQ-PCR)法检测PF、GrB和GNLY的mRNA的表达,并采用免疫印迹法检测GrB、GNLY及PF的蛋白表达,双抗体夹心ELISA方法检测患者及体检者血清中IL-4、IL-6、TNF-α及IFN-γ的水平.并分析PF、GrB和GNLY的蛋白表达水平与IL-4、IL-6、TNF-α及IFN-γ的相关性.结果 银屑病患者与健康体检者比较后,患者PBMC中GNLY、PF蛋白含量和mRNA均明显降低(P<0.01),而GrB无显著变化(P>0.05);IL-4 水平显著下降(P<0.05),IL-6、TNF-α和IFN-γ显著升高(P<0.05).PF和GNLY的蛋白表达水平与IL-6、TNF-α和IFN-γ成负相关,而与IL-4的水平成正相关,与GrB不相关.结论 银屑病患者PF和GNLY的蛋白及mRNA表达与IL-4、IL-6、TNF-α和IFN-γ的变化具有一定的相关性,其可能在银屑病的发病过程中起一定的作用.     

泰能和氨苄西林/舒巴坦治疗鲍曼不动杆菌感染的临床研究

目的　比较泰能和氨苄西林 /舒巴坦治疗鲍曼不动杆菌 (Acinetobacterbaumannii,A baumannii)感染的临床效果和抗生素费用消耗 ,为临床治疗鲍曼不动杆菌感染提供依据。方法　对鲍曼不动杆菌感染的 71例ICU病人进行前瞻性观察 ,分析泰能和氨苄西林 /舒巴坦治疗鲍曼不动杆菌感染病人的临床效果和费用消耗。结果　两种药物在相同时间内治疗有效率没有显著差别 ,而用氨苄西林 /舒巴坦治疗的病人抗生素花费明显低于用泰能治疗的病人 ( 2 113元vs 5 789元 ,P <0 0 0 1) ,且泰能治疗组与抗生素相关住院天数 ( 13 48vs 8 95 ,P =0 0 0 3 )和在ICU的总住院天数 ( 2 8 7vs 13 6,P <0 0 0 1)较长。结论　氨苄西林 /舒巴坦治疗鲍曼不动杆菌感染至少和泰能一样有效 ,且使用氨苄西林 /舒巴坦是一种经济的选择。