Prednisone therapy of membranoproliferative glomerulonephritis in children

Six children with biopsy-proved type 1 membranoproliferative glomerulonephritis (MPGN) improved clinically during a 2-year course of prednisone therapy. All children had nephrotic syndrome. Creatinine clearance was less than or equal to 80 ml/min/1.73 m2 in four patients. Initial prednisone dosage ranged from 20 mg every other day to 2 mg/kg/day (maximum 60 mg), with subsequent modifications based on improvement. After completion of a 2-year course of steroid therapy, a repeat kidney biopsy was performed in each child; a decrease in glomerular disease activity was noted in five of them. After a mean follow-up of almost 5 years, all children have creatinine clearance greater than 120 ml/min/1.73 m2, and only one remains nephrotic. Although the use of prednisone in children with MPGN remains controversial, we have observed a diminution in proteinuria and normalization of creatinine clearance with therapy initiated early in the disease course.     

Changes in the management of severely Rh-immunized patients

Since July 1, 1978, we have instituted the following changes in the management of severely Rh-immunized patients: (1) serial amniotic fluid optical density (delta OD450 ) values and real-time ultrasound scanning beginning at 21 weeks' gestation, (2) fetal transfusions as early as the twenty-third week, (3) ultrasound surveillance during and after intrauterine transfusions, and (4) planned premature delivery with neonatal exchange transfusions for selected cases between 29 to 32 weeks and for all patients after 32 weeks' gestation. The perinatal survival rate (83.8%) in 37 isoimmunized pregnancies managed with this regimen was significantly higher (p less than 0.05) than in 34 such pregnancies (55.9%) managed according to the protocol utilized during the previous four years.     

转变作风真抓实干做好2002年重点卫生工作

根据中共中央、国务院要求,结合卫生工作实际提出卫生部2002年的重点工作是:认真贯彻落实农村卫生改革与发展的指导意见,加快配套文件出台,探索和实行多种形式农民健康保障办法;继续深化城镇医药卫生体制改革,加强医疗服务质量管理,推进医疗机构属地化管理,发展多种形式办医模式,推进社区卫生服务;继续加强重大疾病控制,尤其是艾滋病、结核病、乙型肝炎、血吸病和地方病的预防控制,加强疾病监测和建设,防范生化恐怖活动;进一步依法行政,加大综合执法力度;加强精神文明建设,全面推进各项卫生工作。     

城市居民卫生服务状况纵向分析

本文通过3次卫生服务调查的纵向比较,对我国城市居民卫生服务状况进行了总结,并在分析现状的基础上,展望了今后社区卫生服务的发展前景。     

城市社区卫生服务实践概况及研究进展

本文从近年来城市社区卫生服务概况及相关理论研究两方面进行系统回顾,以期为城市社区卫生服务的实践与研究提供参考。     

南宁市城区人群华支睾吸虫感染调查

目的 了解南宁市城区居民华支睾吸虫病感染情况。方法 以ELISA法和改良醛醚法检查来自门诊和现场采集的血清和粪便样本的华支睾吸虫抗体和虫卵。结果 调查共1388例，其中门诊就诊者772人，感染率61．66％，现场调查人群616人，感染率25．65％，前者明显高于后者；有吃鱼生史、鱼生史不详和无鱼生史者的感染率分别为58．83％、32．77％及1．88％，三者差异高度显著。以ELISA法与改良醛醚法检测门诊就诊者华支睾吸虫病感染率的差异不显著。结论 南宁市华支睾吸虫病流行严重，对市民健康已造成严重威胁。     

6例布氏杆菌病的诊治

目的加强对布氏杆菌临床及实验特征的认识，以利及时诊断与治疗。方法分析我院诊治的布氏杆菌病6例。患者标本进行常规血液培养，鉴定，药敏及血清凝集试验。结果6例患者均为疫区的农民，临床表现有发热、呈波状热、畏寒、大汗、关节痛。6例中有4例有肝炎及肝炎肝硬化病史，脾大，白细胞均偏低，血红蛋白3例，血小板3例均低于正常值。血沉检测5例中3例高于正常，转氨酶5例高于正常。细菌呈小球杆状或短杆状，单个、成对或短链排列，革兰染色不宜着色，延长时间呈革兰染色阴性，生长缓慢。培养阳性的5株布氏杆菌对四环素、米诺环素、复方磺胺甲口恶唑、左氧氟沙星等均敏感。用广谱抗生素无效，细胞内抗菌药联合应用效果明显。结论城市医院临床及检验医师应高度重视布氏杆菌病，早期诊断，正确治疗。     

东莞市结核病控制项目实施10年社会与经济效益评价

目的分析东莞市实施世界银行贷款结核病控制项目10年的成本-效益。方法对1992—2001年东莞市世界银行贷款额度，地方配套经费使用与病人发现、治疗情况进行分析。结果10年利用世界银行贷款79．22万元，地方配套资金316．37万元，共计395．59万元，治愈涂阳肺结核病人3776例。减少结核菌感染3．77—5．66万人。减少肺结核传染源发生0．19-0．28万人。节约治疗资金340．08万元。减少治疗误工费336．10万元。因减少活动性肺结核的发生而避免经济损失522．54—770．06万元。结论东莞市10年世界银行贷款结核病控制项目成效显著，使3．77—5．66万人免受结核菌感染，减少或避免了各种费用1198．72—1446．24万元。     

An Overview of 9/11 Experiences and Respiratory and Mental Health Conditions among World Trade Center Health Registry Enrollees

To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2–3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income <$25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600–70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.