Risk groups for clinical complications of norovirus infections: an outbreak investigation

Norovirus infections have been described as self-limiting diseases of short duration. An investigation of a norovirus outbreak in a university hospital provided evidence for severe clinical features in patients with several underlying diseases. Clinical outcomes of norovirus infection were defined. Risk-factor analysis targeting underlying diseases and medication was performed using multivariate analyses. In five outbreak wards, 84 patients and 60 nurses were infected (an overall attack rate of 32% in patients, and 76% in nurses). The causative agent was the new variant Grimsby virus. Severe clinical features, including acute renal failure, arrhythmia and signs of acute graft organ rejection in renal transplant patients, were observed in seven (8.3%) patients. In multivariate analyses, cardiovascular disease (OR 17.1, 95% CI 2.17-403) and renal transplant (OR 13.0, 95% CI 1.63-281) were risk-factors for a potassium decrease of >20%. Age >65 years (OR 11.6, 95% CI 1.89-224) was a risk-factor for diarrhoea lasting >2 days. Immunosuppression (OR 5.7, 95% CI 1.78-20.1) was a risk-factor for a creatinine increase of >10%. Norovirus infections in patients with underlying conditions such as cardiovascular disease, renal transplant and immunosuppressive therapy may lead to severe consequences typified by decreased potassium levels, increased levels of C-reactive protein and creatine phosphokinase. In the elderly, norovirus infection may lead to an increased duration of diarrhoea. Therefore patients at risk should be hospitalised early and monitored frequently. Strict preventional measures should be implemented as early as possible to minimise the risk of nosocomial outbreaks.     

“分步给药”在低氧易感患者无痛苦胃镜检查中安全性的探讨

目的 探讨在低氧易感患者无痛苦胃镜检查中采用分步给药的安全性和镇静/镇痛效果.方法 接受胃镜检查的180例患者,其中有鼾症、或咳嗽、咳痰症状的患者120例单双号随机入选Ⅰ组(分步给药组)和Ⅱ组(普通组),60例无鼾症、咳嗽、咳痰症状的患者为Ⅲ组(常规给药组),Ⅰ组采用分步给药法,Ⅲ组采用常规给药法对患者实施胃镜检查前的镇静/镇痛术,Ⅱ组则进行普通胃镜检查,分析2种镇静法对SBP、DBP、SpO2、HR、清醒时间、患者反应、患者对检查过程的感受以及是否愿意再次接受检查的影响,评价分步给药法在低氧易感患者无痛苦胃镜检查中的安全性和镇静/镇痛效果.结果 Ⅰ组、Ⅲ组检查中SBP、DBP变化无明显差异(均P＞0.05),Ⅰ组检查前、中SpO2的变化小于Ⅲ组(均P＜0.01);Ⅰ组进镜时咽部受刺激产生的恶心咽吐、流涎、咳嗽、躁动反应多于Ⅲ组(均P＜0.01),但较Ⅱ组少(均P＜0.01);Ⅰ组对胃镜检查的评价与Ⅲ组无明显差异(P＞0.05),与Ⅱ组相比有明显差异(P＜0.01).结论 分步给药法是一种适用于低氧易感患者无痛胃镜检查的安全、有效的镇静/镇痛方法.     

心理干预对社区老年抑郁病人的影响

[目的 ]探讨心理干预对社区老年抑郁病人的影响。 [方法 ]采用对照研究的方法 ,按区域用老年抑郁量表(GDS)将筛选出的符合标准的老年抑郁病人分为干预组及对照组 ,对干预组病人进行 3个月的心理干预 ,3个月后两组进行GDS评分及抑郁障碍缓解率的比较分析。 [结果 ]干预前两组GDS分数比较无统计学意义 ,3个月后干预组GDS得分显著低于对照组 ;干预后干预组的抑郁障碍缓解率显著高于对照组。 [结论 ]心理干预可以显著减轻老年抑郁病人的抑郁症状 ,提高抑郁病人的缓解率。     

Complications Related to Dapsone Use for Pneumocystis Jirovecii Pneumonia Prophylaxis in Solid Organ Transplant Recipients

Dapsone, used for prevention of Pneumocystis jirovecii infections, has been reported to cause hemolytic anemia and methemoglobinemia; its tolerability in solid organ transplant recipients is not well described. We investigated dapsone-related adverse events in patients undergoing solid organ transplantation from 1999 to 2004. Transplant providers identified patients for the investigators who then reviewed the patients' hospital and outpatient records. Sixteen solid organ transplant recipients fit case definitions for dapsone-related hemolytic anemia (n = 11) or methemoglobinemia (n = 5). Median time from event to dapsone discontinuation was 15 days; all patients improved after drug discontinuation. G6PD enzyme activity was normal in all patients whose test results were available. Dapsone may be associated with hemolytic anemia or methemoglobinemia, even with normal G6PD levels. These events are often not promptly recognized, and drug discontinuation is delayed. Dapsone-related hemolytic anemia or methemoglobinemia should be considered in solid organ transplant recipients with unexplained anemia or hypoxia.     

Excessive daytime somnolence in Japanese patients with Parkinson''s disease

To investigate the prevalence and severity of excessive daytime somnolence (EDS) in Japanese patients with Parkinson's disease (PD) and to examine the main cause of EDS. Fifty-three Japanese patients with PD (PDs: 32 females and 21 males) and 17 controls (10 females and seven males) were evaluated using the Epworth Sleepiness Scale (ESS). The severity of the disease was evaluated by Unified Parkinson's disease Rating Scale (UPDRS), and information about quality and quantity of medications was collected. The correlations amongst EDS and age, severity of PD, duration of illness and medications were analyzed. The mean ESS score was significantly higher in advanced PDs than in controls, and correlated with the UPDRS score (r(s) = 0.743, P < 0.0001). Age, duration of illness and the dose of levodopa weakly correlated with ESS score. The intake of dopamine agonists did not affect the severity of EDS. The mean ESS score in PDs was lower than that reported in PD in European and American studies. EDS in Japanese patients with PD was milder compared with Caucasian patients, which might be due to the lower doses of the medications used in Japan. The results suggest that EDS in PD is mainly because of neuropathological changes of the disease itself.     

Critical review of treatment trials in hypertension

Summary: Despite numerous deficiencies in some antihypertensive drug treatment trials, and some questionable selections of studies for inclusion in several meta-analyses, undoubtedly such trials have shown treatment benefits from reducing hypertension. Complications that can be corrected or prevented include malignant hypertension, hypertensive heart failure, stroke and coronary artery morbidity. the all-cause mortality has been lowered in several trials. the benefits have been seen in subjects aged over 60 years, in women and men, and in patients with isolated systolic hypertension. the benefits have been achieved using a wide range of drugs, not only with beta-blockers or diuretics. Non-pharmacological means of lowering blood pressure have not been evaluated in relation to morbidity.     

急性颅脑损伤患者脑脊液中兴奋性和抑制性氨基酸含量改变及其临床意义

采用氨基酸自动分析仪检测了１８例急性颅脑损伤患者脑脊液中谷氨酸、天门冬氨酸、牛磺酸、甘氨酸、丙氨酸、γ－氨基丁酸、脯氨酸含量的动态变化。结果发现，伤情越重、预后越差的患者，脑脊液中牛磺酸、γ－氨基丁酸、丙氨酸含量伤后早期升高越明显，恢复至正常的时间也越长；其中２例早期死于急性弥漫性脑肿胀、脑水肿的患者，伤后当天脑脊液中牛磺酸含量分别为９２．６和５１．５μｍｏｌ／Ｌ，是对照值的９．６倍和５．４倍，γ－氨基丁酸含量分别为１１９．８和２４６．２μｍｏｌ／Ｌ，是对照值的２．７倍和５．５倍。表明伤后脑脊液中牛磺酸、γ－氨基丁酸和丙氨酸含量的动态变化可初步反映颅脑损伤的严重程度及颅脑损伤患者的脑功能恢复状况，并可能与急性脑水肿、脑肿胀的病理生理过程有关。     

克林霉素在老年患者呼吸道感染中的应用

目的:探讨克林霉素在老年呼吸道感染中的应用价值.方法:38例老年呼吸道感染惠者随机分为治疗组(克林霉素)和对照组(青霉素 丁胺卡那霉素),观察临床疗效.结果:治疗组在退热时间和治疗时间上均短于对照组,差异具有显著性意义,而副反应少而轻微.结论:克林霉素治疗老年呼吸道感染安全有效.     

伊贝沙坦治疗老年高血压病

目的　观察伊贝沙坦和卡托普利对老年原发性高血压患者的降压作用及内生肌酐清除率 (Cr-C)的影响。方法　选择 6 8例老年原发性高血压患者 ,Cr -C在 5 0 .0ml± 19.4ml/ (min·1.73m2 ) - 1之间。随机分成伊贝沙坦组 (n =34)、卡托普利组 (n =34) ,对 2组分别进行治疗前、后降压幅度、Cr -C的比较。结果　伊贝沙坦和卡托普利对于老年原发性高血压的降压作用同样有效 ,但前者提高Cr-C的作用明显优于后者 ,2组比较有显著差异性 (P <0 .0 1)。伊贝沙坦组未见干咳现象 ,卡托普利组干咳发生率为 17.6 %。结论　伊贝沙坦不仅有良好的降压作用 ,还能较卡托普利更好地提高Cr-C、改善肾功。     

老年病人睡眠状况及护理干预研究进展

综述了老年人睡眠质量及其影响因素、睡眠障碍的危害、老年病人睡眠的护理干预。建议进行前瞻性干预试验,为改善老年人的睡眠质量提供依据。