家属赋能模式在脊柱结核外科中的应用

目的:探讨家属赋能模式在脊柱结核外科患者及其家属中的应用效果。方法:将80例脊柱结核外科患者随机分为对照组和实验组各40例,对照组采用传统方法进行健康教育,实验组应用家属赋能模式实施健康教育。应用焦虑自评量表、治疗依从性问卷、家属疾病认知及陪护技能调查表对两组患者及家属进行评价。结果:实验组患者及其家属焦虑程度明显低于对照组(P<0.05),患者治疗依从性、家属陪护技能及疾病认知水平均明显高于对照组(P<0.05)。结论:应用家属赋能模式进行健康教育,可显著提高脊柱结核外科患者治疗依从性及家属对疾病的认知水平及护理能力。     

Impact of immigration on tuberculosis epidemiology in a low-incidence country

Mycobacterium tuberculosis strains from 349 patients were isolated in western Sweden during the years 2001–2005. Only 26% of the tuberculosis (TB) patients were born in Sweden. All the others were born in any of 42 different countries; 17% in other European countries, 28% in Africa, 16% in Asia, 11% in the Middle East, and 2% in South America. The mean age of the Swedish-born patients was 67 years, while the mean age among the foreign-born patients was 37 years. The male/female ratio was 1.6 among the Swedes and 0.9 among those born abroad. Extrapulmonary manifestations of TB were most common among patients born in Africa while lung infections without extrapulmonary manifestations were most common in patients born in Europe, including Sweden. Spoligotyping showed that patients with T or Beijing strains had more pulmonary TB than extrapulmonary TB, while patients with EAI and CAS strains had a high proportion of extrapulmonary TB. The ancestral and/or evolutionary older PGGI strains were more often isolated from the foreign-born patients than from the Swedish-born patients, who had strains generally being of the evolutionary recent genogroups PGG2/PGG3. We conclude that immigration from countries with a high incidence of TB has a strong impact on the TB epidemiology in western Sweden, a finding that should be taken into account by TB control strategists when developing programmes for eradication of TB in low prevalence settings.     

妊娠期糖尿病合并生殖道感染危险因素及其免疫状态

目的探究妊娠期糖尿病合并生殖道感染危险因素及其免疫功能情况。方法选取2017年3月-2019年12月宁波市鄞州人民医院收治的妊娠期糖尿病患者(n=135)作为研究对象,编制调查问卷收集患者资料,分析妊娠期糖尿病合并生殖道感染的危险因素;根据是否出现生殖道感染分为感染组和非感染组,另募集同期产检健康的孕妇50名作为对照组,采集受试者分娩前外周静脉血,以免疫散射比浊法检测血清免疫球蛋白(IgG、IgM及IgA)表达水平,流式细胞仪检测外周血T细胞亚群和自然杀伤(NK)细胞比例,酶联免疫吸附法检测免疫细胞分泌细胞因子白细胞介素(IL)-4、IL-10、肿瘤坏死因子α(TNF-α)及γ干扰素(IFN-γ)水平。结果妊娠期糖尿病患者生殖道感染发生率为20.74%(28/135),高于对照组(P<0.05);生殖系统感染史(OR=1.788)、血糖得到控制(OR=0.960)、混用洗外阴用具(OR=1.726)均为患者发生生殖道感染的独立危险因素(P<0.05);感染组IgG、CD4⁺T细胞、CD4⁺/CD8⁺、NK细胞、IL-4及IL-10水平低于非感染组和对照组,IgA、TNF-α及IFN-γ水平高于非感染组和对照组,差异具有统计学意义(P<0.05)。结论妊娠期糖尿病患者生殖道感染发生率较高,影响因素多,患者体液免疫及细胞免疫功能明显失衡,且合并生殖道感染者免疫异常更为严重。     

肺结核合并糖尿病80例分析

目的 探讨两种疾病合并存在的相关规律.方法 对2006～2008年来在市结核病防治所完成规则全疗程的肺结核合并糖尿病患者80例相关临床资料进行分析.结果 肺结核病情严重程度治疗效果控制水平有关.结论 肺结核合并糖尿病患者有病变范围广、痰菌涂阳率、空洞率高,其预后通常较差;通过积极控制血糖水平,早期合理抗结核药物治疗,能提高肺结核治愈率.     

耐多药肺结核患者真菌检测的临床意义

目的 探寻耐多药肺结核（MDR-TB）患者在不同的治疗时期的治疗效果以及合并真菌感染的情况.方法 对77例耐多药肺结核患者在首次以及6个月和12个月分别进行痰液的结核分枝杆菌以及真菌培养.结果 结核分枝杆菌首次培养的阳性率为100%,6个月和12个月培养的阳性率分别为28.57%和36.36%;真菌首次检出率为12.98%,6个月和12个月真菌的检出率分别为29.87%和25.97%,与首次相比,6个月和12个月结核分枝杆菌检出率显著下降（P＜0.01）,真菌的检出率显著增加（P＜0.05）.结论 耐多药肺结核患者在进行抗结核治疗的同时应注意真菌的培养,减少合并感染的机会,以提高耐多药肺结核患者的生存率.     

胰腺结核误诊为胰腺囊腺瘤1例报告

正1病例资料患者男性,42岁,因"发热,上腹部疼痛、黄疸1周"入院。该患者1周前无明显诱因出现发热,体温38~39℃,以午后、夜间为重,伴上腹部疼痛、黄疸,疼痛呈持续性,向腰背部放散,与饮食无关,腹胀、纳差,无恶心、呕吐,无反酸、腹泻,无咳嗽、咯痰,体质量减轻3 kg。查体:体温39℃、心率102次/min、血压120/70 mm Hg,皮肤、巩膜黄染,腹部平坦,剑突下压痛,无反跳痛及肌紧张,肝     

Incidence of Mycobacterial Infections in Cats in Great Britain: Estimate from Feline Tissue Samples Submitted to Diagnostic Laboratories

The aim of this study was to estimate the incidence of mycobacterial infections in cats in Great Britain (GB). This was performed using the proxy measure of feline tissue samples submitted to diagnostic laboratories in GB that were found to have histopathological changes typical of mycobacterial infection (‘MYC’). Sixteen primary diagnostic laboratories were asked for information on the number of feline samples submitted in 2009, the number with MYC, the number undergoing Ziehl–Neelsen (ZN) staining and, for comparison, the number diagnosed with lymphoma. Eight laboratories provided full data for the whole year: 11 782 samples; lymphoma 3.2% (mean, 95% CI: 2.89, 3.5), MYC 1.16% (0.98; 1.37) and ZN‐positive 0.31% (0.22; 0.43). Data on 1569 samples from seven laboratories that provided partial data on samples for the whole year revealed similar results, although all changes were more frequent: lymphoma 5.42% (4.35; 6.66), MYC 2.36% (1.66; 3.23) and ZN‐positive 0.77% (0.40; 1.33). One laboratory only provided data for part of the year (4.5 months), reporting all three types of histopathology less frequently: 18 232 samples; lymphoma 0.2% (0.18; 0.32), MYC 0.07% (0.04; 0.12) and ZN‐positive 0.05% (0.02; 0.09). The reasons for low reporting rates in this high‐throughput laboratory are unclear. In total, 187 samples were reported as having MYC. Five Reference laboratories were also contacted, reporting 174 feline tissue submissions in 2009, with mycobacteria being cultured from 90. The study shows that MYC are frequently reported in tissue samples from cats in GB, being reported in ∼1% of samples, with confirmation as ZN‐positive in ∼0.3%. Lymphoma is recognized as a common disease in cats, being seen in ∼3% of samples in this study. When compared against MYC, lymphoma was reported only twice as frequently. This confirms that far from being rare, clinically significant mycobacterial infections occur commonly in cats in GB.     

Successful use of Tocilizumab in a patient with nephrotic syndrome due to a rapidly progressing AA amyloidosis secondary to latent tuberculosis

AA (secondary) amyloidosis is one of the most severe and uncommon complications of several rheumatic disorders and chronic infections such as tuberculosis (TB). Successful treatment depends on the control of the underlying inflammatory process, what can lead to an improvement or a regression in organ dysfunction. If the disorder persists, it has been reported in some cases of AA amyloidosis secondary to rheumatic diseases, that the use of biologic therapy is so far the only opportunity to reduce the development of AA amyloidosis and to reverse established deposits. We report herein a case of a latent TB infection complicated by a life-threatening AA amyloidosis presented as nephrotic syndrome. After an adequate antituberculostatic treatment, AA amyloidosis remained active and Tocilizumab (TCZ) was started with a dramatic resolution of the proteinuria, stabilization of the amyloid deposits and improvement in general condition.     

Role of fine‐needle aspiration cytology in tuberculosis of bone

This study was designed to evaluate the role of fine‐needle aspiration cytology (FNAC) in diagnosis of skeletal tuberculosis (TB). In this retrospective study, 20 cases were retrieved over a 10‐year period in which a cytologic diagnosis of osseous TB was rendered. The aspirations were performed with a 22‐gauge needle attached on a 20‐ml syringe after taking into consideration the radiological findings. The cytologic findings were subdivided into the following categories—epithelioid cell granulomas with necrosis, epithelioid cell granulomas without necrosis, and necrosis only. These cases were either with or without AFB positivity. The smears showed epithelioid cell granulomas in 23 cases (85.2%), multinucleate and Langhans' giant cells in 15 cases (55.6%), and inflammatory cells were noted in the background in 15 cases (55.6%). AFB was positive in six cases (22.7%). FNA provides a simple and safe outpatient procedure for the diagnosis of osseous TB and obviates the need of an open biopsy. Diagn. Cytopathol. 2010. © 2009 Wiley‐Liss, Inc.