城关社区成人水痘并发症76例诊治分析

目的了解成人水痘并发症的临床特点,为成人水痘的预防和临床诊治提供依据。方法回顾性分析2011~2015年我院收治的76例成人水痘并发症患者的临床资料,对临床流行特征和并发症发生情况及预后进行分析。结果 76例成人水痘并发症患者继发皮肤感染占84.21%,肝功能损害占55.26%,呼吸道感染占47.37%;发病比例男性高于女性,且以冬春季节发病为主。76例患者经临床应用阿昔洛韦联合麻疹减毒活疫苗治疗,均治愈。结论成人水痘发病率有增高趋势,而且成人水痘并发症有发热程度和热程、全身毒血症状以及皮疹数量、各种并发症发生比例均较儿童高且严重,无疫苗免疫史患者病情较重。临床上应尽早明确诊断,及时治疗;可通过接种水痘减毒活疫苗(VarV)(建议推行2剂次接种的免疫策略)来控制发病率和减少并发症发生。     

重症急性胰腺炎并发胰性脑病的临床特点及相关影响因素分析

目的:探究重症急性胰腺炎并发胰性脑病(PE)的临床特点及相关影响因素分析。方法:本研究于2008年3月~2015年3月期间,选择我院收治的重症急性胰腺炎患者93例为研究对象,根据患者是否并发PE临床症状将其分为PE组和非PE组。收集所有患者基本资料、实验室检查指标及病原学培养检查资料,采用logistics回归对PE发病的影响因素进行分析。结果:93例重症急性胰腺炎中23例被诊断为PE,发病率为24.73%,临床主要表现为兴奋性、烦躁不安、谵妄等症状;PE组患者APACHEⅡ评分、MODS发生率、肌酐、甘油三脂水平及真菌感染率均高于非PE组,差异有统计学意义(P0.05);多因素logistics回归显示,高APACHEⅡ评分和高甘油三脂是PE发生的危险因素(OR=3.221,2.973;均P0.05)。结论:重症急性胰腺炎并发PE的发病率较高,临床有较高的APACHEⅡ评分、MODS发生率、肌酐、甘油三脂水平及真菌感染率,其中高APACHEⅡ评分和高甘油三脂是PE发生的危险因素。     

92例新型冠状病毒肺炎患者流行病学及临床特征分析

目的分析新型冠状病毒肺炎(Novel coronavirus pneumonia,NCP;亦称为COVID-19)确诊患者的流行病学和临床特征,为疫情防控提供参考依据。方法描述分析2020年1月23日至3月1日鄂东医疗集团黄石市中心医院收治的92例COVID-19确诊患者的病例资料,归纳COVID-19患者的流行病学及临床特征。结果 92例COVID-19患者中,轻症组71例(无症状感染者5例,普通型66例),重症组21例(重型11例,危重型10例)。有明确武汉旅居史者32例,占34.78%;与COVID-19患者有明确接触史者38例,占41.30%;家族聚集性发病47例,占51.09%。92例患者平均年龄(50.05±16.19)岁;男女比例为1∶1.19;合并其他基础疾病患者32例,占34.78%,居前3位的基础疾病依次为高血压病、糖尿病、冠心病;首发症状以发热、咳嗽、头痛为主。入院时34.78%的患者淋巴细胞减少,33.70%的患者白蛋白下降。40.22%的患者C-反应蛋白(C-reactive protein, CRP)升高,全部患者胸部CT均表现单侧或双侧肺部斑片状磨玻璃密度影,21例重症组患者均出现肺呼吸功能障碍。结论新冠肺炎临床以普通型为主,大多数病例具有明确的流行病学特征。合并基础疾病多、年龄偏大的患者容易发展为重型。淋巴细胞计数下降,炎症反应水平增高可作为重症患者的预警指标,从而提早进行干预。     

疫苗株病毒引起1例成人水痘的病原分离与鉴定

本文旨在探讨1例由疫苗株病毒引起成人水痘的病例,以提高对水痘疫苗二次传播的认识。从1名23岁女性水痘患者皮肤水疱中采集水疱液,接种至人胚胎成纤维细胞,3d后观察到细胞发生病变效应。用水痘-带状疱疹病毒gE`糖蛋白单克隆抗体间接免疫荧光法鉴定,结果阳性。测序分析显示,分离到的毒株其疫苗相关的单核苷酸多态性位点与Oka疫苗株一致,为疫苗株病毒。回顾性调查显示,患者没有水痘史和疫苗接种史,病毒可能来自1名与患者直接接触的接种疫苗后发生带状疱疹的儿童。     

过敏性眼表疾病的临床特点及诊治研究

目的:对过敏性眼表疾病的临床特点和相关的诊治方法进行分析探讨.方法:选取100例过敏性眼表疾病的患者,对其相应的临床资料进行回顾性分析、通过对过敏性眼表疾病的病史、症状、体征等临床特点进行统计,进而对诊治方法进行分析探讨.结果:50例患者有过敏性眼病史,90例患者表现为眼痒,89例患者表现有异物感,88例患者表现为结膜充血,76例患者表现有上眼睑结膜乳头,70例患者表现有上眼睑结膜滤泡.45例患者为常年过敏性结膜炎,30例患者为特异性结膜炎,10例患者为巨乳头结膜炎,80例患者为过敏性结膜炎,嗜酸性粒细胞的阳性率为100％.经过治疗后,57例患者得到缓解,7例患者得到明显改善,30例患者病情得到控制,且有9例重症患者在急性期应用了激素治疗,6例患者临床症状无明显改善.结论:过敏性眼表疾病的临床症状表现差异较大,对过敏性眼表疾病患者的临床特点做出准确的判断并给出正确及时的治疗,对过敏性眼表疾病患者的恢复有一定的临床意义.     

重症眼镜蛇咬伤患者的救治体会

目的探讨提高重症眼镜蛇咬伤的成功救治措施。方法对我科2009年10月~2012年10月收治的3例重症眼镜蛇咬伤患者的临床资料进行回顾性分析。结果 3例患者均给予常规排毒及注射抗蛇毒血清解毒治疗,其中1例入科即行气管插管呼吸机辅助呼吸,1例进行连续性静-静脉血液滤过(CVVH)血液净化治疗,结果3例患者均痊愈出院。结论眼镜蛇咬伤后常出现以神经系统损害为主要表现的多器官功能不全综合征(MODS),应及时采用有效的综合治疗,尽早采取人工辅助呼吸,是救治成功的关键。     

急性重症病毒性心肌炎的临床特征分析

目的:探讨急性重症病毒性心肌炎的临床特征及心脏彩超和血清心肌损伤标志物对重症病毒性心肌炎的早期临床诊断价值。方法:回顾性分析2013年6月至2015年8月入住我院心脏科的临床诊断为急性心肌炎的患者27例,其中符合急性重症心肌炎诊断标准的患者10例,其余17例为非重症心肌炎,另选取10例入院检查后排除心血管疾病的患者为健康对照组。对三组患者的一般临床资料、心脏彩超结果及心肌损伤标志物结果进行分析,选取有统计学差异的指标行ROC曲线分析得出预测重症心肌炎的效能。结果:重症心肌炎组左室室间隔厚度、左室后壁厚度、左房内径、血浆B型尿钠肽较其余两组显著增高,进一步行ROC曲线分析提示左室室间隔厚度、左室后壁厚度预测重症心肌炎的敏感性分别为80%、70%,特异性均为94%,临界值分别为0.855 cm、0.875 cm。结论:急性心肌炎患者室壁厚度增加,当左室室间隔厚度0.855 cm或左室后壁厚度0.875 cm时需引起重视,警惕患者可能进展至重症病毒性心肌炎。     

1例重症水痘病人的抢救及护理体会

我科于2005年10月8日收治1例重症水痘病人,经抗感染、对症等综合治疗和及时有效的护理措施,使病人安全度过危险期,现将抢救及护理报告如下。1临床资料患者,男,20岁,因全身水疱4天,发热、排酱色尿1天,于2005年10月8日入院。患者于5天前感头痛明显,无鼻塞、咽痛、咳嗽等,服感冒药     

ICU重症患者经皮旋转扩张气管造口术的临床应用价值

目的 探讨ICU重症患者经皮旋转扩张气管造口术的临床应用价值.方法 回顾性分析19例行经皮旋转扩张气管造口术的ICU重症患者的临床资料,观察患者的手术时间、出血量、术后并发症及护理时间等指标.结果 19例患者均手术成功,术中平均出血30 ml,平均手术时间15 min,术后出现切口溢痰和切口感染1例;19例患者均未见气管后壁损伤.结论 经皮旋转扩张气管切开术的手术时间短,术中出血少,并发症少,值得在临床上推广.     

7例水痘患者水痘带状疱疹病毒的分离与鉴定分析

目的对7例临床水痘患者的疱疹液样本,进行水痘带状疱疹病毒(varicella-herpes zoster virus,VZV)的分离及鉴定分析。方法对7例临床水痘患者的疱疹液,用2BS细胞进行病毒分离及病毒滴度检测;用特异性引物分别对病毒分离株及疫苗株(Oka株)的ORF68、ORF54、ORF38进行聚合酶链反应(Polymerase Chain Reaction,PCR)扩增及测序,用DNAMAN软件对病毒分离株的ORF68序列与Dumas株序列进行比对鉴定,并对病毒分离株和Oka株的ORF54、ORF38进行限制性片段长度多态性(restriction fragment length polymorphism,RFLP)分析。结果从7例临床水痘患者的疱疹液样本中,分离到4株VZV病毒株;病毒分离株的细胞病变(cytopathic effect,CPE)及病毒滴度随传代次数的增加而增强;4株病毒分离株的ORF68序列与Dumas株完全一致;ORF54、ORF38的RFLP结果显示,4株病毒分离株均为BglⅠ+PstⅠ+型,Oka株为BglⅠ+PstⅠ-型。结论成功分离的4株病毒分离株均为VZV野生毒株。     

Simian Varicella in Old World Monkeys

Simian varicella virus (SVV) causes a natural erythematous disease in Old World monkeys and is responsible for simian varicella epizootics that occur sporadically in facilities housing nonhuman primates. This review summarizes the biology of SVV and simian varicella as a veterinary disease of nonhuman primates. SVV is closely related to varicella–zoster virus, the causative agent of human varicella and herpes zoster. Clinical signs of simian varicella include fever, vesicular skin rash, and hepatitis. Simian varicella may range from a mild infection to a severe and life-threatening disease, and epizootics may have high morbidity and mortality rates. SVV establishes a lifelong latent infection in neural ganglia of animals in which the primary disease resolves, and the virus may reactivate later in life to cause a secondary disease corresponding to herpes zoster. Prompt diagnosis is important for control and prevention of epizootics. Antiviral treatment for simian varicella may be effective if administered early in the course of infection.Abbreviations: FEAU, 1-(2′-deoxy-2′-flouro-β-D-arabinofuranosyl)-5-iodouracil, IE, immediate early, ORF, open reading frame, PBL, peripheral blood lymphocyte, SVV, simian varicella virus, VZV, varicella–zoster virusSimian varicella is a natural erythematous disease of Old World primates (Superfamily Cercopithecoidea, Subfamily Cercopithecinae), involving particularly patas (Erythrocebus patas), African green or vervet (Chlorocebus aethiops), and various species of macaque (Macaca spp.) monkeys. Epizootics of simian varicella occur sporadically in facilities housing nonhuman primates. These outbreaks are sometimes associated with high morbidity and mortality and the loss of valuable research animals. Simian varicella virus (SVV; Cercopithecine herpesvirus 9), a primate herpesvirus, is the etiologic agent of the disease. SVV is antigenically and genetically related to varicella–zoster virus (VZV; Human herpesvirus 3), the cause of human varicella (chickenpox) and herpes zoster (shingles). The clinical similarities between simian and human varicella and the relatedness of SVV and VZV, indicate that SVV infection of nonhuman primates is a useful model for study of varicella pathogenesis and development of antiviral therapies. A previous comprehensive review emphasized simian varicella as an experimental model for VZV infections.²² This review focuses on simian varicella as a veterinary disease of nonhuman primates. Simian varicella outbreaks and their epidemiology are considered, and the etiologic agent, clinical manifestations, pathogenesis, diagnosis, treatment, and control of the disease are discussed.     

Live varicella vaccine: prevention of nosocomial infection and protection of high risk infants from varicella infection

For prevention of nosocomial infection, 25 infants including high risk patients received an emergency injection of live varicella vaccine. Three patients developed a rash within 5 days after vaccination, but their symptoms were mild. The other 22 showed no clinical symptoms and gave an immune response. Twenty-two patients receiving immunosuppressive therapy were vaccinated and 20 of them showed a positive response in the varicella skin test. Of 14 vaccinated patients with malignancies, 2 giving a positive skin test, later showed clinical varicella, but their symptoms were not severe. One case with ALL was immunized safely under very poor conditions during the first induction therapy. No complications were observed in any patients.     

Evaluation of varicella vaccine in childhood leukemia. Observation over 6 years

Since 1977, we have used a live attenuated varicella vaccine to immunize 10 children with acute leukemia. 8 patients had no adverse clinical reaction but 2 patients developed mild fever and papulovesicular rash after vaccination. All 9 tested children became seropositive after the vaccination. Also in all 3 children who were observed for more than 4 years, persistence of neutralizing antibody was detected. Most of the recipients were prevented from developing symptoms of varicella in spite of contact exposure. Two patients developed varicella when they were in severe immunosuppressive states but their symptoms were mild. None of the children developed herpes-zoster during the 6 year follow-up period. The results suggest that the varicella vaccine is effective in children with acute leukemia, and that long-term effectiveness can be expected.     

Effect and follow-up study on varicella vaccine

Attenuated liver varicella vaccine (Oka strain) was used to vaccinate 242 children and 5 adults between August 1976 and December 1982; namely emergency vaccinations were given to 163 cases, including 35 high risk children, on 17 occasions, and non-emergency vaccinations were given to 84 cases including 7 high risk ones in remission. The viral doses varied from 250 to 3,000 PFU. Vaccinations prevented subsequent infection in all cases. Emergency vaccinations were given within 100 h after contact of the subjects with cases of varicella. Humoral and/or cellular immunity was acquired in 97.6% (40/41) of the high risk group and 91.8% (179/195) of the non-high risk group. As clinical reactions, rashes and fever developed in 43.9% (18/41) and in 17.0% (7/41) of high risk patients, and 7.8% (16/204) and 1.0% (2/204) of the non-high risk patients respectively. Reactions were generally slight, but were severe or atypical in 3 immunocompromized patients. Follow-up studies were carried out every year since 1980. Among the 41 high risk patients, herpes-zoster developed in 4, and varicella in 5 patients. Among the 179 non-high risk patients, there were no cases of herpes-zoster but 21 cases (12.3%) of varicella, which were mostly extremely mild. Six patients were revaccinated because of their humoral and/or cellular immunity decreased, and as a result acquired an immune response again. Criteria for varicella vaccination and details of the results of vaccination and follow-up studies are described.     

Comparison of 4 serological tests--complement fixation, neutralization, fluorescent antibody to membrane antigen and immune adherence hemagglutination--for assay of antibody to varicella-zoster (V-Z) virus.

Four tests for antibody to varicella-zoster (V-Z) virus were compared; these were tests of complement fixation (CF), neutralization (NT), fluorescent antibody to membrane antigen (FAMA) and immune adherence hemagglutination (IAHA). Fifty-two sera from patients with varicella and zoster and from recipients of live varicella vaccine were examined by the 4 tests. The CF test was least sensitive, but the antibody titers by the NT, FAMA and IAHA tests were roughly comparable. The IAHA test was the simplest and fastest to perform, and appeared suitable for routine serological assay to V-Z virus. The correlation between the IAHA antibody titer and susceptibility of individuals to clinical varicella was investigated retrospectively using sera obtained during 2 outbreaks of varicella in an institution for children, where all the unvaccinated children had developed varicella symptoms. Most of the 25 pre-exposure sera from unvaccinated children examined by the IAHA test had tiers of less than 1:2. In contrast, all the 23 sera from vaccinated children who did not develop varicella had detectable antibody titers of 1:2 to 1:64. These results indicate that the IAHA titer reflects the susceptibility or resistance of individuals to clinical varicella.     

Metabolic disorders in patients with chronic kidney failure

This review article summarizes the problems of metabolic disorders and nutrition imbalances that often occur in chronic kidney failure (CKF) or following regular dialysis treatment. In this survey, we cover the pathogenesis of these disorders, their clinical consequences, and their association with the most severe complications of chronic kidney failure and dialysis treatment. These complications are primarily atherosclerosis, malnutrition, anemia, hyperparathyroidism, and other serious problems that markedly and negatively affect prognosis and the quality of life of uremic patients. Risk factors for cardiovascular disease are discussed in-depth because cardiovascular disease is the leading cause of death in patients with chronic kidney failure. It is important to pay attention to the development of these complications because early diagnosis and therapy can improve the prognosis for these patients and reduce treatment costs.     

Clinical application of a live varicella vaccine (Oka strain) in a hospital

A total of 239 children, including 22 high-risk children and 55 non-high risk diseased children have been immunized with a live varicella vaccine (Oka strain) since June, 1978. No clinical reaction attributable to the vaccine has been observed. Of these children, 87 received emergency vaccination. Of 47 children receiving emergency vaccination because they had been in contact with varicella patients either in hospital, school or a playground, only 5 developed varicella and their symptoms were mild. Of 40 children receiving emergency vaccination because of exposure to varicella in their home, 10 developed mild varicella and 30 were protected. Clinical symptoms of varicella when seen seemed to be due to incomplete protection because the vaccine was given too late rather than to clinical reactions to the vaccine. During follow-up period of 6 to 66 months after vaccination, 8 children showed very mild rashes without fever as the result of exogenous varicella infection.     

Predementia Alzheimer's disease. Benefits of early diagnosis

Given population aging and the rise in the number of persons with Alzheimer's disease, measures that aim not only to delay but also to prevent the development of this disease are increasingly required. Advances in the diagnosis of Alzheimer's disease support the need for a review of current clinical standards for mild cognitive impairment and provide new goals in the early treatment of this disease. The current diagnostic process should be refocussed toward the pathological substrate of this disease rather than symptoms in order to initiate therapeutic measures as soon as possible without waiting for clinical manifestations to appear. Such an approach is essential in patients with greater cognitive reserve, in whom the lesions are usually more severe at diagnosis and treatment is less effective. To identify disease-modifying therapies to delay the onset of the clinical symptoms of Alzheimer's disease in cognitively intact persons at high risk, biomarkers for this disease must be validated. A single biomarker is unlikely to provide the required diagnostic accuracy and therefore a multimodal approach, incorporating biochemical, neuropathological and anatomical and metabolic neuroimaging methods, should be employed. To optimize the results of drugs under investigation, a combination of biomarkers should be used to select appropriate participants in the earliest phases of the disease, and disease progression should be followed-up. Early diagnosis might clarify essential questions in the care of patients with Alzheimer's disease, such as the possibility of distinguishing among various subtypes, thus encouraging the development of optimal treatments for each. The ultimate goal is to develop disease-modifying treatments that could be initiated early, while patients are asymptomatic or only minimally symptomatic, to maintain their quality of life.     

La enfermedad de Alzheimer antes de la demencia. Beneficios del diagnóstico precoz

Given population aging and the rise in the number of persons with Alzheimer's disease, measures that aim not only to delay but also to prevent the development of this disease are increasingly required. Advances in the diagnosis of Alzheimer's disease support the need for a review of current clinical standards for mildcognitive impairment and provide new goals in the early treatment of this disease. The current diagnostic process should be refocussed toward the pathological substrate of this disease rather than symptoms in order to initiate therapeutic measures as soon as possible without waiting for clinical manifestations to appear. Such an approach is essential in patients with greater cognitive reserve, in whom the lesions are usually more severe at diagnosis and treatment is less effective.To identify disease-modifying therapies to delay the onset of the clinical symptoms of Alzheimer's disease in cognitively intact persons at high risk, biomarkers for this disease must be validated. A single biomarker is unlikely to provide the required diagnostic accuracy and therefore a multimodal approach, incorporating biochemical, neuropathological and anatomical and metabolic neuroimaging methods, should be employed. To optimize the results of drugs under investigation, a combination of biomarkers should be used to select appropriate participants in the earliest phases of the disease, and disease progression should be followedup.Early diagnosis might clarify essential questions in the care of patients with Alzheimer's disease, such as the possibility of distinguishing among various subtypes, thus encouraging the development of optimal treatments for each.The ultimate goal is to develop disease-modifying treatments that could be initiated early, while patients are asymptomatic or only minimally symptomatic, to maintain their quality of life.     

Spread of varicella in hospitalized children having no direct contact with an indicator zoster case and its prevention by a live vaccine

Varicella spread from a child with zoster to a total of 3 susceptible infants in another room in a children's ward, although they had been strictly isolated. To prevent spread of the disease, the staffs and patients were doing their own washing and no source of natural infection could be found. The cases indicate that it is difficult to predict nosocomial varicella infection or to prevent spread of the disease simply by isolation in a children's ward. A total of 11 other children without history of varicella in the ward were given live varicella vaccine before or immediately after this event. None of these children developed symptoms of varicella and all the susceptible children who were vaccinated showed an antibody response.