ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
Objective To explore the application value of Mycoplasma pneumoniae （MP） rapid culture technique for diagnosis of lower respiratory tract infections （LRTIs ） inpatients. Methods 120 LRTIs inpatients in respiratory ward，Anzhen hospital from January 1，2010 to December 31，2010，were recruited in this study. Their pharynx swabs were obtained for rapid MP culture and the serum antibody detection of MP was performed by Gelatin particle agglutination method. Results There were 33 positive yields in 120 LRTIs patients by rapid culture method and 24 positive yields by serological assay. The positive rates were 27.5% and 20.0% respectively. There was no significant difference in the two detecting methods （Pgt;0.05）. Conclusions MP rapid culture method is a better early diagnostic method at the present. MP rapid culture method combined with serological detection can improve the positive yield and avoid missed diagnosis.
摘要:目的: 了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。 方法 :采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取24‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata30 进行数据录入、SPSS130进行统计分析。 结果 :共发放问卷240份,收回有效问卷229份(有效回收率954%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为454%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为336%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P 值分别是0033,0001)。 结论 :震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。Abstract: Objective: To investigate the reality of community health service system after earthquake in Mianzhu, the satisfaction of community residents to the community health service as well as the postdisaster emergency response capability of community hospital in order to provide decisionmaking suggestions on better reconstruction of community health service system. Methods : Jiannan and Tianhe community hospital were randomly selected for visiting and 24‰ of community residents in the city zone of Mianzhu were selected by convenience sampling for a facetoface interview using a questionnaire. Data entry and statistically analysis were completed by Epidata30 and SPSS130 respectively. Results :A total of 240 questionnaires were conducted to facetoface interviews, and 229 questionnaires were returned (response rate 954%).The community health service system was badly injured. Residents’ satisfactory degree of the community health service after earthquake was 454%. The proportions of disaster / disaster prevention education was 336%,medicine supply for familiar diseases and the chronic were the main factors which influenced judgements of residents to the emergency response capabilities of community hospitals(〖WTBX〗P =0033,P=0001,respectively). Conclusion :The community health services after earthquake had not been widely satisfied and the emergency response capability of community hospital was far from enough. The proportions of disaster / disaster prevention education were far from enough. The effectiveness of emergency response work of community hospitals can be enhanced by reinforcing medicine preparation.In the course of the reconstruction, community health service system should pay attention to the resumance of basic community health service,reconstruction of basic establishment and construction of firstaid system.
ObjectiveTo evaluate the diagnostic performance of different screening tools for sarcopenia in the community for the elderly with sarcopenia, and to provide evidence-based support for the accurate screening of elderly patients with sarcopenia. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CINAHL, VIP, CBM, and WanFang Data databases were searched by computer, and the relevant research on the diagnosis of sarcopenia in the elderly by publicly published risk screening tools was found. The retrieval time was from inception to June 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies, and then data analysis was performed by using Stata 15.1 and Meta Disc 1.4 software. ResultsA total of 24 studies were included, including 10 961 patients, involving 8 risk screening tools for sarcopenia in the elderly: leg circumference, MSRA-5, MSRA-7, upper arm circumference, ring test, Ishii score, SARC-CalF and SARC-F. Meta-analysis showed that the combined sensitivities of eight screening tools were 0.84 (95% CI 0.61 to 1.15), 0.82 (95% CI 0.48 to 1.38), 0.80 (95% CI 0.47 to 1.36) and 0.72 (95%CI 0.33 to 1.55), 0.67 (95%CI 0.37 to 1.21), 0.63 (95%CI 0.33 to 1.19), 0.49 (95%CI 0.38 to 0.63), 0.24 (95%CI 0.18 to 0.30), and the combined specificities were 0.39 (95%CI 0.18 to 0.82)、0.52 (95%CI 0.29 to 0.93)、0.54 (95%CI 0.29 to 1.03)、0.62 (95%CI 0.49 to 0.79)、0.63 (95%CI 0.50 to 0.78).The results of reticular meta-analysis showed that the surface under the cumulative ranking curve (SUCRA) of the eight screening tools ranked from high to low according to the cumulative sensitivity: calf circumference (67.4%) > MSRA-5 (65.3%) > MSRA-7 (64.1%) > upper arm circumference (54.5%) > ring test (46.5%) > Ishii score. The values of specificity SUCRA from highest to lowest were as follows: SARC-F (72.2%) > SARC-CALF (71.3%) > Ishii score (60.2%) > ring test (57.1%) > upper arm circumference (40.1%) > lower leg circumference (36.2%) > MSRA-5. ConclusionThe simple screening tool for common sarcopenia has high sensitivity and high specificity, so medical staff can give priority to the combination of the two screening tools, namely SARC-CalF. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.