Objective To explore the clinical and imaging features of patients with acute dizziness and assess their associations with 3-month prognosis. Methods We enrolled adult patients with a chief complaint of acute dizziness, who were admitted to the Neurological Clinic at the Emergency Department of West China Hospital, Sichuan University between January 1st and May 31st 2022. We collected clinical and imaging features at baseline for each patient. The primary outcome was recurrent dizziness within 3 months after index dizziness. Secondary outcome was stroke within 3 months after index dizziness. Results A total of 1 322 patients who visited the Neurological Clinic were included, of which 617 (46.7%) had a chief complaint of acute dizziness. Among 222 patients who performed emergent brain and neck CT angiography, 1 patient presented with intracerebral haemorrhage. Among the remaining 221 patients, 206 patients completed 3-month follow-up, with 76 patients reported recurrent dizziness and 7 patients had stroke (6 ischaemic, 1 hemorrhagic). The multivariate logistic regression showed that chronic dizziness duration and parenchymal hypodensity on brain CT were each associated with a higher risk of recurrent dizziness. Compared with those who did not report stroke, the stroke patients were more likely to present with hypertension, headache symptoms, and exhibit parenchymal hypodensity on baseline CT (P<0.05). Conclusions In patients with acute dizziness, those with chronic dizziness duration and parenchymal hypodensity on baseline CT were associated with a higher risk of 3-month recurrent dizziness. Acute dizziness patients experiencing 3-month stroke often have hypertension, headache symptoms, and parenchymal hypodensity on baseline CT.
Objective To explore the clinical characteristics of Chlamydia psittaci pneumonia. Methods From January 2020 to March 2023, 21 cases of Psittacosis from the First Affiliated Hospital of Nanjing Medical University were diagnosed via metagenomic next-generation sequencing (mNGS). They were divided into a severe group (n=10) and a non-severe group (n=11) based on diagnostic criteria for severe pneumonia, and the clinical presentation, secondary examination, treatment, and prognosis of the two groups were analyzed retrospectively. Results Among the 21 patients, there were 11 males and 10 females, with a mean age of (51.7±11.6) years. All patients had an acute onset and 12 had a confirmed history of exposure to poultry. The onset of the disease occurred in the autumn and winter seasons in 18 patients. All the patients were suffering from high fevers. Other symptoms included coughing, phlegm, tightness in the chest and fatigue. Laboratory examinations showed that the levels of leukocytes, neutrophil counts, C-reactive protein, procalcitonin, aminotransferase, creatine kinase, lactic dehydrogenase, brain natriuretic peptide precursors and D-dimer were significantly higher in the severe group than those in the non-severe group. Chest CT scans revealed varying levels of consolidation and spot shadowing with peripheral exudate in all patients. The patients in the severe group were more likely to have bilateral lung involvement, bilateral pleural effusion, cavity and mediastinal lymph node enlargement. Eleven patients received tetracycline alone, three received laudanum alone, two received respiratory quinolones alone, and five received a combination of two drugs including tetracycline. Chest CT at clinical follow-up showed absorption of lung lesions. Conclusions Chlamydia psittaci pneumonia usually occurs in the fall and winter, and most patients have a history of contact with poultry. Clinical presentation and imaging are not specified. The technology of mNGS enables early diagnosis of the disease, and neutrophil lymphocyte ratio, neutrophil-lymphocyte ratio and lactic dehydrogenase levels help assess the risk of severe disease.
ObjectiveTo study the clinical features, predictive factors and short-term prognosis of active pulmonary tuberculosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). MethodsThis study enrolled patients hospitalized for AECOPD in ten tertiary hospitals of China from September 2017 to July 2021. AECOPD patients with active pulmonary tuberculosis were included as case group, AECOPD patients without pulmonary tuberculosis were randomly selected as control group from the same hospitals and same hospitalization period as the patients in case group, at a ratio of 4:1. The basic information, comorbidities, clinical manifestations and auxiliary examinations, and adverse in-hospital outcomes between the two groups were compared.ResultsA total of 14007 inpatients with AECOPD were included in this study, and 245 patients were confirmed to have active pulmonary tuberculosis, with an incidence rate of 1.75%. In terms of basic information, the proportions of male and patients with history of acute exacerbation in the past year in the case group were higher than those in the control group (P<0.05), and the age and body mass index (BMI) were lower than those of the control group (P<0.05); in terms of comorbidities, the proportions of patients with hypertension and diabetes in the case group were lower than those in the control group (P<0.05). In terms of clinical manifestations, the prevalence of fever and hemoptysis in case group was higher than that of control group (P<0.05); as for laboratory examinations, the levels of hemoglobin, platelet count, serum albumin, inflammatory markers [erythrocyte sedimentation rate (ESR), C reactive protein] and the proportion of positive TB-IGRA were higher than that of control group (P<0.05). The prevalence of pulmonary bullae, atelectasis and bronchiectasis in the case group was higher than that in the control group. After multivariate logistic regression analysis, hemoptysis (OR= 3.68, 95%CI 1.15-11.79, P=0.028), increased ESR (OR=3.88, 95%CI 2.33-6.45, P<0.001), atelectasis (OR = 3.23, 95%CI 1.32-7.91, P=0.01) were independent predictors of active pulmonary tuberculosis in patients with AECOPD. In terms of in-hospital outcomes, there was a trend of higher hospital mortality than the control group (2.3% vs. 1%), but the difference was not statistically significant. However, the case group had longer hospital stay [9 d (6~14) vs. 7 d (5~11), P<0.001] and higher hospital costs [15568 ¥ (10618~21933) vs. (13672 ¥ (9650~21473), P=0.037]. ConclusionIt is not uncommon for AECOPD inpatients to be complicated with active pulmonary tuberculosis, which increases the length of hospital stay and hospitalization costs. When AECOPD patients present with hemoptysis, elevated ESR, and atelectasis, clinicians should be highly alert to the possibility of active pulmonary tuberculosis.
Objective To investigate and analyze the clinical features of primary pulmonary malignant melanoma. Methods The medical records, imaging examinations, pathological results, treatment and prognosis of four primary pulmonary malignant melanoma (PMML) patients were retrospectively collected. In combination with 96 cases reported in the literature, a total of 100 patients with PMML were analyzed. Results Among the 100 PMML patients, there were 60 males (60.0%) and 40 females (40.0%), with an average age of 56.9±10.3 years. Common clinical symptoms were cough (60.0%), chest tightness or pain (18.0%), hemoptysis (16.0%), and dyspnea (11.0%). Distant metastasis was found in 30 cases (30.0%) at the time of consultation. The clinical stage of the first diagnosis and evaluation of the patients was stage Ⅰ in 7 cases (7.0%), stage Ⅱ in 24 cases (24.0%), stage Ⅲ in 13 cases (13.0%), stage Ⅳ in 39 cases (39.0%), and 17 cases (17.0%) did not mention a clear tumor stage. Thirty patients (30.0%) received comprehensive anti-tumor therapy, 53 patients (53.0%) received surgical resection, and 17 patients among them (17.0%) received postoperative adjuvant comprehensive therapy. The overall median survival time of PMML patients was 8.0 (2.0 - 14.4) months. The median survival time of stage Ⅳ PMML patients was 5.0 (3.1 - 6.9) months, which was significantly lower than 24.0 (6.0 - 32.0) months of stage Ⅱ patients (P<0.05) and 15.0 (0.6 - 29.4) months of stage Ⅲ patients (P<0.05). Further analysis showed that different treatment regimens had no significant effect on the median survival time of patients with stage Ⅳ PMML (P>0.05). Conclusions PMML has a high degree of malignancy and no specific clinical symptoms. It is mainly diagnosed by pathology. Surgical resection, postoperative adjuvant chemoradiotherapy or immunotherapy are the main treatment methods, but its overall prognosis is poor.
Objective To explore the clinical characteristics, diagnosis and treatment plan of pulmonary lymphomatoid granulomatosis in order to deepen the understanding of this disease. MethodsA case of pulmonary lymphomatoid granulomatosis complicated with tuberculosis and human immunodeficiency virus (HIV) infection was reported. Literature reviews were searched in PubMed database with "pulmonary, lung, lymphomatoid granulomatosis" as the key words, and in China Knowledge Network and Wanfang database with "lung, lymphomatoid granulomatosis" as the key words. The search time was from January 1, 2017 to December 31, 2021. ResultsThe patient was diagnosed as pulmonary tuberculosis at the beginning of the disease, and the lesion was obviously absorbed and improved after regular anti-tuberculosis treatment. Six months after anti-tuberculosis treatment, chest CT examination showed multiple new circular nodules in both lungs. Intensive anti-tuberculosis treatment did not improve, further lung biopsy, pathology revealed lymphomatoid granulomatosis, grade 2; During the period, HIV infection was proven, and the patient underwent anti-viral infection and re-examination of chest CT lung lesions significantly improved absorption. Literature reviews found 47 same patients, therefore totally 48 patients were analyzed, in which this former case was included. Among the 48 patients, 26 were male (54.2%) and 22 were female (45.8%), with a median age of 60 years old (4 to 87 years old). The most common symptoms were cough, fever and shortness of breath, some of them may be accompanied with fatigue, weight loss, night sweats and loss of appetite. 20.9% of the patients had rashes, mainly manifested as erythema or papules. 39.6% of the patients were accompanied by immune system related diseases or immunosuppressants; The most common manifestations of chest CT were multiple nodules or masses involving both lungs. The main way of diagnosis was surgical lung biopsy, or CT-guided lung puncture biopsy. The positive rate of bronchoscopy biopsy was low. The pathological grade was mainly grade 3 (56.3%). The treatment plan was mainly R-CHOP, with an effective rate of 71.4%. For patients considered drug-induced disease, it was necessary to stop using induced drugs first, and then combined chemotherapy if there was no improvement. For HIV-infected patients, highly active antiretroviral therapy should be given first, if there was no improvement, then took combined chemotherapy; Of the 48 patients, 41 patients had clear follow-up results with a median follow-up time of 12 months, of which 14 patients were dead (34.1%), and the others got better in different degrees. Conclusions Pulmonary lymphomatoid granulomatosis is a rare disease. Clinicians should improve their understanding of it in order to identify the disease early, and choose the appropriate treatment scheme to improve its prognosis.
Objective To investigate the clinical characteristics and death risk factors of patients with community acquired pneumonia and sepsis. Methods Data of 350 patients with community-acquired pneumonia and sepsis admitted to the Intensive Care Unit of Third Xiangya Hospital of Central South University from January 2015 to October 2021 were retrospectively analyzed, and their basic characteristics, laboratory results and treatment were analyzed. Results The absolute value of white blood cell, neutrophil ratio, absolute value of neutrophil, inflammatory index, liver and kidney function, coagulation function, cardiac enzymology, lactic acid and sequential organ failure evaluation score of patients with community acquired pneumonia sepsis in the non-survival group were higher than those in the survival group. Logistic regression analysis showed that respiratory rate, heart rate, mean arterial pressure, blood oxygen saturation, C-reactive protein, D-dimer, lactic acid, creatinine and lymphocyte ratio may be independent risk factors for 28-day death in patients with community-acquired pneumonia and sepsis.The receiver operating characteristic curve shows that the combination of the above indicators to predict the risk of death of patients has the best sensitivity, specificity and maximum area under the curve, which is superior to the prediction value of individual variables. Conclusions Patients in the non-survivor group of community-acquired pneumonia sepsis had more severe inflammatory response and organ function impairment. Respiratory rate, heart rate, mean arterial pressure, blood oxygen saturation, C-reactive protein, D-dimer, lactic acid, creatinine, lymphocyte ratio and other indicators are independent risk factors for death of patients with community-acquired pneumonia and sepsis, which have better prognostic value when combined.
Objective To explore the clinical characteristics of patients who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of different genotypes. Methods A retrospective study was conducted on 111 SARS-CoV-2 infected cases at home and abroad admitted to Chengdu Public Health Clinical Medical Center between January and September 2020. The basic information, gene sequencing results (Pangolin typing method), clinical typing, first laboratory examinations 24 hours after admission, and whether repositive after discharge were collected. According to Pangolin typing, patients were divided into five groups: A, B, B.X, B.1.X and B.1.1.X. The basic information (age, sex, and origin), laboratory test results (lymphocyte count, C-reactive protein, serum amyloid A, CD3+ T lymphocytes, CD4+ T lymphocytes, and CD8+ T lymphocytes), clinical classification and whether repositive were compared among different genotype infected patients. Results Among the 111 infected patients, 54 (48.6%) were males and 57 (51.4%) were females. Their ages ranged from 16 to 87 years, with a median age of 49 years. In terms of clinical classification, there were 10 asymptomatic cases (9.0%), 10 mild cases (9.0%), 64 ordinary cases (57.7%), 13 severe cases (11.7%), and 14 critical cases (12.6%). There were 75 domestic cases (67.6%) and 36 imported cases (32.4%). Eighty cases (72.1%) did not return to positive, and 31 cases (27.9%) returned to positive. There were 8 cases infected by type A virus, 18 cases infected by type B virus, 26 cases infected by type B.X virus, 5 cases infected by type B.1.X virus, and 54 cases infected by type B.1.1.X virus. Among patients infected by different genotype viruses, no statistically significant difference was found in sex, age, clinical type, laboratory examination, or whether repositive (P>0.05), but there was statistically significant difference in the distribution of domestic and imported cases (P=0.016). Type B virus infected patients were mostly domestic cases, while type B.X virus infected patients were mostly imported cases. Conclusion The distribution of domestic and imported cases is different among SARS-CoV-2 of different genotypes.
Carney complex (CNC) is a rare autosomal dominant syndrome, characterized by pigmented lesions of the skin and mucosa, cardiac, cutaneous and other myxomas and multiple endocrine tumors. The disease is caused by inactivating mutations or large deletions of the PRKAR1A gene located at 17q22–24 coding for the regulatory subunit type Ⅰ alpha of protein kinase A (PKA) gene. Most recently, components of the complex have been associated with defects of other PKA subunits, such as the catalytic subunits PRKACA (adrenal hyperplasia) and PRKACB (pigmented spots, myxomas, pituitary adenomas). We reviewed CNC’s clinical features, diagnosis, treatment and molecular etiology.
ObjectiveTo investigate the clinical manifestations of patients with cardiac myxoma and the factors affecting the occurrence of embolic events. Methods A retrospective study of 38 patients with cardiac myxoma diagnosed and surgically removed from January 2010 to December 2017 was performed. There were 11 males and 27 females at age of 32-75 (50.00±16.12) years. The patients were divided into a non-embolized group and an embolized group. The clinical manifestations of the patients were summarized and the factors leading to embolism were analyzed. RseultsOf the 26 patients in the non-embolized group, 22 patients (84.62%) had dyspnea, 14 patients (53.85%) had palpitations, 4 patients (15.38%) had angina pectoris, and 1 patient (3.85%) had heart failure. Of the 12 patients in the embolized group, 4 patients (33.33%) had dyspnea, 3 patients (25%) had palpitations, and 1 patient (8.33%) had angina pectoris. The mean diameter of the non-embolized group was 5.71±1.63 cm, and the maximum diameter of the tumor in the embolized group was 4.52±1.88 cm. There was no significant difference between the maximum diameter of the tumor in the embolized group and the maximum diameter of the non-embolized group (P>0.05). Atrial fibrillation occurred in 2 patients in the non-embolized group before operation. Atrial fibrillation occurred in 5 patients in the embolized group. Atrial fibrillation was more likely to occur in the embolized group (P<0.05). Conclusion Atrial fibrillation in the patients with cardiac myxoma is closely related to embolic events. The size of myxoma is not related to the occurrence of embolic events.
ObjectiveTo analyze the clinical features and prognosis of coronavirus disease 2019 (COVID-19) patients.MethodsA total of 379 confirmed COVID-19 patients admitted to Public Health Clinical Center of Chengdu from January 16 to November 30, 2020 were divided into two groups including an elderly group (42 patients, ≥60 years) and a non-elderly group (337 patients, <60 years) by age. The epidemiology, clinical features, laboratory tests, treatment and prognosis of the two groups were compared.ResultsAmong the 379 patients, 286 (75.5%) were males and 93 (24.5%) were females, aged from 2 months to 87 years, with an average age of 41.2 years. The average age of the elderly group was 69.5 years, and 61.9% of them were females. They were imported from Wuhan or local secondary patients (73.8%), mainly common or critical type (88.1%). While, the average age of the non-elderly group was 37.8 years, and males were more common (80.1%). There were mostly from foreign input (75.7%), mainly mild or ordinary type (95.0%). A total of 179 patients (47.2%) had one or more underlying diseases. Hypertension (15 patients, 35.7%) and diabetes (11 patients, 26.2%) were more common in the elderly group, while non-alcoholic steatohepatitis (132 patients, 39.2%) was more frequent in the non-elderly group. The most common clinical manifestations were fever (138 patients, 36.4%) and cough (129 patients, 34.0%). Fever, cough, dyspnea, and fatigue were more common in the elderly group than those in the non-elderly group (P<0.05). Compared with the non-elderly group, the elderly group had lower total lymphocyte count, CD4+ and CD8+ T-cell count, higher level of myocardial injury or inflammation markers (P<0.05). Abnormal echocardiography in 139 patients (36.7%) was mainly caused by decreased left ventricular diastolic function (22.7%) and heart valve regurgitation (14.0%), and the rate in the elderly group was significantly higher than that in the non-elderly group (85.7% vs. 30.6%, P<0.05). After treatment, 3 patients in the elderly group died, and the others were cured and discharged. The hospitalization duration of the elderly group was longer than that of the non-elderly group (22.1 d vs. 18.8 d, P=0.033).ConclusionsElderly COVID-19 patients are mainly imported from Wuhan or secondary to the local population, mainly common or critical type, often associated with basic diseases such as hypertension or diabetes. While, non-elderly COVID-19 patients are mainly imported from abroad, mainly mild or common type, often associated with non-alcoholic steatohepatitis. After treatment, most of the patients have a good prognosis.