Objective To analyze the clinical characteristics of adverse drug reaction (ADR) caused by 3 kinds of coronavirus disease 2019 drugs, and provide a reference for clinical safe medication. MethodsA total of 33 patients with coronavirus disease 2019 admitted to Xiangtan Central Hospital from January 20 to March 5, 2020 were selected as the research objects. The clinical data of patients with ADR during the antiviral process were analyzed retrospectively. The patients’ gender, age, type of medication, combination medication, organs or systems involved, and clinical manifestations were summarized and analyzed. Results A total of 33 patients were enrolled. A total of 21 cases of ADR were reported. The incidence of ADR is higher in patients older than 60 years (80.0%). The most common clinical manifestations are digestive tract symptoms (66.7%). The incidence of ADR is highest in the combination of lopinavir/ritonavir+arbidol+ribavirin (100.0%), followed by the combination of lopinavir/ritonavir+arbidol (85.7%). Abidol and ribavirin each caused 1 case of severe ADR. Conclusion For patients with coronavirus disease 2019, the combination of two or more antiviral drugs should be avoided, and pharmaceutical monitoring should be strengthened for elderly, severe/critical and allergic patients.
ObjectiveTo explore the clinical features of myasthenia gravis (MG) harboring both acetylcholine receptor antibody (AChRAb) and muscle-specific tyrosine kinase antibody (MuSKAb) positivity.MethodsWe searched PubMed, Web of Science, Embase and China National Knowledge Infrastructure databases (from inception to November 2016), to collect the case reports of MG with both AChRAb and MuSKAb positivity. Along with one case discovered in Department of Neurology, West China Hospital, the clinical data of the cases were retrospectively analyzed.ResultsA total of 13 double-seropositive MG patients were enrolled in this study, demonstrating a marked female predominance (including 1 male and 12 females) and a younger age at onset [(31.07±24.77) years]. During the disease course, 10 of the included patients presented severe bulbar involvement, dyspnea and neck weakness, with myasthenic crisis in 6 individuals. Among the 11 patients with detailed records, abnormal thymus glands comprised 4 thymus hyperplasia and one thymoma. While the response to oral pyridostigmine was unsatisfactory in 11 double-seropositive MG patients, ranging from mild benefit to overt intolerance; the patients treated with plasma exchange (3/3), rituximab (1/1) or corticosteroid (7/12) improved dramatically, with other immumosuppressants and intravenous immunoglobulin partially responsive. Moreover, 5 patients undergoing thymectomy improved markedly or partially.ConclusionsCompared with MG patients with MuSKAb positivity merely, the condition of the double-seropositive MG patients seem to be more severe and further inclined to myasthenic crisis. The incidence of abnormal thymus, such as thymus hyperplasia, is higher. Thymectomy may be an effective treatment for such patients.
ObjectiveTo explore the feasibility and characteristics of three-port laparoscopic cholecystectomy (LC) in the treatment of cholecystitis with gallbladder calculi incarceration. MethodsThe clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively. Among the patients, there were 104 cases of calculi incarcerated in the gallbladder neck area, 20 cases in the cystic gall duct, and 36 cases in the gallbladder ampullar region. Elective operations were carried out for 120 patients and 40 underwent emergency operation. ResultsThree-port LC was successfully completed in 154 patients (96.25%), and the other 6 patients were converted to open surgery among whom 2 underwent elective operation (1.67%) and 4 underwent emergency operation (10.00%). Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively; all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm, causing difficult separation under laparoscope. Seventy patients had varying degrees of enlargement and edema of gallbladder, 60 had varying degrees of gallbladder atrophy, and 30 had almost normal gallbladder. There were 80 cases of dark green thick bile, 10 of purulent bile, 40 of white bile, and 30 of empty gallbladder and no bile. No complications were found during the follow-up of 6 to 36 months, except that one patient was found to have secondary common bile duct stones three months after discharge, and the patient was cured by endoscopic retrograde cholangiopancreatography. Conclusions Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.
ObjectiveTo evaluate the value of incision closure device in laparoscopic cholecystolithotomy. MethodsThe clinical data of 130 patients underwent laparoscopic cholecystectomy from Oct. 2014 to Feb. 2015 were retrospectively analyzed. According to the methods of gallbladder suture, 130 cases were divided into two groups, 72 cases underwent traditional manual suture (MS group), and 58 cases underwent incision closure device (ICD group). The operative time, postoperative gastrointestinal function recovery time, bleeding volume, postoperative hospitalization time, hospitalization expenses, complications, and postoperative 6-12 months follow-up of patients in 2 groups were observed.Results One hundred and thirty cases were performed laparoscopic cholecystolithotomy successfully. The operative time and postoperative gastrointestinal function recovery time of ICD group were significantly shorter than those of MS group, the difference was statistically significant (P < 0.05). The hospitalization expenses of the patients in ICD group were significantly higher than those in the MD group (P < 0.05). There were no significant difference between the two groups in the bleeding volume and postoperative hospital stay (P > 0.05). The patients were followed up for 6-12 months, with an average of 8 months, and no complications occurred and stone recurrence. ConclusionIncision closure device can shorten the time of laparoscopic cholecystolithotomy and postoperative recovery of gastrointestinal function, but the cost is higher. Next development, still need decrease the expend and strengthen clinical promotion.
摘要:目的: 探討如何提高早產兒存活率和生存質量。 方法 :對我院新生兒病房收治的228例早產兒的臨床資料進行了回顧分析。 結果 :引起早產的母親因素以胎膜早破、妊娠期膽汁淤積綜合征及妊娠合并高血壓綜合征為早產的重要因素,而引起早產兒常見疾病的是新生兒肺炎,高膽紅素血癥及新生兒窒息等。而呼吸衰竭、新生兒休克、多器官衰竭則是引起早產兒預后不良的重要因素。 結論 :早產原因以母體因素為主,故加強孕期保健,積極防治母親的有關并發癥,同時提高新生兒急救水平,早期干預,以提高早產兒的生存質量。Abstract: Objective: To exploere the ways of promoting the survival rate and the quality of life in premature infants. Methods :The clinical data on 228 cases of premature infants treated by neonatal wards were analyzed retrospectivelly. Results : The important factors of premature are cholestasis of pregnancy syndrome, premature rupture of membbranes, and hypertemsion in prefnancy. The commom diseases in premature infants are neonatal pnecemonia, hyperbilirubinemia and asphxia, the major factors in poor prognasis are caused by neonatal shock, multiple organ failure in premature infants. Conclusion :The main reasons of premature is maternal factors. It is important to strengthen the health care during pregnancy, control the complications of mothers actively, at the same time, improve the level of neonatal first aid, intervent early, so as to imprive the quality of life in preterm infants.
Objective To investigate the clinical manifestations of two common obstructive airway inflammatory diseases [ chronic obstructive pulmonary disease ( COPD) and asthma] in elderly patients for proper diagnosis and treatment of COPD complicated with asthma.Methods 102 elderly patients diagnosed with either COPD or asthma, who visited the Guangzhou Institute of Respiratory Disease fromOctober 2010 to March 2011, were recruited for the study. Comparisons of clinical manifestation, pulmonary function tests ( PFTs) , chest CT and sputum cytological tests were carried out between the patients with asthma-only,COPD-only, and COPD complicated with asthma. Results Of all 102 patients,18 were diagnosed as asthmaonly ( 17. 6% ) , 36 as COPD complicated with asthma ( 35. 3%) , and 48 as COPD-only ( 47. 1% ) . The patients with COPD-only had longer history of present illness in which most had a history of exposure to cigarette smoking. 91. 7% complained of cough as the first symptom, 80% showed severe impairment in PFTs. Among these patients, sputum neutrophilic granulocytes were ( 78. 3 ±5. 1) % , which was significantly higher than the other two groups ( P lt; 0. 05) . Glucocorticosteroid treatment was less effective in thesepatients. In the patients with COPD complicated with asthma, half were smokers, and cough was the first symptom in 63. 9% subjects and wheezing was the first symptom in rest. About 60% had severely impaired PFTs, and these patients responded to glucocorticosteroid better than the COPD-only patients. In the asthmaonlygroup, most complained of wheezing as the first symptom and had better PFTs. However, sputum eosinophilic granulocyte was as high as ( 13. 5 ±3. 1) % . They responded to glucocorticosteroid effectively.Conclusions COPD and asthma were both obstructive airway inflammatory diseases, but pulmonary function and responses to glucocorticosteroid therapy were different. It is necessary to understand the severity and mechanism of airway function impairment in order to improve the proper diagnosis and treatment of asthmaand COPD in elderly.
ObjectiveTo analyze and summarize the clinical characteristics, risk factors, pathogenic bacteria type, and drug tolerance of diabetes complicated with hospital-acquired pulmonary infection, in order to reduce the incidence of hospital-acquired pulmonary infection in patients with diabetes. MethodsThe clinical data of diabetic patients with hospital-acquired pulmonary infection from 2011 to 2013 were taken for retrospective clinical analysis. ResultsA total of 78 diabetic patients had hospital-acquired pulmonary infection among all the 572 hospitalized patients with diabetes. Age, complications of diabetes, chronic underlying disease, duration of hospital stay, glycated hemoglobin and invasive procedures were all correlated with the incidence of hospital-acquired infection (P<0.05). Through sputum culture and throat culture, 59 strains of pathogens were found, and they were mainly multidrug-resistant Gram-negative bacteria, accounting for 71.2%. ConclusionThe rate of acquired pulmonary infection in diabetic patients is particularly high, and the pathogens are mostly Gram-negative and multidrug-resistant. Glycemic control, rational use of antimicrobial drugs, shorter hospital stay, effective prevention and treatment of diabetes complications and chronic underlying diseases, and aseptic techniques can be effective in preventing acquired pulmonary infection for diabetic patients.
Objective To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience. Methods We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years). Results Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia. Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.
Objective To explore the clinical features and prognosis related factors of severe drug eruption. Methods The clinical data of 48 patients with drug eruption treated between January 2010 and August 2015 were retrospectively analyzed. Results The major type of drug eruption was Stevens-Johnson syndrome (58.3%), followed by toxic epidermal necrolysis (TEN) (27.1%) and hypersensitivity syndrome (14.6%). The major allergenic drug which might cuase drug eruption was antimicrobial agent (25.0%), followed by antipyretic analgesic drug (22.9%) and antigout drug (18.8%). Carbamazepine and allopurino were the common drugs caused TEN. Conclusion It is important to give sufficient corticosteroid earlier combined with intravenous immunoglobulin for reducing mortalities of severe drug eruption.
ObjectiveTo analyze the contact allergens of melanosis. MethodsFifty-six patients confirmed with melanosis between June 2010 and October 2013 received patch test and BICOM test, and the results were analyzed statistically and clinical data of the included patients were retrospectively analyzed. ResultsOf the 56 patients, 50 patch tests and 40 BICOM tests were positive. The top three chemical allergic resources in patch test of these patients were nickel sulfate (33.9%), aluminum (21.4%), and potassium dichromate (16.1%). The positive rates of male patients with aluminum, rubber compounds and cobalt chloride were significantly higher than those of females. The positive rate of female patients with nickel sulfate was significantly higher than that of males. The differences were all significant (P＜0.05) . ConclusionNickel sulfate, aluminum and potassium dichromate may be the main allergens of melanosis.