Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventila...Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.展开更多
INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]T...INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.展开更多
Limbic encephalitis represents a cluster of autoimmune disorders,with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety,affective symptoms,psychosis,...Limbic encephalitis represents a cluster of autoimmune disorders,with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety,affective symptoms,psychosis,short-term memory impairment as well as faciobrachial and grand mal seizures.We aim to present a case of a 53-year-old man with positive anti-voltage-gated potassium channel(VGKC)complex antibodies who initially presented with symptoms of psychotic mania.Six weeks post-psychiatric symptomatology,he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure.The patient had no previous psychiatric history and was initially treated with psychotropic medications.Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms.Furthermore,immunological and laboratory testing takes a rather long time to determine the diagnosis.What is more,few psychiatrists consider autoimmune nature of the neuropsychiatric presentation.Therefore,it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness.Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching,seizures,confusion and cognitive decline.展开更多
COVID-19 has led to an increase in psychiatric disorders,stress,trauma and suicidal behaviour.Study published in the Lancet in 2021 have identified anxiety disorder as the most frequently diagnosed psychiatric disorde...COVID-19 has led to an increase in psychiatric disorders,stress,trauma and suicidal behaviour.Study published in the Lancet in 2021 have identified anxiety disorder as the most frequently diagnosed psychiatric disorder in COVID-19 survivors[1].Fear conditioning and hyper-vigilance towards abnormal breathing patterns attributable to COVID-19 or not,can act as etiological and maintenance factors of panic,and hence we should expect an onset or aggravation of panic disorder in COVID-19[2].展开更多
Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Pat...Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.展开更多
Heart failure(HF)is a devastating condi-tion characterized by a high rate of mor-tality.[1]About 6.2 million individuals are grappling with the burden of HF in the United States(U.S).[2]Of this over 6 million individu...Heart failure(HF)is a devastating condi-tion characterized by a high rate of mor-tality.[1]About 6.2 million individuals are grappling with the burden of HF in the United States(U.S).[2]Of this over 6 million individuals af-fected with HF,a higher proportion is made up of people older than 65 years.[3,4]More than 50%of pa-tients hospitalized due HF are older than 75 years.[5]Seniors do not just account for the greater propor-tion of individuals affected by HF but also have a worse outcome compared to younger individuals with HF.[6−14]In the light of the above,we aim to address racial disparities as they affect seniors with HF in terms of mortality in addition to other potential prognostic indices.展开更多
Background: Delirium is one of the most common medical emergencies and is associated with poor outcomes including: mortality, prolonged length of stay and poor functional outcome. The more severe delirium is the worst...Background: Delirium is one of the most common medical emergencies and is associated with poor outcomes including: mortality, prolonged length of stay and poor functional outcome. The more severe delirium is the worst the clinical outcomes of medical illness. Despite the obvious, not much has been documented on delirium severity and its associated factors among medical inpatients in low income countries including Nigeria. Objectives: This study was conducted to examine the severity of delirium among medical inpatients admitted through the Accident and Emergency unit of Jos University Teaching Hospital as well as to assess its associated Sociodemographic and Clinical characteristics. Method: This was a cross-sectional study that employed a consecutive sampling technique to select 290 eligible subjects from medical inpatients that presented to Accident and Emergency unit of Jos University Teaching Hospital. On admission, patients were assessed for delirium using Confusion Assessment Method and severity of delirium was evaluated using Delirium Rating Scale-Revised-98. Results: Of the 105 delirious medical inpatients, 48 (45.7%) had severe delirium, 41 (39.1%) developed less severe delirium while 16 (15.2) presented with no severe delirium. Sociodemographic characteristics found to be significantly associated with less to more severe delirium include male gender (P = 0.001), nonprofessionals (P = 0.003), income range of N20,000 - N49,000 (P Conclusion: This study demonstrates that delirium is often associated with higher severity in Accident and Emergency unit admission and there are strongly associated clinical characteristics to watch out for in high risk medical inpatients.展开更多
Community-acquired pneumonia(CAP)remains the leading cause of morbidity and mortality among children worldwide.It is critical for these patients to select and timely initiate appropriate empirical antimicrobial therap...Community-acquired pneumonia(CAP)remains the leading cause of morbidity and mortality among children worldwide.It is critical for these patients to select and timely initiate appropriate empirical antimicrobial therapy against the causative pathogens[1].However,conventional pathogen-detecting methods,such as culture and serology,have no prospect of altering empiric therapy owing to their time delay in obtaining results and to their lower detection rates[2].Recent advances in molecular diagnostic assays,such as multiplex polymerase chain reaction PCR(mPCR)methods,have been used to detect multiple pathogens in CAP simultaneously within two hours and have dramatically improved the ability to diagnose respiratory pathogens[3].However,whether this molecular diagnosis method can reduce the use of antibiotics and can improve prognosis in severe CAP children,especially those less than 5 years old,remains to be explored.展开更多
To the Editor:Acute kidney injury(AKI)is a well-known and critical complication of acute pancreatitis in intensive care units(ICUs).Patients with acute pancreatitis who developed AKI had a significantly higher mortali...To the Editor:Acute kidney injury(AKI)is a well-known and critical complication of acute pancreatitis in intensive care units(ICUs).Patients with acute pancreatitis who developed AKI had a significantly higher mortality than those without AKI.[1]Currently,the diagnosis of AKI in acute pancreatitis patients includes a sudden decrease in glomerular filtration rate manifested by an increase in serum creatinine or oliguria within 48 h to 7 days.[2]However,kidney damage occurs unstoppably when creatinineincreases or urine output decreases.This study aimed to establish prediction models based on the machine learning algorithm and traditional logistic regression method only with commonly collected variables when admitted to the ICU,and we also compared their performance for predicting the occurrence of AKI in patients with acute pancreatitis.展开更多
Objective To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection.Methods Patients ...Objective To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection.Methods Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1.展开更多
A high school graduate from Shaanxi Province, Sun Jiankun, found it hard tounderst and his college application experience. He only believed fate played a joke on him. Sun’s long-cherished wish to study history at Fudan
Objective Most patients with sepsis were diagnosed in the emergency department when admitted to the hospital. This study aimed to explore independent factors for hospital mortality in sepsis patients in the emergency ...Objective Most patients with sepsis were diagnosed in the emergency department when admitted to the hospital. This study aimed to explore independent factors for hospital mortality in sepsis patients in the emergency department.Methods It was a retrospective study. All patients with sepsis admitted to the emergency department of Changsha Central Hospital between 1 July 2020 and 1 July 2021 were included. Variables that showed significant differences between the survivor group and the non-survivor group were caculated in multivariate logistic regression analysis. Independent factors associated with in-hospital mortality in sepsis were identified.Results A total of 194 patients were included in this study. In-hospital mortality was 17.01%(n=33). Two independent risk factors including albumin(ALB) and urea nitrogen were identified by multivariate logistic regression analysis. The optimal cut-off values of ALB and urea nitrogen were 26.5g/L and 8.03mmol/L. While combined ALB and urea nitrogen, the area under the ROC curve(AUC) was 0.790, which was superior to the SOFA, qSOFA, and APACHEⅡscores.Conclusions Independent factors including ALB and urea nitrogen for in-hospital mortality in sepsis in the emergency department were identified. It could help physicians identify those patients with a higher risk of a poor prognosis early and easily, so intervention and management could be performed quickly.展开更多
Fever of unknown origin(FUO)is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1]Acute liver fluke infection is characterized by fever,right up...Fever of unknown origin(FUO)is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1]Acute liver fluke infection is characterized by fever,right upper quadrant pain,hepatomegaly,jaundice,and peripheral blood eosinophilia.By contrast,chronic liver fluke infection is asymptomatic in its early stage,but can easily progress to cirrhosis,cancer,or bile duct cancer initslaterstages.The diagnosis of clonorchiasis is particularly challenging in non-endemic areas.We herein report an unusual case of liver fluke infection in a patient who presented with FUO and eosinophilia.A 38-year-old male was admitted to our hospital with a history of intermittent and recurrent fever for over 10 d and a history of sudden abdominal pain for1 h.He had no other medical history.More than 10d ago,he visited our emergency department because of FUO,with his body temperature reaching 39.7℃,and he had no other symptoms at that time.Laboratory and radiological examinations revealed:white blood cell(WBC)counts,10.9×10^(9)/L;neutrophil percentage,84.5%;eosinophil percentage,3.1%;C-reactive protein(CRP),141 mg/L;liver and kidney function,normal;influenza virus,negative;urine and stool tests,normal;and chest computed tomography(CT)findings,normal.The fever subsided after 1 week of anti-infective treatment with moxifloxacin.Subsequent tests revealed the following results:WBC,15.0×10^(9)/L;neutrophil percentage,70.0%;eosinophil percentage,16.8%;and CRP,122 mg/L.The antimicrobial treatment was then discontinued.展开更多
Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture pr...Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture presents significant risks,including dyspnea,respiratory failure,and potentially fatal airway obstruction,and is often overlooked or diagnosed late in clinical settings.Prompt diagnosis and intervention are prognostically crucial.[1,2]Between January 2013 and December 2023,four children(two male and two female)with bronchial rupture were admitted to the Pediatric Surgical Intensive CareUnit(ICU)at Children’s Hospital,Zhejiang University School of Medicine.Here,we share our experience of patient management.展开更多
BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevatio...BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevation myocardial infarction(STEMI)has not been explored.METHODS STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled.The patients were divided into the SR group and the non-SR group according to the index coronary angiography results.The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis.Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.RESULTS Three hundred and fifty-seven patients were finally enrolled in our study,55 patients were divided into the SR group and 302 patients were divided into the non-SR group.In uni-variable analysis,patients with SR were older(P=0.032),with higher red blood cell distribution width(P<0.001)and red blood cell distribution width-to-platelet ratio(P<0.001),higher level of C-reactive protein(P=0.046),higher level of uric acid(P<0.001)compared with patients without SR.Patients with SR had a lower level of platelets(P=0.008),lower level of on-admission B-type natriuretic peptide(P<0.001).As for the level of UAR,STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR[11.1(8.9–13.4)vs.8.3(6.6–10.0),P<0.001].Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables.Receiver operating characteristic analysis showed that UAR had good predictive value in SR(AUC=0.75,95%CI:0.702–0.794,P<0.01).CONCLUSIONS Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.展开更多
OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected...OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all P<0.05).Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-seg-ment elevation myocardial infarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.展开更多
OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Ch...OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing,China,we identified a cohort of elderly inpatients(≥60 years),including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD,from January 2008 to December 2017.We collected demographic characteristics and clinical data.After selecting the important features,we established five ML models,including extreme gradient boosting(XGBoost),random forest(RF),decision tree(DT),adaptive boosting(Adaboost)and logistic regression(LR).We compared the receiver operating characteristic curves,area under the curve(AUC)and other relevant parameters of different models and determined the optimal classification model.The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTS Fifteen features were selected and included in the ML model.The classification precision in the test set of the XGBoost,RF,DT,Adaboost and LR models was 0.778,0.789,0.753,0.750 and 0.689,respectively;and the AUCs of the subjects were 0.851,0.845,0.823,0.833 and 0.731,respectively.Applying the XGBoost model with optimal performance to a newly recruited dataset for validation,the diagnostic sensitivity,specificity,precision,and AUC were 0.792,0.808,0.748 and 0.880,respectively.CONCLUSIONS The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.展开更多
Background With the continuous improvement of people's material living standards,the consumption of alcoholic beverages is increasing.Alcohol dependence caused by alcohol addiction has become a widespread concern ...Background With the continuous improvement of people's material living standards,the consumption of alcoholic beverages is increasing.Alcohol dependence caused by alcohol addiction has become a widespread concern in society.As the brand-new medical and health model created by the modern biomedical technology revolution and the information technology revolution,mobile health has been used more and more widely in the field of medical health with the characteristics of convenience,rapidity and generalisability.With the general use of the social software WeChat,it is feasible to implement mobile health on the WeChat platform.Aim We aimed to explore the clinical effect of WeChat platform used in the cognitive behavioural therapy(CBT)on the maintenance period of alcohol dependence and addiction.Methods Seventy alcohol-dependent patients in the withdrawal maintenance stage admitted into our hospital were randomly divided into the CBT on WeChat platform group(the experiment group,n=35)and the general clinical treatment using sertraline group(the control group,n=35)with block randomisation grouping.They were evaluated with the Severity of Alcohol Dependence Questionnaire(SADQ-C)before the treatment,at the end of the fourth week,at the end of the eighth week and at the end of the twelfth week of treatment.In addition,Zung's Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were employed to evaluate the degree of anxiety and depression of the two groups.Results The SADQ-C,SAS and SDS scores of the two groups after treatment decreased markedly compared with those before treatments,and the differences were statistically significant.Between-group comparison:the SADQ-C scores of the experiment group at the end of the fourth,eighth and twelfth weeks were lower than those of the control group,and the difference was statistically significant,which indicated that the score reduction in the experiment group was larger than that in the control group.The SAS and SDS scores of the experiment group at these time points were not significantly different from those of the control group,which indicated that these two treatment methods were comparable in treating patients1 anxiety and depression.Conclusion The CBT in tervention using WeChat may improve the subjectively reported severity of alcohol dependence of patients who had completed detoxification.It is conducive to prevention of relapse,and is convenient for patients.It is worthy of clinical application and further study.展开更多
To the Editor:Metastatic melanoma of the gallbladder is extremely rare,and despite appropriate therapy its prognosis is poor withfew patients surviving more than 2 years. We present acase of gallbladder involvement by...To the Editor:Metastatic melanoma of the gallbladder is extremely rare,and despite appropriate therapy its prognosis is poor withfew patients surviving more than 2 years. We present acase of gallbladder involvement by malignant melanomain a展开更多
Dear editor,A 21-year-old male student was admitted to the emergency department of our hospital due to chest distress,dyspnea for 1.5 hours, and loss of consciousness for one minute. Before admission, the patient had ...Dear editor,A 21-year-old male student was admitted to the emergency department of our hospital due to chest distress,dyspnea for 1.5 hours, and loss of consciousness for one minute. Before admission, the patient had been advised rest for two months because of left ankle sprain, leading to less activity. At admission, the patient was unconscious,with facial cyanosis, and his limbs were cold.展开更多
文摘Dear editor,After sustaining severe traumatic brain injury(TBI),patients frequently require invasive mechanical ventilation(MV).However,up to 26%of patients require tracheostomy due to failure to wean from the ventilator.[1]The decision of when to perform tracheostomy is important as it balances the risk between avoiding prolonged MV and avoiding risk of tracheostomy.Early predictors for tracheostomy,i.e.,clinical factors when patients first present to an Emergency Department after trauma or when patient fi rst arrive at a regional trauma center,can help clinicians’medical decision-making process.
文摘INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.
文摘Limbic encephalitis represents a cluster of autoimmune disorders,with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety,affective symptoms,psychosis,short-term memory impairment as well as faciobrachial and grand mal seizures.We aim to present a case of a 53-year-old man with positive anti-voltage-gated potassium channel(VGKC)complex antibodies who initially presented with symptoms of psychotic mania.Six weeks post-psychiatric symptomatology,he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure.The patient had no previous psychiatric history and was initially treated with psychotropic medications.Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms.Furthermore,immunological and laboratory testing takes a rather long time to determine the diagnosis.What is more,few psychiatrists consider autoimmune nature of the neuropsychiatric presentation.Therefore,it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness.Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching,seizures,confusion and cognitive decline.
文摘COVID-19 has led to an increase in psychiatric disorders,stress,trauma and suicidal behaviour.Study published in the Lancet in 2021 have identified anxiety disorder as the most frequently diagnosed psychiatric disorder in COVID-19 survivors[1].Fear conditioning and hyper-vigilance towards abnormal breathing patterns attributable to COVID-19 or not,can act as etiological and maintenance factors of panic,and hence we should expect an onset or aggravation of panic disorder in COVID-19[2].
文摘Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.
文摘Heart failure(HF)is a devastating condi-tion characterized by a high rate of mor-tality.[1]About 6.2 million individuals are grappling with the burden of HF in the United States(U.S).[2]Of this over 6 million individuals af-fected with HF,a higher proportion is made up of people older than 65 years.[3,4]More than 50%of pa-tients hospitalized due HF are older than 75 years.[5]Seniors do not just account for the greater propor-tion of individuals affected by HF but also have a worse outcome compared to younger individuals with HF.[6−14]In the light of the above,we aim to address racial disparities as they affect seniors with HF in terms of mortality in addition to other potential prognostic indices.
文摘Background: Delirium is one of the most common medical emergencies and is associated with poor outcomes including: mortality, prolonged length of stay and poor functional outcome. The more severe delirium is the worst the clinical outcomes of medical illness. Despite the obvious, not much has been documented on delirium severity and its associated factors among medical inpatients in low income countries including Nigeria. Objectives: This study was conducted to examine the severity of delirium among medical inpatients admitted through the Accident and Emergency unit of Jos University Teaching Hospital as well as to assess its associated Sociodemographic and Clinical characteristics. Method: This was a cross-sectional study that employed a consecutive sampling technique to select 290 eligible subjects from medical inpatients that presented to Accident and Emergency unit of Jos University Teaching Hospital. On admission, patients were assessed for delirium using Confusion Assessment Method and severity of delirium was evaluated using Delirium Rating Scale-Revised-98. Results: Of the 105 delirious medical inpatients, 48 (45.7%) had severe delirium, 41 (39.1%) developed less severe delirium while 16 (15.2) presented with no severe delirium. Sociodemographic characteristics found to be significantly associated with less to more severe delirium include male gender (P = 0.001), nonprofessionals (P = 0.003), income range of N20,000 - N49,000 (P Conclusion: This study demonstrates that delirium is often associated with higher severity in Accident and Emergency unit admission and there are strongly associated clinical characteristics to watch out for in high risk medical inpatients.
基金supported by pediatric special project from pediatric discipline collaborative development center of Beijing hospital management center(XTZD20180504)(S.Q).
文摘Community-acquired pneumonia(CAP)remains the leading cause of morbidity and mortality among children worldwide.It is critical for these patients to select and timely initiate appropriate empirical antimicrobial therapy against the causative pathogens[1].However,conventional pathogen-detecting methods,such as culture and serology,have no prospect of altering empiric therapy owing to their time delay in obtaining results and to their lower detection rates[2].Recent advances in molecular diagnostic assays,such as multiplex polymerase chain reaction PCR(mPCR)methods,have been used to detect multiple pathogens in CAP simultaneously within two hours and have dramatically improved the ability to diagnose respiratory pathogens[3].However,whether this molecular diagnosis method can reduce the use of antibiotics and can improve prognosis in severe CAP children,especially those less than 5 years old,remains to be explored.
基金the National Natural Science Foundation of China(Nos.81801892,81901998)the 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYGD18020).
文摘To the Editor:Acute kidney injury(AKI)is a well-known and critical complication of acute pancreatitis in intensive care units(ICUs).Patients with acute pancreatitis who developed AKI had a significantly higher mortality than those without AKI.[1]Currently,the diagnosis of AKI in acute pancreatitis patients includes a sudden decrease in glomerular filtration rate manifested by an increase in serum creatinine or oliguria within 48 h to 7 days.[2]However,kidney damage occurs unstoppably when creatinineincreases or urine output decreases.This study aimed to establish prediction models based on the machine learning algorithm and traditional logistic regression method only with commonly collected variables when admitted to the ICU,and we also compared their performance for predicting the occurrence of AKI in patients with acute pancreatitis.
文摘Objective To evaluate the effect of intestinal carbapenem-resistant Enterobacteriaceae (CRE) active screening combined with enhanced intervention in the prevention and control of nosocomial infection.Methods Patients who were admitted to the Department of Hematology in a tertiary-care general hospital from March 1.
文摘A high school graduate from Shaanxi Province, Sun Jiankun, found it hard tounderst and his college application experience. He only believed fate played a joke on him. Sun’s long-cherished wish to study history at Fudan
基金Changsha Natural Science Foundation(NO.kq2208445)Changsha Central Hospital (NO.YNKY202306)Changsha Science and Technology Bureau(NO.kzd21084, kzd22074, kzd22075)。
文摘Objective Most patients with sepsis were diagnosed in the emergency department when admitted to the hospital. This study aimed to explore independent factors for hospital mortality in sepsis patients in the emergency department.Methods It was a retrospective study. All patients with sepsis admitted to the emergency department of Changsha Central Hospital between 1 July 2020 and 1 July 2021 were included. Variables that showed significant differences between the survivor group and the non-survivor group were caculated in multivariate logistic regression analysis. Independent factors associated with in-hospital mortality in sepsis were identified.Results A total of 194 patients were included in this study. In-hospital mortality was 17.01%(n=33). Two independent risk factors including albumin(ALB) and urea nitrogen were identified by multivariate logistic regression analysis. The optimal cut-off values of ALB and urea nitrogen were 26.5g/L and 8.03mmol/L. While combined ALB and urea nitrogen, the area under the ROC curve(AUC) was 0.790, which was superior to the SOFA, qSOFA, and APACHEⅡscores.Conclusions Independent factors including ALB and urea nitrogen for in-hospital mortality in sepsis in the emergency department were identified. It could help physicians identify those patients with a higher risk of a poor prognosis early and easily, so intervention and management could be performed quickly.
文摘Fever of unknown origin(FUO)is recognized as fever with uncertain diagnosis despite three days of hospital admission or three or more outpatient visits.[1]Acute liver fluke infection is characterized by fever,right upper quadrant pain,hepatomegaly,jaundice,and peripheral blood eosinophilia.By contrast,chronic liver fluke infection is asymptomatic in its early stage,but can easily progress to cirrhosis,cancer,or bile duct cancer initslaterstages.The diagnosis of clonorchiasis is particularly challenging in non-endemic areas.We herein report an unusual case of liver fluke infection in a patient who presented with FUO and eosinophilia.A 38-year-old male was admitted to our hospital with a history of intermittent and recurrent fever for over 10 d and a history of sudden abdominal pain for1 h.He had no other medical history.More than 10d ago,he visited our emergency department because of FUO,with his body temperature reaching 39.7℃,and he had no other symptoms at that time.Laboratory and radiological examinations revealed:white blood cell(WBC)counts,10.9×10^(9)/L;neutrophil percentage,84.5%;eosinophil percentage,3.1%;C-reactive protein(CRP),141 mg/L;liver and kidney function,normal;influenza virus,negative;urine and stool tests,normal;and chest computed tomography(CT)findings,normal.The fever subsided after 1 week of anti-infective treatment with moxifloxacin.Subsequent tests revealed the following results:WBC,15.0×10^(9)/L;neutrophil percentage,70.0%;eosinophil percentage,16.8%;and CRP,122 mg/L.The antimicrobial treatment was then discontinued.
文摘Bronchial rupture from penetrating,perforating,or compressive cervical or thoracic injuries can lead to complete tracheal,mainstem bronchial,or lobar bronchial detachment.Although rare in children,bronchial rupture presents significant risks,including dyspnea,respiratory failure,and potentially fatal airway obstruction,and is often overlooked or diagnosed late in clinical settings.Prompt diagnosis and intervention are prognostically crucial.[1,2]Between January 2013 and December 2023,four children(two male and two female)with bronchial rupture were admitted to the Pediatric Surgical Intensive CareUnit(ICU)at Children’s Hospital,Zhejiang University School of Medicine.Here,we share our experience of patient management.
文摘BACKGROUND The association between uric acid-albumin ratio(UAR)with different diseases has been evaluated before.However,the association between UAR with spontaneous reperfusion(SR)in patients with ST-segment elevation myocardial infarction(STEMI)has not been explored.METHODS STEMI patients admitted to our department and underwent primary coronary angiography between 1st November 2018 and 31st December 2020 were retrospectively enrolled.The patients were divided into the SR group and the non-SR group according to the index coronary angiography results.The association between UAR and SR was evaluated by uni-variable and multi-variable logistic analysis.Receiver operating characteristic curve analysis was used to determine the optimum cut-off level of UAR in predicting SR.RESULTS Three hundred and fifty-seven patients were finally enrolled in our study,55 patients were divided into the SR group and 302 patients were divided into the non-SR group.In uni-variable analysis,patients with SR were older(P=0.032),with higher red blood cell distribution width(P<0.001)and red blood cell distribution width-to-platelet ratio(P<0.001),higher level of C-reactive protein(P=0.046),higher level of uric acid(P<0.001)compared with patients without SR.Patients with SR had a lower level of platelets(P=0.008),lower level of on-admission B-type natriuretic peptide(P<0.001).As for the level of UAR,STEMI patients with SR had significantly higher levels of UAR compared with STEMI patients without SR[11.1(8.9–13.4)vs.8.3(6.6–10.0),P<0.001].Further multi-variable logistic analysis reveals that UAR was the independent risk factor of SR in different models after adjusting different variables.Receiver operating characteristic analysis showed that UAR had good predictive value in SR(AUC=0.75,95%CI:0.702–0.794,P<0.01).CONCLUSIONS Our study shows that UAR is an independent risk factor for predicting SR in STEMI patients.
基金supported by the CCC-ACS Project(NCT02306616)which is a collaborative project of the American Heart Association and the Chinese Society of Cardiology.
文摘OBJECTIVE To describe the duration of the pre-hospital delay time and identify factors associated with prolonged pre-hospital delay in patients with acute myocardial infarction(AMI)in China.METHODS Data were collected from November 2014 to December 2019 as part of the Improving Care for Cardiovascular Dis-ease in China-Acute Coronary Syndrome(CCC-ACS)project.A total of 33,386 patients with AMI admitted to the index hospitals were included in this study.Two-level logistic regression was conducted to explore the factors associated with the pre-hospital delay and the associations between different pre-hospital delay and in-hospital outcomes.RESULTS Of the 33,386 patients with AMI,70.7%of patients arrived at hospital≥2 h after symptom onset.Old age,female,ru-ral medical insurance,symptom onset at early dawn,and non-use of an ambulance predicted a prolonged pre-hospital delay(all P<0.05).Hypertension and heart failure at admission were only significant in predicting a longer delay in patients with ST-seg-ment elevation myocardial infarction(STEMI)(all P<0.05).A pre-hospital delay of≥2 h was associated with an increased risk of mortality[odds ratio(OR)=1.36,95%CI:1.09-1.69,P=0.006]and major adverse cardiovascular events(OR=1.22,95%CI:1.02-1.47,P=0.033)in patients with STEMI compared with a pre-hospital delay of<2 h.CONCLUSIONS Prolonged pre-hospital delay is associated with adverse in-hospital outcomes in patients with STEMI in China.Our study identifies that patient characteristics,symptom onset time,and type of transportation are associated with pre-hospital delay time,and provides focuses for quality improvement.
基金supported by the Key Project of Chinese Military Health Care Projects(No.18BJZ32)the Projects of International Cooperation and Exchanges NSFC(No.81820108019)+2 种基金the Technical Fund for the Foundation Strengthening Program of China(2021-JCJG-JJ-1079)the Chinese Military Innovation Project(CX19028)the Project of National Clinical Research Center for Geriatric Disease(NCRCG-PLAGH-2019024).
文摘OBJECTIVE To establish a prediction model of coronary heart disease(CHD)in elderly patients with diabetes mellitus(DM)based on machine learning(ML)algorithms.METHODS Based on the Medical Big Data Research Centre of Chinese PLA General Hospital in Beijing,China,we identified a cohort of elderly inpatients(≥60 years),including 10,533 patients with DM complicated with CHD and 12,634 patients with DM without CHD,from January 2008 to December 2017.We collected demographic characteristics and clinical data.After selecting the important features,we established five ML models,including extreme gradient boosting(XGBoost),random forest(RF),decision tree(DT),adaptive boosting(Adaboost)and logistic regression(LR).We compared the receiver operating characteristic curves,area under the curve(AUC)and other relevant parameters of different models and determined the optimal classification model.The model was then applied to 7447 elderly patients with DM admitted from January 2018 to December 2019 to further validate the performance of the model.RESULTS Fifteen features were selected and included in the ML model.The classification precision in the test set of the XGBoost,RF,DT,Adaboost and LR models was 0.778,0.789,0.753,0.750 and 0.689,respectively;and the AUCs of the subjects were 0.851,0.845,0.823,0.833 and 0.731,respectively.Applying the XGBoost model with optimal performance to a newly recruited dataset for validation,the diagnostic sensitivity,specificity,precision,and AUC were 0.792,0.808,0.748 and 0.880,respectively.CONCLUSIONS The XGBoost model established in the present study had certain predictive value for elderly patients with DM complicated with CHD.
文摘Background With the continuous improvement of people's material living standards,the consumption of alcoholic beverages is increasing.Alcohol dependence caused by alcohol addiction has become a widespread concern in society.As the brand-new medical and health model created by the modern biomedical technology revolution and the information technology revolution,mobile health has been used more and more widely in the field of medical health with the characteristics of convenience,rapidity and generalisability.With the general use of the social software WeChat,it is feasible to implement mobile health on the WeChat platform.Aim We aimed to explore the clinical effect of WeChat platform used in the cognitive behavioural therapy(CBT)on the maintenance period of alcohol dependence and addiction.Methods Seventy alcohol-dependent patients in the withdrawal maintenance stage admitted into our hospital were randomly divided into the CBT on WeChat platform group(the experiment group,n=35)and the general clinical treatment using sertraline group(the control group,n=35)with block randomisation grouping.They were evaluated with the Severity of Alcohol Dependence Questionnaire(SADQ-C)before the treatment,at the end of the fourth week,at the end of the eighth week and at the end of the twelfth week of treatment.In addition,Zung's Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)were employed to evaluate the degree of anxiety and depression of the two groups.Results The SADQ-C,SAS and SDS scores of the two groups after treatment decreased markedly compared with those before treatments,and the differences were statistically significant.Between-group comparison:the SADQ-C scores of the experiment group at the end of the fourth,eighth and twelfth weeks were lower than those of the control group,and the difference was statistically significant,which indicated that the score reduction in the experiment group was larger than that in the control group.The SAS and SDS scores of the experiment group at these time points were not significantly different from those of the control group,which indicated that these two treatment methods were comparable in treating patients1 anxiety and depression.Conclusion The CBT in tervention using WeChat may improve the subjectively reported severity of alcohol dependence of patients who had completed detoxification.It is conducive to prevention of relapse,and is convenient for patients.It is worthy of clinical application and further study.
文摘To the Editor:Metastatic melanoma of the gallbladder is extremely rare,and despite appropriate therapy its prognosis is poor withfew patients surviving more than 2 years. We present acase of gallbladder involvement by malignant melanomain a
文摘Dear editor,A 21-year-old male student was admitted to the emergency department of our hospital due to chest distress,dyspnea for 1.5 hours, and loss of consciousness for one minute. Before admission, the patient had been advised rest for two months because of left ankle sprain, leading to less activity. At admission, the patient was unconscious,with facial cyanosis, and his limbs were cold.
