RESUMEN
Objective:To investigate the clinical features of patients with maintenance hemodialysis (MHD) infected with SARS-CoV-2 and analyze the risk factors of death after SARS-CoV-2 infection, and to provide clinical data for early detection of critically ill patients and timely intervention.Methods:It was a cross-sectional investigation study. MHD patients in the hemodialysis centers of four tertiary hospitals with geographical representation in Shanxi province from December 1, 2022 to January 31, 2023 were enrolled, and the demographic data, dialysis-related indicators, laboratory test results and clinical features of SARS-CoV-2 infection were collected by distributing the questionnaires on SARS-CoV-2 infection, and consulting the hospital medical record system and the outpatient hemodialysis information system. SARS-CoV-2-infected patients were divided into survival group and death group according to whether all-cause death occurred and the differences of baseline data between the two groups were compared. Multivariate logistic regression analysis method was used to analyze the risk factors of mortality in MHD patients infected with SARS-CoV-2.Results:A total of 519 MHD patients were included in this study, with 508 patients (97.88%) infected with SARS-CoV-2, 474 patients in the survival group and 34 patients in the death group. The clinical symptoms of MHD patients infected with SARS-CoV-2 were diverse, and the most common initial symptom was fever (314/508, 61.81%). Other initial symptoms included cough and phlegm in 66 patients (12.99%), fatigue in 66 patients (12.99%), poor appetite in 20 patients (3.94%), dyspnea in 20 patients (3.94%), muscle pain in 14 patients (2.76%) and diarrhea in 8 patients (1.57%). Compared with the survival group, the death group had older age ( t=5.229, P<0.001), high proportions of males ( χ2=12.319, P<0.001) and diabetic nephropathy ( χ2=49.423, P<0.001), and lower levels of red blood cells ( t=-5.060, P<0.001), lymphocyte ( t=-2.614, P=0.011), neutrophil ( t=-5.117, P<0.001), serum albumin ( t=-2.940, P=0.012), serum prealbumin ( t=-3.519, P=0.001), blood phosphorus ( t=-3.309, P=0.002), serum creatinine ( Z=-3.607, P<0.001), total triglyceride ( Z=-2.486, P=0.013), total cholesterol ( Z=-3.291, P=0.001) and low-density lipoprotein cholesterol ( Z=-3.292, P=0.001). Among 508 SARS-CoV-2-infected patients, 194 patients (38.19%) were treated with nonsteroidal anti-inflammatory agents, 154 patients (30.31%) were treated with antibiotics, and 98 patients (19.29%) were treated with antiviral drugs. There were 225 (43.29%) vaccinated patients against SARS-CoV-2. Multivariate logistic regression analysis showed that low red blood cells ( OR=0.256, 95% CI 0.014-0.429), low lymphocytes ( OR=0.487, 95% CI 0.193-0.826), low serum albumin ( OR=0.613, 95% CI 0.329-0.917), older age ( OR=1.227, 95% CI 1.066-1.412) and diabetes mellitus ( OR=1.126, 95% CI 1.025-1.235) were the independent influencing factors of all-cause mortality in MHD patients infected with SARS-CoV-2. Conclusions:The clinical manifestations of SARS-CoV-2 infection in MHD patients are varied. Low red blood cells, low lymphocytes, low serum albumin, elder age and diabetes mellitus are the independent risk factors of death after SARS-CoV-2 infection in MHD patients. Strengthening management of MHD patients especially in the elderly, and improving and correcting anemia and malnutrition in time, may reduce the death risk of SARS-CoV-2 infection in MHD patients.
RESUMEN
Objective To investigate the infection of human cytomegalovirus (HCMV) in patients with atherosclerosis and explore its clinical significance.Methods A total of 134 patients with atherosclerosis (observation group) including 102 patients with coronary heart disease (CHD) and 32 patients with non-CHD from December 2009 to April 2012 were enrolled in this study.The 102 patients with CHD were divided into HCMV infection group (86 cases) and non-HCMV infection group (16 cases).Another 40 healthy person were selected as control group.The carotid intima-media thickness (IMT) was assessed by ultrasonography.The serum HCMV-IgM was measured by enzyme-linked immunosorbent assay.Results The infection rate of HCMV in observation group was 77.6％ (104/134),which was higher than that of 37.5％(15/40) in control group(P ＜ 0.05).The infection rate of HCMV in CHD patients and non-CHD patients was 84.3％(86/102) and 56.2％(18/32),and there was significant difference (P ＜ 0.05).The carotid IMT in HCMV infected atherosclerosis patients was (1.31 + 0.28) mm,which was higher than that of (1.14 ± 0.21)mm in non-HCMV infected atherosclerosis patients (P ＜ 0.05).The incidence of myocardial infarction and multi-vessel lesion in HCMV infection group was higher than that in non-HCMV infection group [39.5％(34/86) vs.25.0％(4/16) and 43.0％(37/86) vs.18.8％(3/16)](P＜ 0.05).The incidence of stable angina pectoris and single-vessel lesion in HCMV infection group was lower than that in non-HCMV infection group [26.7％(23/86) vs.43.8％(7/16) and 22.1％(19/86) vs.56.2％(9/16)](P＜0.05).Conclusion The high-infection rate of HCMV is found in atherosclerosis patients,and it maybe have a close relationship with the occurrence and development of atherosclerosis.
RESUMEN
Objective To analyze the behavioral characteristics and mental health status for patients with chronic hepatitis B,to explore the correlation between them and analyze the influence of behavioral characteristics of patients with chronic hepatitis B on their mental health.And provide a reference of clinical mental health intervention for patients with chronic hepatitis B.Methods 216 cases of patients with chronic hepatitis B in our hospital from October 2010 to October 2011 were chosen as the research object.Symptom checklist-90(SCL-90)and Eysenck personality questionnaire(EPQ)were used for evaluation.The correlation of behavioral characteristics and mental health status for patients with chronic hepatitis B and the effect of behavioral characteristics of patients with chronic hepatitis B for their mental health were analyzed.Results The SCL-90 score for 216 cases of chronic hepatitis B patients showed that its total score was significantly higher than the norm,the difference was statistically significant.The results of EPQ score showed that the neurotic or emotional stability of personality scores were significantly higher than the norm,the difference was significant.The psychotic scores were significantly lower than the norm,the difference was significant.The analysis of the correlation for nine projects in the SCL-90 scale and four items in the EPQ scale showed that introversion had a significant positive correlation with compulsion,depression,anxiety,fear and paranoia.The nervous or emotion had a significant positive correlation with compulsion,interpersonal sensitivity,paranoid,psychotic.Conclusions The behavioral characteristics of chronic hepatitis B patients have a relation with the mental health.The mental health status changes according to the changes of behavioral characteristics.
RESUMEN
Objective To evaluate the effect of percutaneous coronary intervention(PCI) on myocardial perfusion in coronary heart.Methods Fourty-two patients with coronary heart disease who were confirmed to have coronary artery steonsis by the coronary angiography were selected.They were checked by myocardial contrast echocardiography of intravenous before and after treatment by PCI.Then we determined quantitatively the perfusion of coronary microcirculation based on the extent of myocardial imaging and recorded it images.The myocardial contrast echocardiography result was compared before and after treatment by PCI for evaluating the situation of myocardial perfusion and effect of PCL So we can estimte the patients' prognosis.Results There were 39 eases of 42 patients with PCI that their lesion vascular were all opening and unblocked.Repeated radiography showed that their TIMI blood flow was the third level.The partial cross sectional area of all the capillaries [A =15.46 ± 3.27) min] blood flow velocity [β =(0.75 ±0.16)min/s],and myocardial blood flow volume[A - β =(12.00 ±4.51 ) min2/s] dependent on myocardial segments all increased more significantly than those before the PCI[A =(6.68 ± 1.76) min,β =(0.40 ± 0.12) min/s、A · β =(2.82 ± 1.38 ) min2/s] (t =37.2527.58、30.65,P ＜ 0.05 ).After PCI three months the EF value of follow-up patients was increased mote than that of before PCI (t =13.77,P ＜ 0.01 )but the scoring index of ventricular wall motion was decreased more than that of before PCI ( t =8.75,P ＜ 0.01 ).Correlation analysis showed that after PCI A,β,A · β all had a strong correlation ( every P ＜ 0.01 ).Conclusion PCI could effectively improve the situation of myocardial perfusion in myocardial infarction patients.It could save ischemia myocardial in infarction field and also improve the function of left ventricular if patients implemented PCI operation as soon as possible.
RESUMEN
Objective To investigate the effect of therapeutic communication system on alleviation of depression emotion of postoperative tumor patients undergoing chemotherapy.Methods 56 cases of cancer patients undergoing chemotherapy after surgery were randomly divided into the observation group and the control group with 28 cases in each group.The observation group was given therapeutic communication system based on routine care,the control group only received routine care.The self-rating depression scale (SDS),automatic thoughts questionnaire (ATQ) and quality of life evaluation questionnaire (QLQ-C30 3.0) were used for evaluation in two groups before and after intervention.Results The depression mood,negative automatic thoughts and quality of life in the observation group were better than the control group,the difference was statistically significant.Conclusions Application of therapeutic communication system on postoperative tumor patients undergoing chemotherapy can alleviate depression,negative automatic thoughts and quality of life significantly.It implies the effectiveness and feasibility of psychological intervention for postoperative tumor patients undergoing chemotherapy,which is worthy of clinical application.
RESUMEN
Objective To study the effects of different doses of insulin in diabetic ketoacidosisin children.Methods 44 patients with diabetic ketoacidosis in children who were treated with insulin in our hospital were selected as research object,and they were divided into group A(low dose group)22 cases and group B(high dose group)22 cases, and the blood glucose, blood calcium, serum potassium, acidosis corrected time and the levels of serum IL-6,IL-12,IL-18 and TNF-α and incidence of hypoglycemia of the two groups were compared and studied. Results The blood glucose, blood calcium,serum potassium, acidosis corrected time and the levels of serum IL-6, IL-12, IL-18 and TNF-α of the two groups had no differences, there were no significant difference(all P ＞ 0. 05), but the incidence of hypoglycemia of the group B was lower than that of group A,there was significant difference(P ＜0. 05). Conclusion The effects of low dose of insulin in diabetic ketoacidosis in children was better, blood glucose placidity decreases, and was worthy of further studying and popularization and application.