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Leptospirosis: A clinical review of evidence based diagnosis, treatment and prevention

World Journal of Clinical Infectious diseases 2016年第4期6卷 61-66页

作者： Alison B Lane Michael M Dore Walter Reed National Military Medical Center department of Medicine Naval Hospital Guam

Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. The combination of jaundice, renal failure, and hemorrhage is known as Weil's disease and is the most characteristic pattern associated with severe leptospirosis. Clinical suspicion alone may be enough to warrant empiric antibiotic treatment in many cases. Serological methods are the most commonly used means of confirming a diagnosis of leptospirosis. The "gold standard" is the microscopic agglutination test. Typical treatment for mild causes is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, treatment and prevention of leptospirosis.

关键词： Leptospirosis Tropical diseases Infectious disease

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Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

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World Journal of Emergency Medicine 2016年第3期7卷 183-190页

作者： Bill Lukin Li-jun Fan Jing-zhou Zhao Jian-dong Sun Kaeleen Dingle Rhonda Purtill Sam Tapp Xiang-yu Hou department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane Queensland 4006 Australia School of Public Health and Social Work Queensland University of Technology Brisbane Queensland 4059 Australia Bureau of Investment Promotion Wuwei City 733000 Gansu Province China Queensland Health Brisbane Queensland 4029 Australia

BACKGROUND: Hospital emergency department(ED) use by patients from residential aged care facilities(RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home(Hi NH) ***: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency department Information System database, and were analysed by descriptive and comparative ***: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio(95%CI): 0.09(0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio(95%CI): 0.22(0.07, 0.66); P=0.007].CONCLUSION: The Hi NH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

关键词： Residential aged care Emergency department Presenting complaint

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Predictors of severe and critical COVID-19:A systematic review

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World Journal of Clinical Infectious diseases 2020年第2期10卷 24-32页

作者： Sameh Hany Emile Sualeh Muslim Khan General Surgery department Mansoura University HospitalsMansoura UniversityMansoura City 35516Egypt Dow Medical College Dow University of Health SciencesKarachi 74200Pakistan

BACKGROUND Coronavirus disease 2019(COVID-19)has emerged as a public health crisis that was declared as a global pandemic by the World Health *** most cases have no or mild symptoms,around 10%of patients develop severe or critical illness that necessitates hospitalization and intensive care unit *** To assess the literature for the predictive factors that can identify patients having severe/critical COVID-19 *** A Preferred Reporting Items for Systematic Reviews and Meta-Analysescompliant systematic search of the literature was *** databases including PubMed/MEDLINE,Scopus,and Cochrane Library were *** main outcome measures were the predictors of severe/critical COVID-19 and *** Five studies including 583 patients of a median age of 50.5 years were *** were 346(59.4%)male and 237(40.6%)*** 583 hospitalized patients,242(41.5%)had critical *** respiratory distress disease occurred in 291 patients,accounting for 46.7%of total ***(17.1%)mortalities were *** most commonly reported predictors of severe COVID-19 were older age,medical comorbidities,lymphopenia,elevated C-reactive protein,increased D-dimer,and increased neutrophil *** on computed tomography(CT)scanning predictive of severe disease were bronchial wall thickening,CT score>7,linear opacities,consolidation,right upper lobe affection,and crazy paving *** Several demographic,clinical,laboratory,and radiologic factors can help predict severe and critical COVID-19 along with the potential need for mechanical *** that were more commonly reported were older age,medical comorbidities,lymphopenia,increased neutrophil ratio,elevated C-reactive protein,and increased D-dimer.

关键词： COVID-19 SARS-CoV-2 Predictors Severe critical Systematic review

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在5个美国健康计划中上呼吸道感染和支气管炎时抗生素的使用质量调查

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世界核心医学期刊文摘（儿科学分册） 2006年第A3期2卷 45-45页

作者： Mangione-Smith R. Wong L. Elliott M.N. 王经纬 department of Pediatrics UCLA 10833 LeConte Ave Los Angeles CA 90095-1752United States

Objective: To develop and test the validity of a qualityof-care performance measure that examines antibiotic prescribing rates in children diagnosed as having upper respiratory infection (URI) or bronchitis. Design and Methods: The measure developed examines the annual rate of antibiotic prescribing to children aged 3 months to 18 years with an episode of URI or bronchitis. Administrative data from 5 US health plans were used to identify episodes of URI or bronchitis using International Classification of diseases, Ninth Revision, codes 460, 465, 466, and 490. Pharmacy data (National Drug Codes)-were used to determine whether antibiotics were prescribed for the URI or bronchitis episode. Medical record abstractions were performed on a random sample of 465 cases to assess percentage agreement with pharmacy claims data for antibiotic prescribing. Results: For the 84 166 children and adolescents aged 3 months to 18 years who had at least 1 episode of URI or bronchitis during the measurement year, 31% received antibiotics. Prescribing rates for URI and/or bronchitis varied widely among the 5 participating health plans (2% -75% ; P < .001). Inappropriate antibiotic prescribing occurred most frequently for bronchitis episodes, with 4 of 5 health plans prescribing antibiotics in 60% of such cases (range, 60% -80% ). Percentage agreement between administrative and medical records data for antibiotic prescribing was 88% . Conclusions: This quality measure is feasible to implement at the health plan level and validly assesses antibiotic prescribing rates using administrative data. Improvements in adhering to judicious use guidelines for antibiotic prescribing in children with URI and bronchitis are warranted.

关键词：使用质量性比例医疗质量控制质量调查

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患SARS的医护人员中的腹泻状况调查

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世界核心医学期刊文摘（胃肠病学分册） 2005年第4期1卷 51-51页

作者： Chiu Y.-C. WuK.-L. K.-W. Chiu 杨瑗 Division of Gastroen terology Department of Internal Medicine Chang Gung Memorial Hospital 123 Ta -Pei Road Kaohsiung 83305 TaiwanDr.

Background and goal: Several known coronavirus species cause a variety of dise ases, including respiratory or enteric diseases. The purpose of this study was to investigate the interesting enteric symptoms of the medical care workers who were evidently infected with SARS by means of respiratory transmission. Study: Between May 1 and June 16, 2003, we enrolled 16 medical care workers who fulfilled the definition of probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. S erum anti SARS IgG was checked by enzyme linked immunosorbent assays at the co nvalescent phase. Results: The incidence of watery diarrhea was 18.8%(3 of 16). The RT PCR of coronavirus was positive in three (18.8%) of 16 throat swabs an d in none (0%) of seven rectal swabs. Serum anti coronavirus IgG was positive in 13 of the 15 patients (86.7%). The mortality rate was 6.25%(1 of 16). The d iarrhea rate in our hospital was significantly lower in comparison with the 73% (55 of 75) of the Amoy Gardens outbreak in Hong Kong (P = 0.000073), and similar to the 19.6%(27 of 138) of the hospital acquired outbreak in the Prince of Wa les Hospital in Hong Kong (P= 0.798). In contrast to the high positive rate of f eces RT-PCR (97%)in Amoy Gardens, our positive rate in rectal swab RT PCT (0 %) was significantly lower (P = 0.00000002). Conclusions: Hospital acquired SA RS cases infected mainly by respiratory route less commonly presented with diarr hea. Lower intestinal viral load, when the virus spread by respiratory route, may be contributive to lower diarrhea rate and lower positive rate in rectal swab RT-PCR.

关键词：呼吸道传播拭子疑似患者肠道症状肠道病毒医护工作者腹泻率 IgG 暴发病院内感染

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Healthcare seeking trends in acute respiratory infections among children of Pakistan

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World Journal of Clinical Infectious diseases 2017年第3期7卷 38-45页

作者： Hana Mahmood Samina Mohsin Khan Saleem Abbasi Yahya Sheraz International Research Force/Maternal Neonatal and Child Health Research Network (MNCHRN) ARI Research Cell Children Hospital Pakistan Institute of Medical Sciences (PIMS) department of Public Health Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU) MNCHRN and ARI Research Cell Children Hospital PIMS SZABMU International Research Force

AIM To assess healthcare seeking trends among Pakistani children with acute respiratory infections through comparative analysis between demographic health surveys(DHS) 2006-2007 and 2012-2013. METHODS Data of the last born children 0-24 mo of age of the sampled households from both the DHS was analyzedafter seeking permission from the DHS open access website. These were children who had suffered from cough and/or breathing difficulty in the past two weeks and sought health care thereafter. The trends of health care seeking were determined separately for the individual, household and community level according to the study parameters. χ2 test was applied to compare these trends. A P-value of respiratory infections(ARI) according to case definition along with 2142 out of 3419 children in 2012-2013 DHS, whose data was analyzed. During 2006-2007, 69% cases sought healthcare for ARI which improved to 79% in 2012-2013. Additionally, it was revealed that when compared between 2006-2007 and 2012-2013, improvement in care seeking practices was observed among illiterate mothers(64% vs 77%) although there was minimal change in those literate. Similarly, those women working also showed an increase in healthcare seeking from 67% to 79%. Additionally, those belonging to low and middle socioeconomic class showed a marked increase as compared to those in the higher class where there was no significant change. Whereas those living in rural communities also showed an increase from 66% to 78%.CONCLUSION Increasing health budget, improving maternal education and strengthening multi-sectoral coordination are among the effective strategies to improve outcomes associated with healthcare seeking in ARI.

关键词： Acute respiratory infections Demographic health surveys Comparison Pneumonia Healthcare seeking

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