BackgroundPreclinical and clinical evidence suggests that hyperbaric oxygen therapy (HBOT) may benefit newborns. The effectiveness of HBOT for neonatal hypoxic-ischemic encephalopathy (HIE) remains controversial. We conducted a meta-analysis to evaluate the efficacy and prognosis of HBOT in neonates with HIE.MethodsA systematic search of eight databases was performed for available articles published between January 1, 2015, and September 30, 2020, to identify randomized controlled clinical trials (RCTs) on HBOT for neonatal HIE. Methodological quality assessment was performed by applying the simple procedure detailed by the Cochrane collaboration. Afterward, quality assessment and data analysis were performed using Revman 5.3 software. STATA 15 software was used to detect publication bias as well as for sensitivity analysis.ResultsA total of 46 clinical RCTs were selected for the study and included 4,199 patients with neonatal HIE. The results indicated that HBOT significantly improved the total efficiency (TEF) of treatment for neonatal HIE patients [odds ratio (OR) = 4.61, 95% confidence interval (CI) (3.70, 5.75), P < 0.00001] and reduced the risk of sequelae (OR = 0.23, 95% CI (0.16, 0.33), P < 0.00001) and the neonatal behavioral neurological assessment (NBNA) scores [mean difference (MD) = 4.51, 95%CI (3.83,5.19, P < 0.00001)].ConclusionIn light of the effectiveness of HBOT neonatal HIE, this meta-analysis suggested that HBOT can be a potential therapy for the treatment of neonatal HIE. Due to the heterogeneity of studies protocol and patient selection being only from China, more research is needed before this therapy can be widely implemented in the clinic.Protocol RegistrationPROSPERO (ID: CRD42020210639). Available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020210639.
Background Rare diseases are serious and chronic diseases that affect no more than 1 person in 2000 (in European Union criteria). Patients suffering from RDs may come to the emergency department for life-threatening symptoms, such as acute aortic dissection, intracranial haemorrhage, and severe respiratory distress. Diagnostic delay of rare disease patients is common and often caused by low rare disease awareness among physicians. The main aim of this study was to investigate Chinese emergency physicians’ basic knowledge, information access and educational needs regarding rare diseases. An online questionnaire was completed by Chinese emergency physicians during January and March 2021. Methods and results A total of 539 emergency physicians, including 200 females and 339 males, responded to the questionnaire-based study. More than half of the respondents were from Tertiary A hospitals and had engaged in medical clinical work for more than 10 years. Only 4.27% of respondents correctly estimated the prevalence of rare diseases. A few respondents knew the exact number of RDs in the first official list of rare diseases in 2018. A total of 98.5% of respondents rated their knowledge about rare diseases as minimal or insufficient. Most emergency physicians preferred to obtain information through search engines instead of specialized websites on rare diseases. A lack of practice guidelines or consensus was considered the most important reason for the diagnostic delay of RD. Practice guidelines or consensus and professional websites on rare diseases are urgently needed for emergency physicians. Conclusion The investigation shows poor knowledge of rare diseases among emergency physicians. Practice guidelines and professional websites on rare diseases were the primary urgent needs for emergency physicians. Specialized RD courses should also be added to medical education.
Background: To investigate the effects of the (1, 3)-β-D-glucan test (G test) to predict the outcomes of the patients with Pneumocystis pneumonia ( PCP ). Methods: The clinical data of PCP patients diagnosed from 2010 to 2018 in Peking Union Hospital collected. The imaging changes, the independent risk factors of death, changes of the G test and the patients’ outcomes were used as a receiver operating the characteristic (ROC) curves, and the area under the curve (AUC) calculated. Results: A total number of 104 patients enrolled in. The independent risk factors of death for PCP included pulmonary interstitial fibrosis (P=0.003), Cytomegalovirus co-infection (P=0.006), severe complication during treatment (P=0.001). The reduction of the G test was less than 9.13% of the initial G test (P=0.005), and the second imaging was not better than the first imaging (P=0.001). The efficiency of predicting the prognosis by the declined G test (AUC=0.740) is similar (P=0.893) to that of improving the imaging (AUC=0.731). The combination of the risk factors was the most effective predictor of the patients’ outcomes (AUC=0.938, CI 0.873 - 0.976, P < 0.001). Conclusion: The changes of G test can predict patient prognosis, and their efficiency is comparable to that of the changed imaging.
Community-acquiredKlebsiella pneumoniae (K. pneumoniae) central nervous system (CNS) infection combined with bacteremia was rarely identified world. We received a 55-year-old womanwho was under hormone therapy because of Sjogren's syndrome.The onset of this case was acute suppurative otitis,then she developed headache and unconscious, the cerebrospinal fluid (CSF) and imaging examinations were compatible with K. pneumoniae meningitis and suspicious brain abscesses, and K. pneumoniae bacteremia was also combined. Even with adequate antibiotic and supportive therapy, the patient’ relatives refused further assessment of intracranial lesions and took the patient back home, finally the patient died of no spontaneous breathing.Hormone therapy might be the risk factor of community-acquiredK. pneumoniaeinfection. Appropriate antibiotic application and infection focus drainage should be tried for treating this condition. The reason of patient’s death might be the CNS infection combined with K. pneumoniaebacteremia and the absence of intracranial lesion elimination. This case is reported in order to help us know this rare disease and promote a further progress on its pathogenesis and treatment.
Background: Over the past decades, Klebsiella pneumoniae (K. pneumoniae) infections have been increasing and affected immunocompromised patients nosocomially and communally, with extended-spectrum β-lactamase (ESBL) production becoming a major concern. Patients with rheumatic autoimmune diseases, mostly receiving immunosuppressive therapy, are vulnerable to various infections, including K. pneumoniae. However, few have investigated K. pneumoniae infections in this specific population. This study aimed to identify factors associated with ESBL production and mortality of K. pneumoniae pneumonia among patients with rheumatic autoimmune diseases in the Emergency Department. Methods: We retrospectively investigated patients with rheumatic diseases who were diagnosed with pneumonia, with K. pneumoniae isolated from their respiratory tract samples. Prognostic factors and risk factors for ESBL production were determined with univariate and multivariate logistic regression analysis. Empirical therapy and antimicrobial susceptibility data were also collected. Results: Of 477 K. pneumoniae pneumonia patients, 60 were enrolled into this study. The in-hospital mortality was 28.3%. Septic shock, ICU admission, the need for mechanical ventilation and change of antibiotics due to clinical deterioration, all related to mortality, were included as unfavorable clinical outcomes. Multivariate analysis suggested that ESBL production (OR, 6.793; p = 0.012), initial PCT≥0.5 ng/ml (OR, 5.024; p = 0.033) and respiratory failure at admission (OR, 4.401; p = 0.046) predicted increased mortality. ESBL production was significantly associated with dose of corticosteroids (OR, 1.031; p = 0.013) and CMV viremia (OR, 4.697; p = 0.043), instead of previous hospitalization and antibiotic use, in patients with rheumatic autoimmune diseases. The most commonly used empirical antibiotic was ceftazidime, while most isolates showed less resistance to carbapenems and amikacin in susceptibility testing. Conclusions: K. pneumoniae pneumonia could be life-threatening in patients with rheumatic autoimmune diseases. Our findings suggested that ESBL production, initial PCT≥0.5 ng/ml and respiratory failure at admission were independent factors associated with poor prognosis. Dose of corticosteroids and CMV viremia, predicting ESBL production in K. pneumoniae pneumonia, may help make individualized antibiotic decisions in clinical practice.
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