Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock

BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.

Inflammatory response in confirmed non-diabetic foot and ankle infections:A case series with normal inflammatory markers

BACKGROUND The distinction between foot and ankle wound healing complications as opposed to infection is crucial for the appropriate and efficacious allocation of antibiotic therapy.Multiple reports have focused on the diagnostic accuracy of different inflammatory markers,however,mainly in the diabetic population.AIM To evaluate the diagnostic accuracy of white cell count(WCC)and C-reactive protein(CRP)as diagnostic tools for this distinction in the non-diabetic cohort.METHODS Data was reviewed from a prospectively maintained Infectious Diseases Unit database of 216 patients admitted at Leicester University Hospitals–United Kingdom with musculoskeletal infections over the period between July 2014 and February 2020(68 mo).All patients with confirmed diagnosis of diabetes were excluded while only those with confirmed microbiological or clinical diagnosis of foot or ankle infection were included in our study.For the included patients,we retrospectively retrieved the inflammatory markers(WCCs and CRP)at the time of presentation.Values of CRP 0-10 mg/L and WCC 4.0-11.0×109/L were considered normal.RESULTS After exclusion of patients with confirmed diabetes,25 patients with confirmed foot or ankle infections were included.All infections were confirmed microbiolo-gically with positive intra-operative culture results.7(28%)patients with osteomyelitis(OM)of the foot,11(44%)with OM of the ankle,5(20%)with ankle septic arthritis and 2(8%)patients with post-surgical wound infection were identified.Previous bony surgery was identified in 13(52%)patients,either a corrective osteotomy or an open reduction and internal fixation for a foot or ankle fracture with the infection developing on top of the existing metalwork.21(84%)patients did have raised inflammatory markers while 4(16%)patients failed to mount an inflammatory response even with subsequent debridement and removal of metal work.CRP sensitivity was 84%,while WCC sensitivity was only 28%.CONCLUSION CRP has a relatively good sensitivity in the diagnosis of foot and ankle infections in non-diabetic patients,whereas WCC is a poor inflammatory marker in the detection of such cases.In presence of clinically high level of suspicion of foot or ankle infection,a normal CRP should not rule out the diagnosis of OM.

Blood Count Abnormalities Associated with Death in Patients Infected with SARS-COV-2 at the Ziguinchor EpidemicTreatment Center (ETC)

Introduction: SARS-COV-2 infection is a real public health challenge for the World Health Organization and for our country. It is responsible for numerous hematological abnormalities in infected patients. Objectives: To describe the haemogram abnormalities in patients infected with SARS-COV-2 and to determine which ones are associated with death. Material and Method: We conducted a retrospective, descriptive, analytical, cross-sectional study from March 2020 to September 2021. The study included all patients hospitalized with RT-PCR-confirmed COVID-19 who performed a blood count. We evaluated the blood count profile, the pathologies found and the associated blood count abnormalities. Results: A total of 263 patients were included. The mean age of the patients was 63.77 years (range 12 - 90 years). The male sex represented 54.75% (n = 144) while the female sex was 45.25% (n = 119) (sex ratio = 1.21). The most common pathologies were: diabetes: 30.03% (n = 79), high blood pressure: 41.04% (n = 108), and Chronic kidney disease: 7.98 (n = 21). The abnormalities of the haemogram found were essential: anaemia 28.13% (n = 121), hyperleukocytosis with neutrophilic predominance: 29.3% (126), lymphopenia: 34.41% (n = 148), thrombocytopenia: 8.16% (n = 35). The search for hematological factors associated with death in patients showed a significant difference between hyperleukocytosis (p = 0.000) and lymphopenia (p = 0.0001). Conclusion: SARS-COV-2 disease was a mortality factor when associated with lymphopenia and hyperleukocytosis in our series.

Research Progress of Combined Detection of WBC, CRP and SAA in Early Diagnosis of Respiratory Tract Infection in Children

Objective: To investigate the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. Methods: Collect the literature reports on the early diagnosis of respiratory tract infection in children by the combined detection of WBC, CRP and SAA in recent years, and follow up the relevant literature reports from the selection of “new three routine” laboratory items for rapid diagnosis in pediatric outpatient department and the application of the combined detection of WBC, CRP and SAA in the early diagnosis of respiratory tract infection in children. Results: Many literature studies found that the combined detection of WBC, CRP and SAA has important clinical significance in the early diagnosis of respiratory tract infection in children. Conclusion: Through reviewing the relevant literature, we can understand the application of WBC, CRP and SAA combined detection in the early diagnosis of respiratory tract infection in children. To provide more accurate and reliable laboratory data for the early diagnosis and treatment of respiratory tract infection in children in the future.

Progression of Platelet Counts in Treatment Naïve HIV/HCV Co-Infection

Background: Previous research has suggested an association between infection with hepatitis C virus (HCV) or with human immunodeficiency virus (HIV) and low platelet counts. This study estimates platelet count changes over time in HIV/HCV co-infected participants and compares them with the changes in platelet count among HIV mono-infected participants to test if HIV/HCV co-infection is associated with lower platelet counts. Methods: This retrospective cohort study included all HIV treatment naive patients from four sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort with platelet count measurements between 2002 and 2009. We conducted a mixed effects linear regression modeling the mean change in platelet count per year while adjusting for age, sex, race, baseline CD4 cell count, and site. Index date was the first platelet count after 2002, and participants were censored upon initiation of treatment for HIV or HCV. Results: There were 929 HIV/HCV co-infected and 3558 HIV mono-infected participants with a mean follow-up time of 1.2 years. HIV/HCV co-infected participants had on average a slighter lower platelet count at baseline (234,040 vs. 242,780/μL;p-value = 0.004), and a more rapid mean reduction per year (7230 vs. 3580/μL;p-value 0.001) after adjusting for age, sex, baseline CD4 count. Conclusions: In treatment naive participants, HIV/HCV co-infection is associated with a more rapid decline in platelet count compared with HIV mono-infection.

Helicobacter pylori infection in patients with autoimmune thrombocytopenic purpura

AIM:To compare the prevalence of Helicobacter pylori (Hpylon)infection in autoimmune thrombocytopenic purpura (AITP)patients with that of nonthrombocytopenic controls, and to evaluate the efficacy of the treatment in H pylori(+) and H pylor(-)AITP patients. METHODS:The prevalence of gastric H pylori infection in 38 adult AITP patients(29 female and 9 male;median age 27 years;range 18-39 years)who consecutively admitted to our clinic was investagated. RESULTS:H pylori infection was found in 26 of 38 AITP patients(68.5%).H pylori infection was found in 15 of 23 control subjects(65.2%).The difference in H pylori infection between the 2 groups was not significant.Thrombocyte count of H pylori-positive AITP patients was significantly lower than that of H pylori-negative AITP patients(P<0.05). Thrombocyte recovery of H pylori-positive group was less than that of H pylori-negative group(P<0.05). CONCLUSION:H pylori infection should be considerecd in the treatment of AITP patients with H pylori infection.

Does Haptoglobin Phenotype Impact Infection Mortality?

Introduction: The physiological status of a subject and the pathophysiology in some diseases might be under the influence of haptoglobin phenotype. The objective of this work was to determine the relationship between mortality from HIV/AIDS infection and haptoglobin phenotype in a black population in C&#244;te d’Ivoire. Methods: The study was conducted from a retrospective panel of 933 sera/plasma from the previous workup of the ANRS 12136 TEMPRANO trial at month 0 of patients in deferred-ART arms. For each subject, we determined the serum haptoglobin concentration, haptoglobin phenotype, and other variables from patient files from the TEMPRANO trial database. Statistical tests used were Chi-2, Fischer, and Kruskal-Wallis tests for non-gaussian distribution. We used the Kaplan-Meier method for survival analysis. Results: The distributions of the haptoglobin phenotypes were 32.3% for Hp 1-1, 39.5% for Hp 2-1 and 27.2% for Hp 2-2. The blood haptoglobin concentration seemed to be associated with haptoglobin phenotypes (p-value > 5%). The survival rate at M30 and for an extended follow-up up to 6 years was independent of haptoglobin phenotype (p-value > 5%). Besides, the haptoglobin phenotypes do not appear to be associated with CD4+ T-cell count and with hemoglobin concentration. Conclusion: Haptoglobin phenotype seems to not impact the mortality of HIV/AIDS infection. However, given the antioxidant and immunomodulatory properties of some haptoglobin phenotypes, it would be relevant to seek out possible confounding factors indirectly associated with haptoglobin phenotypes and clinical or biological infection variables.

CD4 T-Lymphocytes Count in HIV-<i>Toxoplasma gondii</i>Co-Infected Pregnant Women Undergoing a Prevention of Mother-to-Child Transmission Program

Toxoplasma gondii (T. gondii) is a parasite responsible of toxoplasmosis, a disease often asymptomatic but with serious consequences in pregnant women and immunocompromised subjects. Objective: This study aimed to investigate the impact of T. gondii infection on CD4+ T lymphocytes count in HIV-infected pregnant women. Methods: This was a cross-sectional study of pregnant women co-infected by HIV and T. gondii. The study was conducted from January to July 2016 at the Prevention of Mother-to-Child Transmission of HIV (PMTCT) sites in the Health District of Lacs in Togo. Diagnosis of HIV was performed by immuno-chromatographic methods with Determine TM HIV-1/2 and immuno-filtration with Tri-Dot HIV-1 and 2 kits. Presence of anti-toxoplasmic IgG and IgM antibodies was established via enzyme immunoassay using ELISA-BIOREX&reg;kit. Flow cytometry was used to count CD4+ T lymphocytes. Results: Our study found that of the 4599 pregnant women, 111 (2.41%) were HIV-positive. Among them, 109 (98.20%) were infected by HIV-1 and 2 (1.98%) by HIV-2. Antibodies against T. gondii were detected in 5.36% (IgM), 25% (IgG) and 3.57% (both IgM and IgG) of HIV 56 infected women. There was no significant difference between CD4 cell count in HIV (+)/T. gondii IgM (-)/IgG (-) infected pregnant women (378.8 ± 222.8 cell//μl) compared to HIV (+)/T. gondii/IgM (+) (457.3 ± 183.3 cell//μl), HIV (+)/T. gondii IgG (+) (419.4 ± 287.3 cell//μl) and HIV (+)/T. gondii IgM/IgG (+) (480.5 ± 252.4 cell/μl). Conclusion: This study showed that intracellular parasite T. gondii did not alter CD4+ T lymphocytes count in HIV/T. gondii co-infected pregnant women.

Evidence of Renal Damage in HIV-Infected Patients with High CD4 Counts Following the Use of Traditional Medicine

Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine;12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.

Hepatitis B Virus Co-Infection: Yet Another Reason for Early Initiation of Treatment in HIV Infected Individuals

Background: Hepatitis B virus (HBV) co-infection with HIV is becoming a major challenge due to shared routes of transmission. The burden is apparent in regions with widespread use of antiretroviral treatment, which led to the enhanced emergence of liver-related diseases and mortality. Though there are conflicting results about the effect of chronic HBV infection on response to highly active antiretroviral therapy (HAART) (CD4+ cell count and HIV viral load, HIV RNA copies/ml), HAART is known to cause immune mediated HBV specific liver damage after it reconstitutes cell-mediated immunity. The relationship of different HAART regimes with immune recovery is an area of research interest. Objective: It is in order to determine the changes in immune recovery during HBV infection in the setting of HAART among HIV positive individuals attending care and treatment services. Methods: Two cohorts of co-infected patients were analyzed from data of one to seven months retrospectively. The first group (n = 380) was antiretroviral drug naive and the second cohort (n = 380) was on HAART for the entire period. The study was conducted in one referral hospital and six health centers. Data were gathered from 760 patients using their intake form, their follow-up form and their medical records supplemented by data from a structured questionnaire. HBV infection was determined by using HBsAg rapid and confirmatory tests and CD4 cells were enumerated by using laboratory registers and patient cards. Bivariate and multivariate logistic regressions were done by using SPSS Version 18 and Epi info Version 3.5. Results: Poor immune recovery due to HBV infection was improved after initiation of HAART. Before the initiation of HAART, the mean CD4 cell count of HBV infected individuals was lower than that of non-HBV infected ones, 234/mm3 and 384/mm3, respectively (p 0.05). Individuals co-infected with HBV had experienced delayed recovery of immune cells (CD4 cell count). However, after, on average, more than two years of therapy, the association is reversed. In addition to HBV infection, CD4 cell count of patients on chronic HIV care/pre-ART was decreased by older age, living in rural areas and previous opportunistic infections. Conclusion: HBV infection has different outcomes between pre-ART and ART-initiated individuals. In the former cohort, HBV infection causes significant delays in immune recovery which is reversed after initiation of anti-HIV treatment. HBV co-infection has a significant and immediate negative effect on CD4 cell counts and immune recovery before HAART but such effects slowly subside after initiation of the treatment. As a result, HBV infection is another issue to consider for swift initiating of HAART for HIV infected individuals in long-term care.

Using Statistical Learning to Treat Missing Data: A Case of HIV/TB Co-Infection in Kenya

In this study, we investigate the effects of missing data when estimating HIV/TB co-infection. We revisit the concept of missing data and examine three available approaches for dealing with missingness. The main objective is to identify the best method for correcting missing data in TB/HIV Co-infection setting. We employ both empirical data analysis and extensive simulation study to examine the effects of missing data, the accuracy, sensitivity, specificity and train and test error for different approaches. The novelty of this work hinges on the use of modern statistical learning algorithm when treating missingness. In the empirical analysis, both HIV data and TB-HIV co-infection data imputations were performed, and the missing values were imputed using different approaches. In the simulation study, sets of 0% (Complete case), 10%, 30%, 50% and 80% of the data were drawn randomly and replaced with missing values. Results show complete cases only had a co-infection rate (95% Confidence Interval band) of 29% (25%, 33%), weighted method 27% (23%, 31%), likelihood-based approach 26% (24%, 28%) and multiple imputation approach 21% (20%, 22%). In conclusion, MI remains the best approach for dealing with missing data and failure to apply it, results to overestimation of HIV/TB co-infection rate by 8%.

Sustained heavy ethanol drinking affects CD4⁺cell counts in HIV-infected patients on stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) treatment regimen during 9 months follow-up period

Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.

Udder Health Status of First Parity Dairy Cows in Early-Lactation Based on Somatic Cell Count Categories

The main aim of this study was to investigate the prevalence of intramammary infection (IMI) in early-lactation of primiparous cows using milk recording cow composite somatic cell count (CSCC) categories (combining the first 2 milk recording results after calving). Another aim was to evaluate the milk urea (MU) content as a potential supplementary indicator to SCC or CSCC for the identification of IMI in primiparous cows after calving. This retrospective observational study was conducted on records of test-day of primiparous cows over a period of 6 years (January 2016 to December 2021. The SCC data for 158 Holstein Friesian primiparous cows, with their first milk recording 5 to 35 days after calving and their second milk recording 28 to 56 days in milk (DIM), were identified. Each primiparous cow was assigned a CSCC category (low-low, low-high, high-low or high-high) based on the CSCC at the first 2 milking recordings using the following cut-offs: ≤150,000 cells/ml (low), >150,000 cells/ml (high). The association between CSCC categories and MV content was analyzed using correlation models. At the first milk recording, a proportion of 63.29% was in the low SCC category, and the rest (36.71%) was in the high SCC category. At the second milk recording, a proportion of primiparous cows in CSCC categories was 59.49%, 3.80%, 27.85% and 8.86% in low-low, low-high, high-low and high-high, respectively. At the second milk recording, a proportion of 12.66% of primiparous cows was in the high CSCC category and a proportion of 87.34% of primiparous cows was in the low CSCC category, indicating a poor and a good udder health, respectively. The association of SCC with MU content in low and in high SCC categories at the first milk recording was positive and moderate (+0.49) and negative and strong (-0.97), respectively. The association of CSCC categories with MU contents at the second milk recording was inconclusive. We concluded that CSCC categories may be a useful tool for identifying success and problems regarding the udder health of primiparous cows in early lactation.

红细胞分布宽度与血小板分布宽度可以辅助预测流感合并下呼吸道感染患者预后

目的探讨血细胞计数及相关参数是否可以预测流感合并下呼吸道感染患者的预后。方法回顾性研究2013年至2023年首都医科大学附属北京朝阳医院经急诊医学科、发热门诊或呼吸科收治入院或留观的流感合并下呼吸道感染患者,以28天死亡为研究终点,分为生存组和死亡组,比较分析两组间血细胞计数及相关参数的差异,回归分析死亡的独立预测因素,建模并对模型进行评价。结果此项研究最终纳入417例患者,28天生存组361例(86.6%),死亡组56例(13.4%)。死亡组淋巴细胞计数和血小板计数显著低于生存组,红细胞分布宽度、血小板分布宽度、血小板平均体积及大血小板比率显著高于生存组(P<0.05)。多变量Logistic回归分析筛选独立相关变量,当淋巴细胞计数≤0.68×10^(9)/L,或血小板计数≤147×10^(9)/L,或红细胞分布宽度>12.7%,或血小板分布宽度>13.9 fL时,患者28天死亡风险增加,四个指标建立预测模型的AUC为0.734(95%CI 0.664~0.804),敏感度58.9%,特异度80.4%,阳性预测值32.0%,阴性预测值92.7%,阳性似然比3.01,阴性似然比0.51。模型的一致性指数为0.735,拟合优度Hosmer-Lemeshow检验显示拟合效果较好(P=0.406)。结论淋巴细胞计数、血小板计数、红细胞分布宽度、血小板分布宽度可作为早期预测流感合并下呼吸道感染患者28天死亡风险的指标,以这些指标构建的列线图模型可计算临床实测值所对应的死亡风险概率。

细菌性肺炎患者血清LTB4、NLCR及CRP/PA变化及其与肺损伤程度的关系

目的探讨细菌性肺炎患者血清白三烯B4(LTB4)、中性粒细胞/淋巴细胞计数比值(NLCR)及C-反应蛋白与前白蛋白(CRP/PA)比值变化及其与肺损伤程度的关系。方法回顾性选取172例细菌性肺炎患者(观察组)和同期140例健康体检者(对照组)的临床资料,根据肺损伤程度,将患者分为轻中度组和重度组。比较各组LTB4、NLCR及CRP/PA水平,分析LTB4、NLCR及CRP/PA联合评估患者肺损伤程度的价值。结果与对照组比较,观察组LTB4、NLCR及CRP/PA水平更高(P<0.05);与轻中度组比较,重度组LTB4、NLCR及CRP/PA水平更高(P<0.05);ROC结果显示,LTB4、NLCR和CRP/PA评估患者肺损伤程度的AUC为0.793、0.717、0.758,三者联合评估患者肺损伤程度的AUC为0.933,高于单项评估(P<0.05)。结论LTB4、NLCR及CRP/PA在细菌性肺炎患者中表达水平均会升高,且其均与肺损伤程度有关,其联合评估肺损伤程度的价值较高。

NEUT、ESR、Gal-3水平与感染性心内膜炎患者临床预后的关系

目的探讨中性粒细胞计数(neutrophil count,NEUT)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、半乳糖凝集素-3(galectin-3,Gal-3)水平与感染性心内膜炎(infective endocarditis,IE)患者临床预后的关系。方法选取2021年2月至2023年4月商洛市中心医院收治的88例IE患者,其中男49例,女39例,平均年龄46.20岁,心功能分级Ⅱ~Ⅲ级54例、Ⅳ级34例。随访1年,根据预后结果,将患者分为预后良好组(54例)和预后不良组(34例)。单因素分析患者的临床资料和实验室指标等,然后通过多因素logistic回归分析IE患者预后不良的危险因素。受试者操作特征曲线(ROC)评估NEUT、ESR和Gal-3水平对IE患者预后不良的预测能力。采用t检验、χ^(2)检验。结果预后不良组与预后良好组心功能分级、Pitt评分、治疗前NEUT水平、治疗2周后NEUT、ESR和Gal-3水平比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,心功能分级为Ⅳ级、Pitt评分≥2分及治疗2周后高NEUT、ESR和Gal-3水平是IE患者预后不良的独立危险因素(均P<0.05)。治疗2周后NEUT、ESR和Gal-3水平及三者联合预测IE患者预后不良的曲线下面积(AUC)分别为0.912、0.949、0.905和0.985。结论NEUT、ESR、Gal-3水平在IE患者中具有重要的临床预测价值。高水平的NEUT、ESR和Gal-3与IE患者的不良预后密切相关,可以作为独立的不良预后风险因素,能够为临床提供更精准的风险评估和治疗决策支持。

新发HIV/AIDS患者抑郁心理干预效果及其与CD_(4)^(+)T细胞计数的关系研究

背景HIV/AIDS与抑郁症相关,抑郁症加大HIV相关认知紊乱(HAND)风险,并降低患者抗逆转录病毒治疗(ART)依从性,加剧HIV传播风险。国内研究较少报道新发HIV/AIDS患者(PLWHA)抑郁心理干预效果及与CD_(4)^(+)T细胞计数相关性。目的探究新发PLWHA抑郁心理干预效果及与CD_(4)^(+)T细胞计数相关性,为AIDS临床诊疗提供参考。方法2020年4月—2022年6月采用方便取样方法在江西省ART定点医院抽取新发PLWHA抑郁患者,患者确诊后立即启动ART及心理干预,干预总周期为12周。在干预前后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)进行评估,并检测CD_(4)^(+)T细胞计数进行分析。结果共纳入新发PLWHA抑郁患者200例,有效随访178例,有效率为89.0%。178例PLWHA抑郁患者轻中度88例(49.4%)、重度90例(50.6%),伴焦虑者173例(97.2%)。患者CD_(4)^(+)T细胞计数均值在干预前为(346.39±156.87)个/μL,干预后为(421.93±149.61)个/μL。干预后,新发PLWHA抑郁患者CD_(4)^(+)T细胞计数高于干预前(t_(配对)=10.971,P<0.05),HAMD、HAMA总分及各因子评分均低于干预前(P<0.05)。干预前,HAMD总分与CD_(4)^(+)T细胞计数分级(以500个/μL为分界值)呈负相关(r_(s)=-0.157,P=0.036)、与HAMA总分呈正相关(r_(s)=0.764,P<0.001)。干预后,HAMD总分与干预后CD_(4)^(+)T细胞计数呈负相关(r_(s)=-0.150,P=0.046)、与HAMA总分呈强正相关(r_(s)=0.939,P<0.001)。干预前,新发PLWHA抑郁患者CD_(4)^(+)T细胞计数<500个/μL者HAMD、HAMA总分高于CD_(4)^(+)T细胞计数≥500个/μL者(P<0.05)。结论新发PLWHA抑郁严重程度与CD_(4)^(+)T细胞计数相关,经专业心理干预能显著改善。

不同生物标志物在儿童尿路感染诊断中的应用价值

尿路感染(urinary tract infection,UTI)是一种在社区和医院中普遍存在的感染性疾病。虽然美国儿科学会制定了UTI的评估、治疗和管理指南,但UTI的诊断和管理对临床医师来说仍然具有挑战性。如果治疗不及时,UTI可能会沿输尿管上行至肾脏,甚至进入血液,最终导致脓毒症、肾脏损害,甚至死亡。因此,确保诊断的准确性和治疗的及时性至关重要。尽管尿培养是诊断UTI的金标准,但其耗时较长。近年来,尿路感染生物标志物的研究受到了广泛关注,如白细胞计数、白细胞酯酶、中性粒细胞明胶酶相关脂质运载蛋白、尿髓过氧化物酶/肌酐比值等。本综述将探讨不同生物标志物在UTI诊断中的应用价值,旨在促进早期诊断和治疗,减少不良预后的发生。

淋巴细胞计数及百分比预测膝关节置换术后早期感染的价值

目的:探讨术后淋巴细胞计数及百分比预测全膝关节置换术(TKA)术后早期感染的临床应用价值。方法:回顾性分析2018年12月~2022年12月福建医科大学附属第二医院行TKA治疗的345例患者的临床资料,分为感染组(n=27)与未感染组(n=318),记录并比较两组患者年龄、性别、体重指数(BMI)、手术时间、术中出血量、手术前后血红蛋白差值及各项实验室资料[术前和术后第1天、第4天C反应蛋白(CRP)、红细胞沉降率(ESR)水平、白细胞计数、中性粒细胞和淋巴细胞计数及百分比]。使用SPSS统计学软件处理数据,选取两组样本具有统计学差异的指标后,使用Pearson相关系数进行相关性检验,最后,使用Stata软件做受试者工作特征(ROC)曲线下面积(AUC)、95%CI及P值,并得出所选标志物的诊断临界值及其敏感性、特异性。结果:两组手术年龄、性别、BMI、手术时间、术中出血量、术前术后血红蛋白差值及术前的实验室标志物结果比较差异均无统计学意义(均P>0.05)。两组术后4 d CRP水平、中性粒细胞计数及百分比、术后1 d和4 d的淋巴细胞计数及其百分比比较,差异均有统计学意义(P<0.05)。Pearsons相关性检验发现未感染组中与手术因素(手术时间、术中出血量)均无关的标志物为术后4 d淋巴细胞计数及百分比。本研究采用Stata软件做ROC曲线来得出TKA术后早期感染的术后4 d淋巴细胞百分比及其计数的合适的诊断临界值。术后4 d淋巴细胞百分比的ROC曲线下面积AUC为0.755[95%CI(0.528,0.918),P=0.28],根据Youden指数计算淋巴细胞百分比的最佳预测临界值为<20.0%,利用预测临界值进行诊断试验,此时的敏感性为91.67%,特异性为55.56%;术后4 d淋巴细胞计数的ROC曲线下的面积AUC为0.833[95%CI(0.637,0.970),P=0.28],根据Youden指数计算淋巴细胞计数的最佳预测临界值为<1500/μL。利用预测临界值进行诊断试验,此时的敏感性为91.67%,特异性为66.67%。结论:术后4 d淋巴细胞百分比和淋巴计数是预测TKA术后早期感染的可靠标志。因其具有较高的敏感性,可以早期提示TKA术后感染。

细菌性肺炎患儿外周血细胞计数、形态学检查及其与感染程度的相关性分析

目的 探究细菌性肺炎患儿外周血细胞计数、形态学检查及其与感染程度的相关性。方法 选取2021年1月~2021年12月邯郸市第一医院100例细菌性肺炎患儿作为观察组,另选取同期病毒性肺炎患儿100例作为对照组。比较两组外周血细胞及常规感染指标,评价外周血细胞及常规感染指标对细菌性肺炎的鉴别诊断价值;比较不同感染程度患儿外周血细胞及常规感染指标,分析外周血细胞及常规感染指标与感染程度的相关性,并分析不同感染程度患儿外周血细胞与常规感染指标的相关性,评价外周血细胞及常规感染指标对细菌性肺炎感染加重风险的影响。结果 观察组C-反应蛋白(CRP)[(15.89±3.12)mg/L vs(6.74±1.63)mg/L]、降钙素原(PCT)[(6.28±1.32)μg/L vs(0.92±0.21)μg/L]、白细胞计数(WBC)[(13.27±3.65)×10^(9)/L vs(6.58±1.23)×10^(9)/L]、核左移[(32.54±8.07)个vs(10.23±2.75)个]及中性粒细胞中毒颗粒分级[3(2,4)vs 0(0,1)]均高于对照组(P<0.05);CRP、PCT、WBC、核左移、中性粒细胞中毒颗粒分级鉴别诊断细菌性肺炎的AUC值均在0.7以上,联合诊断AUC值为0.928,明显高于各指标单独诊断AUC值(P均<0.05);细菌性肺炎患儿CRP、PCT、WBC、核左移、中性粒细胞中毒颗粒分级与感染程度呈正相关(P<0.05);轻度、中度及重度细菌性肺炎患儿CRP、PCT均与WBC、核左移、中性粒细胞中毒颗粒分级呈正相关(P<0.05);当CRP、PCT、WBC、核左移、中性粒细胞中毒颗粒分级比例处于高水平时,细菌性肺炎患儿感染加重的相对危险度增加,分别是2.438(95%CI:1.586~3.747)、2.056(95%CI:1.372~3.080)、1.895(95%CI:1.278~2.810)、2.667(95%CI:1.708~4.163)、3.231(95%CI:1.993~5.237)。结论 外周血细胞形态检查作为感染性疾病诊断指标,联合CRP、PCT、WBC对肺炎感染类型,特别是细菌性肺炎早期鉴别诊断效能较高,且与感染程度密切相关。外周血细胞形态检查联合常规感染监测指标诊断可弥补单项指标诊断不足,有效提高诊断效能,为临床治疗工作提供参考。