Validity of Diagnostic Evidence for Deceased Cases in Hospitals

Objective To determine the validity of the diagnostic evidence for deceased cases in hospitals. Methods All information collected from medical records of the deceased cases in tertiary care health facilities was input into ottr database. Four diagnosis levels were determined based on level of diagnostic evidence： level Ⅰ was based on autopsy, pathology or operative exploration, level Ⅱ on physical and laboratory tests plus expert clinical judgment, level Ⅲ on expert clinical judgment, level Ⅳ on postmortem assumptions. After the diagnostic evidence of each deceased case was reviewed by a panel of three experts, the diagnostic level of each diagnosis was determined. Results Among the 2102 medical cases for verbal autopsy study, only 26 （1.24%） afforded diagnostic evidence for level Ⅲ Among the level Ⅲ evidence-based cases of death, the major causes of death were cardiovascular diseases, respiratory diseases, and gastroenterological diseases. According to some special symptoms and medical histories, these cases could be diagnosed by comprehensive clinical judgment. Only one case met the criteria for level Ⅳ. Conclusion Level Ⅰ diagnostic evidence is hard to attain in China because of the traditional concept and economic restriction. The causes for 2101 deaths can be validated by level Ⅱ or Ⅲ diagnostic evidence.

Clinical features and prognosis of patients with novel coronavirus pneumonia complicated with diabetes

Objective:To analyze the clinical characteristics and laboratory examinations of patients with new coronavirus(COVID-19)and compare the effect and prognosis of patients with diabetes mellitus(DM)on COVID-19.Methods:56 cases of COVID-19 with DM and 85 age-matched admitted patients without DM who were admitted to the People's Hospital of Wuhan University from January 31,2020 to March 15,2020 were analyzed through a retrospective cohort study.Patients data were collected through electronic cases,and used SPSS 26.0 and Graphpad Prism 8.0 statistical software to compare changes in various indicators of patients in DM and non-DM groups and to draw the survival curves.Results:Compared with the non-DM group,the DM group has a higher percentage of mechanical ventilation,higher mortality and severe patients,with a higher proportion of initial symptoms of nausea and hypertension(P<0.05).There were no significant differences in the gender,initial symptoms(except nausea),the combined underlying diseases(except hypertension)between the two groups(P<0.05);The white blood cell,centroblast count,CRP,PCT,PT,D-dimer,total bilirubin,Urea,LDH,CK,MB,hs-TnI,CK-MB,NT-proBNP were higher in the DM group(P<0.05),and lymphocytes,single Nuclear cell,CD3,CD4,and CD8 counts were low(P<0.05).There was no statistically significant difference in platelet,IL-6,APTT,ALT,AST,Cr and CD19 counts between the two groups.Conclusion:Compared with COVID-19 patients with non-DM,COVID-19 patients with DM have a higher proportion of mortality and severe cases.Heart function,liver and kidney function,immune function damage and coagulation dysfunction are more obvious.Therefore,the monitoring of such patients should be strengthened,and active treatment should be performed to improve the prognosis.

Analysis of 54 cases of COVID-19

Objective:The clinical features and test results of 2019-nCoV pneumonia(COVID-19)were analyzed retrospectively in order to understand the diagnostic significance of clinical test index,and to summarize the experience of clinical treatment.Methods:From February 10thto February 28th,2020,54 patients with COVID-19 from Wuhan Red Cross hospital were included,whose clinical data were analyzed and integrated.The clinical manifestation and laboratory examination were analyzed by descriptive statistical analysis.Results:The average age of the patients was 63.9 years(40–84 years).The median time from onset to diagnosis was 6.5 days(2–20 days),and the median time from onset to first hospitalization was 8 days(3–20 days).The main manifestations were that the percentage of neutrophil increased and the number of lymphocyte decreased in most cases.Most of them were combined with liver damage and myocardial cell damage,and chest CT showed lesion of bilateral lung.Conclusion:In addition to the nucleic acid test of 2019-nCoV,some laboratory tests may indicate COVID-19 in the early stages.The clinician may conduct repeated follow-up examinations to assess the progress and outcome of the disease.

Early Imaging Features and Differential Diagnosis of Novel Coronavirus Pneumonia

Objective:To discuss the early imaging features of novel coronary pneumonia(NCP)and its differential diagnosis with common pneumonia for the clinical Provide relatively correct imaging diagnosis.Methods:A review of 10 cases of novel coronavirus pneumonia diagnosed in our hospital and surrounding counties was collected,and our hospital's 2019-2020 Common pneumonia such as influenza A and B virus pneumonia,lobar pneumonia and adenovirus confirmed by laboratory tests and abnormal chest radiographs Ten patients each with pneumonia,a total of 40 patients,were collected and their imaging features were analyzed.Results:In 10 patients with neo-coronary pneumonia,there were 30 lesions on chest CT,with typical characteristic lesions containing bronchograms within their Angiographic thickening;located in the subpleura,with grinding glass-like or combined solid changes,referred to as"extratubular halo",with multifocal and multifocal distribution.Morphology or unilobular large lamellar foci without lymph node enlargement and pleural effusion;10 cases of influenza A and B virus pneumonia in chest CT performance In nine patients,the lesions were distributed in the subpleural or along the perimeter of the bronchial vessels in the form of an analogous circular ground-glass shadow,some of which was a small piece of solid shadow,1 The case involved a single lobe of the lung and showed a large mixed ground glass image,and the CT in 10 cases of lobar pneumonia showed that they all had a single large solid lobe The variegated shadow or patchy cloud with blurred margins was triangularly altered with the tip pointing to the lung portal,and there were five cases of air-containing bronchograms.Adenoviral pneumonia is more common in infants and young children,and CT showed single or multiple grinded glass images in both lungs with patchy solid variegated shadows and lobar distribution.Conclusion:NCP and common pneumonia have certain imaging features that,in combination with laboratory tests and epidemiologic history,allow a preliminary diagnosis to be made.It has certain directions and help for clinical diagnosis.

Clinical Study on 136 Children with Sudden Sensorineural Hearing Loss

Background：The prevalence of sudden sensorineural hearing loss in children （CSSNHL） is consistently increasing.However,the pathology and prognosis of CSSNHL are still poorly understood.This retrospective study evaluated clinical characteristics and possible associated factors of CSSNHL.Methods：One hundred and thirty-six CSSNHL patients treated in Department of Otolaryngology-Head and Neck Surgery and Institute of Otolaryngology at Chinese PLA General Hospital between July 2008 and August 2015 were included in this study.These patients were analyzed for clinical characteristics,audiological characteristics,laboratory examinations,and prognostic factors.Results：Among the 136 patients （151 ears）,121 patients （121 ears,80.1%） were diagnosed with unilaterally CSSNHL,and 15 patients （30 ears,19.9%） with bilateral CSSNHL.The complete recovery rate of CSSNHL was 9.3%,and the overall recovery rate was 37.7%.We found that initial degree of hearing loss,onset of treatment,tinnitus,the ascending type audiogram,gender,side of hearing loss,the recorded auditory brainstem response （ABR）,and distortion product otoacoustic emissions （DPOAEs） had prognostic significance.Age,ear fullness,and vertigo had no significant correlation with recovery.Furthermore,the relevant blood tests showed 30.8% of the children had abnormal white blood cell （WBC） counts,22.1% had elevated homocysteine levels,65.8% had high alkaline phosphatase （ALP）,33.8% had high IgE antibody levels,and 86.1% had positive cytomegalovirus （CMV） IgG antibodies.Conclusions：CSSNHL commonly occurs unilaterally and results in severe hearing loss.Initial severe hearing loss and bilateral hearing loss are negative prognostic factors for hearing recovery,while positive prognostic factors include tinnitus,gender,the ascending type audiogram,early treatment,identifiable ABR waves,and DPOAEs.Age,vertigo,and ear fullness are not correlated with the recovery.Some serologic indicators,including the level of WBC,platelet,homocysteine,ALP,positive CMV IgG antibody,fibrinogen,and some immunologic indicators,are closely related to CSSNHL.