Crimean-Congo hemorrhagic fever: etiology, diagnosis, management and potential alternative therapy

Crimean-Congo hemorrhagic fever(CCHF)virus belongs to the genus Nairovirus and family Bunyaviridae.CCHF is a tickborne disease that has mostly been reported from Asia,Africa and Europe.Early diagnosis of CCHF is essential for patient care and preventing its spread to normal individuals.Treatment of CCHF is mostly limited to the use of ribavirin and palliative care.The practice of using interferon and vaccines has also been proved to be ineffective and unsafe.A search for an effective alternative treatment of the CCHF still continues.Therefore,the current review focusses on the cause,prevalence,mode of transmission,pathophysiology,signs,symptoms,diagnostic features and treatment options of CCHF.This review also highlights the possible alternative therapy in the form of antiviral medicinal plants which are effective against viral hemorrhagic fever.These medicinal plants have shown convincing evidence for their activities against different viral hemorrhagic fevers and may be used alone or in combination with existing therapies to achieve an optimum therapeutic response.

A Retrospective Study of Continuous Renal Therapy and Anticoagulation in Patients with Hemorrhagic Fever with Renal Syndrome

Objective To observe the application of continuous renal replacement therapy(CRRT) and heparin anticoagulation in patients with HFRS, and to explore a more suitable anticoagulant strategy. Methods Eighty-five severe-type patients(severe group) and 71 critical-type patients(critical group) were enrolled in this study. The frequency of CRRT was compared between the two groups; the frequency of CRRT treated with and without heparin anticoagulation and the frequency of hemorrhage and channel blood clotting induced by the two anticoagulant strategies were observed. Results The frequency of CRRT in the critical group was higher than that in the severe group(P < 0.001). The frequency of CRRT initiated during the overlapping phases in the critical group was significantly higher than that of the severe group(P = 0.032). The total times of CRRT was 103, and 70 of them were treated with heparin anticoagulation. The frequencies of hemorrhage induced by heparin anticoagulation and no heparinization were 16 and 0, respectively, and the frequencies of channel blood clotting were 2 and 4, respectively. Conclusions CRRT has been used extensively in the critical-type patients with HFRS. The heparin anticoagulation and no anticoagulant strategies should be used more rationally in patients treated with CRRT, according to the clinical characteristics of the disease.

The Risk of Severe Acute Kidney Injury Requiring Renal Replacement Therapy in Viral Hemorrhagic Fevers. A Review of Literature

Objective: It demonstrates the correlation of the viral hemorrhagic fever with kidney failure and the treatment as well as the outcome. Method: A PubMed search of the English literature from 1999 to 2019 was performed using “viral hemorrhagic fever, Case Report, Renal Failure” as the subject. The inclusion criteria were the following: 1) case report and case series of two or more patients;2) the report detailed the clinical presentation and reported the status of the renal system;3) the report described the management of renal failure if any;and 4) the etiology of the infection is known and is one of the known agents of viral hemorrhagic fever, listed on the centers of disease control website. We excluded infections related to vaccination related to viral hemorrhagic fever. Result: We found the mean age of these patients was 41.5. The male to female ratio was about 3.5:1. Dengue and Hantaviruses constituted 70.5% of patients. The overall mortality of the study cohort was 32.2%. Half of the patients had acute kidney injury and required renal replacement therapy. The chi-square statistic is 0.41;The p-value is 0.51;The chi-square statistic is 6.4254. Overall mortality was 32.3% in one cohort of 78 patients. The illness goes through several stages [1] [2] of clinical features and some viruses in the group have a high case fatality rate. Conclusions: Early diagnosis with aggressive supportive care is critical for improving clinical outcomes. Renal involvement is common. Amongst the cohort reviewed, of patients who had acute kidney injury, half of the patients required renal replacement support. However, some viruses cause greater kidney injury than others, for instance, kidney injury is more severe in Dengue hemorrhagic fevers when compared to Hantaviruses. Simultaneous management of public health by prevention and control of outbreaks is particularly important.

采用自配碳酸氢盐置换液行CRRT治疗流行性出血热合并急性肾功能衰竭1例回顾性分析

目的总结1例流行性出血热(EHF)合并急性肾功能衰竭(ARF)患者采用自配碳酸氢盐置换液行连续性肾脏替代治疗(CRRT)的经验,以期为同类病例的治疗提供参考。方法对2021年4月兰州大学第一医院东岗院区综合内科收治的1例EHF合并ARF患者行内科综合治疗,同时采用自配碳酸氢盐置换液行CRRT,依据动态监测血气分析、电解质、肾功能及凝血指标水平调整自配置换液配方及抗凝剂剂量。结果患者住院治疗14 d出院,出院后30 d复查随访,各项指标均恢复正常。结论在内科综合治疗的同时及时采用自配碳酸氢盐置换液行CRRT是治疗EHF合并ARF的有效方法。

无抽搐电休克治疗发热原因分析

无抽搐电休克治疗(MECT)作为治疗难治性重性抑郁、双相情感障碍和难治性精神分裂症等精神疾病的首选方法,然而,它常导致不良反应的发生。其中电休克治疗(ECT)相关的发热很少被提及,但临床上MECT发热的现象却时常出现,本文就MECT发热的原因进行分析,旨在了解发热的相关原因,针对性的采取治疗措施。

中医治疗新型冠状病毒肺炎发热案例3则

发热是新型冠状病毒肺炎(简称“新冠肺炎”)常见症状,中医辨证施治,收效甚佳。兹掇验案3则,表而出之。案例1中年女性,新冠肺炎患者,反复高热,治以宣肺清热、痰通腑,1剂显效,间断调治,预后良好。案例2老年妇人,新冠肺炎患者,年老体弱,担忧恐惧,低热缠绵,予清透邪热、辟秽化浊调治,症状显著好转,避免了向重症转化。案例3高龄产妇,新冠肺炎患者,热势不退,予宣肺清热、化痰凉血、健脾安胎之治,紧扣病机,化裁古方,收效甚捷。

外敷冰硝散联合口服清胰汤治疗急性胰腺炎临床观察

目的观察冰硝散外敷加清胰汤口服联合常规西药治疗急性胰腺炎的临床疗效。方法将文山州中医医院2020年1月—2022年1月收治的63例急性胰腺炎患者按照随机数字表法分为对照组(31例)和试验组(32例)。对照组给予常规西药治疗,试验组在对照组治疗的基础上加用冰硝散外敷联合清胰汤口服治疗。比较治疗前后2组患者的中医证候积分、通便时间、肠道功能评分及临床疗效。结果治疗后,试验组中医证候积分、通便时间及胃肠道功能评分均低于对照组(P<0.05),总有效率高于对照组(P<0.05)。结论冰硝散外敷加清胰汤口服联合常规西药治疗急性胰腺炎,能改善患者胃肠道功能、中医证候学积分,疗效显著。

血必净注射液联合连续性肾替代疗法、白蛋白治疗肾综合征出血热的效果及对炎性因子、相关蛋白表达的影响

目的 探讨血必净注射液联合连续性肾替代疗法、白蛋白治疗肾综合征出血热的效果。方法 选取2022年1月至5月收治的50例肾综合征出血热患者为研究对象,根据随机数字表法将其分为对照组和观察组,各25例。对照组采用连续性肾替代疗法、白蛋白治疗,观察组在对照组基础上联合血必净注射液治疗。比较两组的治疗效果。结果 观察组的治疗总有效率高于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的CD61、热休克蛋白70(HSP70)低于对照组,差异具有统计学意义(P<0.05)。结论 血必净注射液联合连续性肾替代疗法、白蛋白治疗肾综合征出血热的效果显著,可改善炎性因子水平,下调CD61、HSP70表达,值得推广及应用。

用TCD周疗方案对瘤负荷较高的多发性骨髓瘤患者进行治疗的效果观察

目的:观察用沙利度胺联合环磷酰胺与地塞米松(即TCD周疗方案)对瘤负荷较高的多发性骨髓瘤患者进行治疗的临床效果。方法:将2015年至2017年期间在乐山市人民医院肿瘤血液科接受治疗的20例瘤负荷较高的多发性骨髓瘤患者作为TCD组,用TCD周疗方案对其进行治疗。将2013年至2015年期间在该医院接受治疗的23例该病患者作为TD组,用沙利度胺联合地塞米松(即TD方案)对其进行治疗。治疗结束后,对比两组患者治疗的效果、骨痛缓解的情况和不良反应的发生情况。结果:在治疗1个周期后,与TD组患者相比,TCD组患者骨痛的完全缓解率较高,其骨痛缓解的平均时间较短,P<0.05。TCD组患者病情的缓解率明显高于TD组患者,P<0.05。在接受治疗期间,两组患者均未发生感染或死亡,也未出现IV级的血液学毒性反应。两组患者不良反应的发生率相比,P>0.05。结论:用TCD周疗方案对瘤负荷较高的多发性骨髓瘤患者进行治疗可明显减轻其骨痛的程度,降低其不良反应的发生率,提高其治疗的效果。

亚低温治疗联合护理干预在重症监护病房危重症高热患者中的应用

目的 探究对重症监护室危重症高热患者使用亚低温治疗联合护理干预的应用效果。方法 选取2021年3月至2023年6月河南省人民医院收入的62例重症监护室危重症高热患者,按随机数字表法分组。对照组31例患者使用护理干预,研究组31例患者使用亚低温治疗联合护理干预,将两组患者降温效果、神经功能评分、预后情况、颅内压变化情况进行比较。结果 研究组降温有效率(19.35%)明显高于对照组(96.77%),差异有统计学意义(P <0.05)。护理前,两组神经功能评分差异无统计学意义(P> 0.05);护理后,研究组神经功能评分低于对照组,差异有统计学意义(P <0.05)。护理前,两组患者格拉斯哥昏迷评分(GCS)差异无统计学意义(P> 0.05);护理1个月、2个月、3个月后,研究组格拉斯哥昏迷评分明显高于对照组,差异有统计学意义(P <0.05)。护理前,两组颅内压变化比较差异无统计学意义(P> 0.05);护理后,研究组诱导期3 h、维持期9 h、复温期22 h的颅内压数值低于对照组,差异有统计学意义(P <0.05)。结论 亚低温治疗联合护理干预在重症监护病房危重症高热患者中具有重要作用,可以有效改善患者降温效果,降低颅内压,减轻脑水肿,提高生存率,值得应用。

TCD在大脑中动脉闭塞静脉溶栓治疗中的应用

目的:探讨TCD在大脑中动脉闭塞静脉溶栓治疗中的作用。方法:把15例急性大脑中动脉血栓形成患者随机分成治疗组(8例)和对照组(7例),治疗组给予rt-PA静脉溶栓的同时开始低强度TCD监测并且持续2h,对照组单用rt-PA,接受安慰剂检测。2组治疗后评价临床疗效。结果:治疗组临床疗效、血管再通率及出血并发症与对照组相比有显著性差异(p(0.05)。结论:超声能促进溶栓,而持续性TCD检测,它能增加rt-PA诱导动脉再通而不会增加出血风险。

头穴与项穴丛刺治疗脑供血不足性眩晕TCD即时效应对比研究

目的比较头穴丛刺和项穴丛刺对脑供血不足性眩晕患者脑血流即时效应的影响。方法将57例脑供血不足性眩晕患者随机分成治疗组29例和对照组28例。治疗组采用头穴丛刺治疗,对照组采用项穴丛刺治疗。观察两组治疗前后经颅多普勒(transeranial doppler,TCD)所示大脑中动脉(MCA)、颈内动脉(ICA)、基底动脉(BA)、小脑后下动脉(PINCA)、椎动脉(VA)的收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)变化。结果治疗组治疗后各血管(MCA、ICA、BA、PINCA、VA)血流速度(Vs、Vd、Vm)与同组治疗前比较,差异均具有统计学意义(P<0.01,P<0.05)。对照组治疗后MCA、ICA、VA及PINCA血流速度与同组治疗前比较,差异均具有统计学意义(P<0.01)。对照组治疗后BA的Vs与Vm与同组治疗前比较,差异均具有统计学意义(P<0.05)。治疗组治疗后各血管血流速度与对照组比较,差异均无统计学意义(P>0.05)。结论头穴丛刺和项穴丛刺均能即时改善患者大脑各低流速血管的Vs、Vd、Vm,两种刺法对各血管Vs、Vd、Vm改善程度相近。

A Diagnostic Tool for Identification of Etiologies of Fever of Unknown Origin in Adult Patients

The diagnosis and treatment of fever of unknown origin (FUO) are huge challenges to clinicians.Separating the etiologies of FUO into infectious and non-infectious disease is conducive to clinical physicians not only on making decisions rapidly concerning the prescription of suitable antibiotics but also on further analysis of the final diagnosis.In order to develop and validate a diagnostic tool to efficiently distinguish the etiologies of adult FUO patients as infectious or non-infectious disease,FUO patients from the departments of infectious disease and internal medicine in three Chinese tertiary hospitals were enrolled retrospectively and prospectively.By using polynomial logistic regression analysis,the diagnostic formula and the associated scoring system were developed.The variables included in this diagnostic formula were from clinical evaluations and common laboratory examinations.The proposed tool could discriminate infectious and noninfectious causes of FUO with an area under receiver operating characteristic curve (AUC) of 0.83,sensitivity of 0.80 and specificity of 0.75.This diagnosis tool could predict the infectious and non-infectious causes of FUO in the validation cohort with an AUC of 0.79,sensitivity of 0.79 and specificity of 0.70.The results suggested that this diagnostic tool could be a reliable tool to discriminate between infectious and non-infectious causes of FUO.

Establishment of a Predictive Model Related to Pathogen Invasion for Infectious Diseases and Its Diagnostic Value in Fever of Unknown Origin

The present study aimed to establish a list of parameters indicative of pathogen invasion and develop a predictive model to distinguish the etiologies of fever of unknown origin (FUO) into infectious and non-infectious causes.From January 2014 to September 2017,431 patients with FUO were prospectively enrolled in the study population.This study established a list of 26 variables from the following 4aspects:host factors,epidemiological factors,behavioral factors,and iatrogenic factors.Predefined predicted variables were included in a multivariate logistic regression analysis to develop a predictive model.The predictive model and the corresponding scoring system were developed using data from the confirmed diagnoses and 9 variables were eventually identified.These factors were incorporated into the predictive model.This model discriminated between infectious and non-infectious causes of FUO with an AUC of 0.72,sensitivity of 0.71, and specificity of 0.63.The predictive model and corresponding scoring system based on factors concerning pathogen invasion appear to be reliable screening tools to discriminate between infectious and non-infectious causes of FUO.

Neither hereditary periodic fever nor periodic fever, aphthae, pharingitis, adenitis: Undifferentiated periodic fever in a tertiary pediatric center

AIM To describe the frequency and clinical characteristics of patients with undifferentiated periodic fever(UPF) and to investigate whether a clinical classification of UPF based on the PRINTO-Eurofever score can help predicting the response to treatment and the outcome at follow-up.METHODS Clinical and therapeutic information of patients with recurrent fever who presented at a single pediatric rheumatology center from January 2006 through April 2016 were retrospectively collected. Patients with a clinical suspicion of hereditary periodic fever(HPF) syndrome and patients with clinical picture of periodic fever, aphthae, pharingitis, adenitis(PFAPA) who were refractory to tonsillectomy underwent molecular analysis of five HPF-related genes: MEFV(NM_000243.2), MVK(NM_000431.3), TNFRSF1 A(NM_001065.3), NLRP3(NM_001079821.2), NLRP12(NM_001277126.1). All patients who had a negative genetic result were defined as UPF and further investigated. PRINTO-Eurofever score for clinical diagnosis of HPF was calculated in all cases. RESULTS Of the 221 patients evaluated for periodic fever, twelve subjects with a clinical picture of PFAPA who were refractory to tonsillectomy and 22 subjects with a clinical suspicion of HPF underwent genetic analysis. Twenty-three patients(10.4%) resulted negative and were classified as UPF. The median age at presentation of patients with UPF was 9.5 mo(IQR 4-24). Patients with UPF had a higher frequency of aphthae(52.2% vs 0%, P = 0.0026) and musculoskeletal pain(65.2% vs 18.2%, P = 0.0255) than patients with genetic confirmed HPF. Also, patients with UPF had a higher frequency of aphthous stomatitis(52.2% vs 10.7%, P < 0.0001), musculoskeletal pain(65.2% vs 8,0%, P < 0.0001), and abdominal pain(52.2% vs 4.8%, P < 0.0001) and a lower frequency of pharyngitis(56.6% vs 81.3%, P = 0.0127) compared with typical PFAPA in the same cohort. Twenty-one of 23 patients with UPF(91.3%) received steroids, being effective in 16; 13(56.2%) were given colchicine, which was effective in 6. Symptoms resolution occurred in 2 patients with UPF at last follow-up. Classification according to the PRINTOEurofever score did not correlate with treatment response and prognosis. CONCLUSION UPF is not a rare diagnosis among patients with periodic fever. Clinical presentation place UPF half way on a clinical spectrum between PFAPA and HPF. The PRINTOEurofever score is not useful to predict clinical outcome and treatment response in these patients.

TCD对椎动脉型颈椎病针刺疗效的评估

目的 :对椎动脉型颈椎病针刺疗效作出客观、科学、量化的评估。方法 :70例患者随机分为治疗组42例 ,对照组28例 ,治疗组每天针刺1次 ,10天为一疗程 ,共1～3个疗程 ;对照组在未经治疗一个月后 ,用TCD检测椎基底动脉MV(平均血流速度 )的改善情况。结果 :治疗组MV明显改善 ,P<0 01 ;对照组MV无改善 ,P>0 05。结论 :针刺疗法能明显改善椎基底动脉血供 ,TCD是一种科学。

基于数据挖掘的刺络放血疗法治疗外感发热的选穴规律研究

目的:探究基于数据挖掘的刺络放血疗法治疗外感发热的选穴规律。方法:2019年7月至2019年12月采用Excel 2019建立刺络放血数据仓库模型,随后下载、筛选已建数据库中刺络放血疗法治疗外感发热的文献资料,以及所需信息的录入,借助建立的刺络放血数据库平台,对其进行数据挖掘。结果:纳入刺络放血疗法治疗外感发热的文献共计63篇,其中刺络放血针具三棱针使用频次最高,刺络放血刺法使用频次最高的为点刺;刺络放血治疗未配合拔罐的研究占比80%;采用刺络放血配合疗法的有46项,占比73%,其中以拔罐使用频次最高。结论:刺络放血疗法治疗外感发热以三棱针点刺治疗为主,且部分研究常配合其他疗法以明显提升治疗效果,但配合拔罐治疗临床应用较少。

Protective mechanisms of Tuina therapy against lipopolysaccharide-induced fever in young rabbits based on untargeted metabolomics analysis

OBJECTIVE:To investigate the effect of Tuina on the plasma metabolites of lipopolysaccharide-induced febrile in infant rabbits.METHODS:Twenty-four infant New Zealand rabbits were selected and randomly divided into three groups:saline,model,and Tuina.The fever model was established by injecting LPS intravenously through the ear margin vein in the model group and Tuina group,respectively.The modeling was considered successful when the anal temperature increased by 0.5℃or above within 1 h.In the Tuina group,six Tuina techniques(i.e.,opening Tianmen/the heaven gate,pushing Kangong/the superciliary arch,kneading Taiyang and the prominent bone behind the ears,clearing Tianheshui,spine pinching)that alleviate fever were performed on the young rabbits 1 h after the modeling,whereas the model and saline groups were not given Tuina treatment,with the real-time anal temperature monitored during the experiment.The plasma was taken 3 h after the modeling for liquid chromatography-mass spectrometry(LC-MS)untargeted metabolomics study.RESULTS:Our results showed a fever-reducing effects of Tuina therapy on lipopolysaccharide-induced fever in young rabbits,as indicated by a significantly lower anal temperature,maximum rise in body temperature,and body response index at 2 and 3 h after modeling in the Tuina group compared to the model group,with reductions in the PGE2 expression observed in the blood and hypothalamus.The differential metabolites including riboflavin,nicotinamide N-oxide,porphobilinogen,5-hydroxyindoleacetic acid,gamma-aminobutyric acid,and lysoPC(16:1(9Z)/0:0)were found following the Tuina intervention.Tuina primarily involves glycine-serinethreonine,arginine-proline,porphyrin-chlorophyll,pyrimidine,primary bile acid biosynthesis,and cyanoamino acid metabolic pathways.CONCLUSION:Tuina therapy has proven to be effective in reducing body temperature and down-regulating PGE2 expression in LPS-induced febrile young rabbits,with its mechanism of fever-reducing action possibly associated with the changes in plasma metabolites and metabolic pathways.

产后发热病源流考

产后发热病始载于《黄帝内经》,及至《金匮要略》,产后发热病的诊治思路已初步形成。隋代《诸病源候论》始将产后发热病病因细分为外感、内伤,后世各家多宗其述。元代朱震亨提出“产后禁用寒苦发表”,并对明清医家影响深远。近代,随着“西医东渐”,各医家在反对滥用温补的同时,尝试将西医知识融入中医体系之中。

中药“喷灌疗法”治疗普通型手足口病的临床效果、安全性及经济性

目的 探讨中药“喷灌疗法”治疗普通型手足口病的临床效果、安全性及经济性。方法 选取2021年1月至6月在江西省儿童医院感染科住院的90例1~5岁普通型手足口病患儿为研究对象,采用随机数字表法分为对照组、开喉剑组和联合组,每组各30例。比较三组患儿的一般资料、临床症状和体征消退时间、不良反应发生率、重症转化情况、治疗前后炎症因子水平及住院时间、住院费用的情况。结果 联合组临床症状和体征消退时间均短于开喉剑组和对照组,差异有统计学意义(P<0.05);三组患儿不良反应发生率比较,差异无统计学意义(P>0.05);联合组治疗后的炎症因子水平均低于开喉剑组和对照组,差异有统计学意义(P<0.05);联合组的住院时间短于开喉剑组和对照组,住院费用少于开喉剑组和对照组,差异有统计学意义(P<0.05)。结论 中药“喷灌疗法”治疗普通型手足口病给药方式简便、临床疗效显著,有利于缩短患儿发热、皮疹/疱疹、口腔溃疡等症状消退时间和住院时间,大大降低医疗费用,同时能有效调节机体炎症因子,安全性好。