ObjectiveTo summarize the clinical features of cytomegalovirus infection after severe pneumonia in immunocompetent subjects. MethodsTwo cases of cytomegalovirus infection after severe pneumonia in immunocompetent subjects were reported and the literatures were reviewed. ResultsTwo elderly patients were admitted to our Respiratory Intensive Care Unit for severe pneumonia and typeⅠrespiratory failure. After treatment of invasive mechanical ventilation, broad-spectrum antibiotics and steroids, their body temperature became normal with improvement of oxygenation and lung infiltrates on chest radiograph. After extubation, their oxygenation deteriorated, with extensive lung infiltrates on chest X ray. Coincidently, their blood cytomegalovirus DNA became positive and then they were treated with parenteral ganciclovir for more than 2 weeks. After that, their oxygenation and chest radiograph returned to normal. Combined with the results of the related literature, invasive mechanical ventilation and use of corticosteroids could be the risk factors of immunocompetent subjects to develop cytomegalovirus infection after severe pneumonia. The clinical characteristics include deterioration of oxygenation and extensive lung infiltrates without positive pathogenic findings of bacteria and fungi. Quantitive nucleic acid amplification tests for blood cytomegalovirus DNA, cytomegalovirus pp65 antigenemia test and histology/immunohistochemistry are recommended diagnostic tools. Valganciclovir or intravenous ganciclovir are recommended as first-line treatment for at least 2 weeks. ConclusionsCytomegalovirus infection occurs frequently in immunocompe-tent subjects with critical illness. Cytomegalovirus pneumonia should especially be considered in patients with severe pneumonia, receiving mechanical ventilation and steroids. Early diagnosis and treatment may help improve the prognosis of these patients.
Objective To explore the risk factors of invasive fungal infection ( IFI) in respiratory ward. Methods A multi-center, retrospective, case-control study was carried out. Patients from five general hospitals in Chongqing city, diagnosed as fungal infection, or whose respiratory specimens were fungal positive, were retrospectively screened for IFI. Patients with respiratory infection and colonization of nonfungal cases in the same period of hospitalization were enrolled as control. Results Thirty-four patients diagnosed with IFI and 50 patients diagnosed with bacterial infection were analyzed for the risk factors of IFI. The demographic characteristics of patients including age and gender were not different( P gt; 0. 05) , but hospitalization days, carbapenem antibiotic use, chemotherapy, deep venous catheterization, total parenteralnutrition( TPN) , neutropenia, and renal disfunction were different significantly between the IFI group and the control group. Multiple logistic regression analysis showed that carbapenem antibiotic use ( OR = 6. 753) ,central venous catheterization ( OR = 5. 021) and TPN ( OR = 3. 199) were main risk factors of invasive fungal infection. Conclusion The carbapenem antibiotic use, central venous catheterization and TPN are risk factors for IFI in respiratory ward.
ObjectiveTo investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder.MethodsBetween April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up.ResultsAll incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively (P<0.05). The range of internal rotation restored to the level of T6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation (Z=–0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant (P<0.05); and with time, the VAS scores and ASES scores improved further (P<0.05).ConclusionArthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.
Objective To investigate the causes of chronic cough in Chongqing City and assess the efficacy of specific therapy. Methods A total of 233 consecutively non-selected referred patients ( 136 females) whose cough duration more than eight weeks were studied. Their age[ median ( range) ] was 44. 5( 15-78) yrs and cough duration was 2. 6 ( 0. 2-30) yrs. They were diagnosed using a diagnostic protocol based on the Guideline on Diagnosis and Treatment of Chronic Cough established by China Medical Association and American College of Chest Physicians. The etiological diagnosis was made according to clinical manifestations, lab examinations, and response to specific therapy. The effects was assessed four weeks after the drug withdraw. Results The cause of chronic cough was confirmed in 216 patients ( 92. 7% ) . Seventeen patients( 7. 3% ) had not been definitely diagnosed. Cough due to a single cause was found in 163 patients ( 75. 45% ) , and due to multiple causes in 53 patients ( 24. 53% ) . The causes included upper airway cough syndrome ( UACS) in 127 patients( 44. 4% ) , cough variant asthma ( CVA) in 73 patients( 25. 5% ) , gastro-esophageal reflux cough ( GERC) in 26 patients( 9. 1%) , postinfectious cough and angiotensin converting enzyme ( ACE) inhibitor-induced cough in 6 patients( 2. 1% ) , atopic cough in 5 patients( 1. 7% ) , chronic bronchitis in 3 patients ( 1. 0% ) , respectively. After specific therapy based on diagnosis, cough cured in 59 patients ( 25. 3% ) , and alleviated in 114 patients ( 49. 3% ) , no response in 40 patients( 17. 1% ) . Conclusion The causes of chronic cough in different areas maybe variant. UACS, CVA and GREC are the main causes of chronic cough in Chongqing City. Specific therapy is effective in majority of patients with chronic cough.
Objective To explore the application effect of recumbent rehabilitation exercise combined with oscillatory positive expiratory pressure training in pulmonary rehabilitation of patients with moderate to severe inhalation injury. Methods Fifty-seven patients with moderate-to-severe inhalation injuries admitted to the Department of Burns and Plastic Surgery of the People’s Hospital of North Jiangsu Province from January 2021 to March 2023 were selected by convenience sampling. The patients were randomly divided into Group A, Group B, and Group C. Group A received conventional treatment, Group B received the recumbent rehabilitation exercise on the basis of Group A, and Group C received the concussive expiratory pressure training on the basis of Group B. The three groups were compared before and after the intervention with respect to forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), sputum properties, sputum difficulty, sputum viscosity, average daily sputum output, Borg shortness of breath score, and 1-minute sitting and standing test. Results The improvement values of FEV1, FVC, sputum viscosity, average daily sputum discharge, Borg shortness of breath score, and 1-minute sit-to-stand test were compared among the three groups after intervention, and the differences were statistically significant (all P<0.05). The improvement values of Borg shortness of breath score, and 1-minute sit-to-stand test in group B were significantly better than those in group A (all P<0.05). The improvement values of FEV1, FVC, and sputum properties in group C were significantly better than those in group A (all P<0.05), Coughing difficulty, sputum viscosity, total average daily sputum expectoration, Borg shortness of breath score, and 1-minute sit-to-stand test improvement values were significantly better than those of group A (all P<0.05). Improvement values of FEV1, average daily sputum expectoration, and Borg shortness of breath score in group C were significantly better than those of group B (all P<0.05). Conclusion For pulmonary rehabilitation of patients with moderate-to-severe inhalation injuries, prone rehabilitation exercises combined with oscillatory positive expiratory pressure training can effectively improved the patients’ exercise capacity and respiratory function, and improve their quality of life.