In the clinical management of newly diagnosed patients with human immunodeflciency virus (HIV) infection, issues such as delayed initiation of antiretroviral therapy (ART), non-standardized pre-treatment clinical evaluations, and untimely therapeutic efficacy monitoring persist, all of which adversely affect disease control and prognosis.In order to enhance the quality of diagnosis and treatment for HIV-infected patients, the expert panel from the National Medical Quality Control Center for Infectious Diseases has formulated a set of quality control indicators based on global research advancements and China’s clinical experience on HIV management.These indicators include: pretreatment assessment rate for newly diagnosed patients, proportion of ART initiation within 7 days after HIV infection diagnosis,therapeutic efficacy evaluation rate and success rate at 6 months post-ART initiation, and mortality rate among hospitalized acquired immunodeficiency syndrome (AIDS) patients.To guide healthcare institutions at all levels in implementing these quality metrics, the National Medical Quality Control Center for Infectious Diseases has organized experts to develop this consensus document, which provides recommendations regarding the clinical signiflcance of HIV quality control indicators, standardized data collection through information systems, and continuous quality improvement strategies for hospital-based HIV care services.
Tuberculosis (TB), a chronic infectious disease caused by Mycobacterium tuberculosis, is a major global public health issue.China faces a substantial TB burden and signiflcant challenges related to drug resistance.Early identiflcation, pathogen-based diagnosis and standardized treatment of pulmonary TB patients are critical to reducing transmission, mortality and the emergence of drug resistance.To enhance the quality of TB diagnosis and treatment, the National Medical Quality Control Center for Infectious Diseases has established a series of quality control indicators for pulmonary TB.These indicators cover the referral rate of TB patients in non-TB-designated medical institutions, as well as key aspects in TB-designated hospitals, including the pathogen-positive rate, drug resistance screening rate for pathogen-positive patients,utilization rate of standardized treatment regimens, standardized diagnosis rate for pathogen-negative patients,and the proper management rate of adverse drug reactions.This consensus proposes methods for indicators monitoring, data collection requirements, and recommendations for continuous quality improvement, aiming to achieve scientific, precise and standardized TB care, thereby reducing the risk of TB transmission and mortality.
The clinical management of chronic hepatitis B (CHB) and its complications faces critical challenges, including insufficient public awareness, suboptimal diagnosis and treatment rates, and nonstandardized therapeutic protocols with poor follow-up adherence.To enhance the quality management of CHB and its complications, the National Medical Quality Control Center for Infectious Diseases has established six evidence-based quality control indicators.To guide the healthcare institutions at all levels in effectively implementing these quality control indicators, the National Medical Quality Control Center for Infectious Diseases organized experts to formulate this consensus.It provides suggestions on the deflnitions of quality control indicators for the diagnosis and treatment of CHB and its complications, the signiflcance of these quality control indicators, digital data collection of quality control metrics, and continuous improvement of medical quality in hospitals and departments.
The prevention of mother-to-child transmission of hepatitis B virus (HBV) involves multidisciplinary collaboration across departments including obstetrics and gynecology, infectious diseases and others.However, several challenges persist in current clinical practice, such as inadequate hepatitis B virus surface antigen (HBsAg) screening for pregnant women and non-standardized management protocols for HBsAg-positive mothers and their newborns after delivery.To enhance the prevention quality of HBV mother-to-child transmission, the National Medical Quality Control Center for Infectious Diseases has established standardized quality control indicators and developed this consensus document.This consensus aims to assist healthcare institutions at all levels in implementing these quality control indicators.The consensus provides recommendations regarding three key aspects: the clinical signiflcance of quality control indicators, standardized data collection procedures, and continuous quality improvement strategies for optimizing the prevention of mother-to-child transmission of HBV.
Measles is an acute respiratory infectious disease caused by the measles virus.It belongs to Class B infectious diseases stipulated in the “Infectious Disease Prevention and Control Law” of our country.People are generally susceptible to measles virus.It spreads quickly, and severe cases can lead to death.To further standardize the clinical diagnosis and treatment of measles, the National Health Commission (NHC)and the State Administration of Traditional Chinese Medicine issued the “Diagnosis and Treatment Protocol for Measles (2024 Edition)” (hereinafter referred as the “Diagnosis and Treatment Protocol”) on July 19th,2024.Based on the diagnosis and treatment protocol, this paper analyzes the epidemiological characteristics,diagnostic criteria, treatment and prevention.It emphasizes the importance of early diagnosis and treatment of measles.In addition, it highlights the role of combined treatment of traditional Chinese and western medicine in the treatment.These measures aim to improve the quality of diagnosis and treatment, and reduce the complications and mortality of measles.
Vascular graft infection (VGI) is a serious complication that can occur after vascular transplantation.Although the incidence of vascular graft infection is relatively low, the impact is extremely serious.VGI not only leads to organ dysfunction, but also may even cause amputation of a limb, and can be life-threatening in severe cases.In addition, treatment of VGI requires longer hospitalization and high medical costs, placing great flnancial pressure on patients.Therefore, early recognition and prompt treatment of vascular graft infection is crucial.The occurrence of VGI is associated with a variety of factors, including intraoperative infection control, the patient’s immune status and types of graft.The clinical presentation of this complication is usually complex and may manifest as either a localized inflammatory response or result in systemic infection.The diagnosis of VGI requires a comprehensive evaluation of imaging flndings, blood cultures, and histopathology.In order to accurately assess the severity of the infection and the extent of the lesion, the physician also needs to perform a comprehensive analysis based on the patient’s situation.Currently,treatments for vascular graft infections are constantly evolving, ranging from the choice of antibiotics to surgical debridement and reconstructive surgery and clinical experience has been accumulated.Therefore, the aim of this review is to summarize the characteristics and clinical manifestations of VGI at different surgical sites, as well as to summarize the classiflcation, diagnostic criteria, risk factors and therapeutic advances of VGI, so as to provide reference for clinicians in the treatment of VGI.
End-stage liver disease (ESLD) is the late stage of liver disease caused by various chronic liver diseases, with abnormal liver function.Infection is one of the most common complications in the development of ESLD, which can accelerate the deterioration of the patient’s condition and lead to increased mortality.The pathogenesis of ESLD mainly includes immune deflciency, systemic inflammatory response,impairment of liver synthesis function, alteration of intestinal flora and genetic mutations.Concurrent infection with ESLD is characterized by insidious onset, difflculty in early diagnosis and increased multi-drug resistance rate, the diagnosis and treatment of ESLD still face many challenges.This review discusses the pathogenesis of ESLD with infections and intend to provide new ideas for the prevention and treatment.
To investigate the value of two-dimensional shear wave elastography (2D-SWE)in the typing of liver Cystic echinococcosis (CE).
Methods
Total of 91 patients with liver CE were admitted to the Fourth People’s Hospital of Qinghai Province from July 2018 to July 2023.Ultrasound, 2D-SWE, CT or MRI examinations were performed on each patient.As 2D-SWE had almost zero shear wave propagation speed in cystic lesions, 41 cases of CE1 and CE2 type were excluded.Total of 50 cases of CE3-CE5 type with solid components were enrolled as study subjects.According to the CT/MRI results, the patients were divided into CE3 group(15 cases), CE4 group (19 cases) and CE5 group (16 cases).The statistical data (age, left and right diameter of lesion,anterior and posterior diameter of lesion, CE hardness value, surrounding liver hardness value) of overall comparison among the three groups were analyzed by One-way analysis of variance, while pairwise comparison in each group were analyzed by LSD-t test.Counting data (sex, number of lesions and location of lesions) were obtained using Pearson Chi-square test or Fisher’s exact probability method, the correlation analysis was conducted using Spearman rank correlation analysis.The diagnostic capability of the correlation between CE classiflcation and CE hardness value was evaluated by receiver operating characteristic curve (ROC) and area under ROC curve (AUC).
Results
The average hardness values of CE3, CE4 and CE5 were (15.77 ± 5.83) kPa, (34.15 ± 9.28) kPa and (50.80 ± 13.73)kPa, respectively.The correlation analysis results showed that CE classiflcation was positively correlated with the average hardness value of CE (r = 0.821, P ＜ 0.001).The CE hardness values among patients in CE3 group, CE4 group and CE5 group were signiflcantly different (F = 45.991, P ＜ 0.001), while the pairwise comparison results between the CE hardness values showed that the differences were statistically signiflcant (CE3 group vs.CE4 group:t =-5.236, P ＜ 0.001, CE3 group vs.CE5 group: t =-9.590, P ＜ 0.001, CE4 group vs.CE5 group: t =-4.828,P ＜ 0.001).The AUC of 2D-SWE for diagnosis type of CE3 and CE4 was 0.941 (95%CI: 0.867-1.000, P ＜ 0.001),with the cut-off value of 19.5 kPa, the sensitivity and speciflcity of 2D-SWE were 94.7% and 73.3%, respectively.The AUC of 2D-SWE for diagnosis type of CE4 and CE5 was 0.826 (95%CI: 0.684-0.967, P ＜ 0.001), with the cutoff value of 47.5 kPa, the sensitivity and speciflcity of 2D-SWE were 62.5% and 89.5%, respectively.
Conclusions
2D-SWE is a safe, economical, non-invasive, rapid, and visualization imaging method, which quantitatively assesses the biomechanical characteristics of liver CE.It serves as an excellent detection tool for typing CE3, CE4 and CE5.Furthermore, the 2D-SWE color elastic map provides real-time display of the distribution of softness and hardness within the CE lesion area.This information can serve as a valuable reference for selecting appropriate mode of operation and surgical instrument.
To investigatethe clinical characteristics of local cases of severe fever with thrombocytopenia syndrome (SFTS) in Beijing.
Methods
The general condition, epidemiology, clinical symptoms and laboratory indicators of indigenous patients with SFTS admitted to Beijing Ditan Hospital,Capital Medical University from January 2023 to December 2024 were analyzed, retrospectively.
Results
Total of 15 local patients with severe fever complicated with thrombocytopenia syndrome (SFTS) were admitted, comprising 8 males and 7 females.Among these patients, 12 cases recovered, while 3 cases unfortunately died.In 2023, 6 patients were admitted, and all of them recovered.In 2024, 9 patients were admitted, 3 cases of whom died.The average age was (61.0 ± 8.7) years old.The onset of the disease was concentrated from May to September.The main residence areas for the patients included Pinggu, Tongzhou and Mentougou Districts, with 80% (12 cases) being farmers.Three patients (20%) had a clear history of being bitten by ticks, while 4 patients (26.6%) had contact with pet dogs that had been bitten by ticks and 2 patients (13.3%) had contact with sick camels.Among the patients who recovered, 50% (6 cases) had no underlying health conditions, all 3 dead patients had cardiovascular diseases.All 15 patients experienced fever and fatigue, and 73.3% (11 cases) reported digestive symptoms, while 53.3% (8 cases) underwent muscle pain.All 3 dead patients exhibited apparent neurological abnormalities, with 2 of them (66.7%) also showing signs of bleeding.The white blood cell (WBC) ranged (1.0-3.0) × 109/L, one case with the WBC count deceased to 0.9 × 109/L.All patients exhibited thrombocytopenia, and the platelet (PLT) count of 2 patients were less than 30 × 109/L.Additionally, all 15 patients showed varying degrees of organ damage； the urine protein levels of the 3 dead patients ranged from 3+ to 4+, and all had urine occult blood at 3+.The creatinine (Cr) and blood urea nitrogen (BUN) levels were signiflcantly elevated in 2 dead patients.Furthermore, all 15 patients displayed coagulation dysfunction, primarily indicated by elevated D-dimer levels.
Conclusions
The local cases in Beijing were mainly middle-old farmer patients, with the onset of disease from May to September.Their residence was concentrated in the peripheral areas of Beijing.Some patients were in contact with infected animals, such as domestic pet dogs.Patients with old age, cardiovascular underlying disease, abnormal neurological manifestations, bleeding tendency and severe renal impairment may have a poor prognosis.
To investigate the clinical manifestations, diagnosis, differential diagnosis and treatment of cat scratch disease (CSD).
Methods
A 62-year-old male patient, having a history of cat scratching, admitted to the Department of Infection, Southern University of Science and Technology Hospital in August 15, 2024 with “fever with left upper arm elbow and left axillary lymph node enlargement for 5 days” was reported.Lymph node ultrasound indicated that cat scratch disease was waiting to be diagnosed,and was clinically diagnosed by metagenomic sequencing (MetaCAP).
Results
Once Hanssebardia detected by MetaCAP, the patient underwent active anti-infective therapy, resulting in alleviation of fever and a reduction in the size of the enlarged lymph nodes in the left upper arm and axilla compared to previous measurements.The size of the enlarged lymph nodes in the left upper arm decreased from 23 mm × 12 mm to 21 mm ×10 mm, while those in the axilla diminished from 27 mm × 11 mm to 20 mm × 8 mm.
Conclusions
Patients with unexplained fever accompanied by lymphadenopathy, a history of scratches from cats or dogs should be considered the possibility of cat scratch disease.MetaCAP plays a signiflcant role in the diagnosis of cat scratch disease.
