INTRODUCTION: As the number of diabetics increase with younger onset and longer duration, patients are confronted with higher incidence of diabetes related complications such as distal extremity vasculopathy, neuropathy and various infectious diseases. Such diabetics are more prone to a much higher rate of onychomycosis compared to normal subjects and because this could trigger irreversible consequences, confirmation of fungal involvement should be promptly taken care of. Itraconazole is a widely used drug nowadays and compared to drugs such as griseofulvin and ketoconazole, has many advantages in efficacy, cost, duration of therapy which eventually results in better patient compliance. OBJECTIVE: Our study was designed to better dictate the usage of itraconazole in diabetics so these patient can receive quality treatment when it is needed. METHOD: The study consisted of 101 patients with both onychomycosis and diabetes who were receiving treatment in Eulji hospital. They all received 3 pulses of itraconazole and were evaluated for efficacy and safety of their treatment. The patients were observed on routine examinations for 36 weeks and at their visits they were interviewed and received microscopic examinations. RESULT: Eighty four percent of the patients showed clinical and mycological improvement with 33% of them showing total clearance. There were no hypo- or hyperglycemic events and 17 patients complained of mostly mild side effects such as indigestion. Two patients dropped out of the study due to epigastric pain and peripheral extremity swelling. CONCLUSION: The use of itraconazole in the treatment of onychomycosis seemed to be effective and relatively safe for diabetics.
Communicable Diseases ; Diabetes Complications ; Dyspepsia ; Extremities ; Griseofulvin ; Humans ; Incidence ; Itraconazole* ; Ketoconazole ; Onychomycosis* ; Patient Compliance

Natural disasters may lead to the outbreaks of infectious diseases because they increase the risk factors for infectious diseases. This paper reviews the risk factors for infectious diseases after natural disasters, especially earthquake, and the infectious diseases following disasters reported in recent years. The infectious diseases after earthquake include diarrhea, cholera, viral hepatitis, upper respiratory tract infection, tuberculosis, measles, leptospirosis, dengue fever, tetanus, and gas gangrene, as well as some rare infections. Children are vulnerable to infectious diseases, so pediatricians should pay more attention to the research on relationship between infectious diseases and natural disasters.
Child ; Communicable Diseases ; etiology ; Diarrhea ; etiology ; Disasters ; Earthquakes ; Humans ; Respiratory Tract Infections ; etiology ; Wounds and Injuries ; complications

Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs. 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U=41.30, 15.94, 37.08, all P<0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P<0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U=51.05, 15.70, both P<0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P>0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.
Aged ; Child ; Communicable Diseases/complications* ; Female ; Fever of Unknown Origin/etiology* ; Humans ; Length of Stay ; Male ; Neoplasms/complications* ; Retrospective Studies

OBJECTIVES: To study the etiology and clinical features of children with ascites, so as to provide a basis for the diagnosis and treatment of ascites in children. METHODS: The medical data of the children with ascites, who were hospitalized from January 1, 2010 to December 31, 2019, were retrospectively reviewed. RESULTS: Among the 165 children with ascites, the male/female ratio was 1.53:1, and the mean age of onset was (6±4) years. The causes of ascites included surgical acute abdomen (39 children, 23.6%), infectious diseases (39 children, 23.6%), neoplastic diseases (27 children, 16.4%), hepatogenic diseases (18 children, 10.9%), pancreatitis (10 children, 6.1%), cardiogenic diseases (8 children, 4.8%), rheumatic immune diseases (6 children, 3.6%), and nephrogenic diseases (5 children, 3.0%). According to the age of onset, there were 33 infants, 24 young children, 30 preschool children, 41 school-aged children, and 37 adolescents. Surgical acute abdomen and hepatogenic diseases were the main causes of ascites in infants (P<0.05). Neoplastic disease was the leading cause in young children (P<0.05). Infectious diseases were the most common cause in adolescents (P<0.05). CONCLUSIONS Surgical acute abdomen, infectious diseases, neoplastic diseases, and hepatogenic diseases are the common causes of ascites in children, and there are some differences in the leading cause of ascites between different age groups.
Abdomen, Acute/complications* ; Adolescent ; Ascites/etiology* ; Child ; Child, Preschool ; Communicable Diseases ; Female ; Humans ; Infant ; Male ; Neoplasms/complications* ; Pancreatitis/complications* ; Retrospective Studies

Antiphospholipid syndrome is defined as the presence of lupus anticoagulant antibodies or anticardiolipin antibodies with vascular thrombosis or specific pregnancy complications. Antiphospholipid syndrome can be associated with autoimmune, malignant or infectious diseases. Cutaneous manifestations of antiphospholipid syndrome are variable and can be a first clue to the syndrome or other associated diseases. We report a case of systemic lupus erythematosus and secondary antiphospholipid syndrome presenting as livedo reticularis on both legs of a patient. We recommend that patients with livedo reticularis should be examined for systemic lupus erythematosus or antiphospholipid syndrome.
Antibodies ; Antibodies, Anticardiolipin ; Antiphospholipid Syndrome ; Communicable Diseases ; Humans ; Leg ; Livedo Reticularis* ; Lupus Coagulation Inhibitor ; Lupus Erythematosus, Systemic* ; Pregnancy Complications ; Thrombosis

PURPOSE: To evaluate the efficacy of tattooing with tissue marking dye for cosmetic repair of corneal opacity. METHODS: Tattooing by the injection of tissue marking dye into the corneal stroma was performed in 67 eyes of 67 patients in whom there were no changes in visual acuity or size of corneal opacity for at least 5 years. Conjunctivalized corneal opacities and calcium deposits were removed before tattooing. All patients were followed up for a period of at least 3 months. RESULTS: The most common causes of corneal opacity were trauma (56.6%) and infectious disease (19.4%). Combined ocular diseases included sensory exotropia (43.3%) and band keratopathy (31.3%). In this study, 98.5% of patients showed satisfactory results with cosmetic staining. Remaining opacity was observed in 1 eye (1.5%). Intraoperative complications occurred in 6 eyes (9.0%) and were resolved completely during surgery. Foreign body sensations (38.8%) and conjunctival injection (32.8%) disappeared within 2 months after surgery. CONCLUSIONS: Cosmetic repair by tattooing using tissue marking dye is an effective treatment for corneal opacity and is not associated with any significant complications.
Calcium ; Communicable Diseases ; Corneal Opacity* ; Corneal Stroma ; Exotropia ; Foreign Bodies ; Humans ; Intraoperative Complications ; Sensation ; Tattooing* ; Visual Acuity

BACKGROUNDDespite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. To increase the knowledge of FUO, we conducted a retrospective study to investigate the causes of FUO and the change of major causes of FUO during the past 26 years.

METHODSThe clinical data were retrospectively analyzed from 997 patients with FUO hospitalized at the Peking Union Medical College Hospital (PUMCH) between January 2004 and October 2010. Furthermore, the results were compared to that reported in previous studies of FUO in PUMCH since 1985.

RESULTSOf the 997 FUO cases, definite diagnosis was eventually achieved in 797 (79.9%) patients. The most common cause of FUO was infectious diseases (479 cases, 48.0%), with tuberculosis accounting for 45.3% (217/479) of the cases of infections. One hundred and sixty-eight (16.9%) patients were diagnosed with connective tissue diseases, with Still's disease and vasculitis accounted for 31.5% (53/168) and 24.4% (41/168) of this category, respectively. Neoplasms and miscellaneous causes were found in 7.9% (79/997) and 7.1% (71/997), respectively. However, no definite diagnosis had been made in the remaining 200 (20.1%) cases until they were discharged from the hospital.

CONCLUSIONSDuring different periods, infectious diseases, especially tuberculosis, were the leading etiology of FUO and the proportion of tuberculosis had no significant difference. While the frequency of neoplasms was descending, the proportion of lymphoma in neoplasm was ascending; the frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Communicable Diseases ; complications ; Diagnosis, Differential ; Female ; Fever of Unknown Origin ; etiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tuberculosis ; complications ; Young Adult

BACKGROUND: Pregnancy may influence the skin in various ways from physiologic changes to pathologic dermatoses. OBJECTIVE: To analyze and quantify the distribution and clinical features of dermatoses in pregnant patients. METHODS: We retrospectively reviewed medical records of 634 pregnant patients who visited the department of dermatology between May, 2006 and November, 2012. The patients' epidemiologic status and clinical characteristics were analyzed. RESULTS: The mean age of patients was 30.6 and the mean gestational age was 22.3 weeks. They were classified into 3 groups: general dermatoses, pregnancy-specific dermatoses, and physiologic skin change. General dermatoses were observed in 434 patients (68.5%) and infectious disease accounted for 50.0% of them. The most frequent infectious disease was viral infection with herpes zoster (29.5%) and varicella (16.1%). Pregnancy-specific dermatoses were recognized in 177 patients (28.0%). Among them, 96 (54.2%) were diagnosed as atopic eruption of pregnancy and 66 (37.3%) were pruritic urticarial papules and plaques of pregnancy. Primigravida, late onset and abdominal involvement were more frequent in patients with pruritic urticarial papules and plaques of pregnancy. The prognosis of patients with pregnancy specific dermatoses was good without major fetal problems. Pyogenic granuloma was recorded as the most common physiologic changes encountered. We performed examinations and procedures in only 36.3% of pregnant patients. CONCLUSION: We analyzed the distribution and clinical characteristics observed in pregnant patients with dermatological problems. Dermatologists should be aware of the differences to improve the quality of patient care.
Chickenpox ; Communicable Diseases ; Dermatology ; Gestational Age ; Granuloma, Pyogenic ; Herpes Zoster ; Humans ; Medical Records ; Patient Care ; Pregnancy ; Pregnancy Complications ; Prognosis ; Pruritus ; Retrospective Studies ; Skin ; Skin Diseases

BACKGROUND: Although incidence of deep neck infection has decreased after the introduction of antibiotics and improvement of oral hygiene, the disease may remain serious to anesthesiologists and patients, especially relative to postoperative prognosis and airway management. The objective of this study is to clarify clinical characteristics and consider anesthetic implications. METHODS: This study reviews the experience of 116 patients that received operations for deep neck infections 1997–2017 in a university hospital. Variables included in data were age, sex, lesion, etiology, underlying disease, result of culture, anesthetic techniques, C-reactive protein level, and a variety of scores including ASA physical status, APACHE II, and SOFA. Scores were analyzed statistically to elucidate prognostic ability, and influences on intubation. RESULTS: The following background variables were associated postoperative complication; age, presence of diabetes, hypertension, and infectious disease, extended space and use of N2O. APACHE II ≥ 7 and SOFA ≥ 3 were revealed to be associated with postoperative complication. The following background variables were associated with difficult intubation: date of surgery ≤ 2009, non-otolaryngology department, and submental space. CONCLUSIONS: This study revealed the possibility that the preoperative evaluation, including the determination of scoring system, may be useful in predicting outcome and making a clinical decision of airway management in deep neck infections.
Airway Management ; Anti-Bacterial Agents ; APACHE ; C-Reactive Protein ; Communicable Diseases ; Humans ; Hypertension ; Incidence ; Intubation ; Neck ; Oral Hygiene ; Postoperative Complications ; Prognosis ; Retrospective Studies

Among several kinds of diabetic complications reported, diabetic foot ulcers and lower extremity amputations are serious and expensive one. About 10 to 15% of people with diabetes mellitus experience that complication during their life time and half of all nontraumatic lower extremity amputation occur in people with diabetes. The prevention and care of diabetic complication of the foot continue to represent a major challenge to physicians. Neuropathy, infection, deformity and ischemia are major threats to the diabetic foot and overall functional well-being is the main concern of the diabetic foot patients. This retrospective study based on chart reviews 108 cases of diabetic patients: 54 cases of diabetic patients without foot problems and the other 54 cases with foot problems. The mean age of DM foot patients was 57.4 years and they suffered from diabetes for 12.9 years. The diabetic foot problems developed to gangrene, ulcer, and mummification in 33.2 days and their healing time required more than 40 days(mean 42.9 days). The patient of diabetic foot problems had higher level of blood sugar(p=0.023) and longer duration of diabetes mellitus(p=0.040). The most common site was digit, especially 1st and 2nd toe. Multiple lesions were involved in more than 10% of the patients. The majority of operation were debridement and closure, amputation, skin graft. The complications were wound disruption or delayed wound healing and partial skin graft loss. The incidence of diabetic foot was 2.6 times higher in peripheral neuropathic patient and the healing time was related to velocity of development of noticeable diabetic foot(Pearsson correlation coefficient). The peripheral neuropathy was significantly related to diabetic foot(p=0.000), and that was noticed in patients with longer duration of diabetic mellitus (p=0.023) and older age(p=0.032). The majority of DM foot patients was in the 5th to 7th decades(83.3%) and most of DM foot developed more than 5 years after DM diagnosis(91.7%). The mean healing time was 42.9 days and most common healing time was 5 weeks(38.8%). Managements of the diabetic foot require a multisystem approach that addresses the component problems of the neurovascular, skeletal, immune and integumentary system. A coordinated team effort by the plastic surgeon, vascular surgeon, endocrinologist, infectious disease specialist, neurologist, podiatrist as well as the physical therapist and social service representatives are often need to provide the diabetic patient with complete foot care.
Amputation ; Communicable Diseases ; Congenital Abnormalities ; Debridement ; Diabetes Complications ; Diabetes Mellitus* ; Diabetic Foot* ; Foot ; Gangrene ; Humans ; Incidence ; Integumentary System ; Ischemia ; Lower Extremity ; Peripheral Nervous System Diseases ; Physical Therapists ; Retrospective Studies ; Skin ; Social Work ; Specialization ; Toes ; Transplants ; Ulcer ; Wound Healing ; Wounds and Injuries