This study aimed to explore the correlation between traditional Chinese medicine(TCM) and reduced risk of readmission in patients having rheumatoid arthritis with hypoproteinemia(RA-H). A retrospective cohort study was conducted on 2 437 rheumatoid arthritis patients in the information system database of the First Affiliated Hospital of Anhui University of Chinese Medicine from 2014 to 2021, and 476 of them were found to have hypoproteinemia. The patients were divided into TCM users and non-TCM users by propensity score matching. Exposure was defined as the use of oral Chinese patent medicine or herbal decoction for ≥1 month. Cox regression analysis was performed to explore the risk factors of clinical indicators of rheumatoid arthritis. Additionally, the use of TCM during hospitalization was analyzed, and analysis of association rules was conducted to investigate the correlation between TCM, improvement of indicators and readmission of patients. Kaplan-Meier survival curve was plotted to compare the readmission rate of TCM users and non-TCM users. It was found the readmission rate of RA-H patients was significantly higher than that of RA patients. By propensity score matching, 232 RA-H patients were divided into TCM group(116 cases) and non-TCM group(116 cases). Compared with the conditions in the non-TCM group, the readmission rate of the TCM group was lowered(P<0.01), and the readmission rate of middle-aged and elderly patients was higher than that of young patients(P<0.01). Old age was a risk factor for readmission of RA-H patients, while TCM, albumin(ALB) and total protein(TP) were the protective factors. During hospitalization, the TCMs used for RA-H patients were mainly divided into types of activating blood and resolving stasis, relaxing sinew and dredging collaterals, clearing heat and detoxifying, and invigorating spleen and resolving dampness. The improvement of rheumatoid factor(RF), immunoglobulin G(IgG), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and ALB was closely related to TCM. On the basis of western medicine treatment, the application of TCM could reduce the readmission rate of RA-H patients, and longer use of TCM indicated lower readmission rate.
Middle Aged ; Aged ; Humans ; Medicine, Chinese Traditional ; Drugs, Chinese Herbal/therapeutic use* ; Retrospective Studies ; Patient Readmission ; Arthritis, Rheumatoid/drug therapy* ; Hypoproteinemia/drug therapy*

Objective To explore the prognostic factors of central venous catheter-related bloodstream infection(CR-BSI)and provide reference for clinical practice. Methods The clinical data of 346 CR-BSI patients from February 2014 to July 2019 were retrospectively reviewed,and the prognostic factors were analyzed. Results Of the 346 CR-BSI patients,62 died,yielding a case-fatality rate of 17.92%.Univariate analysis showed that 18 factors including age(
Anti-Bacterial Agents ; Carbapenem-Resistant Enterobacteriaceae ; Central Venous Catheters/adverse effects* ; Humans ; Hyperglycemia ; Hypoproteinemia ; Klebsiella Infections ; Klebsiella pneumoniae ; Methicillin-Resistant Staphylococcus aureus ; Mycoses ; Prognosis ; Pseudomonas Infections ; Retrospective Studies ; Risk Factors ; Sepsis/mortality*

PURPOSE: The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis. METHODS: Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients’ medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined. RESULTS: Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, 76.5 kU(A)/L; milk IgE, 20.5 kU(A)/L; peanut IgE, 30 kU(A)/L; eosinophil count, 5,810/μL; eosinophil cationic protein, 93.45 μg/L; and platelet count, 666.5×10³/μL. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients. CONCLUSION: Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.
Anti-Bacterial Agents ; Arachis ; Child ; Dermatitis, Atopic* ; Eosinophil Cationic Protein ; Eosinophils ; Gastrointestinal Tract ; Hematologic Tests ; Humans ; Hyperkalemia ; Hypersensitivity ; Hypoalbuminemia ; Hyponatremia ; Hypoproteinemia* ; Immunoglobulin E ; Infant ; Kaposi Varicelliform Eruption ; Keratoconjunctivitis ; Medical Records ; Milk ; Ovum ; Platelet Count ; Retrospective Studies ; Serum Albumin ; Skin ; Skin Care ; Steroids

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

Menetrier's disease in childhood is a rare form of gastropathy characterized by hypoalbuminemia, endoscopic and/or radiologic findings of hypertrophic gastric folds, and histologic findings of foveolar hyperplasia in the stomach. It tends to have a self-limited course compared to the chronic and complicated course in adult Menetrier's disease. A 7-year-old boy was referred to Incheon St. Mary's Hospital for facial edema. Physical examination on admission showed periorbital swelling, pitting edema in both legs, and epigastric tenderness. Laboratory tests on admission indicated hypoproteinemia (3.0 g/dL) with hypoalbuminemia (2.1 g/dL) and hypogammaglobulinemia. Urinalysis showed no abnormalities. The test results for anti-cytomegalovirus immunoglobulin M and cytomegalovirus PCR were negative. Stool Helicobacter pylori antigen was positive and fecal alpha1-antitrypsin clearance was 40.1 mL/day, consistent with protein-losing gastroenteropathy. Gastroduodenoscopy showed hypertrophic edematous gastric folds, erythema, and superficial erosion in the body of the stomach. The duodenum was normal. Histologic findings showed foveolar hyperplasia. His symptoms improved with conservative treatment including proton pump inhibitor from day 9 of hospitalization and resolved completely. Here we reported a case of pediatric protein-losing hypertrophic gastropathy associated with Helicobacter pylori infection.
Adult ; Agammaglobulinemia ; Child ; Cytomegalovirus ; Duodenum ; Edema ; Erythema ; Gastritis, Hypertrophic* ; Helicobacter pylori* ; Hospitalization ; Humans ; Hyperplasia ; Hypoalbuminemia ; Hypoproteinemia ; Immunoglobulin M ; Incheon ; Leg ; Male ; Physical Examination ; Polymerase Chain Reaction ; Proton Pumps ; Stomach ; Urinalysis

Child, Preschool ; Edema ; diagnosis ; Female ; Humans ; Hypoproteinemia ; diagnosis ; Stomach Diseases ; diagnosis

Menetrier's disease is a rare protein-losing gastropathy characterized by hypertrophic gastric fold, foveolar hyperplasia, and hypoproteinemia with resulting peripheral edema. It is clinically evident as nonspecific gastrointestinal symptoms, including abdominal discomfort, nausea and vomiting, abdominal pain, weight loss, diarrhea, and edema. Pediatric Menetrier's disease usually has an insidious onset and progressive, chronic clinical course and it spontaneously resolves in weeks or months. The pathogenesis of Menetrier's disease is not clearly understood. Menetrier's disease is thought to be associated with some gastric infections. But the cause of Menetrier's disease is unknown, an association with cytomegalovirus (CMV) and Helicobacter pylori has been suggested. In Korea, We present the first a case of pediatric Menetrier's disease with positive evidence of CMV and H. pylori.
Abdominal Pain ; Child ; Coinfection ; Cytomegalovirus ; Diarrhea ; Edema ; Gastritis, Hypertrophic ; Helicobacter ; Helicobacter pylori ; Humans ; Hyperplasia ; Hypoproteinemia ; Korea ; Nausea ; Vomiting ; Weight Loss

PURPOSE: As a complication of atopic dermatitis (AD), the incidence of hypoproteinemia is increasing among infants with severe AD. It can be a life-threatening condition owing to hypovolemic shock as a result of hypoproteinemia. The aim of this study is to investigate the clinical feature and laboratory findings in pediatric AD patients with hypoproteinemia. METHODS: Seventy-five patients who visited pediatric allergy clinic and diagnosed as AD by a physician from January 2005 to January 2012. Patients with low serum protein level were classified as group A (n=27) and those with normal serum protein level were classified as group B (n=48). Age, sex, and parental allergic history were studied. We examined serum protein and albumin, eosinophil count, C-reactive protein (CRP), serum eosinophil cationic protein (ECP), total IgE, specific IgE, skin culture and SCORing Atopic Dermatitis (SCORAD) score. RESULTS: In group A, serum protein and albumin were lower and eosinophil count, CRP, ECP, total IgE and SCORAD score were higher than group B. Group A was sensitized more number of allergens than group B. In parental allergic history, allergic rhinitis was prominent in both group. In skin culture, other species than Staphylococcus aureus were prominent in group A. Egg sensitization was the most common in both group. Serum protein level was positively correlated with serum albumin and negatively correlated with eosinophil count, total IgE, SCORAD score and number of sensitized allergen. CONCLUSION: Risk factors for hypoproteinemia in pediatric atopic dermatitis are considered infants, severe atopic dermatitis, increased number of sensitized allergens.
Allergens ; C-Reactive Protein ; Dermatitis, Atopic* ; Eosinophil Cationic Protein ; Eosinophils ; Humans ; Hypersensitivity ; Hypoproteinemia* ; Immunoglobulin E ; Incidence ; Infant ; Ovum ; Parents ; Rhinitis ; Risk Factors ; Serum Albumin ; Shock ; Skin ; Staphylococcus aureus

Menetrier's disease is a rare form of acquired gastropathy characterized by giant rugal folds in the stomach and protein-losing gastropathy. Children with Menetrier's disease tend to follow a benign self-limited course with symptoms typically completely resolving within 2 to 10 weeks in contrast to the chronic course in adults. A 9-year-old girl presented with a history of gradually worsening abdominal distension, increasing body weight, and abdominal pain for 2 weeks. Physical examination on admission indicated periorbital swelling, pitting edema in both the legs, and abdominal distension with mild diffuse tenderness and shifting dullness. Laboratory tests on admission showed hypoalbuminemia, hypoproteinemia, and peripheral eosinophilia. The test result for anticytomegalovirus immunoglobulin M was negative. Increased fecal alpha 1 anti-trypsin excretion was observed. Radiological findings showed massive ascites and pleural effusion in both the lungs. On gastroscopy, large gastric folds, erythema, erosion, and exudation were noted in the body and fundus of the stomach. Microscopic findings showed infiltration of eosinophils and neutrophils in the gastric mucosa. Her symptoms improved with conservative treatment from day 7 of hospitalization and resolved completely.
Abdominal Pain ; Adult ; Ascites ; Body Weight ; Child ; Cytomegalovirus ; Edema ; Eosinophilia ; Eosinophils ; Erythema ; Gastric Mucosa ; Gastritis, Hypertrophic ; Gastroscopy ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Immunoglobulin M ; Leg ; Lung ; Neutrophils ; Physical Examination ; Pleural Effusion ; Protein-Losing Enteropathies ; Stomach

The objective of this article is to report improvement of nutritional status by protein supplements in the patient with protein-losing enteropathy. The patient was a female whose age was 25 and underwent medical treatment of Crohn's disease, an inflammatory bowl disease, after diagnosis of cryptogenic multifocal ulcerous enteritis. The weight was 33.3 kg (68% of IBW) in the severe underweight and suffered from ascites and subcutaneous edema with hypoalbuminemia (1.3 g/dL) at the time of hospitalization. The patient consumed food restrictively due to abdominal discomfort. Despite various attempts of oral feeding, the levels of calorie and protein intake fell into 40-50% of the required amount, which was 800-900 kcal/d (24-27 kcal/kg/d) for calorie and 34 g/d (1 g/kg/d) for protein. It was planned to supplement the patient with caloric supplementation (40-50 kcal/kg) and protein supplementation (2.5 g/kg) to increase body weight and improve hypoproteinemia. It was also planned to increase the level of protein intake slowly to target 55 g/d in about 2 weeks starting from 10 g/d and monitored kidney load with high protein supplementation. The weight loss was 1.0 kg when the patient was discharged from the hospital (hospitalization periods of 4 weeks), however, serum albumin was improved from 1.3 g/dL to 2.5 g/dL and there was no abdominal discomfort. She kept supplement of protein at 55 g/d for 5 months after the discharge from the hospital and kept it at 35 g/d for about 2 months and then 25 g/d. The body weight increased gradually from 32.3 kg (65% of IBW) to 44.0 kg (89% of IBW) by 36% for the period of F/u and serum albumin was kept above 2.8 g/dL without intravenous injection of albumin. The performance status was improved from 4 points of 'very tired' to 2 points of 'a little tired' out of 5-point scale measurement and the use of diuretic stopped from the time of 4th month after the discharge from the hospital owing to improvement in edema and ascites. During this period, the results of blood test such as BUN, Cr, and electrolytes were within the normal range. In conclusion, hypoproteinemia and weight loss were improved by increasing protein intake through utilization of protein supplements in protein-losing enteropathy.
Ascites ; Body Weight ; Crohn Disease ; Diagnosis ; Edema ; Electrolytes ; Enteritis ; Female ; Hematologic Tests ; Hospitalization ; Humans ; Hypoalbuminemia ; Hypoproteinemia ; Inflammatory Bowel Diseases ; Injections, Intravenous ; Kidney ; Nutritional Status ; Protein-Losing Enteropathies* ; Reference Values ; Serum Albumin ; Thinness ; Ulcer ; Weight Loss