Objectives Retrospective analysis of the Tibetan convulsive status epilepticus (CSE) for the aetiology, prognosis and its influencing factors in Tibet area. Methods Through electronic patient record, making “epilepsy”, “status epilepticus ”, “epileptic seizure” as keywords, convulsive status epilepticus patients in the People’s Hospital of Tibet Autonomous Region hospitalized from January 2015 to December 2020 were retrospectively observed, gathering their clinical data and aided examinations furthermore, and the prognoses were returned by telephone, meanwhile the functional status of those patients was assessed by the modified rankin scale. and the causes differ in gender, age, out-of-hospital antiepileptic treatment, family history of epilepsy and history of epilepsy were analyzed. The prognostic factors were analyzed by logistic regression. Results A total of 2 254 hospitalized patients with epilepsy were retrieved, including 331 CSE patients aged 14~84 years, 219 males and 112 females. There were 36 lost calls, 62 CSE deaths (21.01%), and 4 adverse outcomes (non-death)(1.7%).There were statistically significant differences in etiology of CSE in different ages and history of epilepsy (P<0.05), but there were no statistically significant differences in gender, out-of-hospital antiepileptic treatment, progression of refractory status epilepticus and family history of epilepsy. Cerebrovascular disease was the main cause of CSE in people aged 45 and over (54 cases), while the main cause of CSE in people aged under 45 was unknown (104 cases).Among the patients with previous history of epilepsy, the highest proportion was unknown cause [117 cases (48.8%)]; Among patients without a history of epilepsy, cerebrovascular disease [34 cases (37.4)] was the most common cause of CSE. Multivariate logistic regression analysis of prognostic factors of CSE showed that gender, age, GCS and electrolyte disorder had statistically significant effects on the death of CSE patients (P<0.05), while altitude and their duration and other factors had no statistically significant effects on the death of CSE patients (P>0.05). ConclusionsCerebrovascular disease is the leading cause of CSE in people aged 45 and over. Male, advanced age, low GCS score at discharge, and electrolyte disorder were risk factors.
It has always been an important policy of the Chinese government to provide aid and assistance for the development of Tibet. With nearly one-eighth of China’s total land areas and about 0.002% of China’s total population, the Tibet Autonomous Region lags behind the domestic average level in medical education and is in bad need for medical professionals. The West China Center of Medical Sciences (WCCMS) of Sichuan University has managed to introduce US projects to set up the West China–Tibet Telemedical Education System to transmit medical courses in a real-time and interactive way. Based on this system, WCCMS has established a model for assisting the Tibet University Medical College through transmitting medical courses, training their medical faculty, sending WCCMS faculty to work in Tibet and admitting medical teachers and students from Tibet to study and be trained at West China Medical School and Hospital.
摘要:目的:探讨滋养叶细胞肿瘤的临床特征、治疗、预后。方法:回顾性分析我院1997年1月至2008年12月诊治的28例良、恶性滋养叶细胞肿瘤患者的临床资料。结果:28例中,侵蚀性葡萄胎1例,经化疗后已随访3年无复发征象;2例因“肺部转移”和“持续性葡萄胎”回内地治疗;5例尚在随访中,其余经随访已达临床治愈。结论:妊娠滋养叶细胞肿瘤患病率高;良性葡萄胎预后好,但应警惕其潜在恶变性,应早期发现,早期治疗,以减少其恶变带来的危害;恶性滋养叶细胞肿瘤经积极化学治疗后可达到根治。Abstract: Objective: To explore the clinical feature，treatment and prognosis of gestational trophoblastic tumor. Methods: Retrospectively analyzed the clinical pathological materials of 11 patients with carcinoid and malingnant gestational trophoblastic tumor treated from January.1997 from December 2008 in our hospital. Results: In the 28 cases,1 case of erosive hydatidiform mole did not relapse after the chemical treatment of 3 years’ survey; 2 cases went back to the inland due to “lung transference and continuous hydatidiform mole”; 5 cases was still in the followup survey; the last had been cured after followup survey. Conclusion: Gestational trophoblastic tumor have a higher rate or happening; The carcinoid tumor has a better prognosis, yet people should guard its initial bad change; malignant gestational trophoblastic tumor can be cured after the positive chemical treatment.
ObjectiveTo compare whether the training process of commissioned training residents from Tibet and non-commissioned training residents have achieved homogenized.MethodsThe training time and operation frequency data of 170 commissioned training residents from Tibet and 96 non-commissioned training residents of grade 2016 during the 19 months from September 2016 to April 2018 were collected. The 25 operational data of 11 departments that are representative and comparable are compared.ResultsThe two types of trainees completed the rotation of 47 different departments within 19 months, of which 45 departments were the departments where both types of students were rotated. Among these 11 departments, the average training time of trainees from Tibet in the Departments of Anesthesiology was lower than that of non-commissioned trainees (Z=–4.543, P<0.001). There were statistically significant differences in 7 of the 25 operating data (P<0.05). The operation number of arterial puncture and ventilator management (Intensive Care Unit); patient treatment (Department of Emergency); arterial puncture, ventilator management and intraoperative monitoring (Department of Anesthesiology) of trainees from Tibet were lower than those of non-commissioned trainees (P<0.05). The operation number of lung and mediastinal examinations (Department of Radiology) of trainees from Tibet was higher than that of non-commissioned trainees (P<0.05).ConclusionsDuring the training of the two types of trainees, the rotation schedule was basically the same, but there were differences in the clinical practice operations. Trainees from Tibet have higher requirements for radiology training. Trainees from Tibet will return to Tibet with independent practice needs, so their requirements of medical imaging skills operation would be higher. Due to language and training time, the critically ill, emergency first aid, and surgical skills of trainees from Tibet are not as good as those of non-commissioned trainees, and they need to gradually strengthen and improve these skills in subsequent trainings.
Objective To observe and evaluate the safety and efficacy of anti-vascular endothelial growth factor (VEGF) in the treatment of eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) in Lhasa, Tibet. MethodsA retrospective case series. From September 2018 to January 2022, a total of 41 patients (41 eyes) with BRVO-ME, who were diagnosed in Department of Ophthalmology of Tibet Autonomous Region People’s Hospital, were included in this study. There were 21 eyes in 21 males and 20 eyes in 20 females. The median age was 53 (31,75) years. There were 24 patients with hypertension (58.8%, 24/41). Best corrected visual acuity (BCVA), ocular pressure, fundus color photography and optical coherence tomography (OCT) were performed in all eyes. The BCVA was performed using the international standard logarithmic visual acuity chart, which was converted into logarithm of the minimum angle of resolution (logMAR) BCVA for record. The foveal macular thickness (CMT) was measured by OCT. All eyes were treated with intravitreous injection of anti-VEGF drugs, once a month, among which 23 eyes (56.1%, 23/41) received intravitreous injection of ranibizumab (IVR), and 18 eyes (43.9%, 18/41) received intravitreous injection of conbercept (IVC), and were grouped accordingly. There was no significant difference in age (Z=－0.447), gender composition (Z=－0.485), logMAR BCVA (t=－1.591), intraocular pressure (t=－0.167) and CMT (t=－1.290) between two groups (P＞0.05). During the follow-up, the same devices and methods were used at baseline to perform relevant examinations, and the changes of BCVA, intraocular pressure, CMT and new cardiovascular and cerebrovascular events were compared between baseline and the last follow-up. logMAR BCVA, intraocular pressure and CMT were compared between baseline and last follow-up using Student t test. The comparison of injection times and follow-up time between IVR group and IVC group was conducted by Mann-Whitney U test. ResultsAt baseline, logMAR BCVA, intraocular pressure, and CMT were 0.852±0.431, (12.5±2.5) mm Hg (1 mm Hg= 0.133 kPa), and (578.1±191.1) μm, respectively. At the last follow-up, the number of anti-VEGF drug treatments was (2.7±1.2) times; logMAR BCVA and CMT were 0.488±0.366 and (207.4±108.7) μm, respectively, with CMT > 250 μm in 14 eyes (34.1%, 14/41). Compared with baseline, BCVA (t=4.129) and CMT (t=－0.713) were significantly improved, with statistical significance (P＜0.001). The injection times of IVR group and IVC group were (2.6±0.9) and (3.0±1.5) times, respectively. There were no significant differences in the number of injection times (t=－1.275), logMAR BCVA (t=－0.492), intraocular pressure (t=0.351) and CMT (t=－1.783) between the two groups (P＞0.05). No new hypertension, cardiovascular and cerebrovascular events occurred in all patients during follow-up. At the last follow-up, there were no eye complications related to treatment modalities and drugs. ConclusionShort-term anti-VEGF treatment can improve the visual acuity of BRVO secondary ME patients and alleviate ME in Lhasa, Tibet. The safety and efficacy of ranibizumab and conbercept were similar.
Objective To investigate the inpatients disease constitution of the Tibet autonomous region people’s hospital, to provide baseline date for further rational drug use analysis. Methods The medical records of inpatients from 2014 to 2015 were collected from hospital information system. Diseases were classified based on international Classification of Diseases Coding (ICD-10). We analyzed the general situation, main discharge diagnosis and single diseases. Distribution of inpatients frequency, constituent ratio, cumulative frequency of diseases were calculated by Microsoft office 2007. Results (1) A total of 19 177 patients were discharged in 2014, sex ratio (male : female) was 1.07 : 1, involving all 21 system disease of ICD-10; 20 970 inpatients were discharged in 2015, the sex ratio was 1.05 : 1, covering 20 system diseases of ICD-10. (2) The constituent ratio of 3 diseases were over 10%: exogenous injury or poisoning, digestive disease and diseases concerning pregnancy, childbirth and puerperium. (3) The constituent ratio of 5 diseases were between 5% to 10%: respiratory diseases, circulatory system disease, the factors influencing health status and health care institutions contact-tumor morphology, genitourinary system disease, and tumor. (4) In 2014, the top of 10 single diseases based on constituent ratio were singletons natural birth, lung infection, chemotherapy, type 2 diabetes, gallstones with chronic cholecystitis, bronchial pneumonia, gall bladder stones, neonatal aspiration pneumonia, high altitude pulmonary edema, premature rupture of membranes; in 2015, the top 10 main single diseases included singletons natural birth, lung infection, tumor chemotherapy, type 2 diabetes, gallstones with chronic cholecystitis, bronchial pneumonia, cholelithiasis, neonatal aspiration pneumonia, cancer maintenance chemotherapy, iron deficiency anemia. Conclusion The inpatients disease composition of the Tibet autonomous region people’s hospital has certain regional specificity.
ObjectiveTo investigate the situation of tuberculosis (TB) infection in primary and middle school students and to provide scientific basis for TB prevention and control in Nyingchi. MethodsPrimary and middle school students in Nyingchi were investigated from 2006 to 2008 using a questionnaire, and purified protein derivative (PPD) tests were carried out among the sampling students. Data analysis was conducted by SPSS 13.0. ResultsIn 3 987 included primary and middle students, the positive, strongly positive and overall positive rates of PPD were 11.4%, 5.1%, 16.5%, respectively. Five patients with TB were found in the investigation, and the prevalence was 125.4 per 100 000. The positive and strongly positive rates were 11.3% and 4.4% in male, 11.5% and 5.7% in female, respectively. The positive and strongly positive rates were 6.9% and 3.9% in primary school students, 18.8%, 7.1% in middle school students, respectively. Both the positive rate and strongly positive rate in middle school students were higher than those in primary school students (P < 0.05). The positive rates in town, village and floating population were 16.5%, 9.5%, 8.9%, respectively, and their strongly positive rates were 6.1%, 4.8%, 1.4%, respectively. Both the positive rate and strongly positive rate in town were higher than those in village and floating population (P < 0.05). The strongly positive rates in Tibetan, the Han nationality and other ethnic minorities were 5.2%, 4.0%, 6.0%, respectively. The strongly positive rates in Tibetan and other ethnic minorities were higher than those in the Han nationality (P < 0.05). ConclusionThe infection and prevalence rate of TB of primary and middle school students in Nyingchi are fairly high. TB prevention and control for the high-risk populations should be strengthened in primary and middle schools in Nyingchi.
Objective To analyze the death constitution of inpatients in The Tibet Autonomous Region People's Hospital from 2014 to 2015 and to provide baseline data for further rational drug use. Methods The medical records of death inpatients between 2014 and 2015 were collected. We classified all diseases according to the international classification of diseases coding (ICD-10) and analyzed the general situation, main death discharge diagnosis and single death diseases. Distribution of inpatients frequency, constituent ratio, cumulative frequency of death diseases were calculated by EXCEL 2007 software. Results (1) A total of 40 147 patients were discharged and 339 (8.44‰) inpatients died between 2014 and 2015. The sex ratio of male to female was 2.08 to 1 for death inpatients. (2) Death constitution of four diseases' categories were over 10%, including circulatory system diseases, exogenous injury or poisoning system diseases, respiratory system diseases, and digestive system diseases. (3) Death constitution of 3 diseases' categories were between 5% to 10%, including tumor, abnormal signs and symptoms, urogenital system diseases. (4) The main death cause single diseases were cerebral hemorrhage diseases, myocardial infarction, respiratory failure, damage, pneumonia, cancer, neonatal hypoxic-ischemic encephalopathy. Conclusion The main death inpatients of the Tibet Autonomous Region People's Hospital are of the age 25 to 59, and the main death cause diseases are circulatory system diseases.