Objective: To explore the effect of comprehensive nursing on pain, anxiety and malnutrition of hepatitis B patients. Methods: Totally 100 cases of hepatitis B patients received treatment in our hospital from July 2017 to July 2018 were divided into a study group (64 cases) and a control group (36 cases) for comprehensive nursing and routine nursing. The liver function, nutritional indexes, cognition of relevant nursing knowledge, VAS score, HAMD and HAMA scores, QOL score, total effective rate and incidence of adverse reactions were detected. Results: Compared with the control group, the study group had lower liver function indexes and higher nutrition indexes, suggesting that the liver function of patients in the study group recovered better. Besides, the VAS score of the study group was lower, suggesting better pain relief in the study group. Moreover, the study group had higher scores of related nursing knowledge and lower scores of HAMD and HAMA, indicating that the nursing method in the study group was more effective in reducing depression and anxiety. Higher QOL score, higher total effective rate and lower incidence of adverse reactions of the study group revealed that the nursing mode adopted in this group was better for the recovery of patients. Conclusion: Comprehensive nursing can effectively alleviate the pain of hepatitis B patients, relieve their anxiety and other negative emotions, and improve their malnutrition.

Metamizole, or dipyrone, is a frequently prescribed analgetic drug that can cause drug-induced liver injury (DILI). Still, there are only a few metamizole-associated DILI cases (n = 61, including our study) described in the literature. So far liver transplantation has been reported in 6 patients with metamizole-induced acute liver failure. In 2020, a German group described a bigger cohort (n = 23) of metamizole-related DILI. Shortly thereafter, this issue gained wider attention as the German Federal Institute for Drugs and Medical Devices published a Direct Healthcare Professional Communication, emphasizing DILI as a potential adverse event caused by metamizole. We herein report 2 patients that were admitted to our liver transplant center due to acute liver failure (ALF) in April and May 2021. Both patients reported intake of metamizole as pain medication over a few weeks. After ruling out alternative reasons for ALF and fulfilling the King's College criteria both patients received emergency liver transplantations in our center. Pathology assessment of both explants were consistent with metamizole-associated DILI. As illustrated by our 2 cases of metamizole-induced liver failure with subsequent liver transplantation, this rare but presumably often overlooked adverse drug effect of metamizole should be considered as differential diagnosis in cases of cryptogenic liver failure.

The novel coronavirus pneumonia (NCP) has spread from Wuhan to all parts of China since December 2019, and the prevention and control of NCP is a top priority for medical staff. Now report three cases of NCP patients, whose viral nucleic acids still positive in stool after throat swab detection turned negative. In view of the highly homologous and similar clinical manifestations between the 2019 novel coronavirus (2019-nCoV) and the severe acute respiratory syndrome(SARS) related coronaviruses, it is recommended to attach great importance to the detection of the viral nucleic acids in stool, with the reference of SARS prevention and control experience. In order to minimize the risks of gastrointestinal spread, the detection of 2019-nCoV nucleic acids in stool may be recommended as the reference standard of disisolation and discharge. Key words: Novel coronavirus pneumonia; Stool; Throat swab; Prevention and control

BACKGROUND Coronavirus disease (COVID-19) has affected more than 100 countries worldwide and the discharge criteria of patients with COVID-19 vary across different countries. In China, patients with two negative respiratory viral RNA tests taken at least one day apart can be discharged with no further quarantine required. Currently, PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in fecal sample is not routinely performed. METHODS We present a patient with COVID-19, whose respiratory swabs became negative but fecal sample remained positive for SARS-CoV-2 RNA. RESULTS Stool sample collected on 27th of February was still positive for SARS-CoV-2 RNA, 24 days after the first negative respiratory swab. CONCLUSIONS Based on the experience from the 2003 SARS epidemic, we recommend that fecal RNA testing of SARS-CoV-2 should be incorporated into the discharge criteria to minimize the risk of transmission from the gastrointestinal tract.

BACKGROUND:Coronavirus disease 2019 (COVID-19) has spread outside the initial epicenter of Wuhan. We compared cases in Guangzhou and Wuhan to illustrate potential changes in pathogenicity and epidemiological characteristics as the epidemic has progressed.METHODS:We studied 20 patients admitted to the Third Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China from January 22 to February 12, 2020. Data were extracted from medical records. These cases were compared with the 99 cases, previously published in Lancet, from Wuhan Jinyintan Hospital from January 1 to January 20, 2020.RESULTS:Guangzhou patients were younger and had better prognosis than Wuhan patients. The Wuhan patients were more likely to be admitted to the ICU (23% vs 5%) and had a higher mortality rate (11% vs 0%). Cases in Guangzhou tended to be more community clustered. Diarrhea and vomiting were more common among Guangzhou patients and SARS-CoV-2 RNA was found in feces. Fecal SARA-CoV-2 RNA remained positive when nasopharyngeal swabs turned negative in some patients.CONCLUSIONS:This study indicates possible diminishing virulence of the virus in the process of transmission. Yet persistent positive RNA in feces after negative nasopharyngeal swabs suggests a possible prolonged transmission period that challenges current quarantine practices.