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Sample records for acutely ill child

  1. Mayaro Virus in Child with Acute Febrile Illness, Haiti, 2015.

    Science.gov (United States)

    Lednicky, John; De Rochars, Valery Madsen Beau; Elbadry, Maha; Loeb, Julia; Telisma, Taina; Chavannes, Sonese; Anilis, Gina; Cella, Eleonora; Ciccozzi, Massinno; Okech, Bernard; Salemi, Marco; Morris, J Glenn

    2016-11-01

    Mayaro virus has been associated with small outbreaks in northern South America. We isolated this virus from a child with acute febrile illness in rural Haiti, confirming its role as a cause of mosquitoborne illness in the Caribbean region. The clinical presentation can mimic that of chikungunya, dengue, and Zika virus infections.

  2. [Abnormal reaction for anaesthetics in a critically ill child with acute myeloid leukemia--case report].

    Science.gov (United States)

    Bujok, Grzegorz; Knapik, Piotr; Macioł, Zbigniew

    2004-01-01

    The authors present a case report of an abnormal reaction for anaesthetics correlated with cytostatic therapy in the course of preparation time for bone marrow transplantation due to acute myeloid leukemia. Problems of pharmacological interaction of ketamine and benzodiazepines are emphasized. Special attention was paid to the risk of abnormal drug reactions during general anaesthesia in children with leukemia.

  3. Helping a Child Manage a Chronic Illness

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_160011.html Helping a Child Manage a Chronic Illness Feeling they have control over their ... News) -- Children and teens who feel confident handling a chronic illness on their own appear better able ...

  4. Determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness

    Directory of Open Access Journals (Sweden)

    Zümrüt Başbakkal

    2010-02-01

    Full Text Available The study is executed with mothers of children aged 3-6 (n=170 whose children were hospitalized for the first time between the dates of 15.07.2003 and 15.06.2006, who were reachable by phone and accepted to participate in the study aiming determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness.In this study, for data gathering "Personal Information Form" including 15 questions and "Inquiry Form of Behavior Changes of  3-6 Ages Group Children After Being Hospitalized" with 30 questions were used. Date gathering forms were carried out as pre-test by using face-to-face interview method with mothers of 3-6 aged children who were hospitalized for the first time and were in first 12 hours of hospitalization. "Inquiry Form of Behavior Changes of 3-6 Ages Group Children After Being Hospitalized" was re-carried out with mothers by phone 1 month after children being discharged from hospital.In analyzing of datas statistical programme of SPSS 13.0 for Windows was used. In statistical evaluation;  number-percent dispersion, Wilcoxon Sing Rank test and Paired Sample-t test were used.According to the results obtained from the study, 57.6% of children are male with age average of 4,46±1,18 and 52.3% of them were hospitalized due to Gastroentestinal System Illnesses. A significant difference was determined between average points of behavior changes of 3-6 ages group children hospitalized due to an acute illness before hospitalized (10,735±4,882 and after being discharged from hospital (15,0476±4,306. In the study, it is observed that there are some behavioral changes in children after being hospitalized such as being cranky before going to bed and during eating, disquiet, bed-wetting, seperation anxiety, excessive attachment to a parent, to need help even for the things he/she could accomplish, to have fear from new environments, people or objects, bad temper attacks, fear of doctor/nurse and hospital

  5. Determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illnessDetermination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness

    Directory of Open Access Journals (Sweden)

    Nesrin Şen Celasin

    2010-02-01

    Full Text Available The study is executed with mothers of children aged 3-6 (n=170 whose children were hospitalized for the first time between the dates of 15.07.2003 and 15.06.2006, who were reachable by phone and accepted to participate in the study aiming determination of behavioral reactions of a child of 3-6 ages group to be hospitalized due to an acute illness.In this study, for data gathering "Personal Information Form" including 15 questions and "Inquiry Form of Behavior Changes of 3-6 Ages Group Children After Being Hospitalized" with 30 questions were used. Date gathering forms were carried out as pre-test by using face-to-face interview method with mothers of 3-6 aged children who were hospitalized for the first time and were in first 12 hours of hospitalization. "Inquiry Form of Behavior Changes of 3-6 Ages Group Children After Being Hospitalized" was re-carried out with mothers by phone 1 month after children being discharged from hospital.In analyzing of datas statistical programme of SPSS 13.0 for Windows was used. In statistical evaluation; number-percent dispersion, Wilcoxon Sing Rank test and Paired Sample-t test were used.According to the results obtained from the study, 57.6% of children are male with age average of 4,46±1,18 and 52.3% of them were hospitalized due to Gastroentestinal System Illnesses. A significant difference was determined between average points of behavior changes of 3-6 ages group children hospitalized due to an acute illness before hospitalized (10,735±4,882 and after being discharged from hospital (15,0476±4,306. In the study, it is observed that there are some behavioral changes in children after being hospitalized such as being cranky before going to bed and during eating, disquiet, bed-wetting, seperation anxiety, excessive attachment to a parent, to need help even for the things he/she could accomplish, to have fear from new environments, people or objects, bad temper attacks, fear of doctor/nurse and hospital, fear

  6. Acute Stress Response in Critically Ill Children

    NARCIS (Netherlands)

    M. den Brinker (Marieke)

    2006-01-01

    textabstractThe understanding of the endocrine changes in critically ill children is important, as it provides insights in the pathophysiology of the acute stress in children and its differences compared with adults. Furthermore, it delineates prognostic factors for survival and supports the rati

  7. Energy expenditure of acutely ill hospitalised patients

    Directory of Open Access Journals (Sweden)

    Gariballa Salah

    2006-03-01

    Full Text Available Abstract Objective To measure energy expenditure of acutely ill elderly patients in hospital and following discharge in the community. Design Sixty-three consecutive hospitalised acutely ill elderly patients were recruited. Eight patients were studied to assess the reliability of the Delta Tract Machine as a measure of energy expenditure; 35 patients had their energy expenditure studied in hospital on two occasions and 20 patients had their energy expenditure measured in hospital and at 6 weeks in the community Results Men had higher basal energy expenditure (BMR values compared to women however the difference was not statistically significant [Men, mean (SD 1405 (321 Kcal, women 1238 (322 kcal; mean difference (95% CI 166 kcal (-17 to 531, p = 0.075]. After adjusting for age, gender and body mass index both medication and C-reactive protein (CRP, concentrations showed significant correlation with measured energy expenditure in hospital, (r = -0.36, "p Conclusion Tissue inflammation and medications were associated with change in measured energy expenditure in acutely ill patients.

  8. Caring for a Seriously Ill Child

    Science.gov (United States)

    ... to your child, you may refer to your religious, spiritual, and cultural beliefs about death. You might ... The foremost — and perhaps trickiest — task for worried parents is to treat a sick child as normally ...

  9. Factors associated with acute respiratory illness in day care children.

    Science.gov (United States)

    Hatakka, Katja; Piirainen, Laura; Pohjavuori, Sara; Poussa, Tuija; Savilahti, Erkki; Korpela, Riitta

    2010-09-01

    The aim of this study was to investigate the relationship between child characteristics, parental and environmental factors and the occurrence of acute respiratory illness (ARI) and acute otitis media (AOM) among Finnish children attending day care centres (DCCs). The study was a cross-sectional questionnaire of 594 children aged 1-6 y from 18 DCCs in Helsinki, Finland. Recurrent (> or =4 diseases/y) ARI was present in 44% of the 1-3-y-olds and 23% of the 4-6-y-olds, and recurrent AOM in 15% and 2.5%, respectively. Parent atopic disease (odds ratio (OR) 1.53, p = 0.033), mother's academic education (OR 1.77, p = 0.008) and a medium length of DCC attendance compared to a short period (OR 1.67, p = 0.049) increased, while furry pets (OR 0.44, p = 0.003) and older child age (OR 0.38, p or =6 months (OR 0.20, p = 0.002) and older child age (OR 0.05, p < 0.001) reduced the risk of recurrent AOM. Parental and environmental factors had a significant impact on recurrent ARI and AOM episodes in children attending DCCs. These risk factors should be considered in future studies intending to reduce DCC infections.

  10. Ministry to the Chronically Ill Child.

    Science.gov (United States)

    Spinetta, Pat Deasy; Collins, Denis E.

    1993-01-01

    Reports growth in the number of chronically ill children attending Catholic schools. Describes the separate roles of home, school, and hospital in children's long-term care. Urges educators to obtain necessary information on children's attendance, peer interaction, education, and medical compliance. Reviews issues specific to chronically ill…

  11. Burden of Self-reported Acute Gastrointestinal Illness in Cuba

    OpenAIRE

    Prieto, Pablo Aguiar; Finley, Rita L; Muchaal, P.K.; Guerin, Michele T; Isaacs, Sandy; Domínguez, Arnaldo Castro; Marie, Gisele Coutín; Perez, Enrique

    2009-01-01

    Acute gastrointestinal illness is an important public-health issue worldwide. Burden-of-illness studies have not previously been conducted in Cuba. The objective of the study was to determine the magnitude, distribution, and burden of self-reported acute gastrointestinal illness in Cuba. A retrospective, cross-sectional survey was conducted in three sentinel sites during June-July 2005 (rainy season) and during November 2005–January 2006 (dry season). Households were randomly selected from a ...

  12. Siblings of the Child with a Life-Threatening Illness.

    Science.gov (United States)

    Sourkes, Barbara M.

    1987-01-01

    The experience of siblings of a child with a life-threatening illness may be seen at the juncture of the following perspectives: (1) the family system; (2) a focus on living rather than on dying; and (3) a view toward positive adaptation rather than toward psychopathology. The most critical focus is on the sibling-patient relationship itself. (BJV)

  13. Parents' help-seeking behaviours during acute childhood illness at home: A contribution to explanatory theory.

    Science.gov (United States)

    Neill, Sarah J; Jones, Caroline H D; Lakhanpaul, Monica; Roland, Damian T; Thompson, Matthew J

    2016-03-01

    Uncertainty and anxiety surround parents' decisions to seek medical help for an acutely ill child. Consultation rates for children are rising, yet little is known about factors that influence parents' help-seeking behaviours. We used focus groups and interviews to examine how 27 parents of children under five years, from a range of socioeconomic groups in the East Midlands of England, use information to make decisions during acute childhood illness at home. This article reports findings elucidating factors that influence help-seeking behaviours. Parents reported that decision-making during acute childhood illness was influenced by a range of personal, social and health service factors. Principal among these was parents' concern to do the right thing for their child. Their ability to assess the severity of the illness was influenced by knowledge and experience of childhood illness. When parents were unable to access their general practitioner (GP), feared criticism from or had lost trust in their GP, some parents reported using services elsewhere such as Accident and Emergency. These findings contribute to explanatory theory concerning parents' help-seeking behaviours. Professional and political solutions have not reduced demand; therefore, collaborative approaches involving the public and professionals are now needed to improve parents' access to information.

  14. The First Steps to Learning with a Child Who Has a Mental Illness

    Science.gov (United States)

    Baxter, Joanne

    2009-01-01

    This article shares the author's experience in dealing with her child who has a mental illness. The author hopes that other teachers and school administrators would find her experience helpful when dealing with mentally ill children. The author describes the first steps to learning with a child with a mental illness.

  15. Headache in the presentation of noncephalic acute illness

    Directory of Open Access Journals (Sweden)

    Tomer Tzadok

    2015-01-01

    Full Text Available Background: Headache is a frequent symptom of many systemic diseases that do not involve cranial structures. In this observational study, we assessed factors associated with headache in the acute presentation of systemic conditions in a nonsurgical emergency department (ED. Methods: Consecutive patients, admitted to Soroka University Medical Center ED due to noncephalic illness, were prospectively surveyed using a structured questionnaire focused on the prevalence and characteristics of headache symptoms. Medical data were extracted from the patient's charts. Results: Between 1 and 6/2012, 194 patients aged 64.69 ± 19.52 years, were evaluated. Headache was reported by 83 (42.7% patients and was more common among patients with febrile illness (77.5% vs. 22.5%, P < 0.001. Respiratory illness and level of O2saturation were not associated with headache. Headache in the presentation of a noncephalic illness was associated with younger age (58 vs. 69, P < 0.001 and with suffering from a primary headache disorder (48.2% vs. 10.8%, P < 0.001. Headache was also associated with higher body temperature and lower platelets count. Conclusions: Headache is a common symptom in acute noncephalic conditions and was found to be associated with younger age and febrile disease on presentation. Patients who present with primary headache disorders are more prone to have headache during acute illness. Acute obstructive respiratory disease, hypercarbia or hypoxemia were not associated with headache.

  16. Unusual Presentation of Dengue Fever; A child with acute myocarditis

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    Moaz Aslam

    2016-02-01

    Full Text Available Dengue fever (DF is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.

  17. Thrombo-prophylaxis in acutely ill medical and critically ill patients

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    Saurabh Saigal

    2014-01-01

    Full Text Available Thrombo-prophylaxis has been shown to reduce the incidence of pulmonary embolism (PE and mortality in surgical patients. The purpose of this review is to find out the evidence-based clinical practice criteria of deep vein thrombosis (DVT prophylaxis in acutely ill medical and critically ill patients. English-language randomized controlled trials, systematic reviews, and meta-analysis were included if they provided clinical outcomes and evaluated therapy with low-dose heparin or related agents compared with placebo, no treatment, or other active prophylaxis in the critically ill and medically ill population. For the same, we searched MEDLINE, PUBMED, Cochrane Library, and Google Scholar. In acutely ill medical patients on the basis of meta-analysis by Lederle et al. (40 trials and LIFENOX study, heparin prophylaxis had no significant effect on mortality. The prophylaxis may have reduced PE in acutely ill medical patients, but led to more bleeding events, thus resulting in no net benefit. In critically ill patients, results of meta-analysis by Alhazzani et al. and PROTECT Trial indicate that any heparin prophylaxis compared with placebo reduces the rate of DVT and PE, but not symptomatic DVT. Major bleeding risk and mortality rates were similar. On the basis of MAGELLAN trial and EINSTEIN program, rivaroxaban offers a single-drug approach to the short-term and continued treatment of venous thrombosis. Aspirin has been used as antiplatelet agent, but when the data from two trials the ASPIRE and WARFASA study were pooled, there was a 32% reduction in the rate of recurrence of venous thrombo-embolism and a 34% reduction in the rate of major vascular events.

  18. Acute appendicitis in acute leukemia and the potential role of decitabine in the critically ill patient

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    Deepti Warad

    2015-01-01

    Full Text Available Acute appendicitis in children with acute leukemia is uncommon and often recognized late. Immunocompromised host state coupled with the importance of avoiding treatment delays makes management additionally challenging. Leukemic infiltration of the appendix though rare must also be considered. Although successful conservative management has been reported, surgical intervention is required in most cases. We present our experience with acute appendicitis in children with acute leukemia and a case of complete remission of acute myeloid leukemia with a short course of decitabine. Decitabine may serve as bridging therapy in critically ill patients who are unable to undergo intensive chemotherapy.

  19. New insights towards the acute nonthyroidal illness syndrome

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    ANA LUIZA eMAIA

    2012-01-01

    Full Text Available The non-thyroidal illness syndrome (NTIS refers to changes in serum thyroid hormone levels observed in critically-ill patients in the absence of hypothalamic-pituitary-thyroid primary dysfunction. Affected individuals have low T3, elevated rT3 and inappropriately normal TSH levels. The pathophysiological mechanisms are poorly understood but the acute and chronic changes in pituitary–thyroid function are probably the consequence of the action of multiple factors. The early phase seems to reflect changes occurring primarily in the peripheral thyroid hormone metabolism, best seen in humans since 80-90% of the circulating T3 are derived from the pro-hormone T4. The conversion of T4-to-T3 is catalyzed by type 1 (D1 and type 2 (D2 deiodinases via outer-ring deiodination. In contrast, type 3 deiodinase (D3 catalyzes the inactivation of both T4 and T3. Over the last decades, several studies have attempted to elucidate the mechanisms underlying the changes on circulating thyroid hormones in NTIS. Increased inflammatory cytokines, which occurs in response to virtually any illness, has long been speculated to play a role in derangements of deiodinase expression. On the other hand, oxidative stress due to augmented reactive oxygen species (ROS generation is characteristic of many diseases that are associated with NTIS. Changes in the intracellular redox state may disrupt deiodinase function by independent mechanisms, which might include depletion of the as yet unidentified endogenous thiol cofactor. Here we aim to present an updated picture of the advances in understanding the mechanisms that result in the fall of thyroid hormone levels in the acute phase of NTIS.

  20. Place of Child Care and Medicated Respiratory Illness among Young American Children.

    Science.gov (United States)

    Presser, Harriet B.

    1988-01-01

    Study based on Child Health Supplement to 1981 National Health Interview Survey showed higher prevalence of medicated respiratory illness among children under age five when they were cared for outside the home. For children under age three, prevalence was highest in child care centers, lower in other homes, and lowest in own home. (Author/NB)

  1. An assessment tool for acutely ill medical patients.

    LENUS (Irish Health Repository)

    Gleeson, Margaret

    2012-01-26

    This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.

  2. An assessment tool for acutely ill medical patients.

    LENUS (Irish Health Repository)

    Gleeson, Margaret

    2012-01-31

    This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.

  3. Acute HIV illness following blood transfusion in three African children.

    Science.gov (United States)

    Colebunders, R; Greenberg, A E; Francis, H; Kabote, N; Izaley, L; Nguyen-Dinh, P; Quinn, T C; Van der Groen, G; Curran, J W; Piot, P

    1988-04-01

    Three children are described in whom pre-transfusion samples were HIV-seronegative and post-transfusional samples, obtained within 1 week after transfusion, were HIV-seropositive. Two of them developed a transient fever within 1 week of receiving the blood transfusion, and a transient generalized skin eruption which lasted for about 2 weeks. All three developed persistent generalized lymphadenopathy. One child developed a lumbar herpes zoster 7 months after transfusion. IgM Western blots demonstrated the presence of antibodies to protein bands p17, p24 and p55 in all three children. These three case reports suggest that children who receive a seropositive blood transfusion are at high risk for developing acute manifestations of HIV infection.

  4. Acute Hydrocephaly Following Methadone Intoxication in a Child

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    Afshin FAYYAZI

    2012-03-01

    Full Text Available Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication.

  5. Monitorization of Acute Brain Dysfunction in Critical Illness

    Directory of Open Access Journals (Sweden)

    Günseli Orhun

    2016-08-01

    Full Text Available Acute brain dysfunction is a clinical condition which is commonly observed in intensive care units and exhibits neurological changes ranging from delirium to coma. Typically observed during sepsis in critical patients, this syndrome is also named as “sepsis-associated encephalopathy” and this situation is of significance since it is related to mortality, increase of morbidity and long-term cognitive impairment. Monitorization of brain functions in critically ill patients should be commenced with detailed neurological examination and effects of sedative drugs, which can alter neurological responses during evaluation, should be taken into consideration. On the other hand, brain imaging methods and electrophysiological examinations are diagnostic procedures which complement neurological examination. While computed tomography enables diagnosis of structural intracerebral lesions, magnetic resonance imaging provides important information on primary pathological mechanisms of sepsis-associated encephalopathy and structural alterations developing in the brain. Evidence of diagnosis and prognosis of acute brain dysfunction can be acquired through use of electroencephalography for. Although it was believed that neurological biomarkers can be useful in determination of diagnosis and prognosis, further studies are needed in this subject.

  6. Talking with a child about a parent's terminal illness

    Science.gov (United States)

    ... much as you can without covering up the truth. Explain that your child will continue to live with the surviving parent after you die. The parent without cancer can say, "I do not have cancer. I ...

  7. Preventing the Spread of Illness in Child Care or School

    Science.gov (United States)

    ... Turn off Animations Turn on Animations Our Sponsors Log in | Register Menu Log in | Register Home Our Sponsors Ages & Stages Ages & ... several years of life as their bodies are building immunity to infections. In many child care facilities, ...

  8. Is my child sick? Parents management of signs of illness and experiences of the medical encounter

    DEFF Research Database (Denmark)

    Ertmann, Ruth Kirk; Reventlow, Susanne; Söderström, Margareta

    2011-01-01

    OBJECTIVES: Parents of sick children frequently visit their general practitioners (GPs). The aim was to explore parents' interpretation of their child's incipient signs and symptoms when falling ill and their subsequent unsatisfactory experience with the GP in order to make suggestions...... for improvements in the medical encounter. DESIGN: Semi-structured interviews. SETTING AND SUBJECTS: Twenty strategically selected families with a child from a birth cohort in Frederiksborg County, Denmark were interviewed. RESULTS: Parents wanted to consult their GP at the right time, i.e. neither too early nor...... with the GP's advice if the child only occasionally became sick. However, parents of children with recurrent illnesses seemed very frustrated. During the course of several consultations with their GP, they started to question the GP's competence as the child did not regain health. CONCLUSIONS: Parents want...

  9. Parents' Grief in the Context of Adult Child Mental Illness: A Qualitative Review

    Science.gov (United States)

    Richardson, Meg; Cobham, Vanessa; Murray, Judith; McDermott, Brett

    2011-01-01

    Research indicates that parents and other family members often grieve their child or relative's mental illness. This grief appears resultant from a profound sense of loss, which has been described as complicated and nonfinite (e.g., Atkinson in "Am J Psychiatry" 151(8):1137-1139, 1994; Davis and Schultz in "Soc Sci Med" 46(3):369-379, 1998; Jones…

  10. Care taker blogs in caregiver fabricated illness in a child: a window on the caretaker's thinking?

    Science.gov (United States)

    Brown, Ana N; Gonzalez, Gioia R; Wiester, Rebecca T; Kelley, Maureen C; Feldman, Kenneth W

    2014-03-01

    Three recently diagnosed cases of caregiver-fabricated illness in a child at Seattle Children's Hospital shed light on a new manifestation of their caretakers' attention seeking. The patients' mothers were actively blogging about their children's reputed illnesses. Although it is not uncommon for parents of chronically ill children to blog about their child's medical course, specific themes in these blogs of parents suspected of medically abusing their children were noted. In particular, gross distortions of the information parents had received from medical providers were presented online, describing an escalation of the severity of their children's illnesses. The mothers reported contacting palliative care teams and Wish organizations, independently from their medical providers' recommendations. They sought on-line donations for their children's health needs. We believe these blogs provide additional direct evidence of the suspected caregivers' fabrications. Although we have not performed formal content analysis, blogs might also provide insight into the caretakers' motivations. Protective Services and/or police investigators could consider querying the internet for blogs related to children at risk for caregiver-fabricated illness in a child. These blogs, if viewed in parallel with the children's medical records, could assist medical diagnosis and legal documentation of medical fabrication and assist in protective planning for the affected children.

  11. Domestic violence in women with serious mental illness involved with child protective services.

    Science.gov (United States)

    Lewin, Linda C; Abdrbo, Amany; Burant, Christopher J

    2010-02-01

    The purpose of this study is to describe mothers with serious mental illness who have experienced domestic violence and are involved with child protective services. One hundred twenty-two files from the Department of Child and Family Services were reviewed. According to this retrospective review, the majority of the mothers and children had been exposed to domestic violence (62.6%). Mothers with the diagnoses of major depression-single episode and major depression-recurrent were most likely to have disclosed domestic violence exposure, compared to mothers with other serious mental illnesses. Our findings, and that of other cited studies, support the practice of routine assessment of domestic violence in women with serious mental illnesses, identification of safe havens for mothers and children, and access to continuing parenting support for these vulnerable family groups.

  12. Connecting a sociology of childhood perspective with the study of child health, illness and wellbeing: introduction.

    Science.gov (United States)

    Brady, Geraldine; Lowe, Pam; Olin Lauritzen, Sonja

    2015-02-01

    In the last decades we have seen a growing interest in research into children's own experiences and understandings of health and illness. This development, we would argue, is much stimulated by the sociology of childhood which has drawn our attention to how children as a social group are placed and perceived within the structure of society, and within inter-generational relations, as well as how children are social agents and co-constructors of their social world. Drawing on this tradition, we here address some cross-cutting themes that we think are important to further the study of child health: situating children within health policy, drawing attention to practices around children's health and well-being and a focus on children as health actors. The paper contributes to a critical analysis of child health policy and notions of child health and normality, pointing to theoretical and empirical research potential for the sociology of children's health and illness.

  13. Postpyloric enteral nutrition in the critically ill child with shock: a prospective observational study

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    Bustinza Amaya

    2008-01-01

    Full Text Available Abstract Background Tolerance to enteral nutrition in the critically ill child with shock has not been studied. The purpose of the study was to analyze the characteristics of enteral nutrition and its tolerance in the critically ill child with shock and to compare this with non-shocked patients. Methods A prospective, observational study was performed including critically ill children with shock who received postpyloric enteral nutrition (PEN. The type of nutrition used, its duration, tolerance, and gastrointestinal complications were assessed. The 65 children with shock who received PEN were compared with 461 non-shocked critically ill children who received PEN. Results Sixty-five critically ill children with shock, aged between 21 days and 22 years, received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty patients with shock (30.7% presented gastrointestinal complications, 10 (15.4% abdominal distension and/or excessive gastric residue, 13 (20% diarrhoea, 1 necrotising enterocolitis, and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal complications was significantly higher than in the other 461 critically ill children (9.1%. PEN was suspended due to gastrointestinal complications in 6 patients with shock (9.2%. There were 18 deaths among the patients with shock and PEN (27.7%. In only one patient was the death related to complications of the nutrition. Conclusion Although most critically ill children with shock can tolerate postpyloric enteral nutrition, the incidence of gastrointestinal complications is higher in this group of patients than in other critically ill children.

  14. Are parenting behaviors associated with child sleep problems during treatment for acute lymphoblastic leukemia?

    Science.gov (United States)

    McCarthy, Maria C; Bastiani, Jessica; Williams, Lauren K

    2016-07-01

    Sleep disturbance is a recognized common side effect in children treated for acute lymphoblastic leukemia (ALL). Although associated with treatment factors such as hospitalization and corticosteroids, sleep problems may also be influenced by modifiable environmental factors such as parenting behaviors. The purpose of this study was to examine sleep problems in children undergoing treatment for ALL compared to healthy children and whether parenting practices are associated with sleep difficulties. Parents of 73 children aged 2-6 years who were (1) in the maintenance phase of ALL treatment (ALL group, n = 43) or (2) had no major medical illness (healthy control group, n = 30) participated in the study. Parents completed questionnaires measuring their child's sleep behavior and their own parenting practices. Parents of children undergoing ALL treatment reported significantly more child sleep problems; 48% of children with ALL compared to 23% of healthy children had clinical levels of sleep disturbance. Parents of the ALL group also reported significantly more lax parenting practices and strategies associated with their child's sleep including co-sleeping, comforting activities, and offering food and drink in the bedroom. Results of multivariate regression analysis indicated that, after controlling for illness status, parent-child co-sleeping was significantly associated with child sleep difficulties. Strategies employed by parents during ALL treatment may be a potential modifiable intervention target that could result in improved child sleep behaviors. Future research aimed at developing and testing parenting interventions aimed to improve child sleep in the context of oncology treatment is warranted.

  15. Preventable infant mortality and quality of health care: maternal perception of the child's illness and treatment

    Directory of Open Access Journals (Sweden)

    Hadad Salime

    2002-01-01

    Full Text Available This study used a qualitative methodology to analyze the discourse of mothers from Greater Metropolitan Belo Horizonte, Minas Gerais, Brazil, whose infant children had died from what were considered avoidable causes (diarrhea, malnutrition, and pneumonia, seeking to elucidate the factors associated with utilization of health care services. Identification of the illness by the mother was related to perception of specific alterations in the child's state of health. Analysis of the alterations helped identify the principal characteristics ascribed to each alteration and their relationship to the search for treatment. The authors also studied the mother's assessment of treatment received at health care facilities; 43.0% of the cases involved problems related to the structure of health care services or the attending health care professionals. In 46.0% of the cases, mothers associated the child's death with flaws in the health care service. The study group showed a variety of interpretations of illness, often distinct from the corresponding biomedical concepts. The fact that attending health care personnel overlooked or underrated the mother's perception of the illness and the lack of communications between health care personnel and the child's family had an influence on the child's evolution and subsequent death.

  16. Coping with a child with acute lymphocytic leukemia: the experiences of Chinese fathers in Hong Kong.

    Science.gov (United States)

    Wills, Betty Shuc Han

    2009-01-01

    Using a qualitative approach, this article aims to describe the experiences of Hong Kong Chinese fathers whose children were diagnosed with acute lymphocytic leukemia. The experiences and coping strategies used were viewed from the gender perspective. Two in-depth interviews scheduled to coincide with the disease trajectory of acute lymphocytic leukemia were conducted with 9 fathers, and data were analyzed using the matrix system described by Miles and Huberman. Four categories were identified, including fathers' initial reactions to the child's confirmed diagnosis, the decision to disclose the child's diagnosis to others, social support of the fathers, and their effective coping mechanisms. Previous research has shown that men are expected to be emotionally strong to support their spouse. Findings from this study indicate that Hong Kong Chinese fathers need emotional support especially at the onset of the child's diagnosis. Implications for healthcare professionals include the need for ongoing psychosocial support and education over the course of the child's illness. Thus, assessment of the different coping strategies used by the fathers plays a vital role in providing quality care to these fathers. Limitations of the study and recommendations for future research are also included.

  17. Experiences of parenting a child with medical complexity in need of acute hospital care.

    Science.gov (United States)

    Hagvall, Monica; Ehnfors, Margareta; Anderzén-Carlsson, Agneta

    2016-03-01

    Parents of children with medical complexity have described being responsible for providing advanced care for the child. When the child is acutely ill, they must rely on the health-care services during short or long periods of hospitalization. The purpose of this study was to describe parental experiences of caring for their child with medical complexity during hospitalization for acute deterioration, specifically focussing on parental needs and their experiences of the attitudes of staff. Data were gathered through individual interviews and analyzed using qualitative content analysis. The care period can be interpreted as a balancing act between acting as a caregiver and being in need of care. The parents needed skilled staff who could relieve them of medical responsibility, but they wanted to be involved in the care and in the decisions taken. They needed support, including relief, in order to meet their own needs and to be able to take care of their children. It was important that the child was treated with respect in order for the parent to trust the staff. An approach where staff view parents and children as a single unit, as recipients of care, would probably make the situation easier for these parents and children.

  18. Violence by Parents Against Their Children: Reporting of Maltreatment Suspicions, Child Protection, and Risk in Mental Illness.

    Science.gov (United States)

    McEwan, Miranda; Friedman, Susan Hatters

    2016-12-01

    Psychiatrists are mandated to report suspicions of child abuse in America. Potential for harm to children should be considered when one is treating parents who are at risk. Although it is the commonly held wisdom that mental illness itself is a major risk factor for child abuse, there are methodologic issues with studies purporting to demonstrate this. Rather, the risk from an individual parent must be considered. Substance abuse and personality disorder pose a separate risk than serious mental illness. Violence risk from mental illness is dynamic, rather than static. When severe mental illness is well-treated, the risk is decreased. However, these families are in need of social support.

  19. Diphtheria-like illness in a fully immunised child caused by Corynebacterium pseudodiphtheriticum

    Directory of Open Access Journals (Sweden)

    V A Indumathi

    2014-01-01

    Full Text Available Corynebacterium pseudodiphtheriticum is a common commensal flora of the upper respiratory tract in humans. Though the pathogenicity of C. pseudodiphtheriticum is not rare, its role as an opportunistic pathogen is mainly limited to the lower respiratory tract, particularly in patients with underlying systemic conditions or immune-compromisation. We hereby present the first case of C. pseudodiphtheriticum causing diphtheria-like illness affecting the upper respiratory tract of a 6-year-old fully immunised otherwise healthy child. In countries with very low incidence of diphtheria, C. pseudodiphtheriticum should be included in differential diagnosis for a child presenting with diphtheria-like illness. Simple, rapid screening tests should be used to differentiate it from C. diphtheriae and hence, to prevent unnecessary concern in community.

  20. Evaluation of the child with acute ataxia: a systematic review.

    Science.gov (United States)

    Whelan, Harry T; Verma, Sumit; Guo, Yan; Thabet, Farouq; Bozarth, Xiuhua; Nwosu, Michelle; Katyayan, Akshat; Parachuri, Venu; Spangler, Katie; Ruggeri, Barbara E; Srivatsal, Sindhu; Zhang, Guojun; Ashwal, Stephen

    2013-07-01

    Evaluation of acute ataxia in a child poses a dilemma for the clinician in determining the extent and timing of initial screening tests. This article reviews the evidence concerning the diagnostic yield of commonly ordered tests in evaluating the child with acute ataxia. The literature revealed the following frequencies of laboratory screening abnormalities in children with acute ataxia: CT (∼2.5%), MRI (∼5%), lumbar puncture (43%), EEG (42%), and toxicology (49%). In most studies, abnormalities detected by these screening tests were nondiagnostic. There are insufficient data to assess yields of testing for autoimmune disorders or inborn errors of metabolism. A toxicology screen should be considered in all children presenting with acute ataxia. Neuroimaging should be considered in all children with new onset ataxia. Cerebrospinal fluid analysis has limited diagnostic specificity unless clinically indicated. Studies to examine neurophysiology testing did have sufficient evidence to support their use. There is insufficient evidence to establish a role for autoantibody testing or for routine screening for inborn error of metabolism in children presenting with acute ataxia. Finally, in a child presenting with ataxia and opsoclonus myoclonus, urine catecholamine testing for occult neuroblastoma is recommended. Nuclear scan may be considered, however, there is insufficient evidence for additional body imaging.

  1. Malnutrition in acutely ill children at the paediatric emergency unit in a tertiary hospital in Nigeria

    Directory of Open Access Journals (Sweden)

    Isaac E Ocheke

    2015-01-01

    Full Text Available Background: In many developing countries, malnutrition remains an important cause of morbidity and mortality particularly in under-five children. The factors responsible for malnutrition could be immediate, underlying or basic, acting either alone or together. It has been shown that children who are malnourished have poorer outcomes from other illnesses than well-nourished children. It is important therefore to periodically describe the extent and pattern of childhood malnutrition so that effective preventive measures can be put in place. Objective: To describe the prevalence and pattern of malnutrition in children presenting with acute illnesses at the Jos University Teaching Hospital. Patients and Methods: A cross-sectional descriptive study in children aged 6 to 59 months seen at the paediatric emergency unit from April to October 2012. The subjects were recruited consecutively. Each child had both clinical assessment and appropriate laboratory evaluations done alongside anthropometric measurements. The nutritional/dietary and socio-demographic histories were also obtained. Results: Of the 379 children, 224 (59.1% were males and 155 (40.9% females. The median age was 17 months, range (6-57. Wasting (WFH z-scores ≤−3 to <−1SD was evident in one hundred children, giving an overall prevalence of 26.9%. Severe wasting (WFH z-score <−3, was present in 22 (5.9% children indicating the prevalence of marasmus, whereas only two children (0.53% had oedematous malnutrition (kwashiorkor. Stunting or chronic malnutrition, (HFA z-scores ≤−3 to <−1SD was present in 67 children (18.0%. Seventeen (4.6% were severely stunted (HFA z-score <−3. Conclusions: Wasting was the most common form of malnutrition in the study.

  2. Can illness perceptions predict lower heart rate variability following acute myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Mary Princip

    2016-11-01

    Full Text Available Objective: Decreased heart rate variability (HRV has been reported to be a predictor of mortality after myocardial infarction (MI. Patients’ beliefs and perceptions concerning their illness may play a role in decreased HRV. This study investigated if illness perceptions predict HRV at three months following acute MI. Methods: 130 patients referred to a tertiary cardiology centre, were examined within 48 hours and three months following acute MI. At admission, patients’ cognitive representations of their MI were assessed using the German version of the self-rated Brief Illness Perception Questionnaire (Brief IPQ. At admission and after three months (follow-up, frequency and time domain measures of HRV were obtained from 5-min electrocardiogram (ECG recordings during stable supine resting. Results: Linear hierarchical regression showed that the Brief IPQ dimensions timeline (β coefficient = -0.29; p = .044, personal control (β = 0.47; p = .008 and illness understanding (β = 0.43; p = .014 were significant predictors of HRV, adjusted for age, gender, baseline HRV, diabetes, beta-blockers, left ventricular ejection fraction (LVEF, attendance of cardiac rehabilitation, and depressive symptoms. Conclusions: As patients’ negative perceptions of their illness are associated with lower HRV following acute MI, a brief illness perception questionnaire may help to identify patients who might benefit from a specific illness perceptions intervention.

  3. The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

    Directory of Open Access Journals (Sweden)

    Budi Aji

    2014-10-01

    Full Text Available Background: Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design: Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results: Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions: Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from

  4. Danish parents' experiences when their newborn or critically ill child is transferred to the PICU - a qualitative study

    DEFF Research Database (Denmark)

    Hall, Elisabeth

    2005-01-01

    The aim of this study was to describe Danish parents' experiences when their newborn or small child was critically ill. Thirteen parents were interviewed. Data were analyzed using qualitative content analysis. The child's transfer to the paediatric intensive care unit (PICU) meant either help...

  5. A family nursing approach to the care of a child with a chronic illness.

    Science.gov (United States)

    Whyte, D A

    1992-03-01

    Chronic illness in childhood affects family functioning, and professional support is required when the child is being cared for at home. The focus of concern for this study is the nursing contribution to the support of the family. A longitudinal ethnographic study of the experience of four families caring for a child with cystic fibrosis provided data. Analysis of the four case studies provides insight to the effect of cystic fibrosis on family interaction. The genetic aspects and the life-threatening nature of the illness are seen to have a profound effect on the parents' lives. The experience of crisis and the chronic burden of care are described. The context of long-term care requires the nurse to share the illness trajectory with the families and to help family members to travel it together. This is seen to require a high level of interpersonal skill and considerable emotional investment. The issues for nursing are examined. The research arose from practice, and it contributes to theoretical explanation of nursing interaction, and the relationship of systems thinking to understanding of the nursing situation. The case for the development of family nursing practice to meet contemporary health care needs is argued.

  6. Human Herpesvirus 6 Infection Presenting as an Acute Febrile Illness Associated with Thrombocytopenia and Leukopenia

    Directory of Open Access Journals (Sweden)

    Maja Arnež

    2016-01-01

    Full Text Available We present an infant with acute fever, thrombocytopenia, and leukopenia, coming from an endemic region for tick-borne encephalitis, human granulocytic anaplasmosis, and hantavirus infection. The primary human herpesvirus 6 infection was diagnosed by seroconversion of specific IgM and IgG and by identification of viral DNA in the acute patient’s serum. The patient did not show skin rash suggestive of exanthema subitum during the course of illness.

  7. Acute hypothyroidism in a severely ill surgical patient

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C

    1988-01-01

    A case of acute postoperative hypothyroidism in a 62-year old woman is presented. One month before emergency admission because of a perforated gastric ulcer the patient had normal thyroid function, despite removal of a thyroid adenoma 20 years earlier. Following surgery the patient developed...

  8. Vitamin B deficiencies in a critically ill autistic child with a restricted diet.

    Science.gov (United States)

    Baird, J Scott; Ravindranath, Thyyar M

    2015-02-01

    An 11-year-old male with autism became less responsive and was hospitalized with hepatomegaly and liver dysfunction, as well as severe lactic acidosis. His diet for several years was self-limited exclusively to a single "fast food"-a particular type of fried chicken-and was deficient in multiple micronutrients, including the B vitamins thiamine and pyridoxine. Lactic acidosis improved rapidly with thiamine; 2 weeks later, status epilepticus-with low serum pyridoxine-resolved rapidly with pyridoxine. Dietary B vitamin deficiencies complicated the care of this critically ill autistic child and should be considered in this setting.

  9. Diminishing willingness to pay per quality-adjusted life year: valuing acute foodborne illness.

    Science.gov (United States)

    Haninger, Kevin; Hammitt, James K

    2011-09-01

    We design and conduct a stated-preference survey to estimate willingness to pay (WTP) to reduce foodborne risk of acute illness and to test whether WTP is proportional to the corresponding gain in expected quality-adjusted life years (QALYs). If QALYs measure utility for health, then economic theory requires WTP to be nearly proportional to changes in both health quality and duration of illness and WTP could be estimated by multiplying the expected change in QALYs by an appropriate monetary value. WTP is elicited using double-bounded, dichotomous-choice questions in which respondents (randomly selected from the U.S. general adult population, n = 2,858) decide whether to purchase a more expensive food to reduce the risk of foodborne illness. Health risks vary by baseline probability of illness, reduction in probability, duration and severity of illness, and conditional probability of mortality. The expected gain in QALYs is calculated using respondent-assessed decrements in health-related quality of life if ill combined with the duration of illness and reduction in probability specified in the survey. We find sharply diminishing marginal WTP for severity and duration of illness prevented. Our results suggest that individuals do not have a constant rate of WTP per QALY, which implies that WTP cannot be accurately estimated by multiplying the change in QALYs by an appropriate monetary value.

  10. [Infections in the child with acute leukemia].

    Science.gov (United States)

    Carrillo, J M; Jiménez, E; Jiménez, R

    1981-01-01

    One hundred and twenty-five febrile episodes in 82 children with acute leukemia were studied; 46% of the patients were from urban and 54% from rural areas. The origin of the fever was identified in 91% of the episodes, prevailing pneumonia, septicemia, chickenpox and herpes zoster. The etiological agent was identified in 46% of the cases. A viral predominance was evident, and among them varicela-zoster, following in importance gram-negative bacteria. Histoplasma capsulatum and Pneumocystis carinii were isolated in two occassions each. Sepsis was found more frequently in children with active leukemia than in those in remission (p less than 0.001). Forty-four febrile episodes occurred in patients with less than 1,000 neutrophils/ul. The daily-risk rate of infection was higher in children fom rural than in those from urban areas (p less than 0.001). After clinical and laboratory studies, methicillin and gentamicin were used, in addition to carbenicillin or trimethoprim-sulfamethoxazole is selected cases. This treatment was effective in 86% of the cases. Twelve (15%) children died, 6 of whom were in remission at that moment.

  11. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol

    NARCIS (Netherlands)

    A.T. Cohen; T.E. Spiro; H.R. Büller; L. Haskell; D. Hu; R. Hull; A. Mebazaa; G. Merli; S. Schellong; A. Spyropoulos; V. Tapson

    2011-01-01

    Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine wheth

  12. Thyroid Hormone Receptor beta Mediates Acute Illness-Induced Alterations in Central Thyroid Hormone Metabolism

    NARCIS (Netherlands)

    A. Boelen; J. Kwakkel; O. Chassande; E. Fliers

    2009-01-01

    Acute illness in mice profoundly affects thyroid hormone metabolism in the hypothalamus and pituitary gland. It remains unknown whether the thyroid hormone receptor (TR)-beta is involved in these changes. In the present study, we investigated central thyroid hormone metabolism during lipopolysacchar

  13. Acute child and mother psychophysiological responses and subsequent PTSD symptoms following a child's traumatic event.

    Science.gov (United States)

    Ostrowski, Sarah A; Christopher, Norman C; van Dulmen, Manfred H M; Delahanty, Douglas L

    2007-10-01

    This study examined the relationship between acute cortisol responses to trauma and subsequent PTSD symptoms (PTSS) in children and their biological mothers. Urinary cortisol levels were assessed in 54 children aged 8-18 upon admission to a level-1 trauma center. Six weeks posttrauma, 15-hour urine samples were collected from children and their mothers. Depression and PTSS were assessed at 6 weeks (N = 44) and 7 months (N = 38) posttrauma. Higher child in-hospital cortisol significantly predicted 6-week child PTSS. This was true only for boys at 7 months. In mothers, lower 6-week cortisol levels significantly predicted 7-month PTSS. Results extend findings of differing directions of acute hormonal predictors of PTSS in adults versus children to a sample of genetically related individuals.

  14. Noma in a child with acute leukaemia: when the 'face of poverty' finds an ally.

    Science.gov (United States)

    Singh, Amitabh; Mandal, Anirban; Seth, Rachna; Kabra, Sushil Kumar

    2016-01-06

    A 2-year-6-month old, appropriately immunised, well-thriving boy, symptomatic for the past 6 months, presented with recurrent fever, progressive pallor, lymphadenopathy and a raw area on the right cheek, with discharging sinus. The necrotising infection of the face developed after one and half months of febrile illness. This febrile illness with bicytopaenia was diagnosed as enteric fever and treated with antibiotics. Skin grafting was performed for the full-thickness defect of the face. The patient continued to have a non-healing oral ulcer with progressive pallor and was finally diagnosed as having acute lymphoblastic leukaemia. Immunodeficiency was ruled out by appropriate investigations. Noma is an indirect measure of extreme poverty, but malignancy is known to predispose to this debilitating condition. The worldwide incidence of Noma is reported to be 30,000-140,000, with a preponderance in sub-Saharan Africa. This case emphasises the need for a thorough search for the underlying illness predisposing to a rare opportunistic infection such as Noma in a well-thriving child.

  15. Extended-duration rivaroxaban thromboprophylaxis in acutely ill medical patients: MAGELLAN study protocol.

    Science.gov (United States)

    Cohen, Alexander Thomas; Spiro, Theodore Erich; Büller, Harry Roger; Haskell, Lloyd; Hu, Dayi; Hull, Russell; Mebazaa, Alexandre; Merli, Geno; Schellong, Sebastian; Spyropoulos, Alex; Tapson, Victor

    2011-05-01

    Patients with acute medical illnesses are at increased risk of venous thromboembolism (VTE), a significant cause of morbidity and mortality. Thromboprophylaxis is recommended in these patients but questions remain regarding the optimal duration of therapy. The aim of this study is to determine whether oral rivaroxaban is non-inferior to standard-duration (approximately 10 days) subcutaneous (s.c.) enoxaparin for the prevention of VTE in acutely ill medical patients, and whether extended-duration (approximately 5 weeks) rivaroxaban is superior to standard-duration enoxaparin. Patients aged 40 years or older and hospitalized for various acute medical illnesses with risk factors for VTE randomly receive either s.c. enoxaparin 40 mg once daily (od) for 10 ± 4 days or oral rivaroxaban 10 mg od for 35 ± 4 days. The primary efficacy outcomes are the composite of asymptomatic proximal deep vein thrombosis (DVT), symptomatic DVT, symptomatic non-fatal pulmonary embolism (PE), and VTE-related death up to day 10 + 4 and up to day 35 + 4. The primary safety outcome is the composite of treatment-emergent major bleeding and clinically relevant non-major bleeding. As of July 2010, 8,101 patients from 52 countries have been randomized. These patients have a broad range of medical conditions: approximately one-third were diagnosed with acute heart failure, just under one-third were diagnosed with acute infectious disease, and just under one-quarter were diagnosed with acute respiratory insufficiency. MAGELLAN will determine the efficacy, safety, and pharmacological profile of oral rivaroxaban for the prevention of VTE in a diverse population of medically ill patients and the potential of extended-duration therapy to reduce incidence of VTE.

  16. Incidence and prevention of venous thromboembolism in acutely ill hospitalized elderly Chinese

    Institute of Scientific and Technical Information of China (English)

    LI Xiao-ying; FAN Jin; CHENG You-qin; WANG Yan; YAO Chen; ZHONG Nan-shan

    2011-01-01

    Background As the third most frequent cardiovascular disease, venous thromboembolism (VTE) remains a major cause of morbidity and mortality in hospitalized patients. The aim of this study was to determine the incidence of VTE and steps for its prevention in acutely ill hospitalized elderly Chinese patients.Methods A prospective multi-center study was conducted from June 2006 to November 2007. A total of 607 patientsfrom 40 research centers in China were enrolled. Data of the patients' baseline characteristics, VTE events and prophylaxis/therapy methods were collected.Results Fifty-nine patients (9.7%) had an objectively confirmed VTE during the 90-day follow-up, of which, 59.3%occurred during the first week and 75% within 14 days. Forty-one patients died (6.6%) during the follow-up, 36.6% died within three weeks. We also found that medical disorders including respiratory failure (16.4%), acute brain infarction (15.6%), acute infectious diseases (14.3%), acute coronary artery syndrome (8.7%) and heart failure (7.6%) play a role in provoking VTE. Only 13.0% of the elderly patients with high risk of VTE used low dose unfractionated heparin, 7.1% used low molecular weight heparin, 5.4% used warfarin,0.3% used graduated compression stockings and none of them used intermittent pneumatic compression.Conclusions Our study showed similar results between our study and western countries in the VTE incidence by day 90 in elderly hospitalized patients with acute medical illness. Great caution must be applied in the care of acutely ill elderly hospitalized patients to deal with the complications of VTE. Application of safe and effective prophylaxes against embolism remains a critical challenge.

  17. A patient-centered research agenda for the care of the acutely ill older patient.

    Science.gov (United States)

    Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

    2015-05-01

    Hospitalists and others acute-care providers are limited by gaps in evidence addressing the needs of the acutely ill older adult population. The Society of Hospital Medicine sponsored the Acute Care of Older Patients Priority Setting Partnership to develop a research agenda focused on bridging this gap. Informed by the Patient-Centered Outcomes Research Institute framework for identification and prioritization of research areas, we adapted a methodology developed by the James Lind Alliance to engage diverse stakeholders in the research agenda setting process. The work of the Partnership proceeded through 4 steps: convening, consulting, collating, and prioritizing. First, the steering committee convened a partnership of 18 stakeholder organizations in May 2013. Next, stakeholder organizations surveyed members to identify important unanswered questions in the acute care of older persons, receiving 1299 responses from 580 individuals. Finally, an extensive and structured process of collation and prioritization resulted in a final list of 10 research questions in the following areas: advanced-care planning, care transitions, delirium, dementia, depression, medications, models of care, physical function, surgery, and training. With the changing demographics of the hospitalized population, a workforce with limited geriatrics training, and gaps in evidence to inform clinical decision making for acutely ill older patients, the identified research questions deserve the highest priority in directing future research efforts to improve care for the older hospitalized patient and enrich training.

  18. A feasible strategy for preventing blood clots in critically ill patients with acute kidney injury (FBI)

    DEFF Research Database (Denmark)

    Robinson, Sian I.; Zincuk, A.; Larsen, U. L.;

    2014-01-01

    urine output prior to discontinuing dialysis, and low neutrophil gelatinase-associated lipocalin in dialysis-free intervals, as markers of renal recovery. METHODS/DESIGN: In a multicenter, double-blind randomized controlled trial in progress at three intensive care units across Denmark, we randomly......BACKGROUND: Previous pharmacokinetic trials suggested that 40 mg subcutaneous enoxaparin once daily provided inadequate thromboprophylaxis for intensive care unit patients. Critically ill patients with acute kidney injury are at increased risk of venous thromboembolism and yet are often excluded...... from these trials. We hypothesized that for critically ill patients with acute kidney injury receiving continuous renal replacement therapy, a dose of 1 mg/kg enoxaparin subcutaneously once daily would improve thromboprophylaxis without increasing the risk of bleeding. In addition, we seek to utilize...

  19. [Italian Program for Surveillance of Acute Pesticide-Related Illnesses: cases identified in 2005].

    Science.gov (United States)

    Settimi, L; Davanzo, F; Travaglia, A; Locatelli, C; Cilento, I; Volpe, C; Russo, A; Miceli, G; Fracassi, A; Maiozzi, P; Marcello, I; Sesan, F; Urbani, E

    2007-01-01

    In 2005, the Italian System for Surveillance of Acute Pesticide-Related Illnesses (SIAF) identified 625 cases, among which 520 unintentionally exposed. The majority of these subjects were men (75%) and aged 26-65 years (65%). About 63% of all exposures occurred at work. Severity for these illnesses was low for 94% and moderate for 5%. Four cases were classified as illnesses of high severity. Some 70% of all the reported exposures occurred between May and September. The active ingredients responsible for the largest number of cases were: glyphosate (n. 56), copper sulphate (n. 55), methomyl (n. = 52), metam-sodium (n. 24). Three episodes of collective environmental exposure to soil fumigants involving 23 subjects were also detected.

  20. Nutritional Needs of the Child with a Handicap or Chronic Illness. Manual II: Clinical Nutrition. Presentations from a National Interdisciplinary Symposium.

    Science.gov (United States)

    Ekvall, Shirley M.; Wheby, Elizabeth A.

    The following papers were presented at a symposium on clinical nutrition for the child who is chronically ill or handicapped: (1) "Food Allergy"; (2) "Anemia and the Chronically Ill or Handicapped Child"; (3) "Nutrition and Neurotransmitters--Clinical Implications"; (4) "The Importance of Lipid Type in the Diet after Burn Injury"; (5) "Advances of…

  1. Acute isolated appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia.

    Science.gov (United States)

    Decembrino, Nunzia; Zecca, Marco; Tortorano, Anna Maria; Mangione, Francesca; Lallitto, Fabiola; Introzzi, Francesca; Bergami, Elena; Marone, Piero; Tamarozzi, Francesca; Cavanna, Caterina

    2016-01-01

    We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.

  2. Impact of Integrated Management of Childhood Illness on inequalities in child health in rural Tanzania.

    Science.gov (United States)

    Masanja, Honorati; Schellenberg, Joanna Armstrong; de Savigny, Don; Mshinda, Hassan; Victora, Cesar G

    2005-12-01

    We examined the impact of the Integrated Management of Childhood Illness (IMCI) strategy on the equality of health outcomes and access across socioeconomic gradients in rural Tanzania, by comparing changes in inequities between 1999 and 2002 in two districts with IMCI (Morogoro Rural and Rufiji) and two without (Kilombero and Ulanga). Equity differentials for six child health indicators (underweight, stunting, measles immunization, access to treated and untreated nets, treatment of fever with antimalarial) improved significantly in IMCI districts compared with comparison districts (pstunting among children between 24-59 months of age. The concentration index improved from -0.102 in 1999 to -0.032 in 2002 for IMCI, while it remained almost unchanged -0.122 to -0.133 in comparison districts. IMCI was associated with improved equity for measles vaccine coverage, whereas the opposite was observed for DPT antigens. This study has shown how equity assessments can be incorporated in impact evaluation at relatively little additional cost, and how this may point to specific interventions that need to be reinforced. The introduction of IMCI led to improvements in child health that did not occur at the expense of equity.

  3. EFFECT OF HELICOBACTER PYLORI INFECTION ON ACUTE STRESS-RELATED GASTRIC MUCOSAL DAMAGE OF SERIOUSLY ILL PATIENTS

    Institute of Scientific and Technical Information of China (English)

    赵超; 肖文; 叶光福; 周建平; 周其璋

    2002-01-01

    Emergency endoscopy studies have shown that the most of seriously ill patients develop acute stress-related mucosal damage and ulceration within 24 hours of admission, which manifest the upper gastrointestinal tract

  4. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults.

    Science.gov (United States)

    Kaddourah, Ahmad; Basu, Rajit K; Bagshaw, Sean M; Goldstein, Stuart L

    2017-01-05

    Background The epidemiologic characteristics of children and young adults with acute kidney injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe acute kidney injury. Methods We used the Kidney Disease: Improving Global Outcomes criteria to define acute kidney injury. Severe acute kidney injury was defined as stage 2 or 3 acute kidney injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. Results A total of 4683 patients were evaluated; acute kidney injury developed in 1261 patients (26.9%; 95% confidence interval [CI], 25.6 to 28.2), and severe acute kidney injury developed in 543 patients (11.6%; 95% CI, 10.7 to 12.5). Severe acute kidney injury conferred an increased risk of death by day 28 after adjustment for 16 covariates (adjusted odds ratio, 1.77; 95% CI, 1.17 to 2.68); death occurred in 60 of the 543 patients (11.0%) with severe acute kidney injury versus 105 of the 4140 patients (2.5%) without severe acute kidney injury (P<0.001). Severe acute kidney injury was associated with increased use of mechanical ventilation and renal-replacement therapy. A stepwise increase in 28-day mortality was associated with worsening severity of acute kidney injury (P<0.001 by log-rank test). Assessment of acute kidney injury according to the plasma creatinine level alone failed to identify acute kidney injury in 67.2% of the patients with low urine output. Conclusions Acute kidney injury is common and is associated with poor outcomes, including increased

  5. Cholecystectomy vs. percutaneous cholecystostomy for the management of critically ill patients with acute cholecystitis: a protocol for a systematic review

    OpenAIRE

    Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A.; Zirngibl, Hubert

    2015-01-01

    Background Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed wit...

  6. Portuguese adaptation of the Child Health and Illness Profile, Child Edition (CHIP-CE Adaptación portuguesa del perfil de salud infantil (Child Health and Illness Profile, Child Edition, CHIP-CE Adaptação portuguesa do Child Health and Illness Profile, Child Edition (CHIP-CE

    Directory of Open Access Journals (Sweden)

    Manuel Alves Rodrigues

    2010-12-01

    Full Text Available Background: Valid and comprehensive instruments that allow us to obtain self-reports of children’s health and health-related behaviour are invaluable for understanding health and illness trajectories, for health resource planning and for evaluation of policy. Aim: The aim of this study was to describe the process of adapting the Child Health and Illness Profile, Child Edition (CHIP-CE, a self-report health status instrument for children aged 6 to 11 years, to Portuguese (Riley et al., 2004. Method: After consensual translation by experts, the CHIP-CE was administered to 255 pupils, mean age 9.93 years, and its internal consistency, construct validity and concurrent validity were evaluated. Results: The CHIP-CE Portuguese version had good internal consistency. Cronbach’s alpha coefficient was 0.83 for Satisfaction, 0.79 for Comfort, 0.67 for Resilience, 0.71 for Risk avoidance, 0.77 for Achievement and 0.88 for the total scale. Factor analysis showed a five-factor structure: Satisfaction, Comfort, Resilience, Risk avoidance and Achievement. This was similar to the original version, explaining 40.83% of the total variance. All Satisfaction and Comfort items had factor loadings on their respective domains of at least 0.30, except for 7 items. Conclusions: The properties of the CHIP-CE Portuguese version demonstrate its value for measuring children’s perceptions of their own health and well-being.Encuadramiento: Instrumentos válidos y abarcadores que permitan obtener el autorelato de salud y de comportamientos relacionados con la salud de los niños son de gran valor para comprender la salud y las trayectorias de enfermedad, para el planeamiento de recursos y para la evaluación de políticas en esta área. Objetivo: El objetivo de este estudio es describir el proceso de adaptación al portugués del Health and Illnes Profile, Child Edition, CHIP-CE, instrumento de autorelato del estado de salud de niños con edades comprendidas entre los 6 y

  7. Acute cortical deafness in a child with MELAS syndrome.

    Science.gov (United States)

    Pittet, Marie P; Idan, Roni B; Kern, Ilse; Guinand, Nils; Van, Hélène Cao; Toso, Seema; Fluss, Joël

    2016-05-01

    Auditory impairment in mitochondrial disorders are usually due to peripheral sensorineural dysfunction. Central deafness is only rarely reported. We report here an 11-year-old boy with MELAS syndrome who presented with subacute deafness after waking up from sleep. Peripheral hearing loss was rapidly excluded. A brain MRI documented bilateral stroke-like lesions predominantly affecting the superior temporal lobe, including the primary auditory cortex, confirming the central nature of deafness. Slow recovery was observed in the following weeks. This case serves to illustrate the numerous challenges caused by MELAS and the unusual occurrence of acute cortical deafness, that to our knowledge has not be described so far in a child in this setting.

  8. Access to medicines for acute illness in middle income countries in Central America

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    Isabel Cristina Martins Emmerick

    2013-12-01

    Full Text Available OBJECTIVE : To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS : This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1 seeking care for acute illness in the formal health care system and (2 obtaining all medicines sought for the acute condition. RESULTS : The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0. For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS : A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines.

  9. The amylase-to-creatinine clearance ratio--a non-specific response to acute illness?

    Science.gov (United States)

    McMahon, M J; Playforth, M J; Rashid, S A; Cooper, E H

    1982-01-01

    It was felt that the apparent specificity of the amylase-to-creatine clearance ratio (ACCR) in several previous studies of pancreatitis might reflect a failure to utilize adequately ill control subjects. The ACCR and the renal clearances of beta 2-microglobulin (B2-m), similarly related to creatinine (BCCR) as well as the urinary concentration of albumin, were compared in 27 patients with acute pancreatitis, 8 with a perforated peptic ulcer and 7 with mild biliary colic, during the first 5 days in hospital. Acute pancreatitis was graded as mild (6), moderate (14) or severe (7), using a combination of clinical data, diagnostic peritoneal lavage and multiple criteria. Further assessment of the severity of the acute illness was obtained from measurement of C-reactive protein (C-RP). Lowest C-RP levels were found in the patients with mild pancreatitis and biliary colic, and highest levels in the patients with severe pancreatitis and perforated ulcer (P less than 0.002). Similarly, ACCR and BCCR levels were significantly lower in the two mild groups than in the two severe ones (P less than 0.01 and less than 0.002 respectively), although plasma amylase was raised only in patients with pancreatitis and plasma B2-m was similar in all groups. Electrophoresis of urine showed dense bands of tubuloprotein in patients from both severe groups. Urine albumin was higher in severe pancreatitis than in perforated ulcer (P less than 0.1), perhaps indicating a more specific glomerular lesion in pancreatitis. Thus a rise in amylase clearance appeared to be related to the severity of the acute illness, and may be a component of a non-specific tubuloproteinuria. In this study patients with a perforated peptic ulcer had increases in ACCR similar to those seen in patients with severe pancreatitis, and we are therefore doubtful whether ACCR has any role in the clinical diagnosis of pancreatic disease.

  10. The Feasibility of performing resistance exercise with acutely ill hospitalized older adults

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    Rockwood Kenneth

    2003-10-01

    Full Text Available Abstract Background For older adults, hospitalization frequently results in deterioration of mobility and function. Nevertheless, there are little data about how older adults exercise in the hospital and definitive studies are not yet available to determine what type of physical activity will prevent hospital related decline. Strengthening exercise may prevent deconditioning and Pilates exercise, which focuses on proper body mechanics and posture, may promote safety. Methods A hospital-based resistance exercise program, which incorporates principles of resistance training and Pilates exercise, was developed and administered to intervention subjects to determine whether acutely-ill older patients can perform resistance exercise while in the hospital. Exercises were designed to be reproducible and easily performed in bed. The primary outcome measures were adherence and participation. Results Thirty-nine ill patients, recently admitted to an acute care hospital, who were over age 70 [mean age of 82.0 (SD= 7.3] and ambulatory prior to admission, were randomized to the resistance exercise group (19 or passive range of motion (ROM group (20. For the resistance exercise group, participation was 71% (p = 0.004 and adherence was 63% (p = 0.020. Participation and adherence for ROM exercises was 96% and 95%, respectively. Conclusion Using a standardized and simple exercise regimen, selected, ill, older adults in the hospital are able to comply with resistance exercise. Further studies are needed to determine if resistance exercise can prevent or treat hospital-related deterioration in mobility and function.

  11. Passive smoking, as measured by hair nicotine, and severity of acute lower respiratory illnesses among children

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    Al-Delaimy WK

    2002-01-01

    Full Text Available Abstract The aim of this study was to describe the association between passive smoking and the severity of acute lower respiratory illnesses (ALRI among 351 children aged 3–27 months admitted to hospital. A total of 297 children provided hair samples, which were analysed for hair nicotine levels as an indicator of passive smoking. A severity of illness grading system was developed by using clinical and management criteria used by the medical staff at hospital. The OR for children with more severe illness being exposed to higher nicotine levels was 1.2, 95% CI: 0.57–2.58 when using dichotomised respiratory severity levels and upper versus lower nicotine quartile levels. In an ordinal logistic regression model, the OR of more severe illness being associated with higher nicotine levels was 1.07 (95% CI: 0.92–1.25. When analysis was limited to the more severe cases, the OR of the least severe category compared to the most severe category, in relation to nicotine levels in hair, was 1.79 (95% CI: 0.5–6.30. The ordinal logistic regression of this group of severely-ill children (OR 1.1 (95% CI: 0.94–1.29 was not substantially different from the overall study subjects. Conclusion In general, children with more severe illness tended to have higher levels of nicotine in their hair, although the results were within the limit of chance. Possible explanations of our results include environmental tobacco smoke (ETS being an initiator of ALRI rather than a risk to severity, exposure levels of ETS were too low to demonstrate an effect on severity, or the power of this study was not high enough to detect an association.

  12. Transformation of Myelodysplastic Syndrome to Acute Lymphoblastic Leukemia in a Child

    OpenAIRE

    2010-01-01

    Childhood myelodysplastic syndrome (MDS) is an uncommon condition. Unlike adult MDS, pediatric patients have a more progressive course and rapidly transform to acute myeloid leukemia. Evolution to acute lymphoblastic leukemia is extremely rare. We report a 5 year old female child who presented with refractory anemia with excess blasts and transformed into acute lymphoblastic leukemia 4 months after initial diagnosis.

  13. Acute Stress Reactions in Couples after a Burn Event to Their Young Child

    NARCIS (Netherlands)

    Bakker, A.; Van Loey, N.E.; Van der Heijden, P.G.M.; Van Son, M.J.M.

    2012-01-01

    Objective This multicenter study examines acute stress reactions in couples following a burn event to their preschool child. Methods Participants were 182 mothers and 154 fathers, including 143 couples, of 193 children (0–4 years) with acute burns. Parents’ self-reported acute stress reactions and e

  14. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS

    Directory of Open Access Journals (Sweden)

    2004-03-01

    Full Text Available Severe acute respiratory syndrome (SARS is frequently complicated with acute respiratory failure. In this article, we aim to focus on the management of the subgroup of SARS patients who are critically ill. Most SARS patients would require high flow oxygen supplementation, 20–30% required intensive care unit (ICU or high dependency care, and 13–26% developed acute respiratory distress syndrome (ARDS. In some of these patients, the clinical course can progress relentlessly to septic shock and/or multiple organ dysfunction syndrome (MODS. The management of critically ill SARS patients requires timely institution of pharmacotherapy where applicable and supportive treatment (oxygen therapy, noninvasive and invasive ventilation. Superimposed bacterial and other opportunistic infections are common, especially in those treated with mechanical ventilation. Subcutaneous emphysema, pneumothoraces and pneumomediastinum may arise spontaneously or as a result of positive ventilatory assistance. Older age is a consistently a poor prognostic factor. Appropriate use of personal protection equipment and adherence to infection control measures is mandatory for effective infection control. Much of the knowledge about the clinical aspects of SARS is based on retrospective observational data and randomized-controlled trials are required for confirmation. Physicians and scientists all over the world should collaborate to study this condition which may potentially threaten human existence.

  15. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul F

    2012-02-03

    INTRODUCTION: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers\\' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation. METHODS: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers\\' Criteria applied. RESULTS: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or =5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects. CONCLUSION: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers\\' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.

  16. Detection of respiratory viruses and the associated chemokine responses in serious acute respiratory illness

    Science.gov (United States)

    Sumino, Kaharu C.; Walter, Michael J.; Mikols, Cassandra L.; Thompson, Samantha A.; Gaudreault-Keener, Monique; Arens, Max. Q.; Agapov, Eugene; Hormozdi, David; Gaynor, Anne M.; Holtzman, Michael J.; Storch, Gregory A.

    2010-01-01

    Background A specific diagnosis of a lower respiratory viral infection is often difficult despite frequent clinical suspicion. This low diagnostic yield may be improved by use of sensitive detection methods and biomarkers. Methods We investigated the prevalence, clinical predictors and inflammatory mediator profile of respiratory viral infection in serious acute respiratory illness. Sequential bronchoalveolar lavage (BAL) fluids from all patients hospitalized with acute respiratory illness over 12 months (n=283) were tested for the presence of 17 respiratory viruses by multiplex PCR assay and for newly-discovered respiratory viruses (bocavirus, WU and KI polyomaviruses) by single-target PCR. BAL samples also underwent conventional testing (direct immunoflorescence and viral culture) for respiratory virus at the clinician’s discretion. 27 inflammatory mediators were measured in subset of the patients (n=64) using a multiplex immunoassay. Results We detected 39 respiratory viruses in 37 (13.1% of total) patients by molecular testing, including rhinovirus (n=13), influenza virus (n=8), respiratory syncytial virus (n=6), human metapneumovirus (n=3), coronavirus NL63 (n=2), parainfluenza virus (n=2), adenovirus (n=1), and newly-discovered viruses (n=4). Molecular methods were 3.8-fold more sensitive than conventional methods. Clinical characteristics alone were insufficient to separate patients with and without respiratory virus. The presence of respiratory virus was associated with increased levels of interferon-γ-inducible protein 10 (IP -10)(p<0.001) and eotaxin-1 (p=0.017) in BAL. Conclusions Respiratory viruses can be found in patients with serious acute respiratory illness by use of PCR assays more frequently than previously appreciated. IP-10 may be a useful biomarker for respiratory viral infection. PMID:20627924

  17. Plasticity of the systemic inflammatory response to acute infection during critical illness: development of the riboleukogram.

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    Jonathan E McDunn

    Full Text Available BACKGROUND: Diagnosis of acute infection in the critically ill remains a challenge. We hypothesized that circulating leukocyte transcriptional profiles can be used to monitor the host response to and recovery from infection complicating critical illness. METHODOLOGY/PRINCIPAL FINDINGS: A translational research approach was employed. Fifteen mice underwent intratracheal injections of live P. aeruginosa, P. aeruginosa endotoxin, live S. pneumoniae, or normal saline. At 24 hours after injury, GeneChip microarray analysis of circulating buffy coat RNA identified 219 genes that distinguished between the pulmonary insults and differences in 7-day mortality. Similarly, buffy coat microarray expression profiles were generated from 27 mechanically ventilated patients every two days for up to three weeks. Significant heterogeneity of VAP microarray profiles was observed secondary to patient ethnicity, age, and gender, yet 85 genes were identified with consistent changes in abundance during the seven days bracketing the diagnosis of VAP. Principal components analysis of these 85 genes appeared to differentiate between the responses of subjects who did versus those who did not develop VAP, as defined by a general trajectory (riboleukogram for the onset and resolution of VAP. As patients recovered from critical illness complicated by acute infection, the riboleukograms converged, consistent with an immune attractor. CONCLUSIONS/SIGNIFICANCE: Here we present the culmination of a mouse pneumonia study, demonstrating for the first time that disease trajectories derived from microarray expression profiles can be used to quantitatively track the clinical course of acute disease and identify a state of immune recovery. These data suggest that the onset of an infection-specific transcriptional program may precede the clinical diagnosis of pneumonia in patients. Moreover, riboleukograms may help explain variance in the host response due to differences in ethnic

  18. Burden of Acute Gastrointestinal Illness in Gálvez, Argentina, 2007

    OpenAIRE

    Thomas, M Kate; Perez, Enrique; Shannon E Majowicz; Reid-Smith, Richard; Albil, Silvia; Monteverde, Marcos; McEwen, Scott A.

    2010-01-01

    This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rat...

  19. Acute Hydrocephaly Following Methadone Intoxication in a Child

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    Afshin FAYYAZI

    2012-03-01

    Full Text Available How to Cite this Article: Fayyazi A, Khajeh A, Bagheri M, Ahmadi S. Acute Hydrocephaly Following Methadone Intoxication in a Child. Iranian Journal of ChildNeurology 2012;6(1:35-38.Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication. References:1. Nazari H. Clinical approach to methadone toxication.Quarterly journal of Addiction 2007;2:18-20.2. Plummer JL, Gourlay GK, Cherry DA, Cousins MJ.Estimation of methadone clearance: application in themanagement of cancer pain. Pain 1988 Jun;33(3:313-22.3. Davies D, DeVlaming D, Haines C. Methadoneanalgesia for children with advanced cancer. PediatrBlood Cancer 2008 Sep;51(3:393-7.4. Riascos R, Kumfa P, Rojas R, Cuellar H, Descartes F.Fatal methadone intoxication in a child. Emerg Radiol2008 Jan;15(1:67-70.5. Binchy JM, Molyneux EM, Manning J. Accidental ingestion of methadone by children in Merseyside.BMJ 1994 May 21;308(6940:1335-6.6. Li L, Levine B, Smialek JE. Fatal methadone poisoningin children: Maryland 1992-1996. Subst Use Misuse2000 Aug;35(9:1141-8.7. Milroy CM, Forrest AR. Methadone deaths: atoxicological analysis. J Clin Pathol 2000 Apr;53(4:277-81.8. Afzali S, Jafari MR. One year study of chest X-raychanges in opiate-poisoned patients in Hamadan. JQom Uni Med Sci 2010; 4(2:3-7.9. Zamani N, Sanaei-Zadeh H, Mostafazadeh B. Hallmarksof opium poisoning in infants and toddlers. Trop Doct2010 Oct; 40(4:220-2.10. Besharat S, Besharat M, Akhavan Masouleh A, JabbariA, Yazdi HR. Opium intoxication in children under 5years old, Golestan- Iran (2006-07. J Gorgan Uni MedSci Spring 2010;12(1:85-9.11. Izadi Mood N, Gheshlaghi F, Sharafi SE. Fatalpoisoning cases admitted to the emergency departmentof poisoning, Noor Hospital, Isfahan. J Legal Med IslRep Iran 2003;9(31:122-26.12. Boushehri B, Yekta Z, Zareei-Kheirabad A, Kabiri SH

  20. Addressing the Impact of Trauma before Diagnosing Mental Illness in Child Welfare

    Science.gov (United States)

    Griffin, Gene; McClelland, Gary; Holzberg, Mark; Stolbach, Bradley; Maj, Nicole; Kisiel, Cassandra

    2011-01-01

    Congress set requirements for child welfare agencies to respond to emotional trauma associated with child maltreatment and removal. In meeting these requirements, agencies should develop policies that address child trauma. To assist in policy development, this study analyzes more than 14,000 clinical assessments from child welfare in Illinois.…

  1. A child presenting with acute renal failure secondary to a high dose of indomethacin: a case report

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    González Felipe

    2009-02-01

    Full Text Available Abstract Introduction Acute renal failure caused by nonsteroidal anti-inflammatory drugs administered at therapeutic doses is generally mild, non-anuric and transitory. There are no publications on indomethacin toxicity secondary to high doses in children. The aim of this article is to describe acute renal failure secondary to a high dose of indomethacin in a child and to review an error in a supervised drug prescription and administration system. Case presentation Due to a medication error, a 20-day-old infant in the postoperative period of surgery for Fallot's tetralogy received a dose of 10 mg/kg of indomethacin, 50 to 100 times higher than the therapeutic dose. The child presented with acute, oligo-anuric renal failure requiring treatment with continuous venovenous renal replacement therapy, achieving complete recovery of renal function with no sequelae. Conclusion In order to reduce medication errors in critically ill children, it is necessary to develop a supervised drug prescription and administration system, with controls at various levels.

  2. Gatekeepers of health: A qualitative assessment of child care centre staff's perspectives, practices and challenges to enteric illness prevention and management in child care centres

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    Adams Cindy L

    2008-06-01

    Full Text Available Abstract Background Enteric outbreaks associated with child care centres (CCC have been well documented internationally and in Canada. The current literature focuses on identifying potential risk factors for introduction and transmission of enteric disease, but does not examine why these risk factors happen, how the risk is understood and managed by the staff of CCCs, or what challenges they experience responding to enteric illness. The purpose of this study was to explore the understanding, knowledge and actions of CCC staff regarding enteric illness and outbreaks, and to identify challenges that staff encounter while managing them. Methods Focus groups were conducted with staff of regulated CCCs in Southern Ontario. Five focus groups were held with 40 participants. An open ended style of interviewing was used. Data were analyzed using content analysis. Results CCC staff play an important role in preventing and managing enteric illness. Staff used in-depth knowledge of the children, the centre and their personal experiences to assist in making decisions related to enteric illness. The decisions and actions may differ from guidance provided by public health officials, particularly when faced with challenges related to time, money, staffing and parents. Conclusion CCC staff relied on experience and judgment in coordination with public health information to assist decision-making in the management of enteric illness and outbreaks. Advice and guidance from public health officials to CCC staff needs to be consistent yet flexible so that it may be adapted in a variety of situations and meet regulatory and public health requirements.

  3. Gastrointestinal and respiratory illness in children that do and do not attend child day care centers: a cost-of-illness study.

    Directory of Open Access Journals (Sweden)

    Remko Enserink

    Full Text Available BACKGROUND: Gastrointestinal and respiratory diseases are major causes of morbidity for young children, particularly for those children attending child day care centers (DCCs. Although both diseases are presumed to cause considerable societal costs for care and treatment of illness, the extent of these costs, and the difference of these costs between children that do and do not attend such centers, is largely unknown. OBJECTIVE: Estimate the societal costs for care and treatment of episodes of gastroenteritis (GE and influenza-like illness (ILI experienced by Dutch children that attend a DCC, compared to children that do not attend a DCC. METHODS: A web-based monthly survey was conducted among households with children aged 0-48 months from October 2012 to October 2013. Households filled-in a questionnaire on the incidence of GE and ILI episodes experienced by their child during the past 4 weeks, on the costs related to care and treatment of these episodes, and on DCC arrangements. Costs and incidence were adjusted for socioeconomic characteristics including education level, nationality and monthly income of parents, number of children in the household, gender and age of the child and month of survey conduct. RESULTS: Children attending a DCC experienced higher rates of GE (aIRR 1.4 [95%CI: 1.2-1.9] and ILI (aIRR: 1.4 [95%CI: 1.2-1.6] compared to children not attending a DCC. The societal costs for care and treatment of an episode of GE and ILI experienced by a DCC-attending child were estimated at €215.45 [€115.69-€315.02] and €196.32 [€161.58-€232.74] respectively, twice as high as for a non-DCC-attending child. The DCC-attributable economic burden of GE and ILI for the Netherlands was estimated at €25 million and €72 million per year. CONCLUSIONS: Although children attending a DCC experience only slightly higher rates of GE and ILI compared to children not attending a DCC, the costs involved per episode are substantially higher.

  4. Some considerations on evaluation of the acutely limping child

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    Marić Dušan M.

    2004-01-01

    Full Text Available Introduction An acute limp implies an underlying pathology that causes disruption of the standard gait pattern. Diagnosis and history of disease The differential diagnosis of a limp includes trauma, infection neoplasia, inflammatory, congenital, neuromuscular or developmental disorders. History of disease and clinical examination present first steps in adequate evaluation. A useful approach is to consider the causes of limping from head to foot to avoid overlooking common underlying conditions. The age of patient can further narrow the differential diagnosis, because certain disease entities are age-specific. Laboratory analysis Laboratory analysis should always include complete blood count, erythrocyte sedimetation rate, C-reactive protein, rheumatic factor, PPD 3. In some cases we have to perform tests of enzyme values such as alkaline phosphatase, lactate dehydrgenase, and other subspecial analyses in order to exclude some systemic and autoimmune diseases. Radiologic diagnosis Radiologic diagnosis should include: ultrasonography (doppler ultrasonography and in some cases, arteriography; Plain films (always anteroposterior (AP and profile or some special angle; computed tomography, magnetic resonance imaging. Conclusion In this paper we suggested an algorhytm for examination of a limping child: 1. Analysis of foot morphology and the gait without socks and shoes. 2. Strength test including walking on toes and heels and running. 3. Evaluation of arthritis, stiffness, pain, skin changes. 4. Points of a maximum pain with ROM testing. 5. Traces of trauma with echimosis. 6. Evaluation of leg length discrepancy. 7. Muscle tonus. 8. Abdominal examination 9. Examination of the spine and back.

  5. Ascent schedules, acute altitude illness, and altitude acclimatization: Observations on the Yushu Earthquake

    Institute of Scientific and Technical Information of China (English)

    Wu Tianyi; Hou Shike; Li Shuzhi; Li Wenxiang; Gen Deng

    2013-01-01

    During the Yushu Earthquake on April 14,2010,a large number of rescuers from sea level or lowlands ascended to the quake areas very rapidly or rapidly less than 24 h.However,Yushu Earthquake is the highest quake in the world at altitudes between 3750 m and 4878 m where is a serious hypoxic environment.A high incidence of acute altitude illness was found in the unacclimatized rescuers; the mountain rescue operation changed as "rescue the rescuers".Lesson from the Yushu Earthquake is that the occurrence of acute altitude illness may be closely related to the ascent schedules.This prompted us to study the relationship between ascent rate and the incidence and severity of acute altitude illness; five different groups were compared.The first group was 42 sea level male young soldiers who ascended to quake area very rapidly within 8 h at 4000 m; the second group was 48 sea level male young soldiers who ascended to 4000 m rapidly less than 18 h; the third group was 66 acclimatized medical workers from 2261 m who ascended to 4000 m rapidly within 12 h; the fourth group was 56 Tibetan medical workers from 2800 m who ascended to 4000 m rapidly within 8 h; the fifth group was 50 male sea level workers who ascended to 4000 m gradually over a period of 4 d.The results showed that the sea level rescuers ascended to 4000 m very rapidly or rapidly had the highest incidence of acute mountain sickness (AMS) with the greatest AMS scores and the lowest arterial oxygen saturation (SaO2) ; the sea level workers ascended to 4000 m gradually had moderate incidence of AMS with moderate AMS scores and SaO2 values; whereas the acclimatized and adapted rescuers had the lowest incidence of AMS,lowest AMS scores and higher SaO2; especially none AMS occurred in Tibetan rescuers.AMS score is inversely related to the ascent rate (r=-0.24,p<0.001).Additionally,acute altitude illness is significantly influenced by altitude acclimatization.The ascent rate is inversely related to

  6. Acute hydrocephalus in a child with a third ventricle arachnoid cyst and coincidental enteroviral meningitis

    NARCIS (Netherlands)

    Jeltema, Hanne-Rinck; Kuijlen, Jos M. A.; Hoving, Eelco W.

    2014-01-01

    We present a 2.5-year-old child suffering from acute hydrocephalus. First, the child was diagnosed with aseptic viral meningitis. The PCR of the cerebrospinal fluid (CSF) was positive for enterovirus. Subsequently, MRI revealed that the hydrocephalus was caused by a cyst in the third ventricle. Duri

  7. Using pRIFLE criteria for acute kidney injury in critically ill children

    Directory of Open Access Journals (Sweden)

    Rina Amalia C. Saragih

    2013-01-01

    Full Text Available Background Incidence of acute kidney injury (AKI in critically ill children and its mortality rate is high. The lack of a uniform definition for AKI leads to failure in determining kidney injury, delayed treatment, and the inability to generalize research results. Objectives To evaluate the pediatric RIFLE (pRIFLE criteria (risk for renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease for diagnosing and following the clinical course of AKI in critically ill children. We also aimed to compare AKI severity on days 1 and 3 of pediatric intensive care unit (PICUu stay in critically ill pediatric patients. Methods This prospective cohort study was performed in PICU patients. Urine output (UOP, serum creatinine (SCr, and glomerular filtration rate on days 1 and 3 of PICU stay were recorded. Classification of AKI was determined according to pRIFLE criteria. We also recorded subjects’ immune status, pediatric logistic organ dysfunction (PELOD score, admission diagnosis, the use of vasoactive medications, diuretics, and ventilators, as well as PICU length of stay and mortality. Results Forty patients were enrolled in this study. AKI was found in 13 patients (33%. A comparison of AKI severity on day 1 and day 3 revealed no statistically significant differences for attainment of pRIFLE criteria by urine output only (pRIFLE UOP; P=0.087 and by both UOP and SCr (pRIFLECr+UOP; P=0.577. However, attainment of pRIFLE criteria by SCr only (pRIFLECr was significantly improved between days 1 and 3 (P=0.026. There was no statistically significant difference in mortality or length of stay between subjects with AKI and those without AKI. Conclusion The pRIFLE criteria is feasible for use in diagnosing and following the clinical course of AKI in critically ill children.[Paediatr Indones. 2013;53:32-6.

  8. Acute Childhood Illnesses and Health Seeking Behaviour among under five children in a village of Hooghly district, West Bengal

    Directory of Open Access Journals (Sweden)

    Indira Dey (Pal

    2012-04-01

    Full Text Available Background: – Acute respiratory infections and diarrhoeal diseases are important causes of morbidity in children worldwide. IMNCI component is addressing these two illnesses in a major way and is concentrating on health care practices of community. Objective: – to find out their health seeking behaviour. Methodology: – A community based , cross-sectional study was conducted in the Mollasimla village of Hooghly district of West Bengal using 2 weeks recall for acute illnesses. Results – It was found that 56.8%, 23.8% and 18.9% children suffered from ARI, fever and diarrhea respectively. Overall treatment rate was above 93% and most of the children were treated in hospitals and health centre. Conclusion: – Acute illnesses are still largely prevalent in the rural community. As mothers are the first care givers, they should be made aware of the preventive measures and the need for seeking treatment.

  9. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury

    DEFF Research Database (Denmark)

    2011-01-01

    Introduction: Our aim was to investigate the impact of early versus late initiation of renal replacement therapy (RRT) on clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods: Systematic review and meta-analysis were used in this study. PUBMED, EMBASE, SCOPUS, Web......-regression controlling for illness severity (Acute Physiology And Chronic Health Evaluation II (APACHE II)), baseline creatinine and urea did not impact the overall summary estimate for mortality. Of studies reporting secondary outcomes, five studies (out of seven) reported greater renal recovery, seven (out of eight...

  10. Arboviral etiologies of acute febrile illnesses in Western South America, 2000-2007.

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    Brett M Forshey

    Full Text Available BACKGROUND: Arthropod-borne viruses (arboviruses are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. METHODOLOGY/FINDINGS: A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%. Dengue viruses (Flavivirus were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV] and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban clinic. In contrast, OROV infection was similar between sexes and type of clinic. CONCLUSIONS/SIGNIFICANCE: Our data provide a better understanding of the geographic range of

  11. Arboviral Etiologies of Acute Febrile Illnesses in Western South America, 2000–2007

    Science.gov (United States)

    Forshey, Brett M.; Guevara, Carolina; Laguna-Torres, V. Alberto; Cespedes, Manuel; Vargas, Jorge; Gianella, Alberto; Vallejo, Efrain; Madrid, César; Aguayo, Nicolas; Gotuzzo, Eduardo; Suarez, Victor; Morales, Ana Maria; Beingolea, Luis; Reyes, Nora; Perez, Juan; Negrete, Monica; Rocha, Claudio; Morrison, Amy C.; Russell, Kevin L.; J. Blair, Patrick; Olson, James G.; Kochel, Tadeusz J.

    2010-01-01

    Background Arthropod-borne viruses (arboviruses) are among the most common agents of human febrile illness worldwide and the most important emerging pathogens, causing multiple notable epidemics of human disease over recent decades. Despite the public health relevance, little is know about the geographic distribution, relative impact, and risk factors for arbovirus infection in many regions of the world. Our objectives were to describe the arboviruses associated with acute undifferentiated febrile illness in participating clinics in four countries in South America and to provide detailed epidemiological analysis of arbovirus infection in Iquitos, Peru, where more extensive monitoring was conducted. Methodology/Findings A clinic-based syndromic surveillance system was implemented in 13 locations in Ecuador, Peru, Bolivia, and Paraguay. Serum samples and demographic information were collected from febrile participants reporting to local health clinics or hospitals. Acute-phase sera were tested for viral infection by immunofluorescence assay or RT-PCR, while acute- and convalescent-phase sera were tested for pathogen-specific IgM by ELISA. Between May 2000 and December 2007, 20,880 participants were included in the study, with evidence for recent arbovirus infection detected for 6,793 (32.5%). Dengue viruses (Flavivirus) were the most common arbovirus infections, totaling 26.0% of febrile episodes, with DENV-3 as the most common serotype. Alphavirus (Venezuelan equine encephalitis virus [VEEV] and Mayaro virus [MAYV]) and Orthobunyavirus (Oropouche virus [OROV], Group C viruses, and Guaroa virus) infections were both observed in approximately 3% of febrile episodes. In Iquitos, risk factors for VEEV and MAYV infection included being male and reporting to a rural (vs urban) clinic. In contrast, OROV infection was similar between sexes and type of clinic. Conclusions/Significance Our data provide a better understanding of the geographic range of arboviruses in South

  12. [Parents of a critically ill child - what do they expect from the team of the pediatric intensive care unit?].

    Science.gov (United States)

    Spitz-Köberich, Christine; Barth, Michael; Spirig, Rebecca

    2010-10-01

    Having an ill child that is being treated in a pediatric intensive care unit (PICU) is tremendously stressful for the parents, both physically and emotionally. To help them cope with the circumstances they find themselves in, parents often develop expectations which are addressed to the team of the PICU, and which they find important to be fulfilled. Many of these expectations are culturally shaped. At present, there exist no data from German speaking area. Thus, this qualitative study was undertaken to fill this gap. Episodic interviews were conducted with five mothers and two fathers. Using the content analysis technique described by Mayring, one main category and six subcategories emerged from the data. "Concering about the sick child" was of particular importance for the parents. Their own expectations were reflected in the six subcategories: "Knowing that the child is receiving good care", "Being with the child", "Being involved", "Experiencing care for oneself and one's child", "Being informed" and "Experiencing continuity". These results are congruent with prior research reported in the international literature. Having a desire for a continuous medical support and the clear separation of roles between physicians and nurses are new findings from this investigation which have not been described previously.

  13. Assessment of acutely mentally ill patients' satisfaction of care: there is a difference among ethnic groups.

    Science.gov (United States)

    Anders, Robert L; Olson, Tom; Bader, Julia

    2007-03-01

    The relationship between quality of care and patient satisfaction has been documented. The specific research aim related to this study is to determine if differences exist among Caucasians, Asians, and Pacific Islanders who are hospitalized for an acute mental illness with regard to their perceived satisfaction with the care. The results of the overall study have been reported elsewhere. The sample was composed of 138 patients, of whom 34.7% were Caucasian, 31.2% Pacific Islanders, and 34.8% Asians. Within 24 hours of discharge, patients completed the Perceptions of Care instrument. Caucasians were over-represented in our sample in comparison to their percentage in the general population of Hawaii. These patients were significantly more satisfied (p = .04) with their care than the other ethnic groups. No single variable was found to specifically indicate why they were more satisfied than Pacific Islanders and Asians.

  14. Charcot-Marie-Tooth disease masquerading as acute demyelinating encephalomyelitis-like illness.

    Science.gov (United States)

    Kim, Gun-Ha; Kim, Kyoung Min; Suh, Sang-Il; Ki, Chang-Seok; Eun, Baik-Lin

    2014-07-01

    X-linked Charcot-Marie-Tooth disease (CMTX1) is a clinically heterogeneous hereditary motor and sensory neuropathy with X-linked transmission. Common clinical manifestations of CMTX1 disease, as in other forms of Charcot-Marie-Tooth (CMT) disease, are distal muscle wasting and weakness, hyporeflexia, distal sensory disturbance, and foot deformities. Mutations in the connexin-32 gene (gap junction protein β1 [GJB1]) are responsible for CMTX1 disease. In this report, we describe a patient with CMTX1 disease presenting with recurrent attacks of transient and episodic acute demyelinating encephalomyelitis (ADEM)-like symptoms without previous signs of lower extremity weakness or foot deformities; the patient, as well as his asymptomatic mother, exhibited a novel GJB1 mutation (p.Met1Ile). Differential diagnosis of recurrent and transient ADEM-like illness, if unexplained, should include the possibility of CMTX1 disease.

  15. The effectiveness of the solidary care ahead of events that follow the chronicle illness process of the hospitalized child

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    Alexandra Maria Alves

    2006-08-01

    Full Text Available Article of research that objectified to identify how the nurses carrie through the solidary care front to the alterations in the evolution of the hospitalized child that lead to the chronicle illness process. The methodology is qualitative through the exploratory- description method. The subjects had been nine assisstencial nurses who act in pediatric units of a great hospital of Curitiba-PR wich is reference in the pediatric area in all Brazil. For the collection of the information we used the half-structuralized interview. To accomplish the analysis of the depositions we followed the content analysis proposal by Bardin (1991. The ethical rules had been followed in agreement to the Resolution 196/96. All the subjects had signed the term of content of written informed consent. After the transcription of the interviews that had been recorded, we initiate the categorization. Three Units of Context and six Units of Meaning had been apprehended.The Units of Context include the perception of the chronicle illness process of the hospitalized child by the nurse; the perception of the nursing actions of solidary care by the family and, pointing characteristics that interpose the solidary care. For the analysis of the depositions it was possible to perceive that the lack of familiar structure is visible, therefore the child remains long time in the hospital, modifying its daily routine, affecting the family and changing its routine, that is, coexisting with the chronicle illness process imposes alterations in the existing space and temporality of the child. The family and child need support supplied by the nurse in solidary care. The solidary care is perceived by the bond, interest, contact, dialogue, support, the presence, the listening, for the empathy, reliable transmission and hope. It can be established with multiprofessional work, preparation of the team, knowledge, availability, respect for the other. The solidary care is a process, an event that

  16. Hydroclimatic variables and acute gastro-intestinal illness in British Columbia, Canada: A time series analysis

    Science.gov (United States)

    Galway, L. P.; Allen, D. M.; Parkes, M. W.; Li, L.; Takaro, T. K.

    2015-02-01

    Using epidemiologic time series analysis, we examine associations between three hydroclimatic variables (temperature, precipitation, and streamflow) and waterborne acute gastro-intestinal illness (AGI) in two communities in the province of British Columbia (BC), Canada. The communities were selected to represent the major hydroclimatic regimes that characterize BC: rainfall-dominated and snowfall dominated. Our results show that the number of monthly cases of AGI increased with increasing temperature, precipitation, and streamflow in the same month in the context of a rainfall-dominated regime, and with increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results suggest that hydroclimatology plays a role in driving the occurrence and variability of AGI in these settings. Further, this study highlights that the nature and magnitude of the effects of hydroclimatic variability on AGI are different in the context of a snowfall-dominated regime versus a rainfall-dominated regimes. We conclude by proposing that the watershed may be an appropriate context for enhancing our understanding of the complex linkages between hydroclimatic variability and waterborne illness in the context of a changing climate.

  17. Checklist for early recognition and treatment of acute illness: International collaboration to improve critical care practice.

    Science.gov (United States)

    Vukoja, Marija; Kashyap, Rahul; Gavrilovic, Srdjan; Dong, Yue; Kilickaya, Oguz; Gajic, Ognjen

    2015-02-04

    Processes to ensure world-wide best-practice for critical care delivery are likely to minimize preventable death, disability and costly complications for any healthcare system's sickest patients, but no large-scale efforts have so far been undertaken towards these goals. The advances in medical informatics and human factors engineering have provided possibility for novel and user-friendly clinical decision support tools that can be applied in a complex and busy hospital setting. To facilitate timely and accurate best-practice delivery in critically ill patients international group of intensive care unit (ICU) physicians and researchers developed a simple decision support tool: Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN). The tool has been refined and tested in high fidelity simulated clinical environment and has been shown to improve performance of clinical providers faced with simulated emergencies. The aim of this international educational intervention is to implement CERTAIN into clinical practice in hospital settings with variable resources (included those in low income countries) and evaluate the impact of the tool on the care processes and patient outcomes. To accomplish our aims, CERTAIN will be uniformly available on either mobile or fixed computing devices (as well as a backup paper version) and applied in a standardized manner in the ICUs of diverse hospitals. To ensure the effectiveness of the proposed intervention, access to CERTAIN is coupled with structured training of bedside ICU providers.

  18. Acute Muscular Sarcocystosis: an international investigation among ill travelers returning from Tioman Island, Malaysia, 2011 and 2012

    Science.gov (United States)

    Two provider-based traveler-focused networks allowed for the detection of a large outbreak of acute muscular sarcocystosis (AMS). Clinicians evaluating travelers returning ill from Malaysia with fever and myalgia noted the biphasic aspect of the disease, the later onset of elevated CPK and eosinophi...

  19. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2011-11-01

    Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

  20. Pharmacokinetics of cefotaxime in critically ill patients with acute kidney injury treated with continuous renal replacement therapy : a pilot study

    NARCIS (Netherlands)

    Koedijk, Joost B; Valk-Swinkels, Corinne G H; Rijpstra, Tom A; Touw, Daan J; Mulder, Paul G H; van der Voort, Peter H J; Van't Veer, Nils E; van der Meer, Nardo J M

    2016-01-01

    INTRODUCTION: The objective of this study is to describe the pharmacokinetics of cefotaxime (CTX) in critically ill patients with acute kidney injury (AKI) when treated with continuous renal replacement therapy (CRRT) in the Intensive Care Unit (ICU). MATERIALS AND METHODS: This single-center prospe

  1. Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients

    NARCIS (Netherlands)

    Morandi, A; Pandharipande, P; Trabucchi, M; Rozzini, R; Mistraletti, G; Trompeo, A C; Gregoretti, C; Gattinoni, L; Ranieri, M V; Brochard, L; Annane, D; Putensen, C; Guenther, U; Fuentes, P; Tobar, E; Anzueto, A R; Esteban, A; Skrobik, Y; Salluh, J I F; Soares, M; Granja, C; Stubhaug, A; de Rooij, S E; Ely, E Wesley

    2008-01-01

    BACKGROUND: Delirium (acute brain dysfunction) is a potentially life threatening disturbance in brain function that frequently occurs in critically ill patients. While this area of brain dysfunction in critical care is rapidly advancing, striking limitations in use of terminology related to delirium

  2. Effect of Antiplatelet Therapy on Acute Respiratory Distress Syndrome and Mortality in Critically Ill Patients: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Lijun Wang

    Full Text Available Antiplatelet agents are commonly used for cardiovascular diseases, but their pleiotropic effects in critically ill patients are controversial. We therefore performed a meta-analysis of cohort studies to investigate the effect of antiplatelet therapy in the critically ill.Nine cohort studies, retrieved from PubMed and Embase before November 2015, involving 14,612 critically ill patients and 4765 cases of antiplatelet users, were meta-analysed. The main outcome was hospital or 30-day mortality. Secondary outcome was acute respiratory distress syndrome (ARDS or acute lung injury (ALI. Random- or fixed-effect models were taken for quantitative synthesis of the data.Antiplatelet therapy was associated with decreased mortality (odds ratio (OR 0.61; 95% confidence interval (CI, 0.52-0.71; I2 = 0%; P <0. 001 and ARDS/ALI (OR 0.64; 95% CI, 0.50-0.82; I2 = 0%; P <0. 001. In every stratum of subgroups, similar findings on mortality reduction were consistently observed in critically ill patients.Antiplatelet therapy is associated with reduced mortality and lower incidence of ARDS/ALI in critically ill patients, particularly those with predisposing conditions such as high-risk surgery, trauma, pneumonia, and sepsis. However, it remains unclear whether similar findings can be observed in the unselected and broad population with critical illness.

  3. Electroconvulsive therapy in a child suffering from acute and transient psychotic disorder with catatonic features

    Directory of Open Access Journals (Sweden)

    Satyakam Mohapatra

    2015-01-01

    Full Text Available Electroconvulsive therapy (ECT is a recognized and effective treatment in adults for several psychiatric disorders. However, the lack of knowledge and experience with the use of ECT among child and adolescent psychiatrists is an obstacle to its appropriate use. Treatment using ECT in children of prepubertal age has been less reported. We present a case of 10-year-old child with a diagnosis of acute and transient psychotic disorder with catatonic features, where we have used ECT successfully.

  4. Emergency anesthesia for evacuating a traumatic acute subdural hemorrhage in a child overdosed with hypertonic saline

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    Chulananda Goonasekera

    2016-01-01

    Full Text Available A previously healthy 1-year-old child with a traumatic acute subdural hemorrhage received 10 times higher dose of hypertonic saline inadvertently immediately before surgery. This case report describes deviations in fluid management needed to alleviate salt toxicity and its adverse effects during surgery under anesthesia perioperatively. The child made an uneventful recovery with no evident residual damage at follow-up.

  5. Urinary Kidney Injury Molecule-1 (KIM-1 in Early Diagnosis of Acute Kidney Injury in Pediatric Critically Ill

    Directory of Open Access Journals (Sweden)

    Irma Lestari Paramastuty

    2016-04-01

    Full Text Available Acute kidney injury (AKI often associated with a high hospital morbi-mortality rate in the intensive care unit patients. Kidney injury molecule-1 (KIM-1, has many characteristics of ideal biomarker for kidney injury. The aim of this study was to compared the temporal pattern of elevation urinary KIM-1 level following critically ill children with SCr as standart biomarker of AKI. Prospective analytic observational study was conducted during October to March 2014 in the Saiful Anwar General Hospital and Physiology Laboratory Brawijaya University. There were 13 critically ill as subjects. SCr and KIM-1 levels from all subjects were measured three times ( at admission, after 1st and 6th hour. Subjects were devided into AKI - non-AKI groups by SCr level and survivor - non survivor group at the and of the observations. Results showed that there were significantly increased levels of KIM-1 in the AKI and non-AKI and survivor-non survivor group at time point. However, we found that delta KIM-1 at time point increased significant in non AKI group and survivor group. KIM-1 at admission can diagnosed AKI in critically ill children. We conclude that urinary KIM-1 is a sensitive non-invasive biomarker to diagnosed acute kidney injury in critically ill children. Increase level of KIM-1 by time shows protective and good outcome in critically ill children.

  6. Pott's puffy tumor: a rare complication of acute otitis media in child: a case report.

    Science.gov (United States)

    Urík, Milan; Machač, Josef; Šlapák, Ivo; Hošnová, Dagmar

    2015-09-01

    To describe a rare case of Potts' puffy tumor (PPT) in the zygomatic area, which developed as a complication of acute otitis media in a 6-year-old child. To date, only one case of PPT has been described in the literature as a complication of latent mastoiditis in an adult, and one case of PPT as a complication of acute mastoiditis in a 10-year-old child. Urgent surgical intervention, including evacuation of the purulent lesion, removal of inflamed soft tissue and osteolysis of the involved bone, and antromastoidectomy, intravenous treatment with broad-spectrum antibiotics, including G+, G-, anaerobes and fungi, and local therapy.

  7. Cortical blindness in a child with acute glomerulonephritis.

    Science.gov (United States)

    Kaarthigeyan, K; Vijayalakshmi, A M

    2012-01-01

    The association between hypertensive encephalopathy and cortical blindness in children with acute glomerulonephritis is extremely rare. We report the case of a 9-year old girl who presented with headache, seizures, altered sensorium, hematuria, and transient cortical blindness as a complication of hypertensive encephalopathy which showed complete reversal following normalization of blood pressure and an underlying post-infectious acute glomerulonephritis was revealed.

  8. The provision of thromboprophylaxis and the prediction of renal recovery in critically ill patients with acute kidney injury

    DEFF Research Database (Denmark)

    Robinson, Sian; Larsen, Ulla L.; Zincuk, Aleksander

    2015-01-01

    Background: It is unknown whether the dose of enoxaparin can be optimised, without increasing the risk of bleeding, in critically ill patients with acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) is associated with AKI, and the subsequent need for continuous renal rep...... be able to predict renal recovery in critically ill patients, and allow proper utilization of resources. (EU Clinical Trials Register EudraCT Number: 2012-004368-23; URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-004368-23/DK)....

  9. Sinus Balloon Dilation as Treatment for Acute Sphenoid Sinusitis with Impaired Vision for a Child

    Directory of Open Access Journals (Sweden)

    Yin Zhao

    2016-01-01

    Full Text Available This paper is about sinus balloon dilatation in treatment of acute left sphenoid sinusitis with left impaired vision in a child. Balloon catheter dilatation (BCD of the sinus ostia is a new technique. It has been shown to be a minimally invasive technique to manage chronic sinusitis. However, this method is rarely used in the treatment of acute sinusitis. So far, we know of no reported cases of sinus balloon dilatation in treatment of this case, especially for children.

  10. Burden of acute gastrointestinal illness in Denmark 2009: a population-based telephone survey.

    Science.gov (United States)

    Müller, L; Korsgaard, H; Ethelberg, S

    2012-02-01

    A cross-sectional telephone survey was conducted in Denmark throughout 2009 to determine the incidence of acute gastrointestinal illness (AGI). Using the Danish population register, a random population sample stratified by gender and age groups was selected and mobile or landline phone numbers found. Representative numbers of interviews were performed by gender, age group and month. A recently proposed international case definition of AGI, including cases with diarrhoea and/or vomiting in a 4-week recall period, was used. A total of 1853 individuals were included and 206 (11·1%) fulfilled the case definition; 78% reported diarrhoea. This corresponds to an overall standardized incidence rate of 1·4 (95% CI 1·2-1·6) episodes of AGI per person-year. The incidence rate was generally higher in the younger age groups; only being 2·3, 1·9 and 0·80 per person-year in the 0-9, 10-39 and ≥40 years age groups, respectively. The incidence rate estimates were considerably higher when calculated from shorter recall periods.

  11. Burden of Acute Gastrointestinal Illness in Gálvez, Argentina, 2007

    Science.gov (United States)

    Perez, Enrique; Majowicz, Shannon E.; Reid-Smith, Richard; Albil, Silvia; Monteverde, Marcos; McEwen, Scott A.

    2010-01-01

    This study evaluated the magnitude and distribution of acute gastrointestinal illness (GI) in Gálvez, Argentina, and assessed the outcome of a seven-day versus 30-day recall period in survey methodology. A cross-sectional population survey, with either a seven-day or a 30-day retrospective recall period, was conducted through door-to-door visits to randomly-selected residents during the ‘high’ and the ‘low’ seasons of GI in the community. Comparisons were made between the annual incidence rates obtained using the seven-day and the 30-day recall period. Using the 30-day recall period, the mean annual incidence rates was 0.43 (low season of GI) and 0.49 (high season of GI) episodes per person-year. Using the seven-day recall period, the mean annual incidence rate was 0.76 (low season of GI) and 2.66 (high season of GI) episodes per person-year. This study highlights the significant burden of GI in a South American community and confirms the importance of seasonality when investigating GI in the population. The findings suggest that a longer recall period may underestimate the burden of GI in retrospective population surveys of GI. PMID:20411678

  12. Hospitalization for mental illness among parents after the death of a child

    DEFF Research Database (Denmark)

    Li, Jiong; Laursen, Thomas Munk; Precht, Dorthe Hansen;

    2005-01-01

    , 1.59 to 2.30) and 1.61 (95 percent confidence interval, 1.15 to 2.27) for bereaved mothers and fathers, respectively. Among mothers, the relative risk of being hospitalized for any psychiatric disorder was highest during the first year after the death of the child but remained significantly elevated...... five years or more after the death. Conclusions The risk of psychiatric hospitalization was increased among parents, especially mothers, who lost a child.......Background The loss of a child is considered one of the most stressful events in the life of a parent. We hypothesized that parental bereavement increases the risk of hospital admission for a psychiatric disorder, especially for affective disorders. Methods We studied a cohort of 1,082,503 persons...

  13. Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn

    2015-01-01

    PURPOSE: To describe the prevalence of, risk factors for, and prognostic importance of gastrointestinal (GI) bleeding and use of acid suppressants in acutely ill adult intensive care patients. METHODS: We included adults without GI bleeding who were acutely admitted to the intensive care unit (ICU...... bleeding occurred in 2.6 % (95 % confidence interval 1.6-3.6 %) of patients. The following variables at ICU admission were independently associated with clinically important GI bleeding: three or more co-existing diseases (odds ratio 8.9, 2.7-28.8), co-existing liver disease (7.6, 3.3-17.6), use of renal...

  14. Short-term exposure to ambient particulate matter and emergency ambulance dispatch for acute illness in Japan.

    Science.gov (United States)

    Tasmin, Saira; Ueda, Kayo; Stickley, Andrew; Yasumoto, Shinya; Phung, Vera Ling Hui; Oishi, Mizuki; Yasukouchi, Shusuke; Uehara, Yamato; Michikawa, Takehiro; Nitta, Hiroshi

    2016-10-01

    Short-term exposure to air pollution may be linked to negative health outcomes that require an emergency medical response. However, few studies have been undertaken on this phenomenon to date. The aim of this study therefore was to examine the association between short-term exposure to ambient suspended particulate matter (SPM) and emergency ambulance dispatches (EADs) for acute illness in Japan. Daily EAD data, daily mean SPM and meteorological data were obtained for four prefectures in the Kanto region of Japan for the period from 2007 to 2011. The area-specific association between daily EAD for acute illness and SPM was explored using generalized linear models while controlling for ambient temperature, relative humidity, seasonality, long-term trends, day of the week and public holidays. Stratified analyses were conducted to evaluate the modifying effects of age, sex and medical conditions. Area-specific estimates were combined using meta-analyses. For the total study period the mean level of SPM was 23.7μg/m(3). In general, higher SPM was associated with a significant increase in EAD for acute illness [estimated pooled relative risk (RR): 1.008, 95% CI: 1.007 to 1.010 per 10μg/m(3) increase in SPM at lag 0-1]. The effects of SPM on EAD for acute illness were significantly greater for moderate/mild medical conditions (e.g. cases that resulted in 3weeks hospitalization or which resulted in death). Using EAD data, this study has shown the adverse health effects of ambient air pollution. This highlights the importance of reducing the level of air pollution in order to maintain population health and well-being.

  15. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose fondaparinux

    Directory of Open Access Journals (Sweden)

    Di Nisio M

    2013-09-01

    Full Text Available Marcello Di Nisio,1,2 Ettore Porreca3 1Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, Chieti, Italy; 2Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands; 3Department of Medicine and Aging, Centre for Aging Sciences, Internal Medicine Unit, University G D'Annunzio Foundation, Chieti, Italy Abstract: Venous thromboembolism (VTE is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH, unfractionated heparin (UFH, or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients

  16. [Anemia in the critically ill child and adult: a narrative review].

    Science.gov (United States)

    Demaret, P; Loeckx, I; Mulder, A; Devos, P; Lebrun, F

    2014-01-01

    Anemia is frequent in the pediatric and adult intensive care unit. Anemia decreases oxygen transport which can be harmful in the critically ill patient; it is independently associated with a poor prognosis. The major prophylactic measure against anemia is the limitation of blood draws: several approaches can be used to limit phlebotomy overdraw without harming the patient. Red blood cell transfusion is the quickest way to increase the hemoglobin level, but it is not without risk. It is therefore important to promote the use of evidence-based transfusion strategies. Iron could be useful in case of iron deficiency, but this condition is difficult to diagnose in the critically ill patient. Erythropoietin is no longer relevant in the intensive care unit in the era of restrictive transfusion practice, at least for its hematological effects. Several questions remain to be addressed in order to improve anemia management in the intensive care unit.

  17. Acute functional deterioration in a child with cerebral palsy.

    LENUS (Irish Health Repository)

    Smyth, Elizabeth

    2012-01-01

    We describe a case of acute functional deterioration in a 13-year-old girl with severe spastic diplegia (GMFCS III) and a new diagnosis of diffuse intrinsic pontine glioma (DIPG). She presented with acute deterioration in mobility and motor function over 1 month, which was associated with dysarthria, dysphagia and behavioural change. Her mother had noticed subtle functional deterioration over the 2 months prior to this. Her physiotherapist who was concerned about her acute functional deterioration referred her for emergency review. Neurological imaging revealed a diffuse pontine lesion consistent with DIPG. She was subsequently referred to oncology. She deteriorated further, clinically, over the next few days and following discussion with the team; her family opted for palliative treatment, given the poor prognosis associated with DIPG.

  18. Moyamoya disease in a child with previous acute necrotizing encephalopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Taik-Kun; Cha, Sang Hoon; Chung, Kyoo Byung; Kim, Jung Hyuck; Kim, Baek Hyun; Chung, Hwan Hoon [Department of Diagnostic Radiology, Korea University College of Medicine, Ansan Hospital, 516 Kojan-Dong, Ansan City, Kyungki-Do 425-020 (Korea); Eun, Baik-Lin [Department of Pediatrics, Korea University College of Medicine, Seoul (Korea)

    2003-09-01

    A previously healthy 24-day-old boy presented with a 2-day history of fever and had a convulsion on the day of admission. MRI showed abnormal signal in the thalami, caudate nuclei and central white matter. Acute necrotising encephalopathy was diagnosed, other causes having been excluded after biochemical and haematological analysis of blood, urine and CSF. He recovered, but with spastic quadriparesis. At the age of 28 months, he suffered sudden deterioration of consciousness and motor weakness of his right limbs. MRI was consistent with an acute cerebrovascular accident. Angiography showed bilateral middle cerebral artery stenosis or frank occlusion with numerous lenticulostriate collateral vessels consistent with moyamoya disease. (orig.)

  19. Healthcare-seeking behaviors for acute respiratory illness in two communities of Java, Indonesia: a cross-sectional survey.

    Science.gov (United States)

    Praptiningsih, Catharina Y; Lafond, Kathryn E; Wahyuningrum, Yunita; Storms, Aaron D; Mangiri, Amalya; Iuliano, Angela D; Samaan, Gina; Titaley, Christiana R; Yelda, Fitra; Kreslake, Jennifer; Storey, Douglas; Uyeki, Timothy M

    2016-06-01

    Understanding healthcare-seeking patterns for respiratory illness can help improve estimations of disease burden and inform public health interventions to control acute respiratory disease in Indonesia. The objectives of this study were to describe healthcare-seeking behaviors for respiratory illnesses in one rural and one urban community in Western Java, and to explore the factors that affect care seeking. From February 8, 2012 to March 1, 2012, a survey was conducted in 2520 households in the East Jakarta and Bogor districts to identify reported recent respiratory illnesses, as well as all hospitalizations from the previous 12-month period. We found that 4% (10% of those less than 5years) of people had respiratory disease resulting in a visit to a healthcare provider in the past 2weeks; these episodes were most commonly treated at government (33%) or private (44%) clinics. Forty-five people (0.4% of those surveyed) had respiratory hospitalizations in the past year, and just over half of these (24/45, 53%) occurred at a public hospital. Public health programs targeting respiratory disease in this region should account for care at private hospitals and clinics, as well as illnesses that are treated at home, in order to capture the true burden of illness in these communities.

  20. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

    Science.gov (United States)

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin

    2016-01-01

    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, Pcritically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, Pcritically ill AECOPD patients. PMID:27563239

  1. Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial.

    Science.gov (United States)

    Amouzou, Agbessi; Hazel, Elizabeth; Shaw, Bryan; Miller, Nathan P; Tafesse, Mengistu; Mekonnen, Yared; Moulton, Lawrence H; Bryce, Jennifer; Black, Robert E

    2016-03-01

    We conducted a cluster randomized trial of the effects of the integrated community case management of childhood illness (iCCM) strategy on careseeking for and coverage of correct treatment of suspected pneumonia, diarrhea, and malaria, and mortality among children aged 2-59 months in 31 districts of the Oromia region of Ethiopia. We conducted baseline and endline coverage and mortality surveys approximately 2 years apart, and assessed program strength after about 1 year of implementation. Results showed strong iCCM implementation, with iCCM-trained workers providing generally good quality of care. However, few sick children were taken to iCCM providers (average 16 per month). Difference in differences analyses revealed that careseeking for childhood illness was low and similar in both study arms at baseline and endline, and increased only marginally in intervention (22.9-25.7%) and comparison (23.3-29.3%) areas over the study period (P = 0.77). Mortality declined at similar rates in both study arms. Ethiopia's iCCM program did not generate levels of demand and utilization sufficient to achieve significant increases in intervention coverage and a resulting acceleration in reductions in child mortality. This evaluation has allowed Ethiopia to strengthen its strategic approaches to increasing population demand and use of iCCM services.

  2. The predictive value of the NICE "red traffic lights" in acutely ill children.

    Directory of Open Access Journals (Sweden)

    Evelien Kerkhof

    Full Text Available OBJECTIVE: Early recognition and treatment of febrile children with serious infections (SI improves prognosis, however, early detection can be difficult. We aimed to validate the predictive rule-in value of the National Institute for Health and Clinical Excellence (NICE most severe alarming signs or symptoms to identify SI in children. DESIGN, SETTING AND PARTICIPANTS: The 16 most severe ("red" features of the NICE traffic light system were validated in seven different primary care and emergency department settings, including 6,260 children presenting with acute illness. MAIN OUTCOME MEASURES: We focussed on the individual predictive value of single red features for SI and their combinations. Results were presented as positive likelihood ratios, sensitivities and specificities. We categorised "general" and "disease-specific" red features. Changes in pre-test probability versus post-test probability for SI were visualised in Fagan nomograms. RESULTS: Almost all red features had rule-in value for SI, but only four individual red features substantially raised the probability of SI in more than one dataset: "does not wake/stay awake", "reduced skin turgor", "non-blanching rash", and "focal neurological signs". The presence of ≥ 3 red features improved prediction of SI but still lacked strong rule-in value as likelihood ratios were below 5. CONCLUSIONS: The rule-in value of the most severe alarming signs or symptoms of the NICE traffic light system for identifying children with SI was limited, even when multiple red features were present. Our study highlights the importance of assessing the predictive value of alarming signs in clinical guidelines prior to widespread implementation in routine practice.

  3. Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada

    Directory of Open Access Journals (Sweden)

    Sherilee L. Harper

    2015-05-01

    Full Text Available Background: The incidence of self-reported acute gastrointestinal illness (AGI in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives: This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design: Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC medication utilization related to AGI symptoms. Results: In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4 and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1 were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills were significantly associated with increased odds of taking OTC medication. Conclusions: While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

  4. Urinary L-FABP predicts poor outcomes in critically ill patients with early acute kidney injury.

    Science.gov (United States)

    Parr, Sharidan K; Clark, Amanda J; Bian, Aihua; Shintani, Ayumi K; Wickersham, Nancy E; Ware, Lorraine B; Ikizler, T Alp; Siew, Edward D

    2015-03-01

    Biomarker studies for early detection of acute kidney injury (AKI) have been limited by nonselective testing and uncertainties in using small changes in serum creatinine as a reference standard. Here we examine the ability of urine L-type fatty acid-binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), and kidney injury molecule-1 (KIM-1) to predict injury progression, dialysis, or death within 7 days in critically ill adults with early AKI. Of 152 patients with known baseline creatinine examined, 36 experienced the composite outcome. Urine L-FABP demonstrated an area under the receiver-operating characteristic curve (AUC-ROC) of 0.79 (95% confidence interval 0.70-0.86), which improved to 0.82 (95% confidence interval 0.75-0.90) when added to the clinical model (AUC-ROC of 0.74). Urine NGAL, IL-18, and KIM-1 had AUC-ROCs of 0.65, 0.64, and 0.62, respectively, but did not significantly improve discrimination of the clinical model. The category-free net reclassification index improved with urine L-FABP (total net reclassification index for nonevents 31.0%) and urine NGAL (total net reclassification index for events 33.3%). However, only urine L-FABP significantly improved the integrated discrimination index. Thus, modest early changes in serum creatinine can help target biomarker measurement for determining prognosis with urine L-FABP, providing independent and additive prognostic information when combined with clinical predictors.

  5. Bartonella henselae as a cause of acute-onset febrile illness in cats

    Directory of Open Access Journals (Sweden)

    Edward B Breitschwerdt

    2015-08-01

    Full Text Available Case series summary At different time points spanning 6 months, three adopted feral flea-infested cats, residing in the household of a veterinary technician, became acutely anorexic, lethargic and febrile. Enrichment blood culture/PCR using Bartonella alpha Proteobacteria growth medium (BAPGM confirmed initial infection with the same Bartonella henselae genotype in all three cases. With the exception of anemia and neutropenia, complete blood counts, serum biochemical profiles and urinalysis results were within reference intervals. Also, tests for feline leukemia virus, feline immunodeficiency virus, Toxoplasma gondii and feline coronavirus antibodies were negative. Serial daily temperature monitoring in one case confirmed a cyclic, relapsing febrile temperature pattern during 1 month, with resolution during and after treatment with azithromycin. Bartonella henselae Western immunoblot (WB results did not consistently correlate with BAPGM enrichment blood culture/PCR results or B henselae indirect fluorescent antibody (IFA titers, and WB titration results were not informative for establishing antibiotic treatment failure. During the respective follow-up periods, no illnesses or additional febrile episodes were reported, despite repeat documentation of B henselae bacteremia in two cats available for follow-up (one with the same genotype and the other with a different B henselae genotype; one cat was, unfortunately, killed by dogs before follow-up testing. Relevance and novel information We conclude that microbiological diagnosis and treatment of B henselae infection in cats can be challenging, that antibody titration results and resolution of clinical abnormalities may not correlate with a therapeutic cure, and that fever and potentially neutropenia should be differential diagnostic considerations for young cats with suspected bartonellosis.

  6. HIV knowledge, stigma, and illness beliefs among pediatric caregivers in Ghana who have not disclosed their child's HIV status.

    Science.gov (United States)

    Paintsil, Elijah; Renner, Lorna; Antwi, Sampson; Dame, Joycelyn; Enimil, Anthony; Ofori-Atta, Angela; Alhassan, Amina; Ofori, Irene Pokuaa; Cong, Xiangyu; Kyriakides, Tassos; Reynolds, Nancy R

    2015-01-01

    The majority of HIV-infected children in sub-Saharan Africa have not been informed of their HIV status. Caregivers are reluctant to disclose HIV status to their children because of concern about the child's ability to understand, parental sense of guilt, and fear of social rejection and isolation. We hypothesized that the low prevalence of pediatric HIV disclosure in Ghana is due to lack of accurate HIV information and high HIV stigma among caregivers. This is a preliminary analysis of baseline data of an HIV pediatric disclosure intervention study in Ghana ("Sankofa"). "Sankofa" - is a two-arm randomized controlled clinical trial comparing disclosure intervention plus usual care (intervention arm) vs usual care (control arm) at Korle-Bu Teaching Hospital (KBTH; control arm) and Komfo-Anokye Teaching Hospital (KATH; intervention arm). We enrolled HIV-infected children, ages 7-18 years who do not know their HIV status, and their caregivers. Baseline data of caregivers included demographic characteristics; Brief HIV Knowledge Questionnaire (HIV-KQ-18); Brief Illness Perception Questionnaire; and HIV Stigma Scale. Simple and multivariable linear regression analyses were used to assess the relationship between caregiver characteristics and HIV knowledge, stigma, and illness perception. Two hundred and ninety-eight caregivers were enrolled between January 2013 and July 2014 at the two study sites; KBTH (n = 167) and KATH (n = 131). The median age of caregivers was 41 years; 80.5% of them were female and about 60% of caregivers were HIV-positive. Seventy-eight percent of caregivers were self-employed with low household income. In both unadjusted and adjusted analyses, HIV negative status and lower level of education were associated with poor scores on HIV-KQ. HIV positive status remained significant for higher level of stigma in the adjusted analyses. None of the caregiver's characteristics predicted caregiver's illness perception. Intensification of HIV education in

  7. Acute lymphangitis in a preschool child: A case report

    Directory of Open Access Journals (Sweden)

    Loh Huai Seng

    2012-12-01

    Full Text Available A 3-year old preschool boy presented with apruritic red streak at the dorsum of his right foot travelingupward from the affected site which was red and swollen.Insect sting was the more likely trigger which had causedthe cellulitis and subsequently the acute lymphangitis.

  8. Acute respiratory symptoms and general illness during the first year of life: a population-based birth cohort study

    DEFF Research Database (Denmark)

    von Linstow, Marie-Louise; Holst, Klaus Kähler; Larsen, Karina

    2008-01-01

    Respiratory symptoms are common in infancy. Most illnesses occurring among children are dealt with by parents and do not require medical attention. Nevertheless, few studies have prospectively and on a community-basis assessed the amount of respiratory symptoms and general illness in normal infants....... In this population-based birth cohort study, 228 healthy infants from Copenhagen, Denmark were followed from birth to 1 year of age during 2004-2006. Symptoms were registered using daily diaries and monthly home visits. Interviews were performed at inclusion and every second month. Risk factor analysis was carried...... out by multiple logistic regression analysis. On average, children had general symptoms for 3.5 months during their first year of life, nasal discharge being most frequent followed by cough. Frequency of all symptoms increased steeply after 6 months of age. Each child had on average 6.3 episodes...

  9. Recurrent acute pancreatitis in a Saudi child with isovaleric acidemia

    Directory of Open Access Journals (Sweden)

    Satti Abdelrahim Satti

    2016-01-01

    Full Text Available Isovaleric acidemia (IVA, also known as the sweaty foot syndrome, is an autosomal recessive organic acid disorder due to a defect in the mitochondrial Flavin Adenine Dinucleotide (FAD-dependent enzyme isovaleryl CoA dehydrogenase. Acute pancreatitis as a complication has been reported. We are presenting a rare case of recurrent acute pancreatitis complicating a 9-year-old girl with IVA. She presented with repeated attacks of vomiting, severe abdominal pain, and fever since the age of 18 months. These were diagnosed as attacks of pancreatitis with high serum amylase presenting clinically as diabetic ketoacidosis. Later, she developed chronic pancreatitis which is proved by lapratomy. In the last attack, she was comatosed with fulminant sepsis and sooner the patient died. Blood sample taken during this last attack confirmed the diagnosis of IVA. An inborn error of organic acid metabolism should be considered in children with pancreatitis of unknown origin.

  10. Acute Dystonia in a Child Receiving Metoclopramide: Case Report

    Directory of Open Access Journals (Sweden)

    Alaaddin Yorulmaz

    2016-11-01

    Full Text Available Metoclopramide is a benzamide that is a dopamine receptor, often preferred as a prokinetic agent to accelerate gastrointestinal passage in the treatment of gastroesophageal reflux disease; itis also used as an antiemetic agent in many diseases that progress with nausea-vomiting. It is effective on the digestive system both centrally and peripherally. It easily overcomes the blood-brain barrier and may create side effects pertaining to the extrapyramidal system. Acute dystonic reaction is rare among these side effects; it is, however, a condition that needs to be treated urgently. This paper presents a 5-month-old infant patient who developed acute dystonic reaction secondary to the use of Metpamid at a high dose. The diagnosis in this case was made based onpatient history. The patient%u2019s symptoms rapidly disappeared thanks to treatment with diphenhydramine. It should be remembered that metoclopramide may cause side effects in patients presenting to the emergency service with acute dystonia, soa complete history of drugs should definitely be taken for such patients.

  11. Aspects of protein metabolism in children in acute and chronic illness

    NARCIS (Netherlands)

    Geukers, V.G.M.

    2014-01-01

    In critically ill children, a negative protein balance is associated with an increased incidence of infections, fewer ventilator-free days, and increased length of stay in the pediatric intensive care unit. Additionally, a malnourished state due to chronic illness increases the risk of respiratory i

  12. Exploring the physically ill child's self-perceptions and the mother's perceptions of her child's needs: insights gained from the FIRO-BC--a behavior test for use with children.

    Science.gov (United States)

    Samaniego, L R; Caldwell, H S; Nitschke, R; Humphrey, G B

    1977-02-01

    When dealing with the management of the dying patient and his family, systematic research has been very limited. Understanding the dying child's needs, as well as his family's, is important for approprirate therapy programs. The present study investigated the mother's awareness of her child's expressed and wanted needs in three areas of interpersonal relationships. It also studied the dying child's self-perceived needs and desires as compared with those of children with a non-life-threatening illness and with those of well children.

  13. An unusual cause of acute scrotum in a child.

    LENUS (Irish Health Repository)

    Aworanti, O

    2014-11-01

    Acute non-traumatic scrotal pain in children, commonly due to a torted testicular appendage (hydatid of Morgagni) or torted epididymal appendage is well described. These vestigial embryonal duct remnants are of Müllerian and Wolffian duct origin respectively. Very rarely, the other infrequently encountered Wolffian duct remnants known as the paradidymis or organ of Giraldés and the superior and inferior aberrant ducts known as the organs of Haller can become torted. We describe the presentation, management and diagnosis of a torted embryonal remnant arising from the distal spermatic cord.

  14. A prospective study of symptoms, function, and medication use during acute illness in nursing home residents: design, rationale and cohort description

    Directory of Open Access Journals (Sweden)

    Liu Sophia

    2010-07-01

    Full Text Available Abstract Background Nursing home residents are at high risk for developing acute illnesses. Compared with community dwelling adults, nursing home residents are often more frail, prone to multiple medical problems and symptoms, and are at higher risk for adverse outcomes from acute illnesses. In addition, because of polypharmacy and the high burden of chronic disease, nursing home residents are particularly vulnerable to disruptions in transitions of care such as medication interruptions in the setting of acute illness. In order to better estimate the effect of acute illness on nursing home residents, we have initiated a prospective cohort which will allow us to observe patterns of acute illnesses and the consequence of acute illnesses, including symptoms and function, among nursing home residents. We also aim to examine the patterns of medication interruption, and identify patient, provider and environmental factors that influence continuity of medication prescribing at different points of care transition. Methods This is a prospective cohort of nursing home residents residing in two nursing homes in a metropolitan area. Baseline characteristics including age, gender, race, and comorbid conditions are recorded. Participants are followed longitudinally for a planned period of 3 years. We record acute illness incidence and characteristics, and measure symptoms including depression, pain, withdrawal symptoms, and function using standardized scales. Results 76 nursing home residents have been followed for a median of 666 days to date. At baseline, mean age of residents was 74.4 (± 11.9; 32% were female; 59% were white. The most common chronic conditions were dementia (41%, depression (38%, congestive heart failure (25% and chronic obstructive lung disease (27%. Mean pain score was 4.7 (± 3.6 on a scale of 0 to 10; Geriatric Depression Scale (GDS-15 score was 5.2 (± 4.4. During follow up, 138 acute illness episodes were identified, for an

  15. ACUTE UNDIFFERENTIATED FEBRILE ILLNESS AMONG ADULTS – A HOSPITAL BASED OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Shivkumar

    2013-04-01

    Full Text Available ABSTRACT. BACKGROUND: Fever is a burning issue in the tropics and the mos t common cause of morbidity. Quite frequently this fever goes undi agnosed because of many reasons like the lack of diagnostic facilities, insufficient epidemi ological data available on causes of fever, and so on. This research study was aimed to find out the e tiology and clinical markers of Acute Undifferentiated Febrile Illness [AUFI] among the r ural population of Southern India. METHODOLOGY: This prospective, observational study was conducted at Government Villupuram Medical College and Hospital, a rural ter tiary care centre in Tamil Nadu, India. Consecutive hospitalised adult patients [>16 years] with AUFI[5-14 days fever] were enrolled into the study from August 2010 to February 2012 [1 8 months].Upon enrollment, detailed history was recorded, physical examination done and basic blood tests including biochemical examination, smear study for malaria, blood culture s and serology for the commonly encountered infections were done according to study protocol. The patients were followed up until clinical recovery and convalescence. The data were entered in MS excel and analyzed using Epi-info software 2008 version. RESULTS: A total of 403 patients were included in the study . The distribution of AUFI included Malaria 133[33%], Typhoid 83[20.59%], Dengue 42[10.4%], Leptospirosis 25[6.2%], and other causes 36[8.9%] and unknown cause 84[20.84%]. Malaria patients were significantly associated with jaundice , altered mentation, travel outside the district, elevated AST/ALT levels, thrombocytopenia and splenomegaly. Typhoid fever was associated with longer fever duration, abdominal pai n, coated tongue, relative bradycardia, normal platelet counts and low leucocyte count. Deng ue fever could be predicted by rash, pruritis, petechiae ,retro-orbital pain and low platele t counts. Leptospirosis patients showed significant association with conjunctival suffusion , muscle

  16. Acute hydrocephalus in a child with a third ventricle arachnoid cyst and coincidental enteroviral meningitis.

    Science.gov (United States)

    Jeltema, Hanne-Rinck; Kuijlen, Jos M A; Hoving, Eelco W

    2014-06-01

    We present a 2.5-year-old child suffering from acute hydrocephalus. First, the child was diagnosed with aseptic viral meningitis. The PCR of the cerebrospinal fluid (CSF) was positive for enterovirus. Subsequently, MRI revealed that the hydrocephalus was caused by a cyst in the third ventricle. During ventriculoscopy, the cyst had all aspects of an arachnoid cyst. An endoscopic fenestration and partial removal of the cyst was performed, combined with a ventriculocisternostomy. The coincidental finding of viral meningitis and a third ventricle arachnoid cyst in a patient with acute hydrocephalus has, to our knowledge, not been described in literature before. If there is a relation between the enteroviral meningitis, the arachnoid cyst (possibly causing a pre-existing subclinical hydrocephalus) and the rapidly evolving neurological deterioration, remains speculative. Proposed mechanisms, by which the viral meningitis could accelerate the disease process, are slight brain swelling or increased CSF production. This rare combination of diagnoses could also be coincidental.

  17. Persistent and acute diarrhoea as the leading causes of child mortality in urban Guinea Bissau

    DEFF Research Database (Denmark)

    Mølbak, K; Aaby, P; Ingholt, L;

    1992-01-01

    An investigation of child mortality in a semi-urban community, Bandim II, in the capital of Guinea Bissau was carried out from April 1987 to March 1990. 153 deaths were recorded among 1426 live-born children who were followed for 2753 child-years. The under-five mortality risk was 215 per 1000...... children (95% confidence interval [CI] 176-264), infant mortality 94 per 1000 (95% CI 73-115), and perinatal mortality 52 per 1000 (95% CI 41-63). By prospective registration of morbidity, post-mortem interviews, and examination of available hospital records, a presumptive cause of death was established...... in 86% of the deaths. Persistent and acute diarrhoea were the most frequent causes of death, accounting for 43 and 31 deaths per 1000 children, respectively. Fever deaths (possibly malaria), neonatal deaths, acute respiratory infections, and measles were other frequent causes. The access to health...

  18. [Relationship between child day-care attendance and acute infectious disease. A systematic review].

    Science.gov (United States)

    Ochoa Sangrador, Carlos; Barajas Sánchez, M Verisima; Muñoz Martín, Beatriz

    2007-01-01

    Child day-care attendance is considered to be an acute early childhood disease risk factor, the studies available however not affording the possibility of fully quantifying this risk. A systematic review of clinical trials and cohort studies was conducted, in which the effects child day-care attendance had on the health of young children based on the Cochrane Collaboration, PubMed and Spanish Medical Index databases, without any time or language-related limits, were analyzed and rounded out with analyses of referenced works and an additional EMBASE search. The methodological quality was evaluated by means of personalized criteria. Pooling measures (relative risks, incidence density ratios and weighted mean differences) were calculated with their confidence intervals, assuming random effects models. A significant increase was found to exist of a risk consistent over time and among different social and geographical environments. Considering the most methodologically-stringent studies with adjusted effect estimates, child day-care attendance was related to an increased risk of upper respiratory tract infection (RR=1,88), acute otitis media (RR=1,58), otitis media with fluid draining (RR=2,43), lower respiratory tract infections (overall RR=210; acute pneumonia RR=1.70; broncholitis RR=1,80; bronchitis RR=2,10) and gastroenteritis (RR=1,40). Child day-care attendance could be responsible for 33%-50% of the episodes of respiratory infection and gastroenteritis among the exposed population. In conclusion, it can be said that the risk for childhood health attributable to the child day-care attendance is discreet but of high-impact. This information has some major implications for research, clinical practice, healthcare authorities and society as a whole.

  19. Severe hypoalphalipoproteinaemia in a child with acute post-streptococcal glomerulonephritis (APSGN)

    OpenAIRE

    Alayli, Mohammad B; Sanjad, Sami A.

    2013-01-01

    We describe a child with acute post-streptococcal glomerulonephritis (APSGN), who developed a very low plasma high-density lipoprotein cholesterol (α-lipoprotein) in association with transient but massive proteinuria. The hypoalphalipoproteinaemia resolved spontaneously concomitant with the remission in proteinuria and the patient had a complete clinical recovery. Urinary loss of apolipoprotein A1 may have contributed to the hypoalphalipoproteinaemia. To our knowledge, this has not been repor...

  20. Acute cerebral paragonimiasis presenting as hemorrhagic stroke in a child.

    Science.gov (United States)

    Chen, Zhi; Zhu, Gang; Lin, Jiangkai; Wu, Nan; Feng, Hua

    2008-08-01

    A hemorrhagic stroke in children is rarely secondary to cerebral paragonimiasis. We describe a 9-year-old boy in whom an intracerebral hemorrhage was the leading clinical indication of acute cerebral paragonimiasis. He was hospitalized because of a sudden onset of headache, right hemiparesis, and dysarthria. A computed tomography scan revealed an intracerebral hemorrhage in the left parietal lobe. Magnetic resonance angiography did not confirm any vascular abnormalities at the location of the hematoma. Four weeks later, he presented with right hemiparesis again, and fever. A diagnosis of cerebral paragonimiasis was based on repeated magnetic resonance imaging of the brain and an enzyme-linked immunosorbent assay for paragonimiasis. The patient gradually recovered with praziquantel treatment. Cerebral paragonimiasis should be considered in the differential diagnosis of hemorrhagic strokes in children in areas where paragonimiasis is epidemic.

  1. An Approach to the Child with Acute Glomerulonephritis

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    Thomas R. Welch

    2012-01-01

    Full Text Available Acute glomerulonephritis (AGN is a common condition in childhood. Many children with AGN can be managed in the primary care setting. The diagnosis is usually made on the basis of urinary findings, especially the presence of red blood cell casts. One of the most important initial investigations is determining the complement C3 level; hypocomplementemia is most characteristic of post streptococcal AGN, while normocomplementemia is most often seen with IgA nephropathy. Children whose AGN is accompanied by significant hypertension or renal insufficiency should be assessed by a specialist immediately. The presence of serious extrarenal signs or symptoms also merits urgent referral. Otherwise, serial followup in the primary care office is appropriate.

  2. Management of child victims of acute sexual assault: Surgical repair and beyond

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    Minakshi Sham

    2013-01-01

    Full Text Available Aim: To evaluate the outcome of definitive repair of anogenital injuries (AGI in child victims of acute sexual assault. settings and Design: It is a prospective study of emergency care provided to child victims of acute sexual assault at a tertiary care Pediatric Surgical Unit in Maharashtra, India. Material and Methods : Out of 25 children, who presented during January 2009-December 2010 with suspected sexual assault, five children (one male and four female, between 4-9 years of age, had incurred major AGI. These children underwent definitive repair and a diverting colostomy. Perineal pull-through was performed in the male child with major avulsion of rectum. One 4-year-old girl with intraperitoneal vaginal injury required exploratory laparotomy in addition. Results : The postoperative period and follow-up was uneventful in all our patients. Four out of five patients have excellent cosmetic and functional outcome with a follow-up of 2-4 years. Our continence results are 100%. Conclusion : Children with acute sexual assault need emergency care. To optimally restore the distorted anatomy, all major AGI in such children should be primarily repaired by an expert, conversant with a child′s local genital and perineal anatomy. Along with provision of comprehensive and compassionate medical care, prevention of secondary injuries should be the ultimate goal.

  3. Likely health outcomes for untreated acute febrile illness in the tropics in decision and economic models; a Delphi survey.

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    Yoel Lubell

    Full Text Available BACKGROUND: Modelling is widely used to inform decisions about management of malaria and acute febrile illnesses. Most models depend on estimates of the probability that untreated patients with malaria or bacterial illnesses will progress to severe disease or death. However, data on these key parameters are lacking and assumptions are frequently made based on expert opinion. Widely diverse opinions can lead to conflicting outcomes in models they inform. METHODS AND FINDINGS: A Delphi survey was conducted with malaria experts aiming to reach consensus on key parameters for public health and economic models, relating to the outcome of untreated febrile illnesses. Survey questions were stratified by malaria transmission intensity, patient age, and HIV prevalence. The impact of the variability in opinion on decision models is illustrated with a model previously used to assess the cost-effectiveness of malaria rapid diagnostic tests. Some consensus was reached around the probability that patients from higher transmission settings with untreated malaria would progress to severe disease (median 3%, inter-quartile range (IQR 1-5%, and the probability that a non-malaria illness required antibiotics in areas of low HIV prevalence (median 20%. Children living in low transmission areas were considered to be at higher risk of progressing to severe malaria (median 30%, IQR 10-58% than those from higher transmission areas (median 13%, IQR 7-30%. Estimates of the probability of dying from severe malaria were high in all settings (medians 60-73%. However, opinions varied widely for most parameters, and did not converge on resurveying. CONCLUSIONS: This study highlights the uncertainty around potential consequences of untreated malaria and bacterial illnesses. The lack of consensus on most parameters, the wide range of estimates, and the impact of variability in estimates on model outputs, demonstrate the importance of sensitivity analysis for decision models

  4. Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate

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    Ratzan Susan

    2010-07-01

    Full Text Available Adrenal suppression secondary to prolonged inhaled corticosteroid use is usually limited to biochemical abnormalities, with no obvious clinical effects. Acute adrenal crisis is much rarer event but has been reported with increasing frequency. We report a case of a 7-year-old asthmatic child who presented with an acute history of lethargy after a respiratory infection. He was maintained on 220 g/day of fluticasone propionate for several years. Initial evaluation revealed severe adrenal suppression, with undetectable cortisol levels and minimal response after stimulation with ACTH. After fluticasone was discontinued, a gradual recovery of the adrenal axis was seen. This case shows that acute adrenal crisis may be a consequence even at the usual prescribed doses, stressing the importance of using the lowest dose of inhaled steroids needed to control symptoms and having an increased awareness of this complication.

  5. Acute Adrenal Crisis in an Asthmatic Child Treated with Inhaled Fluticasone Proprionate

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    Angela H. Santiago

    2010-01-01

    Full Text Available Adrenal suppression secondary to prolonged inhaled corticosteroid use is usually limited to biochemical abnormalities, with no obvious clinical effects. Acute adrenal crisis is much rarer event but has been reported with increasing frequency. We report a case of a 7-year-old asthmatic child who presented with an acute history of lethargy after a respiratory infection. He was maintained on 220 μg/day of fluticasone propionate for several years. Initial evaluation revealed severe adrenal suppression, with undetectable cortisol levels and minimal response after stimulation with ACTH. After fluticasone was discontinued, a gradual recovery of the adrenal axis was seen. This case shows that acute adrenal crisis may be a consequence even at the usual prescribed doses, stressing the importance of using the lowest dose of inhaled steroids needed to control symptoms and having an increased awareness of this complication.

  6. Acute febrile neutrophilic dermatosis (Sweet's syndrome in a child, associated with a rotavirus infection: a case report

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    Makis Alexandros

    2010-08-01

    Full Text Available Abstract Introduction Sweet's syndrome characterized by fever, blood neutrophilia and inflammatory skin lesions, is rarely diagnosed in children. It presents in three clinical settings: classical Sweet's syndrome, usually after a respiratory tract infection; malignancy-associated, frequently related to acute myelogeneous leukemia; and drug-induced. We present, to the best of our knowledge, the first case of a rotavirus -infection-related Sweet's syndrome. Case presentation An 18-month-old boy of Hellenic origin was referred to us with diarrhea, fever, neutrophilia, typical skin lesions, asymmetrical hip arthritis and oropharyngeal involvement. A skin biopsy confirmed the diagnosis. Thorough screening did not reveal any underlying systemic illness, except for the confirmation of an overt rotavirus infection. The syndrome responded promptly upon corticosteroid administration; no recurrence was observed. Conclusion Besides describing the connection of Sweet's syndrome to a rotavirus infection, this case report is also a reminder that in a child presenting with a febrile papulo-nodular rash with neutrophilia Sweet's syndrome should be included in the differential.

  7. Detection of human bocavirus from children and adults with acute respiratory tract illness in Guangzhou, southern China

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    Liu Wen-Kuan

    2011-12-01

    Full Text Available Abstract Background Human bocavirus (HBoV is a newly discovered parvovirus associated with acute respiratory tract illness (ARTI and gastrointestinal illness. Our study is the first to analyze the characteristics of HBoV-positive samples from ARTI patients with a wide age distribution from Guangzhou, southern China. Methods Throat swabs (n=2811 were collected and analyzed from children and adults with ARTI over a 13-month period. The HBoV complete genome from a 60 year-old female patient isolate was also determined. Results HBoV DNA was detected in 65/2811 (2.3% samples, of which 61/1797 were from children (Mycoplasma pneumoniae had the highest frequency of 16.9% (11/65. Upper and lower respiratory tract illness were common symptoms, with 19/65 (29.2% patients diagnosed with pneumonia by chest radiography. All four adult patients had systemic influenza-like symptoms. Phylogenetic analysis of the complete genome revealed a close relationship with other HBoVs, and a more distant relationship with HBoV2 and HBoV3. Conclusions HBoV was detected from children and adults with ARTI from Guangzhou, southern China. Elderly people were also susceptive to HBoV. A single lineage of HBoV was detected among a wide age distribution of patients with ARTI.

  8. The Effects of Being an Only Child, Family Cohesion, and Family Conflict on Behavioral Problems among Adolescents with Physically Ill Parents

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    Guo-Yuan Sui; Jia-Na Wang; Guang-Cong Liu; Lie Wang

    2015-01-01

    Background: This study aimed to examine the parental physical illness’ effect on behavioral problems among adolescents, and the effects of being an only child, family cohesion, and family conflict on behavioral problems among adolescents with physically ill parents in Liaoning province, China. Methods: This cross-sectional study was performed in 2009. A questionnaire including two dimensions of the Family Environment Scale (family cohesion and family conflict), self-reported Strength and Diff...

  9. Dengue and other common causes of acute febrile illness in Asia: an active surveillance study in children.

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    Maria Rosario Capeding

    Full Text Available BACKGROUND: Common causes of acute febrile illness in tropical countries have similar symptoms, which often mimic those of dengue. Accurate clinical diagnosis can be difficult without laboratory confirmation and disease burden is generally under-reported. Accurate, population-based, laboratory-confirmed incidence data on dengue and other causes of acute fever in dengue-endemic Asian countries are needed. METHODS AND PRINCIPAL FINDINGS: This prospective, multicenter, active fever surveillance, cohort study was conducted in selected centers in Indonesia, Malaysia, Philippines, Thailand and Vietnam to determine the incidence density of acute febrile episodes (≥ 38 °C for ≥ 2 days in 1,500 healthy children aged 2-14 years, followed for a mean 237 days. Causes of fever were assessed by testing acute and convalescent sera from febrile participants for dengue, chikungunya, hepatitis A, influenza A, leptospirosis, rickettsia, and Salmonella Typhi. Overall, 289 participants had acute fever, an incidence density of 33.6 per 100 person-years (95% CI: 30.0; 37.8; 57% were IgM-positive for at least one of these diseases. The most common causes of fever by IgM ELISA were chikungunya (in 35.0% of in febrile participants and S. Typhi (in 29.4%. The overall incidence density of dengue per 100 person-years was 3.4 by nonstructural protein 1 (NS1 antigen positivity (95% CI: 2.4; 4.8 and 7.3 (95% CI: 5.7; 9.2 by serology. Dengue was diagnosed in 11.4% (95% CI: 8.0; 15.7 and 23.9% (95% CI: 19.1; 29.2 of febrile participants by NS1 positivity and serology, respectively. Of the febrile episodes not clinically diagnosed as dengue, 5.3% were dengue-positive by NS1 antigen testing and 16.0% were dengue-positive by serology. CONCLUSIONS: During the study period, the most common identified causes of pediatric acute febrile illness among the seven tested for were chikungunya, S. Typhi and dengue. Not all dengue cases were clinically diagnosed; laboratory confirmation

  10. A Case of Mixed Infections in a Patient Presenting with Acute Febrile Illness in the Tropics

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    L. S. Yong

    2013-01-01

    Full Text Available Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue.

  11. Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

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    Christopher J. Kirwan

    2013-01-01

    Full Text Available Introduction. RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI, but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI. Aim. This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl in critically ill patients with AKI. Methods. Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl. Results. eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD. Conclusions. eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.

  12. Association between child-care and acute diarrhea: a study in Portuguese children

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    Barros Henrique

    2003-01-01

    Full Text Available OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR and their respective 95% confidence intervals (95% CI, crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]. CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

  13. Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

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    Perencevich Eli N

    2007-05-01

    Full Text Available Abstract Background Inappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs. Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs. Methods This study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders. Results Among 69,936 recipients with URI, 35,786 (51.2% received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not. Conclusion Antibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.

  14. Examining the usefulness of a Family Empowerment Program guided by the Illness Beliefs Model for families caring for a child with thalassemia.

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    Wacharasin, Chintana; Phaktoop, Maneerat; Sananreangsak, Siriyupa

    2015-05-01

    The purpose of this pilot study was to design, implement, and evaluate a Family Empowerment Program (FEP), guided by the Illness Beliefs Model. Participants included 25 Thai family members who were the primary caregivers of a child with thalassemia. In Phase I, data were collected from participants using individual in-depth interviews and focus groups before involvement in the FEP. In Phase II, 12 hr of FEP sessions were offered to groups of participants. Content analysis of the audiotaped FEP sessions is reported in this article. Family caregivers reported that the FEP helped them share beliefs and experiences related to caring for their child with thalassemia, make decisions related to families' problems/needs and beliefs, provide each other mutual social support, and develop increased ability to manage care for their chronically ill child through sharing information and learning from other family caregivers about family functioning, family management, and family relationships. Future research is needed to examine the FEP intervention under more controlled conditions with measures that include family functioning and child health outcomes.

  15. Concurrent acute disseminated encephalomyelitis and Guillain-Barré syndrome in a child

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    Isha S Deshmukh

    2015-01-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM and Guillain-Barrι syndrome (GBS are distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of viral infection or vaccination. Our patient is a 10 years with acute flaccid paralysis, quadriparesis (lower limbs affected more than upper limbs, generalized areflexia and urinary retention. He had difficulty in speech and drooling of saliva. He also presented with raised intracranial pressure with papilledema; then bilateral optic neuritis developed during the later course of illness. Based on the temporal association and exclusion of alternative etiologies, diagnosis of the association between ADEM and GBS was made. Electro-diagnosis (electromyography-nerve conduction velocity and magnetic resonance imaging study supported our diagnosis. He improved remarkably after treatment with intravenous immunoglobulin and intravenous methylprednisolone.

  16. Versión española del perfil de salud infantil, cuestionario para padres y madres: Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE/PRF Spanish version of the Child Health and Illness Profile-Child Edition Parent Report Form [CHIP-CE/PRF

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    Luis Rajmil

    2004-08-01

    Full Text Available Objetivos: Analizar la fiabilidad y validez de las dimensiones del Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE/PRF incluidas en la Encuesta de Salud de Barcelona 2000 (ESB-2000 y obtener sus valores de referencia poblacional. Métodos: Los datos del estudio provienen de las entrevistas a los informadores indirectos de los menores de 5-14 años de edad (n = 836 participantes en la ESB-2000. Se analizaron 4 subdimensiones de la versión para padres del cuestionario CHIP-PRF: «satisfacción con la salud», y bienestar físico, bienestar emocional y limitación de actividad, que constituyen la dimensión de «bienestar». Se analizó la consistencia interna a partir del coeficiente α de Cronbach. Se realizσ un anαlisis factorial exploratorio y se compararon las puntuaciones medias mediante análisis de la covarianza para evaluar la validez de constructo de las subdimensiones. Resultados: El coeficiente alfa fue mayor de 0,70 en todas las subdimensiones analizadas (rango, 0,76-0,98. En el análisis factorial, casi todos los ítems (31/35 presentaron la carga más elevada en su subdimensión correspondiente. Se comprobó la mayoría de las diferencias estadísticas esperadas en las puntuaciones medias entre grupos. Las niñas de 10-14 años de edad presentaron las puntuaciones más bajas tanto en «satisfacción con la salud» (48,93; intervalo de confianza del 95% [IC del 95%], 47,40-50,47 como en «bienestar» (48,87; IC del 95%, 47,51-50,22. No se encontraron diferencias según la clase social de la persona cabeza de familia. Conclusiones: El estudio permite disponer de una medida de salud percibida útil en las encuestas de salud infantil.Objectives: To analyze the reliability and validity of the domains of the Child Health and Illness Profile-Child Edition Parent Report Form (CHIP-CE/PRF included in the Barcelona Health Survey conducted in 2000 and to obtain population-based reference values. Methods: Data were

  17. The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh.

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    M Trent Herdman

    Full Text Available Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0 °C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI. 51% of participants were classified as multidimensionally poor (MPI>0.33. Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009. There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394. Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010 and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083. Deaths were attributed to central nervous system infection (11, malaria (3, urinary tract infection (2, gastrointestinal infection (1 and undifferentiated sepsis (1. Both poor and non-poor households relied predominantly upon the (often informal private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in

  18. The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh.

    Science.gov (United States)

    Herdman, M Trent; Maude, Richard James; Chowdhury, Md Safiqul; Kingston, Hugh W F; Jeeyapant, Atthanee; Samad, Rasheda; Karim, Rezaul; Dondorp, Arjen M; Hossain, Md Amir

    2016-01-01

    Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0 °C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in

  19. The Effects of Being an Only Child, Family Cohesion, and Family Conflict on Behavioral Problems among Adolescents with Physically Ill Parents

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    Guo-Yuan Sui

    2015-09-01

    Full Text Available Background: This study aimed to examine the parental physical illness’ effect on behavioral problems among adolescents, and the effects of being an only child, family cohesion, and family conflict on behavioral problems among adolescents with physically ill parents in Liaoning province, China. Methods: This cross-sectional study was performed in 2009. A questionnaire including two dimensions of the Family Environment Scale (family cohesion and family conflict, self-reported Strength and Difficulties Questionnaire (SDQ, and demographic factors was distributed to the subjects. Results: Among the 5220 adolescents, 308 adolescents lived with physically ill parents. The adolescents with physically ill parents had more behavioral problems than adolescents with healthy parents. Among the girls who lived in families with physically ill parents, the SDQ score and the prevalence of SDQ syndromes were higher in the girls with siblings than the girls without siblings after adjusting for variables; the effect of family cohesion on SDQ was significant after adjusting for variables. Conclusion: Interventions targeting family cohesion may be effective to reduce behavioral problems of adolescents with physically ill parents.

  20. Chronic meningitis by histoplasmosis: report of a child with acute myeloid leukemia

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    G.H. Pereira

    2008-12-01

    Full Text Available Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20%-40% and the relapse rate is as high as 50%; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML, that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.

  1. Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

    Science.gov (United States)

    Lorenzi, Olga D.; Gregory, Christopher J.; Santiago, Luis Manuel; Acosta, Héctor; Galarza, Ivonne E.; Hunsperger, Elizabeth; Muñoz, Jorge; Bui, Duy M.; Oberste, M. Steven; Peñaranda, Silvia; García-Gubern, Carlos; Tomashek, Kay M.

    2013-01-01

    In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2–7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. PMID:23382160

  2. Serum visfatin concentration in acutely ill and weight-recovered patients with anorexia nervosa.

    Science.gov (United States)

    Seidel, Maria; King, Joseph A; Ritschel, Franziska; Döpmann, Johanna; Bühren, Katharina; Seitz, Jochen; Roessner, Veit; Westphal, Sabine; Egberts, Karin; Burghardt, Roland; Wewetzer, Christoph; Fleischhaker, Christian; Hebebrand, Johannes; Herpertz-Dahlmann, Beate; Ehrlich, Stefan

    2015-03-01

    Visfatin is a recently described protein that is thought to regulate the process of adipocyte differentiation. Findings suggest that visfatin may be actively involved in the control of weight regulatory networks. However, to what extent and which role it plays in eating disorders is still poorly understood, as mixed results have been reported. The aim of the current study was to investigate serum visfatin concentrations on a cross sectional sample between acute anorexia nervosa patients (n=44), weight recovered patients (n=13) and healthy controls (n=46) and a longitudinal sample of acute patients (n=57) during weight recovery at three different time-points. Results did not show significant differences in visfatin between the three groups; however, acute patients showed a higher visfatin/BMI-SDS ratio than controls and recovered patients. Longitudinal results revealed an increase of visfatin levels during therapy. Our results suggest that high ratios of visfatin/BMI-SDS could be a state marker in acute anorexia nervosa, displaying a compensatory mechanism of the individual to maintain normal visfatin levels under malnourished conditions.

  3. Self reported incidence and morbidity of acute respiratory illness among deployed U.S. military in Iraq and Afghanistan.

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    Bryony W Soltis

    Full Text Available BACKGROUND: Historically, respiratory infections have had a significant impact on U.S. military missions. Deployed troops are particularly at high risk due to close living conditions, stressful work environments and increased exposure to pathogens. To date, there are limited data available on acute respiratory illness (ARI among troops deployed in support of ongoing military operations, specifically Operation Enduring Freedom (OEF and Operation Iraqi Freedom (OIF. METHODS: Using self-report data from two sources collected from troops deployed to Iraq, Afghanistan and the surrounding region, we analyzed incidence and risk factors for ARI. Military personnel on mid-deployment Rest & Recuperation (R&R or during redeployment were eligible to participate in the voluntary self-report survey. RESULTS: Overall, 39.5% reported having at least one ARI. Of these, 18.5% sought medical care and 33.8% reported having decreased job performance. The rate of self-reported ARI was 15 episodes per 100 person-months among those taking the voluntary survey, and 24.7 episodes per 100 person-months among those taking the clinic health questionnaire. Negative binomial regression analysis found female sex, Navy branch of service and lack of flush toilets to be independently associated with increased rates of ARI. Deployment to OIF, increasing age and higher rank were also positively associated with ARI risk. CONCLUSIONS: The overall percentage of deployed military personnel reporting at least one acute respiratory illness decreased since earlier parts of OIF/OEF. However, the reported effect on job performance increased tremendously. The most important factors associated with increased respiratory infection are female sex, Navy branch of service, lack of improved latrine facilities, deployment to OIF, increasing age and higher rank.

  4. Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia.

    Science.gov (United States)

    Juckel, Georg; Schaub, Daniela; Fuchs, Nina; Naumann, Ute; Uhl, Idun; Witthaus, Henning; Hargarter, Ludger; Bierhoff, Hans-Werner; Brüne, Martin

    2008-09-01

    In trying to more broadly define outcome in the efficient long-term treatment of patients with schizophrenia it is necessary to consider not only a reduction in psychopathological symptoms but also a successful psychosocial reintegration. Thus, a more exact assessment of psychosocial functioning is needed. Since the GAF (Global Assessment of Functioning) scale and the SOFAS (Social and Occupational Functioning Assessment Scale) are less operationalized and confuse psychosocial facts with psychopathological symptoms, the Personal and Social Performance (PSP) scale was developed [Morosini, P.L., Magliano, L., Brambilla, L., Ugolini, S., Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 1001, 323-329.] containing the four main areas "socially useful activities, personal and social relationships, self-care, as well as disturbing and aggressive behaviour". Validation of the PSP scale was conducted in a sample of 62 patients with acute schizophrenia. Rating instruments were PSP, GAF, SOFAS, PANSS, CGI, and Mini-ICF-P (Mini-ICF-Rating for Mental Disorders). The results showed good reliability with alpha=.64-.84, high test-retest reliability as well as good inter-rater reliability for the PSP scale. Furthermore, PSP proved good validity with high correlations to GAF (r=.91), SOFAS (r=.91), and Mini-ICF-P (r=-.69). The hypothesis that more critically ill patients would show lower scores on PSP than lesser ill patients was only confirmed for PANSS negative symptoms. Thus, the findings prove the PSP scale to be a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in the acute state.

  5. Pharmacokinetics of fluconazole in critically ill patients with acute kidney injury receiving sustained low-efficiency diafiltration.

    Science.gov (United States)

    Sinnollareddy, Mahipal G; Roberts, Michael S; Lipman, Jeffrey; Robertson, Thomas A; Peake, Sandra L; Roberts, Jason A

    2015-02-01

    Fluconazole is a widely used antifungal agent in critically ill patients. It is predominantly (60-80%) excreted unchanged in urine. Sustained low-efficiency diafiltration (SLED-f) is increasingly being utilised in critically ill patients because of its practical advantages over continuous renal replacement therapy. To date, the effect of SLED-f on fluconazole pharmacokinetics and dosing has not been studied. The objective of this study was to describe the pharmacokinetics of fluconazole in critically ill patients with acute kidney injury receiving SLED-f and to compare this with other forms of renal replacement therapy. Serial blood samples were collected at pre- and post-filter ports within the SLED-f circuit during SLED-f and from an arterial catheter before and after SLED-f from three patients during one session. Fluconazole concentrations were measured using a validated chromatography method. Median clearance (CL) and 24-h area under the concentration-time curve (AUC0-24) were 2.1L/h and 152 mg·h/L, respectively, whilst receiving SLED-f. Moreover, 72% of fluconazole was cleared by a single SLED-f session (6h) compared with previous reports of 33-38% clearance by a 4-h intermittent haemodialysis session. CL and AUC0-24 were comparable with previous observations in a pre-dilution mode of continuous venovenous haemodiafiltration. The observed rebound concentration of fluconazole post SLED-f was 200mg daily are likely to be required to achieve the PK/PD target for common pathogens because of significant fluconazole clearance by SLED-f.

  6. Manutenção parenteral de líquidos na criança agudamente doente Maintenance parenteral fluids in the critically ill child

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    Karen Choong

    2007-05-01

    clínicos, a fim de melhor orientar esta terapia.OBJECTIVE: To examine electrolyte-free water requirements that should be considered when administering maintenance fluids in a critically ill child. We examine some of the difficulties in estimating these requirements, and discuss the controversies with respect to the traditional recommendations. SOURCES: MEDLINE (1966-2007, Embase (1980-2007, and the Cochrane Library, using the terms: “fluid therapy”, “hypotonic”, “isotonic solution”, and synonyms or related terms. SUMMARY OF THE FINDINGS: The ideal maintenance solution and fluid regimen remains a topic of heated debate in pediatrics. The traditional recommendations for maintenance fluids are increasingly criticized as they do not consistently apply in acute illness, where energy expenditure and electrolyte requirements deviate significantly from the original estimates. A physiologically based framework for prescribing maintenance fluids is presented, with the objective of maintaining tonicity balance, and infusing the minimum volume of maintenance fluid required to maintain hemodynamics. Indications for isotonic and hypotonic solutions are discussed. CONCLUSIONS: Maintenance fluid prescriptions should be individualized. No single intravenous solution is ideal for every child during all phases of illness, but there is evidence to suggest that the safest empirical choice is an isotonic solution. Hypotonic solutions should only be considered if the goal is to achieve a positive free-water balance. Critically ill children may require a reduction by as much as 40-50% of the currently recommended maintenance volumes. All patients receiving intravenous fluids should be monitored closely with daily weights, fluid balances, biochemical and clinical parameters in order to best guide this therapy.

  7. Acute Illness Protocol for Organic Acidemias: Methylmalonic Acidemia and Propionic Acidemia.

    Science.gov (United States)

    Aldubayan, Saud H; Rodan, Lance H; Berry, Gerard T; Levy, Harvey L

    2017-02-01

    Inborn errors of metabolism (IEM) are genetic disorders that disrupt enzyme activity, cellular transport, or energy production. They are individually rare, but collectively have an incidence of 1:1000. Most patients with IEMs are followed by a physician with expertise in Biochemical Genetics (Metabolism), but may present outside of this setting. Because IEMs can present acutely with life-threatening crises that require specific interventions, it is critical for the emergency medicine physicians, pediatricians, internists, and critical care physicians as well as biochemical geneticists to be familiar with the initial assessment and management of patients with these disorders. Appropriate early care can be lifesaving. This protocol is not designed to replace the expert consultation of a biochemical geneticist but rather to improve early care and increase the level of comfort of the acute care physician with initial management of organic acidemias until specialty consultation is obtained.

  8. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: A systematic review and meta-analysis

    NARCIS (Netherlands)

    J.P. van den Akker (Johannes); M. Egal (Mohamud); J. Groeneveld (Johan)

    2013-01-01

    textabstractIntroduction: Mechanical ventilation (MV) is commonly regarded as a risk factor for acute kidney injury (AKI) in the critically ill. We investigated the strength of this association and whether settings of tidal volume (Vt) and positive end-expiratory pressure (PEEP) affect the risk for

  9. Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire

    NARCIS (Netherlands)

    Hallegraeff, J.M.; Schans, Cees van der; Krijnen, W.P.; Greef, M.H. de

    2013-01-01

    The Dutch version of the Brief Illness Perception Questionnaire is an appropriate instrument for measuring patients' perceptions in acute low back pain patients, showing acceptable internal consistency and reliability. Concurrent validity is adequate, however, the instrument may be unsuitable for de

  10. Measurement of acute nonspecific low back pain perception in primary care physical therapy : reliability and validity of the brief illness perception questionnaire

    NARCIS (Netherlands)

    Hallegraeff, Joannes M.; van der Schans, Cees P.; Krijnen, Wim P.; de Greef, Mathieu H. G.

    2013-01-01

    Background: The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric pr

  11. Pilot Study of the Pharmacokinetics of Cefotaxime in Critically Ill Patients with Acute Kidney Injury Treated with Continuous Renal Replacement Therapy

    NARCIS (Netherlands)

    Koedijk, Joost B.; Valk-Swinkels, Corinne G. H.; Rijpstra, Tom A.; Touw, Daan J.; Mulder, Paul G. H.; Van Der Voort, Peter H. J.; Van 't Veer, Nils E.; Van Der Meer, Nardo J. M.

    2016-01-01

    The objective of this study was to describe the pharmacokinetics of cefotaxime (CTX) in critically ill patients with acute kidney injury (AKI) when treated with continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). This single-center prospective observational pilot study was

  12. Determinants of Outcome in Non-Septic Critically Ill Patients with Acute Kidney Injury on Continuous Venovenous Hemofiltration

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    Mark V. Koning

    2011-09-01

    Full Text Available Background/Aims: In view of ongoing controversy, we wished to study whether patient characteristics and/or continuous venovenous hemofiltration (CVVH characteristics contribute to the outcome of non-septic critically ill patients with acute kidney injury (AKI. Methods: We retrospectively studied 102 consecutive patients in the intensive care unit (ICU with non-septic AKI needing CVVH. Patient and CVVH characteristics were evaluated. Primary outcome was mortality up to day 28 after CVVH initiation. Results: Forty-four patients (43% died during the 28-day period after the start of CVVH. In univariate analyses, non-survivors had more often a cardiovascular reason for ICU admission, greater disease acuity/severity and organ failure, lower initial creatinine levels, less use of heparin and more use of bicarbonate-based substitution fluid. The latter two can be attributed to high lactate levels and bleeding tendency in non-survivors necessitating withholding lactate-buffered fluid and heparin, respectively, according to our clinical protocol. In multivariate analyses, mortality was predicted by disease severity, use of bicarbonate-based fluids and lack of heparin, while initial creatinine and CVVH dose did not contribute. Conclusion: The outcome of non-septic AKI in need of CVVH is more likely to be determined by underlying or concurrent, acute and severe disease rather than by CVVH characteristics, including timing and dose.

  13. Investigation of a potential zoonotic transmission of orthoreovirus associated with acute influenza-like illness in an adult patient.

    Science.gov (United States)

    Chua, Kaw Bing; Voon, Kenny; Yu, Meng; Keniscope, Canady; Abdul Rasid, Kasri; Wang, Lin-Fa

    2011-01-01

    Bats are increasingly being recognized as important reservoir hosts for a large number of viruses, some of them can be highly virulent when they infect human and livestock animals. Among the new bat zoonotic viruses discovered in recent years, several reoviruses (respiratory enteric orphan viruses) were found to be able to cause acute respiratory infections in humans, which included Melaka and Kampar viruses discovered in Malaysia, all of them belong to the genus Orthoreovirus, family Reoviridae. In this report, we describe the isolation of a highly related virus from an adult patient who suffered acute respiratory illness in Malaysia. Although there was no direct evidence of bat origin, epidemiological study indicated the potential exposure of the patient to bats before the onset of disease. The current study further demonstrates that spillover events of different strains of related orthoreoviruses from bats to humans are occurring on a regular basis, which calls for more intensive and systematic surveillances to fully assess the true public health impact of these newly discovered bat-borne zoonotic reoviruses.

  14. El padecimiento de los enfermos con Síndrome Coronario Agudo The illness of the patients with Acute Coronary Syndrome

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    Joaquín Jesús Blanca Gutiérrez

    2006-06-01

    Full Text Available Introducción: Si revisamos la literatura enfermera publicada sobre el Síndrome Coronario Agudo, cuatro son los grandes temas que han definido a nuestros estudios: los protocolos de actuación, las vías clínicas, los casos clínicos y la metodología del proceso enfermero. Casi siempre ha sido la propia enfermedad y no tanto el padecimiento del paciente la auténtica protagonista de nuestros escritos. Con nuestro presente trabajo pretendemos adentrarnos en aquellas dimensiones más subjetivas de la enfermedad, es decir, en el padecimiento y en el "sickness". Metodología: Se trata de un estudio cualitativo de tipo descriptivo en el que presentamos algunos de los datos más significativos de los relatos de nuestros pacientes con Síndrome Coronario Agudo. Resultados: los hemos agrupado en siete categorías temáticas: dolor, miedo, impacto en la familia, impacto en la actividad laboral, impacto en las actividades recreativas, impacto en el rol de cuidador y posibles causas.  Discusión: Se comparan los resultados con los de otros trabajos que han estudiado también el Síndrome Coronario Agudo desde diversas perspectivas: la sexualidad, los descriptores verbales, el dolor, y los testimonios de mujeres mexicanas que han pasado por esta misma situación.Introduction. The revision of the nursing literature published about the Acute Coronary Syndrome shows that four are the big themes that have defined to our studies: the performance protocols, the clinical roads, the clinical cases and the methodology of the nursing process. The disease and not so much the patient’s illness has been the authentic main character of our writings. With our present work we seek to go into in those more subjective dimensions of the pain, the illness and the sickness.  Methodology. It is a qualitative study of descriptive type, in that we present some of the most significant data in the stories of our patients with Acute Coronary Syndrome.  Results. We have

  15. Metabolic Acidosis and Strong Ion Gap in Critically Ill Patients with Acute Kidney Injury

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    Cai-Mei Zheng

    2014-01-01

    Full Text Available Purpose. To determine the influence of physicochemical parameters on survival in metabolic acidosis (MA and acute kidney injury (AKI patients. Materials and Methods. Seventy-eight MA patients were collected and assigned to AKI or non-AKI group. We analyzed the physiochemical parameters on survival at 24 h, 72 h, 1 week, 1 month, and 3 months after AKI. Results. Mortality rate was higher in the AKI group. AKI group had higher anion gap (AG, strong ion gap (SIG, and apparent strong ion difference (SIDa values than non-AKI group. SIG value was higher in the AKI survivors than nonsurvivors and this value was correlated serum creatinine, phosphate, albumin, and chloride levels. SIG and serum albumin are negatively correlated with Acute Physiology and Chronic Health Evaluation IV scores. AG was associated with mortality at 1 and 3 months post-AKI, whereas SIG value was associated with mortality at 24 h, 72 h, 1 week, 1 month, and 3 months post-AKI. Conclusions. Whether high or low SIG values correlate with mortality in MA patients with AKI depends on its correlation with serum creatinine, chloride, albumin, and phosphate (P levels. AG predicts short-term mortality and SIG value predicts both short- and long-term mortality among MA patients with AKI.

  16. Acute respiratory failure in critically ill patients with interstitial lung disease.

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    Lara Zafrani

    Full Text Available Patients with chronic known or unknown interstitial lung disease (ILD may present with severe respiratory flares that require intensive management. Outcome data in these patients are scarce.Clinical and radiological features were collected in 83 patients with ILD-associated acute respiratory failure (ARF. Determinants of hospital mortality and response to corticosteroid therapy were identified by logistic regression.Hospital and 1-year mortality rates were 41% and 54% respectively. Pulmonary hypertension, computed tomography (CT fibrosis and acute kidney injury were independently associated with mortality (odds ratio (OR 4.55; 95% confidence interval (95%CI (1.20-17.33; OR, 7.68; (1.78-33.22 and OR 10.60; (2.25-49.97 respectively. Response to steroids was higher in patients with shorter time from hospital admission to corticosteroid therapy. Patients with fibrosis on CT had lower response to steroids (OR, 0.03; (0.005-0.21. In mechanically ventilated patients, overdistension induced by high PEEP settings was associated with CT fibrosis and hospital mortality.Mortality is high in ILD-associated ARF. CT and echocardiography are valuable prognostic tools. Prompt corticosteroid therapy may improve survival.

  17. The role of acuity of illness at presentation in early mortality in black children with acute myeloid leukemia.

    Science.gov (United States)

    Winestone, Lena E; Getz, Kelly D; Miller, Tamara P; Wilkes, Jennifer J; Sack, Leah; Li, Yimei; Huang, Yuan-Shung; Seif, Alix E; Bagatell, Rochelle; Fisher, Brian T; Epstein, Andrew J; Aplenc, Richard

    2017-02-01

    Black patients with acute myeloid leukemia (AML) experience higher mortality than White patients. We compared induction mortality, acuity of illness prior to chemotherapy, and insurance type between Black and White patients to assess whether acuity of presentation mediates the disparity. Within a retrospective cohort of 1,122 children with AML treated with two courses of standard induction chemotherapy between 2004 and 2014 in the Pediatric Health Information System (PHIS) database, the association between race (Black versus White) and inpatient mortality during induction was examined. Intensive Care Unit (ICU)-level resource utilization during the first 72 hours following admission for initial AML chemotherapy was evaluated as a potential mediator. The total effect of race on mortality during Induction I revealed a strong association (unadjusted HR 2.75, CI: 1.18, 6.41). Black patients had a significantly higher unadjusted risk of requiring ICU-level resources within the first 72 hours after initial presentation (17% versus 11%; RR 1.52, CI: 1.04, 2.24). Mediation analyses revealed the indirect effect of race through acuity accounted for 61% of the relative excess mortality during Induction I. Publicly insured patients experienced greater induction mortality than privately insured patients regardless of race. Black patients with AML have significantly greater risk of induction mortality and are at increased risk for requiring ICU-level resources soon after presentation. Higher acuity amongst Black patients accounts for a substantial portion of the relative excess mortality during Induction I. Targeting factors affecting acuity of illness at presentation may lessen racial disparities in AML induction mortality.

  18. Association of renal biomarkers with 3-month and 1-year outcomes among critically ill acute stroke patients.

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    Ying-Chih Huang

    Full Text Available BACKGROUND: The comparative relationships of widely recognized biomarkers of renal injury with short-term and long-term outcomes among critically ill acute stroke patients are unknown. We evaluated the impact of baseline albuminuria [urine albumin-creatinine ratio (UACR ≥ 30 mg/g] or low estimated glomerular filtration rate (eGFR<60 ml/min per 1.73 m(2 on stroke patients admitted to the intensive care unit (ICU. METHODS: We reviewed data on consecutive stroke patients admitted to a hospital ICU in Taiwan from September 2007 to August 2010 and followed-up for 1 year. Baseline UACR was categorized into <30 mg/g (normal, 30-299 mg/g (microalbuminuria, and ≥ 300 mg/g (macroalbuminuria, while eGFR was divided into ≥ 60, 45-59, and <45 ml/min per 1.73 m(2. The outcome measure was death or disability at 3-month and 1-year after stroke onset, assessed by dichotomizing the modified Rankin Scale at 3-6 versus 0-2. RESULTS: Of 184 consecutive patients, 153 (83% met study entry criteria. Mean age was 67.9 years and median admission NIHSS score was 16. Among the renal biomarkers, only macroalbuminuria was associated with poorer 3-month outcome (OR 8.44, 95% CI 1.38 to 51.74, P = 0.021 and 1-year outcome (OR 18.06, 95% CI 2.59 to 125.94, P = 0.003 after adjustment of relevant covariates. When ischemic and hemorrhagic stroke were analyzed separately, macroalbuminuria was associated with poorer 1-year outcome among ischemic (OR 17.10, 95% CI 1.04 to 280.07, P = 0.047 and hemorrhagic stroke patients (OR 1951.57, 95% CI 1.07 to 3561662.85, P = 0.048, respectively, after adjustment of relevant covariates and hematoma volume. CONCLUSIONS: Presence of macroalbuminuria indicates poor 3-month and 1-year outcomes among critically ill acute stroke patients.

  19. Long-term sequelae of severe acute kidney injury in the critically ill patient without comorbidity: a retrospective cohort study.

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    Gijs Fortrie

    Full Text Available Acute kidney injury (AKI necessitating renal replacement therapy (RRT is associated with high mortality and increased risk for end stage renal disease. However, it is unknown if this applies to patients with a preliminary unremarkable medical history. The purpose of this study was to describe overall and renal survival in critically ill patients with AKI necessitating RRT stratified by the presence of comorbidity.A retrospective cohort study was performed, between 1994 and 2010, including all adult critically ill patients with AKI necessitating RRT, stratified by the presence of comorbidity. Logistic regression, survival curve and cox proportional hazards analyses were used to evaluate overall and renal survival. Standardized mortality rate (SMR analysis was performed to compare long-term survival to the predicted survival in the Dutch population.Of the 1067 patients included only 96(9.0% had no comorbidity. Hospital mortality was 56.6% versus 43.8% in patients with and without comorbidity, respectively. In those who survived hospitalization 10-year survival was 45.0% and 86.0%, respectively. Adjusted for age, sex and year of treatment, absence of comorbidity was not associated with hospital mortality (OR=0.74, 95%-CI=0.47-1.15, while absence of comorbidity was associated with better long-term survival (adjusted HR=0.28, 95%-CI = 0.14-0.58. Compared to the Dutch population, patients without comorbidity had a similar mortality risk (SMR=1.6, 95%-CI=0.7-3.2, while this was increased in patients with comorbidity (SMR=4.8, 95%-CI=4.1-5.5. Regarding chronic dialysis dependency, 10-year renal survival rates were 76.0% and 92.9% in patients with and without comorbidity, respectively. Absence of comorbidity was associated with better renal survival (adjusted HR=0.24, 95%-CI=0.07-0.76.While hospital mortality remains excessively high, the absence of comorbidity in critically ill patients with RRT-requiring AKI is associated with a relative good long

  20. Acute biliary pancreatitis and cholecystolithiasis in a child:one time treatment with laparoendoscopic "Rendez-vous" procedure

    Institute of Scientific and Technical Information of China (English)

    Gaetano La Greca; Michele Di Blasi; Francesco Barbagallo; Manuela Di Stefano; Saverio Latteri; Domenico Russello

    2006-01-01

    Acute biliary pancreatitis (ABP) is rare in childhood and endoscopic sphincterotomy should be avoided in the child due to the risk of both early and late complications but, when necessary, the optimal timing between endoscopic procedure and cholecystectomy is still uncertain.A nine years old child with acute biliary pancreatitis underwent successfull laparo-endoscopic "Rendez-Vous" procedure in which endoscopic drainage of the common bile duct and laparoscopic cholecystectomy were performed simultaneously. This is the first case reported of laparo-endoscopic Rendez-Vous in a child. The excellent outcome of this patient and the review of the literature concerning other available options for the treatment of such cases suggest that this procedure offers great advantages, especially in children, of reducing the required number of treatments, the risk of ineffectiveness, the number of anaesthesia, the length of hospital stay and the risk of iatrogenic morbidity.

  1. Acute Generalized Exanthematous Pustulosis (AGEP Induced by Cetirizine in a Child A Case Report

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    Gunseli Pancar

    2014-12-01

    Full Text Available Acute Generalized Exanthematous Pustulosis (AGEP, is a rare cutaneous rash characterized by widespread sterile non-follicular pustules. AGEP is a rare disease in childhood and it is often due to drugs. Antibiotics, sulphanamides and antipyretic-analgesics are the main reasons of this drug reaction . Cetirizine is a second generation antihistamine is often used in the treatment of angioedema, atopic dermatitis and urticaria in children. Cetirizine induced AGEP was not reported in the literature. In this case a twelve year old child was admitted with urticarial plaques located on her trunk. She developed maculopapular lesions and pustular eruption with Cetirizine (once a day treatment. Cetirizine was stopped and the nonfollicular pustules cleared with a desquamation. The result of the oral challenge test was positive. We present this rare case to show that the antihistamines (cetirizine may cause AGEP in childhood.

  2. Acute Generalized Exanthematous Pustulosis (AGEP Induced by Cetirizine in a Child A Case Report

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    Gunseli Pancar

    2016-05-01

    Full Text Available Acute Generalized Exanthematous Pustulosis (AGEP, is a rare cutaneous rash characterized by widespread sterile non-follicular pustules. AGEP is a rare disease in childhood and it is often due to drugs. Antibiotics, sulphanamides and antipyretic-analgesics are the main reasons of this drug reaction . Cetirizine is a second generation antihistamine is often used in the treatment of angioedema, atopic dermatitis and urticaria in children. Cetirizine induced AGEP was not reported in the literature. In this case a twelve year old child was admitted with urticarial plaques located on her trunk. She developed maculopapular lesions and pustular eruption with Cetirizine (once a day treatment. Cetirizine was stopped and the nonfollicular pustules cleared with a desquamation. The result of the oral challenge test was positive. We present this rare case to show that the antihistamines (cetirizine may cause AGEP in childhood.

  3. High creatinine clearance in critically ill patients with community-acquired acute infectious meningitis

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    Lautrette Alexandre

    2012-09-01

    Full Text Available Abstract Background A high dose of anti-infective agents is recommended when treating infectious meningitis. High creatinine clearance (CrCl may affect the pharmacokinetic / pharmacodynamic relationships of anti-infective drugs eliminated by the kidneys. We recorded the incidence of high CrCl in intensive care unit (ICU patients admitted with meningitis and assessed the diagnostic accuracy of two common methods used to identify high CrCl. Methods Observational study performed in consecutive patients admitted with community-acquired acute infectious meningitis (defined by >7 white blood cells/mm3 in cerebral spinal fluid between January 2006 and December 2009 to one medical ICU. During the first 7 days following ICU admission, CrCl was measured from 24-hr urine samples (24-hr-UV/P creatinine and estimated according to Cockcroft-Gault formula and the simplified Modification of Diet in Renal Disease (MDRD equation. High CrCl was defined as CrCl >140 ml/min/1.73 m2 by 24-hr-UV/P creatinine. Diagnostic accuracy was performed with ROC curves analysis. Results Thirty two patients were included. High CrCl was present in 8 patients (25% on ICU admission and in 15 patients (47% during the first 7 ICU days for a median duration of 3 (1-4 days. For the Cockcroft-Gault formula, the best threshold to predict high CrCl was 101 ml/min/1.73 m2 (sensitivity: 0.96, specificity: 0.75, AUC = 0.90 ± 0.03 with a negative likelihood ratio of 0.06. For the simplified MDRD equation, the best threshold to predict high CrCl was 108 ml/min/1.73 m2 (sensitivity: 0.91, specificity: 0.80, AUC = 0.88 ± 0.03 with a negative likelihood ratio of 0.11. There was no difference between the estimated methods in the diagnostic accuracy of identifying high CrCl (p = 0.30. Conclusions High CrCl is frequently observed in ICU patients admitted with community-acquired acute infectious meningitis. The estimated methods of CrCl could be used as a screening tool to

  4. Parenteral clevidipine for the acute control of blood pressure in the critically ill patient: a review

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    W Frank Peacock IV

    2009-08-01

    Full Text Available W Frank Peacock IV1, Jorge E Angeles2, Karina M Soto2, Philip D Lumb3,  Joseph Varon41The Cleveland Clinic, Cleveland, OH, USA; 2Universidad Autónoma de Baja California, Facultad de Medicina, Tijuana, México; 3Keck School of Medicine of University of Southern California, Los Angeles, CA, USA; 4The University of Texas Health Science Center at Houston, and The University of Texas Medical Branch at Galveston. St. Luke’s Episcopal Hospital/Texas Heart Institute, Houston, Texas, USAAbstract: Clevidipine is a new calcium channel blocker of the dihydropyridine class that is characterized by its ultra-short onset of action, vascular selectivity, small volume of distribution and extremely high clearance that coupled together result in an extremely short half-life of approximately 1 minute therefore permitting a rapid titration to the desired effect. Structurally similar to other dihydropyridines, clevidipine has an extra ester link that allows its rapid hydrolization to its inactive carboxylic acid metabolite in blood and extravascular tissues. Clevidipine’s metabolites are then primarily eliminated through urine and fecal pathways. Clevidipine does not affect cytochrome P450 (CYP enzymes and no clinically significant drug interactions have been determined. In trials like the ESCAPE trials, ECLIPSE, and VELOCITY, clevidipine demonstrated a significant improvement in the management of acute hypertension when compared to placebo as shown in both ESCAPE trials. The ECLIPSE trial compared clevidipine to other drugs currently used in the management of acute hypertension, such as sodium nitroprusside, nitroglycerine and nicardipine; clevidipine was superior to all three agents; in providing blood pressure support, safety and tolerability clevidipine also showed a significant reduction in mortality rate (4.7% vs 1.7%, P = 0.0445 when compared to sodium nitroprusside. In the VELOCITY trial clevidipine demonstrated a reduction in blood pressure of 6

  5. A molecular epidemiological study of respiratory viruses detected in Japanese children with acute wheezing illness

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    Noda Masahiro

    2011-06-01

    Full Text Available Abstract Background Recent studies strongly suggest that some respiratory viruses are associated with the induction of acute wheezing and/or exacerbation of bronchial asthma. However, molecular epidemiology of these viruses is not exactly known. Methods Using PCR technology, we attempted to detect various respiratory viruses from 115 Japanese children. Furthermore, the detected viruses were subjected to homology, pairwise distance, and phylogenetic analysis. Results Viruses were detected from 99 (86.1% patients. Respiratory syncytial virus (RSV alone and human rhinovirus (HRV alone were detected in 47 (40.9% and 36 (31.3% patients, respectively. Both RSV and HRV were detected in 14 (12.2% patients. Human metapneumovirus (HMPV alone and human parainfluenza virus (HPIV alone were detected in 1 (0.9% patient each, respectively. Homology and phylogenetic analyses showed that the RSV and HRV strains were classified into genetically diverse species or subgroups. In addition, RSV was the dominant virus detected in patients with no history of wheezing, whereas HRV was dominant in patients with a history of wheezing. Conclusions The results suggested that these genetically diverse respiratory viruses, especially RSV and HRV, might be associated with wheezing in Japanese children.

  6. Air Quality and Acute Respiratory Illness in Biomass Fuel using homes in Bagamoyo, Tanzania

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    Satoshi Nakai

    2007-03-01

    Full Text Available Respiratory Diseases are public health concern worldwide. The diseases have been associated with air pollution especially indoor air pollution from biomass fuel burning in developing countries. However, researches on pollution levels and on association of respiratory diseases with biomass fuel pollution are limited. A study was therefore undertaken to characterize the levels of pollutants in biomass fuel using homes and examine the association between biomass fuel smoke exposure and Acute Respiratory Infection (ARI disease in Nianjema village in Bagamoyo, Tanzania. Pollution was assessed by measuring PM10, NO2, and CO concentrations in kitchen, living room and outdoors. ARI prevalence was assessed by use of questionnaire which gathered health information for all family members under the study. Results showed that PM10, NO2, and CO concentrations were highest in the kitchen and lowest outdoors. Kitchen concentrations were highest in the kitchen located in the living room for all pollutants except CO. Family size didn’t have effect on the levels measured in kitchens. Overall ARI prevalence for cooks and children under age 5 making up the exposed group was 54.67% with odds ratio (OR of 5.5; 95% CI 3.6 to 8.5 when compared with unexposed men and non-regular women cooks. Results of this study suggest an association between respiratory diseases and exposure to domestic biomass fuel smoke, but further studies with improved design are needed to confirm the association.

  7. Association of oliguria with the development of acute kidney injury in the critically ill.

    Science.gov (United States)

    Vaara, Suvi T; Parviainen, Ilkka; Pettilä, Ville; Nisula, Sara; Inkinen, Outi; Uusaro, Ari

    2016-01-01

    Urine output (UO) criterion may increase the sensitivity of the definition of acute kidney injury (AKI). We determined whether the empirically derived definition for oliguria(<0.5 ml/kg/h) is independently associated with adverse outcome. Data analysis included hourly recorded UO from the prospective, multicenter FINNAKI study conducted in 16 Finnish intensive care units. Confounder-adjusted association of oliguria of different severity and duration primarily with the development of AKI defined by creatinine criterion (Cr-AKI) or renal replacement therapy(RRT) was assessed. Secondarily, we determined the association of oliguria with 90-day mortality. Of the 1966 patients analyzed for the development of AKI, 454 (23.1%) reached this endpoint. Within this AKI cohort, 312 (68.7%)developed Cr-AKI, 21 (4.6%) commenced RRT without Cr-AKI, and 121 (26.7%) commenced RRT with Cr-AKI. Episodes of severe oliguria (<0.1 ml/kg/h) for more than 3 h were independently associated with the development of Cr-AKI or RRT. The shortest periods of consecutive oliguria independently associated with an increased risk for 90-day mortality were 6–12 h of oliguria from 0.3 to <0.5 ml/kg/h, over 6 h of oliguria from 0.1 to <0.3 ml/kg/h, and severe oliguria lasting over 3 h.Thus, our findings underlie the importance of hourly UO measurements.

  8. Chronic pain associated with the Chikungunya Fever: long lasting burden of an acute illness

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    Dallel Radhouane

    2010-02-01

    Full Text Available Abstract Background Chikungunya virus (CHIKV is responsible for major epidemics worldwide. Autochthonous cases were recently reported in several European countries. Acute infection is thought to be monophasic. However reports on chronic pain related to CHIKV infection have been made. In particular, the fact that many of these patients do not respond well to usual analgesics suggests that the nature of chronic pain may be not only nociceptive but also neuropathic. Neuropathic pain syndromes require specific treatment and the identification of neuropathic characteristics (NC in a pain syndrome is a major step towards pain control. Methods We carried out a cross-sectional study at the end of the major two-wave outbreak lasting 17 months in Réunion Island. We assessed pain in 106 patients seeking general practitioners with confirmed infection with the CHIK virus, and evaluated its impact on quality of life (QoL. Results The mean intensity of pain on the visual-analogical scale (VAS was 5.8 ± 2.1, and its mean duration was 89 ± 2 days. Fifty-six patients fulfilled the definition of chronic pain. Pain had NC in 18.9% according to the DN4 questionnaire. Conversely, about two thirds (65% of patients with NC had chronic pain. The average pain intensity was similar between patients with or without NC (6.0 ± 1.7 vs 6.1 ± 2.0. However, the total score of the Short Form-McGill Pain Questionnaire (SF-MPQ(15.5 ± 5.2 vs 11.6 ± 5.2; p Conclusions There exists a specific chronic pain condition associated to CHIKV. Pain with NC seems to be associated with more aggressive clinical picture, more intense impact in QoL and more challenging pharmacological treatment.

  9. Nocturnal periodic breathing and the development of acute high altitude illness.

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    Eichenberger, U; Weiss, E; Riemann, D; Oelz, O; Bärtsch, P

    1996-12-01

    We tested the hypothesis that periodic breathing (PB) at high altitude is more frequent and arterial oxygen desaturation more severe during sleep in subjects developing high altitude pulmonary edema (HAPE) or acute mountain sickness (AMS) compared with subjects remaining healthy. We registered thoraco-abdominal movement, electro-encephalogram and oxygen saturation by pulse oximeter (pSao2) in 21 subjects during the first night spent at the altitude of 4,559 m. During the subsequent stay at 4,559 m, eight subjects remained well (controls), five subjects developed AMS and eight subjects developed HAPE. PB was found in all sleep stages and the percentage PB in any sleep stage was not significantly different between groups. There was a trend towards more PB in the HAPE vs. AMS and control group lasting 80 +/- 5 (mean +/- SE), 58 +/- 7, 57 +/- 9% of analyzable time, respectively (p = 0.09). The mean nocturnal decrease of pSao2 for these groups was 8.7 +/- 1.9, 5.4 +/- 2.1, 4.8 +/- 1.2%; (p = 0.36) and the median nocturnal pSao2 was 49 +/- 3, 63 +/- 3, and 63 +/- 4% (p = 0.02). Arterial blood gas analysis before and after sleep recordings indicate that the significantly lower Sao2 in the HAPE group is secondary to gas exchange rather than ventilation. The nocturnal decrease of pSao2 did not correlate with the time of PB nor the number of desaturation events > or = 4%. These findings suggest that more frequent PB in the HAPE group is a consequence of lower Sao2 due to impairment of gas exchange.

  10. Contributing Factors for Acute Illness/Injury from Childhood Pesticide Exposure in North Carolina, USA, 2007–2013

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    Nirmalla Barros

    2016-02-01

    Full Text Available Between 2007 and 2013, there were 685 events with evidence of a relationship between pesticide exposure and acute illness/injury among persons less than 18 years old in North Carolina (United States. Median age of children affected was 4.3 years (range: 0.2–17.9. Distribution by gender was similar across all age groups. One fatality and four high severity events were observed. The greatest proportion (42% of events had ocular exposures, followed by dermal (25% and inhalation (18% exposures. When more than one route of exposure occurred, dermal and ocular routes were the most common (46%. Almost all events took place indoors and 32 events involved contact with pets. Insecticides (53% and insect repellants (31% were the most frequent agents contributing to these events. Manual application of pesticides contributed to the greatest number of events (25%, while application through a pressurized can and use of a trigger pump were involved in 21% and 15% of events, respectively. Additional contributors were due to inappropriate storage of pesticides and improper use of the pesticide. These contributing factors can be removed or minimized if pesticides are stored outside the residence or out of the reach of children and pets, and adequate ventilation is ensured whenever pesticides are applied.

  11. Language skills in a child with Leber hereditary optic neuropathy following intrathecal chemotherapy for acute lymphoblastic leukemia.

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    Lewis, Fiona M; Coman, David J; Murdoch, Bruce E

    2010-11-01

    The language skills of a male child with Leber hereditary optic neuropathy (LHON) and coincidentally treated for acute lymphoblastic leukemia (ALL) with intrathecal chemotherapy at the age of 3 years 8 months were comprehensively evaluated twice over a 6-month period approximately 5½ years after diagnosis of ALL. Despite marked chemotherapy-related leukoencephalopathic changes documented on magnetic resonance imaging, the child presented with stable language skills, which were generally average to above-average based on the normative data from a comprehensive language test battery. In light of the coincidental presentation in the child of a diagnosis of LHON, which may lead to serious vision impairment and increased vulnerability to drug neurotoxicity, coupled with a history of central nervous system (CNS)-directed treatment for ALL resulting in progressive white matter pathology, the study highlights the importance of ongoing monitoring of the child's language development throughout his adolescent years.

  12. Acute Measles Encephalitis in an Immigrant Syrian Child: Case Report and Review of the Literature.

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    Al-Qayoudhi, Abdullah; Al-Kindi, Hanan; Meki, Nabil; Al-Maani, Amal

    2016-03-01

    The introduction of measles vaccination programs and broad coverage worldwide has meant this infection a rare encounter for pediatricians. In Oman, with almost 100% measles vaccination coverage for children, this infection disappeared from the list of fever and rash differential diagnoses. Encephalitis is a well-known complication of measles infection and sometimes can be the only manifestation especially in adults. We report a seven-year-old Syrian immigrant who was admitted to the Royal Hospital, Muscat, with acute encephalitis secondary to wild measles infection. Although she had a classical presentation of measle infection, the diagnosis was missed in the private and regional hospital she attended before getting referred to Royal Hospital. She was later identified to be exposed to an outbreak of the infection in an unvaccinated population. Magnetic resonance imaging showed high signal intensity of both basal ganglia suggestive of measles encephalitis. The diagnosis was confirmed by detection of measles virus from her urine and blood, and a throat swab. The isolated measles virus was D8 serotype, which was prevalent in Syria around the same time. The child was treated with steroids and vitamin A. She achieved full recovery despite her severe presentation. A high degree of suspicion for measles infection should be maintained in unvaccinated children with a compatible presentation of the infection or its complications. There might be a role for steroid use in cases of acute measles encephalitis.

  13. Acute Measles Encephalitis in an Immigrant Syrian Child: Case Report and Review of the Literature

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    Abdullah Al-Qayoudhi

    2016-03-01

    Full Text Available The introduction of measles vaccination programs and broad coverage worldwide has meant this infection a rare encounter for pediatricians. In Oman, with almost 100% measles vaccination coverage for children, this infection disappeared from the list of fever and rash differential diagnoses. Encephalitis is a well-known complication of measles infection and sometimes can be the only manifestation especially in adults. We report a seven-year-old Syrian immigrant who was admitted to the Royal Hospital, Muscat, with acute encephalitis secondary to wild measles infection. Although she had a classical presentation of measle infection, the diagnosis was missed in the private and regional hospital she attended before getting referred to Royal Hospital. She was later identified to be exposed to an outbreak of the infection in an unvaccinated population. Magnetic resonance imaging showed high signal intensity of both basal ganglia suggestive of measles encephalitis. The diagnosis was confirmed by detection of measles virus from her urine and blood, and a throat swab. The isolated measles virus was D8 serotype, which was prevalent in Syria around the same time. The child was treated with steroids and vitamin A. She achieved full recovery despite her severe presentation. A high degree of suspicion for measles infection should be maintained in unvaccinated children with a compatible presentation of the infection or its complications. There might be a role for steroid use in cases of acute measles encephalitis.

  14. Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar - Aetiologies, Antibiotic Treatment and Outcome.

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    Kristina Elfving

    Full Text Available Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission.We prospectively studied the aetiology of febrile illness in 677 children aged 2-59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR of IMCI-pneumonia classified patients, and multiple quantitative (qPCR investigations of nasopharyngeal (NPH (all patients and rectal (GE swabs (diarrhoea patients. For comparison, we also performed NPH and GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical and laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated.NPH-qPCR and GE-qPCR detected ≥1 pathogen in 657/672 (98% and 153/164 (93% of patients and 158/166 (95% and 144/165 (87% of controls, respectively. Overall, 57% (387/677 had IMCI-pneumonia, but only 12% (42/342 had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%, influenza A/B (22.3%, rhinovirus (10.5% and group-A streptococci (6.4%, CXR-confirmed pneumonia (6.2%, Shigella (4.3% were the most common viral and bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83 without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever and West Nile viruses. Antibiotics were prescribed to 500 (74% patients, but only 152 (22% had an infection retrospectively considered to require

  15. Acute Uncomplicated Febrile Illness in Children Aged 2-59 months in Zanzibar – Aetiologies, Antibiotic Treatment and Outcome

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    Elfving, Kristina; Shakely, Deler; Andersson, Maria; Baltzell, Kimberly; Ali, Abdullah S.; Bachelard, Marc; Falk, Kerstin I.; Ljung, Annika; Msellem, Mwinyi I.; Omar, Rahila S.; Parola, Philippe; Xu, Weiping; Petzold, Max; Trollfors, Birger; Björkman, Anders; Lindh, Magnus; Mårtensson, Andreas

    2016-01-01

    Background Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. Methods We prospectively studied the aetiology of febrile illness in 677 children aged 2–59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, and multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) and rectal (GE) swabs (diarrhoea patients). For comparison, we also performed NPH and GE qPCR analyses in 167 healthy community controls. Final fever diagnoses were retrospectively established based on all clinical and laboratory data. Clinical outcome was assessed during a 14-day follow-up. The utility of IMCI for identifying infections presumed to require antibiotics was evaluated. Findings NPH-qPCR and GE-qPCR detected ≥1 pathogen in 657/672 (98%) and 153/164 (93%) of patients and 158/166 (95%) and 144/165 (87%) of controls, respectively. Overall, 57% (387/677) had IMCI-pneumonia, but only 12% (42/342) had CXR-confirmed pneumonia. Two patients were positive for Plasmodium falciparum. Respiratory syncytial virus (24.5%), influenza A/B (22.3%), rhinovirus (10.5%) and group-A streptococci (6.4%), CXR-confirmed pneumonia (6.2%), Shigella (4.3%) were the most common viral and bacterial fever diagnoses, respectively. Blood-PCR conducted in a sub-group of patients (n = 83) without defined fever diagnosis was negative for rickettsiae, chikungunya, dengue, Rift Valley fever and West Nile viruses. Antibiotics were prescribed to 500 (74%) patients, but only 152 (22%) had an infection

  16. A method of teaching critical care skills to undergraduate student midwives using the Maternal-Acute Illness Management (M-AIM) training day.

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    McCarthy, Rose; Nuttall, Janet; Smith, Joyce; Hollins Martin, Caroline J

    2014-11-01

    The most recent Confidential Enquiry into Maternal Deaths (CMACE, 2011) identified human errors, specifically those of midwives and obstetricians/doctors as a fundamental component in contributing to maternal death in the U.K. This paper discusses these findings and outlines a project to provide training in Maternal-Acute Illness Management (M-AIM) to final year student midwives. Contents of the program are designed to educate and simulate AIM skills and increase confidence and clinical ability in early recognition, management and referral of the acutely ill woman. An outline of the Maternal-AIM program delivered at the University of Salford (Greater Manchester, UK) is presented to illustrate how this particular institution has responded to a perceived need voiced by local midwifery leaders. It is proposed that developing this area of expertise in the education system will better prepare student midwives for contemporary midwifery practice.

  17. A predictive model of Health Related Quality of life of parents of chronically ill children: the importance of care-dependency of their child and their support system

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    Heymans Hugo SA

    2009-07-01

    Full Text Available Abstract Background Parents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL. Insight in the dynamics of factors influencing parental HRQoL is necessary for development of interventions. Aim of the present study was to explore the influence of demographic and disease related factors on parental HRQoL, mediated by employment, income, leisure time, holiday and emotional support in a comprehensive model. Methods In a cross-sectional design, 543 parents of chronically ill children completed questionnaires. A conceptual model of parental HRQoL was developed. Structural equation modeling was performed to explore the relations in the conceptual model, and to test if the model fitted the data. Results The model fitted the data closely (CHISQ(14 = 11.37, p = 0.66; RMSEA = 0.0, 90%CI [0.00;0.034]. The effect of socio-demographic and medical data on HRQoL was mediated by days on holiday (MCS: β = .21 and emotional support (PCS: β = .14; MCS: β = .28. Also, female gender (β = -.10, age (β = .10, being chronically ill as a parent (β = -.34, and care dependency of the child (β = -.14; β = -.15 were directly related to parental HRQoL. Conclusion The final model was slightly different from the conceptual model. Main factors explaining parental HRQoL seemed to be emotional support, care dependency, days on holiday and being chronically ill as a parent. Holiday and emotional support mediated the effect of demographic and disease-related factors on HRQoL. Hours of employment, leisure time and household income did not mediate between background characteristics and HRQoL, contrasting the hypotheses.

  18. A two-time-period comparison of the effects of ambient air pollution on outpatient visits for acute respiratory illnesses.

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    Sinclair, Amber Hughes; Edgerton, Eric S; Wyzga, Ron; Tolsma, Dennis

    2010-02-01

    Concentrations of numerous ambient air pollutants have declined in recent years across the United States. Although it can be expected that reductions in air pollutants are associated with reductions in health effects, it is unclear whether this is actually the case. The purpose of this analysis was to compare the levels of and relationships between air pollutants and acute respiratory outpatient visits for two consecutive time periods totaling 53 mo. Air pollution data were collected at a centrally located monitor in Atlanta, GA, and include 24-hr averages of particulate matter (PM) less than 2.5 microm in aerodynamic diameter (PM2.5) and its components; coarse PM (PM10-2.5); PM less than 10 microm in aerodynamic diameter (PM10); oxygenated volatile organic compounds (OVOCs); 8-hr maximum ozone (O3); and 1-hr maximum nitrogen dioxide (NO2), carbon monoxide (CO), and sulfur dioxide (SO2). In addition, several metals and fractions of elemental carbon (EC) and organic carbon (OC) were investigated. Daily outpatient visit data were obtained from the electronic data warehouse of the Atlanta-based region of a nonprofit managed care organization. Poisson general linear modeling determined associations between daily levels of acute visits for four diagnosis groups (adult and child asthma, upper and lower respiratory infection) and air pollution measurements. Overall declining trends were observed in air pollutants and acute visits over the study period. Childhood asthma had the greatest number of significant associations with air pollutants, namely zinc and EC. The significant lag time between pollutant measurement and visit occurrence changed from 3-5 days in the first time period to 6-8 days in the later time period, but there was general consistency in several childhood asthma and pollutant associations over both time periods. The greatest evidence for a reduction in pollution being associated with an improvement in health response was for lower respiratory disease

  19. An analysis of autopsy cases of non-Hodgkin lymphoma-with special reference to those masquerading as acute febrile illness

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    Sonali Rajesh Saraf

    2016-01-01

    Conclusion: As NHL present with nonspecific symptoms, these tumours may not be detected in early stages and hence may not be treated appropriately. These patients have weakened immunity and hence are prone to infection and sepsis which can be a major cause of mortality. This autopsy study experience has shown that NHL can masquerade as acute febrile illness which if not detected early and treated adequately can turn fatal.

  20. Differential Impact of Hyperglycemia in Critically Ill Patients: Significance in Acute Myocardial Infarction but Not in Sepsis?

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    Bernhard Wernly

    2016-09-01

    Full Text Available Hyperglycemia is a common condition in critically ill patients admitted to an intensive care unit (ICU. These patients represent an inhomogeneous collective and hyperglycemia might need different evaluation depending on the underlying disorder. To elucidate this, we investigated and compared associations of severe hyperglycemia (>200 mg/dL and mortality in patients admitted to an ICU for acute myocardial infarction (AMI or sepsis as the two most frequent admission diagnoses. From 2006 to 2009, 2551 patients 69 (58–77 years; 1544 male; 337 patients suffering from type 2 diabetes (T2DM who were admitted because of either AMI or sepsis to an ICU in a tertiary care hospital were investigated retrospectively. Follow-up of patients was performed between May 2013 and November 2013. In a Cox regression analysis, maximum glucose concentration at the day of admission was associated with mortality in the overall cohort (HR = 1.006, 95% CI: 1.004–1.009; p < 0.001 and in patients suffering from myocardial infarction (HR = 1.101, 95% CI: 1.075–1.127; p < 0.001 but only in trend in patients admitted to an ICU for sepsis (HR = 1.030, 95% CI: 0.998–1.062; p = 0.07. Severe hyperglycemia was associated with adverse intra-ICU mortality in the overall cohort (23% vs. 13%; p < 0.001 and patients admitted for AMI (15% vs. 5%; p < 0.001 but not for septic patients (39% vs. 40%; p = 0.48. A medical history of type 2 diabetes (n = 337; 13% was not associated with increased intra-ICU mortality (15% vs. 15%; p = 0.93 but in patients with severe hyperglycemia and/or a known medical history of type 2 diabetes considered in combination, an increased mortality in AMI patients (intra-ICU 5% vs. 13%; p < 0.001 but not in septic patients (intra-ICU 38% vs. 41%; p = 0.53 could be evidenced. The presence of hyperglycemia in critically ill patients has differential impact within the different etiological groups. Hyperglycemia in AMI patients might identify a sicker patient

  1. Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study

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    McKenna Lisa

    2010-10-01

    Full Text Available Abstract Background There is a long history of certain medical conditions being associated with stigma, stereotypes, and negative attitudes. Research has shown that such attitudes can have a detrimental effect on patients presenting with stigmatised medical conditions and can even flow on to impact their family. The objective of this study was to measure the attitudes of undergraduate students enrolled in six different health-related courses at Monash University toward patients with intellectual disability, substance abuse, and acute mental illness. Methods A convenience sample of undergraduate students enrolled in six health-related courses in first, second and third years at Monash University were surveyed. The Medical Condition Regard Scale - a valid and reliable, self-report measure of attitudes - was administered to students along with a brief demographic form. Mean scores, t-tests, and ANOVA were used to analyse student attitudes. Ethics approval was granted. Results 548 students participated. Statistically significant differences were found between the courses (p = 0.05, year of the course (p = 0.09, and gender (p = 0.04 for the medical condition of intellectual disability. There was no statistically significant difference between the courses, year of the course, gender, and age group for substance abuse or acute mental illness conditions. Conclusion The findings suggest that students in undergraduate health-related courses, as a group, have a strong regard for patients with intellectual disability and some regard for patients with acute mental illness, but not for patients presenting with substance abuse problems.

  2. Acute ischemic stroke in a child with cyanotic congenital heart disease due to non-compliance of anticoagulation

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    Mohammad, Misbahuddin; James, Anish F.; Qureshi, Raheel S.; Saraf, Sapan; Ahluwalia, Tina; Mukherji, Joy Dev; Kole, Tamorish

    2012-01-01

    BACKGROUND: Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients. In case of acute ischemic stroke in pediatric age group, management is different from that of adult ischemic stroke where thrombolysis is a good op. METHODS: We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry. The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously. He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke. RESULTS: The patient recovered from acute ischemic stroke without being thrombolyzed. CONCLUSION: In pediatric patients, acute ischemic stroke usually is evolving and may not require thrombolysis. PMID:25215056

  3. Palliative Care for Children: Support for the Whole Family When Your Child Is Living with a Serious Illness

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    ... Pain •Shortness of breath •Fatigue •Depression •Anxiety •Nausea •Loss of appetite •Problems with sleep Palliative care can help your child deal with side effects from medicines and treatments. ...

  4. Reliability and validity of the Spanish version of the Child Health and Illness Profile (CHIP Child-Edition, Parent Report Form (CHIP-CE/PRF

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    Tebé Cristian

    2010-08-01

    Full Text Available Abstract Background The objectives of the study were to assess the reliability, and the content, construct, and convergent validity of the Spanish version of the CHIP-CE/PRF, to analyze parent-child agreement, and compare the results with those of the original U.S. version. Methods Parents from a representative sample of children aged 6-12 years were selected from 9 primary schools in Barcelona. Test-retest reliability was assessed in a convenience subsample of parents from 2 schools. Parents completed the Spanish version of the CHIP-CE/PRF. The Achenbach Child Behavioural Checklist (CBCL was administered to a convenience subsample. Results The overall response rate was 67% (n = 871. There was no floor effect. A ceiling effect was found in 4 subdomains. Reliability was acceptable at the domain level (internal consistency = 0.68-0.86; test-retest intraclass correlation coefficients = 0.69-0.85. Younger girls had better scores on Satisfaction and Achievement than older girls. Comfort domain score was lower (worse in children with a probable mental health problem, with high effect size (ES = 1.45. The level of parent-child agreement was low (0.22-0.37. Conclusions The results of this study suggest that the parent version of the Spanish CHIP-CE has acceptable psychometric properties although further research is needed to check reliability at sub-domain level. The CHIP-CE parent report form provides a comprehensive, psychometrically sound measure of health for Spanish children 6 to 12 years old. It can be a complementary perspective to the self-reported measure or an alternative when the child is unable to complete the questionnaire. In general, the results are similar to the original U.S. version.

  5. Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 1: respiratory muscle function during critical illness.

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    Kallet, Richard H

    2011-02-01

    Since the early 1970s there has been an ongoing debate regarding the wisdom of promoting unassisted spontaneous breathing throughout the course of critical illness in patients with severe respiratory failure. The basis of this debate has focused on the clinical relevance of opposite problems. Historically, the term "disuse atrophy" has described a situation wherein sustained inactivity of the respiratory muscles (ie, passive ventilation) results in deconditioning and weakness. More recently it has been referred to as "ventilator-induced diaphragmatic dysfunction." In contrast, "use atrophy" describes a situation where chronic high-tension inspiratory work causes structural damage to the diaphragm and weakness. Both laboratory and clinical studies demonstrated that relatively brief periods of complete respiratory muscle inactivity, as well as intense muscle loading, result in acute inflammation, loss of muscle mass, and weakness. Yet in critical illness other factors also affect respiratory muscle function, including prolonged use of neuromuscular blocking agents, administration of corticosteroids, and sepsis. This makes the attribution of acquired respiratory muscle weakness and ventilator-dependence to either ventilator-induced diaphragmatic dysfunction or loaded breathing extremely difficult. Regardless, the clinical implications of this research strongly suggest that passive mechanical ventilation should be avoided whenever possible. However, promotion of unassisted spontaneous breathing in the acute phase of critical illness also may carry a substantial risk of respiratory muscle injury and weakness. Use of mechanical ventilation modes in a manner that induces spontaneous breathing effort, while simultaneously reducing the work load on the respiratory muscles, is probably sufficient to minimize both problems.

  6. Study Design of the Microcirculatory Shock Occurrence in Acutely Ill Patients (microSOAP: an International Multicenter Observational Study of Sublingual Microcirculatory Alterations in Intensive Care Patients

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    Namkje A. R. Vellinga

    2012-01-01

    Full Text Available Objective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the prevalence of these alterations is lacking. We present the study design of an international multicenter observational study to investigate the prevalence of microcirculatory alterations in critically ill: the Microcirculatory Shock Occurrence in Acutely ill Patients (microSOAP. Methods. 36 ICU’s worldwide have participated in this study aiming for inclusion of over 500 evaluable patients. To enable communication and data collection, a website, an Open Clinica 3.0 database, and image uploading software have been designed. A one-session assessment of the sublingual microcirculation using Sidestream Dark Field imaging and data collection on patient characteristics has been performed in every ICU patient >18 years, regardless of underlying disease. Statistical analysis will provide insight in the prevalence and severity of sublingual alterations, its relation to systemic hemodynamic variables, disease, therapy, and outcome. Conclusion. This study will be the largest microcirculation study ever performed. It is expected that this study will also establish a basis for future studies related to the microcirculation in critically ill.

  7. Acute Corneal Hydrops Mimicking Infectious Keratitis as Initial Presentation of Keratoconus in a 10-Year-Old Child

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    Elise A. Slim

    2015-01-01

    Full Text Available Purpose. To report a case of acute hydrops in a 10-year-old child with advanced keratoconus. Case Presentation. A ten-year-old boy diagnosed as having right eye (RE infectious keratitis, not responding to antimicrobial therapy, was referred to our hospital. The diagnosis of infectious keratitis was established one month prior to his presentation following an episode of acute corneal whitening, pain, and drop in visual acuity. Topical fortified antibiotics followed by topical antiviral therapy were used with no improvement. Slit lamp examination showed significant corneal protrusion with edema surrounding a rupture in Descemet’s membrane in the RE. The diagnosis of acute corneal hydrops from advanced keratoconus was highly suspected and confirmed with corneal topography. Conclusion. Although a relatively rare disease at the age of 10 years, keratoconus can be rapidly progressive in the pediatric group. Keratoconus should always be considered in the differential diagnosis of progressive vision loss in this age group.

  8. Risk Factors for Development of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-Analysis of Observational Studies

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    Rodrigo Cartin-Ceba

    2012-01-01

    Full Text Available Background. Acute kidney injury (AKI is a frequent complication of critically ill patients. The impact of different risk factors associated with this entity in the ICU setting is unknown. Objectives. The purpose of this research was to assess the risk factors associated with the development of AKI in critically ill patients by meta-analyses of observational studies. Data Extraction. Two reviewers independently and in duplicate used a standardized form to collect data from published reports. Authors were contacted for missing data. The Newcastle-Ottawa scale assessed study quality. Data Synthesis. Data from 31 diverse studies that enrolled 504,535 critically ill individuals from a wide variety of ICUs were included. Separate random-effects meta-analyses demonstrated a significantly increased risk of AKI with older age, diabetes, hypertension, higher baseline creatinine, heart failure, sepsis/systemic inflammatory response syndrome, use of nephrotoxic drugs, higher severity of disease scores, use of vasopressors/inotropes, high risk surgery, emergency surgery, use of intra-aortic balloon pump, and longer time in cardiopulmonary bypass pump. Conclusion. The best available evidence suggests an association of AKI with 13 different risk factors in subjects admitted to the ICU. Predictive models for identification of high risk individuals for developing AKI in all types of ICU are required.

  9. Acute gastro-intestinal illness and its association with hydroclimatic factors in British Columbia, Canada: A time-series analysis

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    Galway, L. P.; Allen, D. M.

    2013-12-01

    Rising global temperatures and expected shifts in regional hydroclimatology in a changing climate are likely to influence the risk of infectious waterborne illness. This study examines the role of hydroclimatology as an underlying driver of the epidemiology of waterborne gastro-intestinal illness and contributes to our currently limited understanding of the possible ecosystem-mediated impacts of climate change on health. Using time-series regression analysis, we examine the associations between three hydroclimatic factors (monthly temperature, precipitation, and streamflow) and the monthly occurrence of AGI illness in two communities in the province of British Columbia, Canada. The two communities were selected as study sites to represent the dominant hydroclimatic regimes that characterize the province of BC: the rainfall-dominated hydroclimatic regime and snowmelt-dominated hydroclimatic regime Our results show that the number of monthly cases of AGI increased with increasing temperature, precipitation, and streamflow in the same month in the context of a rainfall-dominated regime and with increasing streamflow in the previous month in the context of a snowfall-dominated regime. These results suggest that hydroclimatic factors play a role in driving the occurrence and variability of AGI illness in this setting. Further, this study has highlighted that the nature and magnitude of the effects of hydroclimatic factors on waterborne illness vary across different hydroclimatic settings. We conclude that the watershed may be an appropriate context within which we can and should enhance our understanding of water-related climate change impacts on health. Examining the role of hydroclimatology as an underlying driver of the epidemiology of infectious disease is key to understanding of the possible ecosystem-mediated impacts of climate change on health and developing appropriate adaptation responses.

  10. Child abuse - physical

    Science.gov (United States)

    ... way Uses harsh discipline Was abused as a child Alcohol or drug problems Emotional problems or mental illness ... Physical abuse - children References Berkowitz CD, Stewart ST. Child maltreatment. In: Marx JA, Hockberger RS, Walls RM, eds. ...

  11. Cholesterol and triglycerides as biochemical markers of the state of the patient’s illness with acute lymphocytic leukemia

    OpenAIRE

    GUZMÁN, MARCO; Instituto de Enfermedades Neoplásicas; Sandoval, Miguel; Centro de Investigación de Bioquímica y Nutrición.

    2013-01-01

    Objective: To determine the relationship of cholesterol and triglycerides serum levels with the response to induction chemotherapy treatment in patients with acute lymphocytic leukemia. Material and Methods: The sample consisted in 25 patients 2 through 18 years-old admitted to the Neoplasia Diseases Institute with a recent diagnosis of acute lymphocytic leukemia in whom serum concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were determine, before and af...

  12. Acute effects of air pollution on influenza-like illness in Nanjing, China: A population-based study.

    Science.gov (United States)

    Huang, Lei; Zhou, Lian; Chen, Jin; Chen, Kai; Liu, Yang; Chen, Xiaodong; Tang, Fenyang

    2016-03-01

    Influenza-like illness causes substantial morbidity and mortality. Air pollution has already been linked to many health issues, and increasing evidence in recent years supports an association between air pollution and respiratory infections. It is a pioneer study in China to quantify the effects of air pollution on influenza-like illness. This study used wavelet coherence analysis and generalized additive models to explore the potential association between air pollution (including particulate matter with aerodynamic diameter ≦2.5 μm (PM2.5), particulate matter with aerodynamic diameter ≦10 μm (PM10) and nitrogen dioxide (NO2)) and influenza-like illness (a total of 59860 cases) in Nanjing, China from January 1, 2013 to December 31, 2013. The average concentrations of PM2.5, PM10 and NO2 were 77.37 μg/m(3), 135.20 μg/m(3) and 55.80 μg/m(3). An interquartile range increase in PM2.5 concentration was associated with a 2.99% (95% confidence interval (CI): 1.64%, 4.36%) increase in daily influenza-like cases on the same day, while the corresponding increase in NO2 was associated with a 3.77% (95% CI: 2.01%, 5.56%) increase in daily cases. People aged 0-4 were proved to be significantly susceptible to PM10 and NO2; 5-14 ages were significantly susceptible to PM2.5 and PM10; and 15-24 ages were significantly susceptible to all the analyzed air pollutants. Air pollution effects tended to be null or negative for patients aged over 25, which might be due to the small number of influenza-like cases in this age group. This study can be useful for understanding the adverse health effects of air pollution and the cause of influenza-like illness.

  13. A UK general practice population cohort study investigating the association between lipid lowering drugs and 30-day mortality following medically attended acute respiratory illness.

    Science.gov (United States)

    Joshi, Roshni; Venkatesan, Sudhir; Myles, Puja R

    2016-01-01

    Background. Cholesterol lowering drugs HMG-CoA reductase inhibitors (statins) and PPARα activators (fibrates) have been shown to reduce host inflammation via non-disease specific immunomodulatory mechanisms. Recent studies suggest that commonly prescribed drugs in general practice, statins and fibrates, may be beneficial in influenza-like illness related mortality. This retrospective cohort study examines the association between two lipid lowering drugs, statins and fibrates, and all-cause 30-day mortality following a medically attended acute respiratory illness (MAARI). Methods. Primary care patient data were retrospectively extracted from the UK Clinical Practice Research Datalink (CPRD) database. The sample comprised 201,179 adults aged 30 years or older experiencing a MAARI episode. Patient exposure to statins or fibrates was coded as separate dichotomous variables and deemed current if the most recent GP prescription was issued in the 30 days prior to MAARI diagnosis. Multivariable logistic regression and Cox regression were used for analyses. Adjustment was carried out for chronic lung disease, heart failure, metformin and glitazones, comorbidity burden, socio-demographic and lifestyle variables such as smoking status and body mass index (BMI). Statistical interaction tests were carried out to check for effect modification by gender, body mass index, smoking status and comorbidity. Results. A total of 1,096 (5%) patients died within the 30-day follow up period. Of this group, 213 (19.4%) were statin users and 4 (0.4%) were fibrate users. After adjustment, a significant 35% reduction in odds [adj OR; 0.65 (95% CI [0.52-0.80])] and a 33% reduction in the hazard [adj HR: 0.67 (95% CI [0.55-0.83])] of all-cause 30-day mortality following MAARI was observed in statin users. A significant effect modification by comorbidity burden was observed for the association between statin use and MAARI-related mortality. Fibrate use was associated with a non

  14. Intracranial chordoma presenting as acute hemorrhage in a child: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Kenneth A Moore

    2015-01-01

    Conclusion: There are few previous reports of petroclival chordomas causing acute intracranial hemorrhage. To the authors′ knowledge, this is the first case of a petroclival chordoma presenting as acute intracranial hemorrhage in a pediatric patient. Although uncommon, it is important to consider chordoma when evaluating a patient of any age presenting with a hemorrhagic lesion of the clivus.

  15. Acute Promyelocytic Leukemia in Four Year Old Female Child - A Case Report

    Directory of Open Access Journals (Sweden)

    Anirudha V. Kushtagi

    2014-07-01

    Full Text Available Leukemia is the most common malignancy of childhood representing about 30 % of oncohematological diseases diagnosed in children less than 15 years of age. We report the case of a 4 year old girl with acute promyelocytic leukemia whose blasts showed the morphology characteristic of acute promyelocytic leukemia variant. The case is reported because in the paediatric population the acute promyelocytic leukemia is a rare occurrence moreover, it represent a true oncohematology emergency, in this case the laboratory has a significant role since the timing of diagnosis must be very short. It helps in therapeutic protocols compared to conventional therapeutic protocols in Acute Myeloid Leukemia (AML, the introduction of retinoid All-Trans-Retinoic Acid (ATRA, both in children and adults with Acute Promyelocytic Leukemia (APL, has significantly reduced the early mortality.

  16. Prevalence of patients with acute febrile illnesses and positive dengue NS1 tests in a tertiary hospital in Papua New Guinea.

    Science.gov (United States)

    Asigau, Viola; Lavu, Evelyn K; McBride, William J H; Biloh, Eric; Naroi, Francis; Koana, Egi; Ferguson, John K; Laman, Moses

    2015-01-01

    Because the prevalence of dengue fever in urban settings in Papua New Guinea is unknown, we investigated the presence of dengue using the NS1 antigen test in an outpatient-based prospective observational study at Port Moresby General Hospital. Of 140 patients with acute febrile illnesses, dengue fever was diagnosed in 14.9% (20 of 134; 95% confidence interval [95% CI] = 9.6-22.4). Malaria (2 of 137; 1.5%; 95% CI = 0.3-5.7), chikungunya (3 of 140; 2.1%; 95% CI = 0.6-6.6), and bacterial bloodstream infections (0 of 80; 0%; 95% CI = 0-5.7) were uncommon. Dengue fever should no longer be considered rare in Papua New Guinea.

  17. Evaluation of acute kidney injury as defined by the risk, injury,failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    YUE Jia-ning; LUO Zhe; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue

    2013-01-01

    Background Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair.This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012.Multivariable analysis was used to identify factors associated with postoperative AKI,which was defined by risk,injury,failure,loss and end-stage (RIFLE) kidney disease criteria.The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.Results Of the 71 patients enrolled,32 (45.1%) developed AKI,with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU).Risk factors for AKI were ruptured AAA (odds ratio (OR)=5.846,95% confidence interval (Cl):1.346-25.390),intraoperative hypotension (OR=6.008,95% CI:1.176 to 30.683),and perioperative blood transfusion (OR=4.611,95% CI:1.307-16.276).Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery.Overall in-hospital mortality was 2.8% AKI was associated with significantly increased length of stay ((136.9±24.5) hours vs.(70.4±11.3) hours)in Surgical Intensive Care Unit.Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI,which can be early recognized by RIFLE criteria.Rupture,hypotension,and blood transfusion are the significant associated risk factors.Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.

  18. The hemodynamic tolerability and feasibility of sustained low efficiency dialysis in the management of critically ill patients with acute kidney injury

    Directory of Open Access Journals (Sweden)

    Nisenbaum Rosane

    2010-11-01

    Full Text Available Abstract Background Minimization of hemodynamic instability during renal replacement therapy (RRT in patients with acute kidney injury (AKI is often challenging. We examined the relative hemodynamic tolerability of sustained low efficiency dialysis (SLED and continuous renal replacement therapy (CRRT in critically ill patients with AKI. We also compared the feasibility of SLED administration with that of CRRT and intermittent hemodialysis (IHD. Methods This cohort study encompassed four critical care units within a single university-affiliated medical centre. 77 consecutive critically ill patients with AKI who were treated with CRRT (n = 30, SLED (n = 13 or IHD (n = 34 and completed at least two RRT sessions were included in the study. Overall, 223 RRT sessions were analyzed. Hemodynamic instability during a given session was defined as the composite of a > 20% reduction in mean arterial pressure or any escalation in pressor requirements. Treatment feasibility was evaluated based on the fraction of the prescribed therapy time that was delivered. An interrupted session was designated if Results Hemodynamic instability occurred during 22 (56.4% SLED and 43 (50.0% CRRT sessions (p = 0.51. In a multivariable analysis that accounted for clustering of multiple sessions within the same patient, the odds ratio for hemodynamic instability with SLED was 1.20 (95% CI 0.58-2.47, as compared to CRRT. Session interruption occurred in 16 (16.3, 30 (34.9 and 11 (28.2 of IHD, CRRT and SLED therapies, respectively. Conclusions In critically ill patients with AKI, the administration of SLED is feasible and provides comparable hemodynamic control to CRRT.

  19. Rare but numerous serious complications of acute otitis media in a young child.

    Science.gov (United States)

    Van Munster, Mariëtte P E; Brus, Frank; Mul, Dick

    2013-03-12

    Acute otitis media is a very common disease in children. Most children recover with symptomatic therapy like potent analgesics, but occasionally serious complications occur. We present a 3-year-old girl who suffered from acute otitis media for already 2 weeks and presented with fever, abducens nerve palsy of her left eye and vomiting. She was finally diagnosed with an acute otitis media complicated by a mastoiditis, sinus thrombosis, meningitis and cerebellar empyema. Fusobacterium necrophorum was cultured from cerebrospinal fluid. The girl recovered following appropriate antibiotic and anticoagulation treatment.

  20. Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Zhang Zhongheng

    2013-02-01

    Full Text Available Abstract Background Hemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS. The PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany system has been developed and used in critical care settings for several years. However, its impact on clinical outcomes remains unknown. Methods/design The study is a randomized controlled multi-center trial. A total of 708 patients with ARDS, septic shock or both will be included from January 2012 to January 2014. Subjects will be randomized to receive PiCCO monitoring or not. Our primary end point is 30-day mortality, and secondary outcome measures include ICU length of stay, days on mechanical ventilation, days of vasoactive agent support, ICU-free survival days during a 30-day period, mechanical-ventilation-free survival days during a 30-day period, and maximum SOFA score during the first 7 days. Discussion We investigate whether the use of PiCCO monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock. This will provide additional data on hemodynamic monitoring and help clinicians to make decisions on the use of PiCCO. Trial registration http://www.clinicaltrials.gov NCT01526382

  1. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+).

    Science.gov (United States)

    Georgopoulos, Dimitris; Xirouchaki, Nectaria; Tzanakis, Nikolaos; Younes, Magdy

    2016-09-01

    The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+) after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure), respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy "Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?" [1].

  2. Data on respiratory variables in critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+

    Directory of Open Access Journals (Sweden)

    Dimitris Georgopoulos

    2016-09-01

    Full Text Available The data show respiratory variables in 108 critically ill patients with acute respiratory failure placed on proportional assist ventilation with load adjustable gain factors (PAV+ after at least 36 h on passive mechanical ventilation. PAV+ was continued for 48 h until the patients met pre-defined criteria either for switching to controlled modes or for breathing without ventilator assistance. Data during passive mechanical ventilation and during PAV+ are reported. Data are acquired from the whole population, as well as from patients with and without acute respiratory distress syndrome. The reported variables are tidal volume, driving pressure (ΔP, the difference between static end-inspiratory plateau pressure and positive end-expiratory airway pressure, respiratory system compliance and resistance, and arterial blood gasses. The data are supplemental to our original research article, which described individual ΔP in these patients and examined how it related to ΔP when the same patients were ventilated with passive mechanical ventilation using the currently accepted lung-protective strategy “Driving pressure during assisted mechanical ventilation. Is it controlled by patient brain?” [1].

  3. Effects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure.

    Science.gov (United States)

    Pschowski, R; Briegel, S; Von Haehling, S; Doehner, W; Bender, T O; Pape, U F; Hasper, D; Jörress, A; Schefold, J C

    2015-11-01

    Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). Two hundred and fifty-two patients (122 CVVH, 159 male; aged 61.5±13.9 years) with dialysis-dependent acute renal failure were analysed in a sub-analysis of the prospective randomised controlled clinical trial-CONVINT-comparing IHD and CVVH. Bleeding complications including severity of bleeding and RRT-related blood loss were assessed. We observed that 3.6% of patients died related to severe bleeding episodes (between group P=0.94). Major all-cause bleeding complications were observed in 23% IHD versus 26% of CVVH group patients (P=0.95). Under CVVH, the rate of RRT-related blood loss events (57.4% versus 30.4%, P=0.01) and mean total blood volume lost was increased (222.3±291.9 versus 112.5±222.7 ml per patient, P dialysis-dependent acute renal failure in this regard.

  4. Influenza-like illness in acute myocardial infarction patients during the winter wave of the influenza A H1N1 pandemic in London: a case–control study

    Science.gov (United States)

    Warren-Gash, Charlotte; Geretti, Anna Maria; Hamilton, George; Rakhit, Roby D; Smeeth, Liam; Hayward, Andrew C

    2013-01-01

    Objective To investigate recent respiratory and influenza-like illnesses (ILIs) in acute myocardial infarction patients compared with patients hospitalised for acute non-vascular surgical conditions during the second wave of the 2009 influenza A H1N1 pandemic. Design Case–control study. Setting Coronary care unit, acute cardiology and acute surgical admission wards in a major teaching hospital in London, UK. Participants 134 participants (70 cases and 64 controls) aged ≥40 years hospitalised for acute myocardial infarction and acute surgical conditions between 21 September 2009 and 28 February 2010, frequency-matched for gender, 5-year age-band and admission week. Primary exposure ILI (defined as feeling feverish with either a cough or sore throat) within the last month. Secondary exposures Acute respiratory illness within the last month not meeting ILI criteria; nasopharyngeal and throat swab positive for influenza virus. Results 29 of 134 (21.6%) participants reported respiratory illness within the last month, of whom 13 (9.7%) had illnesses meeting ILI criteria. The most frequently reported category for timing of respiratory symptom onset was 8–14 days before admission (31% of illnesses). Cases were more likely than controls to report ILI—adjusted OR 3.17 (95% CI 0.61 to 16.47)—as well as other key respiratory symptoms, and were less likely to have received influenza vaccination—adjusted OR 0.46 (95% CI 0.19 to 1.12)—although the differences were not statistically significant. No swabs were positive for influenza virus. Conclusions Point estimates suggested that recent ILI was more common in patients hospitalised with acute myocardial infarction than with acute surgical conditions during the second wave of the influenza A H1N1 pandemic, and influenza vaccination was associated with cardioprotection, although the findings were not statistically significant. The study was underpowered, partly because the age groups typically affected by acute

  5. Genital ulcers after treatment with all-trans-retinoic acid in a child with acute promyelocytic leukemia.

    Science.gov (United States)

    Unal, Selma; Gümrük, Fatma; Cetin, Mualla; Hiçsönmez, Gönül

    2005-01-01

    All-trans-retinoic acid (ATRA) has been shown to improve the outcome of patients with acute promyelocytic leukemia (APL). However, various adverse effects of ATRA treatment have been noted, such as scrotal and genital ulcers in adult patients. The authors report genital ulcers that developed in a child with APL after ATRA treatment. An 8-year-old girl with APL was treated with ATRA for 21 days and after discontinuation of ATRA treatment she developed genital ulcers. Systemic and local antibiotic pomades were applied and the lesions improved within 15 days. In conclusion, genital ulcers may develop in children with APL as a complication of ATRA treatment and physicians should be alert to this possibility.

  6. Acute Disseminated Encephalomyelitis following Vaccination against Hepatitis B in a Child: A Case Report and Literature Review

    Science.gov (United States)

    Yuan, Jun-liang; Wang, Shuang-kun; Guo, Xiao-juan

    2016-01-01

    Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system, which has been associated with several vaccines such as rabies, diphtheria-tetanus-polio, smallpox, measles, mumps, rubella, Japanese B encephalitis, pertussis, influenza, and the Hog vaccine. Here, we presented a case of 12-year-old child who suffered from ADEM three weeks after hepatitis B vaccination. He was admitted to our hospital with symptoms of weakness of limbs, high fever, and alteration of consciousness. Some abnormalities were also found in CSF. Treatment with high-dose corticosteroids and intravenous immunoglobulin had significant effect, with marked improvement of the clinical symptoms and the results of CSF. The findings of MRI also detected some abnormal lesions located in both brain and spinal cord. The clinical features, the findings of CSF and MRI, and therapeutic effect may contribute to such diagnosis of ADEM. PMID:27478662

  7. Acute Disseminated Encephalomyelitis following Vaccination against Hepatitis B in a Child: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Jun-liang Yuan

    2016-01-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM is an inflammatory demyelinating disease of the central nervous system, which has been associated with several vaccines such as rabies, diphtheria-tetanus-polio, smallpox, measles, mumps, rubella, Japanese B encephalitis, pertussis, influenza, and the Hog vaccine. Here, we presented a case of 12-year-old child who suffered from ADEM three weeks after hepatitis B vaccination. He was admitted to our hospital with symptoms of weakness of limbs, high fever, and alteration of consciousness. Some abnormalities were also found in CSF. Treatment with high-dose corticosteroids and intravenous immunoglobulin had significant effect, with marked improvement of the clinical symptoms and the results of CSF. The findings of MRI also detected some abnormal lesions located in both brain and spinal cord. The clinical features, the findings of CSF and MRI, and therapeutic effect may contribute to such diagnosis of ADEM.

  8. Acute necrotising encephalopathy in a child with H1N1 influenza infection: a clinicoradiological diagnosis and follow-up.

    Science.gov (United States)

    Yoganathan, Sangeetha; Sudhakar, Sniya Valsa; James, Ebor Jacob; Thomas, Maya Mary

    2016-01-11

    Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbreak, and more research to establish standard treatment protocols for this under-recognised entity.

  9. Down syndrome with microgranular variant of acute promyelocytic leukemia in a child: a case report

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    Jain Deepali

    2007-11-01

    Full Text Available Abstract Background Acute promyelocytic leukemia (APL accounts for less than 10% of pediatric AML. Cases of APL in Down syndrome (DS have been described in the literature rarely and it is rarer still to find the microgranular variant (M3v of APL in trisomy 21 patients. Case presentation We present a case of a five-year-old female with Down syndrome diagnosed with acute promyelocytic leukemia (APL. She came to our hospital with bleeding manifestations. Blood and bone marrow examination revealed promyelocytes showing a few fine granules and occasional Auer rods. Based on this morphology and cytochemistry, a diagnosis of APL microgranular variant (M3v was made. Conclusion This case report emphasizes the importance of a high index of suspicion in the diagnosis of acute promyelocytic leukemia microgranular variant in Down syndrome.

  10. Severe delirium on a background of Alzheimer’s dementia - A devastating acute illness; report of a case

    Institute of Scientific and Technical Information of China (English)

    Michael Charlesworth; Abhirami Kanapathyraja; Susie Waddingham; John D Holmes

    2012-01-01

    Delirium is an acute and reversible condition that is common in hospitalised patients. Patients with delirium have extended lengths of stay, double the mortality of matched controls and an increased risk of permanent cognitive decline. We present the case of a patient with severe hypoactive delirium on a background of Alzheimer’s dementia with a significant lasting cognitive deficit. This case presents the devastating impact of delirium on the lives of patients and relatives. The need for more awareness of delirium amongst health care professionals, more routine risk assessment and more studies aimed at managing hospitalised patients with delirium is also implicated.

  11. Severe delirium on a background of Alzheimer's dementia – A devastating acute illness; report of a case

    Directory of Open Access Journals (Sweden)

    Michael Charlesworth

    2012-01-01

    Full Text Available Delirium is an acute and reversible condition that is common in hospitalised patients. Patients with delirium have extended lengths of stay, double the mortality of matched controls and an increased risk of permanent cognitive decline. We present the case of a patient with severe hypoactive delirium on a background of Alzheimer's dementia with a significant lasting cognitive deficit. This case presents the devastating impact of delirium on the lives of patients and relatives. The need for more awareness of delirium amongst health care professionals, more routine risk assessment and more studies aimed at managing hospitalised patients with delirium is also implicated.

  12. Prevalence, codetection and seasonal distribution of upper airway viruses and bacteria in children with acute respiratory illnesses with cough as a symptom.

    Science.gov (United States)

    O'Grady, K F; Grimwood, K; Sloots, T P; Whiley, D M; Acworth, J P; Phillips, N; Goyal, V; Chang, A B

    2016-06-01

    Most studies exploring the role of upper airway viruses and bacteria in paediatric acute respiratory infections (ARI) focus on specific clinical diagnoses and/or do not account for virus-bacteria interactions. We aimed to describe the frequency and predictors of virus and bacteria codetection in children with ARI and cough, irrespective of clinical diagnosis. Bilateral nasal swabs, demographic, clinical and risk factor data were collected at enrollment in children aged bacteria. Logistic regression was used to investigate associations between child characteristics and codetection of the organisms of interest. Between December 2011 and August 2014, swabs were collected from 817 (93.3%) of 876 enrolled children, median age 27.7 months (interquartile range 13.9-60.3 months). Overall, 740 (90.6%) of 817 specimens were positive for any organism. Both viruses and bacteria were detected in 423 specimens (51.8%). Factors associated with codetection were age (adjusted odds ratio (aOR) for age bacteria pairs. Virus-H. influenzae interactions in ARI should be investigated further, especially as the contribution of nontypeable H. influenzae to acute and chronic respiratory diseases is being increasingly recognized.

  13. Acute-onset opioid-induced hyperalgesia in a child with juvenile idiopathic arthritis.

    Science.gov (United States)

    Vijayan, Vini; Moran, Ryan; Elder, Melissa E; Sukumaran, Sukesh

    2012-10-01

    We describe a child with polyarticular juvenile idiopathic arthritis (JIA) presenting with severe diffuse pain refractory to nonsteroidal anti-inflammatory agents and high-dose opioids. Her JIA involved her knees and ankles and was mildly active on etanercept and nonsteroidal anti-inflammatory agents. At presentation, she complained of hip pain progressing to severe diffuse pain and allodynia involving her extremities. No abnormalities were seen in her laboratory parameters and imaging of her lower extremities. After appreciating no substantial benefit by increasing her opioids, her opioids were tapered and discontinued, and this was followed by significant alleviation in her pain, and a diagnosis of opioid-induced hyperalgesia (OIH) was made. Despite reports in adults, the phenomenon of OIH has been reported infrequently in children. To our knowledge, OIH has not been described in children with rheumatologic conditions. We recommend investigating the possibility of OIH when treating a child with JIA and severe refractory pain.

  14. Glioblastoma multiforme in a child with acute lymphoblastic leukemia: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Shah Kirit

    2004-07-01

    Full Text Available An 11-year-old boy with acute lymphoblastic leukemia had received prophylactic cranial irradiation (1800 cGy /10 fractions and intrathecal methotrexate. Five years later, he developed a glioblastoma multiforme in the right frontal region while the leukemia was in remission. It is possible that the glioma may have been induced by radiation and /or chemotherapy.

  15. Predicting Child Ptsd: The Relationship between Acute Stress Disorder and PTSD in Injured Children

    Science.gov (United States)

    Kassam-Adams, Nancy; Winston, Flaura Koplin

    2004-01-01

    Objective: To examine the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in injured children and to evaluate the utility of ASD as a predictor of PTSD. Method: Children hospitalized for injuries sustained in a traffic crash were enrolled in a prospective study. ASD was assessed in 243 children within 1 month…

  16. Fatal Aspergillus rhinosinusitis during induction chemotherapy in a child with acute lymphoblastic leukemia.

    NARCIS (Netherlands)

    Vlaardingerbroek, H.; Flier, M. van der; Borgstein, J.A.; Lequin, M.H.; Sluis, I.M. van der

    2009-01-01

    Invasive fungal infections are a major problem in patients treated for hematologic malignancies. We report a 3-year-old girl who suffered from febrile neutropenia during induction therapy for acute lymphoblastic leukemia. Initial chest computed tomography revealed no evidence of intrapulmonary funga

  17. Utility of the tourniquet test and the white blood cell count to differentiate dengue among acute febrile illnesses in the emergency room.

    Directory of Open Access Journals (Sweden)

    Christopher J Gregory

    2011-12-01

    Full Text Available Dengue often presents with non-specific clinical signs, and given the current paucity of accurate, rapid diagnostic laboratory tests, identifying easily obtainable bedside markers of dengue remains a priority. Previous studies in febrile Asian children have suggested that the combination of a positive tourniquet test (TT and leucopenia can distinguish dengue from other febrile illnesses, but little data exists on the usefulness of these tests in adults or in the Americas. We evaluated the diagnostic accuracy of the TT and leucopenia (white blood cell count <5000/mm(3 in identifying dengue as part of an acute febrile illness (AFI surveillance study conducted in the Emergency Department of Saint Luke's Hospital in Ponce, Puerto Rico. From September to December 2009, 284 patients presenting to the ED with fever for 2-7 days and no identified source were enrolled. Participants were tested for influenza, dengue, leptospirosis and enteroviruses. Thirty-three (12% patients were confirmed as having dengue; 2 had dengue co-infection with influenza and leptospirosis, respectively. An infectious etiology was determined for 141 others (136 influenza, 3 enterovirus, 2 urinary tract infections, and 110 patients had no infectious etiology identified. Fifty-two percent of laboratory-positive dengue cases had a positive TT versus 18% of patients without dengue (P<0.001, 87% of dengue cases compared to 28% of non-dengue cases had leucopenia (P<0.001. The presence of either a positive TT or leucopenia correctly identified 94% of dengue patients. The specificity and positive predictive values of these tests was significantly higher in the subset of patients without pandemic influenza A H1N1, suggesting improved discriminatory performance of these tests in the absence of concurrent dengue and influenza outbreaks. However, even during simultaneous AFI outbreaks, the absence of leucopenia combined with a negative tourniquet test may be useful to rule out dengue.

  18. Factors driving customers to seek health care from pharmacies for acute respiratory illness and treatment recommendations from drug sellers in Dhaka city, Bangladesh

    Science.gov (United States)

    Chowdhury, Fahmida; Sturm-Ramirez, Katharine; Mamun, Abdullah Al; Iuliano, A Danielle; Bhuiyan, Mejbah Uddin; Chisti, Mohammod Jobayer; Ahmed, Makhdum; Haider, Sabbir; Rahman, Mahmudur; Azziz-Baumgartner, Eduardo

    2017-01-01

    Background Pharmacies in Bangladesh serve as an important source of health service. A survey in Dhaka reported that 48% of respondents with symptoms of acute respiratory illness (ARI) identified local pharmacies as their first point of care. This study explores the factors driving urban customers to seek health care from pharmacies for ARI, their treatment adherence, and outcome. Methods A cross-sectional study was conducted among 100 selected pharmacies within Dhaka from June to December 2012. Study participants were patients or patients’ relatives aged >18 years seeking care for ARI from pharmacies without prescription. Structured interviews were conducted with customers after they sought health service from drug sellers and again over phone 5 days postinterview to discuss treatment adherence and outcome. Results We interviewed 302 customers patronizing 76 pharmacies; 186 (62%) sought care for themselves and 116 (38%) sought care for a sick relative. Most customers (215; 71%) were males. The majority (90%) of customers sought care from the study pharmacy as their first point of care, while 18 (6%) had previously sought care from another pharmacy and 11 (4%) from a physician for their illness episodes. The most frequently reported reasons for seeking care from pharmacies were ease of access to pharmacies (86%), lower cost (46%), availability of medicine (33%), knowing the drug seller (20%), and convenient hours of operation (19%). The most commonly recommended drugs were acetaminophen dispensed in 76% (228) of visits, antihistamine in 69% (208), and antibiotics in 42% (126). On follow-up, most (86%) of the customers had recovered and 12% had sought further treatment. Conclusion People with ARI preferred to seek care at pharmacies rather than clinics because these pharmacies were more accessible and provided prompt treatment and medicine with no service charge. We recommend raising awareness among drug sellers on proper dispensing practices and enforcement of

  19. Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients

    DEFF Research Database (Denmark)

    Granholm, Anders; Møller, Morten Hylander; Krag, Mette;

    2016-01-01

    PURPOSE: Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II...... compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores....... Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow's goodness-of-fit Ĉ-statistic. RESULTS: AUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77-0.83) for SAPS II and 0.73 (95% CI 0...

  20. Development and validation of the Thai version of the 4 ‘A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses

    Directory of Open Access Journals (Sweden)

    Kuladee S

    2016-02-01

    elderly patients with acute medical illnesses. Keywords: Thai, delirium, screening tool, delirium screening, acute medical illnesses

  1. A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation

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    Tika Ram Bhandari

    2016-01-01

    Full Text Available Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

  2. A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation).

    Science.gov (United States)

    Bhandari, Tika Ram; Shahi, Sudha; Poudel, Rajesh; Chaudhary, Nagendra

    2016-01-01

    Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

  3. Bacteremia due to imipenem-resistant Roseomonas mucosa in a child with acute lymphoblastic leukemia.

    Science.gov (United States)

    Michon, Anne-Laure; Saumet, Laure; Bourdier, Alice; Haouy, Stéphanie; Sirvent, Nicolas; Marchandin, Hélène

    2014-04-01

    Roseomonas are described as opportunistic pathogens rarely involved in human infections. Their identification requires molecular methods and their antimicrobial susceptibility pattern varies according to the species. We report the first case of bacteremia due to Roseomonas mucosa in a child with leukemia and reviewed pediatric cases of Roseomonas infection, for which undoubted strain identification was available. Favorable outcome was observed despite resistance to numerous β-lactams that may account for delayed effective treatment, suggesting the low virulence of Roseomonas in children. Here, the strain also displayed unusual resistance to imipenem, highlighting the possible acquisition of additional resistance by this pathogen.

  4. Acute rib fracture diagnosis in an infant by US: a matter of child protection

    Energy Technology Data Exchange (ETDEWEB)

    Kelloff, Jennifer; Spivey, Maria [Washington University School of Medicine, Department of Pediatrics, Section on Child Abuse and Neglect, St. Louis Children' s Hospital, One Children' s Place, Box 8116, St. Louis, MO (United States); Hulett, Rebecca [Washington University School of Medicine, Department of Radiology, St. Louis Children' s Hospital, St. Louis, MO (United States)

    2009-01-15

    Rib fractures in infants and children are highly specific for inflicted injury in the absence of a major accidental injury or underlying bone disorder. We present a 9-week-old infant diagnosed with an acute rib fracture by US at the site where physicians palpated chest wall crepitus when no rib fractures had been visualized on the skeletal survey, including oblique views of the ribs. Based on the US diagnosis of the acute rib fracture the infant was taken into protective custody. Follow-up skeletal survey 2 weeks later revealed healing fractures of the left 6th and 7th posterolateral ribs and right 7th, 8th and 9th anterolateral ribs. We were unable to locate previous reports describing the diagnosis of rib fractures in infants by US. (orig.)

  5. A single black ulcer in a child with acute lymphocytic leukemia*

    Science.gov (United States)

    Vestita, Michelangelo; Filoni, Angela; Santoro, Nicola; Arcamone, Gianpaolo; Bonamonte, Domenico

    2016-01-01

    Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out. PMID:28099607

  6. Acute gastritis associated with Epstein-Barr virus infection in a child

    OpenAIRE

    Kim, Ji Mok; Song, Chun Woo; Song, Kyu Sang; Kim, Jae Young

    2016-01-01

    Infectious mononucleosis is Epstein-Barr virus (EBV) inducing a self-limiting clinical syndrome characterized by fever, sore throat, hepatosplenomegaly, and generalized lymphadenopathy. Gastrointestinal symptoms of EBV infection are nonspecific and occur rarely. EBV inducing acute gastrointestinal pathology is poorly recognized without suspicion. Careful consideration is needed to diagnose gastric involvement of EBV infection including gastric lymphoma, gastric cancer, and gastritis. A few re...

  7. Acute adrenal failure as the presenting feature of primary antiphospholipid syndrome in a child

    Directory of Open Access Journals (Sweden)

    Improda Nicola

    2012-09-01

    Full Text Available Abstract Introduction Antiphospholipid syndrome (APS is characterized by recurrent arterial and venous thrombosis and detection of antiphospholipid antibodies (aPLs. This syndrome may be associated with connective tissue disorders, or with malignancies, but it may also appear in isolated form (primary APS. We report on a pediatric patient presenting with acute adrenal failure as the first manifestation of primary APS. Case report A previously healthy 11-year-old boy developed fever, abdominal pain, and vomiting. An abdominal computed tomography scan showed nodular lesions in the adrenal glands. He was referred to our Department and a diagnosis of APS and acute adrenal failure was considered, based on positive aPLs (IgG and IgM, elevated ACTH levels and low cortisol levels. Other features were anemia, thrombocytopenia, elevated inflammatory parameters, hypergammaglobulinemia, prolonged partial thromboplastin time, positive antinuclear, anticardiolipin, anti-platelet antibodies, with negative double-stranded DNA antibodies. Lupus anticoagulant and Coomb’s tests were positive. MRI revealed a bilateral adrenal hemorrhage. A treatment with intravenous metylprednisolone, followed by oral prednisone and anticoagulant, was started, resulting in a progressive improvement. After 2 months he also showed hyponatremia and elevated renine levels, indicating a mineralcocorticoid deficiency, requiring fludrocortisones therapy. Conclusion The development of acute adrenal failure from bilateral adrenal haemorrhage in the context of APS is a rare but life-threatening event that should be promptly recognized and treated. Moreover, this case emphasizes the importance of the assessment of aPLs in patients with acute adrenal failure in the context of an autoreaction.

  8. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2012-02-03

    Introduction: STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers\\' criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. METHODS: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers\\' criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. RESULTS: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers\\' criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers\\' criteria-related PIMs contributed to significantly fewer admissions (6%). CONCLUSION: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers\\' criteria. This finding has significant implications for hospital geriatric practice.

  9. The mortality of acutely ill medical patients for up to 60 days after admission to a resource poor hospital in sub-Saharan Africa compared with patients of similar illness severity admitted to a Danish Regional Teaching Hospital

    DEFF Research Database (Denmark)

    Nabayigga, Barbara; Kellett, John; Brabrand, Mikkel;

    2016-01-01

    BACKGROUND: The outcomes of patients with the same severity of illness in the developed and developing countries have not been compared. Illness severity can now be measured anywhere by the National Early Warning Score (NEWS). METHODS: An exploratory observational study that compared the 7, 30...

  10. Self-collected mid-turbinate swabs for the detection of respiratory viruses in adults with acute respiratory illnesses.

    Directory of Open Access Journals (Sweden)

    Oscar E Larios

    Full Text Available BACKGROUND: The gold standard for respiratory virus testing is a nasopharyngeal (NP swab, which is collected by a healthcare worker. Midturbinate (MT swabs are an alternative due to their ease of collection and possible self-collection by patients. The objective of this study was to compare the respiratory virus isolation of flocked MT swabs compared to flocked NP swabs. METHODS: Beginning in October 2008, healthy adults aged 18 to 69 years were recruited into a cohort and followed up for symptoms of influenza. They were asked to have NP and MT swabs taken as soon as possible after the onset of a fever or two or more respiratory symptoms with an acute onset. The swabs were tested for viral respiratory infections using Seeplex® RV12 multiplex PCR detection kit. Seventy six pairs of simultaneous NP and MT swabs were collected from 38 symptomatic subjects. Twenty nine (38% of these pairs were positive by either NP or MT swabs or both. Sixty nine (91% of the pair results were concordant. Two samples (3% for hCV OC43/HKU1 and 1 sample (1% for rhinovirus A/B were positive by NP but negative by MT. One sample each for hCV 229E/NL63, hCV OC43/HKU1, respiratory syncytial virus A, and influenza B were positive by MT but negative by NP. CONCLUSIONS: Flocked MT swabs are sensitive for the diagnosis of multiple respiratory viruses. Given the ease of MT collection and similar results between the two swabs, it is likely that MT swabs should be the preferred method of respiratory cell collection for outpatient studies. In light of this data, larger studies should be performed to ensure that this still holds true and data should also be collected on the patient preference of collection methods.

  11. CLINICAL CHARACTERISTICS, OUTCOMES AND RISK FACTORS FOR DEATH AMONG CRITICALLY ILL PATIENTS WITH HIV-RELATED ACUTE KIDNEY INJURY

    Science.gov (United States)

    LUNA, Leonardo Duarte Sobreira; SOARES, Douglas de Sousa; JUNIOR, Geraldo Bezerra da SILVA; CAVALCANTE, Malena Gadelha; MALVEIRA, Lara Raissa Cavalcante; MENESES, Gdayllon Cavalcante; PEREIRA, Eanes Delgado Barros; DAHER, Elizabeth De Francesco

    2016-01-01

    SUMMARY Background: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death. PMID:27410912

  12. Levels of protein C and soluble thrombomodulin in critically ill patients with acute kidney injury: a multicenter prospective observational study.

    Directory of Open Access Journals (Sweden)

    Josée Bouchard

    Full Text Available Endothelial dysfunction contributes to the development of acute kidney injury (AKI in animal models of ischemia reperfusion injury and sepsis. There are limited data on markers of endothelial dysfunction in human AKI. We hypothesized that Protein C (PC and soluble thrombomodulin (sTM levels could predict AKI. We conducted a multicenter prospective study in 80 patients to assess the relationship of PC and sTM levels to AKI, defined by the AKIN creatinine (AKI Scr and urine output criteria (AKI UO. We measured marker levels for up to 10 days from intensive care unit admission. We used area under the curve (AUC and time-dependent multivariable Cox proportional hazard model to predict AKI and logistic regression to predict mortality/non-renal recovery. Protein C and sTM were not different in patients with AKI UO only versus no AKI. On intensive care unit admission, as PC levels are usually lower with AKI Scr, the AUC to predict the absence of AKI was 0.63 (95%CI 0.44-0.78. The AUC using log10 sTM levels to predict AKI was 0.77 (95%CI 0.62-0.89, which predicted AKI Scr better than serum and urine neutrophil gelatinase-associated lipocalin (NGAL and cystatin C, urine kidney injury molecule-1 and liver-fatty acid-binding protein. In multivariable models, PC and urine NGAL levels independently predicted AKI (p=0.04 and 0.02 and PC levels independently predicted mortality/non-renal recovery (p=0.04. In our study, PC and sTM levels can predict AKI Scr but are not modified during AKI UO alone. PC levels could independently predict mortality/non-renal recovery. Additional larger studies are needed to define the relationship between markers of endothelial dysfunction and AKI.

  13. Acute Raoultella planticola cystitis in a child with rhabdomyosarcoma of the bladder neck.

    Science.gov (United States)

    Yoon, Jong Hyung; Ahn, Yo Han; Chun, Jong In; Park, Hyeon Jin; Park, Byung-Kiu

    2015-10-01

    Raoultella planticola is a Gram-negative, non-motile, aerobic bacillus. It is an environmental bacteria found in soil and water, and a very rare cause of local or systemic infection in humans. Although some adult cases of R. planticola infection have been reported, childhood local or systemic infection caused by R. planticola is very rare. Reported herein is a rare case of acute cystitis due to R. planticola in a 16-month-old boy with rhabdomyosarcoma of the bladder neck, and a review of the literature.

  14. Acute gastritis associated with Epstein-Barr virus infection in a child

    Science.gov (United States)

    Kim, Ji Mok; Song, Chun Woo; Song, Kyu Sang

    2016-01-01

    Infectious mononucleosis is Epstein-Barr virus (EBV) inducing a self-limiting clinical syndrome characterized by fever, sore throat, hepatosplenomegaly, and generalized lymphadenopathy. Gastrointestinal symptoms of EBV infection are nonspecific and occur rarely. EBV inducing acute gastrointestinal pathology is poorly recognized without suspicion. Careful consideration is needed to diagnose gastric involvement of EBV infection including gastric lymphoma, gastric cancer, and gastritis. A few recent cases of gastritis associated with EBV infection have been reported in adolescents and adults. However, there is no report of EBV-associated gastritis in early childhood. We experienced a rare case of 4-year-old girl with EBV gastritis confirmed by in situ hybridization. PMID:28018450

  15. Acute myeloid leukaemia presenting as bilateral proptosis in a young child

    Directory of Open Access Journals (Sweden)

    Charudutt Kalamkar

    2016-06-01

    Full Text Available Myeloid sarcoma is an extramedullary manifestation of acute myeloid leukaemia (AML. Aims We are reporting a paediatric case presenting with bilateral proptosis, which we were able to diagnose with peripheral blood smear (PBS examination. Methods Case Report Results This case highlights the utility of simple routinely available PBS test in diagnosing this rare disease. Conclusion Our case highlights the importance of haemogram and peripheral blood smear in the initial evaluation of proptosis. Correct diagnosis of this rare entity is vital especially in cases where (myeloid sarcoma MS is the presenting feature of AML.

  16. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    -dwelling subjects. The total number of inappropriate prescriptions identified using the Beers\\' criteria (ID) was 148 affecting 121 patients. The Beers\\' criteria (CD) identified 69 inappropriate prescriptions in 60 patients and the IPET identified 112 inappropriate prescriptions in 78 patients. The Beers criteria (ID and CD combined) identified at least one inappropriate prescription in 34% of subjects and the IPET identified one in at least 22% of subjects. CONCLUSIONS: This study identifies high rates of use of inappropriate medications in community-dwelling elderly presenting with acute illness to hospital. These are comparable with inappropriate prescribing rates identified in previous studies. The revised Beers\\' criteria (2003) identified more inappropriate prescriptions than the IPET in this population of elders.

  17. Towards the burden of human leptospirosis: duration of acute illness and occurrence of post-leptospirosis symptoms of patients in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Marga G A Goris

    Full Text Available BACKGROUND: Leptospirosis is a global zoonotic disease. Although important for the assessment of the burden of leptospirosis, data on the duration of the illness and the occurrence of post-leptospirosis complaints are not well documented. Hence the main objective of this study was to estimate the occurrence of persistent complaints and duration of hospital stay in laboratory confirmed leptospirosis patients in the Netherlands during 1985 to 2010. Additionally, several risk factors potentially impacting on the occurrence of post-leptospirosis complaints were investigated. METHODS/PRINCIPAL FINDINGS: The duration of the acute phase of leptospirosis was 16 days (IQR 12-23; 10 days (IQR 7-16 were spent hospitalized. Eighteen fatal cases were excluded from this analysis. Complaints of leptospirosis patients by passive case investigations (CPC derived from files on ambulant consultations occurring one month after hospital discharge, revealed persistent complaints in 108 of 236 (45.8% laboratory confirmed cases. Data on persistent complaints after acute leptospirosis (PCAC, assessed in 225 laboratory confirmed leptospirosis cases collected through questionnaires during 1985-1993, indicated 68 (30.2% PCAC cases. Frequently reported complaints included (extreme fatigue, myalgia, malaise, headache, and a weak physical condition. These complaints prolonged in 21.1% of the cases beyond 24 months after onset of disease. There was no association between post-leptospirosis complaints and hospitalization. However, individuals admitted at the intensive care unit (ICU were twice as likely to have continuing complaints after discharge adjusting for age and dialysis (OR 2.0 95% CI 0.8-4.8. No significant association could be found between prolongation of complaints and infecting serogroup, although subgroup analysis suggest that infection with serogroups Sejroe (OR 4.8, 95%CI 0.9-27.0 and icterohaemorrhagiae (OR 2.0, 95%CI 0.9-4.3 CI are more likely to result in

  18. Acute cerebellar ataxia

    Science.gov (United States)

    Cerebellar ataxia; Ataxia - acute cerebellar; Cerebellitis; Post-varicella acute cerebellar ataxia; PVACA ... Acute cerebellar ataxia in children, especially younger than age 3, may occur several weeks after an illness caused by a virus. ...

  19. Fatal systemic adenoviral infection superimposed on pulmonary mucormycosis in a child with acute leukemia

    Science.gov (United States)

    Seo, Yu Mi; Hwang-Bo, Seok; Kim, Seong koo; Han, Seung Beom; Chung, Nack-Gyun; Kang, Jin Han

    2016-01-01

    Abstract Background: Although adenovirus (ADV) infection usually causes self-limiting respiratory disorders in immune competent children; severe and systemic ADV infection in children undergoing chemotherapy for leukemia has been continuously reported. Nevertheless, there has been no consensus on risk factors and treatment strategies for severe ADV infection in children undergoing chemotherapy. Case summary: We report a case of a 15-year-old boy with a fatal systemic ADV infection. He had received reinduction chemotherapy for relapsed acute lymphoblastic leukemia under continuing antifungal therapy for previously diagnosed fungal pneumonia. He complained of fever and right shoulder pain 4 days after completing the reinduction chemotherapy. In spite of appropriate antibiotic and antifungal therapy, pneumonia was aggravated and gross hematuria was accompanied. A multiplex polymerase chain reaction test for respiratory viruses was positive for ADV in a blood sample, and a urine culture was positive for ADV. He received oral ribavirin, intravenous immunoglobulin, and intravenous cidofovir therapy; however, he eventually died. Relapsed leukemia, concurrent fungal pneumonia, and delayed cidofovir administration were considered the cause of the grave outcome in this patient. Conclusion: ADV may cause severe infections not only in allogeneic hematopoietic cell transplant recipients, but also in patients undergoing chemotherapy for acute leukemia. The risk factors for severe ADV infection in patients undergoing chemotherapy should be determined in the future studies, and early antiviral therapy should be administered to immune compromised patients with systemic ADV infection. PMID:27749571

  20. Acute airway obstruction by Ascaris lumbricoides in a 14-month-old boy.

    Science.gov (United States)

    Gan, Richard Wei Chern; Gohil, Rohit; Belfield, Katherine; Davies, Patrick; Daniel, Matija

    2014-10-01

    We describe the case of a 14-month-old child with airway obstruction caused by a mature Ascaris lumbricoides worm. The child had been admitted to the paediatric intensive care unit due to overwhelming sepsis, and during the course of his illness developed acute airway obstruction that resolved once the worm was removed from the airway. The Ascaris life-cycle is detailed, and a literature review of patients with airway obstruction due to Ascaris worms is presented.

  1. Treatment-related Myelodysplastic Syndrome in a Child With Acute Myeloid Leukemia and TPMT Heterozygosity

    DEFF Research Database (Denmark)

    Stensman, Lars M; Kjeldsen, Eigil; Nersting, Jacob

    2014-01-01

    INTRODUCTION: We describe a patient diagnosed with acute myeloid leukemia (AML) and low activity of thiopurine methyltransferase (TPMT) who developed secondary myelodysplastic syndrome after treatment. OBSERVATION: A 10-year-old boy presented with AML-M2 with t(8;21)(q22;q22) and genotyping......-related myelodysplastic syndrome with ring chromosome 6. DISCUSSION: The clinical course of this patient raises the possibility that low-activity TPMT genotypes may influence 6TG toxicity in patients with AML and lead to an increased risk of developing secondary malignant neoplasms....... revealing 3*B TPMT heterozygosity. The patient was treated according to the NOPHO-AML 2004 protocol. Two years after the treatment, the patient presented with neutropenia and thrombocytopenia. Bone marrow, including fluorescent in situ hybridization and retrospective aCGH analysis, verified therapy...

  2. Metastatic Calcinosis Cutis: A Case in a Child with Acute Pre-B Cell Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Juan Pablo Castanedo-Cázares

    2015-01-01

    Full Text Available Hypercalcemia in children with malignancy is an uncommon condition. It has been described in leukemia patients with impaired renal excretion of calcium or osteolytic lesions. Metastatic calcinosis cutis (MCC may develop if hypercalcemia persists. We report the case of a 5-year-old girl with an atypical dermatosis and unspecific gastrointestinal symptoms. Considered clinical diagnoses were xanthomas, histiocytosis, molluscum contagiosum, and nongenital warts. Cutaneous histological analysis showed amorphous basophilic deposits in the dermis suggestive of calcium deposits. Laboratory tests confirmed serum hypercalcemia. Extensive investigations such as bone marrow biopsy established the diagnosis of an acute pre-B cell lymphoblastic leukemia. Hypercalcemia in hematopoietic malignancies is unusual, especially as initial manifestation of the disease. Careful review of the literature fails to reveal previous reports of these peculiar cutaneous lesions of MCC in children with leukemia.

  3. Acute necrotizing encephalopathy in a child with H1N1 influenza infection

    Energy Technology Data Exchange (ETDEWEB)

    Lyon, Jane B. [Driscoll Children' s Hospital, Department of Radiology, Corpus Christi, TX (United States); Remigio, Cheryl [Pediatric Residency Program, Department of Medical Education, Corpus Christi, TX (United States); Milligan, Thomas [Driscoll Children' s Hospital, Department of Pathology, Corpus Christi, TX (United States); Deline, Carol [Driscoll Children' s Hospital, Division of Neurology, Corpus Christi, TX (United States)

    2010-02-15

    Since the World Health Organization declared a global pandemic of novel influenza A H1N1 in June 2009, there has been a sustained rise in the number of cases of this strain of influenza. Although most cases are mild with complete and uneventful recovery, multiple cases of severe infection with complications including death have been reported. To the best of our knowledge, the majority of fatal outcomes in the United States have been related to pulmonary complications. We report a 12-year-old girl infected with influenza A H1N1 whose clinical course was complicated by rapid progressive neurologic deterioration and striking CT and MRI findings consistent with acute necrotizing encephalopathy (ANE). To our knowledge this has not been reported in the pediatric radiology literature. We hope this case will alert radiologists to this complication and familiarize radiologists with imaging findings that herald ANE. (orig.)

  4. Acquired protein C deficiency in a child with acute myelogenous leukemia, splenic, renal, and intestinal infarction.

    Science.gov (United States)

    Farah, Roula A; Jalkh, Khalil S; Farhat, Hussein Z; Sayad, Paul E; Kadri, Adel M

    2011-03-01

    We report the case of a 6-year-old boy diagnosed with acute promyelocytic leukemia (AML-M3V) when he presented with pallor, abdominal pain, anorexia, and fatigue. Induction chemotherapy was started according to the AML-BFM 98 protocol along with Vesanoid (ATRA, All-trans retinoic acid). On the sixth day of induction, he developed splenic and gallbladder infarcts. Splenectomy and cholecystectomy were performed while chemotherapy induction continued as scheduled. Four days later, he developed ischemic areas in the kidneys and ischemic colitis in the sigmoid colon. Hypercoagulation studies showed severe deficiency of protein C. Tests showed protein C 16% (reference range 70-140%), protein S 87% (reference range 70-140%), antithrombin III 122% (reference range 80-120%), prothrombin time 13.6 s (reference = 11.3), INR (international normalized ratio) 1.21, partial thromboplastin time 33 s (reference = 33), fibrinogen 214 mg/dl, D-dimer 970 μg/ml, factor II 98%, and that antinuclear antibody, antiphospholipid antibodies, mutation for factor II gene (G20210A), and mutation for Arg506 Gln of factor V were all negative (factor V Leiden). There was no evidence of clinical disseminated intravascular coagulation (DIC). He was treated with low molecular weight heparin and did well. He continues to be in complete remission 7 years later with normal protein C levels. Acquired protein C deficiency can occur in a variety of settings and has been reported in acute myelocytic leukemia. However, clinically significant thrombosis in the absence of clinical DIC, such as our case, remains extremely rare.

  5. Report of a child with acute herpes zoster ophthalmicus induced partial third nerve palsy

    Institute of Scientific and Technical Information of China (English)

    Suraida AR; Evelyn-Tai LM; Madhusudhan; LK Thavaratnam; Mohtar Ibrahim; Wan Hazabbah WH

    2015-01-01

    Herpes zoster is a reactivation of the varicella zoster virus (VZV), which may remain dormant in the dorsal root ganglion of the trigeminal nerve for decades after the patient's initial exposure. The ophthalmic branch of the trigeminal nerve, i.e., the innervation to the ocular structures, is one of the most commonly involved dermatomes, giving rise to herpes zoster ophthalmicus (HZO). A 10-year-old indigenous Malaysian girl presented with a complaint of painful blurring of vision in the right eye for one week. It was followed a few days later by cutaneous vesicular eruptions over the right side of her face and nose and drooping of the right upper lid, associated with double vision. In children, the disease usually follows a mild course, resolving without residual damage. However, this child achieved a best corrected visual acuity of only 6/36 in the affected eye due to corneal scarring. The rashes healed by formation of disfiguring keloids over the right nasal area. This is another rarely reported complication of HZO in immunocompetent individuals.

  6. [Paraquat-induced acute dermatitis in a child after playing with a discarded container].

    Science.gov (United States)

    Villa, L; Pizzini, L; Viganò, G; Ferioli, A; Maroni, M; Ruggeri, R; Barlassina, C; Vannini, P; Salacrist, L

    1995-01-01

    The improper use of pesticide waste containers is a significant risk in rural areas, especially where appropriate systems of draining off refuse are lacking. A case is reported of an eight-year-old child who had played with the abandoned Paraquat container. After contamination with the pesticide she showed several II degree caustic lesions on both thighs and knees, associated with a mild erythemato-desquamative cheilitis and a "strawberry tongue". Common laboratory findings did not reveal any kidney, liver and/or red/white cell alterations and the chest X-ray was normal even several months after the accident. No physical consequences ensued, except for hyperchromic pigmentation on the legs. Where empty pesticide containers are not properly collected, they can represent a risk of pesticide exposure for the general population. They can also be a potential source of pollution for superficial water and soil. In the district where the accident was reported it was estimated that empty containers made up 7% of the weight of the 146,330 kg of pesticides sold to local farmers in 1993, of which about 10,400 kg was burned, buried and dispersed in the soil. Within the framework of a global pesticide prevention programme launched by the Regional Government of Lombardy, local health authorities, with the contribution of farmers, are carrying out a project for the proper collection of empty pesticide containers.

  7. Complete clinical recovery of a central pontine and extrapontine myelinolysis delayed onset in a child with acute myeloblastic leukemia.

    Science.gov (United States)

    Yilmaz, D; Karapinar, B; Balkan, C; Ay, Y; Kavakli, K

    2011-02-01

    Central pontine myelinolysis (CPM) is a demyelinating disease of the pons often associated with the demyelination of extrapontine areas of the central nervous system. It typically occurs 0.5-7 days after a rapid increment in serum Na level in hyponatremic patients and may lead to death. A 2.5-year-old child with a diagnosis of acute myeloblastic leukemia developed febril neutropenia, diarrhea, gastrointestinal hemorrhage followed by pulmonary aspergillosis. He could not tolerate enteral nutrition. He was given broad spectrum antibiotics and antifungal treatment. Laboratory tests showed electrolyte abnormalities including hyponatremia, hypokalemia and hypophosphatemia in a chronic course. Twenty three days after a rapid correction of hyponatremia (16 mEq/L/24 h) he revealed flask quadriparesis, disphagia, mutism, irregular respiratory pattern and loss of cough and gag reflex. Cranial magnetic resonance showed central pontine and extrapontine myelinolysis. He required mechanical ventilation and then he regained his neurologic functions. He completed chemotherapy protocol and underwent hematopoietic stem cell transplantation. After 2.5 years of the occurrence of CPM he is in completely normal physical and neurological status. CPM is a very severe but rare disorder in children with underlying disease. In the presence of multiple etiologic factors it may reveal a delayed onset and optimum outcome can be seen even in the severe clinical presentation with adequate intensive support.

  8. Parent and Child Agreement for Acute Stress Disorder, Post-Traumatic Stress Disorder and Other Psychopathology in a Prospective Study of Children and Adolescents Exposed to Single-Event Trauma

    Science.gov (United States)

    Meiser-Stedman, Richard; Smith, Patrick; Glucksman, Edward; Yule, William; Dalgleish, Tim

    2007-01-01

    Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined…

  9. Acute longitudinal myelitis as the first presentation in child with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Vinay M Shivamurthy

    2013-01-01

    Full Text Available Systemic lupus erythematosus (SLE is a multi-system auto-immune disorder that is characterized by widespread immune dysregulation, formation of auto-antibodies, and immune complexes, resulting in inflammation and potential damage to variety of organs. It is complicated by neurological manifestations in 25-95% of the patients. Acute transverse myelitis (ATM may be a complication in 1-2% of patients with SLE but in some patients it may be the initial manifestation of SLE. This sub-group of patients where ATM is the presenting feature may not fulfil the ACR criteria for the diagnosis of SLE which may delay the diagnosis and may affect the outcome. In those patients where the involvement is more than four segments of the spine are believed to have poor prognosis, but early diagnosis and treatment may alter the course and lead to a better outcome. We describe a young Polish girl where ATM was the initial manifestation of SLE involving almost the whole length of spine but she had a reasonably good outcome following early diagnosis and aggressive treatment.

  10. A predictive model of Health Related Quality of life of parents of chronically ill children: the importance of care-dependency of their child and their support system

    NARCIS (Netherlands)

    Hatzmann, J.; Maurice-Stam, H.; Heymans, H.S.A.; Grootenhuis, M.A.

    2009-01-01

    BACKGROUND: Parents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL). Insight in the dynamics of factors influencing parental HRQoL is necessary for development of interventions. Aim of the present study was to explore the influence of demographic and diseas

  11. Serum cystatin C concentration levels as a marker of acute renal failure in critically ill patients – A cross section study

    Directory of Open Access Journals (Sweden)

    A.R. Shoukath

    2014-01-01

    Full Text Available Objective: The objective of the present study was to assess serum cystatin C concentration levels as a marker of ARF in critically ill patients. Method: This was a randomized cross sectional study done on 100 patient admitted in ICU at Basaveshwar Teaching and General Hospital (BTGH. It included the patient with normal serum creatinine who are at risk of developing failure, and excluded the patient with acute and chronic renal failure, Sr. Cystatin C and Sr. Creatinine levels were determined at admission and these were considered as the first reading of Sr. Creatinine and Sr. Cystatin C. Sr. Creatinine and Sr. Cystatin C were repeated after the patient developed ARF and was considered as second reading and results were analyzedand were compared to know which was earlier marker for acute renal failure and due consideration was given to age, gender, occupation, history, physical examination along with special attention to symptoms of the patient. Result: The present one year cross sectional study was conducted on patients admitted in the Medical Intensive Care Unit of BTGH, Gulbarga, during the period of January 2011 to May 2012.In the present study out of 100 patients, 66 (66% were male and 34 (34% were female. The male: female ratio was 1.94:1. In this study, out of 100 patients, there were 26 (26% patients each in the age group of 18 to 30 years and more than 60 years. There were 36 (36% patients each with primary gastrointestinal and respiratory disease and 12 (12% patients with snake bite. In the present study 56 (56% patients developed ARF. The mean age of patients with ARF was 50.25 ± 17.85 years. Themean Sr. Creatinine and Sr. Cystatin C values in ARF were 1.86 mg/dL and 3.14 mg/L respectively. The mean Sr. Creatinine and Sr. Cystatin C values in patients without ARF were 0.68 mg/dL and 0.73 mg/L respectively. In the present study among patients who developed ARF 39.29%, 53.57% and 7.14% patients have satisfied RCreat (50 to 99%, ICreat

  12. Etiology and Incidence of viral and bacterial acute respiratory illness among older children and adults in rural western Kenya, 2007-2010.

    Directory of Open Access Journals (Sweden)

    Daniel R Feikin

    Full Text Available BACKGROUND: Few comprehensive data exist on disease incidence for specific etiologies of acute respiratory illness (ARI in older children and adults in Africa. METHODOLOGY/PRINCIPAL FINDINGS: From March 1, 2007, to February 28, 2010, among a surveillance population of 21,420 persons >5 years old in rural western Kenya, we collected blood for culture and malaria smears, nasopharyngeal and oropharyngeal swabs for quantitative real-time PCR for ten viruses and three atypical bacteria, and urine for pneumococcal antigen testing on outpatients and inpatients meeting a ARI case definition (cough or difficulty breathing or chest pain and temperature >38.0 °C or oxygen saturation 5 years old (adjusted annual incidence 12.0 per 100 person-years, influenza A virus was the most common virus (22% overall; 11% inpatients, 27% outpatients and Streptococcus pneumoniae was the most common bacteria (16% overall; 23% inpatients, 14% outpatients, yielding annual incidences of 2.6 and 1.7 episodes per 100 person-years, respectively. Influenza A virus, influenza B virus, respiratory syncytial virus (RSV and human metapneumovirus were more prevalent in swabs among cases (22%, 6%, 8% and 5%, respectively than controls. Adenovirus, parainfluenza viruses, rhinovirus/enterovirus, parechovirus, and Mycoplasma pneumoniae were not more prevalent among cases than controls. Pneumococcus and non-typhi Salmonella were more prevalent among HIV-infected adults, but prevalence of viruses was similar among HIV-infected and HIV-negative individuals. ARI incidence was highest during peak malaria season. CONCLUSIONS/SIGNIFICANCE: Vaccination against influenza and pneumococcus (by potential herd immunity from childhood vaccination or of HIV-infected adults might prevent much of the substantial ARI incidence among persons >5 years old in similar rural African settings.

  13. Hospital Performance Indicators and Their Associated Factors in Acute Child Poisoning at a Single Poison Center, Central Saudi Arabia.

    Science.gov (United States)

    Alanazi, Menyfah Q; Al-Jeriasy, Majed I; Al-Assiri, Mohammed H; Afesh, Lara Y; Alhammad, Fahad; Salam, Mahmoud

    2015-12-01

    Admission rate and length of stay (LOS) are two hospital performance indicators that affect the quality of care, patients' satisfaction, bed turnover, and health cost expenditures. The aim of the study was to identify factors associated with higher admission rates and extended average LOS among acutely poisoned children at a single poison center, central Saudi Arabia.This is a cross-sectional, poison and medical chart review between 2009 and 2011. Exposures were child characteristics, that is, gender, age, body mass index (BMI), health history, and Canadian 5-level triage scale. Poison incident characteristics were, that is, type, exposure route, amount, form, home remedy, and arrival time to center. Admission status and LOS were obtained from records. Chronic poisoning, plant allergies, and venomous bites were excluded. Bivariate and regression analyses were applied. Significance at P Poison substances were pharmaceutical drugs (63%) versus chemical products (37%). Main exposure route was oral (98%). Home remedy was observed in (21.9%), which were fluids, solutes, and/or gag-induced vomiting. Almost (52%) arrived to center >1 h. Triage levels: non-urgent cases (58%), less urgent (11%), urgent (18%), emergency (12%), resuscitative (1%). Admission rate was (20.6%) whereas av. LOS was 13 ± 22 h. After adjusting and controlling for confounders, older children (adj.OR = 1.19) and more critical triage levels (adj.OR = 1.35) were significantly associated with higher admission rates compared to younger children and less critical triage levels (adj.P = 0.006) and (adj.P = 0.042) respectively. Home remedy prior arrival was significantly associated with higher av. LOS (Beta = 9.48, t = 2.99), compared to those who directly visited the center, adj.P = 0.003.Hospital administrators are cautioned that acutely poisoned children who received home remedies prior arrival are more likely to endure an extended LOS. This non-conventional practice

  14. Predictive value of RIFLE classification on prognosis of critically ill patients with acute kidney injury treated with continuous renal replacement therapy

    Institute of Scientific and Technical Information of China (English)

    LI Wen-xiong; CHEN Hui-de; WANG Xiao-wen; ZHAO Song; CHEN Xiu-kai; ZHENG Yue; SONG Yang

    2009-01-01

    Background The optimal timing to start continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) patients has not been accurately established. The recently proposed risk, injury, failure, loss, end-stage kidney disease (RIFLE) criteria for diagnosis and classification of AKI may provide a method for clinicians to decide the "optimal timing" for starting CRRT under uniform guidelines. The present study aimed: (1) to analyze the correlation between RIFLE stage at the start of CRRT and 90-day survival rate after CRRT start, (2) to further investigate the correlation of RIFLE stage with the malignant kidney outcome in the 90-day survivors, and (3) to determine the influence of the timing of CRRT defined by RIFLE classification on the 90-day survival and malignant kidney outcome in 90-day survivors. Methods A retrospective cohort analysis was performed on the data of 106 critically ill patients with AKI, treated with CRRT during a 6-year period in a university affiliated surgical intensive care unit (SICU). Information such as sex, age, RIFLE stage, sepsis, sepsis-related organ failure assessment (SOFA) score, number of organ failures before CRRT, CRRT time during SiCU, survival, and kidney outcome conditions at 90 days after CRRT start was collected. According to their baseline severity of AKI at the start of CRRT, the patients were assigned to three groups according to the increasing severity of RIFLE stages: RIFLE-R (risk of renal dysfunction, R), RIFLE-I (injury to the kidney, I) and RIFLE-F (failure of kidney function, F) using RIFLE criteria. The malignant kidney outcome was classified as RIFLE-L (loss of kidney function, L) or RIFLE-E (end-stage kidney disease, E) using RIFLE criteria. The correlation between RIFLE stage and 90-day survival rate was analyzed among these three RIFLE-categorized groups. Additionally, the association between RIFLE stage and the malignant kidney outcome (RIFLE-L+RIFLF-E) in the 90-day survivors was analyzed

  15. Reducing childhood illness - fostering growth : an integrated home-based intervention package (IHIP) to improve indoor-air pollution, drinking water quality and child nutrition

    OpenAIRE

    Hartinger Peña, Stella M.

    2014-01-01

    Child mortality attributable to pneumonia, diarrhoea and malnutrition accounts globally for the majority of 8.8 million annual deaths. More than half of these deaths are preventable. Available and effective interventions include safe water supply, household water treatment, improved chimney stoves and personal- and home-hygiene and -health messages. In Peru, the current health services reform is focused on shifting responsibilities to peripheral levels; thus, empowering community organisation...

  16. Treating parents with attention-deficit/hyperactivity disorder: the effects of behavioral parent training and acute stimulant medication treatment on parent-child interactions.

    Science.gov (United States)

    Babinski, Dara E; Waxmonsky, James G; Pelham, William E

    2014-10-01

    This multiple baseline study evaluated the efficacy of behavioral parent training (BPT) for 12 parents (M age = 39.17 years; 91% mothers) and their children (ages 6-12; 83% boys) both with Attention-Deficit/Hyperactivity Disorder (ADHD), and also explored the acute effect of stimulant medication for parents before and after BPT. Parents rated their own and their children's symptoms and impairment and were stabilized on optimally dosed medication. Then, parents discontinued medication and were randomly assigned to a 3, 4, or 5 week baseline (BL), during which they provided twice-weekly ratings of their impairment, parenting, and their child's behavior. Following BL, parents and their children completed two laboratory tasks, once on their optimally dosed medication and once on a placebo to assess observable effects of medication on parent-child behavior, and they completed additional assessments of family functioning. Parents then completed eight BPT sessions, during which they were unmedicated. Twice-weekly ratings of parent and child behavior were collected during BPT and additional ratings were collected upon completing BPT. Two more parent-child tasks with and without parent medication were conducted upon BPT completion to assess the observable effects of BPT and BPT plus medication. Ten (83.33%) parents completed the trial. Improvements in parent and child behavior were observed, and parents reported improved child behavior with BPT. Few benefits of BPT emerged through parent reports of parent functioning, with the exception of inconsistent discipline, and no medication or interaction effects emerged. These results, although preliminary, suggest that some parents with ADHD benefit from BPT. While pharmacological treatment is the most common intervention for adults with ADHD, further examination of psychosocial treatments for adults is needed.

  17. HIGH-ALTITUDE ILLNESS

    Directory of Open Access Journals (Sweden)

    Dwitya Elvira

    2015-05-01

    Full Text Available AbstrakHigh-altitude illness (HAI merupakan sekumpulan gejala paru dan otak yang terjadi pada orang yang baru pertama kali mendaki ke ketinggian. HAI terdiri dari acute mountain sickness (AMS, high-altitude cerebral edema (HACE dan high-altitude pulmonary edema (HAPE. Tujuan tinjauan pustaka ini adalah agar dokter dan wisatawan memahami risiko, tanda, gejala, dan pengobatan high-altitude illness. Perhatian banyak diberikan terhadap penyakit ini seiring dengan meningkatnya popularitas olahraga ekstrim (mendaki gunung tinggi, ski dan snowboarding dan adanya kemudahan serta ketersediaan perjalanan sehingga jutaan orang dapat terpapar bahaya HAI. Di Pherice, Nepal (ketinggian 4343 m, 43% pendaki mengalami gejala AMS. Pada studi yang dilakukan pada tempat wisata di resort ski Colorado, Honigman menggambarkan kejadian AMS 22% pada ketinggian 1850 m sampai 2750 m, sementara Dean menunjukkan 42% memiliki gejala pada ketinggian 3000 m. Aklimatisasi merupakan salah satu tindakan pencegahan yang dapat dilakukan sebelum pendakian, selain beberapa pengobatan seperti asetazolamid, dexamethasone, phosopodiestrase inhibitor, dan ginko biloba.Kata kunci: high-altitude illness, acute mountain sickness, edema cerebral, pulmonary edema AbstractHigh-altitude illness (HAI is symptoms of lung and brain that occurs in people who first climb to altitude. HAI includes acute mountain sickness (AMS, high-altitude cerebral edema (HACE and high altitude pulmonary edema (HAPE. The objective of this review was to understand the risks, signs, symptoms, and treatment of high-altitude illness. The attention was given to this disease due to the rising popularity of extreme sports (high mountain climbing, skiing and snowboarding and the ease and availability of the current travelling, almost each year, millions of people could be exposed to the danger of HAI. In Pherice, Nepal (altitude 4343 m, 43% of climbers have symptoms of AMS. Furthermore, in a study conducted at sites in

  18. Foodborne Illnesses

    Science.gov (United States)

    ... jejuni (C. jejuni), found in raw or undercooked chicken and unpasteurized milk. Shigella, a bacterium spread from ... health care provider may prescribe medications, such as antibiotics, to treat the illness. Hospitalization may be required ...

  19. The association between farming activities, precipitation, and the risk of acute gastrointestinal illness in rural municipalities of Quebec, Canada: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Gosselin Pierre

    2010-01-01

    Full Text Available Abstract Background Increasing livestock density and animal manure spreading, along with climate factors such as heavy rainfall, may increase the risk of acute gastrointestinal illness (AGI. In this study we evaluated the association between farming activities, precipitation and AGI. Methods A cross-sectional telephone survey of randomly selected residents (n = 7006 of 54 rural municipalities in Quebec, Canada, was conducted between April 2007 and April 2008. AGI symptoms and several risk factors were investigated using a phone questionnaire. We calculated the monthly prevalence of AGI, and used multivariate logistic regression, adjusting for several demographic and risk factors, to evaluate the associations between AGI and both intensive farming activities and cumulative weekly precipitation. Cumulative precipitation over each week, from the first to sixth week prior to the onset of AGI, was analyzed to account for both the delayed effect of precipitation on AGI, and the incubation period of causal pathogens. Cumulative precipitation was treated as a four-category variable: high (≥90th percentile, moderate (50th to th percentile, low (10th to th percentile, and very low (th percentile precipitation. Results The overall monthly prevalence of AGI was 5.6% (95% CI 5.0%-6.1%, peaking in winter and spring, and in children 0-4 years old. Living in a territory with intensive farming was negatively associated with AGI: adjusted odds ratio (OR = 0.70 (95% CI 0.51-0.96. Compared to low precipitation periods, high precipitation periods in the fall (September, October, November increased the risk of AGI three weeks later (OR = 2.20; 95% CI 1.09-4.44 while very low precipitation periods in the summer (June, July, August increased the risk of AGI four weeks later (OR = 2.19; 95% CI 1.02-4.71. Further analysis supports the role of water source on the risk of AGI. Conclusions AGI poses a significant burden in Quebec rural municipalities with a peak in winter

  20. The Ubiquity of Chronic Illness.

    Science.gov (United States)

    Fonseca, Claudia; Fleischer, Soraya; Rui, Taniele

    2016-01-01

    This is a review of five different books dealing with some aspect of what might be termed a "chronic illness" - Alzheimer's disease, lupus, addiction, erectile dysfunction, and leprosy. The array of different subjects examined in these books points to the negotiable limits of this hugely open category. What exactly constitutes an "illness"? Why not use a less biomedical term instead: "disturbance", "problem", or simply "condition"? And how are we to understand "chronic" - simply as the flipside of "acute" or "curable"?

  1. Illness in Children and Parental Response

    NARCIS (Netherlands)

    M.A. Bruijnzeels (Marc)

    1997-01-01

    textabstractMost children suffer from illnesses from time to time. In only a small part of these ill children parents decide to seek professional help. So, most child health care is carried out by parents. In general, this phenomenon is called the iceberg of symptoms. The part of the iceberg under t

  2. Child Wellness and Happiness

    Science.gov (United States)

    Rettew, David C.

    2009-01-01

    Wellness and happiness should be considered in the clinical treatment of child and adolescent psychiatry, in addition with thinking about illness. Meanwhile, various studies on child and adolescent psychiatry,which includes an article from the "Journal of Happiness Studies," are discussed.

  3. Validity of the Child Facial Coding System for the Assessment of Acute Pain in Children With Cerebral Palsy.

    Science.gov (United States)

    Hadden, Kellie L; LeFort, Sandra; O'Brien, Michelle; Coyte, Peter C; Guerriere, Denise N

    2016-04-01

    The purpose of the current study was to examine the concurrent and discriminant validity of the Child Facial Coding System for children with cerebral palsy. Eighty-five children (mean = 8.35 years, SD = 4.72 years) were videotaped during a passive joint stretch with their physiotherapist and during 3 time segments: baseline, passive joint stretch, and recovery. Children's pain responses were rated from videotape using the Numerical Rating Scale and Child Facial Coding System. Results indicated that Child Facial Coding System scores during the passive joint stretch significantly correlated with Numerical Rating Scale scores (r = .72, P Child Facial Coding System scores were also significantly higher during the passive joint stretch than the baseline and recovery segments (P Child Facial Coding System is a valid method of identifying pain in children with cerebral palsy.

  4. Child Acute Malnutrition and Mortality in Populations Affected by Displacement in the Horn of Africa, 1997–2009

    Directory of Open Access Journals (Sweden)

    Paul Spiegel

    2012-03-01

    Full Text Available Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997–2009 were analyzed to investigate: (1 how elevated malnutrition and mortality were among displaced compared to host populations; (2 whether the mortality/malnutrition relation changed through time; and (3 how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR and global acute malnutrition (wasting prevalences, < −2SDs of references plus edema: GAM were extracted from reports of 1,175 surveys carried out between 1997–2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural and by displacement status (refugee/internally displaced, local resident/host population, mixed; associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%, but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day or emergency levels (2/10,000/day in the Horn of Africa; cut-points of 20–25% GAM in pastoral populations and 10–15% GAM in

  5. Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009.

    Science.gov (United States)

    Mason, John B; White, Jessica M; Heron, Linda; Carter, Jennifer; Wilkinson, Caroline; Spiegel, Paul

    2012-03-01

    Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood

  6. Using reflexive tools for coping and bringing closure in pediatric palliative care: A music therapist's story of working with a terminally ill child.

    Directory of Open Access Journals (Sweden)

    Maeve Rigney

    2011-11-01

    Full Text Available This paper outlines the therapeutic journey of a newly qualified music therapist and a young girl with terminal cancer. As well as describing the clinical sessions with this young girl and her family, it includes personal reflections from the journal of the therapist, used as a method of self-review and clarification of thoughts and feelings following each session. The aim of this paper is to narrate the music therapy journey with Tina * from the music therapist's perspective, and to share my thoughts and feelings on coping while working with terminally ill children. In addition to outlining the significance of using reflexive tools for this type of work as a way to improve coping skills and to work more effectively when the future with your client is uncertain, I hope to encourage further others to share their work in pediatric palliative care.

  7. Culture and Comorbidity: Intimate Partner Violence as a Common Risk Factor for Maternal Mental Illness and Reproductive Health Problems among Former Child Soldiers in Nepal.

    Science.gov (United States)

    Kohrt, Brandon A; Bourey, Christine

    2016-12-01

    Our objective was to elucidate how culture influences internal (psychological), external (social), institutional (structural), and health care (medical) processes, which, taken together, create differential risk of comorbidity across contexts. To develop a conceptual model, we conducted qualitative research with 13 female child soldiers in Nepal. Participants gave open-ended responses to intimate partner violence (IPV) vignettes (marital rape, emotional abuse, violence during pregnancy). Twelve participants (92%) endorsed personal responses (remaining silent, enduring violence, forgiving the husband). Twelve participants endorsed communication with one's husband. Only four participants (31%) sought family support, and three contacted police. Ultimately, 12 participants left the relationship, but the majority (nine) only left after the final IPV experience, which was preceded by prolonged psychological suffering and pregnancy endangerment. In conclusion, comorbidity risks are increased in cultural context that rely on individual or couples-only behavior, lack external social engagement, have weak law and justice institutions, and have limited health services.

  8. Diarrheal Illness

    Centers for Disease Control (CDC) Podcasts

    2011-08-30

    Dr. Steve Monroe, director of CDC’s Division of High-Consequence Pathogens and Pathology, discusses diarrheal illness, its causes, and prevention.  Created: 8/30/2011 by National Center for Emerging Zoonotic and Infectious Diseases (NCEZID).   Date Released: 8/31/2011.

  9. Critical illness neuropathy

    Directory of Open Access Journals (Sweden)

    Vijayan J

    2005-01-01

    Full Text Available The neuromuscular syndrome of acute limb and respiratory weakness that commonly accompanies patients with multi-organ failure and sepsis constitutes critical illness polyneuropathy. It is a major cause of difficulty in weaning off the patient from the ventilator after respiratory and cardiac causes have been excluded. It is usually an axonal motor-sensory polyneuropathy, and is usually associated with or accompanied with a coma producing septic encephalopathy. The neuropathy is usually not apparent until the patient′s encephalopathy has peaked, and may be noted only when the brain dysfunction is resolving. Patients usually have a protracted hospital course complicated by multi-organ failure and the systemic inflammatory response syndrome. Elevated serum glucose levels and reduced albumin are risk factors for nerve dysfunction, as is prolonged intensive care unit stay. Polyneuropathy may develop after only one week of the systemic inflammatory response syndrome, but the frequency tends to correlate with the duration of the severe illness.

  10. Outbreak of Mysterious Illness Among Hospital Staff

    DEFF Research Database (Denmark)

    Jacobsen, Peter; Ebbehøj, Niels Erik

    2016-01-01

    department became acutely ill with nonspecific symptoms. After uneventful observation they were discharged, but symptoms worsened at reassembly for debriefing. Poisoning with hydrogen sulfide was suspected, and the victims were transferred by helicopter for hyperbaric oxygen (HBO) treatment. During...

  11. Onset of efficacy with acute long-acting injectable paliperidone palmitate treatment in markedly to severely ill patients with schizophrenia: post hoc analysis of a randomized, double-blind clinical trial

    Directory of Open Access Journals (Sweden)

    Ma Yi-Wen

    2011-04-01

    Full Text Available Abstract Background This post hoc analysis (trial registration: ClinicalTrials.gov NCT00590577 assessed onset of efficacy and tolerability of acute treatment with once-monthly paliperidone palmitate (PP, a long-acting atypical antipsychotic initiated by day 1 and day 8 injections, in a markedly to severely ill schizophrenia population. Methods Subjects entering the 13-week, double-blind trial were randomized to PP (39, 156, or 234 mg [25, 100, and 150 mg eq of paliperidone, respectively] or placebo. This subgroup analysis included those with a baseline Clinical Global Impressions-Severity (CGI-S score indicating marked to severe illness. PP subjects received a 234-mg day 1 injection (deltoid, followed by their assigned dose on day 8 and monthly thereafter (deltoid or gluteal. Thus, data for PP groups were pooled for days 4 and 8. Measures included Positive and Negative Syndrome Scale (PANSS, CGI-S, Personal and Social Performance (PSP, and adverse events (AEs. Analysis of covariance (ANCOVA and last-observation-carried-forward (LOCF methodologies, without multiplicity adjustments, were used to assess changes in continuous measures. Onset of efficacy was defined as the first time point a treatment group showed significant PANSS improvement (assessed days 4, 8, 22, 36, 64, and 92 versus placebo, which was maintained through end point. Results A total of 312 subjects met inclusion criterion for this subgroup analysis. After the day 1 injection, mean PANSS total scores improved significantly with PP (all received 234 mg versus placebo at day 4 (P = 0.012 and day 8 (P = 0.007. After the day 8 injection, a significant PANSS improvement persisted at all subsequent time points in the 234-mg group versus placebo (P P P P Conclusions In this markedly to severely ill population, acute treatment with 234 mg PP improved psychotic symptoms compared with placebo by day 4. After subsequent injections, observed improvements are suggestive of a dose

  12. Towards the Burden of Human Leptospirosis: Duration of Acute Illness and Occurrence of Post-Leptospirosis Symptoms of Patients in The Netherlands

    NARCIS (Netherlands)

    M.G.A. Goris (Marga); V. Kikken (Vanessa); M. Straetemans (Masja); S. Alba (Sandra); M. Goeijenbier (Marco); E.C.M. van Gorp (Eric); K.R. Boer (Kimberly); J.F.P. Wagenaar (Jiri); R.A. Hartskeerl (Rudy)

    2013-01-01

    textabstractBackground:Leptospirosis is a global zoonotic disease. Although important for the assessment of the burden of leptospirosis, data on the duration of the illness and the occurrence of post-leptospirosis complaints are not well documented. Hence the main objective of this study was to esti

  13. Who will be sicker in the morning? Changes in the Simple Clinical Score the day after admission and the subsequent outcomes of acutely ill unselected medical patients.

    LENUS (Irish Health Repository)

    Kellett, John

    2011-08-01

    All doctors are haunted by the possibility that a patient they reassured yesterday will return seriously ill tomorrow. We examined changes in the Simple Clinical Score (SCS) the day after admission, factors that might influence these changes and the relationship of these changes to subsequent clinical outcome.

  14. How well do clinical prediction rules perform in identifying serious infections in acutely ill children across an international network of ambulatory care datasets?

    NARCIS (Netherlands)

    J.Y. Verbakel (Jan); A. van den Bruel (Ann); M.J. Thompson (Matthew); R. Stevens (Richard); B. Aertgeerts (Bert); R. Oostenbrink (Rianne); H.A. Moll (Henriëtte); M.Y. Berger (Marjolein); M. Lakhanpaul (Monica); D. Mant (David); F. Buntinx (Frank)

    2013-01-01

    textabstractBackground: Diagnosing serious infections in children is challenging, because of the low incidence of such infections and their non-specific presentation early in the course of illness. Prediction rules are promoted as a means to improve recognition of serious infections. A recent system

  15. How well do clinical prediction rules perform in identifying serious infections in acutely ill children across an international network of ambulatory care datasets?

    NARCIS (Netherlands)

    Verbakel, Jan Y.; Van den Bruel, Ann; Thompson, Matthew; Stevens, Richard; Aertgeerts, Bert; Oostenbrink, Rianne; Moll, Henriette A.; Berger, Marjolein Y.; Lakhanpaul, Monica; Mant, David; Buntinx, Frank

    2013-01-01

    Background: Diagnosing serious infections in children is challenging, because of the low incidence of such infections and their non-specific presentation early in the course of illness. Prediction rules are promoted as a means to improve recognition of serious infections. A recent systematic review

  16. The Association between Mental Health and Acute Infectious Illness among a National Sample of 18- To 24-Year-Old College Students

    Science.gov (United States)

    Adams, Troy B.; Wharton, Christopher M.; Quilter, Lyndsay; Hirsch, Tiffany

    2008-01-01

    Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Objective and Participants: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship…

  17. Study design of the microcirculatory shock occurrence in acutely Ill patients (microSOAP): An international multicenter observational study of sublingual microcirculatory alterations in intensive care patients

    NARCIS (Netherlands)

    N.A.R. Vellinga (Namkje ); E.C. Boerma (Christiaan); M. Koopmans (Matty); A. Donati (Abele); A. Dubin (Arnaldo); N.I. Shapiro (Nathan ); R.M. Pearse (Rupert ); J. Bakker (Jan); C. Ince (Can)

    2012-01-01

    textabstractObjective. Sublingual microcirculatory alterations are associated with an adverse prognosis in several critical illness subgroups. Up to now, single-center studies have reported on sublingual microcirculatory alterations in ICU patient subgroups, but an extensive evaluation of the preval

  18. Illness representations in patients with hand injury.

    LENUS (Irish Health Repository)

    Chan, Jeffrey C Y

    2009-07-01

    Differences in illness perception about hand injury may partly explain the variation in health behaviours such as adherence to post-operative therapy, coping strategy, emotional response and eventual clinical outcome. This study examined the illness perception of patients with hand injuries in the acute trauma setting.

  19. A experiência da família ao conviver com a família doença crônica da criança The family experience of living with the child's chronic illness

    Directory of Open Access Journals (Sweden)

    Elaine Buchhorn Cintra Damião

    2001-03-01

    Full Text Available Esta pesquisa objetivou compreender como a família vivencia os períodos de dificuldades impostos pela doença crônica da criança. Utilizou-se como método de pesquisa a Teoria Fundamentada nos Dados e como referencial teórico o Interacionismo Simbólico. Foram entrevistadas famílias de crianças com doença crônica, fibrose cística do pâncreas e diabetes, possibilitando desvelar o processo vivenciado e o significado atribuído pela família a sua experiência. Os dados foram analisados até a fase de categorização dos significados, tendo emergido o fenômeno: "Sendo Difícil Não Ter Controle".This research has focused on the family meaning of having a child with chronic illness. The Grounded Theory and the Symbolic Interactionism were employed as research method and theoretical approach respectively. The interviews involved families with children diagnosed as having a chronic disease, cystic fibrosis and diabetes, aiming to study the way the family copes with this situation, and the meaning giving by the family to this experience. Data were analyzed until the phase of categorizing and the phenomenon disclosed was: "Being hard not to have control".

  20. Successful renal transplantation after recovery from acute disseminated encephalomyelitis in a child with end-stage renal disease

    Directory of Open Access Journals (Sweden)

    Bhosale Guruprasad

    2010-01-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM, seen mostly in children, is an acute demyelinating disease, affecting mainly the white matter of brain and spinal cord. We report an unusual case of ADEM in an 11-year old boy with end-stage renal disease, who underwent hemopoietic stem cell transplantation prior to renal transplantation. He needed admission to the intensive care unit and required mechanical ventilation. He responded to intravenous injection of steroids and upon recovery, underwent renal transplantation successfully.

  1. Reversible tetraplegia after percutaneous nephrostolithotomy and septic shock: a case of critical illness polyneuropathy and myopathy with acute onset and complete recovery

    Directory of Open Access Journals (Sweden)

    Li Hai

    2013-02-01

    Full Text Available Abstract Background Critical illness polyneuropathy (CIP and critical illness myopathy (CIM are complications causing weakness of respiratory and limb muscles in critically ill patients. As an important differential diagnosis of Guillain-Barré syndrome (GBS, CIP and CIM should be diagnosed with caution, after a complete clinical and laboratory examination. Although not uncommon in ICU, CIP and CIM as severe complications of percutaneous nephrostolithotomy (PNL have not been documented in literature. Case presentation A 48-year-old Chinese woman was referred to our hospital, complaining of occasional pain in the right lower back for one month. Lithiasis was diagnosed by ultrasonographical and radiological examinations on the urinary system. PNL was indicated and performed. The patient developed CIP and CIM on the fourth day after PNL. Early recognition and treatment of the severe complications contributed to a satisfactory recovery of the patient. Conclusion This case expands our understanding of the complications of PNL and underscores the importance of differentiating CIP/CIM from GBS in case of such patients developing weakness after the treatment. Clinical characteristics and examination results should be carefully evaluated to make the diagnosis of CIP or CIM. Both anti-septic prophylaxis and control of hyperglycemia might be effective for the prevention of CIP or CIM; aggressive treatment on sepsis and multiple organ failure is considered to be the most effective measure to reduce the incidence of CIP/CIM.

  2. Nonthyroidal Illness (NTIs

    Directory of Open Access Journals (Sweden)

    Nanny Natalia Mulyani Soetedjo

    2009-09-01

    Full Text Available Nonthyroidal illness (NTIs can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible. Multiple alterations in serum thyroid function test findings have been recognized in patients with a wide variety of NTI without evidence of preexisting thyroid or hypothalamic-pituitary disease. The most prominent alterations are low serum triiodothyronine (T3 and elevated reverse T3 (rT3, leading to the general term low T3 syndrome. Thyroid-stimulating hormone (TSH, thyroxine (T4, and free T4 also are affected in variable degrees based on the severity and duration of the NTI. It cannot diagnosed NTIs only by measure one thyroid hormone. As the severity of the NTI increases, both serum T3 and T4 levels drop and gradually normalize as the patient recovers. It's still be an argument for administration of replacement T3 and T4 hormone in patients with NTIS. However, it is impossible to be certain at this time that it is beneficial to replace hormone, or whether this could be harmful. Only a prospective study will be adequate to prove this point, and probably this would need to involve hundreds of patients. Ongoing studies document the beneficial effects of replacement of other hormones in these acutely and severely ill patients.

  3. Fabricated or Induced Illness in Children: A Narrative Review of the Literature

    Science.gov (United States)

    Lazenbatt, Anne

    2013-01-01

    Although child maltreatment due to abuse or neglect is pervasive within our society, less is known about fabricated or induced illness by carers (FII), which is considered to be a rare form of child abuse. FII occurs when a caregiver (in 93% of cases, the mother) misrepresents the child as ill either by fabricating, or much more rarely, producing…

  4. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Bo-Guang Fan

    2010-01-01

    Full Text Available Background : Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims : The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods : We reviewed the English-language literature (Medline addressing pancreatitis. Results : Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions : Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  5. Acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Bo-Guang Fan

    2010-05-01

    Full Text Available Background: Acute pancreatitis continues to be a serious illness, and the patients with acute pancreatitis are at risk to develop different complications from ongoing pancreatic inflammation. Aims: The present review is to highlight the classification, treatment and prognosis of acute pancreatitis. Material & Methods: We reviewed the English-language literature (Medline addressing pancreatitis. Results: Acute pancreatitis is frequently caused by gallstone disease or excess alcohol ingestion. There are a number of important issues regarding clinical highlights in the classification, treatment and prognosis of acute pancreatitis, and treatment options for complications of acute pancreatitis including pancreatic pseudocysts. Conclusions: Multidisciplinary approach should be used for the management of the patient with acute pancreatitis.

  6. Acute Respiratory Distress in Children: Croup and Acute Asthma.

    Science.gov (United States)

    Sharma, B S; Shekhawat, Dhananjay S; Sharma, Prity; Meena, Chetan; Mohan, Hari

    2015-07-01

    Acute respiratory distress is one of the most common reason for emergency visits in children under 5 y of age. An accurate understanding of the epidemiology of these diseases, identification of risk factors and etiology is critical for successful treatment and prevention of related mortality. The cause of acute respiratory distress varies in etiology, and hence is amenable to different treatment modalities. Depending on the predominant symptoms and signs, a child presenting to the clinician can be divided into six groups, viz., stridor; cough, fever and difficulty in breathing or fast breathing; wheezing; mediastinal shift with severe respiratory distress; slow or irregular breathing in absence of any pulmonary sign; and respiratory distress with cardiac findings. A detailed history followed by a thorough clinical examination and laboratory evaluation assisted by imaging modalities if indicated, helps to establish the exact cause of respiratory distress in the child. Early recognition and prompt institution of appropriate management or referral can significantly improve the outcome of this illness. This article offers clinicians a brief update on the general management guidelines of respiratory distress in pediatric patients. Specific treatment depends on the exact cause, however croup and acute severe asthma have been discussed in this article.

  7. The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness.

    Science.gov (United States)

    Hay, Alastair D; Birnie, Kate; Busby, John; Delaney, Brendan; Downing, Harriet; Dudley, Jan; Durbaba, Stevo; Fletcher, Margaret; Harman, Kim; Hollingworth, William; Hood, Kerenza; Howe, Robin; Lawton, Michael; Lisles, Catherine; Little, Paul; MacGowan, Alasdair; O'Brien, Kathryn; Pickles, Timothy; Rumsby, Kate; Sterne, Jonathan Ac; Thomas-Jones, Emma; van der Voort, Judith; Waldron, Cherry-Ann; Whiting, Penny; Wootton, Mandy; Butler, Christopher C

    2016-01-01

    BACKGROUND It is not clear which young children presenting acutely unwell to primary care should be investigated for urinary tract infection (UTI) and whether or not dipstick testing should be used to inform antibiotic treatment. OBJECTIVES To develop algorithms to accurately identify pre-school children in whom urine should be obtained; assess whether or not dipstick urinalysis provides additional diagnostic information; and model algorithm cost-effectiveness. DESIGN Multicentre, prospective diagnostic cohort study. SETTING AND PARTICIPANTS Children < 5 years old presenting to primary care with an acute illness and/or new urinary symptoms. METHODS One hundred and seven clinical characteristics (index tests) were recorded from the child's past medical history, symptoms, physical examination signs and urine dipstick test. Prior to dipstick results clinician opinion of UTI likelihood ('clinical diagnosis') and urine sampling and treatment intentions ('clinical judgement') were recorded. All index tests were measured blind to the reference standard, defined as a pure or predominant uropathogen cultured at ≥ 10(5) colony-forming units (CFU)/ml in a single research laboratory. Urine was collected by clean catch (preferred) or nappy pad. Index tests were sequentially evaluated in two groups, stratified by urine collection method: parent-reported symptoms with clinician-reported signs, and urine dipstick results. Diagnostic accuracy was quantified using area under receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) and bootstrap-validated AUROC, and compared with the 'clinician diagnosis' AUROC. Decision-analytic models were used to identify optimal urine sampling strategy compared with 'clinical judgement'. RESULTS A total of 7163 children were recruited, of whom 50% were female and 49% were < 2 years old. Culture results were available for 5017 (70%); 2740 children provided clean-catch samples, 94% of whom were ≥ 2 years old

  8. Child health and parental relationships

    DEFF Research Database (Denmark)

    Loft, Lisbeth Trille Gylling

    2011-01-01

    Using longitudinal national-level representative data from Denmark, this study considers the link between child disability or chronic illness and parental relationship termination as measured by the point in time at which one parent, following the breakup of the relationship, no longer resides...... in the household. By means of event-history techniques, I examine whether a Danish family's experience of having a child diagnosed with a disability or chronic illness affects the chances of parental relationship termination. My findings suggest that families with a child with disabilities or chronic illness do...... have a higher risk of parental relationship termination, when compared to families where no diagnosis of child disability or chronic illness is reported....

  9. Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: A prospective cohort study

    NARCIS (Netherlands)

    A.J.M. Zwiers (Alexandra); S.N. de Wildt (Saskia); J.M. van Rosmalen (Joost); Y.B. de Rijke (Yolanda); E.A.B. Buijs (Erik ); D. Tibboel (Dick); K. Cransberg (Karlien)

    2015-01-01

    textabstractIntroduction: Children admitted to a pediatric intensive care unit (ICU) are at high risk of developing acute kidney injury (AKI). Although serum creatinine (SCr) levels are used in clinical practice, they are insensitive for early diagnosis of AKI. Urinary neutrophil gelatinase-associat

  10. Urinary neutrophil gelatinase-associated lipocalin identifies critically ill young children with acute kidney injury following intensive care admission: A prospective cohort study

    NARCIS (Netherlands)

    A.J.M. Zwiers (Alexandra); S.N. de Wildt (Saskia); J.M. van Rosmalen (Joost); Y.B. de Rijke (Yolanda); E.A.B. Buijs (Erik ); D. Tibboel (Dick); K. Cransberg (Karlien)

    2015-01-01

    markdownabstract#### Introduction Children admitted to a pediatric intensive care unit (ICU) are at high risk of developing acute kidney injury (AKI). Although serum creatinine (SCr) levels are used in clinical practice, they are insensitive for early diagnosis of AKI. Urinary neutrophil gelatinase

  11. High added value of a population-based participatory surveillance system for community acute gastrointestinal, respiratory and influenza-like illnesses in Sweden, 2013-2014 using the web.

    Science.gov (United States)

    Pini, A; Merk, H; Carnahan, A; Galanis, I; VAN Straten, E; Danis, K; Edelstein, M; Wallensten, A

    2017-01-31

    In 2013-2014, the Public Health Agency of Sweden developed a web-based participatory surveillance system, Hӓlsorapport, based on a random sample of individuals reporting symptoms weekly online, to estimate the community incidence of self-reported acute gastrointestinal (AGI), acute respiratory (ARI) and influenza-like (ILI) illnesses and their severity. We evaluated Hӓlsorapport's acceptability, completeness, representativeness and its data correlation with other surveillance data. We calculated response proportions and Spearman correlation coefficients (r) between (i) incidence of illnesses in Hӓlsorapport and (ii) proportions of specific search terms to medical-advice website and reasons for calling a medical advice hotline. Of 34 748 invitees, 3245 (9·3%) joined the cohort. Participants answered 81% (139 013) of the weekly questionnaires and 90% (16 351) of follow-up questionnaires. AGI incidence correlated with searches on winter-vomiting disease [r = 0·81, 95% confidence interval (CI) 0·69-0·89], and ARI incidence correlated with searches on cough (r = 0·77, 95% CI 0·62-0·86). ILI incidence correlated with the web query-based estimated incidence of ILI patients consulting physicians (r = 0·63, 95% CI 0·42-0·77). The high response to different questionnaires and the correlation with other syndromic surveillance systems suggest that Hӓlsorapport offers a reasonable representation of AGI, ARI and ILI patterns in the community and can complement traditional and syndromic surveillance systems to estimate their burden in the community.

  12. Acute phosphine poisoning aboard a grain freighter. Epidemiologic, clinical, and pathological findings.

    Science.gov (United States)

    Wilson, R; Lovejoy, F H; Jaeger, R J; Landrigan, P L

    1980-07-11

    Two children and 29 of 31 crew members aboard a grain freighter became acutely ill after inhaling the toxic fumigant phosphine; one child died. Predominant symptoms were headache, fatigue, nausea, vomiting, cough, and shortness of breath. Abnormal physical findings included jaundice, paresthesias, ataxia, intention tremor, and diplopia. Focal myocardial infiltration with necrosis, pulmonary edema, and widespread small-vessel injury were found at postmortem examination of the dead child. The surviving child showed ECG and echocardiographic evidence of myocardial injury and transient elevation of the MB fraction of serum creatinine phosphokinase. Illness was significantly associated with living or working amidships or on the forward deck areas of the vessel. Phosphine gas was found to have escaped from the holds through a cable housing located near the midships ventilation intake and around hatch covers on the forward deck. The outbreak illustrates the hazards associated with shipboard fumigation.

  13. Impact of childhood chronic illnesses on siblings: a literature review.

    LENUS (Irish Health Repository)

    O' Brien, Irene

    2012-02-01

    BACKGROUND: Childhood illness can have a significant impact on families, particularly on the ill child\\'s siblings. There is a dearth of published literature focusing on the needs of siblings of ill children. AIM: This literature review aims to provide an overview of the current healthcare literature in relation to the impact of childhood chronic illness or disability on siblings. METHOD: A literature review was undertaken by searching the databases CINAHL, PsycINFO, ProQuest and Cochrane Library for relevant articles in English using the search terms: \\'siblings\\

  14. Calcified pulmonary thromboembolism in a child with sickle cell disease: value of multidetector CT in patients with acute chest syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Staser, Jonathan A. [Indiana University Medical Center, Department of Radiology, Indianapolis, IN (United States); Alam, Tariq [Medical College of Ohio, Department of Radiology, Toledo, OH (United States); Applegate, Kimberly [Indiana University Medical Center, Sections of Pediatric Radiology and Health Services Research, Indianapolis, IN (United States); Indiana University Medical Center, Department of Radiology, Riley Hospital for Children, Indianapolis, IN (United States)

    2006-06-15

    The incidence of pulmonary embolism in children is not clearly known, but is believed to be low. Risk factors for pulmonary thromboembolism include central venous catheter, malignancy, surgery, infection, trauma, and congenital hypercoagulable disorders. Children with sickle cell disease are prothrombotic and are at an increased risk of thromboembolism. The incidence of this event is unknown because these children are often not thoroughly imaged. We report here a case of a calcified pulmonary thromboembolism in a child with sickle cell disease and emphasize the use of multidetector CT in detection of pulmonary thromboembolism in children with sickle cell disease. (orig.)

  15. Ultra late onset group B streptococcal sepsis with acute renal failure in a child with urethral obstruction: a case report

    Directory of Open Access Journals (Sweden)

    Freudenstein Daniela

    2012-02-01

    Full Text Available Abstract Introduction Group B streptococci are a well-known cause of early and late onset sepsis. In neonates and older children gram-negative bacteria are mostly found in urinary tract infections and urosepsis. In adults predisposing factors for group B streptococci urinary tract infection may include diabetes mellitus and chronic renal failure. Case presentation We present a rare case of a five-month-old Caucasian boy with ultra late onset urosepsis and acute renal failure caused by group B streptococci serotype V. Excretion urography showed a subvesical obstruction that consequently was surgically corrected after antibiotic treatment of the acute infection. Conclusions Group B streptococci serotype V, urogenitary tract malformations, previous hospitalization and medical interventions may be important risk factors for the development of ultra late onset Group B streptococci sepsis in non-neonates.

  16. Should a Preschool Child with Acute Episodic Wheeze be Treated with Oral Corticosteroids? A Pro/Con Debate.

    Science.gov (United States)

    Beigelman, Avraham; Durrani, Sandy; Guilbert, Theresa W

    2016-01-01

    Traditionally, preschool-aged children with an acute wheezing episode have been treated with oral corticosteroids (OCSs) based on the efficacy of OCSs in older children and adolescents. However, this practice has been recently challenged based on the results of recent studies. The argument supporting the use of OCSs underscores the observation that many children with recurrent preschool wheezing develop atopic disease in early life which predicts both an increased risk to develop asthma in later life and response to OCS therapy. Further, review of the literature demonstrates heterogeneity of study designs, OCS dosage, interventions, study medication adherence, and settings and overall lack of predefined preschool wheezing phenotypes. The heterogeneity of these studies does not allow a definitive recommendation discouraging OCS use. Advocates against the use of OCSs in this population argue that most of studies investigating the efficacy of OCSs in acute episodic wheeze in preschool-aged children have not demonstrated beneficial effects. Moreover, repeated OCS bursts may be associated with adverse effects. Finally, both sides can agree that there is a significant need to conduct efficacy trials evaluating OCS treatment in preschool-aged children with recurrent wheezing targeted at phenotypes that would be expected to respond to OCSs. This article presents a summary of recent literature regarding the use of OCSs for acute episodic wheezing in preschool-aged children and a "pro" and "con" debate for such use.

  17. Caring for a Seriously Ill Child

    Science.gov (United States)

    ... members may be able to help handle errands, carpools, and meals. Siblings should continue to attend school ... hobbies, and friendships. Depend on friends. Let them carpool siblings to soccer or theater practice. Let others — ...

  18. [Nutrition in critical illness].

    Science.gov (United States)

    Ökrös, Ilona

    2014-12-21

    Critically ill patients are often unable to eat by themselves over a long period of time, sometimes for weeks. In the acute phase, serious protein-energy malnutrition may develop with progressive muscle weakness, which may result in assisted respiration of longer duration as well as longer stay in intensive care unit and hospital. In view of the metabolic processes, energy and protein intake targets should be defined and the performance of metabolism should be monitored. Enteral nutrition is primarily recommended. However, parenteral supplementation is often necessary because of the disrupted tolerance levels of the gastrointestinal system. Apparently, an early parenteral supplementation started within a week would be of no benefit. Some experts believe that muscle loss can be reduced by increased target levels of protein. Further studies are needed on the effect of immune system feeding, fatty acids and micronutrients.

  19. Developmental Outcomes in Young Children Born to Mothers with West Nile Illness during Pregnancy

    Science.gov (United States)

    Sirois, Patricia A.; Pridjian, Gabriella; McRae, Scott; Hinckley, Alison F.; Rasmussen, Sonja A.; Kissinger, Patricia; Buekens, Pierre; Hayes, Edward B.; O’Leary, Daniel R.; Swan, Kenneth F.; Xiong, Xu; Wesson, Dawn M.

    2015-01-01

    Background West Nile virus (WNV) infection is associated with acute morbidity and mortality in adults and children. Information on the effects of maternal WNV illness during pregnancy on early childhood development is limited. This study was designed to examine the relationship between maternal WNV illness during pregnancy and birth and developmental outcomes at age 3 years. Methods Mother-child participants were identified using a national surveillance registry for women with WNV illness during pregnancy. Maternal and infant health data and relevant family characteristics were obtained through medical record reviews and maternal questionnaires. All infants received ophthalmologic examinations. Child development was evaluated at age 3 years using the Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III). Results As a group, the children’s (N = 11) birth weight, head circumference, and infant ophthalmologic examination results were within age expectations; one child was born preterm (gestational age 36 weeks). Mean (SD) age at the time of Bayley-III testing was 36.7 (3.8) months. The group’s mean performance on the Bayley-III was at or above age level in all domains, but one child showed a mild delay in the Adaptive domain. The variability observed in this sample (1/53 [1.9%] Domain scores < −2.0 SDs) was consistent with expectations based upon the distribution of Bayley-III Domain scores in the general population. Conclusion Maternal WNV infection does not appear to be associated with global developmental delays in young children. These results are preliminary, however, and require confirmation in future research. PMID:25196266

  20. Pulmonary Thromboembolism in a Child with Sickle Cell Hemoglobin D Disease in the Setting of Acute Chest Syndrome

    OpenAIRE

    Hazel Villanueva; Sandeepkumar Kuril; Jennifer Krajewski; Aziza Sedrak

    2013-01-01

    Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD. Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pu...

  1. Spontaneous Perforation of Common Bile Duct in a Child with a Clinical Manifestation of Acute Abdominal Distension: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Hee Rok; Namkyung Sook; Kim, Heung Cheol; Hong, Myung Sun [Dept. of Radiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    2011-09-15

    Spontaneous perforation of common bile duct (CBD) is extremely rare in children, but potentially a fatal disorder that requires an emergency laparotomy. Most of the patients present with insidious symptoms including slowly progressive abdominal distension with accumulation of the ascites, fluctuating mild jaundice, and clay-colored stools. We report a case of surgically confirmed spontaneous perforation of the CBD in a 3-year-old girl who presented with acute abdominal distension with no biliary symptoms or signs, and who showed imaging findings consistent with anomalous pancreaticobiliary ductal union with a focal stenosis in the CBD.

  2. Diagnosis of congenital Trypanosoma cruzi infection: A serologic test using Shed Acute Phase Antigen (SAPA) in mother-child binomial samples.

    Science.gov (United States)

    Volta, Bibiana J; Russomando, Graciela; Bustos, Patricia L; Scollo, Karenina; De Rissio, Ana M; Sánchez, Zunilda; Cardoni, Rita L; Bua, Jacqueline

    2015-07-01

    Chagas congenital infection is an important health problem in endemic and non-endemic areas in which Trypanosoma cruzi-infected women can transmit the parasite to their offspring. In this study, we evaluated the antibody levels against the T. cruzi Shed Acute Phase Antigen (SAPA) in 91 binomial samples of seropositive pregnant women and their infected and non-infected children by ELISA. In 70 children without congenital T. cruzi transmission, the titers of anti-SAPA antibodies were lower than those of their seropositive mothers. In contrast, 90.5% of 21 congenitally infected children, at around 1 month of age, showed higher anti-SAPA antibody levels than their mothers. Subtracting the SAPA-ELISA mother OD value to the SAPA-ELISA child OD allowed efficient detection of most T. cruzi congenitally infected children immediately after birth, when total anti-parasite antibodies transferred during pregnancy are still present in all children born to seropositive women. A positive correlation was observed between parasitemia levels in mothers and infants evaluated by quantitative DNA amplification and anti-SAPA antibody titers by ELISA. As SAPA serology has proved to be very efficient to detect T. cruzi infection in mother-child binomial samples, it could be of extreme help for early diagnosis of newborns, in maternities and hospitals where DNA amplification is not available. This prompt diagnosis may prevent drop out of the long-term follow-up for future diagnosis and may ensure early trypanocidal treatment, which has proved to be efficient to cure infants with congenital Chagas disease.

  3. Child Nutrition Program

    Institute of Scientific and Technical Information of China (English)

    潘志强

    2005-01-01

    The Child Nutrition Program invites all students to participate in the school breakfast and lunch program at school. Our goal is to improve the health and education of students by providing nutritious meals that promote food choices for a healthy diet. Failure to eat balanced meals increases the risk of illness including obesity ,

  4. Child health in Greenland

    DEFF Research Database (Denmark)

    Niclasen, Birgit V L; Bjerregaard, Peter

    2007-01-01

    child mortality but the same morbidity pattern as in other Western societies was found. Negative health behaviour is frequent in schoolchildren. The influence of rapid cultural changes, and familial and societal factors related to social ill health, together with socioeconomic inequity, are of major...

  5. The effect of protein intake and resistance training on muscle mass in acutely ill old medical patients - A randomized controlled trial

    DEFF Research Database (Denmark)

    Buhl, Sussi F; Andersen, Aino L; Andersen, Jens Rikardt

    2016-01-01

    BACKGROUND & AIM: Stress metabolism is associated with accelerated loss of muscle that has large consequences for the old medical patient. The aim of this study was to investigate if an intervention combining protein and resistance training was more effective in counteracting loss of muscle than...... standard care. Secondary outcomes were changes in muscle strength, functional ability and body weight. METHODS: 29 acutely admitted old (>65 years) patients were randomly assigned to the intervention (n = 14) or to standard care (n = 15). The Intervention Group received 1.7 g protein/kg/day during...... admission and a daily protein supplement (18.8 g protein) and resistance training 3 times per week the 12 weeks following discharge. Muscle mass was assessed by Dual-energy X-ray Absorptiometry. Muscle strength was assessed by Hand Grip Strength and Chair Stand Test. Functional ability was assessed...

  6. Morphine-augmented cholescintigraphy and acute a calculous cholecystitis in critically ill patients: interest and new way of interpreting; Cholescintigraphie et cholecystite aigue alithiasique en reanimation: place et proposition d'une nouvelle interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Emptaz, A.; Prevot, N.; Dubois, F. [Centre Hospitalier Universitaire, Hopital Nord, Service de Medecine Nucleaire, 42 - Saint-Etienne (France); Mahul, P.; Mariat, G.; Jospe, R.; Auboyer, C. [Centre Hospitalier Universitaire, Hopital Nord, Service de Reanimation, 42 - Saint-Etienne (France); Cuilleron, M. [Centre Hospitalier Universitaire, Hopital Nord, Service de Radiologie, 42 - Saint-Etienne (France)

    2005-01-15

    Introduction: Acute acalculous cholecystitis (AAC) is a serious disease, difficult to diagnose in critically ill patients. The aim of the study was to evaluate the diagnostic performances of abdominal ultrasonography (US) and morphine-augmented cholescintigraphy (MC) and to improve diagnostic strategy in patients of intensive care unit (ICU) with suspected AA C. Methods: We retrospectively studied 82 consecutive ICU patients with suspected AA C. US was positive if the triad of gallbladder distension, gallbladder wall thickening and sludge was found. MC was positive if the gallbladder remained non-visualized after morphine injection. In a second time, other scintigraphic criteria of interpretation were tested, according to the visualization of the gallbladder before or after morphine administration. Treatment was decided on the basis of clinical, laboratory and imaging data. Results: The diagnosis of AAC was retained in 34 patients. US and MC had respectively for the diagnosis of AAC a sensitivity of 20.6 and 70.6%, and a specificity of 95.8 and 100%. Interpreting the MC as positive if the gallbladder remains non-visualized after morphine, as negative if it appears before, and as non-conclusive if visualized after, makes it possible to define respectively patients with high probability (100%), with low probability (7.5%) or with intermediate probability (39%) of AAC. Conclusions: MC is better than US for diagnosing AAC in critically ill patients, having in particular excellent specificity using the classical criteria of interpretation. MC must be thus performed in patients at risk for AAC, determined with clinical, laboratory and eventually echographic findings. To decrease false negative rate of MC, a probability categorical classification is proposed to improve patients' care. (author)

  7. 急危重症诊治中疑难电解质异常的辨伪识真%Difficult Electrolyte Abnormalities in the Diagnosis and Treatment for Acute and Critically Ill Patients

    Institute of Scientific and Technical Information of China (English)

    孟庆义

    2015-01-01

    This paper discusses the diagnosis and treatment for several phenomenon of the difficult electrolyte abnor-malities in acute and critically ill patients. The main contents include the fat overload syndrome with hyponatremia, hyponatre-mia in the capillary leak syndrome and syndrome of inappropriate antidiuretic hormone secretion, transferred hyponatremia in high blood sugar coma, monitoring of serum sodium and osmotic pressure gap for hypertonic treatment, hyperkalemia rescue measures using sequential, hypoaldosteronemia for the refractory hyperkalemia, hypokalemia associated with concealed poison-ing, and hypercalcemia with ECG Osborn wave, which are instructive for reducing the misdiagnosis rate and improving the res-cue level for critically ill patients.%介绍几种急危重症诊治中的疑难电解质异常现象及治疗方法,主要内容有脂肪超载综合征中的假性低钠血症,毛细血管渗漏综合征和抗利尿激素分泌异常综合征中的低钠血症,高血糖昏迷中的转移性低钠血症,高渗疗法时血清钠与渗透浓度间隙监测,高钾血症抢救措施,顽固性高钾血症中的低醛固酮血症,隐匿性中毒相关低钾血症和高钙血症时心电图特征性Osborn波,以减少临床误诊误治,为急诊医师提高危重病救治水平提供指导。

  8. Fathers with mental illness: implications for clinicians and health services.

    Science.gov (United States)

    Fletcher, Richard J; Maharaj, O'Neil N; Fletcher Watson, Chloe H; May, Chris; Skeates, Nigel; Gruenert, Stefan

    2013-08-05

    A significant proportion of fathers living with their natural, adopted, step or foster children experience mental illness. Psychiatric illness among fathers can have a devastating impact on children's wellbeing, and even milder forms of paternal mental illness can have serious developmental effects on children. While several pathways linking paternal mental illness with poor child outcomes have been identified, fathers' impaired parenting is an important, potentially malleable factor. Clinicians can assist fathers with mental illness and their families by proactively inquiring about children and by exploring fathering-focused psychological support.

  9. Delayed reversible methotrexate-induced leucoencephalopathy in a four-year-old child with acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Amrita Roy

    2013-01-01

    Full Text Available Intravenous/intrathecal methotrexate (MTX has been implicated as a major cause of treatment-related neurotoxicity particularly leukoencephalopathy in children with hematological malignancy. We report a 4-year-old boy who presented with apathy and aphasia for 1 day while on the maintenance-phase chemotherapy according to MCP 841 protocol. MRI of brain revealed bilateral symmetrical FLAIR hyperintensities in caudate and putaminal region with FLAIR hypersignal in subcortical U-fiber in left frontal lobe consistent with MTX-induced toxic leucoencephalopathy. There was spontaneous resolution of symptoms within 1 week of onset. So, in Pre-B acute lymphoblastic leukemia patients with subtle neurological deficit, this diagnosis should be kept in mind and further treatment with MTX should be carefully decided.

  10. Acute T-cell lymphoblastic leukaemia presenting with cutaneous involvement in a child: a rare case report

    Directory of Open Access Journals (Sweden)

    Lohit Kumar Kalita

    2015-05-01

    Full Text Available Primary cutaneous involvement in T-cell lymphoblastic leukemia is rare in childhood. We present a case of 6-year-old girl admitted to our hospital because of multiple skin lesions. She was looked pale and weak. Generalized lymphadenopathy was present. Complete blood count revealed 216,000/mm3 white blood cell count. Peripheral blood smear showed 80% lymphoblasts. Bone marrow aspiration revealed 96% blastic cells with immunophenotype and morphological characteristics of acute lymphoblastic leukemia (T-ALL which was confirmed by flowcytometry. ALL BFM -95 remission induction treatment protocol was started. Skin lesion remained same after two month of the cytotoxic therapy. The symptoms became more aggressive and she died after 4 months of treatment. [Int J Res Med Sci 2015; 3(5.000: 1285-1287

  11. The diagnosis of urinary tract infections in young children (DUTY: protocol for a diagnostic and prospective observational study to derive and validate a clinical algorithm for the diagnosis of UTI in children presenting to primary care with an acute illness

    Directory of Open Access Journals (Sweden)

    Downing Harriet

    2012-07-01

    Full Text Available Abstract Background Urinary tract infection (UTI is common in children, and may cause serious illness and recurrent symptoms. However, obtaining a urine sample from young children in primary care is challenging and not feasible for large numbers. Evidence regarding the predictive value of symptoms, signs and urinalysis for UTI in young children is urgently needed to help primary care clinicians better identify children who should be investigated for UTI. This paper describes the protocol for the Diagnosis of Urinary Tract infection in Young children (DUTY study. The overall study aim is to derive and validate a cost-effective clinical algorithm for the diagnosis of UTI in children presenting to primary care acutely unwell. Methods/design DUTY is a multicentre, diagnostic and prospective observational study aiming to recruit at least 7,000 children aged before their fifth birthday, being assessed in primary care for any acute, non-traumatic, illness of ≤ 28 days duration. Urine samples will be obtained from eligible consented children, and data collected on medical history and presenting symptoms and signs. Urine samples will be dipstick tested in general practice and sent for microbiological analysis. All children with culture positive urines and a random sample of children with urine culture results in other, non-positive categories will be followed up to record symptom duration and healthcare resource use. A diagnostic algorithm will be constructed and validated and an economic evaluation conducted. The primary outcome will be a validated diagnostic algorithm using a reference standard of a pure/predominant growth of at least >103, but usually >105 CFU/mL of one, but no more than two uropathogens. We will use logistic regression to identify the clinical predictors (i.e. demographic, medical history, presenting signs and symptoms and urine dipstick analysis results most strongly associated with a positive urine culture result. We will

  12. Clinical and radiological features of pandemic H1N1 2009 influenza virus infection manifesting as acute febrile respiratory illness at their initial presentations: comparison with contemporaneous non-H1N1 patients

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Tae Jin (Dept. of Radiology, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of); Dept. of Radiology, Seoul National Univ. Hospital, Seoul (Korea, Republic of)); Park, Chang Min; Choi, Seung Hong; Lee, Hyun Ju; Goo, Jin Mo (Dept. of Radiology, Seoul National Univ. Hospital, Seoul (Korea, Republic of)), email: cmpark@radiol.snu.ac.kr; Kwon, Gu Jin (Dept. of Family Medicine, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of); Dept. of Family Medicine, Gangneung Asan Hospital, Gangneung (Korea, Republic of)); Woo, Sung Koo (Dept. of Radiology, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of)); Park, Seung Hoon (Dept. of Internal Medicine, Armed Force Byukjae Hospital, Gyeonggi-do (Korea, Republic of))

    2011-05-15

    Background Since the first outbreak caused by the pandemic H1N1 2009 influenza in Mexico, the virus has spread widely across the world with meaningful morbidity and mortality. However, there are few data on the comparative investigations to assess the clinical and radiological features between the H1N1 patient and non-H1N1 patients. Purpose To assess the clinical and radiological features of patients infected by the pandemic H1N1 2009 flu virus at their initial presentation and to compare them with contemporaneous non-H1N1 patients with acute febrile respiratory illness. Material and Methods This retrospective study was approved by the ethics committee of the Armed Forces Medical Command, South Korea. From August to September 2009, 337 consecutive patients presented with an acute febrile respiratory illness in a tertiary military hospital. Reverse-transcriptase polymerase-chain-reaction tests were performed in 62 of these patients under the impression of H1N1 infection. Clinical and radiological features at their initial presentation were described for the H1N1 group (n = 35) and non-H1N1 group (n = 27) and compared between the two groups. Results Increased C-reactive protein level (97%) without leukocytosis (9%) or increased erythrocyte sedimentation rate (0%) was common in the H1N1 group at their initial presentation. On chest radiographs, 12 of 35 (34%) H1N1 patients had abnormal findings; nodules in 10 patients (83%) and consolidations in two (17%). Of the 28 H1N1 patients who underwent thin-section CT 16 patients (57%) showed abnormal findings; ground-glass opacities (GGOs) in 15 (94%), and nodules in 13 (81%). However, there were no significant differences between the H1N1 group and non-H1N1 group in terms of symptoms, laboratory results, or radiological findings (P > 0.05). Conclusion Patients with H1N1 infection show consistent clinical and radiological features at their initial presentation, however, clinical and radiological features of the H1N1 group are

  13. Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos Acute kidney injury in children: incidence and prognostic factors in critical ill patients

    Directory of Open Access Journals (Sweden)

    Kenia Machado Souza Freire

    2010-06-01

    revertible renal function impairment involving inability to maintain homeostasis. In pediatrics, the main causes of acute kidney injury are sepsis, use of nephrotoxic drugs and renal ischemia in critically ill patients. The incidence of acute kidney injury in these patients ranges from 20 to 30%, resulting in increased morbid-mortality, a 40 to 90% rate. This study aimed to evaluate the incidence of acute kidney injury in intensive care unit patients, to categorize the severity of the acute kidney injury according to the Pediatric Risk, Injury, Failure, Loss, End-Stage (pRIFLE, examine the relationship between the acute kidney injury and severity using the Pediatric Index of Mortality (PIM and to analyze outcome predictors. METHODS: A prospective study of the patients admitted to the intensive care unit of Hospital Infantil Joana de Gusmão - Florianópolis / SC - Brazil was conducted between July 2008 and January 2009. Were evaluated daily the urine output and serum creatinine, and the patients were categorized according to the pRIFLE criteria. RESULTS: During the follow-up period, 235 children were admitted. The incidence of acute kidney injury was 30.6%, and the maximal pRIFLE score during hospitalization was 12.1% for R, 12.1% for I and 6.4% for F. The mortality rate was 12.3%. The patients who developed acute kidney injury had a ten times bigger risk of death versus the not exposed patients. CONCLUSIONS: Acute kidney injury is frequent in critically ill patients. Early diagnosis and prompt and appropriate therapy for each clinical aspect may change this condition's course and severity, and reduce the patients' morbidity and mortality.

  14. Observation of therapeutic effectiveness of Qiuxieling granules on child acute diarrhea%秋泻灵颗粒治疗小儿急性腹泻疗效观察

    Institute of Scientific and Technical Information of China (English)

    李菊芬; 鲁春红

    2014-01-01

    目的:探讨秋泻灵颗粒治疗小儿急性腹泻的临床疗效。方法随机分成2组,对照组60采用常规治疗措施,治疗组在常规治疗的基础上加用秋泻灵治疗。比较两组主要症状和体征改善情况。结果总有效率治疗组95.4%,对照组83.3%,两组比较有显著差异(p<0.05)。结论秋泻灵颗粒治疗小儿急性腹泻疗效好。%Objectives:To study the efficacy of Qiuxieling granules in treating of child acute diarrhea.Methods:126 cases of child acute diarrhea were randomly divideded into treating group(n=66)who were given qiuxieling granules and the normal therapy.The same therapy was performed in control group(n=60)except qiuxieling granules.Main symptom and improvement of two groups were compared.Results:The incidence of clinical effect in treating group is94.5% which was morethan 83.3%of control group (p<0.01).Conclusions:The Qiuxieling granules is satisfactory in the treatment of child acute diarrhea.

  15. Acute disseminated encephalomyelitis without optic neuritis followed by optic neuritis in a child due to the sudden cessation of steroid therapy.

    Science.gov (United States)

    Ryu, Won Yeol; Sohn, Eun Jung; Kwon, Yoon Hyung; Jeung, Woo Jin; Ahn, Hee Bae; Park, Woo Chan; Rho, Sae Heun

    2014-01-01

    Acute disseminated encephalitis (ADEM) is an autoimmune demyelinating disorder of the central nervous system that usually occurs in children after viral infection or vaccination. It is not uncommon for ADEM to be accompanied by optic neuritis. However, ADEM followed by optic neuritis is a rare. We report the case of a 6-year-old girl who initially presented with ADEM (without optic neuritis) due to a live measles, mumps, and rubella vaccine and was treated with intravenous high-dose corticosteroids. After steroid therapy, she recovered neurologically and was not prescribed any medication, including an oral steroid taper, for use after discharge. Three weeks later, she developed unilateral optic neuritis and was again treated with steroid therapy. This is a rare case of ADEM without optic neuritis in a child, followed by optic neuritis due to the sudden cessation of steroid therapy. Further studies and follow-ups are needed to determine whether ADEM followed by optic neuritis can be considered a specific clinical form of this disorder.

  16. Self-referral and serious illness in children with fever

    NARCIS (Netherlands)

    Y. van Ierland (Yvette); N. Seiger (Nienke); M. van Veen (Mirjam); A.H.J. van Meurs (Alfred); M. Ruige (Madelon); R. Oostenbrink (Rianne); H.A. Moll (Henriëtte)

    2012-01-01

    textabstractOBJECTIVE: The goal of this study was to evaluate parents' capability to assess their febrile child's severity of illness and decision to present to the emergency department. We compared children referred by a general practitioner (GP) with those self-referred on the basis of illness-sev

  17. Mental Illness as a Barrier to Marriage among Unmarried Mothers

    Science.gov (United States)

    Teitler, Julien O.; Reichman, Nancy E.

    2008-01-01

    This study explores how mental illness shapes transitions to marriage among unwed mothers using augmented data from the Fragile Families and Child Wellbeing study (N = 2,351). We estimate proportional hazard models to assess the effects of mental illness on the likelihood of marriage over a 5-year period following a nonmarital birth. Diagnosed…

  18. Phenotyping of peripheral blood mononuclear cells during acute dengue illness demonstrates infection and increased activation of monocytes in severe cases compared to classic dengue fever.

    Science.gov (United States)

    Durbin, Anna P; Vargas, Maria José; Wanionek, Kimberli; Hammond, Samantha N; Gordon, Aubree; Rocha, Crisanta; Balmaseda, Angel; Harris, Eva

    2008-07-05

    In vitro studies have attempted to identify dengue virus (DEN) target cells in peripheral blood; however, extensive phenotyping of peripheral blood mononuclear cells (PBMCs) from dengue patients has not been reported. PBMCs collected from hospitalized children suspected of acute dengue were analyzed for DEN prM, CD32, CD86, CD14, CD11c, CD16, CD209, CCR7, CD4, and CD8 by flow cytometry to detect DEN antigen in PBMCs and to phenotype DEN-positive cells. DEN prM was detected primarily in activated monocytes (CD14(+), CD32(+), CD86(+), CD11c(+)). A subset of samples analyzed for DEN nonstructural protein 3 (NS3) confirmed that approximately half of DEN antigen-positive cells contained replicating virus. A higher percentage of PBMCs from DHF patients expressed prM, CD86, CD32, and CD11c than did those from DF patients. Increased activation of monocytes and greater numbers of DEN-infected cells were associated with more severe dengue, implicating a role for monocyte activation in dengue immunopathogenesis.

  19. The child with an acute limp; Das hinkende Kind. Radiologische Differenzialdiagnostik der akuten Gangstoerung des Kinder- und Jugendalters

    Energy Technology Data Exchange (ETDEWEB)

    Stadler, A.; Puig, S.; Eisenhuber, E.; Rand, T. [Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    2002-03-01

    Limping is a common and often challenging problem in children and adolescents. A limp is defined as asymetric deviation from a normal gait pattern. A systematic approach is necessary to determine the cause of the limp, so the radiologist should combine a thorough history, clinical information and pertinent radiologic testing. The possible differential diagnosis is extensive and includes many pathologies of the lower extremity and spine like trauma, infection, neoplasia, furthermore inflammatory, developmental and congenital disorders. In cases with knee or tight pain, an underlying hip condition should be considered. The childs age can narrow the possible differential diagnoses, because certain entities are age-related. Despite this wide bandwidth of entities, potential catastrophic causes like septic arthritis and malignant disease should be excluded first. Plain radiographs are often diagnostic. The choice of further imaging modalities like ultrasonography, magnetic resonance imaging, computed tomography and bone scan should be guided by the history and clinical findings. (orig.) [German] Die Abklaerung der hinkenden Gangstoerung bei Kindern und Jugendlichen ist ein haeufiges und oft komplexes diagnostisches Problem. Hinken ist definiert als eine asymmetrische Abweichung vom normalen Gangmuster. Um die Ursache des Hinkens suffizient abklaeren zu koennen, ist ein systematisches Vorgehen mit sorgfaeltiger Anamneseerhebung, orientierender klinischer Untersuchung, sowie eine adaequate Wahl der radiologischen Modalitaet durch den Radiologen notwendig. Das weite Spektrum der moeglichen Differenzialdiagnosen umfasst viele Pathologien der unteren Extremitaet wie Trauma, infektioese, neoplastische und entzuendliche Erkrankungen sowie erworbene und angeborene Stoerungen. In Faellen, in denen das Kind Knie- oder Oberschenkelbeschwerden angibt, muss zusaetzlich an eine Erkrankung der Huefte gedacht werden. Da viele Erkrankungen eine bestimmte Altersgruppe bevorzugen, kann

  20. Pulmonary thromboembolism in a child with sickle cell hemoglobin d disease in the setting of acute chest syndrome.

    Science.gov (United States)

    Villanueva, Hazel; Kuril, Sandeepkumar; Krajewski, Jennifer; Sedrak, Aziza

    2013-01-01

    Introduction. Sickle cell hemoglobin D disease (HbSD) is a rare variant of sickle cell disease (SCD). Incidence of pulmonary thromboembolism (PE) and deep venous thrombosis (DVT) in children with HbSD is unknown. PE and DVT are known complications of SCD in adults but have not been reported in the literature in children with HbSD. Case Report. We are reporting a case of a 12-year-old boy with HbSD with acute chest syndrome (ACS) complicated by complete thrombosis of the branch of the right pulmonary artery and multiple small pulmonary artery emboli seen on computed tomography (CT) pulmonary angiogram and thrombosis of the right brachial vein seen on Doppler ultrasound. Our patient responded to treatment with anticoagulant therapy. Conclusion. There are no cases reported in children with HbSD disease presenting as ACS with pulmonary thromboembolism. We suggest that PE should be suspected in patients presenting with ACS who do not show improvement with standard management. CT pulmonary angiogram should be utilized for early diagnosis and appropriate management as there is no current protocol for management of PE/DVT in pediatric patients with SCD.

  1. Resolution of disseminated fusariosis in a child with acute leukemia treated with combined antifungal therapy: a case report

    Directory of Open Access Journals (Sweden)

    Zarallo Luis

    2007-05-01

    Full Text Available Abstract Background Fusarium spp. is being isolated with increasing frequency as a pathogen in oncohematologic patients. Caspofungin and amphotericin B have been reported to have synergistic activity against Fusarium spp. Case presentation We herein report a case of disseminated fusariosis diagnosed by chest CT scan and positive blood cultures to Fusarium spp. Because the patient's clinical condition deteriorated, CRP levels increased, and blood cultures continued to yield Fusarium spp. despite liposomal amphotericin B monotherapy up to 5 mg/kg daily, treatment with caspofungin was added. Within 2 weeks of onset of combined antifungal therapy, the chest CT scan demonstrated a progressive resolution of the pulmonary lesions. Upon discontinuation of intravenous antifungals, the patient received suppressive therapy with oral voriconazole. Three months later, a chest CT scan showed no abnormalities. Twenty-five months after discontinuation of all antifungal therapy, the patient remains in complete remission of her neoplastic disease with no signs of clinical activity of the Fusarium infection. Conclusion This is the first description of successful treatment of disseminated fusariosis in a pediatric patient with acute lymphoblastic leukemia with caspofungin and amphotericin B followed by oral suppressive therapy with voriconazole.

  2. Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia.

    Science.gov (United States)

    Gokcebay, D G; Azik, F M; Isik, P; Bozkaya, I O; Kara, A; Tavil, E B; Yarali, N; Tunc, B

    2011-12-01

    Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase-associated lipid abnormalities that are seen in children is 67-72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l-asparaginase-associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER(®) GEN·S™ system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range (Table 1). Thus, we thought it was a laboratory error, and the patient's follow-up especially for red cell parameters was made by red blood cell and hematocrit values.

  3. Rates of acute respiratory illnesses of infectious and allergic etiologies after permanent changes of duty assignments, active component, U.S. Army, Air Force, and Marine Corps, January 2005-September 2015.

    Science.gov (United States)

    Brundage, John F; Taubman, Stephen B; Clark, Leslie L

    2015-11-01

    Throughout history, acute respiratory illnesses (ARIs) have disproportionately affected military populations, particularly those in recruit training camps. A similar dynamic can affect non-trainee military settings. When military members are reassigned, they often develop ARIs within the first weeks of their arrivals at their new assignments. To assess the natures and magnitudes of the risks associated with new assignments, this analysis compared the experiences of service members within their first full calendar months at new assignments and during the same months at the same locations 1 year later. The results do not support the hypothesis that ARIs of infectious etiologies consistently occur more frequently soon after arriving at new assignments compared to 1 year later at the same locations. In contrast, during two-thirds of the 117 months considered here, rates of ARIs of presumed allergic etiologies (e.g., allergic rhinitis, asthma) were higher during the first months of new assignments compared to 1 year later. The limitations of the study methodology as well as the possible implications of the findings are discussed.

  4. Pancreatic Involvement in Critically ill Patients

    Directory of Open Access Journals (Sweden)

    Abhinav Agrawal

    2015-07-01

    Full Text Available Elevation of pancreatic enzymes is often observed in patients admitted to intensive care units in the United States. Elevated pancreatic enzymes can occur due to acute pancreatitis or numerous non-specific reasons. Non-specific enzyme elevation can be seen in patients with head injury, acute renal failure, diabetic ketoacidosis or patients on hemodialysis. Patients with severe acute pancreatitis can be admitted to the intensive care units for intensive care or patients admitted to the intensive care units for other critical illness can develop acute pancreatitis due to a variety of reasons like ischemia, hypoperfusion, drugs or hypercalcemia. It can be a challenging task to distinguish between acute pancreatitis and non-specific enzyme elevation, especially in critically ill patients with multiple co-morbidities admitted to the intensive care units in whom historical information may not be always available. In addition, the clinical consequences of pancreatic enzyme elevation in the critically ill patients are also not very clear. This review attempts to describe the complex interplay of various factors that can lead to either pancreatic inflammation and/or pancreatic enzyme elevation in the critically ill patients along with the clinical consequences and approach to patient with pancreatic enzyme elevation in the intensive care units.

  5. Moving towards effective chronic illness management: asthma as an exemplar.

    Science.gov (United States)

    Estes, Tracy S

    2011-01-01

    The United States health care system is at a pivotal point in its ability to manage chronic illness. The demands and philosophical differences between the management of acute and chronic illnesses suggest the need for different strategies for effective and efficient management of chronic illness. The purpose of this article is to discuss the Chronic Care Model and the collaborative approach to managing chronic illnesses. Asthma, as an exemplar, will be used to illustrate the need for the development of new models of collaborative care for the treatment of chronic illnesses.

  6. Aggressive Children With Mental Illness: A Conceptual Model of Family-Level Outcomes.

    Science.gov (United States)

    Sporer, Karyn

    2016-04-13

    The purpose of this research was to examine how families adapt and respond to an aggressive child with mental illness. This article presents findings from a qualitative study of four families, which were selected as typifying the experiences of a larger sample of 14 families; each family included a child with mental illness and a history of violent behavior. The analysis revealed a five-stage pattern in how families perceived and responded to victimization and their child or sibling's mental illness. The study suggests that families with a violent child with mental illness and other healthy children cannot live through episodes of violence without removing the child with mental illness from the home or suffering considerable damage to the family. The article concludes with recommendations for mental health practitioners and family intervention specialists.

  7. A population-based survey of acute gastrointestinal illness in Jiangsu Province, 2012%江苏省2012年急性胃肠炎负担调查情况分析

    Institute of Scientific and Technical Information of China (English)

    周翌婧; 吴高林; 戴月; 甄世祺

    2016-01-01

    Objective To determine disease burden and risk factors of acute gastrointestinal illness ( AGI) among residents in Jiangsu Province. Method Cluster random sampling method was used to carry out monthly retrospective cross-sectional survey in 10 sentinel sites in Jiangsu Province in 2012;potential risk factors were assessed by multivariate non-conditional logistic regression analy-sis. Results A total of 12 003 residents were surveyed, resulting adjusted monthly prevalence of 3. 5% ,which was equivalent to 0. 50 AGI episodes/person year. The highest incidence was observed in fall (4. 5%),while the lowest incidence was observed in winter (3. 1%). Children aged younger than 5 years old had the highest incidence(10. 8%);while adults aged from 25 to 44 years old had the lowest incidence(2. 9%). Healthcare was sought by 38. 3% of the ill respondents, among which 78. 4% were treated with antibi-otics while 32. 9% were treated with antidiarrheals. Multivariable regression analysis showed gender, season, sentinel site and travel were risk factors of AGI. Conclusion Disease burden of AGI was heavy in Jiangsu Province. Rate of using antibiotics and antidiar-rheals for treatment was high.%目的:了解江苏居民急性胃肠炎( AGI)负担情况及危险因素。方法2012年,在江苏10个监测点每月采取整群随机的抽样方式,开展回顾性的横断面调查,并采用多因素非条件logistic回归评估潜在的危险因素。结果共调查12003名居民,AGI月患病率3.5%,相当于0.50次/人年;秋季最高(4.5%),冬季最低(3.1%);<5岁儿童的患病率最高(10.8%),25~44岁最低(2.9%);38.3%的患者就诊,药物治疗病例中78.4%报告使用抗生素,32.9%使用止泻药。多因素回归分析显示,年龄、季节、监测点和旅游是AGI的影响因素。结论江苏省AGI负担重,使用抗生素、止泻药比例较高。

  8. Scrub typhus presenting as an acute abdomen

    Directory of Open Access Journals (Sweden)

    PP Abhilash Kundavaram

    2014-01-01

    Full Text Available Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which presents as an acute febrile illness with headache, myalgia, breathlessness, and an eschar, a pathognomonic sign, in a varying proportion of patients. However, this illness can present unusually with fever and severe abdominal pain mimicking acute abdomen. A careful search for an eschar in all patients with an acute febrile illness would provide a valuable diagnostic clue and avoid unnecessary investigations and surgical exploration.

  9. Scrub typhus presenting as an acute abdomen

    OpenAIRE

    PP Abhilash Kundavaram; Sohini Das; M Varghese George

    2014-01-01

    Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which presents as an acute febrile illness with headache, myalgia, breathlessness, and an eschar, a pathognomonic sign, in a varying proportion of patients. However, this illness can present unusually with fever and severe abdominal pain mimicking acute abdomen. A careful search for an eschar in all patients with an acute febrile illness would provide a valuable diagnostic clue and avoid unnecessary investigatio...

  10. Scrub typhus presenting as an acute abdomen.

    Science.gov (United States)

    Kundavaram, Abhilash Pp; Das, Sohini; George, Varghese M

    2014-01-01

    Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, which presents as an acute febrile illness with headache, myalgia, breathlessness, and an eschar, a pathognomonic sign, in a varying proportion of patients. However, this illness can present unusually with fever and severe abdominal pain mimicking acute abdomen. A careful search for an eschar in all patients with an acute febrile illness would provide a valuable diagnostic clue and avoid unnecessary investigations and surgical exploration.

  11. The role of vitamin A in reducing child mortality and morbidity and improving growth

    Directory of Open Access Journals (Sweden)

    RAMAKRISHNAN USHA

    1998-01-01

    Full Text Available This is an update of knowledge on the role of the vitamin A status in determining child mortality, morbidity and growth. Recent information confirms the earlier conclusion of Beaton et al. that a 23% reduction in young child mortality results following improvements in the vitamin A status. Studies show that the mortality effect is primarily due to reductions in deaths due to acute gastroenteritis and measles but not acute respiratory infections (ARI and malaria. While improvement of the vitamin A status enhances the survival of older preschool children, it remains unclear whether it benefits infants (i.e. <6 months. Vitamin A supplementation does not reduce the overall incidence and prevalence of common childhood illness; however, it reduces the incidence of more severe episodes of diarrhea. Also, vitamin A supplementation either during and/or immediately after the illness does not improve its symptomatology. Finally, contrary to earlier expectations, recently completed, placebo-controlled randomized interventions have failed to detect improvements in child growth.

  12. Endocrine and metabolic considerations in critically ill patients 4: Thyroid function in critically ill patients

    OpenAIRE

    Fliers, Eric; Bianco, Antonio C.; Langouche, Lies; Boelen, Anita

    2015-01-01

    Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and ...

  13. The Impact of Caregiver Distress on the Longitudinal Development of Child Acute Post-traumatic Stress Disorder Symptoms in Pediatric Injury Victims

    OpenAIRE

    Ostrowski, Sarah A.; Ciesla, Jeffrey A.; Lee, Timothy J.; Irish, Leah; Christopher, Norman C.; Delahanty, Douglas L.

    2011-01-01

    Objective The present study prospectively examined the development of child PTSD symptoms (PTSS) and the impact of caregiver PTSS on child PTSS following injury. Methods One hundred and eighteen ED patients and their caregivers were interviewed in-hospital and 2- and 6-weeks posttrauma. Structural equation modeling and hierarchical linear regressions examined the development of PTSS. Results A model combining child and caregiver 2-week PTSS into one latent family PTSS variable provided the be...

  14. Skeletal muscle deiodinase type 2 regulation during illness in mice

    NARCIS (Netherlands)

    J. Kwakkel; H.C. van Beeren; M.T. Ackermans; M. Platvoet-ter Schiphorst; E. Fliers; W.M. Wiersinga; A. Boelen

    2009-01-01

    We have previously shown that skeletal muscle deiodinase type 2 (D2) mRNA (listed as Dio2 in MGI Database) is up-regulated in an animal model of acute illness. However, human Studies on the expression Of muscle D2 during illness report conflicting data. Therefore, we evaluated the expression of skel

  15. Coping with Chronic Illness

    Science.gov (United States)

    Having a long-term, or chronic, illness can disrupt your life in many ways. You may often be tired and in pain. Your illness might affect your ... able to work, causing financial problems. For children, chronic illnesses can be frightening, because they may not ...

  16. Parents with Schizophrenia – Insights from notifications of suspected child abuse and neglect

    DEFF Research Database (Denmark)

    Wulf-Andersen, Trine Østergaard; Ranning, Anne

    2016-01-01

    Children of parents with acute symptoms of schizophrenia are at high risk of being exposed to adverse environmental circumstances known to predict future mental and physical illness. To ensure a healthy development of children human services must address the needs of children of patients...... with schizophrenia. In this study, notifications of suspected child abuse and neglect was used to elicit difficulties in parental role functioning in schizophrenia patients. Qualitative text analysis was used to elicit common themes in 49 written documents from social workers at mental health centres expressing...

  17. A case control study to find out child feeding practices responsible for severe acute malnutrition among under-five children admitted in MTC at a tertiary care centre, Bikaner, Rajasthan

    Directory of Open Access Journals (Sweden)

    Kavita Choudhary

    2014-12-01

    Full Text Available Introduction: There is no significant difference between NFHS II &III with respect to under- nutrition data but Gross national income has increased many times, so poverty and unavailability of food alone cannot be the only reasons of under- nutrition. Under-nutrition is the result of many interrelated factors such as poverty, insufficient household food security, inadequate health services, poor maternal and child care practices and inadequate water and sanitation. For communities with a high prevalence of under- nutrition, it may take years or even decades before all of these factors can be addressed. Aims and Objectives:  to find out child feeding practices responsible for severe acute malnutrition among Under-five Children and to recommend a Community Action Plan based on Positive Deviance Approach to deal with under-nutrition quickly, affordably and sustainably in a culturally acceptable manner. Materials & Methods: Study design: Matched Case Control study. Sample size: 143 cases and age, socio-economic status matched 143 controls. Study place: MTC and Immunization clinic. Study Duration: May, 2013- May, 2014. Study Tool and Data Collection: Semi-structured pre-tested questionnaire. Data analysis: with help of SPSS16 (Mean, SD, Proportion, odds ratio. Results: Strong positive association was found between duration of exclusive breast feeding(both shorter and longer, prelacteals, diluted milk as weaning food, bottle feeding, giving excess milk and less solid protein diet, not able to recognize cue of hunger by mother, lack of demand feeding, and severe acute malnutrition. Conclusion: Not any nutritional programme can help in preventing SAM unless we motivate the mothers for good child feeding and rearing practices. This can be achieved by identification of the Positive Deviant mothers from the same community and SES, who can motivate the mothers of SAM children and can practically demonstrate positive child feeding practices in a culturally

  18. Beliefs regarding diet during childhood illness

    Directory of Open Access Journals (Sweden)

    Asha D Benakappa

    2012-01-01

    Full Text Available Background: Fifty percent to 70% of the burden of childhood diarrhea and respiratory infections is attributable to undernutrition. It is compounded by food restriction during illness due to false beliefs, leading to a vicious cycle of malnutrition and infection. In the long run, it decreases the child′s productivity, which is an obstacle to sustainable socioeconomic development. Objectives: To assess the dietary practices during different illnesses, to study the role of education, culture and religion in feeding an ill child and to create awareness against detrimental practices. Materials and Methods: A cross-sectional study was undertaken among 126 caregivers of ill children using an open-ended pretested questionnaire. Statistical package for social sciences software was used for data analysis. Simple proportions, percentages and Chi-square were used. Results: Caregivers believed that a child must be fed less during illness. Educational status did not play a role in maintaining beliefs, but elders and religion did. Doctors too were responsible for unwanted dietary restrictions. Media did not have an impact in spreading nutrition messages. Decreased breast feeds, initiating bottle feeds, feeding diluted milk and reducing complementary feeds during illness was widely practiced. Calorie intake during illness was very less and statistically significant. Firmly rooted beliefs about "hot" and "cold" foods lead to restriction of food available at home. Conclusions: Healthy feeding practices were few, and inappropriate ones predominant. Dietary education was overlooked. While planning community-based nutrition programs, firmly rooted beliefs should be kept in mind. Involving the elderly caregivers and mothers actively along with the health workers is the need of the hour.

  19. "If God wills...next year I will send her back to school": The Effects of Child and Parental Illness on School Participation in Rural Ethiopia. CREATE Pathways to Access. Research Monograph No. 60

    Science.gov (United States)

    Orkin, Kate

    2011-01-01

    Rural Ethiopian children, and members of their households, often suffer from common and preventable but debilitating illnesses, such as malaria, parasite infection and worms. Enrolment rates in Ethiopia are high, but school attendance is patchy, children often drop out of school (although they sometimes return), and grade repetition is common.…

  20. Validation of the Asthma Illness Representation Scale (AIRS©)

    Science.gov (United States)

    Sidora-Arcoleo, Kimberly; Feldman, Jonathan; Serebrisky, Denise; Spray, Amanda

    2016-01-01

    Background Research has suggested a link between parents' illness representations (IRs), use of complementary and alternative medicine, inhaled/oral corticosteroids and leukotriene antagonists, and children's health outcomes. The Asthma Illness Representation Scale (AIRS©) provides a structured assessment of the key components of asthma IRs allowing the healthcare provider (HCP) to quickly identify areas of discordance with the professional model of asthma management. Methods These analyses extend the initial validation of the AIRS© and compares data from the original study conducted among a primarily white and African American sample in Rochester, NY (N = 228) with data obtained from a predominantly inner-city, ethnic minority sample (Puerto Rican, African American, and Afro-Caribbean) from the Bronx, New York (N = 109). Results A larger proportion of the Rochester sample was white and non-poor and had graduated high school. Bronx parents were more likely to perceive their child's asthma to be moderate or severe than the Rochester parents. Bronx children were older and had longer duration of asthma and reported more acute health care visits (past year). Bronx parents reported total AIRS© scores more closely aligned with the lay model than Rochester parents. The AIRS© instrument demonstrated acceptable internal reliability among the Bronx sample (total score α = 0.82) and the AIRS© subscale Cronbach's alpha coefficients were remarkably similar to those obtained from the original validation study (range = 0.54–0.83). Poor parents and those with less than a high school education had lower total AIRS© scores than their counterparts. White parents had AIRS© scores more closely aligned with the professional model compared to each of the ethnic subgroups. A perception of less severe asthma, fewer reports of asthma and somatization symptoms, and a positive HCP relationship were associated with IRs congruent with the professional model. IRs aligned with the

  1. Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone

    Science.gov (United States)

    2014-07-01

    yellow fever , Rift Valley fever , chikungunya, Ebola, and Marburg viruses but not to Crimean-Congo hemorrhagic...Lassa fever . We tested for IgM to dengue virus (DENV), West Nile vi- rus (WNV), yellow fever virus (YFV), Rift Valley fever virus (RVFV), chikungunya...total (%) Dengue 11/253 (4.3) 6/250 (2.4) West Nile 7/253 (2.8) 3/250 (1.2) Yellow fever 5/201 (2.5) 5/201 (2.5) Rift Valley fever 5/253 (2.0)

  2. [Depression in older adults: the National Mental Care Project for People with Physical Illness].

    Science.gov (United States)

    Ito, Hiroto; Fukuda, Koji; Hattori, Hideyuki

    2013-01-01

    Political attention is being increasingly directed to mental health in Japan. Mental disorders are now the fifth priority disease after cancer, stroke, acute myocardial infarction and diabetes for national medical services since April 2013. Each prefecture has to implement strategic mental healthcare plans at the regional level. With the increase in co-morbid mental and physical illnesses, patient information should be shared between psychiatric and non-psychiatric healthcare providers, and coordination is required in the healthcare systems. A better understanding of mental health between patients and medical staffs could contribute to improved access to psychiatric services in the integrated mental health care system. Collaborative care programs focusing on depression screening and management in the Mental Health Care Project for Patients with Physical Illness have been launched among six national specialized care and research centers (cancer, cardiovascular disease, diabetes, child care, geriatric care and neurology and psychiatry) since 2012. These efforts to integrate mental health care into the general health care system would help to improve psychiatric care for elderly patients with physical illnesses.

  3. Child Poverty and Child Outcomes.

    Science.gov (United States)

    Bradshaw, Jonathan

    2002-01-01

    Reviews the evidence on the prevalence of child poverty in Britain including: (1) how child poverty has changed over the last 20 years; (2) how child poverty in Britain compares with that in other countries; (3) characteristics of poor children; (4) impact of poverty on child well-being; and (5) government attempts to abolish child poverty. (SD)

  4. Parental health shocks, child labor and educational outcomes: Evidence from Tanzania.

    Science.gov (United States)

    Alam, Shamma Adeeb

    2015-12-01

    This paper examines the impact of parental illness on children's education. We find that only father's illness decreases children's school attendance. Father's illness also has long-term impacts on child education, as it decreases children's likelihood of completing primary school and leads to fewer years of schooling. However, we find no evidence that father's illness affects schooling through increased child labor. Instead, father's illness decreases household's income and reduces school attendance possibly because of the reduced ability of the family to afford education. In contrast, mother's illness and illness of other household members have no effect on children's schooling.

  5. Foodborne Germs and Illnesses

    Science.gov (United States)

    ... 2020 and Food Safety Food Safety Modernization Act Foodborne Germs and Illnesses Recommend on Facebook Tweet Share Compartir Foodborne Germs Botulism Campylobacter Clostridium perfringens Cyclospora E. coli ...

  6. Etnografía de la infección respiratoria aguda en una zona rural del altiplano mexicano Ethnography of acute respiratory illnesses in a rural zone of the Mexican central highlands

    Directory of Open Access Journals (Sweden)

    HOMERO MARTÍNEZ

    1997-05-01

    menor costo fueron razones frecuentemente aducidas para estas elecciones. Conclusiones. Esta información puede resultar útil para mejorar la comunicación con las madres.Objective. To identify the terms used by mothers to refer to diseases, signs and symptoms related to acute respiratory illnesses (ARI, alarming signs which should motivate them to seek medical attention, and to describe common home practices of disease care and treatment. Material and methods. An ethnographic study was performed in six rural communities of the Mexican central highlands. Interviews were collected from 12 key informers, six mothers of children who had died from ARI and 24 mothers of children younger than five years of age, with several ethnographic techniques to complement information ("triangulation". Results. The most commonly identified diseases were cold, sore throat, cough, bronchitis, pneumonia and "broncomonía". Key signs to establish diagnosis included nasal discharge, sore throat, cough, head and body ache, fever, "bubbling" chest, general malaise and shortness of breath. Tachypnea was referred to as "b breathing", "much breathing", "rapid breathing" or "sizzle"; intercostal depression as "the chest sinks", stridor as "chest moan or chest snore", sibilance as "chest snore" and cyanosis as "he turns purple". Home treatments include herbal teas, lemon, green or red tomato or potato applied to the throat externally, as well as creams applied to chest or back. Antibiotic prescription was not common, contrary to antipiretics. Most mothers recognized mild illnesses: severe illnesses were recognized less frequently. When faced with a severe ARI, mothers sought attention firstly at the project clinic, second in frequency with a private physician in the capital of the province and then at the Health Ministry of the district. The reasons to choose these possibilities were mainly proximity and lower costs. Conclusions. This information can be useful to improve communication with mothers.

  7. Heat Related Illnesses

    Institute of Scientific and Technical Information of China (English)

    Robert Carter III; Samuel N. Cheuvront; Michael N. Sawka

    2007-01-01

    @@ KEY POINTS · Heat illnesses range in severity from mild (heat rash, heat syncope, cramps) to serious (heat exhaustion, heat injury, heat stroke). · Although heat illness can occur in anyone, an increased risk is associated with a variety of environmental factors, personal characteristics,health conditions, and medications.

  8. Life threatening illness and hospice care.

    Science.gov (United States)

    Stein, A; Forrest, G C; Woolley, H; Baum, J D

    1989-01-01

    A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses. PMID:2730123

  9. Early nutritional depletion in critically ill children.

    Science.gov (United States)

    Pollack, M M; Wiley, J S; Holbrook, P R

    1981-08-01

    Nutritional status was evaluated in 50 medical admissions to a pediatric ICU. All patients were evaluated within 48 h of admission; none had chronic organ failure or malignancies. Nutritional assessment included weight/50th percentile weight for length, length/50th percentile length for age, triceps skinfold thickness, and midarm muscle circumference. Acute protein-energy malnutrition (PEM) occurred in 16% of all children. Chronic PEM also occurred in 16%. The nutrient stores of fat and somatic protein were deficient in 18 and 20% of all children. Acute PEM and deficient somatic protein stores were more frequent in children less than 2 years (p less than 0.05). These findings indicate that malnutrition and nutrient store deficiencies are common early in the course of critical illnesses in children, especially in those less than 2 years of age. However, the findings do not indicate if the severity of illness was the cause or effect of poor nutritional status.

  10. Acute severe organophosphate poisoning in a child who was successfully treated with therapeutic plasma exchange, high-volume hemodiafiltration, and lipid infusion.

    Science.gov (United States)

    Yesilbas, Osman; Kihtir, Hasan S; Altiti, Mohammad; Petmezci, Mey Talip; Balkaya, Seda; Bursal Duramaz, Burcu; Ersoy, Melike; Sevketoglu, Esra

    2016-10-01

    Acute severe organophosphate poisoning is a serious complication seen in developing and agricultural countries. Pralidoxime and high dose atropine are the standard treatments. There is no consensus about acute severe organophosphate poisonings that are unresponsive to pralidoxime, atropine, and supportive therapies. We report a case of acute severe organophosphate poisoning that was unresponsive to standard treatments and successfully treated with high-volume continuous venovenous hemodiafiltration and therapeutic plasma exchange combined with lipid infusion. J. Clin. Apheresis 31:467-469, 2016. © 2015 Wiley Periodicals, Inc.

  11. Myopathies in critical illness: characterization and nutritional aspects.

    Science.gov (United States)

    Burnham, Ellen L; Moss, Marc; Ziegler, Thomas R

    2005-07-01

    Myopathies related to critical illness have received increasing recognition over the past decade and are common in patients even after a brief period in the intensive care unit. Recent studies have revealed that myopathies in the critically ill may in fact be more prevalent than neuropathies and that morbidity and mortality may be greater. Protein catabolism, an increase in urinary nitrogen loss, and muscle wasting are observed in critical illness myopathy. Muscle biopsies in critically ill patients demonstrate low glutamine levels, low protein/DNA levels, and high concentrations of extracellular water. The increased flux of glutamine in muscle in these patients is thought to be insufficient to meet the body's requirement for glutamine, and thus in critical illness this amino acid may be classified as "conditionally essential." Three subtypes of critical illness myopathy have been described that are often grouped together as acute quadriplegic myopathy: thick-filament myopathy, critical illness myopathy, and necrotizing myopathy. These can be differentiated based on clinical features and muscle biopsy. Treatments for critical illness myopathies range from primary prevention, i.e., avoiding myopathy-inducing drugs, to novel nutritional therapies, such as glutamine and glutathione supplementation. One should be particularly vigilant for the development of myopathies in critically ill alcoholic patients, who may have a chronic alcoholic myopathy at baseline. In the past decade, advances have been made in characterizing and identifying patients with myopathies due to critical illness. However, additional studies must be performed in order to develop appropriate therapies for this potentially devastating disorder.

  12. Nutrition in chronic critical illness.

    Science.gov (United States)

    Pingleton, S K

    2001-03-01

    Nutritional management of patients with respiratory failure can be a model of nutritional management in chronically critically ill patients. This model requires recognition of the differing metabolic states of starvation and hypermetabolism. Starvation can result in malnutrition, with adverse effect on respiratory muscle strength, ventilatory drive, and immune defense mechanisms. General nutritional goals include preservation of lean body mass by providing adequate energy and positive nitrogen balance. General nutritional prescriptions for both states include a substrate mix of 20% protein, 60% to 70% carbohydrates, and 20% to 30% fat. Positive nitrogen balance is difficult to attain in hypermetabolic patients and energy requirements are increased compared with starved patients. Enteral nutrition should be the mode of initial nutrient delivery unless the gastrointestinal tract is nonfunctional. Monitoring of nutritional support is essential. Complications of nutritional support are multiple. Nutritional hypercapnia is an important complication in a chronically critically ill patient. Outcomes of selected long-term acute patients are poor, with only 8% of patients fully functional 1 year after discharge. Appropriate nutritional therapy is one aspect of management of these patients that has the possibility of optimizing function and survival.

  13. Seizures in the critically ill.

    Science.gov (United States)

    Ch'ang, J; Claassen, J

    2017-01-01

    Critically ill patients with seizures are either admitted to the intensive care unit because of uncontrolled seizures requiring aggressive treatment or are admitted for other reasons and develop seizures secondarily. These patients may have multiorgan failure and severe metabolic and electrolyte disarrangements, and may require complex medication regimens and interventions. Seizures can be seen as a result of an acute systemic illness, a primary neurologic pathology, or a medication side-effect and can present in a wide array of symptoms from convulsive activity, subtle twitching, to lethargy. In this population, untreated isolated seizures can quickly escalate to generalized convulsive status epilepticus or, more frequently, nonconvulsive status epileptics, which is associated with a high morbidity and mortality. Status epilepticus (SE) arises from a failure of inhibitory mechanisms and an enhancement of excitatory pathways causing permanent neuronal injury and other systemic sequelae. Carrying a high 30-day mortality rate, SE can be very difficult to treat in this complex setting, and a portion of these patients will become refractory, requiring narcotics and anesthetic medications. The most significant factor in successfully treating status epilepticus is initiating antiepileptic drugs as soon as possible, thus attentiveness and recognition of this disease are critical.

  14. 血清视黄醇结合蛋白4在危重患者急性肾功能障碍监测中的应用%Application of serum retinol binding protein 4 in the monitoring critically ill patients with acute renal dysfunction

    Institute of Scientific and Technical Information of China (English)

    喻红波; 刘阳; 张强; 李刚

    2011-01-01

    [Objective] To investigate the clinical value of serum retinol binding protein 4 in the monitoring acute renal dysfunction critically ill patients. [Methods] Serum retinol binding protein 4, creatinine and renal creatinine clearance level were determined in 72 critically ill patients, and their difference was analyzed. [Results] The levels of serum retinol binding protein 4 and creatinine clearance rate was negatively correlated, and serum retinol binding protein-4 correlated better with GFR than creatinine. The detection rate of acute renal dysfunction by serum retinol binding protein 4 (28/38) was higher than that of serum creatinine (8/38), the difference was statistically significant. [Conclusion] Retinol binding protein 4 is an accurate marker of subtle changes in GFR, and may be superior to creatinine when assessing this parameter in clinical practice in critically ill patients. The analysis of serum retinol binding protein 4 in critically ill patients may be helpful for the monitoring of acute renal dysfunction.%[目的]探讨视黄醇结合蛋白4在危重患者急性肾功能障碍监测中的应用.[方法]测定72例危重患者视黄醇结合蛋白4,肌酐及肾脏内生肌酐清除率水平,并分析其差异.[结果]危重患者视黄醇结合蛋白4水平与肾脏内生肌酐清除率水平明显负相关,且高于血清肌酐.在急性肾功能障碍检出率上,视黄醇结合蛋白4(28/38)高于血清肌酐(8/38),差异有统计学意义.[结论]视黄醇结合蛋白4是较精准的肾小球滤过率监测指标,可用于危重患者急性肾功能障碍的监测.

  15. Vaccines Stop Illness

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues Vaccines Stop Illness Past Issues / Spring 2008 Table of ... meningitis won't infect, cripple, or kill children. Vaccine Safety In light of recent questions about vaccine ...

  16. Chronic Critical Illness

    Science.gov (United States)

    ... the patient’s situation and on the hospital and city. Do Chronically Critically Ill Patients Regain the Ability ... as the patient. You may feel stress, worry, sadness, or fatigue. Some families worry about financial burdens. ...

  17. Heat-Related Illnesses

    Medline Plus

    Full Text Available ... exhaustion symptoms include cool, moist, pale or flushed skin; headache; dizziness; weakness; feeling exhausted; heavy sweating; nausea; ... stage of heat illness) include flushed, hot, dry skin; fainting; a rapid, weak pulse; rapid, shallow breathing; ...

  18. Chronic Illness & Mental Health

    Science.gov (United States)

    ... is present. For More Information Share Chronic Illness & Mental Health Download PDF Download ePub Order a free hardcopy ... For more information, see the National Institute of Mental Health (NIMH) booklet on Depression at http://www.nimh. ...

  19. Heat-Related Illnesses

    Medline Plus

    Full Text Available ... for signs of heat stroke or exhaustion. Heat Stroke and Exhaustion Symptoms of early heat exhaustion symptoms ... heavy sweating; nausea; and giddiness. Symptoms of heat stroke (late stage of heat illness) include flushed, hot, ...

  20. Violence and Mental Illness

    OpenAIRE

    2008-01-01

    Violence attracts attention in the news media, in the entertainment business, in world politics, and in countless other settings. Violence in the context of mental illness can be especially sensationalized, which only deepens the stigma that already permeates our patients’ lives. Are violence and mental illness synonymous, connected, or just coincidental phenomena? This article reviews the literature available to address this fundamental question and to investigate other vital topics, includi...

  1. Nonthyroidal Illness (NTIs)

    OpenAIRE

    Nanny Natalia Mulyani Soetedjo

    2009-01-01

    Nonthyroidal illness (NTIs) can be described as abnormal findings on thyroid function tests that occur in the setting of a nonthyroidal illness (NTI) without preexisting hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible. Multiple alterations in serum thyroid function test findings have been recognized in patients with a wide variety of NTI without evidence of preexisting thyroid or...

  2. Acute Diarrhoeal Diseases Among Preschool Children in Western Maharashtra, India.

    Directory of Open Access Journals (Sweden)

    Mahesh B Tondare , Vaishali V Raje, Satish V Kakade , Madhavi V Rayate

    2014-01-01

    Full Text Available "Background: Malnutrition and infectious diseases both occur in the same unfortunate children and together they play a major role in causing the high morbidity and mortality in them. Out of all the childhood illnesses, acute respiratory tract infections, diarrhoeal diseases and malnutrition are the principle causes of illness and death in the developing countries. Acute Diarrhoeal diseases (ADD’s are reported to be the 2nd leading cause of child morbidity and mortality. Objectives: To study the attack rate of Acute Diarrhoeal Disease among pre-school children and to study the socio-demographic variables of pre-school children suffering from Acute Diarrhoeal Disease. Methods: A Longitudinal study was conducted among preschool children (3-5years who were selected from Private pre-primary school of urban area and followed for the period of one year. Mother/guardian/teacher was interviewed by using pre-tested proforma during this period. Results: About 56% of children found suffering from ADD with 0.6 episodes per children per year among private pre-primary school. Higher proportions of ADD affected children were residing in nuclear type of family, belonging to middle socio-economic class, mothers were literate & housewives, born with order >2 compared to non ADD affected children. Conclusion: Maximum number of children from private pre-primary schools suffered with nearly one attack of Acute Diarrhoeal Disease with maternal illiteracy and working mothers found favorable factors. Immunization coverage, EBF and proper weaning play a very important role in prevention of infections."

  3. ‘Better medicines for children’ within the Integrated Management of Childhood Illness framework

    DEFF Research Database (Denmark)

    Nsabagasani, Xavier; Ogwal-Okeng, Jasper; Hansen, Ebba Holme;

    2016-01-01

    prioritize funding for the Integrated Management of Childhood Illnesses and revising the Essential Medicines and Health Supplies List of Uganda, the Uganda Clinical Guidelines and, the Treatment Charts for the Integrated Management of Childhood Illnesses to reflect child-appropriate dosage formulations...

  4. Maternal Mental Illness and the Safety and Stability of Maltreated Children

    Science.gov (United States)

    Kohl, Patricia L.; Jonson-Reid, Melissa; Drake, Brett

    2011-01-01

    Objective: Children of mothers with mental illness are at risk for multiple untoward outcomes, including child maltreatment and foster care placement. The purpose of this analysis was to determine the association between maternal mental illness and children's long term safety and stability. Methods: A multi-sector administrative dataset from the…

  5. Parental Involvement of Mothers with Chronic Illness and Children's Academic Achievement

    Science.gov (United States)

    Chen, Yung-Chi; Fish, Marian C.

    2013-01-01

    This study examined how maternal chronic illnesses may affect children's academic achievement through parental involvement. A total of 189 mothers diagnosed with chronic illnesses, such as multiple sclerosis, diabetes, cancer, HIV/AIDS, chronic pain, asthma, myelodysplasic syndrome, and fibromyalgia, and with a child in middle school or high…

  6. Parental Involvement of Mothers with Chronic Illness and Children's Academic Achievement

    Science.gov (United States)

    Chen, Yung-Chi; Fish, Marian C.

    2013-01-01

    This study examined how maternal chronic illnesses may affect children's academic achievement through parental involvement. A total of 189 mothers diagnosed with chronic illnesses, such as multiple sclerosis, diabetes, cancer, HIV/AIDS, chronic pain, asthma, myelodysplasic syndrome, and fibromyalgia, and with a child in middle school or high…

  7. Scoliosis surgery - child

    Science.gov (United States)

    Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... Before surgery, your child will receive general anesthesia. This will make your child unconscious and unable to feel pain ...

  8. [Creativity and mental illness].

    Science.gov (United States)

    Rihmer, Zoltán; Gonda, Xénia; Rihmer, Annamária

    2006-01-01

    It has been known for a long time that people with salient social and artistic creativity suffer more frequently from psychiatric illnesses than the average population. In their review paper, the authors assess the Hungarian and international scientific literature regarding the association of creativity and psychopathology. They conclude that contrary to the concept prevailing in the first part of the 20th century about the strong association between schizophrenia and creativity, the results of empirical research now unambiguously suggest that prominent social and artistic creativity is associated primarily with affective, and more specifically with bipolar affective illnesses. In addition, we already know that as regards the development of creativity, it is not the given affective (depressive, manic, hypomanic) episode which is important, but the hyperthymic or cyclothymic temperament structure which also predisposes for affective illness.

  9. Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses: a case-control study in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Joëlle Castellani

    Full Text Available To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania.A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5.Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness. Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs. $0.90, p<0.0001. Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs. $4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52, p<0.0001. In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%.The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost.

  10. Ending preventable child deaths in South Africa: What role can ward-based outreach teams play?

    Science.gov (United States)

    Doherty, Tanya; Kroon, Max; Rhoda, Natasha; Sanders, David

    2016-06-17

    South Africa (SA) has emerged from the Millennium Development Goal era with a mixture of success and failure. The successful national scale-up of prevention of mother-to-child transmission of HIV services with increasingly efficacious antiretroviral regimens has reduced the mother-to-child transmission rate dramatically; however, over the same period there appears to have been no progress in coverage of high-impact interventions for pneumonia and diarrhoea, which are now leading causes of under-5 mortality. SA embarked on a strategy to re-engineer the primary healthcare system in 2011, which included the creation of ward-based outreach teams consisting of community health workers (CHWs). In this article we argue that the proposed ratio of CHWs to population is too low for public health impact and that the role and scope of CHWs should be extended beyond giving of health information to include assessment and treatment of childhood illnesses (particularly diarrhoea and suspected pneumonia). Evidence and experience amply demonstrate that CHWs in sufficient density can have a rapid and positive impact on neonatal and young child mortality, especially when they are allowed to treat common acute conditions. SA's mediocre performance in child survival could be dramatically improved if there were more CHWs who were allowed to do more.

  11. On being Credibly Ill

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    2011-01-01

    problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women......unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists...... are described by the welfare officers as tired and exhausted or truly stressed after a long working life....

  12. Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children.

    Science.gov (United States)

    Laulajainen-Hongisto, Anu; Aarnisalo, Antti A; Jero, Jussi

    2016-10-01

    Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.

  13. Mesenteric Lymph: The Bridge to Future Management of Critical Illness

    OpenAIRE

    2007-01-01

    Toxic factors released from the intestine have been implicated in the pathophysiology of severe acute illness, including acute pancreatitis, trauma and hemorrhagic shock, and burns. Toxic factors in mesenteric lymph may induce an inflammatory systemic response while bypassing the portal circulation and liver. This paper reviews current knowledge of the anatomy, physiology and pathophysiology of mesenteric lymph and focuses on factors influencing its composition and flow, and potential therape...

  14. 青年急性心肌梗死患者疾病不确定感与应对模式的相关性分析%Investigation and correlation analyze on uncertainty in illness and coping styles among young patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    陈健红; 刘砂沙; 申健; 邓瑞珍

    2015-01-01

    Objective To investigate the uncertainty in illness and coping styles among young patients with acute myocardial infarction ( AMI) and analyze their correlation. Methods We used Mishel Uncertainty in Illness Scale ( MUIS) and the Medical Coping Modes Questionnaire ( MCMQ) to assessed 134 young AMI patients cross section study, and analyzed the correlation among the results. Results Total score regarding young AMI patients′uncertainty in illness was (125. 45 ± 24. 49); the average facing score and the avoidance score and the yield score regarding MCMQ were (20. 08 ± 4. 82), (15. 18 ± 2. 83) and (7. 14 ± 2. 69) respectively. Analysis indicated that both the facing and the avoidance score were negatively correlated with the total score of MUIS ( r=-0. 351,-0. 267;P<0. 05);the yield score were positively correlated with the total score of MUIS (r=0. 344, P<0. 01). Conclusions The uncertainty of illness is at high level among young AMI patients, coping it in a positive way is helpful with decreasing patients′uncertainty in illness.%目的 调查青年急性心肌梗死( AMI)患者的疾病不确定感和应对模式,并分析其相关性.方法 采用疾病不确定感量表( MUIS)、医学应对方式问卷( MCMQ)对134例青年AMI行PCI治疗术后住院患者进行横断面调研,分析两者之间的相关性. 结果 134例青年AMI患者MUIS总分为(125. 45 ± 24. 49)分;MCMQ问卷中面对维度平均分为(20. 08 ± 4. 82)分,回避维度平均分为(15. 18 ± 2. 83)分,屈服维度平均分为(7. 14 ± 2. 69)分. 相关分析显示,面对、回避维度评分与MUIS总分呈负相关( r值分别为-0. 351,-0. 267;P<0. 05),屈服维度评分与MUIS总分均呈正相关(r=0. 344,P<0. 01). 结论 青年AMI患者存在高度不确定感状态,积极地面对方式将有利于降低青年AMI患者的疾病不确定感.

  15. Care in the home for seriously ill children with complex needs: A narrative literature review.

    Science.gov (United States)

    Ward, Cynthia; Glass, Nel; Ford, Rosemary

    2015-12-01

    This article reviews contemporary literature on home care of the seriously ill child with complex care needs and the sick child/parent dyad. The literature search revealed three major themes, namely the increasing acuity of child illness, the evolving role of the parent as care provider, and the health professional as care provider. While there is much known about the complexity of care of children and the role of family in that care, little is known about what families require in terms of support and sustenance during the long years of care provision.

  16. Mental Illness And Brain Disease.

    Science.gov (United States)

    Bedrick, Jeffrey D

    2014-01-01

    It has become common to say psychiatric illnesses are brain diseases. This reflects a conception of the mental as being biologically based, though it is also thought that thinking of psychiatric illness this way will reduce the stigma attached to psychiatric illness. If psychiatric illnesses are brain diseases, however, it is not clear why psychiatry should not collapse into neurology, and some argue for this course. Others try to maintain a distinction by saying that neurology deals with abnormalities of neural structure while psychiatry deals with specific abnormalities of neural functioning. It is not clear that neurologists would accept this division, nor that they should. I argue that if we take seriously the notion that psychiatric illnesses are mental illnesses we can draw a more defensible boundary between psychiatry and neurology. As mental illnesses, psychiatric illnesses must have symptoms that affect our mental capacities and that the sufferer is capable of being aware of, even if they are not always self-consciously aware of them. Neurological illnesses, such as stroke or multiple sclerosis, may be diagnosed even if they are silent, just as the person may not be aware of having high blood pressure or may suffer a silent myocardial infarction. It does not make sense to speak of panic disorder if the person has never had a panic attack, however, or of bipolar disorder in the absence of mood swings. This does not mean psychiatric illnesses are not biologically based. Mental illnesses are illnesses of persons, whereas other illnesses are illnesses of biological individuals.

  17. Child Development

    Science.gov (United States)

    As children grow older, they develop in several different ways. Child development includes physical, intellectual, social, and emotional changes. Children grow and mature at very different rates. It's ...

  18. Foodborne Illness Retrospective

    Centers for Disease Control (CDC) Podcasts

    2015-05-07

    Dr. Paul Mead and Dr. Peter Drotman discuss the historic October 1999 article, Food-related Illness and Death in the United States.  Created: 5/7/2015 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 5/7/2015.

  19. The nonthyroidal illness syndrome.

    Science.gov (United States)

    Adler, Suzanne Myers; Wartofsky, Leonard

    2007-09-01

    This article briefly summarizes thyroid function alterations generally seen in the euthyroid sick syndrome, provides an overview of specific thyroidal adaptations during several clinical conditions and secondary to specific pharmacologic agents, and discusses the current controversy in thyroid hormone treatment of nonthyroidal illness.

  20. High-Altitude Illness

    Science.gov (United States)

    ... also called HAPE), which affects the lungsHigh-altitude cerebral edema (also called HACE), which affects the brainThese illnesses ... HAPE, high altitude, high altitude sickness, high-altitude cerebral edema, high-altitude pulmonary edema, hypobaropathy, mountain sickness, nifedipine, ...

  1. Illness anxiety disorder

    Science.gov (United States)

    ... a serious disease is unreasonable or unfounded. Illness anxiety disorder is different from somatic symptom disorder. With somatic symptom disorder, the person has physical pain or other symptoms, but the medical cause is not found. Exams and Tests The doctor or nurse will examine you and ...

  2. Critical-Illness Polyneuropathy

    OpenAIRE

    J Gordon Millichap

    1993-01-01

    A review of the neurological complications of sepsis from the University of Western Ontario, London, and Queen’s University, Kingston, Ontario, Canada, draws attention to “critical-illness polyneuropathy” as a cause of difficulty in weaning from the ventilator.

  3. The illness of Vincent van Gogh.

    Science.gov (United States)

    Arnold, Wilfred Niels

    2004-03-01

    Vincent van Gogh (1853-1890) was a wonderfully accomplished artist whose work is now widely appreciated. He created a great number of masterpiece paintings and drawings in just one decade devoted to art. His productivity is even more remarkable when considered in the context of his debilitating illness. He suffered from medical crises that were devastating, but in the intervening periods he was both lucid and creative. He left a profound, soul-searching description of his jagged life in his correspondence, which provides the basis for the present analysis. An inherited metabolic disease, acute intermittent porphyria, accounts for all of the signs and symptoms of van Gogh's underlying illness. On this 150th anniversary of the birth of Vincent van Gogh it is appropriate to revisit the subject and to analyze the lack of organized skepticism in the popular media about other diagnoses.

  4. 成功治疗儿童罕见髓系/自然杀伤细胞祖细胞急性白血病1例%An Unusual Child Case of Myeloid/Natural Killer Cell Precursor Acute Leukemia Treated Successfully with Acute Myeloid Leukemia-Oriented Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    陈玉梅; 刘芳; 邹尧; 阮敏; 刘晓明; 刘天峰; 竺晓凡

    2012-01-01

    This study was aimed to identify the characteristics of childhood myeloid/'natural killer cell precursor acute leukemia (M/NKPAL), and to summarize the therapeutical experiences of this rare hematologic malignancy. A child case of M/NKPAL accompanied by CNS leukemia was enrolled in this study, the therapeutic regiments and the results of long time following up were analysed and evaluated. The results showed that the unusual child case of M/NKPAL with CNS infiltration was diagnosed, showing immunophenotype of CD7+, CD33+, CD3child case was treated with daunorubicin and cytarabine, and achieved complete remission. Then, S coures of acute myeloid leukemia-oriented chemotherapy were given as consolidation chemotherapy, all of the 5 courses contained high dose cytarabine. This child case was given 9 times of lumbar puncture and intrathecal injection, besides these, this case was also given cranial radiotherapy with a dose of 36 Gy. After treated with these methods, the child case achieved long-term complete remission. It is concluded that the M/NKPAL is a rare disease with distinctive immunophenotypic characteristics, acute myeloid leukemia-oriented chemotherapy regimen with high dose of cytarabine may be able to induce long-term remission.%本文总结儿童髓系/自然杀伤细胞祖细胞急性白血病(M/NKPAL)的治疗经验以提高对该病的认识.对1例罕见的3岁8个月女童M/NKPAL合并中枢神经系统白血病进行了确诊分析,并对其治疗经过及长期随访结果进行了总结.结果表明,女童M/NKPAL合并中枢神经系统浸润得到了确诊,其免疫表型特征为CD7,CD33,CD34,CD56和HLA-DR共表达,MPO阴性,其他NK细胞和T、B细胞分化抗原阴性,染色体核型有+8和12p -.采用柔红霉素+阿糖胞苷化疗后达完全缓解,随后应用急

  5. Proven Epstein-Barr encephalitis with negative EBV-DNA load in cerebrospinal fluid after allogeneic hematopoietic stem cell transplantation in a child with acute lymphoblastic leukemia.

    Science.gov (United States)

    Barberi, Walter; Perrone, Salvatore; Iori, Anna Paola; Torelli, Giovanni Fernando; Testi, Anna Maria; Moleti, Maria Luisa; Ceglie, Teresa; Papoff, Paola; Caresta, Elena; Antonelli, Manila; Gianno, Francesca; Melone, Antonio; Badiali, Manuela; Giangaspero, Felice; Foà, Robin; Gentile, Giuseppe

    2015-02-01

    We report a case of EBV encephalitis in a seven-yr-old child with Ph+ ALL. Two months after an allogeneic HSCT from his HLA mismatched mother, the patient showed an altered sensorium, generalized seizures, and a left hemiparesis. Brain MRI demonstrated multiple lesions highly suggestive for viral encephalitis. Blood and CSF PCR analyses were negative for the most common viruses involved in immunocompromised patients including EBV. A cerebral biopsy was performed, which showed intense gliosis and perivascular lymphocytic cuffing. PCR analysis performed on brain tissue was positive only for the EBV genome, while extensive investigations for other viral infections were negative. The patient's neurological symptoms rapidly worsened and he died two months later. This case report suggests that in patients presenting neurological and radiological signs of encephalitis after an HSCT, an EBV involvement should be considered, even in the absence of CSF and blood PCR virus detection.

  6. Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients

    DEFF Research Database (Denmark)

    Maffiuletti, Nicola A.; Roig, Marc; Karatzanos, Eleftherios;

    2013-01-01

    Background: Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically...

  7. Hyperglycaemia in critically ill patients : marker or mediator of mortality?

    NARCIS (Netherlands)

    Corstjens, Anouk M.; van der Horst, Iwan C. C.; Groeneveld, A. B. Johan; Zijlstra, Felix; Tulleken, Jaap E.; Ligtenberg, Jack J. M.; Zijlstra, Jan

    2006-01-01

    Acute hyperglycaemia has been associated with complications, prolonged intensive care unit and hospital stay, and increased mortality. We made an inventory of the prevalence and prognostic value of hyperglycaemia, and of the effects of glucose control in different groups of critically ill patients.

  8. Hormones in the critically ill patient : to intervene or not to intervene?

    NARCIS (Netherlands)

    Ligtenberg, JJM; Girbes, ARJ; Beentjes, JAM; Tulleken, JE; van der Werf, TS; Zijlstra, JG

    2001-01-01

    Critically ill patients show a variety of hormonal changes that appear to differ considerably in acute and prolonged critical illness. Whether these endocrine alterations serve as physiological adaptation or contribute to further deterioration remains an intriguing question. We review the recent lit

  9. Exercise Prevents Mental Illness

    Science.gov (United States)

    Purnomo, K. I.; Doewes, M.; Giri, M. K. W.; Setiawan, K. H.; Wibowo, I. P. A.

    2017-03-01

    Multiple current studies show that neuroinflammation may contribute to mental illness such as depression, anxiety, and mood disorder. Chronic inflammation in peripheral tissues is indicated by the increase of inflammatory marker like cytokine IL-6, TNF-α, and IL-1β. Pro-inflammatory cytokine in peripheral tissues can reach brain tissues and activate microglia and it causes neuroinflammation. Psychological stress may led peripheral and central inflammation. Activated microglia will produce pro-inflammatory cytokine, ROS, RNS, and tryptophan catabolizes. This neuroinflammation can promote metabolism changes of any neurotransmitter, such as serotonin, dopamine, and glutamate that will influence neurocircuit in the brain including basal ganglia and anterior cingulated cortex. It leads to mental illness. Exercise give contribution to reduce tissue inflammation. When muscle is contracting in an exercise, muscle will produce the secretion of cytokine like IL-6, IL-1ra, and IL-10. It will react as anti-inflammation and influence macrophage, T cell, monosit, protein Toll-Like Receptor (TLR), and then reduce neuroinflammation, characterised by the decrease of pro-inflammatory cytokine and prevent the activation of microglia in the brain. The objective of the present study is to review scientific articles in the literature related to the contribution of exercise to prevent and ease mental illness.

  10. The Stigma of Mental Illness

    Science.gov (United States)

    Overton, Stacy L.; Medina, Sondra L.

    2008-01-01

    Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its…

  11. Child Care and Child Nutrition

    Science.gov (United States)

    Karolak, Eric

    2009-01-01

    The weak economy is challenging the child care program budget. Fluctuations in enrollment come up against rising costs making every penny count. So for many reasons a federal program that helps defray the costs of snacks and meals in child care programs is particularly important and timely. In this article, the author pushes for the…

  12. Teaching strategies for atypical presentation of illness in older adults.

    Science.gov (United States)

    Gray-Miceli, Deanna; Aselage, Melissa; Mezey, Mathy

    2010-07-01

    Atypical presentation of illness is a phenomenon where "seeing is believing." Expert geriatric nurses and clinicians know all too well the early signs and symptoms of this phenomenon, which frequently masquerades bacterial infections, pain, acute myocardial infarction, heart failure, or other serious medical ailments in older adults. Students, however, as novices to clinical practice, require interactive learning approaches to reflect on the patient's illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and witness resolution of an atypical presentation when found and treated. Use of a case study as an educational tool can facilitate critical thinking about a clinical problem, such as atypical presentation of illness, for students within a problem-based learning format. Furthermore, we highlight strategies for teaching students atypical presentation of illness with consideration of student learning preferences, which include visual, auditory, reading, and kinesthetic modes of learning.

  13. Valores poblacionales de referencia del perfil de salud CHIP-AE a partir de una muestra representativa de adolescentes escolarizados Reference population values for the Spanish Child Health and Illness Profile-Adolescent Edition [CHIP-AE] using a representative school-based sample

    Directory of Open Access Journals (Sweden)

    V. Serra-Sutton

    2003-06-01

    Full Text Available Objetivo: El perfil de salud CHIP-AE (Child Health and Illness Profile, Adolescent Edition es un instrumento genérico para adolescentes de 12 a 19 años que ha sido adaptado para uso en España. El objetivo del estudio fue obtener los valores poblacionales de referencia de la versión española del CHIP-AE. Métodos: Se administró el CHIP-AE a una muestra representativa de adolescentes escolarizados de Barcelona, mediante muestreo por conglomerados, estratificado según la titularidad del centro (público o concertado y el índice de capacidad económica familiar (bajo, medio y alto. Se estandarizaron las puntuaciones a una media de 20 y desviación estándar (DE de 5. Se calcularon las medias y los percentiles. Las medias se compararon por edad, género y nivel socioeconómico mediante análisis de la varianza. Resultados: Las proporción de respuesta fue del 81% (n = 902. Las puntuaciones presentaron un amplio rango de distribución, y aunque en general fueron algo sesgadas hacia las puntuaciones de buena salud, sugieren que la muestra de población general no está exenta de problemas de salud. El 25% presentó puntuaciones por debajo de 17,2 en la dimensión de bienestar, lo que indica un tamaño de efecto de 0,56 unidades estandarizadas de DE. La distribución de las puntuaciones de las muestras de referencia de Barcelona fueron muy similares a las originales de Baltimore (Estados Unidos, con diferencias mínimas en riesgo individual. Conclusiones: El CHIP-AE recoge de manera sistemática las dimensiones propias de la salud de los adolescentes. Los resultados permitirán establecer comparaciones con adolescentes de otras regiones, y/o con diferentes problemas de salud y analizar las desigualdades en salud durante la adolescencia.Aim: The Child Health and Illness Profile (CHIP-AE is a generic health status instrument for adolescents aged 12-19 years adapted for use in Spain. The aim of this study was to obtain reference population values

  14. A rare aggravation of severe mucositis post chemotherapy in a child with acute lymphoblastic leukemia [v1; ref status: indexed, http://f1000r.es/1tf

    Directory of Open Access Journals (Sweden)

    Adlette Inati

    2013-09-01

    Full Text Available Oral mucositis is a debilitating manifestation in children undergoing chemotherapy and radiotherapy. Children with mucositis should be properly managed in order to prevent further exacerbation and adverse complications. We hereby present the first report of a severe chemotherapy-induced mucositis, plausibly aggravated by improper dental hygiene leading to shedding of the ventral part of the tongue in a child with pre-B acute lymphoblastic leukemia (ALL. The patient steadily and gradually recovered her oral maneuvers and ability to speak several months later. Her tongue underwent hypertrophy as a compensatory mechanism. We recommend that critical and regular assessment of the oral mucosa and proper dental care and oral hygiene be emphasized in all pediatric patients receiving chemotherapy. Families of affected children need to be educated about the benefits and modes of optimal oral hygiene for their children and the need to seek immediate care for mouth pain and or lesions. Optimal treatment for mucositis needs to be instituted without delay in this high risk pediatric population. Such a preventive and therapeutic approach may prevent associated life threatening oral and systemic complications, promote rapid and complete mucosal healing, alleviate pain and improve quality of life in children with cancer.

  15. Prevalence and Factors Associated with Child Malnutrition in Nzega District, Rural Tanzania

    Directory of Open Access Journals (Sweden)

    John G. Safari

    2015-07-01

    Full Text Available Children younger than five years are the most vulnerable to diseases and malnutrition. A cross-sectional study was undertaken in rural areas of Nzega district in Tanzania to assess the prevalence and factors of malnutrition among children aged 6-59 months. Simple random sampling technique was used to select a representative sample of households with target children. The study enrolled 460 mother-child pairs from five wards. Data were collected using a semi-structured questionnaire. Child nutritional status was assessed based on anthropometric measurements. The potential contributing factors to malnutrition were also assessed. These included: child feeding practices, socio-demographic characteristics, access to water, sanitation, history of illness episodes (diarrhoea and acute respiratory infection and child immunization status. The survey data were analyzed using SPSS for windows version 17.0 whilst anthropometric data were analysed using the ENA for SMART (2011 software. Almost all children (98.5% were breastfed. It was found that about one quarter (25.6% were breastfed immediately after birth and one third (33.5% received pre-lacteal feeds. Prevalence of stunting (height- for- age Z score <-2, wasting (weight- for-height Z score <-2 and underweight (weight-for-age Z score <-2 were 26.1, 6.5% and 11.7%, respectively. Chronic malnutrition (stunting was significantly (p<0.05 associated with child’s sex and age, mother’s education, number of antenatal care visits (ANC and family size. Others factors were episodes of diarrhea, acute respiratory infection and access to safe water. Overall, the nutritional status of the children is sub-optimal and therefore, attention is needed to address the situation.

  16. Intravenous levetiracetam in critically ill children

    Directory of Open Access Journals (Sweden)

    Faruk Incecik

    2016-01-01

    Full Text Available Background: To report the effectiveness and safety of intravenous (IV levetiracetam (LEV in the treatment of critically ill children with acute repetitive seizures and status epilepticus (SE in a children′s hospital. Materials and Methods: We retrospectively analyzed data from children treated with IV LEV. Results: The mean age of the 108 children was 69.39 ± 46.14 months (1-192 months. There were 58 (53.1% males and 50 (46.8% females. LEV load dose was 28.33 ± 4.60 mg/kg/dose (10-40 mg/kg. Out of these 108 patients, LEV terminated seizures in 79 (73.1%. No serious adverse effects were observed but agitation and aggression were developed in two patients, and mild erythematous rash and urticaria developed in one patient. Conclusion: Antiepileptic treatment of critically ill children with IV LEV seems to be effective and safe. Further study is needed to elucidate the role of IV LEV in critically ill children.

  17. Understanding the impact of chronic childhood illness on families.

    Science.gov (United States)

    Sabbeth, B

    1984-02-01

    A great deal has been written about mothers and their relationships with their ill children. Fathers, however, have been relatively excluded from the research, as they have been from many pediatrician-mother-child interactions. Although it has been noted that some fathers tend to withdraw from the family, in fact very little is known about the impact of childhood illness on their lives. In general, studies of mothers, fathers, siblings, marriage, and families emphasize psychopathology and other psychosocial problems. Yet, there is a growing awareness in the social sciences that we have much to learn from the capacity to adjust. How is it that some families of chronically ill children survive so well? This question has not been addressed. Most studies focus on individual constituents of the family. Minuchin and others have taught us about aberrant family systems that sometimes develop around chronically ill children. Such systems are characterized by high cohesion and conformity, and the absence of apparent friction. How frequently do such systems develop? How can they be prevented? Finally, understanding the impact of chronic childhood illness on families is a difficult task. Parents have reasons for obscuring the impact, and particularly their distress, from the view of their pediatrician. Physicians are often uncertain how much understanding they ought to offer. Careful attention to the parent-pediatrician relationship is essential to a thorough understanding of the impact of childhood illness on the family.

  18. Factors affecting health seeking behavior for common childhood illnesses in Yemen

    Science.gov (United States)

    Webair, Hana Hasan; Bin-Gouth, Abdulla Salim

    2013-01-01

    Introduction Appropriate medical care seeking could prevent a significant number of child deaths and complications due to ill health. This study aims to determine factors affecting health seeking behavior (HSB) for childhood illnesses, thereby improving child survival. Methods A cross sectional study was carried out from January 11 to April 2, 2012. A total of 212 caretakers of children under the age of 5 years participated. Caretakers who visited the vaccination unit in the Shehair Health Center during the study period and had a child with a history of diarrhea, fever, cough, and/or difficulty of breathing during the last 14 days were included. The data were collected by interviewing caretakers and the answers were reported in pretested structured questionnaires. Results Medical care was sought for about half of the sick children (n=109, 51.42%). Seeking medical care was frequently initiated for illnesses that did not improve or worsened. The major reasons for not seeking medical care were “illness was mild” (n=40, 38.83%) and “illness is not for medical treatment” (n=32, 31.07%). The caretakers sought medical care significantly more when they had a higher level of school education (POR [prevalence odds ratio] 5.85, 95% CI [confidence interval]: 2.34–14.61), when the illness was perceived as severe (POR 5.39, 95% CI: 2.81–10.33), and when the child had difficulty of breathing (POR 2.93, 95% CI: 1.10–7.80). Conclusion For the preventable childhood illnesses with existing interventions, appropriate HSB prevalence is low. Symptom type, caretakers’ education, and perception of illness severity are the predictors of HSB. Educational improvement of the mothers, introduction of community based integrated management of childhood illness, and in-depth research are imperative to improve mothers’ HSB. PMID:24187490

  19. The Other Side of Caring: Adult Children with Mental Illness as Supports to Their Mothers in Later Life.

    Science.gov (United States)

    Greenberg, Jan Steven

    1995-01-01

    Discusses the role of adult children with serious mental illness as a source of support to their aging parents. Most mothers reported that their mentally-ill children provided at least some ongoing help with daily living tasks. The adult child's assistance related significantly to lower levels of maternal subjective burden. (RJM)

  20. Fever and feverish illness in children under five years.

    Science.gov (United States)

    McDougall, Penny; Harrison, Maureen

    This article discusses the causes and management of fever in children. In line with guidance from the National Institute for Health and Care Excellence, it explores the importance of identifying children at risk of serious illness and those that can be managed safely at home. The article also identifies the skills and knowledge required by paediatric and general nurses working with children, alongside the need to offer parents guidance on antipyretics and how to care for their child at home.

  1. Pulse oximetry : technology to reduce child mortality in developing countries

    NARCIS (Netherlands)

    Duke, T.; Subhi, R.; Peel, D.; Frey, B.

    2009-01-01

    The causes of hypoxaemia in children include the commonest causes of childhood illness: pneumonia and other acute respiratory infections, and neonatal illness, particularly sepsis, low birthweight, birth asphyxia and aspiration syndromes. The systematic use of pulse oximetry to monitor and treat chi

  2. ILL Annual report 97

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-31

    In 1997 the reactor operated for the planned 225 days and more than 750 experiments were carried out. Among the experimental highlights are 2 contrasting examples of the new types of experiments now possible using the new high-intensity diffractometer D2O: stroboscopic measurements of kinetic processes and rapid texture measurements of structural materials. Some early results from the new high-resolution gamma spectrometer in the study of nuclear structure are also presented. Another new facility is just coming into service: the 2{pi} image-plate detector LADI, optimised for Laue measurements on biological crystals. The contrast between biological experiments and for example those on superconductivity or neutron {beta}-decay, illustrates very well the range of scientific questions addressed through the use of ILL`s neutron beams. 30 brief accounts of research work achieved during this year are given, they are classified under 9 topics: polymers and colloids, chemistry and structure, biology, materials science, liquids and glasses, magnetism, strongly correlated electron systems, quantum systems, nuclear and fundamental physics. The scheduled new developments are described and a list of the publications is also given

  3. A child with narcolepsy

    Directory of Open Access Journals (Sweden)

    Silvério Macedo

    2016-02-01

    Full Text Available Introduction: Narcolepsy is a chronic disease characterized by sleep attacks, excessive daytime sleepiness and nocturnal sleep fragmentation. It can be associated cataplexy and other disturbance of REM sleep (sleep paralysis and hypnagogic hallucinations and hypnopompic. Case report: A 10-year old boy was referred to Pedopsychiatry because of behavioural disturbance, irritability, sleepiness and distraction, being interpreted as an “ill-mannered child.” After clinical evaluation and comprehensive laboratory studies we concluded that he presented narcolepsy with cataplexy. Discussion/conclusion: Patients with narcolepsy face several problems due to the disease which, if left untreated or ineffectively treated, cause embarrassing or distressing symptoms, affecting their quality of life. The purpose of this paper is to draw attention to this problem since it is a rare condition and therefore seldom not recognized by the general public or even by health professionals.

  4. Saving lives, preserving livelihoods: understanding risk, decision-making and child health in a food crisis.

    Science.gov (United States)

    Hampshire, Katherine Rebecca; Panter-Brick, Catherine; Kilpatrick, Kate; Casiday, Rachel E

    2009-02-01

    The purpose of this paper is to analyse household decision-making regarding resource allocation in the aftermath of a food crisis in rural Niger. International attention had resulted in humanitarian agencies launching emergency nutrition programmes to alleviate persistently high levels of acute child malnutrition. We conducted participant observation, 93 in-depth interviews, 15 focus groups, 44 feeding and illness histories for children under 5, and debriefing sessions with local humanitarian staff. The impetus for this study came from observations of marked intra-household differences in child growth and health status, despite the caregivers' ethos of treating children equally. Egalitarian input, however, does not always result in equal outcomes: vulnerable children become "victims of non-discrimination" through a form of benign neglect engendered by pervasive poverty. The ethos and practices of equal investment in children are rooted in a need to balance the perceived risks to children with the preservation of long-term livelihoods. We discuss the mismatch of views between external interventions, which focus on saving individual children's lives, and local priorities, aimed at spreading risk. This mismatch is rooted in the different ways in which humanitarian agencies and local communities weigh up risks and vulnerabilities in matters of child health.

  5. Hypophosphatemia in critically ill children.

    Directory of Open Access Journals (Sweden)

    Kavous Shahsavari Nia

    2016-08-01

    Full Text Available Introduction: Hypophosphatemia is a common disorder in critically ill patients, and is associated with myasthenia, especially in respiratory muscles, and respiratory infections. This study was conducted to describe the prevalence of hypophosphatemia in children hospitalized in the pediatric intensive care unit (PICU of Children’s Hospital in Tabriz, Iran, in 2014-2015. Methods: In this descriptive study, medical records of all children admitted to the PICU of the children’s university hospital affiliated to Tabriz University of Medical Sciences were collected from archives of the hospital from 2014-2015 upon adopting permission. The medical records were examined in terms of demographic information, clinical diagnosis of the disease, serum phosphate level, nutritional status, therapeutic interventions, and other underlying specifications. The data were analyzed using SPSS software and descriptive tests. Results: Of the 83 eligible medical records, 45 records belonged to boys, and 38 records belonged to girls. The most prevalent and the least prevalent diseases in these children were acute pulmonary disease (57.8% and septic shock (1.2% respectively. Regarding the nutritional status, 38.6% of the children suffered malnutrition. Phosphorus deficiency was prevalent in the first day in 10.8% of the children, and abnormal levels of phosphorus were observed from the fourth to the sixth day in 26.5% of the children, which increased to 34.9% from the seventh to the tenth day. Conclusion: This study showed no statistically significant correlation between sex and prevalence of hypophosphatemia. Type of disease was not significantly associated with the level of phosphorus. Moreover, the patients’ nutritional status was not significantly associated with the prevalence of hypophosphatemia.

  6. Prolonged extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in a child affected by rituximab-resistant autoimmune hemolytic anemia: a case report

    Directory of Open Access Journals (Sweden)

    Beretta Chiara

    2009-04-01

    Full Text Available Abstract Introduction Autoimmune hemolytic anemia in children younger than 2 years of age is usually characterized by a severe course, with a mortality rate of approximately 10%. The prolonged immunosuppression following specific treatment may be associated with a high risk of developing severe infections. Recently, the use of monoclonal antibodies (rituximab has allowed sustained remissions to be obtained in the majority of pediatric patients with refractory autoimmune hemolytic anemia. Case presentation We describe the case of an 8-month-old Caucasian girl affected by a severe form of autoimmune hemolytic anemia, which required continuous steroid treatment for 16 months. Thereafter, she received 4 weekly doses of rituximab (375 mg/m2/dose associated with steroid therapy, which was then tapered over the subsequent 2 weeks. One month after the last dose of rrituximab, she presented with recurrence of severe hemolysis and received two more doses of rrituximab. The patient remained in clinical remission for 7 months, before presenting with a further relapse. An alternative heavy immunosuppressive therapy was administered combining cyclophosphamide 10 mg/kg/day for 10 days with methylprednisolone 40 mg/kg/day for 5 days, which was then tapered down over 3 weeks. While still on steroid therapy, the patient developed an interstitial pneumonia with Acute Respiratory Distress Syndrome, which required immediate admission to the intensive care unit where extracorporeal membrane oxygenation therapy was administered continuously for 37 days. At 16-month follow-up, the patient is alive and in good clinical condition, with no organ dysfunction, free from any immunosuppressive treatment and with a normal Hb level. Conclusions This case shows that aggressive combined immunosuppressive therapy may lead to a sustained complete remission in children with refractory autoimmune hemolytic anemia. However, the severe life-threatening complication presented by our

  7. Child sexual abuse.

    Science.gov (United States)

    Hymel, K P; Jenny, C

    1997-08-01

    Multiple obstacles can hinder the medical evaluation of suspected child sexual abuse in pediatric primary care. The need for diagnostic accuracy is high. Knowledge of sexual abuse risk factors, an understanding of the victimization process, and awareness of the varied clinical presentations of sexual abuse can be of assistance. Open-ended questioning of the suspected victim is the most critical component of the evaluation. Skillful medical interviewing requires time, training, patience, and practice. Pediatricians lacking any of these four requirements should defer interviewing in sexual abuse cases to other professionals. Abnormal physical findings from sexual abuse are uncommon. Colposcopy has assisted pediatricians greatly in reaching consensus regarding diagnostic physical findings. Cases of acute sexual assault require familiarity with the forensic rape examination, STD screening and prophylaxis, and pregnancy prevention. Victimization from sexual abuse continues long after the abusive acts end, often requiring long-term therapeutic intervention. An emerging standard of care for medical evaluations of suspected child sexual abuse recognizes the requirement for patience and compassion while retaining objectivity. The pediatrician's primary concern must be for the child's physical and emotional well-being.

  8. Status of acute upper respiratory infection, influenza-like illness, and influenza vaccination coverage among community residents in Jinan%济南市社区居民急性上呼吸道感染与流感样病例发病及其疫苗接种情况

    Institute of Scientific and Technical Information of China (English)

    刘营; 宋绍霞; 王伟; 耿兴义; 刘稳; 韩德彪; 刘倜; 吴巨龙; 李忠

    2015-01-01

    Objective To analyze the status of acute upper respiratory infection and influenza-like illness (ILI) among community residents in Jinan in 2015, and to make a understand of the patient's medical treatment behavior and influenza vaccination coverage status in 2014.Methods Balloting method and convenient sampling method were used to launch a household survey.The residents who had been in Jinan for more than 3 months were selected, to investigate the residents' attack ratio of acute upper respiratory and influenza-like from Jan.8 to Feb.7, 2015.Totally, 1300 persons from 410 families were involved in this survey which recovered 1241 valid questionnaires with the efficiency of 95.5%.Based on the national age-urban demographic statistics in 2010, the attack rates of acute respiratory infections, influenza-like illness were estimated by the direct standardization method, and the influenza vaccination rates were also calculated in this study.x2-test method was used to compare the different status of incidence and vaccination among residents with different features.Results The attack rate of acute upper respiratory infection and influenza-like illness in Jinan from January 8,2015 to February 7, 2015 were 30.2% (375 cases), and 6.1%(76 cases), respectively, with a standardized rate of 29.1% and 5.4%.5.3% (66 cases) of the residents have vaccinated with the influenza vaccine inoculation, with an adjusted rate of 3.8%.The attack rate difference of acute upper respiratory tract infections was statistically significant between each age group (x2=17.121, P=0.002).The 0-4 age group had a highest attack rate (45.4%) of acute respiratory infection, while the 15-24age group got the lowest (26.5%).38.9% (146 cases) of patients went for a treatment in hospital.Among them, 37.7% (55 cases) of them selected the county level hospitals for treatment, 37.7% (55 cases) selected the community level hospitals, and 24.6% (36 cases) selected the individual clinic

  9. Child to child: an approach to the health education of primary school-age children.

    Science.gov (United States)

    Webb, J K

    1988-01-01

    Child to Child is an approach to health education of the primary school-age child. In developing countries, infants and young children spend much of their lives in the care of an older brother or sister. Morley, a paediatrician, saw the potential of teaching these older children to provide better care for their siblings. Working with colleagues in education, Child to Child was launched in 1978, the International Year of the Child. Teaching material was prepared covering developmental needs, nutrition, common illnesses and aspects of the environment; a book was published describing an activity-oriented teaching method. This material was distributed to developing countries world-wide, with encouragement to use the material and ideas freely, adapting, translating, or innovating as found useful. Child to Child is now in use in 60 or more countries, and in at least 15 languages. It is being used by agencies like the World Bank, UNICEF, UNESCO, and OXFAM as a way of reinforcing community education in the search for 'Health for All by 2000'. A world-wide review of Child to Child is in hand. Information from this will help to provide firm guidelines on implementation in the different contexts where its value has already been established.

  10. The stigma of mental illness

    OpenAIRE

    Kordosi A; Saridi M; Souliotis K

    2015-01-01

    Introduction:The stigma of mental illness is not a modern phenomenon, but it can now be approached scientifically. The stigma, because of the mental illness which characterizes a person, can be explained by the natural propensity of man to deliver biased and stereotyped estimates to phenomena he cannot explain, accept or face. Methodology:This study is an attempt to describe the concept of stigma and the impact of the stigma of mental illness in the personal and social life of the...

  11. Subjective Illness theory and coping

    Directory of Open Access Journals (Sweden)

    Gessmann H.-W.

    2015-03-01

    Full Text Available The article presents a view of a problem of subjective illness theory in context of coping behavior. The article compiles the results of the latest studies of coping; discloses the way subjective illness theory affects the illness coping and patient's health; presents the study of differences in coping behaviour of patients at risk of heart attack and oncology. The article is recommended for specialists, concerned with psychological reasons of pathogenic processes and coping strategies of patients.

  12. Protein requirement in critical illness.

    Science.gov (United States)

    Hoffer, Leonard John

    2016-05-01

    How much protein do critically ill patients require? For the many decades that nutritional support has been used there was a broad consensus that critically ill patients need much more protein than required for normal health. Now, however, some clinical investigators recommend limiting all macronutrient provision during the early phase of critical illness. How did these conflicting recommendations emerge? Which of them is correct? This review explains the longstanding recommendation for generous protein provision in critical illness, analyzes the clinical trials now being claimed to refute it, and concludes with suggestions for clinical investigation and practice.

  13. Attributing illness to food

    DEFF Research Database (Denmark)

    Batz, M. B.; Doyle, M. P.; Morris, J. G.

    2005-01-01

    Identification and prioritization of effective food safety interventions require an understanding of the relationship between food and pathogen from farm to consumption. Critical to this cause is food attribution, the capacity to attribute cases of foodborne disease to the food vehicle or other...... source responsible for illness. A wide variety of food attribution approaches and data are used around the world including the analysis of outbreak data, case-control studies, microbial subtyping and source tracking methods, and expert judgment, among others. The Food Safety Research Consortium sponsored...... the Food Attribution Data Workshop in October 2003 to discuss the virtues and limitations of these approaches and to identify future options for collecting food attribution data in the United States. We summarize workshop discussions and identify challenges that affect progress in this critical component...

  14. Criminal history and future offending of juveniles convicted of the possession of child pornography

    OpenAIRE

    Aebi, Marcel; Plattner, Belinda; Ernest, Melanie; Kaszynski, Katie; Bessler, Cornelia

    2014-01-01

    Most child pornography is distributed online. It is estimated that 3% to 15% of child pornography consumers are juveniles. The present study analyzed a consecutive sample of 54 male juveniles convicted of the possession of child pornography. Demographic characteristics, criminal history, and subsequent offending were assessed from criminal files and official reports. Juvenile possessors of child pornography were compared to three different groups of juveniles: Juvenile possessors of other ill...

  15. Antioxidant Vitamins and Trace Elements in Critical Illness.

    Science.gov (United States)

    Koekkoek, W A C Kristine; van Zanten, Arthur R H

    2016-08-01

    This comprehensive narrative review summarizes relevant antioxidant mechanisms, the antioxidant status, and effects of supplementation in critically ill patients for the most studied antioxidant vitamins A, C, and E and the enzyme cofactor trace elements selenium and zinc. Over the past 15 years, oxidative stress-mediated cell damage has been recognized to be fundamental to the pathophysiology of various critical illnesses such as acute respiratory distress syndrome, ischemia-reperfusion injury, and multiorgan dysfunction in sepsis. Related to these conditions, low plasma levels of antioxidant enzymes, vitamins, and trace elements have been frequently reported, and thus supplementation seems logical. However, low antioxidant plasma levels per se may not indicate low total body stores as critical illness may induce redistribution of antioxidants. Furthermore, low antioxidant levels may even be beneficial as pro-oxidants are essential in bacterial killing. The reviewed studies in critically ill patients show conflicting results. This may be due to different patient populations, study designs, timing, dosing regimens, and duration of the intervention and outcome measures evaluated. Therefore, at present, it remains unclear whether supplementation of antioxidant micronutrients has any clinical benefit in critically ill patients as some studies show clear benefits, whereas others demonstrate neutral outcomes and even harm. Combination therapy of antioxidants seems logical as they work in synergy and function as elements of the human antioxidant network. Further research should focus on defining the normal antioxidant status for critically ill patients and to study optimal supplement combinations either by nutrition enrichment or by enteral or parenteral pharmacological interventions.

  16. Clustering of acute respiratory infection hospitalizations in childcare facilities

    DEFF Research Database (Denmark)

    Kamper-Jørgensen, Mads; Benn, Christine Stabell; Simonsen, Jacob;

    2010-01-01

    To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics.......To estimate how risk of acute respiratory infection (ARI) hospitalization in children attending childcare facilities with a recently (within 1 month) hospitalized child is affected by gender, age and other characteristics....

  17. CHILD ALLOWANCE

    CERN Multimedia

    Human Resources Division

    2001-01-01

    HR Division wishes to clarify to members of the personnel that the allowance for a dependent child continues to be paid during all training courses ('stages'), apprenticeships, 'contrats de qualification', sandwich courses or other courses of similar nature. Any payment received for these training courses, including apprenticeships, is however deducted from the amount reimbursable as school fees. HR Division would also like to draw the attention of members of the personnel to the fact that any contract of employment will lead to the suppression of the child allowance and of the right to reimbursement of school fees.

  18. The impact of childhood acute rotavirus gastroenteritis on the parents’ quality of life: prospective observational study in European primary care medical practices

    Directory of Open Access Journals (Sweden)

    Domingo Javier

    2012-05-01

    Full Text Available Abstract Background Rotavirus (RV is the commonest cause of acute gastroenteritis in infants and young children worldwide. A Quality of Life study was conducted in primary care in three European countries as part of a larger epidemiological study (SPRIK to investigate the impact of paediatric rotavirus gastroenteritis (RVGE on affected children and their parents. Methods A self-administered questionnaire was linguistically validated in Spanish, Italian and Polish. The questionnaire was included in an observational multicentre prospective study of 302 children aged Results Questionnaire responses showed that acute RVGE in a child adversely affects the parents’ daily life as well as the child. Parents of children with RVGE experience worry, distress and impact on their daily activities. RVGE of greater clinical severity (assessed by the Vesikari scale was associated with higher parental worries due to symptoms and greater changes in the child’s behaviour, and a trend to higher impact on parents’ daily activities and higher parental distress, together with a higher score on the symptom severity scale of the questionnaire. Conclusions Parents of a child with acute RVGE presenting to primary care experience worry, distress and disruptions to daily life as a result of the child’s illness. Prevention of this disease through prophylactic vaccination will improve the daily lives of parents and children.

  19. Prevent Child Abuse America

    Science.gov (United States)

    ... call the police . Crisis and support contacts For Child Abuse Reporting Numbers in your State please visit: Child ... suspected child abuse and neglect. Parent Resources Prevent Child Abuse America (800) CHILDREN A resource for tips, referrals, ...

  20. Integrated management of childhood illness (IMCI: an innovative vision for child health care Atenção integrada às doenças prevalentes da infância (AIDPI: uma visão inovadora para os cuidados da saúde da criança

    Directory of Open Access Journals (Sweden)

    Yehuda Benguigui

    2001-12-01

    Full Text Available The Integrated Management of Childhood Illness (IMCI strategy developed by the World Health Organization (WHO, Panamerican Health Organization (PAHO and the United Nation Children's Fund (UNICEF, joint experiences of previous frequent diseases programs in children, with prevention and health promotion activities. In this new approach the family, the community and health workers have a leading role in health condition of the child. The strategy aims a reduction in Infant Mortality Rate, specially in those regions and countries in which it is high. Pneumonia, diarrhea, malnutrition and other preventable diseases are the main causes of deaths in this settings. Health workers can early recognized danger signs of severe diseases, as well as they can evaluate and treat the most frequent health problems. By enhancing prevention and health promotion activities, as better conditions of life, giving an holistic vision of the child and his family, and not only looking for the symptom that motivate the consultation.A estratégia de Atenção Integrada às Doenças Prevalentes da Infância (AIDPI, desenvolvida pela Organização Mundial da Saúde (OMS, Organização Panamericana da Saúde (OPAS e Fundo das Nações Unidas para à Infância (UNICEF, incorpora as experiências prévias de programas para tratar as principais doenças infantis, acrescentando aspectos preventivos e de promoção à saúde. Nesta nova visão, outorga papéis fundamentais à família, à comunidade e ao trabalhador de saúde que desenvolve o seu trabalho no primeiro nível de atenção. A estratégia visa principalmente diminuir as taxas de mortalidade infantil em países e regiões onde elas ainda são muito elevadas, com cifras acima de 40 por 1.000 nascidos vivos, situações em que as pneumonias, diarréias, desnutrição e outras doenças evitáveis são as principais causas de óbito. Pretende também mudar o perfil da demanda ambulatorial dando ênfase a atividades

  1. Febrile illness experience among Nigerian nomads

    Directory of Open Access Journals (Sweden)

    Akogun Oladele B

    2012-01-01

    Full Text Available Abstract Background An understanding of the febrile illness experience of Nigerian nomadic Fulani is necessary for developing an appropriate strategy for extending malaria intervention services to them. An exploratory study of their malaria illness experience was carried out in Northern Nigeria preparatory to promoting malaria intervention among them. Methods Ethnographic tools including interviews, group discussions, informal conversations and living-in-camp observations were used for collecting information on local knowledge, perceived cause, severity and health seeking behaviour of nomadic Fulani in their dry season camps at the Gongola-Benue valley in Northeastern Nigeria. Results Nomadic Fulani regarded pabboje (a type of "fever" that is distinct from other fevers because it "comes today, goes tomorrow, returns the next" as their commonest health problem. Pabboje is associated with early rains, ripening corn and brightly coloured flora. Pabboje is inherent in all nomadic Fulani for which treatment is therefore unnecessary despite its interference with performance of duty such as herding. Traditional medicines are used to reduce the severity, and rituals carried out to make it permanently inactive or to divert its recurrence. Although modern antimalaria may make the severity of subsequent pabboje episodes worse, nomads seek treatment in private health facilities against fevers that are persistent using antimalarial medicines. The consent of the household head was essential for a sick child to be treated outside the camp. The most important issues in health service utilization among nomads are the belief that fever is a Fulani illness that needs no cure until a particular period, preference for private medicine vendors and the avoidance of health facilities. Conclusions Understanding nomadic Fulani beliefs about pabboje is useful for planning an acceptable community participatory fever management among them.

  2. Child Laborers

    Institute of Scientific and Technical Information of China (English)

    1998-01-01

    "When I was 12, I started working in a cotton mill as a child laborer." Fan Xiaofeng, the former vice-director of the Labor Protection Department of the All-China Federation of Trade Unions, wrote this sentence in one of her books. In 1932, she came to

  3. Aspects of spirituality concerning illness

    NARCIS (Netherlands)

    van Leeuwen, Rene; Tiesinga, Lucas J.; Jochemasen, Henk; Post, Doeke

    2007-01-01

    The spiritual dimension of illness, health and care may be seen as a unique aspect in addition to the physical, mental and social dimension. This contribution describes experiences of patients, nurses and hospital chaplains in relation to the spiritual aspects of being ill. Qualitative research was

  4. Water Recreation and Illness Severity

    Science.gov (United States)

    Abstract Background: The health endpoint of prior studies of water recreation has been the occurrence gastrointestinal (GI) of illness. The use of this dichotomous health outcome fails to take into account the range of symptom severity among those with GI illness, as well as thos...

  5. Staging of unipolar affective illness

    Directory of Open Access Journals (Sweden)

    Ewa Ferensztajn

    2014-12-01

    Full Text Available In this article, a concept of staging of unipolar affective illness (recurrent depression is presented. In respective subchapters, three most important aspects of this issue have been discussed: 1 staging of unipolar affective illness; 2 staging of treatment-resistant depression; and 3 conversion of unipolar into bipolar affective illness. The evidence for so called neuroprogression of the illness, accumulated in recent years, has allowed for a classification of staging based on a concept of allostasis and allostatic load. In the course of illness, changes in neuroendocrine system (mainly hypothalamic pituitary-adrenal (HPA axis, immunological system, mechanisms of oxidative stress, neurotransmitters, neurotrophic factors as well as structural and functional changes of the brain occur. In their paper of 2007, Fava and Tossani elaborated a concept of staging of unipolar affective illness presenting a continuum model of five consecutive stages with specific clinical features. In the present paper, a concept of treatment-resistant depression and staging of treatment resistance is presented in the context of several models. An important determinant of treatment-resistant depression is so called subthreshold bipolarity which is connected with worse efficacy of antidepressant drugs. In the course of illness, there is a possibility of changing diagnosis from recurrent depression into bipolar affective illness. The studies on this issue show that frequency of such diagnostic conversion is 1,5% of depressed patients per year.

  6. Staging of bipolar affective illness [Etapy przebiegu choroby afektywnej dwubiegunowej

    Directory of Open Access Journals (Sweden)

    Ferensztajn, Ewa

    2012-08-01

    Full Text Available The concept of staging as a description of clinical advancement of illness is prevalent and commonly used in medicine. Regarding bipolar mood disorder (BD a staging model assumes a progression from prodromal (at-risk to more severe and treatment-refractory conditions. Four different staging models of BD have been proposed. The concept of Robert Post’s is based on the phenomenon of kindling and neurosensitization, assuming a role of stressors in triggering the first episode of illness, with subsequent persistent changes in the activity of neurones, greater vulnerability to relapse and worse response to treatment. The concept of Anne Duffy’s is based on the research of high risk bipolar offspring and describes the early development of the illness as successive stages, i.e. non-mood disorders, minor mood disorders and acute episodes of illness, starting in childhood, with an attempt to distinguish subtypes of the disease depending on the parent’s response to prophylactic lithium treatment. The model of Michael Berk’s has been constructed in parallel to the therapeutic algorithms and classifies the stages of illness based on clinical features, prognosis, and response to treatment. It also identifies high risk individuals, highlights need of early intervention and is proposed as a course specifier for BD. The model of Flavio Kapczinski’s is based on a phenomenon of allostatic load and evaluation of the changes of biomarkers and cognitive functions during the episode and between episodes. A significant consequence of introducing the staging model is employing treatment which is adequate to a stage of the illness. The model underlines a necessity of early intervention and defines the first episode of the illness as a critical target of it, in a hope to a possibility of prevention against neuroanatomical, neuropsychological, clinical and functional consequence of the illness.

  7. Assessing the knowledge of perinatal mental illness among student midwives.

    Science.gov (United States)

    Phillips, Louise

    2015-11-01

    The experience of perinatal mental illness (mental illness occurring around the time of pregnancy) currently affect 1 in 10 women and can have adverse effects on the mother and her child (Massie and Szajnberg, 2002; O'Connor et al., 2002). The care and effective management of women experiencing perinatal mental illness is therefore an important issue for health care staff, managers, psychiatrists, commissioners and campaigners. Midwives play a significant part in caring for women throughout their pregnancies, during labour and up to the first month after birth. Midwives are in a unique position to assess a woman's well-being and to offer appropriate support. However, previous research has revealed that midwives often have poor understanding and knowledge of perinatal mental health issues and require improved training (Ross-Davie et al, 2006; McCann and Clark, 2010). This research project aims to systematically assess student midwives awareness of perinatal mental illness. The findings of this study will inform curriculum development for graduate and post-graduate midwifery students therefore improving the care and support women with mental illness receive from antenatal services. The findings from this study will also be used for the formation of an educational web-based programme for student and qualified midwives.

  8. Acute psychosis: A neuropsychiatric dilemma

    Directory of Open Access Journals (Sweden)

    Daniel Saldanha

    2013-01-01

    Full Text Available The acute onset of psychotic symptoms in elderly can be the presenting clinical feature for various Central Nervous System as well as other systemic illnesses. The diagnosis and treatment of such presentation require a cautious medical work up and high level of suspicion even if the patient is not showing any cardinal symptoms for organic pathology.

  9. Reversible binocular visual loss in temporal association with artesunate-amodiaquine treatment in a child on mefloquine chemoprophylaxis.

    Science.gov (United States)

    Adjei, G O; Adabayeri, V M; Annobil, S H

    2012-09-01

    A case of an acute reversible visual loss in a 10-year-old child who was on mefloquine prophylaxis, and was treated with artesunate-amodiaquine for an acute febrile illness diagnosed clinically as uncomplicated malaria, is reported. On admission the patient could not perceive light and had bilateral papilloedema. She was treated with dexamethasone and recovered her sight gradually over a 21-day period. There has been no previous report to our knowledge, of an association between acute visual loss and mefloquine, amodiaquine, or artesunate in the published literature, even though mefloquine is associated with blurring of vision, and antimalarials of the quinoline class have been associated with retinopathy (during long term use). While causality is difficult to ascribe in this case, it may be prudent to avoid the use of quinoline-based antimalarials for treating acute malaria in travelers taking mefloquine prophylaxis, because information on the safety of concurrent use of artemisinin combination therapies and mefloquine, or other recommended prophylactic regimens, is limited.

  10. [Assessment and treatment of hyperglycemia in critically ill patients].

    Science.gov (United States)

    Viana, Marina Verçoza; Moraes, Rafael Barberena; Fabbrin, Amanda Rodrigues; Santos, Manoella Freitas; Gerchman, Fernando

    2014-01-01

    Hyperglycemia is a commonly encountered issue in critically ill patients in the intensive care setting. The presence of hyperglycemia is associated with increased morbidity and mortality, regardless of the reason for admission (e.g., acute myocardial infarction, status post-cardiovascular surgery, stroke, sepsis). However, the pathophysiology and, in particular, the treatment of hyperglycemia in the critically ill patient remain controversial. In clinical practice, several aspects must be taken into account in the management of these patients, including blood glucose targets, history of diabetes mellitus, the route of nutrition (enteral or parenteral), and available monitoring equipment, which substantially increases the workload of providers involved in the patients' care. This review describes the epidemiology, pathophysiology, management, and monitoring of hyperglycemia in the critically ill adult patient.

  11. Deficient Glutathione in the Pathophysiology of Mycotoxin-Related Illness

    Directory of Open Access Journals (Sweden)

    Frederick T. Guilford

    2014-02-01

    Full Text Available Evidence for the role of oxidative stress in the pathophysiology of mycotoxin-related illness is increasing. The glutathione antioxidant and detoxification systems play a major role in the antioxidant function of cells. Exposure to mycotoxins in humans requires the production of glutathione on an “as needed” basis. Research suggests that mycotoxins can decrease the formation of glutathione due to decreased gene expression of the enzymes needed to form glutathione. Mycotoxin-related compromise of glutathione production can result in an excess of oxidative stress that leads to tissue damage and systemic illness. The review discusses the mechanisms by which mycotoxin-related deficiency of glutathione may lead to both acute and chronic illnesses.

  12. Substance abuse and child maltreatment.

    Science.gov (United States)

    Wells, Kathryn

    2009-04-01

    Pediatricians and other medical providers caring for children need to be aware of the dynamics in the significant relationship between substance abuse and child maltreatment. A caregiver's use and abuse of alcohol, marijuana, heroin, cocaine, methamphetamine, and other drugs place the child at risk in multiple ways. Members of the medical community need to understand these risks because the medical community plays a unique and important role in identifying and caring for these children. Substance abuse includes the abuse of legal drugs as well as the use of illegal drugs. The abuse of legal substances may be just as detrimental to parental functioning as abuse of illicit substances. Many substance abusers are also polysubstance users and the compounded effect of the abuse of multiple substances may be difficult to measure. Often other interrelated social features, such as untreated mental illness, trauma history, and domestic violence, affect these families.

  13. Management of acute otitis media in children six months of age and older.

    Science.gov (United States)

    Le Saux, Nicole; Robinson, Joan L

    2016-01-01

    Acute otitis media (AOM) continues to be a common infection in young children. Milder disease, usually due to viruses or less virulent bacteria, resolves equally quickly with or without antibiotics. A bulging tympanic membrane, especially if yellow or hemorrhagic, has a high sensitivity for AOM that is likely to be bacterial in origin and is a major diagnostic criterion for AOM. Perforation of the tympanic membrane with purulent discharge similarly indicates a bacterial cause. Immediate antibiotic treatment is recommended for children who are highly febrile (≥39°C), moderately to severely systemically ill or who have very severe otalgia, or have already been significantly ill for 48 h. For all other cases, parents can be provided with a prescription for antibiotics to fill if the child does not improve in 48 h or the child can be reassessed if this occurs. Amoxicillin remains the clear drug of choice. Ten days of therapy is appropriate for children <2 years of age, whereas older children can be treated for five days.

  14. Management of acute otitis media in children six months of age and older

    Science.gov (United States)

    Le Saux, Nicole; Robinson, Joan L

    2016-01-01

    Acute otitis media (AOM) continues to be a common infection in young children. Milder disease, usually due to viruses or less virulent bacteria, resolves equally quickly with or without antibiotics. A bulging tympanic membrane, especially if yellow or hemorrhagic, has a high sensitivity for AOM that is likely to be bacterial in origin and is a major diagnostic criterion for AOM. Perforation of the tympanic membrane with purulent discharge similarly indicates a bacterial cause. Immediate antibiotic treatment is recommended for children who are highly febrile (≥39°C), moderately to severely systemically ill or who have very severe otalgia, or have already been significantly ill for 48 h. For all other cases, parents can be provided with a prescription for antibiotics to fill if the child does not improve in 48 h or the child can be reassessed if this occurs. Amoxicillin remains the clear drug of choice. Ten days of therapy is appropriate for children <2 years of age, whereas older children can be treated for five days. PMID:26941560

  15. Nutrition intervention in the critically ill cardiothoracic patient.

    Science.gov (United States)

    Cresci, Gail; Hummell, A Christine; Raheem, Sulieman Abdal; Cole, Denise

    2012-06-01

    Despite acute myocardial infarction and cardiac surgery accounting for 2 of the most common reasons patients are admitted to the intensive care unit, little attention and investigation have been directed specifically for these patients. This patient population therefore deserves special attention as they are often malnourished but require emergent interventions, making nutrition intervention challenging. This article reviews current medical interventions implemented in critically ill cardiothoracic patients and discusses evidence-based nutrition therapy, including enteral and parenteral feeding, glycemic control, and antioxidant provision.

  16. Disparities in appendicitis rupture rate among mentally ill patients

    Directory of Open Access Journals (Sweden)

    Bai Ya-Mei

    2007-11-01

    Full Text Available Abstract Background Many studies have been carried out that focus on mental patients' access to care for their mental illness, but very few pay attention on these same patients' access to care for their physical diseases. Acute appendicitis is a common surgical emergency. Our population-based study was to test for any possible association between mental illness and perforated appendicitis. We hypothesized that there are significant disparities in access to timely surgical care between appendicitis patients with and without mental illness, and more specifically, between patients with schizophrenia and those with another major mental illness. Methods Using the National Health Insurance (NHI hospital-discharge data, we compared the likelihood of perforated appendix among 97,589 adults aged 15 and over who were hospitalized for acute appendicitis in Taiwan between the years 1997 to 2001. Among all the patients admitted for appendicitis, the outcome measure was the odds of appendiceal rupture vs. appendicitis that did not result in a ruptured appendix. Results After adjusting for age, gender, ethnicity, socioeconomic status (SES and hospital characteristics, the presence of schizophrenia was associated with a 2.83 times higher risk of having a ruptured appendix (odds ratio [OR], 2.83; 95% confidence interval [CI], 2.20–3.64. However, the presence of affective psychoses (OR, 1.15; 95% CI: 0.77–1.73 or other mental disorders (OR, 1.58; 95% CI: 0.89–2.81 was not a significant predictor for a ruptured appendix. Conclusion These findings suggest that given the fact that the NHI program reduces financial barriers to care for mentally ill patients, they are still at a disadvantage for obtaining timely treatment for their physical diseases. Of patients with a major mental illness, schizophrenic patients may be the most vulnerable ones for obtaining timely surgical care.

  17. Role conflict, uncertainty in illness, and illness-related communication avoidance: College students facing familial chronic illness

    OpenAIRE

    Suchak, Meghana

    2014-01-01

    The focus of the current study was on examining possible differences in college students' adjustment based on residency status (i.e., international Asian vs. domestic students) and illness status (i.e., having a family member with a chronic illness vs. not having a family member with a chronic illness). The study also examined the associations between overall college student adjustment and the family and illness-related factors of role conflict, uncertainty in illness, and illness-related com...

  18. Estimated Numbers of Community Cases of Illness Due to Salmonella, Campylobacter and Verotoxigenic Escherichia Coli: Pathogen-Specific Community Rates

    Directory of Open Access Journals (Sweden)

    M Kate Thomas

    2006-01-01

    Full Text Available OBJECTIVE: To estimate the annual number of cases of illness due to verotoxigenic Escherichia coli (VTEC, Salmonella and Campylobacter in the Canadian population, using data from the National Notifiable Disease registry (NND, estimates of under-reporting derived from several National Studies on Acute Gastrointestinal Illness, and the literature.

  19. Bringing Child Psychology to Religious Curricula: The Cautionary Tale of Goldman and Piaget.

    Science.gov (United States)

    Kay, William K.

    1996-01-01

    British researcher Ronald Goldman's attempts to apply Piagetian theory to children's interpretation of biblical narratives illustrates that the theory is ill suited to text interpretation. However, there are ways that child psychology can contribute to religious education. (SK)

  20. Youth blogging and serious illness.

    Science.gov (United States)

    Nesby, Linda; Salamonsen, Anita

    2016-03-01

    In recent years, a growing number of young people who experience illness tend to blog about it. In this paper, we question whether and how illness blogs illustrate the intercommunicative aspect of blogging by bringing forth both the literary concept of the implied reader and the sociological concepts of empowerment and agency in the analysis. We argue that young people blogging about serious illness demonstrate the inherent intercommunicative potential of blogging. We also argue that youth blogging about serious illness may represent a fruitful strategy for ill young people to create meaning, stay front-stage in youth communities and build self-esteem and confidence out of chaos. Furthermore, we argue that these blogs may contribute rather unique experience-based knowledge and reflections about existential issues to other young blog readers, who may otherwise not get access to this aspect of life. Youth blogging about serious illness thereby reflects a patient group so far not very visible and through the genre youth stand out as more competent when it comes to illness and healthcare issues than what is often presumed.

  1. Role of lactate in critically ill children

    Directory of Open Access Journals (Sweden)

    Chugh Krishan

    2004-01-01

    Full Text Available Lactic acidosis is a common finding in critically ill patients. It has been used as a prognostic marker of the outcome in Pediatric Intensive Care Unit patients. Lactic acid is produced as a product of anaerobic glycolysis and is reversibly converted to pyruvate in the presence of favorable metabolic environment. All the body tissues can produce and consume lactate with few having predominant function of production and others of consumption. Liver is a major organ for lactate consumption and it is the liver, which metabolizes the increased lactic acid produced in regional tissue beds. The lactate levels can be done on arterial, venous, or mixed venous blood and can be measured by various methods. Serial lactate concentrations and the difference in arterial and mixed venous lactate levels or between the arterial and regional blood lactate levels like jugular venous lactate levels have been shown to have better correlation with the outcome. High initial blood lactate levels and persistently high lactate levels have been correlated with poor outcome. There are various causes of lactic acid overproduction, which may produce either hyperlactatemia or lactic acidosis. High blood lactate levels are found in critically ill patients with shock of any etiology and sepsis due to various reasons, which include increased catecholamine induced glucose flux apart from the tissue hypoperfusion and hypoxia. Various other illnesses can cause an increase in blood lactate levels like acute lung/liver injury, severe asthma, poisoning, post cardiac surgery etc. Treating the underlying disease leading to lactic acidosis is the best measure to control lactic acidosis. Some therapeutic choices are available to neutralize the effect of lactic acid on cell function, but none has stood the test of time and are tried only in desperate situations.

  2. 危重症产妇妊娠相关性急性肾损伤的病因、临床特点及预后分析%Etiology, clinical profile and prognosis of pregnancy-related acute kidney injury in critically ill obstetric patients

    Institute of Scientific and Technical Information of China (English)

    宁耀贵; 张民伟; 陈金龙; 郭晶; 吴焱琼; 余剑华; 李娜; 徐颢

    2015-01-01

    Objective To investigate the etiology,clinical profile and prognosis of pregnancyrelated acute kidney injury (PR-AKI) in critically ill obstetric patients.Methods Data of the critically ill obstetric patients admitted to ICU from January 2011 to March 2014 were collected and analyzed retrospectively.PR-AKI patients were screened according to the clinical diagnostic criteria of AKI.The etiological diseases,laboratory indicators,urine output,length of ICU stay,prognosis of PR-AKI were documented and analyzed;and the risk factors of PR-AKI was assessed with logistic regression analysis.Results A total of 124 critically ill obstetric patients were enrolled,and AKI occurred in 46 of them (37.1%) under kidney disease:Improving Global Outeomes Acute kidney injury (KDIGO-AKI) criteria.The main causes of PR-AKI included pre-eclampsia (41.3 %,19/46),hemorrhagic shock (21.7 %,10/46),hemolysis,elevated liver enzymes and low platelet (HELLP) syndrome (17.4%,8/46),acute fatty liver of pregnancy (AFLP) (15.2%,7/46).Of the 46 PR-AKI patients,3 died (6.5%),and the causes of death was cerebral hemorrhage,cerebral venous sinus thrombosis and multiorgan failure (MOF).There were 23 cases in stage 1,13 cases in stage 2 and 10 cases in stage 3 according to KIDGO-AKI stage criteria.Ten patients received renal replacement treatment:1 in stage 1,2 in stage 2 and 7 in stage 3.Complete,partial and no renal recovery was observed in 73.9% (34/46),17.4% (8/46) and 8.7% (4/ 46) of the patients,respectively.Complete renal recovery was observed 91.3% (21/23) in stage 1,9/13 in stage 2,4/10 in stage 3,respectively.On logistic regression,pregnancy-induced hypertension,hemorrhagic shock and HELLP syndrome were risk factors of PR-AKI.Conclusions The incidence of PR-AKI in critically ill obstetric patients is high.A variety of etiological factors and risk factors are related to PRAKI.Early detection and effective therapeutic measures are important to PR-AKI.The prognosis of PR-AKI is

  3. 重症加强治疗病房妊娠期急性肾衰竭危险因素分析%Analysis of risk factors associated with acute renal failure in critically ill obstetric patients in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    李海红; 潘秀丽; 张瑶; 王清文; 谢凤杰

    2015-01-01

    目的 分析导致重症加强治疗病房(ICU)危重孕产妇妊娠期急性肾衰竭(ARF)的危险因素.方法 采用回顾性分析方法,选择因产后并发症入住ICU的危重孕产妇192例,排除3例因羊水栓塞死亡,7例 因记录不完整者,共182例纳入本研究.将患者根据是否合并ARF分为ARF组(68例)和非ARF组(114例),采集两组患者发生先兆子痫、HELLP综合征(溶血、肝酶升高、血小板减少)、妊娠急性脂肪肝、产后出血、脓毒症等指标;以及产后4 d内使用的主要药物: ① 血浆体积膨胀剂:液体(晶体液、人工胶体、高渗白蛋白、4%白蛋白)和血液制品(浓集红细胞、浓缩血小板、纤维蛋白原、新鲜冷冻血浆、活化因子Ⅶ); ② 抗纤溶药:氨甲环酸; ③ 抗高血压药物:血管紧张素转换酶抑制剂(ACEI),利尿剂; ④ 肾毒性药物:氨基糖苷类,造影剂等.对上述指标先进行单因素分析,将有统计学意义的危险因素进行多因素logistic回归分析,筛选出ICU危重孕产妇妊娠期发生急性肾衰竭的危险因素.结果 单因素分析表明:HELLP综合征、产后4 h使用氨甲环酸和高渗白蛋白是ARF的危险因素(χ2值分别为4.92、4.29、5.53,均P<0.05).多因素logistic回归分析表明:HELLP综合征〔优势比(OR)=10.478,95%可信区间(95%CI)为1.248~17.953,P=0.030〕和产后4 h使用高渗白蛋白(OR=6.632,95%CI为1.211~16.328;P=0.029)是ARF发生的独立危险因素.结论 ICU危重孕产妇ARF是多因素参与的过程,应充分认识各种危险因素对ARF的影响,存在HELLP综合征和产后4 h使用高渗白蛋白是ARF发生的独立危险因素,对存在危险因素的患者实施重点防护以减少ARF的发生.%Objective To analyze the risk factors associated with acute renal failure (ARF) in critically ill obstetric patients in intensive care unit (ICU).Methods A retrospective analysis of 192 critically ill obstetric patients admitted to the ICU for postpartum

  4. [Non thyroidal illnesses (NTIS)].

    Science.gov (United States)

    Luca, F; Goichot, B; Brue, T

    2010-09-01

    Abnormalities in the circulating levels of thyroid hormones, without evidence of coexisting thyroid or pituitary gland disease can be observed in all general diseases. These nonthyroidal illnesses (NTIS) are the result of complex mechanisms that combine the effect of some drugs, cytokines, nutritional and endocrine factors at all levels of the thyrotropic axis, from the hypothalamus to the cellular transporters and nuclear receptors of thyroid hormones. The patterns of NTIS depend on the underlying disease and its severity. Thirtyfive years after the initial description, the pathophysiological significance of these anomalies remains controversial. One of the dilemma of NTIS is whether the hormone responses represent an adaptive and normal, physiologic response to conserve energy and protect against hypercatabolism in case of aggression, or whether it is a maladaptive response contributing to a worsening of the disease. This debate is not just a theoretical question, because in the first case the process must be respected, in the other case a vigorous treatment to restore circulating thyroid hormone levels is justified. There have been very few clinical studies designed to address whether the substitution with thyroid hormone is advantageous, and there is at current time no permissive evidence for the use of thyroid hormone replacement in patients with NTIS. But the clinical context, the choice of the molecule or of the dose and the way of administration were not necessarily the most relevant. Theoretically, stimulation of thyreotrope axis used a continuous infusion of TRH seems to provide clinical benefit. With the expectation that randomized clinical trials will provide demonstration of NTIS treatment efficiency, the question might remain unanswered for several more years.

  5. Simultaneous acute appendicitis with right testicular torsion

    Directory of Open Access Journals (Sweden)

    Tanveer Akhtar

    2012-01-01

    Full Text Available We present a child with both acute appendicitis and torsion of the right testis presenting at the same time. Testicular torsion possibly occurring due to vomiting in acute appendicitis so far has not been reported in the literature.

  6. The efficacy of hemoperfusion combined with sustained hemodialysis for critically ill patients with acute renal failure%血液灌流联合血液透析对危重急性肾衰竭患者的疗效观察

    Institute of Scientific and Technical Information of China (English)

    高燕

    2015-01-01

    Objective To evaluate the clinical efficacy of hemoperfusion combined with sustained hemodialysis for criti-cally ill patients with acute renal failure. Methods 80 cases from January 2012 to May 2015 in intensive care unit with simple renal acute renal failure were divided into two groups,each 40 cases,the control group was implemented with simple hematodialysis, the observation group was used hemoperfusion combined with continued dialysis,then kidney function before and after treatment were changes in inflammatory cytokines before and after treatment,renal function re-covery time and complications during treatment in hospital due to renal failure leading were compared. Results After treatment, The urea nitrogen and creatinine level in the observation group was lower than before treatment and control group after treatment,with significant difference (P<0.05),the TNF-α,IL-6 and CRP level in the observation group was lower than that before treatment and control group after treatment respectively,with significant difference (P<0.05),the renal function recovery time and hospital stay in the observation group was shorter than that of control group respec-tively,with significant difference (P<0.05),the hyperkalemia,hypermagnesemia,hyponatremia and metabolic acidosis pro-portion in the observation group was lower than that of control group respectively,with significant difference (P<0.05). Conclusion Hemoperfusion combined with continued dialysis can slow and steady removal of toxins and inflammatory mediators,it can better the clinical results and fewer complications for critically ill patients with acute renal failure,and it has greater tolerance and thus more conducive to critically ill patients with acute renal failure treatment.%目的 探讨血液灌流联合血液透析对危重急性肾衰竭患者的临床疗效. 方法 选择2012年1月~2015年5月我院重症监护室收治的肾性单纯性急性肾功能衰竭患者80例,分为两组,各40例,对照组实

  7. Household food insecurity and child health.

    Science.gov (United States)

    Schmeer, Kammi K; Piperata, Barbara A

    2016-04-29

    Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.

  8. Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan.

    Science.gov (United States)

    Memon, Zahid; Zaidi, Shehla; Riaz, Atif

    2015-11-03

    Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers.

  9. Management of critically ill patients with type 2 diabetes:The need for personalised therapy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Critical illness in patients with pre-existing diabetesfrequently causes deterioration in glycaemic control.Despite the prevalence of diabetes in patients admittedto hospital and intensive care units, the idealmanagement of hyperglycaemia in these groups isuncertain. There are data that suggest that acutehyperglycaemiain critically ill patients without diabetesis associated with increased mortality and morbidity.Exogenous insulin to keep blood glucose concentrations〈 10 mmol/L is accepted as standard of care in thisgroup. However, preliminary data have recently beenreported that suggest that chronic hyperglycaemia mayresult in conditioning, which protects these patientsagainst damage mediated by acute hyperglycaemia.Furthermore, acute glucose-lowering to 〈 10 mmol/Lin patients with diabetes with inadequate glycaemiccontrol prior to their critical illness appears to havethe capacity to cause harm. This review focuses onglycaemic control in critically ill patients with type 2diabetes, the potential for harm from glucose-loweringand the rationale for personalised therapy.

  10. Student Attitudes Toward Mental Illness

    Science.gov (United States)

    Hare-Mustin, Rachel T.; Garvine, Richard

    1974-01-01

    Inquiry into the initial attitudes toward mental illness of students taking an abnormal psychology class indicates students' concerns and preconceptions and provides a basis for shaping the course to respond to student needs. (JH)

  11. Transfusion in critically ill children

    DEFF Research Database (Denmark)

    Secher, E L; Stensballe, J; Afshari, A

    2013-01-01

    Transfusion of blood products is a cornerstone in managing many critically ill children. Major improvements in blood product safety have not diminished the need for caution in transfusion practice. In this review, we aim to discuss the interplay between benefits and potential adverse effects...... of transfusion in critically ill children by including 65 papers, which were evaluated based on previously agreed selection criteria. Current practice on transfusing critically ill children is mainly founded on the basis of adult studies, common practices with cut-off values, and expert opinions, rather than...... evidence-based medicine. Paediatric patients have explicit physiological challenges and requirements to be addressed. Critically ill children often suffer from anaemia, have substantial iatrogenic blood loss with subsequent transfusions, and are at a higher risk of complications, often due to human errors...

  12. Improving Communication About Serious Illness

    Science.gov (United States)

    2017-01-07

    Critical Illness; Chronic Disease; Terminal Care; Palliative Care; Communication; Advance Care Planning; Neoplasm Metastasis; Lung Neoplasms; Pulmonary Disease, Chronic Obstructive; Heart Failure; End Stage Liver Disease; Kidney Failure, Chronic

  13. Dependency in Critically Ill Patients

    Directory of Open Access Journals (Sweden)

    Rumei Yang

    2016-03-01

    Full Text Available By necessity, critically ill patients admitted to intensive care units (ICUs have a high level of dependency, which is linked to a variety of negative feelings, such as powerlessness. However, the term dependency is not well defined in the critically ill patients. The concept of “dependency” in critically ill patients was analyzed using a meta-synthesis approach. An inductive process described by Deborah Finfgeld-Connett was used to analyze the data. Overarching themes emerged that reflected critically ill patients’ experience and meaning of being in dependency were (a antecedents: dependency in critically ill patients was a powerless and vulnerable state, triggered by a life-threatening crisis; (b attributes: the characteristic of losing “self” was featured by dehumanization and disembodiment, which can be alleviated by a “self”-restoring process; and (c outcomes: living with dependency and coping with dependency. The conceptual model explicated here may provide a framework for understanding dependency in critically ill patients.

  14. Acute pancreatitis

    Science.gov (United States)

    ... its blood vessels. This problem is called acute pancreatitis. Acute pancreatitis affects men more often than women. Certain ... pancreatitis; Pancreas - inflammation Images Digestive system Endocrine glands Pancreatitis, acute - CT scan Pancreatitis - series References Forsmark CE. Pancreatitis. ...

  15. Cystitis - acute

    Science.gov (United States)

    Uncomplicated urinary tract infection; UTI - acute cystitis; Acute bladder infection; Acute bacterial cystitis ... cause. Menopause also increases the risk for a urinary tract infection. The following also increase your chances of having ...

  16. Whole-genome sequencing for identification of Mendelian disorders in critically ill infants: a retrospective analysis of diagnostic and clinical findings

    Science.gov (United States)

    Willig, Laurel K; Petrikin, Josh E; Smith, Laurie D; Saunders, Carol J; Thiffault, Isabelle; Miller, Neil A; Soden, Sarah E; Cakici, Julie A; Herd, Suzanne M; Twist, Greyson; Noll, Aaron; Creed, Mitchell; Alba, Patria M; Carpenter, Shannon L; Clements, Mark A; Fischer, Ryan T; Hays, J Allyson; Kilbride, Howard; McDonough, Ryan J; Rosterman, Jamie L; Tsai, Sarah L; Zellmer, Lee; Farrow, Emily G; Kingsmore, Stephen F

    2015-01-01

    Summary Background Genetic disorders and congenital anomalies are the leading causes of infant mortality. Diagnosis of most genetic diseases in neonatal and paediatric intensive care units (NICU and PICU) is not sufficiently timely to guide acute clinical management. We used rapid whole-genome sequencing (STATseq) in a level 4 NICU and PICU to assess the rate and types of molecular diagnoses, and the prevalence, types, and effect of diagnoses that are likely to change medical management in critically ill infants. Methods We did a retrospective comparison of STATseq and standard genetic testing in a case series from the NICU and PICU of a large children's hospital between Nov 11, 2011, and Oct 1, 2014. The participants were families with an infant younger than 4 months with an acute illness of suspected genetic cause. The intervention was STATseq of trios (both parents and their affected infant). The main measures were the diagnostic rate, time to diagnosis, and rate of change in management after standard genetic testing and STATseq. Findings 20 (57%) of 35 infants were diagnosed with a genetic disease by use of STATseq and three (9%) of 32 by use of standard genetic testing (p=0·0002). Median time to genome analysis was 5 days (range 3–153) and median time to STATseq report was 23 days (5–912). 13 (65%) of 20 STATseq diagnoses were associated with de-novo mutations. Acute clinical usefulness was noted in 13 (65%) of 20 infants with a STATseq diagnosis, four (20%) had diagnoses with strongly favourable effects on management, and six (30%) were started on palliative care. 120-day mortality was 57% (12 of 21) in infants with a genetic diagnosis. Interpretation In selected acutely ill infants, STATseq had a high rate of diagnosis of genetic disorders. Most diagnoses altered the management of infants in the NICU or PICU. The very high infant mortality rate indicates a substantial need for rapid genomic diagnoses to be allied with a novel framework for precision

  17. Foundations of Child Psychiatry.

    Science.gov (United States)

    Miller, Emanuel, Ed.; And Others

    Twenty-eight papers examine basic theories and clinical methods in child psychiatry. Theories and methods discussed concern child psychiatry and the World Health Organization, pediatrics, child disturbances, observation, the psychodiagnostic approach, longitudinal research in child development, the comparative approach to early child development,…

  18. Undiagnosed Small-Fiber Polyneuropathy - Is it a Component of Gulf-War Illness

    Science.gov (United States)

    2013-07-01

    fatigue, dizziness, chronic headache , and skin abnormalities - complaints that overlap substantially with Gulf War Illness (GWI). Because SFPN produces...urological symptoms, fatigue, and headache [4], and many patients with SFPN report that their illness had been interpreted as FMS prior to diagnosis of...acute adolescent autoimmune small-fiber axonopathy. Anesth Analg 2007;104:438–41. [39] Reed C, Birnbaum HG, Ivanova JI, Schiller M, Waldman T, Mullen

  19. Inflammatory factors as markers for early development and prognosis of acute deep venous thrombosis in critically ill patients%炎症因子在危重病人急性深静脉血栓形成和转归中的作用分析

    Institute of Scientific and Technical Information of China (English)

    朱晓琼; 王强; 薛冰

    2016-01-01

    目的 探讨炎症因子在危重病人急性深静脉血栓(DVT)病程中的动态变化及与DVT的相关性.方法 收集2013年10月至2015年7月在ICU住院期间发生急性DVT患者26例为病例组,分别于发病第1、4、14 d检测血清白介素-6(IL-6)、白介素-10(IL-10)、C反应蛋白(CRP)、PCT、ESR水平,同期健康体检者30例为对照组.结果 ①病例组发病第1、4d血清IL-6、IL-10、CRP水平均高于发病第14 d和对照组,差异有统计学意义(P<0.05);发病第14 d血清IL-6、IL-10、CRP水平与对照组比较差异无统计学意义(P>0.05);②病例组三个时间段的PCT、ESR水平均高于对照组,差异有统计学意义(P<0.05),三个时间段之间PCT、ESR比较差异无统计学意义(P>0.05).结论 血清IL-6、IL-10、CRP参与危重病人急性DVT的发生与发展.%Objective To evaluate the dynamic changes of inflammatory factors in blood during the development of acute deep venous thrombosis (DVT) and the association between these indices and DVT in critically ill patients.Methods 26 hospitalized patients with acute DVT from ICU from December 2013 to July 2015 were selected as case group.Tested inflammatory factors including IL-6,IL-10,CRP,PCT,ESR on the 1st,4th,14th day after confirmed diagnosis.30 healthy examined people were selected as control group.Results ①The levels of IL-6,IL-10,and CRP on the 1st,4th day after confirmed diagnosis in case group were higher than those on the 14th day and those in control group;there were no statistically significant differences in the levels of IL-6,IL-10,and CRP on the 14th day between two groups (P>0.05).② The levels of PCT,ESR in case group at three time points were significantly higher than those in control group;there were no statistically significant differences in the levels of PCT,ESR among three time points (P>0.05).Conclusion Inflammatory factors such as IL-6,IL-10,CPRjointly participate the onset and development of DVT in critically ill

  20. Value of Urine Liver-Type Fatty Acid Binding Proteins in the Early Diagnosis of Acute Kidney Injury in Critically Ill Patients%肝型脂肪酸结合蛋白在重症患者急性肾损伤早期诊断中的意义

    Institute of Scientific and Technical Information of China (English)

    黄云芳; 陈文莉; 方珣

    2011-01-01

    目的:探讨尿肝型脂肪酸结合蛋白(L-FABP)在重症患者急性肾损伤(AKI)中的早期诊断价值。方法:以我院收治的危重症患者为观察对象,按照阿姆斯特丹AKI诊断标准,将5d内符合诊断标准的AKI患者纳入AKI组(12例),对照组(12例)由匹配的非AKI患者构成。每24 h收集尿标本,持续5d。ELISA法检测尿L-FABP水平。以受试者工作特征曲线评价L-FABP对AKI的诊断作用。结果:与AKI诊断前3d比较,AKI诊断前2d及1d患者尿L-FABP均明显增高(P均<0. 05),但尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)及血肌酐(Scr)无明显改变(P均>0.05);观察期间对照组尿L-FABP、NAG、Scr均无明显变化(P均>0.05)。AKI诊断前3d尿L-FABP、NAG、Scr对AKI均无诊断作用;AKI诊断前2d及1d尿L-FABP对AKI具有早期诊断作用,而NAG、Scr无早期诊断作用。结论:尿L-FABP对重症患者AKI具有较高的敏感性和特异性,可能具有AKI早期诊断价值。%Objective: To investigate the value of urinary liver-type fatty acid binding proteins (L-FABP) in the early diagnosis of acute kidney injury (AKI) in critically ill patients. Methods: Critically ill patients were divided into the AKI group ( n=12) and non-AKI group (n=12). Blood and urinary samples were collected daily for five days. The samples were used to determine serum creatinine(Scr) , N-acetyl-β-D-glucosaminidase (NAG), as well as urinary L-FABP. Standard statistic analysis was used along with receiver operating characteristic curve analysis to evaluate the diagnose value. Results: There were no significant differences in clinical parameters between non-AKI (n=14) and AKI (n = 12) groups. As compared with the levels obtained three days before the diagnosis of AKI, the urinary L-FABP levels in the AKI group increased significantly (P0. 05). The levels of urinary L-FABP, Scr and NAG had no significant changes in the control group (all P> 0.05). Conclusion; Urinary L

  1. The Critically Ill Kidney Transplant Recipient: A Narrative Review.

    Science.gov (United States)

    Canet, Emmanuel; Zafrani, Lara; Azoulay, Élie

    2016-06-01

    Kidney transplantation is the most common solid organ transplantation performed worldwide. Up to 6% of kidney transplant recipients experience a life-threatening complication that requires ICU admission, chiefly in the late posttransplantation period (≥ 6 months). Acute respiratory failure and septic shock are the main reasons for ICU admission. Cardiac pulmonary edema, bacterial pneumonia, acute graft pyelonephritis, and bloodstream infections account for the vast majority of diagnoses in the ICU. Pneumocystis jirovecii pneumonia is the most common opportunistic infection, and one-half of the patients so infected require mechanical ventilation. The incidence of cytomegalovirus visceral infections in the era of preemptive therapy has dramatically decreased. Drug-related neutropenia, sirolimus-related pneumonitis, and posterior reversible encephalopathy syndrome are among the most common immunosuppression-associated toxic effects. Importantly, the impact of critical illness on graft function is worrisome. Throughout the ICU stay, acute kidney injury is common, and about 40% of the recipients require renal replacement therapy. One-half of the patients are discharged alive and free from dialysis. Hospital mortality can reach 30% and correlates with acute illness severity and reason for ICU admission. Transplant characteristics are not predictors of short-term survival. Graft survival depends on pre-ICU graft function, disease severity, and renal toxicity of ICU investigations and treatments.

  2. Influences of Maternal Mental Illness on Psychological Outcomes for Adolescent Children.

    Science.gov (United States)

    Oyserman, Daphna; Bybee, Deborah; Mowbray, Carol

    2002-01-01

    Explores the effects of maternal psychiatric symptoms and community functioning on child outcomes in a diverse sample of seriously mentally ill women caring for their teenaged children. In hierarchical multiple regression, for youth depression, we find effects for parenting style and maternal mental health; for youth anxiety and efficacy, effects…

  3. A Bibliography of Children's and Young Adult's Books about Illness Issues.

    Science.gov (United States)

    Cothern, Nancy B.

    This bibliography presents a list of approximately 360 works of children's and young adult's literature that deal with illness issues or issues connected with adverse life conditions such as various forms of child abuse, alcoholism, AIDS, blindness, cancer, death, handicaps, suicide, and surgery. The bibliography is divided into 42 sections, each…

  4. AN EXPERIENCE OF FACILITY-BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION IN CHILDREN AGED BETWEEN 0-59 MONTHS ADOPTING THE WORLD HEALTH ORGANIZATION RECOMMENDATIONS AT NUTRITION REHABILITATION CENTRE, ANANTHAPURAMU

    Directory of Open Access Journals (Sweden)

    Praveen Deen Kumar

    2016-04-01

    Full Text Available BACKGROUND Severe Acute Malnutrition (SAM increases significantly the risk of death in children under five years of age. It can be an indirect cause of child death by increasing the case fatality rate in children suffering from common illness such as diarrhoea, pneumonia. AIMS The aim of this study is to know the effectiveness of facility based management of children with Severe Acute Malnutrition at Nutrition Rehabilitation Centres (NRCs. SETTINGS AND DESIGN The study was done in the Department of Paediatrics, Government General Hospital at Ananthapuramu as a prospective observational study. METHODS AND MATERIALS A total of 195 patients were selected under Severe Acute Malnutrition as per WHO Child Growth Standards by observing for bilateral pitting oedema and/or MUAC _15% admission weight, while 50 (32.7% did not attain target weight gain (non-recovered. CONCLUSION This study will help to improve the functional activities of NRCs. Conducting audits after such studies will aid in implementation of newer guidelines, which will enhance the functional outcome of NRCs. Such NRCs will greatly help to reduce the under-five child mortality rate.

  5. Missed opportunities in child healthcare

    Directory of Open Access Journals (Sweden)

    Linda Jonker

    2014-01-01

    Full Text Available Background: Various policies in health, such as Integrated Management of Childhood Illnesses, were introduced to enhance integrated service delivery in child healthcare. During clinical practice the researcher observed that integrated services may not be rendered.Objectives: This article describes the experiences of mothers that utilised comprehensive child health services in the Cape Metropolitan area of South Africa. Services included treatment for diseases; preventative interventions such as immunisation; and promotive interventions, such as improvement in nutrition and promotion of breastfeeding.Method: A qualitative, descriptive phenomenological approach was applied to explore the experiences and perceptions of mothers and/or carers utilising child healthcare services. Thirty percent of the clinics were selected purposively from the total population. A convenience purposive non-probability sampling method was applied to select 17 mothers who met the criteria and gave written consent. Interviews were conducted and recorded digitally using an interview guide. The data analysis was done using Tesch’s eight step model.Results: Findings of the study indicated varied experiences. Not all mothers received information about the Road to Health book or card. According to the mothers, integrated child healthcare services were not practised. The consequences were missed opportunities in immunisation, provision of vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice.Conclusion: There is a need for simple interventions such as oral rehydration, early recognition and treatment of diseases, immunisation, growth monitoring and appropriate nutrition advice. These services were not offered diligently. Such interventions could contribute to reducing the incidence of child morbidity and mortality.

  6. Child abuse: discovering the horrifying truth.

    Science.gov (United States)

    Blair, Lee; Clauss, Eric; Meredith, Mark

    2011-10-01

    EMS is called to the residence of a 2-month-old child who's lethargic and has not eaten well for several days. On arrival, the grandmother of the patient states she's concerned because the child isn't acting right. During your assessment, you notice the child isn't acting age appropriate. Initial vital signs after placing the patient in the ambulance reveal: blood pressure 82/46, pulse 146 bpm, respirations 32 and a blood-glucose level of 134 mg/dL. Further assessment reveals bruising to the pinna of the right ear. On arrival at the emergency department (ED), the child begins to have periods of apnea, and the hospital healthcare providers intubate the patient. A post-intubation chest X-ray reveals multiple acute and sub-acute rib fractures. The ED staff exposed the patient during their assessment and noted bruising to the left ear and the jaw. There's also bruising found in different stages of healing to the anterior and posterior chest wall. The ED staff suspects this patient is a victim of child maltreatment, so the proper authorities are notified. During the investigation, the mother admits to abusing the child.

  7. [Gustave Flaubert's illness].

    Science.gov (United States)

    Gastaut, H; Gastaut, Y

    1982-01-01

    All those interested in Gustave Flaubert's illness, during his lifetime as well as after his death, have agreed that he had epilepsy. The one important exception is Jean-Paul Sartre, who, in the 2800 pages of his "Idiot de la famille" claimed that Flaubert was a hysteric with very moderate intelligence who somatized his neurosis in the form of seizures. These, in Sartre's views, were moreover probably hysterical, but possibly epileptic resulting from the existence of a psychogenic epilepsy bred from the neurosis. The basis for this neurosis could have originated at the time of Gustave's birth, as this occurred between those of two brothers who both died young, and as his mother had wished for a daughter. Further development of the neurosis might have taken place during a temporary phase of learning difficulties, exaggerated and exploited by his father to make his youngest son the idiot of a family in which the eldest son was the dauphin. Destroyed in this way, Gustave would have sought refuge in passivity and could have developed a hatred for his father and for his elder brother, who he would have liked to kill before killing himself. But, unable to carry out his wishes and desiring both to die and to survive, Gustave, adolescent, might have chosen the pathway of "false deaths", as exemplified by the seizures. Modern epileptology data enables not only to confirm the epileptic etiology and to discount the hysterical nature of the fits, but also: 1. to establish precise details of the site and nature of the cerebral lesions responsible for the attacks: neonatal atrophy or vascular malformation of the occipitotemporal cortex of the left hemisphere, the only lesion capable of provoking: a) the phosphenes marking the onset of the seizures; b) the intellectual manifestations (forced thoughts or flight of ideas), affective features (panic terror), and psychosensory (ecmnesic hallucinations) or psychomotor (confusional automatism) symptoms accompanying some attacks; c) the

  8. Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study

    Directory of Open Access Journals (Sweden)

    Huang Hsiu-Hua

    2012-05-01

    Full Text Available Abstract Background Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding. Methods One hundred and eight critically ill patients were grouped as “less severe” and “more severe” for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding, length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB, and 24-h urinary urea nitrogen data were collected over 21 days. Results There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036 and prealbumin (p = 0.014 but worsened NB (p = 0.01, more feeding complications (p = 0.005, and prolonged ICU stays (p = 0.005 compared to their late feeding counterparts. Conclusions There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality

  9. Agreement between children and parents demonstrated that illness-related absenteeism was validly reported by children

    DEFF Research Database (Denmark)

    Denbæk, Anne Maj; Bonnesen, Camilla Thørring; Andersen, Anette;

    2016-01-01

    of 22 weeks. Text messages and questionnaire data were linked at the individual level, leaving 2,269 child-parent pairs in the analysis, corresponding to 27% of the eligible sample. RESULTS: The agreement between children's and parents' reports of illness-related absenteeism was good, with high absolute...... parent of each child were invited to participate in the Hi Five baseline study. The response rate for children answering a questionnaire was 89% (n = 7,525), and 36% of the parents (n = 3,008) participated in a weekly illness registration study using text messages (short message service) over a period......OBJECTIVES: To examine the agreement between children's and parents' reporting of illness-related absenteeism from school and to examine predictors for disagreement between children and parents. STUDY DESIGN AND SETTING: A total of 8,438 schoolchildren aged from 5 to 15 years (grade 0-8) and one...

  10. Increased risk of complications in acute onset intestinal malrotation

    DEFF Research Database (Denmark)

    Wallberg, Sidsel Vang; Qvist, Niels

    2013-01-01

    Intestinal malrotation is a potentially life-threatening illness which presents in many different ways and the symptoms span from acute to chronic. The purpose of this study was to determine the clinical presentation of intestinal malrotation at all ages....

  11. The stigma of mental illness

    Directory of Open Access Journals (Sweden)

    Kordosi A

    2015-10-01

    Full Text Available Introduction:The stigma of mental illness is not a modern phenomenon, but it can now be approached scientifically. The stigma, because of the mental illness which characterizes a person, can be explained by the natural propensity of man to deliver biased and stereotyped estimates to phenomena he cannot explain, accept or face. Methodology:This study is an attempt to describe the concept of stigma and the impact of the stigma of mental illness in the personal and social life of the individual. The search for sources of this review was made through books on the topic and articles of the last twenty years, from online internet sources (pubmed, scopus, google scholar. Literature Review:Stigma brought about by illness from mental illness, is a complex process and concept, located in social interaction and the dynamics of social relations. The social stigma borne by mental illness in general, as well as the lack of information, ignorance, stereotypes, myths and prejudices, are the main reasons that characterize, even today, depression as a taboo subject. The stigma of mental illness is indeliblyimprinted in the identity of human suffering. In any case, the impact of stigma is critical for people who are sick. The psychological stress and difficult conditions that shape their daily lives aggravate their already compromised mental health, having a significant impact on the course and outcome of the disease itself. Key strategies to address stigma are protest, education and contact. Conclusions:A significant step in combating the stigma is to raise public awareness on the issues of mental health and their inclusion in society.

  12. Office of Child Care

    Science.gov (United States)

    ... for Children & Families Office of Child Care By Office Administration for Native Americans (ANA) Administration on Children, ... Care Partnerships. Review the profiles. > What is the Office of Child Care (OCC)? The Office of Child ...

  13. The degree of parental awareness of using means of physical rehabilitation on the frequently ill children

    Directory of Open Access Journals (Sweden)

    Ludmyla Demchenko

    2016-04-01

    Full Text Available Purpose: to establish the degree of parental awareness of using means of physical rehabilitation on the frequently ill children with acute respiratory viral infections. Material & Methods: analysis of scientific and methodological literature, surveys and questionnaires. Results: the research involved 54 families with the frequently ill children. The paper characterizes and establishes the degree of parental awareness in the sphere of physical rehabilitation of the frequently ill children, determines the level of parental interest in cooperation, presents the plan of seminars with parents. Conclusions: increasing the degree of parental awareness by studying and explaining is a prerequisite to achieve high effectiveness in health recovery process of the frequently ill children. Keywords: frequently ill children, parental awareness, physical rehabilitation.

  14. Human Coronavirus-Associated Influenza-Like Illness in the Community Setting in Peru.

    Science.gov (United States)

    Razuri, Hugo; Malecki, Monika; Tinoco, Yeny; Ortiz, Ernesto; Guezala, M Claudia; Romero, Candice; Estela, Abel; Breña, Patricia; Morales, Maria-Luisa; Reaves, Erik J; Gomez, Jorge; Uyeki, Timothy M; Widdowson, Marc-Alain; Azziz-Baumgartner, Eduardo; Bausch, Daniel G; Schildgen, Verena; Schildgen, Oliver; Montgomery, Joel M

    2015-11-01

    We present findings describing the epidemiology of non-severe acute respiratory syndrome human coronavirus-associated influenza-like illness from a population-based active follow-up study in four different regions of Peru. In 2010, the prevalence of infections by human coronaviruses 229E, OC43, NL63, or HKU1 was 6.4% in participants with influenza-like illness who tested negative for influenza viruses. Ten of 11 human coronavirus infections were identified in the fall-winter season. Human coronaviruses are present in different regions of Peru and are relatively frequently associated with influenza-like illness in Peru.

  15. Elevated transmission of upper respiratory illness among new recruits in military barracks in Thailand

    Science.gov (United States)

    Levy, Jens W; Bhoomiboonchoo, Piraya; Simasathien, Sriluck; Salje, Henrik; Huang, Angkana; Rangsin, Ram; Jarman, Richard G; Fernandez, Stefan; Klungthong, Chonticha; Hussem, Kittinun; Gibbons, Robert V; Yoon, In-Kyu

    2015-01-01

    Background New recruits within military barracks present conditions favorable for the spread of respiratory pathogens. However, respiratory pathogen transmission in such confined settings in the tropics has not been well studied. Methods Recruits in four successive Royal Thai Army basic training classes living in military barracks were monitored for the symptoms of influenza-like illness (ILI) or upper respiratory illness (URI). Classes 1 and 2 were also monitored after basic training. Nasal/throat swabs from acute illnesses were collected and tested by influenza RT-PCR (all four classes). In addition, class 1 had multiplex PCR performed along with the analysis of bed locations within the barracks. Results Influenza-like illness/upper respiratory illness rates ranged from 4·7 to 6·9 per 100 recruit-weeks in the four classes and generally decreased during the course of basic training (P ILI cases in class 1 tended to be in closer proximity to each other. Conclusion Basic training recruits in military barracks in the tropics had high rates of acute respiratory illnesses with illness patterns consistent with external seeding followed by substantial internal transmission. Our findings may contribute to control measures in similar confined settings both within and outside the military. PMID:26271648

  16. Preventing Child Abuse and Neglect with Parent Training: Evidence and Opportunities

    Science.gov (United States)

    Barth, Richard P.

    2009-01-01

    Researchers have identified four common co-occurring parental risk factors--substance abuse, mental illness, domestic violence, and child conduct problems--that lead to child maltreatment. The extent to which maltreatment prevention programs must directly address these risk factors to improve responsiveness to parenting programs or can directly…

  17. Psychodynamics in medically ill patients.

    Science.gov (United States)

    Nash, Sara Siris; Kent, Laura K; Muskin, Philip R

    2009-01-01

    This article explores the role of psychodynamics as it applies to the understanding and treatment of medically ill patients in the consultation-liaison psychiatry setting. It provides historical background that spans the eras from Antiquity (Hippocrates and Galen) to nineteenth-century studies of hysteria (Charcot, Janet, and Freud) and into the twentieth century (Flanders Dunbar, Alexander, Engle, and the DSM). The article then discusses the effects of personality on medical illness, treatment, and patients' ability to cope by reviewing the works of Bibring, Kahana, and others. The important contribution of attachment theory is reviewed as it pertains the patient-physician relationship and the health behavior of physically ill patients. A discussion of conversion disorder is offered as an example of psychodynamics in action. This article highlights the important impact of countertransference, especially in terms of how it relates to patients who are extremely difficult and "hateful," and explores the dynamics surrounding the topic of physician-assisted suicide, as it pertains to the understanding of a patient's request to die. Some attention is also given to the challenges surrounding the unique experience of residents learning how to treat medically ill patients on the consultation-liaison service. Ultimately, this article concludes that the use and understanding of psychodynamics and psychodynamic theory allows consultation-liaison psychiatrists the opportunity to interpret the life narratives of medically ill patients in a meaningful way that contributes importantly to treatment.

  18. Physical anhedonia in the acute phase of schizophrenia

    OpenAIRE

    Petridou Eleni; Stamouli Sophia S; Margariti Maria M; Havaki-Kontaxaki Beata J; Kollias Costas T; Kontaxakis Vassilis P; Christodoulou George N.

    2006-01-01

    Abstract Background The aim of the current study is to investigate the relationship between physical anhedonia and psychopathological parameters, pharmacological parameters or motor side-effects in a sample of inpatients with schizophrenia in an acute episode of their illness. Method Eighty one patients with schizophrenia, consecutively admitted, with an acute episode of their illness, at the Eginition Hospital, Department of Psychiatry, University of Athens, during a one-year period were inv...

  19. QAP collaborates in development of the sick child algorithm.

    Science.gov (United States)

    1994-01-01

    Algorithms which specify procedures for proper diagnosis and treatment of common diseases have been available to primary health care services in less developed countries for the past decade. Whereas each algorithm has usually been limited to a single ailment, children often present with the need for more comprehensive assessment and treatment. Treating just one illness in these children leads to incomplete treatment or missed opportunities for preventive services. To address this problem, the World Health Organization has recently developed a Sick Child Algorithm (SCA) for children aged 2 months-5 years. In addition to specifying case management procedures for acute respiratory illness, diarrhea/dehydration, fever, otitis, and malnutrition, the SCA prompts a check of the child's immunization status. The specificity and sensitivity of this SCA were field-tested in Kenya and the Gambia. In Kenya, the Malaria Branch of the US Centers for Disease Control and Prevention tested the SCA under typical conditions in Siaya District. The Quality Assurance Project of the Center for Human Services carried out a parallel facility-based systems analysis at the request of the Malaria Branch. The assessment which took place in September-October 1993, took the form of observations of provider/patient interactions, provider interviews, and verification of supplies and equipment in 19 rural health facilities to determine how current practices compare to actions prescribed by the SCA. This will reveal the type and amount of technical support needed to achieve conformity to the SCA's clinical practice recommendations. The data will allow officials to devise the proper training programs and will predict quality improvements likely to be achieved through adoption of the SCA in terms of effective case treatment and fewer missed immunization opportunities. Preliminary analysis indicates that the primary health care delivery in Siya deviates in several significant respects from performance

  20. Somali Refugees' Perceptions of Mental Illness.

    Science.gov (United States)

    Bettmann, Joanna E; Penney, Deb; Clarkson Freeman, Pamela; Lecy, Natalie

    2015-01-01

    Nearly 13% of the U.S. population is comprised of foreign-born individuals, with Somalis constituting one of the largest resettled groups. Research suggests that, among Somali refugees, rates of mental illness are high. Yet research shows Somalis underutilize mental health services. Understanding their perceptions of mental illness and its cures may help practitioners to design more effective treatments for this population. Thus, this pilot study investigated Somali refugees' perceptions of mental illness and its treatments. Using purposive sampling, this qualitative study interviewed 20 Somali refugees using a semi-structured interview guide. Qualitative analysis yielded participants' perceptions of mental illness through their descriptions of physical symptoms accompanying mental illness, the stigma of mental illness, causes of mental illness, medical and non-medical treatments for mental illness, spirit possession causing mental illness, and the Qur'an as treatment for mental illness. Such information may help practitioners in the United States approach Somali clients in the most culturally coherent manner.