RESUMEN

Salmonella enterica serovar typhimurium (S. Typhimurium) is a common Gram-negative foodborne pathogenic bacterium that causes gastrointestinal disease in humans and animals. It is well known that adhesins and invasins play crucial roles in the infection mechanism of S. Typhimurium. S. Typhimurium STM0306 has been denoted as a putative protein and its functions have rarely been reported. In this study, we constructed the STM0306 gene mutant strain of S. Typhimurium and purified the recombinant STM0306 from Escherichia coli. Deletion of the STM0306 gene resulted in reduced adhesion and invasion of S. Typhimurium to IPEC-J2, Caco-2, and RAW264.7 cells. In addition, STM0306 could bind to intestinal epithelial cells and induced F-actin modulation in IPEC-J2 cells. Furthermore, we found that STM0306 activated the nuclear factor kappa B (NF-κB) signaling pathway and increased the mRNA expression of pro-inflammatory cytokines such as IL-1ß, TNF-α, as well as chemokine CXCL2, thus resulting in cellular inflammation in host cells. In vivo, the deletion of the STM0306 gene led to reduced pathogenicity of S. Typhimurium, as evidenced by lower fecal bacterial counts and reduced body weight loss in S. Typhimurium infected mice. In conclusion, the STM0306 of S. Typhimurium is an important adhesin/invasin involved in the pathogenic process and cellular inflammation of the host.

Asunto(s)

Adhesinas Bacterianas , Salmonella typhimurium , Humanos , Animales , Ratones , Salmonella typhimurium/metabolismo , Serogrupo , Células CACO-2 , Adhesinas Bacterianas/genética , Adhesinas Bacterianas/metabolismo , Inflamación/genética

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INTRODUCTION: Emergency departments (ED) globally are addressing the coronavirus disease 2019 (COVID-19) pandemic with varying degrees of success. We leveraged the 17-country, Emergency Medicine Education & Research by Global Experts (EMERGE) network and non-EMERGE ED contacts to understand ED emergency preparedness and practices globally when combating the COVID-19 pandemic. METHODS: We electronically surveyed EMERGE and non-EMERGE EDs from April 3-June 1, 2020 on ED capacity, pandemic preparedness plans, triage methods, staffing, supplies, and communication practices. The survey was available in English, Mandarin Chinese, and Spanish to optimize participation. We analyzed survey responses using descriptive statistics. RESULTS: 74/129 (57%) EDs from 28 countries in all six World Health Organization global regions responded. Most EDs were in Asia (49%), followed by North America (28%), and Europe (14%). Nearly all EDs (97%) developed and implemented protocols for screening, testing, and treating patients with suspected COVID-19 infections. Sixty percent responded that provider staffing/back-up plans were ineffective. Many sites (47/74, 64%) reported staff missing work due to possible illness with the highest provider proportion of COVID-19 exposures and infections among nurses. CONCLUSION: Despite having disaster plans in place, ED pandemic preparedness and response continue to be a challenge. Global emergency research networks are vital for generating and disseminating large-scale event data, which is particularly important during a pandemic.

Asunto(s)

COVID-19 , Servicio de Urgencia en Hospital/organización & administración , Pandemias , Triaje , Estudios Transversales , Salud Global , Humanos , SARS-CoV-2

RESUMEN

INTRODUCTION@#Child sexual abuse (CSA) adversely affects a child's growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department(ED) with CSA.@*METHODS@#Children 0-16 years old presenting to KK Women's and Children's Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years old.@*RESULTS@#There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, @*CONCLUSION@#The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children.

Asunto(s)

Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Maltrato a los Niños , Abuso Sexual Infantil , Servicio de Urgencia en Hospital , Padres , Estudios Retrospectivos

RESUMEN

AIM@#To evaluate the cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury (TBI). Secondary aim was to identify factors associated with high inpatient rehabilitation cost.@*METHOD@#Retrospective review of a tertiary hospital's trauma registry was performed from 2011-2017. All patients aged 16 years or younger who sustained TBI with Glasgow Coma Scale ≤13 were included. Data on patient demographics, mechanism and severity of injury, hospital duration and inpatient rehabilitation cost were collected. We performed a regression analysis to identify factors associated with high rehabilitation cost.@*RESULTS@#There were a total of 51 patients. The median duration of inpatient rehabilitation was 13.5 days (interquartile range [IQR] 4-35), amounting to a median cost of SGD8,361 (IQR 3,543-25,232). Daily ward costs contributed the most to total inpatient rehabilitation cost. Those with severe TBI had longer duration of inpatient rehabilitation that resulted in higher cost of inpatient rehabilitation. Presence of polytrauma, medical complications, post-traumatic amnesia and TBI post-non-accidental injury (NAI) were associated with higher cost of inpatient rehabilitation.@*CONCLUSION@#The cost of inpatient rehabilitation for paediatric patients post-TBI is significant in Singapore. Patients with TBI secondary to NAI had significantly higher cost of inpatient rehabilitation. Ways to reduce duration of hospitalisation post-TBI and early step-down care or outpatient rehabilitation should be explored to reduce cost.

RESUMEN

INTRODUCTION@#Head injuries occur commonly in children and can lead to concussion injuries. We aim to describe the epidemiology of head injuries among school-going children and identify predictors of brain concussions in Singapore.@*METHODS@#This is a retrospective study of children 7-16 years old who presented to the Emergency Department (ED) of KK Women's and Children's Hospital in Singapore with minor head injury between June 2017 and August 2018. Data including demographics, clinical presentation, ED and hospital management were collected using a standardised electronic template. Multivariable logistic regression analysis was performed to identify early predictors for brain concussion. Concussion symptoms were defined as persistent symptoms after admission, need for inpatient intervention, or physician concerns necessitating neuroimaging.@*RESULTS@#Among 1,233 children (mean age, 6.6 years; 72.6% boys) analysed, the commonest mechanism was falls (64.6%). Headache and vomiting were the most common presenting symptoms. A total of 395 (32.0%) patients required admission, and 277 (22.5%) had symptoms of concussion. Older age (13-16 years old) (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.12-2.08), children involved in road traffic accidents (aOR 2.12, CI 1.17-3.85) and a presenting complaint of headache (aOR 2.64, CI 1.99-3.50) were significantly associated with symptoms of concussion.@*CONCLUSION@#This study provides a detailed description of the pattern of head injuries among school-going children in Singapore. High risk patients may require closer monitoring to detect post-concussion syndrome early.

RESUMEN

INTRODUCTION@#We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore.@*METHODS@#Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004).@*RESULTS@#Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020.@*CONCLUSION@#Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.

Asunto(s)

Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , COVID-19/prevención & control , Brotes de Enfermedades , Servicio de Urgencia en Hospital/tendencias , Utilización de Instalaciones y Servicios/tendencias , Política de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Admisión del Paciente/tendencias , Pediatría , Estudios Retrospectivos , Síndrome Respiratorio Agudo Grave/epidemiología , Singapur/epidemiología

RESUMEN

INTRODUCTION@#Frontline healthcare workers (HCWs) exposed to coronavirus disease 2019 (COVID-19) are at risk of psychological distress. This study evaluates the psychological impact of COVID-19 pandemic on HCWs in a national paediatric referral centre.@*METHODS@#This was a survey-based study that collected demographic, work environment and mental health data from paediatric HCWs in the emergency, intensive care and infectious disease units. Psychological impact was measured using the Depression, Anxiety, Stress Scale-21. Multivariate regression analysis was performed to identify risk factors associated with psychological distress.@*RESULTS@#The survey achieved a response rate of 93.9% (430 of 458). Of the 430 respondents, symptoms of depression, anxiety and stress were reported in 168 (39.1%), 205 (47.7%) and 106 (24.7%), respectively. Depression was reported in the mild (47, 10.9%), moderate (76, 17.7%), severe (23, 5.3%) and extremely severe (22, 5.1%) categories. Anxiety (205, 47.7%) and stress (106, 24.7%) were reported in the mild category only. Collectively, regression analysis identified female sex, a perceived lack of choice in work scope/environment, lack of protection from COVID-19, lack of access to physical activities and rest, the need to perform additional tasks, and the experience of stigma from the community as risk factors for poor psychological outcome.@*CONCLUSION@#A high prevalence of depression, anxiety and stress was reported among frontline paediatric HCWs during the COVID-19 pandemic. Personal psychoneuroimmunity and organisational prevention measures can be implemented to lessen psychiatric symptoms. At the national level, involving mental health professionals to plan and coordinate psychological intervention for the country should be considered.

Asunto(s)

Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ansiedad/etiología , COVID-19/psicología , Depresión/etiología , Encuestas Epidemiológicas , Hospitales Pediátricos , Modelos Logísticos , Análisis Multivariante , Enfermedades Profesionales/etiología , Pandemias , Personal de Hospital/psicología , Prevalencia , Factores de Riesgo , Autoinforme , Índice de Severidad de la Enfermedad , Singapur/epidemiología , Estrés Psicológico/etiología

RESUMEN

INTRODUCTION@#Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients.@*METHODS@#This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed.@*RESULTS@#Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; @*CONCLUSION@#General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment.

RESUMEN

INTRODUCTION@#In this study, we described paediatric sports injuries seen in the paediatric emergency department of a large, tertiary paediatric hospital in Singapore and evaluated risk factors for severe sports injuries.@*METHODS@#This is a retrospective review of a paediatric trauma surveillance registry from February 2012 to October 2017, including patient demographics, type of sports, circumstances, type of injuries, and clinical management in the hospital. Patients 5 to 17 years old with a sports-related injury were included. We performed logistic regression to identify predictors of severe sports injuries (defined by Injury Severity Score of ≥9), injuries requiring hospitalisation, trauma team activation, resuscitation, or those that resulted in death.@*RESULTS@#Among 10,951 patients analysed, the most common injuries sustained were fractures (4,819, 44.0%), sprains and contusions (3,334, 30.4%). For patients with severe injuries, the median length of hospital stay was 2 days (IQR 1-3 days), and time away from sports was 162 days (IQR 104-182 days). Predictors for severe injuries include transportation by emergency medical service (aOR 6.346, 95% CI 5.147-7.823), involvement in rugby (aOR 2.067, 95% CI 1.446-2.957), neurological injuries (aOR 4.585, 95% CI 2.393-4.365), dislocations (aOR 2.779, 95% CI 1.744-4.427), fractures (aOR 1.438, 95% CI 1.039-1.990), injuries to the head and neck (aOR 2.274, 95% CI 1.184-4.365), and injuries to the abdomen and pelvis (aOR 5.273, 95% CI 3.225-8.623).@*CONCLUSION@#Predictors for severe sports injuries identified may aid in risk stratification and resource allocation.

RESUMEN

Over the past decades, numerous Mollusca species have received more attention in development and utilization as valuable bio-resources. Many efforts have been focused on investigating mollusk polysaccharides because of their rich content, ease of extraction, diversified sorts, specific structure, various biofunctions and potent activities. To date, many mollusks, especially species of gastropods, bivalves, or cephalopods, have been reported containing polysaccharide compounds in tissues with abundant amount, and most of polysaccharides are obtainable through combining techniques of extraction, separation and purification. The polysaccharides isolated from mollusks appeared with various structural and physicochemical characteristics, ranged from neutral polysaccharides and sulfated polysaccharides, to GAGs series (including Hep/HS, CS/DS, HA and similarities), even to heterogeneous glycan with high molecular weight. This review article provides comprehensive knowledge of recent researches on type classification, tissue origins and possible biofunctions of various polysaccharides from mollusks. The highlights were placed in structure variation including molecular weight, sulfation pattern, linkages and monomer compositions for repeating unit, and primary molecular construction of the mollusks polysaccharides. In addition, this article covers general information on exhibition of mollusks polysaccharide extracts or preparations in the various bioactivities, such as anticoagulant, antiatherogenic, antioxidant, immunomodulatory, antivirus and antitumor activities, which would reveal their possible potentials in medical application. Furthermore, the article presents a brief overview on several challenges and future scope in this field.

Asunto(s)

Moluscos/química , Polisacáridos/química , Polisacáridos/aislamiento & purificación , Animales , Anticoagulantes , Antineoplásicos , Antioxidantes , Antivirales , Factores Inmunológicos , Polisacáridos/clasificación , Polisacáridos/farmacología

RESUMEN

OBJECTIVE: The practice of allowing parental presence during invasive procedures in children varies depending on setting and individual provider preference. We aim to understand the attitudes, preferences, and practices of physicians and nurses with regard to parental presence during invasive pediatric emergency procedures in an Asian cultural context.METHODS: We surveyed physicians and nurses in the pediatric emergency department of a large tertiary hospital using separate self-administered questionnaires over three months. The data collected included the demographics and clinical experience of interview respondents. Each provider was asked about their attitude and preference regarding parental presence during specific invasive procedures.RESULTS: We surveyed 90 physicians and 107 nurses. Most physicians in our context preferred to perform pediatric emergency procedures without parental presence (82, 91.1%). Forty physicians (44.4%) reported that parental presence slowed down procedures, while 75 (83.3%) felt it increased provider stress. Most physicians made the decision to allow parents into the procedure room based on parental attitude (69, 76.7%) and the child's level of cooperation (64, 71.1%). Most nurses concurred that parental presence would add to provider stress during procedures (69, 64.5%). We did not find a significant relationship between provider experience (P=0.26) or age (P=0.50) and preference for parental presence.CONCLUSION: In our cultural context, most physicians and nurses prefer to perform procedures for children in the absence of parents. We propose that this can be changed by health professional training with role play and simulation, adequate supervision by experienced physicians, and clear communication with parents.

Asunto(s)

Niño , Humanos , Asia , Pueblo Asiatico , Demografía , Urgencias Médicas , Servicio de Urgencia en Hospital , Empleos en Salud , Organización y Administración , Padres , Encuestas y Cuestionarios , Centros de Atención Terciaria

RESUMEN

INTRODUCTION@#Growing evidence suggests there is potential harm associated with excess fluid in critically ill children. This study aimed to evaluate the association between percentage fluid overload (%FO) and paediatric intensive care unit (PICU) mortality in children with severe sepsis and septic shock.@*MATERIALS AND METHODS@#Patients with severe sepsis and septic shock admitted to the PICU were identified through discharge codes. Data on clinical characteristics, fluid input and output were collected. %FO was calculated as: (total daily input - total daily output [L]/admission body weight [kg]) × 100. The primary outcome was PICU mortality. Secondary outcomes were 28-day ventilator-free days (VFD), intensive care unit-free days (IFD) and inotrope-free days (InoFD). Multivariate analysis adjusting for presence of comorbidities, Pediatric Index of Mortality (PIM) 2 score and multiorgan dysfunction were used to determine the association between cumulative %FO over 5 days and outcomes.@*RESULTS@#A total of 116 patients were identified, with a mortality rate of 28.4% (33/116). Overall median age was 105.9 (23.1-157.2) months. Cumulative %FO over 5 days was higher in non-survivors compared to survivors (median [interquartile range], 15.1 [6.3-27.1] vs 3.6 [0.7-11.1]%; <0.001). Cumulative %FO was associated with increased mortality (adjusted odds ratio 1.08, 95% confidence interval 1.03-1.13; = 0.001) and decreased VFD, IFD and InoFD (adjusted mean difference -0.37 [-0.53 - -0.21] days, -0.34 [-0.49 - -0.20] days, and -0.31 [-0.48 - -0.14] days, respectively).@*CONCLUSION@#Cumulative %FO within the first 5 days of PICU stay was consistently and independently associated with poor clinical outcomes in children with severe sepsis and septic shock. Future studies are needed to test the impact of restrictive fluid strategies in these children.

RESUMEN

Myeloid-derived suppressor cells(MDSC) play critical roles in immune escape of tumor. We hypothesized that elimination of tumor-induced MDSCs might help to block tumor growth. Therefore, we constructed a cholera toxin B based peptide vaccine that targets a MDSC surface marker S100A8. Immunized BALB/c mice with CTB-S100A8 plus aluminum hydroxide induced high titers of anti-S100A8 antibodies and reduced tumor burden significantly in 4T1 mice model. We also found the vaccination led to significant reduction of tumor-induced monocytic MDSC(M-MDSC), with no effect on innate MDSCs, dendritic cell(DC) and macrophage(Mφ), demonstrating that targeting tumor-induced MDSC may be a promising approach in cancer immunotherapy.

Asunto(s)

Calgranulina A/antagonistas & inhibidores , Vacunas contra el Cáncer , Células Mieloides/efectos de los fármacos , Neoplasias/terapia , Vacunas de Subunidad , Animales , Línea Celular Tumoral , Macrófagos , Ratones , Ratones Endogámicos BALB C

RESUMEN

The polysaccharides from Mactra veneriformis (MVPS) were degraded by controlled mild acid hydrolysis to produce active oligosaccharides. MVPS can easily be hydrolyzed by H2SO4 or HCl. The hydrolyzing process was investigated in acid addition and reaction time by evaluating the producing content of reducing sugar. Hydrolysis with 1M HCl to MVPS can generate a time-depended behavior that is mild and controllable. HPLC analysis monitored the change of oligosaccharides composition in hydrolyzing. Total nine oligosaccharides are recognizable in the HPLC profile, and their content showed a regular transformation in hydrolysis. Those nine ingredients were identified as glucooligosaccharides with DP from 1 to 7 by MS analysis. Antioxidant activities of the typical hydrolyzates as well as MVPs were further tested in assays of DPPH and hydroxyl radicals scavenging, and reducing power. It was found that HCl hydrolyzate exhibited stronger antioxidant effects than MVPS and H2SO4 hydrolyzate due to its higher content of oligosaccharides.

Asunto(s)

Antioxidantes/química , Bivalvos/química , Polisacáridos/química , Animales , Antioxidantes/farmacología , Cromatografía Líquida de Alta Presión , Hidrólisis , Polisacáridos/farmacología , Solubilidad , Agua/química

RESUMEN

: Anaphylaxis is a predominantly childhood disease. Most of the literature on anaphylaxis has emerged from Western countries. This study aimed to describe the incidence, triggers and clinical presentation of anaphylaxis among children in Singapore, look for predictors for anaphylaxis with severe outcomes, and study the incidence of biphasic reactions.: We retrospectively reviewed records of children presenting with anaphylaxis to our paediatric emergency department from 1 January 2007 to 31 December 2014.: We identified 485 cases of anaphylaxis in 445 patients. Cutaneous symptoms (urticarial/angio-oedema) were the most common across all age groups (481 cases, 99%), followed by respiratory (412, 85%), gastrointestinal (118, 24%) and cardiovascular (35, 7.2%) symptoms. Central nervous system symptoms (drowsiness/ irritability) were rare across all age groups (11, 2.2%). Food was identified as the most common trigger across all age groups (45% to 63%). Seafood was the most common food trigger (57, 25%). A total of 420 (86.6%) children were treated with adrenaline, 451 (93%) received steroids and 411 (85%) received antihistamines. Sixty-three (13%) children fulfilled the criteria of severe anaphylaxis. There was no statistically significant association between severe anaphylaxis and the type of trigger (= 0.851), nor an overall past history of atopy (= 0.428). The only independent predictor for severe anaphylaxis was a previous drug allergy (= 0.016). A very low prevalence of biphasic reactions (0.6% of study population) was noted in our study.: We described the presentation and management of anaphylaxis in the Singapore population. A history of drug allergy is associated with severe presentation. Biphasic reactions are rare in our population.

Asunto(s)

Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Corticoesteroides , Usos Terapéuticos , Anafilaxia , Quimioterapia , Epidemiología , Angioedema , Epidemiología , Hipersensibilidad a las Drogas , Epidemiología , Servicio de Urgencia en Hospital , Epinefrina , Usos Terapéuticos , Hipersensibilidad a los Alimentos , Epidemiología , Enfermedades Gastrointestinales , Epidemiología , Antagonistas de los Receptores Histamínicos , Usos Terapéuticos , Hipotensión , Incidencia , Pediatría , Prevalencia , Enfermedades Respiratorias , Epidemiología , Estudios Retrospectivos , Factores de Riesgo , Alimentos Marinos , Índice de Severidad de la Enfermedad , Singapur , Epidemiología , Simpatomiméticos , Usos Terapéuticos , Centros de Atención Terciaria , Urticaria , Epidemiología

RESUMEN

Myeloid-derived suppressor cells (MDSC) play critical roles in immune escape of tumor. We hypothesized that elimination of tumor-induced MDSCs might help to block tumor growth. Therefore, we constructed a cholera toxin B based peptide vaccine that targets a MDSC surface marker S100A8. Immunized BALB/c mice with CTB-S100A8 plus aluminum hydroxide induced high titers of anti-S100A8 antibodies and reduced tumor burden significantly in 4T1 mice model. We also found the vaccination led to significant reduction of tumor-induced monocytic MDSC (M-MDSC), with no effect on innate MDSCs, dendritic cell (DC) and macrophage (Mφ), demonstrating that targeting tumor-induced MDSC may be a promising approach in cancer immunotherapy.

RESUMEN

This paper investigates the impact of trade openness on CO2 emissions using time series data over the period of 1970QI-2011QIV for Malaysia. We disintegrate the trade effect into scale, technique, composition, and comparative advantage effects to check the environmental consequence of trade at four different transition points. To achieve the purpose, we have employed augmented Dickey-Fuller (ADF) and Phillips-Perron (PP) unit root tests in order to examine the stationary properties of the variables. Later, the long-run association among the variables is examined by applying autoregressive distributed lag (ARDL) bounds testing approach to cointegration. Our results confirm the presence of cointegration. Further, we find that scale effect has positive and technique effect has negative impact on CO2 emissions after threshold income level and form inverted U-shaped relationship-hence validates the environmental Kuznets curve hypothesis. Energy consumption adds in CO2 emissions. Trade openness and composite effect improve environmental quality by lowering CO2 emissions. The comparative advantage effect increases CO2 emissions and impairs environmental quality. The results provide the innovative approach to see the impact of trade openness in four sub-dimensions of trade liberalization. Hence, this study attributes more comprehensive policy tool for trade economists to better design environmentally sustainable trade rules and agreements.

Asunto(s)

Contaminantes Atmosféricos/análisis , Dióxido de Carbono/análisis , Países en Desarrollo , Ambiente , Humanos , Cooperación Internacional , Malasia

RESUMEN

<p><b>INTRODUCTION</b>High performing clinical decision rules (CDRs) have been derived to predict which head-injured child requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population.</p><p><b>MATERIALS AND METHODS</b>This is a prospective observational cohort study of children aged less than 16 who presented to the emergency department (ED) from April 2014 to June 2014 with a history of head injury. Predictor variables used in the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected. Decisions on CT imaging and disposition were made at the physician's discretion. The performance of the CDRs were assessed and compared to current practices.</p><p><b>RESULTS</b>A total of 1179 children were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of children being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6).</p><p><b>CONCLUSION</b>The CDRs demonstrated high accuracy in detecting children with positive CT findings but direct application in areas with low rates of significant traumatic brain injury (TBI) is likely to increase unnecessary CT scans ordered. Clinical observation in most cases may be a better alternative.</p>

Asunto(s)

Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Algoritmos , Contusión Encefálica , Diagnóstico por Imagen , Lesiones Traumáticas del Encéfalo , Diagnóstico por Imagen , Traumatismos Craneocerebrales , Diagnóstico por Imagen , Sistemas de Apoyo a Decisiones Clínicas , Servicio de Urgencia en Hospital , Hemorragia Intracraneal Traumática , Diagnóstico por Imagen , Medicina de Urgencia Pediátrica , Neumocéfalo , Diagnóstico por Imagen , Estudios Prospectivos , Singapur , Fracturas Craneales , Diagnóstico por Imagen , Tomografía Computarizada por Rayos X

RESUMEN

<p><b>INTRODUCTION</b>Paediatric sepsis is a global health problem. It is the leading cause of mortality in infants and children worldwide. Appropriate and timely initial management in the first hours, often termed as the "golden hours", has great impact on survival. The aim of this paper is to summarise the current literature and updates on the initial management of paediatric sepsis.</p><p><b>MATERIALS AND METHODS</b>A comprehensive literature search was performed via PubMed using the search terms: 'sepsis', 'septic shock', 'paediatric' and 'early goal-directed therapy'. Original and review articles were identified and selected based on relevance to this review.</p><p><b>RESULTS</b>Early recognition, prompt fluid resuscitation and timely administration of antibiotics remain key in the resuscitation of the septic child. Use of steroids and tight glycaemic control in this setting remain controversial.</p><p><b>CONCLUSION</b>The use of early goal-directed therapy has had significant impact on patient outcomes and protocolised resuscitation of children in septic shock is recommended.</p>

Asunto(s)

Niño , Humanos , Guías de Práctica Clínica como Asunto , Resucitación , Estándares de Referencia , Choque Séptico , Terapéutica

RESUMEN

OBJECTIVES: Pediatric myocarditis is a known cause of dilated cardiomyopathy and is associated with significant mortality. Our primary objective was to describe the frequency of presenting symptoms, signs, and investigation results among children diagnosed with acute myocarditis. Our secondary objective was to review these patients' initial diagnoses by the emergency physicians. METHODS: This was a retrospective chart review of all patients younger than 16 years who were diagnosed with acute myocarditis in our hospital over a 10-year period (January 2001 to December 2010). The symptoms and signs were stratified according to age (infants, 1-5 years, 6 years or older). RESULTS: Thirty-nine children met the search criteria, of whom 10 patients (25.6%) were definite cases proven by myocardial biopsy. The average age was 5.4 years (SD, 4.3 years). The most common symptom complex was that of hypoperfusion (61.5%), which consisted of lethargy (53.8%), syncope (23.1%), and seizure (23.1%). Only 4 patients had cardiac symptoms, and all were older than 6 years old. Hepatomegaly was present in 16 patients (41.0%), whereas gallop rhythm or cardiac murmur was heard only in 5 patients (12.8%), Chest radiographs showed abnormalities in only 21 cases (53.8%), whereas all had abnormal electrocardiogram findings. Fifteen cases (38.5%) were diagnosed correctly at initial presentation, whereas the most common misdiagnosis was that of respiratory tract infections (20.5%). CONCLUSIONS: Pediatric myocarditis rarely presents with specific cardiac symptoms in the younger population. Any child with symptoms and signs of hypoperfusion, especially unexplained seizure or syncope, should have an electrocardiogram performed.

Asunto(s)

Servicio de Urgencia en Hospital , Miocarditis/diagnóstico , Niño , Preescolar , Diagnóstico Diferencial , Electrocardiografía , Femenino , Humanos , Lactante , Masculino , Miocarditis/epidemiología , Radiografía Torácica , Estudios Retrospectivos , Singapur/epidemiología