RESUMEN
BACKGROUND: It is a frequent challenge for physicians to identify pneumonia in patients with acute febrile respiratory symptoms, particularly in stable pediatric patients without respiratory distress. A decision rule is required to assist judgement on the need of ordering a chest radiograph. METHOD: This was a multicenter prospective study in 3 emergency departments. Children younger than 6 years old with an acute onset of fever and respiratory symptoms were recruited. Split sample method was adopted for derivation and validation of the Pediatric Acute Febrile Respiratory Illness rule (PAFRI Rule). PAFRI was derived from logistic regression with weighting based on adjusted odds ratios. RESULTS: Out of 967 children evaluated, 530 had taken chest radiograph examination, with 91 demonstrated evidence of pneumonia on radiograph. PAFRI Rule was derived from logistic regression with 5 weighed predictors: duration of fever <3 days (0 points), 3-4 days (2 points), 5-6 days (4 points), ≥7 days (5 points), chills (2 points), nasal symptoms (-2 points), abnormal chest examination (3 points), SpO2 ≤96% or tachypnea (3 points). The Area under ROC curve of the PAFRI Rule, the Bilkis Decision Rule and Bilkis Simpler Rule were 0.733, 0.600 and 0.579 respectively. A PAFRI score of ≥0 gives a sensitivity of 91.7% and negative predictive value of 97.7%. CONCLUSION: PAFRI rule can be used as a reference tool for guiding the need for taking Chest radiograph examination for pediatric patients. While promising, the PAFRI rule requires further validation. WHAT'S KNOWN ON THIS SUBJECT: It is often a challenge for physicians to identify pneumonia in children acutely febrile with respiratory symptoms, particularly in those who are stable without respiratory distress. The decision to order chest radiograph was based on clinical assessment with heterogenous practice. A valid and verified clinical prediction rule for ordering chest radiograph examination for stable febrile children without signs of respiratory distress would therefore assist in management of this group of patients. WHAT THIS STUDY ADDS: The PAFRI rule, based on parameters from clinical bedside assessment, can be used as a reference tool for guiding the need for referral to emergency department or taking use of chest radiograph for pediatric patients, and triaging for higher priority of clinical care.
Asunto(s)
Reglas de Decisión Clínica , Fiebre/fisiopatología , Hipoxia/fisiopatología , Neumonía/diagnóstico , Ruidos Respiratorios/fisiopatología , Taquipnea/fisiopatología , Niño , Preescolar , Escalofríos/fisiopatología , Infecciones Comunitarias Adquiridas , Tos/fisiopatología , Disnea/fisiopatología , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Pulmón/diagnóstico por imagen , Masculino , Obstrucción Nasal/fisiopatología , Examen Físico , Neumonía/diagnóstico por imagen , Neumonía/fisiopatología , Radiografía Torácica , Rinorrea/fisiopatología , Factores de TiempoRESUMEN
INTRODUCTION: There are two antivenoms that may be administered in Hong Kong following a bite by Trimeresurus albolabris: the green pit viper antivenom from the Thai Red Cross Society in Thailand and the Agkistrodon halys antivenom from the Shanghai Institute of Biological Products in China. Both are recommended by the Central Coordinating Committee of Accident and Emergency Services of the Hospital Authority for treating patients with a bite by Trimeresurus albolabris. The choice of which antivenom to use is based on physician preference. This study aimed to compare the relative efficacy of the two antivenoms. METHODS: This in-vitro experimental study was carried out by a wildlife conservation organisation and a regional hospital in Hong Kong. Human plasma from 40 adult health care worker volunteers was collected. The Trimeresurus albolabris venom was added to human plasma and the mixture was assayed after incubation with each antivenom (green pit viper and Agkistrodon halys) using saline as a control. Fibrinogen level and clotting time in both antivenom groups were studied. RESULTS: The mean fibrinogen level was elevated from 0 g/L to 2.86 g/L and 1.11 g/L after the addition of green pit viper antivenom and Agkistrodon halys antivenom, respectively. When mean clotting time was measured, the value was 6.70 minutes in the control, prolonged to more than 360 minutes by green pit viper antivenom and to 19.06 minutes by Agkistrodon halys antivenom. CONCLUSIONS: Green pit viper antivenom was superior to Agkistrodon halys antivenom in neutralisation of the thrombin-like and hypofibrinogenaemic activities of Trimeresurus albolabris venom.
Asunto(s)
Antivenenos/farmacología , Coagulación Sanguínea/efectos de los fármacos , Venenos de Crotálidos/antagonistas & inhibidores , Adulto , Pruebas de Coagulación Sanguínea , China , Venenos de Crotálidos/envenenamiento , Voluntarios Sanos , Hong Kong , Humanos , Mordeduras de Serpientes/terapia , Tailandia , Factores de TiempoRESUMEN
1. There is no effective anti-H5N1 avian influenza agent. 2. A chemical compound BFDBSCcan inhibit H5N1 virus infection in cell cultures, and such inhibition might be attributable to its halogenated benzoyl residues. 3. This pilot study assessed anti- H5N1 activity and toxicity of four chemical compounds with halogenated benzoyl residues in cell culture system. 4. Two compoundsFPBFDBSC and BFB-gallate showed higher antiviral effectsthan BFDBSC, whearas the other twoBFB-borneol and BFB-mentholshowed lower antiviral effects. These compounds did not show toxicity. 5. The halogenated benzoyl residues may play a key role in anti-H5N1 effects. However, all these compounds showed poor solubility, which may limit their utility
Asunto(s)
Antivirales/farmacología , Diseño de Fármacos , Subtipo H5N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/tratamiento farmacológico , Animales , Antivirales/química , Antivirales/toxicidad , Perros , Humanos , Gripe Humana/virología , Células de Riñón Canino Madin Darby , Proyectos Piloto , SolubilidadRESUMEN
Operative treatment is indicated in displaced intra-articular glenoid fractures. We report the results of treating 14 such fractures with open reduction and stable internal fixation. With an average follow-up period of 30.5 months, all fractures healed. All shoulders are rated good according to Rowe's scoring system. Complication was minimal, apart from those which resulted from the concomitant chest injuries. We therefore conclude that the operative treatment for these fractures gives good and predictable results. Special attention should be paid to treat the complications resulting from the common association of chest injuries in these patients.