RESUMEN
The aim of this study was to test if children with group A beta hemolytic streptococcal infection (GABHS) are more likely to develop neuropsychiatric symptoms or the syndrome of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) compared to children with GABHS-negative throat cultures. Children aged 8 to 12 years (n = 81) with upper respiratory tract infection were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version, Children's Yale Brown Obsession Compulsion Scale, Yale Global Tic Severity Scale, Child Behavior Checklist for Ages 4-18, Conners Parent Rating Scale, and State-Trait Anxiety Inventory for Children at baseline and six weeks later. One case of PANDAS was diagnosed and no other differences were observed between groups and time points. It was suggested that GABHS infection may be a triggering factor for PANDAS in some genetically prone individuals.
Asunto(s)
Trastornos de Ansiedad/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes , Déficit de la Atención y Trastornos de Conducta Disruptiva/epidemiología , Niño , Femenino , Humanos , Masculino , Trastorno Obsesivo Compulsivo/epidemiología , Faringitis/microbiología , Proyectos Piloto , Infecciones del Sistema Respiratorio/microbiología , Infecciones Estreptocócicas/psicología , Tonsilitis/microbiologíaRESUMEN
Although each method has its own advantages and disadvantages compared with the conservative mercury-in-glass thermometers, there are conflicting opinions about the optimal anatomic site for measuring body temperature as well about the variations in measurements with different methods. In this study, we aimed to assess the accuracy and reliability of measurements obtained from the axilla with the chemical thermometer (Tempa DOT TM) compared with the classic mercury-in-glass instruments. Sixty randomly selected pediatric patients who were admitted to our hospital were enrolled. Simultaneous temperature axillary measurements (n: 1300) were performed with the chemical thermometer and mercury-in-glass instruments. The mean results of the axillary mercury-in-glass thermometers and axillary chemical thermometer were 36.8 +/- 0.6 and 37.2 +/- 0.7, respectively. The Bland-Altman plot of differences suggests that 95% of the chemical thermometer (Tempa.DOT TM) readings were within limits of agreement (+0.37 and -1.24 degrees C) when mercury-in-glass thermometer is considered as the standard. Our results showed that limits of agreement were wide (+0.37 and -1.24 degrees C) between readings of axillary mercury-in-glass thermometers and chemical thermometers. Since approximately 20% of febrile patients with mercury-in-glass temperature were misdiagnosed as afebrile with measurements via chemical thermometer, we suggest that the axilla is not a suitable anatomic site for screening of fever with Tempa.DOT. Further studies involving larger study groups with similar age should be done to more definitely assess its screening value in pediatrics.
Asunto(s)
Temperatura Corporal , Fiebre/diagnóstico , Termómetros , Adolescente , Axila , Celulitis (Flemón)/epidemiología , Niño , Preescolar , Diseño de Equipo , Femenino , Fiebre/epidemiología , Humanos , Masculino , Reproducibilidad de los Resultados , Infecciones del Sistema Respiratorio/epidemiología , Termómetros/normasRESUMEN
In clinical practice, when neutropenic-fever patients present with no microbiologically and clinically defined infection, the risk of underestimating an occult infection is of major concern, the clinicians have to make a decision on when to modify antibiotic therapy. Hence, a reliable, specific, and sensitive marker, which is regulated independently from the leukocyte count and the underlying disease, is needed for the early diagnosis of infections in cases of neutropenic fever. We have evaluated the diagnostic and follow-up value of procalcitonin (PCT) compared with C-reactive protein (CRP) and erythrocyte sedimentation rate in documenting the infection in neutropenic-fever patients undergoing intensive chemotherapy, as evidenced by the durational change in these parameters in the presence of defined infection. Forty-nine patients, who had 60 febrile episodes, and who were hospitalized in the Hacettepe University Ihsan Dogramaci Children's Hospital between January 1, 2004 and January 1, 2005 were included in this prospective study. All patients had been diagnosed with neutropenic fever after intensive chemotherapy. In our study, PCT and CRP levels were significantly higher in neutropenic-fever patients (group I and group II separately) than in control patients (P<0.001) throughout the study period; but erythrocyte sedimentation rate levels did not show any significant difference (P>0.05). In sequential analyses of patients without documented infections, the median of PCT concentrations shows a tendency to fall after the 8th hour of onset of fever, whereas in patients with documented infections PCT concentrations fell after the 48th hour. In conclusion, our study suggests that PCT, when measured periodically, is a more useful diagnostic inflammation parameter in pediatric neutropenic-fever patients than CRP, both in estimating the severity of the infection and, the duration and origin of the fever. Hence, PCT might be helpful when deciding on initial therapy modification.
Asunto(s)
Biomarcadores/sangre , Proteína C-Reactiva/análisis , Calcitonina/sangre , Fiebre/sangre , Infecciones/diagnóstico , Neutropenia/sangre , Precursores de Proteínas/sangre , Adolescente , Antineoplásicos/efectos adversos , Sedimentación Sanguínea , Péptido Relacionado con Gen de Calcitonina , Niño , Preescolar , Femenino , Fiebre/etiología , Humanos , Inmunoensayo , Infecciones/sangre , Masculino , Neoplasias/tratamiento farmacológico , Neutropenia/etiología , Valor Predictivo de las Pruebas , Sensibilidad y EspecificidadRESUMEN
UNLABELLED: As the basic sciences develop, temperature measurement methods and devices were improved. For hundreds of years both in clinics and home, mercury-in-glass thermometer was the standard of human temperature measurements. In this study, we aimed to compare tympanic infrared thermometers with the conventional temperature option, mercury-in-glass thermometer, which is historical standard in the clinical conditions. METHODS: A total of 102 randomly selected pediatric patients who admitted to our hospital were enrolled, and simultaneous temperature measurements were performed via axilla and external auditory canal with 3 different techniques. For external auditory recordings, infrared tympanic First Temp Genius for clinical use and Microlife IR 1DA1 for home usage were used. Classic mercury-in-glass thermometers were used for axillary recording. For each method, 886 measurements were performed. RESULTS: The mean results of the axillary mercury-in-glass thermometers, infrared tympanic First Temp Genius, and Microlife IR 1DA1 were 36.8 +/- 0.7, 37.5 +/- 0.9, 36.9 +/- 0.8, respectively. The Bland-Altman plot of differences suggests that 95% of the infrared tympanic clinical use thermometer readings were within the limits of agreement, which is +0.27 and -1.75 degrees C range of mercury-in-glass thermometer. The Bland-Altman plot of differences suggests that 95% of the tympanic home-use thermometer readings were within the limits of agreement, which is +0.98 and -1.27 degrees C range of mercury-in-glass thermometer. In our group, 15% of the patients were misdiagnosed as febrile with home-use tympanic thermometer, whereas this percentage was 4% with clinical tympanic thermometer. Also, 5% and 31% of febrile patients were misdiagnosed as afebrile with clinical tympanic and home-use tympanic thermometer, if axillary mercury-in-glass thermometer recording defines fever. DISCUSSION: Our results showed that there is a significant difference in each recording with different thermometers, and this variance was present in both higher and lower readings. We recommend thathome-use infrared tympanic thermometer could be used for screening but must not be considered as a tool to decide patients follow-up.