[Efficacy and safety of ribavirin aerosol in children with hand-foot-mouth disease].

OBJECTIVE: To evaluate the efficacy and safety of ribavirin aerosol in children with hand-foot-mouth disease (HFMD). METHODS: A randomized, double-blind, placebo-controlled trial was performed. A total of 119 children with mild HFMD were randomly divided into an observed group (n=59) and a control group (n=60). In the observed group, ribavirin aerosol was given four times within the first hour, followed by once every other hour for the remaining time of the day and day 2; from days 3 to 7, it was given 4 times per day, with 2-3 sprays every time, for 7 days. In the control group, placebo was given in the same way as in the observed group. Additionally, both groups used oral antiviral liquid. The scores of clinical symptoms including oral ulcer, skin rash, nasal congestion, runny nose, sneezing, cough, and fever before and after treatment were recorded to evaluate treatment outcomes. Throat swabs were taken before treatment and 5-7 days after treatment to measure viral load by RT-PCR and to compare the negative conversion rate between the two groups. RESULTS: Fifty-seven patients in the observed group and 56 patients in the control group were tested according to the original research design. After 5-7 days of treatment, the observed group had a significantly higher overall negative conversion rate of enterovirus than the control group (P<0.01). The overall marked response rate and overall response rate of the observed group were 89% and 89%, respectively, significantly higher than those of the control group (29% and 43%). During treatment, there were no adverse reactions such as dizziness, vomiting, and notable decreases in hemoglobin, white blood cells, and platelets in the two groups. CONCLUSIONS: Ribavirin aerosol can be effectively and safely used for treating mild HFMD. With low dosage and few adverse reactions, it holds promise for clinical application.

Quality of death certificates in Quemoy, Taiwan.

BACKGROUND AND PURPOSE: The age-adjusted mortality rate on the island of Quemoy was the lowest of any county in Taiwan in the years 2000-2001. However, the island's rate of mortality due to cardiovascular diseases fluctuates widely. This fluctuation suggests that Quemoy may be issuing inaccurate death certificates. METHODS: To assess the quality of death certificates from Quemoy, 123 (15.3%) medical records for 800 deaths between 1994 and 1998 were reviewed by 3 medical specialists. The underlying cause of death from the original death certificate was compared to the underlying cause of death determined by 3 reviewers based on review of all available medical records. RESULTS: The agreement index for all causes of death was 72.4%. Neoplasms had the highest sensitivity and positive predictive value for correct determination of underlying cause of death. Cardiovascular diseases had higher sensitivity, but lower positive predictive value than respiratory diseases. Neoplasms were under-reported by 25.5% but cardiovascular diseases were over-reported by 34.3%. CONCLUSIONS: Therefore, mortality statistics in Quemoy, which are based on death certificate data, may underestimate the frequency of neoplasms and overestimate cardiovascular diseases as underlying causes of death. Our findings also suggest that researchers should exercise considerable caution when using death certificate data to determine cause of death in etiologic studies, especially in neoplasms and cardiovascular diseases.