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Glutaric Aciduria type I (GA1) is a rare neurometabolic disorder caused by mutations in the GDCH gene encoding for glutaryl-CoA dehydrogenase (GCDH) in the catabolic pathway of lysine, hydroxylysine and tryptophan. GCDH deficiency leads to increased concentrations of glutaric acid (GA) and 3-hydroxyglutaric acid (3-OHGA) in body fluids and tissues. These metabolites are the main triggers of brain damage. Mechanistic studies supporting neurotoxicity in mouse models have been conducted. However, the different vulnerability to some stressors between mouse and human brain cells reveals the need to have a reliable human neuronal model to study GA1 pathogenesis. In the present work we generated a GCDH knockout (KO) in the human neuroblastoma cell line SH-SY5Y by CRISPR/Cas9 technology. SH-SY5Y-GCDH KO cells accumulate GA, 3-OHGA, and glutarylcarnitine when exposed to lysine overload. GA or lysine treatment triggered neuronal damage in GCDH deficient cells. SH-SY5Y-GCDH KO cells also displayed features of GA1 pathogenesis such as increased oxidative stress vulnerability. Restoration of the GCDH activity by gene replacement rescued neuronal alterations. Thus, our findings provide a human neuronal cellular model of GA1 to study this disease and show the potential of gene therapy to rescue GCDH deficiency.
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Erros Inatos do Metabolismo dos Aminoácidos , Encefalopatias Metabólicas , Lisina , Neuroblastoma , Humanos , Animais , Camundongos , Lisina/genética , Glutaril-CoA Desidrogenase/genética , Glutaril-CoA Desidrogenase/metabolismo , Camundongos Knockout , Terapia GenéticaRESUMO
PURPOSE: Spinal Muscular Atrophy (SMA) Type II is a neurodegenerative disease that leads to progressive muscle weakness. It prevents children from walking and affects their respiratory function and their activity tolerance, among other health problems. We aimed to assess the activity tolerance showed by a child with SMA using a pediatric gait exoskeleton at home when walking and performing activities. DESIGN AND METHODS: This study presents the case of a 6-year-old boy with SMA Type II and respiratory failure who used a pediatric gait exoskeleton at home for a period of two months. A nursing assessment was done before and during the use of the device to evaluate the child's activity tolerance during the sessions. Nursing interviews, performance, vital signs, fatigue, field notes, and functional scales were analyzed. RESULTS: The nursing assessment showed a good activity tolerance of the child. Performance using the device improved over time; vital signs did not vary significantly during the sessions; fatigue perception decreased over time; and the child reached a higher score on some functional outcomes. CONCLUSIONS: A first step has been taken to evaluate the impact of exoskeleton technology in children with SMA Type II from the nursing point of view, exposing the potential of this technology for the care of children with neuromuscular diseases, and the need for more research on the topic. PRACTICE IMPLICATIONS: The information in this study will be useful to nurses to know the effects of gait exoskeletons in pediatric care of children with neuromuscular diseases like SMA.
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Exoesqueleto Energizado , Atrofia Muscular Espinal , Doenças Neurodegenerativas , Atrofias Musculares Espinais da Infância , Masculino , Criança , Humanos , Atrofia Muscular Espinal/diagnóstico , Atrofias Musculares Espinais da Infância/diagnóstico , FadigaRESUMO
OBJECTIVES: We investigated the reversibility of tenofovir disoproxil fumarate (TDF)-associated renal decline and tubular dysfunction using different antiretroviral strategies. METHODS: A successive evaluation of renal [estimated glomerular filtration rate (eGFR)] and tubular (phosphataemia, proteinuria, albuminuria, phosphaturia, uricosuria, glycosuria and tubular proteinuria) parameters was performed in 231 patients, before and after switching from TDF to abacavir (n = 60), using dual therapy (n = 49), or continuing the same regimen including TDF (n = 122). RESULTS: In a successive evaluation after a median of 8.86 months, or less time if treatment was switched (4.8 months vs. 13.3 months to second evaluation; P < 0.01), a significant improvement in eGFR (median change +0.3 vs. -2.91 mL/min/1.73 m2 in patients who did not discontinue TDF; P = 0.04) and tubular dysfunction (median change -40% vs. +30%, respectively; P < 0.01) was observed. Lineal regression showed that age (ß = -0.14; P = 0.04), previous eGFR decline (ß = -0.42; P < 0.01), and time on TDF (ß = -0.19; P = 0.04) were associated with impaired eGFR recovery. There were no differences in eGFR slopes between patients using abacavir instead of TDF and those using a dual therapy, who showed similar improvement in proteinuria (-22% vs. -19%, respectively), phosphaturia (+10.1% vs. +9.4%, respectively), and urinary beta-2-microglobulin (-9% vs. -15%, respectively; P > 0.1 for all), although patients receiving the dual regimen were more heavily pretreated. A eGFR decrease (-6.17 mL/min/1.73 m2 ) was observed in patients taking dolutegravir or rilpivirine, but with similar improvement to that observed in the rest of switching patients in tubular abnormalities. CONCLUSIONS: Tenofovir disoproxil fumarate discontinuation was associated with a rapid and significant improvement in eGFR and tubular abnormalities, regardless of whether abacavir or dual therapy was chosen. Switching to a regimen that included dolutegravir and/or rilpivirine was associated with a eGFR decrease without differences in the rate of tubular dysfunction improvement in comparison with the rest of patients who discontinued tenofovir.
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Preimplantation genetic diagnosis (PGD) has been applied worldwide for a great variety of single-gene disorders over the last 20 years. The aim of this work was to perform a double-factor preimplantation genetic diagnosis (DF-PGD) protocol in a family at risk for Lynch syndrome. The family underwent a DF-PGD approach in which two blastomeres from each cleavage-stage embryo were biopsied and used for monogenic and comprehensive cytogenetic analysis, respectively. Fourteen embryos were biopsied for the monogenic disease and after multiple displacement amplification (MDA), 12 embryos were diagnosed; 5 being non-affected and 7 affected by the disease. Thirteen were biopsied to perform the aneuploidy screening by short-comparative genomic hybridization (CGH). The improved DF-PGD approach permitted the selection of not only healthy but also euploid embryos for transfer. This has been the first time a double analysis of embryos has been performed in a family affected by Lynch syndrome, resulting in the birth of two healthy children. The protocol described in this work offers a reliable alternative for single-gene disorder assessment together with a comprehensive aneuploidy screening of the embryos that may increase the chances of pregnancy and birth of transferred embryos.
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Aneuploidia , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Transferência Embrionária , Diagnóstico Pré-Implantação/métodos , Proteínas Adaptadoras de Transdução de Sinal/genética , Biópsia , Blastocisto/citologia , Blastocisto/metabolismo , Blastômeros/citologia , Blastômeros/metabolismo , Neoplasias Colorretais Hereditárias sem Polipose/prevenção & controle , Hibridização Genômica Comparativa , Feminino , Fertilização in vitro , Testes Genéticos/métodos , Humanos , Masculino , Proteína 1 Homóloga a MutL , Mutação , Proteínas Nucleares/genética , Linhagem , GravidezRESUMO
OBJECTIVES: To determine the current state of renal function monitoring carried out on patients treated with NSAIDs. MATERIAL AND METHOD: We selected patients from a Primary Care Centre who had received NSAIDs for the first time. We checked if renal function was measured and/or controlled 2 months pre/6 months post-NSAID administration in order to assess if patient renal function was known at the time of prescription and afterwards. RESULTS: During the study period, there were 42 822 prescriptions made. Of these, 8611 were new drug prescriptions, of which 482 (5.6%) were NSAIDs in patients older than 14 years of age. A total of 450 patients (64% female) were treated with NSAIDs. Ibuprofen (66.0%) was the most commonly prescribed. NSAIDs were more frequently used in patients between 14-45 years of age. Only 168 (37.1%) patients underwent any analytical tests over the course of the study (68% female). Before prescription, renal function was measured in only 14% of cases (63 patients). Two patients received NSAIDs despite having high serum creatinine levels. During the follow-up, serum creatinine was measured in 129 patients (28.7%). CONCLUSIONS: In primary care, NSAIDs represent a substantial percentage of the drugs prescribed (5.6%). Ibuprofen is the most commonly prescribed. NSAIDs are more frequently used in women between 14-45 years. Musculo-skeletal pain is the main indication for prescription. Only 14% of patients receiving these drugs had previously measured levels of serum creatinine. These values are rarely taken into account when prescribing NSAIDs. Control of renal function after NSAID prescription was unusual.
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Anti-Inflamatórios não Esteroides/uso terapêutico , Rim/efeitos dos fármacos , Rim/fisiologia , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/farmacologia , Prescrições de Medicamentos , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Atenção Primária à Saúde , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION AND OBJECTIVES: The current definition and classification of acute kidney injury is based on consensus criteria (RIFLE and AKIN systems). Creatinine is the most commonly used of the recommended parameters (creatinine, glomerular filtration rate and diuresis). If the baseline value is not known, it can be calculated based on the simplified MDRD equation, assuming a filtration rate of 75 ml/min/1.73 m2 for the calculation. The aim of this study was to evaluate the diagnostic impact of using estimated baseline creatinine compared to the actual value measured in patients undergoing cardiac surgery. METHODS: Analysis of patients undergoing major cardiac surgery, who were prospectively included in a database. The maximum RIFLE stage reached was calculated for each patient using the measured and estimated baseline creatinine levels. The impact on the diagnosis was analysed using intraclass correlation coefficients, concordance analysis and Bland-Altman plots. RESULTS: The incidence of postoperative acute kidney injury in 2103 cases between 2002 and 2007 was 29.1%, according to estimated creatinine (14.3% with the measure). This represents an overestimation of 104%, with an intraclass correlation of 0.12. By excluding patients with known chronic kidney disease (glomerular filtration rate [<60 ml/min/1.73 m2), both the overestimation (2.4%) and the correlation (0.57) improved. CONCLUSIONS: The calculation of baseline creatinine using the MDRD equation overestimates the incidence of acute kidney injury after cardiac surgery, and is an inadequate method for detection when the baseline value is unknown.
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Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Procedimentos Cirúrgicos Cardíacos , Creatinina/sangue , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Idoso , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
Myiasis is the term used to describe infestations, both obligatory and accidental, in vertebrate animals and humans by dipteral larvae. The oral cavity is rarely affected by this infestation and the circumstances which can lead to oral myiasis include persistent mouth opening together with poor hygiene, or facial traumatism. We present a case of oral myiasis by larvae of Lucilia sericata, a species present in the Iberian Peninsula, in a hospitalized patient with surgical problems.
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The assessment of risk and appropriate treatment of patients with acute pulmonary embolism (PE) remains a challenge. The prognostic performance of cardiac troponin I (cTnI) in predicting 30-day all-cause mortality was prospectively assessed in consecutive haemodynamically stable patients with PE. The present study included 318 haemodynamically stable patients with PE. During the 30-day study period, 23 (7%) patients died. cTnI was elevated (>or=0.1 ng x mL(-1)) in 102 (32%) patients. An age >65 yrs, systolic blood pressure <120 mmHg and severity of illness assessed using the PE severity index (PESI) were significantly associated with an increased risk for mortality, but no significant association was found between elevation of cTnI and 30-day mortality in a logistic regression analysis. When only fatal PE was considered, multivariate analysis showed that severity of illness using the PESI and an elevated cTnI (odds ratio 3.7, 95% confidence interval (CI) 1.1-12.8) were associated with a significant increase in the risk for death. The negative predictive value (95% CI) of a negative cTnI for mortality was 93 (90-97)%. In conclusion, in haemodynamically stable patients with acute pulmonary embolism, cardiac troponin I was not an independent predictor of 30-day all-cause mortality, although it did predict fatal pulmonary embolism.
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Embolia Pulmonar/sangue , Troponina I/sangue , Idoso , Bloqueio de Ramo/sangue , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia Sinusal/sangueRESUMO
Glioblastoma is the most common primary tumor of the central nervous system, but the underlying genetic changes that give rise to these tumors are still poorly understood. We report a primary glioblastoma with an unusual age of presentation. The patient was a 22-year-old man with a survival of 16 months. Morphological findings showed an increase of cellularity with positive GFAP and EGFR expression, increase of proliferate index, vascular hyperplasia with glomeruloid structures and necrosis. Molecular analysis showed EGFR amplification. No mutations of the TP53 or amplification of MDM2 and CDK4 were detected. Neither homozygous deletion of the 9p21 locus genes nor aberrant methylation were found. The cytogenetic study showed a clonal karyotype. The metaphases presented, among other anomalies, a small ring chromosome and double-minutes chromosomes. Using FISH and CGH techniques, it was found that the ring chromosome was a partial trisomy of chromosome 7, and the region implicated corresponded to 7p13-q21. Partial trisomies in glioblastoma could play an important role in defining those regions where genes implicated in this tumor process may be found. We studied the possible correlation of these findings with the tumoral phenotype.
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Neoplasias Encefálicas/genética , Cromossomos Humanos Par 7 , Genes erbB-1/genética , Glioblastoma/genética , Cromossomos em Anel , Adulto , Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/ultraestrutura , Cromossomos Humanos Par 7/ultraestrutura , Fator de Crescimento Epidérmico/genética , Fator de Crescimento Epidérmico/metabolismo , Amplificação de Genes , Proteína Glial Fibrilar Ácida/metabolismo , Glioblastoma/cirurgia , Glioblastoma/ultraestrutura , Humanos , Imuno-Histoquímica , Cariotipagem , Masculino , Trissomia/patologiaRESUMO
OBJECTIVE: To assess the efficacy of oral dexamethasone or nebulized dexamethasone sodium phosphate in children with mild croup. METHODS: Double-blind, placebo-controlled study of 264 children between 6 months and 6 years of age with symptoms of croup for fewer than 48 hours. Patients were excluded if they received racemic epinephrine or corticosteroid treatment. Other exclusion criteria included corticosteroid treatment during the 14 days prior to enrollment or complicating medical condition. Subjects randomly received oral dexamethasone (0.6 mg/kg), nebulized dexamethasone sodium phosphate (160 microg), or placebo. Telephone follow-up was obtained on days 1, 2, 3, 4, and 7. MAIN OUTCOME MEASURES: The primary outcome measure was treatment failure, defined as receiving corticosteroid or racemic epinephrine treatment during the 7 days after enrollment in the study. Secondary outcome measures included seeking additional care and the parental assessments of the patients' condition obtained during follow-up (worse, same, better, or gone). RESULTS: Eighty-five patients received oral dexamethasone, 91 received nebulized dexamethasone, and 88 received placebo. There were 3 treatment failures in the oral dexamethasone-treated group, 12 in the nebulized dexamethasone-treated group, and 10 in the placebo-treated group (P =.05). Ten children in the oral dexamethasone-treated group sought additional care compared with 27 and 29 in the nebulized dexamethasone-treated and placebo-treated groups, respectively (P =.002). Parents of children in the oral dexamethasone-treated group reported greater improvement on day 1 (P<.001) compared with the nebulized dexamethasone-treated and placebo-treated groups. CONCLUSIONS: Children with mild croup who receive oral dexamethasone treatment are less likely to seek subsequent medical care and demonstrate more rapid symptom resolution compared with children who receive nebulized dexamethasone or placebo treatment.
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Anti-Inflamatórios/administração & dosagem , Crupe/tratamento farmacológico , Dexametasona/administração & dosagem , Nebulizadores e Vaporizadores , Administração por Inalação , Administração Oral , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Dexametasona/uso terapêutico , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Falha de TratamentoRESUMO
There is a subset of patients with failed ablation of the cavotricuspid isthmus (CTI) using standard catheters and with 10% of the patients having recurrences. The purpose of this study was to compare the cooled and standard ablation with regard to acute successful electrophysiological achievement of bidirectional isthmus block and the subacute anatomic characteristics of the lesions. This randomized, experimental study compares the effects of ablation on the isthmus using a cooled catheter with those of a standard ablation catheter in 16 pigs. In 12 animals, CTI block was achieved after ablation (8/8 cooled and 4/8 standard). In two animals, it was not possible to achieve complete isthmus block and two had persistent slow conduction (all four using the standard catheter). After 1 week, the animals were slaughtered. The size of the lesion was greater with the irrigated tip catheters. Transmural lesions were found in 14 animals. A complete line of anatomic isthmus block was not documented after thefirst line in six animals, four with the standard and two with the cooled catheter. A conduction block was never present across gaps > or = 5 mm. In conclusion cooled catheters achieved a complete line of electrophysiological and anatomical block in a significantly higher percentage than the standard catheters.
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Flutter Atrial/cirurgia , Ablação por Cateter , Animais , Flutter Atrial/patologia , Ablação por Cateter/instrumentação , Temperatura Baixa , Eletrofisiologia , Desenho de Equipamento , Distribuição Aleatória , SuínosRESUMO
INTRODUCTION AND OBJECTIVES: We performed this study to evaluate the security and efficacy in the lesions produced on the atrial wall by different irrigated catheters in an experimental model. We evaluated the anatomopathologic characteristics of the lesions produced by two different systems of irrigated tip catheters, with opened or closed circuit. METHODS: This study was performed in 16 pigs applying 60 sec radiofrequency pulses with three different energy levels (15, 25 y 50 Watts). Two different systems of radiofrequency ablation irrigated catheters were used, opened and closed. We used 4 pigs in which we performed ablation with a standard catheter as a control group. Under fluoroscopic guidance, catheters were placed on the high and low right atrial lateral wall, where lesions were produced. After 7 days, animals were sacrificed for anatomopathological study. RESULTS: A total of 27 lesions were performed with irrigated catheters (11 closed circuit and 16 opened) and 6 with standard catheters in the control group. We did not find significant differences in the lesion characteristics between the two different systems of irrigated tip catheter used, nevertheless lesions performed with the closed system were slightly greater. Th lesions produced with irrigated catheters were always superior in the control group. Transmurality in the free atrial wall is frequent with both systems. We did not see any perforation in the atrial wall. CONCLUSIONS: We did not find significant differences in the size of the lesions produced with the two systems of irrigated catheters used. These data from an experimental model can provide useful information for atrial tachycardia radiofrequency ablation procedures in humans.
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Ablação por Cateter/métodos , Miocárdio/patologia , Animais , Ablação por Cateter/efeitos adversos , Ablação por Cateter/instrumentação , Desenho de Equipamento , Átrios do Coração/patologia , Suínos , Irrigação Terapêutica/métodosRESUMO
INTRODUCTION: Nurses often use intravenous heparin locks (HL) with pediatric patients while obtaining laboratory studies to evaluate fever without a source. The purpose of the HL is to avoid an intramuscular injection if parenteral antibiotics are subsequently ordered. The objectives of this study were to determine if HL placement in patients undergoing laboratory evaluation for fever without a source (1) results in fewer injections and (2) is associated with increased use of antibiotics. METHODS: A retrospective chart review of ED patients aged 3 to 36 months was performed. Patients included in the review had fever with no identified source of infection, and a complete blood cell count and/or blood culture had been ordered. For analysis, patients who received an HL were compared with patients who did not receive an HL. RESULTS: A total of 439 patients had laboratory studies for fever without a source, with 345 (79%) in the HL group. No statistically significant differences were found in antibiotic administration, number of needle sticks, age, temperature, or white blood cell count between the groups. DISCUSSION: The use of an HL in young febrile ED patients did not change the total number of needle sticks or the likelihood of antibiotic administration.
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Anticoagulantes , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Cateterismo Periférico/normas , Cateteres de Demora/normas , Protocolos Clínicos/normas , Tratamento de Emergência/métodos , Tratamento de Emergência/normas , Febre de Causa Desconhecida/diagnóstico , Febre de Causa Desconhecida/microbiologia , Heparina , Fatores Etários , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Pré-Escolar , Enfermagem em Emergência , Tratamento de Emergência/enfermagem , Humanos , Lactente , Seleção de Pacientes , Estudos RetrospectivosRESUMO
INTRODUCTION AND OBJECTIVES: The right coronary artery (RCA) is found in the AV groove, just below the ablation target of atrial flutter, the cavotricuspid isthmus (ICT). After radiofrequency (RF) ablation with standard catheters, there have been no reports of complications, but it may not be successful in 10% of the cases. However, the use of irrigated tip catheters, which create deeper lesions, might potentially damage the coronary tree. METHODS: We analyzed the effects of ICT RF ablation on the coronary tree, with macroscopic and microscopic anatomopathological study. Ablation on ICT was performed using an irrigated tip catheter in 16 pigs and was randomly compared with a standard ablation catheter. There were no clinical problems, modifications of ST or new arrhythmias during the ablation. The heart was extracted at 1 week. RESULTS: The macroscopic study demonstrated that the right coronary artery was preserved, along the ICT, surrounded by the epicardial fat. The microscopic study showed an inflammatory reaction in the epicardial fat that reached the adventitia of the coronary artery, but never produced necrosis in 14 cases. The muscular wall of the artery had signs of focal inflammation without endothelium involvement in 2 cases. However, we found a subepicardial vein completely damaged by the radiofrequency. CONCLUSIONS: Although the right coronary artery is located just below the isthmus, no necrosis was observed in any case. However, there was an inflammatory reaction that focally reached the muscular wall. The veins may be damaged in RF ablation, perhaps due to the different blood flow of each vessel.
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Ablação por Cateter , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Septos Cardíacos/cirurgia , Animais , Nó Atrioventricular , Cateterismo Cardíaco , Cateterismo , Septos Cardíacos/patologia , SuínosAssuntos
Asma/diagnóstico , Medicina de Emergência/métodos , Medicina de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Tratamento de Emergência/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pico do Fluxo Expiratório , Pediatria/métodos , Pediatria/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Asma/fisiopatologia , Criança , Pré-Escolar , Medicina de Emergência/educação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/psicologia , Pediatria/educação , Projetos PilotoRESUMO
OBJECTIVE: Capno-Flo (Kirk Specialty Systems, Carrouton, TX) is a portable pulmonary resuscitator (self inflating ambu-bag--valve system) with a self-contained, colorimetric end-tidal CO2 detector that has the ability to provide continuous CO2 monitoring for up to 2 hours. The purpose of this study is to determine the accuracy and time interval for the Capno-Flo monitor to detect acute airway obstructions and hypopharyngeal extubations in an intubated animal model. SUBJECTS: Five anesthetized, non-paralyzed, mechanically ventilated Yorkshire minipigs. METHODS: Complete and partial airway obstruction was simulated with complete and partial cross-clamping of the endotracheal (ET) tube. Placement of the ET tube into the hypopharynx was performed to simulate accidental extubation. In addition to the Capno-Flo colorimetric indicator, both sidestream (SS) and mainstream (MS) capnography were used to monitor end-tidal CO2 and comparison. The time intervals for the capnograph wave to flatten and for the monitor to display "zero" were recorded after each airway alteration. Each experiment was carried out for 180 seconds, and a total of 25 trials was performed. RESULTS: Complete obstruction produced a color change in the Capno-Flo monitor in 9+/-2 seconds and flattening of the SS and MS waveform in 8+/-2 seconds and 6+/-2 seconds, respectively. The SS and MS monitors displayed zero in 49+/-7 seconds and 19+/-1 seconds, respectively. Partial obstruction did not produce color change, a flattening of the wave, or a monitor display of zero. Hypopharyngeal extubation produced a color change in 10+/-2 seconds, flattening of the SS and MS waveform in 7+/-2 seconds and 7+/-1 seconds, respectively. The SS and MS monitors displayed "zero" in 76+/-16 seconds and 18+/-3 seconds, respectively. CONCLUSION: The Capno-Flo identified all complete airway obstructions and hypopharyngeal extubations rapidly. The CF monitor performed comparable to the SS and MS capnographs. Neither the Capno-Flo, nor the sidestream, nor the mainstream capnographs detected partial airway obstruction. The clinical application of this portable inexpensive capnometer in the continuous monitoring of the intubated patient, especially the transport patient, should be investigated further.
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Obstrução das Vias Respiratórias/diagnóstico , Intubação Intratraqueal/instrumentação , Ressuscitação/instrumentação , Animais , Capnografia , Cor , Desenho de Equipamento , Suínos , Porco MiniaturaRESUMO
BACKGROUND: Fever is the most common complaint of children seen in a Pediatric Emergency Department (PED). Since pediatric emergency nurses commonly educate parents on fever management, this study sought to examine their knowledge base regarding fever in children. METHODS: Through convenience sampling, pediatric emergency registered nurses working at one of four PEDs were surveyed using a self-administered questionnaire containing 10 open-ended questions pertaining to fever in children. RESULTS: Eighty-eight pediatric emergency registered nurses (median experience 8.0 years, range 3 months to 28 years) were surveyed. The median temperature considered by pediatric emergency nurses to be a fever was 38.0 degrees C (100.4 degrees F) with a range of 37.2 degrees C (99.0 degrees F) to 38.9 degrees C (102.0 degrees F), while the median temperature considered to be dangerous to a child was 40.6 degrees C (105.0 degrees F) with a range of 38.0 degrees C (100.4 degrees F) to 41.8 degrees C (107.0 degrees F). Eleven percent was not sure what temperature constituted a fever while 31% was not sure what temperature would be dangerous to a child. Fifty-seven percent considered seizures the primary danger to a febrile child while 29% stated permanent brain injury or death could occur from a high fever. Sixty percent chose acetaminophen as first line treatment while 7% stated alcohol or tepid water baths were also acceptable treatment options. Thirty-eight percent stated that a different medication should be added if a child was still febrile 1 hour after initial treatment while 31% would not use additional medication. Eighteen percent stated it was dangerous for a child to leave the PED if still febrile. CONCLUSION: Fever phobia and inconsistent treatment approaches occur among experienced pediatric emergency registered nurses. These phobias and inconsistencies subsequently could be conveyed to parents. In order to assure accurate parental education, PEDs should educate their medical team regarding the management of fever in children.
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Enfermagem em Emergência , Febre/enfermagem , Febre/psicologia , Enfermeiras e Enfermeiros/psicologia , Enfermagem Pediátrica , Analgésicos não Narcóticos/uso terapêutico , Temperatura Corporal , Criança , Medo , Febre/complicações , Febre/terapia , Humanos , Pais/psicologia , Pediatria , Convulsões FebrisRESUMO
OBJECTIVE: To compare the patient compliances and time analyses of two methods of assigning primary care providers (PCPs) to ED patients who are without a PCP: phone interview vs face-to-face interaction. METHODS: Prospective observational cohort study following an intervention, performed in a pediatric ED, serving a population of 1.7 million, with a census of 80,000 pediatric ED visits per year. Over one year, a consecutive sampling of 1,062 patients evaluated in the ED and without a PCP were approached to participate in our study (536 enrolled, 526 declined). Patients enrolled were addressed by a nurse practitioner/social worker (NP/SW) who arranged an appointment with a PCP, either in person (in ED) or by phone after discharge. The primary outcome measure was compliance with the arranged appointment. Secondarily, the authors analyzed the time necessary for each approach in person-hours. RESULTS: Of the 536 enrolled, 81 were excluded because data collection was incomplete at the time of the study's completion, leaving 455 study patients. Seventy-six percent of the study patients were between the ages of 1 month and 12 years. Contact was made by phone for 151 (33%) patients and face-to-face for 304 (67%). Sixty-two percent of the phone patients kept their appointments, compared with 52% of face-to-face patients (p = 0.048, RR = 1.20, 1.02 < RR < 1.41). Phone interaction was also more time effective. CONCLUSION: Linking ED patients without a medical provider to PCPs via phone is as effective as a face-to-face interaction.