RESUMO
OBJECTIVES: Vital signs are often not documented in paediatric patients at triage. This study was conducted to find out whether the use of a small, laminated aide memoire and a short teaching session might improve this situation. METHODS: A preliminary audit of the measurement of vital signs in 106 children aged less than 6 years was carried out in a district general hospital emergency department (ED). A small card illustrating normal values for these was then distributed-this could be attached to staff identity cards. At the same time doctors and nursing staff were given a teaching session on the importance of these measures. The audit was then repeated in a further 106 children. RESULTS: There was significant improvement in recording of all vital signs with the exception of blood pressure and temperature. CONCLUSION: A low-cost card together with a short period of training offers a useful strategy to improve the rate of documentation of vital signs in children presenting to the ED.
Assuntos
Serviços de Saúde da Criança , Serviço Hospitalar de Emergência , Controle de Formulários e Registros/métodos , Sinais Vitais , Criança , Auditoria Clínica , Humanos , Capacitação em Serviço , Prontuários Médicos , Avaliação de Processos em Cuidados de SaúdeRESUMO
Care provided to unaccompanied asylum seeking minors in Britain is currently compromised by the issue of age assessment. Existing guidelines are rarely followed leading to striking defects in the protection for a high risk group of children and adolescents.
Assuntos
Fatores Etários , Menores de Idade , Refugiados , Adolescente , Antropometria/métodos , Criança , Proteção da Criança , Feminino , HumanosAssuntos
Aleitamento Materno , Viroses/transmissão , Feminino , Humanos , Leite Humano/virologia , Fatores de RiscoAssuntos
Suplementos Nutricionais , Ácido Fólico/uso terapêutico , Defeitos do Tubo Neural/prevenção & controle , Cooperação do Paciente , Feminino , Humanos , Índia/etnologia , Londres/epidemiologia , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/etnologia , Paquistão/etnologia , GravidezAssuntos
Aleitamento Materno/efeitos adversos , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas , Mastite/imunologia , Mastite/virologia , Adulto , Quimiocinas/imunologia , Feminino , Infecções por HIV/virologia , HIV-1/fisiologia , Humanos , Recém-Nascido , Malaui , Leite Humano/química , Leite Humano/imunologia , Leite Humano/virologia , Monócitos/imunologiaRESUMO
Patients with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) typically have a high HTLV-1 proviral load in peripheral blood mononuclear cells and abundant, activated HTLV-1-specific cytotoxic T lymphocytes (CTLs). No effective treatment for HAM/TSP has been described so far. We report a 10-fold reduction in viral DNA for five patients with HAM/TSP during treatment with the reverse transcriptase inhibitor lamivudine. In one patient with recent-onset HAM/TSP, the reduction in viral DNA was associated with a fall in the frequency of CTLs specific to two peptides in the immunodominant viral antigen Tax. The half-life of peripheral blood mononuclear cell populations was estimated from changes in viral DNA copy number, CTL frequency, reduction in CD25 expression, and the loss of dicentric chromosomes following radiation-induced damage. Each of these four different techniques indicated a cellular half-life of approximately 3 days consistent with continuous lymphocyte replication and destruction. These results indicate that viral replication through reverse transcription significantly contributes to the maintenance of HTLV-1 viral DNA load. The relative contribution of proliferation versus replication may vary between infected people.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Produtos do Gene tax/imunologia , Vírus Linfotrópico T Tipo 1 Humano/efeitos dos fármacos , Lamivudina/uso terapêutico , Paraparesia Espástica Tropical/tratamento farmacológico , Inibidores da Transcriptase Reversa/uso terapêutico , Linfócitos T Citotóxicos/imunologia , Adulto , Linfócitos T CD8-Positivos/imunologia , Sequência Consenso , DNA Viral/efeitos dos fármacos , Feminino , Vírus Linfotrópico T Tipo 1 Humano/enzimologia , Vírus Linfotrópico T Tipo 1 Humano/genética , Humanos , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/imunologia , Paraparesia Espástica Tropical/virologia , DNA Polimerase Dirigida por RNA/efeitos dos fármacos , DNA Polimerase Dirigida por RNA/genéticaRESUMO
Human breast milk has been observed to contain high concentrations of the chemotactic cytokines (chemokines) interleukin-8 (IL-8) and RANTES. Concentrations are greatest in colostrum, but are measurable in milk after several months of lactation. These chemokines are also found in the secretions of patients with galactorrhoea and in the "witch's milk" of the newborn. Chemokine levels show good correlation with the sodium levels but not with cell counts or the creamatocrit of the secreted milk. Mothers with pre-term deliveries show no statistical difference in chemokine secretion in comparison with those with term deliveries. Immunohistochemisty demonstrates IL-8 and RANTES immunoreactivity in the acinary epithelial cells of normal mammary tissue and IL-8 and RANTES were shown to be produced by cultured, human mammary epithelial cells (HMEC) after stimulation with different cytokines. These results suggest that mammary epithelial cells are the source of chemokines in human milk and that the recruitment of leukocytes in human milk is likely to be chemokine-driven.
Assuntos
Quimiocinas/metabolismo , Quimiotaxia , Eosinófilos/citologia , Linfócitos/imunologia , Leite Humano/metabolismo , Monócitos/citologia , Antígenos CD4/sangue , Células Cultivadas , Quimiocina CCL5/análise , Feminino , Humanos , Imuno-Histoquímica , Interleucina-8/análise , Lactação , Linfócitos/citologiaRESUMO
Superantigens are a diverse collection of molecules that share the ability to activate specific lymphocyte subsets. In animal models, many of these molecules delete T-cell populations or render them anergic. The clinical impact of superantigens is significant, but much of their pathophysiology remains unclear.