ABSTRACT
BACKGROUND: In adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients' prognosis. FINDINGS: Prospective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065 nmol/L (range 0.3715 to 7.2840 nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758 nmol/L, p = 0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373 nmol/L, p < 0.001). CONCLUSIONS: In our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization.
Subject(s)
Adrenomedullin/blood , Community-Acquired Infections/blood , Pneumonia/blood , Protein Precursors/blood , Adolescent , Anti-Bacterial Agents/therapeutic use , Biomarkers/blood , Chi-Square Distribution , Child , Child, Preschool , Community-Acquired Infections/complications , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Emergency Service, Hospital , Female , Fever/etiology , Humans , Infant , Intensive Care Units , Length of Stay , Male , Oxygen Inhalation Therapy , Patient Admission , Pleural Effusion/etiology , Pneumonia/complications , Pneumonia/diagnosis , Pneumonia/therapy , Predictive Value of Tests , Prognosis , Prospective Studies , Risk Assessment , Risk Factors , Spain , Up-RegulationABSTRACT
The objective of this study is to assess the impact of various actions in the management of pain in a pediatric hospital emergency department. This is an observational study, preaction (phase 1) and postaction (phase 2), with two cohorts of patients diagnosed with abdominal pain, chest pain, and severe headache. Between the two phases, various actions were carried out (distribution of pain assessment scales and a new guide for the management of pain, and the holding of clinical training sessions). Three hundred patients were included in the study, with an average age of 9 years and average evolution time of pain of 20 h. Pain assessment in phases 1 and 2 was 30 and 99.3%, respectively. Analgesics were administered to 23% (phase 1) and 38.6% (phase 2) of the patients with pain. No side-effects from the analgesics given were recorded. In conclusion, the various actions carried out yielded an improvement in pain management, especially in its assessment.
Subject(s)
Abdominal Pain/drug therapy , Chest Pain/drug therapy , Emergency Service, Hospital/statistics & numerical data , Headache/drug therapy , Program Evaluation , Child , Child, Preschool , Cohort Studies , Female , Humans , Male , Pain Measurement , Pediatrics , Program Development , SpainABSTRACT
BACKGROUND: Recent studies have questioned the use of prolonged intravenous treatment in neonates with urinary tract infection (UTI). The aim of the present study was to examine the clinical course of neonates with UTI with special attention paid to the rates of bacteremia and meningitis and to determine the efficacy of short-term intravenous antibiotic. METHODS: Retrospective review of clinical charts of neonates admitted for UTI. Patients were treated first intravenously with a beta-lactam antibiotic and gentamicin. Treatment was completed orally. RESULTS: One hundred seventy-two neonates (median age, 19 days) were included. Of 129 blood cultures carried out, 16 (12.4%) were positive. Analysis of cerebrospinal fluid was performed in 75 patients; none of the cultures was positive. Forty-nine patients (28.5%) were treated with ampicillin and gentamicin and 105 (61%) with amoxicillin-clavulanate and gentamicin. The median length of intravenous treatment was 4 days (P25: 3; P75: 6). Oral amoxicillin-clavulanate was used in the continuation phase in 75%. No treatment failure or relapse was detected. Eleven (8.7%) of 126 patients had renal scarring at 6 months. CONCLUSIONS: The clinical course in neonates with UTI treated with short-term intravenous antibiotic followed by oral treatment is highly favorable, both in short and long terms. The absence of meningitis and the good evolution of the associated bacteremias argue in favor of a review of the habitual diagnostic-therapeutic protocol in neonates.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Drug Resistance, Bacterial , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Acute Disease , Administration, Oral , Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Bacterial Agents/pharmacology , Dose-Response Relationship, Drug , Drug Administration Schedule , Emergency Service, Hospital , Female , Follow-Up Studies , Gentamicins/administration & dosage , Humans , Infant, Newborn , Infusions, Intravenous , Male , Microbial Sensitivity Tests , Retrospective Studies , Risk Assessment , Treatment Outcome , Urinalysis , beta-Lactams/administration & dosageABSTRACT
Percutaneous poisoning is quite rare, and in particular, topical lactic acid poisoning is even more so. We report a young girl with lamellar ichthyosis and symptoms of poisoning, with clinical signs of irritability, agitation, myoclonia, and difficulty in walking, accompanied by lactic acidosis as a result of the more frequent than recommended application of emollients containing lactic acid. The clinical symptoms resolved upon discontinuation of the topical treatment. Among the possible causes of metabolic acidosis, health care providers should be aware of the possibility of percutaneous poisoning.