A case-control study of SARS versus community acquired pneumonia.

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children.

The six-minute walk test in healthy children: reliability and validity.

The aim of this study was to assess the reliability and validity of the 6-min walk test (6MWT) in healthy children. Chinese secondary school students were randomly recruited. They attended the current authors' unit on two occasions, separated by 2 weeks. Physical examination and standardised maximum incremental exercise testing on a treadmill were performed on the first visit. Spirometry and 6MWT were carried out on the second visit. A randomly selected subgroup was invited to return for repeat 6MWT at an interval of 2-4 weeks. Seventy-eight subjects were recruited; however, four failed to achieve maximal effort on exercise test. The final group included 43 young females and the mean+/-sd age of the subjects was 14.2+/-1.2 yrs. Physical examination was unremarkable in all cases. The mean+/-sd per cent predicted forced expiratory volume in one second was 91.4+/-10.2%. Concurrent validity was demonstrated by good correlation between the 6-min walking distance and maximum oxygen uptake determined on the exercise treadmill. Test-retest reliability was undertaken in 52 subjects, and the intraclass correlation coefficient (95% confidence interval) was calculated as 0.94 (0.89-0.96). In addition, Bland and Altman plots demonstrated a high degree of repeatability. In healthy children, the 6-min walk test is a reliable and valid functional test for assessing exercise tolerance and endurance.

A survey of attitudes to Traditional Chinese Medicine in Hong Kong pharmacy students.

OBJECTIVES: To study the attitudes and personal experiences with Traditional Chinese Medicine (TCM) use in pharmacy students. DESIGN: Prospective cross-sectional study. SETTING: University School of Pharmacy. METHODS: Pharmacy students were asked 17 questions according to an anonymous survey questionnaire. RESULTS: All 91 students (46% males) participated in the survey. The attitude toward TCM use was positive in 40%, neutral in 59% and negative in only 1%. On scales from 0 to 10, the mean (SD) scores for the adequacy of the current curriculum in TCM training and state of TCM knowledge were 3.2 (2.0) and 3.6 (1.6), respectively. Of the 35 participants who had used TCM in the past year, nearly half did so without any TCM practitioner consultation. Seventy-four percent reported that they had not been told of any side effects of TCM. When comparing the third year with first or second year students, there was no significant difference between any of these findings. CONCLUSION: The training in TCM within this 3-year pharmacy curriculum appears inadequate. Most students are not aware of any possible side effects in TCM. The attitude and practice do not appear to vary significantly between successive year of pharmacy students.

Infection control for SARS in a tertiary paediatric centre in Hong Kong.

Severe acute respiratory syndrome (SARS) is an emerging infectious disease. After the appearance of an index patient in Hong Kong in February 2003, SARS outbreaks occurred rapidly in hospitals and spread to the community. The aim of this retrospective study is to evaluate the effectiveness of a triage policy and risk-stratified infection control measures in preventing nosocomial SARS infection among paediatric healthcare workers (HCWs) at the Prince of Wales Hospital, a general hospital to which children with SARS are referred in Hong Kong. The acute paediatric wards were stratified into three areas: (1) ultra high-risk area, (2) high-risk area and (3) moderate-risk area according to different risk levels of nosocomial SARS transmission. The implementation of different levels of infection control precautions was guided by this risk stratification strategy. Between 13 March and 23 June, 38 patients with probable and suspected SARS, 90 patients with non-SARS pneumonia, and 510 patients without pneumonia were admitted into our unit. All probable SARS cases were isolated in negative-pressure rooms. Twenty-six HCWs worked in the ultra high-risk area caring for SARS patients and 88 HCWs managed non-SARS patients in other ward areas. None of the HCWs developed clinical features suggestive of SARS. In addition, there was no nosocomial spread of SARS-associated coronavirus to other patients or visitors during this period. In conclusion, stringent infection control precautions, appropriate triage and prompt isolation of potential SARS patients may have contributed to a lack of nosocomial spread and HCW acquisition of SARS in our unit.

Intratracheal pulmonary ventilation in a rabbit lung injury model: continuous airway pressure monitoring and gas exchange efficacy.

OBJECTIVES: To compare carinal pressures vs. proximal airway pressures, and gas exchange efficacy with a constant minute volume, in lung-injured rabbits during conventional mechanical ventilation (CMV) and intratracheal pulmonary ventilation (ITPV); and to evaluate performance of a prototype ITPV gas delivery and continuous airway pressure monitoring system. DESIGN: Prospective controlled study. SETTING: Animal research laboratory at a teaching hospital. SUBJECTS: Sixteen adult female rabbits. INTERVENTIONS: Anesthetized rabbits were tracheostomized with a multilumen endotracheal tube. Anesthesia and muscle relaxation were maintained continuously throughout the study. Proximal airway pressures and carinal pressures were recorded continuously. The injection port of the multilumen endotracheal tube was used for the carinal pressure monitoring. To prevent obstruction of the port, it was flushed with oxygen at a rate of 11 mL/min. CMV was initiated with a pressure-limited, time-cycled ventilator set at an FiO2 of 1.0 and at a flow of 1.0 L/kg/min. The pressure limit of the ventilator was effectively disabled. A normal baseline for arterial blood gases was achieved by adjusting the inspiratory/expiratory time ratios. ITPV was established using a flow of 1.0 L/kg/min through a reverse thrust catheter, at the same baseline and inspiratory/expiratory ratio. Carinal positive end-expiratory pressure was maintained at a constant value of 2 cm H2O by adjusting the expiratory resistance of the ventilator circuit Lung injury was achieved over a 30-min period by three normal saline lavages of 5 mL/kg each. After lung injury, all animals were consecutively ventilated for 1 hr with CMV, for 1 hr with ITPV, and again for 1 hr with CMV. Six rabbits were ventilated at 30 breaths/min (group 1), and ten rabbits were ventilated at 80 breaths/min (group 2). Four rabbits in group 2 were subjected, 1 hr after return to CMV from ITPV, to another session of ITPV, with positive end-expiratory pressure gradually being increased to 4, 6, and 8 cm H2O for 15 mins each. RESULTS: No significant differences were observed in carinal peak inspiratory pressure between CMV and ITPV modes, at both low and high frequencies of breathing, indicating that the inspired tidal volume remained constant during both modes of ventilation. Significant gradients were noted between proximal airway and carinal peak inspiratory pressure during ITPV but not during CMV. Initiation of ITPV, at a flow of 1.0 L/kg/min, required an increase in the ventilator expiratory resistance to maintain a constant level of positive end-expiratory pressure (2 cm H2O) as measured at the carina. During ITPV, the PaCO2 was significantly reduced by 20% at 30 breaths/min (p < .05) and by 22% at 90 breaths/min (p < .01), compared with CMV. Arterial oxygenation was significantly enhanced with a positive end-expiratory pressure of 6 and 8 cm H2O (p < .05 and .001, respectively), compared with a positive end-expiratory pressure of 2 cm H2O during ITPV. All components of the new prototype gas delivery and airway pressure monitoring system functioned without failure, at least for 3 hrs of the CMV, ITPV, and CMV trials. CONCLUSIONS: ITPV in saline-lavaged, lung-injured rabbits at breathing frequencies of 30 and 80 breaths/min, compared with CMV at the same minute ventilation, can improve CO2 exchange. During ITPV, significant pressure gradients can develop between carinal and proximal airway pressures. Continuous carinal pressure monitoring is therefore necessary for the safe clinical application of ITPV. Reliable carinal pressure monitoring can be achieved by adding a small bias flow through the carinal pressure monitoring port. Although ITPV can remove CO2 from injured lungs efficiently, simultaneous addition of positive end-expiratory pressure can further improve arterial oxygenation.

The survival story of a child with Ondine's curse in Northland.

The case of a six year old European male with congenital central hypoventilation is reported to illustrate that survival and positive developmental outcome is possible in a remote town in the Northland. Initial and ongoing problems include persistent ventilatory requirement, medical, developmental and psychosocial issues. Positive parental attitude, meticulous care to activities of daily living, medical and psychosocial surveillance and continuing support contribute to the success in management. Various treatment options are also discussed. Primary failure of respiratory regulation, also known as congenital central hypoventilation or Ondine's curse, has been infrequently reported in children. Survival and positive developmental outcome is possible but requires intensive support and positive parental attitude, as well as parental education and ongoing medical and psychosocial surveillance. We report this case to illustrate that this could be achieved even in a remote country town.

Overt neonatal seizures: outcome at one year.

Sixty-five infants with seizures in the neonatal period were followed to the age of one year. There were 27 nonsurvivors, with 14 neonatal deaths from causes directly related to the initial neurologic insult, and 13 postneonatal deaths, eight related to neurologic sequelae and five to unrelated causes. Twenty-four (63.2%) of the survivors were neurologically normal, while five (13.2%) had seizures at age one year. Multivariate stepwise analysis identified low birthweight (p less than 0.01) and the number of anticonvulsants used to control the initial seizure(s) (p less than 0.05) as being significantly associated with nonsurvival and neurodevelopmental sequelae amongst the survivors was significantly associated with the duration of initial seizure (p less than 0.05).