Agreement and disagreement in pediatric functional neurological symptom disorders: Comparing patient reported outcome measures (PROMs) and clinician assessments.

Youth with functional neurological symptom disorder (FNSD) often perceive themselves as having limited capabilities, which may not align with clinical evaluations. This study assessed the disparities between clinician evaluations and patient-reported outcome measures (PROMs) regarding pain, motor function, and learning difficulties in youth with FNSD. Sixty-two youths with FNSD participated in this study, all of whom reported experiencing pain, motor problems, and/or learning difficulties. Clinicians also assessed these domains, resulting in a two-by-two categorization matrix: (1) agreement: child and clinician report "problems"; (2) agreement: child and clinician report "no problems"; (3) disagreement: child reports "problems" while the clinician does not; and (4) disagreement: clinician reports "problems" while the child does not. Agreement/disagreement differences were analyzed. No significant differences in prevalence were observed between the evaluators regarding pain (clinician-85%, child-88%), motor (clinician-98%, child-95%), or learning problems (clinician-69%, child-61%). More than 80% of the children and clinicians report pain and motor disorders. Instances in which children and clinicians reported learning problems (40.3%) exceeded cases in which both reported no problems (9.6%) or only the child reported problems (20.9%). Overall, the agreement between pain and motor function assessments was high (>90%), whereas that concerning learning difficulties was moderate (49.9%). Disagreement in pain/motor assessments was minimal (<5%), whereas for learning difficulties, disagreement rates were high (>20%). In conclusion, a significant concordance exists between PROMs and clinician assessments of pain and motor problems. However, the higher frequency of disagreements regarding learning difficulties emphasizes the importance of incorporating patient and clinician evaluations in pediatric FNSD treatment.

Preclinical and clinical research on the toxic and neurological effects of cassava (Manihot esculenta Crantz) consumption.

Cassava (Manihot esculenta Crantz) is a tropical plant that is used as fresh food, processed food, or raw material for the preparation of flours with high nutritional value. However, cassava contains cyanogenic glycosides, such as linamarin and lotaustralin, that can trigger severe toxic effects and some neurological disorders, including motor impairment, cognitive deterioration, and symptoms that characterize tropical ataxic neuropathy and spastic epidemic paraparesis (Konzo). These alterations that are associated with the consumption of cassava or its derivatives have been reported in both humans and experimental animals. The present review discusses and integrates preclinical and clinical evidence that indicates the toxic and neurological effects of cassava and its derivatives by affecting metabolic processes and the central nervous system. An exhaustive review of the literature was performed using specialized databases that focused on the toxic and neurological effects of the consumption of cassava and its derivatives. We sought to provide structured information that will contribute to understanding the undesirable effects of some foods and preventing health problems in vulnerable populations who consume these vegetables. Cassava contains cyanogenic glycosides that contribute to the development of neurological disorders when they are ingested inappropriately or for prolonged periods of time. Such high consumption can affect neurochemical and neurophysiological processes in particular brain structures and affect peripheral metabolic processes that impact wellness. Although some vegetables have high nutritional value and ameliorate food deficits in vulnerable populations, they can also predispose individuals to the development of neurological diseases.

Effects of acetone cyanohydrin, a derivative of cassava, on motor activity and kidney and liver function in Wistar rats. / Efecto de la acetona cianohidrina, un derivado de la yuca, sobre la actividad motora y la función renal y hepática en ratas Wistar.

INTRODUCTION: Acetone cyanohydrin (ACH) is a toxic substance present in cassava roots (Manihot esculenta Crantz) which results from enzymatic hydrolysis of linamarin. Long-term consumption is associated with 2 neurological disorders: konzo and tropical ataxic neuropathy. Previous studies have evaluated behavioural alterations linked to ACH consumption, but the toxic effects of this substance on physiological processes remain unknown. METHOD: 32 male Wistar rats were assigned to 4 experimental groups (n=8 per group): a vehicle group (0.3mL saline solution, IP) and 3 ACH groups (PubChem CID: 6406) dosed at 10, 15, and 20mM/24h for 28 days. We evaluated spontaneous motor activity with the open field test and motor coordination with the rotarod and forced swimming tests at 0, 7, 14, 21, and 28 days of treatment. At the end of the assessment period (day 28), blood samples were collected by transcardiac puncture to evaluate kidney and liver function. RESULTS: ACH caused alterations in locomotor activity and promoted both lateral swimming and spinning in the forced swimming test at 21 and 28 days of treatment. Furthermore, it led to an increase in the levels of the parameters of kidney and liver function in a concentration-dependent manner, except for glucose and total bilirubin. CONCLUSION: Our results suggest that long-term consumption of this toxic compound present in cassava roots may be potentially dangerous for vulnerable subjects.

Contribution of hippocampal area CA1 to acetone cyanohydrin-induced loss of motor coordination in rats. / Participación del área CA1 del hipocampo en la incoordinación motora inducida por acetonacianohidrina en la rata.

INTRODUCTION: Some vegetable foodstuffs contain toxic compounds that, when consumed, favour the development of certain diseases. Cassava (Manihot esculenta Crantz) is an important food source, but it contains cyanogenic glucosides (linamarin and lotaustralin) that have been associated with the development of tropical ataxic neuropathy and konzo. In rats, intraperitoneal administration of acetone cyanohydrin (a metabolite of linamarin) produces neurological disorders and neuronal damage in the hippocampus. However, it is unknown whether hippocampal area CA1 plays a role in neurological disorders associated with acetone cyanohydrin. METHOD: A total of 32 male Wistar rats 3 months old were assigned to 4 groups (n=8 per group) as follows: vehicle (1µl physiological saline), and 3 groups with acetone cyanohydrin (1µl of 10, 15, and 20mM solution, respectively). The substances were microinjected intrahippocampally every 24hours for 7 consecutive days, and their effects on locomotor activity, rota-rod and swim tests were assessed daily. On the fifth day post-treatment, rats underwent further assessment with behavioural tests to identify or rule out permanent damage induced by acetone cyanohydrin. RESULTS: Microinjection of acetone cyanohydrin 20mM resulted in hyperactivity, motor impairment, and reduced exploration from the third day of treatment. All concentrations of acetone cyanohydrin produced rotational behaviour in the swim test from the first day of microinjection. CONCLUSION: The hippocampal area CA1 is involved in motor alterations induced by microinjection of acetone cyanohydrin, as has been reported for other cassava compounds.

Interleukin-1ß increases neuronal death in the hippocampal dentate gyrus associated with status epilepticus in the developing rat. / La interleucina-1ß aumenta la muerte neuronal en el giro dentado del hipocampo asociada al estado epiléptico en la rata en desarrollo.

BACKGROUND: Interleukin-1ß (IL-1ß) increases necrotic neuronal cell death in the CA1 area after induced status epilepticus (SE) in developing rats. However, it remains uncertain whether IL-1ß has a similar effect on the hippocampal dentate gyrus (DG). In this study, we analysed the effects of IL-1ß on 14-day-old Wistar rats experiencing DG neuronal death induced by SE. METHODS: SE was induced with lithium-pilocarpine. Six hours after SE onset, a group of pups was injected with IL-1ß (at 0, 0.3, 3, 30, or 300ng/µL) in the right ventricle; another group was injected with IL-1ß receptor (IL-1R1) antagonist (IL-1Ra, at 30ng/µL) of IL-1RI antagonist (IL-1Ra) alone, and additional group with 30ng/µL of IL-1Ra plus 3ng/µL of IL-1ß. Twenty-four hours after SE onset, neuronal cell death in the dentate gyrus of the dorsal hippocampus was assessed using haematoxylin-eosin staining. Dead cells showed eosinophilic cytoplasm and condensed and fragmented nuclei. RESULTS: We observed an increased number of eosinophilic cells in the hippocampal DG ipsilateral to the site of injection of 3ng/µL and 300ng/µL of IL-1ß in comparison with the vehicle group. A similar effect was observed in the hippocampal DG contralateral to the site of injection of 3ng/µL of IL-1ß. Administration of both of IL-1ß and IL-1Ra failed to prevent an increase in the number of eosinophilic cells. CONCLUSION: Our data suggest that IL-1ß increases apoptotic neuronal cell death caused by SE in the hippocampal GD, which is a mechanism independent of IL-1RI activation.

Do low-risk nulliparous women with abnormal uterine artery Doppler in the third trimester have poorer perinatal outcomes? A longitudinal prospective study on uterine artery Doppler in low-risk nulliparous women and correlation with pregnancy outcomes.

OBJECTIVE: To evaluate uterine artery (UtA) Doppler over the course of pregnancy in low-risk nulliparous women and to analyze whether an abnormal uterine artery pulsatility index (UtA-PI) at a 32-34 week' scan implies poorer perinatal outcomes. METHODS: An observational prospective study was carried out including 616 low-risk nulliparous women. Women with any of the following were excluded: fetal abnormalities, multiple pregnancy, and heparin, metformin or hypotensive treatment. Maternal characteristics, mean arterial pressure measurements and UtA Doppler findings were recorded longitudinally. RESULTS: Complete pregnancy data were available for 489/616 women (79.3%). Of these, 385 women had a normal UtA-PI throughout pregnancy (Group 0), while 50 (10.1%) had an UtA-PI > 95th percentile in the first or the second trimester that normalized in the third trimester (Group 1), and 56 (11.4%) had an abnormal UtA-PI in the third trimester (Group 2). We found that the rate of pre-eclampsia (PE) was higher in Group 2 (7/56 versus 4/435, p = 0.003) as was the rate of intrauterine growth restriction (IUGR) (6/56 versus 14/435, p = 0.02). CONCLUSIONS: Low-risk nulliparous women with abnormal UtA Doppler findings in the third trimester are at a higher risk of developing PE and having a baby with IUGR.

Analysis of activity and motor coordination in rats undergoing stereotactic surgery and implantation of a cannula into the dorsal hippocampus. / Análisis de la actividad y coordinación motora en ratas con cirugía estereotáxica e implante de cánula en el hipocampo dorsal.

INTRODUCTION: Stereotactic surgery is used to place electrodes or cannulas in the brain in order to study the function of several brain structures in preclinical research. The hippocampus has been extensively studied with this methodology due to its involvement in a wide range of neurological, cognitive, emotional, and affective disorders. However, the effects of stereotactic surgery on coordination and motor activity should be evaluated in order to determine whether this surgical procedure causes any neurological alterations that may bias the results of studies incorporating this technique. METHODS: We evaluated the effects of stereotactic surgery and implantation of a cannula into the hippocampus of female Wistar rats on the motor activity, forced swim, and rotarod tests. The stage of the oestrous cycle was included in the statistical analysis. RESULTS: Stereotactic surgery had no impact on any of the motor activity variables assessed in the open field (squares crossed, time spent in grooming, and rearing), forced swim (turning behaviour, lateral swimming, latency to first immobility, and time spent immobile), and rotarod (latency to fall) tests, compared with intact rats. Regardless of surgical manipulation, rats in the metestrus and diestrus stages crossed a greater number of squares and displayed longer immobility times than those in the proestrus and estrus stages. CONCLUSION: Stereotactic surgery for cannula placement in the dorsal hippocampus does not affect coordination and motor activity in rats. We can therefore conclude that this procedure has no neurological complications that may interfere in the interpretation of results of studies applying this technique.

The protective effect of two commercial formats of Ginkgo biloba on motor alterations induced by cassava juice (Manihot esculenta Crantz) in Wistar rats. / Efecto protector de 2 presentaciones comerciales de Ginkgo biloba sobre las alteraciones motoras inducidas por el jugo de yuca (Manihot esculenta Crantz) en la rata Wistar.

INTRODUCTION: This study evaluated the protective effects of 2 commercial formats of Ginkgo biloba on motor alterations induced by cassava (Manihot esculenta Crantz) juice consumption in male Wistar rats. METHODS: The effects were evaluated with the open field and swim tests at 0, 7, 14, 21, and 28 days of treatment, one hour after administering the product. RESULTS: Compared to controls, open field crossings increased after day 21 of cassava juice consumption, and lateral swimming in the swim test was reported after day 7. CONCLUSION: Ginkgo biloba extracts prevented motor alterations associated with cassava juice consumption, probably due to the flavonoid content in both formats of Ginkgo biloba.

Overall Survival and Response to Systemic Therapy in Metastatic Extrauterine Leiomyosarcoma.

Background. Leiomyosarcomas (LMS) represent a heterogeneous subset of soft tissue sarcomas. Factors influencing prognosis for patients with metastatic extrauterine LMS (euLMS) are not well described. Limited data are available regarding responses to systemic therapy. Methods. We collected clinical and pathologic information for all patients with metastatic euLMS seen at Memorial Sloan Kettering Cancer Center between 1989 and 2012. Objective responses to first-line therapy were analyzed for a subset of patients with available baseline and on-treatment imaging using RECIST 1.1. Results. 215 patients with metastatic euLMS had a median overall survival (OS) of 2.6 years from the time of metastasis. Older age, male sex, and ≥3 initial sites of metastasis were associated with worse OS on multivariate analysis. Objective response rate (ORR) in N = 113 was 19% overall and 25%, 26%, and 25% for gemcitabine, gemcitabine plus docetaxel, and anthracycline-alkylator combinations. Patients whose tumors objectively responded to first-line therapy had a lower risk of death versus those who did not (Hazard Ratio 0.46; 95% CI: 0.26-0.79, p = 0.005). Conclusions. Anthracycline- and gemcitabine-based regimens have similar activity in this cohort of euLMS. Prognostic factors for OS include older age, male sex, and ≥3 initial sites.

Motor impairments induced by microinjection of linamarin in the dorsal hippocampus of Wistar rats. / Alteraciones motoras inducidas por la microinyección de linamarina en el hipocampo dorsal de la rata Wistar.

INTRODUCTION: Cassava, also known as yuca or manioc (Manihot esculenta Crantz), is a staple food in tropical and subtropical regions since it is an important source of carbohydrates. Nevertheless, it contains cyanogenic compounds including lotaustralin and linamarin, which have been shown by experimental models to affect brain structures such as the thalamus, the piriform cortex, the hippocampus, and others. These findings may explain the presence of such neurological diseases as konzo and tropical ataxic neuropathy. However, hippocampal involvement in the neurological alterations associated with the chemical compounds in cassava has yet to be explored. METHOD: Male Wistar rats (3 months old), were assigned to 4 groups (n = 8 per group) as follows: a vehicle-control group (receiving injectable solution 1µl) and three groups receiving linamarin (10, 15, and 20mM). The substances were microinjected intrahippocampally (CA1) every 24hours for 7 consecutive days, and their effects on locomotor activity, rotarod, and swim tests were assessed daily. RESULTS: Linamarin microinjected into the dorsal hippocampus produced hyperactivity and loss of motor coordination which became more evident as treatment time increased. In the swim test, rats treated with linamarin displayed lateral rotation beginning on the fourth day of microinjection. CONCLUSIONS: Microinjection of linamarin into the dorsal hippocampus of the rat is associated with impaired motor coordination, suggesting that the dorsal hippocampus, among other brain structures, may be affected by the neurological changes associated with inappropriate consumption of cassava in humans.

Pharmacist's review and outcomes: Treatment-enhancing contributions tallied, evaluated, and documented (PROTECTED-UK).

PURPOSE: The purpose was to describe clinical pharmacist interventions across a range of critical care units (CCUs) throughout the United Kingdom, to identify CCU medication error rate and prescription optimization, and to identify the type and impact of each intervention in the prevention of harm and improvement of patient therapy. MATERIALS AND METHODS: A prospective observational study was undertaken in 21 UK CCUs from November 5 to 18, 2012. A data collection web portal was designed where the specialist critical care pharmacist reported all interventions at their site. Each intervention was classified as medication error, optimization, or consult. In addition, a clinical impact scale was used to code the interventions. Interventions were scored as low impact, moderate impact, high impact, and life saving. The final coding was moderated by blinded independent multidisciplinary trialists. RESULTS: A total of 20517 prescriptions were reviewed with 3294 interventions recorded during the weekdays. This resulted in an overall intervention rate of 16.1%: 6.8% were classified as medication errors, 8.3% optimizations, and 1.0% consults. The interventions were classified as low impact (34.0%), moderate impact (46.7%), and high impact (19.3%); and 1 case was life saving. Almost three quarters of interventions were to optimize the effectiveness of and improve safety of pharmacotherapy. CONCLUSIONS: This observational study demonstrated that both medication error resolution and pharmacist-led optimization rates were substantial. Almost 1 in 6 prescriptions required an intervention from the clinical pharmacist. The error rate was slightly lower than an earlier UK prescribing error study (EQUIP). Two thirds of the interventions were of moderate to high impact.

Epidemiology of asthma exacerbations and their relation with environmental factors in the Basque Country.

BACKGROUND: Asthma is a highly prevalent chronic inflammatory disease characterised by reversible airflow obstruction and hyperreactivity and inflammation of the airways. Factors that cause and/or trigger asthma attacks include host-related factors (genetic predisposition, obesity and sex) and environmental factors (allergens, infections, occupational sensitisation, smoking status, pollution and diet). OBJECTIVE: To describe the epidemiology of asthma exacerbations (AEs) in the Basque Country and to explore its relationship with potentially associated environmental variables. We studied a total of 31,579 emergency department (ED) visits and 28,189 hospitalisations due to asthma. We describe the trends, incidence, seasonality and the influence of age and sex, as well as of exposure to NO2 , CO, PM, O3 , and pollen, temperature, relative humidity and flu status. We calculated the Pearson's R correlation coefficient for the study variables. RESULTS: The incidence was 486 and 88.9 cases per 100,000 people for ED visits and hospitalisations, respectively. Slightly over half (53.5%) of the ED cases were male, while females represented 62.6% of the hospital admissions. Hospitalisations are tending to decrease in children and increase in over 64-year-olds. Peaks in cases occur at the beginning of autumn in children and in winter in adults. AEs were correlated positively with exposure to NO2 , CO and to the influenza virus and negatively with temperature and exposure to O3 . These relationships vary, however, with age and season. CONCLUSIONS AND CLINICAL RELEVANCE: Rates of hospitalisation for AEs and trends in these rates over time are different in adults and children with the patterns varying by sex, season and environmental conditions.

Direct ageing of Thunnus thynnus from the eastern Atlantic Ocean and western Mediterranean Sea using dorsal fin spines.

This study deals with important methodology issues that affect age estimates of eastern Atlantic bluefin tuna Thunnus thynnus using dorsal fin spines. Nearly 3800 spine sections were used from fish caught in the north-east Atlantic Ocean and western Mediterranean Sea over a 21 year period. Edge type and marginal increment analyses indicated a yearly periodicity of annulus formation with the translucent bands (50% of occurrence) appearing from October to May. Nucleus vascularization seriously affected specimens older than 6 years, with the disappearance of 40-50% of the presumed annuli by that age. An alternate sectioning location was a clear improvement and this finding is an important contribution to the methodology of using this structure for ageing the full-length range of eastern T. thynnus. Finally, there were no significant differences between the coefficients of von Bertalanffy growth model estimated from mean length at age data (L∞ = 327.4; k = 0.097; t0 = -0.838) and those estimated from the growth curves accepted for the eastern and western T. thynnus management units.

Cycads and their association with certain neurodegenerative diseases.

INTRODUCTION: Cycads are ornamental plants that in some parts of the world are used as fresh food or raw material for producing flour with a high nutritional value. However, they also contain active compounds, including methylazoxymethanol, ß-methylamino-L-alanine, ß-alanine-L-oxalylamino and cycasin, which may produce neurotoxic effects. Some studies have associated consuming cycads and their derivatives with neurodegenerative diseases such as amyotrophic lateral sclerosis/Parkinsonism dementia complex, and other diseases characterised by motor impairment. Therefore, we must not forget that any product, no matter how natural, may present health risks or benefits depending on the chemical compounds it contains and the susceptibility of those who consume it. DEVELOPMENT: We completed a literature analysis to evaluate the neurotoxic properties of cycads and their association with neurological diseases in order to provide structured scientific information that may contribute to preventing health problems in people who use these plants. CONCLUSION: Cycads contain neurotoxic compounds that may contribute to the development of neurological diseases when ingested improperly. We must be mindful of the fact that while some plants have a high nutritional value and may fill the food gap for vulnerable populations, they can also be toxic and have a negative impact on health.

Variation in the Extraction Efficiency of Estradiol and Progesterone in Moist and Lyophilized Feces of the Black Howler Monkey (Alouatta pigra): Alternative Methods.

Several fecal steroid extraction techniques have been developed to measure the ovary function in different species of mammals. However, regardless of the method of extraction and the sample type chosen, it has been observed that they can yield results with different percentages of recuperation. The objective of this study was to determine whether the type of substratum, solvent and extraction method used have any influence on the extraction efficiency in the feces of Alouatta pigra (black howler monkey). For this purpose we used two methods: agitation and ebullition. With each method, we utilized moist and lyophilized feces. The validation of radioimmunoassay method was accurate and precise for quantify estradiol and progesterone in lyophilized feces of A. pigra. To both of which ethanol and methanol, absolute and at 80%, were added, besides the hormones (125)I-Estradiol and (125)I-Progesterone. The extraction efficiency for (125)I-Estradiol was from 87.72 ± 3.97 to 41.24 ± 2.67%, and for (125)I-Progesterone from 71.15 ± 4.24 to 42.30 ± 1.19% when we used the agitation method. Whereas with the ebullition method, the extraction efficiency for (125)I-Estradiol ranged from 86.89 ± 2.66 to 71.68 ± 3.02% and for (125)I-Progesterone from 98.31 ± 1.26 to 85.40 ± 1.98%. Due to the differences found in these assays, which depend on the method used, the type of feces employed and the type of solvent added to them, we recommend the ebullition method and the lyophilized feces of A. pigra for extracting the hormones, since in moist feces there may exist variables which might interfere in the quantification of (125)I-Estradiol and (125)I-Progesterone.

Efectividad y seguridad del uso de óxido nitroso para sedoanalgesia en urgencias / Safety and effectiveness of nitrous oxide for sedation-analgesia in emergency departments

Objetivos: Principales: evaluar la seguridad y la efectividad (mediante el análisis de la conducta del paciente) con el uso de óxido nitroso durante la realización de procedimientos dolorosos en los servicios de urgencias pediátricos (SUP); secundarios: evaluar su manejabilidad y su aceptación por el equipo médico y el paciente. Pacientes y métodos: Estudio post-autorización, prospectivo, observacional, multicéntrico, no aleatorizado y abierto (noviembre 2007-diciembre 2008), en el que participaron 7 SUP nacionales. Se incluyó a los pacientes de 2-18 años en los que se utilizó óxido nitroso para la realización de procedimientos dolorosos. Resultados: Se incluyó a 213 pacientes (27,2% < 5 años). La conducta del paciente fue considerada «buena/muy buena» en el 79,7%. El porcentaje de casos con conducta «mala/acepta con dificultad» fue mayor en < 5 años (33,3% vs. 15,1%; p=0,006), no detectándose diferencias significativas en función del procedimiento. Se registraron efectos adversos en 17 casos (7,9%), sin diferencias significativas en función de la edad, estar o no en ayunas ni la asociación de otros fármacos. Los más frecuentes fueron mareo y/o cefalea (10), seguido de vómitos (3). La administración fue considerada fácil por parte del equipo médico en el 96,6%. En el 92,7%, los padres aceptarían que volviera a ser utilizado en su hijo en una situación similar. Conclusiones: La administración de óxido nitroso logra una adecuada sedoanalgesia para la realización de procedimientos dolorosos, sobre todo en niños mayores de 5 años. Los efectos adversos registrados son escasos, leves y conocidos. La mayoría de los padres aceptaría nuevamente su uso en condiciones similares (AU)

Objectives: Primary objectives: to assess the safety and the effectiveness (analysing the behaviour of the patient) with the use of nitrous oxide during the performance of painful procedures in the Paediatric Emergency Departments (PED); secondary objectives: to evaluate the manageability of the method and its acceptance by both the medical team and the patient. Patients and methods: Post-marketing observational, prospective, multicentre, non-randomised and open (November 2007-December 2008) study, which involved seven national PED. We included patients between 2 and 18 years-old on whom a painful procedure was performed in the PED and nitrous oxide was used. Results: A total 213 patients were included (27,2% < 5years). Patient behaviour was considered «good/very good» in 79,7%, with no statistically significant difference in relation to the procedure performed. Patient behaviour was more often classified as «bad/accept with difficulty» among those < 5years (33.3% vs 15.1%, P=0.006). Adverse events occurred in 17 cases (7.9%), with no significant difference in the rate in relation to the age, fasting or not or in association with other drugs; the most frequent were dizziness and/or headache (10), followed by vomiting (3). The administration was considered easy by the medical team in the 96.6% of the cases. Parents would accept the use of nitrous oxide in their child in a similar situation in 92.7% of the cases. Conclusions: Administration of nitrous oxide achieves proper sedation and analgesia during painful procedures, especially in children older than 5years. Adverse events reported were few, mild and expected. Most parents would accept its use again in a similar situation (AU)

[Safety and effectiveness of nitrous oxide for sedation-analgesia in emergency departments]. / Efectividad y seguridad del uso de óxido nitroso para sedoanalgesia en urgencias.

PRIMARY OBJECTIVES: to assess the safety and the effectiveness (analysing the behaviour of the patient) with the use of nitrous oxide during the performance of painful procedures in the Paediatric Emergency Departments (PED); secondary objectives: to evaluate the manageability of the method and its acceptance by both the medical team and the patient. PATIENTS AND METHODS: Post-marketing observational, prospective, multicentre, non-randomised and open (November 2007-December 2008) study, which involved seven national PED. We included patients between 2 and 18 years-old on whom a painful procedure was performed in the PED and nitrous oxide was used. RESULTS: A total 213 patients were included (27,2% < 5 years). Patient behaviour was considered «good/very good¼ in 79,7%, with no statistically significant difference in relation to the procedure performed. Patient behaviour was more often classified as «bad/accept with difficulty¼ among those < 5 years (33.3% vs 15.1%, P=.006). Adverse events occurred in 17 cases (7.9%), with no significant difference in the rate in relation to the age, fasting or not or in association with other drugs; the most frequent were dizziness and/or headache (10), followed by vomiting (3). The administration was considered easy by the medical team in the 96.6% of the cases. Parents would accept the use of nitrous oxide in their child in a similar situation in 92.7% of the cases. CONCLUSIONS: Administration of nitrous oxide achieves proper sedation and analgesia during painful procedures, especially in children older than 5 years. Adverse events reported were few, mild and expected. Most parents would accept its use again in a similar situation.

Confirming nasal airway dimensions observed on panoramic and posterior-anterior cephalometric radiographs using an acoustic rhinometer.

AIM: This study aimed to confirm the nasal airway dimensions observed in standard dental radiographs through analysis of the anterior nasal cross-sectional area and nasal volume with acoustic rhinometry. METHOD: Participants were chosen from the patient population under consideration for interceptive orthodontic treatment at Tufts University's Pediatric Dentistry Clinic. A total of 55 Caucasian subjects, of both sexes (males=28, females =27), and ranging from age 6-9 years (mean= 7.33) were enrolled. Utilizing the ImageJ program, the subjects' panoramic and PA cephalometric radiographs were analyzed for radiolucent anterior nasal cross-sectional area. Subjects were then examined with the Eccovision Acoustic Rhinometer, which measured anterior nasal cross-sectional area and nasal volume. Data were grouped together, and areas and volume gathered from the radiographs and rhinometer analyzed for any correlation. Statistical analysis was performed using the SPSS program. Data was further divided into right and left nasal side, and a Pearson Correlation Matrix was created for 8 predictor variables (right and left panoramic area, right and left cephalometric area, right and left rhinometer area, and right and left rhinometer volume). RESULTS: Values in this correlation matrix ranged from 0.712 to 0.988; all were statistically significant at the <0.01 level (2-tailed test). CONCLUSION: A very strong correlation was found between the anterior nasal cross-sectional area calculated from the radiographs, and the anterior nasal cross-sectional area and nasal volume from the rhinometer.

Markers that predict serious bacterial infection in infants under 3 months of age presenting with fever of unknown origin.

OBJECTIVE: To evaluate potential markers of serious bacterial infection (SBI) in infants under 3 months of age presenting with fever of unknown origin. MATERIAL AND METHODS: We retrospectively studied all infants under 3 months of age seen in the emergency department between January 2004 and December 2006 for a febrile syndrome with no identifiable focus. Clinical data, procalcitonin (PCT), C reactive protein (CRP) and leucocyte count were evaluated for their ability to discriminate between SBI and non-SBI; receiver operating characteristic (ROC) curves were constructed for the laboratory markers and analysis was performed by multivariate logistic regression. RESULTS: The sample comprised 347 patients (23.63% with SBI). Mean PCT, CRP, leucocyte and neutrophil count were significantly higher in the group with SBI unlike the other criteria studied. The area under the ROC curve (AUC) for PCT was 0.77 (95% CI 0.72 to 0.81) and 0.79 for CRP (95% CI 0.75 to 0.84); both these variables were stronger predictors than leucocyte count (0.67, 95% CI 0.63 to 0.73). In the 15 infants with more invasive bacterial infections (sepsis, bacteraemia, bacterial meningitis), the diagnostic value of PCT (AUC 0.84, 95% CI 0.79 to 0.88) was higher than CRP (AUC 0.68, 95% CI 0.63 to 0.73). In infants who had been febrile for under 12 h, the differences between PCT, CRP and leucocyte count were statistically significant in both SBI and non-SBI groups, with increasing predictive value of PCT and decreasing value of CRP. CONCLUSIONS: PCT, CRP, and leucocyte count have intrinsic predictive value for SBI in febrile infants under 3 months of age. The diagnostic value of PCT is greater than CRP for more invasive bacterial infections and for fever of short duration.