RESUMO
Exposure to environmental tobacco smoke is associated with increased respiratory morbidity in young children, but few studies have assessed such exposure objectively by urinary cotinine measurements. 501 children aged 1-5 years, a random 5% sample of children attending an outpatient clinic, were classified as exposed or non-exposed to environmental tobacco smoke with a cut-off of 10 ng cotinine per mg creatinine in urine. Exposed children were 3.5 times (95% CI 1.56-7.90, p < 0.0024) more likely to have increased respiratory morbidity (three or more episodes during the previous 12 months) than non-exposed children after adjustment for potential confounding factors.
Assuntos
Exposição Ambiental/efeitos adversos , Doenças Respiratórias/etiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Pré-Escolar , Fatores de Confusão Epidemiológicos , Cotinina/urina , Exposição Ambiental/estatística & dados numéricos , Grécia/epidemiologia , Humanos , Lactente , Modelos Logísticos , Razão de Chances , Distribuição Aleatória , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/urina , Poluição por Fumaça de Tabaco/estatística & dados numéricosRESUMO
Four-day dexamethasone therapy has been used to treat bacterial meningitis. This prospective, randomized study compared the effect of a 2-day versus a 4-day regimen. Children (n = 118, ages 2.5 months to 15 years) were evaluated; 50% of the cases were due to Neisseria meningitidis and 40% to Haemophilus influenzae type b. Patients were treated intravenously (iv) mainly with conventional antimicrobial therapy and were randomly assigned to receive dexamethasone, 0.15 mg/kg iv every 6 h for 2 or 4 days. The clinical response was similar for both dexamethasone regimens. The meningococcal meningitis patients survived without neurologic or audiologic sequelae. On long-term follow-up, neurologic sequelae or moderate or more severe unilateral or bilateral hearing impairment (or both) were found in 1.8% and 3.8% of patients treated with dexamethasone for 2 and 4 days, respectively. The 2-day regimen appears appropriate for the treatment of H. influenzae and meningococcal meningitis.
Assuntos
Dexametasona/uso terapêutico , Meningite por Haemophilus/tratamento farmacológico , Meningite Meningocócica/tratamento farmacológico , Meningite Pneumocócica/tratamento farmacológico , Adolescente , Antibacterianos/uso terapêutico , Líquido Cefalorraquidiano/química , Líquido Cefalorraquidiano/citologia , Proteínas do Líquido Cefalorraquidiano/análise , Criança , Pré-Escolar , Dexametasona/administração & dosagem , Dexametasona/efeitos adversos , Esquema de Medicação , Quimioterapia Combinada , Feminino , Seguimentos , Hemorragia Gastrointestinal/induzido quimicamente , Glucose/líquido cefalorraquidiano , Perda Auditiva/etiologia , Humanos , Lactente , Contagem de Leucócitos , Masculino , Meningite por Haemophilus/complicações , Meningite Meningocócica/complicações , Meningite Pneumocócica/complicações , Doenças do Sistema Nervoso/etiologia , Estudos Prospectivos , Resultado do TratamentoRESUMO
Sixty-three cases of nosocomial sepsis occurring from April through October 1981, in a 500-bed pediatric hospital, were traced to bacterial contamination of intravenous fluid produced by a single manufacturer. Two species of uncommon blood stream pathogens, Enterobacter cloacae and Enterobacter agglomerans contaminated the fluid. Infections with these organisms might have contributed to the death of four patients; two who were immunosuppressed, one who was asplenic and one premature infant. Epidemiologic and laboratory investigations identified the site of contamination to be within the screw-caps of the bottles containing the intravenous fluid. Contamination occurred during insertion of the intravenous fluid administration set into the bottle. The "epidemic" terminated when the hospital discontinued the use of infusion fluids from that manufacturer. We conclude that intravenous fluids should be examined during outbreaks of nosocomial bacteremia due to unusual pathogens.