Lancet
-
Hypoxia caused by pneumonia or bronchiolitis is a common cause of death in children in developing countries. Oxygen is very expensive in developing countries, and it is important that the limited supplies available be used as efficiently as possible. ⋯ A flow rate of 150 ml/kg/min gave an inspired oxygen concentration of about 50% in children less than 2 years old. Thus, newborn infants with pneumonia can usually be treated with 0.5 l/min and infants up to 12 months old with 1.0 l/min of nasopharyngeal oxygen.
-
The calculation of the anion gap is widely used in the diagnosis of metabolic acidosis. It is often taught that the increment in the anion gap will exactly match the fall in serum bicarbonate during a simple metabolic acidosis of the high anion gap type; if the changes in the anion gap and bicarbonate level are not equivalent, a second acid-base disorder should be suspected. ⋯ This review critically examines these assumptions and their clinical implications. Discrepancies between the increment in the anion gap and the reduction in serum bicarbonate must be interpreted cautiously.
-
Letter Comparative Study
Urokinase versus tissue plasminogen activator in pulmonary embolism.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Trial of high-dose Edmonston-Zagreb measles vaccine in Guinea-Bissau: protective efficacy.
In a randomised study of 558 children in an urban African community, the protective effect of the Edmonston-Zagreb (EZ) measles vaccine given in a dose of 40,000 plaque forming units from the age of 4 months was compared with the effects of a standard dose (6000 tissue culture infectious units) of Schwarz measles vaccine given from the age of 9 months. During two years of follow-up, all 14 clinical cases of measles occurred in the Schwarz group; 10 of the children contracted measles before vaccination and 4 after measles vaccination. Thus the EZ vaccine provided significant protection against measles both before and after the usual age of vaccination. Among the children who were exposed to measles at home, those given EZ vaccine were better protected than either unvaccinated children or those given the Schwarz vaccine.
-
Randomized Controlled Trial Clinical Trial
Effects of prolonged naloxone infusion in septic shock.
Fourteen patients suffering sixteen episodes of septic shock requiring inotrope and/or vasopressor support were randomised to receive a 30 micrograms/kg naloxone intravenous bolus followed by a 30 micrograms/kg/h infusion or an equivalent volume placebo bolus and infusion for 8-16 h in a double-blind study. pH and pulmonary wedge pressure were kept constant, and inotrope and/or vasopressor were titrated to maintain a preselected mean blood pressure. Inotrope/vasopressor requirements in the naloxone-treated group were significantly lower than those in the control group at 8 h (eight patients in each group, p less than 0.005) and at 16 h (five patients in each group, p less than 0.02). Late but significant improvements in stroke volume (p less than 0.02) and heart rate (p less than 0.05) were also noted in the eight naloxone-treated patients.