Medicina
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Review Comparative Study
[Febrile infant and small child: what solution could be rational?].
Fever of infant and small child is one of the greatest parental concerns. Mostly the source of fever is viral infection, but sometimes it can be serious bacterial infection: meningitis, sepsis, osteomyelitis, urinary tract infection, pneumonia and enteritis. Non-identified bacterial infection may be a cause of disablement or even death. ⋯ Criteria introduced in these recommendations demonstrate a safe and effective way of screening febrile infants for a serious bacterial infection. Each management strategy involves criteria such as child's age, temperature, clinical appearance, white blood cell count, urinalysis, cerebrospinal fluid test, stool screening, chest radiography. The purpose of this article is to review the data and to validate optimal recommendation regarding the management of febrile infant and child 3 to 36 months of age.
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Comparative Study
Prevalence, clinical features and accompanying signs of post-traumatic headache in children.
The aim of the study was to investigate the prevalence and clinical features of headaches and their accompanying signs in children with mild traumatic brain injury, as well as to evaluate their changes over time. ⋯ Headaches are not more prevalent in children with mild traumatic brain injury, compared to children with other mild body injuries. The frequency of headaches, as well as the prevalence of dizziness in children with mild traumatic brain injury decreases with time.
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Comparative Study
[Influence of sensitization to pollen and food allergens on pollinosis clinical symptoms].
Geographic position and local plants of the country influence the profile of sensitization of the population to airborne allergens. The aim of this study was to evaluate the sensitization pattern to pollen and food allergens in adult patients with pollinosis in Lithuania. 101 patients (age 16-63 years) suffering from seasonal allergic rhinitis and 23.8% of them also diagnosed with concomitant seasonal asthma were investigated. Oral allergy syndrome (OAS) was diagnosed in 29.7% of cases. The sensitization to 21 species of tree-, grass- and weed-pollen and plant food allergens was determined by positive skin prick and prick-prick test. In serum levels of total IgE and timothy and orchard grass specific IgE were determined by immunoenzyme assay. 52.5% of patients suffered from spring-summer pollinosis. 91.2% of patients were sensitized to grass-pollen allergens, 79.3% -to tree pollen-allergens. 74.7% of patients were allergic to weeds. Pollinosis starting in the spring and lasting more than sixteen weeks was associated with increased probability of OAS (OR=7.1, p<0.001 and OR=3.1, p=0.01). Sensitization to hazelnut (OR=8.6, p=0.009), birch (OR=9.6, p=0.07), lamb's quarters (OR=5.2, p=0.04) allergens and twofold and more increase in serum IgE (OR=4.8, p=0.03) were considered the significant risk factors for pollinosis with OAS. More than two times elevated serum IgE increased the probability of seasonal asthma (OR=3.4, p=0.03). Sensitization to ragweed was associated with decreased risk for asthma (OR=0.26, p=0.03). ⋯ Our data indicate that more than a half of patients (52.5%) had pollinosis symptoms during spring and summer seasons because of multiple sensitivity to pollen allergens. Sensitization to hazelnut, birch, lamb's quarters allergens, more than two times elevated serum IgE are significant risk factors for pollinosis with OAS. More than two times elevated serum IgE increased the probability of seasonal asthma, but sensitization to ragweed was associated with decreased risk for pollinosis with asthma.
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Review Comparative Study
[Intra-abdominal hypertension and multiple organ dysfunction syndrome].
In clinical practice, intra-abdominal pressure is usually measured indirectly via the urinary bladder using Foley catheter. This technique is minimally invasive, safe, simple and accurate. Intra-abdominal hypertension is defined as an intra-abdominal pressure above 12 mmHg. ⋯ Intra-abdominal hypertension causes visceral organ hypoperfusion, intestinal ischemia and may also lead to bacterial translocation, release of cytokines and production of free oxygen radicals. All these factors may contribute to the development of multiple organ failure in the critically ill patients. Intravascular fluid replacement and abdominal decompression are the standards of treatment for abdominal compartment syndrome.
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Randomized Controlled Trial Comparative Study
[Minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery: a double-blind, randomized study].
The aim of the study was to find minimal effective dose of spinal hyperbaric bupivacaine for adult anorectal surgery. ⋯ Groups were comparable in demographics. No case of failure was registered but 4 patients (10.5%) in the group 3 received supplemental i/v fentanyl to treat tension in the abdomen intraoperatively. Level of sensory block in groups 1, 2, 3 was 10.4+/-1.7, 7.013+/-2.2, 6.7+/-1.9 dermatomes, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=1.0 group 2 vs 3, Bonferroni). Extent of motor block was 2-3 scores according to the Bromage scale in 70.5% of group 1 cases, compared to 0-1 score in 97.3% of group 2 and 92.1% of group 3 cases. Median (range) duration of motor block in groups 1, 2, 3 was 90 (0-120), 0 (0-90), and 0 (0-60) min, respectively (p<0.0001 ANOVA; p<0.0001 group 1 vs 2, group 1 vs 3, p=0.13 group 2 vs 3, Bonferroni). Time of ambulation was 181.5+/-41.5, 136.6+/-32.2 and 123.0+/-45.9 min, respectively (p<0.0001 ANOVA; p<0.001 group 1 vs 2, p<0.00001 group 1 vs 3, p=0.43 group 2 vs 3, Bonferroni). There was no significant intergroup difference in time to urinate; retention developed in 20.4% of total cases. No difference was found in morphine consumption, 64.5% of cases did not require rescue analgesics. Quality of anesthesia was stated as excellent by the anesthesiologist and surgeon in all groups. However, quality was rated as excellent by patient in the operating room in groups 1, 2, 3: 58.8, 94.7, and 86.8%, respectively (p=0.003), on day 1 postoperatively: 76.5, 92.1, and 97.4%, respectively (p=0.023); by nursing staff: 82.4, 100, and 97.4%, respectively (p=0.019). Lower rates in group 1 were due to extensive motor block. In conclusion, a minimal recommended dose of spinal hyperbaric bupivacaine for anorectal surgery is 4-5 mg; a dose of 7.5 mg is excessive due to prolonged sensory and motor block.