A Comparative Study of Paediatric Thermal Burns Treated with Topical Heparin and Without Heparin

Following reports of heparin use in burn treatment, an ethics-committee-approved prospective randomized study with controls compared results obtained using traditional usual burn treatment without heparin with results in similar patients similarly treated with heparin added topically. The subjects were 100 consecutive burn patients (age <15 years) with second-degree superficial and deep burns of 5–45 % total body surface area size. Two largely similar cohort groups—a control group (C) and a heparin group (H) with 50 subjects per group—were randomly treated. The 50 control group patients received traditional routine treatment, including topical antimicrobial cream, debridement, and, when needed, skin grafts in the early postburn period. The 50 heparin group patients, without topical cream, were additionally treated, starting on day 1 postburn, with 200 IU/ml sodium aqueous heparin solution USP (heparin) dripped on the burn surfaces and inserted into the blisters two to four times a day for 1–2 days, and then only on burn surfaces for a total of 5–7 days, before skin grafting, when needed. Thereafter, control and heparin group treatment was similar. It was found that the heparin patients complained of less pain and received less pain medicine than the control patients. The heparin group needed fewer dressings and oral antibiotics than the control group. The 50 heparin group patients had 4 skin graftings (8 %), while the 50 control group patients had 10 (20 %). Five control group patients died (mortality 10 %). No heparin group patients died. The number of days in hospital for the heparin group versus control group was significantly less (overall P < 0.0001): 58 % of heparin group patients were discharged within 10 days versus 6 % of control group patients; 82 % of heparin group patients were out in 20 days versus 14 % of control group patients; 98 % of the heparin group versus 44 % of the control group were out in 30 days; and while 100 % of heparin group patients were discharged by day 40, 56 % of the control group required up to another 10 days. Burns in heparin group patients healed on average in 15 days (maximum period 37 days) versus an average of 25 days (maximum >48 days) in control group patients (P < 0.0006). Procedures and costs in the heparin group were much reduced compared with the control group. Differences between the heparin and control groups are presented for the sake of comparison. It was concluded that heparin applied topically for 5–7 days improved burn treatment: it reduced pain, pain medicine, dressings, and use of antibiotics; it significantly reduced IV fluids (P < 0.04), days in hospital (P < 0.0001), and healing time (P < 0.0006); and it reduced skin grafts, mortality, and costs.     

右美托咪啶联合用药新方案用于重症医学科长时间镇静的研究

目的比较在重症医学科内长时间镇静状态下不同镇静方案的差别，找出较适合长时间镇静的方案。方法选取在我院重症医学科住院的患者80例，随机分为4组，即右美托咪啶持续泵注联合咪达唑仑间断应用组（A组，n=20），右美托咪啶与咪达唑仑联合持续泵注组（B组，n=20），咪达唑仑单独持续泵人组（C组，n=20），右美托咪啶单独持续泵人组（D组，n=20）。镇静目标为肌肉活动评分法（monitor activity assessment scale, MAAS）3分．镇静过程中持续心电监护，监测镇静满意程度，记录4组患者3日用药量变化，并监测患者不良反应发生率。比较4组患者后3种指标的差别。结果A、B两组较C、D两组镇静满意程度显著增高，用药量变化幅度较小，不良反应较少，其中又以A组不良反应为最少，且与B组相比咪达唑仑用药量显著减少。结论右美托眯啶持续泵注联合咪达唑仑间断应用可显著减少长时间镇静所需药物用量．且减少不良反应。     

Clinical characteristics of patients after dicamba herbicide ingestion

Objective. Despite a widespread use of dicamba herbicide and numerous animal model studies, there had not been studies on acute toxicity of this chemical compound in human subjects following ingestion. Therefore, this study was conducted to investigate clinical characteristics of dicamba poisoning and to guide physicians treating patients intoxicated with dicamba herbicide. Material and method. A retrospective observational case series was conducted for 14 patients with history of dicamba herbicide ingestion. Data were collected for clinical manifestation, patient management, and final outcome. Result. The most common symptom was altered mental state (Glasgow Coma Scale ≤ 14). Laboratory abnormalities were elevations in lactate, and creatine kinase, metabolic acidosis (pH < 7.35, and HCO₃^? < 20 mmol/L), and elevated lipase. QTc prolongation was commonly observed. These abnormal clinical findings had normalized within two days of supportive treatment after dicamba ingestion. One patient did demonstrate corrosive esophagitis. Discussion and conclusion. Acute toxicity of dicamba herbicide in human following oral exposure was manageable with supportive treatment. However, physician should take into account for corrosive effect on GI tract, rhabdomyolysis, or acute pancreatitis.     

医院满意度综合测评体系的建立及实施分析

目的:对医院各科室的满意度进行测评,着力提升医院服务品质。方法:通过文献回顾、专家咨询等方法制定测评方案,设计问卷调查表,分别对患者及院内工作人员进行问卷调查。结果:通过每月的问卷调查获得各科室满意度,并与绩效挂钩;及时反馈意见和建议,为改善医疗服务提供依据。结论:建立的医院综合满意度测评体系覆盖医院所有科室,对进一步提高服务质量,全面提升医院的服务意识及管理能力起到积极的推动作用。     

Diphenhydramine dose–response: a novel approach to determine triage thresholds

Context. It is unclear how much diphenhydramine (DPH) is toxic in humans. Previous dose–response studies have had conflicting results. Objective. We sought to evaluate DPH dose–response using a unique method that utilizes acetaminophen (APAP) serum concentrations to estimate DPH doses in patients ingesting APAP/DPH in a fixed-combination product. Methods. We retrospectively analyzed APAP/DPH-only exposures in patients 2–80 years of age using case data from 15 U.S. poison centers. DPH dose was extrapolated from measured serum APAP concentrations. A clinically significant response (CSR) was predefined in terms of eight specific manifestations (e.g., coma) that would warrant emergency department intervention. Nominal logistic regression was used to model the probability of each recorded manifestation across DPH dose ranges examining fits for mg, mg/kg, log10 mg, and log10 mg/kg DPH doses. The threshold value where patients reliably became symptomatic was determined by further examining receiver operating characteristic curves. Results. There were 509 cases that met inclusion criteria. Forty-five patients (9%) developed CSRs. A higher percentage of patients developed CSR at ≥ 7.5 mg/kg DPH and ≥1 g total DPH cutoff points (p < 0.05, Fisher's exact test). The best model for predicting the probability of CSR was a logistic fit of log₁₀ mg/kg dose (p < 0.05). By this model, for every 1 log₁₀ unit increase of mg/kg DPH dose, the odds of developing a CSR increased 47-fold (95% CI 17, 154). Receiver operating characteristic analyses showed a dose-related progression of symptoms. The cut-point with greatest sensitivity (98%) versus 1-specificity (57%) corresponded to an extrapolated mg/kg DPH dose of 8.2 mg/kg (95% CI 5.6, 10.5). Conclusion. Our findings support the current American Association of Poison Control Centers' guideline recommendation to refer patients to the hospital for evaluation if they have ingested greater than or equal to 7.5 mg/kg of DPH.     

A systematic review on status of lead pollution and toxicity in Iran; Guidance for preventive measures

Lead is an old environmental metal which is presented everywhere and lead poisoning is an important health issue in many countries in the world including Iran. It is known as a silent environmental disease which can have life-long adverse health effects. In children, the most vulnerable population, mental development of children health effects is of the greatest influence. Low level lead exposure can significantly induce motor dysfunctions and cognitive impairment in children. The sources of lead exposure vary among countries. Occupational lead exposure is an important health issue in Iran and mine workers, employees of paint factories, workers of copying centers, drivers, and tile making factories are in higher risk of lead toxicity. Moreover lead processing industry has always been a major of concern which affects surface water, drinking waters, and ground waters, even water of Caspian Sea, Persian Gulf and rivers due to increasing the number of industries in vicinity of rivers that release their waste discharges into river or sea. In addition, lead contamination of soil and air especially in vicinity of polluted and industrialized cities is another health problem in Iran. Even foods such as rice and fishes, raw milk, and vegetables which are the most common food of Iranian population are polluted to lead in some area of Iran. Adding lead to the opium is a recently health hazard in Iran that has been observed among opium addicts. There are few studies evaluated current status of lead exposure and toxicity in the Iranian children and pregnant women which should be taken into account of authorities. We recommend to identify sources, eliminate or control sources, and monitor environmental exposures and hazards to prevent lead poisoning.     

Poisonings in the Nordic countries in 2007: A 5-year epidemiological follow-up

Aim. To map mortality and morbidity of poisonings in Denmark, Finland, Iceland, Norway and Sweden in 2007 and undertake a comparison with a corresponding study in 2002. Methods. Morbidity was as for 2002 defined as acute poisoning (ICD-10 codes, main and subsidiary diagnoses) treated in hospitals. The figures were extracted from the National Patient/Hospital Registers. Deaths recorded as acute poisoning (using corresponding ICD-10 codes) were collected from the National Cause of Death Registers. Results. Annual mortality of acute poisonings per 100000 inhabitants (rate) for 2007 was 22.4 in Finland, an important increase from 16.7 per 100000 in 2002. The increase was mainly due to a change in coding of alcohol, but also represented a slight increase in fatal alcohol intoxications per se. The poisoning death rate in the other Nordic countries varied between 8–13 and was at the same level as for 2002. The morbidity rates for 2007 between158–285 per 100000 inhabitants represented a slight increase compared to 2002 figures. Conclusion. The increase in poisoning death rate for alcohol, and thus total rate in Finland in 2007 compared to 2002, has further increased the gap to the other Nordic countries. Poisoning morbidity rates in the Nordic countries are of the same level, but the variability shown indicates that more harmonization and collaboration is needed to increase the data quality.