Causes, treatment and clinical outcome in infants admitted because of excessive crying to the paediatric department of the Isala clinics, Zwolle, the Netherlands, 1997/'03

OBJECTIVE: Evaluation of the strategy of admitting excessively crying infants after no improvement is seen following measures taken by the family physician. DESIGN: Retrospective. METHOD: By studying medical records, data were collected for all infants who were admitted to the paediatric department of the Isala clinics in Zwolle because of excessive crying in the period 1997/'03. Excessive crying here was defined as 'crying that was regarded by the parents as excessive', whereby strict time criteria did not have to be met. RESULTS: In the study period of 6.5 years, 88 children were admitted because of excessive crying: 51 boys and 37 girls, with an average age of 10 weeks (range: 0.5-40). Measures taken without success prior to referral included: hypoallergenic feeding in 51 cases (58%), alternative medical treatment in 18 (20%) and antacids in 9 (10%). In 3 patients (3%) a possible cause of the excessive crying was identified and improvement occurred after treatment: cow's milk allergy (n = 2) and recurrent respiratory tract infections caused by a humoral immunodeficiency (n = 1). Clinical indications for an underlying cause were present in another 8 patients but this could be neither confirmed nor excluded. In 77 patients (88%) the crying rapidly improved within a few days without a specific intervention. In most children, hypoallergenic feeding could be replaced by regular cow's milk formulas without any problems. After discharge, there were so re-admissions for excessive crying (11%). CONCLUSION: In the majority of infants admitted to hospital for excessive crying, no underlying cause was found and the crying rapidly improved within a few days without a specific intervention. We therefore recommend that excessively crying infants merely be observed clinically for several days. There is no indication for immediate diagnostic or therapeutic interventions. It is important, however, to counsel parents about their own anxiety and distress and the influence these may have on the infant's crying behaviour.     

124例牙外伤急诊临床分析

目的探讨急诊牙外伤的临床特点,为牙外伤的防护和应急处理提供参考。方法对该院2011年3月—2013年3月收治的124例牙外伤急诊患者进行临床分析。结果 124例患者中,男女比例为1.70∶1。外伤时间春季较少,冬季较多;周末较平时增加。外伤牙受伤牙位左右基本对称,上中切牙最易受累。各类型牙外伤中,冠折为最多见。大部分患者在牙外伤后24h内到急诊就诊。结论应针对牙外伤的发病原因、地点、人群、好发季节、好发牙位等采取相应的预防措施,有效避免牙外伤的发生。     

Febrile illness at the emergency department of Cayenne Hospital, French Guiana

Febrile illness is a common cause of attendance at emergency departments. The purpose of this study was to describe infectious aetiologies of fever in a tropical setting. We prospectively included 1443 febrile patients, all French Guiana residents, who presented at Cayenne Hospital emergency department. This report will propose an overview of aetiologies of febrile illness in French Guiana, and tropical diseases such as malaria and arbovirus infections are discussed. Almost 30% of fevers remained unexplained. Further prospective multicentre studies are warranted to improve the diagnosis of overlooked pathogens in French Guiana. Such studies would lead to conclusions of specific interest in the travel medicine field.     

Retrospective study of the incidence of unstable and shock patients presenting to the emergency room

Background

Over a period of three decades, medical personnel working in our emergency room observed that fewer severe cases presented to the emergency department. The objective of this study is to assess whether a genuine change in the presentation rates of clinically unstable non-trauma patients to the emergency room indeed exists.

Methods

We conducted a retrospective review of patients treated in the shock room. Patients’ demographic data, diagnoses and outcomes were accessed. Populations of patients presenting to the shock room over a span of four seasons, in two separate periods eight years apart were compared. This rate was compared with the complementary bulk rate of patients presenting to the emergency room at the center.

Results

While absolute rates of emergency room utilization rose, the rate of unstable patients demanding urgent intensive care showed a clear decline. An absolute reduction of close to 50% across the different seasons of the examined years was found. Per patient, the proportion of those requiring artificial respiration and urgent hemodialysis remained uniform in both periods. All parameters of patient outcomes were similar in both periods of the study.

Conclusion

This unexplored aspect of emergency care demonstrates a dramatic decline in the incidence of unstable patients. While we should continue to reinforce delivery of superior care, our medical educational system should adapt itself to compensate for the diminished exposure of our trainees to emergencies. Further research in this field should explore whether the trend we observed exists in other geographical locations and whether this parameter can be utilized as a quality measure of medical systems.

     

1997～2005年医院内HIV抗体检测结果分析

目的了解综合性医院就诊患者中人类免疫缺陷病毒(HIV)感染状况。方法对1997年6月~2005年3月在中国医科大学附属第一医院就诊的患者,用酶联免疫吸附法(ELISA)和蛋白印迹法(WesternBlot)检测血清HIV抗体,并对其人口学特征、高危因素进行分析。结果在103324人中共检测出23例血清HIV抗体阳性者,其中青壮年占78.3%,以男性为主。除1例外,都具有输血史、静脉吸毒、不安全性行为、伴发性传播疾病等危险因素。结论在综合性医院应该对有可疑AIDS症状、有相关危险因素的就诊者予以高度重视,列入HIV抗体筛查的对象。     

Understanding the meanings of ischemic chest pain of patients admitted in the emergency room

Nursing professionals who work in emergency units are constantly facing patients with ischemic chest pain. This study aimed at understanding the meanings of patients with ischemic chest pain when they are in the emergency room. It is a study with qualitative approach that was carried with ten patients admitted in an emergency room in a private hospital in the south zone of S?o Paulo city. Data were collected through semi-structured interviews and analyzed according to content analysis approach. Resulting thematic axes were: meaning of chest pain and feelings when facing the symptoms. As results it was possible to observe the fear of death, family concerns were more significant. It was concluded that patients with ischemic chest pain need special support from the nursing team in order to decrease or diminish those feelings.     

Microorganisms in clinical material collected from patients at the Public Clinical Hospital Nr 1 in Gdansk from 1997-1999

Occurrence of microorganisms isolated from clinical specimens collected from patients in Clinical Hospital no. 1 in Gdańsk in years 1997-1999 was analyzed. In this period there was no change in occurrence of Gram-negative bacteria, that accounted for 44-46% isolates. The number of isolations of Gram-positive bacteria dropped from 45% to 40%, and yeast risen from 5% to 10%. The analysis of blood cultures shows decrease in occurrence of bacteremia caused by Gram-negative bacteria and increase in occurrence bacteremia caused by Gram-positive bacteria and yeast. We observed also that the number of multi-resistant Gram-positive isolates (MRSA, VRE) decreased but there was rise in occurrence of multiresistant Gram-negative isolates (ESBL+, CRPA).