Frequency and risk factors for toxocariasis in children from a pediatric outpatient center in southeastern Brazil

To estimate the frequency of anti-Toxocara sp. antibodies, and evaluate factors associated with this infection, sera from 242 male and female children, aged from one to fifteen years old, attended at the Hospital of the Federal University of Uberlandia, Minas Gerais State, Brazil, were analyzed by ELISA. Information on the patients was collected and registered using an investigative questionnaire, and details on possible clinical alterations were obtained from the medical charts of 187 patients. Of a total of 242 samples, 21 (8.7%) were positive for anti-Toxocara sp. antibodies. The presence of dogs and cats and the school variable (place of contact), appeared to be significantly associated (p<0.05) with a positive serology. Respiratory symptoms and eosinophil counts greater than 20% also showed a positive statistical correlation with a positive serology for Toxocara sp.. Factors such as sex and age, and symptoms like headache, stomach ache, convulsive crises and anemia were not associated with toxocariasis.     

北京地区某医院2019—2022年儿童流感门诊流行性感冒筛查与监测分析

目的?了解解放军战略支援部队特色医学中心儿童流行性感冒（流感）门诊病例流行病学特点,为该院儿童流感就诊和预防提供指导。方法?收集解放军战略支援部队特色医学中心2019年1月1日—2022年3月31日门诊日志,回顾性分析就诊患儿中流感分型、年龄特征、感染时间分布特征、与新型冠状病毒肺炎（新冠肺炎）流行时间的关系等。结果?2019年1月—2022年3月,该院儿科门诊总计接诊流感阳性病例3672例,其中,甲型流感阳性率最高（2427例,7.94%）,所占比例最高（66.09%）。10～14岁年龄段患儿阳性率最高（629例,17.98%）。发病高峰为冬春季。新冠肺炎疫情期间冬春季病例数减少,主要病原分型由甲型流感转为乙型流感。结论?该院地处北方,儿童流感冬春季高发,患儿发病年龄特征明显。新冠肺炎疫情暴发后,病例数减少,主要病原分型由甲型流感转为乙型流感。     

Impact of rotavirus infection at a large pediatric hospital

Information is limited about national patterns of rotavirus infection throughout the USA. Discharge records and laboratory rotavirus detection for 1979-1989 at the Texas Children's Hospital, Houston, were evaluated to determine the impact of rotavirus gastroenteritis at a large children's hospital. The availability since 1983 of diagnostic assays less expensive than electron microscopy was associated with increased rotavirus detection. Only 67% of rotavirus-positive samples came from children likely to have had community-acquired acute gastroenteritis. Combined laboratory results and ICD-9 discharge diagnosis codes (008.6, 008.8, and 558.9) measured rotavirus activity better than either alone. A case definition for hospitalization for rotavirus infection resulted in an estimate that an average of 473 children were hospitalized for rotavirus infection at Texas Children's Hospital each year over the 10-year period. These cases accounted for 3.0% of all hospital days and $1.5 million per year in bed costs at this hospital. Hospitalization rates and the impact of hospital costs for the USA were estimated by extrapolation.     

Histopathological profile of gastritis in adult patients seen at a referral hospital in Kenya

AIM： To conduct a detailed histological study of gastritis in adult patients attending an endoscopy clinic at a Kenyan teaching and referral hospital.
METHODS： Biopsy specimens from consecutive patients were examined and graded according to the Updated Sydney System for H pylori infection, chronic inflammation, neutrophil activity, glandular atrophy and intestinal metaplasia. Also documented were gastric tissue eosinophil counts and presence of lymphoid follicles.
RESULTS： The rate of the graded variables, in the antrum and corpus respectively, were as follows： H pylori infection （91%, 86%）, chronic inflammation （98%, 93%）, neutrophil activity （91%, 86%）, glandular atrophy （57%, 15%） and intestinal metaplasia （11%, 2%）. Lymphoid follicles were noted in 11% of cases. Duodenal and gastric ulcers were documented in 32% and 2% respectively. The mean eosinophil count was 5.9 ±0.74 eosinophils/ HPF and 9.58 ± 0.93 eosinophils/HPF in the corpus and antrum respectively. Significant association was found between the degree of H pylori colonisation with chronic inflammation, neutrophil activity and antral glandular atrophy. Biopsies from the antrum and corpus showed significant histopathological discordance for all the graded variables. H pylori negative cases were associated with recent antibiotic use.
CONCLUSION： The study the chief cause of gastritis reaffirms that H pylori is in this environment. The majority of patients show a moderate to high degree of inflammation but a low degree of glandular atrophy and intestinal metaplasia. The study shows that interrelationships between the histological variables in this African population are similar to those found in other populations worldwide including non-African populations.     

Evaluation of a multidisciplinary outpatient pain management programme based at a community hospital

Objective: To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. Methods: Patients attending the PMP were assessed at three intervals (pre‐training, and 18 and 44 weeks post‐training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre‐training and final follow‐up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. Results: Between 1997 and 2006, 163 patients completed at least six sessions out of the eight‐week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre‐training and final follow‐up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self‐efficacy questionnaire) at 18 weeks post‐training and their improvement was sustained at the final follow‐up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow‐up. They also reported a significant reduction in pain‐related GP and consultant visits at their final follow‐up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS‐Anx) and sickness impact profile scores, these were not statistically significant. Conclusion: The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions. Copyright © 2008 John Wiley & Sons, Ltd.     

Comparison between clinical and autopsy diagnoses in a cardiology hospital

Background

A few recent studies have evaluated diagnostic accuracy by comparison between clinical and autopsy diagnoses in a hospital specialising in cardiology.

Methods

406 consecutive autopsy cases during 2 years were studied. Patients were aged 47.4±28.4 years; 236 (58.1%) were men and 170 (41.9%) women. Diagnostic comparison was categorised in classes I to V (I, II, III and IV: discrepancy in decreasing order of importance regarding therapy and prognosis; V: concordance). Categorisation was ranked on the basis of the highest degree of discrepancy. Statistical analysis was performed with the Χ² test and stepwise logistic regression.

Results

Each age increase of 10 years added 16.2% to the risk of the diagnostic comparison to be categorised in classes I and II (major discrepancy) in comparison to classes III, IV and V (OR 1.16, 95% CI 1.07 to 1.27, p<0.001). By contrast, admission to intensive care units decreased the risk of categorisation in classes I and II by 47% (OR 0.53, 95% CI 0.32 to 0.85, p = 0.009). The most frequent diagnostic discrepancy occurred for pulmonary embolism: 30 out of 88 (34.1%) diagnoses in classes I and II. The concordance rate was 71.1% for acute myocardial infarction, 75% for aorta dissection, 73.1% for infective endocarditis and 35.2% for pulmonary embolism.

Conclusion

Age and hospital ward influenced the distribution of diagnostic discrepancy or concordance between clinical and autopsy diagnoses. The lower discrepancy rate for myocardial infarction and infective endocarditis may be related to the fact that the study was carried out in a specialist hospital.Diagnostic accuracy may be evaluated by the comparison between clinical and autopsy diagnoses. In studies that compared these results carried out two decades apart, the discrepancies between clinical and autopsy diagnoses persisted in spite of progress in medical skills and technology.^1,2 Further, the diagnoses of cardiovascular diseases were the most frequently missed diagnoses in the patients that died in a general hospital experience,³ including pulmonary embolism, myocardial infarction and infective endocarditis.⁴A few recent studies have evaluated the comparison of clinical and autopsy diagnoses in a university hospital specialising in cardiology with a large outpatient clinic and emergency department as well as an active department of pathology. In spite of the ongoing progress in medical knowledge and technology, diagnostic challenges occur in the care of the patients.^1,2,5The objective of this study was to compare clinical and autopsy diagnoses in classes of diagnostic comparison in a hospital devoted mainly to the care of patients with heart disease in a consecutive autopsy series over two years.     

Survey of isolation practices at a tertiary care pediatric hospital

BACKGROUND: Although isolation precautions are an important aspect of hospital infection control, current rates of isolation in a pediatric hospital and rates of compliance with established precautions are unknown. We therefore initiated hospital-wide point prevalence studies to determine unit-specific rates of patient isolation and compliance with proper isolation requirements focusing on communication of isolation status and availability of personal protective equipment. In this report, we present data from the first 14 months of the study. METHODS: This was a prospective observational study. Twice monthly, between January 2004 and February 2005, infection control professionals reviewed the types and appropriateness of isolation of all hospitalized patients, except for those on the psychiatry unit. RESULTS: Seventeen percent of patients in the hospital during the study period were isolated, most frequently for community-acquired infections. Droplet isolation precautions were the most common form of isolation. Overall, only 74.6% of patients were isolated appropriately. The solid organ transplantation, hematology/oncology, and bone marrow transplantation units were those with the highest rates of inappropriate isolation. CONCLUSION: At our hospital, community-acquired infections, in particular respiratory infections, were the most common reasons for patient isolation. Monitoring of the appropriateness of isolation precautions offers the opportunity to reduce health care-related transmission of infection and identify specific target areas for improvement.     

Frequency of mycosis in immunosuppressed patients at a regional hospital of Mexico City

OBJECTIVE: To isolate and identify the fungi in specimens collected from immunocompromised patients seen in Mexico City hospital, and to assess their association with mycosis. MATERIAL AND METHODS: A total of 268 specimens from 108 patients were processed for mycological study, including direct examination, smears, cultures, and microcultures in specific media, in addition to biochemical tests. Most of the patients had been diagnosed with pulmonary tuberculosis and Acquired Immunodeficiency Syndrome (AIDS). RESULTS: One hundred and eighty-three yeasts and 66 mycelial fungi were isolated. Forty-five mycoses were diagnosed; the most frequent mycosis was pulmonary candidosis (32 cases). Candida albicans and C parapsilosis were the predominant species associated with mycotic infection. Five Cryptococcus neoformans var. neoformans, one C albidus, three Histoplasma capsulatum and one Geotrichum candidum isolates were associated with mycosis. CONCLUSIONS: Of the studied patients, 41.6% showed a mycotic infection, principally associated with AIDS and pulmonary tuberculosis. The English version of this paper is available at:http://www.insp.mx/salud/index.html.     

Antimicrobial resistance of enterococcal blood isolates at a pediatric care hospital in India

Enterococci are one of the leading causes of nosocomial infections. In recent years, enterococci have become increasingly resistant to a wide range of antimicrobial agents. From April to October 2001, a study was conducted to speciate and determine the antimicrobial susceptibility of 50 isolates of enterococci from bacteremic children. These isolates were tested for antimicrobial susceptibility to the commonly used antibiotics. Screening for vancomycin resistance was done by the agar screen method, and the results were confirmed by determining the minimum inhibitory concentration (MIC) using the agar dilution method. It was observed that 33 isolates were Enterococcus faecium, followed by E. faecalis (10), E. durans (4), and E. dispar (3). Seventy-two percent of strains were resistant to ampicillin, 46% to amoxicillin + clavulanic acid, 72% to ciprofloxacin, 54% to doxycyclin, and 74% to erythromycin. Sixty-six percent of isolates showed high-level gentamicin resistance and 42% showed high-level streptomycin resistance. Four strains showed raised MIC to vancomycin (8 microg/ml). It was concluded that multidrug resistant E. faecium is emerging as an important agent of bacteremia in children.     

Appropriateness of outpatient gastrointestinal endoscopy in a non-academic hospital

AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI) endoscopy [381 for esophagogastroduodenoscopy(EGD) and 408 for colonoscopy] were prospectively enrolled in the study.The American Society for Gastrointestinal Endoscopy(ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic f indings.RESULTS:The overall inappropriate rate was 13.3%.The indications for EGD and colonoscopy were,respectively,appropriate in 82.7% and 82.6% of the exams,uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%.The diagnostic yield was signif icant higher forEGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate(EGD:36.6% vs 36.4% vs 11.4%,P = 0.004;Colonoscopy:24.3% vs 20.0% vs 3.3%,P = 0.001).Of the 25 malignant lesions detected,all but one was detected in exams judged appropriate or uncertain.CONCLUSION:This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations,namely in detecting neoplastic lesions.It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.     

Mortality of sick children after outpatient treatment at first-level health facilities in rural western Kenya

OBJECTIVES: (1) To determine whether mortality rates were raised in sick children in the 30 days after visiting first-level health facilities in an area under demographic surveillance in western Kenya, (2) to identify the types of illnesses associated with increased mortality and (3) to estimate the effectiveness of appropriate treatment. METHODS: All sick children (2-59 months of age) who attended one of the seven participating first-level health facilities from May to August 2003 were identified. A standardized mortality ratio was computed to compare their mortality rate in the 30 days after a sick visit with that of the community under active demographic and health surveillance. A multivariate Cox Proportional Hazards model was used to identify illnesses associated with death and to estimate the protective effectiveness of appropriate treatment for potentially life-threatening diseases. RESULTS: A total of 1383 eligible children made 1697 sick visits; 33 (2.4%) died within 30 days. Compared with children 2-59 months in the general population, sick children had a 5.3 times greater mortality rate [95% confidence interval (CI) 3.8-7.5]. In a multivariate survival analysis, significant risk factors for mortality included age <24 months [Hazard Ratio (HR) 4.4, 95% CI 1.5-12.6], malnutrition (HR 15.5, 95% CI 6.1-39.8), severe pneumonia (HR 12.9, 95% CI 3.0-56.4) and anaemia (HR 3.3, 95% CI 1.5-7.2). Appropriate treatment for a child's most severe illness reduced mortality by 78% (95% CI 57-89%). CONCLUSION: We estimate that improvements in diagnosis and appropriate treatment at first-level health facilities for children 2-59 months could reduce overall under-5 mortality in the area by 12-14%.