AbstractBackground:
The public health significance of injuries that occur in
developing countries is now recognized. In 1996, as part of the
injury surveillance registry in Kampala, Uganda, a new score,
the Kampala Trauma Score (KTS) was instituted. The KTS,
developed in light of the limited resource base of sub-Saharan
Africa, is a simplified composite of the Revised Trauma Score
(RTS) and the Injury Severity Score (ISS) and closely resembles
the Trauma Score and Injury Severity Score (TRISS).
Patients and
Methods:
The KTS was applied retrospectively to a cohort of
prospectively accrued urban trauma patients with the RTS, ISS
and TRISS calculated. Using ROC (receiver operating
characteristics) analysis, logistic regression models and
sensitivity and specificity cutoff analysis, the KTS was
compared to these three scores.
Results:
Using logistic regression models and areas under the ROC
curve, the RTS proved a more robust predictor of death at 2
weeks in comparison to the KTS. However, differences in
screening performance were marginal (areas under the ROC curves
were 87% for the RTS and 84% for the KTS) with statistical
significance only reached for an improved specificity (67% vs.
47%; p < 0.001), at a fixed sensitivity of 90%. In addition,
the KTS predicted hospitalization at 2 weeks more
accurately.
Conclusion:
The KTS statistically performs comparably to the RTS and
ISS alone as well as to the TRISS but has the added advantage of
utility. Therefore, the KTS has potential as a triage tool in
resource-poor and similar health care settings. 相似文献
Bivalirudin is indicated for use as an anticoagulant in patients with unstable angina undergoing percutaneous transluminal coronary angioplasty. Cases of intracoronary thrombosis have been reported with beta-radiation when bivalirudin is used as an anticoagulant. We report two cases of intracoronary thrombosis with gamma-radiation when bivalirudin is used. 相似文献
Background: Airway management is the first step in resuscitation. The extraordinary conditions in mass casualty situations impose special difficulties in airway management, even for experienced caregivers. The authors evaluated whether wearing surgical attire or antichemical protective gear made any difference in anesthetists' success of airway control with either an endotracheal tube or a laryngeal mask airway.
Methods: Fifteen anesthetists with 2-5 yr of residency and wearing either full antichemical protective gear or surgical attire intubated or inserted laryngeal masks in 60 anesthetized patients. The study was performed in a prospective, randomized, crossover manner. The duration of intubation/insertion was measured from the time the device was grasped to the time a normal capnography recording was obtained.
Results: Endotracheal tubes were introduced significantly (P < 0.01) faster when the anesthetist wore surgical attire (31 +/- 7 vs. 54 +/- 24 s for protective gear), but the mean times necessary to successfully insert laryngeal masks were similar (44 +/- 20 s for surgical attire vs. 39 +/- 11 s for protective gear). Neither performance failure nor incidences of hypoxemia were recorded. 相似文献
BACKGROUND: Statins improve cardiovascular outcome, but less is known on the renal outcome. We, therefore, studied the relationship between the use of statins and urinary albumin excretion (UAE) and glomerular filtration rate (GFR) in two settings: a randomized controlled trial (RCT) and an observational cohort study, in which patients were included to study the impact of an elevated UAE on renal and cardiovascular prognosis. METHODS: We used data from the Prevention of REnal and Vascular ENd-stage Disease Intervention trial (PREVEND-IT) and the PREVEND cohort study. The PREVEND-IT subjects (788 with a UAE 15-300 mg/day) received pravastatin 40 mg/day vs placebo and/or fosinopril 20 mg/day vs placebo in a 2x2 factorial-RCT design. Of the 3440 cohort subjects, 469 used statins during the 4-year follow-up period. Multivariate-regression adjusted for confounding factors and the propensity score was used to estimate the relation between statin use and UAE and GFR. RESULTS: In the RCT, pravastatin did not change UAE or GFR, neither in fosinopril yes/no subgroups. In the observational cohort, statin use was associated with a rise in UAE (+12.1%), compared with statin non-use (+3.6%, P<0.001). This rise was most pronounced in those on statins prior to the first screening [+24.8% (95% CI: 11.9-39.2)], those using statins>3 years [+18.5% (7.3-30.8)] and those with >1 or >2 defined daily doses (+15.7 and +17.3%, respectively). These differences remained significant after adjustment for relevant variables and propensity score. The rise in UAE could not be attributed to a higher dose or a specific statin. GFR fell in 4 years in both statin users and non-users (4.6+/-13.5 and 2.4+/-11.2, respectively). The fall in GFR between groups was not different after adjustment (P=0.11). CONCLUSIONS: We conclude from the RCT data that statins do not lower UAE in subjects selected because of an elevated UAE instead of hyperlipidaemia. In the observational cohort study, the use of statins similarly was not associated with a fall in UAE; UAE instead increased. Statin treatment was not associated with a significant change in GFR in these subjects with only modestly impaired GFR. 相似文献
Our initial cases of polyoma virus allograft nephropathy (PVAN) received pulse steroids due to anxiety about concomitant acute rejection triggered by the presence of tubulitis. However, our current policy is to reduce immunosuppression in all cases. The aim of this study was to determine whether clinical follow-up in these patient categories shows any differences in: (a) histologic viral load, (b) grade of tubulitis, and (c) graft function. Reduced viral load assessed within 8 weeks was seen in 4/20 (20.0%) biopsies treated initially by increased immunosuppression, compared to 15/19 (83.3%) biopsies treated with reduced immunosuppression (p = 0.001, Fisher's exact test). Yet, >70% reversal of the rise in serum creatinine occurred in only 3/19 (15.8%) and 1/19 (5.3%) patients, respectively, in these two groups. Improved tubulitis was seen in 11/20 (55%) of biopsies treated with steroids, despite the lack of beneficial effect on serum creatinine in 12/19 (63.1%) instances. In biopsies not treated with any change in immunosuppression, the serum creatinine remained stable in 1/5 (20%) and worsened in 4/5 (80%) biopsies. These data demonstrate that in biopsies with PVAN and tubulitis, reduced immunosuppression is more effective in lowering viral load than steroid therapy. Lack of parallelism between viral load, tubulitis grade, and serum creatinine illustrates a complex interplay of viral and alloimmune factors leading to graft injury. 相似文献
Abstract: This study identified illnesses Australians most feared getting, and determined whether there had been any changes between 1986 and 1993. An open-ended question about illnesses was embedded in an omnibus face-to-face survey of representative samples of Australians (1986, n = 1213; 1993, n = 1268). Cancer was by far the most feared illness, with over 60 per cent of first mentions and around 80 per cent of first or second mentions. Acquired immunodeficiency syndrome (AIDS) and heart disease were the only other illnesses mentioned by more than 10 per cent of the sample as the first or second most feared illness. There were no differences across time in first mentions of these illnesses, but cancer had more mentions overall in 1993. Concern about cancer may have increased over the seven years. Mentions of dementia and blindness also increased across the two surveys. 相似文献