Nocturnal emergency department visits, duration of symptoms and risk of hospitalisation among adults with asthma exacerbations: a multicentre observational study

Objectives: We sought to compare the characteristics of patients with asthma presenting to the emergency department (ED) during the night-time with those of patients presenting at other times of the day, and to determine whether the time of ED presentation is associated with the risk of hospitalisation. Design and setting A multicentre chart review study of 23 EDs across Japan. Participants: Patients aged 18–54 years with a history of physician-diagnosed asthma, presented to the ED between January 2009 and December 2011 Outcome measures The outcome of interest was hospitalisation, including admissions to an observation unit, inpatient unit and intensive care unit. Results: Among the 1354 patients (30.1% in the night-time group vs 69.9% in the other time group) included in this study, the median age was 34 years and ∼40% were male. Overall 145 patients (10.7%) were hospitalised. Patients in the night-time group were more likely to have a shorter duration of symptoms (≤3 hours) before ED presentation than those in the other time group (25.9% in night-time vs 13.4% in other times; p0.05). Similarly, the risk of hospitalisation did not differ between the two groups (11.3% in night-time vs 10.5% in other times; p=0.65). In a multivariable model adjusting for potential confounders, the risk of hospitalisation in the night-time group was not statistically different from the other time group (OR, 1.10; 95% CI 0.74 to 1.61; p=0.63). Conclusions: This multicentre study in Japan demonstrated no significant difference in the risk of hospitalisations according to the time of ED presentation

Isolated gestational proteinuria preceding the diagnosis of preeclampsia : an observational study

Introduction. Some pregnant women develop significant proteinuria in the absence of hypertension. However, clinical significance of isolated gestational proteinuria (IGP) is not well understood. This study aimed to determine the prevalence of IGP in singleton pregnancies and the proportion of women with IGP who subsequently developed preeclampsia (IGP-PE) among all PE cases. Material and methods. This was an observational study of 6819 women with singleton pregnancies at 12 centers, including 938 women with at least once determination of protein-to-creatinine ratio (P/Cr). Significant proteinuria in pregnancy (SPIP) was defined as P/Cr (mg/mg) level >0.27. IGP was defined as SPIP in the absence of hypertension. Gestational hypertension (GH) preceding preeclampsia (GH-PE) was defined as preeclampsia (PE) in which GH preceded SPIP. Simultaneous PE (S-PE) was defined as PE in which both SPIP and hypertension occurred simultaneously. Results. IGP and PE were diagnosed in 130 (1.9%) and 158 (2.3%) of 6819 women, respectively. Of 130 women with IGP, 32 (25%) progressed to PE and accounted for 20% of all women with PE. Hence, women with IGP had a relative risk of 13.1 (95% CI; 9.2-18.5) for developing PE compared with those without IGP [25% (32/130) vs. 1.9% (126/6689)]. At diagnosis of SPIP, P/Cr levels already exceeded 1.0 more often in women with S-PE than in those with IGP-PE [67% (33/49) vs. 44% (14/32), respectively, p = 0.031]. Conclusions. IGP is a risk factor for PE, and IGP-PE accounts for a considerable proportion (20%) of all PE

Antibiogram bakterije Escherichia coli i enterokoka izdvojenih iz goveđega izmeta na području Kafue u Zambiji

Antimicrobial resistance to a panel of ten agents was determined by the disc diffusion technique for 83 Escherichia coli isolates, 29 Enterococcus faecium isolates and 62 Enterococcus faecalis isolates from faecal samples of apparently healthy pastoral cattle in the wildlife/livestock interface areas. Of all the E. coli isolates, 8% were diarrhoeagenic E. coli strains, 6% were enteropathogenic E. coli strains and 2% were enterotoxigenic E. coli strains. A high frequency of E. coli resistance to penicillin, erythromycin, cotrimoxazole and nitrofurantoin was observed. Enterococci showed the highest percentage of resistance to gentamycin, amoxycillin, ampicillin and tetracycline. None of the E. coli strains and Enterococci strains was resistant to tetracycline and vancomycin respectively. The results of this study underscore the presence of an animal reservoir of antibiotic resistant microorganisms that have the potential to enter the food chain.Osjetljivost 83 izolata vrste Escherichia coli, 29 izolata vrste Enterococcus faecium i 62 izolata vrste Enterococcus faecalis izdvojenih iz uzoraka izmeta klinički zdravih goveda u području dodira domaćih i divljih životinja, određena je difuzijskim postupkom prema deset antimikrobnih pripravaka. Od ukupno izdvojenih, 8% sojeva bakterije E. coli bilo je dijarejogeno, 6% enteropatogeno i 2% enterotoksigeno. Ustanovljena je česta otpornost vrste E. coli prema penicilinu, eritromicinu, kotrimoksazolu i nitrofurantoinu. Enterokoki su u najvećem postotku bili otporni prema gentamicinu, amoksicilinu, ampicilinu i tetraciklinu. Nijedan od izolata E. coli nije bio otporan prema tetraciklinu, a nijedan od enterokoka nije bio otporan prema vankomicinu. Rezultati istraživanja upućuju na postojanje životinjskoga rezervoara bakterija otpornih na antibiotike za koje postoji mogućnost da se prenesu u ljudski prehrambeni lanac

The QT Intervals in Infancy and Time for Infantile ECG Screening for Long QT Syndrome

Background: Electrocardiographic and molecular studies have clarified an association between sudden infant death syndrome (SIDS) and long QT syndrome (LQTS), and few data are available for the QT interval in infancy from birth to 1 year of age. Appropriate time of electrocardiographic screening is not clarified. Medical examinations during infancy are mandatory in Japan.Methods and Results: The study population included 1,058 infants. Electrocardiograms were collected with information of infants at birth and at examination. The QT intervals of three consecutive beats were measured in lead V5. Statistical analysis revealed that the following formula was appropriate to minimize the effect of heart rate for infants: corrected QT interval; QTc = QT interval/RR interval 0.43. Subjects were divided into four groups as follows: 0–2, 3–6, 6–11, and 12–52 weeks of age. Tukey's multiple comparison showed that the QTc intervals were longest (p < 0:0001) in subjects who were 6–11 weeks of age.Conclusions: The QTc interval showed the highest peak at 6-11 weeks of age in infancy. The peak period of occurrence of SIDS is at approximately 2 months of age. An appropriate time of electrocardiographic screening for QT prolongation will be one month of age, and follow-up studies are needed

Rapid Detection of Salmonella on Commercial Carcasses by Using Isothermal and Chimeric Primer- Initiated Amplification of Nucleic Acids (ICAN)-Enzyme-Linked Immunosorbent Assay (ELISA) in Zambia

KEY WORDS: S a l m o n e l l a, isothermal and chimeric primer, enzyme-linked immunosorbent assay (ELISA), Zambia ABSTRACT S a l m o n e l l a infections in human population belong to the most important foodborne zoonoses in the world. Therefore, studies on rapid methods for detection of S a l m o n e l l a in animal-derived foods and ready-to-eatfoods are needed. We describe a 2-step method using isothermal and chimeric Inter