Emergency Department Septic Screening in Respiratory Syncytial Virus (RSV) and Non-RSV Bronchiolitis

Objective: To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.Methods: We reviewed an existing study database of patients with bronchiolitis. We defined a positive EDSS as urine with ≥10 WBC per high power field or cerebrospinal fluid (CSF) with ≥10 WBC per high power field (>25 WBC in neonates), or if organisms were identified on gram stain. We defined SBI as significant growth of an accepted pathogen in blood, urine or CSF. Our composite endpoint was positive if either of these was positive. The decision to perform testing was modeled using modified Poisson regression; the presence of the combined outcome was modeled using logistic regression modified for rare events.Results: We studied 640 children. Testing was performed in 199/640 (31.1%). These tended to be younger than two months RR 2.69 (95% CI 2.11, 3.44), febrile RR 2.01 (95% CI 1.58, 2.55), more dehydrated RR 1.50 (95% CI 1.28, 1.75) and had more severe chest wall retractions RR 1.54 (95% CI 1.22, 1.94). Only 11/640(1.7%) had a positive EDSS or SBI. Younger age (OR 0.67 per month; 95% CI 0.45, 0.99) and a negative RSV antigen test (OR 6.22; 95% CI 1.30, 29.85) were associated with the composite endpoint.Conclusion: Testing was more likely to be performed in children younger than two months of age, and in those who were febrile, dehydrated, and had more severe chest wall retractions. A positive EDSS or SBI was rare occurring in younger infants with non-RSV bronchiolitis. [West J Emerg Med. 2010; 11(1):60-67]

Olfactory function following open rhinoplasty: A 6-month follow-up study

<p>Abstract</p> <p>Background</p> <p>Patients undergoing any type of nasal surgery may experience degrees of postoperative olfactory dysfunction. We sought to investigate "when" the olfactory function recovers to its preoperative levels.</p> <p>Methods</p> <p>In this cohort design, 40 of 65 esthetic open rhinoplasty candidates with equal gender distribution, who met the inclusion criteria, were assessed for their olfactory function using the Smell Identification Test (SIT) with 40 familiar odors in sniffing bottles. All the patients were evaluated for the SIT scores preoperatively and postoperatively (at week 1, week 6, and month 6).</p> <p>Results</p> <p>At postoperative week one, 87.5% of the patients had anosmia, and the rest exhibited at least moderate levels of hyposmia. The anosmia, which was the dominant pattern at postoperative week 1, resolved and converted to various levels of hyposmia, so that no one at postoperative week 6 showed any such complain. At postoperative week six, 85% of the subjects experienced degrees of hyposmia, almost all being mild to moderate. At postoperative six month, the olfactory function had already reverted to the preoperative levels: no anosmia or moderate to severe hyposmia. A repeated ANOVA was indicative of significant differences in the olfactory function at the different time points. According to our post hoc Benfronney, the preoperative scores had a significant difference with those at postoperative week 1, week 6, but not with the ones at month 6.</p> <p>Conclusion</p> <p>Esthetic open rhinoplasty may be accompanied by some degrees of postoperative olfactory dysfunction. Patients need a time interval of 6 weeks to 6 months to fully recover their baseline olfactory function.</p

Side Effects of Intravenous Streptokinase in Different Age Groups Patients with Acute Myocardial Infarction

Abstract Background & aim: Myocardial infarction is one of the most common cardiovascular diseases. Streptokinase is used in patients with myocardial infarction with ST-segment elevation. The aim of this study was to compare the side effects of intravenous streptokinase in acute myocardial infarction patients in different age groups. Methods: In the present analytic descriptive study, the samples included 100 eligible patients which received intravenous streptokinase. The research instrument was a questionnaire consisting of two parts: the first part was used to measure the underlying data and the second part to evaluate the side effects of intravenous streptokinase,. Data were analyzed by chi-square statistical tests. Results: There were no significant adverse events between intravenous streptokinase and different age groups ((P>0.05).). The most common side effects of this drug were cardiovascular complications in different age groups. Conclusion: the use of streptokinase intravenous drug in different age groups is associated with risk of cardiovascular complications. Key words: age, side effects, streptokinase, acute myocardial infarction, thrombolytic therapy, ST elevatio

Emergency Department Septic Screening in Respiratory Syncytial Virus (RSV) and Non-RSV Bronchiolitis

Objective: To identify factors associated with culture-proven serious bacterial infection (SBI) and positive emergency department septic screening (EDSS) tests in children with bronchiolitis and to identify factors associated with the performance of EDSS.Methods: We reviewed an existing study database of patients with bronchiolitis. We defined a positive EDSS as urine with ≥10 WBC per high power field or cerebrospinal fluid (CSF) with ≥10 WBC per high power field (&gt;25 WBC in neonates), or if organisms were identified on gram stain. We defined SBI as significant growth of an accepted pathogen in blood, urine or CSF. Our composite endpoint was positive if either of these was positive. The decision to perform testing was modeled using modified Poisson regression; the presence of the combined outcome was modeled using logistic regression modified for rare events.Results: We studied 640 children. Testing was performed in 199/640 (31.1%). These tended to be younger than two months RR 2.69 (95% CI 2.11, 3.44), febrile RR 2.01 (95% CI 1.58, 2.55), more dehydrated RR 1.50 (95% CI 1.28, 1.75) and had more severe chest wall retractions RR 1.54 (95% CI 1.22, 1.94). Only 11/640(1.7%) had a positive EDSS or SBI. Younger age (OR 0.67 per month; 95% CI 0.45, 0.99) and a negative RSV antigen test (OR 6.22; 95% CI 1.30, 29.85) were associated with the composite endpoint.Conclusion: Testing was more likely to be performed in children younger than two months of age, and in those who were febrile, dehydrated, and had more severe chest wall retractions. A positive EDSS or SBI was rare occurring in younger infants with non-RSV bronchiolitis. [West J Emerg Med. 2010; 11(1):60-67]