A cross-sectional study of child injury ambulance call-out characteristics and their utility in surveillance

Background: Injuries are a leading cause of death and ill-health in children. Aims: To explore the potential utility of ambulance call-out data in understanding the burden and characteristics of child injury. Methods: A cross-sectional examination was carried out of injury-related ambulance call-outs to children aged 0–14 years in the north west of England between April 2016 and March 2017. Findings: The majority of the 16 285 call-outs were for unintentional injuries (91.4%), with falls the most prevalent injury type (38.4%). The incidence of child injury ambulance call-outs peaked at age 1 year (233.4 per 10 000 population). Burns in children aged 5–9 years were significantly higher at weekends (P=0.003) and on celebration days (P=0.001); poisoning in 10–14 year-olds were significantly higher at weekends (P=0.001); and traffic injuries were significantly lower at weekends in 0–4 year-olds (P=0.009) and 10–14 year-olds (P=0.003). Conclusion: Ambulance call-out data can provide epidemiological support in examining the characteristics of child injury and identifying at-risk groups

The incidence and management of tolerance in intrathecal baclofen therapy

Study design: Retrospective study. Objectives: To study the incidence and management of tolerance in patients treated with intrathecal baclofen (ITB) therapy. Setting: Department of neurology and neurosurgery, University Medical Center Groningen, The Netherlands. Methods: Medical records of all patients who had received an implantable ITB pump at our clinic during 1991-2005 were reviewed. Results: A total of 37 patients (representing 116 pump years) were included. Mean follow-up time was 38 months (range 3-120 months). Baclofen dose increased in the first 18 months after implantation (P 100 mu g per year. No predictive factors for development of tolerance could be determined. Three different treatment regimens for tolerant patients were analyzed. Altering the infusion mode from simple to complex continuous (n = 6) had no effect on the development of tolerance. Pulsatile bolus infusion (n = 1) and a drug holiday (n = 2) were both effective in reducing the daily baclofen dose. Patients who needed surgical revision of the pump system because of mechanical failures (n = 11) showed a significant dose decrease during the first month after revision, indicating that the preoperative dose increase most likely had been caused by the pump failure. Pump-related complications occurred once per 10.5 years of ITB treatment. Drug-related side effects had an annual risk of 13.8%. The reported events were mostly mild. Conclusions: ITB therapy is effective and safe, also in the long term and causes tolerance in only 22% of the treated patients. Spinal Cord (2009) 47, 751-756; doi: 10.1038/sc.2009.34; published online 31 March 200

Evento com aparente risco de morte: uma revisão Evento con aparente riesgo de muerte (alte): una revisión Apparent life-threatening event: a review

OBJETIVO: Realizar uma revisão crítica reunindo informações disponíveis a respeito dos eventos com aparente risco de morte. FONTES DE DADOS: Revisão bibliográfica dos artigos (em português, inglês e espanhol) obtidos dos bancos de dados eletrônicos Medline, Lilacs e SciELO, utilizando as palavras-chave: eventos com aparente risco de morte, evento com aparente risco de vida infantil, lactente, apneia, monitorização e cianose. SÍNTESE DOS DADOS: Os eventos com aparente risco de mortesão súbitos e caracterizados por uma combinação de apneia, alteração na coloração da pele e tônus muscular, com inúmeras causas subjacentes. Sua incidência verdadeira é desconhecida e a faixa etária mais acometida é de 11 a 12 semanas. Não há correlação entre o evento com aparente risco de morte e a síndrome da morte súbita do lactente, embora já tenham sido consideradas manifestações da mesma doença. Muitas vezes, o lactente tem aparência saudável ao ser avaliado pelo pediatra após apresentar eventos com aparente risco de morte, porém, isso não afasta a possibilidade de existir uma doença grave associada ao evento, que deve ser investigada e tratada. Quando não são encontradas as causas, o evento é idiopático, geralmente com boa evolução. CONCLUSÕES: É necessário investigar os lactentes levados ao pronto-socorro após apresentarem eventos com aparente risco de morte, devido ao risco de sequelas e mortalidade. Não há uma padronização das condutas a serem realizadas diante de um lactente com aparência saudável que tenha evento com aparente risco de morte, mas recomenda-se que o paciente seja internado e a causa do evento, investigada. A observação e o monitoramento em ambiente hospitalar devem ocorrer no mínimo 24 horas após o evento.<br>OBJETIVO: Realizar una revisión crítica, reuniendo las informaciones disponibles respecto a los Eventos con Aparente Riesgo de Muerte (ALTE - Apparent life-threatening event). FUENTES DE DATOS: Revisión bibliográfica de los artículos (en portugués, inglés y español) obtenidos de las bases de datos electrónicas MEDLINE, LILACS y SCIELO, utilizándose las palabras clave ALTE, evento con aparente riesgo de vida infantil, lactante, apnea, monitorización y cianosis. SÍNTESIS DE LOS DATOS: Los ALTE (apparent life-threatening event) son eventos súbitos y caracterizados por una combinación de apnea, alteración en la coloración de la piel y tono muscular, con innúmeras causas subyacentes. Su incidencia verdadera es desconocida y la franja de edad más acometida es de 11 a 12 semanas. No hay correlación entre ALTE y SIDS (Síndrome de la Muerte Súbita del Lactante), aunque ya hayan sido consideradas manifestaciones de la misma enfermedad. Muchas veces, el lactante tiene apariencia sana al ser evaluado por el pediatra después de presentar ALTE, pero eso no aleja la posibilidad de que exista una enfermedad grave asociada al evento, la cual se debe investigar y tratar. Cuando no se encuentran causas, el evento es idiopático, generalmente con buena evolución. CONCLUSIONES: Es necesario investigar los lactantes llevados a la emergencia después de presentar ALTE, por riesgo de secuelas y de mortalidad. No hay una estandarización de las conductas a tomar frente a un lactante con apariencia sana que presentó ALTE, pero se recomienda que se interne el paciente y se investigue la causa del evento. La observación y monitoración en ambiente hospitalaria debe ocurrir por un mínimo de 24 horas después del evento.<br>OBJECTIVE: To perform a critical review by gathering all the available information about apparent life-threatening events. DATA SOURCES: Bibliographic review of the articles published in Portuguese, English and Spanish from the electronic databases Medline, Lilacs and SciELO, using the key-words: apparent life-threatening events, apparent life-threatening event, infant, apnea, monitoring, and cyanosis. DATA SYNTHESIS: Apparent life-threatening events define sudden events with, a combination of apnea, color change, and marked change in the muscle tone, that have various underlying causes. The real incidence remains unknown, and it affects infants from 11 to 12 weeks of age. There is no association between apparent life-threatening events and sudden infant death syndrome. There are many possible causes for the events, and they must be investigated even in apparently healthy infants, because the presence of a severe underlying disease associated with the event is possible. If the cause of the apparent life-threatening events is found, it must be treated properly. If there is no explainable cause, the event is considered idiopathic and generally has a benign course. CONCLUSIONS: It is necessary to investigate all the infants taken to the pediatric emergency unit after experiencing an apparent life-threatening event, since there is the risk of morbidity caused by an underlying disease or the event itself, as well as subsequent mortality. Consensus guidelines about the investigation in apparently healthy infants who experienced apparent life-threatening events are not available. Most authors recommend that careful observation and hospital monitoring should be performed for at least for 24 hours after the event

Nitrate and nitrite in biology, nutrition and therapeutics

Inorganic nitrate and nitrite from endogenous or dietary sources are metabolized in vivo to nitric oxide (NO) and other bioactive nitrogen oxides. The nitrate-nitrite-NO pathway is emerging as an important mediator of blood flow regulation, cell signaling, energetics and tissue responses to hypoxia. The latest advances in our understanding of the biochemistry, physiology and therapeutics of nitrate, nitrite and NO were discussed during a recent 2-day meeting at the Nobel Forum, Karolinska Institutet in Stockholm