Prevalence of systemic inflammatory response syndrome (SIRS) in hospitalized children: a point prevalence study

<p>Abstract</p> <p>Background</p> <p>In accordance with the 1st International pediatric sepsis consensus conference, where sepsis was defined as SIRS associated with suspected or proven infection, we have identified the need to assess the prevalence of SIRS and sepsis in children with abnormal temperatures hospitalized in The Children's Clinical University Hospital in Latvia.</p> <p>Methods</p> <p>A descriptive prospective point prevalence study (using two time periods, each 24 h, randomly chosen) was conducted on all children (n = 943) treated in the hospital. All children with abnormal temperatures – fever or hypothermia (n = 92) – were included in the study. Questionnaires evaluating age-specific SIRS criteria were completed. The prevalence of SIRS was detected with 95% CI.</p> <p>Results</p> <p>Out of a total of 943 patients treated in the hospital, 10% (n = 92) had abnormal temperatures. In all these cases the abnormal temperature was a fever; hypothermia was not established in any patient. Of the children with fever, 72% (n = 66) had SIRS. Of the SIRS patients, 8% (n = 5) developed sepsis, 5% (n = 3) severe sepsis and 2% (n = 1) septic shock. Seventy-six percent (n = 50) of the SIRS patients had fever in combination with respiratory rate >2 SD above normal for age; 50% (n = 33) had fever with abnormal leukocyte count; 15% (n = 10) had fever with tachycardia >2 SD above normal for age. Most of the SIRS patients (39%, n = 25) were aged 2–5 years. Twenty-one percent (n = 14) of the children with SIRS and 50% (n = 2) of those with severe sepsis and septic shock had an underlying disease. In no case was SIRS and sepsis recognized by doctors and the diagnoses were not recorded on the patients' cards.</p> <p>Conclusion</p> <p>Our results would indicate a high risk for sepsis development in children with SIRS. Early SIRS diagnosis and awareness of risk of developing sepsis could change the medical approach to the patient in everyday clinical practice, eventually leading to early, goal-directed therapy for sepsis.</p

Transport of small anionic and neutral solutes through chitosan membranes: Dependence on cross-linking and chelation of divalent cations

Chitosan membranes were prepared by solvent casting and cross-linked with glutaraldehyde at several ratios under homogeneous conditions. The cross-linking degree, varying from 0 to 20%, is defined as the ratio between the total aldehyde groups and the amine groups of chitosan. Permeability experiments were conducted using a side-by-side diffusion cell to determine the flux of small molecules of similar size but with different chemical moieties, either ionized (benzoic acid, salicylic acid, and phthalic acid) or neutral (2-phenylethanol) at physiological pH. The permeability of the different model molecules revealed to be dependent on the affinity of those structurally similar molecules to chitosan. The permeability of the salicylate anion was significantly enhanced by the presence of metal cations commonly present in biological fluids, such as calcium and magnesium, but remained unchanged for the neutral 2-phenylethanol. This effect could be explained by the chelation of metal cations on the amine groups of chitosan, which increased the partition coefficient. The cross-linking degree was also correlated with the permeability and partition coefficient. The change in the permeation properties of chitosan to anionic solutes in the presence of these metallic cations is an important result and should be taken into consideration when trying to make in vitro predictions of the drug release from chitosan-based controlled release systems

Evolution of anaesthesia care and related events between 1996 and 2010 in a developed country

Background: Anaesthesia Databank Switzerland (ADS) is a voluntary data registry introduced in 1996. The goal was to promote quality in anaesthesiology. Methods: Analysis of routinely recorded adverse events. Internal and external benchmark comparisons between anaesthesia departments. Results: In 2010, the database included 2'158'735 anaesthetic procedures. Forty-four anaesthesia departments were participating to the data collection in 2010. Over time, the number of patients in older age groups increased, the largest group being patients aged 50 to 64 years. Over time, the percentage of patients with ASA physical status score 1 decreased while the number of ASA 2 or 3 patients increased. The most frequent co-morbidities were hypertension (21%), smoking (16%), allergy (15%), and obesity (12%). Between 1996 and 2010, 146'459 adverse events were recorded, of which 34% were cardiovascular, 7% respiratory, 39% specific to anaesthesia and 17% nonspecific. The overall proportion of adverse events decreased over time, whatever their severity. Conclusion: The ADS routine data collection contributes to monitoring the trends of anaesthesia care in Switzerland

La micropolyangéite: une histoire souvent en deux temps. [Microscopic polyangiitis: an unusual case report]

A 56-year-old woman was referred to our hospital because persistence of fever and inflammatory syndrome after antibiotic treatment for pneumonia. In the past, no special feature. Physical examination revealed only--at first--a pneumonia. Two weeks after, associated with the cough, she developed an acute renal failure. The laboratory revealed an inflammatory syndrome associated with proteinuria, hematuria and anti-neutrophil cytoplasmic antibodies. The CT of thorax shows aspecific infiltrations. The renal biopsy, in the context of the patient, diagnosed an microscopic polyangiitis. All the symptom resolved with the initiation of corticoid and cyclophosphamide treatment

Influence of patient's dressing on spontaneous physical activity and length of hospital stay in surgical patients

Wearing hospital gown (HG) as opposed to plain-clothes (PC) may contribute to the general state of inactivity of hospitalised patients. We designed a randomized study to determine the influence of clothing on the level of spontaneous physical activity (SPA) and to assess the length of hospital stay. Using triaxial accelerometry we measured the SPA in two groups of surgical patients, before and after an elective operation. Twenty eight patients received instructions to wear plain-clothes (group PC) during their stay in the hospital as soon as possible from a surgical point of view. Twenty-nine patients, serving as a control group, did not receive any specific instructions and as a result, were mostly wearing hospital gowns (group HG). Following the admission to the hospital, both groups showed a 50% decrease in SPA when compared to the recordings obtained during the last 24 hours spent at home. During the postoperative period, the SPA increased progressively in both groups. Although patients in group PC tended to be more active than those in the control group, the SPA was not significantly different (P = 0.4). Similarly, patients in group PC left the hospital 10 hours earlier than patients in group HG (P = 0.4). The power of our study was nevertheless low and a sample size of 700 patients might show statistically significant results. We conclude that wearing plain-clothes when hospitalized for elective surgery is not associated with complications and could be included in postoperative rehabilitation program