Therapeutic procedures and use of alternating antipyretic drugs for fever management in children

AbstractObjectiveThe evidence on the effectiveness of alternating antipyretics in fever management is scarce and indicates clinically negligible differences. The present study aimed to describe therapeutic procedures and the use of alternating antipyretics in children, and to evaluate associated factors.MethodsThis was a cross-sectional study with 692 children aged 0 to 6 years, living in Southern Brazil. Household interviews of the children's caregivers were conducted through cluster sampling using a structured questionnaire. A descriptive analysis was carried out, and the association between the use of alternating antipyretics and sociodemographic factors was evaluated. A total of 630 cases were analyzed (91.0%), corresponding to children with a history of fever.ResultsApproximately 73% of caregivers reported that the first measure adopted during the last fever episode was the administration of medication. The mean temperature considered as fever by caregivers was 37.4°C, and as high fever, 38.7°C. The use of alternating antipyretic therapy was reported by 26.7% of respondents, justified by the lack of response to monotherapy and medical indication, in most cases. The drugs most often used were dipyrone and paracetamol. Children whose primary caregiver was a parent with higher socioeconomic status and higher educational level received more alternating medications. Approximately 70% of the doses used were below the minimum recommended dose for the treatment of fever.ConclusionsThe use of medication to control fever is a common practice, including alternating antipyretic regimens. Most caregivers consider as fever temperatures lower than those established and they reported lack of response to monotherapy and medical indication as the main reasons for alternating medication

Lesser than diabetes hyperglycemia in pregnancy is related to perinatal mortality: a cohort study in Brazil

Results: We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Odds of dying increased according to glucose levels, statistically significantly so only for women delivering at gestational age ≥34 weeks (p < 0.05 for glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02). The adjusted OR for IADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria gestational diabetes, 3.10 (95% CI 1.39, 6.88). Conclusions: In settings of limited detection and treatment of gestational diabetes mellitus, women across a spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with increasing levels of glycemia after 34 weeks of pregnancy. Current GDM diagnostic criteria identified this increased risk of mortality

Alloantibodies, Anti-D, Childbearing age, Women, Cameroon

We conducted a cross sectional retrospective study to determine anti-D and D-negative phenotype rates among Cameroonian women of reproductive age (15 – 44 years), in order to evaluate the importance ofD alloimmunization. Analysis of the haematology laboratory records from January 2006 to December 2007 harvested 225 results for red blood cell alloantibody screening and 2460 D phenotypes. Anti-D rate was found to be high at 4% and not linked to women’s parity. Three hundred and fifty two (14.3%) women were found to be D-negative. Anti-D rates significantly decreased with age from 18.8% among teenagers (15-19) to 7.8% among older women (35-44) (p = 0.001). The number of women submitted to both irregular antibody screening and type D phenotype determination was not strong enough (50) to analyse the link between anti-D rate and antigen D distribution in our study (Afr J Reprod Health 2009; 13[3]:47-52)

Skeletopy of the intumescentia lumbalis and conus medullaris applied to epidural anaesthesia in Leopardus geoffroyi

Background: Leopardus geoffroyi is a Neotropical wild felid with wide distribution in the south of the South American continent. The objective was to investigate the skeletopy of the intumescentia lumbalis (IL) and conus medullaris (CM) from 11 specimens of L. geoffroyi collected dead on highways. Materials and methods: The cadavers were fixed in formaldehyde solution and dissected to allow the dorsal exposure of IL and CM. The cranial and caudal limits were marked with radiopaque pins and radiographic projections were used to determine the skeletopy. The lengths of IL and CM were measured with a pachymeter. Results: In most specimens, the IL was located at the level of L4 and L5 vertebrae, although in 4 (1 male and 3 females) individuals its cranial limit was L3 and in 3 specimens (2 male and 1 female) the caudal limit was L6. The length of IL was 35.6 ± 6.7 mm. The CM had its base predominantly at the level of the L5 vertebra, although in some specimens the base was in L4 and in others in L6. The apex of the CM can be found since the lumbosacral junction until the level of the Cd2 vertebra. The CM measured 74.4 ± 14.3 mm. Conclusions: Based on the skeletopy, it can be suggested that epidural anaesthesia procedures in L. geoffroyi are safer with the introduction of the catheter through the sacrocaudal interarcual space, as recommended by some anaesthetists for the domestic cat

The Analyticity of a Generalized Ruelle's Operator

In this work we propose a generalization of the concept of Ruelle operator for one dimensional lattices used in thermodynamic formalism and ergodic optimization, which we call generalized Ruelle operator, that generalizes both the Ruelle operator proposed in [BCLMS] and the Perron Frobenius operator defined in [Bowen]. We suppose the alphabet is given by a compact metric space, and consider a general a-priori measure to define the operator. We also consider the case where the set of symbols that can follow a given symbol of the alphabet depends on such symbol, which is an extension of the original concept of transition matrices from the theory of subshifts of finite type. We prove the analyticity of the Ruelle operator and present some examples

Nível de conhecimento sobre a composição de analgésicos com ácido acetilsalicílico

OBJECTIVE: To evaluate the knowledge of the generic designation, use and composition of analgesic medications containing aspirin. METHODS: A total of124 interviews were carried out between December 1999 and January 2000, in two neighborhoods of the city of Porto Alegre, southern Brazil. The interview was held with the person who came to answer the door at each of the homes that was drawn. The data collection instruments comprised a set of five different pharmaceutical specialties containing acetylsalicylic acid , and an interview consisting of two open questions concerning the differences and similarities between the products. RESULTS: Three major knowledge-level groups were characterized on the basis of the information that the interviewees were able to provide. The group that was knowledgeable about the matter comprised 14 individuals (11%). The group with limited knowledge contained 61 people (49)%. Those who had no knowledge of the matter at all formed a group of 49 people (40%). CONCLUSIONS: Taking the results as a whole, they indicate that most people (about 90% of the sample investigated) are simply not aware of what the active substance is, even in pharmaceutical specialties that they use frequently.OBJETIVO: Avaliar o conhecimento sobre a designação genérica, uso e composição de medicamentos analgésicos contendo ácido acetilsalicílico. MÉTODOS: Foram realizadas 124 entrevistas entre dezembro de 1999 e janeiro de 2000, em dois bairros da cidade de Porto Alegre, RS. As entrevistas foram respondidas pela pessoa que atendeu o entrevistador em cada um dos domicílios sorteados. Os instrumentos de coleta de dados foram uma cartela com cinco especialidades farmacêuticas de analgésicos contendo ácido acetilsalicílico e uma entrevista com duas perguntas abertas sobre diferenças e semelhanças entre os produtos. RESULTADOS: A partir do nível de informação demonstrado pelos entrevistados, foram caracterizados três grandes grupos de conhecimento. O grupo das pessoas que demonstraram domínio sobre o assunto foi de 14 indivíduos (11%); os que demonstraram domínio limitado foi de 61 pessoas (49%); e os que não demonstraram domínio sobre o assunto formaram um grupo de 49 pessoas (40%). CONCLUSÕES: Considerando o conjunto de resultados, verificou-se que a maioria das pessoas (cerca de 90% na amostra avaliada) simplesmente desconhece qual a substância ativa presente em uma especialidade farmacêutica de seu uso freqüente

Bulas de medicamentos e a informação adequada ao paciente

OBJECTIVE: To investigate the adequacy of the content and format of the patient information section in package inserts of commonly prescribed drugs at the internal medicine service of a school hospital. METHODS: Forty eight package inserts were collected from six pharmacies of the city of Porto Alegre in June 1998. The presence of mandatory notification and other information required by Brazilian laws that regulate inserts content was examined. RESULTS: No one package inserts contained all the notification required by law. Warnings about medication storage and expiration date were the most frequently information found in package inserts analyzed. CONCLUSION: Important information for the drug user was not presented in package inserts analyzed, limiting the purpose of inserts as an instrument for patient education.OBJETIVO: Avaliar a adequação da forma e conteúdo da seção de "informações ao paciente" das bulas de medicamentos, freqüentemente prescritos no ambulatório de medicina interna de um hospital universitário. MÉTODOS: Foram selecionadas 48 bulas disponíveis em três redes de farmácia e três farmácias de pequeno porte de Porto Alegre, em junho de 1998. Por meio de um formulário, foi verificada a presença de frases de formato padronizado e outras informações exigidas pela Portaria 110, que regulamenta o conteúdo das bulas de medicamentos. RESULTADOS: Em nenhuma das bulas analisadas foi verificada a presença de todas as frases e demais informações exigidas pela legislação. Cuidados com o armazenamento e com o prazo de validade dos medicamentos foram as informações mais freqüentemente apresentadas nas bulas analisadas. CONCLUSÕES: Ausência de informações importantes para o usuário, sobre o medicamento nas bulas, reduz o seu valor enquanto material educativo para o paciente

Initial impact and cost of a nationwide population screening campaign for diabetes in Brazil: A follow up study

<p>Abstract</p> <p>Background</p> <p>In 2001 Brazilian citizens aged 40 or older were invited to participate in a nationwide population screening program for diabetes. Capillary glucose screening tests and procedures for diagnostic confirmation were offered through the national healthcare system, diagnostic priority being given according to the severity of screening results. The objective of this study is to evaluate the initial impact of the program.</p> <p>Methods</p> <p>Positive testing was defined by a fasting capillary glucose ≥ 100 mg/dL or casual glucose ≥ 140 mg/dL. All test results were tabulated locally and aggregate data by gender and clinical categories were sent to the Ministry of Health. To analyze individual characteristics of screening tests performed, a stratified random sample of 90,106 tests was drawn. To describe the actions taken for positive screenees, a random sub-sample of 4,906 positive screenees was actively followed up through home interviews.</p> <p>Main outcome measures considered were the number of diabetes cases diagnosed and cost per case detected and incorporated into healthcare.</p> <p>Results</p> <p>Of 22,069,905 screening tests performed, we estimate that 3,417,106 (95% CI 3.1 – 3.7 million) were positive and that 346,168 (290,454 – 401,852) new cases were diagnosed (10.1% of positives), 319,157 (92.2%) of these being incorporated into healthcare. The number of screening tests needed to detect one case of diabetes was 64. As many cases of untreated but previously known diabetes were also linked to healthcare providers during the Campaign, the estimated number needed screen to incorporate one case into the healthcare system was 58. Total screening and diagnostic costs were US$26.19 million, the cost per diabetes case diagnosed being US$ 76. Results were especially sensitive to proportion of individuals returning for diagnostic confirmation.</p> <p>Conclusion</p> <p>This nationwide population-based screening program, conducted through primary healthcare services, demonstrates the feasibility, within the context of an organized national healthcare system, of screening campaigns for chronic diseases. Although overall costs were significant, cost per new case diagnosed was lower than previously reported. However, cost-effectiveness analysis based on more clinically significant outcomes needs to be conducted before this screening approach can be recommended in other settings.</p