Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a Pediatric emergency room Impacto do uso da prova rápida para estreptococo beta-hemolítico do grupo A no diagnóstico e tratamento da faringotonsilite aguda em pronto-socorro de PediatriaImpacto del uso de la prueba rápida para estreptococos beta-hemolíticos del grupo A en el diagnóstico y tratamiento de la faringotonsilitis en emergencia de Pediatría Conclusões: O diagnóstico clínico da faringotonsilite estreptocócica mostrou baixa sensibilidade e especificidade. O uso rotineiro da prova rápida para pesquisa de estreptococo permitiu a redução do uso de antibióticos e a identificação de um grupo de risco para as complicações da infecção estreptocócica, pois 42,5% dos pacientes com prova rápida positiva não receberiam antibióticos, se levado em consideração apenas o diagnóstico clínico.Palavras-chave: tonsilite/diagnóstico; Streptococcus grupo A; criança; adolescente. RESUMENObjetivo: Evaluar el impacto de la realización de rutina de la prueba rápida para investigación de estreptococos del grupo A en el diagnóstico y tratamiento de la faringotonsilitis aguda en niños.Métodos: Estudio prospectivo y observacional que contó con el uso de protocolo de investigación establecido en la Unidad de Emergencia del Hospital Universitario de la USP para la atención a niños y adolescentes con faringotonsilitis aguda.Resultados: Con base en la evaluación crítica, de los 650 pacientes estudiados, antimicrobianos serían prescritos a 389 individuos (59,8%) y, con el uso de la investigación de estreptococos del grupo A se los prescribieron a 286 pacientes (44,0%). De los 261 niños que no recibirían antibióticos por el cuadro clínico, 111 (42,5%) tuvieron investigación de estreptococos del grupo A positiva. El diagnóstico basado en el cuadro clínico presentó sensibilidad del 61,1%, especificidad del 47,7%, valor predictivo positivo del 44,9% y valor predictivo negativo del 57,5%, Conclusiones: En este estudio, el diagnóstico clínico de la faringotonsilitis estreptocócica mostró baja sensibilidad y especificidad. El uso de rutina de la prueba rápida para investigación de estreptococos permitió la reducción del uso de antibióticos y la identificación de un grupo de riesgo para las complicaciones de la infección estreptocócica, pues el 42,5% de los pacientes con prueba rápida positiva no recibirían antibióticos si se llevara en consideración solamente el diagnóstico clínico.Palabras clave: tonsilitis/diagnóstico; estreptococos del grupo A; niño; adolescente.
Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection. J Pediatr (Rio J)
<abstract><p>In this work we use simple mathematical models to study the impact of vaccination against COVID-19 in Portugal. First, we fit a SEIR type model without vaccination to the Portuguese data on confirmed cases of COVID-19 by the date of symptom onset, from the beginning of the epidemic until the 23rd January of 2021, to estimate changes in the transmission intensity. Then, by including vaccination in the model we develop different scenarios for the fade-out of the non pharmacological intervention (NPIs) as vaccine coverage increases in the population according to Portuguese vaccination goals. We include a feedback function to mimic the implementation and relaxation of NPIs, according to some disease incidence thresholds defined by the Portuguese health authorities.</p></abstract>
We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 -odds ratio) x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). Conclusion:The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.
Em estudo aberto e prospectivo, avaliou-se, em crianças com infecção urinária (IU) complicada, a eficácia de esquema terapêutico ambulatorial com ceftriaxona, intramuscular, dose única diária-50 a 70 mg/kg, durante 8 a 10 dias. Os pacientes, selecionados inicialmente, apresentavam pelo menos 2 dos seguintes critérios clínicos: idade inferior a 6 meses, sinais de toxemia, forte suspeita ou presença comprovada de alterações morfofuncionais das vias urinárias, dor lombar em maiores de 4 anos. Comprovou-se bacteriúria significativa em urocultura quantitativa em 40 pacientes (21 do sexo masculino, 19 do feminino), cuja idade variou de 15 dias a 6 anos e 9 meses com mediana de 3 meses. Radiologicamente, evidenciou-se refluxo vesicoureteral em 6 crianças, válvula de uretra posterior em 1 e bexiga neurogênica em 4. Os principais agentes bacterianos isolados foram Escherichia coli (30 pacientes), Klebsiella (4) e Proteus (4). O esquema antimicrobiano foi eficaz para 38 pacientes (95%), havendo falha em 1 caso e reinfecção sintomática em outro. Conclui-se que a terapêutica da IU complicada em crianças pode ser realizada ambulatorialmente com ceftriaxona intramuscular, sendo uma alternativa a hospitalização e a medicação endovenosa desses pacientes.
OBJETIVO: O trabalho teve por objetivo padronizar o método e estabelecer valores normais da captação renal absoluta do99mTc-DMSA em crianças. MATERIAIS E MÉTODOS: Vinte e duas crianças (idade de 7 meses a 10 anos; média de 4,5 anos) sem doença renal prévia foram submetidas a cintilografia renal estática com 99mTc-DMSA. Dezoito apresentavam ultra-sonografia, uretrocistografia miccional, "clearance" de creatinina e padrão visual da cintilografia renal estática normais. Quatro crianças foram excluídas por não terem completado ou por apresentarem redução do "clearance" de creatinina. A captação absoluta de DMSA (DMSA-Abs) foi calculada como a porcentagem da atividade administrada retida em cada rim após seis horas da administração do radiofármaco. RESULTADOS: Os valores de DMSA-Abs foram de 21,8% ± 3,2% para o rim direito e de 23,1% ± 3,3% para o rim esquerdo. Os valores da captação absoluta não mostraram correlação com a idade dos pacientes estudados, apesar da tendência de aumento do "clearance" de creatinina com a idade. CONCLUSÃO: A definição de valores normais da DMSA-Abs permite o emprego deste parâmetro na avaliação inicial e acompanhamento de doenças renais, principalmente em pacientes com acometimento bilateral ou com rim único (nos quais a função diferencial direita X esquerda tem valor limitado).
Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection.J Pediatr (Rio J). 2009;85(5):426-432: Fever without source, children, serious bacterial infection.
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