Household water treatment, including boiling, chlorination and filtration, has been shown effective in improving drinking water quality and preventing diarrheal disease among vulnerable populations. We used a case-control study design to evaluate the extent to which the commercial promotion of household water filters through microfinance institutions to women's self-help group (SHG) members improved access to safe drinking water. This pilot program achieved a 9.8% adoption rate among women targeted for adoption. Data from surveys and assays of fecal contamination (thermotolerant coliforms, TTC) of drinking water samples (source and household) were analyzed from 281 filter adopters and 247 non-adopters exposed to the program; 251 non-SHG members were also surveyed. While adopters were more likely than non-adopters to have children under 5 years, they were also more educated, less poor, more likely to have access to improved water supplies, and more likely to have previously used a water filter. Adopters had lower levels of fecal contamination of household drinking water than non-adopters, even among those non-adopters who treated their water by boiling or using traditional ceramic filters. Nevertheless, one-third of water samples from adopter households exceeded 100 TTC/100ml (high risk), and more than a quarter of the filters had no stored treated water available when visited by an investigator, raising concerns about correct, consistent use. In addition, the poorest adopters were less likely to see improvements in their water quality. Comparisons of SHG and non-SHG members suggest similar demographic characteristics, indicating SHG members are an appropriate target group for this promotion campaign. However, in order to increase the potential for health gains, future programs will need to increase uptake, particularly among the poorest households who are most susceptible to disease morbidity and mortality, and focus on strategies to improve the correct, consistent and sustained use of these water treatment products.
Accurate predictions of patient length of stay (LOS) in the hospital can effectively manage hospital resources and increase efficiency of patient care. A study was done to assess emergency medicine physicians' ability of predicting the LOS of patients who enter the hospital through the ER. Results indicate that EM physicians are relatively accurate with their pediatric patients than any other age groups. In addition, as actual hospital LOS increases, the prediction accuracy decreases. Possible reasons may be due increasing medical complications associated with increasing age and this may lead to overall longer stays. Other variables such as the admitted service of the patient are not statistically significant in predicting LOS in this study. Future studies should be done in order to determine other variables that may affect LOS predictions.
There is a little data regarding safety or efficacy of monoclonal antibody treatment for mild-to-moderate COVID-19 in pediatric patients despite it being frequently used in adults. This retrospective study of 17 patients with mild-to-moderate COVID-19 who received monoclonal antibody therapy found that the treatment was well tolerated, safe, and may be effective in halting progression to severe disease.
Isolated visceral arteriopathies of the celiac and hepatic artery are rare. We present a case of a Caucasian man who presented with abdominal pain and was found to have a spontaneous celiac artery dissection. Genetic analysis revealed a mutation consistent with Ehlers-Danlos syndrome type IV. The patient died 2 months later from a spontaneous rupture of his hepatic artery. CASE REPORTA 31-year-old man with fragile, easily bruisable skin, abnormal (atrophic) scarring, joint hypermobility, and extensive varicosities of the legs presented with sudden onset of left upper quadrant abdominal pain. His blood pressure was 146/75 mm Hg and heart rate, 114 beats/ min. The epigastric region was tender and the left upper quadrant of his abdomen was soft. His joints were hypermobile, his skin over the chest was translucent, and severe varicose veins were present on his lower torso and lower extremities. A complete blood count, basic metabolic panel, liver function tests, activated partial thromboplastin time, prothrombin time/international normalized ratio, and amylase and lipase levels were within normal limits (Table). An electrocardiogram showed only sinus tachycardia, and an echocardiogram was normal. Computed tomography (CT) of the abdomen revealed high-density fluid around the pancreas and spleen. A serologic workup for a vasculitis was negative.Due to a normal amylase and lipase level and persistent abdominal pain, a CT angiogram of the thorax and abdomen was performed and revealed a celiac artery dissection with associated thrombus extending into the splenic artery (Figure). Th e spleen was infarcted. Th e patient was managed with anticoagulation by continuous heparin infusion and metoprolol. He responded well to conservative management and was discharged home. Th ere was a clinical suspicion of Ehlers-Danlos syndrome (EDS) type IV. Th e patient's paternal grandmother also had extensive varicosities. Molecular studies revealed a mutation in the COL3A1 gene, which is consistent with the diagnosis of EDS type IV.Approximately 2 months after hospital discharge, the patient complained once again of sudden onset of severe abdominal pain. As he and his wife were on their way to the car to drive to the emergency department, he collapsed and died. Autopsy revealed a ruptured hepatic artery aneurysm with 2.5 to 3 L of fresh blood in the peritoneal cavity. Th eir infant son did not have the COL3A1 mutation.
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