BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiar...BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiary children's hospital in Guangzhou, China and to investigate the risk factors associated with the mortality.METHODS: The mortality of pediatric patients at the hospital from 2011 to 2013 was retrospectively analyzed using descriptive statistics.RESULTS: Altogether 466 919 patients visited the PED during the period and 43 925 of them were admitted for further observation. In 230 deaths, the ratio of boys to girls was 1.4:1, and their age ranged from 2 hours to 16 years(median, 5 months). The time from admission to death ranged from 0 to 216 hours(median, 1.5 hours). There were 92(40%) patients who died within 24 hours after admission and 104(45.2%) patients who died on arrival. The prominent causes of the deaths were respiratory diseases, neuromuscular disorders, cardiovascular diseases, and sepsis, most of which were ascribed to severe infection. Sixty-five deaths were associated with more than one concomitant problem. The top concomitant problems were congenital malformation, low gestational age, and severe birth asphyxia.CONCLUSIONS: In our center, 40% of the patients in the PED died of fatal acute diseases, and pneumonia was the first leading cause of the deaths. Almost half of the deaths occurred on arrival and the rest were due to end-stage malignant diseases. This study emphasized the importance of prevention of birth deficits by reducing deaths in infants and children.展开更多
BACKGROUND： The purpose of triage is to identify patients needing immediate resuscitation, toassign patients to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures asappropriate. This st...BACKGROUND： The purpose of triage is to identify patients needing immediate resuscitation, toassign patients to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures asappropriate. This study aimed to use emergency severity index （ESI） in a pediatric emergency room.METHODS： From July 2006 to August 2010, a total of 21 904 patients visited the InternationalDepartment of Beijing Children＇s Hospital. The ESI was measured by nurses and physicians, andcompared using SPSS.RESULTS： Nurses of the hospital took approximately 2 minutes for triage. The results of triagemade by nurses were similar to those made by doctors for ESI in levels 1-3 patients. This findingindicated that the nurses are able to identify severe pediatric cases.CONCLUSION： In pediatric emergency rooms, ESI is a suitable tool for identifying severecases and then immediate interventions can be performed accordingly.展开更多
AIM To determine the prevalence of Chlamydia trachomatis(CT) and Neisseria gonorrhea(GC) in young men seeking care in the emergency department(ED) for non-sexually transmitted infection(STI) related symptoms.METHODS T...AIM To determine the prevalence of Chlamydia trachomatis(CT) and Neisseria gonorrhea(GC) in young men seeking care in the emergency department(ED) for non-sexually transmitted infection(STI) related symptoms.METHODS This was a prospective, cross-sectional study in an urban ED. The main outcome was the rate of positive CT and GC on urine nucleic acid amplification testing in males aged 16-21 presenting with non-STI related complaints. RESULTS Two hundred and eighty-four patients were enrolled, 271 were included in the final data analysis [age range 16-21, median: 18(quartiles 16-18, 19-21)]. Overall, 17(6.3%, 95%CI: 4%-10%) tested positive for CT and 0%(95%CI: 0%-2%) were found to have GC. The proportion of sexually active subjects was 71%(95%CI: 65%-76%) and 2%(95%CI: 0.6%-4%) reported sex with men. Previous STI testing was reported in 46%(95%CI: 43%-54%) and 13%(95%CI: 8%-20%) of those patients previously tested had a history of STI. Of the patients who tested positive for CT in the ED, 88%(95%CI: 64%-98%) were successfully followed up. CONCLUSION The prevalence of CT infection found by screening was 6.3%. Screening and follow-up from the ED was successful. The findings justify routine STI screening in male adolescents presenting to the ED with non-STI related complaints.展开更多
BACKGROUND:The Broselow?Pediatric Emergency Tape indicates standardized,precalculated medication doses,dose delivery volumes,and equipment sizes using color-coded zones based on height-weight correlations.The present ...BACKGROUND:The Broselow?Pediatric Emergency Tape indicates standardized,precalculated medication doses,dose delivery volumes,and equipment sizes using color-coded zones based on height-weight correlations.The present study attempted to provide more evidence on the effectiveness of the Broselow?Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights.We hypothesized that the Broselow?Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years,leading to inaccurate dosing and equipment sizing in the emergency setting.METHODS:This prospective study of pediatric patients aged<10 years who were divided into three groups based on actual body weight:<10 kg,10–18 kg,and>18 kg.We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias.Concordant results were those with a mean percent difference within 3%.Standard deviation was measured to determine precision.Accuracy was determined as color-coded zone prediction and measured weight concordance,including the percentage overestimation by 1–2 zones.RESULTS:The male-to-female ratio of the patients was 1.3:1.Total agreement between colorcoding was 63.18%(κ=0.582).The Broselow?color-coded zone agreement was 74.8%in the<10kg group,61.24%in the 10–18 kg group,and 53.42%in the>18 kg group.CONCLUSIONS:The Broselow?Pediatric Emergency Tape showed good evidence for being more reliable in children of the<10 kg and 10–18 kg groups.However,as pediatric weight increased,predictive reliability decreased.This raises concerns over the use of the Broselow?Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing>18 kg.展开更多
Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 par...Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.展开更多
Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Ob...Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572);also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.展开更多
Dear editor,Family physicians often serve as the primary resource for parents seeking medical treatment for their children,and it is not uncommon for children with medical emergencies to be brought into primary care o...Dear editor,Family physicians often serve as the primary resource for parents seeking medical treatment for their children,and it is not uncommon for children with medical emergencies to be brought into primary care offices instead of local emergency departments(EDs).Although estimated incidence rates of pediatric emergencies in primary care offices vary based on the definition used,the number of patients seen,and clinic location,[1-3]any healthcare provider who sees pediatric patients should be ready for immediate medical intervention to minimize adverse outcomes.[4,5]Various studies in the USA have shown that outpatient offices are not adequately prepared for pediatric emergencies,whether that is defined as stocking recommended equipment,having policies for the transport of patients to EDs,engaging in mock codes,or being certified in Advanced Pediatric Life Support(APLS)or Basic Life Support(BLS).[1-3]This deficit in preparedness exists despite the presence of multiple nation-and state-wide guidelines on the subject,including a policy by the American Academy of Pediatrics.[3]Limited information exists on the preparedness of primary care physicians for pediatric emergencies in other nations.展开更多
Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as par...Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as participation in physical activity. Herein, we described a case of delayed presentation of chronic Sever’s disease in a child who had been experiencing heel pain for over one year which worsened substantially when the child began to participate in sports. This is important for the emergency medicine physician because Sever’s disease represents an underdiagnosed cause of foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.展开更多
<strong>Introduction:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Ap</span></s...<strong>Introduction:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Ap</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">propriate hand hygiene reduces healthcare associated infections (HCAI). The present study was an attempt to determine the real knowledge and practices of healthcare professionals of pediatric emergency care unit in Benin. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: This was a three-month observational study. First a trained interviewer observed both the premises and the healthcare professionals during their administering treatment, without their knowledge. Second, their level of knowledge about HCAI was examined using a self-administered questionnaire. Finally, bacteria were cultured/measured from their hands before and after hand-washing through swab samples. </span><b><span style="font-family:Verdana;">Outcome: </span></b><span style="font-family:Verdana;">The modes of microorganism transmission were poorly known (21.6%), but knowledge about the 5 moments for hand hygiene was satisfactory (84.1%). Hand hygiene adherence rate was 6.9% in the study population. Simple hand-washing was prevalent (82%</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">). The healthcare professionals did not adhere to the recommended duration for hand-washing. The required hand-washing equipment was inadequate, and alcohol-based handrub dispenser was unavailable. Microorganism isolated from healthcare professionals before hand-washing included </span><i><span style="font-family:Verdana;">Klebsiella</span></i><span> <i><span style="font-family:Verdana;">pneumonia</span></i> <i><span style="font-family:Verdana;">and</span></i> <i><span style="font-family:Verdana;">Enterobacter</span></i> <i><span style="font-family:Verdana;">Cloacae</span></i></span><span style="font-family:Verdana;">. After hand-washing, the transient flora decreased. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Hand hygiene adherence rate is low in the study population. An immediate action is required to improve observance of hand-washing. This may include: training healthcare professionals, displaying visual behavior reminder posters, providing alcohol-based handrub.</span></span></span></span>展开更多
Background: Pediatric emergencies are a public health priority in Senegal. The objective was to describe the epidemiology of admissions to the emergency department of the Albert Royer National Children’s Hospital in ...Background: Pediatric emergencies are a public health priority in Senegal. The objective was to describe the epidemiology of admissions to the emergency department of the Albert Royer National Children’s Hospital in Dakar, Senegal. Methods: Prospective, descriptive and analytical study over a period of 4 months (January-April 2020). The study population was children admitted for vital distress. Results: A total of 300 children met the inclusion criteria and represented the study population (2.83%). The majority (70.67%) were younger than 60 months, compared with 2.00% of newborns. Boys represented 53.8%, sex ratio 1.16. A proportion of 35.1% was referred. More than half of our patients (55.88%) were managed within 30 minutes of arrival. Medicalized transport concerned 21.5% against 78.5% of nonmedicalized. Emergencies were dominated by respiratory distress (56.33%), dehydration (29%) and shock (13.33%). We recorded 16 deaths (5.3%). This mortality was significantly related to the low socio-economic level (p = 0.000), as well as the young age of the children (p = 0.01). Conclusion: Life-threatening emergencies are frequent and responsible for significant lethality. Health policy efforts are still needed to reduce this infant and child morbidity and mortality.展开更多
In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nu...In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.展开更多
There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult p...There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury,but relatively less is known about the effect in pediatric populations.The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibito rs as a potential a djuvant treatment fo r neurocognitive decline in pediatric patients with traumatic brain injury.Investigators queried PubMed to identify literature published from database inception thro ugh June 2023 desc ribing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions.Based on preselected search criteria,340 unique papers we re selected for title and abstra ct screening.Thirty-two reco rds were reviewed in full after eliminating preclinical studies and pape rs outside the scope of the project.In adult traumatic brain injury,we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tole rated and shows both objective and patient-reported efficacy for reducing cognitive impairment.In children,3 pape rs report on 5 children recovering from traumatic brain injury,showing limited efficacy.An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group.Given its promise for efficacy in adults with traumatic brain injury and tole rability in pediatric patients,we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.展开更多
Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP...Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.展开更多
BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive...BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.展开更多
Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to...Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.展开更多
Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD dev...Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD develop stricturing CD(SCD)that requires intervention.Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions.Non-pharmacological therapeutic strategies include endoscopic balloon dilatation,stricturoplasty,and surgical resection of the strictured seg-ment.However,strictures tend to recur postoperatively regardless of treatment modality.The lifetime risk of surgery in patients with childhood SCD remains at 50%-90%.Thus,new and emerging strategies,advanced diagnostic tools,and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.展开更多
With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of...With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of the aircraft play an important role in the judgment and command of the Operational Control Center(OCC). However, how to transmit various operational status data from abnormal aircraft back to the OCC in an emergency is still an open problem. In this paper, we propose a novel Telemetry, Tracking,and Command(TT&C) architecture named Collaborative TT&C(CoTT&C) based on mega-constellation to solve such a problem. CoTT&C allows each satellite to help the abnormal aircraft by sharing TT&C resources when needed, realizing real-time and reliable aeronautical communication in an emergency. Specifically, we design a dynamic resource sharing mechanism for CoTT&C and model the mechanism as a single-leader-multi-follower Stackelberg game. Further, we give an unique Nash Equilibrium(NE) of the game as a closed form. Simulation results demonstrate that the proposed resource sharing mechanism is effective, incentive compatible, fair, and reciprocal. We hope that our findings can shed some light for future research on aeronautical communications in an emergency.展开更多
Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors rema...Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.展开更多
Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients s...Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.展开更多
Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently s...Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.展开更多
文摘BACKGROUND: The quality of treatment for critically ill children varies widely at different hospitals. This study aimed to analyze the characteristics of mortality in a pediatric emergency department(PED) at a tertiary children's hospital in Guangzhou, China and to investigate the risk factors associated with the mortality.METHODS: The mortality of pediatric patients at the hospital from 2011 to 2013 was retrospectively analyzed using descriptive statistics.RESULTS: Altogether 466 919 patients visited the PED during the period and 43 925 of them were admitted for further observation. In 230 deaths, the ratio of boys to girls was 1.4:1, and their age ranged from 2 hours to 16 years(median, 5 months). The time from admission to death ranged from 0 to 216 hours(median, 1.5 hours). There were 92(40%) patients who died within 24 hours after admission and 104(45.2%) patients who died on arrival. The prominent causes of the deaths were respiratory diseases, neuromuscular disorders, cardiovascular diseases, and sepsis, most of which were ascribed to severe infection. Sixty-five deaths were associated with more than one concomitant problem. The top concomitant problems were congenital malformation, low gestational age, and severe birth asphyxia.CONCLUSIONS: In our center, 40% of the patients in the PED died of fatal acute diseases, and pneumonia was the first leading cause of the deaths. Almost half of the deaths occurred on arrival and the rest were due to end-stage malignant diseases. This study emphasized the importance of prevention of birth deficits by reducing deaths in infants and children.
文摘BACKGROUND： The purpose of triage is to identify patients needing immediate resuscitation, toassign patients to a pre-designed patient care area, and to initiate diagnostic/therapeutic measures asappropriate. This study aimed to use emergency severity index （ESI） in a pediatric emergency room.METHODS： From July 2006 to August 2010, a total of 21 904 patients visited the InternationalDepartment of Beijing Children＇s Hospital. The ESI was measured by nurses and physicians, andcompared using SPSS.RESULTS： Nurses of the hospital took approximately 2 minutes for triage. The results of triagemade by nurses were similar to those made by doctors for ESI in levels 1-3 patients. This findingindicated that the nurses are able to identify severe pediatric cases.CONCLUSION： In pediatric emergency rooms, ESI is a suitable tool for identifying severecases and then immediate interventions can be performed accordingly.
文摘AIM To determine the prevalence of Chlamydia trachomatis(CT) and Neisseria gonorrhea(GC) in young men seeking care in the emergency department(ED) for non-sexually transmitted infection(STI) related symptoms.METHODS This was a prospective, cross-sectional study in an urban ED. The main outcome was the rate of positive CT and GC on urine nucleic acid amplification testing in males aged 16-21 presenting with non-STI related complaints. RESULTS Two hundred and eighty-four patients were enrolled, 271 were included in the final data analysis [age range 16-21, median: 18(quartiles 16-18, 19-21)]. Overall, 17(6.3%, 95%CI: 4%-10%) tested positive for CT and 0%(95%CI: 0%-2%) were found to have GC. The proportion of sexually active subjects was 71%(95%CI: 65%-76%) and 2%(95%CI: 0.6%-4%) reported sex with men. Previous STI testing was reported in 46%(95%CI: 43%-54%) and 13%(95%CI: 8%-20%) of those patients previously tested had a history of STI. Of the patients who tested positive for CT in the ED, 88%(95%CI: 64%-98%) were successfully followed up. CONCLUSION The prevalence of CT infection found by screening was 6.3%. Screening and follow-up from the ED was successful. The findings justify routine STI screening in male adolescents presenting to the ED with non-STI related complaints.
文摘BACKGROUND:The Broselow?Pediatric Emergency Tape indicates standardized,precalculated medication doses,dose delivery volumes,and equipment sizes using color-coded zones based on height-weight correlations.The present study attempted to provide more evidence on the effectiveness of the Broselow?Pediatric Emergency Tape by comparing the tape-estimated weights with actual weights.We hypothesized that the Broselow?Pediatric Emergency Tape would overestimate weights in Indian children aged<10 years,leading to inaccurate dosing and equipment sizing in the emergency setting.METHODS:This prospective study of pediatric patients aged<10 years who were divided into three groups based on actual body weight:<10 kg,10–18 kg,and>18 kg.We calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape bias.Concordant results were those with a mean percent difference within 3%.Standard deviation was measured to determine precision.Accuracy was determined as color-coded zone prediction and measured weight concordance,including the percentage overestimation by 1–2 zones.RESULTS:The male-to-female ratio of the patients was 1.3:1.Total agreement between colorcoding was 63.18%(κ=0.582).The Broselow?color-coded zone agreement was 74.8%in the<10kg group,61.24%in the 10–18 kg group,and 53.42%in the>18 kg group.CONCLUSIONS:The Broselow?Pediatric Emergency Tape showed good evidence for being more reliable in children of the<10 kg and 10–18 kg groups.However,as pediatric weight increased,predictive reliability decreased.This raises concerns over the use of the Broselow?Pediatric Emergency Tape in Indian children because body weight was overestimated in those weighing>18 kg.
文摘Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.
文摘Trauma is a physical injury caused by violence or other forces;in serious trauma, the patient will be at risk of death or loss of function. Trauma is a leading cause of morbidity and mortality among all age groups. Objective: To study the pattern and outcome of upper limbs trauma in children attending the pediatric emergency department. Methodology: This was a retrospective cross-sectional study conducted in the Department of Pediatrics at Security Forces Hospital-Al-Riyadh. Result: Total number of patients seen during the study period was 343 patients, their age range between 6 months and 13 years old with a mean age of 5.473 (±3.8572);also, results showed boys were 187 (54.5%) patients and girls were 156 (45.5%) patients. Based on the site of trauma in the upper limbs, lacerations were in 114 (33.2%), Hand and/or wrist fracture in 67 (19.5%), Nursemaid Elbow in 43 (12.5%), both Radius and Ulnar bones fracture in 33 (9.6%), Radius bone fracture in 29 (8.5%), supracondylar fracture in 22 (6.4%), Clavicle bone fracture in 20 (5.8%), Humorous bone fracture in 7 (2%), Condylar bone fracture 6 (1.7%), and there was 1 (0.3%) patient with Scapulae and Ulna fracture.
文摘Dear editor,Family physicians often serve as the primary resource for parents seeking medical treatment for their children,and it is not uncommon for children with medical emergencies to be brought into primary care offices instead of local emergency departments(EDs).Although estimated incidence rates of pediatric emergencies in primary care offices vary based on the definition used,the number of patients seen,and clinic location,[1-3]any healthcare provider who sees pediatric patients should be ready for immediate medical intervention to minimize adverse outcomes.[4,5]Various studies in the USA have shown that outpatient offices are not adequately prepared for pediatric emergencies,whether that is defined as stocking recommended equipment,having policies for the transport of patients to EDs,engaging in mock codes,or being certified in Advanced Pediatric Life Support(APLS)or Basic Life Support(BLS).[1-3]This deficit in preparedness exists despite the presence of multiple nation-and state-wide guidelines on the subject,including a policy by the American Academy of Pediatrics.[3]Limited information exists on the preparedness of primary care physicians for pediatric emergencies in other nations.
文摘Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function as well as participation in physical activity. Herein, we described a case of delayed presentation of chronic Sever’s disease in a child who had been experiencing heel pain for over one year which worsened substantially when the child began to participate in sports. This is important for the emergency medicine physician because Sever’s disease represents an underdiagnosed cause of foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.
文摘<strong>Introduction:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Ap</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">propriate hand hygiene reduces healthcare associated infections (HCAI). The present study was an attempt to determine the real knowledge and practices of healthcare professionals of pediatric emergency care unit in Benin. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: This was a three-month observational study. First a trained interviewer observed both the premises and the healthcare professionals during their administering treatment, without their knowledge. Second, their level of knowledge about HCAI was examined using a self-administered questionnaire. Finally, bacteria were cultured/measured from their hands before and after hand-washing through swab samples. </span><b><span style="font-family:Verdana;">Outcome: </span></b><span style="font-family:Verdana;">The modes of microorganism transmission were poorly known (21.6%), but knowledge about the 5 moments for hand hygiene was satisfactory (84.1%). Hand hygiene adherence rate was 6.9% in the study population. Simple hand-washing was prevalent (82%</span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">). The healthcare professionals did not adhere to the recommended duration for hand-washing. The required hand-washing equipment was inadequate, and alcohol-based handrub dispenser was unavailable. Microorganism isolated from healthcare professionals before hand-washing included </span><i><span style="font-family:Verdana;">Klebsiella</span></i><span> <i><span style="font-family:Verdana;">pneumonia</span></i> <i><span style="font-family:Verdana;">and</span></i> <i><span style="font-family:Verdana;">Enterobacter</span></i> <i><span style="font-family:Verdana;">Cloacae</span></i></span><span style="font-family:Verdana;">. After hand-washing, the transient flora decreased. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Hand hygiene adherence rate is low in the study population. An immediate action is required to improve observance of hand-washing. This may include: training healthcare professionals, displaying visual behavior reminder posters, providing alcohol-based handrub.</span></span></span></span>
文摘Background: Pediatric emergencies are a public health priority in Senegal. The objective was to describe the epidemiology of admissions to the emergency department of the Albert Royer National Children’s Hospital in Dakar, Senegal. Methods: Prospective, descriptive and analytical study over a period of 4 months (January-April 2020). The study population was children admitted for vital distress. Results: A total of 300 children met the inclusion criteria and represented the study population (2.83%). The majority (70.67%) were younger than 60 months, compared with 2.00% of newborns. Boys represented 53.8%, sex ratio 1.16. A proportion of 35.1% was referred. More than half of our patients (55.88%) were managed within 30 minutes of arrival. Medicalized transport concerned 21.5% against 78.5% of nonmedicalized. Emergencies were dominated by respiratory distress (56.33%), dehydration (29%) and shock (13.33%). We recorded 16 deaths (5.3%). This mortality was significantly related to the low socio-economic level (p = 0.000), as well as the young age of the children (p = 0.01). Conclusion: Life-threatening emergencies are frequent and responsible for significant lethality. Health policy efforts are still needed to reduce this infant and child morbidity and mortality.
文摘In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.
基金Division of Neurology,Cincinnati Children’s Hospital Medical Center(as a Medical Student Scholars Program award to ALM)。
文摘There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury,but relatively less is known about the effect in pediatric populations.The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibito rs as a potential a djuvant treatment fo r neurocognitive decline in pediatric patients with traumatic brain injury.Investigators queried PubMed to identify literature published from database inception thro ugh June 2023 desc ribing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions.Based on preselected search criteria,340 unique papers we re selected for title and abstra ct screening.Thirty-two reco rds were reviewed in full after eliminating preclinical studies and pape rs outside the scope of the project.In adult traumatic brain injury,we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tole rated and shows both objective and patient-reported efficacy for reducing cognitive impairment.In children,3 pape rs report on 5 children recovering from traumatic brain injury,showing limited efficacy.An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group.Given its promise for efficacy in adults with traumatic brain injury and tole rability in pediatric patients,we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.
文摘Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.
基金Science and Technology Development Plan Project of Suzhou(SKJYD2021035)Science and Technology Development Plan Project of Suzhou(SKJYD2022078)The Key Project Research Fund of the Second Affiliated Hospital of Wannan Medical College(YK2023Z04)。
文摘BACKGROUND:Postpartum posttraumatic stress disorder(PTSD)can occur in women who give birth after emergency admission.The identification of risk factors for this condition is crucial for developing effective preventive measures.This retrospective study aimed to explore the incidence and risk factors for postpartum PTSD in women who give birth after emergency admission.METHODS:Medical records of women who gave birth after emergency admission were collected between March 2021 and April 2023.The patients’general conditions and perinatal clinical indicators were recorded.The puerperae were divided into PTSD group and control group based on symptom occurrence at six weeks postpartum.Multivariate logistic regression analysis was performed to identify risk factors.RESULTS:A total of 276 puerperae were included,with a PTSD incidence of 20.3% at six weeks postpartum.Multivariate logistic regression analysis identified emergency cesarean section(odds ratio[OR]=2.102;95%confidence interval[CI]:1.114-3.966,P=0.022),admission to the emergency department after midnight(12:00 AM)(OR=2.245;95%CI:1.170-4.305,P<0.001),and cervical dilation(OR=3.203;95%CI:1.670–6.141,P=0.039)as independent risk factors for postpartum PTSD.Analgesia pump use(OR=0.500;95%CI:0.259–0.966,P=0.015)was found to be a protective factor against postpartum PTSD.CONCLUSION:Emergency cesarean section,admission to the emergency department after midnight,and cervical dilation were identified as independent risk factors for postpartum PTSD,while analgesic pump use was a protective factor.These findings provide insights for developing more effective preventive measures for women who give birth after emergency admission.
文摘Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.
文摘Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD develop stricturing CD(SCD)that requires intervention.Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions.Non-pharmacological therapeutic strategies include endoscopic balloon dilatation,stricturoplasty,and surgical resection of the strictured seg-ment.However,strictures tend to recur postoperatively regardless of treatment modality.The lifetime risk of surgery in patients with childhood SCD remains at 50%-90%.Thus,new and emerging strategies,advanced diagnostic tools,and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.
基金supported by the National Natural Science Foundation of China under Grant 62131012/61971261。
文摘With the development of the transportation industry, the effective guidance of aircraft in an emergency to prevent catastrophic accidents remains one of the top safety concerns. Undoubtedly, operational status data of the aircraft play an important role in the judgment and command of the Operational Control Center(OCC). However, how to transmit various operational status data from abnormal aircraft back to the OCC in an emergency is still an open problem. In this paper, we propose a novel Telemetry, Tracking,and Command(TT&C) architecture named Collaborative TT&C(CoTT&C) based on mega-constellation to solve such a problem. CoTT&C allows each satellite to help the abnormal aircraft by sharing TT&C resources when needed, realizing real-time and reliable aeronautical communication in an emergency. Specifically, we design a dynamic resource sharing mechanism for CoTT&C and model the mechanism as a single-leader-multi-follower Stackelberg game. Further, we give an unique Nash Equilibrium(NE) of the game as a closed form. Simulation results demonstrate that the proposed resource sharing mechanism is effective, incentive compatible, fair, and reciprocal. We hope that our findings can shed some light for future research on aeronautical communications in an emergency.
文摘Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.
文摘Background: Diabetic nephropathy is the leading cause of end-stage chronic kidney disease with poor prognosis in resource-limited settings. This study aimed to determine factors associated with mortality in patients starting dialysis treatment for end-stage chronic renal disease in an emergency context. Patients and Methods: This was a retrospective study from January 2020 to December 2022 at CHU-B. Data from 79 diabetic patients requiring emergency dialysis were compared with those of 79 non-diabetic patients with an end-stage renal disease requiring emergency dialysis. Data were collected from the Nephrology Department registry. We studied their initial clinical and biological profiles and factors related to mortality. Results: Out of 545 compiled records, 79 diabetic chronic kidney disease patients needing dialysis were included (group 1). A control group of 79 non-diabetic chronic kidney disease patients requiring emergency dialysis was also included (group 2). The average age of patients was 53.5 ± 17 years, and the duration of diabetes at dialysis initiation was 14.8 ± 4.3 years. Twenty-three percent were hypertensive. Fifty-two percent of patients experienced intra-dialytic hypotension. Death occurred in 22% of patients. Results show that age (adjusted OR 1.955;CI: 1.025 - 1.086;p-value: Conclusion: Emergency dialysis in diabetics is associated with unfavorable outcomes in terms of mortality. Despite follow-up, renal involvement remains poorly explored, emphasizing the need for physician awareness.
文摘Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.
