86例儿童过敏性紫癜的临床分析

目的 探讨儿童过敏性紫癜的临床特点.方法 对86例儿童过敏性紫癜的发病特点、临床表现、治疗进行回顾性分析.结果 86例平均发病年龄7.12岁,四季均有发病,冬春季为高峰,而诱因以上呼吸道感染最常见.所有患儿均先后出现皮肤紫癜,累及的部位以双下肢最常见;25例出现关节肿痛,大关节肿痛以膝关节、踝关节为主;52例出现消化道症状,以腹痛最常见;21例出现不同程度的肾脏损害.结论 过敏性紫癜是儿童的常见病,好发于学龄期儿童,冬春季节发病多,与感染、食物等因素有关.主要累及皮肤、消化道、关节、肾脏,治疗以去除诱因、抗炎、抗过敏、解痉、止痛、使用激素与免疫抑制剂为主,依据病变部位及程度给予相应治疗.     

儿童过敏性紫癜临床分析

目的探讨儿童过敏性紫癜的临床症状及特点。方法对收治的56例儿童过敏性紫癜患儿的发病情况及临床特点进行回顾性分析。结果HSP好发于秋冬季节,主要见于儿童及青年,6岁以上占多数,发病前有明显诱因。临床表现：出现典型的紫癜,有血管神经性水肿,有71．43％的患儿出现轻重不等的消化道症状,48．21％的患儿出现轻重程度不同关节症状,19例患儿表现出肾脏受累。经过治疗,患儿的痊愈率达91．07％。结论充分认识HSP患儿的发病情况和临床特点将有助于HSP的早期诊断及有效治疗。     

儿童过敏性紫癜的临床特征与护理

目的探讨儿童过敏性紫癜(henoch-schnlein purpura,HSP)的临床特征,寻找与之对应的护理对策。方法回顾性分析2011年1-12月在上海交通大学附属儿童医院治疗的221例HSP患儿的发病特点、临床表现及肾损害原因。结果儿童HSP患儿发病年龄2～14岁,平均(7.02±2.7)岁,71.3%于冬春季节发病,79.6%患儿发病前有明确诱因。以呼吸道感染为主(72.8%),其中以胃肠道症状首发(21.3%)易发生误诊;胃肠道及关节受累发生率是62.4%和91.0%;所有患儿均有典型紫癜,主要分布于双下肢(98.6%);76.3%的紫癜于1个月内消退,而紫癜性肾炎发生率为38.9%,以皮肤紫癜为首发与非以皮肤紫癜为首发的HSP患儿的肾损害发生率分别为33.1%、48.2%,两者比较差异有统计学意义(χ2=5.044,P<0.05);临床类型以血尿和(或)蛋白尿(1～2级)最常见(62.8%),病理类型ISKDC分级以Ⅰ～Ⅲ级为主(94.1%),针对患儿的临床特征采取相应的护理对策取得满意的效果。结论 HSP为儿童常见病,以消化道症状首发时易误诊,也较严重;是否有紫癜性肾炎决定预后。不同临床表现的紫癜患儿予以个性化的护理,有利于患儿早日康复。     

小儿过敏性紫癜66例分析

目的探讨小儿过敏性紫癜的临床特点和治疗效果。方法选择邓州市第一医院2007-01-2010-12过敏性紫癜患儿66例,分析其发病诱因、临床表现、症状、体征、实验室检查结果及诊治情况。结果 66例患儿治愈出院64例,治愈率96.9%,出院后3例复发,复发率4.5%,2例患儿因持续血尿,转肾内科治疗。结论过敏性紫癜患儿感染为常见的诱因,多以皮肤紫癜为首发症状,消化道症状和关节疼痛也为常见表现,需根据患儿具体临床情况实施治疗。     

儿童过敏性紫癜193例分析

目的：探讨儿童过敏性紫癜的临床特点，方法：对1993年1月1日－2000年12月31日，在本院住院的193例过敏性紫癜患儿的 病特点，临床表现，肾损害相关因素及预后等方面的进行回顾。结果：（1）1993－2003年，每年的患病率依次为1．03％、0．79％、1．19％、1．01％、0．84％、1．34％，1．27％及1．41％。（2）农村患儿136例，占70．47％，（3）诱因：感染121例，占62．69％，寄生虫史29例，占15．03％，进食特殊食物6例，占3．11％，（4）出现肾脏症状54例，发生率为27．98％，29例皮肤紫癜者，3例出现肾脏损害，占10．34％39例皮肤紫癜加关节症状者，6例出现肾脏损害，占15．38％；59例皮肤紫癜加消化道症状者，20例出现肾脏损害，占33．90％，66例皮肤紫癜加关节症状加消化症状者中25例发生肾脏损害，占37．88％（P＜0．05）。（5）预后：180例治愈好转，占93．26％，结论：（1）HSP患病率有升高趋势，但并非呈逐年升高。农村患儿发病较多，发病诱因仍以感染占第一位。（2）HSP早期出现较多肾外症状，特别是消化道症状明显者，易发生肾脏损害。     

儿童过敏性紫癜246例临床分析

目的探讨儿童过敏性紫癜（HSP）的临床特点及肾损害的相关因素。方法对2006年1月至2010年12月在开封市儿童医院住院治疗的246例过敏性紫癜患儿的发病特点、临床表现、肾脏受累的相关因素进行回顾性分析。结果①儿童过敏性紫癜好发于秋冬季节,高发人群为学龄期儿童,发病诱因以上呼吸道感染为常见。且感染多发生于发病前1周内。②HSP首发症状多为皮疹,少数为腹痛、关节痛等,临床上混合型病例多见,尤其是合并肾损害者多达45%。③对易感因素进行非条件二分类变量的Logistic回归分析,结果提示：发病年龄〉8岁,反复紫癜超过1个月,消化道出血为肾脏损伤的相关危险因素。结论肾脏损害及其相关程度是影响患儿临床转归的最重要因素,而HSP患儿年龄〉8岁,皮疹反复超过1个月者,及消化道出血可能是HSP患儿肾脏损伤的重要相关因素。     

儿童过敏性紫癜155例临床分析

[目的]探讨儿童过敏性紫癜(HSP)的临床特点.[方法]对本院2002年6月至2012年6月住院的155例HPS患儿的临床资料进行回顾性分析.[结果]155例HSP好发年龄为3～6岁,本组共116例(74.84％)；冬春季节发病127例(81.93％)；感染为发病诱因者122例(78.71％)；器官损害主要为皮肤紫癜155例(100％),消化系统损害36例(23.23％),关节损害48例(30.97％),肾脏损害43例(27.74％)；应用综合治疗有效率达96.77％,65例(41.94％)复发病例应用中西医结合治疗有效率为96.92％.[结论]HSP发病以学龄前儿童多见；冬春季节发病率高；感染为发病的主要诱因；HSP可致多器官损害；无特殊治疗方法,以综合治疗为主,中西医结合治疗复发病例效果满意.     

儿童过敏性紫癜108例临床分析

目的通过对108例儿童过敏性紫癜的回顾性分析,了解该病的临床特点,以提高对本病的认识,减少误诊。方法将108例儿童过敏性紫癜的临床资料,包括病史、相关检查、治疗方法作总结分析。结果 108例儿童过敏性紫癜中,除皮肤紫癜外,关节肿痛38.9%;消化道症状21.3%,其中以腹痛为首发症状的患儿入院前有6例误诊;肾脏受累28.7%,伴有肾损害者病程延长,个别病例肾损害迁延数年。结论儿童过敏性紫癜在皮肤紫癜出现前可先以腹部症状为首发症状,易导致误诊,肾损害影响预后及病程,故过敏性紫癜应引起临床重视。     

儿童过敏性紫癜消化道病变与幽门螺杆菌感染的相关性分析

目的分析儿童过敏性紫癜消化道病变与幽门螺杆菌感染的相关性。方法选取2018年1月至2019年6月我院收治的30例过敏性紫癜消化道病变患儿为分析组,另选择同时间段内的30名健康体检儿童为参照组。比较分析组和参照组的幽门螺杆菌感染情况;比较分析组幽门螺杆菌感染和非感染患儿的治疗效果及其他部位受累情况。结果分析组的幽门螺杆菌感染率明显高于参照组,差异具有统计学意义(P<0.05)。分析组幽门螺杆菌感染患儿的治疗总有效率明显低于非感染患儿,差异具有统计学意义(P<0.05);分析组幽门螺杆菌感染患儿其他部位受累总发生率明显高于非感染患儿,差异具有统计学意义(P<0.05)。结论幽门螺杆菌感染是导致过敏性紫癜患儿消化道病变的主要诱因之一,临床需针对过敏性紫癜患儿进行幽门螺杆菌检查,以明确病因,提高治疗效果。     

儿童过敏性紫癜150例临床分析

回顾性分析我科2010年1月～2012年1月收治的150例过敏性紫癜患儿的临床资料。（1）过敏性紫癜发病男性多于女性,季节以秋冬季为主,呼吸道感染是最常见诱因;（2）临床表现以皮疹为主,消化道症状55.4%,以消化道症状为首发的过敏性紫癜临床需与急腹症相鉴别,关节症状32.5%,常表现为关节肿痛,部分存在活动受限,紫癜性肾炎发生率为44.1%,临床主要表现为血尿和（或）蛋白尿,病程易迁延。过敏性紫癜是儿童常见病,需重视过敏性紫癜发病诱因的多样性及临床多系统损害。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.