基于临床表现的疾病预测模型是临床决策支持系统(Clinical Decision Support System,CDSS)的一个重要研究内容.现有临床决策支持系统往往将临床病例作为训练数据集,以临床表现的描述文字为特征,采用统计机器学习方法构建疾病预测模型.然...基于临床表现的疾病预测模型是临床决策支持系统(Clinical Decision Support System,CDSS)的一个重要研究内容.现有临床决策支持系统往往将临床病例作为训练数据集,以临床表现的描述文字为特征,采用统计机器学习方法构建疾病预测模型.然而,在医疗领域往往存在着样本数据集不均衡的问题,导致模型的预测效果降低.欠采样技术是目前解决样本不均衡问题的常用手段.其主要采用一定的方法从多数类样本中抽取部分样本,与少数类样本组成平衡数据集后再构建模型.现有的欠采样方法往往可以显著提高模型对少数类样本的召回率,然而其通常也会造成模型准确率的降低,从而限制了预测模型的整体提升效果.为此,该文提出了一种新的基于迭代提升欠采样的集成分类方法(Under-Sampling with Iteratively Boosting,USIB),该方法迭代地从多数类样本中进行欠抽样,构建多组弱分类器,并采用加权组合方式将这些弱分类器构成一个强分类器,从而提升样本不平衡条件下单种疾病预测效果.另外,医学病例样本数据集通常是多类别、多标签的,为此,该文将多个单种疾病的预测模型进行组合构成一个多标签疾病预测模型,以满足临床意义上的多病种以及并发症的诊断.为了进一步提升多标签预测模型的效果,该文设计了一种基于标签最大互信息生成树的标签选择方法(Labels Selection method based on Maximum Mutual Information Spanning Tree,LS-MMIST),该方法根据原始数据集的分布构建标签之间的最大互信息生成树,在每一次的样本预测阶段,借助树中疾病标签之间的关系确定最终的预测标签集合.实验方面,该文首先选择三种公开的不均衡二分类数据集和我们私有的四种稀有疾病的数据集,对该文提出的迭代提升欠采样方法进行性能评估.其次,分别对比了该文提出的多标签预测模型与现有的多标签预测技术在中医和西医两种多标签数据集上的预测性能.实验结果显示,相对于目前主流的八种欠采样以及两种集成采样技术,该文提出的迭代提升欠采样方法在各个不均衡二分类数据集上的F1值平均提升22.58%;与现有的各种多标签预测技术相比,该文提出的多标签预测方法在西医和中医数据集上正确率分别提升6.30%和12.43%,召回率分别提升4.33%和5.86%,F1值分别提升5.48%和11.16%.展开更多
AIM： To assess the efficacy and safety of Saccharomyces boulardii （S. boulardii） in acute watery diarrhoea and its role in reducing the frequency of episodes of diarrhoea in subsequent two months. METHODS： Childre...AIM： To assess the efficacy and safety of Saccharomyces boulardii （S. boulardii） in acute watery diarrhoea and its role in reducing the frequency of episodes of diarrhoea in subsequent two months. METHODS： Children from 2 mo to 12 years of age, with acute diarrhoea were selected according to inclusion criteria and randomised in S. boulardii group （treated with ORS, nutritional support and S. boulardii, 250 mg bid） and in control group （treated with ORS and nutritional support only）. Active treatment phase was 5 d and each child was followed for two months afterwards. Frequency and consistency of stools as well as safety of drug was assessed on every visit. A comparison of two groups was done in terms of number of diarrhoeal episode in subsequent two months. RESULTS： There were fifty patients in each group. Baseline characteristics such as mean age and the average frequency of stools were comparable in S. boulardii and control group at the time of inclusion in the trial. By d 3 it reduced to 2.7 and 4.2 stools per d respectively and by d 6 it reduced to 1.6 （5. boulardii Group） and 3.3 （control group）. The duration of diarrhoea was 3.6 d in S. boulardii group whereas it was 4.8 d in control group （P = 0.001）. In the following two months, S. boulardii group had a significantly lower frequency of 0.54 episodes as compared to 1.08 episodes in control group. The drug was well accepted and tolerated. There were no reports of the side effects during treatment period CONCLUSION： S. boulardii significantly reduces the frequency and duration of acute diarrhoea. The consistency of stool also improves. The drug is well-tolerated.展开更多
Healthcare-associated infection is a common problem of newborn in neonatal intensive care units. It results in high mortality rate and serious complications. The Aim: to assess the incidence, etiology and the mortalit...Healthcare-associated infection is a common problem of newborn in neonatal intensive care units. It results in high mortality rate and serious complications. The Aim: to assess the incidence, etiology and the mortality of healthcareassociated infections of patients in neonatal intensive care unit at King Abdl Aziz Specialist Hospital (KAASH), Taif, Kingdom of Saudi Arabia. Material and Methods: This is a retrospective study including 8033 neonates admitted to neonatal intensive care unit during period between April, 2006 and December, 2012. The health-care associated infection rate, mortality rate, causative organism and risk factors were studied. Results: The prevalence of health-care associated infection was found to be 6.03%;the mortality rate was 27.1%. The highest prevalence was among children with the birth weight below 1000 g. The most frequent causative pathogen was klebseilla spp, followed by other gram negative bacilli. Conclusion: The rate of healthcare-associated infections in neonatal intensive care unit at KAASH was relatively high. In addition, the mortality rate was observed to be high (27.1%) owing to the high virulence of the causative organisms.展开更多
Pulmonary diseases are common throughout the world,especially in developing countries.These diseases include chronic obstructive pulmonary diseases,pneumonia,asthma,tuberculosis,fibrosis,and recently COVID-19.In gener...Pulmonary diseases are common throughout the world,especially in developing countries.These diseases include chronic obstructive pulmonary diseases,pneumonia,asthma,tuberculosis,fibrosis,and recently COVID-19.In general,pulmonary diseases have a similar footprint on chest radiographs which makes them difficult to discriminate even for expert radiologists.In recent years,many image processing techniques and artificial intelligence models have been developed to quickly and accurately diagnose lung diseases.In this paper,the performance of four popular pretrained models(namely VGG16,DenseNet201,DarkNet19,and XceptionNet)in distinguishing between different pulmonary diseases was analyzed.To the best of our knowledge,this is the first published study to ever attempt to distinguish all four cases normal,pneumonia,COVID-19 and lung opacity from ChestX-Ray(CXR)images.All models were trained using Chest-X-Ray(CXR)images,and statistically tested using 5-fold cross validation.Using individual models,XceptionNet outperformed all other models with a 94.775%accuracy and Area Under the Curve(AUC)of Receiver Operating Characteristic(ROC)of 99.84%.On the other hand,DarkNet19 represents a good compromise between accuracy,fast convergence,resource utilization,and near real time detection(0.33 s).Using a collection of models,the 97.79%accuracy achieved by Ensemble Features was the highest among all surveyed methods,but it takes the longest time to predict an image(5.68 s).An efficient effective decision support system can be developed using one of those approaches to assist radiologists in the field make the right assessment in terms of accuracy and prediction time,such a dependable system can be used in rural areas and various healthcare sectors.展开更多
PhV （pharmacovigilance） knowledge has the outcome of being inadequate in particular due to the lack of instruction. Pediatricians have to face the realization that over-the-counter medicines increments the peril of ...PhV （pharmacovigilance） knowledge has the outcome of being inadequate in particular due to the lack of instruction. Pediatricians have to face the realization that over-the-counter medicines increments the peril of ADRs （adverse drug reactions） has become a public health concern. The purpose of this article is to disseminate knowledge of the PhV and to highlight the cultural and organizational difficulties for its implementation. The objectives of promoting the organization of specific training courses and research projects aimed at： （1） to foster the culture of iatrogenic disease in pediatrics; （2） to improve the appropriateness of prescribing drugs in children; （3） to enco.urage spontaneous reporting of ADRs in children; （4） to involve Pediatricians in PASS （post-authorization safety studies） according to GCP, GVP and ENCEPP Code of Conduct. An up to date proposal of PhV, a procedure of preparation improves the productivity of creating novel informative reports which can be utilized for a benefit/risk scrutiny making strides in medicine prescription. In this context, FP-MCRN （family paediatficians-medicines for children research network） established with the aim of developing competence, infrastructure and education for paediatric clinical trials, plays a crucial role in paediatric PhV, through an improvement of PhV training, a correct research methodology and very strong relationship with the families. The initial necessity is cultural, implementing culture of iatrogenic illnesses and a watchful evaluation of the importance of PASS by FPs （family pediatricians）. Participation in clinical trials that generates a precise database administered by FPs together with follow-up outcomes becomes relevant and vital for a scrupulous and accurate assessment of ADRs. PASS can foresee on one hand training and information regarding the proper use of drugs in children and possible iatrogenic pathologies caused by their improper use, the other to constitute a territorial survey in the prescriptive appropriateness and safety of pediatric drugs aimed at evaluating the risk-benefit balance on usage.展开更多
Fifty years have passed from the first official recognition of the methylmercury （MeHg） poisoning in Niigata （so called the second Minamata disease）, Japan in 2015. The first case of MeHg poisoning was found in Ja...Fifty years have passed from the first official recognition of the methylmercury （MeHg） poisoning in Niigata （so called the second Minamata disease）, Japan in 2015. The first case of MeHg poisoning was found in January 1965, when two surveys were carried out for 20,000 inhabitants lived within 15 km from the mouth of the Agano river. From these surveys, 26 cases （including 5 cases of death） were officially recognized as MeHg poisoning. Moreover, 9 cases who had no symptoms but whose hair mercury concentration were over 200 ppm were found. Within 20 cases, 15 cases are among 26 cases officially recognized as having MeHg poisoning and 5 cases are among 9 cases who had no symptoms but whose hair mercury concentration were over 200 ppm in 1965. The distal dominant sensory disturbances of the extremities lasted for more than several decades among 20 cases. The sensory disturbance of the bilateral distal extremities could be used as the gold standard for the diagnosis of MeHg poisoning in the exposed areas. The distal dominant sensory disturbance of the extremities is a typical characteristic and important sign of the MeHg poisoning.展开更多
Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and t...Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p <</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">0.05 and the 95% confidence interval. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The frequency of referrals was 54.3%.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">g, hypothermic in 43.8% and febrile in 15.1%.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times </span><span style="font-family:Verdana;">in the less than 28 week</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of amenorrhea (WA) (ORa = 18</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5;CI = 1.9</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">180;</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6;CI = 1.4</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">29.7;p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.展开更多
Objectives: This study describes the incidence of all fatal cases associated with Pandemic Influenza A (H1N1) in Yemen. It sets out to highlight the factors associated with poor prognosis *The authors declare that the...Objectives: This study describes the incidence of all fatal cases associated with Pandemic Influenza A (H1N1) in Yemen. It sets out to highlight the factors associated with poor prognosis *The authors declare that they have no competing interests. to enhance the implementation of prevention and control programs. Methods: The study is based on retrospective analysis of available data until 14 March 2010, as compiled by the disease control and surveillance team in Yemen. Results: Between 16 June 2009 and 14 March 2010, a total of 33 laboratory-confirmed death cases associated with pandemic influenza A (H1N1) were reported to the Diseases Control and Surveillance in the Ministry of Public Health and Population. During this period, a total of 6049 suspected influenza A (H1N1) cases were recorded. With this denominator, the case fatality rate (CFR) was 0.54%. During June through August, H1N1 confirmed cases were infrequently detected, including only 30;however, from September through December, over 200 confirmed cases were reported each month. Of the 33 cases recorded, 25 were male (76%) and 8 were female (24%), male to female ratio being 3:1. Overall median age of the death cases was 30.8 years (range 1 - 55). The most common diagnosis upon admission was pneumonia. Out of the deaths, twenty five (75.8%) had no documented underlying diseases. Chronic cardiovascular disease (9.1%) was the most commonly reported disease and 2 deaths (6.1%) were recorded as pregnant women. Conclusions: The most common diagnosis upon admission was pneumonia. Chronic cardiovascular diseases were the most commonly reported underlying conditions, while the most identified risk factor was pregnancy. These findings should be taken into consideration, when vaccination strategies are employed.展开更多
It’s becoming even more widely recognized from neurosciences, epigenetics, and clinical research on observation of infant-caregiver interaction that daily cumulated micro-traumatic experiences cause damages not only ...It’s becoming even more widely recognized from neurosciences, epigenetics, and clinical research on observation of infant-caregiver interaction that daily cumulated micro-traumatic experiences cause damages not only to one’s mental health and identity, but also to immune system, leading to metabolic, eating, sleeping, affective, behavioural, cognitive and linguistic, and social disorders in adults as well as in children and infants. Relational Psychoanalytic treatment argues that the therapeutic change is related to expanding levels of consciousness and exploring new ways of being in the world. Clinical examples are provided.展开更多
Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the gene...Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the general pediatrician should be able to attend its initial management. Objective: To describe final diagnosis of patients with prolonged aPTT in preoperative study. Materials and Methods: This is a descriptive study of patients referred from otorhinolaryngology. Results: Totally, 508 adenoidectomies and/or tonsillectomies were performed in our center, 38 of which referred patients (7.5%) with prolonged aPTT, and 30 of which met inclusion criteria. The median age was 4 years. 56.6% of patients were males. 76.6% of patients normalized aPTT at the second follow-up. Among these, 73.9% showed a normal study, 4.3% ha2d lupus anticoagulant and in 21.7% Von Willebrand disease was detected. Among patients that persisted with prolonged aPTT, 42.8% had coagulant factors deficiency, 28.5% had lupus anticoagulant and in 28.5% of patients a diagnosis could not be achieved with the tests used in the present study. Multivariate analysis did not show correlation between final diagnosis and the variables measured. Conclusion: The presence of a prolonged aPTT in children under preoperative study is due to a pre-analytic factor in the majority of cases or to the presence of lupus anticoagulant, normalizing values on follow-up. We suggest that a new aPTT be performed on these patients, and only those that persist altered or present a symptoms and family history of coagulation disorders be referred to hematology.展开更多
文摘基于临床表现的疾病预测模型是临床决策支持系统(Clinical Decision Support System,CDSS)的一个重要研究内容.现有临床决策支持系统往往将临床病例作为训练数据集,以临床表现的描述文字为特征,采用统计机器学习方法构建疾病预测模型.然而,在医疗领域往往存在着样本数据集不均衡的问题,导致模型的预测效果降低.欠采样技术是目前解决样本不均衡问题的常用手段.其主要采用一定的方法从多数类样本中抽取部分样本,与少数类样本组成平衡数据集后再构建模型.现有的欠采样方法往往可以显著提高模型对少数类样本的召回率,然而其通常也会造成模型准确率的降低,从而限制了预测模型的整体提升效果.为此,该文提出了一种新的基于迭代提升欠采样的集成分类方法(Under-Sampling with Iteratively Boosting,USIB),该方法迭代地从多数类样本中进行欠抽样,构建多组弱分类器,并采用加权组合方式将这些弱分类器构成一个强分类器,从而提升样本不平衡条件下单种疾病预测效果.另外,医学病例样本数据集通常是多类别、多标签的,为此,该文将多个单种疾病的预测模型进行组合构成一个多标签疾病预测模型,以满足临床意义上的多病种以及并发症的诊断.为了进一步提升多标签预测模型的效果,该文设计了一种基于标签最大互信息生成树的标签选择方法(Labels Selection method based on Maximum Mutual Information Spanning Tree,LS-MMIST),该方法根据原始数据集的分布构建标签之间的最大互信息生成树,在每一次的样本预测阶段,借助树中疾病标签之间的关系确定最终的预测标签集合.实验方面,该文首先选择三种公开的不均衡二分类数据集和我们私有的四种稀有疾病的数据集,对该文提出的迭代提升欠采样方法进行性能评估.其次,分别对比了该文提出的多标签预测模型与现有的多标签预测技术在中医和西医两种多标签数据集上的预测性能.实验结果显示,相对于目前主流的八种欠采样以及两种集成采样技术,该文提出的迭代提升欠采样方法在各个不均衡二分类数据集上的F1值平均提升22.58%;与现有的各种多标签预测技术相比,该文提出的多标签预测方法在西医和中医数据集上正确率分别提升6.30%和12.43%,召回率分别提升4.33%和5.86%,F1值分别提升5.48%和11.16%.
文摘AIM： To assess the efficacy and safety of Saccharomyces boulardii （S. boulardii） in acute watery diarrhoea and its role in reducing the frequency of episodes of diarrhoea in subsequent two months. METHODS： Children from 2 mo to 12 years of age, with acute diarrhoea were selected according to inclusion criteria and randomised in S. boulardii group （treated with ORS, nutritional support and S. boulardii, 250 mg bid） and in control group （treated with ORS and nutritional support only）. Active treatment phase was 5 d and each child was followed for two months afterwards. Frequency and consistency of stools as well as safety of drug was assessed on every visit. A comparison of two groups was done in terms of number of diarrhoeal episode in subsequent two months. RESULTS： There were fifty patients in each group. Baseline characteristics such as mean age and the average frequency of stools were comparable in S. boulardii and control group at the time of inclusion in the trial. By d 3 it reduced to 2.7 and 4.2 stools per d respectively and by d 6 it reduced to 1.6 （5. boulardii Group） and 3.3 （control group）. The duration of diarrhoea was 3.6 d in S. boulardii group whereas it was 4.8 d in control group （P = 0.001）. In the following two months, S. boulardii group had a significantly lower frequency of 0.54 episodes as compared to 1.08 episodes in control group. The drug was well accepted and tolerated. There were no reports of the side effects during treatment period CONCLUSION： S. boulardii significantly reduces the frequency and duration of acute diarrhoea. The consistency of stool also improves. The drug is well-tolerated.
文摘Healthcare-associated infection is a common problem of newborn in neonatal intensive care units. It results in high mortality rate and serious complications. The Aim: to assess the incidence, etiology and the mortality of healthcareassociated infections of patients in neonatal intensive care unit at King Abdl Aziz Specialist Hospital (KAASH), Taif, Kingdom of Saudi Arabia. Material and Methods: This is a retrospective study including 8033 neonates admitted to neonatal intensive care unit during period between April, 2006 and December, 2012. The health-care associated infection rate, mortality rate, causative organism and risk factors were studied. Results: The prevalence of health-care associated infection was found to be 6.03%;the mortality rate was 27.1%. The highest prevalence was among children with the birth weight below 1000 g. The most frequent causative pathogen was klebseilla spp, followed by other gram negative bacilli. Conclusion: The rate of healthcare-associated infections in neonatal intensive care unit at KAASH was relatively high. In addition, the mortality rate was observed to be high (27.1%) owing to the high virulence of the causative organisms.
文摘Pulmonary diseases are common throughout the world,especially in developing countries.These diseases include chronic obstructive pulmonary diseases,pneumonia,asthma,tuberculosis,fibrosis,and recently COVID-19.In general,pulmonary diseases have a similar footprint on chest radiographs which makes them difficult to discriminate even for expert radiologists.In recent years,many image processing techniques and artificial intelligence models have been developed to quickly and accurately diagnose lung diseases.In this paper,the performance of four popular pretrained models(namely VGG16,DenseNet201,DarkNet19,and XceptionNet)in distinguishing between different pulmonary diseases was analyzed.To the best of our knowledge,this is the first published study to ever attempt to distinguish all four cases normal,pneumonia,COVID-19 and lung opacity from ChestX-Ray(CXR)images.All models were trained using Chest-X-Ray(CXR)images,and statistically tested using 5-fold cross validation.Using individual models,XceptionNet outperformed all other models with a 94.775%accuracy and Area Under the Curve(AUC)of Receiver Operating Characteristic(ROC)of 99.84%.On the other hand,DarkNet19 represents a good compromise between accuracy,fast convergence,resource utilization,and near real time detection(0.33 s).Using a collection of models,the 97.79%accuracy achieved by Ensemble Features was the highest among all surveyed methods,but it takes the longest time to predict an image(5.68 s).An efficient effective decision support system can be developed using one of those approaches to assist radiologists in the field make the right assessment in terms of accuracy and prediction time,such a dependable system can be used in rural areas and various healthcare sectors.
文摘PhV （pharmacovigilance） knowledge has the outcome of being inadequate in particular due to the lack of instruction. Pediatricians have to face the realization that over-the-counter medicines increments the peril of ADRs （adverse drug reactions） has become a public health concern. The purpose of this article is to disseminate knowledge of the PhV and to highlight the cultural and organizational difficulties for its implementation. The objectives of promoting the organization of specific training courses and research projects aimed at： （1） to foster the culture of iatrogenic disease in pediatrics; （2） to improve the appropriateness of prescribing drugs in children; （3） to enco.urage spontaneous reporting of ADRs in children; （4） to involve Pediatricians in PASS （post-authorization safety studies） according to GCP, GVP and ENCEPP Code of Conduct. An up to date proposal of PhV, a procedure of preparation improves the productivity of creating novel informative reports which can be utilized for a benefit/risk scrutiny making strides in medicine prescription. In this context, FP-MCRN （family paediatficians-medicines for children research network） established with the aim of developing competence, infrastructure and education for paediatric clinical trials, plays a crucial role in paediatric PhV, through an improvement of PhV training, a correct research methodology and very strong relationship with the families. The initial necessity is cultural, implementing culture of iatrogenic illnesses and a watchful evaluation of the importance of PASS by FPs （family pediatricians）. Participation in clinical trials that generates a precise database administered by FPs together with follow-up outcomes becomes relevant and vital for a scrupulous and accurate assessment of ADRs. PASS can foresee on one hand training and information regarding the proper use of drugs in children and possible iatrogenic pathologies caused by their improper use, the other to constitute a territorial survey in the prescriptive appropriateness and safety of pediatric drugs aimed at evaluating the risk-benefit balance on usage.
文摘Fifty years have passed from the first official recognition of the methylmercury （MeHg） poisoning in Niigata （so called the second Minamata disease）, Japan in 2015. The first case of MeHg poisoning was found in January 1965, when two surveys were carried out for 20,000 inhabitants lived within 15 km from the mouth of the Agano river. From these surveys, 26 cases （including 5 cases of death） were officially recognized as MeHg poisoning. Moreover, 9 cases who had no symptoms but whose hair mercury concentration were over 200 ppm were found. Within 20 cases, 15 cases are among 26 cases officially recognized as having MeHg poisoning and 5 cases are among 9 cases who had no symptoms but whose hair mercury concentration were over 200 ppm in 1965. The distal dominant sensory disturbances of the extremities lasted for more than several decades among 20 cases. The sensory disturbance of the bilateral distal extremities could be used as the gold standard for the diagnosis of MeHg poisoning in the exposed areas. The distal dominant sensory disturbance of the extremities is a typical characteristic and important sign of the MeHg poisoning.
文摘Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. </span><b><span style="font-family:Verdana;">Patients and Methods: </span></b><span style="font-family:Verdana;">A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p <</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">0.05 and the 95% confidence interval. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The frequency of referrals was 54.3%.</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">g, hypothermic in 43.8% and febrile in 15.1%.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times </span><span style="font-family:Verdana;">in the less than 28 week</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> of amenorrhea (WA) (ORa = 18</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">5;CI = 1.9</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">180;</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6;CI = 1.4</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">29.7;p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.
文摘Objectives: This study describes the incidence of all fatal cases associated with Pandemic Influenza A (H1N1) in Yemen. It sets out to highlight the factors associated with poor prognosis *The authors declare that they have no competing interests. to enhance the implementation of prevention and control programs. Methods: The study is based on retrospective analysis of available data until 14 March 2010, as compiled by the disease control and surveillance team in Yemen. Results: Between 16 June 2009 and 14 March 2010, a total of 33 laboratory-confirmed death cases associated with pandemic influenza A (H1N1) were reported to the Diseases Control and Surveillance in the Ministry of Public Health and Population. During this period, a total of 6049 suspected influenza A (H1N1) cases were recorded. With this denominator, the case fatality rate (CFR) was 0.54%. During June through August, H1N1 confirmed cases were infrequently detected, including only 30;however, from September through December, over 200 confirmed cases were reported each month. Of the 33 cases recorded, 25 were male (76%) and 8 were female (24%), male to female ratio being 3:1. Overall median age of the death cases was 30.8 years (range 1 - 55). The most common diagnosis upon admission was pneumonia. Out of the deaths, twenty five (75.8%) had no documented underlying diseases. Chronic cardiovascular disease (9.1%) was the most commonly reported disease and 2 deaths (6.1%) were recorded as pregnant women. Conclusions: The most common diagnosis upon admission was pneumonia. Chronic cardiovascular diseases were the most commonly reported underlying conditions, while the most identified risk factor was pregnancy. These findings should be taken into consideration, when vaccination strategies are employed.
文摘It’s becoming even more widely recognized from neurosciences, epigenetics, and clinical research on observation of infant-caregiver interaction that daily cumulated micro-traumatic experiences cause damages not only to one’s mental health and identity, but also to immune system, leading to metabolic, eating, sleeping, affective, behavioural, cognitive and linguistic, and social disorders in adults as well as in children and infants. Relational Psychoanalytic treatment argues that the therapeutic change is related to expanding levels of consciousness and exploring new ways of being in the world. Clinical examples are provided.
文摘Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the general pediatrician should be able to attend its initial management. Objective: To describe final diagnosis of patients with prolonged aPTT in preoperative study. Materials and Methods: This is a descriptive study of patients referred from otorhinolaryngology. Results: Totally, 508 adenoidectomies and/or tonsillectomies were performed in our center, 38 of which referred patients (7.5%) with prolonged aPTT, and 30 of which met inclusion criteria. The median age was 4 years. 56.6% of patients were males. 76.6% of patients normalized aPTT at the second follow-up. Among these, 73.9% showed a normal study, 4.3% ha2d lupus anticoagulant and in 21.7% Von Willebrand disease was detected. Among patients that persisted with prolonged aPTT, 42.8% had coagulant factors deficiency, 28.5% had lupus anticoagulant and in 28.5% of patients a diagnosis could not be achieved with the tests used in the present study. Multivariate analysis did not show correlation between final diagnosis and the variables measured. Conclusion: The presence of a prolonged aPTT in children under preoperative study is due to a pre-analytic factor in the majority of cases or to the presence of lupus anticoagulant, normalizing values on follow-up. We suggest that a new aPTT be performed on these patients, and only those that persist altered or present a symptoms and family history of coagulation disorders be referred to hematology.
