ABSTRACT
INTRODUCTION@#Chest physiotherapy (CPT) may benefit children aged below five years who suffer from lower respiratory tract infection (LRTI). However, its effects depend on the technique used. This study aimed to determine whether mechanical CPT using the LEGA-Kid® mechanical percussion device is superior to manual CPT in children with LRTI.@*METHODS@#Children aged five months to five years who were admitted and referred for CPT from January to April 2017 were randomised to either manual CPT or mechanical CPT with LEGA-Kid. Outcomes measured before intervention and two hours after intervention were respiratory rate (RR), oxygen saturation and modified Respiratory Distress Assessment Instrument (mRDAI) score.@*RESULTS@#All 30 enrolled patients showed significant reduction in post-intervention RR and mRDAI scores. There was an 8% reduction in RR for the manual CPT group (p = 0.002) and a 16.5% reduction in the mechanical CPT group (p = 0.0001), with a significantly greater reduction in the latter (p = 0.024). mRDAI scores decreased by 2.96 in the manual group (p = 0.0001) and 3.62 in the mechanical group (p = 0.002), with no significant difference between the groups. There was no significant improvement in oxygen saturation, and no adverse events were observed after CPT.@*CONCLUSION@#Children receiving both manual and mechanical CPT showed improvements in respiratory distress symptoms, with no adverse effects. A combined strategy of nebulised hypertonic saline followed by CPT for LRTI removes airway secretions and results in improvements in moderately severe respiratory distress. The LEGA-Kid mechanical CPT method is superior to manual CPT in reducing the RR.
Subject(s)
Child , Humans , Percussion/methods , Physical Therapy Modalities , Respiratory Distress Syndrome, Newborn , Respiratory Therapy/methods , Respiratory Tract Infections , Single-Blind MethodABSTRACT
BACKGROUND: Palpation and percussion are standard bedside techniques used to diagnose hepatomegaly. Ultrasonography is a noninvasive and accurate method for measurement of liver size, but many patients in developing countries have limited access to it. We compared the accuracy of palpation and percussion in a rural population in central India, using ultrasonography as a reference standard. METHODS: The study design was a blinded, cross-sectional analysis of a hospital-based case series. Three physicians, blind to clinical data and to each other's results, independently used palpation and percussion to detect hepatomegaly. Diagnostic accuracy was measured by computing sensitivity, specificity, and likelihood ratio values. Inter-physician agreement was assessed using the kappa statistic. RESULTS: Of the 180 study patients, 36 (20%) had enlarged liver on ultrasonography. The likelihood ratios for findings at both palpation (2.2, 3.0, and 2.5 for the three physicians, respectively) and percussion (1.1 for all three physicians) as predictors of true hepatomegaly were low. The kappa values for inter-observer agreement between three physicians for the presence of hepatomegaly at palpation (=0.44-0.53) and percussion (=0.17-0.33) were low, indicating poor reliability of these techniques. CONCLUSION: Clinical assessment of hepatomegaly by palpation and percussion lacks both accuracy and reliability.
Subject(s)
Adult , Aged , Clinical Competence , Confidence Intervals , Cross-Sectional Studies , Double-Blind Method , Female , Hepatomegaly/diagnosis , Hospitals, Rural , Humans , India , Male , Middle Aged , Odds Ratio , Palpation/methods , Percussion/methods , Physical Examination/standards , Predictive Value of Tests , Reference Values , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Ultrasonography, DopplerSubject(s)
Dental Implantation, Endosseous/adverse effects , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Prosthesis Failure , Alveolar Bone Loss/diagnosis , Dental Plaque Index , Dinoprostone/physiology , Gingival Hemorrhage/diagnosis , Gram-Negative Bacteria/isolation & purification , Prosthesis-Related Infections/microbiology , Interleukin-1/physiology , Percussion/methods , Periodontal Pocket/diagnosis , Periodontitis/diagnosis , Stomatitis/diagnosis , Stomatitis/etiologySubject(s)
Periodontal Diseases/diagnosis , Alveolar Bone Loss/diagnosis , Gingival Hemorrhage/diagnosis , Percussion/methods , Periodontal Attachment Loss/diagnosis , Periodontal Diseases , Periodontal Diseases/immunology , Periodontal Diseases/microbiology , Periodontal Index , Periodontal Pocket/diagnosis , Disease Progression , Risk Factors , Tooth Mobility/diagnosisABSTRACT
A study was conducted on 80 patients admitted in a teaching hospital to see the accuracy of two palpatory methods (Supine palpation and Middleton's manoeuvre) and three percussion methods (Traube's space percussion, Castell's and Nixon's manoeuvres) in the diagnosis of splenomegaly. Ultrasonographic findings were considered as gold standard for diagnosing splenomegaly. Mean age of study subjects was 31.5 years and mean Quetelet's index was 17.8 +/- 2.6 kg/m2. Sensitivity of Middleton's and Castell's manoeuvres was similar (85.7%) and higher than other manoeuvres. Nixon's manoeuvre had the least sensitivity (66.7%). Specificity was highest (92.1%) with supine palpation and least (31.6%) with Castell's manoeuvre. Supine palpation showed highest positive predictive value (91.7%). Receiver Operating Characteristics curves showed greater area with middleton's manoeuvre (0.93) followed by supine palpation (0.92), Castell's manoeuvre (0.75) and Traube's space percussion (0.74), the findings of the study suggests that palpatory methods like Middeton's manoeuvre and Supine palpation should be routinely used for diagnosing splenomegaly among non-obese individuals.
Subject(s)
Adolescent , Adult , Double-Blind Method , Female , Humans , Male , Middle Aged , Palpation/methods , Percussion/methods , ROC Curve , Sensitivity and Specificity , Splenomegaly/diagnosisABSTRACT
BACKGROUND: Shifting dullness and fluid wave are two techniques commonly used to detect ascites. However, these may fail to detect moderate or minimal ascites. Ultrasonography is a good non-invasive method to detect ascites but may not be available in distant rural areas of India. We assessed the utility of the puddle sign and auscultatory percussion for detecting ascites. METHODS: Sixty-six patients with suspected ascites were included in the study. Those with a previous history of ascites, or therapeutic paracentesis and in whom ascites was detected by shifting dullness or fluid wave were excluded. The puddle sign and auscultatory percussion were elicited in all the patients. Ultrasonography was used as the gold standard. To eliminate any observer bias the investigators were blinded to each others' findings. RESULTS: Auscultatory percussion had a greater sensitivity (65.7% v. 45%, p < 0.05) but a lower specificity than the puddle sign (48.4% v. 67.7%, p < 0.05). There were no significant differences between positive and negative predictive values and the positive and negative likelihood ratios. CONCLUSION: Auscultatory percussion is a better method than puddle sign for detecting ascites as it has a greater sensitivity.
Subject(s)
Adult , Ascites/diagnosis , Auscultation , Female , Humans , Male , Middle Aged , Percussion/methods , Physical ExaminationSubject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Infant, Newborn , Clinical Diagnosis , Diagnosis, Oral/methods , Dental Care for Children/methods , Auscultation/methods , Dental Restoration, Permanent , Feeding Behavior/classification , Palpation/methods , Patient Education as Topic , Percussion/methods , Pit and Fissure Sealants/therapeutic use , Dental Prophylaxis/methods , Surgery, OralSubject(s)
Adult , False Positive Reactions , Female , Humans , Male , Percussion/methods , Sensitivity and Specificity , Splenomegaly/diagnosisABSTRACT
El diagnóstico de las fracturas de cadera puede no ser claro. La historia y el examen físico pueden ser equívocos y, a veces, los hallazgos radiográficos ser de poco valor, aun en retrospectiva. Aquellos pacientes con hallazgos clínicos sugestivos de una fractura en la cadera, pero sin hallazgos radiográficos, pueden considerarse como portadores de una posible fractura oculta y necesitar de estudios diagnósticos especiales. Se presenta a los lectores otro signo para la detección temprana de las fracturas de cadera, incluyendo las radiográficamente ocultas
Subject(s)
Auscultation/methods , Diagnosis, Differential , Hip Fractures/diagnosis , Hip/injuries , Percussion/methods , RadiographyABSTRACT
Os autores, através desta revisäo bibliográfica, apresentam um roteiro para o exame físico do aparelho respiratório e comentam as alteraçöes fisiopatológicas que däo origem aos sons pulmonares, sugerindo uma classificaçäo simplificada
Subject(s)
Humans , Physical Examination/methods , Respiratory System/physiopathology , Auscultation/methods , Palpation , Percussion/methods , Respiratory Sounds/diagnosis , VibrationSubject(s)
Humans , Male , Female , Clinical Diagnosis , Tooth Injuries/diagnosis , Analgesics/therapeutic use , Diagnosis, Oral/methods , Dental Pulp Diseases/diagnosis , Dental Pulp Diseases , Pain , Pain/classification , Pain/diagnosis , Pain/drug therapy , Pain/etiology , Palpation/methods , Percussion/methods , Radiography, Dental/methods , Tooth , Tooth/pathology , Tooth InjuriesABSTRACT
Para se estabelecer valores de referncia das medidas hepaticas, foram avaliadas 1232 criancas de ambos os sexos, de zero a 10 anos de idade. As medidas hepaticas foram as seguintes: comprimento total na lina axilar anterior , comprimento total na linha hemiclavicular, comprimento total da base do apendice xifoide a borda inferior, comprimento do rebordo costal a borda inferior na linha hemiclavicular. A analise estatistica mostrou que as medidas apresentaram co relacao a idade, peso e estatura, mas nao com sexo. A partir da relacao entre as variaveis e as medidas hepaticas foram estabelecidas formulas que permitiram estimar os maiores e menores valores, de acordo com os limites de estatura e peso em cada faixa etaria. Estas formulas sao de dificil manuseio sendo entao propostas tabelas praticas em que os valores sao apresentados em percentis
Subject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Humans , Male , Female , Anthropometry , Liver/anatomy & histology , Palpation/methods , Percussion/methods , Regression Analysis , Weight by Age , Weight by HeightABSTRACT
O autor faz breves consideraçöes sobre o diagnóstico da apendicite aguda. A seguir descreve a técnica para pesquisa do sinal da percussäo do calcanhar comparando-o com os demais sinais físicos. Para tanto, estudou-os em trinta pacientes operados com diagnóstico de apendicite aguda. Conclui pela validade do referido sinal no exame físico do paciente cirúrgico