Acupoint application for exogenous fever: a multi-central retrospective cohort study / 中国针灸

OBJECTIVE@#To explore the effectiveness on exogenous fever and the characteristics of effective population, as well as the specialties of prescription of acupoint application.@*METHODS@#Using the internet electronic diagnosis and treatment platform (Spring Broadcast Wanxiangyun Clinic Database, and the main TCM suitable technology promoted by this platform is acupoint application therapy), from August 24, 2020 to November 5, 2020, the patients complained with fever and diagnosed as common cold, with a record of initial visit and at least one return visit, were included as the subjects. According to whether acupoint application therapy was received or not, the subjects were divided into an exposure group (with acupoint application therapy, 26 664 cases) and a non-exposure group (without acupoint application therapy, 515 cases). Using the propensity score, the mixed factors, e.g. age and sex, were matched between the two groups. The disappearance rate of fever (within 2 days) and the time for the first fever disappearance were taken as the effect indexes. The association rules extraction was adopted to analyze the characteristics of effective population and acupoint application prescription in treatment of exogenous fever.@*RESULTS@#After propensity score matching, there were 1 229 cases in the application group and 423 cases in the non-application group. The disappearance rate of fever in the application group was 1.82 times as high as that in the non-application group (P<0.05). The time for the first fever disappearance in the application group was shorter than the non-application group (P<0.01). A total of 5 370 cases were effective with acupoint application therapy, of which, the median age was 2 years old and the proportion of children patients under 6 years old was relatively high. In the effective crowd, the most commonly-used acupoints were Shenque (CV 8), Dazhui (GV 14), Yongquan (KI 1) and Tiantu (CV 22), etc. Shenque (CV 8) and Dazhui (GV 14) were highly associated and the support was 62.57%. The most common herbal materials in the acupoint application therapy included Radix et Rhizoma Rhei, Natrii Sulfas, Radix Scutellariae, Herba Ephedrae and Radix Bupleuri, etc. Radix et Rhizoma Rhei and Natrii Sulfas were most commonly used at Shenque (CV 8) and the supports were 57.49% and 57.21% respectively. Herba Ephedrae was most commonly applied to Shenque (CV 8) and Dazhui (GV 14) and the supports were 48.21% and 43.91% respectively. Radix Bupleuri was the most common herb at Dazhui (GV 14) with the support of 46.61%. Besides, the most commonly combined western drugs included cefixime and keteling in the acupoint application therapy and the supports were 13.07% and 12.72% respectively.@*CONCLUSION@#Acupoint application is effective on exogenous fever. The common therapy refers to Radix et Rhizoma Rhei and Natrii Sulfas plaster at Shenque (CV 8), while Herba Ephedrae and Radix Bupleuri at Dazhui (GV 14).

Febre em crianças: procura de pais por serviços médicos de emergência / Fever in children: parents' search for urgent and emergency services

Resumo O estudo analisa a compreensão de pais ou responsáveis por crianças de zero a cinco anos acerca da febre, da condução e do atendimento desse quadro, realizado no serviço de urgência e emergência. A pesquisa qualitativa, por meio da técnica de análise temática, foi feita a partir de entrevistas com 14 pais ou responsáveis que procuraram um serviço pediátrico de urgência e emergência em um município do interior de São Paulo por esse motivo. Os dados coletados foram analisados por meio da técnica de análise temática. As experiencias dos pais que procuram esses serviços relacionam-se a três temas principais: temor da febre; os cuidados com criança febril; e a experiência de atendimento no serviço de urgência e emergência. Identificou-se que o medo exagerado da febre prevalece e que os pais/responsáveis se sentem seguros frente à tecnologia existente nos serviços de urgência e emergência. Os cuidados adotados, todavia, nem sempre são os recomendados para a situação apresentada.

Abstract The study analyses the understanding of parents or guardians of children aged zero to five years old about fever, the conduct and care for this condition, carried out in the urgent and emergency service. The qualitative research, which used the thematic analysis technique, was carried out through interviews with 14 parents or guardians who sought an urgent and emergency Pediatric Service in a municipality in the countryside of São Paulo for this reason. The experiences of parents who seek these services are associated to three main topics: fear of fever; care for a febrile child; and the experience of care at the urgent and emergency services. It was identified that an exaggerated fear of fever predominates and that parents / guardians feel safe regarding the existing technology found in urgent and emergency services. The adopted precautions, however, are not always those recommended for the existing situation.

Manejo não farmacológico da febre e hipertermia da criança: revisão integrativa / Manejo no farmacológico de la fiebre e hipertermia en niños: revisión integradora / Non-pharmacological fever and hyperthermia management in children: an integrative review

Resumo Objetivo: Identificar as intervenções não farmacológicos para febre e hipertermia em crianças indicados na literatura científica. Métodos: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados Lilacs, PubMed e CINAHL e as bibliotecas COCHRANE e SciELO. Foram incluídos artigos que abordassem as intervenções não farmacológicas para febre e hipertermia, publicados em português e inglês, no período de 2000 a 2019. Resultados: A amostra foi constituída por 27 artigos, que foram agrupados, conforme suas similaridades, em sete categorias. As intervenções utilizadas foram: banhos; compressas mornas; sponging ; incentivo à ingestão de líquidos; bolsas de gelo e cobertores refrigerados; e, por último, a categoria ventilação do ambiente. Observaram-se diferentes intervenções no manejo não farmacológico de febre e hipertermia. Conclusão: A prática de medidas não farmacológicas isoladamente não é recomendada para o tratamento de febre em crianças, exceto as intervenções que auxiliem nas respostas fisiológicas do corpo. Os resultados ressaltam a recomendação da realização de novas pesquisas que redundem em evidências para fundamentar o melhor cuidado do enfermeiro pediatra à criança com febre.

Resumen Objetivo: Identificar las intervenciones no farmacológicas para la fiebre e hipertermia en niños recomendadas en la literatura científica. Métodos: Se trata de una revisión integradora de la literatura realizada en las bases de datos Lilacs, PubMed y CINAHL y las bibliotecas COCHRANE y SciELO. Se incluyeron artículos que abordaran las intervenciones no farmacológicas para la fiebre e hipertermia, publicados en portugués e inglés, en el período de 2000 a 2019. Resultados: La muestra estuvo compuesta por 27 artículos, que fueron agrupados en siete categorías según sus similitudes. Las intervenciones utilizadas fueron: baños, compresas tibias, sponging , incentivo a la ingesta de líquidos, bolsas de hielo y mantas refrigeradas y, por último, la categoría ventilación del ambiente. Se observaron diferentes intervenciones en el manejo no farmacológico de la fiebre e hipertermia. Conclusión: No se recomienda la práctica de medidas no farmacológicas de forma aislada para tratar la fiebre en niños, excepto las intervenciones que ayuden a las respuestas fisiológicas del cuerpo. Los resultados resaltan la recomendación de realizar nuevos estudios que tengan como resultado evidencias para fundamentar un mejor cuidado del enfermero pediatra a niños con fiebre.

Abstract Objective: To identify non-pharmacological interventions for fever and hyperthermia in children indicated in the scientific literature. Methods: an integrative literature review carried out in the LILACS, PubMed and CINAHL databases and in the COCHRANE and SciELO libraries. Articles that addressed non-pharmacological interventions for fever and hyperthermia, published in Portuguese and English, from 2000 to 2019, have been included. Results: The sample consisted of 27 articles, which were grouped, according to their similarities, into seven categories. The interventions used were baths, warm compresses, sponging, encouraging fluid intake, ice packs, cooled blankets, and room ventilation. Different interventions were observed in non-pharmacological fever and hyperthermia management. Conclusion: Practicing non-pharmacological measures alone is not recommended for fever treatment in children, except for interventions that assist in the physiological responses of the body. The results highlight the recommendation of conducting further research that results in evidence to support the best care provided by pediatric nurses to children with fever.

Conocimientos y manejo de la fiebre en padres de niños menores de 5 años en un hospital pediátrico / Knowledge and management of fever in parents of children under 5 years of age at a children's hospital

Introducción. La fiebre en pediatría es motivo de consulta frecuente. El objetivo fue evaluar los conocimientos, actitudes y temores de los padres ante la fiebre de sus hijos.Material y métodos. Estudio observacional, analítico, transversal. En 2018, se realizó una encuesta a padres de niños de entre 6 meses y 5 años que asistieron al Hospital de Niños Ricardo Gutiérrez de la Ciudad de Buenos Aires.Se analizó la asociación entre las variables sociodemográficas y los conocimientos, actitudes y temores frente al cuadro febril.Resultados. Se realizaron 201 encuestas. El 56,7 % de los padres consideró que la fiebre era mala para la salud. El 37 % definió fiebre entre 37 °C y 37,5 °C, y el 59 %, 38-38,5 ºC. La media de temperatura considerada grave fue 39,2 °C (desvío estándar 0,69). El 93 % de los cuidadores utilizaba medidas físicas; el 97 % administraba antitérmicos y el 14,5 % los alternaba. Los temores a las consecuencias fueron, en el 82 %, convulsiones; en el 41 %, deshidratación; en el 18 %, daño cerebral y, en el 12 %, muerte. El 86,5 % despertaba a sus hijos para administrarles antitérmico. En el estrato de mayor instrucción materna, fue menor el temor a la fiebre (odds ratio0,5; intervalo de confianza del 95 %: 0,28-0,91).Conclusiones. Un tercio de los encuestados consideró fiebre valores bajos de temperatura. El temor a la fiebre fue elevado y el nivel de instrucción materna podría mitigarlo.

Introduction. In pediatrics, fever is a common reason for consultation. The objective was to assess parental knowledge, behaviors, and fears in the management of fever in their children.Materials and methods. Observational, analytical, cross-sectional study. In 2018, a survey was administered to the parents of children aged 6 months to 5 years who attended Hospital de Niños Ricardo Gutiérrez, in the Autonomous City of Buenos Aires. The association between sociodemographic outcome measures and knowledge, behaviors, and fears in cases of fever was analyzed.Results. A total of 201 surveys were completed: 56.7 % of parents considered that fever was bad for health; 37 % defined fever between 37 °C and 37.5 °C, and 59 %, between 38 °C and 38.5 °C. The mean temperature considered severe was 39.2 °C (standard deviation: 0.69). Physical methods were used by 93 % of caregivers; 97 % administered antipyretic agents, and 14.5 % used alternating agents. Fears of consequences included seizures in 82 %, dehydration in 41 %, brain damage in 18 %, and death in 12 %. Also, 86.5 % woke up their children to give them an antipyretic agent. Among the higher maternal education level, fear of fever was lower (odds ratio: 0.5; 95 % confidence interval: 0.28-0.91).Conclusions. One-third of survey respondents considered low body temperature values as fever. Fear of fever was high, and the level of maternal education may mitigate it.

Clinical management of children with fever: a cross-sectional study of quality of care in rural Zambia

Objective:To evaluate current practices and standards of evaluation and treatment of childhood febrile illness in Southern Province, Zambia.Methods:From November to December 2013, we conducted a cross-sectional survey of facilities and health workers and we observed the health workers' interactions with febrile children and their caregivers. The facility survey recorded level of staffing, health services provided by the facility, availability and adequacy of medical equipment, availability of basic drugs and supplies and availability of treatment charts and guidelines. The health worker survey assessed respondents' training, length of service, access to national guidelines and job aids for managing illnesses, and their practice and knowledge on management of neonatal and child illnesses. We also conducted exit interviews with caregivers to collect information on demographic characteristics, chief complaints, counselling and drug dispensing practices.Findings:This study included 24 health facilities, 53 health workers and 161 children presenting with fever. Facilities were insufficiently staffed, stocked and equipped to adequately manage childhood fever. Children most commonly presented with upper respiratory tract infections (46%; 69), diarrhoea (31%; 27) and malaria (10%; 16). Health workers insufficiently evaluated children for danger signs, and less than half (47%; 9/19) of children with pneumonia received appropriate antibiotic treatment. Only 57% (92/161) were tested for malaria using either rapid diagnostic tests or microscopy.Conclusion:Various health system challenges resulted in a substantial proportion of children receiving insufficient management and treatment of febrile illness. Interventions are needed including strengthening the availability of commodities and improving diagnosis and treatment of febrile illness

Antipyretic effects of hydro-methanol extract ofMelia azedarach Linn, seeds and Cucumis melo Linn, seeds in experimental rabbits

To investigate the antipyretic activity of hydro-methanol extract of Melia azedarach Linn. [HMEMA] seeds and Cucumis melo Linn. [HMECM] seeds in experimental animals. Baker's yeast was used to induce fever in rabbits which were divided into six groups. The animal groups were thereafter administered distilled water [control], paracetamol [reference standard, 150mg/kg], HMEMA [250mg/kg], HMEMA [500mg/kg], HMECM [250mg/kg] and HMECM [500mg/kg] respectively. HMEMA and HMECM were also phytochemically screened for tannins, alkaloids, phenols, flavonoids, saponins and cardiac glycosides. Results indicate that hydro-methanol extract of M. azedarach Linn. Seeds [250mg/kg and 500mg/kg] significantly [p<0.001, p<0.05 respectively] reduced the elevated body temperature in dose dependant manner. Insignificant to no antipyretic effect was produced by hydro-methanol extract of Cucumis melo L. seeds. Phytochemical analysis of the HMEMA showed the presence of flavonoids, saponins, tannins, phenols, alkaloids and cardiac glycosides While HMECM was positive for flavonoids, phenols and saponins. The result shows that there exists a potential benefit in utilizing Melia azedarach L. seeds in treating fever. This property can be attributed to the presence of phytochemical constituents present in the hydro-methanol extract ofMelia azedarach L. seeds and the exact mechanism need to be evaluated

Physical methods for the treatment of fever in critically ill patients: a randomized controlled trial / Métodos físicos para tratamiento de fiebre en pacientes críticos: ensayo clínico controlado randomizado / Métodos físicos para tratamento de febre em pacientes críticos: ensaio clínico controlado randomizado

Abstract OBJECTIVE To evaluate the effects of physical methods of reducing body temperature (ice pack and warm compression) in critically ill patients with fever. METHOD A randomized clinical trial involving 102 adult patients with tympanic temperature ≥ 38.3°C of an infectious focus, and randomized into three groups: Intervention I - ice pack associated with antipyretic; Intervention II - warm compress associated with antipyretic; and Control - antipyretic. Tympanic temperature was measured at 15 minute intervals for 3 hours. The effect of the interventions was evaluated through the Mann-Whitney test and Survival Analysis. "Effect size" calculation was carried out. RESULTS Patients in the intervention groups I and II presented greater reduction in body temperature. The group of patients receiving intervention I presented tympanic temperature below 38.3°C at 45 minutes of monitoring, while the value for control group was lower than 38.3°C starting at 60 minutes, and those who received intervention II had values lower than 38.3°C at 75 minutes of monitoring. CONCLUSION No statistically significant difference was found between the interventions, but with the intervention group I patients showed greater reduction in tympanic temperature compared to the other groups. Brazilian Registry of Clinical Trials: RBR-2k3kbq

Resumen OBJETIVO Evaluar el efecto de métodos físicos (bolsa de hielo y compresa tibia) en la reducción de la temperatura corporal de pacientes críticos con fiebre. MÉTODO Ensayo clínico randomizado con 102 pacientes adultos y temperatura timpánica ≥ 38,3°C de foco infeccioso, aleatorizados en tres grupos: Intervención I ‒ bolsa de hielo asociada con antitérmico; Intervención II ‒ compresa tibia asociada con antitérmico; y Control ‒ antitérmico. La temperatura timpánica fue medida en intervalos de 15 minutos durante 3 horas. El efecto de las intervenciones fue evaluado por la prueba Mann-Whitney y Análisis de Supervivencia. Se hizo el cálculo del "Effect size". RESULTADOS Los pacientes de los grupos Intervención I y II presentaron mayor reducción en la temperatura corporal. A partir de 45 minutos de seguimiento el grupo de pacientes que recibió la Intervención I presentó valor de la temperatura timpánica inferior a 38,3°C; los del grupo control, valor menor que 38,3°C a partir de 60 minutos; y los que recibieron la Intervención II, valor menor que 38,3°C con 75 minutos de seguimiento. CONCLUSIÓN No fue encontrada diferencia estadística significativa entre las intervenciones, sin embargo los pacientes del grupo Intervención I presentaron mayor reducción de la temperatura timpánica con relación a los demás grupos. Registro Brasileño de Ensayos Clínicos: RBR-2k3kbq

Resumo OBJETIVO Avaliar o efeito de métodos físicos (bolsa de gelo e compressa morna) na redução da temperatura corporal de pacientes críticos com febre. MÉTODO Ensaio clínico randomizado com 102 pacientes adultos e temperatura timpânica ≥ 38,3°C de foco infeccioso, aleatorizados em três grupos: Intervenção I ‒ bolsa de gelo associada a antitérmico; Intervenção II ‒ compressa morna associada a antitérmico; e Controle ‒ antitérmico. A temperatura timpânica foi mensurada em intervalos de 15 minutos durante 3 horas. O efeito das intervenções foi avaliado pelo teste Mann-Whitney e Análise de Sobrevivência. Cálculo do "Effect size" foi procedido. RESULTADOS Os pacientes dos grupos Intervenção I e II apresentaram maior redução na temperatura corporal. A partir de 45 minutos de acompanhamento o grupo de pacientes que recebeu a Intervenção I apresentou valor da temperatura timpânica inferior a 38,3°C, os do grupo controle valor menor que 38,3°C a partir de 60 minutos e os que receberam a Intervenção II, valor menor que 38,3°C com 75 minutos de acompanhamento. CONCLUSÃO Não foi encontrada diferença estatística significativa entre as intervenções, porém os pacientes do grupo Intervenção I apresentaram maior redução da temperatura timpânica em relação aos demais grupos. Registro Brasileiro de Ensaios Clínicos: RBR-2k3kbq

Diretrizes de conduta e tratamento de síndromes febris periódicas: síndrome de febre periódica, estomatite aftosa, faringite e adenite / Guidelines for the management and treatment of periodic fever syndromes: periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome

Resumo Objetivo: Estabelecer diretrizes baseadas em evidências científicas para manejo da síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA). Descrição do método de coleta de evidência: A Diretriz foi elaborada a partir de cinco questões clínicas que foram estruturadas por meio do Pico (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustento das recomendações, esses foram graduados pela força da evidência e pelo grau de recomendação. Resultados: Foram recuperados e avaliados pelo título e resumo 806 trabalhos e selecionados 32 artigos, para sustentar as recomendações. Recomendações: 1. O diagnóstico da PFAPA é clínico e de exclusão, deve a suspeita ser considerada em crianças que apresentam episódios febris de origem indeterminada recorrentes e periódicos ou amidalites de repetição, intercalados com períodos assintomáticos, sobretudo em crianças em bom estado geral e com desenvolvimento pondero-estatural mantido; 2. Os achados laboratoriais são inespecíficos. Não existem alterações patognomônicas nos exames complementares; 3. A evidência que sustenta a indicação do tratamento cirúrgico (tonsilectomia com ou sem adenoidectomia) é baseada em dois ensaios clínicos randomizados não cegos que incluíram pequeno número de pacientes; 4. O uso de prednisona no início do quadro febril em pacientes com PFAPA mostrou ser eficaz. Melhores evidências ainda são necessárias para apoiar seu uso na PFAPA; 5. Apesar de os resultados obtidos de estudos com inibidores de IL-1ß serem promissores, esses são limitados a poucos relatos de casos.

Abstract Objective: To establish guidelines based on scientific evidence for the management of periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome. Description of the evidence collection method: The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation. Results: 806 articles were retrieved and evaluated by title and abstract; from these, 32 articles were selected to support the recommendations. Recommendations: 1. PFAPA is a diagnosis of exclusion established on clinical grounds, and one must suspect of this problem in children with recurrent and periodic febrile episodes of unknown origin, or with recurrent tonsillitis interspersed with asymptomatic periods, especially in children in good general condition and with preservation of weight and height development. 2. Laboratory findings are nonspecific. Additional tests do not reveal pathognomonic changes. 3. The evidence supporting an indication for surgical treatment (tonsillectomy with or without adenoidectomy), is based on two non-blinded randomized clinical trials with small numbers of patients. 4. The use of prednisone at the onset of fever in patients with PFAPA proved to be an effective strategy. There is still need for more qualified evidence to support its use in patients with PFAPA. 5. Despite promising results obtained in studies with IL-1β inhibitors, such studies are limited to a few case reports.

Febre de origem indeterminada em portador de marcapasso definitivo / Fever of unknown origin in permanent pacemaker carrier

O implante de marcapasso tem sido cada vez mais utilizado, em decorrência de sua segurança e dos baixos índices de complicação. No entanto, a infecção de dispositivos é um quadro grave, que apresenta elevada morbimortalidade e alto custo de tratamento. Algumas vezes essa infecção evolui com endocardite bacteriana, complicação cuja incidência vem aumentando nos últimos anos. É de difícil diagnóstico e tratamento, seja pela inespecificidade dos sintomas clínicos seja pela variação dos achados de imagem no ecocardiograma. Descrevemosum caso de febre de origem indeterminada em portador de marcapasso, que investigação posterior demonstrou ser decorrente de infecção dos cabos-eletrodos e de endocardite secundária. O paciente foi tratado comantibioticoterapia prolongada e retirada do sistema por cirurgia aberta.

Pacemaker implantation has increased due to their safety and low complications rate. However, the infection of the devices is a serious event with high morbidity and mortality rates and high treatment cost. Infections may evolve to bacterial endocarditis, whose incidence has increased in the last years. It is difficult to diagnose and treat due to the unspecificity of clinical symptoms and variation in imaging findings at theechocardiogram. We report a case of fever of unknown origin in a pacemaker carrier, which later proved to havebeen caused by electrode-cable infection and secondary endocarditis. The patient was treated with prolonged antibiotic therapy and retrieval of the device by open surgery.

Uso de métodos físicos para tratamento do diagnóstico de enfermagem de hipertermia em pacientes adultos internados em UTI: ensaio clínico controlado e randomizado / Use of physical methods for treatment of the nursing diagnosis of hyperthermia in adult patients at an ICU: a randomized clinical and controlled trial

A NANDA International estabelece desde 1986 o diagnóstico de enfermagem de hipertermia. Entretanto, pouco se sabe sobre quais são os melhores cuidados que devem ser prestados a pacientes adultos com temperatura corporal elevada. Geralmente, são utilizados antitérmicos associados a métodos físicos para a diminuição da temperatura. Face ao escasso conhecimento sobre os melhores cuidados de enfermagem a pacientes adultos internados em Unidade de Terapia Intensiva (UTI) com temperatura corporal elevada, questiona-se se o uso de métodos físicos (bolsa de gelo e compressa morna), ambos associados a antitérmico, é mais eficaz quando comparado a somente administração de antitérmico para a redução da temperatura corporal em pacientes adultos internados em UTI com o diagnóstico de enfermagem de hipertermia. Objetivo: Avaliar o efeito da aplicação de métodos físicos (bolsa de gelo e compressa morna) associados à administração de antitérmico na redução da temperatura corporal de pacientes com o diagnóstico de enfermagem de hipertermia internados em UTI. Materiais e Métodos: Ensaio clínico controlado randomizado, desenvolvido em 2 UTIs de adultos de um hospital de Belo Horizonte, MG, no período de março de 2012 a maio de 2013. Amostra constituída por 102 pacientes que apresentaram temperatura corporal ≥38,3°C de foco infeccioso. Os pacientes foram aleatorizados em 3 grupos: 34 pacientes receberam bolsa de gelo associada ao antitérmico (Intervenção I), 34 receberam compressa morna associada ao antitérmico (Intervenção II) e 34 receberam apenas antitérmico (controle). A temperatura timpânica foi mensurada em intervalos de 15 minutos, durante 3 horas. Empregaram-se distribuições de frequências simples, medidas de tendência central e medidas de variabilidade na análise descritiva. Na avaliação da eficácia das intervenções realizou-se o teste de Mann -Whitney e Análise de Sobrevivência. Por fim, foi calculado o tamanho do efeito da intervenção (effect size)...

Since 1986, NANDA-International (NANDA-I) establishes the nursing diagnosis of hyperthermia. However, little is known about what is the best care that must be provided to adult patients with elevated body temperature. Usually, antipyretics are used in association with physical methods to decrease the temperature. Given these considerations, and facing limited knowledge about the best nursing care to adult patients with elevated body temperature admitted in Intensive Care Unit (ICU), it is debatable if the use of physical methods (ice packs and warm compresses), associated with antipyretic is more effective than the single administration of antipyretics, to reduce body temperature in adult patients with the nursing diagnosis hyperthermia at ICU. Objective: To evaluate the effect of application of physical methods (ice packs and warm compresses) associated with administration of antipyretic to reduce body temperature of patients in ICU, with the nursing diagnosis of hyperthermia. Method: Randomized clinical and controlled trial, conducted in 2 adult ICUs in a hospital of Belo Horizonte, MG, Brazil, from March 2012 to May 2013. Sample of 102 patients with body temperature ≥38.3°C of infectious cause. Patients were randomized into three groups: 34 patients received ice packs associated with antipyretic (Intervention I), 34 received warm compresses associated with antipyretic (Intervention II) and 34 received only antipyretic (Control). Tympanic temperature was measured at 15-minute intervals for 3 hours. Descriptive data analysis was used with simple frequency distributions, measures of central tendency and measures of variability. To evaluate the effect of interventions...

Socioeconomic Correlates and the Choice of Treatment for Childhood Fever in Ghana

The study investigated the effect of household socioeconomic factors on the choice of treatment for childhood fever among children under age five in Ghana. Data from the 2008 Ghana Demographic and Health survey was used employing the multinomial probit model. Three treatment choices were considered: Government facility; Private facility and traditional/self-medication. The results suggest that the treatment of childhood fever is related to household wealth; health insurance status and residence. Government health facilities are mostly used by household's with higher wealth and household's with health insurance. Rural households are more likely to use traditional/self-medication; except those with health insurance who use government facilities. The age of the mother and birth order of the child were also found to influence the choice of treatment facility for childhood fever

Efectividad de métodos físicos y antipiréticos versus sólo antipiréticos en el manejo de fiebre en niños de 3 meses a 5 años. Instituto Nacional de Salud del Niño. Ensayo clínico aleatorizado / Effectiveness of antipyretic and physical methods versus only antipyretics in the management of fever in children 3 months to 5 years. National Institute of Child Health. Randomized clinical trial

Antecedentes: La fiebre es uno de los principales motivos de consulta pediátrica. El rol de los métodos físicos en el manejo de la fiebre es controversial. Objetivo: Comparar la efectividad de métodos físicos y antipiréticos versus sólo antipiréticos en el manejo de la fiebre en niños. Método: Ensayo clínico aleatorizado donde participaron niños desde los 3 meses hasta los 5 años que acudieron a emergencia del Instituto Nacional de Salud del Niño con fiebre. 80 pacientes fueron aleatorizados en cada grupo de comparación (paracetamol, ibuprofeno, paracetamol y métodos físicos, ibuprofeno y métodos físicos). El objetivo primario fue determinar la disminución de la temperatura luego de los minutos 15, 30, 45, 60, 90 y 120 de aplicado el tratamiento. Se evaluó también los efectos secundarios. Resultados: En los primeros 30 y 45 minutos, la disminución de la temperatura fue significativamente mayor en el grupo manejado con antipiréticos y métodos físicos (p<0.001). Entre los minutos 60 y 120 no hubo diferencia significativa entre los grupos de tratamiento. Se encontró llanto y escalofríos en el 12.5 por ciento de los pacientes manejados con antipiréticos y métodos físicos y en el 2.5 por ciento de los pacientes manejados sólo con antipiréticos, esta diferencia es estadísticamente significativa (p<0.001). Conclusiones: La efectividad del uso de antipiréticos y métodos físicos es mayor para disminuir la tempera a los minutos 30 y 45, luego la temperatura disminuye con la misma velocidad que al usar sólo antipiréticos. La presencia de efectos secundarios es mayor al usar antipiréticos y métodos físicos.

Investigação e manejo da febre em lactentes e pré-escolares / Investigation and management of fever in infants and pre-school children

Este trabalho visa apresentar uma revisão de um sintoma bastante freqüente nas consultas pediátricas, a febre. A investigação sempre deve ser realizada considerando o grupo etário. O tratamento pode ser sintomático, nos casos de infecções virais benignas, ou específico dependendo da suspeita ou confirmação de infecções invasivas.

This article is here to present a review about one of the most frequent symptoms in pediatrics, the fever. The investigation must always involve the age range. The treatment can be symptomatic, in the cases involving viral infections; Otherwise it can be specific, depending on the diagnostic hypothesis or confirmation of invasive infections

Anti-inflammatory and antipyretic activities of the ethanolic extract of Shorea robusta Gaertn. f. resin.

Shorea robusta Gaertn. f. (Sal) is one of the most important traditional Indian medicinal plants. The resin of the plant has been used in the treatment of inflammation in folklore medicine. In the present study, ethanolic extract (70%) of S. robusta resin (SRE) was investigated for its anti-inflammatory and antipyretic activities. Acute inflammation was produced by carrageenan-induced hind paw edema and sub-acute by cotton pellet-induced granuloma in male Wistar rats. The antipyretic activity of SRE was studied using Brewer’s yeast-induced pyrexia in rats. The rats were divided into five groups with five animals in each group. Group I was treated with vehicle i.e. 1% v/v Tween-80 and served as control. Groups II to IV were treated with three different doses of SRE (30, 100 and 300 mg/kg orally). Group V was treated with standard drug etoricoxib (10 mg/kg orally). The anti-inflammatory activity of SRE was assessed by per cent reduction in edema volume of carrageenan-induced hind paw edema and by per cent decrease in granuloma formation in cotton pellet-induced granuloma test. SRE (100 and 300 mg/kg) produced a significant reduction in edema volume and decrease in granulation tissue formation in rats. Significant reduction in pyrexia was observed at all the dose levels of SRE i.e. 30, 100 and 300 mg/kg. The results of the present study demonstrated anti-inflammatory and antipyretic activities of S. robusta resin and supported its traditional therapeutic use in painful inflammatory conditions and fever.

Efectividad de tratamientos antipiréticos para disminuir la temperatura corporal del lactante febril / Antipyretic effectiveness of treatments to reducethe body temperature of febrile nursling

La fiebre es uno de los signos clínicos que aparece con mayor frecuencia en los pacientes pediátricos, esta puede deberse a procesos infecciosos así como no infecciosos. El antipirético más utilizado en el tratamiento es el paracetamol, también se emplea el baño con agua tibia o la administración de ambos procedimientos. Objetivo: determinar la efectividad del paracetamol, el baño con agua tibia, y la administración de ambos tratamientos indicados para la disminución de la temperatura corporal del lactante febril de 6 a 24 meses. Material y métodos: estudio cuasiexperimental, comparativo y longitudinal realizado en el Servicio de Emergencia del Instituto Nacional de Salud del Niño. La muestra estuvo conformada por 213 lactantes que presentaron una temperatura axilar entre 38 y 39 °C; distribuidos en tres grupos de tratamiento: administración de paracetamol, baño con agua tibia, y administración de ambos tratamientos. Para la recolección de los datos se utilizó tres guías de observación estructuradas donde se evaluó la temperatura corporal cada terinta minutos, durante dos horas. Resultados: el tratamiento con paracetamol presentó una disminución promedio de la temperatura de 1,4 °C; confirmándose su efectividad a los 120 minutos. El baño con agua tibia no resultó efectivo y su reducción promedio fue de 0,5°C a los 120 minutos. El grupo de tratamiento con paracetamol más baño con agua tibia presentó el inicio de su efectividad a los 30 minutos con una disminución promedio de 1,2 °C y a los 120 minutos fue de 2,1 °C. Este estudio se analizó con la prueba de Kruskal-Wallis. Conclusión: el tratamiento con paracetamol más baño con agua tibia resultó ser más efectivo que el tratamiento con paracetamol.

Fever is one of the clinical signs appearing more frequently in pediatric patients, this may be due to an infectious and noninfectious. The most widely used antipyretic treatment is paracetamol, also used the warm bath or administration of the two. Objectives: To determine the effectiveness of paracetamol, the warm bath and the administration of both treatments to decrease body temperature of febrile nursling aged 6 to24 months. Material and methods: Quasiexperimental, corporate and longitudinal study, carried out in service of emergency the National Institute of Children Health. The sample was conformable by 213 nurslings who had a body temperature between 38 to 39 Celsius taken axillary, divided into three treatment groups: administration of paracetamol, warm bath and administration of both treatments. For data collection the instruments were three structured observation guides, evaluating body temperature every 30 minutes at a time of 2 hours. Results: Treatment with paracetamol showed a decrease in average temperature of 1.4 Celsius confirming its effectiveness at 120 minutes. The warm bath was not effective and the average reduction was 0.5 ° C at 120 minutes. The group treated with paracetamol plus warm bath showed the beginning of its effectiveness after 30 minutes with an average decrease of 1.2 ° C and 120 minutes was 2.1 ° C. This study was analyzed with the Kruskal-Wallis test. Conclusion: Treatment with paracetamol plus warm bath was more effective than treatment with paracetamol.

L'association paracetamol+ibuprofene est-elle preferable au paracetamol seul ou a l'ibuprofene seul pour le traitement de la fievre chez les enfants?

Il apparait de plus en plus sur le marche burkinabe des medicaments; des associations de substances d'indication similaire; et dont l'interet therapeutique reste a demontrer. Ces associations contribuent-elles a un usage rationnel des medicaments? Faut-il continuer a homologuer ces associations ? Nous presentons ici les resultats d'une etude sur l'association paracetamol+ibuprofene dans la fievre chez les enfants

Evaluation of the analgesic activity of the methanolic stem bark extract of dialium guineense (wild)

Background: Dialium guineense is a medicinal plant used by some communities of Enugu-Ezike in Enugu State; Nigeria for treatment of fever; headache and other diverse ailments. Objectives: The present study evaluated the analgesic activity of the methanolic stem bark extract of the plant. Method: Acetic acid-induced abdominal constriction or writhing; tail immersion and hot plate analgesic models in albino Wistar mice were used for the study. Three test doses (250; 500; 1000 mg/kg body weight) of the extract were administered orally by gastric gavage. The activity was compared with a standard reference drug; acetylsalicylic acid (aspirin) (400 mg/kg) and negative control. The results were analysed by SPSS version 17 using ANOVA and Post Hoc Duncan. Result: In the acetic acid-induced writhing reflex model; D. guineense extract and the reference drug significantly (P =0.014 - 0.002) decreased the mean total number of abdominal constriction in the mice in a dose dependent fashion. The percentage inhibition of the abdominal constriction reflex was increased dose dependently from 0in the negative control group to 71at the highest dose of the extract (1000mg/kg). In the tail immersion model the extract at the dose of 1000 mg/kg significantly (P = 0. 048) increased the pain reaction time (PRT) while in hot plate model the extract and drug also significantly (P = 0.048 - 0.05) increased the mean PRT at the doses of 500 and 1000 mg/kg. The dose of 250 mg/kg showed no analgesic activity in tail immersion and hot plate models. Conclusion: Dialium guineense demonstrated significant analgesic activity that may be mediated through peripheral pain mechanism