ABSTRACT
OBJECTIVE: To evaluate the value of reflux diagnostic questionnaire in the diagnosis of children with gastroesophageal reflux disease (GERD). METHODS: Forty-five children aged 7-16 years old referred for suspected GERD with vomiting/regurgitation, nausea, heartburn/retrosternal pain, abdominal pain, epigastric pain, acid regurgitation and pain while swallowing were assessed. Each symptom was rated from 0 to 3 according to its severity and frequency. The items of questionnaire were validated against the results from upper gastrointestinal endoscopy and esophageal 24 h pH monitoring. And the results were compared with symptom scores to determine the threshold value for GERD. RESULTS: In 45 patients, the ratio of male to female was 1.37:1 and the mean age (11.1±2.6) years old. Composite score in 23 patients with GERD (20±10) was significantly higher than that in 22 patients without GERD (13±4) (P<0.05). There was no significant difference of composite scores among patients with grades 0, I, II and III according to upper gastrointestinal endoscopy (P>0.05). With 13.0 as threshold score for GERD, the sum of sensitivity and specificity was maximal. The area under the receiver operating characteristic curve (ROC) was 0.79 while true positive diagnostic rate 72.0% and true negative diagnostic rate 75.0% with a sensitivity of 78.3%, a specificity of 68.2% and an accuracy of 73.3%. CONCLUSION: Reflux diagnostic questionnaire is a suitable method in initial diagnosis of GERD. It may serve as a screening test for GERD in 7-16-year-old children.
Subject(s)
Gastroesophageal Reflux/diagnosis , Surveys and Questionnaires , Adolescent , Child , Female , Humans , MaleABSTRACT
OBJECTIVE: To investigate the occurrence and drug resistance of extended-spectrum beta-lactamases (ESBLs)-producing strains of Shigella in pediatric patients, so as to provide information for clinical treatment. METHOD: A total of 59 strains of Shigella were isolated from stool specimens of hospitalized children with shigellosis from January 2004 to December 2008. The broth dilution test recommended by Clinical and Laboratory Standards Institute (CLSI) was performed to detect the ESBLs producers. Susceptibility test was carried out by agar dilution method. Escherichia coli ATCC25922 and Klebsiella pneumonia ATCC700603 were used as quality control strains. RESULT: Of the 59 isolates, 21 (35.6%) strains were identified as ESBLs producers. All of the 21 strains were detected by cefotaxime and cefotaxime/clavulanic acid, only 5 (23.8%) were detected by ceftazidime and ceftazidime/clavulanic acid. Both ESBLs and non-ESBLs producers showed high resistance to penicillins. The resistance of ESBLs-producing strains to third and fourth-generation cephalosporins, aztreonam was significantly higher than that of non-ESBLs-producing strains, as well as sulphonamides and quinolones. The drugs sensitive to ESBLs producers were imipenem, meropenem, piperacillin/tazobactam, cefoperazone/sulbactam and cefoxitin, with resistance rate of 0.0%, 0.0%, 14.3%, 9.5%, 14.3%, respectively. CONCLUSION: The prevalence of ESBLs-producing Shigella in pediatric patients is at a high level in this area, and the enzyme-producing strains are multidrug resistant. It is recommended that the detection of ESBLs in Shigella should be carried out by microbiological laboratories. Any of the above 5 antibiotics of low resistance should be used according to the patient's condition.
