Thrombolysis and mechanical cardiopulmonary resuscitation for pulmonary embolism complicated by hepatic and splenic lacerations resulting in major haemorrhage.

Thrombolysis with prolonged cardiopulmonary resuscitation may be required for the successful resuscitation of patients presenting with massive pulmonary embolism leading to cardiac arrest. A rare, recognised complication of cardiopulmonary resuscitation is traumatic hepatic and splenic laceration. The incidence of complications is believed to be increased in those who receive automated mechanical cardiopulmonary resuscitation, compared to those who receive standard chest compressions. We present a case of a patient with massive pulmonary embolism leading to cardiac arrest which was successfully treated with thrombolysis and mechanical automated cardiopulmonary resuscitation. The patient suffered hepatic and splenic lacerations resulting in major haemorrhage. This required emergency resuscitation with blood products and splenic embolisation. This case highlights the importance of continual re-assessment of patients, the early recognition of complications and an awareness of the potential complications of treatments we deliver.

Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study

Objective: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. Methods: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. Results: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. Conclusions: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost

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Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational study.

OBJECTIVE: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.

Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study

BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children

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Hospitalizations for asthma exacerbation in Chilean children: A multicenter observational study.

BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.

Impact of specific sensitization on asthma and rhinitis in young Brazilian and Chilean adults.

BACKGROUND: The pattern of associations and the attributable fractions (AF) of atopic conditions due to specific sensitizations vary between countries. OBJECTIVE: To assess the level of associations and AF between sensitization to five allergens and atopic conditions in two settings. METHODS: We studied 2063 Brazilians and 1231 Chileans of both sexes using representative samples selected at birth in the 1970s. Information on asthma and rhinitis was based on the European Community Respiratory Health Survey questionnaire. We assessed bronchial hyperresponsiveness (BHR) to methacholine and sensitization to Dermatophagoides pteronyssinus, cat, dog, grass blend and Alternaria alternata. RESULTS: The prevalence of sensitization to one or more allergens was 50% in Brazilians and 22% in Chileans. The level of associations varied according to the outcome used. Strong associations between sensitization and asthma, defined as wheeze or awakening with breathlessness at night and positive BHR, were found for each of the five allergens in Chileans [varying from odds ratio (OR) 3.24, 95% confidence interval (CI) 1.47, 7.15 for D. pteronyssinus to 8.44, 95% CI 3.82, 18.66 for cat], whereas the level of associations was restricted to D. pteronyssinus, cat and dog in Brazilians and was somewhat weaker (highest OR 3.90, 95% CI 2.80-5.44). The AF of sensitization on asthma was 54% in Brazil and 44% in Chile. D. pteronyssinus and cat made an independent contribution to asthma in the two samples. The patterns of associations between sensitization and rhino-conjunctivitis were similar to those for asthma. CONCLUSION: The associations between sensitization, and asthma and rhinitis were high in Chile and moderately high in Brazil, but the AF were higher in Brazil, reflecting a higher prevalence of sensitization. In Brazil, dust mite had the greatest impact on atopic conditions while in Chile several allergens had an impact. Sensitization is as serious a problem in Chile and Brazil as in developed countries.

Prevalence of asthma, atopy and bronchial hyperresponsiveness and their interrelation in a semi-rural area of Chile.

OBJECTIVE: To assess the prevalence of asthma symptoms and their association with sensitisation to eight allergens and bronchial hyperresponsiveness (BHR) to methacholine. SETTING: A random sample of 1232 adults, aged 22 to 28 years, studied in a Chilean semi-rural area. DESIGN: A cross-sectional design for the purpose of this analysis. RESULTS: The prevalence of wheeze was 27.4% (95%CI 24.9-29.9) and waking with breathlessness 13.7% (95%CI 11.8-15.6), higher than the results of a multi-centre European study. Only 7.8% (95%CI 6.3-9.3) had a positive BHR (< or =8 mg/ml) and 26.3% (95%CI 23.8-28.8) were atopic. The Youden index of asthma symptoms in non-atopic subjects varied from 0.184 to 0.259 when using BHR as gold standard for asthma, and increased from 0.379 to 0.504 among those with positive atopy. Only 4.5% reported asthma, and the Youden index was slightly higher in comparison to the asthma symptom groups. CONCLUSION: The prevalence of asthma symptoms in young adults was high, but only a small proportion of these were sensitised or had a positive BHR. We believe that aetiological studies of asthma should analyse subjects with asthma symptoms separately from those with positive atopic status or positive BHR.

[Early introduction of dairy formulas in infant feeding]. / Introducción precoz de fórmulas lácteas en la alimentación del niño.

Frequency, main features and factors associated to introduction of supplemental artificial milk formula at the first month of life were studied in 365 infants born from June 1st, through October 31, 1980, who were under control at a well baby clinic of Santiago, Chile, along years 1986 throughout 1987. By means of life-table analysis, time length of breast feeding was measured and compared in children with and without early formula introduction. In 22.5% of infants an artificial milk formula was given (82/365). In 80% of the cases (66/82) this was done upon instructions of health personnel on grounds of poor weight increase. Early introduction of formula negatively influenced duration of breast feeding which attained a median length of three months in artificially fed infant against ten months in those exclusively breast fed. Main features of infants and mothers prone to early formula introduction were maternal age 35 years or over, previous breast feeding shorter than six months, illegitimacy or first child, fourth or over in birth order, low birth weight and, or, hospital admission in the first four weeks of life. No influence was identified from educational level, of maternal work, desired or unwanted pregnancy, maternal nutritional status in the last three months of pregnancy, child spacing, type of delivery, sex and gestational age of the infants.

[Demographic trends: birth spacing]. / Tendencias demográficas: intervalo intergenésico.

Two studies to measure children spacing in western metropolitan Santiago are compared. The first (1984-85) surveyed a sample of 687 mothers and the second 1,000. Deliveries took place at San Juan de Dios and Félix Bulnes hospitals (both state-finance) which provide medical care for medium and low income groups. Long spacing (5 years or more) accounted for the highest proportion of non-first born children (33.8% in 1984-85 with a significant increase to 40.1% in 1988) while short spacing (under 2 years) accounted for 19.2% in 1984-85 and 21.8% in 1988 (not significant). Mean birth weights were over 3,200 g in every spacing group. Despite the low illiteracy rate, predominant urban origin and having at least one child born before, high proportions of children were conceived despite the use of contraceptive measures (19.7% in 1984-85 and 22.5% in 1988). This contraceptive failure was less frequent among children born after longer spacings.

PIP: Results are compared of 2 studies of child spacing undertaken in public maternity hospitals serving middle and lower income populations in the western area of Santiago, Chile. The 1st study surveyed 687 mothers of live-born infants in 1984-85, while the 2nd surveyed 1000 mothers in February-May 1988. All mothers had at least 1 older child. The surveys were undertaken in the 72 hours following delivery. In the 1984-85 and 1988 studies respectively, the birth interval was under 24 months for 19.2 and 21.8%; 24-35 months for 18.9 and 16.0%; 36-47 months for 16.9 and 13.1%; 48-59 months for 11.2 and 9.0%; and 60 months or more for 33.8 and 40.1%. The increase in birth intervals over 60 months was statistically significant. The average birth weight increased from 32.. g to 3330 g between the 2 studies, but the difference was not significant. The average birth weight increased for all birth intervals. The proportion of infants weighing under 2500 g at birth was 5.8% in 1984-85 and 6.9% in 1988. The proportions of mothers who became pregnant despite using a contraceptive method in 1984-85 and 1988 respectively were 28.0 and 30.7% for birth intervals of 24 months or less, 18.3 and 23.1% for intervals of 24-59 months, and 16.8 and 17.5% for intervals of 60 months or more. 22.5% of all infants in the 1988 survey were conceived while their mothers were using a contraceptive method. The factors involved in this apparently high rate, whether related to availability of family planning services, user knowledge, or method efficacy, should be identified and corrected.