ABSTRACT
BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. OBJECTIVES: To describe the incidence, costs, length of stay (LOS), comorbidities and mortality of SSSS in U.S. children. METHODS: The Nationwide Inpatient Sample 2008-2012 was analysed, including a 20% sample of U.S. hospitalizations and 589 cases of SSSS. RESULTS: The mean annual incidence of SSSS was 7·67 (range 1·83-11·88) per million U.S. children, with 45·1 cases per million U.S. infants age < 2 years. In multivariable logistic regression models, SSSS was significantly associated with the following (shown as adjusted odds ratio and 95% confidence interval): female sex (1·12, 1·00-1·25), age (2-5 years: 13·31, 11·82-14·99; 6-10 years: 2·93, 2·35-3·66; 11-17 years: 0·44, 0·31-0·63); race/ethnicity (black: 0·69, 0·58-0·84) and season (winter: 2·04, 1·66-2·50; summer: 3·47, 2·86-4·22; autumn: 3·04, 2·49-3·70), with increasing odds over time (2010-2011: 2·28, 2·07-2·51; 2012: 2·98, 2·69-3·30). The geometric mean (95% confidence interval) LOS and cost of hospitalization for patients with vs. without SSSS were 3·2 (3·0-3·4) vs. 2·4 (2·4-2·5) days and $4624·0 ($4250-$5030) vs. $1872 ($1782·7-$1965). Crude inpatient mortality rates (with 95% confidence intervals) were similar for children with vs. without SSSS (0·33%, 0·00-0·79% vs. 0·36%, 0·34-0·39%). SSSS was associated with other infections, including in the upper respiratory tract and skin. CONCLUSIONS: The prevalence of SSSS appears to be increasing over time, and was associated with a number of sociodemographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.
Subject(s)
Staphylococcal Scalded Skin Syndrome/mortality , Adolescent , Child , Child, Preschool , Comorbidity , Costs and Cost Analysis , Humans , Incidence , Infant , Infant, Newborn , Length of Stay/economics , Length of Stay/statistics & numerical data , Prevalence , Residence Characteristics/statistics & numerical data , Socioeconomic Factors , Staphylococcal Scalded Skin Syndrome/economics , Staphylococcal Scalded Skin Syndrome/therapy , United States/epidemiologyABSTRACT
Acetaldehyde, the first metabolite of ethanol, caused a reversible block of the end-plate potential (EPP) in the rat and mouse phrenic nerve--hemidiaphragm preparation. Decrease and block of the EPP occurred over a bath concentration range from 3 to 25 mM. The phrenic nerve compound action potential was blocked along with the EPP, and this block was not reversed by high bath Ca2+ concentration. The muscle action potential was unaffected even at concentrations up to 50 mM. Over the same concentration range (3--25 mM), miniature end-plate potential (MEPP) frequency sometimes decreased a few minutes after application, and over the ensuing 10--20 min would steadily increase to as much as 11 times the base-line frequency, particularly with higher doses. However, the shape of averaged MEPPs remained unchanged after acetaldehyde application, suggesting that this aldehyde does not have post-synaptic effects.
Subject(s)
Acetaldehyde/pharmacology , Neuromuscular Junction/drug effects , Synapses/drug effects , Synaptic Transmission/drug effects , Action Potentials/drug effects , Animals , In Vitro Techniques , Male , Membrane Potentials/drug effects , Mice , Motor Endplate/drug effects , Rats , Time FactorsABSTRACT
The equilibrium blocking concentrations of benzyl alcohol, lidocaine and tetrodotoxin just sufficient to block nerve impulse conduction were determined on myelinated single fibers of the bullfrog. For all three anesthetics it was found that the fastest conducting fibers (45 m/sec; about 18 micron diameter) required about 4 times higher blocking concentrations than the slowest fibers (8 m/sec; about 3 micron diameter). The drugs did not affect the frog sciatic nerve length constant (2 mm), using tetrodotoxin to block the action potential. In agreement with Uehara's single fiber study using urethane (Uehara, Y.:Jap. J. Physiol. 10: 267-274, 1960), it is concluded that smaller myelinated fibers are more sensitive to anesthetic blockade.
Subject(s)
Anesthetics/pharmacology , Axons/ultrastructure , Benzyl Alcohols/pharmacology , Benzyl Compounds/pharmacology , Lidocaine/pharmacology , Nerve Fibers, Myelinated/physiology , Neural Conduction/drug effects , Tetrodotoxin/pharmacology , Action Potentials/drug effects , Animals , Axons/drug effects , Depression, Chemical , In Vitro Techniques , Nerve Fibers, Myelinated/drug effects , Rana catesbeiana , Sciatic Nerve/anatomy & histology , Sciatic Nerve/drug effects , Sciatic Nerve/physiologyABSTRACT
1. To examine whether different local anesthetics act on different or similar sites in the nerve membrane, the effects of combinations of lipid-soluble anesthetics and tetrodotoxin (TTX) were studied on the compound action potential of the frog sciatic nerve. 2. The nerve-blocking potency of TTX was potentiated 5-fold by benzyl alcohol and 10-fold by lidocaine, at concentrations of these latter two drugs which were just barely anesthetic; no such synergism occurred between saxitoxin (STX) and TTX, their combined effect being merely additive. 3. Simple additive effects also occurred between benzyl alcohol and phenol, benzyl alcohol and urethane, as well as lidocaine with a spirosuccinimide, RAC 109 II. 4. Synergism occurred between STX and 2-aminobenzimidazole. 5. A small but consistent synergism occurred between lidocaine and benzyl alcohol. 6. It is concluded that uncharged anesthetics, tertiary amines, and TTX act via different membrane binding sites which are all closely associated with the Na+ conductance channels.
