Clinical features and predictors of diphtheritic cardiomyopathy in Vietnamese children.

BACKGROUND: Despite the availability of antitoxin and antibiotics, the mortality rate for diphtheria remains high, mostly because of cardiac complications. METHODS: During 1 year, 154 Vietnamese children with diphtheria admitted to a referral hospital were studied prospectively with clinical examination, including a simple pseudomembrane score, 12-lead and 24-hour electrocardiography, measurement of serum cardiac enzyme levels, and estimation of troponin T levels. RESULTS: Thirteen children had diphtheritic cardiomyopathy on admission, and 19 developed it subsequently. Twelve children (8%) died. The combination of pseudomembrane score of >2 and bull neck predicted the development of diphtheritic cardiomyopathy, with a positive predictive value of 83% and a negative predictive value of 93%. Administration of 24-hour electrocardiography on admission improved the ability to predict diphtheritic cardiomyopathy by 57%. Fatal outcome was best predicted by the combination of myocarditis on admission and a pseudomembrane score of >2. Of the cardiac enzyme levels measured, an elevated aspartate aminotransferase level was the best predictor. The presence of troponin T identified additional children with subclinical cardiac damage. CONCLUSIONS: The development of diphtheritic cardiomyopathy can be predicted by means of simple measures.

Silico-pneumoconiosis among stone exploit workers in the experiment ofdust control using mouth defense cover of high filtering performance

Through studying clinical and para-clinical symptoms in 102 children with diptheria who were treated at The Tropical Hospital in 2001 finding out the incidence of male was higher than female (57% compared with 43%). 71per102 children have vaccinate follow enlarge vaccination program, 1per71 were booster injection, 8per102 with close family members with diptheria, 13per102 with around people have similar disease. Although enlarge was close applied enlarge vaccination the diptheria still present in Ho Chi Minh City and Southern provinces