Prehospital endotracheal intubation for severe head injury in children: a reappraisal.

Controversy exists regarding the efficacy of prehospital assisted ventilation by endotracheal intubation (ETI) versus bag-valve-mask (BVM) in serious pediatric head injury. The National Pediatric Trauma Registry (NPTR-3) data set was analyzed to examine this question. NPTR-3 (n = 31,464) was queried regarding the demographics, injury mechanism, injury severity, prehospital interventions, transport mode, mortality rate, injury complications, procedure and equipment failure or complications, and functional outcome of seriously head-injured patients (n = 578) with comparable injury mechanisms and injury severity who received endotracheal intubation (ETI) (n = 479; 83%) versus those who received BVM (n = 99; 17%). Mortality rate was virtually identical between the 2 groups (ETI = 48%, BVM = 48%), although children receiving ETI were significantly older (P < .01), more often transported by helicopter (P < .01), and more often received intravenous fluid in the field (P < .05). However, injury complications affecting nearly every body system or organ (except kidney, gut, and skin) occurred less often in children receiving ETI (ETI = 58%, BVM = 71%, P < .05). Procedure and equipment failure or complications, and functional outcome, were similar between the 2 groups. Prehospital endotracheal intubation appears to offer no demonstrable survival or functional advantage when compared with prehospital bag-valve-mask for prehospital assisted ventilation in serious pediatric head injury. Injury complications appear to occur somewhat less often among patients intubated in the field.

Pediatric migraine.

Migraine headaches are relatively common, affecting approximately 5% of all children. Although the differential diagnosis is extensive, a complete history and physical will usually lead to the correct diagnosis without laboratory or radiologic studies for most children. In cases of migraine complicated by neurologic problems, such as hemiplegia or ophthalmoplegia, neuroradiologic studies may be helpful to establish the diagnosis of complicated migraine. Treatment of migraine in children consists primarily of avoidance of triggers, rest, and simple analgesics. Behavior therapy, including relaxation-response training, has been shown to be an effective adjunct in managing both the frequency and intensity of the migraine attack. Use of pharmacologic agents for abortive and prophylactic therapy has not been extensively supported by well-designed, well-controlled research. In general, use of these agents should be restricted to the small group of children with frequent, severe attacks. Sumatriptan, a 5-HT1 receptor agonist, has shown promise in adult patients but future gains in treatment will be achieved only after a better understanding of the cause and pathogenesis of migraine.

Certified first responder: a comprehensive model for pediatric training.

The purpose of this document is to present a general approach to educating the First Responder in Emergency Pediatric Care. The First Responder is especially important in the emergency care of the sick or injured child. The majority of mortality and morbidity associated with pediatric emergencies is a result of airway and ventilatory compromise. In addition, most airway and ventilation problems can be corrected with only basic life support interventions that are within the scope of practice of the First Responder. As a result, it is of paramount importance to assure that the First Responder is adequately trained in the initial care of the pediatric patient. This document will review some of the key objectives and topics which the First Responder needs to understand in order to adequately care for children until further emergency care arrives. Templates for lesson plans and suggested activities for training the First Responder are also presented.

Albendazole in the treatment of onchocerciasis: double-blind clinical trial in Venezuela.

A double-blind clinical trial was conducted in Monagas State, Venezuela to assess the tolerance and efficacy of albendazole in the therapy of Onchocerca volvulus infection. Forty-nine patients (26 treated and 23 controls) received a 10-day course of albendazole (400 mg/day) or a placebo. Consistent with the excellent tolerance observed, albendazole did not kill microfilariae. However, analysis of changes in microfilarial densities (mf/mg of skin) over one year showed that albendazole was active against O. volvulus, presumably by interfering with embryogenesis. The nature, degree, and duration of this effect remain to be determined.

Evaluación oftalmológica de un foco de oncercosis en Río Chiquito, Estado Monagas / Oftalmological evaluation of an onchocerciasis focus in Río Chiquito, Monagas

Debido a las pocas modificaciones del tratamiento de la oncocercosis en los últimos años, se practicó estudio doble ciego en 49 pacientes infectados con oncocercosis en la región de Río Chiquito del Estado Monagas, con una droga nueva, el albendazole. La dosis fue de 400 mg. diarios por diez días consecutivos en un grupo escogido al azar, y al otro grupo se le suministró un placebo por igual número de días. Los pacientes fueron hospitalizados para su tratamiento y observación clínica. Se les practicó una evaluación general, oftalmológica, hematológica yparasistológica previa al tratamiento, y durante los días 1, 3 y 10 post-tratamiento, así como controles periódicos post-tratamiento. El examen oftalmológico realizado fue: test de A.V.; test de colores; examen del segmento anterior com lámpara de hendidura; examen del fondo de ojo; tonometría y campimetría. Los hallazgos oftalmológicos no se diferencian del patrón standard del foco norte del país. Excepto de los hallazgos del examen campimétrico, ya que por la comodidad de la evaluación de los pacientes en el ambiente hospitalario, se determina en un 48,44% neuropatía óptica. La droga tuvo buena tolerancia desde el punto de vista general, desde el punto de vista oftalmológico se elevó el conteo de M.F. en cámara anterior en 1 paciente; la T.O. se elevó, en un alto porcentaje, en 3 ó 4 mmHg. pero por debajo de lo normal y en un porcentaje de 11.53% por encima de 20 y por debajo de 28 mmHg, pero sin modificaciones en el nervio óptico ni en sus campos visuales

Rifampin chemoprophylaxis for household contacts of patients with invasive infections due to Haemophilus influenzae type b.

To determine the efficacy of rifampin chemoprophylaxis in eradication of oropharyngeal carriage of Haemophilus influenzae type b, we conducted a multicenter, double-blind, placebo-controlled trial among household contacts of patients hospitalized for invasive HIB infection. Seventy-nine index patients and 400 close contacts were studied; 26.5% of contacts were colonized. The efficacy of rifampin (10 mg/kg/dose, 600 mg/dose maximum, twice daily for two days) in eradicating carriage was 52% and varied with age (75.6% in persons greater than or equal to 5 and 27% in those less than 5 years). Eradication rates in those less than 5 years were not significantly better than for placebo. No resistant isolates were encountered in sensitivity testing. The low efficacy of this rifampin regimen in young children precludes its routine use as a chemoprophylactic agent for family contacts. The occurrence of three cases of invasive HIB infection in individuals outside the defined contact group raises concern regarding the efficacy of any chemoprophylactic regimen.

Resonance Raman evidence for cleavage of the Fe-N epsilon(His-F8) bond in the alpha subunit of the T-structure nitrosylhemoglobin.

Resonance Raman spectra are observed for hybrid nitrosylhemoglobins (NO-Hb) reconstituted from normal and meso-deuterated hemes and also for penta- and hexa-coordinated NO-heme complexes. Upon meso deuteration of both hemes of the alpha and beta subunits [alpha(D)2NO beta(D)2NO], the Raman lines of stripped NO-Hb at 1636 (dp), 1584 (ap), and 1502 (p) cm-1 are shifted by -10, -20, and -7 cm-1, respectively, and those at 1306 (ap) and 1228 (dp) cm-1 disappear. The spectral changes caused by meso deuteration are in good agreement with those observed previously for (octaethyl-porphyrinato)nickel(II), for which the vibrational assignments of resonance Raman lines have been established. Accordingly, the 1636-, 1584-, 1502-, 1306-, and 1228-cm-1 lines of NO-Hb are assigned to nu 10, nu 19, nu 3, nu 21, and nu 13, respectively. Upon conversion from the R to the T structure, both nu 19 and nu 3 are shifted to higher frequencies by 4 cm-1 and nu 10 is split into two lines at 1645 and 1637 cm-1. The 1645-cm-1 line remains unshifted after meso deuteration of the beta heme [alpha(H)2NO beta-(D)2NO], and, conversely, the 1637-cm-1 line remains unshifted after meso deuteration of the alpha heme [alpha(D)2NO beta(H)2NO]. On the basis of the Raman spectra of the model NO-heme complexes, the 1645- and 1637-cm-1 lines are assigned to the penta- and hexacoordinated NO-heme complexes. Consequently, we conclude that the Fe-N epsilon(His-F8) of the alpha subunit within NO-Hb is disrupted in the T structure, while the NO-heme of the beta subunit adopts the hexacoordinated structures, in good agreement with our previous electron paramagnetic resonance work. The Raman spectra of the isolated alpha NO and beta NO chains are appreciably different. The Raman lines of the isolated alpha NO chain at 1606 (p), 1587 (ap), and 1504 (p) cm-1 are shifted by -6, +5, and +4 cm-1 when it is incorporated into the T-structure tetramer. In contrast, all the Raman lines of the isolated beta NO chain are not shifted in the T-structure tetramer.