ABSTRACT
The aims and objectives of this study were to study clinical profile and factors affecting mortality in tetanus. This was a retrospective study of 25 tetanus patients (aged 6 months-12 years) admitted to pediatric intensive care unit of a tertiary center (over 3 years). In this study, 25 tetanus cases (mean age 6.6 years) were analyzed; 16 were males and 9 were females. Incubation period ranged from 2 to 30 days (mean 8.2 days), period of onset from 11 to 120 hours (mean 42.8 hours), and duration of spasms from 4 to 26 days (mean 14 days). The commonest portal of entry was posttrauma (52%), followed by otogenic (40%). Eighteen patients had moderate and 7 had severe tetanus. Fifteen were unimmunized and 10 were partially immunized. The commonest complaints were trismus and spasms (100%), hypertonia (72%), fever (60%), dysphagia (48%), and neck stiffness (44%). Eight patients required primary tracheostomy and 11 required primary endotracheal intubation. Complications encountered were pneumonia (58%), conjunctivitis (41%), gastrointestinal bleed (37.5%), urinary infection (33%), acute kidney injury (AKI) following rhabdomyolysis (33%), sepsis (29%), disseminated intravascular coagulation (DIC) (25%), bedsores (25%), and acute respiratory distress syndrome (ARDS) (20%). Oral diazepam was most commonly used, followed by midazolam, vecuronium, and magnesium sulfate. Mortality rate was 32% (five moderate and three severe cases died). Short period of onset (less than 48 hours), AKI following rhabdomyolysis, sepsis, DIC, ARDS, and inotrope need were significantly associated with higher mortality. It is concluded that the commonest portal of entry was posttrauma. None of the patients was completely immunized. Short period of onset, AKI, sepsis, DIC, ARDS, and inotrope need predicted a higher mortality.
ABSTRACT
Objective A retrospective study was carried out for the analysis of correlation of traditional Chinese medical syndrome patterns of asthma patients at period of onset with five-element motions and six climatic factors. Methods All of the subjects were the inpatients of the First Affiliated Hospital of Guangzhou University of Chinese Medicine admitted from January 20, 2011 to January 19, 2014, matching the year of Xinmao, Renchen, Guisi correspondingly in ancient Chinese calendar. The patients were confirmed as asthma at period of onset and were differentiated into various traditional Chinese medical syndrome patterns. The time of onset was classified into various Yunqi periods according to the theory of five-element motions and six climatic factors, and then the correlation of syndrome patterns with the Yunqi periods was analyzed. Results A total of 308 inpatient case files were collected. In the year of Xinmao (2011) , 31 cases were differentiated as cold pattern asthma, 48 as heat pattern asthma, 6 as turbidity pattern asthma, 5 as wind pattern asthma. In the year of Renchen (2012) , 37 cases were differentiated as cold pattern asthma, 58 as heat pattern asthma, 13 as turbidity pattern asthma, 7 as wind pattern asthma. In the year of Guisi (2013) , 32 cases were differentiated as cold pattern asthma, 47 as heat pattern asthma, 14 as turbidity pattern asthma, 10 as wind pattern asthma. The results of statistical analysis showed that the differences of the distribution of syndrome patterns were insignificant among the year of Xinmao, Renchen, Guisi (P>0.05) . During the 3 years, heat pattern asthma had the highest incidence, cold pattern asthma came next, and turbidity pattern asthma and wind pattern asthma came last. Distribution of syndrome patterns of asthma in the year of Xinmao was consistent with the law of five-element motions and six climatic factors of the year of Xinmao. On the aspects of the theory of six Jianqi ( climatic periods) , the distribution of patterns of asthma in the climatic periods of Chuzhiqi, Erzhiqi, Sizhiqi was consistent with the law of climatic periods, while that in the climatic periods of Sanzhiqi, Wuzhiqi, Liuzhiqi was not consistent with the law of climatic periods. In the year of Renchen, syndrome pattern distribution was not consistent with the law of five-element motions and six climatic factors of the year of Renchen. In the climatic periods of Chuzhiqi, Erzhiqi, Sanzhiqi, the distribution of patterns of asthma was not consistent with the law of climatic periods, while that in the climatic periods of Sizhiqi, Wuzhiqi, Liuzhiqi was consistent with the law of climatic periods. In Guisi year, the distribution of syndrome pattern was not consistent with the law of five-element motions and six climatic factors of Guisi year either. On the aspects of the theory of six Jianqi, except for Erzhiqi, the distribution of patterns of asthma in the other five climatic periods was consistent with the law of climatic periods. Conclusion The theory of five-element motions and six climatic factors has some significance in predicting the pathogenic characteristics of asthma and in guiding the prevention and diag nosis of asthma, but convinced conclusion needs more proof from large-sample clinical trial.
