Effects of benzodiazepine on neuromuscular activity performance in archers.

AIM: The aim of the study was to investigate the effects of benzodiazepine on shooting performance and its components in archers. In order to evaluate the possible effects of benzodiazepine, performance related parameters of body sway, mechanical clicker reaction time, aiming behavior and heart rate values were measured. METHODS: Subjects were 24 (10 females and 14 males) archers competing at international events and trained at least 4 years. Each archer was requested to perform under normal, placebo, and the influence of benzodiazepine (diazepam 5 mg, oral). Thus, each archer competed as control, placebo and benzodiazepine under double blind crossover design. The competition was especially designed to simulate competition environment by having archers shooting in doubles each time, on a specifically designed platforms. One platform was mounted on two force plates, where all the data related to shooting and body swaying was collected. The second platform was a dummy platform, to provide the second subject with similar feelings as the subject on the first platform. With this set of data collection, the archers were asked to compete 6 times each in changing rounds, where they had 24 shots in each competition. Repeated measure of ANOVA was used to compare the differences between control, placebo and benzodiazepine shots. RESULTS: Results showed that there was no difference in shooting scores, resting heart rate, shooting heart rate, aiming behavior (aiming displacement in x and y axis on the target), the amount of changes in the center of pressure both in terms of displacement and velocity (front and rear foot), clicker reaction time between control, placebo and 5 mg diazepam administration shots. CONCLUSION: It can be concluded that the use of 5 mg diazepam has no effect on shooting performance and related parameters on archers in an artificially conducted competition environment.

Can WHO therapy failure criteria for non-severe pneumonia be improved in children aged 2-59 months?

SETTING: In the recent past, there have been reports of rising treatment failure rates for non-severe pneumonia. It is felt that World Health Organization (WHO) criteria for therapy failure are too sensitive and that many children are unnecessarily classified as failures. We studied alternative, less sensitive therapy failure criteria. METHODS: In this nested study we followed the clinical course of non-severe pneumonia in children aged 2-59 months using alternative therapy failure criteria. All children received amoxicillin and were followed up on days 3, 5 and 14 after enrollment. On day 3, children were labelled as therapy failure only if their condition had deteriorated. These failure rates were compared with those using WHO definitions. RESULTS: During the study period, 876 children with non-severe pneumonia were followed up until day 14. On day 3, using alternative therapy failure criteria, 31 (3.5%) children were labelled as therapy failure compared to 95 (10.8%) using current WHO criteria. The difference was statistically significant (P = 0.001). CONCLUSIONS: The alternative therapy failure criteria work reasonably well, without causing any higher risk to children with non-severe pneumonia. Antibiotics should be changed only in those children who show signs of deterioration on day 3. This would prevent unnecessary changes in antibiotic treatment in many children.

Comparison of clinical outcome with oral and inhaled bronchodilators in the management of wheezy children aged 1-59 months in the community: a randomised trial in Pakistan.

BACKGROUND: Wheeze is a significant problem in children. There is a gradual trend of switching from oral to inhaled bronchodilator therapy. No randomised trials have been carried out in the community to compare the clinical outcome of two modes of therapy. If outcome with oral and inhaled bronchodilators is the same in young wheezers in developing countries, it will be easier to manage them. METHODS: In a randomised multicentre trial, wheezy children aged 1-59 months with fast breathing and/or lower chest indrawing received oral or inhaled salbutamol at home after responding to up to three cycles of inhaled bronchodilators. They were re-assessed on days 3 and 5 for clinical outcome. RESULTS: From May 2001 to August 2002, 780 children were enrolled; 390 each were randomised to oral and inhaled salbutamol. On day 5, 324 (83.1%) children in the oral and 328 (84.1%) in the inhaled group were completely well. There were no differences in clinical outcome of both modes of therapy. CONCLUSIONS: The clinical outcome of children aged 1-59 months with wheeze is similar when treated with oral or inhaled salbutamol. Acute respiratory infection control programmes in developing countries should continue to use oral bronchodilators for the management of wheeze to save both time and money.

Assessment and management of children aged 1-59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan.

BACKGROUND AND AIMS: Using current WHO guidelines, children with wheezing are being over prescribed antibiotics and bronchodilators are underutilised. To improve the WHO case management guidelines, more data is needed about the clinical outcome in children with wheezing/pneumonia overlap. METHODOLOGY: In a multicentre prospective study, children aged 1-59 months with auscultatory/audible wheeze and fast breathing and/or lower chest indrawing were screened. Response to up to three cycles of inhaled salbutamol was recorded. The responders were enrolled and sent home on inhaled bronchodilators, and followed up on days 3 and 5. RESULTS: A total of 1622 children with wheeze were screened from May 2001 to April 2002, of which 1004 (61.8%) had WHO defined non-severe and 618 (38.2%) severe pneumonia. Wheeze was audible in only 595 (36.7%) of children. Of 1004 non-severe pneumonia children, 621 (61.8%) responded to up to three cycles of bronchodilator. Of 618 severe pneumonia children, only 166 (26.8%) responded. Among responders, 93 (14.9%) in the non-severe and 63 (37.9%) children in the severe pneumonia group showed subsequent deterioration on follow ups. No family history of wheeze, temperature >100 degrees F, and lower chest indrawing were identified as predictors of subsequent deterioration. CONCLUSIONS: Two third of children with wheeze are not identified by current WHO ARI (acute respiratory infections) guidelines. Antibiotics are over prescribed and bronchodilators under utilised in children with wheeze. Children with wheeze constitute a special ARI group requiring a separate management algorithm. In countries where wheeze is common it would be worthwhile to train health workers in use of the stethoscope to identify wheeze.

Carers' perception of childhood asthma and its management in a selected Pakistani community.

AIMS: To gather information on the level of disease awareness among the carers of asthmatic children and to determine whether it can help us draw inferences about the possible impact of prevailing perceptions on the management of asthma? METHODS: Subjects were children's parents/guardians visiting the asthma clinic, Children's Hospital, Islamabad. The questionnaire included items on general understanding of asthma, its triggers, and management. RESULTS: Two hundred carers of asthmatic patients participated. Thirty six per cent thought that asthma is a communicable disease. Rice and oily foods were blamed for asthmatic exacerbations in up to 57% of cases; 82% felt that inhalation therapy is effective in controlling asthma symptoms. CONCLUSIONS: Asthma awareness is inadequate. The majority of the carers unnecessarily blamed and withheld many nutritious foods. Social stigmata can undermine the self esteem of growing asthmatics. Lack of awareness is not significantly related to the socioeconomic or educational background. Awareness raising strategies are needed in the community.

Therapeutic re-appraisal of multiple drug resistant Salmonella typhi (MDRST) in Pakistani children.

BACKGROUND: The emergence of multi drug-resistant Salmonella typhi (MDRST) in many developing countries including Pakistan, has led to a search for suitable alternatives to conventional therapy. Quinolones have been found to be an effective alternative for the treatment of MDRST, in adults as well as in children. METHODS: The efficacy of various therapeutic regimens currently used for the treatment of Typhoid was analysed. Children 1 month to 12 years of age admitted to the Children's Hospital from 1990 to 1993 with fever and Salmonella typhi isolated from blood cultures were included in this retrospective analysis. RESULTS: The cumulative prevalence of Multiple Drug Resistant Salmonella typhi (MDRST) was 67.2%. Only 32.8% of isolated Salmonella typhi were susceptible to chloramphenicol and amoxicillin. The cumulative cure rate with conventional therapy (chloramphenicol or amoxicillin) was 47.4% and 53.6% children needed a change of therapy. The average hospital stay for the non-responders to conventional therapy was 9.2 days as compared to 7.7 days for the responders. The average hospital stay of the patients treated with a third generation cephalosporin was 12.7 days. Patients treated with ofloxacin, a flouroquinolone drug, did not need a change of therapy. The average hospital stay of the patients treated with flouroquinolones was 6.2 days. CONCLUSION: There was a high prevalence of multiple drug resistant typhoid fever in hospitalized children, leading to a high failure rate with conventional therapy. This resulted in frequent change of therapy, delayed defervesence and prolonged hospital stay. The flouroquinolones were found to be the most effective drug against MDRST.