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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physicians analyzed December 1982-November 1989 data on 48 2-60 month old children with empyema thoracis at the University of Calabar Teaching Hospital in southeastern Nigeria to determine the incidence and etiology of empyema thoracis in this region. The incidence rate stood at 2/1000 pediatric admissions. 3 children died (6.3%), all of heart failure. 47 children suffered from fever, cough, and breathlessness, the symptoms for pneumonia. Even though bronchopneumonia is a common complication of measles which occurs frequently in Calabar, only 3 children (6.25%) also had measles. The most frequent complication of this accumulation of pus in the thoracic cavity was congestive heart failure (16 cases). 47 patients suffered from anemia (hemoglobin levels 11 gm/dl). Hemoglobin levels of 54% of all patients decreased over time to 8 gm/dl. In fact, 2 children had hemoglobin levels of 4.4 gm/dl and they experienced cardiac failure. Laboratory personnel were only able to examine pleural aspirates from 37 patients. They did not detect any organisms in 27% of these aspirates. This may have been due to parent's widespread practice of giving medication to all the children before coming to the hospital. 45.9% of the aspirates only grew Staphylococcus aureus while another 8.1% grew it and other pathogens. About 90% of the pathogens were resistant to ampicillin and penicillin and almost 90% were sensitive to cloxacillin, gentamicin, and erythromycin. Cloxacillin was very expensive and parenteral erythromycin was unavailable. Nevertheless the pediatricians used parenteral gentamicin and cloxacillin. The parents were responsible for buying the antibiotics which tended to be costly. All the patients required emergency closed tube thoracostomy drainage within 24 hours of admission. 83.3% remained in the hospital for 2 weeks and 33.3% for 1 month. Despite the rarity of empyema, long hospitalization and expensive drugs make it an important disease in Calabar.
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PMID:Clinical and bacteriological study on childhood empyema in south eastern Nigeria. 150 92

We review the 257 patients hospitalized for meningitis in the Cantonal University Hospital, Geneva between 1st January 1980 and 31st December 1986. 104 patients had acute bacterial meningitis (32 Str. pneumoniae, 21 N. meningitidis, 10 Listeria monocytogenes, 8 streptococci, 5 H. influenzae, 5 staphylococci, 4 gram negative bacilli and 19 without identified bacteria), 124 patients had viral meningitis and 29 meningitis of other etiologies (6 tuberculous meningitis, 2 fungal meningitis, 1 leptospiral meningitis, 5 neoplastic meningitis--one already counted because of a meningitis due to Staph. epidermidis--2 meningitis consecutive to a meningeal irritation, 4 already treated meningitis of undetermined etiology, 2 chronic meningitis and 8 meningoencephalitis). The total mortality was 14.4%. It was zero in viral meningitis and 28% in bacterial meningitis (47% in cases of Str. pneumoniae, 5% in cases of N. meningitidis, 20% in cases of Listeria monocytogenes, 38% in cases of streptococci, 0% in cases of H. influenzae, 60% in cases of staphylococci, 50% in cases of gram negative bacilli, 16% in cases of unidentified bacteria). The striking difference in mortality emphasizes the importance of recognizing a bacterial etiology in order to institute antibiotic therapy as soon as possible. The delay between admission and lumbar puncture averaged 15 hours (range 0.25-96 h) in patients with acute bacterial meningitis and 6.3 hours (0.5-80 h) in patients with viral meningitis. The delay between admission and institution of the antibiotics averaged 5.3 hours (1-48 h) in cases of acute bacterial meningitis and 4.8 hours (0.5-48 h) in cases of viral meningitis. A better clinical workup may provide a reliable diagnosis sooner. In the collective with bacterial and viral meningitis headaches, fever or nuchal rigidity were present in over 80% of the cases. The following features were significantly associated with a bacterial etiology: age over 30 years, alcoholism, concomitant neoplasm, cough, coma, pulmonary rales, new neurological signs or petechia. At least one of these 4 latter signs was present in more than 70% of the cases with acute bacterial meningitis compared to 6% in cases of viral meningitis. Thus the clinical presentation alone serves to recognize the meningitis and to differentiate between a bacterial or viral etiology, thus permitting an immediate therapeutic decision without waiting for complementary investigations. The 104 patients with acute bacterial meningitis were treated with antibiotics: 60 with penicillin, 17 with ampicillin and 26 with other antibiotics; one case did not receive antibiotics. More than the half of the cases with viral meningitis have got antibiotics (52%).
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PMID:[Meningitis in adults in Geneva. Review of 257 cases]. 185 79

The medical records of 370 patients treated for typhoid fever between 1986 and 1988 at the Communicable Disease Centre, Singapore, were reviewed. The disease was generally mild. There was no mortality. Fever was found in 98.4% of patients on admission and diarrhoea in 21%. Cough was predominantly a symptom of children and occurred in 7.1% of patients aged below 15 years. Other symptoms were uncommon. Hepatomegaly was found in 71% and splenomegaly in 47%. Leucopenia was not a helpful diagnostic marker. Chloramphenicol was the drug of choice. The relapse rate was 5.4% and the convalescent and temporary carrier rates 11.6%. The risk of developing the carrier state was significantly higher among patients who were afebrile on admission compared with those who were febrile (P less than 0.001); it was also higher in patients treated with ampicillin as compared to those treated with chloramphenicol (P less than 0.001, chi 2 = 22.7, odds ratio = 5.25, 95% confidence limits: 2.46 and 11.29). The role of ampicillin as a first line treatment for acute typhoid fever may need further re-evaluation.
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PMID:Typhoid fever in Singapore: a review of 370 cases. 194 16

The clinical and bacteriological efficacy of a sulbactam/ampicillin combination was compared with piperacillin in a group of 50 patients suffering from acute or chronic lower respiratory infections: 26 were treated intravenously with piperacillin and 24 with sulbactam/ampicillin. The treatment was continued for at least 7 days for 24 patients at the dosage of 3 g sulbactam/ampicillin twice daily, for a further 24 patients at the dosage of 6 g piperacillin twice daily and for two patients at the dosage of 8 g piperacillin twice daily. In the patients treated with sulbactam/ampicillin, a rapid decrease in the fever with the concomitant reduction in cough and sputum production was observed, with cure in 18 cases and improvement in six. In the patients treated with piperacillin cure was observed in 14 cases and improvement in 12 cases. In both treatment groups safety was excellent. There was no significant difference, either in effectiveness or tolerability, between the two groups.
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PMID:Sulbactam/ampicillin combination in the treatment of acute and chronic lower respiratory infections. 206 Jun 92

Forty-one cases of empyema thoracis admitted in hospital during April, 1985 to August, 1987 were studied. Majority were males (65.9%) and were of less than 2 years of age (70.7%). Right side (60.9%) was predominantly involved. Abdominal distension (43.9%) was very characteristic, with other usual features like fever, cough and respiratory distress. A large majority of them were victims of malnutrition (73.2%) and anaemia (53.7%) with haemoglobin level ranging from 5-9 g/dl. Mortality was high (17.1%). Therapy with parenteral cloxacillin and gentamicin and continuous intercostal tube drainage accounted for loss of 15.8 bed days (average period of hospitalisation). Staph aureus was the principal aetiopathogen (68.3%). No anaerobe could be isolated. Strains of staphylococci were mostly resistant to penicillin and ampicillin but sensitive to gentamicin, cloxacillin and erythromycin.
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PMID:Clinicobacteriological study of empyema thoracis in infants and children. 226 63

This report describes the clinical, roentgenologic, pathologic, and virologic findings in a 2 years and ten months old girl who died from a severe pneumonia. Initially, the patient presented with fever and cough for 2 days. Physically, the patient appeared lethargic, and breathing sounds revealed diffuse rales and wheezing. Hemogram showed mild leukocytosis and lymphocyte predominant. Chest X ray revealed diffuse interstitial infiltration of the right upper lung, left upper and left lower lung field. Bacteria infection was first impressed. Although treated with several antibiotics (ampicillin, cefuroxime, amikacin, penicillin, cephazolin, imipenem and vancomycin) in three different hospitals, the patient's condition went downhill and the patient died 2 weeks later. Finally, adenoviurs type 3 was isolated from sputum specimen taken before death and necropsy lung tissue. The lung pathology showed diffuse necrotizing inflammation with fibrinopurulent exudate, and eosinophilic intranuclear inclusion bodies were also noted in the alveolar cells. These data proved the diagnosis of adenovirus pneumonia. This case adds to the evidence that adenovirus type 3 infection during childhood may cause fatal disease.
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PMID:A fatal case of viral pneumonia in a child infected with adenovirus type 3. 227 28

The cost of medications affects patient compliance with treatment regimes, and it is of prime importance for poor patients and children. The knowledge of the cost of prescription drugs was studied with the participation of 81 respondents: 18 senior medical students, 11 junior and 23 postgraduate students in pediatrics, 6 pediatric faculty members, and 12 private pediatricians and general practitioners. A questionnaire contained 10 preparations by generic name; and brand name, unit size, and cost of preparations prescribed regularly by the respondents had to be named. The drugs were categorized as commonly used drugs, infrequently used drugs, and non-drugs. The answers on cost were evaluated as correct (within 25% of correct price), underestimated, overestimated, and no-response. After a preliminary analysis interns and junior postgraduates as well as pediatric faculty and private physicians were grouped together. A statistically significant (p.001) improvement of the level of knowledge of drug prices with increasing experience was found: ampicillin, hematinics, and cough syrup prices were better known than the prices of infrequently prescribed drugs (valproic acid, MMR vaccine). Correct responses were 10.6% for medical students, 19.6% for interns and junior postgraduates, 33.5% for senior postgraduates, and 62.2% for pediatricians and general practitioners. 74% of senior medical students had no idea of the prices of most drugs. It is proposed that the prices of medications should be discussed during undergraduate and postgraduate training, as there are huge differences between the costs of different brands listed in the Indian Pharmaceutical Guide, and patients are entitled to the lowest cost drug possible.
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PMID:Knowledge of prescribers regarding cost of pediatric medications. 236 48

Experience with typhoid fever in 111 children over a 5-year period was reviewed. There were 66 boys and 45 girls, ranging in age from 1 to 11.5 years. The symptoms of typhoid fever were quite non-specific. Fever was the most common presenting symptom (in 98.3%). Other common presenting features were diarrhoea (25.7%), constipation (22%), vomiting (21.1%), cough (25%), abdominal pain (27.5%), headache (9.2%), epistaxis, meningism and convulsions. Rose spots were detected in 20% of cases, occurring mainly during the first 2 weeks of illness. Significant Widal reactions were present in 84.7% of cases. Blood and stool cultures were positive in 57% and 44% of cases, respectively. Peripheral blood white cell counts were not found to be of great diagnostic value. Chloramphenicol remained the drug of choice in the treatment of typhoid fever. It was more effective than ampicillin or co-trimoxazole. Complications were uncommon, occurring in only two patients. There were two deaths; both were admitted late and in moribund state. Early diagnosis and treatment is vital in typhoid fever and, as the presenting features are non-specific, a high index of suspicion is required.
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PMID:Typhoid fever in Hong Kong children. 278 7

A 42-year-old man with an atypical pneumonia. He had chest pain and a dry cough for 3 weeks, was dull at the left base clinically, and had left lower zone consolidation on chest radiography. The pneumonia spread despite oral ampicillin and cloxacillin. Blood culture grew Listeria monocytogenes and white cell count showed a monocytosis. He responded to intravenous penicillin and gentamicin with complete X-ray clearance.
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PMID:Listeria pneumonia. A case report. 291 43

Haemophilus influenzae and Streptococcus pneumoniae are found in 87% of all cases of exacerbated chronic obstructive bronchopulmonary disease. Complications of viral respiratory tract disease are most frequently caused by H. influenzae. Not only encapsulated forms of H. influenzae, but also non-encapsulated strains may be responsible for the onset of pneumonia and acute exacerbations of chronic bronchitis in adults. The most common symptoms of infections with H. influenzae are cough, dyspnoea, increase in purulent sputum and wheezing. A quantitative sputum culture is recommended for diagnosing chronic obstructive bronchopulmonary disease. Acute exacerbations of chronic bronchitis are always treated with antibiotics effective against H. influenzae and pneumococci. As a rule, empirical treatment should suffice in general practice. In the comparison between ampicillin, co-trimoxazole and cefaclor included in the study protocol appended to this report, the latter produced the most favourable results both in the empirical and specific forms of treatment. We would recommend cefaclor as the antibiotic of choice for this disease.
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PMID:[Infections of the lower respiratory tract in general practice]. 349 7


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