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5 citations found

1: Br J Dermatol 2002 Aug;147(2):255-60

Atypical exanthems: morphology and laboratory investigations may lead to an aetiological diagnosis in about 70% of cases.

Drago F, Rampini E, Rebora A.

DiSEM Section of Dermatology, University of Genoa, V.le Benedetto XV 7, 16132 Genoa, Italy. rebdermo@unige.it

BACKGROUND: Besides the six classical exanthems, other exanthems may occur, differing in morphology and causative agent (atypical exanthems). Their aetiological diagnosis is difficult but crucial for both the patient and community concerning issues such as time off school, immunizations, and risks for pregnant women and immunocompromised patients. OBJECTIVES: To investigate whether morphology, associated symptoms and laboratory results can help to determine the aetiology of atypical exanthems. METHODS: We studied 112 consecutive out-patients attending two university dermatology departments. Peripheral blood mononuclear cells (PBMC) and throat, rectal and vaginal swabs were studied to identify viral and bacterial growth. Nested polymerase chain reaction was performed on PBMC and plasma using specific primers for herpesviruses. Serology for common viruses was investigated. RESULTS: We classified the exanthems into seven morphological patterns: macular erythema (32 patients), papular erythema (eight), maculopapular erythema (42), maculopapular erythema with petechiae (seven), erythema with vesiculation (11), erythema with pustules (five) and urticaria (seven). On the basis of morphology, in concert with the associated symptoms and laboratory results, we found a causal relationship in 76 patients (68%): 25 cases due to drugs, 32 to viruses, 16 to bacteria and three to parasites. A good correspondence between morphology and aetiology was found. The erythematous-vesicular pattern was exclusive to viral infections and was often accompanied by enanthema. The erythemato-pustular and papular patterns were found only in drug-related cases and in some undiagnosed cases. In contrast, the macular and maculopapular patterns were almost evenly distributed among the various aetiologies, although their colour was duskier in the drug-related exanthems. Severe pruritus was associated with drug-related exanthems. CONCLUSIONS: This is the largest series of consecutive patients with atypical exanthems reported. Their morphology and their association with pruritus or constitutional symptoms proved to be important diagnostic clues.

Publication Types:

Multicenter Study
Review
Review, Multicase

PMID: 12174095 [PubMed - indexed for MEDLINE]

2: J Emerg Med 2002 May;22(4):385-7 Related Articles, Links: Deaths associated with inappropriate intravenous colchicine administration.

Bonnel RA, Villalba ML, Karwoski CB, Beitz J.

Office of Drug Safety, Center for Drug Evaluation and Research, US Food and Drug Administration, Rockville, Maryland 20857, USA.

Intravenous (IV) colchicine is occasionally prescribed for the treatment of acute gouty arthritis. The Food and Drug Administration (FDA) recently received a report of death in a patient that was associated with inappropriate IV dosing of colchicine. This report prompted further investigation of other deaths associated with IV colchicine use in the FDA Adverse Event Reporting System (AERS) and the medical literature. A total of 20 deaths were identified. Eight patients were females, 11 were males, and the gender was unknown in 1. In all cases, the recommended maximum cumulative dose of 2 to 4 mg during a course of therapy was exceeded. Dose reductions are recommended in patients with renal or hepatic disease and in the elderly. All reported adverse events were associated with colchicine toxicity, including thrombocytopenia, leukopenia, pancytopenia, agranulocytosis, aplastic anemia, acute renal failure, and disseminated intravascular coagulopathy. Death occurred within 1 to 40 days after drug administration. Therapeutic guidelines exist for use of IV colchicine and these guidelines should be followed to prevent serious toxicities and death.

PMID: 12113850 [PubMed - indexed for MEDLINE]

3: Pediatr Emerg Care 2002 Jun;18(3):247-9 Related Articles, Links: A comparison of dog bite injuries in younger and older children treated in a pediatric emergency department.

Bernardo LM, Gardner MJ, Rosenfield RL, Cohen B, Pitetti R.

University of Pittsburgh School of Nursing, Pennsylvania 15261, USA. lbe100@pitt.edu

OBJECTIVE: Dog bites account for a significant number of traumatic injuries in the pediatric population that often require medical treatment. Although agent, host, and environmental characteristics of dog bites have been well documented, no attempt has been made to compare these characteristics by patient age group. The purpose of this study is to determine if differences exist in agent, host, and environmental characteristics among younger (< or =6 y) and older (>7 y) patients treated in a pediatric emergency department (ED) for dog bites. Findings from our study could be used to develop age-specific strategies for dog bite prevention. THEORETICAL FRAMEWORK: The epidemiologic triad of agent/host/environment formed the theoretical framework. METHODS: The study setting was the ED at Children's Hospital of Pittsburgh. Patients were enrolled between 1999 and 2000 and were identified through a review of ED records (n = 386) of children sustaining dog bites. Records were abstracted with a researcher-designed and validated form for agent (eg, breed, number of biting dogs, owner, rabies status), host (eg, age, gender, number and location of bites, treatment), and environmental (eg, bite month and time, bite location, events leading to the bite, ZIP code) characteristics. Data were analyzed using descriptive and inferential statistical tests. RESULTS: Children younger than 6 years constituted 52.8% (n = 204) of the sample. As compared with older children, a higher proportion of younger children were bitten by their family dog (chi2 = 27.64, P = 0.001) whose rabies shots were up to date (chi2 = 12.08, P = 0.034). A higher proportion of younger children were bitten on the face (chi2 = 49.54, P = 0.000) and were bitten in their own homes (chi2 = 16.075, P = 0.013). IMPLICATIONS FOR NURSING PRACTICE: Young children frequently sustain dog bites from their family dog in their own homes. Injuries typically involve severe lacerations to the face. Prevention strategies for young children include close supervision of child-dog interactions.

PMID: 12066018 [PubMed - indexed for MEDLINE]

4: Pediatr Emerg Care 2002 Jun;18(3):216-8 Related Articles, Links

Club drugs, smart drugs, raves, and circuit parties: an overview of the club scene.

Tong T, Boyer EW.

Department of Emergency Medicine, Boston Medical Center, Massachusetts, USA.

Publication Types:

Review
Review, Tutorial

PMID: 12066013 [PubMed - indexed for MEDLINE]

5: Pediatr Emerg Care 2002 Jun;18(3):174-8 Related Articles, Links: Acute, unintentional pediatric brodifacoum ingestions.

Shepherd G, Klein-Schwartz W, Anderson BD.

Maryland Poison Center, University of Maryland School of Pharmacy, Baltimore, USA. gsheph@parknet.pmh.org

BACKGROUND: Brodifacoum is the major rodenticide used in the United States today. It is similar to warfarin but has more potent and prolonged effects. Large overdoses and chronic intoxication have been associated with significant coagulopathies and death. Currently, the management of acute unintentional ingestions by young children is controversial. METHODS: American Association of Poison Control Centers (AAPCC) data from 1993 to 1996 were retrospectively searched for acute, unintentional brodifacoum exposures without coingestions followed-up to a known outcome in children aged 6 years and younger. The cases were analyzed by management site, symptoms, therapy, and outcome. Cases coded as having clinical or laboratory evidence of coagulopathy were further evaluated for severity. RESULTS: Our study reviewed 10,762 cases that involved single, acute, unintentional ingestions of brodifacoum. All of the patients were followed-up to a known outcome as defined by AAPCC data collection standards. In this cohort, there were no deaths or major effects reported. Although 67 patients reported evidence of coagulopathy, no major effects or deaths were reported. Minor and moderate effects were reported in 38 and 54 children, respectively. Management occurred outside of a healthcare facility in 5404 (50.2 %) cases. Approximately half of all the children received some form of gastrointestinal decontamination. Decontamination had no effect on the distribution of outcomes. Adverse effects from decontamination therapy were reported in 42 patients. CONCLUSION: Acute pediatric ingestions of brodifacoum rarely caused clinical effects and were not associated with life-threatening symptoms or death in young children. It seems reasonable that acute unintentional ingestions of small quantities of brodifacoum by young children can be adequately managed with home observation and parent education.

PMID: 12066002 [PubMed - indexed for MEDLINE]