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The usefulness of urine fluorescence for suspected antifreeze ingestion in children.
Parsa T, Cunningham SJ, Wall SP, Almo SC, Crain EF.
Department of Pediatrics Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
PURPOSE: To evaluate urine fluorescence as a diagnostic tool. PROCEDURES: Using a Wood lamp, 60 physicians, assigned to group 1 or 2, independently rated 150 urine specimens from nonpoisoned children as fluorescent or nonfluorescent. Interobserver and intraobserver agreements were assessed. Physician ratings were compared with fluorometry results. The prevalence of urine fluorescence was determined by fluorometry. MAIN FINDINGS: Group 1 reported fluorescence in 80.7% (95% CI 73.4%-86.6%) of urine specimens; group 2 reported fluorescence in 69.3% (95% CI 61.3%-76.5%). Interrater agreement was poor (72.5%, kappa = 0.25, 95% CI 0.13-0.37); intrarater agreement was good (physician group 1: 97.9%, kappa = 0.93, 95% CI 0.77-1.00; physician group 2: 93.3%, kappa = 0.85, 95% CI 0.69-1.00). The prevalence of urine fluorescence was 100% (95% CI 98.1%-100%). CONCLUSION: Our data suggest that determination of urine fluorescence using a Wood lamp is a poor screening tool for suspected antifreeze ingestion in children.
Publication Types:
PMID: 16182989 [PubMed - indexed for MEDLINE]
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Emergency management of agitation in schizophrenia.
Marco CA, Vaughan J.
Department of Emergency Medicine, St Vincent Mercy Medical Center, Toledo, OH 43608-2691, USA. cmarco2@aol.com
Schizophrenia is a common psychiatric condition, affecting approximately 1% of the population. Acute emergent presentations often include hallucinations, delusions, thought, and speech disorders. Agitation is common among emergency patients with schizophrenia. Decisional capacity should be assessed in all patients. Reversible causes of agitation should be ruled out, including infection, metabolic disorders, endocrine disorders, trauma, pain, noncompliance, toxicological disorders, and structural brain abnormalities. Agitation may be managed acutely using a combination of pharmacological agents and nonpharmacological interventions. Effective pharmacological agents include several classes of antipsychotic agents and benzodiazepines. Potential life-threatening complications of pharmacological therapy should be anticipated, which may include neuroleptic malignant syndrome (NMS), prolonged QT syndrome, and respiratory depression. Nonpharmacological interventions may include a quiet environment, physical restraints, and behavioral interventions. Disposition decisions should be made based on the etiology of agitation, effective management, decisional capacity, and presence of suicidal or homicidal intentions. Many patients who have required nonpharmacological or pharmacological management of agitation require inpatient psychiatric treatment, either voluntarily or involuntarily. Psychiatric consultation should be sought for patients with schizophrenia and uncertain disposition determinations, or those requiring other complex management decisions.
Publication Types:
PMID: 16182986 [PubMed - indexed for MEDLINE]
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Most lay people can correctly identify indigenous venomous snakes.
Corbett SW, Anderson B, Nelson B, Bush S, Hayes WK, Cardwell MD.
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
We attempted to determine how accurately members of the public can identify venomous snakes. Six different snakes indigenous to southern California were displayed in cages for 265 people to view at a street fair. These included 4 nonvenomous snakes and 2 venomous snakes. People were asked whether the snake was venomous and the name of the snake, if they knew it. Overall, people recognized whether a snake was venomous or nonvenomous 81% of the time. They were most accurate at identifying rattlesnakes as being venomous (95%) but incorrectly identified nonvenomous snakes as being venomous 25% of the time. Men were more accurate than women, and adults were more accurate than children. Subjects were less well able to identify the exact species of snakes. The results suggest that there may be no need to capture, kill, or bring a snake to the hospital for identification, at least in this geographic area.
PMID: 16182984 [PubMed - indexed for MEDLINE]
Fixed drug eruption: a novel side-effect of levocetirizine.
Mahajan VK, Sharma NL, Sharma VC.
Publication Types:
PMID: 16135160 [PubMed - indexed for MEDLINE]
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Pityriasis rosea: an important papulosquamous disorder.
Gonzalez LM, Allen R, Janniger CK, Schwartz RA.
Dermatology and Pediatrics - New Jersey Medical School, Newark, NJ 07103-2714, USA.
Publication Types:
PMID: 16135147 [PubMed - indexed for MEDLINE]
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Erythroderma in adults: a report of 80 cases.
Rym BM, Mourad M, Bechir Z, Dalenda E, Faika C, Iadh AM, Amel BO.
Dermatology Department, La Rabta Hospital, and Preventive Medicine Department, University of Medicine, Tunis, Tunisia.
BACKGROUND: Erythroderma is a generalized erythema of the skin accompanied by a variable degree of scaling. However, most of the published series originate from Western countries. There is only one report from Africa, conducted in Dakar in 1979. The aim of our study was to provide information about this condition in our country. PATIENTS AND METHODS: Our study was retrospective, dealing with 80 erythrodermic adults, examined between January 1981 and December 2000. Patient information included clinical, laboratory, histopathologic and therapeutic data. We also noted patients' outcomes within an average follow-up period of 30 months. Thus, we calculated the mortality rate and estimated the probability of survival without relapses according to the Kaplan-Meier method. RESULTS: The frequency of erythroderma in our dermatology department was 0.3. The sex ratio (male/female) was 2.2. The average age of our patients was 53.78 +/- 18 years. Previous history of skin disease was found in 49/80 patients (61.2%) and 32 of them were suffering from psoriasis. Hyperthermia was significantly associated with drug reactions (P = 0.013). Hypereosinophilia was not a specific finding. The mortality rate was higher than that of an age-matched population. CONCLUSION: Adult erythroderma is a rare condition. Its most common cause in our study was psoriasis. No cases of atopic dermatitis were found. Prognosis was adversely affected by the presence of erythroderma.
PMID: 16135140 [PubMed - indexed for MEDLINE]
Lead poisoning--a differential diagnosis for abdominal pain.
Frith D, Yeung K, Thrush S, Hunt BJ, Hubbard JG.
Department of Surgery, St Thomas' Hospital, London SE1 7EH, UK. danielfrith@hotmail.com
Publication Types:
PMID: 16360796 [PubMed - indexed for MEDLINE]
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