Publications – professor kathryn maitland anoxia meaning

Berkley JA, maitland K, mwangi I,

Ngetsa C, mwarumba S, lowe BS, newton CRJC, marsh K, scott JAG, english M et al., 2005, use of clinical syndromes to target antibiotic prescribing in seriously ill children in malaria endemic area: observational study., BMJ, vol: 330

OBJECTIVES: to determine how well antibiotic treatment is targeted by simple clinical syndromes and to what extent drug resistance threatens affordable antibiotics. DESIGN: observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from world health organization integrated management of childhood illness and inpatient guidelines and application of these rules to a prospectively collected dataset.Anoxia meaning


SETTING: kilifi district hospital, kenya. PARTICIPANTS: 11,847 acute paediatric admissions. MAIN OUTCOME MEASURES: presence of invasive bacterial infection (bacteraemia or meningitis) or plasmodium falciparum parasitaemia; antimicrobial sensitivities of isolated bacteria. RESULTS: 6254 (53%) admissions met criteria for syndromes requiring antibiotics (sick young infants; meningitis/encephalopathy; severe malnutrition; very severe, severe, or mild pneumonia; skin or soft tissue infection): 672 (11%) had an invasive bacterial infection (80% of all invasive bacterial infections identified), and 753 (12%) died (93% of all inpatient deaths). Among P falciparum infected children with a syndromic indication for parenteral antibiotics, an invasive bacterial infection was detected in 4.0-8.8%.Anoxia meaning for the syndrome of meningitis/encephalopathy, 96/123 (76%) isolates were fully sensitive in vitro to penicillin or chloramphenicol. CONCLUSIONS: simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death. Malaria parasitaemia does not justify withholding empirical parenteral antibiotics. Lumbar puncture is critical to the rational use of antibiotics.

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Maitland K, pamba A, english M,

Peshu N, levin M, marsh K, newton CRJC et al., 2005, pre-transfusion management of children with severe malarial anaemia: a randomised controlled trial of intravascular volume expansion., br J haematol, vol: 128, pages: 393-400, ISSN: 0007-1048

anoxia meaning

Symptomatic severe malarial anaemia (SMA) has a high fatality rate of 30-40%; most deaths occur in children awaiting blood transfusion. Blood transfusion services in most of africa are not capable of delivering adequate supplies of safe blood in a timely manner to critically ill children with SMA. Contrary to widely held belief, hypovolaemia, rather than heart failure, has emerged as a common complication in such children. We examined the safety of pre-transfusion management (PTM) by volume expansion, aimed at stabilizing children and obviating the urgency for blood transfusion. Kenyan children with severe falciparum anaemia (haemoglobin 5 g/dl) and respiratory distress were randomly assigned to 20 ml/kg of 4.5% albumin or 0.9% saline or maintenance only (control) while awaiting blood transfusion.Anoxia meaning PTM was apparently safe since it did not lead to the development of pulmonary oedema or other adverse events. There was no significant difference in the primary outcome [mean percentage reduction in base excess between admission and 8 h (95% confidence interval)] between the control group 42% (19-66%) albumin group 44% (32-57%) and saline group 36% (16-57%); adjusted analysis of variance F=0.31, P=0.7. However, the number of children requiring emergency interventions was significantly greater in the control group, four of 18 (22%) than the saline group 0 of 20 (P=0.03). We have established the safety of this PTM in children with SMA whilst awaiting blood transfusion at a hospital with an adequate blood-banking program.Anoxia meaning the impact on mortality should be assessed where blood transfusion services are unable to supply emergency transfusions.

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