[Interobserver reliability among neurology resident physicians in the diagnosis of primary headaches according to the 2004]

INTRODUCTION

We determine the interobserver reliability among neurology resident physicians when diagnosing primary headaches using the 2004 International Headache Classification (IHC) compared to that obtained when compared with these observers and those of a consensus group (CG) made up of investigators and observers.

PATIENTS AND METHODS

The study was performed in an adult and pediatric population from a 4th level Colombian hospital out-patient neurology clinic. After informed consent was obtained from each patient, a video was recorded, eliminating the facial images in order to prevent patient identification. Two same level residents (observer 1 and observer 2) with previous training in the international classification of headache disorders (IHD-2) examined the video. Each video was examined separately with the classification in hand, making the diagnoses. The diagnoses obtained were compared between the observers and with the CG.

RESULTS

We obtained a kappa index: 0.64 comparing residents, k: 0.66 comparing resident 1 to CG and kappa index 0.70 comparing resident 2 to CG in the level of groups. The kappa value obtained for the headache type level was 0.51 interobservers, 0.61 on comparing observer one with CG and 0.65 on comparing observer two with CG.

CONCLUSION

Our results indicate that there is adequate reliability in the application of the 2004 IHC classification in the diagnosis of primary headaches among neurology resident physicians.

Glasgow Coma Scale 7 or Less Surveillance Program for Brain Death Identification in Argentina: Epidemiology and Outcome

BACKGROUND

In Argentina, the rate of cadaveric organ donation per million inhabitants has recently increased to 10.5 (it was previously <7).

PURPOSE

To overcome this challenge, the National Institute for Organ Donation and Transplantation (INCUCAI) created a proactive donor detection plan performed by intensive care unit (ICU) physicians (hospital transplantation coordinators) from 90 selected hospitals across the country.

METHODS

A prospective, observational study of patients in severe coma status was conducted from September 2003 to December 2005. We enrolled hospitalized patients who displayed a Glasgow Coma Scale (GCS) of 7 or less and who were admitted to ICUs. Data included demographics, etiology of coma, cardiac arrest, brain death, discharge or derivation, and positive/negative donation.

RESULTS

Among 9841 enrolled patients, we excluded 498 who were discharged to another hospital or had unknown outcomes, leaving 9343 for analysis including 64% males and 36% females of overall mean age 50 +/- 19 years (adults) and 5 +/- 4 years (children). Herein, we have highlighted the high risk of death during the first 2 days in the ICU of patients with GCS 7 or less. Gunshot to the head-injured patients and those with hemorrhagic strokes were less likely to survive. In this study, cardiac arrest events and organ donors (OD) GCS 7 or less ratios emerged as quality control markers of ICU care, unraveling problems of potential donor maintenance or inadequate policies.

CONCLUSIONS

The GCS 7 or less surveillance program seemed to be a valuable tool for identifying organ donors and potentially treatable events, such as the high rate of cardiac arrest observed in this study.

Efficacy of amoxicillin-sulbactam, given twice-a-day, for the treatment of community-acquired pneumonia: a clinical trial based on a pharmacodynamic model

The present multicenter study reports the results of a clinical trial, designed on the basis of a pharmacodynamic study published previously (Bantar et al., J. Chemother 2000; 12: 223-227) to assess the efficacy of amoxicillin/sulbactam (875 mg/125 mg), given orally twice-a-day for 7 days in the treatment of patients with community-acquired pneumonia (CAP). Eighty-four evaluable subjects older than 19 years with clinical symptoms and features suggestive of CAP, consulting from June 2000 to March 2002 and meeting the PORT risk class I through III, were enrolled in the study. Mean age (y +/- standard deviation) was 46.7 +/- 16.3 and 62% of the patients had some co-morbidity predisposing for CAP. Several individuals (77.4%) fell into a low-risk class (i.e. PORT I or II) and 22.6% of patients belonged to a moderate-risk class at the start of treatment. Six patients (6.45%) had pneumococcal bacteremia. Streptococcus pneumoniae was the organism most frequently isolated (61.9% of all the patients in whom an etiologic diagnosis was made), followed by Haemophilus influenzae. Clinical success was observed in 97.6% of the patients (confidence interval 95%, 94.3%-100%). Almost all the individuals with clinical success became afebrile within the first 3 days of therapy. Ten patients (11.8%) reported mild or moderate adverse events (especially diarrhea) possibly related to the antimicrobial therapy, but this did not lead to withdrawal from the trial. The results of this study suggest that amoxicillin/sulbactam (875 mg/125 mg) is an efficacious and well tolerated option for treating patients with CAP belonging to a low-moderate risk class and support the use of a short, oral (7-day) b.i.d. regimen.

Urban epizootic of rabies in Mexico: epidemiology and impact of animal bite injuries

From 1 July 1987 to 31 December 1988, a total of 317 animals (91% of which were dogs) were confirmed to have rabies in Hermosillo, Mexico. The median age of rabid dogs was 1 year, 69% were male, and 98% were owned. The epizootic started in the southern areas of the city, rapidly involved the entire city, and persisted mainly in lower socioeconomic status areas. The area of the city and mean household size were significant predictor variables for the population density of rabid dogs around household clusters (Poisson linear regression, P < 0.001 and P = 0.03, resp). Approximately 2.5% of city residents were bitten by dogs in 1987, with the rate of reported dog bite injuries being positively correlated with mean household size and the proportion of households that owned dogs. Visits to the city health centre for evaluation of possible exposures to rabies increased by 135% after the start of the epizootic; approximately 273 per 100,000 city residents were administered a full or partial course of rabies post-exposure prophylaxis in 1987. Children were at greatest risk for exposures to rabies, accounting for 60% of all reported animal bite injuries evaluated at the health centre. Also they were more likely than older persons to have received bite injuries to the head, face, and neck (odds ratio = 21.6, 95% confidence interval = 5.4, 186.5).