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Ocampo E.,Catholic University of Uruguay | MacEiras M.,Catholic University of Uruguay | Herrera S.,Clinica Pediatrica | Maurente C.,Catholic University of Uruguay | And 2 more authors.
Expert Systems with Applications | Year: 2011

The amount of information available for physicians has dramatically increased in the recent past. In contrast, the specialist's ability to understand, synthesize and take into account such information is severely constrained by the short time available for the appointments. Therefore, systems reusing available knowledge and implementing reasoning processes become critical to support the tasks of the doctors. As a number of different techniques for building such systems are available, contrasting their effectiveness becomes a major concern. This is especially important in the case of infectious diseases that can be lethal within hours such as the Acute Bacterial Meningitis (ABM) for which implementing and contrasting different techniques allows for an increased reliability and speed in supporting the process of diagnosis. This work focuses on the construction of diagnosis support tools for ABM, reporting a comparative assessment of the quality of a Clinical Decision Support System (CDSS) resulting from the application of Case Based Reasoning (CBR), to that of an existing CDSS system developed using a Bayesian expert system. Although both approaches proved to be useful, the one based in CBR techniques show some interesting capabilities as higher precision, automatic learning or experience capturing, and also a better response to lack of input data. The three developed systems perform with high levels of accuracy- e.g. propose correct diagnostics based on a certain set of symptoms - but the one based on CBR present some additional capabilities that look very promising for implementing these kind of systems in a real world scenario. © 2011 Published by Elsevier Ltd.

Battelino T.,University of Ljubljana | Conget I.,Hospital Clinici Universitari | Olsen B.,Glostrup Hospital | Schutz-Fuhrmann I.,Hospital Hietzing | And 5 more authors.
Diabetologia | Year: 2012

Aims/hypothesis The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitorin (CGM) to insulin pump therapy (CSII) in type 1 diabetes. Methods Children and adults (n=153) on CSII with HbA1c 7.5-9.5% (58.5-80.3 mmol/mol) were randomised to (CGM) a Sensor On or Sensor Off arm for 6 months. After 4 months' washout, participants crossed over to the other arm for 6 months. Paediatric and adult participants were separately electronically randomised through the case report form according to a predefined randomisation sequence in eight secondary and tertiary centres. The primary outcome was the difference in HbA1c levels between arms after 6 months. Results Seventy-seven participants were randomised to the On/Off sequence and 76 to the Off/On sequence; all were included in the primary analysis. The mean difference in HbA1c was -0.43% (-4.74 mmol/mol) in favour of the Sensor On arm (8.04% [64.34 mmol/mol] vs 8.47% [69.08 mmol/mol]; 95% CI -0.32%, -0.55% [-3.50, -6.01 mmol/mol]; p<0.001). Following cessation of glucose sensing, HbA 1c reverted to baseline levels. Less time was spent with sensor glucose <3.9 mmol/l during the Sensor On arm than in the Sensor Off arm (19 vs 31 min/day; p=0.009). The mean number of daily boluses increased in the Sensor On arm (6.8±2.5 vs 5.8±1.9, p<0.0001), together with the frequency of use of the temporary basal rate (0.75± 1.11 vs 0.26±0.47, p<0.0001) and manual insulin suspend (0.91±1.25 vs 0.70±0.75, p<0.018) functions. Four vs two events of severe hypoglycaemia occurred in the Sensor On and Sensor Off arm, respectively (p=0.40). Conclusions/interpretation Continuous glucose monitoring was associated with decreased HbA1c levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects.Trial registration ClinicalTrials.gov registration no. NCT00598663. Funding The study was funded by Medtronic International Trading Sarl Switzerland. © Springer-Verlag 2012.

Marchetti F.,Clinica Pediatrica | Panizon F.,University of Trieste
Medico e Bambino | Year: 2010

It is reasonable to delay the antibiotic treatment of a few days in all the apparently not serious cases of upper respiratory infection. "Risk" groups, in which antibiotics should be used to treat each fever, are: chronic pulmonary, kidney and heart diseases, immunodeficiency, cystic fibrosis, muscular diseases and prematurity. In case of a child with sore throat, if there are other concomitant signs of respiratory infection (nasal secretion, cough) it is certainly a viral disease. If pharyngitis is not accompanied by signs of infection to the upper respiratory tract, perform rapid strep test, it should come out positive in half of cases. Antibiotics are of little help in sinusitis. If the cough that accompanies fever is very severe and the outcome of auscultation is not significant, respiratory rate must be counted. If it is not higher than 45/m (under 2 years) it is not bronchopneumonitis, or at least, the latter is neither significant nor worrying. Waiting is still reasonable. The problem of antibiotic resistance for excessive use is real; it certainly concerns more macrolides than amoxicillin and it is proportional to the antibiotic pressure (which is very high in Italy). The problem of methicillin-resistant Staphylococcus pathology, though quantitatively limited, is growing and may have tragic outcomes. The "complete" resistance of Pneumococcus to amoxicillin is assessed at about 2-3%. An intermediate resistance (between 10% and 15%) can be easily overcome by using, when needed, higher doses of amoxicillin.

The hyperventilation psychogenic Crisis (HPC) can appear as a sensation of shortness of breath, chest pain, palpitations, dizziness, headaches, numbness in the hands, and sometimes as a tetanus like state. For their classification they are included in non-epileptic paroxysmal episodes (NEPE). The patient interview and the clinical examination are the clues for the diagnosis and they prevent from unnecessary treatment and additional studies. The aim of this paper is to present two patients who consulted for NEPE secondary to HPC.

The debate about acute otitis media (AOM) is endless, like any other subject that greatly affects the daily routine of the family paediatrician. However, much greater rigour is needed in the use of antibiotics (to safeguard a heritage that is certainly not infinite), so our prescription habits must be reassessed. Therefore, the vigilant wait in AOM has become a possible tested and recommended behaviour that today guidelines have opportunely fixed. There are no longer excuses or justifications. However, it is true that otitis with severe otalgia (eversion of the tympanic membrane) must be opportunely and conveniently treated immediately upon the onset at all ages. A few days of therapy with high doses of amoxicillina three times a day is the best treatment. The association with clavulanic acid should mainly be administered to children under 2 years old.

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