IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses tachypnoea (rapid breathing) in well babies. It begins by covering the physiology of breathing in infants, noting that respiratory rate typically decreases over the first year of life. It defines tachypnoea in infants as a respiratory rate over 60 breaths per minute. The document emphasizes that accurately measuring respiratory rate can be challenging, and recommends using a stethoscope and taking the rate over a full minute while recording the baby's state. It also discusses periodic breathing patterns seen in infants.
The document discusses pediatric asthma, including when to diagnose it in children under 5 years old. Key points include using a therapeutic trial and symptoms like exercise-induced wheezing to make a diagnosis. Tests can include skin prick tests and FeNO to aid diagnosis but not confirm it. The Asthma Predictive Index uses factors like eczema and family history to predict later asthma. Treatment follows GINA guidelines with a stepwise approach starting with SABAs and considering ICS, LTRAs, and doubling ICS doses if needed. Environmental controls and asthma education are also important for management.
Format 2016: how to get asthma control: from PubMed to the tricks of the trade.Envicon Medical Srl
This document discusses strategies for achieving asthma control. It begins by establishing the importance of a partnership between healthcare providers and patients. Effective self-regulation is key, which involves patients observing their condition, making judgments, and reacting appropriately. Motivational interviewing can help patients progress through stages of change. Active listening from providers helps address patients' cognitive and emotional needs. Both verbal and nonverbal communication impact the relationship and treatment outcomes. Involving children in their care can improve satisfaction and adherence.
The document discusses the evaluation and management of difficult or severe asthma. It notes that in evaluating these patients, it is important to first establish an accurate diagnosis of asthma through objective measures like spirometry before and after bronchodilation. Studies have found that a substantial percentage of patients diagnosed with difficult asthma were later found to have an alternative or incorrect diagnosis after thorough evaluation. Assessing and addressing comorbidities, adherence, environmental factors, and phenotypes is also important for optimizing treatment of difficult asthma. Difficult asthma can be divided into cases where underlying problems can be addressed versus true therapy-resistant severe asthma.
This handbook was designed to support delegates attending a clinical support worker skills workshop run by Trust Interventions. The purpose of the handbook is to enhance learning from the course and serve as a future reference. Trust Interventions offers a range of flexibly delivered training courses and services on topics like taking temperatures, conditions requiring temperature monitoring, and types of thermometers.
This document summarizes established and emerging therapies for severe asthma exacerbations in children. It discusses the prevalence and severity of asthma, as well as standard therapies like oxygen, steroids, and beta agonists. It also reviews newer approaches like continuous albuterol, IV terbutaline, heliox, magnesium sulfate, and mechanical ventilation strategies. Highlights various clinical patterns of asthma and approaches to managing mild-moderate vs. severe exacerbations.
Format 2016: what is new in allergic & diseases respiratory 2016.Envicon Medical Srl
The document summarizes recent research in the fields of allergic and respiratory diseases from 2016. It includes summaries of multiple studies related to topics like drug allergy, food allergy, asthma, allergic rhinitis, and infectious respiratory diseases. The studies examined issues such as improving the effectiveness of penicillin allergy de-labeling through skin and drug testing, using drug provocation tests to diagnose non-immediate reactions to antibiotics like amoxicillin in children, and establishing reference doses for precautionary food labeling. One survey also found discrepancies between what health care professionals believe indicates risks of cross-contamination and what they consider to be best practices for precautionary allergen labeling.
This document discusses tachypnoea (rapid breathing) in well babies. It begins by covering the physiology of breathing in infants, noting that respiratory rate typically decreases over the first year of life. It defines tachypnoea in infants as a respiratory rate over 60 breaths per minute. The document emphasizes that accurately measuring respiratory rate can be challenging, and recommends using a stethoscope and taking the rate over a full minute while recording the baby's state. It also discusses periodic breathing patterns seen in infants.
The document discusses pediatric asthma, including when to diagnose it in children under 5 years old. Key points include using a therapeutic trial and symptoms like exercise-induced wheezing to make a diagnosis. Tests can include skin prick tests and FeNO to aid diagnosis but not confirm it. The Asthma Predictive Index uses factors like eczema and family history to predict later asthma. Treatment follows GINA guidelines with a stepwise approach starting with SABAs and considering ICS, LTRAs, and doubling ICS doses if needed. Environmental controls and asthma education are also important for management.
Format 2016: how to get asthma control: from PubMed to the tricks of the trade.Envicon Medical Srl
This document discusses strategies for achieving asthma control. It begins by establishing the importance of a partnership between healthcare providers and patients. Effective self-regulation is key, which involves patients observing their condition, making judgments, and reacting appropriately. Motivational interviewing can help patients progress through stages of change. Active listening from providers helps address patients' cognitive and emotional needs. Both verbal and nonverbal communication impact the relationship and treatment outcomes. Involving children in their care can improve satisfaction and adherence.
The document discusses the evaluation and management of difficult or severe asthma. It notes that in evaluating these patients, it is important to first establish an accurate diagnosis of asthma through objective measures like spirometry before and after bronchodilation. Studies have found that a substantial percentage of patients diagnosed with difficult asthma were later found to have an alternative or incorrect diagnosis after thorough evaluation. Assessing and addressing comorbidities, adherence, environmental factors, and phenotypes is also important for optimizing treatment of difficult asthma. Difficult asthma can be divided into cases where underlying problems can be addressed versus true therapy-resistant severe asthma.
This handbook was designed to support delegates attending a clinical support worker skills workshop run by Trust Interventions. The purpose of the handbook is to enhance learning from the course and serve as a future reference. Trust Interventions offers a range of flexibly delivered training courses and services on topics like taking temperatures, conditions requiring temperature monitoring, and types of thermometers.
This document summarizes established and emerging therapies for severe asthma exacerbations in children. It discusses the prevalence and severity of asthma, as well as standard therapies like oxygen, steroids, and beta agonists. It also reviews newer approaches like continuous albuterol, IV terbutaline, heliox, magnesium sulfate, and mechanical ventilation strategies. Highlights various clinical patterns of asthma and approaches to managing mild-moderate vs. severe exacerbations.
Format 2016: what is new in allergic & diseases respiratory 2016.Envicon Medical Srl
The document summarizes recent research in the fields of allergic and respiratory diseases from 2016. It includes summaries of multiple studies related to topics like drug allergy, food allergy, asthma, allergic rhinitis, and infectious respiratory diseases. The studies examined issues such as improving the effectiveness of penicillin allergy de-labeling through skin and drug testing, using drug provocation tests to diagnose non-immediate reactions to antibiotics like amoxicillin in children, and establishing reference doses for precautionary food labeling. One survey also found discrepancies between what health care professionals believe indicates risks of cross-contamination and what they consider to be best practices for precautionary allergen labeling.
Surfactant journey,nnk,oct 2017 - Dr Karthik Nageshkarthiknagesh
This document summarizes Dr. Karthik Nagesh's experience with surfactant therapy in India, beginning in the early 1990s. It describes some of Dr. Nagesh's early experiences using surfactant procured from other countries to treat neonatal respiratory distress syndrome. It then outlines how surfactant therapy became more established in India through clinical trials, workshops to educate others, and the eventual commercial availability of surfactants in India. The document provides several cases that demonstrated the benefits of surfactant therapy for reducing the need for oxygen and ventilation support.
The document discusses the use of inhalational devices in asthma care. It describes various aerosol delivery technologies used including metered-dose inhalers, dry powder inhalers, nebulizers, and spacer devices. It emphasizes that the goal of asthma therapy is optimal drug delivery to the lower airways while minimizing deposition in the upper airways. The document provides recommendations for inhaler use and techniques to optimize treatment. It also discusses challenges with various devices and potential solutions through patient education.
PPT presentation supporting education for the NHS SEC SCN Acute Care Pathways: Fever, Bronchiolitis, Diarrhoea and Vomiting, Head Injury and Acute Asthma
1) An 11-month-old male infant was admitted to the hospital with pneumonia. He had a history of fever, cough, difficulty breathing, and poor intake. Examination findings included tachycardia, rales in the lung fields, and a chest x-ray confirming bilateral pneumonia.
2) The nursing care plan addressed ineffective airway clearance and elevated temperature. Interventions included respiratory treatments, antipyretics, fluids, and teaching the mother signs and symptoms of pneumonia.
3) The expected outcomes were for the infant to have effective breathing and clear lungs. The family was educated on prevention of future infections like handwashing and avoiding aspiration risks.
1) A study of 651 children with pollen-related allergic rhinitis found that component-resolved diagnosis identified a lack of IgE antibodies to major allergens in a significant percentage of patients with skin prick test reactivity, calling into question the appropriateness of immunotherapy for some patients.
2) Without component-resolved diagnosis, immunotherapy would have been prescribed inappropriately in 37% of cases based on skin prick test alone.
3) Component-resolved diagnosis led European and American allergists to change their immunotherapy prescription decisions in 42-48% of cases compared to skin prick testing alone.
Mortality meeting is a practice in all hospitals. In ours, we try to discuss the case in depth, so that the management can become better. This is one such case.
This document discusses the dental management of asthmatic pediatric patients. It begins by defining asthma as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, chest tightness and coughing. It notes that asthma prevalence has increased in children over the past 20 years. The document then discusses the burden of asthma in children, signs and symptoms, diagnosis, medications used to treat and manage asthma, as well as considerations for treating asthmatic patients in a dental setting including avoiding triggers and properly managing acute asthma attacks.
Mortality meeting is a practice in all hospitals. In ours, we try to discuss the case in depth, so that the management can become better. This is one such case.
Bacterial meningitis in infants under 90 days old remains a significant burden in the UK and Ireland, with approximately 250 cases reported annually. While mortality has decreased over time to around 12%, long-term neurological complications and disabilities persist in around 20-25% of survivors. Effective diagnosis relies on lumbar puncture since clinical signs are non-specific, but many infants do not receive timely lumbar punctures. There is a lack of evidence regarding optimal antibiotic treatment duration and adjunctive therapies. Two ongoing studies aim to better define the current disease burden and identify opportunities to improve outcomes through earlier recognition, management, and prevention.
This document discusses several studies on the stability and effectiveness of epinephrine in auto-injectors and syringes when exposed to varying temperatures. One study found that outdated EpiPens stored up to 3 years past the expiration date still delivered over 84% of the labeled epinephrine dose. Another found that freezing or refrigerating EpiPens did not significantly affect dose delivery. A review found that real-world temperature fluctuations likely do not cause significant epinephrine degradation. Additionally, the document examines different auto-injector designs and finds that initial training effectiveness was similar for EpiPen and Anapen, but recall was better maintained with EpiPen. Switching devices without retraining showed lower success rates,
1) Antimicrobial stewardship programs aim to optimize antibiotic use and prevent resistance by coordinating actions to improve prescribing. They promote appropriate use through guidelines, education, and monitoring of antibiotic use and outcomes.
2) In NICUs, antimicrobial stewardship faces unique challenges due to non-specific signs of infection in neonates and difficulties obtaining cultures. Programs seek to minimize broad-spectrum antibiotic exposure and duration to reduce resistance and side effects.
3) Effective strategies for neonatal antimicrobial stewardship include developing unit-specific treatment guidelines, prospectively auditing antibiotic use, educating providers, streamlining therapy based on culture results, and implementing bundles to prevent infections.
What is new in general pediatrics, allergic and respiratory diseasesEnvicon Medical Srl
The document discusses several studies related to general pediatrics, allergic and respiratory diseases from 2017.
One study found that early-term deliveries between 37-38 weeks gestation were associated with increased risk of long-term respiratory morbidity compared to full-term deliveries between 39-40 weeks. Another study showed that preschoolers with bedtimes before 8pm had a lower risk of adolescent obesity than those with later bedtimes. A third study found that high school start times later than 8:30am were associated with improved attendance and graduation rates.
Ranitidine is associated with infections, necrotizing enterocolitisCMCH,Vellore
This study found that ranitidine use in very low birth weight newborns was associated with higher rates of infections, necrotizing enterocolitis (NEC), and mortality. Newborns treated with ranitidine had over 5 times higher risk of infections like sepsis and pneumonia compared to those not treated. Rates of NEC and mortality were also significantly higher in newborns receiving ranitidine. The study cautions against the use of ranitidine in preterm newborns due to these risks of severe infectious diseases and fatal outcomes.
Current Controversies in Hypothermic NeuroprotectionMaged Zakaria
This document discusses current controversies around the use of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE). While three randomized controlled trials showed cooling decreases death and disability, adoption has been slow. Reasons include wanting more data on death vs disability outcomes, longer-term follow-up, and concerns about trial size. Practical barriers to implementation include cost of equipment, off-label use of available devices, and complexity of protocols. Widespread adoption may increase as additional large trials report and low-cost options are developed.
- Bronchiolitis is a common respiratory illness that affects infants under 2 years old, usually peaking between 3-6 months. It is diagnosed based on symptoms of persistent cough, wheezing, crackles on the chest, and fast breathing or chest wall indrawing.
- Children with bronchiolitis should be immediately referred to the hospital if they have apnea, appear seriously ill, have very fast or difficult breathing, bluish skin, or low oxygen levels. They may also be referred if they have fast breathing over 60/minute, cannot eat or drink well, or are dehydrated.
- At the hospital, children should be admitted if they have apnea, low oxygen levels,
The document defines focus charting as a systematic method for organizing health information using nursing terminology to describe a patient's health status and care. It involves focusing on key concerns from the care plan like skin integrity or activity tolerance. A focus note includes subjective and objective data supporting the focus, nursing interventions, and the patient's response. An example focus note addresses a patient's pain by documenting their complaint, administering medication, repositioning the patient, and noting their improved pain level in response.
What nelson forgot 4 - Super CME for Common Pediatric OPD questionsGaurav Gupta
What nelson forgot 4 - Super CME for Common Pediatric OPD questions, 12th July 2019
Common Office practice questions, answered in just 5-10 minutes per topic ...
Estratégia da one plus nos meios digitaisVítor Silva
A estratégia de marketing digital da OnePlus foca no marketing boca a boca e na interação com a comunidade online em vez de grandes campanhas publicitárias. Eles usam um sistema de convites para lançamentos de produtos que cria escassez e antecipação entre os consumidores. O OnePlus One foi um sucesso com esta abordagem e o lançamento do OnePlus 2 melhorou ainda mais o sistema de convites.
The document discusses how creatives share similarities with children in that they are curious, imaginative, and enjoy play. It notes that creatives thrive on praise, have short attention spans like consumers, and need to work in fun environments to stay motivated. Harnessing their "childishness" can help lead to business success.
Surfactant journey,nnk,oct 2017 - Dr Karthik Nageshkarthiknagesh
This document summarizes Dr. Karthik Nagesh's experience with surfactant therapy in India, beginning in the early 1990s. It describes some of Dr. Nagesh's early experiences using surfactant procured from other countries to treat neonatal respiratory distress syndrome. It then outlines how surfactant therapy became more established in India through clinical trials, workshops to educate others, and the eventual commercial availability of surfactants in India. The document provides several cases that demonstrated the benefits of surfactant therapy for reducing the need for oxygen and ventilation support.
The document discusses the use of inhalational devices in asthma care. It describes various aerosol delivery technologies used including metered-dose inhalers, dry powder inhalers, nebulizers, and spacer devices. It emphasizes that the goal of asthma therapy is optimal drug delivery to the lower airways while minimizing deposition in the upper airways. The document provides recommendations for inhaler use and techniques to optimize treatment. It also discusses challenges with various devices and potential solutions through patient education.
PPT presentation supporting education for the NHS SEC SCN Acute Care Pathways: Fever, Bronchiolitis, Diarrhoea and Vomiting, Head Injury and Acute Asthma
1) An 11-month-old male infant was admitted to the hospital with pneumonia. He had a history of fever, cough, difficulty breathing, and poor intake. Examination findings included tachycardia, rales in the lung fields, and a chest x-ray confirming bilateral pneumonia.
2) The nursing care plan addressed ineffective airway clearance and elevated temperature. Interventions included respiratory treatments, antipyretics, fluids, and teaching the mother signs and symptoms of pneumonia.
3) The expected outcomes were for the infant to have effective breathing and clear lungs. The family was educated on prevention of future infections like handwashing and avoiding aspiration risks.
1) A study of 651 children with pollen-related allergic rhinitis found that component-resolved diagnosis identified a lack of IgE antibodies to major allergens in a significant percentage of patients with skin prick test reactivity, calling into question the appropriateness of immunotherapy for some patients.
2) Without component-resolved diagnosis, immunotherapy would have been prescribed inappropriately in 37% of cases based on skin prick test alone.
3) Component-resolved diagnosis led European and American allergists to change their immunotherapy prescription decisions in 42-48% of cases compared to skin prick testing alone.
Mortality meeting is a practice in all hospitals. In ours, we try to discuss the case in depth, so that the management can become better. This is one such case.
This document discusses the dental management of asthmatic pediatric patients. It begins by defining asthma as a chronic inflammatory airway disorder characterized by recurrent wheezing, breathlessness, chest tightness and coughing. It notes that asthma prevalence has increased in children over the past 20 years. The document then discusses the burden of asthma in children, signs and symptoms, diagnosis, medications used to treat and manage asthma, as well as considerations for treating asthmatic patients in a dental setting including avoiding triggers and properly managing acute asthma attacks.
Mortality meeting is a practice in all hospitals. In ours, we try to discuss the case in depth, so that the management can become better. This is one such case.
Bacterial meningitis in infants under 90 days old remains a significant burden in the UK and Ireland, with approximately 250 cases reported annually. While mortality has decreased over time to around 12%, long-term neurological complications and disabilities persist in around 20-25% of survivors. Effective diagnosis relies on lumbar puncture since clinical signs are non-specific, but many infants do not receive timely lumbar punctures. There is a lack of evidence regarding optimal antibiotic treatment duration and adjunctive therapies. Two ongoing studies aim to better define the current disease burden and identify opportunities to improve outcomes through earlier recognition, management, and prevention.
This document discusses several studies on the stability and effectiveness of epinephrine in auto-injectors and syringes when exposed to varying temperatures. One study found that outdated EpiPens stored up to 3 years past the expiration date still delivered over 84% of the labeled epinephrine dose. Another found that freezing or refrigerating EpiPens did not significantly affect dose delivery. A review found that real-world temperature fluctuations likely do not cause significant epinephrine degradation. Additionally, the document examines different auto-injector designs and finds that initial training effectiveness was similar for EpiPen and Anapen, but recall was better maintained with EpiPen. Switching devices without retraining showed lower success rates,
1) Antimicrobial stewardship programs aim to optimize antibiotic use and prevent resistance by coordinating actions to improve prescribing. They promote appropriate use through guidelines, education, and monitoring of antibiotic use and outcomes.
2) In NICUs, antimicrobial stewardship faces unique challenges due to non-specific signs of infection in neonates and difficulties obtaining cultures. Programs seek to minimize broad-spectrum antibiotic exposure and duration to reduce resistance and side effects.
3) Effective strategies for neonatal antimicrobial stewardship include developing unit-specific treatment guidelines, prospectively auditing antibiotic use, educating providers, streamlining therapy based on culture results, and implementing bundles to prevent infections.
What is new in general pediatrics, allergic and respiratory diseasesEnvicon Medical Srl
The document discusses several studies related to general pediatrics, allergic and respiratory diseases from 2017.
One study found that early-term deliveries between 37-38 weeks gestation were associated with increased risk of long-term respiratory morbidity compared to full-term deliveries between 39-40 weeks. Another study showed that preschoolers with bedtimes before 8pm had a lower risk of adolescent obesity than those with later bedtimes. A third study found that high school start times later than 8:30am were associated with improved attendance and graduation rates.
Ranitidine is associated with infections, necrotizing enterocolitisCMCH,Vellore
This study found that ranitidine use in very low birth weight newborns was associated with higher rates of infections, necrotizing enterocolitis (NEC), and mortality. Newborns treated with ranitidine had over 5 times higher risk of infections like sepsis and pneumonia compared to those not treated. Rates of NEC and mortality were also significantly higher in newborns receiving ranitidine. The study cautions against the use of ranitidine in preterm newborns due to these risks of severe infectious diseases and fatal outcomes.
Current Controversies in Hypothermic NeuroprotectionMaged Zakaria
This document discusses current controversies around the use of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE). While three randomized controlled trials showed cooling decreases death and disability, adoption has been slow. Reasons include wanting more data on death vs disability outcomes, longer-term follow-up, and concerns about trial size. Practical barriers to implementation include cost of equipment, off-label use of available devices, and complexity of protocols. Widespread adoption may increase as additional large trials report and low-cost options are developed.
- Bronchiolitis is a common respiratory illness that affects infants under 2 years old, usually peaking between 3-6 months. It is diagnosed based on symptoms of persistent cough, wheezing, crackles on the chest, and fast breathing or chest wall indrawing.
- Children with bronchiolitis should be immediately referred to the hospital if they have apnea, appear seriously ill, have very fast or difficult breathing, bluish skin, or low oxygen levels. They may also be referred if they have fast breathing over 60/minute, cannot eat or drink well, or are dehydrated.
- At the hospital, children should be admitted if they have apnea, low oxygen levels,
The document defines focus charting as a systematic method for organizing health information using nursing terminology to describe a patient's health status and care. It involves focusing on key concerns from the care plan like skin integrity or activity tolerance. A focus note includes subjective and objective data supporting the focus, nursing interventions, and the patient's response. An example focus note addresses a patient's pain by documenting their complaint, administering medication, repositioning the patient, and noting their improved pain level in response.
What nelson forgot 4 - Super CME for Common Pediatric OPD questionsGaurav Gupta
What nelson forgot 4 - Super CME for Common Pediatric OPD questions, 12th July 2019
Common Office practice questions, answered in just 5-10 minutes per topic ...
Estratégia da one plus nos meios digitaisVítor Silva
A estratégia de marketing digital da OnePlus foca no marketing boca a boca e na interação com a comunidade online em vez de grandes campanhas publicitárias. Eles usam um sistema de convites para lançamentos de produtos que cria escassez e antecipação entre os consumidores. O OnePlus One foi um sucesso com esta abordagem e o lançamento do OnePlus 2 melhorou ainda mais o sistema de convites.
The document discusses how creatives share similarities with children in that they are curious, imaginative, and enjoy play. It notes that creatives thrive on praise, have short attention spans like consumers, and need to work in fun environments to stay motivated. Harnessing their "childishness" can help lead to business success.
TBEX15 North America Fort Lauderdale Jessica WoodburyTBEX
This document discusses how to create content that builds trust with readers by focusing on their needs and goals. It emphasizes that helping readers through high-quality, relevant content will lead to returning readers, social shares, links from other sites, and higher search rankings, which can then be monetized through sponsored content, affiliate links, and other opportunities. The key is to add a step to the content creation process to evaluate whether each post will help readers.
This document discusses the poor project management of Leatty's construction project in Shanghai, China. The project was delayed by 16% over budget and 2 months behind schedule due to several factors. These included design changes by the architects, supply chain issues that increased material costs and delayed deliveries, difficulties accessing the construction site due to road work, and weather challenges. Additionally, poor communication between the multinational team from different countries exacerbated delays. To get the project back on track, a new project manager implemented solutions like internet training to improve information sharing, adjusting meeting times for different time zones, and enhancing risk management and contingency planning.
The document discusses creating the right support system to keep innovation coming and focuses on outsourcing business services like human resources, strategic planning, risk mitigation, payroll administration, staffing, recruiting, and workers compensation to Barrett Business Services. Barrett Business Services assigns each client a dedicated team of local experts and business partners to improve businesses from the inside out and allow businesses to focus on their core operations with predictability, scalability, sustainability and efficiency.
Matemática Financeira - Aproveite todas as ferramentas da sua HP.
- Descomplique juros, taxas e descontos.
- Aprenda a analisar seus investimentos.
- Simule o potencial dos juros compostos.
- 10 horas de aula.
1. Módulo I - CONHECENDO A CALCULADORA HP 12C
Operações matemáticas
Calculando potência e raiz
Trabalhando com teclas do % (percentual)
Trabalhando com datas
2.Módulo II - JUROS SIMPLES
Cálculo dos juros
Entendendo a expressão do montante
Exercícios
3.Módulo III - DESCONTOS SIMPLES (RACIONAL E COMERCIAL)
Desconto racional (por dentro)
Desconto comercial (por fora)
4.Módulo IV - JUROS COMPOSTOS
Entendendo a expressão dos juros compostos
Calculando o capital presente
Calculando taxa
Convenção linear
Convenção exponencial
5.Módulo V - TAXAS EQUIVALENTES
Expressão geral da taxa equivalente
Taxa efetiva e taxa nominal
6.Módulo VI - CÁLCULO DE PARCELAS
Parcelas iguais e vencidas
Parcelas iguais e antecipadas
Parcelas com carência
Relação em parcela e valor futuro
7.Módulo VII - SISTEMAS DE AMORTIZAÇÃO OU CAPITALIZAÇÃO
Tabela SAC
Tabela Price
8.Módulo VIII - ANÁLISE DE INVESTIMENTO
Método do VPL (Valor Presente Líquido)
Método da TIR (Taxa Interna de Retorno)
A Word Stemming Algorithm for Hausa Languageiosrjce
IOSR Journal of Computer Engineering (IOSR-JCE) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of computer engineering and its applications. The journal welcomes publications of high quality papers on theoretical developments and practical applications in computer technology. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Uma liga é uma solução sólida composta por dois ou mais metais ou por um metal e um ou mais não-metais. As ligas apresentam propriedades distintas dos metais individuais e são amplamente utilizadas em aplicações tecnológicas modernas, como o aço em edifícios e automóveis. Exemplos comuns de ligas incluem latão, bronze e aço inoxidável.
The document discusses the four basic shapes - circles, triangles, squares, and rectangles. It defines each shape and provides examples of objects that correspond to each shape, such as circles including pizza slices and rims of glasses, triangles including doormats and flags, squares including iPads and cushions, and rectangles including books and folded umbrellas. Students are assigned to make a foldable with drawings of the four basic shapes on the cover and examples of corresponding objects written inside for each shape.
A Mesos cluster consists of a Mesos master node and Mesos agent nodes. The master aggregates resources reported by agents and offers "resource bundles" to frameworks. Frameworks can accept offers to run tasks on agents, or reject offers to have resources sent to other frameworks. If a framework accepts, the master sends tasks to agents to run in executors launched by the framework.
RespiDx: The Respimometer Diagnostic Aid for Childhood PneumoniaLeith Greenslade
Learn more about an innovative new tool that assesses respiration rate and temperature in small children to aid in the diagnosis of pneumonia in low resource settings where access to x-rays is severely limited. The recipient of grants from Grand Challenges Israel and USAID's Development Innovation Ventures, RespiDx is now testing the effectiveness of the Respimometer in the Democratic Republic of Congo.
This document from the World Health Organization provides guidelines for managing fever in young children with acute respiratory infections in developing countries. It states that fever alone is not an indication for antibiotic treatment, but fever in the first two months of life could indicate serious bacterial infection requiring hospital referral. Moderate fever may improve immune defense against infection and is usually not harmful, while high fever above 42°C or rapid temperature rise can cause febrile seizures. The safest treatment for fever is paracetamol for temperatures of 39°C or higher.
Organization, Transportation, Setting and Management of Neonatal Intensive Ca...Lipi Mondal
The document discusses neonatal intensive care units (NICUs) and risk factors for nosocomial infections in NICUs. It notes that premature neonates are more likely to develop infections compared to full-term babies. Prolonged intravenous therapy and hospitalization are also associated with increased risk of infection. Common infections seen in NICUs include sepsis and primary bacteremia. Adherence to aseptic techniques and limiting invasive procedures/devices can help reduce nosocomial infections in these units.
This handbook was designed to support delegates attending a clinical support worker skills workshop run by Trust Interventions. The purpose of the handbook is to enhance learning from the course and serve as a future reference. Trust Interventions offers a range of flexibly delivered training courses and services on topics like taking temperatures, conditions requiring temperature monitoring, and types of thermometers.
A Comparative Study of the Efficacy of 5 Days and 14 Days Ceftriaxone Therapy...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Enteric Fever in Paediatrics Age group ExplainedSurajPatel777270
This study compared the efficacy of 5 days versus 14 days of ceftriaxone therapy in children with typhoid fever. 90 children between ages 3-12 were randomly divided into two groups. The first group received ceftriaxone intravenously at 100mg/kg/day for 5 days, while the second group received ceftriaxone intravenously at 75mg/kg/day for 14 days. Results showed that clinical cure was achieved in 84.5% of patients in the 5 day group compared to 97.8% in the 14 day group. Relapse occurred in 15.5% of patients in the 5 day group compared to only 2.2% in the 14 day group. The
Objective: The aim of this study was to evaluate the approach of parents to fever of children and related factors. Methods: In this survey study, A 26-question survey was conducted the parents whose children were under 15 years of age and admitted to the department of Emergency at Ministry of Health Okmeydanı Training and Research Hospital between November 2014 and April 2015 due to fever. The survey questions included the presence of a thermometer at home, their manner of taking temperature, mother’s knowledge level about fever, methods applied for reducing fever, antipyretic use and their concerns as well as the demographic characteristics. Results: In the study, 250 parents who were parents of 132 boys and 128 girls enrolled and the mean age of mothers, fathers and children who participated in the study were 25, 29.3 and 3.6 years, respectively. Most of the families (81.2 %) were nuclear family which consists of mother, father and children. It was recorded that 3.2% of parents with the score 0; 19.2% of parents with the score 10; and 86.4% of parents with the score 5 according to fever concern scale rated from 0 to 10. Conclusion: Parents should be informed correctly about fever in children to prevent fever phobia that causes an excessive number of unnecessary applications to the emergency department, high health care cost, and labor loss at hospitals by physicians and public informative publications.
Human Touch vs. Axillary Digital Thermometry for Detection of Neonatal Hypoth...Siddharth Agarwal
We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against
axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised
activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India. Body
temperature of 148 newborns born between March and August 2005 was measured at four points in time
for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the
axilla using a digital thermometer and by HT method using standard methodology. Total observations
were 533. Hypothermia assessed by HT was in agreement with that assessed by ADT (<36.5
C) in 498
observations. Hypothermia assessed by HT showed a high diagnostic accuracy when compared against
ADT (kappa 0.65–0.81; sensitivity 74%; specificity 96.7%; positive predictive value 22; negative
predictive value 0.26). HT is a simple, quick, inexpensive and programmatically important method.
However, being a subjective assessment, its reliability depends on the investigator being adequately
trained and competent in making consistently accurate assessments. There is also a need to assess
whether with training and supervision even the less literate mothers, traditional birth attendants and
community health volunteers can accurately assess mild and moderate hypothermia before promoting
HT for early identification of neonatal risk in community-based programs.
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Vital signs including temperature, pulse, respiration rate, and blood pressure are important indicators of a patient's health status. Temperature can be measured orally, rectally, in the armpit or ear. Normal temperature is around 98.6°F (37°C). Pulse reflects the heart rate and is usually measured at the wrist, neck or groin. Normal pulse is 60-100 beats per minute. Accurate assessment and
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This document provides information on assessing vital signs, including temperature, pulse, respiration, and blood pressure. It defines each vital sign and outlines the purposes, equipment, procedures, and normal ranges for assessing each one. For temperature, it describes different thermometer types and appropriate sites for taking a reading. For pulse, it identifies common sites and the procedure for counting the pulse rate. For respiration, it explains that assessing respiration involves monitoring inspiration and expiration. The document emphasizes the importance of following proper procedures to obtain accurate vital sign readings and ensure patient comfort.
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This document provides an overview of a seminar on hypothermia in newborns. It begins with introducing the speakers and then presents two case scenarios of newborns admitted with symptoms of prematurity, low birth weight, and respiratory distress. It then covers various topics related to newborn hypothermia including definitions, mechanisms of heat loss, methods of temperature measurement, effects of hypothermia, and approaches to management. The document emphasizes that hypothermia is a major contributor to neonatal mortality and presents epidemiological data showing high rates of hypothermia in newborns globally and in certain countries.
Bacteriological profile of childhood sepsis at a tertiary health centre in so...QUESTJOURNAL
Introduction: Sepsis is a leading cause of morbidity and mortality in children worldwide, even more so in developing countries. Knowledge of common pathogens and their antibiotic susceptibility pattern is useful for guiding initial treatment while awaiting blood culture results. Objective:To determine the major causative organisms and their antibiotic sensitivity pattern of childhood sepsis at the Niger Delta University TeachingHospital (NDUTH), with the aim of revising existing treatment protocols. Methods: Within a 2 year period (1st January 2014 to 31st December 2015) blood culture results of children with clinical suspicion of sepsis were retrospectively studied. Results:During the study period, 116 (12.11%) of the 958 children admitted into the Children Emergency Ward had blood culture tests. Thirty one (26.72%) had positive blood cultures.Eighteen (58.06%) of the organisms were gram positive while thirteen (41.93%) were gram negative. The predominant organism was Staphylococcus aureus in 16 (51.61%) followed by Klebsiella pneumoniae in 5 (16.13%) patients. The bacterial isolates demonstrated the highest sensitivity to the quinolones. Conclusion:There is need for periodic surveillance of the causative organisms and antibiotic susceptibility pattern of childhood sepsis to guide effective management of patients.
What measured temperature is considered FEVER?Reynaldo Joson
There is no consensus on what measured temperature constitutes a fever. Laypeople, nurses, and physicians have different perceptions. Using 37.5°C as a cutoff could lead some with lower temperatures to wrongly suspect they have COVID-19. Taking temperatures daily at set times and calculating a multi-day average can help determine an individual's normal temperature and what constitutes a fever for them. In general, 37.5°C from the armpit or 38°C from the mouth plus other fever symptoms may be used to diagnose a fever until a personal baseline is established. Establishing a standard definition of fever is important for accurate communication and decision making during the pandemic.
Day 1 | CME- Trauma Symposium | Bronchiolitis pittengerNorton Healthcare
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This document discusses different perspectives on what constitutes a fever and proposes a method to determine a personalized baseline body temperature. It notes that there is no universal definition of fever and various organizations define it differently. To address this, it suggests taking daily morning, afternoon and evening temperature readings using an armpit and oral thermometer for 3 days to calculate an average baseline temperature. It then recommends considering anything 1 degree Celsius above this average as a fever. This method aims to provide individuals with a personalized definition of fever that is useful in the context of the COVID-19 pandemic.
Childbirth is generally time of joy for parents and families. As per the medical reports each year 4 million newborns die within 28 days of birth and more suffer from disability, disease, infection and injury. The enabling environment for safe childbirth depends on the care and attention required to newborns by health personnel and the availability of adequate health-care facilities, equipment, and medicines and emergency care when needed. Neonatal monitoring refers to the monitoring of vital physiological parameters of premature infants. Continuous health monitoring of the neonates provides crucial parameters for early detection of adverse events. Health monitoring for the neonates provides crucial parameters for urgent diagnoses and corresponding medical procedures, subsequently increasing the survival rates. In the present paper, we propose a proto type design of a neonatal monitoring system. The system is designed and integrated with different health measurement and display devices. The prototype design is very much useful for monitor the physiological parameters of infants.
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Comparison of Tympanic and Rectal temperature in febrile pediatric patients admitted in Niloufer hospital
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 12 Ver. I (Dec. 2015), PP 12-18
www.iosrjournals.org
DOI: 10.9790/0853-141211218 www.iosrjournals.org 12 | Page
Comparison of Tympanic and Rectal temperature in febrile
pediatric patients admitted in Niloufer hospital
Dr.K.V.Subba Rao1
, Dr.B.Narahari2
, Dr.M.Ranjeet3
Associate Professor of Pediatrics, Department of Pediatrics, Osmania Medical College, NTRUHS Vijayawada,
A.P. India.
Assistant Professor of Pediatrics, Department of Pediatrics, Osmania Medical College, NTRUHS Vijayawada,
A.P. India.
Post Graduate Pediatrics, Department of Pediatrics, Osmania Medical College, NTRUHS Vijayawada, A.P.
India
Abstract
Objective: To compare Tympanic membrane temperature and Rectal temperature in Febrile pediatric patients
and compliance for the subjective methods. Design: Prospective observational descriptive study. Setting:
children between the age group of 6 months to 12 years who were admitted with fever were randomly taken
for the study for a period from Jan 2013 to July 2014) in Institute of Child and Women Health, Niloufer Hospital,
Osmania Medical College, Hyderabad. Participants: During the study period, 588 children both male and
female admitted with fever were chosen for the study. Methods: Five hundred and eighty eight children
between the age group of 6 months to 12years in pediatrics department admitted in Niloufer Hospital were
randomly taken during the period of study from 2013 January to 2014 July. Rectal temperature and two
readings of Ear temperature from each side were taken and compared. It’s an observational study. Results:
Mean rectal temperature was 39.42+ /- 0.59o
c. Mean temperature of both ears was 39.47+/- 0.6o
c. The mean
temperature difference between ear and rectal temperature was 0.004+/- 0.08o
c.Patient resistance was more to
the rectal temperature measurement (74.2%) when compared to the ear temperature measurement (25.8%).
There was a clear preference by all the respondents (parents) towards ear thermometry, which was rated higher
in terms of rapidity, ease of measurement and cleanliness associated. Conclusions: In this study it has been
shown that ear temperature correlates well with “core” body temperature. It is time to consider whether
tympanic thermometry can take over from traditional methods of temperature measurement.
Keywords: Rectal temperature, Tympanic membrane temperature, Parental assessment, Rapidity, Easy, Clean
I. Introduction
Fever is a very common complaint in children accounting for as many as 20% of pediatric visits to
doctors. A patient’s temperature is a critical vital sign that may be used by Emergency Department (ED)
clinicians to determine the degree of illness and the need for further assessment and intervention1
. Accurate
body temperature measurement is necessary for the timely detection and management of fever, as well as
evaluating treatment effectiveness. There are invasive methods which include esophageal, rectal and bladder
measurements1
. Rectal temperature is considered the least invasive among these invasive temperature measures,
and often is assumed to approximate core temperature2
. Noninvasive temperature measurement methods include
oral, temporal artery (TA), axillary and aural [tympanic membrane (TM)] measurements3,4
. All types of
temperature measurements have advantages and limitations related to accuracy and precision, as well as
practicality and feasibility in the ED setting .Fever (pyrexia) may be defined in both pathophysiological and
clinical terms: Interleukin-1 (IL-1) elevates the thermoregulatory set point of the hypothalamic center. In
response to an upward displacement of the set point, an active process occurs in order to reach the new set point.
This is accomplished physiologically by minimizing heat loss with vasoconstriction and by producing heat with
shivering. Behavioral means of raising body temperature include seeking a warmer environment, adding more
clothing, curling up in bed, and drinking warm liquids. Clinically, fever is a body Temperature of 1°C (1.8°F)
or greater above the mean at the site of temperature recording. The importance of at least 1°C higher than the
mean temperature lies in the diurnal variation of normal body temperature, which reaches its highest level in
early evening (5–7p.m.). Diurnal temperature fluctuations are greater in children than in adults and are more
pronounced during febrile episodes. In young children, a relatively high rectal temperature predominates, with a
gradual decrease towards adult levels beginning at 2 years of age. This trend stabilizes soon after puberty5
.
Many decisions concerning the investigation and treatment of children are based on the results of
temperature measurement alone. An incorrect temperature measurement could result in the delayed detection of
a serious illness or alternatively an unnecessary septic workup. Despite the plethora of instruments that have
2. Comparison of Tympanic and Rectal temperature in febrile pediatric patients admitted in Niloufer
DOI: 10.9790/0853-141211218 www.iosrjournals.org 13 | Page
become available in the last 30 years, there remains considerable controversy as to the most appropriate
thermometer and the best anatomical site . The most accepted method for accurate determination of body
temperature in non neonatal ambulatory children is by rectal temperature 6
which is often considered the “gold
standard” for clinical use. However, rectal temperature measurement is inconvenient, invasive, time consuming
and potentially painful and may lead to non-compliance behavior in some children and may not be acceptable to
the parents7
. The tympanic membrane has same vascular supply as that of the hypothalamus and is an excellent,
readily accessible site for core temperature recording.
Infrared thermometers which were used to measure temperature at the external ear canal have become available
in the past 15 years and have been introduced into widespread clinical use 8,9,10.
This study was designed to compare the performance of two commercially available thermometers, one
a rectal digital thermometer and the other an infrared tympanic membrane thermometer and also to assess the
compliance of the method preferred.
II. Material And Methods
A prospective observational cross sectional descriptive study was designed and study setting included
588 children of age group between 6 months to 12 years who were admitted with fever and were randomly taken
from the department of pediatrics, Niloufer Hospital Hyderabad. The period of study is from January 2013 to
July 2014 .It’s an observational study.
Inclusion criteria:
Children between the ages of 6 months to 12years with fever.
Exclusion criteria:
Children less than 6 months of age.
Those with suppurative otitis media.
Those with otitis externa.
Those with moderate to large amount of wax.
Those with CSF leaks.
Those with anal fissures.
Those receiving enemas.
A cutoff of 37.6°C for each device is kept to define a febrile patient.
The following data was collected: Name, Age, Sex Duration of fever in days, presence of cerumen or
otitis media by otoscopic examination, Perineal examination was done, Rectal temperature and two readings of
Ear temperature from each side were recorded .The Ambient temperature was measured by using a mercury
column thermometer. Rectal temperature is obtained by using a digital electronic thermometer and ear
temperature is measured by using Braun Thermoscan instant Thermometer IRT 3520. The instruments were pre-
calibrated. The offset or calibration factor of infrared thermometer to compensate for difference between ear
temperature and that measured from other sites is ± 0.4°C (preset by the manufacturer). For measuring the
Tympanic membrane temperature the probe was gently introduced into the ear canal and oriented towards the
contra-lateral ear, while traction (ear tug) is applied to the pinna. In children less than one year of age, traction
was applied posteriorly while in older children it was in the postero-superior direction. The trigger is depressed
till an audible beep is heard signaling calibration with body temperature (for two seconds). The plastic probe
cover changed with each measurement. The measurement is repeated as soon as possible after the instrument’s
electronic circuitry had reset. Rectal Temperature measured by applying a sterile lubricant jelly on the probe
and following proper positioning of the child (e.g. face down over mother’s lap, child in Left lateral position),
the buttocks are separated and the thermometer is inserted without force up to a distance of 2cm into the
rectum. Reading in the thermometer is obtained after hearing an audible beep is heard signaling calibration with
body temperature. For each child, rectal probe prior to insertion is covered by disposable plastic protector.
Attempts were made to take all readings in a patient within five minutes and in following order: ear temperature
then rectal temperature. After measurements, parental and patient preference is assessed for both techniques. A
comparison in terms of rapidity, ease of technique and cleanliness was noted and resistance on the part of patient
was observed.
III. Results
Total of 588 children of age ranging from 6months to 12 years admitted in the department of pediatrics
Niloufer Hospital Hyderabad were randomly chosen for the study.
The data was analyzed using SPSS for windows version 1.0 and following statistical methods were applied.
3. Comparison of Tympanic and Rectal temperature in febrile pediatric patients admitted in Niloufer
DOI: 10.9790/0853-141211218 www.iosrjournals.org 14 | Page
Descriptive statistics which includes mean, standard deviation and range to know the nature of sample,
age and group wise.
Product moment correlation to find out the relationship between tympanic and rectal temperature
among different age groups.
Graphical representation of these two different methods of temperature measurement on x and y axis.
TABLE 1: DESCRIPTIVE STATISTICS OF THE SAMPLE SELECTED
Gender No. of cases Range of age Mean(years) S.d.(years)
minimum maximum
Male 288 6m 12y 4.87 2.72
Female 300 6m 12y 4.41 2.35
Total 588 6m 12y 4.64 2.53
The mean age of male children was found to be 4.87 years, and that of female children was 4.41
years. There is no significance between groups (p<0.05).
TABLE 2: DESCRIPTIVE STATISTICS FOR RECTAL TEMPERATURE FOR THE
ENTIRE SAMPLE
Temperature N
Minimum ºc Maximum ºc
Rangeo
c
Meanºc S.d. ºc
Rectal 588 38.11 40.74 2.63 39.42 0.59
TABLE 3: DESCRIPTIVE STATISTICS FOR TYMPANIC TEMPERATURE FOR THE
ENTIRE SAMPLE
Ear
temperature
Readings
N Minimum Maximum Range Mean S.d.
ºc ºc ºc ºc ºc
Right ear
Reading1(R1) 588 38.16 40.96 3 39.54 0.635
Reading2(R2) 588 38 41 3 39.5 0.636
Left ear
Reading1(L1) 588 37.84 40.99 2.94 39.14 0.636
Reading2(L2) 588 38 41 3 39.5 0.636
FIGURE 1: COMPARISON OF EAR AND RECTAL TEMPERATURES ACROSS DIFFERENT AGE
GROUPS
38.2
38.4
38.6
38.8
39
39.2
39.4
39.6
0.6-1year
1-1.5year
1.6-2.5year
2.6-3.5year
3.6-4.5year
4.6-5.5year
5.6-6.5year
6.6-7.5year
7.6-8.5year
8.6-9.5year
9.6-10.5year
10.6-11.5year
11.6-12years
meantemperature
ear
rectal
4. Comparison of Tympanic and Rectal temperature in febrile pediatric patients admitted in Niloufer
DOI: 10.9790/0853-141211218 www.iosrjournals.org 15 | Page
TABLE 4: COMPARISON OF RESISTANCE DURING 2 DIFFERENT MODES OF TEMPERATURE
MEASUREMENTS
FIGURE 2: COMPARISON OF RESISTANCE DURING 2 DIFFERENT MODES OF TEMPERATURE
TABLE 5: ACCEPTABILITY BY PARENTS FOR METHOD OF TEMPERATURE MEASUREMENT
Rapidity Ease of measurement Cleanliness associated
Ear Rectal Ear Rectal Ear Rectal
Yes by No by Yes by No by Yes by No by
588 588 588 588 588 588
Parents Parents Parents Parents Parents
There was a clear preference by all the respondents (parents) towards ear thermometry, which was rated higher
in terms of rapidity, ease of measurement and cleanliness associated. There was no case where parents were
indecisive on these.
IV. Discussion
Tympanic thermometry is a new concept and not much research work has been done using this. Results
of our study are in agreement with the previous work of Talo, et al.11
had demonstrated significantly large (P =
0.01) correlations between temperatures in the left and right ear. There was good correlation between TMT and
RT in both the groups. Terndrup, et al12
found excellent correlations (r = 0.90) between TMT and RT in 102
patients (age unspecified).
TABLE 6: COMPARISON OF NUMBER OF CASES, AGE RANGE, GENDER AND MEAN AGE WITH OTHER
STUDIES
Arvind Sehgal
etal 200213
Bernardo etal
199614
Thomas E
Terndrup
etal 199112
Beck strand
etal 199615
present
study
No. of cases 60 38 303 81 588
Age Range in Years 0.6-9 1 to 14 <16 0.06-2 0.6-12
Gender(M/F) 31/29 ---- 176/127 --- 300/288
Mean Age in Years 4.47+/-2.5 6.9 1.6+0.9 0.5 4.64±2.53
0
50
100
150
200
250
300
350
400
450
500
Ear Rectal
yes
no
Type Patient resistance
Yes No
No. of patients % No. of patients %
Ear 110 18.7 478 82.3
Rectal 436 74.2 152 25.8
5. Comparison of Tympanic and Rectal temperature in febrile pediatric patients admitted in Niloufer
DOI: 10.9790/0853-141211218 www.iosrjournals.org 16 | Page
Our findings are in well correlation with other studies also. TMT is considered as an excellent indicator of core
body temperature is important in dynamic situations where the patient’s core temperature is changing rapidly. In
the present study too, high correlations between TMT and RT were observed.
TABLE 7: COMPARISON OF MEAN TEMPERATURE DIFFERENCE BETWEEN EAR AND
RECTAL READING (IN O
C) WITH OTHER STUDIES.
The tympanic membrane which shares a common blood supply with the hypothalamus, the thermostat of the
body, makes it a potential site for measurement of temperature in these babies. On comparing both the
techniques, TMT is an easy, rapid and clean procedure with no contact with mucous membrane and is
acceptable to parents and children. Added advantages include lack of influence of factors known to spuriously
affect oral temperature like (e.g. recent fluid intake, mouth breathing, and tachypnea. Coefficient of correlation
in present study was 0.991(r). Correlations between Tympanic and Rectal readings were highly significant.
Arvind Sehgal et al.13
and Terndrup TE et al.,12
also found excellent correlation (r = 0.994 and r = 0.90
respectively) between the two readings. From the figure 1, it was observed that a perfect correlation existed
between the ear and rectal temperature which implies that ear temperature can be used successfully to predict
the core body temperature.
Arvind Sehgal
etal 200213
Terndrup TE
etal 199112
present study
coefficient of correlation 0.994 0.9 0.991
Ambient temperature was included as a co-variable, because the thermometer uses a microprocessor to self-
calibrate based on the ambient temperature. In the present study, it was found that the ambient temperature had
no significant influence on tympanic thermometer readings from both the ears. In the study done by Brinnel
et.al.,25
it was found that ear temperature changes by 0.00250
C per 10
C change in ambient temperature. In the
Zehner et.al. 27
study, it was observed that oral temperature and ear temperature have a predictable relationship to
rectal temperature at normal ambient temperature. However, in areas with higher ambient temperature (350
C),
spuriously elevated oral and ear temperature may occur.
Our results showed that it is better to use a technique for measuring the child’s body temperature that is
more convenient, painless, and safer than rectal temperature. Tympanic thermometry as per the manufacturer’s
literature has many advantages are listed, not least the safety and speed with which a measurement can be made,
a great bonus for those who work with children. Compared with the rectal temperature, electronic ear
thermometers have been welcomed because measurement can be taken in 1–2 seconds.26
over the past few
years, infrared ear thermometers have become very popular and some hospital trusts have recommended that ear
thermometers replace all previously used electronic thermometers. It is known that other areas of the brain are
involved in thermoregulation so estimation of the hypothalamus may not be as significant as once thought.
Nevertheless, the tympanic membrane has a good blood supply (from the deep auricular branch of the internal
maxillary artery, the stylomastoid branch of the posterior auricular artery, and the tympanic branch of the
maxillary artery) so the temperature at the tympanum is probably the best one can get as an indirect measure of
brain temperature.
Some authors 28
appear to be confident of the accuracy of ear thermometers, reporting good agreement
between the temperatures of the ears. We have shown that, in a constant and comfortable environment there are
no notable differences between the temperatures of the ears in the children. We found that in healthy, afebrile
children the temperature of one ear can, in the worst case, differ from the other ear by not more than half a
degree.
No. Studies
Mean Temperature Difference
Between Ear and Rectal
Readings (in o
c)
1. Present Study 0.004
2. Arvind Sehgal et al., 13
2002 0.01
3. Loveys et al., 21
1999 -0.09
4. Wilshaw et al., 23
1999 0.20
5. Hoffman et al., 24
1999 0.18
6. Draaisma et al 16
1997 -0.01
7. Beckstrand et al.15
1996 -0.05
8. Hooker et al., 19
1996 0.29
9. Bernardo et al.,14
1996 0.29
10. Brennan et al., 18
1995 0.37
11. Petersen Smith et al 17
1994 0.05
12. David et al., 20
1993 0.13
13. Stewart et al., 22
1992 0.20
6. Comparison of Tympanic and Rectal temperature in febrile pediatric patients admitted in Niloufer
DOI: 10.9790/0853-141211218 www.iosrjournals.org 17 | Page
In the febrile child, the difference between the ears is minimal. The ranges of differences are the same
in the febrile patients as they are in the afebrile children (1.2°C). We are clear that there is no difference in one
ear compared to the other .
Both of ear thermometers are detected a rise in core temperature caused by fever29
or exercise,30
.There are
claims that ear temperature represents hypothalamic temperature and therefore the true core temperature. We are
convinced that ear temperature is gold standard for core body temperature measurement than for rectal
temperature.
SUMMARY
A total of 588 children admitted in pediatrics department in niloufer hospital were enrolled in this
study.
The ages ranged from 6 months to 12years.
Maximum numbers of cases were below age groups of 2.5years.
Male were 300 and females were 288 in number.
Mean age was 4.64 years
Maximum cases were Acute Respiratory Infection (31.8%)
Mean rectal temperature was 39.42+ 0.59o
c
Mean temperature of both ears was 39.47+ 0.6o
C.
The mean temperature difference between ear and rectal temperature was 0.004+ 0.080
C
Patient’s resistance was more to the rectal temperature measurement (74.2%) when
Compared to the ear temperature measurement (25.8%).
There was a clear preference by all the respondents (parents) towards ear thermometry, which was
rated higher in terms of rapidity, ease of measurement and cleanliness associated.
V. Conclusion
Ear is the most convenient site for pediatric temperature measurement and in this study it has been
shown that ear temperature correlates well with “core” body temperature. It has good compliance with children
and is a satisfied method for parents. Temperature recording is particularly upsetting for the younger child and it
is time to Consider whether tympanic thermometry can take over from traditional methods of temperature
measurement. Rectal thermometry has a risk of perforation and also a time taking procedure when compared to
ear temperature. So it can be taken over by tympanic membrane thermometry.
Acknowledgements:
The authors want to thank the parents and the guardians who consented for the participation in the
study.
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