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Timothy H Rainer

Publications and source records attributed to Timothy H Rainer.

At least 37 records · Page 2Linked to original sources
PubMed2004

Severe acute respiratory syndrome: clinical features, diagnosis, and management.

PURPOSE OF REVIEW: In November 2003, a new, life-threatening, respiratory illness named severe acute respiratory syndrome (SARS) arose from Guangdong Province in China. The illness spread across the globe, caused many major outbreaks, and had an overall mortality rate of 11%. The purpose of this review is primarily to review the clinical features, diagnosis, and management of SARS, but also to comment briefly on the epidemiology and pathogen. RECENT FINDINGS: SARS is caused by a novel coronavirus that primarily affects the lower respiratory tract. It starts with an influenza-like illness characterized by nonspecific, systemic symptoms. This is followed by the rapid development of a non-specific bronchopneumonia associated with lower tract respiratory symptoms, or gastrointestinal symptoms. Most patients recover after a week or 2, but some go on to develop acute respiratory distress syndrome. There is no proven treatment, although cocktails of broad-spectrum antibiotics, antiviral, and immunomodulatory therapy have been tried. Secondary spread can be prevented and outbreaks brought under control provided that staff wear personal protective equipment and pay close attention to good personal hygiene, and patients are isolated. The most urgent needs at present are to develop a vaccine, to develop rapid, inexpensive, accurate diagnostic tests that can give results early in the illness and within a few hours of sampling. Other needs are to investigate which therapies have the lowest adverse event/efficacy ratios. SUMMARY: Up-to-date knowledge of SARS should help in early detection, isolation of high-risk patients, to reduce mortality and morbidity, and to prevent a new global epidemic arising.

Humans↗
PubMed2004

Motor vehicle deaths in Hong Kong: opportunities for improvement.

OBJECTIVE: This study was undertaken to describe the epidemiology of motor vehicle mortality in Hong Kong, and to assess its impact on trauma service delivery. SETTING: Hong Kong has an area of 1,072 km2 and a population of 6,800,000. There were 500,000 registered vehicles in 2001. METHODS: All motor vehicle deaths must be reported to the coroner in Hong Kong. A manual retrospective review of all coroner case notes involving motor vehicles for 2001 was performed. RESULTS: The review identified 165 cases involving 111 male and 54 female patients. Elderly cases were predominant, with 37% of the cases involving individuals older than 60 years. Most of the cases involved pedestrians (59%), and half of these pedestrians had experienced collisions with public light buses and trucks. Alcohol was not commonly involved, and when it was, it was isolated to the group 20 to 40 years of age. Most individuals died of major head injury alone or multiple injuries. There were very few major vessel injuries, and these included 13 aortic transections. DISCUSSION: Hong Kong has a very low motor vehicle death rate relative to its population (2.4 per 100,000), but the rate is less impressive when it is related to motor vehicle registrations (33 per 100,000 vehicles). The low incidence of motor vehicle trauma has implications for trauma service delivery in terms of trauma expertise and specialization. Despite the low incidence of trauma, there still are opportunities for prevention, especially in relation to elderly pedestrians and public light buses.

Abdominal Injuries↗
PubMed2004

Comparison of thoracic ultrasound, clinical acumen, and radiography in patients with minor chest injury.

BACKGROUND: This study was designed to compare ultrasonography, clinical findings, and radiography in the detection of rib and sternal fractures. METHODS: In a prospective study, 88 patients presenting consecutively to an emergency department with isolated blunt chest injury of mild to moderate force were recruited. RESULTS: Ultrasonography yielded a sensitivity of 80.3 (95% confidence interval [CI], 69.5-88.5) for detecting chest wall fractures compared with sensitivities of 26.0 (95% CI, 15.8-36.3) for clinical acumen and 23.7 (95% CI, 14.7-34.8) for radiography. CONCLUSION: Early ultrasonography is more accurate than clinical and radiologic evaluation at detecting rib and sternal fractures.

Female↗
PubMed2003

Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study.

OBJECTIVES: To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. DESIGN: Prospective observational study. SETTING: A newly set up SARS screening clinic in the emergency department of a university hospital in Hong Kong's New Territories. PARTICIPANTS: 556 hospital staff, patients, and relatives who attended the screening clinic and who had had contact with someone with SARS. MAIN OUTCOME MEASURE: Number of confirmed cases of SARS. RESULTS: Of the 556 people, 141 were admitted to hospital, and 97 had confirmed SARS. Fever, chills, malaise, myalgia, rigor, loss of appetite, vomiting, diarrhoea, and neck pain but not respiratory tract symptoms were significantly more common among the 97 patients than among the other patients. The overall accuracy of the WHO guidelines for identifying suspected SARS was 83% and their negative predictive value was 86% (95% confidence interval 83% to 89%). They had a sensitivity of 26% (17% to 36%) and a specificity of 96% (93% to 97%). CONCLUSIONS: Current WHO guidelines for diagnosing suspected SARS may not be sufficiently sensitive in assessing patients before admission to hospital. Daily follow up, evaluation of non-respiratory, systemic symptoms, and chest radiography would be better screening tools.

Adult↗
PubMed2003

Trauma systems and emergency medicine.

The impact of trauma is a major public health challenge which is likely to escalate in the early 21st century. A systematic approach to this problem is required. This review explains the conceptual framework that defines a trauma system, gives a brief historical perspective and describes some of the essential elements of the system which should make a difference to patient outcome. Emergency physicians are well placed to play a leading role in the development and implementation of trauma systems.

Emergency Service, Hospital↗
PubMed2003

Prognostic use of circulating plasma nucleic acid concentrations in patients with acute stroke.

BACKGROUND: At present there is no simple, accurate blood test that may be used to determine the severity of stroke or to predict mortality and morbidity in stroke patients presenting to emergency departments. METHODS: Patients with stroke-like symptoms who presented to an emergency department of a university hospital in Hong Kong were recruited for the study. DNA extracted from patients' plasma was analyzed for the beta-globin gene with a fluorescent-based PCR test. The primary outcome measures were in-hospital and 6-month mortality and morbidity using the post-stroke modified Rankin Score. RESULTS: Among the 88 consecutive patients recruited to the study, 70 (80%) had ischemic stroke, 11 (13%) had intracerebral hemorrhage, and 7 (8%) had transient ischemic attacks. Median plasma DNA concentrations taken within 3 h of symptom onset were higher in patients who died compared with those who survived at discharge (6205 vs 1334 kilogenome-equivalents/L; P = 0.03). Among patients with NIH Stroke Scale scores >8, median plasma DNA concentrations were higher in patients who died compared with those who survived to 6 months (2273 vs 968 kilogenome-equivalents/L; P = 0.002). Plasma DNA concentrations correlated with the volume of cerebral hematoma (r = 0.66; P = 0.03). Plasma DNA concentrations >1400 kilogenome-equivalents/L had a sensitivity of 100% and a specificity of 74.4% for predicting hospital mortality after stroke, and the area under the ROC curve was 0.89 (95% confidence interval, 0.80-0.94). The adjusted odds ratio for plasma DNA concentrations predicting 6-month mortality was 1.6 (1.1-2.4; P = 0.03) and for predicting 6-month post-Rankin Score >2 was 1.8 (1.0-3.3; P = 0.05). CONCLUSION: Plasma DNA concentrations correlate with stroke severity and may be used to predict mortality and morbidity in the emergency room.

Acute Disease↗
PubMed2003

Quantitative analysis of circulating mitochondrial DNA in plasma.

BACKGROUND: Recent studies have demonstrated the existence of circulating mitochondrial DNA in plasma and serum, but the concentrations and physical characteristics of circulating mitochondrial DNA are unknown. The aim of this study was to develop an assay to quantify mitochondrial DNA in the plasma of healthy individuals. METHODS: We adopted a real-time quantitative PCR approach and evaluated the specificity of the assay for detecting mitochondrial DNA with a cell line (rho(0)) devoid of mitochondria. The concentrations and physical characteristics of circulating mitochondrial DNA were investigated by experiments conducted in three modules. In module 1, we evaluated the concentrations of mitochondrial DNA in plasma aliquots derived from four blood-processing protocols. In module 2, we investigated the existence of both particle-associated and free forms of mitochondrial DNA in plasma by subjecting plasma to filtration and ultracentrifugation. In module 3, we used filters with different pore sizes to investigate the size characteristics of the particle-associated fraction of circulating mitochondrial DNA. RESULTS: The mitochondrial DNA-specific, real-time quantitative PCR had a dynamic range of five orders of magnitude and a sensitivity that enabled detection of one copy of mitochondrial DNA in plasma. In module 1, we found significant differences in the amounts of circulating mitochondrial DNA among plasma aliquots processed by different methods. Data from module 2 revealed that a significant fraction of mitochondrial DNA in plasma was filterable or pelletable by ultracentrifugation. Module 3 demonstrated that filters with different pore sizes removed mitochondrial DNA from plasma to different degrees. CONCLUSIONS: Both particle-associated and free mitochondrial DNA are present in plasma, and their respective concentrations are affected by the process used to harvest plasma from whole blood. These results may have implications in the design of future studies on circulating mitochondrial DNA measured in different disease conditions.

Blood Circulation↗
PubMed2003

Time course of early and late changes in plasma DNA in trauma patients.

BACKGROUND: Cell-free DNA concentrations increase in the circulation of patients after trauma and may have prognostic potential, but little is know concerning the temporal changes or clearance of the DNA or its relationships with posttraumatic complications. We investigated temporal changes in plasma DNA concentrations in patients after trauma with use of real-time quantitative PCR. METHODS: Serial plasma samples were taken from two trauma populations. In the first study, samples were collected every 20 min from 25 patients within the first 3 h of trauma. In the second study, samples were collected every day from 36 other trauma patients admitted to the intensive care unit (ICU). RESULTS: In the first study, plasma DNA was increased within 20 min of injury and was significantly higher in patients with severe injury and in patients who went on to develop organ failure. In patients with less severe injuries, plasma DNA concentrations decreased toward reference values within 3 h. In the second study, plasma DNA concentrations were higher in patients who developed multiple organ dysfunction syndrome between the second and fourth days of admission than in patients who did not develop the syndrome. In patients who remained in the ICU with continuing organ dysfunction, plasma DNA remained higher than in healthy controls even at 28 days after injury. Most survivors with multiple organ dysfunction syndrome showed an initial very high peak followed by a prolonged smaller increase. CONCLUSIONS: Plasma DNA concentrations increase early after injury and are higher in patients with severe injuries and in those who develop organ failure. Increased plasma DNA persists for days after injuries, especially in patients with multiple organ dysfunction syndrome.

Adult↗
PubMed2003

Severe acute respiratory syndrome-associated coronavirus infection.

Whether severe acute respiratory syndrome-associated coronavirus (SARS-CoV) infection can be asymptomatic is unclear. We examined the seroprevalence of SARS-CoV among 674 healthcare workers from a hospital in which a SARS outbreak had occurred. A total of 353 (52%) experienced mild self-limiting illnesses, and 321 (48%) were asymptomatic throughout the course of these observations. None of these healthcare workers had antibody to SARS CoV, indicating that subclinical or mild infection attributable to SARS-CoV in adults is rare.

Adult↗