bluuebunny/crossref_metadata_2025 huggingface dataset:
Low Helicobacter pylori eradication rates with 4‐ and 7‐day regimens in an Iranian population
Authors: MALEKZADEH REZA , MERAT SHAHIN , DERAKHSHAN MOHAMMAD‐HASSAN , SIAVOSHI FARIDEH , YAZDANBOD ABBAS , MIKAELI JAVAD , SOTOUDEMANESH RASOUL , SOTOUDEH MASOUD , FARAHVASH MOHAMMAD‐JAFAR , NASSERI‐MOGHADDAM SIAVOSH , POURSHAMS AKRAM , DOLATSHAHI SHAHAB , ABEDI BEHNOOSH , BABAEI MASOUD , ARSHI SHAHNAM , MAJIDPOUR ALI
Published: March 2003

Background: In Iran, there is insufficient information on the efficacy of Helicobacter pylori eradication regimens shorter than 10 days. This study aims at assessing the efficacy of 4‐ and 7‐day H. pylori eradication regimens in a high‐incidence area of gastric cancer in Iran.

Methods: Subjects with an endoscopic diagnosis of gastritis, positive urease test, and a histological diagnosis of chronic gastritis were enrolled. Patients were randomly assigned to one of three groups: AOC7 (1000 mg amoxicillin, 20 mg omeprazole, and 500 mg clarithromycin twice daily for 7 days), FOT4 (200 mg furazolidone, 20 mg omeprazole, and 500 mg tetracycline twice daily for 4 days) and FOT7 (the same treatment as the FOT4 group but for 7 days). Sensitivity to these antibiotics was determined in all isolates recovered from culture. The efficacy of eradication was assessed 8 weeks after the end‐of‐treatment by the 14C‐urea breath test.

Results: One hundred and twenty‐eight patients were enrolled in the study. Culture was positive for 84 patients and none of these were resistant to amoxicillin, tetracycline or furazolidone, 1.2% were resistant to clarithromycin and 32.1% to metronidazole. Forty‐five, 41 and 42 patients were randomly allocated to the AOC7, FOT4, and FOT7 groups, respectively. The intention‐to‐treat eradication rates were 35.5, 17.1, and 23.8% for the AOC7, FOT4, and FOT7 groups, respectively.

Conclusion: Treatment regimens of 4 or 7 days are unacceptable for H. pylori infection in Iran, even in the presence of a favorable sensitivity profile.

© 2003 Blackwell Publishing Asia Pty Ltd
Hepatocellular carcinoma in a hepatitis B ‘x’ transgenic mouse model: A sequential pathological evaluation
Authors: LAKHTAKIA RITU , KUMAR VIJAY , REDDI HONEY , MATHUR MEERA , DATTAGUPTA SIDDHARTHA , PANDA SUBRAT KUMAR
Published: March 2003

Background: The introduction of transgenic technology has made it possible to study the steps of carcinogenesis and directly establish the link between viral subgenomic fragments and specific types of cancer. Research directed at hepatitis B virus (HBV)‐related carcinogenesis has benefited from this technology. We present a detailed pathological evaluation of the sequential steps of hepatocarcinogenesis in a hepatitis B ‘x’ (HBx) transgenic mouse model. In this model, the transgene incorporates the region encoding amino acids 58–154 of the HBV X protein and the murine c‐myc gene. This model demonstrated changes in the liver from birth with foci of multicentric dysplasia evolving into nodules and overt hepatocellular carcinoma between 20 and 28 weeks.

Methods and Results: The hepatocytes were mitotically active and showed increased proliferative capacity soon after birth, with exponential increase thereafter. This was accompanied by a high rate of apoptosis, which later declined as the tumors developed. Other functional and immunophenotypic characteristics included a high c‐myc expression in the neoplastic lesions, no alteration in p53 expression, and no alteration in the expression of hepatic enzymes except for diffuse expression of succinic dehydrogenase.

Conclusion: The entire process illustrates the disturbances of cell growth and death because of the collaborative influence of HBx and c‐myc genes that result in the development of hepatocellular carcinoma after a prolonged latent period.

© 2003 Blackwell Publishing Asia Pty Ltd
Sialyl Lewis X analog attenuates gastric microcirculatory disturbance and gastric mucosal erosion induced by thermal injury in rats
Authors: ISHIKAWA HIDEKI , YOSHIDA MASASHI , WAKABAYASHI GO , NAKAMURA MASAHIKO , SHIMAZU MOTOHIDE , KITAJIMA MASAKI
Published: March 2003

Background and Aim: We hypothesize that selectins, which are adhesion molecules, are involved in the pathogenesis of stress‐induced gastropathy. We therefore investigated whether the novel Sialyl Lewis X (SLex) analog, which is a clinically available antagonist of selectins, attenuate gastric mucosal lesions induced by thermal injury.

Methods: Male Wistar rats were anesthetized and a 30% full‐skin thickness dorsal burn was inflicted on each rat. The SLex analog was administrated into the jugular vein 30 min before and 2.5 h after the thermal injury. Saline was administered to the vehicle group. The distribution of E‐selectin immunoreactivity on the luminal side of the gastric mucosal microvascular network was observed by immunohistochemical methods. Active oxygen species were measured by the chemiluminescence method. Rolling leukocytes and endothelial damage, investigated by using Monastral Blue B (MBB), of the gastric mucosal microvascular network were observed through an intravital microscope.

Results: A high intensity of E‐selectin fluorescence was observed on the luminal surface of the venular endothelial cells 5 h after thermal injury in the vehicle group. However, E‐selectin‐associated fluorescence was almost negligible in the non‐injury group and in the SLex analog group. The SLex analog also attenuated the rolling of leukocytes in the venules, venular deposits of MBB, luminol‐dependent chemiluminescence activities, and gastric mucosal lesion formation.

Conclusion: It is suggested that the selectin family is involved in gastric microcirculatory disturbance and the pathogenesis of gastric mucosal lesions after thermal injury. A novel preventive therapy using the SLex analog is considered to effectively protect both gastric microcirculation and the gastric mucosa in rats with thermal injury.

© 2003 Blackwell Publishing Asia Pty Ltd
Beneficial effects of terlipressin in hepatorenal syndrome: A prospective, randomized placebo‐controlled clinical trial
Authors: SOLANKI PRASHANT , CHAWLA ATUL , GARG RAMESH , GUPTA RAJIV , JAIN MONIKA , SARIN SHIV K
Published: March 2003

Background and Aim:  Hepatorenal syndrome (HRS) occurs in about 18% of cirrhotic patients with ascites and is characterized by intense renal vasoconstriction, low glomerular filtration rate and preserved tubular function and normal renal histology. The aim of the present study was to examine the effects of terlipressin on renal function, systemic hemodynamics and clinical outcome in patients with HRS.

Methods:  The study was a randomized controlled single‐blind trial. We randomly assigned 24 consecutive patients with HRS to treatment with terlipressin 1 mg i.v. at 12‐h intervals (group A; n = 12) or placebo at 12‐h intervals (group B; n = 12). The end‐point of the study was improvement in renal functions defined as reversal of HRS and survival at 15 days.

Results:  The two groups were comparable at baseline. After treatment with terlipressin, urine output significantly (P < 0.05) increased progressively in group A (day 4, 960 ± 40 mL/24 h; day 8, 1068 ± 56 mL/24 h) compared with group B (day 4, 451 ± 40 mL/24 h; day 8, 291 ± 45 mL/24 h). Creatinine clearance improved (P < 0.05) in group A (day 4, 20.2 ± 2.1 mL/min; day 8, 35 ± 2.8 mL/min) compared with group B (day 4, 11.3 ± 1.3 mL/min; day 8, 9.3 ± 1.7 mL/min). Serum creatinine decreased in group A but not in group B (day 8, 1.6 ± 0.01 compared with 3.9 ± 0.26, P < 0.05). Mean arterial pressure increased significantly (P < 0.05) in group A. Terlipressin administration was associated with transient self‐limiting side‐effects including crampy abdominal pain in two patients and cardiac arrhythmias in three patients. Five of the 12 patients survived in group A compared with none in group B at day 15 (P < 0.05) and all survivors had reversal of HRS.

Conclusion:  In patients with HRS, terlipressin significantly improved renal functions and systemic hemodynamics, and showed a trend towards better clinical outcome. The drug merits further evaluation with different dosages and longer schedules.
Enhancement of aquaporin‐3 by vasoactive intestinal polypeptide in a human colonic epithelial cell line
Authors: ITOH AKIHIKO , TSUJIKAWA TOMOYUKI , FUJIYAMA YOSHIHIDE , BAMBA TADAO
Published: March 2003

Background:  Vasoactive intestinal polypeptide (VIP) plays an important role in water transport in the intestine. Several specialized channels termed aquaporins (AQP) facilitate water transport in the gastrointestinal tract. Aquaporin‐3 localizes to epithelial cells in the human small intestine and colon. However, the regulatory mechanisms underlying the functions of AQP3 remain unclear. To characterize the regulation of AQP3 expression by VIP, we studied messenger (m)RNA expression, protein expression and DNA binding activity in a human colonic epithelial cell line, HT‐29.

Method:  Human colonic epithelial cells, HT‐29, were incubated with VIP (10−12−10−7 M). The cells were treated with protein kinase‐A (PK‐A) inhibitors (H‐89, H‐9) or chloride channel‐blockers (diphenylamine‐2‐carboxylate (DPC), 5‐nitro‐2‐(3‐phenylpropylamino) benzoic acid (NPPD)). The expression of AQP3 mRNA and protein was determined by Northern blot and Western blot, respectively. The DNA‐binding activities of cyclic adenosine monophosphate (cAMP) response elements/activating transcription factor (CRE/ATF)) in the nuclear extract were determined by electrophoretic mobility shift assay.

Results:  Aquaporin‐3 mRNA was up‐regulated at a concentration of 10–10 M VIP. The expression of AQP3 protein was enhanced at 3 h after addition of VIP. The PK‐A inhibitors (H‐89, H‐9) inhibited the expression of AQP3 mRNA enhanced by VIP and cAMP. The gel shift assay of CRE/ATF in HT‐29 cells revealed a single band.

Conclusion:  These results indicate that VIP upregulated the expression of AQP3 mRNA and protein, and that a cAMP‐dependent pathway mediated this effect in a human colonic epithelial cell line, HT‐29.
An aetiological profile of short stature in the Indian subcontinent
Authors: ZARGAR AH , LAWAY BA , MASOODI SR , WANI AI , SALAHUDDIN M
Published: March 2003

Objective:

To determine the aetiological causes of short stature in a developing region of the world.

Methodology:

A retrospective analysis was made of data from 193 subjects who were primarily evaluated for short stature in the Endocrinology Department, Institute of Medical Sciences, Kashmir, India. These subjects had a height of more than 3 standard deviations (SD) below the mean for their age and sex, and were seen over a decade (January 1987 to December 1996). A logical and comprehensive clinical and investigative protocol was followed to identify the aetiology of short stature.

Results:

Growth hormone deficiency was the commonest identifiable cause of short stature and accounted for 22.8% of cases. Thirty‐six subjects (18.7%) had a normal variant short stature. Renal tubular acidosis was diagnosed in 10.4%, primary hypothyroidism, malnutrition and hypothalamic syndrome in 7.8% each, and growth hormone insensitivity syndrome in 4.1% cases.

Conclusions:

We conclude that, in addition to growth hormone deficiency and normal variant short stature, distal renal tubular acidosis and growth hormone insensitivity syndrome are significant causes of short stature in India.
Human immunodeficiency virus prevalence in women at delivery using unlinked anonymous testing of newborns in the Malaysian setting
Authors: Amar HSS , Ho JJ , Mohan AJ
Published: March 2003

Objective: To determine the community prevalence of human immunodeficiency virus (HIV) in women at the time of delivery in a Malaysian setting.

Methodology: Cord blood samples from a pilot screening programme for congenital hypothyroidism in 1995 at Ipoh city and surrounding district hospitals were screened anonymously for HIV 1 and 2. HIV status was determined using chemiluminescent technology. Positive samples were retested using the Genelavia Mixt assay.

Results: A total of 4927 samples were tested. The ethnic breakdown included 51.7% Malays, 18.9% Chinese, 14.3% Indian, 2.3% Others and 12.9% unknown. The geographical distribution of samples was 73.9% urban, 24.2% rural and 1.9% unknown. The seroprevalence of HIV positivity was 3.25 per 1000 deliveries (95% CI: 1.92–5.16). Seroprevalence was higher for samples from rural and Malay mothers.

Conclusion: The high seroprevalence in this study suggests that the spread of HIV is far wider than that anticipated by mandatory national reporting. It also supports antenatal screening and the use of antiretroviral therapy as an important strategy to reduce perinatal transmission.
Clinical versus polysomnographic profiles in children with obstructive sleep apnoea
Authors: Masters IB , Harvey JM , Wales PD , O'Callaghan MJ , Harris MA
Published: March 2003

Objective: To examine the clinical and polysomnographic (PSG) profiles of neurologically normal and abnormal children with obstructive sleep apnoea (OSA) and explore the relationship between these profiles.

Methodology: We enrolled 56 children with persistent snoring and OSA for the study, 16 of whom were neurologically abnormal. All children were examined clinically and attended an overnight PSG study. Total clinical scores, PSG scores, and mild/moderate or severe ratings were derived for each child.

Results: Comparison of individual PSG parameters with neurological status demonstrated that the abnormal children had significantly increased obstructive apnoea indices, increased desaturation events and lower mean arousal indices compared to their neurologically normal OSA peers. For the neurologically abnormal children, there was a significant correlation between severity ratings of disease according to clinical and PSG profiles (r = 0.56, P = 0.03, sensitivity 82%) using the clinical summary as the gold standard, although the association was less marked in the neurologically normal children (r = – 0.08, P = NS, sensitivity 69%).

Conclusion: Neurologically abnormal children are likely to have more severe abnormalities in selected polysomnographic indices and overall scores. However, the clinical assessment is only likely to reflect this at the severe end of the spectrum. These relationships are not seen in the neurologically normal child, where little or no reliance can be placed upon predicting the severity of the polysomnographic findings from the clinical data. Decisions regarding the severity of disease and treatment should be based on the combined findings of the clinical and PSG data rather than overall clinical and polysomnographic scores or selected clinical and polysomnographic parameters.
Inhaled budesonide in acute asthma
Authors: Singhi SC , Banerjee S , Nanjundaswamy HM
Published: March 2003

Objective: To evaluate the efficacy of aerosolized budesonide therapy (with metered dose inhaler and spacer) early in the emergency room treatment of acute moderate exacerbations of bronchial asthma in children.

Design: Randomized, double‐blind, placebo‐controlled trial.

Setting: Paediatric Emergency Service of an urban teaching hospital and a tertiary case referral centre.

Study population: Sixty children between 3 and 12 years of age with an acute moderate exacerbation of asthma.

Intervention: All patients received humidified oxygen (5–8 L/min by Venturi® mask; Hudson Respiratory Care, Temecula, CA, USA), nebulized salbutamol (0.15 mg/kg in 3 mL saline) and were randomized to receive either budesonide (400 μg) or placebo inhalation (MDI and spacer) at half hourly intervals for three doses. If there was an inadequate response or no response to treatment at the end of 2 h, oxygen and salbutamol therapy were continued and the patient was given one of dose intravenous hydrocortisone and was started on an aminophylline infusion. If there was no response at the end of a further 4 h, the patient was hospitalized.

Initial evaluation and monitoring: Colour, respiratory rate (RR), heart rate, accessory muscle usage, chest retraction, wheeze, oxygen saturation (by pulse oximetery) and peak expiratory flow rate (PEFR) was recorded at admission and thereafter at hourly intervals for 3 h or until till the child recovered. The need for oxygen therapy after 2 h and need for hospitalization were recorded.

Main results: Both groups showed a significant improvement in respiratory status at the end of 2 h. However, children in the intervention group showed greater improvements in RR and PEFR (P < 0.05) and respiratory distress score (P < 0.1). A significantly lower proportion of the intervention group patients required oxygen therapy for more than 2 h (23%vs 50%; P < 0.05) and aminophylline infusion and systemic corticosteroid therapy (7%vs 27%; P < 0.05). None of the children in the budesonide group, in contrast to 23% of those in the placebo group, required hospitalization (P < 0.05). The length of hospital stay (i.e. time taken to recover from acute asthma) was significantly shorter in the intervention group (3.2 Â± 2.5 h) than in the placebo group (7.8 Â± 11.3 h; P < 0.01).

Conclusion: Aerosolized budesonide therapy (with MDI and spacer) together with nebulized salbutamol early in the emergency room treatment of acute moderate exacerbations of asthma helped in early recovery and decreased the need for hospitalization. It may be worthwhile calculating this regimen for home‐based early treatment of acute exacerbations.
Residual bladder dysfunction 2 to 10 years after acute transverse myelitis
Authors: Cheng W , Chiu RW , Tam PKH
Published: March 2003

Objective: Acute transverse myelitis (ATM) is a relatively rare condition in children. The recovery rate is reported to be generally complete. In the current study, the long‐term urological outcome of children with ATM was assessed.

Methodology: The medical records of children with ATM admitted to Queen Mary Hospital, Hong Kong, over the last 15 years, were reviewed.

Results: The median age of the five children with ATM at the time of onset was 6 years (range = 2–12 years). The median length of follow up was 5 years (2–10 years). Four children recovered completely from paraparesis; two had no urinary symptoms with normal micturition. However, video‐urodynamic studies 3 years after the acute onset revealed that four out of the five children, including one without any urinary symptom, suffered from residual bladder dysfunction – two from contractile neurogenic bladder and two from intermediate type of neurogenic bladder.

Conclusions: Residual bladder dysfunction is common in children suffering from ATM despite improvement of paraparesis and apparent lack of urological symptoms. Long‐term follow up of urological function in these patients is recommended.
Fire deaths in children in South Australia from 1989 to 1998
Authors: Byard RW , Lipsett J , Gilbert J
Published: March 2003

Abstract: A study was undertaken of childhood deaths caused by fires in South Australia over a 10‐year period from 1989 to 1998. A total of 23 deaths of children occurred with an age range of 2 months to 16 years (mean 5 years 10 months; M:F = 13:10). Fourteen deaths were associated with house fires, four with fires in cars and four were miscellaneous or unspecified. While house fire deaths remained the major cause of childhood fire deaths (65%), deaths in car fires accounted for a significant proportion of cases (17%). Although the numbers are small, cars represented a specific danger because of their confined space with highly flammable interiors, lockable doors, and built in non‐childproof lighters. Cars should not be regarded as suitable places to leave young children, or for children to play in unsupervised.
Medicalizing normality? Management of irritability in babies
Authors: Armstrong Kl , Previtera N , Mccallum Rn
Published: March 2003

Objective: The aims of this project were to identify the scources and quality of the health advice provided to parents with irritable infants; to assess the efficacy of a residential programme in the diagnosis and management of irritable infants; and to assess the intermediate term outcome for such infants and their mothers.

Methodology: All mother–infant pairs admitted during a 3 month period to a residential setting with the primary concern of infant irritability were asked to participate in the study. Pre‐admission and 3 month post‐discharge health‐care advice, investigations and treatment details were collected. Maternal mood at admission and 3 months post‐discharge was measured using the Edinburgh Postnatal Depression Scale (EPDS). On admission, infant medication for proposed cause of excess irritability was ceased, with parental consent, if it was appropriate and following full medical assessment. Individual case plans were designed by the admitting child health nurse in consultation with the mother. These included education as to normal infant behaviour, settling techniques, and establishment of routine; family issues were also explored.

Results: Fifty‐one consecutive mother–infant pairs consented to participate and formed the cohort, 48 (94%) were available for follow‐up interview 3 months post‐discharge. The average age on admission was 13 weeks (range 4–28 weeks), 32 (62.7%) were male, 34 (66.7%) were first born and 45 (88.2%) lived with both their parents. A multiplicity of health professionals had been involved in the pre‐admission care, and 48 of the infants had been or were currently on medication for gastro‐oesophageal reflux disease and or colic. At the end of admission, diagnoses made were predominantly behavioural (22) and feeding problems (20). Nine infants were felt to have an organic cause for their irritability. Maternal mood improved significantly on EPDS from the time of admission (45 (86.2%) of mothers with scores ≥ 12, mean score 16.5) to post‐admission follow up (9 (18.8%) with scores ≥ 12, mean score 7.2).

Conclusions: There is evidence that a proportion of babies with ‘normal’ irritability are being incorrectly diagnosed as having an organic disorder exposing them inappropriately to medication, which may be harmful, and potentially creating lifelong problems for these infants and their families.
Indicators of selenium status in Australian infants
Authors: Daniels La , Gibson Ra , Simmer Kn
Published: March 2003

Objective: To provide the first Australian data for the commonly used indicators of selenium (Se) status including plasma and erythrocyte Se and erythrocyte glutathione peroxidase (GSHPx) activity in newborn term and preterm infants from Adelaide, South Australia. Plasma Se levels from adults from Adelaide and Tasmania are also reported.

Methodology: Descriptive, cross‐sectional study of the indicators of Se status of newborn Australian preterm and term infants.

Results: Mean (± SD) plasma Se concentrations in the first 5 days of life for term (n = 48) and preterm (n = 90) infants were similar at 33 ± 11 and 29 ± 14 μg/L, respectively. Glutathione peroxidase activity was lower in preterm than term infants (P < 0.001). Erythrocyte Se was lower in male (n = 74) compared with female (n = 57) infants (491 ± 98 vs 561 ± 134 ng/g Hb; P < 0.001). Adelaide adult plasma Se levels were 88 ± 20 μg/L and higher than those of adult Tasmanian blood donors (77 ± 13 μg/l, P < 0.05).

Conclusions: These data indicate that values for indicators of Se status of Australian infants and adults are at the lower end of the international range. This article highlights the paucity of Australian data on the Se content in the food supply and the Se status of the Australian population. Given the increasing range and complexity of the biological roles of Se and the emerging evidence that Se may have important roles in prevention of cancer and other disorders, further data are required to clarify the Se status of Australians.
Unilateral right‐sided internal jugular phlebectasia in asthmatic children
Authors: Kwok K‐L , Lam H‐S , Ng Dkk
Published: March 2003

Abstract: The most common cause of a neck mass that increases in size on straining is laryngocele. Internal jugular phlebectasia, which is of unknown cause, may present similarly. We present three cases of internal jugular phlebectasia, all of whom were asthmatic children. This association of asthma and internal jugular phlebectasia has not been reported previously.
Infection and preterm birth: Evidence of a common causal relationship with bronchopulmonary dysplasia and cerebral palsy
Authors: Vigneswaran R
Published: March 2003

Abstract: Subclinical genital tract infection has been clearly established as a significant cause of spontaneous preterm birth, particularly in early gestations. Bacterial vaginosis organisms rank highly among the pathogens involved in preterm labour and there is considerable beneficial evidence from the use of prophylactic antibiotics for women at high risk of preterm birth. The pathogenesis involves activation of macrophages and the generation of pro‐inflammatory cytokines. Bronchopulmonary dysplasia is seen in the most immature of survivors and appears to be secondary to interruption of normal development and maturation of the lungs. The link between chorioamnionitis and lung injury in utero and subsequent development of bronchopulmonary dysplasia has now been substantiated. Exposure to pro‐inflammatory cytokines is implicated in the impairment of the fetal lung. A significant body of evidence supports the association between chorioamnionitis, periventricular leukomalacia and cerebral palsy. Biological mechanisms that explain the association between chorioamnionitis and fetal brain injury involve pro‐inflammatory cytokines. Similarity in the pattern of expression of cytokines suggests a common pathway for the initiation of preterm labour and also injury to the lung and the central nervous system of the fetus.
Leucocyte populations in respiratory syncytial virus‐induced bronchiolitis
Authors: Smith PK , Wang S‐Z , Dowling KD , Forsyth KD
Published: March 2003

Objectives: To enumerate the cellular composition of the airways in infants with acute bronchiolitis.

Methodology: Cells were obtained by airway lavage from the upper and lower airway and the peripheral blood of infants with respiratory syncytial virus (RSV)+ bronchiolitis, RSV– bronchiolitis and age‐matched controls.

Results: Neutrophils are the predominant cells present in the upper and lower airway. Neutrophils are present at a higher number/unit volume in the airway than in the peripheral blood.

Conclusions: Neutrophils, being the dominant cellular infiltrate into the airway, are likely to contribute to the pathophysiology of bronchiolitis. Therapies targeted at limiting neutrophil influx or neutrophil‐mediated damage in the airway may have a therapeutic role.
Lactase deficiency among Malaysian children with recurrent abdominal pain
Authors: Boey CCM
Published: March 2003

Objectives: To determine the prevalence of lactase deficiency among Malaysian children with recurrent abdominal pain and to describe their clinical characteristics.

Methodology: Twenty‐four children referred consecutively to the University of Malaya Medical Centre who fulfilled Apley’s criteria (at least three episodes of abdominal pain severe enough to affect normal activity over a period longer than 3 months) were tested for lactase deficiency using a pocket breath test analyser (BreatH2 meter; Europa Scientific, Cheshire, England). Lactulose was used to check for hydrogen‐producing capacity.

Results: There were 14 males and 10 females in the study, consisting of five Malays, 14 Chinese and five Indians. Mean age was 9.9 years. Seventeen of the 24 children (70.8%) with recurrent abdominal pain who underwent the breath hydrogen test had a positive result. In those with a negative result, subsequent lactulose administration resulted in a positive rise in breath hydrogen. None of the 24 children developed abdominal pain during the test. All the Indian subjects, 71.4% of the Chinese subjects and 40% of the Malay subjects with recurrent abdominal pain had lactase deficiency. The proportion of boys and girls with lactase deficiency was similar (71.4 vs 70.0%, respectively). There was no significant difference between lactase sufficient and deficient children with recurrent abdominal pain with regard to sex, age, ethnic group and clinical features. Following a lactose‐free diet, none of the children in the breath hydrogen positive and negative groups reported any appreciable difference in pain symptoms.

Conclusions: The prevalence of lactase deficiency among this group of Malaysian children with recurrent abdominal pain was high, but lactase deficiency did not appear to play an important role in causing the symptoms.
Nasal continuous positive airway pressure and outcomes of preterm infants
Authors: De Klerk AM , De Klerk RK
Published: March 2003

Objectives: To document the effects of changing to a primarily nasal continuous positive airway pressure (CPAP)‐based system of respiratory support on respiratory and non‐respiratory outcomes in preterm infants.

Methodology: Outcomes in two groups of preterm infants with a birthweight of 1000–1499 g were compared retrospectively over a 5‐year period before (period I; n = 57) and after (period II; n = 59) the introduction of a primarily nasal CPAP‐based approach to respiratory support, modelled closely on that used at the New York Presbyterian Hospital (Columbia University), formally known as the Columbia‐Presbyterian Medical Center, in New York.

Results: From period I to period II, there was a decline in the number of infants ventilated (65 vs 14%, respectively) and receiving surfactant (40 vs 12%, respectively) and in the median days of ventilation (6 vs 2, respectively) and oxygen (4 vs 2, respectively). There were decreases in chronic lung disease (CLD) at 28 days (11 vs 0%, respectively), death or CLD at 28 days (16 vs 3%, respectively), the use of pressor support (34 vs 7%, respectively), the incidence of necrotizing enterocolitis (11 vs 0%, respectively), time to reach full oral feeds (17.3 vs 13.2 days, respectively), discharge weight (2569 vs 2314 g, respectively) and average length of stay (61 vs 52.9 days, respectively). There were no differences in neurosonographic or other morbidity outcomes.

Conclusions: A CPAP‐based approach to respiratory support of the preterm infant may decrease the invasiveness and duration of respiratory support and may decrease respiratory and some non‐respiratory adverse outcomes without an associated increase in neurosonographic or other morbidity outcomes. Further prospective trials are warranted.
Attitudes and practices of general practitioners in the diagnosis and management of attention‐deficit/hyperactivity disorder
Authors: Shaw KA , Mitchell GK , Wagner IJ , Eastwood HL
Published: March 2003

Objective:  To assess understanding of, and actual and potential roles in management of attention‐deficit/hyperactivity disorder (ADHD) among GPs.

Methods:  A cross‐sectional questionnaire survey of Queensland GPs selected randomly from the Royal Australian College of General Practitioners directory of members was carried out. Main outcome measures were knowledge levels of ADHD, current management practices, referral patterns and self‐perceived information and training needs.

Results:  Three hundred and ninety‐nine GPs returned a completed questionnaire (response rate 76%). Roles identified by GPs were: the provisional diagnosis of ADHD and referral to specialist services for confirmation of the diagnosis and initiation of management; assistance with monitoring progress once a management plan was in place; education of the child and their family regarding the disorder; and liaison with the school where necessary. Perceived barriers to increased involvement of GPs were: time and resource constraints of general practice; concerns regarding abuse and addiction liability of prescription stimulants; complex diagnostic issues associated with childhood behavioural problems; and lack of training and education regarding ADHD.

Conclusions:  General practitioners identify a role for themselves in ADHD care that is largely supportive in nature and involves close liaison with specialist services.
Addicted schoolchildren: Prevalence and characteristics of areca nut chewers among primary school children in Karachi, Pakistan
Authors: Shah SMA , Merchant AT , Luby SP , Chotani RA
Published: March 2003

Objectives:  To evaluate the habits of betel quid use and areca nut chewing among school‐aged children in Karachi, Pakistan. Areca nut (betel nut) is chewed by itself, in various scented preparations, and in betel quid (containing betel leaf, areca nut, slaked lime, condiments, sweeteners and sometimes tobacco) in various parts of Pakistan and India. It is associated with carcinogenesis, foreign body aspiration in children and oral submucous fibrosis, and may aggravate asthma.

Methods:  We selected a stratified random sample of 160 primary school children between 4 and 16 years of age in Baba Island, Karachi.

Results:  Seventy‐four per cent of the children (118/159) used areca nut and 35% (55/159) used betel quid daily. More boys chewed areca nut than girls (72% vs 30%). The proportion of areca nut users increased by grade (from 48% in first grade to 90% in fifth grade). Most areca users first tried it with a family member (42%) or a friend (26%), and most (68%) consumed three or more packets a day. Children with fathers with three or fewer years of education were more likely to use areca nut (OR 3.2; 95% CI 1.2−8.4), and children whose mothers helped with homework less likely (OR 0.5; 95% CI 0.2−0.91; P = 0.027) to use it. Boys (OR 6.6; 95% CI 2.3−18.7) and areca nut users (OR 8.8; 95% CI2.8−27.0) were more likely to use betel quid.

Conclusion:  To reduce the use of areca nut, the Pakistan Government should consider imposing taxes on it, limiting advertising and actively communicating its health risks to the public.
Birthweight and stature, body mass index and fat distribution of 14‐year‐old Polish adolescents
Authors: Kozieł S , Jankowska EA
Published: March 2003

Objectives: The relationships between intra‐uterine growth retardation and stature, relative weight and fat distribution at adolescence have not been comprehensively established. The aim of this report is to assess the effect of low birthweight on stature, relative weight and fat distribution in 14‐year‐old boys and girls from Wroclaw, Poland.

Methodology: Cross‐sectional measurements of 1197 boys and 819 post‐menarcheal girls aged 13.50–14.49 years were performed during medical examinations in 1997. Stature, body mass index (BMI; kg/m2), waist‐to‐hip ratio (WHR) and waist‐to‐thigh ratio (WTR) were used in the present study. A cut‐off value of the 10th percentile of birthweight for particular gestational weeks was used in order to define subjects born small for gestational age (SGA) or appropriate for gestational age (AGA). Two‐way ANOVA was used to evaluate the effect of birthweight on anthropometric variables of 14‐year‐old adolescents, allowing for socioeconomic status (determined by the level of the mother’s education).

Results: Birthweight affected stature in boys and girls (P < 0.001), BMI in boys (P < 0.05) and WHR and WTR in girls (P < 0.001 and P < 0.05, respectively). At the age of 14 years, both SGA boys and girls were shorter than their AGA peers. The SGA boys had lower BMI, whereas SGA girls accumulated more centralized fat compared with their AGA counterparts. Conclusion: Fetal growth retardation has a long‐lasting adverse effect on later physical growth. Polish SGA children do not catch up with their peers in terms of stature by adolescence. Moreover, central fat distribution, as observed among SGA girls, constitutes a significant risk for several adult degenerative diseases.
Maternal thyrotoxicosis causing central hypothyroidism in infants
Authors: Lee YS , Loke KY , Ng SCY , Joseph R
Published: March 2003

Abstract: We describe three infants born to mothers with poorly controlled Graves’ disease, who developed transient central hypothyroidism in the immediate postnatal period. Suppression of the fetal pituitary‐thyroid axis may be due to placental transfer of thyroxine from the hyperthyroid mother. This may persist for months postnatally, necessitating treatment to optimise neurodevelopmental outcome.
Chronic fatigue syndrome: Successful outcome of an intensive inpatient programme
Authors: Lim A , Lubitz L
Published: March 2003

Objective:  To study the outcome of adolescents with chronic fatigue syndrome (CFS) following an intensive multi­disciplinary inpatient programme.

Methods:  A follow‐up questionnaire was distributed to all 57 adolescents who had completed the CFS inpatient programme at the Austin and Repatriation Medical Centre.

Results:  Forty‐two adolescents (74%) returned follow‐up questionnaires. Immediately following the programme and up to five years after the programme, the majority of participants had returned to school and were functioning better in terms of physical activity and social interactions as compared with before the programme. Before the programme, 94% of adolescents were attending school half‐time or less. Up to 5 years after the programme, 78% of adolescents were attending school full‐time or with occasional absences only.

Conclusions:  A multidisciplinary inpatient programme for CFS was successful in helping to rehabilitate this group of adolescents who were significantly incapacitated prior to entering the inpatient programme.
Cost‐effectiveness of palivizumab in New Zealand
Authors: Vogel AM , McKinlay MJ , Ashton T , Lennon DR , Harding JE , Pinnock R , Graham D , Grimwood K , Pattemore PK , Schousboe M
Published: March 2003

Objective:  To establish the preterm infant hospitalization risks from respiratory syncytial virus (RSV) in New Zealand and the net cost per hospitalization averted by palivizumab.

Methods:  The 437 infants born < 32 weeks gestation in 1997 and treated at five major neonatal units were identified. Subsequent admissions during the next 2 years for bronchiolitis, pneumonia and croup were tracked, and information collected on RSV tests performed. Data on the length of stay and hospital costs were used to calculate the potential net cost per hospitalization averted associated with the use of palivizumab and the number needed to treat (NNT) to prevent one hospitalization.

Results:  Estimated RSV readmission risk before 1 year corrected age in infants < 32 weeks gestation discharged home on oxygen, and those ≤ 28 weeks gestation, or between 29 and 31 weeks gestation with or without chronic lung disease was 42%, 23%, 19%, 10% and 8%, respectively. The NNT with palivizumab to prevent one hospitalization ranged from six to 26 across subgroups. Mean (range) net cost per hospitalization averted was $NZ60 000 ($28 600−$166 700). In no subgroup would prophylaxis result in net cost saving. Prophylaxis for all NZ infants ≤ 28 weeks gestation would cost approximately $1 090 000 net and prevent 29 hospitalizations annually, being equivalent to $37 000 net per hospitalization averted, with eight infants treated to prevent one hospitalization. Alternative assumptions about cost and efficacy failed to alter these findings.

Conclusion:  If value is placed on preventing morbidity, the priority groups for palivizumab prophylaxis are preterm infants discharged home on oxygen, followed by preterm infants of 28 weeks gestation or less.
Fatal unintentional traumatic asphyxia in childhood
Authors: Byard RW , Hanson KA , James RA
Published: March 2003

Objective:  The present study was undertaken to examine specific features of unintentional traumatic asphyxial deaths in childhood.

Methods:  Coronial files and records at the Forensic Science Centre in Adelaide, South Australia, were examined over a 35‐year period from 1966 to 2000 for all cases of traumatic asphyxial death occurring in children under the age of 17 years.

Results:  Six cases of unintentional fatal traumatic asphyxia were identified. All of the victims were boys with an age range of 2−15 years (mean 6.8 years) and all were found dead at the scene. Fatal traumatic asphyxia resulted from entrapment beneath a chest of drawers, beneath a table tennis table, between a pile of wooden pallets and a metal fence, between a conveyor belt and its frame, and under a motor vehicle (in two cases).

Conclusions:  Fatal traumatic asphyxia in childhood is a rare event, with younger children commonly being trapped by furniture or by industrial equipment while playing, and older children being trapped under motor vehicles in similar circumstances to adult traumatic asphyxial deaths. Unsupervised play of young children around heavy and potentially unstable pieces of furniture may be dangerous, particularly if more than one child is present. Unsupervised play of young children in industrial yards should be avoided.
The provision of preventive care by general practitioners measured by patient completed questionnaires
Authors: Steven Id , Thomas Sa , Eckerman E , Browning C , Dickens E
Published: March 2003

Abstract The objective of this study was, by means of patient self‐report, to measure the provision of preventive care to patients of a sample of Australian general practitioners. Patient‐completed questionnaires from a consecutive sample of Australian general pracitioners enrolled in the Quality Assurance and Continuing Medical Education Program of the Royal Australian College of General Practitioners were used. Patients were attendees at Australian general practices. The main outcome measures included the following: the provision of tetanus immunization within the last 10 years; blood pressure measurement within the last 12 months; cholesterol screening within the past 5 years; provision of adequate information to enable patients to stop smoking if they desired; discussion about the benefits of diet and exercise to enhance life, and about alcohol intake; provision of cervical smears in the past 2 years; provision of adequate instruction in breast self‐examination and overall satisfaction with service provision. A total of 12 605 questionnaires from 133 general practices were completed. There was wide variability between practices in the reported provision of preventive care items including an average of 86% (range 36–100) of patients reporting the provision of blood pressure checking in the past 12 months, 62% (range 25–97%) reporting the provision of tetanus immunization in the past 10 years, and 63% (range 10–91%) reporting having had a cervical smear in the past 2 years. Patients who were very satisfied were more likely to have reported that they had received blood pressure measurement in the past 12 months, participated in discussions about the benefits of diet and exercise in enhancing life, and participated in discussions about alcohol intake and provision of adequate instruction in the technique of breast self‐examination. Patient self‐reporting identified variability between practitioners in the provision of preventive care conforming to accepted guidelines. Patients who reported that they were very satisfied or who regularly attend only one general practice reported the provision of more preventive care than those who were not very satisfied or who regularly visited two or more general practitioners.
Establishing adolescent and young adult therapy programs
Authors: Bouhlas Litsa , Bond Natasha
Published: March 2003

Abstract Perth Clinic is a 35‐bed private psychiatric clinic. In February 1999 an adolescent and young adult therapy service was introduced in response to an increasing number of enquiries regarding the treatment of adolescent and young adults with psychiatric disorders. This program was developed by a working party of mental health professionals including psychiatrists, clinical psychologists, nurses and occupational therapists. The program design described the type of program to be delivered, its content and structure, and the method of evaluation. In consultation with similar services around the world, Perth Clinic developed two therapy streams for this population. The first is an inpatient program based on an open group format of 4
1/2 hours of therapy daily. The second is a closed group program conducted for two 3 hour sessions per week. Groups are held in the late afternoon (16.00–19.00 h) for an 8 week period. Both streams have a maximum of eight participants and all participants are referred by a psychiatrist. Outcomes are measured by a battery of clinical questionnaires which provide objective measurement of mood changes. Patient and parent satisfaction with the program is also measured. Indicators at this early stage are that this is an effective intervention program with high rates of attendance and good prognostic data. This study describes the first 6 months of this program’s operation.
An hypothesis paper on practice environment and the provision of health care: Could hospital occupancy rates effect quality?
Authors: Forster Alan , Tugwell Peter , Walraven Carl Van
Published: March 2003

Abstract This paper will explore whether hospital occupancy influences quality of care. It discusses the ‘systems’ theory of error causation in the context of adverse medical outcomes. It then relates how high occupancy rates may cause problems in hospital systems. The evidence relating to quality of care and occupancy is reviewed. Finally, a new method of studying this relationship using time series analysis is proposed. We conclude that the relationship requires further exploration since revealing ‘system’ problems may compel clinicians to expose problems medical errors.
Enteroviruses in the recreational waters of Lake Orta
Authors: Maiello A. , Guidetti A. , Poncetta D. , Ossola O. , Guidetti L. , Buttinelli G. , Fiore L.
Published: March 2003

The water quality of Lake Orta was evaluated for recreational use. This lake was the only Italian lake to undergo a ‘liming treatment’ which neutralizes water acidity by adding carbonates. Chemical, bacteriological and virological parameters were monitored for 3 years after the treatment ended. Chemical and bacteriological studies were performed according to national standard methods (DPR 470/82) whereas F′ specific bacteriophage were enumerated according to an international standard (ISO 10705–1). Enteroviruses were detected by the observation of a cytophatic effect on buffalo green monkey cultures. Also, the possibility of applying molecular biological techniques for enterovirus detection directly to waters concentrated without previous isolation of viruses in cell culture was verified. The sensitivity, specificity and feasibility of both methods were evaluated. The association between the direct detection of enteroviruses and the indirect indication of their presence by the presence of bacteriophages, and the relationship between bacteriophage presence and bacteriological contamination were also evaluated. In the course of surveillance, none of the samples infringed the law with respect to the physical–chemical parameter (pH < 6). As far as bacteriological characteristics were concerned, 16.6% of the samples taken in 1993 infringed the law, as well as 19.4% of samples in 1994 and 19.4% in 1995. The level of faecal coliforms most frequently exceeded the given limits. The detection test for enteroviruses was positive in 5.1% of the samples using the traditional method with cell culture, and it was positive in 7.6% using the antigen capture polymerase chain reaction (AC‐PCR) method directly applied to concentrated waters, indicating the feasibility and a higher sensitivity of the AC‐PCR method compared to cell culture. Bacteriophages were present in all the samples that were positive in the virological analysis, as well as in 46.7% of negative samples.
Impact of human activities on the evolution of the Romanian Black Sea beaches
Authors: Ungureanu Viorel Gheorghe , Stanica Adrian
Published: March 2003

The Romanian Black Sea coastal zone is divided into two main sectors. Sediment characteristics and general transport patterns are presented for each of them. The human activities influencing the beaches’ evolution are depicted and the present‐day impact described.