bluuebunny/crossref_metadata_2025 huggingface dataset:
High sustained response to daily dosing of interferon with ribavirin in chronic hepatitis C patients naïve to therapy
Authors: ABBAS ZAIGHAM , HAMID SAEED , TABASSUM SHAESTA
Published: March 2003

Background
: Viral kinetics suggests that daily administration of α‐interferon (IFN) will clear hepatitis C virus (HCV) RNA earlier and more frequently compared with standard t.i.w. To reduce the likelihood of viral replication, mutation and subsequent development of resistance, daily dosing with IFN may be appropriate. To determine the safety and efficacy of daily IFN with ribavirin in chronic HCV infection we performed a prospective study.

Methods
: Thirty‐five naïve adult HCV‐positive patients (25 male/10 female) were treated with IFN‐α2b; 5 MU daily for 2 weeks followed by 3 MU daily for 22 weeks and ribavirin 800–1200 mg/day depending on weight. Liver biopsy, performed in 25 patients, showed mild to moderate activity in 19 patients (76%) and severe activity in six patients (24%). Two patients showed staged IV fibrosis. Serotyping was performed in 29 patients by an enzyme immunoassay‐based Murex assay. Type 3 was the predominant serotype, present in 14 cases. Hepatitis C virus RNA was measured by the Chiron bDNA assay.

Results
: Mean baseline HCV‐RNA level was 14.2 ± 18.7 MEq/mL (median 6.09; range 0.2–92.5), which became undetectable in all but three patients at week 4. Normalization of alanine aminotransferase (ALT) at week 4 was seen in 27 patients. Three patients withdrew due to non‐compliance. Thirty‐two patients completed 24 weeks of therapy as per the protocol. At the end of treatment, the HCV‐RNA level was negative in 29 of 32 patients (90.6%) and ALT was normal in 31 of 32 patients (97%). Sustained viral response at 6 months follow up was seen in 28 of 32 patients (88%). The ALT level was normal in 28 of 32 patients (88%).

Conclusion
: Daily administration of IFN with ribavirin is well tolerated in the majority of patients. There is rapid elimination of virus with normalization of ALT and a significantly high sustained viral response.

© 2002 Blackwell Publishing Asia Pty Ltd
Eight‐year nationwide survival analysis in relatives of patients with hepatocellular carcinoma: Role of viral infection
Authors: Tai Dar‐In , Chen Chien‐Hung , Chang Ting‐Tsung , Chen Shinn‐Cherng , Liao Li‐Ying , Kuo Chung‐Huang , Chen YangYuan , Chen Gran‐Hum , Yang Sien‐Sing , Tang Huang‐Shang , Lin Hsien Hong , Lin Deng‐Yn , Lo Sing Kai , Du Jeng‐Ming , Lin Kwo‐Chuan , Changchien Chi‐Sin , Chang Wen‐Yu , Sheu Jin‐Chuan , Liaw Yun‐Fan , Chen Ding‐Shinn , Sung Juei‐Low
Published: March 2003

Abstract Background: Families of patients with hepatocellular carcinoma (HCC) carry a high risk of developing HCC. We determine the number of fatalities in relatives of HCC patients during an 8‐year period to understand the risk and cause of HCC in relatives of patients with HCC.

Methods: From 1992 to 1997, 15 410 relatives of HCC patients in three generations were screened prospectively for HCC by ultrasonography, α‐fetoprotein, liver biochemistry and viral markers. By using national citizen identification numbers, we searched the total fatalities in relatives of HCC patients between 1992 and 1999 from the national mortality data bank. The results were compared among different viral infection groups.

Results: Of the relatives studied, 37.8% were hepatitis B s antigen (HBsAg) positive (+), 4.3% were anti‐hepatitis C virus (HCV) (+) and 1.7% were both HBsAg (+) and anti‐HCV (+). A total of 399 fatalities, including 139 because of HCC (34.8%), 37 because of liver diseases (9.3%), 88 because of other cancers (22.1%) and 135 because of other diseases (33.8%), were found. Relatives who were HBsAg (+) or anti‐HCV (+)showed a lower cumulative survival than did relatives who were negative for both HBsAg and anti‐HCV. Relatives with dual infection of hepatitis B and C virus showed the highest mortality due to HCC or terminal liver diseases.

Conclusions: Chronic viral infection rather than a hereditary factor is the main cause of a familial tendency for HCC. Dual infection of hepatitis B and C virus increases the risk of HCC or decompensated liver diseases.
Roles of tumor necrosis factor‐α‐receptor type 1 and Fas in the Helicobacter pylori‐induced apoptosis of gastric epithelial cells
Authors: HASUMI KEIZO , TANAKA KAZUO , SAITOH SHIN , TAKAGI ATSUSHI , MIWA TAKESHI , MINE TETSUYA , KOGA YASUHIRO
Published: March 2003

Objectives

Helicobacter pylori (HP) infection has been reported to accelerate the apoptosis of gastric epithelial cells. This bacteria has also been known to enhance the expression levels of molecules such as Fas antigen and a receptor for tumor necrosis factor‐α‐receptor type 1 (TNF‐R1). However, whether Fas and/or TNF‐R1 is actually involved in HP‐mediated apoptosis has yet to be evaluated. The purpose of this study was therefore to examine the roles of Fas and TNF‐R1 in HP‐mediated apoptosis.

Methods

Biopsy samples were collected from 10 HP‐negative healthy volunteers and from 39 HP‐positive ulcer patients. Gastric epithelial cells were obtained from the samples. The cells were then stained with anti‐Fas, anti‐TNF‐R1 and Annexin V, which detected apoptotic cells. The findings were analyzed by three‐color flow cytometry.

Results

The percentages of apoptotic cells were significantly higher in HP‐positive patients than in the controls. In HP‐negative controls, almost all of the apoptotic cells lacked both Fas and TNF‐R1. On the other hand, in HP‐positive patients, HP upregulated the expression levels of Fas and TNF‐R1 and, consequently, enhanced the apoptosis mediated by receptors such as Fas and TNF‐R1. However, even in HP‐positive patients, apoptosis was also observed in the cells that lacked both Fas and TNF‐R1.

Conclusions

Fas and TNF‐R1 expressed on gastric epithelial cells from HP‐infected patients were responsible for the accelerated apoptosis of the cells.
Oral administration of lactoferrin reduces colitis in rats via modulation of the immune system and correction of cytokine imbalance
Authors: TOGAWA JUN‐ICHI , NAGASE HAJIME , TANAKA KATSUAKI , INAMORI MASAHIKO , NAKAJIMA ATSUSHI , UENO NORIO , SAITO TOSHIFUMI , SEKIHARA HISAHIKO
Published: March 2003

Background and Aims
: The natural immunomodulator, lactoferrin, is widespread among various biological fluids and is known to exert an anti‐inflammatory effect. However, there has been only one study that examined the mode of action of lactoferrin in reducing intestinal damage. We investigated the therapeutic role of lactoferrin and its effect on the levels of pro‐inflammatory and anti‐inflammatory cytokines, by using a rat model of dextran sulfate sodium (DSS) induced‐colitis.

Methods:
Male Sprague–Dawley rats were given distilled drinking water containing 2.5% (wt/vol) synthetic DSS ad libitum. Bovine lactoferrin was given once daily through gavage, starting 3 days before beginning the DSS administration, until death. The whole colon was removed to be examined macroscopically and histologically. Myeloperoxidase activity, and pro‐inflammatory and anti‐inflammatory cytokines in the colonic tissue were also measured.

Results:
Dextran sulfate sodium‐induced colitis was attenuated by oral administration of lactoferrin in a dose‐dependent manner, as reflected by improvement in clinical disease activity index, white blood cell count and hemoglobin concentration, macroscopic and histological scores, and myeloperoxidase activity. Reduced inflammation in response to lactoferrin was correlated with the significant induction of the anti‐inflammatory cytokines, interleukin‐4 and interleukin‐10, and with significant reductions in the pro‐inflammatory cytokines, tumor necrosis factor α, interleukin‐1β, and interleukin‐6.

Conclusions:
We concluded that oral administration of lactoferrin exerts a protective effect against the development of colitis in rats via modulation of the immune system and correction of cytokine imbalance. Lactoferrin has potential as a new therapeutic agent for inflammatory bowel disease.

© 2002 Blackwell Publishing Asia Pty Ltd
New method for the determination of fecal consistency and its optimal value in the general population
Authors: NAKAJI SHIGEYUKI , FUKUDA SHINSAKU , IWANE SATORU , MURAKAMI HIDEKI , TAMURA KEN , MUNAKATA AKIHIRO , SUGAWARA KAZUO
Published: March 2003

Background
: Although fecal consistency is an important factor, there has been only one study measuring this parameter. We developed a new method to measure fecal consistency and studied the relationship between fecal consistency and other fecal factors, including water content and weight.

Methods
: The new method is a modification of the method of Exton‐Smith and used an even balance. Subjects in the initial trial were 26 healthy women. Subsequently, fecal consistency was measured in a representative sample of the general Japanese population, in order to evaluate the optimal value to maintain large bowel function.

Results
: Correlations between fecal consistency and fecal water content and weight were statistically consistent, although not highly correlated with each other. The optimal mean value was around 300 cm2: ‘normal’ in ‘subjective defecatory state’, 295.5 cm2 and 305.2 cm2; ‘once/day’ in ‘defecation frequency’, 296.1 cm2 and 310.2 cm2; ‘soft and plump’ in ‘fecal characteristics’, 293.6 cm2 and 298.3 cm2, in males and females, respectively. The coefficient of variation of this method ranged from 5.2% to 6.3%.

Conclusions
: This method is thought to be applicable to large‐scale epidemiological surveys. The optimal value of fecal consistency in the general population was evaluated at approximately 300 g/cm2.

© 2002 Blackwell Publishing Asia Pty Ltd
Examination of small bowel enzymes in chronic diarrhea
Authors: SIMADIBRATA MARCELLUS , WANDERS RONALD JA , JAN GERRIT , TYTGAT GUIDO NJ , LESMANA LAURENTIUS A , DALDIYONO  , ARIAWAN IWAN
Published: March 2003

Background: In Indonesia, the proportion of daily carbohydrate intake is approximately 60–80%. A number of small bowel disorders can result in the impairment of absorption and enzyme deficiency. Chronic diarrhea is common in Indonesia.

Methods: Thirty‐four functional dyspeptic patients with an endoscopically normal small bowel as a control group, and 17 chronic diarrhea patients from the Division of Gastroenterology, University of Indonesia/Cipto Mangunkusumo Hospital were included in this study. All patients underwent a gastroduodenojejunoscopy and an ileocolonoscopy examination. Biopsies were taken from the jejunum (two specimens) and the biopsy specimens were examined for enzyme analysis (lactase, maltase, sucrase). The data were analyzed by using the Kruskal–Wallis or anova.

Results: The lactase level of the chronic diarrhea group was significantly lower compared with that of the control group (1.941 ± 1.621 vs 2.502 ± 2.098 µmol/min mg protein; P < 0.001). The maltase level of the chronic diarrhea group was significantly lower compared with that of the control group (280.942 ± 148.173 vs 371.920 ± 250.177 µmol/min mg protein; P < 0.001). The sucrase level of the chronic diarrhea group was significantly lower compared with that of the control group (48.474 ± 28.553 vs 66.727 ± 49.685 µmol/min mg protein; P < 0.001).

Conclusion: The enzyme activity concentrations (lactase, maltase, sucrase) were much lower in chronic diarrhea cases compared with the controls.

© 2003 Blackwell Publishing Asia Pty Ltd
Clinical use of hyaluronic acid as a predictor of fibrosis change in hepatitis C
Authors: PATEL KEYUR , LAJOIE ADRIANNE , HEATON SHANON , PIANKO STEPHEN , BEHLING CYNTHIA A , BYLUND DAVID , POCKROS PAULJ , BLATT LAWRENCE M , CONRAD ANDREW , MCHUTCHISON JOHN G
Published: March 2003

Background and Aim: Hyaluronic acid (HA) is a glycosaminoglycan synthesized by hepatic stellate cells that has been shown to correlate with liver fibrosis in chronic hepatitis C (HCV) patients. However, its use in monitoring fibrosis over time has not been established. The aim of the present study was to assess the serial relationships between HA and liver fibrosis before and after treatment.

Methods: Seventy‐six previously untreated chronic HCV patients received interferon‐based therapy over 48 weeks. Serum HA levels were measured and liver biopsies were obtained at baseline, and 24 weeks post‐treatment. Histological fibrosis was assessed by using the Knodell and METAVIR scoring systems.

Results: Knodell fibrosis was evaluated in 76 patients; METAVIR fibrosis in 72 patients. Following treatment, patients were grouped into those with increased fibrosis (Knodell = 17; METAVIR = 16), no change (Knodell = 50; METAVIR = 45), or decreased fibrosis (Knodell = 9; METAVIR = 11), relative to baseline. Moderate correlations between HA and fibrosis scores were found before treatment (Knodell R = 0.45; METAVIR R = 0.40) and post‐treatment (Knodell R = 0.45; METAVIR R = 0.61). However, changes in HA correlated poorly with changes in fibrosis scores over the study period (Knodell R = 0.11; METAVIR R = 0.06). There was poor qualitative agreement between the direction of HA change and the direction of change in fibrosis scores (Knodell kappa = 0.04; METAVIR kappa = 0.08). The sus‐tained virological response group (n = 18) had a significantly decreased mean HA compared with non‐responders (−27.9 vs 21.7 µg/L; P = 0.009), but pretreatment HA did not predict a response.

Conclusions: Serum HA showed a modest association with hepatic fibrosis, and remains a useful non‐invasive marker. However, serum HA alone has limited value in predicting histological changes over a treatment period.
Role of para‐esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis
Authors: IRISAWA ATSUSHI , OBARA KATSUTOSHI , BHUTANI MANOOP S , SAITO AYAKO , SHISHIDO HIDEO , SHIBUKAWA GORO , TAKAGI TADAYUKI , YAMAMOTO GO , SEINO OSAMU , SHISHIDO FUMIO , KASUKAWA REIJI , SATO YUKIO
Published: March 2003

Background and Aims: Para‐esophageal collateral veins (para‐ECV) are observed by endoscopic ultrasonography (EUS) in patients with portal hypertension. However, the role of para‐ECV in the portal venous system is not clear. To verify the role of para‐ECV in the portal venous system, we investigated the relationship between the development of para‐ECV as determined by EUS, and the portal blood flow ratio (PBFR) as determined by liver scintigraphy using 99mTc‐phytate.

Methods: Eighteen patients who did not have fundal gastric varices were studied before the start of and after the completion of all endoscopic sclerotherapy sessions for esophageal varices. EUS was performed to observe veins around the esophagus, para‐ECV and perforating veins. To quantify the degree of development of para‐ECV, the cross‐sectional area of each para‐ECV observed by EUS was measured. The sum total of these areas was used as an index of development of para‐ECV. The PBFR was calculated by liver scintigraphy using 99mTc‐phytate. The correlation between the sum total cross‐sectional area of para‐ECV and PBFR was examined.

Results: After all endoscopic injection sclerotherapy sessions, the total cross‐sectional area of para‐ECV was 29.32 (26.72) mm2 (mean (SD)) and the PBFR was 48.47 (17.87)% (mean (SD)). A significant correlation between them was noted after treatment (r = − 0.70, P < 0.01). Variceal recurrence was observed in three of the patients who had perforating veins connected with para‐ECV, regardless of degree of the para‐ECV.

Conclusion: The para‐ECV are collaterals, which reflect the portal blood flow after endoscopic sclerotherapy. para‐ECV without perforating veins were considered to be important collaterals after treatment.
Assessment of cancer cell differentiation in small hepatocellular carcinoma by computed tomography and magnetic resonance imaging
Authors: AMANO SUSUMU , EBARA MASAAKI , YAJIMA TAKAYUKI , FUKUDA HIROYUKI , YOSHIKAWA MASAHARU , SUGIURA NOBUYUKI , KATO KAZUKI , KONDO FUKUO , MATSUMOTO TOORU , SAISHO HIROMITSU
Published: March 2003

Aim: To study whether cancer cell differentiation in small hepatocellular carcinoma (HCC) can be assessed by computed tomography (CT) and magnetic resonance (MR) imaging.

Methods: We retrospectively evaluated the relationship between cancer cell differentiation in 127 HCC 3 cm or less in diameter (113 patients) and CT and MR images. Images were reviewed in a consensus conference by three authors (SA, TY, and ME). Histopathological diagnosis of HCC was made from liver specimens obtained by sonographically guided biopsy.

Results: The degree of histological differentiation of cancer cells was significantly different between HCC that were isodense with liver parenchyma in both artery‐dominant and equilibrium phases in contrast‐enhanced CT and tumors that were hyperdense in the artery‐dominant phase and iso‐ or hypodense in the equilibrium phase (P = 0.0054), as well as tumors that were iso‐ or hypodense artery‐dominant and hypodense equilibrium (P = 0.0002). Histological differentiation of lesions that were hyperintense in T1‐weighted images and hypointense in T2‐weighted images differed significantly from those with the opposite MR characteristics (P = 0.0122). In T1‐weighted fat‐suppression images and T2‐weighted images, respectively, the degree of histological differentiation was significant between the hypointense/hyperintense and the hyperintense/hypointense patterns (P < 0.0001), as well as the hyperintense/isointense (P = 0.0296), the hyperintense/hyperintense (P = 0.0434), and the isointense/hyperintense (P = 0.0171). Using these differences an equation was developed that could determine with 76% accuracy whether the tumors were well or less‐well differentiated.

Conclusion: CT and MR imaging patterns were useful in predicting the degree of histological differentiation of cancer cells in HCC.
Retinopathy of prematurity in infants < 32 weeks’ gestation at birth in New South Wales in 1993 and 1994
Authors: Todd DA , Cassell C , Kennedy J , John E ,   The New South Wales Neonatal Intensive Care Units Study Group
Published: March 2003

Objective: To study the incidence and severity of retinopathy of prematurity (ROP) in infants < 32 weeks’ gestation.

Design: Review of the records maintained in the New South Wales Neonatal Intensive Care Unit Study (NICUS) database on infants admitted to the neonatal intensive care units (NICU) in NSW from 1 January 1993 to 31 December 1994.

Results: In the more premature infants, 23–26 weeks’ gestation, 65% developed ROP (102 of 157 examined for ROP). Forty‐four infants (28%) developed severe ROP (Stage ≥ 3 ROP), 19 infants (12.1%) required cryo/laser therapy and one infant (0.6%) in this group had a retinal detachment. One hundred and fifty‐seven of 159 surviving infants (98.7%) were examined for ROP. In the infants 27–28 weeks’ gestation, 38.3% developed ROP (103 of 269 examined for ROP). Fifteen infants (5.6%) developed severe ROP, seven infants (2.6%) required cryo/laser therapy for threshold ROP and three infants (1.1%) in this group had a retinal detachment. Two hundred and sixty‐nine of 299 surviving infants (90%) were examined for ROP. In the infants 29–31 weeks’ gestation, 10.8% developed ROP (48 of 443 examined for ROP). Six infants (1.4%) developed severe ROP, one infant (0.2%) required cryo/laser therapy for threshold ROP and no infant in this group had a retinal detachment. However, only 443 of 681 surviving infants (65.1%) in this group were examined for ROP. Of the four infants with detached retinas, one was a 25 week gestation infant weighing 840 g, two were 27 weeks’ gestation weighing 960 and 980 g and one infant was a 28 week gestation infant weighing 620 g. No infant developed Stage 5 ROP.

Conclusion: In the more mature infants 29–31 weeks’ gestation, the rate of ROP is low, although severe ROP still occurs. However, only 65.1% of these infants were examined for ROP and we should be diligent in screening for ROP in the sicker infants in this group. The incidence of severe ROP as well as the rate of cryo/laser therapy in premature infants 23–26 weeks’ in NSW has not changed since the increases seen in the early 1990s. Retinal detachment also occurs in the infants 27–28 weeks’ gestation and it is important that all these infants are screened for ROP.
Risk factors associated with umbilical vascular catheter‐associated thrombosis in newborn infants
Authors: Boo N‐Y , Wong N‐C , Zulkifli SZ SYED , Lye M‐S
Published: March 2003

Objective: To determine the risk factors associated with umbilical vascular catheter‐associated thrombosis.

Methods: All consecutive inborn infants with umbilical arterial (UAC) and/or umbilical venous catheters (UVC) inserted for more than 6 h duration were included in the study. Each infant was screened for thrombosis in the abdominal aorta and inferior vena cava by 2‐D abdominal ultrasonography within 48–72 h of insertion of umbilical vascular catheters. Subsequent serial scanning was performed at intervals of every 5–7 days, and within 48 h after removal of catheters.

Results: Upon removal of umbilical catheters, abdominal aortic thrombi were detected in 32/99 (32.3%) infants with UAC. Small thrombi were detected in the inferior vena cava of 2/49 (4.1%) infants with UVC (one of whom had both UAC and UVC). When compared with those who received only UVC (n = 18), infants who received either UAC alone (n = 68) or both UAC and UVC (n = 31) had significantly higher risk of developing thrombosis (odds ratio (OR): 7.6, 95% confidence interval (CI): 1.1, 325.5)). Logistic regression analysis of various potential risk factors showed that the only significant risk factor associated with the development of abdominal aortic thrombosis following insertion of UAC was longer duration of UAC in situ (for every additional day of UAC in situ, adjusted OR of developing thrombosis was: 1.2, 95% CI: 1.1, 1.3; P = 0.002).

Conclusion: Umbilical arterial catheter‐associated thrombosis was common. Umbilical arterial catheter should be removed as soon as possible when not needed. Upon removal of UAC, all infants should be screened for abdominal aortic thrombus by 2‐D ultrasonography.
Utilization of alternative therapies in attention‐deficit hyperactivity disorder
Authors: Stubberfield TG , Wray JA , Parry TS
Published: March 2003

Objective: To identify the prevalence of use, the referral patterns and the perceived benefit of alternative therapy in children with attention‐deficit hyperactivity disorder (ADHD).

Methodology: A mailed questionnaire survey was undertaken in June 1993, of the use of various therapies by families of 381 children with ADHD. The respondent rate was 76%.

Results: Of respondents, 69% were using stimulant medication and 64% had used or were using a non‐prescriptional therapy. Diet therapies were the most commonly used alternative therapy (60%). There was no statistical difference in the prevalence of use of other therapies between the medicated and non‐medicated groups. The non‐medicated group reported more benefit from some alternative therapies. Physicians were commonly involved in the suggestion to try a modified diet. School teachers, family and friends were the main source of suggestion of alternative therapies.

Conclusions: Clinicians should be aware of the range of alternative therapies and of their frequent use by families of children with attentional problems.
Limitations of percutaneous endoscopic gastrostomy in facilitating enteral nutrition in children: Review of the shortcomings of a new technique
Authors: Kimber CP , Beasley SW
Published: March 2003

Abstract: Percutaneous endoscopic gastrostomy (PEG) insertion became the preferred technique for facilitating enteral nutrition in children unable to take adequate caloric intake orally once its advantages over the standard Stamm gastrostomy became apparent. It has taken longer for some of its limitations and shortcomings to be recognized. Problems encountered during PEG insertion include: inability to enter the stomach with the trocar, oesophageal laceration, colonic perforation, gastro‐colo‐cutaneous fistula, peritonitis, subcutaneous emphysema, external migration of inner flange, wound infection, peristomal excoriation, symptomatic gastro‐oesophageal reflux requiring later fundoplication, intestinal obstruction and haemorrhage. Many of these complications can be avoided by attention to technique.
Infantile botulism: Clinical and laboratory observations of a rare neuroparalytic disease
Authors: Urdaneta‐Carruyo E , Suranyi A , Milano M
Published: March 2003

Abstract: A 3‐month‐old male infant was admitted to the University Hospital of Los Andes with a history of constipation, weak crying, poor feeding, flaccidity and later bilateral ptosis and hyporeflexia. The admission diagnosis was septicaemia until an electrophysiological study reported postetanic facilitation with 50 Hz/seg stimulations four days later. The Clostridium botulinum toxin type B was isolated from the infant’s stool samples and the organism grew in anaerobic cultures. The patient recovered completely and was discharged 2 months later. Although infant botulism is an uncommon disease in our environment, this diagnosis must be suspected in all afebrile infants with constipation, affected cranial nerves and generalized hypotonia. The principal differential diagnoses are Landry‐Guillain–Barré syndrome, poliomyelitis, myasthenia gravis and infant muscular atrophy.
Neonatal hypoglycaemia in infants of diabetic mothers
Authors: Agrawal Rk , Lui K , Gupta Jm
Published: March 2003

Objective: To determine whether umbilical cord blood glucose correlates with subsequent hypoglycaemia after birth in infants of well‐controlled diabetic mothers.

Methodology: Thirty‐eight term infants of well‐controlled diabetic mothers were enrolled. Five mothers had pre‐existing diabetes. Of the 33 gestational diabetic mothers, 16 were managed on insulin and 17 on diet. Maternal blood glucose was maintained between 4 and 8 mmol/L during labour and delivery. Infants’ plasma glucose levels were measured from venous cord blood and serially, at less than 30 min, 1 h and 2 h of life by glucose hexokinase method. Blood glucose levels were further monitored by bedside Dextrostix for 24 h.

Results: Eighteen (47%) infants developed hypoglycaemia (blood glucose level less than 2 mmol/L) during the first 2 h of life. There was no difference in the cord blood glucose levels between infants with or without hypoglycaemia (3.7 ± 1.1 vs 4.5 ± 1.1 mmol/L, respectively). Infants of mothers with diabetes diagnosed prior to 28 weeks gestation were at a higher risk of developing hypoglycaemia (8 of 10 vs 10 of 28, OR 7.2, 95%CI 1.3–40.7). Hypoglycaemic infants were of significantly higher birthweight, and were more likely to be born to Caucasian mothers and by Caesarean section. Raised maternal fructosamine blood level, the need for insulin treatment or the infant’s haematocrit were not different between infants with or without hypoglycaemia.

Conclusions: In well‐controlled diabetic mothers, the incidence of early hypoglycaemia in infants is still high, particularly in those mothers who had a longer duration of diabetes. Cord blood glucose level did not identify the infants with hypoglycaemia.
A case of vaccine‐associated paralytic poliomyelitis
Authors: Edwards Ea , Grant Cc , Huang Qs , Powell Kfh , Croxson Mc
Published: March 2003

Abstract: Vaccine‐associated paralytic poliomyelitis (VAPP) is a very rare complication of oral polio vaccine (OPV), seen predominantly with first exposure to OPV. Reversion of vaccine strain poliovirus to a more neurovirulent strain of the virus is thought to be necessary for paralytic disease to occur. Vaccine‐associated poliomyelitis can occur in either recipients of the vaccine or in susceptible contacts. We describe an episode of VAPP in an infant in whom paralysis became evident at age 124 days, 14 days after administration of the second dose of OPV vaccine. The second dose of diphtheria–tetanus–pertussis– Haemophilus (DTPH) type‐b vaccine had been given at the time of OPV administration, and the hepatitis B vaccine had been administered in the opposite leg. Paralysis was localized to the limb in which the DTPH had been injected.
Infantile‐onset megalencephalic leucoencephalopathy in two siblings
Authors: Soylu H , Yüksel A , Kutlu N O , AydI.nlI. M , Seven M , Mocan H
Published: March 2003

Abstract: Infantile‐onset megalencephalic leucoencephalopathy (IML) is a recently recognized autosomal recessive white matter disorder. Unlike other megalencephalic leucoencephalopathies, in patients with IML a mild clinical course, a slowly progressive delay in motor development and mild mental deterioration are typical. We report on two affected siblings who have typical clinical and radiological findings of IML. Cranial magnetic resonance imaging showed involvement of the capsula externa, extrema and interna, nucleus dentatus, crus cerebri, periventricular and subcortical white matter. In addition, bilateral cystic changes were determined predominantly in the temporal lobes. There were no clear biochemical or metabolic disturbances. In the present paper, we discuss the clinical and neuroimaging findings of IML.
Epstein–Barr virus associated with immune thrombocytopenic purpura in childhood: A retrospective study
Authors: Hsiao C‐C
Published: March 2003

Objective: Although Epstein–Barr virus (EBV) is known to cause immune thrombocytopenic purpura (ITP), the epidemiology of this pathogen in children with ITP is not known. In the present study, the clinicoepidemiology and laboratory characteristics of EBV‐associated ITP in childhood were analysed retrospectively.

Methods: The study cohort consisted of 108 children in whom ITP was diagnosed between 1990 and 1998. Patients were divided into EBV or non‐EBV groups according to their serological status at diagnosis.

Results: Thirty‐five (32.4%) of 108 children had ITP associated with acute EBV infection. The clinical manifestations and laboratory data were similar in children with and without acute EBV. Responses to various modalities of therapy were analysed. The average time to achieve complete remission (platelet count ≥ 150 × 109/L) in EBV and non‐EBV groups was 26 and 16 days, respectively.

Conclusions: The incidence of childhood ITP associated with acute EBV infection is relatively high in Taiwan. Patients with EBV‐associated ITP tended to resolve more slowly than those without EBV infection.
Pancreatitis associated with Henoch–Schonlein purpura
Authors: Cheung KM , Mok F , Lam P , Chan KH
Published: March 2003

Abstract: A 7‐year‐old Chinese boy presented with acute pancreatitis. The characteristic rash of Henoch–Schonlein purpura (HSP) did not develop until nine days later, together with painful scalp swelling and calf pain. Acute pancreatitis has only rarely been reported in association with HSP and never before as the sole presenting feature.
De novo mutation in the mitochondrial tRNALeu(UUR) gene (A3243G) with rapid segregation resulting in MELAS in the offspring
Authors: Ko CH , Lam CW , Tse PWT , Kong CK , Chan AKH , Wong LJC
Published: March 2003

Abstract: A 14‐year‐old Chinese boy with a normal perinatal and early developmental history presented at 5 years of age with migraine, intractable epilepsy, ataxia, supraventricular tachycardia, paralytic ileus and progressive mental deterioration. Computerized tomography revealed multiple cerebral infarcts in the parieto‐occipital region without basal ganglial calcification. Magnetic resonance imaging showed increased signal intensity in T2 weighted images in the same regions. A cerebral digital subtraction angiogram was normal. Venous lactate, pyruvate, lactate to pyruvate ratio and cerebrospinal fluid lactate were elevated. Muscle biopsy did not reveal any ragged red fibres; dinucleotide–tetrazolium reductase activity was normal. Mitochondrial DNA analysis detected an adenine to guanine mutation at nucleotide position 3243 of tRNALeu(UUR). All four tissues analysed demonstrated heteroplasmy: leucocyte 56%, hair follicle 70%; buccal cell 64%; muscle 54%. The mother and brother of the proband, both asymptomatic, were also found to have a heteroplasmic A3243G mutation in the leucocytes, hair follicle and buccal cells. Other members of the maternal lineage, including the maternal grandmother, did not have the mutation. This report describes a patient with mitochondrial encephalopathy, lactic acidosis, stroke‐like episodes, who presented with multisystem involvement. The absence of ragged red fibres in muscle biopsy did not preclude the diagnosis. Mutational analysis of mitochodrial DNA conveniently confirmed the diagnosis of the disorder. A de novo mutaton is demonstrated in this family.
Hepatitis B vaccine: Risks and benefits of universal neonatal vaccination
Authors: Macintyre CR
Published: March 2003

Abstract: Global eradication of hepatitis B, which has infected over 2000 million people worldwide, is an achievable goal. Hepatitis B vaccine is effective and safe, and is recommended in Australia as a four‐dose childhood schedule commencing with a neonatal dose. A neonatal dose has a greater impact on carriage, the main reservoir of transmission, due to the inverse relationship of age and risk of chronic carriage. Universal vaccination is clearly cost‐effective in countries of high hepatitis B endemicity but less so in countries of low endemicity. Other factors affecting the perceived benefits of universal vaccination in low‐risk countries include the use of the preservative thiomersal in hepatitis B vaccines, and case reports of multiple sclerosis (MS) and unexplained fever in recipients. Careful epidemiological studies have failed to confirm any risk of MS or fever with the hepatitis B vaccine, which is now thiomersal‐free. Other arguments against universal vaccination include ‘unnecessary’ vaccination of low‐risk neonates. However, selective vaccination programmes targeting at‐risk neonates are often poorly implemented and do not protect against horizontal transmission in early childhood. Universal vaccination, which is safe and effective, is the only practical means of achieving global eradication of hepatitis B.
Epidemiology of Munchausen syndrome by proxy in New Zealand
Authors: Denny SJ , Grant CC , Pinnock R
Published: March 2003

Objective: To determine the epidemiology of Munchausen syndrome by proxy (MSBP) in New Zealand and describe the effects of this condition on children and their paediatricians.

Methodology: A mail‐out survey was sent to all paediatricians in New Zealand in 1999. Paediatricians were asked to identify all cases of MSBP, non‐accidental poisoning or non‐accidental suffocation diagnosed or suspected in children less than 16 years of age that had been seen in the past 12 months. Those paediatricians who identified a case were then interviewed by telephone to ensure that identified cases were new cases and that they were unique.

Results: Responses were obtained from 148 (95%) of 156 practising paediatricians in New Zealand. Eighteen unique cases of MSBP were identified where the diagnosis had been made in the preceding 12 months. The incidence rate for MSBP in children aged less than 16 years was 2.0/100 000 children. Eleven (61%) of the 18 cases were referred to child protection agencies or the police. The mean time taken to diagnosis from initial presentation was 7 months in the cases referred to child protection agencies and 23 months in cases not referred. The median age at diagnosis was 2.7 years. The mother was the suspected perpetrator in all cases. Most children (72%) presented with multiple symptoms. Over half (55%) had an underlying chronic illness. The morbidity for the child in the majority of cases was not severe, and in nine (50%) cases it was noted that following diagnosis there was improvement or resolution of symptoms. Ten (56%) of the 18 paediatricians involved with cases reported experiencing considerable stress.

Conclusions: The annual incidence in New Zealand of MSBP in children under 16 years is higher than that reported from other countries. Chronic illness is often associated with this condition. The morbidity for the majority of children was not severe and often improved with diagnosis. Paediatricians reported stress and difficulty in association with caring for children with this syndrome of child abuse.
Maternal awareness of sudden infant death syndrome in North Queensland, Australia: An analysis of infant care practices
Authors: Douglas TA , Buettner PG , Whitehall J
Published: March 2003

Objectives: To assess awareness of sudden infant death syndrome (SIDS) and risk reducing recommendations in a sample of mothers in North Queensland, Australia, and to examine their infant care practices.

Method: Interviews conducted with 195 women using a standardized questionnaire between October 1997 and January 1998.

Results: 191 questionnaires analyzed; 134 (70.2%) Caucasian and 57 (29.8%) indigenous women. Four women with previous SIDS experience were excluded from the analysis. Eight (4.2%) had never heard of SIDS. Twenty‐nine (15.2%) had heard of SIDS and 154 (80.6%) had heard of SIDS and could list risk recommendations to reduce its incidence. Multivariate analysis identified ethnicity as the only significant predictor of maternal knowledge. Indigenous mothers knew less about SIDS: adjusted odds ratio (OR) = 5.4; 95% confidence interval (CI) = [2.1–14.0]. Avoidance of prone sleeping was the most frequently identified recommendation (n = 132), with no smoking in pregnancy (n = 48) and breastfeeding (n = 40) identified least frequently. There were 80.2% of mothers who put their infant in non‐prone positions to sleep. Only 48 (25%) women identified smoking in pregnancy, and 93 (48.6%) smoking in the infant’s environment as risk factors. Indigenous women were more likely to smoke in their pregnancy (P = 0.004), bed share with their infant (P = 0.0001), and have smokers in the home.

Conclusion: There is a high level of awareness of SIDS and the main associated risk factor of infant prone sleeping, but the link between SIDS and smoking requires further emphasis. Future campaigns should ensure the SIDS message is delivered more effectively to the indigenous communities.
The effect of breastfeeding on child development at 5 years: A cohort study
Authors: Quinn PJ , O'Callaghan M , Williams GM , Najman JM , Andersen MJ , Bor W
Published: March 2003

Objective: It is uncertain to what degree the relationship between breastfeeding and later cognitive development is a true biological effect, or is confounded by psychosocial factors. The study aim was to further investigate this relationship and the effect of duration of breast feeding on cognitive development.

Methods: A total of 3880 children were followed from birth. Breastfeeding duration was measured by questionaire at 6 months of age and a Peabody Picture Vocabulary Test Revised (PPVT‐R) was administered at 5 years. PPVT‐R scores were adjusted for the effects of a large array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVT‐R scores were examined using analysis of variance and multiple linear regression.

Results: A strong positive relationship was demonstrated between breastfeeding and the PPVT‐R scores with increasing scores with increased duration of breastfeeding. After adjusting for a wide range of biological and social factors, the adjusted mean for those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when compared to those never breastfed.

Conclusion: These findings suggest a significant benefit to child development is conferred by breastfeeding and is related independently to longer periods of breastfeeding.
Is bag urine culture useful in monitoring urinary tract infection in infants?
Authors: Li PS , Ma LC , Wong SN
Published: March 2003

Objectives:  We studied the false‐positive rate of bag urine cultures in diagnosing bacteriuria in infants and examined the factors responsible for contamination.

Methods:  One hundred asymptomatic patients with previous urinary tract infections (UTI; age range 5−23 months; sex ratio M : F 73:27) were screened by bag urine cultures and confirmed by suprapubic aspiration or catheterization. Those producing contaminated and clean samples were interviewed with a standard questionnaire.

Results:  Sixty patients had insignificant growth and 40 had doubtful or mixed growth. After further interview and instructions, the latter group produced a second bag urine sample with negative results in 23 and positive results in 17. Among the latter, UTI was confirmed in five and excluded in 12 cases. The false‐positive rate of first urine collection was 36.8%. Comparing patients with contaminated urine to those with negative urine samples, we found the former were associated with waiting for more than one void to complete urine collection, and with uncircumcised boys. Other factors did not reach statistical significance. Proper counselling and repeating a second culture reduced the overall false‐positive rate to 12.6%.

Conclusion:  In our population, the contamination rate of one bag urine culture was 36.8%, which is unacceptable and alternative methods need to be sought. Contamination was associated with improper collection procedures and with uncircumcised boys. Proper instructions and doing a second urine culture reduced the overall rate to 12.6%, but at the expense of delaying diagnosis and treatment.
Ivermectin is better than benzyl benzoate for childhood scabies in developing countries
Authors: Brooks PA , Grace RF
Published: March 2003

Objective:  To compare single dose oral ivermectin with topical benzyl benzoate for the treatment of paediatric scabies.

Methods:  An observer‐blinded randomized controlled trial was undertaken at Vila Central Hospital, Vanuatu. One hundred and ten children aged from 6 months to 14 years were randomized to receive either ivermectin 200 µg/kg orally or 10% benzyl benzoate topically. Follow up was at 3 weeks post‐treatment. Primary outcome measures were the number of scabies lesions, the itch visual analogue score and nocturnal itch. Secondary outcome measures were the skin's reaction to treatment, the passage of worms in stool and other side effects.

Results:  Eighty patients completed the study protocol. There was no significant difference between the two treatments; both produced a significant decrease in the number of scabies lesions seen at follow up. Ivermectin cured 24 out of 43 patients (56%), and benzyl benzoate 19 out of 37 patients (51%) at 3 weeks post‐treatment. No serious side effects were noted with either treatment, but benzyl benzoate was more likely to produce local skin reactions (P = 0.004, OR 6.4, 95% CI 1.6−25.0)

Conclusions:  Ivermectin is cheap and effective in the treatment of paediatric scabies. Ivermectin has minimal observed toxicity and has the additional beneficial effects of antiparasitic action in onchocerciasis, filariasis and strongyloidiasis. Ivermectin is better than benzyl benzoate for the treatment of paediatric scabies in developing countries.
Choledocholithiasis in an infant of extremely low birthweight
Authors: Maruyama K , Koizumi T
Published: March 2003

Abstract: A five‐month‐old infant of extremely low birthweight with choledocholithiasis is reported. A baby girl was delivered at 26 weeks gestation as a second twin, weighing 834 g. At 30 days of age, gallbladder stones were found by routine ultrasonography. She had vomiting at 157 days of age. Ultrasonography revealed calculi in the gallbladder and a dilated common bile duct. She was conservatively treated with scopolamine, antibiotics and dehydrocholic and ursodeoxycholic acids, and the calculi had disappeared by 189 days of age. Although conservative treatment succeeded in this patient, further cases should be analysed to establish how to manage choledocholithiasis in such small infants.
Parvovirus B19 in the acute arthropathies and juvenile rheumatoid arthritis
Authors: Oğuz F , Akdeniz C , Ünüvar E , Küçükbasmaci Ö , Sidal M
Published: March 2003

Objective: To evaluate the prevalence of recent parvovirus B19 infection in a cohort of children presenting with acute arthropathy and to determine the prevalence of a subsequent diagnosis of juvenile rheumatoid arthritis in this cohort.

Method: In this prospective study, parvovirus B19 IgM antibody was investigated in 75 patients who were referred to our clinic with acute joint complaints and also in 75 healthy controls. One patient in each group was excluded due to neuroblastoma and acute lymphoblastic leukaemia. The characteristics of parvovirus B19 IgM positive patients who were accepted as parvovirus B19 arthropathy were further evaluated. All the patients were followed up for at least 6 weeks and the patients with chronic progression of joint complaints were followed for at least 6 months to determine their progress. The cases of juvenile rheumatoid arthritis in this chronic group were identified.

Results: Parvovirus B19 IgM was detected in 16 of 74 patients (21.6%) with acute arthropathy compared with 3 of 74 (4.1%) in the healthy control group (χ2 = 8.67; P = 0.003). The parvovirus B19 positive patients with arthropathy were more likely to become chronic (P = 3.7 × 10−7) and to be diagnosed as juvenile rheumatoid arthritis (P = 0.03) than the parvovirus B19 IgM negative group with arthropathy. Additional joint destruction developed in one case who was parvovirus B19 IgM positive in whom juvenile rheumatoid arthritis was diagnosed during follow up.

Conclusion: These data support the hypothesis that parvovirus B19 infection may be associated with the onset of juvenile rheumatoid arthritis in a proportion of patients.
Dosage regimens for inhaled therapy in children should be reconsidered
Authors: Wildhaber JH , Mönkhoff M , Sennhauser FH
Published: March 2003

Abstract: In current asthma guidelines, dosage regimens for inhalation therapy in children are based on adult doses and are generally titrated per kilogram of bodyweight or per square metre of body surface area. However, these recommendations do not correspond well with current knowledge of aerosol therapy in childhood. Lung deposition of the aerosolised drug is the key determinant for clinical efficacy and for systemic side effects of inhalation therapy. Lung deposition increases with age, whereas lung deposition expressed as a percentage per kilogram bodyweight is age‐independent. This finding is explained by the self‐regulating effect of age‐dependent airway anatomy on lung deposition. Therefore, it is more likely that adult doses translate into paediatric doses only by virtue of the differences in self‐limiting pulmonary deposition when using the same absolute nominal doses of the medication. Adapting the adult dose to a paediatric dose calculated on body size might be unnecessary and could lead to insufficient pulmonary deposition of medication. These findings suggest that dosage regimens for inhalation therapy for children may have to be reconsidered, and should be determined from dose‐ranging studies rather than calculated from adult doses based on body size.
Towards safer drug use in general practice
Authors: Steven ID , Malpass A , Moller J , Runciman WB , Helps SC
Published: March 2003

Abstract A voluntary, anonymous incident‐monitoring study was set up to identify and characterize events or circumstances which could have or did harm a patient in general practice. The study included 673 practitioners who made 2582 reports, of which half (n = 1294) involved medication problems. Amongst these reports, 1556 adverse drug events (ADE) were identified. More common in general practice than in hospitals were problems with therapeutic use (26% vs. 8%), and prescribing of contraindicated medications (15% vs. 5%). In the latter group, 64 reports (4%) involved the prescription of a medication to which the patient was known to be allergic, 66 (4%) involved medication for which there was a recognized potential for a drug interaction, and 68 (4%) involved contraindicated medications due to pathophysiological factors. It was estimated that computer‐based prescribing with decision support could eliminate at least a third of these problems in general practice. Further studies are needed to develop this and other preventive strategies.