bluuebunny/crossref_metadata_2025 huggingface dataset:
Self‐care practices and the need for influenza vaccination in healthy individuals
Authors: Bodkin Candice , Klopper Hester C
Published: October 2003

The purpose of this research was to determine whether self‐care practices in healthy individuals reduce the need for trivalent influenza vaccination and whether naturopathic influenza prevention reduces rate, duration and severity of influenza, absenteeism from work due to influenza and side‐effects, as compared to trivalent influenza vaccination. A survey design was followed using exploratory, descriptive and comparative methods. The method of study was an open‐label, two‐group, parallel study. The data collection tool was a self‐administered questionnaire. A two‐group sample was obtained through non‐probability, purposeful sampling. Data was analysed by means of descriptive and inferential statistics at the 0.05 level of significance. Results indicated that there was no significant difference between the rates of influenza infection of the naturopathic group as compared with the trivalent vaccination group but there was a marginal reduction in the duration of febrile illness in the former group. The naturopathic group were less likely to visit a medical practitioner in order to resolve the influenza, however, they were as likely as the trivalent vaccinated group to commence a new treatment plan. Neither method of influenza prevention resulted in a significant reduction in absenteeism from work. The trivalent vaccinated group had significantly more side‐effects than the naturopathic group.
Mother–infant interaction in premature infants at three months after nursery discharge
Authors: Davis Leigh , Edwards Helen , Mohay Heather
Published: October 2003

Both the immature and disorganized behaviour of the premature infant and the psychosocial or socioeconomic factors which adversely affect a mother's responsiveness to her premature infant can jeopardize the mother‐infant relationship. At three months after infant hospital discharge, the interactions of 50 premature infants (≤ 32 weeks) and their mothers were videotaped and coded using the Nursing Child Assessment Feeding Scale. The relationship between data derived from the feeding interaction and maternal psychosocial and infant perinatal variables collected at one month after birth and at three months after discharge from hospital were examined. Results showed that the mothers’ use of coping strategies both in hospital and at home were important factors in explaining mother–infant interaction.
Principles of recruitment and retention in clinical trials
Authors: Aitken Leanne , Gallagher Robyn , Madronio Christine
Published: October 2003

Efficient and effective recruitment and retention of participants is the largest single component of the study workload and forms an essential component in the conduct of clinical trials. In this paper, we present five principles to guide the processes of both recruitment and retention. These principles include the selection of an appropriate population to adequately answer the research question, followed by the establishment of a sampling process that accurately represents that population. Creation of systematic and effective recruitment mechanisms should be supported by implementation of follow‐up mechanisms that promote participant retention. Finally, all activities related to recruitment and retention must be conducted within the framework of ethics and privacy regulations. Adherence to these principles will assist the researcher in achieving the goals of the study within the available resources.
Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children
Authors: Polat Tugçin Bora , Uysalol Metin , Çetinkaya Feyzullah
Published: October 2003

Background
: Intervention trials have shown that zinc may be efficacious in treating acute diarrhea in children of developing countries. A double‐blind placebo‐controlled study was designed to evaluate the effects of zinc supplementation on the clinical course and duration of diarrhea in malnourished Turkish children.

Methods
: The study group comprised 40 subjects with low zinc levels (Group 1a) and 52 subjects with normal zinc levels (Group 1b). The control group was also comprised of two subgroups: 36 subjects with low zinc levels (Group 2a) and 54 subject with normal zinc levels (Group 2b). Forty‐three percent of children in the study group and 40% of controls had low serum zinc levels (<14 µmol/L), and 43% of subjects in both groups had very low serum zinc concentrations (<10 µmol/L). The study group were given 20 mg zinc per day for 10 days and the control group were given 750 mg glucose per day as a placebo for 10 days.

Results
: The mean duration of diarrhea was shorter and the percentage of children with consistent diarrhea for more than 3−7 days was lower in the study subgroups than in the control subgroups. Prolonged diarrhea was present in 12% of children in the study group, and in 44% and 37% of children in the hypozincemic and normozincemic control subgroups, respectively. The was no significant difference among the four subgroups of children in the number of cases with post‐enrollment diarrhea of a duration of>14 days. Stool frequency over the first 4 days after enrollment was lower in children in the study group.

Conclusion
: It was concluded that zinc supplementation in malnourished children with acute diarrhea may reduce the severity and duration of diarrhea, especially in children with low zinc levels.
Determinants of prognosis of acute transverse myelitis in children
Authors: Miyazawa Reiko , Ikeuchi Yuka , Tomomasa Takeshi , Ushiku Hideo , Ogawa Tetsushi , Morikawa Akihiro
Published: October 2003

Background
: Acute transverse myelitis (ATM) is a severe disorder; recovery requires several months and often leaves neurologic residua. To determine what features of patients with acute transverse myelitis significantly influence prognosis, the authors reviewed reports of ATM in Japanese children published in the last 15 years (from 1987 to 2001).

Methods
: The authors studied reports of 50 Japanese patients (17 boys, 26 girls, 7 children of unspecified sex; mean age ± SD, 8.0 ± 3.8 years). Acute‐phase and demographic features including age, increased deep tendon reflexes, Babinski reflex, sex, preceding infection, decreased deep tendon reflexes, time course of peak neurologic impairment, treatment with prednisolone and/or high‐dose methylprednisolone, and the day of illness when treatment was started were used as independent variables in a regression analysis. The dependent variable was long‐term persistence of neurologic deficits.

Results
: Younger patients and those without increased deep tendon reflexes or a Babinski reflex were more likely to have residual neurologic deficits such as paraplegia or tetraplegia, sensory loss and sphincter disturbance. No relationship was seen between prognosis and sex, preceding infections, decreased deep tendon reflexes, time course of peak neurologic impairment, treatment with prednisolone or high‐dose methylprednisolone, or timing of treatment initiation.

Conclusions
: Age at onset and neurologic features were important for outcome prediction in ATM. Steroid therapy did not associate with better outcome.
Somatostatin infusion withdrawal in the diagnosis of childhood growth hormone deficiency
Authors: Bosnak Mehmet , Dikici Bunyamin , Haspolat Kenan , Dogru Omer , Ozkan Ilker , Ece Aydin
Published: October 2003

Objective
: An evaluation of growth hormone (GH) testing for GH deficiency (GHD) in childhood is confounded by the lack of a world‐wide consensus on the definition of GHD. Although a single GH test remains the most powerful biochemical tool in the evaluation of a child with growth failure, the test remains far from ideal. Withdrawal of somatostatin (SS) infusion is followed by a rebound rise of GH thought to be mediated by endogenous GH‐releasing hormone (GHRH) function. This study was designed to compare the GH response to 90 min SS infusion in children with normal GH secretion versus children with GH deficiency.

Methods
: Ten children with GHD and 10 healthy controls (NC) have been evaluated for GH response to somatostatin infusion withdrawal (SSIW) and compared with response of two provocative tests, glucagon plus propranolol test and L‐Dopa test. All children received constant infusion of somatostatin for 90 min (3 µg/kg per h, Stilamin, Serono, Aubonne, Switzerland). In order to determine GH, blood samples were obtained 90 min before the SS infusion and 0, 15, 30, 45, 60, 75, and 90 min after the cessation of infusion.

Results
: Growth hormone peak levels with SSIW were significantly lower in GH deficient children than in healthy children (2.5 ± 1.2 ng/dL, vs 21.9 ± 5.3 ng/dL, respectively, P < 0.01). No adverse effects were observed during or after somatostatin infusion.

Conclusion
: In the present study, SSIW elicited a significant GH rise in healthy children but not in children with GH deficiency. Although further controlled studies using more data are necessary to expand these findings, the results suggested that children with GH deficiency can be reliably discriminated from healthy children by SSIW.
Serum KL‐6 level in newborns with meconium aspiration syndrome
Authors: Kurotobi Shunji , Maekawa Shu , Hara Tatsuyuki , Hamana Keiko , Inada Nahoko , Kawakami Nobuhiro , Honda Atsuko , Matsuoka Taro , Fujita Hiroshi , Nagai Toshisaburo
Published: October 2003

Background
: It has been reported that serum KL‐6 increases in babies with progressing chronic lung disease (CLD). However, there have been few reports assessing KL‐6 in meconium aspiration syndrome (MAS). KL‐6 was measured in neonates with respiratory diseases including MAS.

Methods
: Thirty‐eight neonates with respiratory disease were enrolled in the study. These patients were classified into three groups, 14 patients with respiratory distress syndrome (RDS), 14 with MAS, and 10 with transient tachypnea of the newborn (TTN). The control group consisted of 12 healthy neonates. KL‐6 levels were measured 1 day (median) after the birth. In the RDS group, measurement was repeated just prior to 36 weeks’ postmenstrual age.

Results
: The levels of KL‐6 were 116 ± 40 U/mL in the RDS, 281 ± 138 U/mL in the MAS, and 106 ± 41 U/mL in the TTN groups. KL‐6 levels were significantly higher in the MAS group than in the control group (134 ± 71 U/mL; P < 0.01). In addition, the levels were significantly higher in those with severe MAS than those with mild MAS (P < 0.05). In patients with RDS, KL‐6 increased in patients who developed CLD (P < 0.05), while KL‐6 levels did not change in those who did not develop CLD.

Conclusion
: These data confirm the high level of KL‐6 in CLD, and suggest that KL‐6 is increased in MAS.
Ontogeny of congenital anomalies of the kidney and urinary tract, CAKUT
Authors: Miyazaki Yoichi , Ichikawa Iekuni
Published: October 2003

Ectopic budding of the initial ureter from the Wolffian duct is the first ontogenic misstep that leads to many congenital anomalies of the kidney and urinary tract (CAKUT). The ectopia results in hypoplastic kidney, ectopia of ureterovesical orifice, urinary outflow obstruction and/or reflux. Recent studies on several mutant mouse models verified that ectopic ureteric budding indeed occurs prior to the formation of CAKUT. Often, the genes involved in navigating the site of ureteric budding also regulate later ontogenic processes of the kidney and other urinary tract systems. These additional functions of the genes underlie the wide spectrum of CAKUT, for example multicystic dysplastic kidney, megaureter and atretic ureter, because the genes regulate the morphogenesis of the many portions of the excretory system through their distinctive cellular functions.
Pathogenesis of human renal dysplasia: An alternative scenario to the major theories
Authors: Shibata Sawako , Nagata Michio
Published: October 2003

Among the various congenital anomalies of the kidney and urinary tract (CAKUT), renal dysplasia may deserve the closest attention due to its frequency and clinical severity. However, the pathogenesis of this disease is still not well known. It is believed that renal dysplasia is caused by a nephron induction deficit due to ampullary inactivity, or an abnormal budding of the ureteric bud from the mesonephric duct. Renal dysplasia is frequently associated with urinary tract obstruction, suggesting an alternative mechanism whereby urinary retention causes abnormal kidney development. Multicystic dysplastic kidney (MCDK) and obstructive renal dysplasia (ORD) are two different phenotypes of dysplasia associated with urinary tract obstruction. From detailed morphological studies using fetal dysplastic kidneys, nephron induction with filtrating function occurs before cysts are formed. Moreover, three‐dimensional reconstruction of dysplastic nephrons showed that cysts developed in the once‐induced nephrons as the result of fluid retention in both MCDK and ORD. In utero urinary tract obstruction may cause urine retention in functioning nephrons and lead to multiple cyst formation in the nephrogenic zone. These findings are common to MCDK and ORD, although there may be a difference in the obstruction site. Expansion of cysts with tubular dilatation (cysts) disturbs the subsequent nephrogenesis by the deregulated expression of growth and transcription factors, and may contribute to the misdevelopment of fetal kidneys.
Genetic disorders of human congenital anomalies of the kidney and urinary tract (CAKUT)
Authors: Nakanishi Koichi , Yoshikawa Norishige
Published: October 2003

Congenital abnormalities of the kidney and urinary tract, CAKUT are common in humans, occurring at a frequency of approximately 1 in 500 fetal ultrasound examinations. CAKUT are major causes of chronic renal failure in infants and young children, but little is known about the molecular pathogenesis of these disorders. To date, several gene mutations have been identified as a cause of human CAKUT: these include PAX2, KAL, EYA1, AGTR2 and HNF‐1β. At present, there is only limited information regarding how mutations alter gene expression during development to cause some CAKUT. The most convincing information comes from the multiorgan malformation syndromes with specific gene mutations. However, these syndromes are relatively rare, and most CAKUT appear to occur in isolation. The goal of this review is to provide an overview of these genetic disorders for CAKUT. An understanding of the genetic aspects of human CAKUT will help to unravel the pathogenesis of these disorders and may facilitate the design of genetic screening tests for early diagnosis and appropriate genetic counseling. Moreover, a deeper insight into the relationship between abnormal genes and the pathogenesis of abnormalities of CAKUT will provide an etiological classification of CAKUT. In addition, the importance of developing a registry of patients with various forms of CAKUT is discussed. This information will allow us to combine molecular biology and classical epidemiologic methods, and to continue expanding our knowledge regarding CAKUT.
Ultrasound screening for renal and urinary tract anomalies in healthy infants
Authors: Tsuchiya Masami , Hayashida Mari , Yanagihara Takeshi , Yoshida Junko , Takeda Sachiyo , Tatsuma Noriko , Tsugu Hitoshi , Hino Yoshiaki , Munakata Emiko , Murakami Mutsumi
Published: October 2003

Background
: Nearly 30% of childhood cases of chronic renal failure in Japan are attributed to congenital anomalies of the kidney and urinary tract (CAKUT), and the number is increasing. Urine screening at school facilitates early diagnosis and treatment of glomerulonephritis, but early screening for anomalies is currently not in practice. The authors evaluated the value of early abdominal ultrasonography screening in 1‐month‐old infants.

Methods
: The following characteristics of kidneys were assessed: presence versus absence, size, symmetry of size, position, separation of the central echo complex (CEC), abnormal echogenicity, and other abnormal findings. The bladder and ureter were checked for abnormalities in bladder shape and wall, as well as retrovesical ureteral dilation. Criteria for abnormalities included kidney length of ≤35 mm, or ≥60 mm; a difference in length of left and right kidneys of 10 mm or more; and CEC separation of Society for Fetal Urology (SFU) grade 2 or higher.

Results
: Beginning in April 1994 and continuing until September 2001, screening of 5700 1‐month‐old infants yielded 198 positive cases (3.5%) of CAKUT. Most frequent was abnormal CEC separation (approximately 60% of all abnormalities), followed by abnormal renal size or size asymmetry (30%). Further investigation yielded a specific diagnosis in 32 cases (0.6%) of all subjects. Most prevalent was obstructive uropathy (15 cases); 8 children underwent surgery. Small kidneys and vesicoureteral reflux were next in frequency.

Conclusions
: Ultrasonograpy was effective for early detection of renal and urinary tract anomalies. Ultrasound screening in early infancy may permit early treatment, that can prevent renal dysfunction.
Changing concepts in urological management of the congenital anomalies of kidney and urinary tract, CAKUT
Authors: Nakai Hideo , Asanuma Hiroshi , Shishido Seiichiro , Kitahara Satoshi , Yasuda Kosaku
Published: October 2003

Recent advancement in ultrasonographic evaluation has prompted early detection and diagnosis of congenital anomalies in the kidney and urinary tract (CAKUT) in the asymptomatic phase. Consequently, early surgical intervention has become possible in the asymptomatic phase for the purpose of controlling manifestations early, thereby avoiding renal functional deterioration. However, some lesions detected by ultrasonography have been shown to often resolve or disappear without intervention. Thus, it has become more important to identify and understand the natural history of CAKUT.

For the precise evaluation of the results of surgical intervention, one must understand the maturational process of renal function during infancy. Without considering this process, we cannot differentiate the renal significance of the surgical management from the natural course of CAKUT. Recent advancement in the field of radioisotopic studies has also made a major contribution to the more precise assessment of renal function.

Recent progress in the understanding of the pathophysiology and the natural history of CAKUT has helped rationalize its treatment and management. Improvement in the surgical techniques and tools, together with improvements in pediatric anesthesiology, have made an appreciably positive impact on the outcome.

Herein, we present the emerging concepts in the urological management of CAKUT, specifically, multicystic dysplastic kidney, vesicoureteral reflux, congenital hydronephrosis, ectopic ureters and ureteroceles.
Early head cooling in newborn piglets is neuroprotective even in the absence of profound systemic hypothermia
Authors: Iwata Osuke , Iwata Sachiko , Tamura Masanori , Nakamura Tomohiko , Sugiura Masatoshi , Ogiso Yoshifumi , Takashima Sachio
Published: October 2003

Background
: Selective head cooling in the newborn infant has been proposed as a neuroprotective treatment with a lower level of systemic adverse effect than that of systemic hypothermia. However, the efficacy is not confirmed as well as that of systemic hypothermia. In order to analyze the safety and efficacy of selective head cooling, 25 newborn piglets were randomly selected for either normothermic or hypothermic treatment.

Methods
: Global hypoxic insult was induced by lowering the oxygen concentration to the maximal level to maintain the background electroencephalogram (EEG) voltage under 7 µV for 45 min. The core temperature of normothermic piglets was maintained between 38.5°C and 39°C, while prophylactic cooling was applied to the hypothermic piglets at the same time of the insult. Very mild systemic hypothermia by 1°C was induced in addition to selective head cooling with 10°C coolant temperature. Animals were killed for histopathological examination seven hours after the end of the insult.

Results
: Two normothermic piglets died while all hypothermic piglets survived. Neuropathological findings were significantly severer in the normothermic group than in the hypothermic group. Intracranial pressure was significantly lower, and EEG recovery was significantly better in the hypothermic piglets. There was no significant difference in the lowest oxygen concentration, degrees of acidosis, blood lactate, and blood pressure between the groups, although heart rate was significantly lower in the hypothermic group.

Conclusions
: We have demonstrated that early head cooling was effective in preventing some of the earliest brain damage due to hypoxic insult even in the absence of profound systemic hypothermia.
Flexible endoscopy of aerodigestive tract in small infants
Authors: Lee Yu‐Sheng , Soong Wen‐Jue , Jeng Mei‐Jy , Cheng Chin‐Yuan , Shen Chung‐Min , Sun John , Chen Chiung‐Fang , Hwang Betau
Published: October 2003

Background
: Flexible endoscopy (FE) is a useful method for diagnosing airway problems. Congenital or acquired airway lesions in infants may lead to respiratory distress that requires comprehensive investigation and management. This study was designed to evaluate the use of FE in small infants.

Methods
: Infants who had symptoms of respiratory distress and received FE when they were less than 1‐year‐old were studied and their medical history, diagnoses, interventions, and complications from FE were investigated.

Results
: The study population consisted of 568 small infants (334 boys and 234 girls) who weighed 5.1 ± 2.4 kg, and received FE when they were 4.5 ± 3.6 months of age. Most patients (91.2%) received diagnostic FE and the remainder (8.8%) received therapeutic procedures. Stridor (38.0%) was the most common indication for FE and laryngomalacia (33.3%) was the most frequent finding. Synchronous FE diagnosis was found in 351 (61.8%) cases. No major complications associated with FE were found.

Conclusion
: Flexible endoscopy allows direct visualization of dynamic motion of the small aerodigestive tract. Laryngomalacia was the most common FE finding of respiratory distress in small infants. Synchronous FE lesions were frequently found in this young age group and it necessitated a thorough investigation of the entire aerodigestive tract.
Height improvement by L‐thyroxinetreatment in subclinical hypothyroidism
Authors: Cetinkaya Ergun , Aslan Ayse Tana , Vidinlisan Sadi , Ocal Gonul
Published: October 2003

Background
: Subclinical hypothyroidism(SH) is most commonly an early stage of hypothyroidism. Althoughthe condition may resolve or remain unchanged, within a few yearsin some patients overt hypothyroidism develops, with low free T4levels as well as a raised thyroid stimulating hormone (TSH) level. Patientswith SH may have subtle hypothyroid symptoms with mild abnormalitiesof serum lipoproteins and cardiac functions. L‐thyroxinein a dosage that maintains serum TSH levels within the normal rangeis the preferred therapy in these patients. Although short statureis a well‐known clinical sign of overt hypo­thyroidism,the effect of SH in growth is not well established. The aim of thepresent study is to show the effect of treatment on height in thesepatients.

Methods
: In the present study, 2067 patientswho were admitted to the Endocrinology Department of SSK AnkaraChildren's Hospital, Ankara, Turkey, with the complaintof short stature were evaluated and 39 were diagnosed with SH bythyrotropin releasing hormone stimulation test. The anthropometricdata of the patients who were subdivided into two groups (prepubertaland pubertal) were analyzed before and after 6−12 months of L‐thyroxine treatment. Growth velocity (GV) and GV standard deviation score(GVSDS) of the groups before and after the treatment were statisticallyanalyzed.

Results
: Both groups showed significantincreases in GV and GVSDS by L‐thyroxinetreatment.

Conclusion
: Patients with short staturehave to be evaluated for SH in addition to other potential causes. L‐thyroxinetreatment in these patients provides significant improvement inheight.
Serum leptin concentrations in children with mild‐to‐moderate protein‐energy malnutrition
Authors: Büyükgebİz Benal , Öztürk YeSim , YIlmaz Şebnem , Arslan Nur
Published: October 2003

Background
: The aim of the present study was to clarify the relationship between nutritional anthropometric parameters and serum leptin concentrations in otherwise healthy children with mild‐to‐moderate protein‐energy malnutrition (PEM) secondary to inadequate energy intake.

Methods
: Eighty‐one otherwise healthy children with poor appetite and inadequate energy intake were enrolled in the study. The anthropometric values were evaluated in all subjects. Fasting serum leptin concentrations were assessed.

Results
: Of the 81 otherwise healthy children, 30 were found to have mild‐to‐moderate PEM. The control group consisted of 51 healthy children who had normal anthropometric values, even though they had inadequate energy intake. There was a significant difference in serum leptin concentrations between the two groups (P < 0.01). Furthermore, there was a positive correlation between mean serum leptin concentrations and percentage of standard weight for height in the patient and the control group (P < 0.05). Multiple linear regression analysis indicated that percentage of standard BMI was the best predictor for serum leptin concentrations (P < 0.05).

Conclusion
: In addition to BMI, percentage of standard weight for height is a valuable nutritional anthropometric parameter for serum leptin concentrations in PEM and inadequate energy intake. However in the present study, percentage of standard BMI was the best predictor for serum leptin concentrations. Serum leptin concentrations are low not only in severe PEM, but also in children with mild‐to‐moderate PEM without chronic disease.
Discharge diagnoses in infants with apparent life‐threatening event
Authors: Okada Kazuko , Miyako Motoko , Honma Satoshi , Wakabayashi Yasuko , Sugihara Shigetaka , Osawa Makiko
Published: October 2003

Background
: There are various identifiable diseases or conditions that can be associated with an apparent life‐threatening event (ALTE) in infancy. The present study was carried out to investigate the etiology of ALTE based on the discharge diagnoses.

Methods
: A protocol for the complete work‐up used to examine the cause of ALTE was designed, and was carried out for 69 infants with ALTE.

Results
: Gastroesophageal reflux disease (GERD) was demonstrated in 38 cases, and chronic gastric volvulus (CGV) was diagnosed in 21 (associated with GERD in 13 infants). Four cases of pertussis and two cases each of sepsis, laryngomalacia, respiratory immaturity, and premature ventricular contractions were found. Others cases presented with pneumonia, meningitis, intussuception, food allergy, epilepsy, and adenoid vegetations. In 12 of the 69 infants with ALTE, no abnormalities were found in any of the studies performed, including two patients with breath‐holding spells. In 17 cases, two or more possibly contributing findings were diagnosed.

Conclusion
: It is important to recognize that gastroesophageal impairments such as GERD or CGV could be responsible for many incidences of ALTE in infancy. The authors recommend a trial be established to investigate the causes of ALTE, including gastroesophageal evaluations in all infants with ALTE.
Evaluation of 80 children with prolonged fever
Authors: Cogulu Ozgur , Koturoglu Guldane , Kurugol Zafer , Ozkinay Ferda , Vardar Fadil , Ozkinay Cihangir
Published: October 2003

Background
: Several studies have been published regarding the etiology and evaluation of a child with prolonged fever, however, the reasons for the prolonged fever have changed during the years. The present study aims to determine the causes of prolonged fever, to investigate the relationship of fever using some basic laboratory tests, and to establish guidelines for the approach in those children.

Methods
: The charts of 80 out of 17 490 hospitalized children who were seen between 1996 and 2001 with prolonged fever of longer than 2 weeks and unknown origin were reviewed in the university hospital of Izmir, Turkey. Their charts were evaluated in respect of age, sex, growth curves, educational level of their families, the duration and the magnitude of fever, causes of fever, and basic laboratory investigations such as white blood cell, blood smear, hemoglobin, erythrocyte sedimentation rate, and C‐reactive protein.

Results
: Forty‐four (55.00%) were boys and 36 (45.00%) were girls. Forty‐four children (55.00%) were aged between 1 month and 2 years, 21 (26.25%) were aged 3−6 years, seven (8.75%) were aged 7−10 years, and eight (10.00%) were older than 10 years. The mean age was 3.87 ± 4.17 years (range 3 months−17 years). Forty‐six children (57.50%) had a prolonged fever that had lasted from 15−30 days, 18 (22.50%) from 31−60 days, and 16 (20.00%) had fever lasting more than 60 days. Final diagnosis had been reached in 70 of the 80 children (87.50%). The most common causes were infection (47/80), followed by immune deficiency (6/80), collagen tissue disorder (5/80), neoplasia (2/80), and miscellaneous (10/80) such as central fever in three, diabetes insipidus in two, familial Mediterranean fever in two, Kawasaki disease, foreign body in the respiratory system, and Crohn disease in one patient each. Among the laboratory tests white blood cell count, hemoglobin level and blood smear distribution of infection group were statistically significant.

Conclusions
: The most common cause of fever of unknown origin remains infection. The proportion of collagen tissue disorders and neoplasia have been found to be decreased. Unusual reasons such as diabetes insipidus and foreign body in the respiratory system in the miscellaneous group have been detected. Age plays important role in the diagnosis of prolonged fever, while some basic laboratory tests might give clues in the evaluation and may suggest a diagnosis.
Criteria for medical intervention in obese children: A new definition of ‘Obesity disease’ in Japanese children
Authors: Asayama Kohtaro , Ozeki Takehiko , Sugihara Shigetaka , Ito Keiko , Okada Tomoo , Tamai Hiroshi , Takaya Ryuzo , Hanaki Keiichi , Murata Mitsunori
Published: October 2003

The Committee of the Japan Society for the Study of Obesity reported the new criteria for ‘obesity disease’ for Japanese adults in 2000. We defined the criteria for the diagnosis of obesity in children with medical problems, corresponding to the ‘obesity disease’ criteria in adults. Obesity in childhood was defined as follows: percentage of overweight (POW) and body fat exceeded the criteria. ‘Obesity disease in childhood’ was defined as obesity associated with health or medical problems, and with indications for medical intervention. Medical problems with indications for immediate intervention were grouped as A problems, which consisted of (i) hypertension; (ii) sleep apnea or hypoventilation; (iii) Type 2 diabetes mellitus or impaired glucose tolerance; and (iv) increased waist circumference or accumulation of visceral adipose tissue. Metabolic derangements or equivalent associated with obesity were grouped as B problems: (i) liver dysfunction; (ii) hyperinsulinemia; (iii) hypercholesterolemia; (iv) hypertriglyceridemia; (v) low serum high‐density lipoprotein cholesterol; (vi) acanthosis nigricans, and (vii) hyperuricemia. Obese children over 5 years of age with following conditions were diagnosed as ‘obesity disease in childhood’: (i) any ‘A problem’, (ii) POW ≥ 50% and any ‘B problem’, or (3) POW < 50% and more than one ‘B problem’ or equivalent. We decided to take physicosocial problems related to obesity into consideration as the criteria. The resultant criteria are proposed by the Committee for Research of Appropriate Body Build in Children*.
Medical management of congenital anomalies of the kidney and urinary tract
Authors: Hiraoka Masahiro
Published: October 2003

Renal damage in children has been found to be more congenital in origin than was previously thought. Congenital anomalies of the kidney and urinary tract (CAKUT) involve renal dysplasia, renal hypoplasia, urinary tract obstruction and vesicoureteral reflux. CAKUT are sometimes bilateral and different types often coexist. Depending on their types and severity, children with CAKUT often have varying degrees of a reduced number of nephrons at birth. CAKUT are now the leading cause of renal failure in children. Children with renal dysplasia or obstructive uropathy may have abnormal renal tubules, and tend to lose essential water and sodium in urine. This can lead to poor body growth unless they are supplemented with water and sodium. Children with severe ureteric reflux often develop urinary infection and renal scarring. Renal scarring can further increase the risk of renal failure in children who already have other CAKUT and fewer nephrons than normal. Hypertension and proteinuria may develop in children with renal dysplasia and further aggravate renal function unless they are treated. Recent advances in the understanding and management of CAKUT make it possible for children with CAKUT to grow normally, have fewer complications such as urinary infection, have longer renal survival, and survive even with end‐stage renal diseases through renal replacement therapy.
Causes and determinants of outcome of intestinal perforations in a semiurban African community
Authors: Adesunkanmi Abdul Rashid K. , Badmus Tajudeen A. , Ogundoyin Olukayode
Published: October 2003

Background:  Intestinal perforations are common causes of generalized peritonitis, it is often severe because of faecal contamination and overwhelming sepsis resulting in high morbidity and mortality. The purpose of the present study was to determine the causes and factors affecting the prognosis in patients with generalized peritonitis as a result of intestinal perforation.

Study design:  Patients with acute generalized peritonitis from intestinal perforation were prospectively studied during a 6‐year period from 1995 to 2000. Personal, preoperative and postoperative clinical information of all the patients was entered into a predesigned proforma. Data were analysed and the effect of individual causes of peritonitis on the postoperative outcome was determined.

Results:  More males were affected by a ratio of 3 : 1, with the overall mean age of 27.6 ± 18.3 years (SD). The mean age in patients with typhoid perforation was 21 ± 14 years (SD) and highest in traumatic intestinal perforations (47.2 ± 17.6 years, SD). Typhoid perforation occurred in 75 (58%) patients, acute appendicitis in 21 (16.3%), peptic ulcer disease in 18 (14%), trauma in eight (6.3%), five were idiopathic and one malignant sigmoid carcinoid tumour. Wound infection occurred in 74 (58.3%) and mortality in 24 (18.8%) of the patients. Mortality was high in traumatic and typhoid intestinal perforation than other causes of intestinal perforation. Factors such as age, cause of intestinal perforation, and amount of pus drained during operation independently predicts the postoperative morbidity and mortality rates.

Conclusion:  Typhoid intestinal perforation was the most common cause of acute generalized peritonitis, followed by perforated acute appendicitis. Prognostic factors include age, the causes of perforation, amount of pus, wound infection, wound dehiscence, faecal fistula, and intra‐abdominal abscess.
Free air or colon?
Authors: Iyer Shridar G , Leow CK
Published: October 2003

Background:  Subphrenic abscess can present with respiratory symptoms with minimal or no abdominal signs. The air/fluid level seen on chest X‐ray can be misinterpreted as that within a loop of intestine (Chilaiditi's sign) thus leading to delayed diagnosis.

Methods:  Case report.

Results:  An 83‐year‐old female presented with respiratory symptoms. Chest X‐ray showed an air/fluid level under the right hemi‐diaphragm. This was initially interpreted as Chilaiditi's sign. The subphrenic abscess was confirmed by a computed tomography scan. At laparotomy, the abscess was communicating with a perforation in the fundus of the gall bladder. In addition, there was a fistula connecting the neck of the gall bladder and the second part of the duodenum. The abscess was drained and the fistula tract disconnected. Post‐operatively the patient had an uneventful recovery.

Conclusion:  Patients with subphrenic abscess can present with symptoms mimicking a respiratory infection. The air/fluid level seen on chest X‐ray can be misinterpreted as Chilaiditi's sign. Most subphrenic abscesses occur secondarily to an underlying pathology within the gastrointestinal tract. A thorough search for an underlying intra‐abdominal pathology must be made.
Impact of programmed second endoscopy with appropriate re‐treatment on peptic ulcer re‐bleeding: A systematic review
Authors: Chiu Philip Wai‐Yan , Lau Tai‐Shing , Kwong Kwok‐Hung , Suen Dacita To‐Ki , Kwok Samuel Po‐Yin
Published: October 2003

Objectives:  The aim of the present systematic review is to critically appraise the current evidence from published medical trials on the role of programmed second endoscopy with appropriate therapy on peptic ulcer re‐bleeding.

Methods:  A systematic review of five prospective randomized controlled trials comparing the effect of programmed second endoscopy against conservative management on peptic ulcer re‐bleeding was carried out.

Results:  From the meta‐analysis of the combined results from the five trials on the effect of programmed second endoscopy in ulcer bleeding, we found that a programmed second endoscopy with appropriate therapy reduced the number of recurrent bleeding significantly (Peto odds ratio = 1.97, Mantel Haenszel‐Peto P < 0.01). The number of patients needed for treatment with a programmed second endoscopy in order to prevent one recurrent bleeding ranged from four to 11.

Conclusion:  Programmed second endoscopy with appropriate therapy reduced the number of recurrent bleeding significantly in patients with bleeding peptic ulcers. Individual trials also showed a possible benefit in reduction of the number of surgical interventions.
Audit on transurethral resection of prostate in Tuen Mun Hospital
Authors: Chan Steve Wai‐Hee , Mah Ida Soo‐Fan , Man Chi‐Wai
Published: October 2003

A clinical audit encompasses both quality assessment and improvement and is now an important component of the clinician's practice. The present project applied clinical audit in monitoring both the clinical outcomes and the process of patient management. The first audit cycle in 1999 reviewed the performance of the hospital with respect to clinical outcomes and patient management process. An area of weakness was identified with regard to the process of managing patients with the problem of retention of urine. Subsequent change in the management of patient with retention of urine was implemented. The second audit cycle was completed in 2002. A reduction in hospital stay for patients with retention of urine was achieved.
Repair of large complicated incisional hernia
Authors: Chan Tony Tung‐Fei , Chow Tam‐Lin , Lam Steve Ching‐Wa , Kwong Peter Kwok‐Hung , Lam Siu‐Ho
Published: October 2003

Prosthetic mesh repair is currently the gold standard of treatment for incisional hernia. However, in the presence of bowel fistula or stoma, repair of incisional hernia is very difficult. The use of prosthetic mesh might be contraindicated in these situations. The present case report details the experience of using components separation or sliding myofascial flap technique to repair these complicated incisional hernias. All of the patients from the present report had their hernia repaired without using meshes and there was no recurrence. A review of published reports and discussion on applications of the components separation technique was also undertaken.
Times of life: A tribute to Dr James TK Lau
Authors: Ng Jacob Wai‐Tat
Published: October 2003

Background:  The historically unprecedented severe acute respiratory syndrome crisis saw eight Hong Kong health care workers sacrificing their lives in the line of duty – Dr James TK Lau was the first one. The reviewer looks back at a specific time in the life of this colleague's outstanding career from the end of 1980 to mid‐1984. A Medline search showed that during this short time, Dr Lau published 22 articles in international prestigious journals as first author, as well as being a co‐author for many papers (as well as several local papers). These articles, ranging from experimental study (one), randomized controlled study (one), clinical observations (six), case reports (three) to new techniques (11), reflect the author's inquisitiveness, ingenuity, resourcefulness and most importantly, incessant quest for technical perfection through meticulous attention to detail. Of note, many of the innovative techniques have stood the test of time and have been assimilated into everyday practice. Authoring 21 paediatric surgery papers in international journals over a short span of time was truly remarkable, and also, unprecedented locally. This could not have happened without one most memorable attribute – total devotion – that was clearly evident at all times of his life, and in particular, the final times of his life.
Involving Communities in Community Assessment
Authors: Clark Mary Jo , Cary Susan , Diemert Grover , Ceballos Rose , Sifuentes Maria , Atteberry Irene , Vue Fu , Trieu Sandy
Published: October 2003

Abstract  Focus groups provide an effective means of incorporating the perspectives of “hidden” populations in assessments of community health needs and assets. A series of focus groups was conducted with specifically targeted segments of a community to develop a comprehensive picture of community health. The authors describe the focus group process, major findings, and the use of focus group results in a highly multicultural community. Despite differences in age, length of residence, and ethnicity, the focus groups were remarkably similar in the issues raised. The majority of participants viewed the multicultural nature of the community as an asset but voiced some of the difficulties of living in a multiethnic and multilanguage environment. Similar areas of concern in the community arose from all of the focus groups, including housing and other environmental issues and problems of access to health care. Focus group findings have been used to initiate activity addressing identified community problems. Focus group participation had the added benefit of increasing community members' participation in other community endeavors.
Comprehensive Evaluation of a Community Coalition: A Case Study of Environmental Tobacco Smoke Reduction
Authors: Cramer Mary E. , Mueller Keith J. , Harrop Dianne
Published: October 2003

Abstract  Community coalitions have become an increasingly popular means for addressing community health issues, yet evaluating their effectiveness and performance has presented formidable challenges. To meet the community's need for health program evaluation, public health nurses will need to become better prepared to deal with the complexities of evaluating coalitions and their multifaceted organizational structures. This article presents the methodology and conceptual framework, Targeting Outcomes of Programs (TOP), used to evaluate the performance and impact of a local community coalition. The case study offered here focuses on a tobacco‐prevention coalition composed of 15 public and private agencies and their 121 activities. The TOP evaluation model provided the coalition with formative evaluation, needed to improve the coalition's on‐going program delivery, and summative evaluation, needed for annual reviews of the coalition's effectiveness and impact in the community. The methodological approach and instrument presented here provide the public health nurse with a solid conceptual framework for approaching such a task.
The African American Experience in the Islamic Faith
Authors: Ohm Ruth
Published: October 2003

Abstract Disparity of health outcomes has been identified as a key concern in the health of Americans. Marginalization of the African American population may be a contributing factor. Identification of health protectors may prove key in decreasing disparities. The effect of spirituality on health is discussed. A historical overview of the African American experience in the Islam faith, from the Nation of Islam to universal Islam, is presented. A systematic assessment of the Islamic faith, with emphasis on the African American Muslim, was conducted as an assessment for a Community Health Nursing class. Leininger's Sunrise Model of Culture Care Diversity and Universality, with the ethnonursing model of data collection, served as the framework for data collection and analysis. The Islamic faith was noted to offer holistic direction for a “way of life” that promotes health and harmony of the mind, body, and soul. Implications for research were discussed.
Oxidative Stress–Mediated Down–Regulation of Rat Hydroxyacid Oxidase 1, A Liver–Specific Peroxisomal Enzyme
Authors: Recalcati Stefania , Tacchini Lorenza , Alberghini Alessandra , Conte Dario , Cairo Gaetano
Published: October 2003

Hydroxyacid oxidase 1 (Hao1) is a liver–specific peroxisomal enzyme that oxidizes glycolate to glyoxylate with concomitant production of H2O2. In Hao1 messenger RNA (mRNA), an iron–responsive element (IRE) homologous to the sequence recognized by iron regulatory proteins (IRP), key regulators of iron homeostasis, is present, but the involvement of iron in Hao1 regulation remains unclear. In this study, we found a reduction of Hao1 mRNA content in livers of rats with chronic dietary iron overload, which showed decreased IRP activity and higher ferritin expression as expected, but also induction of heme oxygenase (HO–1), a marker of oxidative damage, and lipid peroxidation. Hao1 mRNA levels were not altered significantly in livers of rats administered doses of iron sufficient to induce ferritin expression and to repress IRP activity, but not to activate HO–1 and to promote lipid peroxidation, as well as in the liver of iron–deficient rats. These observations were not consistent with a post–transcriptional down–regulation of Hao1 by iron through the IRE/IRP pathway and suggested an effect of reactive oxygen species (ROS). Indeed, a marked decrease of Hao1 mRNA was observed in the liver of rats subjected to oxidative stress induced by either glutathione depletion or postischemic reperfusion. Nuclear run–on analysis showed an effect of ROS at the transcriptional level. In conclusion, down–regulation of Hao1 expression during oxidative stress may provide a mechanism to prevent excessive H2O2 formation in liver peroxisomes and may represent the prototype of a poorly recognized but potentially relevant response to oxidative injury involving down–regulation of ROS–producing enzymes.