bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomarkers of Cardiac Injury: An Update
Authors: Rajappa Medha , Sharma Alpana
Published: March 2006

Conventional and promising new markers of myocardial injury have become an important diagnostic tool and their prognostic significance is also recognized. In addition, they help identify patients who will derive the most benefit from therapeutic interventions. The literature was searched from the websites of the National Library of Medicine (http://www.ncbi.nlm.nih.gov/) and PubMed Central, the U.S. National Library of Medicine’s digital archive of life sciences journal literature (http://www.pubmedcentral.nih.gov/). The data were accessed from books and journals that published relevant articles in this field. The diagnosis of acute myocardial infarction (AMI) has traditionally relied on the combination of chest pain, ECG features, and elevation in serum markers. However, chest symptoms are frequently atypical or absent and ECG changes may be nonspecific or absent. Hence, the diagnosis of acute coronary syndromes has become increasingly dependent on serum markers of cardiac injury. Among them, creatine kinase (CK) is an effective and widely used test, with the recent CKMB assay offering greater specificity and sensitivity. Cardiac troponins facilitate early and rapid diagnosis, enable effective risk stratification in patients with AMI (with or without traditional criteria for MI), and identify those who will benefit from aggressive medical or surgical intervention. Recent data suggest the potential of myoglobin and CKMB isoforms as sensitive markers in the early hours after symptom onset. Cardiac-specific troponins help in rapid diagnosis, prognostication, and treatment of AMI. Troponins also facilitate early detection of recent infarction owing to their prolonged diagnostic window and also aid in the detection of “microinfarction.” CKMB is used to detect reinfarction or infarct extension, if levels rise again after declining. Finally, novel biochemical markers are receiving attention in ongoing trials. They may prove to be more effective in diagnosis and prognosis than their existing counterparts.
The Ankle-Brachial Index Is Not Related to Mortality in Elderly Subjects Living in Nursing Homes
Authors: Bo Mario , Zanocchi Mauro , Poli Leone , Molaschi Mario
Published: March 2006

Low ankle-brachial index (ABI) levels are associated with increased risk of all-cause and cardiovascular mortality in middle-aged and older adults. We evaluated the association between low ABI and all-cause and cardiovascular mortality in elderly patients living in nursing homes. In 632 subjects (mean age 82.1 ±7.4 years, 137 men) living in 3 municipal nursing homes, ABI, prevalent cardiovascular diseases, and conventional risk factors were evaluated at baseline in 1998. After a 3-year follow-up the relation between a low ABI and mortality outcomes was evaluated by using multivariable Cox proportional hazards analysis. A low ABI (<0.90) was observed in 177 participants (28%). After 3 years, 304 subjects (48.1%) died; death occurred in 53.6% of those with low ABI and in 45.9% of those with normal ABI. No significant relation between low ABI and all-cause (hazard ratio [HR] 1.1, 95% confidence interval [CI] 0.7-2.0) or cardiovascular mortality (HR 1.3, 95% CI 0.8-2.1) was observed. Among elderly patients living in nursing homes, there is a high prevalence of low ABI, which is not related to all-cause and cardiovascular mortality.
Time Course of Rapid C-Reactive Protein Reduction by Pravastatin in Patients with Stable Angina
Authors: Li Jian-Jun , Fang Chun-Hong , Qian Hai-Yan , Hu Wen-Lan
Published: March 2006

The evidence has indicated that rapid reduction of inflammatory marker, such as C-reactive protein (CRP) could be achieved by administration of a statin. However, limited information is available in evaluating the short-term time course of CRP reduction in patients with coronary artery disease by use of a statin. Forty-two patients with stable angina were randomly assigned to 20 mg/d or 40 mg/d group of pravastatin. Blood samples were drawn at days 0, 1, and 14 for measuring lipid profile, CRP levels, and hepatic enzymes in all patients. The results showed that both doses of pravastatin induced significant reductions in median CRP levels and in mean CRP levels, respectively, at day 1 (20% in the 20 mg/d group and 17.6% in the 40 mg/d group; 15% in the 20 mg/d group and 10% in the 40 mg/d group) as well as at day 14 (28.6% in the 20 mg/d group and 33.3% in the 40 mg/d group; 25% in the 20 mg/d group and 22.8% in the 40 mg/d group) compared with baseline data without a dose-dependent manner. In addition, no changes were found at day 1 regarding lipid profile; however, both doses of pravastatin induced significant reductions in total cholesterol (TC, 22% and 30%), and low-density lipoprotein (LDL) cholesterol (30% and 40%) compared with baseline at 14 days. The higher dose of pravastatin resulted in significantly greater reductions in TC and LDL cholesterol compared with the 20 mg/d dose (p=0.05, p=0.01, respectively). A less significant reduction was observed in triglycerides level (16% and 24%) compared with TC and LDL cholesterol. There was no significant difference in mean high-density lipoprotein (HDL) cholesterol levels compared with baseline in both groups. These data suggested that a common daily dose of pravastatin resulted in rapid reduction of CRP within 24 hours and of lipid profile within 2 weeks, and the benefit to the vascular endothelium might occur quickly by reduction of CRP levels, which may be clinically important for patients in a high-risk subgroup, such as acute coronary artery disease.
Homocysteine Level and Coronary Artery Disease
Authors: Kazemi M. B.Sharif , Eshraghian K. , Omrani G. R. , Lankarani K. Bagheri , Hosseini E.
Published: March 2006

Atherosclerosis, and its most common manifestation, coronary artery disease (CAD), are rather common causes of morbidity and mortality worldwide. Recognition of its various risk factors is important to planning effective preventive measures. After the homocysteine theory was presented in 1969, attention has been directed toward the serum homocysteine level as a coronary artery disease risk factor. The authors aimed to assess the relationship between hyperhomocysteinemia and CAD in an Iranian population. In a case control study, 197 individuals (male: 123 [62.4%]) who were scheduled for coronary angiography were selected. Venous samples were taken from the patients in fasting state before angiography. Data about age, sex, risk factors (eg, hypertension, diabetes, smoking, hyperlipidemia, obesity) were obtained from prepared questionnaires. Homocysteine levels in patients were measured by ELISA method. A homocysteine level above 15 µmol/liter was considered high. Angiography reports and homocysteine levels were analyzed by independent sample t test, one-way ANOVA, multiple linear regression, and stratified analysis. In comparison with the patients with normal angiography reports (32.5%), patients with abnormal angiography reports (67.5%) had increased levels of homocysteine (p=0.001). About 28.1% of patients with normal angiography reports had hyperhomocysteinemia. After further evaluation, linear correlations were detected between the numbers of involved vessels and homocysteine level (p=0.000). Multiple linear regression analysis of data detected that in individuals without any risk factors, the relationship was stronger and more meaningful (p=0.000). These data show that hyperhomocysteinemia is related to CAD as an independent risk factor. In individuals without any risk factors a linear correlation between homocysteine level and numbers of coronary artery involvement was present. If this equation is confirmed prospectively in other studies, the level of plasma homocysteine may he used as a noninvasive way of predicting the number of diseased coronary arteries.
Increased Urinary Albumin Excretion Rates Can Be a Marker of Coexisting Coronary Artery Disease in Patients with Peripheral Arterial Disease
Authors: Sonmez Kenan , Eskisar Arzu Ozdemir , Demir Durmus , Yazicioglu Mehmet V. , Mutlu Bulent , Dogan Yuksel , Izgi Akin , Mansuroglu Denyan , Bakal Ruken Bengi , Elonu Orhan Hakan , Turan Fikret
Published: March 2006

Coexisting coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with peripheral arterial disease (PAD). Clinical evaluation and noninvasive tests have some important limitations for the detection of CAD in patients with PAD. The purpose of this study was to investigate whether urinary albumin excretion (UAE) was a sign of atherosclerotic involvement of coronary arteries in patients with PAD. Our study consisted of 65 consecutive patients (56 men, 9 women, mean age; 59.7 ±7.9 years) with PAD who underwent coronary angiography. Urinary albumin excretion was measured in 24-hour urine samples by immunoprecipitation technique. PAD was defined as the presence of ≥50% stenotic lesions in at least 1 of the iliac, femoral, popliteal, tibialis anterior, tibialis posterior, or peroneal arteries. CAD was defined as ≥25% diameter stenosis in at least 1 coronary artery. Patients without any coronary lesions were accepted as having normal coronaries. Age, sex, distributions of coronary risk factors, and UAE rates were compared between patients with and without CAD. Mean UAE was 17.9 ±15.6 mg/day in the total population. Thirty-seven percent of patients had CAD, and 63% had no coronary lesion. UAE rates were 22.33 ±18.74 and 15.32 ±13.01 mg/day in patients with CAD and those with normal coronary arteries, respectively (p=0.021). Microalbuminuria was detected in 25% in patients with CAD and 12% in those without coronary artery lesions (p=0.184). The difference was not statistically significant. The distributions of other risk factors and sex were not different between the 2 groups. These data suggest that in patients with PAD, urinary albumin excretion rates may be used to determine those with a high probability of CAD. Further studies are required to decide whether this noninvasive testing is appropriate in detecting high-risk patients.
Current Role of Laser Angioplasty of Restenotic Coronary Stents
Authors: Batyraliev Talantbek A. , Pershukov Igor V. , Niyazova-Karben Zarema A. , Karaus Alexandru , Calenici Oleg , Guler Niyazi , Eryonucu Beyhan , Temamogullari Alivahit , Ozgul Sami , Akgul Ferit , Sengul Hakan , Dogru Orhan , Demirbas Onder , Timoshin Ivan S. , Gaigukov Alexei V. , Petrakova Larisa N. , Peresypko Marina K. , Sidorenko Boris A. ,   International Invasive Cardiology Research Group
Published: March 2006

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1 ±9.9 vs 13.6 ±9.1 mm; p=0.034), more complex (36.5% type C stenoses vs 14.3%; p=0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p=0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.
Molecular Viscosity in the Normal Left Coronary Arterial Tree. Is It Related to Atherosclerosis?
Authors: Soulis Johannes V. , Farmakis Thomas M. , Giannoglou George D. , Hatzizisis Ioannis S. , Giannakoulas George A. , Parcharidis George E. , Louridas George E.
Published: March 2006

The purpose of this study is to elucidate, probably for the first time, the distribution of molecular viscosity in the entire left coronary artery (LCA) tree. The governing mass, momentum, and energy flow equations were solved by using a previously validated 3-dimensional numerical (finite-element analysis) code. High-molecular-viscosity regions occur at bifurcations in regions opposite the flow dividers, which are anatomic sites predisposed for atherosclerotic development. Furthermore, high-molecular-viscosity values appear in the proximal regions of the LCA tree, where atherosclerosis frequently occurs. The effect of blood flow resistance, due to increased blood viscosity, gives rise to increased contact time between the atherogenic particles of the blood and the endothelium, probably promoting atherosclerosis. Observations suggest that, whole viscosity distribution within the coronary artery tree may represent a risk factor for the resulting atherosclerosis. This distribution can become a possible tool for the location of atherosclerotic lesions.
Comparison of Oscillometric and Intraarterial Systolic and Diastolic Blood Pressures in Lean, Overweight, and Obese Patients
Authors: Umana Ernesto , Ahmed Waqas , Fraley Matthew A. , Alpert Martin A.
Published: March 2006

To assess the effect of obesity on blood pressure measurement the authors obtained simultaneous oscillometric and intraarterial systolic and diastolic blood pressures on 188 lean, overweight, class I/II obese, and class III obese subjects. Oscillometric arm cuff/bladder size was selected in accordance with standard guidelines. Oscillometry significantly underestimated systolic and significantly overestimated diastolic blood pressures in each of the 4 weight groups studied. The differences between oscillometric and intraarterial systolic and diastolic pressures were not significantly different among lean, overweight, class I/II obese, and class III obese subjects. Thus, obesity per se does not influence the accuracy of blood pressure measurement. However, oscillometric blood pressure measurement is associated with significant error when compared to intraarterial blood pressure.
Hypertension, Antihypertensive Therapy, and Erectile Dysfunction
Authors: Papatsoris Athanasios G. , Korantzopoulos Panagiotis G.
Published: March 2006

Erectile dysfunction represents a common problem in the male hypertensive population. Both erectile dysfunction and hypertension share common pathophysiologic pathways such as atherosclerosis and endothelial dysfunction. Furthermore, traditional cardiovascular risk factors affect both conditions. Notably, several antihypertensive medications seem to adversely affect erectile function whereas others may exert neutral or even favorable effects. Thus, the regular and meticulous clinical evaluation of hypertensive patients, as well as individualization of anti-hypertensive therapy, are important steps in the effective management of such patients. In addition, the administration of phosphodiesterase-5 inhibitors or apomorphine has excellent efficacy and safety profile in hypertensive patients irrespective of taking or not taking anti-hypertensive medications.
Short-term Lipid-Lowering Treatment with Atorvastatin Improves Renal Function But Not Renal Blood Flow Indices in Patients with Peripheral Arterial Disease
Authors: Alnaeb M. E. , Youssef F. , Mikhailidis D. P. , Hamilton G.
Published: March 2006

Some studies have suggested that lipid lowering with statins exerts favorable effects on the progression of chronic kidney disease. Therefore, the authors assessed the effects of short-term atorvastatin treatment on biochemical markers of renal function and evaluated duplex indices of renal blood flow (RBF) in patients with peripheral arterial disease. Hyperlipidemic claudicants (n=18), aged 44-85 years, were treated for 8 weeks with 20 mg/day atorvastatin. Blood tests at baseline and after 8 weeks included serum fasting lipids, creatinine, urate, and cystatin C (a sensitive indicator of renal function) levels. RBF was also assessed (n=9) by measuring pulsatile and resistance duplex indices. As expected, there was a significant improvement in total cholesterol, low-density lipoprotein cholesterol, and triglycerides. There was also a significant (p<0.0001) fall in serum creatinine from 89 (58-125) to 79 µmol/L (54-119) and an increase in calculated creatinine clearance (CrCl) from 72 (40-129) to 80 mL/minute (47-138; p<0.0001). Serum cystatin C values decreased significantly (p=0.0002) from 1.04 (0.57-1.56) to 0.90 mg/L (0.47-1.47). There were no detectable changes in the RBF duplex indices. Treatment of stable claudicants with atorvastatin for 8 weeks was associated with improved renal function (as assessed by serum creatinine, cystatin C, and calculated CrCl) without changes in RBF. Further studies are required to identify the mechanisms involved in this phenomenon.
A Prospective, Case-control Study of Tobacco Dependence in Thromboangiitis Obliterans (Buerger’s Disease)
Authors: Cooper Leslie T. , Henderson Stavonnie S. , Ballman Karla V. , Offord Kenneth P. , Tse Tak Sun , Holmes David R. , Hurt Richard D.
Published: March 2006

Thromboangiitis obliterans (TAO) is often cited as an extreme phenotype of vasculopathy and tobacco dependence. Although tobacco exposure is essential to progression of arterial ischemia in TAO, expert opinion differs regarding the degree of tobacco dependence in this population. The authors designed a prospective, case-control study to test the hypothesis that subjects with TAO have a greater degree of tobacco dependence than control subjects with coronary atherosclerosis (coronary artery disease [CAD]) do. Subjects with TAO (n=218, confirmed by angiography, biopsy, or noninvasive arterial testing) or CAD (n=343, diagnosed by coronary angiography) were mailed a standardized questionnaire regarding tobacco use, to which 103 and 273 responded, respectively. The degree of tobacco dependence in each group was ascertained by several methods, including the Fagerström Test for Nicotine Dependence Questionnaire. The TAO group was younger at index date (year of first diagnosis for TAO patients, year of percutaneous transluminal coronary angioplasty [PTCA] for CAD patients) (TAO 37.6 ±9.0 vs CAD 43.3 ±4.9 yr, p<0.0001), but the groups did not differ in age at first tobacco exposure (TAO 16.7 ±3.1 vs CAD 17.3 ±4.2 yr, p=0.67), current tobacco use at time of survey (TAO 54% vs CAD 46%, p=0.17), or Fagerström score (TAO 4.7 ±2.3 vs CAD 5.1 ±2.3, p=0.24). Kaplan-Meier curves showed no significant difference in time to stopping tobacco use after first diagnosis (p=0.076). TAO subjects smoked fewer cigarettes per day than CAD subjects (TAO 22.3 ±10.7 vs CAD 27.7 ±15.3 cigarettes/day, p=0.003). Among current smokers (n=170), TAO subjects also smoked fewer cigarettes/day (20.2 ±8.2 vs 24.6 ±12.7, p=0.03), and were more likely to have made a serious attempt to stop (97% vs 90%, p=0.03). In contrast to case reports of extreme tobacco dependence in the TAO population, the degree of tobacco dependence in subjects with TAO is similar to that in subjects with CAD.
Recurrent Thrombosis in Patients with Deep Vein Thrombosis and/or Venous Thromboembolism Associated with Anticardiolipin Antibodies
Authors: de Godoy José Maria Pereira , de Godoy Moacir Fernandes , Braile Domingo Marcolino
Published: March 2006

Anticardiolipin antibodies represent one of the main hypercoagulation states associated with venous thromboembolism. The aim of this work was to evaluate symptomatic recurrent thrombosis in patients with anticardiolipin antibodies and deep vein thrombosis of the lower limbs with or without thromboembolism. Sixty patients who suffered from deep vein thrombosis were observed for a 5-year period, whether they had anticardiolipin antibodies or not. The group was made up of 34 females and 26 males with ages ranging from 13 to 73 years. All were diagnosed with deep vein thrombosis by means of phlebography and were tested for anticardiolipin antibodies by use of the ELISA method. The symptomatic signs of recurrent thrombosis were evaluated during this period. In total, 56.6% of the group were considered above normal for anticardiolipin antibodies, 25% positive, another 31.6% borderline, and 43.4% negative. Patients were tested positive when the anticardiolipin antibody count was >15 units/mL, borderline between 10 and 15 units/mL, and normal when <10 units/mL. The method of relative risk was used for statistical analysis of the results. Four positive patients, 1 borderline, and 1 normal patient had recurrent events of thrombosis. In the statistical analysis the relative risk for recurrent thrombosis in the positive patients was 6.0; CI 95%; 1.2 to 29.5. In conclusion patients with deep vein thrombosis who are positive for anticardiolipin antibodies present a higher risk of recurrent thrombosis.
Does P-Wave Dispersion Predict the Atrial Fibrillation Occurrence After Direct-Current Shock Therapy?
Authors: Ozdemir Ozcan , Soylu Mustafa , Demir Ahmet Duran , Alyan Omer , Topaloglu Serkan , Geyik Bilal , Kutuk Emine
Published: March 2006

Supraventricular tachycardia attacks, including atrial fibrillation (AF), occur after both external and internal cardioversions. These attacks of atrial fibrillation after direct-current (DC) shock may be related to hemodynamic impairment, thromboembolic events, or enhanced electrical instability of the ventricular and atrial myocardium, especially in predisposed patients. In this study, the authors aimed to show the importance of P-wave dispersion (PWD), which lead the atrium to fibrillate, in predicting post-DC shock AF after external cardioversion. Thus physicians may be able to choose the patients with high risk for AF occurrence and apply some other therapeutic modalities to those patients. The authors identified 18 patients in whom an AF attack was induced by urgent or elective cardioversion for a ventricular tachycardia attack and compared these patients with a control group composed of 40 patients without AF in regard to some clinical, echocardiographic, and electrocardiographic parameters. Left atrial diameters were greater (4.3 ±0.3 vs 3.5 ±0.5 cm, p=0.001), left ventricular ejection fractions (LVEF) were lower (45.2 ±8.2 vs 54.9 ±7.5, p=0.001), the energy needed for successful cardioversion was higher (166.6 ±59.4 vs 80.8 ±51.6 J, p=0.001), and P max (135.2 ±7.4 vs 118.7 ±10.5 ms, p=0.001) and PWD (53.8 ±12.2 vs 23.8 ±9.5 ms, p=0.001) values were higher in patients with AF when compared to those without AF. Thus, the patients with higher PWD values had a greater risk for development of AF after a DC shock.
The Prostacyclin Analog, Treprostinil Sodium, Provides Symptom Relief in Severe Buerger’s Disease
Authors: Fernandez Bernardo , Strootman Deborah
Published: March 2006

Buerger’s disease (thromboangiitis obliterans or TAO) is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries. The primary treatment for Buerger’s disease is cessation of cigarette smoking. In patients whose disease progresses despite smoking cessation, therapeutic options are limited. Revascularization is rarely indicated and usually not successful because of the diffuse and distal distribution of the disease. Prostacyclin, or PGI2, and its analogs have been proposed as pharmacotherapy for Buerger’s disease and studied in Europe. The authors review the prostacyclin literature in the treatment of Buerger’s disease and present a case report of a patient with progressive Buerger’s disease and the use of treprostinil sodium (Remodulin®). This case report experience suggests that subcutaneous treprostinil therapy could be clinically useful in Buerger’s disease that does not improve with smoking cessation, particularly in the presence of critical limb ischemia where other therapeutic options have failed.
Severe Left Ventricular Dysfunction in Left Atrial Myxoma
Authors: Chockalingam Anand , Jaganathan V. , Gnanavelu G. , Dorairajan Smrita , Chockalingam V.
Published: March 2006

We report 2 patients with left atrial (LA) myxoma with associated severe left ventricular (LV) dysfunction. Both presented with progressive effort intolerance without a history suggestive of acute coronary event. LA myxoma was diagnosed by transthoracic echocardiography, which also detected severe systolic dysfunction and LV dilatation. Regional wall motion abnormality and thinning were absent. Coronary angiograms also showed no occlusive disease, but distal ectasia was seen in 1 patient. Metabolic and endocrine causes of reversible LV dysfunction were excluded. Cardiac function improved following surgery for myxoma in 1 patient. LV dysfunction, thus far, has not been directly attributed to myxoma. Coronary embolization leading to myocardial infarction and coexisting coronary atherosclerosis are the recognized methods by which LV dysfunction manifests in myxoma. Our report suggests the possibility of reversible severe global LV dysfunction due to cardiodepressant effect of myxoma through as yet unclear mechanisms.
Autonomic Syncope in Pediatrics: A Practice-Oriented Approach to Classification, Pathophysiology, Diagnosis, and Management
Authors: Sapin Samuel O.
Published: March 2006

This paper presents a practice-oriented approach to the problem of syncope in pediatrics. Autonomic syncope is the major etiologic category in pediatrics and consists of 2 types: reflex and dysautonomic. The latter type is rare in pediatrics. Reflex syncope has 4 subtypes: neurocardiogenic, central, situational, and cerebral. Neurocardiogenic syncope, the most common subtype, is easily diagnosed by taking a careful, detailed history; identifying diagnostic red flags; performing a complete physical examination; and ordering a minimum of laboratory tests. Patient and parent education is essential, and usually, without medication, outcomes are good.
Are Pediatric Practice Settings Adolescent Friendly? An Exploration of Attitudes and Preferences
Authors: Tivorsak Tanya L. , Britto Maria T. , Klostermann Brenda K. , Nebrig Dawn M. , Slap Gail B.
Published: March 2006

This study describes adolescent preferences about offices and waiting. Fifty-four adolescents participated in 12 discussion groups, which were audiotaped and transcribed. The transcripts were analyzed qualitatively. Two themes emerged about the health care environment: (1) making the interior design less childish, more teen-oriented, and more home-like; and (2) decreasing waiting time and enhancing waiting experience by providing teen diversions (e.g., magazines, tv, games). Teens preferred that artwork portray realistic images, that medical paraphernalia be hidden, and that colors be neutral. Modifying interior décor, constructing smaller subwaiting areas, and incorporating diversions that are teen-oriented may help promote positive health care experiences and utilization by adolescents.
Readmission for Newborn Jaundice: The Value of the Coombs’ Test in Predicting the Need for Phototherapy
Authors: Madan Ashima , Huntsinger Kay , Burgos Anthony , Benitz William E.
Published: March 2006

Current practice at our hospital is to perform a direct antiglobulin test (DAT) on cord blood samples of all infants born to blood type O or Rh-negative mothers. Measurement of serum total bilirubin (STB) level and follow-up after discharge are at the discretion of the individual physician. The purposes of the present study were, first, to determine the clinical utility of performing a routine DAT and, second, to define the clinical characteristics of infants readmitted to the hospital for phototherapy. The study was done over a 1-year period extending from January 1 to December 31, 2000. A retrospective review of the DAT results of all infants born to type O or Rh-negative mothers was conducted. The 2 groups of infants included those who had a positive cord blood DAT and were treated with phototherapy and those who needed readmission to the hospital for phototherapy. We found that routine DAT testing of cord blood from term nonjaundiced infants born to O positive mothers is not necessary. Infants with 2 or more risk factors for jaundice irrespective of the results of the DAT are at an increased risk for needing readmission for phototherapy.
Accuracy and Precision of Low-Dose Insulin Administration Using Syringes, Pen Injectors, and a Pump
Authors: Keith Katherine , Nicholson David , Rogers Douglas
Published: March 2006

We compared the accuracy and precision of low-dose insulin administration using various devices including, for the first time, an insulin pump. We dispensed 1, 2, and 5 unit(s) of soluble insulin (100 units/mL) 15 times each from a NovoPen (3.0 mL), a BD-Mini Pen (1.5 mL), a Humalog Pen (100 units/mL), 30G Precision Sure-Dose Insulin Syringes, 3OG BD Ultra-Fine II Short Needle Syringes, and a H-TRON-plus V100 insulin pump. Each dose was weighed on an analytical scale, and the delivered and target doses were compared. Accuracy was defined by the absolute percent difference from the target dose. Precision was defined as the absolute percent difference from the group sample mean. Overall, we found that the pen and pump devices were more accurate, and the pump more precise, than the syringes at the 1- and 2-unit doses. Syringes were dangerously inaccurate, clinically, at the 1-unit dose. The use of pens and syringes with very fine increment markings (1/2 unit) did not improve accuracy or precision. Earlier researchers used multiple individuals to draw and weigh the samples. In an effort to eliminate the potential introduction of significant error, our study used only 2 investigators: 1 to draw up the doses and another to weigh them. The conclusions in our study were similar to prior studies.
Accuracy of Parental Reporting of Immunization
Authors: AbdelSalam Hossam H. M. , Sokal Myron M.
Published: March 2006

This study was undertaken to evaluate the reliability of parental reporting of their children’s immunization status. One hundred eight consecutively admitted children to Brookdale University Hospital and Medical Center were sampled during October and November 2001. Review of the immunization record, recording the immunizations documented, and matching it with the parents’ report was done for children in whom the parents brought the cards. The primary care physician was contacted to verify the immunization status for children for whom the parents did not bring the card during hospitalization or for whom there was a mismatch between the card and the parents’ report. The study included 100 patients (8 were excluded). Forty-nine patients had their immunization cards on admission; 18 brought the cards later during the hospital stay. Of the 100 parents questioned, 98 stated that their children are up to date and 2 stated that their children are missing vaccinations. Of the 98 parents who stated that their children are up to date, 2 were found not to be up to date. Ninety-eight percent of parents were aware of their children’s immunization status and were accurate with their reporting. Parents are knowledgable of their children’s immunization status (98% parental accuracy) and their statements can be relied on during history-taking. It is important for each child to have a primary care physician.
Clinician Satisfaction with Vaccination Visits and the Role of Multiple Injections, Results from the Covise Study (Combination Vaccines Impact on Satisfaction and Epidemiology)
Authors: Meyerhoff A. , Jacobs R. J. , Greenberg D. P. , Yagoda B. , Castles C. G.
Published: March 2006

Because little is known about clinician satisfaction with infant vaccination visits, we measured satisfaction and the effects of the number of injections on satisfaction. Clinicians from 35 pediatric centers self-administered a questionnaire using visual analog scales augmented by a Likert scale. All 95 pediatricians and 137 nonphysician vaccinators responded. In both populations, increased injections predicted decreased overall satisfaction, and decreased satisfaction with obtaining consent, time to prepare/administer, getting upset during administration, and time to update records (each p<0.01). Satisfaction decreased markedly, on each measure, at 4-injection visits, 5-injection visits, or both.
Systemic Side Effects of Ophthalmic Drops
Authors: Levy Yair , Zadok David
Published: March 2006

Topical application of ocular drugs may cause serious adverse ocular or systemic side effects. Children are at greater risk for systemic side effects because ocular dosing is not weight-adjusted, and infants are especially vulnerable as a consequence of the inability to efficiently metabolize the drug, and/or an immature blood-brain barrier. Four pediatric patients are reported in whom treatment with topical brimonidine, a selective alpha-2 adrenoceptor agonist, indicated for the treatment of glaucoma, produced somnolence. Anti-glaucoma eyedrops that are not approved for use in children are still used frequently in pediatrics. Therefore, physicians should be aware of possible systemic side effects of ophthalmic drops.
Promoting Child Social-Emotional Growth in Primary Care Settings: Using A Developmental Approach
Authors: Thomasgard Michael , Metz W. Peter
Published: March 2006

Clinicians are often faced with meaningful child/family mental health concerns, and yet suggesting a helpful course of action can be very challenging. While pediatricians routinely use a developmental framework to evaluate young children’s cognitive, motor, and language skills, this occurs much less frequently for social-emotional development. Only recently have newer models of child development been put forth that emphasize the central role that emotions play in organizing the interactions among cognitive, motor, and language development across the lifespan. We review such a model of social-emotional growth and consider its implications for use in primary care settings.
Optimizing Antibacterial Therapy for Community-Acquired Respiratory Tract Infections in Children in an Era of Bacterial Resistance
Authors: Low Donald E. , Pichichero Michael E. , Schaad Urs B.
Published: March 2006

The spread of antibacterial resistance in bacteria that commonly cause childhood community-acquired respiratory tract infections (RTIs), such as acute otitis media, community-acquired pneumonia, and acute pharyngitis, is a major healthcare problem. One of the foremost concerns is the rapid increase in penicillin, macrolide, and multidrug resistance in Streptococcus pneumoniae. There is also a rising prevalence of macrolide resistance in Streptococcus pyogenes in pockets of the United States, and β-lactamase production in Haemophilus influenzae is widespread. Although data are limited, some evidence suggests that resistance to antibacterials can impair bacteriologic and clinical outcomes in childhood RTIs. Optimizing antibacterial use is important both in the care of individual patients and within strategies to address the wider problem of antibacterial resistance. This involves encouraging judicious antibacterial use (i.e., reducing overuse for viral infection and prophylaxis), and preventing misuse through the wrong choice, dosage, and duration of therapy. Given that initial therapy is usually empiric, antibacterials used to treat community-acquired RTIs in children should ideally have the following properties: an optimal targeted spectrum of activity; high clinical and bacteriologic efficacy against respiratory pathogens, including resistant strains; simple, short-course therapy; and good tolerability and palatability. New antibacterials will continue to have a role in the treatment of RTIs in children, especially where resistance compromises existing therapies.
Can the Diagnosis of Pelvic Inflammatory Disease be Excluded Without a Bimanual Examination?
Authors: Fisher Lloyd D. , Fletcher Kenneth E. , Blake Diane R.
Published: March 2006

Now that urine-based tests are available for detection of Chlamydia and gonorrhea, we sought to determine whether history alone could be used to exclude pelvic inflammatory disease (PID) and thus preclude a bimanual examination. The study design was a retrospective chart review. The study population included females aged 15-24 years diagnosed with PID. Outcome measures were documentation of screening symptoms (abdominal pain, dyspareunia, or abnormal vaginal bleeding) in the medical record. Our primary analysis was sensitivity of screening symptoms for identifying patients with PID. At least 1 of the 3 screening symptoms was reported by 93% of the PID group. If absence of all 3 screening symptoms were used as a screening instrument to exclude a bimanual examination, many women with lower genital tract symptoms could be evaluated noninvasively. However, this approach could result in delayed diagnosis of PID in a small number of patients. Before this strategy is adopted, a large prospective study is needed.
Diagnosis and Management of Acute Otitis Media in Michigan
Authors: Linsk Richard , Cooke James
Published: March 2006

We surveyed pediatricians (PEDs), family physicians (FPs), otolaryngologists (ENTs), and emergency physicians (ERs) from across Michigan (100 each), as well as 30 nationally recognized experts about their clinical approach to acute otitis media (AOM). The overall response rate was 52%. There was substantial variation within each group with respect to diagnostic criteria and clinical decision-making, but no significant differences among groups. The 63% of respondents who considered symptoms among their diagnostic criteria for AOM were 3.8-fold more likely to defer therapy for an asymptomatic toddler with a bulging, red, immobile tympanic membrane (TM) (95% Confidence Interval (CI) 1.53, 9.74), but 24% of respondents stated that they would prescribe oral antibiotics for a symptomatic child with a red TM, even in the absence of a middle ear effusion. These data suggest that diagnostic criteria are a major factor determining whether clinicians prescribe antibiotics to a particular patient.
Chest Pain in Pediatric Patients Presenting to an Emergency Department or to a Cardiac Clinic
Authors: Massin Martial M. , Bourguignont Astrid , Coremans Christine , Comté Laetitia , Lepage Philippe , Gérard Paul
Published: March 2006

The aim of this study was to assess the epidemiology of chest pain among unselected Belgian children referred to an emergency department or to a cardiology clinic. Material and methods - We analyzed the etiology to chest pain and the diagnostic workup of 168 consecutive pediatric patients, seen in our emergency department with the primary diagnosis of chest pain over a 5-year period (group A). Simultaneously a sample of 69 consecutive pediatric patients referred to the cardiology clinic by primary care physicians with the same chief complaint was prospectively included in the study (group B). Results - Chest wall pain was the most common diagnosis in the group A (64%). Other causes included pulmonary (13%), psychological (9%), cardiac (5%), traumatic (5%), and gastrointestinal problems (4%). The organic causes were easily identified or suspected by history and physical examination. Chest radiography, electrocardiography, and blood analysis were performed in most patients with suspected nonorganic chest pain but in no case were organic diseases diagnosed by those ancillary studies. In group B, chest wall pain was also the most common diagnosis (89%). Supraventricular tachyarrhythmia and exercise-induced asthma were demonstrated in 5 (7%) and 3 patients (4%), respectively. The most important tools in assessing a child with acute chest pain in an emergency department are thorough history and physical examination. Assessment of recurrent chest pain is more difficult; arrhythmia, and allergic and exercise-induced asthma may be underestimated when investigations are not performed.
Benefits of Oral Supplementation With and Without Synbiotics in Young Children With Acute Bacterial Infections
Authors: Schrezenmeir J. , Heller K. , McCue M. , Llamas C. , Lam W. , Burow H. , Kindling-Rohracker M. , Fischer W. , Sengespeik H. C. , Comer G. M. , Alarcon P.
Published: March 2006

Acutely ill children (n = 129) aged 1-6 years receiving antibiotic therapy were randomized to receive a nutritional supplement with (PS) or without (P) synbiotics or a fruit-flavored drink (D) with their medications. Group PS had significantly greater weight gains (versus D) following antibiotic therapy. The percentages of subjects without bacterial illnesses 14 days following antibiotic therapy were as follows: 94.3% (PS), 87.8% (D), and 80.6% (P). PS (vs D) significantly increased fecal Lactobacillus in a subset of subjects. Oral supplements increase energy intake and promote weight gain in acutely ill children receiving antibiotics; synbiotics may confer additional benefits by increasing bifidobacteria levels.
Bicycle-Related Injuries to Children and Parental Attitudes Regarding Bicycle Safety
Authors: Ortega Henry W. , Shields Brenda J. , Smith Gary A.
Published: March 2006

This study was designed to evaluate bicycle-related injuries among children requiring emergency treatment, assess the use of safety measures before and after injuries, and determine parental attitudes regarding bicycle safety. Six hundred fifty-eight children were treated for bicycle-related injuries during the study period. Follow-up contact with patients’ families was made by telephone or mail within 2 months. Use of safety equipment other than brakes and reflectors occurred in less than 7% of cases. Less than 25% of children used hand signals. Sixty-eight percent of children reportedly owned a bicycle helmet before the injury, but only 26.1% “always” and 29.7% “never” wore a helmet. Given the high parental understanding of the importance of bicycle helmet use, more education and warnings alone are unlikely to increase helmet usage. Parents support a mandatory helmet use law, and therefore, local and state bicycle helmet ordinances and laws should be combined with education.
Acute Mastoiditis in Children: Epidemiologic, Clinical, Microbiologic, and Therapeutic Aspects over Past Years
Authors: Nussinovitch M. , Yoeli R. , Elishkevitz K. , Varsano I.
Published: March 2006

Recent studies have indicated possible changes in the incidence of acute mastoiditis. A retrospective review of children discharged with a diagnosis of acute mastoiditis was undertaken to describe the epidemiology, clinical presentation, microbiology, and treatment of acute mastoiditis over past years. Demographic historic, clinical, and laboratory data were collected. Eighty-six children (88 episodes of acute mastoiditis) were identified (1 month-16 years) (median 3.3 years). Almost half had a history of middle ear disease; 8% recurrent episodes and 68.2% received antibiotics preadmission, 91.2% for acute otitis media. Bacterial etiology was established in 43 patients (68.2% isolation rate). Pseudomonas aeruginosa and Streptococcus pneumoniae were the most frequently isolated agents. This review showed a significant increase (150%) in the number of patients with acute mastoiditis.
Pediatrician Attitudes and Practices Regarding Collaborative Asthma Education
Authors: Cabana Michael D. , Slish Kathryn K. , Brown Randall , Clark Noreen M.
Published: March 2006

Pediatric practices were surveyed in 10 regions of the country to determine physician attitudes and practices regarding approaches to asthma education. Many physician respondents thought that nurses were just as effective as physicians in providing asthma education. In almost all practices a physician was involved; in two thirds of practices, an allied health professional; and in almost half of practices (48%), a registered nurse was involved. The type of healthcare professional involved in education was not associated with percentage of patients with Medicaid insurance, practice ownership, or setting. Given the multidisciplinary approach to education in many pediatric practices, quality improvement efforts to enhance asthma education by pediatric practices could be further enhanced by directly involving allied health professionals who practice in primary care settings.
The Increasing Threat of Personal Watercraft Injuries
Authors: Latch Rebecca , Fiser Debra H.
Published: March 2006

A trend of increasing number and severity of injuries associated with use of personal watercraft (PWC) has been noted as the use and popularity of PWC also rises. The rate of injuries secondary to PWC use is greater than that from other water sports. Multiple etiologies of injury have been reported, including closed head trauma, spinal injuries, facial fractures, chest trauma, abdominal injuries, and drowning. These injuries may occur from collision with other objects, falls from the PWC, and encounters with the hydrostatic jet stream. The most significant contributing factors to injury seem to be carelessness and inattention. However, some studies show that substance abuse may also contribute. Recommendations to reduce morbidity and mortality include using U.S. Coast Guard-approved personal flotation devices (PFD), limiting use of PWC to trained adults, and improving recognition of significant PWC injury by medical personnel.
Family Environment Factors and Substance Abuse Severity in an HMO Adolescent Treatment Population
Authors: Wu Nancy S. , Lu Yun , Sterling Stacy , Weisner Constance
Published: March 2006

To examine how parental limit setting, family conflict, and perception of family experience influence severity of alcohol and drug problems, and important gender differences in these relationships, we interviewed consecutive intakes, aged 12 to 18 years, at 4 chemical dependency programs of a large group-model nonprofit health maintenance organization (HMO) (n=419). The Family Conflict, Limit Setting, and Positive Family Experience scales correlated with substance dependence (p<0.01, p<0.01, p<0.05, respectively). Depression also correlated with family conflict (p<0.01), absence of limit setting (p<0.01), poor family experience (p<0.01) and dependence symptoms (p<0.01). Number of substance-using friends correlated with number of dependence symptoms (p<0.01). Gender differences included the following: (1) girls scoring higher in family conflict (p=0.0002), negative perceptions of family experience (p<0.0017), and lower in absence of limit setting (p<0.0001); (2) how family environment predicted problem severity: absence of limit setting was significant for boys and girls but family conflict for boys only; (3) girls had more dependence symptoms (p=<0.0001), psychiatric diagnoses (e.g., depression (p<0.0003), anxiety (p<0.0002), conduct disorder (p=0.07)), and substance-abusing family members (53% versus 39%; p=0.006). To conclude, family and peers influence severity of alcohol and drug problems in adolescents.