bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathologic features seen in cutaneous photoeruptions in HIV‐positive patients
Authors: Smith COL Kathleen J. , Skelton Henry G. , Yeager CDR Josef , Tuur Sylvana , Angritt COL Peter , Wagner Kenneth F. ,   the Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)
Published: November 2003

Background There have been scattered reports of HIV+ patients with increased reactions to light as well as anecdotal reports of HIV+ patients with increased morbidity secondary to radiation therapy.

Methods As a part of a military study of HIV+ patients, we followed 987 patients for cutaneous disease for 4 years. All patients were questioned on a periodic basis about increased sensitivity to light. These patients received a physical examination at each protocol visit, and they were given the opportunity to receive all their dermatologic care within the HIV clinic. Fourteen of the patients with photo‐induced eruptions were evaluated clinically at the time of the eruption, and 11 of these were biopsied.

Results Thirty‐three of the patients reported photo‐induced reactions unrelated to oral medications. Although sensitivity to light often began in the early stages of HIV disease, reactions became more severe and more chronic with disease progression. Histologic features varied from few to numerous apoptotic/necrotic keratinocytes within the mid to upper levels of the epidermis associated with a perivascular inflammatory infiltrate, to apoptotic/necrotic keratinocytes throughout an acanthotic epidermis with a liehenoid/interface infiltrate.

Conclusions Although the pathogenesis of these light reactions is not known, these reactions may be related to depletion of endogenous scavengers which results in increased oxidative stress and is modulated by the pattern of immune dysregulation and metabolic dysregulation induced by HIV disease.
Skin and treponemal diseases among Asian domestic house‐helpers in northern Saudi Arabia
Authors: Kubeyinje Emmanuel P. , Belagavi Charalingappa S.
Published: November 2003

Background Asian domestic house‐helpers in Saudi Arabia come from a different socioeconomic setting with a different disease pattern from that of their host country. This study reports the incidence of skin and treponemal diseases in this group seen at a referral hospital in northern Saudi Arabia.

Methods The study was based on the analysis of the dermatologic and serologic examinations of 1520 domestic house‐helpers during resident permit issue, and a retrospective study of clinical records of house‐helpers with skin disorders. Results Routine examination revealed significant skin disease in 374 (24.6%) individuals, and the disease was transmissible in 126 (8.3%). Treponemal infection (5, 0.3%) and leprosy (1, 0.07%) were seen. Hand dermatitis and chicken pox were the most common causes of hospital attendance. Psychologic skin disorders included three cases of neurotic excoriations, two cases of delusion of parasitosis, and a case of dermatitis artefacta.

Conclusions The prevalence of transmissible skin diseases in Asian domestic house‐helpers is low compared with that in their home countries. Excluding individuals with stigmata of atopic dermatitis from employment as house‐helpers, adequate counselling will reduce the incidence of hand dermatitis and psychologic skin disorders. There is a need for continuous surveillance to prevent the introduction of skin diseases not normally seen in the native population.
Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists' offices in Ontario, Canada ‐ a multicenter survey of 2001 patients
Authors: Gupta Aditya K. , Jain Hem C. , Lynde Charles W. , Watteel Gena N. , Summerbell Richard C.
Published: November 2003

Background Questionnaire studies have been used to determine the prevalence of onychomycosis in the United Kingdom and Europe. One disadvantage of this methodology is that the patient self‐diagnoses the onychomycosis. There have been very few large studies involving clinical examination of the nails of subjects, followed by mycological confirmation of the onychomycosis. We therefore determined the prevalence of onychomycosis in patients visiting dermatologists' offices in Ontario, Canada.

Methods In a prospective, multicenter study, the finger‐ and toenails of all new patients presenting to dermatologists' offices were examined by a board‐certified dermatologist. If there was clinical suspicion of onychomycosis, then nail samples were obtained for mycoiogical examination at a central laboratory. Patients referred specifically for the management of onychomycosis were excluded.

Results Toenails appeared abnormal in 455 (22.7%) of 2001 patients. Mycologically‐confirmed pedal onychomycosis was present in 182 (9.1%) of the 2001 patients. The estimated value of the prevalence of onychomycosis in Ontario is 6.86% (95% confidence interval (Cl): 5.8–8.0%), when corrected for age and sex of the general population using census data. Onychomycosis increased with age (P < 0.0001). The odds of males having onychomycosis was 84.3% greater than females of the same age (P= 0.0003). The distribution of organisms in the 141 patients with pedal onychomycosis who were culture positive was: dermatophytes 131 (92.9%), Candida species 4 (2.8%) and non‐dermatophyte molds 6 (4.3%).

Conclusions The prevalence of mycologically‐confirmed toenail onychomycosis was 9.1%, with the estimated prevalence in Ontario being 6.86%. The majority of patients with abnormal‐appearing nails were unaware they might have onychomycosis, that it is infectious and potentially treatable, suggesting that there is potential for increased public awareness and education.
Rapid patterning of Dictyostelium discoideum cells under confined geometry and its relation to differentiation
Authors: Sawada Yasuji , Maeda Yoshiki , Takeuchi Ikuo , Williams Jeffrey , Maeda Yasuo
Published: November 2003

The following was recently reported by Bonner et al. (1995): (1) Rapid differentiation occurred into two zones in Dictyostelium discoideum cells confined in a fine glass capillary. The cells in the anterior zone exposed to the air appear similar to prestalk cells, while the posterior zone isolated from the air mimics prespore cells. (2) The volumes of the two zones are proportional to each other for different sized cell masses, and the proportion is the same as that in normal migrating slugs. We investigated the nature of this newly discovered rapid differentiation in a slightly modified geometry. Exponentially growing cells were harvested, washed to remove external nutrients, and pelleted by centrifugation. Subsequently, a small drop of the pelleted (starved) cells was placed on a slide glass and then confined in a two‐dimensional space between the slide glass and a coverslip, with help of spacers whose thickness varied from 25 to 100 μm. As a result, a dark zone, which looked optically different, emerged within several minutes in the periphery of the disc of the confined cells, corresponding to the zonation in a capillary as previously reported. When the width of the peripheral zone was measured for more than 30 samples of different diameters for each thickness of the spacers, the width was found to be always about 100 μm, irrespective of the size difference of the cell mass placed. This seems to be contradictory to the previous observation made by Bonner et al. (1995). We also examined oxygen concentration dependence on the zone width. The zone width was found to be independent of the oxygen concentration at low concentrations, but increased rapidly at high concentrations. A reaction‐diffusion mechanism for formation of the zone and possible involvement of atmospheric oxygen (O2) in the initial steps of cell differentiation and pattern formation is discussed.
Visualization of the initiation and sequential expansion of the metamorphic conversion of anuran larval skin into the precursor of adult type
Authors: Tamakoshi Tomoko , Oofusa Ken , Yoshizato Katsutoshi
Published: November 2003

A tadpole of bullfrog, Rana catesbeiana, is originally covered with the larval skin over its entire body. Drastic changes arise in both the epidermis and the subcutaneous connective tissue at an early developmental stage, producing the precursor of adult type skin (pre‐adult skin). It was found that calcium is a useful probe to detect the region where the precursor formation has occurred because its deposition in the upper part of subcutaneous collagen bundles coincides with the appearance of the pre‐adult skin. Whole‐mount in situ staining of tadpoles with alizarin red S revealed the initiation site of the premetamorphic transformation of the larval skin into the adult precursor and its ensuing region‐dependent expansion. The pre‐adult skin first emerged at TK II to III (TK, Taylor and Kollros staging) t lateral sides of the body, which led us to postulate that ‘the center for premetamorphic skin transformation’ is formed at the specific site in this region. This center moved dorsally and then ventrally, then reached to the most proximal region of the tail, yielding a unique sequential conversion pattern by around TK V when the conversion was completed in the trunk. The present study also visualized the process of the hindlimb skin transformation.
Spermatozoon structure and motility in the anuran Lepidobatrachus laevis
Authors: Waggener William L. , Carroll Edward J.
Published: November 2003

Synthetic human gonadotropin releasing hormone (GnRH) injections were used for induction of spermatozoon release followed by cloacal lavage or mechanical stimulation of sperm release in Lepidobatrachus laevis. Light microscopic observations of Lepidobatrachus laevis spermatozoa indicated an acrosomal segment with a length of 4.1 μm delineated by an indentation, a nuclear region of 12.6 μm in length and a midpiece of 0.87 μm in length. The tail was 54.9 μm long by 1.35 μm wide with two lateral axial fibers and a central undulating membrane. At the electron microscopic level, the unusual tail had two complete axonemes that emanated from the distal centriole. The tail also contained two axial fibers 77 nm in diameter medial to the axonemes and was connected by an undulating membrane. An unusual accessory cell adherent to the head of the spermatozoon was noted in freshly obtained suspensions of spermatozoa. Spermatozoa with the accessory cell were motile and a subsequent loss of motility was correlated with the shedding of the accessory cell.
Regulation of ectodermal differentiation in Xenopus laevis animal caps treated with TPA and ammonium chloride
Authors: Sotgia Cristina , Fascio Umberto , Pennati Roberta , De Bernardi Fiorenza
Published: November 2003

Animal caps isolated from Xenopus laevis embryos at the blastula stage were treated sequentially with NH4Cl, a known cement gland inducer, and with 12‐O‐tetradecanoyl phorbol‐13‐acetate (TPA), a known neural inducer. The two artificial inducers were also used in reverse order to see if they can mimic the natural inducers acting during the progressive determination of the ectodermal organ. Immunofluorescence and whole‐mount in situ hybridization were used to study the expression of tubulin, taken to indicate an early step on the pathway of cell elongation, and neural cell adhesion molecule (N‐CAM) taken to indicate an early step in the determination of the nervous system. The expression of XCG‐1, a marker of early specification of the cement gland, was also studied. The results showed that the two artificial inducers can mimic the effects of the natural inducers in animal cap explants. The TPA behaves like a neural inducer, reducing the number and the extension of the cement gland when added to the medium in addition to NH4Cl, before or after NH4Cl treatment. In the process of cement gland/neural induction, it is possible to redirect the ectoderm already specified as cement gland to neural tissue, but it does not seem possible to respecify the neural tissue as cement gland. Moreover, the animal caps were also cut into dorsal and ventral parts and the two halves were treated separately. The results were similar to those obtained with treatment of the entire animal cap, suggesting that a dorsal‐ventral pattern is not yet established before the gastrula stage, and that in normal embryos there are boundaries between the effects of different inducers.
Centrosome‐attracting body: A novel structure closely related to unequal cleavages in the ascidian embryo
Authors: Hibino Taku , Nishikata Takahito , Nishida Hiroki
Published: November 2003

The mechanism of unequal cleavage is one of the most intriguing subjects in cell biology. Previous studies of unequal cleavage have focused on a limited number of organisms such as yeasts, nematodes, sea urchins and annelids. The cleavage pattern of the ascidian embryo is invariant. In the ascidian embryo, the posterior‐most blastomeres divide unequally in three successive cleavages. In the present study, it was shown that the ascidian embryo provides another good experimental system with which to analyze the mechanism of unequal cleavage. A novel structure, designated as CAB (centrosome‐attracting body), which was found specifically in the unequally cleaving blastomeres was described. In the course of unequal cleavages, first, a thick microtubule bundle appeared between CAB and one of the centrosomes. Then with the shortening of the microtubule bundle, the nucleus with the centrosome was drawn toward CAB, situated at the posterior cortex of the blastomere. Finally, a cleavage furrow formed in the middle of the asymmetrically located mitotic apparatus and produced two blastomeres of different size, generating a smaller cell that inherits CAB. The CAB seemed to play an essential role in the unequal cleavages in the ascidian embryo.
Cloning and expression pattern of Xenopus prx‐1 (Xprx‐1) during embryonic development
Authors: Takahashi Shuji , Uochi Takaaki , Kawakami Yasuhiko , Nohno Tsutomu , Yokota Chika , Kinoshita Kei , Asashima Makoto
Published: November 2003

Homeobox genes are expressed both temporally and spatially during vertebrate development, and regulate the tissue‐specific expression of other genes. A Xenopus paired‐related homeobox‐1 (Xprx‐1) cDNA was cloned. Xprx‐1 had a paired‐related homeodomain, but did not contain a paired‐box. The sequence of Xprx‐1 had a high level of homology with K‐2(mouse) and Prx‐1(chicken), thus Xprx‐1 is assumed to be the Xenopus homolog of these genes. Xprx‐1 transcripts were maternally restricted, in Xenopus embryos, and a decrease in the late blastula stage was followed by an increase in zygotic transcripts after gastrulation. The transcripts were localized to the animal hemisphere of the late blastula and were concentrated in the branchial arches of the tail‐bud stage embryo. In animal cap experiments, Activin A dose‐dependently induced Xprx‐1 gene expression. These results suggest that Xprx‐1 plays a role in early Xenopus development similar to other species.
Direct and indirect costs of chickenpox in young children
Authors: FERSON MJ , SHEN WL , STARK A
Published: November 2003

Objective: To estimate the medical and economic or societal costs of chickenpox in young children using a descriptive study

Methods: Children under 5 years of age attending 124 Sydney childcare centres who were reported as having chickenpox were studied to assess the costs of medication use and medical consultations, days of care missed, and parental costs resulting from lost time from work and alternate childcare costs.

Results: There were 174 children (92 girls and 79 boys; in three the sex was not stated) who missed a mean of 5.5 days of care because of chickenpox, currently valued at $154. Medical costs were valued at $33 per child, based on 0.97 medical visits, and topical and oral medication. Labour costs resulting from parental work absenteeism were valued at $160 or $345 depending on the method of calculation, whilst direct economic costs of $24 were incurred through use of alternate childcare arrangements. Total costs including those incurred by secondary cases and by rare hospitalisations were in the range of $393–$578 per affected child.

Conclusions: Medical costs of chickenpox in children are small relative to costs incurred as a result of parental work absenteeism and to costs of foregone childcare. Ascribing precise work‐related costs should take into account some capacity to make up lost work time. Such data will be required when determining the cost‐benefit of childhood varicella immunisation.
The use of lumbar puncture and laboratory tests for sepsis by Australian neonatologists
Authors: JOSHI P , BARR P
Published: November 2003

Objective:

To ascertain the current use of lumbar puncture (LP) and laboratory tests for possible or suspected sepsis by Australian neonatologists.

Methods:

A self administered anonymous response questionnaire.

Results:

Sixty‐nine (73%) of 94 neonatologists responded. None performed LP routinely in preterm infants with respiratory distress syndrome (RDS) or asymptomatic term infants with maternal Group B streptococcus (GBS) colonisation. One (1.6%) performed LP in term infants with respiratory distress, and only 35 (51%) performed LP in preterm infants with suspected late‐onset sepsis (LOS). Twenty‐one percent did not perform LP on all preterm infants with RDS and septicaemia and 24% did not perform LP on all preterm infants with late‐onset septicaemia. Sixty‐six percent and 85% did not perform LP for laboratory evidence suggestive of sepsis in preterm infants with RDS and preterm infants with LOS, respectively. Forty‐nine percent investigated asymptomatic term infants with maternal GBS colonisation.

Conclusions:

Lumbar puncture and laboratory tests for possible or suspected sepsis are not used uniformly by Australian neonatologists. The presently available information in the scientific literature is ambiguous and systematic review and further scientific study are required to determine best practice guidelines.
Bowel dysfunction in cystic fibrosis: Importance of breath testing
Authors: LEWINDON PJ , ROBB TA , MOORE DJ , DAVIDSON GP , MARTIN AJ
Published: November 2003

Objective:

To investigate the prevalence of carbohydrate malabsorption and bacterial overgrowth in children with cystic fibrosis (CF) and abnormal stool pattern referred for breath hydrogen testing.

Methodols:

Results from 89 tests using lactose, sucrose and lactulose in 54 children with CF were compared with 5430 tests on children with non‐CF‐related stool abnormalities.

Results:

Children with CF were more frequently unable to ferment lactulose to hydrogen (39% vs. 20%, P<0.03); they had significantly longer oro‐caecal transit times (mean 99 vs. 68 min, P<0.0003); they had a higher incidence of bacterial overgrowth (32% vs. 7%, P<0.003) and sucrose malabsorption (47% vs. 14.5%, P<0.004); but they had no increase in lactose malabsorption (40% vs. 31%). Children with bacterial overgrowth in both groups had longer transit times (CF 123 min, non‐CF 108 min) compared to the non‐CF children without overgrowth (68 min) and reference normal children (69 min).

Conclusions:

Bacterial overgrowth and carbohydrate malabsorption, particularly of sucrose, should be considered when assessing children with CF and abnormal stool patterns.
The use of alternative therapies by children with asthma: A brief report
Authors: ANDREWS L , LOKUGE S , SAWYER M , LILLYWHITE L , KENNEDY D , MARTIN J
Published: November 2003

Objective:

To identify the nature and prevalence of alternative therapies used by children with asthma attending a children’s hospital.

Methodology:

Subjects consisted of a consecutive series of 51 children with asthma aged 1–6 years who were attending the Women’s and Children’s Hospital, South Australia. Parents of the children completed a questionnaire describing the use of alternative therapies by the children.

Results:

Approximately 55% of children used alternative therapies for asthma management. Therapies used most commonly were massage, relaxation exercises, diet therapy and vitamins. There was no significant difference in the age, asthma severity, length of time since diagnosis or presence of another illness amongst children who did or did not use alternative therapies.

Conclusions:

A substantial proportion of children with asthma who attend paediatric clinics use alternative therapies. Paediatricians should be aware of this and be prepared to discuss alternative therapies with parents. This may facilitate more open doctor–patient relationships and better management of children’s asthma.
Postextubation chest X‐rays in neonates: A routine no longer necessary
Authors: DAVIES MW , CARTWRIGHT DW
Published: November 2003

Objectives:

To ascertain the incidence of postextubation atelectasis (PEA) in neonates, to delineate any objective differences between those infants with PEA and those without, and to see if any of those differences were predictive of the need for a postextubation chest X‐ray (CXR).

Methods:

This is a retrospective review of all infants ventilated in 1994. For each separate period of extubation the medical, physiotherapy and nursing notes were examined. Data were collected on birthweight, gestational age, duration of ventilation, age at extubation, ventilation requirements pre‐extubation, pre‐ and postextubation arterial carbon dioxide tensions (PaCO2) and oxygen requirements, the number of episodes of bradycardia and apnoea, the pulse and respiratory rates pre‐ and postextubation, and the use of nasal continuous positive airway pressure (NCPAP). It was routine practice throughout 1994 for all ventilated babies to have a CXR 6 h postextubation. Each postextubation CXR was examined by one of the authors (MWD) for the presence of atelectasis and other diagnoses. PEA was defined as any atelectasis present on the postextubation CXR that was not present on the pre‐extubation CXR.

Results:

The overall incidence of any PEA was 2.5% (6/236). In those babies with PEA, the increase in oxygen requirement at 1 and 6 h postextubation was higher (change in inspired oxygen (ΔFiO2) of 0.05 vs 0.015, P=0.043 and ΔFiO2 of 0.045 vs 0.0, P=0.033, respectively). There was a higher incidence of the need for NCPAP some time after extubation (2/4 vs 9/163, P<0.001). No infant with PEA required reintubation and ventilation.

Conclusions:

In this nursery the incidence of PEA is low with no significant morbidity. Postextubation CXRs should be performed on only those infants who have an increase in oxygen requirement postextubation or become symptomatic with new or increasing respiratory distress, and to follow up atelectasis on the most recent pre‐extubation CXR.
Neonatal cranial ultrasound screening for intraventricular haemorrhage
Authors: TUDEHOPE DI , LAMONT AC
Published: November 2003

The cost effectiveness of performing routine neonatal cranial ultrasound scans to diagnose intraventricular haemorrhage (IVH) on cohorts of high risk infants is in question. In the early 1980s cranial ultrasound scans were performed on preterm infants to expand knowledge of the incidence, aetiology, pathogenesis and evolution of IVH. In many neonatal units high risk infants are scanned on days 5–7 and 10–14 and prior to discharge for extremely low birthweight (ELBW) infants. Cranial ultrasound scanning is often used as a surrogate for assessment of neurodevelopmental outcome with information from meta analyses used to counsel parents about the likelihood of subsequent neurosensory disability.
Preschool behaviour problems in a multicultural Australian urban area
Authors: PRIOR M , WHITE J , MERRIGAN C , ADLER R
Published: November 2003

Objective:

This paper reports on a survey of behaviour problems in a sample of 4‐year‐old preschoolers from the western suburbs of metropolitan Melbourne. This region consists of a diverse multicultural population and families from lower socio‐economic status (SES) backgrounds.

Methodology:

Nineteen preschools participated in the study and information was obtained for 743 preschool children (Refer to MS) age=4.7 years). Parents were asked to complete the Preschool Behaviour Questionnaire (PBQ) and additional questions referring to demographic and family information. Teachers were also asked to complete the PBQ on each of the children. Three factors were extracted from the PBQ (anxious–fearful, hostile–aggressive, hyperactive), and also a combined externalising behaviours factor.

Results and Conclusions:

Findings indicated lower levels of behaviour problems in this sample compared to that of other Australian studies. Boys showed higher rates of externalising behaviour problems than girls. The relationships between behaviour problems and language difficulties, ethnicity, and socio‐economic status are discussed.
Documentation of children’s vaccination status in child care centres in Victoria
Authors: THOMPSON SC , KENNEDY RI
Published: November 2003

Objective:

To assess the record‐keeping of child care centres in Victoria with respect to children’s vaccination status.

Methodology:

A random sample of 113 centres from a list of over 800 registered Victorian child care centres received a mailed questionnaire on characteristics and policies of the centre, including documentation of attending children’s vaccination status.

Results:

The response rate was 86.7%; more than 95% of centres had children under two in care. Only 85% of centres kept any record of children’s immunisation status, with smaller centres and class 2 centres (occasional care centres) significantly less likely to keep records. Records were updated irregularly. Fewer than half of the centres studied kept a record of whether children had been vaccinated against Haemophilus influenzae type b.

Conclusions:

Despite the importance of documenting children’s vaccination status, many child care centres have failed to develop adequate systems to record or update records of children’s immunisation. This makes exclusion during outbreaks of a vaccine‐preventable disease difficult. The ongoing process of accreditation may eventually improve performance, but both legislation and a better educational strategy to improve practice in this area are needed.
Is a paediatrician needed at all Caesarean sections?
Authors: PARSONS SJ , SONNEVELD S , NOLAN T
Published: November 2003

Objective:

The need for a skilled neonatal resuscitator in the form of a paediatrician or paediatric registrar to attend a vaginal delivery or Caesarean section (CS) is not clearly defined. This study was undertaken in order to ascertain the level of resuscitation a neonate might require dependent on the delivery mode and type of anaesthesia used.

Methodology:

We analysed the Tasmanian Obstetric Audit from 1980 to 1989 for the need for intubation and Apgar scores at 1 min of term singleton deliveries by the mode of delivery.

Results:

The number of singleton term deliveries was 64 739. When the data were analysed annually there was a trend for a reduction in the need for intubation in CS deliveries during the first 5 years, although this was not paralleled by an improvement in Apgar scores. Thus the intubation rate data are also presented for the last 5 years of the study. The intubation rate, Apgar score at 1 min of <4, and Apgar score at 1 min of ≥4<7 for repeat CS under epidural anaesthesia were 0.55% (0.26% for 1985–89) 0.83% and 3.58%, respectively, with relative risks when compared with spontaneous normal vaginal delivery of 1.8 (1.2 for 1985–89), 0.7 and 0.5, respectively. The relative risk of these outcomes was higher than for normal vaginal delivery for all other modes of delivery including repeat CS under general anaesthesia.

Conclusion:

It is concluded that a paediatrician or paediatric registrar is not required to routinely attend repeat CS under epidural anaesthesia, but should be present for repeat CS under general anaesthesia.
Urinary calcium excretion in Chinese adolescents
Authors: WONG GWK , LAM CWK , KWOK MY , MAK TWL
Published: November 2003

Objectives:

To obtain normative reference values for urinary calcium excretion in Chinese adolescents.

Methodology:

A random group of 425 healthy Chinese adolescents aged 12–19 years were recruited from secondary schools in Hong Kong. Each subject provided a sample of morning urine for the assessment of calcium and creatinine excretion. A subgroup of 80 subjects provided a 24‐h urine sample for assessment of daily calcium excretion.

Results:

The mean (±S.D.) and median urinary calcium/creatinine concentration ratios (UCa/Cr) expressed in mmolmmol creatinine were 0.18 (±0.16) and 0.12. Girls had a higher UCa/Cr than boys (P<0.0001). The mean±S.D. 24‐h urinary calcium excretion was 0.043±0.025mmol kg day−1 (1.71±1.01 mg kg day−1).

Conclusion:

The UCa/Cr ratio and 24‐h urinary calcium excretion are low when compared with published values for Caucasian children. The apparent rarity of nephrolithiasis and microscopic haematuria associated with hypercalciuria may be related to the low urinary calcium excretion in this population.
Annotation Medical student education in paediatrics and child health: Where are we going?
Authors: O’KEEFE M , ROBERTON DM
Published: November 2003

In most undergraduate medical curricula, learning is becoming less content based and the emphasis is changing to problem based learning, continuing self directed learning, and the use of a wide range of learning resources. Particular needs in paediatrics and child health are an increasing emphasis on learning in ambulatory care and community based health facilities, and on assessment processes which are formative and reflect the learning objectives appropriately. A wide range of resources is needed for learning at a time when teaching hospital and health system facilities face significant financial restraints.
Carrier identification in X‐linked immunodeficiency diseases
Authors: LI SL , TING SS , LINDEMAN R , FFRENCH R , ZIEGLER JB
Published: November 2003

Objective:

Carrier identification in X‐linked immunodeficiency disorders can be based on the demonstration of non‐random X inactivation (NRXI) in affected blood cell lineages when growth is impaired in cells expressing the abnormal gene. We examined the utility of seeking evidence of NRXI1 to test the carrier status of women in families affected by X‐linked severe combined immunodeficiency (XSCID) and X‐linked hypogammaglobulinaemia (XLH),2 to identify as carriers the mothers of boys with SCID or hypogammaglobulinaemia whose phenotype suggested X‐linkage and3 to infer X‐linkage in boys with SCID or hypogammaglobulinaemia whose disease was not clearly X‐linked on the basis either of family history or clinical and immunological characteristics.

Methodology:

A polymerase chain reaction‐based method was used to amplify a polymorphic CAG repeat in the first exon of the androgen receptor gene after selective digestion of the active X chromosome with a methylation‐sensitive enzyme, HpaII to distinguish between the paternal and maternal alleles and to identify their methylation status.

Results:

Heterozygosity was found in 24 of 31 female subjects (77%). As anticipated, NRXI could be demonstrated in all lymphoid cells studied from obligate carriers of XSCID and an obligate carrier of XLH but not on a carrier of X‐linked immunodeficiency with hyper‐IgM. The finding of NRXI in the mother of a boy with a SCID variant showed her to be a carrier of XSCID and establishes that her son has XSCID, not otherwise evident from available data.

Conclusions:

This PCR assay provides a rapid method for carrier detection of X‐linked immunodeficiencies, and has allowed us to expand the phenotype of XSCID
Prevalence and risk factors of childhood asthma, rhinitis and eczema in Hong Kong
Authors: LAU YL , KARLBERG J
Published: November 2003

Objective: To assess the prevalence and risk factors of childhood asthma and allergies in Hong Kong and compare with that in Singapore and Great Britain.

Methodology: Parents of 3618 randomly selected 6‐ to 7‐year‐old children responded to a questionnaire prepared by the International Study of Asthma and Allergies in Childhood (ISAAC) together with supplementary questions on risk factors.

Results: The 12‐month prevalences of wheezing, rhinitis symptoms and itchy rash were 9.2%, 35.1% and 4.2%, respectively. Wheezing in the past year was significantly associated with rhinitis symptoms in the past year, itchy rash in the past year, rhinitis interfering with daily activities moderately or severely, kept awake by itchy rash in the past year, parental wheezing (one or both parents), frequent upper respiratory tract infections (URTI), born in Hong Kong and male sex. For girls, the prevalence of wheezing in the past year was lowest when they were born in July/August and highest when born in January/February.

Conclusions: The prevalence of allergic disorders in Hong Kong was comparable to that in Singapore and Great Britain. Several potential risk factors such as parental wheezing, frequent URTI, born in Hong Kong, male sex and month of birth in girls were identified.
Immunogenicity and reactogenicity associated with an 18‐month booster dose of a new diphtheria‐tetanus‐whole cell pertussis vaccine
Authors: NOLAN T , HOGG G , DARCY M‐A , CARLIN JB , SKELJO M , VARIGOS J
Published: November 2003

Objective:

To establish safety and immunogenicity of a reformulated whole cell pertussis based diphtheria‐tetanus‐pertussis vaccine (DTPw) at the 18‐month booster stage following a 2,4, and 6‐month primary immunisation course.

Method:

Open trial in suburban Melbourne in 100 healthy children initially recruited through maternal and child health centres. Thirty‐five subjects were bled prior to vaccination, and 4–6 weeks after vaccination. A 7‐day diary card was used to record subject temperatures and other systemic and local clinical signs.

Results:

The increase in antibody geometric mean titres (GMT) after boosting was 19.6‐fold (95%ci 14.2, 27.2) for tetanus and 26.5‐fold (95%ci 16.6, 42.4) for diphtheria. Pertussis antibody GMTs also all showed substantial increases following the booster, with mean fold changes in titre ranging from 7.3 (Agg2) to 31.3 (Fha). Seventeen percent of subjects (95%ci 10%, 26%) experienced axillary temperatures ≥38°C during the 24‐h period following vaccination. Low rates of significant (>25 mm) injection site redness (13%) and swelling (8%) were recorded at 24 h postvaccination.

Conclusion:

This vaccine was well tolerated by children at 18 months of age, and showed substantial boosting of antibody to all components.
Non‐typhoid Salmonella gastroenteritis
Authors: LEE WS , PUTHUCHEARY SD , BOEY CCM
Published: November 2003

Objective:

To study the clinical features of non‐typhoid Salmonella gastroenteritis and the incidence, risk factors and outcome of invasive complications in urban Malaysian children. To describe the serotypes of Salmonella species isolated and the pattern of antibiotic susceptibility.

Methodology:

Retrospective review of a group of 131 children with non‐typhoid Salmonella gastroenteritis seen at the University Hospital, Kuala Lumpur, Malaysia from January 1994 to December 1996.

Results:

Sixty‐seven percent were infants below one year of age. Fever and vomiting were seen in nearly half of children. Seven children (5.3%) had invasive complications: 5 bacteraemia and 2 meningitis. Age below 6 months, fever >38.0°C, and dehydration on admission were significantly associated with invasive complications. The commonest serotypes isolated were S. enteritidis, S. paratyphi B, and S. bovis‐morbificans. A total of 94–100% of isolates were susceptible to commonly prescribed antibiotics.

Conclusions:

Children with Salmonella gastroenteritis below 6 months of age who are febrile and dehydrated should be treated empirically with antibiotics until the result of blood culture is available.
The synergistic effects of stimulants and parental psychotherapy in the treatment of attention deficit hyperactivity disorder
Authors: STIEFEL I , DOSSETOR D
Published: November 2003

A 5‐year‐old boy presented with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and separation anxiety disorder. The clinical assessment revealed longstanding parent‐child relationship problems, ongoing family stress, and a chronic level of low grade depression in the mother. The treatment approach consisted of drug treatment of the child and long‐term psychotherapy of the mother. At termination symptoms associated with ADHD were markedly reduced and parent‐child relationship problems were no longer evident. It is argued that in a subgroup of children family stress and attachment difficulties may be involved in the development of ADHD. These difficulties should be considered separately in the treatment of children with ADHD, especially if still present after the symptomatic treatment. The treatment outcome raises the question whether or not certain symptoms attributed to ADHD may be reversible, and the long‐term adverse outcome of the condition preventable.
Suppression of elevated alanine aminotransferase activity in liver disease by vigabatrin
Authors: WILLIAMS A , SEKANINOVA S , COAKLEY J
Published: November 2003

A patient with hepatic cirrhosis due to Alpers disease is described who had a significantly raised plasma alanine aminotransferase (ALT) activity of 247 U/L which returned to normal (18 U/L) shortly after commencing treatment with the anticonvulsant drug, vigabatrin. Previous studies have reported smaller reductions in plasma ALT activity due to vigabatrin, generally in patients with normal liver function. This case demonstrates that vigabatrin may also reduce markedly elevated ALT activity to the normal range in patients with documented liver disease. Plasma ALT activity cannot be used as an index of liver cell damage in patients receiving vigabatrin.
Renal effects of temocapril hydrochloride (CS‐622) in patients with benign nephrosclerosis
Authors: NONOGUCHI Hiroshi , OWADA Akira , UMEHARA Isao , KIYAMA Shigeru , TERADA Yoshio , MARUMO Fumiaki , TOMITA Kimio
Published: November 2003

SUMMARY: The short‐term effects of temocapril, a new angiotensin‐converting enzyme inhibitor (ACE‐I), on renal function were investigated in 10 patients with benign nephrosclerosis (56.2 ± 7.2 years, mean ± SD). Renal plasma flow and glomerular filtration rate (GFR) were examined before and after 12‐week administration, using 131I‐hippuran and 99mTc‐DTPA, respectively. Temocapril (mean 4.5 mg/day) decreased systolic and diastolic blood pressure (from 162 ± 6 to 140 ± 12 mmHg, P<0.001, and from 101 ± 5 to 89 ± 8 mmHg, P<0.001, respectively). Temocapril increased both renal plasma flow (from 323 ± 67 to 367 ± 72 mL/min/1.73 m2P<0.05) and GFR (from 74 ± 14 to 81 ± 15 mL/min/1.73 m2, P<0.05). These data show that short‐term administration of temocapril improves renal function in patients with benign nephrosclerosis.
The effects of a high salt diet on gene expression of Na+/H+ exchanger and growth factors in 5/6‐nephrectomized rats
Authors: HIGASHI Harumichi , OKUDA Seiya , TAMAKI Kiyoshi , ANDO Takashi , FUJISHIMA Masatoshi
Published: November 2003

SUMMARY: The effects of a high salt diet on renal destruction and the therapeutic effects of amiloride (Na+/H+ exchanger inhibitor) and furosemide (Na+K+/2Cl− exchanger inhibitor) were examined in 5/6‐nephrectomized rats fed a high salt diet. A simultaneous analysis of the effects of a high salt intake on the renal expression of Na+/H+ exchanger‐1 (NHE‐1), transforming growth factor‐β1 (TGF‐β1) or platelet‐derived growth factor‐B (PDGF‐B) mRNA was performed in this model. the 5/6‐nephrectomized Sprague‐Dawley rats were given a diet containing 8 or 1% sodium chloride for 5 weeks. This high salt diet accelerated the elevation of blood pressure and aggravated both glomerulosclerosis and interstitial fibrosis in 5/6‐nephrectomized rats. the daily administration of amiloride was found to be protective against the elevation of blood pressure, glomerular hypertrophy and the aggravation of renal histology which were induced by a high salt diet. the expression of TGF‐β1 and PDGF‐B mRNA was up‐regulated by a high salt diet, but the expression of NHE‐1 mRNA was not. the overexpression of TGF‐β1 and PDGF‐B mRNA was reduced by the daily administration of amiloride but not by furosemide. In conclusion, the destructive effects of a high salt diet on the kidneys may be mediated through hypertension, glomerular hypertrophy and the overexpression of the growth factors. Amiloride may thus be more protective for high salt induced renal aggravation than furosemide, although the expression of NHE‐1 mRNA did not show any substantial increase due to a high salt diet.
The arts and restoration: A fertile partnership?
Authors: Curtis David
Published: November 2003

The creative urge is fundamental to the human condition and provides a conspicuous common ground between members of Landcare and the arts, prompting us to ask whether artists can become more involved in changing community behaviour toward the environment.
Local habitat restoration in streams: Constraints on the effectiveness of restoration for stream biota
Authors: Bond N. R. , Lake P. S.
Published: November 2003

Summary  The restoration of physical habitat has emerged as a key activity for managers charged with reversing the damage done by humans to streams and rivers, and there has been a great expenditure of time, money and other resources on habitat restoration projects. Most restoration projects appear to assume that the creation of habitat is the key to restoring the biota (‘the field of dreams hypothesis’). However, in many streams where new habitat is clearly required if populations and communities are to be restored, there may be numerous other factors that cause the expected link between habitat and biotic restoration to break down. We discuss five issues that are likely to have a direct bearing on the success, or perceived success of local habitat restoration projects in streams: (i) barriers to colonization, (ii) temporal shifts in habitat use, (iii) introduced species, (iv) long‐term and large‐scale processes, and (v) inappropriate scales of restoration. The purpose of the study was primarily to alert ecologists and managers involved in stream habitat restoration to the potential impacts of these issues on restoration success. Furthermore, the study highlights the opportunities provided by habitat restoration for learning how the factors we discuss affect populations, communities and ecosystems.
Feeding of wildlife: How effective are the ‘Keep Wildlife Wild’ signs in Tasmania's National Parks?
Authors: Mallick Stephen A. , Driessen Michael M.
Published: November 2003

Summary  We investigated attitudes of the visiting public to feeding wildlife and the effectiveness of the ‘Keep Wildlife Wild’ signs in Tasmania's National Parks. We surveyed visitors to three visitor nodes in two National Parks for their opinions regarding the feeding of wildlife. Participants were asked whether they had seen a ‘Keep Wildlife Wild’ sign, and the role played by the sign in determining their opinions. A total of 118 visitors were interviewed. The majority of respondents (92.2%) were against feeding wildlife. Only 3.5% of respondents were in favour of feeding wildlife, while 4.3% had no opinion on the subject. The most commonly cited reason against feeding wildlife was that it caused harm to the animal. The majority of respondents (69.6%) had sighted a ‘Keep Wildlife Wild’ sign posted in Tasmania's National Parks since 1996, 84.6% of which said that the sign had reinforced a pre‐existing opinion against feeding. Only 3.9% of respondents who had seen the sign said that the sign had formed their opinion against feeding. We also observed a total of 68 people interacting with wildlife while they were eating lunch. A total of 70 interactions between visitors (n = 68) and wildlife were recorded. Thirty‐seven (52.9%) of these interactions involved feeding an animal, although this feeding activity was carried out by only five people (7.4% of total). Numerous examples of inadvertent feeding were also observed in which Black Currawongs (Strepera fuliginosa) scavenged for food scraps once visitors had left.
Outcome, tolerability and compliance of compassionate use interferon and ribavirin for hepatitis C infection in a shared care hospital clinic
Authors: Kontorinis N. , Garas G. , Young J. , Speers D. , Chester B. P. , MacQuillan G. C. , De Boer B. , Chapman M. D. , Forster E. , Jeffrey G. P.
Published: November 2003

Abstract

Background and aims:  To determine response rate, side‐effects and compliance in patients with chronic hepatitis C virus (HCV) infection following treatment with ­interferon‐α−2b and ribavirin in a ‘shared care’ hospital clinic.

Methods:  Data were collected prospectively on 81 patients treated with combination therapy for chronic HCV infection between 1999 and 2001. All had biochemical and virological evidence of active infection. All patients had undergone liver biopsy except haemophiliac patients. Patients infected with genotype 1 were treated for 12 months. Patients infected with genotypes 2 and 3 were treated for 6 months. Patient care was shared with the referring general practitioner. Intention to treat, end of treatment and sustained virological response (SVR) rates, side‐effects and compliance were assessed.

Results:  Eighty‐one patients with chronic HCV infection were treated with combination therapy. The majority of HCV patients were genotype 1 (n = 46; 57%). There were 12 patients (15%) with cirrhosis. SVR rates were: (i) 24% for genotype 1, (ii) 58% for genotype 3 and (iii) 75% for genotype 2. SVR was achieved in three (23%) cirrhotic patients. Compliance with the treatment regimen was 98%. Seven per cent of patients were withdrawn from therapy prematurely because of side‐effects.

Conclusions:  These ‘shared care’ clinic results compare well with controlled clinical trials using combination therapy for chronic HCV infection. Outcomes were poorer in genotype 1 patients and in patients with cirrhosis. Compliance with therapy was excellent because of the ‘Shared Care Programme’ with participation of general practitioners, psychiatrists and hepatitis C nurse practitioners in the management protocol. (Intern Med J 2003; 33: 500−504)
Verapamil Suppresses the Inhomogeneity of Electrical Remodeling in a Canine Long‐Term Rapid Atrial Stimulation Model
Authors: MORIGUCHI MASAHIKO , NIWANO SHINICHI , YOSHIZAWA NAOTO , KOJIMA JISHO , INUO KIMIATSU , IZUMI TOHRU
Published: November 2003

Verapamil is known to suppress shortening of the atrial effective refractory period (AERP) during relatively short‐term atrial pacing, although the effect of a long‐term stimulation model is unclear. The effect of verapamil on electrical remodeling was evaluated in a canine rapid atrial stimulation model. The right atrial appendage (RAA) was continuously paced (400 beats/min) for 2 weeks. Four pairs of electrodes were sutured at four atrial sites; the RAA, right atrium close to the inferior vena cava, Bachmann's bundle, and LA. AERP, AERP dispersion (AERPd), conduction time, and inducibility of AF were evaluated during the pacing phase and the recovery phase. The same protocol was performed under the administration of verapamil. In five control dogs, the AERP shortening was inhomogeneous and the shortening of the AERP was most prominent in the LA. AERPd increased during the rapid pacing phase by 5 ± 2 ms, but recovered quickly in the recovery phase. The max AERPd was 46 ± 4 ms in the control group and was larger than that in the verapamil group (31 ± 3 ms, P = 0.001). At the LA site, the shortening of the AERP was decreased by verapamil administration (−19 ± 3 vs −5 ± 2 ms, P = 0.04). However, the AF inducibility was not significantly different between the two groups. The effect of verapamil on electrical remodeling was inhomogeneous, depending on the anatomic portion. As a result, AERPd widening during the rapid pacing phase was suppressed by verapamil, while the AF inducibility was unchanged. (PACE 2003; 26:2072–2082)