bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduced colonization of gastric mucosa by Helicobacter pylori in mice deficient in interleukin‐101
Authors: Chen Wangxue , Shu Dairu , Chadwick Vinton S
Published: March 2003

Background and Aims: Interleukin‐10 (IL‐10) is a potent anti‐inflammatory and immunoregulatory cytokine. Mice deficient in IL‐10 production (IL‐10−/−mice) develop a spontaneous chronic enterocolitis, suggesting that IL‐10 is an important regulator of the mucosal immune response in vivo. The objective of this study was to determine the role of endogenous IL‐10 in the host defense against gastric colonization by Helicobacter pylori by using IL‐10‐deficient mice.

Methods: The IL‐10−/−mice were inoculated intragastrically with a mouse‐adapted H. pylori isolate (Sydney Strain 1). Gastric colonization by H. pylori (biopsy urease test and bacterial colony counts), serum levels of H. pylori‐specific immunoglobulin (Ig) M, A, G, isotypes of IgG, and the gastric mucosal inflammatory scores were determined 6 weeks after inoculation. Results were compared with those obtained from H. pylori‐infected control mice (IL‐10 +/−mice).

Results: The colonization of gastric mucosa by H. pylori was reduced approximately 100‐fold (P≤ 0.0001) in IL‐10−/−mice (log10 4.87 ± 0.26 CFU/g tissue) as compared to IL‐10+/−mice (log10 6.64 ± 0.22 CFU/g tissue). Furthermore, IL‐10−/−mice infected with H. pylori had significantly higher H. pylori‐specific IgA and IgG antibodies in serum (P≤ 0.01), and developed much more severe chronic active gastritis than infected IL‐10+/−mice. The median scores of the infiltration of gastric mucosa by mononuclear cells and neutrophils were up to threefold higher in IL‐10−/−mice than they were in IL‐10+/−mice.

Conclusion: Our studies suggest that endogenous IL‐10 is an inhibitor of the protective immune response to H. pylori infection. Interleukin‐10 participates in the downregulation of H. pylori‐induced gastric inflammatory responses, which apparently confers a survival advantage to the organism promoting more effective colonization of gastric mucosa.
Endoscopic duodenitis, gastric metaplasia and Helicobacter pylori
Authors: Urakami Yoshihito , Sano Toshiaki
Published: March 2003

Background and Aims: The purpose of this study was to investigate the relationship between gastric metaplasia and Helicobacter pylori in patients with endoscopic duodenitis.

Methods: The subjects were 57 patients with endoscopic duodentitis with or without H. pylori‐associated gastritis. Biopsy specimens were obtained from the stomach and duodenal bulb to assess the histological findings and H. pylori infection. Gastric metaplasia was divided into three types: complete, intermediate and incomplete, according to the amount of mucus in the metaplastic cells. In 10 H. pylori‐positive patients, endoscopic and histological findings of duodenitis were compared before and after eradication of the bacteria.

Results: There was no significant difference in the extent of gastric metaplasia or the appearance and severity of endoscopic duodenitis between H. pylori‐positive and ‐negative groups. The complete type of gastric metaplasia was frequently detected in the H. pylori‐negative group, whereas the incomplete type was frequently observed in the H. pylori‐positive group. After eradication of H. pylori, the incomplete type changed to the complete type with a decrease of histological inflammation.

Conclusions: The complete type of gastric metaplasia occurred frequently without H. pylori infection, whereas the incomplete type was frequently associated with H. pylori infection.
Long‐term histological prognosis and serum fibrosis markers in chronic hepatitis C patients treated with interferon
Authors: Kojima Hiroshi , Hongo Yasushi , Harada Hideharu , Inoue Toshihiro , Miyaji Katsuhiko , Kashiwagi Motomi , Momose Tetsuya , Arisaka Yoshifumi , Fukui Hideo , Murai Seiyo , Tokita Hajime , Kamitsukasa Hiroshi , Yagura Michiyasu , Katsu Kenichi
Published: March 2003

Background:Interferon (IFN) therapy is effective in 20–40% of patients with chronic hepatitis C, but the relationship between histological changes and the response to interferon is still unclear. We investigated the long‐term histological prognosis and the changes of serum fibrosis markers after interferon therapy relation to the response.

Methods and Results:One hundred and eighteen patients with chronic hepatitis C who received interferon therapy were divided into four groups based on the detection of viremia and the serum alanine aminotransferase (ALT) level after treatment. A histological examination was performed by using the histological activity index and the criteria of the METAVIR score. Serum fibrosis markers were used to measure the levels of hyaluronic acid and type IV collagen 7s. Responders, whose serum ALT levels became normal after treatment, demonstrated histological improvement. Histological improvement was more rapid in sustained virological responders with hepatitis C virus (HCV) RNA seronegativity than in biochemical responders with HCV‐RNA seropositivity. Only sustained virological responders exhibited histological cure. In partial responders, whose serum ALT levels decreased to less than twice the upper of normal, and non‐responders whose serum ALT levels were not reduced, liver fibrosis was unchanged or showed progression. Serum fibrosis markers increased with progression of the histological stage and varied depending on the response to interferon.

Conclusion:Normalization of serum ALT levels after interferon therapy led to a histological improvement, and that with viral clearance achieved histological cure. Serum fibrosis markers were useful indicators for long‐term according to the response of IFN therapy.
Incidence, spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis
Authors: Garg Pramod Kumar , Khanna Sudeep , Bohidar Narendra Prasad , Kapil Arti , Tandon Rakesh Kumar
Published: March 2003

Background and Aim: Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis.

Methods: All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded.

Results: A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty‐four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin.

Conclusion: Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones.
Prevalence of vaccine‐induced escape mutants of hepatitis B virus in the adult population in China: A prospective study in 176 restaurant employees
Authors: He Chuan , Nomura Fumio , Itoga Sakae , Isobe Kazumasa , Nakai Toshiaki
Published: March 2003

Background and Aim: Hepatitis B virus (HBV) variants with mutations in the S gene would pose a substantial risk to the community as current HBV vaccines are not effective in preventing infection with them. The majority of such vaccine escape mutants so far reported have been found while studying vertical transmission of HBV; the vaccine failure rate in connection with vaccine escape mutants in adults is not clear at the moment. The purpose of this study was to evaluate the efficacy of immunization against HBV in the adult population by analysis using polymerase chain reaction (PCR) to detect HBV‐DNA, and also to elucidate the type of mutation encountered in vaccine failure cases.

Method: A total of 176 adult restaurant employees in China, who had been vaccinated according to the food epidemic law, were enrolled in a standard vaccination program. Their serum HBV‐DNA was determined before and 1 year after the completion of the vaccination program. In those infected with HBV, despite having received the HBV vaccine, direct sequencing within the S gene of the amplified samples was conducted.

Results: Although only two cases were found to be hepatitis B surface antigen (HBsAg) positive 1 year after the completion of the vaccination program, six subjects (3.4%) were found to be HBV‐DNA positive assessed by a nested PCR. Four out of these six cases had a point mutation within the ‘a’ determinant; they were Gly‐145‐Ala, and Ile/Thr‐126‐Asn/Ser.

Conclusion: The HBV vaccine failure rate assessed by using PCR analysis was 3.4% (six of 176) in the Chinese adult population undergoing the HBV vaccination program. Hepatitis B virus variants with missense mutation within the ‘a’ determinant were responsible in most cases.
Hepatitis B viral genotypes: Clinical relevance and molecular characteristics
Authors: KAO JIA‐HORNG
Published: March 2003

Abstract  Hepatitis B virus (HBV) infection is a global health problem and the clinical outcome of chronic HBV infection depends on the frequency and severity of hepatitis flares in the immune clearance phase. Currently, four subtypes and seven genotypes of HBV are identified and most have specific geographic distributions. The impact of HBV genotypes on the clinical outcome of chronic HBV infection has been partially clarified. In Taiwan, genotype C is associated with more severe liver disease and genotype B is associated with the development of hepatocellular carcinoma (HCC) in young non‐cirrhotic patients. In contrast, genotype B has a relatively good prognosis in Japan and China and is rarely associated with the development of HCC. Similarly, genotype D is associated with more severe liver disease than genotype A in India and may predict occurrence of HCC in young patients. Although superinfection of HBV on top of hepatitis B carriers occurs in Taiwan, it is rarely associated with acute exacerbations. As to the response to antiviral treatment, genotypes C and D are associated with a lower response rate to interferon therapy compared with genotypes B and A. In addition, the subtype adw is reported to be associated with a higher risk of lamivudine resistance than ayw. In HBV subtype adw‐infected HCC patients, genotype B responds better to embolization therapy and has a lower rate of HCC recurrence than genotype C. In summary, pathogenic and therapeutic differences do exist among HBV genotypes and determining the genotype in patients with chronic HBV infection would help gain further information for etiologic, clinical, virologic and anthropologic investigations. Further studies to clarify the molecular virological factors that contribute to these differences are awaited.
Fusobacterium varium localized in the colonic mucosa of patients with ulcerative colitis stimulates species‐specific antibody
Authors: Ohkusa Toshifumi , Sato Nobuhiro , Ogihara Tatuo , Morita Koji , Ogawa Masayuki , Okayasu Isao
Published: March 2003

Abstract Background: Microbial agents are a possible cause of ulcerative colitis. We have previously reported evidence of bacteria invading the colonic mucosa of patients with ulcerative colitis. We have isolated bacteria from inflamed colonic mucosa, examined the localization of the species in the mucosa, and assayed for serum antibodies to the bacteria.

Methods: Cohorts of 31 per group were enrolled from patients with active ulcerative colitis, Crohn's disease, ischemic colitis, and colon adenomas. A group of 31 healthy controls were also studied. The presence of bacteria in biopsies of patients with ulcerative colitis was analyzed by both isolation and immunohistochemistry. Sera from patients were tested for bacterial antibodies using both Western blots and enzyme‐linked immunosorbent assay (ELISA).

Results: Only sera from patients with ulcerative colitis gave specific reactions with Fusobacterium varium in Western blot assays. The detection rate of specific bands was higher for patients with ulcerative colitis (61%) than for subjects with either Crohn's disease (13%) or healthy controls (29%) (P < 0.001 and P
= 0.021, respectively). The ELISA showed that the mean optical densities with extracts of F. varium as antigen were significantly higher for ulcerative colitis patients than for subjects with either Crohn's disease or healthy controls (P < 0.001). Immunohistochemical detection of F. varium in colonic mucosa was significantly higher in patients with ulcerative colitis (84%) than for subjects with either Crohn's disease (16%) or other controls (3–13%) (P < 0.001).

Conclusions: Fusobacterium varium
bacteria were present in a significant number of patients with active ulcerative colitis, and should be tested in therapeutic trials in order to confirm the causal relationship between
F. varium and ulcerative colitis.
Preventive effects of parathyroid hormone‐related peptide on stress‐induced gastric hypercontraction in the rat
Authors: ITO MASAHIRO , NAKASHIMA MASAHIRO , NAKAYAMA TOSHIYUKI , SHIKUWA SABURO , OHTSURU AKIRA , SEKINE ICHIRO
Published: March 2003

Background and Aims
: Parathyroid hormone‐related peptide (PTHrP) appears to be a potent smooth muscle relaxant, but there has been no study of its effects on gastric motility in vivo. The purposes of this study were to evaluate the effects of external PTHrP on stress‐induced gastric motility in vivo and on the expression of PTHrP and PTH/PTHrP receptors in the rat stomach.

Methods
: Stress‐induced hypercontraction was evoked by restraint water immersion (RWI). Gastric motility was evaluated with a strain gauge force transducer, and the effects of external PTHrP‐(1–34) (10 µ i.p.) on gastric motility were examined. Expressions of PTHrP and PTH/PTHrP receptor mRNA were evaluated by RNase protection assay.

Results
: External PTHrP significantly suppressed abnormal contraction and mucosal lesions upon RWI stress. Upon RWI stress, the expression of PTHrP mRNA decreased, but that of PTH/PTHrP receptor mRNA was enhanced reciprocally. The PTH/PTHrP receptor was localized in smooth muscle cells of the muscle layers immunohistochemically.

Conclusions
: These findings suggest that smooth muscle contractile activity is modified by the autocrine/paracrine mechanism of PTHrP in the rat stomach and that the external PTHrP prevents stress‐induced hypercontraction and mucosal lesions.

© 2002 Blackwell Publishing Asia Pty Ltd
Virtual colonoscopy for the detection of colorectal polyps and cancers in a Chinese population
Authors: WONG BENJAMIN CHUN‐YU , WONG WAI‐MAN , CHAN JOHN KF , LAI KAM‐CHUEN , HU WAYNE HC , CHAN CHI‐KUEN , LAM SHIU‐KUM , CARR‐LOCKE DAVID L
Published: March 2003

Aim:
The aim of this study is to assess the sensitivity of virtual colonoscopy in detecting colorectal polyps and cancers in a Chinese population.

Methods:
Seventy‐one consecutive Chinese patients (38 men and 33 women) referred for diagnostic colonoscopy were recruited. Patients received a routine bowel preparation in the morning followed by a helical abdominal computed tomography (CT) scan with air insufflation of the colon. The CT images were then processed by using surface‐rendered software and interpreted by a single radiologist who was blinded to the clinical information. Colonoscopy was performed in the same afternoon without knowledge of the radiology results. All polyps and cancers were proven histologically.

Results:
Five colorectal cancers were diagnosed and all were detected by virtual colonoscopy. The sensitivity and specificity of virtual colonoscopy for the detection of patients with polyps of all sizes, and patients with polyps ≥10 mm were 59, 92, 88 and 100%, respectively. The procedure was well tolerated by all patients.

Conclusions:
This study was carried out in a real clinical setting without a preselection of cases. Virtual colonoscopy was satisfactory for the detection of polyps greater than 10 mm, and for the diagnosis of cancer, and it is also a promising imaging modality for colorectal neoplasm detection in a Chinese population.

© 2002 Blackwell Publishing Asia Pty Ltd
Clinical and laboratory differentiation of cirrhosis and extrahepatic portal venous obstruction in children
Authors: PETER LORANCE , DADHICH SUNIL KUMAR , YACHHA SURENDER KUMAR
Published: March 2003

Background and Aim:  Differentiation between cirrhosis and extrahepatic portal venous obstruction (EHPVO) in children presenting with features of portal hypertension is important for cost‐effective management and proper resource utilization. We undertook this study to differentiate clinical and laboratory features between these two groups of patients.

Methods:  Clinical features and laboratory parameters at presentation of children with portal hypertension and cirrhosis of the liver were analyzed. The variables analyzed were age at presentation, duration of symptoms, incidence and frequency of upper gastrointestinal (GI) bleeding, encephalopathy, jaundice, ascites, splenomegaly, and presence of dilated abdominal veins. The laboratory parameters studied were hemoglobin, prothrombin time, serum bilirubin, albumin, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase. Two groups were compared using appropriate statistical methods; and the differentiating features were analyzed using logistic regression analysis.

Results:  Of the total of 120 cases, cirrhosis was diagnosed in 28.3% and EHPVO in 71.6%. Children with EHPVO, in comparison to cirrhosis, had significantly higher frequency of upper GI bleeding (61.6%vs 14.7%), increased number of previous bleeding episodes (2.7 ± 0.5 vs 1.2 ± 0.4), longer duration of symptoms (25.7 ± 4.6 vs 12.3 ± 3 months) and a lower frequency of jaundice (2%vs 76.4%). Low hemoglobin (6.4 ± 2.7 g/dL) and preserved liver functions characterized by normal bilirubin, albumin levels and prothrombin time were observed in EHPVO cases. Cirrhosis patients had higher hemoglobin (8.8 ± 2.8 g/dL) and abnormal liver function tests.

Conclusion:  Presence of UGI bleeding and the absence of jaundice are 97.5% accurate in predicting diagnosis of EHPVO.
Wnt signaling in hepatocellular carcinoma: Analysis of mutation and expression of beta‐catenin, T‐cell factor‐4 and glycogen synthase kinase 3‐beta genes
Authors: CUI JIAN , ZHOU XINDA , LIU YINKUN , TANG ZHAOYOU , ROMEIH MAHMOUD
Published: March 2003

Background and Aims: Hepatocellular carcinoma (HCC) is a common killer cancer in the world. Recently, abnormal activation of the Wnt pathway has been found to be involved in the carcinogenesis of several human cancers including HCC. The goal of the present study was to investigate the mechanism of inappropriate activation of the Wnt pathway in hepatocarcinogenesis.

Methods: We analyzed the alterations of three key components of the Wnt pathway: β‐catenin, glycogen synthase kinase (GSK)‐3β and T‐cell factor (Tcf)‐4 in 34 HCC and paracancerous normal liver by immunohistochemistry, polymerase chain reaction (PCR)–single‐strand conformation polymorphism (SSCP), direct sequencing, and quantitative real‐time reverse transcription (RT)–PCR.

Results: We found that 61.8% (21/34) of all HCC examined showed an abnormal β‐catenin protein accumulation in the cytoplasm or nuclei. The RT–PCR–SSCP and direct sequencing showed that β‐catenin exon 3 mutations existed in 44.1% (15/34) of the HCC. No mutations of GSK‐3β or Tcf‐4 were detected in HCC. Moreover, messenger RNA of β‐catenin and Tcf‐4, but not GSK‐3β, was found to be overexpressed in HCC. On analyzing the relationship between alterations of β‐catenin or Tcf‐4 and C‐myc or Cyclin D1 expression, we found that mutations of β‐catenin, as well as overexpression of β‐catenin or the Tcf‐4 gene were independently correlated with C‐myc gene overexpression in HCC.

Conclusion: Our present findings strongly suggest that mutations of β‐catenin, as well as overexpression of β‐catenin and the Tcf‐4 gene, independently activate the Wnt pathway in HCC, with the target gene most likely to be C‐myc.
Post‐traumatic stress disorder in paediatric patients and their parents: An exploratory study
Authors: LANDOLT MA , BOEHLER U , SCHWAGER C , SCHALLBERGER U , NUESSLI R
Published: March 2003

Objective:

To determine the prevalence of post‐traumatic stress disorders (PTSD) in a selected population of paediatric patients and their parents.

Methodology:

Twenty‐three high‐risk patients (serious accidents, newly diagnosed cancer) and 11 low‐risk patients (simple planned surgery) and their parents were consecutively selected and assessed 6–8 weeks after the event with a DSM‐IV based diagnostic interview and the PTSD Symptom Scale.

Results:

There is a high prevalence of PTSD in children and parents of the high‐risk group. In the low‐risk group such disorders are almost nonexistent. Parents in both groups report more PTSD symptoms than their children. Sex and age of the child and duration of hospitalisation have no significant influence on the development of PTSD.

Conclusions:

The high prevalence of PTSD in high‐risk paediatric patients and their parents offers support for the applicability of a post‐traumatic stress model for understanding the psychological impact of accidents, severe illnesses and their medical treatment.
Is urethral catheterization a successful alternative to suprapubic aspiration in neonates?
Authors: Austin BJ , Bollard C , Gunn TR
Published: March 2003

Objective: To compare urine collection by urethral catheterization with suprapubic aspiration in a neonatal intensive care unit.

Methodology: All urine collections were documented, the collection methods attempted recorded and success rates calculated. The incidence of contaminated specimens was determined. The infants ranged in weight from 570 g to 4180 g and in gestation from 24 to 44 weeks.

Results: Thirty‐two out of 65 (49%) suprapubic aspirations were successful. Overall 33/42 (77%) of catheterizations were successful, 12/18 (67%) were successful when following an unsuccessful SPA. No SPA was contaminated compared to 7/22 (22%) of the catheter specimens. Urinary tract infection was present in 4/63 (6.3%) infants. There were no complications following catheterization.

Conclusions: Urethral catheterization is a useful and safe alternative to suprapubic aspiration, but suprapubic aspiration remains the method of first choice.
Risk of gonadoblastoma in female patients with Y chromosome abnormalities and dysgenetic gonads
Authors: Gibbons B , Tan SY , Yu CC‐W , Cheah E , Tan HL
Published: March 2003

Abstract:We report two female patients with gonadal dysgenesis and sex chromosome mosaicism involving the Y chromosome. Conventional karyotyping was supplemented with fluorescentin situhybridisation techniques in order to confirm the presence of Y chromosomes. One patient is a phenotypic female with karyotype 45,X/46,X,idic(Y)(q11.2). She underwent a laparoscopic gonadectomy at which streak ovaries without evidence of gonadoblastoma were removed. The second patient presented as a virilised female with karyotype 45,X/47,XYY. At laparoscopy, she was found to have mixed gonadal dysgenesis with a gonadoblastomain situ. We recommend early gonadectomy in female children presenting with gonadal dysgenesis and the presence of a Y chromosome although once the gonadoblastoma locus on Y chromosome gene has been cloned it may be possible to identify those patients who have a low risk of developing gonadoblastoma.
Favourable neurological outcomes following delivery room cardiopulmonary resuscitation of infants ≤ 750 g at birth
Authors: Jankov RP , Asztalos EV , Skidmore MB
Published: March 2003

Objective: To study short‐ and long‐term outcomes of infants ≤ 750 g birthweight who received cardiopulmonary resuscitation (CPR) in the delivery room.

Methodology: A retrospective analysis of all inborn live births ≤ 750 g birthweight from 1990 to 1996. Cardiopulmonary resuscitation was defined as positive pressure ventilation via an endotracheal tube and chest compressions. Univariate analyses were conducted comparing patients according to the use of CPR or positive pressure ventilation alone.

Results: Cardiopulmonary resuscitation was administered to 16 infants: four received chest compressions only and 12 also received adrenaline. Cardiopulmonary resuscitation recipients had significantly lower Apgar scores at both 1 and 5 min, and had delayed onset of spontaneous respiration (P < 0.01). Seven patients died, and eight of nine survivors were free of major neurodevelopmental abnormalities at follow up. All CPR recipients with a 5 min Apgar score of ≤ 5 and delayed onset of spontaneous respiration beyond 5 min had poor outcomes.

Conclusion: Contrary to the majority of published evidence, delivery room CPR in our extremely small infants was not associated with a high risk of severe neurodevelopmental disability.
Kingella kingae infections in children
Authors: Dodman T , Robson J , Pincus D
Published: March 2003

Objective: To increase awareness of Kingella kingae infections in children by presenting four cases seen at the Gold Coast Hospital, Southport, Queensland, and reviewing the literature.

Methodology: Records of the four cases were reviewed and relevant information described. A MEDLINE search of the English literature from 1983 to 1998 was conducted.

Results: Osteoarticular infections are the commonest type of invasive paediatric infection but bacteraemia and endocarditis also occur. Isolation of the organism is difficult but inoculation of the specimen into enriched blood culture systems improves the recovery rate. The majority of isolates are sensitive to beta‐lactam antibiotics but resistance has been described.

Conclusions: Kingella kingae infections in children are more common than previously recognized. The organism should be actively sought in any child with suspected osteoarticular infections. Recommended empiric therapy is a third generation cephalosporin until susceptibility to penicillin is confirmed.
General practitioners: Their contact with maternal and child health nurses in postnatal care
Authors: Mbwili‐Muleya C , Gunn J , Jenkins M
Published: March 2003

Objective: To assess the level of contact of general practitioners (GP) with maternal and child health nurses (MCHN) in postnatal care.

Methodology: A postal survey of 1104 Victorian GP was used, with a response rate of 70%. To account for the clustered sampling frame, hierarchical data analysis techniques were used.

Results: Half of the GP (351/710) had no contact with their local MCHN in the previous month; and one in 10 had four or more contacts. Eighty‐eight per cent of GP described the contact as helpful. In 56% of cases the MCHN was reported as the usual initiator of the contact. The most common reason for contact concerned the baby’s physical problems (42%). After adjusting for the number of women seen for the routine 6‐week postnatal review and other GP characteristics, male GP were as likely as female GP to report MCHN contact (odds ratio (OR) = 1.00; 95% confidence interval (CI) = 0.67–1.62). General practitioners aged 31–40 years were more likely to report contact with MCHN than GP aged 51–60 (OR = 0.45; 95% CI = 0.22–0.86) as were GP with the FRACGP qualification (OR = 1.64; 95% CI = 1.21–2.45).

Conclusions: This study provides baseline information on the level of GP contact with MCHN as they provide postnatal care. Although there were GP in Victoria who maintained a level of contact with MCHN, almost half reported no contact in the previous month. Most GP who reported contact with MCHN found it useful. This finding should encourage GP and MCHN coordination to improve continuity and postnatal care outcomes.
Echocardiography on neonatal intensive care units in Australia and New Zealand
Authors: Evans N
Published: March 2003

Objective: To establish the number of neonatal intensive care units (NICU) in Australia and New Zealand where echocardiography is performed by neonatologists, and to establish attitudes to the training of neonatologists in echocardiography.

Methodology: A survey was conducted of the directors of all 29 level 3 NICU in the Australian and New Zealand Neonatal Network. Replies were received from all NICU.

Results: In 41% of NICU, a neonatologist provides the primary echocardiography service, with half these units having more than one neonatologist with skills. Sixty‐eight per cent of the other units would like a neonatologist to develop these skills in the future. Units without a neonatologist with echocardiographic skills were generally less satisfied with their service, benefits and problems for both types of unit are described. Eleven per cent of units felt neonatologists should not be doing echocardiography and 96% of units felt training guidelines should be established.

Conclusions: Ultrasound in neonatology and other specialties is moving beyond its traditional boundaries and becoming part of the acute care doctors’ diagnostic repertoire. This trend needs to be recognized in the specialty training and the ultrasound accreditation processes.
Implementation of evidence‐based management of acute bronchiolitis
Authors: Barben Ju , Robertson Cf , Robinson Pj
Published: March 2003

Objective: Implementation of clinical guidelines is frequently delayed well beyond their dissemination and the publication of clinical evidence. The recently published Australian guidelines for the management of acute viral bronchiolitis (AVB) have been evaluated by assessing the current practice of Australian paediatricians.

Methods: Questionnaire survey of all Australian paediatricians and a review of the literature.

Results: Of a total of 891 questionnaires, 555 (62%) were returned. Of the respondents, 373 (67%) treated children with AVB and, of these, 232 (67%) treated 10–50 children per year. A wide variation in management practice for both outpatient and inpatient treatment of AVB was identified. Up to 70% of paediatricians who treated AVB indicated using pharmaceutical agents in their outpatient management (88% in inpatient management), most using these agents ‘sometimes’ or in high‐risk children. Paediatric respiratory physicians tended to use bronchodilators less frequently than general paediatricians. Compared with many countries in Europe, few Australian paediatricians routinely use supplementary drugs in the inpatient management of AVB; in particular, bronchodilators (61 vs 7%) and corticosteroids (11 vs 1%) are used far less often. A review of the literature demonstrated that pharmaceutical agents do not influence the course of AVB.

Conclusions: Despite a lack of evidence for their efficacy and the recommendation of the Australian guidelines, pharmaceutical agents are frequently used in the management of AVB by paediatricians in Australia, although far less than reported in a recently published European survey. Guidelines alone are not sufficient to implement change and there is a need for more specific strategies to ensure that children receive appropriate management for this common condition.
Sudden infant death syndrome in South Australia 1968–97. Part I: Changes over time
Authors: Beal S M
Published: March 2003

Objective: To compare the epidemiology of sudden infant death syndrome (SIDS) over three consecutive decades.

Methodology: The birth history, infant’s developmental and health history, infant care practices for the infant, death scene investigation and autopsy findings for all infants dying suddenly and unexpectedly in South Australia (SA) between January 1968 and December 1997 were studied.

Results: The incidence of SIDS in SA rose through the 1970s and early 1980s with the highest incidence being in infants born in 1986 at 2.4 per 1000 live births (LB). Two factors felt to be dangerous for some infants were identified – being left unobserved in the prone position and having the head covered by bed clothes. Publicity about the risk of prone sleeping has been accompanied by a fall in SIDS deaths, to an incidence of 0.5 per 1000 LB in 1997. The incidence in Aboriginal infants, and infants living in lower socio‐economic conditions has always been high, but the over‐representation of these groups has increased in the last 5 years.

Conclusion: If no infant under 8 months of age was placed prone or was able to get to prone unobserved before the age when they can easily get back to supine, and no infant was able to get the head completely covered while unobserved, the incidence of SIDS in SA should fall below 0.2 per 1000 LB.
Congenital and perinatal infections with cytomegalovirus
Authors: Trincado DE , Rawlinson WD
Published: March 2003

Abstract: Congenital cytomegalovirus (CMV) infections remain the leading viral cause of congenital malformations in the developed world. Despite advances in our knowledge, the epidemiology and natural history of congenital CMV infection are still poorly understood, particularly in Australia. Congenital CMV causes illness ranging from no clinical disease (asymptomatic, but infected) through to prematurity, encephalitis, deafness and haematological disorders and death. Perinatal CMV acquisition usually results in less severe illness including asymptomatic infection, acute infection with hepatitis, fever, and pneumonitis. CMV infects only humans, and in vitro and in vivo models for intrauterine infection are required in order to test new treatments, and better describe the pathogenesis of congenital CMV. Using new knowledge of the epidemiology and natural history of CMV, treatment regimens during late pregnancy are currently undergoing clinical trial although no definitive recommendations are available.
The diagnosis and management of neonatal urinary ascites
Authors: Oei J , Garvey PA , Rosenberg AR
Published: March 2003

Abstract: Urinary ascites in a newborn infant is unusual and most commonly indicates a disruption to the integrity of the urinary tract. The following report describes a case of urinary ascites, probably due to bladder rupture caused by umbilical artery catheterization, associated with hyponatemia, hyperkalemia and elevated serum creatinine. This unusual biochemical profile is characteristic of urinary ‘autodialysis’ and was corrected by bladder drainage.
Controlled trial of cumulative behavioural effects of a common bread preservative*
Authors: Dengate S , Ruben A
Published: March 2003

Objective:  Many anecdotes and one scientific report describe cumulative behavioural effects of bread preservative on children.

Methodology:  Twenty‐seven children, whose behaviour improved significantly on the Royal Prince Alfred Hospital diet, which excludes food additives, natural salicylates, amines and glutamates, were challenged with calcium propionate (preservative code 282) or placebo through daily bread in a double‐blind placebo‐controlled crossover trial.

Results:  Due to four placebo responders, there was no significant difference by anova of weighted placebo and challenge Rowe Behaviour Rating Inventory means, but a statistically significant difference existed in the proportion of children whose behaviours ‘worsened’ with challenge (52%), compared to the proportion whose behaviour ‘improved’ with challenge (19%), relative to placebo (95% confidence intervals 14−60%).

Conclusions:  Irritability, restlessness, inattention and sleep disturbance in some children may be caused by a preservative in healthy foods consumed daily. Minimizing the concentrations added to processed foods would reduce adverse reactions. Testing for behavioural toxicity should be included in food additive safety evaluation.
Successful screening for neonatal hip instability in Australia
Authors: Goss PW
Published: March 2003

Objective:  Australian screening programmes for congenital dislocation of the hip (CDH) are characterized by lower neonatal hip instability (NHI) detection rates than more successful international programmes. Through creating a quality, accountable clinical screening programme for NHI detection, the present study aimed to establish the true incidence of NHI in Australian babies and to eliminate ‘late diagnosed’ CDH.

Methods:  Doctors responsible for routine neonatal care were made accountable for NHI detection and examined 5166 consecutive live births in the first days of life between 1989 and 2000. Techniques for clinical NHI detection were taught, and doctors practised with teaching‐mannequins. Paediatricians clinically determined true positive NHI cases and managed them for a 12‐month period. Peer review of NHI detection rates was introduced to encourage accountability. Surveillance for ‘late diagnosed’ CDH occurred regularly through a variety of methods.

Results:  One hundred babies with NHI were detected (19.4 per 1000): 77% were female; 26% were breech presentation, 25% had a family history of hip instability; and all received some form of splinting. Follow up for 85% of these babies at 12 months revealed no significant complications. Extensive searching has revealed no baby with ‘late diagnosed’ CDH from the study population in 12 years. One baby commenced treatment late (at 4 months) because of a failure of process following early NHI detection.

Conclusions:  The true incidence of NHI in Australia is ≥19 per 1000 births. Successful clinical CDH screening programmes using primary care doctors can be created and might eliminate ‘late diagnosed’ CDH.
Henoch‐Schönlein purpura and priapism
Authors: Lind J , Mackay A , Withers SJ
Published: March 2003

Abstract:  This is the first report of priapism in a child with Henoch‐Schönlein purpura. Priapism is a condition rarely seen in childhood. When seen in the paediatric population, it is most often associated with haematological disorders. On a world‐wide basis, sickle cell anaemia accounts for the majority of childhood priapism. Failure to treat priapism can lead to serious sequelae, including fibrosis and impotence.
Urine amino and organic acids analysis in developmental delay or intellectual disability
Authors: Poplawski NK , Harrison JR , Norton W , Wiltshire E , Fletcher JM
Published: March 2003

Objectives:  To determine the proportion of urine amino and organic acids screening tests (UMS) undertaken for patients referred with developmental delay or intellectual disability (DD/ID), and within the group with DD/ID, to determine the diagnostic yield, the proportion of diagnoses with a therapy and the associated recurrence risks.

Methods:  A retrospective review of request forms and results of UMS, in individuals older than 28 days, referred to the Women's and Children's Hospital, North Adelaide, between 1 January 1992 and 31 December 1998 was carried out. Urine was analysed by ion exchange chromatography (amino acids), gas chromatography/mass spectrometry (organic acids), colorimetric assay (orotic acid) and stable isotope−dilution mass spectrometry (trimethylamine).

Results:  A total of 3316 samples were received, 1447 being from patients with DD/ID. A diagnosis was determined for 1.8% of all referrals. For patients with DD/ID, the diagnostic yield was 1.1%, with a similar yield for isolated DD/ID and DD/ID with other features (9/828 vs 7/619; χ2 = 0.006; P = 0.93). Specific therapies were available for 69% of diagnoses associated with DD/ID and 87.5% had known Mendelian or mitochondrial inheritance.

Conclusion:  Urine metabolic screening is an important part of the evaluation of children with DD/ID as it can enable families to make reproductive decisions and children to receive appropriate therapy early.
Childhood invasive pneumococcal disease in Tasmania, 1994−2000
Authors: Christie DJF , Coleman DJ , Wan X , Jacobs MA , Carapetis JR
Published: March 2003

Objective:  To describe the burden of invasive pneumococcal disease in Tasmanian children, including age‐specific incidence and antibiotic‐resistance pattern.

Methods:  A population‐based retrospective study was carried out, examining cases of childhood disease associated with isolates of Streptococcus pneumoniae from normally sterile sites, identified via scrutiny of laboratory records at all major Tasmanian laboratories during a 7‐year period between January 1994 and December 2000. Medical records were sub­sequently examined for information describing the clinical syndrome and course of disease.

Results:  Invasive pneumococcal disease was identified in 76 children during the 7‐year period. The incidence per 100 000 children was 28.5 (95% CI 22.0−36.3) in children under 5 years and 54.3 (95% CI 40.2−71.8) in children under 2 years. The incidence of meningitis in children younger than 2 years was 12.2 (95% CI 6.1−21.8). Penicillin resistance was observed in 2.6% of cases, with no high level resistance. Predisposing conditions were identified in 34% of children with invasive disease.

Conclusions:  The incidence of invasive pneumococcal disease was comparable to many urban populations in Australia. The high rate of predisposing conditions supports the recommendations of the Australian Technical Advisory Group on Immunisation for targeted immunization in this group. The paucity of data describing Indigenous status is an argument for improved data collection in this area. The low level of penicillin resistance necessitates ongoing surveillance, and the lack of serotype information requires prospective data collection.
Persistent cough in children and the overuse of medications
Authors: Thomson F , Masters IB , Chang AB
Published: March 2003

Objective:  Children referred for persistent cough were evaluated for the referring and final diagnosis, and the extent of the use of medications prior to referral and the side effects encountered.

Methods:  Data on children seen by respiratory paediatricians for persistent cough (≥4 weeks) in a tertiary respiratory setting were collected prospectively over 12 months.

Results:  Of the 49 children, 61.2% were diagnosed with asthma at referral, with similar referral rates from general practitioners and paediatricians. Children with isolated cough were just as likely to have been diagnosed with asthma as children with cough and wheeze. Medication use (asthma, gastro‐oesophageal reflux and antibiotics) prior to referral was high, asthma medications were most common, and of these 12.9% had significant steroid side effects. The most common abnormality found (46.9%) was a bronchoscopically defined airway lesion, and in 56.5% of these children, another diagnosis (aspiration, achalasia, gastro‐oesophageal reflux) existed. No children had a sole final diagnosis of asthma and pre‐referral medications were weaned in all children.

Conclusion:  Over diagnosis of asthma and the overuse of asthma treatments with significant side effects is common in children with persistent cough referred to a tertiary respiratory clinic. Children with persistent cough deserve careful evaluation to minimize the use of unnecessary medications and, if medications are used, assessment of response to treatment is important.
Sudden infant death syndrome in Indigenous and non‐Indigenous infants in north Queensland, 1990–1998
Authors: Panaretto KS , Whitehall JF , McBride G , Patole S , Whitehall JS
Published: March 2003

Objective: To compare the epidemiology of sudden infant death syndrome (SIDS) in Indigenous and non‐Indigenous infants in north Queensland, and to assess the quality of data recorded for SIDS deaths.

Methods: Records were obtained for SIDS cases from all coronial courts in north Queensland from 1990 to 1998. Demographic characteristics, ethnicity, age at death, sleeping and feeding patterns, smoking incidences and autopsy findings were compared. Incidences, medians and univariate associations were generated where appropriate.

Results: There were 83 248 live births for the 9‐year period; 71 389 non‐Indigenous and 11 859 Indigenous births. There were 69 SIDS deaths (0.83 per 1000 live births). Overall, recording of demographic and death scene data was poor. Thirty‐eight autopsies (55%) were performed by specialist pathologists. There were 22 (32%) non‐Indigenous and 22 (32%) Indigenous SIDS deaths (25 ethnicity unknown), giving an estimated relative risk of 2.82 (95% CI 2, 4). Median age at death was 13.1 weeks (range 1–83 weeks) with 14% of deaths occurring in the neonatal period for both groups. Sleeping position was not recorded in 42% of cases and co‐sleeping was not recorded in 27% of cases. Bed sharing was more common amongst Indigenous infants. Fifty‐two per cent of SIDS cases occurred in the wet season and 48% in the dry season.

Conclusions: Data recorded for SIDS deaths in north Queensland are poor, preventing specific conclusions concerning SIDS risk factors. However, SIDS rates may be up to three‐fold higher in the Indigenous population. A uniform system of post‐mortem and death scene data reporting is needed urgently.
Mycobacterium ulcerans infection diagnosed by polymerase chain reaction
Authors: Russell FM , Starr M , Hayman J , Curtis N , Johnson PDR
Published: March 2003

Abstract:  Mycobacterium ulcerans infection is the third most important mycobacterial infection world‐wide affecting immunocompetent individuals and causes chronic progressive skin ulcers. It has been described in many different regions world‐wide. The diagnosis of M. ulcerans infection is often delayed because the diagnosis is difficult to make when new cases appear outside known endemic areas. However, molecular methods are now available to diagnose and distinguish M. ulcerans from other mycobacteria, allowing rapid diagnosis. Presented here is the case of a previously well girl from Townsville, Queensland, with extensive M. ulcerans infection involving the elbow joint, triceps tendon and underlying bone. Rapid diagnosis by polymerase chain reaction confirmed M. ulcerans infection. This is the first known case of M. ulcerans infection from Townsville in over 25 years, highlighting the changing epidemiology of this disease.
Bone marrow transplantation for β‐thalassaemia major by an HLA‐mismatched parent
Authors: Li CF , Zhang YM , Wu XD , He YL , Sun J , Chen SJ , Li CK , Tsang KS
Published: March 2003

Abstract:  A six‐year‐old boy was diagnosed with β‐thalassaemia
major during infancy. Since then, he required monthly blood transfusion
and irregular iron chelation therapy. He had hepatosplenomegaly
and elevated liver enzymes; the serum ferritin was up to 3800 ng/mL.
An echocardiogram showed left‐ventricular enlargement. His one‐antigen‐mismatched mother
was chosen as a bone marrow donor. He was pretreated with intensive
red blood cell transfusion and hydroxyurea for 6 weeks
prior to conditioning. The conditioning included total body irradiation
(300 cGy), busulfan (14 mg/kg), cyclophosphamide
(160 mg/kg) and anti‐thymocyte globulin (rabbit;
90 mg/kg). Marrow cell dose was 5.4 × 108/kg. Graft versus host disease (GVHD) prophylaxis included cyclosporine A (CSA) and methylprednisolone. Neutrophil engraftment occurred on day 23. Grade II acute GVHD occurred on day 45. The patient developed complications including septicaemia, haemorrhagic cystitis, intracranial haemorrhage and heart failure. He subsequently recovered from the complications without sequelae. The patient remained transfusion‐independent at a follow‐up examination after 18 months. This case suggested that a mismatched family member may be considered as a bone marrow donor for β‐thalassaemia major. In places where conventional treatment is not feasible, for example, in China, this approach may be an alternative option. A more intensive immunosuppressive regimen and a higher marrow cell dose may be important for successful engraftment. High‐dose anti‐thymocyte globulin may also prevent severe GVHD.