bluuebunny/crossref_metadata_2025_split huggingface dataset:
RHEUMATIC FEVER IN THE NEW MILLENNIUM
Authors: Kotby Alyaa 
Published: January 2008

INTRODUCTION: During the past 2 decades the presentation of rheumatic fever (RF) has changed markedly from that of an acute florid illness to a more subtle subacute form that is frequently missed.
OBJECTIVE: With this work we attempted to describe the changing face of RF with its different patterns and time of presentation, particularly subclinical carditis.
METHODS: This work included 1732 patients with RF followed up in the pediatric department and pediatric cardiology clinic at Pediatric Hospital, Ain Shams University. Every patient was subjected to a thorough clinical examination, measurement of erythrocyte sedimentation rate and antistreptolysin O titer and C-reactive protein levels, a chest radiograph, electrocardiography, and echocardiography Doppler. Echocardiography was performed at the time of admission and repeated after 2, 4, and 6 weeks and 1 year after the attack. Diagnosis of RF was based on the revised Jones criteria.
RESULTS: Age at the first attack was &lt;5 years for 10% of the patients, 5 to 10 years for 51%, 11 to 15 for 36%, and &gt;15 for 3%; the male/female ratio was 1:1.34. Major clinical RF manifestations were carditis (60%), polyarthritis (56%), chorea (15%), erythema marginatum (0.12%), and subcutaneous nodules (0.12%). Seventy-two percent had carditis, after we combined clinical and echocardiographic criteria of cardiac affection 6 weeks after the attack. Pure arthritis was present in 41% of the patients, arthritis and carditis in 29%, and arthritis and subclinical carditis in 30%. One year after the initial attack the number of patients with echocardiographic features of valve affection remained the same. Pure chorea was present in 55% of the patients, chorea and carditis in 30%, and chorea and subclinical carditis in 25%. One year after the initial attack, 70% of the patients with chorea had echocardiographic features of valve affection. Chronicity of chorea is common with multiple relapses.
CONCLUSIONS: RF is not uncommon in children &lt;5 years of age. Subclinical carditis should be anticipated and looked for at the right time in susceptible patients, particularly those with rheumatic arthritis and chorea. Multicenter studies should be carried out for the addition of the echocardiographic features of carditis to Jones' minor criteria for the diagnosis of RF. Diagnosis of carditis requires a high index of suspicion in at least 1 of 3 cases.
CONGENITAL MALFORMATIONS ASSOCIATED WITH PESTICIDES IN ENCARNACIÓN, PARAGUAY
Authors: Benítez Leite Stela , Acosta Marta , Luisa Macchi María 
Published: January 2008

INTRODUCTION: Exposure to pesticides is a known risk to human health. The association between parental exposure and congenital malformations is described.
OBJECTIVE: We sought to study the association between exposure to pesticides and congenital malformations in newborns who were born at the Regional Hospital of Encarnación in Itapúa, Paraguay.
METHODS: This was a prospective case and control study from March 2006 to February 2007. A case was defined as a newborn who was born with congenital malformations, and a control case was defined as a newborn of the same gender who was born immediately after and was found to be healthy. The exposure to pesticides was considered along with other risk factors that are known to cause congenital malformations.
RESULTS: The cases (52) and controls (87) were analyzed. The average number of births per month was 216. The risk factors that were significantly associated were living near fumigated fields (odds ratio [OR]: 2.46 [95% confidence interval (CI): 1.09–5.57]; P &lt; .02), having pesticides in the house (OR: 15, 35 [95% CI: 1.96–701.63]; P &lt; .003), direct or accidental contact with pesticides (OR: 3.19 [95% CI: 0.97–11.4]; P &lt; .04), and history of family malformations (OR: 6.81 [95% CI: 1.94–30.56]; P &lt; .001). The other risk factors known to cause malformations did not have statistical significance.
CONCLUSIONS: The results show an association between the exposure to pesticides and congenital malformation in newborns who were born at the Regional Hospital of Encarnación. Future studies are required to confirm these findings.
ROTASCORE STUDY: EPIDEMIOLOGICAL OBSERVATIONAL STUDY OF ACUTE GASTROENTERITIS WITH OR WITHOUT ROTAVIRUS IN GREEK CHILDREN YOUNGER THAN 5 YEARS
Authors: Papaevangelou Vassiliki , Kavaliotis Ioannis , Kokori Heleni , Mantagou Lito , Trimis Georgios , Papadopoulou Vithleem , Niotakis Georgios , Nikolakopoulou Nikoleta , Konstantopoulos Andreas 
Published: January 2008

INTRODUCTION: Pediatric rotavirus gastroenteritis (PRG) is the most frequent cause of severe acute gastroenteritis (AGE) in children up to 5 years of age worldwide.
OBJECTIVE: We sought to determine the proportion of PRG and compare its clinical burden to that of AGE caused by other pathogens.
METHODS: The study was conducted in 4 hospital emergency units (HEUs) and 50 private pediatric clinics between January and May 2006. Children up to 5 years of age were included. A rapid stool immunochromatographic test for rotavirus antigen detection was performed. Symptom-severity scores were calculated by using the Clark scale.
RESULTS: Seven hundred and six children participated in the study (median age: 20 months; 385 boys [54.5%]); 273 patients (38.6%) visited HEUs, and 433 (61.4%) visited private clinics. The proportion of PRG was 29% (95% confidence interval [CI]: 25.9%–32.6%) in the total study group, 18.3% (95% CI: 14.9%–22.3%) in private clinics, 45.7% (95% CI: 40.0%–51.7%) in HEUs, and 49.1% in hospitalized patients (95% CI: 42.3%–55.7%). Most children with PRG (71.7%) were between 6 months and 3 years old. Behavioral changes and signs of dehydration, weight loss, fever at ≥38°C, diarrhea, and vomiting were more prevalent with PRG (P &lt; .01). In children with PRG, a higher incidence of moderate or severe gastroenteritis (P = .013 and .021, respectively), hospitalization (P = .011), and need for a clinical reevaluation (P = .012) was observed, as was longer hospitalization (5.14 ± 3.18 vs 3.69 ± 2.25 days; P = .039).
CONCLUSIONS: PRG was responsible for nearly half the patients with AGE who visited HEUs or required hospitalization. Vaccination against rotavirus would help prevent this frequent and often severe disease.
ROLES OF SCAP (STEROL REGULATORY ELEMENT–BINDING PROTEIN CLEAVAGE-ACTIVATING PROTEIN) IN THE MECHANISM FOR MESANGIAL FOAM-CELL FORMATION UNDER INFLAMMATORY STRESS
Authors: Li Qiu , Ruan Xiong Zhong 
Published: January 2008

INTRODUCTION: Our previous studies have demonstrated that lipid abnormalities play a significant role in glomerulosclerosis. Inflammatory cytokines promote lipid accumulation in human mesangial cells (HMCLs) by disrupting low-density lipoprotein receptor (LDLr) feedback regulation. The sterol regulatory element–binding protein (SREBP) cleavage-activating protein (SCAP) carries SREBP from endoplasmic reticulum (ER) to Golgi, where it is known to cleave SREBP, thereby enhancing LDLr gene expression and cholesterol uptake when cells need cholesterol.
OBJECTIVE: We aimed to investigate whether inflammatory mediators interfere with SCAP translocation and its biological consequence.
METHODS: HMCLs were used in all experiments. Total cellular RNA was isolated from these cells for detecting LDLr, SREBP-2, and SCAP messenger RNA levels with real-time quantitative polymerase chain reaction. LDLr protein expression was measured by Western blot. Translocation of the SCAP-SREBP complex from the ER to Golgi was investigated by confocal microscopy.
RESULTS: In the absence of exposure to interleukin 1β, a high concentration of LDL retained SCAP in the ER, a low LDLr promoter activity, messenger RNA synthesis, and protein expression were found, respectively. However, exposure to interleukin 1β caused overexpression of SCAP and enhanced its translocation from the ER to Golgi. This disrupted normal feedback regulation and resulted in inappropriately increased LDL uptake with transformation of HMCLs into foam cells. Overexpression of SCAP in HMCLs resulted in an increased translocation of SCAP from the ER to Golgi, and high concentrations of LDL were unable to suppress SREBP-2 and LDLr gene expression.
CONCLUSIONS: These data suggest that inflammatory mediators promote abnormal translocation of SCAP from the ER to Golgi and play an important role in lipid accumulation in HMCLs.
IMMUNOGENICITY AND SAFETY OF CONCOMITANT ADMINISTRATION OF MEASLES-MUMPS-RUBELLA VACCINE AND VARICELLA VACCINE BY THE INTRAMUSCULAR OR SUBCUTANEOUS ROUTE
Authors: Gillet Yves , Habermehl Pirmin , Fiquet Anne , Thomas Stephane , Eymin Cecile , Bertrand Isabelle , Ledesma Emilio 
Published: January 2008

INTRODUCTION: In Europe, recommended administration route for vaccines and physicians' preferences vary.
OBJECTIVE: The aim of this study was to compare the immunogenicity and safety profile (injection-site and systemic adverse events) of a measles-mumps-rubella vaccine (M-M-RvaxPRO) and a varicella vaccine (Varivax) when given by intramuscular or subcutaneous route.
METHODS: A total of 752 healthy children who were 12 to 18 months of age were randomly assigned to receive concomitantly at 2 separate injection sites 1 dose of both vaccines by the same route, either intramuscular or subcutaneous.
RESULTS: Six weeks after vaccination, response rates in patients who were initially seronegative were similar for all antigens (intramuscular noninferior to subcutaneous), and geometric mean titers were comparable irrespective of the administration route (Table 1). Similar numbers and types of systemic adverse events were observed in both groups, excepted for varicella/varicella-like rashes, which were less frequent in the intramuscular group. Injection-site reactions were also less frequent for both vaccines in the intramuscular group compared with the subcutaneous group (15.8% and 25.8% of patients for M-M-RvaxPRO and 20.9% and 34.3% for Varivax, respectively), but the safety pattern was comparable between groups.
CONCLUSIONS: These results support both intramuscular and subcutaneous administration routes for M-M-RvaxPRO and Varivax.
TABLE 1.Response Rates and Geometric Mean Titers of the Measles-Mumps-Rubella and Varicella Vaccines When Given by Different RoutesPer-Protocol AnalysisIntramuscularSubcutaneous n Relative Risk, %GMTs n Relative Risk, %GMTsMeasles, ≥255 mIU/mL34994.32396.436396.12560.6Mumps, ≥10 ELISA Ab U/mL34997.786.436398.189.8Rubella, ≥10 IU/mL32198.197.231898.194.4Varicella    ≥5 gpELISA U/mL33688.49.834585.59.2    ≥1.25 gpELISA U/mL33698.59.834599.49.2
IMMUNE FINDINGS IN CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME: COULD THEY PREDICT THE RESPONSE TO STEROID THERAPY?
Authors: Printza Nikoleta , Papachristou Fotios , Tzimouli Vassiliki , Taparkou Anna , Kanakoudi-Tsakalidou Floredia 
Published: January 2008

INTRODUCTION: Nephrotic syndrome (NS) is thought to be associated with primary immune disturbances.
OBJECTIVE: The aim of our study was to investigate prospectively the immune disturbances in steroid-sensitive (SS) and steroid-resistant (SR) NS and identify whether these immune disturbances may predict the response to steroid therapy.
METHODS: Thirty children with SS NS and 7 children with SR NS (aged 2 to 14 years) were studied. To evaluate the possible relationship between immune disturbances and response to treatment, patients were evaluated during different disease stages. Data were compared with those obtained from 25 age-matched controls. The following parameters were assessed: basic B- and T-cell populations, percentages of CD23+, CD3+/CD69+/interferon γ+ (IFN-γ+) cells, and CD3+/CD69+/interleukin 4+ (IL-4+) T cells, and serum levels of IL-13 and IL-18.
RESULTS: In patients with SS NS percentages of CD23+ and CD19+ B cells, CD3+/CD69+/IL-4+ T cells and serum levels of IL-13, IL-18 were significantly higher in the active stage compared with the remission stage on steroids, remission off steroids, and controls (P &lt; .05). On the contrary, percentages of CD3+/CD69+/IFN-γ+ T cells were significantly decreased (P &lt; .05). In patients with SR NS, percentages of CD23+B cells, CD3+/CD69+/IL-4+ T cells, and serum levels of IL-13 and IL-18 presented no significant difference between active stage and partial remission. Percentages of CD19+ B cells and CD3+/CD69+/IFN-γ+ T cells were elevated in active stage compared with remission stage of patients with SR NS and in controls (P &lt; .05).
CONCLUSIONS: These findings suggest that when a type-2 immune response is found in the active stage of NS, one could predict a good response to steroid therapy.
RENAL INVOLVEMENT IN CHILDREN WITH GLYCOGEN-STORAGE DISEASE
Authors: Safouh Hesham , Elsayyed Rokayya , Mansour Samah , Taha Gamal , Elshabrawy Mortada , Elkaraksy Hanaa 
Published: January 2008

INTRODUCTION: Long-term complications of glycogen-storage diseases (GSDs) include delayed puberty, hepatic adenomata, and renal disease.
OBJECTIVE: In this study, our aim was to detect renal involvement in children with GSD and to determine the most accurate laboratory test to be the gold standard for early detection of this renal dysfunction.
METHODS: Twenty-seven children known to have GSD were included in this study. Fifteen healthy age- and gender-matched children were also included as controls. Routine urine analysis and measurement of urinary β2-microglobulin and microalbumin levels were performed for all patients and controls. Renal-function tests, measurement of serum electrolyte, alkaline phosphatase, urinary calcium, blood, and urine pH levels, creation of a urinary and plasma aminogram, calculation of the glomerular filtration rate, bone radiography to detect rachitic manifestations, and abdominal ultrasound to measure renal size were performed for all patients.
RESULTS: Twenty-one patients had ≥1 renal abnormality. The most common was increased urinary β2-microglobulin level (15 of 21) followed by an abnormal glomerular filtration rate, whether low or high (8 of 21), and microalbuminuria (6 of 21). Sonographically, there was nephrocalcinosis in 1 case and renal stone in another. The area under the receiver operating characteristic curve for β2-microglobulin was 0.86 (P = .01) and 0.7 for the urinary microalbumin/creatinine ratio (P = .15). The best cutoff level for predicting renal abnormality for urinary β2-microglobulin was 0.22 mg/L with 70% sensitivity and 100% specificity, and the best cutoff value for the urinary microalbumin/creatinine ratio was 4.5 with 86% sensitivity and 50% specificity.
CONCLUSIONS: Renal abnormalities are common in patients with GSD. Urinary B2-microglobulin level can be considered the gold standard for early detection of renal dysfunction in these patients.
MANAGEMENT OF CHILDREN WITH OTITIS MEDIA: A SURVEY OF AUSTRALIAN ABORIGINAL MEDICAL SERVICES
Authors: Gunasekera Hasantha , Morris Peter , Daniels John , Couzos Sophie , Craig Jonathan 
Published: January 2008

INTRODUCTION: Otitis media remains one of the most common reasons for childhood primary health care presentations. Indigenous children are at the highest risk, but there are scarce data on how they are managed.
OBJECTIVE: We sought to determine how Australian primary health care medical practitioners diagnose and manage otitis media in Indigenous and non-Indigenous children.
METHODS: We contacted all of Australia's Aboriginal Medical Services by using the national government's register to identify their medical practitioners. We mailed a pilot 5-page clinical vignette questionnaire instrument to these primary health care practitioners (N = 257). Responses for Indigenous children were compared with those for non-Indigenous children.
RESULTS: Questionnaires were returned from 40.9% of medical practitioners (105 of 257) and 64.8% (57 of 88) of the nation's Aboriginal Medical Services. When examining children, practitioners used otoscopy (99.0% often/always) but not pneumatic otoscopy (67.0% never) or tympanometry (55.8% never). When practitioners diagnosed acute otitis media, they were more likely to use antibiotics (104 of 113 [92.0%]) when the child was Indigenous versus non-Indigenous (53 of 112 [47.3%]) (odds ratio: 12.9 [95% confidence interval: 5.9–27.9]). Amoxicillin was the most common antibiotic used (309 of 356 [86.8%]). The major factors that determined the practitioners' otitis media antibiotic use were Indigenous status (65.7%), wet perforations (63.7%), bulging tympanic membranes (58.3%), and fever (56.3%). The major factors for choosing no antibiotics were dry perforations (35.3%) and a well child (24.8%). Most practitioners were aware of the national guidelines (97.1%) but not the guidelines for Indigenous children (47.0%).
CONCLUSIONS: Aboriginal Medical Service practitioners rely on otoscopy alone to diagnose otitis media and are more likely to use antibiotics for Indigenous children despite not knowing the guidelines.
NUTRITIONAL STATUS IN CYSTIC FIBROSIS
Authors: Fotoulaki Maria , Panagopoulou Paraskevi , Kotsi Eleni , Nousia-Arvanitakis Sanda 
Published: January 2008

OBJECTIVE: We aimed to investigate the nutritional status of patients with cystic fibrosis (CF) in relation to their clinical manifestations.
METHODS: In 68 patients with CF (aged 2–38 years), body weight, height, and composition (bioelectrical impedance analysis), respiratory function, Pseudomonas colonization, pancreatic function, CF-related diabetes mellitus (CF-DM), and genotype were measured.
RESULTS: BMI was &lt;5th percentile in 12 patients (18%), between the 5th and 10th percentiles in 6 (7%), between the 10th and 85th percentiles in 41 (60%), between the 85th and 95th percentiles (overweight) in 4 (6%), and &gt;95th percentile (obese) in 5 (7%). Among 18 patients with a BMI at &lt;10th percentile, 18 (100%) had pancreatic insufficiency, 16 (89%) had Pseudomonas, and 7 (38%) had CF-DM. Among 41 patients with a BMI in the 10th to 85th percentile, 37 (90%) had pancreatic insufficiency, 28 (82%) had Pseudomonas, and 9 (22%) had CF-DM. Among 9 patients with a BMI at &gt;85th percentile, 3 (33%) had pancreatic insufficiency, 1 (11%) had Pseudomonas, and none had CF-DM. Forced expiratory volume in 1 second was significantly better among overweight patients than among patients with a low or normal BMI (P &lt; .05). In addition, forced expiratory volume in 1 second correlated with BMI (P = .014), age (P = .029), and percent free fat mass (P = .039). Overweight/obese patients were homozygotes for mild mutations.
CONCLUSIONS: Most patients with CF had an optimal nutritional status. A small percentage were overweight or obese, especially those with pancreatic sufficiency and carriers of mild mutations. These patients had mild-to-moderate lung disease and were less likely to be colonized with Pseudomonas or have liver disease.
COMBINATION OF ARTESUNATE-AMODIAQUINE AS A TREATMENT FOR UNCOMPLICATED FALCIPARUM MALARIA IN CHILDREN
Authors: Syahril Pasaribu , Pitaloka Pasaribu Ayodhia , Panusunan Lubis Chairuddin 
Published: January 2008

INTRODUCTION: Resistance of falciparum malaria to both chloroquine and pyrimethamine-sulfadoxine has been reported from Indonesia and other countries. Since the end of 2004, we have changed the standard treatment of uncomplicated falciparum malaria to use a combination of artesunate and amodiaquine.
OBJECTIVE: Our aim was to evaluate the efficacy and adverse reactions of artesunate-amodiaquine as a treatment for uncomplicated falciparum malaria in children.
METHODS: We conducted a cross-sectional study at Panyabungan, Mandailing Natal Regency, North Sumatera Province, Indonesia, from August to September 2006. The sample was school-aged children between 5 and 18 years old. The sample received an oral dose of artesunate (4 mg/kg body weight) combined with an oral dose of amodiaquine (10 mg/kg body weight) for 3 days. Parasitemia was assessed at days 0, 2, 7, and 28.
RESULTS: Peripheral blood smears were performed for 376 school-aged children; 135 of them tested positive for falciparum malaria. At the end of the study (28 days), 121 cases completed a full course of study. From the peripheral blood smears on days 2, 7, and 28, we found a 100% cure rate. Adverse reactions included 20 children (16.5%) with headache, 10 (8.3%) with vomiting, and 1 (0.8%) with tinnitus.
CONCLUSIONS: A combination of artesunate and amodiaquine can be used as treatment for uncomplicated falciparum malaria in children with the caution of headache as an adverse reaction of the drug combination.
IMPACT OF ZINC SUPPLEMENTATION ON GROWTH: A DOUBLE-BLIND, RANDOMIZED TRIAL AMONG URBAN IRANIAN SCHOOLCHILDREN
Authors: Masoodpoor Nahideh , Darakshan R. 
Published: January 2008

INTRODUCTION: The first study that linked zinc and growth was carried out in Iran and Egypt almost 3 decades ago. At the time, the circumstances leading to growth impairment secondary to zinc deficiency were believed to be unique in less developed countries. Multiple studies have been carried out to assess the effect of zinc supplementation on children's growth. The results of these studies have been inconsistent.
OBJECTIVE: The aim of this study was to investigate the impact of zinc supplementation on growth (weight and height) among schoolchildren who were underweight or had stunted growth.
METHODS: Our study was a randomized, double-blind, placebo-controlled trial of 90 Iranian urban schoolchildren (50 boys and 40 girls; 7–12 years old) who were underweight or stunted and were supplemented with 10 mg of zinc or placebo on school days for 6 months. Variables were weight and height.
RESULTS: Significant effects on weight gain (2.037 ± 1.240 vs 1.55 ± 0.64 kg; P = .0167) and height (2.030 ± 1.003 vs 1.403 ± 0.521 cm; P = .0002) in the children after zinc supplementation versus placebo administration, respectively, were seen over the 6-month period.
CONCLUSIONS: On the basis of this study, zinc supplementation improved growth in underweight or stunted children and should be considered for populations at risk for zinc deficiency, especially where there are elevated rates of underweight or stunting.