bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hemophagocytic Syndrome: A Misleading Complication of Visceral Leishmaniasis in Children—A Series of 12 Cases
Authors: Gagnaire Marie-Helene , Galambrun Claire , Stéphan Jean Louis 
Published: August 2004

Objective.
To describe the difficulties in diagnosing visceral leishmaniasis (VL) when revealed by hemophagocytic syndrome (HS) in young children.

Design.
Retrospective study of patients identified over a 17-year period in French pediatric units.

Results.
This series comprises 12 cases of VL that were either revealed (n = 11) or complicated (on starting treatment with antimony salts [n = 1]) by HS. Clinical manifestations were those of severe VL with sustained high fever and hepatosplenomegaly in children in very poor condition. Biological manifestations always included pancytopenia, marked hypofibrinogenemia and hypertriglyceridemia, hepatic cytolysis, and prominent hemophagocytosis on the bone marrow smear. These features led to transfer to a hematology unit. Ten children were very young (&lt;38 months) at onset (and consequently at infection). Signs of autoimmunity (Coombs' test-positive erythrocytes, antinuclear factors, and various autoantibodies) were found in 4 cases and were probably secondary to polyclonal B cell activation. Serologic tests forLeishmania were negative at onset in 6 children, and no amastigotes were found on the first marrow smear in 8 of 12 cases despite extensive search. Seven patients had not visited foreign countries. All these factors explain the initial diagnostic confusion. Three cases were initially misdiagnosed as familial erythrophagocytic lymphohistiocytosis or infection-associated HS, and these patients were treated with etoposide (once for 5 months) to control the HS after failure of steroids. The diagnostic delay in these cases was 50, 74, and 134 days. When VL was finally diagnosed, amphotericin B monotherapy was effective in 4 cases. Eight patients were treated with antimony salts; 4 were cured, 3 required adjunctive treatment, and 1 worsened (HS) and was cured with steroids and liposomal amphotericin. Regardless of the type of therapy, all 12 children are presumed cured with a mean follow-up of 7 years (range: 6 months–16 years).

Conclusions.
A diagnosis of VL should, therefore, be seriously considered in all young patients with HS exposed to visceralizing Leishmania sp in Southern Europe. Clinicians and cytopathologists must be aware of the association. Early diagnosis of VL will minimize unnecessary hospitalization and potentially harmful investigations and treatments.
School Disconnectedness: Identifying Adolescents at Risk
Authors: Bonny Andrea E. , Britto Maria T. , Klostermann Brenda K. , Hornung Richard W. , Slap Gail B. 
Published: August 2004

Objective.
School connectedness, or the feeling of closeness to school personnel and the school environment, decreases the likelihood of health risk behaviors during adolescence. The objective of this study was to identify factors differentiating youth who do and do not feel connected to their schools in an effort to target school-based interventions to those at highest health risk.

Methods.
The study population consisted of all students attending the 7th through 12th grades of 8 public schools. The students were asked to complete a modified version of the in-school survey designed for the National Longitudinal Study of Adolescent Health (Add Health). The school connectedness score (SCS) was the summation of 5 survey items. Bivariate analyses were used to evaluate the association between SCS and 13 self-reported variables. Stepwise linear regression was conducted to identify the set of factors best predicting connectedness, and logistic regression analysis was performed to identify students with SCS &gt;1 standard deviation below the mean.

Results.
Of the 3491 students receiving surveys, 1959 (56%) submitted usable surveys. The sample was 47% white and 38% black. Median age was 15. Median grade was 9th. The SCS was normally distributed with a mean of 15.7 and a possible range of 5 to 25. Of the 12 variables associated with connectedness, 7 (gender, race, extracurricular involvement, cigarette use, health status, school nurse visits, and school area) entered the linear regression model. All but gender were significant in the logistic model predicting students with SCS &gt;1 standard deviation below the mean.

Conclusions.
In our sample, decreasing school connectedness was associated with 4 potentially modifiable factors: declining health status, increasing school nurse visits, cigarette use, and lack of extracurricular involvement. Black race, female gender, and urban schools were also associated with lower SCS. Further work is needed to better understand the link between these variables and school connectedness. If these associations are found in other populations, school health providers could use these markers to target youth in need of assistance.
Primitive Neuroectodermal Tumors of the Brainstem: Investigation of Seven Cases
Authors: Zagzag David , Miller Douglas C. , Knopp Edmond , Farmer Jean-Pierre , Lee Mark , Biria Shahriar , Pellicer Angel , Epstein Fred J. , Allen Jeffrey C. 
Published: August 2004

Objective.
We discuss the clinical aspects, pathology, and molecular genetics of 7 patients with primitive neuroectodermal tumors (PNETs) arising in the brainstem that were treated at our institution from 1986 through 1995. Most neuro-oncologists avoid performing biopsies in children with pontine tumors. This article raises the question as to whether biopsies should be performed, because treatment recommendations might differ if a PNET was diagnosed rather than a pontine glioma.

Patients and Methods.
We reviewed the clinical neuro-oncology database and the files of the Division of Neuropathology at New York University Medical Center from 1986 through 1995 and identified 7 histologically confirmed PNETs arising in the brainstem among 146 pediatric brainstem tumors. The clinical, neuroradiological, and neuropathological data were reviewed. Postmortem examinations were performed in 2 cases. Formalin-fixed, paraffin-embedded tumor tissues were also available in 6 of 7 patients that were tested for p53 gene mutations using single-strand conformation polymorphism analysis. We also tested 9 cerebellar PNETs, 9 brainstem gliomas, and 3 normal brains for p53 gene mutations as controls.

Results.
All 7 patients presented with focal cranial nerve deficits, and 2 were also hemiparetic. The median age at diagnosis was 2.7 (1–8 years). Magnetic resonance imaging (MRI) characteristics included a focal intrinsic exophytic nonenhancing brainstem lesion that had low T1-weighted and high T2-weighted signals. Hydrocephalus was present in 5 patients at diagnosis, 3 of whom had leptomeningeal dissemination. Meningeal dissemination occurred later in the course of the disease in 3 other patients. Five children required shunts at diagnosis and another 2 at recurrence. Despite therapy, all 7 PNET patients died within 17 months of diagnosis with a mean survival of 8 (4–17) months. No mutation in the p53 gene was detected.

Conclusions.
Brainstem PNETs tend to arise at a younger age than brainstem gliomas and medulloblastomas. The MRI pattern suggests a localized rather than a diffuse intrinsic nonenhancing brainstem tumor. Like other PNETs, brainstem PNETs have a high predilection to disseminate within the central nervous system. The absence of p53 mutations is similar to other PNETs. Despite their origin close to the cerebellum, brainstem PNETs exhibit a more aggressive behavior and result in worse clinical outcomes than do cerebellar PNETs.
Daily Physical Activity Program Increases Bone Mineralization and Growth in Preterm Very Low Birth Weight Infants
Authors: Moyer-Mileur Laurie J. , Brunstetter Vickie , McNaught Teresa P. , Gill Gurmail , Chan Gary M. 
Published: August 2004

Objective.
A study of daily physical activity was performed with 32 preterm infants to evaluate changes in body weight and bone mineralization.

Study Design.
Subjects were matched by birth weight and gestational age and randomly assigned to the physical activity (PA;n = 16) or to the control (C; n= 16) program. PA consisted of range of motion against passive resistance to all extremities for 5 to 10 minutes daily. Peripheral dual-energy x-ray of the right forearm (ulna and radius); biomarkers of bone formation (serum type I collagen C-terminal propeptide [PICP]) and resorption (urine pyridinoline cross-links of collagen [Pyd]); serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), and 1,25-(OH)2 vitamin D; and urine levels of calcium, phosphate, and creatinine were obtained. All measurements were made at study entry and at 2.0 kg of body weight.

Results.
Despite a similar nutrient intake at advised levels for preterm infants, gains in body weight (g) and forearm bone length (cm), bone area (BA; cm2), bone mineral content (BMC; mg), and fat-free mass (g) were greater in PA infants. Forearm bone mineral density and fat mass gains did not differ between groups. Serum PICP levels remained constant in PA infants but decreased in C infants suggesting a slower rate of bone formation. Urine Pyd or bone resorption activity was similar between groups. A higher level of serum PTH was observed in PA infants at 2.0 kg of body weight; however, the change from study entry to completion did not differ between groups. All other serum and urine values were similar and within normal limits.

Conclusion.
A daily PA program promotes greater gains in body weight, forearm length, BA, BMC, and fat-free mass in premature infants.
Chronic Urticaria in Children: Expanding the “Autoimmune Kaleidoscope”
Authors: Dalal Ilan , Levine Arie , Somekh Eli , Mizrahi Avraham , Hanukoglu Aaron 
Published: August 2004

Most cases of chronic urticaria (CU) are considered idiopathic. It has recently been accepted that autoimmunity plays a critical role in the pathogenesis of CU in some of these patients. Although urticaria is common in the pediatric population, the knowledge regarding CU-associated autoimmunity is very limited.
We describe the association of CU with a wide spectrum of clinical and laboratory autoimmune disorders in 2 children and emphasize the concept that CU is another manifestation of the “autoimmune kaleidoscope.”
Surfactant Treatment of Neonates With Respiratory Failure and Group B Streptococcal Infection
Authors: Herting Egbert , Gefeller Olaf , Land Matthias , van Sonderen Loekie , Harms Karsten , Robertson Bengt ,   Members of the Collaborative European Multicenter Study Group
Published: August 2004

Objective.Connatal pneumonia caused by group B streptococcal (GBS) infection may be associated with surfactant dysfunction. We investigated the effects of surfactant treatment in term and preterm neonates with GBS infection and respiratory failure, in comparison with corresponding data from a control population of noninfected infants treated with surfactant for respiratory distress syndrome (RDS).Design/Methods.The study comprised 118 infants with respiratory failure, clinical and/or laboratory signs of acute inflammatory disease, and GBS infection proven by culture results. They were recruited retrospectively from a database of patients treated with surfactant at 28 neonatology units participating in European multicenter trials (1987–1993) and prospectively from the same units in the following years. A nonrandomized control group of 236 noninfected infants was selected from the same database. The primary parameters evaluated were oxygen requirement, ventilator settings, and incidence of complications.Results.Median birth weight in the GBS study group was 1468 g (25th–75th percentiles: 1015–2170), and median gestational age was 30 (27–33) weeks. Thirty-one percent of the infants weighed &gt;2000 g. Median age at surfactant treatment was 6 hours. The mean initial surfactant dose was 142 mg/kg (standard deviation: 53). Ninety of the infants were treated with Curosurf (Chiesi Farmaceutici, Parma, Italy), 13 with Survanta (Abboth GmbH, Wiesbaden, Germany), 12 with Alveofact (Dr Karl Thomae GmbH, Biberach, Germany), and 3 with Exosurf (Wellcome GmbH, Burgwedel, Germany). Within 1 hour of surfactant treatment, median fraction of inspiratory oxygen was reduced from .84 (25th–75th percentiles: .63–1.0) to .50 (.35–.80). The incidence of complications in the study group (mortality: 30%; pneumothorax: 16%; intracranial hemorrhage: 42%) was high, compared with infants with RDS.Conclusions.Surfactant therapy improves gas exchange in the majority of patients with GBS pneumonia. The response to surfactant is slower than in infants with RDS, and repeated surfactant doses are often needed. The mortality and morbidity are substantial, considering the relatively high mean birth weight of the treated infants.
Safety and Immunogenicity of Heptavalent Pneumococcal Vaccine Conjugated to CRM197 Among Infants With Sickle Cell Disease
Authors: O'Brien Katherine L. , Swift Andrea J. , Winkelstein Jerry A. , Santosham Mathuram , Stover Beth , Luddy Ruth , Gootenberg Joseph E. , Nold Jeffrey T. , Eskenazi Allen , Snader Sally J. , Lederman Howard M. ,   for the Pneumococcal Conjugate Vaccine Study Group
Published: August 2004

Objectives.To determine the immunogenicity and safety of heptavalent pneumococcal polysaccharide vaccine (serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F) conjugated to CRM197 (7-valent conjugate pneumococcal vaccine [7VPnC]) among infants with sickle cell disease (SCD) and a comparison group of infants without SCD (non-SCD).Design.Two cohorts of infants were enrolled and received open-label doses of 7VPnC vaccine; infants enrolled before 2 months of age received 7VPnC vaccine at 2, 4, and 6 months of age followed by 23-valent pneumococcal polysaccharide vaccine (PS-23) at 24 months of age for those infants with SCD (schedule A), and infants enrolled between 2 and 12 months of age received 7VPnC at 12 months of age followed by PS-23 at 24 months of age for infants with SCD (schedule B). Safety data were collected for 3 days after each dose of vaccine. Antibody concentrations were measured to each of the 7VPnC serotypes by enzyme-linked immunosorbent assay before each vaccine dose and 1 month after the last 7VPnC dose and the PS-23 vaccine dose.Results.Forty-five infants (34 SCD and 11 non-SCD) were vaccinated according to schedule A and 16 infants (13 SCD and 3 non-SCD) according to schedule B. The 7VPnC vaccine was highly immunogenic for all serotypes among infants with and without SCD who received 3 doses of vaccine according to schedule A: depending on serotype, 89% to 100% achieved antibody concentrations above .15 μg/mL and 56% to 100% achieved antibody concentrations above 1.0 μg/mL. Among infants immunized according to schedule B, a single dose of 7VPnC vaccine resulted in antibody concentrations above .15 μg/mL in 53% to 92% by serotype and above 1.0 μg/mL in 31% to 71% by serotype. A single dose of PS-23 resulted in dramatic increases in the antibody concentrations to all serotypes regardless of 1- or 3-dose priming. There was no difference in the reactogenicity of the 7VPnC vaccine between those with and without SCD. There were no serious reactions to the 7VPnC or PS-23 vaccines, even among those with high antibody concentrations before immunization.Conclusions.Infants with SCD respond to 7VPnC vaccine with antibody concentrations that are at least as high as infants without SCD. Infants immunized with 7VPnC vaccine at 2, 4, and 6 months of age developed antibody concentrations in the same range as those achieved among infants without SCD enrolled in a large trial that demonstrated vaccine efficacy against invasive disease. Significant rises were seen in antibody concentrations to all 7VPnC serotypes after the PS-23 booster in children receiving schedule A or B.
Economic Impact of Influenza Vaccination in Preschool Children
Authors: Cohen Gail M. , Nettleman Mary D. 
Published: August 2004

Objective.
The economic impact of routine vaccination of preschool children with inactivated influenza vaccine was investigated.

Design.
A decision analysis was performed using data from the literature. Direct and indirect costs of each vaccination strategy were calculated and compared with a strategy of not vaccinating.

Setting.
Two settings were evaluated: a setting in which vaccination was available during flexible hours and a setting in which vaccination was available only during usual work hours (8:00 am–5:00 pm).

Results.
Vaccination resulted in a net cost savings in both settings. The net savings per vaccine recipient were $21.28 in the flexible setting and $1.20 in the restricted setting. Although the analysis was performed for the inactivated vaccine, sensitivity analysis showed that the nasal vaccine could also result in a net cost savings depending on the price of the cold-adapted vaccine when it is licensed.

Conclusion.
Vaccinating preschool children is economically advantageous. Serious consideration should be given to recommending vaccination in this age group.
Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection?
Authors: Bulloch Blake , Bausher Judith C. , Pomerantz Wendy J. , Connors J. Michael , Mahabee-Gittens Melinda , Dowd M. Denise 
Published: August 2004

Objectives.
To determine the association of clear urine by visual inspection with the absence of significant bacteruria, and to compare it with standard urinalysis.

Methods.
The study was performed in the emergency department of Children's Hospital Medical Center, Cincinnati, Ohio. It was a prospective, convenience sample of children &lt;21 years of age who had catheterized or midstream clean-catch urine specimen collected for culture. Clinical findings including the presence or absence of fever, abdominal pain, dysuria, frequency, and urgency were collected for each patient. Urine was visually assessed for clarity by 2 independent observers using a standardized technique. Standard laboratory urinalysis and microscopy were also performed on all specimens. A positive urine culture was defined as ≥104 colony-forming unit (CFU)/mL of a urinary pathogen if obtained by catheterization and ≥105 CFU/mL if obtained by midstream.

Results.
Samples were obtained from 159 patients ranging in age from 4 weeks to 19 years. Females comprised 77% of the patients. One hundred ten of the samples (69%) were clear to visual inspection. There were a total of 29 positive cultures; however, 3 were in children with clear urine. The finding of clear urine on visual inspection had a negative predictive value of 97.3%. These results were similar to those obtained with standard urinalysis.

Conclusion.
Clear urine on visual inspection cannot completely eliminate the possibility that a child has a urinary tract infection. However, it is a reproducible test that offers the advantages of being simple, fast, and inexpensive. The finding of clear urine should be considered a reasonable and relatively effective bedside screen for the presence of a urinary tract infection.
Pneumococcal Facial Cellulitis in Children
Authors: Givner Laurence B. , Mason Edward O. , Barson William J. , Tan Tina Q. , Wald Ellen R. , Schutze Gordon E. , Kim Kwang Sik , Bradley John S. , Yogev Ram , Kaplan Sheldon L. 
Published: August 2004

Objective.To review the epidemiology and clinical course of facial cellulitis attributable toStreptococcus pneumoniae in children.Design.Cases were reviewed retrospectively at 8 children's hospitals in the United States for the period of September 1993 through December 1998.Results.We identified 52 cases of pneumococcal facial cellulitis (45 periorbital and 7 buccal). Ninety-two percent of patients were &lt;36 months old. Most were previously healthy; among the 6 with underlying disease were the only 2 patients with bilateral facial cellulitis. Fever (temperature: ≥100.5°F) and leukocytosis (white blood cell count: &gt;15 000/mm3) were noted at presentation in 78% and 82%, respectively. Two of 15 patients who underwent lumbar puncture had cerebrospinal fluid with mild pleocytosis, which was culture-negative. All patients had blood cultures positive for S pneumoniae. Serotypes 14 and 6B accounted for 53% and 27% of isolates, respectively. Overall, 16% and 4% were nonsusceptible to penicillin and ceftriaxone, respectively. Such isolates did not seem to cause disease that was either more severe or more refractory to therapy than that attributable to penicillin-susceptible isolates. Overall, the patients did well; one third were treated as outpatients.Conclusions.Pneumococcal facial cellulitis occurs primarily in young children (&lt;36 months of age) who are at risk for pneumococcal bacteremia. They present with fever and leukocytosis. Response to therapy is generally good in those with disease attributable to penicillin-susceptible or -nonsusceptible S pneumoniae. Ninety-six percent of the serotypes causing facial cellulitis in this series are included in the heptavalent-conjugated pneumococcal vaccine recently licensed in the United States.
Should Central Venous Catheters Be Removed as Soon as Candidemia Is Detected in Neonates?
Authors: Karlowicz M. Gary , Hashimoto Laura Nickles , Kelly Robert E. , Buescher E. Stephen 
Published: August 2004

Background.
Controversy exists regarding the most appropriate acute management of central venous catheters (CVCs) in neonates with candidemia, with up to two thirds of neonatologists preferring to attempt antifungal therapy without removing CVCs.

Objective.
To determine whether CVCs should be removed as soon as candidemia is detected in neonates.

Methods.
A cohort study of candidemia and CVC was conducted in infants in a neonatal intensive care unit (NICU) over a 5-year period (1994–1998).

Results.
Fifty infants had early-removal CVC (ER-CVC) within 3 days and 54 infants had late-removal CVC (LR-CVC) &gt;3 days after the first positive blood culture for Candidaspecies. All infants were treated with amphotericin B. There was no significant difference between infants in the ER-CVC and LR-CVC groups in terms of gender, ethnicity, birth weight, gestational age, age at candidemia, severity-of-illness scores, distribution of types of CVC, or in the distribution of Candida species causing candidemia. The ER-CVC group had significantly shorter duration of candidemia (median: 3 days; range: 1–14 days), compared with the LR-CVC group (median: 6 days; range: 1–24 days). The case fatality rate of Candida albicans candidemia was significantly affected by the timing of CVC removal: 0 of 21 (95% confidence interval [CI]: 0–14) infants died in the ER-CVC group in contrast to 9 of 23 (39%; 95% CI: 19–59) in the LR-CVC group.

Conclusion.
Failure to remove CVC as soon as candidemia was detected in neonates was associated with significantly increased mortality in C albicans candidemia and prolonged duration of candidemia regardless of Candidaspecies.