bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpemphigus acanthomata: a sign of clinical activity?
Authors: Yesudian Paul Devakar , Krishnan Srivilliputtur G.S. , Jayaraman Muriugaiya , Janaki Vanakampadi R. , Yesudian Patrick 
Published: November 2003

Abstract Background Pemphigus is a group of vesiculobullous disorders in which the blisters usually heal with hyper‐ or hypopigmentation. The appearance of acanthomata at sites of previous blisters has been noted in some cases. Methods All cases of pemphigus admitted to the Madras Medical College hospitals during a 2‐year period from March 1993 to March 1995 were taken into the study and screened for the presence of acanthomata. Results Fifty‐two cases of pemphigus were identified, 47 of pemphigus vulgaris and five of pemphigus foliaceus; and of these 13 developed acanthomata when the blisters healed. Ten of these cases were of pemphigus vulgaris and three were of pemphigus foliaceus; biopsy of these lesions showed hyperkeratosis, acanthosis, papillomatosis, and intraepidermal clefting. Immunofluorescence carried out in two of these acanthomata also showed intercellular fluorescence. Conclusions The occurrence of acanthomata in healed lesions of pemphigus is not uncommon; because histopathologic and immunofluorescence evidence of disease activity is present, cases of this sort require careful follow‐up.
The association of chronic urticaria and angioedema with autoimmune thyroiditis
Authors: Turktas Ipek , Gokcora Nahide , Demirsoy Sadik , Cakir Nuri , Onal Esra 
Published: November 2003

Abstract Background An increased frequency of autoimmune thyroiditis is seen in patients with chronic urticaria and angioedema (CUA) and it has been hypothesized that autoimmunity may be playing a role in the pathogenesis of CUA. The aim of this study was to learn the extent of autoimmune thyroid disease in a series of patients who presented with CUA. Methods Thyroid function tests and thyroid autoantibodies were measured by radioimmunoassay and immunoradiometric assay respectively in 94 CUA patients and 80 age‐ and sex‐matched healthy volunteers. Results Eleven patients (11.7%) were found to have thyroglobulin antibodies (TGA) and nine patients (9.57%) thyroid microsomal (TMA) titers ranging from 150 to 1340.37 and from 165.73 to 8000 lU/mL respectively. Both antibodies were detected in three control cases (3.7%). The association was statistically significant (P < 0.01). Six of 11 patients had thyroid dysfunction and the other five cases were euthyroid. Conclusions Our results justified the use of TMA and TGA for the early diagnosis of autoimmune thyroiditis in combination with CUA. The higher frequency of these antibodies in our patients, along with results from previously published data, suggest that this entity may reflect an autoimmune basis in some CUA patients. Thyroid function tests are not enough to rule out thyroid disease, and thyroid antibody tests should be carried out in all patients with CUA.
Malignancy in adult dermatomyositis
Authors: Leow Yung‐Hian , Goh Chee Leok 
Published: November 2003

Abstract Background Dermatomyositis has been reported to be associated with malignancies in 15%–34% of patients in Western countries, but in as many as two‐thirds of patients in Singapore. The aim of this study was to determine whether a diagnostic measure could be helpful in the diagnosis of a malignancy in patients with dermatomyositis. Methods This is a retrospective study on 38 adult patients with dermatomyositis that were seen over a 6‐year period from 1989 to 1994. Results All the patients presented with cutaneous features that suggest the clinical diagnosis of dermatomyositis; however, not all cases show all the key features of the disease. Of the studied patients, 86.8% were noted to have photosensitivity as a key cutaneous presentation. Thirty (78.9%) of our patients were above the age of 40 years, and 12 (31.6%) of these were found to have an associated malignancy. Nasopharyngeal carcinoma was the most commonly associated malignancy (38.4%) in our study population. Conclusions In our study population, otorhinolaryngologic screening is an essential investigation for the evaluation of dermatomyositis in association with malignancy.
Tinea capitis in south‐western Ethiopia: a study of risk factors for infection and carriage
Authors: Figueroa Jose Ignacio , Hawranek Thomas , Abraha Aynalem , Hay Roderick James 
Published: November 2003

Abstract Background Tinea capitis is a common dermatophyte infection which constitutes an important public health problem among children worldwide. The endemic nature of scalp ringworm in Africa is perpetuated mainly by the lack of knowledge about the prevalence and carrier status, and the absence of control measures. Methods Two hundred and nineteen schoolchildren from urban and rural communities of the Illubabor district, south‐western Ethiopia, were examined, and scalp samples were taken. Children were classified according to clinical signs and mycologic findings. Results Physical examination revealed that 29% of the children had clinical lesions compatible with tinea capitis. Dermatophytes were isolated from 33% of the children's scalp samples; of these, 16% had clinical lesions and 17% were identified as carriers. Trichophyton violaceum was responsible for 97% of infections. Conclusions Tinea capitis was the second most prevalent cutaneous finding in these children, with a higher prevalence in the urban community; the predictive value of the clinical diagnosis was low and a high proportion of children were identified as carriers in these communities. No relationship between household overcrowding and scalp infection was found.
Histopathologic features seen in cutaneous photoeruptions in HIV‐positive patients
Authors: Smith COL Kathleen J. , Skelton Henry G. , Yeager CDR Josef , Tuur Sylvana , Angritt COL Peter , Wagner Kenneth F. ,   the Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)
Published: November 2003

Abstract Background There have been scattered reports of HIV+ patients with increased reactions to light as well as anecdotal reports of HIV+ patients with increased morbidity secondary to radiation therapy. Methods As a part of a military study of HIV+ patients, we followed 987 patients for cutaneous disease for 4 years. All patients were questioned on a periodic basis about increased sensitivity to light. These patients received a physical examination at each protocol visit, and they were given the opportunity to receive all their dermatologic care within the HIV clinic. Fourteen of the patients with photo‐induced eruptions were evaluated clinically at the time of the eruption, and 11 of these were biopsied. Results Thirty‐three of the patients reported photo‐induced reactions unrelated to oral medications. Although sensitivity to light often began in the early stages of HIV disease, reactions became more severe and more chronic with disease progression. Histologic features varied from few to numerous apoptotic/necrotic keratinocytes within the mid to upper levels of the epidermis associated with a perivascular inflammatory infiltrate, to apoptotic/necrotic keratinocytes throughout an acanthotic epidermis with a liehenoid/interface infiltrate. Conclusions Although the pathogenesis of these light reactions is not known, these reactions may be related to depletion of endogenous scavengers which results in increased oxidative stress and is modulated by the pattern of immune dysregulation and metabolic dysregulation induced by HIV disease.
Skin and treponemal diseases among Asian domestic house‐helpers in northern Saudi Arabia
Authors: Kubeyinje Emmanuel P. , Belagavi Charalingappa S. 
Published: November 2003

Abstract Background Asian domestic house‐helpers in Saudi Arabia come from a different socioeconomic setting with a different disease pattern from that of their host country. This study reports the incidence of skin and treponemal diseases in this group seen at a referral hospital in northern Saudi Arabia. Methods The study was based on the analysis of the dermatologic and serologic examinations of 1520 domestic house‐helpers during resident permit issue, and a retrospective study of clinical records of house‐helpers with skin disorders. Results Routine examination revealed significant skin disease in 374 (24.6%) individuals, and the disease was transmissible in 126 (8.3%). Treponemal infection (5, 0.3%) and leprosy (1, 0.07%) were seen. Hand dermatitis and chicken pox were the most common causes of hospital attendance. Psychologic skin disorders included three cases of neurotic excoriations, two cases of delusion of parasitosis, and a case of dermatitis artefacta. Conclusions The prevalence of transmissible skin diseases in Asian domestic house‐helpers is low compared with that in their home countries. Excluding individuals with stigmata of atopic dermatitis from employment as house‐helpers, adequate counselling will reduce the incidence of hand dermatitis and psychologic skin disorders. There is a need for continuous surveillance to prevent the introduction of skin diseases not normally seen in the native population.
Prevalence and epidemiology of unsuspected onychomycosis in patients visiting dermatologists' offices in Ontario, Canada ‐ a multicenter survey of 2001 patients
Authors: Gupta Aditya K. , Jain Hem C. , Lynde Charles W. , Watteel Gena N. , Summerbell Richard C. 
Published: November 2003

Abstract Background Questionnaire studies have been used to determine the prevalence of onychomycosis in the United Kingdom and Europe. One disadvantage of this methodology is that the patient self‐diagnoses the onychomycosis. There have been very few large studies involving clinical examination of the nails of subjects, followed by mycological confirmation of the onychomycosis. We therefore determined the prevalence of onychomycosis in patients visiting dermatologists' offices in Ontario, Canada. Methods In a prospective, multicenter study, the finger‐ and toenails of all new patients presenting to dermatologists' offices were examined by a board‐certified dermatologist. If there was clinical suspicion of onychomycosis, then nail samples were obtained for mycoiogical examination at a central laboratory. Patients referred specifically for the management of onychomycosis were excluded. Results Toenails appeared abnormal in 455 (22.7%) of 2001 patients. Mycologically‐confirmed pedal onychomycosis was present in 182 (9.1%) of the 2001 patients. The estimated value of the prevalence of onychomycosis in Ontario is 6.86% (95% confidence interval (Cl): 5.8–8.0%), when corrected for age and sex of the general population using census data. Onychomycosis increased with age (P < 0.0001). The odds of males having onychomycosis was 84.3% greater than females of the same age (P= 0.0003). The distribution of organisms in the 141 patients with pedal onychomycosis who were culture positive was: dermatophytes 131 (92.9%), Candida species 4 (2.8%) and non‐dermatophyte molds 6 (4.3%). Conclusions The prevalence of mycologically‐confirmed toenail onychomycosis was 9.1%, with the estimated prevalence in Ontario being 6.86%. The majority of patients with abnormal‐appearing nails were unaware they might have onychomycosis, that it is infectious and potentially treatable, suggesting that there is potential for increased public awareness and education.
Direct and indirect costs of chickenpox in young children
Authors: FERSON MJ , SHEN WL , STARK A 
Published: November 2003

Objective: To estimate the medical and economic or societal costs of chickenpox in young children using a descriptive study Methods: Children under 5 years of age attending 124 Sydney childcare centres who were reported as having chickenpox were studied to assess the costs of medication use and medical consultations, days of care missed, and parental costs resulting from lost time from work and alternate childcare costs. Results: There were 174 children (92 girls and 79 boys; in three the sex was not stated) who missed a mean of 5.5 days of care because of chickenpox, currently valued at $154. Medical costs were valued at $33 per child, based on 0.97 medical visits, and topical and oral medication. Labour costs resulting from parental work absenteeism were valued at $160 or $345 depending on the method of calculation, whilst direct economic costs of $24 were incurred through use of alternate childcare arrangements. Total costs including those incurred by secondary cases and by rare hospitalisations were in the range of $393–$578 per affected child. Conclusions: Medical costs of chickenpox in children are small relative to costs incurred as a result of parental work absenteeism and to costs of foregone childcare. Ascribing precise work‐related costs should take into account some capacity to make up lost work time. Such data will be required when determining the cost‐benefit of childhood varicella immunisation.
The use of lumbar puncture and laboratory tests for sepsis by Australian neonatologists
Authors: JOSHI P , BARR P 
Published: November 2003

Objective:To ascertain the current use of lumbar puncture (LP) and laboratory tests for possible or suspected sepsis by Australian neonatologists.Methods:A self administered anonymous response questionnaire.Results:Sixty‐nine (73%) of 94 neonatologists responded. None performed LP routinely in preterm infants with respiratory distress syndrome (RDS) or asymptomatic term infants with maternal Group B streptococcus (GBS) colonisation. One (1.6%) performed LP in term infants with respiratory distress, and only 35 (51%) performed LP in preterm infants with suspected late‐onset sepsis (LOS). Twenty‐one percent did not perform LP on all preterm infants with RDS and septicaemia and 24% did not perform LP on all preterm infants with late‐onset septicaemia. Sixty‐six percent and 85% did not perform LP for laboratory evidence suggestive of sepsis in preterm infants with RDS and preterm infants with LOS, respectively. Forty‐nine percent investigated asymptomatic term infants with maternal GBS colonisation.Conclusions:Lumbar puncture and laboratory tests for possible or suspected sepsis are not used uniformly by Australian neonatologists. The presently available information in the scientific literature is ambiguous and systematic review and further scientific study are required to determine best practice guidelines.
Bowel dysfunction in cystic fibrosis: Importance of breath testing
Authors: LEWINDON PJ , ROBB TA , MOORE DJ , DAVIDSON GP , MARTIN AJ 
Published: November 2003

Objective:To investigate the prevalence of carbohydrate malabsorption and bacterial overgrowth in children with cystic fibrosis (CF) and abnormal stool pattern referred for breath hydrogen testing.Methodols:Results from 89 tests using lactose, sucrose and lactulose in 54 children with CF were compared with 5430 tests on children with non‐CF‐related stool abnormalities.Results:Children with CF were more frequently unable to ferment lactulose to hydrogen (39% vs. 20%, P<0.03); they had significantly longer oro‐caecal transit times (mean 99 vs. 68 min, P<0.0003); they had a higher incidence of bacterial overgrowth (32% vs. 7%, P<0.003) and sucrose malabsorption (47% vs. 14.5%, P<0.004); but they had no increase in lactose malabsorption (40% vs. 31%). Children with bacterial overgrowth in both groups had longer transit times (CF 123 min, non‐CF 108 min) compared to the non‐CF children without overgrowth (68 min) and reference normal children (69 min).Conclusions:Bacterial overgrowth and carbohydrate malabsorption, particularly of sucrose, should be considered when assessing children with CF and abnormal stool patterns.
The use of alternative therapies by children with asthma: A brief report
Authors: ANDREWS L , LOKUGE S , SAWYER M , LILLYWHITE L , KENNEDY D , MARTIN J 
Published: November 2003

Objective:To identify the nature and prevalence of alternative therapies used by children with asthma attending a children’s hospital.Methodology:Subjects consisted of a consecutive series of 51 children with asthma aged 1–6 years who were attending the Women’s and Children’s Hospital, South Australia. Parents of the children completed a questionnaire describing the use of alternative therapies by the children.Results:Approximately 55% of children used alternative therapies for asthma management. Therapies used most commonly were massage, relaxation exercises, diet therapy and vitamins. There was no significant difference in the age, asthma severity, length of time since diagnosis or presence of another illness amongst children who did or did not use alternative therapies.Conclusions:A substantial proportion of children with asthma who attend paediatric clinics use alternative therapies. Paediatricians should be aware of this and be prepared to discuss alternative therapies with parents. This may facilitate more open doctor–patient relationships and better management of children’s asthma.
Postextubation chest X‐rays in neonates: A routine no longer necessary
Authors: DAVIES MW , CARTWRIGHT DW 
Published: November 2003

Objectives:To ascertain the incidence of postextubation atelectasis (PEA) in neonates, to delineate any objective differences between those infants with PEA and those without, and to see if any of those differences were predictive of the need for a postextubation chest X‐ray (CXR).Methods:This is a retrospective review of all infants ventilated in 1994. For each separate period of extubation the medical, physiotherapy and nursing notes were examined. Data were collected on birthweight, gestational age, duration of ventilation, age at extubation, ventilation requirements pre‐extubation, pre‐ and postextubation arterial carbon dioxide tensions (PaCO2) and oxygen requirements, the number of episodes of bradycardia and apnoea, the pulse and respiratory rates pre‐ and postextubation, and the use of nasal continuous positive airway pressure (NCPAP). It was routine practice throughout 1994 for all ventilated babies to have a CXR 6 h postextubation. Each postextubation CXR was examined by one of the authors (MWD) for the presence of atelectasis and other diagnoses. PEA was defined as any atelectasis present on the postextubation CXR that was not present on the pre‐extubation CXR.Results:The overall incidence of any PEA was 2.5% (6/236). In those babies with PEA, the increase in oxygen requirement at 1 and 6 h postextubation was higher (change in inspired oxygen (ΔFiO2) of 0.05 vs 0.015, P=0.043 and ΔFiO2 of 0.045 vs 0.0, P=0.033, respectively). There was a higher incidence of the need for NCPAP some time after extubation (2/4 vs 9/163, P<0.001). No infant with PEA required reintubation and ventilation.Conclusions:In this nursery the incidence of PEA is low with no significant morbidity. Postextubation CXRs should be performed on only those infants who have an increase in oxygen requirement postextubation or become symptomatic with new or increasing respiratory distress, and to follow up atelectasis on the most recent pre‐extubation CXR.
Preschool behaviour problems in a multicultural Australian urban area
Authors: PRIOR M , WHITE J , MERRIGAN C , ADLER R 
Published: November 2003

Objective:This paper reports on a survey of behaviour problems in a sample of 4‐year‐old preschoolers from the western suburbs of metropolitan Melbourne. This region consists of a diverse multicultural population and families from lower socio‐economic status (SES) backgrounds.Methodology:Nineteen preschools participated in the study and information was obtained for 743 preschool children (Refer to MS) age=4.7 years). Parents were asked to complete the Preschool Behaviour Questionnaire (PBQ) and additional questions referring to demographic and family information. Teachers were also asked to complete the PBQ on each of the children. Three factors were extracted from the PBQ (anxious–fearful, hostile–aggressive, hyperactive), and also a combined externalising behaviours factor.Results and Conclusions:Findings indicated lower levels of behaviour problems in this sample compared to that of other Australian studies. Boys showed higher rates of externalising behaviour problems than girls. The relationships between behaviour problems and language difficulties, ethnicity, and socio‐economic status are discussed.
Documentation of children’s vaccination status in child care centres in Victoria
Authors: THOMPSON SC , KENNEDY RI 
Published: November 2003

Objective:To assess the record‐keeping of child care centres in Victoria with respect to children’s vaccination status.Methodology:A random sample of 113 centres from a list of over 800 registered Victorian child care centres received a mailed questionnaire on characteristics and policies of the centre, including documentation of attending children’s vaccination status.Results:The response rate was 86.7%; more than 95% of centres had children under two in care. Only 85% of centres kept any record of children’s immunisation status, with smaller centres and class 2 centres (occasional care centres) significantly less likely to keep records. Records were updated irregularly. Fewer than half of the centres studied kept a record of whether children had been vaccinated against Haemophilus influenzae type b.Conclusions:Despite the importance of documenting children’s vaccination status, many child care centres have failed to develop adequate systems to record or update records of children’s immunisation. This makes exclusion during outbreaks of a vaccine‐preventable disease difficult. The ongoing process of accreditation may eventually improve performance, but both legislation and a better educational strategy to improve practice in this area are needed.
Is a paediatrician needed at all Caesarean sections?
Authors: PARSONS SJ , SONNEVELD S , NOLAN T 
Published: November 2003

Objective:The need for a skilled neonatal resuscitator in the form of a paediatrician or paediatric registrar to attend a vaginal delivery or Caesarean section (CS) is not clearly defined. This study was undertaken in order to ascertain the level of resuscitation a neonate might require dependent on the delivery mode and type of anaesthesia used.Methodology:We analysed the Tasmanian Obstetric Audit from 1980 to 1989 for the need for intubation and Apgar scores at 1 min of term singleton deliveries by the mode of delivery.Results:The number of singleton term deliveries was 64 739. When the data were analysed annually there was a trend for a reduction in the need for intubation in CS deliveries during the first 5 years, although this was not paralleled by an improvement in Apgar scores. Thus the intubation rate data are also presented for the last 5 years of the study. The intubation rate, Apgar score at 1 min of <4, and Apgar score at 1 min of ≥4<7 for repeat CS under epidural anaesthesia were 0.55% (0.26% for 1985–89) 0.83% and 3.58%, respectively, with relative risks when compared with spontaneous normal vaginal delivery of 1.8 (1.2 for 1985–89), 0.7 and 0.5, respectively. The relative risk of these outcomes was higher than for normal vaginal delivery for all other modes of delivery including repeat CS under general anaesthesia.Conclusion:It is concluded that a paediatrician or paediatric registrar is not required to routinely attend repeat CS under epidural anaesthesia, but should be present for repeat CS under general anaesthesia.