bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colonic mucosa in patients with portal hypertension
Authors: MISRA VATSALA , MISRA SRI PRAKASH , DWIVEDI MANISHA , SINGH PREMALA A , KUMAR VINEETA 
Published: March 2003

AbstractBackground and Aims: To do a histomorphometric study of vascular changes in colonic mucosa of patients with portal hypertension (PHT) and to find their association with clinical and upper and lower gastrointestinal endoscopic observations.Methods: Full length colonoscopy was carried out in 55 patients with portal hypertension and 25 controls. Hemorrhoids, anorectal varices and colopathy were carefully looked for and recorded. Two biopsies each were taken from the caecum, ascending colon, transverse colon, descending colon and rectum. Sections from all the five sites were examined for histopathological changes with special reference to changes in mucosal capillaries. Morphometric assessment of the diameter of the capillary and thickness of the capillary wall was performed. These histomorphometric changes were correlated with clinical parameters and findings of upper and lower gastrointestinal endoscopic findings.Results: Dilated and congested capillaries as well as capillaries with irregular thickening of the wall were seen in a significantly higher number of sections from patients than controls in biopsies from all the five sites from caecum to rectum. On morphometry, the diameter of the capillaries and the thickness of the capillary wall in biopsies from all the five sites in patients was significantly higher than that in the control group. Apart from vascular changes, edema and inflammatory infiltrate in lamina propria were the other significant histological features noted. No significant association between clinical and endoscopic features and histomorphometric assessment was found.Conclusion: Dilated tortuous mucosal capillaries with irregular thickening of wall, edema of lamina propria and mild chronic inflammatory infiltrate are the major histopathological changes seen in colonic biopsies of patients with PHT, showing that PHT produces changes in the colonic mucosa similar to those seen in the mucosa of upper GI tract. However, the histological changes had no correlation with the clinical or endoscopic findings except that the thickness of the capillary wall was higher in patients who had undergone endoscopic sclerotherapy as opposed to those who had not received sclerotherapy.
Effects of blood transfusion on left ventricular output in premature babies
Authors: YU CW , SUNG RYT , FOK TF , WONG EMC 
Published: March 2003

Objective: To investigate the acute effects of red blood cell transfusion on haemodynamics in preterm babies. Setting: A neonatal unit in a University Hospital. Patients: Preterm babies whose postnatal age was less than four weeks and who required red blood cell transfusion. Measurement: Cardiac output and left ventricular systolic function was determined using Doppler echocardiography before, one hour and 24 h after red blood cell transfusion. Blood pressure and haematocrit were also recorded at the same time. Mixed‐effects regression model was used to analyse the effect of blood transfusion on left ventricular function and cardiac output. Results: 57 preterm babies were recruited. Univariate analysis showed that cardiac index decreased significantly 24 h after transfusion (P<0.05). Systemic red cell transport increased by an average of 11.1% 24 h after transfusion (P<0.05). Multivariate analysis showed that the cardiac index was negatively associated with haematocrit and the index was higher in male babies. Conclusion: There was a significant drop in cardiac index and an increase in systemic red cell transport 24 h after transfusion in premature babies.
Filling the gap: Weaning practices of children aged 0–2 years in western metropolitan Melbourne
Authors: GRAHAM VA , GIBBONS K , MARRAFFA C , HENRY L , MYERS J 
Published: March 2003

Objective:To investigate weaning practices of children aged 0–2 years in Melbourne’s western metropolitan region (WMR).Methodology:The study group comprised children aged 0–2 years attending six maternal and child health centres in the City of Brimbank in Melbourne’s WMR. One hundred and nineteen parents were asked to complete a questionnaire about their child. Interpreters were used as required. In total, 115 questionnaires were completed representing a response rate of 97%. All maternal and child health nurses working in the target region were asked to complete a questionnaire. Of these, five were selected randomly to participate in follow‐up indepth interviews. Weaning was defined as the addition of food/fluids other than breast milk or formula.Results:The mean age for the introduction of solids was 4.3 months. Of the children already introduced to solids, 67% had commenced between4 and 6 months whilst 29% of the infants were taking solids by 3 months of age. Of the children already having juice, 85% had done so by the age of 6 months. The mean age for the introduction of cow’s milk as the main drink was 10.7 months (S.D. 2.8). For English speaking families the mean age was 11.3 months (S.D. 1.8) whilst for families speaking languages other than English the mean age was 9.7 months (S.D. 4.1).Conclusions:Most parents in this group were following the recommended guidelines for weaning. Some parents had poor knowledge of appropriate weaning time, use of fruit juice and introduction of cow’s milk as the main drink. Additional information and education is required in these areas. Further investigation is required in relation to use of cow’s milk and ethnicity.
Arthrogryposis multiplex congenita in Western Australia
Authors: SILBERSTEIN EP , KAKULAS BA 
Published: March 2003

Objective:Determination of the prevalence of arthrogryposis multiplex congenita in Western Australia as well as the causes of the condition. Overseas reports varied considerably and no such survey had been conducted in Western Australia.Methodology:Case names were obtained from various registers and records as well as from private practitioners covering the 14 years birth cohort between 1980 and 1993. The records, and where possible the patients, were seen by one of the authors. Diagnosis was further established through relevant investigation where possible.Results:Thirty cases were identified, giving a birth prevalence of ≈1 in 12 000. In nine cases there were significant abnormalities of the central nervous system, in seven cases anterior horn cell and/or peripheral nervous involvement was the cause and in three there was primary muscle disease. The remaining 11 had various syndromes for which no definite neuropathological lesions could be demonstrated, but most of these had syndromes such as distal arthrogryposis or amyoplasia. Mortality was 37%. Talipes occurred in 23 of 30 cases. Early intervention and, in more severe cases, radical surgical intervention was the management adopted in most cases.Conclusion:The birth prevalence of arthrogryposis in Western Australia is somewhat less than that reported in Canada and Finland but somewhat greater than the Edinburgh figures, which appear to be the extremes quoted in the literature. Prognosis is worse in cases with serious central nervous system involvement and/or chest involvement, and better in cases of localised arthrogryposis (e.g. distal), as well as in the specific syndrome of amyoplasia as described by Hall.
Growth failure in cystic fibrosis
Authors: McNaughton SA , Stormont DA , Shepherd RW , Francis PWJ , Dean B 
Published: March 2003

Objective: The aim of this study was to describe and compare the nutritional status of children aged 0–18 years attending the cystic fibrosis (CF) clinic at the Royal Children's Hospital, Brisbane, Australia, as outpatients in 1986 and 1996. Methodology: The heights, weights and pulmonary function of children attending the CF clinic as outpatients in 1986 (n = 97) and 1996 (n = 227) were retrospectively analysed using a computerized database maintained by the CF clinic. The heights and weights were analysed in terms of z scores for height for age (HAZ), weight for age (WAZ) and weight for height (WHZ). Pulmonary function data is not available for all children. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and forced mid expiratory flows (FEF) were expressed as a percentage of predicted and are presented here. Results: The 1986 sample consisted of 41 males (age range 0.18–14.59 years, mean age 6.52 (4.33)) and 56 females (age range 0.15–14.97 years, mean age 7.75 (3.70)). The 1996 sample consisted of 111 males (age range 0.09–17.97 years, mean age 8.80 (5.49)) and 114 females (age range 0.12–17.98 years, mean age 8.49 (5.26)). In 1986, males were shorter than females (P = 0.0096) and females had a lower mean FVC than males (P = 0.0438). In 1996, males were shorter, lighter and more wasted than females (P = 0.0357, P = 0.0034 and P = 0.0273, respectively) and females had a lower mean FEV1 and mean FVC than males (P = 0.0176 and P = 0.0079, respectively). Males in 1996 were lighter and more wasted than males in 1986 (P = 0.0023 and P = 0.0139, respectively) and had a lower mean FEV1, mean FVC and mean FEF (P < 0.0001, P = 0.0012 and P = 0.0069, respectively). Females in 1996 were shorter and lighter than females in 1986 (P = 0.0273 and P = 0.0405, respectively) and had a lower mean FEV1, mean FVC and mean FEF (P < 0.0001, P < 0.0001 and P < 0.0001, respectively). When subjects were classified according to FEV1 (FEV1≥ 75% or FEV1 < 75%), there were no significant differences in z scores between the 1986 group and 1996 group. Similarly, when the 1986 group were matched for gender and FEV1 with the 1996 group, there were no significant differences in z scores for males or females. Conclusions: It is suggested that the apparent worsening of nutritional status among the 1996 group of CF patients is in fact due to an effect of increased survival of patients with more severe clinical symptoms. The findings from this study highlight the continuing, and in fact, worsening problem of growth failure in children with CF.
The evolving role of community‐based general paediatricians: The Barwon experience
Authors: Hewson PH , Anderson PK , Dinning AH , Jenner BM , McKellar WJD , Weymouth RD , Gollan And Ra 
Published: March 2003

Objective: To detail the acute and chronic paediatric service and community‐orientated activities and responsibilities of community‐based general paediatricians. Methodology: Data were collected over the 12 months July 1996 to June 1997 relevant to (i) acute neonatology and paediatrics, (ii) the different community paediatric service organizations with which the paediatricians were involved, and (iii) the quantification of the amount of time spent in non‐consulting paediatric work. Results: Findings revealed decreasing hospital admissions, infrequent severe neonatal resuscitation requirements, extensive involvement in community organizations and a great deal of time spent in non‐consulting paediatric work. Conclusions: Ongoing training and upgrading in acute paediatric diagnostic and procedural skills, rationalization of resuscitation expertise, training in management and administrative skills and models of care for the chronically ill should become part of the training of community‐based general paediatricians.
The successful containment of Coxsackie B4 infection in a neonatal unit
Authors: Austin BJ , Croxson MC , Powell KFP , Gunn TR 
Published: March 2003

ABSTRACTThis report describes the containment of a potential enterovirus epidemic in a neonatal intensive care unit.A case of neonatal enterovirus meningitis and myocarditis was identified. Polymerase chain reaction (PCR) was used to assist in appropriate cohorting of contacts. One further infant became cross‐infected with Coxsackie B4. Serum PCR was accurate in detecting the infection in the early stages in this asymptomatic neonate. Neonatal enterovirus infection is relatively rare but has the potential to cause outbreaks in neonatal wards. PCR can be used to diagnose and monitor for cross infection.
Varicella vaccine in non‐immune household contacts of children with cancer or leukaemia
Authors: Kappagoda C , Shaw PJ , Burgess MA , Botham SJ , Cramer LD 
Published: March 2003

Objective: To assess the immunogenicity and reactogenicity of a new formulation of live attenuated varicella vaccine (Oka strain) in non‐immune household contacts of children with cancer or leukaemia. Methodology: This was an open study with one group. Healthy varicella‐susceptible adults and children living in the same household as children with cancer or leukaemia were vaccinated with a new live attenuated varicella vaccine (Oka strain) which is stable when stored at 2–8°C (refrigerator temperature) for at least 24 months (Varilrix). Children less than 13 years of age received one dose (0.5 mL containing at least 103.3 plaque forming units) by subcutaneous injection and those aged over 13 years received two doses 8 weeks apart. Adverse reactions following vaccination were recorded daily by the vaccinees. Post‐vaccination antibody estimation was determined using indirect immunofluorescence 6 weeks after vaccination. Results: Thirty‐five seronegative subjects (28 children and 7 adults and adolescents) were vaccinated. All subjects tested (34) had seroconverted after vaccination. Local injection site reactions were experienced by 15/35. Other adverse reactions were uncommon (rash 2/35, fever (≥ 37.5°C) 3/35). No cases of clinical varicella occurred amongst the high–risk household contacts of the vaccine. Conclusion: This is the first study of this formulation of varicella vaccine in household contacts of children with cancer or leukaemia. The vaccine was found to be safe and immunogenic, but further follow‐up is needed to document duration of immunity.
How well are we doing? – Metabolic control in patients with diabetes
Authors: Thomsett MJ , Shield GJ , Batch JA , Cotterill AM 
Published: March 2003

Objective: To compare the present level of metabolic control in children and adolescents with insulin‐dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data. Methodology: Blood HbA1c concentrations, population characteristics, current treatment practices and short‐term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children’s Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998. Results: Two hundred and sixty‐eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11.2 years); duration of IDDM was 0–16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (Â± SD) was 8.6 Â± 1.4% (range 5.2–14.0%), with 33% of children having a HbA1c concentration &lt; 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 Â± 1.5%) than in those not in puberty (8.5 Â± 1.2%). Conclusions: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.
Invasive Haemophilus influenzae type b infections in Singapore children: A hospital‐based study
Authors: Lee Ys , Kumarasinghe G , Chow C , Khor ESH , Lee Bw 
Published: March 2003

Objective: A 6‐year (1990–95) hospital‐based retrospective study was carried out to investigate the pattern of invasive Haemophilus influenzae type b (Hib) disease. Methodology: Cases with Hib isolated from sterile sites (blood, cerebrospinal fluid, or joint aspirate) were identified from the hospital’s microbiological records, and their reviewed case records. Patients with pyogenic meningitis in the same study period were also identified to estimate the incidence of Hib meningitis. Results: Twelve patients had positive cultures from sterile sites, of whom nine children were less than 5 years of age. These included seven cases of meningitis, one patient with acute epiglottitis, and one case of pneumonia. Three of the seven patients with meningitis had significant long‐term sequelae. Our data also suggests a relatively low proportion of ethnic Chinese children with invasive disease. It was estimated that 18.4% to 41.1% of pyogenic meningitis in children admitted to the National University Hospital were due to Hib. The estimated annual attack rate of invasive Hib disease was at most 3.3 per 100 000 children aged less than 5 years (95% confidence interval: 2.6–3.5/100 000). Conclusion: Invasive Hib infections are relatively uncommon in our community. This justifies the need for a cost effectiveness study before a universal Hib vaccination program is implemented.
Hepatitis C infection in children: A Melbourne perspective
Authors: Karim B , Alex G , Smith Al , Hardikar W 
Published: March 2003

Objective: To examine the clinical spectrum of hepatitis C virus (HCV) infected children in our care by determining presentation, mode of acquisition, degree of co‐infection, biochemical evidence of persisting hepatitis and treatment outcome. Methodology: A retrospective review of the medical records of all children attending the Royal Children’s Hospital, Melbourne, between 1990 and 1998, who had antibodies to HCV infection detected. Detailed clinical information, investigations and the results of treatment were extracted from the clinical notes. Results: A total of 94 children (age range 2 weeks to 19.7 years) were identified, of whom nine had passive transfer of maternal antibodies from HCV‐positive mothers and were excluded from analysis. Sixty‐seven children (79%) were infected by transfusion of blood or blood products. Perinatal transmission occurred in 11 children (13%), and six children (7%) had a history of i.v. drug abuse. The majority of children were asymptomatic at presentation. Of the 65 patients tested for HCV‐ribonucleic acid, 43 (66%) were positive. Fifty‐seven cases had serial alanine aminotransaminase (ALT) measurements over a mean of 28 months. Of these, 38 (67%) had an abnormal ALT. Ten cases (12%) were co‐infected with hepatitis B virus, HIV or both. Of 12 patients treated with interferon, four responded with normalisation of ALT from 3 to 12 months post‐commencement of therapy. Conclusions: Although HCV was largely an asymptomatic condition in our clinic population, more than half the patients had biochemical evidence of ongoing liver damage. Given the chronicity of this infection in the majority of patients and the long‐term risks of cirrhosis and hepatocellular carcinoma, children with HCV infection represent a high‐risk group worthy of regular follow up.
Family data in Rett syndrome: Association with other genetic disorders
Authors: Leonard H , Fyfe S , Dye D , Hockey A , Christodoulou J 
Published: March 2003

Background: Rett syndrome is a neurological disorder, almost exclusively affecting girls. Methodology: Between 1993 and 1995 pedigree data were obtained from families of girls registered with the Australian Rett syndrome database. Results: Although 21 individual disorders were reported to be present in family members of affected girls, there was no apparent clustering of the same disorder in different families. However it was certain that a geneticist had been involved in only 10.9% of cases. Conclusions: Mutations in the MECP2 gene have now been reported in a proportion of sporadic cases. Thus, it will be important to examine this phenotype–genotype correlation in the Australian cohort. Where a mutation is found, prenatal diagnosis in a subsequent pregnancy will be a possibility. Using the Australian population database and in conjunction with the clinical genetic services in each state it is planned to contact families with an affected girl to offer testing and counselling.
Neonatal outcome of gastroschisis and exomphalos: A 10‐year review
Authors: Kitchanan S , Patole Sk , Muller R , Whitehall Js 
Published: March 2003

Objective: To study neonatal outcomes associated with gastroschisis and exomphalos in a regional neonatal unit. Methods: A retrospective (1988–97) data analysis to study the effect of the type of defect/surgery, mode/place of delivery and associated anomalies on time to start and reach full feeds, duration of total parental nutrition (TPN) support and total hospital stay. Exact bivariate test procedures were used for data analysis. Results: Twenty‐one cases of gastroschisis (17 inborn) and five cases (four inborn) of exomphalos were identified. Of these, 23.8% cases of gastroschisis and 60% of cases of exomphalos had associated gut anomalies. The survival rates for gastroschisis and exomphalos were 91 and 100%, respectively. The median time to start and reach full enteral feeds in outborn neonates was longer than in inborn neonates (9 vs 25 days, respectively, P = 0.01; and 16 vs 49 days, respectively, P = 0.01), as was the duration of TPN support (14 vs 42 days, respectively; P = 0.02). Neonates with gastroschisis had significant delays in starting and reaching full feeds compared with neonates with exomphalos (median 13 vs 4.5 days, respectively, P = 0.03; and 24 vs 8, respectively, P = 0.02) and they required prolonged support with TPN (median 23 vs 6 days, respectively; P = 0.01). Antenatal detection was significantly more frequent in inborn compared with outborn neonates (100 vs 67%, respectively; P = 0.03). The severity of associated gut anomalies and the delivery to surgery interval did not differ significantly to explain the increased morbidity in outborn neonates. Outcome was not significantly different after analysis by type of surgery and mode of delivery. Conclusions: Increased morbidity in outborn neonates may be related to factors such as temperature, care, hydration status, care of the defect and vascular compromise of prolapsed gut during prolonged transportation.
A randomized trial of enteral feeding volumes in infants born before 30 weeks’ gestation
Authors: Kuschel C A , Evans N , Askie L , Bredemeyer S , Nash J , Polverino J 
Published: March 2003

Objective: To compare the effect of two volumes of enteral feeds on postnatal growth in infants born before 30 weeks gestation. Methodology: Fifty‐four infants, less than 30 weeks gestational age, who reached full enteral feeds were randomized to remain on 150 mL/kg per day (150 group) or increase to 200 mL/kg per day (200 group). The primary outcome measure was growth at 35 weeks corrected gestational age (CGA). Results: There were no statistically significant differences in demographic or clinical parameters between the study groups at commencement of the study, although there was a trend for infants in the 150 group to be lighter (895 g vs 1020 g, P = 0.27). Milk intakes were increased in 43% of the infants in the 150 group, whereas 54% of the infants in the 200 group required reduced intakes. Infants in the 200 group had greater daily weight gains (16.7 g/kg per day vs 15.2 g/kg per day, P = 0.047) and at 35 weeks CGA were heavier (2020 g vs 1885 g, P = 0.014) and had a greater arm fat area (282 mm2vs 218 mm2, P = 0.009). There was no difference in length or head circumference at 35 weeks CGA, and no difference in any growth parameter at 1 year of age. Morbidity was not different between the groups. Conclusions: The individual milk volume requirements for adequate weight gain without significant adverse effects vary between 150 and 200 mL/kg per day in extremely premature infants. For many infants in both groups, the assigned target volume was not appropriate. Increased milk intakes (and therefore higher caloric and mineral intakes) are associated with increased daily weight gains and a greater weight at 35 weeks CGA. The weight gain may be due to an increase in fat deposition.