注射用胸腺肽治疗反复呼吸道感染患儿临床疗效

目的 探讨注射用胸腺肽治疗小儿反复呼吸道感染患儿临床疗效.方法 采用随机开放对照法,治疗组应用注射用胸腺肽,当感染时加用少量激素.对照组单用注射用羟氨苄青毒素.结果 注射用胸腺肽组较对照组呼吸道感染的次数减少,使用抗生素时间缩短,与对照组比较明显缩短(P<0.05).注射用胸腺肽组有效率为96.8%,对照组有效率为78.1%.且无明显副作用.结论 胸腺肽治疗反复呼吸道感染患儿是有效和安全的.     

Increased prevalence of HIV-2 infection in hospitalized patients with severe bacterial diseases in Guinea-Bissau

We studied the association between HIV-2 infection and bacterial pneumonia, sepsis or pyomyositis, as well as the influence of HIV-2 infection on the clinical outcome in patients with these bacterial infections. A total of 201 consecutive hospitalized patients were included at the Simao Mendes National Hospital in Bissau, Guinea-Bissau. Age- and sex-matched controls were selected from an ongoing census in a semi-urban area of Bissau. Among 201 cases with such bacterial infection the prevalence of HIV-1 was 5.4%, HIV-2, 27.9%, and both HIV-1 and HIV-2 reactivity 6.4%. Among controls, the corresponding prevalence rates were significantly lower, 1.5%, 9.0% and 1.0%, respectively. A total of 140, 31 and 30 cases of pneumonia, sepsis and pyomyositis were included, and the differences in prevalence of HIV-2 compared with the controls also remained significant for each diagnosis separately. Lymphocyte subsets were determined in 93 consecutive patients, and the CD4 cell counts and CD4/CD8 lymphocyte ratios were markedly suppressed in the HIV-2-seropositive group. Due to excess mortality in the seropositive groups with sepsis (75.0%) and pyomyositis (25.0%), the mortality during hospitalization was significantly higher among HIV-2 infected compared to HIV-negative patients. Among cases of pneumonia the mortality was low in the HIV-2-seropositive (2.9%) as well as in the HIV-seronegative (3.4%) group.     

Pyogenic myositis: caused by viridans streptococci in an adult with tetralogy of Fallot

A 34-year-old man came to this Emergency Room because of fever, swelling and pain in the right thigh. Tetralogy of Fallot with bicuspid pulmonary valve was diagnosed after serial examination, and computed tomography of the right thigh revealed pyogenic myositis. Surgical drainage of the right thigh abscess and a further pus culture yielded viridans streptococci. There has been no record in the medical literature of a pyogenic myositis caused by viridans streptococci in an adult tetralogy of Fallot. This is thus the first case reported.     

Long term follow-up of children hospitalized with respiratory syncytial virus lower respiratory tract infection and randomly treated with ribavirin or placebo

PURPOSE: To determine how many cases of breast cancer might be found if women not known to have the disease were thoroughly examined (the disease "reservoir"). DATA SOURCES: MEDLINE search from 1966 to the present. STUDY SELECTION: Hospital-based and forensic autopsy series examining women not known to have had breast cancer during life. DATA EXTRACTION: Observed prevalence of occult invasive breast cancer or ductal carcinoma in situ (DCIS) in which the number of women who were given a diagnosis was the numerator and the number of women examined was the denominator. For each autopsy series, we attempted to ascertain the level of scrutiny (sampling method, number of slides examined) given to the pathologic specimens. DATA SYNTHESIS: Among seven autopsy series of women not known to have had breast cancer during life, the median prevalence of invasive breast cancer was 1.3% (range, 0% to 1.8%) and the median prevalence of DCIS was 8.9% (range, 0% to 14.7%). Prevalences were higher among women likely to have been screened (that is, women 40 to 70 years of age). The mean number of slides examined per breast ranged from 9 to 275; series that reported higher levels of scrutiny tended to discover more cases of cancer. CONCLUSIONS: A substantial reservoir of DCIS is undetected during life. How hard pathologists look for the disease and, perhaps, their threshold for making the diagnosis are potentially important factors in determining how many cases of DCIS are diagnosed. The latter has important implications for what it means to have the disease.     

Association of respiratory symptoms with serum protease inhibitors and albumin levels in Japanese children

BACKGROUND: Some individuals are more susceptible than others to the effects of environmental factors, although the physiological reasons for this are unknown. This study investigates the fundamental association between some serum proteins and respiratory symptoms in Japanese children. METHODS: The serum alpha 1-antitrypsin (alpha 1AT), alpha 2-macroglobulin (alpha 2MG), and albumin concentrations were determined in 480 schoolchildren living in an area with low air pollution levels. Their respiratory symptoms were assessed from responses to questionnaires. RESULTS: Serum alpha 1AT levels were significantly lower in children with histories of allergic diseases, while their alpha 2MG levels were increased. Serum albumin levels were significantly decreased in children with asthma compared with those without, and the levels did not differ significantly for those children with wheezing symptoms or histories of allergic diseases. Serum alpha 1AT levels were only significantly lower in girls with asthma. Fourteen children (2.9%) were found to have decreased alpha 1AT levels of < 160 mg/dl. All of these children had histories of allergic diseases, and the prevalence of asthma was remarkably higher in these children. Children with only wheezing symptoms showed no significant changes in serum alpha 1AT, alpha 2MG, or albumin levels. CONCLUSIONS: These findings suggest that serum alpha 1AT, alpha 2MG, and albumin levels are associated with respiratory and allergic diseases in children. A decreased alpha 1AT level should be considered as a biological risk marker for these diseases.     

Implications and management of oral diseases in children and adolescents with HIV infection

Nurses and midwives may not be directly involved in treating menopausal patients, nevertheless they are in a unique position to offer support and advice to patients concerned about the menopause. Many women want to know about ways of dealing with uncomfortable symptoms and fears associated with going through the menopause. Homoeopathic treatment is one form of therapy which can be used during the menopause, which takes into account both the physical symptoms and the emotional responses. Homoeopathic treatment can be used as an alternative to treatment with hormone replacement therapy (HRT), or alongside HRT, in the management of menopausal symptoms. As well as exploring homoeopathic approaches to the treatment of menopausal symptoms, the current trend of promoting HRT is questioned in this article.     

A comparison of sevoflurane with halothane in outpatient adenotomy in children with mild upper respiratory tract infections

Our educational efforts produced several intersecting interdisciplinary groups: faculty, students, faculty/students and our community sites, with faculty, clinical staff, and students. As we worked through the issues, these interdisciplinary teams found that commitment to change, caring for patients, and open, honest communication were essential to keeping the project teams on track. We have increased our understanding of both the complexity and value of interdisciplinary collaborative education. The LIT faculty provided the initial guidance and support, the students energized the process, and our community sites made our learning and our contributions readily available to our patient populations. It is not easy to learn and teach the language and tools of continuous improvement, but doing so infinitely improves the educational process and the clinical outcome. We must learn to carefully listen to each other so that our patients can fully reap the benefits of our interdisciplinary team efforts. As a result of what we learned, the members of the George Team have expanded our motto to "Blessed Are the Flexible--and the Perseverant!"     

Pulmonary oedema associated with mitral regurgitation: prevalence of predominant right upper lobe involvement in children

OBJECTIVE: To evaluate the hypothesis that pulmonary venous congestion and oedema manifested predominantly in the right upper lobe in children with mitral regurgitation occur more frequently than previously thought. MATERIALS AND METHODS: Three radiologists retrospectively and independently reviewed the plain chest radiographs of 54 children (26 girls, 28 boys, age range 2 days-18 years, median 9.5 years) with mitral regurgitation admitted to our institution during a 5-year period. Radiographs showing pulmonary venous congestion and oedema manifested predominantly in the right upper lobe were identified. Clinical records of these patients were studied to exclude other causes of pulmonary disease. RESULTS: Radiographic signs of pulmonary venous congestion and oedema were present in all patients, with redistribution of flow and interstitial oedema in 39 patients (72 %) and alveolar oedema in 15 children (28 %). In 12 (22 %) of 54 children, these findings were localised or predominant in the upper lobe of the right lung; none of the children had predominantly left-sided involvement. CONCLUSIONS: Pulmonary venous congestion and oedema involving predominantly the upper lobe of the right lung in children with mitral regurgitation occur more frequently than previously thought. This finding is useful in the differential diagnosis of right upper lobe abnormalities, such as pneumonia.     

Acute hemiplegia in children complicating upper respiratory infections. Report of three cases with angiographic findings

Three children presented with acute onset of hemiplegia following an upper respiratory infection. Angiography revealed irregulaities, beading, and slow flow of a peripheral branch of a middle cerebral artery. In addition, one child had narrowing of the cervical segment of the internal carotid artery. An inflammatory arteritis of the cervical internal carotid artery is presumably the site of the formation of cerebral emboli.     

The prevalence of Trichuris, Ascaris and hookworm infection in Orang Asli children

Microcin B17 (MccB17) is a ribosomally encoded DNA-gyrase inhibitor. Ribosomally encoded antibiotics are derived from precursors containing an N-terminal leader, which is removed during maturation, and a C-terminal structural peptide. PreMccB17, the translational product of mcbA, is modified into proMccB17 by the action of three enzymes, McbB, McbC, and McbD. A chromosomally encoded peptidase then converts proMccB17 into MccB17. The role of McbB, McbC, and McbD is to convert glycine, cysteine, and serine residues present in preMccB17 into four thiazole and four oxazole rings. Using a modification-specific antibody rather than antimicrobial activity, we show that the 26-amino-acid N-terminal leader of preMccB17 is essential for the conversion of preMccB17 into proMccB17. Neither a preMccB17 peptide lacking the leader nor a preMccB17-beta-galactosidase fusion lacking the leader are post-translationally modified.     

儿童下呼吸道感染常见病原菌分布及耐药性变迁

目的:研究我院下呼吸道感染患儿病原菌分布及其耐药性变迁,为临床合理使用药物治疗提供参考依据.方法:对2008年1月到2010年12月住院的所有下呼吸道感染患儿,共907例,进行痰培养并对其鉴定和药敏结果进行回顾性分析.结果:3年中分离的革兰阴性杆菌以肺炎克雷伯菌(KPN)和大肠埃希菌(ECO)为主,KPN和ECO产超广谱β-内酰胺酶(ESBLs)率,分别达31.8%～40.0%和41.7%～54.1%;革兰阳性球菌以肺炎链球菌和金黄色葡萄球菌为主,其中耐甲氧西林金黄色葡萄球菌(MRSA)分离率达28.5%～54.4%.病原菌对大部分抗生素有耐药性.结论:儿童下呼吸道感染常见病原菌主要为革兰阴性杆菌,对头孢类耐药率较高,且有逐年升高趋势,故临床上应根据药敏结果合理使用抗生素.