Heart transplantation in Chagas' disease. 10 years after the initial experience

BACKGROUND: Heart transplantation (HT) as a therapeutic option for end-stage chronic Chagas' heart disease (CCHD) is controversial. Reactivation of Trypanosoma cruzi infection and recurrence of the disease in the allograft are likely to occur. Furthermore, active myocarditis has been reported to predispose patients to an increased incidence and severity of rejection. METHODS AND RESULTS: We prospectively investigated the long-term follow-up of 10 patients with CCHD who underwent HT. Immunosuppression was based on cyclosporine A and azathioprine. T cruzi reactivation was prevented with benzonidazole. Besides allograft rejection surveillance, T cruzi infection was monitored through blood tests, myocardial biopsies, and serological tests. Over a mean follow-up period of 34 +/- 38 months (range, 73 to 124 months), 7 patients are alive and in NYHA functional class I. Life expectancy was 78% for the second year and 65% for 10 years. Rejection was less frequent in chagasic than in age- and sex-matched control patients (mean +/- SD, 1.60 +/- 1.26 versus 5.70 +/- 1.89 episodes per patient, respectively; P = .0001); decreased severity of rejection was also observed (P = .006). T cruzi parasitemias detected on three occasions were successfully treated with benzonidazole. There were no signs of recurrence of the disease in the allograft. CONCLUSIONS: These results suggest an important role of HT in the treatment of CCHD. There was a low frequency of T cruzi infection reactivation and no signs of recurrence of the disease in the allograft. The surprisingly decreased rejection incidence and severity require further studies for elucidation.     

Physical assessment of children ages 1 to 10 years with renal disease

This article is a review of the many physical findings that one may encounter when examining a child with renal disease. It is the intention of this article to increase the knowledge base of the novice and heighten the awareness of advanced practitioners in relation to findings specific to infants and children.     

Caries and malocclusions. A statistical-epidemiological study performed on 5399 children between 3 and 10 years old in the schools of Bari

BACKGROUND: The high incidence of decay and malocclusion is an undiscussed fact now. What is the relation between this incidence and sanitary-social standards is to define still. The aim of this survey was to evaluate the incidence of decay and malocclusions in relation to different sanitary-social standards. METHODS: The authors carried out an epidemiological-statistical study upon the incidence of decay and malocclusions on 5399 children whose age ranged from 3 to 10. The subjects belonged to some quarters of Bari: Palese, Santo Spirito, San Paolo e Poggiofranco. Some forms were filled in for any subject upon which data on oral health, oral hygiene and occlusal disorders were annotated. Then some groups was divided on subject's age and origin was created. RESULTS: The incidence of decay and malocclusions resulted extremely high in all considered groups. The examination of data showed a clanger gap about the oral hygienic standards between first three quarters, formed into A group, and Poggiofranco, in the last's favour. CONCLUSIONS: Students and their parents showed a serious sub-estimation of the importance of oral health. An increase of quality and number of information on oral health is indispensable for many examination children and their respective parents.     

The potential risk factors associated with acute viral hepatitis in children under 5 years old]

In studies of the effects of salt intake on blood pressure (SBP, MBP, DBP), influences on heart rate (HR) are usually neglected even though the longterm load on both left ventricle (LV) and systemic arteries (SA) is better related to the product of HR x SBP (or MBP) than to pressure alone. After all, altered salt intakes often induce considerable volume-related changes in HR, and the heart operates more economically at low HR and high stroke volume (SV). Thus, about 3/4 of LV metabolism is used for the build-up of systolic tension, while the cost for SV expulsion, or for SV increases, is far lower. Moreover, low HR prolongs the diastolic period, so important for LV coronary supply. Against this background we have used results from studies in both rats and man, in which both BP and HR were followed during marked changes in salt intake, to explore how this affected the HR x SBP (or HR x MBP) product. Briefly, in ordinarily salt-resistant organisms, whether normo- or hypertensive, salt intake increases, which in man ranged from 10-20 to 250-300 mM (in rats over 100-fold), if anything reduced the computed longterm load (HR x SBP, or MBP) on LV and SA, as consequences of an efficient reflex volume control. By contrast, in salt-sensitive man, HR reflex reductions to increased salt intake were almost absent despite substantial SBP elevations, suggesting the influence of a CNS suppression of bulbar reflex centres combined with CNS neurohormonal interference with renal salt volume excretion, as in SHR.     

A general practice case-control study of delayed immunisation in under two year old children

AIM: To identify social factors which characterise the household of children with delayed immunisation. METHOD: The study was done in 15 general practices in the Wellington city region with a case-control design where preschool children who were not up to date (cases) for their immunisations were compared with children who were up to date (controls). RESULTS: There were 215 cases where immunisation was delayed among 3723 children at the time of audit in June 1996. Ethnic status was available from general practice records in 33% of cases and 40% of controls. There were more Maori and Pacific Island children among the cases compared to controls (39% versus 21%, odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.12-5.10, p = 0.022. CASE SAMPLE HOUSEHOLDS COMPARED WITH CONTROLS HAD: (1) more children in the households (mean 2.27 versus 1.98, p = 0.01); (2) more households with a female as the only adult (35% versus 24%, OR = 1.61, 95% CI 1.04-2.51, p = 0.034). There was no difference in the proportions of male only adults (0.02% versus 0.01%, p = 0.70); (3) more mothers who were under 30 years of age (38% versus 25%, OR = 1.61, 95% CI 1.04-2.51, p = 0.034); and more fathers under 30 years of age (20% versus 10%, OR = 2.16, 95% CI 0.97-4.84, p = 0.06); (4) fewer mothers who were up to date with their recorded cervical smear status (66% versus 83%, OR = 0.69, 95% CI 0.23-0.63, p < 0.001); (5) more parents with an active community services card (38% versus 25%, OR 1.82, 95% CI 1.17-2.82, p = 0.007); (6) fewer siblings being immunised (70% versus 94%, OR = 0.14, 95% CI 0.07-0.28, p < 0.001). CONCLUSION: There is a distinct group of New Zealand children for whom immunisation is delayed. Such children live in households which can be characterised by various social factors easily obtainable from general practice records. The identified households could be targeted for efficient preventive care by general practices.     

陕西省农村6岁以下儿童营养状况两次调查结果比较

儿童营养不良不仅会造成儿童当前身体的发育迟缓,同时还会增加成年时期患许多慢性代谢性疾病的危险.我国0-5岁儿童的营养状况在过去10年中有了很大的改善,但在农村,儿童营养不良率依然很高.     

Evaluation of a serological test for diagnosis of Helicobacter pylori infection in children

A serological test for the diagnosis of Helicobacter pylori infection (Cobas Core Roche, IgG, 2nd Generation; Roche, France) was compared with the examination of biopsy samples (culture and histology) obtained after endoscopy in 115 children to assess its value. In 94 children (42 positive and 52 negative), results were concordant. In 10 children a positive serological test was associated with an absence of Helicobacter pylori, while in 11 others a negative serological test was associated with a positive culture. Sensitivity of the test was 79.2% and specificity 83.9%. A relationship between IgG titers and age (r = 0.31, p < 0.05) was found. Serological tests could be useful for the diagnosis of Helicobacter pylori infection, but a negative test result does not rule out infection, particularly in children under 10 years of age.     

Peritoneal dialysis in children under 5 years of age

The aim of this study was to examine the effect of intensive practice in table tennis on perceptual coincident timing. The main question was whether the perceptual demands encountered in fast ball sports produce modifications of the perceptual visual system. Expert table tennis players and novices were compared in a perceptual task which consisted of estimating, by pressing a key, the arrival of a moving stimulus at a target. The stimulus, which was presented either at constant velocity or at constant deceleration, reproduced as closely as possible the natural visual demands encountered in table tennis. The difference between the time of response and the time of arrival of the stimulus at a target position was measured over 40 trials for each of the 16 participants. The results showed no effect of expertise under the constant-velocity condition but an effect under the decelerative condition, indicating that experts were less trajectory-dependent than novices. This result was interpreted as reflecting a better adaptation of the perceptual system of experts to the constraints encountered during table tennis and specifically to the perceptual demands resulting from varied and decelerated ball trajectories. Finally, some limitations of the coincidence anticipation procedure are highlighted, concerning its use in practical settings for evaluating athletes or detecting sport talents, and the need for the simulation conditions during testing to reproduce as closely as possible the perceptual demands of real life is discussed.     

Cholelithiasis in persons under 25 years old. Clinicopathologic review of 96 cases

Ninety-six of 683 patients undergoing cholecystectomy at the Naval Regional Medical Center, Long Beach, Calif, from 1967 to 1974 were between 7 and 25 years old. Although females predominated in ratio of 4:1, the sex incidence was equal when nulliparous females were compared with males. Signs and symptoms were nonspecific in 70%, leading to delay in proper diagnosis in 26%. Only two patients had an underlying blood dyscrasia. Oral cholecystography proved to be the most reliable diagnostic test. Moreover, the incidence of choledocholithiasis was 4.1%, approximately one third less than in older age groups.     

Accuracy of leg length prediction in children younger than 10 years of age

In this study, the authors attempted to predict the ultimate leg length in normal children with normally growing legs, using Green-Anderson and Moseley techniques with chronologic and skeletal age. The predictions were based on serial growth studies of children between 5 and 10 years of age. Using skeletal age for prediction, the absolute mean error in predicting the ultimate leg length was 2.4 cm using the Green-Anderson method and 2.58 cm using the Moseley method. Using the Moseley method for length prediction in boys, the mean error was 3.8 cm using skeletal age and 1.5 cm using chronologic age. For girls, using the Moseley method of leg length prediction, the mean error was 1.55 cm with skeletal age and 2.46 cm with chronologic age. The significance of this study is that skeletal age, as determined by the Gruelich and Pyle Atlas, does not improve the accuracy of prediction of ultimate leg length in children younger than 10 years of age, except in girls with advanced bone age.     

Clinical and serological study of tsutsugamushi disease in northern Osumi, Kagoshima Prefecture

We report 34 cases of tsutsugamushi disease seen from 1989 to 1993 at Yagi Clinic, northern Osumi, Kagoshima Prefecture. Nineteen patients (55.9%) showed the highest antibody titers against the Kawasaki strain Orientia tsutsugamushi (Ot) and 13 (38.2%) against the Kuroki strain Ot. It is suggested that two antigenic types (Kawasaki and Kuroki) of Ot were distributed in Kagoshima Prefecture, and the Kawasaki type Ot more or less dominates Kuroki type Ot. There was no difference in clinical features between the two groups of patients.     

Posttraumatic stress disorder in children: a review of the past 10 years

OBJECTIVE: To review current knowledge about the clinical presentation, assessment, and treatment of posttraumatic stress disorder (PTSD) in children. METHOD: The literature on PTSD in children is examined. RESULTS: Over the past 10 years, PTSD has been described in children exposed to a variety of traumatic experiences. Little is known about the epidemiology of the disorder in children. Partial symptomatology and comorbidity are common. A variety of factors influence response to trauma and affect recovery. They include characteristics of the stressor and exposure to it; individual factors such as gender, age and developmental level, and psychiatric history; family characteristics; and cultural factors. Since the condition is likely to occur after disaster situations, much of the literature describes the child's response to disaster and interventions tend to include efforts within schools and/or communities. A number of clinical approaches have been used to treat the condition. CONCLUSIONS: While assessment has been studied extensively, the longitudinal course of PTSD and treatment effectiveness have not been. Biological correlates of the condition also warrant greater attention.     

Discrimination of syntactical errors in children under two and one-half years.

Tested 32 8-30 mo old children who spoke in either 1- or 2-word utterances for their ability to discriminate between complete grammatical and ungrammatical sentences. The measure of discrimination used was children's listening preferences. Results show that both types of children can discriminate, and illustrate the extent of the lag between children's acquisition of syntax and their use of that syntax in free production. Preferences may provide a methodology for studying the acquisition of syntax independent of production skills. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of serological diagnosis of Borna disease virus infection using recombinant proteins in experimentally infected rats

We produced two recombinant Borna disease virus (BDV) proteins, p40 and p24, by using a baculovirus vector as a diagnostic antigen. Antigenicities of these recombinant proteins were evaluated by immune rabbit sera. Recombinant p40 was a more sensitive antigen than p24 for the detection of antibodies in infected rats. Rats inoculated with BDV within 24 hr after birth showed higher detection rates of viral RNA and viral proteins from the brain than rats inoculated at 4 weeks-old. Depending on the age of infection and the time postinfection, the detection of BDV RNA, protein, or anti-BDV antibody did not always correlate in individuals. We suggest both serological and molecular biological methods are needed in the diagnosis of BDV infection.