Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry

Caretaker recognition of clinical utility of respiratory signs and symptoms in the prediction of pneumonia was examined in a prospective study of infants and children in four cities in Egypt. In all 688 children aged 2 months-5 years presenting with a history and/or physical examination findings of cough and difficult or fast breathing were recruited from out-patient health facilities. The validity of caretaker terms was determined using paediatrician observation of standard respiratory signs and symptoms, x-ray diagnosis and pulse oximetry as standards. The sensitivity of 'nahagan' (Egyptian Arabic for fast breathing) for identifying elevated respiratory rate was 78% +/- 4, and was slightly higher for < 12 month olds (85% +/- 5) versus children aged 1-5 years (74% +/- 5). 'Sedro tale nazel', which describes the chest as moving up and down, was a sensitive (86% +/- 3) and specific (60% +/- 4) indicator of chest indrawing. 'Tazyeek' (wheeze) had a sensitivity of 75% +/- 3 and specificity of 66% +/- 4 when compared to paediatrician assessment of wheezing during physical examination. Although not specific, the caretaker terms, 'nahagan' or 'nafas seria' (fast breathing) and 'sedro tale nazel' (chest indrawing), either spontaneously or after asking, were sensitive (> 71%) indicators of radiologic pneumonia and oxygen desaturation, and therefore can be used to prompt timely health seeking behaviour in these settings.     

Validity of the children and youth physical self-perception profile: a confirmatory factor analysis

MOTIVATION: The Match-Box software comprises protein sequence alignment tools based on strict statistical thresholds of similarity between protein segments. The method circumvents the gap penalty requirement: gaps being the result of the alignment and not a governing parameter of the procedure. The reliable conserved regions outlined by Match-Box are particularly relevant for homology modelling of protein structures, prediction of essential residues for site-directed mutagenesis and oligonucleotide design for cloning homologous genes by polymerase chain reaction (PCR). RESULTS: The method produces reliable results, as assessed by tests performed on protein families of known structures and of low sequence similarity. A reliability score is computed in relation to a threshold of similarity progressively raised to extend the aligned regions to their maximal length, up to the significance limit of matching segments. The score obtained at each position is printed below the sequences and allows a discriminant reading of each aligned region. AVAILABILITY: Sequences may be submitted to a Web server at http://www.fundp.ac.be/sciences/biologie/bms/+ ++matchbox_submit.html or sent by e-mail to matchbox/biq.fundp.ac.be (help available by just mailing help).     

Sex differences in physical symptoms: the contribution of symptom perception theory

Health surveys, studies on physical symptom reporting, and medical registration of physical complaints find consistent sex differences in symptom reporting, with women having the higher rates. By and large, this female excess of physical symptoms is independent from the symptom measure, response format and time frame used, and the population under study. As most studies concern healthy individuals, the sex difference can not simply be attributed to a greater physical morbidity in women. In this paper we propose a number of explanations for this phenomenon, based on a biopsychosocial perspective on symptom perception. We discuss a symptom perception model that brings together factors and processes from the extant literature which are thought to affect symptom reporting, such as somatic information, selection of information through attention and distraction, attribution of somatic sensations, and the personality factors somatisation and negative affectivity. Finally, we discuss the explanations for sex differences in physical symptoms that arise from the model.     

Urinary tract infections in children due to Pseudomonas aeruginosa in Enugu, Nigeria

Ileal duplication cysts within a giant omphalocele are very rare. Only a few cases have been reported in the English literature (4). We report one case of giant omphalocele, which included a huge ileal duplication cyst, detected by prenatal US, and diagnosed at surgery after birth. This case illustrates the diagnostic and therapeutic problems occurring during pregnancy and the neonatal period.     

Multiple urethral calculi in children: report of two cases

Multiple urethral calculi are rarely found in children. We report herein two unusual cases of children found to have multiple urethral calculi. In one, the calculi formed proximal to a stricture and in the other they formed within a diverticulum. Both patients required urethrotomy for removal of the calculi. A unique cause of urethral stricture is also described in case 1.     

Quantitative analysis of the technetium-99m-DTPA captopril renogram: contribution of washout parameters to the diagnosis of renal artery stenosis

Retrospective analysis of precaptopril and postcaptopril DTPA renograms from 88 hypertensive patients was performed to refine the quantitative criteria used to diagnose renal artery stenosis (RAS). Of the 88 patients, 45 had RAS and 43 had normal renal arteries at angiography. Using time-activity curves from the essential hypertensive group, diagnostic washout criteria for a positive DTPA renogram were developed. These were based on the 20 and 30 min/peak activity ratios in each kidney. When the washout criteria were retrospectively applied to patient data as a whole, sensitivity and specificity for RAS were 67% and 79%, respectively. When previously described uptake criteria, based on the time to peak activity in each kidney and the GFR ratio between the kidneys, were applied to the same data, sensitivity and specificity for RAS were 89% and 84%, respectively. Quantitative analysis of the DTPA renogram using the time to peak and GFR ratio was both sensitive and specific for RAS. Measurement of 20 and 30 min/peak renal activity ratios did not improve the accuracy of the test.     

Tooth wear in children: an investigation of etiological factors in children with cerebral palsy and gastroesophageal reflux

This investigation was undertaken to establish the prevalence and distribution of tooth wear in different groups of medically compromised children and to assess the possible influence of gastroesophageal reflux, dietary factors, and parafunctional activity. Four groups of children including twenty-one with cerebral palsy were clinically examined and had in-depth, structured interviews, including information on medical history, medication, gastroesophageal reflux, feeding and drinking habits, parafunctional activity, and tooth-brushing procedures. All the children with cerebral palsy also had twenty-four-hour gastroesophageal pH monitoring. Of the fifty-one children in total, twenty-five had moderate or severe levels of dental erosion. No statistically significant differences were found between the groups as far as dietary influences, feeding habits, and tooth-brushing procedures. There was a significant association, however, between gastroesophageal reflux and erosion. It is concluded that in children with cerebral palsy this reflux may be much more important in the etiology of tooth surface loss than the parafunctional activity, which has classically been regarded as the cause.     

Urinary tract infections in children: why they occur and how to prevent them

Urinary tract infections (UTIs) usually occur as a consequence of colonization of the periurethral area by a virulent organism that subsequently gains access to the bladder. During the first few months of life, uncircumcised male infants are at increased risk for UTIs, but thereafter UTIs predominate in females. An important risk factor for UTIs in girls is antibiotic therapy, which disrupts the normal periurethral flora and fosters the growth of uropathogenic bacteria. Another risk factor is voiding dysfunction. Currently, the most effective intervention for preventing recurrent UTIs in children is the identification and treatment of voiding dysfunction. Imaging evaluation of the urinary tract following a UTI should be individualized, based on the child's clinical presentation and on clinical judgment. Both bladder and upper urinary tract imaging with ultrasonography and a voiding cystourethrogram should be obtained in an infant or child with acute pyelonephritis. Imaging studies may not be required, however, in older children with cystitis who respond promptly to treatment.     

Tilt test in the etiological diagnosis of syncope unexplained by electrophysiological study

In order to determine the role of tilt testing in the aetiological diagnosis of syncope unexplained by electrophysiological investigation, the authors retrospectively studied the results of this test in 275 patients with a mean age of 64 +/- 16 years. These 275 patients were divided into two groups: group I: 43 patients with a mean age of 50 +/- 19 years presenting with vagal syncopes, group II: 232 patients with unexplained syncope, probably vagal: group IIa (120 patients, mean age: 67 +/- 15 years), sudden syncope: group IIb (112 patients, mean age: 67 +/- 13 years). The electrophysiological investigation was inconclusive in every case. In group II, 50% of tilt tests were positive (19% under basal conditions, 31% after isoproterenol), with 61% of positive tests in group IIa, including 31% on the basal test, and 38% of positive tests in group IIb, including 11% on the basal test. In group I, 84% of tests were positive (33% on the basal test, 51% after isoproterenol), indicating a sensitivity of the test of 84%. In 96 patients with a doubtful electrophysiological investigation, the tilt test was positive in 70% of cases, allowing specific treatment or a pacemaker to be avoided in the majority of cases. 84% of vasovagal syncopes were therefore confirmed by tilt testing; 50% of syncopes unexplained by electrophysiological investigation were demonstrated to be of vasovagal origin. The author emphasize the value of tilt testing in certain discordant situations in which the clinical context is disturbing and/or electrophysiological investigation is not completely reassuring.     

Operationalized psychodynamic diagnosis in childhood and adolescence--a contribution to quality assurance

Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of children's and adolescent's psychiatric disturbances may thus be completed with additional psychodynamic assessment procedures. In adults an operationalized procedure of psychodynamic assessment (OPD) already exists. In child and adolescent psychiatry a working group for psychodynamic diagnostic (OPD-KJ) has been founded. In 4 areas (subjective experiences of disturbances, relationships, intrapsychic conflicts and psychic structure) diagnostic manuals are being worked out. Fundamental questions of developmental psychopathology and diagnostic procedures have to be addressed. The basic proposition takes into account that children should not be psychodynamically compared with adults, but normally have a basic capacity to adapt to environment on a high level of psychic organisation in all developmental stages. Reports of the ongoing work are being given.     

Urinary calculi in small and other animals--a retrospective study of the years 1980-1989]

More than 500 uroliths from dogs, cats, minks, rabbits and 9 further animal species originating from various regions of former East Germany were analysed. The observations were made between 1980 and 1989 using X-ray diffraction and infrared spectroscopy. The urinary stones consisted of struvite, whewellite, weddellite, cystine, ammonium urate, brushite, whitlockite, hydroxyapatite or carbonate-apatite, calcium carbonate, silicon dioxide and organic matrix stones. In dogs, the most frequent types were struvite and apatite concrements, followed by calcium oxalate and cystine uroliths. Among the diseased animals poodles, dachshunds and terriers ranked first. In the analysed material from cats apatite and struvite predominated. With few exceptions, minks formed struvite uroliths only. The analysed calculi from rabbits consisted principally of calcium phosphate or calcium carbonate concrements. The present analysis has been compared with results of former studies, differences are discussed.     

Modern approach to the diagnosis of osteomyelitis in children

Osteomyelitis in childhood is common and causes serious morbidity. X-rays and bone scans are the primary tools of radiological investigation. Other imaging techniques, including ultrasound, computed tomography, magnetic resonance imaging and white cell scintigraphy have a valuable role in difficult cases.     

Spectroscopic analysis of biliary calculi: correlations of the type of calculi and clinical data of 25 consecutive surgical patients

The Authors considering cholelithiasis as an heterogenic pathological entity report their experience of 25 surgical consecutive patients: 20 with cholesterol or combination gallstones and 5 with black pigmented gallstones. In this series the most frequent factors associated with cholesterol gallstones were LDL hypercholesterolemia and hypertriglyceridemia; while the most frequent factors associated with black pigmented gallstones were hepatopathies. The most frequent symptom was dyspepsia. Only the black pigmented and the mixed gallstones were associated with jaundice and pancreatitis. According to the Literature infection is associated to brown pigment gallstones in 95% of cases, in this series infection is rarely associated with other types of gallstones. Treatment with oral bile salts is useful only in pure cholesterol gallstones, so the distinction among different types of gallstones is useful not only for a better knowledge of their pathogenesis but also for a correct choice of the therapeutic options.     

Gastroesophageal reflux in children: clinical manifestations, diagnosis, pathophysiology, and therapy

Gastroesophageal reflux in infants and children is a challenging diagnostic problem. A careful history and physical examination are of foremost importance. In infants, the esophageal manometry study and the Tuttle test are helpful in confirming gastroesophageal reflux. In older children, these two studies as well as the Bernstein test should be done to document reflux. The presence of esophagitis or esophageal strictures is best determined by esophagoscopy with concomitant grasp or suction biopsies. A medical regimen should be tried for three to six weeks in all children except those with esophageal strictures or severe malnutrition. Medical failures should be treated surgically with Nissen fundoplications, performed by a competent pediatric surgeon. The prognosis for children undergoing surgical correction is excellent.     

Urinary calculi and indinavir sulfate in patients with HIV infection. Apropos of 4 cases

We report on 4 cases of urinary stone observed in patients treated with the drug Crixivan (Indinavir Sulfate) and review the literature. Comments include stone composition, clinical aspects, treatment and prevention.     

The contribution of personality characteristics to the relationship between social support and perceived physical health.

Employed structural equation modeling to derive and test a model of the relationships between personality characteristics, social network size, the perceived availability of support, socially supportive behaviors, and perceived physical health with 182 adults (aged 30–90 yrs). Ss completed a telephone interview and a questionnaire that included a version of the Norbeck Social Support Questionnaire and 3 subscales from the Personality Research Form. Significant paths indicated that Ss who perceived themselves as affiliative and as help seekers and help givers reported larger social networks, received more socially supportive behaviors, and perceived more available support. Also, the more support Ss perceived to be available to them, the more positively they rated their perceived physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The human touch: An exploration of the role and meaning of physical touch in psychoanalysis.

This article addressed the meaning and significance of minor physical contact (e.g., a hug or handshake) within the psychoanalytic dyad. Although undoubtedly a controversial topic, the plain fact that it is occurring makes touch an important and necessary subject of discourse. Furthermore, as psychoanalysts come to define the role of the more human analyst within the 2-person field and come to regard so-called extra-analytic techniques as necessary and even highly therapeutic, there is no logical basis from which to exclude the judicious use of actual physical contact as one of the tools of the more "human" analyst. The author presented clinical material in which touch seemed ill-advised as well as that in which it proved efficacious. She thus endeavored to clarify and bring into conscious awareness those factors by which decisions are made to touch or not to touch as well as how, when, and with what types of patients psychoanalysts decide to have physical contact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)