A comparative study of sodium,potassium and bilirubin in maternal and cord blood

Summary Analysis of serum sodium of 12 normal non-pregnant, 64 normal pregnant, 10 pre-eclampsia and 18 mothers of premature babies showed no statistically significant variations. Cord blood was found to exhibit sodium levels identical to that of the mothers’ blood. Serum potassium of the mothers did not show any variation from normal. Serum potassium of cord blood showed a slight increase relative to the mother’s values and this increase was found to be statistically significant. While the maternal blood samples did not exhibit any direct bilirubin, many samples of cord blood had direct bilirubin. A possible explanation for this is offered in the light of recent advances in bile pigment chemistry. From the Department of Biochemistry, Guntur Medical College, Guntur.     

Pulmonary alveolar microlithiasis

Summary An isolated case of pulmonary alveolar microlithiasis in a boy aged 16 years is reported. His main complaint was shortness of breath. Lung function tests showed a restrictive type of insufficiency. X-ray of the chest and lung biopsy confirmed the diagnosis. The literature on the subject is reviewed. From the Government T. B. Hospital, Mangalagiri, Guntur District, Andhra.     

Epidemiology of infantile hydrocephalus in Saudi Arabia: birth prevalence and associated factors

INTRODUCTION: Hydrocephalus is a common central nervous system disorder in children. In spite of its importance, it has not been subjected to sufficient epidemiological studies, particularly in the developing countries. The aim of this study was to provide information from a representative series of newly diagnosed cases of infantile hydrocephalus on the birth prevalence, associated factors and mortality. METHODOLOGY: A prospective study was conducted over a 1-year period from April 1996 to March 1997 in the city of Al-Madinah Al-Munawarah, Saudi Arabia. Except for neural tube defects and brain tumors, all cases of hydrocephalus diagnosed within the first 28 days of life were included. A control group of 104 subjects was studied for comparison. Information about antenatal, natal and early postnatal periods were obtained by interviewing the mothers of the newborns. RESULTS: During the study period, 26 cases of infantile hydrocephalus were detected. The birth prevalence was 1. 6 per 1,000 live births. There was no sex preponderance as the male to female ratio was 1.2:1. Multiple pregnancies were detected in 21 (81%) cases. Nineteen (73%) cases were the product of consanguineous parent and 4 patients had a positive family history of hydrocephalus. The number of preterm infants was 16 (62%). The number of low birth weights (less than 2,500 g) was 18 (69%). An Apgar score of less than 8 occurred in 18 (69%) cases. The mode of delivery was vaginal in 15 (58%) women. The 6 months mortality rate was 23% (6 infants). CONCLUSION: The birth prevalence of infantile hydrocephalus in this study was significantly higher than in the developed countries. A positive family history of hydrocephalus, low birth weight, low Apgar score and abdominal delivery were found to be associated factors. The mortality rate in the first 6 months of life was significantly higher in hydrocephalus infants than in controls.     

616例小儿热性惊厥首次发作的临床特点及危险因素分析

目的了解热性惊厥患儿首次发作的临床特点及危险因素,指导临床医师对有危险因素的患儿采取相应干预措施,降低热性惊厥的发生。方法选取我院2016年8月至2018年8月收治的616例首次热性惊厥患儿为研究对象,回顾性分析患儿的临床特征及首次发作危险因素,并随机抽取同期发热但无惊厥发作(既往也无惊厥病史)的601例患儿为对照组。结果616例热性惊厥患儿,男344例,女272例,汉族584例,蒙古族32例。1岁以下126例(20.5%),~3岁405例(65.8%),3岁以上85例(13.7%)。发作病因中以急性上呼吸道感染[53.6%(330/616)]、疱疹性咽峡炎[25.9%(160/616)]及幼儿急疹[10.5%(65/616)]居前3位。惊厥发作时体温在38.0℃及以上者570例(92.5%),16例(2.6%)患儿惊厥发作后出现发热。534例(86.7%)患儿在发热24 h内出现惊厥发作。608例(98.7%)患儿表现为全面强直阵挛性发作。惊厥持续时间<5 min 548例(89.0%)、~14 min 48例(7.8%)、~29 min 16例(2.6%)及≥30 min 4例(0.4%)。572例(92.9%)患儿在单次热程中仅1次惊厥发作。临床类型中单纯性热性惊厥占88.3%(544/616),复杂性热性惊厥占11.0%(68/616),惊厥持续状态占0.7%(4/616)。危险因素分析显示首次惊厥时年龄、低钠、低铁、低锌、剖宫产、异常出生史、抽搐前1周疫苗接种史及热性惊厥家族史在热性惊厥组和对照组中差异有统计学意义(P<0.05)。Logistic回归分析发现首次发热惊厥年龄、低铁、剖宫产、低钠及热性惊厥家族史是热性惊厥首次发作的独立危险因素(P<0.05)。结论热性惊厥首次发作多见于3岁以内婴幼儿,以单纯性热性惊厥为主,惊厥发作时体温高,易发生于发热后24 h内,病毒感染是最常见病因。引起热性惊厥首次发作的危险因素依次为首次发作年龄、低铁、剖宫产、低钠及热性惊厥家族史,针对危险因素采取相应的干预措施可降低热性惊厥的发生。     

Population attributable fraction of smoking to low birth weight in Japan

BACKGROUND: The purpose of this study is to quantify the population attributable fraction of active and passive smoking for low birth weight in Japan. METHODS: A population-based case-control study was conducted by mailing self-report questionnaires. The cases were all singleton low birth weight babies who were born between 1 January 1998 and 30 June 1999 in Tochigi prefecture, Japan. The controls were randomly selected from all singleton babies who were born during the same period as cases in the prefecture. RESULTS: The number of cases and controls were 286 and 404, respectively. Population attributable fractions of active smoking during and before pregnancy were 7.0% and 8.8%, respectively. Population attributable fraction of passive smoking at home was 15.6% and at the workplace was 1.1%. Combined population attributable fraction of both active and passive smoking was 17.3%. CONCLUSION: Public education to eliminate passive smoking for pregnant women and smoking prevention in adolescence is very important in order to reduce the risk of low birth weight.     

Serum proteins in children with recurrent pustular eruptions

Summary A study of serum proteins in 30 children with recurrent pyoderma is presented. 10 normal children were taken as controls. The commonest site of infection was the scalp, head and neck. Total serum proteins were low in 70% cases; the A : G ratio was altered in 90% and paper electrophoresis was characterised by a fall in the gamma globulin level and a rise in ∝₂ 2 globulin in almost all the cases. The cause of reinfection is suggested to be carriers among adults, low socioeconomic strata and hypoproteinemia resulting in low resistance and increased susceptibility. From the departments of Skin & V.D., and Pediatrics, M.G.M. Medical College and M.Y. Hospital, Indore.     

Sonographic pattern of gallbladder disease in children with sickle cell anaemia

A prospective analysis of ultrasound examinations of the gallbladder in 161 children with sickle cell anaemia revealed cholelithiasis in 7 cases (4.2%). Biliary sludge was present in 12 cases (7.5%). The commonest abnormality noted was gallbladder wall thickening seen in 13 patients (8.1%). The age range of patients studied was 2 1/2 months to 16 years with a mean of 7.96 years. The youngest age for development of cholelithiasis was 10 years while biliary sludge was noted earliest at 5 years. Gallbladder wall thickening appeared as early as 4 years. Dietary and environmental factors are probably responsible for the low incidence of cholelithiasis in Africans with sickle cell anaemia. The low incidence of cholelithiasis in the African child with this disease does not justify routine and follow-up ultrasound scans in all cases with sickle cell anaemia.     

Diagnostic and prognostic value of bromide partition test in tuberculous meningitis.

Bromide partition ratio was determined in 32 cases of tuberculous meningitis, 6 pyogenic meningitis, 8 viral meningitis and 9 cases of febrile convulsions. Bromide partition ratio below the critical value of 1.6 was present in 30 out of 32 tuberculous meningitis patients (93.74%) whereas all the control children had a ratio above 1.6. Two children who were on regular chemotherapy showed progressively rising ratio. It is concluded that in doubtful cases with inconclusive CSF picture, a low bromide partition ratio is a strong reason for starting antituberculous treatment without any delay. A very low ratio also suggests poor prognosis.     

Outcome in low risk pregnancies.

AIMS: To determine the obstetric and neonatal outcomes of a cohort of very low risk pregnancies in hospital, that would be suitable for home delivery. METHODS: A retrospective analysis was undertaken of computerised records covering five years from July 1988 to August 1993 of 32424 pregnant women who delivered at the North Staffordshire Maternity Hospital, Stoke on Trent, during that period. RESULTS: Of 32424 deliveries, only 1314 (4%) fulfilled our criteria for being low risk. Sixty seven (5.1%) of the low risk group had an operative delivery, with Caesarean section accounting for 32 (2.4%) cases, 16 (23.9%) babies were resuscitated and three were intubated. A normal vaginal delivery occurred in 1245 women, but a paediatrician attended 122 births (9.22%), assisted ventilation was provided in 65 cases (5.2%), and five babies were intubated (0.4%). Fourteen babies in total were admitted to the neonatal unit and one died. CONCLUSIONS: These results suggest that at least 5% of women suitable for delivery at home will require transfer in labour. Midwives attending home births must be skilled in bag and mask resuscitation as only rarely will an urgent intubation be required. The British Paediatric Association Working Party report on neonatal resuscitation suggests a need for resuscitation in only 0.2% of low risk deliveries: but these findings suggest that the need is greater.     

Epiglottitis: incidence of extraepiglottic infection: report of 72 cases and review of the literature.

A review of 72 cases of epiglottitis seen at the Children's Hospital of Denver was undertaken to determine the incidence of extraepiglottic and septic foci in this disease. A parallel review of the literature was also undertaken. The clinical, bacteriologic, laboratory, and radiologic findings of this patient population are described. A 25% incidence of both pneumonia and cervical lymphadenitis was found to be associated with this illness. Exudative tonsillitis and otitis media were the only other complications, although they were infrequently noted. No cases of septic arthritis or meningitis were encountered, although 50% of these patients were recognized as bacteremic. A low incidence of septic complications (eight cases of meningitis and one case of periarticular abscess) is noted in a review of the literature. Recommendations for antibiotic management and definition of the population at risk for septic complications are given.     

腺样体肥大低温等离子消融术与经鼻内镜腺样体吸切术疗效分析

目的 比较腺样体低温等离子消融术与经鼻内镜腺样体吸切术的近期及远期疗效.方法 将148例腺样体肥大患儿分为腺样体低温等离子消融术组（A组）75例,经鼻内镜腺样体吸切术组（B组）73例;术后1个月、12个月、24个月进行随访凋查,并复查鼻咽部CT及纤维鼻咽镜.结果 术后1个月时,A组和B组的治疗有效率分别为100%和97.26%,两组有效率比较,差异无统计学意义（P〉0.05）;术后12个月时,A组和B组治疗有效率为98.67%和93.15%（P〉0.05）,亦无统计学意义;24个月时,两组治疗有效率分别为98.67%和87.67%（P〈0.01）,差异有统计学意义.结论 腺样体低温等离子消融术的远期疗效优于经鼻内镜腺样体吸切术.     

Outcome of the Patients Detected by Newborn Screening in Japan

A follow-up study of the cases detected by a newborn mass-screening program has been performed during 1977–1985 by a collaborative study group. The number of hyperphenylalaninemic patients detected was 148, yielding a calculated incidence of one in 82,000. Of these patients, 102 cases were confired as classical PKU, 37 cases as hyperphenylalaninemia, and 9 cases as biopterine deficiency. The ratio of biopterine deficiency to PKU was about 9%. The incidence of maple syrup urine disease was estimated as one in 580,000, and the incidence of homocystimuria and galactosemia was found to be markedly low. Our survey has accumulated 1,362 cases of histidinemia establishing an incidence of one in 9,000. We have evaluated a large-scale base to study the cad relation of histidinemia to mental development. It seems that low DQ or IQ scores of some histidinemic patients do not correspond to the blood histidine level.     

Surfactant protein A and D gene polymorphisms and protein expression in victims of sudden infant death

Aim: To investigate the innate immune components surfactant protein A (SP-A) and D (SP-D) in victims of sudden infant death syndrome (SIDS).
Methods: Ten common single nucleotide polymorphisms (SNPs) in the exons of SP-A1, SP-A2 and SP-D genes were analysed in 42 cases of SIDS and 46 explained sudden infant deaths. SP-A and SP-D protein expression in tissue from the aerodigestive tract was semi-quantitatively evaluated by immunohistochemistry.
Results: SP-D immunoreactivity was found in lungs and tissue from submandibular gland, palatine tonsils and duodenum. Positive SP-A immune staining was found exclusively in lung tissue. Neither the allele nor the haplotype distribution of the SP-A and SP-D genes was significantly different in SIDS compared to explained deaths. The most common SP-A haplotype, 6A2/1A0, tended to be overrepresented in the cases with low immunohistochemical SP-A expression (61%) compared to cases with high expression (49%), p = 0.08. The SP-D expression was not influenced by the 11 C/T or 160 A/G polymorphisms.
Conclusion: No significant association between the common genetic variants of SP-A and SP-D and SIDS is disclosed by the present study. However, low SP-A protein expression may possibly be determined by the 6A2/1A0 SP-A haplotype, this should be subject for further investigation.     

The high morbidity associated with a measles outbreak in a West Australian town

Objective : To determine the effectiveness of the measles vaccine and to record the morbidity during a measles outbreak.
Methodology : A retrospective cohort study was carried out. It was a community-based study in Bunbury. Western Australia, between February and May 1994, of 53 cases of measles and their household contacts.
Results : Of the 53 cases of measles, 24 were from one high school. Only two cases occurred in the high school class that had received the National Health and Medical Research Council of Australia recommended measles, mumps and rubella (MMR) booster 12 months earlier. Neither had been vaccinated. Vaccine effectiveness was 91% (95% confidence interval 67-97%). Ten cases had complications of measles and a further five were admitted to hospital. Doctors prescribed antibiotics to 29 cases and metoclopramide to five cases. One month elapsed between the day the index case became ill and the first notification to the community health centre.
Conclusions : The low herd immunity that led to this high school outbreak can be attributed to low vaccine coverage. There was a significant morbidity associated with this outbreak that may have been averted if earlier notification had occurred. The MMR booster dose should be offered to all 10-16 year olds to prevent high school outbreaks.     

改良DAL-HX83/90方案治疗儿童郎格罕细胞组织细胞增生症24例疗效观察

目的为提高儿童郎格罕细胞组织细胞增生症(LCH)的预后,在复习文献基础上对DAL-HX83/90方案进行改良并观察其初步疗效。方法24例患者按DAL-HX83/90方案分为A、B、C3组治疗,再按国际组织细胞协会疗效标准进行疗效评价。结果18例随访7~53个月,诱导6周时有效率:90·9%(20/22),化疗结束时有效率94·4%(17/18),复发率22.2%(4/18),化疗相关不良反应约50%。3例发生明显后遗症。结论改良DAL-HX83/90方案初步疗效较好,根据不同组别选用不同化疗强度可减少化疗不良反应,可作为儿童LCH治疗的有效方案之一继续观察。     

Snake Bite in Children: A Five Year Population Study from South-East Queensland

A consecutive series of 71 childhood snake bite incidents is reported. The children were admitted for suspected or confirmed snake bite to four hosptials in south-east Queensland in the 5-year period 1971–1975. Toddlers (1–3 years) constituted the most common age group involved. Information on predisposing factors leading to the bite was available in 33 cases; in 75% of these the children were not provoking the snake, which contrasts with the findings from adult series. The snake was seen in 58% of cases, and felt but not seen in a further 16%. Lay identification was made in 18% only. Definite puncture marks were present in 73% of cases. In 73% of victims there were no observed constitutional signs or symptoms whatsoever suggesting, in practice, that bites are generally by snakes of low potential danger. Seventeen per cent showed signs of envenomation. Antivenene was used in two cases. One fatality occurred, but the rest recovered without sequelae. In two of the 71 cases an effective tourniquet was applied.     

Blood zinc in patients with Down's syndrome and its relations with their immune status

Studies performed in the last decade have shown the importance of zinc in human physiology particularly in cell mediated immunity. Blood zinc values were assayed with the atomic absorption method using a Perkin/Elmer 2.380 spectrophotometer in 35 Down's syndrome subjects (DS) (16 boys and 19 girls aged 6 months 20 years) and in normal subjects in good health. The immunological picture was determined as previously described. Zinc values in normal subjects were in the range 92-128 micrograms/dl (mean value 107 +/- 10.46 micrograms/dl). The values are in the normal range. The range of blood zinc values of DS children was 60-138 micrograms/dl (mean value 92.22 +/- 19.76 micrograms/dl). Of the 35 subjects with DS, 16 had values of 60-84 micrograms/dl (mean 74.25 +/- 8.29 micrograms/dl) (table I), which are well below normal. Blood zinc values were not correlated to age and sex. A relationship was found with mortality. Out of 16 patients with low zinc values 10 (68.5%) were particularly susceptible to infections. These data were then related to results concerning the immunological status of a previous study. The only three negative skin tests were observed in subjects with low blood zinc. 62.5% of DS subjects with low blood zinc also had a complete lymphocyte deficit (table I) as compared to 42.1% of DS cases with normal zinc levels. Respectively 56.25% and 36.8% of DS cases with low blood zinc values had an abnormal and normal T helper/T suppressor ratio. Only 3 (8.57% of all cases and 18.75% of low blood zinc values) subjects had an alteration of all the parameter evaluated (including morbility).(ABSTRACT TRUNCATED AT 250 WORDS)     

Mortality from group C meningococcal disease: a case for a conjugate vaccine?

This 17-year retrospective review of children with meningococcal disease (MCD) has determined the mortality due to serogroup C, in order to assess the potential impact of a group C conjugate vaccine. Four hundred and forty-nine cases of MCD were admitted to our hospitals during 1977–1993; 78 due to group C, 11 of whom died. There was a significant increase in the proportion of cases due to group C from 1986 onwards (10% vs 21%), and an increase in the total number of cases of MCD (151 vs 298). The currently available group C polysaccharide vaccine has low efficacy below 2 years of age and could not have prevented 54 cases of group C disease. A conjugate group C vaccine administered between 2 and 4 months of age could have prevented 68 cases, including all fatal cases. The recent increase in MCD is partly due to an increase in group C disease. A meningococcal group C conjugate vaccine could prevent most cases of infection due to group C, and decrease the mortality from MCD by up to 30%.     

Clinical profile of malaria in children--a prospective study from Aligarh (N. India)

In a prospective, hospital-based study in North India, malaria accounted for 1.5% of paediatric outpatient attendances during 1 year. A marked increase in the prevalence of malaria was noted during the post-monsoon months. Plasmodium falciparum was the causative species in 44.4% of cases, contrary to previous reports of low prevalence of this parasite in the area. Pyrexia with or without chills or rigor, vomiting, pallor and hepatosplenomegaly were the common presenting clinical features. Splenic and hepatic enlargement were seen more frequently with P. vivax than P. falciparum infections (P less than 0.001 and P less than 0.01, respectively). Convulsions were present in 20% of cases.     

体质量小于5kg婴儿心内直视手术的体外循环管理

目的 总结体质量＜5 kg婴儿心内直视手术体外循环(CPB)的管理经验.方法 回顾性分析行心内直视手术的体质量＜5 kg 婴儿168例的临床资料.男104例,女64例;年龄3 d～6个月;体质量2～5 kg其中常温5例,浅低温88例,中低温52例,深低温低流量23例,深低温停循环选择性脑灌注10例.深低温患儿应用pH稳态、甲泼尼龙、甘露醇.CPB中监测ECG、平均动脉压、经皮血氧饱和度、鼻咽温、肛温、尿量和中心静脉压.结果 CPB时间为18～155(45.26±23.36) min;主动脉阻断时间为18～85(33.22±20.25) min;自动复跳率为98.2%.患儿均顺利脱离CPB.15例出现并发症,包括低心排综合征、低氧血症各3例,延迟关胸2例,肺不张、气胸、肾功能不全、纵隔感染、消化道出血各1例,再次开胸止血及残余分流各1例.术后死亡4例,病死率为2.34%,主要死亡原因为心肺功能衰竭.结论 CPB中应用个体化管理和采用综合措施是婴儿心内直视手术成功的保障.