Radiographic findings among children hospitalized with severe community-acquired pneumonia

BACKGROUND

Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP.

OBJECTIVE

To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP.

METHODS

A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3-59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported.

RESULTS

Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumococcal isolation (OR 1.8, 95% CI, 1.3-2.7; OR 11.0, 95% CI, 4.6-26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2-2.6; OR 3.1, 95% CI, 1.2-8.0, respectively).

CONCLUSIONS

Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease.

Adsorption of Methylene Blue on magnesium silicate: kinetics, equilibria and comparison with other adsorbents

Batch adsorption from aqueous solutions in a slightly basic medium of Methylene Blue, up to 2500 mg/L, onto synthetic magnesium silicate (Florisil) of three particle size ranges (mean diameters of 112, 200 and 425 microm) was compared to the corresponding adsorption onto activated carbon and Amberlite XAD-2. The best fit of the kinetic results was achieved by a pseudo second-order equation. The equilibrium data were found to be well represented by the Langmuir isotherm equation. Amberlite XAD-2, an unspecific adsorbent capable of adsorbing exclusively through a surface effect, exhibited a poor dye uptake, confirming that the adsorption mechanism on Florisil was due to electrostatic attraction and ion exchange. Moreover, the comparison between Florisil and the other adsorbents was performed on the basis of the evaluation of the surface area and pore volume occupied by the adsorbed dye.

[Current topics in pharmacokinetics and pharmacogenetics of antidepressant drugs]

For antidepressants as well as for other drugs, personalized prescription has become a major challenge, provided the large interindividual variability encountered both at the pharmacokinetic and the efficacy and tolerance levels. Better identification of the numerous relevant factors and quantification of their effects are prerequisites to progress in that direction. On the basis of recent literature, genetic factors are first reviewed, including polymorphisms of genes coding for drug-metabolizing enzymes, transporters and pharmacodynamic target molecules. Current recommendations with respect to therapeutic drug monitoring of antidepressants and use of pharmacogenetic testing are then summarized.

Familial Risk Factors for the Course of Bipolar Disorder

Aims:

The major aims of the present paper were to:1.

Methods:

A family study including 125 bipolar-I patients and all available first-degree relatives has been conducted at two Swiss sites. All participants were evaluated using the Diagnostic Interview for Genetic Studies. Assessed course variables included the age of onset, the number of episodes and social functioning in terms of GAF scores. Among the 237 interviewed relatives of bipolar probands, 32 also exhibited bipolar disorder.

Results:

The occurrence of bipolar disorders in relatives was not associated with course variables in bipolar probands, whereas the occurrence of unipolar depression in relatives was associated with a more favorable course in probands in terms of higher lifetime GAF scores. Regarding the expression of symptoms during episodes, associations between disorders in probands and relatives were observed for dysphoric and psychotic rather than for typical manic symptom patterns.

Conclusion:

Our data did not provide support for a significant association between the course of bipolar disorder and the presence or the course characteristics of bipolar disorders in relatives. Surprisingly, the presence of unipolar depression in relatives was even associated with a better course of the bipolar disorder in probands. Nevertheless, bipolar disorder revealed some degree of similarity across family members, particularly regarding the expression of dysphoric and psychotic symptom patterns.

Prevalence of pathological gambling in Switzerland after the opening of casinos and the introduction of new preventive legislation

OBJECTIVE

This survey aimed to evaluate the prevalence of pathological gambling (PG) in the Swiss population in 2005 and the link between PG and alcohol abuse. This replication study made it possible to compare the prevalence rates of PG measured before and after the introduction of casinos and new preventive legislation.

METHOD

A total of 2803 telephone interviews were completed using standardized assessment instruments for identifying gamblers (South Oaks Gambling Screen) and alcohol abuse (CAGE).

RESULTS

The past-year prevalence rates were 0.8% for problem and 0.5% for PG. No relationship was found between alcohol abuse and gambling behaviour. The past-year prevalence of disordered gambling did not change between 1998 and 2005.

CONCLUSION

Despite widespread openings of casinos in Switzerland since 2002, the prevalence estimates of past-year disordered gambling have remained stable. The discussion focuses on different factors (social measures, legal obligations and social adaptational capacities) that may account for the stabilization of prevalence estimates.

Inter-informant agreement and prevalence estimates for substance use disorders: direct interview versus family history method

OBJECTIVES

Family studies typically use multiple sources of information on each individual including direct interviews and family history information. The aims of the present study were to: (1) assess agreement for diagnoses of specific substance use disorders between direct interviews and the family history method; (2) compare prevalence estimates according to the two methods; (3) test strategies to approximate prevalence estimates according to family history reports to those based on direct interviews; (4) determine covariates of inter-informant agreement; and (5) identify covariates that affect the likelihood of reporting disorders by informants.

METHODS

Analyses were based on family study data which included 1621 distinct informant (first-degree relatives and spouses) - index subject pairs.

RESULTS

Our main findings were: (1) inter-informant agreement was fair to good for all substance disorders, except for alcohol abuse; (2) the family history method underestimated the prevalence of drug but not alcohol use disorders; (3) lowering diagnostic thresholds for drug disorders and combining multiple family histories increased the accuracy of prevalence estimates for these disorders according to the family history method; (4) female sex of index subjects was associated with higher agreement for nearly all disorders; and (5) informants who themselves had a history of the same substance use disorder were more likely to report this disorder in their relatives, which entails the risk of overestimation of the size of familial aggregation.

CONCLUSION

Our findings have important implications for the best-estimate procedure applied in family studies.

Study on the structure and properties of wool keratin regenerated from formic acid

Structural characteristics of keratin regenerated from water (KW) and from formic (KF) acid solutions were compared. Amino acid composition and molecular weight distribution of KW and KF samples were studied by high performance liquid chromatography (HPLC) and SDS-PAGE electrophoresis. Turbidity measurement showed that keratin dissolved in formic acid forms transparent and stable solutions and no flocculation occurs. In addition, because of its good solvation properties, studied by viscosity measurements, formic acid can be used as a co-solvent to prepare keratin-based blend solutions. Structural studies carried out by X-ray diffraction (XRD), Fourier transform infrared (FT-IR) and near infrared (NIR) suggest that formic acid stabilizes the beta-sheet structure. Thermogravimetric analysis (TGA) reveals a higher thermal stability of keratin regenerated from formic acid with respect to keratin regenerated from water.

Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening

BACKGROUND & AIMS

We conducted a study to estimate population coverage and detection rate (DR) achievable through different strategies of colorectal cancer (CRC) screening.

METHODS

A population-based multicenter randomized trial comparing 3 strategies was used: (1) biennial immunologic fecal occult blood test (FIT), (2) "once only" sigmoidoscopy (FS), and (3) "once only" colonoscopy (TC). A random sample of men and women, aged 55 to 64 years, was drawn from general practitioners' (GP) rosters. Eligible subjects, randomized within GP, were mailed a personal invitation. Nonresponders in groups 2 and 3 were invited again at 12 and 24 months. Screenees with "high-risk" distal polyps (villous component >20%, high-grade dysplasia, CRC, size >or=10 mm, >2 adenomas) at FS, or with positive FIT, were referred for TC.

RESULTS

The attendance rate was 32.3% (1965/6075) for FIT, 32.3% (1944/6018) for FS, 26.5% (1597/6021) for TC. FIT detected 2 patients with CRC (0.1%) and 21 with an advanced adenoma (1.1%). The corresponding figures were as follows: 12 (0.6%) and 86 (4.5%) patients, respectively, for FS; 13 (0.8%) and 100 (6.3%) patients, respectively, for TC. To detect 1 advanced neoplasm, it would be necessary to invite 264 people with FIT, 60 with FS, 53 with TC. FS would have detected 27.3% of the proximal advanced neoplasms detected at TC. Assuming the same participation rate at TC as at FS, 48 TCs would be necessary to detect 1 additional advanced neoplasm missed by FS.

CONCLUSIONS

When participants are offered 1 screening test, participation is lower in a TC than in an FS program. However, DR of advanced neoplasia is higher with TC.

Dye removal by low cost adsorbents: hazelnut shells in comparison with wood sawdust

Batch adsorption of Methylene Blue, up to 1000 mg L(-1), and Acid Blue 25, up to 500 mg L(-1), onto ground hazelnut shells was studied in comparison with sawdust of various species of wood, in order to explore the potential use of this material as low cost adsorbent for dye removal in dyehouse effluents. The adsorption kinetics was investigated according to Lagergren's model, but the best fit was achieved by a second order equation. The equilibrium data were processed according to Langmuir's model and higher adsorption capacity values towards both dyes were shown by hazelnut shells than wood sawdust. Moreover, fixed bed adsorption of Methylene Blue was performed on hazelnut shell columns and the breakthrough curves were determined by varying bed depth, flow rate and influent concentration. The data were processed according to Bohart-Adams model and the column performances could be predicted by the bed depth service time (BDST) approach.

Risk factors in newborns with severe acidosis at birth

AIM

The identification of pre and postnatal risk factors as responsible of hypoxic-ischemic brain injury damage results very important in predicting the neurological outcome of newborns. The aim of this study was to investigate a possible correlation between pre and postnatal risk factors and severe acidosis at birth.

METHODS

We collected all data of 559 newborns in our Hospital with risk factors. Risk factors have been subdivided in: maternal, placental, fetal, umbilical and obstetrical risk factors.

RESULTS

Of 559 newborns we collected umbilical cord pH and base excess (BE) in 411. Of these, 32 showed severe acidosis at birth: 29 full-term and 3 preterm. Fourteen out of 32 had almost one obstetric risk factor. Among all obstetric risk factors the application of the vacuum was statistically significant (9/59 applications of vacuum; P 0.003). No signs of brain injury were seen at cerebral echography in 29 cases of acidosis at birth. In all 3 premature neonates we found intraventricular hemorrhage, but without apparent neurological consequences at follow-up. Of 559 newborns with risk factors 21 have been intubated at birth. Only in premature deliveries a significant correlation between intubation at birth and acidosis was found.

CONCLUSION

The only factor which seems to play a significant role in developing a severe acidosis at birth is the use of vacuum in full-term deliveries. Umbilical cord pH and BE are related to intraventricular hemorrhage and need of intubation in delivery room for preterm infants. However, in both groups, no significant effect of acidemia on neurological outcome could be demonstrated.