Oral bacteria accelerate pancreatic cancer development in mice

OBJECTIVE

Epidemiological studies highlight an association between pancreatic ductal adenocarcinoma (PDAC) and oral carriage of the anaerobic bacterium Porphyromonas gingivalis, a species highly linked to periodontal disease. We analysed the potential for P. gingivalis to promote pancreatic cancer development in an animal model and probed underlying mechanisms.

DESIGN

We tracked P. gingivalis bacterial translocation from the oral cavity to the pancreas following administration to mice. To dissect the role of P. gingivalis in PDAC development, we administered bacteria to a genetically engineered mouse PDAC model consisting of inducible acinar cell expression of mutant Kras (Kras +/LSL-G12D; Ptf1a-CreER, iKC mice). These mice were used to study the cooperative effects of Kras mutation and P. gingivalis on the progression of pancreatic intraepithelial neoplasia (PanIN) to PDAC. The direct effects of P. gingivalis on acinar cells and PDAC cell lines were studied in vitro.

RESULTS

P. gingivalis migrated from the oral cavity to the pancreas in mice and can be detected in human PanIN lesions. Repetitive P. gingivalis administration to wild-type mice induced pancreatic acinar-to-ductal metaplasia (ADM), and altered the composition of the intrapancreatic microbiome. In iKC mice, P. gingivalis accelerated PanIN to PDAC progression. In vitro, P. gingivalis infection induced acinar cell ADM markers SOX9 and CK19, and intracellular bacteria protected PDAC cells from reactive oxygen species-mediated cell death resulting from nutrient stress.

CONCLUSION

Taken together, our findings demonstrate a causal role for P. gingivalis in pancreatic cancer development in mice.

Factors Associated With The Covid-19 Infection Severity In Patients With Mental Disorders

Introduction

Recent research showed that persons with mental disorders may represent a population at increased risk for coronavirus disease (COVID-19) infection with more adverse outcomes.

Objectives

We aimed to analyze clinical profile of psychiatric inpatients during their infection with COVID-19, and to explore factors associated with the disease progression.

Methods

We analyzed retrospectively the medical records of 32 psychiatric inpatients, hospitalized in psychiatry “B” department at Hedi Chaker hospital (Sfax, Tunisia), and who contracted the COVID-19 infection. We used “Charlson Comorbidity Index Score” (CCIS), predicting 10-year survival in patients with multiple comorbidities.

Results

Somatic history was reported in 50% of patients. The CCIS ranged between 0 and 4. Psychiatric diagnosis was schizophrenia in 81.3% and bipolar disorder in 18.7% of cases. The clinical symptoms reported were fever (50%), dry cough (75%); dyspnea (34.4%). Biological assessment showed a lymphopenia in 40.6% and a high C-Reactive Protein (CRP) in 53.1%. Among our patients, 37,5% needed oxygen, and 25% were transferred to the intensive care unit. The COVID-19 complications were mostly bacterial pulmonary superinfections (21.9%) and pulmonary embolism (9.4%). Only three (9.4%) patients died from the virus. Patients with medical history were more likely to need oxygen (p<0.001). Clinical and paraclinical parameters associated with oxygen need were: fever (p<0.001); dyspnea (p<0.001); lymphopenia (p<0.001); high CRP (p=0.001). Patients presenting pulmonary superinfection or embolism were more likely to require oxygen (p=0.006 and p=0.044 respectively).

Conclusions

This study highlighted factors that may worsen the COVID-19 infection evolution, and which require special attention, in order to improve the prognosis of this disease.

Disclosure

No significant relationships.

Bidirectional Associations Between Covid-19 Infection And Mental Disorders

Introduction

The COVID-19 pandemic brought unbearable psychological pressure to people worldwide, because of serious threats to one’s physical health and life. From early stages of this pandemic, concerns have been raised about its effect on mental health. However, we still know little whether pre-existing psychiatric disorder (PD) affects the susceptibility and evolution of this infection.

Objectives

We aimed to assess the interactions between COVID-19 infection and PD.

Methods

We conducted a litterature review through pubmed database, using the keywords :«COVID 19», «psychiatry», «mental disorders», « schizophrenia », « anxiety », « depression », «insomnia».

Results

On one hand, prior surveys suggested that the infection is associated with increased incidence of a first psychiatric symptom. Mental health disturbances mostly include anxiety, depression, sleep disturbances, cognitive impairment and post-traumatic stress disorder. On the other hand, recent studies showed that patients with pre-existing mental disorders were associated with high susceptibility to be infected, increased risk of intensive care unit admission and a high mortality. The susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder. Infection severity was associated with pre-existing or subsequent mood disorders and sleep disturbances; or a pre-extisting schizophrenia. Mortality is increased in patients diagnosed with schizophrenia.

Conclusions

The complicated interactions between COVID-19 infection and PD have several implications. Enhanced psychiatric follow-up should be considered for survivors of COVID-19. Besides, early detection and intervention for PD are needed to control morbidity and mortality induced by the COVID-19 infection.

Disclosure

No significant relationships.

Disease Burden Of Co-Occurring Borderline Personality Disorder In Patients With Bipolar Disorder

Introduction

In recent years, advances in the areas of both bipolar disorder (BD) and borderline personality disorder (BPD) have generated considerable interest in the relationship between these two conditions, since that they are commonly comorbid.

Objectives

We aimed to investigate the impact of BPD on course of illness in patients with BP.

Methods

We conducted a cross-sectional, descriptive and analytical study among 30 psychiatric outpatients diagnosed with BD in the Psychiatry « B » department, Hedi Chaker Hospital (Sfax, Tunisia). The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to screen for BPD. Clinical outcomes (hospital stays, comorbidities, suicidality…) were compared between BD- patients with or without BPD comorbidity.

Results

The mean age was 41.63 years, with a sex ratio of ½. Among the patients, 2/3 were diagnosed with BD-I, while 1/3 presented a BD-II. Physical comorbidities, comorbid anxious and eating disorders were noted respectively in 36.7%; 16.7% and 43.3% of patients. Suicidal attempts were reported in 46.7% of cases. According to MSI-BPD, a comorbid BPD was noted in 30% of our sample. Patients with BD-II were significantly more likely to present BDP traits (50%) than those with BD-I (20%) (p<0.001). Patients with BPD were significantly more likely to attempt suicide (p=0.033), and to present physical comorbidities (p<0.001) and comorbid eating disorders (p<0.001).

Conclusions

Our study showed that BPD darkens the prognosis of BD, because of worse outcomes related to suicide, physical and psychiatric comorbidities. Thus, its co-occurrence complicates the management of BD.

Disclosure

No significant relationships.

Has the time come to stop routine N-acetylcysteine treatment in young children in Denmark? A review of 300 suspected paracetamol overdoses in children aged 0-6 years

AIM

To evaluate the prevalence of potentially hepatoxic paracetamol ingestion and associated N-acetylcysteine treatment in young children suspected of paracetamol poisoning.

METHODS

A retrospective cohort study of children aged 0-6 years suspected of paracetamol poisoning with a related plasma-paracetamol measurement in the Capital Region of Denmark in the period 2010-2017. Data from the clinical laboratory system were linked to data from electronic patient records via the unique identification number given to all Danish residents.

RESULTS

Of 297 children included, suspected single paracetamol overdoses were present in 281 (95%). Sixty-nine per cent were treated with N-acetylcysteine, and the mean treatment period was 20.3 h (SD 20.8). A maximum of 6 (2%) of the children suspected of single overdose had plasma-paracetamol concentrations that exceeded the recommended treatment thresholds. No cases of severe hepatotoxicity were registered. Adverse events to N-acetylcysteine-treatment were registered in 3 (2%) children including one anaphylactoid reaction (0.5%).

CONCLUSION

This study shows that initiating N-acetylcysteine as a 'one size fit all' treatment regimen in all children aged 0-6 years with a suspected single paracetamol overdose leads to substantial overtreatment. The data support that it is feasible to initiate N-acetylcysteine within 10 h based on an early plasma-paracetamol test.

ORNInA: A decentralized, auction-based multi-agent coordination in ODT systems

On-Demand Transport (ODT) systems have attracted increasing attention in recent years. Traditional centralized dispatching can achieve optimal solutions, but NP-Hard complexity makes it unsuitable for online and dynamic problems. Centralized and decentralized heuristics can achieve fast, feasible solution at run-time with no guarantee on the quality. Starting from a feasible not optimal solution, we present in this paper a new solution model (ORNInA) consisting of two parallel coordination processes. The first one is a decentralized insertion-heuristic based algorithm to build vehicle schedules in order to solve a particular case of the dynamic Dial-A-Ride-Problem (DARP) as an ODT system, in which vehicles communicate via Vehicle-to-vehicle communication (V2V) and make decentralized decisions. The second coordination scheme is a continuous optimization process namely Pull-demand protocol, based on combinatorial auctions, in order to improve the quality of the global solution achieved by decentralized decision at run-time by exchanging resources between vehicles (k-opt). In its simplest implementation, k is set to 1 so that vehicles can exchange only one resource at a time. We evaluate and analyze the promising results of our contributed techniques on synthetic data for taxis operating in Saint-Étienne city, against a classical decentralized greedy approach and a centralized one that uses a classical mixed-integer linear program (MILP) solver.

Intracellular Porphyromonas gingivalis Promotes the Tumorigenic Behavior of Pancreatic Carcinoma Cells

Porphyromonas gingivalis is a member of the dysbiotic oral microbiome associated with oral inflammation and periodontal disease. Intriguingly, epidemiological studies link P. gingivalis to an increased risk of pancreatic cancer. Given that oral bacteria are detected in human pancreatic cancer, and both mouse and human pancreata harbor microbiota, we explored the involvement of P. gingivalis in pancreatic tumorigenesis using cell lines and a xenograft model. Live P. gingivalis induced proliferation of pancreatic cancer cells; however, surprisingly, this effect was independent of Toll-like receptor 2, the innate immune receptor that is engaged in response to P. gingivalis on other cancer and immune cells, and is required for P. gingivalis to induce alveolar bone resorption. Instead, we found that P. gingivalis survives inside pancreatic cancer cells, a trait that can be enhanced in vitro and is increased by hypoxia, a central characteristic of pancreatic cancer. Increased tumor cell proliferation was related to the degree of intracellular persistence, and infection of tumor cells with P. gingivalis led to enhanced growth in vivo. To the best of our knowledge, this study is the first to demonstrate the direct effect of exposure to P. gingivalis on the tumorigenic behavior of pancreatic cancer cell lines. Our findings shed light on potential mechanisms underlying the pancreatic cancer–periodontitis link.

A novel rat model for tracheal mucosal damage assessment of following long term intubation

OBJECTIVE

Tracheal mucosal damage is a well-known complication of endo-tracheal intubation and animal models are essential for studying the underlying cellular injury cascade. The novel rat model described here is based on retrograde intubation via tracheotomy and suture fixation of the tube. It aims to simulate the common clinical scenario of tube-related airway damage due to long term intubation.

STUDY DESIGN

Prospective randomized control pilot study.

METHODS

Male Sprague-Dawley were randomly assigned into two groups: control (no intubation, n = 10), one week of intubation (n = 13). The animals were then euthanized and the trachea was sent for histological analysis. Epithelial damage, mucosal thickness, mucosal gland hypertrophy and fibrosis were reviewed.

RESULTS

Intubation procedure survival rate was 84.6% (11/13) and 100% in the control (10/10). The damaged ciliary mechanism was a common finding in the intubated group compared to the preserved normal ciliary architecture in almost all control rats. Average tracheal mucosal thickness was 119.0 ± 21.8 μm for the control group and 254.6 ± 22.8 μm for the intubated group, (p < 0.001). The ciliary damage score was 1.00 ± 0.02 in the intubated group, and 0 ± 0.02 in the control group. (p < 0.001). The (objective) average total tracheal mucosal gland area was 19,530 ± 24,606 in the intubated group and 10,031 ± 23,461 in the control group (p < 0,05). Collagen deposition seems higher in the intubated trachea compared to the control.

CONCLUSIONS

We describe a novel rat-based animal model for simulating tracheal mucosal damage following long term intubation. This animal model is easy to carry out, reproducible and involves containable animal mortality rates.

LEVEL OF EVIDENCE

I.

Two-bag intravenous N-acetylcysteine, antihistamine pretreatment and high plasma paracetamol levels are associated with a lower incidence of anaphylactoid reactions to N-acetylcysteine

Context: N-acetylcysteine (NAC) is used worldwide to prevent liver injury after paracetamol overdoses. Anaphylactoid reactions to NAC occur frequently and often lead to treatment interruptions or discontinuations. In Denmark in 2013, the NAC treatment regimen was simplified from a three-bag to a two-bag NAC regimen. Factors of importance for the development of anaphylactoid reaction to this new regimen are poorly explored. Previous studies have suggested a protective effect of high plasma levels of paracetamol on the development of anaphylactoid reactions. Likewise, exposure to antihistamines prior to NAC treatment may protect against these reactions.Methods: This is a retrospective cohort study of patients treated with NAC and with at least one plasma paracetamol sample performed in the Capital Region of Denmark from 2010 to 2017. The primary outcome was the incidence of anaphylactoid reactions to NAC requiring intravenous treatment with antihistamines and/or glucocorticoids. Logistic regression analyses were carried out to identify the risk of developing an anaphylactoid reaction to NAC affected by influencing factors.Results: Of 4315 admissions included in the study, 259 (6.0%) developed an anaphylactoid reaction to NAC. The two-bag regimen (adjusted OR 0.44 [95%CI: 0.32-0.60]), increasing age (adjusted OR 0.84 [95%CI: 0.78-0.90] per 10-year increase) or children <10 years (adjusted OR 0.14 [95%CI: 0.04-0.36]) and antihistamine co-ingestion in overdose (adjusted OR 0.17 [95%CI: 0.02-0.64]) were associated with significantly fewer anaphylactoid reactions. High plasma paracetamol concentrations protected against development of anaphylactoid reactions during the two-bag regimen (adjusted OR 0.59 [95%CI: 0.47-0.71] and three-bag regimen 0.82 [95%CI: 0.72-0.94] per doubling of paracetamol concentration). The effect differed between the two regimens (p = .004 for interaction).Conclusion: In this retrospective cohort, a high peak plasma paracetamol concentration, age, antihistamine co-ingestion and use of the two-bag NAC regimen were associated with fewer anaphylactoid reactions to NAC.

Diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6 and immunoglobulin M

This clinical study was conducted to evaluate the diagnostic value of C-reactive protein (CRP), interlekin-6 (IL-6) and immunoglobulin M (IgM) in the early diagnosis of neonatal sepsis. The diagnostic values of each marker separately or in combinations were evaluated. The optimal cut-off values of each marker in the diagnosis of neonatal sepsis were defined. Between December 2004 and March 2005, a total of 78 neonates at different ages with different diagnoses in a neonatal intensive care unit in North Jordan were enrolled. Patients were classified into 'sepsis' group, 'probable sepsis' group and 'no sepsis' group. Blood samples were collected for CRP, IL-6 and IgM determination. A CRP value of 5 mg/l was the best among the three parameters with 95% sensitivity and 98% negative predictive value. Combination between parameters was helpful in enhancing the ability to diagnose sepsis. The best combination was CRP > or = 5 mg/l and/or IgM of > or =20 mg/dl. We conclude that CRP, IL-6 and IgM are helpful in the early diagnosis of Gram-negative neonatal sepsis. However, CRP continues to be the best single test. The use of both CRP and IgM in combination was the most helpful in predicting Gram-negative neonatal sepsis. We speculate a significant role of this combination in making decisions regarding antibiotics treatment and upgrading the level of medical care and observation in a setting where Gram-negative micro-organisms are causing the majority of neonatal infections.

Synthesis, DTA, IR and Raman spectra of penthylenediammonium hexachlorostannate NH3(CH2)5NH3SnCl6

The Raman and IR spectra of NH3(CH2)5NH3SnCl6 have been measured at ambient temperature. It is shown that the cations in the compound assume a symmetry lower than C2v. Combination bands observed in the 2100-1800 cm(-1) region in the IR spectrum of NH3(CH2)5NH3SnCl6 indicate that the compound contains the C-NH3 grouping, the bands are discussed and their assignment are suggested. No evidence of existence of hydrogen bonding is found from the infrared spectrum in the region of 2800-3200 cm(-1); anions and cations are found not connected by hydrogen bonding and are therfore isolated. The Raman spectrum of anions can be interpreted in terms of disordered groups, not clearly showing the predicted splitting of bands.

Clinical sinusitis in children attending primary care centers

OBJECTIVES

To determine the proportion of children who meet the clinical criteria for the diagnosis of sinusitis among all children attending primary care pediatric practices, to explore the relationship between passive smoking and the occurrence of sinusitis and to study the role of antibiotics in the management of sinusitis.

DESIGN

A prospective observational cohort study.

SETTING

Outpatient Pediatric Clinics of Jordan University of Science and Technology and Princess Rahma Teaching Hospital. Patients. All children ages 1 to 10 years presenting for any reason to participating practices.

METHODS

Physicians participating in this study completed a questionnaire on all children attending the primary care centers, detailing the presence of nasal congestion or discharge, the duration of symptoms, daytime cough and whether symptoms were improving. The presence or absence of smokers in the family was also recorded. Children meeting our clinical criteria for sinusitis were further evaluated for other signs and symptoms including the type of medication prescribed. The severity of symptoms was reassessed at 10-day follow-up after the first visit.

RESULTS

The study population was composed of 3001 children, of whom 249 met our clinical criteria for diagnosis of sinusitis (8.3%; 95% confidence interval, 7.3 to 9.3%). The prevalence rate of clinical sinusitis was greater among children age 5 years and older than among those younger (9.3% vs. 7.2%, P = 0.04). Children exposed to passive smoking in the household had clinical sinusitis significantly more than those not exposed (68.8% vs. 1.2%, P = 0.00). Antibiotics were prescribed for 80% of children who fulfilled the clinical criteria for diagnosis of sinusitis. Marked improvement of symptoms at the 10-day follow-up visit was reported among those who received antibiotics compared with those who did not (91% vs. 21.4%, P = 0.00).

CONCLUSIONS

Sinusitis is not an uncommon problem in children, passive smoking might be a contributing factor and a course of antibiotic therapy is beneficial.

[Experience of ambulatory anesthesia in Charles Nicolle hospital]

The authors report the experience of ambulatory surgery at Charles Nicoll's hospital on ophthalmology and ORL surgery in which 90% and 60% of acts can be realized on ambulatory. The organisation by means of structures and hospital workers makes an important gain. The anesthetic consultation, very important in this organisation, enable to avoid to rescue a patient at the last time.

Neonatal exchange transfusion: a Jordanian experience

The aetiology and complications of exchange transfusion (ET) were studied over a 6-year period in northern Jordan. During that time, 336 neonates (0.46% of total live births) underwent 386 ETs. There was a yearly reduction in the number of ETs, varying from 8.2% in the 1st year of the study to 2.7% in the last year. Thirty-nine (11.9%) required more than one ET. Twenty-five (7.4%) were preterm babies and the remainder full-term. The commonest cause of ET overall was G6PD deficiency, either alone or concomitant with ABO incompatibility (38.1%). ET complications occurred in 51 neonates (15.2%), the commonest being anaemia and bradycardia. Septicaemia occurred in only 3% of cases. Only one baby died. G6PD deficiency, either alone or concomitant with ABO isoimmunization, is the most common cause of ET in northern Jordan. Fewer preterm babies require ET and there is a low incidence of septicaemia following ET.

Henoch-Schonlein purpura and streptococcal infection: a prospective case-control study

A prospective, matched, case-control study conducted over a period of 3 years was designed to examine the association of group A beta-haemolytic streptococcal infections and Henoch-Schonlein purpura. Demographic and clinical data were collected as well as measurement of antistreptolysin O titres and throat swab culture on all children admitted with Henoch-Schonlein purpura, as well as their matched controls. Antistreptolysin O titre positivity was associated with a 10-fold increase in the risk of Henoch-Schonlein purpura. Renal involvement was common among cases with positive antistreptolysin O titres (27%) compared with cases with a negative titre (8%) but this difference has no statistical significance.

Distribution and ecology of ticks (Acari: Ixodidae) infesting livestock in Tunisia: an overview of eighth years field collections

Ticks (Ixodidae) play a significant role as vectors of pathogens of domestic animals in Tunisia. The major losses caused by ticks are related to transmission of protozoan parasites. These include agents of tropical theileriosis and babesiosis in ruminants. Since 1991, we conducted research studies on tick population of livestock in Tunisia. This overview reports a synthesis on tick distribution, their biology and their role as vectors of pathogens in domestic animals, particularly cattle. During the whole period of the study about 15,000 tick specimens were collected from different zones of the country. A total of 14 species were identified. Hyalomma detritum detritum was the most abundant and important (vector of Theileria annulata) species infesting cattle. Hyalomma dromedarii and Hyalomma impeltatum were collected on domestic ruminants in the arid and desertic zones. Hyalomma marginatum marginatum and Hyalomma anatolicum excavatum were widespread and found on livestock hosts. Ixodes ricinus, vector of Babesia divergens and Borrelia burgdorferi sl, colonises mainly the humid zone. Boophilus annulatus and Rhipicephalus bursa infesting cattle, sheep and goats were found in the sub-humid and semi-arid zones. Haemaphysalis sulcata and Hae. punctata were collected in humid and sub-humid zones on cattle and sheep. Rhipicephalus turanicus were collected in different regions, on different animal species. Rhipicephalus sanguineus, tick of dogs, were often collected on livestock. Only few specimens of Hyalomma marginatum rufipes and Hyalomma franchinii were collected.

The effectiveness of BCG vaccination: the Jordanian experience

The objective of the present study was to evaluate the effectiveness of BCG vaccination against tuberculosis (TB). TB cases occurring before 1 January 1995 among the birth cohorts 1980-1986 were identified from the Central TB Registry in Amman, Jordan and their BCG vaccination status determined. The proportion of vaccinated and unvaccinated children by age at vaccination and birth cohort was obtained from the Directorate of Chest Diseases based on the surveys conducted by the Directorate. A total of 429 cases of TB occurred among the above birth cohorts during the follow-up period. The overall BCG effectiveness against TB was 87 per cent (95 per cent CL 0.81-0.91). BCG was highly effective against pulmonary TB (85 per cent, 95 per cent CL 0.78-0.90) as well as extrapulmonary TB (95 per cent, 95 per cent CL 0.82-0.99). Our data suggest that BCG vaccination should continue to be considered as an important component of the strategy of TB prevention and call for improvement of coverage with this vaccine.

[Hemorrhagic surgery in two Jehova's witness children refusing programmed autotransfusion: a place for erythropoietin]

We report two cases of haemorrhagic surgery in a 6-year-old and 16-year-old girl, respectively, whose parents were Jehovah's witnesses and therefore opposed to preoperative blood donation, but accepting intraoperative blood salvage. Erythropoietin and intravenous iron were administered preoperatively to increase red cell mass. Intraoperative blood salvage, including normovolaemic haemodilution and intraoperative autologous transfusion, avoided homologous blood transfusion.

Safety and cost effectiveness of a 10 x 10(9)/L trigger for prophylactic platelet transfusions compared with the traditional 20 x 10(9)/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia

In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 x 10(9)/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 x 10(9)/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 x 10(9)/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

Myositis ossificans: report of seven cases in children

The clinical features of seven children with myositis ossificans (circumscripta and progressiva) and radiographic signs of the disease are described. We recommend systematic radiological examination to seek other skeletal malformations for congenital hallux valgus in young children, for it may be the first sign of a myositis ossificans progressiva. The "zone phenomenon" observed on histology, along with differential diagnosis and evolution, is documented. The necessity of a biopsy and different forms of treatment are discussed.

[Tuberculosis and immigrants. A study of its prevalence in the Umbria region]

In 1995, 463 patients were admitted in the medical service of Perugia (Sanitary District n. 6). Only 20% of them were enrolled in the TBC programme. Mantoux was: < 10 mm in 35%, 10-15 mm in 25%, > 15 mm in 40%. Chest Rx in 30 subjects demonstrated: normality in 19; old TBC in 7, active TBC in 4 (miliary, bilateral upper lobe pneumonitis, left subapical upper lobe pneumonitis and right lobitis of the upper lobe). All patients were admitted in hospital and showed positive sputum culture for Mycobacterium Tuberculosis. They were treated with isoniazid, rifampin, pyrazinamide, ethambutol/streptomycin for 2 months and with isoniazid, rifampin for other 4-8 months. Two patients showed Mycobacterium tuberculosis with isoniazid resistance. Seven patients were treated with isoniazid chemoprophylaxis without side effects. Migrants should receive information about health care service and be encourage to register themselves with a general practitioner. Skin test screening and chest radiographs for those with positive results should be provided at a convenient location.

Neonatal meningitis due to Moraxella catarrhalis and review of the literature

Moraxella catarrhalis has been reported with increasing frequency to be the aetiological agent of serious systemic infection in both children and adults. The first case of neonatal meningitis due to this organism is described herein. The fatal outcome and causes of failure of response to antimicrobial therapy are also discussed. A brief review of the literature describing the disease entities with which M. catarrhalis has been associated is presented.

Ultrasound contribution in the analysis of the newborn and infant normal and clubfoot: a preliminary study

The aim of this study was to evaluate the potential use of ultrasound in the preoperative assessment of clubfoot and follow-up growth. We first studied 50 normal newborns and infants (aged 1 day to 1 year). The normal values established were reliable, dynamic and reproducible measurements allowing the assessment of osteo-articular relationships and cartilage morphology. Ultrasound appears to be more useful than radiography because it allows delineation of cartilaginous structures (which are not visible on conventional radiographs) and dynamic study of foot positions, and has no danger from radiation. A future paper will contain preliminary results of cases of clubfoot studied by ultrasound.

Congenital dislocation of the hip in the older child. The effectiveness of overhead traction

We studied the use of overhead traction in the treatment of congenital dislocation of the hip in thirty-five children (fifty hips) whose mean age at the time of the diagnosis was thirty-three months (range, eighteen to seventy-two months). None of the children had had any previous treatment. The mean time in traction was twenty-three days (range, eight to thirty-six days). Closed reduction was successful for relocation of the femoral head in thirty-eight of the fifty hips; twenty of these hips needed no additional treatment, sixteen were treated with an innominate osteotomy because of severe acetabular dysplasia, and two needed femoral derotation and an innominate osteotomy to correct persistent subluxation. In the remaining twelve hips, closed reduction failed at the outset and an open reduction was necessary. Femoral shortening also was performed in seven of the twelve hips to maintain concentric reduction. After a mean duration of follow-up of forty-eight months (range, thirty-two to sixty-five months), thirty-three hips were rated as class 1; seven, as class 2; four, as class 3; and five, as class 4, according to the criteria of Severin. The remaining hip could not be so classified. Avascular necrosis developed in two hips that had been treated with closed reduction followed by Salter osteotomy and in three hips that had been treated with primary open reduction. We found that preliminary overhead traction facilitated closed reduction of untreated congenitally dislocated hips in children who were eighteen to seventy-two months old.

The clinical spectrum of Henoch-Schönlein purpura in infants and young children

Henoch-Schönlein purpura is a common cause of childhood vasculitis. The rarity of the disease under 2 years of age has been the subject of few reports. We present the clinical spectrum of Henoch-Schönlein purpura in 12 children younger than 2 years of age at presentation. The median age at presentation was 11 months. The purpuric skin rash was present in all patients and involved the face in 10 of them. While oedema was a prominent feature in all of our patients only one third had involvement of the kidneys, gastro-intestinal tract or joints. All patients recovered completely after a mean duration of follow up of 10.6 months (range 2-39 months).

CONCLUSION

Henoch-Schönlein purpura under the age of 2 years is characterized clinically by oedema and a purpuric skin rash which frequently affects the face. Involvement of the joints, kidneys and gastro-intestinal tract is uncommon and the prognosis is excellent. The clinical spectrum in this age group is a continuation with that of Henoch-Schönlein purpura in older children suggesting a nosological entity.