Knowledge management tools and mechanisms for evidence-informed decision-making in the WHO European Region: a scoping review

BACKGROUND

Knowledge management (KM) emerged as a strategy to promote evidence-informed decision-making. This scoping review aims to map existing KM tools and mechanisms used to promote evidence-informed health decision-making in the WHO European Region and identify knowledge gaps.

METHODS

Following the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched Medline, PubMed, EMBASE, the Cochrane library, and Open Grey. We conducted a descriptive analysis of the general characteristics of the included papers and conducted narrative analysis of the included studies and categorized studies according to KM type and phase.

RESULTS

Out of 9541 citations identified, we included 141 studies. The KM tools mostly assessed are evidence networks, surveillance tools, observatories, data platforms and registries, with most examining KM tools in high-income countries of the WHO European region. Findings suggest that KM tools can identify health problems, inform health planning and resource allocation, increase the use of evidence by policymakers and stimulate policy discussion.

CONCLUSION

Policymakers and funding agencies are called to support capacity-building activities, and future studies to strengthen KM in the WHO European region particularly in Eastern Europe and Central Asia. An updated over-arching strategy to coordinate KM activities in the WHO European region will be useful in these efforts.

Family history of atopy in infants with cow's milk protein allergy: A French population-based study

OBJECTIVES

This French multicenter, cross-sectional, observational study aimed to describe the family history of atopy in infants with cow's milk protein allergy (CMPA), and the related diagnostic approaches used by specialists in a real-life ambulatory setting.

PATIENTS AND METHODS

In total, 1674 infants with suspected CMPA [median age 4.5 months (range: 0.1-18.0), males 54%] were enrolled in the study by 466 private physicians (pediatricians: 97%). Family history of atopy was defined as a known history of atopy in at least one first- (father, mother, and/or sibling) and/or second-degree relative (grandparents, uncles, and aunts), as reported by parents to physicians.

RESULTS

Atopy in a first-degree relative was more common among infants with documented or high probability of CMPA (in 84% and 80% of cases, respectively, vs. the other subgroups, P=0.005). Most infants experienced digestive (92%) and skin (61%) symptoms suggestive of CMPA. Delayed reactions were reported in 64% of infants. According to a post-classification based on the results of previous diagnostic tests and procedures, 1133 infants (68%) had highly probable (52%) or documented CMPA (16%). In these infants, a history of atopy was reported in first- and/or second-degree relative(s) in 86% of cases (81% in first-degree relatives). Whatever the family history of atopy, the characteristics of the infants were similar, except for fewer pets in the case of negative family atopy (14% vs. 25%, P<0.001). Atopy in a parent was more frequent in infants who presented with the first signs suggestive of CMPA within the first 6 months of life vs. those with later first symptoms (75% vs. 65%, P=0.063).

CONCLUSION

This French study confirms the high rate of family history of atopy in first-degree relatives of infants with probable or documented CMPA.

[Cutaneous polymorph manifestations of familial Mediterranean fever in a child]

We describe the case of a 4-year-old child with Mediterranean fever characterized by cutaneous features. Familial Mediterranean fever is an autosomal recessive disorder characterized by recurrent attacks of fever and polyserositis including peritonitis, pleuritis, and arthritis. Skin involvement is less common. In our case, the successively patient presented erysipelas-like erythema, edemas of the palmar and plantar regions, and purpuric lesions. From these clinical observations, several diagnoses were raised: infectious erysipelas, Kawasaki disease, Henoch-Schönlein purpura, and familial Mediterranean fever. Only the latter diagnosis was confirmed after exploration and then confirmed with genetic analysis, which found a M694V homozygous mutation. Erysipelas-like erythema is the most frequent cutaneous sign reported in the literature and the only one to be associated with the M694V homozygous mutation. The originality of this case is the dominancy and polymorphism of the skin lesions.

[Health of gypsy children: medical perinatal care until 6-year-old in Lille]

AIM

This study investigated the health of gypsy children, aged 0-6 years. We focused on pregnancy, birth, medical care, growth, and vaccinations.

PATIENTS AND METHODS

This study was conducted between May and December 2004, comparing a gypsy population group (GP) to a sedentary control group with a relatively low socioeconomic level. Both groups were covered by the CMU (French universal health coverage). This study was based on an oral investigation and each child's health records.

RESULTS

The population consisted of 241 children: 120 GP children and 121 CMU children. In the GP children, pregnancy care was lacking, whereas the CMU group received consistent care at regional university hospital centers. For both populations, 85% of births occurred after a mean 38 weeks and 5 days of amenorrhea by ordinary delivery. GP infants were more often transferred to neonatology centers. They were born and were shorter and weighed less than the CMU infants until 6 years of age. They were breast fed more often. They were hospitalized more often, usually for ORL and gastrointestinal infections. Siblings were more numerous. GP child medical care was deemed satisfactory in 40% of cases vs. 70% for CMU children. The vaccinations status was insufficient, particularly in the GP children.

CONCLUSION

Follow-up of GP should be improved.

Fecal expression of human β-defensin-2 following birth

BACKGROUND

Newborns display high intestinal permeability and a naive adaptive immune system, but infections are rare, indicating strong innate defense mechanisms.

OBJECTIVE

To measure the kinetics of fecal β-defensin-2 (HBD2), an inducible endogenous antimicrobial peptide produced by intestinal epithelial cells, in full-term and preterm infants.

METHODS

As a first step of this bicentric study, we enrolled 30 healthy full-term infants and 20 healthy preterm infants, with fecal samples collected at days 3, 7, 12 and 30 in full-term infants and at days 15, 30 and 60 in preterm infants. As a second step, we enrolled 10 preterm infants with intestinal distress, either necrotizing enterocolitis (NEC) Bell's stage III (n = 3) or isolated rectal bleeding (n = 7) and 20 controls, cross-matched for gestational age and age at sampling.

RESULTS

HBD2 decreased significantly from day 3 to day 7 (227 ng/g; 14-440 vs. 117 ng/g; 30-470, p = 0.01) then moderately until day 30 (84 ng/g; 10-500) in healthy full-term infants. Healthy preterm infants showed similar high levels between days 15 and 60 (82 ng/g; 30-154 and 85 ng/g; 26-390, respectively). No significant variation of fecal HBD2 levels was observed between infants with clinical features of intestinal distress (77 ng/g, 2-1,271) and cross-matched controls (56 ng/g, 31-164). However, 2/3 infants with NEC and 1/7 infants with isolated rectal bleeding had HBD2 levels above the maximal level observed in controls.

CONCLUSIONS

The kinetics of fecal HBD2 in the neonatal period indicate that this inducible defensin can be detected at high level in the feces of full-term and preterm infants, independently of gestational age or mode of feeding. The potential role of fecal HBD2 in detecting NEC is suggested.

Ready-to-use house dust mites atopy patch test (HDM-Diallertest), a new screening tool for detection of house dust mites allergy in children

AIM

to assess the accuracy and safety of a ready-to-use atopy patch test (HDM-Diallertest, DBV Technologies, Paris) in the diagnosis of sensitization to house-dust mite (HDM) allergens in children with or without atopic dermatitis.

PATIENTS AND METHODS

prospective analysis of a systematic allergic work-up was carried out in 47 children, age 57.4+42 months (mean + SD, range 7 to 176 mo), presenting with isolated or combined atopic dermatitis (AD, n = 28) or other symptoms without AD (control group, n = 19). Children were routinely tested for specific HDM-IgE [against D. pteronyssinus (DPT) and D. farinae (DF)], and skin testing based on HDM (DPT & DF) skin prick test (SPT) and ready-to-use HDM-ATP (HDM-Diallertest), with a reading at 72 hours.

RESULTS

15 children (31.9%) exhibited specific IgE against both DPT and DF, 16 children (34.04%) exhibited positive SPT against DPT and 17 (36.1%) against DF. HDM-Diallertest was positive in 15 cases (31.9%). Among these, 9 exhibited with an eczematous reaction showed an excellent correlation with both SPT and specific IgE for DPT and DF, respectively 93.3%, 97.77%, 90.47%, and 90.47%. The different diagnostic techniques of HDM sensitization neither differ between groups, nor correlated specifically with the different clinical manifestations. No side effect was observed during and after patch testing, except for a local reaction without diffusion outside the local test area.

CONCLUSION

The 3 diagnostic techniques exhibited a comparable level of accuracy for the diagnosis of HDM allergens sensitization. The excellent concordance of the highest class reactions of HDM-Diallertest with the other diagnostic techniques indicates a potential role as a screening tool for the detection of HDM sensitization in infancy.

In French children, primary gastritis is more frequent than Helicobacter pylori gastritis

The aim of this study was to analyze the histological characteristics according to the updated Sydney classification (intensity of gastritis, degree of activity, gastric atrophy, intestinal metaplasia, and Helicobacter pylori) in symptomatic children referred for upper gastrointestinal endoscopy. A 4-year retrospective descriptive study was carried out in 619 children (282 females and 337 males), median age 3.75 years (15 days to 17.3 years) referred for endoscopy. Six gastric biopsies were done (three antrum and three corpus) for histological analysis (n = 4), direct examination and H. pylori culture (n = 2). H. pylori status was considered positive if at least two out of three tests were positive and negative if all three tests were negative. The results showed that only 66 children (10.66%) were H. pylori positive. Histological antral and corpus gastritis was detected in, respectively, 53.95% and 59.12% of all cases, most of them of mild grade 1. Antral and corpus activity was grade 1 in 18.57% and 20.03% of cases. H. pylori-positive versus H. pylori-negative children did differ in terms of moderate and marked histological gastritis and grade 2 or 3 activities. One girl had moderate gastric atrophy and another one moderate intestinal metaplasia, both being H. pylori negative. The findings indicate that primary antrum and corpus gastritis is 5.3 and 6.9 times, respectively, more frequent than H. pylori gastritis in French children, with usually mild histological gastritis and activity. Gastric atrophy and intestinal metaplasia are rare.

Gastric atrophy and Helicobacter pylori infection in children

AIM

To assess the prevalence of gastric atrophy (GA) in Tunisia (a high prevalence region for Helicobacter pylori), and describe its histological, clinical and endoscopic features in children.

METHODS

345 children, 151 male and 194 female, mean age 8.6 +/- 3.7 years, underwent upper gastrointestinal (UGI) endoscopy with gastric biopsies for recurrent abdominal pain (n=232, 67.2%), vomiting (n=72, 20%) associated with or without upper gastrointestinal bleeding (n=59, 17.1%) and miscellaneous causes (n=53, 15.4 %). Biopsies performed both in the gastric antrum (n=2) and corpus (n=2) were analysed for histological assessment according to the updated Sydney classification system and bacterial culture. A positive result was recorded where histology and/or culture were positive, confirming the presence of H. pylori infection (H. pylori +ve). A negative result was recorded when both tests were concomitantly negative (H. pylori -ve).

RESULTS

9.3% (32/345) of the total population, and 14.5% (32/221) of chronic gastritis patients exhibited GA, M/F: 16/16, mean age (SD) 9.4 (3.4) years. Amongst the 32 children with GA, 30 (93.7%) were H. pylori +ve and 2 (6.3%) were H. pylori -ve. GA was localised in the antrum (n=26, 81.2%), the fundus (n=2, 6.3%) and was also seen in both (n=4, 12.5%). GA was categorised as mild, grade 1 (n=18, 56.3%); moderate, grade 2 (n=13, 46.6%); and severe, grade 3 (n=1, 3.1%). GA was associated with mild active gastritis in 18 cases (56.3%). The prevalence of moderate or severe antral GA was detected in 9/26 (34.6%) of H. pylori +ve vs. any of H. pylori -ve (p=0.4), whereas GA in the corpus was detected in 1/2 (50%) vs. none, respectively. None exhibited intestinal metaplasia. There were no clinical features specific to this pathology. UGI endoscopy in GA patients showed nodular gastritis (n=17, 53.1%), congestive gastritis (n=9, 28.1%), and normal tissue (n=6, 18.8%). GA was significantly associated with H. pylori infection (p<0.0001) and nodular gastritis (p<0.005).

CONCLUSION

GA was found in 9.3% of Tunisian children undergoing UGI endoscopy and was significantly associated with H. pylori infection and nodular gastritis.

Survey of prick test, total and specific age during food allergy in children

AIM

To analyze the results of a systematic survey of biological tests in a symptomatic pediatric population consulting for the exploration of a possible food allergy.

PATIENTS AND METHODS

406 children included in this study, mean age 3.3+3.2 years (2 months-16 years), 159 girls and 247 boys, had cutaneous tests (Stallergènes, Paris, France), assaying of total and specific IgE, and RAST Fx5 (Pharmacia & Upjohn Diagnostics AB, Uppsala, Sweden). Those children suffering from eczema (34.9%), digestive disorders (26.1%), ORL and pulmonary (8.3%), anaphylactic choc (3.4%) or mixed symptoms (27.3%).

RESULTS

The overall positivity of cutaneous tests, all confused age periods, was 34.1% with the following order: egg white (52%, p < 0.05 vs. other food), peanut (46%), egg yolk (42%), fish (34%), wheat (33%), soy (32%), cow's milk (24%) and rice (17%). It decreased significantly with age only for the egg white, 61% (0-1 year) and 68% (1-2 years) vs 31% (> 6 years), p < 0.05. The positivity of cutaneous tests for egg and peanut was more frequent with eczema than with digestive manifestations (64% vs. 44%, 57.6% vs. 34% and 56% vs. 38.7%, p < 0.05). The title of total IgE increased with age, r 0.5 p 0.001. The positivity of specific food IgE was more frequent at 4-6 years (68%) than at 0-1 year (36%), p < 0.05. It revealed, all confused age periods, the following order: egg white (74%) and peanut (64%), p < 0.05 vs. other food, cow's milk (59%), wheat (55%), soy (45%) and fish (24%). The number of high specific food IgE titers was significantly higher than the number of positive cutaneous tests by order of frequency; egg white, peanut, cow's milk, wheat and soy, p < 0.05; the reverse was observed for fish, p < 0.05. Percentage of subjects combining a high title of specific food IgE and a positive cutaneous test for egg white (39.4%) was significantly higher than the percentage of those combining a high RAST Fx5 title and a positive cutaneous test for at least one of 6 corresponding foods (25.2%), p < 0.05.

CONCLUSION

The positivity of different food cutaneous tests, the rate of total and specific IgE titers and the agreement of the results varied according to age, food and symptoms.

Anemia impairs small intestinal absorption measured by intestinal permeability in children

OBJECTIVE

To determine the effect of anemia and iron status on intestinal permeability in children.

DESIGN

A routine prospective study was performed in 64 children with symptoms suggesting cow's milk allergy (CMA) (11.8 +/- 16 mo, 2-94 mo). They exhibited a negative cow's milk challenge upon the ESPGHAN criteria. Hemoglobin (Hb), mean corpuscular volume (MCV), blood iron (Fe) and ferritin (Fer) concentrations were studied in all. Permeability was measured as percent of urinary excretion of lactitol (L,%) and mannitol (M,%) (oral absorption, 0.1 g/Kg for each sugar) and determination of the L/M ratio (L/M,%).

RESULTS

L/M was significantly higher in anemic children than in non-anemic ones, 2.45, (median), 1.92-3.43 (extremes), n = 29, vs. 1.72, 1.56-2.18, n = 35, p = 0.03. Hb correlated negatively with L/M (p = 0.0001) and L (p = 0.05) and positively with M (p = 0.03). Also, L/M correlated negatively with MCV (p = 0.001) and Fe (p = 0.04).

CONCLUSION

IP depends on anemia and iron status. The interpretation of IP should be taken cautiously into account in the diagnosis of CMA in case of anemia or iron deficiency.

Prospective multicentre study on antibiotic resistance of Helicobacter pylori strains obtained from children living in Europe

AIM

To prospectively assess the antibacterial resistance rate in Helicobacter pylori strains obtained from symptomatic children in Europe.

METHODS

During a 4-year period, 17 paediatric centres from 14 European countries reported prospectively on patients infected with H pylori, for whom antibiotic susceptibility was tested.

RESULTS

A total of 1233 patients were reported from Northern (3%), Western (70%), Eastern (9%) and Southern Europe (18%); 41% originated from outside Europe as indicated by mother's birth-country; 13% were <6 years of age, 43% 6-11 years of age and 44% >11 years of age. Testing was carried out before the first treatment (group A, n = 1037), and after treatment failure (group B, n = 196). Overall resistance to clarithromycin was detected in 24% (mean, A: 20%, B: 42%). The primary clarithromycin resistance rate was higher in boys (odds ratio (OR) 1.58; 1.12 to 2.24, p = 0.01), in children <6 years compared with >12 years (OR 1.82, 1.10 to 3.03, p = 0.020) and in patients living in Southern Europe compared with those living in Northern Europe (OR 2.25; 1.52 to 3.30, p<0.001). Overall resistance rate to metronidazole was 25% (A: 23%, B: 35%) and higher in children born outside Europe (A: adjusted. OR 2.42, 95% CI: 1.61 to 3.66, p<0.001). Resistance to both antibiotics occurred in 6.9% (A: 5.3%, B: 15.3%). Resistance to amoxicillin was exceptional (0.6%). Children with peptic ulcer disease (80/1180, 6.8%) were older than patients without ulcer (p = 0.001).

CONCLUSION

The primary resistance rate of H pylori strains obtained from unselected children in Europe is high. The use of antibiotics for other indications seems to be the major risk factor for development of primary resistance.

Double-blind randomized evaluation of clinical and biological tolerance of polyethylene glycol 4000 versus lactulose in constipated children

OBJECTIVES

To assess the safety of a polyethylene glycol (PEG) 4000 laxative without additional salts in pediatric patients.

STUDY DESIGN

This was a 3-month multicenter, randomized, double-blind, double-dummy, lactulose-controlled, parallel study enrolling 96 ambulatory constipated children aged 6 months to 3 years, treated daily with 4-8 g PEG or 3.33 g-6.66 g lactulose. Total protein, albumin, iron, electrolytes, and vitamins B9 (folates), A and D (25OHD3) were measured in blood before and after treatment (day 84) in a central laboratory.

RESULTS

The percentage of children with at least one value out of normal range at day 84 with respect to baseline status (with or without at least one value out of normal range), i.e. the primary endpoint, was 87% and 90% in the PEG and lactulose groups, respectively, without any difference between groups. The whole blood parameters showed no qualitative or quantitative treatment-related changes. Vitamin A values were above normal range in 56% and 41% of children at baseline versus 33% and 36% at day 84 in the PEG and lactulose groups, respectively. Iron values were similarly under normal range in 47% and 51% at baseline versus 42% and 51% at day 84. Clinical tolerance was similar for both treatments except for vomiting and flatulence, which were significantly higher with lactulose. Significantly higher improvements were evidenced with PEG regarding stool consistency, appetite, fecaloma and use of additional laxatives.

CONCLUSION

This 3-month study in 96 constipated children aged 6 months to 3 years confirms the long-term tolerance of PEG 4000 in pediatrics and indicates a PEG efficacy similar to or greater than that of lactulose.

[Familial use of ibuprofen in febrile children: a prospective study in the emergency room of an hospital in Lille]

AIM OF THE STUDY

To assess the place of ibuprofen in the treatment of fever in children.

PATIENTS AND METHODS

An anonymous self-questionnaire was submitted to the parents of 156 children aged less than 15 years and 3 months consulting for a fever in a pediatric emergency care unit. Questions related antipyretic drugs availability at home and their administration modality to the febrile child.

RESULTS

Acetaminophen (liquid or rectal) was the first drug owned by families (N = 149, 96%). Ibuprofen was owned by 79 families (51%). The antipyretic drug administered as a first intention treatment was acetaminophen in 131 children (77%), ibuprofen in 27 (17%) and aspirin in 6 children (4%). An antipyretic bi-therapy was received by 58 children (35%), nearly always acetaminophen and ibuprofen (N = 48, 87%). The use of a bi-therapy was more frequent when ibuprofen was the first drug used. Children who received an antipyretic bi-therapy as compared to those who received a monotherapy exhibited significantly a higher fever level and long lasting fever period. Antipyretic drugs given to the sick children were prescribed by a physician in more than 90% of cases.

CONCLUSION

Ibuprofen was largely used in febrile children. This drug has almost always been prescribed by a physician. However, due to its side effects, ibuprofen should be used only in high and badly tolerated fever that is not altered by a well conducted acetaminophen monotherapy.

[Helicobacter pylori infection in children of developing countries]

A characteristic feature of Helicobacterpylori infection in developing countries is early acquisition of the bacteria during childhood. Recent study has documented the frequency of transient infection in young children in particular during the first year following eradication therapy. Children living in developing countries present several risk factors for acquisition including crowding, young age, and recurrent gastroenteritis. The risk of infection increases significantly in function of the number of infected persons in a child's family. Using molecular biology techniques based on gene sequencing, we have shown that strains in different members of the same family were identical not only between parents and children but also between siblings. The relationship between chronic diarrhoea, retarded growth, iron-deficient anaemia, and Helicobacter pylori infection in children especially from developing countries remains controversial. Gram staining of biopsy smears to detect Helicobacter pylori is an efficient diagnostic method and can be a good alternative when culture is unfeasible. Respiratory testing and detection of antigens in stools are effective and appear to be well suited to diagnosis of Helicobacter pylori infection. In developing countries Helicobacter pylori is a common infectious agent warranting further study to gain insight into clinical presentation, epidemiological features, and treatment requirements including sensitivity to antibiotics

Acquisition nosocomiale de bactéries multirésistantes dans un service de néonatologie : étude prospective et analyse des facteurs de risque

A systematic analysis of weekly nasal and rectal swabs was carried out in a neonatal unit in order to detect colonization with multiresistant bacteria (MRB).

PATIENTS AND METHODS

During a 6-month period, rectal and nasal samples were taken in 187 consecutively hospitalized newborns, the day of the admission (day 0) and every week until discharge, in order to detect MRB, mainly methicillin-resistant coagulase negative staphylococci (MRCoNS), Staphylococcus aureus and multi-resistant Gram-negative bacilli.

RESULTS

Among 187 infants, 50 were already colonized at entrance and excluded from the study. In others, 49 (35%) were colonized by at least one MRB, with a total of 71 strains isolated. The most frequent was MRCoNS, especially Staphylococcus epidermidis (66.1%). Gram-negative bacilli accounted for 9.8%. Colonization began earlier with MRCoNS than with Gram-negative bacilli, 7.8 +/- 6 vs. 15.5 +/- 16 days, P=0.004, and finished earlier 22.7 +/- 15 vs. 38.5 +/- 16 days, P=0.03. Colonized children exhibited by univariate analysis a lower birth weight, more frequent parenteral nutrition or previous hospitalization in a neonatal unit and a younger age at admission. Odds ratio for colonization were 4.06 for prematurity and 43.83 for a previous hospitalization. MRCoNS at days 15 (P <0.05) and 22 (P <0.05) were correlated with the empiric use of antibiotics. No nosocomial infection occurred during the study.

CONCLUSION

A high rate of newborns were colonized with MRB in our unit, especially MRCoNS, acquired earlier than Gram-negative bacilli, with a favoring action of empiric antibiotherapy.

High faecal calprotectin concentrations in newborn infants

BACKGROUND

Calprotectin, a major component of soluble cytosolic proteins in human neutrophil granulocytes, is excreted in excess in stools during inflammatory bowel disease in adults and children. Faecal calprotectin concentrations are also higher during the first year of life than in adults.

OBJECTIVES

To measure faecal calprotectin concentrations in the neonatal period and define reference values according to the mode of feeding: standard infant formula, prebiotic infant formula (Calisma, Blédina SA, France), or breast feeding.

PATIENTS AND METHODS

A prospective study was carried out over three months in 69 full term, healthy newborns with a median gestational age of 39.8 weeks (range 37-41.5) and a birth weight of 3300 g (range 2600-4460). Three groups were formed depending on the mode of feeding: group 1 (n = 18) received a standard infant formula, group 2 (n = 19) the prebiotic infant formula, and group 3 (n = 32) was breast fed. One stool sample was taken from each newborn on day 4 (3-7), and faecal calprotectin analysed using a commercial enzyme linked immunoassay (Calprest, Eurospital, Italy).

RESULTS

Faecal calprotectin concentrations (median 167 micro g/g) were higher than reference values in healthy adults. The concentration was below the upper reference limit for adults (50 micro g/g) for three infants only, one fed the standard formula and two fed the prebiotic formula. Concentrations did not differ significantly according to method of feeding.

CONCLUSIONS

Compared with healthy adults, newborns have high calprotectin concentrations in the first days of life. There is no obvious influence of the mode of feeding.

CT slice index and thickness: impact on organ contouring in radiation treatment planning for prostate cancer

Objective: To assess the impact of CT slice index and thickness (3 mm versus 5 mm) on (i) prostate volume, dimensions, and isocenter coordinates, (ii) bladder and rectal volumes, and (iii) DRR quality, in the treatment of prostate cancer. Methods: 16 patients with prostate cancer underwent two planning CT‐scans using 3 and 5 mm slice index/thickness. Prostate, bladder, and rectum were outlined on all scans. Prostate isocenter coordinates, maximum dimensions, and volumes were compared along with bladder and rectal volumes. Bladder volumes and maximum diameters were further investigated using a second observer. A comparative analysis of DRR quality was conducted as well as a dosimetric analysis using DVH. Results: The differences in measurements of prostate volume, isocenter coordinates and maximum dimensions between the 3 and 5 mm scans, were small and not statistically significant. Similar finding was seen for rectal volume. However, bladder volume was always larger on the 3 mm scan (mean difference=27.9 cc;  SE=4.8 cc;  95% CI:  17.7−38.2 cc;  p<0.001) and the findings were reproduced with the second observer (mean difference=31.9 cc;  SE=4.7 cc;  95% CI:  21.9−41.9 cc;  p<0.001). The differences in volume are caused by a slight increase in (1) the measurement of the longitudinal dimensions on the 3 mm scans, and (2) the slice by slice measured bladder area on the 3 mm scans. The latter is due to partial volume effect. The 3 mm DRR were slightly better than the 5 mm DRR. The bladder DVH differed significantly in some patients. Conclusion: Bladder volume is significantly larger on the 3 mm scans. Differences in contoured areas may be accounted for, in part, by the partial volume effect.

PACS number(s): 87.57.–s, 87.53.–j

Evaluation of a novel monoclonal enzyme immunoassay for detection of Helicobacter pylori antigen in stool from children

BACKGROUND

Reliable non-invasive methods for detection of Helicobacter pylori infection are required to investigate the incidence, transmission, and clearance of infection in childhood.

AIM

To evaluate a new monoclonal enzyme immunoassay (EIA) (FemtoLab H pylori Cnx) for detection of H pylori antigen in stool in a large cohort of children compared with invasive diagnostic methods and the (13)C urea breath test.

PATIENTS AND METHODS

A total of 302 symptomatic previously untreated children (aged 0.5-18.7 years; 148 girls) were recruited at three centres. H pylori status was defined by results of culture, histology, the rapid urease test, and the (13)C urea breath test. Stool samples were investigated locally by the EIA using two different production lots. According to the manufacturer's recommendations, an optical density (OD) of 0.150 was used as a cut off value.

RESULTS

OD values clearly differentiated between the 92 H pylori infected and the 210 non-infected children (median (5th-95th percentiles) 2.729 (0.232->4.000) v 0.021 (0.009-0.075)). Only two false positive and two false negative results occurred, giving a sensitivity, specificity, positive predictive value, and negative predictive value of 98%, 99%, 98%, and 99%, respectively. No significant relation was found between age and OD values in infected or non-infected children.

CONCLUSIONS

The monoclonal stool antigen EIA was excellent in diagnosing H pylori infection in symptomatic children. Accuracy was independent of the laboratory, production lot used, or the child's age. Because only 18/116 children <6 years of age were infected with H pylori, further validation of the test is needed in young infected children.

[Rapid identification of pneumococcal antigenes in urines by the Now Streptococcus pneumoniae Binax test]

Streptococcus pneumoniae is responsible for many infectious conditions but probably with an underestimated incidence especially because of the fragility of the bacteria. The present study has evaluated a new test which detects a pneumococcal antigen in urine (Now S.p Binax). Urine samples from 181 children and 40 adults have been tested. All the patients presented with typical clinical signs of pneumococcal infection. Sensitivity = 91.7 %; specificity = 54.2 %; positive predictive value = 50 %; and negative predictive value = 92.9 % have been observed. Although the sensitivity and specificity were lower than those announced by the manufacturer, the test is easy to handle and provides a rapid argument for the diagnosis of pneumococcal infection, especially in the case of invasive infections like meningitis and bacteraemia.

Low levels of pancreatic elastase 1 in stools of preterm infants

The amount of faecal pancreatic enzyme elastase 1 was significantly lower in 42 preterm newborns than in 12 full term babies at day 2 (89 (3-539) v 354 (52-600) microg/g, p<0.0007) and day 5 (164 (3-600) v 600 (158-600) microg/g, p<0.05) and correlated positively with total nutrient intake during the first week of life in preterm infants. This should probably be taken into account during early feeding.

Helicobacter pylori seroprevalence in asymptomatic pregnant women in France

The purpose of our study was to evaluate the incidence of Helicobacter pylori seropositivity in two different populations of asymptomatic pregnant women from different geographic origins during two separate time periods. A retrospective study of consecutive sera obtained from 169 and 302 asymptomatic pregnant women in 1990 and 1999, respectively, was carried out. The global H. pylori seroprevalences for 1990 and 1999 were 21.3 and 21.5% (where P is nonsignificant), respectively. For both periods the H. pylori seroprevalences were significantly higher in non-French pregnant women (66.6 and 50.6%) than in French pregnant women (18.7 and 11.2%) (P = 0.01 and 0.001, respectively). H. pylori seroprevalence in French pregnant women decreased significantly from the first period (18.7%) to the second one (11.2%) (P = 0.03).

[Acquisition of secondary resistance after failure of a first treatment of Helicobacter pylori infection in children]

AIMS

To assess the frequency of acquisition of secondary Helicobacter pylori resistant-strains after a first course of antimicrobial treatment.

PATIENTS AND METHODS

A retrospective study was performed during the 1994-2000 period, in 15 girls and eight boys, mean age 10.9 +/- 4.8 years (1.4-17 years), with Helicobacter pylori gastritis (culture and antimicrobial susceptibility) presenting a failure of first course treatment, with during one week a proton pump inhibitor and amoxicillin together with either clarithromycin (n = 14) or metronidazole (n = 9). Two endoscopies were performed, the first at the time of diagnosis and the second after the failure of bacterial eradication demonstrated by a positive 13C urea breath test six weeks after the end of treatment. Antimicrobial susceptibility of all Helicobacter pylori strains was tested after each endoscopy and before starting a second course of the treatment.

RESULTS

Comparison of antimicrobial susceptibility before and after the first course of treatment showed that Helicobacter pylori strains were all sensitive to amoxicillin, clarithromycin-resistant in eight children (34.7%) before treatment vs 12 (52.1%) after treatment, p = 0.42, ns, metronidazole-resistant in 13 (56.5%) vs 12 (52.1%), p = 0.80, ns, and both clarithromycin and metronidazole-resistant in four (17.3%) vs seven (30.4%), p = 0.63, ns. Among the 14 children treated by a triple therapy including clarithromycin, three (21.4%) developed a secondary resistance to clarithromycin and in one metronidazole resistance was no more detected. Among the nine children treated with a triple therapy including metronidazole, none developed a secondary resistance to metronidazole and one developed a secondary resistance to clarithromycin.

CONCLUSION

This study shows the absence of amoxicillin-resistant strains, a high initial clarithromycin-resistant strains level (primary resistance), increasing after a first course of treatment, and for metronidazole a high initial level of resistance not influenced by treatment. Secondary clarithromycin-resistance of Helicobacter pylori strains following the first course of treatment could account for failure of bacterial eradication and suggests the importance of antimicrobial susceptibility.