Epidemiology of legionella pneumonia and factors associated with legionella-related mortality at a tertiary care center

Legionella pneumophila is an important pathogen that may cause nosocomial and community-acquired pneumonia in patients with normal or altered immunity. The epidemiology of 40 cases of legionella pneumonia in patients hospitalized between 1986 and 1994 was studied. Fourteen patients (35%) were solid organ transplant recipients. The calculated annual incidence of L. pneumophila infection was highest among lung transplant recipients (2.07 cases per 1,000 transplant-years). There was a trend toward reduced mortality rates and less severe disease among transplant patients vs. nontransplant patients: mortality rate, 36% vs. 54%; incidence of intubation, 50% vs. 69%; rate of concurrent infections, 29% vs. 38%; and overall rate of complications, 86% vs. 96%; respectively. In a multivariate analysis, factors independently associated with an increased mortality rate were nosocomial acquisition, need for intubation, formation of lung abscess or cavitation, and presence of pleural effusion. Thus, despite differing host immune responses, the most important prognostic factors affecting the outcome of legionellosis are nosocomial acquisition and the development of pulmonary complications.

A clinic based educational programme for children with diabetes

Annual review of the knowledge in 49 diabetic children (aged 8-14, mean 12 years) who are regular clinic attenders demonstrated poor theoretical and practical skills that were irrespective of the duration of diabetes. Two 6-hour educational sessions were organized using the novelty of self-made videos along with peer group participative education, assessed by questionnaires. The results showed that this method of education imparts information that is remembered short term, that knowledge can be improved to reach a standard similar to that achieved in diabetic camps, and that the problem-solving approach is more easily tackled in participative teaching. Our children who had previously attended British Diabetic Association Diabetes Camps showed a better general knowledge of their diabetes than non-attenders but did not show a better performance on problem solving approaches to day-to-day practical difficulties. Paediatric diabetes clinics should review the knowledge of their pre-adolescent and adolescent customers along with their problem solving skills and their practical skills. How to offer access to information to those children who obviously need further help should be reviewed.

A changing pattern of cerebral palsy and its implications for the early detection of motor disorders in children

Hemiplegic cerebral palsy is appearing as the commonest cerebral palsy syndrome found at the Yorkshire Regional Child Development Centre, Leeds, and in the majority of cases does not follow a definable perinatal injury. As a practical consequence of this changing pattern of cerebral palsy a large proportion of these children will now be detected at 'well baby' clinics rather than at hospital neonatal 'at risk' clinics. As lack of awareness of the signs of cerebral palsy in the young infant lead to delay in detection and management, the early signs of congenital hemiplegia are discussed.