Efficacy of forced-air warming systems with full body blankets.

Purpose: Postoperative hypothermia after cardiac surgery is still a common problem often treated with forced-air warming. This study was conducted to determine the heat transfer efficacy of 11 forced-air warming systems with full body blankets on a validated copper manikin.

Methods: The following systems were tested: 1) Bair Hugger 505; 2) Bair Hugger 750; 3) Life-Air 1000 S; 4) Snuggle Warm; 5) Thermacare; 6) Thermacare with reusable Optisan blanket; 7) WarmAir; 8) Warm-Gard; 9) Warm-Gard and reusable blanket; 10) WarmTouch; and 11) WarmTouch and reusable blanket.

Children with severe malnutrition: can those at highest risk of death be identified with the WHO protocol?

Background: With strict adherence to international recommended treatment guidelines, the case fatality for severe malnutrition ought to be less than 5%. In African hospitals, fatality rates of 20% are common and are often attributed to poor training and faulty case management. Improving outcome will depend upon the identification of those at greatest risk and targeting limited health resources.

Outcome of children with posterior fossa medulloblastoma: a single institution experience over the decade 1994-2003.

Aim: While the impact of radiotherapy in the management of medulloblastoma was recognised, the introduction of chemotherapy was investigated in clinical trials and shown to confer an additional advantage. We reviewed the outcome of a series of consecutive patients to assess the impact in a population-based clinical establishment.

Materials And Methods: A series of 38 children treated for medulloblastoma at Birmingham Children's Hospital between 1994 and 2003 was analysed.

Lactate levels in severe malarial anaemia are associated with haemozoin-containing neutrophils and low levels of IL-12.

Background: Hyperlactataemia is often associated with a poor outcome in severe malaria in African children. To unravel the complex pathophysiology of this condition the relationship between plasma lactate levels, parasite density, pro- and anti-inflammatory cytokines, and haemozoin-containing leucocytes was studied in children with severe falciparum malarial anaemia.

Methods: Twenty-six children with a primary diagnosis of severe malarial anaemia with any asexual Plasmodium falciparum parasite density and Hb < 5 g/dL were studied and the association of plasma lactate levels and haemozoin-containing leucocytes, parasite density, pro- and anti-inflammatory cytokines was measured.

Peripheral primitive neuroectodermal tumor with postchemotherapy neuroblastoma-like differentiation.

We report the case of an 11-year-old girl with a retroperitoneal tumor in the left upper quadrant. The girl was admitted to hospital with weight loss and a painless abdominal mass that on biopsy was diagnosed as a peripheral primitive neuroectodermal tumor/Ewing sarcoma (pPNET/EWS) of the soft tissue. The patient underwent chemotherapy followed by surgical resection of the tumor 5 months after diagnosis.

Effectiveness of Haemophilus influenzae type b Conjugate vaccine introduction into routine childhood immunization in Kenya.

Context: Haemophilus influenzae type b (Hib) conjugate vaccine is not perceived as a public health priority in Africa because data on Hib disease burden and vaccine effectiveness are scarce. Hib immunization was introduced in Kenyan infants in 2001.

Objective: To define invasive Hib disease incidence and Hib vaccine program effectiveness in Kenya.

Implementation of a structured paediatric admission record for district hospitals in Kenya--results of a pilot study.

Background: The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission record (PAR) for district hospitals as a means of improving documentation of illness.

Methods for reverse genetic screening in zebrafish by resequencing and TILLING.

Animal models provide an in vivo system to study gene function by transgenic and knockout approaches. Targeted knockout approaches have been very successful in mice, but are currently not feasible in zebrafish due to the inability to grow embryonic stem cells. As an alternative, a reverse genetic approach that utilizes screening by resequencing and/or TILLING (Targeting Induced Local Lesions INGenomes) of mutagenized genomes has recently gained popularity in the zebrafish field.

Newborn resuscitation: defining best practice for low-income settings.

Current resuscitation practices are often poor in low-income settings. The purpose of this review was to summarise recent evidence, relevant to developing countries, on best practice in the provision of newborn resuscitation. Potential studies for inclusion were identified using structured searches of MEDLINE via PubMed.

Infantile clivus chordoma without clivus involvement: case report and review of the literature.

Background: We present a giant clival chordoma with disseminated disease but without involvement of the clivus. To our knowledge, this is the youngest child and only the second case, presenting without base of skull involvement, in paediatric literature and the fourth reported case of a chordoma in a patient with tuberous sclerosis.

Discussion: We discuss the subtle presentation, difficulties in diagnosis and management and also review the literature.

Microscopy and outpatient malaria case management among older children and adults in Kenya.

Objective: To evaluate the accuracy of routine malaria microscopy, and appropriate use and interpretation of malaria slides under operational conditions in Kenya.

Methods: Cross-sectional survey, using a range of quality of care assessment tools, at government facilities with malaria microscopy in two Kenyan districts of different intensity of malaria transmission. All patients older than 5 years presenting to outpatient departments were enrolled.

Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: community-based observational study.

Background: Estimates of the burden of invasive bacterial disease in sub-Saharan Africa have previously relied on selected groups of patients, such as inpatients; they are, therefore, probably underestimated, potentially hampering vaccine implementation. Our aim was to assess the incidence of bacteraemia in all children presenting to a hospital in Kenya, irrespective of clinical presentation or decision to admit.

Methods: We did a community-based observational study for which we cultured blood from 1093 children who visited a Kenyan hospital outpatient department.

Working together as culture brokers by building trusting alliances with bilingual and bicultural newcomer paraprofessionals.

The authors' reflect on the challenges and rewards of partnering as casework supervisors with bilingual and bicultural newcomer paraprofessionals in resettlement work with refugee youth. Such individuals are generally recruited for their linguistic abilities and cultural knowledge, but they can lack formal clinical training or licensing credentials. Drawing on their own experience as supervisors of bilingual and bicultural newcomer paraprofessionals from Cambodia, Laos, and Vietnam, the authors compare their early attempts to establish trust and communication with insights gained in more recent supervisory experiences.

Impact of bacterial pneumonias on world child health.

Lower respiratory infections (LRIs) are estimated to cause approximately 4 million deaths each year, the majority in previously healthy young children from low-income countries. Bacterial pneumonias are likely to account for the major proportion of deaths but because accurate diagnosis is difficult, their precise contribution is difficult to estimate. Effective protection against two of the most important pathogens (H.

Neurological and developmental outcome of neonatal jaundice and sepsis in rural Kenya.

Neonatal jaundice (NJ) and sepsis are common causes of neonatal mortality in sub-Saharan Africa, but little is known about the long-term morbidity in this setting. This study aimed to describe the neurological and developmental sequelae of severe neonatal hyperbilirubinaemia and neonatal sepsis (NS) in a district hospital in rural Kenya. Twenty-three term infants with NJ [total serum bilirubin (TSB) >300 mumol/l] and 24 infants with a history of NS were identified from hospital records.

Characterisation of metabolic acidosis in Kenyan children admitted to hospital for acute non-surgical conditions.

Metabolic acidosis is associated with most severe malaria deaths in African children, and most deaths occur before maximum antimalarial action is achieved. Thus, specific acidosis treatment may reduce mortality. However, the underlying mechanisms remain poorly understood and no specific interventions have been developed.

Comparison of three methods of collecting nasal specimens for respiratory virus analysis.

Background: Nasopharyngeal aspiration (NPA) is used widely in the collection of nasal specimens for respiratory virus diagnosis. The method has limitations in relation to technical expertise, patient anxiety, and apparatus dependence. Nasal washing (NW) offers an alternative approach.

WT1 induces apoptosis through transcriptional regulation of the proapoptotic Bcl-2 family member Bak.

Wilms' tumor or nephroblastoma is believed to arise from embryonic nephrogenic rests of multipotent cells that fail to terminally differentiate into epithelium and continue to proliferate. The WT1 tumor suppressor gene, a transcription factor controlling the mesenchymal-epithelial transition in renal development, is mutated in 10% to 15% of Wilms' tumors. This potentially explains the disordered differentiation and proliferation program of a subset of Wilms' tumors.

Child survival: district hospitals and paediatricians.

In a previous article in this series, Zulfiquar Bhutta outlined many of the key sociopolitical issues, both national and international, that currently affect the delivery of health care to children in developing countries. The clear summary of our situation is that we are failing to provide even basic health care (both preventive and curative) that could reduce child mortality globally by more than half. Paediatricians, who have perhaps in the past felt they were at the forefront of articulating and promoting a global health agenda, should be challenged by these conclusions.

Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference.

Context: Severe malnutrition has a high mortality rate among hospitalized children in sub-Saharan Africa. However, reports suggest that malnutrition is often poorly assessed. The World Health Organization recommends using weight for height, but this method is problematic and often not undertaken in practice.