Persistent omphalomesenteric duct in an infant with trisomy 21.

We present the case of a term newborn with trisomy 21 who presented to the paediatric emergency department with periumbilical flare and green-brown discharge from a clamped umbilical cord, initially suspected to be omphalitis. However, it was noticed later, that when the infant strained or cried, a thick, bubbling and offensive green-brown discharge came out of the clamped umbilical cord with umbilical flatus. An ultrasound abdomen and umbilical cord confirmed the presence of a persistent omphalomesenteric duct (POMD).

Social mixing with other children during infancy enhances antibody response to a pneumococcal conjugate vaccine in early childhood.

Children who have siblings and/or who attend day care have higher rates of nasopharyngeal colonization with pneumococci than lone children do. Pneumococcal colonization is usually asymptomatic but is a prerequisite for invasive disease. We studied the effect of social mixing with other children on immunity to a pneumococcal vaccine.

Serogroup C meningococcal glycoconjugate vaccine in adolescents: persistence of bactericidal antibodies and kinetics of the immune response to a booster vaccine more than 3 years after immunization.

Background: The persistence of protection from meningococcal disease following immunization with serogroup C meningococcal (MenC) glycoconjugate vaccines in infancy is short-lived. The duration of protective immunity afforded by these vaccines in other at-risk age groups (i.e.

The kinetics and phenotype of the human B-cell response following immunization with a heptavalent pneumococcal-CRM conjugate vaccine.

Primary immunization of infants with protein-polysaccharide conjugate vaccines induces antipolysaccharide antibody and is highly effective in preventing invasive disease caused by encapsulated bacteria. However, recent experience from the UK indicates that this immunity is not sustained in the absence of booster doses of vaccine. This study aimed to establish the kinetics and phenotype of B-cell subpopulations responding to booster immunization with a heptavalent pneumococcal conjugate vaccine (Pnc7), which is to be introduced into the primary immunization schedule in the UK during 2006.

Immunogenicity and safety of a low-dose diphtheria, tetanus and acellular pertussis combination vaccine with either inactivated or oral polio vaccine as a pre-school booster in UK children.

This open, randomised controlled trial studied the immunogenicity and reactogenicity of two combined low-dose diphtheria, tetanus and acellular pertussis vaccines (Td5aP-IPV, REPEVAX, Aventis Pasteur MSD; and Td5aP, COVAXIS, Aventis Pasteur MSD + OPV, GlaxoSmithKline) in comparison with a standard dose diphtheria pre-school booster vaccine (DT2aP-IPV, TETRAVAC, Aventis Pasteur MSD) in a population of 3.5-5-year-old children administered concomitantly with measles, mumps and rubella vaccine (M-M-R II, Aventis Pasteur MSD). A linked sub-study aimed to evaluate the immunogenicity and reactogenicity of Td5aP-IPV in a population of younger children, aged 3-3.

Implementation of the Ottawa Ankle Rules by nurses working in an accident and emergency department.

Objective: To assess whether accident and emergency (A&E) nurses using the Ottawa Ankle Rules could detect all ankle fractures.

Design: Prospective observational study.

Setting: A&E department of a university teaching hospital.

Sustained change in parents receiving preventive interventions for families with depression.

Objective: The purpose of this study was to compare the sustained effects of two cognitive, psychoeducational preventive interventions for families in which a parent had an affective disorder.

Method: Thirty-seven families, in which there was a child between the ages of 8 and 15 years (mean = 11.5 years) and at least one parent who had experienced a recent episode of affective disorder according to the Research Diagnostic Criteria, were studied 1.

Examination of children's responses to two preventive intervention strategies over time.

Objective: To examine long-term effects of two forms of preventive intervention designed to increase families' understanding of parental affective disorder and to prevent depression in children.

Method: Thirty-six families who had a nondepressed child between ages 8 and 15 years and a parent who had experienced affective disorder were enrolled and randomly assigned to either a clinician-facilitated intervention or a lecture discussion group. Each parent and child were assessed prior to randomization, after intervention, and approximately 1 1/2 years after enrollment.

Examination of preventive interventions for families with depression: evidence of change.

Thirty-seven families who had a child between the ages of 8 and 15 (mean age = 12.0 years) and had at least one parent, who had experienced a recent episode of affective disorder were assigned randomly to one of two psychoeducational interventions. The interventions (clinician-facilitated or lecture-group discussion) were designed to prevent childhood depression and related problems through decreasing the impact of related risk factors and encouraging resiliency-promoting behaviors and attitudes.

Response of families to two preventive intervention strategies: long-term differences in behavior and attitude change.

Objective: To explore the long-term impact of two forms of preventive intervention designed to diminish risk to children in families in which one or both parents suffered from affective disorder.

Method: Fifty-four parents in 18 families were initially assessed and randomly assigned to one of two interventions--a clinician-facilitated, manual-based, psychoeducational preventive intervention or a standardized lecture-group discussion in which similar educational information was presented. Assessments included standard diagnostic interviews, child behavior scales, and semistructured interviews with parents about the effects of the intervention.

Comparison of preventive interventions for families with parental affective disorder.

Twenty families participated in a random assignment trial of two cognitive psychoeducational preventive interventions for families with parental affective disorder. Twelve families were assigned to a clinician-based intervention and eight to a lecture-based intervention, with assessment prior to intervention and an average of 18 weeks following intervention. Both groups were satisfied and believed they received help from the intervention.

Biological measures and cellular immunological function in depressed psychiatric inpatients.

Thirty depressed psychiatric inpatients, including 18 with a diagnosis of major depression, and 25 hospital staff controls were compared with respect to cellular immune function--that is, mitogen responsiveness to concanavalin A (con A), phytohemagglutinin (PHA), and pokeweed mitogen (PWM); natural killer cell (NK) activity; and T cell subsets, including helper/inducer T cells (CD4) and suppressor/cytotoxic cells (CD8). Only physically healthy subjects, who had not used psychoactive medications (except for low dose benzodiazepines) or other medications known to affect the immune system for at least 14 days, were included. Paired comparisons of the immune measures of patients with a DSM-III diagnosis of major depression (n = 18) with their controls demonstrated a statistically significant reduction of the patients' con A response.

The long-term effects of early kwashiorkor compared with marasmus. IV. Performance on the national high school entrance examination.

This is one of a series of studies on the long-term effects of early childhood malnutrition in Barbadian school children. This is the first report of the relationship between early malnutrition and later performance on a national examination administered to all 11-y-old children in Barbados to assign high school seats. We compared scores achieved on the 11-plus examination by 103 boys and girls with histories of marasmus or kwashiorkor with those obtained by 63 healthy comparison children and also with scores obtained by the total island population of children during the same years.

Effect of anaesthetic agents on bile flow and biliary excretion of 131I-cholylglycyltyrosine in the rat.

We have compared in the rat the effects of i.v. anaesthetic agents on bile flow rate and on the biliary excretion of a novel bile acid, 131I-cholylglycyltyrosine (131I-cholylgly.

Anxiety, depression, and menstrual symptoms among freshman medical students.

Based on data from a larger longitudinal study of medical students and physicians, this study establishes the incidence of some menstrual symptoms in a nonclinical population of 82 healthy, female, first-year medical students and investigates the correlation of self-reported anxiety and depression scores with these symptoms. Findings show that nearly half reported the frequent occurrence of at least one menstrual symptom that appeared to cause discomfort but did not interfere with performance. The data suggest an association between anxiety and depression scores and certain self-reported menstrual symptoms in this population.

The influence of early malnutrition on subsequent behavioral development. VII. The effects on maternal depressive symptoms.

A self-rating scale was used to assess the presence or absence of depressive symptoms among mothers of 129 Barbadian school children, ages 5 to 11 years, who had experienced marasmus in the first year of life. They were matched with the same number of mothers of comparison children who had no documented histories of malnutrition. Depressive symptoms, especially feelings of hopelessness, occurred more often among the mothers of previously malnourished children than among mothers of comparison children.

Long-term effects of early kwashiorkor compared with marasmus. III. Fine motor skills.

Children with histories of marasmus (n = 53) or kwashiorkor (n = 50) in the first year of life and healthy comparison children (n = 50) were tested for fine motor skills by the Purdue pegboard test at ages 11-18 years. The performance of children with histories of marasmus was impaired on two of the four test measures. However, the performance of children with a history of kwashiorkor was impaired on three measures.

Long-term effects of early kwashiorkor compared with marasmus. II. Intellectual performance.

Intellectual performance including IQ (Wechsler Intelligence Scale for Children-Revised) and conservation was measured at ages 11-18 years in a follow-up study of Barbadian girls and boys who had histories of kwashiorkor (n = 53) or marasmus (n = 55) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 58). On both IQ and conservation tests, children with previous kwashiorkor or marasmus had similar scores, which were significantly lower than scores of healthy comparison children.

Long-term effects of early kwashiorkor compared with marasmus. I. Physical growth and sexual maturation.

Physical growth and sexual maturation were measured in a follow-up study of Barbadian girls and boys aged 11-18 years with histories of kwashiorkor (n = 54) or marasmus (n = 56) in their first year of life. They were compared with healthy neighborhood children matched by sex and age who had normal patterns of growth in early childhood (n = 59). Girls with histories of marasmus had significant delays in the onset of menarche compared with healthy comparison girls.

Coping resources and health responses among men and women medical students.

The structures and pressures of medical education raise particular concerns about how coping resources vary among students as they enter training. Most past studies have focussed on male students. Our data considers the coping and health-related responses of men and women students during the initial phase of their socialization into medicine.

Orthotopic liver transplantation: postoperative complications and their management.

The Birmingham liver transplant programme started in 1982. Forty-six patients have been transplanted with a follow-up of 3 months or longer. Twenty-seven patients are still alive, of whom sixteen have lived for more than one year.