Sensitivity of the bacterial meningitis score in 889 children with bacterial meningitis.

Objective: To validate sensitivity of the bacterial meningitis score (BMS) in a large population of children with bacterial meningitis (BM).

Study Design: Secondary analysis of prospective data for children presenting with BM to a hospital emergency department between January 2001 and February 2005. The BMS was applied to all children with acute BM using the same inclusion criteria proposed by the authors of the rule.

Is myocardial adrenergic responsiveness depressed in human septic shock?

Objective: To assess left ventricular (LV) contractile function and adrenergic responsiveness in septic patients.

Methods: We used echocardiographically defined fractional area of contraction (FAC), and LV area to end-systolic arterial pressure estimates of end-systolic elastance (E'es) and its change in response to dobutamine (5 microg/kg/min) in 10 subjects in septic shock admitted to an intensive care unit of an academic medical center. Subjects were studied on admission and again at both 5 days and 8-10 days after admission.

Akt phosphorylation in lymphocytes provides an index of in vitro insulin-like growth factor I sensitivity associated with growth hormone-induced growth.

Context: Because IGF-I is the main mediator of GH action on osteogenic cells, individual differences in IGF-I sensitivity are expected to contribute to the variations of GH effects on growth. In GH-treated children, the variable responses in growth rates at a specific IGF-I target level indicate heterogeneity of responses to serum IGF-I exposures.

Objectives: This study tested a cell-based assay as an index of individual IGF-I sensitivity that could help dissect GH pharmacogenetics.

Complementary and alternative approaches to pain relief during labor.

This review evaluated the effect of complementary and alternative medicine on pain during labor with conventional scientific methods using electronic data bases through 2006 were used. Only randomized controlled trials with outcome measures for labor pain were kept for the conclusions. Many studies did not meet the scientific inclusion criteria.

The incidence and treatment of rocker bottom deformity as a complication of the conservative treatment of idiopathic congenital clubfoot.

Rocker bottom deformity may occur during the conservative treatment of idiopathic congenital clubfoot. Between 1975 and 1996, we treated 715 patients (1120 clubfeet) conservatively. A total of 23 patients (36 feet; 3.

Type I interferon subtypes produced by human peripheral mononuclear cells from one normal donor stimulated by viral and non-viral inducing factors.

Through the activation of Toll-like receptors (TLRs) or cytosolic RNA helicases, a large number of pathogenic or synthetic components can induce the transcription of genes coding for type I interferons (IFNs). This family of related cytokines includes notably, a single IFN-beta protein and 13 different IFN-alpha subtypes, whose biological activities are probably not the same. The aim of this study was to characterize the type I IFN subtypes produced in vitro by human peripheral blood mononuclear cells (PBMCs) in response to specific inducers.

Etiology of developmental hip dysplasia or dislocation: review article.

There is no consensus in the literature regarding the impact of several, so-called, etiological factors in the appearance of developmental dysplasia or dislocation of the hip (DDH). Furthermore, the mechanism explaining the appearance of a dislocated or subluxated hip in the perinatal period is not well defined. The latter explains, as well, the different terms used to describe the same clinical entity.

Procalcitonin to reduce the number of unnecessary cystographies in children with a urinary tract infection: a European validation study.

Objective: To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI).

Study Design: This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI.

Results: Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR.

Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis.

Objective: To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED).

Study Design: All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined.

Cryptogenic late-onset epileptic spasms: an overlooked syndrome of early childhood?

Purpose: Few reports detailing late-onset epileptic spasms have been published. To determine whether this condition merely represents a late variant of classic West syndrome or exhibits specific features distinct from the latter and related to a later stage of brain maturation, we analyzed the whole population with this specific seizure type, excluding symptomatic cases to avoid the effect of brain lesion.

Methods: We reviewed the files of the 56 children evaluated for epileptic spasms in clusters having begun at age 12 months or later and analyzed clinical and video-EEG data of the 22 patients (4-17 years; mean, 8.

Study of the impact of liver transplantation on the outcome of intestinal grafts in children.

Background: Successful small bowel transplantation remains a challenge due to the septic and immune content of the gut. The possible beneficial role of the liver was assessed in pediatric recipients of isolated intestinal and liver intestinal combined transplantation, receiving the same immunosuppressive therapy.

Methods: Fifteen children who underwent small bowel transplantation (seven SbTx) or combined liver-small bowel transplantation (eight LSbTx) at a single center between 1994 and 1998 were retrospectively reviewed and compared with fifteen controls (eight normal and seven appendicitis as inflammatory control).

Clinical decision rules to distinguish between bacterial and aseptic meningitis.

Background: Clinical decision rules have been derived to distinguish between bacterial and aseptic meningitis in the emergency room to avoid unnecessary antibiotic treatments and hospitalisations.

Aims: To evaluate the reproducibility and to compare the diagnostic performance of five clinical decision rules.

Methods: All children hospitalised for bacterial meningitis between 1995 and 2004 or aseptic meningitis between 2000 and 2004 have been included in a retrospective cohort study.

Assessment of a rapid urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal infection in children.

The aim of the study was to evaluate the Binax Now rapid immunochromatographic test (ICT) for the detection of Streptococcus pneumoniae urinary antigen in children suffering from potentially pneumococcal infections. A total of 287 patients, with a median age of 34.9 months and divided into 3 groups, were studied; the first group of patients with a suspected pneumococcal infection (n = 112), the second group with infectious symptoms nonsuggestive of a pneumococcal infection (n = 54), and the third group was composed of asymptomatic children (n = 121).

Self-recognition is crucial for maintaining the peripheral CD4+ T-cell pool in a nonlymphopenic environment.

The role of self-recognition in the maintenance of the peripheral CD4+ T-cell pool has been extensively studied, but no clear answer has so far emerged. Indeed, in studies of the role of self-major histocompatibility complex (MHC) molecules in CD4+ T-cell survival, several parameters must be taken into account when interpreting the results: (1) in a lymphopenic environment, observations are biased by concomitant proliferation of T cells arising in MHC-expressing mice; (2) the peripheral T-cell compartment is qualitatively and quantitatively different in nonlymphopenic, normal, and MHC class II-deficient mice; and (3) in C57BL/6 Abeta(-/-) mice (traditionally considered MHC class II-deficient), the Aalpha chain and the Ebeta chain associate to form a hybrid AalphaEbeta MHC class II molecule. In light of these considerations, we revisited the role of interactions with MHC class II molecules in the survival of peripheral CD4+ T cells.

A pilot study of the usefulness and safety of a ready-to-use atopy patch test (Diallertest) versus a comparator (Finn Chamber) during cow's milk allergy in children.

Background: Patch testing is used in the diagnosis of food allergy, especially during delayed manifestations.

Objective: A ready-to-use atopy patch test (APT), the Diallertest, was compared with another APT device, the Finn Chamber, in pediatric cow's milk allergy.

Methods: This prospective study involved 49 children (34.

Is epidural analgesia a risk factor for occiput posterior or transverse positions during labour?

Objective: The aim of this study was to assess whether the station of the fetal head at epidural placement is associated with the risk of malposition during labour.

Study Design: Retrospective study (covering a 3-month period) of patients in labour with singleton cephalic term fetuses and epidural placement before 5 cm of dilatation. We studied the following risk factors for malposition: station and cervical dilatation at epidural placement, induction of labour, parity and macrosomia.

Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours.

This is a retrospective study of 76 children who had had malignant tumours treated with laminectomy or laminoplasty and/or radiation therapy affecting the spine. Spinal tumours in children are extremely rare. However, their treatment can result in progressive spinal deformity.

Detection of interleukin 6 mRNA by RT-PCR in vaginal secretions: association with preterm delivery and neonatal infection in women with preterm labour and intact membranes.

Objective: To find a biological marker associated with preterm delivery or neonatal infection in pregnant women with preterm labour and intact membranes.

Study Design: Cervical secretions were collected from 286 women hospitalized for preterm labour with intact membranes at 24-34 weeks' gestation. The outcomes studied were delivery before 33 and 35 weeks' gestation, chorioamnionitis, and neonatal infection, and their association with the presence of IL-6 mRNA in cervical secretions as detected by RT-PCR.

Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule.

Aims: To test the reproducibility of a highly sensitive clinical decision rule proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combines clinical (family history of uropathology, male gender, young age), biological (raised C reactive protein), and radiological (urinary tract dilation on renal ultrasound) predictors in a score, and provides 100% sensitivity.

Methods: A retrospective hospital based cohort study included all children, 1 month to 4 years old, with a first febrile urinary tract infection.

Procalcitonin as a predictor of vesicoureteral reflux in children with a first febrile urinary tract infection.

Objective: A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal.

Nasal septum giant pyogenic granuloma after a long lasting nasal intubation: case report.

The authors present a case of Pyogenic Granuloma (PG) arising from the nasal septum in the posterior nasal cavity of a patient male sex, caucasian, 32 years old, with a previous history of cranioencephalic trauma, several neurosurgeries for different subsequent neurological problems and the use of a nasogastric tube for feeding (nasal intubation) during 30 days. He underwent surgery in St. Vincent de Paul Hospital (Rio de Janeiro) on May 18, 1993, for the tumor removal and straightening of the nasal septum.

Unexplained mental retardation: is brain MRI useful?

Background: Mental retardation (MR), defined as an IQ below 70, is a frequent cause of consultation in paediatrics.

Objective: To evaluate the yield of brain MRI in the diagnostic work-up of unexplained MR in children.

Patients And Methods: The MRI features and clinical data of 100 patients (age 1-18 years) affected with non-progressive MR of unknown origin were compared to an age-matched control group (n=100).

Primary predictors of preterm labour.

Spontaneous preterm birth accounts for 60% of all preterm births in developed countries. With the increase in multiple pregnancies, induced preterm birth and the progress in neonatal care for extremely preterm neonates, spontaneous preterm birth for singleton pregnancies in developed countries has probably decreased over the past 30 years. This decrease is likely to be related to better prenatal care for all pregnant women because the recognition of primary risk factors in early or late pregnancy remains a basic part of prenatal care.

Detection of interleukin-6 in vaginal secretions of women with preterm premature rupture of membranes and its association with neonatal infection: a rapid immunochromatographic test.

Objective: The purpose of this study was to evaluate the diagnostic value of an interleukin-6 (IL-6) bedside test of vaginal secretions for neonatal infection in cases of preterm premature rupture of membranes.

Study Design: This prospective clinical study included 73 patients. Interleukin-6 protein in vaginal secretions was determined with an immunochromatographic bedside test in <20 minutes.