Protein-Losing Enteropathy Following Fontan Palliation

Protein-losing enteropathy (PLE) is a chronic condition involving multiple organ systems that may develop any time following Fontan completion. The pathogenesis of PLE is complex and multifactorial. Chronic venous hypertension, low cardiac output, and abnormal lymphatics may all play a role in the pathogenesis of PLE. Common signs and symptoms include chronic diarrhea, abdominal pain, and ascites. Diagnosis is based on the presence of signs and symptoms in addition to hypoalbuminemia and elevated stool alpha 1 antitrypsin. Early identification and a comprehensive approach to evaluation and treatment are important, as they may affect survival. The initial evaluation should include cardiac catheterization for hemodynamic assessment. Although an evidence base for treatment is lacking, various medical, interventional, and surgical approaches have been described with variable degrees of success. Commonly used therapies include nutritional support, diuretics, subcutaneous unfractionated heparin, budesonide, and sildenafil. Limited data exist for Fontan conversion or takedown. Assessment for heart transplantation should be considered. PLE mortality is high—approximately 50%—but may be mitigated by aggressive investigation and management. The evolving understanding of the role of lymphatics in the pathophysiology of PLE and the emerging role of interventional lymphatic procedures may further improve outcomes in this patient population.     

泻肾法在治疗小儿支气管哮喘中的运用观察

目的探讨泻肾法治疗小儿支气管哮喘的临床应用。方法选择我院自2010年1月—2011年12月小儿科收治的128例支气管哮喘的患儿,通过大量的文献,结合现代疾病本身的特点,所有患儿均经过中医辨证的肾实证病例,按照患儿入院登记的时间先后顺序,将患儿分为观察组（64例）与对照组（64例）,观察组给予大泻肾汤（黄芩、茯苓、细辛、干姜、芍药及甘草）,2 d/次,连续服用7 d。对照组服用氨茶碱,在临证中根据患儿的临床症状酌情使用抗生素,连续服用7 d,观察两组的治疗效果、症状消失时间,随访观察症状有无复发情况。结果观察组与对照组的疾病临床有效率分别为89.06%（57/64）、81.25%（52/64）,在中医证候疗效方面比较92.19%（59/64）、79.69%（51/64）,观察组的显效率明显优于对照组（P〈0.05）。结论小儿支气管哮喘患者主要按照肾实证加以辨治,通过服用泻肾清热方剂治疗,取得了一定的临床治疗效果。     

伏九贴敷治疗儿童反复咳喘100例临床观察

目的：观察“伏九贴敷”治疗儿童反复咳喘的临床疗效。方法：采用随机对照的方法，将200例反复咳喘患几分成观察组（贴敷组）和对照组（非贴敷组）各100例。观察组给予伏九贴敷治疗，2年为1个疗程。结果：“伏九贴敷”在平喘及消除肺部哮鸣音等方面，显效84例，有效13例，无效3例，总有效率97％，两组有显著性意义。结论：“伏九贴敷”用于治疗咳喘疗效确切，值得临床进一步推广。     

运脾散神阙穴贴敷治疗小儿厌食症67例临床观察

厌食是小儿时期常见的脾胃病症,本文介绍了应用运脾散神阙穴贴敷治疗厌食症67例,取得满意疗效。     

Caries decline before fluoride toothpaste was available: earlier and greater decline in the rural north than in southwestern Norway

The purpose of this study was to evaluate factors related to caries in 6–17-year-olds in 2 groups of Norwegian counties between 1966 and 1983. The average number of surfaces filled and permanent teeth extracted due to caries declined in the 4 northern counties from 1967. An increase was recorded in the 7 southwestern counties until 1971, then a decline. In the 1960s significantly more surfaces were filled and teeth extracted in the north compared to the southwest. Based on intra-county comparisons, the decline in surfaces treated was greater in the north between 1967 and 1983; 5.4 ± 0.4 vs 3.7 ± 0.7, P < 0.01. The averages were 1.9 surfaces treated in the north and the southwest in 1983. Higher infant mortality, lower percentage of people with completed senior secondary education, and more inhabitants per doctor and per dentist in the north indicate a less favorable situation than in the southwest. School-based fluoride programs had been implemented in both groups from the mid-1960s and around 60% participated when fluoride toothpaste became freely marketed in 1971. More fluoride programs and more fluoride tablets were available to children in the north; this may indicate a preventive attitude among dentists. The decline of caries started at different times in different parts of Norway. In the rural north with the most unfavorable situation, the decline was greater and started years before fluoride toothpaste came on to the market. The early decline may partly be ascribed to the school-based fluoride programs, the continued decline to several factors.     

Acute norovirus gastroenteritis in children in a highly rotavirus-vaccinated population in Northeast Brazil

BackgroundGastroenteritis is one of the most important causes of morbidity and mortality in children and an important etiological agent is norovirus.ObjectiveWe describe the occurrence and characteristics of norovirus diarrhoea in children from Sergipe, Northeast-Brazil, over two consecutive periods of three years following rotavirus vaccine introduction.Study designA cross sectional hospital-based survey conducted from October-2006 to September-2009 and from July-2011 to January-2013. Acute diarrhoea cases had a stool sample collected and tested for norovirus by RT-PCR and positive samples were sequenced.ResultsIn total 280 (19.6%) of 1432 samples were norovirus positive, including 204 (18.3%) of 1113 samples collected during the first period and 76 (23.9%) of 318 collected during the second period. The proportion of children with norovirus infection increased significantly through the second study period (χ² for trend = 6.7; p = 0.009), was more frequent in rotavirus vaccinated and in younger children (p < 0.001). Of 280 norovirus-positive specimens, 188 (67.1%) were sequenced. Of these, 12 were genogroup I and 176 genogroup II. The main genotype was GII.4 (149/188, 79.3%), followed by GII.2 (6, 3.2%) and GII.6 (5, 2.6%).ConclusionNorovirus annual detection rates increased over the study period. The detection of norovirus was higher among young children.     

INTENSIVE CHEMOTHERAPEUTIC REGIMENS AGAINST ACUTE LEUKEMIA TRANSIENTLY SUPPRESS ASTHMA SYMPTOMS BUT DO NOT LEAD TO LONG-TERM RELIEF

In some very rare cases children suffer from a combination of asthma and a malignant disease. This study investigated whether intensive chemotherapy might have a positive effect on asthma in these special cases and whether asthma generally relapses after completion of chemotherapy. The authors monitored clinical outcome and lung function of 43 children with acute lymphoblastic leukemia and non-Hodgkin lymphoma who received chemotherapy at the University Children's Hospital of Greifswald between 1993 and 1998. Cytostatic chemotherapy was administered according to the German treatment protocols. Two of the 43 patients had asthma before leukemia was diagnosed. During the course of chemotherapy, asthma symptoms diminished promptly after beginning of chemotherapy but asthma was rediagnosed after completion of chemotherapy in both cases. The third patient developed asthmatic symptoms shortly after completion of chemotherapy for the first time. It can be stated that chemotherapy does not essentially cure asthma. Therefore, it seems mandatory to perform follow-up lung testings after chemotherapy, especially in patients with asthma.     

A Systematic Review and Meta-Analysis of Change in Health-Related Quality of Life for Interactive Telehealth Interventions for Patients With Asthma

ObjectivesAsthma is one of the most common major noncommunicable diseases in the world and affects individuals of all ages. Medication is used to achieve and maintain quality of life (QOL) for people with asthma. Telehealth interventions offer optimized and personalized symptom monitoring with timely treatment adjustment and the potential to increase medication adherence for individuals with asthma. This study examines and synthesizes the available data on the change in the QOL for patients with asthma who use interactive telehealth interventions, and identifies the most effective telehealth modalities used for intervention in this area.MethodsLiterature searches were conducted in 5 databases in November 2018 for studies measuring a change in QOL for patients with asthma. Study QOL outcomes, where possible, were pooled in a meta-analysis.ResultsSeventeen publications (describing 16 studies) comprising 2015 patients were included. Based on a meta-analysis, interactive telehealth interventions can improve QOL outcomes for people living with asthma, although the improved effects may be small: web portals (0.51, 95% confidence interval [CI] –0.00 to 1.03), interactive smartphone apps (0.30, 95% CI –0.16 to 0.76) and remote monitoring (standardized mean difference 0.20, 95% CI –0.11 to 0.52). Intervention delivery modalities identified include interactive web portals, smartphone apps, and remote monitoring programs.ConclusionsThe findings provide a comprehensive overview of the available literature on interactive telehealth interventions, including interactive web portals, smartphone apps, and remote monitoring programs. These findings demonstrated that a positive change in QOL can be attributed to these interventions and provide evidence for the implementation of telehealth interventions for individuals with asthma.