Health-Related Quality of Life and its Correlates in Children with Cerebral Palsy: An Exploratory Study

Recent research has shown a growing interest in the assessment of Health-Related Quality of Life (HRQoL) in children and adolescents with chronic health conditions as a subjective health outcome. However, HRQol in the pediatric population with cerebral palsy (CP) is still understudied, with scarce research assessing self-reported HRQoL and its links with other psychological variables. The present research examined self-reported HRQoL in 64 Portuguese children and adolescents with CP. Results showed that higher HRQoL (generic and specific to chronic health conditions) was significantly related to lower levels of psychopathological symptoms, higher levels of prosocial behavior and a lower need for social activities. Gender moderated the link between prosocial behavior and HRQoL (specific to chronic conditions), which was significant for girls but not for boys. Finally, the need for social activities mediated the associations between psychopathology symptoms and both measures of HRQoL.     

Soluble adhesion molecules as markers for sepsis and the potential pathophysiological discrepancy in neonates,children and adults

Sepsis is a severe and life-threatening systemic inflammatory response to infection that affects all populations and age groups. The pathophysiology of sepsis is associated with aberrant interaction between leukocytes and the vascular endothelium. As inflammation progresses, the adhesion molecules that mediate these interactions become shed from cell surfaces and accumulate in the blood as soluble isoforms that are being explored as potential prognostic disease biomarkers. We critically review the studies that have tested the predictive value of soluble adhesion molecules in sepsis pathophysiology with emphasis on age, as well as the underlying mechanisms and potential roles for inflammatory shedding. Five soluble adhesion molecules are associated with sepsis, specifically, E-selectin, L-selectin and P-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. While increased levels of these soluble adhesion molecules generally correlate well with the presence of sepsis, their degree of elevation is still poorly predictive of sepsis severity scores, outcome and mortality. Separate analyses of neonates, children and adults demonstrate significant age-dependent discrepancies in both basal and septic levels of circulating soluble adhesion molecules. Additionally, a range of both clinical and experimental studies suggests protective roles for adhesion molecule shedding that raise important questions about whether these should positively or negatively correlate with mortality. In conclusion, while predictive properties of soluble adhesion molecules have been researched intensively, their levels are still poorly predictive of sepsis outcome and mortality. We propose two novel directions for improving clinical utility of soluble adhesion molecules: the combined simultaneous analysis of levels of adhesion molecules and their sheddases; and taking age-related discrepancies into account. Further attention to these issues may provide better understanding of sepsis pathophysiology and increase the usefulness of soluble adhesion molecules as diagnostic and predictive biomarkers.     

Ovulation induction in young girls with menometrorragia: a safe and effective treatment

The prevalence of menometrorrhagia in fertile women is 11.4–13.2% and increases with aging. The presence of metrorrhagia is a relatively common cause of concern among adolescents and their parents, as well as a frequent cause of visits to emergency departments, gynaecologists, and pediatricians. Clomiphene is a selective estrogen receptor modulator (SERM) that increases the production of gonadotropins by inhibiting negative feedback on the hypothalamus.

Clomiphene is primarily used in the treatment of female infertility for ovulation induction to reverse oligoovulation or anovulation, as occurs in polycystic ovary syndrome.

Objective: The aim of our study was to evaluate the use of clomiphene citrate in ovulation induction, and therefore, in the cessation of bleeding in adolescents with menometrorrhagia in the absence of uterine, ovarian, or systemic pathologies.

Design: Cohort study.

Materials and methods: The study group was comprised of 50 subjects (age range, 13–16 years) with menometrorrhagia (bleeding >7 days in length with an average blood loss >80?ml). The treatment with clomiphene citrate at a dose of 50?mg/day for 5 days during the attack cycle, and from days 3 to 7 of three subsequent cycles, was offered to the patients.

Results: After three cycles of therapy, all patients had resolution of the menometrorrhagia and resumption of ovulatory cycles. No patient reported unwanted side effects.

Conclusion: We propose that low-dose clomiphene should be the first step in the treatment of adolescent dysfunctional bleeding (DUB).     

An evaluation of the treatment of parapsoriasis with phototherapy

Whether parapsoriasis represents an early stage of T-cell cutaneous lymphoma is still the subject of controversy. We evaluated the efficacy of phototherapy in the treatment of parapsoriasis and its relation with TCCL. Patients diagnosed with parapsoriasis and treated with phototherapy PUVA or UVB-NB were selected. Between 1 to 8 years following treatment the evolution of their disease was evaluated. In 62 patients the cure rate was 79.3% and 17.2% showed improvement of the lesions. Only two patients developed full blown T-cell cutaneous lymphoma. Phototherapy is an excellent treatment for parapsoriasis, with high cure rates, regardless of the type of phototherapy employed. Of the 62 patients under study, parapsoriasis showed no general tendency to progress to T-cell cutaneous lymphoma.     

Liofilchem? O.A. Listeria agar and direct CAMP test provided sooner Listeria monocytogenes identification from neonatal bacteremia

Listeria monocytogenes infection in pregnant women and newborns is a cause for serious concern, and invasive disease outcome strongly depends on prompt antibiotic therapy. To provide sooner identification from neonatal bacteremia we performed a CAMP test directly on positive blood aliquots and inoculated the Liofilchem^® O.A. Listeria chromogenic agar as well, thus providing a 24-h turn-around time for response.