Management of hepatitis B in children

Children with hepatitis B infection require management by physicians knowledgeable about the natural history of this disorder and experienced in the treatment of children. Selection of appropriate pediatric patients for treatment will prevent some cases of advanced liver disease later in life. New treatments under development for adults may benefit children as well, once they have been rigorously investigated in the pediatric population. Prevention of new HBV infections is an important part of management in children, and working with public health campaigns will hopefully reduce both vertical and horizontal transmission.     

Does blood pressure differ between users and non-users of hormone replacement therapy? The Women's Health In the Lund Area (WHILA) Study

OBJECTIVE: To examine whether blood pressure over 24 h differed between postmenopausal women receiving and not receiving hormone replacement therapy. METHODS: One group of hormone replacement postmenopausal women (n = 32) and one group of non-hormone replacement (n = 32) postmenopausal women underwent non-invasive 24-h ambulatory blood pressure monitoring. They were randomly selected among the 2000 firstly screened women in an ongoing project in Lund, Sweden. The study was designed to detect a difference of 5 mmHg in diastolic blood pressure over 24 h with a power of 80% and 5% significance (two-tailed test). RESULTS: The hormone replacement women had a mean (SD) office blood pressure of 128/76 (12/8) mmHg and the non-hormone replacement 126/78 (16/8) mmHg. Mean ambulatory blood pressure over 24 h, day and night, in the hormone replacement group was 121/72 (11/7), 126/76 (12/8), 111/64 (11/7) mmHg. The corresponding values in the non-hormone replacement group were 118/72 (12/7), 124/77 (12/7), and 107/64 (13/7) (p > 0.40 for diastolic blood pressure and p > 0.20 for systolic blood pressure). Mean heart rate over 24 h was 71 (7) and 73 (8) beats/min in the hormone and non-hormone replacement groups, respectively. CONCLUSION: There was no difference in blood pressure or heart rate between the hormone replacement and non-hormone replacement postmenopausal women, either over 24 h or during the day or night. Hormone replacement in postmenopausal women seems not to have an influence on blood pressure, but of course we are aware that this is a cross-sectional study, which has its limitations.     

The role of fondaparinux as an adjunct to thrombolytic therapy in acute myocardial infarction: a subgroup analysis of the OASIS-6 trial.

AIMS: No antithrombotic therapy has been shown to reduce mortality when used with thrombolytics in acute myocardial infarction (AMI). In the OASIS-6 trial, fondaparinux significantly reduced mortality and reinfarction without increasing bleeding in 12 092 patients with acute ST elevation MI. METHODS AND RESULTS: We report the results of a subgroup analysis in the 5436 patients (45%) receiving thrombolytics. According to local practice, 4415 patients did not have an indication for unfractionated heparin (stratum 1) and 1021 did (stratum 2). Fondaparinux reduced the primary study outcome of death or MI at 30 days [Hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.68-0.92] with consistent reductions in both mortality (HR and CI) and reinfarction (HR and CI). There was a non-significantly lower rate of stroke (HR 0.77, CI 0.48-1.25). The risk of severe bleeding was significantly reduced (HR 0.62, CI 0.40-0.94), and thus the balance of benefit and risk (death, MI and severe haemorrhage) was clearly reduced by fondaparinux (HR 0.77, 95% CI 0.67-0.90). Results were consistent in the two strata, by the different types of thrombolytics and across various time intervals from symptom onset to treatment. CONCLUSION: In STEMI patients treated with thrombolytic agents (predominantly streptokinase), fondaparinux significantly reduced the risk of death, re-MI and severe bleeds.     

Creation and maintenance of an adequate interatrial communication in left atrioventricular valve atresia or stenosis

Patients with left atrioventricular (AV) valve atresia or stenosis were studied retrospectively to determine the incidence of early and late failures of procedures to enlarge an interatrial communication. The 61 patients underwent 80 procedures: 5 balloon atrial septostomies, 12 blade atrial septostomies and 63 surgical septectomies. No balloon septostomy provided adequate long-term palliation. Of 12 blade septostomies, 4 resulted in gradients across the atrial septum of 5 to 8 mm Hg and 8 in gradients 3 mm Hg or less. Results from blade septostomy were unrelated to underlying diagnosis, age, gradient before the procedure, number of previous procedures, pulmonary blood flow or size of the postprocedure defect by balloon sizing, but were related to size of the postoperative defect estimated by echocardiography. Among 8 patients with gradients of 3 mm Hg or less after blade septostomy, 7 were followed 9 +/- 7 months and showed no evidence of restenosis. Of 63 surgical septectomies, 11 (17.5%) were inadequate, and in at least 7 cases the failure was due to restenosis of the defect as documented by serial catheterizations or echocardiograms. Outcome after surgical septectomy was unrelated to underlying diagnosis, age or number of previous procedures, but was related to size of the defect created. Our results reveal improved results in terms of residual gradient for blade septostomy compared with previous studies and the need to follow these patients carefully, even those undergoing surgical septectomy.     

Acute anterior wall myocardial infarction secondary to blunt chest trauma

We report here a young patient who developed an acute transmural anterior wall myocardial infarction secondary to blunt chest trauma in an automobile accident. At angiography we demonstrated that this patient had sustained a left anterior descending branch intimal tear (Figure 1). Closed chest wall injury with myocardial contusion is a common occurrence in automobile accidents. However, the occlusion of the coronary artery from blunt chest trauma is rare in itself.     

Hospital and 1-year outcome after acute myocardial infarction in patients with diabetes mellitus and hypertension

Hypertension (HT) and diabetes mellitus (DM) lead to structural and functional cardiac impairment and worsen the prognosis after myocardial infarction (MI). However, the prognosis of male or female patients with the coexistence of HT and DM after MI has not been clearly demonstrated. The study sample comprised 4317 consecutive patients with an acute MI from a prospective nationwide survey conducted in 1992, 1994 and 1996 in all 25 coronary care units operating in Israel. The in-hospital, 30-day and 1-year outcome of diabetic hypertensive patients (n=546) was compared with that of diabetic normotensive patients (n=547) and with that of nondiabetic hypertensive patients (n=1192) and nondiabetic normotensive subjects (n=2032). The crude in-hospital, 30-day and 1-year mortality rates of diabetic hypertensive patients (11.7, 16.5 and 27.6%, respectively) were significantly higher than those of the diabetic normotensive patients (9.5, 15.4 and 22.9%, respectively) and nondiabetic hypertensive patients (7.1, 11.6 and 17.6%, respectively). Kaplan-Meier survival curves showed increased mortality rates during the 1-year follow-up in diabetic hypertensive patients. Adjusted risk for 1-year mortality was increased in diabetic patients. However, the risk was similar in diabetic hypertensive and normotensive patients (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.25-1.93, and 1.62, 95% CI 1.29-2.04, respectively). Adjusted Kaplan-Meier survival curves of diabetic hypertensive patients converged with those of the diabetic normotensives. The existence of DM increases the 1-year mortality after MI by about 60%. However, controlled hypertension did not worsen the outcome of diabetic male or female patients after MI.     

Biodegradation of Titanium Implants After Long-Time Insertion Used for the Treatment of Fractured Upper and Lower Jaws Through Osteosynthesis: Element Analysis by Electron Microscopy and EDX or EELS

Twelve patients underwent an osteosynthesis with titanium to treat upper and lower jaw fractures. Six to 12 months later, the miniplates were removed. Tissue samples were analyzed by light and electron microscopy for detection of a metallosis. The analysis showed new bone formation like callus tissue around the miniplates. In some cases small, rounded deposits and accumulation of colloid-like particles located next to bigger titanium artifacts were detected in the cytoplasm of histiocytes and in the matrix of connective tissue. The titanium was identified by elemental analysis using EDX in SEM as well as by EELS and electron diffraction in TEM. Both kinds of particles contain titanium, but they seem to be different in composition and derivation. The bigger particles seem to consist of metallic titanium and sourced by working on the metallic implants during the implantation itself. On the other hand, the colloidal-like, small, rounded particles in tissue macrophages and outside the cells in the matrix of connective tissue are presumably of other origin; for example, they could be derived from biodegradation and chemical conversion of the metallic implants. The titanium miniplates were examined before and after implantation by using ESCA technique and revealed metallic titanium and different compositions with other elements. The amount of titanium load of the tissue was very low in most cases and presumably not of biomedical relevance.     

Children's dynamic RSA change during anger and its relations with parenting,temperament, and control of aggression

This study examined the moderating effects of child temperament on the association between maternal socialization and 4–6-year-old children's dynamic respiratory sinus arrhythmia (RSA) change in response to anger-themed emotional materials (N = 180). We used latent growth curve modeling to explore adaptive patterns of dynamic RSA change in response to anger. Greater change in RSA during anger-induction, characterized by more initial RSA suppression and a subsequent return to baseline, was related to children's better regulation of aggression. For anger-themed materials, low levels of authoritarian parenting predicted more RSA suppression and recovery for more anger-prone children, whereas more authoritative parenting predicted more RSA suppression and recovery for less anger-prone children. These findings suggest that children's adaptive patterns of dynamic RSA change can be characterized by latent growth curve modeling, and that these patterns may be differentially shaped by parent socialization experiences as a function of child temperament.