Catheter-associated bloodstream infections in pediatric hematology-oncology patients: factors associated with catheter removal and recurrence

The aims of this study were to analyze the factors associated with antibiotic failure leading to tunneled central venous catheter (CVC) removal during catheter-associated bloodstream infections (CABSIs) and with recurrence and reinfection in children with cancer. All cases of CABSI in patients attending the Department of Pediatric Hematology-Oncology between November 2000 and November 2003 were reviewed. A total of 207 episodes of CABSI, including multiple episodes involving the same catheter, were identified in 146 of 410 tunneled CVCs (167 Hickman, 243 implantable ports). The most common organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in 96 (46%) episodes. Hypotension, persistent bacteremia, previous stem cell transplantation, multiple CABSIs in the same CVC, exit-site infection, inappropriate empiric antibiotic therapy, and Candida infection were all significantly associated with increased risk of catheter removal (P < 0.05, odds ratios 7.81, 1.14, 2.22, 1.93, 3.04, 2.04 and 24.53, respectively). There were 12 episodes of recurrent infection, all except 1 caused by CONS (odds ratio 20.5, P = 0.006). Inappropriate empiric therapy, especially in implantable ports, was the only mutable risk factor for antibiotic failure. Because CONS was the predominant isolate in these devices, adding glycopeptides to the empiric therapy for suspected implantable-port CABSI might decrease the removal rate. This issue should be explored in future controlled trials.     

Tympanometry assessment of 61 inbred strains of mice

Otitis media (OM) accounts for more than 20 million clinic visits in the United States every year. Resistance to antibiotics has hampered current management of the disease. Identification of genetic factors underlying susceptibility to OM is greatly needed in order to develop alternative treatment strategies. Genetically defined inbred mouse strains offer a powerful tool for dissecting genetic and environmental factors that may lead to OM in mice. Here, we report a study of middle ear function of 61 genetically diverse inbred strains of mice using tympanometry. Of the 61 inbred strains tested, the 129P1/ReJ, 129P3/J, 129S1/SvImJ, 129X1/SvJ, A/HeJ, BALB/cJ, BUB/BnJ, C57L/J, EL/SuzSeyFrkJ, FVB/NJ, I/LnJ, LP/J, NZB/BlNJ, PL/J and YBR/Ei strains exhibited tympanograms that were statistically different from other healthy strains according to parameters including middle ear pressure, volume and compliance. These differences are most likely the result of genetic factors that, when understood, will facilitate prevention and treatment of otitis media in humans. In addition, a negative correlation between age and compliance of the tympanic membrane was discovered. This is the first report to successfully use tympanometry to measure mouse middle ear function, which has been a challenge for the hearing research field because of the mouse's tiny ear size.     

Community perception of child drowning in South India: a qualitative study

BACKGROUND: World-wide, drowning is one of the leading causes of death in children between 1 and 12 years of age, especially in low- and middle-income countries. AIM: To assess the community's perceptions of the common causes of death in children, the level of awareness of drowning as a major cause and the reasons for the high rate of drowning, and to discuss preventive measures. METHOD: Five focus group discussions were conducted with representatives from five different categories of people in the community. The groups included health aides, extension workers and part-time community health workers in the peripheral health care team of the Department of Community Health, Christian Medical College, Vellore and land owners/village leaders. The data were analysed using content analysis to detect themes and trends. RESULTS: Drowning was not perceived as a major cause of childhood death. Unprotected bodies of water was acknowledged as a reason for the high rate of drowning. The groups suggested some preventive measures including intensive education on the causes of drowning, the introduction of more balwadis (day nurseries) in the villages, and the identification of resources to protect open bodies of water. CONCLUSIONS: There is an urgent need among rural communities to create awareness of the high rate of drowning in children and to motivate and facilitate individuals, communities, organisations and government agencies to make the communities safer for children.     

Personality type of the glaucoma patient

PURPOSE: To characterize the personality profile of glaucoma subjects. PATIENTS AND METHODS: One hundred eight subjects including 56 open-angle glaucoma (OAG) and 52 controls were given the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test and all performed automated perimetry. Clinical and demographic information which could relate to personality type was collected. RESULTS: OAG subjects had significantly higher Hypochondriasis (Hs; P=0.0082), Hysteria (Hy; P=0.0056), and Health Concerns (HEA; P=0.0025) mean scores than the control group. OAG subjects also had a significantly greater frequency of clinically abnormal score for hysteria (P=0.0262), and health concerns (P=0.0018). Multivariate analysis of variance revealed that Hypochondriasis, Hysteria, and Health Concerns scores were related to number of systemic medications used and to diagnostic group. Other potential explanatory variables such as sex, ethnicity, number of medical problems, length of glaucoma diagnosis, occurrence of glaucoma surgery, intraocular pressure, and visual status (logMAR, visual field indices) were not related to these personality scores. CONCLUSIONS: Patients with a diagnosis of OAG had more abnormal MMPI-2 scores in areas that focus upon concerns of somatic complaints and poor health. The use of systemic medications, which may be a constant reminder of illness, is a factor that may contribute to higher MMPI-2 scores.     

The selectin–selectin ligand axis in tumor progression

This review will document that the selectin–selectin ligand axis is actively involved in tumor progression and drives this process. The involvement of selectins and their ligands in tumor progression takes place at three levels which will be reviewed: Interaction of tumor cells with platelets and leukocytes resulting in the formation of circulating emboli; interaction of tumor cells with endothelial cells leading to extravasation of the tumor cells; and utilization of reciprocal pro malignancy signals delivered by the selectins or by their ligands to interacting cells that express the corresponding co-receptor. We propose that the selectin–selectin ligand mediated interactions between cells in the tumor microenvironment constitute an axis of evil, that it be included in the list of pro malignancy factors, and that molecules associated with this axis serve as targets for cancer therapy.     

Synaptic activation of a presynaptic kainate receptor facilitates AMPA receptor-mediated synaptic transmission at hippocampal mossy fibre synapses.

The development of GluR5-selective kainate receptor ligands is helping to elucidate the functions of kainate receptors in the CNS. Here we have further characterised the actions of a GluR5 selective agonist, ATPA, and a GluR5 selective antagonist, LY382884, in the CA3 region of rat hippocampal slices. In addition, we have used LY382884 to study a novel synaptic mechanism. This antagonist substantially reduces frequency facilitation of mossy fibre synaptic transmission, monitored as either AMPA or NMDA receptor-mediated EPSCs. This suggests that GluR5-containing kainate receptors on mossy fibres function as autoreceptors to facilitate the synaptic release of L-glutamate, in a frequency-dependent manner.     

Clinical presentation of fibroids

Uterine fibroids, the most common tumours in women of reproductive age, are asymptomatic in at least 50% of afflicted women. However, in other women, they cause significant morbidity and affect quality of life. Clinically, they present with a variety of symptoms: menstrual disturbances including menorrhagia, dysmenorrhoea and intermenstrual bleeding; pelvic pain unrelated to menstruation; and pressure symptoms such as a sensation of bloatedness, increased urinary frequency and bowel disturbance. In addition, they may compromise reproductive function, possibly contributing to subfertility, early pregnancy loss and later pregnancy complications such as pain, preterm labour, malpresentations, increased need for caesarean section, and postpartum haemorrhage. Large fibroids may distend the abdomen, which may be aesthetically displeasing to many women. Abnormal bleeding occurs in 30% of symptomatic women, and abnormal bleeding, bloating and pelvic discomfort due to mass effect constitute the most common symptoms. The incidence of fibroids is highest in Black women, who tend to have multiple and larger fibroids, and more symptomatic fibroids at the time of diagnosis. The prevalence of clinically significant myomas peaks in the perimenopausal years and declines after the menopause. It is not known why some fibroids are symptomatic while others are quiescent. The size, number and location of fibroids undoubtedly determine their clinical behaviour, but research has yet to correlate these parameters with clinical presentation of the fibroids.     

The risks for very low birth weight infants from multiple pregnancies

Advances in perinatal and neonatal care in recent years have resulted in dramatic improvements in the rate of intact survival of preterm infants. As a result, neonatologists have focused on the new challenge of bringing about similar advances for the tiniest infants who are born at or near the current limits of viability. Although these tiny infants comprise only a small proportion of all births, the ravages of prematurity make them by far the most challenging group of infants who require our attention in the neonatal intensive care unit.     

Comparison between singleton- and triplet-specific "growth" curves to detect growth restricted triplet infants

OBJECTIVE: To evaluate whether triplet- or singleton-specific growth standards should be used to define the growth restricted triplet fetus/neonate. STUDY DESIGN: We retrospectively compared the predictive values of singleton vs. triplet-specific "growth" standards using the neonatal ponderal index as reference for growth restriction. RESULTS: A ponderal index <1 SD from the mean was found in 356 (14.4%) of 2477 triplet infants. A total of 686 (27.7%) infants were small for gestational age (SGA) by singleton standards, but only 168 (6.8%) by triplet standards. After 31 weeks' gestation, triplet standards are significantly better associated with a low ponderal index (OR 2.0, 95% CI 1.1, 3.4 at 32 weeks to OR 4.1, 95% CI 2.8, 6.3 at 36-37 weeks), resulting in better positive predictive value and higher specificity of triplet standards in predicting a low ponderal index. CONCLUSION: Triplet birth weight standards are better than singleton standards at >31 but not at < or =31 weeks' gestation in predicting a low neonatal ponderal index.