DIAGNOSIS AND MANAGEMENT OF HYPERLIPIDAEMIA

Hyperlipidaemia is acknowledged as the major risk factor for coronary heart disease and atheroma progression. This review considers the strategies that should be followed to reduce overall cardiovascular risk in patients with hyperlipidaemia and deals with the identification and management of treating both polygenic and monogenic lipid disorders in the presence or absence of overt cardiovascular disease.     

The trypanocidal effect of drugs in different parts of the brain

Three parts of the brain, cerebral cortex, lining of ventricle and choroid plexus, are cleared of trypanosomes to different extents by different drugs. There appear to be several barriers preventing drugs from acting in different parts of the brain, the concept of a single "blood-brain barrier" does not account for the phenomena observed. The protection of trypanosomes from certain drugs by the choroid plexus and ventricular wall supports the concept of an intracellular stage of Trypanosoma brucei in the ependymal cell; this concept is also supported by differences in parasitaemia resulting from the inoculation of ependymal and of other tissues. Alternative therapies for sleeping sickness are suggested, one of which (suramin/metronidazole) is being advanced for trials in man.     

Nutritional status of children with coeliac disease

Aims: The main aim of this study was to assess the nutritional status of children with newly diagnosed Coeliac disease (CD)with comparison to matched controls. A further aim was to assess relationships between presentation patterns and nutrition in childhood CD. Methods: The nutritional status of newly diagnosed CD was assessed by anthropometry, Bioelectrical Impedance and serum leptin levels, and contrasted to age and gender matched controls. Results: Twenty‐five children with CD (mean age of 8.2 ± 4.5 years) and 25 control children (mean age 8.1 ± 4.4.) were enrolled. Thirteen (52%) children with CD had gastrointestinal symptoms with 14 having a family history of CD. At presentation 8.7% were wasted, 4.2% were stunted and 20.8% overweight, although none were obese. Mean height and weight for age, other nutritional parameters and serum leptin did not differ between the groups. Serum leptin correlated with BMI in both groups. Conclusions: Children with CD more commonly present with atypical symptoms than with classical features. Variations in nutrition (under to overnutrition) may be seen at diagnosis, without relationship to the presence of symptoms. Leptin levels were not altered specifically in the setting of CD. Nutritional assessment remains important in the assessment and management of CD in children.     

Clinical findings associated with abnormal lung function in children aged 3–26 months with recurrent respiratory symptoms

Aim: To evaluate whether there are any associations between parentally reported symptoms, clinical findings and lung function in young children with recurrent lower respiratory tract symptoms. Methods: In 2000–2003, 148 children, aged 3–26 months, with recurrent lower respiratory tract symptoms underwent physical examination, investigation of a chest radiograph, whole body plethysmography and skin prick testing to common food and inhalant allergens. Results: Lung function was considered abnormal (i.e. functional residual capacity z‐score of ≥1.65 and/or specific conductance z‐score of ≤?1.65) in 83 (56%) children. Findings of increased work of breathing (p < 0.001) and nonspecific noisy breathing sounds (p < 0.001) in the physical examination, as well as an abnormal chest radiograph (p = 0.028) were independently associated with abnormal lung function, explaining up to 34% of the variation in lung function. In contrast, parentally reported respiratory symptoms, environmental exposures or atopic trait were not associated with lung function abnormalities. Conclusion: The results of this study emphasize the importance of the meticulous clinical examination in the evaluation of early childhood respiratory disorders. As physical examination alone cannot predict lung function abnormalities reliably in preschool children with troublesome respiratory symptoms, lung function testing may be considered in such patients to obtain additional objective information.