Measurement of cardiac output in children by bioreactance

The objective of this study was to evaluate a new bioreactance method for noninvasive cardiac output (CO) measurement (NICOM) in children. Ten patients between 1 and 144?months of age and with no hemodynamic disturbances were studied. Using bioreactance, heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) measurements were made every 6?C8?h. CI was 2.4?±?1.03?l/min/1.73?m² (range 1?C4.9?l/min/1.73?m²); There were significant correlations between CI and age (r?=?0.50, P?=?0.003), weight (r?=?0.66, P?<?0.001), and MAP (r?=?0.369, P?=?0.037). Significant differences in CI (P?<?0.001) were detected between children weighing <10?kg (1.9?±?0.73?l/min/1.73?m²; range 1?C3.2), 10?C20?kg (2.07?±?0.7?l/min/1.73?m²; range 1?C3.6), and >20?kg (3.7?±?0.8?l/min/1.73?m²; range 2.4?C4.9). We conclude that the CI measured by bioreactance in children varies with the age and weight of the patients and is lower than the normal range in a large percentage of measurements. These data suggest that this method is not useful for evaluating CI in small children.     

Central auditory processes evaluated with psychoacoustic tests in normal children

ObjectiveTo identify the natural tendencies of hits and calculate the cutoff for a test group of central auditory processes (CAP): binaural fusion, filtered words, dichotic digits, frequency patterns and duration patterns and ambient sounds in normal 5-, 7-, 9- and 11-year-old children.Material and methodsWe studied 369 children (738 ears) who attend public schools in Puebla City, administering 6 CAP tests (two binaural and four monaural); we used an audiometer at 50 dB SL re-threshold at 1 kHz, from a CD recorded at the CCECADET-UNAM-INR (Centre for Applied Science and Technological Development at the National Autonomous University of Mexico and the National Institute for Rehabilitation).ResultsWe determined the cutoff points for the six tests.ConclusionThis information represents an advance in the normative standards in the field of psychoacoustic tests for CAP in Spanish and in the socio-educational context prevalent in Mexico. It is important to evaluate these results against CAP disorders.     

Central pontine myelinolysis as a cause of bilateral vocal fold immobility due to hyponatremia

We report a patient admitted with severe dyspnea due to bilateral vocal fold immobility (BVFI), associated with hyponatremia and pneumonia that required emergency tracheotomy. Cerebral magnetic resonance imaging showed a pons lesion compatible with central pontine myelinolysis. Hyponatremia is thought to be caused by hypovolemia. The hyponatremia, and not its correction, is speculated to be the cause of central pontine myelinolysis in this patient. To our knowledge, this is the first case reported of a bilateral vocal fold immobility caused by central pontine myelinolysis induced by hyponatremia.     

Gene Therapy Using a Liver-targeted AAV Vector Restores Nucleoside and Nucleotide Homeostasis in a Murine Model of MNGIE

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder caused by mutations in TYMP, enconding thymidine phosphorylase (TP). TP deficiency results in systemic accumulation of thymidine and deoxyuridine, which interferes with mitochondrial DNA (mtDNA) replication and leads to mitochondrial dysfunction. To date, the only treatment available for MNGIE patients is allogeneic hematopoietic stem cell transplantation, which is associated with high morbidity and mortality. Here, we report that AAV2/8-mediated transfer of the human TYMP coding sequence (hcTYMP) under the control of a liver-specific promoter prevents the biochemical imbalances in a murine model of MNGIE. hcTYMP expression was restricted to liver, and a dose as low as 2 × 10¹¹ genome copies/kg led to a permanent reduction in systemic nucleoside levels to normal values in about 50% of treated mice. Higher doses resulted in reductions to normal or slightly below normal levels in virtually all mice treated. The nucleoside reduction achieved by this treatment prevented deoxycytidine triphosphate (dCTP) depletion, which is the limiting factor affecting mtDNA replication in this disease. These results demonstrate that the use of AAV to direct TYMP expression in liver is feasible as a potentially safe gene therapy strategy for MNGIE.     

Psychosocial Factors Associated with Patterns of Smoking Surrounding Pregnancy in Fragile Families

Although research has documented factors associated with maternal smoking, we need a more in-depth understanding of the risk factors associated with changes in smoking behaviors during the postpartum period. We investigate smoking patterns during pregnancy and 1 year postpartum as a function of relevant psychosocial factors. We use data on 3,522 postpartum mothers from the Fragile Families and Child Wellbeing Study to analyze the predictors of smoking among mothers who did not smoke during pregnancy but smoked at 1 year postpartum, mothers who smoked both during pregnancy and postpartum, and mothers who did not smoke during either period. Our covariates are grouped into four categories of risk factors for smoking: socioeconomic status, health care, life course and health, and partner and social support. Postpartum mothers in our sample were more likely to smoke throughout or after their pregnancies if they had only a high school education or less, had a household income three or more times below the poverty line, had public or no health insurance, breastfed for less than 5 months, were not married to the infant’s father, if the infant’s father currently smoked, and if they attended religious services less than once a week. Mental health problems were consistently associated with an increased risk of constant and postpartum smoking relative to non-smoking. Psychosocial factors play a role in postpartum smoking, but they have a stronger effect in predicting smoking that persists throughout pregnancy and the first year postpartum.     

Psychosocial determinants of parents' intention to vaccinate their newborn child against hepatitis B

From October 2011, The Netherlands started to vaccinate all newborns against hepatitis B. The aim of the present study was to get insight in the psychosocial factors that determine parents' intention to vaccinate their child against hepatitis B, and to test whether intention to vaccinate is a good predictor of actual vaccination behaviour. In total, 2000 parents of newborns (0-2 weeks old) received a self-report questionnaire measuring intention towards hepatitis B vaccination and its psychosocial determinants (response rate 45.6%). Participants were invited for follow-up research and subsequently offered the opportunity to have their child vaccinated against hepatitis B. The findings showed that the large majority of parents intend to vaccinate their child against hepatitis B. The intention to vaccinate was most strongly determined by parents' attitude towards hepatitis B vaccination, which in turn was positively associated with perceived benefits of the vaccination and perceptions of the child's susceptibility to hepatitis B. The majority of the 246 parents that accepted the invitation for a follow-up study had their child vaccinated (83.7%). Intention was found to be a significant predictor of vaccination behaviour although less strong than expected. It is concluded that Dutch parents were positive towards hepatitis B vaccination in terms of both intention and behaviour. To further sustain parents' positive attitudes towards hepatitis B vaccination, educational campaigns should strengthen the benefits of vaccination along with emphasizing the child's risk to hepatitis B infection.     

Vitamin D level: is it related to disease activity in inflammatory joint disease?

The objectives of this study are to assess the vitamin D status in patients (pts) with inflammatory joint diseases (IJD), and its correlation with disease activity. 121 consecutive pts (85 rheumatoid arthritis (RA), 22 psoriatic arthritis (PSA), 14 ankylosing spondylitis (AS)) underwent clinical and laboratory evaluation which included kidney and liver function tests, serum calcium and phosphor levels, 25(OH)D and parathyroid hormone (PTH). Disease activity was assessed by DAS 28 in RA and PSA pts and by BASDAI in AS pts, sedimentation rate (ESR) and CRP. According to activity indexes, pts were divided into subgroups with low (DAS28 < 3.2 and BASDAI < 4), and moderate-to-high disease activity (DAS28 > 3.2 and BASDAI > 4). Associations between serum levels of 25(OH)D and age, gender, ethnicity, type and disease duration, treatment, (anti-tumor necrosis factorα (TNFα) agents or DMARDs), seasonal variations, and disease activity were assessed. Vitamin D deficiency was found in 51 pts (42.1%). The incidence was higher among Arab pts (76.7%) compared to Jews (23%). The difference of 25(OH)D levels between Arabs (mean 9.4 ± 4.2 ng/ml) and Jews (mean 17.8 ± 8.4 ng/ml) was statistically significant (p < 0.0001). We did not find correlation between vitamin D levels and the other evaluated factors. A surprisingly high incidence of vitamin D deficiency was found in IJD patients in a sunny Mediterranean country. This finding justifies the inclusion of vitamin D in the routine lab work-up of pts with IJD. The only statistical significant correlation was found between vitamin D level and ethnic origin. Further studies are needed to look for genetic polymorphism of vitamin D receptors.