The role of the duodenal microflora as a determinant of persistent diarrhoea

It has been suggested that proliferation of enterobacteriaceae and/or anaerobes in the duodenum of some children with acute diarrhoea determines whether the episode becomes persistent. A review of published studies and the comparison of cultures of duodenal aspirates from Peruvian children with acute and persistent diarrhoea and diarrhoea-free children did not support this hypothesis. Although many children had enterobacteriaceae and/or anaerobes cultured there was no correlation with clinical and nutritional outcome. Age, nutritional status, the environment and the aetiology of the episode were determinants of the duodenal microflora independent of diarrhoea. Culture of the duodenal aspirates did not increase the yield of enteropathogens which were isolated more frequently from stools than from the duodenum. Despite the presence of a single strain or serotype of enterobacteriaceae suggesting that these bacteria were colonizing the duodenum, we were unable to demonstrate any adherence mechanisms in the majority of them. Two often bacteria with no other evidence of virulence caused diarrhoea in the RITARD rabbit model.     

Early predictors of daily smoking in young women: the national heart,lung, and blood institute growth and health study

BACKGROUND: Smoking is highly prevalent in young women and little is known about early multilevel independent risk or protective factors that are predictive of daily smoking in young women. METHODS: Multiple logistic regression was conducted on data from NGHS, a 10-year cohort study of Black (1,213) and White (1,166) girls recruited from three clinical centers in the United States, ages 9-10 years on entry to ages 18-19. RESULTS: Compared with never smokers, White girls were at higher risk than Black girls of being daily smokers at ages 18-19. Early predictors of daily smoking at ages 18-19 years included lower parental education, one parent in the household, drinking alcohol at ages 11-12, higher drive for thinness at ages 11-12, lower behavioral conduct at ages 11-12, and lower stress at ages 10-11 and higher stress at ages 12-13. For both Black and White girls weight-related variables were significant. Stress, behavioral conduct, and one-parent household were also important predictors for White girls. CONCLUSIONS: There is evidence that childhood and adolescent factors are related to young adult smoking behavior. Body weight concerns as well as family, social environment, and behavioral factors are important issues in determining which girls will become daily smokers.     

Sulfasalazine for alopecia areata

Sulfasalazine is used as a therapy for various autoimmune conditions, including psoriasis; its effectiveness is presumed to be the result of its immunomodulatory effects. We have treated patients with severe alopecia areata with sulfasalazine as part of our dermatology practice and have noticed cosmetically acceptable regrowth in 23% of patients in whom a response could be determined. In view of its good safety profile, sulfasalazine may be considered for systemic treatment of severe alopecia areata.     

Practice patterns of neurologists regarding bone and mineral effects of antiepileptic drug therapy

BACKGROUND: Antiepileptic drug (AED) therapy has been linked to bone disease that can be treated and prevented with calcium and vitamin D. However, because there have been no definitive studies on this subject, many physicians might not be aware of this association. OBJECTIVE: To determine the approaches of neurologists to skeletal disorders in patients taking AEDs. DESIGN: A self-administered mail survey. PARTICIPANTS: United States board-certified or board-eligible pediatric (n = 404) and adult (n = 624) neurologists. MAIN OUTCOME MEASURES: Practice patterns of neurologists regarding methods of screening for bone disorders and recommendations for treatment and prophylaxis. RESULTS: Few pediatric (41%) and adult (28%) neurologists routinely evaluate AED-treated patients for bone and mineral disease. Of physicians who detect bone disease through diagnostic testing, 40% of pediatric and 37% of adult neurologists prescribe calcium or vitamin D, and about half (54% of pediatric and 57% of adult neurologists) refer patients to specialists. Few neurologists (9% of pediatric and 7% of adult neurologists) prescribe prophylactic calcium or vitamin D for patients taking AEDs. CONCLUSIONS: There is a lack of consensus among neurologists concerning the impact of AED therapy on bone. Because considerable evidence suggests that much of the bone pathology caused by AED therapy can be treated or prevented by administration of calcium and vitamin D, raising physician awareness of this problem could significantly improve the skeletal health of AED-treated individuals.     

Surgical strategies in very-low-birthweight neonates with necrotizing enterocolitis

Very-low-birthweight (VLBW) neonates are more prone to complications and death than term infants are. In a 15-year period, 19 neonates with VLBW were operated on for necrotizing enterocolitis (NEC). Indications for operation were pneumoperitoneum in 12 and deterioration of general condition in 7. Bowel resection and intestinal diversion was performed in 12, a lateral enterostomy at the site of perforation was created in 5, and 2 neonates with necrosis of the whole bowel underwent an exploratory laparotomy without any further surgical treatment. Surgical complications were found in one-third of the patients. The mortality rate was significantly higher when the ileum was affected. The survival rate was 68%. Prior to 1984 the survival rate was 37% (3/8); subsequently, it has improved to 91% (10/11) as a result of improved intensive therapy.     

A psychocutaneous profile of psoriasis patients who are stress reactors. A study of 127 patients

Psoriasis is a chronic, relapsing, cutaneous condition with a 1%-2% prevalence in the general population. About 40% of psoriatics report that psychosocial stress significantly exacerbates their condition. However, the clinical characteristics of the subgroup of psoriatic patients who are stress reactors have not been delineated. At a practical clinical level it is therefore difficult to implement specific psychosocial treatments among the psoriatic population. In this study, we compared the psychocutaneous characteristics of patients who reported that stress exacerbated their psoriasis, i.e., the high stress reactors (N = 64) to the subgroup who reported no significant association between stress and their psoriasis, i.e., the low stress reactors (N = 63). The high stress reactors had more disfiguring disease clinically (p less than 0.02); psychologically they tended to rely more upon the approval of others (p less than 0.05) and experienced more psoriasis-related daily stress (p less than 0.005). The high stress reactors also reported more flare-ups of their psoriasis during the 6 months prior to admission (p less than 0.05). We have shown that the high stress reactors can be clinically delineated from the low stress reactors. Certain psychosocial interventions will most likely decrease the morbidity associated with psoriasis among the high stress reactors, and may possibly even result in a decline in the number of major flare-ups of the psoriasis.