C-reactive protein as a marker of serious bacterial infections in hospitalized febrile infants

Objective:  To determine the potential predictive power of C-reactive protein (CRP) as a marker of serious bacterial infection (SBI) in hospitalized febrile infants aged ≤3 months.
Patients and Methods:  Data on blood CRP levels were collected prospectively on admission for all infants aged ≤3 months who were hospitalized for fever from 2005 to 2008. The patients were divided into two groups by the presence or absence of findings of SBI.
Results:  A total of 892 infants met the inclusion criteria, of whom 102 had a SBI. Mean CRP level was significantly higher in the infants who had a bacterial infection than in those who did not (5.3 ± 6.3 mg/dL vs. 1.3 ± 2.2 mg/dL, p < 0.001). The area under the ROC curve (AUC) was 0.74 (95% CI: 0.67–0.80) for CRP compared to 0.70 (95% CI: 0.64–0.76) for white blood cell (WBC) count. When analyses were limited to predicting bacteremia or meningitis only, the AUCs for CRP and WBC were 0.81 (95% CI: 0.66–0.96) and 0.63 (95% CI: 0.42–0.83), respectively.
Conclusion:  C-reactive protein is a valuable laboratory test in the assessment of febrile infants aged ≤3 months old and may serve as a better diagnostic marker of SBI than total WBC count.     

Parental embodied mentalizing: how the nonverbal dance between parents and infants predicts children’s socio-emotional functioning

Parental mentalizing – the parent’s ability to envision the child’s mental states (such as desires, thoughts, or wishes) – has been argued to underlie a parent’s ability to respond sensitively to their child’s emotional needs, and thereby promote advantageous cognitive and socio-emotional development. Mentalizing is typically operationalized in terms of how parents talk to or about their infants. This work extends research on mentalizing by operationalizing parental mentalizing exclusively in terms of nonverbal, bodily based, interactive behavior, namely parental embodied mentalizing(PEM). The purpose of the current research was twofold: (1) to establish the reliability and validity of the PEM coding system; and (2) to evaluate whether such measurement predicts infant and child cognitive and socio-emotional functioning. Assessing 200 mother–infant dyads at 6 months using the coding of PEM proved both reliable and valid, including predicting child attachment security at 15 and 36 months, and language abilities, academic skills, behavior problems, and social competence at 54 months, in many cases even after taking into consideration traditional measures of parenting, namely maternal sensitivity. Conceptual, empirical, and clinical implications are discussed.     

Carbamate poisoning: treatment recommendations in the setting of a mass casualties event

The threat of using chemical compounds by terrorists as weapons of mass casualties has been a rising concern in recent years. Carbamates, a group of reversible acetylcholinesterase inhibitors, could be potentially involved in such toxic mass casualty events because they can cause cholinergic crisis that could lead to fatality, similar to that of organophosphate poisoning. The medical management of carbamate poisoning consists of supportive measures and specific antidotal treatment, that is, the anticholinergic compound atropine. The administration of oximes, acetylcholinesterase reactivators, in carbamate poisoning is controversial because of the potential toxicity of oximes in conjunction with carbamate especially in the case of the carbamate—“carbaryl” poisoning. However, recent data suggest that this concern may be unwarranted. In this article, we review the current data regarding the pros and cons of using oximes against carbamates poisoning in a mass casualties event scenario. We also propose a new decision-making algorithm for the medical first responders in a mass casualties event suspected to be caused by a cholinergic substance (organophosphate or carbamate). According to this algorithm, treatment should consist of atropine and oxime regardless of the exact toxic compound involved. We speculate that in a mass casualties event, the benefits of using oximes outweigh the low level of potential risk.     

Valsalva retinopathy associated with vigorous dancing in a discotheque.

Valsalva retinopathy develops in response to a Valsalva maneuver. Decreased visual acuity may be caused by preretinal hemorrhage, which is related to the fovea, or by vitreous hemorrhage. The hemorrhage usually clears spontaneously. A case of Valsalva maculopathy in a young, healthy boy caused by physical exertion while dancing at a club is described. Reduced visual acuity and premacular hemorrhage spontaneously resolved during the 5-month postoperative period.     

Lack of association between contraceptive usage and congenital malformations in offspring

Previous reports have linked the use of oral contraceptives and spermicides to the occurrence of malformations in offspring. With information from 12,440 women interviewed during the delivery hospitalization we found no relationship between contraceptive method and the occurrence of malformations. Whereas any unnecessary drug should be avoided during pregnancy, prior contraceptive method seems to be unrelated to the risk of congenital malformations.     

The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules

Purpose: We evaluated the role of intraoperative frozen section (FS) in the surgical management of solitary thyroid nodules, as its true value is a subject of some controversy. Methods: We reviewed the records of 206 consecutive patients operated on for solitary thyroid nodules. All patients had undergone both preoperative fine-needle aspiration (FNA) and intraoperative FS. The diagnostic findings of FNA cytology and FS histology were compared with the final histological results. Results: There were 61 patients with cancer and 145 with various benign conditions. The sensitivity and specificity of FNA were 78.1% and 96.5%, respectively, demonstrating an overall accuracy of 91.3%. The sensitivity, specificity, and accuracy rates for FS were 83.3%, 95.2%, and 91.7%, respectively. FS altered the operative decision in 14 patients, but correctly so in only 8 patients. Correlated with FNA cytology, the yield of FS in assisting in the intraoperative decision making was 1.8%, 3.4%, and 5.2% for benign, malignant, and suspicious cytology, respectively. Conclusions: When the results of FNA and FS are interpreted as either benign or malignant, both are highly accurate predictors of the pathological nature of the nodule. However, the findings of the present study do not support the use of FS in the surgical management of solitary thyroid nodules, regardless of FNA cytology. Received: August 27, 2001 / Accepted: March 5, 2002     

A comparison of individual and group mental health consultation with teachers

Mental health consultation with individual teachers (IC) or with groups of teachers (GC) was provided in eight elementary schools. On a follow-up questionnaire, GC teachers rated the consultation program more favorably than did IC teachers with regard to “general usefulness,” amount of communication generated between teachers, and amount of knowledge of child development acquired. Ratings of improvement in child behavior and parent-school relations were not significantly different for GC and IC. Apparent effects on ratings of such variables as amount of contact with consultant, diagnosis of children referred, group composition, and administrative commitment are discussed. Results suggest that GC is not only more economical than IC but also is a more effective means of educating and supporting teachers.