Cross-sectional echocardiographic measurement of right atrial and right ventricular size in children with atrial septal defect before and after surgery

Summary A total of 25 children operated on for atrial septal defect were studied by cross-sectional echocardiography before and after operation. Right atrial and right ventricular dimensions and areas were measured preoperatively and 1–4 years (median, 32 months) postoperatively. The length, width, and area of the right atrium (RA) and the right ventricle (RV) were measured in the apical and the subcostal four-chamber views. The dimension of the RV outflow tract (RVOT) was measured in the parasternal short-axis view.Preoperatively, all group mean values except the subcostal four-chamber length of the RV were significantly larger than normal.After surgery, there was a significant decrease in all of the parameters studied, except for RV length. The mean postoperative values of RA measurements in the apical four-chamber view and of RVOT were still significantly larger than normal. The RV four-chamber measurements except the apical four-chamber length were not significantly enlarged. The greatest decrease in RA and RV size occurred in the first postoperative year. Longer follow-up periods did not change the measurements significantly.     

Invasion of Haemophilus influenzae and Pseudomonas aeruginosa in humans

Levels of serum IgG antibodies to somatic antigens of Haemophilus influenzae and Pseudomonas aeruginosa were determined in 127 healthy people, 37 patients with chronic bronchitis and 20 patients with bronchiectasis by enzyme-linked immunosorbent assay. The logarithmic mean titers of antibodies to Haemophilus influenzae and Pseudomonas aeruginosa were significantly higher in the patients with chronic bronchitis and bronchiectasis than in healthy people. The invasion rate of Haemophilus influenzae was identical in healthy people, chronic bronchitis and bronchiectasis, while that of Pseudomonas aeruginosa was significantly lower in healthy people than in chronic bronchitis and bronchiectasis patients. These results indicate that patients with chronic bronchitis and bronchiectasis may often have recurrence and are easily infected because of lowered defense mechanisms in the respiratory tract.     

Introducing Vi polysaccharide typhoid fever vaccine to primary school children in North Jakarta, Indonesia, via an existent school-based vaccination platform

OBJECTIVES: To report results on coverage, safety and logistics of a large-scale, school-based Vi polysaccharide immunization campaign in North Jakarta. METHODS: Of 443 primary schools in North Jakarta, Indonesia, 18 public schools were randomly selected for this study. Exclusion criteria were fever 37.5 degrees C or higher at the time of vaccination or a known history of hypersensitivity to any vaccine. Adverse events were monitored and recorded for 1 month after immunization. Because this was a pilot programme, resource use was tracked in detail. RESULTS: During the February 2004 vaccination campaign, 4828 students were immunized (91% of the target population); another 394 students (7%) were vaccinated during mop-up programmes. Informed consent was obtained for 98% of the target population. In all, 34 adverse events were reported, corresponding to seven events per 1000 doses injected; none was serious. The manufacturer recommended cold chain was maintained throughout the programme. CONCLUSIONS: This demonstration project in two sub-districts of North Jakarta shows that a large-scale, school-based typhoid fever Vi polysaccharide vaccination campaign is logistically feasible, safe and minimally disruptive to regular school activities, when used in the context of an existing successful immunization platform. The project had high parental acceptance. Nonetheless, policy-relevant questions still need to be answered before implementing a widespread Vi polysaccharide vaccine programme in Indonesia.     

The influence of diabetes and or periodontitis on inflammation and adiponectin level

BackgroundIn Indonesia, most of diabetic patients had periodontitis and 75.3% of them had severe periodontitis. Previous study found that hyperglycemia and or local inflammation (such as periodontitis) modulated systemic pro-inflammatory and anti-inflammatory cytokines.AimsThis study aimed to investigate the effect of DM and or periodontitis on systemic cytokines and adipocytokines levels.Methods and materialsA total of 57 participants with age of 29–71 years were recruited for this study. We divided them into three groups; DM-periodontitis (n = 22), periodontitis without DM (n = 16) and control (n = 19). All participants underwent physical examinations (BMI, WC, periodontal status examination) and laboratory examinations (FBG, fasting insulin, CRP, adiponektin, leptin, TNF-α and IL-10).ResultsThe proportion of severe periodontitis were higher in DM-periodontitis group compared to periodontitis without DM (77.3% vs 6.2%). DM-periodontitis group had lower adiponectin levels than that of periodontitis without DM group [5860.78 ± 4182.40 vs 9553.13 ± 6794.73; p = 0.046]. TNF-α/IL-10 ratio was significantly higher in the periodontitis without DM compared to control group [1.96 (1.68–2.32) vs 1.55 (1.27–1.85); p = 0.015].ConclusionLocal inflammation such as periodontitis, elevated systemic inflammatory markers (TNF-α/IL-10 ratio). Meanwhile chronic hyperglycemia alter adipocytokines level. The changes of systemic inflammation among diabetic group had not been shown yet in this study since some antidiabetic and antilipid drugs possess anti-inflammtory effect. Age, WC and FBG correlated with severe periodontitis. Adiponectin, leptin, TNF-α and IL-10 levels did not correlated with severe periodontitis.     

Captopril treatment in rheumatic heart disease with congestive heart failure. A preliminary report

A small scale controlled trial of captopril (ACE inhibitor) was conducted in 8 children with congestive heart failure due to rheumatic mitral regurgitation with or without mild mitral stenosis. The age of the patient ranged from 5.5 to 13 years (mean 9.3 years). Four children, served as control group, received digitalis and diuretics as standard treatment; while the other 4 children also received 2 x 12.5 mg of captopril in addition to standard treatment. The effect of both regimens were measured by using changes of left ventricular function as seen on the echocardiogram performed before treatment, and then 3, 7 and 14 days thereafter. Definite conclusion cannot be made because of the small number of patients; but it is apparent that some improvements of left ventricular functions in the captopril group were more evident when compared with that of the control group of standard treatment. Side effects of captopril were not found.     

Rifampicin reduces plasma concentrations of moxifloxacin in patients with tuberculosis.

BACKGROUND: The long duration of the current tuberculosis (TB) treatment is demanding and warrants the development of new drugs. Moxifloxacin shows promising results and may be combined with rifampicin to shorten the duration of TB treatment. Rifampicin induces the phase II metabolic enzymes that are involved in the biotransformation of moxifloxacin. Therefore, the interaction between rifampicin and moxifloxacin should be investigated. PATIENTS AND METHODS: Nineteen Indonesian patients with pulmonary TB who were in the last month of their TB treatment completed a 1-arm, 2-period, fixed-order pharmacokinetic study. In phase 1 of the study, they received 400 mg of moxifloxacin every day for 5 days in addition to 450 mg of rifampicin and 600 mg of isoniazid 3 times per week. In phase 2 of the study, after a 1-month washout period, patients received moxifloxacin for another 5 days (without rifampicin and isoniazid). A 24-h pharmacokinetic curve for moxifloxacin was recorded on the last day of both study periods, and its pharmacokinetic parameters were evaluated for an interaction with rifampicin, using a bioequivalence approach. RESULTS: Coadministration of moxifloxacin with rifampicin and isoniazid resulted in an almost uniform decrease in moxifloxacin exposure (in 18 of 19 patients). The geometric means for the ratio of phase 1 area under the curve to phase 2 area under the curve and for the ratio of phase 1 peak plasma concentration to phase 2 peak plasma concentration were 0.69 (90% confidence interval, 0.65-0.74) and 0.68 (90% confidence interval, 0.64-0.73), respectively. The median time to reach peak plasma concentration for moxifloxacin was prolonged from 1 h to 2.5 h when combined with rifampicin and isoniazid (P=.003). CONCLUSIONS: Coadministration of moxifloxacin with intermittently administered rifampicin and isoniazid results in reduced moxifloxacin plasma concentrations, which is most likely the result of induced glucuronidation or sulphation by rifampicin. Further studies are warranted to evaluate the impact of the interaction on the outcome of TB treatment.