Understanding the Concept of 'Family History' in Black Asthmatic Children

Background. Despite the fact that 71.6 of children at Chris Hani Baragwanath Hospital (CHBH) Asthma Clinic in Soweto; Johannesburg were found to have one or more positive skin-prick tests (SPTs) to common aero-allergens; they reported a low rate of positive family history for atopic conditions (22.2reason(s) why a positive family history has been found so seldom in these children. Methods. A random group of parents of the atopic asthmatic children attending the CHBH Children's Asthma Clinic completed a detailed questionnaire regarding their atopic status. Skin-prick testing was performed. Results. Fifty-four sets of parents and 15 single mothers were studied. Of the 48 atopic children; 37 (77). In the past this has minimised the importance of family history in determining the nature of chest symptoms in children in this population group; suggesting that some new environmental exposure; rather than the established familial factor; was creating the allergic milieu in this group. Objective. To determine the predictive value of a family history of symptoms of atopic disease (and allergy) by seeking evidence for this condition in the parents of asthmatic children attending the CHBH Children's Asthma Clinic; and the ) had at least 1 parent with a positive SPT. Fifty-five per cent of mothers had a positive SPT; while 48 of fathers had at least 1 positive SPT. Seven of 69 mothers (10) had a definitive diagnosis of asthma. Of these; 5 (71) were SPT-positive. Only 3 of the fathers (5.5) had asthma. All had positive SPTs. However; if all the symptoms suggestive of asthma; namely chronic cough or wheeze; were taken into account; the number of potential atopic fathers and mothers increased to 10 (19) and 18 (26) respectively. Conclusion. Simple questioning for family history of atopic disease is therefore not a good predictor of atopy in offspring in this cohort of patients. In order to get maximal yield from this question; parents must rather be asked about specific symptoms suggestive of asthma and/or allergic rhinitis

A comparison of antimicrobial susceptibility profile of urinary pathogens for the years, 1999 and 2003 / Una comparación del perfil de susceptibilidad antimicrobiana de los patógenos urinarios en los Años 1999 y 2003

Urinary tract infection is a common condition worldwide; responsible for significant morbidity in both hospitalized and community patients. The laboratory records, for microbial isolates of infected urine and their susceptibility profiles for the years 1999 and 2003 were retrospectively reviewed and compared. In 2003, there was a significant decline in recovery ofCitrobacter spp compared to 1999. Conversely, the proportion of K pneumoniae, E coli and Enterococci increased dramatically in 2003, in both practices. For Proteus vulgaris and Proteus mirabilis, rates of isolation were increased in 2003, in hospital practice and community practice, respectively. Significant changes in antimicrobial susceptibility were also evident. A greater proportion of isolates from both practices were resistant to ampicillin, amoxicillin-clavulanic acid, cefuroxime, ceftazidime and cotrimoxazole in 2003 when compared to 1999. With respect to E coli, there were significant increases in prevalence of resistance to cefuroxime and amoxicillin-clavulanic acid. The overall resistance rate for norfloxacin remained relatively low and was unchanged for E coli. Continued surveillance of uropathogen resistance trends is important and this information should be communicated to clinicians. The feasibility of using the fluoroquinolones as a first line of therapy in urinary tract infection should be considered.

La infección del tracto urinario es una condición común a nivel mundial. Esa condición es significativamente responsable de la morbilidad, tanto en los pacientes hospitalizados como en los no hospitalizados. Los datos de laboratorio en relación con los aislados microbianos de la orina infectada y sus perfiles de susceptibilidad en los años 1999 y 2003, fueron revisados y comparados de manera retrospectiva. En 2003, se produjo un descenso significativo de la recuperación de infecciones por Citrobacter spp, en comparación con 1999. En contraste con ello, la proporción de K pneumoniae, E coli y Enterococci en ambas prácticas, aumentó dramáticamente en 2003. En el caso de Proteus vulgaris y Proteus mirabilis, las tasas de aislamiento aumentaron en el año 2003 en la práctica médica hospitalaria y comunitaria respectivamente. También aquí se hicieron evidentes cambios significativos en la susceptibilidad antimicrobiana. Una proporción mayor de aislados de ambas prácticas resultó ser resistente a la ampicilina, la combinación amoxicilina/ácido clavulánico, la ceftazidima y el cotrimoxazol en 2003, en comparación con 1999. Con respecto al E coli, hubo aumentos significativos en la prevalencia de la resistencia a la cefuroxima y la asociación amoxicilina/ácido clavulánico La tasa de resistencia general frente a la norfloxacina permaneció relativamente baja y no presentó variaciones frente al E coli. La vigilancia permanente de las tendencias de la resistencia a los patógenos es importante, y la investigación así obtenida, debe ser comunicada a los clínicos. Debe considerarse la factibilidad de usar fluoroquinolonas como terapia de primera línea.

Síndrome de vena cava superior: una emergencia oncológica en niños con linfoma. revisión de 5 casos / Superior Vena Cava Syndrome: an oncologic emergency in children with lymphoma

Introducción: Un niño con cáncer puede presentar durante su enfermedad una emergencia, ya sea como manifestación inicial, en la fase de diagnóstico, durante la evolución o en el período terminal. Objetivo: Presentar nuestra experiencia en el manejo del síndrome de vena cava superior en niños con linfoma. Pacientes y Método: Revisión retrospectiva de 44 fichas clínicas de menores de 15 años con linfoma tratados entre enero de 1989 y diciembre de 1999 en la Unidad de Hematología/Oncología Infantil del Hospital Clínico Regional de Valdivia. Resultados: 5 casos presentaron síndrome de vena cava superior: linfoma de Hodgkin 2. Linfoma no Hodgkin 3. El síndrome de vena cava superior fue la manifestación inicial en 4. En la emergencia todos los pacientes recibieron corticoides y radioterapia. Tres pacientes se encuentran vivos y en remisión completa. Conclusiones: El síndrome de vena cava superior, es poco frecuente en niños con patología tumoral, sin embargo, por constituir una emergencia médica requiere tratamiento inmediato, necesitándose claras pautas de manejo.

Early metabolic defects for developing diabetes mellitus among offspring of patients with type 2 diabetes are independent of gender

The aim of the study was to investigate if the female offspring of patients with Type 2 diabetes have more metabolic defects for developing diabetes mellitus than their male counterparts. Thirty-four offspring (10 males, 24 females) of patients with Type 2 diabetes mellitus aged 28.9 +/- 1.5 years (mean +/- SEM) underwent a standard oral glucose tolerance tests (OGTT; 75 g glucose in 300 ml water). Anthropometric indices, plasma lipids and blood pressure were measured while insulin resistance (IR) and sensitivity (S) were assessed using the Homeostasis Model Assessment (HOMA) method. All the offspring had normal glucose tolerance but high HOMA-derived IR values (27.2 +/- 4.2 vs. 22.5 +/- 2.7 pmol/mmol/l, p > 0.05) and low S (48.1 +/- 5.1 vs. 50.6 +/- 3.9, p > 0.05), all of which did not differ on gender comparisons. Multiple linear regression analyses suggest that gender had no influence on the outcome of the result (p = 0.37). Again, body mass index (BMI), fasting serum insulin, plasma glucose, triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol were all similar in both genders (p > 0.05). The results suggest that though the offspring manifested metabolic defects for developing diabetes in later life, this susceptibility is independent of gender in the population studied. Further studies with a larger sample size are warranted to confirm these findings in this population.

Distribution of Oncomelania hupensis in the Napu Valley of Central Sulawesi, Indonesia.

Fifteen colonies of Oncomelania hupensis were found near trails transecting the North Lore District, Napu Valley, Central Sulawesi. Habitats were in abandoned rice fields, uncultivated grazing areas for livestock, roadside ditches and, in one case, an actively worked rice field. Marsh grasses, Ischaemum barbatum and Laersia hexandra, were the most common plants in oncomelanid habitats. Other mollusks found in association with O. hupensis were Radix sp., Melanoides sp., Gyraulus sp., Idiopoma sp., Thiara sp., Opeas sp. and Indopyrgus sp. in that order of frequency. Schistosoma japonicum cercariae, as determined by mouse exposures, were shed from snails collected at four foci. In Sulawesi, O. hupensis and S. japonicum were found in high mountain valleys near, or above, 1,000 meters in elevation. Oncomelania hupensis, however, were not found in what appeared to be suitable habitats at lower elevations in the same drainage systems.