Axillary and rectal thermometry in the newborn: do they agree?

BACKGROUND: Accurate measurement of body temperature is critical for the assessment of a newborn's general well-being. In nursery settings, the gold standard rectal thermometry has been replaced by the axillary method. However, evidence pertaining to the agreement between axillary and rectal thermometry in the newborn is controversial. In this cross-sectional study, the agreement between axillary and rectal temperature in newborns, as well as the effects of neonatal, maternal and environmental factors on this agreement were investigated. METHODS: The mean difference between axillary and rectal temperatures was compared in stable term and preterm newborns using paired t-test for the means of differences, Pearson correlation coefficient (r), and the Bland-Altman plot. Stepwise multivariate regression assessed predictors of this difference in the overall group and by gestational age categories. RESULTS: The study included 118 newborns with gestational ages ranging from 29 to 41 weeks, median birth weight of 2980 grams (IQR: 2321.3-3363.8). Axillary and rectal temperatures correlated significantly (r = 0.5, p = 0.000) and had similar overall means but differed in 34-36 weeks gestation newborns (p = 0.01). Correlation between both methods increased with advancing gestational age being highest in term newborns (r = 0.6, p = 0.000). Bland-Altman plots revealed good agreement in gestational ages above 29 weeks. The difference between measurements increased with Cesarean delivery (ß = 0.2; 95% CI: 0.02, 0.38), but decreased with advancing chronological age (ß = -0.01; 95% CI: -0.02,-0.01), and with gestational age (ß = -0.05; 95% CI: -0.08,-0.01). CONCLUSION: In clinically stable term and preterm infants, axillary thermometry is as reliable as rectal measurement. Predictors of agreement between the two methods include gestational age, chronological age and mode of delivery. Further studies are needed to confirm this agreement in sick newborns and in extremely premature infants.

Diagnosis of hydatid cyto-biliary disease by intraductal ultrasound (with video).

Hydatid disease is one of the relatively common infections in the Middle Eastern countries. It is seen in areas where dogs are used to raise livestock. In humans, the majority of Echinococcus cysts tends to develop in the liver (70%) and is asymptomatic. The two most common complications of hydatid cysts are abscess formation and rupture. Furthermore, in 5-25% of patients, rupture occurs into the biliary tract and patients may present with cholangitis, jaundice, abscess, or bilio-cutaneous fistula after surgery. Intraductal ultrasound (IDUS) is reportedly superior to conventional endoscopic ultrasound for the depiction of bile duct obstruction owing to its additional capability of providing higher resolution images due to the use of higher frequency transducers. Unfortunately IDUS is rarely used, possibly due to the limited availability of appropriate IDUS equipment, cost of the procedure and interventional endoscopists trained in its interpretation. IDUS with wire-guided, thin-caliber, high-frequency probes is a promising imaging modality, yet no previous reports discuss its usefulness in hydatid disease investigation. We hereby present the first report of biliary hydatid disease being diagnosed by IDUS.

Seasonal variation of vitamin D and HbA(1c) levels in patients with type 1 diabetes mellitus in the Middle East.

INTRODUCTION: The discovery that many tissues express the vitamin D receptor and are able to transform the 25-hydroxyvitamin D into 1,25-dihydroxyvitamin D (active metabolite) has led to the hypothesis that vitamin D could have a role in the pathogenesis and prevention of diabetes mellitus. Accumulating evidence has linked vitamin D deficiency with immunological disturbance in type 1 diabetes mellitus. Several epidemiological studies have shown lower serum 25-hydroxyvitamin D concentrations in diabetic individuals compared to nondiabetic individuals. PATIENTS AND METHODS: A total of 105 Lebanese patients with type 1 diabetes mellitus were recruited. Levels of HbA(1c) and vitamin D were recorded during two phases with phase 1 being the period from June-September 2009 and phase 2 from January-April 2009. RESULTS: Vitamin D levels at the end of sunny season (phase 2), reflecting the previous sunny months, were found to be higher than in the early summer season (phase 1) reflecting the previous cloudy months season, with a mean change of 0.70 ± 6.87 ng/mL (P = 0.029). HbA(1c) levels were higher in phase 2 than in phase 1 with an increase of 0.175% ± 1.46% (P = 0.113). CONCLUSION: Vitamin D levels were higher at the end of the sunny season than at the end of cloudy season. HbA(1c) was also lower (but not significantly so) in the early summer season (cloudy months). There was a weak correlation between seasonal changes of vitamin D levels and the control of blood glucose as monitored by HbA(1c) in a cohort of Lebanese patients with type 1 diabetes mellitus.