Knowledge, attitude and health seeking practice on bats-borne diseases among residents of Tioman Island, Malaysia.

Bats are slowly gaining recognition as a potential reservoir for viruses harmful to human (Smith and Wang, 2013). Bats are reservoir to viruses causing Ebola virus diseases (EBV) (Leroy et al., 2005), Nipah Encephalitis (NiV) (Chua et al., 2002), SARS(Li et al., 2005) and MERS-CoV (Yang et al., 2015) being the latest one making headlines. About 18 years ago, a major outbreak of Nipah virus encephalitis occurred in Peninsular Malaysia resulted in the deaths of 105 persons and the slaughter of approximately 1.1 million pigs. In 2006, a novel bat orthoreovirus was found to be associated with acute respiratory syndrome in Malaysia. Following that incidents, many studies have been done on bats, particularly to determine their species, behaviour, and antibody level and there were also studies in human on antibody prevalence to batsrelated viruses e.g. Nipah and Hendra and PRV. Humans may become infected with viruses from bats through intermediate host (swine, horse) or through aerosol or direct contact with bats. Communities living adjacent to bat roosts should aware of possible risk of infection transmission from bats. An earlier study in Guatemala demonstrated that risk of exposure to bats in communities near bats roosts was common, but recognition of the potential for disease transmission from bats was low (Moran et al., 2015). Surprisingly, there is no local published data on public awareness towards bats-related infection despite potential risk of getting the infection. This study aimed to determine knowledge and awareness on bat-related infections, attitudes towards bats and practices related to health-seeking behaviours following exposure to bats.

Incidence of MLL rearrangement in acute myeloid leukemia, and a CALM-AF10 fusion in M4 type acute myeloblastic leukemia.

To determine the incidence of the mixed lineage leukemia (MLL) gene rearrangements in acute myeloid leukemia (AML) without cytogenetically-detected 11q23 abnormalities, we screened 64 cases of AML at diagnosis for MLL rearrangement by FISH. Three cases (4.7%) had a MLL rearrangement detected; one was shown to have a cryptic t(11;22)(q23;q11) and another to have a t(9;11)(p21-22;q23) which had been missed by the conventional cytogenetic study. No 11q23 structural abnormality was visible in the third case. Twenty-six of the 64 cases were further studied by Southern blotting and DNA hybridization, and four of these cases (15%) were found to have MLL rearrangement: in three of these, FISH had not detected any abnormality. FISH was also used to confirm MLL involvement in eight cases of AML that had a cytogenetic abnormality at 11q23; in one of these, Southern blot did not show a rearrangement. The survival of patients with MLL abnormalities identified by cytogenetics, FISH and/or DNA analysis was significantly worse than that of patients without MLL abnormalities (event-free survival p = 0.016) although two patients with a t(9;11)(p21-22;q23) were long-term survivors, consistent with this particular translocation having a better prognosis. One further case with a cytogenetic abnormality close to 11q23 was studied; it was found to have a t(10;11)(p13;q21), and the breakpoints were shown by FISH to involve the Clathrin Assembly Lymphoid Myeloid (CALM) gene at 11q21 and the AF10 gene at 10p13. Our data confirm the value of combining cytogenetic, FISH and molecular analyses to define the incidence and precise nature of MLL and 11q23 abnormalities in AML.

Fading renal hyperfiltration in children following liver transplantation.

In a prospective longitudinal study, we investigated the renal function (RF) of 23 children before and after orthotopic liver transplantation (OLT). The aim was to assess both the outcome of pretransplant hyperfiltration and the clinical nephrotoxic effects of cyclosporin A (CsA); children with decreased RF prior to OLT were therefore excluded. The RF study of the 13 remaining patients included glomerular filtration rate (GFR) and effective renal plasma flow (RPF) measured by inulin (Cin: mL/min/1.73 m2) and para-amino hippurate (Cpah: mL/min/1.73 m2) clearances, respectively. Hyperfiltration prior to OLT was observed in six children, i.e. Cin>170 [range 172-230] and Cpah>800 [808-1,133]. A significant decrease in RF was noted as soon as 6 months after OLT: Cin (mean+/-SD)=107+/-23 vs. 158+/-46 (p<0.003); Cpah=583+/-119 vs. 791+/-243 (p<0.004). This was due to loss of hyperfiltration in the six children, as there was no significant difference in RF before and 6 months after OLT in the other seven children. With a 36-month follow-up, there was no correlation between CsA trough blood level and RF. In conclusion, following OLT, RF underwent early changes owing to loss of prior hyperfiltration in children without impaired RF before OLT. In addition, no evidence of CsA nephrotoxicity was found and RF remained stable during follow-up.

Vesicoureteral reflux after kidney transplantation in children.

BACKGROUND: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation in adults varies between authors and there have been few reports in children. METHODS: We conducted a retrospective study in a single-centre paediatric cohort. Fifty-five of the 84 children who underwent kidney transplantation over a 5-year period were checked with routine cystography after a median of 8 months post-transplantation. Graft function and urinary-tract infections were assessed during the first 6 years after transplantation. RESULTS: VUR into the graft was present in 58% of the patients. Graft function and incidence of urinary-tract infections were similar in the two groups, independent of VUR. After having excluded infections attributed to the presence of a catheter, actuarial survival rates without pyelonephritis and without pyelonephritis following a first lower urinary-tract infection were worse in patients with VUR (P:=0.017 and P:=0.0039 respectively). None of the eight patients with VUR treated with antibiotic prophylaxis after a first acute pyelonephritis (APN) episode presented subsequent APN after 4.4+/-3.3 years on therapy. CONCLUSIONS: VUR to the graft occurred in more than half paediatric renal transplant recipients. This condition was associated with an increased risk of APN. Long-term antibiotic prophylaxis seems to be able to prevent APN in transplanted children with VUR.

Renal function of children exposed to cyclosporin in utero.

BACKGROUND: The use of cyclosporin (CsA) has improved graft survival in transplant (Tx) patients despite its potential nephrotoxicity. Children born to transplanted women may present with intrauterine growth retardation (IUGR). On the basis of potential reduced nephron mass both in IUGR and in newborn experimental animals exposed to CsA in utero, we investigated the renal function of children >1 year of age born to women under maintenance immunosuppression, including CsA. METHODS: Fourteen children born to 12 Tx women (nine kidney, one pancreas-kidney, one heart, one liver) were investigated using inulin clearance (C(in)), para-aminohippuric acid clearance (C(PAH)), microalbuminuria, and electrolyte reabsorption rate. RESULTS: Gestational age of the 14 infants was 34+/-3 weeks and birth weight 2018+/-620 g. During pregnancy, CsA trough blood level was 234+/-115 microg/l and plasma creatinine range was 96-136 micromol/l. Two children were excluded from the study because renal investigation led to a diagnosis of hereditary nephritis (one Alport syndrome, one familial dominant focal segmental glomerulosclerosis) that was retrospectively completed in the mother. Renal function tests were finally performed in 12 children at 2.6+/-1.8 years of age: BP 94+/-7/55+/-5 mmHg, C(in) 117+/-28 ml/min/1.73 m(2), C(PAH) 545+/-124 ml/min/1.73 m(2), filtration fraction 0.23+/-0.03, microalbuminuria 4.2+/-3.5 mg/mmol. Electrolyte tubular reabsorption rates and urine concentrating capacity were normal. CONCLUSION: These results suggest that in children born to transplanted women taking CsA, renal function develops normally despite prolonged exposure in utero.

Cytomegalovirus infection may cause ureteral necrosis.

Cytomegalovirus (CMV) infection has protean presentation among immunocompromised patients, but the urinary tract is rarely involved. We report a case of extensive ureteral necrosis in a renal transplant, 12-year-old patient with typical histological feature of CMV inclusions. The role of CMV was confirmed by immunohistochemical analysis and concomitant CMV DNA detection in peripheral blood leukocytes by polymerase chain reaction analysis. CMV infection can, therefore, be regarded as a possible cause of ureteral necrosis in renal transplant recipients.

Membranous nephropathy and orbital malignant tumor.

A 7-year-old girl with membranous nephropathy is reported who suffered 16 months later from an orbital rhabdomyosarcoma. Proteinuria disappeared at the time of the remission of the tumor. Membranous nephropathy as paraneoplastic syndrome is exceptional in children, since only two other cases associated with a solid tumor have been reported in the literature.

Mycoplasma pneumoniae-associated nephritis in children.

Mycoplasma pneumoniae infection is a rare cause of acute nephritis. Six children (2 girls) aged 5-10 years, admitted for nephritis, had serological tests showing recent Mycoplasma pneumoniae infection. The diagnosis of Mycoplasma pneumoniae infection was based on the presence of serum IgM, detected either by immunofluorescence (IF) (n = 1) or enzyme-linked immunosorbent assay (n = 5). Four children had a renal biopsy, with analysis of parenchymal Mycoplasma pneumoniae components by indirect IF and polymerase chain reaction. Extrarenal symptoms were: respiratory (n = 3), ear, nose and throat (n = 2), gastrointestinal (n = 3), hepatic (n = 1), neurological (n = 1), articular (n = 1), and hematological (n = 3). The patients presented with acute nephritis (1 had a nephrotic syndrome) or with acute renal failure and proteinuria. Pathological findings included type 1 membranoproliferative glomerulonephritis (MPGN, n = 1), proliferative endocapillary glomerulonephritis (n = 2) and minimal change disease (n = 1). The patient with type 1 MPGN progressed rapidly towards end-stage renal failure because of a congenital solitary kidney. Among the patients with endocapillary glomerulonephritis, 1 relapsed 6 months later and remained proteinuric, while the other recovered, as did the child with minimal change disease. The search for Mycoplasma pneumoniae antigens and nucleic acids in renal tissue was negative. However, the absence of the microorganism in the kidney is a common feature of post-streptococcal glomerulonephritis. We conclude that Mycoplasma pneumoniae is a rare yet potential cause of acute glomerulonephritis.

[Relations between blood pressure at 3-4 years of age and body mass at birth: a population-based study]. / Relation entre la pression artérielle à l'âge de 3-4 ans et la corpulence à la naissance: étude en population.

BACKGROUND: To study the association between blood pressure of 3-4 year-old children and birth corpulence estimated from birth ponderal index (body weight/length3), a school based, cross sectional survey was conducted in the Rhône department. METHODS: 1296 randomly selected children were examined at the time of a school medical visit. Physicians abstracted information on pregnancy and measurements at birth from the Child Health Handbook and from parents interview. Systolic and diastolic blood pressure measurements were carried out by using an automated oscillometric device. RESULTS: Multiple linear regression analyses revealed an inverse association between systolic blood pressure and birth ponderal index (converted into Z-score adapted to gestational age), this was obtained after adjustment for current length and for current body mass index (body weight/length2--converted into Z-score), for child emotion and for linked study factors. Such a model provided an assessment of regression coefficient: -0.67 mmHg/birth ponderal index Z-score unit (95% confidence interval: -1.24 to -0.11). So, estimation of systolic blood pressure difference between two 3-4 year-old children, one at -2 SD birth ponderal index and another at +2 SD, was obtained: 2.6 mmHg. No evidence of an association between diastolic blood pressure and birth ponderal index was observed. CONCLUSION: In this large population with a limited range of age, our results show that, at age 3-4 years, systolic blood pressure is higher with lower birth ponderal index, suggesting that thinness at birth might be a risk factor of hypertension in adulthood.

Outcome of preemptive renal transplantation and pretransplantation dialysis in children.

The present study compares the outcome of 40 children (39%) transplanted without prior dialysis, i.e., preemptive transplantation (PET), with 63 children (61%) transplanted after a variable duration of dialysis, i.e., pretransplantation dialysis (PTD). The two groups were matched for recipient and donor age and for immunological risk factors. There was no statistical difference in the time to first acute rejection episode nor in the number of acute rejection episodes during the 1st year after renal transplantation. In the PET group, 78% of the recipients received blood transfusion versus 92.5% in the PTD group (P < 0.05), and the average number of blood units per patient was 3.2 and 7.8, respectively (P < 0.05). Arterial hypertension was found in 55% of the patients in the PET group versus 73% in the PTD group (P < 0.05). The number of functioning grafts at the end of the study period was 87.5% in the PET group and 73% in the PTD group (NS). The major cause of graft failure was vascular thrombosis in the PET group (3/5) and chronic allograft rejection in the PTD group (10/17). In the PET group, the actuarial graft survival rate was 100%, 84%, 81%, and 76% at 1, 3, 5, and 7 years, which was not statistically different from the PTD group at 1, 3, and 5 years (98%, 91%, and 73%, respectively) but there was a significantly lower graft survival (59%) after 7 years in the PTD (P < 0.05). The 7-year actuarial patient survival rate was 97% in the PET group and 90% in the PTD group (NS). In the PTD group, children on dialysis for less than 1 year (group 1, n = 25) were compared with those on dialysis for more than 1 year (group 2, n = 38). Arterial hypertension was noted in 40% of patients from group 1 and 65% from group 2 (P < 0.05); there was no significant difference in graft loss rate. In conclusion, these results confirm PET as the preferred approach rather than PTD in children who need renal replacement therapy.

Evolution of hyperparathyroidism after renal transplantation in children--effect of pre-emptive transplantation and duration of dialysis.

BACKGROUND: The main causes of secondary hyperparathyroidism in end-stage renal disease are supposed to disappear after renal transplantation thanks to good graft function, but the regression of the glandular hyperfunction often takes a long time. The aim of the present work was to evaluate the possible role of the duration of dialysis in the outcome of parathyroid function after renal transplantation in children. METHODS AND RESULTS: The study was based on data from calcium-phosphate metabolism before and over a 90-day period after renal transplantation in 41 children. Patients were divided into: group I, pre-emptive transplantation (n = 17), and group II, dialysis prior to transplant (n = 24). Groups were matched for age, sex, causes of chronic renal failure, duration of ischaemia time and immunosuppressive treatment. No significant difference was noted with respect to all assessments of serum Ca, P, 25OHD and Mg between the two groups. On the other hand, PTH was statistically different both before and after renal transplantation, while glomerular filtration rate and tubular function tests were identical. CONCLUSION: It is therefore suggested that children submitted to pre-emptive transplantation achieve normal PTH levels sooner than dialysed children, which might denote an 'inappropriate PTH secretion' in the latter group. Skeletal resistance to PTH, low density of calcitriol receptor in parathyroid and/or nodular rather than diffuse hyperplasia of the gland could be speculated to explain such conclusions.

Management of recurrent nephrotic syndrome after kidney transplantation in children.

Steroid-resistant nephrotic syndrome (NS) with focal glomerulosclerosis and its recurrence after transplantation (Tx) are mainly seen in children. The average recurrence rate is 30% and the graft loss is half this; the risk of recurrent NS in subsequent Tx is 50 to 80% according to the fate of the primary allograft. The immediate appearance of proteinuria after Tx suggests that circulating factor(s) might be present which alter the glomerular permeability. Several therapeutic schedules have been proposed and give conflicting results. However, from the current literature, a 3-step management should reasonably be settled: 1) preventive measures in patients at risk include bilateral nephrectomy prior to Tx and introduction of intravenous cyclosporine A (target CyA whole blood level 200 to 250 ng/ml) as early as possible in association with prednisone and azathioprine (+/-anti-thymocyte globulin), 2) in recurrent patients who were not under such a CyA preventive regime, high dose intravenous CyA should be started as soon as possible (target CyA whole blood level 250-350 ng/ml), 3) in children who fail to respond to the above therapeutic proposals, a combination of plasmapheresis followed by substitutive immunoglobulins in association with methylprednisolone pulses and cyclophosphamide instead of azathioprine for 2 months should be proposed early.

Body composition in children with renal disease: use of dual energy X-ray absorptiometry.

Dual energy X-ray absorptiometry (DEXA) is a non-invasive accurate method which estimates bone mineral content and density (BMD), as well as fat (FM) and lean (LM) body mass. This method was used in control children in order to establish normal values for BMD of lumbar spine and whole body composition ¿logistic curves, general equation E = k+K/[1+ alpha exp(- beta A)]¿. In children with chronic renal failure (CRF), LM correlated with the urinary excretion of creatinine (r = 0.97, P = 0.0001) independently from glomerular filtration rate. However, the assessment of LM by DEXA must take into account the hydration level, since there is a positive correlation between fluid loss and reduction in LM in children on hemodialysis (r = 0.98, P = 0.0001). After renal transplantation, a significant loss of BMD (median -9.2%) was observed at 6 months which returned to 95% of pretransplant values by the end of the 1st year. Maximal changes in LM and FM occurred during the first 3 months (-7.8% and +7.2%, respectively) and may be due to steroids; these should be influenced by physical activity since FM correlated inversely with maximal oxygen consumption (r = 0.69, P = 0.0001). Recombinant growth hormone treatment could also increase LM and decrease FM, as shown in 9 patients. DEXA appears therefore to be a reliable method for evaluating therapeutic interventions affecting nutritional status in children with CRF.

[Enuresis and benign micturition disorders in childhood. II. Cost of the management]. / L'énurésie et les troubles mictionnels bénins de l'enfance. II. Coût de la prisé en charge.

The financial cost of bedwetting management is often underestimated. A study including 48 children aged 6 to 16 years was carried out in the outpatient clinic in order to evaluate the cost of these disorders during a 4 month-period. The diagnosis was the following: nocturnal enuresis (n = 15), bladder instability (n = 22) and other voiding dysfunction (n = 11). Our results showed that these expenses were quite important. A relationship between the kind of voiding dysfunction and the subsequent expenses was observed: the more complex was the disorder, the more expensive it was (average expenses = 1317 FF/year for nocturnal enuresis, 2506 FF/year for bladder instability and 3174 FF/year for other dysfunctions). Subsidiary expenses (transport, diapers and extrawashing) constituted an important part of the whole expenses: 46% in nocturnal enuresis, 42% in bladder instability and 38% in other dysfunctions.

Activities of gamma-glutamyl transpeptidase and erythrocyte glutathione dependent enzymes in nasopharyngeal carcinoma patients and normal controls.

Plasma gamma-glutamyltranspeptidase (gamma-GT), glutathione peroxidase (GPx) and glutathione reductase (GR) activities were determined in normal and nasopharyngeal carcinoma (NPC) patients. No difference in enzyme activities was observed in the three major races of the Malaysian population, i.e. Malay, Chinese and Indian patients. However, plasma gamma-GT, erythrocyte glutathione S-transferase (GST) and GPx activities were significantly increased in all NPC patients, while GR activity remained unchanged. Patients with elevated plasma gamma-GT activities also had increased GST and GPx activities. Plasma gamma-GT and GPx activities were then found to be affected by treatment. Patients with plasma gamma-GT activity greater than 70 IU/l had very poor prognoses but patients with decreased gamma-GT activities were found to be in remission.