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Intravenous immunoglobulin 1 g/kg as the initial treatment for Kawasaki disease
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Hirohiko Shiraishi, Mayu Iino, Masaru Hoshina, Kou Ichihashi, Mariko Y Momoi |
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Hirohiko Shiraishi, Mayu Iino, Masaru Hoshina, Kou Ichihashi, Mariko Y Momoi
Tochigi, Japan
Author Affiliations: Department of Pediatrics, Jichi Medical University, Tochigi, 329-0498, Japan (Shiraishi H, Iino M, Hoshina M, Ichihashi K, Momoi MY)
Corresponding Author: Hirohiko Shiraishi, MD, Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan (Tel: +81-285-58-7366; Fax: +81-285-44-6123; Email: shiraish@jichi.ac.jp)
Background: Coronary artery lesion (CAL) in Kawasaki disease (KD) is prevented by intravenous immunoglobulin (IVIG); however, the total amount of IVIG should be reduced if the outcome is the same. Our aim was to determine whether the treatment with IVIG at an initial dose of 1 g/kg on the 5th to 7th day of illness with additional IVIG for refractory patients is effective for preventing CAL.
Methods: A total of 107 KD patients were treated according to the days of illness and the Harada score within 7 days of illness. All the patients with Harada score 4 or more were treated with IVIG at an initial dose of 1 g/kg, and the patients who were refractory to the initial dose, additional IVIG at a dose of 1 g/kg up to 3 g/kg was infused. Echocardiography was performed to detect the incidence of CAL.
Results: Seventy-eight patients (73%) were treated with IVIG at an initial dose of 1 g/kg according to the Harada score and the duration of illness; IVIG was started when their Harada score became 4 or more and basically on the 5th day or later. Six critically ill patients were treated with IVIG at a dose of 1 g/kg starting from the 2nd or 4th day, and all of them were refractory to the initial dose of 1 g/kg and further treated with additional doses of 1 to 3 g/kg (CAL was not observed); whereas the other 72 patients (of whom 42 were admitted by the 4th day and waited until the 5th day) were treated on the 5th to 7th day with IVIG at an initial dose of 1 g/kg. Of the 78 patients, 57 responded to the initial dose of 1 g/kg, but the remaining 21 refractory patients required additional IVIG (a total dose of IVIG up to 4 g/kg). Twenty-nine patients (27%) were treated without IVIG because their Harada score was less than 4, and CAL was not observed. In 4 (3.7%) of the 107 patients who had IVIG at 1 g/kg (n=1) or additional IVIG up to 3 g/kg (n=3), CAL appeared but regressed within 6 months after the onset.
Conclusion: Treatment of KD with IVIG at an initial dose of 1 g/kg on the 5th to 7th day with additional IVIG for refractory patients can have the same effect as the standard protocol (IVIG of 2 g/kg).
Key words: coronary artery; echocardiography; immunoglobulin; Kawasaki disease
World J Pediatr 2007;3(3):195-199 |
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[Abstract] [Full Text] [PDF]
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Pneumocystis jiroveci pneumonia in non-HIV immunocompromised Taiwanese children
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Kin-Sun Wong, Ngern sae-lom S, Iou-Jih Hung, Chao-Ping Yang |
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Kin-Sun Wong, Ngern sae-lom S, Iou-Jih Hung, Chao-Ping Yang
Taoyuan, Taiwan, China
Author Affiliations: Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan, China (Wong KS, Hung IJ, Yang CP); Department of Pediatrics, Provincial Hospital, Taoyuan, Taiwan, China (Ngern sae-lom S)
Corresponding Author: Kin-Sun Wong, MD, Department of Pediatrics, Chang Gung Children's Hospital, 5 Fu Hsin Street, Taoyuan, Taiwan, China (Tel: 886-3-3281200 ext 8202; Fax: 886-3-3288957; Email: pchest@adm.cgmh.org.tw)
Background: Pneumocystis pneumonia (PCP) has been a common opportunistic infection in patients infected with human immunodeficiency virus (HIV). Up to the present, the burden of HIV infections predisposing to PCP is not a major concern in Taiwanese children. This paper describes our experience in dealing with 5 children with PCP in a tertiary children's center in northern Taiwan.
Methods: We retrospectively reviewed cases by computer search of our hospital records with a diagnosis of PCP by microbiological or histological evidence of Pneumocystis jiroveci infection in patients younger than 18 years of age between January 1996 and December 2005 in the Chang Gung Children's Hospital.
Results: A total of 5 patients with PCP were identified. Their ages ranged from 2 months to 14 years. The major underlying diseases were acute lymphoblastic leukemia (1 patient), severe combined immunodeficiency (SCID) (2), Langerhans cell histiocytosis (1), and systemic lupus erythematosis (1). None of the patients received regular chemoprophylaxis, 4 patients survived but 1 died from respiratory failure.
Conclusions: From 1996 to 2005, PCP infections in Taiwanese children were commonly seen in primary immunodeficiency diseases, leukemia, or malignancies receiving cytotoxic and corticosteroid therapy. PCP in susceptible patients suggests non-compliance or under-prescription of PCP chemoprophylaxis by the patients or in-charge physicians respectively.
Key words: Pneumocystis jiroveci pneumonia; non-HIV immunocompromised; immunodeficiency World J Pediatr 2007;3(3):200-202 |
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[Abstract] [Full Text] [PDF]
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Taste development in Chinese newborns
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Lan Zhang, Hai-Qi Li |
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Lan Zhang, Hai-Qi Li
Chongqing, China
Author Affiliations: Department of Primary Child Care, Children's Hospital of Chongqing University of Medical Sciences, Chongqing 400014, China (Zhang L, Li HQ)
Corresponding Author: Lan Zhang, MD, Department of Primary Child Care, Children's Hospital of Chongqing University of Medical Sciences, Chongqing 400014, China (Tel: 86-13982156971; Email: zlan7487@126.com)
Background: Baby facial action coding system (FACS) is a standard instrument created by Oster and Rosenstein. Many researchers used it to study the taste development in infants of different countries. This study was undertaken to investigate the facial responses of newborns to four basic tastes as well as the gender-related taste sensitivity.
Methods: Sixty-two newborns (31 females and 31 males) were tested at 90 minutes after birth in response to four tastes including 25% sucrose (sweet), 5% sodium chloride (salt), 1.43% citric acid (sour), and 0.025% berberine (bitter). The mothers of the newborns had normal pregnancy and spontaneous delivery. The newborns were full-term with Apgar scores ≥8 at 1 and 5 minutes. The facial responses to the four tastes were classified into nine facial action units and expressions from A1 to C3, which also represented as the 1-9 grades of intensity. Cry was defined as intensity of grade 9 and nausea as grade 10. The expressions of the newborns were recorded by video. The chi-square test and the Wilcoxon's rank-sum test were used for statistical analyses.
Results: Most of the newborns showed absence of mouth action or sucking while the sucrose solution was given (P<0.01). No special expressions were seen when the salt solution was fed (P>0.01). The lip pursing with brow and middle face actions was a major response to the sour solution (citric acid) (P<0.01). The expressions responding to the bitter solution were mouth gaping with brow and middle face actions (P<0.01). Male newborns were more sensitive to the sweet and bitter solutions than female ones (P<0.01). There were no sex differences in the intensities of facial responses to the salt and sour solutions (P>0.05).
Conclusions: Newborns can present distinct responses to the four basic tastes (sweet, salt, sour, and bitter). Male newborns are more sensitive to sweet and bitter solutions than female newborns.
Key words: neonates; taste; development
World J Pediatr 2007;3(3):203-208 |
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[Abstract] [Full Text] [PDF]
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Expression of Fas and FasL in human neuroblastoma and its clinical significance
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Qiang-Song Tong, Li-Duan Zheng, Shao-Tao Tang, Shi-Wang Li, Guo-Song Jiang, Jia-Bin Cai, Yuan Liu, Qing-Lan Ruan |
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Qiang-Song Tong, Li-Duan Zheng, Shao-Tao Tang, Shi-Wang Li, Guo-Song Jiang, Jia-Bin Cai, Yuan Liu, Qing-Lan Ruan
Wuhan, China
Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Tong QS, Tang ST, Li SW, Jiang GS, Cai JB, Liu Y, Ruan QL); Department of Pathology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Zheng LD)
Corresponding Author: Qiang-Song Tong, PhD, MD, Department of Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China (Tel: 86-27-85991567; Email: qstong@mails.tjmu.edu.cn)
Background: Recent evidences indicated that tumor cells could induce apoptosis of T cells by combining Fas on active T cells' surface with self-expressed FasL to escape immune surveillance. This study was undertaken to detect the expression of the Fas/FasL system in neuroblastoma (NB) tissues and its clinical significance in clinical practice.
Methods: Immunohistochemical staining was performed to detect the expression of Fas and FasL in 40 cases of NB. The relations among Fas and FasL expression, clinical stages, pathological types, and postoperative survival time of patients were analyzed.
Results: The positive expression rates of Fas in I-II, III-IV and IV-S stages were 64.3%, 22.2% and 50.0% respectively (P<0.05). The positive expression rate of FasL in III-IV stage was 33.3%, which was significantly higher than that in I-II (21.4%) and IV-S stages (12.5%). FasL expression rates in patients with NB (28.1%) and unfavorable histology (UFH) (33.3%) were higher than those of patients with ganglioneuroblastoma (GNB) (12.5%) and favorable histology (FH) (15.8%). However, Fas expression rates in patients with GNB (50%) and FH (63.2%) were higher than those of patients with NB (40.6%) and UFH (23.8%). A positive correlation was observed between Fas expression and postoperative survival time (n=25, r=0.354), but no obvious correlation between FasL expression and postoperative survival time.
Conclusions: Abnormalities of the Fas/FasL system are related to the development of NB. Detection of the expression of Fas/FasL system may be useful to evaluate the clinical prognosis of NB.
Key words: neuroblastoma; Fas; FasL; gene expression; immune escape
World J Pediatr 2007;3(3):209-213 |
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[Abstract] [Full Text] [PDF]
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Asymptomatic urinary abnormalities among primary school children in Egypt
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Ashraf Bakr, Amr Sarhan, Ayman Hammad, Mohamed Ragab, Osama S Salama, Fatma Al-Husseni, Mohamed Azmy |
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Ashraf Bakr, Amr Sarhan, Ayman Hammad, Mohamed Ragab, Osama S Salama, Fatma Al-Husseni, Mohamed Azmy
Mansoura, Egypt
Author Affiliations: Department of Pediatric Nephrology (Bakr A, Sarhan A, Hammad A, Ragab M); Department of Clinical Pathology (Salama OS); Department of Pathology (Al-Husseni F); Department of Community Medicine (Azmy M), Mansoura University Children's Hospital, Mansoura University, Mansoura, Egypt
Corresponding Author: Ashraf Bakr, MD, PhD, Mansoura Faculty of Medicine, Mansoura, Egypt; Mansoura University Children's Hospital, Mansoura, Egypt (Tel: 00 2050 2230376; Fax: 00 2050 2234092; Email: ashbakr@mans.edu.eg)
Background: Mass urinary screening is a useful way to detect the prevalence of renal diseases and to improve its outcome. This study was undertaken to detect the prevalence of asymptomatic urinary abnormalities among primary school children in Egypt.
Methods: A total of 1670 healthy children were included in this study. Urinary screening was performed with the dipstick method.
Results: Twenty-two children (1.3%) had urinary abnormalities at the first screening and only 12 (0.72%) had urinary abnormalities at the second screening. Of the children who had urinary abnormalities, 6 (0.36%) had isolated hematuria (IH), 2 (0.12%) had isolated proteinuria (IP) and 4 (0.24%) had combined hematuria and proteinuria (CHP). Renal biopsy was performed on 4 children (2 with CHP, 1 with IH and 1 with IP). Post streptococcal acute glomerulonephritis (PSAGN) was identified in 3 of the 6 IH children, hypercalciuria and renal stone in 2, and no abnormality in 1. One of the IP children had orthostatic proteinuria and the other had focal segmental glomerulosclerosis. The pattern of renal diseases in CHP children was PSAGN in 2, diffuse mesangial proliferation in 1 and IgA nephropathy in 1.
Conclusions: Asymptomatic urinary abnormalities were detected in a small number of primary school children in Egypt and PSAGN was the leading cause for these abnormalities. Only 3 children had evidence of chronic kidney disease. The study raises question about the cost-benefit ratio for the national implementation of the urine screening program.
Key words: urine screening; hematuria; proteinuria; primary school children World J Pediatr 2007;3(3):214-217 |
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[Abstract] [Full Text] [PDF]
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Effect of S-adenosylmethionine on total parenteral nutrition-associated cholestasis
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Yi-Sheng Liu, Wei Cai, Sheng-Mei Wu, Long-Hua Qian |
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Yi-Sheng Liu, Wei Cai, Sheng-Mei Wu, Long-Hua Qian
Shanghai, China
Author Affiliations: Xinhua Hospital Affiliated to Medical School, Shanghai Jiaotong University, Shanghai Institute for Pediatric Research, Shanghai 200092, China (Liu YS, Cai W, Wu SM, Qian LH)
Corresponding Author: Yi-Sheng Liu, MD, PhD, Xinhua Hospital Affiliated to Medical School, Shanghai Jiaotong University, Shanghai Institute for Pediatric Research, Shanghai 200092, China (Tel: 86-21-65790000 ext 3426; Fax: 86-21-65791316; Email: liuyisheng2002@yahoo.com.cn)
Background: Total parenteral nutrition (TPN) has been used clinically for more than 30 years, but hepatobiliary complications associated with TPN remain to be solved. The aim of this study was to investigate the effect of S-adenosylmethionine (SAMe) on TPN-induced cholestasis and hepatocytic apoptosis.
Methods: Twenty-four newborn rabbits were randomly divided into 3 groups: normal control group receiving breast milk, TPN group receiving TPN at a dose of 200 kcal/kg per day, and SAMe group receiving TPN plus SAMe at an intravenous dose of 100 mg/kg per day. Blood and liver samples were collected one week later. The levels of serum bile acid, alanine aminotransferase (ALT), alkaline phosphatase (AKP), total bilirubin, direct reaction bilirubin, albumin and globulin levels were detected by an automatic biochemical analyzer. Hepatic pathological changes were observed under the light microscope, and apoptosis of hepatocytes was determined with the TUNEL method.
Results: There were no significant differences in the levels of serum bile acid, ALT, AKP, total bilirubin, albumin and globulin between the SAMe group and control group (P>0.05). The level of direct reaction bilirubin in the SAMe group was obviously higher than that in the control group (P<0.01), but significantly lower than that in the TPN group (P<0.01). Cholestatic changes and mild hepatic steatosis were observed in the TPN group, while no such changes were found in the SAMe and control groups. The apoptotic cell counts were 0.263%±0.041% in the control group, 1.060%±0.217% in the TPN group, and 0.467%±0.182% in the SAMe group. The apoptotic cells were much more in the TPN group than in the control (P<0.01) and SAMe groups (P<0.05).
Conclusions: TPN can cause cholestasis and increase apoptosis of hepatocytes in newborn rabbits. SAMe can prevent TPN-induced cholestasis effectively, and the inhibition of hepatocytic apoptosis may be one of its mechanisms.
Key words: S-adenosylmethionine; total parenteral nutrition; apoptosis; cholestasis; steatosis; newborn World J Pediatr 2007;3(3):218-221 |
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[Abstract] [Full Text] [PDF]
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