A simple intervention improves the recording of vital signs in children presenting to the emergency department.

OBJECTIVES: Vital signs are often not documented in paediatric patients at triage. This study was conducted to find out whether the use of a small, laminated aide memoire and a short teaching session might improve this situation. METHODS: A preliminary audit of the measurement of vital signs in 106 children aged less than 6 years was carried out in a district general hospital emergency department (ED). A small card illustrating normal values for these was then distributed-this could be attached to staff identity cards. At the same time doctors and nursing staff were given a teaching session on the importance of these measures. The audit was then repeated in a further 106 children. RESULTS: There was significant improvement in recording of all vital signs with the exception of blood pressure and temperature. CONCLUSION: A low-cost card together with a short period of training offers a useful strategy to improve the rate of documentation of vital signs in children presenting to the ED.

Age assessment: time for progress?

Care provided to unaccompanied asylum seeking minors in Britain is currently compromised by the issue of age assessment. Existing guidelines are rarely followed leading to striking defects in the protection for a high risk group of children and adolescents.

Effect of lamivudine on human T-cell leukemia virus type 1 (HTLV-1) DNA copy number, T-cell phenotype, and anti-tax cytotoxic T-cell frequency in patients with HTLV-1-associated myelopathy.

Patients with human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) typically have a high HTLV-1 proviral load in peripheral blood mononuclear cells and abundant, activated HTLV-1-specific cytotoxic T lymphocytes (CTLs). No effective treatment for HAM/TSP has been described so far. We report a 10-fold reduction in viral DNA for five patients with HAM/TSP during treatment with the reverse transcriptase inhibitor lamivudine. In one patient with recent-onset HAM/TSP, the reduction in viral DNA was associated with a fall in the frequency of CTLs specific to two peptides in the immunodominant viral antigen Tax. The half-life of peripheral blood mononuclear cell populations was estimated from changes in viral DNA copy number, CTL frequency, reduction in CD25 expression, and the loss of dicentric chromosomes following radiation-induced damage. Each of these four different techniques indicated a cellular half-life of approximately 3 days consistent with continuous lymphocyte replication and destruction. These results indicate that viral replication through reverse transcription significantly contributes to the maintenance of HTLV-1 viral DNA load. The relative contribution of proliferation versus replication may vary between infected people.

Physiological secretion of chemokines in human breast milk.

Human breast milk has been observed to contain high concentrations of the chemotactic cytokines (chemokines) interleukin-8 (IL-8) and RANTES. Concentrations are greatest in colostrum, but are measurable in milk after several months of lactation. These chemokines are also found in the secretions of patients with galactorrhoea and in the "witch's milk" of the newborn. Chemokine levels show good correlation with the sodium levels but not with cell counts or the creamatocrit of the secreted milk. Mothers with pre-term deliveries show no statistical difference in chemokine secretion in comparison with those with term deliveries. Immunohistochemisty demonstrates IL-8 and RANTES immunoreactivity in the acinary epithelial cells of normal mammary tissue and IL-8 and RANTES were shown to be produced by cultured, human mammary epithelial cells (HMEC) after stimulation with different cytokines. These results suggest that mammary epithelial cells are the source of chemokines in human milk and that the recruitment of leukocytes in human milk is likely to be chemokine-driven.

The clinical significance of T-cell superantigens.

Superantigens are a diverse collection of molecules that share the ability to activate specific lymphocyte subsets. In animal models, many of these molecules delete T-cell populations or render them anergic. The clinical impact of superantigens is significant, but much of their pathophysiology remains unclear.