[Nutritional status of adolescents from a cohort of preterm children]. / Estado nutricional de adolescentes pertenecientes a una cohorte de niños nacidos prematuros.

INTRODUCTION: Catch-up growth in preterm-born children occurs in the first months of life, but in some cases, growth recovery takes place in adolescence. The objective of this study was to study the growth and development of preterm-born adolescents from a cohort of preterm infants born between 1995 and 1996, who resided in the cities of Chillán and San Carlos in the Biobío Region, Chile. The results were then compared with term-born adolescents. SUBJECTS AND METHOD: A sample of 91 children from the cohort was studied and compared with 91 term-born adolescents matched for gender, age, and attendance at the same educational institution. The nutritional status was assessed by BMI-for-age, height-for-age, body composition by skinfold, cardiovascular risk due to blood pressure, and waist circumference. RESULTS: There was 23.0% and 24.1% overweight and obesity in preterm-born and term-born adolescents, respectively, with 25.5% of preterm-born and small for gestational age adolescents vs. 14.5% of those born adequate for gestational age were overweight. Lower height was observed in 16.5% and 5.5% of the preterm-born and term-born adolescents, respectively, and with a higher proportion of girls (P<.04). Preterm-born adolescents had a more fat mass than the controls, particularly in the suprailiac skinfold. No significant differences were found in blood pressure and waist circumference. CONCLUSIONS: The results indicate that there is a group of preterm-born children who do not recover height during adolescence, especially girls.

Virus-encoded cyclin.

Herpesvirus saimiri contains an open reading frame called eclf2 with homology to the cellular type D cyclins. We now show that the eclf2 gene product is a novel virus-encoded cyclin (v-cyclin). The protein encoded by the v-cyclin gene of this oncogenic herpesvirus was found to have an apparent molecular size of 29 kDa in transformed cells. v-Cyclin protein was found to be associated with cdk6, a cellular cyclin-dependent kinase known to interact with cellular type D cyclins. cdk6/v-cyclin complexes strongly phosphorylated Rb fusion protein and histone H1 as substrates in vitro. Mutational analyses showed that highly conserved amino acids in the cyclin box of v-cyclin were important for association with cdk6 and for activation of cdk6 kinase activity. Thus, v-cyclin resembles cellular type D cyclins in primary sequence, in its association with cdk6, by its ability to activate protein kinase activity, and by the presence of functional cyclin box sequences. v-Cyclin exhibited a selective preference for association with cdk6 over other cyclin-dependent kinases and a high level of kinase activation. The properties of v-cyclin suggest a likely role in oncogenic transformation by this T-lymphotropic herpesvirus.

Marked suppression of ventilation while awake following massive ingestion of atenolol.

We describe a patient who ingested 5 g of atenolol with ethanol. After awakening, with repeat toxicology screen only showing atenolol, and in spite of normal voluntary breathing mechanics, he had marked suppression of his spontaneous respirations as measured by minute ventilation and by occlusion pressure with no incremental response to hypercapnic challenge. Subsequently, he recovered. Although we are unable to prove a causal relationship, future patients with atenolol overdose should be observed carefully for ventilatory failure, even if fully conscious.

Research articles published in the Journal of Adolescent Health: a two-decade comparison.

PURPOSE: To examine changes in subject contents and study designs of research articles published in the Journal of Adolescent Health since its inception. METHODS: A retrospective review of all research articles was conducted from selected years, ranging from 1980 through 1998. The study sample was composed of the following: original articles, case reports, brief scientific reports, international articles, fellowship forum, and health briefs. RESULTS: A total of 582 articles were evaluated. The total percentage of medical topics in research articles published in the Journal decreased from 61% in 1980-1981 to 38% in 1997-1998 (p <.01). This finding was in contrast to topics related to psychosocial issues, which increased from 23% to 50% (p <.01) over the same period. This change was largely accounted for by studies focusing on high-risk behavior. Retrospective designs, including case reports/series and chart reviews, decreased from 25% of all research articles in 1980-1981 to 9% in 1997-1998 (p <.01). The percentage of observational studies, i.e., those using cross-sectional and longitudinal designs, increased from 62% to 79% over the same period (p <.01). No changes were observed in the percentage of experimental designs, never exceeding >5% of total study designs. Finally, over the 20 years, professional background and academic departments of first authors of research broadened, with increasing contributions from nonphysicians and from non-pediatric disciplines such as psychology, public health, and nutrition. CONCLUSION: A shift in subject content of research articles from medical to psychosocial topics was observed over the past 2 decades. A shift in research designs from retrospective to cross-sectional and longitudinal was observed over the same period. The pool of authors has diversified.

Management of clinical side effects of DMPA.

This edition of Tips for Clinicans tackles a common patient complaint: side effects of depot medroxyprogesterone acetate (DMPA). If perception is reality, patient compliance can be greatly enhanced by addressing perception of DMPA side effects proactively. As clinicians, we can educate teens on actual as well as perceived side effects, anticipating problems and providing solutions when problems arise. Doctors Stager and Cromer provide a nice review of what to expect from DMPA and how to help.

[Thromboxane A2 and granulocyte elastase after severe trauma--relationship to complications and survival rates]. / Thromboxan-A2 und Granulozyten-Elastase nach schwerem Trauma--Beziehungen zu Verlaufskomplikationen und Uberlebensraten.

Of 64 polytraumatized patients with a mean injury severity score of 33.1, 42 showed marked systemic release of thromboxane B2 and granulocyte elastase during the initial 18 hours after trauma, reaching peak arterial levels of greater than 1,000 pg/ml and ng/ml, respectively. If those patients ("responders": plasma TXB2 greater than 250 pg/ml) were compared with the remaining 22 ("non-responders": TXB2 less than 250 pg/ml) the following became obvious: "Late" mortality (greater than 3 d) was 31% in responders, which is significantly higher than in non-responders (9%). No correlation was observed between "early" mortality (less than 3 d) and mediator release. There was no difference in the incidence of the adult respiratory distress syndrome (ARDS) (38% versus 32%) or the late sepsis syndrome (17% versus 18%) between responders and non-responders. Morbidity, however, differed markedly in that ARDS in responders was associated with significantly higher elastase levels, a higher mortality and 10 times higher incidence of sepsis as compared to responders without ARDS. ARDS in non-responders, by contrast, did not change elastase maxima or the mortality rate as compared to non-responders without ARDS. It is concluded that TXB2 is not a predictor of posttraumatic ARDS, but is related to a complicated course, in particular to sepsis and mortality. Elastase with high probability predicts ARDS and/or the late sepsis syndrome. Simultaneous determination of TXB2 further enhances the predictive value of elastase.

Estado nutricional de adolescentes pertenecientes a una cohorte de niños nacidos prematuros / Nutritional status of adolescents from a cohort of preterm children

Introducción: La recuperación del crecimiento de los niños prematuros se presenta en los primeros meses de vida y se termina en la adolescencia. El objetivo de este trabajo fue estudiar el crecimiento y desarrollo de una cohorte de adolescentes nacidos prematuros (1995-1996), en las ciudades de Chillán y San Carlos, Región del Biobío, Chile. Sujetos y método: Para el estudio se logró reclutar a 91 adolescentes de la cohorte original, lo que corresponde al 54%, y se incluyeron 91 controles adolescentes nacidos de término (ANT). Se evaluó el estado nutricional por índice de masa corporal para la edad y talla para la edad; composición corporal a través de pliegues cutáneos, riesgo cardiovascular por la presión arterial y circunferencia de cintura. Resultados: El 23,0% de adolescentes nacidos prematuros y el 24,1% de ANT tenía malnutrición por exceso, el 25,5% de los prematuros pequeños para la edad gestacional se encontraban con exceso de peso y el 14,5% de los adecuados para la edad gestacional. Presentaron talla baja un 16,5% de los adolescentes nacidos prematuros versus 5,5% de los ANT, encontrándose mayor proporción en mujeres (p < 0,04). Los adolescentes nacidos prematuros tenían más masa grasa que sus controles, en especial en el pliegue suprailíaco. No hubo diferencias significativas en la presión arterial ni en la circunferencia de cintura. Conclusiones: Los resultados indican que existe un grupo de adolescentes nacidos prematuros que no recupera la talla en la adolescencia, especialmente en las mujeres.

Introduction: Catch-up growth in preterm-born children occurs in the first months of life, but in some cases, growth recovery takes place in adolescence. The objective of this study was to study the growth and development of preterm-born adolescents from a cohort of preterm infants born between 1995 and 1996, who resided in the cities of Chillán and San Carlos in the Biobío Region, Chile. The results were then compared with term-born adolescents. Subjects and method: A sample of 91 children from the cohort was studied and compared with 91 term-born adolescents matched for gender, age, and attendance at the same educational institution. The nutritional status was assessed by BMI-for-age, height-for-age, body composition by skinfold, cardiovascular risk due to blood pressure, and waist circumference. Results: There was 23.0% and 24.1% overweight and obesity in preterm-born and term-born adolescents, respectively, with 25.5% of preterm-born and small for gestational age adolescents vs. 14.5% of those born adequate for gestational age were overweight. Lower height was observed in 16.5% and 5.5% of the preterm-born and term-born adolescents, respectively, and with a higher proportion of girls (P < .04). Preterm-born adolescents had a more fat mass than the controls, particularly in the suprailiac skinfold. No significant differences were found in blood pressure and waist circumference. Conclusions: The results indicate that there is a group of preterm-born children who do not recover height during adolescence, especially girls.

Inadequate vitamin D status in adolescents with substantial bone mineral density loss during the use of depot medroxyprogesterone acetate injectable contraceptive: a pilot study.

STUDY OBJECTIVE: To examine vitamin D and parathormone (PTH) levels in adolescents who experienced substantial bone mineral density (BMD) loss during depot medroxyprogesterone acetate (DMPA) use. DESIGN: A non-randomized, multi-center study, during which DMPA was administered every 12 weeks and evaluation of lumbar spine and hip BMD by dual-energy X-ray absorptiometry (DXA) was conducted every 6 months. A blood sample for vitamin D and PTH measurements was obtained from adolescents who experienced >5% BMD loss. Vitamin D deficiency was defined as 25-hydroxyvitamin D (25OHD) level of <20 ng/mL, insufficiency as 25OHD level of 20-30 ng/mL, and sufficiency as 25OHD level of >30 ng/mL. RESULTS: Evaluation of vitamin D and PTH was carried out in 15 participants who experienced BMD loss of > or = 5% during DMPA use. At initiation of DMPA, participants had mean (+SE) age 17+1 years, gynecologic age 61+4 months, and body mass index 24+1.5 kg/m2. Racial/ethnic distribution was: Caucasian--7 girls, Hispanic--4 girls, African-American--3 girls, and other--1 girl. Six participants had BMD loss of >5% after 2 DMPA injections, five after 3 injections, one after 5 injections, one after 8 injections, one after 10 injections, and one after 13 injections. Only one girl (7%) had sufficient vitamin D. The other participants had vitamin D insufficiency (50%) or deficiency (43%). Participants' mean (+SE) PTH was 22+4 pg/mL (reference range 7-53 pg/mL), and mean (+SE) 1,25-dihydroxyvitamin D was 56+5 pg/mL (reference range 22-67 pg/mL). CONCLUSIONS: Inadequate vitamin D status was evident among the majority of female adolescents who experienced a substantial BMD loss while using DMPA.

Causes of mortality in patients with the adult respiratory distress syndrome.

This study analyzed the factors causing and contributing to death in patients with the adult respiratory distress syndrome (ARDS). Two hundred seven patients were prospectively identified as being at risk for development of ARDS. Forty-seven patients developed ARDS, and the remaining 160 patients were used as a comparison control group. The severity of dysfunction in 8 organ systems and the presence of sepsis syndrome were determined by chart review after discharge or death. Sepsis syndrome was specifically defined by signs and laboratory tests reflecting infection or inflammation plus evidence of a deleterious systemic effect (hypotension, reduced systemic vascular resistance, or unexplained metabolic acidosis). Mortality was 68% in the ARDS group compared to 34% in the control group (p less than 0.005). Only 16% (5 of 32) of deaths in the ARDS group were from irreversible respiratory failure. Most deaths in the first 3 days after entry into the study could be attributed to the underlying illness or injury. The majority of late deaths were related to sepsis syndrome. Of the 22 patients with ARDS who died after 3 days, 16 (73%) met our criteria for sepsis syndrome. There was a sixfold increase in sepsis syndrome after ARDS compared with that in the control group (p less than 0.001). When sepsis syndrome preceded the ARDS, the abdomen was the predominant source, but when sepsis syndrome occurred after the onset of ARDS there was usually a pulmonary source. Our findings indicate that sepsis syndrome, rather than respiratory failure, is the leading cause of death in patients with ARDS.

Early prediction of the adult respiratory distress syndrome by a simple scoring method.

Early identification of patients who will develop the adult respiratory distress syndrome (ARDS) is important in prognosis, management, and candidate selection for studies that evaluate both pathophysiology and early therapy. The purpose of this study was to improve the accuracy of early prediction of ARDS by using a simple scoring method that combines the weighted risks from individual risk factors. By a discriminant function analysis of 136 patients with one or more clinical conditions predisposing to risk of ARDS, simple linear equations were derived in which several different risk factors, weighted by coefficients, served as the variables. We developed several equations from which individual "ARDS scores" could be calculated, and we found retrospectively that half the 46 patients who had developed ARDS scored higher than a particular "index score," while about 90% of the patients who never developed ARDS scored less than that index despite the presence of significant risk factors. We then prospectively tested these equations in 87 other patients and found similar results. In summary, a simple clinical scoring system which can be used soon after admission can identify, with reasonable accuracy, individual patients who are almost assured of developing ARDS.