Prevalence of Helicobacter pylori Infection in Children in The Bahamas / Prevalencia de la Infección por Helicobacter pylori en los Niños en La Bahamas

OBJECTIVE: Helicobacter pylori (H pylori) is a common bacterial infection that is associated with significant morbidity and mortality worldwide. This bacterium causes a chronic infection that is causally related to illnesses ranging from gastritis, peptic ulcer disease to gastric cancer. It is generally considered that it is acquired in childhood but the prevalence varies considerably between countries and communities. There are few data on the prevalence of H pylori in the Caribbean and none on the prevalence of H pylori in children in the Bahamas. The aim of this pilot study was to determine the prevalence of H pylori infection in a cohort of school children in the Bahamas. METHODS: One hundred and sixty-one children attending a public primary school in the Bahamas were invited to participate in this study. Consent was obtained for 107 children and each participant completed a brief questionnaire. Valid data were available for 96 of these children. Active H pylori infection was determined using the 13C urea breath test (UBT). RESULTS: Fifty-two children tested positive for H pylori, yielding a prevalence of 54.2%. The median age in the study was nine years with 46.9% male and 53.1% female. No significant relationship was found between gender, breastfeeding, pets and H pylori status. CONCLUSION: The prevalence reported in this study is the highest reported in asymptomatic children in the Caribbean. Further studies are required to determine risk factors for acquisition of H pylori infection in this population.

OBJETIVO: Helicobacter pylori (H pylori) es la causa de una infección bacteriana común a nivel mundial, asociada con una morbosidad y mortalidad significativas. Esta bacteria causa una infección crónica que se haya causalmente relacionada con un número de enfermedades que van desde la gastritis y la úlcera péptica hasta el cáncer gástrico. Generalmente se considera que es adquirida en la niñez, pero la prevalencia varía considerablemente entre los países y comunidades. Hay pocos datos con relación a la prevalencia de H pylori en el Caribe, y no existe ningún dato sobre la prevalencia de H pylori en los niños de Bahamas. El objetivo de este estudio piloto fue determinar la prevalencia de la infección por H. pylori en una cohorte de niños escolares en la Bahamas. MÉTODOS: Ciento sesenta y un niños que asistían a una escuela primaria pública en Bahamas, fueron invitados a participar en este estudio. Se obtuvo consentimiento para 107 niños, y cada participante respondió a una breve encuesta. Había datos válidos disponibles para 96 de estos niños. La infección activa por H pylori fue determinada usando la prueba de aliento con urea-13C (UBT). RESULTADOS: Cincuenta y dos niños resultaron positivos a la prueba de H pylori, para una prevalencia de 54.2%. La edad promedio de la población en estudio fue de nueve años, con un 46.9% de varones y un 53.1% de hembras. No se halló ninguna relación significativa entre el género, la lactancia materna, las mascotas, y la condición del H pylori. CONCLUSIÓN: La prevalencia reportada en este estudio es la más alta que se haya reportado en niños asintomáticos en el Caribe. Se requieren estudios ulteriores a fin de determinar los factores de riesgo que conducen a la infección por H pylori en esta población.

Duplication of the inferior vena cava: case report and a literaturereview of anatomical variation

Anatomical variation in the inferior vena cava can result in misdiagnosis, making a better understanding of suchvariations crucial. Here we report the case of a 29 year-old male, victim of multiple trauma, who in the courseof treatment presented with a pulmonary thromboembolism confirmed by tomography. Given the gravityof the situation and the need for additional surgeries, a decision was made to implant an inferior vena cavafilter. During phlebography, prior to implantation of the filter, the duplication of the vena cava was detectedand classified as a complete duplication. A review of the literature revealed various anatomical descriptions ofduplicated inferior vena cava, the most common of which were incomplete cases showing greater variationin venous contion. All in vivo anatomical descriptions were done via phlebography, demonstrating the valueof this test for the diagnosis of anatomical variation in the abdominal veins. While duplication of the inferiorvena cava was not the cause of the venous thrombosis in our patient, a detailed phlebography test was neededto both identify the anatomical variation and facilitate the placement of the filter to prevent a new pulmonarythromboembolism.

Prevalence of Helicobacter pylori infection in children in the Bahamas.

OBJECTIVE: Helicobacter pylori (H pylori) is a common bacterial infection that is associated with significant morbidity and mortality worldwide. This bacterium causes a chronic infection that is causally related to illnesses ranging from gastritis, peptic ulcer disease to gastric cancer. It is generally considered that it is acquired in childhood but the prevalence varies considerably between countries and communities. There are few data on the prevalence of H pylori in the Caribbean and none on the prevalence of H pylori in children in the Bahamas. The aim of this pilot study was to determine the prevalence of H pylori infection in a cohort of school children in the Bahamas. METHODS: One hundred and sixty-one children attending a public primary school in the Bahamas were invited to participate in this study. Consent was obtained for 107 children and each participant completed a brief questionnaire. Valid data were available for 96 of these children. Active H pylori infection was determined using the 13C urea breath test (UBT). RESULTS: Fifty-two children tested positive for H pylori, yielding a prevalence of 54.2%. The median age in the study was nine years with 46.9% male and 53.1% female. No significant relationship was found between gender breastfeeding, pets and H pylori status. CONCLUSION: The prevalence reported in this study is the highest reported in asymptomatic children in the Caribbean. Further studies are required to determine risk factors for acquisition of H pylori infection in this population.

Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis.

OBJECTIVE: To determine the clinical consequences of acquiring Pseudomonas aeruginosa infection during early childhood in children with cystic fibrosis (CF). DESIGN: Prospective, observational cohort study of 56 children with CF identified by newborn screening during 1990-92. Each child underwent an annual bronchial lavage during the first 2 to 3 years of life. Clinical outcome was determined at 7 years of age. RESULTS: P aeruginosa infection was diagnosed in 24 (43%) cohort subjects. Four children died before 7 years of age, all of whom had been infected with a multi-resistant, mucoid strain of P aeruginosa (P =.04). In survivors, P aeruginosa infection was associated with significantly increased morbidity as measured by lower National Institutes of Health scores, greater variability in lung function, increased time in the hospital, and higher rates of recombinant human deoxyribonuclease therapy (P <.01). In this young CF cohort, best forced expiratory volume in 1 second was an insensitive measure of increased morbidity. CONCLUSIONS: Acquisition of P aeruginosa was common by 7 years of age in this CF birth cohort and was associated with increased morbidity and mortality. An improved disease severity score would improve the evaluation and study of early CF lung disease.

Diabetes-related lower-extremity amputations disproportionately affect Blacks and Mexican Americans.

BACKGROUND: We sought to identify the age-adjusted incidence of lower-extremity amputation (LEA) in Mexican Americans, blacks, and non-Hispanic whites with diabetes in south Texas. METHODS: We summarized medical records for hospitalizations for LEAs for 1993 in six metropolitan statistical areas in south Texas. RESULTS: Age-adjusted incidence per 10,000 patients with diabetes was 146.59 in blacks, 60.68 in non-Hispanic whites, and 94.08 in Mexican Americans. Of the patients, 47% of amputees had a history of amputation, and 17.7% were hospitalized more than once during 1993. Mexican Americans had more diabetes-related amputations (85.9%) than blacks (74.7%) or non-Hispanic whites (56.3%). CONCLUSIONS: This study is the first to identify the incidence of diabetes-related lower-extremity amputations in minorities using primary data. Minorities had both a higher incidence and proportion of diabetes-related, LEAs compared with non-Hispanic whites. Public health initiatives and national strategies, such as Healthy People 2000 and 2010, need to specifically focus on high-risk populations and high-risk geographic areas to decrease the frequency of amputation and reamputation.

Peroxisomal disorders in children: immunohistochemistry and neuropathology.

Immunohistochemical studies with antisera against four peroxisomal enzymes, catalase and beta-oxidation enzymes (acyl-coenzyme A oxidase, bifunctional protein, and 3-ketoacyl-CoA thiolase), were performed on brain, liver, and kidney specimens from patients with peroxisomal disorders, as well as specimens from three control subjects, by using conventional paraffin-embedded autopsy material. The patients included eight with Zellweger syndrome and one with neonatal adrenoleukodystrophy. In the liver and kidney specimens from all patients, except one with Zellweger syndrome, diffuse immunostaining with all antisera in the cytoplasm of hepatocytes and renal tubular epithelium suggested an absence of peroxisomes but the presence of peroxisomal enzymes. Examination of brain specimens indicated a weak or negative reaction of neurons in the cerebral cortex and a weak reaction of glial cells in the white matter, which suggested maturational delay compared with control subjects. The delayed immunoreactive pattern of peroxisomal enzymes in Zellweger syndrome and neonatal adrenoleukodystrophy may be related to the significant neuropathologic features of polymicrogyria and dysmyelinogenesis. One patient with Zellweger syndrome had a unique finding of a positive granular catalase reaction and a negative reaction with antisera to 3-ketoacyl-coenzyme A thiolase, which suggested a diagnosis of pseudo-Zellweger syndrome. This study validates the application of these immunohistochemical methods to the study of peroxisomal enzymes. Use of these methods improves the accuracy of diagnosis of peroxisomal disorders.

Disseminated Nocardia brasiliensis infection with septic arthritis.

An unusual case of disseminated Nocardia brasiliensis infection is presented. The patient, who had been receiving chronic dexamethasone therapy for 4 years, had pneumonia and septic arthritis of the left knee due to N. brasiliensis. To our knowledge, this is the first report from the United States of a synovial joint infection with this organism. Disseminated disease due to N. brasiliensis is infrequently reported; it is most often seen in the immunocompromised patient and is often unresponsive to therapy.

Investigation of complications of paranasal sinusitis in children - abstract

The on-going study in patients requiring hospitalization for paranasal sinusitis investigates the extent and spread of the infection on admission. Children with paranasal sinusitis are admitted to hospital if they develop fever, proptosis, ophthal moplegia, eyelids swollen shunt, or decrease in consciousness level. They undergo CT scanning on admission, to determine the involvement of other craniofacial compartments. Complications of paranasal sinusitis arise with breach of the sinus walls and spread to the orbit or intracranial space. Orbital sinusitis or abscess formation may follow, while intracraniallym empyema and brain abscess may arise. These complications are readily recognised by CT examination. The use of computerised tomography in the early investigation of spread of paranasal sinusitis affords effective decision-making for appropriate medical and surgical management of this potentially dangerous infection (AU)

Severe cardiopathy in branching enzyme deficiency.

A 7 1/2-year-old girl had exercise intolerance and exertional dyspnea. Four months later, congestive heart failure developed, with recurrent chylous pleural effusions, and she died at age 8 1/2 years. Endomyocardial biopsy tissue showed abundant PAS-positive, diastase-resistant cytoplasmic deposits. Similar inclusions were seen in muscle, skin, and liver specimens. Postmortem studies showed that the abnormal polysaccharide was especially abundant in heart and muscle, but was also present in all other tissues, including the central nervous system. Glycogen isolated from heart, muscle, and spinal cord showed a shift of the iodine spectrum toward higher than normal wavelengths. Branching enzyme activity was lacking in the muscle biopsy specimen and in all postmortem tissues; glycogenolytic enzymes had normal activities. These studies show that cardiomyopathy can be the first symptom of generalized branching enzyme deficiency and that the degree of accumulation of the abnormal polysaccharide may vary in different tissues.

Moderate, rapidly induced hypertension as a cause of intraventricular hemorrhage in the newborn beagle model.

Nine anesthetized, artificially ventilated, term newborn beagle puppies were given phenylephrine hydrochloride intravenously while systemic arterial, carotid arterial, and jugular venous blood pressures, and carotid arterial blood flow were monitored. Systemic blood pressure rose within seconds from a mean of 53.68 +/- 1.10 mm Hg to a mean of 81.92 +/- 5.14 mm Hg. Hypertension was maintained for up to one hour in each animal. Four of the nine pups had intraventricular hemorrhages that were visible to gross inspection at autopsy, and seven of the nine pups had subependymal hemorrhages. The blood pressures produced in these animals were within the range of those seen in premature infants. Thus, moderate, rapidly induced systemic hypertension may be a cause of intraventricular hemorrhage in the premature human newborn infant.

Peripheral median nerve damage secondary to brachial arterial blood gas sampling.

Examination at 18 months post-term of 139 infants of birth weight less than or equal to 1,500 gm revealed 18 instances (13%) of persistent median nerve damage. All affected infants had received frequent percutaneous brachial artery punctures as neonates. Block sections of the cubital fossa done at autopsy on 12 randomly selected very low-birth-weight infants showed perineural hemorrhage, and Wallerian degeneration or traumatic neuroma of the median nerve in eight patients. It is recommended that brachial artery punctures be avoided whenever possible in the neonatal period.

Brain biopsies for neurodegenerative disease in children.

Brain biopsies for neurodegenerative disease performed at The Hospital for Sick Children, Toronto, over a 12-year period (1964 to 1976) were reviewed. Of 64 biopsies, major histologic abnormalities with diagnostic or prognostic significance comprised 39% of the total cases, minor abnormalities represented 13%, and 48% appeared normal. The procedure failed to provide prognostic assistance in 41%. With the advent for newer diagnostic techniques (enzyme assays and muscle, skin, peripheral nerve, rectal, and appendix biopsies) for neurodegenerative disease in childhood, a much lower yield is noted (15 to 20%). Only two progressive degenerative childhood conditions remain in which cerebral tissue is necessary for diagnosis--Alexander disease and Canavan spongy degeneration.

Imported mucocutaneous leishmaniasis in New York City. Report of a patient treated with amphotericin B.

A case of mococutaneous leishmaniasis in a patient referred to Memorial Sloan-Kettering Cancer Center, New York, with a presumptive diagnosis of lethal mid-line granuloma is described. The patient had lived in Bolivia and had been treated with antimony during and after which his mucosal lesions progressed. These lesions completely healed with 971 mg of amphotericin B. Mucocutaneous leishmaniasis is endemic in many areas of Central and South America and may occur in patients in the United States who have lived in or traveled to these areas. Organisms may be difficult to identify, and multiple biopsies and cultures may be necessary. The use of amphotericin B for the treatment of leishmaniasis is reviewed. It is an effective alternative to antimony therapy, and in some cases resistant to antimony, it may be the drug of choice.

Anti-Pseudomonas heat-stable opsonins in acute lymphoblastic leukemia of childhood.

Heat-stable opsonic activity against Pseudomonas aeruginosa and Staphylococcus epidermidis was measured in sera of 33 children with acute lymphoblastic leukemia at selected times during treatment of their disease. Compared to adults, opsonization of P. aeruginosa was normal in children tested at the time of diagnosis and before chemotherapy. Immediately after achievement of remission, opsonic activity against Pseudomonas was significantly decreased (P smaller than 0.05) compared with pretreatment activity. Activity usually returned to normal and remained so during long-term remission maintenance therapy. In children studied just prior to death from unremitting leukemia, however, anti-Pseudomonas opsonic activity was significantly decreased when compared with that of a group of children before any leukemic treatment (p smaller than 0.005). Anti-S. EPIDERMIDIS OPSONIC ACTIVITY SHOWED NO CHANGES DURING THE PATIENT'S COURSE. Decreased serum opsonic activity may significantly contribute to the increased incidence of severe Pseudomonas infections in patients with acute lymphoblastic leukemia.