The Prevalence of Pseudomonas Aeruginosa Infection Over a Ten-Year Period in Children with Cystic Fibrosis

Background Pseudomonas aeruginosa (PA) infection is associated with an increased morbidity and adverse prognosis in children with Cystic Fibrosis(CF). The aim of the study was to evaluate the prevalence and characteristics of PA over a ten year period at a single paediatric tertiary referral centre in Ireland. Methods This was a retrospective cross-sectional study. Patient's case notes, microbiology laboratory results and CF Registry of Ireland(CFRI) data were used to collect the data. Results The overall chronic PA infection prevalence was 28.1%(45/160) in 2004 and 21.3%(35/164) in 2014. In 2004, 54/160(33.8%) patients were never infected with PA, 27/160(16.9%) were free for 12 months and 34/160(21.3%) were intermittently infected. In 2014; 80/164(49%) patients, 38/164(23.2%) and 11/164(6.7%) were never infected, free for 12 months and intermittently infected respectively. Conclusion There has been a decline in the overall prevalence of PA infection and a change in the pattern of prevalence over the last decade at our Centre.

Diagnosis and treatment of sleep related breathing disorders in children: 2007 to 2011.

Sleep related breathing disorders (SRBD) have historically been under-recognised and under-treated. Obstructive sleep apnoea (OSA) affects approximately 3% of children. In line with the increased recognition of SRBD there has been an increase in demand for diagnostic services. We determined the awareness of SRBD amongst Irish paediatricians, examined the provision of sleep services to children throughout the country between 2007 and 2011 and audited diagnostic sleep services in a tertiary centre in 2011. Amongst respondents there was an awareness of SRBD but a poor understanding of diagnostic evaluation with 31/46 (67) referring to inappropriate services. There has been a sharp increase in both diagnostic sleep tests (433-1793 [414]) and in the use of non-invasive ventilation (NIV) (31-186 [627]) for treatment of SRBD between 2007 and 2011. Paediatric sleep services are organized in an ad-hoc manner nationally with significant service variation. The use of domiciliary overnight oximetry reduced the requirement for more formal polysomnography by 70%.

Effect of magnetic resonance imaging on microleakage of amalgam restorations: an in vitro study.

OBJECTIVES: The technique of MRI, using powerful magnets, plays an important role in the diagnosis of diseases of the head and neck without any ionizing radiation. Because of the potential hazard imposed by the presence of ferromagnetic metals, patients with implanted metallic objects are excluded from MRI. However, amalgam restorations seem to be safe. The purpose of this study was to evaluate microleakage of amalgam restorations following MRI. METHODS: 63 human freshly extracted premolars were divided into 3 groups based on 3 high-copper amalgams used to restore standard class V preparations on both buccal and lingual surfaces. Three different amalgam materials were used: Cinalux, GS-80 and Vivacap. The teeth were transferred into saline solution for 2 months at room temperature and then sectioned mesiodistally. MRI was randomly applied to one half of each section, and the other half was kept as a control. Following MRI, all specimens were immersed in a dye solution, sectioned and scored for any microleakage using a stereomicroscope. RESULTS: Differences in microleakage within each group following MRI were significant in the GS-80 and Vivacap groups but not in the Cinalux group. However, there was no significant difference between the three groups regarding the microleakage score. CONCLUSIONS: The results of this study suggest that MRI is not a completely safe technique in patients with amalgam restorations. It was shown that the main effect of fields led to the appearance of thermoelectromagnetic convection, which is responsible for the enhancement of the diffusion process, grain boundary migration and vacancy formation resulting in microleakage.

Longitudinal analysis of FEV1 changes related to antibiotic therapy in children with cystic fibrosis.

The measurement of FEV1 in children with cystic fibrosis has been shown to be the most important objective measurement for survival. It has been observed that children receiving intravenous antibiotics usually show a significant improvement in FEV1 with therapy in the short term. We hypothesized that the FEV1 measured pre-antibiotic therapy and followed longitudinally would show a greater rate of decline and may be a better prognostic indicator than the FEV1 post antibiotic therapy. The study cohort consisted of 60 children with cystic fibrosis who attended the St. James' Hospital cystic fibrosis unit between 1993 and 1999. Mixed model regression analysis provided estimates of the average rate of change of the pre-FEV1, post-FEV1 and FEV1 difference in subgroups based on survival, sex and pseudomonas status. There was no significant difference seen in the rate of decline of the FEV1 difference when comparing those who died and those who survived (p = 0.93). This was also the case when males were compared to females (p = 0.09). Both pre-antibiotic FEV1 and post-antibiotic FEV1 measurements showed a significant difference in rate of decline when comparing those who died (FEV1 slope = -6.4, -6.3) to those who survived (FEV1 slope = -1.9, -1.7) [p = 0.001, p = 0.0005] and when males (FEV1 slope = -0.6, -0.03) were compared to females (FEV1 slope = -3.3, -3.5) [p = 0.03, p = 0.002]. Our study demonstrated that there was no additional value in measuring FEV1 pre-antibiotic therapy compared to the FEV1 post antibiotic therapy in improving the sensitivity of FEV1 as a marker of decline. This study confirms that the rate of decline in FEV1 is a strong predictor of mortality and that females in this age group decline faster than their male counterparts.

Does carbon dioxide retention during exercise predict a more rapid decline in FEV1 in cystic fibrosis?

BACKGROUND: Carbon dioxide (CO2) retention during exercise is uncommon in mild to moderate lung disease in cystic fibrosis (CF). The ability to deal with increased CO2 is dependent on the degree of airflow limitation and inherent CO2 sensitivity. CO2 retention (CO2R) can be defined as a rise in P(ET)CO2 tension of > or =5 mm Hg with exercise together with a failure to reduce P(ET)CO2 tension after peak work by at least 3 mm Hg by the termination of exercise. AIM: To ascertain if carbon dioxide retention during exercise is associated with more rapid decline in lung function. METHODS: Annual spirometric and exercise data from 58 children aged 11-15 years, with moderate CF lung disease between 1996 and 2002 were analysed. RESULTS: The mean FEV1 at baseline for the two groups was similar; the CO2R group (n = 15) was 62% and the non-CO2 retention group (CO2NR) was 64% (n = 43). The decline in FEV1 after 12 months was -3.2% (SD 1.1) in the CO2R group and -2.3% (SD 0.9) in the CO2NR group. The decline after 24 months was -6.3% (SD 1.3) and -1.8% (SD 1.1) respectively. After 36 months, the decline in FEV1 was -5.3% (SD 1.2) and -2.6% (SD 1.1) respectively. The overall decline in lung function was 14.8% (SD 2.1) in the CO2R group and 6.7% (SD 1.8) in the CO2NR group. Using the primary outcome measure as a decline in FEV(1) of >9%, final multivariate analysis showed that the relative risks for this model were (95% CIs in parentheses): DeltaP(ET)CO2 11.61 (3.41 to 24.12), peak VO2 1.23 (1.10 to 1.43), and initial FEV(1) 1.14 (1.02 to 1.28). CONCLUSION: Results show that the inability to defend carbon dioxide during exercise is associated with a more rapid decline in lung function.

The meniscofemoral ligaments of the knee.

The meniscofemoral ligaments (MFL) of the knee have both functional and clinical importance, but have been poorly described. We examined 42 human cadaver knees: there was at least one MFL in every joint and both ligaments were present in 27. The anterior MFL was present in the knees in all 18 males and in 17 of the 24 females. The posterior MFL was present in 16 males and 22 females. Measurement of the ligaments showed that they were of significant size. The mean midpoint width for the anterior MFL was 5.09 +/- 1.41 mm in males and 2.99 +/- 1.29 mm in females. The mean width of the posterior MFL was 5.48 +/- 2.13 mm in males and 3.79 +/- 2.56 mm in females. The average length of the anterior MFL was 27.09 +/- 2.15 mm in males and 24.38 +/- 3.39 mm in females, and the posterior MFL was 31.13 +/- 2.54 mm and 27.59 +/- 3.74 mm, respectively. There were anatomical variations in 16 (38%) knees (62.5% female, 37.5% male), more commonly in the posterior ligament. We conclude that the meniscofemoral ligaments are anatomically and probably functionally important structures in the human knee.