Pediatric gastroenteritis in the emergency department: practice evaluation in Belgium, France, The Netherlands and Switzerland.

BACKGROUND: Based on European recommendations of ESPGHAN/ESPID from 2008, first line therapy for dehydration caused by acute gastroenteritis (AGE) is oral rehydration solution (ORS). In case of oral route failure, nasogastric tube enteral rehydration is as efficient as intra-venous rehydration and seems to lead to fewer adverse events. The primary objective was to describe rehydration strategies used in cases of AGE in pediatric emergency departments (PEDs) in Belgium, France, The Netherlands, and Switzerland. METHODS: An electronic survey describing a scenario in which a toddler had moderate dehydration caused by AGE was sent to physicians working in pediatric emergency departments. Analytical data were analyzed with descriptive statistics and Kruskal -Wallis Rank test. RESULTS: We analyzed 68 responses, distributed as follows: Belgium N = 10, France N = 37, The Netherlands N = 7, and Switzerland N = 14. Oral rehydration with ORS was the first line of treatment for 90% of the respondents. In case of first line treatment failure, intravenous rehydration was preferred by 95% of respondents from France, whereas nasogastric route was more likely to be used by those from Belgium (80%), The Netherlands (100%) and Switzerland (86%). Serum electrolyte measurements were more frequently prescribed in France (92%) and Belgium (80%) than in The Netherlands (43%) and Switzerland (29%). Racecadotril was more frequently used in France, and ondansetron was more frequently used in Switzerland. No respondent suggested routine use of antibiotics. CONCLUSION: We found variations in practices in terms of invasiveness and testing. Our study supports the need for further evaluation and implementation strategies of ESPGHAN/ESPID guidelines. We plan to extend the study throughout Europe with support of the Young ESPID Group.

Inter-observer variability in chest radiograph reading for diagnosing acute lung injury in children.

Acute lung injury (ALI), including its most serious form called acute respiratory distress syndrome (ARDS), is a devastating disease that can occur at any age. ALI/ARDS accounts for only 5-8% of admissions to pediatric intensive care units (PICUs) but is fatal in 30-60% of cases. International multicenter prospective studies are needed to better understand pediatric ALI/ARDS. However, a reproducible definition of ALI/ARDS is crucial to ensure that study populations are homogeneous. We designed a retrospective review to test the inter-observer variability of chest radiograph interpretation for presence of the American-European Consensus Conference (AECC) radiographic criterion for ALI/ARDS. The medical files of 24 children ventilated for ALI/ARDS in our PICU between January 1993 and December 2002 were reviewed. Five pediatric radiologists and five pediatric intensivists interpreted one frontal chest radiograph (FCR) per patient taken on the day of ALI/ARDS diagnosis. Each reader indicated whether the radiograph showed the AECC radiographic criterion for ALI/ARDS. Data analysis involved comparing each reader to all the others based on the raw agreement and Kappa coefficient (kappa). Features in the 24 patients were consistent with earlier studies. Global inter-observer agreement beyond chance was fair (kappa = 0.29 +/- 0.02) among the five radiologists (kappa = 0.26 +/- 0.05) and among the five intensivists (kappa = 0.29 +/- 0.05). Thus, considerable inter-observer variability occurred in assessing the radiographic criterion for ALI/ARDS, as previously shown in adults. Given the low incidence of ALI/ARDS in children, this variability may have a large impact in studies of pediatric ALI/ARDS.

[Polycystic ovary syndrome and congenital adrenal hyperplasia: a different entity for comparable phenotypes?]. / Syndrome des ovaires potykystiques et syndrome adrénogenital: une entité différente pour un phenotype comparable?

The phenotypes of the polycystic ovarian syndrome (PCOS) and congenital adrenal hyperplasia syndrome (CAHS) present a number of similarities. The main symptoms of PCOS are obesity, menstrual disorders, hirsutism, and low fertility in which the pituitary and adrenal glands are spared. The CAHS is a group of various entities all characterised by different degrees of malfunction of the 21-hydroxylase (CYP21) enzyme. The consequences are a downfall of the levels of aldosterone and cortisol, and the hyperproduction of adrenal androgen hormones. It is capital to be able to recognise these 2 entities in terms of identification of high risk families because the female foetuses suffering from CAHS will undergo severe virilization of there genitals in utero, which can efficiently be prevented by a administration of corticotherapy to the mother throughout the pregnancy.

Conformational equilibria of 7-benzyl-2-iodo-9-oxa-7-azabicyclo[4.3.0]nonan-8-one in solution. Correlations between conformational distribution and solvent solvatochromic parameters.

A quantitative study of the variation of the conformational equilibria of 7-benzyl-2-iodo-9-oxa-7-azabicyclo[4.3.0]nonan-8-one 1 in 10 solvents has been carried out. The experimental composition in each solvent has been obtained from experimental NMR vicinal H-H coupling constants together with molecular modeling. The solvent properties, particularly polarity and hydrogen bonding ability, were described according to Kamlet and Taft using experimental parameters. Very good linear relationships were obtained between the equilibrium constants of each single conformational equilibrium and the polarity and hydrogen bonding parameters of the solvent. These linear relationships allow an accurate prediction of the conformational composition in any solvent as well as a thorough understanding of the influence of each separate parameter on the conformational equilibrium composition.

Study of the tautomeric equilibrium of pyridoxine in 1,4-dioxane/water mixtures by 13C nuclear magnetic resonance. Thermodynamic characterization and solvent effects.

A significant temperature dependence has been found for the (13)C NMR chemical shifts of pyridoxine in 10%, 20%, 30%, 40%, 50%, and 60% v/v 1,4-dioxane/water mixtures (pH = 7.0). The nuclei most sensitive to the temperature effect were C-3 and C-6 in all of the mixtures. This dependence has been explained on the basis of a thermally induced tautomeric equilibrium shift between the neutral and the dipolar forms of the pyridoxine molecule. The thermodynamic characterization of this tautomeric equilibrium, which interconverts quickly on the NMR time scale, has been achieved by considering the observed average (13)C NMR chemical shifts at different temperatures through fitting the experimental data to a theoretical curve. The fitting accuracy is greatly improved on using linear correlations between the average chemical shifts obtained from different nuclei at the same temperature. The methodology outlined above allows the DeltaH degrees value to be calculated for the tautomeric process and the chemical shifts of the pure extreme forms, i.e., neutral and dipolar, to be deduced. These values have been used to calculate the thermodynamic parameters of the tautomerization equilibrium in each dioxane/water mixture. The effect of solvent on the tautomeric equilibrium and the averaged chemical shift has been explained in terms of a multiparameter equation developed by Kamlet and Taft. The overall solvent effect is the sum of two different effects: the dipolarity and polarizability of the solvent and the ability of the solvent to act as a hydrogen-bond donor toward a solute.