Medium- or Higher-Dose Acetylsalicylic Acid for Acute Kawasaki Disease and Patient Outcomes.

OBJECTIVE: To investigate the effect of medium- or higher-dose acetylsalicylic acid (ASA) for treating acute-phase Kawasaki disease to prevent coronary artery aneurysm (CAA). STUDY DESIGN: Among the children with acute Kawasaki disease investigated in the eighth nationwide survey in the Republic of Korea, 8456 children with adequate data were included in this study. The subjects were divided into 2 groups according to the use of medium- or higher-dose ASA (≥30 mg/kg/day), or-low dose ASA (3-5 mg/kg/day) during the acute febrile phase. Both z- score-based criteria and Japanese criteria for CAA were used. RESULTS: The prevalence of CAA based on z-score (24.8% vs 18.3%; P = .001) and on the Japanese criteria (19.0% vs 10.4%; P < .001) was higher in the 7947 patients who received medium- or higher-dose ASA compared with the 509 patients who received low-dose ASA. The use of medium- or higher-dose ASA was a significant predictor of CAA based on both sets of criteria by univariate analysis (based on z-score: OR, 1.472, 95% CI, 1.169-1.854, P = .001; based on Japanese criteria: OR, 2.013, 95% CI, 1.507-2.690, P < .001) and multivariate logistic regression analysis (OR, 1.527, 95% CI, 1.166-2.0, P = .003 and OR, 2.198, 95% CI, 1.563-3.092, P < .001, respectively). CONCLUSIONS: The use of medium- or higher-dose ASA in acute Kawasaki disease did not prevent CAA. A future randomized controlled trial is needed to determine the optimum dose of ASA.

Perivascular brightness of coronary arteries in Kawasaki disease.

OBJECTIVE: Because perivascular echo brightness (PEB) of coronary arteries has been proposed as a criterion for diagnosis of incomplete Kawasaki disease, we assessed the clinical importance of PEB during the acute phase of disease. STUDY DESIGN: We enrolled 58 patients with Kawasaki disease who underwent two-dimensional strain analysis of images of pericoronary tissue taken during the acute and the convalescent phases. Echogenicity of pericoronary tissue and of the blood pool was determined by speckle tracking in the respective areas of imaging as the averages of integrated backscatter over a single cardiac cycle. PEB was defined as echogenicity of pericoronary tissue minus blood pool. RESULTS: PEB did not differ in the acute phase in patients and control subjects (P = .10) and between phases of disease (P = .25). In comparison between patient groups, the presence of pericardial effusion was higher in patients with higher PEB during the acute phase (n = 30) than in the remaining patients (33% versus 4%, P < .01). CONCLUSIONS: PEB did not differ between patients and control subjects and is only associated with the presence of pericardial effusion during the acute phase of Kawasaki disease. Our data do not confirm the reliability of PEB as a useful diagnostic sign of incomplete Kawasaki disease.

Partner effects of Mexican cultural values: the couple and parenting relationships.

In this investigation, the authors explored the impact of individuals' cultural values on their partners' relationship adjustment and perceptions of their parenting relationship. The authors examined Mexican cultural values of simpatía (i.e., harmonious interpersonal relationships) and respeto (i.e., respect for authority figures) using a sample of 50 Mexican-origin couples in southern Arizona. Congruent with their hypotheses, results supported the proposition that fathers' simpatía is positively associated with both relationship adjustment and the parenting relationship as reported by mothers, whereas fathers' respeto is negatively associated with both relationship adjustment and the parenting relationship as reported by mothers. However, the authors found little evidence of a contribution of mothers' cultural values to fathers' perceptions of either relationship adjustment or the parenting relationship. They interpret these findings to suggest that mothers' relationship adjustment and parenting relationship are more sensitive to and dependent on fathers' degree of traditional cultural values among Mexican-origin families.

Left atrial diameters in overweight children with normal blood pressure.

OBJECTIVE: To measure left atrial (LA) diameter in normotensive, overweight children and to determine the variables that independently influence LA diameters. STUDY DESIGN: A cross-sectional study on 22 overweight children (age, 13.40 +/- 1.22 years) and 18 control children (age, 13.40 +/- 2.19 years) was performed. LA diameter, left ventricular (LV) geometry, and LV systolic/diastolic function were measured through echocardiography. Data were compared between the two groups. Multiple regression analysis, with LA diameter as dependent variable, was conducted. RESULTS: In the overweight group, LV diastolic dimension, LV mass index, peak S, S/D ratio, Am, maximal LA diameter (34.1 mm vs 25.4 mm), middle LA diameter (26.9 mm vs 18.1 mm), and minimal LA diameter (22.5 mm vs 16.1 mm) were increased and Em/Am ratio was decreased. In multiple regression analysis, body mass index (R(2) = 0.7040, 0.7085, 0.7406 in respective maximal, middle, and minimal LA diameter) and systolic blood pressure (R(2) = 0.0540, 0.0477, 0.030 in respective maximal, middle, and minimal LA diameter) were significant independent correlates of all three measures of LA diameter. CONCLUSIONS: LA diameter in normotensive overweight children is increased. Body mass index and systolic blood pressure were significant correlates of LA diameter.