Rotavirus is the major cause of severe diarrhea in children. A recent study of hospitalizations for diarrhea in the United States suggested that the annual rotavirus epidemic may follow a regional sequence from west to east. As part of a program to establish active surveillance of rotavirus prior to the introduction of vaccines, we obtained 5 years of retrospective data on rotavirus detections from 88 centers throughout North America. Analysis of 34,644 detections indicates that the peak of the annual rotavirus epidemic occurs first in Mexico and the Southwest of the United States in late fall, goes systematically across the continent in the winter, and ends in the Northeast United States and the Maritime Provinces of Canada in the spring. When detections are grouped by region, onset of the epidemic follows the same regional sequence as the peak. To our knowledge, this is the only description of a repetitive geographic sequence for the seasonal epidemic activity of a viral agent. Further studies are indicated to determine whether climate, features of the virus itself, or other factors are responsible for this apparently unique pattern. A system of active surveillance can use this pattern to detect natural alterations in the epidemic behavior of rotavirus and to assess the impact of vaccines.

Canada↗

PubMedDate not supplied

Laboratory diagnosed human viral infections in Canada, 1980-1988. Trends and clinico-epidemiological characteristics.

Between 1980 and 1988, the Laboratory Centre for Disease Control (LCDC) received 261,573 reports of positive laboratory diagnoses of viral and selected nonviral agents from Canadian laboratories for the determination of the distribution of these agents with age, seasonality, periodicity, and symptoms. The agents most frequently associated with diseases of the respiratory and gastrointestinal tracts, skin, and mucous membranes, the eye, and the central nervous system are identified and ranked. The temporal patterns of common enteroviruses and vaccine preventable diseases are also described. New diagnostic techniques, availability of diagnostic services, awareness of the role an agent plays in disease, and real changes in the occurrence of a disease may influence the number of positive laboratory reports.

Adolescent↗

PubMedDate not supplied

Infection control in the burn unit.

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Burn Units↗

PubMedDate not supplied

Candidemia in the pediatric patient with burns.

The incidence of candidemia in patients with burns appears to be falling. However, when it occurs it remains a significant cause of morbidity and a potential cause of death. A 5-year retrospective review revealed that 138 (14.4%) of 962 pediatric patients who had been acutely burned had Candida species isolated from one or more sites during their hospital stay, but candidemia developed in only 17 patients (12.3% of those from whom Candida species were recovered and 1.8% of all admissions). Patients from whom Candida species were recovered at one site had a 0% incidence of candidemia, those from whom Candida species were recovered at two sites had a 22.2% incidence of candidemia, and those from whom Candida species were recovered at three or more sites had a 34.4% incidence of candidemia. These differences were significant by chi-square analysis (p < 0.0001). There was a low mortality rate associated with candidemia, with only one (5.9%) of the 17 patients dying as a direct result of invasive Candida infection. Nystatin administered enterally did not prevent the development of candidemia. Our review suggests that delay in biologic wound closure and exposure to broad-spectrum antibiotics are associated with an enhanced risk of candidemia. Wound closure and systemically administered amphotericin B remain the mainstays of therapy.

Adolescent↗

PubMedDate not supplied

Management of severe toxic epidermal necrolysis in children.

Toxic epidermal necrolysis (TEN) is a severe form of erythema multiforme that results in extensive epidermal sloughing; the condition is associated with a mortality of up to 70%. From 1991 to 1998, 10 children with severe toxic epidermal necrolysis were referred to a regional pediatric burn facility. Wounds were managed with strategy involving prevention of wound desiccation and superinfection, including the frequent use of biologic wound coverings. Children unable to guard their airway because of extensive oropharyngeal involvement were prophylactically intubated. Enteral nutrition was stressed. Steroids were not used and antibiotics were administered to managed specific foci of infection only. The 2 boys and 8 girls had an average age of 7.2+/-1.8 years (range 6 months to 15 years) and sloughed surface area of 76+/-6% of the body surface (range 50 to 95%). Antibiotics (3 children), anticonvulsants (3 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were felt to have triggered the syndrome. Six children (60%) required intubation for an average of 9.7+/-1.8 days (range 2 to 14 days). Buccal mucosal involvement occurred in 9 (90%) and ocular involvement in 9 (90%). Although infectious complications were common (2 pneumonias, 2 urinary infections, 1 bacteremia, 2 central line infections, and 2 candidemias), all children survived after lengths of stay in the burn unit averaging 19+/-3 (range 6 to 40) days. The most common long-term morbidity was keratitis sicca (2 children, 20%), finger nail deformities (3 children, 30%), and variegated skin pigment changes (5 children, 50%). Although having both a cutaneous and visceral wound that predispose them to infectious complications, most children with TEN will survive if managed with a strategy emphasizing biologic wound closure, intensive nutritional support, and early detection and treatment of septic foci. Burn units have the resource set required to manage severe TEN and early referral of such children may have a favorable impact on survival.

Adolescent↗

PubMedDate not supplied

Transformation renders MDR cells more sensitive to polyunsaturated fatty acids.

A series of genetically related cell lines that express mdr genes but differ in their ability to form tumors has been challenged with gamma-linolenate and eicosapentaenoate to verify if the sensitivity of tumorigenic mdr cells to cytotoxic PUFAs differs from the sensitivity of non-tumorigenic mdr cells. The tumorigenic mdr cell lines were derived by transformation of their parental non-tumorigenic mdr cell line with myc and ras oncogenes. Four ras and five myc transformed cell lines were used for the estimation of clonal variability. The data as based on colony forming assays, showed that six out of nine of the tumorigenic mdr cell lines were more sensitive than the non-tumorigenic mdr cells. These results suggest that a tumorigenic phenotype renders mdr cells more sensitive to PUFAs and that PUFA supplementation either alone or in conjunction with existing forms of cancer therapy may have significant clinical implications.

Animals↗

PubMedDate not supplied

Differential sensitivity of tumorigenic and genetically related non-tumorigenic cells to cytotoxic polyunsaturated fatty acids.

A series of closely related rat brain cell lines that differ in their ability to form tumors has been used to investigate the selectivity of cytotoxic polyunsaturated fatty acids. The colony-formation ability of tumorigenic F4 cells was markedly reduced when the cells were challenged with GLA and EPA. In contrast, the non-tumorigenic revertants were less affected. All retransformed tumorigenic variants exposed to GLA were as sensitive as their parental tumorigenic cells and more sensitive than the non-tumorigenic clones. However, two out of three retransformed tumorigenic variants exposed to EPA were less sensitive than either the parental tumorigenic or non-tumorigenic clones. The addition of ferrous chloride to the culture medium increased the cytotoxicity of GLA in tumorigenic but not in non-tumorigenic variants. These results suggest that tumorigenicity per se is characterized by a high sensitivity to PUFAs exogenously administered at appropriate concentrations and that the sensitivity is fatty acid specific.

Animals↗

PubMedDate not supplied

Re-evaluation of immune status to measles, mumps and rubella viruses in the Canada Health Survey population and the Indochinese refugee population.

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Adolescent↗