Testing for hearing loss after meningitis.
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Acoustic Impedance Tests↗
Biomedical subjects
M Tarlow
Publications and source records attributed to M Tarlow.
Otitis media: pathogenesis and medical sequelae.
Eustachian tube abnormalities are a primary determinant of otitis media. Other determinants include viral infections and local and systemic immune deficiencies, which predispose to superimposed bacterial disease. Local infection induces inflammation, which can be exacerbated by the presence of antibiotics. The degree of inflammation determines the extent of damage and the oedema and histological damage correlate with the white blood cell count and not the bacterial count. Local sequelae include recurrent or persistent acute otitis media, recurrent or chronic otitis media with effusion and chronic suppurative otitis media. Other local sequelae include occasional perforation of the tympanic membrane, sensorineural hearing loss, acute serous labyrinthitis, and facial palsy, which can occur associated with the course of the facial nerve across the middle ear. Acute otitis media can lead to persistent loss of a significant amount of sensorineural hearing after treatment and resolution of the effusion. Damage is usually very mild or nonexistent in the speech frequency ranges, but detectable if high frequency audiometry is performed. Studies in otitis media with effusion have shown a mild association between its presence and speech and language development in children under the age of 4 years. But also in older children, there is a continued association between otitis media with effusion, affecting expressive language development, reading skills and behavior. Therefore physicians have a major responsibility in managing otitis media.
Acute Disease↗
Laboratory, clinic and community: the logistics of liaison.
BACKGROUND: Infectious diseases are the cause of much morbidity and mortality in children. In the industrialized world the majority of childhood infections are treated by primary care physicians; nevertheless a high degree of professional liaison is needed among the various specialists concerned with pediatric infectious disease. OBJECTIVE: To review the contributions of the various medical practitioners to the management of pediatric infections and the ways in which communication between them can be improved. DISCUSSION: Primary care physicians, pediatricians and microbiologists are all concerned with the management of infections in children. Factors that can facilitate communication between these experts include the development of professional trust between the groups, effective education techniques and good communication achieved through the use of structured letters, telephone contact, new technology and outreach clinics.
Child↗
Diagnosis of primary human herpesvirus 6 and 7 infections in febrile infants by polymerase chain reaction.
Primary human herpesvirus 6 (HHV-6) and 7 (HHV-7) infections were identified in febrile children by qualitative and quantitative polymerase chain reaction (PCR) assays. Diagnosis was based on the differential detection of viral DNA in peripheral blood mononuclear cells (PBMC), but not in saliva. Six of 41 febrile infants, but none of seven non-febrile controls, were identified with primary infections (three HHV-6, three HHV-7). These children had significantly higher viral loads in PBMC (HHV-6, median 24213 genomes/10(6) PBMC; HHV-7, median 6,040,000 genomes/10(6) PBMC) than DNA-aemic, saliva PCR positive children (HHV-6, median 1606 genomes/10(6) PBMC, p < 0.01; HHV-7, median 7089 genomes/ 10(6) PBMC, p < 0.05). Viral DNA was detected in serum by PCR in only 50% of primary infections. All three children with primary HHV-7 infection had febrile convulsions. Thus PCR, including quantitative assays, may identify primary HHV-6 and HHV-7 infections when an appropriate combination of clinical specimens is used.
DNA, Viral↗
X linked agammaglobulinaemia with a 'leaky' phenotype.
Typical X linked agammaglobulinaemia (XLA) is characterised by absence of immunoglobulin production and lack of mature B cells. The gene responsible for XLA has recently been identified, and codes for a B cell tyrosine kinase, BTK. A family affected by a B cell immunodeficiency, which is less severe than classical XLA, is described but they had a pedigree suggestive of X linked inheritance. Demonstration of a mutation in the BTK gene confirms that this is a mild form of XLA.
Agammaglobulinemia↗
Ultrastructural damage to the organ of corti during acute experimental Escherichia coli and pneumococcal meningitis in guinea pigs.
Experimental meningitis was induced in 16 pigmented guinea pigs by subarachnoid inoculation of mid log-phase 1 x 10(9) E. coli K-12 (n = 8) or 5 x 10(7) Streptococcus pneumoniae type 2 (n = 8). Animals were killed at various times between 3 and 12 h after inoculation and the ultrastructure of the organ of Corti (including the basilar membrane) was examined with high resolution scanning electron microscopy. Both E. coli and S. pneumoniae induced meningitis and invaded scala tympani. In both types of meningitis the apical surface of inner supporting cells developed craters. inner hair cell stereocilia were also disrupted. In pneumococcal meningitis both these lesions were more pronounced but in addition there were breaks in the junctions between inner hair cells and their adjacent supporting cells and there was ballooning and rupture of the apical surface of outer hair cells. Damage to the organ of Corti after bacterial invasion of the inner ear may be one of the mechanisms by which bacterial meningitis can cause deafness. The more severe cochlear lesions induced by S.pneumoniae may explain the higher incidence of deafness after pneumococcal meningitis.
Animals↗
The prognostic significance of caffeine half-life in saliva in children with chronic liver disease.
To evaluate its clinical value, the half-life of caffeine (1,3,7-trimethylxanthine) in saliva (SCT) after 3 mg/kg-1 oral caffeine was measured in 53 children with chronic liver disease (mean age, 4.41 years) and 48 control children (mean age, 6.26 years) in five samples over 24 h and compared with parameters of liver function and outcome. Sensitivity was 60.3% and specificity 97% of SCT for diagnosis of chronic liver disease. The correlation of SCT with serum albumin (ALB) was -0.52 (p < 0.001), total bilirubin (SBR) was 0.585 (p < 0.001), prolonged prothrombin time (PT) was 0.387 (p = 0.004), and aspartate aminotransferase (AST) was 0.538 (p = 0.001). The correlation of SCT with a clinical score of liver dysfunction calculated from the presence of features of hepatic decompensation was 0.627 (p < 0.001) and with Malatack's paediatric prognostic score was 0.505 (p < 0.001). Serial SCT and liver function tests were performed on 53 patients on 127 occasions during a mean follow-up of 361 days (range, 4-709). Of this group, 18 were listed for liver transplantation. Predictive values of outcome by analysis of variance expressed as ratio of mean squares were SBR, 34.1 (p < 0.001); log10 SCT, 20.6 (p < 0.001); ALB, 5.2 (p < 0.05); PT, 1.2 (NS). SCT correlated with clinical and biochemical parameters of severity of liver disease, but SBR was a better predictor of listing for liver transplantation in this group of paediatric patients.
Adolescent↗
Temperature-dependent modulation of lipopolysaccharide-induced interleukin-1 beta and tumor necrosis factor alpha expression in cultured human astroglial cells by dexamethasone and indomethacin.
In bacterial meningitis, LPS induces production in cerebrospinal fluid of the cytokines IL-1 beta and tumor necrosis factor alpha (TNF alpha), which are the principle mediators of meningeal inflammation. IL-1 beta and TNF alpha induce fever, and elevated temperature may affect cytokine expression. Dexamethasone treatment improves outcome in bacterial meningitis possibly by inhibiting IL-1 beta and TNF alpha. In this report, the effects of elevated temperature and dexamethasone on LPS-stimulated IL-1 beta and TNF alpha mRNA gene expression and protein synthesis were studied in human astrocytoma cell lines and primary cultures of human fetal astrocytes. Cells cultured at 40 degrees C exhibited smaller peaks of IL-1 beta and TNF alpha transcription and protein synthesis compared with cells cultured at 37 degrees C. The addition of dexamethasone before, during, or after exposure of the cells to LPS resulted in temperature-dependent inhibition of IL-1 beta transcription and protein synthesis. The most extensive inhibition occurred in pretreated cells cultured at 37 degrees C. Cotreatment with LPS and dexamethasone also inhibited TNF alpha mRNA transcription at both temperatures. The effects of another antiinflammatory agent, indomethacin, on LPS induction of IL-1 beta and TNF alpha mRNA were temperature and cell line dependent. These findings provide a possible explanation for the efficacy of dexamethasone treatment of bacterial meningitis and support the proposal that fever may be beneficial to the host in this disease.
Astrocytes↗
The paediatric lipid clinic in Birmingham.
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Child↗
Reye's syndrome and aspirin.
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Adolescent↗
Organic anions and stool volume in the newborn.
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Colon↗
Centoxin.
Centoxin is one of a new group of immunotherapeutic agents manufactured from 'humanized' antibodies produced using monoclonal antibody technology. It is indicated in the management of patients with Gram-negative septicaemia; its introduction represents a new approach to treatment in these patients (Luce, 1987).
Antibodies, Monoclonal↗
Pets and diseases.
Pet ownership is very common. Pets contribute to the physical and mental wellbeing of their owners but do have the potential to cause disease. These diseases are uncommon but recognition that disease could be because of a family pet will lead to correct management for both the patient and the pet and may prevent further disease.
Adult↗