The Changing Pattern of Rheumatic Fever in Childhood

The manifestations of acute rheumatic fever were compared in 231 children admitted to hospital from 1937 to 1940 with those in 252 children admitted from 1957 to 1960. Of the 178 in the early group seen during an initial attack, 82 had cardiac involvement; of these, 12 died early. Of the 218 patients in the later group with an initial attack, 96 had cardiac involvement; of these, two died early. Despite this decrease in early mortality, the incidence of isolated mitral value involvement (73% in the early group and 62% in the later group) and the incidence of congestive failure (20% and 13%) were similar. This reduction in the number of early deaths may be due to lowered virulence of the streptococcus, improved socioeconomic conditions, or therapy with penicillin and corticosteroids. The incidence of chorea and the frequency of recurrences were also less in the later group.     

Lung Volume,Breathing Pattern and Ventilation Inhomogeneity in Preterm and Term Infants

Background

Morphological changes in preterm infants with bronchopulmonary dysplasia (BPD) have functional consequences on lung volume, ventilation inhomogeneity and respiratory mechanics. Although some studies have shown lower lung volumes and increased ventilation inhomogeneity in BPD infants, conflicting results exist possibly due to differences in sedation and measurement techniques.

Methodology/Principal Findings

We studied 127 infants with BPD, 58 preterm infants without BPD and 239 healthy term-born infants, at a matched post-conceptional age of 44 weeks during quiet natural sleep according to ATS/ERS standards. Lung function parameters measured were functional residual capacity (FRC) and ventilation inhomogeneity by multiple breath washout as well as tidal breathing parameters. Preterm infants with BPD had only marginally lower FRC (21.4 mL/kg) than preterm infants without BPD (23.4 mL/kg) and term-born infants (22.6 mL/kg), though there was no trend with disease severity. They also showed higher respiratory rates and lower ratios of time to peak expiratory flow and expiratory time (t _PTEF/t _E) than healthy preterm and term controls. These changes were related to disease severity. No differences were found for ventilation inhomogeneity.

Conclusions

Our results suggest that preterm infants with BPD have a high capacity to maintain functional lung volume during natural sleep. The alterations in breathing pattern with disease severity may reflect presence of adaptive mechanisms to cope with the disease process.     

Potential Zoonotic Trematodes Recovered in Stray Cats from Kuwait Municipality,Kuwait

Stray cats are a common feature roaming the streets and alleys of Kuwait; they could be a source of parasites, including trematodes, that affect humans. A survey was conducted to identify feline trematodes and throw the light on their public health significance in Kuwait. Out of 240 stray cats trapped from different localities of Kuwait from June 2011 to May 2012, 59 (24.6%) were found to be infected with 14 species of trematodes. The most common were trematodes of the genus Heterophyes, particularly H. heterophyes and H. dispar that were found in respectively 15.8% and 10.8% of the cats examined. Other trematodes recorded, with lower prevalences, were Heterophyes nocens (2.9%), Haplorchis taichui (3.8%), Stictodora sawakinensis (2.1%), Stellantchasmus falcatus (1.6%), Echinochasmus japonicus (1.6%), and Mesostephanus dottrensi (1.3%). Centrocestus cuspidatus, Galactosomum fregatae, Ascocotyle sp., Mesostephanus appendiculatus, Haplorchis yokogawai, and Pygidiopsis genata showed the lowest prevalence (0.4%) and intensity. The majority of the trematodes are recorded for the first time in Kuwait and even in the Gulf region. The study reveals that stray cats are good indicators of fish-borne trematodes in the environment. As all trematodes recovered are zoonotic, their significance to public health should be considred.     

Anaerobic Bacterial Flora of Intra-abdominal Infections and their Antimicrobial Susceptibility Pattern in Kuwait

Clinical samples obtained from 200 patients with intra-abdominal infections were investigated for the presence of anaerobic bacteria. The majority of samples were from patients with appendicitis (108, 54%) followed by peritoneal abscess/peritonitis (37, 18.5%). A total of 153 anaerobes were isolated from 83 culture positive specimens with an isolation rate of 1.8 per sample. Ninety (59%) yielded Bacteroides fragilis group and B. fragilis stricto sensu accounted for half of them. Other isolates were 36 (23.5%) Prevotella species and 15 (9.8%)Peptostreptococcus micros . The susceptibility of the 153 isolates against eight antibiotics was determined by the E-test. All the isolates were susceptible to metronidazole, MIC₉₀s varying between 1–2 μg/mL. ThePrevotella spp., Peptostreptococcus spp., Fusobacterium spp. and Porphyromonas spp. were all susceptible to clindamycin (MIC₉₀s=0.25–2 μg/mL respectively), imipenem (MIC₉₀s=0.12–0.5μg/mL respectively) and meropenem (MIC₉₀=0.25 μg/mL each). About 25% of the B. fragilis group were resistant to clindamycin with MIC more than 256 μg/mL. Piperacillin-tazobactam also exhibited excellent in vitro activity against all the isolates (MIC₉₀=0.25 μg/mL).     

Thirst and salt appetite in horses treated with furosemide.

When a preliminary experiment in sodium-replete ponies revealed an increase, but not a significant increase, in salt consumption after furosemide treatment, the experiment was repeated using sodium-deficient horses in which aldosterone levels might be expected to be elevated to test the hypothesis that a background of aldosterone is necessary for salt appetite. Ten Standardbred mares were injected intravenously with furosemide or an equivalent volume of 0.9% sodium chloride as a control to test the effect of furosemide on their salt appetite and blood constituents. Sodium intake and sodium loss in urine, as well as water intake and urine output, were measured and compared to determine accuracy of compensation for natriuresis and diuresis. Plasma protein and packed cell volume showed significant increases in response to furosemide treatment (F = 29.31, P less than 0.001 and F = 11.20, P less than 0.001, respectively). There were no significant changes in plasma sodium concentration or osmolality in response to the treatment (P greater than 0.05). The furosemide-treated horses consumed 126 +/- 14.8 g salt, significantly more than when they were given the control injection (94.5 +/- 9.8 g; t = 2.22, P = 0.05). In response to furosemide, horses lost 962 +/- 79.7 and consumed 2,170 +/- 5 meq sodium; however, compared with control, they lost 955 meq more sodium and ingested only 570 meq more sodium, so they were undercompensating for natriuresis. The furosemide-treated horses drank 9.6 +/- 0.8 kg of water, significantly more than when they received the control injection (6.4 +/- 0.8 kg; t = 6.9, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Typhoid Fever in Young Children in Bangladesh: Clinical Findings,Antibiotic Susceptibility Pattern and Immune Responses

Background

Children bear a large burden of typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) in endemic areas. However, immune responses and clinical findings in children are not well defined. Here, we describe clinical and immunological characteristics of young children with S. Typhi bacteremia, and antimicrobial susceptibility patterns of isolated strains.

Methods

As a marker of recent infection, we have previously characterized antibody-in-lymphocyte secretion (TPTest) during acute typhoid fever in adults. We similarly assessed membrane preparation (MP) IgA responses in young children at clinical presentation, and then 7-10 days and 21-28 days later. We also assessed plasma IgA, IgG and IgM responses and T cell proliferation responses to MP at these time points. We compared responses in young children (1-5 years) with those seen in older children (6-17 years), adults (18-59 years), and age-matched healthy controls.

Principal Findings

We found that, compared to age-matched controls patients in all age cohorts had significantly more MP-IgA responses in lymphocyte secretion at clinical presentation, and the values fell in all groups by late convalescence. Similarly, plasma IgA responses in patients were elevated at presentation compared to controls, with acute and convalescent IgA and IgG responses being highest in adults. T cell proliferative responses increased in all age cohorts by late convalescence. Clinical characteristics were similar in all age cohorts, although younger children were more likely to present with loss of appetite, less likely to complain of headache compared to older cohorts, and adults were more likely to have ingested antibiotics. Multi-drug resistant strains were present in approximately 15% of each age cohort, and 97% strains had resistance to nalidixic acid.

Conclusions

This study demonstrates that S. Typhi bacteremia is associated with comparable clinical courses, immunologic responses in various age cohorts, including in young children, and that TPTest can be used as marker of recent typhoid fever, even in young children.     

Fever in snails, reflection on a negative result

1. Groups of aquatic snails (Limnaea auricularia) were placed in a temperature gradient and their thermopreferendum measured. 2. Injected with various amounts of killed Escherichia coli, bacterial endotoxin, human interleukin, and prostaglandin E1, E2 and F2 alpha, they did not develop a fever. 3. High doses of prostaglandins were toxic. 4. These results suggest that fever appeared in the course of evolution after the emergence of molluscs and before that of arthropods.     

Fertility levels, trends and differentials in Kuwait

Data used in this study come from the published reports of the censuses and vital registration systems. The crude birth rate in Kuwait is very high, although an apparent decline seems to have started in the period 1975-80. There are considerable differences between the Kuwaiti and non-Kuwaiti populations. The former had a relatively stable high rate around 50 until 1975 and then fell to 47 in 1980. The total fertility rate was 6.8 per woman. The rate for the non-Kuwaitis rose in 1965-70 and then fell sharply throughout 1970-1980, from 44 to 30. Non-Kuwaiti fertility is consistently lower than Kuwaiti fertility at all ages, the differences being relatively greater after age 35. The peak ages of fertility are 25-29 years for Kuwaitis and 20-29 years for non-Kuwaitis. For Kuwaitis, there is clear evidence of declining fertility in the younger age groups but not in the older, largely reflecting the trend towards later marriage among the younger Kuwaitis. As expected, there is a diminishing trend in completed family size from the least to the most educated women in both Kuwaiti and non-Kuwaiti women in all age groups. The illiterate women at marriage are younger than the university educated women by about 5 years. Results further show that women who are economically active have lower fertility than those who are not, both in Kuwaiti and non-Kuwaiti groups. The differences in each group are significant, as are differences in the fertility level by husband's occupation. High fertility in Kuwait, as well as in other oil-exporting Arab countries, is a result of a variety of factors including the generally pronatalist sentiment of the Arab population, improved health facilities, rising wealth, the youthful age structure, the young age at marriage and the substantial incentives in the different governmental schemes to promote native high fertility and keep a balance between the native and immigrant populations.     

Long-Range Correlations in Rectal Temperature Fluctuations of Healthy Infants during Maturation

Background

Control of breathing, heart rate, and body temperature are interdependent in infants, where instabilities in thermoregulation can contribute to apneas or even life-threatening events. Identifying abnormalities in thermoregulation is particularly important in the first 6 months of life, where autonomic regulation undergoes critical development. Fluctuations in body temperature have been shown to be sensitive to maturational stage as well as system failure in critically ill patients. We thus aimed to investigate the existence of fractal-like long-range correlations, indicative of temperature control, in night time rectal temperature (T_rec) patterns in maturing infants.

Methodology/Principal Findings

We measured T_rec fluctuations in infants every 4 weeks from 4 to 20 weeks of age and before and after immunization. Long-range correlations in the temperature series were quantified by the correlation exponent, α using detrended fluctuation analysis. The effects of maturation, room temperature, and immunization on the strength of correlation were investigated. We found that T_rec fluctuations exhibit fractal long-range correlations with a mean (SD) α of 1.51 (0.11), indicating that T_rec is regulated in a highly correlated and hence deterministic manner. A significant increase in α with age from 1.42 (0.07) at 4 weeks to 1.58 (0.04) at 20 weeks reflects a change in long-range correlation behavior with maturation towards a smoother and more deterministic temperature regulation, potentially due to the decrease in surface area to body weight ratio in the maturing infant. α was not associated with mean room temperature or influenced by immunization

Conclusions

This study shows that the quantification of long-range correlations using α derived from detrended fluctuation analysis is an observer-independent tool which can distinguish developmental stages of night time T_rec pattern in young infants, reflective of maturation of the autonomic system. Detrended fluctuation analysis may prove useful for characterizing thermoregulation in premature and other infants at risk for life-threatening events.