Hospital cost of pediatric patients with complicated acute sinusitis

OBJECTIVE

Review costs for pediatric patients with complicated acute sinusitis.

METHODS

A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients.

RESULTS

The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs.

CONCLUSION

Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients.

Nucleotide sequence of the clustered genes for apocytochrome b6 and subunit 4 of the cytochrome b/f complex in the spinach plastid chromosome

A 2.4 kilobase-pair segment of the spinach plastid chromosome carrying the genes for apocytochrome b6 and subunit 4 of the thylakoid membrane cytochrome b/f complex has been analysed by DNA sequencing and Northern blot analysis. The nucleotide sequence reveals two uninterrupted open reading frames of 211 and 139 triplets coding for two hydrophobic proteins of 23.7 kd (cytochrome b6) and 15.2 kd (subunit 4). The genes are located on the same strand and are separated from each other by 1018 untranslated base pairs. They map adjacent to the gene for the P680 chlorophyll α apoprotein of the photosystem II reaction center. The three genes appear to be under common transcriptional control and the transcripts post-transcriptionally modified. The deduced amino acid sequences of cytochrome b6 and subunit 4 both exhibit significant homology with published sequences from mitochondrial b cytochromes (42 kd) suggesting that these functionally equivalent polypeptides in photosynthetic and respiratory electron transport chains arose monophyletically.

Additional binding mechanism of palonosetron to the 5-HT3 receptor versus first generation 5-HT3 receptor antagonists

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Background: Palonosetron has a higher binding affinity and longer plasma half-life than first generation 5-HT3 receptor antagonists. Clinical trials have demonstrated that a single intravenous dose of palonosetron 0.25 mg provides better protection from chemotherapy-induced nausea and vomiting than other 5-HT3 receptor antagonists throughout the 5-day post-chemotherapy period. The purpose of this work is to determine differences in the molecular interactions of the antagonists with the receptor that could help explain the clinical efficacy differences. Methods: Molecular ligand-receptor relationships for commonly used 5-HT3 receptor antagonists were investigated. In particular, competitive vs. potential allosteric interactions between ondansetron, granisetron and palonosetron and the 5-HT3 receptor were examined. Binding experiments were carried out using each unlabeled antagonist in competition with [3H]-antagonist. Concentrations of [3H]-antagonists used in these experiments included the equilibrium dissociation constant (Ki) and several-fold Ki values in an effort to represent the probable concentrations of each antagonist at the receptor site in vivo. The inhibitory concentration of unlabeled antagonist needed to observe half maximal binding (IC50) as a function of [3H]-antagonist concentration was plotted for comparisons between ondansetron, granisetron and palonosetron. Results: A plot of the concentration of unlabeled antagonist needed to observe IC50 as a function of [3H]- antagonist concentration was linear when ondansetron and granisetron were in competition. On the other hand, when palonosetron was in competition with either granisetron or ondansetron the plot was curvilinear in each case. Conclusions: These results indicate that palonosetron exhibits both competitive and allosteric interactions with the 5-HT3 receptor, in contrast to ondansetron and granisetron which display strictly competitive antagonism. As allosteric interactions may induce changes in the receptor conformation, we can speculate that palonosetron's dual action on the 5-HT3-receptor could induce amplification of its inhibitory effect at the primary receptor binding site.

No significant financial relationships to disclose.

Interleukin-1beta stimulates growth hormone-releasing hormone receptor mRNA expression in the rat hypothalamus in vitro and in vivo

Changes in growth hormone-releasing hormone (GHRH), GHRH-receptor (R), somatostatin and interleukin (IL)-1beta mRNA levels were determined in fetal rat hypothalamic cultures after administration of IL-1beta (1, 10, 100 ng/ml, 2 h incubation), and in adult rat hypothalamus 5 h after intracerebroventricular injection of IL-1beta (2.5 and 25 ng). IL-1beta stimulated GHRH-R mRNA expression both in vitro (10 and 100 ng/ml) and in vivo (2.5 and 25 ng). Somatostatin mRNA was significantly stimulated and GHRH mRNA slightly reduced in vitro, while these mRNA species were not altered in vivo in response to IL-1beta. IL-1beta stimulated its own expression both in vitro (10 and 100 ng/ml) and in vivo (25 ng). IL-1beta-induced mRNA responses occurred 2 h after treatment in vitro (incubation times, 30 min to 6 h). IL-1beta also elicited slight GHRH releases in vitro. Up-regulation of hypothalamic GHRH-R by IL-1beta may explain previous findings suggesting that IL-1beta stimulates GHRH activity.

Sleep in mice with nonfunctional growth hormone-releasing hormone receptors

The role of the somatotropic axis in sleep regulation was studied by using the lit/lit mouse with nonfunctional growth hormone (GH)-releasing hormone (GHRH) receptors (GHRH-Rs) and control heterozygous C57BL/6J mice, which have a normal phenotype. During the light period, the lit/lit mice displayed significantly less spontaneous rapid eye movement sleep (REMS) and non-REMS (NREMS) than the controls. Intraperitoneal injection of GHRH (50 microg/kg) failed to promote sleep in the lit/lit mice, whereas it enhanced NREMS in the heterozygous mice. Subcutaneous infusion of GH replacement stimulated weight gain, increased the concentration of plasma insulin-like growth factor-1 (IGF-1), and normalized REMS, but failed to restore normal NREMS in the lit/lit mice. The NREMS response to a 4-h sleep deprivation was attenuated in the lit/lit mice. In control mice, intraperitoneal injection of ghrelin (400 microg/kg) elicited GH secretion and promoted NREMS, and intraperitoneal administration of the somatostatin analog octretotide (Oct, 200 microg/kg) inhibited sleep. In contrast, these responses were missing in the lit/lit mice. The results suggest that GH promotes REMS whereas GHRH stimulates NREMS via central GHRH-Rs and that GHRH is involved in the mediation of the sleep effects of ghrelin and somatostatin.

[Value of endoanal sonography in the assessment of faecal incontinence]

PURPOSE

The aim of this study was to assess the value of endoanal ultrasound (EUS) in comparison to anal manometry and operative findings in patients suffering from faecal incontinence. Patient history, localisation of sphincter defects and therapeutic modalities were analysed.

METHODS

Over a 3-years period, 92 patients with faecal incontinence were investigated by endoanal ultrasound. Results were compared with anal manometry in 81 cases.

RESULTS

At EUS, 27 patients (29 %) showed no sphincter defect, 18 (20 %) had an isolated internal sphincter defect, 13 (14 %) an isolated defect of the external sphincter and 34 (37 %) presented with a combined internal/external sphincter defect. Manometry correlated in 30 % with endoanal ultrasound. Compared with surgery, endoanal ultrasound was correct in 100 % and manometry in only 54 %. An obstetric trauma was most frequently related to faecal incontinence.

CONCLUSION

Endoanal ultrasound is a very sensitive method for localizing anal sphincter defects and is mandatory in the assessment of patients with faecal incontinence.

Influence of photoperiod on N-acetyltransferase activity and melatonin in the fiddler crab Uca pugilator

Melatonin and N-acetyltransferase (NAT) activity were measured in the eyestalks of fiddler crabs acclimated to various photoperiods: constant light, a L:D 12:12 h photoperiod, or constant dark. Following acclimation, eyestalks were collected every 3 h over a 24-h period; they were assayed for melatonin with a radioimmunoassay and for NAT activity with a radioenzymatic assay. In constant light, melatonin levels increased at 1300 h, from 142 to 431 pg x mg(-1) eyestalk; NAT activity increased concurrently, from 97 to 203 pmol x h(-1) x mg(-1) eyestalk, and both remained elevated until 0400 h. In the L:D 12:12 h photoperiod, melatonin levels increased at 1300 h from 28 to 230 pg x mg(-1) eyestalk, and though NAT activity increased significantly, from 80 to 122 pmol x h(-1) x mg(-1) eyestalk, an even greater increase occurred at 0400 h, when melatonin levels were low. In constant dark, melatonin levels increased at 1600 h, from 22 to 196 pg x mg(-1) eyestalk, with a concurrent increase in NAT activity from 93 to 140 pmol x mg(-1) x h(-1) eyestalk. However, the second peak in melatonin (111 pg x mg(-1)), occurring at 0400 h, was out of phase with the second peak of NAT activity (113 pmol x mg(-1) x h(-1) eyestalk) which occurred at 0700 h. NAT may be a rate-limiting step in melatonin synthesis in fiddler crabs under some conditions (constant light and the 1300 h peak in constant dark); however, NAT activity correlates poorly with melatonin levels in a L:D 12:12 h photoperiod and in constant dark relative to the 0400 h melatonin peak.

HIV test counselling at a tertiary hospital

A questionnaire was distributed to 64 of the 78 interns working at a teaching hospital in Cape Town in August 1992 to examine their attitudes and practice in respect of HIV test counselling. The questionnaire was completed by 61 interns. Thirteen per cent of those who responded counselled all patients, 49% counselled some patients and 38% counselled no patients. Thirty-four per cent stated that they felt that pre-test counselling was always necessary and 57% that post-test counselling was always necessary. The most frequently stated reasons for not counselling patients were language barriers, time constraints, feelings of incompetence on the part of the intern and the fact that the patient was too ill. It is recommended that standard counselling procedures be established in each ward and formal under- and postgraduate counselling training for medical students and interns be instituted.

Spinach plastid genes coding for initiation factor IF-1, ribosomal protein S11 and RNA polymerase alpha-subunit

The nucleotide sequence of 2.5 kbp from the cloned SalI fragments 8 and 11 of spinach plastid DNA has been determined. This region was found to encode three open reading frames for hydrophilic polypeptides of 77, 138, and 335 amino acids. Using the computer search algorithm of Lipman and Pearson (Science 227, 1435, 1985), these genes were identified as coding for homologues of E. coli initiation factor IF-1 (inFA), 30S ribosomal protein S11 (rps11), and the alpha-subunit of DNA-dependent RNA polymerase (rpoA). The spinach plastid gene organization is inFA - 381 bp spacer - rps11 - 72 bp spacer - rpoA. The genes are transcribed in vivo and appear to encode functional proteins. These findings imply that plastid chromosomes code for components of the organelle transcription apparatus.

Localization of the gene for apocytochromeb-559 on the plastid chromosome of spinach

The gene for cytochromeb-559, associated with the photosystem II reaction center, has been located on the spinach plastid chromosome by cell-free coupled transcription-translation and RNA-programmed hybrid selection translation using appropriate recombinant DNAs, RNA fractions, and monospecific antisera. The gene is located in the large single-copy segment of the plastid chromosome between the genes for cytochomef and the P680 chlorophylla apoprotein of photosystem II and transcribed in the opposite direction relative to these genes. The 10 kd protein is decoded from a bicistronic 1.0 kb mRNA and is apparently not made as a precursor in cell-free rabbit reticulocyte andE. coli lysates.

Localization of the genes for the two chlorophyll a -conjugated polypeptides (mol. wt. 51 and 44 kd) of the photosystem II reaction center on the spinach plastid chromosome

A core particle of the water-oxidizing photosystem II reaction center has been prepared from stacked spinach thylakoid membranes by a procedure involving extraction with the non-ionic detergent dodecyl-beta-D-maltoside and centrifugation in sucrose gradients. The protein-pigment complex consists of at least four polypeptide species: two components with mol. wts. of 51 and 44 kd which are conjugated with chlorophyll a and beta-carotene, the herbicide-binding protein of mol. wt. 32 kd and cytochrome b 559 (11 kd). The genes for the 51-and 44-kd polypeptides have been located on the circular 150-kbp spinach plastid chromosome. They were identified by hybrid-selection mapping, in vitro transcription-translation of recombinant DNAs and specific antisera which were used to characterize the translation products. The plastid chromosome carries one uninterrupted copy for each of these genes in its large single-copy region. The gene for the 51-kd protein (which probably bears the P(680) reaction center chlorophyll a) is located in close proximity to the gene for cytochrome b6, and some 70 kbp away from the gene for the ;32-kd' herbicide-binding protein of the reducing side of photosystem II. The gene for the 44-kd protein is situated halfway between these two genes adjacent to the gene for the P(700) chlorophyll a apoprotein of the photosystem I reaction center. Both photosystem II genes are transcribed into discrete RNA species in the same direction but from the opposite strand as the gene for the ;32-kd' protein.

Genes and transcripts for the polypeptides of the cytochrome b6/f complex from spinach thylakoid membranes

Cytochrome b6/f complex was prepared from washed thylakoid membranes by a procedure involving detergent treatment and centrifugation in sucrose gradients. The complex is composed of at least four polypeptide species, cytochrome f which occurs in two variant forms (mol. wt. 34/33 kd), cytochrome b6 (23 kd), the high-potential Rieske iron-sulfur protein (19 kd) and a fourth subunit (17 kd) of unknown function. Transcripts for the cytochromes f, b6 and subunit 4 were found in plastid RNA, those for the Rieske iron-sulfur protein in cytosolic poly(A) RNA. Transcripts for cytochrome b6 and subunit 4 are translated in rabbit reticulocyte lysates into products of correct length. The Rieske iron-sulfur protein and the cytochrome f apoprotein appear to be made as precursors with excess sequences of 7 and 4 kd, respectively. Cytochrome f, cytochrome b6 and subunit 4 are encoded by uninterrupted plastid genes that are located in the large single-copy region of the circular DNA molecule. Each of these genes is present once per chromosome. Their location and direction of transcription have been determined by hybrid-selection mapping and by cell-free transcription/translation of various recombinant DNAs. The genes for cytochrome b6 and for subunit 4 lie near each other, but do not overlap. They are transcribed into a single message. The gene for cytochrome f maps 15 kbp away from this cluster, close to the 3' end of the gene for the large subunit of ribulosebisphosphate carboxylase/oxygenase, and is transcribed into a separate 4 kb long RNA. All these genes have the same polarities with respect to each other.

Genes and transcripts for the P700 chlorophylla apoprotein and subunit 2 of the photosystem I reaction center complex from spinach thylakoid membranes

A photosystem I reaction center complex has been purified to homogeneity by a procedure involving partial solubilization of spinach thylakoid membranes, ion exchange chromatography and centrifugation in sucrose gradients. The complex contains 7 polypeptides: the P700 chlorophylla apoprotein with an apparent molecular weight of 67 kd, which at high resolution splits into two bands, and smaller polypeptides of 22 (subunit 2), 18.5, 18, 16, 12 and 10 kd.Stable transcripts for the P700 chlorophylla apojprotein and subunit 2 were found in plastid and cytosolic RNA, respectively. The apoprotein product obtained by translation in a mRNA-dependent cell-free rabbit reticulocyte lysate and also by DNA-programmed transcription-translation of cloned plastid DNA fragments inE. coli lysates was indistinguishable immunologically and electrophoretically from the authentic protein. However, the product immunologically related to subunit 2 was 4 kd larger than the mature compound indicating that this protein is encoded in the nucleus and synthesized as a precursor.The gene for the P700 chlorophylla apoprotein has been physically mapped on the spinach plastid chromosome by hybrid selection mapping and DNA-programmed cell-free transcription-translation using cloned restriction fragments of plastid DNA. There is one gene copy per chromosome and it is located centrally in the large single-copy region of the circular DNA molecule. This gene is uninterrupted and is transcribed in the same direction as that of the large subunit of ribulose bisphosphate carboxylase/oxygenase. Its transcript is approximately 4 kb longer than the 2 kbp structural gene.