Mal-Positioned Umbilical Venous Catheter Causing Liver Abscess in a Preterm Infant

Neonatal liver abscess is uncommon, carries a high mortality and is difficult to diagnose. We report an unusual case of liver abscess in a preterm infant presenting with abdominal distension and suspected gastrointestinal perforation, rather than the more usual features of fever, hepatomegaly, abdominal tenderness, right-sided pleural effusion, and leukocytosis. We discuss current treatments for neonatal liver abscess and argue that in view of the high mortality and difficulty in diagnosis, prevention should be the primary objective. We believe that mal-positioning the umbilical venous catheter in the liver substantially increases the life-threatening risk of this complication, and advocate extreme care in the placement and use of these catheters.

A case-control study of SARS versus community acquired pneumonia

The clinical, laboratory, and radiological features at presentation of 16 children (<12 years) with severe acute respiratory syndrome (SARS) and pneumonia were compared with 32 age matched patients with community acquired pneumonia for determination of predictive factors that could allow early differentiation of the two conditions. A definitive contact history was the most important predictor for SARS. Raised serum lactate dehydrogenase concentration in the presence of low neutrophil count and serum creatine phosphokinase level at presentation also indicated an increased likelihood of SARS-coronavirus infection in young children.

A survey of bathing and showering practices in children with atopic eczema

We evaluated the emollient use and bathing habits of children with atopic eczema (AE) managed at the paediatric dermatology clinic of a university teaching hospital, using children with noneczematous skin diseases as controls. Disease severity of AE in the preceding 12 months was evaluated by the Nottingham Eczema Severity Score. Three-quarters of patients with or without eczema preferred showering to bathing. Patients with AE were more likely to use bath oils than soap and to use emollients after a bath/shower. Review cases, however, were more likely to take a shower and for a longer time (10-30 min) than first-visit eczema patients. These habits did not vary with season or disease severity. Emulsifying ointment was the most commonly used agent for the bath/shower. Most patients applied emollient immediately after a bath/shower. However there were still significant proportions of AE patients who used soap (40% of first-visit vs. 27% of review cases) and who did not apply emollients after a bath/shower (25% of first-visit vs. 23% of review cases). It is important to determine whether this problem is due to inadequate patient education or whether other factors lead to poor compliance.

Non-CF bronchiectasis: does knowing the aetiology lead to changes in management?

The aim of the current study was to review the aetiology of non-cystic fibrosis (CF) bronchiectasis from two tertiary paediatric respiratory units in order to determine how often making a specific aetiological diagnosis leads to a change in management, and to assess the contribution of computed tomography (CT) in determining the underlying diagnosis. The case records of all patients who were diagnosed as having bronchiectasis by CT, currently being seen at the Royal Brompton Hospital and Great Ormond Street Hospital for Children (London, UK), were reviewed. All patients had undergone extensive investigations, and the underlying aetiology and the area of pulmonary involvement (as seen on CT) were recorded. A total of 136 patients were identified; there were 65 young males and the group median (range) age was 12.1 yrs (3.1-18.1). Immunodeficiency, aspiration and primary ciliary dyskinesia accounted for 67% of the cases. In 77 (56%) children, the identification of a cause led to a specific change in management. There was no association between aetiology and the distribution of CT abnormalities. In conclusion, immunodeficiency and other intrinsic abnormalities account for the majority of cases of non-cystic fibrosis bronchiectasis seen in the current authors' units. Computed tomography scans do not contribute towards identifying the aetiology and, most importantly, a specific aetiological diagnosis frequently leads to a change in management.

Resting energy expenditure, oxygen consumption and carbon dioxide production during sleep in children with atopic dermatitis

BACKGROUND

Pruritus and scratching are cardinal symptoms of atopic dermatitis (AD). Sleep and growth may also be affected in children with moderate-to-severe AD. We evaluated whether resting energy expenditure (REE), oxygen consumption (VO2) and carbon dioxide production (VCO2) in various stages of sleep were influenced by the disease severity.

METHODS

Disease severity was evaluated by the scoring atopic dermatitis (SCORAD) index. All-night polysomnography was performed and REE, VO2 and VCO2 were measured.

RESULTS

Twenty children (13 boys and seven girls) with AD and eight controls were recruited. The median overall SCORAD for our AD patients was 36.8. The total sleep efficiency was lower in patients with severe AD than that obtained in the control group (median: 72% versus 88%; p = 0.039). When compared with mild-to-moderate disease (SCORAD40) and controls, REE, VO2 and VCO2 in patients with severe AD (SCORAD > 40) did not differ in sleep stages I and II combined, stages III and IV combined or the rapid eye movement (REM) stage. REE, VO2 and VCO2 in these sleep stages did not show significant correlation with the overall and the three components of the SCORAD scores.

CONCLUSIONS

Children with AD do not appear to have significant disturbance in their resting energy consumption, oxygen consumption and carbon dioxide production during sleep. These parameters do not appear to correlate with the symptomatology of pruritus and sleep disturbance. We speculate that deranged metabolism during sleep is unlikely in children with AD.

RANTES G-401A polymorphism is associated with allergen sensitization and FEV1 in Chinese children

G-401A polymorphism in RANTES promoter was associated with near-fatal asthma and atopic dermatitis in children. We studied whether gain-of-function mutations in RANTES gene were associated with asthma and atopy-related traits in Chinese children. Plasma total and aeroallergen-specific IgE concentrations were measured using micro-particle immunoassay and fluorescent enzyme immunoassay, respectively. Restriction fragment length polymorphism was used to genotype RANTES G-401A and C-28G. One hundred and twenty-nine asthmatic children and 66 controls were recruited. Their mean logarithmic plasma total IgE concentrations were 2.53 and 1.98, respectively (P<0.0001). RANTES G-401A was not associated with physician-diagnosed asthma (P = 0.408). However, RANTES G-401A allele was significantly associated with IgE sensitization to cat (odds ratio 2.35; 95% CI 1.15-4.77; P = 0.010). Those homozygous for -401A had higher plasma cat-specific IgE levels (P = 0.034). Subjects having -401A were also more likely to have mold-specific IgE (odds ratio 3.82; 95% CI 1.24-12.14; P = 0.007). On spirometry, those with -401A/ A had lower forced expiratory volume in 1-s (FEV1; P = 0.044). RANTES C-28G was not associated with any outcome in this study. In conclusion, the gain-of-function mutation at -401 of RANTES promoter is associated with sensitization to cat and mold allergens and FEV1 in Chinese children.

Chemokine response in children with SARS

The chemokine response of eight children with serologically confirmed severe acute respiratory syndrome (SARS) was longitudinally monitored. All had raised plasma interferon gamma inducible protein (IP-10) concentrations, which suggested an active type 1 T-helper lymphocyte mediated immune response. High circulating IP-10 levels could facilitate viral clearance and might play a role in assisting the recovery of the patients.

Childhood obstructive sleep apnoea: an update

OBJECTIVE

To review literature on epidemiology, complications, diagnosis, and treatment of childhood obstructive sleep apnoea.

DATA SOURCE

Literature search of MEDLINE up to July 2004 using the following key words: 'obstructive sleep apnoea syndrome', 'children', 'epidemiology', 'complications', 'treatment', and 'polysomnography'.

STUDY SELECTION

Literature and data related to the aspects of childhood obstructive sleep apnoea.

DATA EXTRACTION

Relevant information and data were reviewed by the authors.

DATA SYNTHESIS

There is a paucity of normal data on childhood obstructive sleep apnoea. Varying definitions and diagnostic criteria have been used in different studies, making direct comparison difficult. However, a small-scale local study found that the prevalence and clinical features of this condition were similar to data published overseas. Increasing evidence suggests that childhood obstructive sleep apnoea is associated with cardiovascular morbidity and neurocognitive dysfunction. Overnight polysomnography has remained the gold standard for diagnosing obstructive sleep apnoea but the diagnostic criteria has not been standardised nor correlated with the long-term outcome. Surgical intervention has remained the treatment of choice, although alternative therapies are being evaluated.

CONCLUSION

Consensus on the various important aspects of childhood obstructive sleep apnoea is still limited, especially the definition, diagnosis, and long-term sequelae of this condition. Further advances can only be made with international collaborative research, using evidence-based definitions, standardised techniques, and polysomnographic criteria.

Hepatic steatosis in obese Chinese children

OBJECTIVES

THE AIMS OF OUR STUDY WERE

(1) to determine the prevalence of asymptomatic hepatic steatosis and presumed nonalcoholic steatohepatitis, in our local population of obese Chinese children referred for medical assessment; and (2) to assess the correlation between severity of ultrasonographic hepatic steatosis and degree of obesity, insulin resistance and serum biochemical abnormalities.

DESIGN

Cross-sectional study.

METHODS

In total, 84 obese children, 25 girls and 59 boys with median age and body mass index (BMI) of 12.0 years (interquartile range (IR): 9.5-14.0) and 30.3 kg/m(2) (IR: 27.1-33.4), respectively, referred for medical assessment were studied. All subjects underwent physical examination, anthropometric and dual energy X-ray absorptiometry (DEXA) scan measurements and real-time ultrasonographic (US) examination of the liver. Fasting blood samples were collected for the measurement of liver function, hepatitis status, levels of serum glucose and insulin and lipid profile. Degree of fatty infiltration of the liver was graded according to ultrasonic appearance of liver echotexture, liver-diaphragm differentiation in echo amplitude, hepatic echo penetration and clarity of hepatic blood vessels.

RESULTS

All recruited subjects had no history of alcohol abuse and tests for Hepatitis B or C virus were negative. Thorough examination showed all of them to be in general good health without signs of chronic liver disease. Hepatic steatosis identified by defined ultrasonic appearances was diagnosed in 65 subjects (77%); 17 girls and 48 boys. The severity of fatty liver was positively related to anthropometric measurements including BMI, waist and hip circumference, subscapular skinfold thickness; insulin resistance markers [QUICKI and homeostasis model assessment (HOMA)], and hypertriglyceridaemia. Multvariate ordinal regression analysis showed that BMI and raised alanine aminotransferase (ALT) were positively associated with fatty liver. Combination of hepatic steatosis with raised ALT (presumptive NASH) was found in 19 subjects (24%). This group of patients had significantly higher waist hip ratio and conicity index compared to those with isolated hepatic steatosis. Boys with presumed NASH were also found to have significantly higher insulin resistance.

CONCLUSION

Nonalcoholic fatty liver disease (NAFLD) was common among our cohort of obese children referred for medical assessment. The prevalence of simple steatosis and presumed NASH was 77 and 24%, respectively. The severity of US steatosis was positively correlated with BMI, raised ALT, insulin resistance and hypertryglyceridaemia. Ultrasonography being noninvasive and readily available could be used for the monitoring of the progression of hepatic steatosis. Further longitudinal studies are required to determine the natural disease progression and the role of insulin resistance and other factors in the pathophysiology of NAFLD.

Infection control for SARS in a tertiary paediatric centre in Hong Kong

Severe acute respiratory syndrome (SARS) is an emerging infectious disease. After the appearance of an index patient in Hong Kong in February 2003, SARS outbreaks occurred rapidly in hospitals and spread to the community. The aim of this retrospective study is to evaluate the effectiveness of a triage policy and risk-stratified infection control measures in preventing nosocomial SARS infection among paediatric healthcare workers (HCWs) at the Prince of Wales Hospital, a general hospital to which children with SARS are referred in Hong Kong. The acute paediatric wards were stratified into three areas: (1) ultra high-risk area, (2) high-risk area and (3) moderate-risk area according to different risk levels of nosocomial SARS transmission. The implementation of different levels of infection control precautions was guided by this risk stratification strategy. Between 13 March and 23 June, 38 patients with probable and suspected SARS, 90 patients with non-SARS pneumonia, and 510 patients without pneumonia were admitted into our unit. All probable SARS cases were isolated in negative-pressure rooms. Twenty-six HCWs worked in the ultra high-risk area caring for SARS patients and 88 HCWs managed non-SARS patients in other ward areas. None of the HCWs developed clinical features suggestive of SARS. In addition, there was no nosocomial spread of SARS-associated coronavirus to other patients or visitors during this period. In conclusion, stringent infection control precautions, appropriate triage and prompt isolation of potential SARS patients may have contributed to a lack of nosocomial spread and HCW acquisition of SARS in our unit.

Urinary leukotriene E4 correlates with severity of atopic dermatitis in children

Leukotriene E4 (LTE(4)) is elevated in adults with atopic dermatitis (AD). We evaluated whether urinary LTE(4) as a noninvasive marker correlates with clinical indices of disease activity in children with AD. AD patients aged 18 years or younger were eligible for inclusion in the study. Disease severity over the preceding 3 days was evaluated by the SCORing Atopic Dermatitis (SCORAD) index. Severity of AD over the past 12 months was evaluated by the Nottingham Eczema Severity Score (NESS) in Chinese. Urinary LTE(4) concentration was measured by competitive enzyme immunoassay. One hundred and twenty-six children with AD (82 boys and 44 girls) and 45 controls were recruited. The mean +/- SD urinary log-transformed LTE(4) concentration in AD patients and controls was 2.94 +/- 0.32 and 2.62 +/- 0.20 pg/mg creatinine, respectively (P < 0.0001). SCORAD significantly correlated with NESS (r = 0.681, P < 0.0001). There were significant correlations between urinary LTE(4) concentration and overall SCORAD score (r = 0.270, P = 0.002) and its extent (r = 0.185, P = 0.038) and intensity components (r = 0.247, P = 0.005), but not with NESS. When compared with mild AD, urinary LTE(4) concentrations were higher in patients with moderate-to-severe disease (P = 0.049). Urinary LTE(4) measurement is noninvasive and may be useful in supplementing the SCORAD for following longitudinal changes in AD severity in children. However, the practical value of this assay in a clinical setting remains to be determined.

Serum levels of cutaneous T-cell attracting chemokine (CTACK) as a laboratory marker of the severity of atopic dermatitis in children

There are at least 13 scoring systems for the assessment of disease severity in atopic dermatitis (AD). Each system has its problems with interobserver and intraobserver variability. Cutaneous T-cell attracting chemokine (CTACK) is a skin-specific chemoattractant which may correlate with AD severity and obviate the issue of observer reliability. We evaluated whether serum CTACK concentrations were associated with the severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Thirty-seven Chinese children with AD (23 boys, 14 girls; aged 1-11 years) and 13 controls were recruited. The median (interquartile range) overall SCORAD for AD patients was 29.7 (20.3-49.7). Serum concentrations of CTACK and two other atopy-related chemokines, macrophage-derived chemokine (MDC) and thymus and activation-regulated chemokine (TARC), were measured by sandwich enzyme immunoassay. There were significant correlations between SCORAD (r = 0.394, P = 0.016), its area (r = 0.528, P = 0.001) and intensity components (r = 0.429, P = 0.008) with serum levels of CTACK. The serum concentrations of inflammatory markers MDC and TARC also correlated with the CTACK concentrations (r = 0.618, P < 0.001, and r = 0.587, P = 0.001, respectively). Serum CTACK concentration appears to be a skin-specific objective marker that correlates with various clinical and laboratory parameters of AD.

Severe acute respiratory syndrome: 'SARS' or 'not SARS'

Accurate clinical diagnosis of severe acute respiratory syndrome (SARS) based on the current World Health Organization definition is difficult and at times impossible at the early stage of the disease. Both false positive and false negative cases are commonly encountered and this could have far-reaching detrimental effects on the patients, their family and the clinicians alike. Contact history is particularly important in diagnosing SARS in children as their presenting features are often non-specific. The difficulty in making a correct diagnosis is further compounded by the lack of a sensitive rapid diagnostic test. Serology is not particularly helpful in the initial triaging of patients as it takes at least 3 weeks to become positive. Co-infection and other treatable conditions should not be missed and conventional antibiotics should remain as part of the first-line treatment regimen. We report five cases to illustrate the difficulties and dilemmas faced by clinicians in diagnosing SARS in children.

Risk factors for childhood overweight in 6- to 7-y-old Hong Kong children

OBJECTIVE

To identify risk factors for overweight in Hong Kong children aged 6-7 y.

DESIGN

Case-control study.

SETTING

Student Health Service Centres, Hong Kong.

SUBJECTS

A total of 343 Hong Kong Chinese children aged 6-7 y old categorised into three groups, an overweight group (> or =92 nd centile for BMI), a normal middle-weight group (45th-55th centile for BMI) and a normal low-weight group (< or =8th centile for BMI).

MEASUREMENTS

Subjects and their parents/caregivers were interviewed at home. Data on lifestyle habits, dietary habits, family structure and demographic background were collected by questionnaire. A 3-day dietary record was administrated by the parents/caregivers to assess dietary intake of the children.

RESULTS

Logistic regression analyses (overweight group compared with middle-weight plus low-weight groups) showed that childhood overweight was significantly associated with parental obesity (BMI > or =25 kg/m(2), Asian reference) (paternal: OR=2.66, 95% CI=1.51-4.70; maternal: 5.07, 2.62-9.79) but not parental overweight (BMI=23-25 kg/m(2)). After adjustment for parental obesity, the odds ratio for childhood overweight was increased by birth weight (<3.0 kg as reference, 3.0-3.5 kg: 2.13, 1.18-3.84; > or =3.5 kg: 4.89, 2.49-9.60) and decreased by sleeping duration (<9 h/day as reference, 9-11 h/day: 0.54, 0.30-0.97; > or =11 h/day: 0.31, 0.11-0.87). Childhood overweight was also significantly associated with higher energy consumption (2.62, 1.20-5.74) and having a father who was a current smoker (2.08, 1.25-3.46).

CONCLUSIONS

Although healthy diet and regular exercise will remain the cornerstones of obesity management in children, our data support the view that education about maintaining a healthy weight could be introduced much earlier in those families with high-risk children, as indicated by high parental BMI or high birth weight. The utility and practicality of such an approach should be carefully evaluated before becoming part of any public health policy. Further study of the role of short sleeping duration and parental smoking on childhood obesity development is warranted.

A controlled study of sleep related disordered breathing in obese children

BACKGROUND

Unlike the adult sleep related disordered breathing (SDB) patients who are typically obese, the relation between obesity and childhood SDB is not clear.

AIMS

To investigate whether obese children are more at risk of obstructive SDB when compared to normal population, and whether this risk is potentiated by the presence of pharyngeal lymphoid tissue.

METHODS

Forty six obese children (age 10.8 (SD 2.3) years; BMI 27.4 (SD 5.1)), and 44 sex and age matched normal weight children (age 11.7 (SD 2.1) years; BMI 18 (SD 1.8)) were studied. All children underwent a set of physical examinations (including the upper airways) and sleep studies.

RESULTS

The obese children were different from the normal weight children in terms of type (predominantly obstructive), frequency, and severity of respiratory disturbances. Depending on the criteria used, 26% or 32.6% of obese children had SDB; 2.3% of normal controls had OAI > or =1 and 4.5% had RDI > or =5. Presence of SDB was related to presence of tonsils (size >2; range 0-4) (OR 12.67, 95% CI 2.14 to 75.17) and BMI (OR 1.20, 95% CI 1.08 to 1.33).

CONCLUSIONS

Results suggest that obese children are at increased risk of obstructive SDB; the presence of any pharyngeal lymphoid tissue enlargement in obese children should therefore be aggressively managed.

Cough frequency in children with stable asthma: correlation with lung function, exhaled nitric oxide, and sputum eosinophil count

BACKGROUND

A study was undertaken to assess the correlation between cough frequency in asthmatic children with lung function and two non-invasive markers of airway inflammation.

METHODS

Thirty two children of median age 12.0 years (interquartile range (IQR) 9.5-13.4) with stable asthma were recruited. They underwent spirometric testing, exhaled nitric oxide (eNO) measurement, sputum induction for differential cell count, and ambulatory cough monitoring over 17 hours and 40 minutes. Coughing episodes were counted both as individual spikes and as clusters.

RESULTS

Complete cough frequency data were available in 29 children (90%) and their median forced expiratory volume in 1 second (FEV1) and eNO were 88.5% (IQR 79.5-98) and 23.9 ppb (IQR 11.4-41.5), respectively. The median number of cough episodes was 14 (IQR 7.0-24.0) which was significantly higher than that of normal children (6.7 (IQR 4.1-10.5), p<0.001). Sputum induction was successful in 61% of the subjects; the median induced sputum eosinophil count was 0.05% (IQR 0-9.0). Cough frequency was found to have a significant positive correlation with eNO (Spearman's r =0.781, p<0.001) but not with FEV1 or sputum eosinophil count (r =-0.270, p=0.157; r =0.173, p=0.508, respectively).

CONCLUSIONS

Children with stable asthma have increased cough frequency compared with normal controls and cough frequency was greater during the day than at night. Cough may be a more sensitive marker of airway inflammation than simple spirometry.

[The role of Anopheles anthropophagus in malaria transmission in in Xinyang City of Henan Province]

OBJECTIVE

To study the role of Anopheles anthropophagus in malaria transmission and transmission threshold so as to provide basis for vector surveillance and malaria control strategy.

METHODS

Parasitological and entomological methods were used in the investigation at 5 villages of Xinyang City, Henan Province.

RESULTS

From July to August, 1999, 74 febrile cases (10.9% of the total population) were examined. Among them 50 were infected, the incidence in the population of surveyed spots was 7.4%. Active detection was made in another randomly selected two villages and found that the parasite rate in the inhabitants was 2.0%, and the positive rate of IFA was 8.4%. Only vivax malaria was detected. An. anthropophagus and An. sinensis were collected, with An. anthropophagus as the predominant one in human dwellings. The estimated man-biting rate and the human blood index were 4.9388 and 0.7858 respectively. The vectorial capacity of An. anthropophagus was 5.5296. The critical man-biting rate of An. anthropophagus was 0.2407 as calculated by the formula (ma = -rlnP/abPh) according to Macdonald's model. The local man-biting rate was 20 times higher than that of the critical man-biting rate.

CONCLUSION

The results demonstrated that An. anthropophagus is the principal vector in malaria transmission in the area. The findings imply that the critical man-biting rate is of practicable importance in vector surveillance.

Sleeping energy expenditure in paediatric patients with obstructive sleep apnoea syndrome

OBJECTIVE

To investigate sleeping energy expenditure in paediatric patients with obstructive sleep apnoea syndrome.

DESIGN

Retrospective study. Setting. University teaching hospital, Hong Kong.

PATIENTS AND METHODS

A retrospective analysis comparing sleeping energy expenditure in patients with confirmed obstructive sleep apnoea syndrome and control subjects matched for age, sex, and ideal weight for body height. Subjects were recruited from the Paediatric Chest Clinic and all had undergone overnight polysomnography and sleeping energy expenditure measurement by open-circuit indirect calorimetry using a metabolic cart and canopy system. The measurements were taken during slow-wave sleep.

RESULTS

Twenty-four cases with obstructive sleep apnoea syndrome (apnoea hypopnoea index >5) and 23 control subjects were studied. Mean age and ideal weight for body height were 9.4 (standard deviation, 3.9) years and 152.5% (27.2%), respectively. Mean sleeping energy expenditure corrected for body weight for the cases and the control group were 44.83 (standard deviation, 10.49) Kcal/day and 40.71 (10.60) Kcal/day, respectively. Sleeping energy expenditure was not found to be associated with the severity of obstructive sleep apnoea syndrome (r=0.34, P=0.27).

CONCLUSION

A trend towards greater sleeping energy expenditure was found in patients with obstructive sleep apnoea syndrome. Further studies on the metabolic aspects of this condition are required.

Hurler's syndrome with cor pulmonale secondary to obstructive sleep apnoea treated by continuous positive airway pressure

A 6-year-old boy with Hurler's syndrome presented with right heart failure and pulmonary hypertension secondary to severe obstructive sleep apnoea. Both his sleep apnoea and cor pulmonale were effectively controlled with continuous positive airway pressure therapy.

Infection control for SARS in a tertiary neonatal centre

The Severe Acute Respiratory Syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus, which can readily spread in the healthcare setting. A recent community outbreak in Hong Kong infected a significant number of pregnant women who subsequently required emergency caesarean section for deteriorating maternal condition and respiratory failure. As no neonatal clinician has any experience in looking after these high risk infants, stringent infection control measures for prevention of cross infection between patients and staff are important to safeguard the wellbeing of the work force and to avoid nosocomial spread of SARS within the neonatal unit. This article describes the infection control and patient triage policy of the neonatal unit at the Prince of Wales Hospital, Hong Kong. We hope this information is useful in helping other units to formulate their own infection control plans according to their own unit configuration and clinical needs.

Role of amination of a polymeric adsorbent on phenol adsorption from aqueous solution

Adsorption of seven phenols, one aromatic carboxylic acid and one sulfonated aromatic acid from aqueous solution, by a hypercrosslinked polymeric adsorbent (CHA-111) and the derivative animated by dimethylamine was compared. The results of different adsorption isotherms indicated that amino group on the polymeric matrix played a significant role on adsorption of almost all the employed compounds. For most employed compounds adsorption capacities increase to different degree and significantly for those with lower value of pK(a). It may be attributed to the enhanced adsorbent-adsorbate interaction for amino group introduced on the polymeric matrix. The empirical Freundlich isotherm equation was employed to interpret the adsorbent-adsorbate interaction. The adsorption enthalpy change indicated the uptake of phenols on MCH-111 to be an enhanced physical adsorption because of the hydrogen-bonding interaction. Adsorption kinetic study of phenols on CHA-111 and MCH-111 was also conducted and amino group on the matrix will reduce the adsorption rate for change of pore size distribution and loss of macroprous volume as well as the hydration effect on the surface partly.

Clinical presentations and outcome of severe acute respiratory syndrome in children

Hong Kong has been severely affected by severe acute respiratory syndrome (SARS). Contact in households and health-care settings is thought to be important for transmission, putting children at particular risk. Most data so far, however, have been for adults. We prospectively followed up the first ten children with SARS managed during the early phase of the epidemic in Hong Kong. All the children had been in close contact with infected adults. Persistent fever, cough, progressive radiographic changes of chest and lymphopenia were noted in all patients. The children were treated with high-dose ribavirin, oral prednisolone, or intravenous methylprednisolone, with no short-term adverse effects. Four teenagers required oxygen therapy and two needed assisted ventilation. None of the younger children required oxygen supplementation. Compared with adults and teenagers, SARS seems to have a less aggressive clinical course in younger children.