To determine the incidence of infections with hepatitis B virus (HBV) among Chinese preschool children, 1,510 children (mean age, 29 months) were tested for HBV markers; 15.9% were infected with HBV (7.8% positive for hepatitis B surface antigen [HBsAg] and 8.1% positive for antibody to HBsAg) and 84.1% were susceptible when the children were enrolled in the study. The average length of follow-up was 2.1 years among 1,110 children. Among the 924 susceptible children who were followed up, 10.6% had seroconversions for HBV markers, none of which was associated with clinical illness; the annual incidence of HBV infections was 5.0%. Among the 98 children who experienced HBV infections during the study, 23% became HBsAg carriers, and HBsAg persistence was age-related, with most carriers being among the youngest children infected. In contrast, among the children with HBV markers at the time of enrollment, 118 (49.2%) were HBsAg-positive and 86% were still positive on follow-up. The incidence of HBV infections was significantly associated with the frequency of previous injections.
Paraquat (PQ) is a widely used bipyridyl contact herbicide with a good safety record when used properly. Most cases of PQ poisoning result from PQ suicidal ingestion. There are three degrees of severity in PQ poisoning (1, 2). Mild poisoning can cause oral irritation and gastric upset, and brings complete recovery. Moderate to severe poisoning produces acute renal failure, and in severe cases, hepatitis followed by pulmonary fibrosis, leading to death after 2 to 3 wk. Acute fulminant poisoning results in death within 1 wk from multiple organ failure and cardiovascular collapse. Retrospective studies (3)(4)(5)(6) show that good predictors of outcome may be plasma and urine concentrations within the first 24 h of intoxication. The urine PQ tests taken on admission are reasonable guides to predict the severity of poisoning and have the advantage that a qualitative or semiquantitative result may be easily and rapidly obtained in an emergency situation (5-7).The results of treatments for PQ poisoning, including absorbents, pharmacological approaches (8), radiotherapy (9), hemodialysis, and hemoperfusion (10), were disappointing. Although the high-dose cyclophosphamide (CP) and dexamethasone (DX) treatments, including intravenous CP 5 mg/kg/d and DX 24 mg/d for 14 d, had a 75% survival rate after PQ poisoning (11), a subsequent study (12) did not demonstrate the efficacy of this approach. Therefore, the efficiency of highdose CP and DX in PQ poisoning remains controversial. Recently, pulse therapy with CP and methylprednisolone (MP), including intravenous CP or MP 1 g/d for 2 to 3 d, has been used to treat effectively many patients with severe lung damage from systemic lupus erythematosus (SLE) and Wegener's granulomatosis (13,14), with greater efficacy and less side effects than those of high doses of CP therapy. In addition, our preliminary report (15) demonstrated that pulse therapy might be effective in treating patients with moderate to severe PQ poisoning. Because the previous study was not prospective and only included a small number of patients, we designed the prospective study to evaluate its efficacy in treating a large group of PQ-poisoned patients.
METHODSThis study was approved by the clinical research committee of Chang Gung Memorial Hospital and had the informed consent of all patients. This prospective study lasted from January 1992 to December 1997. During this period, 142 patients with PQ poisoning were admitted to our hospital within 24 h after ingestion. In urine samples taken on arrival at our emergency department, PQ was immediately detected by the sodium dithionite reaction. The sodium dithionite test is based on the reduction of PQ by sodium thionite under alkaline condition to form its stable blue radical ion. A strong "navy blue" (NB) or "dark blue" (DB) generally indicates significant PQ ingestion and subsequent poor prognosis (5-7). Patients were classified as having:( 1 ) fulminant poisoning if their urinary dithionite reaction yielded a NB or DB and if they died from multiple organ failur...
We conclude that poor glycaemic control before starting dialysis is a strong predictor of cardiovascular morbidity and survival for type II diabetics on haemodialysis. These results imply that better glycaemic control before dialysis might be important in improving the long-term prognosis in type II diabetics on haemodialysis.
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