Showing papers by "Hospital for Sick Children published in 2002"

Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes.

Abstract: Research on attention-deficit/hyperactivity disorder (ADHD), a highly prevalent and controversial condition, has, for the most part, been descriptive and atheoretical. The imperative to discover the genetic and environmental risk factors for ADHD is motivating the search for quantifiable intermediate constructs, termed endophenotypes. In this selective review, we conclude that such endophenotypes should be solidly grounded in the neurosciences. We propose that three such endophenotypes — a specific abnormality in reward-related circuitry that leads to shortened delay gradients, deficits in temporal processing that result in high intrasubject intertrial variability, and deficits in working memory — are most amenable to integrative collaborative approaches that aim to uncover the causes of ADHD.

Report of the National Institute of Neurological Disorders and Stroke workshop on perinatal and childhood stroke.

Abstract: The National Institute of Neurological Disorders and Stroke and the Office of Rare Disorders sponsored a workshop on perinatal and childhood stroke in Bethesda, Maryland, on September 18 and 19, 2000. This was an international workshop to bring together experts in the field of perinatal and childhood stroke. Topics covered included epidemiology, animal models, risk factors, outcome and prognosis, and areas of future research for perinatal and childhood stroke. Stroke in infants and children is an important cause of morbidity and mortality and an emerging area for clinical and translational research. Currently, there is no consensus on the classification, evaluation, outcome measurement, or treatment of perinatal and childhood stroke. Pediatric stroke registries are needed to generate data regarding risk factors, recurrence, and outcome. The impact of maternal and perinatal factors on risk and outcome of neonatal stroke needs to be studied. This information is essential to identifying significant areas for future treatment and prevention.

Neuropsychological profiles of adolescents with ADHD: effects of reading difficulties and gender

Abstract: Background: Executive function, particularly behavioral inhibition, has been implicated as a core deficit specific to Attention-Deficit/Hyperactivity Disorder (ADHD) whereas rapid naming has been implicated as a core deficit specific to reading disabilities (RD). Females may be less impaired in executive function although adolescent females with ADHD have yet to be studied. Method: Neuropsychological profiles of four adolescent groups aged 13–16 with equal female representation were investigated: 35 ADHD, 12 RD, 24 ADHD+RD, and 37 normal controls. A semi-structured interview (K-SADS-PL), the Conners Rating Scales and the Ontario Child Health Study Scales were used to diagnose ADHD. RD was defined as a standard score below 90 on at least one of the following: Reading or Spelling of the WRAT3 or Word Attack or Word Identification of the WRMT-R. The WISC-III, Rapid Automatized Naming, Stroop and Stop tasks were used as measures of cognitive and executive function. Results: The two ADHD groups (ADHD, ADHD+RD) showed deficits in processing speed, naming of objects, poor behavioral inhibition and greater variability in reaction times whereas the two RD groups (RD, RD+ADHD) showed verbal working memory deficits and slower verbal retrieval speed. Only the comorbid group was slower with naming of numbers and colors and had slower reaction times. Regression analyses indicated that incongruent color naming (Stroop) and variability in go reaction time were the best predictors of hyperactive/impulsive ADHD symptoms whereas variability in go reaction time and processing speed were the best predictors of inattentive ADHD symptoms. Speed of letter naming and verbal working memory accounted for the most variability in composite achievement scores. No gender differences were found on any of the cognitive tests. Conclusions: This study challenges the importance of behavioral inhibition deficits in ADHD and that naming deficits are specific to RD. Further investigation into cognitive deficits in these groups is required. ADHD: Attention-Deficit/Hyperactivity Disorder; RD: Reading Difficulties; SES: socio-economic status; CTRS: Conners' Teacher Rating Scale; OCHSS: Ontario Child Health Study Scales; WRAT: Wide Range Achievement Test; WRMT: Woodcock Reading Mastery Test; MDD: Major Depressive Disorder; SAD: Separation Anxiety Disorder; GAD: Generalized Anxiety Disorder; OCD: Obsessive Compulsive Disorder; WISC: Wechsler Intelligence Scale for Children; RAN: Rapid Automatized Naming; SSRT: Stop Signal Reaction Time;

The development of selective inhibitory control across the life span.

Abstract: A modification of the stop-signal task was used to investigate the development of selective inhibitory control. A group of 317 participants, age 6 to 82 years, performed a visual choice reaction time (go) task and attempted to selectively inhibit their response to the go task when hearing one of two randomly presented tones (1000 Hz, 250 Hz), each presented on 20% of trials. Measures of response execution and inhibition were assessed by using reaction times to the go signal (GoRT) and stop signal (SSRT), respectively. Results indicated that SSRT gets faster with increasing age throughout childhood, with pronounced slowing in older adulthood. In addition, strong evidence was obtained for age-related speeding in GoRT throughout childhood, with marked slowing throughout adulthood. Subsequent hierarchical regression analyses illustrated that the age-related changes in selective inhibitory control could not be explained simply by overall slowing or speeding of responses. Findings are discussed in regard to the decay and maturation of selective inhibitory control across the life span.

VSX1: A gene for Posterior Polymorphous Dystrophy and Keratoconus

Abstract: We identified mutations in the VSX1 homeobox gene for two distinct inherited corneal dystrophies; posterior polymorphous dystrophy (PPD) and keratoconus. One of the mutation (R166W) responsible for keratoconus altered the homeodomain and impaired DNA binding. Two other sequence changes (L159M and G160D) were associated with keratoconus and PPD, respectively, and involved a region adjacent to the homeodomain. The G160D substitution, and a fourth defect affecting the highly conserved CVC domain (P247R), occurred in a child with very severe PPD who required a corneal transplant at 3 months of age. In this family, relatives with the G160D change alone had mild to moderate PPD, while P247R alone caused no corneal abnormalities. However, with either the G160D or P247R mutation, electroretinography detected abnormal function of the inner retina, where VSX1 is expressed. These data define the molecular basis of two important corneal dystrophies and reveal the importance of the CVC domain in the human retina.

Anticoagulation for cerebral sinus thrombosis.

Abstract: Background Treatment of cerebral sinus thrombosis with anticoagulants has been controversial. Anticoagulants may prevent new venous infarcts, neurologic deterioration, and pulmonary embolism but may also promote haemorrhages. Objectives To review the available evidence regarding the effectiveness and safety of anticoagulant therapy in patients with confirmed cerebral sinus thrombosis. Search strategy We searched the Cochrane Stroke Group Trials Register (last searched 18 March 2002). We also searched MEDLINE (1966-Oct 2001), EMBASE (1980-Feb 2002) and the Cochrane Controlled Trials Register (Cochrane Library, 2002 Issue 1) and contacted authors to identify additional published and unpublished studies. Selection criteria Unconfounded randomised controlled trials in which anticoagulant therapy was compared with placebo or open control in patients with cerebral sinus thrombosis (confirmed by intra-arterial contrast or magnetic resonance angiography). Data collection and analysis Two reviewers independently extracted outcomes for each of the two treatment groups (anticoagulant treatment and control). The outcome data for each patient are analysed in the treatment group to which the patient was originally allocated ('intention to treat' analysis). A weighted estimate of the treatment effects across trials (relative risk, absolute risk reduction) is calculated using the Cochrane statistical software. Main results Two small trials involving 79 patients fulfilled the inclusion criteria. One trial (20 patients) examined the efficacy of intravenous, adjusted dose unfractionated heparin. The other trial (59 patients) examined high dose, body weight adjusted, subcutaneous, low-molecular weight heparin (Nadroparin). Anticoagulant therapy was associated with a pooled relative risk of death of 0.33 (95 % CI 0.08 to 1.21) and of death or dependency of 0.46 (95 % CI 0.16 to 1.31). No new symptomatic intracerebral haemorrhages were observed. One major gastro-intestinal haemorrhage occurred after anticoagulant treatment. Two control patients (placebo) had a diagnosis of probable pulmonary embolism (one fatal). Reviewer's conclusions Based upon the limited evidence available, anticoagulant treatment for cerebral sinus thrombosis appeared to be safe and was associated with a potentially important reduction in the risk of death or dependency which did not reach statistical significance.

The effects of interactive music therapy on hospitalized children with cancer: a pilot study

Abstract: Background. The use of music therapy with children in health settings has been documented, but its effectiveness has not yet been well established. This pilot study is a preliminary exploration of the effectiveness of interactive music therapy in reducing anxiety and increasing the comfort of hospitalized children with cancer. Methods. Pre- and post-music therapy measures were obtained from children (N=65) and parents. The measures consisted of children's ratings of mood using schematic faces, parental ratings of the child's play performance, and satisfaction questionnaires completed by parents, children and staff. Results. There was a significant improvement in children's ratings of their feelings from pre- to post-music therapy. Parents perceived an improved play performance after music therapy in pre-schoolers and adolescents but not in school-aged children. Qualitative analyses of children's and parents' comments suggested a positive impact of music therapy on the child's well-being. Conclusions. These preliminary findings are encouraging and suggest beneficial effects of interactive music therapy with hospitalized pediatric hematology/oncology patients. In future studies replicating these findings should be conducted in a randomized control trial. Copyright © 2002 John Wiley & Sons, Ltd.

The effect of early visual deprivation on the development of face processing

Abstract: We evaluated the importance of early visual input for the later development of expertise in face processing by studying 17 patients, aged 10 to 38 years, treated for bilateral congenital cataracts that deprived them of patterned visual input for the first 7 weeks or more after birth. We administered five computerized tasks that required matching faces on the basis of identity (with changed facial expression or head orientation), facial expression, gaze direction and lip reading. Compared to an age-matched control group, patients’ recognition of facial identity was impaired significantly when there was a change in head orientation (e.g. from frontal to tilted up), and tended to be impaired when there was a change in facial expression (e.g. from happy to surprised). Patients performed normally when matching facial expression and direction of gaze (e.g. looking left or right), and in reading lips (e.g. pronouncing ‘u’ or ‘a’). The results indicate that visual input during early infancy is necessary for the normal development of some aspects of face processing, and are consistent with theories postulating the importance of early visual experience (de Schonen & Mathivet, 1989; Johnson & Morton, 1991) and separate neural mediation of different components of face processing (Bruce & Young, 1986).

“Proactive” Management of Percutaneously Inserted Central Catheters Results in Decreased Incidence of Infection in the ELBW Population

Abstract: OBJECTIVE: Extremely low birth weight (ELBW) infants often acquire catheter-related infections (CRIs) when a percutaneously inserted central catheter (PICC) is used for parenteral nutrition or drug administration. Our objective was to compare the incidence of CRIs after we established a “PICC Maintenance Team” for the proactive management — compared to expectant management — of these lines. STUDY DESIGN: We did a prospective collection and analysis of catheter-related sepsis data over a 15-month period from February 1, 1998 through May 1, 1999. Eligible patients included all neonates weighing <1000 g at birth. RESULTS: There was a significantly decreased incidence of CRIs, to a rate of 7.1%, or 5.1/1000 catheter days (p<0.05). CONCLUSION: “Proactive” management of PICC, significantly reduced the incidence of CRIs. The reduction in infection rate is estimated to save 180 hospitalized patient days/100 very low birth weight neonates, with a concomitant savings in morbidity and medical expense.

A Systematic Literature Review of the Effectiveness of Community-Based Strategies to Increase Cervical Cancer Screening

Abstract: Objective: To evaluate and summarize evidence of the effectiveness of interventions available to public health staff that could be used to increase cervical cancer screening to women. Method: A thorough literature review was conducted, articles screened for relevance and assessed for quality. Results: Of 42 relevant studies, 1 was rated ‘strong’, 18 ‘moderate’ and 23 ‘weak’. Among the strong/moderate studies, 10 were aimed at disadvantaged women. The most frequently used intervention was mass media campaigns, alone or combined with individual strategies; followed by individual education using lay health educators; and last, letters of invitation. Thirteen of the moderate/strong studies evaluated strategies that reported statistically significant increases in Pap smear rates and other outcomes. Conclusions: Strategies that combined mass media campaigns with direct tailored education to women and/or health care providers seemed most successful. The importance of accurate centralized cytology databases for recall is underscored.

Influenza vaccination during pregnancy.

Abstract: QUESTION: A 27-year-old patient of mine recently learned she is pregnant. She took the influenza vaccine offered at work when she was 7 weeks pregnant. Is her fetus at risk of malformations? ANSWER: No evidence indicates that killed influenza vaccine is teratogenic, even if given during the first trimester. Since 1996, Health Canada's Centre for Disease Control and Prevention has recommended that pregnant women in their second and third trimesters be vaccinated. This should not be interpreted as evidence that the vaccine is teratogenic in the first trimester because such evidence does not exist.

A prospective-controlled study of pregnant veterinary staff exposed to inhaled anesthetics and x-rays.

Abstract: Most veterinary staff are women of reproductive age. They are exposed to "waste" anesthetic gas and ionizing radiation in their workplace, which may endanger fetal safety. Presently, exposure of female veterinary staff to these health hazards has not been adequately addressed in the medical literature. Our primary objective was to investigate the incidence of major malformations associated with occupational exposure to inhaled anesthetics and/or radiation among pregnant veterinary staff. The secondary objective was to determine the rates of other adverse outcomes. We prospectively collected data on and followed-up women occupationally exposed to inhaled anesthetics and/or radiation in veterinary practices in Ontario, and compared them to controls matched for maternal age and gestational age at the time of call to the Motherisk Program. A total of 95 women were prospectively enrolled and followed-up. Among the participants there were 87 (93.5%) and 88 (92.8%) livebirths in the study and control groups, respectively. There were 4 (4.8%) major birth defects in the study group and 3 (3.4%) in the control group. The rates of spontaneous abortion were also similar, 6 (6.4%) cases in the study group and 7 (7.4%) cases in the control group. These results suggest that Ontario female veterinary staff exposed to inhaled anesthetics and/or radiation do not seem to be at an increased risk for major malformations above baseline risk.

Automobile restraints for children: a review for clinicians

Abstract: More Canadian children die of road traffic injuries than of any other cause. Nonuse and misuse of child restraints is common and leads to preventable severe injuries or deaths. This article, intended for clinicians interested in injury prevention counselling, advocacy, research, and treatment of child occupants in car crashes, reviews current knowledge about child safety seats and discusses controversies related to their use. Children should sit in the back seat of a vehicle and should be properly restrained in a current age- and size-appropriate device (rear-facing infant seat, child safety seat, booster seat, or lap and shoulder seat belt) that is properly adjusted. The centre rear seat is safer than side positions, but a lap belt alone should be avoided. The age at which children should start sitting in a forward-facing position is controversial. Children should be seated away from air bags. Resources to aid in patient counselling are described.

Pharmacological interventions for recurrent abdominal pain (RAP) in childhood.

Abstract: Background Between 4% and 25% of school age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. For the majority of such children no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions has been recommended. Objectives To determine the effectiveness of medication for recurrent abdominal pain in school-age children. Search strategy The Cochrane Library (CENTRAL), MEDLINE, EMBASE, CINAHL, ERIC, PsycLIT, LILACS and JICST were searched using a strategy combining (Recurrent OR synonyms) AND (Abdomen OR synonyms) AND (Pain OR synonyms). Where appropriate search filters were employed. In addition, researchers working in this area were asked to identify relevant studies. Selection criteria Any study in which the majority of participants were school age children fulfilling standard criteria for RAP, and who were allocated by random or quasi-random methods to any drug treatment compared with a placebo or no treatment. Data collection and analysis References identified by the searches were screened against the inclusion criteria by two independent reviewers. Main results Only one trial met the inclusion criteria. This cross-over trial in 14 children who met suggested criteria for "abdominal migraine" compared pizotifen and placebo, each given for one month with no washout period. Participants reported a mean of 8.21 (95% CI 2.93, 13.48) fewer days of pain while taking the active drug. They also reported that the mean difference on an "Index of Severity" was -16.21 (95% CI -26.51, -5.90) and on an "Index of Misery" was -56.07 (95% CI -94.07, -18.07). Reviewer's conclusions There is little evidence to suggest that recommended drugs are effective in the management of RAP. At present there seems little justification for the use of these drugs other than in clinical trials. There is an urgent need for trials of all suggested pharmacologic interventions in children with RAP.

Nausea and vomiting of pregnancy. Evidence-based treatment algorithm.

Abstract: QUESTION: One of my patients suffers from a moderate-to-severe form of morning sickness. She responded only partially to doxylamine and pyridoxine (Dicletin), and I wish to try adding another medication. What should my priority be? ANSWER: An algorithm used by Motherisk to manage thousands of patients takes a hierarchical approach to this condition. This approach is evidence based with regard to fetal safety as well as efficacy.

Taking ACE inhibitors during pregnancy. Is it safe

Abstract: QUESTION: A pregnant patient is taking enalapril for primary hypertension. How safe are angiotension-converting enzyme inhibitors (ACEI) during pregnancy? ANSWER: Evidence of whether ACEIs cause problems during the first trimester of pregnancy is reassuring. There is evidence that they cause severe renal and other problems during the second and third trimesters, however. These drugs should be avoided during pregnancy.

Drinking alcohol while breastfeeding. Will it harm my baby

Abstract: QUESTION: I recently delivered a healthy, full-term baby and am now breastfeeding exclusively. I abstained from drinking alcohol during my entire pregnancy and am wondering if drinking alcohol now would harm my nursing baby. ANSWER: Nursing mothers who choose to drink alcohol during the postpartum period should carefully plan a breastfeeding schedule by storing milk before drinking and waiting for complete elimination of alcohol from their breast milk after drinking. Motherisk has created an algorithm to estimate how long it takes to eliminate alcohol from breast milk.

S-SAD, Se-SAD and S/Se-SIRAS using Cu Kα radiation: why wait for synchrotron time?

Abstract: The structure of Escherichia coli argininosuccinate synthetase (EAS) has been determined using S-SAD, Se-SAD and S/Se-­SIRAS data measured with Cu Kα radiation. EAS contains 16 methionines and three cysteines in 455 amino acids. At a wavelength of 1.54 A (Cu Kα), the native (S-Met) and derivative (Se-Met) proteins yield anomalous signals of approximately 0.86 and 1.6%, respectively. Highly redundant data were measured to 2.0 A from native and derivative EAS crystals. All three structure determinations were carried out in a highly automated manner using SnB and SOLVE/RESOLVE. Despite the minute Bijvoet differences at 1.54 A, the signal was sufficient to determine the heavy-atom substructure and produce high-quality electron-density maps in all three cases. These maps were readily interpretable by the RESOLVE automated building algorithm, which modeled greater than 75% of all three structures. The success of these methods has profound implications for crystallographers experiencing difficulty with heavy-atom incorporation or with limited access to a synchrotron source.

Taking ginger for nausea and vomiting during pregnancy.

Abstract: QUESTION: Many of my patients prefer to use natural or herbal medicines, such as ginger, before taking drugs to treat nausea and vomiting of pregnancy. Is there evidence that ginger is safe to use during pregnancy? Is it effective? ANSWER: Although ginger is used in many cultures to treat the symptoms of nausea and vomiting, no trials have established its safety for use during pregnancy. On the other hand, its efficacy has been documented in two randomized, blinded controlled trials.

Ethical Issues in Including Pediatric Cancer Patients in Drug Development Trials

Abstract: Since the biology, pharmacology and toxicology of pediatric cancer is so different from cancer in adults, it is impossible to extrapolate from adult cancer experience; however, conducting studies in children with cancer is ethically and clinically very complex. This is especially so in phase 1 trials, aimed at dose finding for new modalities, where the chances to cure the child who failed standard therapy are marginal to non-existent. Hence, the child may be exposed to risks and discomfort which may be unbalanced by potential benefits. This situation, which is difficult for consenting adults, is much more complex when a parent gives proxy consent. This review addresses the ethical and clinical framework of such studies in the most vulnerable of children.

Update on motherisk updates. Seven years of questions and answers.

Abstract: QUESTION: Every month I read the Motherisk Updates in your journal and find them very helpful in counseling my patients on exposures during pregnancy and breastfeeding. I was wondering: what are the most common questions you receive from family physicians? ANSWER: Since the Motherisk Update began, we have received an increasing number of inquiries from family physicians across Canada. Most questions are about drug exposures. The three classes of drugs asked about most often are antidepressants, antiepileptics, and antihistamines.

Blastomycosis acquired by three children in Toronto.

Abstract: Three paediatric cases of blastomycosis, apparently acquired in or near Toronto, Ontario, a region not known to be endemic for this disease, are described. Blastomycosis was not suspected clinically in any of the three cases, and the diagnosis was established only when the diagnostic net was broadened to include fungal and mycobacterial cultures. All three patients were diagnosed after significant delays, which is consistent with the rarity of the disease in children and its acquisition outside previously accepted geographical boundaries. Pulmonary involvement was present in all three children, while one also had multifocal osteomyelitis. Drug therapy was successful in all three cases, either with amphotericin B followed by itraconazole, or itraconazole alone. Blastomycosis should be included in the differential diagnosis of a patient from the Toronto area who presents with a compatible history despite a negative travel history to known endemic zones.

Red hemiscrotum in a child with abdominal pain.

Abstract: This previously healthy 5-year-old boy presented to hospital with a 2-day history of abdominal pain and nonbilious vomiting, with no change in bowel habits. Originally periumbilical, the abdominal pain had shifted to the right side of the abdomen over 24 hours, gradually worsened and ultimately

Pro/con clinical debate: do colloids have advantages over crystalloids in paediatric sepsis?

Abstract: Despite decades of resuscitating patients with intravenous fluids in intensive care units, it is somewhat surprising that very little consensus exists regarding the type of fluid physicians should choose. Factors that influence decisions are often local culture or politics, hospital administrators, history (i.e. 'I've always done it this way') and budgets, as opposed to strong evidence. In the present issue of Critical Care we are presented with compelling arguments for and against the administration of colloids (as opposed to crystalloids) in paediatric sepsis. One point that appears to be clear is that the ideal choice of intravenous fluid goes beyond the simple haemodynamic effect. As such, in the future, clinicians will need to consider other factors when making their decision. In addition, large-scale quality randomised studies are desperately needed to guide clinicians.

Eating fish during pregnancy. Risk of exposure to toxic levels of methylmercury.

Abstract: QUESTION: One of my pregnant patients consumes four cans of tuna a week. She became very concerned when she read that tuna contains methylmercury, which is toxic to the fetal brain. How should I advise her? ANSWER: Fresh tuna might contain toxic levels of methylmercury, but levels are much lower in canned tuna. Reassure your patient that eating canned tuna will not harm her or her baby.

Deficits in the Development of Contrast Sensitivity in Infants with Prenatal and Neonatal Thyroid Hormone Insufficiencies

Abstract: Thyroid hormone is essential for normal brain development including structures critical for visual processing. While chick and rodent models have demonstrated abnormal visual development following prenatal thyroid hormone loss, comparable data do not exist in the human. To determine whether human infants with intrauterine and early postnatal thyroid hormone insufficiencies have compromised visual abilities, we investigated contrast sensitivity and visual acuity development in 13 infant offspring of women with hypothyroidism during pregnancy (HYPO), 16 preterm infants born between 32 and 35 weeks gestation, 12 infants with congenital hypothyroidism (CH), and 20 typically developing infants. All were assessed with the sweep visual evoked potential technique at 3, 4.5, and 6 months (corrected) age. Results showed significantly reduced contrast sensitivity but normal visual acuity in HYPO and CH groups relative to controls (p < 0.003 and p < 0.05 respectively). Stratification of the HYPO group into subgroups based on maternal TSH levels during the first half of pregnancy revealed lower contrast sensitivities for infants whose mothers' TSH values were above than below the median (p < 0.05). In the CH group, those with an absent thyroid gland and/or a newborn TSH value above 200 mIU/L had lower contrast sensitivities than did those with other etiologies or TSH levels below 100 mIU/L (p < 0.05). There were no significant effects involving the preterm group. These results indicate that thyroid hormone is important for human visual development.

N-Acetylglucosaminyltransferase-II

Abstract: The synthesis of complex N-glycans can be divided into three distinct stages. The first stage occurs primarily in the cytoplasm and rough endoplasmic reticulum, and involves the synthesis of Glc3Man9GlcNAc2-pyrophosphate-dolichol. The second stage begins with the transfer of GlcP3Man9GlcNAc2 from Glc3Man9GlcNAc2-pyrophosphate- dolichol to an Asn residue of the nascent glycoprotein followed by processing to Man5GlcNAc2-Asn-X. The third stage occurs primarily in the Golgi apparatus and starts with the action of GnT-I on Man5GlcNAc2-Asn-X followed by the removal of two mannose residues by mannosidase II to form the substrate for GnT-II (Fig. 1). GnT-II transfers GlcNAc from UDP-α-GlcNAc in the β1,2-linkage to the Manα1-6 arm of the N-glycan core, and is essential for normal complex N-glycan formation (Fig. 1). Open image in new window Fig. 1 Reaction catalyzed by GnT-II (UDP-GlcNAc:Manα1-6R [GlcNAc to Manα1-6] β-1,2-N-acetylglucosaminyltransferase-II). R = 1-4GlcNAcβ1-4GlcNAc-Asn-X

Bacterial vaginosis during pregnancy. Should we screen for and treat it

Abstract: QUESTION: Some of my patients have been diagnosed with bacterial vaginousis (BV) during pregnancy; some have symptoms, others do not. Should I be treating them, and if so, with what? Also, should I be screening all my pregnant pateints for BV? ANSWER: There appears to be no benefit to screening or treating pregnant women with an average risk of BV. It is not even clear that treating pregnant women at high risk of BV is beneficial. If you decide to treat, the drugs of choice are oral or intravaginal gel metronidazole or oral clindamycin. Both these drugs are safe to use throughout pregnancy.