Biomedical subjects

N C Chiu

Publications and source records attributed to N C Chiu.

At least 19 recordsLinked to original sources

PubMed2001

Invasive pneumococcal infection in children.

Streptococcus pneumoniae infections can involve multiple organs and cause high mortality and morbidity. In this retrospective study, we reviewed patients with invasive pneumococcal infection in the pediatric department of a teaching hospital in Taipei. From 1984 to 1998, 81 children with invasive pneumococcal infection were hospitalized. Twenty-eight patients had meningitis, 27 had pneumonia with pleural effusion, 60 had sepsis, and 4 had arthritis. Thirty-eight patients had more than one site of infection. Most of our patients (81.7%) were below 5 years of age. Pneumococcal infections were more common from October to March. Eight patients had a history of trauma that correlated with the site of infection. Thirteen patients (16.0%) expired and 20 (24.7%) had severe sequelae. Multi-regression analysis found that meningitis and complications were independent variables that affected the outcome. The percentage of penicillin-resistant strains increased beginning in 1990 and accounted for about four-fifths of the infections in the final 2 years of the study. Since invasive pneumococcal infections in children may have a poor prognosis and penicillin-resistant strains have become increasingly common, early and adequate antibiotic therapy should be given as soon as possible.

Adolescent↗

PubMed2001

Pathogens in the middle ear effusion of children with persistent otitis media: implications of drug resistance and complications.

Acute otitis media (AOM) is the most common disease for which pediatricians prescribe antimicrobial agents. Middle ear fluid were collected from 243 children with AOM that failed to respond to a previous course of antimicrobial therapy and who had then received myringotomy from September 1997 through August 1999. Bacterial cultures were done and antimicrobial susceptibilities were analyzed. Streptococcus pneumoniae (21.8%) was the most common causative organism, followed by Haemophilus influenzae (10.2%), Staphylococcus aureus (7%), and Pseudomonas aeruginosa (1.8%), while Moraxella catarrhalis (0.7%) and group A beta-hemolytic streptococcus (0.2%) were rarely isolated. In patients whose condition failed to improve after a course of antibiotic treatment, drug resistance became a serious problem. Fourteen percent of the patients in this series had complications, which included recurrent AOM, persistent middle ear effusion necessitating ventilation tube insertion, hearing impairment, mastoiditis, meningitis, chronic otitis media, brain abscess, and sepsis. Possible risk factors such as young age, male sex, underlying diseases, and a culture of S. pneumoniae or H. influenzae were not significantly associated with an increased incidence of complications. More stringent diagnosis and the correct choice of antibiotic treatment combined with the introduction of potential virus and bacterial vaccines are promising ways to reduce the morbidity of AOM in children.

Acute Disease↗

PubMed2000

Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants.

OBJECTIVES: To compare the accuracy of standard and hemocytometer white blood cell (WBC) counts and urinalyses for predicting urinary tract infection (UTI) in febrile infants. METHODS: Enrolled were 230 febrile infants < 12 months of age. All urine specimens were obtained by suprapubic bladder aspiration and microscopically analyzed by the standard urinalysis (UA) and by hemocytometer WBC counts simultaneously, and quantitative urine cultures were performed. Receiver-operating characteristic (ROC) curves were constructed for each method of UA. The optimal cutoff point of the UA test in predicting UTI was determined by ROC analysis. RESULTS: There were 37 positive urine cultures of at least 1,000 CFU/ml. Of these 37 patients, 9 females and 28 males, 1 had a positive blood culture (Escherichia coli). Thirty (81%) of the positive urine cultures had a bacterial colony count > or = 100,000 colony-forming units/ml, whereas the remaining had between 1,000 and 50,000 colony-forming units/ml. The area under the ROC curve for standard UA was 0.790 +/- 0.053, compared with 0.900 +/- 0.039 for hemocytometer WBC counts (P < 0.05). For hemocytometer WBC counts, the presence of < or =10 WBC/microl appeared to be the most useful cutoff point, yielding a high sensitivity (83.8%) and specificity (89.6%). Standard UA, with a cutoff point of 5 WBC/high power field, had a lower sensitivity (64.9%) and similar specificity (88.1%). The hemocytometer WBC counts showed significantly greater sensitivity and positive predictive value (83.8 and 60.8%, respectively) than the standard urinalysis (64.9 and 51.1%, respectively) (P < 0.05). The accuracy, specificity and likelihood ratio of hemocytometer WBC counts were also greater than that of standard UA (88.7, 89.6 and 8.08% vs. 84.3, 88.1 and 5.44%). CONCLUSION: Hemocytometer WBC counts provide more valid and precise prediction of UTI in febrile infants than standard UA. The presence of > or =10 WBC/microl in suprapubic aspiration specimens is the optimum cutoff value for identifying febrile infants for whom urine culture is warranted.

Chi-Square Distribution↗

PubMed2000

Urinary tract infection in febrile infants younger than eight weeks of Age.

OBJECTIVE: To assess the usefulness of laboratory parameters, including peripheral white blood cell (WBC) count, C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and microscopic urinalysis (UA), for identifying febrile infants younger than 8 weeks of age at risk for urinary tract infection (UTI), and comparison of standard UA and hemocytometer WBC counts for predicting the presence of UTI. METHODS: A total of 162 febrile children <8 weeks of age were enrolled in this prospective study. All underwent clinical evaluation and laboratory investigation, including WBC count and differential; ESR; CRP; blood culture; a lumbar puncture for cell count and differential, glucose level, protein level, Gram stain, and culture; and a UA and urine culture. All urine specimens were obtained by suprapubic aspiration and microscopically analyzed with standard UA as well as with hemocytometer WBC counts. Quantitative urine cultures were performed. Sensitivity, specificity, accuracy, likelihood ratios, and receiver operating characteristic (ROC) curves were determined for each of the screening tests. RESULTS: There were 22 positive urine culture results of at least 100 colony-forming unit/mL. Eighteen of these 22 patients were males, and all were uncircumcised. There were significant differences for pyuria >/=5 WBCs/hpf, pyuria >/=10 WBC/microL, CRP >20 mg/L, and ESR >30 mm/hour between culture-positive and culture-negative groups (P <.05). The ROC area for hemocytometer WBC count, standard UA, peripheral WBC count, ESR, and CRP concentration were.909 +/-.045,.791 +/-.065,.544 +/-.074,. 787 +/-.060, and.822 +/-.036, respectively. The ROC curve analysis indicates that the CRP, ESR, and standard UA were powerful but imperfect tools with which to discriminate for UTI in potentially infected neonates. Hemocytometer WBC counts had the highest sensitivity, specificity, accuracy, and likelihood ratios for identifying very young infants with positive urine culture results. For all assessments, hemocytometer WBC counts were significantly different, compared with the standard urinalysis. ESR, CRP, and peripheral WBC counts were not helpful in identifying UTI in febrile infants. CONCLUSION: UTI had a prevalence of 13.6% in febrile infants <8 weeks of age. The CRP, ESR, and standard UA were imperfect tools in discriminating for UTI, and the sensitivity of these laboratory parameters was relatively low. Hemocytometer WBC count was a significantly better predictor of UTI in febrile infants.

Female↗

PubMed2000

Characteristics of neonatal bacterial meningitis in a teaching hospital in Taiwan from 1984-1997.

During the period from 1984 to 1997, 85 bacterial meningitis neonates with positive cerebrospinal fluid cultures were treated. The ages of these patients ranged from 1 to 28 days. The male to female ratio was 1.7 to 1. The most common causative agent was group B beta-hemolytic streptococci (GBS, 31.8%), followed by Escherichia coli (20%), Proteus mirabilis (7.1%), Enterobacter cloacae (5.9%), other streptococci excluding Streptococcus pneumoniae (5.9%), Chryseobacterium meningosepticum (5.9%), enterococci (4.7%), and Klebsiella pneumoniae (3.5%). Among the 85 patients treated, 51 (60%) were younger than 7 days old. Among them, dyspnea was the most common clinical manifestation. In contrast, fever and diarrhea were seen more frequently in neonates with late onset of disease (after seven days of age). Ampicillin and cefotaxime were the most commonly used antibiotics. The most frequently encountered complications were hydrocephalus and seizures. Since 1991, GBS has overtaken E. coli as the leading cause of neonatal bacterial meningitis. This was accompanied by a fall in the mortality rate, but a sustained high incidence of complications and sequelae. The results of this study highlight the importance of developing strategies to prevent group B streptococcal infection.

Female↗

PubMed2000

Clinical presentation of acute mastoiditis in children.

Nineteen children with 21 episodes of acute mastoiditis were treated in our hospital from 1989 to 1998. The diagnosis was based on physical, radiologic, and surgical findings. The affected children were aged from 1 year old to 17 years old, with the peak incidence at 4 years old (23.8%). Postauricular pain (90.5%) and fever (81%) were the most common harbingers of incipient acute mastoiditis. Streptococcus pneumoniae (38.1%) was the most common organism isolated followed by Pseudomonas aeruginosa (23.8%). Underlying diseases such as leukemia and myeloid metaplasia were found in 38.6% of patients. All of the patients were initially treated with intravenous antibiotics during hospitalization. Six patients were managed with an adjunctive drainage procedure such as myringotomy or mastoidectomy. The most common complication of acute mastoiditis was hearing loss (31.6%); the second was meningitis (21.1%). Subperiosteal abscess was found in two patients and brain abscess in one. Although acute mastoiditis is an uncommon condition, early diagnosis and management are necessary to prevent more serious complications.

Acute Disease↗

PubMed1999

Association of allergy with Tourette's syndrome.

In our clinical practice, we often encounter signs and symptoms of allergy, such as rhinitis and asthma, in patients with Tourette's syndrome (TS). Some of the allergic manifestations are similar to the oral tics or motor tics found in TS patients. To clarify the association between TS and allergy, we evaluated 72 consecutive patients with TS from 1 September 1996 through 31 August 1997. The diagnosis of TS was based on the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria. Sixty-five boys and 7 girls, 4 to 17 years old (9.4 +/- 3.1 yr) were evaluated using the Multiple Allergens Simultaneous Tests (MAST) for the detection of total and specific immunoglobulin. Forty-five patients had positive results, of whom 41 (56.9%) had clinical evidence of allergy. The prevalence of allergy in the local population as reported by The International Study of Asthma and Allergy in Childhood Taiwan Group (1994) was 44.3% (33.5% with allergic rhinitis and 10.8% with asthma). These subjects served as controls. Comparing the number of patients with clinical evidence of allergy in the MAST positive group (56.9%) of TS patients with the control group (44.3%), the difference was significant++ (p < 0.05). The prevalence of allergy in TS patients in our study was significantly higher than in the general population. TS had an association with allergy.

Adolescent↗

PubMed1999

Mandibular osteomyelitis caused by Blastoschizomyces capitatus in a child with acute myelogenous leukemia.

A 6-year-old girl with acute myelogenous leukemia (AML) developed fungal mandibular osteomyelitis during chemotherapy. Blastoschizomyces capitatus was recognized histologically by its yeast-like morphology and formation of annelloconidia, and was confirmed by culture. The fungal osteomyelitis of the mandible was treated successfully with prolonged antifungal medication, extensive surgical debridement and an oral care program, without interrupting leukemia chemotherapy. B. capitatus osteomyelitis of the mandible may occur during chemotherapy in AML patients with poor dental condition. Successful treatment can be achieved by careful management without interruption of antineoplastic chemotherapy.

Child↗

PubMed1998

Cerebral perfusion in children with Alice in Wonderland syndrome.

Alice in Wonderland syndrome (AIWS) is characterized by visual hallucinations and bizarre perceptual distortions. Technetium-99m hexamethylpropyleneamine tomography (SPECT) brain scans were performed in four patients during the acute stage of AIWS. Two patients were demonstrated to have Epstein-Barr virus infections. One had abnormal (EEG) findings. The visual-evoked potential, cranial CT, and MRI findings were negative. The decreased cerebral perfusion areas in all patients were near the visual tract and visual cortex. All involved some regions of the temporal lobe. In most patients with AIWS, the EEG, CT, and MRI are unable to determine the precise pathologic areas. However, a SPECT brain scan may demonstrate abnormal perfusion areas and explain the clinical presentations.

Cerebrovascular Circulation↗

PubMed1997

Penicillin-resistant pneumococcal infections in children.

Penicillin-resistant pneumococcal infections have been reported worldwide, but rarely reported in Taiwan. From 1990 to 1995, the rate of penicillin-resistant Streptococcus pneumoniae (PRSP) infections in our hospital increased from less than 10% during the first 2 years (1990-91) to 45% during the last 2 years (1994-95). From 1990 to 1995, twenty-four patients with systemic pneumococcal infections were diagnosed in the Department of Pediatrics at Mackay Memorial Hospital. Pneumococci were isolated from blood in 20 patients, cerebrospinal fluid in 12 patients, joint fluid in one patient and pleural effusion in one patient. Four patients had underlying diseases, including ileal atresia, Wiskott-Aldrich syndrome, congenital heart disease, and perilymph fistula. Of the 24 isolates of S. pneumoniae, 17 (70.8%) were intermediately penicillin resistant (minimum inhibitory concentrations between 0.1 and 1.0 microgram/mL), and 7 (29.2%) were highly resistant (minimum inhibitory concentrations > 1.0 microgram/ml). Fourteen patients recovered completely, two had minor sequelae, two had major sequelae, and six died. Four of the 12 patients with meningitis died. In this study, both the rate of PRSP as well as the mortality of patients with PRSP meningitis were high, as compared to previous reports. To reduce the mortality and morbidity of systemic pneumococcal infections, the oxacillin disc diffusion test is important in addition to appropriate antibiotic therapy.

Child, Preschool↗

PubMed1997

Pediatric nosocomial fungal infections.

During a period of twelve years (1984-1995), ninety-seven pediatric patients experienced 107 nosocomial fungal infections at Mackay Memorial Hospital. The nosocomial fungal infection rate in pediatric patients was lower than that of the hospital as whole, but it increased significantly. The average rate in the last three years (1993-1995) was 1.20 per thousand discharged patients, 10 times that of the first three years (1984-1986). Two-thirds of the patients were below one year of age. Half of the infections occurred in Intensive Care Units. The bloodstream was the most common site of infection (40.2%), followed by the urinary tract and skin. Important underlying diseases included malignancies, prematurity, and congenital anomalies. Common risk procedures included total parenteral nutrition (43.3%), endotracheal intubation (29.9%), central venous catheterization (25.8%), operation (14.4%). Near 90% of the patients had previously received antibiotics. Candida albicans was responsible for 58.1% of the infections. Thirty-three patients expired, of whom 18 died of the fungal infections. With the trend of increasing nosocomial fungal infections, physicians should be more alert to the possibility of such infections.

Adolescent↗

PubMed1996

Neurogenic diabetes insipidus in children with hypoxic encephalopathy: six new cases and a review of the literature.

UNLABELLED: Hypoxic encephalopathy is rarely mentioned as a cause of neurogenic diabetes insipidus (DI) in children. We here report six cases of DI which occurred after severe hypoxic/ischaemic brain damage and include a review of the literature on 28 paediatric cases of neurogenic DI due solely to severe hypoxia/ischaemia. Airway obstruction, haemorrhagic shock and sudden infant death syndrome are the three major causes of hypoxia/ischaemia. The ages (25/28) ranged from 0.03 to 18 years (mean 7.27 years, median 5 years). The intervals between the hypoxic insult and the onset of DI (23/28) ranged from 0.08 days (2 h) to 13 days (mean 4.07 days, median 3.5 days). Linear regression analysis revealed no significant correlation between the age and the interval. Nineteen cases (82.6%) developed DI within 6 days after the hypoxic/ischaemic insult. Only two neonates survived with developmental delay. The remaining 26 cases died. CONCLUSION: Neurogenic DI can be caused by hypoxia/ischaemia and is an ominous sign of severe brain damage in children with hypoxic encephalopathy. It is important to recognize this potential sequel by regularly monitoring intake and output, plasma sodium level, and urine specific gravity.

Adolescent↗

PubMed1996

A common mutation site in the beta-galactosidase gene originates in Puerto Rico.

Several mutation sites have been found in the beta-galactosidase gene of patients with GM1 gangliosidosis. In a previous report we found a common point mutation site in American patients with GM1 gangliosidosis resulting in a 208Arg --> Cys amino acid substitution. From the patients' family history, we suggested that this mutation may have come to South and North America via Puerto Rico. Four new patients with infantile GM1 gangliosidosis have been analyzed with allele-specific hybridization. Two siblings from Puerto Rico of Spanish ancestry are homozygous for this mutation. Another patient also from Puerto Rico is heterozygous for this allele, and another black patient does not have this mutation. These results support our initial hypothesis that this mutation has probably arisen in Puerto Rico.

Alleles↗

PubMed1996

Intracranial fibromuscular dysplasia in a 5-year-old child.

A 5-year-old girl presenting with acute middle cerebral artery stroke was diagnosed as having intracranial fibromuscular dysplasia by angiographic findings of focal changes in the proximal right middle cerebral artery and pathological dilatation of the right internal carotid artery at the base of the skull, as well as dissection of at least one of the middle cerebral artery branches and nonfilling of two or perhaps three remaining middle cerebral artery segmental branches. Her clinical condition improved after management of the increased intracranial pressure. She did not receive any medication after discharge and had virtually no residual sequelae. Our case documents an unusual location and age of onset of a patient with fibromuscular dysplasia.

Brain Diseases↗

PubMed1995

Enamel pitting in childhood tuberous sclerosis.

Dental enamel pitting was studied as a diagnostic sign of pediatric tuberous sclerosis (TSC). Thirteen patients aged 2.5 to 18 years with varying degrees of TSC were evaluated. They were checked for the presence of enamel pitting by the use of two to three drops of dental plaque disclosing stain which was applied to the labial surfaces of dry teeth. This technique provides a remarkable color contrast allowing for the detection of many small and subtle enamel pits. A control group of 39 unrelated patients without TSC were also examined. A total of 77% of TSC patients (10/13) revealed enamel pitting, compared with 13% of controls. The distribution of enamel pitting among TSC patients and normal controls of each sex was statistically significant. The total number of enamel pits in each patient varied from 1 to 26 and increased with age; 90% of the teeth with enamel pitting displayed one to two pits per tooth. The youngest patient with enamel pitting was 5 years old. The simplicity of this test and the high probability of pitting in TSC make the examination useful in the assessment of patients in whom the diagnosis of this serious genetic disease is being considered.

Adolescent↗

PubMed1994

Reversal of diastolic cerebral blood flow in infants without brain death.

The reversal of diastolic cerebral blood flow has been regarded as a characteristic waveform of brain death and a useful confirming sign. We report 2 patients who had diastolic flow reversal but survived. One, a 1-month-old boy with status epilepticus, had reversal of diastolic cerebral blood flow detected by Doppler ultrasound soon after admission. Reversal disappeared after medical management for increased intracranial pressure and seizure control. He recovered without sequelae. The other, a 6-month-old girl with choroid plexus papilloma, had reversal of diastolic flow during abrupt clinical deterioration. Emergent surgical removal of the tumor was performed and she survived with hemiparesis and psychomotor retardation. Our patients demonstrated that even in the presence of diastolic reversal of cerebral blood flow, prompt and effective treatment can avoid a fatal outcome.

Blood Flow Velocity↗

PubMed1993

Duplex Doppler assessment of visceral and cerebral blood flow velocity in full-term newborns.

To assess postnatal visceral and cerebral blood flow velocity changes, transcutaneous duplex Doppler ultrasound was used to measure the superior mesenteric artery (SMA), celiac artery (CA) and anterior cerebral artery (ACA) blood flow velocity in 20 normal healthy newborns. Doppler indices of peak systolic velocity (PSV), time-averaged mean velocity, end-diastolic velocity and Pourcelot resistance index (PI) were measured immediately after delivery and consecutively for three days at 24-hour intervals. At 24 hours after delivery, PSV had risen significantly in the CA, SMA and ACA (p < 0.01). The PI had decreased significantly in all three vessels. We conclude that the most prominent hemodynamic changes in the splanchnic and cerebral artery circulation occur within 24 hours after delivery in normal healthy newborns. Possible mechanisms are discussed.

Blood Flow Velocity↗

PubMed1992

[Tuberculous otitis media, mastoiditis associated with meningitis: report of one case].

Tuberculosis of the middle ear is rare; associated meningitis is even more unusual. This report contains our experience with a one and a half year old psychomotor retarded boy. He had a poor healing left postauricular abscess four months prior to admission. Also noted was postprandial vomiting and left sided involuntary movement. On admission spinal tapping was done. Results showed leukocytosis, with lymphocytes being predominant, as well as high protein and low glucose levels. A cranial CT revealed left mastoiditis, hydrocephalus, basal cistern abnormal enhancement and a prominent posterior fossa postcerebellar CSF space. Left radical mastoidectomy was performed. A biopsy showed caseous necrosis surrounded by epitheloid and Langhan's giant cells. He also received a ventriculoperitoneal shunt. The gastric and CSF were both positive for tuberculous culture.

Humans↗