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Biomedical subjects

S Ludwig

Publications and source records attributed to S Ludwig.

At least 19 recordsLinked to original sources
PubMed1992

Interfacing with police in the pediatric emergency department.

In summary, ED staff and local police departments should make a concerted effort to work together. The ED director should develop management protocols in conjunction with local police chiefs to plan strategies in advance. It is helpful to provide "orientation sessions," so that each group of professionals knows what to expect of the other. It may also be helpful to arrange tours of the ED so that police know where to go when they are called to the ED. All of these efforts should foster better care of children in the ED and will reduce tensions between the dedicated groups who work with such children.

Adolescent↗
PubMed1992

[Infections after bone marrow transplantation in childhood].

In 66 children having undergone bone marrow transplantation (BMT) the occurrence of infections was studied retrospectively. Bacterial infections were mostly found in the early period after transplantation before marrow engraftment. The analysis of positive blood cultures showed a dominance of gram-positive bacteria, especially of coagulase-negative staphylococci. Cytomegalovirus (CMV) infections were most important, because of its high rate and the risk of CMV associated interstitial pneumonia (IP), two patients suffered from. Infections from herpes simplex virus (HSV), varizella zoster virus (VZV) and Epstein Barr virus (EBV) had no influence on prognosis. In fungal infections the systemic aspergillosis was the most important complication. To increase the effectiveness and safety of therapy the serum levels of antibiotics and antifungal drugs should be determined.

Adolescent↗
PubMed1991

Evolution of pig influenza viruses.

There is evidence that the nucleoprotein (NP) gene of the classical swine virus (A/Swine/1976/31) clusters with the early human strains at the nucleotide sequence level, while at the level of the amino acid sequence, as defined by consensus amino acids and in functional tests, its NP is clearly "avian like." Therefore it was suggested that the Sw/31 NP had been recently under strong selection pressure, possibly caused by reassortment with other avian influenza genes, whose gene products have to cooperate intimately with NP (Gammelin et al., 1989. Virology 170, 71-80). This suggestion has been investigated by sequencing the genes of internal and nonstructural proteins of Sw/31. The data on these sequences and on the phylogenetic trees are not in accordance with that suggestion: all these genes cluster with the early human strains at the nucleotide level while, at the level of the amino acid sequence, most of them are more closely related to the avian strains, thus resembling NP in this respect. This indicates that these genes rather evolved concomitantly with the NP gene. Our data are in agreement with the suggestion that, at about the time of the Spanish Flu (1918/19), a human influenza A (H1N1) virus entered the pig population. Furthermore, it is known that the NP of the human influenza A viruses--in contrast to that of the avian and swine strains--has been under strong selection pressure to change (Gammelin et al., 1990. Mol. Biol. Evol. 7, 194-200. Gorman et al., 1990a. J. Virol. 64, 1487-1497). Thus, after transfer of a human strain into pigs, the selection pressure might be released, enabling the NP and the other genes of the swine virus to evolve back to the optimal avian sequences, especially at the functionally important consensus positions. The swine influenza viruses circulating since 1979 in Northern Europe--represented by A/Swine/Germany/2/81 (H1N1)--have all genes, so far examined, derived from an avian influenza virus pool and are different from the classical swine viruses.

Animals↗
PubMed1991

Phylogenetic relationship of the nonstructural (NS) genes of influenza A viruses.

Phylogenetic trees were constructed using 38 sequences of the A group and 10 sequences of the B group of the NS gene of influenza A viruses. Within the A group we found avian as well as mammalian influenza a viruses, while within the B group exclusively avian strains were found. The avian and human NS genes of the A group were derived from a common ancestor existing at about 1912. At 13 positions of the amino acid sequences of the NS1 protein two subtypes of the A group can be differentiated, a human and a non-human subtype. Starting at the time of the introduction of an avian PB1 gene into human strains during the antigenic shift at 1957 the NS1 protein of the human strains came under an enhanced selection pressure which might indicate a cooperation of the NS1 protein with and adaptation of the NS1 protein on the newly introduced PB1 gene. Such a selection pressure on the NS2 protein is completely missing. Comparison of all sequences of the NS1 protein revealed four highly conserved regions within the amino-terminal half of the molecule. One of this regions seems to contain the nuclear migration signal. The carboxy-terminal half is completely variable and seems to be dispensable.

Amino Acid Sequence↗
PubMed1991

Night people: utilization of a pediatric emergency department during the late night.

This study was undertaken to define the factors that enter into the decision to seek care in a pediatric emergency department (ED) during the late evening hours. A questionnaire was administered which sought responses regarding demographic, social/familial, medical, and visit-related information. The questionnaire was completed by 170 nighttime utilizers (11:00 PM to 7:00 AM) and 202 daytime controls. Nighttime users were more likely to have private physicians, were ill for shorter periods of time, were more likely to attempt treatment at home prior to arriving at the ED, tended to use the ED more often, and spent their days outside of the home (in school or daycare), as compared with the daytime controls (P less than 0.05). The average waiting time was longer during the night than during the day (7:00 AM to 5:00 PM). The prime reasons for presenting for care during the night (as well as during the day), according to the caretaker, were illness concerns and not those of convenience.

Adolescent↗
PubMed1991

Pediatric emergency transport and the private practitioner.

A mail survey of 182 pediatricians and 92 family practitioners in Pennsylvania was conducted to determine their methods of transport of seriously ill children from their offices to referral centers and their involvement with professional transport services. Although most physicians (93.1%) stated that they had professional services available to them (at their office location), more than half (53.8%) indicated that the patient's family automobile was their most commonly used method of transport of ill children to tertiary care centers. This was true regardless of the disease entity involved, including suspected epiglottitis. Practice setting had little influence on transport method. However, in general, younger children were judged to need ambulance transport more often than older children. Reasons cited for not using professional transport from the office included a perceived better efficiency of the family car (61.8%), the prohibitively high expense of professional transport (9.8%), and failure to consider professional transport (6.5%). Further study of this component of office preparedness is suggested.

Child↗
PubMed1990

Derivation of the nucleoproteins (NP) of influenza A viruses isolated from marine mammals.

The nucleoprotein (NP) genes of influenza viruses were sequenced from a variety of virus isolates derived from marine mammals: whales from the Pacific and Atlantic oceans, seal and gull from the Western Atlantic, and a tern from the Caspian Sea. In comparison to published NP sequences, we found pairs of NPs derived from avian and marine mammal isolates to be closely related, e.g., the gull-whale and mallard-seal pairs from the Atlantic Coast of the USA and the tern-Pacific Ocean whale pair of the Eastern Hemisphere. Our analysis suggests that influenza viruses have been independently introduced into marine mammals from avian sources for each of our three examples. Furthermore, the closeness of the relationship in these avian-mammalian NP pairs indicates that the introductions are relatively recent. The sequences of these marine mammal NPs are avian-like and can be clearly distinguished from human NPs. Our results provide further support of interspecies transmission of influenza A viruses from the avian host reservoir directly to mammalian hosts.

Amino Acid Sequence↗
PubMed1990

A child-oriented emergency medical services system.

Although the principles of emergency care may be relatively easy to state, it is their promulgation that is so difficult. The development of EMS-C is the challenge. How do we take these principles of preserving children's lives and translate them into services for everyone who needs them? How do we organize a large, diverse health care system which will be responsive to this group of patients in need? How do we prioritize pediatric emergency care among the many other funding needs, both medical and nonmedical? The answer lies with the initiative and advocacy of each of us as child advocates. Providing all the aforementioned elements of the EMS-C will save children's lives. These are lives which are usually responsive to therapy, uncomplicated by interlocking disease states, and filled with potential for future achievement. The challenge is ours.

Child↗
PubMed1988

Major blunt abdominal trauma due to child abuse.

We reviewed 15 years' experience with childhood trauma at two hospitals in different cities, one a city hospital, the other a children's hospital, to learn the extent, circumstances, presentations, and consequences of major blunt abdominal trauma due to child abuse. Some 10,000 children admitted to these hospitals for treatment of injuries from 1972 through 1986 provided the basis for the study; the incidence and severity of pediatric trauma at the two hospitals was similar, in that 13% of the visits to both hospitals' emergency rooms were for trauma, of which 5% resulted in admission. Major blunt abdominal trauma due to child abuse accounted for 22 of these cases, six at the former, 16 at the latter, and represented less than 0.50% of all abused children seen at both institutions. The average age was 24 mo; 14 were boys and eight were girls. In only two instances was the family unit intact; in both, the child was abused by the babysitter. Otherwise, the father, or the mother's "boyfriend," was responsible. Overall mortality was 45%, and was related both to type of injury and presenting signs. Of one who presented with an epigastric mass due to a pancreatic hematoma, none died; the pseudocyst which subsequently developed resolved on bowel rest and TPN. Of three who presented with bilious vomiting due to duodenal hematoma, none died; one required operative evacuation. Of five who presented with peritonitis due to duodenojejunal rupture, one died; this child presented greater than 24 hr following injury in profound septic shock. Of three who presented with hypovolemia due to moderate hemorrhage, none died; the former two were managed conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1988

The insulin receptor gene and its expression in insulin-resistant mice.

Defects of insulin receptor binding and tyrosine kinase activity have been described in genetically diabetic (db/db) and obese (ob/ob) mice. To determine if these changes were related to an abnormality in insulin receptor mRNA expression or structure of the receptor gene, we quantitated receptor mRNA from db/db and ob/ob homozygous, heterozygous (db/x, ob/x) and unaffected [db(x/x), ob(x/x)] mice and also analyzed restriction fragment length patterns of genomic DNA. Northern blot analysis of insulin receptor mRNA in livers from each of the genotypes revealed two major species of 7.5 and 9.5 kilobases. In contrast to known decreased receptor number in various tissues of ob/ob and db/db mice, quantitation of liver insulin receptor mRNA revealed that both homozygous affected strains had 2-fold or more increased levels of both major mRNA species compared to unaffected control groups. (P less than 0.05). Restriction fragment length analysis revealed no major insertion or deletion mutations in either the db/db or ob/ob insulin receptor gene. From the number and size of the fragments generated by this analysis, the minimal size of the mouse insulin receptor gene was calculated to be 97 kilobases, and the minimal number of exons was 16. These data indicate that the insulin receptor gene in ob/ob and db/db mice exhibits no major structural abnormality. Decreases in insulin receptor binding and/or kinase activity in affected mice appear to be due to a defect at the posttranscriptional level and occur despite increased levels of receptor mRNA.

Animals↗
PubMed1988

Stairway injuries in children.

Children frequently injure themselves falling down stairways, but the characteristics of these injuries are not well described. A total of 363 consecutive patients seen in a pediatric emergency department were studied. The majority of patients had minor superficial injuries. Bony injuries occurred in 7% of patients. Head and neck injuries occurred in 73% of patients, extremity injuries, which were predominantly distal, in 28%, and truncal injuries in 2%. Children younger than 4 years of age were more likely to sustain head trauma than children older than 4 years of age (P less than .005). Injury to more than one body part occurred in only 2.7% of patients. Children who fell down more than four steps had no greater number or severity of injury than those who fell down less than four steps (P = .67). Patients were admitted to hospitals in 3% of cases. No patient had life-threatening injuries and no patients required intensive care. When multiple, severe, truncal, or proximal extremity injuries are noted in a patient who reportedly fell down stairs, a different mechanism of injury should be suspected.

Accidental Falls↗
PubMed1987

Minor head trauma in children: an intervention to decrease functional morbidity.

Minor head trauma is common among children and evokes strong parental reaction. Parents often rush the child to an emergency department or consult their pediatrician by telephone despite the minor nature of the injury. In a previous report we showed that children with minor head trauma appear to have limitations in their usual daily activities and a high rate of school absenteeism. This study was a prospective, randomized trial of an intervention designed to reduce this functional morbidity after head trauma. Parents in the control group (n = 168) received routine discharge instructions. Parents in the intervention group (n = 153) received a discharge interview during which the nurse gave more explicit and behaviorally oriented instructions. The nurse also called intervention parents the next day to reassure them and to urge that the children return to their usual routine. One month after the injury a questionnaire was administered by telephone to assess physical health status, social or functional limitations, and behavior problems. The majority of parents (85%) were anxious, and this was not alleviated by previous experience with head trauma. Triage nurses incorrectly rated one third of the parents as not anxious. Physical health status, role activity indices, and behavior problems, were similar for the intervention and control groups 1 month after the head injury. Subsequent morbidity was highly correlated with parental anxiety. In managing children with minor head trauma, pediatricians and emergency department physicians must focus their discharge instructions on the parent's anxiety, emphasize the minor severity of the injury, and urge that the children return to their usual routine.

Adolescent↗