In patients with coronary artery disease undergoing elective PCI, an increase in post-procedural hs-TnT level did not offer prognostic information beyond that provided by the baseline level of the biomarker.

\s=b\Human rotaviruses (HRV) are a common cause of acute nonbacterial gastroenteritis in pediatric patients. A prospective study of HRV disease in a temperate (Dallas) and a tropical (San Jose, Costa Rica) setting demonstrated differences in seasonal distribution. In both locales, HRV accounted for 50% to 60% of acute nonbacterial gastroenteritis episodes from December through February; this period corresponded to the cooler months of winter in Dallas and to the dry season in San Jose. During the rest of the observation year, the virus was not recovered from any Dallas patients, but was found in 30% to 40% of Costa Rican patients in every month but May. Signs, symptoms, and laboratory values suggest the small bowel as the major site of pathophysiology; mucosal disruption may occur in some cases.(Am J Dis Child 132: [853][854][855][856][857][858] 1978) The recent application of electron microscopic techniques to the study of fecal viruses' has resulted in the recognition of a close association between the excretion of human rotaviruses (HRV) and the acute nonbacterial gastroenteritis of infan¬ cy commonly known as "winter vomit¬ ing disease."2 ' Rotaviruses are char¬ acterized by a double-stranded RNA core surrounded by a distinctive double-layered capsid with an outside diameter of 70 nm. These agents were formerly considered as solely veteri¬ nary and plant pathogens/7 They have now been confirmed as impor¬ tant causes of winter season epidem¬ ics of acute nonbacterial gastroenteri¬ tis from many areas of the world.812With the exception of the recent Reprint requests to 5323 Harry Hines Blvd, Dallas, TX 75235 (Dr Hieber). seasonal distribution of HRV excre¬ tion has not been prospectively stud¬ ied in a tropical setting that has no winter season, but only rainy and dry seasons. In the latter study of 50 patients during a one-year period, HRV was recovered from 13 patients (26%) during the cooler months of July through December. No patients could be studied from January through March and no HRV was recovered from April through May. None of the 30 control patients were found to be excreting HRVs.We have compared the seasonal distribution of HRV disease in a temperate (Dallas) and tropical area (San Jose, Costa Rica). METHODSA number of infants and children young¬ er than 8 years of age who were seen in the outpatient department or were hospital¬ ized for nonspecific acute gastroenteritis were selected for study. Patients with clin¬ ical features suggestive of a bacterial pathogen, such as high fever or bloody stools, were excluded. Informed, written parental consent was obtained. Acute serum and stool specimens were obtained from patients and, whenever possible, convalescent specimens were obtained sev¬ en to 14 days later. Similar samples were collected from an age-matched control subject in many instances; these patients and their families had not had acute gastroenteritis in the previous week and were being treated for ailments unrelated to the gastrointestinal (GI) tract (frac¬ tures, respiratory and urinar...

We undertook a prospective study of the pharmacokinetics of penicillin G (administered intravenously every four hours for a total of b50,000 U per kilogram per day) in the cerebrospinal fluid of children with purulent meningitis. Both the absolute mean cerebrospinal-fluid penicillin concentration (0.8, 0.7 and 0.3 microgram per milliliter) and the percentage of the simultaneous serum penicillin concentration measurable in the cerebrospinal fluid (18.4, 9.9, 4.9 per cent) declined on the first, fifth and 10th days of therapy, respectively. A mean peak cerebrospinal-fluid penicillin concentration of 0.96 micrograms per milliliter was measured at least transiently on all three study days. This pharmacokinetic pattern correlated with the return of cerebrospinal-fluid protein concentration toward normal (P less than 0.01). Penicillin G in the dosage studied is adequate therapy for most streptococcal and meningococcal meningitis in children; an increased dosage may be necessary when the minimal inhibitory concentration of penicillin to the etiologic agent is unusually high.

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BACKGROUND:The magnitude of prognostically relevant myocardial injury after percutaneous coronary interventions remains poorly defined. The Society for Cardiovascular Angiography and Interventions (SCAI) proposed marked biomarker elevations to define periprocedural myocardial infarction (PMI). These consensus-based thresholds have not been validated in the era of high-sensitivity cardiac troponins. We sought to assess the prognostic impact of SCAI-defined PMI and explore optimal prognostic thresholds of high-sensitivity cardiac troponin T (hs-cTnT) after elective percutaneous coronary interventions. METHODS AND RESULTS:We evaluated patients who underwent elective percutaneous coronary interventions at 2 tertiary care centers with serial hs-cTnT measurements. PMI was defined as peak postprocedural hs-cTnT >70× upper reference limit (URL) in patients with nonelevated (≤1× URL) baseline levels; or incremental increase >70× URL in patients with elevated baseline levels. The primary outcome was 1-year all-cause mortality. Of 8140 patients, 220 (2.7%) died within 1 year. In multivariable analyses, patients with SCAI-defined PMI (n=140; 1.7%) had a higher risk of 1-year mortality (12.9% versus 2.5%, adjusted hazard ratio 4.10, 95% CI 2.51-6.68; P<0.001) as well as cardiac mortality (11.4% versus 2.1%, adjusted hazard ratio 4.21, 95% CI 2.50-7.11; P<0.001). Based on receiver operating characteristics analysis, the optimal prognostic threshold of hs-cTnT was >10×URL, observed in 14.6% of patients. This threshold showed lower specificity (85.7% versus 98.4%) but higher sensitivity (25.4% versus 8.2%) and better overall performance for prediction of 1-year mortality compared with the SCAI-defined cutoff value of troponin. CONCLUSIONS:In patients undergoing elective percutaneous coronary interventions, SCAI-defined PMI emerged as an independent, highly specific, but insensitive predictor of 1-year mortality. Optimal trade-off between sensitivity and specificity was observed at a lower threshold of hs-cTnT (10× URL) in this cohort.