Bengt Höjer

Autoinduction of carbamazepine metabolism in children examined by a stable isotope technique

Autoinduction of carbamazepine (CBZ) metabolism was investigated in 3 children (10 to 13 yr old) using tetradeuterium‐labeled CBZ (CBZ‐D4). Prior to treatment, CBZ and CBZ‐D4 given as a mixture had almost identical kinetics in each patient. During maintenance therapy with CBZ, part of the CBZ was exchanged for CBZ‐D4 on 3 occasions. The clearance of CBZ‐D4 given on the second day of therapy was 0.036 ± 0.003 1 · kg−1 · hr−1, whereas it had been 0.028 ± 0.003 before treatment. After 17 to 32 days of treatment, clearance doubled (0.056 ± 0.010) but during the next 4 mo there was no further increase, indicating that the autoinduction was complete within 1 mo. As a corollary there was a decrease in steady‐state plasma levels.

Caries prevalence in 2.5-year-old children.

The prevalence of caries and gingivitis was determined clinically in 2.5-year-old children (n = 832) living in the southern suburbs of Stockholm. The occurrence of mutants streptococci and lactobacilli was determined in samples taken from the tongue and the buffer capacity of the saliva was measured. The parents answered a structured questionnaire concerning their childrens dietary habits, oral hygiene, fluoride exposure and their social and ethnic background. Initial or manifest caries was diagnosed in 11.7 and 6.4% of the subjects, respectively. Seventy-two percent of the total number of caries lesions were localized to the maxillary incisors. Caries prevalence in children with an immigrant background was significantly higher (p < 0.001) than in children without. In the multivariate analysis, the variables significantly associated with caries were: colonization with mutans streptococci (p < 0.001), lactobacilli (p < 0.01) and children with immigrant background (p < 0.01). The study demonstrates an association between early colonization of cariogenic microflora and an increased risk of developing dental caries in very young children.

Kinetics of carbamazepine and its 10,11-epoxide metabolite in children.

The plasma steady‐state concentration of carbamazepine (CBZ) and its metabolite (carbamazepine‐10,11‐epoxide, CBZ‐epoxide) was assessed in 43 children (2–15 yr) on CBZ (Tegretol) treatment. Twenty of the children received combined treatment with other anticonvulsant drugs simultaneously. The plasma concentrations were in the same range as had been found in adult patients on corresponding doses. Only a weak correlation was noted between dose and plasma CBZ concentration in the group of children on single‐drug treatment, and there was no correlation in the group of children on combined drug regimen. Plasma levels of CBZ correlated with those of the metabolite. Children on combined treatment had lower CBZ concentration and, expressed as percent of the parent drug, the metabolite concentration was significantly higher than in children treated only with CBZ. In 2 children the plasma half‐life of CBZ was estimated and found to be slightly shorter than has previously been reported in adults. In evaluating the plasma level‐effect relationship of CBZ, the plasma concentration of the CBZ‐epoxide should be measured simultaneously because of its anticonvulsant effect and interindividual variability.

Gender and rural–urban differences in reported health status by older people in Bangladesh

The study aims to (i) describe regional variation and gender differences in health status of older people (60 years and older) in Bangladesh, indicated by self-reported health problems and functional ability; (ii) explore influence of socio-economic factors on health status of older people. In a cross-sectional study in rural and urban Bangladesh, 696 older persons were asked about their health problems and ability to manage activities of daily living (ADL). More than 95% of older people reported health problems. Approximately 80% of elderly women in both the regions reported having four or more health problems compared with 42% and 63% elderly men in the urban and rural regions, respectively. More women (urban: 55%; rural: 36%) than men (urban: 32%; rural: 22%) also reported difficulties with ADL. Irrespective of age, sex and area of residence, those reporting greater number of health problems were more likely to report difficulty with at least one ADL task. Reporting pattern of specific health problems varied between urban and rural regions. Socio-economic indicators were found to have little influence on reporting of health problems, particularly in the rural region. Observed regional difference may be related to the influence of social and environmental factors, and level of awareness concerning certain health conditions.

Persecution and behavior: A report of refugee children from Chile☆

A Swedish study of 50 newly resettled refugee children from Chile describes the childrens experiences of persecution in their home country and coping patterns in the receiving country. Thirty-six children had experiences directly related to persecution, and seven of these had been victims of physical assault for political reasons. Sleep disturbances and dependency were behaviors significantly associated with experiences of persecution. Resettled refugee families need to be approached by concerned professionals as symptoms of trauma in refugee children are often recognized only in the family sphere.

High incidence of a concentration-dependent skin reaction in children treated with phenytoin.

A particularly high incidence of rash was seen in children with epilepsy treated with phenytoin. Ten children with untreated epilepsy were therefore included in a prospective study and given either 3 (group 1) or 6 (group 2) mg of phenytoin/kg body weight/day for five days followed by 6 mg/kg body weight/day for both groups. Four of the five children in group 2 compared with only one of the five in group 1 developed a rash seven to 12 days after the start of treatment. Patients with rashes had significantly higher plasma phenytoin concentrations. Whenever the phenytoin concentration was higher than 14 micromol/l on day 5 a rash occurred. These findings indicate that the generalised skin reaction is caused by a high body burden of phenytoin, which results from either a high load of the drug or a low clearance rate.

Efficacy of Patient-Delivered Partner Medication in the Treatment of Sexual Partners in Uganda

Background Patient-based partner referral (PBPR), which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs), has limited effectiveness. Goal The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala, Uganda. Study Design A total of 383 patients (187 women, 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown. Results The two groups had similar background characteristics. Of the 237 partners elicited, 176 (74%) were reported treated in the PDPM group. In the PBPR group, in which 234 partners were elicited, 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR], 2.44; 95% CI, 1.95–3.07;P < 0.001). Furthermore, PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women, 86 of 103 partners in the PDPM group were reported treated, compared with 23 of 104 partners in the PBPR group (RR, 4.55; 95% CI, 2.92–7.08;P < 0.001). For casual partners, 18 of 51 (34%) were reported treated in the PDPM group, compared with only three of 45 partners (7%) who were referred in the PBPR group (RR, 1.43; 95% CI, 1.40–2.65;P < 0.01). Conclusion Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners.

Lay people's perceptions of sexually transmitted infections in Uganda.

In order to understand lay peoples perceptions of sexually transmitted infections (STIs) focus group discussions and semi-structured interviews were held with community members and patients with STIs in Mbarara and Kampala, Uganda. Symptoms of common STIs and the modes of transmission methods were known. STIs were perceived as naturalistic diseases caused by a tiny insect called akakoko or akawuka, although female infertility, one of the common complications of STIs, was perceived as a supernatural ailment. There was no stigma towards people with AIDS, although stigma towards people with other STIs was high. There were also strong negative attitudes towards the use of condoms. More than 60% of the patients interviewed had received treatment from the informal sector which included self-treatment and traditional healers. To reduce the incidence and complications of STIs, there may be a need to collaborate with the informal sector, to further evaluate the beliefs and practices identified in this study and to target them for health education.

Young Sex-Workers in Ho Chi Minh City Telling Their Life Stories

In this study the life stories of 22 sex-workers (age 15-18 years) in Vietnam are organized into three thematic narratives depicting how the girls presented their lives. Poverty, lack of job alternatives and the responsibility to share in the support of their families led the girls into prostitution. Strong family ties gave many girls connectedness; earning a well-needed income provided them with purpose and meaning; and the need for self-sufficiency forced the girls to manage and protect their lives. For some, a history of abuse led to victimization and rendered them powerless. While many of their human rights were violated, it was the disrespect for their dignity that hurt most.

Loading and conventional dose therapy with phenytoin in children: Kinetic profile of parent drug and main metabolite in plasma

Epileptic children were given phenytoin (DPH) in loading (four doses of 4.4 to 6.3 mg/kg/dose given 8‐hourly and then 6 mg/kg/day) or conventional (5 to 9 mg/kg/day) doses. Plasma levels of DPH and its main metabolite (p‐OH‐DPH) were measured by a mass fragmentographic technique. Plasma DPH levels of >10 μg/ml were achieved within 16 to 38 hr in the children given loading doses and within 5 days in the conventionally dosed children. No immediate side effects were noted, but within 8 to 10 days 9 of 13 children developed a generalized skin rash. Plasma p‐OH‐DPH (free or conjugated) paralleled DPH during the accumulation phase but not during DPH elimination. The ratio of metabolite to DPH in plasma showed both an interindividual variation and an inverse relation to the level of DPH. Identical twins in the study had a similar ratio and plasma level‐time course profile. It is concluded that the loading dose regimen achieves an appropriate plasma level of DPH rapidly, that saturation kinetics are operative for p‐OH‐DPH formation, that the ratio of metabolite to DPH in plasma is an individual characteristic in children, and that further studies on the delayed toxicity are needed before the loading dose regimen can be recommended.