Margaret de Campo
Royal Children's Hospital
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Bulletin of The World Health Organization | 2005
Thomas Cherian; E. Kim Mulholland; John B. Carlin; Harald Østensen; Ruhul Amin; Margaret de Campo; David Greenberg; Rosanna Lagos; Marilla Lucero; Shabir A. Madhi; Katherine L. O'Brien; Steven Obaro; Mark C. Steinhoff
BACKGROUND Although radiological pneumonia is used as an outcome measure in epidemiological studies, there is considerable variability in the interpretation of chest radiographs. A standardized method for identifying radiological pneumonia would facilitate comparison of the results of vaccine trials and epidemiological studies of pneumonia. METHODS A WHO working group developed definitions for radiological pneumonia. Inter-observer variability in categorizing a set of 222 chest radiographic images was measured by comparing the readings made by 20 radiologists and clinicians with a reference reading. Intra-observer variability was measured by comparing the initial readings of a randomly chosen subset of 100 radiographs with repeat readings made 8-30 days later. FINDINGS Of the 222 images, 208 were considered interpretable. The reference reading categorized 43% of these images as showing alveolar consolidation or pleural effusion (primary end-point pneumonia); the proportion thus categorized by each of the 20 readers ranged from 8% to 61%. Using the reference reading as the gold standard, 14 of the 20 readers had sensitivity and specificity of > 0.70 in identifying primary end-point pneumonia; 13 out of 20 readers had a kappa index of > 0.6 compared with the reference reading. For the 92 radiographs deemed to be interpretable among the 100 images used for intra-observer variability, 19 out of 20 readers had a kappa index of > 0.6. CONCLUSION Using standardized definitions and training, it is possible to achieve agreement in identifying radiological pneumonia, thus facilitating the comparison of results of epidemiological studies that use radiological pneumonia as an outcome.
Pediatric Infectious Disease Journal | 2009
Marilla Lucero; Hanna Nohynek; Gail M. Williams; Veronica Tallo; Eric A. F. Simões; Socorro Lupisan; Diozele Sanvictores; Simon J. Forsyth; Taneli Puumalainen; Juanita Ugpo; Marites Lechago; Margaret de Campo; Erma Abucejo-Ladesma; Lydia Sombrero; Antti Nissinen; Anu Soininen; Petri Ruutu; Ian Riley; Helen P. Mäkelä
Background: Pneumococcus is a leading cause of childhood pneumonia worldwide. Pneumococcal conjugate vaccines (PCV) have demonstrated efficacy against childhood invasive pneumococcal disease (IPD) and pneumonia in the United States and Africa. No information is available from Asia on the impact of PCV on childhood pneumonia. Methods: We conducted a randomized, placebo-controlled, double-blind trial in Bohol, the Philippines (ISRCTN 62323832). Children 6 weeks to <6 months of age were randomly allocated to receive 3 doses of either an 11-valent PCV (11PCV, sanofi pasteur, Lyon, France) or a saline placebo, with a minimum interval of 4 weeks between doses to determine vaccine efficacy (VE) against the primary outcome of a child experiencing first episode of community-acquired radiologically defined pneumonia in the first 2 years of life. Secondary end points were clinical pneumonia, IPD, safety, and immunogenicity. Results: Twelve thousand one hundred ninety-one children were enrolled. By per protocol (PP) analysis, 93 of 6013 fully vaccinated 11PCV recipient children had a first episode of radiologic pneumonia compared with 120 of 6018 placebo recipients. VE against radiologically defined pneumonia for the PP cohort of children 3 to 23 months old was 22.9% (95% CI: −1.1, 41.2; P = 0.06), for the prespecified subgroups of children 3 to 11 months of age, 34.0% (95% CI: 4.8, 54.3; P = 0.02), and of those 12 to 23 months old, 2.7% (95% CI: −43.5, 34.0; P = 0.88). By intent-to-treat (ITT) analysis, 119 of 6097 11PCV recipient children had an episode of radiologic pneumonia compared with 141 of 6094 placebo recipients. VE against radiologic pneumonia for the ITT cohort of children <2 years old was 16.0% (95% CI −7.3, 34.2; P = 0.16), for a subgroup of children <12 months of age, 19.8% (95% CI: −8.8, 40.8; P = 0.15). VE against clinical pneumonia by PP was not significant (VE 0.1%; 95% CI −9.4, 8.7; P = 0.99). IPD was rare: only 3 cases of IPD due to vaccine serotypes were observed during the study. 11PCV was immunogenic and well tolerated. Among 11PCV recipients, a small excess of serious adverse respiratory events was observed in the first 28 days after the first and second dose of vaccine, and of nonrespiratory events after the first dose. An excess of pneumonia episodes in 11PCV recipients in the month following the second dose of vaccination was the principal reason for lower VE by ITT analysis than by PP analysis. Conclusions: In PP analysis, a 22.9% reduction of community-acquired radiologically confirmed pneumonia in children younger than 2 years of age in the 11-valent tetanus-diphtheria toxoid-conjugated PCV vaccinated group was observed; a reduction similar as observed in other PCV trials. We could not demonstrate any VE against clinical pneumonia. Our finding confirms for the first time that in a low-income, low-mortality developing country in Asia, at least one-fifth of radiologically confirmed pneumonia is caused by pneumococcus, and thus preventable by PCV. Whether PCV should be included in national program in such settings, however, depends on careful country specific disease burden measurement and cost-effectiveness calculation.
Pediatric Radiology | 1984
J. F. De Campo; Valerie Mayne; David W. Boldt; Margaret de Campo
The radiological findings in 13 patients with total aganglionosis coli were reviewed. There was a male to female ratio of 7:6. Fifty-four percent of patients presented in the first week of life, but a significant number (31%) did not present until after 1 month of age. All patients had plain film evidence of bowel obstruction when referred for a barium enema. There were no pathognomonic barium enema findings, and barium enema results covered the entire spectrum of findings which can be encountered in the neonate and young infant with bowel obstruction. Seventy-seven percent had normal calibre colon, 23% had micro colon, 23% had a shortened colon, 46% had colonic wall irregularity, 33% had significant ileal reflux. Delayed evacuation of barium from colon occurred in the two patients who had delayed films. Total colonic aganglionosis should be considered in any infant or young child with plain film evidence of bowel obstruction, whatever the barium enema findings. Hirschsprungs disease and the level of transition can only be definitively diagnosed by biopsy.
Bulletin of The World Health Organization | 2006
Julie E. Bines; Nguyen Thanh Liem; Frances Justice; Tran Ngoc Son; John B. Carlin; Margaret de Campo; Kris Jamsen; Kim Mulholland; Peter Barnett; Graeme L. Barnes
OBJECTIVE To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. METHODS Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Childrens Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participants status. Sensitivity of the definition was evaluated in 584 infants aged<2 years with suspected intussusception (533 infants in Hanoi; 51 in Melbourne). Specificity was evaluated in 638 infants aged<2 years presenting with clinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne). FINDINGS In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%). CONCLUSION The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely.
Pediatric Surgery International | 1986
Spencer W. Beasley; Margaret de Campo; C. W. Chow; A. W. Auldist
Biliary cystadenomas are rare slow-growing multiloculated lesions which arise from the liver, mainly in middle-aged females, and are occasionally complicated by malignant transformation into cystic adenocarcinoma. This paper reports a case occurring in a 1-year-old male child. The typical radiological appearances that would enable a preoperative diagnosis to be made are described. Careful review of the histological features suggests that the biliary cystadenoma and the slightly less rare, solitary multilocular nonparasitic cyst of the liver in childhood are the same lesion.
Bulletin of The World Health Organization | 2006
Julie E. Bines; Nguyen Thanh Liem; Frances Justice; Tran Ngoc Son; John B. Carlin; Margaret de Campo; Kris Jamsen; Kim Mulholland; Peter Barnett; Graeme L. Barnes
Introduction The withdrawal of the first rotavirus vaccine to be licensed in the United States (RotaShield, Wyeth-Lederle Vaccines, Philadelphia, PA, United States), due to an unexpected association with intussusception, resulted in a major setback in the effort to reduce the global burden of rotavirus gastroenteritis. (1-3) Although the risk of intussusception following immunization with RotaShield is low, it has posed a major challenge to the future development of a safe and effective vaccine. (2) Large-scale clinical trials are now required to detect a risk of intussusception of Intussusception is the invagination of the bowel by a more proximal segment. The intussusception can be propelled distally by peristalsis, resulting in intestinal obstruction and vascular compromise of the intestine. Prompt identification and reduction by air enema or hydrostatic enema or by surgery is vital to minimize the morbidity and mortality that may be associated with this condition. To assist in the early recognition of infants with intussusception a clinical case definition for the diagnosis of acute intussusception in infants and young children was developed by WHO and the Brighton Collaboration. (7) The aim of the clinical case definition is to provide practical clinical criteria that will identify the majority of children with intussusception presenting at a variety of health-care settings. The clinical case definition that was developed showed promise (sensitivity = 97%; specificity = 87-91%) in a retrospective study in a tertiary care hospital in Australia. (8) The aim of this study was to validate the clinical case definition for intussusception by assessing the performance of the criteria prospectively in parallel studies in a developed country and in a developing country where there is a high incidence of intussusception. Each component of the definition was analysed to assess the reliability of individual symptoms and signs as well as groups of symptoms and signs to assess the sensitivity and specificity of the definition. Methods Prospective studies were performed at the National Hospital of Pediatrics in Hanoi, Viet Nam, during a 14-month period (1 November 2002-31 December 2003) and the Royal Childrens Hospital in Melbourne, Australia, over a 24-month period (19 March 2002-18 March 2004). The study was approved by the Ethics Committee of the Ministry of Health, Viet Nam, and the Ethics in Human Research Committee of the Royal Childrens Hospital, Melbourne. Free and informed consent was obtained from each childs legal guardian. The sensitivity of the clinical case definition was evaluated in infants aged The specificity of the definition was assessed in patients with symptoms and signs that may occur in intussusception but for whom an alternative diagnosis was established (non-intussusception control group). The non-intussusception control group included infants aged
The Journal of Pediatrics | 2006
Julie E. Bines; Nguyen Thanh Liem; Frances Justice; Tran Ngoc Son; Carl D. Kirkwood; Margaret de Campo; Peter Barnett; Ruth F. Bishop; Roy M. Robins-Browne; John B. Carlin
Pediatric Radiology | 2007
Frances Justice; Margaret de Campo; Nguyen Thanh Liem; Tran Ngoc Son; Tran Phan Ninh; Julie E. Bines
The Medical Journal of Australia | 2003
Mark Elwood; Donald A. Campbell; Margaret de Campo
The Medical Journal of Australia | 2010
John de Campo; Margaret de Campo