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Background: Telomeres are non-coding regions of DNA that cap the ends of chromosomes. Their length is considered a marker of human replicative senescence and premature aging. Given the high association of liver transplantation with the metabolic syndrome, we hypothesized that liver transplant recipients may exhibit premature and accelerated aging., Material and Methods: Telomere length in peripheral blood lymphocytes was measured by polymerase chain reaction in 62 consecutive liver-transplant recipients and 59 healthy control subjects aged 20-76 years. Clinical and laboratory parameters were collected from the medical files., Results: The liver transplant recipients were significantly older than the control subjects (p=0.012), with significantly higher rates of obesity (BMI >30 kg/m(2)), dyslipidemia, hypertension, diabetes, and fatty liver. Mean telomere length was significantly shorter in the transplant group (0.59±0.6 vs. 1.91±1.78 in the controls, p<0.0001). Within the transplant group, there was no significant association between mean telomere length and underlying liver disease or presence of the metabolic syndrome or its constituents. On multivariate analysis, telomere length was negatively associated with patient age (p=0.0001), male sex (p=0.04), acute rejection (p=0.005), and fatty liver (p=0.009), and was positively associated with time from transplantation (p=0.006)., Conclusions: Liver transplantation is associated with shortened telomere length in peripheral blood lymphocytes, suggesting accelerated senescence.

Background: As of February 2010, the 2009 H1N1 influenza has caused more than 15,000 deaths worldwide. Seasonal influenza vaccination rates among health care workers (HCW) have been universally low; the 2009 H1N1 influenza vaccination of HCW has also been disappointing. In several studies, a correlation between HCW seasonal influenza vaccination status and vaccine recommendation to adult patients was found., Objective: To examine the correlation between the declared influenza vaccination status of pediatric staff and vaccine recommendations to their patients., Instrument: Anonymous questionnaire concerning attitudes and practices regarding seasonal and 2009 H1N1 influenza vaccination., Respondents: 141 pediatric staff attending a conference., Results: Seventy two percent of the respondents had been or intended to be vaccinated against seasonal influenza, 62% against the 2009 H1N1 influenza, and 56% against both diseases. Ambulatory setting employment was positively associated with the recommendation of seasonal influenza vaccination to all children. By multivariate Logistic regression analysis, the "vaccinated or intending to be vaccinated against seasonal influenza" was the only significant independent variable associated with recommending universal pediatric seasonal influenza vaccine (OR=15, 95% CI 6.1-41.4, p < 0.001). Similarly, "being or intending to be vaccinated against the 2009 H1N1 influenza" was the only significant independent variable associated with recommending universal pediatric vaccination against this disease (OR = 5.2, 95% CI 1.85-14.6, P = 0.002)., Conclusion: A strong correlation between the influenza vaccination status of pediatric staff and the recommendation of the vaccines to children emphasizes that intense education of providers is a crucial step in assuring a positive recommendation to families.

Objective: An apparent life-threatening event (ALTE) caused by ingestion of drugs or toxins has been reported rarely among infants. None of these agents was homeopathic medication. We report 11 infants who presented with an ALTE after ingestion of Gali-col Baby, a homeopathic agent indicated for "infantile colic.", Methods: A retrospective case-control study was conducted. Charts of all infants who were younger than 1 year and were admitted with an ALTE from January 2005 through August 2008 to the pediatric division at the Barzilai Medical Center were reviewed. Age-matched infants who were admitted on the same dates for a reason other than ALTE served as a control group. Information on medications administered before admission was recorded., Results: During the study period, 36 635 children visited the pediatric emergency department of the Barzilai Medical Center. There were 11 057 admissions to the pediatric division during this period, 115 of which were because of an ALTE. Eleven of these infants received Gali-col Baby before the event as opposed to none in the control group (P < .005). Three infants received a significant overdose, compared with the manufacturer's recommended dosage. After a thorough investigation, no other presumptive causes for ALTE were found among the 11 infants., Conclusions: Gali-col Baby is associated with an ALTE in some infants. There are no published controlled trials on the efficacy or safety of its use; therefore, better control and supervision of Gali-col Baby and probably other homeopathic medications are needed to prevent possible serious adverse effects.

Background: A substantial number of premature deliveries occur in hospitals lacking neonatal intensive care facilities. We previously demonstrated a comparable outcome of very low birth weight infants delivered in a level II nursery to that of inborn infants delivered in our tertiary care center, but a similar comparison of extremely low birth weight infants has not been done., Objectives: To compare the neonatal outcome (mortality, severe intraventricular hemorrhage/periventricular leukomalacia, bronchopulmonary dysplasia and intact survival) of inborn and outborn ELBW infants, accounting for sociodemographic, obstetric and perinatal variables., Methods: We compared 97 ELBW infants (birth weight < or = 1000 g) delivered between the years 2000 and 2004 in a hospital providing neonatal intensive care to 53 ELBW babies delivered in a referring hospital. A univariate model was first applied to examine the associations of the individual independent variables with the outcome variable, followed by a logistic stepwise regression analysis for each of the outcome variables. The odds ratios for each predictor were reported as well as their P values and 95% confidence intervals., Results: In the stepwise logistic regression analysis, accounting for a possible confounding effect of the independent variables, 'hospital of birth' remained a statistically significant predictor in the final step only for mortality, with odds ratio (inborns relative to outborns) of 3.32 (95% CI 1.19-9.28, P = 0.022). No statistically significant associations with the other outcome variables were found (severe IVH/PVL odds ratio = 1.99, 95% CI = 0.77-5.14, P = 0.155; BPD odds ratio = 0.60, 95% CI = 0.19-1.91, P= 0.384; intact survival OR = 0.56, 95% CI = 0.23-1.35, P = 0.195)., Conclusions: ELBW outborn infants may share an outcome comparable with that of inborn babies, if adequate perinatal care is provided.

Background: Spontaneous coronary reperfusion occurs in 7-27% of patients with ST elevation myocardial infarction, and is an independent predictor of myocardial salvage, percutaneous coronary intervention success, and improved outcome., Objectives: To determine the optimal PCI time for patients admitted to the hospital due to STEMI with SCR., Methods: We performed a retrospective analysis of all patients admitted to the coronary care unit between July 2002 and November 2004 with a diagnosis of STEMI with SCR., Results: The study group comprised 86 patients. There was not a single reinfarction episode during an observation period of 6579 patient hours. Cardiac catheterization was executed early (< 24 hours from pain onset) in 26 patients and late (> 24 hours) in 55. Pre-PCI angiographic TIMI flow 2-3 was seen in > 95% in both groups. PCI was performed more frequently in the "early" group (P = 0.024), while multi-vessel coronary artery disease (P = 0.094) requiring coronary bypass surgery (P = 0.056) was observed more frequently in the "late catheterization" group. Myocardial infarction and angina pectoris at 30 days occurred more frequently in the early catheterization group (P = 0.039), however no difference in any major adverse cardiac events was detected during long-term follow-up (491 +/- 245 days)., Conclusions: Reinfarction after STEMI with SCR is a rare event. Early PCI in patients with STEMI and SCR, even when executed with aggressive antiplatelet therapy, seems to result in an excess of early MACE without any long-term advantage. Prospective randomized trials should determine the optimal PCI timing for these patients.