Vertical transmission of HIV in Belgium: a 1986–2002 retrospective analysis

Prophylactic interventions have lead to the reduction of the mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV-1) to less than 2% in industrialized countries. The aim of this study was to evaluate the changes over time in vertical transmission according to the standard care of prophylaxis in the practice of a single large reference center and to identify the risk factors for failure. The rate of MTCT decreased progressively from 10% in 1986–1993 to 4.7% in 1999–2002, reflecting the progressive implementation of newly available means of prevention. During the last period evaluated (1999–2002), where highly active antiretroviral therapy (HAART) prophylaxis was the standard of care, 17% of women had a viral load between 400 and 20,000 copies/ml around delivery and 5% had a viral load above 20,000 copies/ml. High viral load and low CD4 lymphocyte count were strongly associated with vertical transmission. The rate of MTCT in women who received HAART for more than one month during pregnancy was 1.7%, compared to 13.3% in women treated with HAART for less than one month. The risk of vertical transmission in the absence of therapy was four times higher than before the era of antiretroviral therapy (ART; p=0.05). In conclusion, since the prevention of MTCT of HIV with HAART is the standard of care, a short duration or absence of ART during pregnancy linked to late or absent prenatal care is associated with a high risk of transmission. The early detection of HIV-1 infection in pregnant women, and close follow up and support during pregnancy are crucial to the success of the prevention of transmission.     

Prevention on Parent to Child Transmission of HIV – What is New?

Prevention of Mother-To-Child Transmission (PMTCT) of HIV has been at the forefront of research in the field of HIV/AIDS since the PACTG 076 proved successful in 1994. This was followed by many trials with single, dual, or triple Anti Retroviral Therapy (ART), with or without breast-feeding, with different modes of delivery. These trials aimed and promised to find a relatively simple, low-cost intervention that could virtually eliminate the risk of HIV transmission from mother to child, cutting across all geographic boundaries. However, translation of the findings from most of these research studies into successful national PMTCT programs and health policies has not been optimal. In the west, parent to child transmission of HIV has been virtually eliminated due to universal coverage, screening, planned conception wherever possible, thorough evaluation and appropriate antenatal, intranatal and postnatal interventions. In contrast, in resource limited settings where the magnitude of the problem is the greatest accounting for more than 95?% of all vertical transmissions of HIV, there is a constant struggle dealing with the birth of an infected infant every minute. It is time to make optimal choices to prevent the transmission of HIV from an infected mother to her child and virtually eliminate this largely preventable scourge in children.     

Surgical Placement of Totally Implantable Venous Access Device–An Institutional Experience

Objectives

To investigate the advantages and disadvantages of Totally implantable venous access devices (TIVAD) catheter in pediatric age group and also to review this subject in the recent literature and compare the results with the present results.

Methods

A total of 61 cases, 2 mo to 14 y old, were included in the index study. TIVADs were implanted in these patients for chemotherapy. The device was inserted under general anesthesia (GA) by open technique. All the children were followed up for a mean period of 7.2 mo.

Results

Out of 61 cases, 9 cases had complications; 3 requiring removal of the port due to infection and in one case the device had to be reinserted due to malpositioning, one had late wound dehiscence with exposed port chamber which needed operative correction and four had minor wound infections. There was no mortality. Complications like hemo or pneumothorax, arterial puncture, hematoma formation were very less with open technique of insertion of the port. Most patients and their parents were satisfied with TIVAD.

Conclusions

Thus, TIVAD can be a useful device for many chronic patients who need an IV access for multiple injections especially in pediatric age group.     

An Evaluation of Acid–Base Changes Following Aortic Cross-Clamping Using Transcutaneous Carbon Dioxide Monitoring

To investigate the cause of acidosis following release of an aortic cross-clamp, we measured tissue PCO₂ using a transcutaneous (TC) CO₂ monitor placed below the level of the cross-clamp in 10 patients undergoing aortic arch surgery. Following placement of the aortic cross-clamp, the TC CO₂ value from the lower extremity increased from 41 ± 4 to 92 ± 41, whereas there was no change in the TC CO₂ value from the upper extremity. With release of the cross-clamp, end-tidal CO₂ increased by 6.2 ± 1.9 mmHg, the upper TC CO₂ increased by 8.4 ± 4.8 mmHg, and the lower extremity TC CO₂ value returned to baseline. During cross-clamping, there was an increase in the base deficit of 4.3 ± 2.9 when comparing the baseline arterial blood gas value with the one obtained after cross-clamp release (p = 0.0004). These data demonstrate that the acidosis occurring during aortic cross-clamping is a mixed metabolic and hypercarbic acidosis. Appropriate treatment includes the provision of adequate minute ventilation to ensure CO₂ removal and the use of sodium bicarbonate based on the degree of metabolic acidosis demonstrated by arterial blood gas analysis.     

Pediatric TBI in Finland: An examination of hospital discharges (1998–2012)

Background

Traumatic brain injury constitutes a persistent health problem among pediatric populations worldwide and is often referred to as a silent epidemic. There remains a paucity of scientific exploration with regard to understanding the ecological risk profiles of well-defined populations. In Finland, the healthcare system covers all hospitals, provides uniform access to care and has a universal surveillance system that allows for epidemiological examination of a wide variety of health issues. The present study aims to clarify the incidence, type and geographical presentation of pediatric TBI in Finland.

Risk Factors of Entry in Out-of-Home Care: An Empirical Study of Danish Birth Cohorts, 1981–2003

This paper presents the results of research on children’s risk of being placed in out-of-home care. The purpose is: firstly, to compare children placed in out-of-home care with non-placed children, secondly, to estimate the children’s risk of entry into care and finally, to compare the results of this study with the results from similar studies. The study is based on register data from the Statistics Denmark. The sample includes all children with Danish citizenship who were born 1981–2003. In order to estimate the risk of being placed in out-of-home care, we use information about the child, the mother and the father. We discovered that especially children who had a mother on disability pension, children who came from broken homes but also children whose mothers were unemployed or receiving social assistance and children whose mothers had a conviction had a high risk of being placed in care. The mother’s characteristics are more important risk factors than the corresponding risk factors of the father. The results, the applied method and the epidemiological inspired analysis make an opportunity to discuss the central concepts and methods of calculation of statistical association, risk, prediction and causal inference in applied sociology and social work.     

An unusual presentation of May–Thurner Syndrome in a pediatric patient with a pelvic kidney

We report a case of an adolescent who presented with a deep vein thrombosis (DVT) and clinical findings consistent with May–Thurner Syndrome. Specific imaging demonstrated direct compression of the left common iliac vein by an overlying pelvic kidney. The patient's history and clinical presentation is detailed. The discussion focuses on the potential implications for care and management of a patient with an ectopic left pelvic kidney.     

Postural hallucinations? An unusual presentation of anaemia

The case of a 14 year old girl is reported, referred to Child Psychiatry with tearfulness and possible auditory hallucinations. Closer questioning revealed a history of low energy, sleeping excessively without refreshment, exertional dyspnoea, and poor growth. Psychologically, there was no evidence of low mood or negative cognitions despite the inexplicable tearfulness. Detailed enquiry revealed the "hallucinations" to be "whooshing" noises in her ears precipitated by standing. She was found to have a haemoglobin level of 55 g/l, attributed to a combination of poor diet and menorrhagia.Periodic, anaemic, cerebral hypoxia could be proposed to be the root of most, if not all, of the symptoms, illustrating the importance of marrying physical and psychological history taking with suitable investigations for an eminently treatable condition.     

An experience of facility-based management of severe acute malnutrition in children aged between 6–59 months adopting the World Health Organization recommendations

Objective

To study the output indicators of a nutritional rehabilitation center to assess its performance.

Methods

Data of 182 children aged between 6–59 months with severe acute malnutrition in a nutritional rehabilitation center were analyzed retrospectively. Identification and treatment of severe acute malnutrition was done according to World Health Organization recommendations.

Results

The recovery rate, death rate, defaulter rate, mean (SD) weight gain and mean (SD) duration of stay in the nutritional rehabilitation center were 68%, 2.2%, 4.4%, 13.0 (9.0) g/kg/d, 12.7 (6.8) days, respectively.

Conclusion

Nutritional rehabilitation centers are effective in management of severe malnutrition.     

Accuracy of the Bernoulli Equation for Estimation of Pressure Gradient Across Stenotic Blalock–Taussig Shunts: An In Vitro and Numerical Study

Accurate assessment of the pressure gradient (PG) across a modified Blalock–Taussig (mBT) shunt is important in planning for staging to a cavopulmonary anastomosis for many patients with cyanotic congenital heart disease. The mBT shunt Doppler velocity has been used in the simplified echo Bernoulli equation to predict this PG with variable results. The purpose of this investigation is to provide analysis of the flow dynamics through stenotic mBT shunts and to assess the accuracy of Doppler techniques in determining PGs and the presence and location of stenosis. Three-dimensional models of mBT shunts were created, with and without stenosis. In vitro and computational fluid dynamic flow experiments were carried out. In vitro experiments demonstrated that the Doppler-measured PG underestimated catheter-measured PG in the mBT shunt with diffuse stenosis. In nonstenotic mBT and those that had outlet and inlet stenosis, the Doppler-measured PG showed underestimation of catheter PG at low PG and generally improved estimation at higher PG. In the mBT shunt model with inlet stenosis, there was slight overestimation at higher PG. Numerical simulations provide an ``observation window' into events occurring in and around mBT shunts showing that the hemodynamics vary significantly. Changing hemodynamic processes are at work through stenotic mBT shunts causing variations in overestimation and underestimation of catheter-measured PG using the simplified echo Bernoulli equation. Our results have relevance to the assessment of patients with mBT shunts, helping to explain some of the discrepancies that investigators have found in the past.