The effect of a basic home stimulation programme on the development of young children infected with HIV

Aims The human immunodeficiency virus (HIV) potentially causes a significant encephalopathy and resultant developmental delay in infected children. The aim of this study was to determine whether a home‐based intervention programme could have an impact on the neurodevelopmental status of children infected with HIV. Method A longitudinal, randomized, controlled trial was conducted. A total of 122 children aged less than 2 years 6 months were assigned to either a comparison or an experimental group. Children in the experimental group were given a home stimulation programme that was updated every 3 months. The home programme included activities to promote motor, cognitive, and speech and language development. Children in the comparison group received no developmental intervention. Children were assessed by a blinded assessor at baseline, 6 months, and 12 months using the Bayley Scales of Infant Development, 2nd edition. Results The children in this study came from poor socioeconomic backgrounds and their nutritional status was suboptimal. The experimental group included 60 children (30 males, 30 females) with a mean age of 18 months (SD 8.1mo). The comparison group included 62 children (32 males, 30 females) with a mean age 19 months (SD 8.2mo). Cognitive and motor development were severely affected at baseline, with 52% of the children having severe cognitive delay and 72% having severe motor delay at baseline. Children in the experimental group showed significantly greater improvement in cognitive (p=0.010) and motor (p=0.020) development over time than children in the comparison group. Interpretation A home stimulation programme taught to the caregiver can significantly improve cognitive and motor development in young children infected with HIV.     

A quality improvement nutrition screening and intervention program available to Home and Community Care eligible clients

Objective:  To develop and implement a nutrition screening and dietetic referral system for Home and Community Care (HACC) eligible clients.
Design:  Quality improvement project utilising a prospective, observational design.
Setting:  Sixteen Australian organisations caring for HACC eligible clients.
Subjects:  One thousand one hundred and forty-five HACC eligible clients (mean age 76.5 ± 7.2 years) were screened for nutritional risk during 2003–2005.
Interventions:  Nutrition screening was conducted by trained project officers, allied health staff, community care coordinators and nursing staff using a modified version of the malnutrition screening tool (MST). Dietitians performed a nutrition assessment using the scored Patient Generated-Subjective Global Assessment (PG-SGA) and provided individualised nutrition counselling for those identified to be at risk of malnutrition and agreeing to treatment.
Results:  According to the MST, 170 clients (15%) were identified as being at risk of malnutrition. Of these, 75 (44%) agreed to the dietetic referral and PG-SGA assessment, and 57 were subsequently assessed as malnourished (PG-SGA category B or C), suggesting a malnutrition prevalence between 5% and 11%. Of the 34 malnourished clients receiving multiple dietetic reviews (mean 4.1 ± 2.0 per client), 28 improved, with 17 achieving a well-nourished PG-SGA A rating.
Conclusion:  The development and implementation of a nutrition screening and referral system can identify HACC eligible clients who would benefit from services provided by a dietitian. Further research should identify the reasons why some HACC eligible clients are reluctant to be referred to a dietitian.     

Antibodies to diphtheria, tetanus and pertussis in infants before and after immunization with DTP (Triple Antigen) vaccine

Objective : To determine antibody levels to the Australian manufactured combined diphtheria, tetanus and pertussis (DTP) vaccine (Triple Antigen, CSL Ltd) in infante before and after their primary immunization course.
Methodology : Serosurvey (antibody prevalence study) in two groups: infants aged 5-9 weeks who had not received any immunizations ( n = 25), and infants aged 7-10 months who had received two ( n = 25) or three immunizations ( n = 57) with DTP, sampled from infants attending the Royal Children's Hospital, Melbourne, either as inpatients or outpatients between February and April 1993. The immunization history for each infant was determined from hospital records, the parent-held child health record, or the local council or family doctor who immunized the infant.
Results : Enzyme immunoassay (EIA) of antibodies to diphtheria and tetanus showed all infants to have adequate protective levels after two or three vaccinations (£0.01 IU/mL). All subjects who had received all three DTP vaccinations had detectable antibody to at least one pertussis antigen. Antibodies to the pertussis antigens filamentous haemagglutinin and pertussigen (pertussis toxin) were comparable to levels determined for whole cell pertussis vaccines used elsewhere in the world. EIA-determined antibodies to pertussis agglutinogen type 2 and agglutinogen type 3 showed substantially higher geometric mean titres when results for pre-immunization and post-immunization subjects were compared.
Conclusions : These data show that the Australian manufactured DTP vaccine has immunogenic properties similar to those of vaccines used elsewhere, and that antibody concentrations following immunization are at levels consistent with efficacy.     

Massive Cystic Hepatomegaly in a Female Patient with Polycystic Kidney Disease Treated by Combined Hepatic and Renal Transplantation

A patient with cystic kidney disease of adult onset and severecystic hepatomegaly is presented. The patient was severely disabledsolely by her abdominal bulk. Simultaneous liver and renal transplantationwas undertaken successfully.     

Is pure red cell aplasia (PRCA) a clonal disorder?

Summary Pure red cell aplasia (PRCA) is an uncommon disorder, many cases lacking a well defined aetiology. This report describes three cases of PRCA (two idiopathic and one associated with B-CLL) who were investigated to assess the possibility of their PRCA being associated with a clonal proliferation of T-lymphocytes. The results show that one patient had evidence of T-cell receptor (TCR) gamma chain rearrangement, and the other had a TCR delta chain rearrangement. These two cases raise the possibility of PRCA being associated with a clonal proliferation of T-cells and further studies are warranted.     

The Spectrum of Angiographic Findings in Transitional Cell Carcinoma of the Kidney

The spectrum of angiographic finding in 20 patients with transitional cell carcinomas of the kidney is described. In 15 of 20 patients (75%), prospective diagnosis of transitional cell carcinomas were made because of a combination of the angiographic findings; tumour vessels, tumour stain, prominent pelviureteric arteries and arterial encasement. In 4 patients with negative angiograms the lesions were relatively small in size and were situated within the renal parenchyma, primarily involving the calyces. The use of pharmacoangiographic agents such as epine-phrine and priscoline improved the angiographic visualization of transitional cell carcinomas of the kidney. For the past several years angiography has had a central role in the evaluation of patients with hematuria and renal masses¹. 5,6,7,8. Although the use of diagnostic ultrasound and renal puncture have eliminated angiography from the diagnosis of renal cysts, most renal masses which are solid or which have equivocal findings at ultrasound still undergo angiography. At the same time, the decreasing use of retrograde urography has resulted in more frequent angiography in patients with unilateral nonfunctioning kidneys. Transitional cell carcinomas of the renal pelvis are an important cause of both hematuria and non-functioning kidneys. We have therefore reviewed our material to reassess the angiographic abnormalities caused by the transitional cell carcinomas and the overall accuracy of the angiography in the diagnosis of these lesions.