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.     

Differential expression of hMLH1 in sporadic human colorectal cancer tumors and distant metastases

Somatic defects in the mismatch repair system constitute an important pathway in colorectal carcinogenesis. We have examined the expression of mismatch repair proteins in sporadic stage IV colorectal tumors and their derived metastases. Sporadic tumors were further examined for differences in expression between the tumor transition zone and the invasive front. Expression of hMSH2, hMLH1, and hPMS2 was screened immunohistochemically in 92 stage IV tumors and derived liver metastases. In cases with loss of mismatch repair protein expression, lymph node metastases were also examined. Clinicopathological parameters and Ki‐67 staining indexes were evaluated and compared. Four tumors displayed a complete loss of hMLH1/hPMS2 expression at the transition zone; however, three of these expressed both proteins at the invasive front and in liver and lymph node metastases. A further four were predominantly hMLH1/hPMS2 negative at the transition zone, but with distinct subclones of hMLH1/hPMS2‐expressing cells at the transition zone. All of these tumors expressed hMLH1/hPMS2 at the invasive front and in liver metastases, with three also expressing hMLH/hPMS2 in lymph node metastases. No significant difference in the proliferative index was observed for the hMLH1/hPMS2‐compromised group. In stage IV tumors re‐expression of hMLH1/hPMS2 occurred, leading to different patterns of expression within the primary tumor and between tumor and metastases. This may have functional importance for the chemosensitivity of metastases compared to the primary tumor.     

Lipoprotein Alterations and Plasma Lipoprotein Lipase Reduction in Familial Hemophagocytic Lymphohistiocytosis

ABSTRACT. Serum lipid abnormalities are common in familial hemophagocytic lymphohistocytosis (FHL), a disorder also characterized by fever, hepatosplenomegaly, pancytopenia and a prominent lymphohistiocytic accumulation in the mononuclear phagocyte system. The lipoprotein pattern in nine children with FHL was studied with a quantitative method measuring cholesterol and triglycerides in each major class of lipoproteins. Triglycerides were markedly elevated during active FHL in serum, very low density lipoproteins, and low density lipoproteins. Cholesterol was increased in very low density lipoproteins whereas both triglycerides and cholesterol were extremely low in high density lipoproteins. These lipoprotein abnormalities, reversible on successful therapy, are compatible with a depressed lipolytic activity. Post-heparin levels of lipoprotein lipase and hepatic lipase in plasma were studied in four children and found to be markedly low during active FHL. We suggest that inflammatory cytokines, which may strongly suppress lipoprotein lipase activity, can be important mediators in the pathophysiology of FHL and that they may participate in the development of the lipid abnormalities.     

Nutritional assessment of children with juvenile chronic arthritis

Nutritional assessment was performed in 38 children with juvenile chronic arthritis (polyarticular [15]; pauciarticular [13]; systemic [10]). This included anthropometric measurements (height, weight, mid-upper arm circumference and four skinfolds) and a 7 day weighed food record. The children were classified according to current type of arthritis which in some cases was not the same as the initial onset type. Mean height Z scores were significantly below the Z score population mean of 0 in the systemic (P = 0.02) and polyarticular (P = 0.009) groups. Mean weight Z scores were also below the mean in the polyarticular group (P = 0.001) but the systemic group did not reach significance. Mean energy intakes were significantly below the recommended dietary intake (RDI) in the systemic (P = 0.01) and polyarticular (P = 0.001) groups. Mean intakes of calcium and zinc were below the RDI of 100% in the polyarticular group (P = 0.0001). Thirteen (34%) of children were taking some form of self-prescribed vitamin and/or mineral supplement. Vitamin C was the most commonly used supplement, despite dietary intakes greatly exceeding the RDI. Nutritional assessment is essential in the management of patients with JCA, in particular those with systemic or polyarticular disease.     

Evaluation of a Transcutaneous Oxygen and Carbon Dioxide Monitor in a Neonatal Intensive Care Department

Transcutaneous-Po₂; (tc-Po₂ (tc-Pco₂) at 44^oC and transcutaneous-Pco₂) at 38, 42, 43 and 44^oC were measured with a currently available monitoring system (TCM222, Radiometer, Copenhagen) in 64 newborn infants with severe respiratory insufficiency during the first five days of life. Tc-Pco₂ at all four temperatures correlated better with arterial blood-Pco₂ (aB-Pco₂)> than tc-Po₂ with aB-Po2. However, the sensitivity and specificity of tc-Po₂ and tc-Pco₂ were similar with regard to maintaining aB-Po₂, and aB-Pco₂ within specified limits. Tc-Pco₂ increased relatively with increasing electrode temperature by a factor which was similar to the anaerobic temperature coefficient of Po₂, in blood. The coefficient of variation of duplicate measurements was 10 % for tc-Po₂ and 5 % for tc-Pco₂. Electrode drift after an average of 3 hours patient monitoring was 2%±6% (1SD) for tc-Pco₂, and -3 %±6 % for tc-Pco₂- We conclude that tc-Po₂ and tc-Pco₂ are a valuable supplement to arterial blood gas measurements, but the variable correlation with arterial blood gas values and the electrode drifts which may occur, mean that they cannot fully replace arterial sampling.     

Effect of epidural analgesia on maximum and minimum blood pressures during the first stage of labour in primigravidae with mild/moderate gestational hypertension

Summary. One of the arguments used in favour of epidural analgesia for hypertensive patients in labour is its effect on mean arterial blood pressure, although the fetal and maternal risk from hypertension is more closely linked to maximum recorded levels. We have therefore assessed the effect of epidural analgesia on maximum blood pressure. There was no change in the maximum systolic or diastolic blood pressure after epidural analgesia when compared to baseline values or levels in untreated hypertensive controls. We conclude that this form of analgesia should be offered to hypertensive patients purely for its analgesic effect and not as a method for blood pressure control.     

THE INTERACTION BETWEEN THE INFANT AND THE ENVIRONMENT: THE IMPORTANCE OF MOTHER-CHILD CONTACT AFTER DELIVERY

Abstract. Birth is more than just the physical beginning of a new life — it is also the start of the psychosocial development of the newborn infant together with its family. Immediately after delivery parents and infants can start to exchange signals that maybe are of major importance for this development. The early post partum period has been regarded to have great potentials and especially the mother has been regarded to play a very powerful role, whereas the infant's contribution has been accorded little discussion. The individual reactive capacity of the newborn baby and its influence on the environment can be illustrated in a number of ways. In recent years studies of fetal movements have been made by means of ultra sound registration and it has been discussed whether these are precursors of later behavior in the neonate-infant. The transition at birth can be considered either to be continuous or discontinuous, the outcome of this discussion has great bearing on the importance of early neonate-environment interactions.
Short and long term outcome of different routine care procedures around the time of delivery and transition are controversial subjects. Although several studies support the importance of early post delivery interaction, other studies do not seem to find correlations between early experiences and later developmental outcome measurements. In this paper several of these aspects will be discussed, examples from the literature given and possible clinical applications suggested, as well as their impact on the care of healthy and sick newborns and their families.     

Early Intravenous Indomethacin Prolongs Respiratory Support in Very Low Birth Weight Infants

ABSTRACT. Infants weighing 1500 g at birth requiring either intermittent positive pressure ventilation or continuous positive airway pressure by 12 hours of age were entered in a randomized double blind controlled trial to test the efficacy of early intravenous indomethacin therapy in preventing chronic pulmonary disease of prematurity. Of the 30 newborns enrolled, 15 were treated with indomethacin and 15 were treated with placebo at 12, 24 and 36 hours of age. The groups were similar for birth weight, gestational age, sex, hyaline membrane disease and intracranial hemorrhage. Infants in the placebo group were successfully weaned from intermittent positive pressure ventilation at an earlier age than infants in the indomethacin group ( p <0.05). Furthermore, chronic pulmonary disease of prematurity was similar in the two groups despite a reduction in the incidence of patent ductus arteriosus in the indomethacin group.     

Salivary oestriol in normal and abnormal pregnancies

Summary. Profiles of daily salivary oestriol concentrations throughout the third trimester of pregnancy have been constructed for 14 normal and 11 abnormal pregnancies. Day-to-day variations were significantly higher than those reported for unconjugated oestriol in plasma or serum. A sustained decline in salivary oestriol concentrations was observed in one pregnancy in which intrauterine death occurred. Sustained falls were also observed in two pregnancies in which a healthy infant was born at term. In all other patients a normal salivary oestriol profile correlated with a favourable outcome. Salivary oestriol measurements provide similar information to plasma unconjugated oestriol measurements while offering the advantages of a simple, non-invasive sample collection procedure.