Newborn screening for human immunodeficiency virus infection in the Bronx, NY, and evolving public health policy

New advances in the diagnosis and treatment of HIV infection continue to propel changes in public understanding of HIV infection and the administration of public health law. Over the past decade, New York State has moved from a policy of blind newborn screening for seroprevalence data to mandatory HIV testing as part of the statewide Newborn Screening (NBS) Program. A new statewide program of expedited HIV testing (48-hr turnaround results) of pregnant women and newborns (whose HIV status is unknown at the time of delivery) began in the summer of 1999. To better understand the impact this program might have on the patients who receive health care at Lincoln Medical and Mental Health Center (Lincoln Hospital), we evaluated our experience with the current NBS program prior to inauguration of the new expedited testing program. We evaluated the NBS program from February 1, 1997, to January 31, 1999, including total number of HIV-exposed/infected infants born, mother's HIV status (if known) at the time of delivery, amount of time between blood sampling and return of the test results to the Hospital, and medical follow-up of infants with positive newborn screening test results. This was a retrospective study of the NBS registry and the medical records of patients who receive primary health care from the Pediatric Immunology Service of the Department of Pediatrics at Lincoln Hospital. One hundred and four newborns were identified with positive-HIV antibody (HIV-Ab-positive), and 13 (12.5%) were confirmed to be HIV-infected by positive polymerase chain reaction (PCR) test of viral DNA. Sixty-five (62.5%) of the newborns with positive NBS screening test results were born to mothers who were known to be HIV-infected prior to delivery; 39 (37.5%) were unanticipated. Four (30%) of the 13 HIV-infected babies were born to mothers who were known to be HIV-infected prior to delivery, and 9 (70%) were born to mothers whose HIV status was unknown at the time of delivery. Eighty percent (80%) of HIV-Ab-positive infants continued to receive follow-up care at Lincoln Hospital. Relocation to other health-care facilities occurred as a result of parental choice or due to foster care placement. No babies were "lost" from the NBS program. The average time between sampling and receipt of results for all blood tests was 16 days (range 10 to 141). Nearly 40% of newborns who acquired HIV infection from their mothers were unanticipated because the mother's HIV status was unknown at the time of delivery. These unanticipated HIV-infected infants represent missed opportunities for prevention of maternal-to-child transmission of HIV infection and early therapeutic intervention for HIV-infected infants. The new expedited HIV-testing program for New York State will facilitate early diagnosis, prevention and treatment of the HIV-exposed/infected infant for whom maternal HIV status is unknown at the time of delivery.     

Motor and cognitive performances in pre-lingual cochlear implant adolescents,related with vestibular function and auditory input

Background: Information about the role of auditory input and motor control is limited.

Objectives: Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions.

Methods: Posturography in 17 Pre-lingual Cochlear Implant Adolescents, (PCIA) age 14.06?±?3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10-meter test. Vestibulo-ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC-V test.

Results: SV had no significant difference between conditions A and B (p?=?.2461). Comparing C and D, SV values decreased when CI was turned on (p?=?.0036). A significant linear relationship between VOR and GV (p?=?.0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p?=?.685).

Conclusions and significance: Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.     

Cytotoxic effects of cytokines on rat islets: Evidence for involvement of free radicals and lipid peroxidation

Summary We have previously reported that oxygen free radical scavengers protect rat islet cells from damage by cytokines and we interpreted these findings as suggesting the involvement of oxygen free radicals but did not directly measure indices of free radical activity. In this study, we report on malondialdehyde, an end product of lipid peroxidation, in rat islets incubated with cytokines. The individual cytokines, interleukin 1 (1 U/ml), tumour necrosis factor (10² U/ml), and interferon gamma (10² U/ml) inhibited insulin release but did not increase islet malondialdehyde levels. Combination of these cytokines however, produced significant increases in islet malondialdehyde and this was accompanied by islet necrosis. Furthermore, an inhibitor of lipid peroxidation, U78518E, significantly decreased the cytokine-induced increase in islet malondialdehyde and protected islet Beta cells from destruction by the cytokine combination of interleukin 1, tumour necrosis factor and interferon gamma. These findings suggest that the cytotoxic action of cytokines on islet Beta cells may result from free radical production and lipid peroxidation in the islet cells.     

Mental health interventions in divorce proceedings

The protracted process involved in family disruption provides the opportunity for different types of mental health intervention. In addition to the traditional diagnostic and evaluative services typically requested by the legal system, preventive and therapeutic programs can be developed. Implementation of a program by the UCLA Section on Legal Psychiatry is described.     

Induction of infectious virus DNA and virus particles by mitomycin C in SV40-transformed mouse cells.

A line of SV40-transformed mouse cells (SV/3T3-4E) was isolated and four clones were derived from this line. Spontaneous production of small amounts of infectious SV40 DNA was detected in the parental line and in three out of the four clones tested, although no synthesis of virions could be demonstrated. The yields of SV40 DNA were significantly enhanced following treatment of these cells with mitomycin C and infectious virus particles became detectable occasionally.