Orbital cellulitis in a neonate of the tooth bud origin : A case report

Orbital cellulitis is a serious, yet uncommon infection in neonates. It can result in significant sight and life threatening complications. Most commonly, it occurs secondarily as the result of a spread of infection from the sinuses. Orbital cellulitis, secondary to dental infection is rare. We hereby report a case of orbital cellulitis secondary to dental infection in a 15-day-old neonate without any systemic features.     

Lack of association between stavudine exposure and lipoatrophy,dysglycaemia, hyperlactataemia and hypertriglyceridaemia: a prospective cross sectional study

Background  

Stavudine continues to be widely used in resource poor settings despite its toxicity. Our objective was to determine association between plasma stavudine concentrations and lipoatrophy, concentrations of glucose, lactate and triglycerides.     

Usefulness of total lymphocyte count in monitoring highly active antiretroviral therapy in resource-limited settings

OBJECTIVE: To assess the usefulness of total lymphocyte count (TLC) for monitoring HIV-infected patients receiving highly active antiretroviral therapy.DESIGN Observational cohort study. METHODS: Correlation between difference (Delta) from baseline at week 4, 8, 12 and 48 in TLC, CD4 cell count and viral load was determined in patients initiating HAART in phase III clinical trials between 1995 and 2001 at the HIV Clinical Research Unit, Somerset Hospital, Cape Town. RESULTS: The study included 266 patients. At weeks 4, 8, 12 and 48, median increase in TLC was 30, 52, 139 and 219 cells x 10 /l, median increase in CD4 cell count was 8, 48, 88, and 145 cells x 10 /l, and median decrease in viral load was -1.6, -2.2, -2.5 and -2.7 log copies/ml, respectively. The correlation between all pairs of DeltaTLC and DeltaCD4 cell counts was significant (r, 0.61; P < 0.0001), but between DeltaTLC and Delta viral load it was not (r, -0.014; P= 0.73). However, the correlation between median viral load reduction and median increase in both DeltaCD4 cell count (r, -0.96; P< 0.0001) and DeltaTLC (r, -0.89; P< 0.0001) was significant. The slope of DeltaCD4 cell count was [52.493 + 0.14(DeltaTLC)]. Sensitivity and specificity of an increase or decrease from baseline in TLC for similar trend in CD4 cell count during follow-up were 83.4% and 87.3% respectively. CONCLUSION: TLC correlated well with changes in CD4 cell count and at a group level with viral load changes. TLC may have a role in inexpensive monitoring of the immunological response to highly active antiretroviral therapy in a resource-constrained setting.     

Initiating highly active antiretroviral therapy in sub-Saharan Africa: an assessment of the revised World Health Organization scaling-up guidelines

OBJECTIVES: To assess the utility of the 2003 revised World Health Organization (WHO) criteria [initiating highly active antiretroviral therapy (HAART) in stage IV, in stage III plus CD4 cell count < 350 x 10(6) cells/l, or in stage I or II plus CD4 cell count < 200 x 10 cells/l] relative to other scenarios of HAART initiation. METHODS: Progression to AIDS and death in 292 patients taking HAART and 974 not taking HAART in a South African institution in 1992-2001, stratifying patients by baseline CD4 cell count and WHO stage. RESULTS: HAART was associated with decreased AIDS [adjusted rate ratio [ARR], 0.16; 95% confidence interval (CI), 0.08-0.31) and death (ARR, 0.10; 95% CI, 0.06-0.18). Benefit of HAART was significant across all WHO stages plus CD4 cell counts. The greatest number of deaths averted was in stages IV [74.0/100 patient-years (PY); 95% CI, 50.2-84.5) and III (32.8/100 PY; 95% CI, 22.4-40.9). AIDS cases averted in stage III (22.0/100 PY; 95% CI, 6.1-26.9) were higher than in stage I and II with CD4 cell count < 200 x 10(6) cells/l (8.9/100 PY 95% CI, 5.6-13.3). Treatment initiation for symptomatic disease resulted in greater benefits than using any CD4 cell thresholds. Application of WHO criteria increased the treatment-eligible proportion from 44.5% to 56.7% (P < 0.05) but did not prevent more death (P > 0.05) than treating symptomatic disease. CONCLUSION: Implementation of the revised WHO guidelines in sub-Saharan Africa may result in a significantly increased number of individuals eligible for treatment but would not be as effective a strategy for preventing death as treating symptomatic disease.     

Utility of interferon-γ ELISPOT assay responses in highly tuberculosis-exposed patients with advanced HIV infection in South Africa

Background  

Interferon-gamma (IFN-γ) ELISPOT assays incorporating Mycobacterium tuberculosis-specific antigens are useful in the diagnosis of tuberculosis (TB) or latent infection. However, their utility in patients with advanced HIV is unknown. We studied determinants of ELISPOT responses among patients with advanced HIV infection (but without active TB) living in a South African community with very high TB notification rates.     

Evaluation of a spirituality informed e-mental health tool as an intervention for major depressive disorder in adolescents and young adults – a randomized controlled pilot trial

Background

Depression in adolescents and young adults is a major mental health condition that requires attention. Research suggests that approaches that include spiritual concepts and are delivered through an online platform are a potentially beneficial approach to treating/managing depression in this population. The purpose of this study was to evaluate the effectiveness of an 8-week online spirituality informed e-mental health intervention (the LEAP Project) on depression severity, and secondary outcomes of spiritual well-being and self-concept, in adolescents and young adults with major depressive disorder of mild to moderate severity.

Methods

A parallel group, randomized, waitlist controlled, assessor-blinded clinical pilot trial was conducted in Calgary, Alberta, Canada. The sample of 62 participants with major depressive disorder (DSM-IV-TR) was defined by two age subgroups: adolescents (ages 13 to 18 years; n?=?31) and young adults (ages 19 to 24 years; n?=?31). Participants in each age subgroup were randomized into the study arm (intervention initiated upon enrolment) or the waitlist control arm (intervention initiated after an 8-week wait period). Comparisons were made between the study and waitlist control arms at week 8 (the point where study arm had completed the intervention and the waitlist control arm had not) and within each arm at four time points over 24-week follow-up period.

Results

At baseline, there was no statistical difference between study and waitlist participants for both age subgroups for all three outcomes of interest. After the intervention, depression severity was significantly reduced; comparison across arms at week 8 and over time within each arm and both age subgroups. Spiritual well-being changes were not significant, with the exception of an improvement over time for the younger participants in the study arm (p?=?0.01 at week 16 and p?=?0.0305 at week 24). Self-concept improved significantly for younger participants immediately after the intervention (p?=?0.045 comparison across arms at week 8; p?=?0.0175 in the waitlist control arm) and over time in the study arm (p?=?0.0025 at week 16). In the older participants, change was minimal, with the exception of a significant improvement in one of six factors (vulnerability) in study arm over time (p?=?0.025 at week 24).

Conclusions

The results of the LEAP Project pilot trial suggest that it is an effective, online intervention for youth ages 13 to 24 with mild to moderate major depressive disorder with various life situations and in a limited way on spiritual well-being and self-concept.

Trial registration

ClinicalTrials.gov NCT00985686. Registered 24 September 2009.