Severe malaria in children in Papua New Guinea

The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.      

Évaluation médico-économique du baclofène intrathécal chez les patients présentant une spasticité chronique sévère

A medicoeconomic evaluation of continuous intrathecal baclofen (Lioresal^®) infusion for symptomatic treatment of severe spinal spasticity was realised using a monocentric, comparative, retrospective approach where subjects were their own controls (n = 22). Study results confirm the efficacy of baclofen on symptoms, functional status of patients and on a non specific quality of life scale. Conversely, use of baclofen lead to a 67% increase of average annual costs of care for these patients and reaches around 173,500 French francs (~29,000 US$)/year. Such a cost seems to be acceptable with respect to clinical benefits. © 1998 Elsevier, Paris     

胎儿和新生儿同种异体免疫性血小板减少症:进展与持续性争议

胎儿和新生儿同种异体免疫性血小板减少症(AIT)是引起胎儿和新生儿严重血小板减少的最常见原因.母亲针对源自父亲的胎儿血小板抗原的IgG抗体,在妊娠早期就可通过胎盘,通常导致胎儿严重血小板减少.由于一些血小板减少症临界值(50、100或150×109/L)的不同,他们的发生率亦各不相同.但在多数未经选择的人群中,AIT影响1/1 000到1/2 000活产数.在新生儿病房,临床确诊的重症AIT很罕见,可能只有1:10 000分娩数.     

Group a streptococcal antigens cross-reactive with myocardium. Purification of heart-reactive antibody and isolation and characterization of the streptococcal antigen

Heart-reactive antibody (HRA) appears in the sera of experimental animals inoculated with group A streptococci as well as patients with acute rheumatic fever. Adsorption of either serum with group A streptococcal membranes will remove the HRA. Blocking experiments between these two types of HRAs have demonstrated that the antibodies are directed towards different antigenic determinants on either the same or different molecules. To isolate and purify the antigen from the group A streptococcus cross-reactive with sarcolemmal sheaths of cardiac myofibers, it became necessary to purify the HRA from rheumatic fever patients’ sera. Isolated gamma globulin containing all of the HRA was adsorbed onto human sarcolemmal sheaths. The specific HRA was released by using potassium iodide. Over 99 percent of the purified HRA was shown to bind the sarcolemmal sheath whereas less than 1 percent of the antibody would bind nonspecifically to other material. Preparations of group A streptococcal membrane will bind HRA purified from the sera of acute rheumatic patients at levels of 97 percent or greater. The cross-reactive antigen solubilized by nonionic detergent was purified 120-fold by column chromatography. On sodium dodecyl sulfate polyacrylamide electrophoresis, the antigen was demonstrated to be composed of four polypeptides with mol wt of 32,000, 28,000, 26,000, and 22,000 daltons, respectively. Only proteolytic enzymes could destroy the antigenic determinant whereas glycosidases and lipases had no effect. The purified antigen blocked the binding of purified HRA to normal human heart sections.     

A COMPLEX TRUE KNOT OF THE UMBILICAL CORD

SUMMARY A case of cord presentation associated with the presence of a complex true knot is described and the aetiology and risks reconsidered.     

Integration of neuropsychological theory,assessment, and application

Abstract

Theories of brain-behavior relationships have been proposed for more than a century, and they recently have progressed to a point of both heuristic and clinical value. Assessment procedures in clinical neuropsychology are quite variable among practioners. In this paper, criteria have been identified that should be met in clinical evaluation of brain-behavior relationships. Finally, there is a review of an approach to brain retraining that is integrated with both theory and clinical assessment, with assessment procedures stemming from theoretical considerations and also providing a basis for prescribing a brain retraining program.     

Relationships between measures of brain functions and general intelligence

Relationships between measures of general intelligence (Wechsler-Bellevue Verbal IQ, Performance IQ, and Full-scale IQ) and a measure designed to reflect adequacy of brain functions (Halstead Impairment Index) were studied using a control group and groups with left, right and generalized cerebral lesions. The results confirmed earlier findings of (1) differential levels of Verbal and Performance intelligence depending on damage of the left or right cerebral hemisphere; and (2) the greater general sensitivity of the Impairment Index than IQ values to brain damage. Comparative data suggested particularly that IQ values may underestimate brain-dependent adaptive abilities among non-brain-damaged subjects. A significant relationship between IQ values and the Impairment Index was present. This finding permitted evaluation of use of a differing cut-off Impairment Index, as an indicator of cerebral damage, depending on the subject's IQ level. The results suggested that increased accuracy in classifying subjects as brain-damaged might be achieved using a cutting Impairment Index of .4 or greater when the IQ value is 100 or more and .5 or greater when the IQ value is below 100.     

同种免疫性与非免疫性血小板减少症新生儿的临床及诊断比较

胎儿和新生儿同种免疫性血小板减少症(alloimmune thrombocytopenia,AIT)的发生是由于胎儿的血小板特异性抗原刺激母体产生同种抗体而引起的。胎儿的这种特异性抗原来源于父亲。通常,胎儿和新生儿发生严重AIT绝大多数是由于胎儿-母体PIA1抗原不相容所致,估计这种病例有20％可并发颅内出血。最近,在挪威和苏格兰进行的AIT发生率的前瞻性研究中发现因PIA1所致的新生儿AIT的发病率大约是1％。由于AIT与其他病因引起的新生儿血小板减少症的治疗方法不同,故对AIT的快速诊断将有助于患儿获得最佳治疗。本研究比较了血清学诊断为AIT的新生儿与血清学不支持诊断为     

Coinfection with hepatitis C virus,oxidative stress and antioxidant status in HIV‐positive drug users in Miami*

Background

The pathogenesis of HIV/hepatitis C virus (HCV) coinfection is poorly understood. We examined markers of oxidative stress, plasma antioxidants and liver disease in HIV/HCV‐coinfected and HIV‐monoinfected adults.

Methods

Demographics, medical history, and proof of infection with HIV, hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV were obtained. HIV viral load, CD4 cell count, complete blood count (CBC), complete metabolic panel, lipid profile, and plasma concentrations of zinc, selenium, and vitamins A and E were determined. Malondialdehyde (MDA) and glutathione peroxidase concentrations were obtained as measures of oxidative stress. Aminotransferase to platelet ratio index (APRI) and fibrosis index (FIB‐4) markers were calculated.

Results

Significant differences were found between HIV/HCV‐coinfected and HIV‐monoinfected participants in levels of alanine aminotransferase (ALT) (mean±standard deviation: 51.4±50.6 vs. 31.9±43.1 U/L, respectively; P=0.014), aspartate aminotransferase (AST) (56.2±40.9 vs. 34.4±30.2 U/L; P<0.001), APRI (0.52±0.37 vs. 0.255±0.145; P=0.0001), FIB‐4 (1.64±.0.91 vs. 1.03±0.11; P=0.0015) and plasma albumin (3.74±0.65 vs. 3.94±0.52 g/dL; P=0.038). There were no significant differences in CD4 cell count, HIV viral load or antiretroviral therapy (ART) between groups. Mean MDA was significantly higher (1.897±0.835 vs. 1.344± 0.223 nmol/mL, respectively; P=0.006) and plasma antioxidant concentrations were significantly lower [vitamin A, 39.5 ± 14.1 vs. 52.4±16.2 μg/dL, respectively (P=0.0004); vitamin E, 8.29±2.1 vs. 9.89±4.5 μg/mL (P=0.043); zinc, 0.61±0.14 vs. 0.67±0.15 mg/L (P=0.016)] in the HIV/HCV‐coinfected participants than in the HIV‐monoinfected participants, and these differences remained significant after adjusting for age, gender, CD4 cell count, HIV viral load, injecting drug use and race. There were no significant differences in glutathione peroxidase concentration, selenium concentration, body mass index (BMI), alcohol use or tobacco use between groups. Glutathione peroxidase concentration significantly increased as liver disease advanced, as measured by APRI (β=0.00118; P=0.0082) and FIB‐4 (β=0.0029; P=0.0177). Vitamin A concentration significantly decreased (β=?0.00581; P=0.0417) as APRI increased.

Conclusion

HIV/HCV coinfection is associated with increased oxidative stress and decreased plasma antioxidant concentrations compared with HIV monoinfection. Research is needed to determine whether antioxidant supplementation delays liver disease in HIV/HCV coinfection.

     

肝硬变和肝细胞癌组织中CD54,CD80,CD86和HLA-ABC的表达

目的探讨CD54,CD80,CD86和HLA-ABC在肝硬变的免疫损伤和抗肝癌免疫中的意义.方法用免疫组化方法检测CD54,CD80,CD86和HLA-ABC在肝硬变(n=30)和肝癌(n=48)中的表达、定位和分布.结果在LC中,CD54阳性率为40%(12/30),CD80为50%(15/30),CD86为37%(11/30),HLA-ABC为63%(19/30);在HCC中,CD54阳性率为77%(37/48),CD80为19%(9/47),CD86为13%(6/47),HLA-ABC为30%(12/40);在癌周围组织(PCT)中,CD54为阴性,CD80阳性率为44%(14/32),CD86为47%(15/32),HLA-ABC为53%(17/32).统计学处理显示,在LC中,CD54阳性率显著低于HCC(P＜0.01);CD80(P＜0.01),CD86(P＜0.05)和HLA-ABC(P＜0.01)均显著高于HCC;而与PCT无显著差别.在HCC中,CD80(P＜0.05),CD86(P＜0.01),HLA-ABC(P＜0.05),均显著低于PCT.结论 CD54,CD80,CD86和HLA-ABC在LC和HCC中的同时足量表达有可能引起肝细胞损伤和有效抗肿瘤免疫应答,而CD80,CD86表达的缺失或不足可能是HCC产生免疫逃避的主要原因.