Bacteraemia as Predictor of HIV Infection in African Children

ABSTRACT. In Rwanda, both HIV infection and bacteraemia represent major health problems among paediatric populations. We carried out a prospective study to determine if bacteraemia is a marker of HIV infection among ambulatory and hospitalized Rwandese children. All children presenting at the Department of Paediatrics of the Centre Hospitalier de Kigali and who had their blood cultured during a two-month period were eligible for the study. One hundred and thirty-five children were included in the study. A pathogen was isolated from 36 children (26.7 %): S. typhimurium (10 cases), S. enteritidis (6), S. typhi (4), Str. pneumoniae (9). H. influenzae (6) and S. aureus (1). No association was found between bacteraemia and HIV seropositivity when all the children were considered. However, among patients less than 2 years old, bacteraemic subjects were more frequently ( p ≤0.05) HIV seropositive (44 %) than those with negative blood cultures (19 %). Our study shows that in young children in Central Africa, the presence of bacteraemia may be an important marker of HIV seropositivity.     

Anemia in Experimental Protein Deficiency in the Rhesus Monkey with Special Reference to Iron Metabolism

1. This investigation deals with a study of the anemia of protein deficiencyin Rhesus monkeys.

2. Protein deficiency was induced in 17 rhesus monkeys. Seven animals,given a protein-rich diet, served as controls. The diets of both the groupswere identical in all respects, except protein. All animals were tube-fed toensure adequate caloric intake.

Hematocrit, hemoglobin, erythroctye count, serum iron, serum iron binding capacity, plasma iron tolerance curves, and iron absorption using theFe⁵⁹ fecal recovery method were studied before and at intervals of theexperiment in both deficient and control groups.

Protein-deficient monkeys consistently developed normocytic normochromicanemia of moderate severity. A striking fall in serum iron binding capacity,total proteins and albumin with a rise in gamma globulin was observed inall deficient animals. A significant and comparable fall in serum iron wasalso observed. The Fe⁵⁹ absorption was depressed and there was flatteningof plasma iron tolerance curves. Two deficient animals, refed a high proteindiet, showed reversal of all these changes. The control animals did not showany of these changes.

The mechanism of anemia and decreased iron absorption observed in theprotein-deficient animals and the relevance of these findings to those inKwashiorkor are discussed.

Submitted on November 20, 1964 Accepted on January 25, 1965     

The Clinical Utility of Entrainment Pacing

Entrainment mapping is an important concept in electrophysiology that allows clinicians to characterize and treat reentrant arrhythmias. Entrainment mapping has been particularly useful for the treatment of atrial flutter, reentrant atrial tachycardias, and scar-related ventricular tachycardia. In this article, we outline the conduction properties of reentrant rhythms that permit entrainment mapping to be a useful technique. In addition, we highlight the differences between manifest and concealed entrainment. Finally, we describe useful strategies for diagnosing and treating atrial flutter and ventricular tachycardia.     

ECG Criteria for Accurate Localization of Left Anterolateral and Posterolateral Accessory Pathways

Background : Left lateral accessory pathway (AP) location along the mitral annulus (MA) can influence ablation strategy, including choice of a transseptal or retrograde aortic approach and the use of deflectable sheaths and/or bidirectional catheters. We aimed to develop electrocardiographic (ECG) criteria to accurately localize a left lateral AP, hypothesizing that the relationship of QRS amplitudes in limb leads II and III could be used to differentiate left anterolateral (LAL) from left posterolateral (LPL) AP locations. Methods : The ECGs from patients who underwent ablation of a left‐sided AP between 2001 and 2008 were evaluated for the relationship of QRS amplitudes in limb leads II and III. A LAL‐AP was defined by successful ablation between 12 and 3 o’clock on the MA, as seen in left anterior oblique (LAO) fluoroscopic projection. A LPL‐AP was defined by successful ablation between 3 and 6 o’clock in the LAO projection. Results : In 249 consecutive patients undergoing AP ablation, 23 met the prespecified inclusion criteria: manifest preexcitation due to single AP, ablated successfully in a LAL or LPL location. The ratio of dominant QRS amplitude in lead II to lead III was ≥1 in 10/11 patients with LAL‐AP, compared with 3/12 patients with a LPL‐AP (P = 0.002). Using these criteria, two blinded reviewers predicted a LAL or LPL location with 87% accuracy and 100% interobserver agreement. Conclusions : We report new ECG criteria that can be used to accurately predict the anterior and posterior location of a left lateral AP. Such localization may facilitate procedural planning. (PACE 2012;35:1444–1450)