Acute acquired comitant esotropia simulating late onset accommodative esotropia

Acute acquired comitant esotropia in the older child, adolescent, and young adult may represent uncorrected accommodative esotropia. Three young patients developed spontaneous diplopia associated with acute comitant esotropia. In all cases, cycloplegic refraction revealed high uncorrected hyperopia suggesting late onset accommodative esotropia. However, for one patient an intracranial neoplasm precipitated the strabismus and for the other patients the hyperopic correction did not alter the deviation. Clinicians confronted with older children or adolescent patients with acute comitant esotropia associated with large uncorrected hyperopia should not hastily classify the deviation as being accommodative in etiology. Although the latter is possible, the hyperopia may be coincidental and masking an underlying mechanism.     

Down's syndrome and the acquisition of phonology by Cantonese-speaking children

ABSTRACT. The phonological abilities of two groups of 4–9-year-old intellectually impaired Cantonese-speaking children are described. Children with Down's syndrome did not differ from matched non-Down's syndrome controls in terms of a lexical comprehension measure, the size of their phoneme repertoires, the range of sounds affected by articulatory imprecision, or the number of consonants, vowels or tones produced in error. However, the types of errors made by the Down's syndrome children were different from those made by the control subjects. Cantonese-speaking children with Downs syndrome, as compared with controls, made a greater number of inconsistent errors, were more likely to produce non-developmental errors and were better in imitation than in spontaneous production. Despite extensive differences between the phonological structures of Cantonese and English, children with Downs syndrome acquiring these languages show the same characteristic pattern of speech errors. One unexpected finding was that the control group of non-Down's syndrome children failed to present with delayed phonological development typically reported for their English-speaking counterparts. The argument made is that cross-linguistic studies of intellectually impaired children's language acquisition provide evidence concerning language-specific characteristics of impairment, as opposed to those characteristics that, remaining constant across languages, are an integral part of the disorder. The results reported here support the hypothesis that the speech disorder typically associated with Down's syndrome arises from impaired phonological planning, i.e. a cognitive linguistic deficit.     

Utilization and clinical manifestations of human immunodeficiency virus type 1-infected children presenting to a pediatric emergency department

A retrospective review was conducted of 22 human immunodeficiency virus type 1 (HIV-1)-infected children under 13 years of age presenting to an inner city pediatric emergency department to determine their clinical manifestations of disease and utilization of emergency department services. When compared with a population of 78 normal children, the infected children were more likely to present with cough, difficulty in breathing, and lethargy. Pneumonia, diarrhea, and dehydration were more common diagnoses in the infected children, who were more likely to be admitted, had more invasive procedures, and required more professional staff to provide care. There was no significant difference in the frequency of visits (visits/month of age) when comparing the two groups. As expected, the infected children presented with problems associated with pediatric HIV-1 infection. Our results suggest that HIV-1-infected children require an increased level of care in the emergency department and subsequent admission to the hospital. These children did not visit the emergency department more frequently than the controls. This may be the result of an active outpatient HIV clinic in our hospital, which is available to both scheduled and unscheduled patients.     

Prevention of collagen-induced arthritis (CIA) by treatment with polyethylene glycol-conjugated type II collagen; distinct tolerogenic property of the conjugated collagen from the native one

Administration of a soluble protein into animals prior to challenge immunization induces immunological tolerance which is specific for the protein. In addition, chemical modification of proteins with polyethylene glycol (PEG) has been reported to convert the immunogenic proteins to become tolerogenic. However, differences in tolerogenic properties between PEG-modified proteins and the native counterparts have never been analysed. The ability of PEG-conjugated type II collagen (PEG-CII) to attenuate CIA, an animal model for rheumatoid arthritis, was compared with the native unconjugated CII. Groups of DBA/1 J mice were treated weekly with i.p. injections with PEG-CII, native CII, or vehicle alone for 3 weeks, before they were challenged with CII in adjuvants. The induction of tolerance was confirmed in both PEG-CII- and CII-pretreated mice when suppression of lymph node T cell proliferation in response to CII was noted. The degrees of suppression of T cell proliferation were comparable between the two pretreated groups. However, induction of arthritis and production of IgG anti-CII antibody were more markedly suppressed in PEG-CII-pretreated mice than in native CII-pretreated mice, although the severity of arthritis and antibody levels in the latter group were also lower than in control mice. IgG2a and IgG2b antibody levels were equally suppressed in the two pretreated groups, whereas the IgG1 level was significantly lower in the PEG-CII-pretreated group than in the native CII-pretreated group. The results provide the first evidence that attachment of PEG to CII renders the protein more tolerogenic.     

A randomized controlled trial evaluating combination detection of HIV in Malawian sexually transmitted infections clinics

IntroductionHIV diagnosis is the necessary first step towards HIV care initiation, yet many persons living with HIV (PLWH) remain undiagnosed. Employing multiple HIV testing strategies in tandem could increase HIV detection and promote linkage to care. We aimed to assess an intervention to improve HIV detection within socio‐sexual networks of PLWH in two sexually transmitted infections (STI) clinics in Lilongwe, Malawi.MethodsWe conducted a randomized controlled trial to evaluate an intervention combining acute HIV infection (AHI) screening, contract partner notification and social contact referral versus the Malawian standard of care: serial rapid serological HIV tests and passive partner referral. Enrolment occurred between 2015 and 2019. HIV‐seropositive persons (two positive rapid tests) were randomized to the trial arms and HIV‐seronegative (one negative rapid test) and ‐serodiscordant (one positive test followed by a negative confirmatory test) persons were screened for AHI with HIV RNA testing. Those found to have AHI were offered enrolment into the intervention arm. Our primary outcome of interest was the number of new HIV diagnoses made per index participant within participants’ sexual and social networks. We also calculated total persons, sexual partners and PLWH (including those previously diagnosed) referred per index participant.ResultsA total of 1230 HIV‐seropositive persons were randomized to the control arm, and 561 to the intervention arm. Another 12,713 HIV‐seronegative or ‐serodiscordant persons underwent AHI screening, resulting in 136 AHI cases, of whom 94 enrolled into the intervention arm. The intervention increased the number of new HIV diagnoses made per index participant versus the control (ratio: 1.9; 95% confidence interval (CI): 1.2 to 3.1). The intervention also increased the numbers of persons (ratio: 2.5; 95% CI: 2.0 to 3.2), sexual partners (ratio: 1.7; 95% CI: 1.4 to 2.0) and PLWH (ratio: 2.3; 95% CI: 1.7 to 3.2) referred per index participant.ConclusionsCombining three distinct HIV testing and referral strategies increased the detection of previously undiagnosed HIV infections within the socio‐sexual networks of PLWH seeking STI care. Combination HIV detection strategies that leverage AHI screening and socio‐sexual contact networks offer a novel and efficacious approach to increasing HIV status awareness.     

222例儿童住院死亡病例分析

为进一步降低儿童死亡率,本文就1989－1998年我院儿童住院死亡病例进行回顾统计分析,以探讨儿童的重要死亡原因及死因结构,现报告如下。l资料资料来源与方法：本文222例病例均为1989－1998年在我院死亡的住院儿童。同一患者患两种以上疾病时,以入院第一诊断列入分析。2结果分析2．l性别与年龄222例中男性148例（66．67％）,女性74例（刀‘33阮）,男女比为2：1,年龄分组见表1。表1本组病例年龄分组2工入院时病危情况：入院时病危人数168人,占75．67％,其余病倒入院时未达病危,住院期间病情加重而死亡。23住院日与确诊日数：222例死…     

Relationship between anisometropia, amblyopia, and binocularity.

PURPOSE: To determine if higher degrees of anisometropia cause deeper amblyopia and poorer binocularity than lower degrees of anisometropia in children and adults. METHODS: The clinical records for 60 patients with untreated anisometropic amblyopia without strabismus, ranging in age from 3 to 39 years, were reviewed. The refractive error, the initial best corrected visual acuities in the amblyopic and nonamblyopic eyes, and the level of binocularity were recorded from each chart. The degree of anisometropia was determined by: (1) calculating the difference between spherical equivalents for each eye; (2) calculating the difference in the vertical meridians for each eye; (3) calculating the difference in the horizontal meridians for each eye; and (4) calculating the root mean square difference which also takes into account differences in astigmatic axis. The depth of amblyopia was determined by converting the visual acuity score to its logarithmic value, logarithm of the minimum angle of resolution (logMAR), and calculating the difference between the amblyopic and nonamblyopic eye. The level of binocularity was determined from stereopsis testing. RESULTS: For all patients, there was a significant relationship between the four measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.61 and 0.61, respectively). For the myopes (N = 10), there was no significant relationship between the 4 measures of anisometropia, the depth of amblyopia, and the level of binocularity (median correlations 0.34 and 0.61, respectively). For the hyperopes (N = 50), the relationship was significant for all 4 measures of anisometropia (median correlations 0.72 and 0.62, respectively). CONCLUSION: As the degree of anisometropia increases, the depth of amblyopia becomes greater and the level of binocularity becomes poorer, at least for hyperopic patients.     

Mortality trends of young children in developing countries

The findings of a World Fertility Survey of infant and early childhood mortality trends in 29 countries in Africa, the Americas, and Asia are reported. The national surveys, carried out in 1974-79, utilized the synthetic cohort method. Analysis of the infant and child mortality 0-4 years before the data of each survey revealed wide variation. A moderate percentage (4-8%) of children died before reaching age 5 in 10 of the 29 countries studied: Costa Rica, Fiji, Guyana, Jamaica, Jordan, Korea, Malaysia, Panama, Trinidad and Tobago, and Venezuela. A moderate to high percentage (8-12%) of infant and child deaths was noted in Colombia, Mexico, Paraguay, Philippines, Sri Lanka, Syria, and Thailand. Mortality in this age group was high (12-15%) in Dominican Republic, Indonesia, Kenya, Peru, and Sudan; very high (16-20%) in Haiti, Lesotho, and Turkey; and extremely high (20% or more) in Bangladesh, Nepal, Pakistan, and Senegal. Even the countries with the lowest mortality levels have more than twice the mortality of developed countries. The neonatal death rate has been the most difficult to control. To determine time trends, children born to women ages 20-29 at time of the survey were further analyzed. Mortality has declined over time in all countries studied. There was an average of 43 fewer deaths under the age of 5 years per 1000 births in the period 0-4 years before the surveys than 15-19 years earlier, for an overall 28% decrease. Per 1000 births, 20 infant, 10 toddler, and 13 preschooler deaths were averted. However, the declines have not been equal or consistent across countries. When the countries were grouped by region, Western Asia recorded the greatest decline, with an average of 93 fewer infant and early childhood deaths in the period 0-4 years before survey than 15-19 years earlier. With 26 fewer deaths per 1000 births, the countries of Africa demonstrated the least fall. Asia (excluding Western Asia) and the Americas showed average declines of 34 and 45 deaths, respectively. There is some indication of a slowdown in the rate of decline of mortality, and 4 countries have shown increases in the recent period. This finding must be interpreted with caution, however, since recently born children may have been better reported.