Effects of Antiretroviral Therapy and HIV Exposure in Utero on Adverse Pregnancy and Infant Outcomes:A Prospective Cohort Study in Guangzhou, China

Objective This study aimed to evaluate the effects of in-utero exposure to HIV and ART on pregnancy outcome and early growth of children.Methods This cohort study enrolled 802 HIV-infected pregnant women between October 2009 and May 2018 in Guangzhou, China. The women were assigned to receive combination ART(c ART) or mono/dual ART or no treatment. The primary outcomes were the combined endpoints of any adverse pregnancy outcome [including ectopic pregnancy, spontaneous abortion, stillbirth, preterm birth, small for gestational age(SGA)] and adverse early growth outcome(including infant death, HIV infection of mother-to-child transmission, and underweight, wasting and stunting of infants at 4 weeks of age).Results Adverse pregnancy outcomes occurred in 202(35.1%) of all enrolled HIV-infected women, and121(31.3%) of all infants exhibited adverse effects on early growth at 4 weeks of age. The rates of adverse pregnancy outcomes, spontaneous abortion, ectopic pregnancy, stillbirth, infant death and perinatal HIV infection were higher among women not receiving ART, compared to those treated with c ART or mono/dual ART(P < 0.05). However, women treated with c ART had a higher rate of SGA,compared to untreated women(P < 0.05). No differences in early infant growth were observed among the different treatment regimens.Conclusion Our findings underscore the essentiality of prioritizing HIV-positive pregnant women for ART, as even mono/dual ART available in resource-limited countries could improve pregnancy outcomes and infant survival.

Genital Warts in Infants and Children <br>—Re-Evaluation of Podophylline 15% as an Effective Topical Therapy

Background: Condylomataacuminata is an infection caused by Human Papilloma Virus, rarely reported in infants and children. Podophylline as a treatment for this condition has been used cautiously in this age group. Objective: To report the cases of anogenital warts including condy lomataacuminata in infants and children and to evaluate the effectiveness and side effects of 15% podophyllin in treatment of genital warts. Patient and Methods: Thirty infants and young children were seen in Department of Dermatology and Venereology—Baghdad Teaching Hospital in this case descriptive and therapeutic trial, in the period from January 2011 to August 2012. Their ages ranged from 8 - 72 (30.43 ± 15.85) months, 20 females and 10 males with a female:male ratio of 2:1. The duration of the disease ranged from 1 - 12 (5.26 ± 4.00) months. All demographics data were recorded in this study. History and examination were carried out to all patients. Family members including mothers were assessed about the presence of any type of viral warts in other location of body. Podophyllin (15%) in tincture benzoin was applied once weekly to all viral warts and the parents advised to wash out after 2 hours of application. The number of applications was repeated until full recovery. Follow-up after recovery was carried out for 6 months to watch for any relapse and to record local or systemic side effects. Results: The clinical pictures were mostly acondylomata acuminata in a form of cauliflower like warts in 20 (73.33%) patients, while in 10 (26.77%) patients there were ordinary verruca vulgaris like warts. The location of warts was perianal in 23 (76.66%) patients, genital only in 2 (6.66%) patients, and mixed in 5 (16.66%) patients. Topical applications of podophyllin 15% gave a full recovery in 27 (90%) patients, while in 3 (10%) patients there was partial response. The number of applications ranged from 1 - 4 (2.7 ± 1.42) applications. Follow up for 6 months after recovery showed relapse in only one patient, and no side effects were reported in any patients. Conclusion: There is upsurge of cases of anogenital warts among infants and children. Podophyllin (15%) in tincture benzoin is an effective therapy and no local or systemic side effects were recorded in any case.

Recent Advances in Bronchopulmonary Dysplasia Protection and Therapy

For preterm infants, bronchopulmonary dysplasia (BPD) is usually caused by abnormal lung development due to various factors during prenatal and postnatal process. One of the reasons for death and bad prognosis of preterm infants is to have BPD. Up to now, there are no unified strategies or drugs to treat BPD. In clinical, many intervention treatments have been applied to achieve BPD therapy, mainly including preterm protection, protective ventilation strategies, and delivery of corticosteroids, pulmonary vasodilators, and antioxidants. This review summarizes the current advances in BPD protection and treatment, and notes that gut microbiota and mesenchymal stem cells (MSCs) can be the promising strategy for protecting and treating BPD in the future.

Use of probiotics for prevention of radiation-induced diarrhea

AIM： To investigate the efficacy of a high-potency probiotic preparation on prevention of radiation-induced diarrhea in cancer patients.METHODS： This was a double-blind, placebo-controlled trial. Four hundred and ninety patients who underwent adjuvant postoperative radiation therapy after surgery for sigmoid, rectal, or cervical cancer were assigned to either the high-potency probiotic preparation VSL#3 （one sachet t.i.d.,） or placebo starting from the first day of radiation therapy. Efficacy endpoints were incidence and severity of radiation-induced diarrhea, daily number of bowel movements, and the time from the start of the study to the use of Ioperamide as rescue medication. RESULTS： More placebo patients had radiation-induced diarrhea than VSL#3 patients （124 of 239 patients, 51.8%, and 77 of 243 patients, 31.6%; P 〈 0.001） and more patients given placebo suffered grade 3 or 4 diarrhea compared with VSL#3 recipients （55.4% and 1.4%, P 〈 0.001）. Daily bowel movements were 14.7 ± 6 and 5.1 ± 3 among placebo and VSL#3 recipients （P 〈 0.05）, and the mean time to the use of Ioperamide was 86 ± 6 h for placebo patients and 122 ± 8 h for VSL#3 patients （P 〈 0.001）. CONCLUSION： Probiotic lactic acid-producing bacteria are an easy, safe, and feasible approach to protect cancer patients against the risk of radiation-induced diarrhea.

Therapeutic methods for diarrhea in children

DEFINITIONAcute diarrhoea is defined as passage of loose or waterystools at least three times in a 24 h period.When loosestools contain blood,it is called bloody diarrhoea(dysentery).It is the consistency of the stools which ismost important rather than the frequency.Breast-fed babiesoften pass'pasty'stools frequently which is not diarrhoea.The raother can often tell accurately whether child hasdiarrhoea or not.

Successful treatment of infantile hepatitis B with lamivudine: A case report

BACKGROUND How to treat infantile hepatitis B virus(HBV)infection remains a controversial issue.The nucleoside analogue lamivudine(LAM)has been approved to treat children(2 to 17 years old)with chronic hepatitis B.Here,we aimed to investigate the benefit of LAM treatment in infantile hepatitis B.CASE SUMMARY A 4-mo-old infant born to a hepatitis B surface antigen(HBsAg)-positive woman was found to be infected by HBV during a health checkup.Liver chemistry and HBV seromarker tests showed alanine aminotransferase of 106 U/L,HBsAg of 685.2 cut-off index,hepatitis B“e”antigen of 1454.0 cut-off index,and HBV DNA of>1.0×10^(9) IU/mL.LAM treatment(20 mg/d)was initiated,and after 19 mo,serum HBsAg was entirely cleared and hepatitis B surface antibody was present.The patient received LAM treatment for 2 years in total and has been followed for 3 years.During this period,serum hepatitis B surface antibody has been persistently positive,and serum HBV DNA was undetectable.CONCLUSION Early treatment of infantile hepatitis B with LAM could be safe and effective。

Therapies for children with cerebral palsy A Web of Science-based literature analysis

OBJECTIVE： To identify global research trends in three therapies for children with cerebral palsy. DATA RETRIEVAL： We performed a bibliometric analysis of studies on therapies for children with cerebral palsy from 2002 to 2011 retrieved from Web of Science. SELECTION CRITERIA： Inclusion criteria： （a） peer-reviewed published articles on botulinum toxin, constraint-induced movement therapy, or acupuncture for children with cerebral palsy indexed in Web of Science; （b） original research articles, reviews, meeting abstracts, proceedings papers, book chapters, editorial material, and news items; and （c） publication between 2002 and 2011. Exclusion criteria： （a） articles that required manual searching or telephone access; （b） documents that were not published in the public domain; and （c） a number of corrected papers from the total number of articles. MAIN OUTCOME MEASURES： （1） Number of publications on the three therapies; （2） annual publication output, distribution by journals, distribution by institution, and top-cited articles on botulinum toxin; （3） annual publication output, distribution by journal, distribution by institution, and top-cited articles on constraint-induced movement therapy; （4） annual publication, distribution by journal, distribution by institution, and top-cited articles on acupuncture. RESULTS： This analysis, based on Web of Science articles, identified several research trends in studies published over the past 10 years of three therapies for children with cerebral palsy. More articles on botulinum toxin for treating children with cerebral palsy were published than the articles regarding constraint-induced movement therapy or acupuncture. The numbers of publications increased over the 10-year study period. Most papers appeared in journals with a focus on neurology, such as Developmental Medicine and Child Neurology and Journal of Child Neurology.Research institutes publishing on botulinum toxin treatments for this population are mostly in the Netherlands, the United States of America, and Australia; those publishing on constraint-induced movement therapy are mostly in Australia and the United States of America; and those publishing on acupuncture are mostly in China, Sweden and the United States of America.CONCLUSION： Analysis of literature and research trends indicated that there was no one specific therapy to cure cerebral palsy. Further studies are still necessary.

Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant:A case report

BACKGROUND Gastrointestinal cytomegalovirus(CMV)disease occurs commonly in immunocompromised/immunodeficient patients with advanced human immunodeficiency virus infection,neoplasm,solid organ transplantation,hematopoietic stem cell transplantation,or treatment with immunosuppressants,but is rarely reported in association with measles infection.CASE SUMMARY We describe a case of extensive gastrointestinal CMV disease secondary to measles infection in a 9-mo-old boy who presented with persistent fever and bloody diarrhea.His condition was improved after ganciclovir treatment.Serological analysis of CMV showed negative immunoglobulin(Ig)M and positive IgG.Blood CMV-DNA was 9.26×103 copies/mL.The diagnosis of gastrointestinal CMV disease was confirmed by histopathological findings of intranuclear and intracytoplasmic inclusions and Owl’s eye inclusion.This case highlights the differential diagnosis and histopathological characteristics of gastrointestinal CMV infection and laboratory tests.CONCLUSION Extensive gastrointestinal CMV lesions can be induced by the immune suppression secondary to measles infection.Rational,fast,and effective laboratory examinations are essential for suspected patients.

Occurrence and characterization of toxigenic Bacillus cereus in food and infant feces

Objective: To investigate the true incidence of Bacillus cereus(B. cereus) in food and children diarrhea cases. Methods: A total of 110 samples of various dairy products such as raw milk, long life pasteurized milk, yoghurt and infant powdered milk formulas, raw rice, and feces were examined for the presence of B. cereus by selective plating on mannitol-egg-yolk-polymyxin agar. Confirmation of B. cereus was carried out by biochemical tests and PCR. Identification of non-B. cereus isolates was carried out by 16 S r DNA sequencing. Antimicrobial susceptibility was done by disk diffusion method.Results: Overall 35 samples(31.8%, n = 110) yielded Bacillus-like growth. Of which 19 samples(54.28%) were positive for B. cereus. All isolates were positive for enterotoxin production. No psychrotolerant B. cereus strains were detected in all samples. All B. cereus isolates were resistant to penicillin G, but susceptible to vancomycin, erythromycin and clindamycin. Conclusions: The results of this study confirm the importance of including B. cereus in disease control and prevention programs, as well as in routine clinical and food quality control laboratories in both Saudi Arabia and Egypt.

Clinical Exploration of Transcatheter Closure of Patent Ductus Arteriosus With Duct Occluder in Infants

Objectives To explore the feasibility, necessity, and security of transcatheter closure of patent ductus arteriosus （PDA） in infants. Methods There were 230 infants with PDA. The ages were （7.3 ±3.2 ） months and the weight （6.6 ± 2.8） Kg in average. They were separated into two groups. Group A was formed by the infants weighing less than 6 Kg, Group B over 6 Kg. Right heart catheterization was performed first to calculate the ratio of Qp/Qs. Then descending aortography demonstrated the diameter and shape of PDA. Proper occluder was selected to finish the inter- vention. Echocardiography was performed after intervention 24 hours and 1, 3, 6, 12 and 24 months. Results In Group A the technical achievement ratio was 94.6% with the average diameter of PDA （6.2±3.2） mm. In Group B the technical achievement ratio was 100% with the average diameter of PDA （4.8 ± 2.5 ） mm. We used the Amplatzer Duct Occluder with the type from 6 -8 mm to 12 - 14 ram, the delivery sheath from 6 French to 8 French. 24 hours after intervention, echocardiography demonstrated that there were 6 residual shunts in Group A while 22 in Group B. After 1 year, residual shunt existed in neither group. There were 4 patients whose femoral arteries pulsed weakly after intervention in Group A, while in Group B there were 3. They all recovered 24 hours after the application of urokinase. In Group A blood flow velocity in descending aorta increased in 5 infants, while in Group B there were 3. They all resumed in 6 - 12 months. Conclusions Transcatheter closure of PDA in infants is safe and technically feasible. However, indication should be strictly selected and the intervention should be performed by experienced physician.

How Infant Mortality Was Reduced in the Early Twentieth Century in Osaka

In 1983, the Vice Secretary-General of United Nations Children＇s Fund （UNICEF）, Karl Knutsson, visited Japan and remarked that the method of reducing the Japanese infant mortality rate （IMR） was a model for every country. In the early twentieth century, Osaka and at the time of UNICEF＇s plan in the 1980s, diarrhea was the cause of most babies＇ deaths, so we consider infant nutrition to be the central issue. The average IMR was 155.4 in rural areas in Japan, and IMR in Osaka city was 231.6 during 1906 to 1910. IMR in Osaka city might have been influenced by somewhat negative urban factors, which we can call the ＂urban penalty＂. Dr. Hiroshi Maruyama discovered the a-index in 1938. The a-index represents infant mortality number divided by neonatal mortality number. After all, Maruyama set one month after birth as a boundary to divide endogenous and exogenous. The a-index shows a qualitative measure of infant mortality. Post neonatal mortality was increased due to acquired diseases such as diarrhea, pneumonia, and beriberi. This shows that the effect of the urban penalty was raising the a-index. The a-index of the industrial zones shows that bad maternal conditions affected endogenous factors. Most mothers suffered from a deficiency of breast-feeding capability.

Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant

Yang et al reported an immunocompetent infant with gastrointestinal cytomegalovirus disease secondary to measles infection.We express our opinion about the diagnosis and treatment of this rare disease.

Diarrhea

Institute of Acupuncture and Moxibustion,China Academy of Traditional Chinese Medicine Beijing 100700

Thirty-six Cases of Infantile Proctoptosis Treated by Extremely Shallow Puncture

Proctoptosis, a disease of downward displacement of the anal canal, rectal mucosa, rectum or partial sigmoid colon, is known as prolapse of the rectum in TCM, which is frequently seen in the weak and thin babies or children of 2-4 years old. The author treated 36 cases of infantile proctoptosis by using extremely shallow puncture in the acupuncture techniques from Aug. 1995 to Dec. 1998 and obtained satisfactory results as reported in the following.……

Atypical Presentation of Classical Bartter Syndrome as a Case of Chronic Diarrhea and Failure to Thrive

The classical Bartter syndrome is an uncommon tubular disorder of autosomal recessive inheritance, characterized by early childhood onset of polyuria, polydipsia, vomiting, dehydration, constipation and salt craving habit. The long-term outlook for patients with Bartter syndrome is not certain. If not properly treated, it may lead to failure to thrive and growth retardation. We herein report a case of 18-month-old girl child who presented chronic diarrhea and failure to thrive and then was diagnosed as a case of classical Bartter syndrome. She was successfully treated with potassium supplementation and ibuprofen therapy.

Suicide attempt using potassium tablets for congenital chloride diarrhea:A case report

BACKGROUND Congenital chloride diarrhea(CCD)is a rare inherited disorder of intestinal electrolyte transport that results in a large wastage of electrolytes and water.Advances in substitution therapy using sodium chloride(NaCl)and potassium chloride(KCl)have dramatically improved survival for patients with CCD.Slowrelease KCl is widely prescribed as a potassium supplement;however,it has also occasionally been used in suicide attempts,as potassium poisoning can generate life-threatening hyperkalemia.CASE SUMMARY A 26-year-old female presented to the emergency department(ED)with selfpoisoning,having taken 30 tablets of slow-release KCl(total:240 mmol potassium)following an auditory hallucination.The patient had been undergoing substitution therapy with NaCl and KCl for CCD and been followed up in the pediatric department.One month prior,she developed insomnia and anxiety and had consulted a psychiatrist.At the ED,although her general condition was good,she appeared agitated.Her serum potassium level was 7.0 mmol/L,indicating hyperkalemia,and electrocardiographic changes showed tenting of the T-waves.She responded to the administration of calcium gluconate,sodium bicarbonate,and insulin with glucose,and the serum potassium level improved.Finally,she was diagnosed with schizophrenia.CONCLUSION In CCD management,physicians should pay careful attention to patients’extraintestinal issues,including psychological disorders that may emerge in adulthood.

Prevalence of HIV and Associated Factors among Infants Born to HIV Positive Women in Amhara Region, Ethiopia

Background: An estimated 1.2 percent of pregnant women are living with HIV in Ethiopia and sadly, one of every 3 children born to these women is infected with HIV. Elimination of these mother-to-child transmissions (MTCT) of HIV is possible through HIV testing during pregnancy and taking antiretroviral medications. However, only 24 percent of pregnant women living with HIV have yet received the medication needed to prevent MTCT of HIV in Amhara region, Ethiopia. Hence, there exists a concern that the rate of HIV infection among infants born to HIV positive mothers might be high. This study assessed the prevalence of HIV infection and associated factors among infants born to women living with HIV. Methods: All eligible records of HIV-exposed infants enrolled between January and December 2012 were reviewed from 17 health facilities which were providing PMTCT services. The study included 434 HIV-exposed infants having HIV DNA/PCR test result. Data were collected using structured data extraction formats. Data were then entered into EPI INFO Version 3.5.1 and analyzed by SPSS Version 16.0. Both bivariate and multivariate analyses were carried out to calculate odds ratios and to control for the effect of confounding. Result: The prevalence of HIV among exposed infants was 10.1%. Delay in HIV diagnosis (AOR = 1.3), mixed infant feeding (AOR = 8.8), failure to receive antiretroviral therapy during pregnancy or breast feeding (AOR = 21.6), failure to attend skilled delivery service (AOR = 6.1) and shorter duration of HIV treatment (AOR = 12) were the factors that increase the risk of mother-to-child transmission of HIV in this study. Conclusion: The prevalence of HIV among infants born to HIV positive women in the region is close to the national estimate of 10.9%. Delayed HIV diagnosis, inadequate use of antiretroviral therapy and lack of skilled delivery care were the factors that enhance mother-to-child transmission of HIV. Having such a significant figure in the era of the world’s pledge to eliminate MTCT of HIV is unbearable. Ensuring access and use of integrated PMTCT services should be the top priorities of the national PMTCT program.

Electroacupuncture for Treatment of 12 Cases of Infantile Peroneal Nerve Injury

Infantile peroneal nerve injury,also calledperoneal paralysis,is mostly caused by intraglutealinjection.Clinically,it is characterized by foot drop,strephenopodia,digital flexion,and high leg raisingwhile walking.The authors have treated 12 cases ofperoneal nerve injury by electroacupuncture,withsatisfactory results reported as follows.

Treatment of Infantile Morbid Night Crying by Acupuncture at Zhongchong Point in 100 Cases

Morbid night crying is often found in infants. Applying acupuncture at Zhongchong (PC 9) point, the author treated 100 infants with morbid night crying and achieved satisfactory therapeutic effects. The results are reported as follows.……

Feeding Infants and Toddlers--An Intuitive and Simple Action,Is It?

Feeding infants and toddlers is a natural action that can at times be challenging.A chronic illness or a neurodevelopmental problem maybe the source of the initial difficulty.When feeding is also difficult for the parent,an additional component is present which may exacerbate the situation and require therapeutic intervention,including diagnosis and parental counseling.Integrative therapy is essential in the processes of diagnosis and treatment of infants and toddlers and parents with eating and feeding challenges.This is presented in the paper in four cases from the Feeding and Eating Clinic for infants and toddlers.