What is the burden of genetic disease in Rwandan children with developmental delay?
Annette Uwineza from the Center’s for Medical Genetics in both the University of Rwanda and the University of Liege in Belgium worked with colleagues from both institutions to start to understand the contribution that genetic disorders make to developmental delay in Rwanda. This is important work because as childhood mortality from preventable diseases continues to fall in the years ahead, genetic disease will emerge as an important cause of morbidity and mortality.
664 children with a global developmental delay (defined as a significant delay in two or more of the developmental domains), intellectual disability (IQ less than 75) and/or multiple congenial anomalies had cytogenetic studies performed and 260 chromosomal abnormalities were identified, with Down syndrome as the most common. Of course, genetic technology is moving on a pace and microarray CGH (Comparative Genetic Hybridisation) is able to identify micro deletions and duplications below the resolution of the light microscope and there will be many of these in addition to the conditions identified by cytogenetics and the authors make this point in their conclusion
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What is the most effective way to monitor HIV treatment when CD4 counts are not available?
Minke H. W. Huibers from the Global Child health Group at the Emma Children Hospital of the University of Amsterdam in The Netherlands with a team from the University of Malawi College of Medicine and Queen Elizabeth Central Hospital in Blantyre, Malawi and the Centre for International Child health of the University of Melbourne assessed alternative markers to CD4 counts to guide treatment decisions in HIV management. As the World Health Organisation has recently changed its advice so that all diagnosed children under the age of 5 start antiretroviral treatment irrespective of CD4 count, this decision is now only clinical for children over 5 years of age.
This paper assesses alternatives to CD4 counts in a cohort of 261 Malawian children and the only marker associated with CD4 count was total lymphocyte count (p < 0.001), however sensitivity was only 21% (95% CI 15-29%) with the current WHO cut-offs, but could be improved to a sensitivity of 73% (95% CI 65-80%), specificity 62% (95% CI 52-72%) with different cut-offs. Clinical staging alone was not a reliable strategy to guide initiation of antiretroviral treatment.
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How common is healthcare associated conjunctivitis in babies and what can be done to reduce the problem?
Neonatal conjunctivitis is a common problem and sometimes it can be precipitated by healthcare itself; proximity in neonatal units, mechanical trauma from eye care and patches for phototherapy add to the risk. Kanika Goel working at the Department of Microbiology at Lady Hardinge Medical College, New Dehli, India and the Department of Medicine at the University of Kentucky, USA with collaborators from both institutions prospectively studied the epidemiology of healthcare associated conjunctivitis in the Smt. Sachet Kriplani Hospital in New Dehli.
24 cases were identified in a cohort of 591 neonates. Escherichia coli was the most common microorganism and on multivariate analysis healthcare interventions that are markers of severity of illness; intubation and orogastric feeding were associated with healthcare associated conjunctivitis.
The authors point out the importance of hand hygiene, remember the WHO hand washing technique available at http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf.
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