ABSTRACT
Despite the use of highly active antiretroviral therapy (HAART) and the success of protocol PACTG-076 in decreasing perinatal transmission of HIV infection in many industrialized countries, a total of 5,600,000 new cases of HIV infection were diagnosed worldwide in 1999. Of those cases, more than 10% are children under 15 years of age. The vast majority of pediatric HIV infection is due to perinatal transmission. More than 95% of HIV-infected people live in the developing world. Different studies are currently being conducted with modifications of the original PACTG-076, especially shorter courses of zidovudine (ZDV), combinations of antiretrovirals (ZDV and 3TC), or comparison of a modified version of the standard ZDV course vs. a single dose of nevirapine for the mother intrapartum and also for the newborn. The results of these studies may provide more affordable, alternative regimens to prevent maternal-to-child HIV-1 transmission for developing countries than the PACTG-076 protocol. It is very important that physicians and physician extenders (nurse practitioners and physician assistants) caring for infants born to HIV-infected mothers have an understanding of the pathophysiology of vertical HIV-1 infection transmission. They should be familiar with the conditions associated with an increased risk of transmission, interventions available to decrease this risk, current medications, and laboratory resources.
Subject(s)
Anti-HIV Agents/administration & dosage , HIV Infections/transmission , HIV-1 , Infectious Disease Transmission, Vertical/prevention & control , Antiretroviral Therapy, Highly Active , Drug Administration Schedule , Female , HIV Infections/prevention & control , Humans , Infant, Newborn , Lamivudine/administration & dosage , Nevirapine/administration & dosage , Pregnancy , Zidovudine/administration & dosageABSTRACT
OBJECTIVE: We performed this study to assess whether parental perception of hearing loss predicted the results of audiometric testing in children with recurrent otitis media or persistent otitis media with effusion. METHODS: As part of a larger prospective observational outcomes study of children undergoing tympanostomy tube placement, the child's parent completed a standardized questionnaire before and after tube placement. In addition, patients underwent age-appropriate audiologic threshold and tympanometry testing before and after tube placement. RESULTS: We enrolled 113 patients (median age, 2 years), and 93 (82%) completed follow-up. Before treatment, parental perception of hearing loss did not predict hearing threshold level. After tube placement, parental perception of hearing loss was also poorly correlated with change in threshold. CONCLUSIONS: Parental perception of their child's hearing loss is a poor predictor of objective audiologic findings both before and after treatment with tympanostomy tubes. These findings have important implications concerning the importance of screening for hearing loss in children with otitis media with effusion.
Subject(s)
Attitude to Health , Hearing Disorders/diagnosis , Mass Screening/methods , Otitis Media with Effusion/complications , Parents/psychology , Surveys and Questionnaires/standards , Audiometry , Child , Child, Preschool , Female , Hearing Disorders/etiology , Humans , Infant , Male , Middle Ear Ventilation , Otitis Media with Effusion/surgery , Predictive Value of Tests , Prospective Studies , Recurrence , Reproducibility of Results , Risk FactorsABSTRACT
The discovery of variably decreased olfactory ability in Type Ia pseudohypoparathyroidism (PHP), a syndrome in which generalized hormone resistance is associated with deficiency of the alpha chain of the stimulatory guanine nucleotide-binding protein (Gs alpha) of adenylyl cyclase, has been used to support the hypothesis that Gs alpha plays a major role in human olfactory transduction. However, only a limited number of olfactory tests have been administered to such patients, and these patients have other problems that might cause or contribute to their olfactory dysfunction, including an unusual constellation of skeletal and developmental deficits termed Albright hereditary osteodystrophy (AHO). In this study, we administered tests of odor detection, identification, and memory to (i) 13 patients with Type Ia PHP; (ii) 8 patients with Type Ib PHP; (iii) 7 patients with pseudopseudohypoparathyroidism (PPHP); and (iv) 3 sets of normal controls matched to these groups on the basis of age, gender, and smoking history. Although we confirm that PHP Type Ia patients evidence olfactory dysfunction, we also demonstrate that (i) patients with Type Ib PHP, who have no AHO, no generalized hormone resistance, and normal Gs alpha activity, also evidence olfactory dysfunction relative to matched controls; and (ii) patients with PPHP, who have AHO, no generalized hormone resistance, and deficient Gs alpha protein activity, have relatively normal olfactory function. These observations do not support the hypothesis that the olfactory dysfunction associated with PHP is the result of generalized Gs alpha protein deficiency and imply that other mechanisms (e.g. ones associated with PTH or PTHrP resistance) are responsible for the olfactory deficits of this disorder.
Subject(s)
GTP-Binding Proteins/deficiency , Pseudohypoparathyroidism/physiopathology , Smell/physiology , Adult , Female , Humans , Male , Memory , Odorants , Receptors, Odorant/physiologyABSTRACT
De una serie de 308 hernias hiatales por deslizamiento con reflujo gastroesofagico, se documento la existencia de complicaciones broncopulmonares cronicas en 39 (12, 6%). A la luz de los resultados obtenidos se considera la necesidad del tratamiento quirurgico
Subject(s)
Humans , Gastroesophageal Reflux , Hernia, Hiatal , Lung Diseases, ObstructiveABSTRACT
De una serie de 308 hernias hiatales por deslizamiento con reflujo gastroesofagico, se documento la existencia de complicaciones broncopulmonares cronicas en 39 (12, 6%). A la luz de los resultados obtenidos se considera la necesidad del tratamiento quirurgico
