Epidemiological study on vocal disorders in paediatric age.

Few studies analyzed the diffusion of vocal alterations especially in childhood. Aim of our study was to quantify the numbers of subjects, in paediatric age, in which dysphonia was diagnosed in our department of Phoniatrics, during a period of 5 years, (January 2002-December 2006), and also to evaluate the influence of some potential risk factors. In the considered period it emerged that the diagnosis of dysphonia was made in 312 children (17.2% of the patients affected from dysphonia), aged between 2 and 16-years-old, with a major prevalence amongst males (57%) than females (43%). On the contrary in the adult population the prevalence was: 23% in males and 77% in females. In paediatric population, the most affected range of age is the one between 8 and 14, in both male and female gender (59.6%). In 82.4% of the cases there were vocal fold lesions. The 90.3% of children with vocal fold alterations presented lesions secondary to vocal abuse and misuse and classifiable as functional dysphonia. The proportion of functional dysphonia in our sample was 92%. The 65% of children belonged to large families with more than two children, and the 30% had a family history of dysphonia (brothers, parents). The study of the behavioural characteristics has shown aggressive and hyperactive attitudes in 83% of the cases. Since in the ethiopathogenesis of the childhood dysphonia the tendency to vocal abuse has a predominant role, it would be useful to encourage the diffusion of programmes of information to show the risks linked to this abuse in children, in order to prevent the development of dysphonia in paediatric age.

[Overproduction of tumor necrosis factor-alpha in African patients with HIV-1 infection, cachexia and low tri-iodothyronine syndrome]. / Surproduction de tumor necrosis factor alpha chez les malades africains infectes par le VIH-1, cachectiques et ayant un syndrome de tri-iodothyronine basse.

Sick euthyroid syndrome characterized by low triiodothyronine (T3) levels is observed in advance stages of HIV infection. The purpose of this prospective study was to determine if proinflammatory cytokines play and role in the pathogenesis of this syndrome in HIV-1-infected patients. Serum levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-1 beta were measured in 40 African patients presenting HIV-1 infection associated with low T3 levels in 20 cases (group I) and normal or elevated T3 levels in 20 cases (group II). Elevation of serum TNF-alpha levels was more common and mean serum TNF-alpha level was significantly higher in group I than group II (116 +/- 39 versus 3.05 +/- 0.04 pg/ml; p < 0.01). Serum IL-1 beta levels were not significantly different between the two groups. These findings are consistent with previous experimental data and suggest that sick euthyroid syndrome in cachectic HIV-1 infected patients may be due to overproduction of TNF-alpha.

Free and decomplexed human immunodeficiency virus p24 antigenaemia in black patients with AIDS and AIDS-related disorders.

OBJECTIVES: To determine the clinical signification of free and decomplexed p24 antigenaemia in HIV1-infected black individuals. PATIENTS AND METHODS: Sixty African patients with pre-AIDS (n = 12) and AIDS (n = 48), hospitalized in the Centre National Hospitalier Universitaire de Bangui, Central African Republic, were prospectively included. 15 HIV1-seronegative healthy African subjects served as controls. Serum p24 antigenaemia was detected using a polyclonal and a monoclonal sandwich enzyme immunoassay (EIA). All sera were tested again after acid pretreatment (45 mn incubation of serum with a 0.5 N solution of HCl at +37 degrees C). RESULTS: The polyclonal EIA and the monoclonal EIA detected respectively four (7%) to six (10%) free p24 antigen positive samples from the HIV1-infected individuals, with a similar frequency in pre-AIDS and AIDS patients. None of the controls were found p24 antigen positive. After acid pretreatment, the rate of detectable p24 antigenaemia increased significantly, leading with the monoclonal EIA to a 47% positivity rate (p < 0.001), and the patients with AIDS became more frequently p24 antigen positive (54%), than the patients with pre-AIDS (17%) (p = 0.02). CONCLUSION: Detectable p24 antigenaemia in HIV1-infected African subjects could be obtained in nearly half of cases by increasing the sensitivity of the assay using monoclonal EIA and acid hydrolysis of circulating immune complexes. Decomplexed p24 antigenaemia in HIV1-infected Black African patients could have predictive signification similar to free p24 antigenaemia in Caucasians.

The slim disease in African patients with AIDS.

Ten unselected African patients infected with human immunodeficiency virus (HIV) and with slim disease were evaluated using physical examination, anthropometric measurements, Karnovsky performance score, and muscle biopsy. All had marked weight loss (36.8 +/- 10.8%) with extreme fatigue, marked diffuse wasting with significantly decreased circumferences of arms, thighs and calves (P < or = 0.002), and a low Karnovsky performance score (range 30-70). Mild to moderate motor deficit (in 9/10 patients) contrasted with the major amyotrophy. Chronic diarrhoea (in 7/10) and/or prolonged fever (in 7/10) were always associated with the amyotrophy. Atrophy of muscle fibers was the main finding of muscle biopsy. Only 5 patients met the CDC criteria for the 'HIV wasting syndrome'. We conclude that slim disease, which is highly suggestive of the acquired immune deficiency syndrome (AIDS) in Africa, is a condition associated with chronic diarrhoea and/or prolonged fever, that encompasses the 'HIV wasting syndrome' sensu stricto and probably other debilitating diseases associated with AIDS, such as tuberculosis.

Peripheral facial nerve palsy related to HIV infection: relationship with the immunological status and the HIV staging in Central Africa.

Twelve cases of infranuclear facial nerve palsy associated with infection by the human immunodeficiency virus in the heterosexual African are reported with clinical and immunological studies. Eight cases were healthy HIV carriers, three patients manifested AIDS-related complex and one case fulfilled the CDC criteria for AIDS. Nine patients had a typical Bell's palsy, two presented cephalic Herpes zoster infection with Ramsay Hunt syndrome and one, who suffered from progressive facial weakness, could be considered as having a cephalic form of Guillain-Barré syndrome.

PIP: 12 cases of peripheral facial nerve palsy in African patients attending the Centre National Hospitalier Universitaire de Bangui, Central African Republic, with HIV infections are described with clinical and serological findings. All sera were tested with ELISA and confirmed with Western blot for both HIV-1 and HIV-2 (ELAVIA 1, ELAVIA 2, LAV BLOT I, LAV BLOT II, Diagnostics Pasteur). All 12 were HIV-1 positive and HIV-2 negative. Clinically, 1 patient met the clinical definition of AIDS, 3 had AIDS-related complex, and 8 had been previously health. In 11 cases, facial nerve palsy was the 1st presenting syndrome of HIV infection. ONset was acute in all, and associated with flu-like symptoms in 7. The palsy resembled Bell's palsy in 9, but was associated with unilateral vesicular eruptions suggestive of Ramsay-Hunt syndrome, or varicella-zoster, in 2 cases. In 1 19-year old woman complete facial paralysis with peri-oral numbness and paresthesia of the cheek developed in 1 hour. All recovered in 2 weeks to 3 months. The T4 lymphocyte counts averaged 764 in the healthy patients and 373 in the ARC and AIDS patients, compared to 1949 in controls. T4/T8 ratios averaged 0.66 and 0.45 in these groups compared to 1.32 in controls. 4 other cases of facial palsy in persons testing negative for HIV are also described. Speculative explanations for the pathophysiology of these palsies were offered: local infection of the facial nerve or ganglion by HIV, inflammatory demyelinating neuropathy, or secondary infection, due to immunosuppression, by agents such as Herpes zoster.

[Ophthalmologic manifestations of acquired immunodeficiency syndrome (AIDS) in central Africa]. / Manifestations ophtalmologiques du syndrome d'immunodépression acquise (SIDA) en Afrique centrale.

In central Africa, the authors have performed an ophthalmological examination of 77 adult patients (18-55 years) with AIDS: 33.7% had ocular abnormalities. Frequent manifestations included cotton-wool patches and retinal hemorrhages, while lacrymal hyposecretion, palpebral and conjunctival kaposi sarcoma, ocular palsy, ptosis, herpes zoster, papillar oedema, cytomegalovirus retinitis and periphlebitis were less frequent. The authors underline the necessity to perform an ocular examination for each patient with AIDS.

[Seroprevalence of HIV infection in a population of neurological patients in the Central African Republic]. / Séroprévalence de l'infection HIV au sein d'une population de patients neurologiques en République centrafricaine.

In order to evaluate the predictivity of neurological signs and symptoms in african patients, in Bangui's National Hospital Center (Central African Republic), 79 inpatients (aged 15-65 years) presenting with neurological manifestations (vascular attack, proved metabolic coma, or neuro-paludism excluded), and 64 age and sex matched controls in the same ward, without neurological or AIDS-related symptoms, were tested for the presence of HIV1-antibodies. 51/79 (65%) patients with neurological manifestations were HIV1-seropositive, and 10 (16%) of 64 controls (P less than 0.001). The positive predictive value (PPV) for HIV1 was 100% for patients with cutaneous zona (9 cases), Bell's palsy (4 cases) or cryptococcal meningitis (8 cases). The PPV for HIV1 was less important for the other neurological disorders: 43% for purulent meningitis (21 cases), 62% for major involvements of the central nervous system, without diagnosed etiology (32 cases; in which 13 were meningo-encephalitis, 16 focal deficits and 3 possible meningeal tuberculosis). In central Africa, the predictivity of neurological manifestations is high for HIV1 infection that emphasises the need for including neurological signs in clinical case definitions of AIDS in Africa.

Peripheral facial paralysis and HIV infection: report of four African cases and review of the literature.

Four cases of infranuclear facial palsy associated with infection by the human immunodeficiency virus in young heterosexual African patients are reported. Two cases were healthy HIV carriers, one patient manifested AIDS-related complex, and one case fulfilled the CDC criteria for AIDS. Two patients had a typical Bell's palsy, one presented with manifest cephalic Herpes zoster infection and one, who suffered from facial diplegia, could be considered to have a cephalic form of Guillain-Barré syndrome. A review of the literature confirmed that peripheral facial palsy can occur at any stage of HIV infection and in various clinical contexts. In stages I and II of the HIV infection, patients may develop either Bell's palsy or Guillain-Barré syndrome. In stages III and IV, when the cellular immunity has begun to decline, Herpes zoster-related facial paralysis, seventh cranial nerve involvement secondary to meningeal lymphomatosis, and peripheral facial paralysis as one aspect of widespread chronic peripheral neuropathy may also occur.

[Neurologic and psychiatric manifestations of AIDS in Central African Republic]. / Manifestations neurologiques et psychiatriques du SIDA en République centrafricaine.

To describe and evaluate the frequency of neurological and psychiatric manifestations in African patients with AIDS, 93 in patients at the National Hospital Center, Bangui, were chosen according to the WHO clinical definition of AIDS and were confirmed to be HIV-1 positive (92/93) or HIV-2 positive (1/93) by Western blot. Patients were given both neurologic and psychiatric examinations. Cortico-spinal fluid (CSF) analysis was performed in case of neuro-psychiatric signs. 11 patients presented neurologic symptoms: 5 had focal processes associated in 2 cases with deep coma, 4 had cryptococcal meningitidis, 1 demonstrated peripheral facial paralysis, and there was one case of abnormal movement, choréo-athétotic type. 4 patients presented frank psychiatric symptoms (3 dementia syndromes, one of whom was HIV-2 positive, and 1 case of hallucinatory psychosis). CSF analysis was only helpful in the etiologic diagnosis of cryptococcal infection. The mortality rate in these 15 patients was 60% during the 2-month study. In this series, neurologic and/or psychiatric symptoms were detected in 16 (15/93)% of African patients with AIDS.

Transamination of l-cystathionine and related compounds by bovine brain glutamine transaminase.

Glutamine transaminase (EC 2.6.1.15) has been purified 113 fold from bovine brain. The product is free of aspariate amino transferase (EC 2.6.1.1.) and other common transaminases. The enzyme shows a wide specificity similar to that reported from the same transaminase purified from bovine kidney and liver as regards both the amino donor and the amino acceptor. Of interest is the transamination and cyclization of l-cystathionine, l-lanthionine, l-cystine and S-aminoethylcysteine. The latter result indicates that the deamination and the cyclization of the sulfur containing diamino acids described for bovine liver and kidney enzyme is feasible also in the brain and suggests the possible endogenous origin of cyclothionine and thiomorpholine dicarboxylate recently detected in bovine brain.