Acceptability of neonatal male circumcision for HIV prevention among adults in the Bahamas

OBJECTIVES: To assess parents’ knowledge of HIV and sexually transmitted infection (STI) reduction through male circumcision, determine their desire to have their newborn son circumcised, and quantify impacts of circumcision procedural awareness. DESIGN AND METHODS: A cross-sectional survey of parents attending public healthcare facilities in Nassau, Bahamas, including a subsection completed after reading a circumcision information pamphlet. RESULTS: 314 mothers and 39 fathers were included. 87.8% were Bahamian and 7.4% Haitian. 97.1% followed Christianity. 7.4% had at least one other circumcised son and 25.7% of parents reported a circumcised father. 15.7% were aware that male circumcision reduces a man’s chance of getting HIV and 29.8% knew the procedure reduces STI. 88.5% and 88.4% of Haitians were unaware of male circumcision reducing HIV and STI acquisition, while awareness was greater amongst all those with higher levels of formal education. 55.6% of parents initially opted for neonatal male circumcision - especially circumcised fathers, Bahamian and Jamaican nationals, those who completed at least high school, and those believing male circumcision reduces HIV and STI rates. Improved health, appearance, and hygiene motivated participants more than cultural and religious affiliation. Both parents felt that the decision on neonatal male circumcision should be made in unison. Acceptance rose to 68.0% after reading the information pamphlet on male circumcision. CONCLUSION: Newborn male circumcision is decided on by both parents in most cases with little influence of culture and religion. Information on neonatal male circumcision risks and benefits, including reduction of HIV and STI, lead to an increase in its acceptance.

Microsatellite polymorphisms in Bolivian squirrel monkeys (Saimiri boliviensis).

Two different approaches were used to identify new microsatellite polymorphisms among captive Bolivian squirrel monkeys (Saimiri boliviensis). In the first case, PCR primers for published human microsatellite loci were screened using genomic DNA from squirrel monkeys. Six polymorphic loci were identified using DNA samples from 19 unrelated individuals. The average heterozygosity among these six loci is 0.73. In the second set of experiments, a DNA library was created from Saimiri genomic DNA, and clones were selected from that library by screening with probes containing di-, tri-, and tetranucleotide repeats. Six novel microsatellites were identified this way, with an average heterozygosity of 0.59. Primer pairs for these six cloned microsatellites were also screened using a series of DNA samples from ten other platyrrhine species to assess the potential utility of these loci in other taxa. This study provides 12 new DNA polymorphisms that will be useful for various studies of this genus and demonstrates that both approaches can be used to develop new DNA polymorphisms in platyrrhine species.

The use of heparinase to neutralize residual heparin in blood samples drawn through pediatric indwelling central venous catheters.

Routine-coagulation screening is unreliable if obtained through a previously heparinized central venous catheter. Screening tests were performed on 14 paired peripheral and central venous catheter samples without and with heparinase. The heparinase treated central venous catheter samples correlated well with the peripheral samples and can be used to atraumatically screen for hemostatic abnormalities.

Efficacy of cough suppressants in children.

To test the hypothesis that codeine and dextromethorphan are effective in alleviating the symptoms of acute cough, we conducted a randomized, controlled trial. Eligible patients were children 18 months to 12 years of age, seen in private pediatric practices, with significant night cough of less than 14 days' duration. Study patients were randomly selected to receive codeine, dextromethorphan, or placebo at bedtime for 3 consecutive nights. Outcomes were assessed by the use of a parent questionnaire rating the severity of symptoms at the initiation of therapy, and after each night of the study. Every patient had a cough score (range 0 to 4) and composite symptom score (range 0 to 9) computed for each day of the study. One hundred forty-one doses of study medication were evaluated in 49 patients, including 13 children receiving placebo, 19 dextromethorphan, and 17 codeine. Mean cough and composite symptom scores decreased in each of the three treatment groups on each day of the study; there were no significant differences. Regression analysis, with reduction in cough score as the outcome of interest, showed that neither dextromethorphan nor codeine was significantly more effective than placebo (p = 0.41 and 0.70, respectively). Reduction in cough score was positively correlated with the severity of cough at the start of treatment (p = 0.007). Our data suggest that, in the doses used, neither codeine nor dextromethorphan is superior to placebo in treating night cough in children.

The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis.

BACKGROUND: In experimental models of meningitis and in children with meningitis, dexamethasone has been shown to reduce meningeal inflammation and to improve the outcome of disease. METHODS: We conducted a placebo-controlled, double-blind trial of dexamethasone therapy in 101 infants and children admitted to the National Children's Hospital, San José, Costa Rica, who had culture-proved bacterial meningitis or clinical signs of meningitis and findings characteristic of bacterial infection on examination of the cerebrospinal fluid. The patients were randomly assigned to receive either dexamethasone and cefotaxime (n = 52) or cefotaxime plus placebo (n = 49). Dexamethasone (0.15 mg per kilogram of body weight) was given 15 to 20 minutes before the first dose of cefotaxime and was continued every 6 hours thereafter for four days. RESULTS: The demographic, clinical, and laboratory profiles were similar for the patients in the two treatment groups. By 12 hours after the beginning of therapy, the mean opening cerebrospinal pressure and the estimated cerebral perfusion pressure had improved significantly in the dexamethasone-treated children but worsened in the children treated only with cefotaxime (controls). At 12 hours meningeal inflammation and the concentrations of two cytokines (tumor necrosis factor alpha and platelet-activating factor) in the cerebrospinal fluid had decreased in the dexamethasone-treated children, whereas in the controls the inflammatory response in the cerebrospinal fluid had increased. At 24 hours the clinical condition and mean prognostic score were significantly better among those treated with dexamethasone than among the controls. At follow-up examination after a mean of 15 months, 7 of the surviving 51 dexamethasone-treated children (14 percent) and 18 of 48 surviving controls (38 percent) had one or more neurologic or audiologic sequelae (P = 0.007); the relative risk of sequelae for a child receiving placebo as compared with a child receiving dexamethasone was 3.8 (95 percent confidence interval, 1.3 to 11.5). CONCLUSIONS: The results of this study, in which dexamethasone administration began before the initiation of cefotaxime therapy, provide additional evidence of a beneficial effect of dexamethasone therapy in infants and children with bacterial meningitis.

Familial syndrome of mental retardation, short stature, contractures of the hands, and genital anomalies.

Two teen-age XY brothers with mental retardation, short stature, obesity, genital abnormalities, and contractures of their hands are described. They have generalized osteoporosis and a history of frequent fractures. Their endocrinologic evaluation was normal except for mild glucose intolerance and delayed, but normal puberty. Although these brothers are similar to individuals with Prader-Willi syndrome, their unusual hand contractures, clinically significant osteoporosis, and lack of hypotonia indicate that they represent a different entity.

Use and complications of high-dose disodium etidronate therapy in fibrodysplasia ossificans progressiva.

A boy with fibrodysplasia ossificans progressiva received nearly twice the usual therapeutic dose of disodium etidronate for 13 months in an attempt to prevent reossification following a second operation to correct severe torticollis. The operation was successful, but during therapy he developed weakness and distinctive bone lesions characterized by general osteopenia, widened physes, and unique radiolucent bands in the metaphyses. The osseous abnormalities were distinct from those of rickets and healed after withdrawal of the drug.

A postaxial polydactyly-dental-vertebral syndrome.

Three patients with postaxial polydactyly and other abnormalities of the hands and feet, hypoplasia and fusion of the vertebral bodies, and dental abnormalities are reported. Two were sisters born to normal unrelated parents; the other patient was the male offspring of a consanguineous marriage. We suggest that this constellation of abnormalities represents a recessively inherited syndrome.

Macrodactyly, hemihypertrophy, and connective tissue nevi: report of a new syndrome and review of the literature.

Macrodactyly and hemihypertrophy have been described in association with a number of syndromes which are reviewed. We describe a child who, in addition to macrodactyly and hemihypertrophy, has extensive connective tissue nevi. He does not conform to any known entity and would appear to represent a "new" syndrome.

Shifting linear growth during infancy: illustration of genetic factors in growth from fetal life through infancy.

A percentile linear growth chart, from the third to ninety-seven percentiles, was derived from longitudinal data on 90 normal full-term infants of middle class suburban families, and the individual growth curves of each infant was contrasted to the growth chart for the entire group. Individual shifting in growth rate was noted in two thirds of the infants. To better determine the timing and nature of these shifts in linear growth, a search was made for otherwise normal full-term infants who were at or below the tenth percentile for length at birth and who moved up to the fiftieth percentile or better by age 2 years and those who were at or above the ninetieth percentile at birth and moved down to the fiftieth percentile or less by 2 years of age. Those shifting upward had accelerated linear growth soon after birth; they achieved a new "channel" at a mean age of 11.5 months. Those shifting downward did not decelerate until after the first three to six months; they achieved a new channel by the mean age of 13 months. These findings plus the correlation coefficients relating parental size to the length of the infant at birth, one year, and two years of age are compatible with the following statements: Birth length relates predominantly to maternal size whereas by 2 years of age the length correlates best to mean parental height, reflecting the genetic growth factors of both parents. Those infants "catching-up" after birth usually do so in early infancy, whereas those "lagging-down" tend to do so in midinfancy.