Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant.

Cytomegalovirus (CMV) infection is the most common intrauterine and perinatal viral infection. Postnatal CMV infection is acquired mainly from breast milk and may cause severe illness in preterm infants. We report an extremely low birth weight infant who presented with a sepsis-like syndrome and multiple organ involvement, notably hepatitis and pneumonitis, and treated with ganciclovir without adverse effect or relapse.

Hyperekplexia in a neonate: a novel finding in Fukuyama type congenital muscular dystrophy.

The Fukuyama type congenital muscular dystrophy (FCMD) is a rare autosomal recessive disorder characterized by cranial, cerebellar and ocular malformations and congenital muscular dystrophy. Hyperekplexia is characterized by transient, generalized rigidity in response to unexpected loud noises or sudden tactile stimulation. Herein, we report an infant who had typical clinical features of FCMD with hyperekplexia. Our purpose is to draw attention to this first report of concomitant FCMD and hyperekplexia.

Gender and HIV/AIDS.

The impact of gender on HIV/AIDS is an important dimension in understanding the evolution of the epidemic. How have gender inequality and discrimination against women affected the course of the HIV epidemic? This paper outlines the biological, social and cultural determinants that put women and adolescent girls at greater risk of HIV infection than men. Violence against women or the threat of violence often increases women's vulnerability to HIV/AIDS. An analysis of the impact of gender on HIV/AIDS demonstrates the importance of integrating gender into HIV programming and finding ways to strengthen women by implementing policies and programs that increase their access to education and information. Women's empowerment is vital to reversing the epidemic.

The health dimension.

PIP: Recognizing the adverse health consequences of violence against women, the World Health Organization (WHO) has emphasized the need for a public health approach to prevention as well as the need for the delivery of care to victims of abuse. The WHO is also aware of the need for intersectoral collaboration to address this complex problem. Domestic violence affects all aspects of women's lives and undermines the basis for sustainable human development while violating women's human rights. The WHO included a section on violence against women in its position paper presented to the Fourth World Conference on Women and has accelerated its activities in this area since the Conference. WHO's work on violence has included a 1996 expert consultation that focused on domestic violence and resulted in recommendations that formed the basis of the WHO's Plan of Action on Violence Against Women. The WHO's work on violence also includes efforts to eliminate female genital mutilation and violence visited upon women during situations of armed conflict. The WHO is developing population-based data, innovative research methods, an inventory and assessment of interventions, policy guidelines, and information and advocacy materials to combat domestic violence. Existing data remain scattered and anecdotal but indicate that domestic violence is a major problem.^ieng

More than biomedical interventions. WHO's response to the challenge of reproductive health is based on a fourfold approach: advocacy, normative functions, technical cooperation and research.

PIP: The World Health Organization's (WHO) response to the challenge of reproductive health is based upon advocacy, normative functions, technical cooperation, and research. WHO will undertake international and national advocacy for the concept of reproductive health and relevant policies and programs with the goal of creating an enabling environment and securing more resources. Such advocacy will be broad-based, directed to people, international and national agencies, and institutions and nongovernmental organizations within the health sector and in related sectors. WHO will work to develop policies, strategic approaches, norms, standards, indicators, and guidelines for reproductive health programs which will be adapted in accordance with experience in country situations and the results of operational research. In its technical cooperation with countries, the WHO will continue to provide support in formulating, implementing, and evaluating comprehensive national reproductive health policies and programs, and will promote and facilitate the transfer of knowledge and expertise to member states and others working to improve reproductive health. WHO acknowledges that reproductive health cannot be externally imposed. Finally, with regard to research, WHO will support research designed to improve the knowledge base and develop new approaches and technologies. WHO's support to research in reproductive health is intended to strengthen policy formation, program development and implementation, and capacity for essential national research.^ieng

Effect of caffeine on control of breathing in infantile apnea.

Abnormalities in control of breathing have been associated with near-miss sudden infant death syndrome. Because caffeine is a respiratory stimulant, its effect on breathing pattern was evaluated in 12 infants with infantile apnea. Caffeine induced a significant increase in ventilation, tidal volume, and mean inspiratory flow. In contrast, no changes were noted in inspiratory time, expiratory time, or total cycle duration. These effects were observed with plasma concentrations of caffeine ranging from 8 to 20 mg/L. Caffeine increases ventilation mainly by increasing central inspiratory drive, and not be effective timing (T1/TTOT). This drug may be of value in near-miss SIDS.

Protein binding and bilirubin displacing properties of bumetanide and furosemide.

We evaluated the protein binding and comparative bilirubin displacing properties of bumetanide and furosemide in pooled adult and cord serum by ultrafiltration (UF), difference spectra (DS), and Sephadex Gel-25 (SG-25) filtration. By UF, bumetanide was found to be highly protein bound (96.7 per cent), similar to published data on furosemide (97.2 per cent). SG-25 filtration and DS showed an equal shift to the left of the free bilirubin curve when bumetanide and furosemide were added to serum, in adult and cord, at equimolar concentrations and both shifted the free bilirubin curve equally. Bilirubin displacement was greater (P less than 0.001) in cord than in adult serum with both drugs. When "presumed therapeutic" plasma concentration of furosemide (1-2 mg/liter) and bumetanide (0.5 mg/liter) were compared, it was noted that bumetanide displaced significantly less (P less than 0.001) bilirubin from albumin in cord blood than furosemide. Hence, bumetanide displaces less bilirubin at "presumed therapeutic" plasma concentrations than furosemide, suggesting that it might be more prudent to use bumetanide in sick neonates with hyperbilirubinemia. Data also provide evidence that bilirubin displacement by both diuretics is greater in neonatal serum albumin than in the adult.

Tolazoline therapy for persistent pulmonary hypertension after congenital diaphragmatic hernia repair.

To determine whether vasodilators are useful in persistent pulmonary hypertension associated with congenital diaphragmatic hernia, we reviewed the clinical course, laboratory data, and outcome of 37 patients with respiratory distress and diaphragmatic hernia requiring an operation before 24 hours of life. These patients were divided into two groups, Group I (n = 17) included patients treated prior to the use of tolazoline; Group II (n = 20) included those treated after tolazoline became available. Postoperative severe respiratory distress was observed in ten patients in Group I, and all died. In Group II, 16 patients had severe postoperative respiratory distress and four survived; 12 of these 16 patients received tolazoline, including all four survivors. Treated survivors had significantly higher increase in Pao2 after a test dose of tolazoline than did nonsurvivors. A transient "honeymoon period" of adequate oxygenation correlated with good response to tolazoline, and the presence of both was predictive of survival. No patient survived with the combination of no "honeymoon period" and no response to tolazoline, whereas response to tolazoline without a honeymoon period was sometimes followed by survival. All nonsurvivors had severe lung hypoplasia at autopsy.