A comparison of chest radiographic findings in human immunodeficiency virus-positive and -negative children with pulmonary tuberculosis

AIM

To compare chest radiography (CXR) findings in human immunodeficiency virus (HIV)-positive and HIV-negative children who had microbiologically confirmed pulmonary tuberculosis (PTB).

MATERIALS AND METHODS

Retrospective analysis of CXRs from children with known HIV status and microbiologically confirmed PTB (culture or GeneXpert Xpert MTB/RIF positive), who were hospitalised or seen at a primary healthcare centre over a 5-year period. Radiological findings were compared according to HIV and nutritional status.

RESULTS

CXRs of 130 children were analysed from 35 (27%) HIV- positive and 95 (73%) HIV-negative children with confirmed PTB, median age 45.7 months (interquartile range [IQR] 18-81.3 months). CXR changes consistent with PTB were reported in 21/35 (60%) of HIV-positive and 59/95 (62%) of HIV-negative patients, (p=0.81). Normal CXR was identified in 3/35 (8.6%) of HIV-positive and 5/95 (5.3%) of HIV-negative patients (p=0.81). Airway compression was present in 3/35 (8.6%) of HIV-positive and 7/95 (7.4%) of HIV-negative patients (p>0.99). Overall, lymphadenopathy was identified in 42/130 (32.3%) of patients, 11/35 (31.4 %) were HIV-positive compared with 31/95 (32.6%) HIV-negative patients. Airspace consolidation was present in 60% of both HIV-positive (21/35) and HIV-negative patients (57/95). Pleural effusion was present in 2/35 (5.7 %) of HIV-negative and 9/95 (9.5 %) of HIV-negative patients. There were no statistically significant radiological differences by HIV group.

CONCLUSION

There were no significant differences in the CXR findings between the HIV-positive and HIV-negative children with confirmed PTB.

Polygamous Interest in a Mononormative Nation: The Roles of Sex and Sociosexuality in Polygamous Interest in a Heterosexual Sample from the UK

Polygamy is a form of "one-sided" consensually non-monogamous relationship where one person has multiple committed partners, each of whom is only involved with that one person. It was likely a reoccurring feature of ancestral mating that posed adaptive problems for our ancestors. Yet polygamy, and multi-partnering more generally, is understudied in Western cultures, raising questions about the existence of polygamous interest and whether this is calibrated adaptively to personal conditions. In two studies, we examined polygamous interest in two heterosexual online samples from the UK. In Study 1 (N = 393), modest interest was found for polygamous relationships overall. Men were six times more open to polygyny than women, but there was little sex difference in openness to polyandry. Further analysis revealed that all forms of multi-partnering were undesirable relative to singlehood and monogamy; however, consensual multi-partner relationships were less undesirable than non-consensual ones. Sex differences were largest for polygyny and arrangements where men had agreed access to a casual partner alongside a committed one, yet these were two of the most acceptable forms of multi-partnering when men and women's responses were combined. Sociosexuality positively predicted interest in most forms of multi-partnering. Study 2 (N = 735) focused on polygyny and added status-linked traits as predictors. The results of Study 1 were broadly replicated, though the status-linked traits did not predict polygynous interest specifically. Instead, sociosexuality and male intrasexual competitiveness uniquely predicted general interest in multi-partner relationships. Overall, interest in polygamy appears to emerge despite social discouragement and sex differences in interest track the relative costs and benefits associated with it. However, there is no strong evidence that polygamous interest is uniquely calibrated to personal conditions when compared to other forms of multi-partnering.

Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis

IgE antibodies (Ab) specific to galactose-α-1,3-galactose (alpha-gal) are responsible for a delayed form of anaphylaxis that occurs 3-6 hours after red meat ingestion. In a unique prospective study of seventy participants referred with a diagnosis of idiopathic anaphylaxis (IA), six (9%) were found to have IgE to alpha-gal. Upon institution of a diet free of red meat, all patients had no further episodes of anaphylaxis. Two of these individuals had indolent systemic mastocytosis (ISM). Those with ISM had more severe clinical reactions but lower specific IgE to alpha-gal and higher serum tryptase levels, reflective of the mast cell burden. The identification of alpha-gal syndrome in patients with IA supports the need for routine screening for this sensitivity as a cause of anaphylaxis, where reactions to alpha-gal are delayed and thus may be overlooked.

Pharmacokinetics of Sulfadoxine and Pyrimethamine for Intermittent Preventive Treatment of Malaria During Pregnancy and After Delivery

Sulfadoxine/pyrimethamine is recommended for intermittent preventative treatment of malaria during pregnancy. Data from 98 women during pregnancy and 77 after delivery in four African countries were analyzed using nonlinear mixed‐effects modeling to characterize the effects of pregnancy, postpartum duration, and other covariates such as body weight and hematocrit on sulfadoxine/pyrimethamine pharmacokinetic properties. During pregnancy, clearance increased 3‐fold for sulfadoxine but decreased by 18% for pyrimethamine. Postpartum sulfadoxine clearance decreased gradually over 13 weeks. This finding, together with hematocrit‐based scaling of plasma to whole‐blood concentrations and allometric scaling of pharmacokinetics parameters with body weight, enabled site‐specific differences in the pharmacokinetic profiles to be reduced significantly but not eliminated. Further research is necessary to explain residual site‐specific differences and elucidate whether dose‐optimization, to address the 3‐fold increase in clearance of sulfadoxine in pregnant women, is necessary, viable, and safe with the current fixed dose combination of sulfadoxine/pyrimethamine.

Self-Perception of Intelligence in Male and Female Undergraduates in Old and New Welsh Universities

In 1991 John Major's UK government announced that the binary divide in UK higher education was to be phased out as polytechnics would be given permission by the Privy Council to apply for university status. But has the binary divide really ceased to exist in higher education? Given that the ‘old’ universities typically ask for higher A-level grades than the ‘new’ ones we might ask: do students at new universities perceive themselves as being less able than those at old universities? In addition to the possibility of differences between institutions we might also ask do the sexes differ in their self-perceptions of intelligence? Over the last 25 years, a number of studies have demonstrated a robust gender difference in self-estimation of intelligence, with female undergraduates consistently producing lower ratings of their own intelligence than their male counterparts (see for example Hogan, 1978; Higgins, 1987 and Furnham, 2000, 2001). Does this situation still prevail in today's universities where more women than men now enter higher education? Finally, given the rapid rise in the proportion of the population entering higher education during the 1990s we might ask whether this rise has had an effect on the self-perception of intelligence in students. The current study was designed to throw some light on all three of these questions by simply asking undergraduate samples at an old and a new Welsh university what score they think they would achieve on an IQ test. The findings suggest that female undergraduates still rate themselves less highly than males, that students attending new universities perceive themselves as being less intelligent than those studying at old universities and finally, that during the 1990s there was a general fall in self-estimates of IQ amongst university students.

Analysis of cytokine production by peanut-reactive T cells identifies residual Th2 effectors in highly allergic children who received peanut oral immunotherapy

BACKGROUND

Only limited evidence is available regarding the cytokine repertoire of effector T cells associated with peanut allergy, and how these responses relate to IgE antibodies to peanut components.

OBJECTIVE

To interrogate T cell effector cytokine populations induced by Ara h 1 and Ara h 2 among peanut allergic (PA) children in the context of IgE and to evaluate their modulation during oral immunotherapy (OIT).

METHODS

Peanut-reactive effector T cells were analysed in conjunction with specific IgE profiles in PA children using intracellular staining and multiplex assay. Cytokine-expressing T cell subpopulations were visualized using SPICE.

RESULTS

Ara h 2 dominated the antibody response to peanut as judged by prevalence and quantity among a cohort of children with IgE to peanut. High IgE (> 15 kU(A)/L) was almost exclusively associated with dual sensitization to Ara h 1 and Ara h 2 and was age independent. Among PA children, IL-4-biased responses to both major allergens were induced, regardless of whether IgE antibodies to Ara h 1 were present. Among subjects receiving OIT in whom high IgE was maintained, Th2 reactivity to peanut components persisted despite clinical desensitization and modulation of allergen-specific immune parameters including augmented specific IgG4 antibodies, Th1 skewing and enhanced IL-10. The complexity of cytokine-positive subpopulations within peanut-reactive IL-4(+) and IFN-γ(+) T cells was similar to that observed in those who received no OIT, but was modified with extended therapy. Nonetheless, high Foxp3 expression was a distinguishing feature of peanut-reactive IL-4(+) T cells irrespective of OIT, and a correlate of their ability to secrete type 2 cytokines.

CONCLUSION

Although total numbers of peanut-reactive IL-4(+) and IFN-γ(+) T cells are modulated by OIT in highly allergic children, complex T cell populations with pathogenic potential persist in the presence of recognized immune markers of successful immunotherapy.

The interaction between artemether-lumefantrine and lopinavir/ritonavir-based antiretroviral therapy in HIV-1 infected patients

Background

Artemether-lumefantrine is currently the most widely recommended treatment of uncomplicated malaria. Lopinavir–based antiretroviral therapy is the commonly recommended second-line HIV treatment. Artemether and lumefantrine are metabolised by cytochrome P450 isoenzyme CYP3A4, which lopinavir/ritonavir inhibits, potentially causing clinically important drug-drug interactions.

Methods

An adaptive, parallel-design safety and pharmacokinetic study was conducted in HIV-infected (malaria-negative) patients: antiretroviral-naïve and those stable on lopinavir/ritonavir-based antiretrovirals. Both groups received the recommended six-dose artemether-lumefantrine treatment. The primary outcome was day-7 lumefantrine concentrations, as these correlate with antimalarial efficacy. Adverse events were solicited throughout the study, recording the onset, duration, severity, and relationship to artemether-lumefantrine.

Results

We enrolled 34 patients. Median day-7 lumefantrine concentrations were almost 10-fold higher in the lopinavir than the antiretroviral-naïve group [3170 versus 336 ng/mL; p = 0.0001], with AUC_(0-inf) and C_max increased five-fold [2478 versus 445 μg.h/mL; p = 0.0001], and three-fold [28.2 versus 8.8 μg/mL; p < 0.0001], respectively. Lumefantrine C_max, and AUC_(0-inf) increased significantly with mg/kg dose in the lopinavir, but not the antiretroviral-naïve group. While artemether exposure was similar between groups, C_max and AUC_(0-8h) of its active metabolite dihydroartemisinin were initially two-fold higher in the lopinavir group [p = 0.004 and p = 0.0013, respectively]. However, this difference was no longer apparent after the last artemether-lumefantrine dose. Within 21 days of starting artemether-lumefantrine there were similar numbers of treatment emergent adverse events (42 vs. 35) and adverse reactions (12 vs. 15, p = 0.21) in the lopinavir and antiretroviral-naïve groups, respectively. There were no serious adverse events and no difference in electrocardiographic QTcF- and PR-intervals, at the predicted lumefantrine T_max.

Conclusion

Despite substantially higher lumefantrine exposure, intensive monitoring in our relatively small study raised no safety concerns in HIV-infected patients stable on lopinavir-based antiretroviral therapy given the recommended artemether-lumefantrine dosage. Increased day-7 lumefantrine concentrations have been shown previously to reduce the risk of malaria treatment failure, but further evidence in adult patients co-infected with malaria and HIV is needed to assess the artemether-lumefantrine risk : benefit profile in this vulnerable population fully. Our antiretroviral-naïve patients confirmed previous findings that lumefantrine absorption is almost saturated at currently recommended doses, but this dose-limited absorption was overcome in the lopinavir group.

Trial registration

Clinical Trial Registration number NCT00869700. Registered on clinicaltrials.gov 25 March 2009

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1345-1) contains supplementary material, which is available to authorized users.

Effect of urban vs. rural residence on the association between atopy and wheeze in Latin America: findings from a case-control analysis

Background

The association between atopy and asthma is attenuated in non-affluent populations, an effect that may be explained by childhood infections such as geohelminths.

Objective

To investigate the association between atopy and wheeze in schoolchildren living in urban and rural areas of Ecuador and examine the effects of geohelminths on this association.

Methods

We performed nested case–control studies among comparable populations of schoolchildren living in rural communities and urban neighbourhoods in the Province of Esmeraldas, Ecuador. We detected geohelminths in stool samples, measured recent wheeze and environmental exposures by parental questionnaire, and atopy by specific IgE (sIgE) and skin prick test (SPT) reactivity to aeroallergens.

Results

Atopy, particularly sIgE to house dust mite (HDM), was more strongly associated with recent wheeze in urban than rural schoolchildren: (urban, adj. OR 5.19, 95% CI 3.37–8.00, P < 0.0001; rural, adj. OR 1.81, 95%CI 1.09–2.99, P = 0.02; interaction, P < 0.001). The population fractions of wheeze attributable to atopy were approximately two-fold greater in urban schoolchildren: SPT to any allergen (urban 23.5% vs. rural 10.1%), SPT to HDM (urban 18.5% vs. rural 9.6%), and anti-HDM IgE (urban 26.5% vs. rural 10.5%), while anti-Ascaris IgE was related to wheeze in a high proportion of rural (49.7%) and urban (35.4%) children. The association between atopy and recent wheeze was attenuated by markers of geohelminth infections.

Conclusions

Our data suggest that urban residence modifies the association between HDM atopy and recent wheeze, and this effect is explained partly by geohelminth infections.

Safety and efficacy of induced sputum in young children hospitalised with suspected pulmonary tuberculosis

BACKGROUND

Induced sputum (IS) is increasingly used to provide specimens for microbiological confirmation of Mycobacterium tuberculosis. The aim of this study was to investigate the safety of and yield from IS in children hospitalised with suspected pulmonary tuberculosis (PTB).

METHODS

In a prospective study of children hospitalised with suspected PTB in Cape Town, South Africa, between February 2009 and February 2012, two IS specimens were obtained on consecutive days or at intervals of at least 4 hours. Specimens were investigated for M. tuberculosis using concentrated fluorescent acid-fast smear, liquid culture and GeneXpert(®) MTB/RIF. The safety of IS was assessed by recording clinical signs and symptoms before and for 30 min after sputum induction.

RESULTS

Among 843 children enrolled, at least one IS was performed for 823 (97.6%). The safety of sputum induction was recorded for 690 children (median age 27.3 months [IQR 13.4-64.2]), representing a total of 1270 IS procedures. Of these, 129 (18.7%) had at least one sputum culture positive for M. tuberculosis. Side effects were epistaxis (249, 19.4%) or wheezing (14, 1.1%). The median drop in oxygen saturation during the IS procedure was 1%.

CONCLUSION

Sputum induction is a safe and useful method for the microbiological confirmation of tuberculosis (TB) in young children.

Sensitization to food and inhalant allergens in relation to age and wheeze among children with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is common in children; however, persistence of AD with or without asthma is less common. Longitudinal studies remain limited in their ability to characterize how IgE antibody responses evolve in AD, and their relationship with asthma.

OBJECTIVE

To use a cross-sectional study design of children with active AD to analyse age-related differences in IgE antibodies and relation to wheeze.

METHODS

IgE antibodies to food and inhalant allergens were measured in children with active AD (5 months to 15 years of age, n = 66), with and without history of wheeze.

RESULTS

Whereas IgE antibodies to foods persisted at a similar prevalence and titre throughout childhood, IgE antibodies to all aeroallergens rose sharply into adolescence. From birth, the chance of sensitization for any aeroallergen increased for each 12-month increment in age (OR ≥ 1.21, P < 0.01), with the largest effect observed for dust mite (OR = 1.56, P < 0.001). A steeper age-related rise in IgE antibody titre to dust mite, but no other allergen was associated with more severe disease. Despite this, sensitization to cat was more strongly associated with wheeze (OR = 4.5, P < 0.01), and linked to Fel d 1 and Fel d 4, but not Fel d 2. Comparison of cat allergic children with AD to those without, revealed higher IgE levels to Fel d 2 and Fel d 4 (P < 0.05), but not Fel d 1.

CONCLUSIONS AND CLINICAL RELEVANCE

Differences in sensitization to cat and dust mite among young children with AD may aid in identifying those at increased risk for disease progression and development of asthma. Early sensitization to cat and risk for wheeze among children with AD may be linked to an increased risk for sensitization to a broader spectrum of allergen components from early life. Collectively, our findings argue for early intervention strategies designed to mitigate skin inflammation in children with AD.

The effects of temperature priming on cooperation in the iterated prisoner's dilemma

Based on initial research findings by Williams and Bargh (2008) and Kang, Williams, Clark, Gray and Bargh (2011) on the interaction between interpersonal and physical warmth, theoretical models such as cognitive scaffolding and the importance of evaluations of interpersonal warmth in trust-based decisions, this experiment investigated the effect of temperature priming on 30 pairs of British university students with hot and cold objects on frequency of cooperation in a game of iterated Prisoner's Dilemma. Participants were found to cooperate significantly more frequently when primed with hot objects than with cold objects, supporting the assertion that physical warmth sensation positively affects interpersonal trust evaluation. No support was found for the prediction that male-male pairs would cooperate less than female-female pairs. The implications of these findings to evolutionary and developmental theories of interpersonal warmth are discussed.

The Effects of Temperature Priming on Cooperation in the Iterated Prisoner's Dilemma

Based on initial research findings by Williams and Bargh (2008) and Kang, Williams, Clark, Gray and Bargh (2011) on the interaction between interpersonal and physical warmth, theoretical models such as cognitive scaffolding and the importance of evaluations of interpersonal warmth in trust-based decisions, this experiment investigated the effect of temperature priming on 30 pairs of British university students with hot and cold objects on frequency of cooperation in a game of iterated Prisoner's Dilemma. Participants were found to cooperate significantly more frequently when primed with hot objects than with cold objects, supporting the assertion that physical warmth sensation positively affects interpersonal trust evaluation. No support was found for the prediction that male-male pairs would cooperate less than female-female pairs. The implications of these findings to evolutionary and developmental theories of interpersonal warmth are discussed.

Emotion lateralisation: developments throughout the lifespan

There is a great amount of research on hemispheric lateralisation for processing emotions and on the recognition of emotions across the lifespan. However, few researchers have explored the links between these two measures. This paper highlights how trends in these two research areas inform our understanding of how lateralisation for emotion processing may influence emotion recognition performance throughout the lifespan, including if the development of emotion lateralisation is a response to our environmental experiences of learning (experience dependent) or a result of having specific experiences at a particular time (experience expectant). The development of emotion lateralisation across the lifespan (infancy through to late adulthood) is explored with reference to past research and through the integration of the novel research offered within this special issue of Laterality. We also explore what we can learn from atypical populations. We propose that researchers need to focus on three key avenues of future research (longitudinal research, investigating the role of hormones, and research that explores the evolution of laterality) all which will provide greater insight into the development of laterality and how this may be associated with emotion processing.

Tuberculosis case finding for vaccine trials in young children in high-incidence settings: a randomised trial

SETTING

A high tuberculosis (TB) burden rural area in South Africa.

OBJECTIVE

To compare TB case yield and disease profile among bacille Calmette-Guérin (BCG) vaccinated children using two case-finding strategies from birth until 2 years of age.

DESIGN

BCG-vaccinated infants were enrolled within 2 weeks of birth and randomised to 3-monthly home visits for questionnaire-based TB screening plus record surveillance of TB registers, hospital admission and X-ray lists at health facilities for TB suspects and cases (Group 1), or record surveillance (as above) only (Group 2). Both groups received a close-out visit after 2 years. Participants were evaluated for suspected TB disease using standardised investigations.

RESULTS

A total of 4786 infants were enrolled: 2392 were randomised to Group 1 and 2394 to Group 2. The case-finding rate was significantly greater in Group 1 (2.2/100 py) than in Group 2 (0.8/100 py), with a case-finding rate ratio of 2.6 (95%CI 1.8-4.0, P < 0.001). Although the proportion of cases with bacteriological confirmation was lower in Group 1, this difference did not reach statistical significance. There was also no significant difference in the proportions with TB symptoms and signs.

CONCLUSION

Home visits combined with record surveillance detected significantly more cases than record surveillance with a single study-end visit. The TB case profile did not differ significantly between the two groups.

Tuberculin skin test and QuantiFERON® assay in young children investigated for tuberculosis in South Africa

SETTING

Although the literature on interferon-gamma release assays on tuberculosis (TB) in children has increased, data pertaining to young children remain relatively limited.

OBJECTIVE

To compare results from the tuberculin skin test (TST) and the QuantiFERON®-TB Gold In-Tube assay (QFT) in children aged <3 years investigated for TB disease.

DESIGN

TB suspects were evaluated by medical history and examination, TST, QFT, chest radiography, induced sputum and gastric washings for smear and culture for Mycobacterium tuberculosis.

RESULTS

A total of 400 children were enrolled. Among 397 children with both test results, 68 (17%) were QFT-positive and 72 (18%) were TST-positive (≥10 mm). Agreement between the tests was excellent (94%, κ = 0.79, 95%CI 0.69-0.89). TB disease was diagnosed in 52/397 (13%) participants: 3 definite, 35 probable and 14 possible TB. QFT sensitivity and specificity for TB disease were respectively 38% and 81%. TST sensitivity and specificity were respectively 35% and 84%.

CONCLUSION

While TST and QFT had excellent concordance in this population, both tests had much lower sensitivity for TB disease than has been reported for other age groups. Our results suggested equivalent performance of QFT and TST in the diagnosis of TB disease in young children in a high-burden setting.

Abnormal patterns of cerebral lateralisation as revealed by the Universal Chimeric Faces Task in individuals with autistic disorder

A previous study by Workman, Chilvers, Yeomans, and Taylor (2006), using the "Universal" Chimeric Faces Task (UCFT) for six emotional expressions, demonstrated that an overall left hemispatial/right hemisphere (RH) advantage has begun to develop by the age of 7-8. Moreover, the development of this left hemispatial advantage was observed to correlate positively with the ability to read emotions in the faces of others. Adopting the UCFT, the current study compared autistic children (11-15) with unimpaired children of two age groups (5-6 and 7-8) from this previous study. The autistic children showed a left hemispatial/RH advantage only for the two emotional expressions of "happiness" and "anger". Results for the autistic children revealed a similar overall pattern of lateralisation to the 5-6-year-olds and one that is less lateralised than the pattern for the 7-8-year-olds. Autistic children appear to show a developmental deficit for left hemispatial/RH advantage for emotional expression with the exception of "happiness" and "anger." The findings are discussed in terms of role hemisphericity and an approach-avoidance model.

Induced sputum or gastric lavage for community-based diagnosis of childhood pulmonary tuberculosis?

OBJECTIVES

To compare the diagnostic yield of Mycobacterium tuberculosis from induced sputum (IS) and gastric lavage (GL) among children in a community setting.

METHODS

Specimen-collection methods for bacteriological confirmation of pulmonary tuberculosis (PTB) were compared during a tuberculosis vaccine trial near Cape Town, South Africa (2001-2006). Children with a tuberculosis contact or compatible symptoms were investigated for suspected PTB. Diagnostic yields from 764 paired IS and GL specimens were compared in 191 culture-confirmed cases.

MEASUREMENTS AND MAIN RESULTS

The crude yield of M tuberculosis was 10.4%, n = 108 by IS (5.8%) and n = 127 by GL (6.8%), from a total of 194 cases, of which three had incomplete IS/GL specimen pairs. Agreement between IS and GL was poor (kappa = 0.31). The comparative yield of a single IS sample (38%) was equivalent to a single GL sample (42%), with a difference in yield of -4% (95% CI -15% to +7%). The combined yield of same-day IS and GL specimens (67%) was equivalent to two consecutive GL specimens (66%), with a difference in yield of 1% (95% CI -9% to 11%), but significantly greater than two consecutive IS specimens (55%), with a difference in yield of 12% (95% CI 2% to 21%). The adjusted odds of a M tuberculosis culture were increased by a positive tuberculin skin test or chest radiograph compatible with PTB.

CONCLUSIONS

In this community setting, the diagnostic yield of a single IS sample was equivalent to that of a single GL sample. The optimal diagnostic yield may be obtained from paired IS and GL specimens taken on a single day or two GL specimens taken on consecutive days.

Prevalence of bacterial contamination of powdered infant feeds in a hospital environment

BACKGROUND

The study arose as part of a best-practice nutrition model regarding the introduction of ready-to-use (RTU) infant feeds in place of powdered infant feeds (PIFs) as a standard formula for infants under the age of 1 year who are unable to be breastfed. Internationally and locally there is grave concern regarding the safety and efficacy of mixing PIFs, especially in a hospital setting, and the resultant bacterial contamination causing enteric infections, especially in premature, immunocompromised and sick infants.

OBJECTIVE

To evaluate the prevalence of bacterial contamination of PIFs given to infants at Red Cross War Memorial Children's Hospital, Cape Town.

METHODS

Quantitative levels of bacterial contamination were determined and were expressed as colony-forming units (CFUs) per millilitre of sample. Aliquots of milk were inoculated onto agar, and the milk samples were then incubated at 25 degrees C overnight (N = 10), 30 degrees C overnight (N = 48) and 30 degrees C for 6 hours (N = 34). Post-incubation milk samples were cultured again. Contamination was defined as any positive culture before administration (i.e. pre incubation) or > 10(2) CFU/ ml after administration (i.e. post incubation).

RESULTS

Fifty samples of PIFs (N = 82) were contaminated pre incubation, with 25/82 samples (30.4%) being heavily contaminated ( >or= 10(4) CFU/ml). Post incubation, 43/92 samples (46.7%) were contaminated with > 102 CFU/ml. The acidified PIFs appeared to have some bactericidal effect against some of the organisms, but not all.

CONCLUSIONS

RTU infant feeds are sterile and are recommended for use in all hospitalised infants. The results of this study indicate that even when milk is prepared in a controlled environment there is significant bacterial contamination of PIFs post production. As RTU feeds are now readily available in South Africa every attempt should be made to use a sterile RTU system for hospitalised infants.

Visual laterality effects in readers of a deep and a shallow orthography

Using a tachistoscopic split-field paradigm, hemifield asymmetry for single word recognition was examined in monolingual English speakers and in fluent bilingual English-Welsh speakers. A robust right hemifield advantage was found for both groups and both languages. Among bilinguals, the laterality index was significantly greater for Welsh than for English, supporting previous findings. The magnitude of the laterality index was unaffected by which language was learned first (Welsh or English) and by the age of acquisition (before or after 5-6years old) of the second language. However, among bilinguals there was a significant difference in the laterality index for Welsh words compared with English words for those participants brought up in a predominantly Welsh-speaking environment, but not for those brought up in a predominantly English-speaking or dual-language environment. We attribute our results to the difference in orthographic depth between Welsh and English. and argue that the transparency of Welsh favours adoption of a left-hemisphere based phonological decoding strategy in reading. Such a strategy is not necessarily used exclusively by readers of Welsh, but is encouraged by regular exposure to the Welsh language on a day-to-day basis.

Development of cerebral lateralisation for recognition of emotions in chimeric faces in children aged 5 to 11

In contrast to research into the development of language laterality, there has been relatively little research into the development of lateralisation of emotional processing. If language lateralisation begins in childhood and is complete by puberty (Lenneberg, 1967) it seems reasonable that the lateralisation of the perception of emotions might also occur during this period. In this study a split field chimeric faces test using the six universal facial expressions proposed by Ekman and Friesen (1971), an emotion in the eyes test, and a situational cartoon test were administered to three groups of children aged 5/6, 7/8, and 10/11. No overall hemispace advantage was seen for the 5/6-year-old group, but by the age of 10/11 a clear left hemispace advantage (right hemisphere) was found for all six emotions. Such a pattern is comparable to a previous study that made use of adults on this task (Workman, Peters, & Taylor, 2000b). Moreover, a significant positive correlation between a child's ability to recognise emotions in cartoon situations and their left hemispatial advantage score was uncovered. Finally, a significant positive correlation between a child's ability to recognise emotions in the eyes of others and their left hemispatial advantage score was also uncovered. These findings are taken as evidence that there may be a relationship between the development of emotional processing in the right hemisphere and a child's emerging ability to perceive or attend to the emotional states of others. Results are discussed in relation to the child's development of a theory of mind.

Determining the prevalence of malnutrition in hospitalized paediatric patients

AIM

To determine the prevalence of malnutrition in hospitalised paediatric patients at Red Cross War Memorial Children's Hospital.

METHOD

A 1-day cross-sectional survey was completed in all medical and surgical wards and some specialist outpatient clinics.

RESULTS

A total of 227 children participated in the study. Thirty-five per cent of patients were moderately malnourished (< or = -2 z-score), of whom 70% had no road to health card with them. Thirty-four per cent of children under 60 months of age received supplements in addition to a normal ward diet, 7.8% were enterally fed and less than 1% were parenterally fed. Almost 14% of children were found to be overweight/obese, which is higher than the national average of 6%. The prevalence of HIV infection on the day of the audit was 18% across all age groups compared with the Western Cape antenatal prevalence of 15.7% (2005).

CONCLUSION

The overall prevalence of undernutrition was 34%, which is comparable with similar studies. However, the proportion of overweight children (14%) was greater than the national average. In view of the level of malnutrition seen, a nutrition risk-screening tool, identifying risk factors for malnutrition such as food access and vulnerability, should be developed. The tool should be used to assess nutrition status and risk during the course of hospitalisation, in addition to planning appropriate nutrition care plan interventions for discharge.

Lateralisation of perceptual processing of pro- and anti-social emotions displayed in chimeric faces

Previous studies using a restricted range of split field chimeric faces suggest that the processing of facial emotional expressions is a highly lateralised phenomenon. Two theories have emerged with regard to the role the two cerebral hemispheres play in this processing. The "right hemisphere" hypothesis (e.g. Borod, Koff, Lorch, & Nicholas, 1988) suggests that the right hemisphere plays a prominent role in the processing of both positive and negative facial expressions. In contrast, the "valence hypothesis" (e.g. Reuter-Lorenz & Davidson, 1981) proposes that, while the right hemisphere plays the major role in processing negative emotions, the left hemisphere has a special role for positive emotions. Using all six of the human "universal facial expressions" (Ekman &Friesen, 1971) we present evidence that, superimposed onto a left visual field advantage (right hemisphere specialisation) for emotional processing, there is a "left shift" (right visual field advantage) for pro- as opposed to anti-social expression. We propose that facial expressions that are likely to be related to approach for communicative purposes initiate a greater degree of left hemisphere involvement. As a consequence, we suggest that for future laterality studies, the six universal emotional expressions should be reconsidered using a pro- to anti-social dimension rather than positive and negative groupings.

Differential bilingual laterality: mythical monster found in Wales

Paradis (1992) likens studies of bilingual laterality to reported sightings of the Loch Ness Monster, in that although some studies claim differential laterality much conflicting research evidence does not-and like the mythical Scottish monster, what reason have we to suspect that any such phenomenon might exist? This study reexamines differential bilingual laterality using four groups of English-Welsh bilinguals which differ in their age of acquisition and in their environment of acquisition. Using a split visual field paradigm we present evidence which, supports the notion of greater right hemisphere processing in a later learned language. Our findings also suggest the pattern of lateralization in bilinguals is strongly affected by the specific language environment during development such that the shift toward greater right hemisphere involvement for the later learned language will be more pronounced in individuals which are brought up in areas where that language is not regularly heard.

Language laterality in English/Welsh bilinguals: Language-acquisitional and language-specific factors in the development of lateralisation

In order to test the hypothesis that monolinguals differ from bilinguals in their pattern of language lateralisation and to examine the relative merits of language-acquisitional versus language-specific factors, two experiments involving divided screen presentation of two languages were conducted using Welsh/English speaking participants. In the first experiment 80 monolingual teenagers were compared to 80 bilingual teenagers on a tachistoscopic "visual half-field" test of Welsh and English nouns and verbs. ANOVA revealed a greater left hemisphere advantage for Welsh-English bilinguals as compared to English monolinguals. Thus, in contrast to previous studies, in our bilinguals there was evidence of greater left hemisphere involvement in the processing of language. In the second experiment, four separate groups of 40 teenagers, varying in the age and manner of acquisition of their languages, were compared on the same test of Welsh and English words. These groups can be viewed as graded from the early to late bilinguals. ANOVA revealed a greater left hemisphere advantage when processing Welsh as compared to English words for all four groups. However no significant difference was observed between the four groups in respect of laterality for Welsh and English, indicating an equally greater left hemisphere bias for all four groups when processing Welsh words. We discuss these results in terms of a language-specific effect and suggest the specific orthography of the Welsh language (for individually presented nouns and verbs) promotes a left hemisphere advantage over and above language-acquisitional factors.

Qualitative analysis of value judgments in interpreting cervicovaginal smears using the Bethesda system

CONTEXT

We hypothesize that there are unrecognized value judgments that influence cytopathologists in interpreting borderline cervicovaginal smears and that these judgments contribute to the well-documented variation among cytopathologists regarding such diagnoses.

OBJECTIVE

To identify and map these values.

DESIGN

Survey consisting of Kodachromes and histories for 5 borderline smears. Respondents were asked to give their diagnoses, recommendations for treatment, and reasoning.

RESULTS

We demonstrated a wide variation in interpretation of borderline smears similar to previous studies. We then used inductive qualitative analysis to identify the clinical reasoning and value judgments that influenced the responses.

CONCLUSIONS

We mapped those diagnostic value judgments that should be used in evaluation borderline cases. We believe this map can be used to rigorously manage and standardize the use of such judgments.

Use of amniotic fluid amino acids in prenatal testing for argininosuccinic aciduria and citrullinaemia

Prenatal testing of 12 pregnancies at risk for argininosuccinic aciduria due to argininosuccinate lyase (ASAL) deficiency and three pregnancies at risk for citrullinaemia due to argininosuccinate synthatase (ASAS) deficiency was performed by metabolite detection in amniotic fluid and measurement of enzyme activity in uncultured and cultured chorionic tissue and in cultured amniocytes. From our data and those of previous studies, amniotic fluid argininosuccinate measurement alone is clearly a reliable and rapid diagnostic test for both severe and mild ASAL deficiency if maternal ASAL deficiency can be excluded. For prenatal diagnosis of ASAS deficiency, however, both measurement of the amniotic fluid citrulline level and enzyme assay should be employed.

Crystallization and preliminary X-ray analysis of an anti-staphylococcal nuclease-staphylococcal nuclease complex and of a second anti-staphylococcal nuclease antibody

The Fab fragments of several monoclonal antibodies that bind Staphylococcal nuclease have been screened for crystallization conditions. Two of these, N10 and N25, have been crystallized in forms suitable for X-ray structural analysis. The anti-Staphylococcal nuclease antibody complex N10 Fab-nuclease crystallizes with symmetry consistent with space group C2 and cell parameters of a = 234.7 A; b = 43.5 A; c = 74.4 A; beta = 106.4 degrees. A second anti-Staphylococcal nuclease antibody, N25, although crystallized starting with the Fab-nuclease complex, apparently crystallizes as uncomplexed N25 Fab with symmetry consistent with space group P3(1)21 (or its enantiomorph P3(2)21) and cell parameters of a = b = 80.9 A; c = 138.4 A.