Outcome of HIV-exposed uninfected children undergoing surgery

<p>Abstract</p> <p>Background</p> <p>HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure.</p> <p>Methods</p> <p>A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality.</p> <p>Results</p> <p>Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.</p> <p>The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06).</p> <p>Conclusion</p> <p>HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.</p

South African burn society burn stabilisation protocol

ArticleThe original publication is available at http://www.samj.org.zaENGLISH SUMMARY : No abstract available.Publisher’s versio

South African Burn Society burn stabilisation protocol

Minimal criteria for transfer to a burn centre (Modified from the Australian and New Zealand Burn Association (ANZBA) protocol) Burn injury patients who should be referred to a burn unit include the following: • All burn patients less than 1 year of age • All burn patients from 1 - 2 years of age with burns > 5% total body surface area (TBSA) • Patients in any age group with third-degree burns of any size • Patients older than 2 years with partial-thickness burns greater than 10% TBSA • Patients with burns of special areas – face, hands, feet, genitalia, perineum or major joints • Patients with electrical burns, including lightning burns • Chemical burn patients • Patients with inhalation injury resulting from fire or scald burns • Patients with circumferential burns of the limbs or chest • Burn injury patients with pre-existing medical disorders that could complicate management, prolong recovery or affect mortality • Any patient with burns and concomitant trauma • Paediatric burn cases where child abuse is suspected • Burn patients with treatment requirements exceeding the capabilities of the referring centre • Septic burn wound cases

The psychosocial experiences and needs of children undergoing surgery and their parents: a systematic review

Introduction:Surgery in children can be difficult for patients and parents. We aimed to summarize pediatric patients' and parents' psychosocial experiences and needs in surgery.Method:We used the Ovid search engine and screened 877 abstracts across three databases to extract data on pediatric patients' and parents' surgical experiences.Results:Our search yielded 11 eligible studies representing 1,307 children undergoing surgery and their parents. Children's adverse experiences included psychological and behavioral changes before, during, and after surgery (e.g., anxiety, eating disturbances). Parents commonly experienced psychological distress. Children's needs related to medical and health care services, whereas parents had high information needs.Discussion:Children's adverse experiences can negatively affect medical outcomes. Children's experiences are inextricably linked to their parents' and can become negatively affected by their parents' adverse experiences. Patients and parents with previous hospitalizations and surgeries had worse surgical experiences, highlighting further research in the context of chronic illness

Pediatric surgery for childhood cancer: Lasting experiences and needs of children and parents

Objective: surgery for pediatric cancer presents many stresses on patients and families. The authors aimed to understand the long-term impact of childhood cancer surgery on survivors and parents.Methods: the study recruited participants from 11 Australia/New Zealand hospitals for telephone interviews. The authors used descriptive statistics to analyse participants’ quantitative distress ratings and conducted thematic analysis of shared surgical experiences and needs.Results: of 32 participants (n=17 survivors, n=15 parents), survivors’ mean age at surgery was 6.9 (SD=5.17) and parents’ children were 2.1 years old (SD=1.41) at time of surgery. Survivors had surgery on average 15.2 years ago (SD=6.72) and parents’ children 11.5 years ago (SD=3.94). Parents and survivors rated surgery as highly distressing. Preoperatively, survivors recalled experiencing fear and pain mainly associated with preoperative procedures. Postoperatively, survivors reported immobility and some lasting behavioral disturbances. Parents described pre- and intraoperative anxiety and stress and some lasting postoperative psychological disturbances. Experiences appeared toimprove with clear/consistent communication from hospital staff, proximity to hospital, and with support for parents and children postoperatively.Conclusions: surgical treatment for childhood cancer can have a lasting impact for survivors and parents. Better information provision may improve families’ surgical experience whilst reducing anxiety, distress and physical discomfort

From Pediatric to Adult Brain Cancer: Exploring Histone H3 Mutations in Australian Brain Cancer Patients

Genetic histone variants have been implicated in cancer development and progression. Mutations affecting the histone 3 (H3) family, H3.1 (encoded by HIST1H3B and HIST1H3C) and H3.3 (encoded by H3F3A), are mainly associated with pediatric brain cancers. While considered poor prognostic brain cancer biomarkers in children, more recent studies have reported H3 alterations in adult brain cancer as well. Here, we established reliable droplet digital PCR based assays to detect three histone mutations (H3.3-K27M, H3.3-G34R, and H3.1-K27M) primarily linked to childhood brain cancer. We demonstrate the utility of our assays for sensitively detecting these mutations in cell-free DNA released from cultured diffuse intrinsic pontine glioma (DIPG) cells and in the cerebral spinal fluid of a pediatric patient with DIPG. We further screened tumor tissue DNA from 89 adult patients with glioma and 1 with diffuse hemispheric glioma from Southwestern Sydney, Australia, an ethnically diverse region, for these three mutations. No histone mutations were detected in adult glioma tissue, while H3.3-G34R presence was confirmed in the diffuse hemispheric glioma patient