Efavirenz as a cause of ataxia in children

Acute ataxia in childhood is often caused by toxin ingestion. With the increasing number of paediatric patients on antiretroviral medication,we observe more side-effects of these drugs. Acute ataxia is defined as unsteadiness of walking or fine motor movement of <72 hours. The mostcommon causes are postinfectious acute cerebellar ataxia, toxin ingestion and Guillain-Barré syndrome. However, the possibility of a masslesion must always be excluded.Reported neurological abnormalities in HIV-positive children range from 10% to 68%. A South African study found the prevalenceof neurological complications to be 59%, the most common of which were HIV encephalopathy and long-tract motor signs; however, nocases of cerebellar dysfunction were documented. Ataxia rarely ocurs in an HIV-positive person, the chronic sequelae being neurocognitiveimpairment and polyneuropathy.Ataxia in the setting of HIV is generally secondary to an infectious, vascular or neoplastic cerebellar lesion. However, most infections areopportunistic and unlikely to occur when CD4 levels are adequate. The vascular or mass lesions are readily excluded with neuro-imaging.We report 2 cases of efavirenz toxicity that caused ataxia. We treated 2 children who presented in a 1-month period, which highlighted animportant differential to consider in HIV-positive paediatric patients presenting with ataxia

Efavirenz as a cause of ataxia in children

Acute ataxia in childhood is often caused by toxin ingestion. With the increasing number of paediatric patients on antiretroviral medication, we are seeing more side-effects of these drugs. We report two cases of efavirenz toxicity causing ataxia

Water quality modelling of the Mekong River basin: climate change and socioeconomics drive flow and nutrient flux changes to the Mekong Delta

The Mekong delta is recognised as one of the world's most vulnerable mega-deltas, being subject to a range of environmental pressures including sea level rise, increasing population, and changes in flows and nutrients from its upland catchment. With changing climate and socioeconomics there is a need to assess how the Mekong catchment will be affected in terms of the delivery of water and nutrients into the delta system. Here we apply the Integrated Catchment model (INCA) to the whole Mekong River Basin to simulate flow and water quality, including nitrate, ammonia, total phosphorus and soluble reactive phosphorus. The impacts of climate change on all these variables have been assessed across 24 river reaches ranging from the Himalayas down to the delta in Vietnam. We used the UK Met Office PRECIS regionally coupled climate model to downscale precipitation and temperature to the Mekong catchment. This was accomplished using the Global Circulation Model GFDL-CM to provide the boundary conditions under two carbon control strategies, namely representative concentration pathways (RCP) 4.5 and a RCP 8.5 scenario. The RCP 4.5 scenario represents the carbon strategy required to meet the Paris Accord, which aims to limit peak global temperatures to below a 2 °C rise whilst seeking to pursue options that limit temperature rise to 1.5 °C. The RCP 8.5 scenario is associated with a larger 3–4 °C rise. In addition, we also constructed a range of socio-economic scenarios to investigate the potential impacts of changing population, atmospheric pollution, economic growth and land use change up to the 2050s. Results of INCA simulations indicate increases in mean flows of up to 24%, with flood flows in the monsoon period increasing by up to 27%, but with increasing periods of drought up to 2050. A shift in the timing of the monsoon is also simulated, with a 4 week advance in the onset of monsoon flows on average. Decreases in nitrogen and phosphorus concentrations occur primarily due to flow dilution, but fluxes of these nutrients also increase by 5%, which reflects the changing flow, land use change and population changes

Photographic Validation of Target Versus Nontarget Take of Brown Treesnake Baits

Use of toxic baits or other tools for managing nuisance species must ensure that the species of interest is adequately targeted while exposure to nontarget species is minimized. Nontarget takes of acetaminophen‐laced baits for control of invasive brown treesnakes (Boiga irregularis) on Guam may put those animals at risk of lethal intoxication and render the bait unavailable to the intended target species. We used wildlife cameras to identify species removing toxic and nontoxic baits from brown treesnake bait stations designed to exclude nontarget taxa in 2015 and 2016. Throughout various sites and habitat types, and balanced by season (wet vs. dry), we monitored 512 bait stations. From those, 140 of the baits were taken and the species taking the bait was successfully identified. Brown treesnakes took 124 (88.6%) of the baits, 13 (9.3%) were taken by small coconut crabs (Birgus latro), and 3 (2.1%) were taken by monitor lizards (Varanus indicus). The greatest incidence of nontarget bait takes was by small coconut crabs at 2 adjacent sites atop the same cliff line during a single season; 96.9% of bait takes at all other sites were by brown treesnakes. Bait takes by brown treesnakes were particularly infrequent (2.3%) at sites associated with endangered swiftlet (Aerodramus bartschi) caves where intensive snake control was employed. Although the majority of baits in bait stations are taken by brown treesnakes, local and temporal pulses in nontarget species activity, particularly by crabs, may bias results, which would not be accounted for without supplemental validation by cameras