Risks of infections among HIV exposed infants during the first 18 months of life in Western Kenya

BACKGROUNDInfants exposed to HIV are more vulnerable to infections compared to those not HIV exposed. The occurrence and risks of infections among these infants are less understood. High maternal viral load can result in advanced disease, low maternal survival rates and puts the infant at higher risk of having early T- cell abnormality [24]. AIMThis study aimed at characterizing the infections among HIV Exposed Infants (HEI) and establishing the risk factors associated with infections for interventions that will improve their health outcomes. METHODOLOGYA cohort study was conducted using records of HEI enrolled at the PMTCT program in Kisumu County Referral Hospital (KCRH) in western Kenya, between January 2015 and December 2017. Using a simple random sampling technique, 260 records were obtained and a structured checklist resembling HEI follow-up cards was developed for quality assurance in data abstraction. Targeting those who had completed the 18 months follow-up, died or confirmed HIV positive during the process. Excluded were transfers, loss to follow-up and infants who had incomplete records. Data entry was done using Microsoft Excel then exported to SPSS version 20 for data analysis. RESULTSA total of 46 infants reported different infections with an incidence rate of 17.3 new cases per 100 persons. Respiratory tract infections were the leading cause of infections contributing to 34.6% (18) of the infections. Other infections were malaria 17.4% (9), gastroenteritis 8 15.4% (8), oral thrush 11.5% (6), measles 9.6% (5), UTIs 5.8% (3). The risks to infections were high maternal viral load (OR 8.20 CI 3.32-20.25, p≤ 0.001), incomplete Co-trimoxazole prophylaxis (OR 2.23 CI 0.91- 5.50, p≤0.050) and mixed feeding (OR 2.59 CI 1.05 -6.36, p≤0.040). High burden of gastroenteritis peaking at around the 7 th month of the 18 month was recorded. CONCLUSIONHigh maternal viral load, incomplete Co-trimoxazole prophylaxis dosage and mixed feeding are a risk to infections among HEI. These findings provide critical information for health promotion and improvement of PMTCT interventions. Lifespan approach in understanding and protecting these infants from risks and infections, pneumonia in particular is crucial. RECOMENDATIONSHome delivery and breastfeeding for only 1 year compared to the recommended breastfeeding duration of 2 years should be discouraged. Future studies be conducted in multiple sites involving HIV infant comparator to enrich the findings

THE VAXED PROJECT: An Assessment of Immunization Education in Canadian Health Professional Programs

<p>Abstract</p> <p>Background</p> <p>Knowledge & attitudes of healthcare providers (HCP) have significant impact on frequency with which vaccines are offered & accepted but many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can be integrated into formal education curricula.</p> <p>Methods</p> <p>(i) A questionnaire was sent to all Canadian nursing, medical & pharmacy schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to final-year students in medicine, nursing, & pharmacy at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum.</p> <p>Results</p> <p>The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Time spent on immunization content varied substantially between & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but there was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during training.</p> <p>Conclusions</p> <p>Important gaps were identified in the knowledge of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & safety. The national curriculum review revealed wide variability in immunization curriculum content & evaluation. There is clearly a need for educators to assess current curricula and adapt existing educational resources such as the Immunization Competencies for Health Professionals in Canada.</p

Homocysteine, vitamin B12, and folic acid levels in Alzheimer\u27s disease, mild cognitive impairment, and healthy elderly: Baseline characteristics in subjects of the Australian Imaging Biomarker Lifestyle study

There is some debate regarding the differing levels of plasma homocysteine, vitamin B12 and serum folate between healthy controls (HC), mild cognitive impairment (MCI), and Alzheimer\u27s disease (AD). As part of the Australian Imaging Biomarker Lifestyle (AIBL) study of aging cohort, consisting of 1,112 participants (768 HC, 133 MCI patients, and 211 AD patients), plasma homocysteine, vitamin B12, and serum and red cell folate were measured at baseline to investigate their levels, their inter-associations, and their relationships with cognition. The results of this cross-sectional study showed that homocysteine levels were increased in female AD patients compared to female HC subjects (+16%, p-value \u3c 0.001), but not in males. Red cell folate, but not serum folate, was decreased in AD patients compared to HC (−10%, p-value = 0.004). Composite z-scores of short- and long-term episodic memory, total episodic memory, and global cognition all showed significant negative correlations with homocysteine, in all clinical categories. Increasing red cell folate had a U-shaped association with homocysteine, so that high red cell folate levels were associated with worse long-term episodic memory, total episodic memory, and global cognition. These findings underscore the association of plasma homocysteine with cognitive deterioration, although not unique to AD, and identified an unexpected abnormality of red cell folate

Use of dual section mRNA in situ hybridization/immunohistochemistry to clarify gene expression patterns during the early stages of nephron development in the embryo and in the mature nephron of the adult mouse kidney

The kidney is the most complex organ within the urogenital system. The adult mouse kidney contains in excess of 8,000 mature nephrons, each of which can be subdivided into a renal corpuscle and 14 distinct tubular segments. The histological complexity of this organ can make the clarification of the site of gene expression by in situ hybridisation difficult