Neurodevelopmental Outcomes Following Severe Hand Foot and Mouth Disease in Vietnam

In 2011, more than 160 children died in an unprecedented outbreak of Hand foot and mouth disease (HFMD) in Vietnam, predominantly associated with enterovirus 71 (EV-A71). The occurrence of encephalitis outbreaks in children at vulnerable developmental stages raised concerns of long-term consequences. Limited retrospective outcome studies in the literature lack either a healthy comparison group or a locally validated neurodevelopmental assessment tool. Brain MRI retrospective observations identified stereotypical patterns of brainstem lesions predominantly in severe EV-A71 HFMD cases with conflicting opinions on the prognostic role of MRI. I adapted the “Bayley Scales of Infant and Toddler Development (3rd edition)” for Vietnam and demonstrated that the adaptation was reliable and valid. I conducted a prospective observational cohort study to test the hypothesis that children with severe HFMD, graded per Vietnam Ministry of Health classification, would have lower cognitive, language and motor Z scores than a healthy comparison group. All HFMD cases had virological samples taken and a sample of severe HFMD cases had brain MRI scans. All Z score 95% confidence intervals were within 2 standard deviations of the comparative healthy cohort mean suggesting outcomes at six months were not significantly lower than the healthy comparative group. I identified novel nonspecific brain white matter abnormalities on MRI in all severity grades, lower motor Z scores in grade 2b children with MRI abnormalities and that Coxsackievirus A10 (CV-A10) was significantly associated with MRI abnormalities. These findings support surveillance of all enteroviruses during HFMD outbreaks and suggest MRI may be predictive of motor impairment in a subset of severe HFMD cases. No significant impairment was identified at six months follow-up, but more complex developmental skills are yet to emerge. Hence the study continues for an eighteen-month follow up to robustly determine emergence of long-term sequelae

The Use of Self-Management Procedures to Increase on Task Behavior of Three Children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a complex neurological disorder that affects 1 in 68 individuals (Centre for Disease Control and Prevention, 2014). Autism is characterized as deficits in social skills, verbal and non-verbal communication, and challenging behaviors. The number of participants with autism in a general education classroom has increased. Self-Management is an easy way to increase on-task behavior in classrooms. The purpose of this study was to increase the on-task behavior of three participants in Transition Support Services (TSS) using a self-management package and to generalize the skill to at least one other setting (i.e., inclusion classroom, IBI classroom or community). Data were collected using 10 seconds momentary time sampling for 5 minutes. A multiple baseline design across participants was used to evaluate the effectiveness of the self-management treatment package. The intervention was conducted during homework time in the participant’s home. The results of the study showed increase in on-task behavior for all three participants

What can eye-tracking tell us?

Background: Early development of neurocognitive functions in infants can be compromised by poverty, malnutrition and lack of adequate stimulation. Optimal management of neurodevelopmental problems in infants requires assessment tools that can be used early in life, and are objective and applicable across economic, cultural and educational settings. Objective and design: The present study examined the feasibility of infrared eye tracking as a novel and highly automated technique for assessing visual-orienting and sequence-learning abilities as well as attention to facial expressions in young (9-month-old) infants. Techniques piloted in a high-resource laboratory setting in Finland (N=39) were subsequently field-tested in a community health centre in rural Malawi (N=40). Results: Parents' perception of the acceptability of the method (Finland 95%, Malawi 92%) and percentages of infants completing the whole eye-tracking test (Finland 95%, Malawi 90%) were high, and percentages of valid test trials (Finland 69-85%, Malawi 68-73%) satisfactory at both sites. Test completion rates were slightly higher for eye tracking (90%) than traditional observational tests (87%) in Malawi. The predicted response pattern indicative of specific cognitive function was replicated in Malawi, but Malawian infants exhibited lower response rates and slower processing speed across tasks. Conclusions: High test completion rates and the replication of the predicted test patterns in a novel environment in Malawi support the feasibility of eye tracking as a technique for assessing infant development in low-resource setting. Further research is needed to the test-retest stability and predictive validity of the eye-tracking scores in low-income settings

Quantitative elasticity measurement of urinary bladder wall using laser-induced surface acoustic waves

The maintenance of urinary bladder elasticity is essential to its functions, including the storage and voiding phases of the micturition cycle. The bladder stiffness can be changed by various pathophysiological conditions. Quantitative measurement of bladder elasticity is an essential step toward understanding various urinary bladder disease processes and improving patient care. As a nondestructive, and noncontact method, laser-induced surface acoustic waves (SAWs) can accurately characterize the elastic properties of different layers of organs such as the urinary bladder. This initial investigation evaluates the feasibility of a noncontact, all-optical method of generating and measuring the elasticity of the urinary bladder. Quantitative elasticity measurements of ex vivo porcine urinary bladder were made using the laser-induced SAW technique. A pulsed laser was used to excite SAWs that propagated on the bladder wall surface. A dedicated phase-sensitive optical coherence tomography (PhS-OCT) system remotely recorded the SAWs, from which the elasticity properties of different layers of the bladder were estimated. During the experiments, series of measurements were performed under five precisely controlled bladder volumes using water to estimate changes in the elasticity in relation to various urinary bladder contents. The results, validated by optical coherence elastography, show that the laser-induced SAW technique combined with PhS-OCT can be a feasible method of quantitative estimation of biomechanical properties

Social Identity Complexity Theory: Attitudes Towards Diversity and Its Relationship with Nationalism, Religiosity, and Aggression

In this study we tested social identity complexity theory (Roccas & Brewer, 2002) in relation to attitudes towards diversity and the associated variables of nationalism, religiosity, and aggression in a cross-cultural study of 397 Malaysian and 240 Australian students. Australians reported higher positive attitudes towards diversity than Malaysians. Diversity was positively associated with nationalism, religiosity, and aggression in Malaysians. Traditional nationalism was negatively associated with diversity in Australians. These results support social identity complexity theory and partially support associated predictions for Australian, while contradicting predictions for Malaysians

Treatment Strategies for Central Nervous System Effects in Primary and Secondary Haemophagocytic Lymphohistiocytosis in Children

Purpose of Review: This review presents an appraisal of current therapeutic options for the treatment of central nervous system haemophagocytic lymphohistiocytosis (CNS-HLH) in the context of systemic disease, as well as when CNS features occur in isolation. We present the reader with a diagnostic approach to CNS-HLH and commonly used treatment protocols. We discuss and evaluate newer treatments on the horizon. Recent Findings: Mortality is high in patients who do not undergo HSCT, and while larger studies are required to establish benefit in many treatments, a number of new treatments are currently being evaluated. Alemtuzumab is being used as a first-line treatment for CNS-HLH in a phase I/II multicentre prospective clinical trial as an alternative to traditional HLH-1994 and 2004 protocols. It has also been used successfully as a second-line agent for the treatment of isolated CNS-HLH that is refractory to standard treatment. Ruxolitinib and emapalumab are new immunotherapies that block the Janus kinase—Signal Transducer and Activator of Transcription (JAK-STAT) pathway that have shown efficacy in refractory HLH, including for CNS-HLH disease. Summary: Treatment of CNS-HLH often requires HLH-94 or 2004 protocols followed by haematopoietic stem cell transplantation (HSCT) to maintain remission, although relapse can occur, particularly with reduced intensity conditioning if donor chimerism falls. CNS features have been shown to improve or stabilise following HSCT in CNS-HLH in the context of systemic disease and in isolated CNS-HLH. Encouraging reports of early cohort studies suggest alemtuzumab and the Janus kinase (JAK) inhibitor ruxolitinib offer potential salvage therapy for relapsed and refractory CNS-HLH. Newer immunotherapies such as tocilizumab and natalizumab have been shown to be beneficial in sporadic cases. CNS-HLH due to primary gene defects may be amenable to gene therapy in the future

Nocardia – Opportunistic chest infection in elderly: A case report

In this rare case a non-immunocompromised patient with old Tuberculosis on low dose of steroids presents with opportunistic infection of a weakly aerobic gram positive acid fast, filamentous bacteria called Nocardia

Can touch screen tablets be used to assess cognitive and motor skills in early years primary school children? A cross-cultural study

Assessment of cognitive and motor functions is fundamental for developmental and neuropsychological profiling. Assessments are usually conducted on an individual basis, with a trained examiner, using standardized paper and pencil tests, and can take up to an hour or more to complete, depending on the nature of the test. This makes traditional standardized assessments of child development largely unsuitable for use in low-income countries. Touch screen tablets afford the opportunity to assess cognitive functions in groups of participants, with untrained administrators, with precision recording of responses, thus automating the assessment process. In turn, this enables cognitive profiling to be conducted in contexts where access to qualified examiners and standardized assessments are rarely available. As such, touch screen assessments could provide a means of assessing child development in both low- and high-income countries, which would afford cross-cultural comparisons to be made with the same assessment tool. However, before touch screen tablet assessments can be used for cognitive profiling in low-to-high-income countries they need to be shown to provide reliable and valid measures of performance. We report the development of a new touch screen tablet assessment of basic cognitive and motor functions for use with early years primary school children in low- and high-income countries. Measures of spatial intelligence, visual attention, short-term memory, working memory, manual processing speed, and manual coordination are included as well as mathematical knowledge. To investigate if this new touch screen assessment tool can be used for cross-cultural comparisons we administered it to a sample of children (N = 283) spanning standards 1–3 in a low-income country, Malawi, and a smaller sample of children (N = 70) from first year of formal schooling from a high-income country, the UK. Split-half reliability, test-retest reliability, face validity, convergent construct validity, predictive criterion validity, and concurrent criterion validity were investigated. Results demonstrate “proof of concept” that touch screen tablet technology can provide reliable and valid psychometric measures of performance in the early years, highlighting its potential to be used in cross-cultural comparisons and research

Neurodevelopment at 2 years corrected age among Vietnamese preterm infants

Background Preterm infants are at risk of neurodevelopmental delay, but data on long-term outcomes in low-income and middle-income countries remain scarce. Objectives To examine neurodevelopment using Bayley Scales of Infant and Toddler Development-3rd edition (Bayley-III) and neurological findings in 2-year-old preterm infants, and to compare with healthy Vietnamese infants. Further, to assess factors associated with neurodevelopmental impairment. Design and setting Cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children’s hospital in Vietnam. Participants Infants born at <37 weeks of gestational age. Main outcomes Bayley-III assessment and neurological examination at 2-year corrected age (CA) compared with healthy Vietnamese infants. Results Of 294 NICU preterm infants, Bayley-III scores of all 184/243 (76%) survivors at 2 years CA were significantly lower than those of healthy Vietnamese peers in all three domains: cognition (mean (SD): 84.5 (8.6) vs 91.4 (7.5), p<0.001), language (mean (SD): 88.7 (12.5) vs 95.9 (11.9), p<0.001) and motor (mean (SD): 93.1 (9.0) vs 96.8 (9.3), p=0.003). The mean differences in Bayley-III scores between preterm and healthy Vietnamese infants were −6.9 (−9.1 to −4.7), −7.2 (−10.5 to −3.8) and −3.7 (−6.1 to −1.2) for cognitive, language and motor scores, respectively. The prevalence of neurodevelopmental impairment was 17% for cognitive, 8% for language and 4% for motor performance. In total, 7% were diagnosed with cerebral palsy. Higher maternal education was positively associated with infant neurodevelopment (OR 0.32, 95% CI 0.11 to 0.94). Conclusions Vietnamese preterm infants in need of neonatal intensive care showed poor neurodevelopment at 2 years. Higher maternal education was positively associated with infant neurodevelopment. Standard follow-up programmes for preterm infants should be considered in low-resource settings