A case of outflow obstruction of a peritoneal dialysis catheter in a 12-year-old boy is presented. The cause of obstruction was identified and remedied by laparoscopic means. Laparoscopy has important diagnostic and therapeutic roles in the evaluation of malfunctioning peritoneal dialysis catheters.
The Philippines, a country with a young population, is currently experiencing an intense and persistent tuberculosis epidemic. We analysed patient-based national surveillance data to investigate the epidemiology of reported tuberculosis among children (aged 0-9 years), adolescents (aged 10-19 years) and young adults (aged 20-24 years) to better understand the burden of disease and treatment outcomes in these age groups. Descriptive analyses were performed to assess age-related patterns in notifications and treatment outcomes. Data quality was assessed against international benchmarks at the national and regional levels. Overall, 27.3% of tuberculosis notifications for the Philippines in 2015 pertained to children, adolescents and young adults aged 0-24 years. Treatment outcomes were generally favourable, with 81% of patients being cured or completing treatment. The data quality assessment revealed substantial regional variation in some indicators and suggested potential underdetection of tuberculosis in children aged 0-4 years. Children, adolescents and young adults in the Philippines constitute a substantial proportion of patients in the national tuberculosis surveillance data set. Long-term progress against tuberculosis in the Philippines relies on improving the control of tuberculosis in these key age groups.
The diagnosis and management of human immunodeficiency virus (HIV) infected infants and children who do not respond to recommended empiric therapy for acute or chronic pneumonia is a frequent clinical challenge, especially as the greatest burden of childhood HIV-related lung disease occurs in low-income regions where options for investigation and treatment are limited. Lung disease is due to a wider spectrum of causes in HIV-infected than non-infected children. Bacterial pneumonia, viral pneumonia and pulmonary tuberculosis (TB) are common in children throughout the developing world, and the added impact of HIV infection on the incidence and outcome of these diseases is covered in companion articles. This review focuses on lung diseases that are more specifically HIV-related. Pneumocystis jirovecii pneumonia (PJP) is a major cause of pneumonia and death in HIV-infected infants, especially in regions where maternal HIV status is often not known and the provision of PJP prophylaxis for HIV-exposed infants is unusual. Cytomegalovirus is commonly found in the lungs of HIV-infected infants, with implications for the use of corticosteroids for PJP. Lymphoid interstitial pneumonitis, a common cause of persistent respiratory symptoms in HIV-infected children, must be differentiated from pulmonary or miliary TB. The incidence of uncommon causes such as fungal pneumonia or HIV-related pulmonary malignancy varies among regions. The burden of lung disease due to opportunistic infections would be significantly reduced by more widely applying available measures that reduce mother-to-child HIV transmission, by providing cotrimoxazole prophylaxis for HIV-exposed infants, and by increasing the availability of antiretroviral therapy.
Introduction Children and adolescents with HIV (CAHIV) may experience recurrent and severe respiratory disease and are at risk of residual lung sequelae, and long-term morbidity from chronically damaged lungs. With improved survival due to increased access to effective antiretroviral therapy there is an increasing population of CAHIV who require optimal life-long care. Chronic lung disease in CAHIV is an under-recognised problem in African settings. We sought to determine the prevalence, clinical presentation and factors associated with chronic lung disease (CLD) among CAHIV in Kenya. Methods CAHIV aged ≤19 years in care at a public hospital in Nairobi were enrolled into a longitudinal cohort study. Sociodemographic and clinical information were obtained through interview, medical record review, physical examination and six-minute walk test. CD4 counts and viral load were determined. Enrolment data was analysed to determine baseline sociodemographic and clinical characteristics. Prevalence of CLD defined as presence of ≥2 respiratory symptoms or signs at enrolment was computed. Logistic regression analysis was performed to evaluate for association between various factors and presence or absence of CLD. Results We enrolled 320 CAHIV of median age 13 (IQR 10–16) years, 80 (25%) were <10 years, 46% were female, 31% lived in a one-room house and 51% used polluting cooking fuel. Antiretroviral therapy (ART) was initiated after age five years in 56%, 43% had prior pneumonia or tuberculosis, 11% had low CD4 count and 79% were virologically suppressed. Common respiratory symptoms and signs were exertional breathlessness (40%), chronic cough (23%), chest problems in the preceding year (24%), tachypnoea (52%), finger clubbing (6%), exercise limitation (59%) and oxygen desaturation during exercise (7%). CLD was present in 82 (26%) participants, and adding the six-minute walk distance <70% of predicted (exercise limitation) identified an additional 28 (9%) CAHIV with CLD. CLD was more common among older teenagers (odds ratio (OR) 1.95), those who had prior TB or pneumonia (OR 2.04), delayed initiation of ART (OR 2.60), cotrimoxazole prophylaxis (OR 3.35) or TB preventive therapy (OR 2.81). CLD was associated with viraemia (OR 2.7), lower quality of life (OR 12.7), small houses (OR 2.05), caregiver having fewer years of education (OR 2.46), outdoor pollution exposure (OR 3.31) and lower use of polluting cooking fuel indoors (OR 0.26). Adjusted analysis revealed CLD to be associated with prior tuberculosis or pneumonia (adjusted OR (aOR) [95%CI] 2.15 [1.18–3.91]), small house (aOR 1.95 [1.02–3.73]), lower use of polluting cooking fuel (aOR 0.35 [0.13–0.94]) and negative impact on health-related quality of life (aOR 6.91 [3.66–13.03]). Conclusions CLD is highly prevalent across the age spectrum of CAHIV, and most are symptomatic with cough or exertional breathlessness. CLD is associated with prior tuberculosis or pneumonia, socio-environmental factors, and lower quality of life. Structured interventions are needed to provide optimal care specific to their needs.
SummaryThree recent cases of chloramphenicol-resistant pyogenic meningitis are reported from Malawi. The implications of the emergence of antibiotic-resistant strains of Streptococcus pneumoniae and Haemophilus influenzae type b causing childhood meningitis are discussed.
Objective To evaluate the pneumonia specific case fatality rate over time following the implementation of a Child Lung Health Programme (CLHP) within the existing government health services in Malawi to improve delivery of pneumonia case management. Methods A prospective, nationwide public health intervention was studied to evaluate the impact on pneumonia specific case fatality rate (CFR) in infants and young children (0 to 59 months of age) following the implementation of the CLHP. The implementation was step-wise from October 1st 2000 until 31st December 2005 within paediatric inpatient wards in 24 of 25 district hospitals in Malawi. Data analysis compared recorded outcomes in the first three months of the intervention (the control period) to the period after that, looking at trend over time and variation by calendar month, age group, severity of disease and region of the country. The analysis was repeated standardizing the follow-up period by using only the first 15 months after implementation at each district hospital. Findings Following implementation, 47,228 children were admitted to hospital for severe/very severe pneumonia with an overall CFR of 9•8%. In both analyses, the highest CFR was in the children 2 to 11 months, and those with very severe pneumonia. The majority (64%) of cases, 2–59 months, had severe pneumonia. In this group there was a significant effect of the intervention Odds Ratio (OR) 0•70 (95%CI: 0•50–0•98); p = 0•036), while in the same age group children treated for very severe pneumonia there was no interventional benefit (OR 0•97 (95%CI: 0•72–1•30); p = 0•8). No benefit was observed for neonates (OR 0•83 (95%CI: 0•56–1•22); p = 0•335). Conclusions The nationwide implementation of the CLHP significantly reduced CFR in Malawian infants and children (2–59 months) treated for severe pneumonia. Reasons for the lack of benefit for neonates, infants and children with very severe pneumonia requires further research.
This is the start of my sixth year as editor of Exceptional Children. It takes many people to run a journal successfully, and I would like to take a moment to recognize some folks who make my job as editor much easier. First, I would like to thank my assistant, Xiaolun Qi, who has done an incredible job of keeping everything on time and running smoothly during the past several years. I would also like to extend a special thanks to Meridee Mucciarone at the Council for Exceptional Children (CEC). Once we have accepted a manuscript and sent it to CEC, she takes over, moving the manuscript through a process of in-house editing to eventual publication. I would further like to thank the other members of the editorial team--Donna Ford, Joan Lieber, and Margaret McLaughlin. Finally, we could not do this job without the excellent help of all of the members of the editorial board, the guest reviewers who generously lend their expertise to evaluating submitted manuscripts (their names and affiliations are listed at the end of this report), and all of you who have submitted papers to the journal over the years. I would like to remind everyone that you can nominate yourself as a guest reviewer by simply contacting me via e-mail (steve.graham@ vanderbilt.edu). Please send me a copy of your vita and in the text of the e-mail indicate your areas of expertise. We try to call on everyone who volunteers. Also, please note that a doctoral student can do a review in conjunction with a university or college faculty member. We would like to increase the number of doctoral students who participate in this process. Thus, if you are a field reviewer or a guest reviewer, encourage a doctoral student to do a separate review with you. You can initiate this process by sending me an e-mail when you receive a manuscript to review. Although this report to the readership is published in the fall (the start of the 75th volume), I must complete it about one month before the 74th volume year is completed. During the first 11 months of the current volume year, we received 106 new submissions. Projecting forward to a full 12 months, we should receive 116 submissions for the year. This is about a 22% increase in manuscript submissions from the previous volume year. It must be noted that we evidenced declines in the number of submissions during the past several years. Consequently, I am very pleased that the number of submissions is on the upswing again. A notable event for the journal during Volume 74 was the publication of a special issue, edited by Donna Ford, entitled Culturally Diverse Exceptional Students: Remembering the Past, Looking Toward the Future. Collectively, these peer-reviewed papers make an incredible contribution to our understanding of where we have been, where we are, and where we must go in working with diverse students and their families. …
'%3e%3ccircle r='20' fill='%23008'/%3e%3ccircle r='17.5' fill='%23fff'/%3e%3ccircle r='3.5' fill='%23008'/%3e%3cg id='d'%3e%3cg id='c'%3e%3cg id='b'%3e%3cg id='a' fill='%23008'%3e%3ccircle r='.875' transform='rotate(7.5 -8.75 133.5)'/%3e%3cpath d='M0 17.5.6 7 0 2l-.6 5L0 17.5z'/%3e%3c/g%3e%3cuse xlink:href='%23a' transform='rotate(15)'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(30)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(60)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(120)'/%3e%3cuse xlink:href='%23d' transform='rotate(-120)'/%3e%3c/g%3e%3c/svg%3e)
'/%3e%3c/g%3e%3cuse xlink:href='%23b' transform='rotate(10)'/%3e%3c/g%3e%3cuse xlink:href='%23c' transform='rotate(20)'/%3e%3c/g%3e%3cuse xlink:href='%23d' transform='rotate(40)'/%3e%3c/g%3e%3cuse xlink:href='%23e' transform='rotate(-80)'/%3e%3c/g%3e%3cpath d='M-225-21.5h450v7.5h-450z'/%3e%3cpath fill='%23339E35' d='M-225 86h450v100h-450z'/%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)