Successful Handling of Disseminated BCG Disease in a Child with Severe Combined Immunodeficiency

In high-burden countries, Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccine is administered in newborn to prevent severe Mycobacterium tuberculosis infection. Because life-threatening disseminated BCG disease may occur in children with primary immunodeficiency, vaccination strategy against tuberculosis should be redefined in non-high-burden countries. We report the case of a patient with X-linked severe combined immunodeficiency (SCID) who developed disseminated BCG disease, highlighting the specific strategies adopted.

Kerion Caused by Microsporum Audouinii in a Child

Kerion celsi is rarely associated with Microsporum audouinii infection. We report the case of a 3-year-old girl with a kerion celsi caused by M. audouinii and successfully treated with oral terbinafine. Fungi identification was made by macro and microscopical colony morphology analyses and molecular (genotypic) studies.

Validating Regulatory Sensory Processing Disorders Using the Sensory Profile and Child Behavior Checklist (CBCL 1 –5)

The objective was to validate Regulatory Sensory Processing Disorders’ criteria (DC:0-3R, 2005) using empirical data on the presence and severity of sensory modulation deficits and specific psychiatric symptoms in clinical samples. Sixty toddlers who attended a child mental health unit were diagnosed by a clinical team. The following two groups were created: toddlers with RSPD(N = 14) and those with ‘‘other diagnoses in Axis I/II of the DC:0-3R00(OD3R) (N = 46). Independently of the clinical process, parents completed the Infant Toddler Sensory Profile (as a checklist for sensory symptoms) and the Achenbach Behavior Checklist for ages 1/2–5 (CBCL 1/2–5). The scores from the two groups were compared. The results showed the following for the RSPD group: a higher number of affected sensory areas and patterns than in the OD3R group; a higher percentage of sensory deficits in specific sensory categories; and a higher severity of behavioral symptoms such as withdrawal, inattention, other externalizing problems and pervasive developmental problems in CBCL 1/2–5. The results confirmed our hypotheses by indicating a higher severity of sensory symptoms and identifying specific behavioral problems in children with RSPD. The results revealed convergent validity between the instruments and the diagnostic criteria for RSPD and supported the validity of RSPD as a unique diagnosis. The findings also suggested the importance of identifying sensory modulation deficits in order to develop an early intervention to enhance the sensory capacities of children who do not fully satisfy the criteria for some DSM-IV-TR disorders.

Child with Choledochal Cyst Presenting with Episodes of Vomitting and Jaundice

A 2 year old girl presented to the emergency department with frequent episodes of vomiting and jaundice. Analytically, there was leucocytosis with normal neutrophil count, RCP of 5, 66 mg/dL and GGT 87 U/L. Colluria was also found.

Hereditary Neuropathy with Liability to Pressure Palsy Presenting with Hand Drop in a Young Child

Hereditary neuropathy with liability to pressure palsy (HNPP) results from the deletion of the PMP22 gene in chromosome 17p11.2. Clinically, it presents with painless pressure palsies, typically in the 2nd and 3rd decades of life, being a rare entity in childhood. We present the case study of a six-year-old male child who presented with left hand drop that he kept for over four weeks. Electrophysiological studies suggested HNPP and genetic studies confirmed it. With this paper, we pretend to create awareness to this entity as a diagnosis to be considered in a child with painless monoparesis and to emphasize the importance of electrophysiological studies in the diagnosis.

Methadone Intoxication in a Child: Toxic Encephalopathy?

Methadone is used in the treatment of opioid addiction. Acute intoxication can lead to severe consequences and can even be lethal. In several case reports and small series, a presumably toxic leukoencephalopathy is described resulting from inhalation of heroin. We present the case of a 3-year-old boy who ingested methadone accidentally. In a coma with acute obstructive hydrocephalus owing to massive cerebellar edema and supratentorial lesions, he was successfully treated with methylprednisolone and cerebrospinal fluid external drainage. To our knowledge, this is the first report of an encephalopathy associated with synthetic opioid intoxication.

The Management of the Allergic Child at School: EAACI/GA2LEN Task Force on the Allergic Child at School

Allergy affects at least one-quarter of European schoolchildren, it reduces quality of life and may impair school performance; there is a risk of severe reactions and, in rare cases, death. Allergy is a multi-system disorder, and children often have several co-existing diseases, i.e. allergic rhinitis, asthma, eczema and food allergy. Severe food allergy reactions may occur for the first time at school, and overall 20% of food allergy reactions occur in schools. Up to two-thirds of schools have at least one child at risk of anaphylaxis but many are poorly prepared. A cooperative partnership between doctors, community and school nurses, school staff, parents and the child is necessary to ensure allergic children are protected. Schools and doctors should adopt a comprehensive approach to allergy training, ensuring that all staff can prevent, recognize and initiate treatment of allergic reactions.

Reduction of spleen size in a child with Hyperreactive Malarious Splenomegaly (HMS) treated outside the Brazilian endemic area of malaria with only one course of quinine

We report the clinical picture, treatment and evolution of a child with hyperreactive malarious splenomegaly treated outside the endemic area of malaria. The patient presented gross splenomegaly, proceeded from an area where malaria is endemic, showed increased immunoglobulins levels, high antimalarial antibody titres and hepatic sinusoidal lymphocytosis. The child did not return to an area where malaria is endemic and showed a favorable response to only one course of quinine. The response of this patient to limited antimalarial therapy suggests the importance of reinfection with malaria in the development and maintenance of this syndrome.

Molecular evidence of mother-to-child transmission of HTLV-IIc in the Kararao Village (Kayapo) in the Amazon Region of Brazil

Blood samples from native Indians in the Kararao village (Kayapo), were analysed using serological and molecular methods to characterize infection and analyse transmission of HTLV-II. Specific reactivity was observed in 3/26 individuals, of which two samples were from a mother and child. RFLP analysis of the pX and env regions confirmed HTLV-II infection. Nucleotide sequence of the 5' LTR segment and phylogenetic analysis showed a high similarity (98%) between the three samples and prototype HTLV-IIa (Mot), and confirmed the occurrence of the HTLV-IIc subtype. There was a high genetic similarity (99.9%) between the mother and child samples and the only difference was a deletion of two nucleotides (TC) in the mother sequence. Previous epidemiological studies among native Indians from Brazil have provided evidence of intrafamilial and vertical transmission of HTLV-IIc. The present study now provides molecular evidence of mother-to-child transmission of HTLV-IIc, a mechanism that is in large part responsible for the endemicity of HTLV in these relatively closed populations. Although the actual route of transmission is unknown, breast feeding would appear to be most likely.

Child programming: an adequate domain specific language for programming specific robots

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

Implementation of a pilot project for the treatment and prevention of substance abuse in children and adolescents : strengthening families for parents and youths 12-16

RESUMO: Antecendentes: Uma avaliação dos serviços de abuso de substâncias em Barbados identificou a necessidade de programas e serviços que são projetados especificamente para crianças e adolescentes. Objetivo: Realizar programa com base em evidências para reduzir a incidência de abuso de drogas entre crianças e adolescentes por meio do fortalecimento da unidade familiar através de parentalidade positiva, de maior funcionamento familiar e de resistência dos jovens. Método: Dois projetos-piloto foram realizadas com base no programa "Fortalecer as Famílias para Pais e Jovens de 12 a 16 anos (SFPY). O programa de nove semanas foi empregado como uma intervenção para criar laços familiares mais fortes, aumentar a resistência dos jovens e reduzir o abuso de drogas entre crianças e adolescentes de idades de 11 a 16 anos. A decisão foi tomada para incluir participantes de 11 anos desde que as crianças possam estar no primeiro ano da escola secundária nessa idade. IMPLEMENTATION OF SUBSTANCE ABUSE PILOT PROJECT FOR CHILDREN AND ADOLESCENTS 5 Resultados: Quinze famílias participaram em dois projetos-piloto e a avaliação final mostrou que os jovens após o programa, geralmente tornaram-se mais positivos sobre o seu lugar na unidade familiar e sentiram que sua participação no programa foi benéfica. Os pais, da mesma forma, relataram que eles conquistaram, com o programa uma relação mais positiva, uma melhor compreensão das necessidades, e consciência das mudanças de desenvolvimento de seus jovens. Desta forma, considera-se que o programa atingiu o resultado desejado de criar unidades familiares mais fortes. Conclusão: O Projeto Piloto “SFPY” foi bem sucedido em fazer pais e jovens mais conscientes de suas necessidades individuais e de responsabilidades dentro da unidade familiar. Como resultado, o relacionamentos das respectivas famílias melhorou. Estudos baseados em evidências têm demonstrado que um relação familiar mais forte diminui a incidência de uso e abuso de drogas na população adolescente, aumentando os fatores de proteção e diminuindo os fatores de risco. A implementação do programa, que foi desenvolvido e testado no ambiente norte-americano, demonstrou que era transferível para a sociedade de Barbados. No entanto, seu impacto total só pode ser determinado através de um estudo comparativo envolvendo um grupo de controle e / ou uma intervenção alternativa ao abuso de substâncias. Portanto, é recomendável que um estudo comparativo da intervenção SFPY deve envolver uma amostra representativa de adolescentes que estão em estágio de desenvolvimento anterior mais cedo. Evidências já demonstram que o programa é mais eficaz, com impacto mais longo sobre os jovens que participam em uma idade maisABSTRACT:Background: An evaluation of substance abuse services in Barbados has identified the need for programmes and services that are specifically designed for children and adolescents. Aim: To conduct an evidence-based programme to reduce the incidence of substance abuse among children and adolescents by strengthening the family unit through positive parenting, enhanced family functioning and youth resilience. Method: Two pilot projects were conducted based on the ‘Strengthening Families for Parents and Youths 12– 16’ (SFPY) programme. The nine-week programme was employed as an intervention to create stronger family connections, increase youth resiliency and reduce drug abuse among children and adolescents between the ages of 11 to 16. The decision was made to include participants from age 11 since children may be in the first year of secondary school at this age. IMPLEMENTATION OF SUBSTANCE ABUSE PILOT PROJECT FOR CHILDREN AND ADOLESCENTS 3 Results: Fifteen families participated in two pilot projects and an evaluation conducted at the conclusion showed that the youth were generally more positive about their perceived place in the family unit and felt that the being in the programme was generally beneficial. The parents similarly reported they had a more positive relationship with their youths and also had a better understanding of their needs, and an awareness of their developmental changes. This affirmed that the programme had achieved its desired outcome to create stronger family units. Conclusion: The SFPY Pilot Project was successful in making parents and youths more aware of their individual needs and responsibilities within the family unit. As a result relationships within their respective families were strengthened. Evidence-based studies have shown that enhanced family functioning decreases the incidence of substance use and abuse in the adolescent population by increasing protective factors and decreasing risk factors. The implementation of the programme, which was developed and tested in the North American environment, demonstrated that it was transferable to the Barbadian society. However, its full impact can only be determined through a comparative study involving a control group and/or an alternative substance abuse intervention. It is therefore recommended that a comparative study of the SFPY intervention should be delivered to a representative sample of adolescents who are at an earlier developmental stage. Evidence has shown that the programme is more effective, with longer impact on youths who participate at a younger age.

Mother-child transmission of Chagas disease: could coinfection with human immunodeficiency virus increase the risk?

A study was conducted on all newborns from mothers with Chagas disease who were attended at Hospital Donación F. Santojanni between January 1, 2001, and August 31, 2007. Each child was investigated for the presence of Trypanosoma cruzi parasitemia through direct examination of blood under the microscope using the buffy coat method on three occasions during the first six months of life. Serological tests were then performed. Ninety-four children born to mothers infected with Trypanosoma cruzi were attended over the study period. Three of these children were born to mothers coinfected with the human immunodeficiency virus. Vertical transmission of Chagas disease was diagnosed in 13 children, in all cases by identifying parasitemia. The overall Chagas disease transmission rate was 13.8% (13/94). It was 100% (3/3) among the children born to mothers with HIV infection and 10.9% (10/91) among children born to mothers without HIV [Difference = 0.89; CI95 = 0.82-0.95; p = 0.0021]. We concluded that coinfection with HIV could increase the risk of vertical transmission of Chagas disease.

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

Policing and planning child and adolescent neuropsychiatry : the reform process in Bologna 2009-2014

Desde a aprovação do plano de saúde mental regional em Itália ... o Departamento Local de Saúde Mental e Perturbações aditivas em Bolonha, tem desenvolvido um projeto de reforma cujo objectivo é inovar o sistema de saúde mental local. ...ABSTRACT: Since the Regional mental health plan 2009-2011 was approved in Italy the Department of Mental Health and addictions of the Bologna local health trust developed as a laboratory aimed at innovating the mental health systen locally. ...