Search

Objective Children with sickle cell disease (SCD) are at greater risk for certain neuropsychological deficits due to their medical condition and associated complications. Previous studies have explored the relationship between Transcranial Doppler (TCD) ultrasonography and various domains of neuropsychological functioning in pediatric SCD populations; however, these studies are dated, present variable and inconsistent findings, and are somewhat limited in scope. The goal of this study was to update and expand upon previous research by examining the predictive relationship of TCD results with measures of attention, motor, and social-emotional functioning. Methods Thirty-six patients ages 3-19 with SCD with no known history of stroke, with TCD completed within the past 12 months, underwent a brief neuropsychological exam. Attention, motor, and social-emotional functioning were assessed as appropriate for age using the Conners Continuous Performance Test (K-CPT2/CPT3), Purdue Pegboard, and PROMIS, respectively. TCD values were gathered via medical record review, using the highest value of most recent TCD. Results TCD significantly predicted certain aspects of attention and motor ability, but not social-emotional functioning. Specifically, TCD significantly predicted Detectability (p = .005), Omissions (p = .001), Commissions (p = .012), Perseverations (p = .035), and HRT SD (p = .046) on K-CPT2/CPT-3 and the non-dominant (p = .009) and bilateral (p = .024) trial scores on the Purdue Pegboard. Conclusion This study provides new evidence that TCD may be predictive of motor functioning in pediatric SCD. Results confirm that TCD is predictive of attentional function, though subdomains impacted varied from previous research. While no significant relationship between psychosocial symptoms and TCD were identified, further studies utilizing more comprehensive measurement within this domain is warranted.

Background Although mucosal leishmaniasis is a prominent disease, it has been studied only to a limited extent. It is classically treated with parenteral antimony or, as a last resort, amphotericin B. Methods We treated Bolivian mucosal leishmaniasis due to Leishmania braziliensis with the oral agent miltefosine, 2.5 mg/kg/day for 28 days, and followed-up for 12 months. Results Seventy-two patients were evaluable. The cure rate for the 36 patients who had "mild" disease (i.e., affecting nasal skin and nasal mucosa) was 83%. The cure rate for the 36 patients who had more extensive disease (involving the palate, pharynx, and larynx) was 58%. Patients refused to be randomized to parenteral agents, but the cure rate for an almost contemporary group who was receiving amphotericin B (45 mg/kg over 90 days) was 7 (50%) of 14. Conclusions In this unrandomized trial, oral miltefosine was at least as effective as heroic doses of parenteral amphotericin B. The cure rate for miltefosine was approximately equivalent to historical cure rates using parenteral pentavalent antimony for mild and extensive disease in neighboring Peru. Although gastrointestinal side reactions do occur with miltefosine, its toxicity profile is superior to that of antimony and far superior to that of amphotericin B--in part because of the inherent attractiveness of oral versus parenteral agents. Our results suggest that miltefosine should be the treatment of choice for mucosal disease in North and South America.