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INTRODUCTION There are increasing reports of a pediatric multi-system inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) that presents with varying clinical features, but includes features of Kawasaki disease or toxic shock syndrome. Symptoms include fever, rash, abdominal pain, vomiting, and diarrhea. Many patients present without any respiratory symptoms and testing for SARS-CoV-2 is often negative. METHODS A retrospective chart review was performed. RESULTS A 7-year-old previously healthy male presented with 3 days of fevers up to 102.4F, headaches, abdominal pain, and intractable vomiting. Both parents had tested positive for SARS-CoV-2 four weeks prior. Nasopharyngeal swab tested positive for SARS-CoV-2 RNA. Echocardiogram was normal. CT venogram of his head was negative for any pathology. He developed severe neck pain and persistent headache during his hospitalization. Soon after receiving hydroxychloroquine, he developed a facial rash and altered mental status with episodes of aphasia, agitation, and pinpoint pupils. He then became unresponsive with left gaze deviation. A non-contrast head CT and CT angiography were negative. He was given levetiracetam and cefazolin and transferred to the pediatric intensive care unit. An electroencephalogram (EEG) showed no epileptiform activity. Over the following 7 hours, the EEG demonstrated left frontotemporal slowing, which progressed into a loss of fast activity over the right hemisphere with increased delta activity in the left hemisphere, then abruptly changed to generalized voltage attenuation.He rapidly lost brainstem reflexes, developing fixed and dilated pupils. Repeat CT scan revealed diffuse cerebral edema with loss of gray-white differentiation. Lab results then were consistent with severe inflammation. An intracranial pressure monitor revealed pressures greater than 76 mmHg. His exam soon became consistent with brain death. Pathologic evaluation showed diffuse cerebral edema with perivascular mononuclear infiltrates. CONCLUSION The cause of this pediatric multi-system inflammatory syndrome is unclear and the mechanism by which SARS-CoV-2 affects the nervous system is unknown. Pediatric patients with COVID-19 and neurologic symptoms should be closely monitored as they can rapidly decline due to fulminant cerebral edema.

Objectives: Increasingly, HIV-infected parents are surviving to nurture their children. Parental HIV disclosure is beneficial, but disclosure rates to younger children remain low. Previously, we demonstrated that the ‘Amagugu’ intervention increased disclosure to young children; however, effects on psychological outcomes have not been examined in detail. This study investigates the impact of the intervention on the maternal and child psychological outcomes. Method: This pre-post evaluation design enrolled 281 HIV-infected women and their HIV-uninfected children (6‐10 years) at the Africa Centre for Health and Population Studies, in rural South Africa. The intervention included six home-based counselling sessions delivered by lay-counsellors. Psychological outcomes included maternal psychological functioning (General Health Questionnaire, GHQ12 using 0,1,2,3 scoring); parenting stress (Parenting Stress Index, PSI36); and child emotional and behavioural functioning (Child Behaviour Checklist, CBCL). Results: The proportions of mothers with psychological distress reduced after intervention: GHQ threshold at least 12 (from 41.3 to 24.9%, P

Objectives: Sub-Saharan Africa has large populations of HIV-infected parents who need support to raise their HIV-uninfected children. This research evaluates the ‘Amagugu Intervention’ aimed at supporting mothers to disclose their own HIV diagnosis to their HIV-uninfected children. Design: Uncontrolled pre and post-intervention evaluation. Setting: Africa Centre for Health and Population Studies, South Africa. Participants: Two hundred and eighty-one HIV-infected women and their HIV-uninfected children aged 6–10 years. Intervention: This lay counsellor-led intervention included six sessions conducted with mothers at home, providing printed materials and child-friendly activities to support disclosure of their diagnosis. Main outcome measure: The primary outcome was disclosure to the child (full, partial, none). The secondary outcomes included maternal mental health (General Health Questionnaire) and child mental health (Child Behaviour Checklist). Results: One hundred and seventy-one (60%) women ‘fully’ disclosed and 110 (40%) women ‘partially’ disclosed their HIV status to their child. Women who perceived their health to be excellent were less likely to ‘fully’ disclose compared to those considering their health to be poorer [adjusted odds ratio 0.48 (0.28–0.95), P ¼ 0.11]. Compared to those not in a current partnership, those with a current partner were almost three times more likely to ‘fully’ disclose [adjusted odds ratio 2.92 (1.33–6.40),P ¼ 0.008]. Mothers reported that most children reacted calmly to ‘full’ (79%) or ‘partial’ disclosure (83%). Compared to ‘partial’ disclosure, ‘full’ disclosure was associated with more children asking questions about maternal death (18 versus 8%). Conclusions: This intervention is acceptable in resource-limited settings and shows promise. Further research using a controlled design is needed to test this intervention. 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2014, 28 (Suppl 3):S331–S341

Background Neurodevelopmental disorders are increasingly believed to originate from intrauterine growth restriction (IUGR). Current reviews exploring the neurodevelopmental effects of IUGR, however, are mostly based on birthweight, an inadequate proxy. Objective We aimed to examine the association between IUGR documented in utero, and neurodevelopmental outcomes during childhood. Search strategy Medline, CINAHL, PsycInfo and Scopus were searched for relevant studies published after 1970. Selection criteria The analysis included studies that identified IUGR in utero, with follow-up assessments between 1 month and 12 years of age. Data collection and analysis Data was extracted for cognitive, behavioural, language, motor, hearing, vision or sleep outcomes. Studies were summarised separately for children born at

A computer system for the analysis of computed tomography and positron emission tomography scans of the brain is described. The system, called TOAP (Tomographic Overlay and Analysis Program), permits the registration of user specified slices from a digital brain atlas with the tomographic images. Regions of interest can then be defined with respect to the atlas. The system thus affords an objective and reproducible means for the analysis of tomographic images.

We used 18-F-fluoro-2-deoxyglucose positron emission tomography (PET) and computed tomography (CT) to study eight patients with homonymous hemianopias or quadrantanopias due to ischemic lesions of the visual pathways. Four patients with ischemic damage to all or part of the occipital lobe had decreased glucose metabolism in the affected region. Three patients with ischemic damage limited to the optic radiations had decreased glucose metabolism in the portion of striate cortex appropriate for the visual field defect. Changes in glucose metabolism frequently occurred in the undamaged ipsilateral thalamus and visual association areas.