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Neuroleptospirosis is a rare disease caused by pathogenic Leptospira interrogans in humans; however, it has not been fully studied in animals. A young wild raccoon dog was found convulsing in the recumbent position and died the next day. Histologic examination revealed nonsuppurative meningoencephalitis in the cerebrum, cerebellum, midbrain, and medulla oblongata. The lesions consisted of mixed infiltrates of Iba1-positive macrophages and CD3-positive T cells, with a small number of CD79α-positive B cells and myeloperoxidase-positive neutrophils. In the frontal cortex, perivascular cuffs and adjacent microglial nodules were distributed diffusely, especially in the molecular layer. Glial nodules were comprised of Iba1- and myeloperoxidase-positive activated microglia. Immunohistochemistry revealed leptospires in mononuclear cell perivascular cuffs, but not in glial nodules. Neuroleptospirosis was accompanied by Leptospira-related nonsuppurative interstitial nephritis, pulmonary edema and hemorrhage, and coronary periarteritis, as well as Toxocara tanuki in the small intestine and nonspecific foreign-body granulomas in the lungs and stomach.

With political will, modest financial investment and effective technical assistance, public sector hepatitis C virus (HCV) programmes can be established in low- and middle-income countries as a first step towards elimination. Seven countries, with support from the Clinton Health Access Initiative (CHAI) and partners, have expanded access to HCV treatment by combining programme simplification with market shaping to reduce commodity prices. CHAI has supported a multipronged approach to HCV programme launch in Cambodia, India, Indonesia, Myanmar, Nigeria, Rwanda and Vietnam including pricing negotiations with suppliers, policy development, fast-track registrations of quality-assured generics, financing advocacy and strengthened service delivery. Governments are leading programme implementation, leveraging HIV programme infrastructure/financing and focusing on higher-HCV prevalence populations like people living with HIV, people who inject drugs and prisoners. This manuscript aims to describe programme structure and strategies, highlight current commodity costs and outline testing and treatment volumes across these countries. Across countries, commodity costs have fallen from >US$100 per diagnostic test and US$750–US$900 per 12-week pan-genotypic direct-acting antiviral regimen to as low as US$80 per-cure commodity package, including WHO-prequalified generic drugs (sofosbuvir + daclatasvir). As of December 2019, 5900+ healthcare workers were trained, 2 209 209 patients were screened, and 120 522 patients initiated treatment. The cure (SVR12) rate was >90%, including at lower-tier facilities. Programmes are successfully implementing simplified, decentralised public health approaches. Combined with political will and affordable pricing, these efforts can translate into commitments to achieve global targets. However, to achieve elimination, additional investment in scale-up is required.

The effects of 7-ketocholesterol on rat hepatocytes prepared by collagenase perfusion were examined. The viability of cells incubated with 100 microM 7-ketocholesterol was significantly lower than those with cholesterol, although the LDH activity in the cultured medium remained unchanged during the incubation. Hepatocytes treated with 7-ketocholesterol produced large amounts of .NO and O2- in the early stage of incubation. Treatment of the hepatocytes with Carboxy-PTIO, which selectively scavenged .NO, or with L-NMMA, an inhibitor of .NO synthase, increased the cell viability. The addition of 7-ketocholesterol to the culture medium tended to increase the ratio of total sterol to phospholipid of the hepatocytes in a time-dependent manner without changing the content of phospholipid. No lipid peroxidation or oxidation of the cellular SH groups, protein SH and glutathione, was apparent. Vitamin E added 1 h before the addition of 7-ketocholesterol prevented the hepatocytes from cell death by suppressing the incorporation of 7-ketocholesterol into the hepatocytes and by scavenging O2-.

Two new natural pteridines have been isolated from the cultured medium of Rhodopseudomonas sphaeroides GM-1. The compounds are tentatively identified as 2-amino-4-hydroxy-6-hydroxy-6-(1,2, 3,4-tetrahydroxybutyl)pteridine and 2-amino-4-hydroxy-6-(3-hydroxy-4-phosphonoxy-1-butenyl)pteridine by degradative experiments and by electrophoretic and paper chromatographic comparison with authentic materials.

In this retrospective study from Saudi Arabia, which is a rich and sunny country, we report our experience with 34 adolescents (20 females, 10 males) with rickets. The commonest cause was vitamin D deficiency (58.8%) followed by rickets due to low calcium intake (11.8%) and genetic causes, including possible 25-hydroxylase deficiency (8.8%). The etiology of nutritional rickets is multifactorial, including lack of sun exposure and inadequate calcium intake. The clinical symptoms were nonspecific and therefore cases in this country are either underdiagnosed or missed. Vitamin D deficient patients needed an average of 19 months of treatment before recovery. High dose vitamin D plus calcium supplementation are recommended for treatment. Measures to prevent rickets in all age groups including adolescents are suggested. Further studies on nutritional and genetic forms of rickets are recommended.

The Southern Cone Initiative to control Chagas disease is a major public health success story [1]. Household insecticide spray programs have greatly diminished infestation by Triatoma infestans, the major domestic vector, blood bank and congenital Chagas disease screening have been implemented widely, and the estimated prevalence of Trypanosoma cruzi infection has fallen by more than 50% in the last 20 years [2]. Morbidity and mortality from Chagas cardiomyopathy, the most serious manifestation of T. cruzi infection, have declined progressively with disruption of domestic vector-borne transmission and increasing availability of advanced cardiac care [3]. The major exception to this pattern of success is the Gran Chaco, an ecological zone shared among Argentina, Bolivia, and Paraguay, and host to the highest rates of vector infestation and T. cruzi infection ever reported. Challenges include rapid reinfestation after spray campaigns, insecticide resistance, and sylvatic Tri. infestans populations [4]–[6]. Chagas cardiomyopathy occurs in an estimated 20%–30% of T. cruzi-infected individuals and features a chronic inflammatory process affecting the conduction system and myocardium [2], [7]. The earliest signs are typically bundle branch blocks and segmental wall motion abnormalities, usually beginning in early adulthood [8]. Later, patients may develop ventricular tachycardia, severe sinus bradycardia, high degree atrioventricular block (AVB), apical aneurysm, progressive dilated cardiomyopathy, and thromboemboli [2]. Syncope from heart block or severe bradycardia is common. Once conduction system abnormalities or arrhythmias are present, patients have shortened survival; signs of left ventricular dysfunction are associated with high short-term mortality [2]. Where accessible, advanced cardiac management has significantly improved the prognosis for patients with Chagas cardiomyopathy [9]. In 2011, we conducted a study of T. cruzi infection in seven villages in the Bolivian Chaco [6]. T. cruzi infection prevalence was 26.2% among residents younger than 20, 85.4% among 20–29-year-olds and 96.7% among participants 30 years or older. We then offered electrocardiograms (ECGs) to all study participants 20 years or older with T. cruzi infection. A total of 327 seropositive participants, 59% of infected study participants, had an ECG evaluated by the study cardiologists. Within a few days, we began to see patients who urgently needed pacemakers. In this article, we present a patient case report and a brief description of other patients found to need pacemakers, and we place these findings in the larger context of the Bolivian Chaco and the impact of Chagas heart disease there.

✓ Two sisters, aged 6 and 2 1/2 years, presented with macrocephaly and delayed motor development and were found on computerized tomography to have bilateral arachnoid cysts of the sylvian region. Cystoperitoneal shunting of the larger cysts resulted in considerable neurological improvement in both children. Subsequent screening of the patients' urine for organic acids showed that the two sisters were suffering from glutaric aciduria type I (GA-I). To the best of the authors' knowledge, this is the first report to provide clear radiological and surgical evidence of the association between GA-I and bilateral arachnoid cysts of the sylvian region. The role of the shunting procedure used in these cases is discussed.

To determine the electromyographic characteristrics of normal infant walking, we studied 10 approximately one-year-old infants who were learning to walk. We examined the functional mechanisms of their leg muscles from the initial period of learning to walk through the transitional period to the adult walking pattern. The co-contraction of the antagonistic leg muscles, which indicated a lack of stable equilibrium, seemed to characterize the onset of independent walking around 12 months after birth. The period of transition to the child walking pattern, i.e., comparatively stable walking with the body inclined forward, seemed to take place around 2 or 3 months after the infant had learned to walk. The period of transition to the adult walking pattern, characterized by active motions of lifting the heel with the body erect, appeared to start around the end of the child’s second year of life.

Three infants, ages 3 months to 3 years, presented with chorea as the initial manifestation of herpes simplex encephalitis (HSE) relapse. Patient 2, treated with repeated 10 day courses of 30 mg/kg/day of acyclovir, had no clear improvement in neurological status. Patient 1, treated with a repeated 10-day course, improved only to have another HSE relapse 4 years later. Patient 3 clearly improved soon after a 3-week course of acyclovir at conventional dosages. A fourth patient (Patient 4) who relapsed with chorea after what was thought to be HSE, and who did not respond to repeated acyclovir treatment, was negative for herpes simplex virus indicators on brain biopsy and DNA testing. We recommend treating all patients suffering from HSE with a minimum 3-week course of acyclovir at 30-35 mg/kg/day in 3 divided doses.

• The weights and heights of 1670 Harlem children aged 5 to 11 years (879 boys, 791 girls) were compared with the National Center for Health Statistics standards. The median height for age and weight for age were greater by 1.4 cm and 2.2 kg in boys and 2.7 cm and 2.8 kg in girls. Weight distribution was skewed to the right and showed a bimodal pattern. "Height-ages" were advanced by an average of 0.24 years in boys and 0.47 years in girls. Weight for height in 13.9% of girls and 13.6% of boys were above the 95th percentile. The results are consistent with early maturation. However, even after adjusting for height, shift to the right of the weight distribution persists with a large subgroup of boys and girls who are overweight. (AJDC. 1993;147:155-159)

Plasma and urinary taurine concentrations, growth, nitrogen balance, duodenal bile salt concentration and pattern, fecal bile acid excretion, and intestinal fat absorption were determined in appropriate for gestational age low-birth-weight infants fed either a whey-predominant cow milk formula or the same formula supplemented with taurine (45 mumol/kg/day). Mean plasma taurine concentration in the two groups did not differ. Mean urinary taurine concentration in the control and supplemented groups over the entire study period were 2.67 +/- 0.69 and 12.41 +/- 5.20 mumol/dl, respectively (P less than 0.05). Urinary taurine concentration in the supplemented infants, however, decreased significantly during the study period. Neither growth nor nitrogen retention differed between the two groups. Mean duodenal concentrations of taurine as well as glycine conjugates of both cholate and chenodeoxycholate were higher in supplemented infants. Total duodenal bile salt concentration correlated positively with taurine status as reflected by urinary taurine excretion (r = 0.71); this correlation plus the lower duodenal cholesterol concentration in supplemented infants suggests that conversion of cholesterol to bile acids was greater in supplemented infants. Mean intestinal fat absorption in control and supplemented infants, however, did not differ.

• Intestinal fat absorption and anthropometric and clinical variables were monitored weekly in 21 low-birth-weight (LBW) infants fed either a whey-predominant cow's-milk formula (formula 1) or identical formulas with medium-chain triglycerides (MCTs) comprising 40% (formula 2) or 80% (formula 3) of the fat content. Fat absorption of infants fed formula 1 averaged 86.7% of intake, whereas that of infants fed formulas 2 and 3 averaged 93.8% and 95.4%, respectively. However, no differences in weight, length, head circumference, or skin fold thickness were observed. Moreover, intestinal symptoms were encountered more frequently in infants fed formulas 2 and 3. This demonstrated failure of the resulting small increase in fat absorption incident to MCTs either to promote enhanced growth or to confer obvious clinical benefit does not support the increasing use of MCT formulas for routine feeding of LBW infants. ( Am J Dis Child 1982;136:428-431)

To provide insight into the cause of metabolic acidosis (MA) observed in LBW infants fed high casein formulas, net acid balances (NAB) were preformed in infants (BW 900-1750g) fed formulas with a whey:casein ratio of either 18:82 (A; n=8) or 60:40 (B; n=8). Both provided 3.4g/kg.d of protein and 120 kcal/kg.d. Simultaneously, plasma and urinary amino acid (AA) concentrations including both bound and free cysteine concentrations (Malloy, et al, Anal. Biochem.112:407, 1981) were determined. Neither growth nor nitrogen retention of the 2 groups differed. No infant in A or B developed MA and NAB did not differ (A=-1.61 mEq/kg.d; B=-1.72 mEq/kg.d). However, urinary organic acid excretion (OA), a component of net acid intake (NAI), was greater in A(1.81±0.3 mEq/kg.d vs 1.45±0.12 mEq/kg.d; p