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BACKGROUND: Plasma HIV-1 RNA levels are high in vertically infected infants. Information in older children is limited, particularly in those who have not received antiretroviral therapy. OBJECTIVES: To describe the relationships between HIV-1 RNA, age and CD4 cell count in untreated vertically infected children. DESIGN: HIV-1 RNA was measured in 70 children [median age, 3.5 years (range, 0.4-11.9 years); median CD4 cell count, 881 x 10(6)/l (interquartile range, 576-1347 x 10(6) cells/l)] enrolled in a randomized placebo-controlled trial comparing immediate with deferred zidovudine in asymptomatic or mildly symptomatic vertically infected children (PENTA-1 trial). Short-term variability was assessed by comparing HIV-1 RNA at -2 and 0 weeks (prior to randomization). The relationship between age and HIV-1 RNA, and CD4 cell count was analysed using data from all children prior to randomization and sequential samples from 35 remaining on placebo for up to 105 weeks, by fitting mixed linear models. RESULTS: The within-individual SD in viral load was 0.26 log10 copies/ml. The median plasma HIV-1 RNA at enrollment was 4.61 log10 (range, 2.3-6.56 log10 copies/ml), significantly higher in children aged < or = 2 years (median, 5.23 log10 copies/ml) than in those aged > 2 years (4.51 log10 copies/ml; P < 0.0001). Mean HIV-1 RNA fell by 0.38 log10 copies/ml per year up to 2 years of age, by 0.21 log10 copies/ml per year from 2 to 4 years of age, and by 0.03 log10 copies/ml per year from 4 to 6 years of age reaching a nadir of 4.25 log10 copies/ml at 6 years. Mean log10 CD4 cell count declined steadily with age and was not significantly correlated with HIV-1 RNA, although there was some evidence that the rate of log10 CD4 cell decline was negatively correlated with the initial rate of HIV-1 RNA decline. No mutations associated with resistance to zidovudine were observed. CONCLUSIONS: Age is a key factor in the interpretation of both viral load and CD4 cell count in vertically infected children

Cytomegalovirus retinitis (CMV) is the most frequently found opportunistic eye infection in adults with AIDS, with mean incidence of 20%-50%. However, only 5% of children with AIDS have this infection.We present the case of a six year old girl with stage C3 AIDS diagnosed at the age of 20 months, who developed unilateral diffuse retinitis due to CMV. The infection involved the posterior pole of the right eye, with retinal atrophy along the temporal vascular arcodes, and an active advance front in the temporal macula. The optic nerve was not found to be involved although the peripheral areas of the retina were involved leading to rhegmatogenous detachment of the superotemporal retina. In view of the systemic deterioration of the patient, no specific anti-CMV treatment was given. The patient died of respiratory insufficiency a few weeks later.CMV retinitis in paediatric AIDS patients is usually associated with more severe illness and a poorer general health than the adult population. In view of the absence of symptoms in these patients, periodic ophthalmoscopic examinations should be done in those who have severe immunological deterioration.

In the present study the objective was to evaluate whether therapeutic doses of paracetamol in children has an impact on the concentrations of erythrocyte reduced glutathione (GSH) and urinary thioethers (UT), used as indicators of internal exposure to electrophiles, as well as to establish the association between the two parameters. The population sample consisted of 40 children. From each patient, two blood and two urine samples were taken. Sample A was obtained one week after completing treatment and sample B was taken two hours after taking the last dose of paracetamol. The total group was divided into three subgroups according to age: subgroup I from 9 to 8 months, subgroup II from 19 to 72 months and subgroup III from 73 to 132 months. The concentrations of GSH and UT have been determined in blood and urine, respectively. The results demonstrate that after treatment with paracetamol for a period of days (3.57 +/- 0.86) an elevation in GSH was produced in the total group (Z = -2.40, p0.05). A significant and positive association (r = 0.52) existed between the GSH and UT values. No correlation was observed either between plasma levels, or the duration of treatment and the effects observed on GSH and UT.

Helicobacter pylori-associated gastritis has been put forward as a distinct risk factor for gastric cancer. Furthermore, among H. pylori-positive individuals a correlation between a high serum level of H. pylori antibodies and the risk of gastric cancer has been found in two different studies. Other studies have challenged this hypothesis. We therefore studied the presence and level of H. pylori serum antibodies, using an enzyme-linked immunosorbent assay technique in 116 gastric cancer patients (65 men; mean age, 67 years; range, 23-92 years) and 116 controls matched for age and sex. Patients and controls were selected on referral for gastroscopy. The prevalence of infection in gastric cancer patients was 77% (89 of 116) and in controls 79% (92 of 116). This difference is not statistically significant, nor is the prevalence of infection in cases and controls of different age cohorts significantly different. High levels of serum antibodies were found in 46% (53 of 116) of gastric cancer patients and 40% (46 of 116) of controls. Comparison of the prevalence of high serum levels of antibodies for the total population and for the different age cohorts did not show significant differences either. We conclude that the comparison of actual H. pylori infection in a cross-sectional study of gastric cancer patients and controls does not enable relative risk calculation in the study of the role of H. pylori infection in gastric carcinogenesis. Prospective studies showing diminishment of the risk for gastric cancer after eradication of H. pylori are required.

Diarrheic processes from an infectious origin constitute a frequent pathology during childhood. We have analyzed, from a epidemiological point of view, a series of 117 children diagnosed as having diarrhea and having stool cultures bacteriologically positive for Salmonella. Special reference has been made to the epidemiological chain of this infection. Of the patients studied, 68 (58.2%) were boys and 49 (41.8%) were girls. Their ages ranged between 1 month and 14 years. An epidemiological environment was recognized in 34.1% of the cases. The most frequent serotype was Salmonella Enteritidis (72.6%).

Infectious diarrhoea are common causes of morbility in children. Although viral agents are responsible for the majority of cases of acute diarrhoea during infancy, bacterial infections are also well recognized as causes of them. 256 patients with diarrhoea due to a bacterial pathogen were studied to determine the importance of different epidemiologic factors. The study group comprised 151 boys (59%) and 105 girls (41%) aged between first month and 14 years. Family history of acute diarrhoea was found in 15% of children. 63,7% of them were hospitalized by the severity of clinical features. 32% of cases were detected in summer. Salmonella entérica was isolated in 45% of stool samples and Campylobacter spp in 33,2%. Clinical evolution of diarrhoea differentiated the patients into three groups: acute diarrhoea (95,7%), prolonged diarrhoea (3,1%) and chronic diarrhoea (1,1%).

Cortical auditory evoked potentials (CAEP) were recorded from scalp electrodes in 47 patients, who survived to bacterial meningitis in their childhood. CAEP were obtained from 1 month to 8 years after recovering from acute disease. Neisseria meningitidis was the microorganism more frequently isolated from CSF (43.5%). Exclusively abnormal values in amplitude of CAEP were registered in 15 cases (32%), mainly at the lower tones explored; 14 of them were subjected to conventional audiometric test, which demonstrated unilateral hearing loss only in 2. No alterations in the latency of P2 wave were seen. We recommend to include CAEP in search of hearing disorders in younger children after recovering from meningitis, since they can detect lesions in cortical-subcortical auditory tracts, which otherwise could go unnoticed.