The function of adrenal glands in children and adolescents during and after oncological treatment.

The purpose of this work was to present the current state of knowledge on the effects of frequently used therapeutic forms, selected pharmacotherapy (including glucocorticosteroids, immune checkpoint inhibitors, mitotane, metyrapone, aminoglutetimide, etomidate, ketoconazole, fluconazole), but also radiation therapy on the functioning of the hypothalamic-pituitary-adrenal axis in children and adolescent during and after oncological treatment. The most common pediatric cancers, where complications of adrenal insufficiency occur, are presented. Moreover, current recommendations how to diagnose the function of the adrenal axis in oncological pediatric patients, as well during oncological treatment as after it, including patients treated with steroids and also patients in severe stages, are reported. The rules of the treatment of adrenal dysfunction in those patients are presented. This understanding is of key importance for oncologists and endocrinologists in the process of diagnosing, treating and developing patient health care, as well as during therapy as after it, offering safety and improving the quality of life.

Assessment of adrenal function in pediatric cancer survivors.

INTRODUCTION: Oncological therapy can temporarily or permanently disrupt adrenal gland function. The aim of our study was to assess the function of adrenal glands in cancer survivors and to find the best diagnostic tools for it. MATERIAL AND METHODS: Sixty patients aged 1.2-14.9 years (mean 8.3 ±3.5) with diagnosed malignancies and 45 healthy children as controls were recruited to the study. Patients were assessed 0-8 years (mean 2.4 ±2.0 years) after the oncological therapy. In all patients fasting blood samples were collected to measure: glucose, sodium, potassium, cortisol, aldosterone, plasma renin activity (PRA), dehydroepiandrostenedione-sulphate (DHEA-S), adrenocorticotropic hormone (ACTH) and antibodies against the adrenal cortex (AAA). Moreover, 24-hour urinary free cortisol (UFC) was assessed. Test with synthetic ACTH was carried out with 250 µg in neuroblastoma and nephroblastoma patients and with 1 µg in other oncological patients. RESULTS: The levels of morning cortisol and sodium were significantly lower and blood glucose were higher in cancer survivors than in controls (p = 0.006, p = 0.043, p = 0.008). Basal laboratory tests confirmed adrenal insufficiency (AI) in 1 patient with neuroblastoma. Low-dose ACTH revealed AI in 3 patients with acute lymphoblastic leukemia. In the study group, UFC correlated with evening and midnight cortisol (p = 0.001, p = 0.006). In the control group UFC correlated with DHEA-S (r = 0.623, p = 0.0001). None of assessed parameters correlated with the time since the completion of oncological therapy. CONCLUSIONS: The study confirmed possibility of developing asymptomatic AI in cancer survivors even several years after therapy. Instead of morning cortisol, classical diagnostic low-dose ACTH test seems to be an optimal tool for adrenal function's assessment.

The Assessment of the Hypothalamic-Pituitary-Adrenal Axis After Oncological Treatment in Pediatric Patients with Acute Lymphoblastic Leukemia

Objective: Oncologic treatment can affect the adrenal glands, which in stressful situations may lead to life threatening adrenal crisis. The aim of the study was to assess adrenal function in pediatric acute lymphoblastic leukemia (ALL) survivors and to identify the best markers for this assessment. Methods: Forty-three ALL survivors, mean age 8.5±3.6 years and 45 age and sex-matched healthy controls were recruited to the study. ALL patients were assessed once within five years following oncological treatment completion. Fasting blood samples were collected from all participants to measure: fasting blood glucose (FBG); cortisol; aldosterone; plasma renin activity (PRA); dehydroepiandrostendione-sulfate (DHEA-S); and adrenocorticotropic hormone (ACTH). Moreover, diurnal profile of cortisol levels and 24-hour urinary free cortisol (UFC) were assessed. ALL survivors underwent a test with 1 ug of synthetic ACTH. Results: The study revealed lower level of PRA (1.94±0.98 ng/mL/h vs 3.61±4.85 ng/mL/h, p=0.029) and higher FBG (4.6±0.38 mmol/L vs 4.41±0.39 mmol/L, p=0.018) in the ALL group compared to controls. UFC correlated with evening cortisol (p=0.015, r=0.26), midnight cortisol (p=0.002, r=0.33), and DHEA-S (p=0.004, r=0.32). UFC also correlated with systolic and diastolic blood pressure (p=0.033, r=0.23 and p=0.005, r=0.31, respectively). The ACTH test confirmed impaired adrenal function in 4/43 ALL survivors (9%). Two of the patients who needed permanent hydrocortisone replacement had low UFC, midnight cortisol and DHEA-S levels. Conclusion: These results highlight the importance of reviewing adrenal gland functionality after chemo/radiotherapy in ALL survivors. DHEA-S proved to be a good marker to assess the adrenal glands after oncological therapy. Post-treatment disturbances of the adrenal axis could be associated with metabolic complications.

Local complex permittivity measurements of porcine skin tissue in the frequency range from 1 GHz to 15 GHz by evanescent microscopy.

The near-field evanescent microwave microscope is based on a coaxial transmission line resonator with a silver plated tungsten tip protruding through an end-wall aperture. The sensor is used to measure the local dielectric properties of porcine skin in the frequency range from 1 GHz to 15 GHz. The dielectric property of the skin within the near field of the tip frustrates the electric field and measurably changes the transmission line's resonant frequency and quality factor (Q). The shift of the resonator's frequency and Q is measured as a function of tip-sample separation, and a quantitative relationship between the real and imaginary parts of the local dielectric constant using the method of images is established. The associated changes in quality factor image scans of subsurface tissue structure and dielectric properties of skin surface lesions are presented.

Cushing disease in children and adolescents - assessment of the clinical course, diagnostic process, and effects of the treatment - experience from a single paediatric centre.

INTRODUCTION: Adrenocorticotropic hormone-dependent Cushing syndrome, known as Cushing disease (CD), is a rare disease in paediatric patients, the signs and symptoms of which differ from those seen in adult patients. AIM OF THE STUDY: The objective of the study was to present the diagnostics and treatment results of CD in children and adolescents. MATERIAL AND METHODS: We included four consequent patients in the study, 7-15 years old, with CD confirmed by laboratory tests and finally by histology ex-aminations after surgery. The data were retrospectively retrieved from the medical records of all the patients from the years 2012-2018. RESULTS: The median time from the onset of clinical symptoms to CD diagnosis was 1.5 years. All patients presented with rapid weight gain ac-companying growth retardation, and behavioural, puberty, or menstruation disorders. The diagnostic process was carried out in accord-ance with the current standard. Diagnostic difficulties regarded the cyclic CD. All patients underwent transsphenoidal complete resection of the pituitary adenoma, and they all required transient glucocorticoid substitution for a period that correlated with the time from onset of symptoms to diagnosis. All subjects achieved normalisation of hormonal results and resolution of clinical symptoms, but all are still obese. Currently the patients are in remission, but there is a suspicion of the regrowth of the tumour mass in the eldest patient. CONCLUSIONS: In each case of the coexistence of growth velocity inhibition (not necessarily short stature) with the weight gain (not necessarily obesity) and the appearance of hyperandrogenism and depressive-anxiety disorders, biochemical diagnostics of CS should be performed. Obesi-ty could be a chronic complication of CD in childhood, even after effective neurosurgery treatment.

Cyclic Cushing's Disease in the Prepubertal Period-A Case Report and Review of Literature.

Background: Cyclic Cushing's disease (CD) has been described in about 15% of adult patients with CD. In the pediatric population, diagnosis of CD is rare and cyclic presentations of the disease are not adequately understood or described. Moreover, prepubertal patients usually do not present with the typical signs and symptoms of CD, which can obscure or delay diagnosis. In this paper, we report a case of cyclic CD in a prepubertal age girls whose etiology was a pituitary corticotropinoma. Case presentation: A Caucasian 7.8 year old girl was admitted to pediatric endocrinology for the evaluation of short stature and prior obesity. The patient remained overweight despite significant lifestyle modifications, resulting in 6 kg weight loss during the prior 6 months. The physical exam was notable for precocious adrenarche and thelarche, but difficult to differentiate from steatomastia. Hypothalamo-pituitary-adrenal axis diagnostics, including single diurnal excretion of urinary cortisol, morning ACTH, and serum cortisol levels, were all within normal limits, and MRI of the pituitary gland showed no deviations at this time. Because of the clinical suspicion of cyclic hypercortisolemia, she was referred to our outpatient clinic for follow-up. After 6 months, the patient returned with rapid weight gain, accompanied by nocturnal anxiety, exacerbation of depressive behavior, insomnia and excessive sweating, and was readmitted to the ward for testing. Standard diagnostics confirmed CD and repeat MRI at 8.6 years old showed a microadenoma of 3 × 4 mm in the right side of the anterior pituitary gland. Histopathologic examination described an atypical, densely-granulated pituitary corticotroph adenoma with Ki-67 expression above 3%. Conclusion: Cyclic presentations of CD in the prepubescent age group could cause difficulties in diagnosis because of atypical signs and symptoms, which can be absent in the remission phase. Decreases in height percentiles and velocities obtained from the growth chart, as well as fluctuations in weight, and signs of androgenization can allow the clinician to suspect cycling CD in prepubertal patients. Confirmation of cyclic CD diagnosis is only possible during periods of relapse (hypercortisolemic state) and should be investigated according to the current diagnostic standard.

Inflammatory cytokines and cell adhesion molecules in a rat model of decompression sickness.

To characterize early blood and tissue markers predictive of decompression sickness (DCS), this study focused on identifying changes in inflammatory mediators during the 24-h period immediately following compression-decompression of female Sprague-Dawley rats. Early blood and tissue markers predictive of DCS include inflammatory cytokines and cell adhesion molecules (CAMs). Increased levels of inflammatory cytokines, especially tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interferon-gamma (IFN-gamma), were detected in the circulation 6 h after decompression. Increased levels of only IL-6 were observed at 24 h. Compared with control animals maintained at 1 atmospheres absolute pressure ATA (101 kPascal), significant increases in expression of E-selectin, and L-selectin, as well as intercellular adhesion molecule-1 (ICAM-1), were observed immunohistochemically in the lungs and brains of the rats 6 h after exposure to 2 (203 kPascal), 3 (303 kPascal), or 4 (404 kPascal) ATA, followed by rapid decompression. These levels drop by 24 h. In contrast to the observations in brain, greater increases in expression of E-selectin and L-selectin around vessels and connective tissue were seen at 24 h after decompression in the quadriceps of rats exposed to either 3 or 4 ATA. Significant increases in expression of the A(2A) receptor, which modulates inflammation by downregulating production of these cytokines, were detected only in the quadriceps removed at 24 h after decompression from 4 ATA. This study demonstrated that rapid decompression induces the release of mediators of inflammation and resulting tissue inflammation cascades, as well as a protective anti-inflammatory response.

Case study: enhancing effective and efficient congestive heart failure management at Columbus Regional Hospital.

For left ventricular function assessment, angiotensin converting enzyme inhibitor at discharge, smoking cessation education, and congestive heart failure (CHF) discharge instructions, a CHF team developed interventions to improve current practices.

Effects of PCB 126 on primary immune organs and thymocyte apoptosis in chicken embryos.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) and polychlorinated biphenyl (PCB) 126 produce thymic atrophy and immunosuppression. This study explored the hypothesis that the thymic atrophy produced by developmental exposure to PCB 126 is associated with an increase in apoptotic thymocytes at the end of incubation in chicken embryos. Eggs were injected via the air cell with PCB 126 (0.05, 0.13, 0.32, 0.64, and 0.80 ng/g egg) on d 0 of incubation, and tissues were collected on d 20. Controls included noninjected and vehicle-injected (sunflower oil) eggs. Thymocytes were cultured for 6 h and analyzed by flow cytometry for decreased DNA content (propidium iodide staining) and cell size (forward scatter), which indicate apoptosis. PCB 126 induced dose-dependent mortality with an LD50 of 1.01 ng/g and lowest-observed-effect concentration (LOEC) of 0.32 ng/g. Teratogenic effects commonly associated with TCDD and planar PCBs, including cranial and foot deformities and subcutaneous edema, tended to increase with dose of PCB 126. PCB 126 reduced thymus mass by approximately 20% at 0.64 and 0.8 ng/g, the number of viable thymocytes by approximately 20-24% at and above 0.13 ng/g, and the number of bursal lymphoid cells by 57% at 0.64 ng/g. The percentage of apoptotic thymocytes increased with dose, reaching levels 2 times greater than controls at 0.8 ng/g. Electrophoresis of low-molecular-weight DNA from thymocytes of all doses demonstrated fragments in multiples of 180 bp. This DNA laddering is a hallmark of apoptosis. At all doses, thymocytes exhibited caspase-3 activation, another indicator of apoptosis. The results of this experiment supported the hypothesis that the thymic atrophy produced by developmental exposure to PCB 126 in chicken embryos is associated with an increase in apoptotic thymocytes on embryonic d 20.

The effect of m-xylene on cytotoxicity and cellular antioxidant status in rat dermal equivalents.

Exposure of the skin to volatile organic chemicals (VOCs) can lead to irritation, inflammation and cytotoxicity. Since VOCs are used in industrial, commercial and military applications, concern is mounting with respect to VOC safe exposure limits. Although traditional toxicological assessment of VOCs has utilized animal models, the use of alternative in vitro models is becoming more widespread. We have previously developed a sealed exposure system that prevents chemical loss through evaporation and enables calculation of target cell chemical dose. The present study utilized this in vitro exposure method to assess m-xylene-induced cytotoxicity and antioxidant status in dermal equivalents (dermal fibroblasts in a collagen matrix). At the end of a 1- or 4-h exposure, cytotoxicity was measured using the MTT assay and the EC50 values determined were 1481 +/- 88 and 930 +/- 33, respectively. Decreases in cellular thiols and catalase activity were observed, which occurred in a time and dose-dependent manner. Treatment of dermal equivalents with the antioxidants N-acetylcysteine (NAC) and catalase provided some protection against m-xylene-induced cytotoxicity. When compared to m-xylene exposures, treatment with either 1.0 or 5.0 mM NAC led to increases in the EC50 values at 1 and 4 h. Increases in these EC50 values ranged from 1.22- to 1.32-fold at 1 h and 1.27- to 1.54-fold at 4 h. Although treatment with catalase (1000 U/ml) led to a 1.35-fold increase in cell viability at 1 h, no significant differences were observed at either 1 or 4 h when compared to dermal equivalents exposed to m-xylene alone. These results suggest that exposure to m-xylene leads to a time- and dose-dependent decrease in cellular antioxidants and that cellular thiols may provide protection against the cytotoxic properties of m-xylene.

Encuesta serológica de dengue y otros arbovirus en Curazao y Aruba, 1973 / Serologic survey of dengue and other arboviruses in Curaçao and Aruba

Se examinaron muestras de suero obtenidas principalmente de niños de unas islas del Caribe, Aruba y Curazao, en busca de anticuerpos para diversos arbovirus. Los ensayos indicaron que el dengue 2 era endémico en Curazao, pero no en Aruba, posiblemente debido a que Aruba había adoptado medidas de control vectorial más eficaces. Las pruebas de neutralización practicadas en un reducido número de muestras serológicas sugieren que las infecciones de dengue pueden haber proporcionado cierto nivel de protección contra la fiebre amarilla a un sector de la población de Curazao (AU)

Virus surveillance in Trinidad - January 1970 - January 1973

A continuing surveillance programme is being carried out at the Trinidad Regional Virus Laboratory, and the report summarises information obtained during period 1970 to 1973. Specimens were collected regularly from cases of suspected viral illness at health clinics in North and South Trinidad and at the Port of Spain and San Fernando General Hospitals. Two primary cell cultures, RhMK and HEK and one continuous line, HEp-2, were used for virus isolation from all specimens. Acute sera and rectal swabs were inoculated into baby mice. Virus identification was done by neutralization tests in Tissue Culture or mice, or by haemagglutination and haemadsorption inhibition. A total of 3780 cases were investigated from which 758 viruses were isolated. The viruses most frequently isolated from respiratory cases were influenza A Hong Kong. Parainfluenza, Herpesvirus and Adenoviruses, while isolates from gastroenteritis cases were mainly Echoviruses, Adenoviruses and Coxsackie viruses. Several outbreaks of respiratory illness occurred during this period. The first in April 1970 yield a mixture of Influenza a Hong Kong *(11) and Parainfluenza 1, 2, 3, *(11). Influenza A Hong Kong was the predominant virus isolated from outbreaks in October - December, 1970 (23), August - December, 1971 (47). The December 1972 - January 1973 (38) outbreak yielded isolates which appears to be closely related to Influenza A Hong Kong, but have not yet been completely identified. In February - May 1971 there was an increase in respiratory cases from which Adenovirus type 2 and Parainfluenza 1 and 3 (14) were recovered. Poliovirus surveillance yield only one isolate of Poliovirus type two in 1970, but several isolates, Jan.- Sept 1971 (3 type 1, 7 type 2 and 3 type 3) gave wrarning of the epidemic which started in December 1971 and ended in February 1972. One hundred and one stains of Poliovirus type 1 were isolated during this outbreak. Following this a serological survey was undertaken to determine the response to the polio immunization campaingn which was started during the epidemic. Of 60 paired sera tested, 90 percent showed a fourfould or greater increase in antibody level to Poliovirus 1. Sera of infants aged 6 to 48 months were also tested and 129 of 162 had titers of 1/8 or greater to poliovirus type 1. Echo virus and Coxsackie virus isolations remained at a low level during 1970 (20) and 1971 (41) but in the second half of 1972 there was an unusually long outbreak of gastroenteritis in children from which 168 Echo viruses, mainly types 12, 13, 14, and 22 were recovered. * number of isolates (AU)

An alternative test strategy for confirmation of HIV serology - abstract

Conventional HIV confirmatory testing algorithms use Western Blot (WB), radioimmunoprecipitation assay (RIPA) or immunofluorescence assay (IFA). All are costly and require well-trained staff. An alternative confirmatory test strategy was evaluated. This involved testing of a panel of 231 stored frozen samples with known WB results with a first generation enzyme linked immunosorbent assay, ELISA (Pharmacia HIV-I E ELISA) and a second generation ELISA (Abbott Recombinant HIV-I ELISA). The panel consisted of 122 WB positive, 37 WB indeterminate and 72 WB negative results. Ninety-six percent of the WB positive samples were positive by both ELISAs; 4 percent gave inconclusive results. Twenty-five (67.6 percent) of the WB indeterminate samples gave inconclusive results by the 2 ELISAs, 11 (29.7 percent) were negative by 2 ELISAs and were probably from truly negative patients. One sample (2.7 percent) was positive by both ELISAs, 53 (74 percent) gave inconclusive results. No WB negative samples gave positive results in both ELISAs. This alternative test strategy could be adopted with results being reported only for samples found clearly positive by both ELISAs (51 percent of samples tested). Other samples should be tested using conventional algorithms. For 51 percent of samples, the cost of confirmatory tests will be reduced from US$70.00 to US$4.00 per samples (AU)

Epidemiology of HIV infection and AIDS in Antigua - abstract

In December 1985, the first case of AIDS in Antigua occurred in a homosexual male. As of March 1991, Antigua recorded 43 cases of HIV infection. Seven of these, (16.3 percent) were donors. Apart from one donor, a female, the remaining six donors had unprotected sex with prostitutes. Thirteen (30 percent) of the 43 cases were prostitutes, 10 (1.6 percent) of whom were diagnosed in a serosurvey of 622 prostitutes between January 1988 and March 1991. Despite the heterosexual/prostitute linkage, the male homosexual/bisexual group is significant: 12 (28 percent) of the 43 cases were in this category. There were 13 cases of AIDS with 6 cases (46 percent) in the male homosexual/bisexual group. This figure should be interpreted cautiously since all 13 of the HIV prostitutes returned home to Santo Domingo and the status of 12 of them was unknown. The homosexual/bisexual group does not seem to be closely associated with the heterosexual-prostitute group (AU)

Neonatal manifestation of congenital rubella following an outbreak in Trinidad

An outbreak of rubella occurred in Trinidad during 1982 and continued into 1983 when 992 cases were reported in a 17-month period. Twenty infants were diagnosed as suffering from the congenital rubella syndrome based on clinical and laboratory findings. There was a positive history of maternal rubella in 17 (85 per cent), the majority of whom were under 25 years of age. There was equal sex distribution in the affected infants; half of whom showed growth retardation. Hepatosplenomegaly was the commonest finding (90 and 80 per cent). Other findings were thrombocytopenia (55 per cent) abnormal central nervous system signs (60 per cent), congenital heart disease (55 per cent), eye defects (50 per cent), X-ray changes in the lung (35 per cent) and bones (35 per cent), purpura (25 per cent) and anaemia (40 per cent). Two of the twenty neonates died (10 per cent mortality). Positive rubella antibody titre (HAI) ranged from 1:20 to 1:320. Rubella-specific IgM was positive in seven of 15 babies (46 per cent) (AU)

Neonatal manifestations of congenital rubella following an outbreak in Trinidad - abstract

An outbreak of rubella occurred in Trinidad during 1982-1983 when nine hundred and ninety-two (992) cases were reported during a 17-month period. Twenty (20) neonates were diagnosed as having the congenital rubella syndrome on the basis of clinical and laboratory findings. There was a positive history of maternal rubella in 17 (85 per cent), and 90 per cent were under 25 years of age. There was equal sex distribution in the affected neonates half of whom were growth retarded. Hepatomegaly and splenomegaly were the commonest findings (90 per cent and 80 per cent respectively). Other findings were thrombocytopenia (55 per cent), abnormal central nervous system signs (60 per cent), congenital heart disease (55 per cent), eye defects (50 per cent), X-rays changes in lung (35 per cent) and bones (35 per cent), purpura (25 per cent) and anaemia (40 per cent). Unusual manifestations include neonatal convulsion and dissemination intravascular coagulation. Two of the twenty neonates died (10 per cent mortality). Positive rubella antibody titres (HAI) ranged from 1:20 to 1:320 and rubella specific Igm was positive in 7 of 15 babies (46 per cent) (AU)

Implications of the circulation of three dengue serotypes in the Caribbean - abstract

By the end of 1979, dengue type 1 virus which had been introduced into Jamaica in 1977, was isolated as far south as Guyana. In 1981 the type 4 virus appeared in the French islands and the type 2 virus cased a severe epidemic in Cuba. The threat of dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) presented by the potential circulation of these 3 types in the Caribbean countries, prompted an intensification of the laboratory programme of virus isolation and strain identification. During 1981 and 1982 acute sera from febrile cases were inoculated into mosquito tissue culture for virus isolation, and paired sera were tested for antibody development. Dengue type 4 virus activity was detected in countries from Jamaica to Grenada in 1981. Other countries Barbados, St. Vincent, Suriname and Trinidad continued to experience dengue type 1, but at the beginning of 1982 there was abrupt replacement of this type by the advancing dnegue type 4. Sporadic dengue 2 activity has been detected in Jamaica, Trinidad and St. Vincent. Diagnosis has been confused by the presence of other viral infections. In spite of this, an alert medical profession can assist public health authorities in confirming cases, typing the causative agents and liasing with vector control authorities to avert the threat of DHF or DSS in the Caribbean (AU)

Knowledge, attitudes and practices of Caribbean laboratory workers: adoption of bio-safety guidelines - abstract

Biomedical laboratories are work environments which pose special infectious disease risks to personnel who work in them. With the advent of the AIDS pandemic, emphasis has been placed on adoption of Universal Precautions Policy by all health care workers. In order to assess the extent of safety management, knowledge of, and compliance with established safety standards, laboratory workers in the English-speaking Caribbean were surveyed via an anonymous, self-administered, pre-coded questionnaire. One hundred and thirty-one questionnaires were returned from 16 laboratories in 13 countries (50 percent response rate). Responses indicated that there were universal deficiencies in safety management. Only 38 percent of respondents indicated that a safety manual was readily available. Most staff indicated some familiarity with Universal Precautions but there was inadequate awareness (60 percent affirmative responses) regarding the possibility of contracting infections in the laboratory. There were instances of eating, drinking, smoking, mouth pipetting and recapping of needles. The preliminary survey indicates that there is inadequate compliance with safety standards among laboratory workers in the English-speaking Caribbean. Safety management needs to be improved with intervention strategies designed to heighten laboratory workers' perception of the real risk of infection, in order to accomplish the neccessary behaviour modification. (AU)

An outbreak of acute flaccid paralysis in Jamaica associated with echovirus

An outbreak of acute flaccid paralysis in Jamaica in 1986 associated with echovirus type 22 is described. Six patients aged 1 to 27 years developed acute onset of severe flaccid paralysis, with inability to walk. Three cases had facial weakness, four required intensive care with assisted ventilation and two died. Echovirus type 22 was isolated from the stool of two patients who showed a significant increase in antibody titre. Echovirus type 22 was also isolated from the stool of another patient who had aseptic meningitis without any neurological deficit. There was no evidence of poliovirus infection in any of these patients, most of whom were fully immunized. Of the four surviving cases with flaccid paralysis, three had residual weakness in their lower limbs and walked with an abnormal gait 3 years after the acute paralytic attack. This is the first report in the literature of acute flaccid paralysis associated with type 22 echovirus. (AU)

Epidemiology of AIDS and HIV infection in the Caribbean

A review of surveillance data on AIDS and HIV infection in the 18 English-speaking Caribbean countries and Suriname suggests that the epidemiologic pattern of AIDS in the Caribbean is evolving from an epidemic that began in 1983 among homosexual and bisexual males to one in which cases are increasingly resulting from hetrosexual contact, with different countries at various stages of transition. Overall, there has been a decline in many countries-19 percent of cases in the Bahamas are among children in Trinidad and Tobago, Jamaica, Antigua, St.Vincent and the Grenadines, and other countries show high HIV sero-prevalence among homosexuals (15-40 percent), prisoners (4-10 percent), prostitutes (up to 13 percent), and cocaine users (2 percent); at present, prevalence in general population continues to be low. (AU)