Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity.

BACKGROUND: Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation. OBJECTIVE: To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients. METHODS: A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions. RESULTS: HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens. CONCLUSIONS: On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases.

Pica Practices among Apparently Healthy Women and Their Young Children in Ghana.

BACKGROUND: Pica is an increased appetite/craving for food or non-food substances like clay, and chalk, and is strongly associated with iron deficiency (ID) anemia. This study assessed pica practices among non-pregnant mothers and their children, 12-to-59 months, in an anaemia endemic population in Ghana. SUBJECTS AND METHODS: A cross-sectional quantitative survey was conducted in two randomly selected districts in Northern Ghana. The researchers developed semi-structured questionnaires with components on pica practice, history and experiences and administered via structured face-to-face interviews with mothers (N=161) and all their children 6-59 months. Of this population, 132 mothers had children 12-to-59 months (N=139) in April 2012. Pica practice among children was reported by their mothers. Data was analysed using SPSS version 23.0. RESULTS: Few mothers (3%) spontaneously reported pica (for uncommon food and/or non-food substances) at the time of the interview, however, 16 (12.1%) mothers with pica were confirmed after further probing. Twelve (8.6%) children were reported to have ingested/craved clay/soil/dust (11 / 91.7 %), paper (1 / 7.1%) and chalk (1/7.1%) prior to the interview. One child had poly-pica (pica for two substance). Pica was reported to have been practised by expecting mothers during 37 (26.6%) of the pregnancies of the children involved in the study, and was mostly for clay/soil (33 / 89.1%), kola nut (5 / 3.6%), uncooked rice and bambara beans. Children's pica practices were significantly associated (χ2=6.33; p=0.011) with their mothers' pica practices during pregnancy as well as with mothers' pica practices at the time of the study (χ2=5.98; p=0.035). A logistic regression analysis seemed to show that pica of the mother during pregnancy was more strongly associated with the child's pica than later pica behaviour of the mother. Many myths and misconceptions associated with the practice of pica were also reported in these communities. CONCLUSIONS: The reported pica practice among mothers and their children was lower than what has been observed in other studies. Knowledge and perceptions regarding pica were mostly inaccurate. Education on pica and associated dangers of its practices should be included in nutrition interventions in communities with known high anemia prevalence.

Reticulocyte Haemoglobin Content as a Diagnostic Tool for Iron Deficiency and Iron-Deficiency Anaemia in Ill Infants and Children

Background. The diagnosis of iron deficiency (ID) and iron-deficiency anaemia (IDA) in ill children is complicated by the unreliability of serum ferritin (S-ferritin). The presence of a microcytic; hypochromic anaemia suggests IDA but is not specific. There is a need for a diagnostic test that will be accessible; cost-effective and accurate for the diagnosis of ID in ill children. Studies done in healthy children have reported that reticulocyte haemoglobin content (CHr) is a reliable diagnostic test for ID; eliminating the need for S-ferritin determination.Objective. To evaluate the accuracy of CHr to diagnose ID and IDA in ill infants and children.Methods. A prospective; descriptive study was conducted. One hundred children; aged 6 months to 6 years; who were admitted to Pelonomi Regional Hospital; Bloemfontein; South Africa; during July 2012 and August 2012 were included. Results. The study group was divided into an iron-deficient group and an iron-sufficient group based on transferrin saturation (TfS). A statistically significant difference was found between mean corpuscular haemoglobin (MCH); serum transferrin and CHr in these two groups (p=0.0001). The sensitivity of a CHr level ?29 pg to detect ID was 86; and the specificity was 50. Conclusion. CHr is an accurate diagnostic test for ID; and for IDA in combination with a low haemoglobin level; in ill infants and children