[Assessment of psychomotor development in preschool and early preschool children, as a long term outcome of neonatal bacterial meningitis].

Disorder of the cognitive function and psychomotor retardation in the preschool and early preschool children is a result of neonatal bacterial meningitis in most cases. We have investigated 142 patients after neonatal bacterial meningitis and bacterial sepsis. We followed these children during 7 years (1998-2005). The whole contingency was divided into three groups: I group - bacterial meningitis (64 cases), II group - bacterial meningitis and sepsis (56 cases) and III (control) group - 22 patients with bacterial sepsis of different degrees. With the purpose of estimation of the psychomotor development, we have applied: Bayley screening test of infant developmental test (0 -2 y); Denver developmental screening test, and Denver-2 (0-6 y); Raven progressive matrices (5-11 y); Wechsler Intelligence scale for children (6-15 y). We have determined that the results of neonatal bacterial meningitis are predictors of severe long-term outcome of the disease. Analysis of the obtained data enables us to conclude that outcome of neonatal bacterial meningitis and sepsis in combination with bacterial meningitis is more severe than of bacterial sepsis.

Steroid prophylaxis for prevention of nerve function impairment in leprosy: randomised placebo controlled trial (TRIPOD 1).

OBJECTIVE: To determine whether addition of low dose prednisolone to multidrug treatment can prevent reaction and nerve function impairment in leprosy. DESIGN: Multicentre, double blind, randomised, placebo controlled, parallel group trial. SETTING: Six centres in Bangladesh and Nepal. PARTICIPANTS: 636 people with newly diagnosed multibacillary leprosy. INTERVENTION: Prednisolone 20 mg/day for three months, with tapering dose in month 4, plus multidrug treatment, compared with multidrug treatment alone. MAIN OUTCOME MEASURES: Signs of reaction, impairment of sensory and motor nerve function, and nerve tenderness needing full dose prednisolone at four months and one year. RESULTS: Prednisolone had a significant effect in the prevention of reaction and nerve function impairment at four months (relative risk 3.9, 95% confidence interval 2.1 to 7.3), but this was not maintained at one year (relative risk 1.3, 0.9 to 1.8). Fewer events occurred in the prednisolone group at all time points up to 12 months, but the difference at 12 months was small. Subgroup analysis showed a difference in response between people with and without impairment of nerve function at diagnosis. CONCLUSIONS: The use of low dose prophylactic prednisolone during the first four months of multidrug treatment for leprosy reduces the incidence of new reactions and nerve function impairment in the short term, but the effect is not sustained at one year. The presence of nerve function impairment at diagnosis may influence the response to low dose prednisolone.

Cognitive and motor impairments associated with SIV infection in rhesus monkeys.

Cognitive and motor deficits are now recognized as significant clinical features of infection with the human immunodeficiency virus (HIV). Juvenile rhesus macaques infected with simian immunodeficiency virus (SIV) were found to exhibit cognitive and motor deficits characteristic of HIV infection. Impairment on a motor skill task was the most reliable indicator of infection. Various cognitive impairments were also evident. These deficits were related to SIV infection of the brain but not to inflammatory lesions at a particular locus. The results suggest that the SIV-infected rhesus macaque is a valuable model for understanding the cause of HIV-associated central nervous system dysfunction and for developing a treatment.