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Biomedical subjects

C Kind

Publications and source records attributed to C Kind.

At least 37 records · Page 2Linked to original sources
PubMed1995

Mother-to-child transmission of human immunodeficiency virus type 1: influence of parity and mode of delivery. Paediatric AIDS Group of Switzerland.

UNLABELLED: In a national prospective study of risk factors for mother-to-child transmission of human immunodeficiency virus (HIV), 316 children of HIV-positive mothers were followed up for at least 6 months. Infection status was determined in 254 of them and 46 were found to be infected giving a transmission rate of 18.1%. Univariate analysis of potential risk factors for mother-to-child transmission showed an association between primiparity and increased transmission rate: odds ratio 2.2, 95% confidence interval (CI) 1.1-4.6, P < 0.05. Analysis by logistic regression confirmed this association (adjusted odds ratio 2.4) and showed, in addition, a negative association between transmission rate and elective Caesarean section (adjusted odds ratio 0.36, 95% CI 0.13-0.97, P < 0.05). The effect of primiparity was less pronounced in combination with elective Caesarean section (odds ratio 1.7) than with other delivery modes (odds ratio 2.5, difference not significant). HIV-infected children were less likely to experience the birth of a younger sibling during the observation period than their uninfected counterparts (2 of 46 vs 27 of 208, P < 0.05 by logrank test). CONCLUSION: Primiparous women appear to transmit HIV to their children at a higher rate. This could be explained by increased intrapartum transmission because of longer and more complicated labour in primiparas and/or by a self-selection of women with lower risk of transmission among those deciding to have additional children.

Adult↗
PubMed1995

[Pregnancies in HIV infected women in Switzerland].

In a national multicentre study, 229 pregnancies in 219 HIV-positive women were prospectively followed up between January 1, 1990, and October 30, 1993. 69.8% were infected by intravenous drug abuse and 91.5% were asymptomatic (CDC classes II and III) in early pregnancy. 48 (21.0%) were first discovered to be HIV-infected during the index pregnancy: 46 of these had risk factors. The present epidemiologic development does not seem to warrant a general HIV-screening in pregnancy at this time. 71 pregnancies (31%) were terminated; 158 children were born, 17 (23.3%) of the 73 definitely classified are HIV-infected. An asymptomatic HIV infection with a sufficiently high (> 200/microliters) CD4 cell count has no proven influence on the pregnancy. Otherwise, however, maternal infectious diseases can lead to prematurity. For mothers with i.v. drug abuse, there is a significantly higher incidence of prematurity and fetal growth retardation. The maternal HIV infection can be transmitted to the child either during pregnancy or at delivery. The incidence of vertical transmission in our study was 23.3%; the most predictive parameter for a prenatal HIV transmission is a low anti-p24 antibody titre. The risk of intrapartum transmission seems to be somewhat, but not significantly, reduced for primary Caesarean sections. Recently, prophylaxis with Zidovudin during pregnancy, beginning after the 14th GW, was found to reduce vertical HIV-transmission by 66%. Since the virus can also be transmitted through mothers' milk, HIV-positive mothers should not nurse their babies. Maternal infections are significantly more frequent in HIV-positive women, and are a risk factor for prematurity.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1995

[Cost-benefit analysis of screening for congenital toxoplasmosis].

A comprehensive cost-benefit analysis of possible screening strategies for congenital toxoplasmosis is necessary as a basis for the decision whether or not screening is efficient and socially desirable. The total costs of the disease in Switzerland were calculated for the year 1990. Direct costs (all diagnostic and therapeutic interventions, including care of handicapped children) and indirect costs (partial and total work losses in the future) were taken into account. Today, the direct costs amount to approx. SFr. 20 mio per year (i.e. approx. SFr. 2.8 mio per million population). The indirect costs were calculated at SFr. 4 mio per year. Moreover, the costs incurred with three possible screening programs (1 test with all pregnant women, with 1, 2 or 5 additional tests, depending on the strategy) were estimated, together with the concomitant cost savings. The financial resources needed for the screenings would amount to SFr. 7 mio-18 mio per year, depending on the strategy chosen. However, the possible savings would be in the range of SFr. 4 mio-12 mio only. The possible savings are, in any case, of the same order of magnitude as the costs for screening. Screening would become cost-efficient if costs for the serological tests could be lowered.

Cost-Benefit Analysis↗
PubMed1995

[Congenital toxoplasmosis: pediatric approach. Consensus report of the Swiss infectious disease pediatricians].

The first part of this paper reviews: (1) the spectrum of clinical features of congenital toxoplasmosis; (2) the natural course of fetal infection; (3) the influence of antitoxoplasma therapy on the course of the disease; (4) methods for diagnosing the toxoplasma infection and assessing the severity of the disease; (5) currently used antitoxoplasma drugs and different therapeutic regimens. The second part suggests a practical approach to the problem of congenital toxoplasma infection, including diagnostic work-up, drug therapy, and follow-up. This practical approach is modulated according to the clinical syndrome in the infant and diagnostic and therapeutic considerations in the mother.

Coccidiostats↗
PubMed1994

[Therapy in unfavorable prognosis. Ethical dilemma in the treatment of newborn infants with severe abnormalities].

The doctor treating a baby destined to be handicapped with certainty has to find a way between the two extremes of overtreatment and selective medicine. Medico-ethical directives cannot replace personal commitment in this process. The observation of the jargon used in team discussions can reveal tendencies to one or the other extreme position. An attitude is proposed that tries to balance the gain in joy of life, in possibilities for human relations and in experience of life, the start or pursuit of a therapeutic measure possibly allows against the pain, discomfort and deprivation it inevitably entails.

Child Advocacy↗
PubMed1994

Sensitive detection and early prognostic significance of p24 antigen in heat-denatured plasma of human immunodeficiency virus type 1-infected infants. Swiss Neonatal HIV Study Group.

Immune complex formation causes underdetection of p24 antigen in human immunodeficiency virus (HIV) infection. Briefly boiling diluted plasma releases all complexed antigen, which can then be measured by some commercial assays. In a retrospective pediatric cohort study, the specificity of this procedure in 390 uninfected samples was 96.9% after initial testing and 100% after neutralization. Sensitivity among 125 postnatal infected samples was, at a detection of 2 pg/mL, 96.0% (97% neutralizable) compared with 47.7% for regular antigen (76% neutralizable), 96% for polymerase chain reaction, and 77% for viral culture. The high sensitivity and specificity of heat-denatured antigen was confirmed by prospectively testing 113 additional samples. Quantitative analysis of samples from infected infants showed low levels of p24 antigen in 29% of cord blood sera, a postnatal increase to levels that were during the first 6 months of life inversely associated with survival, and persistence of antigenemia thereafter independent of clinical status. Prevalence and antigen levels were significantly lower in mothers. The persistent antigenemia in children indicates that their immune systems cannot restrict HIV expression as efficiently as those of adults.

Age Factors↗
PubMed1994

IgG, IgM, and IgA response to HIV in infants born to HIV-1 infected mothers. Swiss Neonatal HIV Study Group.

Children born to HIV-1-positive mothers were prospectively tested for HIV-reactive IgG, IgM, and IgA by Western blot, in order to study the children's humoral immune response in the background of passively transferred maternal IgG. In infected infants, a response was first seen at 1-3 months for env-reactive IgM and IgA, as well as gag-reactive IgM and IgG. This was followed by production of IgG to env, IgA to pol and to gag p17 and p55 at 7-9 months, and IgG to pol at 10-12 months. IgG Western blot positivity by all interpretation guidelines in all infected infants was found by 10-12 months. Subsequently, only IgG to env and p24, and IgA to env were maintained in all, whereas IgG to pol and p17 disappeared again in a significant fraction. A considerable proportion of uninfected infants also produced gag-reactive antibodies: IgM at 1-3 months, followed by IgG, which persisted in 10-20% and were also found in children born to uninfected mothers. These antibodies were, however, present at lower titers than in infected infants and were apparently produced in response to agent(s) different from HIV. Maternal antibodies to env disappeared significantly faster in infected than uninfected infants. Traces of HIV-reactive IgG were present for up to 21 months in children who subsequently seroreverted completely.

Age Factors↗
PubMed1993

[Management of mono-amnion twin pregnancy].

There have been only a few reports on monoamniotic twin pregnancies from the period of modern perinatology. Consequently, available recommendations about the management of these high-risk pregnancies are uncertain. In this study, we present the management and the outcome of three monoamniotic twin pregnancies and two further pregnancies with acardiac acephalus twin in comparison to other case reports and case series from the literature. Practical ways of caring for these high-risk pregnancies are outlined, emphasising the continuous search for entanglement of umbilical cord by ultrasound and cardiotocography. The special importance of intensified cardiotocographic monitoring is demonstrated.

Adult↗
PubMed1992

[Growing-up of children from HIV-positive mothers in Switzerland. Pediatric AIDS-Group Switzerland].

OBJECTIVE: The social situation (placements, material conditions, needs) of children of HIV-infected mothers living in Switzerland was studied and their future needs were estimated. METHOD: Data were gathered by anonymous questionnaires mailed to the primary care physicians of the children of HIV-infected mothers registered in the Swiss Neonatal HIV Study. The physicians handed a copy to the parents or guardians. RESULTS: The social situation could be adequately evaluated for 84 children. With respect to the proportion of mothers with a history of intravenous drug use (75%) or of foreign origin (19%), the children did not differ significantly from the whole population represented in the Swiss Neonatal HIV Study. Of a total of 3154 months, the children spent 75% with their natural mother, 14% with other family members, 6% in a foster family, 3% in a foster home and 2% with adoptive parents. At the time of the study 32 children (38%) could not be cared for by their own mother. The cumulative probability (by the Kaplan-Meier method) of continuing care by the mother was estimated at 78%, 70%, 60% and 50% for an age of 12, 24, 36 and 48 months respectively. Maternal reasons for placement in foster care were: enrollment in an institutional drug withdrawal program (11), neglect (8), death (8) or illness (5). The following ways of improving social conditions were identified: social acceptance without discrimination, early planning of the future care of children in anticipation of the imminent disruption of the family, financial support, assistance in baby sitting and support groups for parents and guardians. CONCLUSION: A minimum annual requirement of 25 new foster care places for children of HIV-infected mothers can be estimated--assuming a stable annual incidence of some 50 deliveries of seropositive women in Switzerland. For primary care physicians it is a major challenge to stay sufficiently informed about the ever changing social situation in order to identify the often wide variety of assistance needed by the family. The quality and coordination of medical and psychosocial care for families confronted with HIV infection definitely needs improvement, especially outside metropolitan areas.

Adoption↗
PubMed1992

Epidemiology of vertically transmitted HIV-1 infection in Switzerland: results of a nationwide prospective study. Swiss Neonatal HIV Study Group.

A nationwide study involving 286 children of human immunodeficiency virus (HIV)-infected mothers living in Switzerland has been performed with the participation of all paediatricians interested in HIV infection in the country. Of these children 201 could be followed up prospectively from birth up to a median age of 22 months. Prevalence of HIV infection in Swiss parturients was estimated at 0.1% and apparently remained stable from 1986 to 1989. Vertical transmission rate was estimated at 14%-20%. Variables of maternal or perinatal history were not associated with transmission rate. Transmission to pairs of siblings of the same mothers was discordant in 33% (6 of 18), with always the elder sibling being infected. Postneonatal mortality in infants of HIV-infected mothers followed up from birth was increased 15-fold over the general population with a very high incidence (2 in 100) of sudden infant death apparently unrelated to HIV infection.

Child↗
PubMed1990

Congenital scalp and skull defects with terminal transverse limb anomalies (Adams-Oliver syndrome): report of three additional cases.

Aplasia cutis congenita of the scalp combined with terminal transverse limb defects (Adams-Oliver syndrome) is a rare congenital disorder with autosomal dominant inheritance. Thirty-one patients with the complete syndrome have been published. We report three additional patients (one mother and her affected child, one sporadic case) and discuss the probable vascular disruptive pathogenesis, the clinical variability and the treatment of this condition in the light of a comprehensive review of the literature.

Family Health↗
PubMed1989

Frequent detection of HIV- and IgG-specific IgM and IgA antibodies in HIV-positive cord-blood sera: fine analysis by western blot.

Cord-blood sera of 36 babies born to HIV-positive mothers in Switzerland were tested for immunoglobulin (Ig) M or IgA by HIV Western blot. IgM was found in 28, and IgA in 19 of unabsorbed sera. Preabsorption with immobilized protein A or G was used to remove IgG, which allowed differentiation between HIV-specific and IgG-specific IgM or IgA. Protein G proved superior and showed that 30% of 23 sera had HIV-specific IgM, while 48% had HIV-specific IgA. HIV-specific IgM and/or IgA was found in 13 out of 21 cases (62%); four out of 21 (19%) had both. HIV-specific IgM reacted most frequently with pol or env proteins, while HIV-specific IgA reacted more frequently with gag than pol; no IgA were directed against env proteins. IgG-specific IgM and IgA, mostly at gag bands, were present in 83 and 38%, respectively. Thus, a large percentage of children born to HIV-positive mothers have HIV-specific IgA and/or IgM which can be distinguished from IgG-specific IgA or IgM, which is also present in the majority of such children. Future studies will have to show whether these antibodies are of diagnostic relevance.

AIDS Serodiagnosis↗
PubMed1988

Evaluation of diagnostic tests for HIV infection in infants born to HIV-infected mothers in Switzerland.

Children born to HIV-infected women in Switzerland were tested every 3 months for HIV-reactive serum immunoglobulin (Ig) G, IgM and IgA antibodies by Western blot, viral antigen, virus replicating in T-lymphocyte cultures, and immunologic and clinical parameters. At birth, 27% were isolation-positive, 68% had IgM, 48% IgA and 10% circulating antigen. The proportion of IgM and IgA declined to about 18 and 27%, respectively, during the first 2 years. Detection of circulating antigen was less frequently positive than virus isolation in all age and disease groups. Clinical symptoms were only seen in infants or children who were or had been positive for IgM and/or IgA, but only 39% of children positive for these markers have developed disease so far. Clinical symptoms combined with signs of immunodeficiency were seen only in children who were isolation-positive or had evidence of HIV-reactive IgA or child-produced IgG. Absorption studies showed that Western blot-detected IgM and IgA antibodies were of two types: 42% were directed against various HIV proteins, while the rest represented rheumatoid-factor-like IgM or IgA binding to HIV-specific IgG. HIV-specific IgG antibodies were detected in all samples up to the age of 12 months and were still found in 83% of infants 13-18 months old. We observed weak HIV-specific IgG above the age of 15 months with no other signs of HIV infection, suggesting that the demonstration of antibodies in children beyond this age does not necessarily indicate HIV infection.

AIDS Serodiagnosis↗