Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:2.7.10.2 (focal adhesion kinase)
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Medical professionals in countries with only poor and limited laboratory facilities often must diagnose diseases solely upon the basis of clinical manifestations. In an attempt to facilitate the surveillance of AIDS in developing countries, the World Health Organization (WHO) recommended criteria for the clinical case definition of AIDS in adults and children. Preliminary examination of children in Zambia, however, found that a number of patients with obvious AIDS did not fit the published WHO case definition for pediatric AIDS. The Zambia National AIDS Surveillance Committee therefore subsequently designed local criteria for the clinical case definition of pediatric AIDS. This paper presents findings from a comparison of the Zambian criteria with the WHO criteria for the diagnosis of pediatric AIDS. Major signs of pediatric AIDS in the WHO clinical case definition are weight loss or abnormally slow growth, chronic diarrhea of more than one month's duration, and prolonged fever of more than one month's duration, while the major signs in the Zambian clinical criteria are recurrent fever of at least one month's duration, recurrent oropharyngeal candidiasis, and recurrent respiratory infections. 134 consecutively admitted children to one of the pediatric wards at the University Teaching Hospital in Lusaka were studied. The FUJIREBIO particle agglutination test, ELISA, and Western blot tests found 29 patients to be HIV-1-seropositive and 105 to be HIV-1-seronegative. Among the 29 HIV-seropositive patients, the Zambian criteria identified 23 and the WHO criteria identified 20 children as having AIDS. The 105 HIV-seronegative children were classified as having AIDS in 9 cases by the Zambian criteria and in 38 cases by the WHO criteria. These results indicate a sensitivity, specificity, and positive predictive value of 79.3%, 91.4%, and 86.8%, respectively, for the Zambian criteria for the diagnosis of AIDS, compared to 69%, 64%, and 38%, respectively, for the WHO criteria. The authors conclude that current WHO criteria are inadequate for the diagnosis of pediatric AIDS, and discuss the need to refine the WHO criteria for that diagnosis.
Int J STD AIDS
PMID:Case definitions for paediatric AIDS: the Zambian experience. 847 70

We conducted a mail survey of Thai physicians involved in obstetric care to assess attitudes and practices regarding zidovudine use during pregnancy and willingness to provide care for HIV-infected women in 1999. Of 845 respondents, 57% reported using perinatal zidovudine prophylaxis, an increase from 20% reported in 1997. Highest failure-to-use rates (52%) were among the respondents from Central and Southern Thailand and lowest failure rate was among those from the North (37%). Predictors of failure to use zidovudine in a multivariable logistic regression analysis were not knowing a source from which to obtain zidovudine (odds ratio [OR]=3.1), working in smaller hospitals (district/provincial/private hospitals) (OR=2.0), being from Eastern/Central/Southern Thailand (OR=1.4), unwillingness to perform caesarean section delivery on a HIV-positive women (OR=1.8), having provided antenatal care to fewer than 100 women in 1998 (OR=1.7), and unfamiliarity with Pediatric AIDS Clinical Trial Group 076 protocol (OR=2.9). A number of respondents described themselves as unwilling to perform pelvic examinations (15%), vaginal delivery (29%), or caesarean sections (37%) on HIV-infected pregnant women. About 39% of the respondents advocated elective terminations of pregnancy for HIV-infected women. Our survey indicates an increasing willingness of Thai physicians to use antiretroviral therapy to prevent mother-to-child HIV transmission and to provide obstetric care to HIV-infected women. However, availability and affordability remained major barriers to more widespread antiretroviral use in 1999.
Int J STD AIDS 2003 Jun
PMID:Mother-to-child HIV transmission prevention in Thailand: physician zidovudine use and willingness to provide care. 1281 69