Advances in paediatric anaesthesia include the availability of dedicated facilities with appropriate equipment, monitoring and specialised personnel trained in paediatric anaesthesia and resuscitation. These developments have contributed to the reduction in perioperative risk for paediatric patients. However, access to all the resources available in dedicated paediatric facilities is limited in resource-constrained settings. The objective of this review is to provide guidance with regard to the selection of suitable facilities for perioperative care, risk stratification and patient selection, safe selection of medication and standardisation of its use, and implementation of specific anaesthetic techniques that can minimise risk in the paediatric surgical population.

OBJECTIVE: To measure the prevalence, severity and morbidity of neuropathic pain in AIDS patients, prior to the initiation of antiretroviral (ARV) therapy. DESIGN: A prospective, cross-sectional and descriptive-analytical study. SETTING: The Kalafong Hospital HIV Clinic in Pretoria. SUBJECTS: All patients with confirmed AIDS who were referred to the Kalafong HIV clinic to be initiated on ARV therapy during the period August 2006 to March 2007. OUTCOME MEASURES: Data were collected regarding the presence and severity of neuropathic pain in each subject. Pain of predominantly neuropathic origin (POPNO) was identified using the Neuropathic Pain Diagnostic Questionnaire (DN4). Numerical rating scales (NRS), adapted from the Brief Pain Inventory, were used to measure pain severity and pain-related interference with six aspects of daily living. RESULTS: Of the 354 patients studied, 20.9% (95% confidence interval (CI) 16.8 - 25.2%) had POPNO. This pain was significantly more frequent in patients who were male, had lower CD4+ counts or higher viral load levels, and those on TB treatment. Eighty per cent of patients with POPNO experienced significant pain (worst pain severity >5 out of 10 on a NRS). Pain-related interference was highest for enjoyment of life, mood and ability to work. There was a significant positive correlation between severity of pain and pain-related interference for all domains of daily living evaluated. CONCLUSIONS: POPNO results in significant suffering and impaired functioning in patients with AIDS. It is therefore imperative that clinicians assess patients with AIDS for the presence and severity of neuropathic pain and manage it, using the most recent evidence-based guidelines.

Culturas de tecido de embrião de galinha foram contaminadas com Schizotrypanum de diversas procedências. Serviram como material de contaminação, culturas em tubos de agar-sangue e em um caso sangue parasitado de cobaia. Os transplantes de tecidos foram mantidos em cultura de acordo com a técnica de Carrel, ligeiramente modificada. Os tecidos usados foram baço, miocárdio, fígado, epitélio da iris, gânglio espinhal e monócitos do sangue de galinha adulta. Em todos estes tecidos o Schizotrypanum foi facilmente cultivado, parasitando os diferentes tipos de células existentes: fibroblastos, histiocitos, macrófagos, células epiteliais, células nervosas, etc. Os autores puderam seguir o ciclo completo do parasito, confirmando os conhecimentos clássicos da sua evolução no tecido: transformação em leishmânia, multiplicação por divisão binária, transformação em critídia e finalmente em tripanosoma adulto. Também observaram formas parasitárias que aparentemente evoluiram diretamente da forma de leishmânia à de tripanosoma, sem passar por critídia. Conseguiu-se a infecção de um camondongo inoculado com S. cruzi de origem humana passado por cultura de tecidos. Os autores também estudam diferentes fenômenos observados nas relações entre as células e os parasitos.

Chick embryo tissue cultures were smeared with Schizotrypanum from different sources. The cultures were inoculated with flagellates from blood-agar cultures and in one instance from blood of an infected guinea-pig. Carrel’s technique of tissue culture, with slight modifications, was employed. The tissue used were spleen, myocardium, liver, epithelium of the iris, spinal ganglion and monocytes from chicken blood. In all these tissues the flagellate developed easily, parasitizing different types of cells: fibroblasts, histiocytes, macrophages, epithelial cells, cells of the nervous system, etc. The authors were able to follow the complete cycle of the parasite, observing its classic evolution: transformation into leishmania, multiplication by binary division, transformation into crithidia and finally into trypanosome. They also observed forms of the parasite which possibly developed directly from leishmania to trypanosome without apparently going through the crithidia stage. They succeeded in infecting a white mouse with a human strain of S. cruzi after passage through tissue culture. The authors also pointed out different phenomena observed in the relations between the cells and the parasites.