11/38. Congenital rubella cataract: a timely reminder in the new millennium? Maternal infection with rubella in the first trimester is an important cause of congenital cataract. Any injury affecting the foetus following maternal rubella infection in the phase of organogenesis results in congenital defects collectively termed as congenital rubella syndrome (CRS). Although rubella embryopathy is a less common cause for congenital cataract than in the past, it is still seen. The number of cases reduced to one in 1997 after which there were no new cases till 2002. However, there have been two new cases of CRS in 2003. Herein another one in early 2004 is reported. Outbreaks of CRS will continue until the percentage of susceptible individuals is reduced to a minimum through immunization. The majority of rubella cases in australia are confined to young female immigrants, many coming for marriage. We must continue to immunize children, identify and immunize vaccine failures and susceptible women before they become pregnant, and to screen pregnant women so they can be vaccinated after delivery. ( info) |
12/38. Duodenal stenosis, a new finding on congenital rubella syndrome: case description and literature review. Congenital rubella syndrome (CRS) continues to represent a public healthcare problem although an effective vaccination program. Gastrointestinal involvement is rather infrequent and the association of CRS with duodenal stenosis has been never reported. In this study a case of CRS with duodenal diaphragm is reported and the gastrointestinal diseases described in association with CRS are reviewed. A 10-month-old child affected by CRS with congenital hearth disease, perceptive deafness and microcephaly, was admitted because of vomiting and failure to thrive. An upper endoscopy demonstrated dilated proximal duodenum and a perforated diaphragm in the second segment of the duodenum. Endoscopic membranectomy was therefore performed. Two months later the patient was submitted to a further endoscopic evaluation that showed a partial diaphragm persistence and a second excision was performed. Follow-up one year after the first treatment showed good clinical conditions, reasonable physical growth and disappearance of vomiting. In conclusion we report the first case of CRS in association with duodenal stenosis. Duodenal stenosis in the absence of other intestinal localizations may be due to rubella capacity of infecting only small numbers of fetal cells but we cannot exclude that the duodenal stenosis in our patient be only a casual association. ( info) |
13/38. Blueberry muffin syndrome owing to congenital rubella: case report. A case of congenital rubella is reported in a 22-day-old boy presenting with a 'blueberry muffin' rash. Late-onset blueberry muffin syndrome following congenital rubella is very rare. ( info) |
14/38. Congenital rubella syndrome with positive serology and virus isolation. An effective live attenuated rubella vaccine was available since 1969 and congenital rubella syndrome can be prevented with appropriate vaccination. We report a baby with congenital rubella syndrome born in Klang valley to indicate that the Universal Rubella vaccination Programme adopted by the Ministry of Health malaysia since 2002 has yet to achieve its effect of eliminating transmission of rubella and preventing congenital rubella infection in the community. To our knowledge, the virus isolate represents the first successful isolation of rubella virus in this country and will serve as the reference strain for future comparison in molecular epidemiological tracking of rubella virus activity this country. ( info) |
15/38. Confirmed congenital rubella syndrome--A case report. BACKGROUND: Congenital Rubella syndrome (CRS) is defined clinically as an illness usually manifesting in infancy, resulting from rubella infection in utero with certain specific signs and symptoms. Confirmed CRS is a clinically consistent case which is laboratory confirmed. A report of a 3 month old male diagnosed with confirmed congenital rubella is here presented on account of its rarity and easy prevention with vaccination. METHOD: The case notes of 3 month old male admitted with features consistent with CRS and managed for overwhelming septicaemia with heart failure and encephalitis and review of literature on the subject using manual library and medline search. RESULT: The infant's Rubella-specific immunoglobulin m (IgM) antibody demonstrated positive and the rubella antibody level was high at 11.6 IU/ml. CONCLUSION: This is the first report of confirmed CRS in our centre. Though few cases are seen, the effects and defects on the child are severe and irreversible thus, vaccination with measles-mump-rubella (MMR) vaccine is recommended as part of the National Programme on immunization and for all females of child bearing age, who did not receive it in childhood. ( info) |
16/38. The use of contingent water misting in the treatment of self-choking. A 25-year-old, deaf-blind, mentally retarded male was treated for chronic self-choking using water mist treatment and positive reinforcement. During pre-treatment baseline, self-chokes occurred at a rate of 2.09 per minute. During treatment sessions each self-choke was followed by water misting of the subject's face paired with a forceful "No!". Periods of 20 sec absent of self-chokes were positively reinforced with liquids and/or social contacts. Treatment procedures were generalized from the initial therapists, location, and absence of other clients and staff to other locations, and the presence of other clients and staff. water mist treatment was associated with at least a 10-fold and as much as a 100-fold reduction of self-choking (i.e. to 0.02-0.20 self-chokes per min) across treatment and generalization phases. Eight-month follow-up observations showed that self-choke rates were at zero. ( info) |
| neuroimaging observations of three infants with congenital rubella syndrome are reported. We have observed congenital rubella syndrome lesions in the subependymal area, the basal ganglia and the deep white matter. Cranial ultrasonography defines subependymal cysts, calcification and possible vascular changes in the basal ganglia while MRI is the most sensitive to minor atrophic changes and white matter lesions. Although CT defines calcification, it is less sensitive than MRI to white matter changes and does not demonstrate subependymal cysts. ( info) |
18/38. A preventable case of congenital rubella syndrome and its public health implications. A failure to provide rubella immunization prior to conception, followed by failure to diagnose typical rubella during the first trimester of pregnancy, resulted in a case of congenital rubella syndrome. The ensuing malpractice suit was settled out of court 11 years later. Several reasons for the failure of prevention and diagnosis are discussed, along with the implications of the case for rubella prevention today. ( info) |
19/38. Successful haemodialysis via an unusually sited subclavian catheter. A 38-year old woman with a history of congenital rubella required temporary venous access for haemodialysis. A left sided subclavian catheter was inserted percutaneously and on check radiography it was found to be on the left side of the mediastinum. Contrast radiography showed that the catheter was in a left sided superior vena cava which drained into the right atrium via the coronary sinus. Haemodialysis was performed without any difficulty. ( info) |
20/38. Symptomatic rubella re-infection in early pregnancy and subsequent delivery of an infected but minimally involved infant. A case report. A case of serologically proven symptomatic rubella re-infection in early pregnancy in a healthy multigravida who had been successfully vaccinated is reported to illustrate that the risk to the fetus is considerably less than with primary infection. The infant was infected, as evidenced by specific IgM in cord blood, but had no stigmata of congenital rubella at birth. growth retardation was apparent at 6 months and hearing loss, not necessarily due to rubella, was detected at 8 months. Rubella re-infection, which may now be distinguished serologically by the urea degradation test from primary rubella, need not necessarily be an indication for termination of pregnancy. ( info) |