Estudio de costos de la atención odontológica en niños infectados con VIH o con SIDA / A study of the costs of dental care in HIV-infected children or children with AIDS

Alrededor de un tercio de las mujeres embarazadas e infectadas por el VIH trasmitirán el virus a sus hijos, ya sea en el útero, durante el parto o la lactancia. El costo de los programas de prevención de la transmisión vertical dependen tanto de la fecundidad como de la prevalencia de la infección por VIH. El objeto del presente estudio fue determinar el costo-beneficio de la incorporación de la atención odontolólgica con fuerte componente preventivo para caries dental en niños infectados por VIH. La muestra estuvo integrada por dos grupos de niños infectados: (Grupo A) 40 niños entre 5 y 13 años de edad bajo atención odontológica con fuerte componente preventivo durante 2 años y /Grupo B) 40 niños de edades similares que recién se incorporaban a la atención odontológica. En ambos grupos fue establecido el CPOD + ceod y el INTC (Bordoni et al, 1993) y se determinó el costo-beneficio del programa aplicado. Los resultados revelaron: (a) la media del CPOD + ceod del Grupo A fue significativamente menor que la del Grupo B; (b) la moda del índice de necesidad de tratamiento para el grupo A fue de 03, mientras que para el Grupo B ascendió a 09. El estudio de costo-beneficio de la atención necesaria más la acumulada en el grupo A comparado con el costo de la atención necesaria para los niños del grupo B estableció una relación entre 1:3. Esto permite inferir que la atención con fuerte componente preventivo alcanza buena relación costo-beneficio para el mantenimiento de niveles aceptables de caries dental en niños con infección por VIH (AU)

Estudio de costos de la atención odontológica en niños infectados con VIH o con SIDA / A study of the costs of dental care in HIV-infected children or children with AIDS

Alrededor de un tercio de las mujeres embarazadas e infectadas por el VIH trasmitirán el virus a sus hijos, ya sea en el útero, durante el parto o la lactancia. El costo de los programas de prevención de la transmisión vertical dependen tanto de la fecundidad como de la prevalencia de la infección por VIH. El objeto del presente estudio fue determinar el costo-beneficio de la incorporación de la atención odontolólgica con fuerte componente preventivo para caries dental en niños infectados por VIH. La muestra estuvo integrada por dos grupos de niños infectados: (Grupo A) 40 niños entre 5 y 13 años de edad bajo atención odontológica con fuerte componente preventivo durante 2 años y /Grupo B) 40 niños de edades similares que recién se incorporaban a la atención odontológica. En ambos grupos fue establecido el CPOD + ceod y el INTC (Bordoni et al, 1993) y se determinó el costo-beneficio del programa aplicado. Los resultados revelaron: (a) la media del CPOD + ceod del Grupo A fue significativamente menor que la del Grupo B; (b) la moda del índice de necesidad de tratamiento para el grupo A fue de 03, mientras que para el Grupo B ascendió a 09. El estudio de costo-beneficio de la atención necesaria más la acumulada en el grupo A comparado con el costo de la atención necesaria para los niños del grupo B estableció una relación entre 1:3. Esto permite inferir que la atención con fuerte componente preventivo alcanza buena relación costo-beneficio para el mantenimiento de niveles aceptables de caries dental en niños con infección por VIH

Purpuric phototherapy-induced eruption in transfused neonates: relation to transient porphyrinemia.

OBJECTIVE: Blue light phototherapy is commonly administered to neonates as treatment of indirect hyperbilirubinemia, often in conjunction with blood transfusions to treat hemolytic anemia. We observed a distinctive cutaneous complication of phototherapy in six neonates with hyperbilirubinemia. METHODOLOGY: We studied the clinical and histologic characteristics of the eruption, as well as the porphyrin levels in affected neonates. Five of the patients had erythroblastosis fetalis; the other had profound anemia from twin-twin transfusion. All of the neonates developed purpuric patches at sites of maximal exposure to the phototherapy lights, with dramatic sparing at shielded sites within 24 hours after initiation of the phototherapy. On discontinuation of phototherapy, all eruptions cleared within 1 week. Examination of skin biopsy sections showed purpura without significant inflammation or keratinocyte necrosis. Plasma porphyrins (copro- and proto-) were elevated in the two patients in which they were assessed. CONCLUSIONS: The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.

Neonatal acute hemorrhagic edema of childhood: case report and review of the English-language literature.

Acute hemorrhagic edema of childhood is an unusual form of leukocytoclastic vasculitis previously reported in children age 4 months to 3 years. The etiology remains unknown, however, many authors describe the process as an immune-mediated vasculitis in response to a variety of antigenic stimuli. We report a case of congenital acute hemorrhagic edema of childhood associated with maternal gastroenteritis six weeks before delivery.

Linear IgA bullous dermatosis. Characterization of a subset of patients with concurrent IgA and IgG anti-basement membrane autoantibodies.

BACKGROUND AND DESIGN: The term linear IgA bullous dermatosis defines an immune-mediated blistering skin disease characterized by pruritic blisters, subepidermal separation with neutrophilic infiltration, and linear IgA antibody deposition at the basement membrane zone (BMZ). However, some patients with linear IgA bullous dermatosis demonstrate both IgA and IgG anti-BMZ autoantibodies on immunofluorescence. We describe four such patients and attempt to define this group of patients by studying their clinical, histopathologic, immunopathologic, immunoultrastructural, and immunochemical characteristics. RESULTS: Clinically, all four patients had a generalized pruritic blistering skin disease consistent with linear IgA bullous dermatosis. Histopathologically, all four cases demonstrated subepidermal blister formation with a predominantly neutrophilic dermal infiltrate. Immunopathologically, tissue-bound IgA (in four of four patients) and IgG (in three of four patients) antibodies were detected at the BMZ. Circulating IgA (in four of four patients) and IgG (in four of four patients) labeled the epidermal BMZ of normal human skin fractured at the lamina lucida and did not label the dermal BMZ. By immunoblot analyses, IgA (in three of three patients) and IgG (in one of three patients) circulating antibodies labeled the 97-kd linear IgA bullous dermatosis antigen. By direct immunoelectron microscopy, IgA and IgG antibodies were localized (in two of two patients) exclusively within the upper lamina lucida of the BMZ. CONCLUSIONS: Four cases of an immune-mediated blistering skin disease typical for linear IgA bullous dermatosis demonstrated both IgA and IgG anti-BMZ autoantibodies against the linear IgA bullous dermatosis antigen within the upper lamina lucida. We conclude that linear IgA bullous dermatosis should include a subgroup of patients with both IgA and IgG anti-BMZ autoantibodies.

Congenital apocrine hamartoma: an unusual clinical variant of organoid nevus with apocrine differentiation.

Congenital apocrine hamartomas are rare tumors of the skin composed of mature apocrine glands in the papillary and reticular dermis. Several cases have been reported in the literature but few were of uniform clinical appearance. The term apocrine nevus has been used interchangeably with apocrine hamartoma in the literature, however, based on their distinctive morphologies we believe they are different entities. We describe a 7-year-old girl with a congenital apocrine hamartoma of the left cheek. A stained biopsy specimen from the lesion revealed large mature apocrine glands with decapitation secretion in the dermis. The presence of periodic acid-Schiff-positive, diastase-resistant granular material in the apical cytoplasm of some secretory cells helped differentiate these as apocrine glands. We think this lesion may represent a form of organoid nevus with pure apocrine differentiation.

Localized linear bullous eruption of systemic lupus erythematosus in a child.

A 9-year-old girl newly diagnosed with systemic lupus erythematosus (SLE) developed a localized linear papulovesicular eruption over the right dorsal hand and ulnar forearm. The skin findings were clinically suggestive of herpes zoster, lichen striatus, or lichen planus-lupus erythematosus overlap. However, histologic, immunofluorescent, immunoelectron microscopic, and immunoblot studies revealed findings compatible with bullous SLE. Our patient is noteworthy because she is the first one reported with bullous SLE presenting in a localized linear pattern. She is also the second-youngest reported patient with bullous SLE.

Hand-foot syndrome associated with liposome-encapsulated doxorubicin therapy.

BACKGROUND: Acquired immune deficiency syndrome (AIDS)-related Kaposi's sarcoma (KS) is a common complication of patients infected with human immunodeficiency virus and can cause significant morbidity. Long term therapy with standard chemotherapeutic regimens has been limited by relatively short durations of response and potential toxicity. Once therapy is discontinued, the disease typically progresses. Liposome-encapsulated doxorubicin (DOX-SL) currently is being evaluated for treating patients with AIDS-related KS. Early reports suggest a high response rate and good patient tolerance permitting continued therapy for extended periods. METHODS: Patients with AIDS-related KS are treated with a DOX-SL regimen every 2-3 weeks and are followed carefully for evidence of adverse treatment effects. RESULTS: Two cases of hand-foot syndrome (HFS) in patients receiving DOX-SL for AIDS-related KS are reported. Tissue studies demonstrated changes consistent with a toxic effect of the drug on keratinocytes. Hand-foot syndrome was reversible once treatment stopped; however, treatment cessation resulted in primary disease recurrence. CONCLUSIONS: Hand-foot syndrome can be debilitating and may be a limiting factor in the prolonged use of DOX-SL for AIDS-related KS for some patients. It is critical for clinicians using this drug to identify this side effect to limit HFS-associated morbidity.

Disseminated Rhizopus infection in a premature infant.

A 16-day-old premature male infant developed rapidly expanding necrotic facial plaques. Histology and cultures of tissue biopsy specimens revealed infection with Rhizopus arrhizius. The patient was treated aggressively with surgical debridement, amphotericin B, and rifampin, but had a progressive spread of the cutaneous infection and a fatal clinical course. He had gastrointestinal and pulmonary involvement on autopsy. Zygomycoses are rapidly progressive infections which generally affect immunocompromised hosts. Premature infants should be included as individuals at risk for disseminated zygomycotic disease.

Hereditary benign telangiectasia.

We describe a father and two daughters with hereditary benign telangiectasia. Both girls had numerous telangiectases distributed over the upper limbs, trunk, face, and vermilion border of the lips. The father displayed less extensive lesions and had been unaware of their presence. All three patients were in good health; the younger daughter had a past history of mild recurrent epistaxis. Differentiation of this benign entity from other primary telangiectatic disorders is discussed.

Hydroa vacciniforme. Diagnosis by repetitive ultraviolet-A phototesting.

Hydroa vacciniforme is a rare disorder manifested in early childhood by recurrent photoinduced vesicles that heal with scarring. We report a case in which repetitive exposures to artificial ultraviolet light in the A range reproduced the clinical findings induced by natural sunlight. Phototesting may be viewed as an important diagnostic aid, as the induction of lesions clinically identical to hydroa vacciniforme can provide a reliable criterion for the diagnosis.

Ichthyosis follicularis with alopecia and photophobia.

We treated two unrelated boys with ichthyosis follicularis, a rare skin disorder characterized by extensive noninflammatory spiny follicular hyperkeratoses, severe photophobia, and generalized noncicatricial alopecia. This disorder must be differentiated from keratosis follicularis spinulosa decalvans; ulerythema ophryogenes; keratosis pilaris rubra atrophicans faciei; atrichia with papular lesions; atrophodermia vermiculata; and keratitis, ichthyosis, and deafness syndrome, all of which share some clinical features. Ichthyosis follicularis with alopecia and photophobia appears to be a familial disorder, but too few cases have been reported to establish the exact mode of inheritance.