ABSTRACT
Our aim was to analyze factors associated with non-adherence to antiretroviral (ARV) treatment among children and adolescents. A cross-sectional study was carried out involving non-institutionalized children and adolescents between 2 and 20 years of age, addressing non-adherence to ARV treatment, which was defined as taking ≤89% of the medications on the day of the interview and the three previous days. The investigation into the association between non-compliance and the variables of interest was performed using unconditional logistic regression. The independent factors associated with non-adherence were forgetfulness (OR = 3.22; 95%CI = 1.75-5.92), difficulties coping with treatment (OR = 2.65; 95%CI = 1.03-6.79), and living with grandparents (OR = 2.28; 95%CI = 1.08-4.83), whereas a protective effect was found with participation in multidisciplinary activities (OR = 0.49; 95%CI = 0.25-0.96), i.e., this factor indicates that the exposure to the variable is beneficial, promoting adherence. We concluded that forgetting to take the medications and reporting having difficulty coping with ARV treatment are potentially modifiable factors through educational and programmatic actions. Residing with one's grandparents may strongly impact adherence to ARV treatment, indicating the need for the systematic support of these family members. Participation in multidisciplinary activities should be stimulated at health-care services.
Subject(s)
Anti-HIV Agents/therapeutic use , Medication Adherence/statistics & numerical data , Patient Care Team , Patient Compliance , Adolescent , Antiretroviral Therapy, Highly Active , Brazil/epidemiology , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Self Report , Socioeconomic Factors , Young AdultSubject(s)
Humans , Child , Communicable Diseases , Infections , Vaccines , Fever , Sexually Transmitted Diseases , TuberculosisSubject(s)
Humans , Child , Communicable Diseases , Fever , Infections , Sexually Transmitted Diseases , Tuberculosis , VaccinesABSTRACT
HIV-1 genetic diversity information from a pediatric population is scarce. This study enrolled 128 children living with HIV/AIDS, 103 antiretroviral-treated and 25 naive, from the Sao Paulo metropolitan area. Gag, pol and env regions were amplified, and drug resistance mutations, V3 loop, tropism and viral clades were evaluated. Drug resistance mutations among naïve children infected by vertical transmission were uncommon (4.2%), whereas most ARV-experienced children showed extensive mutation patterns. Clade B predominated at the pol region, but the analysis of the three regions concatenated showed 28% with BF mosaic structures. The most common V3 motif was GPGR, followed by GWGR in clade B samples and GPGQ in clade F samples. A predicted X4 phenotype was observed in 27%, without correlation to HIV clade. These findings expand the limited information on molecular characteristics of HIV-1 among children living with HIV/AIDS in the area and may provide information useful for monitoring the epidemic.
Subject(s)
Genetic Variation , Genome, Viral , HIV Infections/virology , HIV-1/genetics , RNA, Viral/genetics , Adolescent , Amino Acid Sequence , Brazil , Child , Child, Preschool , Cluster Analysis , Drug Resistance, Viral , Female , Humans , Infant , Male , Molecular Sequence Data , Mutation, Missense , Phylogeny , Sequence Analysis, DNA , Sequence Homology , env Gene Products, Human Immunodeficiency Virus/genetics , gag Gene Products, Human Immunodeficiency Virus/genetics , pol Gene Products, Human Immunodeficiency Virus/geneticsABSTRACT
An unusual case of leptospirosis is described in a 19-month-old male child presenting with meningitis and acute renal failure without jaundice. Some aspects concerning the pathogenesis and treatment of this potentially life-threatening disease are also discussed. Leptospirosis was diagnosed on the basis of history and serological tests.
Subject(s)
Acute Kidney Injury/etiology , Meningitis, Bacterial/etiology , Weil Disease/complications , Acute Kidney Injury/diagnosis , Antibodies, Bacterial/blood , Humans , Infant , Leptospira interrogans serovar icterohaemorrhagiae/immunology , Male , Meningitis, Bacterial/diagnosis , Weil Disease/diagnosis , Weil Disease/immunologySubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Infectious Disease Transmission, Vertical , HIV Infections/diagnosis , HIV Infections/therapy , HIV Infections/transmission , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/therapy , Acquired Immunodeficiency Syndrome/transmissionSubject(s)
Humans , Enterovirus Infections , Virus Diseases , Poliovirus , Gastroenteritis , HIV Infections , Acquired Immunodeficiency SyndromeABSTRACT
As infecções fúngicas, em particular aquelas causadas por Candida spp, têm aumentado na população pediátrica hospitalizada e submetida a procedimentos de risco, determinando alta letalidade. O objetivo desse estudo foi caracterizar a população de crianças com diagnóstico de candidemia hospitalar num hospital pediátrico em São Paulo no período de janeiro de 1994 a dezembro de 1997, e identificar os fatores de risco para essa doença, através de um estudo caso-controle pareado. Quarenta crianças com cultura positiva para Candida spp foram identificadas e um controle (sem candidemia) foi selecionado para cada caso. A idade das crianças variou de dois dias a 14 anos e mais de metade dos casos (52,5 por cento) tinha idade inferior a seis meses. Além da C. albicans, foram isoladas C. tropicalis, C. parapsilosis, C. krusei e C. guilliermondi. A letalidade global foi de 57,5 por cento entre os casos e de 2,5 por cento nos controles. A analise univariada revelou 11 procedimentos de risco para a candidemia hospitalar: uso de cateter venoso (OR=17,00), sonda nasogástrica (OR=6,50), ventilação mecânica (OR=5,67), utilização de mais de cinco antibióticos na internação (OR=10,00), transfusão sanguínea (OR=5,00), permanência em UTI (OR=4,50), uso de vancomicina (OR=19,00), imipenem (OR=14,00), ceftazidime (OR=5,66), cefotaxime (OR=3,75) e metronidazol (OR=5,00). Para obter-se fatores provavelmente preditores para a infecção, inclui-se na análise, as variáveis clínicas e laboratoriais estatisticamente significativas encontradas: a presença de febre (OR=7,00), hepatomegalia (OR=4,00), candidíase oral e/ou perineal (OR=3,50), leucocitose (OR=4,25) e plaquetopenia (OR=18,70). Considerando-se o tamanho da amostra pareada, para a análise multivariada, obteve-se duas variáveis preditoras para a infecção fúngica, a saber: a presença de candidemia oral e/ou perineal (OR=4,29) e a utilização de cinco ou mais antimicrobianos (OR=11,32)
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Candidiasis/blood , Amphotericin B , Risk Factors , Cross InfectionABSTRACT
A autora estuda conceito, etiologia, epidemiologia e apresentação clínica das formas visceral e mucocutânea da leishmaniose, detendo-se nos diversos esquemas de tratamento modernamente disponíveis, considerando as drogas de primeira e segunda linhas, a terapêutica tópica e os critérios de cura.
Subject(s)
Humans , Amphotericin B , Leishmaniasis, Visceral , Administration, Topical , Antimony Sodium Gluconate/therapeutic use , Leishmaniasis, Mucocutaneous/epidemiology , Leishmaniasis, Mucocutaneous/etiology , Leishmaniasis, Mucocutaneous/drug therapy , Leishmaniasis, Mucocutaneous/therapy , Leishmaniasis , LeishmaniaABSTRACT
Análise das medidas preventivas e de controle das infecções no ambiente hospitalar, incluindo uma revisão histórica dos métodos de isolamento e atualização das técnicas e precauções hoje adotadas, compreendendo precauções-padrão, universais, entéricas, por contato, com drenagem e secreções, respiratórias, especiais para tuberculose, isolamento total e protetor, bem como a conduta técnica preconizada em cada caso.
