Health-related quality of life and functionality in primary caregiver of surviving pediatric COVID-19.

Objectives: To prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19. Methods: A longitudinal observational study was carried out on primary caregivers of surviving pediatric post-COVID-19 patients (n = 51) and subjects without COVID-19 (n = 60). EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 12-question WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) were answered for both groups. The univariate regression analysis was carried out using SPSS (v 20) and significance was established at 5%. Results: The median duration between COVID-19 diagnosis in children and adolescents and longitudinal follow-up visits was 4.4 months (0.8-10.7). The median age of children and adolescents caregivers with laboratory-confirmed COVID-19 was similar to primary caregivers of subjects without laboratory-confirmed COVID-19 [43.2 (31.6-60.9) vs. 41.5 (21.6-54.8) years, p = 0.08], as well as similar female sex (p = 1.00), level of schooling (p = 0.11), social assistance program (p = 0.28), family income/month U$ (p = 0.25) and the number of household's members in the residence (p = 0.68). The frequency of slight to extreme problems (level ≥ 2) of the pain/discomfort domain according to EQ-5D-5L score was significantly higher in the former group [74% vs. 52.5%, p = 0.03, OR = 2.57 (1.14-5.96)]. The frequency of disability according to WHODAS 2.0 total score was similar to those without disability and unknown (p = 0.79); however, with a very high disability in both groups (72.5% and 78.3%). Further analysis of primary caregivers of children and adolescents with post-COVID-19 condition (PCC) [n = 12/51 (23%)] compared to those without PCC [n = 39/51(77%)] revealed no differences between demographic data, EQ-5D-5L and WHODAS 2.0 scores in both groups (p > 0.05). Conclusion: We longitudinally demonstrated that pain/discomfort were predominantly reported in approximately 75% of primary caregiver of COVID-19 patients, with high disability in approximately three-quarters of both caregiver groups. These data emphasized the prospective and systematic caregiver burden evaluation relevance of pediatric COVID-19.

Circulating sTREM-1 as a predictive biomarker of pediatric multisystemic inflammatory syndrome (MIS-C).

The exacerbation of the inflammatory response caused by SARS-CoV-2 in adults promotes the production of soluble mediators that could act as diagnostic and prognostic biomarkers for COVID-19. Among the potential biomarkers, the soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been described as a predictor of inflammation severity. The aim was to evaluate sTREM-1 and cytokine serum concentrations in pediatric patients during the acute and convalescent phases of COVID-19. This was a prospective study that included 53 children/adolescents with acute COVID-19 (Acute-CoV group); 54 who recovered from COVID-19 (Post-CoV group) and 54 controls (Control group). Preexisting chronic conditions were present in the three groups, which were defined as follows: immunological diseases, neurological disorders, and renal and hepatic failures. The three groups were matched by age, sex, and similar preexisting chronic conditions. No differences in sTREM-1 levels were detected among the groups or when the groups were separately analyzed by preexisting chronic conditions. However, sTREM-1 analysis in the seven multisystemic inflammatory syndrome children (MIS-C) within the Acute-Cov group showed that sTREM-1 concentrations were higher in MIS-C vs non-MIS-C acute patients. Then, the receiver operating curve analysis (ROC) performed with MIS-C acute patients revealed a significant AUC of 0.870, and the sTREM-1 cutoff value of > 5781 pg/mL yielded a sensitivity of 71.4 % and a specificity of 91.3 % for disease severity, and patients with sTREM-1 levels above this cutoff presented an elevated risk for MIS-C development in 22.85-fold (OR = 22.85 [95 % CI 1.64-317.5], p = 0.02). The cytokine analyses in the acute phase revealed that IL-6, IL-8, and IL-10 concentrations were elevated regardless of whether the patient developed MIS-C, and those levels decreased in the convalescent phase, even when compared with controls. Spearman correlation analysis generated positive indexes between sTREM-1 and IL-12 and TNF-α concentrations, only within the Acute-CoV group. Our findings revealed that sTREM-1 in pediatric patients has good predictive accuracy as an early screening tool for surveillance of MIS-C cases, even in patients with chronic underlying conditions.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital.

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

Oral health-related quality of life of paediatric patients with AIDS.

BACKGROUND: Children with Acquired Immune Deficiency Syndrome (AIDS) exhibit impaired dental status, which can affect their quality of life. This study assessed the oral health-related quality of life of these patients and associated factors. METHODS: The "Child Perceptions Questionnaire 11-14", rating overall and domain-specific (oral symptoms, functional limitations, emotional well being, and social well being) oral health-related quality of life (OHR-QoL) was completed by 88 children with AIDS assisted in the Child Institute, Sao Paulo, Brazil. Parents or guardians provided behavioural and socio-demographic information. The clinical status was provided by hospital records. OHR-QoL covariates were assessed by Poisson regression analysis. RESULTS: The most affected OHR-QoL subscale concerned oral symptoms, whose rate was 23.9%. The direct answer for oral health and well being made up a rate of 47.7%. Brushing the teeth less than two times a day and viral load exceeding 10,000 HIV-RNA copies per millilitre of plasma were directly associated (p < 0.05) with a poorer oral health-related quality of life. CONCLUSIONS: Children with more severe AIDS manifestations complained of poorer status of oral symptoms, functional limitations, emotional and social well being related to their oral health. Recognizing the factors that are associated with poorer OHR-QoL in children with AIDS may contribute to the planning of dental services for this population.

Description of an HIV-1 BC recombinant virus identified in a pediatric patient in the city of São Paulo.

This case report refers to a 10-year-old HIV-1 infected patient, who was found to harbor a BC recombinant virus. This child lives in São Paulo and was infected by the mother-to-child route. Phylogenetic analyses revealed that this mosaic virus shares common breakpoints in the polymerase region with the recently published CRF31_BC.

Diarreia em criancas infectadas pelo HIV / Diarrhea in children HIV infected

OBJETIVO: rever a literatura atual acerca do tema, especialmente sua etiofisiopatogenia. Trata-se de ocorrencia ainda importante devido a sua morbi-mortalidade e consequente malabsorvicao e desnutricao. FONTES DE DADOS: realizou-se uma revisao bibliografica no Medline nos últimos 15 anos, dando-se ênfase aos artigos envolvendo a fisiopatologia e a etiologia da doenca gastrointestinal associada ao HIV. SINTESE DE DADOS: a doenca gastrointestinal na crianca infectada pelo HIV pode ocorrer por infeccoes entericas oportunistas ou por acao do proprio HIV. Os principais patogenos relacionados a diarreia incluem protozoarios (Cryptosporidium, Microsporidium), bacterias (Salmonella, Mycobacterium avium intracellulare, Clostridium difficile), fungos (Candida albicans, histoplasma capsulatum) e virus (rotavirus, citomegalovirus, adenovirus). Como consequencia da infeccao enterica, ocorre lesao intestinal, malabsorcao e desnutricao, o que contribui ainda mais para a disfuncao imune. Em 1/3 dos casos nao se consegue identificar o agente patogenico. O tratamento inclui dieta, uso de antimicrobianos e antivirais, alem de agentes antidiarreicos. CONCLUSAO: felizmente, com a introducao do HAART (Hard Active Antiretroviral Therapy) houve uma drastica reducao na prevalencia das infeccoes entericas nas criancas infectadas pelo HIV, embora, especialmente no continente africano, ainda se constitua em importante causa de morte

Trombocitopenia Associada ao HIV / HIV-Associated Thrombocytopenia

OBJETIVO: rever a literatura atual acerca do tema, especialmente seu tratamento. Trata-se de ocorrencia importante na pratica linica do infectologista pediatrico, frequente e de dificil manejo, frente a refratariedade e efeitos adversos serios dos tratamentos atualmente disponiveis. FONTES DE DADOS: realizou-se uma revisao bibliografica no Medline nos ultimos 10 anos, dando-se enfase aos artigos envolvendo a fisiopatologia e o tratamento da trombocitopenia associada ao HIV. SINTESE DE DADOS: o quadro clinico e similar ao da purpura trombocitopenica imune e inclui sangramentos prodeminantemente da pele e mucosas e hemorragia gastro-intestinal. A trombocitopenia e geralmente leve com contagem plaquetaria entre 50 e 100.000/mm3. A fisiopatologia envolve basicamente dois mecanismos: infeccao dos megacariocitos pelo HIV, levando a insuficiencia medular e destruicao imunologica devido a deposicao de imuno-complexos plaquetarios ou ligacao auto-anticorpo especifica. O tratamento inclui o uso de corticoides, gamaglobulina intra-venosa, esplenectomia, irradiacao esplenica, imunoglobulina anti-D, AZT e terapia combinada altamente efetiva (HAART). CONCLUSAO: A trombocitopenia associada ao HIV parece ser uma entidade clinica distinta da purpura trombocitopenica imune classica com mecanismos fisiopatologicos complexos e tratamento dificil, constitui-se num verdadeiro desafio ao pediatra

Pneumonia por S. pneumoniae em criancas infectadas pelo HIV / S. pneumoniae pneumonia in HIV - infected children

A pneumonia e uma doenca prevalente em criancas, especialmente nas infectadas pelo HIV. O Streptococcus pneumoniae e o patogeno mais frequente. No Brasil, a sensibilidade desse agente a penicilina permanece favoravel observando-se boa resposta ao tratamento das pneumonias com o seu uso. O objetivo desse trabalho e avaliar a prevalencia de pneumonias pelo S.pneumoniae obtido em hemocultura, em criancas HIV, acompanhadas na Infectologia ICR-HCFMUSP, internadas no periodo de janeiro/1988 a julho/2001. Estudo descritivo, retrospectivo atraves de revisao de prontuarios, avaliando-se o numero de episodios de pneumonias comunitarias, distribuicao quanto a idade, sexo, categoria clinico-imunologica (criterios CDC), tratamento empirico e final, complicacoes, isolamento do agente etiologico e perfil de sensibilidade a penicilina para o pneumococo

A supressao do Aleitamento materno e o HIV / Breast feeding suppression and HIV

O crescimento da epidemia de AIDS entre as mulheres levou, consequentemente, ao aumento do numero de casos em criancas, pois a grande maioria e devido a transmissao vertical do hiv, cuja probalidade de ocorrencia foi demonstrada em varios estudos. Foi evidenciado que a maioria dos casos, cerca de 65 porcento, ocorre durante o trabalho de parto e no parto propriamente dito e os 35 porcento restantes ocorrem intra-utero, principalmente nas ultimas semanas de gestacao; o aleitamento materno representa risco adicional de transmissao de 7 porcento a 22 porcento. A evidencia de transmissao do HIV pela amamentacao levou o Ministerio da Saude a contra-indicar o aleitamento materno por mulheres portadoras do HIV, assim como o aleitamento cruzado (feito por outra mulher). O presente artigo apresenta consideracoes sobre a utilizacao do teste rapido para pesquisa do HIV nas parturientes e sobre a importancia da supressao da lactacao nas mulheres HIV+, descrevendo os metodos que podem ser recomendados

[Sexuality of women living with HIV/AIDS in São Paulo]. / Sexualidade de mulheres vivendo com HIV/AIDS em São Paulo.

The social and cultural setting which increases female vulnerability to HIV does not disappear when women living with HIV/AIDS discover that they are infected. Following diagnosis, new challenges arise in their emotional lives, an issue which has received little attention in the literature. This study interviewed 1068 women living with HIV/AIDS using a questionnaire consisting of both open and closed questions, aimed at describing aspects of their sexual and reproductive lives and how they perceive counseling at Reference Centers in two cities in the State of São Paulo, where they have access to free antiretroviral therapy. Of the women with stable sexual partners, 63% used condoms in all their sexual relations, or three times the national average; 43% of the partners were HIV-negative and 14% had unknown serological status; 73% of the women had children and 15% were considering becoming pregnant. Knowledge on mother-to-child transmission was less than expected, and the interviewees complained of limited space and receptiveness for discussing sexuality, especially with regard to their childbearing wishes. Counseling on sexuality should be a continuing process and requires interdisciplinary training for the professional team working in health care services, with an emphasis on sexual and reproductive rights.

Balanço de energia em lactentes filhos de mães soropositivas para o HIV / Energy balance in infants child of HIV positive mothers

Objetivo: o Balanço de Energia (BE) é um bom marcador para avaliar as necessidades de nutrientes em crianças. Os lactentes portadores da Síndrome da Imunodeficiência Adquirida (Aids), causada pelo vírus da Imunodeficiência Humana (HIV), recebem uma melhor atenção nutricional quando essa técnica é aplicada rotineiramente. Casuística e Métodos: as determinações do BE foram realizadas, prospectivamente, em 13 lactentes, filhos de mães HIV positivas. Até a definição diagnóstica de infecção pelo HIV, isso ocorreu em duas oportunidades. O intervalo entre os dois balanços variou de 2 a 6 meses. O grupo era constituído por sete crianças do sexo masculino e seis do feminino. Após a definição diagnóstica da infecção pelo HIV, pode-se subdividir o grupo em um subgrupo de infectados (5/13) e um outro de Não-Infectados (8/13). Resultados: do ponto de vista antropométrico, as crianças infectadas apresentaram maior comprometimento nutricional nas duas avaliações efetuadas. Os valores médios da energia ingerida (kcal/kg/dia) e da energia fecal (kcal/kg/dia) dos dois grupos, separadamente, e quando comparados entre si, foram semelhantes nas duas avaliações. Os valores médios do Gasto Energético de Repouso (obtidos por técnica de calorimetria indireta) em kcal/kg/dia do grupo dos Infectados foram maiores que aqueles do grupo dos Não-infectados nas duas avaliações, de maneira significante: 64.5±16.8 vs 48.0±5.7 (p<0.05) na primeira, e 68.0±11.7 vs 51.8±3.1 (p<0.05) na segunda avaliação, respectivamente. Discussão e Conclusão: o aumento do Gasto Energético de Repouso nas crianças infectadas deve ser considerado como responsável pela desnutrição mais acentuada dessas crianças, podendo ser identificado em fase precoce, mesmo antes do diagnóstico definitivo da infecção pelo HIV. Esta constatação tem grande utilidade para o manuseio nutricional dessas crianças.

Vaccine-associated paralytic poliomyelitis: a case report of domiciliary transmission

Poliomyelitis associated with live strain vaccine is defined as the paralytic form of the acute anterior poliomyelitis related to the vaccine strain. Since these strains behave similarly to the wild-type virus, we can differentiate, epidemiologically, two types of vaccine-associated poliomyelitis: cases in which the patient was vaccinated and cases in which the patient had had contact with vaccinated individuals. We herein present the case of an unvaccinated child, with a clinical picture of an acute anterior poliomyelitis associated with the live strain vaccine, whose brother received the Sabin vaccine 20 days before the onset of the symptoms. Vaccine strain of the type 3 poliovirus was isolated in fecal culture and a presented mutation in nucleotide 472 (C(r)U) in the 5' non-coding region, which is strongly related to the higher strain virulence

Balanço de energia em lactentes filhos de mães soropositivas para o HIV / Energy balance in infants born from HIV seropositive mothers

Objetivo: A avaliação nutricional de lactentes filhos de mães soropositivas para o HIV foi efetuada durante seguimento clínico e investigação diagnóstica. Os balanços de energia (BE) das crianças infectadas e não-infectadas pelo HIV foram comparados. Métodos: As determinações do BE (energia ingerida, energia fecal e gasto energético de repouso, determinados por calorimetria indireta) foram realizadas prospectivamente em 13 lactentes filhos de mães soropositivas para o HIV (6 meninas e 7 meninos), com idades entre 1 e 6 meses. Isso ocorreu em duas oportunidades: antes e depois da definição diagnóstica da criança. Uma avaliação nutricional completa, incluindo exame físico e medidas antropométricas (peso, estatura e pregas cutâneas), também foi realizada nessas duas etapas. Com a definição diagnóstica as crianças foram divididas em dois grupos: infectados (5/13) e não infectados (8/13). As crianças foram seguidas em ambulatório durante todo o estudo, e atendidas mensalmente para avaliação clínica e orientação. Resultados: Do ponto de vista antropométrico, as crianças infectadas apresentaram maior comprometimento nutricional nas duas avaliações efetuadas. Os valores médios do gasto energético de repouso em kca/kl/dia das crianças infectadas foram maiores que aqueles das não infectadas nas duas avaliações, de maneira significante: 64.5ñ16.8 vs 48.0ñ5.7 (p<0.05) na primeira e 68.0 ñ 11.7 vs 51.8 ñ 3.1 (p<0.05) na segunda avaliação, respectivamente. Conclusões: O aumento do gasto energético de repouso do grupo das crianças infectadas pelo HIV deve ser considerado resposável pela desnutrição mais acentuada dessas crianças, podendo ser identificado precocemente, mesmo antes do diagnóstico definitivo da infecção pelo HIV. Essa constatação tem grande utilidade para o manuseio nutricional dessas crianças

Human cryptosporidiosis: detection of specific antibodies in the serum by an indirect immunofluorescence

Utilizando a técnica de imunofluorescência indireta, foram demonstradas imunoglobulinas G e M, no soro humano, contra o Cryptosporidium, coccídeo implicado recentemente como agente de doença intestinal humana, principalmente em pacientes imunocomprometidos. Foi obtida positividade de 62 por cento para imunoglobulinas G e M nos soros das crianças imunocompetentes com oocistos nas fezes, e, respectivamente, 20 por cento e 40 por cento, nos soros das crianças sem oocistos. Nos pacientes adultos, com o vírus da imunodeficiência humana e excreçäo fecal do parasita, foram encontrados índices de positividade de 57 por cento da IgG mas apenas 2 por cento para IgM e aqueles com excreçäo näo determinada apresentaram 23 por cento da IgG. Crianças com o vírus da imunodeficiência humana, apresentaram apenas 14 por cento da IgG e foram negativas quanto à IgM. Os resultados apontaram para a utilidade do teste, associado a outras técnicas parasitológicas, em estudos populacionais retrospectivos ou diagnósticos na infecçäo aguda e, ainda, que a resposta imune humoral a este protozoário necessita de maiores investigaçöes, nos pacientes imunocomprometidos, principalmente crianças