Nosocomial Infection Among Children With Symptomatic Human Immunodeficiency Virus Infection

A prospective cohort study was conducted during a 15-month period to compare nosocomial infections (NIs) among pediatric patients without (n = 989) and with (n = 50) symptomatic human immunodeficiency virus (HIV) infection. Patients with symptomatic HIV infection presented higher overall NI incidence density rates (relative risk, 1.65; P = .0001), and may represent a population at high risk for the acquisition of N

Translation and cultural adaptation of the Modified-University of California at Los Angeles Shoulder Rating Scale to portuguese language

OBJECTIVES: the aims of this study were to translate into Brazilian-Portuguese the Modified - University of California at Los Angeles Shoulder Rating Scale and to cross-culturally adapt it to the Brazilian environment. METHODS: the scale was translated to Portuguese and back translated into English according to internationally recommended process described by Guillemin et al(28). The translated and revised version was administered to two groups (patients between 45 and 75 years old and health professionals) to evaluate the comprehension level of the items. If 15% or more of health professionals or patients reported difficulty in understanding, that item was reformulated and reapplied. RESULTS: we did three applications. Each group had 20 consecutive people, totalizing 120 people. To obtain the final Brazilian version, we modified five items in the pain parameter and four in the function parameter. Beyond these alterations, we identified problems about the structure suggesting that we need to continue the validity and possible modifications of this scale.OBJETIVOS: os objetivos deste estudo foram traduzir a versão original da avaliação funcional de ombro Modified-University of California at Los Angeles Shoulder Rating Scale da língua inglesa para a portuguesa e adaptar culturalmente à população brasileira. MÉTODOS: a escala foi traduzida e adaptada culturalmente para a população brasileira de acordo com a metodologia internacionalmente aceita descrita por Guillemin et al(28). A versão traduzida e revisada pelo comitê foi aplicada em dois grupos (indivíduos leigos com idade entre 45 e 75 anos e profissionais da saúde) para avaliação do nível de compreensão das alternativas. Encontrando 15% ou mais de alternativas não-compreendidas, os termos foram substituídos por palavras equivalentes de modo que não fossem alterados conceito, estrutura e propriedade de base do instrumento, e reaplicadas até que valores menores que 15% fossem alcançados. RESULTADOS: foram necessárias três aplicações. Cada grupo continha 20 indivíduos selecionados consecutivamente, totalizando 120 pessoas. Para obtenção da versão final, foram modificadas cinco alternativas do domínio dor e quatro alternativas do domínio função. Além dessas alterações, foram identificados problemas, por ambos os grupos, quanto à estrutura da escala, sugerindo a continuação do estudo de sua validade e possíveis modificações desta.Universidade Federal de São Paulo (UNIFESP)Lar Escola São Francisco Centro de Reabilitação Ambulatório de Fisioterapia do OmbroUniversidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e TraumatologiaUNIFESP, Depto. de Ortopedia e TraumatologiaSciEL

Healthcare-Associated Infections Among Neonates in Brazil

Abstract Objective: To describe the epidemiology of healthcare-associated infections (HAIs) among neonates. Design: Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI. Setting: Seven neonatal units located in three Brazilian cities. Patients: All admitted neonates were included and observed until discharge. Results: Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, ≤ 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, ≤ 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14). Conclusions: The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this populatio

Expression of TIGIT, PD-1 and HLA-DR/CD38 markers on CD8-T cells of children and adolescents infected with HIV and uninfected controls

Immune exhaustion and senescence are scarcely studied in HIV-pediatric patients. We studied the circulatory CD8 T cells activation/exhaustion and senescent phenotype of children and adolescents vertically infected with HIV or uninfected controls based on the expression of human leukocyte antigen (HLA-DR), CD38, T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif (ITIM) domain (TIGIT), programmed death 1 (PD-1) and CD57 by flow cytometry, during approximately one year. Eleven HIV-infected (HI) and nine HIV-uninfected (HU) children/adolescents who received two doses or one dose of meningococcal C conjugate vaccine (MenC), respectively, were involved in this study. Blood samples were collected before the immunization (T0), 1–2 months after the first dose (T1), and 1–2 months after the second dose (T2), which was administered approximately one year after the first one. HI patients not receiving combined antiretroviral therapy (cART) showed a higher frequency of CD8 T cells TIGIT+, PD-1+ or CD57+, as well as a higher frequency of CD8 T cells co-expressing CD38/HLA-DR/TIGIT or CD38/HLA-DR/PD-1 when compared to HI treated or HU individuals, at all times that they were assessed. CD8 T cells co-expressing CD38/DR/TIGIT were inversely correlated with the CD4/CD8 ratio but positively associated with viral load. The co-expression of CD38/DR/TIGIT or CD38/DR/PD-1 on CD8 T cells was also inversely associated with the CD4 T cells expressing co-stimulatory molecules CD127/CD28. The results showed a higher expression of exhaustion/senescence markers on CD8 T cells of untreated HI children/adolescents and its correlations with viral load

Association between circulating exhausted CD4+ T cells with poor meningococcal C conjugate vaccine antibody response in HIV-infected children and adolescents

OBJECTIVES: To investigate the expression levels of surface markers of activation (CD38 and HLA-DR), inhibition (PD-1, TIGIT and CD57) and co-stimulation (CD28 and CD127) on CD4+ T cells of children/adolescents with vertical HIV infection (HI patients) and HIV-uninfected (HU) controls vaccinated with the meningococcal C conjugate vaccine (MCC). METHODS: HI patients (n=12), aged 8–17 years, were immunized with two MCC injections, while HU controls (n=9), aged 5.3–10.7 years, received a single MCC dose (as per national recommendation at the time of this study, a single MCC vaccine dose should be given for healthy children and youth aged 1–18 years). The HI patients were categorized according to the combined antiretroviral therapy (cART) treatment. Blood samples were obtained before vaccination, after priming, and after the administration of a booster dose of vaccine to determine the serum bactericidal antibody (SBA) titers and the expression levels of surface markers on CD4+ T cells by flow cytometry. The levels of serum cytokines, IL-4 and CXCL-13 were also measured using Luminex kits. RESULTS: The co-expression of the TIGIT-HLA-DR-CD38 molecules increased in the CD4+ T cells of HI patients/ no-cART who also showed a lower frequency of CD127+CD28+ CD4+ T cells than HI patients/cART and HU group subjects. There were significant negative correlations between the frequency of exhausted CD4+ T cells and the SBA response. IL-4 levels were higher in HI patients/cART and positively correlated with SBA titers but negatively associated with the expression of exhaustion markers. Moreover, the CXCL-13 levels were positively correlated with the exhausted CD4+ T cells. CONCLUSION: The results of our study suggest that the co-expression of exhaustion markers and/or loss of co-stimulatory molecules influence the SBA response in HI patients

Baseline Circulating Activated TFH and Tissue-Like Exhausted B Cells Negatively Correlate With Meningococcal C Conjugate Vaccine Induced Antibodies in HIV-Infected Individuals

Since 2006, meningococcal serogroup C (MenC) conjugate (MCC) vaccines have been supplied by the Brazilian government for HIV-infected children under 13 years old. For measuring protection against MenC, the serum bactericidal antibody (SBA) assay is the method of choice. The characterization of T follicular helper cells (TFH) cells has been an area of intensive study because of their significance in multiple human diseases and in vaccinology. The objective of this study was to characterize the phenotype of peripheral TFH cells and B cells and how they associated with each other and with SBA levels induced by vaccination as well as with serum cytokine levels of HIV-infected and non-infected children and adolescents. We found that CD27−IgD−CD21−CD38+ (exhausted B cells) as well as short-lived plasmablasts (CD27+IgD−CD21−CD38+) are increased in cART treated HIV patients and negatively associated with MCC vaccine induced SBA levels. Baseline frequency of activated peripheral TFH cells was a negative correlate for SBA response to MCC vaccine but positively correlated with circulating plasmablast frequency. Baseline IL4-levels positively associated with SBA response but showed a negative correlation with activated peripheral TFH cells frequency. The increased frequency of activated peripheral TFH cells found in non-responders to the vaccine implies that higher activation/differentiation of CD4 T cells within the lymph node is not necessarily associated with induction of vaccine responses

Efeito do uso de álcool em pessoas vivendo com HIV/aids: revisão integrativa

Estudo objetivou analisar as produções científicas sobre o efeito do uso de álcool em pessoas com HIV/aids. Trata-se de uma revisão integrativa realizada nas bases de dados LILACS, SciELO, MEDLINE, CINAHL, SCOPUS, COCHRANE, Web of Scienceem outubro de 2017. Utilizaram-se os descritores Síndrome da Imunodeficiência Adquirida, HIV e Álcool, em português, inglês e espanhol, com o operador booleano AND. Foram encontrados 2.355 artigos e selecionados 46. Os dados obtidos foram organizados em quatro categorias temáticas: Efeitos do álcool na adesão à terapia antirretroviral; Efeitos neurológicos e metabólicos do álcool; Aumento do risco de transmissão do HIV e Aumento da progressão da doença. Conclui-se que a comorbidade HIV/aids e o consumo de álcool têm efeito sinérgico na vida de pessoas com HIV, causando maiores danos à saúde, com destaque para as alterações neurológicas e metabólicas, baixa adesão ao tratamento, aumento da transmissão do vírus e progressão da doença

In Utero Exposure to Antiretroviral Drugs: Effect on Birth Weight and Growth Among HIV-exposed Uninfected Children in Brazil.

BACKGROUND There are concerns about the effects of in utero exposure to antiretroviral drugs (ARVs) on the development of HIV-exposed but uninfected (HEU) children. The aim of this study was to evaluate whether in utero exposure to ARVs is associated with lower birth weight/height and reduced growth during the first 2 years of life. METHODS This cohort study was conducted among HEU infants born between 1996 and 2010 in Tertiary children's hospital in Rio de Janeiro, Brazil. Weight was measured by mechanical scale, and height was measured by measuring board. Z-scores for weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length were calculated. We modeled trajectories by mixed-effects models and adjusted for mother's age, CD4 cell count, viral load, year of birth and family income. RESULTS A total of 588 HEU infants were included of whom 155 (26%) were not exposed to ARVs, 114 (19%) were exposed early (first trimester) and 319 (54%) later. WAZ were lower among infants exposed early compared with infants exposed later: adjusted differences were -0.52 (95% confidence interval [CI]: -0.99 to -0.04, P = 0.02) at birth and -0.22 (95% CI: -0.47 to 0.04, P = 0.10) during follow-up. LAZ were lower during follow-up: -0.35 (95% CI: -0.63 to -0.08, P = 0.01). There were no differences in weight-for-length scores. Z-scores of infants exposed late during pregnancy were similar to unexposed infants. CONCLUSIONS In HEU children, early exposure to ARVs was associated with lower WAZ at birth and lower LAZ up to 2 years of life. Growth of HEU children needs to be monitored closely