Primary Sjögren's syndrome in children: Is a family approach indicated?

[No abstract available

Lack Of Association Between Nutritional Status And Change In Clinical Category Among Hiv-infected Children In Brazil.

Malnutrition is common among HIV-infected children. Our objective was to study the occurrence of malnutrition and its relationship with changes in clinical category among HIV-infected children. Longitudinal study, at the Pediatrics Department and Pediatrics Investigation Center (CIPED), Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp). We reviewed the hospital records of 127 vertically HIV-infected children. Anthropometric measurements were obtained at the beginning of follow-up, at clinical category change and five months later. These were converted to z-scores of weight/age, height/age and weight/height. Data were presented as means, standard deviations, frequency counts and percentages. The Wilcoxon and Kruskal-Wallis tests and odds ratios were used in the analysis. We found that 51 (40.2%) were undernourished and 40 (31.5%) were stunted, with higher risk of being included in clinical category C. There was an association between nutritional condition and the clinical categories of the Centers for Disease Control classification (1994), and with age at symptom onset (except for height z-score). During follow-up, 36 patients (28.4%) changed their clinical category, which occurred early among the undernourished patients. The group that changed its clinical category maintained the same z-score distribution for weight, height and weight/height throughout follow-up. Aids manifestation severity was associated with nutritional status and with age at symptom onset, but change in clinical category was not followed by worsening of nutritional status.12362-

Serum immunoglobulins in children perinatally exposed to human immunodeficiency virus

OBJECTIVE: Hypergammaglobulinemia is an early manifestation of perinatal HIV infection. Our objective was to analyze the differences in serum immunoglobulin levels between infected and seroreverting children and their association with clinical outcome. METHODS: We carried out a historical prospective study with 107 infected and 90 seroreverting children. We compared the IgA, IgG, and IgM levels between infected and seroreverting patients within the first 18 months of life; IgA, IgG, and IgM as surrogate markers of infection; and IgA, IgG, and IgM levels within the first 5 years in infected children, according to clinical outcome. The Mann-Whitney test was used for comparison between groups. Surrogate markers were assessed according to sensitivity, specificity, positive and negative predictive values, and Youden's index. RESULTS: Infected children, when compared to seroreverters, showed significantly higher levels of IgM between the 1st and 5th trimesters; IgA and IgG between the 2nd and 6th trimesters (P less than or equal to 0.05). Levels of IgA greater than or equal to 90 mg/dl in the 2nd trimester and IgG greater than or equal to 1,700 mg/dl or 1,200 mg/dl in the 2nd and 3rd trimesters were associated with HIV infection, with Youden's indexes of 0.97, 0.92, and 0.93, respectively. Infected children in the B and C categories, compared to those in the N and A, showed higher levels of IgM between the 2nd and 4th years, and IgA between the 3rd and 5th year (P > 0.05). CONCLUSIONS: The temporal progression of IgA, IgG, and IgM levels showed an early and intense stimulation to the synthesis of immunoglobulin in infected children. Clinical and epidemiological indicators showed that such levels may be surrogate markers of infection. Higher IgM and IgA levels between the 2nd and 5th years in more severely infected children suggest a dysfunction in immune regulation secondary to persistent antigenic stimulation.OBJETIVO: a hipergamaglobulinemia é uma manifestação precoce da infecção perinatal por HIV. O objetivo foi analisar as diferenças nos níveis séricos de imunoglobulinas entre crianças infectadas e sororreversoras, e sua associação com a evolução clínica. MÉTODOS: Em um estudo prospectivo histórico, avaliaram-se 107 crianças infectadas e 90 sororreversoras. Compararam-se: IgA, IgG e IgM entre infectados e sororreversores nos primeiros 18 meses de vida; IgA, IgG e IgM como marcadores indiretos de infecção; IgA, IgG e IgM nos 5 primeiros anos em infectados, de acordo com a evolução clínica. Utilizou-se o teste de Mann-Whitney para a comparação entre grupos. Na avaliação de marcadores indiretos, analisaram-se Sensibilidade, Especificidade, Valores Preditivos Positivo e Negativo, e índice J. RESULTADOS: Infectados, em relação a sororreversores, apresentaram níveis significativamente superiores de IgM, do 1o ao 5o trimestre; IgA e IgG, do 2o ao 6o trimestre (P 90 mg/dl no 2o trimestre e IgG > 1.700 mg/dl ou 1.200 mg/dl no 2o e 3o trimestres associaram-se à infecção por HIV com índices J de 0,97, 0,92 e 0,93, respectivamente. Crianças infectadas nas categorias B e C, comparadas àquelas nas categorias N e A, apresentaram níveis superiores de IgM, do 2o ao 4o ano e IgA, do 3o ao 5o ano (P £.0,05). CONCLUSÕES: A evolução temporal dos níveis de IgA, IgG e IgM demonstra um estímulo intenso e precoce à síntese de imunoglobulinas em infectados. Indicadores clínico-epidemiológicos demonstram que tais níveis podem ser marcadores indiretos de infecção. Níveis superiores de IgM e IgA do 2o ao 5o ano em crianças infectadas com maior gravidade sugerem disfunção na regulação imune secundária ao estímulo antigênico persistente.20921

Quality of sleep and quality of life in adolescents infected with human immunodeficiency virus

Objectives: To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. Methods: A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. Results: A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. Conclusions: HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. This may be explained by the steady improvements in daily living as a result of successful anti-retroviral therapy, and by the vulnerability that affects Brazilian adolescents living in major urban centers.Coordenacao do Aperfeicoamento do Pessoal de Nivel Superior (CAPES)Coordenacao de Aperfeicoamento do Pessoal de Nivel Superior (CAPES)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP

Sobrevivencia de crianças infectadas por transmissão vertical pelo virus da imunodeficiencia humana do tipo 1(HIV-1)

Orientadores: Maria Marluce dos Santos Vilela, Ricardo CordeiroDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A partir da revisão dos prontuários de 165 crianças com infecção congênita pelo HIV-1 seguidas no Ambulatório de Imunodeficiência Pediátrica do Hospital de Clínicas da UNICAMP, construímos curvas de sobrevida abrangendo o período de 1989 a 1999. Os sujeitos foram divididos em três grupos segundo seu ano de início de seguimento ambulatorial. O primeiro grupo incluiu crianças que iniciaram seu seguimento entre 1989 e 1992, quando o único tratamento disponível era a zidovudina (AZT), indicada apenas em estágios avançados da doença. O segundo grupo foi de 1993 a 1996, quando já existiam outros medicamentos disponíveis, sua indicação era mais precoce e o avanço do conhecimento da doença permitiu medidas preventivas da transmissão vertical. O terceiro grupo abrangeu o período de 1997 a 1999, quando foram introduzidos os inibidores de protease, classe de medicamentos mais eficazes em interromper a replicação viral. As curvas de sobrevida construídas a partir desses grupos mostraram-se significativamente diferentes, ocorrendo maior risco de óbito conforme a gravidade da doença e a precocidade do início do seguimento e diagnóstico, não havendo mudança no risco de óbito relacionado a outras variáveis, como gênero, peso de nascimento e aleitamento maternoAbstract: By the record review of 165 HIV-1 perinatally infected children followed at HC-UNICAMP Immunologic Pediatrics Service, between 1989 and 1999, data were gotten for this population construction of a survival curves. The population was divided into three groups according to its follow-up starting: Group 1: from 1989 t0 1992; Group 2: from 1993 to 1996; Group 3: from 1997 to 1999. These periods were based on treatment changes and on improuving knowledges about disease. In the first period the current treatment was the use of AZT, and it was just started whem the child was severily simpthomatic. In the second period there were more avaiable drugs, and the first treatment must be the combination of two drugs. A new kind of drugs was aviable in the third period. They would be protease inhibitor, used together with the previous ones. This association can inhibit the viral replication completely. Our data showed that the three groups survival expectance was diferent. The survival expectance is bigger in group 3 than in group 2 and group 1. It probably reflects the drug treatment improvement, as well as the support offered to these patients. We also found that early onset simptoms and clinical classification C at folow-up starting were associated with lower survival expectance. In other hand, birth weight, gender and breast feeding were not correlated with survival expectance changesMestradoPediatriaMestre em Saude da Criança e do Adolescent

Koebner's phenomenon in systemic lupus erythematosus

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Koebner phenomenon is defined as a nonspecific skin stimulus eliciting a disease skin reaction. The nature of the skin trauma varies greatly and includes areas of thermal injury, excoriations, surgical incisions, and scars. We report a patient with recent onset of systemic lupus erythematosus who developed Herpes zoster on immunosuppressant medication. Two weeks after resolution of the vesicles, the patient presented with new ulcerative reddish lesions over the herpes zoster scare and worsening of her malar rash without evidence of worsening of any other organ. Koebner phenomenon was suspected. We review the literature on Koebner phenomenon in SLE.32514031405Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Koebner's phenomenon in systemic lupus erythematosus

Koebner phenomenon is defined as a nonspecific skin stimulus eliciting a disease skin reaction. The nature of the skin trauma varies greatly and includes areas of thermal injury, excoriations, surgical incisions, and scars. We report a patient with recent onset of systemic lupus erythematosus who developed Herpes zoster on immunosuppressant medication. Two weeks after resolution of the vesicles, the patient presented with new ulcerative reddish lesions over the herpes zoster scare and worsening of her malar rash without evidence of worsening of any other organ. Koebner phenomenon was suspected. We review the literature on Koebner phenomenon in SLE3214031405CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP300447/2009-42008-02917-0; 2009-06049-