Disease progression unrelated to passive environmental tobacco smoke exposure in HIV-infected children

BACKGROUD: Studies in adults have shown that smokers have a higher risk of death and a higher risk of developing AIDS. Other studies have shown an increased risk of smoking HIV-positive adults to infections. There is, however, no available data on HIV-related disease progression in environmental tobacco smoke exposed children. AIM: The aim of this study was to determine if passive ETS exposure is a risk factor for HIVrelated disease progression in children. METHODS: An observational, descriptive study of children attending the HIV Clinic at a District Hospital during October 2007. RESULTS: 127 children were enrolled. 47 (37%) were living in households where adults smoke. There was no difference between passive tobacco smoke exposed children and those not exposed for CD4 percentage (p=0.66) or HIV stage (p=0.70). HIV-infected children were no more likely to be admitted to hospital if caregivers smoked (p=0.70). CONCLUSION: This study of HIV-infected children, did not reveal significant differences in objective measures of HIV status (CD4 count and HIV stage), nor increased rates of more severe illness (hospitalization) between children exposed to passive ETS and those not exposed. This is in contra-distinction to adult studies. The small sample size may limit comparison in this study.http://www.iomcworld.com/ijcrimph

Cytomegalovirus pneumonia occuring soon after initiation of highly active antiretroviral therapy in an infant

A two-month-old HIV-infected infant was ventilated for very severe Pneumocystis jiroveci pneumonia. After successful extubation, he was started on antiretroviral therapy. He developed a proven cytomegalovirus infection, localising as pneumonia. This required repeated ventilation. He was extubated after six weeks and completed 32 days of ganciclovir.http://www.sajei.co.za/index.php/SAJE

HIV-related bronchiectasis in children : an emerging spectre in high tuberculosis burden areas

BACKGROUND: Human immunodeficiency virus (HIV) infected children have an eleven-fold risk of acute lower respiratory tract infection. This places HIV-infected children at risk of airway destruction and bronchiectasis. OBJECTIVE: To study predisposing factors for the development of bronchiectasis in a developing world setting. METHODS: Children with HIV-related bronchiectasis aged 6–14 years were enrolled. Data were collected on demographics, induced sputum for tuberculosis, respiratory viruses (respiratory syncytial virus), influenza A and B, parainfluenza 1–3, adenovirus and cytomegalovirus), bacteriology and cytokines. Spirometry was performed. Blood samples were obtained for HIV staging, immunoglobulins, immunoCAP®-specific immunoglobulin E (IgE) for common foods and aeroallergens and cytokines. RESULTS: In all, 35 patients were enrolled in the study. Of 161 sputum samples, the predominant organisms cultured were Haemophilus influenzae and parainfluenzae (49%). The median forced expiratory volume in 1 second of all patients was 53%. Interleukin-8 was the predominant cytokine in sputum and serum. The median IgE level was 770 kU/l; however, this did not seem to be related to atopy; 36% were exposed to environmental tobacco smoke, with no correlation between and CD4 count. CONCLUSION: Children with HIV-related bronchiectasis are diagnosed after the age of 6 years and suffer significant morbidity. Immune stimulation mechanisms in these children are intact despite the level of immunosuppression.This study was funded by the Research Development Program Fund of the University of Pretoria awarded to RM.http://www.theunion.org/about-the-journal/about-the-journal.htm

Disagreement between common measures of asthma control in children

BACKGROUND: Asthma is a worldwide problem. It cannot be prevented or cured, but it is possible, at least in principle, to control asthma with modern management. Control usually is assessed by history of symptoms, physical examination, and measurement of lung function. A practical problem is that these measures of control may not be in agreement. The aim of this study was to describe agreement among different measures of asthma control in children. METHODS: A prospective sequential sample of children aged 4 to 11 years with atopic asthma attending a routine follow-up evaluation were studied. Patients were assessed with the following four steps: (1) fraction of exhaled nitric oxide (F ENO ), (2) spirometry, (3) Childhood Asthma Control Test (cACT), and (4) conventional clinical assessment by a pediatrician. The outcome for each test was coded as controlled or uncontrolled asthma. Agreement among measures was examined by cross-tabulation and k statistics. RESULTS: Eighty children were enrolled, and nine were excluded. Mean F ENO in pediatricianjudged uncontrolled asthma was double that of controlled asthma (37 parts per billion vs 15 parts per billion, P , .005). There was disagreement among measures of control. Spirometric indices revealed some correlation, but of the unrelated comparisons, those that agreed with each other most often (69%) were clinical assessment by the pediatrician and the cACT. Worst agreement was noted for F ENO and cACT (49.3%). CONCLUSION: Overall, different measures to assess control of asthma showed a lack of agreement for all comparisons in this study.Division of Pulmonology Research Fund, Department of Paediatrics, University of Pretoriahttp://journal.publications.chestnet.orghb201

Barriers and determinants of asthma control in children and adolescents in Africa : a systematic review

OBJECTIVE : To identify reasons for poor asthma control in African children and adolescents. DESIGN : Systematic review DATA SOURCES : PubMed, Scopus, CINHAL, PsycINFO, MEDLINE and Web of Science databases were systematically searched up to 31 May 2020. Hand searching was done on Sabinet, African Journal online and Google Scholar. ELIGIBILITY CRITERIA : Studies identifying barriers to asthma control, where asthma control was assessed by the validated Asthma Control Test/Child Asthma Control Test and/or Asthma Control Questionnaire were included. DATA EXTRACTION AND SYNTHESIS : Two reviewers independently selected studies for inclusion with disagreements resolved by a research team discussion, including a third reviewer. Data were extracted using the Cochrane Effective Practice and Organization of Care data collection form. The quality of the included studies was assessed using the modified Newcastle-Ottawa quality assessment scale. Identified barriers were reported in a thematic narrative synthesis. PRIMARY OUTCOMES : Poorly controlled asthma and associated factors. RESULTS : From 914 records, three studies conducted between 2014 and 2019 in Nigeria, Uganda and South Africa met the inclusion criteria. A total of 883 children aged 4–19 years were analysed. Older age, concurrent allergy and city-dwelling significantly impacted asthma control. Few children with asthma symptoms in the community had ever used inhaled corticosteroids (6.7%) and identified reasons included lack of asthma diagnosis (38.8%) and no prescribed treatment (47.6%). CONCLUSION : Asthma control in African children is impacted by age, allergy, urbanisation and lack of access to asthma diagnosis and treatment. More studies focusing on identifying barriers to asthma control in Africa are needed.http://bmjopen.bmj.comam2022Paediatrics and Child Healt

The value of pimecrolimus in improving quality of life of children with severe eczema – an open non-randomised study

BACKGROUND: Atopic eczema is a common skin condition. It has the potential to severely impair quality of life in affected children. Pimecrolimus is currently registered for mild-moderate eczema but in clinical practice children with more severe disease are often treated with this therapy in an attempt to find a safe addition to long-term topical corticosteroid usage. The aim of this study was to test the value of pimecrolimus in improving quality of life in children with severe atopic eczema. METHODS: This a single site, phase 4, non-randomised, open label trial of pimecrolimus use in children aged 4 months to 12 years living with moderate to very severe atopic eczema. The study was conducted at Steve Biko Academic Hospital. Patients with unsatisfactorily controlled disease despite conventional topical therapy, adequate use of emollients, allergen avoidance and non-pharmacological skin hygiene were enrolled. A Parent Index Quality of Life Questionnaire was completed by parents before and three months after using pimecrolimus. RESULTS: A total of 24 patients were recruited, 20 of whom completed the study. Ninety per cent of patients had co-morbid asthma and allergic rhinitis. The Parent Index Quality of Life demonstrated a mean 33% score improvement after the use of pimecrolimus. There was an attendant reduction in cost of therapy to these patients. CONCLUSIONS: Pimecrolimus usage should be extended to patients with more severe atopic eczema as the improvement in quality of life is important and demonstrable

Asthma control - practical suggestions for practicing doctors in family practice

Many surveys of asthma care suggest that only 5% of asthmatics are meeting the ‘Goals of asthma management’ as set out in the Global Initiative for Asthma (GINA) guidelines. Despite the availability of useful asthma therapies and treatment strategies, the morbidity from asthma has remained significant. This review includes practical suggestions on optimal asthma control for the family practitioner

Acute viral bronchiolitis : aetiology and treatment implications in a population that may be HIV co-infected

No abstract available

Costs of admission for paediatric pneumonia in a setting of human immunodeficiency virus infection

BACKGROUND: Pneumonia in South African children remains a major public health concern. The costs of hospital admission for pneumonia should be determined, especially where human immunodeficiency virus (HIV) infection is common. OBJECTIVE: To determine the hospital costs of children (HIV-infected vs. non-HIV-infected) admitted for the management of pneumonia and compare them in the public and fee-for-service sectors. METHODS: A retrospective review of paediatric admissions in 2007 was performed. Costs were determined for the public and fee-for-service sectors. Outcome measures included hospital mortality and comparative costs of admission. RESULTS: There were 132 admissions in a public sector facility (67% HIV-infected), and 7882 in the fee-fors ervice sector (1.2% HIV-infected). Total mortality was respectively 25% in the public and 0.04% in the fee-forservice sectors. The mean cost for HIV-infected patients was respectively US$639.06 and US$10 540.04 in the public and fee-for-service sectors. For non-HIV-infected patients, the cost was respectively US$399.45 and US$3936.87. Length of stay for HIV-infected patients was longer by respectively 1.8 days and 5.7 days in the public sector among admissions to the ward and to the paediatric intensive care unit. CONCLUSION: Admission for HIV-infected children with pneumonia costs significantly more in both sectors. Preventive strategies are needed.CONTEXTE : La pneumonie reste une préoccupation majeure de santé publique chez les enfants en Afrique du Sud. Les coûts d’admission pour pneumonie devraient être déterminés, particulièrement là où l’infection par le virus de l’immunodéficience humaine (VIH) est courante. OBJECTIF : Déterminer les coûts hospitaliers chez les enfants infectés par le VIH par comparaison avec ceux noninfectés lorsqu’ils sont admis pour le traitement d’une pneumonie, et les comparer entre le secteur public et le secteur privé. MÉTHODES : Revue rétrospective des admissions pédiatriques en 2007. Les coûts sont déterminés pour le secteur public et les secteurs privés. Les mesures de résultats finaux incluent la mortalité hospitalière et les coûts comparatifs de l’admission. RÉSULTAT S : On a noté 132 admissions dans un service du secteur public (67% de patients infectés par le VIH) et 7882 dans le secteur privé (1,2% de patients infectés par le VIH). La mortalité totale a été de 25% dans le secteur public et de 0,04% dans les secteurs privés. Les coûts moyens chez les patients infectés par le VIH ont été respectivement de 639,06 US$dans le secteur public et de 10 540,04 US$ dans les secteurs privés. Chez les individus non-infectés par le VIH, de tels coûts ont été respectivement de 399,45 US$et de 3936,87 US$. Dans le secteur public, la durée de séjour chez les patients infectés par le VIH a été supérieure respectivement de 1,8 jours et de 5,7 jours pour l’hospitalisation en salle ou en unité pédiatrique de soins intensifs. CONCLUSION : Les enfants infectés par le VIH et admis pour pneumonie impliquent un coût significativement supérieur dans les deux secteurs de santé. Des stratégies de prévention sont importantes.MARCO DE REFERENCIA: La neumonía en los niños surafricanos sigue siendo una preocupación mayor de salud pública. Es importante determinar los costos de las hospitalizaciones por neumonía, sobre todo en lugares donde es frecuente la infección por el virus de la inmunodeficiencia humana (VIH). OBJETIVO: Determinar y comparar los costos de hospitalización de los niños por neumonía (los niños infectados por el VIH comparados con los niños sin coinfección) en el sector público y un sector de remuneración por prestación. MÉTODOS: Se llevó a cabo un análisis retrospectivo de las hospitalizaciones registradas en el 2007 y se determinaron los costos en el sector público y en el sector de remuneración por acto. Las variables de evaluación fueron la mortalidad hospitalaria y los costos comparativos de la hospitalización. RESULTADOS: Se contabilizaron 132 hospitalizaciones en una institución del sector público (67% de casos con infección por el VIH) y 7882 hospitalizaciones en el sector de remuneración por prestación (1,2% de casos con infección el VIH). La mortalidad total fue 25% en el sector público y 0,04% en el sector de remuneración por acto. El costo promedio por hospitalización de un paciente con infección por el VIH fue 639,06 dólares en el sector público y 10 540,04 dólares US en el sector de remuneración por prestación. Los costos por hospitalización de un paciente sin infección por el VIH fueron 399,45 dólares US y 3936,87 dólares US respectivamente. La duración de la hospitalización de los pacientes infectados por el VIH en el sector público fue 1,8 días más prolongada en el servicio general de pediatría y 5,7 días mayor en la unidad pediátrica de cuidados intensivos. CONCLUSIÓN: La hospitalización por neumonía fue más costosa en los niños infectados por el VIH en ambos sectores. Estos resultados destacan la importancia de las estrategias de prevención.Discovery Foundation and Nycomed Madaushttp://dx.doi.org/10.5588/ijtld.11.016

Outcome of human immunodeficiency virus–exposed and –infected children admitted to a pediatric intensive care unit for respiratory failure

Objective: Acute severe pneumonia with respiratory failure in human immunodeficiency virus-infected and -exposed infants carries a high mortality. Pneumocystis jiroveci is one cause, but other organisms have been suggested to play a role. Our objective is to describe the coinfections and treatment strategies in a cohort of human immunodeficiency virus-infected and -exposed infants with respiratory failure and acute respiratory distress syndrome, in an attempt to improve survival. Design: Prospective intervention study. Setting: Steve Biko Academic Hospital, Pretoria, South Africa. Patients: Human immunodeficiency virus–exposed infants with respiratory failure and acute respiratory distress syndrome were recruited into the study. Interventions: All infants were treated with routine therapy for Pneumocystis jiroveci and bacterial coinfection. However, in addition, all infants received ganciclovir from admission until the cytomegalovirus viral load result was demonstrated to be <log 4. Measurements: Routine investigations included human immunodeficiency virus polymerase chain reaction, cytomegalovirus viral load, blood culture, C-reactive protein, and white cell count. Tracheal aspirates for Pneumocystis jiroveci detection, bacterial culture, tuberculosis culture, and viral identification were performed. Main Results: Sixty-three patients met the recruitment criteria. The mortality rate was 30%. Pneumocystis jiroveci was positive in 33% of infants, while 38% had cytomegalovirus viral load ≥log 4. Only 7.9% of infants had a positive tuberculosis culture. Nineteen deaths occurred, 13 of which had a cytomegalovirus viral load ≥log 4. Bacterial coinfection and CD4 count were not predictors of mortality. Conclusions: A case fatality rate of 30% is achievable if severe pneumonia with respiratory failure and acute respiratory distress syndrome is managed with a combination of antibiotics and ventilation strategies. Cytomegalovirus infection appears to be associated with an increased risk of death in this syndrome. This may, however, be a marker of as yet undefined pathology.http://www.pccmjournal.orghb201