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1
Dunaiski and Denning. "Estimated Burden of Fungal Infections in Namibia." Journal of Fungi 5, no. 3 (August 16, 2019): 75. http://dx.doi.org/10.3390/jof5030075.
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Namibia is a sub-Saharan country with one of the highest HIV infection rates in the world. Although care and support services are available that cater for opportunistic infections related to HIV, the main focus is narrow and predominantly aimed at tuberculosis. We aimed to estimate the burden of serious fungal infections in Namibia, currently unknown, based on the size of the population at risk and available epidemiological data. Data were obtained from the World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), and published reports. When no data existed, risk populations were used to estimate the frequencies of fungal infections, using the previously described methodology. The population of Namibia in 2011 was estimated at 2,459,000 and 37% were children. Among approximately 516,390 adult women, recurrent vulvovaginal candidiasis (≥4 episodes /year) is estimated to occur in 37,390 (3003/100,000 females). Using a low international average rate of 5/100,000, we estimated 125 cases of candidemia, and 19 patients with intra-abdominal candidiasis. Among survivors of pulmonary tuberculosis (TB) in Namibia 2017, 112 new cases of chronic pulmonary aspergillosis (CPA) are likely, a prevalence of 354 post-TB and a total prevalence estimate of 453 CPA patients in all. Asthma affects 11.2% of adults, 178,483 people, and so allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) were estimated in approximately 179/100,000 and 237/100,000 people, respectively. Invasive aspergillosis (IA) is estimated to affect 15 patients following leukaemia therapy, and an estimated 0.13% patients admitted to hospital with chronic obstructive pulmonary disease (COPD) (259) and 4% of HIV-related deaths (108) — a total of 383 people. The total HIV-infected population is estimated at 200,000, with 32,371 not on antiretroviral therapy (ART). Among HIV-infected patients, 543 cases of cryptococcal meningitis and 836 cases of Pneumocystis pneumonia are estimated each year. Tinea capitis infections were estimated at 53,784 cases, and mucormycosis at five cases. Data were missing for fungal keratitis and skin neglected fungal tropical diseases such as mycetoma. The present study indicates that approximately 5% of the Namibian population is affected by fungal infections. This study is not an epidemiological study—it illustrates estimates based on assumptions derived from similar studies. The estimates are incomplete and need further epidemiological and diagnostic studies to corroborate, amend them, and improve the diagnosis and management of these diseases.
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Chipare, Mwakanyadzenin Abigail, Agnes van Dyk, and Hans Justus Amukugo. "A health education programme to enhance the knowledge and communication skills of health care workers who serve people living with HIV / AIDS on HAART in Namibia." International Journal of Advanced Nursing Studies 4, no. 2 (September 27, 2015): 137. http://dx.doi.org/10.14419/ijans.v4i2.4992.
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<p>This paper aims at describing the findings of a health education programme that enhances the knowledge and communication skills of health-care workers who serve people living with HIV / AIDS on HAART in Namibia. Namibian health-care workers are unable to provide quality health care services to people who are living with HIV / AIDS (PLWHA) when they do not have the necessary knowledge, as well as adequate interpersonal communication and counselling skills. In a health care facility system, all patients either come from the community, or are referred from the wards or other departments by health-care workers. The health care worker as a sender conveys information (messages), and a patient (receiver) is expected to comprehend these messages and to respond by giving feedback to the sender who, in turn, provides feedback until the communication process is completed. The process should take place in a conducive environment without any interference, such as noise, to allow the swift completion of the communication process. The messages that both parties convey should be clear, accurate, coherent, and concise. This article covered the following: background, methods, ethical measures, results (participants’ responses) conclusions and recommendations.</p>
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Mnubi-Mchombu, Chiku, and Dennis N. Ocholla. "INFORMATION NEEDS AND SEEKING BEHAVIOUR OF ORPHANS AND VULNERABLE CHILDREN, THEIR CAREGIVERS, AND SERVICE PROVIDERS IN RURAL REGIONS IN NAMIBIA." Mousaion: South African Journal of Information Studies 32, no. 1 (October 4, 2016): 23–45. http://dx.doi.org/10.25159/0027-2639/1698.
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A big problem in Namibia is the issue of destitute orphans and vulnerable children (OVC), many of whose parents have died from HIV/AIDS related illnesses. This study sought to examine the information needs of OVC and their caregivers and their information seeking strategies in managing the OVC situation in Namibia. Both qualitative and quantitative survey research methods were employed. Questionnaires were posted to various service providers, while interviews were conducted with OVC and their caregivers. Focus group discussions were also used for caregivers and informants in order to collect data on the respondents’ general attitudes, feelings, beliefs, experiences and reactions. The study took place in the rural Ohangwena region in January 2009 and urban Khomas region in April 2009. The preliminary findings indicated that there was a higher school dropout rate among rural OVC. Both rural and urban OVC expressed the need for financial assistance or grants, child care support, feeding schemes and health services as their top priorities. The rural OVC said they required information about school development fund exemptions, financial assistance or grants, health services, childcare support, and training opportunities. The urban OVC expressed the same priorities except for counselling, which was added to their list instead of training opportunities. Both the rural and urban OVC stated that they consulted relatives, teachers and friends for advice or information, thus indicating that interpersonal sources of information were the most important source of information. The study provided useful information for interventions and further research.
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Buriti, Ana Karina Lima, Simone Helena dos Santos Oliveira, and Lilian Ferreira Muniz. "Hearing loss in children with HIV/AIDS." CoDAS 25, no. 6 (December 16, 2013): 513–20. http://dx.doi.org/10.1590/s2317-17822013.05000013.
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PURPOSE: To investigate the occurrence of hearing loss in children with HIV and its association with viral load, opportunistic diseases, and antiretroviral treatment. METHODS: A cross-sectional study was carried out with 23 HIV-positive children under care at two specialized centers in João Pessoa, Paraíba, Brazil. Their parents or legal guardians responded to a questionnaire, containing data on the clinical situation and the hearing health of the children, who were then submitted to audiological assessment. We complied with the guidelines for human research contained in the CNE (National Education Council) Resolution number 196/1996. The findings were analyzed through descriptive statistics. RESULTS: We observed that lamivudine (3TC) was the antiretroviral drug most used in 17 (94.4%) patients, followed by Kaletra (KAL), administered in 14 (77.8%) patients, d4T in 11 (61.1%) patients, and zidovudine (AZT) in 7 (38.9%) participants. Otitis was the most frequent opportunistic disease, with 11 (61.1%) cases. In the audiometric examination, we observed 39 (84.8%) ears with hearing loss and 7 (15.2%) normal ears. After the immitance testing, we found five (10.9%) normal ears, characterized by type A tympanometric curves. The other 41 (89.1%) ears were revealed as altered, with predominance of type B curves in 67.4% of the cases. CONCLUSION: There were hearing alterations in children with HIV/AIDS analyzed in this study. Discreet hearing losses were the most occurring. We verified statistically significant associations with the use of antiretroviral therapy and otitis. Therefore, we point out the importance of auditory monitoring and intervention as soon as possible, thus favoring adequate development in language and decreasing possible difficulties in learning and social inclusion.
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Kurpas, Donata, Bozena Mroczek, Lucyna Sochocka, and Joseph Church. "School age children with HIV/AIDS: possible discrimination and attitudes against." Revista da Escola de Enfermagem da USP 47, no. 6 (December 1, 2013): 1305–10. http://dx.doi.org/10.1590/s0080-623420130000600008.
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Survey-based study what purpose was to analyse respondents’ opinions about contacts with HIV/AIDS-affected people. It was performed using a paper-pencil method during visits of respondents at primary care centres and on-line through a link to the questionnaire distributed among patients of primary care physicians. The study involved 302 respondents, 80% of whom were women; the average age was 34.48 years. The majority of respondents did not know anyone with HIV/AIDS (89.6%). About 83.3% claimed that they would not decrease contacts with HIV/AIDS-affected people. According to 64.1% of respondents, children with HIV/AIDS should go to kindergarten/public or non-public school. We selected a group of respondents, who previously were not but now are inclined to limit such contacts. These respondents can be a potential target group for HIV/AIDS educational programmes. Most respondents think that there is insufficient information about the HIV/AIDS in the mass media.
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Anyanwu, Onyinye Uchenna, Benson Nnamdi Onyire, and Faith W. Daniyan. "Prevalence of Wasting, Thinness, Stunting and Under-weight among Paediatric AIDS Patients in a Tertiary Centre." Journal of Nepal Paediatric Society 36, no. 2 (December 31, 2016): 156–59. http://dx.doi.org/10.3126/jnps.v36i2.14904.
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Introduction: Malnutrition is a common occurrence in HIV positive children. Its presence reflects the level of care the child receives as well as affects the outcome of their infection. The objective of this study was to determine the prevalence of various forms of malnutrition among HIV positive children. This was a Hospital based Cross-sectional study in HIV-positive children receiving care in FETHA.Material and Methods: using the WHO reference standards, we determined the prevalence of wasting, thinness, stunting and underweight in HIV-positive children receiving care in FETHA. Height and weight measurements of 89 HIV-positive children aged 0-18year old were taken. Socioeconomic stratification was done by Olusanya’s criteria.Results: The prevalence of wasting, thinness, stunting and underweight in HIV- positive children were 31(34.8%), 22(24.7%), 30(33.7%), and 33(37.1%) respectively. Age group and socioeconomic status were significantly associated with the various forms of malnutrition while gender and clinical stage of disease were not.Conclusion: There is still a high prevalence of acute and chronic malnutrition amongst paediatric-AIDS patients which is significantly more amongst adolescents and the lower socioeconomic class.J Nepal Paediatr Soc 2016;36(2):156-159.
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Mittal, Meenu. "Nutritional Considerations and Dental Management of Children and Adolescents with HIV/AIDS." Journal of Clinical Pediatric Dentistry 36, no. 1 (September 1, 2011): 85–92. http://dx.doi.org/10.17796/jcpd.36.1.h858tw2488v17164.
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The HIV infected child has increased caloric needs, yet multiple factors interfere with adequate nutritional intake. Nutritional support is needed to maintain optimum nourishment during the symptomatic period, in order to prevent further deterioration of the nutritional status during acute episodes of infection, and to improve the nutritional status during the stable symptom free period. With the advent of better methods of detection and better therapies, we are beginning to see HIV infected children surviving longer, and thus coming under the care of a host of affiliated medical personnel, including dentists. Oral health care workers need to provide dental care for HIV-infected patients and recognize as well as understand the significance of oral manifestations associated with HIV infection. The present article reviews, on the basis of literature, nutritional status, nutrition assessment and counseling in HIV/ AIDS children and adolescents. Dental treatment considerations in these, as well as modifications in treatment if required, are also discussed.
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K Muli-Kinagwi, Sara, Meshack Ndirangu, Onesmus Gachuno, and Samuel Muhula. "Retention of pediatric patients in care: a study of the Kibera Community Health Center HIV/AIDS Program." African Health Sciences 21 (May 23, 2021): 39–43. http://dx.doi.org/10.4314/ahs.v21i.7s.
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Background: In 2011, 3.4 million children were living with HIV worldwide1.
Objectives: Describe the characteristics of pediatric patients enrolled into the HIV program at the Kibera community health center between January 2012 and March 2013. Determine the proportion of enrolled paediatric patients lost to follow up. Determine the correlates associated with retention and loss to follow up.
Methods: The study was a retrospective cohort study of program data of all pediatric patients enrolled into the HIV pro- gram in the facility between January 2012 and March 2013. The data was analyzed using SPSS.
Results: Of the 100 pediatric patients enrolled during the study period, 79 and 21 were HIV negative and positive respec- tively. Only 4 (5%) of the HIV exposed Infants and 11 (52%) of the HIV positive children were started on ART within the study period. The retention rate of the children at 3 months was 87% while the retention at both 12 and 15 months was 79%. There was an association between the mother or guardian disclosing their status and the retention of the child (p-value 0.026).
Conclusion: The disclosure of the HIV status by parent/guardian to the child was associated with better retention of the children in the program.
Keyword: Pediatric patients in care; Kibera community health center; HIV/AIDS.
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K Muli-Kinagwi, Sara, Meshack Ndirangu, Onesmus Gachuno, and Samuel Muhula. "Retention of pediatric patients in care: a study of the Kibera Community Health Center HIV/AIDS Program." African Health Sciences 21, no. 1 (May 23, 2021): 39–43. http://dx.doi.org/10.4314/ahs.v21i1.7s.
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Background: In 2011, 3.4 million children were living with HIV worldwide1.
Objectives: Describe the characteristics of pediatric patients enrolled into the HIV program at the Kibera community health center between January 2012 and March 2013. Determine the proportion of enrolled paediatric patients lost to follow up. Determine the correlates associated with retention and loss to follow up.
Methods: The study was a retrospective cohort study of program data of all pediatric patients enrolled into the HIV pro- gram in the facility between January 2012 and March 2013. The data was analyzed using SPSS.
Results: Of the 100 pediatric patients enrolled during the study period, 79 and 21 were HIV negative and positive respec- tively. Only 4 (5%) of the HIV exposed Infants and 11 (52%) of the HIV positive children were started on ART within the study period. The retention rate of the children at 3 months was 87% while the retention at both 12 and 15 months was 79%. There was an association between the mother or guardian disclosing their status and the retention of the child (p-value 0.026).
Conclusion: The disclosure of the HIV status by parent/guardian to the child was associated with better retention of the children in the program.
Keyword: Pediatric patients in care; Kibera community health center; HIV/AIDS.
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Ferreira, Dennis de Carvalho, Mauro Romero Leal Passos, Norma de Paula Motta Rubini, Rosiangela Ramalho de Souza Knupp, José Alexandre da Rocha Curvelo, Helena Lucia Barroso dos Reis, and Gesmar Volga Haddad Herdy. "Validation study of a scale of life quality evaluation in a group of pediatric patients infected by HIV." Ciência & Saúde Coletiva 16, no. 5 (May 2011): 2643–52. http://dx.doi.org/10.1590/s1413-81232011000500034.
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With the advent of potent antiretroviral therapy and the increase in life expectancy of pediatric patients infected with HIV, the quest for the promotion of enhanced quality of life should currently be the main focus in care of children with HIV/Aids. The scope of this study was to validate the Scale of Children's Quality of Life in a group of children infected with HIV receiving clinical care in Aids Service Units in Rio de Janeiro, Brazil. This scale consists of 26 questions and was tested on 100 children, with ages varying between 4 and 12, and their respective parents or guardians. Statistical analysis was conducted using canonical correlation and confidence interval analysis and the c² test. The results showed that the cut-off point obtained was 49; the internal consistency with Cronbach's alpha was 0.73 for the children and 0.67 for parents or guardians. The response profile revealed marked satisfaction with aspects such as vacations and birthdays, though less satisfaction with items including hospitalization and playing alone. The conclusion was that the scale revealed satisfactory psychometric measurements, proving to be a reliable, consistent, valid and recommended instrument for measuring the quality of life of children infected with HIV.
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Kang′ethe, SM. "The dangers of involving children as family caregivers of palliative home-based-care to advanced HIV/AIDS patients." Indian Journal of Palliative Care 16, no. 3 (2010): 117. http://dx.doi.org/10.4103/0973-1075.73641.
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Ohemeng, Fidelia N. A., and Steve Tonah. "“I Want to Go Gently”." OMEGA - Journal of Death and Dying 75, no. 4 (March 5, 2015): 395–410. http://dx.doi.org/10.1177/0030222815575010.
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This article examines the views of persons living with AIDS about how they want to die and how they are planning for their deaths. Participants for the study were purposefully drawn from an HIV clinic in an urban town in Ghana. In-depth interviews were conducted with 25 persons living with AIDS. Three preferences of death were identified by the participants. These include the desire for a quick death, death at home, and death without emaciating. Planning for death involved attending church and taking care of children. Inherent in the responses of the participants is the concern for cost of care, dwindling network of family carers, and stigmatization and shame. The article concludes that the government needs to provide support for home-based care, establish a pension for AIDS patients, support families to pay for the funeral expenses of their relatives, and scale up effort to reduce HIV/AIDS-related stigma.
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Su, Brooke M., Jason S. Park, and Dylan K. Chan. "Impact of Primary Language and Insurance on Pediatric Hearing Health Care in a Multidisciplinary Clinic." Otolaryngology–Head and Neck Surgery 157, no. 4 (September 12, 2017): 722–30. http://dx.doi.org/10.1177/0194599817725695.
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Objective This study aims to describe the effects of primary language and insurance status on care utilization among deaf or hard-of-hearing children under active otolaryngologic and audiologic care. Study Design Cross-sectional analysis. Setting Multidisciplinary hearing loss clinic at a tertiary center. Subjects and Methods Demographics, hearing loss data, and validated survey responses were collected from 206 patients aged 0 to 19 years. Two-sided t tests and χ2 tests were used to obtain descriptive statistics and hypothesis testing. Results Of the sample, 52.4% spoke primarily English at home. Non-English-speaking children and families were less likely to receive psychiatric counseling (12.2% vs 35.2% in the English group, P < .001) and reported more difficulty obtaining educational interventions ( P = .016), and 68.9% had public insurance. Parents of publicly insured children were less likely to know the type or degree of their child’s hearing loss (56.9% vs 75.4%, P = .022), and these children were older on presentation to the clinic (8.5 vs 6.5 years of age, P = .01) compared to privately insured children. Publicly insured children were less likely to receive cochlear implants ( P = .046) and reported increased difficulty obtaining hearing aids ( P = .047). While all patients reported impairment in hearing-related quality of life, publicly insured children aged 2 to 7 years were more likely to perform below minimum thresholds on measures of auditory/oral functioning. Conclusion Even when under active care, deaf or hard-of-hearing children from families who do not speak English at home or with public insurance face more difficulty obtaining educational services, cochlear implants, and hearing aids. These findings represent significant disparities in access to necessary interventions.
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Hughes, Jing W., Tonya D. Riddlesworth, Linda A. DiMeglio, Kellee M. Miller, Michael R. Rickels, and Janet B. McGill. "Autoimmune Diseases in Children and Adults With Type 1 Diabetes From the T1D Exchange Clinic Registry." Journal of Clinical Endocrinology & Metabolism 101, no. 12 (September 27, 2016): 4931–37. http://dx.doi.org/10.1210/jc.2016-2478.
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Background and Aims: Type 1 diabetes (T1D) is associated with other autoimmune diseases (AIDs), but the prevalence and associated predictive factors for these comorbidities of T1D across all age groups have not been fully characterized. Materials and Methods: Data obtained from 25 759 participants with T1D enrolled in the T1D Exchange Registry were used to analyze the types and frequency of AIDs as well as their relationships to gender, age, and race/ethnicity. Diagnoses of autoimmune diseases, represented as ordinal categories (0, 1, 2, 3, or more AIDs) were obtained from medical records of Exchange Registry participants. Results: Among the 25 759 T1D Exchange participants, 50% were female, 82% non-Hispanic white, mean age was 23.0 ± 16.9 years and mean duration of diabetes was 11 years. Of these participants, 6876 (27%) were diagnosed with at least one AID. Frequency of two or more AIDs increased from 4.3% in participants aged younger than 13 years to 10.4% in those aged 50 years or older. The most common AIDs were thyroid (6097, 24%), gastrointestinal (1530, 6%), and collagen vascular diseases (432, 2%). Addison’s disease was rare (75, 0.3%). The prevalence of one or more AIDs was increased in females and non-Hispanic whites and with older age. Conclusions: In the T1D Exchange Clinic Registry, a diagnosis of one or more AIDs in addition to T1D is common, particularly in women, non-Hispanic whites, and older individuals. Results of this study have implications for both primary care and endocrine practice and will allow clinicians to better anticipate and manage the additional AIDs that develop in patients with T1D.
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Lima, Núbia Maria Freire Vieira, and Anamarli Nucci. "Clinical attention and assistance profile of patients with amyotrophic lateral sclerosis." Arquivos de Neuro-Psiquiatria 69, no. 2a (April 2011): 170–75. http://dx.doi.org/10.1590/s0004-282x2011000200005.
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OBJECTIVE: To evaluate the functional status of amyotrophic lateral sclerosis (ALS) patients diagnosed at this institution; to analyze hospital and palliative care; to identify patients' knowledge about home care and supportive resources. METHOD: Twenty-nine patients were evaluated on the ALSFRS-R scale and two semi-structured questionnaires, at the start of the study and every four months thereafter for 1 year. RESULTS: ALSFRS-R score was 30.1±11.5 initially and 24.4±10.5 at 1 year. There was an increase in use of physiotherapeutic care and adaptive aids. The primary caregivers were spouses (55.2%), parents/children/cousins (20.7%), friends (10.3%) and private nurses (3.5%); 10.3% of patients had no caregivers. Basic ALS patient care was provided by the public health system. CONCLUSION: ALS patients' multidisciplinary care was provided by UNICAMP hospital and its outpatient clinics and, in some patients, complemented by a private health plan or personal expenditure. Few ALS patients were aware of the possibility of home nursing. It is necessary to implement national and regional public home nursing in addition to multidisciplinary specialized care of ALS patients.
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Brough, Helen, and Tiwaope Kachaje. "Follow-Up Care for Pediatric Hearing Aid Users at an Audiology Clinic in Malawi." Perspectives of the ASHA Special Interest Groups 5, no. 6 (December 17, 2020): 1809–12. http://dx.doi.org/10.1044/2020_persp-20-00129.
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Purpose Hearing loss can have a negative impact on a child's development. Hearing aids, if fitted appropriately, maintained well, and used regularly, can offer benefit to children with hearing loss. Regular reviews of hearing aid users can help to monitor a child's progress and provide timely intervention when problems arise or needs change. This study investigates the follow-up care received by children fitted with hearing aids at a clinic in Malawi. Method A clinical audit was done of the frequency of face-to-face follow-up appointments, following which all pediatric hearing aid users who had not recently received follow-up care were called to invite them for a review, and then a re-audit was conducted. Results Of the 47 children in the audit, 46 had not had a recent face-to-face follow-up appointment. Strenuous efforts were made to call those 46 children to the clinic for review: 20 caregivers agreed to bring their child for review, 10 of whom attended. It was not possible to contact 24 caregivers. Conclusions Reasons for low attendance for review at this service are not known, but may be related to the financial circumstances of the patients' families as well as difficulty in maintaining contact with families. It has not yet been possible to establish a system for routine follow-up care for pediatric hearing aid users at this well-established clinic in a low-income country.
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Mani, Geo. "Effect of audio and audio-visual distraction aids in reducing anxiety during pedodontic care." Bioinformation 16, no. 12 (December 31, 2020): 1007–12. http://dx.doi.org/10.6026/973206300161007.
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The use of audio-visual and audio distraction tools can lead to the improvement of the quality of treatment and benefit both the dentist and the patient. It is of interest to evaluate the anxiety levels using audio and audio-visual distraction aids during pedodontic care. We collected data on 30 children between 6 to 12 years old. Subjects were randomly assigned into three groups of ten each. The three groups were control group, audio distraction group and audio-visual distraction group. The pulse rate of all the patients were assessed, Venham’s picture test and Venham’s Clinical Rating scale was recorded for all the subjects during the first and second visits. A statistically significant (p<0.01) difference in pulse rates was observed when audio and audio-visual groups were used during treatment. This implies that distraction aids help to reduce the levels of anxiety pedodontic care.
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Gisselquist, David, John J. Potterat, Stuart Brody, and Francois Vachon. "Let it be sexual: how health care transmission of AIDS in Africa was ignored." International Journal of STD & AIDS 14, no. 3 (March 1, 2003): 148–61. http://dx.doi.org/10.1258/095646203762869151.
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The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.
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Mani, Geo. "Effect of audio and audio-visual distraction aids in reducing anxiety during pedodontic care." Bioinformation 16, no. 12 (December 31, 2020): 1007–12. http://dx.doi.org/10.6026/973206300161007.
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The use of audio-visual and audio distraction tools can lead to the improvement of the quality of treatment and benefit both the dentist and the patient. It is of interest to evaluate the anxiety levels using audio and audio-visual distraction aids during pedodontic care. We collected data on 30 children between 6 to 12 years old. Subjects were randomly assigned into three groups of ten each. The three groups were control group, audio distraction group and audio-visual distraction group. The pulse rate of all the patients were assessed, Venham’s picture test and Venham’s Clinical Rating scale was recorded for all the subjects during the first and second visits. A statistically significant (p<0.01) difference in pulse rates was observed when audio and audio-visual groups were used during treatment. This implies that distraction aids help to reduce the levels of anxiety pedodontic care.
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K. K., Santhosh Kumar, Narayanappa D., Ravi M. D., and Jagadish Kumar K. "Clinical spectrum of paediatric HIV infection in a tertiary care centre in South India." International Journal of Contemporary Pediatrics 5, no. 4 (June 22, 2018): 1348. http://dx.doi.org/10.18203/2349-3291.ijcp20182497.
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Background: The global burden of paediatric HIV and acquired immune deficiency syndrome (AIDS) remains a challenge for healthcare workers around the world, particularly in developing countries. The objective of this study is to describe the spectrum of HIV infection in children including the mode of transmission, clinical manifestations and opportunistic infections associated with HIV infection.Methods: Confirmed HIV seropositive children aged between 18 months to 19 years admitted to paediatric ward of JSS hospital, Mysore during two-year period were enrolled in this prospective observational study. Detailed history, socio-demographic characteristics and clinical manifestations were recorded in the predesigned performa. Nutritional assessment, complete physical, systemic and neurological examination was performed at the time of admission and was supplemented with ancillary investigations. Patients were correlated with modified WHO clinical case definition for AIDS and categorized as per revised CDC NABC classification of pediatric HIV infection.Results: Forty HIV-infected children were enrolled: with mean age of 4.5 years. Vertical transmission was the predominant mode of HIV transmission (97.5%). Most of the children were severely symptomatic belonging to category-C of NABC classification. Common clinical manifestations noted were failure to thrive (45%), recurrent respiratory infections (42%), bacterial skin infection (36%), recurrent otitis (42.5%), papulo-pruritic dermatitis (22%), hepatosplenomegaly (85%), lymphadenopathy (45%) and HIV encephalopathy (52%). The common opportunistic infections observed were pulmonary tuberculosis (45%), recurrent diarrhoea (35%), oral candidiasis (30%). The rare presentations of HIV noted were chronic thrombocytopenia and a case of dilated cardiomyopathy.Conclusions: Vertical transmission was the major route of HIV infection. HIV encephalopathy was more common among severely affected children. Tuberculosis was the commonest opportunistic infection.
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Gahan, Ajaya Kumar, Jyoti Ranjan Champatiray, and Saroj Kumar Satpathy. "Study of tuberculosis in HIV positive children in a tertiary care hospital of Odisha." International Journal of Contemporary Pediatrics 4, no. 4 (June 21, 2017): 1374. http://dx.doi.org/10.18203/2349-3291.ijcp20172669.
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Background: Tuberculosis and HIV have been closely linked since the emergence of AIDS. Worldwide, TB is the most common opportunistic infection affecting HIV seropositive individuals and it remains the most common cause of death in patients with AIDS. HIV infection has contributed to a significant increase in the worldwide incidence of TB. So, an attempt was made in the present study to know the magnitude/extent of tuberculosis, associated clinical patterns, epidemiological factors and outcomes in HIV positive children attending the ART Centre of SCB medical college and hospital, Cuttack.Methods: A tertiary care hospital based prospective study was carried out in 50 children between 6 months to 14 years of age for a period of 2 years.Results: Most of the cases were less than 6 years old. TB was more common in male children than in females. Most cases were from rural areas. Majority belong to Class IV (Upper Lower) and Class V(Lower) socio-economic class. Most had Grade II and Grade III malnutrition as per IAP classification. Definite history of contact and recent infection was present in most. Majority (75%) had pulmonary tuberculosis. Pleural variant was predominant in extra-pulmonary form followed by TB lymphadenitis and disseminated forms. 5% had both PTB and EPTB. Most cases were un vaccinated. Common clinical features were fever, cough, FTT, chronic diarrhoea. Disseminated TB was common in unvaccinated group. Recovery pattern was almost similar in vaccinated and unvaccinated groups. Most of the PTB cases were cured of the disease with only 2 deaths in this group whereas the number of deaths, children going LAMA and development of MDR-TB was more in disseminated forms.Conclusions: Occurrence of TB is high in HIV positive cases. EPTB is common in unvaccinated cases. TB is common in rural and underprivileged children. Drug compliance is poor in disseminated forms. Mortality is high in disseminated forms. Sequele is more in disseminated forms of TB.
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Mujjuzi, Ibrahim, Paul Mutegeki, Sarah Nabuwufu, Ashim Wosukira, Fazirah Namata, Patience Alayo, Sharon Bright Amanya, and Richard Nyeko. "Care Burden and Coping Strategies among Caregivers of Paediatric HIV/AIDS in Northern Uganda: A Cross-Sectional Mixed-Method Study." AIDS Research and Treatment 2021 (September 13, 2021): 1–14. http://dx.doi.org/10.1155/2021/6660337.
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Background. Family caregivers provide the bulk of care to children living with HIV. This places an enormous demand and care burden on the caregivers who often struggle to cope in various ways, some of which may be maladaptive. This may adversely affect their quality of care. Very little literature exists in resource-limited contexts on the burden of care experienced by caregivers on whom children living with HIV/AIDS depend for their long-term care. We assessed care burden and coping strategies among the caregivers of paediatric HIV/AIDS patients in Lira district, northern Uganda. Methods. A mixed-method cross-sectional study was conducted among 113 caregivers of paediatric HIV patients attending the ART clinic at a tertiary healthcare facility in Lira district, northern Uganda. A consecutive sampling method was used to select participants for the quantitative study, while 15 respondents were purposively sampled for the qualitative data. Quantitative data were collected using standard interviewer-administered questionnaires, while in-depth interview guides were used to collect qualitative data. Data were entered, cleaned, and analysed using SPSS version 23. Qualitative data were analysed thematically. Results. The majority of the caregivers, 65.5% (74), experienced mild-to-moderate burden. The mean burden scores significantly differed by caregivers’ age ( P = 0.017 ), marital status ( P = 0.017 ), average monthly income ( P = 0.035 ), and child’s school attendance ( P = 0.039 ). Accepting social support, seeking spiritual support, and reframing were the three most commonly used strategies for coping. Marital status and occupation were, respectively, positively and negatively correlated with information-seeking as a coping strategy, while monthly income was positively correlated with psychosocial support as a strategy. Seeking community support was negatively correlated with the duration of the child’s care. Conclusions. Our findings show that care burden is a common problem among the caregivers of children living with HIV in the study context.
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Dalir, Maryam, Soheila Mashouf, and Simin Esmailpourzanjani. "The Effect of Spiritual Self-Care Education on the Care Burden of Mothers With Children Hospitalized in Intensive Care Units for Open Heart Surgery." Complementary Medicine Journal 10, no. 1 (June 1, 2020): 34–45. http://dx.doi.org/10.32598/cmja.10.1.866.1.
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Objective: Spiritual health of caregivers has association with the patients’ health, but less attention has been paid to spiritual self-care education in health programs. This study aimed to assess the effect of spiritual self-care education on the care burden of mothers with children in hospitalized in Intensive Care Units (ICUs) for open heart surgery. Methods: This quasi-experimental study was conducted on 60 mothers of children hospitalized in ICUs of Shahid Modarres Hospital in Tehran, Iran. They were selected randomly from among those gave informed consent to participate in the study. The data collection tools were a demographic form and Zarit Burden Interview which were completed before and after intervention. The spiritual self-care education was presented using the teaching aids in four 45-min sessions, twice a week. Collected data were analyzed in SPSS V. 24 software using descriptive (frequency, percentage) and inferential (paired t-test) statistics at a significance level of P<0.05. Results: Before the intervention, 72.3% of the samples had a severe care burden and 24.5% had a very severe care burden, which decreased after the intervention such that only 32.7% had a severe care burden. The mean and standard deviation of mothers’ care burden also decreased after the educational intervention (from 62.3±7.6 to 42.1±3.8). The results of paired t-test showed that this difference was statistically significant (P<0.001). Conclusion: Spiritual self-care education can reduce the care burden of children’ caregivers; hence, planning and implementing appropriate programs to increase self-care knowledge of caregivers (especially the mothers of children with heart problems) and medical staff and paying more attention to mothers’ education are recommended.
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Schmid, Tim, Elisabeth Strehl, Regina Trollmann, Raimund Forst, and Albert Fujak. "Orthotic Care Based on the Ferrari Concept for Children and Adults with Meningomyelocele." Zeitschrift für Orthopädie und Unfallchirurgie 157, no. 06 (July 10, 2019): 695–705. http://dx.doi.org/10.1055/a-0853-8009.
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Abstract Background Even today, myelomeningocele (MMC) is still encountered in clinical medicine and its incidence has not decreased over the last 20 years despite a known reduction in risk due to the use of folic acid supplements. The spectrum of clinical symptoms is extremely broad and, depending on the level of the defect, varies from mild to severe. Subject to the degree of paralysis, patients are reliant on the use of orthopaedic aids and orthoses for the treatment of primary contractures and deformities and the prevention of secondary ones. This forms the basis for attaining or maintaining mobility in many patients. The objective of the study was to determine the practical application of the proposed Ferrari concept for the provision of orthoses for children and adults. Patients and Material The retrospective study comprised medical records of 180 patients (97 m) with an average age of 19.44 years (3 – 52 years, SD 9.3) at the time of investigation. The average duration of treatment was 15.34 years (1 – 38 years, SD 8.96). Data relating to deformities of the vertebral column and lower limbs, provision of hydrocephalus shunts and orthoses, and patient mobility was evaluated. Results Most patients were given systematic treatment with orthoses at an early stage. In 58,9% of cases, it was possible to implement the proposed concept for providing patients with dynamic orthoses, whereby the treatment concept was more difficult to implement with high lumbar lesions than with lower lesions. Moreover, a decrease in the patientsʼ mobility with increasing age was noticeable. Some 42.3% of adult patients were able to walk with marked variations in mobility in relation to the different levels of lesions. Conclusion Taking into consideration the complexity of both the clinical picture and therefore the provision of orthopaedic devices, the result of the implementation of the proposed orthotic concept can be considered positive. Similarly, early commencement of provision of orthoses and hence the possibility of achieving a positive influence on later mobility can be considered a success. The need for individual concepts and further development in order to increase mobility particularly in the case of patients with thoracic or high lumbar lesions is evident. A more comprehensive provision of information to patients regarding orthotic treatment options and their consequences for prophylaxis and quality of life should be an important component of interdisciplinary long-term patient care.
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Schramm, W., and M. M. Schneider. "Ein Vierteljahrhundert psychosoziale Hämophilie-Beratung im Wandel der Zeit." Hämostaseologie 30, S 01 (2010): S19—S22. http://dx.doi.org/10.1055/s-0037-1619061.
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SummaryWith the development of clotting-factors in the seventies the haemophilia patients were released from being handicapped and began to live a quite normal life. Thus, psychosocial counselling did not seem to be necessary. But the impact of HIV-infection to the world of haemophilia was so intense that professional help was offered at the Munich Hemophilia Centre since 1985.During the preceeding 25 years we talked to about 120 patients and relatives every year in more than 10 000 psychotherapeutic talks. 70 of our patients were HIV-infected. For about half of them we took care until they died on AIDS or of liver-disease. The other 50 patients (HIV-negative) were also distressed enormously. At the beginning the highlights in counselling were e. g. fear of manifestation of AIDS, dying and death, social stigma. Around 1993 with the decoding of HCV and the first useful HIV therapies the topics in counselling changed: New HIV-medical-treatment, menacing by HCV, wish for own children due to improved HIV medical care etc. Conclusion: Our experiences have shown that self esteem and social integration of haemophilia patients have reached again normality. By our psychosocial counselling we would like to contribute.
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Anker, J. N. Y. van den, S. Sanduja, Kathleen Ferrer, N. Rakhmanina, and Marc Pfister. "NOVEL APP FOR PRACTICAL DOSING OF COMBINATION ANTIRETROVIRAL THERAPY IN PEDIATRIC PATIENTS WITH HIV/AIDS." Archives of Disease in Childhood 101, no. 1 (December 14, 2015): e1.20-e1. http://dx.doi.org/10.1136/archdischild-2015-310148.27.
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BackgroundCombination antiretroviral therapy (ART) of HIV infection in pediatric patients requires lifetime daily administration of a minimum of three antiretroviral drugs (ARVs). A wide range of dosing regimens is used in these patients. Dosing errors are common and may result in ARVs overdosing with associated toxicities orARVs underdosing resulting in the development of viral resistance. Attempts have been made to produce compact ARVs dosing charts, but have not been successful due to the complexity of regimens, ARV drug-drug interactions and compatibility restrictions. Advances in mobile technology have brought new opportunities for creating dosing support tools, including smartphone applications (Apps). In middle and low income countries, most affected by HIV epidemic,smartphones and tablets are widespread among medicalprofessionals. A mobile Appthat produces correct pediatric ARVs dosing, warnings for compatibility and most important drug interactions,has the potential to significantly improve the quality of ART in HIV-infected children.MethodsUsing reference ARVs guidelines from the 2014 Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection by the HHS Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children and 2013 World Health Organization pediatric HIV treatment guidelines we have developed a novel drug prescription App for pediatric ART.ResultsA noveldrug prescription App, based on up to date references, permits health care providers to easily access up-to-date dosing information and quickly calculate individualdoses of all ARVsbased on a patient's characteristics (e.g. weight, height, age, serum creatinine value). Most importantly, the App can be easily updated and synchronized remotely, allowing for timelydelivery of most important pediatric ARVs dosing updates.ConclusionThe smartphone App for pediatric ARVs can serve as an important healthcare worker support tool in the treatment of HIV-infected infants and children. Pharmacometric modelingcan be built in such App to leverage resistance and clinical patient data, individualize dosing strategies particularly for co-morbidities and optimize ART outcome. Most importantly, in the era of the global scale up of pediatric ART and task shifting of ART management to nursing staff, this App can have significant capacitating effect on the healthcare workforce.
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Mathur, Ajay, Laxmi Kant Goyal, Manoj Kumar Sharma, Arvind Kumar Gupta, Nupur Hooja, and R. N. Yadav. "Seroprevalence of hepatitis C virus among patients at a tertiary health care centre in Rajasthan, India." International Journal of Advances in Medicine 7, no. 4 (March 21, 2020): 683. http://dx.doi.org/10.18203/2349-3933.ijam20201123.
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Background: To ascertain the prevalence of Hepatitis C infection among patients visiting a tertiary care center in Jaipur, Rajasthan.Methods: An observation analytic study was done at a tertiary care center affiliated to Medical College with retrospective analysis of the hospital data of two calendar years. During this period HCV infection screening (anti-HCV) was offered to every suspected patient admitted in hospital and every pregnant women visiting antenatal care clinic.Results: The study prevalence of HCV infection was 0.05% (13/25311). The prevalence was more in female (0.03%) than male (0.02%). The study prevalence of anti-HCV among pregnant female was 0.02% (3/16224). Maximum positive cases (4/13, 30.77% positive cases) were in the age group of 21-30 years (sexually active group) and >50 years age group while minimum positivity was found in children (00 case, 0-20 years age).Conclusions: In this study, prevalence of HCV infection was 0.05%. The study prevalence of HCV among pregnant females was 0.02%. Maximum positive cases (4/13, 30.77% positive cases) were in the age group of >50 years and 21-30 years. This study aids in view to strengthen proper screening for HCV infection to reduce HCV related morbidity and mortality
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Andrew Kiboneka. "The evolving burden of asthma and contemporary advances in management: Implications for clinical practice in Southern Africa." World Journal of Advanced Research and Reviews 8, no. 3 (December 30, 2020): 059–70. http://dx.doi.org/10.30574/wjarr.2020.8.3.0315.
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Asthma is a rising significant global public health burden especially in the developing countries. The annual prevalence of severe asthma episodes is estimated from 1% to 21% for adults and over 20% for children aged 6–7 years. The prevalence of asthma varies widely around the world, ranging from 0.2% to 21.0% in adults and from 2.8% to 37.6% in 6- to 7-year-old children. The International Study of Asthma and Allergies in Children (ISAAC) reports a significant increase in the global prevalence of asthmatic episodes among children. t was estimated that more than 339 million people had Asthma globally in 2016. It is a common disease among children. The common disease asthma is probably not a single disease, but rather a complex of multiple, separate syndromes that overlap. Most asthma-related deaths occur in low- and lower-middle income countries. According to the World Health Organization (WHO) estimates, there were 417,918 deaths due to asthma at the global level and 24.8 million DALYS attributable to Asthma in in 2016. The WHO has estimated that the economic costs associated with asthma have exceeded those of TB and HIV/AIDS combined, and the Global Initiative for Asthma Program forecasted the number of asthma patients to grow globally to greater than 400 million by the year 2025. Since its first description by Hippocrates, asthma remains a treatable yet incurable disease. It is now clear that asthma is a complex syndrome with variable severity, natural history and response to treatment In Namibia a prevalence of Asthma of 11.2 % has been reported in adult populations. The increase in asthmatic episodes, morbidity and mortality among populations in Africa, Latin America and parts of Asia is a rising public health concern. The development of novel asthma phenotyping & endo typing plus better classification of patients using machine learning and big data have markedly improved asthma treatment outcomes in both children and Adults. Several research groups have developed cluster analyses of phenotypes in severe asthma. These clusters support the importance of disease heterogeneity in asthma and suggest differences in pathophysiologic mechanisms that define these clusters. Precision medicine is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.
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Wong Quiles, Chris Ivette, Marc A. Schwartz, Riley M. Mahan, and Amy Billett. "Value of central line care teaching for families of pediatric oncology patients." Journal of Clinical Oncology 35, no. 8_suppl (March 10, 2017): 60. http://dx.doi.org/10.1200/jco.2017.35.8_suppl.60.
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60 Background: Pediatric oncology care depends on central lines (CLs) in both outpatient and inpatient settings. Although inpatient implementation of CL maintenance bundles has been achieved, little attention has focused on families who care for CLs at home. Families are expected to follow best practice, but most have no prior experience or medical background. We sought to understand the comfort level and knowledge of families caring for external CLs at home and the value of our program’s existing teaching strategies, prior to an improvement initiative. Methods: Families caring for children with new and existing external CLs at home from May 2015-May 2016 were eligible for a survey and approached during outpatient visits if their primary team agreed. Using Likert scales, families were asked to assess their current comfort level with CL care, evaluate existing teaching strategies (instructional sheets; hands-on teaching by program nurses, and by home health nurses), and comment on other potentially helpful strategies. Five content questions regarding CL care were included to evaluate knowledge. Results: 80 of 82 (97.6%) families approached completed the survey. 70% had a CL in place for > 60 days. 46.3% felt "very comfortable" performing CL care, 42.5% were "comfortable", and 11.2% were "sort of or not comfortable". Only 17.5% of families found instruction sheets indispensable. Hands-on teaching was indispensable for 51.3% of families; 1.3% responded that teaching was not performed. 27.5% of families found hands-on teaching by home health nurses indispensable, but 22.5% had not received this. 98% of content questions were answered correctly. Other helpful strategies concentrated on 3 themes: standardization of educational content, increased opportunity for hands-on practice, and cognitive aids (e.g. a checklist) for CL care. Conclusions: A minority of families feel the highest level of comfort with CL care at home even after months of experience. Improvement opportunities and gaps in CL care teaching strategies are prevalent. To help support families caring for CLs at home and ensure adherence to best practice, programs should engage families to better understand their needs and develop solutions to meet them.
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Kaufmann, Beatrice, Tannys Helfer, Dana Pedemonte, Marika Simon, and Sarah Colvin. "Communication challenges between nurses and migrant paediatric patients." Journal of Research in Nursing 25, no. 3 (May 2020): 256–74. http://dx.doi.org/10.1177/1744987120909414.
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Background Many people receiving medical treatment in Switzerland speak none of the country’s four languages or English, which is a major communicative barrier for health staff. Appropriate treatment in hospitals depends on the successful communication between hospital staff and patients. Consequently, migrant patients can be particularly challenging for hospital staff. Aims The aim of this project was to examine the following topics: (a) which communicative challenges hospital nurses are confronted with in the care of migrant paediatric patients and how they cope with them, and (b) what requirements nurses (and other stakeholders) have regarding a digital communication aid to improve the care of migrant paediatric patients in the hospital setting. Methods This study used a qualitative approach. The following steps of data collection were undertaken: (a) two literature searches corresponding to the research questions, (b) a focus group interview with paediatric hospital nurses, (c) observation of communication between paediatric nurses/healthcare professionals and children/parents through shadowing, (d) short interviews with paediatric nurses who were being shadowed, and (e) a focus group interview with experts. Data analysis was based on thematic analysis and was supported by MAXQDA software. Results Evaluation of the data showed there are multiple communicative challenges that emerge in the care of migrant paediatric patients. These challenges influence each other and appear at different moments in the hospital stay. Additionally, the results revealed that digital communication aids must be user friendly and easily accessible. Conclusions This study highlights the areas of hospital care in which a digital communication aid could be feasible. However, many of the described communication challenges stem from issues that cannot be solved solely with a digital communication aid. Instead, strategies to tackle these issues must be embedded in the training of nursing staff, in the hospital management strategy and at the political level.
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Patrawala, Meera, Gerald Lee, and Brian Vickery. "Shared decision-making in food allergy management." Journal of Food Allergy 2, no. 1 (September 1, 2020): 124–27. http://dx.doi.org/10.2500/jfa.2020.2.200009.
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Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.
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Krastiņš, Jēkabs. "Acute Kidney Injury – An Underestimated Problem In Pediatric Intensive Care / Akûts Nieru Bojâjums — Nenovçrtçta Problçma Bçrnu Intensîvajâ Terapijâ." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 68, no. 5-6 (December 1, 2014): 207–15. http://dx.doi.org/10.2478/prolas-2014-0025.
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AbstractAcute kidney injury (AKI) frequently occurs in critically ill children and adults, with 5-20% of patients experiencing an episode during their stay in an intensive care unit. AKI rarely is an isolated event and is associated with a broader spectrum of diseases, including sepsis and respiratory insufficiency, and often progresses into multiorgan dysfunction syndrome. Despite recent advancements in renal replacement therapy (RRT), mortality among patients who sustain AKI complicated by multiorgan dysfunction appears to have remained unchanged and is estimated at approximately 50%. Recent clinical evidence suggests that AKI is not only an indicator for severity of illness, but that it also leads to earlier onset of multiorgan dysfunction with profound effects on mortality rates. The aim of this paper is to inform medical professionals involved in the paediatric intensive care of recent advances in AKI diagnosis and management. Studies were identified from MEDLINE (OVID), PubMed, and the Cochrane Library for topics relevant to AKI. There is limited evidence in paediatrics regarding effective therapy for acute kidney injury, a significant problem in the paediatric intensive care unit that extends length of stay, duration of mechanical ventilation, and overall mortality. Sublethal kidney injury may be contributing to overall morbidity. Prospective clinical trials are needed to evaluate specific diagnostic aids, such as biomarkers, and therapeutic strategies like early initiation of continuous RRT in children with fluid overload
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Ojha, Chet Raj, Geeta Shakya, and Shyam Prakash Dumre. "Virological and Immunological Status of the People Living with HIV/AIDS Undergoing ART Treatment in Nepal." BioMed Research International 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/6817325.
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Antiretroviral therapy (ART) has increased the life span of the people living with HIV (PLHIV), but their virological and immunological outcomes are not well documented in Nepal. The study was conducted at a tertiary care center including 826 HIV-1 seropositive individuals undergoing ART for at least six months. Plasma viral load (HIV-1 RNA) was detected by Real Time PCR and CD4+T-lymphocyte (CD4+) counts were estimated by flow cytometry. The mean CD4+count of patients was 501 (95% CI = 325–579) cells/cumm, but about 35% of patients had CD4+T cell counts below 350 cells/cumm. With increasing age, average CD4+count was found to be decreasing (p=0.005). Of the total cases, 82 (9.92%) were found to have virological failure (viral load: >1000 copies/ml). Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV), the frequently used ART regimen in Nepal, showed virological failure in 11.34% and immunological failure in 37.17% of patients. Virological failure rate was higher among children < 15 years (14.5%) (p=0.03); however, no association was observed between ART outcomes and gender or route of transmission. The study suggests there are still some chances of virological and immunological failures despite the success of highly active ART (HAART).
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Singh, Rakesh, Manish Katiyar, Reena Gulati, Sreejith Parameswaran, Abdoul Hamide, and Nonika Rajkumari. "A new single run polymerase chain reaction assay for cyclosporiasis in immunocompromised patients." IP International Journal of Medical Microbiology and Tropical Diseases 7, no. 3 (September 15, 2021): 207–12. http://dx.doi.org/10.18231/j.ijmmtd.2021.042.
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causes human intestinal cyclosporiasis. It is more common in the immunocompromised patients and mainly seen in people living with HIV/AIDS (PLHA), post-renal transplant (PRT) patients and immunocompromised children (IC). Diagnostic microscopy for the oocysts of the parasite is less sensitive, requiring examination of multiple stool samples. Here we developed a new single run polymerase chain reaction (PCR) assay for the detection of and it was used to know the hospital based prevalence of cyclosporiasis. A cross-sectional study was conducted from June 2016 to October 2020 in a tertiary care teaching hospital. A new single run amplification PCR-based diagnostic assay was developed for . Stool samples were collected from 121 PLHA, 135 PRT and 79 immunocompromised children (IC) other than PLHA and PRT. All stool samples were examined for the presence of oocysts as well as tested with new PCR assay. Modified Ziehl-Neelsen staining of the concentrated stool smear did not reveal oocysts of species in any stool specimen. However, new PCR assay detected in 2 stool specimens – one from a PLHA patient and another from a PRT patient, giving a prevalence of 0.6% (2/335), 0.8% (1/121) in PLHA and 0.7% (1/135) in PRT. It was not detected in IC. Cyclosporiasis is infrequent in southern part of India. The new single run PCR assay developed by us is simple and cost effective molecular assay for the detection of .
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Jianu, Cristian, Sorana D. Bolboacă, Adriana Violeta Topan, Irina Filipescu, Mihaela Elena Jianu, and Corina Itu-Mureşan. "A View of Human Immunodeficiency Virus Infections in the North-West Region of Romania." Medicina 55, no. 12 (November 29, 2019): 765. http://dx.doi.org/10.3390/medicina55120765.
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Background and Objectives: In Romania, the human immunodeficiency virus (HIV) epidemic is almost the same as it is in Central Europe, with some differences; particularity the following one: people with nosocomial HIV infection, also known as Romanian cohort. Aim: The study aimed to present a local view of HIV infection in the North-West part of Romania, and to identify the particularities of patients under medical care in the Cluj AIDS Center. Materials and Methods: The demographic characteristics (age and gender), and medical and epidemiological data (stage of HIV infection and mode of transmission) of patients in a medical care in the Cluj Acquired Immunodeficiency Syndrome (AIDS) Center were evaluated. Data from the first patients admitted between 1989 and 2018, and the statuses of the infected persons as per 31 December 2018 were analyzed. Results: Nine hundred and fourteen patients were included in the study. The patients’ ages varied from 0 (newborns from HIV-infected mothers) to 72 years old, and most patients were men (596 men vs. 318 women). The main mode of transmission was sexual (>50%), with an increased number of men who have sex with men (MSM) in the last years (from two cases in 2006 to thirty-four cases in 2018), and a very small percentage of intravenous drug users (IDU; <1%). The patients from the Romanian cohort were more frequently women as compared with men (p-value <0.0001), women were more frequently later presenters than men (p-value <0.0001), and the women more frequently had candidosis (p-value = 0.0372), cerebral toxoplasmosis (p-value = 0.0404), and co-infection with hepatitis B virus (p-value = 0.0018). One hundred and sixty patients died by the end of 2018 (17.5%). Sixty-eight children had been born from HIV-infected mothers, and 17 were HIV infected (25%). Conclusion: The main mode of HIV transmission in our sample was sexual, with an increased number of MSM over the last years and a low number of cases of intravenous drug users. A quarter of children borne from HIV-infected mothers were HIV infected.
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Morrow, Allison S., Stephen P. Whiteside, Leslie A. Sim, Juan P. Brito, Zhen Wang, and Mohammad H. Murad. "Developing tools to enhance the use of systematic reviews for clinical care in health systems." BMJ Evidence-Based Medicine 23, no. 6 (September 7, 2018): 206–9. http://dx.doi.org/10.1136/bmjebm-2018-110995.
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We aimed to develop tools that can facilitate uptake of evidence summarised in systematic reviews by clinical decision makers in health systems. After conducting a systematic review on the management of anxiety in children, we interviewed health system representatives, clinicians and patients to ask about additional information needed for decision-making. Using stakeholders’ feedback and literature searches for contextual and implementation information, we developed two tools (decision aids (DAs)), one for the health system and the second for the clinical encounter. This information mapped to factors of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Evidence to Decision Framework. The health system DAs provided information on which patients are candidate for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates and prognosis. Health system stakeholders found the DA useful for clinical decision-making and generalisable to other conditions. The encounter DA was produced as cards containing information on issues that drive treatment decisions (effect on symptoms, effect on function, treatment burden, side effects and cost). Patients and parents prioritised the cards and chose the order in which these issues were discussed with clinician. The encounter DA was found to be helpful by patients, parents and clinicians. We conclude that the uptake of evidence summaries by health systems can be enhanced by developing tools that provide contextual and implementation information about clinical care. A dual approach addressing health system stakeholders as well as clinicians and patients is likely feasible and helpful.
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Massavon, William, Levi Mugenyi, Martin Nsubuga, Rebecca Lundin, Martina Penazzato, Maria Nannyonga, Charles Namisi, et al. "Nsambya Community Home-Based Care Complements National HIV and TB Management Efforts and Contributes to Health Systems Strengthening in Uganda: An Observational Study." ISRN Public Health 2014 (March 6, 2014): 1–10. http://dx.doi.org/10.1155/2014/623690.
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Community Home-Based Care (CHBC) has evolved in resource-limited settings to fill the unmet needs of people living with HIV/AIDS (PLHA). We compare HIV and tuberculosis (TB) outcomes from the Nsambya CHBC with national averages in Kampala, Uganda. This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC to national averages from 2007 to 2011. Outcomes included numbers of HIV and TB patients enrolled into care, retention, loss to follow-up (LTFU), and mortality among patients on antiretroviral therapy (ART) at 12 months from initiation; new smear-positive TB cure and defaulter rates; and proportion of TB patients tested for HIV. Chi-square test and trends analyses were used to compare outcomes from Nsambya CHBC with national averages. By 2011, approximately 14,000 PLHA had been enrolled in the Nsambya CHBC, and about 4,000 new cases of TB were detected and managed over the study period. Overall, retention and LTFU of ART patients 12 months after initiation, proportion of TB patients tested for HIV, and cure rates for new smear-positive TB scored higher in the Nsambya CHBC compared to national averages. The findings show that Nsambya CHBC complements national HIV and TB management and results in more positive outcomes.
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Bessoff, Kovi, Adam Sateriale, K. Kyungae Lee, and Christopher D. Huston. "Drug Repurposing Screen Reveals FDA-Approved Inhibitors of Human HMG-CoA Reductase and Isoprenoid Synthesis That Block Cryptosporidium parvum Growth." Antimicrobial Agents and Chemotherapy 57, no. 4 (February 4, 2013): 1804–14. http://dx.doi.org/10.1128/aac.02460-12.
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ABSTRACTCryptosporidiosis, a diarrheal disease usually caused byCryptosporidium parvumorCryptosporidium hominisin humans, can result in fulminant diarrhea and death in AIDS patients and chronic infection and stunting in children. Nitazoxanide, the current standard of care, has limited efficacy in children and is no more effective than placebo in patients with advanced AIDS. Unfortunately, the lack of financial incentives and the technical difficulties associated with working withCryptosporidiumparasites have crippled efforts to develop effective treatments. In order to address these obstacles, we developed and validated (Z′ score = 0.21 to 0.47) a cell-based high-throughput assay and screened a library of drug repurposing candidates (the NIH Clinical Collections), with the hopes of identifying safe, FDA-approved drugs to treat cryptosporidiosis. Our screen yielded 21 compounds with confirmed activity againstC. parvumgrowth at concentrations of <10 μM, many of which had well-defined mechanisms of action, making them useful tools to study basic biology in addition to being potential therapeutics. Additional work, including structure-activity relationship studies, identified the human 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitor itavastatin as a potent inhibitor ofC. parvumgrowth (50% inhibitory concentration [IC50] = 0.62 μM). Bioinformatic analysis of theCryptosporidiumgenomes indicated that the parasites lack all known enzymes required for the synthesis of isoprenoid precursors. Additionally, itavastatin-induced growth inhibition ofC. parvumwas partially reversed by the addition of exogenous isopentenyl pyrophosphate, suggesting that itavastatin reducesCryptosporidiumgrowth via on-target inhibition of host HMG-CoA reductase and that the parasite is dependent on the host cell for synthesis of isoprenoid precursors.
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Hussainy, Syed Areefulla, Madiha Habeeb, Ayesha Jeelani, Sumaiya Sultana, and Mohammed Mohiuddin Meeran. "A Prospective Observational Study on Risk Factors and Prescribing Patterns of Drugs used in Stroke Patients at a Tertiary Care Teaching Hospital." Journal of Drug Delivery and Therapeutics 10, no. 5-s (October 15, 2020): 71–75. http://dx.doi.org/10.22270/jddt.v10i5-s.4469.
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Objectives: The main aim of the study is to identify the different risk factors, prescribing patterns of medication and rationality of the prescription by observing the management of stroke patients carefully.
Methodology: A prospective and observational study was carried out for a period of 6 months in an in-patient department of a tertiary care hospital. Patients above 18 years of age, patients of either sex and patients who previously had stroke were included. Children below 18 years, pregnant women, AIDS patients, patients unable to respond to verbal questions with no caretakers and patients with head injury were excluded.
Results: A total of 100 prescriptions were analyzed during the 6 months study period. This was found to be higher in males (79) and females (21). The higher risk with notable occurrence in the age group of 60-79 years (43%). Out of these study populations, (68%) experienced Ischemic stroke and (32%) experienced Hemorrhagic stroke. The major risk factors were Hypertension (62%), alcoholics (41%). Smoking (33%) and Diabetes (24%). Among the 100 prescriptions, Atorvastatin was highly prescribed (96) followed by Pantoprazole (92), Mannitol (64). Out of 100 prescriptions, (67) were rational and (33%) were irrational.
Conclusion: The prescribing patterns of drug should be based on specificity and severity of stroke in order to facilitate rational use of drugs providing optimal care. Early management of hypertension and diabetes may reduce risk of stroke. Cessation of smoking and alcohol place a key role in prevention of stroke.
Keywords: Ischemic stroke, hemorrhagic stroke, hypertension, diabetes.
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Wang, Annie M. Q., Min Kim, Emily S. Ho, and Kristen M. Davidge. "Surgery and Conservative Management of Camptodactyly in Pediatric Patients: A Systematic Review." HAND 15, no. 6 (March 22, 2019): 761–70. http://dx.doi.org/10.1177/1558944719834654.
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Camptodactyly is a pediatric hand condition, the treatment of which remains controversial. The authors’ aim was to improve patient care through clarifying the definition of camptodactyly and indications for surgical and/or conservative management, summarizing outcomes, and defining risks. A systematic review was conducted of articles in all languages on outcomes following surgical and/or conservative management of idiopathic camptodactyly in children using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, EMBASE (Excerpta Medica database), AMED (Allied and Complementary Medicine), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) (until January 2017). The primary outcome was posttreatment flexion contracture, and the secondary outcomes were indications for surgery, complications, and patient satisfaction. Database searching generated 16 final articles, with 7 case series and 9 retrospective cohort studies. There was a lack of consistency on the definition of camptodactyly and in outcome reporting. All 16 studies received a “Weak” global rating and demonstrated low-quality evidence, suggesting that treatment of camptodactyly with operative or nonoperative measures reduces the degree of flexion contracture in most patients (from pretreatment averages of 20°-85° to posttreatment averages of 5°-37°). There was general agreement that surgery should be reserved for contracture >30° or failure to respond to conservative management. Surgery generally led to more complications compared with conservative management. Only one study reported on functional limitations, and another reported on patient-reported outcomes. Current evidence of the effectiveness of camptodactyly treatment in addressing both joint-specific deformity and patient-perceived function and appearance is insufficient to guide patient care. Future research may consider the development of decision aids to guide patients and families through selecting management strategies and to promote shared decision making.
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E., Enwereji Ezinne, Ezeama Martina C., and Enwereji Kelechi O. "Creating and sustaining healthy work environment for professional advancement in health care institutions: a case study of nursing students’ clinical posting in Abia State." International Journal of Research in Medical Sciences 5, no. 9 (August 26, 2017): 3798. http://dx.doi.org/10.18203/2320-6012.ijrms20173952.
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Background: The need for nursing students to care and support patients especially those living positively with HIV and AIDS as well as those with terminal diseases should not be underestimated. By training, nursing students are expected to interact cordially with patients and other health care professionals but most times, the reverse is the case. Inter-professional and interpersonal education prepare nursing students on clinical posting to provide quality health care services to all patients irrespective of their ages and health conditions. Therefore, creating healthy work environment by encouraging team work, integrating treatment and prevention services to promote good health is imperative in ensuring patients’ safety, and enhanced inter-professional relationship.Methods: A two-day pre-clinical seminar which centered on professionalism, teamwork, interpersonal and inter-professional relationships, as well as effective communication to guarantee healthy work environments was carried out. The pre-clinical seminar was also used to prepare 186 nursing students on their expected roles during the twelve weeks’ clinical posting in health institutions. At the end of the students’ posting, two days post-clinical seminar aimed to harness students’ experiences, views and performances, as well as the teachers’ observations during the clinical posting was conducted. Thereafter, all comments on performances, observations, experiences and other remarks from the teachers and students were grouped together and analyzed qualitatively and quantitatively.Results: A good proportion of the students 142 (76.3%) established good interpersonal relationship with the patients who are HIV positive while 135 (72.6%) had effective inter-professional interaction with health care workers. Also 135 (72.6%) had good team work relationship with other health care professionals. There were better health care services to clients as evidenced by 95 (51.1%) of students who shared case managements with the health care workers and 122 (65.6%) of the students who used mobilization and advocacy to identify pressing challenges like inter-professional conflicts, poor uptake of messages about treatment and referrals as well as malnutrition among children. A respectable number of the students, 144 (77.4%) collaborated with colleagues to provide nutrition to malnourished children to improve their nutritional status, while 75 (40.3%) assisted in resolving some inter-professional conflicts.Conclusions: Students’ initiatives in management of cases, inter-professional and interpersonal learning experiences during clinical postings increased students’ understanding of teamwork and professionalism as well as promoted friendlier environments that guaranteed better health care services to patients.
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Lemos, Lígia Mara Dolce de, Thaísa Fonseca Siqueira Rocha, Marcos Vinícius da Conceição, Eduardo de Lemos Silva, Alessandro Henrique da Silva Santos, and Ricardo Queiroz Gurgel. "Evaluation of preventive measures for mother-to-child transmission of HIV in Aracaju, State of Sergipe, Brazil." Revista da Sociedade Brasileira de Medicina Tropical 45, no. 6 (December 2012): 682–86. http://dx.doi.org/10.1590/s0037-86822012000600005.
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INTRODUCTION: The main route of human immunodeficiency virus (HIV) infection in children is from mother to child. The preventive measures established for the Aids Clinical Trial Group protocol 076 (ACTG 076) significantly reduces HIV vertical transmission rates. This study aims to evaluate the implementation of the ACTG 076 protocol in the maternity units of State of Sergipe, Brazilian northeast. METHODS: This is a descriptive, retrospective study with a quantitative approach, with HIV positive women and children exposed, attending a Maternity reference for high-risk pregnancies. Data were obtained from patient records registered in the years 1994 to 2010. RESULTS: Amongst the 110 pregnant women and exposed newborns, the ACTG 076 protocol was fully utilized in only 31.8% of the participants. During the prenatal period, zidovudine (ZDV) was taken by 79.1% of the pregnant women. Only 49.1% of HIV seropositive patients used ZDV during delivery. Two (1.8%) children were considered infected and 50 (45.5%) do not have a conclusive diagnosis to date. CONCLUSIONS: There were significant deficiencies in the prevention of mother-to-child transmission of HIV, including lack of compliance with the three phases of the ACTG 076 protocol; inadequacies in prenatal care; inappropriate mode of delivery and lack of adequate follow up of exposed children.
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Parmar, Katrin, Brenda Banwell, Nadine Akbar, and Sandra Bigi. "Imaging Pediatric Multiple Sclerosis—Challenges and Recent Advances." Neuropediatrics 49, no. 03 (February 26, 2018): 165–72. http://dx.doi.org/10.1055/s-0038-1635123.
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AbstractPediatric onset multiple sclerosis (POMS) is a rare disease with an incidence of 0.07 to 2.9/100'000 children per year. It follows a relapsing–remitting disease course and is characterized by rapid accrual of inflammatory lesions, high relapse frequency, and early cognitive impairment. Magnetic resonance imaging (MRI) plays a pivotal role in the diagnosis of POMS, and in the exclusion of other disorders mimicking POMS. Furthermore, MRI aids in disease monitoring, and in the evaluation of therapeutic efficacy in both clinical practice and clinical trials. Volumetric MRI studies, diffusion tensor imaging, resting-state, and task-based functional MRI provide deeper insight into the impact of POMS on maturing neural networks. This review article aims to highlight the importance of MRI in the care of POMS patients and to provide an overview on the different MRI techniques used in the management of POMS.
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Bimer, Kirubel Biweta, Girum Teshome Sebsibe, Kalkidan Wondwossen Desta, Ashenafi Zewde, and Migbar Mekonnen Sibhat. "Incidence and predictors of attrition among children attending antiretroviral follow-up in public hospitals, Southern Ethiopia, 2020: a retrospective study." BMJ Paediatrics Open 5, no. 1 (August 2021): e001135. http://dx.doi.org/10.1136/bmjpo-2021-001135.
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BackgroundIt is a global challenge to enrol and retain paediatric patients in HIV/AIDS care. Attrition causes preventable transmission, stoppable morbidity and death, undesirable treatment outcomes, increased cost of care and drug resistance. Thus, this study intended to investigate the incidence and predictors of attrition among children receiving antiretroviral treatment (ART).MethodA retrospective follow-up study was conducted among children <15 years who had ART follow-up in Gedeo public hospitals. After collection, data were entered into Epi-data V.4.6, then exported to and analysed using STATA V.14. Data were described using the Kaplan-Meier statistics, life table and general descriptive statistics. The analysis was computed using the Cox proportional hazard regression model. Covariates having <0.25 p values in the univariate analysis (such as developmental stage, nutritional status, haemoglobin level, adherence, etc) were fitted to multivariable analysis. Finally, statistical significance was declared at a p value of <0.05.ResultsAn overall 254 child charts were analysed. At the end of follow-up, attrition from ART care was 36.2% (92 of 254), of which 70 (76.1%) were lost to follow-up, and 22 (23.9%) children died. About 8145.33 child-months of observations were recorded with an incidence attrition rate of 11.3 per 1000 child-months (95% CI: 9.2 to 13.9), whereas the median survival time was 68.73 months. Decreased haemoglobin level (<10 g/dl) (adjusted HR (AHR)=3.1; 95% CI: 1.4 to 6.9), delayed developmental milestones (AHR=3.6; 95% CI: 1.2 to 10.7), underweight at baseline (AHR=5.9; 95% CI: 1.6 to 21.7), baseline CD4 count ≤200 (AHR=4.4; 95% CI: 1.6 to 12.2), and poor or fair ART adherence (AHR=3.5; 95% CI: 1.5 to 7.9) were significantly associated with attrition.Conclusion and recommendationRetention to ART care is challenging in the paediatrics population, with such a high attrition rate. Immune suppression, anaemia, underweight, delayed developmental milestones and ART non-adherence were independent predictors of attrition to ART care. Hence, it is crucial to detect and control the identified predictors promptly. Serious adherence support and strengthened nutritional provision with monitoring strategies are also essential.
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Palmowski-Wolfe, Anja, Katarina Stingl, Imen Habibi, Daniel Schorderet, and Hoai Tran. "Novel PDE6B Mutation Presenting with Retinitis Pigmentosa – A Case Series of Three Patients." Klinische Monatsblätter für Augenheilkunde 236, no. 04 (January 15, 2019): 562–67. http://dx.doi.org/10.1055/a-0811-5480.
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Abstract Background Retinitis pigmentosa (RP) affects 2.5 million people worldwide. Increased identification of causative gene defects and the increasing possibility of treatment necessitates better knowledge of phenotype-genotype correlations to help identify patients who would benefit from targeted gene therapy and improve patientsʼ care. Here, we report on three RP patients with mutations in the PDE6Β Gene that have not been described previously. History and Signs Three patients with a PDE6Β mutation were identified: 1. A 30-year-old male with a homozygotous mutation (c.[2351dupA],[2351dupA], p.[Q785Gfs*20],[Q785Gfs*20]) who was followed for 8 years. 2. A 54-year-old Caucasian woman with a heterozygous mutation [p.(K611Nfs*6), p.(Q567*)] who was followed for 40 years. 3. A 46-year-old Caucasian male [p.(E271K), p.(R627_E631del)]. All had noted an onset in childhood and complained of night blindness and photophobia. Typical bone spiculae were seen, and peripheral visual fields were progressively affected in all patients. Ganzfeld-ERG showed typical signs of rod-cone dystrophy. Patients 1 and 2 underwent cataract surgery at ages 27 and 36 years with an improvement in vision, while patient 3 had not developed a cataract at age 54. Conclusions In children complaining of night blindness, a PDE6Β-associated RP needs to be taken into consideration. Apart from helping patients with optical aids, such as polarizing filters or magnification, a specific diagnosis is especially important in view of emerging genetic treatment options. In particular, in RP patients with a PDE6Β mutation, a phase I/II study is currently ongoing (https://clinicaltrials.gov/ct2/show/NCT03328130).
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Vasey, Nicola, Yincent Tse, Ailsa Pickering, and Emma Lim. "SP9 The KidzMed project part 1: pill popping heroes." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e5.2-e6. http://dx.doi.org/10.1136/archdischild-2020-nppg.9.
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BackgroundThere are large groups of children where families have problems obtaining ongoing supplies of their children’s medicines in primary care due to them being high risk and complex, unlicensed, off label or expensive. The KidzMeds project was established ‘For all children to get the right medicine at the right dose at the right time with the right monitoring with minimum fuss wherever they live.’Tablets are safer, more convenient and cheaper than liquid medications. Children often remain on liquid due to habit, reluctance and parental and staff not knowing how to convert. The idea of converting came from initial HIV medications which were only available in tablets1; children as young as 3 years could be taught.2 3AimQuality improvement project to teach children and young people (CYP) on long term medication how to take tablet medication in an out-patient setting.MethodWorking with families and our teams we created an interactive training package with video (http://northernpaediatrics.com/kidzmed/) and comic poster. We ran interactive hour-long training sessions for staff. Using positive reinforcement and play, the trainer sat facing the learner with sweets or dummy filled capsules of increasing sizes, from size 3 (15 mm) to size 00 (23 mm).Over the next 12 weeks in one team we embedded a process for children ≥5 years attending complex renal clinics to be converted from liquid to tablet medication unless contraindicated (e.g. swallowing or cognitive impairment).Outcome measures included successful conversion rate, patient and staff feedback and cost savings.We overcame practical barriers by placing easily accessible ‘switching kits’ in clinic filled with the necessary dummy pills, awards and certificates. To increase confidence, we created a sealed dosette box with common medications so children could see the size of tablets they needed to swallow. Working with the clinical team we standardised processes (e.g. how to round doses, pre-screening clinic lists and creating prompts).ResultsOver three months, 90 CYP were seen in 13 multi-disciplinary renal clinics, 25 were suitable for conversion to tablet medication. 21 CYP (median age 8.4 years range 5.1 to 15.5) were successfully converted (only one patient required two sessions). 36 medicines were switched, generating £46,500 per year recurrent savings.Feedback was good. Staff liked the opportunity for positive interaction with children and families appreciated the ease of obtaining tablet medications versus liquids. We subsequently trained other teams, including our research team who were recruiting for a study in which swallowing tablets is an inclusion criteria.ConclusionsIn a short timeframe it is possible to embed a system to convert children to tablet medication, improving patient experience and realising considerable cost savings. It requires staff training and cultural change. Pill swallowing is an easy skill to teach and learn and children as young as five can successfully swallow pills. We automatically teach inhaler technique so equally we should teach CYP how to swallow tablets as a skill for life. We would encourage all units to set up pill swallowing training.ReferencesFischl MA, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. NEJM 1987;317:185–91Garvie PA. Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients With HIV/AIDS. Pediatrics 2007;119:e893–e899Patel A, et al. Effectiveness of pediatric pill swallowing interventions: a systematic review. Pediatrics 2015;135:883–889
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Phiri, Sam, Joe Gumulira, Hannock Tweya, Lameck Chinula, Agnes Moses, Bongani Kaimila, Christopher Stanley, et al. "The Malawi Cancer Consortium – Catalyzing Cancer Care and Research in Southern Africa." Journal of Global Oncology 2, no. 3_suppl (June 2016): 3s—4s. http://dx.doi.org/10.1200/jgo.2016.003780.
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Abstract 68 Background: Cancer burden is increasing in Malawi, particularly for HIV-associated malignancies. Methods: With support from the National Cancer Institute, the Malawi Cancer Consortium (MCC) was initiated in September 2014. Partners include the UNC Lineberger Comprehensive Cancer Center, Malawi Ministry of Health, University of Malawi College of Medicine, and Lighthouse Trust. Spanning Malawi’s two major cities, Lilongwe and Blantyre, MCC includes three support cores (administration, analysis, mentoring) and three multi-institution research projects: (1) a national HIV-cancer match study to assess cancer incidence in the ART era; (2) a longitudinal cohort to identify clinical and molecular correlates of KS chemotherapy response; and (3) a longitudinal cohort to elucidate lymphoma biology and develop better treatments for HIV-associated lymphoma. Results: For project 1, 65,500 records from the Malawi National Cancer Registry and Malawi HIV cohorts have been abstracted, and initial data harmonization completed. Record linkage is planned for February 2016, will be updated at regular intervals, and will contribute to regional analyses through the IeDEA- Southern Africa network. For project 2, KS studies through MCC have led to descriptions of KS biologic subtypes defined by viral gene expression profiling, and detailed characterization of multicentric Castleman disease. Malawi has also led enrollment into multinational phase III KS clinical trials implemented by the AIDS Clinical Trials Group and AIDS Malignancy Consortium. For project 3, more than 300 adults and children with lymphoma have been enrolled since June 2014, with approximately 2/3 of adults being HIV-infected. Patients receive standardized treatment and supportive care, and standardized clinical and laboratory evaluations. Specimen-based correlative studies (virologic, genomic, biomarker studies) are ongoing. Finally, the consortium provides a platform for pilot studies in breast and esophageal cancer, and facilitates career development for Malawian cancer investigators. Conclusions: MCC has initiated a national coalition to address cancer in Malawi, and continued progress is anticipated. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Sam Phiri No relationship to disclose Joe Gumulira No relationship to disclose Hannock Tweya No relationship to disclose Lameck Chinula No relationship to disclose Agnes Moses No relationship to disclose Bongani Kaimila No relationship to disclose Christopher Stanley No relationship to disclose Edwards Kasonkanji No relationship to disclose Steady Chasimpha No relationship to disclose Richard Nyasosela No relationship to disclose Leo Masamba No relationship to disclose Tamiwe Tomoka No relationship to disclose Steve Kamiza No relationship to disclose Mina Hosseinipour No relationship to disclose Nora Rosenberg Research Funding: NIH/NCI Ron Mataya No relationship to disclose Charles Dzamalala No relationship to disclose George Liomba No relationship to disclose Irving Hoffman No relationship to disclose Dirk Dittmer No relationship to disclose Yuri Fedoriw Honoraria: Alexion Pharmaceuticals Blossom Damania No relationship to disclose Satish Gopal No relationship to disclose
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Focà, Emanuele, Silvia Odolini, Nigritella Brianese, and Gianpiero Carosi. "MALARIA AND HIV IN ADULTS: When The Parasite runs into The Virus." Mediterranean Journal of Hematology and Infectious Diseases 4, no. 1 (May 7, 2012): e2012032. http://dx.doi.org/10.4084/mjhid.2012.032.
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Malaria and HIV/AIDS are among the principal causes of morbidity and mortality worldwide, particularly in resource-limited settings such as sub-Saharan Africa. Despite the international community’s efforts to reduce incidence and prevalence of these diseases, they remain a global public health problem. Clinical manifestations of malaria may be more severe in HIV infected patients, which have higher risks of severe malaria and malaria related death. Co-infected pregnant women, children and international travelers from non-malaria endemic countries are at higher risk of clinical complications. However, there is a paucity and conflicting data regarding malaria and HIV co-infection, particularly on how HIV infection can modify the response to antimalarial drugs and about drug-interactions between antiretroviral agents and artemisinin-based combined regimens. Moreover, consulting HIV-infected international travelers and physicians specialized in HIV care and travel medicine should prescribe an adequate chemoprophylaxis in patients travelling towards malaria endemic areas and pay attention on interactions between antiretrovirals and antimalarial prophylaxis drugs in order to prevent clinical complications of this co-infection. This review aims to evaluate the available international literature on malaria and HIV co-infection in adults providing a critical comprehensive review of nowadays knowledge.
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Bredahl, Eric C., Joan M. Eckerson, Steven M. Tracy, Thomas L. McDonald, and Kristen M. Drescher. "The Role of Creatine in the Development and Activation of Immune Responses." Nutrients 13, no. 3 (February 26, 2021): 751. http://dx.doi.org/10.3390/nu13030751.
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The use of dietary supplements has become increasingly common over the past 20 years. Whereas supplements were formerly used mainly by elite athletes, age and fitness status no longer dictates who uses these substances. Indeed, many nutritional supplements are recommended by health care professionals to their patients. Creatine (CR) is a widely used dietary supplement that has been well-studied for its effects on performance and health. CR also aids in recovery from strenuous bouts of exercise by reducing inflammation. Although CR is considered to be very safe in recommended doses, a caveat is that a preponderance of the studies have focused upon young athletic individuals; thus there is limited knowledge regarding the effects of CR on children or the elderly. In this review, we examine the potential of CR to impact the host outside of the musculoskeletal system, specifically, the immune system, and discuss the available data demonstrating that CR can impact both innate and adaptive immune responses, together with how the effects on the immune system might be exploited to enhance human health.
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Janse van Rensburg, Bernard. "The South African Society of Psychiatrists (SASOP) and SASOP State Employed Special Interest Group (SESIG) position statements on psychiatric care in the public sector." South African Journal of Psychiatry 18, no. 3 (August 1, 2012): 16. http://dx.doi.org/10.4102/sajpsychiatry.v18i3.374.
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<p><strong>Executive summary.</strong> National mental health policy: SASOP extends its support for the process of formalising a national mental health policy as well as for the principles and content of the current draft policy.</p><p><strong> Psychiatry and mental health:</strong> psychiatrists should play a central role, along with the other mental health disciplines, in the strategic and operational planning of mental health services at local, provincial and national level.</p><p><strong>Infrastructure and human resources:</strong> it is essential that the state takes up its responsibility to provide adequate structures, systems and funds for the specified services and facilities on national, provincial and facility level, as a matter of urgency.</p><p><strong>Standard treatment guidelines (STGs) and essential drug lists (EDLs)</strong>: close collaboration and co-ordination should occur between the processes of establishing SASOP and national treatment guidelines, as well as the related decisions on EDLs for different levels.</p><p><strong>HIV/AIDS in children:</strong> national HIV programmes have to promote awareness of the neurocognitive problems and psychiatric morbidity associated with HIV in children.</p><p><strong>HIV/AIDS in adults:</strong> the need for routine screening of all HIV-positive individuals for mental health and cognitive impairments should also be emphasised as many adult patients have a mental illness, either before or as a consequence of HIV infection, constituting a ‘special needs’ group.</p><p><strong> Substance abuse and addiction:</strong> the adequate diagnosis and management of related substance abuse and addiction problems should fall within the domain of the health sector and, in particular, that of mental health and psychiatry.</p><p><strong>Community psychiatry and referral levels:</strong> the rendering of ambulatory specialist psychiatric services on a community-centred basis should be regarded as a key strategy to make these services more accessible to users closer to where they live.</p><p><strong>Recovery and re-integration:</strong> a recovery framework such that personal recovery outcomes, among others, become the universal goals by which we measure service provision, should be adopted as soon as possible.</p><p><strong> Culture, mental health and psychiatry:</strong> culture, religion and spirituality should be considered in the current approach to the local practice and training of specialist psychiatry, within the professional and ethical scope of the discipline.</p><p><strong> Forensic psychiatry:</strong> an important and significant field within the scope of state-employed psychiatrists, with 3 recognised groups of patients (persons referred for forensic psychiatric observation, state patients, and mentally ill prisoners), each with specific needs, problems and possible solutions.</p><p><strong> Security in psychiatric hospitals and units:</strong> it is necessary to protect public sector mental healthcare practitioners from assault and injury as a result of performing their clinical duties by, among others, ensuring that adequate security procedures are implemented, appropriate for the level of care required, and that appointed security staff members are appropriately trained and equipped.</p>