RESUMEN
For identification of the features of disseminated Mycobacterium avium complex (DMAC) in human immunodeficiency virus (HIV)-infected children, a retrospective medical record review of 31 long-term survivors with transfusion-acquired HIV was conducted. Nine patients developed DMAC defined as positive isolation of M. avium complex from peripheral blood. DMAC was diagnosed in patients 51 to 132 months of age (mean, 101). The time from HIV-infecting transfusion to DMAC diagnosis ranged from 37 to 132 months (mean, 92) and survival from the time of DMAC diagnosis ranged from 4 to 21 months (mean, 10). Selected laboratory and clinical measures in DMAC-positive and DMAC-negative subjects were compared. DMAC-positive patients had significantly lower CD4+ T cell counts and higher HIV p24 antigen concentrations than DMAC-negative patients at comparable times. Increased percentages of circulating leukocyte band forms and increased aspartate aminotransferase values were seen more often in DMAC-positive patients. Fever and abdominal pain were the only clinical features seen more often in DMAC-positive than in DMAC-negative patients. At the end of the study period overall survival of DMAC-positive patients was less than that of DMAC-negative children, at 33% vs. 73%. DMAC occurs in profoundly immunocompromised children with advanced HIV disease and significantly affects survival. The clinical and laboratory features of DMAC are relatively nonspecific and a high index of suspicion in patients with markedly reduced CD4+ T cells is essential.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Infecciones por VIH/transmisión , Infección por Mycobacterium avium-intracellulare/fisiopatología , Reacción a la Transfusión , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adolescente , Linfocitos T CD4-Positivos/inmunología , Niño , Preescolar , Femenino , Proteína p24 del Núcleo del VIH/inmunología , Infecciones por VIH/mortalidad , Infecciones por VIH/fisiopatología , Humanos , Recuento de Leucocitos , Masculino , Complejo Mycobacterium avium/aislamiento & purificación , Infección por Mycobacterium avium-intracellulare/diagnóstico , Infección por Mycobacterium avium-intracellulare/mortalidad , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
Using a classic Delphi methodology, this study identified the nursing behaviors and interventions that oncology nurses rated as most important in facilitating the patient's, parents', and siblings' coping efforts with the effects of disease and treatment. Random selection of 300 pediatric oncology nurses resulted in a final sample of 69 nurses who completed all 3 rounds of the Delphi. The majority of the nurses were younger than 35 years of age, had less than 10 years of experience, were educated with at least a bachelor's degree, and practiced in an all-oncology setting. Twenty-eight facilitative behaviors were identified for the child with cancer, 25 for the parents, and 25 for the siblings. Results of this study support previous research on patient, parent, and sibling coping.
Asunto(s)
Técnica Delphi , Enfermería Oncológica , Enfermería Pediátrica , Apoyo Social , Adaptación Psicológica , Adulto , Niño , Femenino , Humanos , Persona de Mediana Edad , Neoplasias/enfermería , Neoplasias/psicología , Enfermería Oncológica/estadística & datos numéricos , Enfermería Pediátrica/estadística & datos numéricos , Relaciones Profesional-Familia , Distribución AleatoriaRESUMEN
Myths and misconceptions about human immunodeficiency virus (HIV) are prevalent in both the lay and health care populations. It is imperative that health professionals have accurate knowledge about HIV infection and feel comfortable as they educate parents and children about this major health problem confronting society. Health care providers are always looking for innovative ways to approach the subject of patient teaching. Thus, this quiz was developed as a teaching tool to educate parents and older children about HIV infection. You can use the following true/false quiz or parts of it in any type of practice setting to teach about HIV infection and to dispel the myths and misconceptions that surround this illness. After your clients have completed the quiz, go over their responses with them using the explanation or rationale provided in the key for each answer.
Asunto(s)
Evaluación Educacional , Infecciones por VIH/transmisión , Educación en Salud/normas , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Factores de RiesgoRESUMEN
Medical records of 18 pediatric acquired immunodeficiency syndrome patients with 24 central venous catheters (CVCs) were reviewed to determine the rates and types of CVC complications and to evaluate the influence of selected social factors, absolute granulocyte counts and CD4+ T cell counts on the rate of CVC infections. CVCs were in place for a total of 4233 days. CVCs were used for blood sampling, administration of blood products and infusions of intravenous immune globulin, parenteral nutrition and medications. Complications included catheter-related infections (8 episodes; with a rate of 1.9/1000 CVC days), occlusions (15 episodes) and unplanned catheter removals (9 episodes). Reduced CD4+ T cell counts were not predictive of CVC infection. The CVC infection rate in our pediatric acquired immunodeficiency syndrome patients was similar to rates reported in children with cancer and adults with cancer and acquired immunodeficiency syndrome.