RESUMO
OBJECTIVES: The inadequacy of resistance monitoring in Latin America leads to circulation of HIV strains with drug resistance mutations (DRMs), compromising ART effectiveness. This study describes the DRM prevalence in HIV-infected paediatric patients in Panama. METHODS: During 2018-19, plasma was collected from 76 HIV-infected children/adolescents (5 ART-naive, 71 treated) in Panama for HIV-1 DRM pol analysis, predicted antiretroviral (ARV) susceptibility by Stanford, and HIV-1 variant phylogenetic characterization. RESULTS: HIV-1 pol sequences were recovered from 67 (88.2%) of 76 children/adolescents (median age 12 years), carrying 65 subtype B, 1 subtype G and 1 unique recombinant URF_A1B. Five were ART-naive and 62 ART-treated under virological failure (viraemia >50 copies/mL) with previous exposure to NRTIs, (100%), NNRTIs (45.2%), PIs (95.2%) and integrase strand transfer inhibitors (INSTIs, 17.7%). Among the treated patients, 34 (54.8%) carried resistant strains, with major DRMs to one (40.3%), two (9.7%) or three (4.8%) ARV families. Most of them harboured DRMs to NRTIs (58.5%) or NNRTIs (39%), but also major DRMs to PIs (4.9%) and INSTIs (6.5%). We also found dual-class NRTIâ+âNNRTI (12.2%) and NNRTIâ+âPI (2.6%) resistance. Two naive subjects carried viruses with DRMs to NRTIs and NRTIâ+âNNRTI, respectively. Sequenced viruses presented high/intermediate resistance mainly to emtricitabine/lamivudine (48.9% each) and efavirenz/nevirapine (33.3% each). Most participants were susceptible to PIs (91.3%) and INSTIs (88.1%). CONCLUSIONS: The high DRM prevalence to NRTIs and NNRTIs observed among treated HIV-infected children/adolescents in Panama justifies the need for routine resistance monitoring for optimal rescue therapy selection in this vulnerable population.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Humanos , Criança , Adolescente , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Filogenia , Farmacorresistência Viral/genética , Lamivudina/uso terapêutico , Antirretrovirais/uso terapêutico , Mutação , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , GenótipoRESUMO
New treatments have increased the life expectancy of pediatric patients diagnosed with malignant hematological diseases, often at the cost of protracting their immunocompromised state in the form of prolonged neutropenia. This neutropenic state favors the development of bacterial and fungal infections. Moreover, recent years have seen a series of changes in the epidemiology of fungal and Clostridium infections. These changes necessitate adaptations to the management of pediatric patients with febrile neutropenia, who are at risk of further increases in already high rates of morbidity and mortality. This article discusses the current bases for the management of febrile neutropenia and associated emerging fungal infections, as well as the epidemiology, diagnosis, and treatment of Clostridioides difficile in pediatric patients diagnosed with malignant hematological diseases.
Assuntos
Neutropenia Febril , Leucopenia , Micoses , Neoplasias , Humanos , Criança , Antibacterianos , Neoplasias/complicações , Neoplasias/terapia , Micoses/induzido quimicamente , Micoses/tratamento farmacológico , Micoses/epidemiologia , Neutropenia Febril/etiologia , Neutropenia Febril/terapiaRESUMO
BACKGROUND: Emotional exhaustion causes adverse effects in those who suffer from it. Housewives are not excluded. Domestic and care chores, which are considered to be sources of stress, increase when taking on the role of caregiver for a family member with Alzheimer's disease. OBJECTIVE: To analyse the influence of emotional exhaustion, somatic symptoms and social dysfunction, based on the activity they carry out. METHODOLOGY: Cross-sectional survey. 193 women participated, of which: housewives (HWs) (n = 97), and Alzheimer's patient caregiver-housewives (CHWs) (n = 96). The evaluation tools were: sociodemographic/working data questionnaire (ad hoc), Maslach Burnout Inventory (MBI) and Goldberg General Health Questionnaire (GHQ-28). RESULTS: High rates of emotional exhaustion are observed, as well as an existing positive link between chronic diseases, somatic symptoms and social dysfunction. The structural model indicates that emotional exhaustion predicts the amount and extent of diseases, somatic symptoms and social dysfunction. The influence is higher in CHWs. LIMITATIONS: Sample procedure implemented at convenience; the variable of the grade of dependence of the Alzheimer's patient caregiver was not included in the study. CONCLUSIONS: The domestic and care chores that HWs and CHWs carry out affect their health. Hence the need to develop psychoeducative programmes that are adapted to the particular needs of these women and focused on the different areas of their everyday lives.
Assuntos
Doença de Alzheimer , Esgotamento Psicológico , Cuidadores/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Estudos Transversais , Emoções , Feminino , Humanos , Sintomas Inexplicáveis , Pessoa de Meia-Idade , Isolamento Social , Inquéritos e Questionários , Adulto JovemAssuntos
Erros de Diagnóstico , Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Transtornos Linfoproliferativos/diagnóstico , Doença Relacionada a Viagens , Adolescente , Anticorpos Antifúngicos/sangue , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Febre de Causa Desconhecida/etiologia , Histoplasma/imunologia , Histoplasmose/complicações , Histoplasmose/diagnóstico por imagem , Histoplasmose/tratamento farmacológico , Humanos , Imunocompetência , Itraconazol/uso terapêutico , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/diagnóstico por imagem , Pneumopatias Fúngicas/tratamento farmacológico , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Masculino , México , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To assess whether dexamethasone (DXM) decreases the time to recovery in patients with parapneumonic pleural effusion. STUDY DESIGN: This was a multicenter, randomized, double blind, parallel-group, placebo-controlled clinical trial of 60 children, ranging in age from 1 month to 14 years, with community-acquired pneumonia (CAP) and pleural effusion. Patients received either intravenous DXM (0.25?mg/kg/dose) or placebo every 6 hours over a period of 48 hours, along with antibiotics. The primary endpoint was the time to recovery in hours, defined objectively. We also evaluated complications and adverse events. RESULTS: Among the 60 randomized patients (mean age, 4.7 years; 58% female), 57 (95%) completed the study. Compared with placebo recipients, the patients receiving DXM had a shorter time to recovery, after adjustment by severity group and stratification by center (hazard ratio, 1.95; 95% CI, 1.10-3.45; P?=?.021). The median time to recovery for patients receiving DXM was 68 hours (2.8 days) shorter than patients receiving placebo (109 hours vs 177 hours; P?=?.037). In exploratory subgroup analysis, the median time to recovery for patients with simple effusion receiving DXM was 76 hours (3.1 days) shorter than for patients with simple effusion receiving placebo (P?=?.017). The median time to recovery for patients with complicated effusion receiving DXM was 14 hours (0.5 days) shorter than for patients with complicated effusion receiving placebo (P?=?.66). The difference in the effect of DXM in the 2 severity groups was not statistically significant (P?=?.138 for interaction). There were no significant differences in complications or adverse events attributable to the study drugs, except for hyperglycemia. CONCLUSION: In this trial, DXM seemed to be a safe and effective adjunctive therapy for parapneumonic pleural effusion. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01261546.