RESUMO -O envolvimento do sistema nervoso central SNC na infecção pelo HIV-1 em crianças pode estar evidente desde o início ou demorar muitos anos para se manifestar. Microcefalia, rebaixamento cognitivo, sinais piramidais, distúrbios do humor e do comportamento e complicações pelo uso da terapia antire t ro v i r a l são comuns. Este é um trabalho observacional, descritivo e seccional cuja finalidade é descrever as alterações do exame neurológico em um grupo de crianças e adolescentes expostos pelo HIV-1 durante o período perinatal. Foram avaliados 173 pacientes. Muitos pacientes tinham superposição de alterações de exame n e u rológico e/ou mais de um diagnóstico. As alterações mais comuns foram: re t a rdo do desenvolvimento n e u ro p s i c o m o t o r, atraso de linguagem, deficiência mental, síndrome piramidal, hiporreflexia. O exame n e u rológico foi alterado em 67% dos casos, mesmo naqueles pacientes soro -re v e rtidos. Sugerimos que e x i s t e alto risco para doença neurológica nesse grupo de pacientes e que a pro g ressão da infecção pelo HIV-1 a c e ntua o aparecimento de co-morbidades e comprometimento de seu prognóstico.PALAVRAS-CHAVE: HIV-1, sistema nervoso, exame neurológico.Neurological findings in a group of children and adolescents exposed and infected by HIV-1ABSTRACT -The CNS infection by HIV-1 in infancy could be present immediately after infection or became manifest later. Microcephalia, mental re t a rdation, pyramidal signs, humor and behavioral disorders and a n t i re t roviral therapy complications are common. This is an observational, sectional and descriptive study about findings on neurological examination of 173 patients in a group of children and adolescents infected and exposed to HIV-1 in perinatal period. Most of them had more than one neurological finding or diff e re n t diagnosis. The more common findings were: encephalopathy, mental re t a rdation, language d e l a y, pyramidal signs, hyporreflexia. The neurological examination was abnormal in 67% of all patients even in soro re v e rt e r s . We sugest that this group has a high risk to neurological disease and the development of co-morbidity is directly correlated to clinical deterioration by HIV-1 infection.KEY WORDS: HIV-1,nervous system, neurological examination.Durante os primeiros anos da epidemia de SIDA, a encefalopatia foi considerada uma das manifestações precoces da doença, acreditando-se que era mais comum na infância. Atualmente, após o estudo de duas grandes coortes, uma francesa 1 e outra a m e r i c a n a 2 , verificou-se que a pro g ressão dos sintomas definidores de SIDA no primeiro ano de vida era de 19% e 4,5% ao ano, respectivamente e, a posteriori, muito menor do que descrita no passado, p rovavelmente devido ao diagnóstico precoce da infecção e conseqüente intervenção terapêutica 3 , 4 . No lactente jovem, a encefalopatia pelo HIV-1 é, p rovavelmente, conseqüência direta da ação do víru s em um cére b ro em desenvolvimento, o que poderia justificar a diferença de evolução clínica entre adultos ...
SUMMARYThis study evaluated the adherence to influenza vaccination among medical students in 2010 and 2011. From August to December 2011, a questionnaire was used to record the influenza vaccination in 2010 and 2011, reasons for acceptance of the influenza vaccine and knowledge of healthcare workers about the influenza vaccine recommendation. One hundred and forty-four students from the 2ndto the 6th years of the medical school were interviewed. A great adherence to pandemic influenza vaccine was noted in 2010, (91% of the students), with "self-protection" being the most common reason cited for vaccination. Other determinants for the vaccination during pandemic were "convenient access to vaccine" and "encouragement by peers and teachers in workplaces and at the university". However, there was a great decay in the acceptance to vaccine in the next influenza season (2011). Only 42% of the students received the vaccine. They claimed "lack of time" and "have forgotten to take the vaccine" as the main reasons. The "knowledge on the recommendation of influenza vaccine to healthcare workers" increased when the students come to attend the last year of the medical school, but that was an insufficient motivator for vaccination. Strategies to increase vaccination should be based on the abovementioned aspects for the adoption of effective measures in both, pandemic and seasonal periods.
Objective: To evaluate the prevalence of hepatitis A virus antibodies in HIV-exposed and/or HIV-infected children and adolescents.Methods: Between September 1996 and August 2002, 352 patients (200 exposed, but not HIV-infected and 152 HIV exposed and infected) were included in this study. These children and adolescents (age ranged between 1 and 14 years) were all followed up at the Pediatric AIDS Clinic of the Federal University of São Paulo (UNIFESP) and had anti-HAV antibodies determined by a commercially available ELISA method (tests for total anti-HAV antibodies and specific IgM antibodies) (Dia Sorin and Radim). Statistical analyses were done with chi-squared and t test.Results: The prevalence of hepatitis A virus antibodies in HIV-infected and HIV-exposed, but uninfected patients was 34% and 19.7%, respectively. We noticed that in the age range between 2 years and 10 years, the group of HIVinfected children presented a higher prevalence of hepatitis A virus antibodies (35.5%) than the group of uninfected children (16.7%) (p = 0.005). In the HIV infected group, children from B and C categories had a prevalence of hepatitis A virus antibodies (40.5%) higher than N and A categories (24.1%) (p = 0.042). Mean age did not differ when children from B and C categories were compared with N and A categories (5.18 and 5.66 years, respectively) (p = 0.617). Conclusions:The prevalence of hepatitis A virus antibodies in HIV exposed and/or infected children and adolescents between 1 and 14 years old was 26%. Considering the possibility of HIV infection aggravation when associated with hepatitis A virus infection, we suggest that hepatitis A virus inactivated vaccine should be administered to these patients.
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