No abstract

No abstract

There is an inherent complexity within clinical markers that is challenging to determine HIV-pediatric failure and further research is needed to build a complete picture to guide clinical, evidence-based practice.

BackgroundHIV-infected children suffer from higher levels of treatment failure compared to adults. Immunoactivation, including humoral immunoactivation reflected by increased immunoglobulin levels, is believed to occur early during HIV infection. Therefore, we wanted investigate alteration in immunoglobulin levels in association with treatment response in HIV-infected children.MethodsA nested case–control study was conducted using clinical data collected from 68 HIV-infected children enrolled at the National Hospital of Pediatrics, Vietnam.ResultsThe results showed that immunoglobulin levels, CD4 T-cell counts, CD4 T-cell percentage, and HIV load were significantly higher in the treatment-failure group than the treatment-success group at treatment initiation. IgG and IgA levels were negatively correlated with CD4 T-cell counts (P=0.049 and P<0.01, respectively) and positively correlated with HIV load (P=0.04 and P=0.02, respectively). In addition, IgG and IgA levels were independently associated with treatment response, analyzed by Cox regression analysis (HR 1.19 [P=0.049] and HR 1.69 [P<0.01], respectively).ConclusionElevation of IgA levels occurred early during HIV infection, and might have a prognostic role in treatment response.

Purpose: To investigate whether children undergoing a tonsillectomy or adenotonsillectomy (AT) with Coblation ® will experience less postoperative pain and return to a normal diet and a regular activity level sooner compared to the same procedure using electrocautery dissection. This may manifest less school and work missed by the child and caregiver, respectively. Materials and Methods: Seventy-four children between the ages 2-13 years with either obstructive sleep apnea or chronic tonsillitis were recruited at a single tertiary-care center from January 2011 to November 2012 and underwent an AT via electrocautery or Coblation ®. Caregivers were given a ten-point Wong-Baker FACES pain scale and questions inquiring the degree of oral intake, activity level, and impact on both the child and caregiver in regards to missing work or school on postoperative days (POD) 0, 1, 2, 3, 5, 7, and 14. Results: Children in the Coblation ® arm required less pain medications (p < 0.0022) and improved drinking subjectively (p < 0.0049) on POD 0. Subsequent results were not significantly different for any other day. Age-and gendered-controlled multivariate analysis revealed a statistically significant difference in pain medications administered (p < 0.0001) but not pain scores (p < 0.2115) between the two techniques, although this difference in medications is likely related to the results observed on POD 0. There was no incidence of postoperative hemorrhage in either group. Conclusions: While there was less pain medication administered and slightly improved oral intake of liquids on POD 0 for children in the Coblation ® arm, there was no difference in subsequent postoperative outcome or hemorrhage rates.