Medication adherence in children and adolescents with HIV infection: associations with behavioral impairment

The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000-2007). A total of 1134 participants, aged 3-17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T?>?65) in the areas of conduct problems (14%, z?=?7.0, p?相似文献   

Angiogenic growth factor expression in benign and malignant vascular tumours

Angiosarcomas are rare malignant vascular tumours. Angiosarcoma expression of vascular endothelial growth factor (VEGF) has previously been reported, but angiosarcoma expression of other angiogenic growth factors has not been systematically studied. Non-VEGF angiogenic growth factors are a potential mechanism of resistance to VEGF-targeted therapy, but they also represent potential therapeutic targets.     

Paraneoplastic granulomatous vitritis and retinitis as a presentation of recurrent classical Hodgkin’s lymphoma

We describe a unique case of a patient with an established diagnosis of Hodgkin’s lymphoma in clinical remission who later presented with apparent vitreous inflammation. A vitreous biopsy (including fortuitously some peripheral retinal fragments) exhibited granulomatous inflammation. Since the latter can be a paraneoplastic phenomenon of active Hodgkin’s lymphoma in distant organ sites, the haematologists were alerted to the possibility of recurrent lymphoma, despite the patient having no clinical symptoms. Repeat body imaging showed enlarged mediastinal lymph nodes, biopsy of which confirmed recurrent Hodgkin’s lymphoma. The patient responded well to systemic chemotherapy with resolution of the visual symptoms. This case report illustrates the importance of vitreous biopsy in this clinical setting and how to interpret the significance of granulomas in this context, and outlines a unique vitreo-retinal paraneoplastic granulomatous presentation in the setting of recurrent Hodgkin’s lymphoma and how this diagnosis triggered a prompt review of the patient who had no constitutional symptoms, with hopefully a favourable impact on prognosis given the early recurrent disease detection.     

Efficacy of xylitol and fluoride mouthrinses on salivary mutans streptococci

Objective

To evaluate the level of salivary Mutans streptococci (MS) after rinsing with xylitol, fluoride, and a combination of xylitol and fluoride solutions, compared with distilled water.

Methods

Eighty healthy 8-9 years old subjects with high level of MS (> 10⁵ CFU/mL) were equally divided into 4 groups. Subjects rinsed their mouths for 1 min with 10 mL of 0.05% (w/v) sodium fluoride (NaF), 12.5% (w/v) xylitol or 0.05% (w/v) NaF + 12.5% (w/v) xylitol 3 times daily over 10 weeks. Distilled water rinsed group served as a control. Paraffin-stimulated whole saliva samples were collected at baseline, 5 weeks, and 10 weeks after rinsing to determine the level of salivary MS by culturing on Mitis Salivarius Bacitracin agar. The statistical significance was calculated by Kruskal Wallis, Mann Whitney U, and Wilcoxon signed-rank tests at a significant level of P< 0.05.

Results

Significant reductions in MS count were observed in subjects using 0.05% NaF + 12.5% xylitol over other groups within 5 weeks and after 10 weeks and 12.5% xylitol alone after 10 weeks compared with baseline.

Conclusions

The present study provides evidence for the inhibitory effect of xylitol, used in combination with fluoride, delivered in the form of mouthrinse, on salivary MS in the group of schoolchildren.     

Risk of cesarean wound complications in diabetic gestations

OBJECTIVE: This study was undertaken to examine the association between pregestational diabetes mellitus (DM) and wound complications after cesarean delivery (CD). STUDY DESIGN: This was a retrospective, observational cohort study in patients with type 1 and 2 DM compared with non-DM controls undergoing CD. Wound complications were defined as wound infection, wound separation greater than 1 cm, and wound dehiscence. RESULTS: There was an overall incidence of wound complications of 18.4% (34/185) in DM versus 5.8% (10/174) in non-DM (unadjusted odds ratio of 3.7; 95% CI = 1.8-7.7). Mean body mass index before pregnancy was 30.9 in DM versus 26.5 kg/m 2 in non-DM (P < .01). A multivariable logistic regression model adjusting for body mass index, length of surgery, and previous CD demonstrated a 2.5-fold increased risk of wound complications in DM patients compared with non-DM patients (95% CI = 1.1-5.5). CONCLUSION: Pregestational diabetes is associated with a 2.5-fold increase in wound complications after CD.     

Sclerosing lipogranuloma of the nose: a new treatment using adipose tissue transplantation

We report a series of 45 patients visiting our clinic with distorted contour of the nose after having their noses augmented with injectable substances. The most common clinical presentation was a palpable mass on the dorsum of the nose, erythema with or without telangiectasia on the overlying skin, and nodularity of the nose. The onset of symptoms varied from 1 to 16 years after injection. They were treated by surgical excision, but this was always followed by a saddle-nose deformity. To correct this defect, we propose a new technique of adipose tissue transplantation that yields satisfactory results. Pathological reports of the excised mass showed a foreign body granuloma known as a sclerosing lipogranuloma (paraffinoma or siliconoma).     

Outcome of very low birth weight infants with histopathologic chorioamnionitis

OBJECTIVE: To determine neonatal outcome at 7 months of corrected age in very low birth weight (VLBW) infants with placental chorioamnionitis. METHODS: We conducted a cohort study of 287 VLBW infants delivered as a result of preterm premature rupture of membranes (PROM) or preterm labor. Control subjects (n = 123) had placentas with absent umbilical cord inflammation and absent or low-grade membrane inflammation. Case subjects (n = 164) had moderate membrane inflammation or any umbilical cord inflammation. Neonatal and 7-month outcomes were compared. A power analysis showed that 98 total subjects were needed to reject the two-sided null hypothesis with a difference in mean Bayley index scores of at least 8. RESULTS: Infants in the study group had significantly more preterm PROM, antenatal antibiotics, lower birth weight, lower gestational age, longer duration of ruptured membranes, and clinical chorioamnionitis. Intraventricular hemorrhage occurred more commonly in infants with placentas demonstrating chorioamnionitis (relative risk = 1.6, 95% confidence interval 1.1, 2.4, P =.013). One hundred sixty-seven (69%) of the 243 surviving infants had 7-month follow-up. There was no difference between cases and controls in mean Bayley mental developmental index (93 compared with 90, P =.25), psychomotor developmental index (89 compared with 90, P =.68), or in the number of infants that were developmentally delayed. CONCLUSION: Despite a higher frequency of intraventricular hemorrhage, no difference in developmental scores was detected at 7 months of corrected age in VLBW infants with histologic chorioamnionitis.     

Adrenocortical activity in the newborn spontaneously hypertensive rat.

Blood pressure is reportedly elevated in the spontaneously hypertensive rat (SHR) neonate, the etiology of which remains unclear. Aberrations in the hypothalamic-pituitary-adrenal axis have been implicated, as it is well accepted that excess corticosteroids are associated with hypertension. We examined aspects of adrenocortical activity in the neonatal SHR 1 to 21 days old and its normotensive genetic control, the Wistar-Kyoto rat (WKY). We found a fourfold greater abundance of P450scc mRNA in adrenals of SHR versus WKY day 1 neonates, and increasing but comparable abundance of adrenal P450c11B mRNA on neonatal days 1 to 21. The pattern of P450c11AS mRNA expression was distinctly different in the adrenals of SHR and WKY neonates; the relative abundance of this mRNA in SHR increased 15-fold over the 21-day period examined, whereas that in WKY remained fairly stable. RT-PCR for the presence/abundance of adrenal P450c11B3 mRNA showed absence in day 1 SHR and WKY, comparable abundances on neonatal days 7 and 14, and a distinctly greater abundance in the day 21 SHR adrenals. Peripheral corticosterone levels were threefold greater in the day 1 SHR neonate; aldosterone levels were elevated in both the SHR and WKY day 1 neonate. Thereafter, corticosterone and aldosterone levels were comparable on days 7, 14, and 21, although the anticipated depression in circulating corticosterone levels typical of the stress hyporesponsive period was noted in both SHR and WKY neonates. Although patterns of adrenocortical activity differ in the newborn SHR and WKY rat, our findings do not support an etiologic role for corticosteroids in the reported hypertension of the SHR. However, observed differences in corticosteroid profiles may augment or have a permissive effect upon the etiologic factor(s).