Koebner's phenomenon in systemic lupus erythematosus.

Koebner phenomenon is defined as a nonspecific skin stimulus eliciting a disease skin reaction. The nature of the skin trauma varies greatly and includes areas of thermal injury, excoriations, surgical incisions, and scars. We report a patient with recent onset of systemic lupus erythematosus who developed Herpes zoster on immunosuppressant medication. Two weeks after resolution of the vesicles, the patient presented with new ulcerative reddish lesions over the herpes zoster scare and worsening of her malar rash without evidence of worsening of any other organ. Koebner phenomenon was suspected. We review the literature on Koebner phenomenon in SLE.

Panniculitis in childhood-onset systemic lupus erythematosus: a multicentric cohort study.

OBJECTIVE: To evaluate prevalence, clinical manifestations, laboratory abnormalities, treatment and outcome in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients with and without panniculitis. METHODS: Panniculitis was diagnosed due to painful subcutaneous nodules and/or plaques in deep dermis/subcutaneous tissues and lobular/mixed panniculitis with lymphocytic lobular inflammatory infiltrate in skin biopsy. Statistical analysis was performed using Bonferroni correction(p < 0.004). RESULTS: Panniculitis was observed in 6/847(0.7%) cSLE. Painful subcutaneous erythematosus and indurated nodules were observed in 6/6 panniculitis patients and painful subcutaneous plaques in 4/6. Generalized distribution was evidenced in 3/6 and localized in upper limbs in 2/6 and face in 1/6. Cutaneous hyperpigmentation and/or cutaneous atrophy occurred in 5/6. Histopathology features showed lobular panniculitis without vasculitis in 5/6(one of them had concomitant obliterative vasculopathy due to antiphospholipid syndrome) and panniculitis with vasculitis in 1/6. Comparison between cSLE with panniculitis and 60 cSLE without panniculitis with same disease duration [2.75(0-11.4) vs. 2.83(0-11.8) years,p = 0.297], showed higher frequencies of constitutional involvement (67% vs. 10%,p = 0.003) and leukopenia (67% vs. 7%,p = 0.002). Cutaneous atrophy and hyperpigmentation occurred in 83% of patients. CONCLUSIONS: Panniculitis is a rare skin manifestation of cSLE occurring in the first three years of disease with considerable sequelae. The majority of patients have concomitant mild lupus manifestations.

Initial Benchmarking of the Quality of Medical Care in Childhood-Onset Systemic Lupus Erythematosus.

OBJECTIVE: To assess the quality of medical care in childhood-onset systemic lupus erythematosus (SLE) at tertiary pediatric rheumatology centers as measured by observance of SLE quality indicators (SLE-QIs). METHODS: International consensus has been achieved for childhood-onset SLE-QIs capturing medical care provision in 9 domains: diagnostic testing, education of cardiovascular (CV) risk and lifestyles, lupus nephritis (LN), medication management, bone health, ophthalmologic surveillance, transition, pregnancy, and vaccination. Using medical record information, the level of performance of these childhood-onset SLE-QIs was assessed in childhood-onset SLE populations treated at 4 tertiary pediatric rheumatology centers in the US, 2 in Brazil, and 1 center in India. RESULTS: A total of 483 childhood-onset SLE patients were assessed. Care for the 310 US patients differed markedly for childhood-onset SLE-QIs addressing LN, bone health, vaccinations, education on CV risk, and transition planning. Performance of safety blood testing for medications was high at all centers. Despite often similar performance on the childhood-onset SLE-QI, access to kidney biopsies was lower in Brazil than in the US. Irrespective of the country of practice, larger centers tended to meet the childhood-onset SLE-QIs more often than smaller centers. CONCLUSION: The childhood-onset SLE-QIs, evidence-based minimum standards of medical care, are not consistently met in the US or some other countries outside the US. This has the potential to contribute to suboptimal childhood-onset SLE outcomes.

Lack of association between nutritional status and change in clinical category among HIV-infected children in Brazil.

CONTEXT AND OBJECTIVE: Malnutrition is common among HIV-infected children. Our objective was to study the occurrence of malnutrition and its relationship with changes in clinical category among HIV-infected children. DESIGN AND SETTING: Longitudinal study, at the Pediatrics Department and Pediatrics Investigation Center (CIPED), Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp). METHODS: We reviewed the hospital records of 127 vertically HIV-infected children. Anthropometric measurements were obtained at the beginning of follow-up, at clinical category change and five months later. These were converted to z-scores of weight/age, height/age and weight/height. Data were presented as means, standard deviations, frequency counts and percentages. The Wilcoxon and Kruskal-Wallis tests and odds ratios were used in the analysis. RESULTS: We found that 51 (40.2%) were undernourished and 40 (31.5%) were stunted, with higher risk of being included in clinical category C. There was an association between nutritional condition and the clinical categories of the Centers for Disease Control classification (1994), and with age at symptom onset (except for height z-score). During follow-up, 36 patients (28.4%) changed their clinical category, which occurred early among the undernourished patients. The group that changed its clinical category maintained the same z-score distribution for weight, height and weight/height throughout follow-up. CONCLUSION: Aids manifestation severity was associated with nutritional status and with age at symptom onset, but change in clinical category was not followed by worsening of nutritional status.

Panniculitis in childhood-onset systemic lupus erythematosus: a multicentric cohort study

Abstract Objective: To evaluate prevalence, clinical manifestations, laboratory abnormalities, treatment and outcome in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients with and without panniculitis. Methods: Panniculitis was diagnosed due to painful subcutaneous nodules and/or plaques in deep dermis/subcutaneous tissues and lobular/mixed panniculitis with lymphocytic lobular inflammatory infiltrate in skin biopsy. Statistical analysis was performed using Bonferroni correction(p < 0.004). Results: Panniculitis was observed in 6/847(0.7%) cSLE. Painful subcutaneous erythematosus and indurated nodules were observed in 6/6 panniculitis patients and painful subcutaneous plaques in 4/6. Generalized distribution was evidenced in 3/6 and localized in upper limbs in 2/6 and face in 1/6. Cutaneous hyperpigmentation and/or cutaneous atrophy occurred in 5/6. Histopathology features showed lobular panniculitis without vasculitis in 5/6(one of them had concomitant obliterative vasculopathy due to antiphospholipid syndrome) and panniculitis with vasculitis in 1/6. Comparison between cSLE with panniculitis and 60 cSLE without panniculitis with same disease duration [2.75(0-11.4) vs. 2.83(0-11.8) years,p = 0.297], showed higher frequencies of constitutional involvement (67% vs. 10%,p = 0.003) and leukopenia (67% vs. 7%,p = 0.002). Cutaneous atrophy and hyperpigmentation occurred in 83% of patients. Conclusions: Panniculitis is a rare skin manifestation of cSLE occurring in the first three years of disease with considerable sequelae. The majority of patients have concomitant mild lupus manifestations.

Quality of sleep and quality of life in adolescents infected with human immunodeficiency virus.

OBJECTIVES: To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. METHODS: A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. RESULTS: A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. CONCLUSIONS: HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. This may be explained by the steady improvements in daily living as a result of successful anti-retroviral therapy, and by the vulnerability that affects Brazilian adolescents living in major urban centers.

Quality of sleep and quality of life in adolescents infected with human immunodeficiency virus / Qualidade do sono e qualidade de vida em adolescentes infectados pelo vírus da imunodeficiência humana

OBJECTIVES: To assess sleep characteristics of adolescents infected by HIV, and to ascertain whether psychosocial aspects are associated to the quality of sleep. METHODS: A cross-sectional study assessing 102 HIV-infected adolescents of both genders, aged between 10 and 20 years-old and 120 Controls. Data collection was performed by applying the Sleep Disturbance Scale for Children, the Epworth Sleepiness Scale, and the Pediatric Quality of Life Inventory. RESULTS: A sleep disturbance prevalence of 77.4% was found in patients, and a 75% prevalence in controls, and there was correlation between quality of sleep and of life. HIV-infected adolescents scored higher for sleep breathing disorders and had higher prevalence of excessive daytime sleepiness. CONCLUSIONS: HIV-infected adolescents had similar quality of sleep compared to healthy adolescents. This may be explained by the steady improvements in daily living as a result of successful anti-retroviral therapy, and by the vulnerability that affects Brazilian adolescents living in major urban centers.

OBJETIVOS: Avaliar as características do sono de adolescentes infectados pelo HIV e estudar se os aspectos psicossociais estão associados à qualidade do sono. MÉTODOS: Estudo transversal, que avaliou 102 adolescentes, com idades entre 10 e 20 anos, infectados pelo HIV, e 120 controles, de ambos os gêneros. Para a coleta de dados, aplicaram-se: a Sleep Disturbance Scale for Children, a Epworth Sleepiness Scale, e o Pediatric Quality of Life Inventory. RESULTADOS: Verificou-se prevalência de distúrbios do sono em 77,4% dos pacientes e em 75% nos controles, e houve correlação entre qualidade do sono e de vida. Adolescentes HIV-positivos apresentaram maior pontuação nos distúrbios respiratórios do sono e maior prevalência de sonolência diurna excessiva. CONCLUSÕES: Adolescentes infectados pelo HIV apresentaram qualidade de sono semelhante à da população saudável. Isso provavelmente decorre pela melhora de suas condições de vida resultante do sucesso da terapia antirretroviral em pacientes HIV-positivos e pelas vulnerabilidades que afetam adolescentes brasileiros de grandes centros urbanos.

Lack of association between nutritional status and change in clinical category among HIV-infected children in Brazil

CONTEXTO E OBJETIVO: A ocorrência de desnutrição é freqüente em crianças com infecção pelo HIV. O objetivo do estudo foi estudar a ocorrência de desnutrição e sua relação com a mudança de categoria clínica em crianças infectadas pelo HIV. TIPO DE ESTUDO E LOCAL: Estudo longitudinal, no Departamento de Pediatria e Centro de Investigação em Pediatria (CIPED). Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp). MÉTODOS: Revisamos os prontuários de 127 pacientes com infecção perinatal pelo HIV com o propósito de obter medidas de peso e estatura no início do acompanhamento ambulatorial, no momento da mudança de categoria clínica e cinco meses após a mudança. Estes dados foram transformados em z-escores de peso/idade, altura/idade e peso/altura. Os testes de Wilcoxon, Kruskal-Wallis e o cálculo da razão de chances foram usados. RESULTADOS: 51 (40,2%) das crianças avaliadas apresentavam desnutrição, sendo 40 (31,5%) com comprometimento de altura, e portanto com maior risco de inclusão na categoria clínica C. Encontramos associação entre condição nutricional, categoria clínica e idade no início dos sintomas. 36 (28,4%) pacientes mudaram de categoria clínica durante o acompanhamento, e a mudança ocorreu em idade mais precoce entre os desnutridos. O grupo que mudou de categoria clínica manteve as mesmas distribuições de z-escore de peso, altura e peso/altura durante o acompanhamento. CONCLUSAO: A gravidade das manifestações da aids associa-se com a condição nutricional e com a idade de início dos sintomas. A mudança de categoria clínica não se acompanhou de piora no estado nutricional.

Imonuglobulina séricas em crianças com exposição perinatal ao vírus da imunodeficiência humana / Serum immunoglobulins children perinatally exposed to human immunodeficiency virus

Objetivo: a hipergamaglobulinemia é uma manifestação precoce da infecção perinatal por HIV. O objetivo foi analisar as diferenças nos níveis séricos de inoglobulinas entre crianças infectadas e sororreversoras e sua associação com a evolução clínica. Métodos: em um estudo prospectivo histórico, avaliaram-se 107 crianças infectadas e 90 sororreversoras. Comparam-se: IgA, IgG IgM entre infectados e sororreversores nos primeiros meses de vida; IgA, IgG IgM como marcadores indiretos de infecção; IgA, IgG e IgM nos 5 primeiros anos em infectados de acordo com a evolução clínica. Utilizou-se o teste de Mann-Whitney para a comparação entre grupos. Na avaliação de marcadores indiretos, analisaram-se sensibilidade, especificidade, valores positivos e negativo, e índice J. Resultados: infectados, em relação a sororreversores, apresentaram níveis significativos superiores de IgM do 1§ ao 5§trimestre; IgA e IgG, do 2§ ao 6§ trimestre (P menor ou igual 0,05). Os níveis de IgA maior ou igual a 90mg/dl no 2§ trimestre e IgG maior ou igual a 1.700mg/dl ou 1.200mg/dl no 2§ e 3§ trimestres associaram-se à infecção por HIV com índices J de 0,97, 0,92 e 0,93, respectivamente. Crianças infectadas nas categorias B e C, comparadas àquelas nas categorias N e A, apresentaram níveis superiores de IgM do 2§ ao 4§ ano e IgA do 3§ ao 5§ ano (P menor ou igual a 0,05). Conclusões: a evolução temporal dos níveis de IgA, IgG e IgM demonstra um estímulo intenso e precoce à síntese de imunoglobulinas em infectados. Indicadores clínico-epidemiológicos demonstram que tais níveis podem ser marcadores indiretos de infecção. Níveis superiores de IgM e IgA do 2§ ao 5§ ano em crianças infectadas com maior gravidade sugerem disfunção na regulação imune secundária ao estímulo antigênico persistente

Incidência e tipos mais frequentes de castigos aplicados pelos pais ou responsáveis a escolares, na cidade de Campinas - SP / The incidence and various types of punishment inflicted by family to children students in the city of Campinas - SP

O presente levantamento foi feito a partir de um estudo sobre violência familiar näo notificada na cidade de Campinas-Säo Paulo, onde se procurou conhecer os tipos de castigos incidentes na populaçäo estudada, que se compöe de 1.456 crianças, com idades variando entre 7 e 14 anos. As respostas recebidas foram agrupadas em 16 categorias, desde "broncas" até agressöes físicas. Procuramos conhecer, também, quais castigos foram percebidos pelas crianças como os piores, sendo três mais frequentes "näo brincar", "ficar de castigo" e "apanhar".