Covid-19 and absence of music therapy: Impact on mother-child dyad during invasive procedures in pediatric oncology.

During COVID-19 pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures to minimize the risk of in-hospital infections in frail patients and staff members. Access to the wards was significantly reduced and music therapy (MT) activities were suspended. The aim of this study was to compare the level of anxiety and sedation in pediatric patients undergoing invasive procedure before (T1), during(T2) and after(T3) the pandemic, with and without the presence of MT. From January to September 2020, all children aged 2-15 with oncological and hematological diseases undergoing to invasive procedure were enrolled. During T1 and T3 children received preoperative preparation with MT by a certified music-therapist. In T2 they received music or video by clinical staff. Preoperative anxiety scores were measured with the m- YPAS scale. Interviews with mothers were performed. The average consumption of drugs used was analyzed. Significant differences in preoperative anxiety levels between scores in T1, T2 (p.value = 0,0000014) and in T2, T3 (p.value = 0,0000031) were observed. No difference between T1-T3 (p.value = 0,96). Higher dosage of midazolam in T2 (1,14 mg 0,189) compared to T1 (0, 71 mg 0,399) and T2 (1,14 mg 0,189) were observed. Mothers also recorded higher scores on anxiety and stress without music therapy.

Third Trimester Vitamin D Status Is Associated With Birth Outcomes and Linear Growth of HIV-Exposed Uninfected Infants in the United States.

BACKGROUND: Vitamin D status in pregnancy may influence the risk of prematurity, birth size, and child postnatal growth, but few studies have examined the relationship among pregnant women living with HIV. METHODS: We conducted a prospective cohort study of 257 HIV-infected mothers and their HIV-exposed uninfected infants who were enrolled in the 2009-2011 nutrition substudy of the Surveillance Monitoring for ART Toxicities (SMARTT) study. HIV-infected pregnant women had serum 25-hydroxyvitamin D (25(OH)D) assessed in the third trimester of pregnancy, and their infants' growth and neurodevelopment were evaluated at birth and approximately 1 year of age. RESULTS: The mean third trimester serum 25(OH)D concentration was 35.4 ± 14.2 ng/mL with 15% of women classified as vitamin D deficient (<20 ng/mL) and 21% as insufficient (20-30 ng/mL). In multivariable models, third trimester vitamin D deficiency and insufficiency were associated with -273 g [95% confidence interval (CI): -450 to -97] and -203 g (95% CI: -370 to -35) lower birth weights compared with vitamin D sufficient women, respectively. Maternal vitamin D deficiency was also associated with shorter gestation (mean difference -0.65 weeks; 95% CI: -1.22 to -0.08) and lower infant length-for-age z-scores at 1 year of age (mean difference: -0.65; 95% CI: -1.18 to -0.13). We found no association of vitamin D status with infant neurodevelopment at 1 year of age. CONCLUSION: Third trimester maternal vitamin D deficiency was associated with lower birth weight, shorter length of gestation, and reduced infant linear growth. Studies and trials of vitamin D supplementation in pregnancy for women living with HIV are warranted.

Interventions to address chronic disease and HIV: strategies to promote exercise and nutrition among HIV-infected individuals.

Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.

Terapia nutricional enteral na síndrome do intestino curto com fórmula infantil elementar / Enteral nutrition therapy in short bowel syndrome with infantile elemental diet

A Síndrome do Intestino Curto (SIC) se caracteriza por importante estado de má absorçäo de nutrientes, que resulta de uma reduçäo substancial do intestino delgado. Este estudo é um relato de caso de um paciente com SIC, com história de ampla rececçäo intestinal. Paciente do sexo masculino, 23 meses, negro, com desnutriçäo grave, peso de internaçäo 6460 g. Avia de acesso para a nutriçäo foi nasogástrica, sonda de polietileno, infusäo contínua e a dieta utilizada foi uma formula infantil elementar (NEOCATE). A oferta calórica inicial foi de 100 kcal/kg/dia e a propéica foi de 3,0 g/kg/dia, com evoluçäo dependente do ganho ponderal e da readaptaçäo intestinal, alcançando oferta calórica final de 200 kcal/kg/dia e protóica de 6 kcal/kg/dia. O paciente foi mantido em balanço metabólico, com acompanhamento diário de peso, ingestäo e perdas. Cuidados das lesöes infectadas nas ostomias, avaliaçäo nutricional bioquímica, antropométrica e clínica constante foram realizadas. Apesar do paciente ter sido encaminhado inicialmwente para Nutriçäo Parenteral Total (NPT), a via enteral foi utilizada com o uso de uma dieta elementar como última escolha antes da NPT. O paciente foi abordado com sucesso, exclusivamente com nutriçäo enteral. Apresentou curva enteral ascendente, com recuperaçäo do estado geral e nutricional, alcançando no quinquagésimo quarto DHI o peso de 8540 g, que possibilitou um teto cirúrgico necessário para a reconstruçäo do transito intestinal. Apesar do encaminhamento inadequado e do manejo inicial incorreto, o estabelecimento de uma terapia nutricional eficaz foi capaz de proporcionar a sobrevida de um paciente absolutamente viável.(au)