@article {8491, title = {Dyslipidemia, Diet, and Physical Exercise in Children on Treatment with Anti-Retroviral Medication in El Salvador: A Cross-Sectional Study.}, journal = {Pediatr Infect Dis J}, year = {2016}, month = {2016 May 31}, abstract = {

BACKGROUND: Dyslipidemias are common in HIV-infected children, especially if treated with protease-inhibitors, but there are few data on how to treat dyslipidemias in this population. We estimated the dislypidemia prevalence and its association with treatment, diet, and physical exercise in children on anti-retroviral treatment at the El Salvador reference center for pediatric HIV care (CENID).

METHODS: Information was gathered regarding socio-demographic characteristics, treatment, diet, and physical activity of 173 children aged 5-18 years and receiving anti-retroviral therapy.Triglycerides, total cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), viral load, and CD4 T-lymphocytes were measured. Abnormal concentrations were defined as triglycerides >=130 mg/dl in 10- to 18-year-olds and >=100 mg/dl in <10 year-olds; total cholesterol >=200 mg/dl; LDL-C >=130 mg/dl; and HDL-C <=35 mg/dl.We adjusted four different multivariate models to assess the independent association of each type of dyslipidemia with protease-inhibitors, diet, and physical exercise.

RESULTS: Of the 173 children, 83 (48\%) had hypertriglyceridemia and 25 (14.5\%) hypercholesterolemia. High LDL-C concentrations were observed in 17 children (9.8\%) and low HDL-C in 38 (22\%). Treatment with protease-inhibitors was significantly associated with hypertriglyceridemia (Prevalence Ratio (PR) 2.8; 95\%CI 2.0-3.8) and hypercholesterolemia (PR 9.0; 95\%CI 3.6-22.2).Higher adherence to a "high fat/sugar diet" was associated with hypercholesterolemia (PR 1.6; 95\%CI 1.1-2.3) and high LDL-C (PR 1.7; 95\%CI 1.0-2.9).Compared with those exercising <3 times/week, children exercising >=7 times were less likely to have low HDL-C (PR=0.4; 95\%CI 0.2-0.7).

CONCLUSIONS: These results suggest that a healthy diet and exercise habits can contribute to controlling some aspects of the lipid profile in this population.

}, issn = {1532-0987}, doi = {10.1097/INF.0000000000001244}, author = {Sonego, Michela and Sagrado, Maria Jos{\'e} and Escobar, Gustavo and Lazzerini, Marzia and Rivas, Estefanie and Mart{\'\i}n-Ca{\~n}avate, Rocio and de L{\'o}pez, Elsy P{\'e}rez and Ayala, Sandra and Castaneda, Luis and Aparicio, Pilar and Custodio, Estefan{\'\i}a} } @article {8037, title = {Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis.}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0136166}, abstract = {

OBJECTIVE: To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC).

DESIGN: Systematic review and meta-analysis.

STUDY SELECTION: Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC.

DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015.

RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger{\textquoteright}s test to evaluate publication bias.

RESULTS: Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6\%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90\% associated with significantly increased odds of death from ALRI (OR 5.47, 95\% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92\% associated with a similar increased risk of mortality (OR 3.66, 95\% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude.

CONCLUSIONS: The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92\% and 90\% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.

}, issn = {1932-6203}, doi = {10.1371/journal.pone.0136166}, author = {Lazzerini, Marzia and Sonego, Michela and Pellegrin, Maria Chiara} } @article {8054, title = {Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies.}, journal = {PLoS One}, volume = {10}, year = {2015}, month = {2015}, pages = {e0116380}, abstract = {

OBJECTIVE: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries.

DESIGN: Systematic review and meta-analysis.

STUDY SELECTION: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries.

DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014.

RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger{\textquoteright}s test to evaluate publication bias.

RESULTS: Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95\% confidence interval 6.37-13.92); age below two months (5.22, 1.70-16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67-8.61), chronic underlying diseases (4.76, 3.27-6.93); HIV/AIDS (4.68, 3.72-5.90); and severe malnutrition (OR 4.27, 3.47-5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03-3.31); low maternal education (1.43, 1.13-1.82); low socio-economic status (1.62, 1.32-2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11-4.31). Immunisation (0.46, 0.36-0.58) and good antenatal practices (0.50, 0.31-0.81) were associated with decreased odds of death.

CONCLUSIONS: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

}, keywords = {Child, Preschool, Developing Countries, Environmental Exposure, Humans, Infant, Infant, Newborn, Observational Studies as Topic, Poverty, Respiratory Tract Infections, Risk Factors, Survival Analysis}, issn = {1932-6203}, doi = {10.1371/journal.pone.0116380}, author = {Sonego, Michela and Pellegrin, Maria Chiara and Becker, Genevieve and Lazzerini, Marzia} }