Neurological Manifestations of HIV in children：儿童艾滋病的神经系统表现.ppt

Reactive Arthritis Clinical signs and symptoms Onset is most often acute, with malaise, fatigue, and fever asymmetrical predominately lower extremity oligo-arthritis (usually no more than 6 joints) Stiffness may develop at first before pain Joints may become quite swollen. The severity of pain and swelling can vary from mild to severe Treatment Rest Physiotherapy maintain and restore joint ROM NWB gait with crutches initially Maintain muscle strength Splinting may be useful to relieve pain Pain management NSAIDS Corticosteroids Antibiotic therapy Arthritic drug therapy Reactive Arthritis Prognosis Resolution of symptoms by 3-12 months, but symptoms may persist for 12 months or more. About 15% of patients develop a long-term, and sometimes destructive arthritis There is a high incidence of recurrence Lymphoid Interstitial Pneumonitis Lymphoid Interstitial Pneumonitis (LIP) Slowly progressive interstitial lung disease Unknown cause Characterised peribronchiolar lymphoid nodulescausing diffuse infiltration of the alveolar septae Later leads to widespread Bronchiectasis with a clinical picture similar to Cystic Fibrosis Usually the older HIV-infected children Often leads to chronic bronchiectasis Clinical signs and symptoms: Tachypnoea Productive cough Wheezing Hypoxaemia Right heart failure Lymphoid Interstitial Pneumonitis (LIP) Role of Physiotherapy in LIP Role of physiotherapy here has not been well described Similar to the management of Bronchiectasis, children admitted with CHF may slightly more complicated to treat in acute phase where severe dyspnoea and SOB is present Due to the destruction of the cilia postural drainage is essential Dyspnoea management Forced expiratory techniques e.g. Huffing/cough Active cycle of breathing “Flutter” or bronchi-vibe/ bubble PEP Localised breathing exercises to improve ventilation Individualised CVS exercise programme to maintain and improve endurance and functional abilities Central