scholarly journals Substantial gap in primary care: older adults with HIV presenting late to care

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Faiza Yasin ◽  
Christina Rizk ◽  
Bennie Taylor ◽  
Lydia A. Barakat
Keyword(s):  
Older Patients ◽  
Viral Suppression ◽  
Demographic Data ◽  
Treatment Strategies ◽  
Health Concern ◽  
Cart Initiation ◽  
Patient Demographic Data ◽  
Hiv Viral Suppression ◽  
New Diagnosis ◽  
Record Review

Abstract Background Late diagnosis of human immunodeficiency virus (HIV) is associated with increased morbidity and mortality, and represents a serious public health concern. Methods A retrospective medical record review was conducted on 188 patients with newly diagnosed HIV at a large academic center’s HIV clinic from 1/2010 to 12/2019. Patient demographic data, HIV staging, and response to combination antiretroviral therapy (cART) as measured by HIV viral suppression at 12 weeks (HIV RNA < 50 copies) were collected. Bivariate analyses were applied to compare patients ≥50 years old to those < 50 years old. Results Over two-thirds of the older patients with a new diagnosis of HIV presented with a CD4 count < 200, or an AIDS-defining illness. Though not statistically significant, this same group also had a delay to viral suppression with only 59% achieving viral suppression after 12-weeks of cART initiation. Conclusions This study suggests that older patients are presenting to care with advanced stages of HIV, and may also have a delay in achieving viral suppression after cART initiation. Future studies should aim to target HIV testing and treatment strategies for this at-risk older adult group.

Treatment strategies for inverted papillomas with intracranial or intraorbital involvement

2021 ◽  
pp. 1-7
Author(s):  
D Spinos ◽  
T Kalamatianos ◽  
D Terzakis ◽  
M Piagkou ◽  
C Georgalas
Keyword(s):  
Demographic Data ◽  
Treatment Strategies ◽  
Case Series ◽  
Recurrence Rates ◽  
Case Series Study ◽  
Patient Demographic Data ◽  
Complete Tumour ◽  
Prospective Case Series ◽  
Benign Tumours ◽  
Inverted Papillomas

Abstract Objective Sinonasal inverted papillomas are challenging benign tumours of the nasal cavity because of their high recurrence rates and the lifetime malignant transformation risk of 10 per cent as well as their locally aggressive behaviour. This study aimed to describe treatment strategies for inverted papillomas with intracranial or intraorbital involvement. Method This was a prospective case series study of 18 patients with inverted papilloma with intracranial or intraorbital involvement. Patient demographic data, imaging, pathology, surgical technique and recurrences were recorded prospectively over a period of seven years. Results A total of 83 per cent of the patients in this study had been previously operated on, consisting of 8 cases with intracranial involvement, 1 case with intraorbital involvement and 9 with both. During follow up with a medium of 37 months (range, 13–115 months) there were two recurrences. Conclusion It was postulated that intracranial or intraorbital involvement observed in this series was the result of multiple revisions. However, using accurate imaging protocols and the pedicle-oriented approach for tumour excision, complete tumour removal was achieved in most cases with minimal post-operative complications.

scholarly journals Far from MCAR: obtaining population-level estimates of HIV viral suppression

2019 ◽  
Author(s):  
Laura B. Balzer ◽  
James Ayieko ◽  
Dalsone Kwarisiima ◽  
Gabriel Chamie ◽  
Edwin D. Charlebois ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Treatment Strategies ◽  
Likelihood Estimation ◽  
Population Level ◽  
Hiv Positive ◽  
Hiv Viral Suppression ◽  
Rural Kenya ◽  
Using Data ◽  
Group Sex ◽  
And Control

ABSTRACTBackgroundPopulation-level estimates of disease prevalence and control are needed to assess the effectiveness of prevention and treatment strategies. However, available data are often subject to differential missingness. Consider population-level HIV viral suppression: proportion of all HIV-positive persons who are suppressing viral replication. Individuals with measured HIV status, and, among HIV-positive individuals, those with measured viral suppression are likely to differ from those without such measurements.MethodsWe discuss three sets of assumptions sufficient to identify population-level suppression over time in the intervention arm of the SEARCH Study (NCT01864603), a community randomized trial in rural Kenya and Uganda (2013-2017). Using data on nearly 100,000 participants, we compare estimates from an unadjusted approach assuming data are missing-completely-at-random (MCAR); stratification on age group, sex, and community; and, targeted maximum likelihood estimation (TMLE) with Super Learner to adjust for baseline and time-updated predictors of measurement.ResultsDespite high annual coverage of testing, estimates of population-level viral suppression varied by identification assumption. Unadjusted estimates were most optimistic: 50% of HIV-positive persons suppressed at baseline, 80% at Year 1, 85% at Year 2, and 85% at Year 3. Stratification on baseline predictors yielded slightly lower estimates, and full adjustment reduced estimates further: 42% of HIV-positive persons suppressed at baseline, 71% at Year 1, 76% at Year 2, and 79% at Year 3.ConclusionsEstimation of population-level disease burden and treatment coverage require appropriate adjustment for missingness. Even in “Big Data” settings, estimates relying on the MCAR assumption or baseline stratification should be interpreted with caution.

scholarly journals Updated Insights on EGFR Signaling Pathways in Glioma

2021 ◽  
Vol 22 (2) ◽  
pp. 587
Author(s):  
Alexandru Oprita ◽  
Stefania-Carina Baloi ◽  
Georgiana-Adeline Staicu ◽  
Oana Alexandru ◽  
Daniela Elise Tache ◽  
...  
Keyword(s):  
Signaling Pathways ◽  
Treatment Strategies ◽  
Growth Factor Receptor ◽  
Standard Of Care ◽  
Egfr Signaling ◽  
Current Standard ◽  
Egfr Amplification ◽  
Epidermal Growth ◽  
New Diagnosis ◽  
Clear Clinical Benefit

Nowadays, due to recent advances in molecular biology, the pathogenesis of glioblastoma is better understood. For the newly diagnosed, the current standard of care is represented by resection followed by radiotherapy and temozolomide administration, but because median overall survival remains poor, new diagnosis and treatment strategies are needed. Due to the quick progression, even with aggressive multimodal treatment, glioblastoma remains almost incurable. It is known that epidermal growth factor receptor (EGFR) amplification is a characteristic of the classical subtype of glioma. However, targeted therapies against this type of receptor have not yet shown a clear clinical benefit. Many factors contribute to resistance, such as ineffective blood–brain barrier penetration, heterogeneity, mutations, as well as compensatory signaling pathways. A better understanding of the EGFR signaling network, and its interrelations with other pathways, are essential to clarify the mechanisms of resistance and create better therapeutic agents.

Venous stent versus conventional stent for the treatment of central vein obstruction in hemodialysis patients: a retrospective study

2021 ◽  
pp. 028418512110051
Author(s):  
Surasit Akkakrisee ◽  
Keerati Hongsakul
Keyword(s):  
Endovascular Treatment ◽  
Patency Rate ◽  
Demographic Data ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Central Vein ◽  
Primary Patency Rate ◽  
Patient Demographic Data ◽  
Upper Thoracic ◽  
Vein Stenosis

Background Endovascular treatment is a first-line treatment for upper thoracic central vein obstruction (CVO). Few studies using bare venous stents (BVS) in CVO have been conducted. Purpose To evaluate the treatment performance of upper thoracic central vein stenosis between BVS and conventional bare stent (CBS) in hemodialysis patients. Methods Hemodialysis patients with upper thoracic central vein obstruction who underwent endovascular treatment at the interventional unit of our institution from 1 January 2008 to 31 December 2018 were enrolled in the present study. CBS was used to treat central vein obstruction in 43 patients and BVS in 34 patients. We compared the primary patency rates and complications between the two stent types. P values < 0.05 were considered statistically significant. Results The patient demographic data between the CBS and BVS groups were similar. The characteristics of the lesions, procedures, and complications were not significantly different between the two groups ( P > 0.05). There were no statistically significant differences of primary patency rates at three and six months between the BVS and CBS groups (94.1% vs. 86.0% and 73.5% vs. 58.1%, respectively; P > 0.05). The primary patency rate at 12 months in the BVS group was significantly higher than that in the CBS group (61.8% vs. 32.6%; P = 0.008). Conclusion Endovascular treatment of central vein obstruction with BVS provided a higher primary patency rate at 12 months than CBS.

scholarly journals SAT0056 INITIAL PRESENTATION OF RHEUMATOID ARTHRITIS (RA) – IS IT STILL “SYMMETRIC POLYARTHRITIS”?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 960.2-960
Author(s):  
T. Sokka-Isler ◽  
K. Paalanen ◽  
M. Kauppi ◽  
E. Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Demographic Data ◽  
Initial Presentation ◽  
X Rays ◽  
Clinical Database ◽  
Duration Of Symptoms ◽  
The Public ◽  
Small Joint ◽  
New Diagnosis ◽  
Sat 1

Background:RA is traditionally described as a symmetric polyarthritis. The ACR/EULAR 2010 criteria are met if patient has high positive ACPA, symptoms >=6 wks and one small joint swollen. The public and all steps of health care have been informed for many years that RA should be found early.Objectives:To study variations in pattern on first presentation of RA.Methods:All patients with the new diagnosis of RA were extracted from the GoTreatIT clinical database between 2008 to 2019 at a single RA clinic that covers a population of 250.000. Demographic data, clinical variables, labs, x-rays, joint status and PROs at baseline were included in the analysis. Appropriate parametric/non-parametric tests were used to study differences between groups.Results:A total of 1044 (73.5% CCP+) patients with no prior diagnosis of RA were included; 683 (65%) female, mean age 56; 361 (35%) male, mean age 61. At initial presentation in 2008, 60% had >=6 swollen joints (Figure) and a mean DAS28 of 4.4 compared to 22% and 3.8 respectively, in 2019 (p<0.007). Duration of symptoms prior to diagnosis decreased from 6 to 4 months (p=0.033), and the proportion of patients with erosions from 20% in 2008 to 14% in 2019 (ns). Symptoms (PROs) such as pain, fatigue and global health were similar/slightly worse in 2019 compared to 2008.Conclusion:RA cannot be marketed as “symmetric polyarthritis”, as more than half of the patients have a maximum of 2 swollen joints at the time of the diagnosis at the most recent years. Patients with RA can be identified earlier, with less disease activity and damage, compared to previous years.Figure:Disclosure of Interests:None declared

scholarly journals The Effect of Partnership Presence and Support on HIV Viral Suppression Among Serodiscordant Partnered and Single Heterosexual HIV-Positive Individuals in Brazil

2021 ◽  
Author(s):  
Zoë Baker ◽  
Pamina Gorbach ◽  
Marineide Gonçalves de Melo ◽  
Ivana Varela ◽  
Eduardo Sprinz ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Positive ◽  
Hiv Viral Suppression

scholarly journals 1311. Ryan White HIV Care Continuum Model Doubled the Rate of Community HIV Viral Suppression for Newly Diagnosed Patients: A 10-Year Review

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S473-S473
Author(s):  
Christina Rizk ◽  
Alice Zhao ◽  
Janet Miceli ◽  
Portia Shea ◽  
Merceditas Villanueva ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Linkage To Care ◽  
Hiv Care ◽  
Hiv Care Continuum ◽  
Newly Diagnosed ◽  
New Haven ◽  
Care Continuum ◽  
Art Initiation ◽  
Ryan White ◽  
Hiv Viral Suppression

Abstract Background It is estimated that 1,295 per 100,000 are people living with HIV (PLWH) in New Haven, which is the second highest rate of HIV prevalence in Connecticut. Since 2009, New Haven has established the Ryan White (RW) HIV Care Continuum. The main goals of HIV care are early linkage to care, ART initiation, and HIV viral suppression. This study is designed to understand the trends and outcomes in newly diagnosed PLWH in New Haven County. Methods This study is a retrospective medical record review of all newly diagnosed RW eligible PLWH from January 1, 2009 to December 31, 2018. The data were collected in REDCap database and included demographics, HIV risk factor, presence of mental health and/or substance abuse disorder, date of diagnosis, date of initial visit, and ART initiation. Health outcomes such as AIDS at diagnosis and rate of viral suppression were evaluated. The data were then analyzed to show the trends over 10 years. Results From January 1, 2009 to December 31, 2018 there were 420 newly diagnosed RW PLWH. Sixty-seven percent of those were male, 56% were non-white, 47% self-identified as Men who have Sex with Men (MSM), and 41% were heterosexual. Twenty-nine percent had AIDS-defining condition at the time of the diagnosis. Thirty-four percent of the 420 patients had a mental health and/or substance use disorder; 53% of those were MSM and 51% were non-white. Over the 10-year period, it was noted that the duration between date of HIV diagnosis and linkage to care as well as ART initiation decreased. This decline was associated with a substantial increase in viral suppression. The average time between the dates of HIV diagnosis and initial visit decreased from 269 days in 2009 to 13 days in 2018. Moreover, the average time between the dates of diagnosis and ART initiation dropped from 308 days in 2009 to 15 days in 2018. The 1-year HIV viral suppression rate subsequently doubled from 44% in 2009 to 87% in 2018 (P < 0.01). Conclusion The Ryan White HIV Care Continuum Model with emphasis on early linkage to care and ART initiation can have a significant impact on HIV viral suppression at a community level for newly diagnosed patients. Another important observation in this study was the alarming high rate of AIDS at diagnosis, which highlights the need for universal HIV testing, and early diagnosis. Disclosures All authors: No reported disclosures.

scholarly journals Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya

2021 ◽  
pp. 108587
Author(s):  
Loice W. Mbogo ◽  
Betsy Sambai ◽  
Aliza Monroe-Wise ◽  
Natasha T. Ludwig-Barron ◽  
Brandon L. Guthrie ◽  
...  
Keyword(s):  
Viral Suppression ◽  
People Who Inject Drugs ◽  
Hiv Viral Suppression
Sign in / Sign up

Export Citation Format

Share Document