scholarly journals Characteristics and outcomes of antiretroviral-treated HIV-HBV co-infected patients in Canada

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Urvi Rana ◽  
◽  
Matt Driedger ◽  
Paul Sereda ◽  
Shenyi Pan ◽  
...  
Keyword(s):  
T Cell ◽  
Liver Fibrosis ◽  
Clinical Characteristics ◽  
Cohort Analysis ◽  
Cd4 T Cell ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Cell Counts ◽  
Using Data

Abstract Background Hepatitis B (HBV) and Human Immunodeficiency Virus (HIV) share common risk factors for exposure. Co-infected patients have an increased liver-related mortality risk and may have accelerated HIV progression. The epidemiology and demographic characteristics of HIV-HBV co-infection in Canada remain poorly defined. We compared the demographic and clinical characteristics and factors associated with advanced hepatic fibrosis between HIV and HIV-HBV co-infected patients. Methods A retrospective cohort analysis was conducted using data from the Canadian Observational Cohort (CANOC) Collaboration, including eight sites from British Columbia, Quebec, and Ontario. Eligible participants were HIV-infected patients who initiated combination ARV between January 1, 2000 and December 14, 2014. Demographic and clinical characteristics were compared between HIV-HBV co-infected and HIV-infected groups using chi-square or Fisher exact tests for categorical variables, and Wilcoxon’s Rank Sum test for continuous variables. Liver fibrosis was estimated by the AST to Platelet Ratio Index (APRI). Results HBV status and APRI values were available for 2419 cohort participants. 199 (8%) were HBV co-infected. Compared to HIV-infected participants, HIV-HBV co-infected participants were more likely to use injection drugs (28% vs. 21%, p = 0.03) and be HCV-positive (31%, vs. 23%, p = 0.02). HIV-HBV co-infected participants had lower baseline CD4 T cell counts (188 cells/mm3, IQR: 120–360) compared to 235 cells/mm3 in HIV-infected participants (IQR: 85–294) (p = 0.0002) and higher baseline median APRI scores (0.50 vs. 0.37, p < 0.0001). This difference in APRI was no longer clinically significant at follow-up (0.32 vs. 0.30, p = 0.03). HIV-HBV co-infected participants had a higher mortality rate compared to HIV-infected participants (11% vs. 7%, p = 0.02). Conclusion The prevalence, demographic and clinical characteristics of the HIV-HBV co-infected population in Canada is described. HIV-HBV co-infected patients have higher mortality, more advanced CD4 T cell depletion, and liver fibrosis that improves in conjunction with ARV therapy. The high prevalence of unknown HBV status demonstrates a need for increased screening among HIV-infected patients in Canada.

scholarly journals Predicting Outcome in Skull Base Osteomyelitis: An Assessment of Demographic, Clinical, and Pathological Attributes

2021 ◽  
Author(s):  
Alisha Saxena ◽  
Birinder Singh Paul ◽  
Gagandeep Singh ◽  
Archana Ahluwalia ◽  
Gunchan Paul
Keyword(s):  
Skull Base ◽  
Clinical Characteristics ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Duration Of Treatment ◽  
Chi Square ◽  
Duration Of Symptoms ◽  
Skull Base Osteomyelitis ◽  
Male Predominance ◽  
Diabetes Status

Abstract Objective Skull base osteomyelitis (SBO) is an enigmatic clinical diagnosis which is difficult to decipher and is associated with poor outcomes. The study aims to examine the demographic and clinical characteristics of patients with SBO and its outcomes. Materials and Methods Medical records of 30 patients with diagnosis of SBO over past 5 years were assessed for demographic and clinical characteristics, type of SBO, radiological parameters, treatment received, procedure performed, microbiological profile, comorbidities, and complications including cranial nerve (CN) palsies. These factors were analyzed for prediction of outcome (death or survival). Statistical Analysis Microsoft Office Excel 2010 SAS 10.0 for Windows was used. Student's t-test for continuous variables (age, duration of symptoms, number of days of hospitalization, and treatment duration) and chi-square test for categorical variables (imaging findings, symptomatology, presence of comorbidities, surgical procedure, complications, and type of antibiotics) were utilized. Results We found SBO was the disease of elderly population (64.07 ± 6.13 years) with male predominance (83.3%) highly associated with uncontrolled diabetes status (93.3%). Headache (100%) and CN palsy (80%) were the most common neurological presenting complaints followed by stroke (17%) and encephalopathy (10%). Pathological and radiological correlation showed that fungal infection (Aspergillus) was associated with anterior SBO (10%), while bacteria (Pseudomonas) was cultured from posterior SBO (30%). Fifty per cent of patients were alive after 1 year out of which 33% had good functional outcome. The mortality rate was 33.3% in our cohort and multiple lower CN palsies (p = 0.04), suboptimal duration of medical treatment (p = 0.03), surgical intervention during clinical course (p = 0.02), and development of intracranial or extracranial complications (p = 0.03) were the predictors of mortality. Conclusion Early diagnosis including identification of pathogenic organisms and optimal duration of treatment are crucial factors for improved outcomes in SBO.

Differences in response to imatinib between gastrointestinal stromal tumors involving the liver and tumors that do not: Experience from Nairobi.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e20504-e20504
Author(s):  
Nicolas Anthony Othieno-Abinya ◽  
Malkit Singh Riyat ◽  
Raymond Omollo ◽  
Gladwell Wantiru Gichuru
Keyword(s):  
Mutational Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Assistance Program ◽  
Apparent Lack ◽  
Exact Test ◽  
Prognostic Features ◽  
Cell Counts ◽  
Level Of Significance

e20504 Background: More than 60% of gastrointestinal stromal tumours (GISTs) arise from the stomach and about 20% from the small intestines. About 95% of GISTs express kit receptor tyrosine kinase (CD117) which is used for purposes of diagnosis and targeted treatment. However, kit expression alone is not specific for GIST, nor does it necessarily imply kinase activation. Poor prognostic features include involvement of the liver, and other bulky sites of disease. Methods: Patients with CD117-positive leiomyosarcomas arising in the abdomen and treated through the Glivec International Patient Assistance Program (GIPAP) clinics in Nairobi were studied. Details taken included sites involved by disease at diagnosis, stage, sites of metastases, whether the tumour had been resected or not, and outcome of treatment with imatinib. Data were summarized using proportions where the variables were categorical while mean (SD) or median (range) was used for continuous variables. Comparisons for categorical variables were done using chi square tests (or Fishers exact test for cell counts less than 5). The statistical level of significance was set to 5%. Results: In total 54 patients were included. Males were 36 (66.7%) and females 18 (33.3%). Age range was 25-86 years, median 50. Stomach was involved primarily in 22 of 47 cases evaluable (46.8%). The liver was primarily involved in 3 (6.4%) and liver metastases in 7 (15%). None of 8 patients (0%) with evaluable liver involvement regressed or stabilized on treatment for at least 6 months compared with 10 of 14 (71.4%) from the stomach, 7 of 7 (100%) from small bowel, and 7 of 13 (53.8%) with mesenteric/omental involvement. These differences were statistically significant (p = 0.001). Conclusions: Apparent lack of response by tumours involving the liver could suggest that the kit expression here may not be the factor activating the kit target in this subset of patients, or they could be of exon 9 mutation predominantly. Mutational analysis studies may shed more light in this issue.

scholarly journals Relationship of Hydroxychloroquine and Ophthalmic Complications in Patients with Type 2 Diabetes in Taiwan

2021 ◽  
Vol 18 (15) ◽  
pp. 8154
Author(s):  
Hung-Chih Chen ◽  
Hung-Yu Lin ◽  
Michael Chia-Yen Chou ◽  
Yu-Hsun Wang ◽  
Pui-Ying Leong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Conditional Logistic Regression ◽  
Categorical Variables ◽  
Control Group ◽  
Case Group ◽  
Research Database ◽  
Continuous Variables ◽  
Chi Square ◽  
Increased Risk

The purpose of this study is to evaluate the relationship between hydroxychloroquine (HCQ) and diabetic retinopathy (DR) via the national health insurance research database (NHIRD) of Taiwan. All patients with newly diagnosed type 2 diabetes (n = 47,353) in the NHIRD (2000–2012) were enrolled in the study. The case group consists of participants with diabetic ophthalmic complications; 1:1 matching by age (±1 year old), sex, and diagnosis year of diabetes was used to provide an index date for the control group that corresponded to the case group (n = 5550). Chi-square test for categorical variables and Student’s t-test for continuous variables were used. Conditional logistic regression was performed to estimate the adjusted odds ratio (aOR) of DR. The total number of HCQ user was 99 patients (1.8%) in the case group and 93 patients (1.7%) in the control group. Patients with hypertension (aOR = 1.21, 95% CI = 1.11–1.31) and hyperlipidemia (aOR = 1.65, 95% CI = 1.52–1.79) significantly increased the risk of diabetic ophthalmic complications (p < 0.001). Conversely, the use of HCQ and the presence of rheumatoid diseases did not show any significance in increased risk of DR. HCQ prescription can improve systemic glycemic profile, but it does not decrease the risk of diabetic ophthalmic complications.

scholarly journals Lymphocyte subset analysis to evaluate the prognosis of HIV-negative patients with pneumocystis pneumonia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fan Jin ◽  
Jing Xie ◽  
Huan-ling Wang
Keyword(s):  
T Cell ◽  
Cell Count ◽  
Lymphocyte Subsets ◽  
Nk Cell ◽  
Cd8 T Cell ◽  
Pneumocystis Pneumonia ◽  
Lymphocyte Subset ◽  
Cd4 T Cell ◽  
Cell Counts ◽  
Hiv Negative

Abstract Objectives We analysed the peripheral blood lymphocyte subsets of human immunodeficiency virus (HIV)-negative patients infected with pneumocystis pneumonia (PCP) to determine the relationships between the levels of different types of lymphocytes and the prognosis of patients. Methods We retrospectively reviewed HIV-negative patients with PCP diagnosed in our department. All the eligible patients underwent lymphocyte subset analysis on admission. Results A total of 88 HIV-negative PCP patients were enrolled in the study. In univariate analyses, low CD4+ T cell count, low CD8+ T cell count, and low natural killer cell (NK cell) count were associated with higher in-hospital mortality. CD8+ T cell count ≤300/μL was found to be an independent risk factor for poor prognosis in multivariate logistical regression analysis (p = 0.015, OR = 11.526, 95% CI = 1.597–83.158). Although low CD4+ T cell and NK cell counts were not independent risk factors, the mortality rates of PCP patients decreased as the CD4+ T cell and NK cell counts increased. Conclusion The immune process of Pneumocystis jirovecii infection is complex but important. We propose that lymphocyte subsets could give clinicians a better understanding of patient immune status, helping with the early identification of potentially lethal infections and treatment decision making, such as adjusting the immunosuppressive regimen and choosing an appropriate patient monitoring level.

scholarly journals The predictive value of absolute lymphocyte counts on tumor progression and pseudoprogression in patients with glioblastoma

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Xi ◽  
Bilal Hassan ◽  
Ruth G. N. Katumba ◽  
Karam Khaddour ◽  
Akshay Govindan ◽  
...  
Keyword(s):  
Tumor Progression ◽  
Predictive Value ◽  
Absolute Lymphocyte Count ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Current Standard ◽  
Surgical Biopsy ◽  
Cell Counts ◽  
Significant Difference ◽  
True Progression

Abstract Background Differentiating true glioblastoma multiforme (GBM) from pseudoprogression (PsP) remains a challenge with current standard magnetic resonance imaging (MRI). The objective of this study was to explore whether patients’ absolute lymphocyte count (ALC) levels can be utilized to predict true tumor progression and PsP. Methods Patients were considered eligible for the study if they had 1) GBM diagnosis, 2) a series of blood cell counts and clinical follow-ups, and 3) tumor progression documented by both MRI and pathology. Data analysis results include descriptive statistics, median (IQR) for continuous variables and count (%) for categorical variables, p values from Wilcoxon rank sum test or Fisher’s exact test for comparison, respectively, and Kaplan-Meier analysis for overall survival (OS). OS was defined as the time from patients’ second surgery to their time of death or last follow up if patients were still alive. Results 78 patients were included in this study. The median age was 56 years. Median ALC dropped 34.5% from baseline 1400 cells/mm3 to 917 cells/mm3 after completion of radiation therapy (RT) and temozolomide (TMZ). All study patients had undergone surgical biopsy upon MRI-documented progression. 37 had true tumor progression (47.44%) and 41 had pseudoprogression (52.56%). ALC before RT/TMZ, post RT/TMZ and at the time of MRI-documented progression did not show significant difference between patients with true progression and PsP. Although not statistically significant, this study found that patients with true progression had worse OS compared to those with PsP (Hazard Ratio [HR] 1.44, 95% CI 0.86–2.43, P = 0.178). This study also found that patients with high ALC (dichotomized by median) post-radiation had longer OS. Conclusion Our results indicate that ALC level in GBM patients before or after treatment does not have predictive value for true disease progression or pseudoprogression. Patients with true progression had worse OS compared to those who had pseudoprogression. A larger sample size that includes CD4 cell counts may be needed to evaluate the PsP predictive value of peripheral blood biomarkers.

scholarly journals 350. Neurocysticercosis – Gender Differences in Clinical Presentations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S244-S244
Author(s):  
Bharath Pendyala ◽  
Prasanth Lingamaneni ◽  
Patricia DeMarais ◽  
Lakshmi Warrior ◽  
Gregory Huhn
Keyword(s):  
Gender Differences ◽  
Categorical Variables ◽  
Public Health Issue ◽  
Diagnostic Code ◽  
Continuous Variables ◽  
Chi Square ◽  
Generalized Seizures ◽  
Icd 10 ◽  
Chi Square Test ◽  
Reported Data

Abstract Background Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients. Methods A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Results Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P &lt; 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with &gt; 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P &lt; 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P &lt; 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P &lt; 0.001). Conclusion Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed. Disclosures All Authors: No reported disclosures

Low absolute CD4+ T cell counts in peripheral blood predict poor prognosis in patients with newly diagnosed multiple myeloma

2020 ◽  
Vol 61 (8) ◽  
pp. 1869-1876 ◽  
Author(s):  
Yan Gu ◽  
Yuanyuan Jin ◽  
Jie Ding ◽  
Wu Yujie ◽  
Qinglin Shi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
T Cell ◽  
Peripheral Blood ◽  
Poor Prognosis ◽  
Cd4 T Cell ◽  
Newly Diagnosed ◽  
Cell Counts

scholarly journals BANA-Positive Plaque Samples Are Associated with Oral Hygiene Practices and Not CD4+ T Cell Counts in HIV-Positive Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Cathy Nisha John ◽  
Lawrence Xavier Graham Stephen ◽  
Charlene Wilma Joyce Africa
Keyword(s):  
T Cell ◽  
Periodontal Disease ◽  
Oral Hygiene ◽  
Periodontal Diseases ◽  
Cd4 T Cell ◽  
Hiv Positive ◽  
Hygiene Practices ◽  
Cell Counts ◽  
Probing Depth ◽  
Clinical Indices

Background. The “red complex” microorganisms, namely,Porphyromonas gingivalis,Treponema denticola, andTannerella forsythiaare considered as potential pathogens causing HIV-associated periodontal diseases. Moreover, it has been recognized that an association exists between CD4+ T cell counts and periodontal disease progression.Objective. To establish whether CD4+ T cell counts or oral hygiene plays a greater role in producing BANA-positive results in HIV-associated periodontal disease.Materials and Methods. One hundred and twenty HIV-positive patients participated in the study, and their CD4+ T cell counts were obtained from their medical records. The six Ramfjord teeth were used for evaluating periodontal clinical indices and subgingival plaque sampling. BANA test was used for the detection and prevalence of the “red complex” bacteria in plaque samples.Results. A majority of 69.17% HIV-positive patients were BANA-positive. No significant associations were found between BANA and CD4+ T cell counts. A highly significant association was found between BANA with probing depth and clinical attachment level (P≤0.0001) and between BANA and the use of interdental aids (P=0.0168).Conclusion. HIV-associated periodontal diseases are strongly related to oral hygiene practices rather than the effect of CD4+ T cell counts, and the use of interdental aids was marked as a significant predictor of BANA-negative plaque samples.

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