scholarly journals Dynamic Predictions From Longitudinal CD4 Count Measures And Time To Death of HIV/AIDS Patients Using a Bayesian Joint Model

2021 ◽  
Author(s):  
Feysal Kemal Muhammed ◽  
Aboma Temesgen Sebu ◽  
Anne M Presanis ◽  
Denekew Bitew Belay
Keyword(s):  
Model Averaging ◽  
Joint Model ◽  
Cd4 Count ◽  
Time To Death ◽  
Hiv Mortality ◽  
The Mean ◽  
Association Structure ◽  
The Individual ◽  
Bayesian Joint Model

Abstract Background: Personalised or stratified medicine has played an increasingly important role in improving bio-medical care in recent years. A Bayesian joint modelling approach to dynamic prediction of HIV progression and mortality allows such individualised predictions to be made for HIV patients, based on monitoring of their CD4 counts. This study aims to provide predictions of patient-specific trajectories of HIV disease progression and survival.Methods: Longitudinal data on 254 HIV/AIDS patients who received ART between 2009 and 2014, and who had at least one CD4 count observed, were employed in a Bayesian joint model of disease progression, as measured by CD4 counts, and survival, to obtain individualised dynamic predictions of both processes that were updated at each visit time in the follow-up period. Different forms of association structure that relate the longitudinal CD4 biomarker and time to death were assessed; and predictions were averaged over the different models using Bayesian model averaging.Results: A total of 254 subjects were observed in the dataset with a median age of 30 years (interquartile range, IQR, 26–38). The individual follow-up times ranged from 1 to 120 months, with a median of 22 months and IQR 7 -39 months. The median baseline CD4 count was 129 cells/mm3 (IQR 61–247 cells/mm3). From the joint model with highest posterior weight, subjects whose functional status was working were significantly associated with a higher baseline CD4 count (β = 1.86; 95% CI: 0.65 3.04) whereas subjects who were bedridden were significantly associated with a lower baseline CD4 count (estimated effect β = -3.54; 95% CI: -5.65, -1.39), compared to ambulatory patients. A unit increase in weight of the individual increased the mean square root CD4 measurement by 0.06. The estimates of the association structure parameters from all three models considered indicated that the HIV mortality hazard at any time point is associated with the current underlying value of the CD4 count at the same time point. The model with highest posterior weight also had a time-dependent slope, indicating that HIV mortality is also associated with the rate of change in CD4 count. From both the model-averaged predictions and the highest posterior weight model alone, an increase in CD4 count was predicted at different visit times from the dynamic predictions. It was also found that there was an increase in the width of prediction intervals as time progressed.Conclusions: Functional status, weight and alcohol intake are important contributing factors that affect the mean square root of CD4 measurements. For this particular dataset, model averaging the dynamic predictions resulted in only one of the hypothesised association structures having non-zero weight at the majority of time points for each individual. The predictions were therefore similar whether we averaged them over models or derived them from the highest posterior weight model alone. We also observed that the parameter estimates in the both the CD4 count and survival sub-models showed slight variability between the postulated association structures.

Evaluation of retinal inflammatory biomarkers after intravitreal steroid implant and Ranibizumab injection in diabetic macular edema

2021 ◽  
pp. 112067212110294
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Ecem Onder Tokuc ◽  
Fatma Sümer ◽  
V Levent Karabas
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outer Nuclear Layer ◽  
Plexiform Layer ◽  
Retinal Layer ◽  
Treatment Naïve ◽  
The Mean ◽  
The Individual ◽  
Inflammatory Component

Purpose: To compare the efficacy of intravitreal (IV) ranibizumab (IVR) injection with IV dexamethasone implant (IVDEX) in treatment naive diabetic macular edema (DME) patients with inflammatory component. Materials and methods: Treatment naive DME eyes with subfoveal neurosensorial detachment (SND) and hyperreflective spots (HRS) were treated either three loading doses of IVR (18 eyes) or one dose of IVDEX (19 eyes). Central macular thickness (CMT), height of SND, the number of HRSs scattered on the individual retinal layers and photoreceptor integrity were assessed using spectral domain- optical coherence tomography scans over 3-months follow-up. Results: The mean change in best-corrected visual acuity (BCVA) was −0.11 ± 0.08 logMAR in IVDEX group and −0.04 ± 0.06 logMAR in IVR group at 1-month ( p = 0.011). IVDEX group showed statistically significant more increase in BCVA compared to those receiving IVR injections at 2-months ( p = 0.004) and 3-months ( p = 0.017) visits. Compared to baseline, the number of total HRSs and the number of HRSs at each individual inner retinal layer significantly decreased in both groups at all follow-up visits. However, IVDEX group showed more decrease in the total number of HRSs at 2- and 3-months ( p < 0.001 at 2-months, and p = 0.006 at 3-months) and in the mean number of HRSs located at inner nuclear layer–outer plexiform layer level ( p = 0.016 at 1-month, p < 0.001 at 2-months, and p < 0.001 at 3-months). After treatment, the number of HRSs on the outer nuclear layer showed some non-significant increase in both groups. Conclusion: HRSs tended to migrate from inner retina to the outer retina in DME eyes by treatment. Dexamethasone seemed to be more effective option in such cases with inflammatory component.

scholarly journals 375. Cryptococcal Antigenemia in Advanced HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S196-S196
Author(s):  
Jatin Ahuja ◽  
Manish Soneja ◽  
Naveet Wig ◽  
Immaculata Xess ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Cd4 Count ◽  
North India ◽  
World Health ◽  
P Value ◽  
The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

scholarly journals Radiative forcing and climate metrics for ozone precursor emissions: the impact of multi-model averaging

2014 ◽  
Vol 14 (19) ◽  
pp. 27195-27231
Author(s):  
C. R. MacIntosh ◽  
K. P. Shine ◽  
W. J. Collins
Keyword(s):  
Radiative Forcing ◽  
Transport Model ◽  
Task Force ◽  
Mean Field ◽  
Model Averaging ◽  
Chemical Transport Model ◽  
Ensemble Mean ◽  
The Mean ◽  
The Individual ◽  
The Impact

Abstract. Multi-model ensembles are frequently used to assess understanding of the response of ozone and methane lifetime to changes in emissions of ozone precursors such as NOx, VOC and CO. When these ozone changes are used to calculate radiative forcing (RF) (and climate metrics such as the global warming potential (GWP) and global temperature potential (GTP)) there is a methodological choice, determined partly by the available computing resources, as to whether the mean ozone (and methane lifetime) changes are input to the radiation code, or whether each model's ozone and methane changes are used as input, with the average RF computed from the individual model RFs. We use data from the Task Force on Hemispheric Transport of Air Pollution Source-Receptor global chemical transport model ensemble to assess the impact of this choice for emission changes in 4 regions (East Asia, Europe, North America and South Asia). We conclude that using the multi-model mean ozone and methane responses is accurate for calculating the mean RF, with differences up to 0.6% for CO, 0.7% for VOC and 2% for NOx. Differences of up to 60% for NOx 7% for VOC and 3% for CO are introduced into the 20 year GWP as a result of the exponential decay terms, with similar values for the 20 years GTP. However, estimates of the SD calculated from the ensemble-mean input fields (where the SD at each point on the model grid is added to or subtracted from the mean field) are almost always substantially larger in RF, GWP and GTP metrics than the true SD, and can be larger than the model range for short-lived ozone RF, and for the 20 and 100 year GWP and 100 year GTP. We find that the effect is generally most marked for the case of NOx emissions, where the net effect is a smaller residual of terms of opposing signs. For example, the SD for the 20 year GWP is two to three times larger using the ensemble-mean fields than using the individual models to calculate the RF. Hence, while the average of multi-model fields are appropriate for calculating mean RF, GWP and GTP, they are not a reliable method for calculating the uncertainty in these fields, and in general overestimate the uncertainty.

scholarly journals Clinical profile and outcome of HIV-TB Co‑Infection at a centre of excellence for HIV care

2018 ◽  
Vol 9 (2) ◽  
pp. 19-24
Author(s):  
Diwakar Tumkur Narasimhamurthy ◽  
David Mathew Thomas ◽  
Ravi Krishnegowda ◽  
Asif Ali Thayyil ◽  
Shruthi K R Nagar Mallesh ◽  
...  
Keyword(s):  
Demographic Characteristics ◽  
Cd4 Count ◽  
Hiv Care ◽  
Medical Sciences ◽  
Resource Limited ◽  
Retrospective Clinical Study ◽  
Centre Of Excellence ◽  
Study Population ◽  
The Individual

Background: Tuberculosis (TB) and Human Imuunodeficiency Virus (HIV) co-infection has detrimental effects on both the individual and the health care system especially in resource limited countries like India. Tuberculosis ranks among the most common cause of death in HIV patients. In this review we have analysed the clinical and immunological characteristicsof HIV-TB coinfected patients and their clinical outcomes.Aims and Objectives: To assess the co-relation between socio-demographic characteristics, clinical and immunological Profile of HIV-TB co-infected patients and the clinical outcome.Materials and Methods: A retrospective clinical study of patient records at the Centre of Excellence for anti-retroviral therapy was done. The records of HIV-TB co-infected patients were collected and data extracted pertaining to the socio- demographic characteristics, clinical profiles and outcomes.Results: Among the 377 cases included as per criteria, 76.9 % completed the treatment for TB while 23.1% patients died before treatment completion. Twenty-nine point seven percent of the patient population constituted women, while 0.5% was transgenders. Regarding the pattern of tuberculosis, 58.4% patients had extra pulmonary TB while 39.5% and 2.1% of the study population were diagnosed as pulmonary and disseminated TB respectively. Mean baseline CD4 count was 191 cells/mm3 and the mean CD4 count during first and second follow up were 298 and 362 cells/mm3 respectively. There was a statistically significant correlation noted with poor clinical outcomes and low baseline CD4 counts.Conclusion: Age, gender, the clinical pattern of tuberculosis and the treatment category did not have a statistically significant association on the outcome. We found that the TB associated mortality in HIV co-infected patients had a direct correlation with the stage of HIV at presentation as there was a strongly significant association between low CD4 counts and adverse clinical outcomes.Asian Journal of Medical Sciences Vol.9(2) 2018 19-24

scholarly journals EFFECTIVENESS OF SPIRULINA MOUTHWASH ON REDUCTION OF DENTAL PLAQUE AND GINGIVITIS: A CLINICAL STUDY

2017 ◽  
Vol 9 (7) ◽  
pp. 136
Author(s):  
Radhika Maniyar ◽  
Umashankar G. K.
Keyword(s):  
Visual Analog Scale ◽  
Dental Plaque ◽  
Rank Test ◽  
Analog Scale ◽  
Mean Values ◽  
Significant Difference ◽  
Intervention Protocol ◽  
The Mean ◽  
The Individual

Objective: The present study evaluated the effectiveness of Spirulina mouthwash on the reduction of dental plaque and gingivitis.Methods: A single-blind clinical trial was conducted among thirty patient’s aged 18-40 y visiting dental college and hospital in Bangalore city. Mouthwash was prepared using 0.5% Spirulina. Intervention protocol consisted of instructing the patients to rinse with 10 ml of mouthwash for 1 minute twice daily for 7 d. Plaque index and Gingival index were used to assess the variables at the baseline and after the intervention. The perception of the individual subjects with regard to the use of mouthwash was assessed using 10 cm long visual analog scale (VAS). Statistical analysis was carried out using Wilcoxon signed rank test for mean pre and post plaque and gingival scores respectively. Descriptive statistics was performed for VAS questionnaireResults: The results showed a highly significant difference (p<0.001) between the mean plaque scores at the baseline (2.16±0.34) and at the follow up (1.27±0.46). The mean gingival scores at the baseline (1.86±0.38) and at the follow-up (1.05±0.43) also showed a highly significant difference (p<0.001). Regarding the Visual Analog Scale, the mean values of 5 or greater than suggested the responses to be favourable as the values were reflectedConclusion: The study showed that Spirulina mouthwash resulted in significant reduction in dental plaque and gingivitis. Also, the mouthwash was convenient to use without any adverse effects. Hence, the use of herbal mouth rinses such as Spirulina should be supported.

Use of telephone interviews to follow up patients after total hip replacement

2005 ◽  
Vol 11 (4) ◽  
pp. 211-214 ◽  
Author(s):  
Sanjeev Sharma ◽  
Ravi Shah ◽  
Kingsley Paul Draviraj ◽  
M S Bhamra
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Harris Hip Score ◽  
Face To Face ◽  
Total Hip ◽  
Telephone Interviews ◽  
Significant Difference ◽  
The Mean ◽  
The Individual

We studied the feasibility of telephone interviews to assess hip function in patients who had had a total hip replacement. One hundred patients attending the orthopaedic clinic for follow-up after undergoing total hip replacement were studied. A modified Harris hip score was used. Since range of motion and deformity cannot be assessed by telephone, only pain and function were assessed. The maximum possible score was 100. Patients attending follow-up clinics were contacted by telephone one to two weeks prior to their appointment and a telephone assessment was completed. This was then compared with a face-to-face assessment in the subsequent clinic. The mean hip score obtained with the telephone interview was 85.2 and the mean hip score at face-to-face assessment was 86.1. The mean of the differences between the individual scores was −0.9 (SD 5.5). This difference was not significant ( P=0.11). Only three patients had a clinically significant difference (>20 points) between the two methods. Telephone questionnaires may be a useful adjunct to face-to-face assessment for patient follow-up after total hip replacement.

Cohort fertility of Polish women, 1945–2015: the context of postponement and recuperation

2018 ◽  
pp. 5-23 ◽  
Author(s):  
Krzysztof Tymicki ◽  
Krystof Zeman ◽  
Dorota Holzer-Żelażewska
Keyword(s):  
Driving Forces ◽  
Cohort Analysis ◽  
Individual Data ◽  
Cohort Fertility ◽  
The Mean ◽  
The One ◽  
The Individual ◽  
The Postponement ◽  
Second Births

The article is a follow-up and an extension to previously published papers by Holzer-Żelażewska & Holzer (1997) and Holzer-Żelażewska & Tymicki (2009). Fristly, we have added new cohorts to the cohort analysis based on the individual data from births registration for the years 2009–2015. Secondly, we have extended the scope of the study by taking into account the context of postponement and recuperation to analyses of cohort fertility of Polish women. The approach applied to the fertility postponement and recuperation on the cohort data refers to the method which was originally proposed by Frejka (2011) and Lesthaeghe (2001) and further developed by Sobotka et al. (Sobotka et al., 2011). This method allows for calculation of fertility postponement and recuperation measures with respect to a benchmark cohort chosen as the one that first experiences an onset of the increase in the mean age of motherhood at first birth. The results show the remarkable changes in the fertility patterns in Poland. The main driving forces behind the change in fertility patterns in Poland are related to the postponement of first births along with a relatively good recuperation. The magnitude of recuperation for Polish cohorts dropped significantly for second births and was almost non-existent for third and higher births. Therefore, the pattern of fertility in Poland observed till 2015 could be characterized by postponement and recuperation of first births along with a significant decrease in second births with perpetual postponement of third and higher births.

scholarly journals Menstrual Suppression Practice among Female Malaysian Pilgrims

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Rafidah MR ◽  
Zuhra H ◽  
Harlina Halizah S ◽  
Azah AS ◽  
Tan CE
Keyword(s):  
Oral Contraceptive ◽  
Oral Contraceptive Pills ◽  
Combined Oral Contraceptive ◽  
Menstrual Suppression ◽  
Contraceptive Pills ◽  
Observational Cohort ◽  
Klang Valley ◽  
The Mean ◽  
The Individual

INTRODUCTION: Performing the Hajj or pilgrimage is obligatory for all Muslims. Certain Hajj religious rites cannot be performed during menstruation. Hence, it is common for female pilgrims to seek a doctor’s advice on methods of menstrual suppression during Hajj. This exploratory study aimed to determine the prevalence and usage profile of menstrual suppression practices among Malaysian women performing Hajj and their associated factors. MATERIALS AND METHODS: An observational cohort study involved 437 women aged 18-55 years old who attended compulsory pre-Hajj courses in Klang Valley, Malaysia. The self-administered questionnaires contained sociodemographic information, and biomedical characteristics were obtained. A follow-up call was made after their return from Hajj to obtain information regarding practice, medication is taken, and their intended duration of menstrual suppression. Descriptive and inferential analysis were done. RESULTS: Post Hajj, about 81.3% (347/437) of women were contactable and completed their menstrual calendar and 17.6% (62/347) of female pilgrims practiced menstrual suppression. The mean duration of hajj was 44 days and 77.4% (48/61) intended to suppress their menstruation throughout the whole of their Hajj travel. Previous use of contraception was associated with menstrual suppression practice (p<0.001). The commonest method of menstrual suppression was combined oral contraceptive pills (53.2%) followed by oral progestogens only pill (35.5%). CONCLUSION: Almost one-fifth of Malaysian female Hajj pilgrims practiced menstrual suppression. Previous use of contraception was associated with menstrual suppression practice. Combined oral contraceptive pills were the commonest method used and the method was chosen was based on the individual desired duration of menstrual suppression. ><0.001). The commonest method of menstrual suppression was combined oral contraceptive pills (53.2%) followed by oral progestogens only pill (35.5%). CONCLUSION: Almost one-fifth of Malaysian female Hajj pilgrims practiced menstrual suppression. Previous use of contraception was associated with menstrual suppression practice. Combined oral contraceptive pills were the commonest method used and the method was chosen was based on the individual desired duration of menstrual suppression.

Long-term Reliability of Endoscopic Third Ventriculostomy

Neurosurgery ◽  
2005 ◽  
Vol 56 (6) ◽  
pp. 1271-1278 ◽  
Author(s):  
David Kadrian ◽  
James van Gelder ◽  
Danielle Florida ◽  
Robert Jones ◽  
Marianne Vonau ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Aqueduct Stenosis ◽  
Previous Infection ◽  
Long Term Follow Up ◽  
The Mean ◽  
The Individual ◽  
Operating Surgeon

Abstract OBJECTIVE: To describe the short-term operative success and the long-term reliability of endoscopic third ventriculostomy (ETV) for treatment of hydrocephalus and to examine the influence of diagnosis, age, and previous shunt history on these outcomes. METHODS: We retrospectively analyzed 203 consecutive patients from a single institution who had ETV as long as 22.6 years earlier. Patients with hydrocephalus from aqueduct stenosis, myelomeningocele, tumors, arachnoid cysts, previous infection, or hemorrhage were included. RESULTS: The overall probability of successfully performing an ETV was 89% (84–93%). There was support for an association between the surgical success and the individual operating surgeon (odds ratios for success, 0.44–1.47 relative to the mean of 1.0, P = 0.08). We observed infections in 4.9%, transient major complications in 7.2%, and major and permanent complications in 1.1% of 203 procedures. Age was strongly associated with long-term reliability. The longest observed reliability for the 13 patients 0 to 1 month old was 3.5 years. The statistical model predicted the following reliability at 1 year after insertion: at 0 to 1 month of age, 31% (14–53%); at 1 to 6 months of age, 50% (32–68%); at 6 to 24 months of age, 71% (55–85%); and more than 24 months of age, 84% (79–89%). There was no support for an association between reliability and the diagnostic group (n = 181, P = 0.168) or a previous shunt. Sixteen patients had ETV repeated, but only 9 were repeated after at least 6 months. Of these, 4 procedures failed within a few weeks, and 2 patients were available for long-term follow-up. CONCLUSION: Age was the only factor statistically associated with the long-term reliability of ETV. Patients less than 6 months old had poor reliability.

The Association between Sinusitis and Survival among Individuals Infected with the Human Immunodeficiency Virus

2001 ◽  
Vol 15 (5) ◽  
pp. 343-345 ◽  
Author(s):  
Peter C. Belafsky ◽  
Ronald Amedee ◽  
Brian Moore ◽  
Patricia J. Kissinger
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cd4 Count ◽  
Cd4 Cell Count ◽  
Loss To Follow Up ◽  
Gender And Race ◽  
Entire Cohort ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
Cox Proportional Hazard Regression

The purpose of this study was to determine the association between sinusitis and survival among human immunodeficiency virus (HIV)–infected persons. All patients enrolled in the adult spectrum of disease data base from November 1, 1990 to November 1, 1999 were included. Patients were followed until death, loss to follow-up, or the end of the study on January 10, 2000. A Cox proportional hazard regression analysis was conducted to evaluate the association between sinusitis, various other cofactors, and survival. Of the 7513 HIV-infected patients followed, 57% were <35 years old, 59.5% were black, 78.5% were male, and 20.8% had an opportunistic infection (OI) at entry. The incidence of one or more diagnoses of sinusitis in the cohort was 14.5%. The mean entry CD4 count for the entire cohort was 347.8 (SD, 298.9) and the mean follow-up time was 33.2 months (SD, 25.7). The mean CD4 count at the time of sinusitis diagnosis was 391 (SD, 316). In the multivariate analysis, older age and lower CD4 cell count were associated with death. Sinusitis, gender, and race were not associated with survival. Sinusitis is frequent in individuals infected with HIV. After adjusting for level of immunodeficiency, age, gender, and race, sinusitis is not associated with an increased hazard of death. This may have implications for treatment, because a diagnosis of sinusitis does not portend a poor prognosis in individuals infected with HIV.

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