scholarly journals Clinical and immunological characteristic and dynamic of the secondary diseases stage of HIV infection in children, taking into account the route of infection

2021 ◽  
Vol 20 (3) ◽  
pp. 18-22
Author(s):  
V. B. Denisenko ◽  
E. M. Simovanyan
Keyword(s):  
Hiv Infection ◽  
Clinical Picture ◽  
Cox Regression ◽  
Opportunistic Infections ◽  
Clinical Laboratory ◽  
Rapid Progression ◽  
Subsequent Stage ◽  
Kaplan Meier ◽  
Group I ◽  
Secondary Diseases

The purpose is to characterize the clinical picture, immune status and the natural history of HIV infection in the stage of secondary diseases in vertical and parenteral infected children.Materials and methods. A clinical, laboratory, instrumental, immunological examination of 132 children in the stage of secondary diseases infected with HIV in a vertical way (90; I group) and parenteral way in infancy (42; II group) was carried. Results. The clinical picture of HIV infection in the stage of secondary diseases included various combinations of HIV-associated symptoms, opportunistic infections, tumors, which determines the symptomatology of a particular stage. The use of the Cox regression mathematical model of proportional intensities demonstrated a reduction in the duration of stage 4A (RR 5.8; 95% CI 1.4—10.5; P < 0.001), 4B (RR 3.4; 95% CI 1.8—4.3; P < 0.001) and 4V (RR 4.8; 95% CI 1.2—8.9; P < 0.001) in children of group I. Using the method of multiplying Kaplan-Meier estimates, the significant differences between the time curves from the beginning of the 4A stage (Р = 0.044), 4B (P < 0.001) and 4V (Р = 0.029) before the transition to the subsequent stage in children of groups I and II were established. The content of CD4 lymphocytes in the blood in patients of group I was higher as compared with group II at the time of debut of stages 4A (Me 37.5%, IQI 33—40% and Me 22%, IQI 18—24%; Р < 0.001), 4B (Me 25%, IQI 22—28% and Me 20%, IQI 18—22%; Р < 0.001) and 4V (Me 14%, IQI 12—18% and Me 11%, IQI 10—14%; Р = 0.047).Conclusion. HIV infection in the stage of secondary diseases in children infected with the vertical way is characterized by more rapid progression compared with parenteral infected in infancy patients, which is associated with the immaturity of the immune system.

Long-term risk of major cardiovascular events after cavotricuspid isthmus ablation: when and in whom to discontinue oral anticoagulation?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
TE Graca Rodrigues ◽  
J Brito ◽  
P Silverio-Antonio ◽  
P Couto Pereira ◽  
B Valente Silva ◽  
...  
Keyword(s):  
Cox Regression ◽  
Cavotricuspid Isthmus ◽  
Funding Sources ◽  
Major Cardiovascular Events ◽  
Kaplan Meier ◽  
Group I ◽  
Typical Atrial Flutter ◽  
Clinical Records ◽  
Patient At Risk

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cavotricuspid isthmus ablation (CTA) is the 1st line therapy to accomplish rhythm control in typical atrial flutter (AFL). Several studies have shown that AFL is frequently associated with AF, which may be silent, posing the patient at risk of systemic embolism. Nowadays, there are no formal recommendations for OAC after CTA in patients with isolated AFL. Aim To determine the risk of MACE after CTA and compare: 1) the presence of concomitant AF, 2) concomitantly performing PVI and 3) persistence on OAC. Methods Single-center retrospective study of  pts submitted to CTA between 2015 and 2019, comprising 3 groups: I – pts with lone AFL; II – patients with AFL and prior AF submitted to CTA only; and III – patients with AFL and prior AF submitted to PVI and CTA. Clinical records were analyzed to determine the occurrence of MACE - death (of CV or unknown cause), stroke, clinically relevant bleed or hospitalization due to HF or arrhythmic events. Long-term OAC was defined as its persistence over 18 months after CTA. Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses. Results A total of 476 pts (66 ± 12 years, 80% males) underwent CTA: group I – 284 pts (60%), II – 109 pts (23%) and III – 83 pts (17%). Baseline characteristics were similar between groups, except for age with group I pts being older (68 ± 12, 67 ± 11, 61 ± 11, p &lt; 0.03). The mean baseline CHA2DS2VASc was 2.3 ± 1.5 and the median post-CTA follow-up was 2.8 year. The 1-, 3- and 5-years MACE risk was 7%, 21% and 32%, respectively and did not differ significantly between groups. OAC was suspended on the long-term in 105 pts (23%), at a mean of 241 days post-CTA. Suspension of OAC was significantly associated with lower MACE risk (HR: 0.26, 95%CI 0.12-0.56, p = 0.001). This effect was independent of the age and CHA2DS2VASc. The prognostic benefit of OAC suspension was driven by the group I and was not verified in patients with concomitant AF. In group I, withdraw of OAC (56 pts - 27%) was associated with a 70% relative risk reduction in the 5-year MACE risk (16% vs 43%, HR: 0.30, 95%CI 0.13-0.69, p = 0.005). In group I, OAC was suspended in patient who were younger (65 ± 11 vs. 69 ± 12, p = 0.002), had lower CHA2DS2VASc (1.9 ± 1.6 vs. 2.7 ± 1.4, p &lt; 0.001) and less often had cerebral vascular disease (1% vs. 8%, p = 0.036), HF (14% vs. 38%, p = 0.001), ischemic cardiomyopathy (9% vs. 19%, p = 0.04) and HTN(61% vs. 75%, p = 0.019). Conclusions In pts with AFL submitted to CTA, the long-term risk of MACE is frighteningly high, even in the ones without prior documentation of concomitant AF. Pts with prior AF presenting at the electrophysiological procedure in typical AFL and submitted just to CTA were not significantly harmed, from a prognostic perspective. In pts with lone AFL submitted to successful CTA, it may be reasonable to suspend OAC within 18 months provided that the concomitant AF is carefully excluded. Abstract Figure.

scholarly journals Opportunistic diseases in patients with HIV infection in the intensive care unit

2018 ◽  
Vol 90 (11) ◽  
pp. 13-17
Author(s):  
G M Kozhevnikova ◽  
S L Voznesenskiy ◽  
T N Ermak ◽  
E V Petrova ◽  
V P Golub ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Chronic Hepatitis ◽  
Intensive Care ◽  
Hiv Infection ◽  
Comparative Study ◽  
Opportunistic Infections ◽  
Pneumocystis Pneumonia ◽  
Hiv Patients ◽  
Number Of Patients ◽  
Secondary Diseases

The aim of the study was to analyze the incidence and prevalence of opportunistic diseases and comorbidities in patients admitted in the intensive care unit. Materials and methods. A specialized intensive care unit (ICU) for patients with severe HIV infection was set up in 2014 at the infectious diseases 2nd state hospital Moscow. It provides intensive care and treatments for HIV patients with severe co-morbidities and opportunistic infections. Retrospective analysis of medical records from 2014-2016 was carried out. Also carried out was a comparative study of the most common presentation of secondary diseases with available data of HIV patients in Russia from 1993-1997. Results. The number of patients treated increased from 455 to 852, and the death rate in the department decreased from 64.8 to 50.2% since it began operating. The opportunistic infections noted were cytomegalovirus, pneumocystis pneumonia, esophageal candidiasis, tuberculosis and toxoplasmosis of the brain. The most common comorbidities were chronic hepatitis C and mixed form of chronic hepatitis with cirrhosis complications. Despite the vast diagnostic possibilities, bacterial pneumonia and encephalitis of unknown origin significantly occurred. Comparative study of secondary disease since the early 1990s revealed a significant increase in cerebral toxoplasmosis (from 1.7 to 10.4%), pneumocystis pneumonia (from 5.2 to 16.0%) and encephalitis of unspecified etiology (from 13.8 to 39.4%) Conclusion. Disease severity among HIV patients is increasing. CMV and pneumocystis pneumonia were predominant opportunistic diseases. There were significant changes in the presentation of secondary diseases compared to data from 1993-1997.

scholarly journals Progress in the Prevention and Treatment of AIDS Associated with Tuberculosis

2016 ◽  
Vol 5 (2) ◽  
pp. 44-49 ◽  
Author(s):  
Wenlong He ◽  
Rui Li ◽  
Yaogang Wang
Keyword(s):  
Hiv Infection ◽  
Opportunistic Infections ◽  
Epidemiological Studies ◽  
Public Health Care ◽  
Rapid Progression ◽  
The Public ◽  
Immunodeficiency Virus ◽  
Latent Tb ◽  
Latent Tb Infection ◽  
And Control

AbstractEpidemiological studies have shown that infection with the human immunodeficiency virus (HIV) is an influential risk factor for infection withMycobacterium tuberculosis(MTb), the rapid progression of the initial infection to active tuberculosis (TB), and the reactivation of latent TB infection. MTb infection is also one of the most common opportunistic infections in people with HIV, including AIDS patients receiving anti-retroviral therapy. Given the prevalence of HIV infection, the incidence of TB infection, which had begun to decline, is facing a severe situation. HIV associated with TB exerts an immense burden on the public health-care system, especially in countries with high incidences of HIV infection. Therefore, the global policies for the prevention and control of TB should be revised. Moreover, an increased investment in TB control has to be guaranteed. The purpose of this review is to summarize the recent progress in the prevention, treatment, and control of HIV and TB co-infection.

scholarly journals EPIDEMOILOGY, DIAGNOSIS, AND TREATMENT OF HIV-ASSOCIATED NON-HODGKIN LYMPHPOMAS

2018 ◽  
Vol 10 (3) ◽  
pp. 17-29
Author(s):  
V. V. Rassokhin ◽  
A. V. Nekrasova ◽  
V. V. Baikov ◽  
N. V. Ilyin ◽  
Yu. N. Vinogradova
Keyword(s):  
Hiv Infection ◽  
Opportunistic Infections ◽  
Clinical Laboratory ◽  
B Cell Lymphoma ◽  
Current Treatment ◽  
Infectious Complications ◽  
Hospital Environment ◽  
Team Approach ◽  
Oncological Diseases ◽  
Cd4 Lymphocyte

The objective of the study was to analyze clinical, immunological and morphological features of malignant non-Hodgkin lymphpomas (MNHL) in HIV-infected patients, evaluate the options and the results of the treatment for the patients in oncohematological hospital environment. Materials and methods. The study evaluated the data from Original Medical Records of 185 HIVinfected patients (mean age 36–40 years) with MNHL that was detected during the period from 1994 to 2017. The results of clinical, laboratory, morphological and immunohistochemical methods used for the study in HIV-infected patients with MNHL were represented. Results. During the period from 1994 to 2017, increasing in the number of HIV-infected patients with MNL, mean age of which was less than 40 years, had been marked. Duration of HIV-infection up to the time of detection the MNHL was 7 years but in 23% of cases the HIV-infection and tumor disease were diagnosed at the same time. Low number of CD4 lymphocyte cells (132 cells/μL) and high number of RNA HIV (more than 550 000 copies/μL) were detected in the blood of the patients. The following distribution was among morphological types of MNHL: diffuse large B-cell lymphoma (DLBCL) — 42%, Burkitt's lymphomas — 32%, plasmablastic lymphomas — 26%. Clinical lymphomas with the extranodal manifestations accompanied with large quantity of complications and opportunistic infections directly resulted from immunosuppression severity (p<0,05) were predominant (76%). Evaluation of combined chemoimmunotherapy effectiveness in HIV-infected patients and in the patients with MNHL showed comparable results in contrast with the population of seronegative HIV-infected patients under using standard polychemotherapy regimens with rituximab, antiretroviral therapy, prevention of infectious complications and immune reconstitution syndrome. Conclusion. Malignant non-Hodgkin lymphpomas represent the group of oncological diseases, which is predominant in HIV-infected patients. These diseases require team approach in early detection, current treatment, prevention of complications in the multidisciplinary team that will significantly improve disease outcome.

scholarly journals Immunopathogenetic significance of activation and apoptosis of immunocompetent cells in children with HIV infection

2020 ◽  
Vol 12 (4) ◽  
pp. 23-28
Author(s):  
V. B. Denisenko ◽  
E. M. Simovanyan
Keyword(s):  
Hiv Infection ◽  
Opportunistic Infections ◽  
Immunocompetent Cells ◽  
Cell Component ◽  
Immunological Parameters ◽  
Latent Stage ◽  
Associated Symptoms ◽  
Immunological Examination ◽  
Late Stages ◽  
Secondary Diseases

The purpose is to clarify the immunopathogenetic significance of immunocompetent cells activation and apoptosis in children with HIV-infection.Materials and methods. A clinical and immunological examination of 92 children aged 1 to 5 years old with HIVinfection in latent stage 3 (25), in the stage of secondary diseases 4A (21), 4B (22) and 4V (24) was conducted.Results. During the clinical examination, the consistent appearance of HIV-associated symptoms, opportunistic infections, and tumors was noted. Changes in the immune status included abnormalities in the T-cell component – a decrease in the number of CD4-, CD3-, increase of CD8-lymphocytes, inversion of the CD4/CD8 ratio, in the B-cell component – hyperimmunoglobulinemia, increase in the content of circulating immune complexes, in the part of innate immunity factors – a decrease in the intensity of the oxygen-dependent neutrophil metabolism and its reserve capabilities. Identified impaired positive activation of lymphocytes – a decrease in the number of CD25- and an increase in HLADR-cells. An increase in the expression of CD95-receptors on the lymphocyte membrane, an increase in the number of lymphocytes in the early (AnV) and late stages of apoptosis (AnV/Pr) was found. With the progression of HIV infection, there was a deepening of these shifts in immunological parameters, especially during the transition to the stage of secondary diseases 4V (AIDS).Conclusion. An immunological examination and correlation analysis showed that an important immunopathogenetic mechanism for reducing the number of CD4 lymphocytes in children with HIV infection is the activation of apoptosis involving the receptor and mitochondrial mechanisms. One of the reasons for the formation of depressed cellular immunity was the hyperactivation of immunocompetent cells. The findings provide a rationale for the timely prescription of antiretroviral therapy for children with HIV-infection, which will prevent hyperactivation and apoptosis of immune system cells. 

scholarly journals Impacto do Escore de Desnutrição-Inflamação na sobrevida de pacientes em hemodiálise

2020 ◽  
Vol 35 (3) ◽  
pp. 264-269
Author(s):  
Melissa Nihi Sato ◽  
Caroline Finger Sostisso ◽  
Mayara Olikszechen ◽  
Scheila Karam ◽  
Miriam de Aguiar Souza Cruz Oliveira ◽  
...  
Keyword(s):  
Vascular Access ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Regression ◽  
Clinical Laboratory ◽  
Protein Energy Malnutrition ◽  
Nutritional Risk ◽  
Chi Square ◽  
Integrated Method ◽  
Kaplan Meier

Introduction: The protein-energy malnutrition is found in a large proportion in dialysis patients. The malnutrition-inflammation score (MIS) seems to be the most appropriate integrated method for assessing the nutritional status or nutritional risk of these patients. The aim of the study is to evaluate the MIS, in the diagnostic accuracy for the assessment of malnutrition, and its correlation with the survival time of patients in hemodialysis (HD). Methods: Study carried out in HD units in the city of Curitiba, Brazil, from January 2013 to December 2015. Clinical, laboratory and anthropometric data were evaluated. The data comparison between patients was made according to the t-test and the chi-square. The Kaplan-Meier curve was constructed to assess the influence of MIS on patient survival and log rank tests were used to verify the equality of survival distributions in these groups. Results: 113 HD patients were evaluated, 74% male. From the multivariable proportional hazards model (Cox regression), the MIS> 5 was a predictor of mortality, as well as creatinine <7 mg/dl and vascular access via HD catheter. In Kaplan-Meier survival analysis, patients with MIS <5 had a significantly higher survival rate. It was also possible to confirm a significant association between creatinine <7 mg/dl and catheter vascular access, and mortality. Conclusion: MIS is an independent predictor of mortality in HD patients. The cutoff 5 was able to predict mortality

Longevity of Direct Restorations in Stress-Bearing Posterior Cavities: A Retrospective Study

2013 ◽  
Vol 38 (6) ◽  
pp. 572-582 ◽  
Author(s):  
Y-J Rho ◽  
C Namgung ◽  
B-H Jin ◽  
B-S Lim ◽  
B-H Cho
Keyword(s):  
Cox Regression ◽  
Clinical Performance ◽  
Resin Composite ◽  
Rapid Progression ◽  
Posterior Teeth ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Retrospective Clinical Study ◽  
Usphs Criteria ◽  
And Gender

SUMMARYThe aims of this retrospective clinical study were to compare the longevities of direct posterior amalgam restorations (AMs) and resin composite restorations (RCs) that were subjected to occlusal stresses and to investigate variables predictive of their outcome. A total of 269 AMs and RCs filled in Class I and II cavities of posterior teeth were evaluated with Kaplan-Meier survival estimator and multivariate Cox proportional hazard model. Seventy-one retreated restorations were reviewed from dental records. The other 198 restorations still in use were evaluated according to modified US Public Health Service (USPHS) criteria by two investigators. The longevity of RCs was significantly lower than that of AMs (AM = 8.7 years and RC = 5.0 years, p&lt;0.05), especially in molars. The prognostic variables, such as age, restorative material, tooth type, operator group, diagnosis, cavity classification, and gender, affected the longevity of the restorations (multivariate Cox regression analysis, p&lt;0.05). However, among the restorations working in oral cavities, their clinical performance evaluated with modified USPHS criteria showed no statistical difference between both restoratives. In contrast to the short longevity of RCs relative to AMs, the clinical performance of RCs working in oral cavities was observed to be not different from that of AMs. This suggests that once a RC starts to fail, it happens in a rapid progression. As posterior esthetic restorations, RCs must be observed carefully with periodic follow-ups for early detection and timely repair of failures.

scholarly journals Lesions of brain structures in HIV infection

2019 ◽  
Vol 19 (3) ◽  
pp. 83-95 ◽  
Author(s):  
Tatyana Trofimova ◽  
Vadim V. Rassokhin ◽  
Olga N. Leonova ◽  
Alexey S. Shelomov ◽  
Aleksey A. Yakovlev ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Hiv Infection ◽  
Brain Damage ◽  
Clinical Laboratory ◽  
Pathological Process ◽  
Resonance Imaging ◽  
Intravenous Contrast ◽  
The Brain ◽  
Secondary Diseases

A feature of the HIV epidemic is currently a large number of comorbid and severe forms of the disease, with frequent involvement in the pathological process of the brain. Brain lesions can be primary, caused by the human immunodeficiency virus itself and secondary, due to the development of opportunistic and secondary diseases and tumors. Correct and timely deciphering of the nature of brain damage is necessary for the choice of treatment tactics and as a consequence of reducing mortality. Objective. To study the radiological manifestations of brain damage in HIV infection in urgent and planned admission of patients to specialized hospitals. Materials and methods of research. In the work, studies were conducted to study the clinical and radiological manifestations of brain damage in HIV-infected patients admitted to various medical institutions with a diagnosis of HIV infection. Radiation examination of the brain was performed in adult HIV-infected patients (n = 410) using magnetic resonance imaging with intravenous contrast. The final diagnosis was made taking into account clinical, laboratory, radiological studies on the classification of ICD-10 in accordance with the domestic requirements of the formulation of comorbid diagnosis. Conclusion. To correctly decipher the nature of brain damage, it is necessary to use comprehensive studies including clinical, laboratory and radiation examination methods. Magnetic resonance imaging with intravenous contrast is the method of choice in the examination of the brain in HIV-infected patients. The structure of brain damage in HIV-infected patients had a different nature: in 54.4% there were signs of the presence of opportunistic and secondary diseases; in 24.9% signs of HIV encephalopathy; in 13.2% signs of nonspecific changes in small vessels of the brain, indicating premature aging or abnormal development; in 7.56% signs of involvement of the brain in the pathological process were not detected. Structure and opportunistic secondary diseases were presented: toxoplasmosis of the brain 18.3%; herpes lesions 12.2%; chief of 10.24%; neuroinfection unspecified etiology is 12.2%; cryptococcosis 4.39%; TB is 2.44%; lymphoma of the brain is 2.44%; MAC infection is 0.24%. Brain damage in HIV-infected patients is largely characterized by synchronicity (mixed infection in 8.52 %) and multifactorial lesions.

scholarly journals P0406ASSOCIATION OF MICROHEMATURIA WITH OUTCOMES IN ADULT PATIENTS WITH IGA NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Safak Mirioglu ◽  
Erdem Gurel ◽  
Merve Guzel-Dirim ◽  
Asli Kara ◽  
Yasemin Ozluk ◽  
...  
Keyword(s):  
Iga Nephropathy ◽  
Cox Regression ◽  
Clinical Laboratory ◽  
Survival Rates ◽  
Study Groups ◽  
Adult Patients ◽  
High Power Field ◽  
Kaplan Meier ◽  
Cardinal Symptom

Abstract Background and Aims Although hematuria is the cardinal symptom of IgA nephropathy (IgAN), its effects on the outcome have not been studied extensively. We, therefore, aimed to analyze the association between microhematuria and clinicopathological features as well as outcome parameters in adult patients with IgAN. Method 129 adults with IgAN, diagnosed by kidney biopsy, and followed up for a median duration of 54.5 (IQR: 24.25-92.75) months, were included in this retrospective study. Urinary sediment analyses during the bouts of macrohematuria were not taken into consideration. For the purpose of this analysis, microhematuria was described as ≥5 red blood cells per high-power field (RBCs/hpf) and classified as mild (5-9 RBCs/hpf), moderate (10-19 RBCs/hpf), or severe (≥20 RBCs/hpf). Study outcome (event) was defined as at least a 50% reduction in baseline eGFR or development of stage 5 chronic kidney disease (eGFR &lt;15 ml/min/1.73 m2). eGFRs of the patients were calculated by using CKD-EPI formula. Results Demographic, clinical, laboratory and histopathological features of patients at the time of diagnosis are summarized in the table. Usage of ACEi/ARBs [75/81 (92.5%) vs 45/48 (93.75%), p=0.803], fish oil [30/81 (37%) vs 19/48 (39.5%), p=0.773], azathioprine [16/81 (19.7%) vs 10/48 (20.8%), p=0.882] and mycophenolic acid derivatives [14/81 (17.2%) vs 11/48 (22.9%), p=0.434] were comparable among the patients with and without microhematuria. Corticosteroids were more frequently used in patients with microhematuria [41/81 (50.6%) vs 17/48 (35.4%)], although this difference was not statistically significant (p=0.093). Overall 30 patients (23.2%) reached the study outcome, and there were no differences between patients with (19, 23.4%) and without (11, 22.9%) microhematuria (p=0.944). Kaplan-Meier analysis revealed that event free survival rates were similar across study groups: 77.1% for patients without microhematuria; while 80% for mild, 77.3% for moderate, and 72.7% for severe microhematuria (p=0.436) (Figure). Microhematuria did not predict the study outcome when multivariable Cox regression analyses were performed [HR: 1.847 (95% CI: 0.696-4.904), p=0.218]. Throughout the follow-up, microhematuria disappeared (dropped below 5 RBCs/hpf) in 43 patients (53%), 8 of whom (18.6%) reached the study outcome as compared to 11 patients (28.9%) with persistent microhematuria (p=0.273). Disappearance of microhematuria was not a predictor of study outcome, as well [HR: 0.386 (95% CI: 0.068-2.180), p=0.281]. Conclusion Microhematuria is not associated with renal outcomes of adult patients with IgAN.

Tuberculosis and HIV — infection in psychiatric hospital environment

2020 ◽  
pp. 57-65
Author(s):  
Oksana Ovchinnikova
Keyword(s):  
Hiv Infection ◽  
Psychiatric Hospital ◽  
Clinical Picture ◽  
Clinical Laboratory ◽  
Hospital Environment ◽  
Laboratory Studies ◽  
History Data

Quantitative comparative statistics of data for twenty-one treatment units of GBOZ «SOKPB» have been carried out. Data of clinical picture, clinical laboratory studies of patients have been studied. Records of the disease have been monitored and history data have been studied. The results of the survey were analysed.

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