scholarly journals The Most Frequent Neurological Complications in HIV Patients in Constanta and the Influence that Coinfections Have in the Onset of Such Conditions

2020 ◽  
Vol 26 (3) ◽  
pp. 131-136
Author(s):  
Pascu Corina ◽  
Dumitru Irina Magdalena ◽  
Cernat Roxana Carmen ◽  
Petcu Lucian Cristian ◽  
Rugina Sorin
Keyword(s):  
Opportunistic Infections ◽  
Neurological Complication ◽  
Treponema Pallidum ◽  
Neurological Complications ◽  
Hiv Patients ◽  
Statistical Probability ◽  
Viral Loads ◽  
Precise Diagnosis ◽  
History Of ◽  
Disease Specialist

Abstract Abstract: This paper shows the results of a retrospective observational analytical study that has enrolled 166 HIV positive patients diagnosed with a neurological complication between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. 119 patients (71,69%) were diagnosed with one of the three neurological complications: HIV associated dementia (HAD), Progressive Multifocal Leukoencephalopathy (PML) and CNS Toxoplasmosis (CT). We have noted CD4 levels, viral loads, and the presence/absence of other infections like: HBV, HCV, Treponema pallidum, Mycobacterium Tuberculosis. The results show that PML and CT, in this order, are the main opportunistic infections with important neurological impact. Both, PML and CT are in direct correlation with the immune status, but also with other infections like the infection with HCV or with M. Tuberculosis. CD4 nadir <100 cells/mmc and viral load ≥100000copies/ml have a stronger association with PML (p<0,05). Patients known with HIV and T. pallidum infection are more likely, in case of new sudden neurological signs, to be diagnosed with Neurotoxoplasmosis versus PML, or HAD (p<0,05). Given the fact that HIV patients can have multiple alterations of neurological functions, and spectaculous but complicated neuro imagistic results, knowing the history of the patients, the lab results, and the statistical probability can help the physician, infectious disease specialist or neurologist, to make a faster and precise diagnosis.

scholarly journals Hemorrhagic Posterior Reversible Encephalopathy Syndrome: A Rare Neurological Complication of COVID-19 Infection

2021 ◽  
Vol 8 (3) ◽  
pp. 149-152
Author(s):  
Esmaeil KhanMohammadi ◽  
Marziyeh Shahrabi ◽  
Mohsen Koosha
Keyword(s):  
Posterior Reversible Encephalopathy Syndrome ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Convulsive Status Epilepticus ◽  
Posterior Reversible Encephalopathy ◽  
Cerebrovascular Complication ◽  
History Of ◽  
Reversible Encephalopathy ◽  
Hypertensive Therapy

Neurological complications of COVID-19 are well documented. However, there are limited reports of posterior reversible encephalopathy syndrome (PRES) associated with COVID-19 in the literature. Herein, we described a 21-year-old man with a history of bipolar disease and opioid addiction who was admitted because of COVID-19 infection. He suddenly experienced a convulsive status epilepticus following hypertension crisis. The patient was intubated and underwent antiepileptic and anti-hypertensive therapy. His brain imaging was compatible with PRES. The patient gradually improved and was eventually discharged after 40 days. On the next month follow-up, the patient was able to walk with a cane without a history of seizure. In this report, we aimed to highlight the less common cerebrovascular complication of COVID-19 infection.

scholarly journals Neurological Complications after Liver Transplantation According to Immunosuppressive Therapy

2020 ◽  
pp. 1-5
Author(s):  
Laura Tortolero ◽  
Laura Tortolero ◽  
Javier Nuño ◽  
Patricia Luengo ◽  
Luis Gajate ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Renal Failure ◽  
Immunosuppressive Therapy ◽  
Opportunistic Infections ◽  
Neurological Complication ◽  
Neurological Complications ◽  
Number Of Patients ◽  
Group A ◽  
One Year ◽  
Group B

Background: Neurological complications (NC) after liver transplantation (LT) are frequent, appearing in up to 60% of patients. Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections. The use of basiliximab allows for less toxic immunosuppressive therapies. The aim of this study was to evaluate the neurological complications present during the first 30 days after LT and to evaluate its relationship with renal function, immunosuppressive therapy, and mortality. Methods: A total of 231 recipients were included in the retrospective, longitudinal, and nonrandomized study under 2 different immunosuppression protocols (with -group B- or without basiliximab -group A-). Results: NC were present in 14.3% of patients (n: 33), the average age of these patients was 55.4 years. The incidence of NC was significantly higher in group A than in group B (19.5% vs. 9.3% p <0.05), with no differences in the incidence of infection or rejection between both groups. The incidence of acute renal failure, the need for renal replacement therapy, the days of admission to the ICU, the days of hospital admission, as well as mortality during admission and one year after LT were higher among patients with NC. However, when analyzing patients with a neurological complication, patients in group A had a higher incidence of complications than in group B. Conclusion: The use of immunosuppressive therapies that apply lower doses of anticalcineurinics and with a later onset, classically called nephroprotective as used in group B, could also be neuroprotective, reducing the appearance of neurological complications and, therefore, morbidity. These findings most be verified in studies with a larger number of patients and randomized.

scholarly journals The Efficiency of the Fight Against HIV, in Constanta, from the Perspective of Neurological Complications

2020 ◽  
Vol 26 (3) ◽  
pp. 126-130
Author(s):  
Pascu Corina ◽  
Dumitru Irina Magdalena ◽  
Cernat Roxana Carmen ◽  
Petcu Lucian Cristian ◽  
Rugina Sorin
Keyword(s):  
Hiv Infection ◽  
Opportunistic Infections ◽  
Neurological Complication ◽  
Treatment Compliance ◽  
Hiv Infections ◽  
Neurological Complications ◽  
Antiretroviral Drugs ◽  
Treatment Regimens ◽  
Neurological Conditions ◽  
Cns Penetration

Abstract In order to control and end the AIDS epidemic, we all need to hit the 0-0-0 target. That means 0 HIV infections, 0 mortality caused by AIDS and 0 discrimination. We performed a retrospective observational analytical study on 166 HIV positive patients with a neurological complication, diagnosed between June 2012 and June 2020, in Clinical Infectious Diseases Hospital of Constanta. We collected data from the observational charts that revealed if the patient was known with HIV infection at the time of the neurological complication diagnosis, information about the treatment (how many treatment regimens, classes of antiretroviral drugs, CNS Penetration-Effectiveness Rank), treatment compliance. The patients were divided into two groups: first group “opportunistic infections (OI)” and second group “other neurological conditions (ONC)”. 16 patients (9,6%) have the neurological condition as first manifestation of HIV infection. Opportunistic infections, correlated with a poor immunological status continue to have a high percentage (46,98%) of neurological complications, being associated with a poor treatment compliance (p<0,001). Integrase inhibitors were associated, in this study, more with opportunistic infections and less with other neurological conditions (OR=2,885; 95% IC), this finding needs further research. Long term survivors have problems with treatment compliance manifesting treatment fatigue, even if they have treatment regimens with good CNS penetrability. Poor compliance is associated with high risk of opportunistic infections and opportunistic infections have a higher mortality than other neurological complications. Our task for the future is to find ways to improve treatment adherence in order for HIV patients to have a better and longer life.

Objectivization of vacuum-compression therapy effects on micro- and macrovascular perfusion in type 2 diabetic patients

2020 ◽  
Vol 65 (4) ◽  
pp. 469-476
Author(s):  
Jaroslav Prucha ◽  
Vladimir Socha ◽  
Lenka Hanakova ◽  
Andrej Lalis ◽  
Karel Hana
Keyword(s):  
Lower Limb ◽  
Compression Therapy ◽  
Neurological Complications ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Therapeutic Procedures ◽  
History Of ◽  
Injury Recovery ◽  
Type 2 Diabetic

AbstractThe present study aimed to evaluate the characteristic influence of physical therapeutic procedures of vacuum-compression therapy (VCT) on microvascular perfusion (MiP) and macrovascular perfusion (MaP) of the lower limb in diabetic patients. A sample of nine patients with a medical history of type 2 diabetes was used for the purpose of this study. Most of the subjects’ medical conditions included venous and neurological complications of the lower limb, whereas the rest of the subjects entered the treatment due to injury recovery or their phlebological disease. The PeriFlux System 5000 (Perimed, Sweden) diagnostic device was used to measure MiP. The MaP was evaluated based on the perfusion index (PI) using the Extremiter monitoring device (Embitron, Czech Republic) designed to perform VCT procedures. The study found that MiP and MaP increase as an effect of VCT procedures and at the same time PI clearly reflects the effect of the applied vacuum and compression phases, verifying the method’s vital influence on peripheral perfusion disorders.

Oro-facial opportunistic infections and related pathologies in HIV patients: A comprehensive review

2021 ◽  
pp. 101170
Author(s):  
Shailesh Gondivkar ◽  
Sachin C. Sarode ◽  
Amol R. Gadbail ◽  
Monal Yuwanati ◽  
Gargi S. Sarode ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Hiv Patients ◽  
Comprehensive Review

scholarly journals Subacute Sclerosing Panencephalitis manifesting as Bell’s palsy and bilateral macular necrotizing retinitis: an atypical presenting feature

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lagan Paul ◽  
Tanya Jain ◽  
Manisha Agarwal ◽  
Shalini Singh
Keyword(s):  
Subacute Sclerosing Panencephalitis ◽  
Clinical History ◽  
Neurological Complications ◽  
Bell’S Palsy ◽  
Ocular Involvement ◽  
Bell's Palsy ◽  
Diagnostic Challenge ◽  
Bladder Control ◽  
Mri Brain ◽  
History Of

Abstract Background Subacute sclerosing panencephalitis (SSPE) is a potentially lethal complication of measles infection. Neurological complications take years to manifest after primary viral infection of brain and can lead to blindness in some individuals. Findings A 13-year-old female patient with history of Bell’s palsy 2 months prior, presented with rapidly progressing necrotizing retinitis in both eyes. Soon after, she was unable to walk, developed myoclonic jerks, altered sensorium and loss of bowel and bladder control. Her clinical history, CSF IgG measles antibody analysis, MRI brain and EEG findings confirmed the diagnosis of SSPE. Conclusion SSPE in our case presented as Bell’s palsy and sudden painless diminution of vision due to ocular involvement, and developed full blown disease within 2 months. SSPE can present as a diagnostic challenge and warrants early identification and referral for timely diagnosis and management.

Streptococcus salivarius endogenous endophthalmitis

2021 ◽  
Vol 14 (2) ◽  
pp. e239299
Author(s):  
Carl-Joe Mehanna ◽  
Lea Kallassi ◽  
Ahmad M Mansour ◽  
Rola N Hamam
Keyword(s):  
Opportunistic Infections ◽  
External Source ◽  
Endogenous Endophthalmitis ◽  
Streptococcus Salivarius ◽  
Source Of Infection ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
Atypical Presentations ◽  
High Index Of Suspicion ◽  
Valve Implantation

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius. An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius. Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.

PREDICTORS OF NEUROLOGICAL COMPLICATIONS AFTER CARDIAC SURGICAL INTERVENTIONS IN OLDERY PATIENTS

2020 ◽  
pp. 319-324
Author(s):  
О. В. Каменская ◽  
А. С. Клинкова ◽  
В. В. Ломиворотов ◽  
В. А. Шмырев ◽  
А. М. Чернявский
Keyword(s):  
Intraoperative Monitoring ◽  
Cerebral Oxygenation ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Myocardial Infarctions ◽  
Bypass Grafting ◽  
Surgical Interventions ◽  
Increased Risk ◽  
History Of ◽  
Left And Right

Для выявления предикторов неврологических осложнений в госпитальный период после коронарного шунтирования (КШ) проанализированы данные 92 больных 70 лет и старше с ИБС. Интраоперационно проведен мониторинг церебральной оксигенации ( rSO , %). На этапе вводной анестезии средний уровень rSO по правому и левому полушариям составлял 64-65% без значительных изменений во время операции. Снижение rSO во время искусственного кровообращения (ИК) связано с увеличением риска развития неврологических осложнений в раннем послеоперационном периоде. При снижении rSO во время ИК на 20% и более относительно исходных значений по левому и правому полушариям риск неблагоприятных неврологических событий возрастает в 7 и 9 раз соответственно. Два и более инфаркта миокарда в анамнезе в 3 раза увеличивают риск неврологических осложнений после КШ. To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation ( rSO , %) was carried out. At the stage of induction anesthesia, the average level of rSO for left and right hemispheres was 64-65 % without significant changes during the operation. A decrease in rSO during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO by 20 % or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

scholarly journals Treatment with Tumor Necrosis Factor-α Inhibitors, History of Allergy, and Hypercalcemia Are Risk Factors of Immune Reconstitution Inflammatory Syndrome in HIV-Negative Pulmonary Tuberculosis Patients

2019 ◽  
Vol 9 (1) ◽  
pp. 96
Author(s):  
Yoshimasa Hachisu ◽  
Yasuhiko Koga ◽  
Shu Kasama ◽  
Kyoichi Kaira ◽  
Masakiyo Yatomi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Immune Reconstitution ◽  
Tumor Necrosis ◽  
Hiv Patients ◽  
Tnf Α ◽  
History Of ◽  
Inflammatory Syndrome ◽  
Necrosis Factor ◽  
Inhibitor Treatment

Immune reconstitution inflammatory syndrome (IRIS) is an immune reaction that occurs along with the recovery of the patient’s immunity. Tuberculosis-related IRIS (TB-IRIS) upon tumor necrosis factor (TNF)-α inhibitor treatment has been reported in non-human immunodeficiency virus (HIV) patients. However, the importance of biological treatment, as a risk factor of IRIS, has not yet been established. In this study, we examined TB-IRIS in non-HIV patients to explore the role of TNF-α inhibitor treatment. Out of 188 patients with pulmonary TB, seven patients had IRIS. We examined univariate logistic and multivariate analysis to elucidate risk factors of TB-IRIS. Univariate analysis indicated that usage of immunosuppressive drugs, TNF-α inhibitors, and history of food or drug allergy were significantly related with TB-IRIS. On initial treatment, the values of serological markers such as serum albumin and serum calcium were significantly related with TB-IRIS. There was a higher mortality rate in patients with TB-IRIS. Furthermore, multivariate analysis revealed that usage of TNF-α inhibitors, history of allergy, and serum hypercalcemia were related to TB-IRIS. Usage of TNF-α inhibitors, history of allergy, and serum hypercalcemia may be independent predictors of TB-IRIS in non-HIV patients. Since higher mortality has been reported for TB-IRIS, we should pay attention to TB patients with these risk factors.

scholarly journals Routine screening for hepatitis C viral infection in patients undergoing elective cranial neurosurgery

2019 ◽  
Vol 131 (3) ◽  
pp. 941-948
Author(s):  
Eric S. Nussbaum ◽  
Kevin Kallmes ◽  
Jodi Lowary ◽  
Leslie A. Nussbaum
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Drug Abuse ◽  
Positive Result ◽  
Rapid Test ◽  
Cost Effective ◽  
Viral Loads ◽  
Iv Drug Abuse ◽  
History Of ◽  
The Cost

OBJECTIVEUndiagnosed hepatitis C virus (HCV) and HIV in patients present risks of transmission of bloodborne infections to surgeons intraoperatively. Presurgical screening has been suggested as a protocol to protect surgical staff from these pathogens. The authors sought to determine the incidence of HCV and HIV infection in elective craniotomy patients and analyze the cost-effectiveness of universal and risk factor–specific screening for protection of the surgical staff.METHODSAll patients undergoing elective craniotomy between July 2009 and July 2016 at the National Brain Aneurysm Center who did not refuse screening were included in this study. The authors utilized rapid HCV and HIV tests to screen patients prior to elective surgery, and for each patient who tested positive using the rapid HCV or HIV test, qualitative nucleic acid testing was used to confirm active viral load, and risk factor information was collected. Patients scheduled for nonurgent surgery who were found to be HCV positive were referred to a hepatologist for preoperative treatment. The authors compared risk factors between patients who tested positive on rapid tests, patients with active viral loads, and a random sample of patients who tested negative. The authors also tracked the clinical and material costs of HCV and HIV rapid test screening per patient for cost-effectiveness analysis and calculated the cost per positive result of screening all patients and of screening based on all patient risk factors that differed significantly between patients with and those without positive HCV test results.RESULTSThe study population of patients scheduled for elective craniotomy included 1461 patients, of whom 22 (1.5%) refused the screening. Of the 1439 patients screened, 15 (1.0%) tested positive for HCV using rapid HCV screening; 9 (60%) of these patients had active viral loads. No patient (0%) tested positive for HIV. Seven (77.8%) of the 9 patients with active viral loads underwent treatment with a hepatologist and were referred back for surgery 3–6 months after sustained virologic response to treatment, but the remaining 2 patients (22.2%) required urgent surgery. Of the 9 patients with active viral loads, 1 patient (11%) had a history of both intravenous drug abuse and tattoos. Two of the 9 patients (22%) had tattoos, and 3 (33%) were born within the age-screening bracket (born 1945–1965) recommended by the Centers for Disease Control and Prevention. Rates of smoking differed significantly (p < 0.001) between patients who had active viral loads of HCV and patients who were HCV negative, and rates of smoking (p < 0.001) and IV drug abuse (p < 0.01) differed significantly between patients who were HCV rapid-test positive and those who were HCV negative. Total screening costs (95% CI) per positive result were $3,877.33 ($2,348.05–$11,119.28) for all patients undergoing HCV rapid screening, $226.29 ($93.54–$312.68) for patients with a history of smoking, and $72.00 ($29.15–$619.39) for patients with a history of IV drug abuse.CONCLUSIONSThe rate of undiagnosed HCV infection in this patient population was commensurate with national levels. While the cost of universal screening was considerable, screening patients based on a history of smoking or IV drug abuse would likely reduce costs per positive result greatly and potentially provide cost-effective identification and treatment of HCV patients and surgical staff protection. HIV screening found no infected patients and was not cost-effective.

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