Evaluation of Perinatal and Postnatal Outcomes of Delivery Type, Delivery Period and Follow-up Labor in HIV Positive Pregnancies from the Perspective of Fetal Infection

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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Impact of the Israeli Ministry of Health Cytomegalovirus Guidelines on the Local Pregnancy Outcome

Fetal Diagnosis and Therapy ◽

10.1159/000510816 ◽

2020 ◽

pp. 1-6

Author(s):

Marina Pekar-Zlotin ◽

Anat Alufi Naim ◽

Perry Eliassi Revivo ◽

Nadav Kugler ◽

Yaakov Melcer ◽

...

Keyword(s):

Pregnant Women ◽

Telephone Survey ◽

Pregnancy Termination ◽

Maternal Serum ◽

Cmv Infection ◽

Ministry Of Health ◽

Newborn Outcomes ◽

Fetal Infection ◽

Postnatal Outcome

Objective: In 2011, the Israeli Ministry of Health (MOH) published standard guidelines for the follow-up of pregnant women infected by CMV, recommending that amniocentesis be performed in cases of maternal serum viral seroconversion or abnormal sonographic findings suggestive of CMV, in order to prove fetal infection before electing for pregnancy termination. Methods: A retrospective cohort study was performed, describing 448 pregnant women from 2006 to 2017. We collected data from all women that elected to continue their pregnancies after seroconversion and also of those who chose to undergo pregnancy termination. Subsequently, a telephone survey was then conducted to record outcomes of the newborns of women with CMV seroconversion during pregnancy. Results: 325 (73%) women chose to continue their pregnancy, while 123 (27%) opted for termination of pregnancy. We found that pregnancy termination due to CMV infection was reduced by 7%, from 72 cases (32%) to 51 cases (25%) after the implementation of the MOH guidelines in 2011. In addition, 182/305 (60%) of women responded to our telephone questionnaire regarding newborn outcomes. Of these women, 45/305 (14%) reported complications, and no correlation was found between the prenatal findings and postnatal outcome among those who have responded to our survey. Conclusion: Implementation of the new MOH guidelines has reduced the rate of pregnancy termination, without increasing the rate of neonatal complications in Israel with a similar outcome of complication rate as reported in the literature.

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Kuhmilchallergie: Die Bedeutung von Registerstudien für die Allergieforschung

Karger Kompass Dermatologie ◽

10.1159/000503619 ◽

2019 ◽

pp. 200-202

Author(s):

Claudia Traidl-Hoffmann

Keyword(s):

Recovery Time ◽

Lactobacillus Rhamnosus ◽

Casein Hydrolysate ◽

Common Diagnosis ◽

Ige Mediated ◽

Casein Hydrolysates ◽

Type Of Delivery ◽

Delivery Type ◽

Gender Type

Introduction: Cowʼs milk allergy (CMA) is a common diagnosis in infants, requiring the exclusion of cowʼs milk until tolerance is recovered. In the present study, we aim to determine which factors are associated with the development of tolerance.Methods: Retrospective, observational study of subjects who underwent the same clinical follow-up methodology. We studied 245 cases of CMA (125 IgE-mediated and 120 non-IgE-mediated). The following variables were analysed: age at diagnosis, gender, type of delivery, type of feeding received, feeding during the first months of life, clinical features, and type of feed received as treatment: casein hydrolysates or casein hydrolysates with Lactobacillus rhamnosus GG (LGG).Results: Factors associated with earlier tolerance were non-IgE-mediated CMA (HR = 2.92; 95% CI: 2.20-3.88) and patients receiving casein hydrolysate with LGG (HR = 1.79; 95% CI: 1.33-2.42). Later tolerance was associated with caesarean delivery (HR = 0.78; 95% CI: 0.58-1.05) and breastfeeding for a period of at least 3 days (HR = 0.64; 95% CI: 0.44-0.93). The multivariate study shows that the type of formula (HR = 1.61; 95% CI: 1.19-2.18) and the type of CMA (HR = 2.82; 95% CI: 2.12-3.85) have an effect on the recovery time. Casein hydrolysates with LGG reduces the recovery time in IgE-mediated (HR = 1.88; 95% CI: 1.17-3.01) and non-IgE-mediated CMA (HR = 1.46; 95% CI: 0.98-2.17).Conclusion: Tolerance acquisition is faster in non-IgE-mediated CMA subjects and in those who received casein hydrolysate with LGG.

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Cognitive and physical development in HIV-positive children in South Africa and Malawi: A community-based follow-up comparison study

Child Care Health and Development ◽

10.1111/cch.12533 ◽

2017 ◽

Vol 44 (1) ◽

pp. 89-98 ◽

Cited By ~ 9

Author(s):

L. Sherr ◽

I. S. Hensels ◽

M. Tomlinson ◽

S. Skeen ◽

A. Macedo

Keyword(s):

South Africa ◽

Physical Development ◽

Hiv Positive ◽

Comparison Study ◽

Community Based

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Elevated HIV and STI Prevalence and Incidence Among Methamphetamine-Using Men Who Have Sex With Men in Los Angeles County

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.4.350 ◽

2018 ◽

Vol 30 (4) ◽

pp. 350-356 ◽

Cited By ~ 10

Author(s):

Cathy J. Reback ◽

Jesse B. Fletcher

Keyword(s):

Los Angeles ◽

Sexual Risk ◽

Risk Behaviors ◽

Los Angeles County ◽

Hiv Positive ◽

Sexual Risks ◽

Methamphetamine Use ◽

Baseline Testing ◽

Sex With Men

Methamphetamine use is associated with increased HIV/STI infection among men who have sex with men (MSM). From March 2014 through January 2016, 286 methamphetamine-using MSM enrolled in a study to reduce methamphetamine use and sexual risk behaviors. Participants were tested for HIV/STIs at baseline and every 3 months for 9 months. At baseline, 115 participants (40.2%) were HIV–positive; three participants seroconverted (incidence = 2.6/100 person-years). Baseline testing diagnosed 77 STI cases (21 chlamydia, 18 gonorrhea, 38 syphilis); by 9-month follow-up, 71 incident STIs were diagnosed (22 chlamydia, 24 gonorrhea, 25 syphilis); 78% occurred among HIV–positive participants. Despite efforts to reduce sexual risks among methamphetamine-using MSM, HIV/STI prevalence and incidence remain elevated.

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Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatients

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v21i3.695 ◽

2015 ◽

Vol 21 (3) ◽

pp. 5

Author(s):

Yvette M Nel ◽

Gregory Jonsson

Keyword(s):

Psychiatric Patients ◽

Mental Healthcare ◽

Limited Resource ◽

Primary Objective ◽

Hiv Treatment ◽

Hiv Positive ◽

Hiv Status ◽

Post Discharge ◽

Resource Setting

Background. Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART). There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative perceptions regarding future adherence may affect the clinical decision to initiate ART in hospitalised psychiatric patients. Attendance at clinic appointments is an indicator of medication adherence, and is easily measurable in a limited-resource setting. Objectives. The primary objective of this study was to examine the rate of attendance at the first clinic appointment post discharge from a period of psychiatric hospitalisation in HIV-positive psychiatric patients initiated on ART as inpatients. A secondary objective was to determine which factors, if any, were associated with clinic attendance. Methods. This study was a retrospective record review, conducted at the Luthando Neuropsychiatric HIV Clinic in Soweto, which is an integrated mental healthcare and ART clinic. Patients who were initiated on ART as psychiatric inpatients from 1 July 2009 to 31 December 2010, and subsequently discharged for outpatient follow-up at Luthando Clinic were included in the sample. Results. There were 98 patients included in the analysis. The sample was predominantly female. The rate of attendance was 80%. The attendant and non-attendant groups were similar in terms of demographic and clinical data. Significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (p=0.01). Conclusion. Non-disclosure of HIV status needs to be further addressed in integrated psychiatric HIV treatment facilities in order to improve attendance. Female predominance in this setting should also be further investigated.

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