Semi-Markov Modelling of HIV/AIDS Disease Progression

Background: HIV/AIDS epidemic continues to be the main challenge in the world. According to United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) reports of 2013, 35 million people were living with HIV worldwide, with 2.1 million new infections and with 1.5 million deaths occurred each year. Among these, 24.7 million lived in sub-Saharan Africa with 1.5 million new infections and 1.1 million AIDS deaths.Method: The main objective of this study is finding factors affecting HIV/AIDS disease progression. This study was conducted to investigate the effect of factors on HIV/AIDS disease progression. Patient follow-up data is obtained at Yirgalim General Hospital. A sample of 370 Patient data from a follow-up cohort is obtained at Yirgalim General Hospital. Multivariate generalized hazard regression model was employed to investigate the disease progression using both time independent and time dependent covariates. Result: The study revealed that the risk of transition differs by patient's body mass index. Increase in the body mass index reduces the risk of transiting into the next worst states. The effects of sex, weight, age and body mass index of patients are significantly associated with AIDS disease progression. The risk of transition differs by patient's body mass index. Increase in the body mass index reduces the risk of transiting into the next worst states. The effect of sex, weight, age and body mass index of patients are significantly associated with AIDS disease progression. The results further revealed that the semi-Markov model with Weibull waiting time distribution has smaller log likelihood and AIC values compared to a semi-Markov model with exponential waiting time distribution.Conclusion: Transition probabilities are highly dependent on the choice of waiting times. We recommend that while choosing waiting time distributions for semi-Marko models one should consider appropriate distributions as waiting time distribution effect have a significant change on the estimated model parameters. In addition, this study recommends that concerned bodies should look at deferent contributing factors of AIDS diseases progression in addition to the ART services administered for slowing the current level of high diseased population in the country.

Remission of adult-onset asthma is rare: a 15-year follow-up study

BackgroundThere are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up.MethodsA cohort of 309 adults aged 20–60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months.ResultsOf eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma.ConclusionHigher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.

Effect of Obesity on Cognitive Functions in Elderly People

Aim: We aimed to evaluate effect of obesity on cognitive functions in 65 years and older patients. Methods: This study was conducted in the Recep Tayyip Erdogan University Family Medicine outpatient clinic between November 2018 and January 2019. 65 years and older 83 voluntary patients were included in our study. All participants evaluated by a survey for their socio-demographic characteristics, Standardized Mini Mental Examination Test and Rey Auditory and Verbal Learning Test. Statistical comparison was made between patients’ body mass indexes and their test scores. Results: Mini Mental Test total score was statistically higher in men. Besides that, working patients had higher Mini Mental Test total score compared to retired patients and housewives. As participants’ waist circumference and body mass index increase, their Mini Mental Test language scores were decreasing. Conclusions: We found that as body mass index increases, Mini Mental Test language scores were significantly decreasing. In literature there are studies that suggesting obesity is related to decline in cognitive functions, but there are also studies that suggesting obesity has protective effect for cognitive decline. More comprehensive prospective studies are required for clearer results. Keywords: geriatrics, obesity, cognitive dysfunction