A Review on Secondary Immune Thrombocytopenia in Malaysia

Immune thrombocytopenia (ITP) is an acquired autoimmune disease that occurs in adults and children. In Malaysia, the clinical practice guideline (CPG) for the management of ITP was issued in 2006, which focused almost exclusively on primary ITP (pITP), and only a few secondary ITP (sITP) forms were addressed. All published (twenty-three) sITP articles among children and adults in Malaysia, identified on the academic databases were retrieved. The articles were published between 1981 and 2019, at a rate of 0.62 publications per year. The publications were considered low and mainly focused on rare presentation and followed-up of secondary diseases. This review revealed that sITP in Malaysia is commonly associated with autoimmune diseases (Evan’s syndrome, SLE and WAS), malignancy (Kaposi’s sarcoma and breast cancer) and infection (dengue haemorrhagic fever, Helicobacter pylori and hepatitis C virus). The relationship between ITP and autoimmune diseases, malignancy and infections raise the question concerning the mechanism involved in these associations. Further studies should be conducted to bridge the current knowledge gap, and the further information is required to update the existing CPG of management of ITP in Malaysia.

The use of computer techniques to optimize the diagnosis of tuberculosis in HIV-infected patients at the secondary diseases stage

Вackground: The course of tuberculosis in HIV-infected patients has no significant clinical and diagnostic differences from damage to organs and systems of other etiology. The growth of new cases of HIV / TB co-infection necessitates a revision of diagnostic approaches, their improvement in order to increase the efficiency of examination and management of HIV-infected patients, depending on the stage and indicators of the immune status. The aim of the study was to determine by the method of complex statistical processing the main clinical and laboratory-instrumental criteria for improving the diagnosis of tuberculosis in HIV-infected patients at the stage of secondary diseases. Methods: The study design was retrospective. The object of the research was the case histories of 113 patients with HIV infection at the stage of secondary diseases (classification by V.I. Methods of parametric and nonparametric statistics, computer analysis of images with the gradient program proposed by Dr. Sci. A.N. Gerasimov, to assess the possibility of using micro- and macro-preparations of tissues and organs of patients with HIV infection. Results: Using the method of correlation adaptometry, it was found that there are no significant differences in the clinical course of HIV-infected patients with tuberculosis of various localization, and with lesions of the respiratory organs of other etiology. The use of multivariate probability models made it possible to identify significant diagnostic risk factors for lethal outcome - 66.7% of patients with further lethal outcome complained of chest pain during breathing (p = 0.004), and ESR was significantly accelerated in patients with a lethal outcome in the hospital 77 1.99 (p = 0.019). Conclusion: The multicomplex instrumental and laboratory examination makes it possible to diagnose tuberculosis of various localization at the initial stage of development. The use of computer techniques optimizes and unifies the diagnostic search in patients with HIV infection and determines the timely treatment tactics

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

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.

Mobile diagnostics and consultation for the prevention of the metabolic syndrome and its secondary diseases in Brandenburg—study protocol of a regional prospective cohort study: the Mobile Brandenburg Cohort

Background The metabolic syndrome (MetS) is a risk cluster for a number of secondary diseases. The implementation of prevention programs requires early detection of individuals at risk. However, access to health care providers is limited in structurally weak regions. Brandenburg, a rural federal state in Germany, has an especially high MetS prevalence and disease burden. This study aims to validate and test the feasibility of a setup for mobile diagnostics of MetS and its secondary diseases, to evaluate the MetS prevalence and its association with moderating factors in Brandenburg and to identify new ways of early prevention, while establishing a “Mobile Brandenburg Cohort” to reveal new causes and risk factors for MetS. Methods In a pilot study, setups for mobile diagnostics of MetS and secondary diseases will be developed and validated. A van will be equipped as an examination room using point-of-care blood analyzers and by mobilizing standard methods. In study part A, these mobile diagnostic units will be placed at different locations in Brandenburg to locally recruit 5000 participants aged 40-70 years. They will be examined for MetS and advice on nutrition and physical activity will be provided. Questionnaires will be used to evaluate sociodemographics, stress perception, and physical activity. In study part B, participants with MetS, but without known secondary diseases, will receive a detailed mobile medical examination, including MetS diagnostics, medical history, clinical examinations, and instrumental diagnostics for internal, cardiovascular, musculoskeletal, and cognitive disorders. Participants will receive advice on nutrition and an exercise program will be demonstrated on site. People unable to participate in these mobile examinations will be interviewed by telephone. If necessary, participants will be referred to general practitioners for further diagnosis. Discussion The mobile diagnostics approach enables early detection of individuals at risk, and their targeted referral to local health care providers. Evaluation of the MetS prevalence, its relation to risk-increasing factors, and the “Mobile Brandenburg Cohort” create a unique database for further longitudinal studies on the implementation of home-based prevention programs to reduce mortality, especially in rural regions. Trial registration German Clinical Trials Register, DRKS00022764; registered 07 October 2020—retrospectively registered.

Analysis of the Consumption of Non-Oncological Medicines: A Methodological Study on Patients of the Ada Cohort

Cancer patients are identified as fragile patients who are often immunodepressed and subject to secondary diseases. The Ada cohort comprises cancer survivors aged 15–39 years at diagnosis included in 34 Italian cancer registries. This study aimed to analyze the possible excess of non-cancer medicines use on the basis of the medicine database of the Ada cohort. Records of medicines present in the pharmaceutical flows collected by eight Lombardy cancer registries and used by patients with any type of cancer were extracted for the year 2012. Medicine consumption data were processed to assign a defined daily dose value and to evaluate the consumption of medicines belonging to different groups of the ATC (Anatomical Therapeutic Chemical) classification. The values were compared with values in the Lombardy population. Medicine consumption related to 8150 patients was analyzed, for a total of 632,675 records. ATC groups A and C for females and group N for both sexes showed significant increases. Group J for males and group M for females showed intermediate increases, and group H for both sexes showed smaller increases. This method allowed the identification of excess medicine use to reduce cancer therapy side effects and primary disease sequelae in this group of patients.

Diagnostic Evaluation of Doshaja Kasa w.s.r to Hematological Investigations

Kasa is one of the commonest complaints in day to day life and clinical manifestation affecting Pranavaha Srotas. Among the five major types of Kasa mentioned by Acharyas, Vata, Pitta & Kaphaja Kasa have distinct and significant clinical features and Samprapti. Early intervention is necessary in case of Kasa as it is a potential Nidanarthakara Vyadhi (disease having tendency to produce secondary diseases) to produce Kshaya. This observational study involving 150 subjects of age group 16 to 60 was carried out to assess the utility of hematological investigations (T.C, D.C, AEC, and ESR) to diagnose Vata, Pitta and Kaphaja Kasa respectively. Assessment of type of Kasa was done by scoring system of classical symptoms and changes in laboratory parameters were noted for each. Results are drawn based on Statistical evaluation of each type of Kasa with respect to each of the hematological investigation involved in the study. Investigations like neutrophil count, absolute eosinophil count and lymphocyte count have shown significant association with respect to Vataja, Pittaja and Kaphaja Kasa.

Retinal detachment in cytomegalovirus uveitis in HIV-infected patients: treatment outcomes

Cytomegalovirus (CMV) uveitis in HIV infection is one of the most dangerous secondary diseases of the visual organ, leading to blindness in the absence of treatment. The aim is to characterize the clinical features of the course of retinal detachment in HIV infection. Materials and methods. The study group included 29 patients, 34 eyes (9 men and 20 women). All patients underwent a standard routine ophthalmological examination. To confirm the diagnosis, an ultrasound of the eyeball was performed. Results. Retinal detachment was detected in 29 patients (34 eyes) out of 72 (94 eyes) and was 40.3% (95% CI=29.3-51.79%). According to the mechanism of retinal detachment, the following forms were identified: acute retinal necrosis, regmatogenic and traction detachment. In 50% of cases, the disease occurred as acute retinal necrosis of CMV-etiology. Visual acuity in the group of patients with operated retinal detachment became significantly lower after complex treatment. Conclusions. CMV-uveitis has a chronic sluggish course, despite multicomponent treatment. Retinal detachment is detected in 40% of HIV-infected patients with CMV-uveitis and in half of cases has the character of acute retinal necrosis. Keywords: cytomegalovirus, uveitis, HIV, HIV-infection, AIDS, retinal detachment.

X-RAY-morphological features of the current COVID-19 and HIV infection

Infection of HIV-infected with a new coronavirus infection, due to its high contagiousness, is inevitably growing all over the world. According to estimates of Chinese scientists, their number is currently more than 500 thousand people. Considering that COVID-19 leads to suppression of immunity and the emergence of opportunistic infections in HIV-negative patients, the activation of secondary diseases in patients with HIV is natural. In view of this, the study of the features of the X-ray morphological picture of inflammatory changes in the lungs according to MSCT data in patients with COVID-19/HIV became the goal of this study. 13 patients who underwent treatment at the Surgut Regional Clinical Hospital during the period from March to July 2020 underwent MSCT of the chest organs upon admission, before discharge, as well as in case of deterioration or lack of effect from the therapy — every 3 days. The detection of pathognomonic CT signs of COVID-19 in the lungs in patients with HIV (the nature of the lesion, the stage of the disease, the severity of the inflammatory process) was carried out in parallel with the diagnosis of opportunistic infections. During the examination, atypical clinical and X-ray morphological signs of the course of COVID-19/HIV coinfection were identified. In HIV-infected people, COVID-19 proceeds more easily and in disguise, while opportunistic infections both in clinical and radiological manifestations have priority signs. They are the reasons for the aggravation of the course of the disease, as well as the development of complications in these patients.

Decellularized pericardium tissues at increasing glucose, galactose and ribose concentrations and at different time points studied using scanning X-ray microscopy

Diseases like widespread diabetes or rare galactosemia may lead to high sugar concentrations in the human body, thereby promoting the formation of glycoconjugates. Glycation of collagen, i.e. the formation of glucose bridges, is nonenzymatic and therefore cannot be prevented in any other way than keeping the sugar level low. It relates to secondary diseases, abundantly occurring in aging populations and diabetics. However, little is known about the effects of glycation of collagen on the molecular level. We studied in vitro the effect of glycation, with D-glucose and D-galactose as well as D-ribose, on the structure of type 1 collagen by preparing decellularized matrices of bovine pericardia soaked in different sugar solutions, at increasing concentrations (0, 2.5, 5, 10, 20 and 40 mg ml−1), and incubated at 37°C for 3, 14, 30 and 90 days. The tissue samples were analyzed with small- and wide-angle X-ray scattering in scanning mode. We found that glucose and galactose produce similar changes in collagen, i.e. they mainly affect the lateral packing between macromolecules. However, ribose is much faster in glycation, provoking a larger effect on the lateral packing, but also seems to cause qualitatively different effects on the collagen structure.

Secondary diseases of infectious and non-infectious origin in patients diagnosed with COVID-19

The article considers the features of the occurrence and course of secondary diseases of infectious and non-infectious genesis in patients with a diagnosis of COVID-19, and also examines individual clinical cases described in the literature. The author concludes that the results showed that major respiratory diseases, in particular COPD (chronical obstructive pulmonary disease) and smoking, are associated with severe COVID-19 outcomes. The results of this study can help policy makers, doctors and healthcare professionals in the front line to make evidence-based decisions and reduce the mortality and morbidity of this 21st century pandemic. Understanding the proportion of COVID-19 patients with acute respiratory bacterial co-infection and pathogens is critical for the treatment of COVID-19 patients and helps ensure responsible use of antibiotics and minimize the negative effects of overuse. In addition, this knowledge may have a significant impact on clarifying recommendations for empirical antibiotic therapy for patients with COVID-19.