Virologic and immunologic status of children with HIV-TB co-infections

Background Studies about virologic and immunologic status of HIV children are lacking. Tuberculosis (TB) is the most common opportunistic infection in HIV patients and co-infection is associated with much worse prognosis. Objective To describe the virologic and immunologic status of patients with HIV and TB co-infection, before and after HIV and TB treatment. Methods A prospective study was conducted in HIV co-infected with TB patients in an Indonesian tertiary hospital between November 2016—December 2018. Viral load and CD4 levels were performed at diagnosis and after 6 months of HIV and TB treatment. Results Of 44 children hospitalized due to HIV, 15 newly diagnosed HIV cases had TB co-infection. Thirteen were included as subjects. Most patients (10/13) were under 5 years of age, with similar female and male proportions (7/13 vs. 6/13, respectively). All were diagnosed with stage 4 HIV. Six patients had respiratory problems at admission. First examinations revealed severe immunodeficiency (CD4+ <20%) in all patients, and high viral loads (>105 copies/mL) in most (9/13) patients. Despite good compliance to medications, 8/13 patients died before the sixth month follow-up. Deterioration of virologic and immunologic status was seen in 3/4 of the followed-up patients. Conclusion Children with HIV-TB coinfections have severe immunodeficiency and high viral loads. Most such patients die before 6 months, while survivors experience virologic and immunologic status deterioration. Future study must take into account for HIV drug resistance investigation.

Paresthesia of mucosae membranes of an oral cavity against the background of taking inhaled hormonal drugs

Bronchial asthma draws the attention of increasing number of doctors worldwide. The prevalence of this disease is from 4 to 10%. Nowadays basic medicines for treatment and control of bronchial asthma are inhalation hormonal drugs which are taken daily and for a long time, often the whole life of a patient. According to numerous literary data, this drug group owing to a way of their introduction causes a series of complications in an oral cavity. The most frequent of them are the oropharyngeal candidiasis, a dysphonia and paresthesia of a mucosa of a mouth. Above-mentioned complications are directly bound to the existence of a dysbiosis of a mouth that contributes to the development of an immune failure and sensitivity to organism microbial antigens. It was established, that patients with bronchial asthma of medium-weight severity with various experience of intake of inhalation hormonal drugs were examined highly often complaint to dryness, a burning sensation not only in an oral cavity, but also in the field of a larynx and a pharynx, on a food faddism, pain at meal, on availability of scurf of white color on various sites of a mucosa of an oral cavity. There were not only existence of characteristic symptoms of these diseases, but also depression of the immunologic status and change of a microbial landscape of an oral cavity at the patients with bronchial asthma taking the inhalation hormonal drugs. The above confirms the fact of obligatory detailed studying of implications in an oral cavity at the patients with bronchial asthma taking the inhalation hormonal drugs and the related complications, their nature, and further development of a rational way of the etiopathogenetic scheme of treatment and also their prevention.

P.047 IDH mutations are associated with pro-inflammatory microglia and macrophages in heterogeneously infiltrated glioblastomas

Background: CNS innate immune cells, microglia and macrophages (MMs), are the largest component of the inflammatory infiltrate in glioblastoma (GBM). They initially participate in tumor surveillance, but are co-opted by GBM to further angiogenesis and invasion. There are no effective immunotherapies against GBM in part because GBM-associated MMs are not well understood. We hypothesized that the extent and inflammatory phenotype of MM infiltration into GBM is variable between patients. This variability could have important implications on immunotherapy selection and treatment outcomes. Methods: Using automated quantitation of fluorescently labeled human GBMs, flow cytometry/live cell sorting, collection of conditioned GBM-associated MM media, and corroboration with TCGA and previously published scRNA-seq data, we have uncovered there is surprisingly marked variation in the amount of MM infiltration between tumors. Results: MM infiltration can range from almost non-existent, to comprising ~70% of GBM cells. By detecting cell surface markers and secreted cytokines, we determined that a mixture of pro- and anti-inflammatory MMs are found in each tumor. The overall inflammatory phenotype did not depend on the amount of infiltration. Interestingly, IDH-mutant GBM-associated MMs are more pro-inflammatory and less heterogeneous than IDH-wildtype GBMs. Conclusions: Taken together, the highly variable immunologic status of GBMs suggests the success of immunotherapies hinges on selecting appropriately vulnerable tumors.

Genital endometriosis at women a hypothyrosis: pathogenesis, tactics of treatment and prophylaxis of recurrence

The objective: rising of efficiency of treatment of genital endometriosis in combination with hypothyrosis and depression of frequency of recurrence on the basis of improvement and introduction of algorithm diagnostic, medical prophylactical and rehabilitational actions with use of modern endoscopic technologies and medicamental correction. Patients and methods. Аt first was carried out the analysis of frequency of extragenital pathology at 789 patients with an internal genital endometriosis, then we surveyed 110 patients who received conservative and 100 patients – expeditious treatment. Research methods: clinical, laboratory, tool, functional, morphological and statistical. Results. Аt women with various forms of genital endometriosis obligatory inspection of funcshionale condition of thyroid gland, the endocrinologic and immunologic status is necessary; at vibor of a method of expeditious treatment of women with genital endometriosis and hypothyrosis the preference should be given to endoscopic and vaginal techniques, and also organ-preserving volume; for postoperative aftertreatment of women with genital endometriosis and hypothyrosis the preference should be given to hormonal therapy, courses not less 6 months. Conclusion. Introduction of the received results will allow to increase efficiency of treatment of genital endometriosis as is conservative, and operative that increases quality of life of women. Key words: genital endometriosis, hypothyrosis, pathogenesis, treatment.

Management of a tracheoesophageal fistula in a patient with AIDS

Despite the high frequency of gastrointestinal complications and opportunistic infections in HIV-1 infected patients, tracheoesophageal (TEF) and bronchoesophageal (BEF) fístulas are rare. Our objective is to comunicate an additional and unusual case of TEF in an HIV-1-infected patient whose immunologic status was good with complete suppression of viral replication, so although uncommon, TEF/BEF of an infectious origen should be considered in AIDS. Endoscopic treatment with tracheal/esophageal stents is not without morbidity and mortality. As long as the patient can undergo reconstructive surgery, this should be the technique of choice.