Página 1 dos resultados de 744 itens digitais encontrados em 0.051 segundos

‣ Exfoliative toxin detection using reversed passive latex agglutination: clinical and epidemiologic applications.

Kawabata, A; Ichiyama, S; Iinuma, Y; Hasegawa, Y; Ohta, M; Shimokata, K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /08/1997 Português
Relevância na Pesquisa
780.48%
A rapid and simple method for detecting exfoliative toxin serotypes A and B from clinical isolates has been developed as a test kit (EXT-RPLA; Denka Seiken Co. Ltd., Niigata, Japan). This method is based on reversed passive latex agglutination. The detection limit of the EXT-RPLA observed for purified exfoliative toxin serotypes A and B was 1 ng/ml. We evaluated the clinical and epidemiologic uses of the EXT-RPLA. A total of 381 isolates of Staphylococcus aureus, 292 from various clinical specimens and 89 from the skin of dermatologic patients, were studied. The EXT-RPLA detected 19 exfoliative toxin producers, including 16 serotype A producers and 3 serotype B producers, but no double producers. The sensitivity and specificity of the EXT-RPLA were confirmed by the newborn mouse bioassay and a PCR assay for the structural genes for exfoliative toxin serotypes A and B (eta and etb, respectively). The overall positivity rate of exfoliative toxin producers was 5.0% (19 of 381), including 16 serotype A isolates and 3 serotype B isolates. Of the 89 isolates from the skin of dermatologic patients, 12 (13.5%) were positive for exfoliative toxin production. Only 2 (1.3%) of the 153 methicillin-resistant S. aureus isolates produced exfoliative toxin...

‣ Clinical and epidemiologic characteristics of hepatitis C in a gastroenterology/hepatology practice in Ottawa.

Scully, L J; Mitchell, S; Gill, P
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 01/04/1993 Português
Relevância na Pesquisa
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OBJECTIVE: To examine the clinical and epidemiologic features of hepatitis C virus (HCV) infection in a gastroenterology/hepatology practice in Ottawa. DESIGN: Retrospective chart review. PATIENTS: Sixty-three consecutive patients found to be anti-HCV positive. Their charts were analysed with respect to risk factors, history of hepatitis, serum aspartate aminotransferase (AST) levels and the presence of hepatitis B markers. The long-term sexual partners of 29 patients agreed to undergo HCV antibody testing. RESULTS: Of the patients 48 (76%) had been exposed to HCV parenterally: 27 used intravenous drugs, and 21 had received blood or blood products. Eleven patients did not have any known risk factor (sporadic infection), but eight of them had lived in countries where hepatitis C may be more prevalent; the other three had locally acquired infection. The mean serum AST level at the first visit was 140 (normally less than 40) IU/L. At least one hepatitis B marker was identified in 33% of the patients. None of the sexual partners who were tested were anti-HCV positive. CONCLUSION: Most cases of hepatitis C in Ottawa are acquired through parenteral exposure; sexual transmission is rare. Sporadic infection in the Ottawa region is rare but may be more common in people from countries with a higher prevalence rate of hepatitis C. Most cases of hepatitis C are asymptomatic.

‣ A Data Base Management System for Clinical and Epidemiologic Studies In Systemic Lupus Erythematosus: Design and Maintenance

Kosmides, Victoria S.; Hochberg, Marc C.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 07/11/1984 Português
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This report describes the development, design specifications, features and implementation of a data base management system (DBMS) for clinical and epidemiologic studies in SLE. The DBMS is multidimensional with arrays formulated across patients, studies and variables. The major impact of this DBMS has been to increase the efficiency of managing and analyzing vast amounts of clinical and laboratory data and, as a result, to allow for continued growth in research productivity in areas related to SLE.

‣ Concurrent Validity of a Computer-Based Cognitive Screening Tool for Use in Adults with HIV Disease

Becker, James T.; Dew, Mary Amanda; Aizenstein, Howard J.; Lopez, Oscar L.; Morrow, Lisa; Saxton, Judith
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /06/2011 Português
Relevância na Pesquisa
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As the incidence of HIV-associated dementia has decreased, the survival of HIV-infected individuals with milder forms of cognitive impairment has increased. Detecting this milder impairment in its earliest stages has great clinical and research importance. We report here the results of an initial evaluation of the Computer Assessment of Mild Cognitive Impairment (CAMCI®), a computerized screening tool designed to assess abnormal cognitive decline with reduced respondent and test administrator burden. Fifty-nine volunteers (29 HIV infected; age=50.9 years; education=14.9 years; 36/59 males) completed the CAMCI® and a battery of neuropsychological tests. The CAMCI was repeated 12 and 24 weeks later. The results from the CAMCI were compared to Global and Domain Impairment scores derived from the full neuropsychological test battery. The CAMCI detected mild impairment (compared with normal and borderline test performance) with a sensitivity of 0.72, specificity of 0.97, positive predictive rate of 0.93, and a negative predictive rate of 0.89. Median stability over 12 and 24 weeks of follow-up was 0.32 and 0.46, respectively. These rates did not differ as a function of serostatus. A discriminant function analysis correctly classified 90% of the subjects with respect to their overall Global Impairment Rating from six of the CAMCI scores. This preliminary study demonstrates that the CAMCI is sensitive to mild forms of cognitive impairment...

‣ Jeremiah Metzger Lecture: Cholesterol, Inflammation and Atherosclerotic Cardiovascular Disease: Is It All LDL?

Gotto, Antonio M.
Fonte: American Clinical and Climatological Association Publicador: American Clinical and Climatological Association
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
Relevância na Pesquisa
671.6972%
Scientific investigation of the relationship between atherosclerosis, inflammation, and lipoprotein metabolism originated in the mid-19th century and has increased exponentially over the past 50 years. Basic research that characterized the lipoproteins and their metabolism was followed by clinical and epidemiologic studies that began to link elevated levels of cholesterol in the blood to the development of atherosclerosis and increased risk for cardiovascular disease. The link between elevated serum cholesterol levels and cardiovascular disease, known as the “lipid hypothesis,” was confirmed with the discoveries of the low-density lipoprotein (LDL) receptor and of the statins. Subsequent results of multiple clinical trials, particularly with statins, have established that reductions in LDL cholesterol are associated with reduced risk for coronary heart disease (CHD). A growing body of evidence suggests that measures of inflammation, such as C-reactive protein (CRP), may enhance cardiovascular risk assessment and help guide clinical decision-making. Reductions in CRP in individuals with low serum levels of LDL cholesterol have been shown to reduce cardiovascular events. A variety of agents designed to further reduce LDL cholesterol...

‣ Quality of Sleep: Associations with Antiretroviral Nonadherence

Saberi, Parya; Neilands, Torsten B.; Johnson, Mallory O.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /09/2011 Português
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Poor quality of sleep (QOS) is frequently reported in HIV-positive individuals; however, despite its clinical and public health significance, few studies have examined the correlation between QOS and antiretroviral (ARV) adherence. The objective of this study was to estimate the prevalence of sleep disturbances, determine the characteristics of those with poor QOS, and establish the relationship between QOS and ARV nonadherence among HIV-positive individuals. We conducted a cross-sectional secondary data analysis of 2845 HIV-positive adults taking ARV therapy from the Healthy Living Project baseline cohort. Mean self-reported ARV nonadherence was estimated using a 3-day measure. QOS was assessed using three questions regarding sleep pattern changes, amount of bother from difficulty falling/staying asleep, and amount of bother from vivid dreams. Over 68% of individuals reported sleep pattern changes, 50.3% reported difficulty falling/staying asleep, and 20.5% reported bother from vivid dreams. Depression, suicidal ideation, unemployment, use of illicit substances, history of incarceration, and HIV viral load were all independently associated with poor QOS. Individuals reporting feeling bothered about difficulty falling/staying asleep had a 1.66 higher odds of nonadherence (95% confidence interval [CI]=1.18...

‣ Peer Health Workers and AIDS Care in Rakai, Uganda: A Mixed Methods Operations Research Evaluation of a Cluster-Randomized Trial

Arem, Hannah; Nakyanjo, Neema; Kagaayi, Joseph; Mulamba, Jeremiah; Nakigozi, Gertrude; Serwadda, David; Quinn, Thomas C.; Gray, Ronald H.; Bollinger, Robert C.; Reynolds, Steven J.; Chang, Larry W.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /12/2011 Português
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Settings with limited health care workers are challenging environments for delivery of antiretroviral therapy. One strategy to address this human resource crisis is to task shift through training selected patients as peer health workers (PHWs) to provide care to other individuals receiving antiretroviral therapy. To better understand processes of a cluster-randomized trial on the effect of these PHWs on AIDS care, we conducted a mixed methods operations research evaluation. Qualitative methods involved patients, PHWs, and clinic staff and included 38 in-depth interviews, 8 focus group discussions, and 11 direct observations. Quantitative methods included staff surveys, process, and virologic data analyses. Results showed that task shifting to PHWs positively affected structural and programmatic functions of care delivery—improving clinical organization, medical care access, and patient-provider communication—with little evidence for problems with confidentiality and inadvertent disclosure. Additionally, this evaluation elucidated trial processes including evidence for direct and indirect control arm contamination and evidence for mitigation of antiretroviral treatment fatigue by PHWs. Our results support the use of PHWs to complement conventional clinical staff in delivering AIDS care in low-resource settings and highlight how mixed methods operations research evaluations can provide important insights into community-based trials.

‣ Clinical Significance of Hyperbilirubinemia Among HIV-1–Infected Patients Treated with Atazanavir/Ritonavir Through 96 Weeks in the CASTLE Study

McDonald, Cheryl; Uy, Jonathan; Hu, Wenhua; Wirtz, Victoria; Juethner, Salome; Butcher, David; McGrath, Donnie; Farajallah, Awny; Moyle, Graeme
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /05/2012 Português
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668.5514%
CASTLE was a randomized 96-week study that demonstrated that atazanavir/ritonavir (ATV/r) was noninferior to lopinavir/ritonavir (LPV/r) in treatment-naïve HIV-infected patients. Analyses were carried out among patients who received ATV/r in the CASTLE study to better understand the clinical significance of unconjugated hyperbilirubinemia associated with administration of boosted ATV. Hyperbilirubinemia was defined as total bilirubin (conjugated and unconjugated) elevation greater than 2.5 times the upper limit of normal (grade 3–4). Patients in the ATV/r arm were assessed based on the presence or absence of hyperbilirubinemia through week 96. Analyses included number of confirmed virologic responders (CVR; HIV RNA <50 copies per milliliter), impact of hyperbilirubinemia on symptoms, elevations in liver enzymes, patient quality of life, and medication adherence. Through 96 weeks in the CASTLE study, 44% of patients who received ATV/r had hyperbilirubinemia at any time point, and between 12.5% and 21.6% had hyperbilirubinemia at any single study visit. At 96 weeks, 74% of patients overall and 84% and 69% of patients with and without hyperbilirubinemia, respectively, achieved CVR. Symptoms of jaundice or scleral icterus occurred in 5% of patients overall and in 11% with hyperbilirubinemia and 0% without hyperbilirubinemia. Four percent of patients with and 3% of patients without hyperbilirubinemia had grade 3–4 elevations in liver transaminases. Less than 1% of patients discontinued treatment due to hyperbilirubinemia. There were no differences in quality of life or adherence between patients with or without hyperbilirubinemia. In the CASTLE study...

‣ Co-Morbidities in Persons Infected with HIV: Increased Burden with Older Age and Negative Effects on Health-Related Quality of Life

Rodriguez-Penney, Alan T.; Iudicello, Jennifer E.; Riggs, Patricia K.; Doyle, Katie; Ellis, Ronald J.; Letendre, Scott L.; Grant, Igor; Woods, Steven Paul
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /01/2013 Português
Relevância na Pesquisa
666.9357%
This study sought to determine the synergistic effects of age and HIV infection on medical co-morbidity burden, along with its clinical correlates and impact on health-related quality of life (HRQoL) across the lifespan in HIV. Participants included 262 individuals across four groups stratified by age (≤40 and ≥50 years) and HIV serostatus. Medical co-morbidity burden was assessed using a modified version of the Charlson Co-morbidity Index (CCI). Multiple regression accounting for potentially confounding demographic, psychiatric, and medical factors revealed an interaction between age and HIV infection on the CCI, with the highest medical co-morbidity burden in the older HIV+cohort. Nearly half of the older HIV+group had at least one major medical co-morbidity, with the most prevalent being diabetes (17.8%), syndromic neurocognitive impairment (15.4%), and malignancy (12.2%). Affective distress and detectable plasma viral load were significantly associated with the CCI in the younger and older HIV-infected groups, respectively. Greater co-morbidity burden was uniquely associated with lower physical HRQoL across the lifespan. These findings highlight the prevalence and clinical impact of co-morbidities in older HIV-infected adults and underscore the importance of early detection and treatment efforts that might enhance HIV disease outcomes.

‣ Clinical and Epidemiologic Features of Diarrheal Disease due to Aeromonas hydrophila and Plesiomonas shigelloides Infections Compared with Those due to Vibrio cholerae Non-O1 and Vibrio parahaemolyticus in Bangladesh

Klontz, Erik H.; Faruque, Abu S. G.; Das, Sumon K.; Malek, Mohammed A.; Islam, Zhahirul; Luby, Stephen P.; Klontz, Karl C.
Fonte: International Scholarly Research Network Publicador: International Scholarly Research Network
Tipo: Artigo de Revista Científica
Publicado em 24/09/2012 Português
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668.4692%
Using data from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) from 1996 to 2001, we compared the clinical features of diarrhea in patients with stool specimens yielding only A. hydrophila (189 patients; 1.4% of 13,970 patients screened) or P. shigelloides (253 patients) compared to patients with sole V. cholerae non-O1 infection (99 patients) or V. parahaemolyticus infection (126 patients). Patients exhibited similar frequencies of fever (temperature >37.8°C), stools characterized as watery, and stools containing visible mucus. Dehydration was observed more often among patients with V. parahaemolyticus or V. cholerae non-O1 infection. Compared to patients infected with V. parahaemolyticus, those with A. hydrophila, P. shigelloides, or V. cholerae non-O1 infection were less likely to report visible blood in the stool and, on microscopic examination, less likely to exhibit stool red blood cell and white blood cell counts exceeding 20 cells per high power field. The proportion of patients reporting subjective cure at the time of discharge was significantly smaller for those infected with V. parahaemolyticus. These findings suggest that A. hydrophila and P. shigelloides produce diarrheal disease that is less severe than that resulting from infection with V. cholerae non-O1 or V. parahaemolyticus.

‣ Atazanavir and Other Determinants of Hyperbilirubinemia in a Cohort of 1150 HIV-Positive Patients: Results from 9 Years of Follow-Up

Laprise, Claudie; Baril, Jean-Guy; Dufresne, Serge; Trottier, Helen
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /07/2013 Português
Relevância na Pesquisa
666.8725%
Hyperbilirubinemia is common among patients exposed to atazanavir (ATV), but its long-term significance is not well documented. The objective was to analyze hyperbilirubinemia (incidence, regression, determinants, and outcome) among 1150 HIV-positive patients followed-up in a prospective cohort between 2003 and 2012. Cumulative incidence of hyperbilirubinemia grades 3–4 and its probability of regression were estimated using Kaplan-Meier method. Cox proportional hazards model was used to study the determinants. Generalized estimating equation (GEE) regression was used to evaluate the association between hyperbilirubinemia grades 3–4 and adverse health outcome. Eight years cumulative incidence of hyperbilirubinemia was 83.6% (95% CI:79.0–87.7) and 6.6% (95% CI:4.7–9.2) among ATV users and non-users, respectively. This clinical outcome fluctuated considerably, as most patients exposed to ATV (91%) regressed, transiently, to lower grade at some point during follow-up. Determinants were atazanavir (HR=147.90, 95% CI: 33.64–604.18), ritonavir (HR=5.18, 95% CI:2.33–11.48), zidovudine (HR=2.62, 95% CI:1.07–6.46), and age (HR=1.04 95% CI:1.01–1.08). Alcohol consumption and others non-antiretroviral medications including hepatotoxic and recreational drugs were not available for analyses. Incidence of hyperbilirubinemia was very high among ATV users and...

‣ The Association of Clinical Follow-Up Intervals in HIV-Infected Persons with Viral Suppression on Subsequent Viral Suppression

Buscher, April; Mugavero, Michael; Westfall, Andrew O.; Keruly, Jeanne; Moore, Richard; Drainoni, Mari-Lynn; Sullivan, Meg; Wilson, Tracey E.; Rodriguez, Allan; Metsch, Lisa; Gardner, Lytt; Marks, Gary; Malitz, Faye; Giordano, Thomas P.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /08/2013 Português
Relevância na Pesquisa
666.7312%
The recommendation for the frequency for routine clinical monitoring of persons with well-controlled HIV infection is based on evidence that relies on observed rather than intended follow-up intervals. We sought to determine if the scheduled follow-up interval is associated with subsequent virologic failure. Participants in this 6-clinic retrospective cohort study had an index clinic visit in 2008 and HIV viral load (VL) ≤400 c/mL. Univariate and multivariate tests evaluated if scheduling the next follow-up appointment at 3, 4, or 6 months predicted VL >400 c/mL at 12 months (VF). Among 2171 participants, 66%, 26%, and 8% were scheduled next follow-up visits at 3, 4, and 6 months, respectively. With missing 12-month VL considered VF, 25%, 25%, and 24% of persons scheduled at 3, 4, and 6 months had VF, respectively (p=0.95). Excluding persons with missing 12-month VL, 7.1%, 5.7%, and 4.5% had VF, respectively (p=0.35). Multivariable models yielded nonsignificant odds of VF by scheduled follow-up interval both when missing 12-month VL were considered VF and when persons with missing 12-month VL were excluded. We conclude that clinicians are able to make safe decisions extending follow-up intervals in persons with viral suppression...

‣ Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

Guy, Rebecca; Wand, Handan; McManus, Hamish; Vonthanak, Saphonn; Woolley, Ian; Honda, Miwako; Read, Tim; Sirisanthana, Thira; Zhou, Julian; Carr, on behalf of Australia HIV Observational Database (AHOD) and Treat Asia HIV Observation Database (TAHOD), And
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em 01/12/2013 Português
Relevância na Pesquisa
758.9568%
Both antiretroviral treatment interruption (TI) and cessation have been strongly discouraged since 2006. We describe the incidence, duration, and risk factors for TI and loss-to-follow-up (LTFU) rates across 13 countries. All 4689 adults (76% men) in two large HIV cohorts in Australia and Asia commencing combination antiretroviral therapy (ART) to March 2010 were included. TI was defined by ART cessation >30 days, then recommencement, and loss to follow-up (LTFU) by no visit since 31 March 2009 and no record of death. Survival analysis and Poisson regression methods were used. With median follow-up of 4.4 years [interquartile range (IQR):2.1–6.5], TI incidence was 6.7 per 100 person years (PY) (95% CI:6.1–7.3) pre-2006, falling to 2.0 (95% CI:1.7–2.2) from 2006 (p<0.01). LTFU incidence was 3.5 per 100 PY (95% CI:3.1–3.9) pre-2006, and 4.1 (95% CI:3.5–4.9) from 2006 (p=0.22). TIs accounted for 6.4% of potential time on ART pre-2006 and 1.2% from 2006 (p<0.01), and LTFU 4.7% of potential time on ART pre-2006 and 6.6% from 2006 (p<0.01). Median TI duration was 163 (IQR: 75–391) days pre-2006 and 118 (IQR: 67–270) days from 2006 (p<0.01). Independent risk factors for the first TI were: Australia HIV Observational Database participation; ART initiation pre-2006; ART regimens including stavudine and didanosine; three nucleoside analogue reverse transcriptase inhibitors; ≥7 pills per day; and ART with food restrictions (fasting or with food). In conclusion...

‣ Brief Sexual Histories and Routine HIV/STD Testing by Medical Providers

Lanier, Yzette; Castellanos, Ted; Barrow, Roxanne Y.; Jordan, Wilbert C.; Caine, Virginia; Sutton, Madeline Y.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em 01/03/2014 Português
Relevância na Pesquisa
666.7867%
Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief...

‣ Comparison of Adherence Monitoring Tools and Correlation to Virologic Failure in a Pediatric HIV Clinical Trial

Intasan, Jintana; Bunupuradah, Torsak; Vonthanak, Saphonn; Kosalaraksa, Pope; Hansudewechakul, Rawiwan; Kanjanavanit, Suparat; Ngampiyaskul, Chaiwat; Wongsawat, Jurai; Luesomboon, Wicharn; Apornpong, Tanakorn; Kerr, Stephen; Ananworanich, Jintanat; Puthan
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em 01/06/2014 Português
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669.945%
There is no consensus on a gold standard for monitoring adherence to antiretroviral therapy (ART). We compared different adherence monitoring tools in predicting virologic failure as part of a clinical trial. HIV-infected Thai and Cambodian children aged 1–12 years (N=207) were randomized to immediate-ART or deferred-ART until CD4% <15%. Virologic failure (VF) was defined as HIV-RNA >1000 copies/mL after ≥6 months of ART. Adherence monitoring tools were: (1) announced pill count, (2) PACTG adherence questionnaire (form completed by caregivers), and (3) child self-report (self-reporting from children or caregivers to direct questioning by investigators during the clinic visit) of any missed doses in the last 3 days and in the period since the last visit. The Kappa statistic was used to describe agreement between each tool. The median age at ART initiation was 7 years with median CD4% 17% and HIV-RNA 5.0 log10copies/mL and 92% received zidovudine/lamivudine/nevirapine. Over 144 weeks, 13% had VF. Mean adherence by announced pill count before VF in VF children was 92% compared to 98% in children without VF (p=0.03). Kappa statistics indicated slight to fair agreement between tools. In multivariate analysis adjusting for gender, treatment arm ethnicity and caregiver education...

‣ Cross-Sectional Study of Unexplained White Matter Lesions in HIV Positive Individuals Undergoing Brain Magnetic Resonance Imaging

Haddow, Lewis J.; Dudau, Cristina; Chandrashekar, Hoskote; Cartledge, Jonathan D.; Hyare, Harpreet; Miller, Robert F.; Jäger, H. Rolf
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em 01/07/2014 Português
Relevância na Pesquisa
666.8725%
White matter (WM) abnormalities are frequently seen on brain MRI of HIV positive (HIV+) patients. We aimed to determine the prevalence of unexplained WM abnormalities and their associations with HIV disease and cardiovascular risk factors. We conducted a retrospective, cross-sectional study of brain MRI of HIV+ patients conducted between 2004 and 2009 at our center. Clinical and laboratory data were compiled, and images were independently reviewed for WM lesions. Images were obtained from 254 patients: 70% male, 53% white, 40% black, mean age 42 years, median current CD4 count 240 cells/mm3, and 41% not taking antiretroviral therapy (ART). Hyperintense WM lesions were present in 161 patients (63.4%): 89 scans (35.0%) showed diffuse WM signal abnormality (DWMSA), 61 (24.0%) were consistent with small vessel disease (SVD, graded by Fazekas' scale), and 37 (14.6%) showed large asymmetrical focal WM lesions. SVD changes were associated with age and cardiovascular risk factors, and while cerebral SVD may be related to HIV infection, the MRI findings were not associated with HIV-related factors. The only risk factor for DWMSA was black race, and no correlation with cardiovascular risk factors, CD4 count, or clinical presentation was identified. DWMSA are therefore of uncertain neurological significance in HIV+ patients and could represent more than one clinicopathological entity.

‣ Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

Sánchez-Carrillo, C I
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1989 Português
Relevância na Pesquisa
775.8668%
Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries...

‣ Evolution of Massachusetts Physician Attitudes, Knowledge, and Experience Regarding the Use of Antiretrovirals for HIV Prevention

White, Jaclyn M.; Mimiaga, Matthew J.; Krakower, Douglas S.; Mayer, Kenneth H.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /07/2012 Português
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666.9439%
The Center for the AIDS Programme of Research in South Africa (CAPRISA) 004 and Pre-exposure Prophylaxis Initiative (iPrEx) studies demonstrated that topical or oral chemoprophylaxis could decrease HIV transmission. Yet to have an appreciable public health impact, physicians will need to be educated about these new HIV prevention modalities. Massachusetts physicians were recruited via e-mail to complete an online survey of their knowledge and use of HIV prevention interventions. Data were collected before (July–December, 2010) (n=178) and after (December, 2010–April, 2011) (n=115) the release of iPrEx data. Over the two time intervals, knowledge of oral PrEP significantly increased (79% to 92%, p<0.01), whereas knowledge about topical microbicides was already high (89% pre-iPrEx). Post-iPrEx, specialists were more knowledgeable about oral PrEP (p<0.01) and topical microbicides (p<0.001) than generalists. The majority of the respondents would prefer to prescribe topical microbicides (75%) than oral PrEP (25%; p<0.001), primarily because they perceived fewer side effects (95%). Respondents indicated that PrEP should be available if it were a highly effective, daily pill; however, ongoing concerns included: potential drug resistance (93%)...

‣ Effects of Darunavir/Ritonavir-Based Therapy on Metabolic and Anthropometric Parameters in Women and Men Over 48 Weeks

Currier, Judith S.; Martorell, Claudia; Osiyemi, Olayemi; Yin, Michael T.; Ryan, Robert; De La Rosa, Guy; Mrus, Joseph
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em /06/2011 Português
Relevância na Pesquisa
666.9842%
Gender-based differences in lipids have been noted in antiretroviral clinical trials. We present the metabolic and anthropometric data from the GRACE (Gender, Race And Clinical Experience) study by gender. Treatment-experienced adults received darunavir/ritonavir (DRV/r) 600/100 mg twice daily, plus a background regimen, over 48 weeks. Fasting blood samples were obtained for lipid, glucose, and insulin measurements at baseline and at weeks 24 and 48/early discontinuation. Anthropometric measurements were taken at baseline and at weeks 12, 24, and 48/discontinuation. The Assessment of Body Change and Distress questionnaire was administered at baseline and regular intervals. Descriptive statistics as well as comparisons using a Wilcoxon rank-sum test are reported. Four hundred twenty-nine patients (women, n=287; men, n=142) enrolled in GRACE; 94 women (32.8%) and 33 men (23.2%) discontinued the trial. Median changes in triglycerides from baseline to week 48 were higher in men (25 mg/dL versus 8 mg/dL; p=0.006); the mean change in triglycerides was higher in men than in women in all racial subgroups. Other lipid and glucose level changes were similar between genders. Anthropometric parameters increased for both genders, with larger increases in women. Patients' perceptions of body changes concurred with physical measurements. The proportion of women who were “satisfied” or “very satisfied” with their bodies increased from 45.2% to 57.8% from baseline to week 48 (p=0.005)...

‣ Prevalence and Outcomes of Recycling NNRTIs Despite Documented NNRTI Resistance in HIV-Infected Children and Youth

Agwu, Allison L.; Chang, Jennifer Y.; Wiegand, Ryan E.; Wheeling, John T.; Bohannon, Beverly A.; Dominguez, Kenneth L.
Fonte: Mary Ann Liebert, Inc. Publicador: Mary Ann Liebert, Inc.
Tipo: Artigo de Revista Científica
Publicado em 01/01/2014 Português
Relevância na Pesquisa
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Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are commonly used in pediatric patients; however, rapid development of resistance, due to non-adherence and cross-resistance, results in their discontinuation and limits their recycling. We evaluated the clinical experience of recycling NNRTIs despite documented NNRTI resistance (NNRTI-R), and examined virologic and CD4 cell count outcomes among participants enrolled in Longitudinal Epidemiologic Study to Gain Insight into HIV/AIDS in Children and Youth (LEGACY), a national HIV-infected pediatric cohort. We conducted a retrospective analysis of LEGACY participants with major NNRTI-R. Using chi-square analyses and logistic regression, we examined demographic and clinical factors associated with prescription of NNRTIs despite documented NNRTI-R, and associated changes in plasma HIV RNA viral load and CD4 cell counts. Sixteen of 133 (12%) participants with documented NNRTI-R re-started NNRTIs for a median of 370 days (IQR 105–919) with a median 402 days (IQR 70–841) between documentation of NNRTI-R to NNRTI recycling. Participants recycling NNRTIs were less likely to have documented past non-adherence (40.0% vs. 69.2%; p=0.02). Among twelve patients with virologic data at 24 (±8) weeks; seven (58.3%) experienced virologic suppression while on the recycled NNRTI-based regimens. Of the five who failed to suppress...