Evaluating Hepatotoxicity: A Comparative Analysis of New Generation versus Historical Antiretroviral Agents.

(1) Background: Since the advent of zidovudine in 1987, antiretroviral therapy has undergone significant evolution, marked by the introduction of 34 antiretroviral drugs and 24 fixed-dose combinations. Despite these advances, hepatotoxicity remains a formidable challenge, influencing morbidity, mortality, and treatment adherence in HIV-infected patients. This study aims to compare the hepatotoxic effects of latest-generation antiretroviral medications with those of older-generation therapies, assessing their long-term impact on liver health in HIV patients. (2) Methods: This retrospective study analyzed data from 304 HIV patients treated with either latest-generation or older-generation antiretroviral drugs over four years. Patients were monitored for hepatotoxicity through liver function tests at diagnosis, six months, and one-year post-treatment initiation. (3) Results: Initial and six-month liver function tests showed no significant differences between the two groups. However, at one-year post-treatment, patients on latest-generation antiretrovirals exhibited significant improvements in ALT, AST, and ALP levels, suggesting a better safety profile regarding hepatotoxicity. Additionally, a significantly lower incidence of splenomegaly was observed in patients treated with newer medications. (4) Conclusions: The findings suggest that the latest-generation antiretroviral medications may offer a safer profile in terms of hepatotoxicity compared to older therapies, with potential benefits for long-term liver health. This study underscores the importance of continuous monitoring and further research to optimize ART strategies, ensuring improved patient outcomes and quality of life for individuals living with HIV.

Comparison between Exercise Program-Foot Orthoses Treatment and Exercise Program Alone after Pilon Fracture Surgery: Study Protocol for a Randomized Controlled Trial.

The management of tibial pilon fractures is challenging and often leads to complications and limitations in ankle function. The study aims to investigate myotonometric parameters and muscle strength of ankle muscles, as well as gait pattern and balance among patients following surgical treatment of pilon fractures. The randomized controlled study will analyze the differences between the patients who will follow a 3-month physical exercise program and will wear customized foot orthoses (i.e., customized orthotic arch support insoles) versus patients who will attend only the physical exercise program. For each group, at least 21 patients will be required. The assessment involves four different testing procedures: myotonometry (anterior tibialis, medial and lateral gastrocnemius, and longus peroneus assessed using MyotonPRO), muscle strength testing (ankle dorsiflexors, plantar flexors, and peroneal muscles assessed using MicroFET2 dynamometer), analysis of gait parameters (using Scheinworks treadmill), and double-leg and single-leg balance tests (using K-Force plate). After 3 months, the assessments will record which of the two treatments (physical exercise program with or without wearing customized foot orthoses) has better outcomes in regaining ankle muscle properties and tone, as well as the restoration of gait and balance.

Comparative Analysis of Surgical Approaches for Distal Biceps Tendon Rupture: Single-Incision Technique versus Double-Incision Technique.

Background: This study aimed to compare the outcomes of the single-incision technique with a distal biceps repair system versus the modified double-incision technique, specifically the Morrey-modified approach, Krackow sutures, and drill holes, for the management of acute and chronic distal biceps tendon rupture. The study was conducted at the Orthopedic-Traumatology Clinic II of SCJUPBT Timisoara, Romania, between 2014 and 2022. Methods: A total of sixty-nine patients with acute distal biceps tendon rupture and five patients with chronic distal tendon rupture were included in the study. Forty-eight cases underwent the single-incision technique with the distal biceps repair system, while twenty-four patients were treated with the modified double-incision technique. Results: Both surgical techniques demonstrated favorable outcomes in terms of successful tendon repair and functional restoration. However, the single-incision technique exhibited slightly superior results in terms of patient satisfaction, range of motion, and postoperative rehabilitation. The modified double-incision technique showed comparable outcomes but had a higher incidence of complications, particularly related to wound healing. Conclusion: The single-incision technique with the distal biceps repair system and the modified double-incision technique, including the Morrey-modified approach, Krackow sutures, and drill holes, are effective surgical approaches for the management of distal biceps tendon rupture. The single-incision technique yielded better functional outcomes and patient satisfaction, while the modified double-incision technique had a higher risk of complications. Further research with larger sample sizes and longer follow-up periods is necessary to validate these findings and determine the most appropriate surgical approach for distal biceps tendon rupture.

Assessment of Gastrointestinal Adverse Effects during the First Six Months of "Biktarvy" Antiretroviral Therapy: Age-Related Patterns and Their Relation with Changes of 5 kg Weight Loss/Gain in the Initial Treatment Period.

BACKGROUND: The battle against HIV has led to the development of antiretroviral therapy (ART), including BIKTARVY®, which combines three potent agents. However, concerns about gastrointestinal side effects during the early phases of treatment have emerged, potentially impacting patient adherence and outcomes. MATERIALS AND METHODS: This retrospective cohort study, conducted over four years in Romania, examined 222 patients initiated on BIKTARVY® therapy. Data were collected from electronic medical records, and stringent inclusion and exclusion criteria were applied to ensure data accuracy and relevance. Statistical analysis was performed to assess age-related patterns in gastrointestinal symptoms and their relation with significant weight loss. RESULTS: This study revealed significant differences in the prevalence of gastrointestinal symptoms between age groups, with older patients experiencing more symptoms. Notably, diarrhea did not exhibit a statistically significant age-related difference. Furthermore, weight loss exceeding 5 kg was more common in older patients. Of the patients who continued BIKTARVY® therapy, 84.9% showed an increase in CD4 cell counts, and most expressed satisfaction with treatment. CONCLUSION: Understanding age-related patterns and gastrointestinal side effects of BIKTARVY® is crucial for optimizing HIV patient care. Future research should aim to corroborate and expand upon these findings, potentially leading to improved therapeutic approaches in the ongoing fight against HIV.