RESUMO
The purpose of this study was to evaluate the impact of surgical timing on survival in patients with left-sided infective endocarditis (IE). This was a retrospective study including 313 patients with left-sided IE between 2009 and 2017. Surgery was defined as urgent (US) or early (ES) if performed within 7 or 28 days, respectively. A multivariable Cox regression analysis including US and ES as time-dependent variables was performed to assess the impact on 1-year mortality. ES was associated with a better survival (aHR 0.349, 95% CI 0.135-0.902), as US (aHR 0.262, 95% CI 0.075-0.915). ES and US were associated with a better prognosis in patients with left-sided IE.
Assuntos
Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/cirurgia , Endocardite/mortalidade , Endocardite/cirurgia , Idoso , Endocardite/diagnóstico , Endocardite Bacteriana/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
ABSTRACT Diagnosis of schistosomiasis in migrants coming from endemic areas can be difficult, especially in asymptomatic subjects. Light-intensity disease, in fact, may be missed due to the low sensitivity of the stool microscopy and serologic testing cannot distinguish between a resolved infection and an active infection in patients who have been infected and treated in the past, because specific antibodies can persist despite cure. We describe a cross-sectional study conducted on 82 migrants tested for Schistosoma mansoni on single blood (anti-schistosome antibodies, total IgE) and urine [point-of-care (POC) circulating-cathodic-antigen (CCA) test] samples. A positive POC-CCA test (active infection) resulted in two untreated patients with a positive serology while all patients (n = 66) with a past infection showed a negative POC-CCA test. POC-CCA urine test in combination with serology may be helpful in rapidly differentiate active from past S. mansoni infection in migrants coming from endemic areas.
Assuntos
Humanos , Animais , Masculino , Feminino , Adulto , Schistosoma mansoni/imunologia , Migrantes/estatística & dados numéricos , Esquistossomose mansoni/diagnóstico , Antígenos de Helmintos/análise , Estudos Transversais , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Itália , Pessoa de Meia-IdadeAssuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV/efeitos dos fármacos , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Contagem de Linfócito CD4 , Cobicistat/administração & dosagem , Cobicistat/efeitos adversos , Cobicistat/uso terapêutico , Emtricitabina/administração & dosagem , Emtricitabina/efeitos adversos , Emtricitabina/uso terapêutico , HIV/genética , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Quinolonas/administração & dosagem , Quinolonas/efeitos adversos , Quinolonas/uso terapêutico , Estudos Retrospectivos , Tenofovir/administração & dosagem , Tenofovir/efeitos adversos , Tenofovir/uso terapêutico , Resultado do Tratamento , Carga Viral/efeitos dos fármacosRESUMO
INTRODUCTION: During HIV-1 infection the B-cell compartment undergoes profound changes towards terminal differentiation, which are only partially restored by antiretroviral therapy (cART). MATERIALS AND METHODS: To investigate the impact of infection as early as during primary HIV-1 infection (PHI) we assessed distribution of B-cell subsets in 19 PHI and 25 chronic HIV-1-infected (CHI) individuals before and during 48 weeks of cART as compared to healthy controls (n = 23). We also analysed Immunoglobulin-expression of memory B-cell subsets to identify alterations in Immunoglobulin-maturation. RESULTS: Determination of B-cell subsets at baseline showed that total and Naive B-cells were decreased whereas Activated Memory (AM), Tissue-like Memory (TLM) B-cells and Plasma cells were increased in both PHI and CHI patients. After 4 weeks of cART total B-cells increased, while AM, TLM B-cells and Plasma cells decreased, although without reaching normal levels in either group of individuals. This trend was maintained until week 48, though only total B-cells normalized in both PHI and CHI. Resting Memory (RM) B-cells were preserved since baseline. This subset remained stable in CHI, while was expanded by an early initiation of cART during PHI. Untreated CHI patients showed IgM-overexpression at the expenses of switched (IgM-IgD-) phenotypes of the memory subsets. Interestingly, in PHI patients a significant alteration of Immunoglobulin-expression was evident at BL in TLM cells, and after 4 weeks, despite treatment, in AM and RM subsets. After 48 weeks of therapy, Immunoglobulin-expression of AM and RM almost normalized, but remained perturbed in TLM cells in both groups. CONCLUSIONS: In conclusion, aberrant activated and exhausted B-cell phenotypes rose already during PHI, while most of the alterations in Ig-expression seen in CHI appeared later, despite 4 weeks of effective cART. After 48 weeks of cART B-cell subsets distribution improved although without full normalization, while Immunoglobulin-expression normalized among AM and RM, remaining perturbed in TLM B-cells of PHI and CHI.
Assuntos
Antirretrovirais/administração & dosagem , Subpopulações de Linfócitos B , Infecções por HIV , HIV-1 , Memória Imunológica/efeitos dos fármacos , Plasmócitos , Adulto , Subpopulações de Linfócitos B/imunologia , Subpopulações de Linfócitos B/patologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Regulação da Expressão Gênica/imunologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/patologia , Humanos , Imunoglobulina D/imunologia , Imunoglobulina M/imunologia , Masculino , Pessoa de Meia-Idade , Plasmócitos/imunologia , Plasmócitos/patologia , Fatores de TempoRESUMO
Aim of this study was to report the 204-week efficacy and safety results of a novel PI- and NRTI-sparing regimen for salvage therapy including maraviroc, raltegravir, etravirine in 28 failing HIV-infected patients with R5-tropic virus. The trend of laboratory parameters was tested by ANOVA for repeated measures and Greenhouse-Geisser probabilities were reported. Results were described as median (Q1-Q3) values. Twenty-six (93%) out of 28 patients completed 204 weeks of treatment. Virological success (HIV-RNA<50 copies/mL) at week 204 was 96%. CD4+ counts significantly increased [244 (158-213) cells/mm3, p<0.0001] from baseline [247 (68-355) cells/mm(3)] as well as CD4+ percentage. Four serious adverse events (1 death due to Hodgkins's lymphoma, 1 anal cancer, 1 Hodgkins's lymphoma, 1 recurrence of mycobacterial spondylodiscitis) were observed; three events led to transitory discontinuation of the antiretroviral therapy due to drug-drug interaction. BMI (p<0.0001) and waist circumference (p<0.0001) significantly increased over 204 weeks. An amelioration was also observed in relation to haemoglobin (p=0.0006), platelets (p<0.0001), white blood cell (p=0.013), neutrophils (p=0.301), lymphocytes (p=0.207) and creatinine (p<0.0001). In highly treatment-experienced patients the maraviroc, raltegravir and etravirine combination is associated with a good long-term efficacy and safety profile.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Cicloexanos/administração & dosagem , Infecções por HIV/tratamento farmacológico , Piridazinas/administração & dosagem , Pirrolidinonas/administração & dosagem , Triazóis/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Contagem de Células Sanguíneas , Cicloexanos/efeitos adversos , Quimioterapia Combinada , Feminino , Seguimentos , Infecções por HIV/sangue , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , HIV-1/fisiologia , Humanos , Maraviroc , Pessoa de Meia-Idade , Nitrilas , Piridazinas/efeitos adversos , Pirimidinas , Pirrolidinonas/efeitos adversos , Raltegravir Potássico , Resultado do Tratamento , Triazóis/efeitos adversosRESUMO
Pustulosis acuta generalisata is an uncommon condition characterized by scattered symmetrical eruption of sterile pustules associated with elevated inflammatory markers, leukocytosis, fever and arthropathy caused by previous infection by group A streptococci (GAS). We reported here a case of pustulosis acuta generalisata in an HIV-positive patient recently treated with chemotherapy for a seminoma.