RESUMEN
BACKGROUND: To evaluate intravitreal injection of expansile sulfur hexafluoride (SF6) as a low cost and effective treatment for symptomatic vitreomacular adhesion (sVMA). METHODS: Retrospective analysis of all patients with sVMA treated with pneumatic vitreolysis using SF6 gas presenting to a clinical practice from January 2005 and June 2013. RESULTS: Six cases were included in the study. Five patients (83%) experienced complete resolution of the vitreomacular adhesion. One patient had a partial release of the vitreomacular adhesion. Four patients (67%) had a one line improvement in best corrected visual acuity. CONCLUSION: Due to its low cost, wide availability, and apparent efficacy, intravitreal injection of expansile SF6 should be investigated further as a possible treatment modality for sVMA.
RESUMEN
In persons with advanced immunosuppression, Mycobacterium avium complex (MAC) typically causes disseminated disease with systemic symptoms. We report 2 cases in which MAC caused localized osteomyelitis in human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy with rising CD4 counts. We summarize 17 additional cases of HIV-associated MAC osteomyelitis from the literature and compare CD4 count at presentation for vertebral cases versus nonvertebral cases, which reveals a significantly higher CD4 at presentation for vertebral cases (median 251 cells/µL vs 50 cells/µL; P = .043; Mann-Whitney U test). The literature review demonstrates that the majority of cases of MAC osteomyelitis, especially vertebral, occurs in individuals with CD4 counts that have increased to above 100 cells/µL on antiretroviral therapy. Among HIV-infected individuals with osteomyelitis, MAC should be considered a possible etiology, particularly in the setting of immune reconstitution.
RESUMEN
BACKGROUND: The risk of pneumococcal disease persists, and antibody responses to revaccination with the 23-valent polysaccharide vaccine (PPV) are low among human immunodeficiency virus (HIV)-infected adults. We determined whether revaccination with the 7-valent pneumococcal conjugate vaccine (PCV) would enhance these responses. METHODS: In a randomized clinical trial, we compared the immunogenicity of revaccination with PCV ( n = 131) or PPV (n = 73) among HIV-infected adults (median CD4 cell count, 533 cells/mm(3)) who had been vaccinated with PPV 3-8 years earlier. HIV-uninfected adults (n = 25) without prior pneumococcal vaccination received 1 dose of PCV. A positive response was defined as a >or=2-fold increase (from baseline to day 60) in capsule-specific immunoglobulin G, with a postvaccination level >or=1000 ng/mL for at least 2 of the 4 serotypes. RESULTS: HIV-infected persons demonstrated a higher frequency of positive antibody responses to PCV than to PPV (57% vs 36%) (P = .004) and greater mean changes in the immunoglobulin G concentration from baseline to day 60 for serotypes 4, 9V, and 19F (P < .05, for all), but not for serotype 14. However, by day 180, both outcomes were similar. Responses to PCV were greater in frequency and magnitude for all serotypes in HIV-uninfected adults, compared with those in HIV-infected adults. CONCLUSIONS: Among persons with HIV infection, revaccination with PCV was only transiently more immunogenic than PPV, and responses were inferior to those in HIV-uninfected subjects with primary vaccination. Pneumococcal vaccines with more robust and sustained immunogenicity are needed for HIV-infected adults. Clinical trial registration. ClinicalTrials.gov identifier NCT00622843.
Asunto(s)
Infecciones por VIH/inmunología , Inmunización Secundaria/métodos , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Adolescente , Adulto , Anticuerpos Antibacterianos/sangre , Recuento de Linfocito CD4 , Femenino , Vacuna Neumocócica Conjugada Heptavalente , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Vacunas Neumococicas/administración & dosificación , Resultado del Tratamiento , Adulto JovenAsunto(s)
Colitis/microbiología , Endoscopía Gastrointestinal , Proctitis/microbiología , Sífilis/diagnóstico , Adulto , Colitis/patología , Guaiacum , Historia del Siglo XVI , Humanos , Masculino , Medicina en la Literatura , Fitoterapia/historia , Poesía como Asunto/historia , Proctitis/patología , Recto/patología , Sífilis/tratamiento farmacológico , Sífilis/historia , Sífilis/patologíaRESUMEN
Methicillin-resistant Staphylococcus aureus is now a common isolate of community-acquired staphylococcal infections. We present the first case of concomitant mycotic pseudoaneurysm and purulent pericarditis caused by methicillin-resistant S. aureus. The isolate was found to be SCCmec type I, sequence type 8, and to carry the PVL gene. The patient was successfully treated with a combined surgical and medical approach.