SARS-CoV-2 testing, positivity, and factors associated with COVID-19 among people with HIV across Europe in the multinational EuroSIDA cohort.

BACKGROUND: Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus 2019 [COVID-19]), regional and temporal differences in SARS-CoV-2 testing in people with HIV across Europe have not been previously described. METHODS: We described the proportions of testing, positive test results, and hospitalizations due to COVID-19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS-CoV-2 and with ever testing positive. RESULTS: Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3-26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3 , and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9-4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6-0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe). CONCLUSIONS: We observed large heterogeneity in SARS-CoV-2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe.

Two centuries of southwest Iceland annually-resolved marine temperature reconstructed from Arctica islandica shells.

Iceland's exposure to major ocean current pathways of the central North Atlantic makes it a useful location for developing long-term proxy records of past marine climate. Such records provide more detailed understanding of the full range of past variability which is necessary to improve predictions of future changes. We constructed a 225-year (1791-2015 CE) master shell growth chronology from 29 shells of Arctica islandica collected at 100 m water depth in southwest Iceland (Faxaflói). The growth chronology provides a robust age model for shell oxygen isotope (δ18Oshell) data produced at annual resolution for 251 years (1765-2015 CE). The temperature reconstruction derived from δ18Oshell shows coherence with May-October local surface temperature records and sea surface temperatures in the North Atlantic region, suggesting it is a useful proxy indicator of water temperature variability at 100 m depth within Faxaflói. Field correlations between the shell-based records and gridded sea surface temperature data reveal strong positive correlations between the 1-year lagged shell growth and temperatures within the subpolar gyre post-1972, suggesting a delayed influence of subpolar gyre dynamics on ecological indicators in southwest Iceland in recent decades. However, the shell growth chronology and δ18Oshell record generally show relatively weak and insignificant correlations with larger region climate indices including the Atlantic Multidecadal Variability, North Atlantic Oscillation, and East Atlantic pattern. Therefore the interannual variations in the newly produced shell-based records appear to reflect more local to regional dynamics around southwest Iceland than large-scale modes of climate variability.

Healthcare delivery for HIV-positive people with tuberculosis in Europe.

BACKGROUND: In a 2013 survey, we reported distinct discrepancies in delivery of tuberculosis (TB) and HIV services in eastern Europe (EE) vs. western Europe (WE). OBJECTIVES: To verify the differences in TB and HIV services in EE vs. WE. METHODS: Twenty-three sites completed a survey in 2018 (EE, 14; WE, nine; 88% response rate). Results were compared across as well as within the two regions. When possible, results were compared with the 2013 survey. RESULTS: Delivery of healthcare was significantly less integrated in EE: provision of TB and HIV services at one site (36% in EE vs. 89% in WE; P = 0.034), and continued TB follow-up in one location (42% vs. 100%; P = 0.007). Although access to TB diagnostics, standard TB and HIV drugs was generally good, fewer sites in EE reported unlimited access to rifabutin/multi-drug-resistant TB (MDR-TB) drugs, HIV integrase inhibitors and opioid substitution therapy (OST). Compared with 2013, routine usage of GeneXpert was more common in EE in 2018 (54% vs. 92%; P = 0.073), as was access to moxifloxacin (46% vs. 91%; P = 0.033), linezolid (31% vs. 64%; P = 0.217), and bedaquiline (0% vs. 25%; P = 0.217). Integration of TB and HIV services (46% vs. 39%; P = 1.000) and provision of OST to patients with opioid dependency (54% vs. 46%; P = 0.695) remained unchanged. CONCLUSION: Delivery of TB and HIV healthcare, including integration of TB and HIV care and access to MDR-TB drugs, still differs between WE and EE, as well as between individual EE sites.

Cerebral toxoplasmosis in HIV-infected patients over 2015-2018 (a case study of Russia).

Cerebral toxoplasmosis is a leading cause of the central nervous system disorders in acquired immune deficiency syndrome. This study aimed to investigate the clinical course of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected individuals. The study included 90 HIV-infected patients with cerebral toxoplasmosis, who underwent inpatient treatment. In case of positive enzyme immunoassay, HIV infection was confirmed with the immunoblot test. The HIV-1 ribonucleic acid level was determined using the polymerase chain reaction method. The flow cytometry was used for counting CD4 (cluster of differentiation 4 cells). Pathomorphological examination included the autopsy, gross and microscopic examination of internal organs, histological and other methods. The incidence of cerebral toxoplasmosis significantly increases at the CD4 count below 100 cells/µl, P < 0.001, and at the HIV viral load above 50 copies/ml, P < 0.05. The clinical picture of cerebral toxoplasmosis included focal symptoms, cognitive impairment, toxic syndrome, mild cerebral symptoms and a meningeal symptom. Given the absence of a specific clinical picture and the absence of abnormal laboratory and instrumental findings, the cerebral toxoplasmosis needs to be diagnosed with a number diagnostic methods combined: clinical examination, laboratory testing, immunological examination, molecular genetic testing and neuroradiological imaging.

[Regional metabolic changes of supraventricular tissue in patients with relapsing-remitting and secondary-progressive multiple sclerosis]. / Regionarnye osobennosti metabolizma strukturno neizmenennogo veshchestva supraventrikuliarnykh prostranstv golovnogo mozga pri remittiruiushchem i vtorichno-progressiruiushchem tipakh techeniia rasseiannogo skleroza.

AIM: To evaluate and compare the intensity of changes in a regional meta-analysis in relapsing-remitting and secondary-progressive multiple sclerosis (RRS and SPMS). MATERIAL AND METHODS: The results of longitudinal studies of multiple sclerosis (MS) using positron emission tomography, magnetic resonance spectroscopy and diffusion tensor imaging are presented. RESULTS: In MS, metabolic changes precede the structural ones. The markers of neuronal and axonal dysfunction (a decrease in NAA/Cr ratios in the white and grey matters, without the structural changes) are recorded in the early stages. The metabolic changes in the grey matter were recorded mostly in the middle frontal gyrus and posterior cingulate cortex. With the increase of duration and severity of MS, the metabolic changes spread to the other regions of supraventricular areas. The distribution of degeneration zones is related to MS course. CONCLUSION: There is substantial evidence on the irreversible damage of neurons in the medial prefrontal cortex in SPMS that confirms the vulnerability of the frontal cingulate gyrus in MS.

[Predictors of survival after heart transplantation: role of pretransplantation and posttransplantation factors].

Objective of this study was to assess the impact of pre- and posttransplantation factors on 12-month survival after orthotopic heart transplantation (OHT). Annual survival after OHT was 79.2%. The following factors were significantly negatively associated with annual survival: recipient's serum C-reactive protein (CRP) > or = 11.5 mg/ml prior to donor heart transplant (odds ratio [OR] 5.74, p = 0.011) and infectious complications after OHT (OR = 4.80, p = 0.009). Recipient's high CRP level was associated with mortality due to infectious complications (r(pb) = 0.47, p = 0.006), elevated troponin I concentrations (r(s) = 0.44, p = 0.012), and impaired hemodynamics of both recipient's heart and graft: right ventricular (RV) end diastolic area (EDA) prior to OHT (r(s) = 0.41, p = 0.015), elevated pulmonary artery pressure (PAP) (r(s) = 0.36, p < 0.001), and decreased left ventricular ejection fraction (LVEF) (r(s) = -0.45, p < 0.001) of the transplanted heart. Hearts of those who died after OHT irrespective of cause of death were characterized by more severe right heart dilation as evidenced by statistically significant increase of median RV EDA prior to OHT. After heart transplantation in those who later died decreased RV contractility was accompanied with elevation of PAP and decrease of LVEF. Acute graft rejection events 71.4% of which occurred in patients younger than 30 years had no influence on survival during 12 months after OHT. Other factors not associated with 12 months survival were donor and recipient age, pretransplant pathology, patient's UNOS status, graft ischemia duration, artificial circulatory support and preexistent surgical interventions. Development of diabetes mellitus in posttransplantation period, arterial hypertension and sinus node dysfunction requiring permanent pacing also were not identified as factors affecting 1 year survival after OTH.

[On the mechanism of radioprotective effect of NO-synthase inhibitors].

We studied the influence on hemodynamics and radioprotective activity of two inhibitors of NO-synthase (NOS)--isothiourea derivatives with different NOS isoform selectivity: T1023--a selective inhibitor of endothelial and inducible NOS; and NTT2--a highly selective inhibitor of neuronal NOS. Both compounds at a dose of 1/7 LD50/15 caused a vasopressive effect and baroreflex response in normal Wistar rats. However, the nature of hemodynamic changes was qualitatively different. T1023 caused a prolonged elevation of vascular tone and reflex shift resulted in a significant and lasting reduction in the systemic blood flow (35-45%), which created conditions for the development of circulatory hypoxia. The use of NTT2 caused a reflex change in hemodynamics accompanied by vasodilation; and systemic blood flow was maintained at the initial level. T1023 effectively protected mice subjected to 10 Gy γ-irradiation and their bone marrow stem cells irradiated with 6 Gy, not yielding to the radioprotective effect of cystamine. NTT2 at these doses did not show any radioprotective effect. The obtained results support the leading mechanism of the radioprotective effect of NOS inhibitors is the induction of hypoxia. With this mechanism of action a significant radioprotective activity can be expected for the inhibitors which effectively suppress primarily endothelial NOS.

[Cortical atrophy in multiple sclerosis]. / Atrofiia kory golovnogo mozga pri rasseiannom skleroze.

Objective. To identify clear patterns of the cerebral cortex atrophy in multiple sclerosis that may provide valuable information for the development of additional paraclinical methods of stages and variants of MS objectification and verification and used for assessing treatment efficacy. Material and methods. The results of morphometric data analysis of 117 patients with different variants of MS and 25 healthy volunteers are presented. The original algorithm for postprocessing MRI images was used. Age, disease duration, type of disease, FS and EDSS scores, morphometric results were the source parameters for the statistical analysis. Results. The correlation analysis showed that the total cortex volume was in inverse correlation with EDSS score, pyramidal and cerebellar dysfunction, but not with disease duration. An analysis of regional changes in 43 bilateral regions of interest (ROI) demonstrated similar results in 7 ROIs in the left (dominant) hemisphere and in 4 ROIs in the right hemisphere. ANOVA revealed atrophic changes in 20 ROIs bilaterally. Deficit of certain functional systems was accompanied by the atrophy of various functional cortex regions. ANOVA of the regional cortical atrophy in groups with varying disease severity showed the presence of significant changes in patients with moderate to severe disability. Duration and type of MS were not predictive for development of atrophy, with the exception of the precuneus bilaterally, the right paracentral lobule and right posterior cingulate gyrus. Conclusion. Regional cortical atrophy is detected in the earliest stages of the disease and increases as the disease progresses. Inconsistency of data across studies can be explained by the lack of generally accepted morphometric standards and pathogenetic heterogeneity of MS. Regional cortical atrophy may be considered as a sensitive neuroradiological biomarker for MS.

[Mechanisms of cerebral damage in patients with HIV-infection].

Mechanisms of HIV transportation through blood-brain barrier, vascular plexus and interaction with cerebral cells having CD-4-receptors, CCR-5- and CXCR-4-coreceptors were studied. Cerebral damage developed through latent and acute periods also known as HIV-encephalopathy, HIV-associated neurocognitive dysfunction etc. Cerebral lesions are caused by a variety of chemical agents from pro-inflammatory cytokines to toxic HIV-proteins resulting in development of HIV-dementia through several years. Even early stage of this process revealed significant disturbances of glucose metabolism and evoked potentials EEG alterations which can serve as a marker of HIV-infection. Genetic differences of HIV in blood and spinal liquor with different drug resistance were revealed implying a new approach to therapy development.

[Current possibilities of the comprehensive diagnostic assessment in the differential diagnosis of inflammation and tumors of the spine cord].

The article discusses the differential diagnosis of transverse myelitis. An algorithm for the assessment of patients was given. The authors present two clinical examples demonstrating the role of the integrated neuroradiological approach in the differential diagnosis of difficult cases.

[Possibilities of a computer tomography and 3D-reconstruction in estimation of temporomandibulare joint in patients with the secondary lowered bite].

In considerable decrease of bite height the interposition of firm and soft tissues of temporomandibulare joint (TMJ) varied, its function was broken. By means of a computer tomography we estimated width of departments of the articulate crack. The increase in back articulate space was regarded at bite correction as optimum result of treatment. Measurements were made at use of multiplanar 2D-reconstruction in sagittal projections. At performance of volume (3D) reconstruction it was noticed that in patients with atypical change of interposition of TMJ elements prospective rotation of position of a head at performance of functional tests (research performance in position of the closed mouth and at bite restoration on silicone forms) was not caught. However, in these patients clinical improvement was noted in all cases. Use of 3D-reconstruction facilitate understanding of an arrangement of heads of lower jaw in cavities of joints, including with the use of functional tests. However, to estimate the minimum degrees of rotation of position of heads of articulate shoots was not obviously possible. Also measurements of width of an articulate crack weew not absolutely representative in comparison with interpretation of multiplanar 2D-reconstruction.

[Use of the multislice spiral computed tomography in planning the treatment of patients with tumors of the biliopancreatoduodenal zone].

The authors elucidate an experience with using multislice spiral computed tomography with the method of multiphase scanning (CT-angiography) in patients with suspected tumors of organs of the biliopancreatoduodenal zone. The proposed method allows getting information on the character of the pathological process, dissemination of the tumor lesion. It helps to decide on the strategy of treatment of the patient, to plan the operative intervention and assess the results of operative treatment.

[Use of postmortem brain magnetic resonance imaging at autopsy].

The study was undertaken to define the possibilities of using postmortem MRI for examining the brain. A complex study was made to explore 21 neutral formalin-fixed gross brain specimens from patients with neurosurgical pathology. Macroscopic and target histological studies of the changed signal areas detected by MRI were performed using histochemical stains. The significance of the results obtained by MRI in vitro has been defined, which furnish considerable opportunities to use the technique for the postmortem diagnosis of various diseases, to detect macroscopically undetectable changes (perifocal changes, metastases), to make a complex of intractable diagnostic problems, and to study the histological substrate of changed MR signal areas.

[Potentials of computed-tomography colonography with added investigations of the abdominal cavity and small pelvis in the diagnosis of diseases of the colon, assessment of dissemination of the pathological process].

The aim of the investigation was an assessment of potentials of computed-tomography colonography (CTC) in diagnosis of diseases of the colon. CTC was made in 125 patients. The investigation was performed after special preparation of the patients for purgation of the colon. The patient was in the supine and prone position. After introduction of room air in the colon the axial sections were laid from the diaphragm cupola to the pelvic floor. The obtained data were estimated and the reconstructions were fulfilled using special software. Pathological alterations or anatomical specific features of the colon were detected in 86 out of 125 cases (68.8%), in 26 of the cases (28.6%) a conclusion was made of malignant tumors in the colon according to the data of CTC. The data obtained by CTC were compared with the data of fibrocolonoscopy, rectomanoscopy, irrigoscopy and histological investigation. In most cases the coincidence of the findings was noted.

[The influence of some retarding agents NOS of dihydrothiazine-thiazoline rank on postradiational of recovery endogenous CFU-S-8 of mice].

In this work the attempt to estimate a nitric oxide (NO*) role in regulation of the number of pool haemopoietic stem cells at the irradiated mice was made. With this purpose the number of new compounds from dihydrothiazine-thiazoline line was synthesized, their NO-inhibiting activity was investigated in vivo by the method of ESR-spectroscopy of spin trap and their influence on an output endogenous spleen colonies (CFU-S-8) after the total sublethal y-irradiation of mice in a doze of 6 Gy was also investigated. Was shown, that the tested compounds reduced the contents of NO* in a liver tissue of mice which have received an injection of nitric oxide synthesis inductor - lipopolysaccharide, and also increased an output CFU-S-8 forming endogenous colonies in the spleen of the irradiated mice. Received data testify to perceptivity of search radioprotective agents among NO* synthesis inhibitors.

[Current methods of noninvasive imaging of coronary arteries in the diagnosis of coronary atherosclerosis].

The lecture contains: presentation of possibilities of ultrasound and tomographic methods of investigation in visualization of major coronary arteries; consideration in a comparative aspect of main advantages, disadvantages and limitations of these methods in diagnostics of coronary atherosclerosis; analysis of indications for application and perspectives of their use in everyday clinical practice in patients with a diagnosis of possible or verified ischemic heart disease.

[Ultrasound and morphological diagnosis of thyroid diseases in radiation-exposed persons].

The purpose of the present investigation was to enhance the efficiency of diagnosis of thyroid diseases in irradiated persons. Three hundred persons exposed to radiation in doses of 5 to 250 SeV and the postexposure period was 9 to 48 years. A control group comprised 100 military men unexposed to ionizing radiation. Thyroid ultrasound study and morphological diagnosis revealed diffuse nodular goiter transformation in 66% of the irradiated persons and malignant thyroid neoplasms in 3.7% whereas 38% of the control patients were found to have only benign diffuse nodular thyroid alterations and autoimmune thyroiditis (AIT). The investigation identified the echosemiotic features of nodular masses and AIT in the study group patients and established their association with the pathomorphological changes of the thyroid. The authors note the high efficiency of complex clinicoradiation and morphological studies in detecting thyroid pathology and the priority in establishing an accurate diagnosis at the preoperative stage and in determining management tactics.

[Role of cytologic and histologic examination in the diagnosis of thyroid diseases in patients exposed to radiation]. / Rol' tsitologicheskogo i gistologicheskogo issledovanii v diagnostike zabolevanii shchitovidnoi zhelezy u lits, podvergshikhsia vozdeistviiu radiatsii.

Complex cytological and ultrasound study was conducted in 300 patients with thyroid pathology exposed to 5-250 cSv. Benign goiter changes and autoimmune thyroiditis were detected in 66.2% while malignant thyroidal nodules--in 3.7%. Benign and autoimmune changes alone were in 38%. Pathomorphological features of nodular changes and autoimmune thyroiditis patterns as well as their ultrasound representations were identified.

[NO-inhibiting activity of radioprotectors]. / NO-ingibiruiushchaia aktivnost' radioprotektorov.

The effect of radioprotectors of different structure on the syntheses of nitric oxide induced by endotoxin in mice was studied. Using ESR-spectroscopy and spin trap techniques, it was shown that compounds of different chemical structure, such as aminothiols, isothiuronium derivatives, thiazolines, indolylalkylamines and others, suppressed the nitric oxide production in a whole body. The analysis of the relevant literature has confirmed the phenomenon described by the authors: radioprotectors show NO-inhibiting activity.

[Possibilities of magnetic resonance visualization in the diagnosis of multiple sclerosis]. / Vozmozhnosti metodov magnitno-rezonansnoi vizualizatsii v diagnostike rasseiannogo skleroza.

Magnetic-resonance imaging (MRI) is considered to be the most informative non-invasive method in diagnosis, differential diagnosis and estimation of activity of multiple sclerosis (MS). MRI data of 270 patients with clinically and laboratory definite MS were analyzed to assess diagnostic MRI-criteria for MS, MRI presentations at the time of first clinical manifestation of the disease, neuroimaging patterns in children and elderly persons with MS. The MRI variants of MS are substantiated. Neuroimaging data of cervical spinal cord in 28 patients with MS are presented in parallel with corresponding clinical data. The most typical patterns are singled out. The data of brain 1H-magnetic-resonance spectroscopy (MRS) in 20 patients with MS and 8 patients with inflammatory and vascular disorders were analyzed to reveal biochemical distinction between MS and non-MS lesions as well as changes in normal appearing white matter in MS. The differential-diagnostic value of MRS is limited although decreased N-acetyl-aspartate peak is characteristic for MS lesions and in some cases in normal appearing white matter in primary-progressive MS.