Prevalence of Cryptococcal Antigen and Outcomes in People With Human Immunodeficiency Virus in Honduras: A Cohort Study.

BACKGROUND: Cryptococcal meningitis is a major cause of death among people with human immunodeficiency virus (PWH). Cryptococcal antigen (CrAg) testing of asymptomatic patients is an important public health measure to reduce mortality in high-incidence areas. However, limited data exist on CrAg prevalence in Central America. METHODS: We conducted a prospective cohort study at the 2 largest human immunodeficiency virus (HIV) clinics and hospitals in Honduras. Cryptococcal antigen in serum and cerebrospinal fluid was performed in individuals with HIV who had CD4 ≤100 cells/mm3 between 2017 and 2018. After CrAg testing, individuals were observed for 12 months to assess mortality using adjusted Cox proportional hazard models. RESULTS: A total of 220 PWH were tested for CrAg, 12.7% (n = 28) of which tested positive. Cryptococcal antigen prevalence was higher among hospitalized individuals in 40% (n = 10 of 25) of the cases. The proportion (35.8%) of individuals taking antiretroviral therapy was significantly (P < .01) lower among those who tested positive for CrAg. Overall mortality among the cohort was 11.4% (n = 25 of 220) by 12 months. Cryptococcal antigen-positive cases were at a significantly higher risk of death (adjusted hazard ratio, 2.69; 95% confidence interval, 1.07-6.84) compared with CrAg-negative participants. CONCLUSIONS: Cryptococcal antigen prevalence in Honduras was high among PWH. Moreover, individuals who tested positive for CrAg testing were at a higher risk of death. Systemic CrAg of PWH with a CD4 ≤100 cells/mm3 should be routinely performed in Central America.

Caracterización clínico-epidemiológica de traumatismo craneoencefálico severo pediátrico en Hospital Nacional Mario Catarino Rivas 2016-2018 / Clinical-epidemiological characterization of severe pediatric brain injury at Hospital Nacional Mario Catarino Rivas 2016-2018

Antecedentes: Traumatismo craneoencefá-lico (TCE) se define como un intercambio brusco de energía mecánica causado por una fuerza externa que tiene como resultado una alteración a nivel anatómico-funcional del encéfalo y sus envolturas. Objetivo: Caracterizar clínica y epidemiológicamente los TCE severos en pacientes de 2-18 años, atendidos en Unidad de Cuidados Intensi-vos Pediátricos (UCIP) del Hospital Mario Catarino Rivas (HMCR) durante enero 2016 a mayo 2018. Pacientes y métodos: Estu-dio descriptivo transversal observacional. Universo de 809 pacientes. La muestra por conveniencia fue de 77 (9.5%, IC95%), se incluyó pacientes de 2-18 años, con expe-diente clínico completo. Se excluyeron ingresos por causa no traumática, traslados a otros centros hospitalarios y pacientes con TCE leve-moderado. Las variables incluye-ron datos sociodemográficos, característi-cas del traumatismo, manifestaciones clíni-cas, tratamiento en UCIP, complicaciones asociadas y condición de egreso. La infor-mación recolectada fue ingresada en una base de datos en Epiinfo versión 7.2.2.6, se realizó un análisis univariado. La informa-ción extraída de los expedientes se manejó confidencialmente. Resultados: El grupo etáreo más afectado fueron escolares 40.2% (31), el mecanismo de lesión másClinical-epidemiological characterization of Severe Pediatric Brain injury atHospital Nacional Mario Catarino Rivas 2016-2018Caracterización clínico-epidemiológica de Traumatismo CraneoencefálicoSevero Pediátrico en Hospital Nacional Mario Catarino Rivas 2016-2018común accidente de tránsito 64.9% (50). El 97.4% (75) presentó pérdida del estado de consciencia, la región anatómica más afec-tada fue temporal en 52.0% (40). 45.9% iniciaron alimentación enteral antes de las 12 hrs, la prevalencia fue de 9.5% y la mor-talidad del 10%. Conclusión: Es importante identificar los mecanismos de trauma, para dar un manejo oportuno e intervenir de manera eficaz, con el fin de disminuir la morbimortalidad de estos...(AU)

Impact of tobacco use on the development of opportunistic respiratory infections in HIV seropositive patients on antiretroviral therapy.

The increased risk of developing lung diseases in cigarette smokers has been well recognized. The association between smoking and the risk of developing pulmonary infections in HIV-1-infected patients, however, which has not been established, was evaluated in the present study. Twenty-seven cases with lower respiratory infections (15 Pneumocystis carinii pneumonia (PCP), 12 TB cases) were compared with 27 age, gender, socio-economic and HIV status-matched patients, without history of respiratory diseases. Medical history and physical examinations were obtained every 6 months. Blood was drawn for CD4 and viral load measurements. A substantial number of HIV + smokers who developed PCP (one-third) had been on highly active retroviral therapy (HAART) for more than 6 months and prophylaxis had been discontinued. Multivariate analyses indicated that in HIV-infected people, after controlling for HIV status and antiretrovirals, cigarette smoking doubled the risk for developing PCP (p = 0.01). Multivariate analyses demonstrated that long-term smoking also increased the risk (2 x) of developing tuberculosis (p = 0.04). Moreover, daily tobacco use seemed to attenuate by 40% the immune and virological response to antiretroviral therapies. These findings indicate that tobacco use significantly increases the risk of pulmonary diseases in HIV infected subjects and has a potential deleterious impact on antiretroviral treatment.