Association of body mass index with immune recovery, virological failure and cardiovascular disease risk among people living with HIV.

OBJECTIVES: We conducted a longitudinal cohort analysis to evaluate the association of pre-treatment body mass index (BMI) with CD4 recovery, virological failure (VF) and cardiovascular risk disease (CVD) markers among people living with HIV (PLHIV). METHODS: Participants who were enrolled between January 2003 and March 2019 in a regional Asia HIV cohort with weight and height measurements prior to antiretroviral therapy (ART) initiation were included. Factors associated with mean CD4 increase were analysed using repeated-measures linear regression. Time to first VF after 6 months on ART and time to first development of CVD risk markers were analysed using Cox regression models. Sensitivity analyses were done adjusting for Asian BMI thresholds. RESULTS: Of 4993 PLHIV (66% male), 62% had pre-treatment BMI in the normal range (18.5-25.0 kg/m2 ), while 26%, 10% and 2% were underweight (< 18.5 kg/m2 ), overweight (25-30 kg/m2) and obese (> 30 kg/m2 ), respectively. Both higher baseline and time-updated BMI were associated with larger CD4 gains compared with normal BMI. After adjusting for Asian BMI thresholds, higher baseline BMIs of 23-27.5 and > 27.5 kg/m2 were associated with larger CD4 increases of 15.6 cells/µL [95% confidence interval (CI): 2.9-28.3] and 28.8 cells/µL (95% CI: 6.6-50.9), respectively, compared with normal BMI (18.5-23 kg/m2 ). PLHIV with BMIs of 25-30 and > 30 kg/m2 were 1.27 times (95% CI: 1.10-1.47) and 1.61 times (95% CI: 1.13-2.24) more likely to develop CVD risk factors. No relationship between pre-treatment BMI and VF was observed. CONCLUSIONS: High pre-treatment BMI was associated with better immune reconstitution and CVD risk factor development in an Asian PLHIV cohort.

Evaluation and management of hemoptysis in infants and children. A report of nine cases.

Hemoptysis is an occasional complication of adult pulmonary disease and is rare in children. The most common causes in adults are infection, bronchiectasis, pulmonary neoplasm, cystic fibrosis, pulmonary infarct, and trauma; in children the most common causes are infection and congenital abnormalities of the cardiopulmonary vasculature. Nine cases of hemoptysis in seven infants and two children will be presented. Two cases were fatal, thus illustrating the importance of rapid and definitive therapy early in the course. One of the fatal cases is the first case report in the otolaryngological literature of fatal hemoptysis in the newborn as a result of vascular anomalies associated with an absent left pulmonary artery. Eight cases of various causes, including small vessel vascular abnormality, trauma, recurrent pulmonary infection, and laryngotracheal papilloma, are discussed. The literature is reviewed, embryology is discussed, and a mechanism of death is theorized for the patient with the congenital vessel anomaly. Management considerations for hemoptysis in infants and children are discussed.

Predictive value of AMES scoring system in selection of extent of surgery in well differentiated carcinoma of thyroid.

The extent of surgical resection continues to be controversial for treatment of well-differentiated thyroid carcinoma (WDTC). It has been proposed that age, distant metastases, extent, and size (AMES) are prognostic indicators for WDTC. In this retrospective study, the role of AMES in selection and extent of surgical resection was evaluated. A total of 155 patients with WDTC treated between 1970 and 1990 at this institution were reviewed. The mean follow-up was 9 years. Patients were divided into low risk (Group A), and high risk (Group B) based on AMES. Group A had 141 patients, and Group B had 14 patients. Ninety-eight patients underwent total or subtotal thyroidectomy; 87 of these were in Group A and 11 in Group B. Fifty-seven patients had lesser surgical resection (53 lobectomy and isthmusectomy, three excision of nodule, and one needle biopsy). Five of the 11 in Group B who had more extensive surgery and none of 3 who had lesser surgery have died of their disease. Three patients in Group A have died of WDTC, of which two had total thyroidectomy and one had lobectomy with isthmusectomy. This study suggests that conservative resection is an adequate treatment in low risk patients based on AMES. This treatment may be enough for high risk patients, although the number of patients is small to make definitive recommendations.