740 research outputs found

    Evolving approaches and resources for clinical practice in the management of HIV infection in the HAART era

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    Physicians treating HIV infection concentrate not only on the viral management but they also have to take into account the potential age and lifestyle-related conditions likely to influence long-term morbidity, correlated with patients' survival. Hypertension, diabetes, cardiovascular, bone, kidney and liver disease, better than opportunistic infection, depict the changing spectrum of HIV disease in the HAART era. These conditions, the so called non infectious co-morbidities, are age-related diseases affecting the general population. However, their prevalence in HIV-infected individuals is higher, with earlier onset, probably as a result of the complex inter-relationship between HIV infection, co-infection and antiretroviral therapy. Regular screening for non infectious co-morbidities helps identify those asymptomatic HIV-infected individuals who are most at risk of developing comorbidities; this means that appropriate intervention, either by lifestyle changes to reduce modifiable risk factors or by the use of pharmacological management, can be initiated. © GERMS 2011

    Management of human immunodeficiency virus in older people

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    The proportion of older (aged ≥50 years) people living with human immunodeficiency virus (PLHIV) within the HIV-positive population is increasing. Many comorbidities associated with ageing are observed more frequently and/or occur at an earlier age among PLHIV, compared with people who are uninfected

    MR quantitative biomarkers of non-alcoholic fatty liver disease: technical evolutions and future trends

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    Non-alcoholic fatty liver disease (NAFLD) is characterized by hepatic steatosis as the earliest manifestation and hallmark, and ranges from benign fatty liver to non-alcoholic steatohepatitis (NASH). Liver biopsy (LB) is considered the reference standard for NAFLD diagnosis, grading and characterization, but it is limited by its invasiveness and observer-dependence. Among imaging surrogates for the assessment of hepatic steatosis, MR is the most accurate. (1)H MR spectroscopy (MRS) provides a quantitative biomarker of liver fat content (LFC) called proton density fat fraction (PDFF), but it is time-consuming, not widely available and limited in sample size. Several MR imaging (MRI) techniques, in particular fat suppression and in-opposed phase techniques, have been used to quantify hepatic steatosis, mainly estimating LFC from water and fat signal intensities rather than proton densities. Several technical measures have been introduced to minimize the effect of confounding factors, in particular a low flip angle, a multiecho acquisition and a spectral modeling of fat with multipeak reconstruction to address respectively T1 effect, T2* effect, and the multifrequency interference effects of fat protons, allowing to use MRI to estimate LFC based on PDFF. Tang et al. evaluated MRI-estimated PDFF, obtained by applying the above-mentioned technical improvements, in the assessment of hepatic steatosis, using histopathology as the reference standard. The identification of PDFF thresholds, even though to be further explored and validated in larger and more diverse cohorts, is useful to identify steatosis categories based on MRI-based steatosis percentages. MRI, with the new refined techniques which provide a robust quantitative biomarker of hepatic steatosis (PDFF) evaluated on the whole liver parenchyma, is a promising non-invasive alternative to LB as the gold standard for steatosis diagnosis and quantification

    Clinical Research Nurse involvement to foster a community based transcultural research in RODAM European study

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    Background and aim of the work: The Clinical Research Nurse (CRN) can be considered the fulcrum of clinical studies, being a vital link between patient, principal investigator, study sponsor and administrative staff. The clinical research’s way is still long and the contribution that CRNs can provide is crucial. In Italy, a CRN was employed in the study: Research on Obesity & Type 2 Diabetes among African Migrants (RODAM). The aim of the paper is to explore and describe the experience of this involvement. Methods: The CRN managed the project in order to gain a complete collaboration from the Ghanaian population. From the first contact, the CRN decided to adopt a transcultural approach with the aim to create a relationship of understanding, mutual trust respect for each other’s cultural diversity. The CRN also used organizational, technical and linguistic skills. Results: The day-to-day trial management from CRN included the following activities: obtaining local Ethics Committee study approval; recruiting the study staff; planning the study activities; identifying potential study participants; collaborating with the mediators; managing contacts with other RODAM centers; conducting a follow-up of patients. The most important results of CRN involvement have been the empowerment of Ghanaian community and the effective healthcare promotion. Conclusions: The project encouraged the Ghanaian community to increase their healthcare awareness and encouraged the Ghanaian population to create new strategies to face the hard health challenges. The CRN is the most versatile and appropriate health professional to deal the entire study
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