Evaluation of Cellular Phenotypes Implicated in Immunopathogenesis and Monitoring Immune Reconstitution Inflammatory Syndrome in HIV/Leprosy Cases

BACKGROUND: It is now evident that HAART-associated immunological improvement often leads to a variety of new clinical manifestations, collectively termed immune reconstitution inflammatory syndrome, or IRIS. This phenomenon has already been described in cases of HIV coinfection with Mycobacterium leprae, most of them belonging to the tuberculoid spectrum of leprosy disease, as observed in leprosy reversal reaction (RR). However, the events related to the pathogenesis of this association need to be clarified. This study investigated the immunological profile of HIV/leprosy patients, with special attention to the cellular activation status, to better understand the mechanisms related to IRIS/RR immunopathogenesis, identifying any potential biomarkers for IRIS/RR intercurrence. METHODS/PRINCIPAL FINDINGS: Eighty-five individuals were assessed in this study: HIV/leprosy and HIV-monoinfected patients, grouped according to HIV-viral load levels, leprosy patients without HIV coinfection, and healthy controls. Phenotypes were evaluated by flow cytometry for T cell subsets and immune differentiation/activation markers. As expected, absolute counts of the CD4+ and CD8+ T cells from the HIV-infected individuals changed in relation to those of the leprosy patients and controls. However, there were no significant differences among the groups, whether in the expression of cellular differentiation phenotypes or cellular activation, as reflected by the expression of CD38 and HLA-DR. Six HIV/leprosy patients identified as IRIS/RR were analyzed during IRIS/RR episodes and after prednisone treatment. These patients presented high cellular activation levels regarding the expression of CD38 in CD8+ cells T during IRIS/RR (median: 77,15%), dropping significantly (p<0,05) during post-IRIS/RR moments (median: 29,7%). Furthermore, an increase of cellular activation seems to occur prior to IRIS/RR. CONCLUSION/SIGNIFICANCE: These data suggest CD38 expression in CD8+ T cells interesting tool identifying HIV/leprosy individuals at risk for IRIS/RR. So, a comparative investigation to leprosy patients at RR should be conducted

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Cuidados aos idosos institucionalizados - opiniões do sujeito coletivo enfermeiro para 2026

OBJETIVO: Identifica a percepção de enfermeiros a respeito do cuidado de enfermagem direcionados às pessoas idosas residentes em Instituição de Longa Permanência para Idosos. MÉTODOS: Estudo prospectivo com elaboração de cenários futuros, com seis enfermeiros, nas quais se aplicou questionário. Na análise dos dados, utilizou-se o Discurso do Sujeito Coletivo (ILPI). RESULTADOS: Do Discurso do Sujeito Coletivo, originaram-se as categorias: papel da Instituição de Longa Permanência para Idosos na vida dos idosos e familiares; desafios para o Brasil, a respeito do cuidado de enfermagem aos idosos residentes em ILPI; cuidados de enfermagem necessários para os idosos institucionalizados; realização de cuidados de enfermagem para os idosos residentes em ILPI; preparo do enfermeiro brasileiro para enfrentar adequadamente o cuidado de enfermagem para os idosos residentes em ILPI. Nessas categorias, considerou-se a elaboração de cenários futuros para o ano 2026. CONCLUSÃO: A questão central enfocou a necessidade de preparo dos enfermeiros para cuidar de idosos institucionalizados, agora e em 2026.OBJECTIVE: To identify the perceptions of nurses regarding the nursing care residents in Long-Stay Institution for the Elderly(LSIE). METHODS: Is a prospective study with development of future scenarios, with six nurses, in which a questionnaire was applied. In the data analysis, was used the Collective Subject Discourse (CSD). RESULTS: From the CSD were originated 5 categories: 1) role of the LSIE in the lives of elderly and their families; 2) challenges for Brazil, regarding nursing care to elderly residents in LSIE; 3) nursing care needed for the institutionalized elderly; 4) performance of nursing care for elderly residents in LSIE; and 5) preparation for the Brazilian nurses to adequately address the nursing care for elderly residents in LSIE. In these categories, was considered the development of future scenarios for the year 2026. CONCLUSION: The central question focused on the need of preparing nurses to care for institutionalized elderly, now and in 2026.Identificar la percepción de enfermeros sobre el cuidado de enfermería orientado a personas ancianas residentes en una Institución de Larga Permanencia para Ancianos (ILPA). Métodos: Estudio prospectivo con elaboración de escenarios futuros, con seis enfermeros, en los cuales se aplicó un cuestionario. En el análisis de los datos, se utilizó el Discurso del Sujeto Colectivo (DSC). Resultados: Del DSC se originaron cinco categorías: 1) papel de la ILPA en la vida de los ancianos y familiares; 2) desafíos para Brasil, al respecto del cuidado de enfermería a los ancianos residentes en ILPA; 3) cuidados de enfermería necesarios para los ancianos institucionalizados; 4) realización de cuidados de enfermería para los ancianos residentes en ILPA; y, 5) preparación del enfermero brasileño para enfrentar adecuadamente el cuidado de enfermería para ancianos residentes en ILPA. En esas categorías, se consideró la elaboración de escenarios futuros para el año 2026. Conclusión: La cuestión central se enfocó en la necesidad de preparar a los enfermeros para cuidar de ancianos institucionalizados, ahora y en 2026