Bland-Altman plot of measurement differences against measurements averages with 95% limits of agreement superimposed for pair-wise comparisons of Scoring of radiographic abnormalities (SRA), for inter-observer agreement: A) between reader 1 vs reader 2 for the first measurement, B) between reader one vs reader two for the second measurement.

<p>Bland-Altman plot of measurement differences against measurements averages with 95% limits of agreement superimposed for pair-wise comparisons of Scoring of radiographic abnormalities (SRA), for inter-observer agreement: A) between reader 1 vs reader 2 for the first measurement, B) between reader one vs reader two for the second measurement.</p

Bland-Altman plot of measurement differences against measurements average with a 95% limit of agreement superimposed for pair-wise comparisons of scoring of radiographic abnormalities (SRA), for intra-observer agreement: A) between reader one for the first and second measurements, B) between reader two for the first and second measurements.

<p>Bland-Altman plot of measurement differences against measurements average with a 95% limit of agreement superimposed for pair-wise comparisons of scoring of radiographic abnormalities (SRA), for intra-observer agreement: A) between reader one for the first and second measurements, B) between reader two for the first and second measurements.</p

Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series

<div><p>Background</p><p>Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases.</p><p>Objective</p><p>To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS.</p><p>Material and Methods</p><p>We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions.</p><p>Results</p><p>We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm³ [interquartile range (IQR): 30–150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. <i>Pneumocystis jirovecii</i> pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08–0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06–0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses.</p><p>Conclusions</p><p>HAART for 180 days or more was associated with 79% decrease in all-cause in-hospital mortality and lower frequency of PJP as discharge diagnosis. The prevalence of poorly controlled HIV was high, regardless of whether HIV was diagnosed before or during admission. HIV diagnosis and treatment resources should be improved, and strengthening of HAART program needs to be promoted.</p></div

Representative example of the result of the scoring system for radiographic abnormalities.

<p>Score =6.5, which represents the mean value of two evaluations.</p

Association of absolute values and percentage of predicted of forced vital capacity (FVC) (A, B); for whom forced expiratory volume in 1 s (FEV₁) (C, D) with the score of degree of radiographic abnormalities.

<p>(FEV₁).</p

Characteristics of HIV/AIDS patients in a specialty hospital for respiratory diseases in Mexico City, from January 2010 to December 2010, according to diagnosis of HIV infection previous to hospitalization.

<p>HIV, Human Immunodeficiency Virus; AIDS, Acquired Immunodeficiency Syndrome; IQR, interquartile range; PJ, <i>Pneumocystis jirovecii</i>;</p><p>^aDefined as the time elapsed between the onset of the symptoms and diagnosis of respiratory disease.</p><p>^bChi square test;</p><p>^cKruskal- Wallis test.</p><p>Characteristics of HIV/AIDS patients in a specialty hospital for respiratory diseases in Mexico City, from January 2010 to December 2010, according to diagnosis of HIV infection previous to hospitalization.</p

Characteristics of HIV/AIDS patients in a reference hospital for respiratory diseases in Mexico City, from January 2010 to December 2010, according to discharge respiratory diagnoses.

<p>HIV, Human Immunodeficiency Virus; AIDS, Acquired Immunodeficiency Syndrome; IQR, interquartile range; PJ, <i>Pneumocystis jirovecii</i>;</p><p>^aDefined as the time elapsed between the onset of the symptoms and diagnosis of respiratory disease.</p><p>^bChi square test;</p><p>^cKruskal- Wallis test.</p><p>Characteristics of HIV/AIDS patients in a reference hospital for respiratory diseases in Mexico City, from January 2010 to December 2010, according to discharge respiratory diagnoses.</p

Assessing the individual risk of fecal poliovirus shedding among vaccinated and non-vaccinated subjects following national health weeks in Mexico

<div><p>Background</p><p>Mexico introduced inactivated polio vaccine (IPV) into its routine immunization (RI) schedule in 2007 but continued to give trivalent oral polio vaccine (tOPV) twice a year during national health weeks (NHW) through 2015.</p><p>Objectives</p><p>To evaluate individual variables associated with poliovirus (PV) shedding among children with IPV-induced immunity after vaccination with tOPV and their household contacts.</p><p>Materials and methods</p><p>We recruited 72 children (both genders, ≤30 months, vaccinated with at least two doses of IPV) and 144 household contacts (both genders, 2 per household, children and adults) between 08/2010 and 09/2010 in Orizaba, Veracruz. Three NHW took place (one before and two after enrollment). We collected fecal samples monthly for 12 months, and tested 2500 samples for polioviruses types 1, 2 and 3 with three serotype-specific singleplex real-time RT-PCR (rRT-PCR) assays. In order to increase the specificity for OPV virus, all positive and 112 negative samples were also processed with a two-step, OPV serotype-specific multiplex rRT-PCR.</p><p>Analysis</p><p>We estimated adjusted hazard ratios (HR) and 95% CI using Cox proportional hazards regression for recurrent events models accounting for individual clustering to assess the association of individual variables with the shedding of any poliovirus for all participants and stratifying according to whether the participant had received tOPV in the month of sample collection.</p><p>Results</p><p>216 participants were included. Of the 2500 collected samples, using the singleplex rRT-PCR assay, PV was detected in 5.7% (n = 142); PV1 in 1.2% (n = 29), PV2 in 4.1% (n = 103), and PV3 in 1.9% (n = 48). Of the 256 samples processed by multiplex rRT-PCR, PV was detected in 106 (PV1 in 16.41% (n = 42), PV2 in 21.09% (n = 54), and PV3 in 23.05% (n = 59). Both using singleplex and multiplex assays, shedding of OPV among non-vaccinated children and subjects older than 5 years of age living in the same household was associated with shedding of PV2 by a household contact. All models were adjusted by sex, age, IPV vaccination and OPV shedding by the same individual during the previous month of sample collection.</p><p>Conclusion</p><p>Our results provide important evidence regarding the circulation of poliovirus in a mixed vaccination context (IPV+OPV) which mimics the “transitional phase” that occurs when countries use both vaccines simultaneously. Shedding of OPV2 by household contacts was most likely the source of infection of non-vaccinated children and subjects older than 5 years of age living in the same household.</p></div

Association of individual characteristics with OPV in fecal samples by serotype-specific multiplex rRT-PCR using Cox proportional hazards regression for recurrent events models accounting for individual clustering among 256 samples.

<p>Association of individual characteristics with OPV in fecal samples by serotype-specific multiplex rRT-PCR using Cox proportional hazards regression for recurrent events models accounting for individual clustering among 256 samples.</p

Percentage of positive stool samples with each serotype according to whether the person received tOPV in the NHW previous to sample collection.

<p><b>Samples processed by singleplex (Panels A) and multiplex rRT-PCR (Panel B) assays</b>. Panel A. Among stools from vaccinated individuals, serotype 2 was more frequent than serotype 1(10.1% versus 4.9%, p = 0.003). No differences were observed between serotype 1 compared to 3 or 2 compared to 3. In contrast, among stools samples from persons who did not receive tOPV in the past NHW, Sabin serotype 2 was more frequent than Sabin 1 (2.8% versus 0.3%, p<0.001) and Sabin 3 (2.8% versus 0.6%, p<0.001). There were no differences between serotype 1 versus 3 (0.3% versus 0.6%, p = 0.156). Panel B. We did not find differences for frequency of OPVs in samples from vaccinated or non-vaccinated individuals.</p