Safety of efavirenz in first-trimester of pregnancy: a systematic review and meta-analysis of outcomes from observational cohorts.

INTRODUCTIO

Intestinal protozoa in HIV-infected patients: effect of rifaximin in Cryptosporidium parvum and Blastocystis hominis infections

In HIV-1 infected patients severe enteritis and chronic diarrhea are often documented as a consequence of multiple opportunistic infections. We analyzed 48 HIV-1 positive patients for the presence of intestinal pathogenic protozoa. Patients with CD4 > or = 200/mm3 showed a higher prevalence of a single pathogenic protozoa than patients with CD4 or = 200/mm3, who presented enteric and systemic symptoms due to Criptosporidium or Blastocystis associated with enteropathogenic bacteri

Effectiveness, Longevity, and Complications of Facelift by Barbed Suture Insertion

Background Minimally invasive facelift techniques involving barbed suture insertion have become popular among patients who wish to correct facial tissue ptosis.Objectives The authors sought to determine the effectiveness, longevity, complications, and postoperative sequelae associated with facelift by means of barbed polydioxanone (PDO) threads.Methods A total of 160 consecutive patients who underwent facelift with barbed threads were evaluated retrospectively. For malar augmentation and correction of nasolabial grooves, 2 or 3 PDO threads (23 gauge) were placed per side; for treatment of mandibular lines, 2 to 4 PDO threads (21 gauge) were inserted per side.Results Immediately after suture placement and for 1 month postoperatively, patients experienced improvement in facial tissue ptosis. This aesthetic result declined noticeably by 6 months and was absent by 1 year. The overall complication rate in the early postoperative period was 34% (55 of 160 patients). Eighteen patients (11.2%) had superficial displacement of the barbed sutures, 15 (9.4%) experienced transient erythema, 10 (6.2%) had infection, 10 (6.2%) experienced skin dimpling, and 2 (1.2%) had temporary facial stiffness.Conclusions Placement of barbed threads yields instantaneous improvement in facial ptosis that is no longer apparent by 1 year. Given this transient benefit and the complication rate of 34%, we recommend limiting this procedure to patients with contraindications for more invasive facial surgery.Level of Evidence: 4</p

Ductal Carcinoma in Situ of the Breast: MR Imaging Findings With Histopathologic Correlation.

Ductal carcinoma in situ (DCIS) is a noninvasive malignancy that is commonly encountered at routine breast imaging. It may be a primary tumor or may be seen in association with other focal higher-grade tumors. Early detection is important because of the large proportion of DCIS that can progress to invasive carcinoma. The extent of DCIS involvement is frequently underestimated at mammography, which can reliably help detect only calcified DCIS; consequently, magnetic resonance (MR) imaging evaluation can alter the course of treatment. Seven biopsy-proved cases of DCIS were evaluated with T2-weighted MR imaging sequences, as well as T1-weighted sequences performed both before and after contrast material administration. The signal intensity and enhancement patterns of the tumors were analyzed, and the findings were correlated with the relevant underlying histopathologic features. Common enhancement patterns of DCIS include clumped linear-ductal enhancement, clumped focal enhancement, and masslike enhancement. The most common enhancement distribution pattern is segmental, followed by focal, diffuse, linear-ductal, and regional patterns. At T2-weighted MR imaging, DCIS is typically isointense relative to breast parenchyma; less commonly, it is hypointense or hyperintense. The use of MR imaging in the evaluation of DCIS is controversial, and many questions remain with regard to treatment and management. However, breast MR imaging can be extremely useful in the preoperative diagnosis and evaluation of DCIS when used in conjunction with other imaging modalities

Combined antiretroviral therapy reduces hyperimmunoglobulinemia in HIV-1 infected children

Objective: To evaluate the effect of combined antiretroviral therapy on serum immunoglobulin (Ig) levels in HIV-1 perinatally infected children. Methods: Data from 1250 children recorded by the Italian Register for HIV Infection in Children from 1985 to 2002 were analysed. Since Ig levels physiologically vary with age, differences at different age periods were evaluated as differences in z-scores calculated using means and standard deviations of normal population for each age period. Combined antiretroviral therapy has become widespread in Italy since 1996, thus differences in Ig z-scores between the periods 1985-1995 and 1996-2002 were analysed. Data according to type of therapeutic regimen were also analysed. Results: Between the two periods 1985-1995 and 1996-2002, significant (P < 0.0001) decreases in IgG (6.29 ± 4.72 versus 4.44 ± 4.33), IgM (9.25 ± 13.32 versus 5.61 ± 7.93), and IgA (10.25 ± 15.68 versus 6.48 ± 11.56) z-scores, together with a parallel significant (P < 0.0001) increase in CD4 T-lymphocyte percentages, were found. These decreases were confirmed regardless of whether the children were receiving intravenous Ig or not. Ig z-scores were significantly higher in children receiving mono-therapy than in those receiving double-combined therapy (IgC, P < 0.0001; IgM, P = 0.003; IgA, P = 0.031) and in the latter children than in those receiving three or more drugs (P < 0.0001 for all z-scores). Ig z-scores correlated inversely with CD4 T-lymphocyte percentages and, directly, with viral loads. Conclusions: Our data show that in HIV-1 infected children combined antiretroviral therapy leads to reduction of hyperimmunoglobulinemia which parallels restoration of CD4 T-lymphocyte percentage and viral load decrease, which it turn probably reflects improved B-lymphocyte functions. © 2004 Lippincott Williams & Wilkins

Good prenatal detection rate of major birth defects in HIV-infected pregnant women in Italy

What's already known about this topic? Exposure to antiretroviral treatment in pregnancy does not seem to increase the risk of birth defects, but there is no information on the rate of prenatal detection of such defects. What does this study adds? We provide for the first time, in a national case series, information about prenatal detection rate in women with HIV (51.6% for any major defect, 66.7% for chromosomal abnormalities, and 85% for severe structural defect

Ventilation and outcomes following robotic-assisted abdominal surgery: an international, multicentre observational study

Background: International data on the epidemiology, ventilation practice, and outcomes in patients undergoing abdominal robotic-assisted surgery (RAS) are lacking. The aim of the study was to assess the incidence of postoperative pulmonary complications (PPCs), and to describe ventilator management after abdominal RAS. Methods: This was an international, multicentre, prospective study in 34 centres in nine countries. Patients ≥18 yr of age undergoing abdominal RAS were enrolled between April 2017 and March 2019. The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score was used to stratify for higher risk of PPCs (≥26). The primary outcome was the incidence of PPCs. Secondary endpoints included the preoperative risk for PPCs and ventilator management. Results: Of 1167 subjects screened, 905 abdominal RAS patients were included. Overall, 590 (65.2%) patients were at increased risk for PPCs. Meanwhile, 172 (19%) patients sustained PPCs, which occurred more frequently in 132 (22.4%) patients at increased risk, compared with 40 (12.7%) patients at lower risk of PPCs (absolute risk difference: 12.2% [95% confidence intervals (CI), 6.8–17.6%]; P&lt;0.001). Plateau and driving pressures were higher in patients at increased risk, compared with patients at low risk of PPCs, but no ventilatory variables were independently associated with increased occurrence of PPCs. Development of PPCs was associated with a longer hospital stay. Conclusions: One in five patients developed one or more PPCs (chiefly unplanned oxygen requirement), which was associated with a longer hospital stay. No ventilatory variables were independently associated with PPCs. Clinical trial registration: NCT02989415

Investigating determinants of yawning in the domestic (Equus caballus) and Przewalski (Equus ferus przewalskii) horses

International audienceYawning is rare in herbivores which therefore may be an interesting group to disentangle the potential function(s) of yawning behaviour. Horses provide the opportunity to compare not only animals living in different conditions but also wild versus domestic species. Here, we tested three hypotheses by observing both domestic and Przewalski horses living in semi-natural conditions: (i) that domestic horses may show an elevated rate of yawning as a result of the domestication process (or as a result of life conditions), (ii) that individuals experiencing a higher level of social stress would yawn more than individuals with lower social stress and (iii) that males would yawn more often than females. The study involved 19 Przewalski horses (PHs) and 16 domestic horses (DHs) of different breeds living in large outdoor enclosures. The results showed that there was no difference between the PH and DH in yawning frequency (YF). PHs exhibited much higher levels of social interactions than DHs. There was a positive correlation between yawning frequency and aggressive behaviours in PHs, especially males, supporting the idea that yawning may be associated with more excitatory/stressful social situations. A correlation was found between yawning frequency and affiliative behaviours in DHs, which supports the potential relationship between yawning and social context. Finally, the entire males, but not castrated males, showed much higher levels of yawning than females in both species. The intensity (rather than the valence) of the interaction may be important in triggering yawning, which could therefore be a displacement activity that helps reduce tension