Different patterns of HIV-1 DNA after therapy discontinuation

BACKGROUND: By persisting in infected cells for a long period of time, proviral HIV-1 DNA can represent an alternative viral marker to RNA viral load during the follow-up of HIV-1 infected individuals. In the present study sequential blood samples of 10 patients under antiretroviral treatment from 1997 with two NRTIs, who refused to continue any antiviral regimen, were analyzed for 16 - 24 weeks to study the possible relationship between DNA and RNA viral load. METHODS: The amount of proviral DNA was quantified by SYBR green real-time PCR in peripheral blood mononuclear cells from a selected group of ten patients with different levels of plasmatic viremia (RNA viral load). RESULTS: Variable levels of proviral DNA were found without any significant correlation between proviral load and plasma HIV-1 RNA levels. Results obtained showed an increase or a rebound in viral DNA in most patients, suggesting that the absence of therapy reflects an increase and/or a persistence of cells containing viral DNA. CONCLUSION: Even though plasma HIV RNA levels remain the basic parameter to monitor the intensity of viral replication, the results obtained seem to indicate that DNA levels could represent an adjunct prognostic marker in monitoring HIV-1 infected subjects. Key words: HIV-1DNA viral load, therapy interruption

Self-reported history of Pap-smear in HIV-positive women in Northern Italy: a cross-sectional study

BACKGROUND: The incidence of invasive cervical cancer in HIV-positive women is higher than in the general population. There is evidence that HIV-positive women do not participate sufficiently in cervical cancer screening in Italy, where cervical cancer is more than 10-fold higher in women with AIDS than in the general population. The aim of the present study was to evaluate the history of Pap-smear in HIV-positive women in Italy in recent years. We also examined the sociodemographic, clinical, and organizational factors associated with adherence to cervical cancer screening.METHODS: A cross-sectional study was conducted between July 2006 and June 2007 in Emilia-Romagna region (Northern Italy). All HIV-positive women who received a follow-up visit in one of the 10 regional infectivology units were invited to participate. History of Pap-smear, including abnormal smears and subsequent treatment, was investigated through a self-administered anonymous questionnaire. The association between lack of Pap-smear in the year preceding the interview and selected characteristics was assessed by means of odds ratios (OR) and 95% confidence intervals adjusted for study centre and age.RESULTS: A total of 1,002 HIV-positive women were interviewed. Nine percent reported no history of Pap-smear, and 39% had no Pap-smear in the year prior to the date of questionnaire (last year). The lack of Pap-smear in the last year was significantly associated with age <35 years (OR = 1.4, compared to age > or =45 years), lower education level (OR = 1.3), first HIV-positive test in the last 2 years (OR = 1.4), and CD4 count <200 cells/microl (OR = 1.6). Conversely, when women were advised by a gynecologist rather than other health workers to undergo screening, it significantly increased adherence. Non-significantly higher proportions of lack of Pap-smear in the last year were found in women born in Central-Eastern Europe (OR = 1.8) and Africa (OR = 1.3). No difference in history of Pap-smear emerged by mode of HIV-acquisition or AIDS status.Three hundred five (34%) women reported a previous abnormal Pap-smear, and of the 178 (58%) referred for treatment, 97% complied.CONCLUSIONS: In recent years the self-reported history of Pap-smear in HIV-positive women, in some public clinics in Italy, is higher than previously reported, but further efforts are required to make sure cervical cancer screening is accessible to all HIV-positive women

Machine learning in predicting respiratory failure in patients with COVID-19 pneumonia - challenges, strengths, and opportunities in a global health emergency.

Aims- The aim of this study was to estimate a 48 hour prediction of moderate to severe respiratory failure, requiring mechanical ventilation, in hospitalized patients with COVID-19 pneumonia. Methods- This was an observational study that comprised consecutive patients with COVID-19 pneumonia admitted to hospital from 21 February to 6 April 2020. The patients\u2019 medical history, demographic, epidemiologic and clinical data were collected in an electronic patient chart. The dataset was used to train predictive models using an established machine learning framework leveraging a hybrid approach where clinical expertise is applied alongside a data-driven analysis. The study outcome was the onset of moderate to severe respiratory failure defined as PaO 2 /FiO 2 ratio <150 mmHg in at least one of two consecutive arterial blood gas analyses in the following 48 hours. Shapley Additive exPlanations values were used to quantify the positive or negative impact of each variable included in each model on the predicted outcome. Results- A total of 198 patients contributed to generate 1068 usable observations which allowed to build 3 predictive models based respectively on 31-variables signs and symptoms, 39-variables laboratory biomarkers and 91-variables as a composition of the two. A fourth \u201cboosted mixed model\u201d included 20 variables was selected from the model 3, achieved the best predictive performance (AUC=0.84) without worsening the FN rate. Its clinical performance was applied in a narrative case report as an example. Conclusion- This study developed a machine model with 84% prediction accuracy, which is able to assist clinicians in decision making process and contribute to develop new analytics to improve care at high technology readiness levels

Lieviti e disordini intestinali

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Hulls of codes from incidence matrices of connected regular graphs

The hulls of codes from the row span over F_p, for any prime p, of incidence matrices of connected k-regular graphs are examined, and the dimension of the hull is given in terms of the dimension of the row span of A+kI over \F_p, where A is an adjacency matrix for the graph. If p=2, for most classes of connected regular graphs with some further form of symmetry, it was shown that the hull is either {0} or has minimum weight at least 2k-2. Here we show that if the graph is strongly regular with parameter set (n,k,\lambda,\mu), then, unless k is even and $\mu$ is odd, the binary hull is non-trivial, of minimum weight generally greater than 2k-2, and we construct words of low weight in the hull; if k is even and $\mu$ is odd, we show that the binary hull is zero. Further, if a graph is the line graph of a $k$-regular graph, $k \ge 3$, that has an $\ell$-cycle for some $\ell \ge 3$, the binary hull is shown to be non-trivial with minimum weight at most $2\ell(k-2)$. Properties of the $p$-ary hulls are also established.

EARLY OXYGEN DESATURATION IS RELATED TO AMS DEVELOPMENT DURING ACUTE EXPOSURE TO HIGH ALTITUDE (HA

Early desaturation during acute HA exposure (hypobaric chamber) has been reported to be significantly related to AMS development. We aimed to study the hypoxic profile and the AMS development during the ascent from Alagna (1200m) to Capanna Regina Margherita (4559m) with an overnight stay in Rifugio Gnifetti (3647m). Forty-four (8F) subjects (mean age 37.412.7) were recruited at the cable care station in Alagna, equipped with a 24-h data memory pulse oximeter (Pulsox-3Si,Minolta, Osaka, Japan) and asked to fill the Lake Louise questionnaire. Only data from Alagna to Rifugio Gnifetti and the subsequent night are reported. Fifteen subjects (34%) showed a LL score ≥3 (AMS+). In Alagna, SpO2 data were similar (94.5%1.6 vs 95%1.4 n.s.) but during HA exposure AMS+ group had a significantly lower SpO2: at Punta Indren (3275m) after a 30-45 minutes cable car ascent (84%4.5 vs 86.8%3.7 p <0.049; in Rifugio Gnifetti during 3 hours rest after the arrival (84%2.1 vs 86.11.9 p<0.01) and during the subsequent night (76.7%3.8 vs 79.1%3.4 p 0.049). There was no significant difference during the 2 hours exercise to reach Rifugio Gnifetti (81.3%2.9 vs 82.1%2.5 n.s.). No difference was found in the lower peak SpO2 during the night but the AMS+ group always spent more time with a lower SpO2: percentage of total time spent with SpO2 <85% at rest in Rifugio Gnifetti was 56%20.6 vs 34%18 p 0.017; percentage of total time spent with SpO2<75% during the night was 35%27 vs 18%19 p 0.036. We conclude that in subjects who develop subsequent AMS, hypoxemia is always more pronounced and prolonged than in healthy subjects; the new finding is that the higher desaturation occurs very early at the beginning of altitude exposure

Seroprevalence of West Nile virus-specific antibodies in a cohort of blood donors in northeastern Italy

IgG and IgM levels against West Nile virus (WNV) were measured in 20,033 serum samples that were obtained between October 2008 to September 2009 from 9913 blood donors in the district of Ferrara, northeastern Italy. As confirmatory test, a microneutralization assay was used to detect the presence of neutralizing antibodies against WNV. Sixty-eight subjects (0.69%) were positive for anti-WNV by immunofluorescence assay. Large differences in the prevalence of antibodies to WNV were noted between towns in the area evaluated