Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan

Entamoeba histolytica, morphologically identical to but genetically different from E. dispar and E. moshkovskii, is the causative agent of amebiasis. Recently there have been reports of increased risk for amebiasis among men who have sex with men (MSM) due to oral-anal sexual contact in several developed countries. In this longitudinal follow-up study, the incidence of amebiasis was determined among HIV-infected patients using serological and specific amebic antigen assays. DNA extracted from stool samples containing E. histolytica were analyzed by PCR, sequenced, and compared. Clinical manifestations and treatment response of invasive amebiasis in HIV-infected patients were reviewed. The results demonstrated that HIV-infected MSM were at significantly higher risk of amebiasis than patients from other risk groups. Clustering of E. histolytica isolates by sequencing analyses from geographically unrelated patients suggested person-to-person transmission. Despite immunosuppression, amebic liver abscesses and colitis responded favorably to metronidazole therapy. It is important to investigate in areas of high incidence of both amebiasis and HIV (sub-Saharan Africa) how generalizable these findings are

Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients

PURPOSE: Discussing end-of-life care with patients is often considered taboo, and signing a do-not-resuscitate (DNR) order is difficult for most patients, especially in Chinese culture. This study investigated distributions and details related to the signing of DNR orders, as well as the completeness of various DNR order forms. METHODS: Retrospective chart reviews were performed. We screened all charts from a teaching hospital in Taiwan for patients who died of cancer during the period from January 2010 to December 2011. A total of 829 patient records were included in the analysis. The details of the DNR order forms were recorded. RESULTS: The DNR order signing rate was 99.8 %. The percentage of DNR orders signed by patients themselves (DNR-P) was 22.6 %, while the percentage of orders signed by surrogates (DNR-S) was 77.2 %. The percentage of signed DNR forms that were completely filled out was 78.4 %. The percentage of DNR-S forms that were completed was 81.7 %, while the percentage of DNR-P forms that were completely filled out was only 67.6 %. CONCLUSION: Almost all the cancer patients had a signed DNR order, but for the majority of them, the order was signed by a surrogate. Negative attitudes of discussing death from medical professionals and/or the family members of patients may account for the higher number of signed DNR-S orders than DNR-P orders. Moreover, early obtainment of signed DNR orders should be sought, as getting the orders earlier could promote the quality of end-of-life care, especially in non-oncology wards

Risk of pneumocystosis after early discontinuation of prophylaxis among HIV-infected patients receiving highly active antiretroviral therapy

<p>Abstract</p> <p>Background</p> <p>Risk of pneumocystosis after discontinuation of primary or secondary prophylaxis among HIV-infected patients before CD4 counts increase to ≧200 cells/μL (early discontinuation) after receiving highly active antiretroviral therapy (HAART) is rarely investigated.</p> <p>Methods</p> <p>Medical records of 660 HIV-infected patients with baseline CD4 counts <200 cells/μL who sought HIV care and received HAART at a university hospital in Taiwan between 1 April, 1997 and 30 September, 2007 were reviewed to assess the incidence rate of pneumocystosis after discontinuation of prophylaxis for pneumocystosis.</p> <p>Results</p> <p>The incidence rate of pneumocystosis after HAART was 2.81 per 100 person-years among 521 patients who did not initiate prophylaxis or had early discontinuation of prophylaxis, which was significantly higher than the incidence rate of 0.45 per 100 person-years among 139 patients who continued prophylaxis until CD4 counts increased to ≧200 cells/μL (adjusted risk ratio, 5.32; 95% confidence interval, 1.18, 23.94). Among the 215 patients who had early discontinuation of prophylaxis after achievement of undetectable plasma HIV RNA load, the incidence rate of pneumocystosis was reduced to 0.31 per 100 person-years, which was similar to that of the patients who continued prophylaxis until CD4 counts increased to ≧200 cells/μL (adjusted risk ratio, 0.63; 95% confidence interval, 0.03, 14.89).</p> <p>Conclusions</p> <p>Compared with the risk of pneumocystosis among patients who continued prophylaxis until CD4 counts increased to ≧200 cells/μL after HAART, the risk was significantly higher among patients who discontinued prophylaxis when CD4 counts remained <200 cells/μL, while the risk could be reduced among patients who achieved undetectable plasma HIV RNA load after HAART.</p

Immune reconstitution inflammatory syndrome of Kaposi’s sarcoma in an HIV-infected patient

We present a case of Kaposi’s sarcoma-related immune reconstitution inflammatory syndrome in an HIV-infected patient who developed fever, worsening pulmonary infiltrates with respiratory distress, and progression of skin tumors at the popliteal region and thigh that resulted in limitation on movement of the right knee joint at 3.5 months following a significant increase of CD4 count after combination antiretroviral therapy

Herschel Observations of Major Merger Pairs at z=0: Dust Mass and Star Formation

We present Herschel PACS and SPIRE far-infrared (FIR) and submillimeter imaging observations for a large K-band selected sample of 88 close major-merger pairs of galaxies (H-KPAIRs) in 6 photometric bands (70, 100, 160, 250, 350, and 500 μm). Among 132 spiral galaxies in the 44 spiral–spiral (S+S) pairs and 44 spiral–elliptical (S+E) pairs, 113 are detected in at least 1 Herschel band. The star formation rate (SFR) and dust mass (M_(dust)) are derived from the IR SED fitting. The mass of total gas (M_(gas)) is estimated by assuming a constant dust-to-gas mass ratio of 0.01. Star-forming spiral galaxies (SFGs) in S+S pairs show significant enhancements in both specific star formation rate (sSFR) and star formation efficiency (SFE), while having nearly the same gas mass compared to control galaxies. On the other hand, for SFGs in S+E pairs, there is no significant sSFR enhancement and the mean SFE enhancement is significantly lower than that of SFGs in S+S pairs. This suggests an important role for the disk–disk collision in the interaction-induced star formation. The M_(gas) of SFGs in S+E pairs is marginally lower than that of their counterparts in both S+S pairs and the control sample. Paired galaxies with and without interaction signs do not differ significantly in their mean sSFR and SFE. As found in previous works, this much larger sample confirms that the primary and secondary spirals in S+S pairs follow a Holmberg effect correlation on sSFR

Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

Background: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms. Objectives: We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF. Methods: We compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 38) groups using multi-detector computed tomography and echocardiography. Results: LA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 ± 3.8 vs. 13.4 ± 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6–15.3) vs. 12.0 (10.2–13.7); p = 0.01] and LAWT(SD) [0.68 (0.61–0.71) vs. 0.60 (0.56–0.65); p &lt; 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement &lt;0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70–0.86) among all LA wall indices. Conclusions: Despite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF.</p

Insights on Distinct Left Atrial Remodeling Between Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) commonly coexist with overlapping pathophysiology like left atrial (LA) remodeling, which might differ given different underlying mechanisms. OBJECTIVES: We sought to investigate the different patterns of LA wall remodeling in AF vs. HFpEF. METHODS: We compared LA wall characteristics including wall volume (LAWV), wall thickness (LAWT), and wall thickness heterogeneity (LAWT[SD]) and LA structure, function among the controls (without AF or HFpEF, n = 115), HFpEF alone (n = 59), AF alone (n = 37), and HFpEF+AF (n = 38) groups using multi-detector computed tomography and echocardiography. RESULTS: LA wall remodeling was most predominant and peak atrial longitudinal strain (PALS) was worst in HFpEF+AF patients as compared to the rest. Despite lower E/e' (9.8 ± 3.8 vs. 13.4 ± 6.4) yet comparable LA volume, LAWT and PALS in AF alone vs. HFpEF alone, LAWV [12.6 (11.6–15.3) vs. 12.0 (10.2–13.7); p = 0.01] and LAWT(SD) [0.68 (0.61–0.71) vs. 0.60 (0.56–0.65); p < 0.001] were significantly greater in AF alone vs. HFpEF alone even after multi-variate adjustment and propensity matching. After excluding the HFpEF+AF group, both LAWV and LAWT [SD] provided incremental values when added to PALS or LAVi (all p for net reclassification improvement <0.05) in discriminating AF alone, with LAWT[SD] yielding the largest C-statistic (0.78, 95% CI: 0.70–0.86) among all LA wall indices. CONCLUSIONS: Despite a similar extent of LA enlargement and dysfunction in HFpEF vs. AF alone, larger LAWV and LAWT [SD] can distinguish AF from HFpEF alone, suggesting the distinct underlying pathophysiological mechanism of LA remodeling in AF vs. HFpEF

Local Benchmarks for the Evolution of Major-Merger Galaxies -- Spitzer Observations of a K-Band Selected Sample

We present Spitzer observations for a sample of close major-merger galaxy pairs (KPAIR sample) selected from 2MASS/SDSS-DR3 cross-matches. The goals are to study the star formation activity in these galaxies and to set a local bench mark for the cosmic evolution of close major mergers. The Spitzer KPAIR sample (27 pairs, 54 galaxies) includes all spectroscopically confirmed S+S and S+E pairs in a parent sample that is complete for primaries brighter than K=12.5 mag, projected separations of 5< s < 20 kpc/h, and mass ratios<2.5. The Spitzer data consist of images in 7 bands (3.6, 4.5, 5.8, 8, 24, 70, 160 um). Compared to single spiral galaxies in a control sample, only spiral galaxies in S+S pairs show significantly enhanced specific star formation rate (sSFR=SFR/M), whereas spiral galaxies in S+E pairs do not. Furthermore, the SFR enhancement of spiral galaxies in S+S pairs is highly mass-dependent. Only those with \rm M \gsim 10^{10.5} M_\sun show significant enhancement. Relatively low mass (\rm M \sim 10^{10} M_\sun) spirals in S+S pairs have about the same SFR/M compared to their counterparts in the control sample. There is evidence for a correlation between the global star formation activities (but not the nuclear activities) of the component galaxies in massive S+S major-merger pairs (the "Holmberg effect"). There is no significant difference in the SFR/M between the primaries and the secondaries, nor between spirals of SEP<1 and those of SEP.1. The contribution of KPAIR galaxies to the cosmic SFR density in the local universe is only 1.7%.Comment: 73 pages; accpected by Ap