High rate of lymphoma among a UK cohort of adolescents with vertically acquired HIV-1 infection transitioning to adult care in the era of antiretroviral therapy

Among an inner London UK cohort of 147 adolescents transitioning from paediatric into adult care between 2007 and 2015, a new diagnosis of lymphoma was made in five patients; incidence rate = 0.425/100 person-years (95% confidence interval = 0.424–0.426). Previously described risk factors, including low nadir CD4+ cell count and ongoing HIV-1 viraemia, appeared to be important. These data suggest that careful surveillance and a low threshold for investigating relevant symptoms continue to be essential for such patients

A qualitative study exploring perceptions and attitudes of community pharmacists about extended pharmacy services in Lahore, Pakistan

Background In recent decades, community pharmacies reported a change of business model, whereby a shift from traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations. Within this context, the present study was aimed to explore knowledge, perception and attitude of community pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan. Methods A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Results Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3) training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware of EPS and only a handful had the concept of extended services. Although majority of our study respondents were unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and deprived salary structures were reported as barriers towards the provision of EPS at the practice settings. Conclusion Although the study reported poor awareness towards EPS, the findings indicated a number of key themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude toward practice change provided to the support and facilitation of health and community based agencies in Pakistan

Human impact on the transport of terrigenous and anthropogenic elements to peri-alpine lakes (Switzerland) over the last decades

Terrigenous (Sc, Fe, K, Mg, Al, Ti) and anthropogenic (Pb and Cu) element fluxes were measured in a new sediment core from Lake Biel (Switzerland) and in previously well-documented cores from two upstream lakes (Lake Brienz and Lake Thun). These three large peri-alpine lakes are connected by the Aare River, which is the main tributary to the High Rhine River. Major and trace element analysis of the sediment cores by inductively coupled plasma mass spectrometry (ICP-MS) shows that the site of Lake Brienz receives three times more terrigenous elements than the two other studied sites, given by the role of Lake Brienz as the first major sediment sink located in the foothills of the Alps. Overall, the terrigenous fluxes reconstructed at the three studied sites suggest that the construction of sediment-trapping reservoirs during the twentieth century noticeably decreased the riverine suspended sediment load at a regional scale. In fact, the extensive river damming that occurred in the upstream watershed catchment (between ca. 1930 and 1950 and up to 2300 m a.s.l.) and that significantly modified seasonal suspended sediment loads and riverine water discharge patterns to downstream lakes noticeably diminished the long-range transport of (fine) terrigenous particles by the Aare River. Concerning the transport of anthropogenic pollutants, the lowest lead enrichment factors (EFs Pb) were measured in the upstream course of the Aare River at the site of Lake Brienz, whereas the metal pollution was highest in downstream Lake Biel, with the maximum values measured between 1940 and 1970 (EF Pb >3). The following recorded regional reduction in aquatic Pb pollution started about 15 years before the actual introduction of unleaded gasoline in 1985. Furthermore, the radiometric dating of the sediment core from Lake Biel identifies three events of hydrological transport of artificial radionuclides released by the nuclear reactor of Mühleberg located at more than 15 km upstream of Lake Biel for the time period 1970 to 200

Therapeutic Management of Primary Immunodeficiency in Older Patients

Primary immunodeficiency disease (PID) has traditionally been viewed as a group of illnesses seen in the paediatric age group. New advances in diagnosis and treatment have led to an increase in the number of elderly PID patients. However, there is lack of research evidence on which to base clinical management in this group of patients. Management decisions often have to be based therefore on extrapolations from other patient cohorts or from younger patients. Data from the European Society for Immunodeficiencies demonstrates that the vast majority of elderly patients suffer from predominantly antibody deficiency syndromes. We review the management of PID disease in the elderly, with a focus on antibody deficiency disease