Defining the clinical role of adapted digital light field photography in the treatment of HIV-induced Kaposi\u27s sarcoma lesions

Kaposi’s sarcoma (KS): a vascular tumor associated with HHV8 and HIV infection KS burden at Maputo Central Hospital (MCH): •Referral center for all of southern Mozambique, 1500 beds, \u3e65% HIV+ patients on medical services •Dermatology ward: 50 beds, \u3e30% of admitted patients suffer from Kaposi’s sarcoma and its complications •10-15 cases/month admitted with advanced KS; additional 15-20 cases/month treated outpatient •KS is the most common form of malignancy seen at MCH among men, second most frequent among women Current KS standard of care: •First line treatment: chemo- and concomitant antiretroviral-therapy •Pre-treatment photographs rarely taken to establish a baseline for therapeutic monitoring •Post-therapy improvement is based on gross examination and clinical judgment •Tracking correlation between therapy dosing and shrinkage of lesion size is difficult due to variation and number of lesions Aim of the study: determine the utility of adapted digital light field photography in a resource-limited setting and establish best clinical practice for future KS monitoring via photograph

'I saw it as a second chance': A qualitative exploration of experiences of treatment failure and regimen change among people living with HIV on second- and third-line antiretroviral therapy in Kenya, Malawi and Mozambique.

Increasing numbers of people living with HIV (PLHIV) in sub-Saharan Africa are experiencing failure of first-line antiretroviral therapy and transitioning onto second-line regimens. However, there is a dearth of research on their treatment experiences. We conducted in-depth interviews with 43 PLHIV on second- or third-line antiretroviral therapy and 15 HIV health workers in Kenya, Malawi and Mozambique to explore patients' and health workers' perspectives on these transitions. Interviews were audio-recorded, transcribed and translated into English. Data were coded inductively and analysed thematically. In all settings, experiences of treatment failure and associated episodes of ill-health disrupted daily social and economic activities, and recalled earlier fears of dying from HIV. Transitioning onto more effective regimens often represented a second (or third) chance to (re-)engage with HIV care, with patients prioritising their health over other aspects of their lives. However, many patients struggled to maintain these transformations, particularly when faced with persistent social challenges to pill-taking, alongside the burden of more complex regimens and an inability to mobilise sufficient resources to accommodate change. Efforts to identify treatment failure and support regimen change must account for these patients' unique illness and treatment histories, and interventions should incorporate tailored counselling and social and economic support

Infeção Cutânea por Citomegalovírus em Doente com Infecção VIH/SIDA

Infection by cytomegalovirus has worldwide distribution with high prevalence in developing countries, where it reaches almost 100% of the population. Cutaneous manifestations are rare. Moreover, unspecific presentation of dermatological lesions may contribute to subdiagnosis of the disease. We report a case of a 24 years-old female patient, severely immunocompromised, with ulcerations on the skin with 4 months of evolution, diagnosed with human immunodeficiency virus type 1 infection two months after the onset of lesions. In the third week of hospitalization she developed an acute cytomegalovirus retinitis, and despite initiation of anti-retroviral and anti- cytomegalovirus treatment initiation, she died after three months with an acute pericarditis.A infecção por citomegalovírus tem distribuição mundial com alta prevalência nos países subdesenvolvidos, onde atinge quase 100% da população. As manifestações cutâneas são raras. A apresentação inespecífica das mesmas pode contribuir para o subdiagnóstico da doença. Relatamos o caso clínico de uma doente de 24 anos, gravemente imunodeprimida, com ulcerações na pele com quatro meses de evolução, e diagnóstico de infecção por vírus de imunodeficiência humana tipo 1 dois meses após o início das lesões. Na terceira semana de internamento desenvolveu uma retinite aguda por citomegalovírus e, embora tenha iniciado tratamento antirretrovírico e depois ganciclovir acabou por falecer após três meses por pericardite aguda

Patterns of Antibodies Against Latent and Lytic Antigens of Human Herpesvirus 8 in an Endemic Population and Patients With Kaposi`s Sarcoma in Mozambique

The patterns of antibodies against latent and lytic antigens of human herpesvirus 8 (HHV-8) were assessed using immunofluorescence assays of samples from 155 persons seropositive for HHV-8 seen at public health centers and 24 patients with Kaposi`s sarcoma (KS) from Mozambique. Of the 155 persons without KS, 48(31%) had antibodies against latent antigens only, 29 (18.7%) had antibodies against lytic antigens only, and 78 (50.3%) had antibodies against both types of antigen. The HHV-8 antibody titer tended to increase with age until age 40, after which it began to decrease. High titers of antibodies against latent and lytic antigens of HHV-8 were detected mostly in persons co-infected with HIV, and these increased titers could have a predictive value. All patients with KS except four patients who were seronegative for HHV-8 had elevated titers of HHV-8 antibodies, predominantly against latent antigens. The data suggest the potential for an increase in the development of KS in this endemic area for HHV-8. J. Med. Virol. 82:1576-1581, 2010. (C) 2010 Wiley-Liss, Inc.Ministerio da Ciencia e Tecnologia/Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (MCT/CNPq), Brasil (PROAFRICA)[490452/2007-8]Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Ministerio da Ciencia e Tecnologia/Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (MCT/CNPq), Brasil (PROAFRICA)[304372/2006-4]Instituto Adolfo LutzInstituto Adolfo Lutz (CTC)[55/06

Endoscopic imaging results: web-based solution for video diffusion with real-time assistance

The technological evolution seen in the past years led to an increase in the number therapeutic and diagnostic tests. In this paper a new solution for storage, diffusion, and real-time remote assistance in endoscopic exams is presented. The aim is to solve the problem of endoscopic examinations not being archived and easily accessed anywhere within a health care network by authorized health care professionals and researchers. Solving that problem avoids unneeded repetition of unpleasant exams and allows the comparison of video segments with future procedures. The presented solution also allows the streaming and real-time remote assistance of exams being carried out. This way health care professionals can contribute with their expertise even if they cannot attend onsite.This work is funded by ERDF - European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by Nation- al Funds through the FCT - Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01- 0202-FEDER- 013853

HIV-1 Genetic Diversity and Transmitted Drug Resistance in Health Care Settings in Maputo, Mozambique

Objectives: To characterize HIV-1 diversity and transmitted drug resistance in persons with access to care and treatment in Maputo, Mozambique. Methods: Samples were collected in 2002-2004 from 144 drugnaive patients attending public hospitals and private. - Fundacao para a Ciencia c Tecnologia, Portugal [PSIDA/ESP/49699]. - Supported by Fundacao para a Ciencia c Tecnologia, Portugal (project PSIDA/ESP/49699). I.B., C.R., and A.B.A. are Supported by PhD grants from Fundacao para a Ciencia e Teenologia

Endoscopic imaging results: web based solution with video diffusion

In this paper we present a solution for diffusion of endoscopic imaging results. The aim is to solve the problem of endoscopy examinations access anywhere within a health care network by authorized health care professionals and researchers avoiding the need to repeat unpleasant exam procedures. The presented solution also enables streaming in real time of exams being carried out, which means that the health professionals can contribute with their expertise even when, for some reason, they cannot attend the exam onsite. All this information is archived and accessible at any moment. The proposed solution also provides tools to export the exams in any video format.This work is funded by ERDF - European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by Nation- al Funds through the FCT - Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01-0202-FEDER- 013853