PLWH treated with modern ART and high CD4 T cell counts: no evidence of HIV-associated vasculopathy measured by extra- and intracranial ultrasound

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Current Treatment Options in CLL

After impressive developments in recent years with the rise of new targeted agents, chemoimmunotherapy (CIT) only plays a minor role in the treatment of patients with chronic lymphocytic leukemia (CLL). Inhibitors of the Bruton tyrosine kinase (BTK), such as ibrutinib or more recently acalabrutinib, are highly effective, even in poor-risk or chemo-refractory patients. Venetoclax, an inhibitor of the anti-apoptotic BCL2 protein and, to a lesser extent, phosphoinositide-3 kinase (PI3K) delta inhibitors, add to the armamentarium of targeted agents for the treatment of CLL. Furthermore, anti-CD20 monoclonal antibodies are used very successfully either alone or in combination with BTK, BCL2 or PI3K inhibitors. Despite these advances, there is still an ongoing pursuit for new therapeutic approaches in the treatment of CLL. An even bigger challenge poses the determination of the optimal combination and sequence of those drugs. Here, we give an overview of current treatment options in CLL, weighing the advantages and disadvantages of each approach in the light of different clinical settings

Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives

Extranodal marginal zone lymphoma (EMZL) encompasses a subgroup of non-Hodgkin lymphomas that often present with localized involvement and may manifest in a diversity of organs and tissues. EMZL pathogenesis is in some cases linked to chronic inflammation/infection, which may impose additional diagnostic and clinical challenges. The most studied and established connection is the presence of Helicobacter pylori in gastric EMZL. Due to its heterogeneity of presentation and intricate pathological features, treatment can be complex, and staging systems are decisive for the choice of therapy. Nevertheless, there is no consensus regarding the most suitable staging system, and recommendations vary among different countries. As a rule of thumb, in limited stages, a local therapy with surgery or radiation is the preferred option, and it is potentially curative. Of note, eradicating the causal agent may be an important step of treatment, especially in gastric EMZL, in which Helicobacter pylori eradication remains the first-line therapy for the majority of patients. In patients with more advanced stages, watch-and-wait is a valuable option, especially amongst those without clear indications for systemic therapy, and it may be carried on for several years. If watch-and-wait is not an option, systemic therapy may be needed. Even though several agents have been tested as monotherapy or in combination in recent years, there is no consensus regarding the first-line therapy, and decisions can vary depending on individual factors, such as age, clinical performance and stage. This review aims to discuss the several aspects of EMZL, including genetic milieu, pathogenesis and staging systems, that may influence the choice of therapy. In addition, we present a summary of evidence of several systemic therapies, compare different recommendations worldwide and discuss future perspectives and novelties in its therapy

Relative prevalence of methicilline resistant Staphylococcus aureus and its susceptibility pattern in Mulago Hospital, Kampala, Uganda

Methicilline resistant Staphylococcus aureus (MRSA) strains are becoming increasingly multiresistant, and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for many years. In-vitro determination of resistance patterns of S. aureus is critical in terms of administering suitable antimicrobial treatments. The objective of this study was to determine the relative prevalence of MRSA among S. aureus isolates from surgical site infections and their antibiotic susceptibility pattern in Mulago Hospital, Kampala, Uganda. One hundred eighty eight pus swabs were collected from patients with surgical site infections. Swabs were inoculated for culture at the Microbiology Laboratory of the Faculty of Medicine, Makerere University. S. aurues isolates were identifi ed using standard procedures and tested for oxacillin resistance according to methods of the National Committee for Clinical Laboratory Standards. Out of the 188 specimens, 54 (28.7%) grew S. aureus. Seventeen (31.5%) of the S. aureus isolates were confi rmed as MRSA by PCR. Resistance rates of MRSA were 88.2% for trimethoprim-sulfamethoxazole, 88.2% for erythromycin, 58.8% for gentamycin, 70.6% for ciprofl oxacin, and 88.2% for chloramphenicol. All isolates were found to be sensitive to vancomycin and clindamycin though the D-test was found to be positive in 82.4% of the isolates. In our region, although methicillin resistance increased in S. aureus strains, because of the unavailability and the high cost of alternative antibiotics, gentamycin is still suggested as an alternative for treatment of S. aureus infections. These results however indicate that vancomycin seemed to be the only antimicrobial agent effective against MRSA and it could be the drug of choice in treating multidrug resistant MRSA infection

Nasopharyngeal carriage rate of Streptococcus pneumoniae in Ugandan children with sickle cell disease

<p>Abstract</p> <p>Background</p> <p>Nasopharyngeal carriage of <it>Streptococcus pneumoniae </it>is a determinant for invasive pneumococcal disease, which often complicates homozygous sickle cell disease. Here, we determined the nasopharyngeal carriage rate of <it>S. pneumoniae </it>in Ugandan children with homozygous sickle cell disease, who attended the outpatient Sickle Cell Clinic at Mulago National Referral hospital in Kampala, Uganda.</p> <p>Results</p> <p><it>S. pneumoniae </it>occurred in 27 of the 81 children with homozygous sickle cell disease (giving a carriage rate of 33%, 27/81). Twenty three children were previously hospitalized of whom <it>S. pneumoniae </it>occurred in only two (9%, 2/23), while among the 58 who were not previously hospitalized it occurred in 25 (43%, 25/58, χ²= 8.8, <it>p </it>= 0.003), meaning there is an association between high carriage rate and no hospitalization. Two children previously immunized with the pneumococcal conjugate vaccine did not carry the organism. Prior antimicrobial usage was reported in 53 children (65%, 53/81). There was high resistance of pneumococci to penicillin (100%, 27/27) and trimethoprime-sulfamethoxazole (97%, 26/27), but low resistance to other antimicrobials. Of the 70 children without sickle cell disease, <it>S. pneumoniae </it>occurred in 38 (54%, 38/70) of whom 43 were males and 27 females (53% males, 23/43, and 56% females, 15/27).</p> <p>Conclusion</p> <p>Nasopharyngeal carriage of penicillin resistant pneumococci in Ugandan children with homozygous sickle cell disease is high. While nasopharyngeal carriage of <it>S. pneumoniae </it>is a determinant for invasive pneumococcal disease, pneumococcal bacteremia is reportedly low in Ugandan children with sickle cell disease. Studies on the contribution of high carriage rates to invasive pneumococcal disease in these children will be helpful. This is the first report on pneumococcal carriage rate in Ugandan children with sickle cell disease.</p

Advances in Lymphoma Molecular Diagnostics

Lymphomas encompass a diverse group of malignant lymphoid neoplasms. Over recent years much scientific effort has been undertaken to identify and understand molecular changes in lymphomas, resulting in a wide range of genetic alterations that have been reported across all types of lymphomas. As many of these changes are now incorporated into the World Health Organization’s defined criteria for the diagnostic evaluation of patients with lymphoid neoplasms, their accurate identification is crucial. Even if many alterations are not routinely evaluated in daily clinical practice, they may still have implications in risk stratification, treatment, prognosis or disease monitoring. Moreover, some alterations can be used for targeted treatment. Therefore, these advances in lymphoma molecular diagnostics in some cases have led to changes in treatment algorithms. Here, we give an overview of and discuss advances in molecular techniques in current clinical practice, as well as highlight some of them in a clinical context

Prevalence of Helicobacter pylori in HIV-infected, HAART-naïve Ugandan children: a hospital-based survey

<p>Abstract</p> <p>Background</p> <p>The aim of this survey was to determine the prevalence of and factors associated with <it>Helicobacter pylori </it>(<it>H. pylori</it>) colonization in HIV-infected, highly active antiretroviral therapy-naïve Ugandan children aged 0-12 years.</p> <p>Methods</p> <p>In a hospital-based survey, 236 HIV-infected children were tested for <it>H. pylori </it>colonization using a faecal antigen test. A standardized interview with socio-demographic information and medical history was used to assess risk factors. A cluster of differentiation 4 (CD4) cell percentage was prevalent in most children.</p> <p>Results</p> <p>The overall prevalence of <it>H. pylori </it>in the HIV-infected children was 22.5%. Age-specific prevalence was as follows: up to one year, 14.7%; 1-3 years, 30.9%; and 3-12 years, 20.7%. HIV-infected children who were more seriously affected by their disease (low CD4 cell percentage or WHO clinical stage II-IV) were less likely to be colonized with <it>H. pylori</it>. There was a trend for a lower prevalence of <it>H. pylori </it>in children who had taken antibiotics for the preceding two weeks (21.6%) than in those who had not taken antibiotics (35.7%). There was no statistically significant difference in prevalence by gender, housing, congested living, education of the female caretaker, drinking water or toilet facilities.</p> <p>Conclusions</p> <p>HIV-infected, HAART-naïve Ugandan children had a lower prevalence of <it>H. pylori </it>colonization compared with apparently healthy Ugandan children (44.3%). Children with a low CD4 cell percentage and an advanced clinical stage of HIV had an even lower risk of <it>H. pylori </it>colonization. Treatment with antibiotics due to co-morbidity with infectious diseases is a possible explanation for the relatively low prevalence.</p

The Prevalence of Asymptomatic Bacteriuria and Associated Factors among Women Attending Antenatal Clinics in Lower Mulago Hospital, Uganda

Asymptomatic bacteriuria (ASB) complicates 2-14% of pregnancies. If not treated in pregnancy it may progress to symptomatic urinary tract infection in 25 % of the cases. Some of the complications of untreated ASB in pregnancy include maternal anaemia, pregnancy and premature rupture of membranes.  In the fetus it may cause abortion, and premature labour. Our objective was to determine the prevalence of asymptomatic bacteriuria in pregnancy and associated factors.  This cross sectional study was carried out in lower Mulago hospital antenatal clinic. We consecutively recruited 385 women with no symptoms of urinary tract infection. The outcome of interest was asymptomatic bacteriuria. A questionnaire was used to record clients’ data. Urine specimens were taken for culture and sensitivity. The prevalence of asymptomatic bacteria was determined. Bivariate analysis was done to find the association between asymptomatic bacteriuria, with maternal risk factors. Four hundred and eight (408) pregnant women were enrolled in the study. The prevalence of ASB+ was found to be 12.2%.The factors associated with asymptomatic bacteriuria were maternal age ≥35 years, OR 2.84, 95 % CI ( 1.2-6.4), Gravidity≥5, OR 2.2, 95%CI  (1.1-4.4), history of UTI, OR 2.6, 95 % CI (1.3-5.1). The prevalence of asymptomatic bacteriuria among women attending antenatal clinic in lower Mulago hospital is high.  Screening for asymptomatic bacteriuria should be done for all women attending lower Mulago hospital antenatal clinic with particular emphasis in all women of the age of  ³ 35 years, multiparous women and those with history of urinary tract infection.