Detection of HIV-1 dual infections in highly exposed treated patients

<p>Abstract</p> <p>Background</p> <p>Genetic characterization of HIV-1 in Argentina has shown that BF recombinants predominate among heterosexuals and injecting drug users, while in men who have sex with men the most prevalent form is subtype B.</p> <p>Objectives</p> <p>The aim of this work was to investigate the presence of HIV dual infections in HIV-infected individuals with high probability of reinfection</p> <p>Study design</p> <p>Blood samples were collected from 23 HIV positive patients with the risk of reinfection from Buenos Aires. A fragment of the HIV gene <it>pol </it>was amplified and phylogenetic analyses were performed. Antiretroviral drug resistance patterns of all the sequences were analyzed.</p> <p>Results</p> <p>Five dual infections were detected with four patients coinfected with subtype B and BF recombinants and one patient was coinfected with two BF recombinants presenting different recombination patterns. Prolonged infection with a stable clinical condition was observed in the five individuals. Resistance mutation patterns were different between the predominant and the minority strains.</p> <p>Conclusions</p> <p>Our results show that HIV dual infection can occur with closely related subtypes, and even with different variants of the same recombinant form in certain populations. Clinical observations showed neither aggressive disease progression nor impact on the resistance patterns in the dually-infected patients.</p

An 1H NMR study of the cytarabine degradation in clinical conditions to avoid drug waste, decrease therapy costs and improve patient compliance in acute leukemia

Cytarabine, the 4-amino-1-(β-D-arabinofuranosyl)-2(1H)-pyrimidinone, (ARA-C) is an antimetabolite cytidine analogue used worldwide as key drug in the management of leukaemia. As specified in the manufacturers' instructions, once the components-sterile water and cytarabine powder-are unpackaged and mixed, the solution begins to degrade after 6 hours at room temperature and 12 hours at 4°C. To evaluate how to avoid wasting the drug in short-term, low-dose treatment regimens, the reconstituted samples, stored at 25°C and 4°C, were analyzed every day of the test week by reversed-phase HPLC and high-field NMR spectroscopy. All the samples remained unchanged for the entire week, which corresponds to the time required to administer the entire commercial drug package during low-dose therapeutic regimens. The drug solution was stored in a glass container at 4°C in an ordinary freezer and drawn with sterile plastic syringes; during this period, no bacterial or fungal contamination was observed. Our findings show that an cytarabine solution prepared and stored in the original vials retains its efficacy and safety and can, therefore, be divided into small doses to be administered over more days, thus avoiding unnecessary expensive and harmful waste of the drug preparation. Moreover, patients who require daily administration of the drug could undergo the infusion at home without need to go to hospital. The stability of the aliquots would help decrease hospitalization costs

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Innovative and Sustainable Composite Material for the Seismic and Energetic Upgrade of Historic Masonry Buildings

Usually, energy and structural improvements for historic masonry buildings are addressed separately using distinct methods and protocols. This paper covers an integrated assessment of new composite materials to reduce the seismic vulnerability of historic masonry buildings while complying with sustainable conservation requirements, emissions’ reduction, and energy savings. Firstly, this study focused on selecting suitable thermal mortars that could serve as the base material for the innovative composite. Subsequently, the mechanical characteristics of these mortars were examined by subjecting them to compressive and three-point bending tests. Dynamic thermo-hygrometric simulations were conducted using commercially available software to check the energy performance of the composite material when used on walls of existing masonry buildings. The thermal mortar that exhibited the most favorable mechanical and thermal properties was subsequently reinforced with a basalt fabric. A composite sample was assembled and subjected to direct tensile testing to determine its stress–strain behavior

Evaluation of the quality of life in children and adolescents with type 1 diabetes, coeliac disease and healthy controls.

Our results demonstrate that children and adolescents with chronic disease, despite a good adherence to therapy, have impairment in psychosocial health fx. Our data disagree with common opinion that children with CD have a better adaptation and functioning. These findings contribute significant information on the effects of pediatric chronic conditions on generic QOL from the perspectives of children. It is conceivable that a immediate multidisciplinary approach to patients with T1DM can be responsible for this differences

A novel STAT5B mutation causing GH insensitivity syndrome associated with hyperprolactinemia and immune dysfunction in two male siblings

Background: GH insensitivity (GHI) syndrome caused by STAT5B mutations was recently reported, and it is characterized by extreme short stature and immune dysfunction. Treatment with recombinant human IGF1 (rhIGF1) is approved for patients with GHI, but the growth response to this therapy in patients with STAT5B mutations has not been reported. Objectives: To report the clinical features, molecular findings, and the short-term growth response to rhIGF1 therapy in patients with STAT5B mutation. Subjects and methods: Hormonal and immunological evaluations were performed in two male siblings with GHI associated with atopic eczema, interstitial lung disease, and thrombocytopenic purpura. STAT5B genes were directly sequenced. The younger sibling was treated with rhIGF1 at a dose of 110 mu g/kg BID. Results: Both siblings had laboratory findings compatible with GHI associated with hyperprolactinemia. Lymphopenia and reduced number of natural killer cells without immunoglobulin abnormalities were observed. STAT5B sequence revealed a homozygous frameshift mutation (p.L142fsX161) in both siblings. The younger sibling (9.9 years of age) was treated with rhIGF1 at appropriate dosage, and he did not present any significant change in his growth velocity (from 2.3 to 3.0 cm/year after 1.5 years of therapy). The presence of a chronic illness could possibly be responsible for the poor result of rhIGF1 treatment. Further studies in patients with STAT5B defects are necessary to define the response to rhIGF1 treatment in this disorder. Conclusion: GHI associated with immune dysfunction, especially interstitial lung disease, and hyperprolactinemia is strongly suggestive of a mutation in STAT5B in both sexes.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP[09/00313-3]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPq[143524/2008-9]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPq[300982/2009-7]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico - CNPq[301477/2009-4

Network Italiano Asplenia: dati allarmanti sullo stato di copertura vaccinale nei pazienti asplenici registrati

Recentemente la Società Italiana Talassemia ed Emoglobinopatie (SITE) ha prodotto le prime raccomandazioni nazionali per la gestione del rischio infettivo nelle asplenie, dirigendo in tal modo la strategia formativa ed educativa in questo ambito altamente carente. Al fine di valutare il grado di copertura vaccinale in un’ampia popolazione di pazienti asplenici, abbiamo analizzato i dati del Network Italiano Asplenia per definire eventuali criticità e attività formative prioritarie. Sono stati valutati 1352 pazienti asplenici affetti da anemia emolitica congenita (407), talassemia trasfusione- dipendente (334), falcemia (204), talassemia non trasfusione- dipendente (152), malattie autoimmunitarie (122), disordini non ematoncologici (58), patologie oncologiche (57), immunodeficit (10) e asplenia congenita (8). Considerando il numero di pazienti che avevano ricevuto almeno una dose di ogni vaccino, 419 (31%) non aveva ricevuto neanche una dose tra i vaccini raccomandati, 689 pazienti (51%) avevano ricevuto una dose di vaccino antipneumococcico polisaccaridico, 370 (27%) una dose di vaccino antipneumococcico coniugato 13- valente, 175 (13%) pazienti una dose di vaccino antipneumococcico 7-valente. La vaccinazione contro l’ Haemophilus influenzae b era riportata in 609 pazienti (47%), mentre 676 pazienti (50%) aveva praticato almeno una dose di un vaccino antimeningococcico (monovalente o quadrivalente, coniugato o polisaccaridico). Questi dati dimostrano la necessità di aumentare la formazione in ambito preventivo, maggiormente nei gruppi ad alto rischio come i pazienti asplenici, e rispondono alla raccomandazione dell’Organizzazione Mondiale della Sanità di implementare tutte le strategie grazie alle quali “ogni individuo, indipendentemente da dove sia nato, dove viva e chi sia, possa godere di una vita libera dalle malattie prevenibili da vaccinazione, grazie alla disponibilità dei vaccini, che deve essere garantita dalle Autorità Sanitarie, e da una politica coerente con gli obiettivi di Health 2020 e di altre strategie e politiche regionali fondamentali”. Inoltre, tra gli obiettivi del Piano Europeo per le Vaccinazioni 2015- 2020 vi è l’attivazione di “meccanismi di monitoraggio e valutazione coerenti e rilevanti, per controllare l'attuazione e l’efficacia del piano vaccinale stesso” e le azioni del Network Italiano Asplenia supportate dalla SITE possono garantirne il raggiungimento in gruppi ad alto rischi