Caution is needed in interpreting HIV transmission chains by ultradeep sequencing.

OBJECTIVES: Molecular epidemiology is applied to various aspects of HIV transmission analyses. With ultradeep sequencing (UDS), in-depth characterization of transmission episodes involving minority variants is permitted. We explored HIV-1 epidemiological linkage and evaluated characteristics of transmission dynamics and transmitted drug resistance (TDR) detection through the added value of UDS. DESIGN: HIV pol gene fragments were sequenced by UDS and Sanger sequencing on samples of 70 HIV-1-infected, treatment-naive recently diagnosed MSM. METHODS: Pairwise genetic distances and maximum likelihood phylogenies were computed. Transmission events were identified as clades with branch support at least 70% and intraclade genetic difference less than 4.5%. TDR mutations were recognized from the TDR consensus list. Transmission directionality, directness and inoculum size were inferred from tree topologies. RESULTS: Both datasets concurred in the identification of seven transmission pairs and one cluster of three patients. With UDS, direction of transmission was inferred in four out of eight chains. Evidence for multiple founder viruses was found in two out of eight chains. No transmission of minority-resistant variants was evidenced. TDR mutations prevalence in protease and reverse transcriptase fragments was 4.3% with Sanger sequencing and 18.6% with UDS. CONCLUSION: Although Sanger sequencing and UDS identified the same transmission chains, UDS provided additional information on founder viruses, direction of transmission and levels of TDR. Nevertheless, topology of clusters was not always consistent across gene fragments, calling for a cautious interpretation of the data. Moreover, unobserved intermediary links cannot be excluded. Phylogenetic analysis use as a forensic technique for HIV transmission investigations is risky

Sternochondroplasty with metal blade retainers located retrosternal efficacy in patients with pectus excavatum

State Medical and Pharmaceutical University Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Pectus Excavatum (PE) is a deformity of the anterior chest wall, in which the sternum and rib cartilage presents an abnormal development. In these cases, the anterior thoracic wall presents a concave shape depression. Surgical treatment of this condition is a great need for patients, because symptoms are often severe and affect the quality of life of these patients. Objective: Present study aims to objectify early and late postoperative complications after it was performed sternochondroplasty with metal blade retainers located retrosternal. Material and methods: We conducted a retrospective observational study over a period of 20 years (1.10.1995-1.10.2015). In this regard I used casuistry of Surgical Clinic no. 1 of SCJU Mures. We introduced in the study 68 patients (41 male, 27 female) diagnosed with PE, on whom we practiced sternochondroplasty with metal blade retainers located retrosternal. Results: Mean age of the patients in the study was 17.4 years, with a range between 8 and 20 years. Most common symptoms on this patients were recorded: palpitations (n=23), exertional dyspnea (n=15), cough (n=15), chest pain (n=22) and dysphagia (n=2). Also 29 patients at clinical examination presented deformations of the spine (12 patients – kyphosis; 17 patients- scoliosis). The degree of deformation was evaluated by measuring the angle formed by the body of the sternum and the manubrium towards the spine. Thereby, we obtained the following results: 42 patients had an angle of 10 to 15 degrees; 20 patients had an angle of 15 to 20 degrees and 11 patients with an angle greater than 20 degrees. Of the total number of operated patients, 11 had immediate postoperative complications, as follows: 3 hematoma patients, 4 patients with bilateral pneumothorax, 3 with unilateral pneumotorax and one patient experienced hemorrhage at cartilage section. Late complications were represented by 2 cases of thoracic deformity recurrence and 4 cases of patients with keloid scars. In the study group we observed that early complication rate was 16%, while the late complications rate was 9%. Conclusions: Surgery is the only treatment able to lead to improvements of symptoms in patients with PE. Sternochondroplasty with metal blade disposed retrosternal represents a viable surgical method of treatment of these parietal chest defects

Repurposing an Old Drug: Aztreonam as a New Treatment Strategy for Gonorrhoea

International audienceObjectives: To determine whether aztreonam is still an effective drug for the treatment of gonorrhoea.Methods: Observational study of patients with gonorrhoea diagnosed by urine multiplex PCR, with a past medical history of allergy to β-lactams or relapse after treatment with a third-generation cephalosporin. Patients received a single 1 g dose of aztreonam in accordance with the manufacturer's instructions.Results: Five patients (four males, one female) were enrolled, comprising two who were allergic to β-lactams and three previously treated with cephalosporins who relapsed. Median age was 38 years (range 23-51). Following treatment with aztreonam all were cured without any adverse event. All the men were free of symptoms, and the woman tested negative for gonorrhoea 1 month after treatment.Conclusion: Aztreonam appears to be an effective alternative to cephalosporins in the treatment of uncomplicated gonorrhoea, particularly when patients are suspected of being infected by strains with reduced susceptibility to ceftriaxone or are known to be allergic to penicillin

Breast abscess due to Bacillus Calmette-Guérin

International audienc

Surgical Treatment in Silicone Oil-Associated Glaucoma

Glaucoma is a vision threatening, not uncommon complication of eyes that have undergone pars plana vitrectomy with silicone oil endotamponade. Although most patients respond well to medical antiglaucoma therapy, there are refractory cases where surgery is required to control the intraocular pressure. This review, following a comprehensive literature search in the Medline database, aims to present the most important surgical techniques currently in use for glaucoma associated with silicone oil endotamponade and their indication depending on the mechanism of glaucoma. In cases of pupillary block, the presence of a patent iridotomy or iridectomy must be ensured, either by laser or surgically. When silicone oil is in excess and whenever the retinal status permits it, partial or complete removal of the silicone oil should be performed. Trabeculectomy has shown higher failure rates and more complications in these cases compared to other indications, so alternate methods are warranted. For very high intraocular pressures, glaucoma drainage devices and transscleral cyclophotocoagulation are the most used options, with good efficacy and safety profiles, although rarely they may have serious complications. The Ex-PRESS mini shunt has shown excellent results and lower rates of complications. For less important IOP elevations, minimally invasive glaucoma surgery and selective laser trabeculoplasty may be used, either alone or in conjunction with other methods

A case of tuberculosis and black-grain eumycetoma co-infection in a non-endemic country: clinical presentation and therapeutic management

International audienceWe report a case of black-grain eumycetoma co-localized with Mycobacterium tuberculosis infection, presenting as a painless leg abscess and associated with vertebral tuberculosis. The rare association of these two pathogens raises several challenges regarding foreseeable drug interactions, side effects, the most appropriate management and the potential link between these two diseases

Efficacy of Intermittent Short Cycles of Integrase Inhibitor-Based Maintenance ART in Virologically Suppressed HIV Patients

Abstract Background Several studies have shown that NNRTI/PI-based triple therapy could be safely administered as a 4\,days (4D) or 5\,days (5D) a week maintenance strategy. We report here our experience of using an integrase inhibitor (INSTI)-based 4D/5D regimen in virologically suppressed HIV patients. Methods This cohort study enrolled adult patients on ART with viral load (VL) <50 copies/mL for >1\,year, who switched to an INSTI-based triple regimen given 4D/5D a week. The primary endpoint was the virological efficacy rate at Week (W) 48, with virological failure defined as confirmed VL ≥q50 copies/mL. Results A total of 73 patients were included (n\,=\,28 for 4D, n\,=\,45 for 5D): 54 men (74%), median (IQR) age 51 (45\textendash 57) years, ART duration 10 (6\textendash 18) years and duration of viral suppression 5 (2\textendash 9) years at baseline. As of 25 March 2019, the median follow-up was 21 (14\textendash 35) months, with a total of 161 patient-years of follow-up; all patients had reached the W24 visit, 66 (90%) W48 and 34 (47%) W96. Four patients discontinued the strategy: virological failure (n\,=\,2) at W60 and W67, respectively, switch for renal toxicity (n\,=\,1) at W28 and switch to rilpivirine/dolutegravir (n\,=\,1) at W65. Overall the rate of virological success (95% CI) was 100% (94%\textendash 100%) at W24 and W48 and 93.7% (79.8%\textendash 98.2%) at W96. Conclusions While waiting for the final results of the large randomized QUATUOR ANRS-170 study, our real-life results suggest that the use of an intermittent maintenance triple-drug regimen given as a weekend (2 or 3\,days) off is as effective with an INSTI-based regimen as with a PI or an NNRTI