Antiretroviral treatment uptake and attrition among HIV-positive patients with tuberculosis in Kibera, Kenya

Using data of human immunodeficiency virus-positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow-up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre-ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing

Reduced Phagocytic Capacity of Blood Monocyte/Macrophages in Tuberculosis Patients Is Further Reduced by Smoking.

Tuberculosis (TB) and tobacco use are two major alarming global health issues posing immense threats to human populations. Mycobacterium tuberculosis (MTB) by activation of macrophages could induce the sequences of cells activation and releases of inflammatory cytokines such as CXCL-8, Il-12 and TNF-α which in turn induces the immune system network. However no information is available on other activity of cells by MTB and smoking. In the current study we aimed to investigate the serum levels TNF-a, CXCL-8 and phagocytosis capacity in tuberculosis patients with and without smoking. 103 subjects entered the study including 61 new diagnosed pulmonary TB patients (23 smokers and 38 nonsmokers) and 42 control healthy subjects. The phagocytosis of fluorescein isothiocyanate dextran (FITC-dextran) in blood monocytes/macrophages through flowcytometry was assessed. Serum levels of TNF-a and CXCL-8 were analyzed by ELISA methods. A lower percentage of cells from TB patients who smoked [50.29% (43.4-57.2), p<0.01] took up FITC-dextran after 2h compared to non-smoking TB subjects [71.62% (69.2-74.1)] and healthy cases [97.45% (95.9-99.1). Phagocytic capacity was inversely correlated with cigarette smoking as measured by pack years (r=-0.73, p<0.001). The serum levels of TNF-a and CXCL-8 were significantly higher in the TB patients who smoked compared to the TB non-smoker group (p<0.001, p<0.01 respectively). Blood monocytes/macrophages from TB patients have reduced phagocytic capacity which is further reduced in TB patients who smoke. Smoking enhanced serum levels of TNF-a and CXCL-8 suggesting a greater imbalance between the proinflammatory and anti-inflammatory factors in these patients

The prevalence of cryptococcal antigenemia in serum of human immunodeficiency viruses-infected patients of iran

BACKGROUND: Cryptococcus species are the most prevalent opportunistic agents found in patients with HIV which may result in life-threatening cryptococcal meningitis (CM). A non-invasive way for diagnosis of CM is the detection of cryptococcal antigen (CrAg) in the blood to reduce either the mortality rate or the treatment complications associated with antiretroviral therapy. Not much information is available in CM among HIV patients in Iran. AIM: Thus, in the current study, we aimed to evaluate the prevalence of cryptococcal disease by antigen testing, possible associated factors, and outcomes in HIV-infected patients being managed in a referral HIV/TB hospital in Tehran-Iran. METHODS: In this cross-sectional study, blood samples were screened for CrAg using a rapid latex agglutination test between 2017 and 2018 at Masih Daneshvari Hospital (Tehran-Iran) as referral land center for HIV/TB patients. Based on CD4 counts, 106 HIV-positive infected patients including 101 (95.3) males and 5 (4.7) females with the mean ± standard deviation age of 42.40 ± 10.687 and 36.50 ± 6.403 years enrolled in the study. The patients were categorized into 4 groups, (a) &lt;50, (b) 50�100, (c) 101�200, and (d)&gt;200 CD4+ T cells/µL. Whole blood was obtained with EDTA (for flow cytometry of CD4 counts) or without for harvesting serum for determination of CrAg in serum. RESULTS: The results showed only one positive case for CrAg, indicating that CrAg is rare in Iranian HIV patients (overall estimation is lower than 0.01). CONCLUSIONS: With the paucity of information about the prevalence of cryptococcosis in Iran, there is a need for better screening tests and strategies for detection of CrAg in addition to the prevention and treatment approaches of CM. © 2020 Monireh Kamali, Payam Tabarsi, Khorshid Badihi, Esmaeil Mortaz

Cause-Specific Mortality among HIV-Infected Persons in One Medical Center, Tehran, Iran

Background: Human immunodeficiency virus (HIV) is one of the major infectious agents, which has important role in the public health challenges, which have affected the world's economic and social situation recent decades. During the last decades, millions of people died due to HIV infection worldwide. However, data remain limited on the causes of death among HIV-infected in Iranian population. The aim of the present study was to assess the cause specific death among HIV positive inpatient persons in Iran.Materials and Methods: This surveillance was conducted on inpatient HIV positive admissions at Masih Daneshvari Hospital, Tehran, Iran during October 2016 and April 2017.All patient’s data were collected via abstraction form, which were ascertained, from medical records and from written logbooks that were kept by the nursing staff on the ward. The data of each admission was recorded from the medical reports at the time of admission and upon discharge. All laboratory data were collected and recorded separately.Results: Fifty persons were diagnosed as HIV-infected patients, of which 58% of them were classified as AIDS patients. Our findings indicated that the cause of hospitalization were pulmonary 54%, neurological 20%, gastrointestinal 16%, and dermal 10% complications. Overall, 21 patients (42%) were diagnosed with pulmonary tuberculosis, of which one patient died from tuberculosis complications. Four patients died during the study period.Conclusion: In conclusion, early treatment and/or early use of ART can be improved outcomes. Therefore, early HIV testing and early ART use play important role in mortality reduction among eligible persons

Olfactory and gustatory manifestations in hospitalized patients with COVID-19

Background: Pulmonary involvement is the main clinical and imaging feature of the novel corona virus disease (COVID-19). However, some patients present with upper airway symptoms. Aim: In this study, we report upper respiratory manifestations, specifically focusing on smell and taste disorders in COVID-19. Methods: We performed this cross-sectional prospective study in patients admitted to Masih Daneshvari Hospital, a tertiary referral center in Tehran, Iran, with severe COVID-19 as documented by the polymerase chain reaction assay. Results: We included 268 hospitalized patients, 183 (68.3%) men and 85 (31.7%) women. The average age was 52.8±16.4. The sinonasal symptoms included nasal obstruction (44 [16.4%]), rhinorrhea (31 [11.5%]), sneeze (33 [12.3%]), headache (77 [28.6%]), facial pain (12 [4.5%]), associated with hypogeusia (65 [24.2%]) and olfactory dysfunction (90 [33.5%]). In 35 (38.9%) patients with olfactory symptoms, change in the smell was the sole initial manifestation of COVID-19. On logistic regression, the relationship between the olfactory symptoms and headache (p=0.002), nasal obstruction (p=0.0001) and sneeze (p=0.018) were statistically significant. Conclusion: We report a considerable prevalence of olfactory and gustatory symptoms in hospitalized patients with COVID-19. Not infrequently, these symptoms were the sole initial presenting symptoms in the course COVID-19. During the current pandemic, we suggest that presence of these symptoms should mandate expedited screening for COVID-19, isolation and close monitoring of the patients for evolution of the clinical course

Changes in glycosylated haemoglobin and treatment outcomes in patients with tuberculosis in Iran: a cohort study.

BACKGROUND: Diabetes mellitus (DM) affects tuberculosis (TB) treatment outcomes, mostly by increasing recurrence, mortality and treatment failure. The objectives were to determine the pattern of change in glycosylated haemoglobin (HbA1c) level in new TB patients admitted to hospital at the start and 3-months after TB treatment, and to relate the measurements at these two time intervals to whether patients successfully completed treatment. METHODS: A prospective cohort study was conducted on hospitalized new TB patients at Masih Daneshvari Hospital from 2012 to 2013. All patients were tested for HbA1c at the beginning and 3 months after initiation of TB treatment. Changes in HbA1c were compared to TB treatment outcome. RESULTS: There were 317 new TB cases admitted to hospital of which 158 had HbA1c at baseline and 3-months. Of these, 67 (42%) had normal values, 54 had an elevated HbA1c at either base-line or 3-months (uncertain diabetes status) and 37 (24%) had elevated HbA1c (≥6.5%) at both time points (DM). There were differences between the groups: those with DM were older, had a known history of DM and a higher prevalence of cavities on chest x-ray. There were 150 (95%) patients who successfully completed treatment with no significant differences between the groups. CONCLUSION: There were changes in HbA1c during the first three-months of anti-TB treatment, but these were not associated with differences in TB treatment outcomes. Transient hyperglycemia should be considered in TB patients and needs to be taken into account in planning care and management

The analysis of exosomal micro-RNAs in peripheral blood mononuclear cell-derived macrophages after infection with bacillus Calmette–Guérin by RNA sequencing

AbstractObjective/BackgroundTuberculosis (TB) is a major global threat to human health, especially in low-income countries. The diagnosis of TB is challenging because of the limitations of specificity and sensitivity with the current diagnostics. Novel, selective biomarkers for TB would be of great practical value. Exosomes are bioactive vesicles with 30–100nm in diameter, which are secreted from almost all cell types and are found in virtually every human body fluid. Exosomes transport micro-RNAs (miRNAs), which are post-transcriptional regulators of gene expression, around the body and allow miRNAs to modulate biological pathways in target cells. Our aim was to investigate the potential of exosomal miRNAs as biomarkers by examining their release from human monocyte-derived macrophages (MDMs) after infection with Mycobacterium using miRNA sequencing.MethodsHuman monocytes were obtained from blood and driven to an MDM phenotype using standard protocols. MDMs were infected with Mycobacterium bovis Bacillus Calmette–Guérin (BCG) or left uninfected as control. Exosomes were collected 72 h postinfection from the cell culture medium and subjected to RNA isolation. Small RNA libraries were constructed and RNA sequencing performed. The raw reads were filtered to eliminate adaptor and primer sequences, and the sequences in FASTQ format were run against the mature human miRNA sequences available in miRBase using BLAST software using a Linux operating system. Micro-RNAs were identified using E=0.01 or 1.ResultsInfection of MDMs with BCG lead to the release of a number of exosomal miRNAs. These mainly consisted with Let-7 family members, miR-155, miR-146a, miR-145, and miR-21 all of which were predicted to target important immune-related genes and pathways.ConclusionThis study provides evidence for the release of specific miRNAs from BCG-infected MDMs. These results need to be confirmed and the presence of this panel of miRNAs tested in the blood of patients to determine their selectivity and specificity as a diagnostic in patients with TB

Real-time RT-PCR Detection of HCN4 and ADAM8 genes in ventilator-associated pneumonia patients Hospitalized in intensive care unit

IntroductionVentilator-associated pneumonia (VAP)  is One of the most serious and  prevalence of  complication  among patients in the intensive care unit nosocomial infections, which are often recognized after detecting symptoms. To date, there has been no proper clinical and diagnostic marker for early detection of this disease. In this study, two HCN4 and ADAM8 genes in patients with VAP were assessed to be used as a biomarker to recognize and distinguish the disease.   MethodologyThis study was done in Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences,Tehran,Iran since 2015-2016 and was case /control study . current study was administered by using peripheral blood samples, including 30 patients with VAP and 30 Healthy person. First, the peripheral blood samples were taken and then RNA was extracted and then synthesis CDNA. Finally, the evaluation of genes was performed by Realtime PCR method.   FindingsIn peripheral blood samples, patients individuals , 10 out of 30 cases had positive HCN4 markers. Among the healthy individuals, 6 out of 30 cases had positive HCN4  biomarkers. Moreover, in ADAM8 marker patients individuals, 13 out of 30 cases had positive ADAM8 marker and 8 out of 30 healthy individuals had positive ADAM8 biomarkers.ConclusionGenes HCN4 and ADAM8  assessment with Real Time-PCR  in this study can be used as promising markers in early detection of VAP disease. More extensive studies on larger sample sizes may yield higher sensitivity for these molecular markers