HIV-Infektion : Update 2009 für Hausärzte. Teil 1

Quintessenz: In der Schweiz werden jährlich >750 HIV-Infektionen neu diagnostiziert. Die Ansteckung geschieht via Blut oder Sex, und nicht bei alltäglichen sozialen Kontakten. Die CD4-Lymphozytenzahl ist bestens etabliert zur Messung der Immunsuppression. Die grösste Gefahr opportunistischer Infekte droht bei CD4-Werten <200/μl. Dank antiretroviraler Therapie (ART) sollten viele HIV-infizierte Patienten in der Schweiz eine quasi normale Lebenserwartung haben. Momentan ist eine ART bei CD4-Werten <350/μl indiziert. Die HIV-Diagnose wird auch in der Schweiz häufig zu spät gestellt. Hausärzte spielen bei der frühzeitigen Diagnosestellung (grosszügiges Anbieten von HIV-Tests) und bei der Prävention von Immundefizienz und opportunistischen Komplikationen eine entscheidende Rolle. P Bei HIV-Neudiagnose soll der Patient einem HIV-Spezialisten zugewiesen werden, um weitere Abklärungen durchzuführen und die Indikation zum ART-Beginn zu stellen

Social welfare [law] advice provision during the pandemic in England and Wales: a conceptual framework

An ambitious reform programme in the UK to digitalize the justice system has been underway since 2016. The report on Digitisation and accessing justice in the community (based on the Digitalisation Welfare Advice Survey), on how prepared advice providers were for digital assistance for welfare benefits, found that organisations were unable to meet the demand for services across all levels of social welfare law, and that there is a high demand for digital assistance. This was just before the pandemic. This paper explores the technical capability of the advice sector to provide remote social welfare delivery during the pandemic. It is based on a Pandemic Welfare Advice survey to help understand how advice providers have been working during the first seven months of the pandemic in 2020 and how the migration to remote advice delivery has changed their services and impacted their clients. A conceptual framework of needs is offered as a lens though which to think about the new sets of demands on advisers and clients

Human lectins and their roles in viral infections

© 2015 by the authors; licensee MDPI. Innate recognition of virus proteins is an important component of the immune response to viral pathogens. A component of this immune recognition is the family of lectins; pattern recognition receptors (PRRs) that recognise viral pathogen-associated molecular patterns (PAMPs) including viral glycoproteins. In this review we discuss the contribution of soluble and membrane-associated PRRs to immunity against virus pathogens, and the potential role of these molecules in facilitating virus replication. These processes are illustrated with examples of viruses including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and Ebola virus (EBOV). We focus on the structure, function and genetics of the well-characterised C-type lectin mannose-binding lectin, the ficolins, and the membrane-bound CD209 proteins expressed on dendritic cells. The potential for lectin-based antiviral therapies is also discussed

Measurement of gut permeability using fluorescent tracer agent technology

Abstract The healthy gut restricts macromolecular and bacterial movement across tight junctions, while increased intestinal permeability accompanies many intestinal disorders. Dual sugar absorption tests, which measure intestinal permeability in humans, present challenges. Therefore, we asked if enterally administered fluorescent tracers could ascertain mucosal integrity, because transcutaneous measurement of differentially absorbed molecules could enable specimen-free evaluation of permeability. We induced small bowel injury in rats using high- (15 mg/kg), intermediate- (10 mg/kg), and low- (5 mg/kg) dose indomethacin. Then, we compared urinary ratios of enterally administered fluorescent tracers MB-402 and MB-301 to urinary ratios of sugar tracers lactulose and rhamnose. We also tested the ability of transcutaneous sensors to measure the ratios of absorbed fluorophores. Urinary fluorophore and sugar ratios reflect gut injury in an indomethacin dose dependent manner. The fluorophores generated smooth curvilinear ratio trajectories with wide dynamic ranges. The more chaotic sugar ratios had narrower dynamic ranges. Fluorophore ratios measured through the skin distinguished indomethacin-challenged from same day control rats. Enterally administered fluorophores can identify intestinal injury in a rat model. Fluorophore ratios are measureable through the skin, obviating drawbacks of dual sugar absorption tests. Pending validation, this technology should be considered for human use

AMBIVALENT IMPLICATIONS OF HEALTH CARE INFORMATION SYSTEMS: A STUDY IN THE BRAZILIAN PUBLIC HEALTH CARE SYSTEM

This article evaluates social implications of the ""SIGA"" Health Care Information System (HIS) in a public health care organization in the city of Sao Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors

Nosocomial nontyphoidal salmonellosis after antineoplastic chemotherapy: reactivation of asymptomatic colonization?

An increased frequency of nontyphoidal salmonellosis is well established in cancer patients, but it is unclear whether this represents increased susceptibility to exogenous infection or opportunistic, endogenous reactivation of asymptomatic carriage. In a retrospective study, a simple case definition was used to identify the probable presence of reactivation salmonellosis in five cancer patients between 1996 and 2002. Reactivation salmonellosis was defined as the development of nosocomial diarrhea >72h after admission and following the administration of antineoplastic chemotherapy in an HIV-seronegative cancer patient who was asymptomatic on admission, in the absence of epidemiological evidence of a nosocomial outbreak. Primary salmonellosis associated with unrecognized nosocomial transmission or community acquisition and an unusually prolonged incubation period could not entirely be ruled out. During the same time period, another opportunistic infection, Pneumocystis pneumonia, was diagnosed in six cancer patients. Presumably, asymptomatic intestinal Salmonella colonization was converted to invasive infection by chemotherapy-associated intestinal mucosal damage and altered innate immune mechanisms. According to published guidelines, stool specimens from patients hospitalized for longer than 72h should be rejected unless the patient is neutropenic or ≧65 years old with significant comorbidity. However, in this study neutropenia was present in only one patient, and four patients were <65 years old. Guidelines should thus be revised in order not to reject stool culture specimens from such patients. In cancer patients, nosocomial salmonellosis can occur as a chemotherapy-triggered opportunistic reactivation infection that may be similar in frequency to Pneumocystis pneumoni