Proteinuria is common among HIV patients: what are we missing?

OBJECTIVES:HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients.METHODS:A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes.RESULTS:The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with

Changing lifestyle of persons with multiple sclerosis : development, feasibility and preliminary results of a novel high-impact collaborative intervention in leisure environments

Objective: Only a limited percentage of persons with MS (pwMS) participate to multidisciplinary rehabilitation (MDR) because of poor support, knowledge and motivation. We reasoned that pwMS should be more effectively prepared to increase their adherence. We implemented an innovative collaborative approach, called “brief highimpact preparatory experience” (b-HIPE), inspired by an overarching model based on the interplay between competence, motivation and opportunity to increase in a short time awareness and motivation of pwMS. Methods: B-HIPE integrates physiotherapy, mindfulness, sailing, healthy diet, and cultural activities to be experienced in a convivial form at a beautiful seaside location in Sardinia. Sixteen pwMS participated to 3 successive one-week editions of the b-HIPE, co-sponsored by the Rotary Club of Milan and supported by researchers of our Institute and of partner associations. The feasibility was assessed with structured questionnaires and free reports concerning accommodation, logistics, coordination, social climate and the specific activities proposed. For this pilot study we used a single-group design with repeated measurements at baseline and post-intervention. The SF-36 QoL scale was the main outcome measure, the Fatigue Severity Scale (FSS), the Berg Balance scale (BBS) and the 9 hole peg test (9HPT) were the secondary outcomes. Results: The approach was feasible. Scores on several FS-36 scales and secondary outcomes were significantly improved. Participants’ satisfaction with all aspects of the experience was above expectations. PwMS became more motivated and aware of physical and mental resources, all learned to sail adapted monohulls, strategies to master stress and to modify their diet according to specific recommendations. Conclusion: B-HIPE is safe and feasible. The interplay of multiple factors produced in a very short time the expected changes in participants’ attitude toward a healthier lifestyle. A monitoring program is ongoing to assess long-term effects including adherence to hospital-based MDR.Publisher PDFPeer reviewe

Proteinuria is common among HIV patients: what are we missing?

OBJECTIVES:HIV-related renal diseases are the leading causes of chronic kidney diseases worldwide. The present study aimed to investigate the prevalence of pathological proteinuria and its risk factors among HIV patients.METHODS:A review of the medical records of 666 HIV-infected individuals aged 18 years or older in an urban HIV/AIDS clinic based in Porto Alegre in southern Brazil. Overt proteinuria was defined as a protein-to-creatinine ratio greater than 150 mg/g according to Kidney Disease: Improving Global Outcomes.RESULTS:The prevalence of pathological proteinuria in the present study cohort was 20%. Characteristics associated with pathological proteinuria after univariate analysis included alcohol abuse, hepatitis C virus coinfection, the occurrence of diabetes and therapy including tenofovir. Adjusted residuals analysis indicated an association between pathological proteinuria and both a CD4 lymphocyte count below 200 cells/mm3 and a viral load higher than 1000 copies/mL. Additionally, an absence of pathological proteinuria was associated with a CD4 lymphocyte count higher than 500 cells/mm3. After adjustment for variables with p<0.2 in the univariate analysis using a Poisson regression model, tenofovir-containing regimens and a CD4 lymphocyte count below 200 cells/mm3 were significantly associated with pathological proteinuria.CONCLUSION:The risk of chronic kidney diseases in this large contemporary cohort of HIV-infected individuals appeared to be attributable to a combination of HIV-related risk factors. In addition to the traditional risk factors cited in the literature, both regimens containing tenofovir and HIV disease severity seem to be associated with chronic kidney diseases in patients with HIV. Assessment of proteinuria constitutes a novel method for chronic kidney disease staging in HIV-infected individuals and may be effectively used to stratify the risk of progression to end-stage renal disease

HIV AND HEPATITIS C VIRUS COINFECTION. WHO IS THIS PATIENT TODAY?

ABSTRACT Background - The increase in the survival following the introduction of highly active antiretroviral therapy (HAART) has seen the emergence of hepatitis C virus (HCV) infection, renal and cardiovascular diseases as important morbidity and mortality causes together with HIV. Objective - The present study aimed to investigate the differences between HIV/hepatitis C virus coinfected and HIV-monoinfected regarding demographic and clinical aspects from a HIV/AIDS clinic in Porto Alegre, Brazil. Methods - Review of medical records of 1,030 HIV infected individuals aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, Southern Brazil. Clinical and demographical Data were collected from the records of the patients attended between March 2008 and December 2012. Results - The present study is a cross-sectional study among HIV-infected patients attended at a public HIV/AIDS clinic in Porto Alegre, Brazil. The prevalence of hepatitis C virus in the present study cohort was 11.8% (CI 95%: 9.9%-13.8%). Hypertension and pathological proteinuria were more common in the coinfected compared to monoinfected group. By the other hand, dyslipidemia were more common among monoinfected patients. There was no difference between the groups regarding CD4+ count or HIV-RNA. Variables significant in the univariate analysis with P<0.05 were further analyzed using a Poisson regression model with robust variance. Coinfected were likely to be older, with lower lipid levels and higher prevalence of pathological proteinuria compared to HIV-monoinfected patients. Although coinfected patients had higher prevalence of tenofovir-based regimen, there was a strong association between hepatitis C virus individuals to pathological proteinuria and dyslipidemia. Conclusion - Clinicians should recognize that coinfected and monoinfected individuals are different groups regarding the traditional and HIV-related risk factors and should be managed and screened individually in order to prevent cardiovascular and renal complications

Helium Gas Evacuation in Superconducting RFQ Structure

The PIAVE injector for the Legnaro Accelerator complex is an accelerating machine made of superconducting resonators. One of them, the superconducting RFQ, needs to be cooled by the helium bath on the whole outer surfaces. In particular the region of the electrode tips and the lower vertical electrode are involved in RF power dissipation and can have a trapped volume of liquid. During the operation the liquid evaporates and the produced gas needs to be evacuated, in order to cool the structure properly. The problem of gas production and evacuation from a trapped volume of liquid helium has been studied and solved. Studies of the possible evacuation systems and experimental apparatus are presente