27 research outputs found
Recent HIV Infection: Diagnosis and Public Health Implications
The early period of infection with human immunodeficiency virus (HIV) has been associated with higher infectiousness and, consequently, with more transmission events. Over the last 30 years, assays have been developed that can detect viral and immune biomarkers during the first months of HIV infection. Some of them depend on the functional properties of antibodies including their changing titers or the increasing strength of binding with antigens over time. There have been efforts to estimate HIV incidence using antibody-based assays that detect recent HIV infection along with other laboratory and clinical information. Moreover, some interventions are based on the identification of people who were recently infected by HIV. This review summarizes the evolution of efforts to develop assays for the detection of recent HIV infection and to use these assays for the cross-sectional estimation of HIV incidence or for prevention purposes
Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients with COVID-19
The coronavirus disease 2019 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a major impact on global health, continuing to put strain on healthcare systems and disrupting socioeconomic life [...
The Brain-Gut Axis: Psychological Functioning and Inflammatory Bowel Diseases
The brain-gut axis represents a complex bi-directional system comprising multiple interconnections between the neuroendocrine pathways, the autonomous nervous system and the gastrointestinal tract. Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic, relapsing-remitting inflammatory disorder of the gastrointestinal tract with a multifactorial etiology. Depression and anxiety are prevalent among patients with chronic disorders characterized by a strong immune component, such as diabetes mellitus, cancer, multiple sclerosis, rheumatoid arthritis and IBD. Although psychological problems are an important aspect of morbidity and of impaired quality of life in patients with IBD, depression and anxiety continue to be under-diagnosed. There is lack of evidence regarding the exact mechanisms by which depression, anxiety and cognitive dysfunction may occur in these patients, and whether psychological disorders are the result of disease activity or determinants of the IBD occurrence. In this comprehensive review, we summarize the role of the brain-gut axis in the psychological functioning of patients with IBD, and discuss current preclinical and clinical data on the topic and therapeutic strategies potentially useful for the clinical management of these patients. Personalized pathways of psychological supports are needed to improve the quality of life in patients with IBD
Thromboelastometry in Neonates with Respiratory Distress Syndrome: A Pilot Study
Background: Although respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. We aimed to evaluate the hemostatic profile of neonates with RDS using rotational thromboelastometry (ROTEM). Methods: An observational study was conducted from November 2018 to November 2020 in the NICU of General Hospital of Nikaia “Aghios Panteleimon”. Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. Results: A hypocoagulable profile was noted in neonates with RDS compared to controls, expressed as significant prolongation of EXTEM CT (clotting time) and CFT (clot formation time), lower EXTEM A10 (amplitude at 10 min), MCF (maximum clot firmness), and LI60 (lysis index). Furthermore, prolongation of INTEM CFT and FIBTEM CT, and decreased INTEM and FIBTEM A10 and MCF were found in neonates with RDS. Multivariable logistic regression analysis showed that RDS is an independent factor for the recorded alterations in ROTEM variables. Conclusions: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates
Thromboelastometry in Neonates with Respiratory Distress Syndrome: A Pilot Study.
BACKGROUND: Although respiratory distress syndrome (RDS) constitutes a postnatal risk factor for bleeding and thromboembolic events in neonates, few studies have addressed this issue. We aimed to evaluate the hemostatic profile of neonates with RDS using rotational thromboelastometry (ROTEM). METHODS: An observational study was conducted from November 2018 to November 2020 in the NICU of General Hospital of Nikaia "Aghios Panteleimon". Preterm and term neonates with RDS hospitalized in the NICU were included and EXTEM (tissue factor-triggered extrinsic pathway), INTEM (ellagic acid activated intrinsic pathway), and FIBTEM (with platelet inhibitor cytochalasin D) assays were performed at the onset of the disease. RESULTS: A hypocoagulable profile was noted in neonates with RDS compared to controls, expressed as significant prolongation of EXTEM CT (clotting time) and CFT (clot formation time), lower EXTEM A10 (amplitude at 10 min), MCF (maximum clot firmness), and LI60 (lysis index). Furthermore, prolongation of INTEM CFT and FIBTEM CT, and decreased INTEM and FIBTEM A10 and MCF were found in neonates with RDS. Multivariable logistic regression analysis showed that RDS is an independent factor for the recorded alterations in ROTEM variables. CONCLUSIONS: RDS is associated with a hypocoagulable profile and greater hyperfibrinolytic potential compared to healthy neonates
SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review
The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with PIBD. A systematic search of PubMed and Scopus databases was conducted to identify studies published up until September 2022. Out of the 475 articles screened, 14 studies were included in the review. Of the 4006 children with PIBD included, 390 (9.7%) tested positive for COVID-19. Among those with COVID-19, 5.9% (0–16.7%) needed hospitalization, 0.6% (0–1%) were admitted to the pediatric intensive care unit (PICU), and no deaths were reported. Among the included studies, only four presented details regarding patients’ symptoms, with 21% (0–25%) presenting gastrointestinal (GI) symptoms. An association between PIBD activity or specific treatment and COVID-19 outcome could not be established. The prevalence of COVID-19 in patients with PIBD was low; therefore, the initial concerns regarding higher infection risk and worse prognosis in this population are not supported by the currently available data. Further research is needed to determine the natural history of the infection and the optimal treatment for these patients. Much is still unclear and additional studies should be performed in order to optimize prevention and care for this special group of patients
Rotational Thromboelastometry Findings Are Associated with Symptomatic Venous Thromboembolic Complications after Hip Fracture Surgery
Background Venous thromboembolism is a common complication after hip
fractures. However, there are no reliable laboratory assays to identify
patients at risk for venous thromboembolic (VTE) events after major
orthopaedic surgery. Question/purposes (1) Are rotational
thromboelastometry (ROTEM) findings associated with the presence or
development of symptomatic VTE after hip fracture surgery? (2) Were any
other patient factors associated with the presence or development of
symptomatic VTE after hip fracture surgery? (3) Which ROTEM parameters
were the most accurate in terms of detecting the association of
hypercoagulability with symptomatic VTE? Methods This retrospective
study was conducted over a 13-month period. In all, 354 patients with
femoral neck and peritrochanteric fractures who underwent hip
hemiarthoplasty or cephallomedullary nailing were assessed for
eligibility. Of those, 99% (349 of 354) were considered eligible for
the study, 1% (3 of 354) of patients were excluded due to coagulation
disorders, and another 1% (2 of 354) were excluded because they died
before the postoperative ROTEM analysis. An additional 4% (13 of 354)
of patients were lost before the minimum study follow-up of 3 months,
leaving 95% (336 of 354) for analysis. A ROTEM analysis was performed
in all patients at the time of their hospital admission, within hours of
the injury, and on the second postoperative day. The patients were
monitored for the development of symptoms indicative of VTE, and the
gold standard tests for diagnosing VTE, such as CT pulmonary angiography
or vascular ultrasound, were selectively performed only in symptomatic
patients and not routinely in all patients. Therefore, this study
evaluates the association of ROTEM with only clinically evident VTE
events and not with all VTE events. ROTEM results did not affect the
clinical surveillance of the study group and the decision for further
work up. To determine whether ROTEM findings were associated with the
presence or development of symptomatic VTE, ROTEM parameters were
compared between patients with and without symptomatic VTE. To establish
whether any other patient factors were associated with the presence or
development of symptomatic VTE after hip fracture surgery, clinical
parameters and conventional laboratory values were also compared between
patients with and without symptomatic VTE. Finally, to determine which
ROTEM parameters were the most accurate in terms of detecting the
association of hypercoagulability with symptomatic VTE, the area under
the curve (AUC) for certain cut off values of ROTEM parameters was
calculated. Results We found several abnormal ROTEM values to be
associated with the presence or development of symptomatic VTE. The
preoperative maximum clot firmness was higher in patients with
clinically evident VTE than in patients without these complications
(median [interquartile range] 70 mm [68 to 71] versus 65 mm [61 to
68]; p < 0.001). The preoperative clot formation time was lower in
patients with clinically evident VTE than those without clinically
evident VTE (median 61 seconds [58 to 65] versus 70 seconds [67 to
74]; p < 0.001), and also the postoperative clot formation time was
lower in patients with clinically evident VTE than those without these
complications (median 52 seconds [49 to 59] versus 62 seconds [57 to
68]; p < 0.001). Increased BMI was also associated with clinically
evident VTE (odds ratio 1.26 [95% confidence interval 1.07 to 1.53];
p < 0.001).
We found no differences between patients with and without clinically
evident VTE in terms of age, sex, smoking status, comorbidities, and
preoperative use of anticoagulants. Lastly, preoperative clot formation
time demonstrated the best performance for detecting the association of
hypercoagulability with symptomatic VTE (AUC 0.89 [95% CI 0.81 to
0.97]), with 81% (95% CI 48% to 97%) sensitivity and 86% (95% CI
81% to 89%) specificity for clot formation time <= 65 seconds.
Conclusion ROTEM’s performance in this preliminary study was promising
in terms of its association with symptomatic VTE. This study extended
our earlier work by demonstrating that ROTEM has a high accuracy in
detecting the level of hypercoagulability that is associated with
symptomatic VTE. However, until its performance is validated in a study
that applies a diagnostic gold standard (such as venography,
duplex/Doppler, or chest CT) in all patients having ROTEM to confirm its
performance, ROTEM should not be used as a regular part of clinical
practice