Is HAART based on newest active antiretroviral drugs influenced by GSS

Methods Major enrollment criterion was the administration of maraviroc, enfuvirtide, raltegravir, etravirine, darunavir/r or tipranavir/r, alone or in combination, in the latest antiretroviral regimen, decided upon the last genotypic RNA resistance test. This allowed us to assess the genotypic sensitivity score (GSS) at the same time. We also recorded previous presence of specific mutations in all available genotypic resistance tests, their persistence in time and their correlation to the last GSS

Haemoptysis and fever in a young refugee from Somalia

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Mediastinal lymphadenopathies and skin lesions in a 49-year-old Sinhalese man

Leprosy is a neglected disease sporadically reported in high-income countries. Skin lesion and peripheral nerve involvement represent most common manifestations. Mediastinal lymphadenopathy in the absence of superficial lymph nodes involvement is very rare. Atypical or rare clinical presentations of disease may delay diagnosis and therapy and cause potential life-threatening manifestations and disabilities. We describe the case of a 49-year-old Sinhalese man who was admitted to our hospital with a one-month history of peripheral neurological symptoms and skin lesions on lower limbs. CT scan showed the presence of mediastinal lymphadenopathies without lung parenchymal and superficial lymph nodes involvement. Endobronchial ultrasound-guided transbronchial needle aspiration showed the presence of granulomas while skin biopsy revealed dermo-hypodermic granulomas with perineural lymphohistiocytic inflammatory reaction. Fite-Faraco staining demonstrated the presence of acid-fast bacilli in both lymph nodal and skin biopsy and polymerase chain reaction was positive for Mycobacterium leprae. Multibacillary leprosy was then diagnosed

Real World Estimate of Vaccination Protection in Individuals Hospitalized for COVID-19

Whether vaccination confers a protective effect against progression after hospital admission for COVID-19 remains to be elucidated. Observational study including all the patients admitted to San Paolo Hospital in Milan for COVID-19 in 2021. Previous vaccination was categorized as: none, one dose, full vaccination (two or three doses >14 days before symptoms onset). Data were collected at hospital admission, including demographic and clinical variables, age-unadjusted Charlson Comorbidity index (CCI). The highest intensity of ventilation during hospitalization was registered. The endpoints were in-hospital death (primary) and mechanical ventilation/death (secondary). Survival analysis was conducted by means of Kaplan-Meier curves and Cox regression models. Effect measure modification by age was formally tested. We included 956 patients: 151 (16%) fully vaccinated (18 also third dose), 62 (7%) one dose vaccinated, 743 (78%) unvaccinated. People fully vaccinated were older and suffering from more comorbidities than unvaccinated. By 28 days, the risk of death was of 35.9% (95%CI: 30.1–41.7) in unvaccinated, 41.5% (24.5–58.5) in one dose and 28.4% (18.2–38.5) in fully vaccinated (p = 0.63). After controlling for age, ethnicity, CCI and month of admission, fully vaccinated participants showed a risk reduction of 50% for both in-hospital death, AHR 0.50 (95%CI: 0.30–0.84) and for mechanical ventilation or death, AHR 0.49 (95%CI: 0.35–0.69) compared to unvaccinated, regardless of age (interaction p > 0.56). Fully vaccinated individuals in whom vaccine failed to keep them out of hospital, appeared to be protected against critical disease or death when compared to non-vaccinated. These data support universal COVID-19 vaccination

Behavioural and emotional features of brain-damaged patients with abnormal social space boundaries

Introduction: The Interpersonal space (IPS) is the area surrounding the body that works as a defensive zone, and it is considered personal or private(1). The extension of this “comfort” space is flexible and modulable both by social and biological factors. These factors also include empathic abilities and personality traits such as impulsivity and behavioral regulation. It is commonly recognized that acquired brain lesions may lead to personality changes(2). Here we examine the alteration of the IPS in patients with acquired brain damage, and its association with empathy and behavior and personality changes featuring the frontal lobe syndrome. Methods: We measured IPS and empathic abilities in a group of patients (N=11) with acquired brain damage of traumatic or stroke aetiology and in a control group of age-matched healthy participants (N=40). IPS was assessed with the “stop-distance” paradigm, while cognitive and af ective emphatic abilities were assessed with the Interpersonal Reactivity Index (IRI). Moreover, in brain-damaged patients personality and behavioral changes were assessed through the Frontal Behavioral Index administered to patients’ caregivers. Noteworthy, patients’ selection was based on a clinical diagnosis of frontal lobe syndrome. Lesion size and its location were also analyzed. Results: Although the extension of the IPS in brain-damaged patients was overall comparable to that of controls, single case analyses showed that 2 out of 11 patients presented an enlargement of the IPS, which was associated with behavioral symptoms such as apathy, inattention, and emotional flatness. On the other hand, patients who showed a total loss of space boundaries exhibited impulsivity and inappropriateness. Our results also highlighted an overall reduction of empathic abilities in brain-damaged patients, as compared to healthy controls. Further single case analyses unveiled that the same patients exhibiting an IPS alteration have lower empathy. Patients exhibiting an alteration of IPS and empathy had brain lesions involving mostly frontal and temporal lobes. Discussion:The present study of ers a novel insight on the interplay between social space extension, personality traits and empathy: patients with brain damages causing clinical symptoms of frontal lobe syndrome may also present an alteration of IPS boundaries, along with behavioural dysregulation and empathic impairments. These findings support the view that the boundaries of the social, interpersonal, space are linked to empathy and behavioural regulation, likely sharing a common neural network

New Macrocyclic Amines Showing Activity as HIV Entry Inhibitors Against Wild Type and Multi-Drug Resistant Viruses †

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Incidence, Risk Factors and Impact on Clinical Outcomes of Bloodstream Infections in Patients Hospitalised with COVID-19: A Prospective Cohort Study

With the aim of describing the burden and epidemiology of community-acquired/healthcare-associated and hospital-acquired bloodstream infections (CA/HCA-BSIs and HA-BSIs) in patients hospitalised with COVID-19, and evaluating the risk factors for BSIs and their relative impact on mortality, an observational cohort study was performed on patients hospitalised with COVID-19 at San Paolo Hospital in Milan, Italy from 24 February to 30 November 2020. Among 1351 consecutive patients hospitalised with COVID-19, 18 (1.3%) had CA/HCA-BSI and 51 (3.8%) HA-BSI for a total of 82 episodes of BSI. The overall incidence of HA-BSI was 3.3/1000 patient-days (95% CI 2.4–4.2). Patients with HA-BSI had a longer hospital stay compared to CA/HCA-BSI and no-BSI groups (27 (IQR 21–35) vs. 12 (7–29) vs. 9 (5–17) median-days, p < 0.001) but a similar in-hospital mortality (31% vs. 33% vs. 25%, p = 0.421). BSI was not associated with an increased risk of mortality (CA/HCA-BSI vs. non-BSI aOR 1.27 95% CI 0.41–3.90, p = 0.681; HA-BSI vs. non-BSI aOR 1.29 95% CI 0.65–2.54, p = 0.463). Upon multivariate analysis, NIMV/CPAP (aOR 2.09, 95% CI 1.06–4.12, p = 0.034), IMV (aOR 5.13, 95% CI 2.08–12.65, p < 0.001) and corticosteroid treatment (aOR 2.11, 95% CI 1.06–4.19, p = 0.032) were confirmed as independent factors associated with HA-BSI. Development of HA-BSI did not significantly affect mortality. Patients treated with corticosteroid therapy had double the risk of developing BSI

Real World Estimate of Vaccination Protection in Individuals Hospitalized for COVID-19

Whether vaccination confers a protective effect against progression after hospital admission for COVID-19 remains to be elucidated. Observational study including all the patients admitted to San Paolo Hospital in Milan for COVID-19 in 2021. Previous vaccination was categorized as: none, one dose, full vaccination (two or three doses >14 days before symptoms onset). Data were collected at hospital admission, including demographic and clinical variables, age-unadjusted Charlson Comorbidity index (CCI). The highest intensity of ventilation during hospitalization was registered. The endpoints were in-hospital death (primary) and mechanical ventilation/death (secondary). Survival analysis was conducted by means of Kaplan-Meier curves and Cox regression models. Effect measure modification by age was formally tested. We included 956 patients: 151 (16%) fully vaccinated (18 also third dose), 62 (7%) one dose vaccinated, 743 (78%) unvaccinated. People fully vaccinated were older and suffering from more comorbidities than unvaccinated. By 28 days, the risk of death was of 35.9% (95%CI: 30.1–41.7) in unvaccinated, 41.5% (24.5–58.5) in one dose and 28.4% (18.2–38.5) in fully vaccinated (p = 0.63). After controlling for age, ethnicity, CCI and month of admission, fully vaccinated participants showed a risk reduction of 50% for both in-hospital death, AHR 0.50 (95%CI: 0.30–0.84) and for mechanical ventilation or death, AHR 0.49 (95%CI: 0.35–0.69) compared to unvaccinated, regardless of age (interaction p > 0.56). Fully vaccinated individuals in whom vaccine failed to keep them out of hospital, appeared to be protected against critical disease or death when compared to non-vaccinated. These data support universal COVID-19 vaccination