Cardiovascular system and human immunodeficiency virus infection

Iako su rana klinička opažanja ukazivala da virus humane imunodeficijencije (HIV) pošteđuje srce, novija istraživanja dokazuju da se kardiovaskularne bolesti u tijeku infekcije HIV-om susreću sve češće. Na pojavnost ovih bolesti utječu brojni čimbenici: produljenje života osoba zaraženih HIV-om, sve učinkovitije antiretrovirusno liječenje, smanjenje imunosupresije, a time i rjeđa pojava oportunističkih infekcija, kao i nuspojave nekih lijekova. Klinički oblici kardiovaskularnih bolesti u tijeku infekcije HIV-om uključuju: miokarditis, dilatacijsku kardiomiopatiju, endokarditis, perikardni izljev i perikarditis, tumore srca povezane s AIDS-om (Kaposijev sarkom i maligni limfomi) te plućnu hipertenziju. Uvođenjem vrlo učinkovite antiretrovirusne terapije (HAART) znatno se promijenila pojavnost kardiovaskularnih manifestacija u sklopu infekcije HIV-om. S jedne strane HAART je modificirao klinički tijek HIV-bolesti, produljio preživljenje te poboljšao kvalitetu života osoba zaraženih HIV-om. S druge strane, HAART se dovodi u vezu s ranijom pojavom i napredovanjem ateroskleroze odnosno koronarne bolesti i bolesti perifernih arterija. Stoga se u cilju ranog otkrivanja i adekvatnog liječenja kardiovaskularnih bolesti povezanih s HIV-om preporuča detaljan periodički monitoring kardiovaskularnog sustava svih osoba zaraženih HIV-om, osobito onih u kojih su prisutni i drugi predisponirajući čimbenici rizika. Ovaj članak prikazuje kliničke aspekte osnovnih kardiovaskularnih manifestacija u tijeku infekcije HIV-om s osobitim osvrtom na novija saznanja o patogenezi i liječenju ovih bolesti.Although early clinical observations suggested that human immunodeficiency virus (HIV) spared the heart, subsequent experience has shown that cardiovascular diseases in the course of HIV infection are becoming more frequent. The frequency of these diseases is influenced by different variables such as survival prolongation in HIV-infected patients, advances in antiretroviral treatment, improvement of immunosupression and reduction in the occurrence of opportunistic infections, adverse effects of some drugs. Cardiac abnormalities in patients with HIV infection may include myocarditis, dilated cardiomyopathy, endocarditis, pericardial effusion and pericarditis, AIDS-related heart tumors (Kaposi\u27s sarcoma and malignant lymphomas), and pulmonary hypertension. Introduction of highly active antiretroviral therapy (HAART) regimens have greatly altered cardiovascular manifestations of HIV. On one hand, HAART has significantly modified the course of HIV disease, lengthened survival, and improved the quality of life of HIV-infected patients. On the other hand, HAARTis associated with acceleration of atherosclerotic arterial disease, both peripheral and coronary. Therefore, detailed periodically cardiovascular monitoring is warranted for all HIV-infected patients, especially those with other known underlying cardiovascular risk factors, for early identification and appropriate treatment of HIV-related cardiovascular diseases. This article reviews clinical aspects of principal HIV-associated cardiovascular diseases with an emphasis on new knowledge about pathogenesis and treatment of such conditions

Disturbance patterns in a socio-ecological system at multiple scales

Ecological systems with hierarchical organization and non-equilibrium dynamics require multiple-scale analyses to comprehend how a system is structured and to formulate hypotheses about regulatory mechanisms. Characteristic scales in real landscapes are determined by, or at least reflect, the spatial patterns and scales of constraining human interactions with the biophysical environment. If the patterns or scales of human actions change, then the constraints change, and the structure and dynamics of the entire socioecological system (SES) can change accordingly. Understanding biodiversity in a SES requires understanding how the actions of humans as a keystone species shape the environment across a range of scales. We address this problem by investigating the spatial patterns of human disturbances at multiple scales in a SES in southern Italy. We describe an operational framework to identify multi-scale profiles of short-term anthropogenic disturbances using a moving window algorithm to measure the amount and configuration of disturbance as detected by satellite imagery. Prevailing land uses were found to contribute in different ways to the disturbance gradient at multiple scales, as land uses resulted from other types of biophysical and social controls shaping the region. The resulting profiles were then interpreted with respect to defining critical support regions and scale-dependent models for the assessment and management of disturbances, and for indicating system fragility and resilience of socio-ecological systems in the region. The results suggest support regions and scale intervals where past disturbance has been most likely and clumped - i.e. where fragility is highest and resilience is lowest. We discuss the potential for planning and managing landscape disturbances with a predictable effect on ecological processes. (c) 2006 Elsevier B.V. All rights reserved

Screening for carriage of carbapenem-resistant Enterobacteriaceae in settings of high endemicity: A position paper from an Italian working group on CRE infections

A variety of national and international guidelines exist around the management of carbapenem resistant Enterobacteriaceae (CREs), but some of these are several years old and do not reflect current epidemiology and they also do not necessarily give pragmatic advice around active surveillance of CREs in countries with a high burden of cases and limited resources. This paper aims to provide a best practice position paper to guide active surveillance in a variety of scenarios in these settings, and discusses which patients should be screened, what methods could be used for screening, and how results might influence infection prevention interventions

Comment on: "Diagnosis of Periprosthetic Joint Infection: The Role of Nuclear Medicine May Be Overestimated" by Claudio Diaz-Ledezma, Courtney Lamberton, Paul Lichtstein and Javad Parvizi

We read with interest the article by Diaz-Ledezma et al entitled“Diagnosis of Periprosthetic Joint Infection: The Role of NuclearMedicine May Be Overestimated”recently published in The Journal ofArthroplast

Joint EANM/ESNR and ESCMID-endorsed consensus document for the diagnosis of spine infection (spondylodiscitis) in adults

Purpose: Diagnosis of spondylodiscitis (SD) may be challenging due to the nonspecific clinical and laboratory findings and the need to perform various diagnostic tests including serologic, imaging, and microbiological examinations. Homogeneous management of SD diagnosis through international, multidisciplinary guidance would improve the sensitivity of diagnosis and lead to better patient outcome. Methods: An expert specialist team, comprising nuclear medicine physicians appointed by the European Association of Nuclear Medicine (EANM), neuroradiologists appointed by the European Society of Neuroradiology (ESNR), and infectious diseases specialists appointed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), reviewed the literature from January 2006 to December 2015 and proposed 20 consensus statements in answer to clinical questions regarding SD diagnosis. The statements were graded by level of evidence level according to the 2011 Oxford Centre for Evidence-based Medicine criteria and included in this consensus document for the diagnosis of SD in adults. The consensus statements are the result of literature review according to PICO (P:population/patients, I:intervention/indicator, C:comparator/control, O:outcome) criteria. Evidence-based recommendations on the management of adult patients with SD, with particular attention to radiologic and nuclear medicine diagnosis, were proposed after a systematic review of the literature in the areas of nuclear medicine, radiology, infectious diseases, and microbiology. Results: A diagnostic flow chart was developed based on the 20 consensus statements, scored by level of evidence according to the Oxford Centre for Evidence-based Medicine criteria. Conclusions: This consensus document was developed with a final diagnostic flow chart for SD diagnosis as an aid for professionals in many fields, especially nuclear medicine physicians, radiologists, and orthopaedic and infectious diseases specialists

Risk factors for recurrence in patients with Clostridium difficile infection due to 027 and non-027 ribotypes

Objectives: Our objective was to evaluate factors associated with recurrence in patients with 027+ and 027– Clostridium difficile infection (CDI). Methods: Patients with CDI observed between January and December 2014 in six hospitals were consecutively included in the study. The 027 ribotype was deduced by the presence of tcdB, tcdB, cdt genes and the deletion Δ117 in tcdC (Xpert® C. difficile/Epi). Recurrence was defined as a positive laboratory test result for C. difficile more than 14 days but within 8 weeks after the initial diagnosis date with reappearance of symptoms. To identify factors associated with recurrence in 027+ and 027– CDI, a multivariate analysis was performed in each patient group. Subdistributional hazard ratios (sHRs) and 95% confidence intervals (95%CIs) were calculated. Results: Overall, 238 patients with 027+ CDI and 267 with 027– CDI were analysed. On multivariate analysis metronidazole monotherapy (sHR 2.380, 95%CI 1.549–3.60, p <0.001) and immunosuppressive treatment (sHR 3.116, 95%CI 1.906–5.090, p <0.001) were factors associated with recurrence in patients with 027+ CDI. In this patient group, metronidazole monotherapy was independently associated with recurrence in both mild/moderate (sHR 1.894, 95%CI 1.051–3.410, p 0.033) and severe CDI (sHR 2.476, 95%CI 1.281–4.790, p 0.007). Conversely, non-severe disease (sHR 3.704, 95%CI 1.437–9.524, p 0.007) and absence of chronic renal failure (sHR 16.129, 95%CI 2.155–125.000, p 0.007) were associated with recurrence in 027– CDI. Conclusions: Compared to vancomycin, metronidazole monotherapy appears less effective in curing CDI without relapse in the 027+ patient group, independently of disease severity

Key fundamental aspects for mapping and assessing ecosystem services: Predictability of ecosystem service providers at scales from local to global

How an apparent static and ordered landscape condition in social ecological landscapes (SELs), can be made sustainable in terms of maintenance and improvement of the provision of ecosystem services (ESs) in face of unpredictable disturbance and change? Our contribution to the Mapping and Assessment of Ecosystem Services (MAES) working group is to advance some recommendations on how to approach the dynamic analysis of complex adaptive systems to improve ecosystem resilience, habitat connectivity and the delivery of ESs. We show exemplary cases where we utilize the NDVI provided by remote sensing to evaluate land cover transformations and processes and ES provisioning. We focus on NDVI because it allows the supply of information on net primary production, i.e., the energetic foundation of nearly all ecosystems and that provides the basis of most of ESs. The use of spectral entropy, and nonlinear analysis of spatial temporal dynamics to investigate trajectory predictability of SELs provide very useful insight into the dynamics of SELs and can assist in the characterization of the links between land cover patterns with ecological processes to support more reliable assessments and accountings of ESs

Cases of cryptosporidiosis co-infections in AIDS patients: a correlation between clinical presentation and GP60 subgenotype lineages from aged formalin-fixed stool samples

Nine cases of cryptosporidiosis co-infections in AIDS patients were clinically categorised into severe (patients 1, 3, 8 and 9), moderate (patients 4 and 5) and mild (patients 2, 6 and 7). Formalin-fixed faecal specimens from these patients were treated to obtain high quality DNA competent for amplification and sequencing of the 60-kDa glycoprotein (GP60) gene. Sequence analysis revealed that one patient was infected with Cryptosporidium hominis whereas the remaining eight patients were infected with C. parvum. Interestingly, the patients showing severe cryptosporidiosis harboured two subtypes within the C. parvum allelic family IIc (IIcA5G3 and IIcA5G3R2), whereas patients with moderate or mild infections showed various subtypes of the C. parvum allelic family IIa (IIaA14G2R1, IIaA15G2R1, IIaA17G3R1 and IIaA18G3R1)

Clostridium difficile Toxins A and B: Insights into Pathogenic Properties and Extraintestinal Effects

Clostridium difficile infection (CDI) has significant clinical impact especially on the elderly and/or immunocompromised patients. The pathogenicity of Clostridium difficile is mainly mediated by two exotoxins: toxin A (TcdA) and toxin B (TcdB). These toxins primarily disrupt the cytoskeletal structure and the tight junctions of target cells causing cell rounding and ultimately cell death. Detectable C. difficile toxemia is strongly associated with fulminant disease. However, besides the well-known intestinal damage, recent animal and in vitro studies have suggested a more far-reaching role for these toxins activity including cardiac, renal, and neurologic impairment. The creation of C. difficile strains with mutations in the genes encoding toxin A and B indicate that toxin B plays a major role in overall CDI pathogenesis. Novel insights, such as the role of a regulator protein (TcdE) on toxin production and binding interactions between albumin and C. difficile toxins, have recently been discovered and will be described. Our review focuses on the toxin-mediated pathogenic processes of CDI with an emphasis on recent studies