2224 research outputs found
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Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study.
Get PDFOBJECTIVE:
To characterize the profile of non-AIDS-related comorbidities (NARC) in the older HIV-1-infected population and to explore the factors associated with multiple NARC.
METHODS:
This was a multicentre, cross-sectional study including HIV-1-infected patients aged ≥50 years, who were virologically suppressed and had been on a stable antiretroviral therapy (ART) regimen for at least 6 months. A multiple regression model explored the association between demographic and clinical variables and the number of NARC.
RESULTS:
Overall, 401 patients were enrolled. The mean age of the patients was 59.3 years and 72.6% were male. The mean duration of HIV-1 infection was 12.0 years and the median exposure to ART was 10.0 years. The mean number of NARC was 2.1, and 34.7% of patients had three or more NARC. Hypercholesterolemia was the most frequent NARC (60.8%), followed by arterial hypertension (39.7%) and chronic depression/anxiety (23.9%). Arterial hypertension and diabetes mellitus were the most frequently treated NARC (95.6% and 92.6% of cases, respectively). The linear regression analysis showed a positive relationship between age and NARC (B=0.032, 95% confidence interval 0.015-0.049; p=0.0003) and between the duration of HIV-1 infection and NARC (B=0.039, 95% confidence interval 0.017-0.059; p=0.0005).
CONCLUSIONS:
A high prevalence of NARC was found, the most common being metabolic, cardiovascular, and psychological conditions. NARC rates were similar to those reported for the general population, suggesting a larger societal problem beyond HIV infection. A multidisciplinary approach is essential to reduce the burden of complex multi-morbid conditions in the HIV-1-infected population.info:eu-repo/semantics/publishedVersio
A rare and threatening complication in a cirrhotic patient
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Changes in choroidal thickness following trabeculectomy and its correlation with the decline in intraocular pressure
No full textPURPOSE:
Evaluate whether there are significant changes in choroidal thickness following trabeculectomy, and how they relate do the decline in intraocular pressure.
METHODS:
This was a prospective evaluation of 28 eyes who underwent Moorfields modified trabeculectomy. The choroidal thickness was measured via OCT with enhanced depth imaging, before surgery and 1 day, 1 week and 1 month after surgery. Measurements were taken at the fovea, 1000 µm temporal to the fovea and 1000 µm nasal to the fovea. The relationship between choroidal thickness and intraocular pressure was statistically evaluated.
RESULTS:
The mean intraocular pressure before surgery was 25.07 ± 4.64 mmHg; 8.57 ± 3.62 mmHg after 1 day; 10.36 ± 4.39 mmHg after 1 week and 13.71 ± 5.13 mmHg after 1 month. Mean choroidal thickness increased after trabeculectomy with maximal values at 1 week. The largest increase was found at the fovea, with an average before surgery of 253.54 ± 62.01 µm; 286.75 ± 64.20 µm at 1 day, 286.36 ± 63.14 µm at 1 week and 271.00 ± 60.31 µm at 1 month. Increase in choroidal thickness was significant 1 day and 1 week after surgery in the foveal (p = 0.012, p = 0.007) and temporal (p = 0.040, p = 0.000) locations and 1 week postoperatively on the nasal location (p = 0.016). None of them were significant at 1 month after surgery. Preoperative IOP and choroidal thickness were correlated at all macular locations (ρ = 0.449-0.525, p = 0.004-0.016) yet no correlation was found between increase in choroidal thickness and decline in intraocular pressure in the postoperative period.
CONCLUSION:
Choroidal thickness appears to increase temporarily after trabeculectomy and these changes were not correlated with the decline in intraocular pressure. Further research is required to fully understand this phenomenon.info:eu-repo/semantics/publishedVersio
Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare?
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Antibodies against HDL Components in Ischaemic Stroke and Coronary Artery Disease
Get PDFQuantitative and qualitative defects of high-density lipoprotein (HDL) are important in atherogenesis. In this study, we investigated whether antibodies against HDL components had additional value to conventional cardiovascular risk factors for the diagnosis of ischaemic stroke (IS) and coronary artery disease (CAD). Cross-sectional study was conducted on 53 patients with IS, 51 with CAD and 55 healthy controls, and in vitro studies to validate findings of the clinical study. We determined serum immunoglobulin G (IgG) antibodies against HDL (aHDL), apolipoproteins (aApoA-I, aApoA-II and aApoC-I) and paraoxonase-1 (aPON1) as well as PON1 activity (PON1a), total antioxidant capacity and biomarkers of endothelial activation (serum nitric oxide metabolites, 3-nitrotyrosine, VCAM-1 and ICAM-1); in vitro assays tested the capacity of IgG aHDL purified from high titer patients to inhibit PON1a and to reverse protective effect of HDL on endothelial cells. IgG aHDL, aApoA-I and aPON1 were higher in IS and CAD than controls (p < 0.001), predicted negatively PON1a and positively VCAM-1 and ICAM-1. By adding IgG aHDL and aApoA-I to a traditional cardiovascular risk factors model for IS and by adding IgG aHDL in a similar model for CAD, we obtained better discrimination of IS and CAD from healthy controls. IgG aHDL purified from IS and CAD inhibited PON1a by 38% (p < 0.01) and abrogated the protective effect of HDL on VCAM-1 expression by 126% compared with non-specific human IgG (p < 0.001). IgG against HDL components interfere with the antioxidant and anti-inflammatory properties of HDL and may represent novel biomarkers for vascular disease that need to be investigated in prospective studies.info:eu-repo/semantics/publishedVersio
Pseudotumor cerebri as the presentation of Lyme disease in a non-endemic area
No full textIntracranial hypertension is a rare entity in prepubertal children, and its differential diagnosis includes a number of systemic diseases, drugs, vitamin deficiencies and excesses, and hereditary conditions. Infectious aetiology is rare. The case of a 9-year-old boy with intracranial hypertension secondary to acute neuroborreliosis is described. He presented with daily pulsatile frontotemporal headache, pallor, photophobia and phonophobia. His neurological examination revealed papilledema with no nuchal rigidity. The lumbar puncture showed increased pressure (50 cm H2O) and lymphocytic pleocytosis. Serum and cerebrospinal fluid (CSF) Borrelia burgdorferi antibodies were positive. This kind of infection is rare in Portugal but a trip to an endemic area was identified. A careful history, considering the exposure to rural areas together with the intracranial hypertension and inflammatory CSF, are important clues to the diagnosis, allowing the institution to select appropriate treatment.info:eu-repo/semantics/publishedVersio
Massa vulvar – a ponta do iceberg
Get PDFUterine fibroids are benign monoclonal tumors that originates from the smooth muscle cells of the myometrium and are
the most common solid pelvic tumors in women. In the differential diagnosis of vulvar masses we should considered Bartholin's cysts or abscesses, Bartholin's tumors, fibroids (usually fibroids of the round ligament), subcutaneous lipomas, inguinal hernia or adenomegaly. With this images we present a case of a vulvar mass caused by a fibroid, probably from the round ligament, which was a tip of the iceberg of an extensive pelvic leiomyomatosis.info:eu-repo/semantics/publishedVersio
Ischaemic Stroke in a Child of a Vegan Mother
Get PDFO acidente vascular cerebral é uma doença rara na infância (2,7 por 100 000 crianças por ano). A hiperhomocisteinemia é um
fator de risco independente para a aterosclerose prematura, sendo habitualmente secundário a mutações na enzima metiltetrahidrofolato redutase ou défice de vitamina B12, na idade pediátrica. Descreve-se o caso clínico de um lactente de 10 meses,
observado no serviço de urgência por queda da própria altura, com diminuição dos movimentos espontâneos do hemicorpo
esquerdo e com postura flexora do membro superior esquerdo. A tomografia computorizada realizada na admissão mostrava
imagens de hipodensidade nos corpos estriados bilaterais, e a ressonância magnética lesões isquémicas nas áreas das artérias
lentículo-estriadas externas. Analiticamente apresentava aumento da homocisteína sérica (25,2 µmol/L) e défice de vitamina
B12 (< 150 pg/mL). A mãe apresentava igualmente défice de vitamina B12, associado a dieta vegana. Foi feita suplementação
com vitamina B12, iniciada a diversificação alimentar com introdução da carne, verificando-se normalização dos níveis de
homocisteína sérica. Após seis meses de cumprimento do plano terapêutico de medicina física e de reabilitação não eram
objetiváveis assimetrias sequelares.
A dieta vegana pode associar-se a défices nutricionais que obrigam a uma vigilância nutricional por um profissional experiente,
nos casos em que esta seja a opção materna durante a gravidez, sobretudo se prolongada no período de aleitamento materno,
e/ou na criança ou adolescente.info:eu-repo/semantics/publishedVersio
