1,721,225 research outputs found
Utilizzo di EVG/COBI/FTC/TDF in una paziente con viremia elevata e cirrosi HCV-correlata
No full textBacterial community-acquired pneumonia in HIV-infected patients
No full textPurpose of Review: In this review, we focus on the clinical features, diagnosis, outcome and management of bacterial community-acquired pneumonia (BCAP) in HIV-infected patients, with particular attention to the most Recent Findings in this area. Recent Findings: Clinical features of BCAP are often atypical in HIV-infected individuals, especially when liver cirrhosis is also present. Streptococcus pneumoniae is the most common causative agent and is frequently associated with bacteriemic disease even in low-risk patients according to pneumonia severity index. An etiologic diagnosis is obtained in an average 35% of cases with standard culture methods. In such conditions, urinary antigen test for S. pneumoniae identification may help in reaching a rapid and etiologic diagnosis. CD4 cell count should be carefully considered in HIV patients with BCAP. In consideration of their high mortality risk, patients with a CD4 cell count of less than 200 cells/μl should be hospitalized, whereas those with a CD4 cell count of at least 200 cells/μl could be managed according to pneumonia severity index score. Empiric antibiotic therapy should include a combination of a β-lactam and a macrolide or a respiratory fluoroquinolone alone. Finally, prevention strategies should include lifestyle modification, highly active antiretroviral therapy access and adherence programs and the implementation of pneumococcal vaccination. Summary: A correct diagnosis and management together with a comprehensive approach to preventive measures, including lifestyle modification, highly active antiretroviral therapy access and adherence programs and the implementation of pneumococcal vaccination, are key factors to reduce BCAP incidence and mortality in HIV-infected patients
Trends in the European HIV/AIDS epidemic: a perspective from Italy
No full textThe HIV/AIDS epidemic represents one of the major public-health challenges in present days. Despite the relevant improvement in the prognosis of HIV disease following the introduction of highly active antiretroviral therapy (HAART), numerous new challenges are progressively emerging as patient characteristics evolve. In this article, we give an insight into more actual topics in the HIV/AIDS epidemic in Italy and Europe, including recent epidemiological trends, emerging drug resistance and non-B-subtype circulation, the lights and shadows of HAART and the potential of HARRT to reduce sexual transmission of HIV
Special Issue “Efficacy and Safety of Antiviral Therapy”
No full textThis comprehensive collection of papers contains a wide range of studies and observations centered on antiviral therapies, with a particular focus on HIV and other viral infections such as monkeypox and SARS-CoV-2 [...
Shedding new light on COVID-19 therapeutics during the omicron era: a deeper dive into real-world data
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The usefulness of 99mTc-tetrofosmin SPECT in the detection of lung metastases from extrapulmonary primary tumors
No full textPurpose. The appearance of pulmonary metastases in neoplastic patients previously submitted to radical operation of an extrapulmonary primary tumor and with no recurrences and/or secondary distant localizations can markedly worsen disease prognosis if the lesions are in advanced stages and no longer removable by surgical procedures. In this study, we evaluated the usefulness of 99mTc-tetrofosmin scintigraphy, both planar and SPECT, in the detection of pulmonary metastases from previously treated extrapulmonary primary tumors, comparing the results with those obtained with CT. Materials and methods. We studied 73 patients, 33 M and 40 F, aged 24 to 79 yrs, had who undergone previously surgical resection extrapulmonary primary tumors; 31 patients had mammary, 13 gastrointestinal, 13 genitourinary, 13 thyroid and 3 laryngeal carcinomas. In all patients CT ascertained single (42 cases) or multiple (31 cases) pulmonary lesions. 99mTc-tetrofosmin scintigraphy, always performed within a week of CT, was acquired 10 min after 740 MBq i.v. tracer injection, using a rectangular, large field of view, dual head gamma camera, equipped with low energy, parallel-hole and high resolution collimators. Conventional planar acquisition, with the patient in the supine position, was followed by SPECT over 360° with body contouring system, using a zoom factor of 1-1.3. a 64×64 matrix size, a 3° angular step and an acquisition time of 30 sec/frame; image reconstruction was performed with the Back Projection Filtered Method using a Metz filter. In the coronal slices of SPECT images a semiquantitative analysis of the lesion was also made and the tumor-to-background (T/B) ratio was calculated; the calculation of the latter, considered indicative for tumor when >1.4, was performed in the lesion with the highest radiotracer uptake in patients with multiple lung lesions. The results of SPECT qualitative images were compared with those of planar scintigraphy and both of these with the data obtained with CT, and statistical difference was calculated with McNemar's test. The definitive diagnosis was achieved after scintigraphy by the analysis of cytologic or histologic specimens obtained by thoracotomy, percutaneous thoracic needle biopsy or bronchoscopic biopsy, and in some cases by the confirmation of instrumental exams at 6-8 month follow up. Pulmonary metastases were ascertained in 65/73 cases, while benign lesions were present in the remaining 8 patients. Results. CT was true positive in 60/65 (92.3%) patients with metastases and false negative in the remaining five, four with a single lesion and one with two lesions in the same lung. SPECT detected metastases in 62/65 (95.4%) patients, including the five CT false negative cases, while it was false negative in three cases with single lesions, all positive at CT, with a size of 1.0, 1.0, 2.0 cm, respectively. Planar scintigraphy was only positive in 23/65 (35.4%) patients, with a sensitivity value significantly (p6 lesions ≤0.5 cm in size, while it was more sensitive in three other cases; CT and SPECT were concordant in macronodular metastases detection, except in one case in which SPECT depicted more lesions. Planar scintigraphy had 42 false negative results and, when positive, underestimated the number of multiple lesions in respect of both SPECT and CT; it was positive but CT negative in only one case with two lesions. Specificity was higher for both SPECT and planar scan (87.5%) than CT (62.5%) but not significantly; accuracy was higher for SPECT (94.5%) than both planar scan (42%) and CT (89%), but the difference was significant only in respect of planar. The combined use of SPECT and CT achieved 100% sensitivity and accuracy values. The T/B ratio was >1.4 in all SPECT positive cases (range: 1.6-5.3), indicating a suspected tumor, while it was 1.2 in the only benign case which turned out to be false positive at qualitative SPECT imaging. Conclusions. 99mTc-tetrofosmin SPECT seems to be a reliable diagnostic tool in the detection of pulmonary metastases from extrapulmonary primary tumors, in particular in the cases in which CT is indeterminate or false positive, and therefore contributes to a more correct patient classification. Moreover, SPECT image semiquantitative analysis can give additional information for a differential diagnosis between malignant and benign lesions as well as offering a more accurate selection of the lesions to be subjected to biopsy in patients with multiple metastases. However, only the combined use of CT and 99mTc-tetrofosmin SPECT can achieve the highest sensitivity and accuracy values and obtain the correct staging in most patients, thus suggesting that these two procedures must be employed together
Pneumococcal pneumonia: clinical features, diagnosis and management in HIV-infected and HIV noninfected patients
No full textPurpose of review: In this review, we focus on the clinical features, diagnosis and management of pneumococcal pneumonia in HIV-infected and noninfected patients, with particular attention to the most recent advances in this area.
Recent findings: Classical clinical features are found in young adults, whereas atypical forms occur in immunocompromised patients including HIV-infected individuals. Bacteremic pneumococcal pneumonia is more frequently observed in HIV-infected and also in low-risk patients, according to the Pneumonia Severity Index (PSI). Pneumococcal pneumonia diagnostic process includes physical examination, radiologic findings and microbiologic diagnosis. However, etiologic diagnosis using traditional culture methods is difficult to obtain. In this setting, urinary antigen test, which recognizes Streptococcus pneumoniae cell wall C-polysaccharide, increases the probability of etiologic diagnosis. A correct management approach is crucial in reducing pneumococcal pneumonia mortality. The use of the PSI helps clinicians in deciding between inpatient and outpatient management in immunocompetent individuals, according to Infectious Diseases Society of America (IDSA)–American Thoracic Society (ATS) guidelines. Recent findings support PSI utility also in HIV-infected patients. Recently, efficacy of pneumococcal vaccine in reducing pneumococcal disease incidence has been evidenced in both HIV-infected and noninfected individuals.
Summary: Rapid diagnosis and correct management together with implementation of preventive measures are crucial in order to reduce pneumococcal pneumonia related incidence and mortality in HIV-infected and noninfected patients
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