Relationship of polypharmacy to HIV RNA suppression in people aged ≥ 50 years living with HIV

OBJECTIVES

People living with HIV (PLWH) aged ≥ 50 years face unique challenges regarding their medication therapies, especially antiretroviral therapy (ART). Use of ARTs, along with medications for comorbidities, may lead to adverse events, drug-drug interactions (DDIs) and poor adherence. The objective of this study was to identify the number of medications above which PLWH aged ≥ 50 years are less likely to be virally suppressed and to describe other associated patient-specific risk factors.

METHODS

This was a cross-sectional study of PLWH aged ≥ 50 years, prescribed ART, and seen at least once in the Northwestern Infectious Disease Center between 1 June 2013 and 31 May 2015. Variables concerning medication use and comorbidities were collected. The primary outcome was the presence of an undetectable plasma HIV RNA level (viral load).

RESULTS

Among the 621 included patients, there was a higher percentage taking ≤ 15 medications with an undetectable plasma HIV RNA (n = 453; 80.6%) vs. patients taking > 15 medications (n = 40; 67.8%; P = 0.03). Taking > 15 medications [odds ratio (OR) 0.49; 95% confidence interval (CI) 0.26-0.96], pulmonary disease (OR 0.54; 95% CI 0.3-0.97) and CD4 T-lymphocyte count < 200 cells/μL (OR 0.39; 95% CI 0.22-0.68) decreased the odds of having an undetectable plasma HIV RNA.

CONCLUSIONS

PLWH taking > 15 medications were less likely to have an undetectable HIV RNA. Further studies are needed to evaluate the impact of overall medication economic burden on clinical outcomes among PLWH ≥ 50 years of age.

Hepatic Transplants in Espirito Santo State, Brazil

BACKGROUND

The Meridional Hospital Liver transplant unit is the only one active in all Espírito Santo State, Brazil, since 2004.

OBJECTIVE

The aim is to analyze data of the first 250 transplants performed by the team.

METHODS

This retrospective study reviewed files from patients transplanted in the Meridional Hospital from January 2005 to December 2015.

RESULTS

There were 250 liver transplants in 236 patients and 14 retransplants. 72.4% were male recipients, with average age of 51.1 years (1-70 years), and the main etiology was alcoholic cirrhosis (33.6% of the cases). Surgical reintervention occurred in 58 patients (include retransplantations) during the same hospitalization, with revision of homeostasis and retransplant as main indications. In the retransplant group, 73.3% of patients died within 2 months. Thrombosis of the hepatic artery was responsible for 40% of the indications for retransplant. The average time between first and second transplant was 223 days (median 14 days). Currently 152 of 236 patients are living, with 1-year life expectancy of approximately 71%. The mortality peak occurred from the immediate postoperative period to 2 months post-transplant (63.8% of the deaths). 32% of subjects did not need intraoperative blood transfusion. The average time of intensive care unit stay was of 8.52 days, and overall hospital stay was 21.7 (median 15 days).

CONCLUSION

Despite the logistic difficulties and lack of donors our unit, keep in advance with survival comparable to other national centers (68% to 74% in 1-year).

Acute management of traumatic cervical spinal cord injuries

Successful outcome from a traumatic cervical spinal cord injury (SCI) depends heavily upon the quality of the acute care rendered to the affected individual. In recent years, there have been significant advances in the acute management of SCI. We discuss current management strategies in the areas of prehospital care and transport, emergency room management, surgical considerations and pharmacotherapy.

Three women with lupus transverse myelitis: case reports and differential diagnosis

Although the association between transverse myelitis (TM) and systemic lupus erythematosus (SLE) has been reported previously, it remains a rare clinical condition. Our experience treating three women with lupus TM within a few months is presented. In each patient, spinal cord dysfunction was accompanied by laboratory or clinical evidence of SLE. Further neurologic manifestations, such as optic neuritis, developed in all patients, suggesting other diagnoses, including multiple sclerosis (MS), Devic's syndrome, and lupoid sclerosis. The outcomes for these three women were severe disability, death, and moderate disability, respectively. The severity of outcome did not seem to correlate with the timing or intensity of treatment. Physiatrists should be aware of the potential for neurologic progression in lupus TM, because patients with this condition invariably require rehabilitation.

The rheumatoid thumb

The thumb frequently is involved in rheumatoid arthritis and often is a source of significant functional loss, pain, and deformity. Fortunately, much can be done to provide pain relief, improve function, enhance appearance, and slow the progression of disease. Specific surgical interventions should be based on the nature and stage of deformity as well as the status of tendons, ligaments, and adjacent joints. Treatment options, in isolation or in combination, include synovectomy, arthrodesis, arthroplasty, and tendon repair or transfer. Although most thumb deformities can be classified as one of six common types, other patterns of deformity also are seen. It therefore is imperative not to operate on pattern recognition alone, but to examine each patient carefully and individualize treatment.

Metronidazole bioassay

Urine from patients receiving metronidazole [1-(2-hydroxyethyl)-2-methyl-5-nitromidazole] orally or per vagina were subjected to paper chromatographic fractionation and examined for anticlostridial activity. Unmodified metronidazole and several metabolites were detected. These findings indicate that the clostridial bioassay may be limited in its applicability to the study of the pharmacodynamics of metronidazole as it does not differentiate between the parent substance and some of its metabolites. Moreover, some of the latter, although they possess antibacterial activity, may not have antiprotozoan activity.

Mutagenicity of metronidazole: presence of several active metabolites in human urine

Mutagenic activity was found in the urine of 10 patients given therapeutic dosages of metronidazole orally or per vagina. Paper chromatographic separation revealed that mutagenicity in the urine was associated with unmodified metronidazole and at least four of its known urinary metabolites. Activity was also recovered in a region of the chromatogram heretofore not assigned to a metronidazole metabolite.

Cognitive tempo and the mode of representation in emotionally disturbed and normal children

The relationship between cognitive tempo, MA, and mode of representation as inferred from equivalence groupings was investigated in 60 emotionally disturbed and normal boys and girls. No differences on any of the measures were obtained between the two groups of children or between males and females, so the data were combined for further analysis. A significant negative correlation between MA and both the number of errors on the Matching Familiar Figures Test (MFF) and the proportion of analytic concepts on the equivalence task was found. MFF latency was related to MFF errors only. On the other hand, MFF errors were related inversely to the proportion of both superordinate and functional concepts. Results were discussed in terms of supporting the previous findings of Olver and Hornsby in regard to equivalence and MA. Contrasts between the present findings and those of Kagan, Rosman, Day, Albert, and Phillips were discussed, and the differences in the nature if the array emphasized.