A Retrospective Analysis of the Disruptions in the HIV Continuum of Care During the COVID-19 Pandemic: Lessons From a Clinic-Based Study

BACKGROUND

The COVID-19 pandemic profoundly affected healthcare services, including HIV patient care. This study assessed the impact of the pandemic on diverse aspects of care for individuals living with HIV (PLWH).

METHODS

Patient data from 2019 to 2021 were collected using the Cascades template, provided by the New York State Department of Health, focusing on viral testing and suppression outcomes. Age, ethnicity, sex, and race were considered variables and analyzed via chi-square analysis, logistic regression model, and F test.

RESULTS

The pandemic significantly reduced viral testing in 2020 due to restrictions and closures, but telemedicine and tele-pharmacy helped maintain care. Age was a crucial factor, predicting higher viral testing and suppression odds for older individuals, but no significant differences were observed between patient gender, race, or ethnicity in obtaining viral testing or achieving suppression.

CONCLUSIONS

While limitations existed, this study provides insights into sustaining care during crises, highlighting the importance of innovative healthcare delivery methods and age-sensitive approaches for PLWH.

Heart of the Matter: Decoding the Underdiagnosed Cardiac Amyloidosis

Cardiac amyloidosis, a rare disorder marked by toxic amyloid protein deposition in the myocardium, contributes significantly to restrictive cardiomyopathy. We present an 85-year-old female diagnosed with amyloid transthyretin (ATTR) cardiac amyloidosis, emphasizing the under-recognition of this condition. The pathophysiology of cardiac amyloidosis involves misfolded protein accumulation, which impairs myocardial function. Differentiating AL and ATTR is crucial, with ATTR predominance. Diagnosis relies on echocardiography, cardiac magnetic resonance, nuclear imaging, and biomarker testing. A positive pyrophosphate (PYP) scan, compatible echocardiographic features, and the absence of systemic myeloma signs diagnose ATTR amyloidosis. Management includes heart failure treatment, arrhythmia control, and disease-modifying strategies like Tafamidis, Inotersen, and Patisiran. Genotyping guides prognostic and therapeutic considerations. Recognizing cardiac amyloidosis as an underlying cause of heart failure with preserved ejection fraction necessitates collaboration between cardiology and hematology. Improved awareness, innovative diagnostics, and targeted therapies are crucial to reduce diagnostic delays and enhance outcomes.

A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery

OBJECTIVE

The Siemens servo 300 A ventilator has an automode function that allows automated weaning of patients from mechanical ventilation. Spontaneous breathing triggers the ventilator. After two spontaneously triggered breaths, the ventilator automatically changes from mandatory mechanical ventilation to spontaneous ventilation. If spontaneous breathing or triggering does not occur, the Siemens servo 300 A ventilator changes from spontaneous ventilation back to mandatory mechanical ventilation. We compared the effects of automated versus conventional protocol-driven weaning on the time until extubation in patients undergoing coronary artery bypass graft (CABG) surgery. In addition, we studied the effects of the mode of weaning on hemodynamic and physiologic parameters.

METHODS

Twenty consecutive male patients without respiratory disease scheduled for CABG at the University Hospital of Regensburg were entered into the study. Patients were randomized to postoperative ventilation with the Siemens 300 A/automode ventilator (group A, n = 10) or with the Siemens 300 ventilator (group B, n = 10). All patients were weaned from ventilation according to a standardized protocol.

RESULTS

On average, patients in group A were younger and had lower pulmonary artery pressure (PAP) and higher cardiac output compared to patients in group B. However, patients in group A had longer ischemic and bypass times compared to patients in group B. Postoperative use of analgesia and sedation were similar in both groups. Time from tracheal intubation until extubation was 2 h shorter in patients assigned to automode ventilation compared to patients assigned to conventional ventilation (mean time group A 7.9 h, group B 10.0 h; p = 0.069). Peak airway pressure was reduced by 2 cm H2O at the beginning of spontaneous ventilation in group A compared to group B. After extubation, cardiac index showed a greater increase in patients assigned to group A compared to those in group B.

CONCLUSIONS

Automode ventilator weaning trended toward more rapid extubation than did conventional protocol-driven ventilation in conjunction with a standardized weaning protocol. Physiologic and hemodynamic factors were better in patients using automode ventilation compared to patients using conventional ventilation. Automode ventilation was well tolerated and did not induce significant adverse effects.

[Injuries of the heart--diagnosis and therapy]

Injuries of the heart are present in 7-12% of all thoracic trauma cases. Most of these (80%) are polytrauma patients. The mechanism of the accident, the localisation of injuries, the physical condition of the patients and the skills of the hospital stuff are determinant factors for the outcome. Hemodynamic instability needs an urgent echocardiography, signs of an obstructive pericardial hematoma and/or progressive bleeding require an urgent operation using a left lateral or mediosternal approach. ECC and cell saving should be available. The contusion of the heart is monitored by ECG and Troponin tests. The application of a "mini" heart-lung machine in difficult situations could be very useful.

A mammalian homolog of unc-53 is regulated by all-trans retinoic acid in neuroblastoma cells and embryos

The vitamin A metabolite, all-trans retinoic acid (atRA), plays an important role in neuronal development, including neurite outgrowth. However, the genes that lie downstream of atRA and its receptors in neuronal cells are largely unknown. By using the human neuroblastoma cell line, SH-SY5Y, we have identified an atRA-responsive gene (RAINB1: retinoic acid inducible in neuroblastoma cells) that is induced within 4 h after exposure of SH-SY5Y cells to atRA. RAINB1 mRNA is highly expressed in the nervous system (10.5- to 11-kb transcript) in both developing embryos and adults. Its expression is perturbed in developing rat embryos exposed to excess or insufficient atRA. RAINB1 is present on chromosome 11 and is spread over 38 exons, resulting in a putative ORF of 2,429 amino acids. The RAINB1 protein shows high similarity to a gene in Caenorhabditis elegans, unc-53, that is required for axonal elongation of mechanosensory neurons, suggesting that these proteins are orthologs. Thus, RAINB1 may represent a critical downstream gene in atRA-mediated neurite outgrowth.

One-step immunoaffinity purification of recombinant human retinoic acid receptor gamma

Retinoic acid receptors (RAR) are members of the steroid/thyroid hormone receptor superfamily and serve as ligand-activated transcription factors. In order to facilitate studies of receptor protein, we have generated a monoclonal antibody to the human RAR gamma, and have developed a procedure to purify the full-length receptor expressed in insect cells. The monoclonal antibody (A10) was developed using as antigen a carboxy-terminal fragment of the human RAR gamma expressed as a bacterial fusion protein. The A10 monoclonal antibody binds to both native and denatured forms of the human RAR gamma. This antibody was immobilized on a resin and used to purify full-length, baculovirus-expressed human RAR gamma to near homogeneity. The immunoaffinity-purified receptor is > 90-95% pure as revealed by silver-stained gels. The identity of the single protein band as RAR gamma was verified by immunoblotting using a polyclonal antibody to an epitope distinct from that recognized by the A10 antibody. The pure human RAR gamma is functional with respect to both ligand and DNA binding. Scatchard analysis of 3H-labeled all-trans retinoic acid binding to purified human RAR gamma revealed a single, high-affinity binding site with a Kd of approximately 2 nM. Binding of the pure RAR gamma to a DR5-type retinoic acid response element was also studied. Response element binding by RAR gamma required the presence of the retinoid X receptor, but did not require the presence of additional proteins. Human RAR gamma protein purified in this fashion will be useful in future structural and functional studies.

Apolipoprotein B and a second major gene locus contribute to phenotypic variation of spontaneous hypercholesterolemia in pigs

The Lpb5 apolipoprotein B (apoB) allele occurs in pigs with spontaneous hypercholesterolemia. Low-density lipoprotein (LDL) from these pigs binds to the LDL receptor with a lower affinity and is cleared from the circulation more slowly than control pig LDL. However, the severity of hypercholesterolemia in pigs with the mutant apoB allele is highly variable. This study aimed to determine the metabolic basis for the phenotypic heterogeneity among Lpb5 pigs. Lpb5 pigs were divided into two groups: those with plasma cholesterol greater than 180 mg/dL (Lpb5.1) and those with plasma cholesterol less than 180 mg/dL (Lpb5.2). LDL from both Lpb5.1 and Lpb5.2 pigs was catabolized in vivo and in vitro at a similarly reduced rate. The difference in plasma cholesterol between the two phenotypic groups was in part due to a higher buoyant LDL production rate in Lpb5.1 pigs than in Lpb5.2 pigs. The in vivo LDL receptor status was evaluated by measuring the catabolism of LDL chemically modified to abrogate LDL receptor binding. Approximately 50% of LDL clearance in normal and Lpb5.2 pigs was via the LDL receptor; in Lpb5.1 pigs, 100% of LDL clearance was LDL receptor independent. Quantitative pedigree analysis of the segregation of the plasma cholesterol phenotype suggested that two major gene loci (the apoB locus and a second apparently unlinked locus) contribute to the determination of plasma cholesterol levels in this pig population.

Determination of pig apolipoprotein B genotype by gene amplification and restriction fragment length polymorphism analysis

Sequence differences within the pig apoB gene can be used to identify rapidly four of eight known pig apoB alleles, designated LPB1-LBP8. We describe the use of gene amplification, followed by endonuclease digestion and agarose gel electrophoresis, to discern size and restriction site differences. LPB5, a common allele associated with reduced low density lipoprotein clearance and hypercholesterolaemia in pigs, is identified by a 283-bp insertion in intron 28. LPB3 and LPB7 are distinguished by a unique HindIII site; LPB8 shares a unique HincII site with LPB5. This method facilitates identification of the apoB genotype of pigs used in lipoprotein research and allows for further investigation into the association of particular apoB alleles with lipoprotein metabolism abnormalities.