Cognitive screening in treatment-naïve HIV-infected individuals in Hong Kong - a single center study

Background

HIV-associated neurocognitive disorder (HAND) remains prevalent in the era of combination antiretroviral therapy (cART). The prevalence of HAND in Hong Kong is not known.

Methods

Between 2013 and 2015, 98 treatment-naïve HIV-1-infected individuals were referred to and screened by the AIDS Clinical Service, Queen Elizabeth Hospital with (1) the International HIV Dementia Scale (IHDS), a screening tool that targets moderate to severe HAND, (2) the Montreal Cognitive Assessment (MoCA), a frequently used cognitive screening test and (3) the Patient Health Questionnare-9 (PHQ-9), a 9-item questionnaire that evaluates depression symptoms. Within the study period, 57 of them completed the second set of IHDS and MoCA at 6 months after baseline assessment.

Results

Most participants were male (94%), with a median age of 31 years. At baseline, 38 (39%) and 25 (26%) of them scored below the IHDS (≤10) and MoCA (25/26) cut-offs respectively. Poor IHDS performers also scored lower on MoCA (p = 0.039) but the correlation between IHDS and MoCA performance was weak (r = 0.29, p = 0.004). Up to a third of poor IHDS performers (13/38) showed moderate depression (PHQ-9 > 9). In the multivariable analysis, a lower education level (p = 0.088), a history of prior psychiatric illness (p = 0.091) and the presence of moderate depression (p = 0.079) tended to be significantly associated with poor IHDS performance.

At follow-up, 54 out of 57 were on cART, of which 46 (85%) had achieved viral suppression. Their blood CD4+ T-lymphocytes and IHDS scores were higher at follow-up compared to baseline values (both p < 0.001) but their MoCA performance was similar at both assessments. Of note, 17 participants in this subgroup scored below the IHDS cut-off at both assessments.

Conclusions

Poor IHDS performance, and likely cognitive impairment, was frequently observed in treatment-naïve HIV-infected individuals in our locality. A considerable proportion continued to score below the IHDS cut-off at 6 months after cART. Depression was frequently observed in this vulnerable population and was associated with poor IHDS performance.

Electronic supplementary material

The online version of this article (10.1186/s12879-019-3784-y) contains supplementary material, which is available to authorized users.

The benefit of prothrombin complex concentrate in decreasing neurological deterioration in patients with warfarin-associated intracerebral haemorrhage

OBJECTIVE

To compare the outcomes of patients with warfarin-associated intracerebral haemorrhage given different treatments to reverse the effect of anticoagulation.

DESIGN

Historical cohort study.

SETTING

A regional hospital in Hong Kong.

PATIENTS

Patients on warfarin who developed intracerebral haemorrhage.

INTERVENTIONS

Prothrombin complex concentrate versus fresh frozen plasma treatment.

MAIN OUTCOME MEASURES

The primary outcome measures included the international normalised ratio before and after prothrombin complex concentrate treatment and the neurological deterioration in patients with Glasgow Coma Scale score of more than 8/not intubated/not planned for immediate surgery (target group). Secondary outcome measures were haematoma expansion, 7-day and 30-day mortality rates, and 3-month functional outcome. Safety outcome was the occurrence of a thrombotic event after prothrombin complex concentrate treatment within the index admission.

RESULTS

Among 33 patients with clearly documented time of infusion of prothrombin complex concentrate, and whose international normalised ratio was checked before and after prothrombin complex concentrate treatment, the mean international normalised ratio was reduced from 2.81 to 1.21 within 24 hours. Within the target group of patients, there was a significantly lower rate of neurological deterioration in the prothrombin complex concentrate group (17.4% of 23 patients) versus fresh frozen plasma group (45.5% of 33 patients) [P=0.027]. In terms of the 7-day mortality, 30-day mortality, and 3-month functional outcome, prothrombin complex concentrate-treated group showed a favourable trend although the difference did not reach a statistical significance. No patient developed thrombotic complications after prothrombin complex concentrate treatment.

CONCLUSIONS

Prothrombin complex concentrates can reverse the warfarin effect of prolonged international normalised ratio in a timely manner. It might better improve the outcome of warfarin-associated intracerebral haemorrhage compared with fresh frozen plasma treatment by reduction in neurological deterioration.

Integer lapped transforms and their applications to image coding

This paper proposes new integer approximations of the lapped transforms, called the integer lapped transforms (ILT), and studies their applications to image coding. The ILT are derived from a set of orthogonal sinusoidal transforms having short integer coefficients, which can be implemented with simple integer arithmetic. By employing the same scaling constants in these integer sinusoidal transforms, integer versions of the lapped orthogonal transform (LOT), the lapped biorthogonal transform (LBT), and the hierarchical lapped biorthogonal transform (HLBT) are developed. The ILTs with 5-b integer coefficients are found to have similar coding gain (within 0.06 dB) and image coding performances as their real-valued counterparts. Furthermore, by representing these integer coefficients as sum of powers-of-two coefficients (SOPOT), multiplier-less lapped transforms with very low implementation complexity are obtained. In particular, the implementation of the eight-channel multiplier-less integer LOT (ILOT), LBT (ILBT), and HLBT (IHLBT) require 90 additions and 44 shifts, 98 additions and 59 shifts, and 70 additions and 38 shifts, respectively.