Predictors of mortality among HIV–infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

ObjectiveTo assess early mortality and identify its predictors among the ART naive HIV–infected patients initiating anti retroviral therapy (ART) available free of cost at the ART Centres.MethodsA retrospective cohort analysis of routinely collected programme data was done for assessing mortality of all ART naive adult patients who received first-line ART at a government tertiary care hospital in eastern India during 1st March 2009 and 28th February 2010. Bivariate and multiple regression analyses of the baseline demographic, clinical and laboratory records using SPSS 15.0 were done to identify independent predictors of mortality.ResultsThe mortality rate at one year was estimated to be 7.66 (95% CI 5.84-9.83) deaths/100 patient-years and more than 50% of the deaths occurred during first three months of ART initiation with a median time interval of 73 days. Tuberculosis was the major cause of death. ART naive patients with baseline serum albumin <3.5 mg/dL were eight (OR 7.9; 95% CI: 3.8-16.5) at risk of death than those with higher serum albumin levels and patients with CD4 count <100 cells/μ L were two times (OR 2.2; 95% CI1.1–4.4) at risk of death compared to higher CD4 counts.ConclusionsRisk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme.     

Youth mortality due to HIV/AIDS in South Africa, 2001–2009: An analysis of the levels of mortality using life table techniques

South Africa has one of the highest HIV/AIDS prevalence rates in the world. It is estimated that 5.38 million South Africans are living with HIV/AIDS. In addition, new infections among adults aged 15+ were reportedly 316 900 in 2011. New infections among children (0–14 years old) was also high in 2011 at 63 600. This paper examines South Africa's mortality due to HIV/AIDS among the youth (15–34 years old). This age group is of fundamental importance to the economic and social development of the country. However, the challenges of youth development remain vast and incomparable. One of these challenges is the impact of HIV/AIDS on mortality. Life table techniques are used to estimate among others, sex differentials in death rates for the youth population, probability of dying from HIV/AIDS before the age of 35 and life expectancy should HIV/AIDS be eradicated from the population. The study used data from the National Registry of Deaths, as collated by Statistics South Africa from 2001 to 2009. Results show that youth mortality due to HIV/AIDS has remained consistently higher among older youths than in younger ones. By sex, mortality due to this cause has also remained consistent over the period, with mortality due to HIV/AIDS being higher among females than males. Cause-specific mortality rates and proportional mortality ratios reflect the increased mortality of older youth (especially 30–34 years old) and females within the South African population. Probability of dying from HIV/AIDS shows that over the period, fluctuations in likelihood of mortality have occurred, but for both males and females (of all age groups) the chances of dying from this cause decreased in 2007–2009.     

Venous thromboembolism prophylaxis-prescribing patterns among elderly medical patients in a Saudi tertiary care center: success or failure?

BackgroundHospitalized elderly patients are at high risk of venous thromboembolism (VTE), and the appropriate use of thromboprophylaxis can significantly reduce the incidence of VTE in high-risk patients. We investigated the pattern of VTE prophylaxis administration among elderly medical patients and assessed its appropriateness based on the American College of Chest Physicians (ACCP) recommendations.MethodsA cross-sectional single-center study was conducted between October 2019 and March 2020, including hospitalized (> 48 h), elderly (≥ 60 years), medical patients, and excluding patients receiving anticoagulant for other reason, having contraindication to thromboprophylaxis, or had VTE diagnosed within 48 h. The Padua prediction score was used to determine the patients'' risk for VTE, and thromboprophylaxis use was assessed against the ACCP recommendations.ResultsThe study included 396 patients with an average age of 75.0 ± 9.01 years, and most patients (71.7%) were classified as high risk for VTE development (Padua score ≥ 4 points). Thromboprophylaxis use was inappropriate in 27.3% of patients, of whom 85.2% were ineligible but still received thromboprophylaxis. Patients who were classified as low risk of VTE were more likely to receive inappropriate thromboprophylaxis (AOR = 76.5, 95% CI: 16.1-363.2), whereas patients with acute infection or rheumatologic disorder were less likely to receive inappropriate thromboprophylaxis (AOR = 0.46, 95% CI: 0.22-0.96).ConclusionsAlthough the use of thromboprophylaxis among high-risk elderly patients was reasonably adequate, a large proportion of low-risk patients were exposed to unnecessary risk through inappropriate overutilization of thromboprophylaxis. Thus, healthcare providers should accurately assess patients'' risk before prescribing thromboprophylaxis to ensure patient safety.     

"I understand just a little…" Perspectives of HIV/AIDS service providers in South Africa of providing mental health care for people living with HIV/AIDS

Research conducted in South Africa and other parts of the world has revealed that people living with HIV/AIDS (PLWHA) are more at risk of developing a mental disorder than the general population. It makes sense to explore means of integrating HIV/AIDS and mental health care thereby facilitating access of PLWHA to prompt mental health care. We conducted qualitative interviews with 22 HIV/AIDS service providers of three occupational categories (10 nurses, six adherence counsellors and six patient advocates) at three primary health care clinics in the Western Cape, South Africa. We explored the issues of knowledge and practice in mental health care as well as the role of nurses and lay health workers in providing mental health care to PLWHA thereby attempting to integrate mental health and HIV/AIDS care. Although the majority of participants were in favour of mental health screening for PLWHA, they lacked confidence to conduct the screening themselves. Most participants displayed poor knowledge of mental disorders and reported that they referred to colleagues or to an external mental health service if they suspected a possible mental disorder in a patient. Integration of mental health and HIV/AIDS care has potential benefit to the public HIV/AIDS care system. Mental health training should be provided to HIV/AIDS service providers in this regard.     

The role of community health workers in supporting South Africa’s HIV/ AIDS treatment programme

Community health workers deployed around South Africa’s primary health care clinics, supply indispensable support for the world’s largest HIV/AIDS treatment programme. Interviews with these workers illuminated the contribution they make to anti-retroviral treatment (ART) of HIV/AIDS patients and the motivations that sustain their engagement. Their testimony highlights points of stress in the programme and supplies insights into the quality of its implementation. Finally, the paper addresses issues about the sustainability of a programme that depends on a group of workers who are not yet fully incorporated into the public sector.     

Prevalence of syphilis seropositivity in antenatal clinic clients in a teaching hospital in South–South region of Nigeria

ObjectiveTo assess the seroprevalence of syphilis among women receiving antenatal care in University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria.MethodsBetween July 2009 to March 2010, blood samples of 415 consenting clients submitted for prevention of mother to child transmission (PMTCT) HIV screening programme were screened for syphilis antibodies using the Immunochromatographic ACON Ultra Rapid Syphilis Test Strip (ACON laboratory Inc. USA). Any positive result was repeated with another test strip (Diaspot Ultra Rapid Syphilis Test Strip, Diaspot Inc. USA).ResultsOf the 415 samples, 9 (2.2%) were syphilis seropositive and 14 (3.4%) were HIV positive. Assessment of risk factors for syphilis revealed an observed trend with increasing parity though statistically not significant (P=0.268). More than half of the syphilis positive clients believed their spouses were promiscuous.ConclusionsThere is still a substantial carriage of syphilis among antenatal clinic attendees in UUTH, Uyo. The need for routine screening is imperative. Point of care testing should conveniently be incorporated into the PMTCT programme.     

Tackling frontal lobe–related functions in PKU through functional brain imaging: a Stroop task in adult patients

Background  

Profound mental retardation in phenylketonuria (PKU) can be prevented by a low phenylalanine (Phe) diet. However, even patients treated early have inconsistently shown deficits in several frontal lobe–related neuropsychological tasks such as the widely accepted Stroop task. The goal of this study was to investigate whether adult patients exhibit altered brain activation in Stroop-related locations in comparison to healthy controls and if an acute increase in blood Phe levels in patients has an effect on activation patterns.     

HIV infection and related risk behaviours in a disadvantaged youth institution of São Paulo, Brazil

In order to study the prevalence of HIV and related risky behaviours among disadvantaged youth, we interviewed and bled, between December 1994 and April 1995, 1122 young males and 93 young females who were serving time in FEBEM, a state institution that cares for homeless and offender youth of S?o Paulo, Brazil. Our questionnaire covered the following areas: sexual practices and use of illicit drugs; knowledge of HIV and STDs and their prevention; and myths and beliefs about AIDS. Seroprevalence of HIV was assessed and related with risk-taking behaviours by means of uni-, bi- and multivariate analysis. We found 2.6% of the males and 10.3% of the females to be positive to HIV. The prevalence of hepatitis C virus (HCV) antibodies resulted in 5.9% for males and 4.6% for females, respectively. The risk for parenterally transmitted HIV among the males was higher than that for sexually related transmission. The inverse relationship was found among the females.     

Predictors of parent–child communication among a nationally representative sample in Nigeria

This study explores what constructs are associated with parent–adolescent communication about AIDS/sexually transmitted infections (STIs) and sexual relationships in Nigeria. The analyses use data from the 2007 National HIV/AIDS and Reproductive Health Survey on 2593 men and women who had at least one child over the age of 12 years. The respondents were classified as low, medium, or high communicators. Low communicators were parents who did not talk to their child about either AIDS/STIs or sexual relationships. Medium communicators were parents who discussed only one topic with at least one child. High communicators were parents who discussed both topics with at least one child. Logistic regression was used to compare high communicators with low/medium communicators. There are commonalities and differences among men and women in the factors associated with parent–adolescent communication. Age, religion, and knowing where to obtain information about HIV/AIDS were associated with the extent of communication, regardless of the parent's gender. Perceived social support was an important correlate for fathers, while knowledge of female STI symptoms showed a significant association only for mothers. Programmatic and communication implications of the findings include addressing men and women differently, developing strategies to specifically reach younger parents and Muslims, and increasing general awareness of HIV/AIDS information resources. Further research is needed to understand the context, content, and timing of parent–adolescent conversations about AIDS/STIs and sexual relationships and how these factors affect the sexual behaviors of adolescents.     

Rotavirus infection in children and adult patients attending in a tertiary Hospital of S?o Paulo, Brazil.

During the period of January 2003 to December 2005, 3,768 stool samples were received in the Microbiology Laboratory for rotavirus antigen detection from outpatients and inpatients of Albert Einstein Hospital, SP. Fresh stool samples from children and adults were analyzed by two methodologies: during 2003 and 2004 by latex agglutination (Slidex Rotavirus, Biomerieux) and 2005 by an immunochromatographic assay for the combined detection of rotavirus and adenovirus (Vikia Rota-Adeno, Biomerieux). Rotavirus group A was detected in 755 (20%) samples. The annual prevalence was 19.8% in 2003, 21.7% in 2004, and 18.7% in 2005. Rotavirus was detected every month during the period of the study, with peak of positivity between June and August (>35%). The prevalence in hospitalized patients was 26.1% (352/1,350) and in outpatients was 16.7% (403/2,418). For hospitalized patients most of the rotavirus infections were diagnosed in Pediatric setting, age range of 0 to 10 years (prevalence of 55.3%, 295/534). Overall positivity was up to 30% in patients between six months and five years of age (67% of all positive patients), all other age groups had at least 10% positive tests. Rotavirus infection is common in Sao Paulo, and besides the expected higher frequency in children it is also frequent in adults.     

HIV/AIDS Epidemic Features and Trends in Iran, 1986–2006

This study describes the reported HIV/AIDS data for all verified cases in Iran between 1986 and 2006. The cumulative number of the reported cases of HIV/AIDS among Iranians, up to the end of September 2006 was 13,702. Over the 20-year surveillance period, the rate of HIV/AIDS infections diagnosed annually among Iranian citizens gradually increased and, over the period 1997–2004, it reached from 1.38 to 4.6 cases per 100,000 populations per year. Our findings highlight the need for intensified HIV prevention efforts with men who use drugs via injection and strengthened efforts to encourage the individual at risk to get tested for HIV.     

Risk factors influencing mortality related to Stenotrophomonas maltophilia infection in hematology–oncology patients

Stenotrophomonas maltophilia infection is of concern in patients with cancer. Antibiotics active against S. maltophilia are rarely used in the treatment of febrile neutropenia, making it important to identify the factors influencing mortality in cancer patients with S. maltophilia infection. The objective of this study was to analyze the clinical characteristics and outcomes of cancer and hemopathic patients with S. maltophilia infection and assess the factors influencing the mortality. The microbiology laboratory records of Erciyes University, Faculty of Medicine Hospital were reviewed to retrospectively identify patients with S. maltophilia infection between January 2007 and June 2011. A total of 38 patients (25 male, 13 female) were eligible for the study. The median age of the patients was 53 years. The underlying disease was hematological malignancy and disorders in 76.3 % (29 cases), solid tumors in 15.8 % (six cases), aplastic anemia in 7.9 % (three cases), while 18.4 % (seven cases) were hematopoietic stem cell transplantation (HSCT) recipients. An indwelling central venous catheter was used in 32 cases (84.2 %). Twenty-seven patients (71.1 %) were neutropenic at the onset of infection. Nine patients (23.7 %) were receiving corticosteroid therapy. The overall 14-day mortality rate was 50 %. Three of the patients received empirical antibacterial treatment, and three HSCT recipients received trimethoprim–sulfamethoxazole prophylaxis, which is active against S. maltophilia. Severe sepsis (OR 13.24, 95 % confidence interval (CI) 1.62–108.57) and the duration of the treatment (OR 0.73, 95 % CI 0.60–0.90) were related to death based on logistic regression analysis findings. In immunocompromised hematology–oncology patients with severe sepsis, S. maltophilia should be considered as a possible cause of infection, and should be given effective empirical antibiotic treatment immediately; the antimicrobial spectrum may be narrowed according to results of antibiotic susceptibility test.     

How do patients with HIV/AIDS understand and respond to health value questions?

Background

Utility assessment involves assigning values to experienced or unfamiliar health states. Pivotal to utility assessment, then, is how one conceptualizes health states such as “current health” and “perfect health.” The purpose of this study was to ascertain how patients with HIV think about and value health and health states.

Methods

We conducted open-ended in-depth interviews with 32 patients with HIV infection purposefully sarmpled from a multicenter study of quality of life in HIV. After undergoing computer-assisted utility assessment using the rating scale, time tradeoff, and standard gamble methods, patients were asked how they thought about the utility tasks and about the terms “current health” and “perfect health”.

Results

Patients understood the health valuation tasks but conceptualized health states in different ways. Many patients believed that “perfect health” was a mythical health state, and some questioned whether it was even desirable. “Current health” was variably interpreted as the status quo; deteriorating over time; or potentially improving with the hope of a cure.

Conclusion

Patients with HIV infection vary in the way they conceptualize health states central to utility assessment, such as perfect health and current health. Better understanding of these issues could make important methodologic and policy-level contributions.

     

Ophthalmic practice health hazards among ophthalmologists in a resource–limited setting

ObjectiveTo determine ophthalmic practice health hazards among ophthalmologists in a resource-limited setting.MethodsThe study was conducted through a cross-sectional survey of 53 ophthalmologists' experiences on ophthalmic practice health hazards using semi-structured questionnaire.ResultsMost practitioners felt eye surgical procedures 40 (75.5%) and examination of eye patients (62.3%) were potentially hazardous to practitioners and, 49 (92.5%) thought clerking was not. Most, 92.5% had experienced patients' halitosis/cough during ophthalmoscopy and, 77.4% experienced hand smeared with patients' eye discharges/tears. Important health hazards experiences included, having contacted systemic diseases (5.7%) and infective eye diseases (18.9%), knife cut during surgical procedure (7.6%), needle pricks (49.1%) and hand smeared with patients' blood (49.1%). Others were neck pain at ophthalmoscopy (35.9%), blurred vision at retinoscopy (20.8%) and hoarseness while performing visual acuities (1.9%).ConclusionsEye practitioners are exposed to hazards in their practice including potentially life threatening ones. Necessary precautions at work, use of hazard free ophthalmic equipment and working conditions would reduce hazards in ophthalmic practice.     

Characteristics among adult patients with diabetes who received a foot exam by a health care provider in the past year: An analysis of NHANES 2011–2016

IntroductionAccording to the American Diabetes Association (ADA), patients with diabetes should receive annual foot exams from a HCP to identify and reduce risk factors for ulcers and other complications. Little is known regarding factors that may increase or decrease the likelihood of having an annual foot examination by a health care provider (HCP).MethodsCross-sectional analysis of 1830 patients age 20 years and older with a previous diagnosis of diabetes. Patients selected for inclusion in NHANES receive an in-home interview and then undergo a comprehensive physical at a CDC mobile examination center. The adjusted odds ratios for a patient having received a foot exam from a HCP in the past year were conducted using appropriate weighting variables assessed with logistic regression analysis.ResultsBoth Hispanic Americans with diabetes [aOR 0.62 (0.47, 0.82)] and Asian Americans with diabetes [aOR 0.65 (0.44, 0.97)] were significantly less likely to have had a foot exam by a HCP in the last year, when compared to non-Hispanic White Americans.ConclusionsHispanic Americans and Asian Americans with diabetes were significantly less likely to have had a foot exam by a HCP in the last year.     

Data-protection standards and confidentiality of HIV/AIDS status in the workplace — a South African case study

The article contextualises an emerging new regime for information privacy in South Africa (i.e. the draft Protection of Personal Information Bill). Subsequently, it discusses the possibility of successful implementation of international data-protection standards in an environment where there is an urgent need to balance HIV/AIDS confidentiality rights with public health requirements. Also, the article presents a preliminary assessment of the possible impact of professionalisation (and outsourcing) of workplace HIV/AIDS management on workplace data-protection practices, and it identifies some spaces for social dialogue on HIV/AIDS-data treatment in South Africa. The study methods comprise an analysis of legal documents (concerning international data-protection standards and the development of law governing data protection and HIV/AIDS confidentiality in South Africa) and interviews conducted with workplace health managers and trade union representatives, in Johannesburg, in 2007.