Acquired immunodeficiency syndrome and human immunodeficiency virus infection in Bujumbura, Burundi

In the first seroepidemiological survey in Burundi in 1984, only 59 acquired immunodeficiency syndrome (AIDS) cases were recognized. We report here clinical surveillance of AIDS cases in the 4 hospitals in Bujumbura during a 4-month period in 1986. The project was combined with a seroprevalence study of pregnant women in the 6 dispensaries in Bujumbura. 258 AIDS patients were recorded. 16% of the 925 pregnant women were seropositive for human immunodeficiency virus (HIV). The clinical characteristics of 120 adult AIDS patients were similar to those reported in Kinshasa or Kigali. From demographic findings we presume that the major mode of HIV transmission in Bujumbura is by sexual contact. The results of this study formed the starting point of prevention activities against AIDS in Burundi.     

Nutritional status in patients with HIV infection and AIDS

The aim of this study was to evaluate the nutritional status of adults with HIV infection or with AIDS through the use of biochemical parameters. The study was performed on 43 patients (19 HIV+ and 24 AIDS patients), between 26 and 44 years of age, from low and medium socioeconomic status, with access to health care services; 35 patients were under highly active antiretroviral therapy (HAART) treatment. Body weight and height were determined, and the Body Mass Index calculated (kg/m2). Blood samples were collected from fasting patients. Plasma cholesterol (total, HDL and LDL), triacylglycerol, total protein, apolipoproteins A-I and B, albumin, transthyretin, retinol binding protein, and ceruloplasmin concentrations were determined. Plasma levels of zinc, copper, and selenium were determined in a haemolysis-free sample by flame atomic absorption spectrometry. Statistical analyses were performed with the Student's t-test. AIDS patients showed changes in biochemical parameters, particularly an increase in fibrinogen and a trend to decreased transthyretin levels. These findings stress the importance of the inclusion of functional biochemical parameters in the periodic evaluation of these patients. This would allow an early assessment of the need for appropriate nutritional support, implemented along with the specific retroviral treatment. This would aim at delaying the progression of the disease, and might improve the prospects of survival and quality of life.     

湖北省老年住院患者营养状况调查及评价

目的 评估湖北省老年住院患者营养状况及其影响因素,为老年住院患者合理营养支持提供依据。方法 采取分层随机抽样方法,对2014年5—12月湖北省黄冈市等5个地区住院治疗的4 946例老年患者进行营养状况评估。结果 城市和农村居民肥胖率分别34.16%和15.44%,差异有统计学意义(χ²=30.47,P<0.05);营养风险筛查(NRS)评分中,老年住院患者营养风险发生率、贫血发生率、血清总蛋白(TP)异常发生率、血清白蛋白(ALB)异常发生率、总淋巴细胞计数(TLC)和红细胞计数(RBC)异常发生率分别为53.62%、44.54%、53.98%、59.12%、43.17%和39.39%,其中,城市和农村老年住院患者贫血发生率、TP异常发生率、ALB异常发生率、RBC异常发生率差异均有统计学意义(χ²=21.72、32.85、38.23、21.07,均P<0.05)。结论 随着年龄的增长,农村地区老年住院患者的营养风险和营养不良发生率高于城市地区,需要社会和家庭更加关注农村老年患者的营养状况,及时调整膳食结构和食物品种搭配,合理补充各类营养素。     

Nutritional status study of inpatients in hospitals of Galicia

OBJECTIVE: To know the prevalence of malnutrition and to validate a nutritional screening protocol (SP) in patients hospitalised in Hospitals representative of inpatients admitted for acute illnesses in Galicia. DESIGN: Cross-sectional study of 376 randomised patients (189 female, 210 > or =65 y old) from 12 public hospitals admitted to hospital for acute medical, surgical or trauma illnesses. The patients elicited were evaluated by a simple SP, including variables relative to recent weight changes, serum albumin, lymphocytes, food ingestion and diagnosis at admission (Cardona's Protocol), and with a diagnostic protocol (DP, Subjective Global Assessment). Both SP and DP were performed by personnel trained in nutritional evaluation. Results of SP and DP were compared; principal factors related to malnutrition were also analysed; statistical significance was considered at P<0.05. RESULTS: From patients studied, according to DP 169/360 (46.94%), patients presented malnutrition (134 B category and 35C category). SP rate was significantly related to severity of malnutrition detected by DP (P<0.001). The principal factors related to the presence of malnutrition were older age and degree of metabolic stress. CONCLUSIONS: In adult patients admitted for acute illnesses, the prevalence of protein-energy malnutrition is high. The risk was related to age and to metabolic stress. The risk of malnutrition in a hospital setting is evaluated appropriately by a simple screening procedure that may contribute to detecting and correcting malnutrition risk.     

消化内科住院患者幽门螺旋杆菌感染情况

目的 对消化内科住院患者幽门螺旋杆菌（Hp）感染情况及其影响因素进行分析,为更好地干预Hp感染相关疾病提供依据。方法 以2018—2019年在郑州市某医院消化内科住院的所有≥18岁患者为研究对象,收集患者年龄、性别、学历、居住地、职业等信息,并对患者在入院次日进行¹⁴C呼气试验检查,采用描述流行病学分析方法对结果进行分析,并采用单、多因素分析方法对Hp感染影响因素进行分析。结果 2018—2019年郑州市某医院消化内科住院患者共2 763例,根据纳入标准和排除标准并完成¹⁴C呼气试验检查者2 589例。其中男性1 441例,女性1 148例,年龄18~87岁,平均（56.08±16.80）岁。消化内科住院患者以上消化道疾病为主,占68.91%,主要病种为慢性胃炎、肝硬化和消化性溃疡,分别占43.18%、15.33%、14.48%,检出Hp阳性694例,阳性率为26.81%。居住地为城市（OR=1.528）、年龄越大（OR=1.861）、职业为农林牧渔（OR=2.787）、生产运输（OR=3.766）、商业服务（OR=3.480）、机关事业人员（OR=1.998）、专业技术人员（OR=2.056）、病种为慢性胃炎（OR=2.678）、肝硬化（OR=2.617）、消化性溃疡（OR=4.600）、功能性胃肠病（OR=1.881）、结肠息肉（OR=2.787）、胃癌（OR=7.135）、结肠癌（OR=2.617）、肝癌（OR=1.992）的患者Hp阳性可能性较大。结论 消化内科住院患者Hp感染率较高,居住地、年龄、职业、病种不同的患者Hp感染率不同,可针对不同特征患者加强Hp的监测,尽早对症治疗。     

Nutritional support in HIV infection and AIDS

Weight loss and wasting are common features of HIV infection and AIDS.Patterns of weight loss can be acute or chronic which appear to be related primarily to systemic infections and gastrointestinal pathology, respectively. However, weight loss is not inevitable. and periods of weight stability and weight gain have been documented. Reduced food intake appears to be a major cause of weight loss in HIV infection. Since time of death has been associated with degree of wasting, it seems reasonable to suggest that nutritional support may contribute to enhancing survival and quality of life. All patients should have early access to a qualified dietitian such that assessment of individual situations can be made and appropriate dietary advice given, within a multi-disciplinary approach. Choice of nutritional therapy should be made based on an assessment of the causes of weight loss and an assessment of gut function. Treating infections and alleviating symptoms is vital for ensuring effective nutritional support. Enhancing the energy and protein density of foods and use of oral supplements should be considered if a normal diet alone cannot meet nutritional requirements. Unnecessary dietary restrictions should be avoided. Enteral feeding is indicated for patients unable to meet their needs via the oral route, and in cases of inadequate gut function, parenteral nutrition may be necessary. There is currently insufficient clinical evidence to justify the need for special enteral formulae specifically for patients with HIV infection.     

Nutritional and metabolic abnormalities in pre-AIDS HIV infection

Since the earliest reports of human immunodeficiency virus (HIV) disease, undernutrition has been associated with HIV infection, typically with the late stages of the disease (namely acquired immunodeficiency syndrome), and may advance to severe wasting and cachexia. Specific micronutrient deficiencies are also recognized to occur with HIV infection, but their actual effect on the clinical course of the disease is hard to assess. The studies reviewed provide more insight into the complex interface between undernutrition and, in some cases, obesity and HIV/acquired immunodeficiency syndrome and highlight the possibility of alleviating or curing undernutrition by means of simple and comparatively inexpensive dietary adjustments.     

Nutritional support in the patient with HIV infection

Weight loss and malnutrition are the most common symptoms associated with active infection with human immunodeficiency virus. The origin of the malnutrition is considered multifactorial and broadly includes decreased nutrient intake, nutrient malabsorption, and metabolic alterations. Steady advances have been made in understanding the mechanisms underlying weight loss in these patients. The utility and optimal modes of nutrition support have not yet been fully established.     

Nutritional status of an adult cystic fibrosis population

Nutritional management and dietary recommendations in patients with cystic fibrosis (CF) have changed considerably over the past 10-15 y. The nutritional status of adult CF patients was assessed in a clinical survey before these changes in nutritional management. The aim of the study was to assess the current nutritional status of the CF population and compare the results with those of the previous study. Forty-three (24 male, 19 female) subjects participated in this study. Subjects' height, weight, mid-upper-arm circumference, and skinfolds at four sites were measured. Nutritional intake was measured by using a 7-d food intake diary including documentation of supplements taken. Compared with the 1983 study, the incidence of malnutrition, as indicated by a body mass index of less than 20, has decreased from 62% to 9%. Furthermore, there have been significant improvements in the weight, height, and body mass index of both males (P < 0.001) and females (P < 0.04). Individuals with CF are no longer subject to growth arrest, as their mean height is now comparable to the Australian average. Mid-upper-arm circumference (P < 0.0001), triceps skinfold (P < 0.0001), and percentage of body fat (P < 0.05) of males and females have also significantly increased. The fat intake (P < 0.02) of females and males and energy intake (P < 0.03) of females have increased significantly, and the mean energy intake of subjects has exceeded the recommended 120% of the recommended daily intake. A significant number of patients in the present study receive dietary oral and/or enteral supplements. Multiple linear regression analysis indicated that nutritional management was principally responsible for improvements in nutritional status. The findings suggest that there has been a significant improvement in the nutritional status of the adult CF population, which may be due primarily to changes in nutritional management.     

Nutritional status of the older adult is associated with dentition status

OBJECTIVE: This study was designed to examine associations between the number of posterior occlusal pairs of teeth and the nutritional status of older adults participating in the third National Health and Nutrition Examination Survey (NHANES III) survey. DESIGN: Impaired dentition was assessed by number of posterior occluding pairs of teeth (grinding teeth, n=8 pairs) and complete denture status. Nutritional status was measured by nutrient intake, Healthy Eating Index (HEI) score, serum values, and body mass index (BMI). Subjects/setting Data from 5,958 participants in NHANES III ages 50 years and over with dental examination were included in the analysis. Statistical analyses performed Analysis of covariance and multivariate linear regression analyses were performed to examine associations between number of tooth pairs and nutritional status indicators controlled for potential confounders. RESULTS: Compared with individuals with five to eight posterior occluding pairs (HEI=68.2), those with impaired dentition (no posterior pairs, one to four pairs remaining, or full dentures) had consistently lower HEI scores (HEI=64.3, 66.5, and 66.5, respectively), consumed fewer servings of fruits, and had lower serum values of beta carotene and ascorbic acid. Participants with one to four posterior pairs also had a higher mean BMI (28.0) than those with five or more pairs (27.2). Participants in one or more groups with impaired dentition had lower dietary intake levels of vitamin A, carotene, folic acid, and vitamin C, and scored less well on diet variety, cholesterol, and sodium components of the HEI. APPLICATIONS/CONCLUSIONS: Results show that dental health is closely associated with nutritional status and suggest that status of dentition should be considered in nutritional counseling and assessment of older adults.     

Nutritional status of a group of self-sufficient institutionalized elderly people in Perugia (Italy).

The nutritional status of forty-six self sufficient institutionalized elderly people of Perugia was assessed. The diet of this group is slightly better than that of other groups of elderly people previously examined. As observed in other studies, the diet of the elderly from this region of Italy does not seem to be of the Mediterranean type. The location of subcutaneous fat in elderly men is prevalent in the upper trunk and in women in the arms. The clinical signs of nutritional status among this group of self-sufficient institutionalized elderly people are in general not specific and mostly associated with old age. The pathological conditions observed and the administration of drugs do not appear to substantially influence the nutritional status of this group.     

老年糖尿病足溃疡住院患者营养状况及营养不良相关影响因素研究

目的 对老年糖尿病足溃疡（DFU）住院患者的营养状况进行调查,并分析其营养不良的相关影响因素。方法 以2019年1月1日至2020年12月31日在西安市某医院内分泌科收治的初诊≥60岁DFU住院患者为研究对象进行营养状况相关调查,采用描述流行病学分析方法对老年DFU患者营养不良发生情况进行分析,并对DFU患者发生营养不良影响因素进行单、多因素分析。结果 纳入研究的559例住院老年DFU患者中男321例,女238例,男女比为1.3∶1。年龄为60~88岁,平均年龄（71.57±4.39）岁。559例老年DFU患者的微型营养评估表评分为（14.81±4.39）分,营养不良者387例,营养不良率为69.23%。多因素Logistic回归分析结果显示,年龄每增加10岁（OR=2.344）、糖尿病病程>5年（OR=2.179）、DFU感染（OR=1.728）、糖化血红蛋白>7.0%（OR= 2.502）、C反应蛋白≥10 mg/L（OR=1.850）、Wagner分级为3~5级（OR=8.406）、老年抑郁量表评分越高（OR=6.013）的老年DFU患者营养不良的发生风险越大,日常生活活动能力评分越高（OR=0.106）的老年DFU患者营养不良的发生风险越小。结论 老年DFU住院患者营养不良率较高,影响营养状况的相关因素众多,应及时提出针对性预防和干预措施对营养状况进行改善。     

HIV infection in women: impact on contraception

A study was performed to evaluate the impact of knowledge of HIV infection (diagnosis) on contraception information and choices for HIV infected women. A questionnaire was given to 140 HIV infected women. Most of the studied population included young women with a low educational level. A significant increase in the knowledge of contraceptive methods was observed after diagnosis of being HIV infected. The data suggested that the women who received information had never received it before, or that the diagnosis created a stronger motivation to listen to the counseling offered. A significant increase in the use of contraceptive methods was also found, especially male condoms and tubal ligation. Total number of children had a strong impact on contraceptive method at the time of interview. Only 5 of 23 HIV infected women who had no children used hormonal contraceptives, while 15 of 23 preferred condom use, and 3 of 23 chose not to use any contraceptive method. Tubal ligation was performed in approximately 9% of the women who had only one child. However, 12.4% of the sexually active HIV infected women were still not using any contraceptive method at the time of the interview. A combined method (male condom plus another contraceptive) was used by only 27% of sexually active HIV infected women, despite health service counseling. In conclusion, the realization of being HIV infected had a strong impact on contraceptive practice among these women. It is expected that HIV and family planning clinics will address HIV infected women's needs and be prepared to integrate contraception and gynecological care.     

Tuberculosis, human immunodeficiency virus infection, and malnutrition in Burundi.

In order to compare the nutritional status of tuberculosis (TB) patients who were human immunodeficiency virus (HIV)-seropositive with those who were seronegative, we carried out a cross-sectional anthropometric and biochemical assessment, together with bioelectrical impedance analysis (BIA) of the nutritional status of TB patients hospitalized in the Department of Internal Medicine, Bujumbura University Hospital, Burundi, East Africa. Of the 65 TB patients (33 pulmonary, 6 extrapulmonary, and 26 disseminated TB), 50 (76.9%) were HIV-seropositive (HIV+). When assessed according to anthropometric, BIA, and biochemical variables, HIV+ TB patients had more pronounced malnutrition than HIV- patients. Similar results were obtained when the comparison was restricted to patients with only pulmonary TB: HIV+ patients were more malnourished than HIV- patients. The results according to anthropometric measurements were: weight loss (13.5% of HIV- patients versus 26.4% of HIV+ patients, P = 0.005), body mass index (18.6 versus 15.1, P = 0.003), fat free mass (FFM) (13.9 versus 11.9, P < 0.01), and body fat (BF) (4.55 versus 3.71, P = 0.03) expressed per unit height2. BIA showed that the difference in FFM between HIV- and HIV+ TB pulmonary patients was mostly due to a decrease in body cellular mass. Measurements of albumin, prealbumin, and transferrin showed a marked decrease in all three markers in HIV+ TB pulmonary patients. The nutritional status of HIV+ patients with disseminated versus pulmonary TB was similar. The nutritional status of HIV+ TB patients is far worse than that of HIV- TB patients. In such patients, anthropometry underestimates the degree of malnutrition because it does not account for the water component of FFM. Nutritional status should be assessed and nutritional intervention should be provided in an attempt to improve the prognosis of TB patients, especially those who are infected by HIV.     

父母主动告知HIV感染状况对HIV阴性未成年子女的短期影响

HIV感染者/艾滋病患者(HIV/AIDS)约70％为青壮年,他们中大多已婚并育有子女[1].虽然抗病毒治疗方案的广泛应用已使艾滋病转变为一种可以治疗的慢性疾病[2],但需长期坚持服药、定期复诊,这些现象会引起患者子女的怀疑和焦虑,如何向他们解释也是这些HIV阳性父母面临的难题之一.担心告知真相会失去子女的尊重、年幼的子女不能保守秘密、子女因为承受与艾滋病有关的歧视而影响生活质量等是大多数HIV阳性父母向子女隐瞒病情的主要原因.但是随着子女对艾滋病知识的了解,或者意外了解到父母的病情,反而影响子女与父母间的信任[3].为了解父母主动告知HIV感染状况后对未成年子女的短期影响,本研究收集19名告知案例进行分析,报道如下.     

Nutritional status of adult men from the oraon tribe in ranchi district of jharkhand, India

A cross-sectional study was undertaken to investigate anthropometric characteristics and nutritional status among adult male (18 years and above) Oraons (n = 290), a tribe in the Ranchi District of the state of Jharkhand in India. The anthropometric characteristics (stature, body weight and mid upper arm circumference or MUAC) were categorised into three age-groups (18-39 years, 40-59 years and 60 years and above). This particular investigation recorded a low (18.48Kg/m2) body mass index (BMI) and a high frequency of under-nutrition (53.10% chronic energy deficiency or CED) among the adult Oraons. BMI and CED of the adult Oraons were also compared with some populations of eastern India. It is noted that 38.28% of adult Oraons suffer from under-nutrition when the nutritional status of their population is evaluated by the standard cut-off points of MUAC. Pearson correlations of BMI and MUAC with age exhibited significantly (p< 0.001) negative correlations among the Oraons. Correlations between BMI and MUAC in their population showed a high significance (p< 0.0001). Significant age-related variations (tested by one-way ANOVA) in anthropometric parameters were observed in the Oroan population. Linear regression analyses revealed more or less significant negative impacts of age on BMI and MUAC in the population.     

The natural history, current status, and future trends of HIV infection

Nearly 50 million people worldwide have been infected with human immunodeficiency virus (HIV), and an estimated 12 to 13 million children have been orphaned by the acquired immune deficiency syndrome (AIDS) epidemic. The natural history of HIV infection continues to evolve as researchers and clinicians unearth new facts about the virus and develop new treatment regimens for patients. The status of anti-HIV treatments is never static but constantly changing. Patients and providers struggle with adherence issues. Vaccine development, viewed as an essential step in controlling the epidemic, is complicated by the genetic diversity of the virus and the inability of the body to clear the virus. Tremendous strides have occurred in the HIV/AIDS arena, yet daunting challenges remain. This overview article presents the natural history, the current status, and future trends of HIV infection.