AIDS in pregnancy, part I: epidemiology, testing, effect on disease progression, opportunistic infections, and risk of vertical transmission

Contribution of acquired immunodeficiency syndrome/human immunodeficiency virus (HIV) infection to pregnancy mortality rates is difficult to estimate; however, it appears to be one of the leading causes of death, at least in developing countries. Prenatal HIV testing affords the best opportunity for the prevention of perinatal HIV transmission. Rapid HIV testing substantially increases the proportion of women who obtain HIV results compared with conventional enzyme-linked immunosorbent assay testing, thus maximizing perinatal HIV interventions. Pregnancy appears to have no effect on the course of HIV disease. Infections due to a variety of pathogens influence the clinical course of the HIV infection and may complicate pregnancy and increase maternal mortality. The main risk factors for mother-to-child HIV transmission are high maternal viral load and CD4 cell count <700 cells/mm3. The main protective factor is antiretroviral therapy.     

A magnetoencephalography study of choice bias

Many factors can influence, or bias, human decision making. A considerable amount of research has investigated the neural correlates of such biases, mostly correlating hemodynamic responses in brain areas with some aspect of the decision. These studies, typically done using functional magnetic resonance imaging or positron emission tomography, have provided useful information about the location of processing in the brain. However, comparatively little research has examined when these processes occur. The present experiment addressed this question by using magnetoencephalography (MEG) to record brain activity while subjects chose preferred options from decision sets. We found that MEG signal deviations for biased decisions occurred as early as 250–750 ms following stimulus onset. Such deviations occurred earliest in sensors over the right anterior cortex. These findings improve our understanding of temporal dynamics of decision biases and suggest ways that existing explanations for this bias could be refined.     

Mefloquine-induced eosinophilic pneumonia

Mefloquine has been widely used for prophylaxis and treatment of patients with chloroquine-resistant malaria; the drug is usually well tolerated. Rarely, adverse effects may be severe, including gastrointestinal disturbances, neuropsychiatric reactions, cardiovascular manifestations, skin lesions, musculoskeletal symptoms, and bone marrow toxicity. We describe a 67-year-old woman with fever, dyspnea on exertion, peripheral blood eosinophilia, and diffuse pulmonary infiltrates on chest radiography. She had taken mefloquine for malaria prophylaxis for an 8-week trip to South Africa. A thorough work-up led to the diagnosis of eosinophilic pneumonia caused by the mefloquine. Her condition improved after the drug was discontinued. To our knowledge, this is the first report of mefloquine-induced eosinophilic pneumonia. Clinicians should be aware of this rare, potential adverse effect of mefloquine.     

Synchronous neural interactions assessed by magnetoencephalography: a functional biomarker for brain disorders

We report on a test to assess the dynamic brain function at high temporal resolution using magnetoencephalography (MEG). The essence of the test is the measurement of the dynamic synchronous neural interactions, an essential aspect of the brain function. MEG signals were recorded from 248 axial gradiometers while 142 human subjects fixated a spot of light for 45-60 s. After fitting an autoregressive integrative moving average (ARIMA) model and taking the stationary residuals, all pairwise, zero-lag, partial cross-correlations (PCC(ij)(0)) and their z-transforms (z(ij)(0)) between i and j sensors were calculated, providing estimates of the strength and sign (positive, negative) of direct synchronous coupling at 1 ms temporal resolution. We found that subsets of z(ij)(0) successfully classified individual subjects to their respective groups (multiple sclerosis, Alzheimer's disease, schizophrenia, Sj?gren's syndrome, chronic alcoholism, facial pain, healthy controls) and gave excellent external cross-validation results.     

Calibration of Accelerometer Output for Ambulatory Adults With Multiple Sclerosis

Motl RW, Snook EM, Agiovlasitis S, Suh Y. Calibration of accelerometer output for ambulatory adults with multiple sclerosis.

Objectives

To examine the association between the rates of accelerometer activity counts and energy expenditure during walking in persons with multiple sclerosis (MS) versus controls and then to calibrate the output of accelerometers for computing time spent in light, moderate, and vigorous physical activity based on common metabolic equivalent unit categories in persons with MS.

Design

Mixed-model design.

Setting

Laboratory.

Participants

People with MS (n=24) and people without MS (n=24) who were similar in age, sex, height, and weight.

Interventions

The participants undertook three 6-minute periods of walking at 3.2, 4.8, and 6.4km·h⁻¹ on a motor-driven treadmill.

Main Outcome Measures

Activity counts and energy expenditure were measured with an accelerometer worn on the right hip and open-circuit spirometry, respectively.

Results

The results indicated that (1) persons with MS had greater energy expenditure, but not activity counts, during walking on a treadmill than did controls; (2) there was a strong linear relationship between activity counts and energy expenditure during treadmill walking, but the slope of the relationship was steeper in persons with MS than in controls; and (3) the cut-points for light, moderate, and vigorous physical activity were lower in persons with MS than in controls.

Conclusions

Such findings provide evidence for a strong linear relationship between activity counts and energy expenditure during walking in persons with MS and cut-points based on counts per minute for quantifying time spent in light, moderate, and vigorous physical activity using accelerometers in this population.     

Role of T and NK cells and IL7/IL7r interactions during neonatal maturation of lymph nodes

Lymph node (LN) development depends on prenatal interactions occurring between LN inducer and LN organizer cells. We have distinguished defects in LN formation due to failure in embryonic development (aly/aly) from defects in postnatal maturation (Il2rgamma(-/-)Rag2(-/-)). Both mutant strains form normal primordial LNs with differing fate. In aly/aly mice, the LN primordium dissipates irreversibly late in gestation; in contrast, Il2rgamma(-/-)Rag2(-/-) LN anlage persists for a week after birth but disperses subsequently, a process reversible by neonatal transfer of WT IL7r(+) TCR(+) T or natural killer (NK) cells, suggesting a role for IL7/IL7r interactions. Thus, we reveal a unique stage of postnatal LN development during which mature lymphocytes and IL7/IL7r interactions may play an important role.     

In vitro activity and synergism of amphotericin B, azoles and cationic antimicrobials against the emerging pathogen Trichoderma spp

OBJECTIVES: The uncommon fungal pathogen Trichoderma shows increasing medical importance particularly in immunocompromised patients. Despite systemic antifungal therapy, prognosis of Trichoderma infection is poor regardless of the type of infection and the therapy used. The aim of the present study was to evaluate the in vitro activity and synergism of double antifungal combinations including amphotericin B, voriconazole, fluconazole, chlorhexidine digluconate and Akacid plus against 15 isolates of Trichoderma longibrachiatum and 1 isolate of Trichoderma harzianum. METHODS: Individual MICs were determined by using broth microdilution method following the NCCLS M38-A guidelines with standard RPMI 1640 broth. Synergy tests were performed using the chequerboard method. RESULTS: All clinical Trichoderma strains showed reduced susceptibility to fluconazole (MICs>or=64 mg/L) and amphotericin B (MICs=2 mg/L), whereas lower MICs of 0.5-1 mg/L were detected for voriconazole. Akacid plus reached the lowest MIC values in a range of 0.06-0.5 mg/L, 4- to 32-fold higher MICs were found for chlorhexidine. No antagonism was observed for any of the antifungal combinations tested. Interaction of amphotericin B and azoles was indifferent (fractional inhibitory concentration index, FICI 2-4). The combination of one azole and one cationic biocide showed different degree of synergism (FICI 0.07-2.03). Interaction of Akacid plus and chlorhexidine resulted in synergism for each Trichoderma isolate (FICI-range 0.05-0.5). CONCLUSIONS: These results demonstrate no interaction between antifungals and some degree of synergism between azoles and cationic antimicrobials against Trichoderma spp.     

Endothelin system and atrial fibrillation post-cardiac surgery

Objective We investigated the relation between the endothelin system and atrial fibrillation. Background Endothelin has been implicated in the pathophysiology of atrial fibrillation, but the exact role of A- and B-receptors is unknown. Methods We obtained right atrial biopsies from patients in sinus rhythm and preserved left ventricular function, undergoing off-pump coronary artery bypass grafting. The expression of endothelin, A- and B-receptors was measured using real time reverse-transcribed polymerase chain reaction. Results We studied 52 patients (45 male, mean age 66 ± 1 years, mean ejection fraction 52 ± 1%). During a 5-day post-operative period, persistent atrial fibrillation occurred in 15 patients (28.8%). Endothelin mRNA expression was comparable in patients who subsequently developed atrial fibrillation and in those maintaining sinus rhythm. However, the former group displayed down-regulation of endothelin A- (by approximately 60%, p = 0.0059) and of B-receptors (by approximately 40%, p = 0.0084). The decreased endothelin A-receptor expression could predict atrial fibrillation occurrence (Wilks λ = 0.86, F = 6.16, p = 0.017). Conclusion Decreased endothelin A- and B-receptor expression is associated with atrial fibrillation after bypass surgery. Theofilos M. Kolettis and Zenon S. Kyriakides contributed equally to the study.