자연주의적 탐구조사(Naturalistic Inquiry)

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

https://openresearch-repository.anu.edu.au/bitstream/1885/164632/2/01_Bin%2bSayeed_Global%252C_regional%252C_and_national_2018.pdf

Global, regional, and national incidence, prevalence, andyears lived with disability for 354 diseases and injuries for195 countries and territories, 1990–2017: a systematicanalysis for the Global Burden of Disease Study 2017

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

In many countries, HIV testing among tuberculosis (TB) patients is recommended so that both infections are appropriately treated. Cross-reacting antibodies to HIV antigens have been reported for several conditions, including TB, leprosy, malaria, and rheumatoid arthritis. To study the pattern and prevalence of cross-reacting antibodies to HIV antigens, we examined sera from 153 HIV-negative TB patients and 40 healthy individuals in Chennai, south India. We also studied the differences in cross-reactivity of various HIV antigens using two different Western blot kits. Of the 153 samples studied, 80 were tested using HIV Western blot and 73 were tested using INNOLIA. Most patients in the study had concordantly negative ELISA and rapid tests, and no subject had a positive Western blot. However, seven TB patients had antibodies that cross-reacted with HIV antigens, giving rise to an indeterminate result. While p51/55 was the most frequently recognized antigen in the Western blot assay, antibodies to sgp120 was most frequently identified in INNOLIA. Sequence similarities between the two organisms could be responsible for eliciting cross-reacting antibodies, since a few related epitopes were identified in HIV and Mycobacterium. These findings could have potential implications for the development of diagnostics and vaccines.

Prevalence and pattern of cross-reacting antibodies to HIV in patients with tuberculosis.

Patient adherence to treatment is an important factor in the effectiveness of antiretroviral regimens. Adherence to treatment could be monitored by estimation of antiretroviral drugs in biological fluids. We aimed to obtain information on the quantity and duration of excretion of lamivudine in urine following oral administration of a single dose of 300 mg and to assess its suitability for adherence monitoring purposes. Spot urine samples were collected before dosing and at 4, 8, 12, 24, 28, 32, 48, 72, and 96 hours post dosing from 10 healthy subjects, and lamivudine was estimated by high-pressure liquid chromatography (HPLC). Lamivudine values were expressed as a ratio of urine creatinine. About 91% of the ingested drug was excreted by 24 hours, and the concentration thereafter in urine was very negligible. A lamivudine value of 0.035 mg/mg creatinine or less at 48 hours is suggestive of a missed dose in the last 24 hours. The study findings showed that estimation of urine lamivudine in spot specimens could be useful in monitoring patient adherence to antiretroviral treatment. However, this needs to be confirmed on a larger sample size and among patients on once-daily and twice-daily treatment regimens.

/pdf/can-urine-lamivudine-be-used-to-monitor-antiretroviral-5fooy2r87d.pdf

Can Urine Lamivudine Be Used to Monitor Antiretroviral Treatment Adherence

The HIV epidemic has increased the burden of tuberculosis (TB) among young adults especially in populations where the prevalence of TB infection is high. Infection with HIV is the most potent risk factor for progression to active tuberculosis. Individuals who are infected with Mycobacteriwn tuberculosis only have an approximately 10% lifetime risk of developing active tuberculosis compared with 60% or more in persons infected with HIV and TB. This is particularly important in India where more than half the adult population harbours M. tuberculosis. It is estimated that there are about 14 million cases of tuberculosis in India about 2 million new cases occur annually and we are home to 1/4th the world’s TB prevalence. The situation is likely to get worse as the prevalence of HIV in the community increases. Therefore it is important to understand the effect of TB and HIV on each other and take adequate measures to control this dual epidemic. Tuberculosis is the commonest opportunistic infection in HIV/AIDS patients with an attack rate of 7 per 100 person-years. The seroprevalence of HIV among TB patients in India varies widely and many studies have reported increasing rates reflecting the spread of HIV in the general population. Most cases of tuberculosis in HIV infected patients are due to reactivation of previous lesions. However HIV infection also greatly increases the risk of developing TB following fresh infection and the actual proportion of each type in India needs further study. Tuberculosis may occur at any time after HIV infection but becomes more common as the immune system weakens. (excerpt)

Clinical presentation and treatment of HIV - TB.

Background: Mycobacteremia in HIV positive tuberculosis patients is associated with extra-pulmonary tuberculosis and disseminated tuberculosis. Objective: To study the occurrence of mycobacteremia among HIV-infected patients with tuberculosis (both pulmonary and extra-pulmonary forms) using radiometric BACTEC method. Methods: HIV positive patients admitted to the Government Hospital of Thoracic Medicine with a clinical diagnosis of tuberculosis were screened. HIV serology was reconfirmed using ELISA (two different tests) at Tuberculosis Research Centre. Five ml of venous blood was collected on the day of admission to the ward before start of anti-tuberculosis therapy. Results: Of the 105 patients screened, 85 were were found to be eligible for analysis. Patients were aged between 20-40 years, with a male preponderance (5:1). Pulmonary tuberculosis was the predominant form of tuberculosis (85%), while 15 % had associated extra-pulmonary involvement. Eight-four percent of the patients had CD4 counts of less than 200 cells/mm 3 , with 42% being below 50 cells/mm 3 . Four of the 85 patients were blood culture positive; three were identified as M.tuberculosis and one as Mycobacterium phlei. Conclusions: Mycobacteremia was detected in 4% of HIV positive patients with tuberculosis. All of them were immunosuppressed with CD4 counts of 3 . More work needs to be done in India to understand the risk factors and outcome of patients with mycobacteremia.

Mycobacteremia in tuberculosis patients with HIV infection

Background & objectives: Resistance to nevirapine (NVP) has been described with single dose preventive regimens in other populations. Our aim was to study the pattern and prevalence of HIV drug resistance (DR) at baseline (during pregnancy) and after delivery among antenatal women exposed to single dose NVP for prevention of parent to child transmission (PPTCT). Methods: HIV-infected, ART-naive primigravidae between 18-25 years of age, attending government antenatal clinics in Chennai, Vellore or Madurai were recruited. Drug resistance testing was carried out during pregnancy and after Sd-NVP treatment (one month after delivery) by Viroseq sequencing. HIV-1 testing by DNA PCR was done in newborns at 30 days. Results: Thirty one women were enrolled but only twenty six plasma specimens were analyzable (24 paired and two postnatal only). No major mutations were observed in any drug class at baseline though many polymorphisms were observed in both the reverse transcriptase and protease genes. Mutations to non-nucleoside reverse transcriptase inhibitors (NNRTI) were observed post-delivery in 33 per cent of women who were treated with Sd-NVP. None of the infants were HIV-positive. Interpretation & conclusions: Among pregnant ART-naοve women, baseline HIV drug resistance was not observed. A high rate of development of NNRTI class resistance among women treated with single-dose NVP was observed. Our results emphasize the need to implement more effective PPTCT regimens, minimizing emergence of drug resistance and thereby preserving long-term treatment options for HIV-infected women in India.

Soumya Swaminathan

Papers

Prevalence and pattern of cross-reacting antibodies to HIV in patients with tuberculosis.

Can Urine Lamivudine Be Used to Monitor Antiretroviral Treatment Adherence

Clinical presentation and treatment of HIV - TB.

Mycobacteremia in tuberculosis patients with HIV infection

Emergence of drug resistant mutations after single dose nevirapine exposure in HIV-1 infected pregnant women in south India.