Geriatric Patients Living with HIV/AIDS (GEPPO) is a new prospective observational multicentre cohort consisting of all the HIV-positive geriatric patients being treated at 10 clinics in Italy, and ...HIV-negative controls attending a single geriatric clinic. The aim of this analysis of the GEPPO cohort was to compare prevalence and risk factors of individual non-communicable diseases (NCD), multi-morbidity (MM) and polypharmacy (PP) amongst HIV positive and HIV negative controls at enrolment into the GEPPO cohort.
This cross-sectional study was conducted between June 2015 and May 2016. The duration of HIV infection was subdivided into three intervals: < 10, 10-20 and > 20 years. The NCD diagnoses were based on guidelines defined criteria, including cardiovascular disease, hypertension, type 2 diabetes, chronic kidney disease, dyslipidaemia, chronic obstructive pulmonary disease. MM was classified as the presence of two or more co-morbidities. The medications prescribed for the treatment of comorbidities were collected in both HIV positive and HIV negative group from patient files and were categorized using the Anatomical Therapeutic Chemical (ATC) classification. PP was defined as the presence of five or more drug components other than anti-retroviral agents.
The study involved a total of 1573 patient: 1258 HIV positive and 315 HIV negative). The prevalence of individual comorbidities was similar in the two groups with the exception of dyslipidaemia, which was more frequent in the HIV-positive patients (p < 0.01). When the HIV-positive group was stratified based on the duration of HIV infection, most of the co-morbidities were significantly more frequent than in control patients, except for hypertension and cardiovascular disease, while COPD was more prevalent in the control group. MM and PP were both more prevalent in the HIV-positive group, respectively 64% and 37%.
MM and PP burden in geriatric HIV positive patients are related to longer duration of HIV-infection rather than older age per se.
Abstract
Since the discovery of high temperature superconductors, a possible cryogen-free scenario has always been wished. Nowadays, liquid Helium is running out, and it is likely that the cooling by ...will be a large part of the costs of any superconducting system. Bi-2212 wires at temperature higher than 4.2 K still show a very high irreversibility field and thus a deep investigation of their properties in such a range of temperature is very useful in order to assess the applicability in high field cryogen-free magnets. Here electrical transport and magnetic properties characterization at variable temperature and magnetic field on our “GDG—processed” wires are reported together with a well-described original approach to calculate the irreversibility field
H
irr
. This study is devoted to provide reference data on the behaviour of the only isotropic wire for high field application with an eye to the performances at temperatures above 4.2 K.
Summary
Background Expected benefits of gluten‐free diet (GFD) in coeliac patients include healing of small intestinal mucosa, but it remains unclear to what extent this benefit is achieved in ...adults.
Aim To assess factors affecting histological outcome of GFD in a large cohort of adult coeliac patients.
Methods We extracted information on 465 consecutive coeliac patients studied before and during GFD.
Results Duodenal biopsies at diagnosis were classified as Marsh I in 11, II in 25 and III in 429 cases. After a median 16 months GFD, 38 (8%) patients had histological ‘normalization’, 300 (65%) had ‘remission’ with persistent intraepithelial lymphocytosis, 121(26%) had ‘no change’ and 6 (1%) had ‘deterioration’. Coeliac disease related serology was negative in 83% of patients with Marsh III lesion during GFD. Male gender and adherence to GFD were independently associated with histological ‘normalization’ and ‘remission’. Persistence of intraepithelial lymphocytosis was not associated with human lymphocyte antigen gene dose or with Helicobacter pylori infection.
Conclusions Complete normalization of duodenal lesions is exceptionally rare in adult coeliac patients despite adherence to GFD, symptoms disappearance and negative CD related serology. Control biopsies are mandatory to identify lack of response to gluten‐free diet.
Objectives
Frailty is a predictor of adverse health outcomes and can be measured across the life course, including among people living with HIV. The purpose of this study was to examine two commonly ...used measures of frailty ‐ the frailty index (FI) and frailty phenotype – to assess common characteristics and to describe associations with multimorbidity, falls, and disability in people aging with HIV.
Methods
This was a cross‐sectional observational study including 482 consecutive HIV‐infected patients (mean age 53.9 ± SD 6.9 years; 75% male) attending the multidisciplinary metabolic clinic at the University of Modena, Italy. Frailty was measured with the frailty phenotype and a 37‐item FI.
Results
The mean FI score was 0.28±0.1 and frailty phenotype categories were: 3.1% frail, 51.9% pre‐frail, and 45% robust. The duration of antiretroviral therapy was significantly different across levels of frailty as measured by both frailty tools (P < 0.01), but the nadir CD4 count was only significant for the FI (P = 0.01); current CD4 count was not significantly different across frailty levels using either tool. Both frailty measures were associated with multimorbidity; the FI was associated with Instrumental Activities of Daily Living impairment and falls history, whereas the frailty phenotype was not.
Conclusions
The frailty phenotype and the FI demonstrated similar characteristics in patients at a tertiary‐level HIV clinic. The FI had a stronger association with age, nadir CD4 count, comorbidities, falls, and disability. Integrating frailty assessments in clinical practice will be crucial for the development of interventions in age‐related conditions, including disability and falls, in older persons living with HIV.
Objectives
Current guidelines recommend use of a diagnostic algorithm to assess disease severity in cases of suspected nonalcoholic fatty liver disease (NAFLD). We applied this algorithm to ...HIV‐monoinfected patients.
Methods
We analysed three prospective screening programmes for NAFLD carried out in the following cohorts: the Liver Disease in HIV (LIVEHIV) cohort in Montreal, the Modena HIV Metabolic Clinic (MHMC) cohort and the Liver Pathologies in HIV in Palermo (LHivPa) cohort. In the LIVEHIV and LHivPa cohorts, NAFLD was diagnosed if the controlled attenuation parameter (CAP) was ≥ 248 dB/m; in the MHMC cohort, it was diagnosed if the liver/spleen Hounsfield unit (HU) ratio on abdominal computerized tomography scan was < 1.1. Medium/high‐risk fibrosis category was defined as fibrosis‐4 (FIB‐4) ≥ 1.30. Patients requiring specialist referral to hepatology were defined as either having NAFLD and being in the medium/high‐risk fibrosis category or having elevated alanine aminotransferase (ALT).
Results
A total of 1534 HIV‐infected adults without significant alcohol intake or viral hepatitis coinfection were included in the study. Of these, 313 (20.4%) patients had the metabolic comorbidities (obesity and/or diabetes) required for entry in the diagnostic algorithm. Among these patients, 123 (39.3%) required specialist referral to hepatology, according to guidelines. A total of 1062 patients with extended metabolic comorbidities (any among obesity, diabetes, hypertension and dyslipidaemia) represented most of the cases of NAFLD (79%), elevated ALT (75.9%) and medium/high‐risk fibrosis category (75.4%). When the algorithm was extended to these patients, it was found that 341 (32.1%) would require specialist referral to hepatology.
Conclusions
According to current guidelines, one in five HIV‐monoinfected patients should undergo detailed assessment for NAFLD and disease severity. Moreover, one in ten should be referred to hepatology. Expansion of the algorithm to patients with any metabolic comorbidities may be considered.
Objectives
The aim of the study was to describe chronic lung disease in HIV‐infected never‐smokers by looking at clinical, structural and functional abnormalities.
Methods
This comparative ...cross‐sectional study included 159 HIV‐infected never‐smoking patients mean (± standard deviation) age 54.6 ± 9.1 years; 13.2% female; 98.1% with undetectable viral load and 75 nonmatched never‐smoking controls mean (± standard deviation) age 52.6 ± 6.9 years; 46.7% female. We examined calcium scoring computer tomography (CT) scans or chest CT scans, all with a lung‐dedicated algorithm reconstruction, to assess emphysema and airway disease (respiratory bronchiolitis and/or bronchial wall thickening), tested pulmonary function using spirometry, lung volumes and the diffusion lung capacity of carbon monoxide (DLCO), and assessed respiratory symptoms using the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT).
Results
Twenty‐five (17.2%) of the HIV‐infected patients versus two (2.7%) of the controls had a CAT score > 10. Only 5% of the HIV‐infected patients showed FEV1% < 80%, and 25% had DLCO < 75% of the predicted value. Based on the CT scans, they had increased prevalences, compared with the controls, of airway disease (37% versus 7.9%, respectively) and emphysema (18% versus 4%, respectively), with more severe and more frequent centrilobular disease. After correction for age, sex and clinical factors, HIV infection was significantly associated with CAT > 10 odds ratio (OR) 7.7, emphysema (OR 4), airway disease (OR 4.5) and DLCO < 75% of predicted (OR 4).
Conclusions
Although comparisons were limited by the different enrolment methods used for HIV‐infected patients and controls, the results suggest that never‐smoking HIV‐infected patients may present with chronic lung damage characterized by CT evidence of airway disease. A minority of them showed respiratory symptoms, without significant functional abnormalities.
Right ventricular (RV) involvement is frequently detected in patients presenting with acute left ventricular myocardial infarction. The ischemic right ventricle carries a dismal outcome by ...predisposing the heart to arrhythmic events and mechanical or hemodynamic complications. A comprehensive RV evaluation by multimodality imaging could guide clinical practice but has always been a conundrum for the imagers. Two-dimensional echocardiography is the best first-line tool due to its availability of bedside capabilities. More advanced imaging techniques provide a more comprehensive evaluation of the complex RV geometry but are mostly reserved for the post-acute setting. Three-dimensional echocardiography has improved the evaluation of RV volumes and function. The recent application of speckle-tracking echocardiography to the right ventricle appears promising, allowing the earlier detection of subtle RV dysfunction. Cardiac magnetic resonance imaging is considered the gold standard for the RV assessment. Cardiac multidetector computed tomography could be a reliable alternative. The aim of this review is to focus on the growing importance of multimodality imaging of the ischemic right ventricle and to propose a diagnostic algorithm, in order to reach a comprehensive assessment of this too frequently neglected chamber.
Abstract Objectives Definitive evidence that red blood cell transfusion improves outcome after vascular surgery is lacking. The aims of the study were to determine, among stable consecutive patients ...who underwent elective major vascular surgery, (1) the association between postoperative transfusion and 30-day death, myocardial infarction, and both, and (2) and if this association differs according to the presence of postoperative anaemia (haemoglobin value less than 9.0 g/dL within 7 days after surgery). Methods A retrospective observational study was conducted on 359 patients prospectively screened according to the ACC/AHA guidelines for preoperative risk in non-cardiac surgery. Main outcome was 30-day death; secondary outcomes 30-day myocardial infarction, and composite of 30-day myocardial infarction or death. Results Of the patients included, 95 (26.5%) received at least one unit of red blood cells. Patients who received transfusion had a significantly increased hazard of 30-day death (hazard ratio HR 11.72, 95% confidence interval CI 3.92–35.10; p < 0.0001), myocardial infarction (HR 3.3, 95% CI 1.7–6.1; p = 0.0003), and both (HR 4.0 95% CI 2.2–7.3; p < 0.0001). Such associations held even after adjusting for baseline characteristics, surgical risk, bleeding, and propensity to receive transfusion. There was a significant interaction between transfusion and postoperative anaemia ( p = 0.012). In patients without anaemia, transfusion was associated with higher risk of 30-day death (HR 19.20, 95% CI 3.99–92.45; p = 0.007), myocardial infarction (HR 5.05, 95% CI 2.23–11.44; p = 0.0001), and both. Conversely, in patients with anaemia this association was not significant. Conclusions In patients who underwent elective major vascular surgery, perioperative transfusion was associated with a significantly increased risk of 30-day events which was more attributable to patients with lesser degree of anaemia. Our data caution against the use of liberal transfusion in stable vascular surgery patients.
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