To describe the impact of the introduction of highly active antiretroviral therapy (HAART) on the nature and frequency of rheumatic complications in human immunodeficiency virus (HIV)-infected ...patients.
Case report and systematic review of a newly described syndrome of rheumatic immune reconstitution syndrome and prospective longitudinal cohort study analyzing the frequency and nature of rheumatic complications in the setting of HIV infection from 1989 through 2000.
A newly described syndrome of either the de novo appearance or the exacerbation of clinically occult autoimmunity following immune reconstitution from HAART is described. Including the present case report, 32 cases have been individually described with sarcoidosis and autoimmune thyroid disease being most common with arthritis and various forms of connective tissue disease making up the rest. The mean onset to their appearance following HAART was nearly 9 months and most resolved with little or no therapy. In addition, a longitudinal analysis of 395 HIV-infected patients from 1989 to 2000 designed to detect the appearance of rheumatic complications has revealed a dramatic decline in certain problems such as reactive arthritis, psoriatic arthritis, and various forms of connective tissue disease. New rheumatic complications possibly due to the effects of longer survival and metabolic derangements associated with this form of therapy are now being described and may become more formidable problems in this population in the future.
HAART has had a profound beneficial effect on survival in HIV-infected patients but has also contributed to both an altered frequency and a different nature of rheumatic complications now being observed in this population. Rheumatologists need to be aware of these changes to provide optimal diagnosis and treatment for this group.
Active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) is among the strategies recommended by the Society for Healthcare Epidemiology of America for control of nosocomial MRSA ...infections. Infection control and laboratory personnel desire rapid, sensitive, and inexpensive methods to enhance surveillance activities. A multicenter study was performed to evaluate a new selective and differential chromogenic medium, BBL CHROMagar MRSA (C-MRSA) medium (BD Diagnostics, Sparks, MD), which enables recovery and concomitant identification of MRSA strains directly from nasal swab specimens taken from the anterior nares. Specimens were inoculated to C-MRSA and Trypticase soy agar with 5% sheep blood agar (TSA II, BD Diagnostics). Mauve colonies on C-MRSA at 24 h and 48 h and suspicious colonies on TSA II were confirmed as Staphylococcus aureus by Gram stain morphology and a coagulase test. In addition, the results of C-MRSA were compared to results of susceptibility testing (five different methods) of S. aureus strains isolated on TSA II. A total of 2,015 specimens were inoculated to C-MRSA and TSA II. Three hundred fifty-four S. aureus isolates were recovered; 208 (59%) were oxacillin (methicillin) susceptible and 146 (41%) were oxacillin resistant (MRSA). On C-MRSA, 139/146 or 95.2% of MRSA isolates were recovered, whereas recovery on TSA II was 86.9% (127/146) (P = 0.0027). The overall specificity of C-MRSA was 99.7%. When C-MRSA was compared to each susceptibility testing method, the sensitivity and specificity, respectively, were as follows: oxacillin MIC by broth microdilution, 94.4% and 96.7%; oxacillin screen agar, 94.3% and 96.7%; PBP2' latex agglutination, 93.7% and 98.5%; cefoxitin disk diffusion, 95.0% and 98.1%; and mecA PCR, 95.1% and 98.1%. In this study, C-MRSA was superior to TSA II for recovery of MRSA from surveillance specimens obtained from the anterior nares and was comparable to conventional, rapid, and molecular susceptibility methods for the identification of MRSA isolates.
A 32-year-old male diagnosed with transverse myelitis in 2013 came to our clinic in 2015 with complaints of paraplegia, sensory disturbances, pain, exertional dyspnea, poor quality of sleep, ...emotional instability, and depression. This was a recurrent attack that had been exacerbated by post-traumatic stress. Owing to pain and functional disabilities, he was struggling to actively participate in the treatment modalities offered at our center. A modified protocol of electroacupuncture was planned for a period of 21 days, every day, with each session lasting for 30 minutes. Assessments based on the brief version of World Health Organization Brief Quality of Life (WHO Brief QOL) questionnaire, Pittsburgh sleep quality index, visual analog scale, and a disease-specific physical examination showed momentous improvement in functional health status as well as mental well-being. The quality of life showed significant improvement particularly in the physical and psychological dimensions of WHO Brief QOL. The patient reported a reduction in pain, dyspnea, and fatigue accompanied by an improvement in the quality of sleep and mood. This case report suggests that acupuncture can play a vital role in amelioration of symptoms, thereby improving the health status in patients with transverse myelitis.
Micromachining has become a necessary manufacturing process. Micro-milling tool and its evolution play a vital role in the development of micromachining. This study optimizes the grinding process of ...polycrystalline diamond (PCD) compact for manufacturing PCD micro-tool. The optimization is conducted by using four parameters, i.e., grain size of PCD compact, grain size of abrasive wheel, grinding speed, and feed rate designed by the Taguchi orthogonal array. The study then evaluates two grinding characteristics, i.e., grinding forces and cutting edge radius of the PCD compact. The results of ANOVA show that the most influential parameter on grinding PCD compact is the grain size of the PCD compact, followed by the grain size of the abrasive wheel, feed rate, and grinding speed. As an example, a quadrilateral PCD micro-milling tool with a cutting edge diameter of 80 μm is fabricated by using the optimized parameters.
The use of humanized antibody against tumor necrosis factor alpha (TNF-alpha) may increase the risk of various opportunistic infections, including tuberculosis and fungal infections. We report a case ...of cryptococcal pneumonia in a patient who was taking infliximab for rheumatoid arthritis. A temporally related exposure history raised the possibility that our patient acquired the infection from his pet cockatiel. It seems prudent to advise patients receiving infliximab to avoid exposure to pet avian excreta.
Introduction Myotonic dystrophy type I (DM1) is the most common adult-onset form of muscular dystrophy with autosomal dominant inheritance and incomplete penetrance. EDS is the most frequent ...non-muscular symptom and patients may present with EDS for years before DM1 is diagnosed. We are presenting an 18-year-old Caucasian female with myotonic dystrophy and progressive daytime sleepiness. Report of Case 18 y/o female with medical history of myotonic dystrophy, scoliosis s/p spinal fusion, pectus excavatum, restrictive lung disease, exercise induced asthma, chronic abdominal pain was following in the myotonic dystrophy clinic for 4 years. She has a long and complicated medical history and currently on Baclofen, Carbamazepine, Clonazepam, Duloxetine, Cyproheptadine, Diazepam, Gabapentin and Prednisone. She had complaints of decreased exercise tolerance, daytime fatigue, snoring and excessive nocturnal sleep (11–12 hours) but no significant daytime sleepiness. She had three sleep studies done 2 years apart showing normal sleep with absence of significant sleep disordered breathing. In the past several months she reported more daytime sleepiness and occasional sleep in school. Multiple sleep latency test done after the third sleep study shows mean sleep latency of 3 minutes with no sleep onset REM episodes. She has recently been started on clinical trial of Modafinil. Conclusion In patients with DM1, sleepiness mainly occurs in monotonous situations in contrast to narcolepsy. Sleepiness is mostly unrelated to the duration and the quality of the night time sleep. Sleep phenotype is closer to that of idiopathic hypersomnia with long sleep time (ICSD-2), along with increased sleep fragmentation related to respiratory events, nocturnal agitation, reduced motility and pain. Increased SWS/REM and decreased N2 with impaired delta power dissipation have been reported. Different phenotypes mimic idiopathic hypersomnia, narcolepsy without cataplexy, sleep apnea syndrome, and periodic leg movement disorder, however there is no clear data on how and when to evaluate sleep complaints and clarify the indications of different tools and the frequency of repetition to identify and manage these problems.
Abstract
Introduction
Obstructive sleep apnea (OSA) is the second most common sleep disorder among Veterans and carries risk of serious health complications when untreated. The gold standard for OSA ...treatment is Positive Airway Pressure (PAP). However, adherence to PAP therapy is chronically low. Interventions to enhance adherence include education, practical support, and psychotherapy. Cognitive behavioral therapy and motivational interviewing have been shown to improve CPAP usage by approximately 1 hour per night. Telemedicine-delivered CPAP education and telemonitoring-with-feedback has demonstrated improved adherence in patients with OSA. Our study evaluated the effectiveness of a telemedicine group psychotherapy intervention for Veterans diagnosed with OSA and found to be nonadherent to CPAP therapy. The intervention is delivered in four weekly 60-minute sessions.
Methods
We identified a cohort of 29 patients who participated in the intervention via telemedicine from April 2020 - September 2020 (Telemedicine Psychotherapy cohort). The cohort was compared to a historical control of 35 patients who participated in the in-person group psychotherapy from April 2019 - September 2019 (In-Person Psychotherapy cohort). Through retrospective chart review, we analyzed baseline and post-intervention data from both cohorts. Demographics collected included age, sex, BMI, ethnicity, zip code, as well as medical and mental health comorbidities. Data collected from the medical record included: OSA severity, pre- and post-psychotherapy 90-day average nightly CPAP usage (in minutes), number of psychotherapy classes attended (out of 4) and number of sleep clinic visits at 90-days post-psychotherapy. We used descriptive statistics to provide summary data of this sample and t-test to evaluate Veteran’s average CPAP usage per night and number of sleep clinic visits at 90-days post-psychotherapy between cohorts.
Results
Compared to a cohort of in-person group psychotherapy to improve CPAP adherence, a telemedicine-based cohort demonstrated improvement in 90-day average nightly CPAP usage by an average of 76 minutes per night. (p=0.08) Additionally, patient engagement with the sleep clinic at 90 days following completion of telemedicine psychotherapy was significantly higher compared to in-person psychotherapy (p<0.001).
Conclusion
In a haphazardly-collected convenient sample of veterans during the COVID-19 pandemic, telemedicine psychotherapy led to improved CPAP usage. Veterans who underwent telemedicine intervention also significantly increased engagement with the sleep clinic.
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