Patient-reported Satisfaction with Current Clinical Management of Systemic Lupus Erythematosus in Kazakhstan

BACKGROUND: Over the past decades, patient satisfaction has been increasingly recognized as a powerful tool to measure the quality of health-care services. AIM: This study evaluated the satisfaction of systemic lupus erythematosus (SLE) patients with current clinical management in Semey, East Kazakhstan, and explored the factors associated with dissatisfaction. METHODS: All adult SLE patients registered at health-care facilities of Semey were enrolled in a cross-sectional study. RESULTS: Out of 67 patients, 66 were females and their mean age was 39 years. Symptoms associated with the musculoskeletal system were the most commonly reported (95.5%), followed by fatigue (88.1%) and neurological symptoms (53.7%). None of the patients were very satisfied or satisfied with current clinical management and the overall rate of patient dissatisfaction was 83.6%. Education (p = 0.04), monthly income (p = 0.01), SLE disease activity index score (p = 0.031), therapy with biologic agents (p = 0.029), immunosuppressants (p = 0.01), and corticosteroids (p = 0.01) were predictors of patient dissatisfaction in multiple logistic regression analysis. CONCLUSION: This real-world study is the first effort to understand the experience of SLE patients within the health-care system of Kazakhstan and the results may facilitate doctor-patient discussions on the initiatives that need to be taken to improve the quality of the medical services provided.

Optimal fosamprenavir regimen to prevent lipid abnormalities

We report our experience on the impact of different fosamprenavir boosted regimens on plasma lipid levels in 48 naive monoinfectd- HIV-seropositive patients. Eighteen months after starting antiretroviral therapy (ART), all patients showed a good immuno-virological response, with no statistically significant differences among the three groups; no changes in ART regimens were necessary and no adverse events were reported. On the contrary, a statistically significant difference among the three groups of patients was observed in cholesterol and triglyceride levels, since higher levels of cholesterol (including LDLs) and triglycerides were observed in patients taking the higher dose of ritonavir. (www.actabiomedica.it)

Short-Cycle Therapy with Bictegravir/Emtricitabine/Tenofovir Alafenamide in a Small Cohort of Virally Suppressed People Living with HIV: A Long-Term Follow-Up

BACKGROUND

Antiretroviral triple therapy has considerably reduced morbidity and mortality in people living with HIV and is the standard-of-care treatment. However, it is lifelong and linked to long-term side effects and adherence problems.

METHODS

Here, we report long-term virological and immunological outcome in 12 virally suppressed people on short-cycle therapy with bictegravir/emtricitabine/tenofovir alafenamide administered five days a week (Monday to Friday).

RESULTS

All patients, after a long term follow-up, were virally suppressed Conclusions: In the wait for new long-acting antiretroviral drugs and new antiretroviral formulations, short-cycle therapy has proven to be a safe and effective alternative to the standard daily antiretroviral regimen for individuals living with HIV who are virologically suppressed.

Risk of reactivation of tuberculosis in the course of human immunodeficiency virus infection

OBJECTIVES

To establish, in a longitudinal study, whether reactivation of latent tuberculous infection takes place below an identifiable immunological threshold in subjects with human immunodeficiency virus (HIV) infection.

METHODS

We followed up for 2 years 44 subjects with HIV infection who had a positive intradermal reaction to tuberculin. All subjects were asymptomatic at enrollment. End points of the study were the development of active tuberculosis or the final evaluation (24 months since the beginning) for those who did not develop tuberculosis over the study period. Total lymphocyte count, CD4+ lymphocyte count and beta-2 microglobulin serum levels were measured at baseline, during the period of observation (every 3-6 months) and at the end point. Multiple Antigen Skin Testing and purified protein derivative (PPD) testing were also performed at baseline and end point, as well as in intermediate phases of the study (every 6 and 12 months respectively).

RESULTS

Ten subjects (22.7%) developed tuberculosis during the study period. Both baseline and end point values of the parameters investigated differed significantly between subjects who developed tuberculosis and those who did not. Cox's model showed that total and CD4+ lymphocyte counts as well as beta-2 microglobulin levels had a prognostic value at a univariate analysis; CD4+ and beta-2 microglobulin retained statistical significance in a multivariate evaluation. CD4+ lymphocyte count was the parameter most strongly associated with the development of tuberculosis.

CONCLUSIONS

Tuberculosis in this setting most often reactivates only when immune surveillance has fallen to an identifiable level. Planners of antituberculous chemoprophylactic policies should consider the downgrading tendency of immune function in these subjects in order to choose the most appropriate time to intervene in the course of HIV infection. Starting prophylaxis in HIV-infected subjects only when CD4+ cells have dropped below the value of 500/mm3 seems to be a more fruitful option than the currently adopted strategy, which recommends time-limited (12 months) administration of daily isoniazid to all PPD+ HIV-infected subjects regardless their immunological status.

Malignant tumours of the genital tract among Batswana women

BACKGROUND

To determine the frequency and pattern of malignant tumours of the female genital tract among Batswana women.

DESIGN

A four-year retrospective histological study of the pattern of female genital tract malignancy in Botswana.

SETTING

University of Botswana and the National Health Laboratory Gaborone, Botswana. The National Health Laboratory is the only public tertiary referral laboratory that provides diagnostic pathology services in the South-Eastern part of Botswana. It is located just adjacent to Princess Marina Hospital, the major tertiary referral hospital in the country.

METHODS

All histologically confirmed diagnoses of female genital tract malignancies from January 1(st) 2006 to December 31(st) 2009 were reviewed by two pathologists and diagnoses re-confirmed by taking fresh tissue sections from paraffin embedded archival tissue blocks.

RESULTS

The age of patients ranged from 13-96 years with a mean age of 54.5 ± 6.4 years. Cancer of the cervix constituted 80.6%, followed by uterine cancer (10.0%), carcinomas of the vulva (4.5%) and ovary (3.4%) in that order. Ovarian cancers predominated in the younger age group. There was a steady increase in the frequencies of cervical, uterine and ovarian cancers over the 4-year study period with a decline in uterine cancer in the 4(th) year.

CONCLUSION

Cervical cancer incidence is high among Batswana women and all female genital tract cancers occurred at a relatively early mean age. Therefore the importance of established and accessible screening programs and awareness campaigns need more emphasis than it is being given currently.