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Cotte L, Katlama C, Post F, Clarke A, Short W, Das M, Fordyce M. VIH-13 - Tolérance à plus long terme du ténofovir alafénamide chez l’insuffisant rénal. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mansfeld M, Skrahina A, Shepherd L, Schultze A, Panteleev AM, Miller RF, Miro JM, Zeltina I, Tetradov S, Furrer H, Kirk O, Grzeszczuk A, Bolokadze N, Matteelli A, Post FA, Lundgren JD, Mocroft A, Efsen A, Podlekareva DN. Major differences in organization and availability of health care and medicines for HIV/TB coinfected patients across Europe. HIV Med 2015; 16:544-52. [PMID: 25959854 DOI: 10.1111/hiv.12256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of the study was to investigate the organization and delivery of HIV and tuberculosis (TB) health care and to analyse potential differences between treatment centres in Eastern (EE) and Western Europe (WE). METHODS Thirty-eight European HIV and TB treatment centres participating in the TB:HIV study within EuroCoord completed a survey on health care management for coinfected patients in 2013 (EE: 17 respondents; WE:21; 76% of all TB:HIV centres). Descriptive statistics were obtained for regional comparisons. The reported data on health care strategies were compared with actual clinical practice at patient level via data derived from the TB:HIV study. RESULTS Respondent centres in EE comprised: Belarus (n = 3), Estonia (1), Georgia (1), Latvia (1), Lithuania (1), Poland (4), Romania (1), the Russian Federation (4) and Ukraine (1); those in WE comprised: Belgium (1), Denmark (1), France (1), Italy (7), Spain (2), Switzerland (1) and UK (8). Compared with WE, treatment of HIV and TB in EE are less often located at the same site (47% in EE versus 100% in WE; P < 0.001) and less often provided by the same doctors (41% versus 90%, respectively; P = 0.002), whereas regular screening of HIV-infected patients for TB (80% versus 40%, respectively; P = 0.037) and directly observed treatment (88% versus 20%, respectively; P < 0.001) were more common in EE. The reported availability of rifabutin and second- and third-line anti-TB drugs was lower, and opioid substitution therapy (OST) was available at fewer centres in EE compared with WE (53% versus 100%, respectively; P < 0.001). CONCLUSIONS Major differences exist between EE and WE in relation to the organization and delivery of health care for HIV/TB-coinfected patients and the availability of anti-TB drugs and OST. Significant discrepancies between reported and actual clinical practices were found in EE.
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Yombi JC, Jones R, Pozniak A, Hougardy JM, Post FA. Monitoring of kidney function in HIV-positive patients. HIV Med 2015; 16:457-67. [PMID: 25944246 DOI: 10.1111/hiv.12249] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/11/2023]
Abstract
HIV-positive patients are at increased risk of developing chronic kidney disease. Although guidelines recommend regular monitoring of renal function in individuals living with HIV, the optimal frequency remains to be defined. In this review, we discuss the renal syndromes that may be identified at an earlier stage via routine assessment of kidney function, and provide guidance in terms of the frequency of monitoring, the most useful tests to perform, and their clinical significance. Specifically, we address whether annual monitoring of kidney function is appropriate for the majority of HIV-positive patients.
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Cheserem E, Mabonga E, Post FA. HIV and the kidney: a UK perspective. Br J Hosp Med (Lond) 2014; 75:197-201. [PMID: 24727957 DOI: 10.12968/hmed.2014.75.4.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Schnabel RB, Post F, Blankenberg S. [Diagnosis of acute coronary syndrome]. Dtsch Med Wochenschr 2014; 139 Suppl 1:S9-12. [PMID: 24446046 DOI: 10.1055/s-0033-1360000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The acute coronary syndrome (ACS) is one of the most frequent differential diagnoses in emergency medicine. The causal mechanism of the ACS most often is an atherosclerotic plaque rupture. The differential diagnosis of ACS is guided by the clinical symptom of chest discomfort. The diagnosis is based on the electrocardiographic, biomarker and imaging findings before targeted therapy can be initiated. Over the last years we have witnessed breakthroughs in imaging techniques and the application of biomarkers such as highly sensitive or ultrasensitive cardiac troponin assays. They permit an early and sensitive diagnosis of ACS. Furthermore, they exhibit a high negative predictive value for a safe rule-out. Trained personnel and optimized structures in chest pain units constitute optimal conditions for a guideline conform therapy of patients with ACS. The number of certified chest pain units in Germany has constantly been increasing.
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Samuel M, Jose S, Winston A, Nelson M, Johnson M, Chadwick D, Fisher M, Leen C, Gompels M, Gilson R, Post FA, Hay P, Sabin CA. The effects of age on associations between markers of HIV progression and markers of metabolic function including albumin, haemoglobin and lipid concentrations. HIV Med 2013; 15:311-6. [PMID: 24245861 PMCID: PMC4265250 DOI: 10.1111/hiv.12103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We investigated whether age modified associations between markers of HIV progression, CD4 T lymphocyte count and HIV RNA viral load (VL), and the following markers of metabolic function: albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC). METHODS A retrospective analysis of data from the United Kingdom Collaborative HIV Cohort was carried out. Analyses were limited to antiretroviral-naïve subjects to focus on the impact of HIV disease itself. A total of 16670 subjects were included in the analysis. Multilevel linear regression models assessed associations between CD4 count/VL and each of the outcomes. Statistical tests for interactions assessed whether associations differed among age groups. RESULTS After adjustment for gender and ethnicity, there was evidence that lower CD4 count and higher VL were associated with lower TC, LDL-C, haemoglobin and albumin concentrations but higher triglyceride concentrations. Age modified associations between CD4 count and albumin (P < 0.001) and haemoglobin (P = 0.001), but not between CD4 count and HDL-C, LDL-C and TC, or VL and any outcome. Among participants aged < 30, 30-50 and > 50 years, a 50 cells/μL lower CD4 count correlated with a 2.4 [95% confidence interval (CI) 1.7-3.0], 3.6 (95% CI 3.2-4.0) and 5.1 (95% CI 4.0-6.1) g/L lower haemoglobin concentration and a 0.09 (95% CI 0.07-0.11), 0.12 (95% CI 0.11-0.13) and 0.16 (95% CI 0.13-0.19) g/L lower albumin concentration, respectively. CONCLUSIONS We present evidence that age modifies associations between CD4 count and plasma albumin and haemoglobin levels. A given reduction in CD4 count was associated with a greater reduction in haemoglobin and albumin concentrations among older people living with HIV. These findings increase our understanding of how the metabolic impact of HIV is influenced by age.
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Lucas GM, Cozzi-Lepri A, Wyatt CM, Post FA, Bormann AM, Crum-Cianflone NF, Ross MJ. Glomerular filtration rate estimated using creatinine, cystatin C or both markers and the risk of clinical events in HIV-infected individuals. HIV Med 2013; 15:116-23. [PMID: 24024499 DOI: 10.1111/hiv.12087] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The accuracy and precision of glomerular filtration rate (GFR) estimating equations based on plasma creatinine (GFR(cr)), cystatin C (GFR(cys)) and the combination of these markers (GFR(cr-cys)) have recently been assessed in HIV-infected individuals. We assessed the associations of GFR, estimated by these three equations, with clinical events in HIV-infected individuals. METHODS We compared the associations of baseline GFR(cr), GFR(cys) and GFR(cr-cys) [using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations] with mortality, cardiovascular events (CVEs) and opportunistic diseases (ODs) in the Strategies for the Management of Antiretroviral Therapy (SMART) study. We used Cox proportional hazards models to estimate unadjusted and adjusted hazard ratios per standard deviation (SD) change in GFR. RESULTS A total of 4614 subjects from the SMART trial with available baseline creatinine and cystatin C data were included in this analysis. Of these, 99 died, 111 had a CVE and 121 had an OD. GFR(cys) was weakly to moderately correlated with HIV RNA, CD4 cell count, high-sensitivity C-reactive protein, interleukin-6, and D-dimer, while GFR(cr) had little or no correlation with these factors. GFR(cys) had the strongest associations with the three clinical outcomes, followed closely by GFR(cr-cys), with GFR(cr) having the weakest associations with clinical outcomes. In a model adjusting for demographics, cardiovascular risk factors, HIV-related factors and inflammation markers, a 1-SD lower GFR(cys) was associated with a 55% [95% confidence interval (CI) 27-90%] increased risk of mortality, a 21% (95% CI 0-47%) increased risk of CVE, and a 22% (95% CI 0-48%) increased risk of OD. CONCLUSIONS Of the three CKD-EPI GFR equations, GFR(cys) had the strongest associations with mortality, CVE and OD.
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Podlekareva DN, Grint D, Post FA, Mocroft A, Panteleev AM, Miller RF, Miro JM, Bruyand M, Furrer H, Riekstina V, Girardi E, Losso MH, Caylá JA, Malashenkov EA, Obel N, Skrahina AM, Lundgren JD, Kirk O. Health care index score and risk of death following tuberculosis diagnosis in HIV-positive patients. Int J Tuberc Lung Dis 2013; 17:198-206. [PMID: 23317955 DOI: 10.5588/ijtld.12.0224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome. METHODS A total of 1061 HIV patients diagnosed with TB in four regions, Central/Northern, Southern and Eastern Europe and Argentina, between January 2004 and December 2006 were enrolled in the TB-HIV study. A weighted HCI score (range 0-5), based on independent prognostic factors identified in multivariable Cox models and the final score, included performance of TB drug susceptibility testing (DST), an initial TB regimen containing a rifamycin, isoniazid and pyrazinamide, and start of combination antiretroviral treatment (cART). RESULTS The mean HCI score was highest in Central/Northern Europe (3.2, 95%CI 3.1-3.3) and lowest in Eastern Europe (1.6, 95%CI 1.5-1.7). The cumulative probability of death 1 year after TB diagnosis decreased from 39% (95%CI 31-48) among patients with an HCI score of 0, to 9% (95%CI 6-13) among those with a score of ≥4. In an adjusted Cox model, a 1-unit increase in the HCI score was associated with 27% reduced mortality (relative hazard 0.73, 95%CI 0.64-0.84). CONCLUSIONS Our results suggest that DST, standard anti-tuberculosis treatment and early cART may improve outcome for TB-HIV patients. The proposed HCI score provides a tool for future research and monitoring of the management of TB-HIV patients. The highest HCI score may serve as a benchmark to assess TB-HIV management, encouraging continuous health care improvement.
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Peters B, Post F, Wierzbicki AS, Phillips A, Power L, Das S, Johnson M, Moyle G, Hughes L, Wilkins E, McCloskey E, Compston J, Di Angelantonio E. Screening for chronic comorbid diseases in people with HIV: the need for a strategic approach. HIV Med 2012; 14 Suppl 1:1-11. [DOI: 10.1111/j.1468-1293.2012.01055.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Asboe D, Aitken C, Boffito M, Booth C, Cane P, Fakoya A, Geretti AM, Kelleher P, Mackie N, Muir D, Murphy G, Orkin C, Post F, Rooney G, Sabin C, Sherr L, Smit E, Tong W, Ustianowski A, Valappil M, Walsh J, Williams M, Yirrell D. British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011. HIV Med 2012; 13:1-44. [PMID: 22171742 DOI: 10.1111/j.1468-1293.2011.00971.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schnelle N, Hink U, Wohlhöfer M, Ister D, Jabs A, Kasper-König W, Post F, Münzel T, Vahl CF. Postoperative occlusion of a transapical implanted valve due to mechanical CPR. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abugameh A, Weiler H, Post F, Vahl CF. Ascending aorta perforation following dislocation of percutaneous transcatheter aortic valve implantation (TAVI). Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kober C, Johnson M, Fisher M, Hill T, Anderson J, Bansi L, Gompels M, Palfreeman A, Dunn D, Gazzard B, Gilson R, Post F, Phillips AN, Walsh J, Orkin C, Delpech V, Ainsworth J, Leen C, Sabin CA. Non-uptake of highly active antiretroviral therapy among patients with a CD4 count < 350 cells/μL in the UK. HIV Med 2011; 13:73-8. [PMID: 22106827 DOI: 10.1111/j.1468-1293.2011.00956.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2011] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Current British HIV Association (BHIVA) guidelines recommend that all patients with a CD4 count <350 cells/μL are offered highly active antiretroviral therapy (HAART). We identified risk factors for delayed initiation of HAART following a CD4 count <350 cells/μL. METHODS All adults under follow-up in 2008 who had a first confirmed CD4 count <350 cells/μL from 2004 to 2008, who had not initiated treatment and who had >6 months of follow-up were included in the study. Characteristics at the time of the low CD4 cell count and over follow-up were compared to identify factors associated with delayed HAART uptake. Analyses used proportional hazards regression with fixed (sex/risk group, age, ethnicity, AIDS, baseline CD4 cell count and calendar year) and time-updated (frequency of CD4 cell count measurement, proportion of CD4 counts <350 cells/μL, latest CD4 cell count, CD4 percentage and viral load) covariates. RESULTS Of 4871 patients with a confirmed low CD4 cell count, 436 (8.9%) remained untreated. In multivariable analyses, those starting HAART were older [adjusted relative hazard (aRH)/10 years 1.15], were more likely to be female heterosexual (aRH 1.13), were more likely to have had AIDS (aRH 1.14), had a greater number of CD4 measurements < 350 cells/μL (aRH/additional count 1.18), had a lower CD4 count over follow-up (aRH/50 cells/μL higher 0.57), had a lower CD4 percentage (aRH/5% higher 0.90) and had a higher viral load (aRH/log(10) HIV-1 RNA copies/ml higher 1.06). Injecting drug users (aRH 0.53), women infected with HIV via nonsexual or injecting drug use routes (aRH 0.75) and those of unknown ethnicity (aRH 0.69) were less likely to commence HAART. CONCLUSION A substantial minority of patients with a CD4 count < 350 cells/μL remain untreated despite its indication.
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Keller T, Tzikas S, Scheiba O, Krahn U, Post F, Arnolds S, Blankenberg S, Warnholtz A, Münzel T, Genth-Zotz S. Reduktion der stationären Verweildauer bei Patienten mit akutem Koronarsyndrom durch Einrichtung einer Chest Pain Unit. Herz 2011; 37:301-7. [DOI: 10.1007/s00059-011-3544-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 09/29/2011] [Indexed: 11/28/2022]
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Garvey L, Winston A, Walsh J, Post F, Porter K, Gazzard B, Fisher M, Leen C, Pillay D, Hill T, Johnson M, Gilson R, Anderson J, Easterbrook P, Bansi L, Orkin C, Ainsworth J, Palfreeman A, Gompels M, Phillips AN, Sabin CA. Antiretroviral therapy CNS penetration and HIV-1-associated CNS disease. Neurology 2011; 76:693-700. [PMID: 21339496 DOI: 10.1212/wnl.0b013e31820d8b0b] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The impact of different antiretroviral agents on the risk of developing or surviving CNS disease remains unknown. The aim of this study was to investigate whether using antiretroviral regimens with higher CNS penetration effectiveness (CPE) scores was associated with reduced incidence of CNS disease and improved survival in the UK Collaborative HIV Cohort (CHIC) Study. METHODS Adults without previous CNS disease, who commenced combination antiretroviral therapy (cART) between 1996 and 2008, were included (n = 22,356). Initial and most recent cART CPE scores were calculated. CNS diseases were HIV encephalopathy (HIVe), progressive multifocal leukoencephalopathy (PML), cerebral toxoplasmosis (TOXO), and cryptococcal meningitis (CRYPTO). Incidence rates and overall survival were stratified by CPE score. A multivariable Poisson regression model was used to identify independent associations. RESULTS The median (interquartile range) CPE score for initial cART regimen increased from 7 (5-8) in 1996-1997 to 9 (8-10) in 2000-2001 and subsequently declined to 6 (7-8) in 2006-2008. Differences in gender, HIV acquisition risk group, and ethnicity existed between CPE score strata. A total of 251 subjects were diagnosed with a CNS disease (HIVe 80; TOXO 59; CRYPTO 56; PML 54). CNS diseases occurred more frequently in subjects prescribed regimens with CPE scores ≤ 4, and less frequently in those with scores ≥ 10; however, these differences were nonsignificant. Initial and most recent cART CPE scores ≤ 4 were independently associated with increased risk of death. CONCLUSION Clinical status at time of commencing cART influences antiretroviral selection and CPE score. This information should be considered when utilizing CPE scores for retrospective analyses.
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Campbell LJ, Ibrahim F, Fisher M, Holt SG, Hendry BM, Post FA. Spectrum of chronic kidney disease in HIV-infected patients. HIV Med 2009; 10:329-36. [PMID: 19226409 DOI: 10.1111/j.1468-1293.2008.00691.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of the study was to investigate the prevalence and aetiology of chronic kidney disease (CKD) and trends in estimated glomerular filtration rate (eGFR) in HIV-infected patients. METHODS Ascertainment and review of CKD cases among patients attending King's College and Brighton Hospitals, UK were carried out. CKD was defined as eGFR <60 mL/min for > or =3 months. Longitudinal eGFR slopes were produced to examine trends in renal function before, during and after exposure to indinavir (IDV) or tenofovir (TFV). RESULTS CKD prevalence was 2.4%. While HIV-associated nephropathy accounted for 62% of CKD in black patients, 95% of CKD in white/other patients was associated with diabetes mellitus, hypertension, atherosclerosis and/or drug toxicity. Exposure to IDV or TFV was associated with an accelerated decline in renal function (4.6-fold and 3.7-fold, respectively) in patients with CKD. In patients initiating IDV, age > or =50 years increased the odds of CKD [odds ratio (OR) 4.9], while in patients initiating TFV, age > or =50 years (OR 5.4) and eGFR 60-75 mL/min (OR 17.2) were associated with developing CKD. CONCLUSION This study highlights the importance of metabolic and vascular disease to the burden of CKD in an ageing HIV-infected cohort. In patients who developed CKD, treatment with IDV or TFV was associated with an accelerated decline in renal function.
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Sebastian M, Schad A, Schadmand-Fischer S, Post F, Meier S, Springer E, Makowski J, Taube C, Wiewrodt R, Fischer B, Buhl R. Hämorrhagischer Perikarderguss mit multiplen pulmonalen Rundherden bei einem 37-jährigen „Nie-Raucher“. Internist (Berl) 2008; 50:91-4. [DOI: 10.1007/s00108-008-2239-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yong PFK, Post FA, Gilmour KC, Grosse-Kreul D, King A, Easterbrook P, Ibrahim MAA. Cerebral toxoplasmosis in a middle-aged man as first presentation of primary immunodeficiency due to a hypomorphic mutation in the CD40 ligand gene. J Clin Pathol 2008; 61:1220-2. [DOI: 10.1136/jcp.2008.058362] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Cerebral toxoplasmosis can occur outside the setting of advanced HIV immunodeficiency or drug-induced immunosuppression. A case of cerebral toxoplasmosis is reported in a previously healthy 41-year-old man who was found to have a genetic defect in CD40 ligand, resulting in the X linked hyper-IgM syndrome despite normal surface protein expression on flow cytometry. This highlights the fact that primary immunodeficiencies can first present late in life with a relatively mild phenotype and should be considered in the differential diagnosis of opportunistic infections in non-HIV infected patients; in addition, normal protein expression does not necessarily rule out hypomorphic mutations.
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Bailey AC, Samarawickrama A, Ibrahim F, Barker RD, Post FA. Characteristics distinguishing disseminated Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacterial (NTM) infection in HIV patients. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Münzel TF, Post F. Pathogenese und Therapie des akuten Koronarsyndroms differenzieller Nutzen von GPIIb/IIIa-Rezeptorantagonisten bei Hochrisikopatienten. Dtsch Med Wochenschr 2006; 131:S215-8. [PMID: 17109252 DOI: 10.1055/s-2006-956264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pathogenesis and therapy of the acute coronary syndrome: differentiated advantage of glycoprotein IIb/IIIa receptor antagonists for high-risk patients Activated thrombocytes and their aggregation into a thrombus play a decisive role in the pathogenesis of the acute coronary syndrome. Glycoprotein (GP) IIb/IIIa receptor antagonists block the binding of fibrinogen to GP IIb/IIIa receptors of activated thrombocytes and inhibit their aggregation. Patients with an acute coronary syndrome and raised troponin levels who are to undergo primary coronary revascularization profit particularly from treatment with GPIIb/IIIa receptor antagonists. This is especially so if they also have diabetes.
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Schaars CF, Meintjes GA, Morroni C, Post FA, Maartens G. Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole. BMC Infect Dis 2006; 6:118. [PMID: 16846523 PMCID: PMC1540428 DOI: 10.1186/1471-2334-6-118] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 07/18/2006] [Indexed: 11/17/2022] Open
Abstract
Background AIDS-associated cryptococcal meningitis has a high mortality. Fluconazole was the only systemic antifungal therapy available in our centre. From 1999–2001 we used low-dose fluconazole (200 mg daily initially), and did not offer therapy to patients perceived to have poor prognoses. In 2001 donated fluconazole became available, allowing us to use standard doses (400 mg daily initially). Antiretroviral therapy was not available during the study period. Methods Retrospective chart review of adult patients before and after the fluconazole donation. Results 205 patients fulfilled the inclusion criteria, 77 before and 128 after the donation. Following the donation fewer patients received no antifungal treatment (5% vs 19%, p = 0.002), and more patients received standard-dose fluconazole (90% vs 6%, p < 0.001). In-hospital mortality was 25%. Impaired consciousness, no antifungal treatment received and cerebrospinal fluid antigen titre > 1,000 were independent predictors of in-hospital mortality. Concomitant rifampicin did not affect in-hospital survival. Thirteen patients were referred to the tertiary referral hospital and received initial treatment with amphotericin B for a mean of 6 days – their in-hospital survival was not different from patients who received only fluconazole (p = 0.9). Kaplan-Meier analysis showed no differences in length of survival by initial treatment with standard or low doses of fluconazole (p = 0.27 log rank test); median survival was 76 and 82 days respectively. Conclusion Outcome of AIDS-associated cryptococcal meningitis is similar with low or standard doses of fluconazole. The early mortality is high. Initial therapy with amphotericin B and other measures may be needed to improve outcome.
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Post F, Peetz D, Knoess P, Rupprecht HJ. [Brain-natriuretic-peptide (BNP) for improvement of the diagnostic determination in a conserving emergency room]. ACTA ACUST UNITED AC 2004; 93 Suppl 4:IV31-5. [PMID: 15085364 DOI: 10.1007/s00392-004-1406-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dyspnea is one of the most common symptoms for presentation in an emergency department. Evaluation of this very unspecific symptom can be very time-consuming and costly. Thus, we investigated the value of a rapid bedside-test for BNP in discriminating dyspnea due to "cardiac" reasons from "non-cardiac" dyspnea in the emergency room. METHODS AND RESULTS We studied 100 patients who presented to the emergency department with "severe dyspnoea" as the leading symptom. In all patients BNP was determined from blood samples drawn on admission. All patients had to complete a dyspnea score for severity of dyspnea. The treating physician was blinded to the results of BNP measurements. After discharge patients were divided into "cardiac" and "non-cardiac" dyspnea on the basis of all findings gathered during the hospital stay by a panel of 3 physicians blinded to the results of BNP measurements. The 2 groups were compared for difference in BNP levels and for differences in the dyspnea score. While the dyspnea score showed no significant difference, there was a significant difference in BNP measurements (p < 0.0001). CONCLUSIONS With the TRIAGE BNP test a rapid discrimination between dyspnea due to ventricular failure and "non-cardiac" dyspnea can be obtained within 20 minutes after first presentation. This test can save time and resources in this critical group of patients.
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Rupprecht HJ, Genth-Zotz S, Jungmair W, Espinola-Klein C, Blankenberg S, Post F. [Acute coronary syndrome (without ST-elevation)]. ACTA ACUST UNITED AC 2004; 93 Suppl 4:IV1-8. [PMID: 15085360 DOI: 10.1007/s00392-004-1401-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antithrombotic therapy in acute coronary syndrome without ST-segment elevation should be initiated with aspirin 100 mg/day (loading dose 250-500 mg) and Clopidogrel 75 mg/day (loading dose 300 mg). In addition, anticoagulation with unfractionated heparin or low molecular weight heparin should be started. A GP IIb/IIIa receptor blocker can be given either upfront (Eptifibatide/Tirofiban) or directly in the cathlab preceding PCI (Abciximab). Aspirin should be given in the chronic phase lifelong, Clopidogrel for at least nine months. An invasive strategy is recommended in high-risk patients within 48 hours.
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Thanassi W, Post FA, Shean K, Bekker LG, Maartens G. Impact of HIV on admissions and deaths in a tuberculosis hospital--recommendations for admission and discharge criteria. S Afr Med J 2003; 93:463-4. [PMID: 12916389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Mortality and HIV prevalence rose concordantly at Brooklyn Chest Hospital from 1998 to 2001. Death and unconfirmed tuberculosis (TB) (15% of adult admissions in a sample from 2000) were associated with HIV seropositivity. Excluding unconfirmed TB and shortening length of stay would increase the number of patients able to benefit from hospitalisation.
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Vos F, Serlie I, van Gelder R, Stoker J, Vrooman H, Post F. A review of technical advances in virtual colonoscopy. Stud Health Technol Inform 2002; 84:938-42. [PMID: 11604871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Early detection of polyps has proven to lead to a decrease in incidence of colon cancer. In the past few years, virtual colonoscopy has been developed as a patient-friendly screen-ing technique. The procedure comprises the following steps. First, the patient's colon is cleansed and transanally inflated with air. Subsequently, a 3D image volume is acquired of the abdomen by CT or MRI. Finally, the bowel surface is extracted and visualized, after which the physician virtually navigates through the colon and examines the surface for abnormalities. This paper describes the progress in research for virtual colonoscopy.
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