1
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Chen VH, Patterson KM, Montaner J, Wiseman SM. Improved outcomes following gastrointestinal surgery among people living with HIV in the HAART-era: A scoping review. Am J Surg 2024:S0002-9610(24)00166-1. [PMID: 38599893 DOI: 10.1016/j.amjsurg.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND This study aimed to review the varied 1-4 gastrointestinal (GI) system surgical outcomes among people living with Human Immunodeficiency Virus (PLWH) in the HAART-era. METHODS MEDLINE and EMBASE were searched for primary publications on GI surgery outcomes exclusively in HAART-treated HIV patients. NSQIP-reported complications (NRCs), all-cause complications (ACC) and HIV disease parameters were extracted. RESULTS 12 studies met study inclusion criteria, examining bowel (4), bariatric (5), cholecystectomy (1), appendectomy (1), and other general abdominal operations (1). The NRC rate was 0%, ≥44.4% and 13.3% in bariatric, bowel and appendix surgeries, respectively. Over half of NRCs were infectious. HAART-treated patients had lower ACC, LOS, and sepsis versus untreated-HIV, and higher ACC, LOS and reoperation rates versus HIV-negative patients. CONCLUSION HAART use is associated with markedly improved NRC outcomes post GI surgery among PLWH; however, these remained inferior to those documented among HIV uninfected individuals.
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Affiliation(s)
- Victoria H Chen
- Department of Surgery, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keiko M Patterson
- Department of Surgery, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Julio Montaner
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC-Centre for Excellence in HIV/AIDS, Providence Health Care & Division of AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, University of British Columbia & St. Paul's Hospital, Vancouver, British Columbia, Canada.
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2
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Laäs R, Clarke DL, Dufourq N, Smith MTD, Bruce JL, Naidoo M. The Influence of HIV Status on Acute Appendicitis: A Retrospective Study from South Africa. World J Surg 2023; 47:2608-2616. [PMID: 37580602 PMCID: PMC10545630 DOI: 10.1007/s00268-023-07103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Despite the human immunodeficiency virus (HIV) being the most common comorbidity in South African surgical patients, its impact on appendicitis has not been well-described. We aimed to determine HIV status' influence on patients' presentation, assessment, management and outcomes with acute appendicitis. METHODS The retrospective chart review included all patients aged 12 years and older who were HIV-positive or HIV-negative and presented with acute appendicitis between 1 January 2013 and 31 December 2019. The primary outcome measure was survival to discharge. Secondary outcomes included analysis of the presentation (vital signs), assessment (biochemical, inflammatory markers) and management (intraoperative anatomical severity grading, length of hospital stay). RESULTS Of the 1096 patients with appendicitis, 196 (17.9%) were HIV-positive, and CD4 counts were available for 159. The median age was 23 years, with the HIV-positive patients being older and HIV-negative group having more males (58.7%). While the HIV-positive patients had a longer median length of hospital stay, there was no statistically significant difference in the two groups' incidence of high-grade appendicitis (p = 0.670). The HIV-positive patients had a higher median shock index (OR 7.65; 95% [CI 2.042-28.64]) than their HIV-negative counterparts. HIV-positivity had a significant association with mortality (OR 9.56; 95% CI [1.68-179.39]), and of the seven HIV-positive patients who died, 66.7% (n = 4) had a CD4 < 200 cells/mm3 (OR 8.6; 95% CI [1.6-63.9]). CONCLUSION HIV-positive patients, those with CD4 < 200 cells/mm3 or not on ART, have increased mortality risk and may benefit from increased perioperative surveillance. Patients with an unknown HIV status in a high-prevalence population should be offered HIV testing to risk stratify more accurately.
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Affiliation(s)
- Reza Laäs
- Department of Emergency Medicine, Nelson R Mandela, School of Medicine, University of KwaZulu-Natal, 719 Umbilo Rd, Umbilo, Berea, 4001, South Africa.
| | - Damian L Clarke
- Department of General Surgery and Trauma, Grey's Hospital, 201 Townbush Road, Pietermaritzburg, 3201, South Africa
| | - Nicholas Dufourq
- Department of Emergency Medicine, Nelson R Mandela, School of Medicine, University of KwaZulu-Natal, 719 Umbilo Rd, Umbilo, Berea, 4001, South Africa
- Department of Emergency Medicine, Harry Gwala Regional Hospital, 89 Selby Msimang Road, Pietermaritzburg, 3201, South Africa
| | - Michelle T D Smith
- Department of Anaesthetics and Critical Care, Grey's Hospital, 201 Townbush Road, Pietermaritzburg, 3201, South Africa
| | - John L Bruce
- Department of General Surgery and Trauma, Grey's Hospital, 201 Townbush Road, Pietermaritzburg, 3201, South Africa
| | - Mergan Naidoo
- Discipline of Family Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Room 225F, George Campbell Building, King George V Avenue, Durban, South Africa
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3
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Millar AJW, Cox SG. Surgical implications of HIV infection. Pediatr Surg Int 2022; 39:39. [PMID: 36482099 DOI: 10.1007/s00383-022-05333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
According to the joint United Nations Programme on HIV/AIDS (UNAIDS), 37.7 million adults and children worldwide were estimated to be living with HIV or acquired immune deficiency syndrome (AIDS) at the end of 2020 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. Most reside in low- and middle-income countries, with approximately 67% in sub-Saharan Africa (SSA). At the end of 2020, the total number of children less than 15 years of age living with HIV infection was 2.6 million, of whom 2.3 million (88%) were living in SSA. Aggressive interventions have reduced the annual number of incident (new) HIV infections among children to around 150,000 [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. However, paediatric HIV infection remains a pandemic affecting children predominantly in SSA but is also seen in Asia and sporadically elsewhere particularly in areas of civil strife such as is currently the case in Ukraine [War in Ukraine. (2022). https://www.unaids.org/en/War-Ukraine-special . Accessed Apr 2022]. New HIV infections among children declined by more than half (54%) from 2010 to 2020, due mainly to the increased provision of antiretroviral therapy to pregnant and breastfeeding women living with HIV [UNAIDS. (2022). http://www.unaids.org . Accessed 30 May 2022]. These programmes include early identification of HIV infection in pregnant or breastfeeding women through routine HIV testing, provision of antiretroviral therapy (ART) to all HIV-infected women who are pregnant or breastfeeding, provision of antiretroviral prophylaxis to their newborn infants during the first 6-12 weeks of life, delivery by elective Caesarean section when indicated, promotion of exclusive breastfeeding, early infancy screening for HIV infection, and initiation of ART in infants with HIV infection. HIV-infected children may require surgery either as an emergency to deal with a life-threatening incidental condition unrelated to HIV infection or for a complication of the disease such as tuberculosis or an aggressive soft tissue infection like necrotising fasciitis. Non-emergency surgical procedures may be required to assist in the diagnosis of an HIV-related condition or to correct a routine surgical problem electively. Surgical conditions associated with HIV infection are described under categories of soft tissue or organ-specific infections requiring drainage or debridement; gastrointestinal tract disease and complications; infections in the perineal area; malignancies and HIV-associated vasculitis. Although surgical outcomes are less favourable in HIV-infected children, pre-operative treatment of coinfections, administration of cotrimoxazole prophylaxis, nutritional support and antiretroviral therapy, together with peri-operative antibiotic prophylaxis have resulted in excellent short-term outcomes [World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach, June 201 http://www.apps.who.int/iris/bitstream/10665/85321/1/9789241505727_eng.pdf?ua=1 ; World Health Organization Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV, September 2015. http://www.apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf?ua=1;Eley et al. in BMC Infect Dis 2:3, 2002;Karpelowsky et al. in Pediatr Surg Int 28:1007-1014, 2012;].
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Affiliation(s)
- Alastair J W Millar
- Health Sciences Faculty, University of Cape Town and Red Cross War Memorial Children's Hospital, Rondebosch, 7700, Cape Town, South Africa.
| | - Sharon G Cox
- University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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4
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Coccolini F, Improta M, Sartelli M, Rasa K, Sawyer R, Coimbra R, Chiarugi M, Litvin A, Hardcastle T, Forfori F, Vincent JL, Hecker A, Ten Broek R, Bonavina L, Chirica M, Boggi U, Pikoulis E, Di Saverio S, Montravers P, Augustin G, Tartaglia D, Cicuttin E, Cremonini C, Viaggi B, De Simone B, Malbrain M, Shelat VG, Fugazzola P, Ansaloni L, Isik A, Rubio I, Kamal I, Corradi F, Tarasconi A, Gitto S, Podda M, Pikoulis A, Leppaniemi A, Ceresoli M, Romeo O, Moore EE, Demetrashvili Z, Biffl WL, Wani I, Tolonen M, Duane T, Dhingra S, DeAngelis N, Tan E, Abu-Zidan F, Ordonez C, Cui Y, Labricciosa F, Perrone G, Di Marzo F, Peitzman A, Sakakushev B, Sugrue M, Boermeester M, Nunez RM, Gomes CA, Bala M, Kluger Y, Catena F. Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines. World J Emerg Surg 2021; 16:40. [PMID: 34372902 PMCID: PMC8352154 DOI: 10.1186/s13017-021-00380-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/18/2021] [Indexed: 02/08/2023] Open
Abstract
Immunocompromised patients are a heterogeneous and diffuse category frequently presenting to the emergency department with acute surgical diseases. Diagnosis and treatment in immunocompromised patients are often complex and must be multidisciplinary. Misdiagnosis of an acute surgical disease may be followed by increased morbidity and mortality. Delayed diagnosis and treatment of surgical disease occur; these patients may seek medical assistance late because their symptoms are often ambiguous. Also, they develop unique surgical problems that do not affect the general population. Management of this population must be multidisciplinary.This paper presents the World Society of Emergency Surgery (WSES), Surgical Infection Society Europe (SIS-E), World Surgical Infection Society (WSIS), American Association for the Surgery of Trauma (AAST), and Global Alliance for Infection in Surgery (GAIS) joined guidelines about the management of acute abdomen in immunocompromised patients.
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Affiliation(s)
- Federico Coccolini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Mario Improta
- grid.8982.b0000 0004 1762 5736Emergency Department, Pavia University Hospital, Pavia, Italy
| | | | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Robert Sawyer
- grid.268187.20000 0001 0672 1122General Surgery Department, Western Michigan University, Kalamazoo, MI USA
| | - Raul Coimbra
- grid.488519.90000 0004 5946 0028Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
| | - Massimo Chiarugi
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Andrey Litvin
- grid.410686.d0000 0001 1018 9204Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Timothy Hardcastle
- Emergency and Trauma Surgery, Inkosi Albert Luthuli Central Hospital, Mayville, South Africa
| | - Francesco Forfori
- grid.144189.10000 0004 1756 8209Intensive Care Unit, Pisa University Hospital, Pisa, Italy
| | - Jean-Louis Vincent
- grid.4989.c0000 0001 2348 0746Departement of Intensive Care, Erasme Univ Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Andreas Hecker
- grid.411067.50000 0000 8584 9230Departementof General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Richard Ten Broek
- grid.10417.330000 0004 0444 9382General Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luigi Bonavina
- grid.416351.40000 0004 1789 6237General Surgery, San Donato Hospital, Milano, Italy
| | - Mircea Chirica
- grid.450307.5General Surgery, CHUGA-CHU Grenoble Alpes UGA-Université Grenoble Alpes, Grenoble, France
| | - Ugo Boggi
- grid.144189.10000 0004 1756 8209General Surgery, Pisa University Hospital, Pisa, Italy
| | - Emmanuil Pikoulis
- grid.5216.00000 0001 2155 08003rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Salomone Di Saverio
- grid.18887.3e0000000417581884General Surgery, Varese University Hospital, Varese, Italy
| | - Philippe Montravers
- grid.411119.d0000 0000 8588 831XDépartement d’Anesthésie-Réanimation, CHU Bichat Claude Bernard, Paris, France
| | - Goran Augustin
- grid.4808.40000 0001 0657 4636Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Dario Tartaglia
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Enrico Cicuttin
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Camilla Cremonini
- grid.144189.10000 0004 1756 8209General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Bruno Viaggi
- grid.24704.350000 0004 1759 9494ICU Department, Careggi University Hospital, Firenze, Italy
| | - Belinda De Simone
- grid.418056.e0000 0004 1765 2558Department of Digestive, Metabolic and Emergency Minimally Invasive Surgery, Centre Hospitalier Intercommunal de Poissy/Saint Germain en Laye, Saint Germain en Laye, France
| | - Manu Malbrain
- grid.8767.e0000 0001 2290 8069Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vishal G. Shelat
- General and Emergency Surgery, Tan Tock Seng Hospital, Kuala Lumpur, Malaysia
| | - Paola Fugazzola
- grid.8982.b0000 0004 1762 5736General and Emergency Surgery, Pavia University Hospital, Pavia, Italy
| | - Luca Ansaloni
- grid.8982.b0000 0004 1762 5736General and Emergency Surgery, Pavia University Hospital, Pavia, Italy
| | - Arda Isik
- grid.411776.20000 0004 0454 921XGeneral Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ines Rubio
- grid.81821.320000 0000 8970 9163Department of General Surgery, La Paz University Hospital, Madrid, Spain
| | - Itani Kamal
- grid.38142.3c000000041936754XGeneral Surgery, VA Boston Health Care System, Boston University, Harvard Medical School, Boston, MA USA
| | - Francesco Corradi
- grid.144189.10000 0004 1756 8209Intensive Care Unit, Pisa University Hospital, Pisa, Italy
| | - Antonio Tarasconi
- grid.411482.aGeneral Surgery, Parma University Hospital, Parma, Italy
| | - Stefano Gitto
- grid.8404.80000 0004 1757 2304Gastroenterology and Transplant Unit, Firenze University Hospital, Firenze, Italy
| | - Mauro Podda
- grid.7763.50000 0004 1755 3242General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Anastasia Pikoulis
- grid.5216.00000 0001 2155 0800Medical Department, National & Kapodistrian University of Athens, Athens, Greece
| | - Ari Leppaniemi
- grid.15485.3d0000 0000 9950 5666Abdominal Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marco Ceresoli
- grid.18887.3e0000000417581884General Surgery, Monza University Hospital, Monza, Italy
| | - Oreste Romeo
- grid.268187.20000 0001 0672 1122Department of Surgery, Western Michigan University School of Medicine, Kalamazoo, MI USA
| | - Ernest E. Moore
- grid.239638.50000 0001 0369 638XTrauma Surgery, Denver Health, Denver, CL USA
| | - Zaza Demetrashvili
- grid.412274.60000 0004 0428 8304General Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | - Walter L. Biffl
- grid.415402.60000 0004 0449 3295Emergency and Trauma Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Imitiaz Wani
- General Surgery, Government Gousia Hospital, Srinagar, Kashmir India
| | - Matti Tolonen
- grid.15485.3d0000 0000 9950 5666Abdominal Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | | | - Sameer Dhingra
- National Institute of Pharmaceutical Education and Research, Hajipur (NIPER-H), Vaishali, Bihar India
| | - Nicola DeAngelis
- grid.50550.350000 0001 2175 4109General Surgery Department, Henry Mondor University Hospital, Paris, France
| | - Edward Tan
- grid.10417.330000 0004 0444 9382Emergency Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Fikri Abu-Zidan
- General Surgery, UAE University Hospital, Sharjah, United Arab Emirates
| | - Carlos Ordonez
- grid.8271.c0000 0001 2295 7397Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Universidad del Valle, Cali, Colombia
| | - Yunfeng Cui
- grid.265021.20000 0000 9792 1228Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | - Gennaro Perrone
- grid.411482.aGeneral Surgery, Parma University Hospital, Parma, Italy
| | | | - Andrew Peitzman
- grid.21925.3d0000 0004 1936 9000General Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital St George Plovdiv, Plovdiv, Bulgaria
| | - Michael Sugrue
- General Surgery, Letterkenny Hospital, Letterkenny, Ireland
| | - Marja Boermeester
- grid.5650.60000000404654431Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | | | - Carlos Augusto Gomes
- Department of Surgery, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Hospital Universitário Terezinha de Jesus, Juiz de Fora, Brazil
| | - Miklosh Bala
- grid.17788.310000 0001 2221 2926General Surgery, Hadassah Hospital, Jerusalem, Israel
| | - Yoram Kluger
- General Sugery, Ramabam Medical Centre, Tel Aviv, Israel
| | - Fausto Catena
- grid.411482.aGeneral Surgery, Parma University Hospital, Parma, Italy
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5
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Zhao R, Ding R, Zhang Q. What Are the Risk Factors for Surgical Site Infection in HIV-Positive Patients Receiving Open Reduction and Internal Fixation of Traumatic Limb Fractures? A Retrospective Cohort Study. AIDS Res Hum Retroviruses 2021; 37:551-556. [PMID: 33386058 DOI: 10.1089/aid.2020.0184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A lack of studies analyze risk factors associated with surgical site infection (SSI) in human immunodeficiency virus (HIV)-positive patients with trauma undergoing orthopedic surgery. We questioned, (1) "What is the proportion of SSI in HIV-positive patients receiving open reduction and internal fixation (ORIF) of traumatic limb fractures?" and (2) "What are the independent risk factors for SSI of HIV-positive patients with traumatic limb fractures who received ORIF?" A retrospective study was performed in our institution from May 2011 to December 2019. A total of 246 patients were enrolled. Data of HIV-positive adult patients with traumatic limb fractures treated by ORIF were extracted from the electronic medical records, including the demographic information, characteristics of fractures, treatment-related variables, and indexes of laboratory examination. Multivariable logistic regression was used to identify independent predictors of SSI. A total of 26 patients developed SSI in this study, the overall proportion was 10.6% [95% confidence interval (CI) = 7.2%-15.3%]. Among them, 18 cases (7.3%) suffered from superficial SSI and 8 cases (3.3%) had the deep SSI. Independent predictors of SSI identified by multivariable logistic regression analysis were CD4+ T-lymphocyte count (adjusted odds ratio per 100/μL increase = 0.55; 95% CI = 0.37-0.81; p = .002) and albumin (adjusted odds ratio per 5 g/liter increase = 0.50; 95% CI = 0.30-0.81; p = .003). We recommend that orthopedic surgeons assess immunosuppression and nutritional status of HIV-positive patients rigorously and optimize the perioperative strategy of supplementary to reduce the risk of SSI.
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Affiliation(s)
- Rugang Zhao
- Department of Orthopedic, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Emerging Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Rui Ding
- Center of Liver Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qiang Zhang
- Department of Orthopedic, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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6
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Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Diverticulitis: An Update From the Age Old Paradigm. Curr Probl Surg 2020; 57:100862. [PMID: 33077029 DOI: 10.1016/j.cpsurg.2020.100862] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Alexander T Hawkins
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Tiffany Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet T Lee
- Department of Surgery, University of Minnesota, Saint Paul, MN
| | - Tamara Glyn
- University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Verity Wood
- Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Timothy Eglinton
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Frank Frizelle
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Adil Khan
- Raleigh General Hospital, Beckley, WV
| | - Jason Hall
- Dempsey Center for Digestive Disorders, Department of Surgery, Boston Medical Center, Boston, MA
| | | | | | | | | | | | - Scott R Steele
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Oh
| | - Karim Alavi
- Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - C Tyler Ellis
- Department of Surgery, University of Louisville, Louisville, KY
| | | | - Des C Winter
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Michele Carvello
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center IRCCS, Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Antonino Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center IRCCS, Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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7
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Bierle DM, Raslau D, Regan DW, Sundsted KK, Mauck KF. Preoperative Evaluation Before Noncardiac Surgery. Mayo Clin Proc 2020; 95:807-822. [PMID: 31753535 DOI: 10.1016/j.mayocp.2019.04.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/23/2019] [Accepted: 04/30/2019] [Indexed: 01/19/2023]
Abstract
The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with the perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.
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Affiliation(s)
- Dennis M Bierle
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN.
| | - David Raslau
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Dennis W Regan
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karna K Sundsted
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
| | - Karen F Mauck
- Mayo Clinic Rochester, Division of General Internal Medicine, Rochester, MN
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8
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Tsirouki T, Steffen J, Dastiridou A, Praidou A, Androudi S. Endophthalmitis in HIV Infection. Ocul Immunol Inflamm 2020; 28:1060-1065. [PMID: 31944150 DOI: 10.1080/09273948.2019.1699580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: The role of HIV infection in exogenous and endogenous endophthalmitis has not been clarified. We aim to assess the potential role of HIV as a risk factor or a poor prognostic feature in this sight-threatening condition. Methods: Literature review. Review of evidence: Evidence for endophthalmitis in HIV patients is based on scarce retrospective case series and case reports. Infrequency of literature on this topic is owed to the diversity of the different types of endophthalmitis as well as the rarity of the coexistence of the two conditions. Conclusions: Endophthalmitis in HIV patients are a rare but potentially devastating condition. Many forms of endophthalmitis tend to occur in severely immunosuppressed HIV patients with low CD4 counts. Therefore, the early introduction of cART with full immune reconstitution is an essential part of the prevention of endophthalmitis in the HIV population.
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Affiliation(s)
- Theodora Tsirouki
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Jonel Steffen
- Division of Ophthalmology, University of Cape Town , Cape Town, South Africa
| | - Anna Dastiridou
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
| | - Anna Praidou
- Department of Ophthalmology, Agios Dimitrios Hospital , Thessaloniki, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly , Larissa, Greece
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9
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Tisdale CS, Justin GA, Wang X, Chu X, Carlton DK, Okulicz JF, Schofield C, Maves RC, Agan BK, Legault GL. Refractive surgery in the HIV-positive U.S. Military Natural History Study Cohort: complications and risk factors. J Cataract Refract Surg 2019; 45:1612-1618. [PMID: 31585850 PMCID: PMC6842682 DOI: 10.1016/j.jcrs.2019.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE This study sought to assess the frequency of refractive surgery complications in HIV+ individuals and related risk factors. SETTINGS Multiple centers in the United States. DESIGN Prospective observational cohort study. METHODS The U.S. Military HIV Natural History Study is a prospective observational cohort study of HIV+ service members and beneficiaries. Participants were selected who had Current Procedural Terminology codes for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and other refractive surgeries. The frequency of complications was determined using International Classification of Diseases-9 codes. Covariates included age, sex, antiretroviral therapy, time since HIV diagnosis, history of AIDS, and CD4 (T lymphocytes) count and viral load. Statistical analysis was completed using univariate (χ2 and Wilcoxon-Mann-Whitney tests) and multivariate analyses. RESULTS Seventy-nine of 2073 participants had refractive surgery. Fifty-three patients underwent PRK, 23 LASIK, 2 radial keratotomy (RK), and 1 astigmatic correction. Complications occurred in 6 (7.6%) of 79 participants, including 5 patients who underwent PRK and 1 after RK, occurring between 8 and 217 days after surgery. Five ulcers and 1 unspecified keratitis were noted. In the univariate analysis, type of surgery (P = .02) and history of AIDS (P = .02) were risk factors for complications. In logistic regression analysis, no variables were found to be risk factors for complications. CONCLUSION Complications were infrequent among HIV+ participants after refractive surgery. Point estimates suggest that PRK might have more complications than LASIK and that advanced HIV, reflected by previous AIDS, might be associated with an increased risk for complications. Further study will be required to confirm these findings.
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Affiliation(s)
- Carter S Tisdale
- 563rd Operations Support Squadron, Nellis Air Force Base, Las Vegas, Nevada, USA
| | - Grant A Justin
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas, USA; Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, USA.
| | - Xun Wang
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Xiuping Chu
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Darrel K Carlton
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas, USA; Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, USA
| | - Jason F Okulicz
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Christina Schofield
- Division of Infectious Diseases, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, USA
| | - Ryan C Maves
- Division of Infectious Diseases (Maves), Naval Medical Center San Diego, California, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Gary L Legault
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas, USA; Department of Surgery, Uniformed Services University of the Health Science, Bethesda, Maryland, USA
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The Effect of Human-Immunodeficiency Virus Status on Outcomes in Penetrating Abdominal Trauma: An Interim Analysis. World J Surg 2018; 42:2412-2420. [PMID: 29387958 DOI: 10.1007/s00268-018-4502-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether the outcomes of hemodynamically stable patients undergoing exploratory laparotomy for penetrating abdominal trauma differed as a result of their HIV status. METHODS This was an observational, prospective study from February 2016 to May 2017. All hemodynamically stable patients with penetrating abdominal trauma requiring a laparotomy were included. The mechanism of injury, the HIV status, age, the penetrating abdominal trauma index (PATI), and the revised trauma score (RTS) were entered into a binary logistic regression model. Outcome parameters were in-hospital death, morbidity, admission to intensive care unit (ICU), relaparotomy within 30 days, and length of stay longer than 30 days. RESULTS A total of 209 patients, 94% male, with a mean age of 29 ± 10 years were analysed. Twenty-eight patients (13%) were HIV positive. The two groups were comparable. Ten (4.8%) laparotomies were negative. There were two (0.96%) deaths, both in the HIV negative group. The complication rate was 34% (n = 72). Twenty-nine patients (14%) were admitted to the ICU. A higher PATI, older age, and a lower RTS were significant risk factors for ICU admission. After 30 days, 12 patients (5.7%) were still in hospital. Twenty-four patients (11%) underwent a second laparotomy. The PATI score was the single independent predictor for complications, relaparotomy, and hospital stay longer than 30 days. CONCLUSIONS Preliminary results reveal that HIV status does not influence outcomes in patients with penetrating abdominal trauma.
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Abstract
The emergence of HIV in the United States has had important implications in the surgical setting. This blood-borne pathogen poses risks to both the surgeon and the patient undergoing an orthopaedic procedure. Although there has been research regarding the likelihood of orthopaedic surgeons contracting HIV during a surgical procedure, the correlation of HIV with postoperative prognosis has not been extensively examined. Because HIV-positive patients may be immunodeficient, they are at increased risk for certain postoperative complications, especially infection. Orthopaedic surgeons should have a thorough understanding of the effects of this disease on patients to optimize preoperative decision making, intraoperative care, and postoperative recovery.
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12
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Shephard SN, Lengmang SJ, Anzaku SA, Mamven OV, Kirschner CV. Effect of HIV infection on outcomes after surgical repair of genital fistula. Int J Gynaecol Obstet 2017; 138:293-298. [PMID: 28602050 DOI: 10.1002/ijgo.12233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/11/2017] [Accepted: 06/07/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare outcomes following surgical repair of genital fistula among Nigerian women with or without HIV. METHODS A retrospective review was conducted of all genital fistula repair surgeries performed at Evangel Vesicovaginal Fistula Center in Jos, Nigeria, between January 1, 2004, and April 30, 2014. Patient characteristics, HIV status, genital fistula characteristics, and postoperative outcomes were assessed for between-group variance. The odds ratio (OR) and 95% confidence intervals (CIs) were the primary measures used for determining the association between HIV status and surgical outcomes. RESULTS Of the 3313 surgeries recorded, 201 (6.1%) were performed among patients with HIV infection. No statistically significant between-group differences were found for patient or fistula characteristics. By contrast, failed vesicovaginal failure (VVF) closure was significantly more common among women infected with HIV than among their HIV-negative counterparts (OR 0.629, 95% CI 0.443-0.894). No between-group differences in failure rates were found for ureterovaginal or rectovaginal fistulas. CONCLUSION Determining HIV status before surgery could aid prediction of outcomes among Nigerian women undergoing repair of VVF. Further studies are required to examine factors that might improve outcomes for women with HIV infection.
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Affiliation(s)
- Steven N Shephard
- Evangel Vesicovaginal Fistula Center, Bingham University Teaching Hospital, Jos, Nigeria.,Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Bingham University, Jos Campus, Nigeria
| | - Sunday J Lengmang
- Evangel Vesicovaginal Fistula Center, Bingham University Teaching Hospital, Jos, Nigeria.,Department of Family Medicine, College of Medicine and Health Sciences, Bingham University, Jos Campus, Nigeria
| | - Stephen A Anzaku
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Bingham University, Jos Campus, Nigeria
| | - Oluwatobi V Mamven
- Evangel Vesicovaginal Fistula Center, Bingham University Teaching Hospital, Jos, Nigeria.,Department of Family Medicine, College of Medicine and Health Sciences, Bingham University, Jos Campus, Nigeria
| | - Carolyn V Kirschner
- Evangel Vesicovaginal Fistula Center, Bingham University Teaching Hospital, Jos, Nigeria.,NorthShore University HealthSystem, Evanston, IL, USA
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13
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Moodley Y, Govender K. An HIV-positive status and short term perioperative mortality – a systematic review. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2016.1192822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Nyale GM, Anderson R, Patel AR, Feldman C. A 10 years audit of cardiothoracic referrals from a pulmonology service in a developing country: impact of patient human immunodeficiency virus status. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:132. [PMID: 27162782 DOI: 10.21037/atm.2016.03.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few studies that have documented the clinical presentation, complication rate and outcome of cardiothoracic referrals from a Pulmonology Service, particularly in developing countries. Furthermore, the impact of human immunodeficiency virus (HIV) status on such referrals and their outcomes is not well documented. METHODS This was a retrospective audit of combined pulmonologist/cardiothoracic consultations, undertaken among the tertiary academic hospitals attached to the University of the Witwatersrand, Johannesburg, South Africa, over a 10 years period (2001-2010) in order to document the clinical features of these referrals and to determine any impact of HIV status on trends in disease presentations, complications and outcome. RESULTS A total of 847 patients were evaluated on whom a variety of surgical procedures was performed, 50.4% being therapeutic, 32.8% diagnostic and 16.9% both therapeutic and diagnostic. HIV status was known in 488 cases. Of these 229 (46.9%) were HIV-seropositive and 259 (53.1%) -seronegative. The main reasons for referral were for infective conditions, including tuberculosis (TB), pleural disease/effusion/empyema, and other bacterial infections, with significantly more of the TB patients being HIV-seropositive (P<0.0001).There was a trend for increasing presentations for TB and pleural conditions, particularly during the last 4-5 years of the audit, coinciding with an increase in the numbers of HIV-positive referrals. HIV status had no impact on the frequency of surgical complications or mortality. CONCLUSIONS The audit indicates an increasing referral rate of HIV-seropositive patients to cardiothoracic services in Johannesburg, particularly in association with TB and pleural diseases. However with careful cardiothoracic/pulmonologist evaluation of the cases the frequency of complications and mortality appear to be no different from that of HIV-seronegative cases.
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Affiliation(s)
- George Mwamnemo Nyale
- 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ronald Anderson
- 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Atulkumar Ramanlal Patel
- 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- 1 Respiratory and Infectious Disease Unit, Kenyatta National Referral and Academic Hospital, Nairobi, Kenya ; 2 Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa ; 3 Department of Cardiothoracic Surgery, 4 Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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15
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Chew GWM, Teoh SCB, Agrawal R. Analysis and Outcomes of Cataract Surgery in Patients with Acquired Immunodeficiency Syndrome. Ocul Immunol Inflamm 2016; 25:535-539. [PMID: 27082491 DOI: 10.3109/09273948.2016.1158281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the surgical outcomes, complications and postoperative progression in HIV patients undergoing cataract surgery in a teaching hospital. METHODS A retrospective cohort study of patients with HIV/AIDS who had cataract surgery from January 2000 until December 2011 at a tertiary referral multidisciplinary hospital in Singapore. RESULTS We identified 44 eyes from 29 patients. Preoperatively, 41.3% had no ophthalmic manifestations of HIV/AIDS, while 16 eyes had quiescent cytomegalovirus retinitis (CMVR). Postoperatively, 1 eye developed new CMVR, while 1 eye had reactivation of previous CMVR. Of eyes with new or previous CMVR, 1 eye developed rhegmatogenous retinal detachment (RD) postoperatively. Only 3 eyes had prolonged postoperative inflammation. There were no cases of endophthalmitis or cystoid macular edema. Postoperative improvement of at least two Snellen lines was achieved in 86.6% of eyes. CONCLUSIONS Cataract surgery in HIV patients is generally safe, regardless of CD4 count, but their general and ocular health should be optimized preoperatively.
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Affiliation(s)
- Grace W M Chew
- a National Healthcare Group Eye Institute Tan Tock Seng Hospital , Singapore
| | - Stephen C B Teoh
- a National Healthcare Group Eye Institute Tan Tock Seng Hospital , Singapore.,b Eagle Eye Centre , Mt Alvernia Hospital , Singapore
| | - Rupesh Agrawal
- a National Healthcare Group Eye Institute Tan Tock Seng Hospital , Singapore
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16
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Agarwal J, Ganjoo P, Hansda U, Sharma MU, Tandon MS, Singh D. Perioperative concerns in neurosurgical patients with human immunodeficiency virus infection. Asian J Neurosurg 2016; 11:103-8. [PMID: 27057214 PMCID: PMC4802929 DOI: 10.4103/1793-5482.145050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: The perioperative management of human immunodeficiency virus (HIV) infected patients undergoing neurosurgery is challenging due to the presence of HIV-related multi-system derangements, opportunistic infections and malignancies, history of substance abuse, and adverse effects of anti-retroviral therapy (ART), together with the inherent risks of neurosurgery. The possible adverse impact of HIV disease on the anesthetic outcome due to the associated co-morbidities, and conversely, the role of surgery and anesthesia in HIV disease progression due to their immunosuppressive effects, and also, the fear of HIV transmission among the attending medical personnel are the important perioperative concerns in such surgeries. Aim: To present our experience in the perioperative management of HIV-infected patients who underwent neurosurgery at our institute in the past 5 years and highlight the relevant perioperative issues. Materials and Methods: A retrospective analysis of the records of HIV-infected neurosurgical patients was undertaken to determine their HIV status and ART, anesthesia and surgery details, perioperative complications, and instances of postoperative worsening of HIV disease or its transmission, if any. Results: Seven HIV infected patients with variable severity of HIV infection and systemic disease underwent neurosurgery for different indications. Their perioperative management was modified in accordance with the co-morbidities and the type of neurosurgery. There was no obvious adverse impact of the HIV disease on the anesthetic outcome, no obvious clinical evidence of post-surgery worsening of the HIV disease, and no instance of HIV transmission in our patients. Conclusion: A goodunderstanding of the HIV disease and its perioperative implications during neurosurgery helps in better patient management and enables a safe outcome.
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Affiliation(s)
- Jyotsna Agarwal
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Pragati Ganjoo
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Upendra Hansda
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Megha U Sharma
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Monica S Tandon
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
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17
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Haser GC, Sumpio B. Systemic and cell-specific mechanisms of vasculopathy induced by human immunodeficiency virus and highly active antiretroviral therapy. J Vasc Surg 2016; 65:849-859. [PMID: 26994951 DOI: 10.1016/j.jvs.2016.01.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Patients infected with human immunodeficiency virus (HIV) have higher rates of dyslipidemia, atherosclerosis, and chronic inflammation that can damage the vascular system compared with the general population. This can be attributed both to HIV itself and to highly active antiretroviral therapy (HAART) they receive. This review outlines the mechanisms by which HIV and HIV medications can cause vascular complications and identifies strategic areas of research to treat these dysfunctions. REVIEW HIV and HAART affect the vascular system through several mechanisms that target systemic or metabolic systems and specific cells. HIV causes dyslipidemia and chronic immune activation, which can contribute to atherosclerosis. In addition, HIV damages macrophages, endothelial cells, smooth muscle cells, and platelets, and this damage also plays a role in the development of atherosclerosis. HAART, particularly protease inhibitors, interferes with cholesterol metabolism and can affect macrophages, endothelial cells, and smooth muscle cells. The metabolic changes and cell damage induced by HIV and HAART put HIV patients at increased risk for atherosclerosis, dyslipidemia, and serious cardiovascular events such as myocardial infarction and stroke. CONCLUSIONS HIV patients have increased risk of developing potentially life-threatening cardiovascular pathology, which cannot be explained by traditional cardiovascular risk factors alone. More research is needed into therapies to target this HIV-specific vasculopathy.
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Affiliation(s)
- Grace C Haser
- Department of Vascular Surgery, Yale School of Medicine, New Haven, Conn
| | - Bauer Sumpio
- Department of Vascular Surgery, Yale School of Medicine, New Haven, Conn.
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18
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CD4 Count is Still a Valid Indicator of Outcome in HIV-Infected Patients Undergoing Major Abdominal Surgery in the Era of Highly Active Antiretroviral Therapy. World J Surg 2016; 39:1692-9. [PMID: 25663010 DOI: 10.1007/s00268-015-2994-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients with HIV/AIDS on antiretroviral therapy (ART) live longer and now require surgery for indications similar to those described for the general population. They have been previously reported to carry higher mortality and complication rates, especially septic complications. The aim of this study was to compare the outcome of major abdominal surgery in three groups of patients with different CD4 counts. METHODS This is a prospective study comparing HIV-negative patients and two groups of HIV-infected patients on ART with different CD4 counts. The primary outcomes considered were mortality and complication rates after abdominal surgery. We emphasised on the value of CD4 as a predictor of outcome and the impact of the indication for surgery (septic versus non-septic). RESULTS We included 63 patients (21 per group). The majority of patients (71 %) were operated on as an emergency and the indications were similar in all groups. The overall and the septic complication rates were both higher in the group with a low CD4 count. This resulted in a significantly longer admission period but did not result in a higher mortality rate. The duration of ART and the World Health Organisation stage of the disease did not significantly influence surgical outcomes. CONCLUSIONS HIV-infected patients on ART can now safely undergo major abdominal surgery with encouraging results though still relatively poorer than those of HIV-negative subjects. CD4 count remains a significant predictor of outcome and patients with a low CD4 count, however, still require closer pre- and post-operative monitoring.
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19
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Cronley K, Wenzke J, Hussan H, Vasquez AM, Hinton A, El-Dika S, Conwell DL, Krishna SG, Stanich PP. Diverticulitis in HIV-infected patients within the United States. HIV Med 2015; 17:216-21. [PMID: 26283564 DOI: 10.1111/hiv.12304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Diverticulitis in patients on immunosuppressant therapy has been associated with increased mortality, but there are no data for HIV-infected patients. Our aim was to compare the outcomes of hospitalizations for diverticulitis in patients with and without HIV infection. METHODS Cross-sectional study of hospitalizations in the United States accessed through the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project. Patients hospitalized for diverticulitis in 2007-2011 were included in the analysis. The primary outcomes of interest were mortality and surgical therapy rates. Patients from 2003 to 2011 were utilized to analyse trends in prevalence. RESULTS There were 2375 patients with HIV infection hospitalized for diverticulitis and 1 160 391 patients without HIV infection hospitalized for diverticulitis from 2007 to 2011. The patients with HIV infection were younger and more likely to be male and nonwhite (P < 0.001 for all). There were also differences in insurance types (P < 0.001) and hospitals [size (P = 0.008), type (P < 0.001) and location (P < 0.001)]. After multivariate analysis, patients with diverticulitis and HIV infection had a significantly increased in-hospital mortality rate [odds ratio (OR) 3.94 (95% confidence interval, CI, 1.52-10.20)] and a lower rate of surgical intervention [OR 0.74 (95% CI 0.57-0.95)]. From 2003 to 2011, there was a linear increasing trend in the prevalence of HIV infection among patients hospitalized for diverticulitis (P < 0.001). CONCLUSIONS HIV-infected patients with diverticulitis had increased mortality and received less surgical treatment in comparison to the general population. Diverticulitis in HIV-infected patients increased in prevalence over the study period.
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Affiliation(s)
- K Cronley
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - J Wenzke
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - H Hussan
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - A M Vasquez
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - A Hinton
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA.,Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - S El-Dika
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - D L Conwell
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - S G Krishna
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
| | - P P Stanich
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Columbus, OH, USA
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20
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Abstract
The Revised Cardiac Risk Index (RCRI) was incorporated into the American College of Cardiology/American Heart Association (ACC/AHA) recommendations for the preoperative evaluation of the cardiac patient for noncardiac surgery. The purpose of this review was to analyze studies on cardiovascular clinical risk prediction that had used the previous "standard best" model, the RCRI, as a comparator. This review aims to determine whether modification of the current risk factors or adoption of other risk factors or other risk indices would improve upon the discrimination of cardiac risk prediction when compared with the RCRI. This is necessary because recent risk prediction models have shown better discrimination for major adverse cardiac events, and the pre-eminence of the RCRI is now in question. There is now a need for a new "best standard" cardiovascular risk prediction model to supersede the RCRI. This is desirable because it would: (1) allow for a global standard of cardiovascular risk assessment; (2) provide a standard comparator in all risk prediction research; (3) result in comparable data collection; and (4) allow for individual patient data meta-analyses. This should lead to continued progress in cardiovascular clinical risk prediction. A review of the current evidence suggests that to improve the preoperative clinical risk stratification for adverse cardiac events, a new risk stratification model be built that maintains the clinical risk factors identified in the RCRI, with the following modifications: (1) additional glomerular filtration rate cut points (as opposed to a single creatinine cut point); (2) age; (3) a history of peripheral vascular disease; (4) functional capacity; and (5) a specific surgical procedural category. One would expect a substantial improvement in the discrimination of the RCRI with this approach. Although most noncardiac surgeries will benefit from a standard "generic" cardiovascular risk prediction model, there are data to suggest that patients with human immunodeficiency virus disease who are undergoing vascular surgery may benefit from specific cardiovascular risk prediction models.
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Affiliation(s)
- Bruce Biccard
- From the Department of Anaesthesiology and Critical Care, University of Kwazulu-Natal, Congella, Kwazulu-Natal, South Africa
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21
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Pillay B. HIV-associated large-vessel vasculopathy: a review of the current and emerging clinicopathological spectrum in vascular surgical practice. Cardiovasc J Afr 2015; 26:70-81. [PMID: 25940120 PMCID: PMC4832607 DOI: 10.5830/cvja-2015-017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
An established relationship exists between human immunodeficiency virus (HIV) and the vascular system, which is characterised by clinical expressions of aneurysmal and occlusive disease that emanate from a common pathological process. The exact pathogenesis is currently unknown; attempts to implicate opportunistic pathogens have been futile. Theories converge on leucocytoclastic vasculitis with the vaso vasora as the vasculopathic epicentre. It is thought that the virus itself or viral proteins trigger the release of inflammatory mediators that cause endothelial dysfunction and smooth muscle proliferation leading to vascular injury and thrombosis. The beneficial effects of highly active anti-retroviral therapy alter the natural history of the disease profile and promote longevity but are negated by cardiovascular complications. Atherosclerosis is an emerging challenge. Presently patients are managed by standard surgical protocols because of non-existent universal surgical interventional guidelines. Clinical response to treatment is variable and often compounded by complications of graft occlusion, sepsis and poor wound healing. The clinical, imaging and pathological observations position HIV-associated large-vessel vasculopathy as a unique entity. This review highlights the spectrum of HIV-associated large-vessel aneurysmal, occlusive and atherosclerotic disease in vascular surgical practice.
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MESH Headings
- Aneurysm/etiology
- Aneurysm/therapy
- Animals
- Atherosclerosis/etiology
- Atherosclerosis/therapy
- Blood Vessels/immunology
- Blood Vessels/virology
- Endothelium, Vascular/immunology
- Endothelium, Vascular/surgery
- Endothelium, Vascular/virology
- HIV Infections/complications
- HIV Infections/therapy
- Humans
- Myocytes, Smooth Muscle/immunology
- Myocytes, Smooth Muscle/pathology
- Myocytes, Smooth Muscle/virology
- Practice Guidelines as Topic
- Thrombosis/etiology
- Thrombosis/therapy
- Vascular Surgical Procedures
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
- Vasculitis, Leukocytoclastic, Cutaneous/therapy
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Affiliation(s)
- Balasoobramanien Pillay
- Department of Vascular/Endovascular Surgery, Nelson R Mandela School of
Medicine, Durban, South Africa
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22
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Haac BE, Charles AG, Matoga M, LaCourse SM, Nonsa D, Hosseinipour M. HIV testing and epidemiology in a hospital-based surgical cohort in Malawi. World J Surg 2014; 37:2122-8. [PMID: 23652356 DOI: 10.1007/s00268-013-2096-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the high prevalence of HIV in adults (11 %) in Malawi, testing among surgical patients is not routine. We examined the feasibility of universal opt-out HIV testing and counseling (HTC) on the surgical wards of Kamuzu Central Hospital in Lilongwe, Malawi, and sought to further delineate the role of HIV in surgical presentation and outcome. METHODS We reviewed HTC and surgical admission records from May to October 2011 and compared these data to data collected prospectively on patients admitted from November 2011 through April 2012, after universal HTC implementation. RESULTS Prior to universal HTC, 270 of the 2,606 (10.4 %) surgical admissions were tested; 13 % were HIV-infected. After universal HTC implementation, HTC counselors reviewed 1,961 of the 2,488 admissions (79 %): 310 (16 %) had known status (157 seropositive, 153 seronegative) and 1,651 had unknown status (81 %). Among those with unknown status, 97 % (1,598, of 64 % of all admissions) accepted testing, of whom 9 % were found to be HIV-infected. Patients with longer lengths of stay (LOS) (mean = 11 vs. 5 days, p < 0.01) and those who underwent surgical intervention (odds ratio [OR] 2.5; confidence interval [CI] 2.0-3.1) were more likely to have a known status on discharge. HIV was more prevalence in patients with infection and genital/anal warts or ulcers and lower in trauma patients. HIV-positive patients received less surgical intervention (OR 0.69; CI 0.52-0.90), but there was no association between HIV status and length of stay or mortality. CONCLUSIONS Universal opt-out HTC on the surgical wards was well accepted and increased the proportion of patients tested. High HIV prevalence in this setting merits implementation of universal HTC.
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Affiliation(s)
- Bryce E Haac
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Redman LA, Naidoo P, Biccard BM. HIV, vascular surgery and cardiovascular outcomes: a South African cohort study. Anaesthesia 2014; 69:208-13. [PMID: 24548352 DOI: 10.1111/anae.12521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 11/28/2022]
Abstract
Risk factors for peri-operative cardiac morbidity are poorly described in HIV-positive patients. This prospective observational study describes cardiovascular risk factors in a cohort of vascular surgical patients of known HIV status. We recruited 225 patients with 73 (32%) being HIV-positive. When compared with HIV-negative patients, the HIV-positive patients were younger (mean (SD) 56.4 (13.3) vs 40.5 (10.4) years, respectively, p < 0.01). They had fewer Revised Cardiac Risk Index cardiovascular risk factors (median (range [IQR]) 1 (0-5 [0-2]) vs 0 (0-2 [0-0]), respectively, p < 0.001), with the exception of congestive cardiac failure (p = 0.23) and renal dysfunction (p = 0.32), and so were of a significantly lower Revised Cardiac Risk Index risk category (p < 0.01). HIV-positive and -negative patients had similar outcomes in: 30-day mortality (p = 0.78); three-day postoperative troponin leak (p = 0.66); and a composite outcome of mortality and troponin release (p = 0.69). We conclude that although HIV-positive patients have fewer cardiovascular risk factors, they have similar peri-operative major adverse cardiac events to HIV-negative patients. Research should focus on why this is the case, and if alternative clinical risk predictors can be developed for HIV patients.
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Affiliation(s)
- L A Redman
- Entabeni Hospital, Durban, KwaZulu-Natal, South Africa
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Comparison of in-hospital morbidity and mortality in HIV-infected and uninfected children after surgery. Pediatr Surg Int 2012; 28:1007-14. [PMID: 22922947 DOI: 10.1007/s00383-012-3163-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE Increasingly HIV-infected children can be expected to require surgery. The aim of this study was to compare the outcome of HIV-infected and HIV-unexposed children undergoing surgery. PATIENTS AND METHODS A prospective study of children less than or equal to 60 months admitted to a tertiary pediatric surgical service from July 2004 to July 2008. Children underwent age-definitive HIV testing and were followed up postoperatively for complications, length of stay and mortality. RESULTS Three hundred and twenty-seven children were enrolled: 82 (23 %) HIV-infected and 245 (67 %) were HIV-unexposed. Eighty-four (26 %) children were malnourished, which was higher in the HIV-infected group [41 (50.0 %) vs. 43 (17.5 %), relative risk (RR) 2.9; 95 % confidence interval (CI) 2.0-4.1; p < 0.0001]. Three hundred and twenty-eight surgical procedures were performed. A similar number of major [28 (34.2 %) vs. 64 (26.1 %); p = 0.2] and emergency procedures [37 (45.1 %) vs. 95 (38.8 %); p = 0.34] were performed in each group. HIV-infected children had a higher rate of contamination at surgery [40 (48.7 %) vs. 49 (20 %); RR 2.43 (CI 1.7-3.4); p < 0.0001]. There were more complications in the HIV-infected group [34 (41.5 %) vs. 14 (5.7 %); RR 7.3 (CI 4.1-12.8); p < 0.0001]. The most common complications were surgical site complications 30 (55 %), followed by postoperative infections, 19 (34 %). Infections with drug-resistant organisms occurred more commonly in HIV-infected children [11/19 (58 %) vs. 2/13 (15 %); RR 3.8 (CI 1.3-14.2); p = 0.02]. The median length of hospital stay was longer in the HIV-infected group [4 (IQR 2-14) vs. 2 (IQR 1-4) days; p = 0.0001]. There was a higher mortality amongst the HIV-infected group [6 (7.3 %) vs. 0 (0 %); p < 0.0001]. CONCLUSION HIV-infected children have a higher rate of postoperative complications and mortality compared with HIV-unexposed children.
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Karpelowsky J, Millar AJW. Surgical implications of human immunodeficiency virus infections. Semin Pediatr Surg 2012; 21:125-35. [PMID: 22475118 DOI: 10.1053/j.sempedsurg.2012.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric HIV (human immunodeficiency virus) is a pandemic predominantly in sub-Saharan Africa. Approximately 2.2 million children aged less than 15 years are infected with HIV, representing almost 95% of the total number of children globally infected with HIV. Therefore, increasing numbers of HIVi or -exposed but uninfected children can be expected to require a surgical procedure to assist in the diagnosis of an HIV/acquired immune deficiency syndrome-related complication, to address a life-threatening complication of the disease, or for routine surgery encountered in HIV-unexposed children. HIVi children may present with both conditions unique to HIV infection and surgical conditions routine in pediatric surgical practice. HIV exposure confers an increased risk of complications and mortality for all children after surgery, whether they are HIV infected or not. This risk of complications is higher in the HIVi group of patients. These findings seem to be independent of whether patients undergo an elective or emergency procedure, but the risk of an adverse outcome is higher for a major procedure. Surgical implications of HIV infection are comprehensively reviewed in this article.
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Effect of CD4+ T-lymphocyte count on hospital outcome of elective general thoracic surgery patients with human immunodeficiency virus. Gen Thorac Cardiovasc Surg 2011; 59:743-7. [PMID: 22083692 DOI: 10.1007/s11748-011-0808-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 03/21/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Traditionally, the chief surgical indicator for human immunodeficiency virus (HIV)-infected patients was the CD4-positive T-lymphocyte count; however, there is no current consensus. Reports published after 2006 indicated that HIV-infected patients had a higher incidence of postoperative pneumonia and higher 12-month mortality rates. In addition, CD4 counts had no relation to the in-hospital outcome. Therefore, we retrospectively examined all of the previous patients who underwent operations in our department on the basis of these findings. METHODS Regardless of the initiation of highly active anti-retroviral therapy (HAART), we retrospectively reviewed 10 general thoracic surgeries performed in our department according to the CD4 cell count, HIV-ribonucleic acid (RNA) viral load, time of HAART initiation, operating time, amount of blood, postoperative course, and period of observation. RESULTS There was no incidence of postoperative pneumonia or wound infection. There were also no complications during the perioperative period. One patient died 7 months after surgery. CONCLUSION Our retrospective study demonstrates that the indicator for elective general thoracic surgery is not the CD4-positive T-lymphocyte count and that the initiation of HAART may reduce the 12-month mortality rates. In HIV-positive patients, regardless of the CD4-positive T-lymphocyte count, surgeons can operate in the same manner as they would with HIV-negative patients.
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Bornard L, Blay M, Roger PM, Raucoules-Aimé M, Carles M. [Anaesthesia for HIV-infected patients]. ACTA ACUST UNITED AC 2011; 30:501-11. [PMID: 21684100 DOI: 10.1016/j.annfar.2011.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
Abstract
France is one of main countries affected by the HIV-outbreak in Europe with more than 120,000 cases, among which 34,600 patients having developed an AIDS. The antiretroviral combination therapies (combined antiretroviral therapy [cART]) reduced by half the mortality. A low compliance to cART alters the virologic control and increases the morbimortality. If required, the therapeutic break should be the shortest possible, including the whole treatment (to limit the risk of viral resistance). The perioperative care should take into account the underlying conditions. During the preoperative period, the clinical picture could combine various complications: 1: respiratory impairment; 2: impairment of neuronal functions (related to viral factors, host response and environmental factors such as alcohol, drug addiction, HCV co-infection) inducing a cognitive dysfunction or a peripheral neuropathy; 3: lipodystrophy, dyslipidemia and insulin resistance are the main metabolic cART-related side effects, responsible for atherosclerosis and coronaropathy; 4: major nutritional impairment. Anesthesia for HIV patients is almost the same than usual, without HIV-related contraindication to regional anesthesia. Anesthetic drugs can be associated to cART. The main restriction belongs to the protease inhibitors, which could affect the metabolic pathways of opioids, NSAIDs and benzodiazepines (over dosage risks). During the postoperative period, the follow-up should include the thromboembolism prevention (increased risk compared to main people), the cardiovascular side effects, the nutritional status and the continuation of the treatment. Moreover, the psychological status related and a close collaboration with the corresponding physician is critical.
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Affiliation(s)
- L Bornard
- Pôle d'anesthésie réanimation chirurgicale, hôpital Archet 2, CHU de Nice, université de Nice-Sophia-Antipolis, 151 route de Saint-Antoine-Ginestière, Nice cedex, France
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Madiba TE, Jack CL, Vawda YA. Cold comfort for healthcare workers? Medico-ethical dilemmas facing a healthcare worker after occupational exposure to HIV. S Afr Fam Pract (2004) 2011. [DOI: 10.1080/20786204.2011.10874163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- TE Madiba
- Department of Surgery, University of KwaZulu-Natal, Durban
| | - CL Jack
- Department of TeleHealth, University of KwaZulu-Natal, Durban
| | - YA Vawda
- Faculty of Law, Howard College, University of KwaZulu-Natal, Durban
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De Nardi P, Stratta G, Fumagalli L, Ferretti F, Albarello L, Staudacher C. Rhodococcus equi colonic lesion mimicking colon cancer. Colorectal Dis 2011; 13:e353-4. [PMID: 21689297 DOI: 10.1111/j.1463-1318.2011.02604.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P De Nardi
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
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Madiba TE, Jack CL, Vawda YA. Cold comfort for health care workers? Medico-ethical dilemmas facing a health care worker after occupational exposure to HIV. S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10874000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Balestra MR, Baratti D, Crippa F, Laterza B, Kusamura S, Langer M, Deraco M. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in a Patient with Peritoneal Mesothelioma and HIV Infection. TUMORI JOURNAL 2010; 96:340-4. [DOI: 10.1177/030089161009600226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background High rates of septic complications have been associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, which has been suggested as the treatment of choice for isolated peritoneal malignancies. Patients infected by the human immunodeficiency virus (HIV) are still considered at a high operative risk. Method A 58-year-old man with HIV infection and diffuse peritoneal mesothelioma underwent optimal cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Results The patient experienced a complete clinical response to therapy with no adverse effect on disease course or markers for HIV (CD4 count, beta2-microglobulin, neopterin, p24 antigen, and viral load). Conclusion This report suggests that this innovative approach can be successfully performed also in this clinical setting. In selected patients who respond to all criteria, surgery is possible and is a safe and effective therapeutic option.
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Affiliation(s)
- Maria Rosaria Balestra
- Department of Surgery, National Cancer Institute, Milan
- Department of Surgery, University G. d'Annunzio, Chieti
| | - Dario Baratti
- Department of Surgery, National Cancer Institute, Milan
| | - Fulvio Crippa
- Clinic of Infectious Diseases, San Raffaele Hospital, Milan
| | | | | | - Martin Langer
- Department of Anesthesiology, National Cancer Institute, Milan, Italy
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