The Banff 97 working classification of renal allograft pathology

BACKGROUND

Standardization of renal allograft biopsy interpretation is necessary to guide therapy and to establish an objective end point for clinical trials. This manuscript describes a classification, Banff 97, developed by investigators using the Banff Schema and the Collaborative Clinical Trials in Transplantation (CCTT) modification for diagnosis of renal allograft pathology.

METHODS

Banff 97 grew from an international consensus discussion begun at Banff and continued via the Internet. This schema developed from (a) analysis of data using the Banff classification, (b) publication of and experience with the CCTT modification, (c) international conferences, and (d) data from recent studies on impact of vasculitis on transplant outcome.

RESULTS

Semiquantitative lesion scoring continues to focus on tubulitis and arteritis but includes a minimum threshold for interstitial inflammation. Banff 97 defines "types" of acute/active rejection. Type I is tubulointerstitial rejection without arteritis. Type II is vascular rejection with intimal arteritis, and type III is severe rejection with transmural arterial changes. Biopsies with only mild inflammation are graded as "borderline/suspicious for rejection." Chronic/sclerosing allograft changes are graded based on severity of tubular atrophy and interstitial fibrosis. Antibody-mediated rejection, hyperacute or accelerated acute in presentation, is also categorized, as are other significant allograft findings.

CONCLUSIONS

The Banff 97 working classification refines earlier schemas and represents input from two classifications most widely used in clinical rejection trials and in clinical practice worldwide. Major changes include the following: rejection with vasculitis is separated from tubulointerstitial rejection; severe rejection requires transmural changes in arteries; "borderline" rejection can only be interpreted in a clinical context; antibody-mediated rejection is further defined, and lesion scoring focuses on most severely involved structures. Criteria for specimen adequacy have also been modified. Banff 97 represents a significant refinement of allograft assessment, developed via international consensus discussions.

A case-control dietary study of primary liver cancer risk from aflatoxin exposure

The dietary intakes of 90 confirmed primary liver cancer cases were compared against 90 age-sex matched controls. Dietary recall, obtained by the same nutritionist, was taken for each change of residence lasting one year or more. The frequency and amounts of food items consumed were calculated into units of aflatoxin load per day using a Philippine table of aflatoxin values of these items. Of the total subjects' aflatoxin load, 51.2% came from cassava, 20.3% from corn, 6.8% from peanuts and 5.8% from sweet potato. The mean aflatoxin load per day of the cases as found to be 440% that of the controls. Upon grouping dietary aflatoxin loads (and alcohol intakes) into Heavy and Light, and upon comparing cases versus controls, the relative risk (RR) of developing primary liver cancer was found to be statistically significant in the following order of rank: cassava, peanuts, sweet potato, corn and alcohol. Boiled rice which had negligible aflatoxin content gave no difference in risk. Combining aflatoxin load and alcohol intake gave a synergistic and a statistically significant effect on RR with Light Aflatoxin, Light Alcohol as RR = 1.

RESULTS

Light Aflatoxin, Heavy Alcohol RR = 3.9; Heavy Aflatoxin, Light Alcohol RR = 17.5; Heavy Aflatoxin, Heavy Alcohol RR = 35.0.

A low-cost instrumented glove for monitoring forces during object manipulation

A rehabilitation program toward restoring upper limb movements based on neuromuscular electrical stimulation (NMES) depends on closed-loop control performance, which has been limited by the development of sensors for practical daily use. This work proposes a system to obtain force feedback. The system is comprised of a Lycra commercial glove with force sensing resistors (FSR's) attached to the distal phalanxes of the thumb, index and long fingers. After amplification and filtering, the signal is digitized through an analog-to-digital (A/D) converter. The polynomial fitting coefficients for the characteristic curves, obtained during the sensor calibration process, were inserted in the software thus enabling the reading of forces exerted during object manipulation. The system was applied to 30 normal subjects in order to verify its feasibility and to acquire knowledge of the normal hand function. Different ways of grasping have been detected according to the Force versus Time curve pattern and to the fingers predominantly used in grasping. Results have also shown the influence of parameters such as gender, age, hand size, and object weight in the normal function. The system did show efficacy. It was able to determine grasp forces during object manipulation for up to 73% of the studied sample. This is significant since a single glove was used in a wide range of subjects. For best results in medical applications, the glove should be tailored to the particular characteristics of an individual user.

Infliximab does not activate replication of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis

OBJECTIVE

The reactivation of human lymphotropic herpesviruses can be related to the intensity of immunosuppression. We analysed the risk of reactivation of lymphotropic herpesviruses in patients with refractory rheumatoid arthritis treated with an anti-tumour necrosis factor-alpha (TNF-alpha) agent (infliximab).

METHODS

Fifteen patients were treated with infliximab (3 mg/kg) at weeks 0, 2 and 6. Samples of both plasma and peripheral blood mononuclear cells (PBMC) were obtained before treatment (week 0) and before each infusion at weeks 2 and 6. Samples were analysed using a multiplex qualitative polymerase chain reaction (PCR) for lymphotropic herpesviruses. Quantification of cytomegalovirus (CMV) viral load (copies/ml) was performed using quantitative PCR. Reactivation was defined as the presence of viral DNA in plasma. Latent infection was defined as the presence of viral DNA in PBMC samples but not in plasma.

RESULTS

On baseline, latent CMV infection was detected in eight patients (53.3%), human herpesviruses-6 (HHV-6) in two (13.3%), Epstein-Barr virus (EBV) in seven (46.6%), CMV + HHV-6 in one (6.6%), CMV + EBV in two (13.3%) and HHV-6 + EBV in one (6.6%). Viral reactivation related to infliximab treatment was not observed. There was only one patient who had HHV-6 reactivation, but this was already detected in the baseline sample.

CONCLUSIONS

Infliximab treatment does not induce replication of human lymphotropic herpesviruses in patients with rheumatoid arthritis. Thus, herpesviruses prophylaxis would not be indicated in these patients.

7Li nuclear magnetic resonance study for the determination of Li+ properties in neuroblastoma SH-SY5Y cells

Lithium has been used clinically in the treatment of manic depression. However, its pharmacologic mode of action remains unclear. Characteristics of Li+ interactions in red blood cells (RBCs) have been identified. We investigated Li+ interactions on human neuroblastoma SH-SY5Y cells by developing a novel 7Li NMR method that provided a clear estimation of the intra- and extracellular amounts of Li+ in the presence of the shift reagent thulium-1,4,7,10-tetrazacyclododecane-N,N',N'',N'''-tetramethylene phosphonate (HTmDOTP4-). The first-order rate constants of Li+ influx and efflux for perfused, agarose-embedded SH-SY5Y cells in the presence of 3 mM HTmDOTP4- were 0.055 +/- 0.006 (n = 4) and -0.025 +/- 0.006 min(-1) (n = 3), respectively. Significant increases in the rate constants of Li+ influx and efflux in the presence of 0.05 mM veratridine indicated the presence of Na+ channel-mediated Li+ transport in SH-SY5Y cells. 7Li NMR relaxation measurements showed that Li+ is immobilized more in human neuroblastoma SH-SY5Y cells than in human RBCs.

Double outlet right ventricle. Study of 27 cases

Out of 1610 children's hearts with congenital malformations there were 27 specimens showing double outlet right ventricle. Cases with dextrocardia, situs inversus, or l-venticular loop were excluded. Anatomical examination was performed with particular reference to the infundibular region, the great vessels, and the ventricular septum. The commonest associated malformations were ventricular septal defect and pulmonary stenosis. Aortic stenosis was the predominant finding in those cases dying in the neonatal period. An aortic conus was associated with pulmonary stenosis, ventricular septal defect, and d-transposition, a pulmonary conus with ventricular septal defect and a double conus with stenosis of either great vessel. The anterior vessel always had a muscular conus and the posterior vessel was commonly stenotic.

Measurement of blood urea concentration during haemodialysis is not an accurate method to determine equilibrated post-dialysis urea concentration

BACKGROUND

The double-pool urea kinetic model requires the measurement of the blood urea concentrations 30 min after haemodialysis (C(t+30)) to calculate equilibrated Kt/V. However, it has been suggested that urea concentrations 30 min before the end of dialysis (C(t-30)) may be representative of C(t+30). The aim of this study was to validate this suggestion.

METHODS

Twenty-two patients underwent haemodialysis for 180, 210, and 240 min. For each patient in each dialysis session, urea exponential decay curve was calculated. Because we measured C(t+30), we calculated the time (T(c)) before the end of dialysis that blood urea concentrations would be the same as C(t+30). In an additional 33 patients, we measured blood urea concentrations at T(c) and in C(t+30).

RESULTS

We found that C(t-30) was significantly lower than C(t+30) independent of the duration of dialysis. However, there was a significant correlation between Kt/V(t-30) and Kt/V(t+30). The T(c) was 45 min before the end of dialysis. In the additional 33 patients, C(t-45) and C(t+30) were 54+/-17 and 52+/-17 mg/dl (NS), and Kt/V(t-45) and Kt/V(t+30) were 1.27+/-0.21 and 1.29+/-0.18 (NS), respectively. There were significant correlations between C(t-45) and C(t+30) (r=0.96; P<0.001), and between Kt/V(t-45) and Kt/V(t+30) (r=0.82; P<0.001). However, when measurements were analysed individually, 48% of the data points from C(t-45) vs C(t+30), and 42% of the data points from Kt/V(t-45) vs Kt/V(t+30) fell out of the 95% confidence interval of regression line.

CONCLUSIONS

Although C(t-45) is useful to estimate Kt/V when assessing mean values, it is not suitable when assessing patients individually. This study demonstrates that the best method to calculate equilibrated Kt/V was a blood sample for urea concentrations 30 min after haemodialysis.

Fracture of the unresurfaced patella after total knee arthroplasty: a report of two cases

Patellar fractures are unusual in total knee arthroplasty without patellar resurfacing. We present 2 such cases that occurred within postoperative 2 months and were managed conservatively. Both patients had their knee function preserved.

Effects of comorbidities on quality of life in Filipino people with tuberculosis

BACKGROUND: We investigated health-related quality of life (HrQoL) in Filipino people undergoing TB treatment, and whether HrQoL was negatively impacted by comorbidity with undernutrition, diabetes (DM) and anaemia.METHODS: Adult participants were enrolled in public facilities in Metro Manila (three sites) and Negros Occidental (two sites). Multivariate linear regression was used to model the four correlated domain scores from a WHOQOL-BREF questionnaire (physical, psychological, social, environmental). A forward-stepwise approach was used to select a final multivariable model with inclusion based on global tests of significance at P < 0.1.RESULTS: In 446 people on drug-susceptible TB treatment, DM and moderate/severe anaemia were not associated with HrQoL. After adjustment for age, sex, education, food insecurity, treatment adherence, inflammation, Category I or II TB treatment, treatment phase, current side effects and inhibited ability to work, moderate/severe undernutrition (body mass index < 17 kg/m²) was associated with lower HrQoL (P = 0.003) with reduced psychological (coefficient: -1.02, 95% CI -1.54 to -0.51), physical (-0.62, 95% CI -1.14 to -0.09) and environmental domain scores (-0.45, 95% CI -0.88 to -0.01). In 225 patients with known HIV status in Metro Manila, HIV was associated with modestly reduced HrQoL (P = 0.014).CONCLUSION: Nutritional status and food insecurity represent modifiable risk factors for poor HrQoL that may be alleviated through interventions.

Pre- and posttransplant monitoring of alloantibodies by complement-dependent cytotoxicity and luminex methodologies in liver transplantation

BACKGROUND

This study evaluated the influence of circulating anti-HLA antibodies on outcomes of 97 liver allografts from deceased donors.

METHODS

Human leukocyte antigen (HLA) antibody screening was performed by both complement-dependent cytotoxicity (CDC) and multiparameter Luminex microsphere-based assays (Luminex assay).

RESULTS

The agreements between T- and B- cell CDC and Luminex assays were 67% and 77% for pre- and posttransplant specimens, respectively. Graft dysfunction was not associated with either positive pretransplant CDC or Luminex panel-reactive antibody (PRA) values. Likewise, positive posttransplant T- or B- cell CDC PRA values were not associated with graft dysfunction. In contrast, posttransplant Luminex PRA values were significantly higher among patients with graft dysfunction compared with subjects with good outcomes (P = .017).

CONCLUSION

Posttransplant monitoring of HLA antibodies with Luminex methodology allowed identification of patients at high-risk for poor graft outcomes.

Performance of HTLV-1 screening assays in Brazil

In recent years a variety of studies have been carried out to compare the accuracy (generally expressed in terms of sensitivity and specificity) of commercially available anti-HTLV tests. None of these studies were performed in Brazil or in any other South American country. During the characterization of our Brazilian reference panel we evaluated the sensitivities and specificities of the Abbott HTLV EIA (100%; 89.7%) and the Biochrom HTLV-1/-2 ELISA (100%; 42.4%). Our conclusion was that both assays may be problematic in terms of correctly identifying HTLV-negative sera. We therefore adjusted the cut-off values using receiver operating characteristics (ROC). ROC analysis, which involves calculating sensitivity and specificity for several cut-off values, can be used to ascertain the co-variation in the specificity and sensitivity of any assay giving quantitative results. The optimum cut-off value for the assay in a given study population is the point that gives highest possible sensitivity in conjunction with a small false-positive fraction. Using the HTLV-1/-2 Western blot as the "gold standard", we were able to improve the specificity of the Biochrom HTLV-1/-2 assay to 95% without affecting its sensitivity of 100%. However, it seems that when using the Biochrom HTLV-1/-2 ELISA, there may be problems in separating positive and negative sera. In the case of the Abbott HTLV EIA, our ROC analysis revealed that the cut-off value suggested by the manufacturer was nearly identical to the optimum cut-off value. Adjustment will affect neither sensitivity nor specificity. However, a slight adjustment of the cut-off value result in a clearer separation of the positive and negative populations. Furthermore, we assume that this adjustment will help to avoid false-positive results when larger serum panels are investigated. Further investigations will show whether or not this problem is linked to the geographical regions where the test is performed (e.g. polyclonal stimulation due to parasitic infections in tropical countries).

[Tumor of ceruminous gland with intracranial invasion: case report]

Ceruminous glands are modified apocrine glands, confined to the skin lining of the cartilaginous part of the external auditory meatus. Tumors arising from these glands are rare. Controversy exists regarding the term "ceruminoma". Actually this neoplasia should be classified as adenoma, adenocarcinoma, adenoid cystic carcinoma and pleomorphic ceruminous adenoma. We report a 39-year-old woman first seen at Santa Casa of Belo Horizonte, in 1998, presenting with headache, nausea, vertigo, hearing loss and tinnitus on the right for the past two years. CT scan showed a tumor eroding cartilaginous and bony limits with intracranial invasion. She was submitted to multidisciplinary treatment with surgery followed by radiotherapy (6000 cG). Histology showed a ceruminous adenoid cystic carcinoma. The patient manifested a right peripheral facial palsy and had no recovery of the previous deficits. After one year from surgery she is clinically stable.

Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology

Acute rejection is associated with a poor long-term prognosis for renal allografts. Sequential fine-needle aspiration cytology (FNAC) has been used to monitor rejection. However, FNAC diagnoses rejection only when the infiltrating cells are already damaging the graft and, in some borderline cases with a low increment of inflammatory cells in the graft, FNAC lacks the specificity to diagnose rejection. In these cases, the number of inflammatory cells within the graft can decline, stabilize or increase with time. In this study, we sought to determine whether the analysis of the expression of ICAM-I, HLA-DR and IL-2R along with borderline FNAC results increases the specificity to diagnose rejection. Of 117 FNAC samples taken from 24 patients after renal transplantation, 85 (72%) were considered suitable for cytological analysis. Of these patients, 9 (37%) did not suffer an acute cellular rejection (ACR) episode and 15 (63%) had at least one ACR episode. ICAM-1 and IL-2R were studied using an immune-peroxidase technique. The ICAM-1 results are expressed as the percentage of tubular cells in the aspirate stained with this marker and the IL-2R results are expressed as the absolute number of positively stained lymphocytes in the whole cytopreparation. With a total corrected increment (TCI) of > 3 there was a sharp increase in the specificity index for rejection that reached almost 100% at a TCI of > or = 4. Sensitivity for rejection at this level was only 20%. Between a TCI of 2.5 and 2.9 the sensitivity increased to 75%, with specificity for rejection around 75%. There was an upregulation of ICAM-1 and IL-2R when FNAC diagnosed rejection but with a large overlap of the results when compared either to normal graft or acute tubular neurosis. The mean TCI during the week preceding the rejection episode was 2.5 and the TCI reached a mean value of > or = 3 only during rejection. The peak ICAM-1 and IL-2R expression occurred during the week preceding the clinically evident rejection episode. The expression of ICAM-1 by > or = 70% of the tubular cells increased the specificity for rejection of a TCI of > or = 2.5 to 100%. In the same way, the specificity for rejection increased up to 90% when eight to ten IL-2R-positive lymphocytes were seen along with a TCI of > or = 2.5. There was no further increase in specificity after that. A specificity index of 100% for rejection could be obtained for moderate levels of both ICAM-1 (70% or more tubular cells) and IL-2R (eight or more lymphocytes). ICAM-1 expression in 70% or more tubular cells and/or IL-2R expression in eight or more lymphocytes was found in 58% of the FNAC aspirates with a TCI between 2.5 and 2.9. In conclusion, the expression of IL-2R in lymphoid cells and ICAM-1 in tubular cells was upregulated during rejection episodes and the upregulation preceded both the clinical and the routine FNAC diagnosis of rejection by 1 week. The ddition of these markers to the FNAC increased substantially the specificity of the FNAC to diagnose rejection.

Multifocal Torpedo Maculopathy Complicated by Choroidal Neovascularization

Purpose: To present a pediatric patient with a unique configuration of torpedo maculopathy complicated by macular choroidal neovascularization (CNV). Methods: A single case was retrospectively reviewed. Results: An 8-year-old male child presented with decreased vision in the left eye and was found to have 2 distinct torpedo maculopathy lesions, 1 a smaller hypopigmented lesion in the temporal parafovea and the other a larger hyperpigmented comet-shaped lesion in the temporal periphery. Multimodal imaging showed active CNV. The patient received 2 intravitreal injections of ranibizumab with regression of CNV and recovery of visual acuity. Conclusions: CNV is a rare complication of torpedo maculopathy that can affect pediatric patients in the absence of choroidal excavation. The presence of a hyperpigmented peripheral lesion exhibiting symmetry across the horizontal raphe lends support to the hypothesis that an alteration in the development and migration of retinal pigment epithelium cells across the fetal bulge results in this disorder.

Sexual dating violence victimization and adolescent psychological distress in Rio de Janeiro, Brazil

Background

Studies from high income countries showed physical and psychological dating violence associated with poor mental health (MH) outcomes, including depressive symptoms and suicide attempts. However, sexual dating violence (SDV) has received less attention, especially in low middle-income countries like Brazil. This study investigated the prevalence and the effect of SDV victimization on MH in adolescent students from Rio de Janeiro, Brazil.

Methods

This is a school-based study comprising 550 students enrolled in 13 high schools. Only adolescents reporting at least one romantic relationship in the prior twelve months were eligible. SDV and MH were measured using the Conflict in Adolescent Dating Relationships Inventory (CADRI) and General Health Questionnaire (GHQ-12), respectively. Frequency of SDV was assessed in the aggregate and by specific sociodemographic subgroups. Multivariate logistic models were employed to study the relationship between SDV victimization and MH status. Direct Acyclic Graphs steared the covariates selection process: skin color, maternal education, history of child sexual abuse, and sex.

Results

The prevalence of SDV victimization experienced over the last 12 months was 16.5%. SDV victimization was a significant risk factor for MH problems (OR = 2.04; 95%CI: 1.01 - 4.15).

Conclusions

The high prevalence of SDV among students in the sample was striking. Its relationship with psychological suffering highlights the importance of involving schools and health services in actions aimed at reducing all forms of SDV and at mitigating its consequences. The findings also indicate that mental health professionals should regurlarly investigate SDV victimization among adolescents reporting MH symptoms.

Key messages

Rio de Janeiro schools and health services need to join efforts to develop and implement actions aimed at the prevention of sexual dating violence. Health professionals might investigate if adolescents with psychological distress are also victims of sexual dating violence.

[Echocardiographic study of corrected transposition (author's transl)]

We studied patients with corrected transposition of the great arteries by M and bidimensional echocardiography. Three patients in situs solitus and one in atrial situs inversus. The characteristics of the atrio-ventricular valves, and it's relation with other heart structures was determined, as well as the ventriculo-arterial connections and the presence of associated defects. The approximations employed were parasternal and suprasternal. The cases of discordant ventriculo-arterial connection in atrial situs solitus showed mitro-pulmonary continuity. In these cases the pulmonary artery, located in a right posterior situation with respect to the aorta, became intensely opaque when contrast material was injected in a peripheral vein. In atrial situs inversus, the aorta had a right and anterior position. We conclude that it is possible to establish the diagnosis of atrioventricular discordance by an adequate systematization of the echocardiographic recordings.

Distinct regulatory pathways control neurofilament expression and neurotransmitter synthesis in immortalized serotonergic neurons

Following infection of dissociated embryonic day 13 rat medullary raphe cells with a retrovirus encoding the temperature-sensitive mutant of SV40 large T-antigen (T-ag), a neuronal cell line, RN46A, was cloned by serial dilution. At 33 degrees C, RN46A cells express nuclear T-ag immunoreactivity and divide with a doubling time of 9 hr. Undifferentiated RN46A cells express low levels of neuron-specific enolase (NSE) and low (NF-L)-and medium (NF-M)- but not high (NF-H)-molecular-weight neurofilament proteins. Under differentiation conditions, RN46A cells cease dividing, take on a neuronal morphology, and express enhanced levels of NSE and all three NF proteins. Elevation of intracellular cAMP levels increases neurofilament protein expression, whereas activators of various other intracellular second messenger systems have no effect. Differentiated RN46A cells express low-affinity nerve growth factor (NGF) receptor (p75NGFR) and are immunoreactive using an antibody that recognizes the carboxy-terminal 13 amino acids of all three trk proteins (pan-trk). Both immunoreactivities could be potentiated by treatment with brain-derived neurotrophic factor (BDNF), NGF, and adrenocorticotropic hormone, fragment 4-10 (ACTH4-10). Differentiated RN46A cells express low levels of tryptophan hydroxylase (TPH) immunoreactivity, which could be enhanced by treatment with ACTH4-10, BDNF, or NGF. Low levels of serotonin immunoreactivity are detected in differentiated RN46A cells, and this was potentiated by differentiating RN46A cells with BDNF for 8 d and 40 mM KCl for days 4-8. HPLC analysis confirmed these immunohistochemical data. RN46A cells should prove useful to elucidate intracellular mechanisms that control neurofilament assembly and 5-HT expression in differentiating raphe neurons.

[Surgery of congenital cardiopathies without catheterization: initial experience with 141 consecutive cases]

Our initial experience with surgical treatment of congenital heart disease in 141 consecutive cases without the need of hemodynamic study is described. Ages ranged between 1 day and 15 years; 39 cases under 1 months of age (23 in the first week of life), 38 between 1 and 12 months, and 64 above 1 year of age. Diagnosis were: ductus 32 cases, atrial septal defect 24, Fallot's tetralogy 14, aortic coarctation 13, complete AV canal defect 7, D-transposition of the great arteries 5, ventricular septal defect 6, pulmonary atresia with intact ventricular septum 5, aortic stenosis 3, tricuspid atresia 4, pseudotruncus 2, univentricular heart 2, atrial myxomas, 2, Fallot's like 3, other type of congenital heart defect 19 cases. There was an adequate correlation between eco-2D images and anatomic-surgical findings. In conclusion, we think that a great percentage of cases affected of congenital heart disease should be considered for surgery without the need of a hemodynamic and angiocardiographic study.

Health system costs of providing outpatient care for diabetes in people with TB in the Philippines

BACKGROUND

Diabetes mellitus (DM) is a known risk factor for active TB. A key activity in the Philippines is to integrate TB services with other disease programmes, with a target of DM screening in 90% of TB cases. However, costs of providing DM outpatient services for TB patients are not well known.

METHODS

We estimated the costs of providing integrated DM outpatient services within TB services from the health system perspective. Resources for outpatient DM services were valued using the bottom-up approach for capital goods, staff time and consumables. Resource quantities were obtained by interviewing 60 healthcare professionals in 11 health facilities in the Philippines.

RESULTS

The mean cost per service ranged from USD0.53 for DM risk assessment to USD23.72 for oral glucose tolerance test. The cost per case detected for different algorithms varied from USD17.43 to USD80.81. The monthly cost per patient was estimated at USD8.95 to USD12.36.

CONCLUSION

Our study provides the first estimates of costs for providing integrated DM outpatient services and TB care in a low- and middle-income country. The costs of DM detection in TB patients suggests that it may be useful to further investigate the cost-effectiveness and affordability of service delivery.

[Echocardiographic aspects of the aortopulmonary window. Report of a case with angiocardiographic correlations]

A case of complex congenital heart disease is presented with diagnosis of; ventricular septal defect, interrupt aortic arch, patent ductus arteriosus and aorticopulmonary window. The latter condition was studied by means of M mode and two-dimensional echocardiographic techniques. The heart was scanned perpendicular to its long axis at the origin of the great arteries. This scan revealed an image of two adjacent circular structures which has been previously described as suggestive of dTGA or Double-outlet right ventricle. The clinical picture discarded the possibility of dTGA, and the atrioventricular relationship established by the cross-sectional echocardiography invalidated the diagnosis of Double-outlet right ventricle. The cause of the echocardiographic morphologies observed are discussed.

2486. Clinical Outcomes of Patients Treated with Dolutegravir Functional Monotherapy or Dolutegravir plus an Active Non-cytosine Nucleoside Analog: A Retrospective Observational Cohort Study of Treatment-Experienced Patients

Background

Dual dolutegravir (DTG)-containing regimens (DCRs) are currently approved for the treatment of antiretroviral (ARV) naïve and experienced patients with HIV-1 infection. DTG monotherapy has resulted in unacceptable rates of virologic failure and subsequent development of DTG resistance. Here, we evaluate the “real-world” efficacy and “barrier to resistance” of DCRs containing 0–1 active ARVs.

Methods

This is a retrospective observational study evaluating clinical outcomes of treatment-experienced patients on combination DCRs found to be on DTG functional monotherapy or DTG plus an active non-cytosine analog between 2013 and 2014. The primary endpoint was virologic suppression (HIV-1 RNA< 50 copies/mL) at week 48. Virologic failure (VF) was defined as confirmed HIV-1 RNA≥ 50 copies/mL 12 weeks after initiating DTG or any time after achieving HIV-1 RNA< 50 copies/mL. Adherence, adverse events (AEs) and laboratory parameters were analyzed throughout the study.

Results

Thirty-nine patients were included in the analysis, 19 (49%) were on DTG functional monotherapy and 20 (51%) were on DTG plus a non-cytosine nucleoside analog. The median age (range) was 53 (40–74) years, median baseline CD4+ count (range) was 564 (92–1217) cells/mm³, 22 (56%) had baseline HIV-1 RNA< 50 copies/mL, and 24 (62%) had previously used INSTIs (Table 1). At Weeks 48 and 96, virologic suppression was observed in 78.3% and 86% of patients respectively (Figures 1 and 2). Among 7 VFs (2 on DTG functional monotherapy, 5 on DTG plus a non-cytosine nucleoside analog), there was no evidence of treatment-emergent resistance to DTG. There was a significant median increase in CD4+ count from baseline to Week 48 (+90 cells/mm³, 95% confidence interval: [14.18, 165.9]). No significant changes in lipid parameters were observed. Treatment-related AEs occurred in 17/39 (44%) patients (all Grade 1–2) and 1 patient discontinued DCR treatment due to rash.

Conclusion

In this “real-world” cohort of treatment-experienced patients, we observed that DTG functional monotherapy and DTG plus a non-cytosine nucleoside analog maintained long-term virologic control and was well tolerated. These data supports use of DTG as a partner for dual DCRs given its high efficacy in patients with underlying ARV resistance.

Disclosures

All authors: No reported disclosures.

Determination of chlorimuron and metsulfuron residues in two soils of Argentina using a rapid seed-bioassay

The presence of chlorimuron ethyl and metsulfuron methyl in two soils was determined by a modified petri dish bioassay. Pregerminated seeds of maize and sunflower were placed in petri dishes containing 85 to 100 g of treated soil. Radicle root lengths were measured after 24 h. Chlorimuron had no effect on maize on the Balcarce soil, however 0.007 microg g(-1) decreased sunflower root length. Chlorimuron decreased maize and sunflower root length regardless application dose on the San Cayetano soil. Metsulfuron decreased maize root length at 0.04 microg g(-1) and sunflower at 0.021 microg g(-1) on the Balcarce soil. On the San Cayetano soil metsulfuron at 0.001 microg g(-1) decreased maize and sunflower root length. The phytotoxicity of chlorimuron and metsulfuron changed according to soil type and dose. Maize and sunflower were 1.3-1.5 and 1.3-1.8 times respectively more sensitive to chlorimuron on the San Cayetano soil than on the Balcarce soil. In the case of metsulfuron, maize was similarly sensitive on both soils but sunflower was 1.7-2.0 times more sensitive on the San Cayetano soil than on the Balcarce soil. Phytotoxicity increased as organic matter (OM) content decreased and/or when the soil pH and concentration increased.