Palliative care considerations for the older adults with HIV/AIDS: a clinical practice review.

Human immunodeficiency virus (HIV) has historically been viewed as a terminal condition affecting younger populations, however, with advancements in antiretroviral therapy (ART) and better healthcare provisions, people with HIV are now living longer than ever before. This shift has highlighted the need to readdress the end-of-life care needs of patients aging with HIV. People aging with HIV face a double burden. Aging itself comes with an array of health challenges, including cognitive decline, frailty, and increased susceptibility to chronic illnesses. Despite effective management with ART, HIV is associated with ongoing inflammation, and may accelerate aging processes, increasing the risk of certain cancers and comorbidities, as well as an increased risk of cardiovascular disease. The stigma surrounding HIV, though diminished over the years, still lingers. People living with HIV have experienced decades of intersecting stigmatized identities in the context of social isolation, leading to potential psychological challenges like depression, anxiety, and loneliness, all of which may be amplified by aging. Addressing these emotional and social needs is as crucial as managing their physical health. The integration of primary palliative care into geriatric practice is crucial, as it improves the quality of life for older patients with chronic illnesses, lifelimiting conditions. This is particularly relevant for aging individuals with HIV, who often face complex medical needs and multiple comorbidities. Primary palliative care is the basic, integrated palliative care support provided by non-specialists as part of routine care, while specialist palliative care involves more complex and specialized support from a team with specific training in palliative care. Incorporating palliative care principles enables geriatric healthcare providers to address these comprehensive needs more effectively. This approach encompasses not only physical symptom management but also the emotional well-being of patients. It aids in advanced care planning and decision-making that resonate with the patients' values and goals. Ultimately, this integrated approach leads to improved patient outcomes and a higher quality of care. This review delves into the unique considerations and challenges of providing palliative care to people aging with HIV, recognizing the interplay of age and HIV in the era of modern ART.

Critical conditions for liquid chromatography of statistical polyolefins: Evaluation of diene distribution in EPDM terpolymers.

Liquid chromatography at critical conditions is of interest as it may unravel molecular information on macromolecular structures not accessible by any other analytical techniques. Yet so far, such conditions have never been experimentally established for copolymers, where a particular need for such information exists. Toward this goal, critical conditions for statistical ethylene propylene copolymers were identified. In the first approach the composition of the binary mobile phase was varied at a constant temperature, and secondly by modulating the adsorption-desorption temperature at constant mobile phase composition. Solvents for both methods were identified by using a novel approach that combines structure retention relationships with Hansen Solubility Parameters. As a result, for the first time, the heterogeneity of an ethylene propylene diene terpolymer sample with regard to the pendant double bond of the diene could be determined. The novel chromatographic approach was validated by measuring the composition of fractions taken over the chromatographic run offline by nuclear magnetic resonance. In summary, this work gave the first experimental evidence for the existence of critical conditions for polyolefin random copolymers, as postulated by Brun. This novel chromatographic approach holds immense potential to engineer complex polymers towards future applications by making use of the now-accessible molecular information.

Navigating Human Immunodeficiency Virus Screening Recommendations for People on Pre-Exposure Prophylaxis and the Need to Update Testing Algorithms.

Incident HIV infections occurring in people on PrEP may have delayed seroconversion. New CDC guidelines recommend the addition of HIV-1 viral load for screening for all on PrEP. We believe antigen/antibody screening should continue for tenofovir-based PrEP at this time.

Separation of ethylene-norbornene copolymers using high performance liquid chromatography.

The elution behavior of ethylene-norbornene (EN) copolymers prepared with various catalysts was studied in selected binary solvent gradients using porous graphite (HypercarbTM) as stationary phase. It was found that the elution volumes of the EN copolymers correlated with their average norbornene content. For a series with norbornene content lower than 20 mol % the correlation was positive (i.e. increasing elution volumes with increasing norbornene content), whereas for a series with norbornene contents above 20 mol % it was negative (decreasing elution volumes with increasing norbornene content). It is known that EN copolymers have complicated microstructures that depend on norbornene content and the catalyst system used for synthesis. Thus, it is supposed that the opposing trends in the elution behavior of the EN copolymers are caused by differences in their microstructure, ultimately governed by the norbornene content. Our conclusions are supported by results from NMR spectroscopy, which revealed the microstructure, and differential scanning calorimetry (DSC).

Disseminated Mycobacterium tuberculosis following renal transplant with alemtuzumab induction.

Mycobacterium tuberculosis presents unique challenges in the peritransplant period. Here, we describe a case of disseminated tuberculosis following renal transplantation with alemtuzumab induction immunosuppression in a patient with remotely treated pulmonary tuberculosis and ongoing risk factors for re-infection. We also review the available literature regarding the prevalence of tuberculosis infection following solid organ transplant and management of high-risk patients, including the role for isoniazid preventative therapy.

Therapeutic Challenges of Hepatic Mucormycosis in Hematologic Malignancy: A Case Report and Review of the Literature.

BACKGROUND The clinical presentation of mucormycosis can vary widely based on various host factors. Among malignancy- and bone marrow transplant-associated infections, the lungs are the most common site of infection. Involvement of the gastrointestinal tract is less frequently encountered. The clinical presentation is often nonspecific, and cultures typically yield no growth, making the diagnosis challenging. CASE REPORT We present a case of isolated hepatic mucormycosis in the setting of neutropenic fever and abdominal pain following induction chemotherapy for the treatment of acute myeloid leukemia. The patient was treated with combination antifungal therapy with amphotericin and posaconazole without surgical resection, given the presence of multiple liver lesions. After a prolonged course of dual antifungal therapy, the size of her liver lesions improved. Unfortunately, her lymphoproliferative disorder proved fatal, following approximately 13 months of antifungal therapy. CONCLUSIONS Among patients with mucormycosis, mortality remains high, especially in the setting of gastrointestinal involvement. Although surgical resection along with dual antifungal therapy can improve outcomes, the high mortality rate necessitates further investigation into improved diagnostic and treatment strategies including optimal antifungal therapy.