ABSTRACT
Introduction: Periodontal Disease (PD), a chronic inflammatory disease, is highly prevalent among Persons Living With HIV (PLWH) and is characterized by microbial symbiosis and oxidative stress. Our hypothesis stipulates that periodontal therapy attenuates systemic inflammatory and bacterial burden while improving periodontal status in PLWH. Methods: Sixteen African Americans (AA) with suppressed HIV viremia on long-term Antiretroviral Therapy (ART) were recruited to this study. Participants were placed into two groups, based on their dental care status: group 1 (In-Care, IC) and group 2 (Out of Care, OC). Periodontal health was investigated at baseline, 3 months, 6 months, and 12 months. Cytokine/chemokines, microbial phyla, and Asymmetric Dimethylarginine (ADMA, a marker for endothelial cell dysfunction) levels were assessed in the serum. Statistical comparisons between groups and at different visits were performed using multiple comparison tests. Results: Across longitudinal visits, periodontal treatment significantly reduced the levels of several cytokines and chemokines. At baseline, the out of care group had significantly higher blood levels of ADMA and actinobacteria than the IC group. Periodontal treatment significantly altered the abundance of circulating genomic bacterial DNA for various phyla in out of care group. Conclusions: Periodontal treatment interventions effectively attenuated circulating pro-inflammatory cytokines and altered microbial translocation, both critical drivers of systemic inflammation in PLWH.
Subject(s)
AIDS-Related Opportunistic Infections/complications , Acquired Immunodeficiency Syndrome/complications , Cryptococcosis/complications , Cryptococcus neoformans/isolation & purification , Meningoencephalitis/complications , Sarcoma, Kaposi/complications , AIDS-Related Opportunistic Infections/pathology , Autopsy , Diagnosis, Differential , Fatal Outcome , Humans , Intestines/pathology , Kidney/pathology , Lung/pathology , Male , Middle Aged , Myocardium/pathology , Sarcoma, Kaposi/mortality , Sarcoma, Kaposi/pathologyABSTRACT
OBJECTIVES: A directly observed therapy program was established at Harlem Hospital, New York, NY, in 1993 to promote high tuberculosis treatment completion rates. METHODS: The Harlem program used an on-site surrogate family model. Treatment completion rate, visit adherence rate, human immuno-deficiency virus seroprevalence, and time to sputum culture conversion were assessed. RESULTS: Out of 145 enrolled patients with suspected and confirmed tuberculosis, 95 (92 confirmed and 3 suspected) continued treatment. The visit adherence rate was 91.1 +/- 7.9%, with one patient (1%) lost to follow-up. CONCLUSION: High rates of treatment completion and visit adherence were achieved because of unique program characteristics. Thus, directly observed therapy is advocated as a means of ensuring treatment completion.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Antitubercular Agents/therapeutic use , Home Care Services, Hospital-Based/organization & administration , Hospitals, Municipal/organization & administration , Patient Compliance , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Adult , Continuity of Patient Care , Female , Humans , Male , Middle Aged , Models, Organizational , New York City/epidemiology , Patient Dropouts , Program Evaluation , Treatment OutcomeABSTRACT
This article reports a case of pyogenic arthritis with Hemophilus influenzae in a previously healthy woman. This infection was the initial manifestation of an underlying serious systemic illness, multiple myeloma. Certain laboratory parameters as well as the causative organism suggested the underlying disease. Although infections are common in patients with known multiple myeloma, certain infections can provide a hint to concomitant serious systemic diseases and thus facilitate their early diagnosis.
