ABSTRACT
Background Coinfection of viral hepatitis and human immunodeficiency virus (HIV) is not uncommon in Pakistan. Coinfection of hepatitis B virus (HBV) and hepatitis C virus (HCV) with HIV is associated with a poor prognosis. The current study evaluated the occurrence of coinfection of HBV/HIV and HCV/HIV in Peshawar, Khyber Pakhtunkhwa, Pakistan. Methodology A prospective, observational study was conducted at Khushal Medical Center and Hayatabad Medical Complex (HMC) between February 2019 and April 2020. All patients with confirmed HIV positive serum samples aged above 18 years were eligible to apply for anonymous screening for hepatitis B and C virus markers. Sociodemographic data including patient's age, gender, marital status, occupation, employment status, and body mass index among others were documented on a predefined proforma. The presence of viral markers of HBV and HCV in HIV patients was the primary outcome of the study. Results Out of the total of 650 HIV patients, 78 (12%) had coinfection with hepatitis virus. The mean age was 42.40 ± 10.96 years. Sixty-three (80.77%) patients had coinfection with hepatitis B virus infection while 15 (19.23%) had hepatitis C coinfection. No cases of triple infections were identified. It was found that patients infected with HIV/HBV were more frequent in the age group of 30 to 45 years (36; 85.71%) while the HIV/HCV patients were older, i.e. 72.72% were older than 45 years (p<0.001). The sexual route was strongly associated with HIV/HBV group compared to HIV/HCV group [51 (89.47%) vs. six (10.53%); p<0.0001]. Conclusion The current study highlighted the rate of coinfection of HBV and HCV in HIV-infected individuals in Pakistan. We found that four-fifths of patients had coinfection with HBV while only one-fifth had coinfection with HCV. These findings are consistent with the published literature revealing that HIV/HBV and HIV/HCV are common in developing countries. Young sexually active individuals are at a significantly higher risk of acquiring HIV/HBV infection than HIV/HCV. We advocate screening for these hepatitis viral markers in patients with HIV infection as well as their sexual partners. Further large-scale, multicentre, and multistate studies should be conducted to determine the burden of these communicable diseases.
ABSTRACT
Aim Mitral valve pathology in rheumatic heart disease patients is a common cause of secondary pulmonary hypertension (PH). Our aim was to evaluate pulmonary hypertension severity as a predictor of in-hospital mortality and early complications following mitral valve replacement. Methods A retrospective review of rheumatic heart disease patients who underwent mitral valve replacement between January 2017 and August 2020 was performed. Systolic pulmonary artery pressure (sPAP) was used to classify patients as no PH (<35 mmHg), mild PH (35-44 mmHg), moderate PH (45-59 mmHg) or severe PH (>60 mmHg). Patients subjected to additional cardiac procedures (such as aortic valve replacement and coronary artery bypass grafting) were excluded from the study sample. Results The study group was composed of 159 patients (mean age: 40; 73 male, 86 female) categorized as no PH (n = 32; 20.1%), mild PH (n = 14; 8.8%), moderate PH (n = 65, 40.9%) and severe PH (n = 48, 30.2%) groups. Patient demographic data and preoperative comorbidities were comparable among the four groups. Use of intraoperative and postoperative blood products was similar in all the groups. Severe PH patients had similar in-hospital mortality (4.2%; p = 0.74) as in groups with lesser degrees of pulmonary hypertension. Likewise, increasing severity of pulmonary hypertension did not confer any significant increase in early postoperative complications, namely prolonged ICU stay (10.4%; p = 0.41), prolonged ventilation (2.1%; p = 0.70), reintubation (4.2%; p = 0.90), reopening for bleeding tamponade (6.3%; p = 0.39), new-onset renal failure (6.3%; p = 0.91), postoperative stroke (4.2%; p = 0.52) or prolonged length of stay (mean: 5.6 + 2.8 days; p = 0.49). Conclusions Increasing severity of pulmonary hypertension does not appear to have a significant impact on in-hospital mortality or early postoperative outcomes of patients undergoing mitral valve replacement.
ABSTRACT
Introduction Ventilator-associated tracheobronchitis is a condition that occurs prior to the development of ventilator-associated pneumonia among patients who have been intubated. This study aimed to determine the impact of nosocomial tracheobronchitis (NTB) related to new bacteria on the outcome in patients with chronic obstructive pulmonary disease (COPD). Methodology A prospective, observational study was conducted in the department of surgical ICU of a tertiary care hospital between May 2019 and December 2019. All patients ventilated, irrespective of age and gender, were enrolled in the study. Individuals who had nosocomial pneumonia, before or followed by NTB, were excluded. Throughout the study, endotracheal aspirates for quantitative bacterial cultures were obtained routinely on admission, weekly thereafter, and whenever NTB or nosocomial pneumonia was suspected. All data were prospectively collected by the researchers from admission day till discharge or death of the patient. The outcomes of NTB patients were compared with those without NTB. Results A total of 24 patients with NTB and 214 patients without NTB were evaluated. There were a total of 24 patients who were diagnosed with NTB and 214 patients were NTB negative. There was a dominance of the male gender in the NTB group; however, the difference was not significant. The most common complication in patients was renal failure. During hospitalization, the Aspergillus tracheobronchitis (ATB) rate was significantly higher in patients with NTB as compared to patients with no NTB, i.e., 18 (75%) vs. 80 (37.4%) (p < 0.001). The mean length of stay in patients with NTB was significantly greater than the NTB negative group (p < 0.0001). The mortality in the case group was significantly greater than in the NTB negative group, i.e., 66.67% vs. 48.50% (p = 0.03). Conclusion NTB is associated with an increased duration of mechanical ventilation and hospitalization in intensive care units. The mortality rate in the NTB group was considerably higher than in the patients who did not have NTB. Future studies can explore the interventional and management aspect of the disease, such as determining whether early administration of broad-spectrum antibiotics can help improve the prognostic outcome of patients with NTB on mechanical ventilation.
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BACKGROUND: Optical spectroscopy has been studied for biologic plausibility, technical efficacy, clinical effectiveness, patient satisfaction, and cost-effectiveness. OBJECTIVE: We sought to identify health care provider attitudes or practices that might act as barriers or to the dissemination of this new technology. METHODS: Through an academic-industrial partnership, we conducted a series of focus groups to examine physician barriers to optical diagnosis. The study was conducted in 2 stages. First, a pilot group of 10 physicians (8 obstetrician gynecologists and 2 family practitioners) was randomly selected from 8 regions of the United States and each physician was interviewed individually. Physicians were presented with the results of a large trial (N = 980) testing the accuracy of a spectroscopy-based device in the detection of cervical neoplasia. They were also shown a prototype of the device and were given a period of time to ask questions and receive answers regarding the device. They were also asked to provide feedback on a questionnaire that was then revised and presented to 3 larger focus groups (n = 13, 15, and 17 for a total N = 45). The larger focus groups were conducted during national scientific meetings with 20 obstetrician gynecologists and 25 primary care physicians (family practitioners and internists). RESULTS: When asked about the dissemination potential of the new cervical screening technology, all study groups tended to rely on established clinical guidelines from their respective professional societies with regard to the screening and diagnosis of cervical cancer. In addition, study participants consistently agreed that real-time spectroscopy would be viewed positively by their patients. Participants were positive about the new technology's potential as an adjunct to colposcopy and agreed that the improved accuracy would result in reduced health care costs (due to decreased biopsies and decreased visits). Although all participants saw the potential of real-time diagnosis, there were many perceived barriers. These barriers included changes in scheduling and work-flow, liability, documentation, ease of use, length of training, device cost, and reimbursement by third-party payers. CONCLUSIONS: Barriers exist to the dissemination of optical technologies into physician practice. These will need to be addressed before cervical screening and diagnosis programs can take advantage of spectroscopy-based instruments for cancer control.
