Tuberculosis infection in HIV vs. non-HIV patients.

OBJECTIVES: Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. METHODS: The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. RESULTS: This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. CONCLUSIONS: There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.

Pneumocystosis pneumonia: A comparison study between HIV and non-HIV immunocompromised patients.

Pneumocystis pneumonia (PCP) is caused by the fungus Pneumocystis jirovecii, and its incidence has been on the rise in immunosuppressed patients without HIV. We performed a cross sectional study in patients with PCP and assessed demographic, clinical presentation and outcome measures such as mechanical ventilation and mortality differences between HIV and non-HIV patients. The two groups were statistically significantly different, with the HIV group being younger (45.5 years vs 55.9 years, p-value 0.001) and mostly composed of male patients (69% vs 31%, p-value <0.001). Also, the HIV patients had higher percentage of respiratory complaints (90% vs 68%, p-value 0.02) and lactate dehydrogenase elevation (73% vs 40%, p-value 0.001). In contrast, non-HIV patients had worse outcomes with higher incidence of invasive mechanical ventilation (23% vs 46%, p-value 0.005) and in-hospital mortality (13% vs 37%, p-value 0.002). These results reflect the literature and should raise awareness to a potentially fatal medical situation of increasing incidence.

Myelodysplastic syndromes, from French-American-British to World Health Organization: comparison of classifications on 431 unselected patients from a single institution.

In 1999 a working group of the World Health Organization (WHO) published a revised classification for myelodysplastic syndromes (MDS): RA, RARS, refractory cytopenia with multilineage dysplasia (RC+Dys), RAEB I and II, del (5q) syndrome, and MDS unclassifiable. Chronic myelomonocytic leukemia (CMML) and RAEB-t were excluded. Standard French-American-British (FAB) and new WHO classifications have been compared in a series of patients (n = 431) from a single center, analyzing morphologic, clinical, and cytogenetic data. According to the WHO findings, dysgranulocytopoiesis or dysmegakaryocytopoiesis only were found in 26% of patients with less than 5% medullary blasts. These patients are thus unclassified and should remain in the subgroups RA and RARS. Splitting of heterogeneous RAEB into 2 subgroups according to blast count was supported by a trend to a statistically significant difference in the single-center study population. Patients with CMML whose white blood cell counts are above 13 000/microL may be excluded from the MDS classification, as warranted by WHO, but a redistribution of patients with dysplastic CMML according to medullary blast count leads to more heterogeneity in other WHO subgroups. Although the natural courses of RAEB-T and acute myeloid leukemia (AML) with dysplasia are different, comparable median survival durations after treatment in patients with RAEB-T and AML were in favor of the proposed 20% medullary blast threshold for AML. The homogeneity of subgroups was studied by evaluating prognostic scores. A significant shift into lower IPSS risk groups was evident in the new classification. These data cannot provide evidence for the new WHO proposal, which should not be adopted for routine clinical use at present. Some of its aspects can provide a starting point for further studies involving refined cytogenetics and clinical results.

Dysplastic versus proliferative CMML--a retrospective analysis of 91 patients from a single institution.

In chronic myelomonocytic leukemia (CMML) segregation of two subtypes has been suggested depending on WBC count-myelodysplastic (MD-CMML) and myeloproliferative (MP-CMML). In a retrospective analysis of 91 (60/31) previously untreated CMML patients, we compared the presenting clinical, haematological, laboratory and bone marrow features and examined the clinical impact of this reclassification. LDH values and bone marrow cellularity were significantly increased in MP-CMML. Median survival was significantly longer for patients with MD-CMML, progression rate was higher for MP-CMML. Patients with MD-CMML had longer median preleukemic duration; after transition to AML, MP-CMML patients had longer median survival. In MDS phase anemia was more common in MP-CMML and thrombocytopenia more common in MD-CMML whereas transfusion rates showed no difference. Evaluation of prognostic scoring systems for both groups confirmed that patients' characteristics and outcome could be well compared. Our data suggest that segregation into MD-CMML and MP-CMML is justified.

Mapping of leukaemia-associated breakpoints in chromosome band 3q21 using a newly established PAC contig.

Chromosome aberrations affecting band 3q21 are associated with a particularly poor prognosis in patients with acute myeloid leukaemia. To facilitate the molecular characterization of such rearrangements, we established a PAC contig covering the relevant genomic region. Using these PACs as probes in fluorescence in situ hybridization (FISH) experiments, we showed that a number of 3q21 breakpoints in patient samples map to a previously defined 'breakpoint cluster region'. Others, however, are located at varying distances centromeric of it. These results have important implications in the search for genes affected by 3q21 rearrangements.

Cross-validation of prognostic scores in myelodysplastic syndromes on 386 patients from a single institution confirms importance of cytogenetics.

In myelodysplastic syndromes (MDS) different prognostic risk analysis systems based on clinical and morphological data are used for predicting survival. Data on diagnostic and prognostic relevance of karyotype aberrations have prompted the development of scores including cytogenetics. The aim of this study was to assess and compare the explanatory power of different scoring systems and to assess the additional explanatory power of cytogenetics by evaluating the clinical and laboratory data of MDS patients from a single institution. Data of 386 MDS patients was available, with cytogenetic analysis at time of diagnosis in 256. Clinical/morphological scores: Bournemouth, modified Bournemouth and Düsseldorf; and scores including cytogenetics: Lausanne-Bournemouth, Lille and the International Prognostic Scoring System (IPSS), were calculated and their predictive power was compared for both overall survival and preleukaemic duration. Each of the scores had significant correlation on both endpoints. Calculating the prognostic value of different cytogenetic aberrations we found that differentiating between evidence for no aberration, single aberrations excluding chromosomes 7 and 8, aberrations on chromosomes 5, 7 or 8 and complex aberrations was important. These data were incorporated in a 'prognostic index cytogenetics' (pi score). Cytogenetic scores significantly improved the prognostic value of the best clinical/morphological score in regard to both overall survival and preleukaemic duration. In conclusion, our data further stress the importance of cytogenetics for predicting prognosis in MDS.

Trisomy 13 is associated with poor prognosis in idiopathic myelofibrosis with myeloid metaplasia.

We report a case of idiopathic myelofibrosis with trisomy 13 as the sole clonal aberration, as demonstrated by metaphase cytogenetics. The clinical course was especially poor in this case, with death in blast crisis occurring within two weeks from diagnosis. The dismal outcome bears striking similarity to two previous cases of idiopathic myelofibrosis and trisomy 13 reported in the literature. Therefore trisomy 13 may be a predictor of a rapidly fatal outcome in this otherwise indolent disease. Fluorescence in situ hybridisation (FISH) with a chromosome 13 specific probe may enhance the detection of this aberration, since only 50% of cases of idiopathic myelofibrosis are karyotyped successfully using conventional techniques.

NaOH treatment of vacuum-plasma-sprayed titanium on carbon fibre-reinforced poly(etheretherketone).

Carbon fibre-reinforced polyetheretherketone (CF-PEEK) substrates were coated with titanium by vacuum-plasma-spraying and chemically treated in 10 M sodium hydroxide (NaOH) solution. After NaOH treatment, the specimens were immersed in simulated body fluid (SBF) containing ions in concentrations similar to those of human blood plasma. Scanning electron microscopy, energy-dispersive X-ray analysis and diffuse reflectance Fourier transformed-infrared spectroscopy were used to analyse the NaOH-treated VPS-Ti surface and the calcium phosphate layer formed during immersion in SBF. It was observed that a carbonate-containing calcium phosphate layer was formed on the NaOH-treated VPS-Ti surface during immersion in SBF, whereas no calcium phosphate precipitation occurred on the untreated surfaces. It is therefore concluded that vacuum-plasma-spraying with titanium and subsequent chemical modification in 10 M NaOH solution at 60 degrees C for 2 h is a suitable method for the preparation of bioactive coatings for bone ongrowth on CF-PEEK.

Topographical characterization and microstructural interface analysis of vacuum-plasma-sprayed titanium and hydroxyapatite coatings on carbon fibre-reinforced poly(etheretherketone).

In the present study, topographical characterization and microstructural interface analysis of vacuum-plasma-sprayed titanium and hydroxyapatite (HA) coatings on carbon fibre-reinforced polyetheretherketone (CF/PEEK) was performed. VPS-Ti coatings with high roughness values (Ra=28.29+/-3.07 microm, Rz=145.35+/-9.88 microm) were obtained. On this titanium, intermediate layer HA coatings of various thicknesses were produced. With increasing coating thickness, roughness values of the HA coatings decreased. A high increase of profile length ratio, Lr, of the VPS-Ti coatings (Lr=1.45) compared to the grit-blasted CF/PEEK substrate (Lr=1.08) was observed. Increasing the HA coating thickness resulted in a reduction of the Lr values similar to the roughness values. Fractal analysis of the obtained roughness profiles revealed that the VPS-Ti coatings showed the highest fractal dimension of D=1.34+/-0.02. Fractal dimension dropped to a value of 1.23-1.25 for all HA coatings. No physical deterioration of the CF/PEEK substrate was observed, indicating that substrate drying and the used VPS process parameter led to the desired coatings on the composite material. Cross-section analysis revealed a good interlocking between the titanium intermediate layer and the PEEK substrate. It is therefore assumed that this interlocking results in suitable mechanical adhesive strength. From the results obtained in this study it is concluded that VPS is a suitable method for manufacturing HA coatings on carbon fibre-reinforced PEEK implant materials.

Cytogenetic findings in 175 patients indicate that items of the Kiel classification should not be disregarded in the REAL classification of lymphoid neoplasms.

Cytogenetics have proved to be a valuable tool for classifying systemic lymphatic neoplasms, as this technique allows different stem line aberrations and clonal developments to be distinguished. This study was designed to analyze how far groups defined according to common cytogenetic features correlated with their position in either the Kiel (KC) or the REAL classification. Cytogenetic analyses were performed on material from 175 patients with lymphoid neoplasms (LN). Samples were prepared from peripheral blood and bone marrow in acute lymphoblastic leukemia (ALL), from bone marrow in multiple myeloma (MM), and from lymph node biopsies in lymphomas. The results of this study support the inclusion of ALL, MM, and extranodal lymphomas into a comprehensive classification, because their chromosomal aberrations were always characteristic for LN. From the cytogenetic point of view, a subgroup of ALL appears as a leukemic manifestation of lymphoblastic lymphoma. MM have structural aberrations of chromosomes 1, 11, and 14 and secondary aberrations of chromosomes 3, 6, 7, 12, 13, and 18, all of which are characteristic for lymphatic disease. The groups with follicle center cell lymphoma and mantle cell lymphoma correlate well with our results both in the low-grade subtype and in the blastic variant type, the majority of cases demonstrating t(14; 18) and its variants and t(11; 14), respectively. In contrast, the group of diffuse large B-cell (DLB) lymphomas proved to be heterogeneous on the basis of our cytogenetic results. Accordingly, we would suggest keeping the immunoblastic lymphoma (IB) subtype defined by the KC. IB demonstrates no stem line aberration in common with any other group and seems to be characterized by stem line aberrations involving chromosomes 3 and 6. As some DLB lymphomas have a t(14;18) or variant translocations involving chromosome 18, they should either be separated as a subgroup or included into the group of follicle center lymphomas.

[Synthesis and alpha-adrenolytic activities of 2-(1,4-benzodioxan-2-yl- methyl)-6,7-dimethoxy-1,2,3,4-tetrahydroisoquinoline derivatives]. / Synthese und alpha-adrenolytische Wirkungen von 2-(1,4-Benzdioxan-2-yl- methyl)-6,7-dimethoxy-1,2,3,4-tetrahydroisochinolinderivaten.

The synthesis of the title compounds starting from 2-Chlormethylbenzdioxan and Tetrahydroisochinolines is presented. Their actions on the platelet aggregation and the inhibition of alpha-adrenoceptors at the isolated rabbit aorta and the vas deferens of the guinea pig were investigated.

Liver structure and function during long-term treatment with cyproterone acetate.

Animal experiments and clinical observations have raised the question of liver function in patients on long-term, high-dose administration of sex steroids. The effective treatment of androgenisation demands the prolonged administration of the antiandrogen cyproterone acetate (CPA), which is also a highly effective progestogen. Biochemical tests of liver function and ultrasonographic examinations were performed in 77 women who had been treated with CPA given in the reverse sequential scheme - 100 mg CPA/day from the 1st-10th day combined with 2 mg CPA + 0.05 mg ethinylestradiol/day from the 1st-21st day of each treatment cycle - for 3 to 11 years. No disturbances of the liver structure or function were found.

[Sonography and pharmacoangiography of the pancreas (author's transl)]. / Sonographie und Pharmakoangiographie des Pankreas.

Real-Time-Sonography and pharmacoangiography with vasodilating drugs was performed in 63 patients with suspected pancreatic disease. Confirmation of the pancreatic lesion could be obtained in 41 cases by the symptomatology, pancreatic function test, autopsy, operation, laparoscopy with fine-needle-biopsy and by the roentgenologic visualization of pancreatic calcifications. Considering the relatively advanced disease of pancreatic carcinoma in our six patients the sonographic diagnosis was correct in all of them and with pharmacoangiography we failed on one case. In chronic pancreatitis correct diagnostic results with pharmacoangiography could be obtained in 8 of 18 cases and with sonography in 14 of 18 patients. In this study sonography showed certain advantages in comparison with angiography, but both methods were complementary and a better result in the differential diagnosis between chronic pancreatitis and pancreatic carcinoma could be achieved.

[Considerations on the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy (author's transl)]. / Zur pathogenetischen Einordnung der akuten hinteren multifokalen plakoiden Pigmentepitheliopathie.

Considerations brought about by one of the authors own cases are presented on the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy. Two theories are hitherto mainly discussed: (1) Primary changes in the pigment epithelium are pathogenetically responsible, (2) primary changes in the choriocapillaris cause secondary changes in the pigment epithelium. The authors, led by their own observations tend to place the disease in the group of primary diseases of the pigment epithelium.

Optic nerve hypoplasia.

Optic nerve hypoplasia is rarely met in otherwise normal eyes. Three unilateral cases of patients with small optic disks, reduced visual acuity, and convergent squint on the affected eye are presented. The anomaly is probably caused by failure of development of the ganglion cell layer of the retina causing a small optic nerve head with normal central vessels. Inheritance or induction by drugs could not be found in our cases.

[Cytarabine treatment of herpes zoster (author's transl)]. / Zostertherapie mit Cytarabin.

Systemic treatment of herpes zoster becomes possible by cytarabine. Complications of herpes zoster ophthalmicus such as relapsing corneal ulceration, perforation or scarring, secondary glaucoma, Argyll Robertson pupils, extraocular muscle palsies, and optic atrophy, as well as postherpetic neuralgia can be prevented by the use of this drug. For this reason the authors believe treatment with cytarabine to be the therapy of choice in herpes zoster.