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Volume 7, Emitir 9 (2016)

Artigo de Pesquisa

Nodal Donovanosis as the Sentinel Clue to Acquired Immunodeficiency Syndrome

Pratistadevi K Ramdial, Yetish Sing, Amsha Ramburan, Jayanthilall S Bagratee, Tesuven K Naidu and Bhugwan Singh

Abstract Objective: Donovanosis, caused by Calymmatobacterium granulomatis, is a recognized cause of genital ulcer disease. Extragenital donovanosis in acquired immunodeficiency syndrome (AIDS) and lymph nodes is documented rarely. The aim of this report is to highlight implications of lymph node involvement as the initial manifestation of donovanosis, especially in AIDS. Materials and methods: This is a retrospective clinicopathological 6 year study that reviewed the features of lymph node biopsies and patients presenting with nodal donovanosis. Results: Of a total of 198 patients with donovanosis, 4 patients with nodal disease were identified. Patient 1, on anti-tuberculous therapy for pulmonary tuberculosis for 2 weeks, developed subcutaneous nodules on her legs and left-sided inguinal lymphadenopathy. Biopsies confirmed erythema induratum and nodal donovanosis in the former and latter sites, respectively. Patients 2 and 3 presented with right-sided inguinal lymphadenopathy that simulated lymphoma. Lymph node biopsy confirmed donovanosis. Further examination on follow-up, confirmed ulcers on the cervix and penis, in patients 2 and 3, respectively. Biopsies of these genital ulcers demonstrated donovanosis in both patients. Patient 4 presented with a left-sided neck mass, biopsy of which confirmed nodal donovanosis. Subsequent biopsy of a pre-auricular ulcer and of the cervix confirmed donovanosis. HIV seropositivity and AIDS were confirmed in all patients. Patient 1 died of pulmonary tuberculosis while disease resolution was achieved in the others following 4-6 weeks of trimethoprim-sulfamethoxazole treatment. Conclusion: Heightened clinicopathological recognition of nodal donovanosis, lymph node biopsy and careful histomorphological assessment thereof are pivotal, not only for diagnostic confirmation of nodal donovanosis and its distinction from other common nodal infections, especially in the AIDS context, but also as a sentinel clue to genital donovanosis, HIV infection and AIDS.  

Artigo de Pesquisa

Patterns of Presentation in Gonococcal Urethritis and Assessment of Antibiotic Sensitivity in Gonorrhea

Khawer Saleem and Waqar Azim

Objective: To see various features of Gononcoccal Urethritis and assess the results of Gram stain and culture tests in cases of Gonorrhea and to see the antibiotic resistance pattern in them, in our local population (PNS Shifa hospital Karachi, Pakistan). Design: Prospective case series. Place and duration of study: Skin department of PNS Shifa Hospital Karachi, Pakistan. June 2004 to December 2007. Materials and methods: The study was carried out in the outpatient dermatology department of PNS Shifa hospital Karachi during the period from June 2004 to Dec 2007. It was a prospective study. One hundred clinically suspected patients of Gonococcal urethritis were included in the study. Detailed history including history of sexual contact was taken. General and systemic physical examination was carried out in all the patients. Dermatological examination including examination of external genitalia was also done. In all these patients following investigations were carried out. Urine complete examination ,complete blood counts, pus sample was collected from external urethral meatus by two sterile inoculating loops on to a clean glass slide for Gram staining which was seen under the microscope for the presence of gram-negative diplococci. The other loop was inoculated onto chocolate agar plate and was incubated in an atmosphere of 5% CO2 at 37ºC for 24-48 h. The growths obtained were identified with colony morphology, Gram staining, oxidase reaction and rapid sugar fermentation. The Gonococci isolated were tested for antibiotic sensitivity using modified Kerby buer technique. The antibiotics included Penicillin G, Tetracycline, Cefotaxime, Cefuroxime, Ceftriaxone and Ciprofloxacin. HIV test was done in all patients. The results of two types of tests and their merits and demerits were assessed and compared. Results: A total of 100 patients having urethral discharge and dysuria were studied. All the patients were males. The ages varied from 20 to 40 years, the average being 29.2 years+5.8 years. History of illicit sexual exposure was elicited in 43 (43%) patients. The duration of period of symptoms ranged between 4 and 30 days with a mean of 12.8 days and a median of 12 days. The patients with gonorrhea presented with purulent discharge in 66 (66%) cases, and dysuria in 49 (49%) cases. No case had anal or oral symptoms. Examination showed a reddened external urethral meatus in 53(53%) cases. Eighty seven (87%) cases showed intracellular diplococci on direct microscopy of Gram stained smear. Sixty-two (62%) cases showed growth of gonococci on culture of urethral pus. No case was seen to be HIV positive. Tetracycline resistance was seen in 34(55%) strains. Penicillin resistance was seen in 25 (41%) strains of Neisseria Gonorrhea. Five strains (11.5%) showed resistance to Ciprofloxacin. No resistance was seen with Cephalosporins. Conclusion: Gram staining and culture for Neisseria Gonorrhea are both useful diagnostic tests for Gonococcal urethritis. Drug resistance of Neisseria Gonorrhea is high with various antibiotics except for Cephalosporins stressing the need for culture based therapy and enthusiastic prevention of Gonorrhea in our society.
Artigo de Pesquisa

Stigma towards People Living with HIV/AIDS (PLWAs) among Adolescents of Riyadh, Kingdom of Saudi Arabia

Hafsa Raheel

Background: After three decades of fight with HIV/AIDS in the Kingdom of Saudi Arabia (KSA), its control remains a challenge. Stigma against PLWAs is a major barrier to its control. Objective: To assess the stigma and associated factors, towards PLWAs in Riyadh, Saudi Arabia. Materials and methodology: Cross-sectional study using a structured self-administered questionnaire was conducted among 713 adolescents (15–20 years). Descriptive analysis and adjusted odds ratio (OR) was calculated using SPSS. Results: More males were of the view of; ending friendship with people infected with HIV, they should be isolated; kept out of school and moved out of the house. Females were willing to work with PLWAs. These stigmatizing attitudes were significantly related to lack of knowledge regarding HIV/AIDS. Conclusion and recommendations: Educated adolescents in Riyadh have stigmatizing attitudes towards PLWAs. There is a great need to formulate interventions providing in depth knowledge regarding HIV transmission and prevention and to focus on changing people's negative attitudes against PLWAs.
Comunicação curta

IL28B and ITPA Single Nucleotide Polymorphisms in a Cohort of Patients with HCV and HCV/HIV, Southern Brazil

Avanzi VM, Vicente BA, Gomes-da-Silva MM, Vidal LRR, Nogueira MB, Tuon FF and Raboni SM

Objective: The aim of this study is to describe the single nucleotide polymorphisms (SNP) in human genes for IL28B and ITPA of HIV/HCV coinfected patients followed at a referral Hospital of Universidade Federal do Paraná (UFPR). Methods: A cross-sectional study was carried out. HIV/HCV coinfected and HCV monoinfected patients were enrolled. Clinical and epidemiological data from medical records were reviewed, and peripheral blood was collected to analyze the IL28B and ITPA SNPs. Results: A total of 37 HCV- and 41 HCV/HIV-positive subjects were included in the study, 13 (35.1%) monoinfected subjects were previously treated, 12 (92.3%) with PEG-INFα/RBV and of these, 8 (61.5%) had sustained virological response (SVR). Regarding HCV/HIV coinfected patients, 23 (56.1%) received treatment with PEG-INFα/RBV and 12 (52.1%) had SVR. IL28B CC genotype was found in all HCV monoinfected patients and in 56.5% of coinfected subjects. Regarding ribavirin-induced anemia, all patients showed the ITPA SNP favorable for this event, and anemia was present in 38.5% of monoinfected and in 65.2% of coinfected patients. Conclusion: With the availability of direct-acting antivirals (DAAs) for the treatment of chronic infection by the hepatitis C virus, free-INF regimens have been implemented worldwide. However, in the setting of HIV/HCV coinfection ribavirin will continue to compose some therapeutic schemes. Thus, tests related to genetic markers that influence the response to HCV treatment should be recommended in pretreatment, since results would benefit both the patient and the public healthcare system, guiding rational drug use in situations where responses to treatment are particularly low and adverse effects are high.
Relato de caso

LGBTI-Psychosocial Services and Support Adolescents and Young People in Gauteng, Pretoria South Africa: Profiling the Psychosocial Support Services of OUT (Servicing the Lesbian, Gay, Bisexual and Transgender Community)

Leon Swartz and Gerda Erasmus

The lesbian, gay, bisexual, transgender and intersex (LGBTI) case study was undertaken by the National Population Unit (NPU) to assess the activities that is run by the organisation OUT. This study form part of 10 such studies with regard to youth which was undertaken by the NPU. The study made use of a mix method approach where the qualitative aspect was the dominant method. The main aim of the study was to assess how the organisation OUT provide Psychosocial Support Services to the (LGBTI) community including HIV counselling, general lifestyle counselling as well as advice and support. This programme focuses on the psychosocial well-being of LGBTI individuals and communities. This psychosocial support services forms part of the mission and vision of OUT. The study found that LGBTI individuals still experience stigma and discrimination although the South African constitution and Bill of Rights ensure the protection of the rights of all South African citizens. The study made some recommendations in this regard.
Artigo de Pesquisa

Factors Affecting Voluntary Counseling and Testing VCT among Ambo Secondary School Students, West Shoa, Ethiopia

Teka Girma, Diriba Tolera and Fenet Melaku

Background: Acquired immunodeficiency syndrome (AIDS) is a chronic infection disease which is by human immune suppressive virus. HIV slowly attacks the immune system, the body’s defense against infection, leaving an individual vulnerable to variety of other in infections and certain malignancies which eventually causes death. There are various options in reducing of this pandemic such as voluntary counseling and testing, anti-retroviral therapy and education for behavioral change. The objective was to assess the knowledge, attitude and practice HIV voluntary counseling and testing among Ambo secondary school students. Methods: Across sectional quantitative study to be from December 2015 to January 2016 in Ambo secondary school. The data was entered, coded and analyzed using SPSS 20. The results are presented using numbers, percentages, tables and charts. Results: From the total respondents 43.4% were male and 56.6 were females and 62.3% were grade 9 and 37.7 were grade 10. Majority of the respondent’s age were ranged from 15-19 years that was 95.08%. Almost all, ninety eight (98%) were Oromo in ethnicity, 59.84% were protestant in religion. Majority of respondents to knew the mode of transmission and protection. Out of total respondents 48.36% were undergone VCT and 69.7% were willingness to undergo VCT. When compared with a study conducted in Addis Ababa showed 55% study subject had HIV test, 63% to wish to have HIV testing and 45% who did not have HIV test. Majority of respondents were choice hospital 50 (40.87%) and health center 50 (40.98%) on place of VCT. Conclusion: The needs of adolescents were important to provide youth-friendly services and practice of the study subjects about HIV/AIDS and VCT.
Artigo de Pesquisa

In Silico Identification and Molecular Validation of Putative Antimicrobial Peptides for HIV Therapy

Marius Belmondo Tincho, Musa Nur Gabere and Ashley Pretorius

Objective: Despite the effort to reduce the rate of HIV infection, AIDS still remains the major cause of death around the world, predominantly in Sub-Sahara Africa. Neither a cure, nor an HIV vaccine has been found to date and the disease can only be managed by using High Active Antiretroviral Therapy (HAART). The need for non-toxic regiments has brought about the necessity for additional HIV treatment to lower mortality rates. Antimicrobial Peptides (AMPs) had proven to be a promising therapeutic agent against HIV. The aim of this research was to identify AMPs, which binds gp120 at the area where gp120 interacts with CD4+, to prevent HIV invasion and HIV replication. Method: Putative AMPs were identified using an In Silico mathematical algorithm, Profile Hidden Markov Models (HMMER). The AMPS 3-D structures was carried out using I-TASSER and the modelled AMPs were docked against the HIV protein gp120 using PATCHDOCK. Subsequently, molecular method was used to show the anti-HIV ability of these putative to validate by inhibiting HIV-1 replication. Results: The In Silico results showed that 30 putative anti-HIV AMPs were identified. Furthermore, out of the 10 best ranked putative AMPs, based on their E-value, selected for In Silico docking, two AMPs proved to inhibit HIV-1 NL4- 3 with maximal effective concentration (EC50) values of 37.5 μg/ml and 93.75 μg/ml respectively. This result looks promising since 150 μg/ml AMPs could not achieved 80% toxicity of the human T cells, thus high Therapeutics Index (TI) might be obtained if 50% cytotoxic concentration (CC50) is established. Conclusion: The ability of these AMPs to inhibit HIV replication justifies the usage of HMMER in design and discovery. Additionally, these AMPs pave the way for the design of anti-HIV peptide-based drugs.

Artigo de Pesquisa

Mother to Child HIV Transmission and Its Predictors among HIV-Exposed Infants: A Retrospective Follow-Up Study in Southwest Ethiopia

Belay Birlie, Tadele A Diriba, Kibrealem Sisay, Abdisa Gurmessa, Dinberu Seyoum and Mulualem Tadesse

Despite the marked progress in coverage of prevention of mother to child HIV transmission (PMTCT) programs, mother to child HIV transmission (MTCT) rate is not well documented in Southwest Ethiopia. A retrospective follow up study was carried at Jimma University Specialized Hospital PMTCT clinic to quantify MTCT rate and its predictors among HIV-exposed infants. Data were extracted from medical records of HIV-infected women and exposed infants between September 2010 and December 2012. Univariate and multivariate logistic regression analyses were carried out to identify potential factors predicting MTCT. A total of 146 infants born to HIV-infected mothers were included in the analysis. Out of 146 infants, 25 (17%, 95% CI: 11%-23.2%) were HIV positive. In the adjusted multivariate logistic regression analysis, mothers being on late AIDS stage (AOR=5.8; 95% CI: 1.6-16.5), absence of maternal PMTCT interventions (AOR=4.9; 95% CI: 1.4-16.5), home delivery (AOR=8.1; 95% CI: 2.1-31.9) and mixed infant feeding (AOR=5.6; 95% CI: 1.4-41.2) were independently associated with MTCT. We documented a high rate of MTCT among exposed infants in Southwest Ethiopia. All pregnant HIV positive mothers should be enrolled in PMTCT programs at earlier stage and exclusive breast feeding should be encouraged so as to decrease MTCT.

Artigo de Pesquisa

Growth of Infants Born to HIV-Infected Women in Madurai, South India

Poorana Ganga Devi Navaneethapandian, Mahalakshmi Rajendran, Ramesh K, Thiruvalluvan Elangovan, Sudha Subramanyan, Rajapandian Thanapandy, Prabhakaran Rathinam and Soumya Swaminathan

Objective: To compare the growth patterns of HIV-infected and HIV-exposed, uninfected infants. Methods: Design: Prospective cohort study. Setting: Clinic of National Institute for Research in Tuberculosis, Madurai located in the Governement Rajaji Hospital (GRH) campus. Participants: Infants born to HIV-infected women in GRH, Madurai between January 2006 to October 2008. Infants were excluded if they were too ill, or had congenital abnormalities. Intervention: Baseline socio-demographic details and feeding patterns were recorded. Clinical assessment, anthropometric measurement, complete blood count, CD4 and CD8 counts and DNA PCR testing were performed. Anthropometric assessments and immunology profile were repeated once in 3 months till 24 months of age. Main outcome: Rate of change of weight and CD4% in HIV exposed and infected infants. Results: Of 76 infants enrolled, 25 were found to be HIV-infected by DNA PCR and fourteen of them died (11 before their first birthday). Weight gain in HIV-infected infants was 0.144 kg ((95% CI: -0.237, -0.051), P=0.003) less per month compared to negative infants, after adjusting for age, gender and feeding practice. Similarly, when compared to HIV negative infants, the decline in CD4 percentage was 3.1% ((95% CI: -4.735, -1.461), P<0.001) more in HIV positive infants. Changes in height, CD4 count, head circumference and haemoglobin were not associated with HIV status. Conclusion: Growth faltering occurs early in life in HIV-infected infants and its identification is important for developing appropriate treatment and nutritional management strategies. Mortality is high in the absence of early antiretroviral treatment.

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