FANCMi immunohistokeemiline ekspressioon väheneb eesnäärmevähi stroomas sõltuvalt diferentseerumisastme rühmast

Eesti Arst 2021; 100(5):324 &nbsp

HIV resistance to antiretroviral drugs: Mechanisms, genotypic and phenotypic resistance testing in clinical practice

HIV resistance to antiretroviral agents is a major contributory cause of treatment failure. The dynamics of HIV replication, together with patient-, physician-, and drug-related factors, lead to emergence of HIV resistant strains in most of the patients. Phenotypic assays look for an increase in the antiretroviral drug (ARV) concentration that inhibits 50% of the growth of the tested HIV strain (IC50), comparatively with a reference strain cultivated in parallel. Genotypic tests detect resistance mutations in the reverse transcriptase and protease genes by comparing the gene sequences of a resistant virus to those of a wildtype strain that has previously been described. The efficacy of each ARV class and each individual ARV is threatened by specific mutations and resistance mechanisms. In retrospective studies of genotypic or phenotypic resistance testing, baseline resistance tests results were correlated with virological outcomes. There is some evidence from prospective studies that resistance testing may have some benefits when used to choose salvage regimens. However, problems in the areas of test interpretation, patient compliance, availability of active drugs, and technical test performance limit the usefulness of resistance testing in clinical practice. This article reviews the mechanisms underlying HIV resistance, the principles of phenotypic and genotypic tests, and the use of these tests in clinical practice

Factors Predicting Suicide among Russians in Estonia in Comparison with Estonians: A Case-Control Study

Aim: To explore differences between suicide victims among Russian immigrants in Estonia and native Estonians, according to socio-demographic background, substance use pattern, and recent life events to find out immigration-specific factors predicting suicide. Methods: The psychological autopsy study included 427 people who committed suicide in 1999 and 427 randomly selected controls matched by region, gender, age, and nationality. Results: The only variable that differed significantly between Russian and Estonian suicide cases was substance use pattern. Logistic regression models showed that factors associated with suicide for both nationalities were substance dependence and abuse (Russians: odds ratio [OR], 12.9; 95% confidence interval [95% CI], 4.2-39.2; Estonians: OR, 8.1; 95% CI, 3.9-16.4), economical inactivity Russians: OR 5.5; 95% CI, 1.3-22.9; Estonians: OR, 3.1; 95% CI, 1.3-7.1), and recent family discord (Russians: OR, 3.2; 95% CI, 1.1-9.9; Estonians: OR, 4.5; 95%, CI, 2.1-9.8). The variables that remained significant in the final model were having no partner (Estonians: OR, 3.0; 95% CI, 1.6-5.5), being unemployed (Estonians: OR, 5.5; 95% CI, 2.0-15.4), and being an abstainer (Estonians: OR, 6.7; 95% CI, 2.5-17.6) for Estonians, and somatic illness (Russians: OR, 4.1; 95% CI, 1.4-11.7), separation (Russians: OR, 32.3; 95% CI, 2.9-364.1), and death of a close person (Russians: OR, 0.2; 95% CI, 0.04-0.7) for Russians. Conclusion: Although the predicting factors of suicide were similar among the Estonian Russians and Estonians, there were still some differences in the nature of recent life events. Higher suicide rate among Estonian Russians in 1999 could be at least partly attributable to their higher substance consumption