Delayed diagnosis of human immunodeficiency virus infection in a patient with non-specific neurological symptoms and pancytopenia: a case report

INTRODUCTION: Both non-specific presentation and asymptomatic course of human immunodeficiency virus infection lead to undiagnosed long-term persistence of the virus in a patient's organism. CASE PRESENTATION: Here, we present a case of a 31-year-old Caucasian man with non-specific neurological symptoms and pancytopenia, who was referred to an internal medicine ward for further diagnosis. Upon admission to our hospital, he denied any past risky behaviors and refused to have his blood collected for human immunodeficiency virus testing. Later, he eventually provided consent to conduct the human immunodeficiency virus test which turned out to have a positive result. The overall clinical pattern indicated an advanced-stage of acquired immunodeficiency syndrome, which contrasted with the history he had provided. CONCLUSIONS: This case report indicates the need to consider human immunodeficiency virus/acquired immunodeficiency syndrome diagnosis in patients with non-specific neurological and hematological disorders. Our report also demonstrates difficulties that can be experienced by the physician while trying to obtain both a clear history and consent to perform human immunodeficiency virus testing

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Jak być polskim Żydem i zwolennikiem syjonizmu rewizjonistycznego po 1939 r.? Rzecz o losach Jakuba Perelmana

Jakub Perelman, the author of memoirs, was born on 20 December 1902 in Warsaw. He was politically linked to the Zionist revisionists. This movement was created after the First World War thanks to the activity of Vladimir Jabotinsky. He was a poet, a soldier and a politician. Perelman’s memoirs concern his political activity, Polish-Jewish relations during the Second Polish Republic, events from the Second World War, and his views on life in People’s Poland. The last fragment of the memoir is related to Israel, where Perelman was in the early 1960s.Jakub Perelman, autor wspomnień urodził się 20 grudnia 1902 r. w Warszawie. Politycznie związany był z syjonistami – rewizjonistami. Ruch ten powstał po I wojnie światowej dzięki działalności Włodzimierza Żabotyńskiego. Był poetą, żołnierzem oraz politykiem. Wspomnienia J. Perelmana dotyczą jego aktywności politycznej, relacji polsko-żydowskich w okresie II Rzeczypospolitej Polskiej, wydarzeń z II wojny światowej, a także jego zapatrywań za życie w Polsce Ludowej. Ostatni fragment wspomnień jest związany z Izraelem, w którym J. Perelman znalazł się na początku lat 60. XX w.&nbsp

Jak być polskim Żydem i zwolennikiem syjonizmu rewizjonistycznego po 1939 r.? Rzecz o losach Jakuba Perelmana

Jakub Perelman, autor wspomnień urodził się 20 grudnia 1902 r. w Warszawie. Politycznie związany był z syjonistami – rewizjonistami. Ruch ten powstał po I wojnie światowej dzięki działalności Włodzimierza Żabotyńskiego. Był poetą, żołnierzem oraz politykiem. Wspomnienia J. Perelmana dotyczą jego aktywności politycznej, relacji polsko-żydowskich w okresie II Rzeczypospolitej Polskiej, wydarzeń z II wojny światowej, a także jego zapatrywań za życie w Polsce Ludowej. Ostatni fragment wspomnień jest związany z Izraelem, w którym J. Perelman znalazł się na początku lat 60. XX w

Incidence of tuberculosis and mycobacteriosis among HIV-infected patients — clinical and epidemiological analysis of patients from north-eastern Poland

INTRODUCTION: According to WHO data, among patients infected with HIV, tuberculosis occurs in about 30% of patients and causes approximately 25% of deaths due to AIDS worldwide. The incidence rate of tuberculosis in the Polish population was 22.2/100,000 in 2011, while the average in European Union countries in 2011 was 14/100,000. Since 1985 to 30 April 2013 HIV infection in Poland was confirmed in 16,588 patients, while the number of reported tuberculosis cases in HIV-infected individuals in 2011 was 26. The aim of this study was to assess the prevalence and clinical course of tuberculosis and mycobacterial disease in HIV-infected patients treated in the Department of Infectious Diseases and Hepatology in Białystok.MATERIAL AND METHODS: We analysed documentation of 577 HIV-infected patients, their demographic data, epidemiological status, degree of immunosuppression (T CD4 and CD8 numbers) and stage of HIV infection.RESULTS: Complete follow-up was possible in 389 patients, of whom 265 (68%) were male. Tuberculosis (TB) was diagnosed in 41 patients (10.5%) and mycobacteriosis in 4 patients (1.03%). In 19 patients (42%) HIV and TB or mycobacteriosis were diagnosed simultaneously. The median CD4 T lymphocyte count was lower in patients with a simultaneous diagnosis of HIV and tuberculosis or mycobacteriosis compared to the group in whom TB/mycobacteriosis was diagnosed later. The number of CD4 T-cells less than 50 cells/μL was found in 63.2% (12/19) of patients when HIV and TB or mycobacteriosis were diagnosed simultaneously and in 38.5% (10/26) of patients who were diagnosed with TB or mycobacteriosis later than the HIV infection (p = 0.14). The median HIV viral load in patients in whom HIV infection and tuberculosis or mycobacteriosis were diagnosed at the same time was higher than in other patients and this difference was statistically significant. Pulmonary tuberculosis was the most common form of clinical disease and accounted for 60% of all cases. Among the analysed cases with HIV and tuberculosis or mycobacteriosis coinfection, tuberculosis or mycobacteriosis was the cause of death in 8 patients, and 9 died of other causes.CONCLUSION: In our material of 389 HIV-infected patients, tuberculosis was diagnosed in 41 (10.5%) and mycobacterial diseases in 4 (1.03%). In 42% of co-infected patients (HIV+TB or mycobacteriosis) the diagnosis of both diseases was made at the same time. In these patients, a deep deficit of cellular immunity (CD4 &lt; 50 cells/μL) was observed more frequently than in patients diagnosed with TB or mycobacteriosis in the later course of HIV. HIV RNA viral load was significantly higher in the group diagnosed simultaneously than in the remaining patients with HIV and TB or mycobacteriosis coinfection.WSTĘP: Zgodnie z danymi WHO wśród pacjentów zakażonych HIV, gruźlica występuje u około 30% pacjentów i jest przyczyną około 25% zgonów z powodu AIDS na świecie. Zapadalność na gruźlicę wśród populacji polskiej w 2011 roku wynosiła 22,2/100 000, natomiast średnia zapadalności w krajach Unii Europejskiej w 2011 roku — 14/100 000. W Polsce, od 1985 roku do 30 kwietnia 2013 roku potwierdzono 16 588 zakażeń HIV, natomiast liczba zgłoszonych w 2011 roku przypadków gruźlicy u zakażonych HIV wynosiła 26 przypadków. Celem pracy była ocena częstości i objawów klinicznych gruźlicy i mykobakterioz w materiale chorych zakażonych HIV, hospitalizowanych w Klinice Chorób Zakaźnych i Hepatologii Uniwersytetu Medycznego w Białymstoku.MATERIAŁ I METODY: Analizowano dokumentację 577 chorych zakażonych HIV. Analizowano dane demograficzne, epidemiologiczne, stan układu immunologicznego w zakresie limfocytów T CD4 i CD8, fazę zakażenia HIV.WYNIKI: Pełna obserwacja możliwa była u 389 pacjentów, z których 265 (68%) to mężczyźni. Gruźlicę rozpoznano u 41 pacjentów (10,5%), mykobakteriozy u 4 pacjentów (1,03%). U 19 pacjentów (42%) rozpoznanie gruźlicy lub mykobakteriozy było równoczasowe z diagnozą HIV. Mediana liczby limfocytów T CD4 była niższa u pacjentów z równoczesnym rozpoznaniem gruźlicy i zakażenia HIV w porównaniu do grupy, u której gruźlicę rozpoznano później. Liczbę limfocytów T CD4 niższą niż 50 kom./μl stwierdzono u 63,2% (12/19) pacjentów, u których zakażenie HIV i gruźlicę (albo mykobakteriozę) rozpoznano równocześnie oraz u 38,5% (10/26) pacjentów, u których te choroby rozpoznano w późniejszym czasie (p = 0,14). Mediana wiremii HIV u pacjentów, u których zakażenie HIV i gruźlicę lub mykobakteriozę zdiagnozowano równocześnie, była wyższa niż u pozostałych pacjentów i różnica ta była istotna statystycznie. Gruźlica płuc była najczęstszą postacią kliniczną choroby i stanowiła 60% wszystkich przypadków. Wśród analizowanych przypadków pacjentów z współwystępowaniem gruźlicy lub mykobakteriozy i HIV, gruźlica/mykobakterioza była przyczyną zgonu 8 pacjentów, natomiast 9 zmarło z innych przyczyn.WNIOSKI: W badanej populacji pacjentów gruźlicę rozpoznano u 41 pacjentów (10,5%), a mykobakteriozę u 4/389 pacjentów (1,03%). W 42% przypadków wśród badanych osób rozpoznanie zakażenia HIV i gruźlicy nastąpiło równoczasowo. W tej grupie chorych częściej obserwowano głęboki deficyt odporności komórkowej (limfocyty T CD4 &lt; 50 kom./μl), a wiremia HIV RNA była istotnie wyższa niż w grupie chorych z HIV, u których gruźlicę lub mykobakteriozę rozpoznano później

Regional differences in AIDS and non-AIDS related mortality in HIV-positive individuals across Europe and Argentina: the EuroSIDA study

BACKGROUND Differences in access to care and treatment have been reported in Eastern Europe, a region with one of the fastest growing HIV epidemics, compared to the rest of Europe. This analysis aimed to establish whether there are regional differences in the mortality rate of HIV-positive individuals across Europe, and Argentina. METHODS 13,310 individuals under follow-up were included in the analysis. Poisson regression investigated factors associated with the risk of death. FINDINGS During 82,212 person years of follow-up (PYFU) 1,147 individuals died (mortality rate 14.0 per 1,000 PYFU (95% confidence interval [CI] 13.1-14.8). Significant differences between regions were seen in the rate of all-cause, AIDS and non-AIDS related mortality (global p<0.0001 for all three endpoints). Compared to South Europe, after adjusting for baseline demographics, laboratory measurements and treatment, a higher rate of AIDS related mortality was observed in East Europe (IRR 2.90, 95%CI 1.97-4.28, p<.0001), and a higher rate of non-AIDS related mortality in North Europe (IRR 1.51, 95%CI 1.24-1.82, p<.0001). The differences observed in North Europe decreased over calendar-time, in 2009-2011, the higher rate of non-AIDS related mortality was no longer significantly different to South Europe (IRR 1.07, 95%CI 0.66-1.75, p = 0.77). However, in 2009-2011, there remained a higher rate of AIDS-related mortality (IRR 2.41, 95%CI 1.11-5.25, p = 0.02) in East Europe compared to South Europe in adjusted analysis. INTERPRETATIONS There are significant differences in the rate of all-cause mortality among HIV-positive individuals across different regions of Europe and Argentina. Individuals in Eastern Europe had an increased risk of mortality from AIDS related causes and individuals in North Europe had the highest rate of non-AIDS related mortality. These findings are important for understanding and reviewing HIV treatment strategies and policies across the European region

Evaluation of CD40, its ligand CD40L and Bcl-2 in psoriatic patients

Psoriasis is a chronic, recurrent, inflammatory disease. Recent investigations indicate an autoimmune pathogenesis of the disease. Apoptosis plays an important role in the regulation of immune mechanisms in many autoimmune diseases. Although CD40, CD40L, and Bcl-2 have already been studied in psoriatic skin lesions, little is known about their circulating forms. The aim of the present study was to evaluate the serum concentrations of Bcl-2, soluble CD40 and CD40L in psoriatic patients. The study was performed using ELISA kits in 39 psoriatic patients before treatment and after two weeks of topical ointment. Data was analyzed with respect to severity of psoriasis, duration of the disease, and coexisting psoriatic arthritis. Our results revealed that serum concentrations of soluble CD40 and CD40L before and after treatment were significantly higher (p &lt; 0.01 and p &lt; 0.001) in patients with psoriasis compared to the control group. Topical treatment of psoriatic lesions with dithranol ointment failed to decrease serum of CD40 and CD40L, which has not been described until now. There was no significant difference in serum Bcl-2 concentration between the compared groups. We did not find significant differences in serum concentrations of Bcl-2, CD40 or CD40L between patients with mild or severe psoriasis, nor any correlation between disease duration and the presence of psoriatic arthritis symptoms. Our data indicates upregulation of the CD40/CD40L system in psoriatic patients despite topical treatment and suggests their possible role in the pathogenesis of psoriasis

Methods of determining indicators of similarity of 3D motion

This paper includes methods for comparing three-dimensional movements with data saved in a C3D file usingPearson's linear correlation algorithms and a mean-quadratic error. Their accuracy was also examined. The movements of a person rowing on an ergometer at a&nbsp;distance of 500 meters were recorded by motion acquisition technology. The article presents the created application used for analysis

Difficulties in the treatment of acne fulminans – case report

Introduction. Acne fulminans is the most severe form of acne. It occurs predominantly in boys in the peripubertal period. Skin lesions are accompanied by general symptoms and laboratory abnormalities. Objective. Presentation of a patient with acne vulgaris in whom after 6 weeks of treatment with isotretinoin a rapid exacerbation of acne lesions occurred. Case report. A 38-year-old patient with a history of acne was admitted to the department due to severe symptoms of acne with associated fever, loss of weight and muscle and joint pain, which developed during isotretinoin therapy. Laboratory tests showed anemia and increased inflammatory markers. After administration of systemic glucocorticosteroids partial local improvement and regression of general symptoms were achieved. Addition of isotretinoin again caused pain of spine. After therapy with lymecycline a clinical improvement was achieved. Conclusions. Acne fulminans is a rare complication of therapy with isotretinoin. Due to the coexistence of systemic symptoms and risk of disfiguring scars, early diagnosis and introduction of appropriate treatment are required