HIV screen ; Changing

Opportunistic pneumonias are major causes of morbidity and mortality in HIV infected individuals. The majority of new HIV infections in Malaysia are adults aged 20 to 39 years old and many are unaware of their HIV status until they present with an opportunistic infection. HIV associated opportunistic pneumonias can progress rapidly without appropriate therapy. Therefore a proper diagnostic evaluation is vital and prompt empiric treatment of the suspected diagnosis should be commenced while waiting for the results of the diagnostic studies. Tuberculosis, Pneumocystis pneumonia (PCP) and recurrent bacterial pneumonias are common causes of AIDS-defining diseases and are discussed in this article.

Background: Co-infection by human immunodeficiency and hepatitis C viruses (HIV/HCV) is common and results in significant morbidity and mortality despite effective antiretroviral therapies (ART). Method: A retrospective and prospective evaluation of the efficacy and safety of pegylated interferon alfa 2a/2b plus ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected patients treated in real life clinical practice in Malaysia. Results: Forty-five HIV/HCV co-infected patients with a median age (interquartile range, IQR) of 41 years (37; 47) were assessed for treatment with PEG-IFN/RBV. All except one are of male gender and the most common risk behaviour was injecting drug use. At baseline 75.5% was on ART and the median (IQR) CD4 count was 492 cells/µl (376; 621). The HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver biopsies in forty patients showed 10% had liver cirrhosis and another 50% had significant liver fibrosis. The treatment completion rate was 79.5% with 15.9% dropped out of treatment due to adverse effects (AE) or default and 4.6% due to lack of early virological response. The AE causing premature discontinuations were neuropsychiatric and haematological. The overall sustained virological response (SVR) was 63.6% with a trend towards higher SVR in GT3 compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients with bridging fibrosis plus occasional nodules or cirrhosis on liver biopsy, the SVR was significantly lower at 20% (p=0.030) compared to those with milder fibrosis. Conclusion: HIV/HCV co-infected patients can be successfully and safely treated with PEG-IFN/RBV achieving high rates of SVR except in cirrhotic patients.
HIV ; Hepacivirus

Drug and Narcotic Control ; Humans ; Marijuana Abuse ; Medical Marijuana ; Singapore

Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.

PURPOSE: To investigate the reproducibility of choroidal thickness measurements in healthy Koreans using two spectral domain optical coherence tomography (SD-OCT) instruments: Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA) and Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany). METHODS: Images were obtained in 60 eyes of 30 healthy undilated volunteers without ocular pathology in a clinical setting. The choroid was imaged in all subjects using Cirrus HD 1-line raster and Spectralis enhanced depth imaging (EDI). The choroid was measured subfoveally, 1500 microm temporal, and 1500 microm nasal to the fovea. All measurements were performed by two independent observers. One-way analysis of variance (ANOVA), Pearson correlation, and Bland-Altman analysis were used to compare measurements. RESULTS: The study group consisted of 15 males and 15 females. The mean age was 50.73 +/- 15.09 years (range, 24-75 years). There was no significant difference in the mean choroidal thickness (p > 0.05) between systems for any location. The choroidal thickness measurements using two instruments (Cirrus vs. Spectralis) were also strongly correlated (p < 0.001). CONCLUSIONS: In the present study of healthy Korean adults, good reproducibility was observed between choroidal thickness measurements of images obtained from Cirrus and Spectralis.
Adult ; Choroid ; Eye ; Female ; Humans ; Male ; Reproducibility of Results ; Tomography, Optical Coherence

PURPOSE: To characterize epidemiologically open-globe injuries and to identify prognostic factors for visual outcomes after open-globe injuries in Korea. METHODS: The medical records of 138 patients with open-globe injuries presenting to the Severance Hospital between January 2005 and June 2011 were retrospectively reviewed. RESULTS: Out of 138 patients, 85.5% were men. The types of injury included penetrating injury (44.2%), intraocular foreign body (15.9%), blunt injury (35.5%), and perforating injury (3.6%). The most common cause of injury was accidents at work (49.3%) and 60.9% of these injuries were a penetrating wound in zone I limited to the cornea. Predictors of poor visual outcome using univariate analysis included wound extended to posterior sclera, wound length of 10 mm or more, poor initial visual acuity of hand motion or less, and presence of associated ocular injuries at presentation including hyphema, lens injury, vitreous hemorrhage, and retinal detachment. Initial visual acuity and wound size were independent prognostic factors of visual outcome. CONCLUSIONS: Accidents at work are the most important cause of open-globe injuries in Korea. Accordingly, protective measures such as appropriate eyewear and safety education at work are warranted. Initial visual acuity and wound size predicted favorable visual outcome.
Cornea ; Foreign Bodies ; Hand ; Humans ; Hyphema ; Korea ; Male ; Medical Records ; Retinal Detachment ; Retrospective Studies ; Sclera ; Visual Acuity ; Vitreous Hemorrhage ; Wounds, Nonpenetrating ; Wounds, Penetrating

Purpose: To understand the pathophysiology of Best disease (BD) and autosomal recessive bestrophinopathy (ARB) by establishing an in vitro model using human induced pluripotent stem cell (iPSC). Materials and Methods: Human iPSC lines were generated from mononuclear cells in peripheral blood of one ARB patient, one autosomal dominant BD patient, and two normal controls. Immunocytochemistry and reverse transcriptase polymerase chain reactionin iPSC lines were conducted to demonstrate the pluripotent markers. After the differentiation of iPSC into functional retinal pigment epithelium (RPE), morphological characteristics of the RPE were evaluated using confocal microscopy and immunocytochemistry.The rates of fluid flow across iPSC-RPE monolayer were measured to compare apical to basal fluid transports by RPE. RNA sequencing was performed on iPSC-RPE to identify the differences in gene expression profiles, and specific gene sets were tested using Gene Set Enrichment Analysis. Results: Morphological characteristics, gene expression, and epithelial integrity of ARB iPSC were comparable to those of BD patient or normal control. Fluid transport from apical to basal was significantly decreased in ARB iPSC-RPE compared with BD iPSCRPE or control iPSC-RPE. Gene Set Enrichment Analysis confirmed that ARB iPSC-RPE exhibited significant enrichments of epithelial-mesenchymal transition gene set and TNF-α signaling via NF-κB gene set compared to control iPSC-RPE or BD iPSC-RPE. Conclusion A human iPSC model of ARB showed a functional deficiency rather than anatomical defects. ARB may be caused by RPE dysfunction following BEST1 mutation.

PURPOSE: To evaluate the efficacy and safety of primary intravitreal bevacizumab injection in stage 3 retinopathy of prematurity with plus signs. METHODS: We reviewed retrospectively the medical records of 30 eyes of 16 patients diagnosed with stage 3 retinopathy of prematurity with plus signs treated with primary intravitreal bevacizumab injection between March 1, 2011 and February 28, 2013 and followed up for at least 9 months. RESULTS: Mean gestational age was 26 + 4 weeks +/- 11 days and mean birth weight was 822 +/- 251.4 g. The locations of disease were zone II in 24 eyes and zone III in 6 eyes. Intravitreal bevacizumab injection was performed after the mean 1.3 +/- 1 day after plus signs were detected. Mean postconceptional age at treatment was 38 + 2 weeks +/- 16 days. Mean follow-up period was 16.6 +/- 6.9 months. Plus signs started to regress after the mean 4.6 +/- 2.3 days after injection and completely regressed after the mean 24.3 +/- 12.4 days. Cataract extraction was performed in 1 eye due to a cataract that appeared not associated with the injection procedure, but was regarded as a treatment failure. There were no local or systemic complications. CONCLUSIONS: Primary intravitreal bevacizumab injection in stage 3 retinopathy of prematurity with plus signs demonstrated excellent short-term efficacy and safety.
Birth Weight ; Cataract ; Cataract Extraction ; Follow-Up Studies ; Gestational Age ; Humans ; Medical Records ; Retinopathy of Prematurity* ; Retrospective Studies ; Treatment Failure ; Bevacizumab

No abstract available.
Animals ; Cattle ; Encephalopathy, Bovine Spongiform/epidemiology ; Meat/*analysis ; United States