1.Causes of death and factors associated with early death among human immunodeficiency virus (HIV)-infected persons in Singapore: pre-highly active antiretroviral therapy (HAART) and Peri-HAART.
Angela CHOW ; Jeannie TEY ; Mar Kyaw WIN ; Yee Sin LEO
Annals of the Academy of Medicine, Singapore 2012;41(12):563-570
INTRODUCTIONHighly active antiretroviral therapy (HAART) has greatly changed the epidemiology of human immunodefi ciency virus (HIV) mortality. The aim of this study is to compare the causes of death and factors associated with early death in HIV-infected persons in the pre- and peri-highly active antiretroviral therapy (HAART) periods.
MATERIALS AND METHODSWe conducted a retrospective review of 483 HIV-infected persons who were diagnosed with HIV from 1985 to 2000, and had died within 5 years of the diagnosis. We examined the temporal change in the primary causes of death between those who were diagnosed in the pre-HAART (1985 to 1995) and peri-HAART (1996 to 2000) periods, and compared the demographic and clinical characteristics of the 2 groups.
RESULTSDuring the peri-HAART period, HIV encephalopathy, cryptococcal meningitis, and lymphoma were no longer the leading causes of death. Opportunistic infections remained important causes of death. Early deaths from the peri-HAART period were older (60 years and above) at diagnosis (Adj OR 7.50; 95% CI, 1.78 to 31.58), more likely to be divorced (Adj OR 5.05, 95% CI, 1.96 to 13.02) and tended to have a low baseline CD4 cell count of <50 cells/ uL (Adj OR 2.18, 95% CI, 1.14 to 4.16) , and were more likely to have received HAART (Adj OR 5.19; 95% CI, 2.22 to 12.12) than early deaths from the pre-HAART period.
CONCLUSIONIn the peri-HAART era, HIV-infected persons who died within 5 years of diagnosis were those who were older (≥60 years), divorced, or who presented with very late-stage disease (CD4 <50) at diagnosis. More targeted public health interventions, such as targeted public health messages and outreach to increase access to HIV testing and treatment should be developed for these subpopulations.
AIDS-Related Opportunistic Infections ; mortality ; Adult ; Anti-Retroviral Agents ; therapeutic use ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Cause of Death ; trends ; Confidence Intervals ; Female ; HIV Seropositivity ; drug therapy ; immunology ; mortality ; HIV-1 ; drug effects ; immunology ; Humans ; Male ; Medical Audit ; Middle Aged ; Mortality, Premature ; trends ; Odds Ratio ; Retrospective Studies ; Singapore ; epidemiology
2.Diastolic dysfunction grading, echocardiographic and electrocardiogram findings in 50 patients with apical hypertrophic cardiomyopathy
Aslannif Roslan ; Suraya Hani Kamsani ; Hui Beng Koh ; Yee Sin Tey ; Kin Leong Tan ; Chan Ho Tham ; Mohd Saad Jalaluddin ; Mohamed Nazrul Mohamed Nazeeb ; Nay Thu Win ; Ahmad Tantawi Jauhari Aktifanus ; Malini Kerisnan ; Wan Nabeelah ; Muhd Najmi Hakim Abdul Rani ; Ai Ming Tan ; Amin Ariff Nuruddin
The Medical Journal of Malaysia 2019;74(6):521-526
Introduction: Apical Hypertrophic Cardiomyopathy (Apical
HCM) is an uncommon variant of hypertrophic
cardiomyopathy, but it is relatively more common in Asian
countries. This is a retrospective, non-randomised, single
centre study of patients with Apical HCM focusing on their
diastolic dysfunction grading, echocardiographic
parameters and electrocardiograms (ECG).
Methods: All Apical HCM patients coming for clinic visits at
the Institut Jantung Negara from September 2017 to
September 2018 were included. We assessed their
echocardiography images, grade their diastolic function and
reviewed their ECG on presentation.
Results: Fifty patient were included, 82% (n=41) were males
and 18% (n=9) females. The diastolic function grading of 37
(74%) patients were able to be determined using the updated
2016 American Society of Echocardiography (ASE) diastolic
guidelines. Fifty percent (n=25) had the typical ace-ofspades shape left ventricle (LV) appearance in diastole and
12% (n=6) had apical pouch. All patients had T inversion in
the anterior leads of their ECG, and only 52% (n=26) fulfilled
the ECG left ventricular hypertrophy (LVH) criteria. Majority
of our patients presented with symptoms of chest pain (52%,
n=26) and dyspnoea (42%, n=21).
Conclusion: The updated 2016 ASE guideline makes it easier
to evaluate LV diastolic function in most patients with Apical
HCM. It also helps in elucidating the aetiology of dyspnoea,
based on left atrial pressure. Clinicians should have a high
index of suspicion for Apical HCM when faced with deep T
inversion on ECG, in addition to a thick LV apex with an aceof-spades appearance during diastole.