Prevention Of Opportunistic Infections Research Articles

Newly Diagnosed HIV Infection in Patients with Progressive Multifocal Leukoencephalopathy (Literature Review and Clinical Cases)

In recent years, in the Kyrgyz Republic, HIV infection is more often detected at an advanced stage based on of advanced opportunistic infections. Late detection of people living with HIV causes disability and death due to untimely initiation of antiretroviral therapy and late prevention of opportunistic infections. The most difficult secondary disease to diagnose in the advanced stage of HIV infection is progressive multifocal leukoencephalopathy, often with an unfavorable outcome. This article presents two newly identified clinical cases of HIV infection in patients with difficult-to-diagnose progressive multifocal leukoencephalopathy, which may increase doctors' alertness to these diseases.

Adolescent’s and youth’s adherence to antiretroviral therapy for better treatment outcome and its determinants: multi-center study in public health facilities

BackgroundLow-adherence to Anti-retroviral therapy (ART) negatively affects the clinical, immunological, and virologic outcomes of patients. Adherence is the most important factor in determining Antiretroviral Therapy (ART) treatment success and long-term viral suppression which ultimately reduces morbidity and mortality. Thus, this study aimed to identify factors affecting adherence to antiretroviral therapy among adolescents and youth living with HIV.MethodsFacility-based cross-sectional study was conducted from March 21 to April 30, 2020 among 316 respondents in selected five high-loaded hospitals with adolescent and youth clients using systematic random sampling technique. Patients’ adherence was assessed when they had reportedly taken 95% or higher of their prescribed antiretroviral drugs in the five days before the interview. Data were collected, entered into EPI Data and exported to SPSS for analysis. Binary logistic regression was used to see the association between dependent and independent variables.ResultsIn this study, 316 respondents participated in the study, with a 99.7% response rate. The mean age of respondents were 17.94 years and majority of them (58.5%) were females. The overall ART adherence among adolescents and youths was found to be 70.6%. Being female (AOR = 0.323, 95% CI, 0.164–0.637), presence of opportunistic infection (AOR = 0.483, 95% CI, 0.249–0.936), taking additional medication beside ART (AOR = 0.436, 95% CI, 0.206–0.922) and availability of youth friendly services within the facility (AOR = 2.206, 95% CI, 1.031–4.721) were found to be predictors.ConclusionThe adherence rate in this study was low which is below the recommended adherence level. Being female, taking additional medication beside ART and presence of opportunistic infection were determinants of adherence. As a result, significant work must be done on opportunistic infection prevention through health education and promotion for screening and risk reduction. Similarly, adolescents and youths service integration with the ART Clinic is strongly advised.

2222. A study of the role of trimethoprim-sulfamethoxazole in opportunistic infection prevention in lupus patients taking low-level immunosuppressive treatment: An open-labeled, randomized controlled trial

Abstract Background Individuals with lupus are at risk of opportunistic infections (OIs), especially pneumocystis pneumonia and nocardiosis. The current recommendation to prevent OIs is to take trimethoprim-sulfamethoxazole (TMP/SMX) regularly while on treatment for lupus. However, there has yet to be a standard recommendation on whether TMP/SMX prophylaxis is necessary and when prophylaxis can be discontinued. Objectives To assess the role of TMP/SMX in primary prophylaxis of OIs and to study the incidence of TMP/SMX sensitive OIs and the adverse events of TMP/SMX in the real-world setting among lupus patients taking low-level immunosuppressive therapy. Methods An open-label, randomized controlled trial was conducted among lupus patients taking low-level immunosuppressive at Ramathibodi Hospital between May 2021 and April 2023. The patient's demographic and relevant data were retrieved. The patients were randomized to receive or not receive TMP/SMX in a 1:1 ratio. The dose of TMP/SMX was adjusted based on renal function. The incidence of TMP/SMX-sensitive OIs was monitored until one year from enrollment, and the adverse events were assessed. Results The study was terminated prematurely due to an exceedingly high rate of adverse events secondary to TMP/SMX use. The analysis was made for the enrolled 138 lupus patients at six months, and OIs were monitored until one year. The mean ages were 45.4 in both groups. Most patients (98.4%) had SLEDAI-2K score < 4. The doses of immunosuppressive therapy were adjusted in six patients due to active disease and therefore excluded from the study. No TMP/SMX sensitive OIs documented in 114 lupus patients who completed follow-ups over nine months since enrollment. Eight from 10 patients had grade 1, whereas 2/10 patients had grade 3 adverse drug reactions, and all declined to resume prophylaxis. There was no mortality in the study. Conclusion The incidence of TMP/SMX-sensitive OIs among lupus patients taking low-level immunosuppressive was not a significant concern after a one-year follow-up, and high rates of adverse events with TMP/SMX prophylaxis were documented. Therefore, TMP/SMX primary prophylaxis may not be justified in this population. Disclosures All Authors: No reported disclosures

Prevalence, characteristics and challenges of late HIV diagnosis in Germany: an expert narrative review.

We aimed to review the landscape of late HIV diagnosis in Germany and discuss persisting and emerging barriers to earlier diagnosis alongside potential solutions. We searched PubMed for studies informing the prevalence, trends, and factors associated with late HIV diagnosis in Germany. Author opinions were considered alongside relevant data. In Germany, older individuals, heterosexuals, and migrants living with HIV are more likely to be diagnosed late. The rate of late diagnosis in men who have sex with men (MSM), however, continues to decrease. Indicator conditions less often prompt HIV testing in women and non-MSM. During the COVID-19 pandemic, the absolute number of late diagnoses fell in Germany, but the overall proportion increased, probably reflecting lower HIV testing rates. The Ukraine war and subsequent influx of Ukrainians living with HIV may have substantially increased undiagnosed HIV cases in Germany. Improved indicator testing (based on unbiased assessments of patient risk) and universal testing could help reduce late diagnoses. In patients who receive a late HIV diagnosis, rapid treatment initiation with robust ART regimens, and management and prevention of opportunistic infections, are recommended owing to severely compromised immunity and increased risks of morbidity and mortality. Joint efforts are needed to ensure that UNAIDS 95-95-95 2030 goals are met in Germany. These include greater political will, increased funding of education and testing campaigns (from government institutions and the pharmaceutical industry), continued education about HIV testing by HIV experts, and broad testing support for physicians not routinely involved in HIV care.

Rapidly progressive interstitial lung disease combined with pneumocystis jiroveci pneumonia in a patient with single anti-TIF-1γ antibody positive dermatomyositis in the context of an underlying tumor

BackgroundInterstitial lung disease (ILD) is a frequently observed comorbidity in autoimmune diseases such as dermatomyositis/polymyositis (DM/PM), and it is significantly associated with specific autoantibody types. One unique antibody type is the anti-transcription intermediate factor-1γ antibody (anti-TIF-1γ Ab), which has a positive rate of only 7%. It is often found in combination with malignancy and rarely with ILD, particularly rapidly progressive ILD (RPILD). In some cases, the presence of ILD in individuals with DM may indicate a paraneoplastic syndrome. Pneumocystis jiroveci pneumonia (PJP) typically occurs due to intensive immunosuppressive therapy, human immunodeficiency virus (HIV) infection, or malignancy, and rarely as an isolated condition.Case presentationA 52-year-old man with a history of rapid weight loss but non-HIV infected and not immunosuppressed who presented with fever, cough, dyspnea, weakness of the extremities, characteristic rash and mechanic's hand. Pathogenic tests suggested PJP, laboratory tests suggested a single anti-TIF-1γ Ab positive DM, imaging suggested ILD, and pathology revealed no malignancy. RPILD and acute respiratory distress syndrome (ARDS) developed after anti-infection and steroid hormone therapy. After mechanical support therapy such as Extracorporeal Membrane Oxygenation (ECMO), the patient developed late-onset cytomegalovirus pneumonia (CMVP), complicated bacterial infection, and ultimately death. Additionally, we discuss the potential causes of rapid weight loss, the mechanisms by which anti-TIF-1γ Ab may lead to ILD, and the possible connection between anti-TIF-1γ Ab positivity, rapid weight loss, immune abnormalities, and opportunistic infections.ConclusionsThis case emphasizes the importance of early recognition of malignant tumors and pulmonary lesions, assessment of the body's immune status, prompt initiation of immunosuppressive treatment, and prevention of opportunistic infections in individuals with single anti-TIF-1γ Ab positive DM presenting with rapid weight loss.

Adherence to antiretroviral therapy and associated factors among human immunodeficiency -positive patients accessing treatment at health centers in East Gojjam Zone, Northwest Ethiopia, 2019: Community-based cross-sectional study

BackgroundTo achieve an effective treatment outcome, Antiretroviral Therapy (ART) for people living with the Human immunodeficiency virus (HIV) needs at least a 95% adherence level. The aim was to assess adherence to antiretroviral therapy and its associated factors among patients accessing treatment at Health centers in East Gojjam Zone, Northwest Ethiopia. MethodsA community-based cross-sectional study was conducted on 770 HIV-positive patients from April 1 to May 10, 2019, in East Gojjam Zone. The study participants were selected by simple random computerized sampling methods. Primary data was collected from the patients through face-to-face interviews and home-to-home visits. Bivariable and multivariable binary logistic regression analyses were done. Independent variables with a P-value of <0.2 in bivariable binary logistic regression analysis were considered for multivariable binary logistic regression analysis. A P-value of <0.05 was used as the cut-off point for the presence of statistical significance. ResultsAbout 396 (51.8%) of the study participants had good adherence. Being 18–24 years old [Adjusted Odd Ratio (AOR) = 0.43; 95% CI = 0.21–0.86], having a marital status of being widowed (AOR = 0.29; 95% CI = 0.14–0.58), having a disease duration of >10 years (AOR = 0.47; 95% CI = 0.24–0.94), taking a drug regimen of Tenofovir (TDF) + Lamivudine (3 TC) + Nevirapine (NVP) (AOR = 2.94; 95% CI = 1.406.15), not being socially stigmatized (AOR = 0.52; 95% CI = 0.34–0.78), and having not encountered an opportunistic infection (AOR = 3.91; 95% CI = 2.68–5.72) were significant factors. ConclusionsThe level of adherence was low. Opportunistic infection prevention, reduction of social stigma, and other intervention activities should be strengthened to increase the level of adherence.

Stevens-Johnson syndrome in an 18-year-old Nigerian female: A case report

Purpose: This is a Stevens-Johnson syndrome (SJS) case with an atypical presentation. Stevens-Johnson syndrome is a hypersensitivity reaction distinguished by necrosis of skin tissue and mucosal linings including the genitals and eyes. It usually occurs as a reaction to certain medications. The condition is regarded as a medical emergency and management is tailored according to presenting symptoms with emphasis on airway and hemodynamic stability, lesion treatment, and prevention of opportunistic infection. While the condition is not hereditary, genetic codes passed on may increase the risk of similar immune-mediated hypersensitivity responses among progenies of affected individuals. Cyclosporine and other immunomodulatory therapeutics have shown promise in managing this condition.&#x0D; Case Report: This patient presented with severely reduced vision. The patient also had a recent history of bilateral ocular adnexal surgery and a family (father) history of kidney disease. An extensive case history, ocular workup, and microbial sensitivity testing were carried out to reach a diagnosis. The patient was initially placed doxycycline, Vitamin C, Moxifloxacin and Fluconazole. These were later adjusted when culture results returned. Unfortunately, due to the delay in presentation, the condition had progressed significantly, and management was palliative rather than restorative.&#x0D; Conclusion: A knowledge of SJS and quick intervention is key to minimizing morbidity and possible mortality from this condition. Management of this condition is multi-disciplinary and eye care providers should examine sufferers for ocular involvement so as to mitigate visual morbidity.

The consensus guideline of perioperative antiviral therapy for AIDS patients in China based on clinical practice.

The prevalence of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) has emerged as a major public health concern in China. When patients with HIV infection undergo surgical treatment, there are two main challenges. Firstly, medical staff face a high risk of HIV infection due to occupational exposure. Secondly, the patient's immune function is impaired, increasing the risk of opportunistic infections and postoperative complications. The surgical treatment of such patients is unique, and the risk of occupational exposure during the operation primarily depends upon the viral load of HIV/AIDS patients. Therefore, perioperative antiretroviral therapy is of paramount importance in order to standardize the perioperative antiretroviral therapy (ART) for HIV/AIDS patients. The Surgery Group of the Chinese Association of STD and AIDS Prevention and Control, in collaboration with the Treatment Association, and Surgery Group of the Chinese Medical Association of Tropical Diseases and Parasitology, has developed an expert consensus on perioperative antiretroviral therapy for HIV/AIDS patients. This consensus encompasses various aspects, including surgical risk assessment, selection of perioperative antiretroviral therapy regimens, prevention of opportunistic infections, and the crucial focus on rapid preoperative viral load reduction and immune function reconstruction for HIV/AIDS patients.

Determinant of Perception Factors in People Living with HIV/AIDS (Plwha) with the Attitude of Preventing Opportunistic Infections

HIV and AIDS are worldwide health concerns. Opportunistic infections are brought on by a weakened immune system and the introduction of germs (bacteria, fungi, and viruses) into the body. Opportunistic Infections (OIs) can cause death in &gt;90% of AIDS patients. The objective of this research is to identify perception factors associated with a positive attitude toward preventing opportunistic infections in people living with HIV/AIDS (PLWHA). This research was an analytical study applying a cross-sectional design and quantitative approaches. This study included 30 samples from PLWHA from the General Hospital of South Tangerang City, Indonesia. Samples were collected using a non-random sampling technique involving accidental sampling. From the results of the study, a relationship of perceived threat (p-value = 0.001; r = 0.515), perceived susceptibility (p-value = 0.044; r = 0.345), perceived severity (p-value = 0.361), perceived benefit (p-value = 0.643), perceived barrier (p-value = 0.094; r = 0.463), and perceived self-efficacy (p-value = 0,004; r = 0.463) was obtained with the prevention attitude of opportunistic infections. The perceived threat is a major factor influencing attitudes toward OI prevention.

Dapsone improves the vincristine-induced neuropathic nociception by modulating neuroinflammation and oxidative stress.

Peripheral neuropathy is a dose-limiting adverse effect of vincristine (VCR) in cancer chemotherapies. Dapsone is commonly used for the prevention of opportunistic infections following cancer therapies. Therefore, a high rate of VCR and dapsone co-administration has occurred in leukemias. Recently neuroprotective effects of dapsone have been reported in various diseases. Regarding the physiopathology of VCR-induced peripheral neuropathy (VIPN) and dapsone neuroprotection, this study evaluated the effect of dapsone on VIPN. VIPN was induced by VCR injection (0.5mg/kg IP, every other day, 1week) in male Wistar rats. In the treatment group, dapsone(12.5mg/kg IP, 1week) was injected 30min before VCR. Hot plate, Von Frey, motor neuron conduction velocity (MNCV), and histopathological tests were applied. The levels of TNF-α and NF-kB in the sciatic nerve and caspase-3 activity in dorsal root ganglion were measured by the ELISA method. The levels of malondialdehyde (MDA) and Glutathione (GSH) in the sciatic nerve were measured by spectrophotometry and colorimetric assays. VIPN was observed as araised thermal and mechanical threshold, reduced MNCV, and sciatic nerve demyelination. However, dapsone reduced the mechanical and thermal threshold and improved the MNCV. Also, dapsone reduced TNF-α, NF-kB, MDA, and Caspase-3 activity, and increased the GSH level in the sciatic nerve. Moreover, dapsone prevented VCR-induced demyelination in the sciatic nerve. This research demonstrated that dapsone could be used as a protective drug against VIPN. It improves the impaired thermal and mechanical sensations by reducing inflammatory, oxidant, and apoptosis factors and preventing demyelination in the sciatic nerve.

Indicaciones y tratamiento preventivo de las enfermedades oportunistas en el paciente con infección por el virus de la inmunodeficiencia humana

Opportunistic infections are an important cause of morbidity and mortality in patients with HIV infection. The best strategy for preventing them is appropriate antiretroviral treatment with a good adherence on the part of the patient. However, when there is a decrease in CD4 lymphocytes below 200cells/μl, primary and secondary prevention of opportunistic infections is essential for improving quality of life and decreasing its morbidity and mortality in these patients.

Mixed methods systematic review and metasummary about barriers and facilitators for the implementation of cotrimoxazole and isoniazid-Preventive therapies for people living with HIV.

BackgroundCotrimoxazole and isoniazid preventive therapy (CPT, IPT) have been shown to be efficacious therapies for the prevention of opportunistic infections and tuberculosis (TB) among people living with human immunodeficiency virus (HIV). Despite governments’ efforts to translate World Health Organization recommendations into practice, implementation remains challenging. This review aimed to explore and compare CPT and IPT with respect to similarities and differences of barriers identified across high TB/HIV burden countries. A secondary objective was to identify facilitators for implementing both preventive therapies.MethodsWe searched MEDLINE, Web of Science and SCOPUS databases for peer-reviewed literature published before September 2020. We extracted and synthesized our findings using Maxqda software. We applied framework synthesis in conjunction with metasummary to compare both therapies with respect to similarities and differences of barriers identified across seven health system components (in line with the modified WHO’s Framework for action). Protocol registration: PROSPERO (CRD42019137778).FindingsWe identified four hundred and eighty-two papers, of which we included forty for review. Although most barrier themes were identical for both preventive therapies, we identified seven intervention-specific themes. Like for CPT, barriers identified for IPT were most frequently classified as ‘service delivery-related barriers’ and ‘patient & community-related barriers’. ‘Health provider-related barriers’ played an important role for implementing IPT. Most facilitators identified referred to health system strengthening activities.ConclusionsFor researchers with limited working experience in high TB/HIV burden countries, this review can provide valuable insights about barriers that may arise at different levels of the health system. For policymakers in high TB/HIV burden countries, this review offers strategies for improving the delivery of IPT (or any newer therapy regimen) for the prevention of TB. Based on our findings, we suggest initial and continuous stakeholder involvement, focusing on the efficient use and reinforcement of existing resources for health.

Liposomes as Carriers for the Delivery of Efavirenz in Combination with Glutathione-An Approach to Combat Opportunistic Infections.

Human immunodeficiency virus (HIV)-infected individuals display an enhanced production of reactive oxygen species (ROS). This reduction of antioxidant capacity in host tissues has been related to the decrease in total levels of ROS scavengers such as glutathione (GSH). Prevention of opportunistic infections due to a weakened immune system is becoming a key strategy along with HIV elimination. Research in these directions is clearly warranted, especially a combination of antiretrovirals and antioxidants to ameliorate oxidative stress, improve intracellular uptake and target viral reservoirs. Hence, we aimed to formulate liposomes loaded with the antiretroviral drug efavirenz (EFA) in the presence of glutathione, as these carriers can be engineered to enhance the ability to reach the target reservoirs. The goal of the present work was to investigate the intracellular uptake of EFA-loaded liposome (with and without GSH) by human monocytic leukemia cells (THP-1 cells) and examine cell viability and ROS scavenging activity. Results obtained provided significant data as follows: (i) treatment with EFA and GSH combination could enhance the uptake and reduce cytotoxicity; (ii) encapsulation of EFA into liposomes increased its levels in the macrophages, which was further enhanced in the presence of GSH; (iii) delivery of EFA in the presence of GSH quenched the intracellular ROS, which was significantly higher when delivered via liposomes. Data revealed that a combination of EFA and GSH encompasses advantages; hence, GSH supplementation could be a safe and cost-effective treatment to slow the development of HIV infection and produce an immune-enhancing effect.

Securing the future of kidney transplantation by addressing the challenges of transplant nephrology.

Kidney transplant is a life-changing procedure, and transplant nephrologists, as part of a larger transplant team, play an important role in the field by managing the complex medical needs of transplant patients. The subspecialty of transplant nephrology, however, faces structural challenges related to its workforce, reporting structures, compensation, research and innovation, and health care information technology. The position of transplant nephrology at the academic and operational intersection of medicine and surgery may limit its access to critical resources, hinder academic promotion, and contribute to physician burnout. The authors provide an overview of the subspecialty transplant nephrology and propose solutions. Collaborative efforts that fortify the subspecialty of transplant nephrology will ultimately improve the lives of patients suffering from kidney disease.

Undernutrition Among HIV-Positive Adolescents on Antiretroviral Therapy in Southern Ethiopia.

PurposeAdolescents living with HIV are vulnerable to undernutrition secondary to elevated nutritional needs imposed by growth spurt and HIV-infection. Yet, in low-income countries, evidence on the epidemiology of undernutrition among adolescents living with HIV is scarce. We assessed the prevalence and predictors of stunting and thinness among adolescents receiving anti-retroviral therapy (ART) in Hawassa city, Southern Ethiopia.MethodsIn this facility-based cross-sectional study, we enrolled 260 adolescents (10–19 years of age) living with HIV on ART in two public hospitals and three health centers. Anthropometric measurements, household food insecurity and dietary diversity were measured following standard approaches. Predictors of stunting and thinness were identified using multivariable logistic regression analyses and interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI).ResultsOne-third of the adolescents were stunted, and 20% were thin. The prevalence of severe stunting (7.7%) and severe thinness (7.3%) was also high. Significant proportions of the adolescents (38.5%) were from food insecure households, and 28.1% had low or medium dietary diversity. Significant predictors of stunting were lack of food or financial support (AOR=2.71; 95% CI: 1.36–5.39); meal skipping (AOR=2.13; 95% CI: 1.16–3.91); recent history of opportunistic infections (AOR=2.25; 95% CI: 1.11–4.55) and disclosure of HIV status to the adolescent (AOR=1.88; 95% CI: 1.12–4.34). History of opportunistic infection was the only significant predictor of thinness (AOR=3.21; 95% CI: 1.54–6.73).ConclusionThe burden of undernutrition among adolescents living with HIV is disturbingly high. Prevention of opportunistic infections promoting social support and discouraging practice of meal skipping may help to reduce the problem.

Microbial Biofilm Formation on Vanillin Incorporated Surgical Obturator Resin

Self-cure poly-methyl methacrylate (PMMA) resin has been the material commonly used for fabrication of surgical obturator. The appliance is used in the cancer patient after surgical removal of the affected maxillofacial tissues. However, wearing of this resin appliance can enhance a condition for microbial biofilm aggregation and put patients at increased risk of infection. Vanillin-incorporated heat-cure PMMA resin and self-cure PMMA resin have been developed and demonstrated to have antimicrobial activity. This study aimed to evaluate antimicrobial property of vanillin-incorporated self-cure PMMA obturator resin on the biofilm formation of C. albicans and S. aureus. The resin samples (Orthocryl® EQ, Dentaurum, Germany) were prepared with vanillin incorporation (0.1% and 0.5% vanillin). All samples were coated with sterile saliva and incubated at 37 °C for 60 min. The Staphylococcus aureus ATCC 5638 and Candida albicans ATCC 10231 suspensions (107 colony forming unit/mL) were prepared and microbial biofilm formation was done in 96-well plate at 37°C for 24 h. The amount of biofilm was quantified by Cell Counting Kit WST-8 (Dojindo Molecular Technologies, USA) at 450 nm. All tests were performed in triplicate on three separate occasions. One-way ANOVA and Tukey’s test were used for the statistical analysis. It was found that approximately 52% and 48% biofilm reductions were observed in 0.1% and 0.5% vanillin groups against S.aureus compared with 0% vanillin (control group) whereas 46% and 54% biofilm reductions were seen against C. albicans biofilm. In conclusion, the incorporation of vanillin in surgical obturator PMMA resin was demonstrated to have antimicrobial property against biofilm formation of S. aureus and C. albicans. This can help the patient who wears surgical obturator for the prevention of opportunistic infections.

PENGARUH PENDEKATAN MELALUI KONSELING INTERPERSONAL TERHADAP RESPON SOSIAL, EMOSIONAL DAN SPIRITUAL PADA PASIEN HIV/AIDS

Approach to PLWHA by providing interpersonal counseling is the right thing to do to overcome psychological problems including social, emotional and spiritual aspects of PLWHA. This study aims to look at the effect of interpersonal counseling on social, emotional and spiritual responses in HIV/ AIDS patients. This research is a type of non-experimental research with a cross-sectional approach. The sample is post-test people and tested positive for HIV in the Kediri region, which is 32 with purpossive sampling technique. Data on social, emotional and spiritual responses were obtained based on the results of data recapitulation from the instrument in the form of a questionnaire. The results of the study with the non-parametric Wilcoxon test showed there were differences between social responses of HIV/AIDS patients before and after given interpersonal counseling with p value = 0,000, there were differences between the emotional responses of HIV/AIDS patients before being given interpersonal counseling and after being given counseling with p value = 0,000, and there is a difference between spiritual responses in HIV/AIDS patients before being given interpersonal counseling and after being given interpersonal counseling with p value = 0,000. It can be concluded that interpersonal counseling influences social, emotional and spiritual responses of HIV/AIDS patients. It is recommended that the mentoring of HIV/AIDS patients through interpersonal counseling can continue so as to enhance physiological responses that will have an impact on disease prognosis, prevention of opportunistic infections and reduce mortality rates for HIV patients/ AIDS.

Detection of airborne bacteria from patient spaces in tuberculosis hospital.

The spread of nosocomial bacterial infection greatly threatens public health and the impact of nosocomial infection worsens if highly pathogenic bacteria, Mycobacterium tuberculosis as an instance, involves. In this study, we have investigated the presence of airborne M. tuberculosis in a specialized tuberculosis hospital. The study sites selected were waiting room I, II, and ward VI patient lounge, Masan National Tuberculosis Hospital, where the modern ventilation system is on the operation for opportunistic infection prevention. The air samples were collected from the different sites three times for 1 day, and after air collection, air sampled disposable filter membrane was incubated for 4 weeks on nine Middlebrook 7H11 agar plates. Our data showed that out of nine incubated 7H11 plate agars, four plates showed bacterial growth and these grown bacterial colonies were isolated and identified. Among bacterial species identified, there was a colony of Mycobacterium mageritense, one of nontuberculous Mycobacteria. Although there was no M. tuberculosis, the cause of tuberculous disease and transmitted through the nosocomial infection, all pathogens detected were known to be associated with nosocomial infection. Hospitals dealing with infectious diseases should always be wary that ventilation system does not guarantee safety from airborne pathogen exposure hence should continuously monitor the presence of other hospital-associated infection causing pathogenic microorganisms.

Prevention of Opportunistic Infections in Women With HIV Infection

Opportunistic infections are those that are either more frequent or more severe as a result of the patient's immunosuppressed condition. Opportunistic infections are, of course, the distinguishing feature of HIV infection, and they can be the cause of serious morbidity and even mortality. Some opportunistic infections can be prevented by vaccination, for example, pneumococcal infection, meningococcal infection, influenza, hepatitis A and B, and varicella. Other major opportunistic infections require prophylactic antibiotics or antiviral medications. In obstetric patients, pneumocystis infections and toxoplasmosis are most effectively prevented by the administration of trimethoprim-sulfamethoxazole. The most effective agents for prevention of reactivation of tuberculosis are isoniazid, rifampin, and rifapentine. Fluconazole is of value in preventing cryptococcal infection and candidiasis. Acyclovir, valacyclovir, and famiclovir are effective in preventing recurrent outbreaks of herpes simplex virus. Ultimately; however, the best way to prevent opportunistic infections is to treat the patient with highly active antiretroviral agents and restore her immune competence.

The beneficial effect of traditional Japanese herbal (Kampo) medicine, Hochu‐ekki‐to (Bu‐Zhong‐Yi‐Qi‐Tang), for patients with chronic wounds refractory to conventional therapies: A prospective, randomized trial

Hochu-ekki-to (HET) is a traditional Japanese herbal (Kampo) medicine for the treatment of severe weakness, loss of appetite, and indigestion in elderly patients and for the prevention of opportunistic infections. The impact of HET on patients with chronic wounds refractory to conventional therapies was investigated in a prospective, randomized trial, including 18 patients divided into medication (7.5 g oral HET per day, n = 9) and control (n = 9) groups. Wound healing during the 12-week study period was scored based on depth, exudate, size, inflammation/infection, granulation tissue, necrotic tissue, and pocket size. At 12 weeks, wound healing progressed in all nine patients in the medication group, whereas wound healing progressed in only three patients in the control group (significant difference, p < 0.01; relative risk: 3.00). In the medication group, the total score decreased significantly at 8 weeks and later. To the best of our knowledge, this study was the first to show that HET promoted the healing of chronic wounds resistant to conventional treatments. HET may be a choice as an adjunctive therapy for chronic wounds, particularly for patients with malnutrition. This trial was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000031620).