MyMedR

Fulltext Short Communication: Impact of Viral Load Use on Treatment Switch in Perinatally HIV-Infected Children in Asia

Jamal Mohamed T, Teeraananchai S, Kerr S, Phongsamart W, Nik Yusoff NK, Hansudewechakul R, et al.

AIDS Res Hum Retroviruses, 2017 03;33(3):230-233.

PMID: 27758114 DOI: 10.1089/AID.2016.0039

We sought to assess the impact of routine HIV viral load (VL) monitoring on the incidence of switching from a first- to a second-line antiretroviral therapy (ART) regimen, and to describe factors associated with switch. Data from a regional cohort of 16 clinical programs in six Asian countries were analyzed. Second-line switch was defined as a change from a non-nucleoside reverse transcriptase inhibitor (NNRTI) to a protease inhibitor (PI) or vice versa, and ≥1 of the following: (1) reported treatment failure by local criteria, (2) switch of ≥1 additional drug, or (3) a preceding HIV VL ≥1,000 copies/ml. Routine VL was having ≥1 test after ≥24 weeks of ART and ≥1 time/year thereafter. Factors associated with time to switch were evaluated with death and loss to follow-up as competing risks. A total of 2,398 children were included in this analysis. At ART initiation, the median (interquartile range) age was 6.0 (3.3-8.9) years, more than half had WHO stage 3 or 4, the median CD4 was 189 (47-456) cells/mm3, 93% were on NNRTI-based first-line ART, and 34% had routine VL monitoring. Treatment switch occurred in 17.6% of patients, at a median of 35 (22-49) months. After adjusting for country, sex, first ART regimen, and CD4% at ART initiation, children with routine VL monitoring were 1.46 (95% confidence interval 1.11-1.93) times more likely to be switched (p = .007). Scale-up of VL testing will lead to earlier identification of treatment failure, and it can help guide earlier switches to prevent resistance.

Matched MeSH terms: Female; Male

Fulltext Factors associated with pre-treatment HIV RNA: application for the use of abacavir and rilpivirine as the first-line regimen for HIV-infected patients in resource-limited settings

Kiertiburanakul S, Boettiger D, Ng OT, Van Kinh N, Merati TP, Avihingsanon A, et al.

AIDS Res Ther, 2017;14:27.

PMID: 28484509 DOI: 10.1186/s12981-017-0151-1

BACKGROUND: Abacavir and rilpivirine are alternative antiretroviral drugs for treatment-naïve HIV-infected patients. However, both drugs are only recommended for the patients who have pre-treatment HIV RNA <100,000 copies/mL. In resource-limited settings, pre-treatment HIV RNA is not routinely performed and not widely available. The aims of this study are to determine factors associated with pre-treatment HIV RNA <100,000 copies/mL and to construct a model to predict this outcome.

METHODS: HIV-infected adults enrolled in the TREAT Asia HIV Observational Database were eligible if they had an HIV RNA measurement documented at the time of ART initiation. The dataset was randomly split into a derivation data set (75% of patients) and a validation data set (25%). Factors associated with pre-treatment HIV RNA <100,000 copies/mL were evaluated by logistic regression adjusted for study site. A prediction model and prediction scores were created.

RESULTS: A total of 2592 patients were enrolled for the analysis. Median [interquartile range (IQR)] age was 35.8 (29.9-42.5) years; CD4 count was 147 (50-248) cells/mm3; and pre-treatment HIV RNA was 100,000 (34,045-301,075) copies/mL. Factors associated with pre-treatment HIV RNA <100,000 copies/mL were age <30 years [OR 1.40 vs. 41-50 years; 95% confidence interval (CI) 1.10-1.80, p = 0.01], body mass index >30 kg/m2(OR 2.4 vs. <18.5 kg/m2; 95% CI 1.1-5.1, p = 0.02), anemia (OR 1.70; 95% CI 1.40-2.10, p 350 cells/mm3(OR 3.9 vs. <100 cells/mm3; 95% CI 2.0-4.1, p 2000 cells/mm3(OR 1.7 vs. <1000 cells/mm3; 95% CI 1.3-2.3, p 25 yielded the sensitivity of 46.7%, specificity of 79.1%, positive predictive value of 67.7%, and negative predictive value of 61.2% for prediction of pre-treatment HIV RNA <100,000 copies/mL among derivation patients.

CONCLUSION: A model prediction for pre-treatment HIV RNA <100,000 copies/mL produced an area under the ROC curve of 0.70. A larger sample size for prediction model development as well as for model validation is warranted.

Matched MeSH terms: Female; Male

Fulltext A multi-step pace towards a cure for HIV: kick, kill, and contain

López M

AIDS Rev, 2013 Jul-Sep;15(3):190-1.

PMID: 24002204

The 7th IAS Conference held in July 2013 in Kuala Lumpur, Malaysia, heard about a number of cases of "functional cure" in people who had started antiretroviral therapy soon after HIV infection, including a German case that can now be added to the "Mississippi baby" report presented at CROI 2012 and 14 individuals of the French VISCONTI cohort. All these persons maintained an undetectable viral load after coming off antiretrovirals.

Matched MeSH terms: Female; Male

Fulltext Bone mineral density loss, osteoporosis, and fractures in HIV

Labarga P

AIDS Rev, 2013 Jul-Sep;15(3):189-90.

PMID: 24002203

The link between HIV and reduced bone mineral density, including osteopenia and the more severe osteoporosis, is well established. HIV infection has also been associated with an increased risk of fractures. It is so far unclear whether this is due to HIV itself, resulting inflammatory and metabolic changes, antiretroviral toxicity, or some combination of factors. This topic was the focus of major debate at the 7th IAS Conference held in Kuala Lumpur, Malaysia, in early July 2013.

Matched MeSH terms: Female; Male

Fulltext HIV incidence in Asia: a review of available data and assessment of the epidemic

Dokubo EK, Kim AA, Le LV, Nadol PJ, Prybylski D, Wolfe MI

AIDS Rev, 2013 Apr-Jun;15(2):67-76.

PMID: 23681434

Rates of new HIV infections in Asia are poorly characterized, likely resulting in knowledge gaps about infection trends and the most important areas to target for interventions. We conducted a systematic review of peer-reviewed English language publications and conference abstracts on HIV incidence in thirteen countries - Bangladesh, Cambodia, China, India, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Taiwan, Thailand, and Vietnam. We obtained data on HIV incidence rate, incidence estimation method, population, and risk factors for incident infection. Our search yielded 338 unique incidence estimates from 70 published articles and 41 conference abstracts for eight countries. A total of 138 (41%) were obtained from prospective cohort studies and 106 (31%) were from antibody-based tests for recent infection. High HIV incidence rates were observed among commercial sex workers (0.4-27.8 per 100 person-years), people who inject drugs (0.0-43.6 per 100 person-years) and men who have sex with men (0.7-15.0 per 100 person-years). Risk factors for incident HIV infection include brothel-based sex work and cervicitis among commercial sex workers; young age, frequent injection use and sharing needles or syringes among people who inject drugs; multiple male sexual partners, receptive anal intercourse and syphilis infection among men who have sex with men. In the countries with available data, incidence rates were highest in key populations and varied widely by incidence estimation method. Established surveillance systems that routinely monitor trends in HIV incidence are needed to inform prevention planning, prioritize resources, measure impact, and improve the HIV response in Asia.

Matched MeSH terms: Female; Male

Nipah viral encephalitis or Japanese encephalitis? MR findings in a new zoonotic disease

Lim CC, Sitoh YY, Hui F, Lee KE, Ang BS, Lim E, et al.

AJNR Am J Neuroradiol, 2000 Mar;21(3):455-61.

PMID: 10730635

BACKGROUND AND PURPOSE: An epidemic of suspected Japanese encephalitis occurred in Malaysia in 1998-1999 among pig farmers. In neighboring Singapore, an outbreak occurred among pig slaughterhouse workers. It was subsequently established that the causative agent in the outbreak was not the Japanese encephalitis virus but a previously unknown Hendra-like paramyxovirus named Nipah virus.

METHODS: The brain MR images of eight patients with Nipah virus infection were reviewed. All patients tested negative for acute Japanese encephalitis virus. Seven patients had contrast-enhanced studies and six had diffusion-weighted examinations.

RESULTS: All patients had multiple small bilateral foci of T2 prolongation within the subcortical and deep white matter. The periventricular region and corpus callosum were also involved. In addition to white matter disease, five patients had cortical lesions, three had brain stem involvement, and a single thalamic lesion was detected in one patient. All lesions were less than 1 cm in maximum diameter. In five patients, diffusion-weighted images showed increased signal. Four patients had leptomeningeal enhancement and four had enhancement of parenchymal lesions.

CONCLUSION: The brain MR findings in patients infected with the newly discovered Nipah paramyxovirus are different from those of patients with Japanese encephalitis. In a zoonotic epidemic, this striking difference in the appearance and distribution of lesions is useful in differentiating these diseases. Diffusion-weighted imaging was advantageous in increasing lesion conspicuity.

Matched MeSH terms: Female; Male

Fulltext Postoperative intraspinal subdural collections after pediatric posterior fossa tumor resection: incidence, imaging, and clinical features

Harreld JH, Mohammed N, Goldsberry G, Li X, Li Y, Boop F, et al.

AJNR Am J Neuroradiol, 2015 May;36(5):993-9.

PMID: 25614472 DOI: 10.3174/ajnr.A4221

Postoperative intraspinal subdural collections in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MR imaging or CSF analysis, potentially impacting therapy. We investigated the incidence, imaging and clinical features, predisposing factors, and time course of these collections after posterior fossa tumor resection.

Matched MeSH terms: Female; Male

MR imaging features of Nipah encephalitis

Sarji SA, Abdullah BJ, Goh KJ, Tan CT, Wong KT

AJR Am J Roentgenol, 2000 Aug;175(2):437-42.

PMID: 10915690

The newly discovered Nipah virus causes an acute febrile encephalitic illness in humans that is associated with a high mortality. The purpose of this study is to describe the MR imaging findings of Nipah encephalitis.

Matched MeSH terms: Female; Male

Fulltext Loculated transudative pleural effusion masquerading as right upper lobe consolidation in a haemodialysis patient

Kho SS, Tay PS, Lee J, Tie ST

AME Case Rep, 2017;1:4.

PMID: 30263991 DOI: 10.21037/acr.2017.09.05

Pleural effusion is a common encounter in renal failure patients and frequently possess a diagnostic challenge to clinician especially when it was exudative. Fortunately, transudative pleural effusion secondary to fluid overload remains the commonest cause of pleural effusion in haemodialysis patients. Frequent thoracocentesis enhance pleural inflammation and potentially complicate further this challenging clinical presentation. We report a middle-aged gentleman with advanced chronic kidney disease presented with dyspnea and new right upper lobe consolidation on chest roentograph. He had a history of recurrent bilateral pleural effusion secondary to fluid overload and hence multiple attempts of thoracocentesis were performed. Medical thoracoscopy performed previously yielded non-specific pleuritis. Flexible bronchoscopy demonstrates normal airway with negative microbiological studies. Computed tomography (CT) of the thorax shown a loculated hypodense pleural effusion at the apical region of the right upper lobe. Ultrasound guided thoracocentesis anteriorly yield 400 mL of clear straw color fluid which was transudative by Light's criteria. Post tapping chest X-ray shown complete resolution of right upper lobe consolidation and patient reports immediate relieve of dyspnea. Patient was started on regular effective haemodialysis and pleural effusion did not recur during follow up. Loculated pleural effusion masquerading as mediastinal tumour had been reported but pleural effusion that conformed to the contour of a lung lobe is rare. This case highlights the atypical but unique presentation of a transudative pleural effusion and demonstrates the risk of repeated thoracocentesis complicating a simple clinical presentation.

Matched MeSH terms: Male

Fulltext Anaplastic thyroid carcinoma mimicking thyroid abscess

Loh TL, Zulkiflee AB

AME Case Rep, 2018;2:20.

PMID: 30264016 DOI: 10.21037/acr.2018.04.05

Anaplastic thyroid carcinoma (ATC) is a particularly fearsome form of thyroid cancer due to its extreme aggressiveness and dismal prognosis. Patients with ATC typically present with a rapidly enlarging neck mass with compressive symptoms. We report a case of ATC, mimicking a thyroid abscess; in a 52-year-old Chinese male with one month history of enlarging neck mass. Ultrasound of the neck was suggestive of a thyroid cyst and fine needle aspiration cytology was negative for malignancy. He presented again 2 weeks later with increased swelling and pain suggestive of right neck abscess. An incision and drainage was performed and histopathology result of a proximal isolated enlarged lymph node biopsied revealed metastatic carcinoma. Subsequent right thyroid wedge biopsy finding 1 month later were confirmatory of ATC.

Matched MeSH terms: Male

Multinodular/plexiform schwannoma of the ulnar nerve

Lim CY, Low TH, Sivanoli R, Teh KK, Thuraisingham R

ANZ J Surg, 2014 Jan-Feb;84(1-2):93-4.

PMID: 24165375 DOI: 10.1111/ans.12231

Matched MeSH terms: Male

Pre-emptive intraperitoneal local anaesthesia: an effective method in immediate post-operative pain management and metabolic stress response in laparoscopic appendicectomy, a randomized, double-blinded, placebo-controlled study

Thanapal MR, Tata MD, Tan AJ, Subramaniam T, Tong JM, Palayan K, et al.

ANZ J Surg, 2014 Jan-Feb;84(1-2):47-51.

PMID: 23057502 DOI: 10.1111/j.1445-2197.2012.06210.x

Although laparoscopic surgeries are associated with reduced surgical stress response and shortened post-operative recovery, intense pain and high analgesia requirements in the immediate post-operative period are often the chief complaints.

Matched MeSH terms: Female; Male

Adrenal tuberculosis: the atypical presentations of eggshell-like calcifications

Imisairi AH, Hisham AN

ANZ J Surg, 2009 Jun;79(6):488-9.

PMID: 19566876 DOI: 10.1111/j.1445-2197.2009.04953.x

Matched MeSH terms: Female; Male

980-nm laser therapy versus varicose vein surgery in racially diverse Penang, Malaysia

Lakhwani MN, Dadlani NI, Wong YC

ANZ J Surg, 2009 May;79(5):352-7.

PMID: 19566516 DOI: 10.1111/j.1445-2197.2009.04888.x

Chronic venous disorders are conditions of increasing prevalence in the developing world, and venous ulceration is the terminal sequel. Currently there are only limited data on all aspects of this from Southeast Asia. The aim of the present study was to assess differences in the demography and outcome between varicose vein surgery (VVS) and the relatively new endovenous laser therapy (EVT) in patients from Penang, Malaysia.

Matched MeSH terms: Female; Male

Intraoperative methylene blue sentinel lymph node mapping in colorectal cancer

Chan SH, Ng C, Looi LM

ANZ J Surg, 2008 Sep;78(9):775-9.

PMID: 18844907 DOI: 10.1111/j.1445-2197.2008.04648.x

Isosulfan blue is not available for clinical use in Malaysia. This study describes the use of methylene blue as an alternative to isosulfan blue in colorectal sentinel node mapping.

Matched MeSH terms: Female; Male

The sequelae of barium aspiration

Gendeh HS, Hashim ND, Mohammad Yunus MR, Gendeh BS, Kosai NR

ANZ J Surg, 2018 09;88(9):937-938.

PMID: 27122196 DOI: 10.1111/ans.13624

Matched MeSH terms: Male

Initial experience of abdominal aortic aneurysm repairs in Borneo

Yii MK

ANZ J Surg, 2003 Oct;73(10):790-3.

PMID: 14525567

Abdominal aortic aneurysms (AAA) repairs are routine operations with low mortality in the developed world. There are few studies on the operative management of AAA in the Asian population.This study reports the initial results from a unit with no previous experience in this surgery by a single surgeon on completion of training.

Matched MeSH terms: Female; Male

Intravesical explosion during transurethral resection of the prostate

Dublin N, Razack AH, Loh CS

ANZ J Surg, 2001 Jun;71(6):384-5.

PMID: 11409027

Matched MeSH terms: Male

Post-thyroidectomy sore throat following endotracheal intubation

Hisham AN, Roshilla H, Amri N, Aina EN

ANZ J Surg, 2001 Nov;71(11):669-71.

PMID: 11736830 DOI: 10.1046/j.1445-1433.2001.02230.x

Background: Sore throat is not an uncommon complaint following general anaesthesia (GA) with endotracheal intubation. It has been a source of considerable discomfort particularly in those patients who had thyroid surgery. Driven by the increased number of patients with post-intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the contributing factors of sore throat in patients who had thyroid surgery under general anaesthesia.
Methods: A total of 57 consecutive patients who had thyroid surgery from November 1998 to April 1999 was included in this prospective study. Factors such as intubation time, number of intubation attempts, size and type of endotracheal tube (ETT) used, gender and age were recorded. The nature and extent of the surgical procedures were also studied. Postoperative symptoms were assessed by questionnaire on the day after surgery and the different parameters were compared and analysed.
Results: The incidence of post-intubation sore throat following thyroid surgery was documented in 39 (68.4%) patients. Twenty-seven (47.4%) patients had a mild complaint of sore throat, which resolved after the third day. The data from the present study show that the size of ETT and extent of surgical procedure were significant contributing factors affecting the postoperative recovery.
Conclusion: The outcome of the present study demonstrated a substantial increased incidence of sore throat after thyroid surgery under GA. Postoperative sore throat following thyroid surgery under GA may be caused by multiple contributing factors. Nonetheless effort and care should be taken during endotracheal intubation and surgery to reduce this unpleasant complaint arising mainly from pharyngeal irritation or trauma.

Matched MeSH terms: Female; Male

External laryngeal nerve in thyroid surgery: recognition and surgical implications

Aina EN, Hisham AN

ANZ J Surg, 2001 Apr;71(4):212-4.

PMID: 11355727

Injury to the external laryngeal branch of the superior laryngeal nerve during thyroid surgery is not uncommon. Most surgeons tend to avoid rather than expose and identify the external laryngeal nerve (ELN). The aim of the present study was to analyse the frequency and types of ELN crossing the avascular space in relationship to the structures to the upper pole of the thyroid and related thyroid pathology.

Matched MeSH terms: Female; Male

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