Total elbow arthroplasty for active primary tuberculosis of the elbow: a curious case of misdiagnosis

The incidence of musculoskeletal tuberculosis (TB) is on the rise due to the current Acquired Immunodeficiency Syndrome (AIDS) pandemic. Spine is the most common osseous site, followed by other joints. TB identified in the elbow accounts for 2%–5% of skeletal TB cases, which are secondary to pulmonary TB. Primary elbow TB is rare. We report a case of primary TB of the elbow which had a negative synovial biopsy. A 46-year-old right-hand dominant female patient with chronic pain and disability of the right elbow was diagnosed with chronic non-specific arthritis based on an arthroscopic synovial biopsy. The case was diagnosed retrospectively as active TB from bone cuts post total elbow arthroplasty (TEA). Anti-tuberculosis treatment (ATT) was given postoperatively for 12 months. The patient reported good functional outcomes at 3 years of follow-up. Such atypical presentations of osteoarticular TB are challenging to diagnose. Therefore, particularly in endemic areas, clinicians should be careful before excluding such a diagnosis even after a negative biopsy. Further research should investigate whether active TB of small joints such as the elbow can be treated with ATT, and early arthroplasty should be a focus of this research.

Mechanisms of immune aging in HIV

Massive CD4+ T-cell depletion as well as sustained immune activation and inflammation are hallmarks of Human Immunodeficiency Virus (HIV)-1 infection. In recent years, an emerging concept draws an intriguing parallel between HIV-1 infection and aging. Indeed, many of the alterations that affect innate and adaptive immune subsets in HIV-infected individuals are reminiscent of the process of immune aging, characteristic of old age. These changes, of which the presumed cause is the systemic immune activation established in patients, likely participate in the immuno-incompetence described with HIV progression. With the success of antiretroviral therapy (ART), HIV-seropositive patients can now live for many years despite chronic viral infection. However, acquired immunodeficiency syndrome (AIDS)-related opportunistic infections have given way to chronic diseases as the leading cause of death since HIV infection. Therefore, the comparison between HIV-1 infected patients and uninfected elderly individuals goes beyond the sole onset of immunosenescence and extends to the deterioration of several physiological functions related to inflammation and systemic aging. In light of this observation, it is interesting to understand the precise link between immune activation and aging in HIV-1 infection to figure out how to best care for people living with HIV (PLWH).

Currently, there is no cure for Human immunodeficiency virus /Acquired immunodeficiency syndrome (HIV/AIDS) but, there are medications to control HIV and prevent opportunistic infections. Clinicians must be vigilant enough to extract history and send rele

Currently, there is no cure for Human immunodeficiency virus /Acquired immunodeficiency syndrome (HIV/AIDS) but, there are medications to control HIV and prevent opportunistic infections. Clinicians must be vigilant enough to extract history and send relevant laboratory investigations to diagnose the disease in early stage. Patient may not have known his /her diagnosis or intentionally avoided to reveal the disease status which further complicates the diagnosis and treatment. This is case of a 51 years male, where social stigma forces the patient to hide his diagnosis and reluctant to seek medical treatment ultimately reaps the life. Hence, government and concerned authority must work up for wide availability of HIV/AIDS medications and motivate people to seek medical advices as soon as possible. Concerned authority must motivate people to consider it as any other treatable disease.

Prevalence of Pneumocystosis in Sub-Saharan Africa and Helminth Immune Modulation

Sub-Saharan Africa is the region of the world with the highest prevalence of helminth infections. To protect themselves from the defensive mechanisms of their respective hosts, helminths modulate their immune responses. This modulation has relevant clinical and epidemiological consequences, including the inhibition of inflammatory processes that characterize infection by other microorganisms. Severe Pneumocystis pneumonia is characterized by an intense inflammatory reaction that can lead to death. Acquired immunodeficiency syndrome is the main predisposing factor to the development of pneumocystosis. Although the introduction of highly active antiretroviral therapy has led to a notable decline in the incidence of acquired immunodeficiency syndrome-associated complications, pneumocystosis continues to be an important global health problem. Despite the high incidence of human immunodeficiency virus infection in the sub-Saharan region, the prevalence of Pneumocystis pneumonia there has been lower than expected. Several factors, or combinations thereof, may contribute to this evolution. Here, we hypothesize the possible role of helminth immune modulation as an important issue at play. On the other hand, and looking ahead, we believe that the immune modulation achieved by helminths may be an important factor to consider during the design and evaluation processes of vaccines against Pneumocystis jirovecii to be used in Sub-Saharan Africa. The requirements of a balanced triggering of different types of immune responses for controlling the infection produced by this microorganism, as observed during experiments in animal models, support this final consideration.

Pendampingan Remaja Dalam Meningkatkan Pengetahuan Dan Sikap Pencegahan HIV/AIDS Di Daerah Pesisir Kabupaten Sumenep

Background: Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS) is a growing health problem in Indonesia. From 1987 to 2019, there were 102,667 AIDS sufferers. Adolescents aged 15-24 years are a group that is vulnerable to HIV. The purpose of PKM is for universities to play a role in developing public knowledge about reproductive health and the spread of HIV/AIDS among adolescents infection. Adolescents are a group that is more likely to transmit HIV/AIDS because they are vulnerable to risky behavior problems, such as premarital sex and substance abuse. Methods: The target of service is youth in coastal areas. Problems are solved in three stages of activity, namely preparation, implementation and evaluation. Preparation is done by conducting a preliminary survey to see conditions in the field. The implementation is carried out by training, using the lecture method, namely the presentation technique, followed by question and answer discussions and exercises as a form of PKM activities. Evaluation of activities is carried out for each stage by collecting and concluding data from each stage of activity. Results: Before distributing 24 questionnaires containing information about adolescent reproductive function and HIV/AIDS to counseling participants, the result was 65%. Meanwhile, from the results of a survey of all participants to assess expansion achievement, it was found that 84%. A significant increase in participants' knowledge was 18%. Conclusion: By providing knowledge to parents, we can reach youth to avoid problems related to HIV/AIDS.

Effektifitas Media Audio terhadap Media Visual untuk Peningkatan Pengetahuan Mahasiswa Tentang HIV/AIDS di Ambon

Penyakit AIDS (Acquired Immunodeficiency Syndrome) merupakan suatu syndrome / kumpulan gejala penyakit yang disebabkan oleh Retrovirus yang menyerang sistem kekebalan atau pertahanan tubuh. Dengan rusaknya sistem kekebalan tubuh, maka orang yang terinfeksi mudah diserang penyakit-penyakit lain yang berakibat fatal, yang dikenal dengan infeksi oportunistik. AIDS pada anak pertama kali dilaporkan oleh Oleske, Rubinstein dan Amman pada tahun 1983 di Amerika Serikat. Untuk meningkatkan pengetahuan HIV/AIDS pada mahasiswa peneliti menggunakan media audio visual. Media audio visual gerak adalah media intruksional modern yang sesuai dengan perkembangan zaman (kemajuan ilmu pengetahuan dan teknologi) karena meliputi penglihatan, pendengaran dan gerakan, serta menampilkan unsur gambar yang bergerak.Metode yang digunakan didalam penelitian ini adalah metode Penalitian Qusi eksperimen. Metode yang digunakan didalam penelitian ini adalah metode Penalitian Quasi eksperimen. Pada penelitian ini dilibatkan tiga kelas yang dibandingkan, yaitu kelas B (Audio) dan kelas C (Visual). Populasi dalam penelitian ini adalah mahasiswa Jurusan Keperawatan Politeknik Kesehatan Kemenkes Maluku yang berjumlah 352 orang. Dan sampelnya dalam penelitian ini adalah mahasiswa tingkat I semester I Jurusan Keperawatan Kemankes Maluku. Yang berjumlah 80. Karena pada kelas – kelas tersebut belum pernah memperoleh materi tentang HIV/AIDS. Media Audio dan Visual mempunyai pengaruh yang besar untuk meningkatkan pengatahuan mahasiswa dengan hasil uji t diperoleh thitung= 13,980 > ttabel (2.048) yang berarti H1 diterima. Sehingga dapat disimpulkan bahwa terdapat pengaruh yang signifikan antara hasil belajar siswa sebelum dan sesudah menggunakan media audio dan visual (Video) dalam belajar Materi Penyakit HIV/AIDS. Media Visual mempunyai pengaruh terhadap peningkatan pengetahuan mahaiswa dengan dari hasil uji t diperoleh thitung= 10,370 > ttabel (2.048) yang berarti H1 diterima. Sehingga dapat disimpulkan bahwa terdapat pengaruh yang signifikan antara hasil belajar siswa sebelum dan sesudah menggunakan media visual (gambar dan hand out) dalam belajar Materi Penyakit HIV/AIDS. Media Audio mempunyai pengaruh untuk meningkatkan pengatahuan mahaiswa dengan hasil uji t diperoleh thitung= 13,552 > ttabel (2.048) yang berarti H1 diterima. Sehingga dapat disimpulkan bahwa terdapat pengaruh yang signifikan antara hasil belajar siswa sebelum dan sesudah menggunakan media audio (tape recorder) dalam belajar Materi Penyakit HIV/AIDS

In Vitro Susceptibility of Talaromyces Marneffei In Malaysia: Comparison of Yeast and Mycelial Phases

Talaromyces marneffei is an etiologic agent of talaromycosis. It can cause serious complications and death in immunocompromised patients, particularly in acquired immunodeficiency syndrome (AIDS) patients. This infectious disease is endemic in Southeast Asia including Malaysia. To date, published reports on the antifungal susceptibility profile of T. marneffei is very limited. The objective of this study is to determine the minimum inhibitory concentration (MIC) of T. marneffei in yeast and mycelial phases in Malaysia. In the year 2020, 27 clinical strains of T. marneffei were received from various hospitals in Malaysia. The identification was carried out using microscopic, macroscopic and molecular methods. Following that, the susceptibility of each isolate in both yeast and mycelial form to thirteen common antifungals was performed according to the broth microdilution in Clinical & Laboratory Standards Institute (CLSI) M38 method. The antifungals tested were anidulafungin, micafungin sodium, caspofungin diacetate, 5-fluorocytosine, amphotericin B and terbinafine hydrochloride, posaconazole, voriconazole, itraconazole, ketoconazole, ravuconazole, clotrimazole and isavuconazole. The geometric mean of all antifungals other than anidulafungin, micafungin sodium, caspofungin diacetate and 5-fluorocytosine against T. marneffei mould (mycelial) were >2 μg/ml. However, the geometric mean of all antifungals against T. marneffei yeast was <2 μg/ml. Our in vitro data suggests promising activities of amphotericin B, terbinafine hydrochloride, posaconazole, voriconazole, itraconazole, ketoconazole, ravuconazole, clotrimazole and isavuconazole against yeast and mould phases of T. marneffei.

ATENÇÃO FARMACÊUTICA NA ADESÃO A TERAPIA ANTIRRETROVIRAL DO HIV/AIDS

Introdução: A Acquired Immunodeficiency Syndrome - AIDS é uma doença que afeta o sistema imunológico humano, sendo proveniente da infecção pelo Vírus da Imunodeficiência Humana - HIV. O indivíduo infectado pelo HIV, é denominado soropositivo, sendo que os estágios iniciais da infecção em geral são assintomáticos. O farmacêutico apresenta conhecimento técnico e prático, sendo então capacitado para atuar diante dos casos onde é necessária a intervenção farmacológica no paciente, para que o mesmo passe a aceitar a terapia antirretroviral (TARV). Objetivos: Identificar os desafios que levam a não adesão a TARV e caracterizar a atenção farmacêutica em relação a adesão da terapia antirretroviral. Metodologia: Trata-se de uma revisão de literatura, onde foram obtidos estudos na base de dados Scielo. Dez (10) estudos foram inclusos para alcançar os objetivos do tema proposto, sendo trabalhos publicados entre 2015 à 2019. Resultados: Os resultados obtidos indicam que a não adesão ao tratamento envolvem os efeitos colaterais dos medicamentos, número de doses, mudanças no esquema terapêutico, bem como, características sócio demográficas, a não utilização dos serviços de saúde de forma correta, condições psicossociais. O farmacêutico deve prestar orientações em torno da importância de se realizar o tratamento medicamentoso, prestando a atenção farmacêutica, o profissional tem o dever de estar junto ao paciente, orientando e o aconselhando diante de um diagnóstico de HIV e do início do tratamento, pois, são diversas as dúvidas e incertezas que começam a surgir, portanto, tal profissional pode fazer toda a diferença na forma com que o paciente passa a lidar com as novas mudanças. Conclusão: Em relação aos motivos que levam a não adesão a TARV, pode-se evidenciar aspectos relacionados com os medicamentos e também sociais. O farmacêutico deve atuar orientando os pacientes, ao mesmo tempo em que contribui com o acompanhamento farmacoterapêutico do indivíduo, recomendando as mudanças que se fizerem necessárias.