Background-The extent to which the prognosis for AIDS and death of patients initiating highly active antiretroviral therapy (HAART) continues to be affected by their characteristics at the time of initiation (baseline) is unclear.Methods-We analyzed data on 20,379 treatment-naive HIV-1-infected adults who started HAART in 1 of 12 cohort studies in Europe and North America (61,798 person-years of followup, 1844 AIDS events, and 1005 deaths).Results-Although baseline CD4 cell count became less prognostic with time, individuals with a baseline CD4 count <25 cells/µL had persistently higher progression rates than individuals with a baseline CD4 count >350 cells/µL (hazard ratio for AIDS = 2.3, 95% confidence interval [CI]: 1.0 to 2.3; mortality hazard ratio = 2.5, 95% CI: 1.2 to 5.5, 4 to 6 years after starting HAART). Rates of AIDS were persistently higher in individuals who had experienced an AIDS event before starting HAART. Individuals with presumed transmission by means of injection drug use experienced substantially higher rates of AIDS and death than other individuals throughout follow-up (AIDS hazard ratio = 1.6, 95% CI: 0.8 to 3.0; mortality hazard ratio = 3.5, 95% CI: 2.2 to 5.5, 4 to 6 years after starting HAART).Conclusions-Compared with other patient groups, injection drug users and patients with advanced immunodeficiency at baseline experience substantially increased rates of AIDS and death up to 6 years after starting HAART.

No abstract

Background. Neurological manifestations are not an unusual expression of multisystem dysimmune disorders, some etiopathogenic correlations being more common than others. We report here four distinct patterns of recurrent central nervous system (CNS) involvement and neuromuscular junction dysfunction occurring in an autoimmune chronic disease. Our patient presented diagnosis clues suggestive for systemic lupus erythematosus, antiphospholipid syndrome and Sjögren’s syndrome along with clinical findings highly characteristic for two primary vasculitis (i.e. Churg-Strauss syndrome and Behçet’s disease) and an increased susceptibility to infections. To our knowledge no similar case has been described previously. Case presentation. The patient is a Caucasian female of current age 26. Her neurological condition evolved over the last 6 years in a relapsing-remitting manner with recurrent cerebral venous system thrombosis/thrombophlebitis, recurrent myelopathy consistent with acute transverse myelitis, recurrent encephalopathy manifested as psychosis, recurrent pancerebellar syndrome and recent onset myasthenic syndrome. In spite of reaching life-threatening illness severity several times, following each one of the disease flare-ups the patient eventually showed a complete clinical resolution with therapy, as a peculiar and unexpected feature of her repeated CNS autoimmune attacks. Conclusion. When facing a complex and atypical immune disorder involving CNS one should remain cautious in labeling it. In such beyond-guidelines cases several treatment approaches should be tried and reevaluation of different organ involvement is a must.

Background: Antimicrobial resistance is one of the world’s most serious health issues. Antibiotic resistance, excessive drug expense, and an increased risk of adverse reactions are all common outcomes of incorrect antibiotic prescribing. The goal of this study was to evaluate the prevalence of antibiotic prescriptions for inpatients to find areas for improvement. Methods: A retrospective study at Emergency Clinical County Hospital of Oradea, Romania was performed for five years between 2017 and 2021. Data was collected using medical records of the patients and reports from the pharmacy. Antibiotic consumption was expressed as DDD/100 BD according to the World Health Organization (WHO) by antibiotics, classes, and AWaRe classification. Results: The prevalence of antibiotic prescription was 53.8% during five years evaluated with a significant increase in 2021. A total of 13,677.42 DDD/100 BD antibiotics were prescribed, especially for surgical and medical prophylaxes. The most prescribed antibiotics were ceftriaxone, followed by metronidazole, and cefuroxime but there were some differences between years and wards. The most frequent antibiotic classes prescribed were cephalosporins (43.73%). The use of Watch Group antibiotics was high in all wards (59.69%). Conclusions: The prevalence of antibiotic use was high with cephalosporins being the most prescribed antibiotics. As a result, interventions are required.

We present the case of a 60 year-old woman diagnosed with meningiomatosis (multiple sporadic meningiomas), in the absence of neurofibromatosis type 2. The cerebral computerized axial tomography (CT scan) revealed six expansive lesions (one isodense and five spontaneously hyperdense partially or completely calcified), which at the cerebral magnetic resonance imaging (MRI) examination showed typical features of meningiomas. Case particularity: the very low incidence of sporadic multiple meningiomas and a rare cause of secondary epilepsy.