Background: Cluster of differentiation 4 (CD4) T cells play a central role in regulation of adaptive T cell-mediated immune responses. Low CD4 T cell counts are not routinely reported as a marker of immune deficiency among HIV-negative individuals, as is the norm among their HIV positive counterparts. Despite evidence of mortality rates as high as 40% among Ugandan critically ill HIV-negative patients, the use of CD4 T cell counts as a measure of the immune status has never been explored among this population. This study assessed the immune status of adult critically ill HIV-negative patients admitted to Ugandan intensive care units (ICUs) using CD4 T cell count as a surrogate marker. Methods: A multicentre prospective cohort was conducted between 1st August 2017 and 1st March 2018 at four Ugandan ICUs. A total of 130 critically ill HIV negative patients were consecutively enrolled into the study. Data on sociodemographics, clinical characteristics, critical illness scores, CD4 T cell counts were obtained at baseline and mortality at day 28. Results: The mean age of patients was 45± 18 years (mean±SD) and majority (60.8%) were male. After a 28-day follow up, 71 [54.6%, 95% CI (45.9-63.3)] were found to have CD4 counts less than 500 cells/mm³, which were not found to be significantly associated with mortality at day 28, OR (95%) 1 (0.4–2.4), p = 0.093. CD4 cell count receiver operator characteristic curve (ROC) area was 0.5195, comparable to APACHE II ROC area 0.5426 for predicting 24-hour mortality. Conclusions: CD4 T cell counts were generally low among HIV-negative critically ill patients. Low CD4 T cells did not predict ICU mortality at day 28. CD4 T cell counts were not found to be inferior to APACHE II score in predicting 24 hour ICU mortality.
treatment patterns and drug treatment costs in such patients. METHODS: Retrospective analysis of pooled US health insurance claims data for commercially insured (Pharmetrics/I3/Thomson) and Thomson Medicaid patients, 2007-2009. RESULTS: Data from 14,002 treatment-naïve patients were collected. 6,801 patients (49%) started on an NNRTI (of which 99.8% on efavirenz, mainly as part of a fixeddose combination), 5,966 (43%) on a PI and 1,235 (9%) on an II or another third agent. As expected due to the teratogenic potential of efavirenz, substantially fewer women aged Ͻ40 years started NNRTI treatment (32.5% vs 60% starting a PI). Of all patients who started on efavirenz, 66% remained on this initial treatment at 1 year. Of patients who switched to another regimen after discontinuing efavirenz, 85% changed to a PI-based regimen. At the start of efavirenz treatment, mean daily drug cost (including 2 NRTIs) was 46 USD. For patients who switched subsequently to a PI-based regimen, mean daily drug cost rose by 51% to 70 USD. Corresponding values from the individual databases were consistent. CONCLUSIONS: Within one year after initiation of therapy, many patients discontinue efavirenz. When changing to another regimen, the majority switch to a PI, with an associated rise in costs. The study highlights opportunities in the current HIV treatment-naïve market and the need for new third agents which are as effective but better tolerated than efavirenz, and may be used in women of childbearing potential. Such agents may alleviate the need to start with and/or delay the switch to more expensive treatments, potentially reducing HIV treatment costs. OBJECTIVES:Vaccinating birth mothers with influenza vaccine in the immediate postpartum period can protect both the vaccine recipients and their young infants who are ineligible for any influenza vaccine. The study objective was to estimate the potential economic benefit associated with this intervention. METHODS: A decision analysis model was constructed to determine the probabilities, costs and potential cost-benefit of a postpartum influenza vaccination strategy using a societal perspective. A hypothetical cohort of 4 million healthy birth mothers in the United States was included into a decision tree model assuming an influenza season beginning September 1 and ending April 30. Probabilities and costs used in this study were derived from our review of published literature, unpublished data reported from Centers for Disease Control and Prevention (CDC), and recent published clinical trial data. All direct and indirect cost estimates were inflated to year 2010 US dollars and discounted at a 3% annual discount rate. RESULTS: Under the base-case assumptions, the average costs per vaccinated mother and per unvaccinated mother were estimated at $328.45 and $341.02, respectively. Our model suggests an expected net societal benefit of $12.57 per post-partum vaccinated mother, compared to no vaccination. The overall societal savings in this cohort ranged from $20,112,186 to $45,252,420, depend...
Background: Intra-abdominal hypertension (IAH) is sustained increase in intra-abdominal pressure (IAP) ≥12 mmHg in adults and ≥10 mmHg in children. IAH has been noted to be associated with increased morbidity and mortality among critically ill patients. Measurement of IAP is common among at risk patients in the developed world. However, it has not received due attention in the majority of intensive care units (ICUs) in low-income countries, Uganda being one of these. This is evidenced by paucity of data and lack of protocols from the Ugandan Ministry of Health. This multi-center study was thus conducted to assess the prevalence, incidence and mortality associated with IAH among patients admitted to Ugandan ICUs. Methods: A multi-center prospective cohort study was conducted from September 2017 to February 2018 at three ICUs in Uganda. We consecutively enrolled 126 patients into the study. IAP was measured using the Harrahil manometer technique. Categorical variables were analyzed using the Chi square test and continuous variables analyzed using the t-test and Man Whitney test. The prevalence and incidence were determined using proportions and mortality was determined using survival analysis. Results: The median age was 33 years (26-48.5) for the patients without IAH and 42 years (29-55) for those with IAH. The majority of the patients were male and 9.6% of the patients were below 18 years. The prevalence of IAH was 62.7 (CI 54.1-71.3), whereas the 24 hour and 72 hour incidence of IAH was 9.3% (CI 1.3-17.2) and 14.3 % (CI 4.1-24.4), respectively. Mortality was higher in patients with IAH compared to those without (p-value 0.003 and 0.028, mean and maximum IAP, respectively). Conclusion: We found a high prevalence and incidence of IAH among critically ill patients, associated with a high mortality. Routine screening for IAH can preempt management strategies to mitigate this.
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