Human papillomavirus (HPV) is the most common cause of cervical cancer worldwide, and Romania has the highest rate of cervical cancer in Europe. Sixty-five young Romanian women infected with HIV during early childhood and 25 control subjects were evaluated for the presence of cervical HPV infection and for cytologic abnormalities. HPV infection was evaluated longitudinally in 42 HIV-infected individuals. Overall 28/65 (43.1%) of HIV-infected and 8/25 (32.0%) of uninfected subjects were infected with HPV, and 21/65 (32.3%) and 6/25 (24%) had high-risk subtypes, respectively. In HIV-infected women, those maintaining or acquiring a new subtype in follow-up were more likely to have a lower nadir ( p = 0.04) and current ( p = 0.01) CD4 cell counts. The incidence rate for HPV acquisition events was 0.69 per subject per year, and 0.52 for high-risk subtypes. In the HIV-infected group, 9/13 (69.2%) individuals with abnormal cytology progressed at follow-up. Although HPV prevalence was similar to controls, the rate of Pap smear abnormalities was much higher, possibly due to the decreased ability to mount new immune responses. Given the high rate of incident detection of vaccine preventable strains and cytologic progression in this cohort, HPV vaccination may be beneficial at any age in co-infected women.
In this retrospective case-control study conducted in Cluj-Napoca, Romania, we assessed the effect of ulcerations/amputations on hospitalization costs of patients with diabetes. Patients with (Group 1) or without (Group 2) ulcerations/amputations (case-control ratio 3:1) admitted to a single diabetes center between 2012–2017 were included. The effects of hospitalization days, age, duration of diabetes, body mass index and glycated hemoglobin (HbA1c) on total costs was explored using a multivariate linear regression analysis, enter model. Overall, 876 patients were included (Group 1: 682, 323 [47.4%] with amputations; Group 2: 194). Median (interquartile range) total expenses in Group 1 were 40% higher compared to Group 2 (€724 [504; 1186] vs €517 [362; 645], p < 0.001). Significant differences were observed between hospitalization costs (p < 0.001), cost of food (p < 0.001), medication (p = 0.044), drugs administered at the emergency room/intensive care unit (p < 0.001) and other expenses (p = 0.003). Hospitalization costs represented 80.5% of total expenses in Group 1 and 76.3% in Group 2. In multivariate analysis, hospitalization days influenced significantly the total costs in both groups (p < 0.001); in Group 2, the effect of HbA1c was also significant (p = 0.021). Diabetic foot ulcers and subsequent amputations most likely impose a significant economic burden on the Romanian public healthcare system.
Transition from adolescent to adult care can be challenging for youth living with HIV. We describe the level of engagement in care and its impact on HIV outcomes in a group of patients infected in early childhood and followed-up through adolescence (15-19 years) and young adulthood (20-24 years) by the same medical team. We conducted a cohort study of youth born between 1985-1993 and infected with HIV parenterally, followed at a single tertiary care centre. Individuals were followed from age 15 years or first clinic visit (whichever came last) until age 25 years or 30 Nov 2016 (whichever came first). A longitudinal continuum-of-care was constructed, categorizing individuals' status for each month between the ages of 15-25 years as: engaged in care (EIC); not in care (NIC: no clinic visits within past year); lost-to-follow-up (LTFU: NIC and did not return to clinic); or died. Those EIC were further subdivided by current CD4 count and viral load (VL). 545 individuals (52% male) were followed for 4775 person-years. 64 (12%) became LTFU and 27 (5%) died. At age 15, 92% were EIC, decreasing to 84% at age 20 and 74% at age 25. Of those EIC, HIV markers improved with age: 79% and 52% had a CD4≥200 cells/µl and VL<400 cps/ml at age 15; increasing to 86% and 73% at age 20 and 87% and 80% at age 25. 277 (55.5%) spent their entire adolescence EIC; this decreased to 202 (37%) for the years of young adulthood (p=0.0001). There were no observed demographic differences between those with continuous and intermittent engagement in care. We conclude that youth infected during early childhood tended to disengage from care, even when followed by the same medical team for a lengthy period of time. For those that did engage in care, HIV-related outcomes improved from adolescence through to adulthood.
Aim
To evaluate the changes in quality of life (QOL), diabetic neuropathy (DN) and amputations over 4 years in patients with diabetes.
Methods
In 2012, 25,000 Romanian‐translated Norfolk QOL‐DN self‐administered questionnaires were distributed during a cross‐sectional study. Between March‐December 2016, all patients identified from the 2012 cohort and enrolled in this follow‐up study completed the Norfolk QOL‐DN questionnaire; amputations suffered since 2012 were recorded. The influence of age and duration of diabetes (DD) on delta QOL scores (defined as the differences between 2012 and 2016 scores) and of sex, age, diabetes type, DD and declared DN on amputations was explored using multivariate linear and logistic regression, respectively.
Results
The mean (standard deviation) age of the 1865 participants was 60.6 (10.3) years. Mean total QOL‐DN score increased from 2012 to 2016 by 4.39% (P = .079). Both DD (b = 0.39, 95% confidence interval [CI] 0.21‐0.57, P < .001) and age (b = 0.25, 95% CI 0.13‐0.36, P < .001) were significantly correlated with total QOL‐DN score. Delta total QOL was higher in patients whose statement about having DN changed since 2012. Over 4 years, 36 patients suffered amputations. Male sex (OR = 3.11, 95% CI 1.46‒6.62, P = .003), physical functioning/large‐fibre neuropathy subscale score (OR = 1.04, 95% CI 1.001‒1.09, P = .047), autonomic neuropathy subscale score (OR = 0.78, 95% CI 0.64‒0.94, P = .011) and small‐fibre neuropathy subscale score (OR = 1.21, 95% CI 1.05‒1.40, P = .007) were significant predictors of amputations. Delta total QOL‐DN score was 10 times higher in patients who suffered amputation(s) compared with their amputation‐free counterparts.
Conclusion
QOL deteriorates with age and DD. Norfolk QOL‐DN subscale scores can predict amputations.
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