We assessed the prevalence and factors related to the time to antiretroviral (ART) initiation among persons who entered HIV care and subsequently started ART in Croatia from 2005 to 2014. Included were patients ≥ 18 years, the follow-up ended on Dec/31/2017. 628 patients were included into the study 91.9% were men; median age was 36.1 (Q1–Q3: 29.6–43.8) years. Rapid (within 7 days of diagnosis) ART initiation was observed in 21.8% patients, 49.8% initiated ART within 30 days, 21.7% and 28.5% had intermediate (31 days–1 year) and late initiation (> 1 year), respectively. Of 608 patients that achieved an undetectable viral load, 94% had a plasma HIV-1 RNA < 50 copies/ml at last measurement after a median follow-up of 5.2 years. On quantile regression analysis, calendar year of entry into care, and markers of more advanced HIV disease (higher viral load, lower CD4 cell count and clinical AIDS) were significantly associated with earlier ART initiation. Early ART was not related to a gap in care afterwards at all quantiles. In conclusion, a significant proportion of patients started ART early in Croatia in 2005–2014. Early ART initiation led to durable viral load suppression and was not associated with a subsequent gap in care.
A case of enormous Chiari's network in a 7-year-old girl is described. It formed a parachute or spinnaker-like sack which moved freely into the pulmonary artery causing mild pulmonic stenosis. The preoperative diagnosis was believed to be myxoma of the right ventricle. The real condition was recognized during the operation. This is the seventh reported case of correction of so-called cor triatriatum dextrum.
The echocardiographic features and management of 10 children with right heart thrombus (RHT) are presented. The patients' ages ranged from 2 weeks to 12 years. Three patients were less than 3 weeks old. The echocardiographic diagnosis was confirmed in five patients by surgery or autopsy. The thrombus was detected in the right atrium (five patients), in the right ventricle (three), on the tricuspid valve or within the inferior vena cava, the superior vena cava, or its extension following Senning's operation for transposition of great arteries (TGA). Seven patients had structural heart disease: TGA in four, tricuspid atresia in three. In two of three patients with anatomically normal heart, the thrombus occurred as a complication of a ventriculoatrial and a lymphovenous shunt system. The third patient had no predisposing factor. Five patients were treated with anticoagulants or platelet anti-aggregating agents and four by surgery. Seven patients survived and were followed by echocardiography.
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