The frequency of cytomegalovirus (CMV)-specific CD4؉ T lymphocytes was determined in CMV-seropositive rhesus macaques with or without simian immunodeficiency virus (SIV) infection by using the sensitive assays of intracellular cytokine staining and gamma interferon ELISPOT. Both techniques yielded 3-to 1,000-foldhigher frequencies of CMV-specific CD4 ؉ T lymphocytes than traditional proliferative limiting dilution assays. The median frequency of CMV-specific CD4 ؉ T lymphocytes in 23 CMV-seropositive SIV-negative macaques was 0.63% (range, 0.16 to 5.8%). The majority of CMV-specific CD4 ؉ T lymphocytes were CD95 pos and CD27 lo but expressed variable levels of CD45RA. A significant reduction (P < 0.05) in the frequency of CMV-specific CD4 ؉ T lymphocytes was observed in pathogenic SIV-infected macaques but not in macaques infected with live attenuated strains of SIV. CMV-specific CD4 ؉ T lymphocytes were not detected in six of nine pathogenic SIV-infected rhesus macaques. CMV DNA was detected in the plasma of four of six of these macaques but in no animal with detectable CMV-specific CD4 ؉ T lymphocytes. In pathogenic SIV-infected macaques, loss of CMV-specific CD4 ؉ T lymphocytes was not predicted by the severity of CD4 ؉ T lymphocytopenia. Neither was it predicted by the pre-SIV infection frequencies of CD45RA neg or CCR5 pos CMV-specific CD4 ؉ T lymphocytes. However, the magnitude of activation, as evidenced by the intensity of CD40L expression on CMV-specific CD4 ؉ T lymphocytes pre-SIV infection, was three-to sevenfold greater in the two macaques that subsequently lost these cells after SIV infection than in the two macaques that retained CMV-specific CD4 ؉ T lymphocytes post-SIV infection. Future longitudinal studies with these techniques will facilitate the study of CMV pathogenesis in AIDS.

Although opportunistic infections like cytomegalovirus (CMV) are common sequelae of end-stage AIDS, the immune events leading to CMV reactivation in human immunodeficiency virus (HIV)-infected individuals are not well defined.

Human cytomegalovirus (HCMV) infection is usually asymptomatic in immunocompetent people. However, it may cause severe and, sometimes, fatal disease in immunologically immature or immunocompromised individuals, such as transplant recipients, human immunodeficiency virus (HIV)-infected patients, and developing fetuses (4, 63). The clinical significance of HCMV has increased due to the increased number of organ allograft transplant recipients and HIV-infected individuals. Furthermore, HCMV is the leading infectious cause for birth defects in newborns. Development of a safe and effective HCMV vaccine is thus required for those people at risk for HCMV infection and disease and has been placed in the top priority by the Institute of Medicine for the clinical and economic benefit that a vaccine would produce (64).Studies of HCMV immunity are important for the development of vaccines. Although the nature of protective immune responses to HCMV infection is incompletely defined, clinical observations in immunocompromised humans and congenital infection have pointed to the importance of neutralizing antibody and cytotoxic T-lymphocyte (CTL) responses in controlling HCMV disease. Neutralizing antibodies appear to be critical for limiting the incidence and severity of HCMV congenital infection following primary and nonprimary maternal infection (10, 25) and the severity of HCMV disease in transplant patients and HIV-infected patients (1, 2, 10). Likewise, the recovery of HCMV-specific CD8 ϩ CTL response in organ recipients correlates to the protection from HCMV disease after transplantation (36,(54)(55)(56). In addition, passive transfer of ex vivo-expanded CD8 ϩ HCMV-specific CTL clones from seropositive donors reconstitutes cellular immunity in seronegative bone marrow recipients and prevents the onset of viremia and HCMV-related disease (68). Investigations into HCMV antigens that induce protective immunity have shown that glycoprotein B (gB) is the immunodominant target for neutralizing antibodies (13, 43) and lower matrix phosphoprotein 65 (pp65) is the principal target for HCMVspecific CTL responses after natural infection (11,28,45,70). Studies of gB-and pp65-based DNA vaccines in the murine and guinea pig CMV models have demonstrated the ability of gB and pp65 to stimulate CTL and neutralizing antibody responses that confer protection against CMV infection and disease (46-48, 59, 60, 71). However, since results obtained in mice do not always predict the responses in humans (42, 69), experimental studies in nonhuman primates can provide insight into the efficacy of vaccine strategies prior to commencement of clinical trials in humans.

BackgroundCutaneous metastases from internal malignancies are uncommon. Moreover, endometrial carcinoma rarely metastasizes to the skin, with a reported prevalence of 0.8%. Here, we report the case of a 62-year-old woman who developed cutaneous metastases from an endometrial carcinoma.Case presentationWhen admitted to our department, the patient underwent a biopsy that showed the presence of cutaneous metastasis in relation to her initial endometrial cancer, diagnosed 3 years earlier. Thereafter, she was treated with a bilateral uterine artery embolization and chemotherapy. The patient had complications and survived 5 months after the diagnosis of the cutaneous metastasis. She died from sepsis.ConclusionCutaneous metastases of the endometrial carcinoma are usually incurable and suggest an unfortunate prognosis where palliation is the mainstay of patient management.

Purpose To study the distribution of breast mammogram density in Lebanese women and correlate it with breast cancer (BC) incidence. Methods Data from 1,049 women who had screening or diagnostic mammography were retrospectively reviewed. Age, menopausal status, contraceptives or hormonal replacement therapy (HRT), parity, breastfeeding, history of BC, breast mammogram density, and final BI-RADS assessment were collected. Breast density was analyzed in each age category and compared according to factors that could influence breast density and BC incidence. Results 120 (11.4%) patients had BC personal history with radiation and/or chemotherapy; 66 patients were postmenopausal under HRT. Mean age was 52.58 ± 11.90 years. 76.4% of the patients (30–39 years) had dense breasts. Parity, age, and menopausal status were correlated to breast density whereas breastfeeding and personal/family history of BC and HRT were not. In multivariate analysis, it was shown that the risk of breast cancer significantly increases 3.3% with age (P = 0.005), 2.5 times in case of menopause (P = 0.004), and 1.4 times when breast density increases (P = 0.014). Conclusion Breast density distribution in Lebanon is similar to the western society. Similarly to other studies, it was shown that high breast density was statistically related to breast cancer, especially in older and menopausal women.

Objective: To evaluate the cesarean section rate using the Robson Classification for the first time in Lebanon, at Hôtel-Dieu de France University Hospital, a tertiary referral center in Beirut.Methods: Routine medical record data that included all live births from January 1, 2018 to September 30, 2020 was investigated. The overall cesarean section rate was recorded, and the size, cesarean section rate, and absolute and relative contributions were calculated within each group. Results:The overall cesarean section rate was 56.8%. The highest relative contribution to this rate came from Robson groups 5, 2 and 10, respectively. A decrease in cesarean section rate was noted in 2020 among women admitted for induction of labor (groups 2 and 4) following the implementation of new department policies and the restrictions caused by the coronavirus disease 2019 pandemic. Conclusion:More than 50% of the deliveries in our department were by cesarean sections (CS). Strategies to reduce this rate should include stricter departmental policies for avoidance of unindicated primary CS and raising practitioners' and patients' awareness about trial of labor after cesarean section.

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