Venous thromboembolism in patients with HIV/AIDS: a case-control study

BACKGROUND: Retrospective cohort studies of HIV-infected patients suggest an incidence of venous thromboembolism (VTE) of 1% to 2%, which is 10 times that expected among people without HIV. We investigated the prevalence of established risk factors for VTE in this population and explored novel risk factors. METHODS: We conducted a case-control study using patients in the Johns Hopkins University AIDS Service cohort. We used conditional logistic regression and paired t tests to test for covariates significantly associated with VTE. RESULTS: We identified 160 patients with VTE diagnosed radiologically or with a clinical course consistent with VTE; 23% of the cases of VTE were diagnosed in hospitalized patients. The incidence of VTE was approximately 0.5% per patient-year. Patients with VTE and control patients did not differ by gender, but black patients were overrepresented among those with VTE (odds ratio [OR]=1.9, 95% confidence interval [CI]: 1.11 to 3.08) and patients with VTE were older than controls (mean: 39 vs. 37 years; P=0.001). Patients with VTE had lower CD4 counts (229 vs. 362 cells/mm; P<0.0001), higher HIV RNA titers (120,254 vs. 71,262 copies/mL; P=0.013), and lower hemoglobin concentrations (11.4 vs. 12.7 g/dL; P<0.0001) preceding the event than those without VTE. The use of highly active antiretroviral therapy was not associated with VTE. In multivariate analyses, independent risks for VTE were age, hospitalization in the past 3 months (OR=13, 95% CI: 6.4 to 27), central venous catheter use in the past 3 months (OR=6.0, 95% CI: 2.3 to 16), and a CD4 count<500 cells/mm (OR=3.0, 95% CI: 1.2 to 7.8). CONCLUSIONS: The incidence of VTE in our cohort is similar to that reported in other cohorts of patients with HIV. Recent hospitalization was the risk factor most strongly associated with VTE.     

Predicting death from HIV/AIDS: a case-control study from Florida public HIV/AIDS clinics

BACKGROUND: After markedly decreasing for 3 years, HIV/AIDS mortality declined only slightly in 1999. METHODS: The authors conducted a case-control study in four Florida urban public health HIV clinics to evaluate modifiable factors associated with HIV/AIDS mortality in a non-research setting. Structured chart review was conducted for 120 case-patients who died in 1999 and for 240 randomly selected control-patients. Risk factors associated with death in univariate analysis were entered into three conceptually related, matched logistic regression models. RESULTS: In the final multivariate model, homelessness (adjusted odds ratio [AOR], 9.98; 95% confidence interval [CI], 2.34-42.5), Medicaid insurance (AOR, 3.10; 95% CI, 1.43-6.74), having a documented adherence problem (AOR, 3.50; 95% CI, 1.64-7.47), injection drug use (AOR, 2.46; 95% CI, 1.11-5.43), non-specific liver failure (AOR, 76.9; 95% CI, 6.79-870.9), interrupted highly active antiretroviral therapy (HAART) secondary to side effects (AOR, 4.00; 95% CI, 1.46-10.9), and not receiving HAART (AOR, 2.62; 95% CI, 1.03-6.68) were independent predictors of mortality. CONCLUSIONS: In addition to medical and clinical indicators, several sociobehavioral-demographic factors remained important throughout the multivariate analysis. Improvement in care should include a focus on social circumstances of infected people. Special attention to the homeless, those with adherence problems, and those with liver disease is clearly indicated.     

Microglia activation in sepsis: a case-control study

Background  

infection induces an acute phase response that is accompanied by non-specific symptoms collectively named sickness behavior. Recent observations suggest that microglial cells play a role in mediating behavioral changes in systemic infections. In animal models for sepsis it has been shown that after inducing lipopolysaccharide, LPS, microglia in the brain were activated. The aim of this study was to investigate whether activation of microglia can be detected in patients who died of sepsis.     

Factors associated with late presentation to HIV/AIDS care in South Wollo ZoneEthiopia: a case-control study

Background  

Access to free antiretroviral therapy in Sub-Saharan Africa has been steadily increasing. The success of large-scale antiretroviral therapy programs depends on early initiation of HIV/AIDs care. The purpose of the study was to examine factors associated with late presentation to HIV/AIDS care.     

Suicide in Hong Kong: a case-control psychological autopsy study

BACKGROUND: The relative contribution of psychosocial and clinical risk factors to suicide among Chinese populations is an important issue. In Hong Kong, this issue requires vigorous examination in light of a 50% increase in suicide rate between 1997 and 2003. METHOD: Using a case-control psychological autopsy method, 150 suicide deceased were compared with 150 living controls matched by age and gender. Semi-structured interviews were conducted with the next-of-kin of the subjects. Data were collected on a wide range of potential risk and protective factors, including demographic, life event, clinical and psychological variables. The relative contribution of these factors towards suicide was examined in a multiple logistic regression model. RESULTS: Six factors were found to significantly and independently contribute to suicide: unemployment, indebtedness, being single, social support, psychiatric illness, and history of past attempts. CONCLUSIONS: Both psychosocial and clinical factors are important in suicides in Hong Kong. They seem to have mediated suicide risk independently. In addition, socio-economic adversities seem to have played a relatively important role in the increasing suicide rate in Hong Kong.     

Osteonecrosis in patients infected with HIV: clinical epidemiology and natural history in a large case series from Spain

BACKGROUND: There is a paucity of data on clinical epidemiology of osteonecrosis in HIV-infected patients. We aimed to describe patients' characteristics and natural history of this poorly known condition. METHODS: All cases of symptomatic HIV-related osteonecrosis diagnosed from 1990 through 2003 in 19 Spanish clinics were reviewed. Functional status at the last visit was assessed with the validated Western Ontario and McMaster Universities Index questionnaire. RESULTS: Of 54 patients analyzed, 29 (53.7%) had a single bone necrosis, and 25 (46.3%) had 2 or more sites involved. Progression of symptoms happened more often in patients with hip involvement (17/39 vs 0/8 patients; P = 0.019). Twenty patients (37%) required surgical intervention. Male sex and higher CD4 cell count were associated with surgery on multivariable analysis. Overall, at the end of the follow-up period, half of the patients had moderate to severe disability (Western Ontario and McMaster Universities Index score > or =60). During a follow-up period of 137 person-years, only 2 new episodes of osteonecrosis were observed (rate of recurrences, 1.5/100 person-years; 95% confidence interval, 0.4-5.1). CONCLUSIONS: HIV-related osteonecrosis is associated with significant disability over time. Location of bone necrosis, sex, and CD4 cell count may influence the outcome. The risk for recurrences for patients who have experienced 1 episode is low.     

A case-control study of factors associated with HIV infection among black women

OBJECTIVE: To identify social, behavioral and epidemiologic factors associated with HIV infection among HIV-infected and HIV-uninfected black women residing in North Carolina. DESIGN: A case-control study conducted in August 2004 in North Carolina. METHODS: Cases were 18-40-year-old women with HIV infections diagnosed from 2003-2004. Controls were 18-40-yearold, HIV-negative heterosexually active women recruited from HIV testing sites. Five focus group discussions were also conducted with women not participating in the case-control study. RESULTS: Multivariate analyses of 31 cases and 101 controls showed that HIV-positive women were more likely to receive public assistance [adjusted odds ratio (aOR) 7.3; 95% confidence interval (CI) 2.1, 26.0], to report a history of genital herpes infection (aOR 10.6; 95% CI 2.4, 47.2), and were less likely to have discussed a variety of sexual and behavioral issues relevant to risk of HIV infection with their male partners (aOR 0.6; 95% CI 0.4, 0.8). Focus group participants indicated that financial and social demands created competing challenges for making HIV prevention a priority. CONCLUSIONS: Inadequate communication between black women and their sexual partners may create barriers to sexual and behavioral risk reduction. A multidimensional approach that addresses both biological factors such as herpes infection and socioeconomic factors may be needed to reduce HIV transmission in this population.     

Mannose-binding lectin genotypes and pre-eclampsia: a case-control study

Both immunological and placental factors are involved in the pathogenesis of pre-eclampsia. The complement factor mannose-binding lectin (MBL) is associated with adverse pregnancy outcomes and has been suggested to play a role in abnormal placentation. We investigated whether MBL genotypes are associated with the systemic maternal syndrome pre-eclampsia. MBL2 gene polymorphisms were determined in a case-control study including 157 women with pre-eclampsia (case subjects) and 157 women with uncomplicated pregnancies (control subjects). Considering MBL polymorphisms, case and control subjects were categorized in groups of high (A), intermediate (B), and low (C) MBL production. No association was found between MBL genotypes and pre-eclampsia; adjusted odds ratios and 95% confidence intervals (95% CI) for group B were 0.97 (95% CI = 0.46-2.07) and for group C were 1.44 (95% CI = 0.52-3.94). A trend was found between MBL genotype groups B and C and severe pre-eclampsia or eclampsia. MBL genotypes were not found to be associated with pre-eclampsia; however low-MBL production genotypes might be considered as disease modifier. This suggests that MBL may play a role in modulating placental inflammation by facilitating clearance of apoptotic cells and cell debris.     

Acculturation and suicide: a case-control psychological autopsy study

BACKGROUND: The relationships between acculturation and suicide were investigated in East Taiwan. METHODS: Psychological autopsy interviews were conducted for consecutive suicides from two native Taiwanese groups (Atayal and Ami) (N = 30 for each group); each of them was matched with two controls for age, sex and area of residence. The Taiwan Aboriginal Acculturation Scale was used to measure the extent of acculturation. RESULTS: A lower degree of social assimilation was significantly associated with a higher risk of suicide in the Atayal and the male groups. In multivariable regression analysis, a significant effect of low social assimilation on the risk of suicide was found in Atayal and in men, even after controlling for the effects of ICD-10 depressive episode and emotionally unstable personality disorder. Meanwhile, there was a significant trend across low, moderate and high social assimilation on suicide risk in Atayal and in men. CONCLUSIONS: For the native Taiwanese, the stress from rapid acculturation into the main Chinese society is crucial to their mental health. It might be reduced through targeted social and educational programmes.     

Postpartum psychiatric emergency visits: a nested case-control study

Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006–2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n?=?8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12–1.50; 1.17, 95 % CI 1.01–1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38–1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01–1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.     

Mortality risk factors in sleep apnoea: a matched case-control study

Sleep apnoea syndrome was reported to be associated with increased mortality but it is not known if this association is independent of obesity and co-morbidities. The present study investigated predictors of mortality in a large cohort of men with sleep apnoea using a case-control design. The study population consisted of 10,981 men diagnosed during 1991-2000 by whole-night polysomnography with sleep apnoea; 331 men died prior to 1 September 2001, of whom 277 were matched by age, gender, site and time of study to patients who were alive in September 2001. Multivariate analysis revealed that all-cause mortality was associated with chronic obstructive pulmonary disease (COPD) (odds ratio, OR: 7.07, 95% CI 2.75-18.16), chronic heart failure (CHF) (OR: 5.47, 95% CI 1.06-28.31), diabetes mellitus (DM) (OR: 3.30, 95% CI 1.51-7.20) and body mass index (BMI) (increase of 5 kg m(-2), OR: 1.44, 95% CI: 1.04-1.99). Chronic upper airway problems were associated with survival (OR: 0.45, 95% CI 0.23-0.90). There were significant interactions between respiratory disturbance index and BMI and COPD. Mortality of patients younger than the median age (62 years) was associated with COPD, DM and an interaction between BMI and apnoea severity. Predictors of mortality for the older patients were COPD, CHF and DM. We conclude that all-cause mortality in sleep apnoea is associated with co-morbidities and obesity. Severity of sleep apnoea affects mortality by interacting with obesity and lung disease.     

Risk factors for suicide in China's youth: a case-control study

BACKGROUND: Suicide is the most common cause of death among youth in China. METHOD: A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15-24 years who died by suicide (cases) and 91 who died of other injuries (controls). RESULTS: Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6-390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6-97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8-34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8-11.9; high: OR 9.1, 95% CI 1.2-66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6-76.5) but not in females (OR 0.3, 95% CI 0.0-3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts. CONCLUSIONS: Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.     

Apolipoprotein E gene polymorphism in cerebrovascular disease: a case-control study

The association between apolipoprotein E (apo E) polymorphism and stroke has been controversial. So far there are no studies reported on the polymorphism of apolipoprotein E in cerebrovascular diseases in the Asian Indians. A blinded case-control study was therefore undertaken and the apo E genotypes and lipid profile of a total of 120 subjects (63 stroke patients and 57 healthy controls) were done. The frequency distribution of apo E alleles and genotypes were assessed and their relation with the occurrence of stroke in Asian Indian subjects was determined. A significantly high frequency of apo epsilon4 allele (30%) was observed in the stroke patients than the controls (11%) (p < 0.005), and patients with epsilon4 allele had a fourfold higher odds to develop stroke OR (95%CI) 4.2 (1.8-10.1) (p < 0.005). On multivariate analysis, after adjusting for age, triglycerides and hypertension, the association of epsilon4 allele with stroke was found to be no longer statistically significant, OR (95%CI) 1.2 (0.4-4.5) (p = NS). On multiple logistic regression analysis age, OR (95%CI) 1.1 (1.1-1.2) (p < 0.001), and hypertension OR (95%CI) 15.1 (2.6-89.1) (p < 0.005) were found to be independent risk factors for development of stroke. This is the first report to have examined the association of apo E gene polymorphism with stroke in the Asian Indians. This study suggests that apo epsilon4 allele, triglycerides, age and hypertension are the predictors for stroke development.