Prophylaxis and treatment of opportunistic infections in HIV patients - Toxoplasmosis .
Updated guide lines for treatment of Toxoplasmosis in HIV patient accodring to DHHS guide lines 2013 and other recommendations
Immunisation and Immunodeficiency, as part of the Immunology MRCP 1 course. These are slideshows only. The demonstration with video presentation and explanation that goes along with these slides, as well as free example exam questions and the paid full e-lecture can be viewed at https://www.123doc.com/electures/immunology/
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Ong Tien Lee, neurologist in Sungai Buloh Hospital, Ministry of Health Malaysia.
Immunisation and Immunodeficiency, as part of the Immunology MRCP 1 course. These are slideshows only. The demonstration with video presentation and explanation that goes along with these slides, as well as free example exam questions and the paid full e-lecture can be viewed at https://www.123doc.com/electures/immunology/
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Ong Tien Lee, neurologist in Sungai Buloh Hospital, Ministry of Health Malaysia.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Richard Lim Boon Leong is a Consultant Palliative Medicine Physician and Head of Palliative Care Unit, Selayang Hospital, Ministry of Health Malaysia.
Vaccines in immunocompromised children - Slideset by Professor Kathryn EdwardsWAidid
The slideset by Professor Edwards provides recommendations on vaccinations in immunocompromised children and underlines that innovative new approaches to vaccination are available and need to be explored.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Veena Selvaratnam is a Haematologist, Ampang Hospital, Ministry of Health Malaysia.
Perception and Behavioural Outcome towards COVID-19 Vaccine among Students an...Kailash Nagar
ntroduction: Perception and behaviour towards corona vaccine among peoples in India was poor due to some side effects and negative media publicity in primary phases of vaccination. India has developed two types of vaccine (Covaxin and Covishield). During primary phase of corona vaccine we don’t have appropriate research and literature, about side effects and how far vaccine is reliable that why due so some minor side effect and negative media publicity peoples are very scared to take vaccine. So few peoples were started denial get vaccinated. The researcher wan to explore the positivity through the research result to reduce the negative mindset of the peoples toward corona vaccine, Because in India few peoples has fear to take vaccine against corona due to negative media publicity and scared of side effect.
Guidelines On COVID-19 Vaccination In Pregnancy And Breastfeeding, Version 2 (23rd June 2021)
By Ministry of Health, Malaysia
Update: Addendum added in 10th Aug 2021 - https://www.slideshare.net/ICRInstituteForClini/updated-guidelines-on-covid19-vaccination-for-pregnant-and-breastfeeding-mothers
Webinar Series on Demystifying Phases in Clinical Trials & COVID-19 Updates organized by Institute for Clinical Research (ICR), NIH
Speaker: Dr. Richard Lim Boon Leong is a Consultant Palliative Medicine Physician and Head of Palliative Care Unit, Selayang Hospital, Malaysia
More information, please visit: https://clinupcovid.mailerpage.com/resources/w5b4h7-palliative-care-in-covid-19-malay
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Richard Lim Boon Leong is a Consultant Palliative Medicine Physician and Head of Palliative Care Unit, Selayang Hospital, Ministry of Health Malaysia.
Vaccines in immunocompromised children - Slideset by Professor Kathryn EdwardsWAidid
The slideset by Professor Edwards provides recommendations on vaccinations in immunocompromised children and underlines that innovative new approaches to vaccination are available and need to be explored.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Veena Selvaratnam is a Haematologist, Ampang Hospital, Ministry of Health Malaysia.
Perception and Behavioural Outcome towards COVID-19 Vaccine among Students an...Kailash Nagar
ntroduction: Perception and behaviour towards corona vaccine among peoples in India was poor due to some side effects and negative media publicity in primary phases of vaccination. India has developed two types of vaccine (Covaxin and Covishield). During primary phase of corona vaccine we don’t have appropriate research and literature, about side effects and how far vaccine is reliable that why due so some minor side effect and negative media publicity peoples are very scared to take vaccine. So few peoples were started denial get vaccinated. The researcher wan to explore the positivity through the research result to reduce the negative mindset of the peoples toward corona vaccine, Because in India few peoples has fear to take vaccine against corona due to negative media publicity and scared of side effect.
Guidelines On COVID-19 Vaccination In Pregnancy And Breastfeeding, Version 2 (23rd June 2021)
By Ministry of Health, Malaysia
Update: Addendum added in 10th Aug 2021 - https://www.slideshare.net/ICRInstituteForClini/updated-guidelines-on-covid19-vaccination-for-pregnant-and-breastfeeding-mothers
Webinar Series on Demystifying Phases in Clinical Trials & COVID-19 Updates organized by Institute for Clinical Research (ICR), NIH
Speaker: Dr. Richard Lim Boon Leong is a Consultant Palliative Medicine Physician and Head of Palliative Care Unit, Selayang Hospital, Malaysia
More information, please visit: https://clinupcovid.mailerpage.com/resources/w5b4h7-palliative-care-in-covid-19-malay
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
Its INC initiates to educate with services of all nurse working in clinical case management of AIDS, Malaria, Filaria, Tuberculosis,other leading infectoious diseases to prevent and control aspect of health of individual/community/society.
GFATM for nurses The Global Fund provides 30% of all international financing for HIV programs and has invested US$24.2 billion in programs to prevent and treat HIV and AIDS and US$5 billion in TB/HIV programs as of June 2022.12- make more awareness for nursinfg officer
Tuberculosis Treatment Symposia - The CRUDEM Foundation presented in Milot, Haiti at Hôpital Sacré Coeur.
CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.
It is unacceptable that there is still a lot of new HIV infections, particularly when there is a known high-risk exposure to the disease. It is important to know that Post-exposure prophylaxis is a medical emergency, and as part of effort to reduce the burden of HIV, post-exposure prophylaxis has been found to be effective when done appropriately. This presentation explores the concept of post-exposure prophylaxis for HIV and the latest changes in the guidelines.
Immunization of children with cancer is a burning topic. Not only concerned parents but also paediatric oncologists have so many questions and queries regarding this matter. This presentation will try to answer those questions with the help of recent and updated guidelines on immunization of both developed and developing countries.
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First Case :Treatment of Sever Refracroy CDF Colitis
Second Case : Intrathecal or Intraventricular colistin for CNS Infection with PDR/MDR acinetobacter baumannii.
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
EVD outbreaks have a case fatality rate of up to 90%.
EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.
The First Case Report : Mycobacterium riyadhense Pneumonia First Miss Identified as a Mycobacterium Terrae in Newly Diagnosed HIV Patient .
First Case Report
Prophylaxis and treatment of opportunistic infections in HIV patients - Toxoplasmosis .
Updated guide lines for treatment of Toxoplasmosis in HIV patient accodring to DHHS guide lines 2013 and other recommendations
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Prophylaxis and treatment of opportunistic infections in HIV patients
1. Prophylaxis and Treatment of Opportunistic
Infections in HIV Patient
Toxoplasmosis
Dr Hythum Salah H. Mohamed .
MBBS-AAHIVS .
King Abdulaziz Medical City-IM-ID-Riyadh ..May 2014
2. Toxoplasma-seropositive patients who have CD4 counts <100
cells/μL should receive prophylaxis against TE (toxoplasma
Encephalitis ) (AII) .
The one double-strength-tablet daily dose of trimethoprim-
sulfamethoxazole (TMP-SMX), which is the preferred regimen for
Pneumocystis jirovecii pneumonia (PCP) prophylaxis, is effective
against TE and is recommended ( AII) .
TMP-SMX, one double-strength tablet three times weekly, is an
alternative (BIII) .
dapsone-pyrimethamine plus leucovorin, which is also effective
against PCP (BI) .
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Primary Prophylaxis
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
3. Aerosolized pentamidine does not protect against TE and is not
recommended for antitoxoplasma prophylaxis (AI).
Prophylaxis against TE should be discontinued in adult and
adolescent patients receiving ART whose CD4 counts increase to
>200 cells/μL for more than 3 months
Preferred Regimen:
• TMP-SMX 1 DS PO daily (AII)
Alternative Regimens:
• TMP-SMX 1 DS PO TIW (BIII), or
• TMP-SMX SS PO daily (BIII), or
• Dapsone 50 mg PO daily + (pyrimethamine 50 mg + leucovorin 25 mg) PO weekly (BI),
or
• (Dapsone 200 mg + pyrimethamine 75 mg + leucovorin 25 mg) PO weekly (BI), or
• Atovaquone 1500 mg PO daily (CIII), or
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
4. Start after acute treatment of toxoplasmosis .
combination of pyrimethamine plus sulfadiazine plus leucovorin is
highly effective as suppressive therapy for patients with TE (AI) and
provides protection against PCP (AII) .
Pyrimethamine plus clindamycin is commonly used as suppressive
therapy for patients with TE who cannot tolerate sulfa drugs (BI) not
provide protection against PCP (AII) .
Pyrimethamine 25–50 mg PO daily + sulfadiazine 2000–4000 mg PO
daily (in 2 to 4 divided doses) + leucovorin 10–25 mg PO daily (AI).
Alternative Regimen:
Clindamycin 600 mg PO q8h + (pyrimethamine 25–50 mg +
leucovorin 10–25 mg) PO daily (BI); must add additional agent to
prevent PCP (AII)
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Secondary Prophylaxis
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
5. Duration and discontinuation : Patient who remain asymptomatic
with regard to signs and symptoms of TE, and have an increase in
their CD4 counts to >200 cells/μL after ART that is sustained for more
than 6 months (BI) .
Secondary prophylaxis (chronic maintenance therapy) for TE should
be reintroduced if the CD4 count decreases to <200 cells/μL (AIII).
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
For many patients, we use TMP-SMX (TMP 5 mg/kg/day - SMX
25 mg/kg/day) for secondary prophylaxis to help reduce pill
burden.
This regimen is not recommended in standard guidelines because
of the lack of sufficient clinical trial data.
www.uptodate.com/
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
6. The initial therapy of choice for TE consists of the combination of
pyrimethamine plus sulfadiazine plus leucovorin (AI) .
Pyrimethamine plus clindamycin plus leucovorin (AI) is the preferred
alternative .
In a small (77 patients) randomized trial, TMP-SMX was reported to
be effective and better tolerated than pyrimethamine-sulfadiazine
(BI) .
Azithromycin plus pyrimethamine plus leucovorin daily (CII).
Clinical response to acute therapy occurs in 90% of patients with TE
within 14 days of initiation of appropriate anti-toxoplasma treatment
Acute therapy for TE should be continued for at least 6 weeks, if
there is clinical and radiologic improvement (BII) .
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Treatment of Disease
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
7. The initial therapy of choice for TE consists of the combination of
pyrimethamine plus sulfadiazine plus leucovorin (AI).
TMP-SMX was reported in a small (77 patients) randomized trial to
be effective and better tolerated than pyrimethamine-
sulfadiazine (BI).
www.cdc.gov/mmwr/preview/mmwrhtml/rr58e324a1.htm
there are limited data, it appears that AIDS patients with extra
cerebral toxoplasmosis respond to pyrimethamine plus either
sulfadiazine or clindamycin. The mortality rate in patients with
pulmonary or disseminated toxoplasmosis may be higher than in
patients with toxoplasmic encephalitis alone .
www.hivinsite.ucsf.edu/InSite.
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
8. Corticosteroids such as dexamethasone should only be
administered to patients with TE when they are clinically indicated
to treat a mass effect associated with focal lesions or associated
edema (BIII) .
Anticonvulsants should be administered to patients with TE who
have a history of seizures (AIII) .
Anticonvulsants should not be administered prophylactically to all
patients (BIII).
Anticonvulsants, if administered, should be continued at least
through the period of acute therapy.
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Steroids and Anticonvulsant
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
9. There are no data on which to base a recommendation regarding
when to start ART in a patient with TE , however, many physicians
would initiate ART within 2 to 3 weeks after the diagnosis of
toxoplasmosis(CIII) .
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Antiretroviral therapy (ART) should be initiated within two to three
weeks of starting treatment for toxoplasmosis , this recommendation
is based upon expert opinion.
www.uptodate.com
Starting ART
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
10. Baseline maternal T. gondii serologic status (IgG) should be obtained
in HIV-infected pregnant women .
Maternal treatment of TE should be the same as in non-pregnant
adults (BIII) .
pyrimethamine plus Sulfadiazine plus leucovorin (AI) .
The above regimen is also believed to prevent mother-to-child
transmission of T. gondii and it may be therapeutic for affected
fetuses .
The preferred alternative regimen is pyrimethamine plus
clindamycin plus leucovorin (AI).
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Special Considerations During Pregnancy
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
11. Detailed ultrasound examination of the fetus specifically evaluating
for hydrocephalus, cerebral calcifications, and growth restriction
should be done for HIV-infected women with suspected primary or
symptomatic reactivation of T. gondii during pregnancy (AIII).
TMP-SMX can be administered for primary prophylaxis against TE
(AIII). The risks of TMP-SMX in the first trimester must be balanced
against the risk of TE.
Perinatal HIV transmission is decrease by 6% to 8% per week of ART,
clinicians should consider immediate initiation of ART for pregnant
women who are diagnosed with TE and not yet on ART (BIII) .
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
12. Treatment Failure is defined by clinical or radiologic deterioration
during the first week despite adequate therapy or lack of clinical
improvement within 2 weeks .
Switch to an alternative regimen as previously described should be
considered (BIII) .
A brain biopsy, if not previously performed, should be strongly
considered for patients who fail to respond to initial therapy for TE
(BII) .
www.cdc.gov/.
Treatment Failure
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
13. Changes in antibody titers are not useful for monitoring
responses to therapy.
Patients with TE should be monitored routinely for adverse events
and clinical and radiologic improvement (AIII).
Common pyrimethamine toxicities such as rash, nausea, and
bone marrow suppression , often can be reversed by increasing
the leucovorin dose to 10, 25, or 50 mg 4 times daily (CIII).
IRIS associated with TE has been reported but appears to be
rare (~5% in one report).
Monitoring of Response to Therapy and
Adverse Events (including IRIS)
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014
14. Toxoplasma Encephalitis is AIDS defining illness .
Primary Prophylaxis indicated when CD4 count is <100 .
Primary Prophylaxis TMP-SMX 1 DS PO daily (AII) .
Secondary Prophylaxis is Pyrimethamine + sulfadiazine + leucovor PO
daily (AI) .
Discontinue secondary prophylaxis when Successfully completed initial
therapy, remain asymptomatic of signs and symptoms of TE, and CD4
count >200 cells/mm3 for >6 months in response to ART (BI)
The initial therapy of choice for TE consists of the combination of
pyrimethamine plus sulfadiazine plus leucovorin (AI) at least for six seeks
(BII) .
Maternal treatment of TE should be the same as in non-pregnant adults
(BIII).
aidsinfo.nih.gov/guidelines on 5/7/2013 Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults
Conclusions
Dr Hythum Salah
KAMC-IM-ID-Riyadh ..May 2014