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Bekker L.-G.,University of Cape Town | Johnson L.,University of Cape Town | Wallace M.,University of Cape Town | Hosek S.,Stroger Hospital of Cook County
Journal of the International AIDS Society | Year: 2015

Adolescents and young adults are at increased risk for HIV due to the many developmental, psychological, social, and structural transitions that converge in this period of the lifespan. In addition, adolescent deaths resulting from HIV continue to rise despite declines in other age groups. There are also young key populations (YKPs) that bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, young people who inject drugs, and adolescent and young adult sex workers. As a society, we must do more to stop new HIV infections and untimely HIV-related deaths through both primary and secondary prevention and better management approaches. Using an interwoven prevention and treatment cascade approach, the starting point for all interventions must be HIV counselling and testing. Subsequent interventions for both HIV-negative and HIV-positive youth must be ''adolescent-centred,'' occur within the socio-ecological context of young people and take advantage of the innovations and technologies that youth have easily incorporated into their daily lives. In order to achieve the global goals of zero infections, zero discrimination and zero deaths, a sustained focus on HIV research, policy and advocacy for YKPs must occur. © - 2015 Bekker L-G et al;. Source

Harper G.W.,DePaul University | Fernandez I.M.,Nova Southeastern University | Bruce D.,DePaul University | Hosek S.G.,Stroger Hospital of Cook County | Jacobs R.J.,Nova Southeastern University
AIDS and Behavior | Year: 2013

Adolescents living with HIV require engagement with care providers in order to access the critical medical and psychosocial services they need. The current study sought to explore developmental determinants of adherence to medical appointments as one aspect of engagement in care among a geographically diverse sample of 200 gay/bisexual male adolescents (16-24 years) living with HIV, with a specific focus on ethnic identity, sexual orientation identity, and identity as a young man living with HIV. Ethnic identity affirmation (OR = 0.6; 95% CI: 0.3, 0.9), morality of homosexuality (OR = 1.7; 95% CI: 1.2, 2.5), and HIV-positive identity salience (OR = 1.5; 95% CI: 0.9, 2.4) were associated with significantly higher risk for missed appointments in the past 3 months. These findings highlight the importance of attending to developmental factors, such as the development of multiple identities, when attempting to increase engagement in care for gay/bisexual male adolescents living with HIV. © 2011 Springer Science+Business Media, LLC. Source

Boateng A.A.,Syracuse University | Sriram K.,Stroger Hospital of Cook County | Meguid M.M.,Syracuse University | Crook M.,University of London | Crook M.,University of Greenwich
Nutrition | Year: 2010

Refeeding syndrome (RFS) represents a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support. Cardiac arrhythmias, multisystem organ dysfunction, and death are the most severe symptoms observed. As the cachectic body attempts to reverse its adaptation to the starved state in response to the nutritional load, symptoms result from fluid and electrolyte imbalances, with hypophosphatemia playing a central role. Because guidelines for feeding the malnourished patient at risk for refeeding syndrome is scarce, we have provided management recommendations based on the knowledge derived from a collection of reported English literature cases of the RFS. A MEDLINE search using keywords including "refeeding syndrome," "RFS," and "refeeding hypophosphatemia" was performed. References from initial cases were utilized for more literature on the subject. We have emphasized the continued importance of managing patients at risk for RFS, compared how management of the severely malnourished patients have evolved over time, and provided comprehensive clinical guidelines based on the sum of experience documented in the case reports for the purpose of supplementing the guidelines available. Based on our review, the most effective means of preventing or treating RFS were the following: recognizing the patients at risk; providing adequate electrolyte, vitamin, and micronutrient supplementation; careful fluid resuscitation; cautious and gradual energy restoration; and monitoring of critical laboratory indices. © 2010 Elsevier Inc. All rights reserved. Source

Sriram K.,Stroger Hospital of Cook County | Manzanares W.,University of the Republic of Uruguay | Joseph K.,Stroger Hospital of Cook County
Nutrition in Clinical Practice | Year: 2012

Clinicians involved with nutrition therapy traditionally concentrated on macronutrients and have generally neglected the importance of micronutrients, both vitamins and trace elements. Micronutrients, which work in unison, are important for fundamental biological processes and enzymatic reactions, and deficiencies may lead to disastrous consequences. This review concentrates on vitamin B1, or thiamine. Alcoholism is not the only risk factor for thiamine deficiency, and thiamine deficiency is often not suspected in seemingly well-nourished or even overnourished patients. Deficiency of thiamine has historically been described as beriberi but may often be seen in current-day practice, manifesting as neurologic abnormalities, mental changes, congestive heart failure, unexplained metabolic acidosis, and so on. This review explains the importance of thiamine in nutrition therapy and offers practical tips on prevention and management of deficiency states. © 2012 The American Society for Parenteral and Enteral Nutrition. Source

Valentino D.,Stroger Hospital of Cook County | Sriram K.,Stroger Hospital of Cook County | Shankar P.,Georgia Southern University
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2011

Purpose of Review: Obesity is a growing worldwide epidemic. Obese patients are often deficient in micronutrients despite macronutrient excess. Bariatric surgery is an increasingly utilized modality in the treatment of obesity and obesity-related conditions. Bariatric surgery itself may cause or exacerbate micronutrient deficiencies with serious sequelae. This review will focus on perioperative strategies to detect, prevent and treat micronutrient deficiencies in patients undergoing bariatric surgery, and will highlight practical and clinical aspects of these nutritional problems. Recent Findings: Micronutrient deficiency is common in obese patients undergoing bariatric surgery both preoperatively and postoperatively. Bariatric procedures with a malabsorptive component are more likely to result in postoperative micronutrient deficiency. A system-based approach will facilitate clinical suspicion of specific or combined micronutrient deficiencies, leading to appropriate laboratory tests for confirmation. Supplementation by the oral route is always tried first, reserving parenteral administration for specific situations. Summary: Clinicians should be aware that micronutrient deficiencies are common in obese patients who may have macronutrient excess. Micronutrient deficiency may exist preoperatively or be caused by bariatric procedures themselves. A systematic and team-based approach will decrease morbidity associated with delays in diagnosis and treatment. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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