Richmond Schroeder (flowerbeet3)

Increased total body fat with truncal redistribution is common in antiretroviral therapy (ART)-controlled persons living with HIV(PLWH), leading to insulin resistance, prediabetes/diabetes and dyslipidaemia. We address these topics here. Most antiretrovirals are associated with gain in trunk fat, including visceral adipose tissue (VAT). Protease-inhibitors could inhibit white fat ability to dissipate energy (i.e. beiging) favouring fat gain. Expansion of VAT is associated with a pro-inflammatory profile linked to the tryptophan-kynurenine pathway and CD4+ subtypes. ART-associated increased adipose tissue (AT) quantity leads to decreased AT density, insulin resistance and dyslipidaemia that could be improved by lifestyle modifications.PLWH present high level of insulin resistance, regardless of their treatment, and a higher prevalence of prediabetes, but not diabetes, than noninfected persons. Otherwise, HbA1c values appear inaccurate to diagnose prediabetes/diabetes in PLWH.ART-related-dyslipidaemia is characterized by elevated LDL-C and/or high triglycerides and reduced HDL-C. Whereas treatment with protease inhibitors generally results in worsened lipid values, treatment with integrase-strand-transfer-inhibitors is associated with a better profile. Tenofovir-alafenamide is associated with higher lipid levels than tenofovir-disoproxil-fumarate. Treatment of LDL-C-dyslipidaemia could benefit, in statin-insufficiently controlled patients, from the class of proprotein-convertase-subtilsin-kenin-type-9 (PCSK-9) inhibitors. Lifestyle modifications are mandatory to reduce fat and improve dysglycaemia/dyslipidaemia. New drugs can efficiently control diabetes and LDL-C-dyslipidaemia. Lifestyle modifications are mandatory to reduce fat and improve dysglycaemia/dyslipidaemia. New drugs can efficiently control diabetes and LDL-C-dyslipidaemia. In this quality improvement program, named QPID, we constructed a nation-wide platform that prospectively recorded clinically important quality indicators in pediatric inflammatory bowel diseases (PIBD), aiming at improving clinical management across the country. Representatives of all 21 PIBD facilities in Israel formed a Delphi group to select quality indicators (process and outcomes), recorded prospectively over 2 years in children with Crohn's disease 2-18 years of age seen in the outpatient clinics. Monthly anonymized reports were distributed to all centers, allowing comparison and improvement. Trends were analyzed using the Mann-Kendall test, reporting τ(tau) values. The indicators of 3,254 visits from 1,709 patients were recorded from 09/2017 to 09/2019 (mean age 14.7 ± 3.1 years, median disease duration 1.8 years (IQR 0.69-4.02)). An increase in three of five process indicators was demonstrated obtaining drug levels of anti-TNF (tumor necrosis factor) (τ = 0.4; p = 0.005), utilization of fecal calprotectin (τ = 0.38; p = 0.008) and bone density testing (τ = 0.45; p = 0.002). Among outcome indicators, three of nine improved as measured during the preceding year calprotectin < 300 μg/mg (τ = 0.35; p = 0.015), and "resolution of inflammation" defined as a composite of endoscopy, imaging and fecal calprotectin (τ = 0.39 p = 0.007). Endoscopic healing reached borderline significance (τ = 0.28, p = 0.055). An increase in the use of biologics throughout the study was observed (τ = 0.47; p = 0.001) with a concurrent decrease in the use of immunomodulators (τ = -0.47 p = 0.001). Quality improvement nationwide programs can be implemented with limited resources while facilitating a standardization of care, and may be associated with improvements in measured indicators. Quality improvement nationwide programs can be implemented with limited resources while facilitating a standardization of care, and may be associated with improvements in measured indicators. Human milk (HM) is a complex fluid that meets the nutritio