Characteristics and management of HIV-1-infected pregnant women enrolled in a randomised trial: differences between Europe and the USA

<p>Abstract</p> <p>Background</p> <p>Rates of mother-to-child transmission of HIV-1 (MTCT) have historically been lower in European than in American cohort studies, possibly due to differences in population characteristics. The Pediatric AIDS Clinical Trials Group Protocol (PACTG) 316 trial evaluated the effectiveness of the addition of intrapartum/neonatal nevirapine in reducing MTCT in women already receiving antiretroviral prophylaxis. Participation of large numbers of pregnant HIV-infected women from the US and Western Europe enrolling in the same clinical trial provided the opportunity to identify and explore differences in their characteristics and in the use of non-study interventions to reduce MTCT.</p> <p>Methods</p> <p>In this secondary analysis, 1350 women were categorized according to enrollment in centres in the USA (n = 978) or in Europe (n = 372). Factors associated with receipt of highly active antiretroviral therapy and with elective caesarean delivery were identified with logistic regression.</p> <p>Results</p> <p>In Europe, women enrolled were more likely to be white and those of black race were mainly born in Sub-Saharan Africa. Women in the US were younger and more likely to have previous pregnancies and miscarriages and a history of sexually transmitted infections.</p> <p>More than 90% of women did not report symptoms of their HIV infection; however, more women from the US had symptoms (8%), compared to women from Europe (4%). Women in the US were less likely to have HIV RNA levels <400 copies/ml at delivery than women enrolling in Europe, and more likely to receive highly active antiretroviral therapy, and to start therapy earlier in pregnancy. The elective caesarean delivery rate in Europe was 61%, significantly higher than that in the US (22%). Overall, 1.48% of infants were infected and there was no significant difference in the rate of transmission between Europe and the US despite the different approaches to treatment and delivery.</p> <p>Conclusion</p> <p>These findings confirm that there are important historical differences between the HIV-infected pregnant populations in Western Europe and the USA, both in terms of the characteristics of the women and their obstetric and therapeutic management. Although highly active antiretroviral therapy predominates in pregnancy in both settings now, population differences are likely to remain.</p> <p>Trial registration</p> <p>NCT00000869</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Rapid and sensitive on-line liquid chromatographic/tandem mass spectrometric determination of an ethylene oxide-DNA adduct, N7-(2-hydroxyethyl)guanine, in urine of nonsmokers

[[abstract]]Ethylene oxide (EtO) is classified as a known human carcinogen. The formation of EtO-DNA adducts is considered as an important early event in the EtO carcinogenic process. An isotope-dilution on-line solid-phase extraction and liquid chromatography coupled with tandem mass spectrometry method was then developed to analyze one of the EtO-DNA adducts, N7-(2-hydroxyethyl)guanine (N7-HEG), in urine of 46 nonsmokers with excellent accuracy, sensitivity and specificity. The merits of this method include small sample volume (only 120 mu L urine required), automated sample cleanup, and short total run time (12 minutes per sample). This method demonstrates its high-throughput capacity for future molecular epidemiology studies on the potential health effects resulting from the low-dose EtO exposure

Analysis of urinary N-acetyl-S-(propionamide)-cysteine as a biomarker for the assessment of acrylamide exposure in smokers

[[abstract]]Acrylamide, classified by the IARC as a probable human carcinogen (Group 2A), is present in cigarette mainstream smoke and also some high-temperature-processed foods, thus smokers and consumers of certain foods are at risk of acrylamide exposure. The objectives of this study were to analyze N-acetyl-S-(propionamide)-cysteine (NASPC), an acrylamide metabolite, in the urine of smokers and nonsmokers, and to investigate the association between acrylamide exposure and urinary NASPC levels in smokers and nonsmokers in order to validate NASPC as a biomarker for the assessment of acrylamide exposure. Urine samples from 63 male military officers were collected as well as background personal information and smoking habits using questionnaires. Acrylamide exposure from tobacco smoke was represented by self-reported daily cigarette consumption and urinary cotinine levels. NASPC and cotinine were analyzed using our newly developed liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) methods. Our results reveal a statistically significant linear relationship between urinary NASPC and cotinine levels for smokers (Spearman correlation coefficient r = 0.402, P = 0.028), but insignificantly so for nonsmokers. These results verify our suggestion that urinary NASPC could serve as a sensitive, specific, noninvasive, and easily accessible biomarker for low-dose acrylamide exposure as also exposure to carcinogens in tobacco smoke. Routine monitoring of urinary NASPC could be used to assess human exposures to acrylamide in the living environment and the workplace. (c) 2007 Elsevier Inc. All rights reserved