The relationship between adverse neighborhood socioeconomic context and HIV continuum of care outcomes in a diverse HIV clinic cohort in the Southern United States

Retention in care and viral suppression are critical to delaying HIV progression and reducing transmission. Neighborhood socioeconomic context (NSEC) may affect HIV care receipt. We therefore assessed NSEC's impact on retention and viral suppression in a diverse HIV clinical cohort. HIV-positive adults with ≥1 visit at the Vanderbilt Comprehensive Care Clinic and 5-digit ZIP code tabulation area (ZCTA) information between 2008 and 2012 contributed. NSEC z-score indices used neighborhood-level socioeconomic indicators for poverty, education, labor-force participation, proportion of males, median age, and proportion of residents of black race by ZCTA. Retention was defined as ≥2 HIV care visits per calendar year, >90 days apart. Viral suppression was defined as an HIV-1 RNA <200 copies/mL at last measurement per calendar year. Modified Poisson regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI). Among 2272 and 2541 adults included for retention and viral suppression analyses, respectively, median age and CD4 count at enrollment were approximately 38 (1st and 3rd quartile: 30, 44) years and 351 (176, 540) cells/μL, respectively, while 24% were female, and 39% were black. Across 243 ZCTAs, median NSEC z-score was 0.09 (-0.66, 0.48). Overall, 79% of person-time contributed was retained and 74% was virally suppressed. In adjusted models, NSEC was not associated with retention, though being in the 4th vs. 1st NSEC quartile was associated with lack of viral suppression (RR = 0.88; 95% CI: 0.80-0.97). Residing in the most adverse NSEC was associated with lack of viral suppression. Future studies are needed to confirm this finding

The effect of ketamine on shivering in patients undergoing spinal anesthesia

Background: Sever shivering is the most common adverse effect of spinal anesthesia during and after operation that causes physiologic complication. One of the drugs that could decrease operative shivering is ketamine. Objective: The aim of this study is the effect of ketamine to reduce shivering, during spinal anesthesia. Methods: This prospective randomized, and double-blind clinical trial was conducted on 355 patients of candida different surgeries with spinal anesthesia in Bu-Ali and Velayat Hospitals in Qazvin (2017). Patients were randomly divided into experimental (n=175) and control (n=180) groups. For the experimental and control groups, ketamine (0.2 ml/kg) or an equal volume of distilled water were administered with intravenous infusion pumps immediately after initiating spinal anesthesia, respectively. Then degree of shivering checked by anesthesiologist with visual scale during surgery. Findings: The rate and intensity of shivering at ketamine group significantly decreased compared to the control group. Shivering during surgery was less than in men, urological surgery and age (20-40 years) in both groups. Conclusion: Adding ketamine to drug’s pump in patients undergoing spinal anesthesia could be effective method to control shivering during operation. Keywords: Operative shivering, Spinal anesthesia, Ketamine, Intensity of shiverin

Lipoprotein Alterations in the Spontaneously Hypertensive Rat Fed Diets Deficient in Selenium and Vitamin E

Both vitamin E and selenium (Se) are antioxidant nutrients that play important roles in preventing in vivo lipid peroxidation. In this investigation, Se and vitamin E were found to influence lipoprotein levels in the spontaneously hypertensive rat (SHR). Four-week-old inbred SHRs were fed a basal (B) diet with 1% cholesterol deficient in both selenium and vitamin E (B+cho diet) or identical diets to which either vitamin E (B+E+cho) or selenium (B+Se+cho) or both micronutrients were added (B+Se+E+cho). Plasma-cho and lipoprotein-cho levels were measured after 6, 12, 16, and 18 weeks of feeding the experimental diets. Rats fed the B+cho diet for at least 12 weeks had plasma-cho levels about twice that observed for rats fed the B+E+Se+cho diet. Plasma-cho levels for rats in the two Se deficient groups (B+cho and B+E+cho) were, however, similar at any time point. Se deficiency was associated with increased plasma-cho, very low density lipoprotein-cho (VLDL-cho) and low-density lipoprotein-cho (LDL-cho). Vitamin E supplementation interacted with Se deficiency to increase plasma VLDL-cho levels. Neither vitamin E alone nor the interaction between vitamin E and Se consistently influenced LDL-cho levels. The percent cholesteryl ester in LDL from rats fed the Se-deficient diets (B+cho or B+E+cho) was at least twice that observed for rats fed the B+E+Se+cho diet. Plasma lipid peroxidation products were highly elevated in rats fed the B+cho diet compared with values for the B+E+cho or the B+E+Se+cho fed rats (which were not significantly different). These results suggest that dietary Se deficiency increases plasma-cho, VLDL-cho, and LDL-cho levels by a mechanism that may be unrelated to its role as an antioxidant nutrient