Antithrombotic Therapy in Patients with Acute Coronary Syndrome in the Intermountain Heart Collaborative Study

Objective. To determine factors associated with single antiplatelet (SAP) or dual antiplatelet (DAP) therapy and anticoagulants (AC) use in hospital and after discharge among patients with acute coronary syndrome (ACS). Methods. We evaluated 5,294 ACS patients in the Intermountain Heart Collaborative Study from 2004 to 2009. Multivariable logistic regressions were used to determine predictors of AC or AP use. Results. In hospital, 99% received an AC, 79% DAP, and 19% SAP; 78% had DAP + AC. Coronary stents were the strongest predictors of DAP use in hospital compared to SAP (P<0.001). After discharge, 77% received DAP, 20% SAP, and 9% AC; 5% had DAP + AC. DAP compared to SAP was less likely for patients on AC (odds ratio [OR] = 0.30, P<0.0001) after discharge. Placement of a stent increased the likelihood of DAP (bare metal: OR = 54.8, P<0.0001; drug eluting: OR = 59.4, P<0.0001). 923 had atrial fibrillation and 337 had a history of venous thromboembolism; these patients had increased use of AC (29% and 40%, resp.). Conclusion. While in-hospital use of AC was nearly universal, postdischarge AC use was rare. Concern for providing the best antithrombotic therapy, while maintaining an acceptable bleeding risk, may explain the selection decisions

Distribution of Kaposi Sarcoma–Associated Herpesvirus/Human Herpesvirus 8 in Maternal Saliva and Breast Milk in Zambia: Implications for Transmission

Background. The seroprevalence of Kaposi sarcoma–associated herpesvirus (KSHV)/human herpesvirus 8 (HHV-8) in sub-Saharan Africa suggests that multiple routes of transmission exist. In the present study,we examined 2 possible routes of mother-to-child transmission, through breast milk and saliva, during the first 6 months after delivery. Methods. The prevalence of HHV-8 DNA in the breast-milk cells (n=75), milk supernatant (n=56), colostrum (n=2), and saliva cells (n=65) of HHV-8–seropositive mothers who recently gave birth was examined. Polymerase chain reaction analysis was performed for the detection of HHV-8 in cross-sectional samples isolated at 2, 4, and 6 months after delivery. Results. None of the 75 breast-milk samples but 2 of the colostrum samples that were analyzed contained HHV-8 DNA at a limit of detection of ∼1 HHV-8 copy/104 cellular genomes, whereas Epstein-Barr virus DNA and HIV-1 DNA were detected in 16 and 22 samples, respectively. Analysis of 65 saliva cell samples, which were obtained from mothers who also provided milk samples, revealed that 19 of the samples had detectable HHV-8 DNA. Viral DNA was found at all time points, but the presence of viral DNA in saliva was independent of maternal HIV-1 serostatus ( x2=0.33; P=.57). Conclusions. Our findings demonstrate the lack of HHV-8 DNA in the breast milk of seropositive mothers, and they suggest that contact with breast milk is not a likely source of horizontal transmission of virus to infants in sub-Saharan Africa

Vertical Transmission of Kaposi\u27s Sarcoma-Associated Herpesvirus

Little is presently known about the specific routes of transmission of Kaposi’s sarcoma-associated herpesvirus (KSHV) or human herpesvirus-8 (HHV-8). To investigate whether this agent might be transmitted vertically from mother to infant, we conducted a study on 89 KSHV seropositive mothers and their newborn infants. Thirteen mothers (14.6%) had KSHV DNA detected in their peripheral blood mononuclear cells (PBMC). Two of 89 samples drawn at birth from infants born to KSHV seropositive mothers had KSHV DNA detectable within their PBMC. These findings suggest that KSHV can be transmitted perinatally, but infrequently. Other routes of transmission such as horizontal transmission remain the most likely means of KSHV transmission

Mortality Among HIV-1- and Human Herpesvirus Type 8 – Affected Mother-Infant Pairs in Zambia

Objective: To determine the respective trends in mortality of Zambian mother-infant pairs based on maternal infection with HIV-1 and human herpesvirus type 8 (HHV-8). Methods: A prospective cohort study was done on Zambian mother-infant pairs, stratified by maternal serologic status and followed from 6 weeks postdelivery for 48 months. Statistical analysis of the differences in the calculated mortality rates among the four groups was done using Stata 7.0. Kaplan-Meier analysis and Cox proportional hazard models were used to measure subject survival time. Results: Between September 1998 and March 2002, a total of 1,425 mother-infant pairs were enrolled. The crude mortality rate among children born to dually infected mothers was ~9 times higher (245.90 deaths per 1,000 live births) when compared with the death ratio of children born to seronegative mothers (24.63 deaths per 1,000 live births). The incidence rate for death was 0.34/1,000 in infants of co-infected mothers in comparison with 0.32/1,000 among HIV-1-infected mothers, 0.0336/1,000 among uninfected mothers, and 0.0403/1,000 among HHV-8-infected mothers (X2 = 154.56; P \u3c 0.01). Infants of co-infected mothers had a comparable risk of death in comparison with infants infected with HIV-1 alone {hazard ratio, 9.91 [95% confidence interval (95% Cl), 5.08-19.37] for co-infected versus 9.26 [95% CI, 4.75-18.07] for HIVI- infected alone}. Infants of mothers infected only with HHV-8 also had comparable survival in comparison with uninfected infants (hazard ratio, 1.21; 95% CI, 0.56-2.61). Conclusion: Infants born to mothers dually infected with both HIV-1 and HHV-8 have comparable survival with infants exposed to HIV-1 alone. Infants born to mothers infected only with HHV-8 have comparable survival with uninfected infants

HUMAN HERPESVIRUS 8 CAN BE TRANSMITTED THROUGH BLOOD IN DRUG ADDICTS

Human Herpes virus type-8 (HHV-8) seroprevalence was studied in a population of HIV positive intravenous drug users (IVDUs) from Argentina. Analysis of this population also indirectly made it possible to study HHV-8 blood transmission, because these individuals frequently engage in needle sharing behavior and are capable of acquiring a broad array of blood borne pathogens, including Hepatitis B/C virus. The seroprevalence of HHV-8 in IVDUs was compared to a group of non-IVDUs and HIV negative individuals. Of the 223 individuals tested, 13.45% were HHV-8 positive, 16.99% in the IVDUs group, and 5.71% in the non-IVDUs. Among HIV positive IVDUs, 25/144 (17.36%) were also HHV-8 seropositive. The seropositivity rate of HHV-8 in HIV negative IVDUs was 11.1%. In contrast, HHV-8 seroprevalence in HIV negative heterosexual individuals without drug usage behavior was even lower (5.71%). The rate of HHV-8 infection in HIV positive IVDUs was three times as high compared to the non IVDU HIV negative individuals, suggesting that IVDU is a risk for HHV-8 infection. Furthermore, it was found that IVDUs showed a very high rate of Hepatitis B/C (52.77%), which also correlate with HHV-8 infection in this population (23.68%). All Hepatitis B/C positive individuals were also HIV positive. Our data confirm other studies showing that individuals who share needles are at risk for acquiring Hepatitis B/C and HIV infections. In addition, our results suggest that they are also at risk to acquiring HHV-8 infection by the same route

Herpesvirus-like DNA in AIDS Kaposi’s Sarcoma in Argentina [Letter to the Editor]

First paragraph: Recently, Chang et al., using a new molecular biology technique termed Representational Difference Analysis, found herpesvirus-like DNA (KSHV) in AIDS patients with Kaposi’s sarcoma (KS). The presence of KSHV DNA sequences suggests that a new human herpesvirus may be associated with KS. The 5′ end of the 1853-bp flanking region of KSHV (nucleotides 1 to 607) was found to have 66 and 67% homologies to the corresponding regions of the major capsid protein gene of Herpesvirus Saimiri (ORF25) and Epstein Barr virus (BcLF1), respectively, both members of the gammaherpesvirus family. This finding is an important breakthrough, because a sexually transmitted agent was suspected to cause KS. The putative virus was also detected in classical KS and in African endemic KS found in young black individuals from sub-Saharan regions. KSHV sequences have also been identified in KS tissues from Taiwanese and French patients

Increased prevalence of Plasmodium falciparum malaria in Honduras, Central America Aumento de la prevalencia de malaria por Plasmodium falciparum en Honduras, Centroamerica

We report on our investigation of a malaria outbreak in Honduras, Central America, in January 1997. We tested 202 patients with fever and chills using thin and thick blood film microscopy. Sixteen patients lived in the city and the rest lived in rural areas. A total of 95 samples (47%) were positive for malaria parasites. Seventy-nine percent (63/80) of the rural patients were infected with Plasmodium vivax and 21% (17/80) were infected with P. falciparum. In the urban area, all 15 infected patients had P. vivax malaria and none showed evidence of P. falciparum. Since previous reports indicate that falciparum malaria accounts for only 2% of the overall malaria infections in Honduras, the results reported here suggest that there is a dramatic increase in falciparum malaria in the area of Honduras investigated in this study.<br>Notificamos los resultados de un estudio de un brote de malaria que se produjo en Honduras, Centroamérica, en enero de 1997. Sometimos a examen microscópico frotis delgados y frotis gruesos de la sangre de 202 pacientes con fiebre y escalofríos. Dieciséis pacientes eran habitantes de la zona urbana y el resto de la zona rural. Un total de 95 especímenes (47%) fueron positivos a parásitos de la malaria. Setenta y ocho por ciento (62/80) de los pacientes del área rural estaban infestados con Plasmodium vivax y 22% (17/80) con P. falciparum. En la zona urbana, todos los 15 pacientes que estaban infestados tenían P. vivax y en ninguno se detectó P. falciparum. Ya que según informes previos la malaria de tipo falciparum representa solamente 2% de todos los casos de malaria en Honduras, nuestros resultados sugieren que hay un gran incremento del número de casos de malaria falciparum en la zona de Honduras en que se llevó a cabo esta investigación

Increased prevalence of Plasmodium falciparum malaria in Honduras, Central America

We report on our investigation of a malaria outbreak in Honduras, Central America, in January 1997. We tested 202 patients with fever and chills using thin and thick blood film microscopy. Sixteen patients lived in the city and the rest lived in rural areas. A total of 95 samples (47%) were positive for malaria parasites. Seventy-nine percent (63/80) of the rural patients were infected with Plasmodium vivax and 21% (17/80) were infected with P. falciparum. In the urban area, all 15 infected patients had P. vivax malaria and none showed evidence of P. falciparum. Since previous reports indicate that falciparum malaria accounts for only 2% of the overall malaria infections in Honduras, the results reported here suggest that there is a dramatic increase in falciparum malaria in the area of Honduras investigated in this study

Increased prevalence of Plasmodium falciparum malaria in Honduras, Central America

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Postnatal Human Herpesvirus 8 and Human Immunodeficiency Virus Type 1 Infection in Mothers and Infants from Zambia

The specific route and timing of human herpesvirus (HHV) 8 infection in regions where Kaposi sarcoma is endemic are not known. HHV-8 infection and any risk factors that may be associated with HHV-8, including human immunodeficiency virus (HIV) type 1 infection, were monitored during the 12-month post-delivery period for 416 mothers and 485 infants from Lusaka, Zambia. HHV-8 incident infection rates during this period were 3.2 and 5.3 infections/100 person-years for infants and mothers, respectively. HHV-8 infection among infants was not associated with HHV-8 or HIV-1 infection in the mother. Among the HHV-8–positive infants, 2 of 12 tested were found to have HHV-8 DNA in their peripheral blood mononuclear cells at birth, which suggests that in utero infection is possible. However, most HHV-8–positive infants appeared to have acquired infection either intrapartum or postpartum. The present study indicates that transmission of HHV- 8 to infants can occur early and is likely via multiple routes