Antenatal atazanavir: a retrospective analysis of pregnancies exposed to atazanavir.

INTRODUCTION: There are few data regarding the tolerability, safety, or efficacy of antenatal atazanavir. We report our clinical experience of atazanavir use in pregnancy. METHODS: A retrospective medical records review of atazanavir-exposed pregnancies in 12 London centres between 2004 and 2010. RESULTS: There were 145 pregnancies in 135 women: 89 conceived whilst taking atazanavir-based combination antiretroviral therapy (cART), "preconception" atazanavir exposure; 27 started atazanavir-based cART as "first-line" during the pregnancy; and 29 "switched" to an atazanavir-based regimen from another cART regimen during pregnancy. Gastrointestinal intolerance requiring atazanavir cessation occurred in five pregnancies. Self-limiting, new-onset transaminitis was most common in first-line use, occurring in 11.0%. Atazanavir was commenced in five switch pregnancies in the presence of transaminitis, two of which discontinued atazanavir with persistent transaminitis. HIV-VL < 50 copies/mL was achieved in 89.3% preconception, 56.5% first-line, and 72.0% switch exposures. Singleton preterm delivery (<37 weeks) occurred in 11.7% preconception, 9.1% first-line, and 7.7% switch exposures. Four infants required phototherapy. There was one mother-to-child transmission in a poorly adherent woman. CONCLUSIONS: These data suggest that atazanavir is well tolerated and can be safely prescribed as a component of combination antiretroviral therapy in pregnancy

Stent graft repair of subclavian and axillary vascular injuries: The Groote Schuur experience

BACKGROUND: Trauma-related subclavian and axillary vascular injuries (SAVIs) are generally associated with high morbidity and mortality rates in the surgical literature. There is an emerging trend towards increasing use of stent grafts (covered stents) for repair, with evidence limited to small case series and case reports. OBJECTIVES: To report on the clinical and device-related outcomes of stent graft repair of trauma-related SAVIs at a single institution. METHODS: A retrospective chart review of all patients with trauma-related SAVIs requiring stent graft repair was performed. Outcome measures included technical success, mortality, amputation rate, device-related complications (early and late), and reintervention rates (early and late). RESULTS: A total of 31 patients was identified between June 2008 and October 2013 (30 males, 1 female). Mean age was 27.9 years (range 19-51). All 31 patients sustained a penetrating injury (93.5% stab, 6.5% gunshot injuries). There were 21 subclavian and 10 axillary artery injuries. Five patients (16%) were HIV-positive. Nine patients (29%) were shocked on presentation. Early results (30 days): There were no periprocedural deaths. Primary technical success was 83.9% (26/31). Five patients required adjunctive interventional or operative procedures. There were no early procedure-related complications, reinterventions or open conversions in this study. Overall, suboptimal results were seen in five patients (one type I endoleak and four type II endoleaks). Follow-up results (>30 days): Nineteen patients (61.3%) were available for follow-up. Mean duration of follow-up was 55.7 weeks (range 4 - 240). Overall stent graft patency was 89.5% (17/19). Four patients (21.1%) had an occluded stent graft. Stent graft salvage was possible in two patients. Three type II endoleaks were seen on follow-up. Late reinterventions were performed in five patients (26.3%). Conversion to an open procedure was not required in any patient. There was one late death and one major amputation of a stented limb in a patient who had sustained severe soft-tissue injuries during the follow-up period. CONCLUSION: Perioperative, early and intermediate results suggest that stent graft repair of select trauma-related SAVIs is relatively safe and effective. Axillary arteriovenous fistulas remain a particular challenge using this treatment modality. Larger prospective studies are required to define the utility of stent grafts for select trauma-related SAVIs better

Not Available

Not AvailableThe use of ozone in the processing of foods has recently come to the forefront as an anti-microbial agent for food treatment, storage and processing. Ozone is now being used as a safe, powerful disinfectant to control biological growth of unwanted organisms in products and equipment used in the food and beverage industries. In liquid solution, ozone can be used to disinfect equipment, process water, and some food products. In gaseous form, ozone helps sanitize and assist in the preservation of certain food products, and is also used to sanitize food packaging materials. Some products currently being preserved with ozone include eggs during cold storage, fresh fruits and vegetables, and fresh fish. In the agriculture industry ozone is being used for disinfection. Another important application is the use of ozone as an alternative to methyl bromide as a fumigant to control insect infestations in stored food, grains and other agricultural products. It is also being used as a general soil fumigant/sterilant in drip irrigation systems. In this review, present status of ozone application in food industry was discussed.Not Availabl

Not Available

Not AvailableThe use of ozone in the processing of foods has recently come to the forefront as an anti-microbial agent for food treatment, storage and processing. Ozone is now being used as a safe, powerful disinfectant to control biological growth of unwanted organisms in products and equipment used in the food and beverage industries. In liquid solution, ozone can be used to disinfect equipment, process water, and some food products. In gaseous form, ozone helps sanitize and assist in the preservation of certain food products, and is also used to sanitize food packaging materials. Some products currently being preserved with ozone include eggs during cold storage, fresh fruits and vegetables, and fresh fish. In the agriculture industry ozone is being used for disinfection. Another important application is the use of ozone as an alternative to methyl bromide as a fumigant to control insect infestations in stored food, grains and other agricultural products. It is also being used as a general soil fumigant/sterilant in drip irrigation systems. In this review, present status of ozone application in food industry was discussed.Not Availabl

A Model of HIV Disclosure: Disclosure and Types of Social Relationships

Purpose: The purpose of this study was to assess perceptions of HIV positive (+) persons regarding disclosure of their serostatus to others with the goal of developing a model of HIV disclosure that could be used by healthcare providers (HCPs) in HIV prevention. Data sources: Data were collected through 13 focus groups from 104 HIV+ participants. The groups were formed based on three HIV risk exposure categories—men who have sex with men, high-risk heterosexuals, and substance users. Conclusions: Data analysis revealed three themes: disclosure of one’s HIV+ serostatus depends on type of social relationships, fear, and stigma, with social relationships being the major theme. A model of HIV disclosure emerged from the data analysis of social relationships. In the model, social relationships were categorized as sexual and nonsexual, with varying degrees of HIV disclosure—depending on the social relationship with the person to whom one did or did not disclose. Results indicated that HIV is still a fearful and stigmatizing disease, and disclosure of HIV status is a complex phenomenon embedded in various types of social relationships. Implications for practice: Results of this study provide a “Model of HIV Disclosure” that can be utilized by nurse practitioners and other HCPs in clinical practice when providing treatment, counseling, and prevention education for HIV+ clients and for prevention education for HIV negative clients—especially for family, friends, sexual partners, and employers of HIV+ clients

Aflibercept in clinical practice; visual acuity, injection numbers and adherence to treatment, for diabetic macular oedema in 21 UK hospitals over 3 years

Introduction: Randomised controlled trials provide evidence that a treatment works. Real world evidence is required to assess if proven treatments are effective in practice. Method: Retrospective data collection on patients given aflibercept for diabetic macular oedema over 3 years from 21 UK hospitals: visual acuity (VA); Index of multiple deprivation score (IMD); injection numbers; protocols used, compared as a cohort and between sites. Results: Complete data: 1742 patients (from 2196 eligible) at 1 year, 860 (from 1270) at 2, 305 (from 506) at 3 years. The median VA improved from 65 to 71, 70, 70 (ETDRS letters) at 1, 2 and 3 years with 6, 9 and 12 injections, respectively. Loss to follow-up: 10% 1 year, 28.8% at 3. Centres varied: baseline: mean age 61-71 years (p < 0.0001); mean IMD score 15-37 (p < 0.0001); mean VA 49-68 (p < 0.0001). Only four centres provided a loading course of five injections at monthly intervals and one 6. This did not alter VA outcome at 1 year. Higher IMD was associated with younger age (p = 0.0023) and worse VA at baseline (p < 0.0001) not total number of injections or change in VA. Lower starting VA, higher IMD and older age were associated with lower adherence (p = 0.0010). Conclusions: The data showed significant variation between treatment centres for starting age, VA and IMD which influenced adherence and chances of good VA. Once treatment was started IMD did not alter likelihood of improvement. Loading dose intensity did not alter outcome at one year