Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women.

CAPRISA, 2018.Abstract available in pdf

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

The inhibition of phosphodiesterase type 5 as a novel target for antidepressant action

Thesis (Ph.D. (Pharmacology))--North-West University, Potchefstroom Campus, 2010.Major depression is one of the most debilitating diseases of our time, while current antidepressant treatments remain deficient in several ways. The nitric oxide (NO) / cyclic guanosine monophosphate (cGMP) / cGMP-dependent protein kinase (PK-G) pathway shows promise as a novel target for the drug therapy of depression. A recent study from our laboratory reported an antidepressant-like response in the rat forced swim test (FST) following chronic (11 day) co-administration of the phosphodiesterase type 5 (PDE5) inhibitor sildenafil and the muscarinic acetylcholine (mACh) receptor antagonist atropine in Sprague Oawley rats. In the current study we explored the antidepressant-like properties of POE5 inhibitors in Flinders Sensitive Line (FSL) rats, a genetic animal model of depression, and investigated the mechanism(s) that may be involved in the antidepressant-like activity of these drugs. We also evaluated possible anxiolytic-like activity following chronic POE5 inhibition, examined the effects of sildenafil ± atropine on frontal cortical and hippocampal mACh receptor densities and investigated the potential for sildenafil as a possible augmentation strategy to current antidepressant therapy. FSL rats were treated with vehicle/drug(s) for 14 days, whereafter immobility, swimming and climbing behaviours were measured in the FST, or time spent in social interaction in the social interaction test. Following decapitation, saturation binding studies were performed for the measurement of mACh receptor density. For the investigation of PK-G involvement, a subacute FST paradigm and Sprague Oawley rats were used. Chronic treatment of FSL rats with sildenafil or tadalafil (in combination with atropine) induced antidepressant-and anxiolytic-like responses in the FST and the social interaction test, respectively. The effects of known antidepressants were not potentiated by sildenafil in the FST. The dependency of the antidepressant-like response of sildenafil on the co-administration of atropine, as well as effects on behavioural correlates of serotonergic and noradrenergic neurotransmission were dose-related, suggesting that it may differentially affect the regulation of neurotransmission associated with antidepressant and depressogenic responses at different doses. Unlike the mood-regulating responses, however, the anxiolytic-like responses following chronic PDE5 inhibition does not appear to involve an interaction with the cholinergic system. We also demonstrated that the antidepressant-like mechanisms of sildenafil appear to involve cGMP-mediated activation of PK-G, but that unrelated mechanism(s) are also likely to playa role. Lastly, we demonstrated that the pro-cholinergic action of sildenafil does not involve upregulation of frontal cortical and hippocampal mACh receptors. In summary, this project emphasises the potential of POE5 inhibition as a novel antidepressant and anxiolytic strategy, and provides important insight into the specific neuronal mechanism(s) that may be involved in the antidepressant-like responses of inhibitors of this enzyme.Master

Nitric oxide involvement in the antidepressant-like effect of ketamine in the Flinders sensitive line rat model of depression

Objective: We investigated whether the nitric oxide (NO) precursor, L-arginine, can prevent the antidepressant-like action of the fast-acting antidepressant, ketamine, in a genetic rat model of depression, and/or induce changes in the glutamate (Glu)/N-methyl-D-aspartate receptor (NMDAR)/NO/cyclic guanosine monophosphate (cGMP) signalling pathway. Hereby it was evaluated whether the NO signalling system is involved in the antidepressant mechanism of ketamine. Methods: Flinders sensitive line (FSL) rats received single i.p. injections of ketamine (15 mg/kg) with/without pre-treatment (30 min prior) with L-arginine (500 mg/kg). Depression-like behaviour was assessed in the forced swim test (FST) in terms of immobility, and the activation state of the Glu/NMDAR/NO/cGMP pathway was evaluated ex vivo in the frontal cortex and hippocampus regions in terms of total constitutive NOS (cNOS) activity and cGMP concentration. Results: L-Arginine pre-treatment prevented the antidepressant-like effect of ketamine in the FST, as well as a ketamine-induced increase in cGMP levels in the frontal cortex and hippocampus of FSL rats. Ketamine reduced cNOS activity only in the hippocampus, and this effect was not reversed by L-arginine. Conclusion: Both the behavioural and molecular results from this study indicate an involvement for the NO signalling pathway in the antidepressant action of ketamine. Although not easily interpretable, these findings broaden our knowledge of effects of ketamine on the NO systemDanish Medical Research Council (grant 11-107897) and the AUIDEAS initiative (eMOOD

Antidepressant-like properties of phosphodiesterase type 5 inhibitors and cholinergic dependency in a genetic rat model of depression

We explored the antidepressant-like properties of two phosphodiesterase type 5 (PDE5) inhibitors in a genetic animal model of depression, namely Flinders sensitive line rats. We investigated the dose-dependency of the antidepressant-like action of sildenafil, and its interaction with the cholinergic system and behavioural correlates of monoaminergic neurotransmission, in the forced swim test. Antidepressant-like properties of tadalafil (a structurally distinct PDE5 inhibitor) were also evaluated. Flinders sensitive line rats were treated for 14 days with vehicle, fluoxetine, atropine or PDE5 inhibitors±atropine. Immobility, swimming and climbing behaviours were assessed in the forced swim test. In combination with atropine (1 mg/kg), both sildenafil (10, 20 mg/kg) and tadalafil (10 mg/kg) decreased immobility while increasing swimming (serotonergic) and climbing (noradrenergic) behaviours. Interestingly, sildenafil (3 mg/kg) decreased immobility while selectively increasing climbing behaviour in the absence of atropine. These results suggest that the antidepressant-like activity of PDE5 inhibitors involve alterations in monoaminergic neurotransmission, but involve a dependence on inherent cholinergic tone so that the final response is determined by the relative extent of activation of these systems. Furthermore, the behavioural profile of sildenafil alone, and its observed antidepressant-like properties, shows strict dose-dependency, with only higher doses showing an interaction with the cholinergic syste