Comparative study of efficacy and safety of intravenous ferric carboxy maltose versus iron sucrose in treatment of postpartum iron deficiency anemia

Background: As postpartum iron deficiency anemia is observed in about 65% of women in India, it is the major contributing factor and indirect cause of maternal death. Postpartum anemia may lead to postpartum depression, stress, anxiety and cognitive impairment. Adequate treatment of anemia in postpartum period will have improved life quality in women in child bearing age so this study was designed with the objective to compare the safety and efficacy of intravenous FCM versus iron sucrose in treatment of postpartum iron deficiency anemia.Methods: It was a prospective observational study of postpartum women (within 10 days of delivery) with iron deficiency anemia (7-9 gm%) who delivered in LG hospital, Ahmedabad. A sample size of 215 women was estimated based on prevalence of anemia which is 65% among postpartum women in India including dropout rate of 10% which were further divided into 2 groups. Group 1: iron sucrose group, Group 2: ferric carboxy maltose group.Results: FCM has greater rise in Hb, less side effects, and easy administration of dose as compared to iron sucrose. The rise in Hb with FCM as compared to iron sucrose is (4.6 versus 3.5 respectively).Conclusions: FCM has more safety and efficacy as compared to iron sucrose in treatment of postpartum iron deficiency anemia

Willingness to participate in a randomized trial comparing catheters to fistulas for vascular access in incident hemodialysis patients: an international survey of nephrologists

BACKGROUND: Current guidelines favor fistulas over catheters as vascular access. Yet, the observational literature comparing fistulas to catheters has important limitations and biases that may be difficult to overcome in the absence of randomization. However, it is not clear if physicians would be willing to participate in a clinical trial comparing fistulas to catheters. OBJECTIVES: We also sought to elicit participants' opinions on willingness to participate in a future trial regarding catheters and fistulas. DESIGN: We created a three-part survey consisting of 19 questions. We collected demographic information, respondents' knowledge of the vascular access literature, appropriateness of current guideline recommendations, and their willingness to participate in a future trial. SETTING: Participants were recruited from Canada, Europe, Australia, and New Zealand. PARTICIPANTS: Participants include physicians and trainees who are involved in the care of end-stage renal disease patients requiring vascular access. MEASUREMENTS: Descriptive statistics were used to describe baseline characteristics of respondents according to geographic location. We used logistic regression to model willingness to participate in a future trial. METHODS: We surveyed nephrologists from Canada, Europe, Australia, and New Zealand to assess their willingness to participate in a randomized trial comparing fistulas to catheters in incident hemodialysis patients. RESULTS: Our results show that in Canada, 86 % of respondents were willing to participate in a trial (32 % in all patients; 54 % only in patients at high risk of primary failure). In Europe and Australia/New Zealand, the willingness to participate in a trial that included all patients was lower (28 % in Europe; 25 % in Australia/New Zealand), as was a trial that included patients at high risk of primary failure (38 % in Europe; 39 % in Australia/New Zealand). Nephrologists who have been in practice for a few years, saw a larger volume of patients, or self-identified as experts in vascular access literature were more likely to participate in a trial. LIMITATIONS: Survey distribution was limited to vascular access experts in participating European countries and ultimately led to a discrepancy in numbers of European to non-European respondents overall. Canadian views are likely over-represented in the overall outcomes. CONCLUSIONS: Our survey results suggest that nephrologists believe there is equipoise surrounding the optimal vascular access strategy and that a randomized controlled study should be undertaken, but restricted to those individuals with a high risk of primary fistula failure

Streamlined design of a self-inactivating feline immunodeficiency virus vector for transducing ex vivo dendritic cells and T lymphocytes.

BACKGROUND: Safe and efficient vector systems for delivering antigens or immunomodulatory molecules to dendritic cells (DCs), T lymphocytes or both are considered effective means of eliciting adaptive immune responses and modulating their type, extent, and duration. As a possible tool toward this end, we have developed a self-inactivating vector derived from feline immunodeficiency virus (FIV) showing performance characteristics similar to human immunodeficiency virus-derived vectors but devoid of the safety concerns these vectors have raised. METHODS: The pseudotyped FIV particles were generated with a three-plasmid system consisting of: the packaging construct, providing Gag, Pol and the accessory proteins; the vector(s), basically containing FIV packaging signal (psi), Rev responsive element, R-U5 region at both ends, and the green fluorescent protein as reporter gene; and the Env plasmid, encoding the G protein of vesicular stomatitis virus (VSV-G) or the chimeric RD114 protein. Both packaging and vector constructs were derived from p34TF10, a replication competent molecular clone of FIV. The pseudotyped particles were produced by transient transfection in the Crandell feline fibroblast kidney (CrFK) or the human epithelial (293T) cell line. RESULTS: To broaden its species tropism, the final vector construct was achieved through a series of intermediate constructs bearing a longer psi, the FIV central polypurin tract sequence (cPPT), or the woodchuck hepatitis post-regulatory element (WPRE). These constructs were compared for efficiency and duration of transduction in CrFK or 293T cells and in the murine fibroblast cell line NIH-3T3. Whereas psi elongation and cPPT addition did not bring any obvious benefit, insertion of WPRE downstream GFP greatly improved vector performances. To maximize the efficiency of transduction for ex-vivo murine DCs and T-lymphocytes, this construct was tested with VSV-G or RD114 and using different transduction protocols. The results indicated that the FIV construct derived herein stably transduced both cell types, provided that appropriate vector makeup and transduction protocol were used. Further, transduced DCs underwent changes suggestive of an induced maturation. CONCLUSION: In contrast to previously described FIV vectors that were poorly efficient in delivering genetic material to DCs and T lymphocytes, the vector developed herein has potential for use in experimental immunization strategies

Effects of lockdown on emergency room admissions for psychiatric evaluation: an observational study from the AUSL Romagna, Italy

Objectives: An observation of the admissions to the emergency room (ER) requiring psychiatric evaluation during the lockdown and investigation of the demographic and clinical variables. Methods: Retrospective longitudinal observational study of ER accesses for psychiatric evaluation was performed, comparing two periods (9 March–3 May 2020 vs. 9 March–3 May 2019). Data (number of admissions, key baseline demographic and clinical variables) were extracted from the ER databases of referral centres in a well-defined geographic area of North-Eastern Italy (Cesena, Ravenna, Forlì, and Rimini). Results: A 15% reduction of psychiatric referrals was observed, together with a 17% reduction in the total number of patients referring to the ER. This reduction was most evident in the first month of the lockdown period (almost 25% reduction of both referrals and patients). Female gender (OR: 1.52: 95%, CI: 1.12–2.06) and being a local resident (OR: 1.54: 95%CI: 1.02–2.34) were factors associated with the decrease. Conclusions: Lockdown changed dramatically health priorities in the local population, including people with mental health. We speculate that our observations do not only refer to the confinement due to the lockdown regime but also to fear of contagion and adoption of different coping strategies, especially in women.Key-points During lockdown 15% reduction of psychiatric visits and >17% reduction in the number of psychiatric patients referring to the ER was observed. in the first four weeks of the lockdown almost 25% reduction of both visits and patients was observed Female gender and being a local resident were factors associated with the decrease

Osteopontin plasma levels and accelerated atherosclerosis in patients with CAD undergoing PCI: a prospective clinical study.

OBJECTIVES: Growing evidence supports the role played by inflammation in atherosclerosis. Identifying sensitive biomarkers is useful in predicting accelerated atherosclerosis. We investigated prospectively the relationship between plasma levels of inflammatory biomarkers [osteopontin, C-reactive protein (CRP), interleukin-6 (IL-6)] and instent restenosis, and rapid coronary plaque progression in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). METHODS: We studied 77 patients with CAD: 45 affected by unstable angina/non-ST elevation myocardial infarction [acute coronary syndrome (ACS)], and 32 by chronic coronary syndrome (CCS). Plasma osteopontin, IL-6, and CRP levels were measured before intervention in all patients; measurements were carried out on the basis of the following time course at 1,15, 30, 90, and 180 days follow-up in a subgroup of 39 consenting patients. Clinical and biohumoral data were correlated with baseline and 6-month PCI follow-up angiography. RESULTS: Osteopontin, IL-6, and CRP were higher in patients with ACS than in those with CCS (analysis of variance: P<0.001, 0.05, and 0.05, respectively). Baseline osteopontin levels proved to be associated with rapid coronary plaque progression (P=0.005) and instent restenosis (P=0.05). The highest osteopontin levels were found in patients with CAD with both rapid plaque progression and instent restenosis (P=0.003). PCI increased inflammatory markers acutely, and osteopontin remained elevated in patients with ACS. Patients with ACS showed a higher percentage (74%) of rapid plaque progression than those with CCS (26%) (P<0.05). CONCLUSION: The study prospectively shows the link between inflammatory status and accelerated atherosclerosis in patients with CAD undergoing PCI. The baseline and persistent rise of osteopontin is an expression of its contribution to the accelerated plaque progression, and therefore osteopontin may be a useful prognostic biomarker

La sequenza archeologica di Barbiano &#8211; Caserma dei vigili del fuoco (Bolzano) : evidenze di sistemazioni dei versanti durante il neolitico

Il sito di Barbiano \ue8 stato occupato in varie fasi dalla Preistoria all\u2019Et\ue0 Romana Le prime evidenze insediative risalgono all\u2019inizio del Neolitico medio, circa 7000 anni BP. L\u2019occupazione venne preceduta dalla creazione di una ampia piattaforma, un terrazzo, realizzato asportando i depositi fluvioglaciali e la sovrastante copertura pedologica. La piattaforma venne completata con il riporto su tutta la superficie di alcuni decimetri di sabbia. Si tratta di una delle pi\uf9 antiche evidenze di significative modificazioni antropiche del paesaggio in area alpina. Questi importanti lavori suggeriscono inoltre che l\u2019ampia area insediativa fosse abitata per la maggior parte dell\u2019anno. L\u2019insediamento marca dunque la transizione dalle pi\uf9 antiche attivit\ue0 agricole basate sulla pratica dello "slash and burn" a quelle stanziali. I livelli neolitici vennero coperti da sedimenti alluvionali e colluviali deposti come conseguenza dell\u2019attivazione di processi di degradazione dei versanti innescati dalla deforestazione. Durante l\u2019Et\ue0 Romana il torrente locale era delimitato da argini artificiali ed una serie di strutture murarie vennero edificate per delimitare e proteggere aree insediative che per\uf2 si sviluppano al di fuori dell\u2019area scavata. I sedimenti grossolani all\u2019interno del canale suggeriscono che limitati processi erosivi ancora interessavano il versante. I livelli romani sono stati successivamente sepolti da una sottile coltre colluviale che suggeriscono come i versanti sovrastanti, oggigiorno largamente terrazzati, non sono pi\uf9 stati interessati da processi erosivi che sono invece noti in altre aree della regione.The archaeological succession of Barbiano-Firehouse (Bozen): evidence of slope terracing during the Neolithic Barbiano archaeological site was occupied at various stages from the Prehistory to the Roman era. The earliest occupation of the area, seems to have occurred at the beginning of the Middle Neolithic, around 7 ka bP. It was preceded by the excavation of a large almost flat platform, a terrace, realised with the stripping of fluvioglacial deposits and the overlying soil cover. The platform was later covered with a few decimetre-thick layer of sand. This is one of the earliest evidence of important anthropogenic topographic and landscape modification in the Alps. These important works suggest that the large occupation surface was probably settled for most of the year following the transition from the nomadic agriculture and the "slash and burn" practices usually associated with the Neolithic . The Neolithic settlement was lately buried under colluvial and alluvial sediments that indicate slope degradation processes most probably triggered by deforestation. In Roman Times the local stream was delimited by artificial levee and a series of walls were built to delimitate and protect larger structures that extended beyond the excavated area. The coarse sediments that fill the channel bear witness that limited erosional processes still affected on the slope. The Roman structures were buried under shallow colluvial deposits suggesting that the overlying slope, nowadays largely terraced, did not experienced anymore erosive processes that are known to have occurred in nearby areas