PCV62 Annual Medication Cost Attributed To Each Kind Of Treatment Of Patients Subjected To Crmds Implantation

Le gouvernement de la Dominique a adopté une politique vigilante sur 1importation et l'utilisation de pesticides. Dans ce pays, ure Office de contrôle des pesticides octroie des licences d'importation aux firmes agrochimiques tandis que le rninistere de l'Agriculture organise des Sessions de formation destinées aux agriculteurs et portant sur 1utilisation de ces produits. En outre, ure programme d'analyse régulière des sols a été mis en place pour détecter la présence de résidus de pesticides. Comme la rnajorité des pays ACP, la Dominique dépend de l’agriculture pour nourrir sa population et générer des devises à l'ëxportation. Dans cette agriculture, la banane est un des piliers de L’économie agriccolle nationale; il est indéniable que La cornpétiton sur le marché européen va s'accroitre lurs de la creation effective-du rnarché unique en I992-. Pour' assurer leur avenir, les agriculteurs de la Dominique souhaitent maintenir to quantité et la qualité de la production de bananes mais aussi diversifier leurs exportations grâce au développement de la production de fruits, de légumes et de fleurs. Dans cette optique, 1utilisation croissante de pesticides est inévitable et suppose donc une grande, vigilance quant à leur utilisation. Dans la Dominique, le relief est escarpé, les pluies abondantes, les sols volcaniques : tous ces facteurs fàvorisent le ruissellement et le lessivage des sols.'Le risque de pollution des nappes phréatiques est donc potëntiellement important , notamment dans les:régions bananières 'ou les paysans ont recours aux nematicidés. Pour minimiser ces- risques, seuls les produits agrochimiques testés sort autorisés à l’importation et Ieur utilisation est contrôlée par le ministère de 1Agriculture. Ce dernier incite par ailleurs les groupements paysans à suivre des sessions régulières de formation ou ure enseignement est dispensé portant sur le mélange et l’epandagé des produits chimiques, sur 1utilisation de vêtements de protection et sur le stockage des denrées selon les normes de sécurité. Parallèlement, un programme de détection des, résidus de pesticides a été lancé dernièrement, grâce à 1appui de la FAO qui fournit des -équipements de chromatographie par gaz liquide. Les agriculteurs de la Dominique ont compris 1importance de ces formations et la majorité d'entre, eux sont aujourd’hui conscients de la nécessite d’exporter des produit de qualité,et de 1importance d'une utilisation maîtrisée des pesticides .Les épandages «excessifs» (en particulier, surdosage et mélanges inadéquats), fréquents dans de nombreux pays, sont extrêmement rares à la Dominique .Dans ce pays, on utilise les pesticides avec prudence et économie : alors, le risque est minime pour les agriculteurs les consommateurs et 'l'environnement. Pour plus de détails : Colin Bulley Chief Technical Officer Ministry of Agriculture Roseau DOMINIQUELe gouvernement de la Dominique a adopté une politique vigilante sur 1importation et l'utilisation de pesticides. Dans ce pays, ure Office de contrôle des pesticides octroie des licences d'importation aux firmes agrochimiques tandis que le..

Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial.

Oral anticoagulation prevents ischemic strokes in patients with atrial fibrillation (AF). Early detection of AF and subsequent initiation of oral anticoagulation help to prevent strokes in AF patients. Implanted cardiac pacemakers and defibrillators allow seamless detection of atrial high rate episodes (AHRE), but the best antithrombotic therapy in patients with AHRE is not known. RATIONALE: Stroke risk is higher in pacemaker patients with AHRE than in those without, but the available data also show that stroke risk in patients with AHRE is lower than in patients with AF. Furthermore, only a minority of patients with AHRE will develop AF, many strokes occur without a temporal relation to AHRE, and AHRE can reflect other arrhythmias than AF or artifacts. An adequately powered controlled trial of oral anticoagulation in patients with AHRE is needed. DESIGN: The Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6 ) trial tests whether oral anticoagulation with edoxaban is superior to prevent the primary efficacy outcome of stroke or cardiovascular death compared with aspirin or no antithrombotic therapy based on evidence-based indications. The primary safety outcome will be major bleeding. NOAH-AFNET 6 will randomize 3,400 patients with AHRE, but without documented AF, aged ≥65 years with at least 1 other stroke risk factor, to oral anticoagulation therapy (edoxaban) or no anticoagulation. All patients will be followed until the end of this investigator-driven, prospective, parallel-group, randomized, event-driven, double-blind, multicenter phase IIIb trial. Patients will be censored when they develop AF and offered open-label anticoagulation. The sponsor is the Atrial Fibrillation NETwork (AFNET). The trial is supported by the DZHK (German Centre for Cardiovascular Research), the BMBF (German Ministry of Education and Research), and Daiichi Sankyo Europe. CONCLUSION: NOAH-AFNET 6 will provide robust information on the effect of oral anticoagulation in patients with atrial high rate episodes detected by implanted devices

Immunization coverage and risk factors for failure to immunize within the Expanded Programme on Immunization in Kenya after introduction of new Haemophilus influenzae type b and hepatitis b virus antigens

Background: Kenya introduced a pentavalent vaccine including the DTP, Haemophilus influenzae type b and hepatitis b virus antigens in Nov 2001 and strengthened immunization services. We estimated immunization coverage before and after introduction, timeliness of vaccination and risk factors for failure to immunize in Kilifi district, Kenya. Methods: In Nov 2002 we performed WHO cluster-sample surveys of > 200 children scheduled for vaccination before or after introduction of pentavalent vaccine. In Mar 2004 we conducted a simple random sample (SRS) survey of 204 children aged 9 - 23 months. Coverage was estimated by inverse Kaplan-Meier survival analysis of vaccine- card and mothers' recall data and corroborated by reviewing administrative records from national and provincial vaccine stores. The contribution to timely immunization of distance from clinic, seasonal rainfall, mother's age, and family size was estimated by a proportional hazards model. Results: Immunization coverage for three DTP and pentavalent doses was 100% before and 91% after pentavalent vaccine introduction, respectively. By SRS survey, coverage was 88% for three pentavalent doses. The median age at first, second and third vaccine dose was 8, 13 and 18 weeks. Vials dispatched to Kilifi District during 2001 - 2003 would provide three immunizations for 92% of the birth cohort. Immunization rate ratios were reduced with every kilometre of distance from home to vaccine clinic (HR 0.95, CI 0.91 - 1.00), rainy seasons ( HR 0.73, 95% CI 0.61 - 0.89) and family size, increasing progressively up to 4 children ( HR 0.55, 95% CI 0.41 - 0.73). Conclusion: Vaccine coverage was high before and after introduction of pentavalent vaccine, but most doses were given late. Coverage is limited by seasonal factors and family siz

Impact of contractile reserve on acute response to cardiac resynchronization therapy

Background: Cardiac resynchronization therapy (CRT) provides benefit for congestive heart failure, but still 30% of patients failed to respond to such therapy. This lack of response may be due to the presence of significant amount of scar or fibrotic tissue at myocardial level. This study sought to investigate the potential impact of myocardial contractile reserve as assessed during exercise echocardiography on acute response following CRT implantation. Methods: Fifty-one consecutive patients with heart failure (LV ejection fraction 27% ± 5%, 67% ischemic cardiomyopathy) underwent exercise Doppler echocardiography before CRT implantation to assess global contractile reserve (improvement in LV ejection fraction) and local contractile reserve in the region of the LV pacing lead (assessed by radial strain using speckle tracking analysis). Responders were defined by an increase in stroke volume ≥15% after CRT. Results: Compared with nonresponders, responders (25 patients) showed a greater exercise-induced increase in LV ejection fraction, a higher degree of mitral regurgitation and a significant extent of LV dyssynchrony. The presence of contractile reserve was directly related to the acute increase in stroke volume (r = 0.48, p<0.001). Baseline myocardial deformation as well as contractile reserve in the LV pacing lead region was greater in responders during exercise than in nonresponders (p<0.0001). Conclusions: Heart failure patients referred to CRT have less chance of improving under therapy if they have no significant mitral regurgitation, no LV dyssynchrony and no contractile myocardial recruitment at exercise

Characterization of variable regions of the Gp120 protein from HIV-1 subtype C virus variants obtained from individuals at different disease stages in Sub-Saharan Africa

Background: The development of a vaccine against HIV/AIDS capable of preventing virus infection has been hampered by the HIV envelope (Env) heterogeneity that makes it difficult to induce neutralizing antibodies against Env proteins from different HIV clades. Several studies have indicated that gp120 Env protein sequence tends to change considerably during the course of HIV disease which allows the virus to escape the immune responses. In order to define gp120 sequence changes, we have characterized the V1, V2, V4 and V5 variable regions of gp120 variants from 72 HIV-1-clade-C-infected subjects from South Africa and Swaziland, which were naïve to antiretroviral (ARV) therapy and at different disease stages. Sequence characteristics, such as aminoacid sequence length, presence of Putative N- Glycosylation Sites (PNGSs) and electric charge were investigated. Methods: According to the Avidity Index value and CD4+ T cell count, patients were classified for disease stage in three groups: recent, chronic and late stage, each one comprised of 24 patients. The V1 to V5 Env variable regions were directly PCR amplified from plasma virus RNA and sequenced. Results: A significant increase in the amino acid sequence length of V1 and V4 domains, and a corresponding increase of the “shifting” PNGSs were observed in the HIV variants obtained from individuals at chronic stage of disease, as compared to the recent infection group. Finally, a significant increase of the net electric positive charge of the V5 loop was found in the HIV variants from the group of subjects with late disease, as compared to the chronic disease group. Conclusion: We conclude that changes in sequence length, glycosylation pattern and net electrical charge in the variable V1, V4 and V5 regions of gp120 occur in the course of HIV infection, possibly in response to the pressure of the host immune response