Five-year trends in epidemiology and prevention of mother-to-child HIV transmission, St. Petersburg, Russia: results from perinatal HIV surveillance

<p>Abstract</p> <p>Background</p> <p>The HIV epidemic in Russia has increasingly involved reproductive-aged women, which may increase perinatal HIV transmission.</p> <p>Methods</p> <p>Standard HIV case-reporting and enhanced perinatal HIV surveillance systems were used for prospective assessment of HIV-infected women giving birth in St. Petersburg, Russia, during 2004-2008. Trends in social, perinatal, and clinical factors influencing mother-to-child HIV transmission stratified by history of injection drug use, and rates of perinatal HIV transmission were assessed using two-sided χ²or Cochran-Armitage tests.</p> <p>Results</p> <p>Among HIV-infected women who gave birth, the proportion of women who self-reported ever using injection drugs (IDUs) decreased from 62% in 2004 to 41% in 2008 (<it>P </it>< 0.0001). Programmatic improvements led to increased uptake of the following clinical services from 2004 to 2008 (all <it>P </it>< 0.01): initiation of antiretroviral prophylaxis at ≤28 weeks gestation (IDUs 44%-54%, non-IDUs 45%-72%), monitoring of immunologic (IDUs 48%-64%, non-IDUs 58%-80%) and virologic status (IDUs 8%-58%, non-IDUs 10%-75%), dual/triple antiretroviral prophylaxis (IDUs 9%-44%, non-IDUs 14%-59%). After initial increase from 5.3% (95% confidence interval [CI] 3.5%-7.8%) in 2004 to 8.5% (CI 6.1%-11.7%) in 2005 (<it>P </it>< 0.05), perinatal HIV transmission decreased to 5.3% (CI 3.4%-8.3%) in 2006, and 3.2% (CI 1.7%-5.8%) in 2007 (<it>P </it>for trend <0.05). However, the proportion of women without prenatal care and without HIV testing before labor and delivery remained unchanged.</p> <p>Conclusions</p> <p>Reduced proportion of IDUs and improved clinical services among HIV-infected women giving birth were accompanied by decreased perinatal HIV transmission, which can be further reduced by increasing outreach and HIV testing of women before and during pregnancy.</p

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Analysis of the microbial communities from a restored tomb in the Necropolis of Carmona, Sevilla, Spain

4 páginas, 1 figura, 23 referencias.The protection and conservation of the European Cultural Heritage is a matter of global relevance. Increasing deterioration of materials (stone, brick, leather, paper, wood, paintings, metals, etc.) is causing great concern. Atmospheric pollution, urbanization, tourism, groundwater fluctuations or inappropriate conservation treatments all play a role which need to be investigated.This work was supported by the European Commission, Marie Curie Action MEST-CT2004-513915 and Consejería de Innovación, Ciencia y Empresa, project RNM 2318.Peer reviewe

Clinical effectiveness of magnesium orotate in patients with cardiac arrhythmias, arterial hypertension, and mitral valve prolapse

Aim. To evaluate the effectiveness of magnesium orotate in the patients with cardiac arrhythmias, arterial  hypertension (AH), and idiopathic mitral valve prolapse (MVP). Material and methods. The complex examination, dynamic follow-up, and placebo-controlled differentiated  treatment were performed in 84 patients with idiopathic MVP. All participants underwent echocardiography,  24-hour blood pressure monitoring (BPM) and electrocardiography (ECG) monitoring, office BP measurement,  spectral analysis of heart rate variability (HRV), and physical stress test. The main group (MG; n=43) received  magnesium orotate (3000 mg/d) for 6 months; the comparison group (CG; n=41) received placebo. Results. According to the 24-hour ECG monitoring data, the treatment was associated with disappearance of  high-grade arrhythmias and a 40% reduction in supraventricular (paroxysmal and non-paroxysmal) tachycardia  incidence. The number of ventricular extrasystoles was reduced in 26%, and they disappeared in 54%. In 8%,  polytopic ventricular extrasystoles were substituted by occasional monotopic extrasystoles. These changes were not  observed in the CG patients. The percentage of Stage I AH patients decreased from 38% to 8% in the MG, and  from 30% to 20% in the CG. Conclusion. In MVP patients, magnesium orotate treatment improved electro-physiological heart parameters,  with reduced supraventricular and ventricular extrasystole incidence and improved circadian BP profile

Presencia de actinobacterias del género Rubrobacter en tumbas de la Necrópolis de Carmona.

3 páginas, 13 referencias. Póster publicado en el Libro de Resúmenes de la 9ª Reunión de la Red Temática del CSIC de Patrimonio Histórico y Cultural. Sevilla, 4 y 5, marzo,2008.La Necrópolis de Carmona fue descubierta a finales del siglo XIX. Está formada por un gran número de tumbas excavadas en la roca, de las que se conocen más de 600 y otras muchas, aún por descubrir. Fue utilizada por los romanos durante los siglos I y II antes de Cristo y es uno de los yacimientos de la Península Ibérica que conservaba mayor número de pinturas, pues las tumbas se decoraban con enlucidos de cal para ocultar la roca. Sin embargo, la Necópolis se encuentra en mal estado de conservación y las pocas pinturas existentes presentan un acusado biodeterioro. Por ello, en los últimos años, se han realizado varios estudios encaminados a caracterizar y controlar el biodeterioro de estas tumbas (Ariño y Sáiz- Jiménez 1997, Piñar et al. 2001, Akatova et al. 2007).LL y JMG agradecen al CSIC los proyectos 200740I011 y 200640I197, respectivamente. EA y VJ agradecen los contratos Marie Curie Action MEST-CT2004-513915 e I3P-postdoctoral (CSIC-ESF) respectivamente. Este trabajo ha sido financiado por la Consejería de Innovación, Ciencia y Empresa, proyecto P06-RNM-02318.Peer reviewe

Alprazolam therapy effects on quality of life and vegetative dysfunction syndrome in patients with idiopathic mitral valve prolapse

Aim. To assess quality of life (QoL) and severity of vegetative dysfunction syndrome (VDS) in patients with idiopathic mitral valve prolapse (MVP); to evaluate the effects of alprazolam therapy on QoL and VDS. Material and methods. This single-blind, placebo-controlled study included 60 patients with idiopathic MVP (33,3% men, 66,7% women). All patients were randomised into two groups: the main group (MG), receiving alprazolam, and the control group (CG), receiving placebo. Both groups were comparable by age (mean age 30,8±0,4 and 31,1±0,2 years, respectively) and gender structure. In all patients with idiopathic MVP, organic internal pathology was ruled out. Both groups underwent complex examination at baseline and 10 weeks after the therapy started. Results. Clinically significant effectiveness of the treatment (VDS severity reduction (in points) by at least 50%, comparing to the baseline level) was observed among 80,0% of the patients receiving alprazolam (71,4% men, 82,6% women) and only in 33,3% (58,3% men, 16,7% women) of the controls. Alprazolam was clinically effective by the “DISS-work” scale in 30% (28,6% men, 30,4% women), by the “social life” scale – in 43,3% (57,1% men, 39,1% women), and by the “personal relationships” scale – in 56,7% (42,8% men, 60,9% women). In the placebo group, the respective percentages were 43,3% (50% men, 38,9% women), 30,0% (41,7% men, 22,2% women), and 46,7% (58,3% men, 38,9% women). Conclusion. Alprazolam therapy demonstrated significant QoL improvement and VDS severity reduction in patients with MVP

TRUE RESISTANCE AND PSEUDORESISTANCE TO ASPIRIN

Low dose aspirin reduces the secondary incidence of myocardial infarction and stroke. Drug resistance to aspirin might result in treatment failure. Despite this concern, no clear definition of aspirin resistance has emerged, and estimates of its incidence have varied remarkably. Researchers from university of Pennsylvania (Philadelphia, the USA), led by Dr. Tilo Grosser, aimed to determine the specific phenotype of true pharmacological resistance to aspirin — such as might be explained by genetic causes. However the study failed to identify a single case of true drug resistance. Pseudoresistance, reflecting delayed and reduced drug absorption, complicates enteric coated but not immediate release aspirin administration

Analysis of microbial communities involved in biodeterioration of the Roman Necropolis of Carmona (Seville, Spain)

Comunicación presentada a la citada conferencia, celebrada del 28 noviembre-1 diciembre, 2007, Sevilla, España.Peer reviewe