Maximum Flow Rates Possible During Power Injection Through Currently Available PICCs: An In-Vitro Study

PurposeCurrently available 4 French and 5 French PICCs were investigated to evaluate their possible application for contrast injection using power injectors. The study was performed using an in-vitro model to demonstrate the feasibility of using PICCs for contrast enhanced studies.Materials and MethodsAn evaluation of 24 catheter versions consisting of 4 French single lumen and 5 French dual lumen PICCs from 13 different manufacturers was conducted. Six of the catheter types were silicone and 18 catheter types were polyurethane. Ten catheters of each type were evaluated with five at full length and five trimmed to 40 cm. Using a silicone-based simulated superior vena cava model, the catheters were infused with 50 cc of intravenous contrast at each flow rate increment. Catheters were tested at increasing flow rates from 0.5 cc/second to 5 cc/second in 0.5 cc/second increments using a Percupump CT injector. Catheters that failed to rupture were then infused at 1 cc/second increments at flow rates from 5 cc/second to 17 cc/second using a MedRad Mark V™ power injector. Tolerated and bursting pressures were recorded.ResultsPolyurethane catheters ruptured at flow rates between 4–15.4 cc/second, with one catheter not rupturing at the maximum flow rate (17 cc/second). Silicone catheters ruptured at flow rates between 0.5–3.5 cc/second. Average rupture locations by type and length were at the extension leg/hub connection area on 5 of the PICCs, on the extension legs on 21 of the PICCs, on the catheter/hub connection on 4 PICCs, and on the proximal catheter on 16 of the PICCs.ConclusionThe low burst rates at which all silicone catheters ruptured suggest those catheters are not able to withstand typical flow rates used for CTA. Conversely, although a wide range of discrepancy is found in the polyurethane catheter burst pressures, many polyurethane catheters can tolerate relatively high flow rates without rupture. This suggests that they may be safely used for CTA with appropriate precautions and protocols in place.     

Incidence of Nonelective Removal of Single-Lumen Silicone and Dual-Lumen Polyurethane Percutaneously Inserted Central Catheters in Neonates

ObjectiveTo compare the incidence of nonelective removal of single-lumen silicone and dual-lumen polyurethane percutaneously inserted central catheters (PICCs).Study DesignA prospective cohort study was conducted with neonates in whom 247 PICC lines had been successfully inserted. Patients were assigned to either the single-lumen silicone group or the dual-lumen polyurethane group and nonelective removal incidence was compared using a logistic regression model.ResultsIncidence of nonelective removal in dual-lumen polyurethane PICCs (n = 91) was 48.3% versus 34% in single-lumen silicone PICCs (n = 156). Thus, dual-lumen polyurethane catheters had a significantly increased chance of nonelective removal compared with single-lumen silicone PICCs (P = .004). The most usual complication in dual-lumen polyurethane PICCs was suspected catheter-related bloodstream infection; in single-lumen silicone PICCs it was external rupture.ConclusionsDual-lumen polyurethane PICCs are associated with higher rates of nonelective removal and complications such as suspected catheter-related bloodstream infection. Cautious nursing care is necessary to prevent complications.     

Impact of the Positive Pressure Valve on Vascular Access Device Occlusions and Bloodstream Infections

Background/PurposeThe use of needleless positive pressure connector valves (PPVs) on venous access devices (VADs) has been shown to have possible benefits in decreasing VAD occlusion rates. Catheter-related bloodstream infection (CRBSI) rates, however, have been variable. With this potential for improving patient outcomes, decreasing costs, and facilitating nursing care and catheter management, the use of PPV devices becomes both advantageous and desirable.MethodologyThis was a randomized, prospective, parallel clinical study of 160 medical and surgical step-down unit patients requiring parenteral therapies. Patients were equally randomized to two study groups to assess the impact on occlusion and CRBSI rates, using a PPV versus a standard cap without PPV. VADs included both peripherally inserted catheters (PICCs) and midlines.ResultsSeven VAD occlusions occurred; six in the experimental group, one in the control group (p = 0.43). Also, two CRBSIs occurred in the experimental group, with none in the control group (p = 0.497). All incidents occurred in doublelumen PICCs. The lack of statistical difference between the two groups for occlusions and CRBSIs indicates that the use of PPVs had no impact in preventing such outcomes. However, it was observed that the number of double-lumen PICCs and their dwelling time in the experimental group was significantly higher (p = 0.003).ConclusionThere was no difference in the rate of catheter occlusions or CRBSIs when using PPVs or standard caps. We consider that the study outcomes may be due to the study's small sample size, and we speculate that longer dwell time of double lumen catheters may have contributed to these outcomes. These observations deserve further investigation. However, the use of PPVs may still be advantageous from a nursing process perspective.     

The Effects of Focused Nursing Education on 3F Groshong™ PICC Occlusion Rates: The Experience of One Tertiary Pediatric Care Facility

ObjectiveThe primary aim of this project is to reduce the incidence of 3 Fr. Groshong? PICC occlusions through focused nursing education.BackgroundThe use of Peripherally Inserted Central Catheters (PICC) has become an essential tool in the care of pediatric patients. The small lumen and long length of PICCs requires specialized skill and knowledge in proper care, maintenance and flushing in order to prevent catheter occlusion and other complications. Occluded catheters compromise patient care and increase costs. Reducing the incidence of catheter occlusion, will have a significant impact on the quality of patient care; patient, family and nursing satisfaction, patient outcomes, and costs.MethodsA pre-test/post-test design using a convenience sample of all the core staff nurses working on the medical/surgical unit at a Southern California Children's Hospital was utilized. Objective measures included a written assessment of nursing knowledge, direct observations of nurses' flushing technique, and retrospective chart review to determine the rate of total catheter occlusion.ResultsMean written test scores improved from 0.78 to 0.93 (p = 0.00) Mean observation scores improved from 0.88 to 0.95, (p = 0.004). The pre-test occlusion rate was 21.11/1000 catheter days. The post test occlusion rate was 15.49/1000 catheter days (p = 0.057).ConclusionFocused nursing education contributed to reducing 3F Groshong? PICC occlusions and the associated costs due to PICC occlusions.     

Maximum Flow Rates Achievable Through Peripherally Inserted Central Catheters Using Standard Hospital Infusion Pumps

PurposeTo determine maximum flow rates through peripherally inserted central catheters (PICCs) using a standard hospital infusion pump.BackgroundTwo questions asked with the use of PICCs and flow rates are (1) can a PICC be used to give nonemergent fluid boluses, and (2) can standard hospital infusion pumps develop enough pressure to rupture a catheter?MethodsNew PICCs of different brands and gauges were gathered. Six standard hospital infusion pumps and tubing of the same brand and model were used. The pressure sensor was set at 600 mm Hg. The pumps were connected through the access ports of each intravenous tube in a series fashion. The PICC end was submerged under 5 cm of water. All equipment and fluids were at 70°F. PICCs were trimmed to 45 cm. Fluids were run starting with the first pump at 999 mL/hour and then additional pumps were added until the pump's 600 mm Hg limit stopped the infusion or catheter rupture. Tests with the same PICC were repeated and recorded.ResultsFlow rates varied with the type, size, gauge, and brand of PICC catheter. Flows were achieved from 2,100 mL/hour to >6,000 mL/hour. None of the PICCs ruptured.ConclusionsMaximum flow rates through PICCs were limited by the maximum pressure allowed by the standard hospital infusion pump. A standard hospital infusion pump cannot generate enough pressure to rupture a new-out-of-the-package catheter.Implication for PracticeNonemergent fluid boluses can be given through PICCs and standard infusion pumps will not rupture a PICC.     

Mortality and risk factor analysis for Candida blood stream infection: A three-year retrospective study

BackgroundThe aim of this study was to evaluate the possible risk factors for mortality in adult patients with candidemia by investigating the causative agents, underlying conditions and predisposing factors.Material and methodsThe data including causative Candida species, predisposing factors, and underlying conditions of candidemia patients between the years 2015–2017 were collected and the impact of these factors on mortality was evaluated. Patients were divided into two groups as died (died patients within 30 days of the onset of candidemia) and survived and risk factors were evaluated for each group.ResultsWe found 163 adult candidemia cases during the study period. Overall 30-day mortality was 40.5%. Candida parapsilosis was the most frequent causative agent (49.1%). C. parapsilosis candidemia was more common in the survived group compared with the died group (n: 49 (61.3%) vs. n: 31 (38.8%), P = 0.888). Mortality rates were significantly higher in patients with dialysis (n: 27 (69.2%) vs. n: 12 (30.8%), P < 0.00) and concurrent bacteremia (n: 20 (57.1%) vs. n: 15 (42.9%), P = 0.024). Survival rates were significantly higher in patients with follow-up blood cultures (n: 75 (65.8%) vs. n: 39 (34.2%), P = 0.013). The most important source of candidemia was catheter (49.7%), and C. parapsilosis was the most common causative agent (58%). The catheter was removed in 96.3% of these patients and the mortality rate was 38.5%. All of the patients received antifungal therapy and there was no significant difference between the effects of antifungals on mortality (n: 65 (39.9%) vs. 98 (60.1%), P = 0.607).ConclusionsDialysis and concurrent bacteremia are strong predictors of mortality in 30 days within patients with candidemia, whereas follow-up blood cultures have a protective role with lower mortality rates. In our study, the most important source of candidemia was catheter, and C. parapsilosis was the most common causative agent. The catheter was removed in almost all patients and the mortality rate was almost one third among these patients.     

Comparison of in vitro antifungal activity of novel triazoles with available antifungal agents against dermatophyte species caused tinea pedis

ObjectiveDermatophytes are a group of keratinophilic fungi that invade and infect the keratinized tissues and cause dermatophytosis. We investigated effectiveness of novel triazole (luliconazole and lanaconazole) in comparison with available antifungal agents against dermatophyte species isolated from patients with tinea pedis.Material and methodsA total of 60 dermatophytes species were isolated from the patients with tinea pedis. Identification of species was done by DNA sequencing of the ITS1-5.8S rDNA-ITS2 rDNA region. In vitro antifungal susceptibility testing with luliconazole and lanaconazole and available antifungal agent was done in accordance with the Clinical and Laboratory Standards Institute, M38-A2 document.ResultsIn all investigated isolates, luliconazole had the lowest minimum inhibitory concentration (MIC) (MIC range = 0.0005–0.004 μg/mL), while fluconazole (MIC range = 0.4–64 μg/mL) had the highest MICs. Geometric mean MIC was the lowest for luliconazole (0.0008 μg/mL), followed by lanoconazole (0.003 μg/mL), terbinafine (0.019 μg/mL), itraconazole (0.085 μg/mL), ketoconazole (0.089 μg/mL), econazole (0.097 μg/mL), griseofulvin (0.351 μg/mL), voriconazole (0.583 μg/mL) and fluconazole (11.58 μg/mL).ConclusionThe novel triazoles showed potent activity against dermatophytes and promising candidates for the treatment of tinea pedis caused by Trichophyton and Epidermophyton species. However, further studies are warranted to determine the clinical implications of these investigations.     

A novel device for the clearance and prevention of blockages within biomedical catheters

Biomedical catheters are commonly used to move fluids from one part of the body to another, or remove them from the body completely. In some instances, these catheters become occluded due to blood or other debris. Such occlusions may prove fatal or require re-operation with enormous costs and effects on the health-care system and the individual. We developed a model of occlusion in both a ventriculo-peritoneal shut system and en external ventricular drain. Having demonstrated that occlusions can be reliably generated in a manner that resembles the clinical situation we show that vibration can clear the blockages. Vibration in the 50–60 Hz range was able to maintain patency in the catheters or to clear the blockage when the catheter was completely occluded. In high concentrations of blood, 150 s of vibration applied every 30 min was able to maintain the patency of the catheter. Clinically, as the level of blood in the fluid decreases, the time intervals between vibration applications could be increased. We believe that vibration offers a safe, non-invasive method to maintain the patency of biomedical catheters.     

Proud osteochondral autograft versus synthetic plugs — Contact pressures with cyclical loading in a bovine knee model

PurposeTo determine whether proud synthetic and proud osteochondral plugs conform to native surrounding cartilage after cyclical loading and if there are differences in height and contact pressure after loading.MethodsSixteen bovine knees were used. Each received one osteochondral plug and one of two types of synthetic plugs (Smith & Nephew TruFit® BGS plug or Kensey Nash OsseoFit® plug). Plugs were placed in the center of each condyle's highest pressure area of articulation identified prior to defect creation (control). Static loads of 800 N were applied and contact pressures measured with Tekscan sensors.ResultsBoth types of synthetic grafts and the osteochondral grafts all subsided with cyclical loading (p < 0.001). The OsseoFit® plug displayed a greater reduction in height than the TruFit® plug compared to osteochondral grafts. The OsseoFit® plugs had significantly lower height than osteochondral grafts after both periods of cyclical loading (p < 0.001), while height of the TruFit® plugs was not significantly different than the heights of osteochondral grafts after either first (p = 0.387) or second (p = 0.261) periods of cyclical loading. Contact pressures for the OsseoFit® plugs were significantly lower than contact pressures for osteochondral grafts after both periods of cyclical loading (p < 0.001 for both). There was no difference between the pressures of TruFit® and osteochondral plugs after the first (p = 0.381) or second (p = 0.292) periods of cyclical loading.ConclusionsPrecision and accuracy are demanded to achieve flush osteochondral plug placement and OsseoFit synthetic plugs may subside more with less pressure than TruFit plugs if placed proud.     

Cytomegalovirus load at treatment initiation is predictive of time to resolution of viremia and duration of therapy in hematopoietic cell transplant recipients

BackgroundPreemptive antiviral therapy relies on viral load measurements and is the mainstay of cytomegalovirus (CMV) prevention in hematopoietic cell transplant (HCT) recipients. However, optimal CMV levels for the initiation of preemptive therapy have not been defined.ObjectivesThe objectives of our work were to evaluate the relationship between plasma CMV DNA levels at initiation of preemptive therapy with time to resolution of viremia and duration of treatment.Study designRetrospective analysis of HCT recipients undergoing serial CMV PCR testing between June 2011 and June 2014 was performed.Results221 HCT recipients underwent preemptive therapy for 305 episodes of CMV viremia. Median time to resolution was shorter when treatment was initiated at lower CMV levels (15 days at 135–440 international units (IU)/mL, 18 days at 441–1000 IU/mL, and 21 days at >1000 IU/mL, P < .001). Prolonged viremia lasting >30 days occurred less frequently when treatment was initiated at 135–440 IU/mL compared to 441–1000 IU/mL and >1000 IU/mL (1%, 15%, 24%, P < .001). Median treatment duration was also shorter in the lower viral load groups (28, 34, 37 days, P < .001).ConclusionInitiation of preemptive therapy at low CMV levels was associated with shorter episodes of viremia and courses of antiviral therapy. These data support the utility of initiating preemptive CMV therapy at viral loads as low as 135 IU/mL in HCT recipients.     

CMV plasma DNAemia and risk of cancer among HIV-infected patients: A case–control study nested in the ANRS CO3 Aquitaine Cohort,France, 2002–2007

BackgroundCMV reactivation, which enhances immune senescence, could be associated with a higher risk of cancer.ObjectivesWe compared the prevalence of positive CMV DNAemia in HIV-infected patients with and without cancer.Study designThis case–control study, nested in the ANRS-CO3 Aquitaine Cohort, included patients with a first diagnosis of cancer (2002–2007) as cases. Two controls were matched per case.Cancer risk was estimated using conditional logistic regression models, an Odds Ratio (OR) of 2 could be detected with 80% power. The variables considered were: ≥1 positive CMV DNAemia, CD4+ and CD8+ counts, HIV plasma load. Plasma CMV DNA was retrospectively quantified within the 3-year period preceding the endpoint.ResultsThe 143 cases (93 non-AIDS-related and 50 AIDS-related cancers) and 284 controls had a median age of 47 years (IQR: 41–56). At the time of diagnosis or censorship, for cases and controls, median values were respectively, for CD4+ count: 327 cells/mm³ (IQR: 164–514) and 416 (IQR: 275–582), and for HIV plasma load: 2.6 log₁₀ copies/mL (IQR: 1.7–4.7) and 1.7 log₁₀ copies/mL (IQR: 1.7–3.3). We performed 2056 CMV PCR; 14 cases (9.8% [95% CI: 4.9–14.7]) and 19 controls (6.7% [CI: 3.8–9.6]) presented ≥1 positive PCR. CMV DNAemia was not associated with the risk of cancer (unadjusted and adjusted p-values = 0.19 and 0.54, respectively). HIV load >500 copies/mL was independently associated with a higher risk of cancer (OR = 2.02; p = 0.002; 95% CI: 1.29–3.17).ConclusionThis large case–control study did not show any differential exposure to positive CMV plasma DNAemia between cancer cases and controls.     

Rate and predictors of serum HCV-RNA >6 million IU/mL in patients with chronic hepatitis C

BackgroundBaseline serum HCV-RNA predicts sustained virological response in chronic hepatitis C patients treated with antiviral therapy. A threshold at 6 million IU/mL has been proposed to best discriminate treatment outcomes on sofosbuvir-based regimens. In comparison with the general population, immunosuppressed individuals exhibit greater viral load values.ObjectivesTo estimate the rate and predictors of serum HCV-RNA above 6 million IU/mL in chronic hepatitis C patients on care outside clinical trials.Study designSerum HCV-RNA values recorded from all chronic hepatitis C patients consecutively attended at our clinic during the last decade were analyzed. Testing had been performed using the COBAS TaqMan HCV test v2.0.ResultsA total of 816 individuals with detectable serum HCV-RNA were identified. The main characteristics of this population were as follows: mean age 48.6 years-old; 73.4% males; mean ALT 82.6 IU/L; mean HCV-RNA 6.02 log IU/mL; 80.6% HCV genotypes 1 or 4; 34.9% advanced liver fibrosis; 35.4% IL28B-CC alleles. HIV coinfection in 78.7%, of whom 91% were on antiretroviral therapy.Overall, 127 (15.6%) had serum HCV-RNA values >6 million IU/mL. This high viremia was found in 18.2% of HIV-positive versus 5.7% of HIV-negative subjects (p < 0.001). In multivariate analysis, serum HCV-RNA >6 million IU/mL was only significantly associated with HIV coinfection (OR: 4.03; 95% CI: 1.98–8.19, p < 0.01) and HCV genotypes 1 or 4 (OR: 1.88; 95% CI: 1.05–3.37, p = 0.03).ConclusionsSerum HCV-RNA >6 million IU/mL is roughly seen in 6% of chronic hepatitis C monoinfected patients, and increases up to 18% in HIV coinfection.     

Real life experience with direct-acting antivirals agents against hepatitis C infection in elderly patients

BackgroundNew direct-acting antivirals agents (DAAs) are very safe and well tolerated.ObjectivesThe purpose of this study is to analyse the efficacy and safety of DAAs in elderly patients, who have co-morbidities and are on chronic medications.Study designAll HCV-infected patients over 65 years old in clinical follow-up at two Hospitals in Spain who initiated anti-HCV therapy were included (August 2012–October 2015).ResultsA total of 120 HCV mono-infected patients were recorded. Mean age of patients was 72.6 ± 7.4 years. There were 53.3% women and GT1b was the most frequent (83.3%); 64.2% had cirrhosis and 42.5% were treatment experienced. Ombitasvir + Paritaprevir/r ± Dasabuvir ± Ribavirin (RBV) and sofosbuvir/ledipasvir ± RBV were the most frequently used regimens. Weight-adjusted dosing of RBV was included in 61.7% and 43.6% of them required a dose reduction. Most of the patients (86.7%) had concomitant chronic medication and in 35.8% adjustment was necessary. Adverse events (AE) were seen in 65% of the patients; more frequent when a protease inhibitor (PI) was being used. The sustained virological response (SVR12) per ITT was 88.3%. Only 3 patients discontinued treatment and 2 patients died.ConclusionsHigh rates of SVR12 (88.3%) were observed among elderly patients with DAAs-based regimens. The presence of AE was frequent (65%). The majority of these patients (86.7%) had concomitant medication that required adjustment in 1/3 of them. These findings highlight the high rates of response to DAAs in the elderly HCV-population. However, special caution must be taken when using RBV and a PI.     

Evaluation of pandemic H1N1 (2009) influenza vaccine in adults with solid tumor and hematological malignancies on active systemic treatment

BackgroundOver 85% of healthy individuals vaccinated with the pandemic H1N1 (pH1N1) vaccine achieve seroprotection.ObjectivesWe evaluated the safety and immunogenicity of pH1N1 vaccine in patients undergoing chemotherapy for hematological and solid tumor malignancies.Study designAdult patients, receiving chemotherapy undergoing pH1N1 vaccination at our institution had blood samples drawn for CBC (baseline only) and serology prior to and ≥21 days post vaccination. HAI antibody testing was performed for pH1N1 (A/California/7/2009 strain) and seasonal H1 (A/Brisbane/59/07 strain). Seroprotection was defined as a pH1N1 antibody titre ≥1:40 and seroconversion as an antibody titre >4× baseline. Patients completed a symptom diary card.ResultsPaired samples were available for 46 patients (20 solid tumor, 26 hematological), median age 56 (range 23–76) years. The seroprotective rate post-vaccination for solid tumors was 50% compared to 27% for hematological malignancy (p = 0.11), respective seroconversion rates were 45% and 19% (p = 0.06). In patients with solid tumors vaccination mid cycle resulted in the highest pH1N1 titres, although timing and blood count were not associated with seroconversion or seroprotection. For hematological patients, a normal leukocyte count and vaccination at the beginning of a cycle were associated with higher rates of seroconversion (p ≤ 0.05). Addition of rituximab to chemotherapy resulted in a failure to seroconvert (p = 0.05). Vaccination was well tolerated by all patients.ConclusionsAlthough well tolerated, the seroprotection rate following pH1N1 vaccination is lower than that would be expected. Further investigation into immunization strategies in patients receiving chemotherapy is required.     

Insulin growth factor (IGF) 1, IGF-binding proteins and ovarian cancer risk: A systematic review and meta-analysis

BackgroundInsulin resistance (IR) has been implicated in carcinogenesis, but there is no consensus regarding its involvement in ovarian cancer. We performed a systematic review and meta-analysis to evaluate the association between IR and ovarian cancer.MethodsSearches were conducted in five databases for studies evaluating IR markers (levels of serum insulin, C peptide, insulin growth factor [IGF] 1 and IGF-binding proteins [IGFBPs], homeostatic model assessment insulin resistance, and quantitative insulin-sensitivity check index) and ovarian cancer risk. Study selection, data extraction and an assessment of risk of bias were performed independently by three researchers. The associations between IR markers and ovarian cancer were quantified as mean differences (MDs) or standardized MDs (SMDs) and their 95% CIs using random-effects models.ResultsFourteen case-control studies satisfied our inclusion criteria (n = 8130). There was little information on IR markers with the exception of the IGF system. Ovarian cancer was associated with lower IGF-1 levels (SMD −0.43 ng/mL, 95% CI −0.67 to −0.18; p = 0.0006), and lower IGFBP-3 levels (SMD −0.11 ng/mL, 95% CI −0.21 to −0.00; p = 0.04). However, ovarian cancer was associated with higher levels of IGFBP-2 and IGFBP-1 (MD 527.3 ng/mL, 95%CI 473.6, 581.0; p < 0.00001, and MD 3.47 ng/mL, 95%CI 1.42, 5.52; p = 0.0009 respectively). Subgroup analyses by menopausal status and age (≤55 vs >55y) for IGF-1 and IGFBP-3 showed the subgroups were similar, although heterogeneity remained high.ConclusionThe evidence suggests that levels of IGF-1 and IGFBP-3 are lower in patients with ovarian cancer. In contrast, higher levels of IGBP-2 and IGBP-1 are found in patients with ovarian cancer.     

Profil clinico-biologique et immunohématologique des patients atteints de β-thalassémie en Tunisie : à propos de 26 cas

Aim of the studyTo study the clinical and biological profile of β-thalassemic patients in our region, reflecting the quality of their care.Patients and methodsA retrospective study (2010–2011) on 26 β-thalassemic patients followed in the pediatrics service at CHU Farhat Hached Sousse, Tunisia. Epidemiological, clinical and biological data were collected from medical records and transfusion files of patients. The transfusion protocol adopted was to maintain a hemoglobin level > 10 g/dL by regular transfusions every 3–4 weeks. Iron chelation therapy, in order to maintain serum ferritin < 1500 ng/mL, was introduced when serum ferritin exceeded 800–1000 ng/mL.ResultsThe mean age of patients at diagnosis was 15 months. The clinical impact of anemia had resulted in failure to thrive in 54% of patients and facial dysmorphism in 23%. The average transfusion requirement was estimated at 311.02 mL/kg/year with 6 cases of hyperconsumption. The immunohaematological monitoring showed the appearance of anti-RBC alloimmunization in one patient and 4 cases of autoimmunization. Poor adherence of chelation therapy was 62% and causing 5 cases of cardiac complications, 4 cases of liver injury and 14 cases of endocrine complications.ConclusionImproving the therapeutic care of β-thalassemic children requires better monitoring of transfusion recovery and improved adherence to chelation therapy.     

Low mother-to-child-transmission rate of Hepatitis C virus in cART treated HIV-1 infected mothers

BackgroundMaternal transmission is the most common cause of HCV infection in children. HIV co-infection and high levels of plasma HCV-RNA have been associated with increased HCV transmission rates.ObjectivesWe assessed the vertical HCV transmission rate in the HIV–HCV co-infected group of pregnant women on cART.Study designWe conducted a retrospective study in a Dutch cohort of HIV-positive pregnant women and their children. We identified co-infected mothers. Results of the HCV tests of the children were obtained.ResultsAll 21 women were on cART at the time of delivery. We analyzed data of the 24 live-born children at risk for mother-to-child transmission (MTCT) of HCV between 1996 and 2009. HIV-RNA was <500 copies/ml during 18/24 [75%] deliveries, the median CD4⁺ cell count was 419 cells/μl (290–768). There was no transmission of HIV. The median plasma HCV-RNA in our cohort of 23 non-transmitting deliveries in 21 women was 3.5 × 10E5 viral eq/ml (IQR 9.6 × 104–1.5 × 106 veq/mL). One of 24 live-born children was found to be infected with HCV genotype 1. At the time of delivery the maternal plasma HIV-RNA was <50 copies/ml, the CD4⁺ cell count was 160 cells/μl and maternal plasma HCV-RNA was 4.6 × 10E6 veq/ml. This amounted to a prevalence of HCV-MTCT of 4%.ConclusionIn this well-defined cohort of HIV–HCV co-infected pregnant women, all treated with cART during pregnancy, a modest rate of vertical HCV transmission was observed.     

Profound week 4 interferon responsiveness is mandatory for hepatitis C genotype 1 patients with unfavorable IL-28B genotype

BackgroundViral kinetics and host interleukin 28B (IL-28B) genotype determine treatment outcome in hepatitis C virus genotype 1 (HCV-1) infection.ObjectivesWe aimed to explore the interplay between interferon responsiveness at treatment week 4 and IL28B genotype in the achievement of a sustained virological response (SVR; undetectable HCV RNA 24-weeks after end-of-treatment).Study designsRs8099917 genotypes were determined in 528 HCV-1 patients with peginterferon/ribavirin. Interferon responsiveness were evaluated by the degree of week 4 viral reduction: <1 log₁₀ IU/mL, 1–2 logs₁₀ IU/mL, 2–3 logs₁₀ IU/mL, 3–4 logs₁₀ IU/mL and ≥4 logs₁₀ IU/mL reduction and/or undetectable HCV RNA, respectively.ResultsThe SVR rate was significantly higher in patients with great interferon responsiveness at week 4. A great interferon responsiveness was associated with younger age (P < 0.0001), lower body mass index (P = 0.0056), lower aspartate aminotransferase levels (P = 0.0009), higher hemogloblin concentration (P = 0.0033), higher platelet counts (P < 0.0001), male gender (P < 0.0001) and rs809997 TT-genotype (P < 0.0001). Comparing to non-TT genotype patients, TT genotype patients had a significantly higher SVR rate with moderate viral reduction (1–3 logs₁₀ IU/mL) at week 4 (58.9% vs. 18.2%, P < 0.001), and the SVR rate did not differ between TT/non-TT patients on the extreme ends (<1 or >3 log₁₀ IU/mL reduction) of week 4 interferon responsiveness. For non-TT genotype carriers who were with <3 logs₁₀ reduction, none (0/15) could have a complete early virological response and only 10.9% (7/64) of the patients had an SVR.ConclusionsMore profound interferon responsiveness is mandatory for HCV-1 patients with unfavorable IL-28B genotype.     

Cardiopulmonary responses to robotic end-effector-based walking and stair climbing

BackgroundA recently developed robotic end-effector device (G-EO system, Reha Technology AG) can simulate walking and stair climbing. This approach has the potential to promote cardiovascular exercise training during rehabilitation. The aim of this study was to characterise cardiopulmonary responses of end-effector-based exercise in able-bodied subjects and to evaluate the feasibility of intensity-guided exercise testing.MethodsFive healthy subjects aged 33.7 ± 8.8 years (mean ± SD) performed a constant load test and an intensity-guided incremental exercise test. The outcome measures were steady-state and peak cardiopulmonary performance parameters including oxygen uptake (VO₂) and heart rate (HR).ResultsPassive end-effector-based stair climbing (VO₂ = 13.6 ± 4.5 mL/min/kg, HR = 95 ± 23 beats/min) showed considerably lower cardiopulmonary responses compared to reference data (VO₂ = 33.5 ± 4.8 mL/min/kg, HR = 159 ± 15 beats/min). Peak performance parameters during intensity-guided incremental exercise testing were: VO₂ = 35.8 ± 5.1 mL/min/kg and HR = 161 ± 27 beats/min, corresponding to a relative VO₂ = 76.0 ± 18.7% of predicted aerobic capacity and a relative HR = 87.3 ± 14.5% of age-predicted HR maximum.ConclusionEnd-effector-based exercise is a promising method for the implementation of cardiovascular exercise. Although end-effector-based stair climbing evoked lower cardiopulmonary responses than conventional stair climbing, active contribution during exercise elicited substantial cardiopulmonary responses within recommended ranges for aerobic training.