Fungal infections associated with HIV infection

Oral candidiasis is perhaps the commonest infection seen in HIV disease. The aim of this workshop was to provide a sketch of the multifarious aspects of the disease from a global perspective. To this end the panellists addressed issues such as the virulence of Candida , emergence of antifungal resistance, management of candidiasis and other exotic, oral mycotic diseases. An all-pervasive theme was the dramatic differences in the management of fungal infections consequential to the availability (or the lack) of anti-HIV drugs in the developed and the developing world. Further, the social stigmata associated with the HIV disease in many developing regions in Africa and Asia appears to modify the therapeutic strategies. Additionally, the lesser-known regional variations in the disease manifestations and therapeutic approaches were stark. Further work is direly needed to address these issues.     

Cervical cancer prevention in Australia: Planning for the future

The high rate of coverage that has been achieved to date by the Australian government's Human Papillomavirus (HPV) Vaccination Program has already led to profound reductions in the prevalence of biopsy‐confirmed, high‐grade abnormalities and of vaccine‐preventable HPV types in Australia. Declines in the prevalence of vaccine preventable HPV have occurred not only in vaccinated women but also in unvaccinated women, suggesting a herd‐immunity affect. These declines were anticipated on the basis of modelling and were the major drivers for the changes proposed to the Australian National Cervical Screening Program. The federal and state‐based Australian governments established a “Renewal Steering Committee,” which conducted a literature search and a review of the available evidence to assess its applicability and quality. Together with this information the committee also used modeling to determine the optimal screening pathway for cervical cancer screening and constructed a plan for implementing the changes that will be required to transition from the currently successful screening program to the renewed program. The committee recommended that Australia move to a screening program based on testing every 5 years using an HPV test with partial genotyping with reflex liquid‐based cytology (LBC) triage for HPV‐vaccinated and unvaccinated women ages 25 to 69 years, and an additional exit test for women up to age 74 years. Primary HPV testing and reflex LBC will be funded by government. Symptomatic women outside the screening program will also be able to access government funded testing. The new screening program, to be rolled out in 2017, will also provide a cost‐effective framework for an evaluation of the national HPV vaccination program, enabling ongoing monitoring of HPV genotypes and cervical lesions in screened women. Cancer Cytopathol 2016;124:235–40 . © 2015 American Cancer Society.     

噻托溴铵升级治疗成人未控制支气管哮喘

背景和目的:对于单用吸入糖皮质激素控制不佳的成人支气管哮喘(简称哮喘)患者,加用长效β-受体激动剂(LABA)可有效改善患者的症状及肺功能.但是最近对LABA长期治疗的安全性受到了美国食品药品管理局(FDA)及部分哮喘专家的质疑.另外,鉴于每个哮喘患者对治疗的反应不尽相同,因此寻求未控制哮喘患者的其他治疗方法是必要的.     

From research to phase III: preclinical, industrial and clinical development of the Sanofi Pasteur tetravalent dengue vaccine

Dengue vaccine development has reached a major milestone with the initiation, in 2010, of the first phase III clinical trial to investigate the Sanofi Pasteur CYD tetravalent dengue vaccine (TDV). The CYD TDV candidate is composed of four recombinant, live, attenuated vaccines (CYD-1-4) based on a yellow fever vaccine 17D (YFV 17D) backbone, each expressing the pre-membrane and envelope genes of one of the four dengue virus serotypes. The vaccine is genetically and phenotypically stable, non-hepatotropic, less neurovirulent than YFV 17D, and does not infect mosquitoes by the oral route. In vitro and in vivo preclinical studies showed that CYD TDV induces controlled stimulation of human dendritic cells, and significant immune responses in monkeys. Scale up and industrialization are being conducted in parallel with preclinical and clinical development to fulfill the needs of phase II/III trials, and to anticipate and facilitate supply and access to vaccine in the countries where the dengue disease burden makes it an urgent public health priority. The vaccine has now been administered to more than 6000 children and adults from dengue endemic and non-endemic areas and no safety concerns have arisen in any of the completed or ongoing trials. A three-dose vaccination regimen induces an immune response against all four serotypes in the large majority of vaccinees. Preexisting flavivirus immunity favors quicker and higher immune responses to CYD TDV, without adversely effecting clinical safety or increasing vaccine viremia. The observed level and nature of the cellular immune responses in humans are consistent with the good safety and immunogenicity profile of the vaccine. Preliminary results of an ongoing, proof-of-concept efficacy and large scale safety study in Thai children are expected by the end of 2012. Here we discuss the different steps and challenges of developing CYD TDV, from research to industrialization, and summarize some of the challenges to the successful introduction of a dengue vaccine into immunization programs.     

Phytochemical standardization of Aloe vera extract by HPTLC techniques

ObjectiveTo examine the phytochemical parameters of Aloe vera (A. vera) L. which can be used as a tool for its standardization.MethodsThe phytochemical analysis, solubility test, heavy metal analysis, antimicrobial study and quantitative analysis of gallic acid and berberine by HPTLC method were included in present study.ResultsPhytochemical analysis revealed the presence of alkaloid, carbohydrate, tannin, steroid, triterpenoid and glycoside. Total flavonoid and phenol content was found to be 1.9% and 13.11%. Concentartion of lead, arsenic, mercury and cadmium was found to be under the limit. Total bacterial count, yeast and moulds contents were found to be under the limit whereas Escherichia coli (E. coli) and salmonella was found to be absent in the extract. Quantitative analysis through HPTLC revealed the presence of 2.74% and 0.543% w/w of berberine and gallic acid.ConclusionsThe results indicate that the plant extract are rich in berberine and gallic acid implying their importance to human health. This investigation could be used as source of standard parameters which can play an important role in its standardization.     

Catching up with the catch-up: HPV vaccination coverage data for Australian women aged 18-26 years from the National HPV Vaccination Program Register

This report describes human papillomavirus (HPV) vaccine coverage data for Australian women 18-26 years of age, as notified to the National Human Papillomavirus Vaccination Program Register. A cross-sectional analysis was conducted of notifications to the Register of HPV vaccine doses delivered as part of the National HPV Vaccination Program, which provided free catch-up vaccination to women 18-26 years of age across Australia between 2007 and 2009. HPV vaccination coverage estimates were calculated by age, state or territory of residence and dose number, using the Australian Bureau of Statistics population estimates as the denominator. As at March 2011, approximately 4.49 million doses had been notified to the Register of females of all ages, and 1.7 million of these were for women aged 18-26 years in 2007. Vaccination coverage was highest for females aged 18 years and lowest in females aged 26 years. For the entire 18-26 years cohort, coverage was estimated at 55.2% for dose 1, 44.8% for dose 2 and 31.7% for dose 3. Notified dose 1 coverage rates by single year of age and state or territory ranged between 22% for females aged 26 years in the Northern Territory and 76% in females aged 18 years in Queensland, with dose 1 coverage highest across the age range in the Northern Territory, Queensland and South Australia. These data suggest that over half of Australian women aged 18-26 years commenced HPV vaccine courses and about one-third are fully vaccinated. Some of the differences in the coverage observed between states and territories likely reflect differing mechanisms for notifying to the Register.