Reproductive decision-making among HIV-Infected women

OBJECTIVE: To describe factors related to reproductive decision-making among HIV-infected women. MATERIALS AND METHODS: A sample of HIV-infected women (N=104) who received care at an HIV clinic in the southern United States were interviewed about their reproductive decision-making. Women who became pregnant subsequent to HIV diagnosis were compared to women who did not become pregnant, and women who underwent a sterilization procedure subsequent to HIV diagnosis were compared to women who did not get sterilized. RESULTS: Compared to women who did not get pregnant after receiving an HIV diagnosis, women who became pregnant were more likely to be young, single, diagnosed earlier in the epidemic and to have more recently used a noninjecting drug. Among women who did not get pregnant, 63% reported their diagnosis greatly affected that decision. Having a partner who wants more children was not associated with pregnancy. Compared to women who did not get sterilized after learning their HIV status, women who did get sterilized tended to be Baptist and already had a prior live birth. Neither a woman's desire nor her partner's desire for more children was associated with sterilization. CONCLUSIONS: HIV is an important influence on HIV-infected women's reproductive choices, regardless of the decision being made. Reproductive counseling by HIV care providers needs to be sensitive to all the issues faced by these women.     

Coronary MR angiography: comparison of quantitative and qualitative data from four techniques

OBJECTIVE: The optimal coronary MR angiography sequence has yet to be determined. We sought to quantitatively and qualitatively compare four coronary MR angiography sequences. SUBJECTS AND METHODS. Free-breathing coronary MR angiography was performed in 12 patients using four imaging sequences (turbo field-echo, fast spin-echo, balanced fast field-echo, and spiral turbo field-echo). Quantitative comparisons, including signal-to-noise ratio, contrast-to-noise ratio, vessel diameter, and vessel sharpness, were performed using a semiautomated analysis tool. Accuracy for detection of hemodynamically significant disease (> 50%) was assessed in comparison with radiographic coronary angiography. RESULTS: Signal-to-noise and contrast-to-noise ratios were markedly increased using the spiral (25.7 +/- 5.7 and 15.2 +/- 3.9) and balanced fast field-echo (23.5 +/- 11.7 and 14.4 +/- 8.1) sequences compared with the turbo field-echo (12.5 +/- 2.7 and 8.3 +/- 2.6) sequence (p < 0.05). Vessel diameter was smaller with the spiral sequence (2.6 +/- 0.5 mm) than with the other techniques (turbo field-echo, 3.0 +/- 0.5 mm, p = 0.6; balanced fast field-echo, 3.1 +/- 0.5 mm, p < 0.01; fast spin-echo, 3.1 +/- 0.5 mm, p < 0.01). Vessel sharpness was highest with the balanced fast field-echo sequence (61.6% +/- 8.5% compared with turbo field-echo, 44.0% +/- 6.6%; spiral, 44.7% +/- 6.5%; fast spin-echo, 18.4% +/- 6.7%; p < 0.001). The overall accuracies of the sequences were similar (range, 74% for turbo field-echo, 79% for spiral). Scanning time for the fast spin-echo sequences was longest (10.5 +/- 0.6 min), and for the spiral acquisitions was shortest (5.2 +/- 0.3 min). CONCLUSION: Advantages in signal-to-noise and contrast-to-noise ratios, vessel sharpness, and the qualitative results appear to favor spiral and balanced fast field-echo coronary MR angiography sequences, although subjective accuracy for the detection of coronary artery disease was similar to that of other sequences.     

Estimating HIV incidence and detection rates from surveillance data

BACKGROUND: Markov models that incorporate HIV test information can increase precision in estimates of new infections and permit the estimation of detection rates. The purpose of this study was to assess the functioning of a Markov model for estimating new HIV infections and HIV detection rates in Louisiana using surveillance data. METHODS: We expanded a discrete-time Markov model by accounting for the change in AIDS case definition made by the Centers for Disease Control and Prevention in 1993. The model was applied to quarterly HIV/AIDS surveillance data reported in Louisiana from 1981 to 1996 for various exposure and demographic subgroups. When modeling subgroups defined by exposure categories, we adjusted for the high proportion of missing exposure information among recent cases. We ascertained sensitivity to changes in various model assumptions. RESULTS: The model was able to produce results consistent with other sources of information in the state. Estimates of new infections indicated a transition of the HIV epidemic in Louisiana from (1) predominantly white men and men who have sex with men to (2) women, blacks, and high-risk heterosexuals. The model estimated that 61% of all HIV/AIDS cases were detected and reported by 1996, yet half of all HIV/non-AIDS cases were yet to be detected. Sensitivity analyses demonstrated that the model was robust to several uncertainties. CONCLUSIONS: In general, the methodology provided a useful and flexible alternative for estimating infection and detection trends using data from a U.S. surveillance program. Its use for estimating current infection will need further exploration to address assumptions related to newer treatments.     

Physiotherapeutische Interventionen bei Osteoporose

Osteoporosis is an increasing public health problem which ultimately causes fractures and a significant reduction in patient's health-related quality of life. In this context, physiotherapists are involved in a wide range of therapies related both to prevention and treatment of osteoporosis. The reduction of the risk of falling by elderly patients with osteoporosis is a very important goal for physiotherapists because it is known to significantly decrease fracture incidence. Indeed, exercise programs including elements of muscle strengthening and better body balance control have a positive effect on the risk of falling, hence reducing the incidence of fractures and increasing the health-related quality of life of osteoporotic patients. As a further consequence, the decreased fracture incidence has a key roll in reducing health care costs. Once a patient presents with an osteoporotic fracture, he may be assisted with various forms of passive, active-assisted and active therapies. This treatment will help reduce pain, increase patient's mobility and prevent the occurrence of additional fractures. In addition, a good and well-balanced education process regarding secondary osteoporosis prevention may also help to modify the behavior of patients and help to improve skeletal health in the longer term. The physiotherapist has definitively a major role to play in the interdisciplinary team aimed at preventing osteoporotic fractures in both primary and secondary prevention levels.     

Effect of excisional therapy and highly active antiretroviral therapy on cervical intraepithelial neoplasia in women infected with human immunodeficiency virus

OBJECTIVE: Our purpose was to determine the rates of recurrence, persistence, and progression of cervical intraepithelial neoplasia in women who were seropositive for human immunodeficiency virus after excisional therapy with and without highly active antiretroviral therapy.Study Design: The records of 118 women with cervical intraepithelial neoplasia, 56 of whom were infected with human immunodeficiency virus and 62 of whom were not infected, were examined to compare outcomes. Demographic, behavioral, and clinical indices were analyzed. RESULTS: Of 54 women infected with human immunodeficiency virus, 31 (57.4%) had persistent or recurrent cervical intraepithelial neoplasia, in comparison with 10 (16.7%) of 60 noninfected women (P <.01). Progression occurred in 4 (16.7%) of 54 in the infected group and in 3 (5.0%) of 60 in the noninfected group (P <.05). In 21 (60.0%) of 35 infected women, in comparison with 8 (32%) of 25 noninfected women, disease persisted 6 months after diagnosis if treatment was not given (P <.05). Of 19 infected women, 10 (52.6%) had recurrent disease after treatment, compared with 2 (5.7%) of 35 noninfected women (P <.01). Risk factors for recurrence in women who were seropositive for human immunodeficiency virus included margin involvement of specimens obtained by loop electrosurgical excision (87.5% vs 20.0%l; P <.05). Exposure to highly active antiretroviral therapy, including therapy with protease inhibitors, was associated with a lower recurrence or persistence rate (17.6% vs. 70.3%; P <.05) and a lower progression rate (0% vs. 24%; P <.05). CONCLUSION: Women infected with human immunodeficiency virus had high rates of recurrent and persistent cervical intraepithelial neoplasia despite standard therapy. Low CD4(+) levels and margin involvement of specimens obtained by loop electrosurgical excision are risk factors for recurrence. The use of highly active antiretroviral therapy is associated with a lower risk of recurrence, persistence, and progression of cervical intraepithelial neoplasia.     

Comparison of aortic elasticity determined by cardiovascular magnetic resonance imaging in obese versus lean adults

The vascular properties of large vessels in the obese have not been adequately studied. We used cardiovascular magnetic resonance imaging to quantify the cross-sectional area and elastic properties of the ascending thoracic and abdominal aorta in 21 clinically healthy obese young adult men and 25 men who were age-matched lean controls. Obese subjects had greater maximal cross-sectional area of the ascending thoracic aorta (984 +/- 252 vs 786 +/- 109 mm(2), p <0.01) and of the abdominal aorta (415 +/- 71 vs 374 +/- 51 mm(2), p <0.05). When indexed for height the differences persisted, but when indexed for body surface area, a significant difference between groups was found only for the maximal abdominal aortic cross-sectional area. The obese subjects also had decreased abdominal aortic elasticity, characterized by 24% lower compliance (0.0017 +/- 0.0004 vs 0.0021 +/- 0.0005 mm(2)/kPa/mm, p <0.01), 22% higher stiffness index beta (6.0 +/- 1.5 vs 4.9 +/- 0.7, p <0.005), and 41% greater pressure-strain elastic modulus (72 +/- 25 vs 51 +/- 9, p <0.005). At the ascending thoracic aorta, only the pressure-strain elastic modulus was different between obese and lean subjects (85 +/- 42 vs 65 +/- 26 kPa, respectively; p <0.05), corresponding to a 31% difference-but arterial compliance and stiffness index were not significantly different between groups. In clinically healthy young adult obese men, obesity is associated with increased cross-sectional aortic area and decreased aortic elasticity.     

Comparison of three assays for cytomegalovirus detection in AIDS patients at risk for retinitis

The purpose of this study was to determine the sensitivity and specificity of three different methods of cytomegalovirus (CMV) detection for AIDS patients at risk for CMV retinitis. Patients with CD4(+) counts of <100/microl and negative baseline screening eye examinations were tested for CMV infection by (i) pp65 antigenemia expression in leukocytes, (ii) the Digene Hybrid Capture CMV DNA System, and (iii) the Roche Amplicor Qualitative PCR Test. The incidence of CMV retinitis in our study of 296 patients at the Medical Center of Louisiana-New Orleans HIV Outpatient Clinic was 7. 2 per 100 person-years (a total of 20 episodes in 18 patients from April 1997 to February 1999). Receiver operating characteristic curves were calculated for each assay to determine optimal cutoff points which maximized the sensitivity and specificity of each assay. The sensitivities of the assays compared to the eye examinations were 80% for the pp65 antigenemia assay (cutoff, >0 cell per 1.5 x 10(5) leukocytes), 85% for the Digene assay (cutoff, 1,400 genome copies/ml of whole blood), and 60% for the Amplicor assay. The specificities of the assays were 84, 84, and 87%, respectively. The Digene assay with a cutoff of >/=1,400 genome copies/ml gave optimal sensitivity and specificity and was found to have predictive values equal to those of the more technically cumbersome antigenemia assay.     

Elevation of serum riboflavin carrier protein in breast cancer.

Presently available tumor markers have had a limited clinical impact. Riboflavin carrier protein (RCP) is an estrogen inducible protein that occupies a key position in riboflavin metabolism. Because other vitamin carrier proteins (VCP) have been shown to be overexpressed in patients with malignant disease, we evaluated serum RCP levels in patients with adenocarcinoma of the breast. In this prospective blinded study, patients with breast cancer, benign breast disease, and healthy controls were analyzed for RCP levels. Using a highly sensitive RIA, we observed that serum RCP levels were significantly elevated in women with breast cancer (n = 52) as compared with control subjects [n = 50; 6.06 +/- 7.27 ng/ml versus 0.70 +/- 0.19 ng/ml (mean +/- SD), respectively; P < 0.0001]. A serum RCP level of > or = 1.0 ng/ml was highly predictive of the presence of breast cancer, detecting 88% of tumors in stages I-II and 100% of tumors in stages III-IV. Overall, this RCP assay has a sensitivity of 92.3%, a specificity of 88%, a positive predictive value of 88.9%, and a negative predictive value of 91.7%. These results show increased serum levels of RCP in breast adenocarcinoma patients and suggest that RCP levels may be useful as a new marker for breast cancer. The positive predictive value in early-stage breast cancer suggests that the RCP assay may be a useful adjunct to present screening technology.