Are countries using global fund support to implement HIV drug resistance surveillance? A review of funded HIV grants

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) is the largest funder of human immunodeficiency virus (HIV) prevention and treatment programs worldwide. Since 2002, the Global Fund has encouraged grant recipients to implement drug resistance surveillance (DRS) as part of treatment programs. We reviewed documentation of 147 grants funded in 2004-2008 (funding rounds 4-8) to assess grantees' use of funds to support HIV DRS. Overall, 94 grants (64%) described HIV DRS as part of the national treatment program. However, only 32 grants (22%) specifically documented DRS as a grant-funded activity. This review provides baseline information suggesting limited use by countries of Global Fund financing to support HIV DRS. Additional assessment is required to evaluate barriers to using Global Fund grants to support DRS.     

Overutilization of post-polypectomy surveillance colonoscopy in clinical practice: a prospective, multicentre study

BackgroundAlthough the adherence to post-polipectomy recommendations is advocated as a quality indicator of colonoscopy programmes, prospective data on actual use of surveillance are lacking.AimTo evaluate the appropriateness of post-polypectomy surveillance colonoscopy on a community-wide basis and to identify factors associated with it.MethodsData on consecutive post-polypectomy surveillance examinations performed over a 4-week period in 29 Italian endoscopy units were collected. The time interval between index and surveillance colonoscopy was calculated and compared to guidelines recommendations. Determinants of surveillance timing appropriateness were assessed by logistic step-wise regression.ResultsOf 7081 consecutive outpatients, 1218 (17.2%) were referred for post-polypectomy surveillance and 902 were included into the analysis. Surveillance colonoscopy was prescribed correctly in 330 subjects (36.6%) and earlier than recommended by guidelines in 490 (54.3%). Low-risk subjects had an anticipated surveillance colonoscopy more frequently than global cohort (67.4% vs. 54.3%, p < 0.001). At multivariate analysis, determinants of correct surveillance timing were high-volume workload centres (OR 1.92; 1.41–2.63 95%CI), centres providing written recommendation on surveillance interval (OR 1.70; 1.18–2.58 95%CI) and surveillance examinations performed within the national screening programme (OR 2.62; 1.92–3.59 95%CI).ConclusionsIn community practice, post-polipectomy surveillance colonoscopy is often performed earlier than recommended, especially in low-risk subjects. Interventions to improve adherence to guidelines and to reduce unnecessary examinations are needed.     

Very late stent thrombosis complicating a previously lost and partially crushed stent: Demonstration by optical coherence tomography

Stent thrombosis (ST) is the most dramatic complication of coronary stenting. Mechanisms of ST are multiple, including procedural and patient-related factors. A considerable burden of metal inside the coronary has been associated with ST as suggested by the higher rate of ST in case of multiple overlapping or complex two stents procedure in bifurcation lesions. However, occasional stent loss and failure to retrieve it may be a substrate of ST, especially if multiple layers of stent struts are incompletely crushed. Here, we describe a case of very late ST on a partially crushed stent previously lost inside the coronary circulation, using optical coherence tomography (OCT) for guidance during the procedure.     

Obstructive Sleep Apnea Is Associated with Fatty Liver and Abnormal Liver Enzymes: a Meta-analysis

Background

Obstructive sleep apnea (OSA) is associated with the cluster of clinical conditions that comprise the metabolic syndrome, including nonalcoholic fatty liver disease (NAFLD). Our primary purpose was to estimate the effect of OSA on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Our secondary purpose was to investigate the potential influence of OSA on histological severity of NAFLD to explore whether chronic intermittent hypoxia is associated with inflammation and fibrosis.

Methods

Our literature search identified 11 studies, from which we extracted information about numbers of control subjects and OSA patients, and ALT, AST, and NAFLD.

Results

From a total of 668 OSA patients and 404 controls, we found that the standardized difference in mean values of ALT and AST levels in patients with OSA was significantly different from that in the controls. Meta-regression showed that the association was independent of body mass index and type 2 diabetes. Fatty liver was associated with OSA in five studies with 400 subjects. OSA was significantly associated with liver fibrosis in 208 subjects, but not with lobular inflammation.

Conclusions

Routine assessment of liver enzymes and liver damage should be implemented in OSA patients because they have an increase of 13.3 % of ALT and 4.4 % of AST levels, and a 2.6-fold higher risk of liver fibrosis when they have NAFLD, which is 2.6 times more frequent in OSA patients.     

Vitamin D Deficiency in Pregnancy after Bariatric Surgery

The objective of this study was to describe the main factors related to the installation and/or aggravation of vitamin D deficiency (VDD) and its clinical consequences in pregnant women after bariatric surgery. An electronic search on VDD in pregnancy and after bariatric surgery was conducted in publications from 1998 until 2012 that presented studies performed in humans. We provided an overview of VDD after bariatric surgery, in pregnancy, and in pregnancy in women who underwent bariatric surgery. In view of the high percentage of VDD postoperatively and the role of this vitamin in pregnancy, we recommend the investigation of vitamin D nutritional status in prenatal care.     

Impact of Different Protocols of Nutritional Supplements on the Status of Vitamin A in Class III Obese Patients after Roux-en-Y Gastric Bypass

Background

This study aims to investigate the nutritional status of vitamin A (VA) using biochemical and functional indicators in subjects with class III obesity, before and after RYGB, supplemented with three protocols.

Methods

The sample comprised 90 patients, with BMI ≥40 kg/m², divided into three groups: G1 that received routine supplementation containing 5,000 IU of retinol daily; G2 that received 10,000 IU of retinol daily; and G3 that received routine supplementation plus complementary of 50,000 IU of retinol intramuscularly every month. The status of VA was evaluated before (T0), 30 days (T1), and 180 days (T2) after surgery.

Results

The vitamin A deficiency (VAD) in G1, G2, and G3 was respectively 20.7, 21.2, and 20.2 % as regards retinol and 37.8, 63.3, and 40 % as regards β-carotene in T0; 26.7, 10, and 23.4 % as regards retinol and 68, 37, and 32 % as regards β-carotene in T1; and 21, 8.7, and 20.2 % as regards retinol and 63.3, 20, and 32 % as regards β-carotene in T2. A reduction of retinol and β-carotene with increasing BMI and waist circumference was observed in T0. The prevalence of night blindness (XN) in groups 1, 2, and 3 was respectively 23.3, 26.7, and 16.7 % in T0; 56.7, 40, and 60 % in T1; and 70, 43, and 63.3 % in T2.

Conclusion

The study showed high prevalence of VAD. Among the supplementation protocols used, the one containing 10,000 IU of retinol showed the best impact. However, in cases of more severe VAD, intramuscular supplementation should be considered. The prevalence of XN, justifies attention to this segment of population.