Prolonged survival of end-stage AIDS patients immunized with therapeutic HIV vaccine V-1 Immunitor.

Death, rather than surrogate markers, is a single and most straightforward clinical endpoint, defining unequivocally the merit of a therapeutic intervention. As there is still neither a cure for AIDS nor a vaccine to prevent HIV infection, an AIDS diagnosis remains associated with a death sentence. V-1 Immunitor (V1) is an experimental, oral, therapeutic AIDS vaccine licensed as a dietary supplement. As part of a charity program V1 has been offered at Wat Phra Baht Nam Phu--a Buddhist hospice for end-stage AIDS patients. Out of 117 approached individuals, 53 decided to take V1 and 64 declined the treatment. Patients in both groups did not differ in age, gender, or severity of disease. All patients were in WHO terminal stage 4 at study entry and had received similar palliative care. None of the patients had received conventional antiviral drugs. At 9 weeks the last two patients in the non-V1 group died. In contrast, 56.6% (30/53) in the V1 group remained alive. Kaplan-Meier survival analysis showed that median short-term survival time for non-treated and treated patients was 4 and 10 weeks, respectively. The difference was statistically significant by Wilcoxon signed rank test (P=0.000089). Patients who remained alive were followed until the last patient died at 142 weeks. Based on the main outcome, i.e. time to death, patients on V1 had a 15.8 times longer life expectancy than the control group (P<0.000001). Observed results are encouraging and V1 needs to be tested in controlled clinical trials as a life-saving immunotherapy.     

Development of indicators to assess the quality of nursing care in Thailand

In Thailand, quality of nursing care has been defined. The next step is to determine how to measure quality. Given the limited resources to provide health care and the demands to justify the use of registered nurses, there is an urgent need to demonstrate how professional nursing care makes a difference to outcomes of care. The purpose of this study was to further refine nursing indicators of quality by developing operational definitions, validating them and then determining their applicability in a variety of clinical settings. The process included three phases. The first phase used focus groups to identify and define indicators of quality nursing care and the second phase included testing these indicators in four settings to determine if data could be collected. Manuals were developed that defined the quality indicators and the scoring system to be used in the assessment. In the third phase, the findings were presented to a group of experts and minor changes were made to the indicators. Then, the indicators were categorized into three groups: structure, process, and outcome. The validated outcomes and manual for their assessment and monitoring were sent to all hospitals in Thailand. The study relied upon the findings from the four different hospitals. If the indicators were implemented in a wider variety of settings, other differences might have emerged. There is also a possibility that 'best practice' might not be reflective of the scientific basis of nursing practice. The findings generally support the initial work carried out in the USA. There is a need to continue to study how these indicators can improve patient outcomes.     

Anti‐HIV‐1 Integrase Activity and Molecular Docking Study of Compounds from Caesalpinia sappan L.

Caesalpinia sappan L. (Caesalpiniaceae) has been traditionally used as blood tonic, expectorant, and astringent by boiling with water. Searching for HIV‐1 integrase (IN) inhibitors from this plant is a promising approach. The EtOH extract of C. sappan and its isolated compounds were tested for their anti‐HIV‐1 IN effect using the multiplate integration assay, and the active compounds were determined for their mechanisms by molecular docking technique. Extraction from the heartwoods and roots of C. sappan led to the isolation of nine compounds. Among the compounds tested, sappanchalcone (2) displayed the strongest effect against HIV‐1 IN with an IC₅₀ value of 2.3 μM followed by protosappanin A (9, IC₅₀ = 12.6 μM). Structure‐activity relationships of compounds from C. sappan were found, in which the vicinal hydroxyl moiety were essential for anti‐HIV‐1 IN effect of compounds 2 and 9 by binding with the amino acid residues Gln148 and Thr66 in the core domain of the HIV‐ 1 IN enzyme, respectively. Copyright © 2015 John Wiley & Sons, Ltd.     

Anti‐allergic activity of principles from the roots and heartwood of caesalpinia sappan on antigen‐induced β‐hexosaminidase release

The dichloromethane extract of the roots and heartwood of Caesalpinia sappan exhibited potent inhibitory activity against β‐hexosaminidase release as marker of degranulation in rat basophilic leukemic (RBL‐2H3) cells, with inhibition of 98.7% and 87.5% at concentration of 100 µg/ml, respectively. These extracts were further separated by chromatographic techniques to give two chalcones and seven homoisoflavones. Among the compounds tested, sappanchalcone (2) possessed the most potent effect against allergic reaction in RBL‐2H3 cells with an inhibitory concentration (IC₅₀) value of 7.6 µM, followed by 3‐deoxysappanchalcone (1, IC₅₀ = 15.3 µM), whereas other compounds showed moderate and mild effects. The results suggested the following structural requirements of chalcones (1 and 2) and homoisoflavones (3‐9) for anti‐allergic activity: (i) chalcone exhibited higher activity than homoisoflavone (ii) vicinal hydroxylation at B‐ring of chalcone conferred higher activity than one hydroxylation; and (iii) for homoisoflavone, the hydroxyl groups at C‐3 and C‐4 positions decreased the activity. This is the first report of C. sappan for anti‐allergic activity. Copyright © 2009 John Wiley & Sons, Ltd.     

Doppler velocimetry of fetal pericardial fluid

Objective

To investigate the flow of normal fetal pericardial fluid (PF) with increasing gestational age using Doppler velocimetry.

Method

Ninety-five fetuses between 18 and 37 weeks of gestation with PF within the normal range were studied. PF was measured in 4-chamber view using M-mode or real-time ultrasound. Color Doppler was used to display and guide the pulse wave assessment of PF flow. PF waveforms as well as systolic and diastolic velocities were recorded and correlated with gestational age.

Results

PF was detected in all of the fetuses. The mean thickness of the PF rim was 0.95 ± 0.45 mm. PF flowed toward the cardiac apex during systole and toward the atrium during diastole. PF waveforms showed bidirectional flow in all fetuses. The flow velocity PF was positively correlated with gestational age in both systole and diastole.

Conclusion

Flow velocity of fetal PF increases linearly in both systole and diastole with gestational age. This might indirectly indicate a maturational change in myocardial performance as myocardial velocity is increased.