Prevalence and risk factors of measles seronegativity in a cohort of HIV-positive subjects: a retrospective study

OBJECTIVES

Measles infection is a vaccine-preventable disease currently resurging in Europe. HIV-infected subjects are at higher risk of complications following measles infection. We investigated the risk factors associated with being seronegative in a cohort of HIV-infected subjects.

METHODS

All HIV-infected subjects in our cohort who had a measles serological test performed between December 2005 and May 2017 were retrospectively identified. A measles immunoglobulin G (IgG) titre > 275 mIU/mL was considered protective. Risk factors were analysed using logistic regression.

RESULTS

Measles serology was available in 273 of 3124 subjects in active follow-up (8.7%). The prevalence of measles seronegativity was 21.6% (59 of 273). In the univariate analysis, being born after 1970 and HIV infection by vertical transmission were both associated with a higher risk of measles seronegativity, while a nadir CD4 T-cell count < 200 cells/μL was associated with a lower risk of measles seronegativity. In the multivariate analysis, only being born after 1970 [odds ratio (OR) 4.9; 95% confidence interval (CI) 1.3-18.7] and vertical transmission (OR 7.7; 95% CI 3.3-18.3) were significantly associated with seronegativity. Among the vertically infected subjects with measles-mumps-rubella (MMR) immunization documentation, the median number of doses of vaccine received before testing was 2 (range 1-3).

CONCLUSIONS

HIV-infected subjects born after 1970 and vertically infected subjects should be screened for measles seropositivity.

Semen parameters are unaffected by statin use in men evaluated for infertility

The effects of statin use on conventional semen parameters in humans are largely unknown and have not been previously studied in subfertile men. We retrospectively reviewed data from 10,140 patients seen at our fertility clinic between 2002 and 2013 to assess the effects of statin use on semen parameters. Men who used any statins for >3 months before semen sample collection were included as cases. Data were gathered on patient age, medication use and conventional semen parameters. A total of 118 patients (126 samples) used statins for at least 3 months before semen sample collection. Data from 7698 patients (8,760 samples), who were not using any medications, were used as controls. In age-adjusted regression models, statin use was not associated with statistically significant changes in semen parameters. When used in combination with other nonspermatotoxic medications, it was associated with 0.3 ml decrease in semen volume (95% confidence interval: 0.02 to 0.58 ml, p-value = .04). In conclusion, statin use was not adversely associated with semen parameters other than semen volume in subfertile patients. These findings from our large-scale retrospective study suggest that there are no clinically relevant deleterious effects from statin use on conventional semen parameters.

Abstract P4-12-13: Comparative analysis of costs between subcutaneous formulation of trastuzumab versus intravenous formulation from the perspective of the Instituto Oncológico Nacional of Panamá from January to December 2016

Objective: Because there is actually availability of both Intravenous(IV) and subcutaneous(SC) formulation of Trastuzumab for use in the public sector in the Instituto Oncológico Nacional and knowing that de SC formulation has been compared previously with the IV in term of efficacy in and it was not inferior and also is prefered by patients it is useful to count with a study of costs minimization that can determine what formulation results more convenient to maintain available for use in the Instituto Oncológico Nacional based on the criteria of efficiency of the intervention.(1)(2)

Methodology: This is a cost minimization study considering the cost of the treatment, the supplies and the time utilized by Pharmacy and Nursing to prepare and administer it.

Results: In relation to the cost of the treatment the SC presentation has a cost per patient 17% less than the IV presentation in relation to the cost that offers the Pharmaceutical company, considering a weight of 70 kg per patient ( IV presentation) and a fixed dose of 600 mg(SC presentation). Considering the supplies utilized by Pharmacy and Nursing to prepare and administer the IV and SC presentation, the SC presentation requires less supplies and this facilitates its administration and decreases the cost of the treatement in a 67%. In terms of time invested in preparing and administering the IV and the SC formulation, accounting for both, nursing and pharmacy, it is observed that the SC formulation requires less amount of time than the IV formulation and this decreases the cost of the treatment in a 90%.

Analisis of Saving by Use of SC Trastuzumab vs IV TrastuzumabItemSC TrastuzumabIV Trastuzumab% SavingTreatment10,578,0538,826,89417%Nursing Supplies18,9662,50387%Pharmacy Supplies31,98217,02047%Nursing Time71,7916,33591%Pharmacy Time2,28971669%Total anual cost10703081885346717%

Conclusion: With the use of the SC formulation of Trastuzumab there is combined savings of 17%, that represents anually 5985 USD per patient based on a treatment of 18 cycles of Traztuzumab per year, that results in a total saving of 1,84 million USD per year.

(1) Pivot et al. Lancet Oncol 2013 Sep;14(10):962-70.

(2)Ismael G et al. Lancet Oncol 2012 Sep;13(9):869-78

Citation Format: Martin C, Alcedo J, Araúz E. Comparative analysis of costs between subcutaneous formulation of trastuzumab versus intravenous formulation from the perspective of the Instituto Oncológico Nacional of Panamá from January to December 2016 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-12-13.

Event Oriented Representation for Collaborative Activities (EORCA)

Objectives: In this paper, we introduce a method that aims at describing components of medical activities that are performed by a medical team, including physicians and nurses, during patients’ management in an ICU (intensive care unit). This method is based on formal taskanalyses developed in cognitive ergonomics.

Our ultimate aim is to build a method covering the observation and the representation of collective activities during patients’ management, which should be re-usable by the team members in order to prepare themselvesfor accreditation.

Methods: This method comprises two main steps: – the formal observations of medical staff’s activities that occur during patient management, -a representation of the findings with regard to an ontology and a temporal flowchart, which describes actors and events related to patient management.

Results: This paper describes field studies performed in ICUs. This method has been used for analyzing the management of 24 cases of neurological and multiple traumas. We have represented the different actions of the medical team members (clinicians, nurses and outside medical consultants).

Conclusion: The results allow us to identify the specific features of these complexand time-constrained situations, especially about the strong collaborative activities between members of the patient-care teams, especially the interaction between information management and medical actions.

Alteration of vitrified intermediate level nuclear waste in alkaline media: effects of cementitious materials, pH and temperature

Alteration experiments involving intermediate level nuclear waste (ILW) glass in contact with hardened cement paste (HCP) were performed to assess its behavior under simulated repository conditions. Batch experiments were conducted at 20 °C and 50 °C in several artificial cement pore water (ACW) samples (pH from 10 to 13), in the presence of HCP (CEM-I, CEM-V and low pH), with a ratio of glass surface to volume of solution of 8000 m⁻¹ and a ratio of mass of HCP to volume of solution of 10 g L⁻¹. Glass alteration rates increase up to ∼4 × 10⁻² g m⁻² d⁻¹ with pH in contact with HCP, notably with CEM-I. This value decreases by 2 orders of magnitude in low pH cement solution and also for residual alteration rates. The effect of calcium on glass alteration was observed, mainly in Ca(OH)₂ saturated solution, with an incubation effect on the release of Si in solution. Experimental data were successfully modeled with the PhreeqC geochemical code. Glass and HCP samples were characterized via SEM/EDX and micro-Raman studies. This work showed that vitrified glass exhibits good performance in terms of low alteration rates (∼10⁻⁴ g m⁻² d⁻¹), the absence of secondary phases, and the formation of a gel layer at the surface, when in contact with low pH conditions (in the presence or absence of low pH HCP).

Alteration experiments involving intermediate level nuclear waste (ILW) glass in contact with hardened cement paste (HCP) were performed to assess its behavior under simulated repository conditions.

Phytosterols Synergize With Endotoxin to Augment Inflammation in Kupffer Cells but Alone Have Limited Direct Effect on Hepatocytes

INTRODUCTION

Phytosterols are implicated in the development of parenteral nutrition-associated liver disease. A newly proposed mechanism for phytosterol-mediated parenteral nutrition-associated liver disease is through phytosterol-facilitated hepatic proinflammatory cytokine release following exposure to intestinally derived bacteria. Whether the proinflammatory effects are liver cell specific is not known.

AIM

To determine if phytosterols cause inflammation in hepatocytes or Kupffer cells independently or require costimulation by lipopolysaccharide (LPS).

METHODS

In an in vivo study, neonatal piglets on parenteral nutrition for 11 days received an 8-hour infusion of LPS. In the in vitro studies, neonatal piglet Kupffer cells and hepatocytes were treated with media, media + 1% soy oil, or media + 1% soy oil + 100µM phytosterols. After 24-hour incubation, cells were treated with farnesoid X receptor (FXR) agonist obeticholic acid or liver X receptor (LXR) agonist GW3965 and challenged with LPS or interleukin 1β.

RESULTS

LPS administration in piglets led to transient increases in proinflammatory cytokines and suppression of the transporters bile salt export pump and ATP-binding cassette transporter G5. In hepatocytes, phytosterols did not activate inflammation. Phytosterol treatment alone did not activate inflammation in Kupffer cells but, combined with LPS, synergistically increased interleukin 1β production. FXR and LXR agonists increased transporter expression in hepatocytes. GW3965 suppressed proinflammatory cytokine production in Kupffer cells, but obeticholic acid did not.

CONCLUSIONS

LPS suppresses transporters that control bile acid and phytosterol clearance. Phytosterols alone do not cause inflammatory response. However, with costimulation by LPS, phytosterols synergistically maximize the inflammatory response in Kupffer cells.

[Trauma surgery in Pacific Small Island Developing States (SIDS)]

BACKGROUND

The small developing countries in the Pacific are grouped together as Small Island Development States (SIDS) because they face similar problems which they cannot cope with nationally. They are developing countries, so-called low and lower middle income countries (LMIC), are economically weak and the islands of the different nations are widely scattered. Approximately 80% of the 10 million inhabitants live in rural regions.

EPIDEMIOLOGY AND SURGICAL CAPACITY

Over 40% of patients in the surgical departments of hospitals are hospitalized for injuries, and this tendency is increasing. Fractures of the upper extremities are relatively more frequent in the Pacific than in the countries of the North. Long distances, lack of possibilities for treatment and lack of transport often cause complications, such as infected open fractures, pseudarthrosis and posttraumatic malformations. There are too few hospitals with sufficiently competent surgeons, anesthetists and obstetricians (SAO) and appropriate equipment.

PACIFIC ISLANDS ORTHOPEDIC ASSOCIATION (PIOA)

The PIOA was founded in Honiara, Solomon Islands, and offers surgeons of the Pacific SIDS a comprehensive, structured trauma and orthopedic surgery training in their own countries. It lasts 4 years and leads to an M‑Med (orthopaedic surgery) diploma and to a Fellowship of the International College of Surgeons (FICS), which are both recognized by the participating hospitals. It is free for participants.

THE AO ALLIANCE FOUNDATION (AOAF)

The AOAF is an independent organization with the only aim to enhance trauma surgery capacity in LMICs. The AOAF supports the PIOA program together with the Wyss Medical Foundation. Currently, 18 trainees from 8 Pacific SIDS are participating in the PIOA training program.

Health-related quality of life as measured by the EQ-5D in the prevention, screening and management of cervical disease: A systematic review

PURPOSE

Cost-effectiveness analyses (CEAs) of screening can be highly sensitive to the health-related quality of life (HRQoL) effects of screen tests and subsequent treatment. Accordingly, accurate assessment of HRQoL is essential. We reviewed the literature regarding HRQoL in cervical prevention and management in order to appraise the current evidence regarding this important input to CEA.

METHODS

We searched the MEDLINE, Scopus and EconLit databases for studies that estimated HRQoL in cervical cancer prevention and management published January 1995-December 2015. The primary inclusion criterion was for studies that assess HRQoL using the EQ-5D. Data were abstracted from eligible studies on setting, elicitation group, sample size, elicitation instruments, health state valuations, study design and follow-up. We assessed the quality and comparability of the studies with a particular focus on the HRQoL reported across states and groups.

RESULTS

Fifteen papers met the inclusion criteria. Most used patient elicitation groups (n = 11), 2 used the general public and 2 used a mix of both. Eight studies were cross-sectional and seven were longitudinal. Six studies used both the EQ-5D-3L and the EQ-VAS together with other measures of overall HRQoL or condition-specific instruments. Extensive heterogeneity was observed across study characteristics.

CONCLUSIONS

Our results reveal the challenges of sourcing reliable estimates of HRQoL for use in CEAs of cervical cancer prevention and treatment. The EQ-5D appears insufficiently sensitive for some health states. A more general problem is the paucity of HRQoL estimates for many health states and their change over time.

A search for new phenomena in pp collisions at [Formula: see text] in final states with missing transverse momentum and at least one jet using the [Formula: see text] variable

A search for new phenomena is performed in final states containing one or more jets and an imbalance in transverse momentum in pp collisions at a centre-of-mass energy of 13[Formula: see text]. The analysed data sample, recorded with the CMS detector at the CERN LHC, corresponds to an integrated luminosity of 2.3[Formula: see text]. Several kinematic variables are employed to suppress the dominant background, multijet production, as well as to discriminate between other standard model and new physics processes. The search provides sensitivity to a broad range of new-physics models that yield a stable weakly interacting massive particle. The number of observed candidate events is found to agree with the expected contributions from standard model processes, and the result is interpreted in the mass parameter space of fourteen simplified supersymmetric models that assume the pair production of gluinos or squarks and a range of decay modes. For models that assume gluino pair production, masses up to 1575 and 975[Formula: see text] are excluded for gluinos and neutralinos, respectively. For models involving the pair production of top squarks and compressed mass spectra, top squark masses up to 400[Formula: see text] are excluded.

Tubotympanic system functioning

The Eustachian (auditory) tube and tympanomastoid cavities form an anatomic and functional whole that cannot easily be divided, and is therefore known as the "tubotympanic system". The system has been the focus of several studies, with complex and sometimes contradictory results, making an overview of its functioning difficult to obtain. The objective of the present article is to review the current state of knowledge, as an indispensable preliminary to understanding tubotympanic system dysfunction, and notably the development of chronic otitis. The system as a whole is covered by mucosa, which provides continuity, although with certain particularities from one area to another, and plays a primordial role. Thus, under physiological conditions, gas diffusion across the tympanomastoid mucosa largely ensures the equilibrium of pressure between the middle ear and outside environment, the tube orifice being very little involved. Under large rapid change in atmospheric pressure, the aeration function of the Eustachian tube comes into play, governed by a reflex mechanism. The system also has other functions that are essential to good middle-ear functioning: protection against nasopharyngeal secretions and pathogens and against certain physiological noises; middle-ear cavity clearance by mucociliary transport of pathogens, partly related to submucosal gland secretion; and immune defense.

Relative Modification of Prompt ψ(2S) and J/ψ Yields from pp to PbPb Collisions at sqrt[s_{NN}]=5.02 TeV

The relative modification of the prompt ψ(2S) and J/ψ yields from pp to PbPb collisions, at the center-of-mass energy of 5.02 TeV per nucleon pair, is presented. The analysis is based on pp and PbPb data samples collected by the CMS experiment at the LHC in 2015, corresponding to integrated luminosities of 28.0  pb^{-1} and 464  μb^{-1}, respectively. The double ratio of measured yields of prompt charmonia reconstructed through their decays into muon pairs, (N_{ψ(2S)}/N_{J/ψ})_{PbPb}/(N_{ψ(2S)}/N_{J/ψ})_{pp}, is determined as a function of PbPb collision centrality and charmonium transverse momentum p_{T}, in two kinematic intervals: |y|<1.6 covering 6.5<p_{T}<30  GeV/c and 1.6<|y|<2.4 covering 3<p_{T}<30  GeV/c. The centrality-integrated double ratios are 0.36±0.08(stat)±0.05(syst) in the first interval and 0.24±0.22(stat)±0.09(syst) in the second. The double ratio is lower than unity in all the measured bins, suggesting that the ψ(2S) yield is more suppressed than the J/ψ yield in the explored phase space.