bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using standard and institutional mentorship models to implement SLMTA in Kenya
Authors: Makokha Ernest P. , Mwalili Samuel , Basiye Frank L. , Zeh Clement , Emonyi Wilfred I. , Langat Raphael , Luman Elizabeth T. , Mwangi Jane 
Published: November 2014

Background: Kenya is home to several high-performing internationally-accredited research laboratories, whilst most public sector laboratories have historically lacked functioning quality management systems. In 2010, Kenya enrolled an initial eight regional and four national laboratories into the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme. To address the challenge of a lack of mentors for the regional laboratories, three were paired, or ‘twinned’, with nearby accredited research laboratories to provide institutional mentorship, whilst the other five received standard mentorship.Objectives: This study examines results from the eight regional laboratories in the initial SLMTA group, with a focus on mentorship models.Methods: Three SLMTA workshops were interspersed with three-month periods of improvement project implementation and mentorship. Progress was evaluated at baseline, mid-term, and exit using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) audit checklist and scores were converted into a zero- to five-star scale.Results: At baseline, the mean score for the eight laboratories was 32%; all laboratories were below the one-star level. At mid-term, all laboratories had measured improvements. However, the three twinned laboratories had increased an average of 32 percentage points and reached one to three stars; whilst the five non-twinned laboratories increased an average of 10 percentage points and remained at zero stars. At exit, twinned laboratories had increased an average 12 additional percentage points (44 total), reaching two to four stars; non-twinned laboratories increased an average of 28 additional percentage points (38 total), reaching one to three stars.Conclusion: The partnership used by the twinning model holds promise for future collaborations between ministries of health and state-of-the-art research laboratories in their regions for laboratory quality improvement. Where they exist, such laboratories may be valuable resources to be used judiciously so as to accelerate sustainable quality improvement initiated through SLMTA.
Imaging in pancreatic transplants
Authors: Heller Matthew T , Bhargava Puneet 
Published: November 2014

AbstractPancreatic transplantation, performed alone or in conjunction with kidney transplantation, is an effective treatment for advanced type I diabetes mellitus and select patients with type II diabetes mellitus. Following advancements in surgical technique, postoperative management, and immunosuppression, pancreatic transplantation has significantly improved the length and quality of life for patients suffering from pancreatic dysfunction. While computed tomography (CT) and magnetic resonance imaging (MRI) have more limited utility, ultrasound is the preferred initial imaging modality to evaluate the transplanted pancreas; gray-scale assesses the parenchyma and fluid collections, while Doppler interrogation assesses vascular flow and viability. Ultrasound is also useful to guide percutaneous interventions for the transplanted pancreas. With knowledge of the surgical anatomy and common complications, the abdominal radiologist plays a central role in the perioperative and postoperative evaluation of the transplanted pancreas.
Nonmydriatic Fundus Camera for Diabetic Retinopathy Screening in a Safety Net Hospital: Effectiveness, Prevalence, and Risk Factors
Authors: Schwartz Shulamit , Harasawa Mariana , Baldivieso Valeria , Sabel Allison L. , Mandava Naresh , Quiroz-Mercado Hugo 
Published: November 2014

Purpose To evaluate diabetic retinopathy (DR) prevalence and risk factors, and the effectiveness of nonmydriatic fundus camera as a screening tool for the detection of DR, in a safety net hospital. Methods This was a retrospective, population-based, cross-sectional study. Diabetic patients, referred by their primary care physicians to a DR community screening program, were included. A Topcon TRC NW-6S camera was used to obtain 45-degree digital color fundus images. Images were interpreted by retina specialists using a quality rating system. Patients with retinal findings or unreadable photographs were referred for a complete examination. Outcome measures were attendance rates, photograph quality, DR prevalence, and associated risk factors. Results A total of 948 diabetic patients were sent for camera screening, with an attendance rate of 65.6%, which increased during the study period. The mean age was 55.8 ± 11.6 years, the majority (56.9%) were Hispanic, and 43.5% were uninsured. Overall photograph quality rating was relatively high, with 81.7% graded as good or fair. Thirty photographs (2.9%) were unreadable. The prevalence of newly diagnosed DR was 11.1%. Independent DR-associated risk factors included Hispanic race (odds ratio [OR] = 2.29), lack of health insurance (OR = 2.49), longer duration of diabetes (OR = 1.07), higher HbA1c levels (OR = 1.19), presence of diabetic complications (OR = 2.93), and lack of previous eye examination (OR = 13.22). Conclusions Nonmydriatic fundus camera is an effective and feasible screening tool for the early detection of DR in a safety net institution. It should be considered in areas with limited access to health care to improve quality of care and potentially reduce vision loss rates.
Posterior Polymorphous Corneal Dystrophy Concomitant to Large Colloid Drusen
Authors: Del Turco Claudia , Pierro Luisa , Querques Giuseppe , Gagliardi Marco , Corvi Federico , Manitto Maria Pia , Bandello Francesco M. 
Published: November 2014

Purpose To describe the previously unreported concomitance of 2 uncommon ocular conditions: posterior polymorphous corneal dystrophy (PPCD) and large colloid drusen (LCD). Methods A 45-year-old woman underwent a complete ophthalmologic examination with slit-lamp biomicroscopy and blue fundus autofluorescence with spectral-domain optical coherence tomography, as well as complete systemic examination and renal function investigation. Results On slit-lamp biomicroscopy, a corneal lesion located at Descemet membrane was observed in the right eye. The clinical features of deep posterior stromal-endothelial linear bands with vesicles and irregular opacities of posterior corneal surface were consistent with the diagnosis of PPCD. Fundus biomicroscopy and blue fundus autofluorescence showed LCD. Discussions We report the unusual coexistence of PPCD and LCD in a young, healthy subject. Posterior polymorphous corneal dystrophy and LCD share morphologic similarities and dysfunctions of collagen architecture in the basement membrane layer, which suggests a possible common pathogenic pathway.
Posteriorly Enclavated Iris Claw Intraocular Lens for Aphakia: Long-Term Corneal Endothelial Safety Study
Authors: Anbari Anas , Lake Damian B. 
Published: November 2014

Purpose To report 2 years follow-up experience, corneal endothelial cell loss results, and A constant used in retroiridis-fixated iris-claw aphakic intraocular lens (IOL) secondary implantation to correct aphakia in eyes without adequate capsule support. Methods In this prospective, interventional, clinical case series, 16 consecutive eyes of 14 patients (13 adults and 1 child) underwent retroiridis implantation of Artisan iris-claw aphakic IOL (Ophtec BV, Groningen, the Netherlands). Outcome measures included spherical equivalent (SE) of refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) expressed as the logarithm of the minimum angle of resolution (logMAR), endothelial cell density (ECD), and complications, including raised intraocular pressure (IOP) and pigment dispersion. Results All eyes were followed up for 2 years postoperatively. Postoperative SE of refractive error was between −1.25 and +1.63 D in all eyes at last follow-up. The mean CDVA was 0.27 ± 0.30 logMAR preoperatively and 0.13 ± 0.21 logMAR at 2 years postoperatively (p = 0.0188). Postoperative UDVA mean was 0.31 ± 0.26 logMAR at last follow-up. Preoperative manual ECD mean of 2269 ± 611 cells/mm2 decreased postoperatively to 2002 ± 532 cells/mm2 at 2 years (p = 0.0005) (mean endothelial cell loss of 11.9 ± 2.0%). No intraoperative complications occurred. There was no significant postoperative IOP increase throughout the follow-up. Iris pigment precipitates on the IOLs occurred in 1 eye (6.3%). No other serious complications occurred. Conclusions Two-year results show that retroiridis-fixated iris-claw aphakic IOL implantation is an effective and safe method with regards to corneal endothelial cell loss, and a new A constant is suggested.
Direct Complications of the Avalon Bicaval Dual-Lumen Cannula in Respiratory Extracorporeal Membrane Oxygenation (ECMO): Single-Center Experience
Authors: Rubino Antonio , Vuylsteke Alain , Jenkins David P. , Fowles Jo-anne , Hockings Lisen , Valchanov Kamen 
Published: October 2014

Purpose Cannulation for veno-venous extracorporeal membrane oxygenation (VVECMO) may involve a single site when using a dual-lumen cannula. Benefits include a decrease in blood recirculation, easier patient mobilization, and lower risk of dislodgment. We aimed to review all complications related to the cannula. Methods The study included all adult patients admitted to a single intensive care unit (ICU), between November 2009 and September 2013, requiring VVECMO in whom an Avalon Cannula was inserted. The list of patients, complications, and patient data were retrieved from the local ECMO database and the intensive care Clinical Information System (CIS). Results Seventy two patients were cannulated with an Avalon cannula between November 1, 2009 and September 31, 2013. Forty-four patients had no cannula-related complications. A total of 35 complications were recorded in 28 patients, 6 of whom required further intervention. Conclusions Successful cannulation was possible in all patients with the majority of complications graded as minor.
Influence of Different Oxygenator Types on Changing Frequency, Infection Incidence, and Mortality in Ards Patients on Veno-Venous Ecmo
Authors: Robak Oliver , Lakatos Philipp K.S. , Bojic Andja , Hermann Alexander , Laczika Klaus-Felix , Chiari Astrid , Hiesmayr Jörg M. , Staudinger Thomas , Locker Gottfried J. 
Published: November 2014

Purpose Veno-venous extracorporeal membrane oxygenation (vv-ECMO) is pivotal in the treatment of patients suffering from acute respiratory distress syndrome (ARDS). Comparative data with different oxygenator models have not yet been reported. The aim of this retrospective investigation was therefore to assess whether different oxygenator types might influence changing frequency, infection incidence, and mortality in patients on vv-ECMO. Methods 42 patients undergoing vv-ECMO between 1998 and 2009 were identified. In 20 out of these patients, a polypropylene (PP) microporous hollow fiber membrane oxygenator, and in 22 patients a nonmicroporous polymethylpentene (PMP) diffusion membrane oxygenator was used. Infection incidence, changing frequency, and mortality were documented. Results In the PMP group, an oxygenator change was necessary less often than in the PP group (p<0.001). The incidence of bacterial, viral, or fungal growth was similar in the groups, thus independent of the frequency of oxygenator change. Irrespective of the groups, the occurrence of Candida sp. tended to correlate with death (p = 0.06). In general, there was a trend towards a higher infection incidence in the subgroup with pulmonary ARDS (p = 0.07). Moreover, infection incidence was associated with a longer ICU stay (p = 0.03) and longer ECMO therapy (p = 0.03). ICU mortality was lower in the PMP group than in the PP group, although not statistically significant (p = 0.10). Conclusions The PMP oxygenator membranes showed benefits with regards to changing frequency, but not infection incidence, length of ICU stay, and length of ECMO therapy. There was a trend towards a lower ICU mortality in patients with PMP oxygenators.
Efavirenz‐ but not nevirapine‐based antiretroviral therapy decreases exposure to the levonorgestrel released from a sub‐dermal contraceptive implant
Authors: Scarsi Kimberly , Lamorde Mohammed , Darin Kristin , Dilly Penchala Sujan , Else Laura , Nakalema Shadia , Byakika‐Kibwika Pauline , Khoo Saye , Cohn Susan , Merry Concepta , Back David 
Published: November 2014

IntroductionSub‐dermal hormone implants, such as levonorgestrel (LNG), are a safe and desirable form of long‐acting contraception, but their use among HIV‐positive women on antiretroviral therapy (ART) may be compromised given the potential for a cytochrome P450 3A‐mediated drug–drug interaction. Our study aimed to characterize the pharmacokinetics of LNG released from a sub‐dermal implant over six months in HIV‐positive Ugandan women on nevirapine (NVP)‐ or efavirenz (EFV)‐based ART.Material and MethodsThis non‐randomized, parallel group study compared LNG pharmacokinetics between HIV‐positive Ugandan women not yet eligible for ART (control group, n=18) and those on stable NVP‐ (n=20) or EFV‐ (n=20) based ART. The two‐rod (75 mg/rod) LNG sub‐dermal implant was inserted at study enrolment. LNG sampling was obtained pre‐implant and at weeks 1, 4, 12 and 24 post‐insertion. LNG concentrations were analyzed using a validated LC‐MS/MS method, with an assay calibration range of 50–1500 pg/mL. Safety monitoring, including a pregnancy test, was conducted at each study visit.ResultsAt enrolment, participants had a mean age of 31 years; CD4+ cell counts were similar between the control, NVP and EFV groups (758, 645 and 568 cells/mm3, respectively; p=0.09); all women in the NVP and EFV groups had an undetectable HIV‐RNA. Women in the control group had a higher baseline body weight (73 kg) compared to those in the NVP (63 kg; p=0.03) or EFV groups (60 kg; p<0.01). By linear regression, weight was a significant predictor of LNG concentrations (1 kg increase in weight=5 pg/mL decrease in LNG, p=0.03). LNG concentrations are reported in the table.ConclusionsOver a 24‐week period, LNG concentrations were 40–54% lower in women on EFV‐based ART, despite their having a significantly lower body weight, compared to those not on ART. In women on NVP‐based ART, LNG concentrations were 32–39% higher than those observed in the control group, a difference partially explained by body weight. These data confirm a significant drug interaction occurs between the LNG implant and EFV, adding to growing concern for reduced contraceptive efficacy with their combined use. In contrast, these data support use of the LNG implant with NVP‐based ART.
Safety and efficacy of ombitasvir – 450/r and dasabuvir and ribavirin in HCV/HIV‐1 co‐infected patients receiving atazanavir or raltegravir ART regimens
Authors: Eron Joseph J , Lalezari Jay , Slim Jihad , Gathe Joseph , Ruane Peter J , Wang Chia , Elion Richard , Blick Gary , Khatri Amit , Hu Yiran B , Gibbons Krystal , Fredrick Linda , Co Melannie , D'Amico Ronald , Da Silva‐Tillmann Barbara , Trinh Roger , Sulkowski Mark S 
Published: November 2014

ObjectiveWhether concomitant HIV antiretroviral therapy (ART) affects the safety and efficacy of interferon‐free HCV therapies or whether HCV treatment may negatively affect HIV control is unclear. We assessed the 3 direct‐acting antiviral (3D) regimen of ombitasvir, ABT‐450 (identified by AbbVie and Enanta; co‐dosed with ritonavir) and dasabuvir with ribavirin (RBV) in HCV/HIV‐1 co‐infected patients with and without cirrhosis, including HCV treatment‐experienced, receiving atazanavir (ATV)‐ or raltegravir (RAL)‐based ART therapy.MethodsHCV genotype 1‐positive treatment‐naïve or pegIFN/RBV‐experienced patients, with or without Child‐Pugh A cirrhosis, CD4+ count ≥200 cells/mm3 or CD4 + % ≥14%, and plasma HIV‐1 RNA suppressed on stable ART received open‐label 3D + RBV for 12 or 24 weeks. Rates of HCV‐sustained virologic response at post‐treatment weeks 4 and 12 (SVR4 and SVR12, respectively) and bilirubin‐related adverse events (AEs) are reported from post‐hoc analyses for subgroups defined by treatment duration and ART regimen.ResultsThe SVR12 rate for patients receiving 12 weeks of 3D + RBV was 93.5% with comparable rates in patients receiving either ATV (93.8%) or RAL therapy (93.3%) (Table 1). The SVR4 rate for the 24‐week arm was 96.9% with a single virologic breakthrough at treatment week 16 in a patient receiving RAL therapy. Patients receiving concomitant ATV had more AEs related to indirect hyperbilirubinemia including ocular icterus, jaundice and grade 3 or 4 elevations in total bilirubin (predominantly indirect). No patient discontinued the study due to AEs, and no serious AEs were reported during or after treatment. No patient had a confirmed plasma HIV‐1 RNA value ≥200 copies/mL during the treatment period.ConclusionsIn this first study to evaluate an IFN‐free regimen in HCV genotype 1‐positive treatment‐naïve and experienced patients with HIV‐1 co‐infection, including those with cirrhosis, high rates of SVR were comparable to those with HCV monoinfection. Indirect hyperbilirubinemia was consistent with the known ABT‐450 inhibition of the OATP1B1 bilirubin transporter, RBV‐related haemolytic anaemia and inhibitory effect of ATV on bilirubin conjugation. The laboratory abnormalities and AEs observed did not negatively affect treatment response or lead to treatment discontinuation.
The cascade of HIV care in Russia, 2011–2013
Authors: Pokrovskaya Anastasia , Popova Anna , Ladnaya Natalia , Yurin Oleg 
Published: November 2014

IntroductionThe cascade of HIV care is one of the main tools to assess the individual and public health benefits of antiretroviral therapy (ART) and identify barriers of treatment as prevention (TasP) concept realization. We aimed to characterize the changes in engagement of HIV‐positive persons in care in Russia during three years (2011–2013).MethodsWe defined seven steps in the cascade of care framework: HIV infected (estimation data), HIV diagnosed, linked to HIV care, retained in HIV care, need ART, on ART and viral suppressed (VL < 1000 copies/mL during 12 month ART). Information was extracted from the Federal AIDS Centre database and from the national monitoring forms of Rospotrebnadzor from the beginning of 2011 to 31 December 2013.ResultsNearly 668,032 HIV‐diagnosed Russian residents were alive by the end of 2013, which consisted 49% of the estimated 1,363,330 people living with HIV. Among the alive HIV‐diagnosed patients, 516,403 (77%) were linked to care and 481,783 (72%) were retained. Of 163,822 (25% of HIV diagnosed) patients who were eligible for ART, 156,858 (96%) were on treatment while 127,054 (81%) had viral suppression. However, only 19% of HIV‐diagnosed patients achieved viral suppression which is necessary to prevent viral transmission. We noted substantial improvements over time in the proportion of individuals on ART. The proportion of patients who received ART increased from 24% in 2011 to 34% in 2013. The most significant leakages of patients during three years were on steps: “HIV infected → HIV diagnosed” (loss −55% in 2011, −53% in 2012, and −51% in 2013), “HIV diagnosed → Linked to care” (−23% yearly) and “Retained in care → Need ART” (−76%, −70%, and −66%, respectively).ConclusionThe stages of HIV diagnosis and estimation of ART eligibility were the most vulnerable to leakage. Encouraging HIV testing and earlier ART initiation are needed to maximize the effects of TasP interventions and to contain the spread of HIV in Russia.
CD4 cell count and the risk of infective and non‐infective serious non‐AIDS events in HIV‐positive persons seen for care in Italy
Authors: Madeddu Giordano , D'Arminio Monforte Antonella , Girardi Enrico , Di Biagio Antonio , Lo Caputo Sergio , Piolini Roberta , Marchetti Giulia , Pellizzer Giampietro , Giacometti Andrea , Galli Laura , Antinori Andrea , Cozzi Lepri Alessandro ,   on behalf of the ICONA Foundation Study
Published: November 2014

IntroductionSerious non‐AIDS events (SNAE) are frequent in HIV patients receiving cART. Current CD4 count was shown to be more strongly associated with infective compared to not‐infective SNAE and unable to predict cardiovascular events. We investigated the relationship between baseline and current CD4 count and the risk of both infective and non‐infective SNAE in HIV‐positive patients according to current ART use.MethodsWe included all HIV‐positive persons enrolled in the ICONA Foundation Study cohort who had at least one follow‐up visit. SNAE were grouped in infective (pneumonia, sepsis, endocarditis and meningitis) and non‐infective (malignancies, chronic kidney disease, cardiovascular events, hepatic events and pancreatitis) aetiology. Incidence of these event groups were calculated overall and according to baseline and current CD4 count (grouped as 0–200, 201–350, 351–500, 501–750, and >750 cells/mm3). Participants’ follow‐up accrued from the date of enrolment (baseline) to a diagnosis of SNAE or their last visit. An event was defined the first time one of the considered SNAE occurred so that each person contributed a single event. A Poisson regression model for each of the two endpoints was used.ResultsA total of 10,822 patients were included (25.3% females, 38.2% heterosexuals) and 26.6% had hepatitis co‐infections. Median age was 36 (IQR 31–42) years. Overall, 423 not‐infective and 385 infective SNAE were included. The most frequent non‐infective SNAE were malignancies (n=202) and the most frequent infective SNAE were pneumonia (n=289). Crude rates of non‐infective SNAE were 0.78, 1.08 and 0.80/100 PYFU, and those of infective SNAE were 1.00, 0.51 and 0.66/100 PYFU in ART naive, currently off and currently on ART patients, respectively. Higher current CD4 count was associated with reduced risk of both infective and non‐infective SNAE in naives and in patients on ART (Table 1). The association was less strong in the group which suspended ART (for non‐infective SNAE the p value for interaction between current log‐CD4 and ART‐status, p=0.004). Conversely, we found no association between baseline CD4 count and risk of non‐infective SNAE in people treated with ART (p value for interaction = 0.0001). When CVD were considered separately, there was no association with CD4 count (not shown).ConclusionsOur findings show that, differently from ART naive, in ART‐treated patients, non‐infective SNAE are predicted by current but not by baseline CD4, suggesting that immune restoration is crucial to prevent these events.