bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of immunosuppressive therapy on patients with inflammatory bowel diseases and hepatitis B or C virus infection
Authors: Morisco F. , Castiglione F. , Rispo A. , Stroffolini T. , Sansone S. , Vitale R. , Guarino M. , Biancone L. , Caruso A. , D'Inca R. , Marmo R. , Orlando A. , Riegler G. , Donnarumma L. , Camera S. , Zorzi F. , Renna S. , Bove V. , Tontini G. , Vecchi M. , Caporaso N. 
Published: July 2012

SummaryViral hepatitis reactivation has been widely reported in patients undergoing immunosuppressive therapy; however, few data are available about the risk of HBV and HCV reactivation in patients with inflammatory bowel disease, receiving immunosuppressive drugs. The aim of our study was to assess the prevalence of HBV and HCV infection in a consecutive series of patients with inflammatory bowel disease and to value the effects of immunosuppressive therapy during the course of the infection. Retrospective observational multicenter study included all consecutive patients with inflammatory bowel disease who have attended seven Italian tertiary referral hospitals in the last decade. A total of 5096 patients were consecutively included: 2485 Crohn's disease and 2611 Ulcerative Colitis. 30.5% and 29.7% of the patients were investigated for HBV and HCV infection. A total of 30 HBsAg positive, 17 isolated anti‐HBc and 60 anti‐HCV‐positive patients were identified. In all, 20 patients with HBV or HCV infection received immunosuppressive therapy (six HBsAg+; four isolated anti‐HBc+ and 10 anti‐HCV+). One of six patients showed HBsAg+ and one of four isolated anti‐HBc+ experienced reactivation of hepatitis. Two of six HBsAg patients received prophylactic therapy with lamivudine. Only one of 10 anti‐HCV+ patients showed mild increase in viral load and ALT elevation. Screening procedures for HBV and HCV infection at diagnosis have been underused in patients with inflammatory bowel disease. We confirm the role of immunosuppressive therapy in HBV reactivation, but the impact on clinical course seems to be less relevant than previous reported.
Antiretroviral therapy uptake and coverage in four HIV community cohort studies in sub‐Saharan Africa
Authors: Wringe Alison , Floyd Sian , Kazooba Patrick , Mushati Phyllis , Baisley Kathy , Urassa Mark , Molesworth Anna , Schumacher Christina , Todd Jim , Zaba Basia 
Published: July 2012

AbstractObjective  To compare socio‐demographic patterns in access to antiretroviral therapy (ART) across four community HIV cohort studies in Africa.Methods  Data on voluntary counselling and testing and ART use among HIV‐infected persons were analysed from Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and Manicaland (Zimbabwe), where free ART provision started between 2004 and 2007. ART coverage was compared across sites by calculating the proportion on ART among those estimated to need treatment, by age, sex and educational attainment. Logistic regression was used to identify socio‐demographic characteristics associated with undergoing eligibility screening at an ART clinic within 2 years of being diagnosed with HIV, for three sites with information on diagnosis and screening dates.Results  Among adults known to be HIV‐infected from serological surveys, the proportion who knew their HIV status was 93% in Karonga, 37% in Kisesa, 46% in Masaka and 25% in Manicaland. Estimated ART coverage was highest in Masaka (68%) and lowest in Kisesa (2%). The proportion of HIV‐diagnosed persons who were screened for ART eligibility within 2 years of diagnosis ranged from 14% in Kisesa to 84% in Masaka, with the probability of screening uptake increasing with age at diagnosis in all sites.Conclusions  Higher HIV testing rates among HIV‐infected persons in the community do not necessarily correspond with higher uptake of ART, nor more equitable treatment coverage among those in need of treatment. In all sites, young adults tend to be disadvantaged in terms of accessing and initiating ART, even after accounting for their less urgent need.
Patterns of uptake of HIV testing in sub‐Saharan Africa in the pre‐treatment era
Authors: Cremin Ide , Cauchemez Simon , Garnett Geoffrey P. , Gregson Simon 
Published: July 2012

AbstractObjectives  To compare nationally representative trends in self‐reported uptake of HIV testing and receipt of results in selected countries prior to treatment scale‐up.Methods  Demographic and Health Survey (DHS) data from 13 countries in sub‐Saharan Africa were used to describe the pattern of uptake of testing for HIV among sexually active participants. Univariate and multivariate logistic regression were used to analyse the associations between socio‐demographic and behavioural characteristics and the uptake of testing.Results  Knowledge of serostatus ranged from 2.2% among women in Guinea (2005) to 27.4% among women in Rwanda (2005). Despite varied levels of testing, univariate analysis showed the profile of testers to be remarkably similar across countries, with respect to socio‐demographic characteristics such as area of residence and socio‐economic status. HIV‐positive participants were more likely to have tested and received their results than HIV‐negative participants, with the exception of women in Senegal and men in Guinea. Adjusted analyses indicate that a secondary or higher level of education was a key determinant of testing, and awareness that treatment exists was independently positively associated with testing, once other characteristics were taken into account.Conclusion  This work provides a baseline for monitoring trends in testing and exploring changes in the profile of those who get tested after the introduction and scale‐up of treatment.
The impact of antiretroviral treatment on mortality trends of HIV‐positive adults in rural Uganda: a longitudinal population‐based study, 1999–2009
Authors: Kasamba Ivan , Baisley Kathy , Mayanja Billy N. , Maher Dermot , Grosskurth Heiner 
Published: July 2012

AbstractObjective  To investigate trends in all‐cause adult mortality after the roll‐out of an antiretroviral therapy (ART) programme in rural Uganda.Methods  Longitudinal population‐based cohort study of approximately 20 000 residents in rural Uganda. Mortality in adults aged 15–59 years was determined for the 5‐year period (1999–2003) before introduction of ART in January 2004 and for the 5‐year period afterwards. Poisson regression was used to estimate mortality rate ratios (RRs) for the period before ART, 1 year after ART introduction (from January 2004 to January 2005) and more than 1 year after ART introduction. Trends in mortality were analysed by HIV status, age and sex.Results  Before ART became available, the mortality rate (deaths per 1000 person‐years) was 4.0 (95% CI = 3.3–4.8) among HIV‐negative individuals and 116.4 (95% CI = 101.9–133.0) among HIV‐positive individuals. During the period January 2004–end November 2009, 279 individuals accessed ART. In the year after ART was introduced, the mortality rate (deaths per 1000 person‐years) among HIV‐negative individuals did not change significantly (adjusted RR = 0.95, 95% CI = 0.61–1.47), but among HIV‐positive individuals dropped by 25% to 87.4 (adjusted RR = 0.75, 95% CI = 0.53–1.06). In the period 2005–2009, the mortality rate (deaths per 1000 person‐years) among HIV‐positive individuals fell further to 39.9 (adjusted RR = 0.33, 95% CI = 0.26–0.43). The effect was greatest among individuals aged 30–44 years, and trends were similar in men and women.Conclusion  The substantially reduced mortality rate among HIV‐positive individuals after ART roll‐out lends further support to the intensification of efforts to ensure universal access to ART.
HIV status and participation in HIV surveillance in the era of antiretroviral treatment: a study of linked population‐based and clinical data in rural South Africa
Authors: Bärnighausen T. , Tanser F. , Malaza A. , Herbst K. , Newell M. ‐L. 
Published: July 2012

AbstractObjective  To examine whether HIV status affects participation in a population‐based longitudinal HIV surveillance in the context of an expanding HIV treatment and care programme in rural South Africa.Method  We regressed consent to participate in the HIV surveillance during the most recent fieldworker visit on HIV status (based on previous surveillance participation or enrolment in pre‐antiretroviral treatment (pre‐ART) care or ART in the local HIV treatment and care programme), controlling for sex, age and year of the visit (N = 25 940). We then repeated the regression using the same sample but, in one model, stratifying HIV‐infected persons into three groups (neither enrolled in pre‐ART care nor receiving ART; enrolled in pre‐ART care but not receiving ART; receiving ART) and, in another model, additionally stratifying the group enrolled in pre‐ART and the group receiving ART into those with CD4 count ≤200/μl (i.e. the ART eligibility threshold at the time) vs. those with CD4 count >200/μl.Results  HIV‐infected individuals were significantly less likely to consent to participate in the surveillance than HIV‐uninfected individuals [adjusted odds ratio (aOR), 0.74; 95% confidence interval, 0.70–0.79, P < 0.001], controlling for other factors. Persons who were receiving ART were less likely to consent to participate (aOR, 0.75, 0.68–0.84, P < 0.001) than those who had never sought HIV treatment or care (aOR, 0.82, 0.75–0.89, P < 0.001), but more likely to consent than persons enrolled in pre‐ART care (aOR 0.62, 0.56–0.69, P < 0.001). Those with CD4 count ≤200/μl were significantly less likely to consent to participate than those with CD4 count >200/μl in both the group enrolled in pre‐ART and the group receiving ART.Conclusion  As HIV test results are not made available to participants in the HIV surveillance, our findings agree with the hypothesis that HIV‐infected persons are less likely than HIV‐uninfected persons to participate in HIV surveillance because they fear the negative consequences of others learning about their HIV infection. Our results further suggest that the increased knowledge of HIV status that accompanies improved ART access can reduce surveillance participation of HIV‐infected persons, but that this effect decreases after ART initiation, in particular in successfully treated patients.
Adult mortality and probable cause of death in rural northern Malawi in the era of HIV treatment
Authors: Chihana Menard , Floyd Sian , Molesworth Anna , Crampin Amelia C. , Kayuni Ndoliwe , Price Alison , Zaba Basia , Jahn Andreas , Mvula Hazzie , Dube Albert , Ngwira Bagrey , Glynn Judith R. , French Neil 
Published: July 2012

AbstractObjectives  Developing countries are undergoing demographic transition with a shift from high mortality caused by communicable diseases (CD) to lower mortality rates caused by non‐communicable diseases (NCD). HIV/AIDS has disrupted this trend in sub‐Saharan Africa. However, in recent years, HIV‐associated mortality has been reduced with the introduction of widely available antiretroviral therapy (ART). Side effects of ART may lead to increased risk of cardiovascular diseases, raising the prospects of an accelerated transition towards NCD as the primary cause of death. We report population‐based data to investigate changes in cause of death owing to NCD during the first 4 years after introduction of HIV treatment.Methods  We analysed data from a demographic surveillance system in Karonga district, Malawi, from September 2004 to August 2009. ART was introduced in mid‐2005. Clinician review of verbal autopsies conducted 2–6 weeks after a death was used to establish a single principal cause of death.Results  Over the entire period, there were 905 deaths, AIDS death rate fell from 505 to 160/100 000 person‐years, and there was no evidence of an increase in NCD rates. The proportion of total deaths attributable to AIDS fell from 42% to 17% and from NCD increased from 37% to 49%.Discussion  Our findings show that 4 years after the introduction of ART into HIV care in Karonga district, all‐cause mortality has fallen dramatically, with no evidence of an increase in deaths owing to NCD.
Access to, and uptake of, antiretroviral therapy in a developing country with high HIV prevalence: a population‐based cohort study in rural Uganda, 2004–2008
Authors: Kazooba Patrick , Kasamba Ivan , Baisley Kathy , Mayanja Billy N. , Maher Dermot 
Published: July 2012

AbstractObjectives  To investigate antiretroviral therapy (ART) uptake after its introduction in 2004 in a longitudinal population‐based cohort and its nested clinical cohort in rural Uganda.Methods  A HIV serosurvey of all adults aged ≥15 years is conducted annually. Two intervals were selected for analysis. Interval 1 (November 2004–October 2006) provided 2 years of follow‐up to prospectively evaluate access to HIV services. Interval 2 (November 2007–October 2008) was used to evaluate current coverage of services. Logistic regression was used to identify sociodemographic factors associated with ART screening within 2 years of diagnosis. ART coverage was assessed using Weibull survival models to estimate the numbers needing ART.Results  In Interval 1, 636 HIV‐positive adults were resident and 295 (46.4%) knew their status. Of those, 248 (84.1%) were screened for ART within 2 years of diagnosis. After adjusting for age, those who were widowed, separated or never married were more likely to be screened than those who were married. In Interval 2, 575 HIV‐positive adults were residents, 322 (56.0%) knew their status, 255 (44.3%) had been screened for ART and 189 (32.9%) had started ART. Estimated ART coverage was 66%.Conclusions  In this cohort, ART access and uptake is very high once people are diagnosed. Owing to intensive screening in the study clinic, nearly all participants who were eligible initiated ART. However, this is unlikely to reflect coverage in the general population, intensified efforts are needed to promote HIV testing, and ART screening and uptake are needed among those found to be HIV‐positive.
The effect of antiretroviral therapy provision on all‐cause, AIDS and non‐AIDS mortality at the population level – a comparative analysis of data from four settings in Southern and East Africa
Authors: Floyd Sian , Marston Milly , Baisley Kathy , Wringe Alison , Herbst Kobus , Chihana Menard , Kasamba Ivan , Bärnighausen Till , Urassa Mark , French Neil , Todd Jim , Zaba Basia 
Published: July 2012

AbstractObjective  To provide a broad and up‐to‐date picture of the effect of antiretroviral therapy (ART) provision on population‐level mortality in Southern and East Africa.Methods  Data on all‐cause, AIDS and non‐AIDS mortality among 15–59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll‐out, to 4–6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV‐negative and HIV‐positive individuals. For Karonga and the Africa Centre, trends in AIDS and non‐AIDS mortality are analysed using verbal autopsy data.Results  For all‐cause mortality, overall rate ratios (RRs) comparing the period 2–6 years following ART roll‐out with the pre‐ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person‐years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person‐years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person‐years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person‐years) in the Africa Centre DSS. The mortality decline was seen only in HIV‐positive individuals/AIDS mortality, with no decline in HIV‐negative individuals/non‐AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower.Conclusions  Falls in all‐cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important.
Cohort monitoring of persons with hypertension: an illustrated example from a primary healthcare clinic for Palestine refugees in Jordan
Authors: Khader Ali , Farajallah Loai , Shahin Yousef , Hababeh Majed , Abu‐Zayed Ishtaiwi , Kochi Arata , Harries Anthony D. , Zachariah Rony , Kapur Anil , Venter Wendy , Seita Akihiro 
Published: July 2012

AbstractObjective  Recording and reporting systems borrowed from the DOTS framework for tuberculosis control can be used to record, monitor and report on chronic disease. In a primary healthcare clinic run by UNRWA in Amman, Jordan, serving Palestine refugees with hypertension, we set out to illustrate the method of cohort reporting for persons with hypertension by presenting on quarterly and cumulative case finding, cumulative and 12‐month analysis of cohort outcomes and to assess how these data may inform and improve the quality of hypertension care services.Method  This was a descriptive study using routine programme data collected through E‐Health.Results  There were 97 newly registered patients with hypertension in quarter 1, 2012, and a total of 4130 patients with hypertension ever registered since E‐Health started in October 2009. By 31 March 2012, 3119 (76%) of 4130 patients were retained in care, 878 (21%) had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow‐up. Cumulative and 12‐month cohort outcome analysis indicated deficiencies in several components of clinical performance related to blood pressure measurements and fasting blood glucose tests to screen simultaneously for diabetes. Between 8% and 15% of patients with HT had serious complications such as cardiovascular disease and stroke.Conclusion  Cohort analysis is a valuable tool for the monitoring and management of non‐communicable chronic diseases such as HT.
Leprosy trends in Zambia 1991–2009
Authors: Kapata Nathan , Chanda‐Kapata Pascalina , Grobusch Martin Peter , O’Grady Justin , Bates Matthew , Mwaba Peter , Zumla Alimuddin 
Published: July 2012

AbstractObjective  To document leprosy trends in Zambia over the past two decades to ascertain the importance of leprosy as a health problem in Zambia.Methods  Retrospective study covering the period 1991–2009 of routine national leprosy surveillance data, published national programme review reports and desk reviews of in‐country TB reports.Results  Data reports were available for all the years under study apart from years 2001, 2002 and 2006. The Leprosy case notification rates (CNR) declined from 2.73/10 000 population in 1991 to 0.43/10 000 population in 2009. The general leprosy burden showed a downward trend for both adults and children. Leprosy case burden dropped from approximately 18 000 cases in 1980 to only about 1000 cases in 1996, and by the year 2000, the prevalence rates had fallen to 0.67/10 000 population. There were more multibacillary cases of leprosy than pauci‐bacillary cases. Several major gaps in data recording, entry and surveillance were identified. Data on disaggregation by gender, HIV status or geographical origin were not available.Conclusion  Whilst Zambia has achieved WHO targets for leprosy control, leprosy prevalence data from Zambia may not reflect real situation because of poor data recording and surveillance. Greater investment into infrastructure and training are required for more accurate surveillance of leprosy in Zambia.
Apoptosis of mouse mast cells is reciprocally regulated by the IgG receptors FcγRIIB and FcγRIIIA
Authors: Fang Y. , Larsson L. , Bruhns P. , Xiang Z. 
Published: July 2012

AbstractBackgroundMast cells are important effector cells in allergy. They usually have a long life span and resist cell death induction. Fcγ receptor– and IgG immune complex–mediated apoptosis has been demonstrated in B‐lineage cells, but not in mast cells. The aim of the current study was to investigate whether mast cells could respond to apoptosis induction by IgG immune complex aggregation of Fcγ receptors. It is known that mouse mast cells express the low‐affinity Fcγ receptors FcγRIIB and FcγRIIIA, which bind IgG especially in the form of antigen–IgG immune complexes.MethodsMouse bone marrow–derived cultured mast cells were examined for surface expression of FcγRIIB and FcγRIIIA. Apoptosis of such cells from wild‐type, FcγRIIB−/− or FcγRIIIA−/− mice was measured following receptor aggregation by IgG immune complexes.ResultsOur data demonstrate that aggregation of either FcγRIIB or FcγRIIIA by IgG immune complexes induced apoptosis of mouse bone marrow–derived cultured mast cells. However, mast cells expressing both FcγRIIB and FcγRIIIA were able to resist cell death induction by IgG immune complexes.ConclusionOur findings reveal a fine‐tuning system for regulating mast cell apoptosis through aggregating Fcγ receptors by IgG immune complexes. Such apoptosis regulation may have a substantial impact on mast cell homeostasis during allergic inflammation.
The impact of local anesthetic distribution on block onset in ultrasound‐guided interscalene block
Authors: LANG R. S. , KENTOR M. L. , VALLEJO M. , BIGELEISEN P. , WISNIEWSKI S. R. , OREBAUGH S. L. 
Published: July 2012

BackgroundRecent investigations of local anesthetic distribution in the lower extremity have revealed that completely surrounding the sciatic nerve with local anesthetic provides the advantage of more rapid and complete anesthesia in the territory served by the nerve. We hypothesized that a pattern of distribution that entirely envelops the targeted nerve roots during interscalene block would provide similar benefits of more rapid anesthesia onset.MethodsDuring interscalene block guided by ultrasound with nerve stimulator confirmation, the pattern of local anesthetic distribution was recorded and later classified as complete or incomplete envelopment of the visible nerve elements in 50 patients undergoing ambulatory shoulder arthroscopic surgery. The pattern was then compared with the extent of block setup at pre‐determined intervals, as well as to post‐operative pain levels and block duration.Results Twenty‐two patients (44%) had complete envelopment of the nerves in the plane of injection during ultrasound imaging of the interscalene block. There was no difference in the fraction of blocks that were fully set‐up at 10 min with regards to complete or incomplete envelopment of the nerves by local anesthetic. All of the patients had complete setup of the block by 20 min. In addition, the post‐operative pain levels and duration of block did not vary among the two groups with complete vs. incomplete local anesthetic distribution around the nerves.ConclusionThe presence or absence of complete envelopment of the nerve elements in the interscalene groove by local anesthetic did not determine the likelihood of complete block effect at pre‐determined time intervals after the procedure.