Excimer laser technology in percutaneous coronary interventions: Cardiovascular laser society's position paper.

Excimer Laser Coronary Atherectomy (ELCA) is a well-established therapy that emerged for the treatment of peripheral vascular atherosclerosis in the late 1980s, at a time when catheters and materials were rudimentary and associated with the most serious complications. Refinements in catheter technology and the introduction of improved laser techniques have led to their effective use for the treatment of a wide spectrum of complex coronary lesions, such as thrombotic lesions, severe calcific lesions, non-crossable or non-expandable lesions, chronic occlusions, and stent under-expansion. The gradual introduction of high-energy strategies combined with the contrast infusion technique has enabled us to treat an increasing number of complex cases with a low rate of periprocedural complications. Currently, the use of the ELCA has also been demonstrated to be effective in acute coronary syndrome (ACS), especially in the context of large thrombotic lesions.

Viral hepatitis, HIV, human herpes virus and Treponema pallidum infection in haemodialysis patients from Kosovo, 2005.

The serological status of hepatitis viruses and other infectious diseases in the 66 dialysed patients of one haemodialysis unit in Kosovo were studied, comparing the data with a large group of blood donors and out-patients. All dialysed patients were hepatitis A virus (HAV) positive. Prevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (anti-HBs), and hepatitis B core antibodies (anti-HBc) was 14 of 66, 21% (95% confidence interval (CI): 12-33%), 5 of 66, 8% (95%CI: 5-22%), and 50 of 66, 76% (95%CI: 64-85%), respectively. Antibodies to hepatitis C virus (anti-HCV) prevalence was 57 of 66, 86% (95%CI: 76-94%). No human immunodeficiency virus (HIV) positive case was found. Prevalence of past herpes simplex virus type 2 (HSV-2) infection was 29% (95%CI: 18-41%). Two patients (3%, 95%CI: 0-10%) were positive for Treponema pallidum and 18% (95%CI: 10-30%) were human herpesvirus 8 (HHV-8) antibody positive. Four hundred and fifty-two subjects were recruited for comparison. Markers of past HAV infection was associated with haemodialysis (Fisher s exact test p-value=0.037). Dialysed patients were at a higher risk of being HBsAg positive than others: the sex- and age-adjusted odds ratio (OR) was 5.18 (95%CI: 1.87-14.32). Anti-HBc positivity was strongly associated with haemodialysis: the sex- and age-adjusted OR was 6.43 (95%CI: 3.22-12-85). Anti-HCV positivity was 86% and 1% in presence and absence of haemodialysis, respectively. The Fisher s exact test for association proved a strong association between haemodialysis and HCV (p-value<0.0001). The OR for association between haemodialysis and HSV-2 positivity was 3.20 (95%CI: 1.46-7.00). Significant associations were also observed between haemodialysis status and antibodies to Treponema pallidum (Fisher s exact test p-value=0.044). In Kosovo, the prevalence of viral hepatitis infection and other viral infections and Treponema pallidum among dialysed patients is high, indicating major ongoing nosocomial transmission.

Contamination of drinking water sources during the rainy season in an urban post-conflict community in Guinea Bissau: implications for sanitation priority.

Since the 1998 civil warcholera outbreaks and waterborne infections have been a major cause of morbidity and mortality during the rainy season in Guinea Bidsau. Our survey aims at: (1) describing the distribution, characteristics and use of water sources and sewage facilities in a central area of the capital city of Bissau; (2) determining the microbiological quality of drinking water during the rainy season. After mapping of the Cuntum 3 study area, water sources' and latrines' location, characteristics and use were determined by visual inspection and interviews with householders. Microbiological analyses were peformed from water sources for evaluation of total Coliforms, E. coli, Enterococcus faecalis. Twelve water sources (9 wells, 3 taps) and 15 latrines were identified and used by 444 inhabitants. Water sources and latrines were at less than 5 meters distance apart. Wells were self-built, hand-dug, shallow (4-6 meters), unprotected. Taps were located outdoor. Latrines were self-built, open air, unprotected. None of the houses had a bathroom. Maintenance of wells, taps and latrines is not performed on regular basis and well's handling habits are not safe. Well and tap water showed heavy faecal contamination with more than 1000 CFU/100 ml. The contamination of drinking water in Bissau due to poor construction, maintenance and improperuse ten years after the civil war, demonstrates the need to allocate resources after conflicts in the area of water and sanitation. Both should be included as a priority in post-conflict reconstruction programs in order to reduce cholera outbreaks and diarrhoea related mortality.

Elevation of red cell sodium-lithium countertransport in hyperlipidemias.

Red cell Na-Li countertransport was measured in 78 normal subjects, 64 patients with essential hypertension, and 67 patients with hyperlipidemias. Both hypertensive and hyperlipidemic patients had elevated Na-Li countertransport compared to normal controls (p less than 0.001). Subjects with hyperlipidemia and hypertension had higher countertransport (p less than 0.02) than patients with only hyperlipidemia. Normotensive hyperlipidemic subjects had higher countertransport than normotensive and normolipidemic controls (p less than 0.02). This suggest that hypertension and high plasma lipids can influence independently the Na-Li countertransport. In another group of 52 normotensive subjects, Na-Li countertransport was positively correlated with serum total and free (unesterified) cholesterol, phospholipids and triglycerides. No correlations were found with HDL-cholesterol or HDL-phospholipids. A very high positive correlation was found between Na-Li countertransport and plasma acetylcholinesterase (p less than 0.005). These findings suggest that plasma lipids, probably through membrane lipids, can affect the maximal rate of the Na-Li exchange in red cells. The relationship between plasma or membrane lipids and cation transport should be further studied in erythrocytes and other cells.

Membrane polyunsaturated fatty acids and lithium-sodium countertransport in human erythrocytes.

Two groups of individuals, 26 normotensive normolipemic and 37 normotensive hyperlipemic, all without family history of hypertension have been selected in attempt to demonstrate whether Li-Na countertransport of erythrocytes is influenced by plasma and membrane lipid composition. The maximal rate of Li-Na countertransport was elevated in hyperlipemics (0.344 +/- 0.168 vs 0.220 +/- 0.074 mmol/l erythrocytes/h). This difference is highly significant. Hyperlipemics had different composition of membrane lipids than normals. The most important variations were: increase of palmitic, palmitoleic and total saturated fatty acids (SFA) as well as increase of cholesterol/phospholipids ratio (C/PL); in contrast, hyperlipemics had a reduced amount of linoleic acid and total unsaturated fatty acids (UFA) as well as total polyunsaturated fatty acids (PUFA). Consequently, UFA/SFA and PUFA/SFA ratios were lower than in normals. Li-Na countertransport was negatively correlated with the amount of PUFA (P less than 0.02), whereas it was positively correlated with the following parameters: oleic/linoleic ratio (p less than 0.02), monounsaturated fatty acids/polyunsaturated fatty acids ratio (p less than 0.03) as well as with the SFA + monounsaturated fatty acid/PUFA ratio (p less than 0.03). These findings suggest that the V max of Li-Na countertransport in erythrocytes is influenced by the lipid composition of the membrane.

[Health education and the prevention of HIV infection in schools]. / L'educazione alla salute e la prevenzione delle infezioni da HIV nella scuola.

This review describes the HIV prevention strategies adopted since 1990 by the Italian Ministry of Health and Ministry of Education, coordinated by the National Health Institute, for use in Italian schools. It sets out reasons for believing that action in schools is essential in containing the spread of the HIV epidemic and presents teaching materials prepared for school use. An analysis is made of the IV national HIV information campaign, in which the Ministry of Health trained 4,000 middle and senior schools principals. The prospects for continuing the work with these 4,000 principals in the V information campaign, are also reported.

[The replication of the educational activities of a course developed by the National Training Program for social health workers for controlling HIV infection]. / Replicazione dell'attività formativa di un corso previsto dal Piano nazionale di formazione per operatori socio-sanitari per la lotta alle infezioni da HIV.

A course for regional trainers was organized by the Working Group for HIV training (PFH) and held in Rome. This course has motivated the participants and has given them the ability to organize similar training activities at local level. The training methodology, the evaluation methods and the objectives used in the course are described. An investigation has been carried out by the Working Group of PFH to evaluate the training activity of the participants at the regional level. The results show that 17 out of the 25 participants have been able to organize a total number of 53 peripheral courses and train 2144 health workers. The training methodology and the evaluation method utilized at the different local levels have followed the ones used in the central course.

Prevalence of antibodies to phleboviruses and flaviviruses in Peja, Kosovo.

In order to investigate the current and past activity of phlebovirus and flavivirus in Kosovo, a seroprevalence study among 200 blood donors was performed. Positive results were obtained for the phleboviruses TOSV and SFNV, and for a flavivirus of the Japanese Encephalitis group. No positive results for TBEV were observed.