Comparing effectiveness of high-dose Atorvastatin and Rosuvastatin among patients undergone Percutaneous Coronary Interventions: A non-concurrent cohort study in India.

INTRODUCTION: Atorvastatin-80mg/day and Rosuvastatin-40mg/day are the commonest high-dose statin (3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitors) regimes for post-PCI (Percutaneous Coronary Interventions) patients to lower (by ≥50%) blood low-density-lipoprotein cholesterol (LDL-C). Dearth of conclusive evidence from developing world, regarding overall safety, tolerability and comparative effectiveness (outcome/safety/tolerability/endothelial inflammation control) of Rosuvastatin over Atorvastatin in high-dose, given its higher cost, called for an overall and comparative assessment among post-PCI patients in a tertiary cardiac-care hospital of Kolkata, India. METHODS: A record-based non-concurrent cohort study was conducted involving 942 post-PCI patients, aged 18-75 years, on high-dose statin for three months and followed up for ≥one year. Those on Atorvastatin-80mg (n = 321) and Rosuvastatin-40mg (n = 621) were compared regarding outcome (death/non-fatal myocardial infarction: MI/repeated hospitalization/target-vessel revascularisation/control of LDL and high-sensitivity C-reactive protein: hsCRP), safety (transaminitis/myopathy/myalgia/myositis/rhabdomyolysis), tolerability (gastroesophageal reflux disease: GERD/gastritis) and inflammation control adjusting for socio-demographics, tobacco-use, medications and comorbidities using SAS-9.4. RESULTS: Groups varied minimally regarding distribution of age/gender/tobacco-use/medication/comorbidity/baseline (pre-PCI) LDL and hs-CRP level. During one-year post-PCI follow up, none died. One acute MI and two target vessel revascularizations occurred per group. Repeated hospitalization for angina/stroke was 2.18% in Atorvastatin group vs. 2.90% in Rosuvastatin group. At three-months follow up, GERD/Gastritis (2.18% vs 4.83%), uncontrolled hs-CRP (22.74% vs 31.08%) and overall non-tolerability (4.67% vs. 8.21%) were lower for Atorvastatin group. Multiple logistic regression did show that compared to Atorvastatin-80mg, Rosuvastatin-40mg regime had poorer control of hs-CRP (A3OR = 1.45,p = 0.0202), higher (A3OR = 2.07) adverse effects, poorer safety profile (A3OR = 1.23), higher GERD/Gastritis (A3OR = 1.50) and poorer overall tolerability (A3OR = 1.50). CONCLUSION: Post-PCI high dose statins were effective, safe and well-tolerated. High dose Rosuvastatin as compared to high dose Atorvastatin were similar in their clinical efficacy. Patients treated with Atrovastatin had significantly lower number of patients with hs-CRP (high-sensitivity C-reactive protein)/C-reactive protein (CRP) level beyond comparable safe limit and relatively better tolerated as opposed to Rosuvastatin-40mg.Thus given the lower price, Atorvastatin 80mg/day appeared to be more cost-effective. A head-to-head cost-effectiveness as well as efficacy trial may be the need of the hour.

Condomless Vaginal Intercourse and Its Associates among Men Who Have Sex with Men in China.

BACKGROUND: HIV prevalence has increased rapidly among men who have sex with men (MSM) in China reaching alarmingly high levels in some cities. Bisexual MSM have potential to transmit HIV and syphilis to their female partners through condomless vaginal intercourse (CVI). Thus, estimation of the burden of CVI and identification of its associates seemed necessary to control this cross-gender transmission. METHOD: In a cross-sectional study, using respondent-driven-sampling and snowball sampling, 2958 MSM were recruited from seven Chinese cities, interviewed and tested for HIV and syphilis. Descriptive analysis of the socio-demographic and behaviors followed by simple and multiple logistic regressions [adjusted for income, city, race and social network size to determine adjusted odds ratio (aOR)] were performed using SAS-9.1. RESULTS: Among participating MSM, 19.03% were engaged in CVI. Prevalence of HIV and syphilis among participants involved in CVI were 5.86% and 14.74% respectively. MSM who were older [aOR for aged 40-49 = 2.60 (95% CI: 1.54-4.37)], married [aOR = 6.13 (4.95-7.58)], attended primary school or below [aOR = 3.86 (2.26-6.69)], met male partners at spa/bathhouse/sauna/massage parlor [aOR = 3.52 (2.62-4.72)] and had heterosexual orientation [aOR = 13.81 (7.14-26.70)] were more likely to have CVI. Furthermore, correct knowledge regarding HIV [aOR = 0.70 (0.55, 0.88)] and exposure to HIV prevention interventions [aOR = 0.67 (0.54, 0.82)] were negatively associated with CVI. CONCLUSIONS: CVI was found to be common among MSM in China. To minimize the transmission of HIV and syphilis from bisexual MSM to their relatively female partners, targeted interventions should specifically focus on bisexual MSM especially the older and married subgroups.

The effectiveness of UV-C radiation for facility-wide environmental disinfection to reduce health care-acquired infections.

BACKGROUND: Health care-acquired infections (HAIs) constitute an increasing threat for patients worldwide. Potential contributors of HAIs include environmental surfaces in health care settings, where ultraviolet-C radiation (UV-C) is commonly used for disinfection. This UV-C intervention-based pilot study was conducted in a hospital setting to identify any change in the incidence of HAIs before and after UV-C intervention, and to determine the effectiveness of UV-C in reducing pathogens. METHODS: In a hospital in Culver City, CA, during 2012-2013, bactericidal doses of UV-C radiation (254 nm) were delivered through a UV-C-based mobile environmental decontamination unit. The UV-C dosing technology and expertise of the specifically trained personnel were provided together as a dedicated service model by a contracted company. The incidence of HAIs before and after the intervention period were determined and compared. RESULTS: The dedicated service model dramatically reduced HAIs (incidence difference, 1.3/1000 patient-days, a 34.2% reduction). Reductions in the total number and incidence proportions (28.8%) of HAIs were observed after increasing and maintaining the coverage of UV-C treatments. CONCLUSION: The dedicated service model was found to be effective in decreasing the incidence of HAIs, which could reduce disease morbidity and mortality in hospitalized patients. This model provides a continuously monitored and frequently UV-C-treated patient environment. This approach to UV-C disinfection was associated with a decreased incidence of HAIs.

Nested Case-control Study of Occupational Radiation Exposure and Breast and Esophagus Cancer Risk among Medical Diagnostic X Ray Workers in Jiangsu of China.

Medical diagnostic X-ray workers are one occupational group that expose to the long-term low-dose external radiation over their working lifetime, and they may under risk of different cancers. This study aims to determine the relationship between the occupational X-ray radiation exposure and cancer risk among these workers in Jiangsu, China. We conducted Nested case-control study to investigate the occupational X-ray radiation exposure and cancer risk. Data were collected through self-administered questionnaire, which includes but not limits to demographic data, personal behaviors and family history of cancer. Retrospective dose reconstruction was conducted to estimate the cumulative doses of the x-ray workers. Inferential statistics, t-test and 2 tests were used to compare the differences between each group. We used the logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) of cancer by adjusting the age, gender. All 34 breast cancer cases and 45 esophageal cancer cases that detected in a cohort conducted among health workers between 1950~2011 were included in this presented study, and 158 cancer-free controls were selected by frequency-matched (1:2). Our study found that the occupational radiation exposure was associated with a significantly increased cancer risk compared with the control, especially in breast cancer and esophageal cancer (adjusted OR=2.90, 95% CI: 1.19-7.04 for breast cancer; OR=4.19, 95% CI: 1.87-9.38 for esophageal cancer, and OR=3.43, 95% CI: 1.92-6.12 for total cancer, respectively). The occupational X-ray radiation exposure was associated with increasing cancer risk, which indicates that proper intervention and prevention strategies may be needed in order to bring down the occupational cancer risk.

Burden and correlates of non-communicable-diseases among rural residents: a cross-sectional study in Hebei, China.

BACKGROUND: Burden of non-communicable diseases (NCDs) is increasing rapidly in most of the developing countries including China, even in rural areas. Dearth of representative data called for an investigation to estimate the burden and identify the correlates of NCDs in rural China. METHODS: A cross-sectional study was conducted involving a representative sample of 6003 consenting randomly selected rural residents aged 15 years or more, from 36 villages of Shijiazhuang in Hebei province of China between July 2010 and June 2011. Information on demographics and behavior were collected, body mass index (BMI) and blood pressure were measured and blood samples were tested to diagnose diabetes and hyperlipidemia. RESULTS: Majority participants were aged < 30 year, married and educated up to junior/senior high school level. Mean age for the 6003 participants was 37.4 ± 14.8. About 55.7% had BMI of 18.6-24.9. In past 12 months: 19.8% smoked daily, 41.6% were exposed to passive smoking, 28.5% drank alcohol, 10.4% skipped breakfasts frequently, 82.8% did never exercise and 25.3% had psychological disturbances. 51.1% were hypertensive, 6.7% were diabetic and 9.2% had hyperlipidemia. Based on self-reports, cardiovascular diseases (4.5%), cerebrovascular diseases (2.3%), cancers (0.2%), chronic obstructive pulmonary diseases (2%), orthopedic problems (12.1%) and gastrointestinal NCDs (7.8%) were identified among the participants, while proportion of subjects with one, two and three or more NCDs were 43%, 14.4% and 5.5% respectively. Higher odds of having more NCDs were associated with higher BMI (Kg/M(2)), family history of NCDs, daily and past history of smoking and drinking, passive smoking, lack of exercise, skipping breakfast and psychological disturbances. CONCLUSION: Despite limitations associated with cross-sectional design and self-reporting, observation in this large sample of rural residents could develop important insights regarding high burden of NCDs in this population. Based on the identified correlates, targeted intervention strategies seem to be required urgently to control NCDs in rural China.

The epidemic of HIV, syphilis, chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu, China, 2009.

BACKGROUND: In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs. METHODS: In order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009. RESULTS: In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03-20.75), 1.91(95%CI 1.14-3.21) and 2.36(95%CI 1.07,5.24). CONCLUSION: Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too.

Distribution and determinants of non communicable diseases among elderly Uyghur ethnic group in Xinjiang, China.

BACKGROUND: Non-communicable diseases (NCDs) are showing an increasing trend globally as well as in China. Elderly population are more prone to these NCDs. Situation in China is worse owing to the higher proportion of geriatric population. Burden of NCDs and the role of their socio-demographic and behavioral predictors among these elderly and more so among the ethnic minority groups among them, need to be investigated specifically, owing to their distinct genetic background, lifestyles and behavior. METHODS: A cross-sectional study was conducted among 1329 randomly selected persons of Uyghur ethnicity, aged 60 years or more in Xinjiang, the largest administrative division in China to measure the burden of NCDs, understand the distribution of socio-demographic, behavioral and life event-related potential correlates of them and to estimate the association of the NCDs with these correlates. RESULTS: Among these participants 54.2% were female, 86.8% were married and more than half had only attended elementary school or less. 41.46% was suffering from at least one NCD. 20.22% had one NCD, 12.11% had two and 8.58% had three or more. 27.3% had hypertension, 4.06% had diabetes, 6.02% had hyperlipidemia, 7.37% had angina, 14.52% had cardiovascular diseases, 11.59% had any kind of cancers and 9.78% had chronic obstructive pulmonary diseases. Rural residents (OR = 1.45, 95% CI: 1.17-1.80, AOR = 2.00, 95% CI: 1.53-2.61) and current smokers had higher odds of having more NCDs (AOR = 1.53, 95% CI: 1.00-2.34). Additionally not being satisfied with current life, not being able to take care of self in daily life, currently not being involved in farm work, less intake of fresh vegetables, fruits and garlic, too less or too much salt intake, not having hobbies were found to be positively associated with having more NCDs. CONCLUSION: Implementation of effective intervention strategies to promote healthy life styles among the Uyghur elderly population of China seems urgent.

siRNA against KIR3DL1 as a potential gene therapeutic agent in controlling HIV-1 infection.

OBJECTIVES: The aim of this study was to develop a small interfering RNA (siRNA) against the expression of KIR3DL1 receptor on natural killer (NK) cells, in order to promote the ability of NK cells to destroy human immunodeficiency virus (HIV)-infected cells and thus prevent failure of siRNA therapy targeting human immunodeficiency virus type 1 (HIV-1) virus among HIV-1 infected patients in vitro. METHODS: A siRNA targeting KIR3DL1 was synthesized and then modified with cholesterol, methylene, and sulfate. The inhibitory action of the siRNAs on primary cultured NK cells was detected. The amount of IFN-γ and TNF-α secretions in NK cells was measured. The intended functions of NK cells in vitro were analyzed by CFSE and PI methods. RESULTS: There were no significant differences in inhibiting the expression of KIR3DL1 on NK cells between the modified and unmodified siRNAs, while inhibition by each of them differed significantly from controls. The amount of IFN-γ and TNF-α secretions in the NK cells was abundant due to unsuccessful expression of KIR3DL1 on NK cells, which further promoted function of the NK cells. CONCLUSION: The siRNA against KIR3DL1 could enhance the ability of the NK cells to kill the HIV-1 infected cells in vitro and successfully prevented the failure of siRNA therapy targeting the HIV-1 virus. Therefore, it can act as a potential gene therapeutic agent among HIV-1 infected people.

Cognitive mediators and disparities in the relation between teen depressiveness and smoking.

BACKGROUND: Depressiveness and tobacco use in adolescents are linked, however, there is limited evidence about the cognitive mediators involved and how the role of mediators may differ by gender and racial/ethnic subgroups. METHODS: We used a racially/ethnically diverse population-based cross-sectional sample of middle and high school students (n=24,350). Logistic regression models measured the associations of depressiveness with tobacco smoking status, and whether smoking-related knowledge and attitudes (KA) and smoking refusal self-efficacy (SE) attenuated the associations indicating preliminary evidence of mediation. RESULTS: Depressiveness was associated with intention to smoke (OR=2.41; 95% CI=2.22, 2.61), experimental smoking (OR=1.93; 95% CI=1.72, 2.17) and established smoking (OR=1.85; 95% CI=1.57, 2.18). The percent attenuation of these associations due to the inclusion of smoking-related KA and smoking refusal SE was 58% for intention to smoke (p<0.001), 68% for experimental smoking (p<0.001) and 86% for established smoking (p<0.001). The association of depressiveness with established smoking did not remain statistically significant (OR=1.16; CI=0.97, 1.40) after including smoking-related KA and smoking refusal SE. Attenuation was more pronounced in males and white students. CONCLUSIONS: The results suggest that smoking-related KA and smoking refusal SE attenuated the relation between depressiveness and smoking, indicating that they may serve as mediators of the link between depressiveness and smoking. Tobacco use prevention programs targeting teens with the aim of increasing anti-smoking KA and smoking refusal SE may benefit from addressing depressiveness, particularly by using gender and racially/ethnically tailored strategies. The cross-sectional nature of the data precludes causal inferences.

Prevalence and predictors of HIV among Chinese tuberculosis patients by provider-initiated HIV testing and counselling (PITC): a multisite study in South Central of China.

BACKGROUND: Tuberculosis (TB) and HIV are two worldwide public health concerns. Co-infection of these two diseases has been considered to be a major obstacle for the global efforts in reaching the goals for the prevention of HIV and TB. METHOD: A comprehensive cross-sectional study was conducted to recruit TB patients in three provinces (Guangxi, Henan and Sichuan) of China between April 1 and September 30, 2010. RESULTS: A total of 1,032 consenting TB patients attended this survey during the study period. Among the participants, 3.30% were HIV positive; about one quarter had opportunistic infections. Nearly half of the participants were 50 years or older, the majority were male and about one third were from minority ethnic groups. After adjusting for site, gender and areas of residence (using the partial/selective Model 1), former commercial plasma donors (adjusted OR [aOR] = 33.71) and injecting drug users(aOR = 15.86) were found to have significantly higher risk of being HIV-positivity. In addition, having extramarital sexual relationship (aOR = 307.16), being engaged in commercial sex (aOR = 252.37), suffering from opportunistic infections in the past six months (aOR = 2.79), losing 10% or more of the body weight in the past six months (aOR = 5.90) and having abnormal chest X-ray findings (aOR = 20.40) were all significantly associated with HIV seropositivity (each p<0.05). CONCLUSIONS: HIV prevalence among TB patients was high in the study areas of China. To control the dual epidemic, intervention strategies targeting socio-demographic and behavioral factors associated with higher risk of TB-HIV co-infection are urgently called for.

Epidemiologic correlates of willingness to be tested for HIV and prior testing among married men in India.

There has been limited research in India on determinants of seeking HIV testing by Indian married couples. We analyzed data obtained from husbands of married couples participating in the National Family Health Survey 2005-06. Socio-demographic and behavioural predictors for willingness to be tested and self-reported prior testing were explored, using multivariate logistic regression. Factor scores were used to summarize knowledge variables related to HIV prevention and places of testing. Sixty-nine percent of the husbands were willing to be tested as part of National Family Health Survey 2005-06, and 7% reported some form of prior testing. Our results indicate that knowledge about HIV testing in hospitals and other health/welfare centres, knowledge about transmission of HIV, poor education, religion, economic status, occupation, early sexual debut, and use of contraceptives other than barrier methods were significant predictors for reported willingness to be tested. Knowledge about routes of transmission of HIV, younger age, educational level, religion other than Hindu or Muslim, economic status, occupation, history of blood transfusion, and condom use were significant correlates of previously being tested. Strategies to improve knowledge about HIV testing sites and HIV prevention may encourage married men to be tested and reduce the spread of infection from them to their wives.

Factors associated with unprotected anal intercourse among men who have sex with men: results from a respondent driven sampling survey in Nanjing, China, 2008.

Unprotected anal intercourse (UAI) is a well-documented risk factor for acquiring HIV, but not well-studied in China. We studied demographic and behavioral correlates for UAI among men who have sex with men (MSM) in a respondent-driven-sampling (RDS) survey in Nanjing, China. Four hundred and thirty MSM (including ten seeds) participated in this study, rendering an adjusted rate of UAI as 62.3 % (95 % CI 56.4-68.4 %). Adjusted HIV and syphilis prevalence rates were 6.6 % (95 % CI 3.0-10.4) and 12.6 % (95 % CI 8.1-18.3), respectively. HIV- and syphilis-positive cases were more likely to have engaged in UAI. Being unwilling to use condoms, meeting partners in non-conventional venues, having multiple male sex-partners in the past 6 months, having sex with regular and casual male partners in the past 6 months, and consumption of alcohol before sex were all positively associated with UAI. Based on the observed high prevalence of UAI among MSM in Nanjing, we can conclude that implementation of strategies to motivate MSM with high-risk behaviors to use condoms is urgently required in Nanjing.

Breast cancer screening among females in Iran and recommendations for improved practice: a review.

Breast cancer is the second most common cancer amongst women, in Iran comprising 21.4% of female cancers. There are several screening modalities for breast cancer including breast self-examination, clinical breast examination and mammography. This research reviews the literature surrounding the implementation of these screening approaches in the Islamic Republic of Iran. After initial results produced approximately 208 articles, a total of 96 articles were included because they specifically addressed epidemiological characteristics of breast cancer, culture, religion, health seeking behavior, screening programs and the health system in Iran. Literature showed that breast self-examination and clinical breast examination were most common as there is no population-based mammography screening program in Iran. Additionally, most women appear to obtain information through the mass media. Results also indicate that Islamic beliefs and preventative medicine are very much aligned and can be used to promote breast cancer screening in Iran. These results highlight that there is a need for aggressive preventative measures focusing on breast self examination and gradually moving towards national mammography programs in Iran ideally disseminated through the media with government support.