Vaccination against hepatitis B with 4-double doses increases response rates and antibodies titers in HIV-infected adults.

BACKGROUND: Antibody responses to standard regimens of hepatitis B (HBV) vaccination are lower in HIV-infected subjects and the best hepatitis B vaccine schedule in this population is not known. OBJECTIVE: To assess the immunogenicity and to evaluate predictors of serologic response of a modified regimen of a HBV recombinant vaccine in a cohort of HIV-infected subjects. METHODS: HIV-infected subjects received 4 doses (40 µg) of a recombinant HBV vaccine at 0, 1, 2 and 6 months. Demographic information as well as CD4 cell count and plasma viral load were assessed at baseline. Protective and strong responses were defined as an anti-HBs titer ≥10 mIU/mL and ≥100 mIU/mL, respectively and were evaluated one month after the third and the fourth doses. RESULTS: 163 HIV-infected individuals were evaluated 67 (40%) were male and median age was 37 years. Median CD4 cell count was 385 cells/mm(3) and 113 (70%) had undetectable HIV-1 viral load. Protective antibody response was observed in 83 and 91% and a strong antibody response was observed in 62 and 80% of the subjects after 3 and 4 doses, respectively. In a multivariate logistic model undetectable HIV-1 viral load and higher CD4 cell counts were independent predictors of a strong antibody response after 4 doses. Patients with undetectable HIV viral load were almost 3 times more likely to have anti-HBs titers above 100 mIU/mL than those with detectable viral load. CONCLUSIONS: A 4-double-dose regimen of a recombinant HBV vaccine increased response rates and determined higher antibody titers which may translate in prolonged protection against HBV. Inclusion of a fourth dose of HBV vaccine for HIV-infected subjects should be considered in the public health setting.

Expression of inflammatory cytokines and Toll-like receptors in the brain and respiratory tract of pigs infected with porcine reproductive and respiratory syndrome virus.

The objective of this experiment was to evaluate the central and peripheral expression of selected pro-inflammatory cytokines and Toll-like receptors (TLRs) in pigs infected with porcine reproductive and respiratory syndrome virus (PRRSV). Twenty-four 8-week-old pigs were inoculated with either sterile medium or PRRSV. Pigs were monitored 14d after inoculation and then euthanized for tissue sample collection. PRRSV was detected in serum, lung and brain tissue of pigs given PRRSV but not in any tissue of pigs given medium. Infection with PRRSV increased serum levels of IL-1beta, IL-6, TNFalpha, and IFNgamma and elicited a mild transient fever and reduced growth performance. Infection by PRRSV also increased mRNA for the pro-inflammatory cytokines as well as mRNA for TLR3, TLR4, and TLR7 in the tracheobronchial lymph nodes. The TLR3, TLR4, TLR7 and most of the pro-inflammatory genes also were up-regulated in discrete brain areas of PRRSV-infected pigs. Collectively, the results indicate that following inoculation, PRRSV is present in the periphery and brain and that infection is associated with a peripheral and central pro-inflammatory response, fever, and reduced growth performance. The findings are interpreted to suggest the innate immune system of the brain is responsive to PRRSV infection.

High rates of serological response to a modified hepatitis B vaccination schedule in HIV-infected adults subjects.

We evaluated a modified HBV regimen in a cohort of HIV-infected subjects in Rio de Janeiro, Brazil. HIV-infected subjects with no serologic evidences of previous hepatitis B infection were immunized with 4 doses (40 microg each) of recombinant hepatitis B vaccine given at 0, 1, 2 and 6 months. Blood samples were collected 1 month after the last dose and anti-HBs titers were measured. A protective antibody response was defined as an anti-HBs titer >or=10 mIU/mL. Forty-seven subjects (30 women, 17 men; mean age was 36 years, ranging from 21 to 58 years) were included in the final analysis. Median baseline CD4+ lymphocyte count was 402 cells/mm(3) and 33 subjects (70%) had an HIV viral load below 80 copies/mL. A protective antibody response was observed in 42 (89%) subjects. Thirty-seven (78%) and 28 (60%) patients developed anti-HBs titers higher than 100 mIU/mL and 1000 mIU/mL, respectively. 1 out of 5 non-responders (20%) had an HIV viral load below the detection limit, in contrast with 32 (76%) of those with an adequate serologic response (p=0.02). These findings suggest that 4-double dose alternative schedule may be considered to overcome the lower seroconversion rates observed with the standard regimens in HIV-infected subjects.

Trends in HCV prevalence, risk factors and distribution of viral genotypes in injecting drug users: findings from two cross-sectional studies.

In the last decade, a declining prevalence of HCV infection has been described in injecting drug users (IDUs) in different countries. This study is the first to assess temporal trends in drug-injecting patterns, HCV infection rates and viral genotype distribution in 770 Brazilian IDUs, recruited by two cross-sectional studies (1994-1997 and 1999-2001). A substantial decline in the prevalence of HCV infection was found over the years (75% in 1994 vs. 20.6% in 2001, P<0.001) that may be a consequence of the significant reduction in the overall frequencies of drug injection and needle-sharing, as well as the participation of IDUs in initiatives aimed at reducing drug-related harm. No trend was found in terms of viral genotype distribution. Despite the favourable scenario, preventive measures must be maintained, especially in vulnerable subgroups such as young or new injectors, where risky behaviours through direct and indirect sharing practices remain common.

Shirley Glasstone Hughes Memorial Prize for Dental Research: an evaluation of the output 15 years after the Trust's inception.

In May 2005, a decision was taken by the Shirley Glasstone Hughes (SGH) Foundation trustees to suspend investments in research for one year, to allow a review of the outcomes of SGH research funding over the past 15 years. Money was instead directed to the BDA Research Unit, to employ a staff member who would conduct the evaluation under the supervision of the BDA Scientific Adviser. The evaluation focused on three aspects of the research produced: 1) relevance to primary dental care, 2) scientific quality and impact on the research community, and 3) grant recipients' feelings about SGH funding and whether the mechanisms of supporting research could be improved. The methods used included questioning BDA members about the research they found of interest and relevance, checking research outputs against standardised quality criteria, examining impact factors and citation rates (relative to the funding received) and questioning grant recipients about their experience with SGH funding. The results implied that the fund had largely been spent on research themes felt to be relevant to practice by BDA members. In addition, the publication rate, publication quality, impact and citation indices demonstrated the SGH research work to be largely of high quality. Recipients of the fund indicated several factors which might improve the experience of receiving funding and possibly also improve the research output. It can be concluded that the SGH funds have largely been well spent but that it is worth considering implementing changes which would make the research findings of greater relevance to clinical practice.

Effects of mannan oligosaccharide and an antimicrobial product in nursery diets on performance of pigs reared on three different farms.

The objective of this experiment was to compare the effects of dietary mannan oligosaccharide (MOS) and a feed-grade antimicrobial (AM) on growth performance of nursery pigs reared on three different farms (A and B were large-scale commercial farms, and C was located at Michigan State University). On all farms, production was continuous flow by building, but all-in/all-out by room. Within each nursery facility, all pigs on the experiment were in one room. Pigs (Farm A, n = 771, weaning age = 18.4 d; Farm B, n = 576, weaning age = 19.0 d; Farm C, n = 96, weaning age = 20.6 d) were blocked (within farm) by BW and sex and allotted randomly to dietary treatments arranged in a 2 x 2 factorial. The two factors were 1) with and without MOS (0.3% in Phase I, 0.2% in Phases II, III, and IV; as-fed basis) and 2) with and without AM (110 mg of tylosin and 110 mg of sulfamethazine/kg of diet in all phases; as-fed basis). The four nursery phases were 4, 7, 14, and 17 d, respectively. With 35, 20, and 4 pigs per pen on Farms A, B, and C, respectively, space allowances per pig were 0.29, 0.26, and 0.56 m2. Across all farms, the addition of AM and MOS plus AM increased (P < 0.05) ADG (368, 406, and 410 g/d for control, AM, and MOS plus AM, respectively and increased ADFI (661, 703, and 710 g/d for control, AM, and MOS plus AM, respectively) for the entire 42-d experiment. The addition of MOS also increased ADG (P < 0.05) from d 0 to 42 of the experiment (394 g/d). Performance differed depending on farm (P < 0.01). Antimicrobial did not affect growth performance on Farm B, but it increased (P < 0.05) ADG on Farms A and C, ADFI on Farm A, and G:F on Farm C. Growth improvements with MOS on Farms A and B were not significant; however, pigs on Farm C fed MOS had greater (P < 0.05) ADG, ADFI, and G:F than controls. The results of this study suggest that MOS may be an alternative to tylosin and sulfa-methazine as a growth promotant in nursery diets.

Assessing the cariogenic potential of some infant formulas, milk and sugar solutions.

Using a desalivated rat model, the authors found that several commonly used infant formulas had significant cariogenic potential. Sucrose was by far the most cariogenic and cows' milk the least cariogenic of all the products examined. The data show that dental practitioners and other health care professionals should discourage the use of sugar in baby bottles and provide information on which formulas are least likely to induce caries when continuous bottle feeding is unavoidable.

Effects of iron salts in sucrose on dental caries and plaque in rats.

Anaemia caused by iron deficiency and dental caries are still among the most prevalent diseases in some developing countries. Anaemia can be prevented by iron fortification of food. Previous studies demonstrated that iron-sucrose, which has been used for prevention of anaemia, reduces the incidence of caries in rats. The aim of the present study was to compare the influence of ferrous sulphate and ferric glycerophosphate co-crystallized with sucrose on the incidence of dental caries in rats. Forty-eight desalivated rats were caged in a programmed feeder and received their essential nutrition by gavage. The animals were fed 17 meals per day at hourly intervals of 88 parts/10(6) Fe++ or Fe co-crystallized with sucrose. Plain sucrose and calcium glycerophosphate with sucrose were used as control groups. Both ferric- and ferrous-sucrose meals reduced the incidence of smooth-surface and sulcal caries in rats. Stain formation, organic acid production and acidogenic activity of dental plaque in animals receiving iron-sucrose meals were also investigated. Ferric glycerophosphate did not induce extrinsic staining on the tooth surface. The concentration of organic acids did not differ significantly among the groups. The acidogenic activity of plaque in animals receiving either of the iron-sucrose meals tended to be lower than that of the control groups. The possibility that iron-sucrose might reduce the prevalence of two major public health problems, dental caries and anaemia, makes this preventive approach extremely attractive for additional investigation.

Effects of frequency of exposure to iron-sucrose on the incidence of dental caries in desalivated rats.

World Health Organization (WHO) estimates that 2.5 billion people have anemia caused by iron deficiency that could be prevented by fortification of food; sugar, for example, has been used successfully as a vehicle for dietary iron fortification. The inclusion of 88 ppm of iron (as FeSO4) co-crystallized with sugar has been shown to reduce the incidence of caries by more than 30% when rats are fed 17 meals daily at hourly intervals. The purpose of the present study was to determine the influence of varying the number of daily exposures to iron on caries in desalivated rats. Four litters of 12 Sprague-Dawley rats were desalivated when aged 25 days and caged in a programmed feeder. All animals received their essential nutrition by gavage and 17 meals of sucrose daily. In Group A, 6 meals contained 88 ppm Fe; in Group B, 3 meals continued iron: Group C had 2 meals, and in Group D, no iron was added. The investigation continued for 3 weeks. Smooth-surface and sulcal (in parentheses) caries scores were: Group A 60.8 (39.4); Group B 72.4 (41.3); Group C 73.1 (41.3), and Group D 92.9 (49.2). Caries scores in all the iron groups were statistically lower than in the control group. Severity scores followed a similar pattern. Thus, as few as 2 daily exposures to iron-sucrose had a significant effect on caries development; therefore the use of iron as a cariostatic agent is worthy of further exploration. The concept that two major public health problems could be alleviated by the addition of iron to sucrose is indeed attractive.

Influence of iron alone or with fluoride on caries development in desalivated and intact rats.

Sugar is used as a vehicle for iron fortification in communities where anemia is prevalent. The purpose of the present study was to investigate the relationship between caries experience and iron concentration in sugar fed to rats subjected to a severe cariogenic challenge. Desalivated and intact animals were assigned to 4 different diet subgroups, 3 receiving iron sucrose (350, 175 and 88 ppm Fe) and a control group. The influence of iron sugar combined with 10 ppm F in drinking water was explored in an additional study. Iron reduces the incidence of smooth-surface carries in desalivated rats at concentrations as low as 88 ppm Fe. In addition, a combination of iron and fluoride reduced the incidence of dental caries in our rats.

[Colonoscopy and "hot" biopsy. Its value in vascular ectasias of the colon]. / Colonoscopía y biopsia "caliente". Su valor en las ectasias vasculares del colon.

According to Gerald Rogers et. al., we believe about the usefulness of colonoscopy and endoscopic biopsy using Williams' forcep (hot biopsy forcep) for the diagnosis and final treatment of colon vascular ectasias. This method should be used immediately after the hemorrhage has finished. Angiography is prescribed when: 1) endoscopy suggests or confirm the presence of vascular ectasias in order to establish the degree of lesions and the therapeutic management. 2) When the caecum cannot be reached by the colonoscope. 3) When endoscopy is negative and there is firm clinic assumption of ectasias but the colonoscopic study has been done to much later after the bleeding stopped. Selective angiography would be the first prescription in case of bleeding which doesn't stop quickly with the necessity of immediate therapeutic measures taking into account the difficulties of intrahemorrhagic colonoscopy. Five cases are presented to support this point of view concerning the diagnosis of vascular ectasias of the right colon and considerations are made about local treatment by mean of colonoscopy and hot biopsy forcep which, when it's possible, has less morbidity and mortality than surgery, specially in attention than this is an entity concerning elderly patients.