For Rapid HIV Testing, Community-based Pharmacies are Effective Locations

The researchers are from Albert Einstein College of Medicine of Yeshiva University. The study is in the August edition of the journal AIDS Patient Care and STDs. The Centers of Disease Control and Prevention (CDC) estimates that the number of new HIV infections each year in the United States has remained stubbornly stable for more than a decade at approximately 50,000. More than 1.1 million people in the U.S. are living with HIV. Nearly one in five of that group are unaware they are infected.

"There are many reasons why these numbers have not improved, but access to testing likely plays a large role," said Yvette Calderon, M.D., lead author for the study. "Access to healthcare remains particularly poor among low-income and minority populations - groups that shoulder the highest HIV burden. We have been looking for new ways to reach out and offer testing to individuals in these groups and bring them into care if they need it." Dr. Calderon is professor of clinical emergency medicine and associate dean for the office of diversity enhancement at Einstein, and adult urgent care director at Jacobi Medical Center.

The Bronx, where Einstein and Jacobi are located, is ethnically diverse and has one of the highest HIV rates in the country, with some groups at much higher risk than others. Nationally, the rate of new infections among African-Americans (8.7 per 100,000) is nearly eight-times greater than that of whites (11.5). Hispanics have the second-highest rate (29.3), which is three times that of whites.

Dr. Calderon and her Einstein-Jacobi colleagues Jason Leider, M.D., Ph.D., and Ethan Cowan, M.D., M.S., formed partnerships with five community-based pharmacies in the Bronx and Manhattan (Chelsea and Hell's Kitchen) in an effort to test hard-to-reach, high-risk individuals. Public Health Advocates (PHAs) were trained to approach people in the pharmacies and on the sidewalks outside to offer HIV testing. When an individual agreed, the PHA would administer the rapid HIV test, which needs only a swab of saliva and provides results in 20 minutes.

While waiting for the results, the PHAs asked the participants to fill out an HIV-risk factor and test satisfaction questionnaire, and then counseled them about HIV-risk reduction behavior based on their answers. If the HIV test result was positive, the PHA offered to escort the participant to the HIV clinic at Jacobi or a collaborating HIV clinic near the testing site, where they were seen immediately by an HIV specialist. All participants were allowed to accept or decline the escort. On average, HIV-positive clients saw an HIV specialist less than an hour after being diagnosed.

During 294 testing days, 2,030 individuals agreed to HIV testing, six of whom tested positive. Five of the six agreed to accompany the PHA to a HIV clinic. Further testing revealed that their median CD4 count was 622 white blood cells/mL, indicating they were diagnosed at a relatively earlier stage of infection. (A CD4 count above 500 for someone with HIV in treatment is considered good. The immune system of someone who is HIV-negative person would have a CD4 count of 700-1,000. CD4 counts for those who are HIV positive indicate the person has AIDS.)

"In many urban areas, community pharmacies play an important role," said Dr. Calderon. "While New York pharmacies are not currently allowed to provide blood tests or medical care, they do administer vaccines and provide wellness help. Many area residents view the pharmacists as trustworthy and more accessible than doctors and go to them for advice."

"Our results demonstrate that pharmacies can effectively supplement the current healthcare system for HIV testing, especially in some of our lower-income communities" said Dr. Calderon. "They could become an important component of an extended network for informing more people to their HIV status and bringing them into care."

Source-Eurekalert

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Tocilizumab effective in the treatment of arthritis juvenile idiopathic

Tocilizumab is a recombinant, humanized antibody that blocks receptors where Interleukin 6 (IL-6) is attached to the surface of the cells. 6 - It is impossible to attach to these cells, they are banned from lead to inflammation. Serum and joint fluid IL-6 levels were shown to be associated with the activity of the disease in patients with pcJIA.1

"JIA is a chronic arthritis in 1 child per 1,000. Without apparent cause, it can lead to joint damage and permanent disability. "These data demonstrate that tocilizumab improves rapidly of the signs and symptoms of pcJIA, with significant, maintained clinical responses in a large proportion of patients at week 40," said author Dr. Fabrizio De Benedetti of the Pediatric IRCCS Ospedale Bambino Gesu, Rome.

Speaking on behalf of the Paediatric Rheumatology International Trials Organization (Florence) and pediatric Rheumatology Collaborative Study Group (PRCSG), who supervised the study, Mr. De Benedetti has concluded that "these data suggest that tocilizumab is going to be a partly biological novel of the therapeutic arsenal for pcJIA."

CHERISH is a two year trial, 3 - part implemented in 58 centres in 15 countries. Patients aged 2-17 years were included in the study if they had pcJIA active for at least 6 months and had not responded to methotrexate (a cornerstone of therapy in the world for this condition).

Part 1 of the study was an open 16-week phase in which 188 patients received tocilizumab every four weeks. 166 Patients who have reached at least a 30% improvement in signs and symptoms of pcJIA (JIA ACR30 response *) were then part 2, which was a 24-week study in which patients were randomized to continue on the same dose of tocilizumab or receiving a placebo. Part 3 is a study in an ongoing open.

For primary point of end ACR30 rounded, fewer patients in tocilizumab group than in the placebo group experienced a flare of the week 40 (25.6% versus 48.1%) and JIA ACR30/50/70 * responses were significantly higher with tocilizumab than placebo, with up to 65% of children achieving an ACR70 response.

Determination of tocilizumab was based on the body weight of the patient (BW): with a BW 30 kg, the dose was 8 mg/kg [n = 119]; with a BW<30 kg,="" patients="" were="" randomly="" assigned="" to="" 8="" mg/kg="" [n="34]" or="" 10="" mg/kg="" [n="35].">

"The degree of improvement at week 16 was lower for each of the endpoints for patients under the age of 30 kg on tocilizumab 8 mg/kg than in the other two groups." The data therefore support the efficacy of tocilizumab in pcJIA by using a monthly scheme at doses of 8 mg/kg if BW 30 kg or more and 10 mg/kg if BW less than 30 kg, "said Benedetti.

The patients were also taking background medications, such as methotrexate and oral corticosteroids (respectively 79% versus 46%).

Tocilizumab safety profile was consistent with that of the other patients.2 tocilizumab treated with data security hack, 184 patients years of follow-up were produced in 188 patients recruited. The infection was the most common adverse event (164/100 patient years) and adverse events serious (4.9/100 patient years). Liver enzymes (ALT/AST) elevation 3 upper limit of normal occurred at 3.7%.<1% of="" patients,="" neutropenia=""><1000 cells/mm3)="" in="" 3.7%="" of="" patients,="" thrombocytopenia=""><50,000 cells/mm3)="" in="" 1.1%="" of="" patients.="" an="" elevation="" of="" ldl-cholesterol="" ??110="" mg/dl="" was="" reported="" in="" 11.4%="" of="" patients="" who="" received="" tocilizumab.="">

Source-Eurekalert

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High Protein Diet May Not be Very Effective in Reducing Body Weight and Risk of Heart Disease

The recent study published in the BioMed Central Nutrition Journal, aimed at identifying the long-term benefits of low protein diet and high protein diet in reducing body weight and risk of heart disease.

Researchers systematically reviewed 15 long term randomized control studies that compared low and high protein diets, low in fat, and estimated the dietary effects on weight, waist circumference, fat mass, total body cholesterol, LDL and HDL cholesterol, triacylglycerols, blood pressure, C-reactive protein (CRP), fasting glucose, fasting insulin and glycosylated hemoglobin.

Primary analysis of the findings revealed that a decrease in fasting insulin and an increase in good cholesterol (LDL cholesterol) were significant with high protein diets. However, with further analysis, the increase in HDL levels was attributed to the high fat content in the diet rather than the protein content.

The analysts note that the findings of the studies do not reveal any significant benefits of high protein diet on the biomarkers for obesity, heart disease and blood sugar level.

Hence, the authors opine that further research is required before high protein diets are recommended as a control measure for obesity and heart disease.

Reference:

Long-term effects of low-fat diets either low or high in protein on cardiovascular and metabolic risk factors: a systematic review and meta-analysis; Lukas et al; BMC Nutrition Journal 2013.

Source-Medindia

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