Early infant diagnosis of HIV: review of current and innovative practices.

Purpose Of Review: Only 51% of HIV-exposed infants receive an HIV test between 4 and 6 weeks of age, with even lower repeat testing rates at older ages, and only 49% of infants tested are initiated on antiretroviral therapy. The purpose of this article is to discuss potential solutions for increasing coverage of early infant diagnosis (EID), decreasing turnaround time for result return, improving linkages to care and treatment and fulfilling the objective of improving outcomes for HIV-infected children.

Recent Findings: Differences in HIV testing guidelines have emerged in different countries, with some recommending HIV testing at birth.

Attitudes of medical school deans toward interprofessional education in Western Pacific Region countries.

To examine the attitudes of medical school deans toward interprofessional education (IPE) and collaborative practice (CP), we conducted survey research in the Western Pacific Region. This regional survey was conducted as a collaborative research project with the World Health Organization. A survey was distributed to the medical school deans in Malaysia, the Philippines, Republic of Korea and Japan.

Educating a new generation of doctors to improve the health of populations in low- and middle-income countries.

Francesca Celletti and colleagues from WHO argue that a transformation in the scale-up of medical education in low- and middle-income countries is needed, and detail what this might look like.

Task-shifting in HIV care: a case study of nurse-centered community-based care in Rural Haiti.

Introduction: At least 36 countries are suffering from severe shortages of healthcare workers and this crisis of human resources in developing countries is a major obstacle to scale-up of HIV care. We performed a case study to evaluate a health service delivery model where a task-shifting approach to HIV care had been undertaken with tasks shifted from doctors to nurses and community health workers in rural Haiti.

Methods: Data were collected using mixed quantitative and qualitative methods at three clinics in rural Haiti.

Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries.

National health systems need strengthening if they are to meet the growing challenge of chronic diseases in low-income and middle-income countries. By application of an accepted health-systems framework to the evidence, we report that the factors that limit countries' capacity to implement proven strategies for chronic diseases relate to the way in which health systems are designed and function. Substantial constraints are apparent across each of the six key health-systems components of health financing, governance, health workforce, health information, medical products and technologies, and health-service delivery.

Can the deployment of community health workers for the delivery of HIV services represent an effective and sustainable response to health workforce shortages? Results of a multicountry study.

In countries severely affected by HIV/AIDS, shortages of health workers present a major obstacle to scaling up HIV services. Adopting a task shifting approach for the deployment of community health workers (CHWs) represents one strategy for rapid expansion of the health workforce. This study aimed to evaluate the contribution of CHWs with a focus on identifying the critical elements of an enabling environment that can ensure they provide quality services in a manner that is sustainable.

An assessment of interactions between global health initiatives and country health systems.

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes.

Can non-physician health-care workers assess and manage cardiovascular risk in primary care?

Objective: To ascertain the reliability of applying the WHO Cardiovascular Risk Management Package by non-physician health-care workers (NPHWs) in typical primary health-care settings.

Methods: Based on an a priori 80% agreement level between the NPHWs and the "expert" physicians (gold standard), 649 paired (matched) applications of the protocol were obtained for analysis using Kappa statistic and multivariate logit regression.

Findings: Results indicate over 80% agreement between raters, from moderate to perfect levels of agreement in almost all of the sections in the package.

Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point.

Objective: Assess capacity of health-care facilities in a low-resource setting to implement the absolute risk approach for assessment of cardiovascular risk in hypertensive patients and effective management of hypertension.

Design And Setting: A descriptive cross-sectional study in Egbeda and Oluyole local government areas of Oyo State in Nigeria in 56 randomly selected primary- (n = 42) and secondary-level (n = 2) health-care and private health-care (n = 12) facilities.

Participants: One thousand consecutive, known hypertensives attending the selected facilities for follow-up, and health-care providers working in the above randomly selected facilities, were interviewed.

Inhibition of vascular endothelial growth factor-mediated neointima progression with angiostatin or paclitaxel.

Purpose: Therapeutic angiogenesis represents a new paradigm for treatment of ischemic vascular syndromes. However, vascular endothelial growth factor (VEGF) enhances the rate and degree of plaque formation. This study evaluates the potential to block these effects nonspecifically with paclitaxel or specifically with angiostatin.

Magnetic resonance imaging evaluation of aortic elastic properties as early expression of Marfan syndrome.

In Marfan syndrome, early identification and treatment of aortic involvement could improve prognosis, but clinical diagnosis may be difficult at a young age, before aortic dilation occurs. The aim of this study was to evaluate biomechanical aortic properties in Marfan patients and in their relatives to identify an early index of aortic involvement. A magnetic resonance imaging (MRI) morphologic and functional study of the thoracic aorta was performed in 20 Marfan patients, 15 family members, and 14 healthy volunteers as a control group.

Effect of human recombinant vascular endothelial growth factor165 on progression of atherosclerotic plaque.

Objectives: This study was designed to evaluate the impact of recombinant human vascular endothelial growth factor165 (rhVEGF) on atherosclerotic plaque progression.

Background: Therapeutic angiogenesis represents a promising treatment for ischemic diseases. However, angiogenesis may impact atherosclerosis.

Vascular endothelial growth factor enhances atherosclerotic plaque progression.

Vascular endothelial growth factor (VEGF) can promote angiogenesis but may also exert certain effects to alter the rate of atherosclerotic plaque development. To evaluate this potential impact on plaque progression, we treated cholesterol-fed mice doubly deficient in apolipoprotein E/apolipoprotein B100 with low doses of VEGF (2 microg/kg) or albumin. VEGF significantly increased macrophage levels in bone marrow and peripheral blood and increased plaque area 5-, 14- and 4-fold compared with controls at weeks 1, 2 and 3, respectively.

Composite graft replacement of the ascending aorta: leakage detection with gadolinium-enhanced MR imaging.

Purpose: To assess the value of magnetic resonance (MR) imaging in the detection of postoperative complications after composite valve graft replacement.

Materials And Methods: Spin-echo and gradient-echo MR imaging was performed in 52 patients 1/2 to 200 months after composite graft replacement of the ascending aorta (22 for dissection, 30 for aneurysm). The prosthetic aortic segment, distal and proximal anastomoses, general morphologic characteristics, and diameter of the reimplanted coronary arteries were evaluated.

Effects of wave reflection timing on left ventricular mechanics.

Unlabelled: The aim of this study was to evaluate how the timing of the pressure pulse produced by peripheral reflection affects the left ventricle (stroke volume, ventricular work, coronary driving pressure). Ten isolated perfused rabbit hearts were attached to rubber tubes of different lengths (0.5, 0.

Assessment of restrictive cardiomyopathy of amyloid or idiopathic etiology by magnetic resonance imaging.

This study was designed to assess the role of magnetic resonance imaging in the differential diagnosis of amyloid and idiopathic etiology of cardiomyopathy. This technique demonstrated the capability to differentiate the 2 forms, providing high-resolution evaluation of the myocardial wall and detecting the infiltrative pathology by tissue characterization.

Contribution of magnetic resonance imaging in the differential diagnosis of cardiac amyloidosis and symmetric hypertrophic cardiomyopathy.

Background: Magnetic resonance imaging (MRI) provides a high-resolution study of atrial and ventricular myocardium depicting morphologic alterations in cardiomyopathies. Furthermore, in systemic amyloidosis, MRI demonstrates the capability to detect amyloid protein by tissue characterization. The aim of this study was to evaluate the potential of MRI in the diagnosis of cardiac amyloidosis.

Evolution of post-traumatic aortic aneurysm in the subacute phase: magnetic resonance imaging follow-up as a support of the surgical timing.

Objectives: A recent surgical series documented that in traumatic aortic rupture (TAR) a surgical repair postponed to the treatment of associated lesions reduced operative and overall mortality. Nevertheless some isolated cases may develop to free rupture. Until now, no imaging follow-up studies of post-traumatic aortic lesions have been reported in the early stage.

Intramural posttraumatic hematoma of the ascending aorta in a patient with a double aortic arch.

We report a case of posttraumatic intramural hematoma (IMH) of the ascending aorta in a patient with a double aortic arch and coronary artery disease. This unusual and asymptomatic finding came to our observation because the patient presented an acute myocardial infarction and underwent coronary angiography. The diagnosis was performed by magnetic resonance imaging (MRI) which defined well the anatomy of aorta and showed the characteristics of the hematoma.

Delayed surgery of traumatic aortic rupture. Role of magnetic resonance imaging.

Background: Traumatic aortic rupture (TAR) is a pathological entity with a high mortality, both spontaneous and perioperative. Delayed surgical repair has been proposed when associated lesions are stabilized. The aim of this study was to validate MRI for detecting both the presence and type of TAR and to monitor posttraumatic aneurysm and associated lesions.

[Diagnostic contribution of magnetic resonance in clinically suspected arrhythmogenic dysplasia of the right ventricle].

Backgrounds: Magnetic Resonance (MR) imaging gives information about the complex anatomy of the right ventricle (RV). Because of the capability of tissue characterization, in addition to the functional and morphologic analysis, MR imaging is an optimal technique to investigate patients (pts) with clinical suspicion of arrhythmogenic right ventricular dysplasia (ARVD).

Methods: The purpose of the current study was to investigate a group of 55 pts with ventricular arrhythmias in order to detect ARVD.