The COVID-19 pandemic has disrupted access to critical health services, resulting in diminished gains in HIV epidemic control. This review assesses the magnitude of the impact that the COVID-19 ...pandemic has had on HIV services for adolescents.
PEPFAR Monitoring, Evaluation, and Reporting programmatic data were analyzed from across 16 USAID-supported adolescent care and treatment programs for fiscal year 2020 (FY20; October 2019-September 2020). Descriptive statistics were used to calculate absolute number and percent change between the pre-COVID-19 (Quarters 1-2; October 2019-March 2020) and COVID-19 periods (Quarters 3-4; April 2020-September 2020) for clinical cascade indicators. All analyses were conducted in Microsoft Excel.
The number of HIV tests conducted during COVID-19 decreased by 21.4% compared with pre-COVID-19, with a subsequent 28% decrease in adolescents identified living with HIV. The rate of proxy linkage to antiretroviral therapy increased between periods, from 86.9% to 90.4%. There was a 25.9% decrease in treatment initiations among adolescents during COVID-19. During FY20, viral load coverage rates for adolescents dropped from 81.6% in FY20Q1 to 76.5% in FY20Q4, whereas the rates of viral load suppression for adolescents increased from 76.1% in FY20Q1 to 80.5% in FY20Q4.
There was a substantial decrease in case-finding, treatment initiations, and viral load coverage rates for adolescents supported in USAID/PEPFAR programs during the COVID-19 pandemic. Additional health systems adaptations and strategies are required to ensure adolescents have continued access to HIV services during pandemic disruptions.
The spontaneous recruitment of acute coronary collaterals in the setting of an ST elevation myocardial infarction (STEMI) is seen frequently in those patients undergoing primary percutaneous coronary ...intervention (pPCI) and is associated with improved clinical outcomes. However, it is unknown whether in patients who present with a recurrent STEMI, the degree of collateral recruitment remains the same as in the index procedure. We reviewed all patients presenting to our tertiary centre with a STEMI undergoing primary or rescue percutaneous coronary intervention (PCI) from July 2010 until December 2018. We identified patients who presented with a recurrent STEMI following their index procedure. We defined patients with poor collateral recruitment as Rentrop grade 0 or 1, whilst patients with robust collateral recruitment as Rentrop grade 2 or 3. Of the 1795 patients who were identified, there were 27 cases in 25 patients who presented with a repeat STEMI following their index procedure. The median time between cases was 12.8 days (IQR 2.3–589.5 days). Compared to the index case, there was no statistically significant difference in the degree of collateral recruitment in recurrent presentations (
Z
= − 0.378,
p
= 0.70). In those patients presenting more than 6 months following the index procedure, the median time between cases was 654.5 days (IQR 479.5–1151.9). There was no difference in the degree of collateral recruitment in recurrent presentations (
Z
= 0.000,
p
= 1.0). Cases which had poorer collateral recruitment in recurrent presentations were less likely to be current smokers (0% vs 50%,
p
< 0.001) and less likely to have diabetes (0% vs 27.3%,
p
< 0.05) The recruitment of spontaneous coronary collaterals remains constant in recurrent STEMI presentations suggesting an innate biological process rather than merely a manifestation of alteration of haemodynamic blood flow. Further investigations to identify these processes is required.
The predictors and prognostic implications of well-matured collaterals in those with a chronic total occlusion (CTO) are unknown. We sought to identify the determinants of collateral maturation and ...to determine its effects on procedural outcomes and prognosis.Patients presenting for CTO percutaneous coronary intervention (PCI) between April 2010 and July 2019 were included. Patients with a previous coronary artery bypass (CABG) to the CTO and those with only bridging collaterals were excluded. The degree of collateral maturation was determined by the Rentrop grading classification. Demographic, biochemical, and anatomical factors and procedural and longer-term outcomes were identified.A total of 212 patients were included in the study. Patients with well-matured collaterals were more likely to be females (29.7% versus 15.2% versus 0%, P < 0.005 for Rentrop grade 3, 2, and 0 or 1, respectively), less likely to have chronic kidney disease (CKD) (8.8% versus 4.5% versus 19.2%, P < 0.05) and less likely to have had a prior CABG (15.6% versus 18.7% versus 19.2%). Patients with well-matured collaterals had lower neutrophil-to-leukocyte ratio (NLR) (2.8 versus 4.0 versus 5.7, P < 0.0001). Patients with well-matured collaterals were more likely to have procedural success (90.5% versus 62.5% versus 34.6%, P < 0.0001). The degree of collateral maturation was not associated with longer-term mortality.Improved collateral maturation was associated with female sex and lower rates of CKD and CABG and a lower NLR. Those with well-matured collaterals had a significantly higher rate of procedural success but not improved prognosis.
Elevated blood pressure, dyslipidemia, and impaired glycemic control are well-established cardiovascular risk factors in Europeans, but there are comparatively few studies focused on East Asian ...populations. This study evaluated the potential causal relations between traditional cardiovascular risk factors and disease risk in East Asians through a 2-sample Mendelian randomization approach. We collected summary statistics for blood pressure parameters, lipid subsets, and type 2 diabetes mellitus liability from large genome-wide association study meta-analyses conducted in East Asians and Europeans. These were paired with summary statistics for ischemic heart disease (IHD), ischemic stroke (IS), peripheral vascular disease, heart failure (HF) and atrial fibrillation (AF). We performed univariable Mendelian randomization analyses for each exposure-outcome pair, followed by multivariable analyses for the available lipid subsets. The genetically predicted risk factors associated with IHD and AF were similar between East Asians and Europeans. However, in East Asians only genetically predicted elevated blood pressure was significantly associated with IS (odds ratio 1.05, 95% confidence interval 1.04 to 1.06, p <0.0001) and HF (odds ratio 1.05, 95% confidence interval 1.04 to 1.06, p <0.0001), whereas nearly all genetically predicted risk factors were significantly associated with IS and HF in Europeans. In conclusion, this study provides supportive evidence for similar causal relations between traditional cardiovascular risk factors and IHD and AF in both East Asian and European ancestry populations. However, the identified risk factors for IS and HF differed between East Asians and Europeans, potentially highlighting distinct disease etiologies between these populations.
In 2020, an estimated 150,000 infants acquired HIV infection through vertical transmission. With pregnant and breastfeeding women facing numerous social and health system barriers, continuity of care ...for mother-infant pairs (MIPs) requires prioritized engagement for timely infant HIV testing and linkage to treatment.
PEPFAR Monitoring, Evaluation, and Reporting indicators were analyzed from across 14 USAID-supported countries across 3 fiscal years (FYs) (October 2018-September 2021): number of HIV-exposed infants (HEIs) with a sample collected for an HIV test by age 2 months, percentage of HEI who received an HIV test by age 2 months (EID 2 mo coverage), and final outcome status of HEIs. Qualitative information on implementation of PVT interventions was gathered using a structured survey disseminated to USAID/PEPFAR country teams.
From October 2018 to September 2021, 716,383 samples were collected for infant HIV tests. EID 2 mo coverage increased across the FYs from 77.3% in FY19% to 83.5% in FY21. Eswatini, Lesotho, and South Africa demonstrated the highest EID 2 mo coverage across all 3 FYs. Burundi (93.6%), DRC (92%), and Nigeria (90%) had the highest percentage of infants with a known final HIV outcome. Qualitative survey data showed that the most implemented interventions used by the countries were mentor mothers, appointment reminders, cohort registers, and joint provision of MIP services.
Achieving eVT requires a client-centered and multipronged approach, typically combining several PVT interventions. Country and program implementers should use person-centered solutions to best target MIPs to be retained in the continuum of care.
Large observational studies have demonstrated a clear inverse association between renal function and risk of aortic stenosis (AS). Whether this represents a causal, reverse causal or correlative ...relationship remains unclear. We investigated this using a bidirectional 2-sample Mendelian randomization approach.
We collected summary statistics for the primary analysis of chronic kidney disease (CKD) and AS from genome-wide association study meta-analyses including 480 698 and 653 867 participants, respectively. We collected further genome-wide association study summary statistics from up to 1 004 040 participants for sensitivity analyses involving estimated glomerular filtration rate (eGFR) derived from creatinine, eGFR derived from cystatin C, and serum urea nitrogen. Inverse-variance weighted was the primary analysis method, with weighted-median, weighted-mode, Mendelian randomization-Egger, and Mendelian randomization-Pleiotropy Residual Sum and Outlier as sensitivity analyses. We did not find evidence of a causal relationship between genetically predicted CKD liability as the exposure and AS as the outcome (odds ratio OR, 0.94 per unit increase in log odds of genetic liability to CKD 95% CI, 0.85-1.04,
=0.26) nor robust evidence of AS liability as the exposure and CKD as the outcome (OR, 1.04 per unit increase in log odds of genetic liability to AS 95% CI, 0.97-1.12,
=0.30). The sensitivity analyses were neutral overall, as were the analyses using eGFR derived from creatinine, eGFR derived from cystatin C, and serum urea nitrogen. All positive controls demonstrated strong significant associations.
The present study did not find evidence of a substantial effect of genetically predicted renal impairment on risk of AS. This has important implications for research efforts that attempt to identify prevention and treatment targets for both CKD and AS.
Despite appropriate guidelines, healthcare services worldwide often fail to deliver high‐impact evidence‐based care. This case study describes a large‐scale programme to improve integrated postpartum ...care for mothers and newborns in Niger and Mali. As a result of an improvement effort based on common objectives, local ownership and shared learning to accelerate implementation of best practices, 78 facilities demonstrated rapid improvement in compliance with standards for post‐partum haemorrhage prevention and Essential Newborn Care as well as a reduction in estimated postpartum haemorrhage. This approach yields rapid results and can be efficiently spread to improve care in low‐resource settings.
Electrospinning has by far proved to be the most successful method to spin high aspect and surface area to volume ratio nanofiber for multidisciplinary applications. Its application, however, as ...reinforcement in fiber reinforced polymer matrix composites (FRPC's) started from interlaminar fracture toughness improvement through interleaving. Since then, its usage both in short fiber and nonwoven mat formation has been phenomenally increased to tailor mechanical properties. This review paper focuses on application of nanofiber in multiscale reinforced epoxy matrix composites for mechanical performance. After a brief overview of electrospinning and spinning parameters, it presents a case for nanofiber as reinforcement with attendant mechanisms to develop insight into nanocomposite performance. Next, it summarizes and shares findings of studies, carried out in last 10 years, seeking to enhance tensile, flexural, interlaminar toughness, impact, and fatigue properties of epoxy composites through electrospun nanofiber reinforcement. Finally, it presents a perspective to gain headways in nanofiber reinforced FRPC's research through a variety of processing and material variables.
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