| 1. |
- Freedman, Ben, et al.
(författare)
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Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration
- 2017
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Ingår i: Circulation. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-7322 .- 1524-4539. ; 135:19, s. 1851-
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Tidskriftsartikel (refereegranskat)abstract
- Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country-and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.
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| 2. |
- Fuchs, Dietmar, et al.
(författare)
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Increase of tryptophan in serum and in cerebrospinal fluid of patients with HIV infection during zidovudine therapy
- 1996
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Ingår i: Adv Exp Med Biol. ; 398, s. 131-4
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Tidskriftsartikel (refereegranskat)abstract
- A high percentage of patients with human immunodeficiency virus infection presents with decreased tryptophan concentrations in serum and cerebrospinal fluid. In parallel degradation products of tryptophan like kynurenine and quinolinic acid are increased. We investigated the behavior of tryptophan concentrations in 14 patients with HIV infection before and during treatment with zidovudine, and we found a significant increase of tryptophan in serum and cerebrospinal fluid after 4-14 months of therapy. In parallel, neopterin concentrations decreased significantly. Moreover, an association existed in cerebrospinal fluid between the degree of tryptophan increase and neopterin decrease. Thus, treatment with zidovudine contributes to a gradual normalization of tryptophan metabolism in patients with HIV-1 infection. The data imply that zidovudine therapy is associated not only with a reduction of virus replication but also immune activation is reduced.
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| 3. |
- Gisslén, Magnus, 1962, et al.
(författare)
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Markers of immune stimulation in the cerebrospinal fluid during HIV infection: a longitudinal study
- 1994
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Ingår i: Scand J Infect Dis. - : Informa UK Limited. ; 26:5, s. 523-33
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Tidskriftsartikel (refereegranskat)abstract
- Markers of immune stimulation were studied in 76 sequential cerebrospinal fluid (CSF) samples from 19 patients infected with HIV-1 without antiretroviral treatment during observation periods ranging from 22 months to 6 years. Eight of these patients were further followed with 14 CSF samples for 3-24 months of zidovudine treatment. During the course of HIV-1 infection, the mean CSF neopterin and beta 2-microglobulin (beta 2M) concentrations increased from 12.7 to 20.4 nmol/l (p < 0.01) and from 1.93 to 2.17 mg/l (p < 0.05), respectively, while the mean peripheral CD4 + T cell count decreased from 624 to 320 cells x 10(6)/l (p < 0.001). The IgG index, reflecting intrathecal immunoglobulin production, increased from 0.72 to 0.92 (p = 0.08). The number of patients with CSF pleocytosis did not change significantly during follow-up (8/19 at baseline, 7/19 at endpoint). In the 8 patients followed up during antiretroviral treatment, a significant reduction in mean CSF levels of neopterin and beta 2M (-48% and -32%, respectively, p < 0.01) was seen after 3-12 months on zidovudine. We suggest that gradual increase in immune stimulation reflected by the rising CSF concentrations of neopterin and beta 2M indicates that HIV-1 infection in the central nervous system is progressive even in neurologically asymptomatic stages.
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| 4. |
- Gisslén, Magnus, 1962, et al.
(författare)
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Tryptophan concentrations increase in cerebrospinal fluid and blood after zidovudine treatment in patients with HIV type 1 infection
- 1994
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Ingår i: AIDS Res Hum Retroviruses. ; 10:8, s. 947-51
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Tidskriftsartikel (refereegranskat)abstract
- Cerebrospinal fluid (CSF) and blood concentrations of indoleamines and catecholamines were analyzed in 14 HIV-1-seropositive individuals before antiviral treatment with zidovudine, after 3-14 months of treatment, and, in 8 of the patients, also after 14-30 months. The median pretreatment concentrations of tryptophan in CSF and blood were low (224 ng/ml and 6.0 micrograms/ml, respectively), but an increase in these values by an average of 40% in CSF and 23% in blood was seen after 3-14 months of zidovudine treatment (p < 0.01) and remained undiminished after 14-30 months of treatment. No significant change was observed in the 5-hydroxytryptamine (5-HT, serotonin) level in blood or in the CSF concentrations of the 5-HT metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the dopamine metabolite homovanillic acid (HVA). The CSF concentrations of the noradrenalin metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) had decreased by 12% on average (p < 0.01) by the time of the second follow-up, that is, after 14-30 months of zidovudine treatment. A decrease in neopterin during antiretroviral treatment correlated with an increase in tryptophan (p < 0.01). The data suggest that an association between decreased immune stimulation and reduced tryptophan degradation in patients treated with zidovudine.
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| 5. |
- Hagberg, Lars, 1951, et al.
(författare)
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Intrathecal immunoactivation in patients with HIV-1 infection is reduced by zidovudine but not by didanosine
- 1996
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Ingår i: Scand J Infect Dis. - : Informa UK Limited. ; 28:4, s. 329-33
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Tidskriftsartikel (refereegranskat)abstract
- The effect of zidovudine and didanosine on the cerebrospinal fluid (CSF) concentrations of neopterin was studied in 12 patients with human immunodeficiency virus type-1 (HIV-1) infection 3-12 months after initiation of antiretroviral therapy. Ten treatment periods on zidovudine and 7 on didanosine were analysed. The CSF concentrations of neopterin decreased by 63% (from 29.6 to 12.9 nmol/l, p < 0.01) during zidovudine but increased by 15% (from 22.6 to 25.9 nmol/l, not significant during didanosine treatment. The CSF monocytic cell count decreased during zidovudine but increased during didanosine treatment. The results suggest that zidovudine but not didanosine reduces intrathecal immunoactivation during HIV-1 infection.
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