Who will be lost? Identifying patients at risk of loss to follow-up in Malawi. The DREAM Program Experience.

OBJECTIVES: Retention of subjects in HIV treatment programmes is crucial for the success of treatment. We evaluated retention/loss to follow-up (LTFU) in subjects receiving established care in Malawi. METHODS: Data for HIV-positive patients registered in Drug Resource Enhancement Against AIDS and Malnutrition centres in Malawi prior to 2014 were reviewed. Visits entailing HIV testing/counselling, laboratory evaluations, nutritional evaluation/supplementation, community support, peer education, and antiretroviral (ART) monitoring/pharmacy were noted. LTFU was defined as > 90 days without an encounter. Parameters potentially associated with LTFU were explored, with univariate/multivariate logistic regression analyses being performed. RESULTS: Fifteen thousand and ninety-nine patients registered before 2014; 202 (1.3%) were lost to follow-up (LTFU) (1.3%). Nine (0.5%) of 1744 paediatric patients were LTFU vs. 1.4% (n = 193) of 13 355 adults (P < 0.001). Subjects who were LTFU had fewer days in care than retained subjects (1338 vs. 1544, respectively; P < 0.001) and a longer duration of ART (1530 vs. 1300 days, respectively; P < 0.001). Subjects who were LTFU had higher baseline HIV viral loads (P = 0.016) and higher body mass indexes (P < 0.001), were more likely to live in urban settings (88% of patients who were LTFU lived in urban settings) with better housing [relative risk (RR) 2.3; 95% confidence interval (CI) 1.67-3.09; P < 0.001], and were more likely to be educated (RR 1.88; 95% CI 1.42-2.50; P < 0.001). Distance to the centre and cost of transportation were associated with LTFU (RR 3.4; 95% CI 2.84-5.37; P < 0.001), as was absence of a maternal figure (RR 1.57; 95% CI 1.17-2.09; P < 0.001). Viral load, distance index, education and a maternal figure were predictive of LTFU. CONCLUSIONS: Educated, urbanized HIV-infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when developing retention strategies.

Effects of a dietary supplement on cholesterol in subjects with moderate hypercholesterolemia.

BACKGROUND AND AIMS: Prospective studies have demonstrated that the risk of death due to ischaemic heart disease is strongly correlated with blood cholesterol (TC) levels. Diet is the basic treatment for all dyslipidaemia. If diet alone proves inadequate, supplements can be used to try to reduce cholesterol levels. These substances are indicated in moderate dyslipidaemia, as they are able to induce a moderate reduction in blood cholesterol. The objective of our study was to investigate the effects of a dietary supplement containing Omega-3, Policosanol, Resveratrol, L-carnitine, Monascus purpureus, Coenzyme Q10, Vitamin B6 and Vitamin B12 on TC (primary end point) and LDL, triglycerides and HDL (secondary endpoints). PATIENTS AND METHODS: The study involved 40 men and 40 women recruited from the outpatient section of our Department randomly assigned to the treatment group (A) or the control group (B). RESULTS: There was a statistically significant reduction in TC 6 months after the end of treatment in both groups. In Group A, there was also a statistically significant change in HDL, LDL and TG, while in group B, there was no statistically significant change in HDL, LDL or TG. CONCLUSIONS: The dietary supplement used in our study, in combination with a balanced diet and physical exercise, was found to induce a significant reduction in TC and LDL-C and an improvement in HDL-C. In contrast, while a balanced diet together with physical exercise but without the dietary supplement produced a significant reduction in TC, it had no significant effect on the other lipid parameters tested.

Effects of a dietary supplement on chronic pelvic pain syndrome (Category IIIA), leucocytospermia and semen parameters.

Chronic prostatitis (CP) is one of the most common male urogenital diseases and a significant public health problem in industrialised countries. It is associated with a low quality of life and significant expense. Given the poor results achieved with antibiotics, scientific interest has turned to the use of natural substances with a known activity on prostate function. The aim of our study was to evaluate the effect of a new dietary supplement containing lycopene, epigallocatechin gallate, ellagic acid, selenium and zinc on semen parameters and on leucocyte concentration in seminal fluid and expressed prostate secretion (EPS) in patients with CP without infection [National Institute of Health (NIH) Category IIIA], in comparison with a control group with the same condition who did not undergo any treatment during the study period. Our data showed a statistically significant reduction in inflammatory parameters (leucocytes in seminal fluid and EPS) and a statistically significant improvement in progressive sperm motility and sperm morphology in patients treated with the supplement in comparison with the untreated group. Improvements were also seen in the pain score of the NIH-Chronic Prostatitis Symptom Index (CPSI), confirming that the reduced inflammation also resulted in a reduction in pain.

[Hashimoto's thyroiditis and autoimmunity parameters: descriptive study]. / Tiroidite di Hashimoto e parametri di autoimmunità. Studio descrittivo.

AIM: Aim of the study is a prospective evaluation of the simultaneous presence of antinuclear antibodies (ANA) in patients with Hashimoto's thyroiditis as a sign of a possible occurrence of another autoimmune disease. METHODS: Thirty two patients with Hashimoto's thyroiditis have been selected. No other immunological parameters have been used for the selection. All the patients have been submitted to ANA research and to thyroid colour-Doppler ultrasonography. Moreover, subgroups of patients have been submitted to the research of other autoimmunity parameters: 25 patients to AMA (anti-mitochondrial antibodies), ASMA (anti-smooth muscle antibodies), ENA (extractable nuclear antigens) and anti-double stranded-DNA; 7 patients to anti-gastric mucosa; 8 patients to ACA (anti-cardiolipin antibodies) IgM and IgG; 12 patients to rheuma-screen. Twenty five patients were under L-thyroxine therapy at the time of the samples. RESULTS: Forty-seven percent of the patients were ANA positive. Of them 60% showed a title of 1:40. The most frequent sonography picture was pseudo-nodular (66%) with predominance in ANA negative subgroups (71%) than in ANA positive one (60%). On the basis of all the autoimmune parameters evaluated in every subgroups, 72% of our patients were positive to at least one autoimmunity parameter and/or have an autoimmune disease besides Hashimoto's thyroiditis. CONCLUSION: The conclusion is drawn that the patient with Hashimoto's thyroiditis should be considered as an autoimmune patient. Thus, it is necessary to carry out an autoimmune screening with ANA in every new diagnosed patients and to study in depth the familiar and phatological history. Periodical checking of the autoimmune parameters should not be underestimated in these patients.

Cytogenetic studies on Cervus elaphus. II. Synaptonemal complexes and NOR activity during spermatogenesis.

The activity of the nucleolus organizer regions (NORs) in various stages of spermatogenesis of the red deer was studied with the silver staining technique. The Ag-stainability of the NORs, an indicator of the transcriptional activity of the r-RNA genes, is present during the meiotic prophase until pachytene and is absent during the remainder of the meiotic prophase, to reappear during the first stages of spermiogenesis and then disappear again during the elongation phase of the spermatids. The development and behaviour of synaptonemal complexes (SCs) of primary spermatocytes were also studied with the silver staining technique under the light microscope. The organization of SC is similar to that of other mammalian species. The pairing behaviour of the axes of the sex chromosomes is described.