Audio Journal of Fertility Circulating Markers Herald Onset of Preeclampsia REFERENCE: N Engl J Med 2006; 355:992 RICHARD LEVINE, National Institutes of Health, Bethesda In pregnant women circulating levels of the anti-angiogenic substances: soluble endoglin and soluble Flt-1 herald the onset of preeclampsia, according to a publication in the New England Journal of Medicine. Richard Levine told Peter Goodwin about his group?s findings from the Calcium for Preeclampsia Prevention Trial which give hope of designing molecularly targeted drugs to treat preeclampsia or of spotting the disease early.

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Audio Journal of Global Health Issues Circulating Markers Herald Onset of Preeclampsia REFERENCE: Lancet 2006; 368: 1973-83 CHARLOTTE WATTS, London School of Hygiene and Tropical Medicine A large and groundbreaking study has shown that microfinance, combined with a gender and HIV training scheme, can help reduce domestic violence among poor women living in rural South Africa. Charlotte Watts of the London School of Hygiene and Tropical Medicine told Derek Thorne about the IMAGE study.

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Audio Journal of Global Health Issues Three-Class Antiretroviral Therapy for HIV Not Appropriate: Results from the FIRST Study REFERENCE: Lancet 2006; 368: 2125-35 RODGER MacARTHUR, Wayne State University, Detroit A three-class HIV antiretroviral therapy is not necessary, according to data published in the Lancet. The FIRST study had three arms which included non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), or both, all in the presence of nucleoside reverse transcriptase inhibitors. Derek Thorne heard more from Rodger MacArthur of Wayne State University in Detroit.

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Audio Journal of Cardiovascular Medicine Telomere Length Predicts Coronary Heart Disease Risk and Statin Response REFERENCE: Lancet 2007; 369:107 NILESH SAMANI, Glenfield Hospital, Leicester A new genetic test could help predict which individuals will develop coronary heart disease among those with similar conventional risk factors. The length of the terminating structures of chromosomes, telomeres, can be used to predict cardiovascular mortality in middle-aged men, according to a study from Leicester in the UK which analysed blood samples collected for the West of Scotland Primary Prevention Study, (WOSCOPS). Nilesh Samani gave Helen Morant the details.

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Audio Journal of Global Health Issues, January 26th, 2007 Miscarriage Risk in Women with Low Body Mass Index REFERENCE: BJOG 2007 114:170 PAT DOYLE, London School of Hygiene and Tropical Medicine Underweight women were found to be at increased risk of miscarriage, according to a study published in the British Journal of Obstetrics and Gynaecology. A team from the London School of Hygiene and Tropical Medicine conducted a survey by questionnaire of 6 000 women among whom 600 had a first trimester miscarriage. Using a ?case-control? method of comparison it emerged that women with a body mass index below 18.5 had a 70 per cent increase in their risk of miscarriage. Peter Goodwin heard more about the study from Pat Doyle of the London School of Hygiene and Tropical Medicine.

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Audio Journal of Global Health Issues The Genetics of Obesity: Genetic Mutation, Possible Marker for Obesity? REFERENCE: N Engl J Med 2007;356:237-47 SADAF FAROOQI, Addenbrooke?s Hospital, Cambridge UK Gene defects and mutations could be markers for early onset obesity. This is according to a study published in the New England Journal of Medicine which concludes that the leptin receptor should be further explored as a cause of obesity, along with other genetic factors emerging from a multinational study called: the Genetics of Obesity Study. Sarah Maxwell heard the latest from Sadaf Farooqi in Cambridge, England.

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Audio Journal of Global Health Issues Folic Acid Supplement Improves Cognitive Function in Older Adults: FACIT Trial REFERENCE: Lancet 2007;369:208 JANE DURGA, Nestlé Research Centre, Lausanne A trial that randomised older adults to receive a folic acid supplement or placebo has shown that folic acid can significantly improve cognitive performance in older individuals. Jane Durga in Lausanne told Sarah Maxwell about the study findings and the hopes these may hold out.

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Audio Journal of Cardiovascular Medicine Aggressive Statin Therapy: Better than Endarterectomy for Patients with Carotid Stenosis? REFERENCE: Abstract No. 17 HENRIK SILLESEN, University of Copenhagen Patients with carotid artery stenosis run much lower risks of further events if treated aggressively with a statin, according to a study reported at the International Stroke Conference in San Francisco by Henrik Sillesen. Of 1,000 patients in the Stroke Prevention By Aggressive Reduction of Choleseterol Levels (SPARCL) study with documented carotid stenosis, those who received high-dose atorvastatin had a reduced need for endarterectomy in the follow up period. The aggressive statin treatment was as effective as endarterectomy at preventing future strokes. Helen Morant talked to Henrik Sillesen about the promise of this medical approach to treating such high-risk patients.

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Audio Journal of Cardiovascular Medicine MRI Scans Expand Therapeutic Window for Thrombolysis in Stroke REFERENCE: Abstract 2 PETER SCHELLINGER, University Clinic of Erlangen, Germany MRI scanning could make it possible to treat stroke patients safely and effectively with thrombolytics such as tPA beyond the recommended 3 hour window. The International Stroke Conference heard analysis of pooled data from five European Stroke Centers that compared CT and treatment within 3 hours with the use of MRI plus treatment either within 3 hours or longer than this. After his presentation in San Francisco Peter Schellinger explained the study to Helen Morant.

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Audio Journal of Cardiovascular Medicine "NIHSS-Plus": Improvement on National Institutes of Health Stroke Scale? REFERENCE: Poster 456 REBECCA GOTTESMAN, Johns Hopkins University, Baltimore Two simple bedside tests could be added to the NIHSS to make it more accurate, researchers claim. The team from Johns Hopkins University evaluated a range of cognitive tests for stroke patients and found that two corresponded particularly well to the size of the stroke on MRI scan. Rebecca Gottesman spoke to Helen Morant about why she thinks the NIHSS needs changing.

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Audio Journal of Cardiovascular Medicine Transthoracic Echo: A Wasted Test in Stroke Patients? REFERENCE: Poster 434 NICOLE PAGEAU, Trillium Health Centre, Ontario Stroke patients may be going through pointless tests, according to a poster presented by researchers at the Trillium Health Centre in Ottawa. The Stroke clinic there looked at whether routinely ordered tests, trans thoracic echo and 24 hour rhythm monitoring, actually changed patients' treatment, and found that generally, the results of these tests didn?t change a thing. Helen Morant talked to Nicole Pageau about their findings.

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Audio Journal of Cardiovascular Medicine The Wingspan Stent: Safe Intra-Cranial Angioplasty? REFERENCE: Abstract 102 FELIPE ALBUQUERQUE, Barrow Neurological Institute, Phoenix The Wingspan stent is a new approach to keeping open the atherosclerotic intracranial vessels of stroke and TIA patients. Early results presented to the San Francisco Conference suggest that it doesn?t harm patients, but that it seemed to block fairly quickly, Felipe Albuquerque talked to Helen Morant about these much anticipated results.

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Audio Journal of Cardiovascular Medicine Thrombectomy For Acute Stroke: Results of the Multi MERCI Trial REFERENCE: Abstract No. LB5 WADE SMITH, University of California, San Francisco Mechanical removal of the clot that?s causing an acute stroke is showing promising early signs, and is safe. The first of a new generation of the MERCI (Mechanical Embolus Removal in Cerebral Ischemia) devices for removing clots has compared favorably to its predecessors and can also be used in patients for whom the standard therapy, thrombolysis, has failed. Wade Smith on behalf of the MERCI investigators talked to Helen Morant about the results.

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Audio Journal of Cardiovascular Medicine GIST Trial: Treating Glucose Levels Acutely Doesn?t Help Survival, but Does Cause Hypotension REFERENCE: Abstract No. LB2 CHRISTOPHER GRAY, University of Newcastle Treating high blood sugar in the acute phases of stroke doesn?t reduce risk of death or severe disability, the GIST ? UK (Glucose Insulin in Stroke Trial) has found. This is despite other trials reporting that high glucose levels are associated with increase risk of stroke. Investigators also found that treating glucose levels aggressively also lowered blood pressure. To discuss this surprise result, and the background to the trial, Helen Morant talked to Chris Gray.

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Audio Journal of Global Health Issues Herpes Simplex Therapy Reduces HIV Activity in Co-Infected Patients REFERENCE: N Engl J Med 2007; 356: 790-9 PHILIPPE MAYAUD, London School of Hygiene and Tropical Medicine In patients who are infected with both HIV and herpes simplex type 2 the activity of the AIDS virus may be diminished by therapy with one of the established anti-herpes drugs, according to the findings of a study published in the New England Journal of Medicine by authors in France, England and Burkina Faso. Philippe Mayaud talked about his results with Peter Goodwin in which HIV concentrations in the blood and vagina of patients co-infected with both herpes and HIV were found to be reduced by continuous treatment with the anti-herpes agent valacyclovir.

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Audio Journal of Global Health Issues Growth Hormone Releasing Factor Analog: Slimming Aid for Patients Receiving HAART? REFERENCE: 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-29, 2007 STEVEN GRINSPOON, Massachusetts General Hospital, Boston COMMENT: JUDITH CURRIER, University of California, Los Angeles Daily administration of an analog of growth hormone releasing factor to HIV patients receiving highly active antiretroviral therapy significantly decreased visceral fat and improved their lipid profiles. This development-stage drug, TH9507, was well tolerated and may help patients reduce central fat accumulation and abnormal lipid profiles, both of which are know cardiovascular risk factors. In addition, decreases in central fat may have a positive effect on patients' self-image. Steven Grinspoon gave Dan Keller details during the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles.

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Audio Journal of Global Health Issues Entecavir Shows Activity Against HIV But Also Selects for an Antiretroviral Drug Resistance Mutation REFERENCE: Abstract: 136LB, 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-29, 2007 CHLOE THIO, Johns Hopkins University School of Medicine Entecavir, used to treat hepatitis B virus infections, can lower levels of HIV in co-infected patients but also selects for a mutation that makes HIV resistant to entecavir as well as the antiretroviral drugs lamivudine and emtracitabine. These findings, derived from three case reports and associated laboratory studies, have important implications for the treatment of HBV in HIV-infected patients. Current guidelines, issued in October 2006 and which recommend entecavir as a first-line treatment of HBV in co-infected individuals who do not require anti-HIV therapy, need to be reconsidered. Chloe Thio discussed her study results and their implications with Dan Keller at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles.

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Audio Journal of Global Health Issues Integrase Inhibitor Raltegravir Doubles Antiviral Response Rate in Treatment Experienced HIV-Infected Patients Compared to Optimised Background Therapy Alone REFERENCE: Abstract 105aLB, 105bLB, 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-28, 2007 ROY STEIGBIGEL, State University of New York at Stony Brook JOHN W. MELLORS, University of Pittsburgh Raltegravir doubled the antiviral response rate and the increase in CD4 cells among treatment-experienced HIV-infected patients who were resistant to at least one drug in each of the nucleoside, non-nucleoside, and protease inhibitor classes. Two placebo controlled trials (BENCHMRK-1 and BENCHMRK-2) randomized a total of almost 700 subjects to either raltegravir 400 mg twice daily or to placebo, each on a background of optimized antiviral background therapy. Raltegravir is an integrase inhibitor and acts to block the enzyme that allows HIV?s nuclei acid to integrate into the DNA of host cells.

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Audio Journal of Global Health Issues Maraviroc: New Antiretroviral Drug Shows Efficacy and Safety REFERENCE: Abstract Number: 104aLB, 104bLB, 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-28, 2007 HOWARD MAYER, Pfizer Global Research, New London CT MARK WAINBERG, McGill University, Montreal In a population of treatment-experienced HIV-infected subjects, maraviroc plus optimised background antiretroviral therapy provided significantly superior virologic control and increases in CD4 cell counts compared with placebo plus optimized background therapy. There were no clinically relevant differences in the safety profiles between the maraviroc and the placebo treatment groups. These drugs do not attack the virus itself but rather block host cells? CCR5 cell surface cytokine receptors that HIV interacts with to gain entry into the cell.

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Audio Journal of Global Health Issues 6 Months Exclusive Breast Feeding for Mothers with HIV Lowers Transmission Rates REFERENCE: Abstract 13, 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles February 25-28, 2007 HOOSEN COOVADIA, University of KwaZulu-Natal, Durban In the developing world breastfeeding is the recommended infant feeding method, even for women infected with HIV. While early cessation of breastfeeding reduces HIV transmission to the baby, studies have shown that it increases morbidity and mortality in the infants. Exclusive breastfeeding for the first six months of life appears to reduce HIV transmission, as opposed to ?mixed? breastfeeding with supplementation with formula or solid foods. Dan Keller spoke with Hoosen Coovadia, who delivered a plenary talk on the subject at the14th Conference on Retroviruses and Opportunistic Infections in Los Angeles.

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Audio Journal of Cardiovascular Medicine Thrombin Receptor Antagonist: Advantages in Percutaneous Coronary Intervention? REFERENCE: ACC New Orleans, March 24th Late Breaking Trials DAVID MOLITERNO, University of Kentucky, Lexington An oral thrombin receptor antagonist, SCH 530348 has proved safe and effective, and may be better than conventional anti-coagulation treatments for patients receiving percutaneous coronary intervention. Results of the TRA-PCI study were presented at the ACC's New Orleans meeting by David Moliterno who discussed the new data with Peter Goodwin.

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Audio Journal of Cardiovascular Medicine Rapid Genotype Assay for Individualized Warfarin Dosing REFERENCE: Abstract 1020-89, American College of Cardiology New Orleans JEFFREY ANDERSON, University of Utah, Salt Lake City COMMENT: DOUGLAS ZIPES, University of Indiana, Indianapolis The hope of refining treatments for cardiovascular disease by genotyping patients to detect individual sensitivities to particular medical therapies was brought a step closer at the ACC meeting in New Orleans by results from a study using a rapid genothype test. Jeffrey Anderson told Peter Goodwin about the assay they've been investigating which indicates required dosing of warfarin.

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Audio Journal of Cardiovascular Medicine Increased Use of Recommended Drugs Explains Improved Trends in Prognosis after Myocardial Infarction REFERENCE: Abstract 1018-148, American College of Cardiology New Orleans SOKO SETOGUCHI, Brigham And Women?s Hospital, Boston COMMENT: DOUGLAS ZIPES, University of Indiana, Indianapolis The increased adherence to recommendations and guidelines for drug therapy after myocardial infarction during the last ten years has led to hoped-for improvements in outcomes and prognosis among patients treated. This is the finding of a study presented to the ACC meeting in New Orleans by Soko Setoguchi who discussed her group?s findings with Peter Goodwin.

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Audio Journal of Cardiovascular Medicine Bioabsorbable Everolimus-Eluting Stent: 6-Month Angiographic and IVUS Results REFERENCE: Abstract 2402-3, American College of Cardiology New Orleans PATRICK SERRUYS, Erasmus University, Rotterdam COMMENT: SPENCER KING, Piedmont Hospital, Atlanta Six-months follow-up of patients receiving a new bioabsorbable drug-eluting stent are favourable, according to Patrick Serruys whose group has been investigating the stent which elutes everolimus in a group of 30 patients. During the ACC Annual Meeting in New Orleans he discussed with Peter Goodwin the potential benefits the new device can bring to coronary patients.

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Audio Journal of Cardiovascular Medicine - COURAGE Trial: Optimal Medical Therapy Alone is Sufficient for Patients with Stable Angina: Adding PCI Does Not Help - ILLUSTRATE Study Shows Torcetrapib Raises HDL But Fails to Lower Coronary Risk REFERENCE: N Engl J Med 2007 356 Published: March 26th Reporting from: American College of Cardiology New Orleans STEVEN NISSEN, Cleveland Clinic, OH Two big studies published in the New England Journal of Medicine and presented simultaneously at the American College of Cardiology meeting in New Orleans have shown that two emerging therapies aimed at reducing risks in patients with coronary disease have failed to do so. The president of the ACC, Steven Nissen, talked with Peter Goodwin about the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, in which patients with stable coronary artery disease were randomized to receive optimal medical therapy with or without PCI. He also discussed findings of the ILLUSTRATE (Investigation of Lipid Level Management Using Coronary Ultrasound to Assess Reduction of Atherosclerosis by CETP Inhibition and HDL Elevation) study in which the cholesteryl ester transfer protein inhibitor, torcetrapib was found to have adverse effects when used for modifying lipid profiles among coronary patients.

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Audio Journal of Cardiovascular Medicine Bioabsorbable Everolimus-Eluting Stent: 6-Month Angiographic and IVUS Results REFERENCE: Abstract 2402-3, American College of Cardiology New Orleans PATRICK SERRUYS, Erasmus University, Rotterdam COMMENT: SPENCER KING, Piedmont Hospital, Atlanta Six-months follow-up of patients receiving a new bioabsorbable drug-eluting stent are favourable, according to Patrick Serruys whose group has been investigating the stent which elutes everolimus in a group of 30 patients. During the ACC Annual Meeting in New Orleans he discussed with Peter Goodwin the potential benefits the new device can bring to coronary patients.

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Audio Journal of Cardiovascular Medicine "RADIANCE-1" Study: Cholesteryl Ester Transfer Protein Inhibitor Fails to Benefit Patients with Familial Hypercholesterolemia REFERENCE: Abstract 407-7, American College of Cardiology New Orleans JOHN KASTELEIN, Academic Medical Center, Amsterdam A drug which raises HDL and reduces circulating levels of LDL has nevertheless failed to reduce atherosclerotic progression in patients with familial hypercholesterolemia. This disappointing outcome of a study using the cholesteryl ester transfer protein inhibitor (CETP), torcetrapib, was announced at the American College of Cardiology meeting in New Orleans. John Kastelein discussed the findings, and their implications for therapies targeting HDL, with Peter Goodwin.

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Audio Journal of Cardiovascular Medicine Direct Renin Inhibitor Combined with Angiotensin Receptor Blockade Gives Additional Blood Pressure Lowering REFERENCE: Abstract 405-12, American College of Cardiology New Orleans SUZANNE OPARIL, University of Alabama, Birmingham A combination of two antihypertensive agents has given improved blood pressure control in a study with nearly 2000 patients reported to the ACC meeting in New Orleans by a group from the University of Alabama at Birmingham. Suzanne Oparil presented findings on the use of the direct rennin inhibitor, aliskiren, combined with the angiotensin receptor blocker, valsartan. She explained to Peter Goodwin how this ?dual renin system blockade? gave enhanced blood pressure lowering in patients with mild to moderate hypertension who were followed with ambulatory monitoring.

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Audio Journal of Cardiovascular Medicine ?EXACT? Study: Carotid Stenting Benefits Are Maintained in the Real World REFERENCE: Abstract 2409-5, American College of Cardiology New Orleans WILLIAM GRAY, Columbia University, New York The benefits of carotid stenting as compared with surgery have been maintained in real-world settings since USA-approval of the technique in 2004, according to William Gray who reported findings from the EXACT study of 1500 patients to the annual meeting of the American College of Cardiology. He discussed his conclusions and recommendations with Peter Goodwin.

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Audio Journal of Cardiovascular Medicine Reporting from American College of Cardiology, New Orleans, March 24-27, 2007 "COURAGE" Trial Assessed: New Guidelines for Patients with Stable Coronary Disease? REFERENCE: ACC 2007 & N Engl J Med 356: March 2007 HARVEY WHITE, Auckland City Hospital The finding from the COURAGE trial: that angioplasty adds no benefits to optimal medical therapy alone for patients with stable coronary disease, should give pause for thought among clinicians all over the world, according to Harvey White, who discussed the new data with Peter Goodwin.

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Audio Journal of Global Health Issues Once-And-For-All TB Assay Brings Cheap, Sensitive, Specific, Seven-Day Diagnosis and Drug-Susceptibility Testing REFERENCE: N Engl J Med 355: 1539-50 DAVID MOORE, Imperial College, London and Lima A new test for TB, trialled in Peru, has proved more powerful and yet faster and cheaper than alternatives, making it especially suitable for use in resource-limited settings where tuberculosis is becoming more rampant, partly through the world-wide advance of HIV. David Moore and his colleagues have published results in the New England Journal of Medicine of a massive investigation conducted in Lima with nearly 4 000 samples of the sputum test called: Microscopic-Observation Drug-Susceptibility (MODS) Assay. Their findings promise not only to improve diagnosis and save lives in developing countries and other settings with limited health-care resources, but also out-perform costly gold-standard technology-intensive TB diagnosis methods currently used where cash is not a problem. The MODS test, David Moore told Peter Goodwin during a visit to Peru, gives sensitive and specific diagnosis in as little as seven days, and concurrently yields drug susceptibility data which helps combat multi-drug resistant TB.

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Audio Journal of Global Health Issues Rural to Urban Migration: Cardiovascular Health Risks Assessed in Lima, Peru JAIME MIRANDA, London School of Hygiene and Tropical Medicine, Peru The consequences of migration from rural to urban areas in Peru has provided an opportunity for studying the impact of a radically altered lifestyle and diet upon health. Jaime Miranda is investigating the disease patterns among migrants from the Andes Mountains and the Amazon Jungle regions of Peru in the capital, Lima. He discussed his group's investigation with Peter Goodwin.

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Audio Journal of Global Health Issues reporting from American College of Physicians Annual Meeting: Internal Medicine 2007; San Diego April 19-21 Study on Longevity Genes And Aging Raises Prospects for Therapy REFERENCE: ABSTRACT ERA 001 ACP 2007, San Diego NIR BARZILAI, Albert Einstein College of Medicine, New York The prospect of modulating the activity of "longevity genes" to extend life was held out at a special session of the ACP Internal Medicine annual meeting in San Diego. Nir Barzilai, Director of the Institute for Aging Research in New York, presented data from his group's study of patients up to 100 years old and over which have shown that specific genes are related to longevity and freedom from physical illness. Afterwards he talked about his findings and the clinical opportunities they present with Peter Goodwin.

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Audio Journal of Global Health Issues reporting from American College of Physicians Annual Meeting: Internal Medicine 2007; San Diego April 19-21 Patient Power Best to Manage Diabetes REFERENCE: ABSTRACT Press Release, San Diego ACP 2007 HILARY SELIGMAN, University of California, San Francisco Doctors can best help their patients with diabetes by taking particular care to put management into the hands of the patients themselves, rather than asking them to slavishly follow the doctors' instructions, conference-goers in San Diego heard. A new ACP guide booklet for diabetes management called "Living with Diabetes", designed to be used by patients in consultation with their doctors, has made concrete improvements in diabetic management, according to results from a study released during the American College of Physicians annual meeting. Peter Goodwin talked with one of the authors of the new initiative, Hilary Seligman.

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Audio Journal of Global Health Issues reporting from American College of Physicians Annual Meeting: Internal Medicine 2007; San Diego April 19-21 Drug Eluting Stents, PFO Closure: Indications Not Obvious REFERENCE: ABSTRACT ACP Internal Medicine 2007, ERA 002 MARK REISMAN, Swedish Medical Center, Seattle Drug eluting stents may not always be the automatic choice over the bare metal variety for patients requiring intervention, despite the important clinical advantages that have been emerging from their introduction recently. This is according to Mark Reisman who gave the Internal Medicine 2007 conference in San Diego his latest insights from the rapidly changing world of interventional cardiology. At this (recently renamed) annual meeting of the American College of Physicians he also discussed the difficult question of which patients are candidates for PFO closure, and what the clinical objectives of this might be: including the possible reduction of migraine headaches. After his session he talked with Peter Goodwin.

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Audio Journal of Cardiovascular Medicine Reporting from ACC 2007 Fewer Major Bleeding Events with Bivalirudin For Patients with Acute Coronary Syndromes: The ACUITY Study REFERENCE: ACUITY Trial, ACC.07 Scientific Session and i2 Innovations Summit. Presentation Number: 2414-5 Patients with acute coronary syndromes who take bivalirudin have fewer major bleeding events and a lower incidence of late stent thrombosis? compared with those who receive standard heparin therapy. This is the finding of one year results from the ACUITY Study announced by Gregg Stone of Columbia University, New York during the American College of Cardiology annual meeting that took place in New Orleans. Sarah Maxwell asked Harvey White at the Auckland City Hospital in New Zealand to comment about the ACUITY investigation.

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Audio Journal of Global Health Issues Can Road-Side Tranexamic Acid Therapy Reduce Mortality and Blood Transfusions after Trauma? The CRASH Trial. JAIME MIRANDA, London School of Hygiene and Tropical Medicine, Lima An antifibrinolytic agent, tranexamic acid (commonly used to reduce bleeding during surgery) is being investigated as first-aid to cut mortality and the need for blood transfusion immediately after trauma or injury. The CRASH trial, still in its early phases in a worldwide adult population, aims to bring particular benefit to developing countries, many of which are blighted by trauma with few measures, if any, having been available up to now to reduce the death toll. In Lima, Peru, Jaime Miranda discussed his group's ongoing investigation with Peter Goodwin.

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Audio Journal of Cardiovascular Medicine Reporting from ACC 2007 Reduced Mortality and Repeat MI with Enoxaparin for Patients with ST Elevation Myocardial Infarction HARVEY WHITE, Auckland City Hospital, New Zealand REFERENCE: European Heart Journal Advanced On-Line Publication April 24th, 2007 Enoxaparin could be the new standard anti-thrombotic therapy for patients receiving fibrinolysis for ST elevation myocardial infarction. This finding is from the double-blind EXTRACT-TIMI 25 Trial which compared the low molecular weight heparin with unfractionated heparin and saw a consistent treatment superiority from enoxaparin with a reduction in repeat myocardial infarction and mortality. Sarah Maxwell spoke with the principal investigator Harvey White at the Auckland City Hospital in New Zealand.

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Audio Journal of Global Health Issues Type 1 Polio Vaccine Could Help Finally Eradicate Polio REFERENCE: Lancet 2007; 369:1356-62 NICHOLAS GRASSLY, Imperial College London A case-control study performed in India has provided hope that polio could finally be eradicated. India is one of six countries in which polio transmission has not yet been interrupted and, specifically, it is the type 1 poliovirus that persists there. Nicholas Grassly of Imperial College London told Derek Thorne about his team?s study, published in the Lancet.

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Audio Journal of Global Health Issues Non-Perfect HIV Vaccine Could Still Have Major Benefits REFERENCE: N Engl J Med 2007;356:2073-81 ANTHONY FAUCI, National Institutes of Health, Bethesda Is there any hope for an HIV vaccine? According to Anthony Fauci, of the National Institutes of Health in Bethesda, there is ? but it might not be a perfect vaccine. He believes that even a vaccine that does not confer total immunity could still be of use, because it may slow disease progression and also reduce the spread of the disease. He talked with Derek Thorne about his co-authored paper in the New England Journal of Medicine.

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Audio Journal of Global Health Issues Pneumonia in Children Under One Year: Current Guidelines Not Sufficient REFERENCE: The Lancet 2007; 369:1440-1451 Lisa McNally, Institute of Child Health, London, and University of KwaZulu-Natal, Durban A new study suggests that current guidelines for the treatment of severe pneumonia in children under one year should change. The investigation, which took place in South Africa, found that HIV status and polymicrobial disease were among the predictors for treatment failure, and these findings have implications for the guidelines drawn up by the WHO. Derek Thorne heard more from Lisa McNally, who worked with the Institute of Child Health in London, and the University of KwaZulu-Natal in Durban.

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Audio Journal of Global Health Issues Simple Intervention Could Significantly Improve TB Detection in Women REFERENCE: The Lancet 2007; 369:1955-1960 MISHAL KHAN, London School of Hygiene and Tropical Medicine Giving comprehensive instructions to women before they produce a sputum sample can make tuberculosis detection more effective ? that?s the conclusion of a study published in the Lancet. A team from the UK and Pakistan carried out a large randomised trial in both men and women, and Derek Thorne got the details from Mishal Khan, of the London School of Hygiene and Tropical Medicine.

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Audio Journal of Medicine Reporting from European Society of Human Reproduction and Embryology (ESHRE) 23rd Annual Meeting, Lyon, July 1-4, 2007 Elective Single Embryo Transfer in IVF: 13 Year Data From Sweden REFERENCE: ABSTRACT Oral 005 Per-Olof Karlström, Academic Hospital Uppsala COMMENT: Richard Kennedy, University Hospital, Coventry Elective single embryo transfer, now the norm in Sweden for in-vitro fertilisation, has greatly reduced rates of multiple pregnancy and the risks that go with it. And there are other benefits, according to Per-Olof Karlström from Uppsala who talked with Peter Goodwin during the ESHRE conference on fertility held in Lyon. The evidence from Sweden was put in perspective during the conference by Richard Kennedy from Coventry.

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Audio Journal of Medicine Reporting from European Society of Human Reproduction and Embryology (ESHRE) 23rd Annual Meeting, Lyon, July 1-4, 2007 1. Eggs From Young Patients Before Chemotherapy: New Hope for Future Fertility REFERENCE: ABSTRACT O-107 Ariel Revel, Hadassah University Hospital, Jerusalem Harvesting eggs from young girls before they undergo aggressive chemotherapy can now be done to give the hope of pregnancy in the future, according to fertility experts from Jerusalem reporting to the European conference on fertility being held in Lyon. The investigators have obtained oocytes from girls as young as five years. Lead author Ariel Revel talked about his group's findings with Sarah Maxwell. 2. First Baby Born From Thawed, Frozen, In-Vitro Matured Oocytes REFERENCE: ABSTRACT Oral 018 Hananel Holzer, McGill University, Montreal The results of a study that has produced the first live birth by maturing oocytes in vitro which have been collected from unstimulated ovaries, freezing them, and subsequently thawing them for fertilization were presented to the ESHRE meeting in Lyon. This is the first time oocytes collected without hormonal stimulation have resulted in pregnancies. For some women potentially facing sterility, such as those with breast cancer who do not have time for hormonal stimulation, this technique provides the hope of pregnancy which could otherwise be denied. Sarah Maxwell interviewed Hananel Holzer about the findings. 3. Ovarian Stimulation: Menotrophin Gives More Live Births than Follicle-Stimulating Hormone for Assisted Reproduction REFERENCE: ABSTRACT Oral 098 Masoud Afnan, Birmingham Women's Hospital Of two types of gonadotrophins currently used for ovarian stimulation in assisted reproduction one has now clearly demonstrated superiority in a meta-analysis presenteted to the fertility conference in Lyon. Human menotrophin (hGH) gave more live births than recombinant follicle-stimulating hormone (rFSH) whether reproduction was by in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Peter Goodwin talked with Masoud Afnan from Birmingham after his presentation of the study which he co-authored with Madelon van Wely and Julko van der Veen. 4. Single Embryo Transfer Recommended For Most Patients Receiving Donated Oocytes REFERENCE: ABSTRACT O-007 Viveca So?derstro?m-Anttila, Väestoliitto Fertility Clinics, Helsinki When oocytes are donated to achieve a pregnancy, single embryo transfer should generally be recommended over double transfer, according to the findings of a study from Helsinki. Sarah Maxwell discussed the data with Viveka Söderström.

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