Publications

BACKGROUND

Fulminant myocarditis (FM) is often a self-resolving entity if the patient survives the acute illness. Venoarterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest due to FM. However, clinical outcomes are not well understood, in part because of small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining survival rates for ECMO.

METHODS

A systematic Medline search was conducted on ECMO for the treatment of FM, updated up to November 2012. Studies with n ≥10 published in the year 2000 or later that reported survival to hospital discharge for FM requiring ECMO were included. Studies that reported only on pediatric patients were excluded. The smaller of studies with overlapping patients were excluded. Cochran Q and I(2) were calculated and reported.

RESULTS

Six studies were included in the analysis, encompassing 170 patients. The minimum and maximum reported rates of survival to hospital discharge were 60.0% and 87.5%, respectively. The cumulative rate was 115/170. The calculated Cochran Q value was 3.63, which was not significant for heterogeneity. The I(2) value was 0%. The pooled estimate rate was 66.9% with a 95% confidence interval of 59.4%-73.7%.

CONCLUSION

More than two-thirds of patients with FM and either cardiogenic shock and/or cardiac arrest survive to hospital discharge with ECMO. These findings could be used in the risk-benefit analysis when initiation of a cardiopulmonary bypass system is being considered for FM.

While raised levels of monocyte chemoattractant protein 1 (MCP-1) have been observed in patients with chronic muscle pain, direct evidence for its role as an algogen in skeletal muscle is still lacking. In the rat, MCP-1 induces a dose-dependent mechanical hyperalgesia lasting for up to 6weeks. Following recovery, rats exhibited a markedly prolonged hyperalgesia to an intramuscular injection of prostaglandin E2, hyperalgesic priming. Intrathecal pretreatment with isolectin B4 (IB4)-saporin, which selectively destroys IB4-positive (IB4+) nociceptors, markedly decreased MCP-1-induced hyperalgesia and prevented the subsequent development of priming. To evaluate the involvement of MCP-1 in stress-induced chronic pain we administered, intrathecally, antisense (AS) or mismatch oligodeoxynucleotides directed against CCR2 (the canonical receptor for MCP-1) mRNA, during the exposure to water-avoidance stress, a model of stress-induced persistent muscle pain. The AS treatment attenuated this hyperalgesia, whereas IB4-saporin abolished water-avoidance stress-induced muscle hyperalgesia and prevented stress-induced hyperalgesic priming. These results indicate that MCP-1 induces persistent muscle hyperalgesia and a state of latent chronic sensitization to other algogens, by action on its cognate receptor on IB4+ nociceptors. Because MCP-1 also contributes to stress-induced widespread chronic muscle pain, it should be considered as a player in chronic musculoskeletal pain syndromes.

INTRODUCTION AND AIMS

Alcohol and substance use can have negative health consequences among both human immunodeficiency virus (HIV)-positive and -negative individuals, and are associated with behaviors that facilitate HIV transmission and acquisition. The relationship of substance use and HIV is well documented among key populations at risk for HIV. However, although transwomen (male-to-female transgender) are disproportionately impacted by HIV, this overlap remains understudied in this population. We sought to evaluate the association between HIV, alcohol and substance use among transwomen.

DESIGN AND METHODS

We conducted a secondary data analysis of Respondent Driven Sampling study which collected information on self-reported alcohol and substance use among 314 transwomen. We used multivariable logistic regression to assess relationship between HIV infection and classes and patterns of alcohol and substance use.

RESULTS

We found that 58% of transwomen used alcohol, and 43.3% used substances. The most common substances used were: marijuana (29%), methamphetamine (20.1%), crack cocaine (13.4%), and 'club drugs' (13.1%). Transwomen who reported any methamphetamine use [adjusted odds ratio (AOR) 3.02 (95% confidence interval (CI) = 1.51-6.02)], methamphetamine use before or during anal intercourse [AOR 3.27 (95% CI = 1.58-6.77)], and at least weekly methamphetamine use [AOR 3.89 (95% CI = 1.64-9.23)] had significantly greater odds of testing positive for HIV.

DISCUSSION AND CONCLUSIONS

Transfemales have high prevalence of alcohol and substance use; those tested positive for HIV used significantly more methamphetamine in general, and in conjunction with sex. Given the disproportionate prevalence of HIV and substance use in this population, interventions aimed at addressing both substance use and HIV risk among transwomen are urgently needed.