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The randomized study in Uganda showed a slight increase in infections of the female partners of circumcised males (Waver 2008) purchase on line motrin pain treatment satisfaction scale (ptss). This can be mainly explained by couples probably having sexual intercourse earlier than recommended motrin 400mg mastercard pain treatment center ky. Several weeks of absti- nence are stipulated after the operation generic finax 1mg fast delivery. Is there a protective effect for MSM after circumcision? If there is, the data is less clear compared to the results for heterosexual men. A meta-analysis of 15 greatly varying studies with 53,567 MSM (52% with circumcision) showed no significant difference between circumcised and uncircumcised males (Millet 2008). Another newer study confirms these results (Sanchez 2011). Taken together, it remains unclear whether the protective effects of circumcision apply to the MSM population. Preventive treatment of HSV and other diseases Genital infections clearly increase the risk of acquiring HIV. For example, in a large prospective trial, bacterial vaginosis was associated with a greater than 3-fold increased risk of female-to-male HIV-1 transmission (Cohen 2012). Even more rele- vant is human herpes virus 2 (HSV-2) as this common virus can be easily detected and quantified in genital fluids.. Genital HSV-2 infection is associated with increased cervicovaginal and plasma RNA among coinfected women with genital ulcers, inde- pendently of the level of immunodeficiency (LeGoff 2007). According to a meta- analysis, the risk of HIV increases with HSV-2-seropositivity: when HSV-2 antibod- ies are detected in the blood, the risk increases in male patients 2. A considerable amount of new HIV infections are due to HSV coinfection, with an estimated 38–69% in female patients and 8–49% in male patients. Considering these data, several studies have been conducted in which the protective effect of HSV therapy has been evaluated both in HIV-negative and HIV-positive populations. HPTN 039, a double- blind, randomized, Phase III trial investigated this question (Celum 2008). In total, 1871 MSM from the USA and Peru and 1,380 women from Zimbabwe, Zambia and South Africa received 400 mg acyclovir or placebo twice daily. Enrolled subjects were all HIV-negative and HSV-2-positive at the beginning of the trial. Although less HSV ulcers were observed in the active group, the trial failed to show a decline in HIV incidence in the acyclovir -group, with 3. These disappointing results were confirmed by the Mwanza trial with 821 women in Tanzania, in which again no decline was observed (Watson- Jones 2008). It is still not clear why, however, resistance to acyclovir is unlikely (Watson-Jones 2010).

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Low-dose carvedilol improves left ventricular function and reduces cardiovascular hospitalization in Japanese patients with chronic heart failure: The Multicenter Carvedilol Heart Failure Dose Assessment (MUCHA) trial buy discount motrin 400mg on-line pain treatment electrical stimulation. Beta blockers Page 68 of 122 Final Report Update 4 Drug Effectiveness Review Project 92 quality 400 mg motrin myofascial pain treatment center reviews. Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective purchase generic celexa on line, placebo-controlled trial. Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Trial: Carvedilol in severe heart failure. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in Dilated Cardiomyopathy (MDC) Trial Study Group. Increased exercise ejection fraction and reversed remodeling after long-term treatment with metoprolol in congestive heart failure: A randomized, stratified, double-blind, placebo-controlled trial in mild to moderate heart failure due to ischemic or idiopathic dilated cardiomyopathy. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Effects of metoprolol CR in patients with ischemic and dilated cardiomyopathy : the randomized evaluation of strategies for left ventricular dysfunction pilot study. Effects of nebivolol on left ventricular function in elderly patients with chronic heart failure: results of the ENECA study. Metoprolol controlled release/extended release in patients with severe heart failure: analysis of the experience in the MERIT-HF study. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Prospective, randomized comparison of effect of long-term treatment with metoprolol or carvedilol on symptoms, exercise, ejection fraction, and oxidative stress in heart failure. Metra M, Giubbini R, Nodari S, Boldi E, Modena MG, Dei Cas L. Differential effects of beta-blockers in patients with heart failure: A prospective, randomized, double-blind comparison of the long-term effects of metoprolol versus carvedilol. Beta-blocker therapy influences the hemodynamic response to inotropic agents in patients with heart failure: a randomized comparison of dobutamine and enoximone before and after chronic treatment with metoprolol or carvedilol. Beta-blockade in heart failure: a comparison of carvedilol with metoprolol. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Beta blockers Page 69 of 122 Final Report Update 4 Drug Effectiveness Review Project Metoprolol European Trial (COMET): randomised controlled trial.

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