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Observational studies have demonstrated that the pneumococcal polysaccharide vaccine (PPV) is associated with reduced risk of cardiovascular events. This may be mediated through IgM antibodies to OxLDL, which have previously been associated with cardioprotective effects. The Australian Study for the Prevention through Immunisation of Cardiovascular Events (AUSPICE) is a double-blind, randomised controlled trial (RCT) of PPV in preventing ischaemic events. Participants received PPV or placebo once at baseline and are being followed-up for incident fatal and non-fatal myocardial infarction or stroke over 6 years.A subgroup of participants at one centre (Canberra; n = 1,001) were evaluated at 1 month and 2 years post immunisation for changes in surrogate markers of atherosclerosis, as pre-specified secondary outcomes: high-sensitive C-reactive protein (CRP), pulse wave velocity (PWV), and carotid intima-media thickness (CIMT). In addition, 100 participants were randomly selected in each of the intervention and control groups for measurement of anti-pneumococcal antibodies (IgG, IgG2, IgM) as well as anti-OxLDL antibodies (IgG and IgM to CuOxLDL, MDA-LDL, and PC-KLH).Concentrations of anti-pneumococcal IgG and IgG2 increased and remained high at 2 years in the PPV group compared to the placebo group, while IgM increased and then declined, but remained detectable, at 2 years. There were statistically significant increases in all anti-OxLDL IgM antibodies at 1 month, which were no longer detectable at 2 years; there was no increase in anti-OxLDL IgG antibodies. There were no significant changes in CRP, PWV or CIMT between the treatment groups at the 2-year follow-up.PPV engenders a long-lasting increase in anti-pneumococcal IgG, and to a lesser extent, IgM titres, as well as a transient increase in anti-OxLDL IgM antibodies. However, there were no detectable changes in surrogate markers of atherosclerosis at the 2-year follow-up. Long-term, prospective follow-up of clinical outcomes is continuing to assess if PPV reduces CVD events.

Background Research has shown that vaccination with Streptococcus pneumoniae reduced the extent of atherosclerosis in experimental animal models. It is thought that phosphorylcholine lipid antigens in the S. pneumoniae cell wall induce the production of antibodies that cross-react with oxidized low-density lipoprotein, a component of atherosclerotic plaques. These antibodies may bind to and facilitate the regression of the plaques. Available data provide evidence that similar mechanisms also occur in humans, leading to the possibility that pneumococcal vaccination protects against atherosclerosis. A systematic review and meta-analysis, including 8 observational human studies, of adult pneumococcal polysaccharide vaccination for preventing cardiovascular disease in people older than 65 years, showed a 17% reduction in the odds (odds ratio 0.83, 95% CI 0.71-0.97) of having an acute coronary syndrome event. Methods/Design The AUSPICE is a multicenter, randomized, placebo-controlled, double-blind, clinical trial to formally test whether vaccination with the pneumococcal polysaccharide vaccine protects against cardiovascular events (fatal and nonfatal acute coronary syndromes and ischemic strokes). Cardiovascular outcomes will be obtained during 4 to 5 years of follow-up, through health record linkage with state and national administrative data sets. Conclusion This is the first registered randomized controlled trial (on US, World Health Organization, Australia and New Zealand trial registries) to be conducted to test whether vaccination with the pneumococcal polysaccharide vaccine will reduce cardiovascular events. If successful, vaccination can be readily extended to at-risk groups to reduce the risk of cardiovascular diseases.

Patients with a spontaneous low cerebrospinal fluid pressure headache commonly present with a severe headache on assuming an upright posture which is relieved when lying flat. However, initial neuroimaging may not reveal abnormalities typically associated with a low-pressure state. A 37-year-old woman presented to Gosford Hospital with a 10 day history of severe headache associated with nausea and mild photophobia, relieved completely by recumbency. There was no history of preceding trauma, lumbar puncture, epidural anaesthesia or spinal or neurosurgical intervention. While the initial MRI of the brain was normal, symptoms persisted with conservative management. Further neuroimaging was required to confirm a diagnosis. A further MRI of the brain and spine with gadolinium was performed 12 days later demonstrating diffuse pachymeningeal thickening. An MRI of the spine using sagittal fat suppression and gradient-echo sequencing showed cerebrospinal fluid collection within the thoracic spine. Given the presence of perineural cysts at C7–T1 and T10–T11 in the spinal cord, a lumbar myelogram was performed to confirm the site of the leak at T10–T11 and a blood patch was applied. Despite initial symptom resolution, the headache returned. However, a second blood patch was effective in abolishing the headache. This patient demonstrates the importance of repeating imaging to confirm diagnosis and guide therapy when the history strongly suggests a low cerebrospinal fluid pressure headache and initial imaging is negative.

Background: Patient education is a vital component of Heart Failure Management Programs (HF-MPs) and should be specifically designed to meet the needs of this patient population. Aim: To investigate the learning style and preferences for information delivery of heart failure patients for the purposesof informing thedesignofeducational resources. Methods: A purposive sample of 12 participants, diagnosed with heart failure and enrolled in a HF-MP, participated in semi-structured in-depth interviews. Results: Four themes emerged: knowledge quest (L(AIS) causes alteration to left ventricular volumes and function. We studied patients with acute ischaemic stroke using NT–pro-BNP blood assays on days 1 and 5 after admission to Gosford Hospital Stroke Unit. Patients were submitted to 3-dimentional (3-D) echocardiographic assessment using Phillips Sonos 7500 Equipment. End diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were measured on presentation and days 3–5 following admission. The echocardiographic images were analysed using Phillips Q Lab Software. NT–pro-BNP level at presentation (mean±S.E.) was 1027± 429 pg/ml (N= 14) which was higher than day 5 (535± 215 pg/ml, N= 14, p< 0.5). Day 1 EDV, ESV and SV were 87± 6 ml, 44± 5ml and 48± 3ml, respectively (N= 21). Day 1 EFwas 55± 3 (N= 21). Days 3–5 EDV, ESV and SV were 90± 7ml, 43± 6ml and 53± 4ml, respectively (N= 21). Days 3–5 EF was 58± 4 (N= 21). The results demonstrate a trend towards a reduction in EF and SV in the acute post-AIS phase associated with evidence of neurohormonal regulation. The role of BNP in altering myocardial kinetics in early post-AIS phase deserves further investigation and needs to be viewed in the context of interaction between different neurohormones including catecholamines.