RESUMEN
Hymenopteran parasitoids are important biological control agents in agroecosystems, and their diversity can be increased with habitat heterogeneity. Thus, the purpose of the study is to evaluate the influence of distance of rice-growing areas from natural fragment, type of crop management (organic and conventional) and crop stages (vegetative and reproductive stages) on parasitoids family diversity. The work took place in two irrigated rice crops, one with organic management (O.M.) and another one with conventional management (C.M.), in the municipality of Nova Santa Rita, RS, Brazil, during the 2013/2014 and 2014/2015 seasons. The parasitoids were collected with Malaise trap arranged at different distances in relation to the native vegetation surrounding the rice crop in both places. Specimens were collected twice a month from seeding until the rice harvest. Average abundance between management, distances and rice development were compared. The most abundant families were Platygastridae, Mymaridae, Encyrtidae, Eulophidae and Trichogrammatidae. Parasitoid average abundance was significantly higher on OM only in the second season. There was a negative correlation between distance from native vegetation and parasitoid abundance in C.M. areas. There were differences in the composition of the parasitoid assembly between the phenological stages of rice.(AU)
Os himenópteros parasitoides são importantes agentes de controle biológico em agroecossistemas com sua diversidade variando de acordo com a heterogeneidade de habitat. Nesse sentido, o objetivo deste trabalho foi avaliar a influência da distância de áreas com fragmentos de vegetação natural das áreas de cultivo de arroz, o tipo de manejo (orgânico ou convencional) e os estágios da cultura (vegetativo e reprodutivo) na diversidade de famílias de parasitoides. O trabalho foi conduzido em duas áreas com plantio de arroz irrigado, uma com manejo orgânico (MO) e outra com manejo convencional (CM), no município de Nova Santa Rita, RS, Brasil, durante a safra 2013/2014 e 2014/2015. Os parasitoides foram coletados com armadilha Malaise colocadas sob diferentes distâncias em relação a vegetação nativa circundante ao cultivo em ambas as áreas. Os espécimes foram coletados duas vezes ao mês da semeadura até a colheita. Foram comparadas a abundância média entre os manejos, distâncias e estágio de desenvolvimento do arroz. As famílias mais abundantes foram Platygastridae, Mymaridae, Encyrtidae, Eulophidae e Trichogrammatidae com suas abundâncias variando ao longo da safra. A abundância média de parasitoides foi significativamente maior no MO somente na segunda safra. Houve uma correlação negativa entre a distância da vegetação nativa e a abundância de parasitoides. Houve diferença na composição da assembleia de parasitoides entre os estágios fenológicos do arroz.(AU)
Asunto(s)
Animales , Oryza , Brasil , Bosques , Ciudades , BiodiversidadRESUMEN
Abstract Hymenopteran parasitoids are important biological control agents in agroecosystems, and their diversity can be increased with habitat heterogeneity. Thus, the purpose of the study is to evaluate the influence of distance of rice-growing areas from natural fragment, type of crop management (organic and conventional) and crop stages (vegetative and reproductive stages) on parasitoids family diversity. The work took place in two irrigated rice crops, one with organic management (O.M.) and another one with conventional management (C.M.), in the municipality of Nova Santa Rita, RS, Brazil, during the 2013/2014 and 2014/2015 seasons. The parasitoids were collected with Malaise trap arranged at different distances in relation to the native vegetation surrounding the rice crop in both places. Specimens were collected twice a month from seeding until the rice harvest. Average abundance between management, distances and rice development were compared. The most abundant families were Platygastridae, Mymaridae, Encyrtidae, Eulophidae and Trichogrammatidae. Parasitoid average abundance was significantly higher on OM only in the second season. There was a negative correlation between distance from native vegetation and parasitoid abundance in C.M. areas. There were differences in the composition of the parasitoid assembly between the phenological stages of rice.
Resumo Os himenópteros parasitoides são importantes agentes de controle biológico em agroecossistemas com sua diversidade variando de acordo com a heterogeneidade de habitat. Nesse sentido, o objetivo deste trabalho foi avaliar a influência da distância de áreas com fragmentos de vegetação natural das áreas de cultivo de arroz, o tipo de manejo (orgânico ou convencional) e os estágios da cultura (vegetativo e reprodutivo) na diversidade de famílias de parasitoides. O trabalho foi conduzido em duas áreas com plantio de arroz irrigado, uma com manejo orgânico (MO) e outra com manejo convencional (CM), no município de Nova Santa Rita, RS, Brasil, durante a safra 2013/2014 e 2014/2015. Os parasitoides foram coletados com armadilha Malaise colocadas sob diferentes distâncias em relação a vegetação nativa circundante ao cultivo em ambas as áreas. Os espécimes foram coletados duas vezes ao mês da semeadura até a colheita. Foram comparadas a abundância média entre os manejos, distâncias e estágio de desenvolvimento do arroz. As famílias mais abundantes foram Platygastridae, Mymaridae, Encyrtidae, Eulophidae e Trichogrammatidae com suas abundâncias variando ao longo da safra. A abundância média de parasitoides foi significativamente maior no MO somente na segunda safra. Houve uma correlação negativa entre a distância da vegetação nativa e a abundância de parasitoides. Houve diferença na composição da assembleia de parasitoides entre os estágios fenológicos do arroz.
Asunto(s)
Animales , Oryza , Brasil , Bosques , Ciudades , BiodiversidadRESUMEN
Hymenopteran parasitoids are important biological control agents in agroecosystems, and their diversity can be increased with habitat heterogeneity. Thus, the purpose of the study is to evaluate the influence of distance of rice-growing areas from natural fragment, type of crop management (organic and conventional) and crop stages (vegetative and reproductive stages) on parasitoids family diversity. The work took place in two irrigated rice crops, one with organic management (O.M.) and another one with conventional management (C.M.), in the municipality of Nova Santa Rita, RS, Brazil, during the 2013/2014 and 2014/2015 seasons. The parasitoids were collected with Malaise trap arranged at different distances in relation to the native vegetation surrounding the rice crop in both places. Specimens were collected twice a month from seeding until the rice harvest. Average abundance between management, distances and rice development were compared. The most abundant families were Platygastridae, Mymaridae, Encyrtidae, Eulophidae and Trichogrammatidae. Parasitoid average abundance was significantly higher on OM only in the second season. There was a negative correlation between distance from native vegetation and parasitoid abundance in C.M. areas. There were differences in the composition of the parasitoid assembly between the phenological stages of rice.
Asunto(s)
Oryza , Animales , Biodiversidad , Brasil , Ciudades , BosquesRESUMEN
Abstract Hymenopteran parasitoids are important biological control agents in agroecosystems, and their diversity can be increased with habitat heterogeneity. Thus, the purpose of the study is to evaluate the influence of distance of rice-growing areas from natural fragment, type of crop management (organic and conventional) and crop stages (vegetative and reproductive stages) on parasitoids family diversity. The work took place in two irrigated rice crops, one with organic management (O.M.) and another one with conventional management (C.M.), in the municipality of Nova Santa Rita, RS, Brazil, during the 2013/2014 and 2014/2015 seasons. The parasitoids were collected with Malaise trap arranged at different distances in relation to the native vegetation surrounding the rice crop in both places. Specimens were collected twice a month from seeding until the rice harvest. Average abundance between management, distances and rice development were compared. The most abundant families were Platygastridae, Mymaridae, Encyrtidae, Eulophidae and Trichogrammatidae. Parasitoid average abundance was significantly higher on OM only in the second season. There was a negative correlation between distance from native vegetation and parasitoid abundance in C.M. areas. There were differences in the composition of the parasitoid assembly between the phenological stages of rice.
Resumo Os himenópteros parasitoides são importantes agentes de controle biológico em agroecossistemas com sua diversidade variando de acordo com a heterogeneidade de habitat. Nesse sentido, o objetivo deste trabalho foi avaliar a influência da distância de áreas com fragmentos de vegetação natural das áreas de cultivo de arroz, o tipo de manejo (orgânico ou convencional) e os estágios da cultura (vegetativo e reprodutivo) na diversidade de famílias de parasitoides. O trabalho foi conduzido em duas áreas com plantio de arroz irrigado, uma com manejo orgânico (MO) e outra com manejo convencional (CM), no município de Nova Santa Rita, RS, Brasil, durante a safra 2013/2014 e 2014/2015. Os parasitoides foram coletados com armadilha Malaise colocadas sob diferentes distâncias em relação a vegetação nativa circundante ao cultivo em ambas as áreas. Os espécimes foram coletados duas vezes ao mês da semeadura até a colheita. Foram comparadas a abundância média entre os manejos, distâncias e estágio de desenvolvimento do arroz. As famílias mais abundantes foram Platygastridae, Mymaridae, Encyrtidae, Eulophidae e Trichogrammatidae com suas abundâncias variando ao longo da safra. A abundância média de parasitoides foi significativamente maior no MO somente na segunda safra. Houve uma correlação negativa entre a distância da vegetação nativa e a abundância de parasitoides. Houve diferença na composição da assembleia de parasitoides entre os estágios fenológicos do arroz.
RESUMEN
Abstract Hymenopteran parasitoids are important biological control agents in agroecosystems, and their diversity can be increased with habitat heterogeneity. Thus, the purpose of the study is to evaluate the influence of distance of rice-growing areas from natural fragment, type of crop management (organic and conventional) and crop stages (vegetative and reproductive stages) on parasitoids family diversity. The work took place in two irrigated rice crops, one with organic management (O.M.) and another one with conventional management (C.M.), in the municipality of Nova Santa Rita, RS, Brazil, during the 2013/2014 and 2014/2015 seasons. The parasitoids were collected with Malaise trap arranged at different distances in relation to the native vegetation surrounding the rice crop in both places. Specimens were collected twice a month from seeding until the rice harvest. Average abundance between management, distances and rice development were compared. The most abundant families were Platygastridae, Mymaridae, Encyrtidae, Eulophidae and Trichogrammatidae. Parasitoid average abundance was significantly higher on OM only in the second season. There was a negative correlation between distance from native vegetation and parasitoid abundance in C.M. areas. There were differences in the composition of the parasitoid assembly between the phenological stages of rice.
Resumo Os himenópteros parasitoides são importantes agentes de controle biológico em agroecossistemas com sua diversidade variando de acordo com a heterogeneidade de habitat. Nesse sentido, o objetivo deste trabalho foi avaliar a influência da distância de áreas com fragmentos de vegetação natural das áreas de cultivo de arroz, o tipo de manejo (orgânico ou convencional) e os estágios da cultura (vegetativo e reprodutivo) na diversidade de famílias de parasitoides. O trabalho foi conduzido em duas áreas com plantio de arroz irrigado, uma com manejo orgânico (MO) e outra com manejo convencional (CM), no município de Nova Santa Rita, RS, Brasil, durante a safra 2013/2014 e 2014/2015. Os parasitoides foram coletados com armadilha Malaise colocadas sob diferentes distâncias em relação a vegetação nativa circundante ao cultivo em ambas as áreas. Os espécimes foram coletados duas vezes ao mês da semeadura até a colheita. Foram comparadas a abundância média entre os manejos, distâncias e estágio de desenvolvimento do arroz. As famílias mais abundantes foram Platygastridae, Mymaridae, Encyrtidae, Eulophidae e Trichogrammatidae com suas abundâncias variando ao longo da safra. A abundância média de parasitoides foi significativamente maior no MO somente na segunda safra. Houve uma correlação negativa entre a distância da vegetação nativa e a abundância de parasitoides. Houve diferença na composição da assembleia de parasitoides entre os estágios fenológicos do arroz.
RESUMEN
OBJECTIVE: Restoration of euthyroidism with l-thyroxine reportedly reduces obstetric complications associated with subclinical hypothyroidism (SCH). The objective was to determine if obstetric outcomes of treated subjects were equivalent to euthyroid subjects. METHODS: This was a prospective cohort study. Subjects were considered euthyroid if serum thyroidstimulating hormone (TSH) was 0.4-3 mIU/L and free thyroxine (FT4) 10.29-17.05 pmol/L with negative thyroid peroxidase antibodies (TPOAb). Subclinical hypothyroidism was diagnosed if FT4 was 10.29-24.45 pmol/L and TSH 2.5-3 mU/L with positive TPOAb, or TSH > 3.0 mU/L regardless of antibody status. Subclinical hypothyroidism subjects were treated with l-thyroxine until TSH < 2.5 mIU/L. Data were analysed with Stata (StataCorp, USA). RESULTS: Seven hundred and sixty-nine singleton pregnancies were screened; 96% at 14 weeks gestation. Five hundred and eleven (66%) were euthyroid by study definition. Prevalence of SCH was 1.9% (15/769); 26% (4/15) were TPOAb positive. Eighty-one per cent were treated according to protocol; compliance was 54%. Mean gestational age (GA) at first endocrinologist visit was 22.7 ± 2.7 weeks. Normal TSH was documented in 36% at GA 33 ± 2.94 weeks. Subjects with SCH had significantly greater pre-existing history of preterm premature rupture of membranes (PPROM) and preterm labour, Caesarean sections for non-reassuring fetal heart rate and neonatal necrotizing enterocolitis. CONCLUSION: L-thyroxine appeared to reduce obstetric complications. However, prevalence of SCH was low and compliance was < 50%.
RESUMEN
We reveal universal dynamical scaling behavior across adiabatic quantum phase transitions in networks ranging from traditional spatial systems (Ising model) to fully connected ones (Dicke and Lipkin-Meshkov-Glick models). Our findings, which lie beyond traditional critical exponent analysis and adiabatic perturbation approximations, are applicable even where excitations have not yet stabilized and, hence, provide a time-resolved understanding of quantum phase transitions encompassing a wide range of adiabatic regimes. We show explicitly that even though two systems may traditionally belong to the same universality class, they can have very different adiabatic evolutions. This implies that more stringent conditions need to be imposed than at present, both for quantum simulations where one system is used to simulate the other and for adiabatic quantum computing schemes.
RESUMEN
OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIV-positive women evaluated at the University Hospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.
Asunto(s)
Infecciones por VIH/complicaciones , Recurrencia Local de Neoplasia , Displasia del Cuello del Útero/terapia , Neoplasias del Cuello Uterino/terapia , Técnicas de Ablación , Adulto , Estudios de Casos y Controles , Estudios de Cohortes , Colposcopía , Femenino , Hospitales Universitarios , Humanos , Jamaica , Prueba de Papanicolaou , Modelos de Riesgos Proporcionales , Factores de Tiempo , Resultado del Tratamiento , Neoplasias del Cuello Uterino/complicaciones , Frotis Vaginal , Adulto Joven , Displasia del Cuello del Útero/complicacionesRESUMEN
OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIVpositive women evaluated at the University H ospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.
OBJETIVO: Determinar la tasa de recurrencia de la neoplasia intraepitelial cervical (NIC) en las mujeres VIH-positivas evaluadas en el Hospital Universitario de West Indies (HUWI). MÉTODO: Una revisión de las historias clínicas de todas las mujeres VIH-positivas no embarazadas que asistieron a la clínica ginecológica y la clínica colposcópica entre enero de 1994 y diciembre de 2004, identificó 21 de estas mujeres. Quince de estas pacientes que tenían NIC y habían tenido al menos una prueba de Papanicolaou de seguimiento, fueron los sujetos principales de este estudio. Estas pacientes fueron comparadas con 21 controles de VIH-negativos que fueron vistos durante el mismo período y que también tuvieron al menos una prueba de Papanicolaou de seguimiento. Las modalidades de tratamiento para los grupos incluyeron coagulación fría y escisión con asa grande de la zona de transformación (LLETZ). El modelo de análisis de riesgos proporcionales de Cox fue utilizado para determinar el efecto del estatus de VIH al momento de la primera recurrencia de CIN. RESULTADOS: Las edades promedios de los sujetos fueron 32.7 ± 8.0 y 33.2 ± 8.1 años, respectivamente. Con un período de seguimiento promedio de 1.7 años, la tasa de recurrencia de NIC en pacientes con y sin VIH fue 66.24 (95% IC 27.6, 159.1) y 3.0 (95% IC 1.3, 7.3) por 100 persona/años. El cociente de tasas de riesgo de recurrencia en pacientes con VIH después de ajustar por edad y etapa de CIN fue 19.1 (95% IC 4.4, 82.1). CONCLUSIÓN: El VIH aumenta el riesgo de recurrencia de la NIC.
Asunto(s)
Humanos , Femenino , Adulto , Adulto Joven , Infecciones por VIH/complicaciones , Neoplasias del Cuello Uterino/terapia , Displasia del Cuello del Útero/terapia , Recurrencia Local de Neoplasia , Factores de Tiempo , Frotis Vaginal , Estudios de Casos y Controles , Modelos de Riesgos Proporcionales , Neoplasias del Cuello Uterino/complicaciones , Estudios de Cohortes , Resultado del Tratamiento , Displasia del Cuello del Útero/complicaciones , Colposcopía , Técnicas de Ablación , Prueba de Papanicolaou , Hospitales Universitarios , JamaicaRESUMEN
BACKGROUND: Compared with ultrasound, magnetic resonance imaging (MRI) offers superior visualization ofthe fetal brain. It confirms and characterizes brain abnormalities detected by prenatal ultrasound, particularly in late pregnancy when acoustic windows are difficult or fetal position is inaccessible. Prior to July 2008, only two studies were attempted at our institution as local technical expertise was unavailable. Following collaboration with a neuroradiologist at an expert centre, images ofsufficient quality for diagnosis were obtained. OBJECTIVE: The study objective is to evaluate the initial experience with fetal brain MRI and its effects on patient counselling and management in a resource limited healthcare system. METHOD: In seven fetuses with abnormal ultrasound neuroimaging, fetal MRI was performed with T2-weighted single-shot fast spin-echo (SSFSE) sequences using a 1.5T magnet (GE Medical Systems, Milwaukee, WI). RESULTS: Magnetic resonance imaging did not alter ultrasound diagnosis in two patients (28%); however it changed the diagnosis in three (43%), provided additional information in one (14%) and changed management in two (28%) patients. CONCLUSION: Magnetic resonance imaging availability further elucidated brain pathology, aided patient counselling, parental decision-making and multidisciplinary management.
Asunto(s)
Encefalopatías/diagnóstico , Enfermedades Fetales/diagnóstico , Imagen por Resonancia Magnética , Malformaciones del Sistema Nervioso/diagnóstico , Adulto , Femenino , Humanos , Jamaica , Embarazo , Ultrasonografía Prenatal , Adulto JovenRESUMEN
BACKGROUND: Compared with ultrasound, magnetic resonance imaging (MRI) offers superior visualization of the fetal brain. It confirms and characterizes brain abnormalities detected by prenatal ultrasound, particularly in late pregnancy when acoustic windows are difficult or fetal position is inaccessible. Prior to July 2008, only two studies were attempted at our institution as local technical expertise was unavailable. Following collaboration with a neuroradiologist at an expert centre, images of sufficient quality for diagnosis were obtained. OBJECTIVE: The study objective is to evaluate the initial experience with fetal brain MRI and its effects on patient counselling and management in a resource limited healthcare system. METHOD: In seven fetuses with abnormal ultrasound neuroimaging, fetal MRI was performed with T2- weighted single-shot fast spin-echo (SSFSE) sequences using a 1.5T magnet (GE Medical Systems, Milwaukee, WI). RESULTS: Magnetic resonance imaging did not alter ultrasound diagnosis in two patients (28%); however, it changed the diagnosis in three (43%), provided additional information in one (14%) and changed management in two (28%) patients. CONCLUSION: Magnetic resonance imaging availability further elucidated brain pathology, aided patient counselling, parental decision-making and multidisciplinary management.
ANTECEDENTES: A diferencia del ultrasonido, la imagen por resonancia magnética (IRM) ofrece una visualización superior del cerebro fetal. Mediante ella, se hace posible confirmar y caracterizar las anormalidades detectadas por el ultrasonido prenatal, particularmente en la última etapa del embarazo, cuando las ventanas acústicas son difíciles, o la posición fetal es inaccesible. Antes del 2008 de julio, se intentaron sólo dos estudios en nuestra institución, ya que a nivel local no se disponía de conocimientos técnicos especializados. Tras la colaboración con un neuroradiólogo en un centro especializado, se obtuvieron imágenes de calidad suficiente para realizar el diagnóstico. OBJETIVO: El objetivo del estudio es evaluar la experiencia inicial con el IRM del cerebro fetal y sus efectos en cuanto a brindar consejos y tratamiento a los pacientes en un sistema de atención a la salud con recursos limitados. MÉTODO: En siete fetos con neuroimágenes de ultrasonido anormales, se llevó a cabo un IRM fetal con secuencias potenciadas en T2 como single-shot fast spin-echo (SSFSE), usando un imán 1.5T (GE Medical Systems, Milwaukee, WI). RESULTADOS: La imagen por resonancia magnética (IRM) no alteró el diagnóstico del ultrasonido en dos pacientes (28%). Sin embargo, cambió el diagnóstico en tres (43%), dio información adicional en uno (14%), y cambió el tratamiento en dos (28%) pacientes. CONCLUSIÓN: Poder contar con la imagen de resonancia magnética permitió dilucidar aún más la patología del cerebro, ayudar a dar consejos al paciente, tomar decisiones a los padres, y alcanzar un tratamiento multidisciplinario.
Asunto(s)
Adulto , Femenino , Humanos , Embarazo , Adulto Joven , Encefalopatías/diagnóstico , Enfermedades Fetales/diagnóstico , Imagen por Resonancia Magnética , Malformaciones del Sistema Nervioso/diagnóstico , Jamaica , Ultrasonografía PrenatalRESUMEN
OBJECTIVE: The objective of this study was to compare outcomes of patients with prenatally versus postnatally diagnosed congenital abnormalities seen during the first 18 months of a recently established MFM unit. METHODS: Hospital charts of all congenital abnormalities diagnosed between July 2008 and December 2009 were reviewed. Data collected included: maternal demographics, perinatal outcome, neonatal mortality and morbidity as defined in the Radius trial. RESULTS: Fifty-five pregnancies with 57 anomalous fetuses were identified: 13 (23%) postnatally and 44 (77%) prenatally. Most frequent postnatally diagnosed anomalies were gastrointestinal (33%), central nervous system (CNS) (16%) and cardiac (16%); whereas prenatally diagnosed were CNS (29%) and genitourinary (23%). Mothers postnatally diagnosed had a 12 kg (17%) greater mean weight; 12 (92%) had anomaly scans reported as normal; birth weight and moderate neonatal morbidity were statistically greater (2.8 vs. 2.13 kg, p < 0.02) and (9/12 vs. 11/29, p < 0.03), respectively. Neonatal morbidity was 6.2 times more likely in the postnatally diagnosed group adjusting for birth weight, gestational age and route of delivery [OR (95% CI) 6.2, (1.2-32.4), p = 0.03]. CONCLUSIONS: Most abnormalities were diagnosed prenatally; however, the majority of postnatally diagnosed had false negative anomaly scans and experienced significantly more moderate neonatal morbidity.
Asunto(s)
Anomalías Congénitas/epidemiología , Resultado del Embarazo/epidemiología , Adulto , Anomalías Congénitas/diagnóstico , Femenino , Edad Gestacional , Humanos , Jamaica/epidemiología , Centros de Salud Materno-Infantil/estadística & datos numéricos , Relaciones Materno-Fetales , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Diagnóstico Prenatal/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Adulto JovenRESUMEN
The study was conducted to characterize and compare twelve different additives distributed in Mexico as mycotoxin binders utilizing: (1) equilibrium isothermal analysis for aflatoxin B(1) (AFB(1)) adsorption, (2) a variety of mineralogical probes, and (3) Hydra toxicity bioassay. The test additives Milbond-TX (MLB), Mycoad (MCA), Volclay FD181 (VOL), Fixat (FXT), Toxinor (TOX), Mexsil (MEX), Mycosil (MYC), Klinsil (KLS), Zeotek (ZEO), Duotek (DUO), Mycosorb (MSB), and Mycofix Plus 3.0 (MIX) were compared with NovaSil Plus (NSP). Isotherms for AFB(1) adsorption were conducted at pH 2 and pH 6.5, mimicking pH conditions in the stomach and small intestine. Mineralogical analysis included determination of swelling volume, X-ray diffraction analysis, and fractionation procedures. A Hydra vulgaris toxicity study was performed to evaluate the potential safety of the additives. Computer-generated isotherm data were fit using the Langmuir model, and parameters of Q(max) and K(d) were estimated. The most effective additives for AFB(1) at both pH conditions were NSP, MLB, MCA and VOL, while the least effective was MSB. The amounts of sand, silt and clay fractions varied among the additives. Nine of the additives showed the presence of smectite. Most of the additives were found to be non-toxic to Hydra except for the organoclays (ZEO, DUO) and MSB. In general, NSP demonstrated the highest sorption capacity in the bulk material and the different fractions. Studies to characterize these binding additives further and to evaluate their multiple mycotoxin sorption claims are ongoing.
Asunto(s)
Aflatoxinas/envenenamiento , Alimentación Animal/microbiología , Micotoxinas/envenenamiento , Silicatos/química , Adsorción , Silicatos de Aluminio/química , Animales , Arcilla , MéxicoRESUMEN
BACKGROUND: Paediatric and Perinatal HIV/AIDS remain significant health challenges in the Caribbean where the HIV seroprevalence is second only to Sub-Saharan Africa. METHOD: We describe a collaborative approach to the prevention, treatment and care of HIV in pregnant women, infants and children in Jamaica. A team of academic and government healthcare personnel collaborated to address the paediatric and perinatal HIV epidemic in Greater Kingston as a model for Jamaica (population 2.6 million, HIV seroprevalence 1.5%). A five-point plan was utilized and included leadership and training, preventing mother-to-child transmission (pMTCT), treatment and care of women, infants and children, outcomes-based research and local, regional and international outreach. RESULTS: A core group of paediatric/perinatal HIV professionals were trained, including paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data managers, information technology personnel and students to serve Greater Kingston (birth cohort 20 000). During September 2002 to August 2007, over 69 793 pregnant women presented for antenatal care. During these five years, significant improvements occurred in uptake of voluntary counselling (40% to 91%) and HIV-testing (53% to 102%). Eight hundred and eighty-three women tested HIV-positive with seroprevalence rates of 1-2% each year. The use of modified short course zidovudine or nevirapine in the first three years significantly reduced mother-to-child transmission (MTCT) of HIV from 29% to 6% (RR 0.27; 95% CI - 0.10, 0.68). During 2005 to 2007 using maternal highly active antiretroviral therapy (HAART) with zidovudine and lamivudine with either nevirapine, nelfinavir or lopinavir/ritonavir and infant zidovudine and nevirapine, MTCT was further reduced to an estimated 1.6% in Greater Kingston and 4.75% islandwide. In five years, we evaluated 1570 children in four-weekly paediatric infectious diseases clinics in Kingston, St Andrew and St Catherine and in six rural outreach sites throughout Jamaica; 24% (377) had HIV/AIDS and 76% (1193) were HIV-exposed. Among the infected children, 79% (299 of 377) initiated HAART, resulting in reduced HIV-attributable childhood morbidity and mortality islandwide. An outcomes-based research programme was successfully implemented. CONCLUSION: Working collaboratively, our mission of pMTCT of HIV and improving the quality of life for families living and affected by HIV/AIDS in Jamaica is being achieved.
ANTECEDENTES: El VIH/SIDA pediátrico y el perinatal continúan siendo retos significativos para la salud en el Caribe, donde la seroprevalencia de VIH ocupa el segundo lugar tras el África Subsahariana. MÉTODO: Se describe un enfoque colaborativo para tratamiento, prevención y cuidado de embarazadas, bebés y niños en Jamaica. Un equipo de personal académico y gubernamental vinculados a la salud, colaboraron para abordar la epidemia de VIH pediátrico y perinatal en Greater Kingston, como modelo para Jamaica (población de 2.6 millones, 1.5% seroprevalencia VIH). Se utilizó un plan de cinco puntos que incluyó liderazgo y entrenamiento, prevención de la transmisión madre a hijo (PTMAH), tratamiento y cuidado de mujeres, bebés y niños, investigaciones basadas en resultados, y outreach local, regional e internacional. RESULTADOS: Un grupo básico de profesionales del VIH pediátrico/perinatal, que incluía pediatras, obstetras, trabajadores de la salud, enfermeras, microbiólogos, administradores de datos, así como personal y estudiantes de la tecnología de la información, fue entrenado para servir en Greater Kingston (cohorte de nacimiento 20 000). De septiembre de 2002 hasta Agosto de 2007, más de 69 793 embarazadas se presentaron para recibir atención prenatal. Durante estos cinco años, tuvieron lugar mejoras significativos en cuanto a la recepción de asesoramiento (40% to 91%) y pruebas (53% to 102%) de VIH voluntarios. Ochocientos ochenta y tres mujeres resultaron VIH positivas en las pruebas, con tasas de seroprevalencia de 1-2% cada año. El uso de un ciclo corto modificado de zidovudina o nevirapina en los primeros tres años, redujo la transmisión madre a hijo (TMAH) de VIH significativamente de 29% a 6% (RR 0.27; 95% CI - 0.10, 0.68). Durante el 2005 hasta 2007, usando terapia antiretroviral altamente activa (TARAA) materna, con zidovudina y lamivudina con nevirapina, nelfinavir o lopinavir/ritonavir y nevirapina y zidovudina para niños, la TMAH se redujo a un estimado de 1.6 % en Greater Kingston y a .75% a lo largo de la isla. En cinco años, evaluamos 1570 niños en cuatro clínicas infecciosas pediátricas semanales en Kingston, Saint Andrew y Saint Catherine, así como en seis otros lugares destinados al servicio comunitario (outreach) por toda Jamaica; 24% (377) tenían VIH/SIDA y 76% (1193) estaba expuestos al VIH. Entre los niños infectados, 79% (299 de 377) iniciaron el TARAA, lo que trajo como resultado una reducción de la mortalidad y la morbilidad infantil atribuible al VIH, en todo el país. Se implementó exitosamente un programa de investigación basado en resultados. CONCLUSIÓN: Trabajando en colaboración, estamos logrando nuestra misión de prevenir la TMAH del VIH, y mejorar la calidad de vida de las familias que viven afectadas por el VIH/SIDA en Jamaica.
Asunto(s)
Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Desarrollo de Programa , Salud Pública , Fármacos Anti-VIH/uso terapéutico , Región del Caribe/epidemiología , Protección a la Infancia , Intervalos de Confianza , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Bienestar del Lactante , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Cooperación Internacional , Jamaica/epidemiología , Pediatría , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Estudios SeroepidemiológicosRESUMEN
BACKGROUND: The Ministry of Health, Jamaica, is scaling-up programmes to improve the health of HIV-positive pregnant women according to the modified WHO recommended preventative mother to child transmission (pMTCT) regimens of therapy based upon the mother's clinical and immunological status. Highly-active antiretroviral drugs (HAART) can result in successful pMTCT to < 1%. We report the clinical and immunological characteristics of HIV/AIDS in an era of evolving treatment and care of HIV-infected pregnant Jamaican women. SUBJECTS AND METHOD: Clinical records were reviewed of patients registered in antenatal clinics in Greater Kingston and St Catherine, Jamaica (annual birth cohort - 20 000) between September 2002 and August 2006. Disease status was determined using the Centers for Disease Control and Prevention (CDC) classification system for adult HIV/AIDS. Demographic, clinical and laboratory data were documented and analyzed. RESULTS: During the four-year period, 571 HIV-infected women were enrolled; 62% from Victoria Jubilee Hospital, 25% from Spanish Town Hospital and 13% from the University Hospital of the West Indies. Mean age was 27-29 (range 15-41) years, median parity was 2 (range 0-9) and 68-70% were unemployed. Ninety-five per cent had live births. CDC categories of illnesses were A - mild disease in 82% (n = 473), B - moderate disease in 4.4% (n = 24) and C - severe disease in 1.4% (n = 8) while 12% (n = 66) had insufficient data. During the first three years, CD4+ cell counts were evaluated in only 2.5% (10 of 406) of patients with median of 344 cells/uL, compared to CD4 evaluation in 50% (83 of 165 women) in the last year with median of 573 cells/uL. Antiretroviral (ARV) medications primarily for pMTCT were given to 89% (n = 506) of women. Of these, uptake of HAART increased during years 1-3 from 2-3% to 62% in year four. Within two years post-partum, 24 women died, 92% (n = 22) from the direct complications of HIV/AIDS. CONCLUSION: A comprehensive system of care of HIV in the peripartum period has been developed in Jamaica. Detailed medical evaluation during pregnancy is performed with modern guidelines and increasing laboratory availability of CD4+ cell counts and viral loads. We believe declining HIV infection rates in Jamaican infants and healthier mothers are a direct consequence of increased testing in pregnancy with early diagnosis and initiation of HAART-based pMTCT regimens in pregnant women.
ANTECEDENTES: En la actualidad el Ministerio de Salud de Jamaica se halla en plena campaña por aumentar los programas de salud para mujeres embarazadas por el VIH positivo, sobre la base de regímenes terapéuticos para prevenir la transmisión de madre a hijo (PTMAH), de acuerdo con recomendaciones modificadas de la OMS, a partir del estatus inmunológico y clínico de la madre. Los medicamentos antiretrovirales altamente activos (TARAA) pueden traer como resultado un exitoso PTMAH a < 1%. Reportamos las características clínicas e inmunológicas del VIH/SIDA en una etapa en la que el tratamiento y cuidado de las mujeres embarazadas infectadas con VIH en Jamaica, se halla en evolución. SUJETOS Y MÉTODOS: Se revisaron las historias clínicas de pacientes registrados en las clínicas prenatales en Greater Kingston y Saint Catherine (cohorte de nacimiento anual - 20 000), entre septiembre de 2002 y agosto de 2006. El estatus de la enfermedad fue determinado usando el sistema de clasificación para el VIH/SIDA en adultos, según los Centros para el Control y Prevención de las Enfermedades (CCPE). Se documentario y analizaron datos demográficos, clínicos y de laboratorio. RESULTADOS: Durante el período de cuatro años, se reclutaron 571 mujeres infectadas con el VIH, 62% del Hospital Victoria Jubilee, 25% del Hospital de Spanish Town, y 13% del Hospital Universitario de West Indies. La edad promedio fue de 27-29 años (rango 15-41), la paridad mediana fue 2 (rango 0-9), y el 68-70% eran desempleadas. El noventa y cinco por ciento tuvo nacimientos vivos. Las categorías de enfermedades de CCPE fueron la enfermedad leve A- en 82% (n = 473), la enfermedad moderada B - en 4.4% (n = 24) y la enfermedad severa C - en 1.4% (n = 8) mientras que para el 12% (n = 66) los datos fueron insuficientes. Durante los primeros tres años, los conteos CD4+ fueron evaluados en sólo 2.5% (10 de 406) de los pacientes con la mediana de 344 células/uL, en comparación con la evaluación CD4 en 50% (83 de 165 mujeres) en el último año con una mediana de 573 células/uL. Los medicamentos antiretrovirales (ARV) fundamentalmente para PTMAH fueron dados al 89% (n = 506) de las mujeres. Entre éstas, el consumo de TARAA aumentó durante los años 1-3 de 2-3% a 62% en el cuarto año. En los dos años posteriores al parto, murieron 24 mujeres, 92% (n = 22) de complicaciones directas del VIH/SIDA, CONCLUSIÓN: Un sistema integral de atención al VIH en el período de periparto ha sido desarrollado en Jamaica. Durante el embarazo, se lleva a cabo una evaluación médica detallada con normas modernas y con aumento de la disponibilidad en los laboratorios del conteo CD4+ y cargas virales. Creemos que la disminución de las tasas de infección por VIH en los infantes jamaicanos y el número de madres más saludables, son consecuencia directa del aumento de las pruebas durante el embarazo con diagnóstico precoz y regímenes de PTMAH basados en TARAA en las mujeres embarazadas.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Embarazo , Adulto Joven , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Nevirapina/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Salud Pública , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Jamaica/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal , Desarrollo de Programa , Estudios Retrospectivos , Inhibidores de la Transcriptasa Inversa/uso terapéuticoRESUMEN
BACKGROUND: The Ministry of Health, Jamaica, is scaling-up programmes to improve the health of HIV-positive pregnant women according to the modified WHO recommended preventative mother to child transmission (pMTCT) regimens of therapy based upon the mother's clinical and immunological status. Highly-active antiretroviral drugs (HAART) can result in successful pMTCT to < 1%. We report the clinical and immunological characteristics of HIV/AIDS in an era of evolving treatment and care of HIV-infected pregnant Jamaican women. SUBJECTS AND METHOD: Clinical records were reviewed of patients registered in antenatal clinics in Greater Kingston and St. Catherine, Jamaica (annual birth cohort--20,000) between September 2002 and August 2006. Disease status was determined using the Centers for Disease Control and Prevention (CDC) classification system for adult HIV/AIDS. Demographic, clinical and laboratory data were documented and analyzed. RESULTS: During the four-year period, 571 HIV-infected women were enrolled; 62% from Victoria Jubilee Hospital, 25% from Spanish Town Hospital and 13% from the University Hospital of the West Indies. Mean age was 27-29 (range 15-41) years, median parity was 2 (range 0-9) and 68-70% were unemployed. Ninety-five per cent had live births. CDC categories of illnesses were A--mild disease in 82% (n=473), B--moderate disease in 4.4% (n=24) and C--severe disease in 1.4% (n=8) while 12% (n=66) had insufficient data. During the first three years, CD4+ cell counts were evaluated in only 2.5% (10 of 406) of patients with median of 344 cells/microL, compared to CD4 evaluation in 50% (83 of 165 women) in the last year with median of573 cells/uL. Antiretroviral (ARV) medications primarily for pMTCT were given to 89% (n=506) ofwomen. Of these, uptake of HAART increased during years 1-3 from 2-3% to 62% in year four Within two years post-partum, 24 women died, 92% (n=22)from the direct complications of HIV/AIDS. CONCLUSION: A comprehensive system of care of HIV in the peripartum period has been developed in Jamaica. Detailed medical evaluation during pregnancy is performed with modern guidelines and increasing laboratory availability of CD4+ cell counts and viral loads. We believe declining HIV infection rates in Jamaican infants and healthier mothers are a direct consequence of increased testing in pregnancy with early diagnosis and initiation of HAART-based pMTCT regimens in pregnant women.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Nevirapina/uso terapéutico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Salud Pública , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Jamaica/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal , Desarrollo de Programa , Estudios Retrospectivos , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Adulto JovenRESUMEN
BACKGROUND: Paediatric and Perinatal HIV/AIDS remain significant health challenges in the Caribbean where the HIV seroprevalence is second only to Sub-Saharan Africa. METHOD: We describe a collaborative approach to the prevention, treatment and care ofHIVin pregnant women, infants and children in Jamaica. A team of academic and government healthcare personnel collaborated to address the paediatric and perinatal HIV epidemic in Greater Kingston as a model for Jamaica (population 2.6 million, HIV seroprevalence 1.5%). A five-point plan was utilized and included leadership and training, preventing mother-to-child transmission (pMTCT), treatment and care of women, infants and children, outcomes-based research and local, regional and international outreach. RESULTS: A core group of paediatric/perinatal HIV professionals were trained, including paediatricians, obstetricians, public health practitioners, nurses, microbiologists, data managers, information technology personnel and students to serve Greater Kingston (birth cohort 20,000). During September 2002 to August 2007, over 69 793 pregnant women presented for antenatal care. During these five years, significant improvements occurred in uptake of voluntary counselling (40% to 91%) and HIV-testing (53% to 102%). Eight hundred and eighty-three women tested HIV-positive with seroprevalence rates of 1-2% each year The use of modified short course zidovudine or nevirapine in the first three years significantly reduced mother-to-child transmission (MTCT) of HIV from 29% to 6% (RR 0.27; 95%0 CI--0.10, 0.68). During 2005 to 2007 using maternal highly active antiretroviral therapy (HAART) with zidovudine and lamivudine with either nevirapine, nelfinavir or lopinavir/ritonavir and infant zidovudine and nevirapine, MTCT was further reduced to an estimated 1.6% in Greater Kingston and 4.75% islandwide. In five years, we evaluated 1570 children in four-weekly paediatric infectious diseases clinics in Kingston, St Andrew and St Catherine and in six rural outreach sites throughout Jamaica; 24% (377) had HIV/AIDS and 76% (1193) were HIV-exposed. Among the infected children, 79% (299 of 377) initiated HAART resulting in reduced HIV-attributable childhood morbidity and mortality islandwide. An outcomes-based research programme was successfully implemented. CONCLUSION: Working collaboratively, our mission of pMTCT of HIV and improving the quality of life for families living and affected by HIV/AIDS in Jamaica is being achieved.
Asunto(s)
Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Desarrollo de Programa , Salud Pública , Fármacos Anti-VIH/uso terapéutico , Región del Caribe/epidemiología , Niño , Protección a la Infancia , Preescolar , Intervalos de Confianza , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Lactante , Bienestar del Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Cooperación Internacional , Jamaica/epidemiología , Pediatría , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Estudios SeroepidemiológicosRESUMEN
BACKGROUND: The seroprevalence of HIV among pregnant women in the Caribbean is 2-3 and increasing. The Kingston Paediatric and Perinatal HIV Programme is developing and implementing a unified programme to eliminate mother-to-child transmission (MTCT) of HIV in Kingston, Jamaica. METHODS: Pregnant women presenting to Kingston Metropolitan Antenatal Clinics, Victoria Jubilee Hospital, Spanish Town Hospital and the University Hospital of the West Indies had HIV serology performed by ELISA, or by the new Determine Rapid Test after receiving group counselling. HIV-positive women were referred to High Risk Antenatal Clinics. Antiretroviral prophylaxis with zidovudine (AZT), or nevirapine was given. Care was administered using a standard protocol by a multi-disciplinary team of public and academic healthcare personnel. RESULTS: In year one, 19,414 women delivered Among 14,054 women who started antenatal care for this period, 5,558 (40) received group counselling and 7,383 (53) received HIV-testing. During the fourth quarter of follow-up, these comparative rates were 66 (2049/3 118) and 72 (2260/3118) respectively. HIV seroprevalence overall was 2.1 (152/7 383). One hundred and seven HIV+ women at varying gestational ages were identified in the programme, 72 had so far received AZT and nine nevirapine (76). 0f 84 deliveries, birth outcomes were 75 live births (89), six neonatal deaths and four maternal deaths (all from HIV/AIDS). Major challenges include repeat pregnancies of 36 despite prior knowledge of HIV seropositivity and poor partner notification with only 30 (32) having a HIV-test. Although rates of HIV testing in pregnant women in Greater Kingston are increasing, rates of testing overall remain sub-optimal. On the labour ward, there was sub-optimal identification of the HIV+ pregnant woman and administration of AZT chemoprophylaxis, along with issues of patient confidentiality and stigma. CONCLUSION: This programme needs strengthening in order to reduce maternal-fetal transmission of HIV in Greater Kingston, Jamaica [quot]pMTCT-PLUS, or comprehensive family-centred care, is the next step[quot]
Asunto(s)
Humanos , Femenino , Embarazo , Adolescente , Adulto , Transmisión Vertical de Enfermedad Infecciosa , Evaluación de Programas y Proyectos de Salud , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal , Infecciones por VIH/prevención & control , Seroprevalencia de VIH , Atención Perinatal , Complicaciones Infecciosas del Embarazo/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Jamaica/epidemiología , Nevirapina/administración & dosificación , Resultado del Embarazo , Seropositividad para VIH , Zidovudina/administración & dosificaciónAsunto(s)
Antineoplásicos Hormonales/uso terapéutico , Leiomioma/tratamiento farmacológico , Acetato de Medroxiprogesterona/uso terapéutico , Menorragia/tratamiento farmacológico , Neoplasias Uterinas/tratamiento farmacológico , Adulto , Antineoplásicos Hormonales/administración & dosificación , Relación Dosis-Respuesta a Droga , Femenino , Hemoglobinas/efectos de los fármacos , Humanos , Leiomioma/complicaciones , Leiomioma/cirugía , Acetato de Medroxiprogesterona/administración & dosificación , Menorragia/etiología , Persona de Mediana Edad , Cuidados Preoperatorios , Estudios Retrospectivos , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/cirugíaRESUMEN
BACKGROUND: The seroprevalence of HIV among pregnant women in the Caribbean is 2-3% and increasing. The Kingston Paediatric and Perinatal HIV Programme is developing and implementing a unified programme to eliminate mother-to-child transmission (MTCT) of HIV in Kingston, Jamaica. METHODS: Pregnant women presenting to Kingston Metropolitan Antenatal Clinics, Victoria Jubilee Hospital, Spanish Town Hospital and the University Hospital of the West Indies had HIV serology performed by ELISA, or by the new Determine Rapid Test after receiving group counselling. HIV-positive women were referred to High Risk Antenatal Clinics. Antiretroviral prophylaxis with zidovudine (AZT), or nevirapine was given. Care was administered using a standard protocol by a multi-disciplinary team of public and academic healthcare personnel. RESULTS: In year one, 19,414 women delivered Among 14,054 women who started antenatal care for this period, 5,558 (40%) received group counselling and 7,383 (53%) received HIV-testing. During the fourth quarter of follow-up, these comparative rates were 66% (2049/3 118) and 72% (2260/3118) respectively. HIV seroprevalence overall was 2.1% (152/7 383). One hundred and seven HIV+ women at varying gestational ages were identified in the programme, 72 had so far received AZT and nine nevirapine (76%). 0f 84 deliveries, birth outcomes were 75 live births (89%), six neonatal deaths and four maternal deaths (all from HIV/AIDS). Major challenges include repeat pregnancies of 36% despite prior knowledge of HIV seropositivity and poor partner notification with only 30% (32) having a HIV-test. Although rates of HIV testing in pregnant women in Greater Kingston are increasing, rates of testing overall remain sub-optimal. On the labour ward, there was sub-optimal identification of the HIV+ pregnant woman and administration of AZT chemoprophylaxis, along with issues of patient confidentiality and stigma. CONCLUSION: This programme needs strengthening in order to reduce maternal-fetal transmission of HIV in Greater Kingston, Jamaica "pMTCT-PLUS, or comprehensive family-centred care, is the next step".