RESUMEN
BACKGROUND: People living with HIV have an increased risk of meningococcal disease. The Propositive trial evaluated co-administration of two doses of a four-component recombinant protein-based MenB vaccine (4CMenB) and a quadrivalent conjugate polysaccharide MenACWY vaccine (MenACWY-CRM197) given 1 month apart in people with HIV. The follow-up trial assessed the immunogenicity of these vaccines at 1.5 and 2.5 years after primary vaccination. METHODS: Participants who completed the parent Propositive trial were invited to the follow-up study. Immunogenicity analysis was performed at 18 and 30 months after primary vaccination. Primary outcome measures were serum bactericidal antibody (SBA) geometric mean titres (GMTs) against three MenB reference strains and the proportion of participants maintaining a protective SBA titre of ≥4 at 18 and 30 months. Secondary outcome measures were SBA GMTs against MenA, C, W, and Y serogroups and the proportion of participants maintaining a protective SBA titre of ≥8 at 18 and 30 months. The trial is registered with Clinicaltrials.gov (NCT042394300). RESULTS: A total of 40 participants aged 22-47 years were enrolled. Geometric mean titres waned by 18 and 30 months but remained higher than pre-vaccination for all MenB strains and MenA, C, W, and Y. In total, 75%-85% of participants retained protective SBA titres by 30 months against individual MenB strains, whereas 68.8% of patients retained protective antibody titres against all three MenB strains. Antibodies against MenC waned more rapidly than did those against MenA, W, and Y. The proportion of participants with protective titres against MenC at 30 months was also lower (46.9%) than that with protective titres against MenA (87.5%), W (78.1%), and Y (87.5%). CONCLUSIONS: Immune responses against MenB in our cohort of people living with HIV at 2.5 years of follow-up were reassuring, with 68.8% of participants retaining protection against all three reference strains. However, responses against MenC were lower than those against MenA, W, and Y serogroups.
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Infecciones por VIH , Infecciones Meningocócicas , Vacunas Meningococicas , Humanos , Vacunas Meningococicas/efectos adversos , Infecciones Meningocócicas/prevención & control , Infecciones Meningocócicas/inducido químicamente , Estudios de Seguimiento , Anticuerpos Antibacterianos , Inmunidad , Vacunas ConjugadasRESUMEN
Affordable, polyvalent meningococcal vaccines are needed for use in emergency reactive immunization campaigns. A phase IV randomized, observer-blind, controlled study compared the safety and immunogenicity of a quadrivalent meningococcal polysaccharide vaccine (MPV-4, MPV ACYW135) and quadrivalent meningococcal ACWY conjugate vaccine (MCV-4, Menactra®). Healthy, 2- to 10-year-old children in Bamako, Mali, were randomized 1:1 to receive one dose of MPV-4 or MCV-4. Safety outcomes were evaluated for 6 months post-immunization. Immunogenicity for all serogroups was assessed for non-inferiority between MPV-4 and MCV-4 30 days post immunization by serum bactericidal antibody assay using baby rabbit complement (rSBA). From December 2020 to July 2021, 260 healthy subjects were consented and randomized. At Day 30 post-immunization, the proportions of subjects with rSBA titers ≥ 128 for all serogroups in the MPV-4 group were non-inferior to those in MCV-4 group. The proportions of subjects with rSBA ≥ 4-fold increase and rSBA titers ≥ 8 for all serogroups were similar among vaccine groups (P > .05). Geometric Mean Titers and Geometric Mean Fold Increases for all serogroups in both vaccine groups were similar (P > .05). Few local and systemic post-immunization reactions of similar severity and duration were observed within 7 days and were similar in both groups (P > .05). All resolved without sequelae. Unsolicited adverse events were similar in both groups regarding relationship to study vaccine, severity and duration. No serious adverse events were reported during the study period. MPV ACYW135 showed a non-inferior immunogenicity profile and a comparable reactogenicity profile to MCV-4 in Malian children aged 2-10 years.Clinical Trial Registration: NCT04450498.
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Infecciones Meningocócicas , Vacunas Meningococicas , Neisseria meningitidis , Humanos , Vacunas Conjugadas , Vacunación , Serogrupo , Anticuerpos Antibacterianos , Infecciones Meningocócicas/prevención & controlRESUMEN
BACKGROUND: People living with HIV have been shown to have an increased risk of invasive meningococcal disease. In some countries, meningococcal vaccines are now routinely recommended to all people living with HIV, but no study has yet assessed the immunogenicity and safety of a meningococcal serogroup B vaccine or the co-administration of a MenB and MenACWY vaccine in people living with HIV. METHODS: This phase IV open-label clinical trial investigated the immunogenicity and safety of two doses of a four-component recombinant protein-based MenB vaccine (4CMenB) and a quadrivalent conjugate polysaccharide MenACWY vaccine (MenACWY-CRM197) given 1 month apart in a population of people living with HIV. Immunogenicity analysis was performed before vaccination and 1 month after the second doses of 4CMenB and MenACWY. Primary outcome measures were serum bactericidal assay geometric mean titres against three MenB reference strains at baseline and 1 month post vaccination, the proportion of participants achieving a putative protective titre of ≥4, and the proportion of participants with a ≥4-fold rise in titre from baseline. Secondary outcome measures were serum bactericidal assay geometric mean titres against MenA, C, W, and Y reference strains at baseline and 1 month post vaccination, the proportion achieving a putative protective titre of ≥8, and the proportion with a ≥4-fold rise in titre from baseline. Safety outcomes were solicited and unsolicited adverse events in the 7 days following vaccination. The trial was registered with clinicaltrials.gov (NCT03682939). FINDINGS: In total, 55 participants aged 20-45 years were enrolled. All participants (100%; 95% confidence interval [CI] 93-100) achieved putative protective titres for two of the three MenB strains and for MenA, W, and Y. A total of 98% (95% CI 89-100) achieved a protective titre for the third MenB strain and 94% (95% CI 83-99) for MenC. No serious adverse events were reported. INTERPRETATION: 4CMenB and MenACWY were immunogenic and well-tolerated in a population of people living with HIV 1 month after two doses.
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Infecciones por VIH , Infecciones Meningocócicas , Vacunas Meningococicas , Humanos , Vacunas Meningococicas/efectos adversos , Infecciones Meningocócicas/prevención & control , Infecciones Meningocócicas/inducido químicamente , Vacunas Combinadas , Proteínas RecombinantesRESUMEN
Invasive meningococcal disease (IMD) affects approximately 1.2 million people worldwide annually. Prevention of IMD is mostly provided through vaccination; however, no licensed vaccine is currently available to protect against meningococcal serogroup X associated infection. Limited data are available on the natural immunity to Neisseria meningitidis serogroup X within the African sub-Saharan meningitis belt. The objective of the study was to provide an overview of natural immunity to serogroup X within a community in the African meningitis belt prior to the introduction of a pentavalent conjugate vaccine (NmCV-5). Prior to its introduction, a validated assay to assess vaccine efficacy was also required. This study therefore incorporated two objectives: a seroprevalence study to assess natural immunity in serum samples (n = 377) collected from Niger, West Africa in 2012, and the validation of a serogroup X serum bactericidal antibody (SBA) assay. Seroprevalence data obtained found that natural immunity to N. meningitidis serogroup X were present in 52.3% of study participants. The highest putative protective titres (≥8) to serogroup X were seen in age group 5-14 years-old (73.9%) and lowest in ages < 1 year old (0%). The SBA assay was successfully validated for selectivity/specificity, precision/reproducibility, linearity, and stability. This study demonstrated the suitability of the serogroup X SBA assay in clinical trials for future meningococcal conjugate vaccines containing serogroup X polysaccharides.
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Infecciones Meningocócicas , Vacunas Meningococicas , Neisseria meningitidis , Adolescente , Anticuerpos Antibacterianos , Niño , Preescolar , Humanos , Lactante , Infecciones Meningocócicas/prevención & control , Niger/epidemiología , Reproducibilidad de los Resultados , Estudios Seroepidemiológicos , Serogrupo , Determinación de Anticuerpos Séricos Bactericidas , Vacunas Combinadas , Vacunas ConjugadasRESUMEN
OBJECTIVE: To implement a quality improvement (QI) scorecard as a tool for enhancing quality and safety efforts in level 1 and 2 community hospital nurseries affiliated with Nationwide Children's Hospital. STUDY DESIGN: A QI scorecard was developed for data collection, analytics, and reporting of neonatal quality metrics and cross-sector collaboration. Newborn characteristics were included for risk stratification, as were clinical and process measures associated with neonatal morbidity and mortality. Quality and safety activities took place in community hospital newborn nurseries in Ohio, and education was provided in both online and in-person collaborations, followed by local team sessions at partner institutions. Baseline (first 12 months) and postbaseline comparisons of clinical and process measures were analyzed by logistic regression, adjusting for potential confounders. RESULTS: In logistic regression models, at least 1 center documented improvements in each of the 4 process measures, and 3 of the 4 centers documented improvements in compliance with glucose checks obtained within 90 minutes of birth among at-risk infants. CONCLUSION: Collaborative QI projects led to improvements in perinatal metrics associated with important outcomes. Formation of a center-driven QI scorecard is feasible and provides community hospitals with a framework for collecting, analyzing, and reporting neonatal QI metrics.
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Hospitales Comunitarios , Casas Cuna , Niño , Femenino , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Salas Cuna en Hospital , Embarazo , Mejoramiento de la CalidadRESUMEN
BACKGROUND: Neisseria meningitidis serogroups A, B, C, W, X, and Y cause outbreaks of meningococcal disease. Quadrivalent conjugate vaccines targeting the A, C, W, and Y serogroups are available. A pentavalent vaccine that also includes serogroup X (NmCV-5) is under development. METHODS: We conducted a phase 2, observer-blinded, randomized, controlled trial involving Malian children 12 to 16 months of age. Participants were assigned in a 2:2:1 ratio to receive nonadjuvanted NmCV-5, alum-adjuvanted NmCV-5, or the quadrivalent vaccine MenACWY-D, administered intramuscularly in two doses 12 weeks apart. Participants were followed for safety for 169 days. Immunogenicity was assessed with an assay for serum bactericidal antibody (SBA) with rabbit complement on days 0, 28, 84, and 112. RESULTS: A total of 376 participants underwent randomization, with 150 assigned to each NmCV-5 group and 76 to the MenACWY-D group; 362 participants received both doses of vaccine. A total of 1% of the participants in the nonadjuvanted NmCV-5 group, 1% of those in the adjuvanted NmCV-5 group, and 4% of those in the MenACWY-D group reported local solicited adverse events; 6%, 5%, and 7% of the participants, respectively, reported systemic solicited adverse events. An SBA titer of at least 128 was seen in 91 to 100% (for all five serotypes) of the participants in the NmCV-5 groups and in 36 to 99% (excluding serogroup X) of those in the MenACWY-D group at day 84 (before the second dose); the same threshold was met in 99 to 100% (for all five serotypes) of the participants in the NmCV-5 groups and in 92 to 100% (excluding serogroup X) of those in the MenACWY-D group at day 112. Immune responses to the nonadjuvanted and adjuvanted NmCV-5 formulations were similar. CONCLUSIONS: No safety concerns were identified with two doses of NmCV-5. A single dose of NmCV-5 elicited immune responses that were similar to those observed with two doses of MenACWY-D. Adjuvanted NmCV-5 provided no discernible benefit over nonadjuvanted NmCV-5. (Funded by the U.K. Foreign, Commonwealth, and Development Office; ClinicalTrials.gov number, NCT03295318.).
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Inmunogenicidad Vacunal , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/inmunología , Adyuvantes Inmunológicos , Compuestos de Alumbre , Femenino , Humanos , Lactante , Inyecciones Intramusculares , Masculino , Malí , Vacunas Meningococicas/efectos adversos , Neisseria meningitidis , Serogrupo , Método Simple Ciego , Vacunas Conjugadas/inmunologíaRESUMEN
INTRODUCTION: There is persistent speculation that testosterone therapy (TTh) may induce worsening of obstructive sleep apnea (OSA). As both the incidence of OSA and the use of TTh grow more prevalent, it is important to review the current evidence that supports or refutes this relationship. OBJECTIVES: To review the current literature regarding the relationship between TTh and OSA. METHODS: A literature search was conducted to identify relevant studies. Search terms included "obstructive sleep apnea" and "testosterone replacement therapy." Titles and abstracts were reviewed for relevance. References from identified articles were searched and included, if appropriate. RESULTS: The association between TTh and OSA was initially described in a 1978 case report of an individual with worsened nighttime apneas during testosterone administration, a trend seen again in subsequent small case series. In the 1990s, a large retrospective analysis and the first randomized controlled trial on the subject revealed no increased incidence of OSA in individuals on TTh. A randomized controlled trial conducted in 2012 provided a possible explanation to the previously reported discrepancies, describing a time-limited effect, wherein measures of OSA were elevated at seven weeks but were not significantly different at 18 weeks after initiation of TTh. A recent cohort study demonstrated an incidence of OSA in individuals on TTh of 16.5% compared with 12.7% in controls. TTh is thought to affect OSA in several ways. Theories that the anabolic effects of testosterone may decrease airway patency or that testosterone alters sleep architecture have been largely disproven. More likely, testosterone plays a role in altering neural response pathways to hypoxemia. CONCLUSIONS: TTh likely plays a small role in exacerbating or inducing changes in OSA that may be time limited in nature. Clinicians may choose to exercise caution in prescribing TTh to individuals suffering from severe OSA. Payne K, Lipshultz LI, Hotaling JM, et al. Obstructive Sleep Apnea and Testosterone Therapy. J Sex Med 2021;9:296-303.
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Apnea Obstructiva del Sueño , Testosterona , Terapia de Reemplazo de Hormonas/efectos adversos , Humanos , Incidencia , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Apnea Obstructiva del Sueño/inducido químicamente , Apnea Obstructiva del Sueño/complicaciones , Testosterona/efectos adversosRESUMEN
INTRODUCTION: Erectile dysfunction (ED) is a prevalent and under-recognized complaint among male solid organ transplant recipients. Most research on this topic has focused on kidney transplant recipients alone. In this review, we integrate current research on ED across all types of solid organ transplant recipients and assess the success of current methods of ED treatment in transplant populations. AIM: To review the current literature addressing the prevalence and treatment of ED in the male solid organ transplant population. METHODS: A literature search was conducted using PubMed to identify relevant studies. Search terms included "organ transplant" and "erectile dysfunction." Titles and abstracts were reviewed for relevance. References from identified articles were also searched and included, if appropriate. MAIN OUTCOME MEASURES: Review of peer-reviewed literature. RESULTS: The prevalence of ED among transplant recipients is higher than that in the general population: 39.8-86.2% in liver transplant recipients, 54-66% in renal transplant recipients, 71-78% in heart transplant recipients, and 79% in simultaneous pancreas-kidney transplant recipients. Phosphodiesterase-5 inhibitors have up to 80% efficacy in treating ED in kidney transplant recipients. Intracavernosal injections have been used with success rates of 60-70% in cardiac and renal transplant recipients. Penile prostheses have also been shown to be safe and effective across transplant types. A low incidence of infection has been reported in several case series, although there is concern for an increased rate of mechanical complications in pelvic organ transplant recipients. Accordingly, placement of a two-piece or malleable prosthesis or ectopic reservoir placement with a three-piece inflatable prosthesis is suggested in this population. CONCLUSION: ED is highly prevalent among male solid organ transplant recipients and should be routinely screened in this population. Current modalities of ED treatment used in the general population are safe and effective in solid organ transplant recipients, although success rates are often lower than those in the general population. Payne K, Popat S, Lipshultz LI, et al. The Prevalence and Treatment of Erectile Dysfunction in Male Solid Organ Transplant Recipients. Sex Med Rev 2021;9:331-339.
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Disfunción Eréctil , Trasplante de Órganos , Prótesis de Pene , Disfunción Eréctil/epidemiología , Disfunción Eréctil/etiología , Disfunción Eréctil/terapia , Humanos , Masculino , Trasplante de Órganos/efectos adversos , Prevalencia , Receptores de TrasplantesRESUMEN
INTRODUCTION: The 21st century has seen a series of viral pandemics that have collectively infected millions of individuals. To understand factors that may contribute to viral spread and address long-term health sequelae for survivors, it is important to review evidence regarding viral presence in semen, sexual transmission potential, and possible effects on fertility. AIM: To review the current literature regarding the sexual transmissibility of recent viral pandemics and their effects on semen parameters and fertility. We review evidence for the following viruses: Ebola, Zika, West Nile, pandemic influenza, severe acute respiratory syndrome (SARS), and SARS-corona virus-2 (SARS-CoV-2). METHODS: A literature search was conducted to identify relevant studies. Titles and abstracts were reviewed for relevance. References from identified articles were searched and included, if appropriate. MAIN OUTCOME MEASURES: The main outcome measure of this study was reviewing of peer-reviewed literature. RESULTS: Both the Ebola virus and Zika virus are present in semen, but only the Zika virus shows consistent evidence of sexual transmission. Current evidence does not support the presence of the West Nile virus, pandemic influenza, SARS, and SARS-CoV-2 in semen. The Zika virus appears to alter semen parameters in a way that diminishes fertility, but the effect is likely time limited. The West Nile virus and SARS have been associated with orchitis in a small number of case reports. Viruses that cause febrile illness, such as pandemic influenza, SARS, and SARS-CoV-2, are associated with decreased sperm count and motility and abnormal morphology. SARS and SARS-CoV-2 may interact with angiotensin-converting enzyme 2 receptors present in the testes, which could impact spermatogenesis. CONCLUSIONS: We have reported the presence in semen, sexual transmission potential, and fertility side effects of recent viral pandemics. Overall, semen studies and fertility effects are highly understudied in viral pandemics, and rigorous study on these topics should be undertaken as novel pandemics emerge. Payne K, Kenny P, Scovell JM, et al. Twenty-First Century Viral Pandemics: A Literature Review of Sexual Transmission and Fertility Implications for Men. Sex Med Rev 2020;8:518-530.
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Betacoronavirus , Infecciones por Coronavirus/transmisión , Infertilidad Masculina/epidemiología , Infertilidad Masculina/virología , Neumonía Viral/transmisión , Enfermedades Virales de Transmisión Sexual/epidemiología , Enfermedades Virales de Transmisión Sexual/transmisión , COVID-19 , Infecciones por Coronavirus/epidemiología , Humanos , Masculino , Pandemias , Neumonía Viral/epidemiología , SARS-CoV-2RESUMEN
PURPOSE OF REVIEW: Recently in October 2019 a Global Consensus Position on the use of Testosterone Therapy for Women was published. The use of testosterone and other agents for female sexual dysfunction (FSD) is an important topic for the urologist focusing on sexual health. This review describes the known causes for FSD, and discusses the role of androgens in this disorder, the evidence for using testosterone treatment, and other current and emerging therapies. RECENT FINDINGS: A recent meta-analysis, published in The Lancet Diabetes & Endocrinology evaluated a total of 36 randomized control trials spanning 1990-2018 and includes a total of 8480 patients. The primary findings were that testosterone therapy (TTh) increased sexual function including satisfactory sexual event frequency, sexual desire, pleasure, arousal, orgasm, responsiveness, and self-image when compared with either a placebo or drug-control (e.g., estrogenâ±âprogestogen). In addition, TTh reduced sexual concerns and distress in postmenopausal women. Side effects included an increase in weight, acne, and hair growth, but there was no increase in serious adverse events. Importantly, TTh duration was greater than 12 weeks in all randomized control trials included in this meta-analysis. SUMMARY: TTh is effective to treat FSD in postmenopausal women. More data is required to evaluate the long-term safety data on the effects of TTh on cardiovascular health, breast health, cognitive function, and the musculoskeletal system in women.
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Andrógenos , Terapia de Reemplazo de Hormonas/métodos , Disfunciones Sexuales Fisiológicas/tratamiento farmacológico , Disfunciones Sexuales Psicológicas/tratamiento farmacológico , Testosterona/uso terapéutico , Andrógenos/efectos adversos , Andrógenos/uso terapéutico , Nivel de Alerta/efectos de los fármacos , Femenino , Humanos , Libido/efectos de los fármacos , Orgasmo/efectos de los fármacos , Testosterona/efectos adversosRESUMEN
PURPOSE: With cannabis consumption on the rise and use prominent among males of reproductive age it is essential to understand the potential impact of cannabis on male fertility. We reviewed the literature regarding the effects of cannabis on male fertility. MATERIALS AND METHODS: We performed a literature search using PubMed®/MEDLINE® to identify relevant studies of the effects of cannabis on male fertility. Relevant studies were identified and reviewed. RESULTS: The strongest evidence of cannabis induced alterations in male fertility is in the category of semen parameters. Research supports a role for cannabis in reducing sperm count and concentration, inducing abnormalities in sperm morphology, reducing sperm motility and viability, and inhibiting capacitation and fertilizing capacity. Animal models demonstrate a role for cannabis in testicular atrophy, and reduced libido and sexual function but to our knowledge these results have not yet been replicated in human studies. Studies of hormonal changes suggest inconclusive effects on testosterone levels, lowered luteinizing hormone levels and unchanged follicle-stimulating hormone levels. CONCLUSIONS: Current research suggests that cannabis may negatively impact male fertility. Further studies are needed to validate that robust findings in animal models will carry over into human experience. Clinicians should be aware of these potential effects when prescribing medical marijuana therapies to men of reproductive age, and they should consider the degree of cannabis use as a possible component of a complete male infertility workup.
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Fertilidad/efectos de los fármacos , Infertilidad Masculina/inducido químicamente , Marihuana Medicinal/efectos adversos , Animales , Supervivencia Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Humanos , Infertilidad Masculina/patología , Masculino , Semen/efectos de los fármacos , Motilidad Espermática/efectos de los fármacos , Testículo/efectos de los fármacos , Testículo/patologíaRESUMEN
Serum bactericidal antibody (SBA) assays measure functional antibody titers against Neisseria meningitidis in sera. Induction of complement-dependent SBA after vaccination with meningococcal polysaccharide or conjugate or protein based vaccines is regarded as the surrogate of protection and thus acceptable evidence of the potential efficacy of these vaccines. This chapter discusses and details SBA assay protocols for measuring the complement-mediated lysis of serogroup A, B, C, W, X, and Y meningococci by human sera, for example, following vaccination or disease.
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Anticuerpos Antibacterianos/inmunología , Proteínas del Sistema Complemento/inmunología , Infecciones Meningocócicas/inmunología , Neisseria meningitidis/inmunología , Serogrupo , Determinación de Anticuerpos Séricos Bactericidas/métodos , Humanos , Infecciones Meningocócicas/microbiología , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/administración & dosificación , Neisseria meningitidis/clasificación , VacunaciónRESUMEN
Children who develop invasive Haemophilus influenzae serotype b (Hib) disease after immunisation with a highly-effective conjugate vaccine are more likely to have been infected with Hib strains possessing multiple copies of the capsulation locus. Using a recently-validated serum bactericidal antibody (SBA) assay, we tested convalescent sera from 127 Hib vaccine failure cases against clinical Hib strains expressing 1-5 copies of the capsulation locus. SBA titres correlated weakly with anti-capsular IgG antibody concentrations and there was no association between SBA geometric mean titres and number of capsulation locus copies. After infection, children with Hib vaccine failure were equally protected against Hib strains with 1-5 copies of the capsulation locus.
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Anticuerpos Antibacterianos/sangre , Infecciones por Haemophilus/prevención & control , Vacunas contra Haemophilus/uso terapéutico , Cápsulas Bacterianas , Preescolar , Haemophilus influenzae tipo b , Humanos , Inmunoglobulina G/sangre , Lactante , Determinación de Anticuerpos Séricos Bactericidas , Insuficiencia del Tratamiento , Vacunas Conjugadas/uso terapéuticoRESUMEN
This paper presents long-term monitoring data for 19 elements with a focus on arsenic (As), copper (Cu), and selenium (Se), in surface water (2002-2011), brine shrimp (2001-2011), and brine flies (1995-1996) collected from Great Salt Lake (GSL, Utah, USA). In open surface waters, mean (±standard deviation [SD]; range; n) As concentrations were 112 (±22.1; 54.0-169; 47) and 112 µg/L (±35.6; 5.1-175; 68) in filtered and unfiltered surface water samples, respectively, and 16.3 µg/g (±5.6; 5.1-35.2; 62) dry weight (dw) in brine shrimp. Mean (±SD; range; n) Cu concentrations were 4.2 (±2.1; 1.3-12.5; 47) and 6.9 µg/L (±6.6; 1.9-38.1; 68) in filtered and unfiltered surface water samples, respectively, and 20.6 µg/g (±18.4; 5.4-126; 62) dw in brine shrimp. Finally, mean (±SD; range; n) dissolved and total recoverable Se concentrations were 0.6 (±0.1; 0.4-1.2; 61) and 0.9 µg/L (±0.7; 0.5-3.6; 89), respectively, and 3.6 µg/g (±2.2; 1.1-14.9; 98) dw in brine shrimp. Thus, Se in open lake surface waters was most often in the range of 0.5-1 µg/L, and concentrations in both surface water and brine shrimp were comparable to concentrations measured in other monitoring programs for the GSL. Temporally, the statistical significance of differences in mean dissolved or total recoverable As, Cu, and Se concentrations between years was highly variable depending which test statistic was used, and there was no clear evidence of increasing or decreasing trends. In brine shrimp, significant differences in annual mean concentrations of As, Cu, and Se were observed using both parametric and nonparametric statistical approaches, but, as for water, there did not appear to be a consistent increase or decrease in concentrations of these elements over time.
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Arsénico/análisis , Artemia/química , Cobre/análisis , Dípteros/química , Monitoreo del Ambiente , Lagos/química , Selenio/análisis , Contaminantes Químicos del Agua/análisis , Animales , Sales (Química) , UtahRESUMEN
BACKGROUND: Several studies have reported increased resting energy expenditure (REE) in people with human immunodeficiency virus (HIV). However, limited data exist on REE in HIV-infected women and the effect of antiretroviral therapy (ART) on REE in this population. OBJECTIVE: The purpose of this study was to compare REE in healthy controls to adult HIV-infected women classified in three groups: naïve to ART, on ART with virologic suppression, and on ART with an HIV-1 RNA level >5,000 copies/mL. DESIGN: After a fast, body composition by bioelectrical impedance analysis and REE by indirect calorimetry were determined. Anthropometric measures were also taken. STATISTICAL ANALYSIS: Distributionally appropriate two-sample tests were used for between-group analyses and analysis of covariance was used for confounding adjustment. RESULTS: Eighty-seven women were enrolled and the HIV-infected and control women were matched for age and body mass index. Log-transformed REE was significantly higher in HIV-infected women naïve to ART compared to controls (7.26±0.22 vs 7.14±0.19; P=0.04, respectively) and the difference remained significant after adjustment for body cell mass (P=0.008). Log-transformed REE was not different in HIV-infected women on ART compared to HIV-infected women naïve to ART (7.25±0.25 vs 7.26±0.23; P=0.81, respectively). Adjusting for body cell mass did not change the results (P=0.56). Similarly, REE was not different between women naïve to ART and those on ART with undetectable HIV-1 RNA, regardless of adjustment for body cell mass. REE correlated to current and nadir CD4 count and trended toward a negative correlation with HIV-1 RNA levels. CONCLUSIONS: We showed that REE is elevated in ART-naïve, HIV-infected women and continues to be elevated when on ART, regardless of virologic suppression, compared to age and body mass index-matched healthy women. This suggests an effect of HIV infection itself and not ART on REE in these HIV-infected women, and should be considered during nutrition assessment and counseling of HIV-infected adult women.
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Fármacos Anti-VIH/farmacología , Antirretrovirales/farmacología , Metabolismo Basal , Infecciones por VIH/fisiopatología , Carga Viral , Adulto , Fármacos Anti-VIH/efectos adversos , Antirretrovirales/efectos adversos , Metabolismo Basal/efectos de los fármacos , Metabolismo Basal/fisiología , Composición Corporal , Índice de Masa Corporal , Calorimetría Indirecta , Estudios de Casos y Controles , Estudios Transversales , Impedancia Eléctrica , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Estudios ProspectivosRESUMEN
Naturally occurring arsenic contaminates groundwater in many countries, including the United States, at levels greater than 10 microg l(-1), the current WHO guideline value, increasing the risk of skin, lung, bladder, and kidney cancer in millions of people. Arsenic toxicity is dependent on its chemical form; arsenite is more toxic due to its higher affinity for protein than arsenate. This study supports worldwide research efforts to obtain drinking water with arsenic levels below 10 microg l(-1). Batch adsorption kinetic and isotherm studies were conducted to compare and evaluate iron-treated adsorbents for arsenate and arsenite removal from aqueous media. Two iron treatments were investigated as well as the effects of varied pH, temperature, and ionic strength increases on adsorption effectiveness. Adsorbent materials such as activated carbon and naturally occurring zeolites (clinoptilolite and chabazite) were selected because of their relative low cost and because the zeolites are potential point-of-use materials for mitigating arsenic contaminated groundwater. Molecular sieves, Faujasite (13X) and Linde type A (5A) were selected because they provide a basis for comparison with previous studies and represent well-characterized materials. Iron-treated activated carbon and chabazite showed the most promise as low-cost arsenic adsorbents; activated carbon removed approximately 60% of arsenate and arsenite while chabazite removed approximately 50% of arsenate and 30% of arsenite. Modeling arsenate and arsenite adsorption by these adsorbents using the Langmuir and Freundlich isotherm expressions determined the adsorbents' capacity for arsenic removal from aqueous media. Arsenate removal by iron-treated activated carbon and clinoptilolite best fit the Langmuir model. Arsenate removal by iron-treated chabazite and arsenite removal by activated carbon, chabazite, and clinoptilolite best fit the Freundlich model. Applications of iron-modified activated carbon for effective arsenate removal would require pH values between 7 and 11, chabazite between 4 and 5, and clinoptilolite between 3 and 7. Arsenite removal by iron-modified activated carbon would require pH values between 7 and 11, chabazite between 7 and 10, and clinoptilolite between 4 and 11. Increasing temperature improved adsorption performance for activated carbon and the zeolites. Increasing ionic strength improved performance of iron-treated activated carbon and zeolites.
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Arseniatos/aislamiento & purificación , Arsenitos/aislamiento & purificación , Contaminantes Químicos del Agua/aislamiento & purificación , Adsorción , Arseniatos/química , Arsenitos/química , Carbono/química , Concentración de Iones de Hidrógeno , Hierro , Concentración Osmolar , Temperatura , Factores de Tiempo , Purificación del Agua/economía , Purificación del Agua/métodos , Zeolitas/químicaRESUMEN
Lead alloy bullets used at the 2600 military small arm ranges and 9000 nonmilitary outdoor shooting ranges in the United States are a source of mobilized lead ions under conditions of low pH, significant changes in ionic strength, changes in the reduction oxidation potential (redox), and through binding metal ions to soil organic matter. Once mobile, these lead ions can contaminate adjacent soil and water. Batch adsorption kinetic and isotherm studies were conducted to compare and evaluate different types of adsorbents for lead ion removal from aqueous media. The effects on lead ion absorption from pH changes, competing ions, and temperature increases were also investigated. Adsorbent materials such as activated carbon and naturally occurring zeolites (clinoptilolite and chabazite) were selected because of their relative low cost and because the zeolites are potential point-of-use materials for mitigating wastewater runoff. Molecular sieves, Faujasite (13X) and Linde type A (5A) were selected because they provide a basis for comparison with previous studies and represent well-characterized materials. The relative rate for lead ion adsorption was: 13X > chabazite > clinoptilolite > 5A > activated carbon. Modeling lead ion adsorption by these adsorbents using the Langmuir and Freundlich isotherm expressions determined the adsorbents' capacity for lead ion removal from aqueous media. 13X, 5A, and activated carbon best fit the Langmuir isotherm expression; chabazite and clinoptilolite best fit the Freundlich isotherm. Applications of chabazite would require pH values between 4 and 11, clinoptilolite between 3 and 11, while activated carbon would operate at a pH above 7. Ionic competition reduced lead ion removal by the zeolites, but enhanced activated carbon performance. Increasing temperature improved adsorption performance for the zeolites; activated carbon lead ion adsorption was temperature independent.
Asunto(s)
Plomo/química , Plomo/aislamiento & purificación , Contaminantes del Suelo/aislamiento & purificación , Zeolitas/química , Adsorción , Carbono/química , Concentración de Iones de Hidrógeno , Iones , Oxidación-Reducción , TemperaturaRESUMEN
Limbic system functioning is integral to the control and modulation of affect, motivation, reward, and memory. Neuropsychiatric disturbances involving disruptions in these cognitive and emotional dimensions exhibit different prevalence rates for men and women. Gender-specific differences in this integrated brain area may therefore be important in understanding both normal behavioral functioning and the etiologic underpinnings of neuropsychiatric disorders. To further explore such differences in limbic system function, we assessed regional cerebral blood flow, by SPECT, in men and women following the administration of procaine. Procaine is a local anesthetic that preferentially stimulates limbic structures. Psychiatrically and medically healthy, age-matched women (n = 15, 33.2 +/- 6.9 years) and men (n = 15, 32.8 +/- 6.9 years) were administered 1.38 mg/kg procaine or saline intravenously in two separate sessions. Using voxel-based analyses (P < 0.001), males significantly activated the bilateral insular cortex following procaine, whereas females more strongly activated the bilateral anterior and mesial temporal cortex. Both groups demonstrated significant anterior cingulate activation. Subjective responses to procaine did not significantly differ between the men and women. To our knowledge, this is the first report demonstrating gender-specific responses in limbic activation following a pharmacologic challenge. These findings suggest that men and women can activate different limbic structures following the same provocative pharmacologic stimulus, despite sharing a similar subjective experience. Studies assessing pharmacologic challenges of limbic system structures should consider gender as a critical variable in assessing biologic responsiveness.