RESUMO
BACKGROUND: Children < 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children < 5 who have been prescribed IPT. METHODS: An open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged < 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up > 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker. DISCUSSION: Unfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children < 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children. TRIAL REGISTRATION: ClinicalTrials.gov NCT03881228. Registered on March 19, 2019.
Assuntos
Isoniazida , Tuberculose , Pré-Escolar , Humanos , Antituberculosos/uso terapêutico , Busca de Comunicante , Isoniazida/uso terapêutico , Peru/epidemiologia , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Mosquitoes, the major vectors of viruses like dengue, are naturally host to diverse microorganisms, which play an important role in their development, fecundity, immunity, and vector competence. The composition of their microbiota is strongly influenced by the environment, particularly their aquatic larval habitat. In this study, we used 2×300 bp 16s Illumina sequencing to compare the microbial profiles of emerging adult Aedes aegypti mosquitoes and the water collected from common types of aquatic habitat containers in Puerto Rico, which has endemic dengue transmission. We sequenced 141 mosquito and 46 water samples collected from plastic containers, septic tanks, discarded tires, underground trash cans, tree holes, or water meters. We identified 9 bacterial genera that were highly prevalent in the mosquito microbiome, and 77 for the microbiome of the aquatic habitat. The most abundant mosquito-associated bacterial OTUs were from the families Burkholderiaceae, Pseudomonadaceae, Comamonadaceae, and Xanthomonadaceae. Microbial profiles varied greatly between mosquitoes, and there were few major differences explained by container type; however, the microbiome of mosquitoes from plastic containers was more diverse and contained more unique taxa than the other groups. Container water was significantly more diverse than mosquitoes, and our data suggest that mosquitoes filter out many bacteria, with Alphaproteobacteria in particular being far more abundant in water. These findings provide novel insight into the microbiome of mosquitoes in the region and provide a platform to improve our understanding of the fundamental mosquito-microbe interactions.
Assuntos
Aedes , Microbiota , Animais , Humanos , Larva , Mosquitos Vetores , Porto Rico , ÁguaRESUMO
There is not in Argentina publications regarding the presentation of patients with COVID-19 requiring hospitalized and emergency care in vulnerable populations (lower incomes and less education tend at greater risk for poor health status and healthcare access), and it has few reports in developing countries. The objective is to determine whether in the care of vulnerable patients, to succeed against COVID-19, multiple public health tools and interventions will be needed to minimize morbidity and mortality. The study is a prospective cohort investigation of patients with lab-confirmed COVID-19, who required to any of the Health Centers response from April 8, 2020, to August 18, 2020. In Buenos Aires Metropolitan Area (AMBA), April 8, 2020 the virus was identified in patients hospitalized in the "Southeast Network" (SN), AMBA. SN covering an area of 661 square kilometers, with 1.8 million inhabitants residing in urban, and rural areas. A total of 14 health centers with different levels of care complexity provide care to patients in the region. The information of each patient with COVID-19 evaluated by SN, was incorporated in an Epidemiological Dashboard. The investigation was designed and reported with consideration of observational studies in epidemiology. We describe the hospitals presentation and care of persons who required SN response and were ultimately diagnosed with COVID-19. From April 8, 2020, to August 18, 2020, were included 1495 patients with lab-confirmed COVID-19 in SN. A total of 58% patients were men, and the mean age (SD) was 48.9 (15.59) years. Eighty one percent patients with pre-existing diseases, most frequent hypertension and diabetes, but hypertension, chronic lung disease, and cardiovascular disease presented higher risk. A total of 13% were hospitalized in Intensive Therapy Unit. The mortality of the cohort was 9.77%. Mortality was higher for patients aged 65 or more (OR 5.09), and for those had some pre-existing disease (OR 2.61). Our observations are consistent with reports demonstrating older persons, and those with comorbidities have the highest risk of mortality related to COVID-19. However, unlike other reports from developed or some developing countries, the mortality in our study is lower. This finding may be related to age of our cohort is younger than other published. Also, the health system was able to respond to the demand.
Assuntos
COVID-19/diagnóstico , COVID-19/epidemiologia , SARS-CoV-2/isolamento & purificação , Adulto , Idoso , Argentina/epidemiologia , COVID-19/mortalidade , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Saúde Pública , Populações VulneráveisRESUMO
The Membrane Attack Complex-Perforin (MACPF) family is ubiquitously found in all kingdoms. They have diverse cellular roles, however MACPFs with pore-forming toxic function in venoms and poisons are very rare in animals. Here we present the structure of PmPV2, a MACPF toxin from the poisonous apple snail eggs, that can affect the digestive and nervous systems of potential predators. We report the three-dimensional structure of PmPV2, at 17.2 Å resolution determined by negative-stain electron microscopy and its solution structure by small angle X-ray scattering (SAXS). We found that PV2s differ from nearly all MACPFs in two respects: it is a dimer in solution and protomers combine two immune proteins into an AB toxin. The MACPF chain is linked by a single disulfide bond to a tachylectin chain, and two heterodimers are arranged head-to-tail by non-covalent forces in the native protein. MACPF domain is fused with a putative new Ct-accessory domain exclusive to invertebrates. The tachylectin is a six-bladed ß-propeller, similar to animal tectonins. We experimentally validated the predicted functions of both subunits and demonstrated for the first time that PV2s are true pore-forming toxins. The tachylectin "B" delivery subunit would bind to target membranes, and then the MACPF "A" toxic subunit would disrupt lipid bilayers forming large pores altering the plasma membrane conductance. These results indicate that PV2s toxicity evolved by linking two immune proteins where their combined preexisting functions gave rise to a new toxic entity with a novel role in defense against predation. This structure is an unparalleled example of protein exaptation.
Assuntos
Complexo de Ataque à Membrana do Sistema Complemento/ultraestrutura , Lectinas/ultraestrutura , Perforina/ultraestrutura , Conformação Proteica , Sequência de Aminoácidos/genética , Animais , Membrana Celular/química , Membrana Celular/ultraestrutura , Complexo de Ataque à Membrana do Sistema Complemento/química , Complexo de Ataque à Membrana do Sistema Complemento/imunologia , Cristalografia por Raios X , Dimerização , Lectinas/química , Lectinas/imunologia , Modelos Moleculares , Perforina/química , Perforina/imunologia , Subunidades Proteicas/genética , Espalhamento a Baixo Ângulo , Caramujos/ultraestrutura , Difração de Raios XRESUMO
OBJECTIVE: Colorectal cancer (CRC) and hypodontia are frequent and different diseases with common genes are involved in their etiology. The objective of this study was to identify the association between AXIN2 rs2240308 with hypodontia and CRC. PATIENTS AND METHODS: This study consisted of 50 individuals with hypodontia, 50 individuals with CRC, and 155 healthy individuals from Colombia. SNP genotyping assays of rs2240308 were performed and family history of cancer in individuals with hypodontia was documented. In silico analysis was implemented to define the genomic profile of the AXIN2 gene associated with CRC. Multivariate analysis, chi square, odd ratio tests, and R software were used for statistical analysis. RESULTS: AXIN2 rs2240308 showed association with CRC (OR = 5.4 CI: 2.7-10.4; p < 0.001) and with other familial cancer in individuals with hypodontia (p < 0.005 OR = 1.75, 95% CI: 1.22-6.91). In silico analysis showed that variations in AXIN2 found in CRC patients, were more frequently in earlier stages of tumor and patients who carry variations in the AXIN2 gene have a worse prognosis (p < 0.05). The association between AXIN2 rs2240308 with hypodontia was not significant. CONCLUSIONS: These results suggest that AXIN2 rs2240308 polymorphism is associated with CRC and AXIN2 could be a risk marker for predisposition and prognosis of CRC.
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We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.
Assuntos
Análise Custo-Benefício , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/métodos , Características da Família , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Tuberculose Pulmonar/diagnóstico , Doenças Endêmicas , Infecções por HIV/epidemiologia , Humanos , Peru/epidemiologia , Tuberculose Pulmonar/epidemiologiaRESUMO
Egg, larva, and pupa of Gamelia anableps (C. Felder & R. Felder, 1874) are described for the first time and the chaetotaxy of the first instar provided. Eggs and selected structures of larvae and pupae were also investigated by means of scanning electron microscopy. Eggs are laid in clusters, are ellipsoidal and laterally flat. Larvae passed through eight instars in about 78 days. Pupation occurs inside a poorly organized cocoon of yellowish silk. The dark brown pupa is cylindrical in shape with appendages firmly fused together and to the body wall. The chaeotaxy is compared with other Saturniidae species belongining to Hemileucinae, Ceratocampinae, and Saturniinae and the natural history of G. anableps compared with other Saturniidae.
Assuntos
Mariposas/anatomia & histologia , Oviposição , Animais , Larva , Microscopia Eletrônica de Varredura , Pupa , SedaRESUMO
OBJECTIVE: To determine the time from diagnosis to start of multidrug resistant tuberculosis (MDR TB) treatment in Lima, Peru. METHODS: We studied new smear-positive TB adults that were started on MDR TB treatment or that were switched to it between June 2008 and December 2011. RESULTS: Time from the first positive smear to MDR-TB treatment was >30 days in 35% (13/37) of patients. Among the 27% (24/88) of patients that switched to MDR-TB treatment, time from the last dose of a drug-susceptible regimen was >30 days. CONCLUSION: Start of and switching to MDR TB treatment is still delayed.
Assuntos
Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Substituição de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Avaliação de Resultados em Cuidados de Saúde , Peru/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologiaRESUMO
La hipertrigliceridemia severa se asocia con pancreatitis aguda y suele producirse por una deficiencia genética o adquirida en la actividad de la lipoproteín lipasa (LPL). El tratamiento habitual en pacientes ambulatorios se basa en una alimentación saludable, ejercicio físico, control del peso, complementos de omega 3 y fármacos como los fibratos y la niacina. Ante situaciones de hipertrigliceridemia severa asociados o no a pancreatitis, se recomienda el tratamiento con insulina y/o heparina para disminuir rápidamente el nivel de triglicéridos aumentando la actividad de la LPL, tanto en pacientes diabéticos como en no diabéticos. En esta presentación se describe el caso de una mujer joven, tabaquista y obesa, sin antecedentes de dislipemia previa que en un análisis de control se detecta una hipertrigliceridemia severa (12214 mg/dL) en contexto de una diabetes de reciente diagnóstico. Durante la internación se administró insulina endovenosa, heparina sódica y gemfibrozil, disminuyendo rápidamente los niveles de triglicéridos y evolucionando favorablemente sin desarrollar pancreatitis. Los autores declaran no poseer conflictos de interés.(AU)
Severe hypertriglyceridemia is associated with acute pancreatitis and it is usually caused by a genetic or acquired deficiency in the activity of lipoprotein lipase (LPL). The usual treatment in outpatients is based on healthy eating, exercise, weight control, omega-3 supplements and drugs such as fibrates and niacin. In situations of severe hypertriglyceridemia, whether or not associated with pancreatitis, treatment with insulin and/or heparin is recommended to rapidly decrease triglyceride levels by increasing LPL activity, in diabetic and non-diabetic patients. We report the case of a young, obese smoker woman with no prior history of dyslipidemia, who had severe hypertriglyceridemia (12214 mg/dL) detected in a control test in the context of new onset diabetes. During hospitalization, intravenous insulin, sodium heparin and gemfibrozil were administered, with a rapid decrease in triglyceride levels and good progress with no development of pancreatitis. No financial conflicts of interest exist.(AU)
RESUMO
La hipertrigliceridemia severa se asocia con pancreatitis aguda y suele producirse por una deficiencia genética o adquirida en la actividad de la lipoproteín lipasa (LPL). El tratamiento habitual en pacientes ambulatorios se basa en una alimentación saludable, ejercicio físico, control del peso, complementos de omega 3 y fármacos como los fibratos y la niacina. Ante situaciones de hipertrigliceridemia severa asociados o no a pancreatitis, se recomienda el tratamiento con insulina y/o heparina para disminuir rápidamente el nivel de triglicéridos aumentando la actividad de la LPL, tanto en pacientes diabéticos como en no diabéticos. En esta presentación se describe el caso de una mujer joven, tabaquista y obesa, sin antecedentes de dislipemia previa que en un análisis de control se detecta una hipertrigliceridemia severa (12214 mg/dL) en contexto de una diabetes de reciente diagnóstico. Durante la internación se administró insulina endovenosa, heparina sódica y gemfibrozil, disminuyendo rápidamente los niveles de triglicéridos y evolucionando favorablemente sin desarrollar pancreatitis. Los autores declaran no poseer conflictos de interés.
Severe hypertriglyceridemia is associated with acute pancreatitis and it is usually caused by a genetic or acquired deficiency in the activity of lipoprotein lipase (LPL). The usual treatment in outpatients is based on healthy eating, exercise, weight control, omega-3 supplements and drugs such as fibrates and niacin. In situations of severe hypertriglyceridemia, whether or not associated with pancreatitis, treatment with insulin and/or heparin is recommended to rapidly decrease triglyceride levels by increasing LPL activity, in diabetic and non-diabetic patients. We report the case of a young, obese smoker woman with no prior history of dyslipidemia, who had severe hypertriglyceridemia (12214 mg/dL) detected in a control test in the context of new onset diabetes. During hospitalization, intravenous insulin, sodium heparin and gemfibrozil were administered, with a rapid decrease in triglyceride levels and good progress with no development of pancreatitis. No financial conflicts of interest exist.
RESUMO
We compared the application of high hydrostatic pressure (HHP) on unfrozen carpaccio (HHP at 20 °C) and on previously-frozen carpaccio (HHP at -30 °C). HHP at 20 °C changed the color. The pressure increase from 400 to 650 MPa and the time increment from 1 to 5 min at 400 MPa increased L* and b*. a* decreased only with 650 MPa for 5 min at 20 °C. The prior freezing of the carpaccio and the HHP at -30 °C minimized the effect of the HHP on the color and did not change the shear force, but increased expressible moisture as compared to the untreated carpaccio. HHP at 20 °C was more effective in reducing the counts of microorganisms (aerobic total count at 30 °C, Enterobacteriaceae, psychrotrophs viable at 6.5 °C and lactic acid bacteria) than HHP at -30 º C. With HHP at 20 °C, we observed a significant effect of pressure and time on the reduction of the counts.
Assuntos
Fast Foods/análise , Conservação de Alimentos/métodos , Qualidade dos Alimentos , Carne/análise , Animais , Argentina , Bovinos , Fenômenos Químicos , Temperatura Baixa , Dieta/etnologia , Enterobacteriaceae/crescimento & desenvolvimento , Enterobacteriaceae/isolamento & purificação , Fast Foods/microbiologia , Alimentos Congelados/análise , Alimentos Congelados/microbiologia , Pressão Hidrostática , Lactobacillales/crescimento & desenvolvimento , Lactobacillales/isolamento & purificação , Carne/microbiologia , Fenômenos Mecânicos , Viabilidade Microbiana , Pigmentação , Resistência ao Cisalhamento , Fatores de Tempo , Água/análiseRESUMO
SETTING: Ten peripheral laboratories performing routine acid-fast bacilli (AFB) smear microscopy in Lima, Peru. OBJECTIVES: To test whether external quality assessment (EQA) rechecking of AFB smears becomes more efficient with stratified lot sampling of treatment follow-up smears. DESIGN: In 2 consecutive years, a stratified lot sample of 36 treatment follow-up slides and 24 diagnostic slides were randomly selected and blindly rechecked. A second controller determined the final result for discordant slides. Feedback was provided to laboratory technicians during supervisory visits. RESULTS: More false-negative errors were found in the follow-up slides than in the tuberculosis suspect slides: 25 vs. 3. This represented a yield of 3.5% in 720 follow-up slides and only 0.6% in 480 diagnostic slides. Positive predictive values were high in both years. Respectively three and eight laboratories did not reach a relative sensitivity of >65% during the first and second year, and a clear improvement was seen in only one laboratory. Excessive workload seemed to preclude raising the level of routine performance. CONCLUSIONS: EQA with stratified lot sampling of treatment follow-up slides proved very efficient and effective for identifying laboratories with substandard performance in a setting with low positivity rates in routine diagnostic smears.
Assuntos
Técnicas de Laboratório Clínico/normas , Microscopia/normas , Mycobacterium tuberculosis/isolamento & purificação , Indicadores de Qualidade em Assistência à Saúde , Tuberculose/diagnóstico , Antituberculosos/uso terapêutico , Reações Falso-Negativas , Reações Falso-Positivas , Humanos , Variações Dependentes do Observador , Peru , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/microbiologia , Carga de TrabalhoRESUMO
Tissue factor (TF) is a molecular marker that is up-regulated in cancer cells and aids tumoral dissemination. Our purpose was to develop a nested RT-PCR strategy against TF for detecting blood-borne tumour cells. Our method detected TF expression in a minimum of 1.5 pg total RNA from MCF7 cells. A preliminary study in blood samples from 16 advanced breast carcinoma patients showed that 80% of patients with high TF load progressed and died, while only 18% with low TF load showed the same behaviour. Kaplan-Meier analysis confirmed worse overall survival in patients with high TF load.
Assuntos
Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Tromboplastina/análise , Biomarcadores/sangue , Neoplasias da Mama/sangue , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/metabolismo , Linhagem Celular Tumoral , Progressão da Doença , Intervalo Livre de Doença , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Estimativa de Kaplan-Meier , Prognóstico , Recidiva , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Sensibilidade e Especificidade , Tromboplastina/genética , Tromboplastina/metabolismoRESUMO
OBJECTIVE: To determine the efficiency of routine tuberculosis (TB) case detection by examining sputum smear positivity for acid-fast bacilli in relation to duration of cough, characteristics of TB suspects examined and health service factors. METHOD: We combined patient interviews with routine data from laboratory registers in 6 health care facilities in San Juan de Lurigancho district, Lima, Peru. A TB case was defined as a TB suspect with at least one positive sputum smear. We calculated adjusted odds ratios with 95% confidence intervals for the association between smear positivity and health service and patient's characteristics. RESULTS: Smear positivity was 7.3% (321/4376). Of the 4376 adults submitting sputa, 55.3% (2418) reported cough for <14 days. In this group, smear microscopy yielded 3.2% (78/2418) positive results vs. 12.4% (243/1958) in patients coughing for 14 or more days. Having cough for >2 weeks, being referred by health care staff, attending a secondary-level health care facility, male sex and age between 15 and 44 years were independent determinants of smear positivity. CONCLUSIONS: Routine case detection yields a low proportion of smear-positive cases because of the inclusion of a high proportion of patients without cough or coughing for <2 weeks. Adherence to the national TB control programme guidelines on the selection of TB suspects would have a positive impact on the smear positivity rate, reduce laboratory costs and workload and possibly improve the reading quality of smear microscopy.
Assuntos
Tosse/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Adolescente , Adulto , Distribuição por Idade , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Peru/epidemiologia , Distribuição por Sexo , Fatores de Tempo , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia , Adulto JovemRESUMO
INTRODUCTION: The inheritance of class III malocclusion has been well documented, but the inheritance of craniofacial structures in Colombian families with this malocclusion has been not yet reported. PATIENTS AND METHODS: The study sample of 25 families comprised 186 untreated orthodontic individuals from 8 to 60 years old. Pedigrees were drawn using Cyrillic software. Complete family histories for each proband were ascertained and the affection status of relatives was confirmed by lateral cephalograms and facial and dental photographs. Analysis of variance and odds ratio test for each parameter was performed to estimate inheritance from parents to offspring and to determine similar phenotypic features in relatives. RESULTS: The analysis of the pedigrees suggests autosomal dominant inheritance. The craniofacial characteristics that showed more resemblance between parents and offspring were middle facial height, shorter anterior cranial base and mandibular prognathism. In contrast the protrusion of upper lip and maxillary retrusion were the phenotypic features that contributed to class III in the majority of families. CONCLUSION: Knowledge of the inheritance of craniofacial phenotypes in class III malocclusion will enable the design of new therapies to treat this malocclusion.
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UNLABELLED: BK virus nephropathy (BKVN) is an increasingly recognized cause of kidney allograft loss and is thought to be related to the newer, more potent immunosuppressive agents. Conflicting information has been reported on risk factors for BK infection. PURPOSE: To determine incidence, associated factors, and outcome of BKVN in our kidney transplant population in order to improve identification and management. METHODS: Kidney transplants from January 2000 to December 2005 were retrospectively reviewed. Data were collected for patients with biopsy-proven BKVN including age, sex, body mass index (BMI), etiology of renal failure, other medical diseases, donor type, surgical complications, rejection and infection, time to diagnosis, induction, immunosuppressive and antiviral therapy, and clinical outcome. A control group of patients matched for sex, age, type of graft, etiology of kidney disease, and BMI, was established for comparison. STUDY GROUP: During this period, 20 (4%) of 497 transplanted patients were diagnosed with BKVN. Thirteen (65%) were males, 8 (40%) were young adults (ages 21-40), and 18 (90%) received grafts from cadaveric donors (P=0.05). Twelve (60%) had hypertensive renal disease, 2 (10%) also had diabetes, and 16 (80%) had a BMI >25 (P=0.01). Lymphoceles occurred in 5 patients (25%). Mean creatinine level at diagnosis was 2.7 mg/dL and mean time to diagnosis was 23 months. Ten patients (50%) had leukopenia at or within a year before biopsy (P=0.001). Viruses other than BK occurred in 9 patients: varicella zoster virus in 3, cytomegalovirus in 2, herpes simplex virus in 1, molluscum contagiosum in 1, Epstein-Barr virus in 1, and human papillomavirus in 1. Eighteen patients (90%) had related rejection (P= 0.001) and 4 (20%) suffered allograft loss (P= 0.001). Basiliximab (living donors) and anti-thymocyte globulin (cadaver donors) were given for induction. All patients were on triple therapy; 15 on prednisone and sirolimus, with either tacrolimus in 8, cyclosporine in 4, mycophenolate in 1, or mycophenolate and tacrolimus in 2. The other 5 received prednisone with tacrolimus and mycophenolate. Graft loss occurred in 2 patients on tacrolimus and mycophenolate, 1 patient on tacrolimus and sirolimus, and 1 patient on cyclosporine and sirolimus. Immunosuppression was decreased in all patients. Two were given cidofovir for 6 months and had stable creatinine levels at the end of the study. Records were reviewed until April 2007. There were no deaths in this cohort. CONTROL GROUP: The number of rejections experienced by patients with BKV was much higher (P<0.0001), but the rate of graft loss was similar between the 2 groups (P=0.19). Viral co-infection was more frequent in patients with BKV (P=0.04). No episodes of leukopenia were reported for any of the patients in the control group (P=0.001). Immunosuppression with tacrolimus and sirolimus was more frequent in the BKV group, but this was not statistically significant (P=0.18, 0.28, respectively). The number of lymphoceles was larger in patients with BKV, but the difference was not statistically significant (P=0.35). CONCLUSION: BKVN is present in our transplant population and results in a high rate of allograft rejection with varying rates of graft loss. Associated factors were deceased donor and immunosuppression with potent agents, particularly tacrolimus and sirolimus. We also found a higher frequency of obesity, viral co-infection, and leukopenia. Routine screening and timely biopsy could prove cost-effective and significantly reduce morbidity.
Assuntos
Vírus BK , Rejeição de Enxerto/epidemiologia , Hispânico ou Latino , Nefropatias , Transplante de Rim/efeitos adversos , Infecções por Polyomavirus , Infecções Tumorais por Vírus , Adulto , Vírus BK/isolamento & purificação , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Incidência , Nefropatias/epidemiologia , Nefropatias/etnologia , Nefropatias/virologia , Masculino , Infecções por Polyomavirus/epidemiologia , Infecções por Polyomavirus/etnologia , Infecções por Polyomavirus/virologia , Prognóstico , Porto Rico/epidemiologia , Porto Rico/etnologia , Fatores de Risco , Infecções Tumorais por Vírus/epidemiologia , Infecções Tumorais por Vírus/etnologia , Infecções Tumorais por Vírus/virologia , Adulto JovemRESUMO
Herbivore attack by Bolax palliata Burmeister is reported on two sympatric bracken species: Pteridium caudatum (L.) Maxon and P. arachnoideum (Kaulf.). Laboratory and field observations revealed a preference for the last of the two species. Available phytochemical information suggests it could be based on differences in concentration of condensed tannins.
Se reporta la herbivoría de Bolax palliata Burmeister sobre dos especies simpátricas del helecho macho: Pteridium caudatum (L.) Maxon and P. arachnoideum (Kaulf.). Observaciones de laboratorio y campo mostraron preferencia por la última de estas especies. La información fitoquímica disponible sugiere que esta selección podría estar basada en diferencias en la concentración de taninos condensados.
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Animais , Besouros/fisiologia , Preferências Alimentares , Pteridium/parasitologia , VenezuelaRESUMO
UNLABELLED: Organ transplantation as a substitute for diseased organs in end-stage organ failure has led to a worldwide increase in this treatment modality, but donation has not kept pace with the demand, despite scientific, social, and government efforts. For many years, Hispanic donation in Puerto Rico was meager and lagged behind major centers in North America and Europe. Studies signaled mostly cultural factors in this limited donation. We report a 16-fold increase in organ donation with the development of a formal procurement organization tailored to a local culture. METHODS: The 30-year, 1400-transplant experience of the Puerto Rico Transplant Center was divided in three periods: 1977 through 1893, the latter signaling the approval of a transplant law; 1984 through 1995, signaling the commencement of a formal organ procurement organization; and 1996 through 2006. The subset of 2001 to 2006 was used in an additional calculation against 1984 to 1995. RESULTS: The comparison of the mean deceased donors from 1984 to 1995 with 1998 to 2006 shows a 12-fold increase; and the last 6 years versus 1984 to 1995, a 16.8-fold increase. CONCLUSION: Cultural and educational obstacles in a given country may be overridden by aggressive administrative and educational approaches and strategic planning tailored to local realities, with improvement in organ transplantation.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Transplante/estatística & dados numéricos , Cadáver , Cultura , Educação , Humanos , Porto Rico , Estudos Retrospectivos , Fatores de Tempo , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/legislação & jurisprudênciaRESUMO
OBJECTIVES: To assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success. METHODS: Twenty-six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six-month periods pre- and post-intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals' clinical behaviour after the introduction of clinical audit. RESULTS: We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients' attitudes towards illness. CONCLUSIONS: Clinical audit may drive improvements in the quality of clinical care in resource-poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit.