RESUMO
OBJECTIVE: Pretreatment HIV-drug resistance (PDR, HIVDR) to non-nucleoside reverse transcriptase inhibitors (NNRTIs) is increasing globally. NNRTIs continue to be used as first-line antiretroviral therapy (ART) in some communities due to the cost of dolutegravir-based ART or dolutegravir-associated adverse events. A simplified version of the oligonucleotide ligation assay (OLA) - 'OLA-Simple' - is a low-cost, near point-of-care assay that provides ready-to-use lyophilized reagents and reports HIVDR mutations as colored lines on lateral flow strips. Our objective was to design and validate OLA-Simple for a Mexican cohort. DESIGN: OLA-Simple probes to detect K65R, K103N/S, Y181C, M184V, and G190A were optimized for HIV Mexican sequences. Sixty clinical plasma specimens were analyzed by OLA-Simple by technicians blinded to Illumina-MiSeq sequences, and HIVDR results were compared. METHODS: Plasma RNA was tested using OLA-Simple kits. OLA-Simple lateral flow strips were read by in-house software, and were classified as mutant or wild-type at each codon. The comparison of results by OLA-Simple and Miseq was used to generate receiver-operating characteristic curves. RESULTS: OLA-Simple PCR amplified 59 of 60 specimens and successfully genotyped 287 of 295 codons, with eight of 295 (2.7%) indeterminate results. Compared to MiSeq, OLA-Simple gave five of 295 (1.7%) false-positive and four of 295 (1.4%) false-negative results. Excluding indeterminate results, OLA-Simple classified mutant with an accuracy of 97.4 and 98.8% when using thresholds at 10 and 25% mutant within an individual's HIV quasispecies, respectively. CONCLUSIONS: Compared to MiSeq, OLA-Simple detected HIVDR with high sensitivity and accuracy. OLA-Simple could expand access to affordable and rapid HIVDR testing to guide appropriate ART choices in populations using NNRTI-based ART.
Assuntos
Terapia Antirretroviral de Alta Atividade , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , HIV-1/genética , Mutação/efeitos dos fármacos , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Medicina de Precisão , Inibidores da Transcriptase Reversa/farmacologia , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Genótipo , Infecções por HIV/sangue , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Humanos , México , Testes de Sensibilidade Microbiana/métodos , Sondas de Oligonucleotídeos , Reação em Cadeia da Polimerase , DNA Polimerase Dirigida por RNA/genética , Reprodutibilidade dos Testes , Inibidores da Transcriptase Reversa/administração & dosagem , Sensibilidade e Especificidade , Análise de Sequência de DNARESUMO
OBJECTIVE: To assess the prevalence of human T cell leukaemia/lymphoma virus (HTLV) infection in pregnant women in the United Kingdom. DESIGN: Population study. SUBJECTS: Guthrie card samples from babies born in 1997-8. Samples were linked to data on mother's age and ethnic status and parents' country of birth and then anonymised. SETTING: North Thames Regional Health Authority. MAIN OUTCOME MEASURES: Presence of antibodies against HTLV in eluates tested by gelatin particle agglutination assay and results confirmed by immunoblot. RESULTS: Of 126 010 samples tested, 67 had confirmed antibodies to HTLV (59 HTLV-I, 2 HTLV-II, 6 untyped) and six had indeterminate results. Seroprevalence was 17.0 per 1000 (95% confidence interval 9.2 to 28.3) in infants whose mothers were born in the Caribbean, 3.2/1000 (1.5 to 5.9) with mothers born in west and central Africa, and 6.8/1000 (3.1 to 12.9) in infants of black Caribbean mothers born in non-endemic regions. In infants with no known risk (both parents born in non-endemic regions and mother not black Caribbean) seroprevalence was 0.06-0.12 per 1000. Mother's country of birth, father's country of birth, and mother's ethnic status were all independently associated with neonatal seroprevalence. An estimated 223 (95% confidence interval 110 to 350) of the 720 000 pregnant women each year in the United Kingdom are infected with HTLV. CONCLUSIONS: The prevalence of HTLV and HIV infections in pregnant women in the United Kingdom are comparable. The cost effectiveness of antenatal HTLV screening should be evaluated, and screening of blood donations should be considered.
Assuntos
Infecções por HTLV-I/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Anticorpos Antideltaretrovirus/análise , Feminino , Infecções por HTLV-I/imunologia , Infecções por HTLV-I/transmissão , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Vírus Linfotrópico T Tipo 2 Humano/imunologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Gravidez , Prevalência , Fatores de Risco , Estudos Soroepidemiológicos , Reino Unido/epidemiologia , Índias Ocidentais/etnologiaRESUMO
Nutritional deficiencies would appear to be an important determinant of morbidity in homozygous sickle cell (SS) disease. This is evidenced by the growth and development deficits which are observed in children with SS disease. In a study of the nutritional status of Jamaican children with SS disease aged 3 to 6 years, serum samples from blood taken after an overnight fast in the SS children and children of the same age with normal haemoglobin (AA) were collected. Micro-nutrient analyses of these serum samples for vitamin A (retinol) and vitamins E (alpha and gamma tocopherol) and the carotenoids, beta-carotene and lycopene were carried out using high performance liquid chromatography (HPLC). The results suggest that in children with SS disease several of the micro-nutrients which are essential for maintaining optimal antioxidant status are found in decreased amounts in serum. The confirmation of these micronutrients deficiencies in SS children provide the basis fo further exploration of their interrelationshipo with the growth and development deficits in this population. (AU)
Assuntos
Pré-Escolar , Humanos , Anemia Falciforme/complicações , Deficiência de Vitamina E/complicações , Deficiência de Vitamina A/complicações , Carotenoides , Estado Nutricional , JamaicaRESUMO
The purpose of this paper is to examine the determinants of household health expenditures in Mexico. Our analysis involves the estimation of household monetary health care expenditures, using the economic and demographic characteristics of the household as covariates. We pay particular attention to the impact of household income on health expenditures, estimating the elasticity of health care expenditures with respect to income for different income groups and according to health insurance status. For the empirical analysis, we use the Mexican National Survey of Income and Expenditures of 1989. Our principle findings show that monetary health expenditures by Mexican households are sensitive to changes in household income levels and that the group which is most responsive to changes in income levels in the lower-income uninsured group. This suggests that in times of economic crisis, these households reduce cash expenditures on health care by proportionately more than higher-income and insured households.
Assuntos
Pesquisas sobre Atenção à Saúde , Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Interpretação Estatística de Dados , Demografia , Política de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , México/epidemiologia , Saúde Pública/estatística & dados numéricos , Setor Público , População Rural , Previdência Social , Fatores Socioeconômicos , População UrbanaRESUMO
PIP: "This paper analyzes the supply and organization of public day care in Mexico and presents a series of considerations as to the formulation of future policy. The research concentrates on the evolution of public policies to provide day care to working women in the formal sector through the Mexican Social Security Institute (IMSS). Data on the evolution of female labor force participation, changes in family structure, the supply of day care and patterns of child care arrangements, suggest that access to formal facilities falls short of demand.... Innovative policies for the reorganization and expansion of the provision of day care are presently under consideration." (EXCERPT)^ieng
Assuntos
Cuidado da Criança , Emprego , Características da Família , Política de Planejamento Familiar , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Organização e Administração , Política Pública , América , Comportamento , Educação Infantil , Países em Desenvolvimento , Economia , América Latina , México , América do Norte , Avaliação de Programas e Projetos de Saúde , Classe Social , Fatores SocioeconômicosRESUMO
The use of an enzyme immunoassay (EIA) employing a baculovirus-expressed recombinant human calicivirus (Mexico virus, MxV) for the detection of IgG-specific antibodies is described. MxV appeared to be related antigenically to a strain of small round structured virus, SRSV/UK4/Leeds/91, which had previously been shown by solid phase immune electron microscopy (SPIEM) to be related to Snow Mountain agent (SMA). One other outbreak which occurred in San Anita, USA in 1980 and was due to consumption of contaminated water was caused by a virus antigenically related to MxV. Volunteers and patients who developed significant IgG responses to rMxV showed anamnestic IgG responses (2 to 4-fold) in the recombinant Norwalk virus (rNV) IgG assay. Patients and volunteers who were known to have been infected with several other strains of calicivirus/small round spherical viruses (SRSV) including NV and SRSV UK3 showed no significant antibody response to rMxV in the EIA. A seroepidemiological survey of sera from 338 children in London showed that infection with MxV occurred earlier in life than NV. Primary infections with MxV were common after the age of 6 months. Over 70% of children had evidence of infection by the ages of 2 years, whereas only 12% of these children had been infected with NV. High concentrations of maternal antibody were present during the first month of life which was detected in 96% of the neonates. The results suggest that the high sensitivity of the EIA may be detecting maternal antibody throughout the first 8 months of life.
Assuntos
Anticorpos Antivirais/sangue , Infecções por Caliciviridae/epidemiologia , Caliciviridae/imunologia , Técnicas Imunoenzimáticas , Imunoglobulina G/sangue , Adolescente , Adulto , Baculoviridae , Caliciviridae/genética , Infecções por Caliciviridae/imunologia , Infecções por Caliciviridae/virologia , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Vírus Norwalk/imunologia , Prevalência , Proteínas Recombinantes de Fusão , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Reino Unido/epidemiologia , Proteínas Virais/imunologiaAssuntos
Biópsia por Agulha/instrumentação , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Biópsia por Agulha/métodos , Desenho de Equipamento , Humanos , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/instrumentação , Ultrassonografia/instrumentaçãoRESUMO
The efficacy of developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status was evaluated. Mothers were assigned to an experimental group in which they met at least weekly with an infant-development specialist or to a control group in which they did not. During the sessions, they participated in a structured developmental and behavioral assessment of their infants, with the goal of enhancing their ability to provide appropriate interactions and environmental stimulation for their infants. When the infants were 4 and 8 months of age, follow-up home visits by a nurse who was unaware of group assignment showed that the experimental-group infants performed more optimally on the Bayley Mental scale (Bayley Scales of Infant Development) at 4 and 8 months of age and on the Bayley Motor scale at 4 months. In addition, the home environment was more developmentally appropriate at 4 months of age, and the mothers rated their babies as temperamentally less difficult at 4 and 8 months. We conclude that a mother-focused, neonatal intensive care unit-based program that utilizes the assessment process in a therapeutic way is an effective strategy in the initiation of interventions for families of low socioeconomic status whose infants were born prematurely.
Assuntos
Cuidado do Lactente/psicologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Unidades de Terapia Intensiva Neonatal , Relações Mãe-Filho , Pobreza , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Recém-Nascido , Fatores SocioeconômicosRESUMO
The relationship of maternal use of marijuana and cocaine during pregnancy to measures of neonatal body proportionality and body composition was assessed in a multiethnic sample of 1082 newborn infants. Maternal use of marijuana and cocaine during pregnancy was ascertained by self-report and by an enzyme-multiplied immunoassay technique for screening of urine samples obtained prenatally and again post partum. After each substance was analytically controlled for use of the other and for other potentially confounding variables, detection of marijuana metabolites in maternal urine was associated (p less than 0.05) with depressed mean arm muscle circumference and nonfat area of the arm but not with any measure of neonatal fatness. In contrast, detection of cocaine in maternal urine was associated (p less than 0.05) with decrements of subscapular fat folds and of the fat and nonfat areas of the arm. Although both substances were associated with depressed birth weight, there was no decrement of neonatal ponderal index or of the arm circumference/head circumference ratio in association with exposure to either substance. We conclude that both marijuana exposure and cocaine exposure during pregnancy are associated with symmetric intrauterine growth retardation, but that deficits are in differing compartments of intrauterine growth. These findings suggest that marijuana may retard fetal growth through maternal-fetal hypoxia, whereas cocaine may alter nutrient transfer to the fetus and fetal metabolism.
Assuntos
Composição Corporal/efeitos dos fármacos , Canabinoides/farmacologia , Cocaína/farmacologia , Troca Materno-Fetal , Tecido Adiposo/efeitos dos fármacos , Antropometria , Canabinoides/farmacocinética , Cocaína/farmacocinética , Feminino , Retardo do Crescimento Fetal/induzido quimicamente , Humanos , Recém-Nascido , Abuso de Maconha/complicações , Gravidez , Complicações na GravidezRESUMO
To determine the prevalence of antituberculous drug resistance in Haiti, we conducted a 1-yr survey in a central district. From a bacillary positive (smear and/or culture positive) case rate of 80/100,000, there were 282 patients from whom Mycobacterium tuberculosis was cultured. Each isolate was packaged and delivered to Canada where speciation and drug susceptibility testing were performed. Reported resistances are those using the proportions method (Laboratory Center for Disease Control, Ottawa, Canada). Resistance to one or more drugs was found in 22% of isolates. Age was the most important predictor of resistance in Haiti; resistance rates for age groups less than 14, 14 to 29, 30 to 44, greater than or equal to 45 were 8, 19, 22, and 31%, respectively. In patients not known to have received antituberculous drugs in the past, resistances were isoniazid (19%), streptomycin (5%), ethambutol (2%), ethionamide (2%), rifampin (1%). We conclude that antituberculous drug resistance is prevalent in Haiti, especially in older age groups, and that in persons with no known antituberculous drug use in the past, resistance to isoniazid is significant.
Assuntos
Antituberculosos/farmacologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antituberculosos/uso terapêutico , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Etambutol/farmacologia , Etambutol/uso terapêutico , Etionamida/farmacologia , Etionamida/uso terapêutico , Feminino , Haiti , Humanos , Lactente , Isoniazida/farmacologia , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Rifampina/farmacologia , Rifampina/uso terapêutico , Estreptomicina/farmacologia , Estreptomicina/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologiaRESUMO
An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.
Assuntos
Educação em Saúde/normas , Fenômenos Fisiológicos da Nutrição do Lactente , Pais/educação , Negro ou Afro-Americano , Serviços de Saúde da Criança , Agentes Comunitários de Saúde , Comportamento Alimentar , Haiti/etnologia , Hispânico ou Latino , Humanos , Lactente , Alimentos Infantis , Cidade de Nova Iorque , Porto Rico/etnologiaRESUMO
Infant feeding practices among low-income infants in East Harlem were surveyed prior to undertaking a nutrition education program. Data were obtained from 24-hr. recalls on 153 infants seen in a well-baby clinic. Intakes of energy, protein, fat, ascorbic acid, iron, and sodium showed wide variations among infants of similar ages. Nutrient intakes were similar for black and Puerto Rican infants, although some ethnic differences were observed in the types of milk and solid foods consumed. Black infants received formula for a longer period, while Puerto Rican infants were transferred to whole cow's milk at a younger age. In contrast black infants were introduced to table foods earlier.