RESUMO
Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41 ± 19 minutes in J-GUA, 99 ± 64 minutes in P-PER, 40 ± 19 minutes in K-RWA, and 31 ± 19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P < 0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pneumonia/diagnóstico , Pneumonia/terapia , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Geografia , Guatemala , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Oximetria , Peru , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos , RuandaRESUMO
BACKGROUND: In resource-limited settings, pneumonia diagnosis and management are based on thresholds for respiratory rate (RR) and oxyhaemoglobin saturation (SpO2) recommended by WHO. However, as RR increases and SpO2 decreases with elevation, these thresholds might not be applicable at all altitudes. We sought to determine upper thresholds for RR and lower thresholds for SpO2 by age and altitude at four sites, with altitudes ranging from sea level to 4348 m. METHODS: In this cross-sectional study, we enrolled healthy children aged 0-23 months who lived within the study areas in India, Guatemala, Rwanda, and Peru. Participants were excluded if they had been born prematurely (<37 weeks gestation); had a congenital heart defect; had history in the past 2 weeks of overnight admission to a health facility, diagnosis of pneumonia, antibiotic use, or respiratory or gastrointestinal signs; history in the past 24 h of difficulty breathing, fast breathing, runny nose, or nasal congestion; and current runny nose, nasal congestion, fever, chest indrawing, or cyanosis. We measured RR either automatically with the Masimo Rad-97, manually, or both, and measured SpO2 with the Rad-97. Trained staff measured RR in duplicate and SpO2 in triplicate in children who had no respiratory symptoms or signs in the past 2 weeks. We estimated smooth percentiles for RR and SpO2 that varied by age and site using generalised additive models for location, shape, and scale. We compared these data with WHO RR and SpO2 thresholds for tachypnoea and hypoxaemia to determine agreement. FINDINGS: Between Nov 24, 2017, and Oct 10, 2018, we screened 2027 children for eligibility. 335 were ineligible, leaving 1692 eligible participants. 30 children were excluded because of missing values and 92 were excluded because of measurement or data entry errors, leaving 1570 children in the final analysis. 404 participants were from India (altitude 1-919 m), 389 were from Guatemala (1036-2017 m), 341 from Rwanda (1449-1644 m), and 436 from Peru (3827-4348 m). Mean age was 7·2 months (SD 7·2) and 796 (50·7%) of 1570 participants were female. Although average age was mostly similar between settings, the average participant age in Rwanda was noticeably younger, at 5·5 months (5·9). In the 1570 children included in the analysis, mean RR was 31·9 breaths per min (SD 7·1) in India, 41·5 breaths per min in Guatemala (8·4), 44·0 breaths per min in Rwanda (10·8), and 48·0 breaths per min in Peru (9·4). Mean SpO2 was 98·3% in India (SD 1·5), 97·3% in Guatemala (2·4), 96·2% in Rwanda (2·6), and 89·7% in Peru (3·5). Compared to India, mean RR was 9·6 breaths per min higher in Guatemala, 12·1 breaths per min higher in Rwanda, and 16·1 breaths per min higher in Peru (likelihood ratio test p<0·0001). Smooth percentiles for RR and SpO2 varied by site and age. When we compared age-specific and site-specific 95th percentiles for RR and 5th percentiles for SpO2 against the WHO cutoffs, we found that the proportion of false positives for tachypnoea increased with altitude: 0% in India (95% CI 0-0), 7·3% in Guatemala (4·1-10·4), 16·8% in Rwanda (12·9-21·1), and 28·9% in Peru (23·7-33·0). We also found a high proportion of false positives for hypoxaemia in Peru (11·6%, 95% CI 7·0-14·7). INTERPRETATION: WHO cutoffs for fast breathing and hypoxaemia overlap with RR and SpO2 values that are normal for children in different altitudes. Use of WHO definitions for fast breathing could result in misclassification of pneumonia in many children who live at moderate to high altitudes and show acute respiratory signs. The 5th percentile for SpO2 was in reasonable agreement with the WHO definition of hypoxaemia in all regions except for Peru (the highest altitude site). Misclassifications could result in inappropriate management of paediatric respiratory illness and misdirection of potentially scarce resources such as antibiotics and supplemental oxygen. Future studies at various altitudes are needed to validate our findings and recommend a revision to current guidelines. Substantiating research in sick children is still needed. FUNDING: US National Institutes of Health, Bill & Melinda Gates Foundation.
Assuntos
Altitude , Oxigênio/sangue , Taxa Respiratória , Estudos Transversais , Feminino , Guatemala , Humanos , Índia , Lactente , Masculino , Peru , Valores de Referência , RuandaRESUMO
High-fat diets (HFDs) lead to obesity and inflammation in the central nervous system (CNS). Estrogens and estrogen receptor α (ERα) protect premenopausal females from the metabolic complications of inflammation and obesity-related disease. Here, we demonstrate that hypothalamic PGC-1α regulates ERα and inflammation in vivo. HFD significantly increased palmitic acid (PA) and sphingolipids in the CNS of male mice when compared to female mice. PA, in vitro, and HFD, in vivo, reduced PGC-1α and ERα in hypothalamic neurons and astrocytes of male mice and promoted inflammation. PGC-1α depletion with ERα overexpression significantly inhibited PA-induced inflammation, confirming that ERα is a critical determinant of the anti-inflammatory response. Physiologic relevance of ERα-regulated inflammation was demonstrated by reduced myocardial function in male, but not female, mice following chronic HFD exposure. Our findings show that HFD/PA reduces PGC-1α and ERα, promoting inflammation and decrements in myocardial function in a sex-specific way.
Assuntos
Dieta Hiperlipídica/efeitos adversos , Receptor alfa de Estrogênio/metabolismo , Hipotálamo/metabolismo , Fatores de Transcrição/metabolismo , Animais , Astrócitos/metabolismo , Linhagem Celular , Receptor alfa de Estrogênio/genética , Feminino , Hipotálamo/citologia , Hipotálamo/efeitos dos fármacos , Inflamação/etiologia , Inflamação/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neurônios/metabolismo , Ácido Palmítico/efeitos adversos , Ácido Palmítico/metabolismo , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo , Fatores Sexuais , Esfingolipídeos/metabolismo , Fatores de Transcrição/genética , Disfunção Ventricular/etiologia , Disfunção Ventricular/metabolismoAssuntos
DNA Topoisomerase IV/genética , Farmacorresistência Bacteriana/genética , Mutação , Vibrio cholerae O1/genética , Sequência de Aminoácidos , Antibacterianos/química , Antibacterianos/farmacologia , Sequência de Bases , Cólera/tratamento farmacológico , Cólera/microbiologia , Toxina da Cólera/genética , Ciprofloxacina/química , Ciprofloxacina/farmacologia , DNA Topoisomerase IV/química , Proteínas de Fímbrias/genética , Humanos , Índia , Testes de Sensibilidade Microbiana , Simulação de Acoplamento Molecular , Dados de Sequência Molecular , Tipagem de Sequências Multilocus , Termodinâmica , Vibrio cholerae O1/efeitos dos fármacos , Vibrio cholerae O1/enzimologia , Vibrio cholerae O1/isolamento & purificaçãoRESUMO
BACKGROUND: The metabolic syndrome is associated with increased risk for both diabetes and coronary artery disease, which insulin resistance alone does not satisfactorily explain. We propose an additional and complementary underlying mechanism of glucocorticoid resistance. RESULTS: Using acanthosis nigricans (AN) and skin vasoconstrictor (SVC) response to topically applied beclomethasone dipropionate as markers of insulin and glucocorticoid resistance, respectively, we compared anthropometric, biochemical, pro-inflammatory markers and the SVC response in subjects with AN in two studies: STUDY 1 was used to compare subjects with AN (Grade 4, n = 32), with those without AN (n = 68) while STUDY 2 compared these responses among a cross-section of diabetic patients (n = 109) with varying grades of AN (grade 0, n = 30; grade 1, n = 24; grade 2, n = 18; grade 3, n = 25; grade 4, n = 12). FINDINGS: In both studies there was an inverse relationship between AN Grade 4 and the SVC response, (P < 0.001). In STUDY 1, AN Grade 4 was associated with age, waist circumference, BMI, fasting blood glucose, plasma lipids and hs-CRP (P < 0.05). SVC was an independent predictor of CRP and those with combined AN and a negative SVC response, CRP levels were highest. In Study 2 when the SVC response in subjects with type 2 diabetes mellitus with varying degrees of AN was studied, it showed that for any degree of AN, the SVC response is more likely to be negative and was independent of gender and ethnicity. CONCLUSION: An absent SVC response represents a new biomarker for the metabolic syndrome and the exaggerated inflammatory response, which characterizes the metabolic syndrome, may be an outcome of deficient glucocorticoid action in vascular tissue.
Assuntos
Acantose Nigricans/tratamento farmacológico , Acantose Nigricans/fisiopatologia , Resistência a Medicamentos/fisiologia , Glucocorticoides/uso terapêutico , Resistência à Insulina/fisiologia , Síndrome Metabólica/fisiopatologia , Acantose Nigricans/epidemiologia , Adulto , Beclometasona/uso terapêutico , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Comorbidade , Estudos Transversais , Feminino , Humanos , Resistência à Insulina/etnologia , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Pele/irrigação sanguínea , Vasoconstrição/fisiologia , Índias OcidentaisRESUMO
Erythema migrans is the skin manifestation of Lyme disease and southern tick-associated rash illness. Neither disease is found in the Caribbean. We report 4 cases of erythema migrans of a possible emerging clinical entity, Caribbean erythma migrans-like illness.
Assuntos
Eritema Migrans Crônico/diagnóstico , Eritema Migrans Crônico/epidemiologia , Adolescente , Adulto , Animais , Mordeduras e Picadas , Região do Caribe/epidemiologia , Eritema Migrans Crônico/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , CarrapatosRESUMO
Hypohidrotic ectodermal dysplasia (HED) is a hereditary syndrome, characterized by a classictriad of hypotrichosis, hypodontia and hypohidrosis. The case of an 8-year-old girl with HEDpresenting oligodontia and marked resorption of maxillary and mandibular alveolar ridges is reported. A specially designed aluminum wire tray was used for taking impressions of both dental arches. Prosthetic rehabilitation included a removable maxillary over denture and a mandibular conventional acrylic resin denture made tissue-compatible by means of a soft denture liner attached to denture base. The proposed treatment plan provided improved esthetics, function,and quality of life.
Assuntos
Humanos , Feminino , Criança , Anodontia/reabilitação , Dentaduras , Displasia Ectodérmica/complicações , Reabilitação Bucal , Resinas Acrílicas , Mandíbula/anatomia & histologia , Maxila/anatomia & histologiaRESUMO
Samples of green colonial unicellular microalga Botryococcus braunii were collected from Bear Shola Falls at Kodaikanal (latitude 10.31 N and longitude 77.32 E), Tamil Nadu, India. Specimens were isolated, cultured and examined for its hydrocarbon content, morphological features and DNA structural resemblance with the known strain to confirm its identity. Inter simple sequence repeats (ISSR) finger printing revealed strong genetic similarity among the authentic strain (B. braunii N-836) and the Indian isolated strain (B. braunii CFTRI- Bb1) from Kodaikanal. The type of hydrocarbons produced by the Kodaikanal isolates were analyzed and identified as saturated hydrocarbons in the range of C21 to C33 by GCMS. Tetracosane and octacosane were found as the major components among the saturated hydrocarbons produced by this alga, constituting 17.6 percent and 14.8 percent respectively. Hydrocarbon content of the organism was in the range of 13-18 percent of its dry biomass. The fat content of the organism was found to be 22 percent (w/w). Palmitic and oleic acids were found to be major fatty acids produced by the alga. Lutein and beta-carotene were found to be the major carotenoids and constituted about 64.1 percent and 25.1 percent respectively of the total carotenoids. Based on ISSR finger printing and hydrocarbon analyses the new algal strain from Kodaikanal was identified as Botryococcus braunii.
RESUMO
Se describe una nueva especie de un cestode, perteneciente al género phyllobothrium, obtenida de la valva espiral del pez elasmobraquio rhinoptera javanica. Fueron observadas notables diferencias en relación a otras especies conocidas de phillobothrium, por poseer un escolex grande, botridias bifurcadas y sésiles, número de testículos y características de las proglótidas. Se da el nombre de phyllobothrium rhinoptera a la nueva especie
Assuntos
Animais , Cestoides/anatomia & histologia , Peixes/parasitologia , Cestoides/isolamento & purificação , Índia , Intestinos/parasitologia , Manejo de EspécimesRESUMO
A new species of a cestode, belonging to genus Phyllobothrium, obtained from spiral valve of the intestine of the elasmobranch Rhinoptera javanica is described. It shows remarkable differences from other known species of Phyllobothrium in having big scolex, bifurced and sessile nature of bothridia, testes number and nature of proglottids. The new species is designated as Phyllobothrium rhinoptera.
Assuntos
Cestoides/classificação , Peixes/parasitologia , Animais , Índia , Intestinos/parasitologiaRESUMO
Se describe la nueva especie tylocephalum chiralensis, parásito del pez elasmobranquio dasyatis uarnak de la costa de Chirala, andra Pradesh. Difiere de otras especies conocidas del género tylocephalum en el mayor tamaño de su cuerpo, ausencia de cuello, número de testículos, número de proglótidas, distribución de los folículos vitelinos y aberturas genitales
Assuntos
Animais , Cestoides/anatomia & histologia , Peixes/parasitologia , Cestoides/crescimento & desenvolvimento , Índia , Interações Hospedeiro-Parasita , Águas SalinasRESUMO
A new species of the cestode genus Tylocephalum obtained from the host Dasyatis uarnak is described. A detailed examination of specimens have allowed us to erect a new species Tylocephalum to accommodate the worm. It shows remarkable differences from other known species of Tylocephalum in large size of the worm, absence of neck, variation in number of testes arrangement of vitellaria and genital openings. The new species is designated as Tylocephalum chiralensis.
Assuntos
Cestoides/isolamento & purificação , Elasmobrânquios/parasitologia , Animais , Cestoides/anatomia & histologia , ÍndiaRESUMO
Se describe anthobothrium loculatum, una nueva especie de cestode encontrada en la válvula espiral del intestino del pez dasyatis uarnak. Este gusano tiene la especial característica de poseer 4-5 pares de notables hendiduras en cada surco del escólex. Difiere de otras especies de anthobothrium en muchos aspectos tales como su tamaño, dimensiones de las botrias y número de testículos
Assuntos
Animais , Cestoides/classificação , Peixes/parasitologia , Enteropatias Parasitárias/parasitologia , Parasitos/fisiologia , Interações Hospedeiro-Parasita/fisiologia , Especificidade da EspécieRESUMO
Se describe la nueva especie de cestode parásito acanthobothrium satyanarayanaraoi del huésped elasmobranquio rhinobatus granulatus. Este gusano se diferencia de otras especies conocidas del género acanthobothrium en su mayor tamaño, escólex más grande, botridias y en algunas otras características
Assuntos
Animais , Cestoides/parasitologia , Peixes/parasitologia , Enteropatias Parasitárias/parasitologia , Cestoides/classificação , Interações Hospedeiro-Parasita/fisiologiaRESUMO
A new species of the cestode genus Acanthobothrium obtained from the elasmobranch Rhinobatus granulatus (Cuvier) is described. It shows remarkable differences from other known species of Acanthobothrium in respect of length of the worm, craspedote nature, size of scolex, bothridia, hooks and unilateral genital pores. The new species is designated as Acanthobothrium satyanarayanaraoi.
Assuntos
Cestoides/classificação , Peixes/parasitologia , Animais , Cestoides/anatomia & histologia , Ducto Cístico/parasitologiaRESUMO
A new species of cestode belonging to the genus Anthobothrium is obtained from the host Dasyatis uarnak. A detailed examination of this specimen has allowed us to erect a new species Anthobothrium to accommodate the worm. It shows remarkable differences from other known species of Anthobothrium in having 4-5 pairs of bigger loculi, number of testes size of the worm, bothridial size, shape and size of proglottids and ovary. The new species is designated as Anthobothrium loculatum.