Predictors of immunodeficiency-related death in a cohort of low-income people living with HIV: a competing risks survival analysis.

We conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3 (SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.

The influence of biopsy in cervical high-grade squamous intraepithelial lesion, evaluated by HPV E6/E7 mRNA, Pap test, and conization results.

OBJECTIVE: To evaluate the influence of biopsy on cervical intraepithelial neoplasia (CIN). MATERIALS AND METHODS: A study was conducted involving 124 women underwent colposcopy-guided biopsy. At the first appointment, the women answered the survey questionnaire, cervical samples were collected for Papanicolaou (Pap) testing and the HPV E6/E7 mRNA test. At the second appointment at three to four months after the first, samples were collected from 81 patients with indications for conization, Pap test, and HPV E6/E7 mRNA testing before they underwent the procedure. PCR was used to detect HPV mRNA. The percentage of negative results before and after the biopsy was evaluated. The agreement between the tests results was evaluated using Cohen's kappa. RESULTS: Sixty-two patients (76.4%) were between 21 and 40 years of age, 35 (43.2%) had four or more pregnancies, 41 (50.5%) had their sexual debut at 16 years of age or more, and 52 patients (64.2%) had undergone five or more Pap tests. The initial biopsy was negative for CIN2/3 in 14 (12.3%) patients; however, all patients were submitted to conization. Among those women with biopsy showing CIN2/3 (66 [81.5%]), 7.41% showed CIN1 and 14.81% were negative in the conization (kappa = 0.2052). The E6/E7 test performed before and after biopsy showed the best level of agreement by the kappa coefficient (0.7491) Conclusions: A higher percentage of negative results were observed in the histopathology, cytopathology, and E6/E7 after biopsy, suggesting that biopsy could affect the regression of CIN.

The Sirius project.

The lattice design and beam dynamics optimization for Sirius, a new low-emittance synchrotron light source presently under construction at the Brazilian Synchrotron Light Laboratory (LNLS) in Campinas, Brazil, is presented. The electron storage ring is based on a five-bend achromat (5BA) design achieving a bare lattice emittance of 0.28 nm rad for a 3 GeV beam. The circumference of 518 m contains 20 achromatic straight sections of alternating 7 m and 6 m in length. An innovative approach is adopted to enhance the performance of the storage ring dipoles by combining low-field (0.58 T) magnets for the main beam deflection with a very short 2 T permanent-magnet superbend sandwiched in the center dipole. This superbend creates 12 keV critical photon energy dipole sources with modest total energy loss from dipoles. In addition it also creates a longitudinal dipole field gradient that reduces the emittance by about 10%. The optimized dynamic aperture allows for top-up operation with off-axis injection and the optimized energy acceptance allows for a total beam lifetime of around 11 h at nominal current with a third-harmonic cavity.

The introduction of Physa acuta (Gastropoda: Physidae) on Ilha Grande, Southeast Brazil, from initial stages to an established population.

This study presents a four-year follow-up of an introduced population of Physa acuta Draparnaud, 1805, from initial stages to an established population. This introduction occurred on a small impacted stream of Vila do Abraão, the main village of Ilha Grande (Angra dos Reis, Rio de Janeiro, Brazil). The population size increased during the study, and presented a relationship to environmental factors, especially with rainfall. On the initial stages of introduction prevailed the smaller specimens, but on the overall, predominated the intermediate size classes. After less than a year, P. acuta becomes established on this stream and was possibly affecting the other species found on the stream. The information presented here is useful to understand the invasion process of invasive snails, as well as directing conservation efforts.

Unawareness of HIV status in pregnancy, delay in testing and conflict between information on antenatal card and interview in Recife, Brazil.

Overall HIV test coverage among pregnant women in Brazil is 62%, but only 41% in northeastern Brazil. We aimed to identify risk factors for unawareness of HIV status among pregnant women and determine test coverage up to 14th week of pregnancy. We conducted a case-control study in a reference maternity hospital for high-risk pregnancy in Recife, where 485 puerperae were interviewed about their knowledge of results of HIV testing, biological, sociodemographic and health-care data. Cases were those who were not aware of their HIV status and controls were those who were. Only 21.65% stated that they were unaware of their HIV status during pregnancy (78.35% coverage); however, test results were recorded on an antenatal card in only 48.35%. Only 22% received the result by the 14th week of pregnancy. Unawareness was associated with low schooling (odds ratio [OR] = 2.92; P = 0.006); living outside the state capital's metropolitan region (OR = 4.11; P = 0.001); test performed in the third trimester (OR = 11.6; P = 0.000); and lack of counselling (OR = 2.31; P = 0.022) in multivariate analysis. In conclusion, there has been a considerable delay in having an HIV test. Conflict of Information obtained by interview and that on the antenatal card raises questions about deficiencies in antenatal care or lack of comprehension about the HIV test.

The introduction of Physa acuta (Gastropoda: Physidae) on Ilha Grande, Southeast Brazil, from initial stages to an established population / A introdução de Physa acuta Draparnaud, 1805 (Gastropoda: Physidae) na Ilha Grande, Sudeste do Brasil, desde os estágios iniciais até uma população estabelecida

Abstract This study presents a four-year follow-up of an introduced population of Physa acuta Draparnaud, 1805, from initial stages to an established population. This introduction occurred on a small impacted stream of Vila do Abraão, the main village of Ilha Grande (Angra dos Reis, Rio de Janeiro, Brazil). The population size increased during the study, and presented a relationship to environmental factors, especially with rainfall. On the initial stages of introduction prevailed the smaller specimens, but on the overall, predominated the intermediate size classes. After less than a year, P. acuta becomes established on this stream and was possibly affecting the other species found on the stream. The information presented here is useful to understand the invasion process of invasive snails, as well as directing conservation efforts.

Resumo Neste estudo é apresentado um acompanhamento de quatro anos de uma população de Physa acuta Draparnaud, 1805, desde os estágios iniciais da introdução até seu pleno estabelecimento. Esta introdução ocorreu em um pequeno riacho impactado da Vila do Abraão, o principal vilarejo da Ilha Grande (Angra dos Reis, Rio de Janeiro, Brasil). A população cresceu durante o estudo, e apresentou uma relação com os fatores ambientais, especialmente a pluviosidade. Nos estágios iniciais de introdução prevaleceram os exemplares menores, contudo no panorama geral, predominaram as classes de tamanho intermediárias. Em menos de um ano de introdução, P. acuta se estabeleceu neste riacho, e possivelmente está afetando as demais espécies encontradas no rio. A informação apresentada aqui é importante para a compreensão do processo de invasão de moluscos invasores no Brasil, assim como no direcionamento de esforços de conservação.

The introduction of Physa acuta (Gastropoda: Physidae) on Ilha Grande, Southeast Brazil, from initial stages to an established population / A introdução de Physa acuta Draparnaud, 1805 (Gastropoda: Physidae) na Ilha Grande, Sudeste do Brasil, desde os estágios iniciais até uma população estabelecida

This study presents a four-year follow-up of an introduced population of Physa acuta Draparnaud, 1805, from initial stages to an established population. This introduction occurred on a small impacted stream of Vila do Abraão, the main village of Ilha Grande (Angra dos Reis, Rio de Janeiro, Brazil). The population size increased during the study, and presented a relationship to environmental factors, especially with rainfall. On the initial stages of introduction prevailed the smaller specimens, but on the overall, predominated the intermediate size classes. After less than a year, P. acuta becomes established on this stream and was possibly affecting the other species found on the stream. The information presented here is useful to understand the invasion process of invasive snails, as well as directing conservation efforts.

Neste estudo é apresentado um acompanhamento de quatro anos de uma população de Physa acuta Draparnaud, 1805, desde os estágios iniciais da introdução até seu pleno estabelecimento. Esta introdução ocorreu em um pequeno riacho impactado da Vila do Abraão, o principal vilarejo da Ilha Grande (Angra dos Reis, Rio de Janeiro, Brasil). A população cresceu durante o estudo, e apresentou uma relação com os fatores ambientais, especialmente a pluviosidade. Nos estágios iniciais de introdução prevaleceram os exemplares menores, contudo no panorama geral, predominaram as classes de tamanho intermediárias. Em menos de um ano de introdução, P. acuta se estabeleceu neste riacho, e possivelmente está afetando as demais espécies encontradas no rio. A informação apresentada aqui é importante para a compreensão do processo de invasão de moluscos invasores no Brasil, assim como no direcionamento de esforços de conservação.