RESUMO
OBJECTIVES: We aimed to assess HIV symptoms from the perspective of both patients and HIV specialists and the impact of discontinuing antiretroviral treatment (ART) on symptomology. We gathered opinions from HIV specialists and people living with HIV about ideal ART parameters and treatment satisfaction. METHODS: Ex post-facto cross-sectional surveys were administered to 502 people living with HIV and 101 HIV clinicians in Spain (18 sites). RESULTS: The median age of participants with HIV was 43.2 years, 74.5% were male, and 91.6% had an undetectable viral load. The mean time since initiation of ART was 10.2 years. Between 54% and 67% of people living with HIV reported experiencing nervousness or anxiety, sadness, fatigue, sleep problems, or muscle/joint pain during the preceding 4 weeks. However, only 22%-27% of specialists acknowledged the presence of these symptoms. The most bothersome symptoms were related to mental health or the central nervous system. There were significant differences between the burden of symptoms reported by people living with HIV and those acknowledged by specialists. The symptoms that more frequently caused ART discontinuation were depression, dizziness, and sleep problems. Both people living with HIV and specialists prioritized ART efficacy and low toxicity, but their importance ratings differed for 5 of the 11 ART characteristics assessed. People living with HIV rated their satisfaction with ART at a mean (± standard deviation) of 8.9 ± 1.5 out of 10, whereas HIV specialists rated it lower, at 8.3 ± 0.7 (p < 0.001). CONCLUSIONS: Despite advances in HIV care and treatment, a large proportion of patients still experience symptoms. HIV specialists may not be fully aware of these. People living with HIV and HIV specialists are, overall, satisfied with ART. However, the importance they place on different ART characteristics may vary.
Assuntos
Infecções por HIV , Humanos , Masculino , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Infecções por HIV/complicações , Adulto , Estudos Transversais , Pessoa de Meia-Idade , Espanha , Antirretrovirais/uso terapêutico , Inquéritos e Questionários , Satisfação do Paciente , Fármacos Anti-HIV/uso terapêuticoRESUMO
BACKGROUND: Organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCB), they have contributed to the exposure of women to persistent organic pollutants (POPs). These compounds can cross the placental barrier and interfere with the hormonal system of newborns. AIM: To determine concentrations of OCPs and PCBs and their xenoestrogenic activity in placentas of women from the PA-MAMI cohort of Panama. METHODS: Thirty-nine placenta samples from women in the Azuero peninsula (Panama) were analyzed. Five OCPs [p-p'-dichlorodiphenyldichloroethylene (p-p'-DDE), beta-hexachlorohexane (ß-HCH), γ-hexachlorohexane (lindane), hexachlorobenzene (HCB) and mirex] and three PCB congeners (PCB-138, PCB-153 and PCB-180) were quantified in placenta extracts. The xenoestrogenic activity of extracts was assessed with the E-Screen bioassay to estimate the total effective xenoestrogen burden (TEXB). RESULTS: All placental samples were positive for at least three POP residues and >70% for at least six. The frequencies of quantified OCPs ranged from 100% for p,p'-DDE and HCB to 30.8% for ß-HCH. The highest median concentration was for lindane (380.0 pg/g placenta), followed by p,p'-DDE (280.0 pg/g placenta), and HCB (90.0 pg/g placenta). Exposure to p,p'-DDE was associated with greater meat consumption, suggesting that animal fat is a major source of exposure to DDT metabolites. The frequency of detected PCBs ranged between 70 and 90%; the highest median concentration was for PCB 138 (17.0 pg/g placenta), followed by PCB 153 (16.0 pg/g placenta). All placentas were positive in the estrogenicity bioassay with a median TEXB-α of 0.91 pM Eeq/g of placenta. Exposure to lindane was positively associated with the xenoestrogenicity of TEXB- α, whereas this association was negative in the case of exposure to PCB 153. CONCLUSIONS: To our best knowledge, this study contributes the first evidence on the presence of POPs and xenoestrogenic burden in placentas from Latin-American women. Given concerns about the consequences of prenatal exposure to these compounds on children's health, preventive measures are highly recommended to eliminate or minimize the risk of OCP exposure during pregnancy.
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Poluentes Ambientais , Hidrocarbonetos Clorados , Praguicidas , Bifenilos Policlorados , Recém-Nascido , Animais , Feminino , Humanos , Gravidez , Bifenilos Policlorados/análise , Hexaclorocicloexano/análise , Hexaclorocicloexano/metabolismo , Diclorodifenil Dicloroetileno , Hexaclorobenzeno/análise , DDT/análise , Placenta/química , Hidrocarbonetos Clorados/análise , Praguicidas/análise , Poluentes Ambientais/análise , Relações Mãe-FilhoRESUMO
The occurrence of microplastics (MPs) in wastewater has been studied in the last years. The high efficiency of their removal from wastewater is linked to their transfer to the sludge. In this work, the effect of high-density polyethylene (HDPE) on aerobic digestion was evaluated and these MPs were monitored, characterizing them by three different techniques. Two parallel batch digesters were monitored. AD-Control (meaning Aerobic Digester) operated as a reference, with no external HDPE particles, whereas these polymeric fragments were introduced to the second aerobic digester (AD-HDPE) using ring pulls as microplastic support. FTIR, Raman spectroscopies and fluorescence analysis of these microparticles showed some relevant results that should be highlighted. Higher fluorescence appeared after 7 days in the digester. It coincided with an increase of active volatile suspended solids (AVSS) in the AD-HDPE, which means that an increase of the microbial activity took place. Despite the presence of HDPE particles in the sludge, the digester performance was not compromised. Besides, the HDPE particles did not affect the microbial diversity (Shannon index) of the bacterial community at the end of the experiment compared to the bacterial community of the aerobic digester control tank. Based on the analysis of the relative abundances of microbial taxa, it was concluded that HDPE had selective effects on sludge microbial community, increasing the relative abundance of Bacteroridota phylum.
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Polietileno , Esgotos , Aerobiose , Microplásticos , Águas Residuárias/química , Eliminação de Resíduos Líquidos/métodosRESUMO
INTRODUCTION: Since the advent of HIV pre-exposure prophylaxis (PrEP), stigma has been shown to be a major barrier to its uptake and adherence. It is therefore essential to define the proportion of users who consider that PrEP can negatively impact their image and the factors associated with this perception. METHOD: We performed a multivariable logistic regression on data from the 2567 participants in the ANRS-PREVENIR study who answered the outcome question. RESULTS: Almost one-third of the sample (comprising mostly cisgender men who have sex with men [94.3%]) considered that taking PrEP could give others a negative image of them. Younger participants (adjusted odds ratio [aOR] 0.98; 95% confidence interval [CI] 0.97-0.99) and more psychologically vulnerable participants (i.e., lower self-esteem score [aOR 0.98; 95% CI 0.96-0.99] and higher depression score [aOR 1.02; 95% CI 1.00-1.03]) were also more likely to have this perception. In contrast, participants encouraged to take PrEP by their main partner (aOR 0.67; 95% CI 0.51-0.88) and friends (aOR 0.79; 95% CI 0.66-0.95), and those who protected themselves more because they had knowledge of their most recent sexual partner's HIV status (aOR 0.83; 95% CI 0.69-0.99) and systematic use of PrEP and/or condoms during intercourse in the previous 3 months (aOR 0.80; 95% CI 0.67-0.96) were less likely to have this perception. DISCUSSION: Given the strong interrelation between stigmatization (real or perceived), risky behaviours and adherence, our results emphasize the need for HIV prevention campaigns to promote a positive image of PrEP users. They also show that stigmatization and its effects need to be fully considered to improve HIV prevention offers to current and potential PrEP users who are most likely to be psychologically vulnerable.
Assuntos
Infecções por HIV , Profilaxia Pré-Exposição , Minorias Sexuais e de Gênero , Masculino , Humanos , Homossexualidade Masculina , Infecções por HIV/prevenção & controle , Infecções por HIV/tratamento farmacológico , Comportamento Sexual , Percepção , Profilaxia Pré-Exposição/métodosRESUMO
BACKGROUND AND OBJECTIVE: To determine the relationship between short-acting ß-adrenergic agonist (SABA) overuse and health care resource use and costs in asthma patients in routine clinical practice. METHODS: A longitudinal retrospective study was conducted in Spanish primary and specialized care centers using the BIG-PAC medical records database. The study population comprised asthma patients ≥12 years of age who attended ≥2 consultations during 2017 and had 1-year follow-up data available. The main outcomes were demographics, comorbidities, medication, and clinical and health care resource use and costs. The relationship between SABA overuse and health care costs and between asthma severity and health care costs was determined. RESULTS: The SABA use IN Asthma (SABINA) study included 39 555 patients, with a mean (SD) age of 49.8 (20.7) years (64.2% female). The Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥3 canisters/y) was 28.7% (95%CI, 27.7-29.7), with a mean of 3.3 (3.6) canisters/y. Overall, 5.1% of patients were prescribed ≥12 canisters/y. SABA overuse was correlated with health care costs (ρ=0.621; P<.001). The adjusted mean annual cost/patient according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity was 2231, 2345, 2735, 3473, and 4243 for steps 1-5, respectively (P<.001). Regardless of asthma severity, SABA overuse yielded a significant increase in health care costs per patient and year (5702 vs 1917, P<.001) compared with recommended use (<2 canisters/y). CONCLUSION: SABA overuse yields high costs for the Spanish National Health System. Costs increased with severity of asthma.
Assuntos
Antiasmáticos , Asma , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Espanha/epidemiologia , Asma/tratamento farmacológico , Asma/epidemiologia , Comorbidade , Agonistas Adrenérgicos/uso terapêutico , Antiasmáticos/uso terapêutico , Administração por InalaçãoRESUMO
OBJECTIVES: To assess the degree of consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care. METHODS: A 61-item survey was developed based on guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement. RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments. CONCLUSION: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.
Assuntos
Asma , Transição para Assistência do Adulto , Humanos , Adolescente , Adulto , Criança , Consenso , Espanha , Asma/tratamento farmacológico , Terapia BiológicaRESUMO
To contribute of the knowledge of the immune mechanisms underlying the response to the immunization of goats with thiol-binding proteins fractions (PBS-TSBP) from Haemonchus contortus (H. contortus) adult worms, this study analyzed the degree of protection and the immune responses developed against the parasite after vaccination with this antigenic complex during the time-elapsing between challenge with L3 of the parasite and the development of adult worms, evidenced by the appearance of first faecal eggs (prepatent period or prepatency). Goat kids immunized with PBS-TBSP generated an immune response during the prepatency which translates into a reduction in the number of worms, as well as a lower reduction on packed cell volume and plasma protein levels in relation to the non-vaccinated animals. As previously described in other studies carried out after the prepatent period, this protection was associated with a systemic humoral response. At the local level, a specific humoral response was also observed, together with an immune-inflammatory infiltrate in the gastric mucosa of MCH-II + cells and CD4+ lymphocytes, whose number was associated with a reduction in the number of worms and an increase in plasma proteins. A high peripheral eosinophilia was detected, but no corresponding increased infiltration of the gastric mucosa by eosinophils or globular leukocytes was observed. In agreement with previous data on the immunolocalization of the antigens used here, the results obtained contribute to the idea that these may be excretion/secretion (E/S) products necessary for parasite survival, whose inactivation during the larval and/or pre-adult stages may have contributed to immunoprotection.
Assuntos
Doenças das Cabras , Hemoncose , Haemonchus , Animais , Cabras , Imunização , Vacinação/veterinária , Eosinófilos , Fezes/parasitologia , Hemoncose/prevenção & controle , Hemoncose/veterinária , Contagem de Ovos de Parasitas/veterinária , Doenças das Cabras/parasitologiaRESUMO
The fate and presence of nanoplastics in wastewater treatment systems is a topic of increasing interest. Furthermore, challenges related to their quantification and identification have made it difficult to set up experimental conditions and compare results between studies. In this study, the effect of 100 nm polystyrene nanoplastics on activated sludge was evaluated. A concentration of 2 µg/L was used to continuously feed a sequencing batch reactor (SBR-NPs). Under the experimental conditions used in this study, no changes were observed in the process performance of the SBR-NPs compared to the reactor used as a control. Neither nitrification nor organic matter removal efficiency, which was 96% for both SBRs, were affected by the presence of 100 nm polystyrene nanoplastics, which suggests that the tested nanoplastics were not sufficiently toxic to the biomass. Although no significant differences in the relative abundances of predominant phyla between SBR-Control and SBR-NPs were observed, a slight shift in the relative abundance of Patescibacteria (1.5 ± 0.6% and 3.7 ± 0.8% in SBR-Control and SBR-NPs, respectively, at the end of the test) occurred. The higher abundance of this phylum in SBR-NPs compared to SBR-Control may suggest that these bacteria have some sensitivity to the presence of 100 nm polystyrene nanoplastics. Furthermore, even with the absence of nitrification inhibition, it was observed stagnation of the growth of Nitrotoga bacteria in SBR-NPs, which also suggests that the polystyrene nanoplastics could have an inhibitory effect on these cells and an impact on nitrification in the long term.
Assuntos
Esgotos , Eliminação de Resíduos Líquidos , Eliminação de Resíduos Líquidos/métodos , Microplásticos , Poliestirenos , Biomassa , Reatores Biológicos , Bactérias , NitrogênioRESUMO
In this placebo-controlled phase II randomized clinical trial, 103 human immunodeficiency virus type 1 (HIV-1)-infected patients under cART (combined antiretroviral treatment) were randomized 2:1 to receive either 3 doses of DNA GTU-MultiHIV B (coding for Rev, Nef, Tat, Gag, and gp160) at week 0 (W0), W4, and W12, followed by 2 doses of LIPO-5 vaccine containing long peptides from Gag, Pol, and Nef at W20 and W24, or placebo. Analytical treatment interruption (ATI) was performed between W36 to W48. At W28, vaccinees experienced an increase in functional CD4+ T-cell responses (P < 0.001 for each cytokine compared to W0) measured, predominantly against Gag and Pol/Env, and an increase in HIV-specific CD8+ T cells producing interleukin 2 (IL-2) and tumor necrosis factor alpha (TNF-α) (P = 0.001 and 0.013, respectively), predominantly against Pol/Env and Nef. However, analysis of T-cell subsets by mass cytometry in a subpopulation showed an increase in the W28/W0 ratio for memory CD8+ T cells coexpressing exhaustion and senescence markers such as PD-1/TIGIT (P = 0.004) and CD27/CD57 (P = 0.044) in vaccinees compared to the placebo group. During ATI, all patients experienced viral rebound, with the maximum observed HIV RNA level at W42 (median, 4.63 log10 copies [cp]/ml; interquartile range [IQR], 4.00 to 5.09), without any difference between arms. No patient resumed cART for CD4 cell count drop. Globally, the vaccine strategy was safe. However, a secondary HIV transmission during ATI was observed. These data show that the prime-boost combination of DNA and LIPO-5 vaccines elicited broad and polyfunctional T cells. The contrast between the quality of immune responses and the lack of potent viral control underscores the need for combined immunomodulatory strategies. (This study has been registered at ClinicalTrials.gov under registration no. NCT01492985.)IMPORTANCE In this placebo-controlled phase II randomized clinical trial, we evaluated the safety and immunogenicity of a therapeutic prime-boost vaccine strategy using a recombinant DNA vaccine (GTU-MultiHIV B clade) followed by a boost vaccination with a lipopeptide vaccine (HIV-LIPO-5) in HIV-infected patients on combined antiretroviral therapy. We show here that this prime-boost strategy is well tolerated, consistently with previous studies in HIV-1-infected individuals and healthy volunteers who received each vaccine component individually. Compared to the placebo group, vaccinees elicited strong and polyfunctional HIV-specific CD4+ and CD8+ T-cell responses. However, these immune responses presented some qualitative defects and were not able to control viremia following antiretroviral treatment interruption, as no difference in HIV viral rebound was observed in the vaccine and placebo groups. Several lessons were learned from these results, pointing out the urgent need to combine vaccine strategies with other immune-based interventions.
Assuntos
Vacinas contra a AIDS , Antirretrovirais/uso terapêutico , Infecções por HIV/terapia , Vacinas de DNA , Vacinas contra a AIDS/administração & dosagem , Vacinas contra a AIDS/imunologia , Adulto , Linfócitos T CD4-Positivos/citologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/citologia , Linfócitos T CD8-Positivos/imunologia , Feminino , Infecções por HIV/imunologia , HIV-1/efeitos dos fármacos , Humanos , Imunização Secundária , Masculino , Pessoa de Meia-Idade , Vacinas de DNA/administração & dosagem , Vacinas de DNA/imunologiaRESUMO
Climate change and the accumulation of surface fuel are leading to global changes in the occurrence of increasingly severe fires. In light of current budgetary constraints, prescribed fire can be a very cost-efficient tool for both reducing wildfire hazards and managing fire-prone landscapes. However, despite its widespread use in some countries, social and administrative constraints arise when applied at the European or larger scales. Science-based knowledge concerning fire behavior, fuel load reduction, and tree impacts is required to support the use of prescribed fire. Spatial ignition patterns can increase or decrease the spread rate, flame length, and flame residence time according to the objectives of a prescribed fire. This work aims to analyze fire behavior using different fire ignition patterns (strip-heading fire, flanking fire, and spot-heading fire) and meteorological and fuel conditions. Seventy-seven observations or sampling units using twenty-three prescribed fires were established for fire monitoring. Non-linear models based on environmental variables were fitted for the spread rate and flame length. Our study proposes a novel way of sharing scientific knowledge in relation to the most common distances between ignition lines and ignition points used in the southern Iberian Peninsula. The spread rate and flame length can be increased in strip-heading fire, by more than 3.5-fold and more than 1.95-fold, respectively, by modifying only the distance between ignition lines. Flanking fire could lead to a decrease in the spread rate by approximately half. Although spot-heading fire can reduce the spread rate by more than 78% and flame length by more than 41%, the highest distances between points could increase the flame residence time by 39-132%. This research seeks to achieve a trade-off between fire intensity and the impacts of fire on trees, soil, and surface roots.
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Incêndios , Pinus , Incêndios Florestais , Florestas , ÁrvoresRESUMO
BACKGROUND: Non-surgical artificial insemination techniques for sheep may benefit from larger numbers of sperm in the insemination dose because the ewe cervix is convoluted and often cannot be traversed with an insemination gun resulting in deposition of the sperm at the os cervix. OBJECTIVE: To compare a range of sperm concentrations when cryopreserving semen from Santa Ines rams and determine the effects of this on post-thaw quality. MATERIALS AND METHODS: One ejaculate from each ram (n = 10) was diluted to four sperm concentrations to obtain the following groups: G-400, G-800, G-1200, and G-1600 x 106 sperm/mL. The semen samples were packaged in 0.25 mL straws, cooled to 5 degree C, cryopreserved in liquid nitrogen vapor, thawed in a water bath (40 degree C per 20 s), and were analyzed for computerized kinetics, capacitation and acrosome integrity, and plasma membrane integrity of sperm. RESULTS: The G-400 treatment resulted in samples with the highest linearity and progressive motion (P < 0.05) and had significantly greater plasma membrane integrity, and lower capacitation and acrosome reaction rates compared to G-1600 (P < 0.05). Overall, use of the G-400 treatment resulted in better kinetics, less plasma membrane damage and less early capacitation. However, despite reducing the ejaculate yield and increasing the costs of the semen freezing process, the G-800 and G-1200 treatments make a greater absolute number of sperm with good kinetics, plasma membrane integrity and capacitation status available. CONCLUSION: Ram sperm concentration impacts cryopreservation, and higher concentrations may be advantageous if a single artificial insemination protocol is desirable. doi.org/10.54680/fr22610110812.
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Criopreservação , Preservação do Sêmen , Feminino , Masculino , Ovinos , Animais , Criopreservação/veterinária , Criopreservação/métodos , Sêmen , Preservação do Sêmen/veterinária , Preservação do Sêmen/métodos , Motilidade dos Espermatozoides , Espermatozoides , Carneiro DomésticoRESUMO
Hydrochlorothiazide and other thiazide diuretics have been used for decades to treat high blood pressure, heart failure, and chronic kidney disease. Thiazides have been linked to photosensitivity with heterogeneous clinical manifestations and recovery times. Diagnosis can be aided by phototesting, photopatch testing, and skin biopsy. Long-term use of hydrochlorothiazide has been linked to an increased dose-dependent risk of certain types of skin cancer in recent years. In this review, we also look at other less common or lesser-known adverse effects of thiazide diuretics that have been described in isolated reports.
Assuntos
Hipertensão , Tiazidas , Anti-Hipertensivos/uso terapêutico , Dermatologistas , Humanos , Hidroclorotiazida/efeitos adversos , Hipertensão/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Tiazidas/efeitos adversosRESUMO
Eimeria ninakohlyakimovae represents a highly pathogenic coccidian parasite causing severe haemorrhagic typhlocolitis in goat kids worldwide. NETosis was recently described as an efficient defense mechanism of polymorphonuclear neutrophils (PMN) acting against different parasites in vitro and in vivo. In vitro interactions of caprine PMN with parasitic stages of E. ninakohlyakimovae (i. e. oocysts and sporozoites) as well as soluble oocyst antigens (SOA) were analyzed at different ratios, concentrations and time spans. Extracellular DNA staining was used to illustrate classical molecules induced during caprine NETosis [i. e. histones (H3) and neutrophil elastase (NE)] via antibody-based immunofluorescence analyses. Functional inhibitor treatments with DPI and DNase I were applied to unveil role of NADPH oxidase (NOX) and characterize DNA-backbone composition of E. ninakohlyakimovae-triggered caprine NETosis. Scanning electron microscopy (SEM)- and immunofluorescence-analyses demonstrated that caprine PMN underwent NETosis upon contact with sporozoites and oocysts of E. ninakohlyakimovae, ensnaring filaments which firmly entrapped parasites. Detailed co-localization studies of E. ninakohlyakimovae-induced caprine NETosis revealed presence of PMN-derived DNA being adorned with nuclear H3 and NE corroborating molecular characteristics of NETosis. E. ninakohlyakoimovae-induced caprine NETosis was found to be NOX-independent since DPI inhibition led to a slight decrease of NETosis. Exposure of caprine PMN to vital E. ninakohlyakimovae sporozoites as well as SOA resulted in up-regulation of IL-12, TNF-α, IL-6, CCL2 and iNOS gene transcription in stimulated PMN. Since vital E. ninakohlyakimovae-sporozoites induced caprine NETosis, this effective entrapment mechanism might reduce initial sporozoite epithelial host cell invasion during goat coccidiosis ultimately resulting in less macromeront formation and reduced merozoites I production.
Assuntos
Coccidiose/veterinária , Citocinas/genética , Eimeria/imunologia , Doenças das Cabras/parasitologia , Neutrófilos/parasitologia , Análise de Variância , Animais , Quimiocina CCL2/genética , Quimiocina CCL2/metabolismo , Coccidiose/imunologia , Coccidiose/parasitologia , Colite/parasitologia , Colite/veterinária , Citocinas/metabolismo , Eimeria/genética , Eimeria/ultraestrutura , Hemorragia Gastrointestinal/parasitologia , Hemorragia Gastrointestinal/veterinária , Doenças das Cabras/imunologia , Cabras , Interleucina-12/genética , Interleucina-12/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Microscopia Eletrônica de Varredura/veterinária , NADPH Oxidases/metabolismo , Neutrófilos/imunologia , Neutrófilos/ultraestrutura , Óxido Nítrico Sintase Tipo II/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Oocistos/genética , Oocistos/imunologia , Reação em Cadeia da Polimerase/veterinária , Esporozoítos/genética , Esporozoítos/imunologia , Transcrição Gênica , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo , Tiflite/parasitologia , Tiflite/veterinária , Regulação para CimaRESUMO
The world's oceans are one of the most valuable sources of biodiversity and resources on the planet, although there are areas where the marine ecosystem is threatened by human activities. Marine protected areas (MPAs) are distinctive spaces protected by law due to their unique characteristics, such as being the habitat of endangered marine species. Even with this protection, there are still illegal activities such as poaching or anchoring that threaten the survival of different marine species. In this context, we propose an autonomous surface vehicle (ASV) model system for the surveillance of marine areas by detecting and recognizing vessels through artificial intelligence (AI)-based image recognition services, in search of those carrying out illegal activities. Cloud and edge AI computing technologies were used for computer vision. These technologies have proven to be accurate and reliable in detecting shapes and objects for which they have been trained. Azure edge and cloud vision services offer the best option in terms of accuracy for this task. Due to the lack of 4G and 5G coverage in offshore marine environments, it is necessary to use radio links with a coastal base station to ensure communications, which may result in a high response time due to the high latency involved. The analysis of on-board images may not be sufficiently accurate; therefore, we proposed a smart algorithm for autonomy optimization by selecting the proper AI technology according to the current scenario (SAAO) capable of selecting the best AI source for the current scenario in real time, according to the required recognition accuracy or low latency. The SAAO optimizes the execution, efficiency, risk reduction, and results of each stage of the surveillance mission, taking appropriate decisions by selecting either cloud or edge vision models without human intervention.
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Ecossistema , Robótica , Inteligência Artificial , Biodiversidade , Conservação dos Recursos Naturais , Humanos , Oceanos e MaresRESUMO
BACKGROUND: The European AIDS Clinical Society (EACS) Guidelines cover key aspects of HIV management with major updates every two years. GUIDELINE HIGHLIGHTS: The 2019 Guidelines were extended with a new section focusing on drug-drug interactions and other prescribing issues in people living with HIV (PLWH). The recommendations for treatment-naïve PLWH were updated with four preferred regimens favouring unboosted integrase inhibitors. A two-drug regimen with dolutegravir and lamivudine, and a three-drug regimen including doravirine were also added to the recommended initial regimens. Lower thresholds for hypertension were expanded to all PLWH and for cardiovascular disease prevention, the 10-year predicted risk threshold for consideration of antiretroviral therapy (ART) modification was lowered from 20% to 10%. Frailty and obesity were added as new topics. It was specified to use urine albumin to creatinine ratio to screen for glomerular disease and urine protein to creatinine ratio for tubular diseases, and thresholds were streamlined with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations. Hepatitis C virus (HCV) treatment recommendations were split into preferred and alternative treatment options. The algorithm for management of recently acquired HCV infection was updated and includes recommendations for early chronic infection management. Treatment of resistant tuberculosis (TB) was streamlined with the World Health Organization (WHO) recommendations, and new tables on immune reconstitution inflammatory syndrome, on when to start ART in the presence of opportunistic infections and on TB drug dosing were included. CONCLUSIONS: The EACS Guidelines underwent major revisions of all sections in 2019. They are available in four different formats including a new interactive web-based version and are translated into Chinese, French, German, Japanese, Portuguese, Russian and Spanish.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , Fatores Etários , Comorbidade , Interações Medicamentosas , Quimioterapia Combinada , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Humanos , Lamivudina/uso terapêutico , Oxazinas/uso terapêutico , Piperazinas/uso terapêutico , Piridonas/uso terapêutico , Resultado do Tratamento , Triazóis/uso terapêuticoRESUMO
BACKGROUND: Intraoperative findings during gastroschisis surgery are the main predictor associated with increased mortality. The aim of our study was to determine the type of surgical findings associated with inpatient mortality in a cohort of patients with gastroschisis from a university hospital in Western Mexico. MATERIALS AND METHODS: Infants with surgically repaired gastroschisis during the period 2011-2017 at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, Mexico) were studied. Data regarding demographics, perinatal history, and intraoperative findings were collected and compared according to whether they were nonsurvivors (cases) or survivors (controls) at hospital discharge. Data were analyzed using logistic regression, determining its adjusted odds ratio (aOR) and its respective 95% confidence intervals (95% CIs). The proper adjustment of the model was verified using the Hosmer and Lemeshow test. RESULTS: Ninety-four patients with gastroschisis were studied, of which 13 were nonsurvivors (13.8%), and 81 (86.2%) were survivors at hospital discharge. In the group of survivors, primary surgical closure was performed more frequently (P = 0.018), whereas staged reduction with a silo predominated in the group of nonsurvivors (P = 0.018), and an increased frequency of complex gastroschisis (0.0001). After logistic regression analysis, intraoperative findings associated with nonsurvival were severe bowel matting (aOR: 7.3; 95% CI: 1.2-44), and prolapse of the small intestine and large intestine, plus any other organ (aOR: 15.9; 95% CI: 1.1-219.6). CONCLUSIONS: Mortality in our cohort was high (13.8%) and was significantly associated with severe bowel matting, and the prolapse of the small and large intestines, plus any other organ.
Assuntos
Gastrosquise/mortalidade , Gastrosquise/cirurgia , Pacientes Internados/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Gastrosquise/patologia , Hospitais Universitários , Humanos , Recém-Nascido , Enteropatias/patologia , Intestinos/patologia , Período Intraoperatório , México , Razão de Chances , Gravidez , Prolapso , Resultado do Tratamento , Técnicas de Fechamento de FerimentosRESUMO
The ANRS-PREVENIR (2017-2020) prospective cohort study aims to reduce the number of new HIV infections in the "Ile-de-France" region in France, by enrolling individuals at high risk of HIV infection and proposing daily and on-demand pre-exposure prophylaxis (PrEP). The qualitative component of the ANRS-PREVENIR study aimed to investigate social and relational evolutions associated with PrEP use in men who have sex with men (MSM). In 2018, 12 focus groups with MSM (n = 68) were conducted by a social sciences researcher in Paris. A thematic analysis was performed. Results showed that stigma concerning PrEP use is a complex issue, with various kinds of stigmatization being practiced, sometimes even by the wider MSM population and PrEP users themselves. All types of stigma identified were expressed in forms of verbal abuse which made PrEP use taboo. Inside the wider MSM population a PrEP-user "community" was identified which shared a certain complicity in terms of values and a positive attitude towards PrEP. The emergence of new intragroup and intergroup social norms should be taken into account by policy makers to promote a more positive image of PrEP users.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição , Estigma Social , Estereotipagem , Adulto , Fármacos Anti-HIV/uso terapêutico , Grupos Focais , França , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Pesquisa Qualitativa , Assunção de Riscos , Sexo Seguro , Comportamento Sexual , Parceiros Sexuais , Normas SociaisRESUMO
BACKGROUND: Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS: We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS: A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS: Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.
Assuntos
Bacteriemia/microbiologia , Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Hemocultura/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bactérias Aeróbias/patogenicidade , Bactérias Anaeróbias/patogenicidade , Hemocultura/métodos , Queimaduras/complicações , Queimaduras/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/microbiologia , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
OBJECTIVE: To use Internet search data to compare duration of compliance for various diets. DESIGN: Using a passive surveillance digital epidemiological approach, we estimated the average duration of diet compliance by examining monthly Internet searches for recipes related to popular diets. We fit a mathematical model to these data to estimate the time spent on a diet by new January dieters (NJD) and to estimate the percentage of dieters dropping out during the American winter holiday season between Thanksgiving and the end of December. SETTING: Internet searches in the USA for recipes related to popular diets over a 15-year period from 2004 to 2019. PARTICIPANTS: Individuals in the USA performing Internet searches for recipes related to popular diets. RESULTS: All diets exhibited significant seasonality in recipe-related Internet searches, with sharp spikes every January followed by a decline in the number of searches and a further decline in the winter holiday season. The Paleo diet had the longest average compliance times among NJD (5.32 ± 0.68 weeks) and the lowest dropout during the winter holiday season (only 14 ± 3 % dropping out in December). The South Beach diet had the shortest compliance time among NJD (3.12 ± 0.64 weeks) and the highest dropout during the holiday season (33 ± 7 % dropping out in December). CONCLUSIONS: The current study is the first of its kind to use passive surveillance data to compare the duration of adherence with different diets and underscores the potential usefulness of digital epidemiological approaches to understanding health behaviours.
Assuntos
Dieta Redutora/estatística & dados numéricos , Obesidade/dietoterapia , Dieta Rica em Proteínas e Pobre em Carboidratos/estatística & dados numéricos , Dieta Paleolítica/estatística & dados numéricos , Monitoramento Epidemiológico , Férias e Feriados , Humanos , Internet , Modelos Teóricos , Estações do Ano , Fatores de Tempo , Estados Unidos/epidemiologia , Redução de PesoRESUMO
BACKGROUND: Exposure to pets can be a predisposing factor in the development of certain diseases, including allergic diseases. OBJECTIVE: We analyzed the role that exposure to indoor dogs and cats plays in the prevalence of allergic diseases. METHODS: We examined the cross-sectional data of 1056 women and 936 men aged 15 to 18 years; these individuals were selected through stratified and cluster random sampling. We asked all participants about their exposure to indoor dogs and cats during the year that preceded our study. The prevalence of allergic diseases was determined through core questions taken from The International Study of Asthma and Allergies in Childhood questionnaire. RESULTS: The prevalence was 12.7% (95% CI: 11.3%-14.2%) for asthma, 9.0% (95% CI: 7.8%-10.4%) for allergic rhinitis, and 5.2% (95% CI: 4.3%-6.2%) for atopic dermatitis. The multivariate analyses showed that exposure to indoor dogs, but not indoor cats, was associated with asthma prevalence (aOR 1.37; 95% CI: 1.03-1.83), as was male sex (aOR=1.42; 95% CI: 1.08-1.86), a personal history of allergic rhinitis (aOR=3.24; 95% CI: 2.25-4.66), and a maternal history of asthma (aOR=3.06; 95% CI: 1.89-4.98). The population attributable risk for exposure to indoor dogs was 18%. Notably, neither allergic rhinitis nor atopic dermatitis was found to be associated with dog or cat exposure (p> 0.05). CONCLUSION: Exposure to dogs in late adolescence is a factor associated with asthma, although its contribution to the development of asthma should be investigated in new studies.