Effects of exercise training on bone health in adults living with HIV: a systematic review with meta-analysis.

We investigated the effects of exercise training on bone mineral density (BMD) in people living with Human Immunodeficiency Virus (PLHIV). Pubmed, Scopus, Cochrane Library, and ScienceDirect databases were searched for trials investigating exercise training-induced changes in BMD of PLHIV at baseline vs. post-intervention assessed by dual-energy X-ray absorptiometry (DXA). Hedge effect sizes (ES) were calculated incorporating fixed effects for BMD variation assumptions. Disaggregated comparisons were performed for trials with more than one intervention or BMD site assessment. Seven trials included 210 PLHIV and 35 non-HIV-infected controls. Methodological quality evaluated using the Physiotherapy Evidence Database (PEDro) scale ranged from poor to moderate. Interventions applied isolated resistance, combined aerobic and resistance, and multimodal exercise protocols performed 3 d/wk for 12-to 104 week. One controlled and another uncontrolled trial presented significant effects, reporting improvements at the femoral neck and total (ES 2.14 and 0.49, respectively). Magnitude of those specific ES influenced the overall effect (controlled and uncontrolled trials), which was small but significant (k = 12, ES 0.277, 95% confidence interval 0.120-0.434). Resistance training may promote favorable adaptations in BMD of PLHIV, particularly in femur. Future research should elucidate the optimal dose-response relationship and physiological mechanisms underlying exercise-induced adaptations on the BMD of PLHIV.

Rhodotorula mucilaginosa YR29 is able to accumulate Pb2+ in vacuoles: a yeast with bioremediation potential.

Microorganisms showed unique mechanisms to resist and detoxify harmful metals in response to pollution. This study shows the relationship between presence of heavy metals and plant growth regulator compounds. Additionally, the responses of Rhodotorula mucilaginosa YR29 isolated from the rhizosphere of Prosopis sp. growing in a polluted mine jal in Mexico are presented. This research carries out a phenotypic characterization of R. mucilaginosa to identify response mechanisms to metals and confirm its potential as a bioremediation agent. Firstly, Plant Growth-Promoting (PGP) compounds were assayed using the Chrome Azurol S (CAS) medium and the Salkowski method. In addition, to clarify its heavy metal tolerance mechanisms, several techniques were performed, such as optical microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) supplemented with assorted detectors. Scanning transmission electron microscopy (STEM) was used for elementary mapping of the cell. Finally, yeast viability after all treatments was confirmed by confocal laser scanning microscopy (CLSM). The results have suggested that R. mucilaginosa could be a PGP yeast capable of triggering Pb2+ biosorption (representing 22.93% of the total cell surface area, the heavy metal is encapsulated between the cell wall and the microcapsule), and Pb2+ bioaccumulation (representing 11% of the total weight located in the vacuole). Based on these results, R. mucilaginosa as a bioremediation agent and its wide range of useful mechanisms for ecological purposes are highlighted.

Isolation and characterization of yeasts associated with plants growing in heavy-metal- and arsenic-contaminated soils.

Yeasts were quantified and isolated from the rhizospheres of 5 plant species grown at 2 sites of a Mexican region contaminated with arsenic, lead, and other heavy metals. Yeast abundance was about 10(2) CFU/g of soil and 31 isolates were obtained. On the basis of the phylogenetic analysis of 26S rRNA and internal transcribed spacer fragment, 6 species were identified within the following 5 genera: Cryptococcus (80.64%), Rhodotorula (6.45%), Exophiala (6.45%), Trichosporon (3.22%), and Cystobasidium (3.22%). Cryptococcus spp. was the predominant group. Pectinases (51.6%), proteases (51.6%), and xylanases (41.9%) were the enzymes most common, while poor production of siderophores (16.1%) and indole acetic acid (9.67%) was detected. Isolates of Rhodotorula mucilaginosa and Cystobasidium sloffiae could promote plant growth and seed germination in a bioassay using Brassica juncea. Resistance of isolates by arsenic and heavy metals was as follows: As(3+) ≥ 100 mmol/L, As(5+) ≥ 30 mmol/L, Zn(2+) ≥ 2 mmol/L, Pb(2+) ≥ 1.2 mmol/L, and Cu(2+) ≥ 0.5 mmol/L. Strains of Cryptococcus albidus were able to reduce arsenate (As(5+)) into arsenite (As(3+)), but no isolate was capable of oxidizing As(3+). This is the first study on the abundance and identification of rhizosphere yeasts in a heavy-metal- and arsenic-contaminated soil, and of the reduction of arsenate by the species C. albidus.

Complete genome sequence of the Bacillus paralicheniformis strain HAS-1.

We present the complete genome of the halotolerant strain Bacillus paralicheniformis HAS-1.

Apalutamide-Induced Toxic Epidermal Necrolysis in a Caucasian Patient with Metastatic Castration-Sensitive Prostate Cancer: A Case Report and Review of the Literature.

Apalutamide is a novel nonsteroidal androgen receptor inhibitor that has been shown to improve outcomes for patients with nonmetastatic castration-resistant prostate cancer and metastatic castration-sensitive prostate cancer when combined with androgen deprivation therapy. Apalutamide-induced skin rash occurred commonly in clinical trials, with 23.8-27.1% of patients experiencing a rash of any grade, and 5.2-6.3% experiencing a rash of grade three or higher. There were no cases of severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) reported in clinical trials; however, there are rare cases reported in the literature with the majority occurring in Asian patients. An 83-year-old Caucasian male was commenced on apalutamide, combined with degarelix, for the management of metastatic castration-sensitive prostate cancer. During week five of apalutamide treatment, the patient developed a widespread erythematous maculopapular rash. On presentation, the rash affected 80% of his body surface area (BSA) and a diagnosis of a severe cutaneous drug eruption was made. He was commenced on methylprednisolone (MP) therapy. Despite 5 days of MP, the rash continued to deteriorate involving 95% of his BSA. Nikolsky's sign was positive. A diagnosis of overlap SJS/TEN was made, supported by skin biopsy. His SCORTEN score was three. He was then commenced on intravenous immunoglobulin and transferred to the intensive care unit. Over the coming days, the rash began to stabilise, and his steroid dose was weaned. He was discharged from hospital 38 days after rash onset. We report the first suggested case of apalutamide-induced SJS/TEN in a Caucasian patient. We discuss other cases of apalutamide-induced SCARs reported in the literature. Risk factors seem to include low body weight and Japanese race, as well as short time to onset of rash.

Assembled mixed co-cultures for emerging pollutant removal using native microorganisms from sewage sludge.

The global pharmaceutical pollution caused by drug consumption (>100,000 tonnes) and its disposal into the environment is an issue which is currently being addressed by bioremediation techniques, using single or multiple microorganisms. Nevertheless, the low efficiency and the selection of non-compatible species interfere with the success of this methodology. This paper proposes a novel way of obtaining an effective multi-domain co-culture, with the capacity to degrade multi-pharmaceutical compounds simultaneously. To this end, seven microorganisms (fungi and bacteria) previously isolated from sewage sludge were investigated to enhance their degradation performance. All seven strains were factorially mixed and used to assemble different artificial co-cultures. Consequently, 127 artificial co-cultures were established and ranked, based on their fitness performance, by using the BSocial analysis web tool. The individual strains were categorized according to their social behaviour, whose net effect over the remaining strains was defined as 'Positive', 'Negative' or 'Neutral'. To evaluate the emerging-pollutant degradation rate, the best 10 co-cultures, and those which contained the social strains were then challenged with three different Pharmaceutical Active compounds (PhACs): diclofenac, carbamazepine and ketoprofen. The co-cultures with the fungi Penicillium oxalicum XD-3.1 and Penicillium rastrickii were able to degrade PhACs. However, the highest performance (>80% degradation) was obtained by the minimal active microbial consortia consisting of both Penicillium spp., Cladosporium cladosporoides and co-existing bacteria. These consortia transformed the PhACs to derivate molecules through hydroxylation and were released to the media, resulting in a low ecotoxicity effect. High-throughput screening of co-cultures provides a quick, reliable and efficient method to narrow down suitable degradation co-cultures for emerging PhAC contaminants while avoiding toxic metabolic derivatives.

High-Throughput Microbial Community Analyses to Establish a Natural Fungal and Bacterial Consortium from Sewage Sludge Enriched with Three Pharmaceutical Compounds.

Emerging and unregulated contaminants end up in soils via stabilized/composted sewage sludges, paired with possible risks associated with the development of microbial resistance to antimicrobial agents or an imbalance in the microbial communities. An enrichment experiment was performed, fortifying the sewage sludge with carbamazepine, ketoprofen and diclofenac as model compounds, with the aim to obtain strains with the capability to transform these pollutants. Culturable microorganisms were obtained at the end of the experiment. Among fungi, Cladosporium cladosporioides, Alternaria alternata and Penicillium raistrickii showed remarkable degradation rates. Population shifts in bacterial and fungal communities were also studied during the selective pressure using Illumina MiSeq. These analyses showed a predominance of Ascomycota (Dothideomycetes and Aspergillaceae) and Actinobacteria and Proteobacteria, suggesting the possibility of selecting native microorganisms to carry out bioremediation processes using tailored techniques.

The effects of exercise training on autonomic and hemodynamic responses to muscle metaboreflex in people living with HIV/AIDS: A randomized clinical trial protocol.

BACKGROUND: People living with HIV (PLHIV) present impaired muscle metaboreflex, which may lead to exercise intolerance and increased cardiovascular risk. The muscle metaboreflex adaptations to exercise training in these patients are unknown. The present study aims to investigate the effects of a supervised multimodal exercise training on hemodynamic and autonomic responses to muscle metaboreflex activation in PLHIV. METHODS AND DESIGN: In this randomized clinical trial protocol, 42 PLHIV aged 30-50 years will be randomly assigned at a ratio of 1:1 into an intervention or a control group. The intervention group will perform exercise training (3x/week during 12 weeks) and the control group will remain physically inactive. A reference group composed of 21 HIV-uninfected individuals will be included. Primary outcomes will be blood pressure and heart rate variability indices assessed during resting, mental stress, and activation of muscle metaboreflex by a digital sphygmomanometer and a heart rate monitor; respectively. Mental stress will be induced by the Stroop Color-Word test and muscle metaboreflex will be activated through a post-exercise circulatory arrest (PECA) protocol, being the latter performed without and with the application of a capsaicin-based analgesic balm in the exercised limb. Secondary outcomes will be heart rate, peripheral vascular resistance, stroke volume, cardiac output, blood lactate, anthropometric markers and handgrip maximal voluntary contraction. The intervention and control groups of PLHIV will be evaluated at baseline and after the intervention, while the HIV-uninfected reference group only at baseline. DISCUSSION: The findings of the present study may help to elucidate the muscle metaboreflex adaptations to exercise training in PLHIV. TRIAL REGISTRATION: This study will be performed at University of Rio de Janeiro State following registration at ClinicalTrials.gov as NCT04512456 on August 13, 2020.

Effects of exercise training on bone mineral density in adults living with HIV: a retrospective study.

Background: Evidence on the effects of exercise training on the bone health of men and women living with HIV (MLHIV and WLHIV) is limited.Objective: To investigate the effects of a long-term multimodal exercise program on the bone mineral density (BMD) of MLHIV and WLHIV.Methods: A retrospective cohort of 39 patients (13 women; 48.4 ± 7.6 y; HIV-infection for 15.5 ± 6.5 y; combined antiretroviral therapy for 12.2 ± 7.0 y) performed a multimodal exercise program (60-min sessions of aerobic, resistance, and flexibility exercises performed 3 times/week for 9-106 months). MLHIV and WLHIV were allocated into groups showing either advanced osteopenia/osteoporosis or normal BMD (+ or -).Results: MLHIV+ increased BMD at the femoral neck, total femur, and lumbar spine (∼3-4%) compared to MLHIV- (p ≤ 0.03). Changes in whole-body BMD were similar between MLHIV groups (p = 0.55). WLHIV+ exhibited higher loss of BMD at the femoral neck (∼6%) than WLHIV- (p = 0.04), whereas reductions in the whole-body, total femur, and lumbar spine (∼3-5%) were similar between groups (p ≥ 0.25). Among men, changes in femoral neck BMD were inversely correlated to femoral neck T-score (r = -0.62; p < 0.001), but not to the time of follow-up, appendicular skeletal muscle mass (ASM) index, or age (p ≥ 0.08). In women, these changes were inversely correlated with time of follow-up (r = -0.58) and age (r = -0.70) and positively correlated with femoral neck T-score (r = 0.46) and ASM index (r = 0.47) (p < 0.01).Conclusion: Multimodal exercise training may improve the BMD in people living with HIV, especially men with advanced osteopenia/osteoporosis. Adjuvant therapies to exercise should be considered to counteract losses in WLHIV.

Evaluation of the Potential of Sewage Sludge Mycobiome to Degrade High Diclofenac and Bisphenol-A Concentrations.

One of the most challenging environmental threats of the last two decades is the effects of emerging pollutants (EPs) such as pharmaceutical compounds or industrial additives. Diclofenac and bisphenol A have regularly been found in wastewater treatment plants, and in soils and water bodies because of their extensive usage and their recalcitrant nature. Due to the fact of this adversity, fungal communities play an important role in being able to safely degrade EPs. In this work, we obtained a sewage sludge sample to study both the culturable and non-culturable microorganisms through DNA extraction and massive sequencing using Illumina MiSeq techniques, with the goal of finding degraders adapted to polluted environments. Afterward, degradation experiments on diclofenac and bisphenol A were performed with the best fungal degraders. The analysis of bacterial diversity showed that Dethiosulfovibrionaceae, Comamonadaceae, and Isosphaeraceae were the most abundant families. A predominance of Ascomycota fungi in the culturable and non-culturable population was also detected. Species such as Talaromyces gossypii, Syncephalastrum monosporum, Aspergillus tabacinus, and Talaromyces verruculosus had remarkable degradation rates, up to 80% of diclofenac and bisphenol A was fully degraded. These results highlight the importance of characterizing autochthonous microorganisms and the possibility of selecting native fungal microorganisms to develop tailored biotransformation technologies for EPs.

Muscle mass, strength, bone mineral density and vascular function in middle-aged people living with HIV vs. age-matched and older controls.

INTRODUCTION: Combination antiretroviral therapy (cART) substantially extended the life of people living with HIV (PLHIV). However, prolonged HIV infection and cART increase the risk of comorbidities accelerating age-related muscle, bone, and vascular disorders. This cross-sectional study compared muscle mass and strength, bone mineral density (BMD), and vascular function in middle-aged PLHIV treated with cART vs. non-infected age-matched and older controls. METHODS: After careful screening for secondary diseases and medications, body composition, muscular and vascular function were assessed in 12 PLHIV (43.9±8.7 yrs old; HIV-infection for 16.2±8.6 yrs; on cART for 11.6±9.2 yrs), 12 age-matched (CONT, 43.2±8.5 yrs old), and 12 older (OLDER, 74.4±8.3 yrs old) controls through dual x-ray absorptiometry, isokinetic dynamometry, and venous occlusion plethysmography, respectively. RESULTS: PLHIV and CONT showed similar relative muscle mass (65.3±8.0 vs. 66.9±7.3%, respectively; P= 0.88) and strength (160.7±53.9 vs. 152.0±52.9 N.m-1, respectively; P= 0.90), which were greater than OLDER (80.6±18.8 N.m-1; P= 0.001). Total BMD was similar in PLHIV (1.04±0.13 g.cm-2) and OLDER (1.00±0.15 g.cm-2, P= 0.86), and both groups presented lower values than CONT (1.20±0.13 g.cm-2, P< 0.01). No significant difference across groups was detected for macrovascular reactivity (P= 0.32). CONCLUSION: Age-related osteopenia might be accelerated in middle-aged PLHIV on prolonged cART, as their BMD approached values found in older adults. On the other hand, muscle mass, isokinetic strength, and vasodilation capacity were similar in PLHIV and age-matched uninfected controls.

Pediatric Oncology Palliative Care Programs in Central America: Pathways to Success.

Palliative care offers children who have life-limiting and life-threatening oncologic illnesses and their families improved quality of life. In some instances, impeccable symptom control can lead to improved survival. Cultural and financial barriers to palliative care in oncology patients occur in all countries, and those located in Central America are no exception. In this article, we summarize how the programs participating in the Asociación de Hemato-Oncólogos Pediatras de Centro America (AHOPCA) have developed dedicated oncology palliative care programs. The experience in Guatemala, El Salvador, Costa Rica, Panama, Dominican Republic and Haiti is detailed, with a focus on history, the barriers that have impeded progress, and achievements. Future directions, which, of course, may be impacted by the COVID-19 pandemic, are described as well.

Tracking gene expression, metabolic profiles, and biochemical analysis in the halotolerant basidiomycetous yeast Rhodotorula mucilaginosa EXF-1630 during benzo[a]pyrene and phenanthrene biodegradation under hypersaline conditions.

Polyaromatic phenanthrene (Phe) and benzo[a]pyrene (BaP) are highly toxic, mutagenic, and carcinogenic contaminants widely dispersed in nature, including saline environments. Polyextremotolerant Rhodotorula mucilaginosa EXF-1630, isolated from Arctic sea ice, was grown on a huge concentration range -10 to 500 ppm- of Phe and BaP as sole carbon sources at hypersaline conditions (1 M NaCl). Selected polycyclic aromatic hydrocarbons (PAHs) supported growth as well as glucose, even at high PAH concentrations. Initially, up to 40% of Phe and BaP were adsorbed, followed by biodegradation, resulting in 80% removal in 10 days. While extracellular laccase, peroxidase, and un-specific peroxygenase activities were not detected, NADPH-cytochrome c reductase activity peaked at 4 days. The successful removal of PAHs and the absence of toxic metabolites were confirmed by toxicological tests on moss Physcomitrium patens, bacterium Aliivibrio fischeri, human erythrocytes, and pulmonary epithelial cells (A549). Metabolic profiles were determined at the midpoint of the biodegradation exponential phase, with added Phe and BaP (100 ppm) and 1 M NaCl. Different hydroxylated products were found in the culture medium, while the conjugative metabolite 1-phenanthryl-ß-D-glucopyranose was detected in the medium and in the cells. Transcriptome analysis resulted in 870 upregulated and 2,288 downregulated transcripts on PAHs, in comparison to glucose. Genomic mining of 61 available yeast genomes showed a widespread distribution of 31 xenobiotic degradation pathways in different yeast lineages. Two distributions with similar metabolic capacities included black yeasts and mainly members of the Sporidiobolaceae family (including EXF-1630), respectively. This is the first work describing a metabolic profile and transcriptomic analysis of PAH degradation by yeast.

Factores predictivos de litiasis coledociana / Predictive factors of Choledocholithiasis

Antecedentes: Existen factores clínicos y ecográficos considerados predictivos de litiasis canalicular; su efectividad permitiría plantear el uso sistemático o selectivo de la colangiografía intraoperatoria. Objetivo: Correlacionar el incremento de los valores de laboratorio y ecográficos como factores predictivos con los hallazgos intraoperatorios y la colangiografía sistemática. Método: Descriptivo de corte transversal. Resultados: Se analizaron 147 historias clínicas (97 mujeres). 124 cumplieron con los criterios de inclusión. Se encontraron 24 pacientes con litiasis coledociana; de estos 10 presentaron aumento de todas las enzimas y del diámetro de la vía biliar principal por ecografía. En 5 pacientes no se encontró ningún factor predictivo y en los 9 restantes, se encontraron alteraciones de uno o más factores predictivos. Conclusiones: -Los distintos factores predictivos han mostrado en nuestros pacientes baja sensibilidad; ninguno de ellos aislado llega al 70 por ciento. -El estudio escográfico de la vía biliar ha mostrado una especificidad de 91 por ciento, pero baja sensibilidad para el diagnóstico de litiasis coledociana; esto podría estar relacionado con la tardanza en la cirugía a la que se vieron obligados algunos pacientes. -Ninguno de los factores predictivos (FAL, gGT, Bilirrubina, Ecografía) pueden reemplazar, el uso sistemático de la CIO.

Efectividad de higiene broncopulmonar en la resolución de atelectasia en pacientes pediátricos sometidos a ventilación mecánica / Efficiency of bronchopulmonar hygiene in the resolution of atelectasy in pediatric patients submitted to mechanical ventilation

Introducción: La utilización de la ventilación mecánica en el paciente crítico conlleva implícito riesgo de complicaciones, con el agravante de la mayor dificultad de la ventilación en el niño, tanto por las características propias de la edad pediátrica, como de los ventiladores mecánicos utilizados. Existen una series de complicaciones que son inducidas por la ventilación mecánica entre las cuales se puede mencionar: barotrauma, volutrauma, ateletrauma y biotrauma. Las atelectasias ocupan un lugar importante entre las complicaciones que ocurren en los pacientes pediátricos sometidos a ventilación mecánica. Para la resolución de la misma el personal de enfermería aplica medidas que facilitan la eliminación de las secreciones y otros detritos situados en la vía aérea artificial, mediante el uso de la higiene broncopulmonar consistente en las aplicaciones de todas aquellas medidas destinadas a mantener limpias y permeables las vías aéreas. Objetivos: evaluar la efectividad de la higiene broncopulmonar en la resolución de atelectasia en pacientes pediátricos sometidos a ventilación mecánica. Métodos: la muestra estuvo conformada por 30 pacientes (24 por ciento) en edades comprendidas desde un mes a catorce años ingresados al servicio de cuidados intensivos pediátricos del Hospital "J. M. de los Ríos" de Caracas durante los meses de junio a octubre de 2005. Los criterios de inclusión son de pacientes que presenta clínica y radiológicamente atelectasia. Resultados: en la distribución anatómica lobular de las atelectasias predominó la lobar izquierda, el tiempo de resolución en menos horas fue la global izquierda. Conclusiones: aunque la evidencia no sustenta la hipótesis inicial clínicamente es importante para el personal de salud que labora en el Servicio de Cuidados Intensivos Pediátricos en la aplicación de las técnicas de (HBP) en pacientes sometidos a ventilación mecánica.