Monitoring and evaluation of HIV screening and testing of hospitalized infants and their mothers.

SETTING: Improved HIV monitoring and evaluation (M&E) is urgently needed to help close gaps in inpatient infant provider-initiated testing and counseling (PITC) and pediatric case identification. A revised reporting system was piloted on the Breastfeeding Ward at Hospital Central de Maputo in Maputo, Mozambique. OBJECTIVE: To demonstrate how a simplified reporting system designed for pediatric inpatient ward registers can be used to easily calculate key PITC indicators, including testing coverage, HIV status, linkage to antiretroviral therapy, maternal testing, and point-of-care nucleic acid testing. DESIGN: This was a retrospective review of PITC data documented in the ward discharge register for all inpatient infants with charts closed from January 1 to June 30, 2020. RESULTS: At chart closure, 97.7% of infants (477/488) had known serostatus: 76.3% were not exposed (364/477), 15.3% were exposed (73/477), 1.9% definitively non-infected (9/477), and 6.5% infected (31/477). There was a 26.9% positivity rate (14/52) for infant point-of-care nucleic acid testing. Of all HIV-infected infants, 80.6% (25/31) were linked to antiretroviral therapy by the time of discharge. Preferred maternal testing was done in 80.5% of eligible mothers (276/343), with 3.0% newly positive (8/276). CONCLUSION: This straightforward PITC reporting system enabled simple calculation of key indicators needed for standard M&E, contributed to quality improvement efforts to increase testing coverage, and could be easily adapted for use in other settings.

CONTEXTE: Une amélioration du suivi et de l'évaluation du VIH est urgemment nécessaire afin d'aider à combler les lacunes en matière de conseil et de dépistage à l'initiative du soignant (PITC) chez l'enfant hospitalisé et d'identification des cas pédiatriques. Une nouvelle version du système de notification des cas a été testée dans l'unité dédiée à l'allaitement maternel de l'hôpital central de Maputo, Mozambique. OBJECTIF: Démontrer comment un système simplifié de notification des cas conçu pour les registres des unités hospitalières pédiatriques peut être utilisé afin de facilement calculer les indicateurs PITC clés, dont la couverture du dépistage, le statut VIH, le lien avec le traitement antirétroviral, le dépistage maternel et le test d'amplification des acides nucléiques au point de services. MÉTHODE: Il s'agissait d'une revue rétrospective des données PITC documentées dans le registre des sorties de l'unité pour tous les enfants hospitalisés dont les dossiers ont été clôturés entre le 1er janvier et le 30 juin 2020. RÉSULTATS: Au moment de la clôture de leur dossier, 97,7% des enfants (477/488) avaient un statut sérologique connu : 76,3% n'avaient pas été exposés au VIH (364/477), 15,3% avaient été exposés (73/477), 1,9% étaient définitivement non infectés (9/477) et 6,5% étaient infectés (31/477). Le taux de positivité aux tests d'amplification des acides nucléiques réalisés au point de services pédiatriques était de 26,9% (14/52). Parmi tous les enfants infectés par le VIH, 80,6% (25/31) étaient reliés à un traitement antirétroviral d'ici à leur sortie de l'hôpital. Le test préféré de dépistage maternel a été réalisé chez 80,5% des mères éligibles (276/343), dont 3,0% ont reçu un résultat positif (8/276). CONCLUSION: Ce système de notification PITC simplifié a permis de facilement calculer les indicateurs clés nécessaires à un M&E standard, tout en contribuant aux efforts d'amélioration qualitative visant à accroître la couverture du dépistage. Il pourrait aisément être adapté à une utilisation dans d'autres contextes.

Availability, characteristics, and barriers of rehabilitation programs in organ transplant populations across Canada.

Rehabilitation is receiving increasingly more attention from the medical community in the management of individuals' pre- and post-organ transplantation. A cross-sectional descriptive survey was administered to all known transplant programs across Canada to explore the availability, characteristics, and barriers of rehabilitation programs pre- and post-heart, lung, kidney, and liver transplantation. Of the 58 programs surveyed, 35 agreed to participate (nine heart, six lung, 13 kidney, seven liver), and six refused for a response rate of 71%. Twelve transplant programs that offered rehabilitation were identified (six heart, five lung, one liver). All rehabilitation programs identified included aerobic exercises, strength training, and education and involved a multidisciplinary team. The Six Minute Walk Test and the Medical Outcomes Short Form-36 questionnaire were the most commonly used outcome measures. In kidney and liver transplant programs, over 50% of respondents from these programs cited lack of funding, shortage of health care personnel, and a low volume of patients in a centralized region as barriers to providing rehabilitation programs. Rehabilitation can play an integral role in pre- and post-transplantation management, and barriers to access and provision of rehabilitation for organ transplant populations should be examined further.

Active-site variants of Streptomyces griseus protease B with peptide-ligation activity.

BACKGROUND: Peptide-ligating technologies facilitate a range of manipulations for the study of protein structure and function that are not possible using conventional genetic or mutagenic methods. To different extents, the currently available enzymatic and nonenzymatic methodologies are synthetically demanding, sequence-dependent and/or sensitive to denaturants. No single coupling method is universally applicable. Accordingly, new strategies for peptide ligation are sought. RESULTS: Site-specific variants (Ser195-->Gly, S195G, and Ser195-->Ala, S195A) of Streptomyces griseus protease B (SGPB) were generated that efficiently catalyze peptide ligation (i.e., aminolysis of ester-, thioester- and para-nitroanilide-activated peptides). The variants also showed reduced hydrolytic activity relative to the wild-type enzyme. The ratio of aminolysis to hydrolysis was greater for the S195A variant, which was also capable of catalyzing ligation in concentrations of urea as high as 2 M. CONCLUSIONS: Mutagenic substitution of the active-site serine residue of SGPB by either glycine or alanine has created a unique class of peptide-ligating catalysts that are useful for coupling relatively stable ester- and para-nitroanilide-activated substrates. Ligation proceeds through an acyl-enzyme intermediate involving His57. Serine to alanine mutations may provide a general strategy for converting proteases with chymotrypsin-like protein folds into peptide-coupling enzymes.

Calcification of the human thoracic aorta during aging.

The rate of calcification within the human thoracic aorta from completion of body growth to advanced old age was examined. Fifty-eight aortae, obtained at necropsy, were dissected into four layers: the complete intima and the separated media, which was subdivided into three tissue samples of equal thickness, defined as the media-inner, -middle, and -outer layers. The sampling sites selected for analysis were from regions of the aortic surface that were free of atherosclerotic plaques. The calcium content within each tissue layer of the aorta was determined. Arterial wall thickness and the cholesterol content of the four layers were also measured. Intimal calcification increased progressively during aging: from 1.6 micrograms Ca/mg tissue at 20 years of age to 5.2 micrograms Ca/mg tissue by 90 years of age. When intima calcium concentration was expressed by tissue volume (w/v), no significant change during aging was found. Medial calcification, as w/v and by w/w, increased throughout aging. Calcium accumulation was most marked in the middle, elastin-rich layer of the media, increasing from 1.4 micrograms Ca/mg tissue at 20 years of age to 49.50 micrograms Ca/mg tissue by 90 years of age. Calcium levels also increased in the other media layers, but at a slower rate than that found within the middle media.

Formation of a lipid gradient across the human aortic wall during ageing and the development of atherosclerosis.

The smooth muscle cell invasion and macrophage stimulation within the intima during prolonged exposure to high blood levels of cholesterol esters contribute to increased production of connective tissue matrix. The thickened intima in turn immobilising more LDL derived lipid from the plasma. With damage to the internal elastic lamellae, from essential hypertension, the absorbed lipid can move down a concentration gradient into the medial tissue. This model was supported by our laboratory finding of a lipid gradient across the aorta wall. The gradient commenced shortly after completion of body growth, when the transmedial gradient became detectable. The slope of the gradient progressively increased during ageing. Association of the lipid medial gradient with the degree of atherosclerotic involvement suggested that the gradient influenced the development of intimal lesions. Accumulation of lipid within the medial tissue may then reduce the inward lipid transfer rate from the intima, promoting increased intimal retention and cause the formation of atherosclerotic plaques from the fat saturated intima.

Lipid analysis and fatty acid profiles of individual arterial atherosclerotic plaques.

A protocol for the analysis of the lipid profile of microsamples of aortic tissue was developed. Lipid extraction was from intact tissue using acetone and chloroform/methanol (2/1, v/v). The extract was analyzed for total lipid, esterified cholesterol, cholesterol, triacylglycerol, and phospholipid. The extract was then processed to separate cholesteryl esters, triacylglycerol, and phospholipid which were hydrolyzed and the fatty acid composition was determined by GLC of pentafluorobenzyl ester derivatives. A lipid profile could be obtained on samples with a wet weight of 5 mg.