Disparities in HIV continuum of care in the paediatric population: A real-life study in Brazil.

INTRODUCTION: Paediatric HIV follow-up is challenging, and treatment indicators are markedly far from Joint United Nations Programme on HIV/AIDS (UNAIDS) goals. In this study, we describe the 2019 Brazilian HIV cascade according to age categories and sociodemographic variables and address temporal trends between 2009 and 2019. METHODS: We obtained data from the Brazilian Ministry of Health monitoring database. Cascade outcomes included retention in care, antiretroviral use, and viral suppression. We assessed the effect of age on timely initiation of antiretroviral treatment (ART; initiation with CD4+ T-cell count ≥350 cells/mm3 or a first ART dispensation ≤30 days after the first CD4+ T-cell measurement) and detectable HIV viral load (>50 copies/mL) in univariable and multivariable analysis adjusted for sex, race, and social vulnerability index (SVI). Temporal trends in timely ART initiation and viral suppression were evaluated graphically. RESULTS: Among 771 774 people living with HIV, those in the youngest age categories had poorer indicators in the care cascade. Those in younger age groups, those with higher SVI, and those declaring Black and native Brazilian race/ethnicity had higher odds of having detectable viral load and delayed ART initiation. Although children living with HIV tend to start ART with higher CD4+ T-cell counts, time-series analysis suggests that improvements in treatment indicators seen in the adult population are not observed in the paediatric population. CONCLUSION: Our results highlight the challenges faced by children and adolescents living with HIV in achieving UNAIDS goals. Lower access to ART among children is a central barrier to improved paediatric care.

Impact of antiretroviral regimen on viral suppression among pregnant women living with HIV in Brazil.

Human immunodeficiency virus (HIV) viral load (VL) during pregnancy is a critical determinant of the risk of HIV mother-to-child transmission (MTCT). Prior studies suggest that VL suppression is influenced by antiretroviral regimen. In this study, using secondary real-life data from the Ministry of Health of Brazil, we compared VL suppression at 60-180 days after the first antiretroviral therapy (ART) prescription during pregnancy and time to undetectable VL among pregnant women under treatment with double nucleoside/nucleotide regimens combined with efavirenz, boosted lopinavir, boosted atazanavir, or raltegravir, with adjustment for potential confounders in multivariable models. A total of 18,997 pregnant women living with HIV were included in the study. Compared to regimens containing lopinavir, we found that atazanavir-, efavirenz-, and raltegravir-based regimens were superior in achieving both outcomes after adjustment for age, social vulnerability index, time under ART, baseline CD4+ cell count, and baseline HIV VL. Raltegravir-containing regimens had the highest adjusted odds/rates of VL suppression compared to patients with other regimens. Elimination of HIV MTCT is still a critical public health issue in many countries. Our findings suggest that raltegravir-based regimens were superior when compared to efavirenz-, lopinavir-, and atazanavir-based antiretroviral regimens in achieving suppression of HIV VL.

O suicídio na adolescência nas publicações da enfermagem brasileira: revisão integrativa da literatura adolescent / Suicidio adolescente en las publicaciones de la enfermería brasileña: revisión de la literatura integradora / Suicide in brazilian nursing publications: an integrative literature review

Trata-se de um estudo de revisão integrativa que tem por objetivo analisar o levantamento das produções publicadaspela enfermagem brasileira acerca do suicídio na adolescência. Foram analisadas as bases de dados LILACS, MEDLINE,SciELO, BDENF e Rev Enf. O levantamento abrangeu as publicações da enfermagem brasileira entre os anos 2000 e2014, sendo identificadas nove referências que compuseram a amostra do estudo. A avaliação dos trabalhospossibilitou a elaboração de três categorias de análise: 1. Quem é o adolescente que tenta o suicídio e quais os meiosutilizados; 2. Os motivos que levam o adolescente ao suicídio; 3. A atuação do enfermeiro na recuperação doadolescente que tenta suicídio. Os resultados destacam a multicausalidade do suicídio na adolescência, os fatores de risco para o suicídio e o papel do enfermeiro na assistência a este sujeito...

The objective of this integrative review study is to survey the works published by Brazilian nursing about suicide inadolescence. The LILACS, MEDLINE, SciELO, BDENF, and Rev Enf databases were analyzed. The survey coveredBrazilian nursing publications from 2000 to 2014; 9 references, which comprised the study sample, were identified.The assessment of the works enabled the development of three categories of analysis: 1 - Who is the teenager whoattempts suicide and what means did he/she use? 2 - The reasons teenagers commit suicide; 3 - The role of the nursein the recovery of the teenager who attempts suicide. The results highlight the multiple causes of suicide inadolescence, risk factors for suicide and the role of nurses in the care for the subject...

Un estudio de revisión integradora fue hecho con el objetivo de estudiar las producciones publicadas por la enfermeríabrasileña a respecto de casos de suicidio en la adolescencia. Los datos fueron obtenidos de las bases de datos LILACS,MEDLINE, SciELO BDENF y Rev Enf. La encuesta abarcó las publicaciones de enfermería brasileñas entre los años 2000a 2014. Se identificaron nueve referencias que compusieron la muestra del estudio. La evaluación del trabajo permitióel desarrollo de tres categorías de análisis: 1 - Quién es el adolescente que intenta suicidarse y cuáles son los mediosutilizados; 2 - Las razones que llevan el adolescente al suicidio; 3 - El papel del enfermero en la recuperación deladolescente que intenta suicidarse. Los resultados ponen de relieve las múltiples causas de suicidio en laadolescencia, factores de riesgo para el suicidio y el papel de los enfermeros en el cuidado de este sujeto...

A randomized controlled trial on the effects of combined aerobic-resistance exercise on muscle strength and fatigue, glycemic control and health-related quality of life of type 2 diabetes patients.

AIM: to evaluate the effects of a 12--weeks combined aerobic--resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health--related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients. METHODS: a randomized controlled trial design was employed. Forty--three T2DM patients were assigned to an exercise group (n = 22), performing 3 weekly sessions of 60 minutes of combined aerobic--resistance exercise for 12--weeks; or a no exercise control group (n = 21). Both groups were evaluated at a baseline and after 12--weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF--36 questionnaire. RESULTS: the exercise therapy led to improvements in muscle fatigue in knee extensors (--55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (--18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%). CONCLUSION: 12--weeks of combined aerobic--resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.

Actin expression in trypanosomatids (Euglenozoa: Kinetoplastea).

Heteroxenic and monoxenic trypanosomatids were screened for the presence of actin using a mouse polyclonal antibody produced against the entire sequence of the Trypanosoma cruzi actin gene, encoding a 41.9 kDa protein. Western blot analysis showed that this antibody reacted with a polypeptide of approximately 42 kDa in the whole-cell lysates of parasites targeting mammals (T. cruzi, Trypanosoma brucei and Leishmania major), insects (Angomonas deanei, Crithidia fasciculata, Herpetomonas samuelpessoai and Strigomonas culicis) and plants (Phytomonas serpens). A single polypeptide of approximately 42 kDa was detected in the whole-cell lysates of T. cruzi cultured epimastigotes, metacyclic trypomastigotes and amastigotes at similar protein expression levels. Confocal microscopy showed that actin was expressed throughout the cytoplasm of all the tested trypanosomatids. These data demonstrate that actin expression is widespread in trypanosomatids.

Actin expression in trypanosomatids (Euglenozoa: Kinetoplastea)

Heteroxenic and monoxenic trypanosomatids were screened for the presence of actin using a mouse polyclonal antibody produced against the entire sequence of the Trypanosoma cruzi actin gene, encoding a 41.9 kDa protein. Western blot analysis showed that this antibody reacted with a polypeptide of approximately 42 kDa in the whole-cell lysates of parasites targeting mammals (T. cruzi, Trypanosoma brucei and Leishmania major), insects (Angomonas deanei, Crithidia fasciculata, Herpetomonas samuelpessoai and Strigomonas culicis) and plants (Phytomonas serpens). A single polypeptide of approximately 42 kDa was detected in the whole-cell lysates of T. cruzi cultured epimastigotes, metacyclic trypomastigotes and amastigotes at similar protein expression levels. Confocal microscopy showed that actin was expressed throughout the cytoplasm of all the tested trypanosomatids. These data demonstrate that actin expression is widespread in trypanosomatids.

Evaluation of glutaraldehyde as antimicrobial agent used in intraoral x-ray film holder bite block / Avaliação do glutaraldeído como agente microbiano usado em blocos de mordida de posicionadores para filmes radiográficos

The aim of the present study was to evaluate sterilizationof intraoral X-ray film holder bite blocks by immersionin 2% glutaraldehyde solution for 10 hours. Seventeen intraoral X-ray film holder bite blocks were inoculated in Tryptic Soy Broth media containing one of the tested microorganisms(S. aureus and B. subtilis) and were incubated at 37 °C for 48 hours. One bite block was used as a positive control. The other blocks were immersed in 2% glutaraldehydefor 10 hours and one block was used as a negative control. Fifteen bite blocks were removed and five of them were washed with 70% alcohol, five blocks were washed with distilled water and the others were washed in running water. Bacterial growth was observed after incubation. No bacterial growth was found on any block, however, on the blocks that were washed with running water and distilled water, various colonies of fungi were observed, while no growth was found on the blocks which underwent a final wash with 70% alcohol. The 2% glutaraldehyde solution was effective for the sterilization of intraoral X-ray film holder bite blocks when they were immersed for 10 hours using 70% alcohol during the last wash.