Antiviral Prescriptions to U.S. Ambulatory Care Visits with a Diagnosis of Influenza before and after High Level of Adamantane Resistance 2005–06 Season

Rapid emergence of influenza A viruses resistance to anti-influenza drugs has been observed in the past five years. Our objective was to compare antiviral prescription patterns of ambulatory care providers to patients with a diagnosis of influenza before and after the 2005-2006 influenza season, which was temporally concordant with the emergence of adamantane resistance. We also determined providers' adherence to Centers for Disease Control and Prevention (CDC) 2006 interim treatment guidelines for influenza after the dissemination of guidelines.We conducted a multi-year cross-sectional analysis using 2002-2006 data from the national representative ambulatory care surveys, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Our main outcome measure was prescription of any anti-influenza pharmaceutical medication, including amantadine, rimantadine, oseltamivir, and zanamivir. Analyses were performed using procedures taking into account the multi-stage survey design and weighted sampling probabilities of the data source. Overall, there were 941 visits to U.S. ambulatory care providers for which the diagnosis of influenza was made, representing 12,140,727 visits nationally. Antiviral drugs were prescribed in 21.7% of visits. Even though prescription rates were not significantly different by influenza season (2001-02: 26.4%; 2002-03: 11.2%; 2003-04: 16.5%; 2004-05: 18.0%; 2005-06: 35.8%; 2006-07: 46.5%, p = 0.061), significantly higher prescription rates were observed in the high adamantane resistance period (18.7% versus 37.0%, p = 0.023), and after the announcement of the 2006 guidelines (18.5% versus 38.8%, p = 0.032). Use of adamantanes decreased over time, in that they were commonly used during influenza seasons 2001-03 (60.1%), but used much less frequently during seasons 2003-05 (31.9%), and used rarely after high adamantane resistance emerged (2.2%) (p<0.001). Adherence to 2006 guidelines was 97.7%. After March 2006, no prescriptions for adamantanes were given to patients with a diagnosis of influenza.In this nationally representative study of U.S. ambulatory care visits, we found a complete absence of the use of adamantanes in all ambulatory care settings after March 2006, closely corresponding to release of the 2006 CDC interim guidelines. Adherence to such practice is an essential element for control and prevention of influenza, especially during the era of emergence of resistance to anti-viral drugs

Feasibility of community-based control of tsetse: A pilot project using Tiny Targets in the Democratic Republic of Congo

Gambianse Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70%Most (>80%) of the cases in 2019 (604/863) occur in the Democratic Republic of Congo (DRC). and Thea national programme for g-HAT to eliminatione HAT in DRC includes athe large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC’s g-HAT elimination programme

Update to the Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) protocol: statistical analysis plan for a prospective, multicenter, double-blind, adaptive sample size, randomized, placebo-controlled, clinical trial.

BACKGROUND: Observational research suggests that combined therapy with Vitamin C, thiamine and hydrocortisone may reduce mortality in patients with septic shock. METHODS AND DESIGN: The Vitamin C, Thiamine and Steroids in Sepsis (VICTAS) trial is a multicenter, double-blind, adaptive sample size, randomized, placebo-controlled trial designed to test the efficacy of combination therapy with vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) given every 6 h for up to 16 doses in patients with respiratory or circulatory dysfunction (or both) resulting from sepsis. The primary outcome is ventilator- and vasopressor-free days with mortality as the key secondary outcome. Recruitment began in August 2018 and is ongoing; 501 participants have been enrolled to date, with a planned maximum sample size of 2000. The Data and Safety Monitoring Board reviewed interim results at N = 200, 300, 400 and 500, and has recommended continuing recruitment. The next interim analysis will occur when N = 1000. This update presents the statistical analysis plan. Specifically, we provide definitions for key treatment and outcome variables, and for intent-to-treat, per-protocol, and safety analysis datasets. We describe the planned descriptive analyses, the main analysis of the primary end point, our approach to secondary and exploratory analyses, and handling of missing data. Our goal is to provide enough detail that our approach could be replicated by an independent study group, thereby enhancing the transparency of the study. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03509350. Registered on 26 April 2018

The role of emergency department HIV care in resource-poor settings: lessons learned in western Kenya

The human immunodeficiency virus (HIV) pandemic in sub-Saharan Africa and other high prevalence regions continues to overwhelm health care systems. While there has been a global response to improve the delivery of antiretroviral therapy in these high prevalence regions, there are few models that have developed an adequate plan to deal with HIV specifically in resource-poor emergency department settings. In this manuscript, we report on the experience scaling up HIV care at one emergency department in a large referral hospital located in western Kenya. Specifically, we describe how rapid bedside HIV testing helps to narrow the differential diagnosis of disease processes in acute care patients and how HIV screening of patients discharged from the emergency department can detect HIV-infected individuals

Arabidopsis RCD1 coordinates chloroplast and mitochondrial functions through interaction with ANAC transcription factors

Reactive oxygen species (ROS)-dependent signaling pathways from chloroplasts and mitochondria merge at the nuclear protein RADICAL-INDUCED CELL DEATH1 (RCD1). RCD1 interacts in vivo and suppresses the activity of the transcription factors ANAC013 and ANAC017, which mediate a ROS-related retrograde signal originating from mitochondrial complex III. Inactivation of RCD1 leads to increased expression of mitochondrial dysfunction stimulon (MDS) genes regulated by ANAC013 and ANAC017. Accumulating MDS gene products, including alternative oxidases (AOXs), affect redox status of the chloroplasts, leading to changes in chloroplast ROS processing and increased protection of photosynthetic apparatus. ROS alter the abundance, thiol redox state and oligomerization of the RCD1 protein in vivo, providing feedback control on its function. RCD1-dependent regulation is linked to chloroplast signaling by 3'-phosphoadenosine 5'-phosphate (PAP). Thus, RCD1 integrates organellar signaling from chloroplasts and mitochondria to establish transcriptional control over the metabolic processes in both organelles.Peer reviewe

Prevalence of hepatitis B and C markers in high-risk hospitalised patients in Crete: a five-year observational study

BACKGROUND: So far the prevalence of viral hepatitis infection in hospitalized patients has not been extensively studied. Therefore we conducted the present five-year observational study to evaluate the prevalence of HBV and HCV infection in high-risk hospitalized patients of Crete, the largest Greek island, Due to the homogeneous population, epidemiological studies can be accurately done. METHODS: The study was carried out in two out of four District General Hospitals, and in the University Hospital of the island. Markers for HBV and HCV were studied and statistically evaluated according to age, sex and geographical area, in a well-defined hospitalized population. RESULTS: The total prevalence of HBsAg and anti-HCV in the three prefectures during the five-year study is 2.66% and 4.75% respectively. Overall the relative risks were higher in males than females for each hepatitis marker (p < 0.001). Higher prevalence of HBcAb was found in the 41–60 years age group for both sexes (males 36.17%, females 27.38%). Peak HBsAg prevalence was found in the age group of 21–40 and 41–60 years for males (5.4%) and females (3.09%) respectively. Anti-HCV prevalence increases with age reaching the highest prevalence in the age group of 41–60 years for males (7.19%) and in the 61–90 years age group for females (7.16%). For both sexes significant differences between the three locations were identified. For HBsAg a higher prevalence in Heraklion (3.96%) compared to Chania (2.30%, males: p < 0.0001, females: p < 0.05) and Rethymnon (1.45%, males: p < 0.01, females: p < 0.0001) was detected. For HCV a significantly higher prevalence in Heraklion (6.54%) compared to Chania (2.39%, males: p < 0.001, females: p < 0.001) but not in Rethymnon (5.15%, NS). A lower prevalence rate of HBcAb in Heraklion compared to Chania (20.07% versus 23.05%, males: p < 0.001, females: p < 0.001) was found. CONCLUSIONS: These results were possibly overestimated, but nevertheless reflect the situation of the general population within the island as shown by our previous publications in other study groups. Moreover they contribute to the mapping of viral hepatitis prevalence in a geographical area of Southern Europe and may be helpful in planning public health interventional strategies

Height and timing of growth spurt during puberty in young people living with vertically acquired HIV in Europe and Thailand.

OBJECTIVE: The aim of this study was to describe growth during puberty in young people with vertically acquired HIV. DESIGN: Pooled data from 12 paediatric HIV cohorts in Europe and Thailand. METHODS: One thousand and ninety-four children initiating a nonnucleoside reverse transcriptase inhibitor or boosted protease inhibitor based regimen aged 1-10 years were included. Super Imposition by Translation And Rotation (SITAR) models described growth from age 8 years using three parameters (average height, timing and shape of the growth spurt), dependent on age and height-for-age z-score (HAZ) (WHO references) at antiretroviral therapy (ART) initiation. Multivariate regression explored characteristics associated with these three parameters. RESULTS: At ART initiation, median age and HAZ was 6.4 [interquartile range (IQR): 2.8, 9.0] years and -1.2 (IQR: -2.3 to -0.2), respectively. Median follow-up was 9.1 (IQR: 6.9, 11.4) years. In girls, older age and lower HAZ at ART initiation were independently associated with a growth spurt which occurred 0.41 (95% confidence interval 0.20-0.62) years later in children starting ART age 6 to 10 years compared with 1 to 2 years and 1.50 (1.21-1.78) years later in those starting with HAZ less than -3 compared with HAZ at least -1. Later growth spurts in girls resulted in continued height growth into later adolescence. In boys starting ART with HAZ less than -1, growth spurts were later in children starting ART in the oldest age group, but for HAZ at least -1, there was no association with age. Girls and boys who initiated ART with HAZ at least -1 maintained a similar height to the WHO reference mean. CONCLUSION: Stunting at ART initiation was associated with later growth spurts in girls. Children with HAZ at least -1 at ART initiation grew in height at the level expected in HIV negative children of a comparable age

DOENÇAS DIAGNOSTICADAS PELO LABORATÓRIO DE PATOLOGIA VETERINÁRIA NO QUINQUÊNIO 2013-2017

Este trabalho apresenta a casuística de diagnósticos nos anos de 2013 a 2017 do Laboratório de Patologia Veterinária do IFC Campus Concórdia. Foram 865 diagnósticos em bovinos, 131 em ovinos e 367 em suínos, totalizando 1363. Destes, 1000 (80,4%) foram através de necropsias e 363 (19,6%) através de amostras formolizadas enviadas por veterinários. Em bovinos as doenças mais incidentes foram miosite clostridial com 34 casos (3,8%); babesiose com 31 casos cada (3,6%); leucose enzoótica bovina com 28 casos (3,2%); anaplasmose com 27 casos (3,1%); hemoncose com 26 casos (3,0%); intoxicação por Pteridium arachnoideumcom 26 casos (3,0%); peritonite com 23 casos (2,7%) e endocardite com 23 casos (2,7%). Já em ovinos hemoncose com 28 casos (21,4%) e suínos doença de Glässer com 27 casos (7,3%) e circovirose com 22 casos (6,0%)