Programa de formación en el acompañamiento de navegación de pacientes para la detección temprana y tratamiento del cáncer cérvico uterino dirigido a profesionales de salud y voluntariado de la Asociación Nacional contra el Cáncer (ANCEC) de la Provincia de Veraguas, República de Panamá

El cervicouterino es el segundo cáncer más frecuente en el mundo y en la provincia de Veraguas es la segunda causa de muerte en mujeres. Esto, debido a la debilidad del sistema de salud por no ofrecer una atención oportuna y eficaz. A pesar del apoyo de la Asociación Nacional contra el Cáncer (ANCEC), con las giras de patología cervical en la provincia de Veraguas, las pacientes siguen llegando al Instituto Oncológico Nacional en etapas avanzadas. Por esto nació el interés de diseñar un programa de navegación de pacientes para tratar de aminorar el tiempo de 22 meses que dura el proceso de atención del cáncer de cérvix hasta llegar al tratamiento. Para definir el perfil de las navegadoras, se desarrolló una investigación mixta donde se estudiaron tres grupos: personal de salud, voluntariado de ANCEC(navegadoras) y personal de ANCEC. Los resultados demuestran que las navegadoras deben tener conocimientos generales sobre estilos de vida saludables, cáncer, cuidados paliativos y voluntariado y deben demostrar habilidades blandas y actitudes de compromiso con el voluntariado, capacidad de escucha y trato al paciente. Estos resultados se aplicaron en el diseño de la propuesta de la formación de navegadoras para el acompañamiento de pacientes, con un enfoque curricular por competencia

Increase of plasma IL-9 and decrease of plasma IL-5, IL-7, and IFN-γ in patients with chronic heart failure

BACKGROUND: Several cytokines are associated with the development and/or progression of chronic heart failure (CHF). Our aim was to look more closely at the cytokine networks involved in CHF, and to assess whether disease etiology affects cytokine expression. The study population was comprised of a) 69 patients with stable CHF, New York Heart Association (NYHA) II/IV classes, secondary to ischaemic (ICM) and non ischaemic dilated (NIDCM) cardiomyopathy and b) 16 control subjects. We analyzed and compared the plasma levels of 27 pro- and anti-inflammatory mediators, in the study population and assessed for any possible correlation with echocardiographic parameters and disease duration. METHODS: 27 cytokines and growth factors were analyzed in the plasma of ICM- (n = 42) and NIDCM (n = 27) NYHA class II-IV patients vs age- and gender-matched controls (n = 16) by a beadbased multiplex immunoassay. Statistical analysis was performed by ANOVA followed by Tukey post-hoc test for multiple comparison. RESULTS: Macrophage inflammatory protein (MIP)-1\u3b2, Vascular endothelial growth factor (VEGF), interleukin (IL)-9, Monocyte chemotactic protein (MCP)-1, and IL-8 plasma levels were increased in both ICM and NIDCM groups vs controls. In contrast, IL-7, IL-5, and Interferon (IFN)-\u3b3 were decreased in both ICM and NIDCM groups as compared to controls. Plasma IL-6 and IL-1 \u3b2 were increased in ICM and decreased in NIDCM, vs controls, respectively.IL-9 levels inversely correlated, in ICM patients, with left ventricular ejection fraction (LVEF) while IL-5 plasma levels inversely correlated with disease duration, in NYHA III/IV ICM patients.This is the first time that both an increase of plasma IL-9, and a decrease of plasma IL-5, IL-7 and IFN-\u3b3 have been reported in ICM as well as in NIDCM groups, vs controls. Interestingly, such cytokines are part of a network of genes whose expression levels change during chronic heart failure. The altered expression levels of MIP-1 \u3b2, VEGF, MCP-1, IL-1 \u3b2, IL-6, and IL-8, found in this study, are in keeping with previous reports. CONCLUSIONS: The increase of plasma IL-9, and the decrease of plasma IL-5, IL-7 and IFN-\u3b3 in ICM as well as in NIDCM groups vs controls may contribute to get further insights into the inflammatory pathways involved in CHF

Regulation of the Chemokine Receptor CXCR4 by Hypoxia

Cell adaptation to hypoxia (Hyp) requires activation of transcriptional programs that coordinate expression of genes involved in oxygen delivery (via angiogenesis) and metabolic adaptation (via glycolysis). Here, we describe that oxygen availability is a determinant parameter in the setting of chemotactic responsiveness to stromal-derived factor 1 (CXCL12). Low oxygen concentration induces high expression of the CXCL12 receptor, CXC receptor 4 (CXCR4), in different cell types (monocytes, monocyte-derived macrophages, tumor-associated macrophages, endothelial cells, and cancer cells), which is paralleled by increased chemotactic responsiveness to its specific ligand. CXCR4 induction by Hyp is dependent on both activation of the Hyp-inducible factor 1 α and transcript stabilization. In a relay multistep navigation process, the Hyp–Hyp-inducible factor 1 α–CXCR4 pathway may regulate trafficking in and out of hypoxic tissue microenvironments

Frequency of subtype B and F1 dual infection in HIV-1 positive, Brazilian men who have sex with men

Introdução: Como varios estudos sobre vacinacao contra HIV estao em progresso, e importante compreender a frequencia na qual ocorrem co/superinfeccoes intra ou intersubtipos em grupos de alto risco. Esse conhecimento auxiliaria no desenvolvimento de programas de prevencao futuros. Nesse estudo transversal, relatamos a frequencia de coinfeccao entre os subtipos B e F1 em uma cohorte clinica de 41 homens que fazem sexo com homens (HSH), recem infectados com HIV-1, em São Paulo, Brasil. Metodologia: O DNA proviral do HIV-1 foi isolado a partir de leucocitos de sangue periferico de sujeitos polimorfonucleares (PMNs), que foram obtidos no momento da inscricao. Cada individuo era conhecidamente infectado por um virus do subtipo B, conforme determinado em estudo anterior. Um pequeno fragmento do gene da integrase (nucleotideo 4255-4478 do HXB2) foi amplificado por PCR utilizando primers especificos para F1. Os resultados da PCR foram confirmados por analise filogenetica. Os dados de carga viral (VL) foram inferidos a partir dos prontuarios de cada paciente. Resultados: Das 41 amostras estudadas, 5 apresentaram DNA proviral do subtipo F1, O que representa uma taxa de 12,2% de coinfeccao. A comparacao entre os valores de carga viral entre os coinfectados e os infectados apenas pelo subtipo B nao foi estatisticamente diferente (p> 0,16). Nos individuos com infeccao dupla a carga viral mediana foi de 5,3 x 104 copias/mL (intervalo de <400 u 12,5 x 104 copias/mL), e nos individuos infectados apenas pelo subtipo B a carga viral mediana foi de 4,3 x 104 copias/mL (intervalo de <400 u 39,9 x 104 copias/mL). Conclusao: Esse estudo indicou que a coinfeccao entre os subtipos B e F1 ocorre com frequencia na populacao de homens que fazem sexo com homens, HIV-1 positivos, como sugerido por um grande numero de virus recombinantes BF1 relatados no Brasil. Na ausencia de uma vacina eficaz contra o HIV-1, o teste para co/superinfeccao e a implantacao de medidas eficazes nos grupos de risco podem ajudar a reduzir a exposicao viral, a transmissao e a recombinacaoBV UNIFESP: Teses e dissertaçõe

Characterization of Partial and Near Full-Length Genomes of HIV-1 Strains Sampled from Recently Infected Individuals in São Paulo, Brazil

Background: Genetic variability is a major feature of human immunodeficiency virus type 1 (HIV-1) and is considered the key factor frustrating efforts to halt the HIV epidemic. A proper understanding of HIV-1 genomic diversity is a fundamental prerequisite for proper epidemiology, genetic diagnosis, and successful drugs and vaccines design. Here, we report on the partial and near full-length genomic (NFLG) variability of HIV-1 isolates from a well-characterized cohort of recently infected patients in Sao Paul, Brazil.Methodology: HIV-1 proviral DNA was extracted from the peripheral blood mononuclear cells of 113 participants. the NFLG and partial fragments were determined by overlapping nested PCR and direct sequencing. the data were phylogenetically analyzed.Results: of the 113 samples (90.3% male; median age 31 years; 79.6% homosexual men) studied, 77 (68.1%) NFLGs and 32 (29.3%) partial fragments were successfully subtyped. of the successfully subtyped sequences, 88 (80.7%) were subtype B sequences, 12 (11%) BF1 recombinants, 3 (2.8%) subtype C sequences, 2 (1.8%) BC recombinants and subclade F1 each, 1 (0.9%) CRF02 AG, and 1 (0.9%) CRF31 BC. Primary drug resistance mutations were observed in 14/101 (13.9%) of samples, with 5.9% being resistant to protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTI) and 4.9% resistant to non-NRTIs. Predictions of viral tropism were determined for 86 individuals. X4 or X4 dual or mixed-tropic viruses (X4/DM) were seen in 26 (30.2%) of subjects. the proportion of X4 viruses in homosexuals was detected in 19/69 (27.5%).Conclusions: Our results confirm the existence of various HIV-1 subtypes circulating in São Paulo, and indicate that subtype B account for the majority of infections. Antiretroviral (ARV) drug resistance is relatively common among recently infected patients. the proportion of X4 viruses in homosexuals was significantly higher than the proportion seen in other study populations.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Univ São Paulo, Fac Med, Div Clin Immunol & Allergy, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Translat Med, São Paulo, BrazilFundacao Pro Sangue, Blood Ctr Sau Paulo, São Paulo, BrazilUniv São Paulo, Dept Infect Dis, São Paulo, BrazilPubl Hlth Dept São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Translat Med, São Paulo, BrazilFAPESP: 04/15856-9FAPESP: 2006/50096-0Web of Scienc

Trends in HIV surveillance data in the EU/EEA, 2005 to 2014: New HIV diagnoses still increasing in men who have sex with men

Human immunodeficiency virus (HIV) transmission remains significant in Europe. Rates of acquired immunodeficiency syndrome (AIDS) have declined, but not in all countries. New HIV diagnoses have increased among native and foreign-born men who have sex with men. Median CD4+T-cell count at diagnosis has increased, but not in all groups, and late diagnosis remains common. HIV infection and AIDS can be eliminated in Europe with resolute prevention measures, early diagnosis and access to effective treatment

Multicenter Observational Retrospective Study on Febrile Events in Patients with Acute Myeloid Leukemia Treated with Cpx-351 in "Real-Life": The SEIFEM Experience

: In the present study, we aimed to evaluate the absolute risk of infection in the real-life setting of AML patients treated with CPX-351. The study included all patients with AML from 30 Italian hematology centers of the SEIFEM group who received CPX-351 from July 2018 to June 2021. There were 200 patients included. Overall, 336 CPX-351 courses were counted: all 200 patients received the first induction cycle, 18 patients (5%) received a second CPX-351 induction, while 86 patients (26%) proceeded with the first CPX-351 consolidation cycle, and 32 patients (10%) received a second CPX-351 consolidation. A total of 249 febrile events were recorded: 193 during the first or second induction, and 56 after the first or second consolidation. After the diagnostic work-up, 92 events (37%) were classified as febrile neutropenia of unknown origin (FUO), 118 (47%) were classifiable as microbiologically documented infections, and 39 (17%) were classifiable as clinically documented infections. The overall 30-day mortality rate was 14% (28/200). The attributable mortality-infection rate was 6% (15/249). A lack of response to the CPX-351 treatment was the only factor significantly associated with mortality in the multivariate analysis [p-value: 0.004, OR 0.05, 95% CI 0.01-0.39]. Our study confirms the good safety profile of CPX-351 in a real-life setting, with an incidence of infectious complications comparable to that of the pivotal studies; despite prolonged neutropenia, the incidence of fungal infections was low, as was infection-related mortality