WHO Clinical Staging of HIV Infection and Disease, Tuberculosis and Eligibility for Antiretroviral Treatment: Relationship to CD4 Lymphocyte Counts.

SETTING: Thyolo district, Malawi. OBJECTIVES: To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). DESIGN: Cross-sectional study. METHODS: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. RESULTS: A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. CONCLUSIONS: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy

Efecto del tiempo de grabado con ácido fosfórico al 37.5% sobre la superficie de esmalte haciendo uso de agentes cementantes autoadhesivos.

OBJETIVO: Comparar la resistencia traccional de resina compuesta adherida a la superficie del esmalte de bovino en diferentes intervalos de tiempos de 15 y 30 segundos haciendo uso de ácido grabador  en tres agentes cementantes autoadhesivos y un grupo control. MATERIALES Y MÉTODOS: Fueron utilizados treinta y cinco incisivos inferiores sanos de bovino menor de 3 años, los cuales fueron divididos aleatoriamente en siete grupos correspondientes a cada cemento autoadhesivo y tiempo de grabado ácido: RelyX U200 (3M) (grupo U15”) (grupo U30”), Bis Cem (BISCO)(grupo B15”)(grupo B30”), MaxCem Elite (KERR)(grupo M15”)(grupo M30”), RelyX Ultimate (3M)(grupo UL) se procedió a la cementación con los bloques de resina compuesta como se indica el protocolo previo grabado ácido del esmalte de 15 y 30 segundos para cada cemento . Los especímenes de 1 mm2 de área transversal (n = 30 por grupo) se almacenaron en agua destilada por 24 horas a 36 °C. La prueba de microtensión se realizó haciendo uso del Microtensile Tester (Bisco). Para el análisis estadístico se utilizaron las pruebas de Kruskal Wallis y U Mann Whitney (p&lt;0.05). RESULTADOS: El grupo U 30” presentó una resistencia promedio de 24.82 (±3.80) MPa; el U 15”, 23.40 (±5.80 ) MPa, el M30”,30.86 (±9.85) MPa, el M15”, 28.29 (±2.02) MPa, el B 30”, 17.42(±3.49) MPa, el B15”,17.63 (±3.61) MPa, y el UL, 31.53 (±6.39 ) MPa, encontrando diferencia significativa entre ellos (p &lt; 0.001) a través del análisis de Kruskal Wallis . CONCLUSIÓN: El cemento Relyx Ultimate obtuvo el valor más alto de resistencia traccional encontrándose diferencias estadísticamente significativas con todos cementos autoadhesivos. No se encontraron diferencias estadísticamente significativas al comparar los dos tiempos de grabado ácido de 15 y 30 seg. en esmalte entre los grupos de cementos autoadhesivos, al cabo de 24 horas

Modified toggle pin technique combined with prosthetic capsular reconstruction for surgical stabilization of coxofemoral luxation in a Shetland pony

Objective To describe open reduction and surgical stabilization of a coxofemoral luxation in a pony using a modified toggle pin technique and prosthetic joint capsule reconstruction without osteotomy of the greater trochanter. Animal A 2-year-old Shetland pony with a bodyweight of 167 kg. Study design Case report. Methods Radiographic examination confirmed craniodorsal luxation of the left coxofemoral joint. An open reduction with the aid of a pulley system was performed. A toggle pin was inserted through a bone tunnel extending from the level of the femoral shaft through the femoral head and the center of the acetabulum for the pin to be positioned on the medial wall of the acetabulum. FiberWire was subsequently passed through the cranial and caudal aspects of the acetabulum as well as a transverse tunnel in the femoral neck in a figure of 8 to facilitate capsular reconstruction. The pony was placed in a sling for 8 weeks and gradually returned to normal activity over 2 months. Results Postoperative radiographic examination confirmed the position of the femoral head in the acetabulum with the implants in place. On 2-year follow-up the pony was sound at walk and trot. Conclusion A combined intra- and extra-articular stabilization technique for coxofemoral luxation in a pony resulted in successful long-term reduction and excellent outcome

Can we get more HIV-positive tuberculosis patients on antiretroviral treatment in a rural district of Malawi?

The World Health Organization (WHO) has set a target of treating 3 million people with antiretroviral treatment (ART) by 2005. In sub-Saharan Africa, HIV-positive tuberculosis (TB) patients could significantly contribute to this target. ART (stavudine/lamivudine/nevirapine) was initiated in Thyolo district, Malawi, in April 2003, and all HIV-positive TB patients were considered eligible and offered ART. Despite this, only 44 (13%) of 352 TB patients were eventually started on ART by the end of November 2003. Most TB patients leave hospital after 2 weeks to complete the initial phase of anti-tuberculosis treatment (rifampicin-based) in the community, and ART is offered to HIV-positive TB patients after they have started the continuation phase of treatment (isoniazid/ ethambutol). ART is only offered at hospital, while the majority of TB patients take their continuation phase of anti-tuberculosis treatment from health centres. HIV-positive TB patients therefore find it difficult to access ART. In this paper, we discuss a series of options to increase the uptake of ART among HIV-positive TB patients. The main options are: 1) to hospitalise HIV-positive TB patients with a view to starting ART in the continuation phase in hospital; 2) to decentralise ART delivery so ART can be delivered at health centres; 3) to replace nevirapine with efavirenz so ART can be started earlier in the initial phase of anti-tuberculosis treatment. Decentralisation of ART from hospitals to health centres would greatly improve ART access

Mucopolysaccharidosis type II: identification of 30 novel mutations among Latin American patients

In this study, 103 unrelated South-American patients with mucopolysaccharidosis type II (MPS II) were investigated aiming at the identification of iduronate-2-sulfatase (IDS) disease causing mutations and the possibility of some insights on the genotype-phenotype correlation The strategy used for genotyping involved the identification of the previously reported inversion/disruption of the IDS gene by PCR and screening for other mutations by PCR/SSCP. The exons with altered mobility on SSCP were sequenced, as well as all the exons of patients with no SSCP alteration. By using this strategy, we were able to find the pathogenic mutation in all patients. Alterations such as inversion/disruption and partial/total deletions of the IDS gene were found in 20/103 (19%) patients. Small insertions/deletions/indels (<22 bp) and point mutations were identified in 83/103 (88%) patients, including 30 novel mutations; except for a higher frequency of small duplications in relation to small deletions, the frequencies of major and minor alterations found in our sample are in accordance with those described in the literature1112133138CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESRoscoe Brady program of NORD (National Organization of Rare Disorders); Institutional FIPE-HCPA fund

Instructions to authors

Made available in DSpace on 2015-06-08T14:06:19Z (GMT). No. of bitstreams: 2 Mucopolysaccharidosis type II Identification of 30 novel mutations among Latin American patients.pdf: 188876 bytes, checksum: ae8b735010afc03b6cf726def963e227 (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2014Hospital de Clínicas de Porto Alegre. Serviço de Genética Médica. Porto Alegre, RS, Brasil.Universidade Federal do Rio Grande do Sul. Programa de Pós-Graduação em Ciências Médicas. Porto Alegre, RS, Brasil / Universidade Federal do Rio Grande do Sul. Departamento de Genética. Porto Alegre, RS, Brasil / Hospital de Clínicas de Porto Alegre. Serviço de Genética Médica. Porto Alegre, RS, Brasil.Hospital de Clínicas de Porto Alegre. Serviço de Genética Médica. Porto Alegre, RS, Brasil.Universidade Federal do Rio de Janeiro. Instituto de Puericultura e Pediatria Martagão Gesteira. Serviço de Genética. Rio de Janeiro, RJ, Brasil.Universidade Federal da Bahia. Departamento de Pediatria. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Rio de Janeiro, RJ, Brasil.Universidade Estadual de Ciências da Saúde de Alagoas. Departamento de Pediatria. Maceió, AL, Brasil.Universidade Estadual de Ciências da Saúde de Alagoas. Departamento de Pediatria. Maceió, AL, Brasil.Faculdade de Medicina de São José do Rio Preto. Departamento de Biologia Molecular. São José do Rio Preto, SP, Brasil.Universidade Estadual de Campinas. Departamento de Genética Médica. Campinas, SP, Brasil.Instituto de Medicina Integral Professor Fernando Figueira. Serviço de Genética Médica. Recife, PE, Brasil.Universidade do Estado do Rio de Janeiro. Departamento Mãe e Criança. Rio de Janeiro, RJ, Brasil.University of Chile. International Trademark Association. Genetics and Metabolic Diseases Unit. Chile.ILCS-UNA. Department of Genetics. Asunción, Paraguay.Universidad Peruana Cayetano Heredia. Lima, Peru.Royal Manchester Children's Hospital. Willink Biochemical Genetics Unit. Manchester, UK.Hospital Roberto del Río. Unidad de Genética Clínica. Santiago, Chile.Universidade Federal do Rio Grande do Sul. Programa de Pós-Graduação em Ciências Médicas. Porto Alegre, RS, Brasil. / Universidade Federal do Rio Grande do Sul. Departamento de Genética. Porto Alegre, RS, Brasil. / Hospital de Clínicas de Porto Alegre. Serviço de Genética Médica. Porto Alegre, RS, Brasil.Universidade Federal do Rio Grande do Sul. Programa de Pós-Graduação em Ciências Médicas. Porto Alegre, RS, Brasil. / Universidade Federal do Rio Grande do Sul. Departamento de Genética. Porto Alegre, RS, Brasil. / Hospital de Clínicas de Porto Alegre. Serviço de Genética Médica. Porto Alegre, RS, Brasil.In this study, 103 unrelated South-American patients with mucopolysaccharidosis type II (MPS II) were investi-gated aiming at the identification of iduronate-2-sulfatase (IDS) disease causing mutations and the possibility of some insights on the genotype–phenotype correlation The strategy used for genotyping involved the identifica-tion of the previously reported inversion/disruption of theIDSgene by PCR and screening for othermutations by PCR/SSCP. The exons with altered mobility on SSCP were sequenced, as well as all the exons of patients with no SSCP alteration. By using this strategy, we were able tofind the pathogenic mutation in all patients. Alterations such as inversion/disruption and partial/total deletions of theIDS gene were found in 20/103 (19%) patients. Small insertions/deletions/indels (b22 bp) andpointmutationswere identified in83/103 (88%) patients, includ-ing 30 novel mutations; except for a higher frequency of small duplications in relation to small deletions, the fre-quencies of major and minor alterations found in our sample are in accordance with those described in the literature

Devices for Rapid Diagnosis of Malaria: Evaluation of Prototype Assays That Detect Plasmodium falciparum Histidine-Rich Protein 2 and a Plasmodium vivax-Specific Antigen

The ParaSight F test was developed as a pioneer industry effort in the large-scale, process-controlled production of a device for the rapid diagnosis of malaria. This device performed well in field settings but was limited to the detection of a single malaria species, Plasmodium falciparum. The ParaSight F+V assay advanced upon the ParaSight F test format by incorporating a monoclonal antibody directed against a proprietary Plasmodium vivax-specific antigen, in addition to the antibody directed against P. falciparum histidine-rich protein 2, which was used in the ParaSight F assay. The modified assay was developed to add the capability to detect P. falciparum and P. vivax in a single-test-strip format. The present study evaluated three distinct ParaSight F+V prototypes with samples from symptomatic patients in regions of Thailand and Peru where malaria is endemic. Over a 2-year enrollment period (1998 and 1999), a total of 4,894 patients consented to participation in the study. Compared with the results for duplicate microscopic examinations of Giemsa-stained blood smears as the reference diagnostic standard, each successive prototype showed substantial improvement in performance. The final ParaSight F+V prototype, evaluated in 1999, had an overall sensitivity for detection of asexual P. falciparum parasites of 98%. The sensitivity of the device was 100% for P. falciparum densities of >500 parasites/μl, with a sensitivity of 83% for parasite densities of ≤500/μl. The specificity for the exclusion of P. falciparum was 93%. For P. vivax, the overall sensitivity was 87% for the final 1999 prototype. The sensitivities calculated for different levels of P. vivax parasitemia were 99% for parasite densities of >5,000/μl, 92% for parasite densities of 1,001 to 5,000/μl, 94% for parasite densities of 501 to 1,000/μl, and 55% for parasite densities of 1 to 500/μl. The specificity for the exclusion of P. vivax was 87%. The areas under the receiver operating characteristic curves for the diagnostic performance of the assay for the detection of P. falciparum and P. vivax were 0.8907 and 0.8522, respectively. These findings indicate that assays for rapid diagnosis have the potential to enhance diagnostic capabilities in those instances in which skilled microscopy is not readily available

Ethics preparedness : facilitating ethics review during outbreaks : recommendations from an expert panel

BackgroundEnsuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, researchers and other concerned stakeholders also have to carefully balance time and resources allocated to immediate treatment and control activities, with an approach that integrates research as part of the outbreak response. Under such circumstances, research ethics preparedness constitutes an important foundation for an effective response to infectious disease outbreaks and other health emergencies.Main textA two-day workshop was convened in March 2018 by the World Health Organisation Global Health Ethics Team and the African coaLition for Epidemic Research, Response and Training, with representatives of National Ethics Committees, to identify practical processes and procedures related to ethics review preparedness. The workshop considered five areas where work might be undertaken to facilitate rapid and sound ethics review: preparing national ethics committees for outbreak response; pre-review of protocols; multi-country review; coordination between national ethics committees and other key stakeholders; data and benefit sharing; and export of samples to third countries.In this paper, we present the recommendations that resulted from the workshop. In particular, the participants recommended that Ethics Committees would develop a formal national standard operating procedure for emergency response ethical review; that there is a need to clarify the terminology and expectations of pre-review of generic protocols and agree upon specific terminology; that there is a need to explore mechanisms for multi-country emergency ethical consultation, and to establish procedures for communication between national ethics committees and other oversight bodies and public health authorities. In addition, it was suggested that ethics committees should request from researchers, at a minimum, a preliminary data sharing and sample sharing plan that outlines the benefit to the population from which data and samples are to be drawn. This should be followed in due time by a full plan.ConclusionIt is hoped that the national ethics committees, supported by the WHO, relevant collaborative research consortia and external funding agencies, will work towards bringing these recommendations into practice, for supporting the conduct of effective research during outbreaks