A infecção pelo HTLV- I não está associada a maior risco de morte em pacientes peruanos infectados pelo HIV

Limited and contradictory information exists regarding the prognosis of HIV/HTLV-I co-infection. Our goal was to estimate the effect of HTLV-I infection on mortality in HIV-infected patients at a HIV reference center in Peru. We studied a retrospective cohort of HIV-infected patients, who were exposed or unexposed to HTLV-I. Exposed patients were Western Blot (WB) positive for both retroviruses. Unexposed patients were WB positive for HIV, and had least one negative EIA for HTLV-I. These were selected among patients who entered our Program immediately before and after each exposed patient, between January 1990 and June 2004. Survival time was considered between the diagnosis of exposure to HTLV-I and death or censoring. Confounding variables were age, gender, baseline HIV clinical stage, baseline CD4+ T cell count, and antiretroviral therapy. We studied 50 exposed, and 100 unexposed patients. Exposed patients had a shorter survival compared to unexposed patients [median survival: 47 months (95% CI: 17-77) vs. 85 months (95% CI: 70-100), unadjusted p = 0.06]. Exposed patients had a higher rate of mortality compared to unexposed patients (HIV/HTLV-I (24/50 [48%]) vs. HIV only (37/100 [37%]), univariable p = 0.2]. HTLV-I exposure was not associated to a higher risk of death in the adjusted analysis: HR: 1.2 (0.4-3.5). AIDS clinical stage and lack of antiretroviral therapy were associated to a higher risk of dying. In conclusions, HTLV-I infection was not associated with a higher risk of death in Peruvian HIV-infected patients. Advanced HIV infection and lack of antiretroviral therapy may explain the excess of mortality in this population.Existe informação limitada e contraditória sobre o prognóstico da co-infecção pelo Vírus da Imunodeficiência Humana Tipo 1 (HIV-1) e Vírus Linfotrópico de Células T Humanas Tipo I (HTLV-I). Nosso objetivo foi estimar o efeito da infecção pelo HTLV-I na mortalidade de pacientes infectados pelo HIV-1 em Centro de Referência de HIV no Peru. Trata-se de uma coorte retrospectiva de pacientes infectados pelo HIV, expostos ou não expostos ao HTLV-I. Os pacientes expostos tiveram resultados positivos no Western Blot (WB) para ambos retrovírus. Os pacientes não expostos tiveram resultados positivos para o HIV-1 e pelo menos um teste de EIA negativo para o HTLV-I. Esses pacientes foram selecionados entre aqueles que entraram no nosso Programa imediatamente antes ou depois de cada paciente exposto, no período de janeiro de 1990 a junho de 2004. O tempo de sobrevida foi considerado entre o diagnóstico da exposição ao HTLV-I e a morte. As variáveis de confusão foram: idade, gênero, estágio clínico basal da infecção pelo HIV-1, contagem basal de células CD4, e terapia anti-retroviral. Estudamos 50 pacientes expostos e 100 não expostos. Os pacientes expostos tiveram menor sobrevida quando comparados aos não expostos [mediana de sobrevida: 47 meses (95% IC: 17-77) versus 85 meses (70-100), p não ajustado < 0.06]. Os pacientes expostos tiveram maior risco de morte quando comparados aos não expostos (HIV-1/HTLV-I (24/50 [48%]) versus HIV-1 só (37/100 [37%]) p univariado = 0.2). A exposição ao HTLV-I não foi associada a maior risco de morte na análise ajustada: HR: 1.2 (0.4-3.5). O estágio clínico da infecção pelo HIV-1 e a ausência de terapia anti-retroviral foram associados a maior risco de morte. Em conclusão, a infecção pelo HTLV-I não foi associada a maior risco de morte em pacientes peruanos infectados pelo HIV-1. A infecção avançada pelo HIV-1 e a falta de terapia anti-retroviral podem explicar o excesso de mortalidade nesta população

Comparative evaluation of R1234yf, R1234ze(E) and R450A as alternatives to R134a in a variable speed reciprocating compressor

A comparative energetic evaluation of R1234yf, R1234ze(E) and R450A as alternatives to R134a in a variable speed compressor is carried out. A compressor model based on dimensionless numbers was obtained using the Buckingham p -theorem, which was validated with experimental data; showing that the prediction error of the model is lower than ± 10% and ± 2 K for temperature. The experimental data were obtained by testing R134a, R1234yf, R1234ze(E) and R450A for a wide range of operating condi- tions. Results obtained with the validated model, show that the dimensionless approach provides a similar estimation of energy parameters compared with the experimental results, such as power con- sumption, refrigerant mass fl ow rate, cooling capacity, COP, discharge temperature and compressor ef- fi ciencies for each refrigerant tested using the dimensionless approach proposed. The comparative evaluation of the compressor predictions shows a reduction in the cooling capacity obtained with R1234yf, R450A and R1234ze(E), in comparison with R134a. Also, COP values for R1234yf, R450A, and R1234ze(E) are lower than those obtained from R134a. Finally, results shows that the dimensionless correlation compressor model can be used to predict the performance of other reciprocating compres- sors, at similar operating conditions for a wide range of compressor rotation speed, with a reasonable accuracy.The authors thankfully acknowledge to the "Consejo Nacional deCiencia y Tecnología (CONACYT)” for their support to this study, and to the “Ministerio de Educación, Cultura y Deporte” (Grant number FPU12/02841) for sponsoring this work through “Becas y Contratosde Formación de Profesorado Universitario del Programa Nacional de Formación de Recursos Humanos de Investigación del ejercicio 2012”

Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 years-old

A genome-wide association study follow-up suggests a possible role for PPARG in systemic sclerosis susceptibility

Introduction: A recent genome-wide association study (GWAS) comprising a French cohort of systemic sclerosis (SSc) reported several non-HLA single-nucleotide polymorphisms (SNPs) showing a nominal association in the discovery phase. We aimed to identify previously overlooked susceptibility variants by using a follow-up strategy.&lt;p&gt;&lt;/p&gt; Methods: Sixty-six non-HLA SNPs showing a P value &#60;10-4 in the discovery phase of the French SSc GWAS were analyzed in the first step of this study, performing a meta-analysis that combined data from the two published SSc GWASs. A total of 2,921 SSc patients and 6,963 healthy controls were included in this first phase. Two SNPs, PPARG rs310746 and CHRNA9 rs6832151, were selected for genotyping in the replication cohort (1,068 SSc patients and 6,762 healthy controls) based on the results of the first step. Genotyping was performed by using TaqMan SNP genotyping assays. Results: We observed nominal associations for both PPARG rs310746 (PMH = 1.90 × 10-6, OR, 1.28) and CHRNA9 rs6832151 (PMH = 4.30 × 10-6, OR, 1.17) genetic variants with SSc in the first step of our study. In the replication phase, we observed a trend of association for PPARG rs310746 (P value = 0.066; OR, 1.17). The combined overall Mantel-Haenszel meta-analysis of all the cohorts included in the present study revealed that PPARG rs310746 remained associated with SSc with a nominal non-genome-wide significant P value (PMH = 5.00 × 10-7; OR, 1.25). No evidence of association was observed for CHRNA9 rs6832151 either in the replication phase or in the overall pooled analysis.&lt;p&gt;&lt;/p&gt; Conclusion: Our results suggest a role of PPARG gene in the development of SSc

Status and Recent Results of the Acoustic Neutrino Detection Test System AMADEUS

The AMADEUS system is an integral part of the ANTARES neutrino telescope in the Mediterranean Sea. The project aims at the investigation of techniques for acoustic neutrino detection in the deep sea. Installed at a depth of more than 2000m, the acoustic sensors of AMADEUS are based on piezo-ceramics elements for the broad-band recording of signals with frequencies ranging up to 125kHz. AMADEUS was completed in May 2008 and comprises six "acoustic clusters", each one holding six acoustic sensors that are arranged at distances of roughly 1m from each other. The clusters are installed with inter-spacings ranging from 15m to 340m. Acoustic data are continuously acquired and processed at a computer cluster where online filter algorithms are applied to select a high-purity sample of neutrino-like signals. 1.6 TB of data were recorded in 2008 and 3.2 TB in 2009. In order to assess the background of neutrino-like signals in the deep sea, the characteristics of ambient noise and transient signals have been investigated. In this article, the AMADEUS system will be described and recent results will be presented.Comment: 7 pages, 8 figures. Proceedings of ARENA 2010, the 4th International Workshop on Acoustic and Radio EeV Neutrino Detection Activitie

Measurement of Atmospheric Neutrino Oscillations with the ANTARES Neutrino Telescope

The data taken with the ANTARES neutrino telescope from 2007 to 2010, a total live time of 863 days, are used to measure the oscillation parameters of atmospheric neutrinos. Muon tracks are reconstructed with energies as low as 20 GeV. Neutrino oscillations will cause a suppression of vertical upgoing muon neutrinos of such energies crossing the Earth. The parameters determining the oscillation of atmospheric neutrinos are extracted by fitting the event rate as a function of the ratio of the estimated neutrino energy and reconstructed flight path through the Earth. Measurement contours of the oscillation parameters in a two-flavour approximation are derived. Assuming maximum mixing, a mass difference of $\Delta m_{32}^2=(3.1\pm 0.9)\cdot 10^{-3}$ eV$^2$ is obtained, in good agreement with the world average value.Comment: 9 pages, 5 figure

Guía de práctica clínica para el diagnóstico y tratamiento de hemofilia en el Seguro Social de Salud del Perú (EsSalud)

Introduction. Hemophilia is a rare congenital bleeding disorder; which requires interdisciplinary, complex, and often expensive management. The objective of this clinical practice guideline (CPG) is to provide evidence-based clinical recommendations for the evaluation and management of patients with hemophilia in the Peruvian Social Security (EsSalud). Methods. A local elaboration group (GEG-Local) was established, conformed by specialists in hematology and methodologists. The GEG-Local formulated 8 clinical questions to be answered by this CPG. We searched for and selected hemophilia CPGs that answered the questions posed and obtained a score higher than 60% in domains 1 and 3 of the Appraisal of Guidelines for Research and Evaluation II (AGREE-II). During 2016, bibliographic searches were conducted in Pubmed, EMBASE and the Cochrane library, to update 7 clinical questions of the preselected CPG, and to answer a question de novo. In regular work meetings, the GEG-Local reviewed the evidence and formulated the recommendations and flowcharts using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Finally, the CPG was approved with Resolution No. 32-IETSI-ESSALUD-2016. Results. This CPG addressed 8 clinical questions. Based on these questions, 22 recommendations were formulated (three strong recommendations and 19 weak recommendations) and four flowcharts. Conclusion. This article is the summary of the EsSalud CPG, in which the available scientific evidence on the diagnosis and treatment of hemophilia was assessed.Introducción. La hemofilia es un trastorno hemorrágico congénito poco común que requiere un manejo interdisciplinario, complejo, y frecuentemente costoso. El objetivo de la presente guía de práctica clínica (GPC) es proveer recomendaciones clínicas basadas en evidencia para el diagnóstico y tratamiento de hemofilia en el seguro social del Perú (EsSalud). Métodos. Se conformó un grupo elaborador local (GEG-Local) conformado por especialistas en hematología y metodólogos. El GEG-Local formuló ocho preguntas clínicas a ser respondidas por la presente GPC. Se buscaron y seleccionaron GPC de hemofilia que respondieran a las preguntas planteadas y obtuvieran un puntaje mayor a 60% en los dominios uno y tres del instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE-II). Durante el 2016 se realizaron búsquedas bibliográficas en Pubmed, EMBASE y biblioteca Cochrane, para actualizar siete preguntas clínicas de la GPC preseleccionada, y para responder una pregunta de novo. En reuniones de trabajo periódicas, el GEGLocal revisó la evidencia y formuló las recomendaciones y flujogramas usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Finalmente, la GPC fue aprobada con Resolución N° 32-IETSI-ESSALUD-2016. Resultados. La presente GPC abordó ocho preguntas clínicas. En base a dichas preguntas se formularon 22 recomendaciones (tres recomendaciones fuertes y 19 recomendaciones condicionales) y cuatro flujogramas. Conclusión. Este artículo es el resumen de la GPC de EsSalud, en la cual se valoró la evidencia científica disponible sobre diagnóstico y tratamiento de hemofilia

A First Search for coincident Gravitational Waves and High Energy Neutrinos using LIGO, Virgo and ANTARES data from 2007

We present the results of the first search for gravitational wave bursts associated with high energy neutrinos. Together, these messengers could reveal new, hidden sources that are not observed by conventional photon astronomy, particularly at high energy. Our search uses neutrinos detected by the underwater neutrino telescope ANTARES in its 5 line configuration during the period January - September 2007, which coincided with the fifth and first science runs of LIGO and Virgo, respectively. The LIGO-Virgo data were analysed for candidate gravitational-wave signals coincident in time and direction with the neutrino events. No significant coincident events were observed. We place limits on the density of joint high energy neutrino - gravitational wave emission events in the local universe, and compare them with densities of merger and core-collapse events.Comment: 19 pages, 8 figures, science summary page at http://www.ligo.org/science/Publication-S5LV_ANTARES/index.php. Public access area to figures, tables at https://dcc.ligo.org/cgi-bin/DocDB/ShowDocument?docid=p120000