Teste rápido para o HIV como estratégia de prevenção da transmissão vertical no Brasil

OBJECTIVE: To assess the feasibility of HIV rapid testing for pregnant women at maternity hospital admission and of subsequent interventions to reduce perinatal HIV transmission. METHODS: Study based on a convenience sample of women unaware of their HIV serostatus when they were admitted to delivery in public maternity hospitals in Rio de Janeiro and Porto Alegre, Brazil, between March 2000 and April 2002. Women were counseled and tested using the Determine HIV1/2 Rapid Test. HIV infection was confirmed using the Brazilian algorithm for HIV infection diagnosis. In utero transmission of HIV was determined using HIV-DNA-PCR. There were performed descriptive analyses of sociodemographic data, number of previous pregnancies and abortions, number of prenatal care visits, timing of HIV testing, HIV rapid test result, neonatal and mother-to-child transmission interventions, by city studied. RESULTS: HIV prevalence in women was 6.5% (N=1,439) in Porto Alegre and 1.3% (N=3.778) in Rio de Janeiro. In Porto Alegre most of women were tested during labor (88.7%), while in Rio de Janeiro most were tested in the postpartum (67.5%). One hundred and forty-four infants were born to 143 HIV-infected women. All newborns but one in each city received at least prophylaxis with oral zidovudine. It was possible to completely avoid newborn exposure to breast milk in 96.8% and 51.1% of the cases in Porto Alegre and Rio de Janeiro, respectively. Injectable intravenous zidovudine was administered during labor to 68.8% and 27.7% newborns in Porto Alegre and Rio de Janeiro, respectively. Among those from whom blood samples were collected within 48 hours of birth, in utero transmission of HIV was confirmed in 4 cases in Rio de Janeiro (4/47) and 6 cases in Porto Alegre (6/79). CONCLUSIONS: The strategy proved feasible in maternity hospitals in Rio de Janeiro and Porto Alegre. Efforts must be taken to maximize HIV testing during labor. There is a need of strong social support to provide this population access to health care services after hospital discharge.OBJETIVO: Analizar la viabilidad de evaluación rápida del HIV entre gestantes en la admisión en la maternidad y de intervenciones para reducir la transmisión perinatal del HIV. MÉTODOS: Muestra de conveniencia de mujeres que desconocían su situación serológica para el HIV al ser admitidas para el parto en maternidades públicas de Rio de Janeiro (Sureste) y de Porto alegre (Sur de Brasil), entre marzo de 2000 y abril de 2002. Las mujeres fueron aconsejadas y evaluadas con prueba rápida Determine HIV1/2 en la maternidad. Infección por el HIV fue confirmada por el algoritmo brasilero para el diagnóstico de la infección por el HIV. La transmisión intra- útero fue determinada por el PCR-DNA-HIV. Fueron realizados análisis descriptivos de los datos sociodemográficos, número de gestaciones y de abortos previos, número de visitas de prenatal, momento de la evaluación para el HIV, resultado de la prueba rápida para el HIV, intervenciones recibidas por los recién nacidos y de transmisión vertical del HIV, de acuerdo con cada ciudad. RESULTADOS: La prevalencia de HIV entre las mujeres fue de 6,5% (N=1.439) en Porto Alegre y 1,3% (N=3,778) en Rio de Janeiro. La mayoría fue evaluada durante el trabajo de parto en Porto Alegre y en el postparto, en Rio de Janeiro. Ciento y cuarenta y cuatro niños nacieron de 143 mujeres infectadas por el HIV. Todos los recién nacidos recibieron al menos la profilaxia con zidovudina oral, excepto uno en cada ciudad. Fue posible evitar cualquier exposición a la leche materna en 96,8% y 51,1% de los recién nacidos en Porto Alegre y en Rio de Janeiro, respectivamente. La zidovudina inyectable fue administrada durante el trabajo de parto a 68,8% de los recién nacidos en Porto Alegre y 27,7% en Rio de Janeiro. Entre aquellos con muestras de sangre colectadas hasta 48 horas de nacimiento, la transmisión intra-útero fue confirmada en cuatro casos en Rio de Janeiro (4/47) y en seis casos en Porto Alegre (6/79). CONCLUSIONES: La estrategia se mostró factible en las maternidades de Rio de Janeiro y de Porto Alegre. Esfuerzos deben ser emprendidos para maximizar la evaluación durante el trabajo de parto. Fuerte soporte social precisa ser acoplado a esa estrategia para garantizar el acceso de dicha población al sistema de salud posterior a ser dado de alta de la maternidad.OBJETIVO: Analisar a viabilidade da testagem rápida para o HIV entre gestantes na admissão à maternidade e de intervenções para reduzir a transmissão perinatal do HIV. MÉTODOS: Amostra de conveniência de mulheres que desconheciam sua situação sorológica para o HIV quando admitidas para o parto em maternidades públicas do Rio de Janeiro, RJ, e de Porto Alegre, RS, entre março de 2000 e abril de 2002. As mulheres foram aconselhadas e testadas com teste rápido Determine HIV1/2 na maternidade. Infecção pelo HIV foi confirmada pelo algoritmo brasileiro para o diagnóstico da infecção pelo HIV. A transmissão intra-útero foi determinada pelo PCR-DNA-HIV. Foram realizadas análises descritivas dos dados sociodemográficos, número de gestações e de abortos prévios, número de visitas de pré-natal, momento da testagem para o HIV, resultado do teste rápido para o HIV, intervenções recebidas pelos recém-natos e de transmissão vertical do HIV, de acordo com cada cidade. RESULTADOS: A prevalência de HIV entre as mulheres foi 6,5% (N=1.439) em Porto Alegre e 1,3% (N=3.778) no Rio de Janeiro. A maioria foi testada durante o trabalho de parto em Porto Alegre e no pós-parto, no Rio de Janeiro. Cento e quarenta e quatro crianças nasceram de 143 mulheres infectadas pelo HIV. Todos os recém-natos receberam ao menos a profilaxia com zidovudina oral, exceto um em cada cidade. Foi possível evitar qualquer exposição ao leite materno em 96,8% e 51,1% dos recém-natos em Porto Alegre e no Rio de Janeiro, respectivamente. A zidovudina injetável foi administrada durante o trabalho de parto para 68,8% dos recém-natos em Porto Alegre e 27,7% no Rio de Janeiro. Entre aqueles com amostras de sangue coletadas até 48 horas do nascimento, a transmissão intra-útero foi confirmada em quatro casos no Rio de Janeiro (4/47) e em seis casos em Porto Alegre (6/79). CONCLUSÕES: A estratégia mostrou-se factível nas maternidades do Rio de Janeiro e de Porto Alegre. Esforços devem ser empreendidos para maximizar a testagem durante o trabalho de parto. Forte suporte social precisa ser acoplado a essa estratégia para garantir o acesso dessa população ao sistema de saúde após a alta da maternidade

Narrowing maize yield gaps across smallholder farming systems in Zambia : What interventions, where, and for whom?

Maize production in Zambia must increase with a view towards improved food security and reduced food imports whilst avoiding cropland expansion. To achieve this, it is important to understand the causes behind the large maize yield gaps observed in smallholder farming systems across the country. This is the first study providing a yield gap decomposition for maize in Zambia, and combining it with farm typology delineation, to identify the key limiting factors to maize yield gaps across the diversity of farms in the country. The analysis builds upon a nationally representative household survey covering three growing seasons and crop model simulations to benchmark on-farm maize yields and N application rates. Three farm types were delineated, including households for which maize is a marginal crop, households who are net buyers of maize, and households who are market-oriented maize producers. Yield gap closure was about 20% of the water-limited yield, corresponding to an actual yield of 2.4 t ha− 1. Market-oriented maize farms yielded slightly more than the other farm types, yet the drivers of yield variability were largely consistent across farm types. The large yield gap was mostly attributed to the technology yield gap indicating that more efficient production methods are needed to raise maize yields beyond the levels observed in highest yielding fields. Yet, narrowing efficiency and resource yield gaps through improved crop management (i.e., sowing time, plant population, fertilizer inputs, and weed control) could more than double current yields. Creating a conducive environment to increase maize production should focus on the dissemination of technologies that conserve soil moisture in semi-arid areas and improve soil health in humid areas. Recommendations of sustainable intensification practices need to consider profitability, risk, and other non-information constraints to improved crop management and must be geographically targeted to the diversity of farming systems across the country

Risk aversion, impatience, and adoption of conservation agriculture practices among smallholders in Zambia

Sustainable agricultural practices such as conservation agriculture have been promoted in southern Africa for nearly three decades, but their adoption remains low. It is of policy interest to unpack behavioural drivers of adoption to understand why adoption remains lower than anticipated. This paper assesses the effects of risk aversion and impatience on the extent and intensity of the adoption of conservation agriculture using panel data collected from 646 households in 2021 and 2022 in Zambia. We find that 12% and 18% of the smallholders were impatient and risk averse, respectively. There are two main empirical findings based on panel data Probit and Tobit models. First, on the extensive margin, being impatient is correlated with a decreased likelihood of adopting combined minimum-tillage (MT) and rotation by 2.9 percentage points and being risk averse is associated with a decreased propensity of adopting combined minimum tillage (MT) and mulching by 3.2 percentage points. Being risk averse is correlated with a decreased chance of adopting basins by 2.8 percentage points. Second, on the intensive margin, impatience and risk aversion are significantly correlated with reduced adoption intensity of basins, ripping, minimum tillage (MT), and combined MT and rotation by 0.02–0.22 ha. These findings imply a need to embed risk management (e.g., through crop yield insurance) in the scaling of sustainable agricultural practices to incentivise adoption. This can help to nudge initial adoption and to protect farmers from yield penalties that are common in experimentation stages

Real‐world experience with weight gain among pregnant women living with HIV who are using integrase inhibitors

ObjectivesWe assessed real-world weight change and pregnancy outcomes among pregnant women living with HIV who used integrase strand transferase inhibitor (INSTI)-based combined antiretroviral therapy (cART).MethodsIn a retrospective cohort study from 2014 to 2021 for prevention of perinatal HIV infection, we evaluated changes in weight from the first prenatal visit to near delivery for two groups. The categories of change were: low (< 0.18 kg/week), normal (0.18-0.59 kg/week), and high (> 0.59 kg/week). The backbones were lamivudine + tenofovir disoproxil or lamivudine + zidovudine. The comparison groups were women with body mass index (BMI) < 25 kg/m2 versus BMI ≥ 25 kg/m2 and INSTI-naïve versus INSTI-experienced. Continuous variables were analysed with a Kruskal-Wallis test and count or categorical data with χ2 tests.ResultsWe enrolled 198 pregnant women. At study entry, 74 had BMI < 25 kg/m2 and 124 had BMI ≥ 25 kg/m2 . Excess gestational weight gain was more frequent among women who were INSTI-naïve among both BMI groups (< 25 and ≥ 25). However, the proportion of participants per weight change category was only significantly different between INSTI-naïve women with baseline BMI < 25 kg/m2 and INSTI-experienced women with BMI < 25 kg/m2 . In particular, INSTI-naïve women with BMI < 25 kg/m2 had significantly higher rates of excess gestational weight gain (31.6%) compared with participants with BMI < 25 kg/m2 who conceived while on INSTIs (11.8%, p = 0.004). Rates of unfavourable pregnancy outcomes were low and did not differ significantly between groups.ConclusionsINSTI-naïve participants with BMI < 25 kg/m2 gained more weight during pregnancy than participants with BMI ≥ 25 kg/m2 who conceived while using INSTIs. Rates of adverse pregnancy outcomes did not differ between the groups

Predictors of Viremia in Postpartum Women on Antiretroviral Therapy.

BackgroundHIV-infected, postpartum women on antiretroviral therapy (ART) have high rates of viremia. We examined predictors of postpartum viremia in the PROMISE study.MethodsWomen with pre-ART CD4 T-cell counts ≥400 cells/mm who started ART during pregnancy were randomized postpartum to continue ART (CTART) or discontinue ART (DCART). Viral load and self-reported adherence were collected every 12 weeks, up to 144 weeks. Women in DCART reinitiated therapy when clinically indicated. Viremia was defined as 2 consecutive viral loads >1000 copies/mL after 24 weeks on ART. Adherence was dichotomized as missing versus not missing ART doses in the past 4 weeks. Predictors of viremia were examined using Cox proportional hazards regression with adherence as a time-varying covariate.ResultsAmong 802 women in the CTART arm, median age at entry was 27 years and median CD4 T-cell count 696 cells/mm. Of 175 women in CTART with viremia (22%), 141 had resistance data, and 12% had resistance to their current regimen. There was an estimated 0.12 probability of viremia by week 48 and 0.25 by week 144. Predictors of viremia included missed ART doses within the past 4 weeks, younger age, shorter duration of pre-entry ART, and being from the South American/Caribbean region. Of 137 women in DCART who reinitiated therapy, probability of viremia was similar to CTART (0.24 by week 96; 0.27 by week 144).ConclusionsRates of postpartum viremia are high and viremia is more likely in younger postpartum women who start ART later in pregnancy. Interventions should target these higher-risk women

Embolismo por mercúrio metálico: relato de caso Embolism caused by metallic mercury: a case report

Relata-se um caso de um paciente do sexo masculino, de 29 anos de idade, que na tentativa de auto-extermínio injetou 2 ml de mercúrio industrial no antebraço esquerdo. O estudo radiológico mostrou várias esferas metálicas no subcutâneo da fossa olecraniana e ao longo das veias do braço esquerdo, com disseminação para pulmões, coração, fígado, baço e encéfalo.<br>A case of a male, 29-year-old patient who, in a suicide attempt, has self-administered a 2 ml injection of metallic mercury into his left arm is reported. Radiological studies have shown the presence of several metallic spheres in the subcutaneous tissue of the olecranal fossa and along the veins of the left arm, with dissemination to lungs, heart, liver, spleen and brain

Studies on stem cuttings of kiwi (Actinidia chinensis PL. CV Bruno)

The work was carried out to study the effects of some auxins and boron in the rooting of kiwi (Actinidia chinensis Planch cv Bruno) stem cuttings.. These cuttings were treated on the base individually with H2O; NAA 300 mg.L-1; IBA 300 mg.L-1; NAA 300 mg.L-1 + Boron; IBA 300 mg.L-1 + Boron; NAA 0,5%-talc and IBA 0,5%-talc. After the treatments, the cuttings were placed in styrofoam trays with vermiculite under moist conditions for 120 days. The evaluation of auxin and boric acid effects were made by observing rooted stem cuttings percentage; reducing and total sugar analysis (g/100 g of dry matter); and tryptophan analysis (in µg/100 mg of dry matter). The effects of such treatments were observed during four seasons of the year. The results showed that summer season was the best for rooting. Use of IBA or NAA in the cuttings showed to be unnecessary.<br>O presente trabalho teve como objetivo, estudar o efeito de auxinas sintéticas e do boro, sobre o enraizamento de estacas caulinares de kiwi (Actinidia chinensisPlanch. cv Bruno). As estacas continham dois nós com aproximadamente 10 cm de comprimento, contendo 2 folhas cortadas ao meio. As bases das estacas receberam os seguintes tratamentos: control (H2O); NAA 300 mg.L-1; IBA 300 mg.L-1; NAA 300 mg.L-1 + B; IBA 300 mg.L-1 + B; NAA 0,5%-pó e IBA 0,5%-pó. Após os tratamentos as estacas foram plantadas em bandejas de enraizamento contendo vermiculita pura e colocadas em câmara de nebulização por 120 dias até a coleta das mesmas. Para a avaliação do efeito das auxinas e boro, foram realizadas as seguintes observações: 1. porcentagem de estacas enraizadas; 2. análise de açúcares redutores e açúcares totais (em g/100 g de matéria seca); 3. análise de triptofano (em µg/100 mg de matéria seca). Além disso, foram verificados o efeito dos tratamentos em quatro épocas, que corresponderam às estações do ano (primavera, verão, outono e inverno). Através dos resultados obtidos no processo de enraizamento de estacas caulinares de kiwi (Actinidia chinensis Planch. cv Bruno), conclui-se ser o verão a melhor época de coleta dos ramos para a produção das estacas sem a necessidade do tratamento com auxinas