Augmented plasma microparticles during acute Plasmodium vivax infection

Background: In the last few years, the study of microparticles (MPs) - submicron vesicles released from cells upon activation or apoptosis - has gained growing interest in the field of inflammation and in infectious diseases. Their role in the human malaria parasite Plasmodium vivax remains unexplored. Because acute vivax malaria has been related to pro-inflammatory responses, the main hypothesis investigated in this study was that Plasmodium vivax infection is associated with elevated levels of circulating MPs, which may play a role during acute disease in nonimmune patients. Methods: Plasma MPs were analysed among thirty-seven uncomplicated P. vivax infections from an area of unstable malaria transmission in the Brazilian Amazon. The MP phenotype was analysed by flow cytometry using the classical MP marker, annexin, and fluorochrome-labeled monoclonal antibodies against specific cell surface markers. The frequencies of plasma MPs in P. vivax patients (n = 37) were further compared to malaria-unexposed controls (n = 15) and ovarian carcinoma patients (n = 12), a known MPs-inducing disease non-related to malaria. Results: The frequencies of plasma circulating MPs were markedly increased in P. vivax patients, as compared to healthy age-matched malaria-unexposed controls. Although platelets, erythrocytes and leukocytes were the main cellular sources of MPs during vivax malaria, platelet derived-MPs (PMPs) increased in a linear fashion with the presence of fever at the time of blood collection (b = 0.06, p < 0.0001) and length of acute symptoms (b = 0.36, p < 0.0001). Finally, the results suggest that plasma levels of PMPs diminish as patient experience more episodes of clinical malaria (b = 0.07, p < 0.003). Conclusions: Abundant circulating MPs are present during acute P. vivax infection, and platelet derived-MPs may play a role on the acute inflammatory symptoms of malaria vivax

Working with interpreters: how student behavior affects quality of patient interaction when using interpreters

Background: Despite the prevalence of medical interpreting in the clinical environment, few medical professionals receive training in best practices when using an interpreter. We designed and implemented an educational workshop on using interpreters as part of the cultural competency curriculum for second year medical students (MSIIs) at David Geffen School of Medicine at UCLA. The purpose of this study is two-fold: first, to evaluate the effectiveness of the workshop and second, if deficiencies are found, to investigate whether the deficiencies affected the quality of the patient encounter when using an interpreter. Methods: A total of 152 MSIIs completed the 3-hour workshop and a 1-station objective-structured clinical examination, 8 weeks later to assess skills. Descriptive statistics and independent sample t-tests were used to assess workshop effectiveness. Results: Based on a passing score of 70%, 39.4% of the class failed. Two skills seemed particularly problematic: assuring confidentiality (missed by 50%) and positioning the interpreter (missed by 70%). While addressing confidentiality did not have a significant impact on standardized patient satisfaction, interpreter position did. Conclusion: Instructing the interpreter to sit behind the patient helps sustain eye contact between clinician and patient, while assuring confidentiality is a tenet of quality clinical encounters. Teaching students and faculty to emphasize both is warranted to improve cross-language clinical encounters

New mutations at the imprinted Gnas cluster show gene dosage effects of Gsα in postnatal growth and implicate XLαs in bone and fat metabolism, but not in suckling

The imprinted Gnas cluster is involved in obesity, energy metabolism, feeding behavior, and viability. Relative contribution of paternally expressed proteins XLαs, XLN1, and ALEX or a double dose of maternally expressed Gsα to phenotype has not been established. In this study, we have generated two new mutants (Ex1A-T-CON and Ex1A-T) at the Gnas cluster. Paternal inheritance of Ex1A-T-CON leads to loss of imprinting of Gsα, resulting in preweaning growth retardation followed by catch-up growth. Paternal inheritance of Ex1A-T leads to loss of imprinting of Gsα and loss of expression of XLαs and XLN1. These mice have severe preweaning growth retardation and incomplete catch-up growth. They are fully viable probably because suckling is unimpaired, unlike mutants in which the expression of all the known paternally expressed Gnasxl proteins (XLαs, XLN1 and ALEX) is compromised. We suggest that loss of ALEX is most likely responsible for the suckling defects previously observed. In adults, paternal inheritance of Ex1A-T results in an increased metabolic rate and reductions in fat mass, leptin, and bone mineral density attributable to loss of XLαs. This is, to our knowledge, the first report describing a role for XLαs in bone metabolism. We propose that XLαs is involved in the regulation of bone and adipocyte metabolism

Mineralization of sheep manure and its influence on lettuce production

Diversos resíduos orgânicos são utilizados na agricultura sem o adequado conhecimento da sua dinâmica de mineralização. Avaliou-se a mineralização de esterco de ovinos e sua influência na produção de alface. Utilizou-se o delineamento experimental de blocos ao acaso com três repetições. Foram utilizadas 25 t ha-1 como dose de esterco para cada um dos seguintes tratamentos: 1) esterco de ovinos que se alimentaram de feno de mandioca (PAM); 2) esterco de ovinos que se alimentaram de subproduto de ervilha (ERV); 3) esterco de ovinos que se alimentaram de feno de capim coast-cross (FCC); 4) esterco de ovinos que se alimentaram de subproduto de saccharina (SAC) e 5) solo sem aplicação de esterco (testemunha). Foi determinada semanalmente a respiração basal do solo, utilizada como indicador de mineralização da matéria orgânica. A massa fresca de alface foi avaliada como medida de produção. Os tratamentos ERV, FCC e SAC apresentaram ganhos de massa fresca na ordem de 68, 65 e 62% em relação à testemunha e de 43, 39 e 33% em relação ao PAM, respectivamente. A produção menor promovida pelo PAM, em relação às demais, pode ser explicada pela forma de mineralização da matéria orgânica que apresentou elevada respiração microbiana cinco dias após o transplantio, com acentuado declínio, nas medições subseqüentes, ao longo do ciclo da cultura. Os demais tratamentos apresentaram mineralização sincronizada com conseqüente aumento na produção de massa fresca. ____________________________________________________________________________________________________________ ABSTRACTSeveral organic wastes are used in agriculture with no precise knowledge about the mineralization dynamics of these materials. In this study the sheep manure mineralization and its influence on the lettuce production was evaluated. A randomized block design with three replications was used. Five treatments were studied using 25 t ha-1 as dose of manure: 1) sheep manure obtained from animals fed with cassava straw (PAM); 2) sheep manure obtained from animals fed with residue of pea crop (ERV); 3) sheep manure obtained from animals fed with Coast-Cross hay (FCC), 4) sheep manure obtained from animals fed with saccharin residue (SAC) and 5) soil without application of manure (control). Weekly the basal respiration was determined and used as an indicator of organic matter mineralization. Lettuce fresh mass was evaluated as a measure of production. Treatments ERV, FCC and SAC showed superior weight gains of 68, 65 and 62% compared to the control and 43, 39 and 33% compared to MAP, respectively. Lower production promoted by the MAP in relation to the other treatments can be explained by organic matter mineralization that showed a high microbial respiration five days after transplanting, with marked decline in subsequent measurements during the crop cycle. The other systems showed mineralization synchronized with the production increase of lettuce fresh mass

Dietary supplement use among health care professionals enrolled in an online curriculum on herbs and dietary supplements

BACKGROUND: Although many health care professionals (HCPs) in the United States have been educated about and recommend dietary supplements, little is known about their personal use of dietary supplements and factors associated with their use. METHODS: We surveyed HCPs at the point of their enrollment in an on-line course about dietary supplements between September, 2004 and May, 2005. We used multivariable logistic regression to analyze demographic and practice factors associated with use of dietary supplements. RESULTS: Of the 1249 health care professionals surveyed, 81 % reported having used a vitamin, mineral, or other non-herbal dietary supplements in the last week. Use varied by profession with highest rates among nurses (88%), physician assistants or nurse practitioners (84 %) and the lowest rates among pharmacists (66%) and trainees (72%). The most frequently used supplements were multivitamins (60%), calcium (40%), vitamin B (31%), vitamin C (30%), and fish oil (24%). Factors associated with higher supplement use were older age, female, high knowledge of dietary supplements, and discussing dietary supplements with patients. In our adjusted model, nurses were more likely than other professionals to use a multivitamin and students were more likely to use calcium. CONCLUSION: Among HCPs enrolled in an on-line course about dietary supplements, women, older clinicians, those with higher knowledge and those who talk with patients about dietary supplements had higher use of dietary supplements. Additional research is necessary to understand the impact of professionals' personal use of dietary supplements on communication with patients about them

Changes in use of herbs and dietary supplements (HDS) among clinicians enrolled in an online curriculum

<p>Abstract</p> <p>Background</p> <p>Little is known about clinicians' use of herbs and dietary supplements (HDS), how their personal HDS use changes with time and training, and how changes in their personal use affect their confidence or communication with patients about HDS.</p> <p>Methods</p> <p>We conducted a prospective cohort study of clinicians before and after an on-line curriculum about HDS in winter-spring, 2005.</p> <p>Results</p> <p>Of the 569 clinicians who completed surveys both at baseline and after the course, 25% were male and the average age was 42 years old; 88% used HDS before and after the course. The average number of supplements used fell slightly from 6.2 at baseline to 5.8 after the course (P < 0.01). The most commonly used supplements at baseline were: multivitamins (65%), calcium (42%), B vitamins (34%), vitamin C (34%), green tea (27%), fish oil (27%) and vitamin E (25%). Use of fish oil increased to 30% after the course (P = 0.01). Use of supplements traditionally used to treat colds decreased: vitamin C (34% to 27%), zinc (13% to 10%), and echinacea (7% to 5%, P < 0.05 for all three). Changes in personal HDS use were not associated with significant changes in confidence or communication with patients.</p> <p>Conclusion</p> <p>Many clinicians use HDS personally; use changes seasonally and to a small extent with professional education. Professional use of HDS is dynamic and seasonal. Additional research is needed to understand the impact of personal use on professional attitudes and behavior in populations with lower baseline uses of HDS.</p

Comprehensiveness and programmatic vulnerability to stds/hiv/aids in primary care

This study aimed to identify programmatic vulnerability to STDs/HIV/AIDS in primary health centers (PHCs). This is a descrip - tive and quantitative study carried out in the city of São Paulo. An online survey was applied (FormSUS platform), involving administrators from 442 PHCs in the city, with responses received from 328 of them (74.2%), of which 53.6% were nurses. At - tention was raised in relation to program - matic vulnerability in the PHCs regarding certain items of infrastructure, prevention, treatment, prenatal care and integration among services on STDs/HIV/AIDS care. It was concluded that in order to reach comprehensiveness of actions for HIV/ AIDS in primary health care, it is necessary to consider programmatic vulnerability, in addition to more investment and reor - ganization of services in a dialogue with the stakeholders (users, multidisciplinary teams, and managers, among others)

Factors Associated with Colposcopy-Histopathology Confirmed Cervical Intraepithelial Neoplasia among HIV-Infected Women from Rio De Janeiro, Brazil

Introduction: Despite the availability of preventive strategies (screening tests and vaccines), cervical cancer continues to impose a significant health burden in low- and medium-resourced countries. HIV-infected women are at increased risk for infection with human papillomavirus (HPV) and thus development of cervical squamous intraepithelial neoplasia (CIN). Methods:Study participants included HIV-infected women enrolling the prospective open cohort of Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/FIOCRUZ). At cohort entry, women were subjected to conventional Papanicolaou test, HPV-DNA test and colposcopy; lesions suspicious for CIN were biopsied. Histopathology report was based on directed biopsy or on specimens obtained by excision of the transformation zone or cervical conization. Poisson regression modeling was used to assess factors associated with CIN2+diagnosis. Results:The median age of the 366 HIV-infected women included in the study was 34 years (interquartile range: 28–41 years). The prevalence of CIN1, CIN2 and CIN3 were 20.0%, 3.5%, and 2.2%, respectively. One woman was found to have cervical cancer. The prevalence of CIN2+was 6.0%. Factors associated with CIN2+diagnosis in the multivariate model were age,years compared to$35 years (aPR = 3.22 95CD4 T-cell count,350 cells/mm3 when compared to$350 cells/mm3 (aPR = 6.03 95%CI 1.50–24.3) and concomitant diagnosis of vulvar and/or vaginal intraepithelial lesion (aPR = 2.68 95%CI 0.99–7.24). Discussion:Increased survival through wide-spread use of highly active antiretroviral therapy might allow for the development of cervical cancer. In Brazil, limited cytology screening and gynecological care adds further complexity to the HIV-HPV co-infection problem. Integrated HIV care and cervical cancer prevention programs are needed for the prevention of cervical cancer mortality in this group of wome

Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups