Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Population-level sexual mixing by HIV status and pre-exposure prophylaxis use among men who have sex with men in Montreal, Canada: implications for HIV prevention

There is are limited data on population-level mixing patterns by HIV status or pre- exposure prophylaxis (PrEP) use. Using cross-sectional survey data (Engage, 2017- 2018) of 1137 men who have sex with men (MSM) ≥16 year-old in Montreal, we compared observed seroconcordance in the past-six6-month sexual partnerships to what would have been observed by chance if zero individuals serosort. Of five 5 recent partnerships where both individuals were HIV-negative, we compared observed concordance in PrEP use to the counterfactual if zero individuals selected partners based on PrEP use. We estimated the concordance by chance using a balancing- partnerships approach assuming proportionate-mixing. HIV-positive respondents had a higher proportion of HIV-positive partners (66.4% (95% confidence interval: 64.0%- 68.6%)) than by chance (23.9%(23.1%-24.7%)). HIV-negative respondents (both on and not on PrEP) had higher proportions of HIV-negative partners (82.9%(81.1%- 84.7%), and 90.7%(89.6%-91.7%), respectively) compared with by chance (82.9%(81.1%-84.7%), and 90.7%(89.6%-91.7%), respectively, vs. 76.1%(75.3%- 76.9%)); but those on PrEP had a higher proportion of HIV-positive partners than those not on PrEP (17.1%(15.3%-18.9%) vs. 9.3%(8.3%-10.4%)). Those on PrEP also had a higher proportion of partners on PrEP among their HIV-negative partners (50.6%(42.5%-58.8%)) than by chance (28.5%(27.5%-29.4%)). The influence ofrelationship between PrEP on and sexual-mixing patterns demonstrated by less population-level serosorting among those on PrEP and PrEP-matching warrants consideration during PrEP roll-out.<br/

HIV pre-exposure prophylaxis (PrEP) use among Urban Canadian gay, bisexual and other men who have sex with men for whom PrEP is clinically recommended: baseline results from the Engage cohort study

Background: in Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Use of HIV pre-exposure prophylaxis (PrEP) by GBM for whom PrEP is clinically recommended, is unknown. We report on PrEP access and factors associated with not using PrEP, among HIV-negative/unknown GBM in Montreal, Toronto and Vancouver. Methods: from 2017 to 2019, the Engage study recruited sexually-active GBM≥16 years in Montréal(M), Toronto(T), and Vancouver(V) via respondent-driven sampling (RDS). Participation included HIV/STI testing and a questionnaire. We examined PrEP access using a health services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those who were PrEP-aware and clinically recommended. Results: a total of 2449 GBM were recruited. 2008 were HIV-negative/unknown with 1159 (n=511(M), n=247(T), n=401(V)) meeting PrEP recommendations. Of these, 1100 were PrEP-aware (RDS-adjusted %: M=85%, T=94%, V=93%), 678 felt the need for PrEP (M=39%, T=56%, V=49%), 406 tried to access it (M=21%, T=33%, V=30%) and 319 used PrEP (M=15%, T=22%, V=22%) in the past 6 months. Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider, and lacking medication insurance. Conclusion: while half of GBM from Canada’s three largest cities met clinical recommendations for PrEP, less than a quarter reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health system barriers is needed to scale-up PrEP access and ultimately end the HIV epidemic among GBM in Canada.<br/

New mutations of CIAS1 that are responsible for Muckle-Wells syndrome and familial cold urticaria: A novel mutation underlies both syndromes

Mutations of CIAS1 have recently been shown to underlie familial cold urticaria (FCU) and Muckle-Wells syndrome (MWS), in three families and one family, respectively. These rare autosomal dominant diseases are both characterized by recurrent inflammatory crises that start in childhood and that are generally associated with fever, arthralgia, and urticaria. The presence of sensorineural deafness that occurs later in life is characteristic of MWS. Amyloidosis of the amyloidosis-associated type is the main complication of MWS and is sometimes associated with FCU. In FCU, cold exposure is the triggering factor of the inflammatory crisis. We identified CIAS1 mutations, all located in exon 3, in nine unrelated families with MWS and in three unrelated families with FCU, originating from France, England, and Algeria. Five mutations—namely, R260W, D303N, T348M, A439T, and G569R—were novel. The R260W mutation was identified in two families with MWS and in two families with FCU, of different ethnic origins, thereby demonstrating that a single CIAS1 mutation may cause both syndromes. This result indicates that modifier genes are involved in determining either a MWS or a FCU phenotype. The finding of the G569R mutation in an asymptomatic individual further emphasizes the importance of such modifier a gene (or genes) in determining the disease phenotype. Identification of this gene (or these genes) is likely to have significant therapeutic implications for these severe diseases

Echinodermata: The Complex Immune System in Echinoderms

View references (418) The Echinodermata are an ancient phylum of benthic marine invertebrates with a dispersal-stage planktonic larva. These animals have innate immune systems characterized initially by clearance of foreign particles, including microbes, from the body cavity of both larvae and adults, and allograft tissue rejection in adults. Immune responsiveness is mediated by a variety of adult coelomocytes and larval mesenchyme cells. Echinoderm diseases from a range of pathogens can lead to mass die-offs and impact aquaculture, but some individuals can recover. Genome sequences of several echinoderms have identified genes with immune function, including expanded families of Toll-like receptors, NOD-like receptors, and scavenger receptors with cysteine-rich domains, plus signaling pathways and cytokines. The set of transcription factors that regulate proliferation and differentiation of the cellular immune system are conserved and indicate the ancestral origins of hematopoiesis. Both larval and adult echinoderms are in constant contact with potential pathogens in seawater, and they respond to infection by phagocytosis and encapsulation, and employ proteins that function in immune detection and response. Antipathogen responses include activation of the SpTransformer genes, a complement system, and the production of many types of antimicrobial peptides. Echinoderms have homologues of the recombinase activating genes plus all associated genes that function in vertebrates for immunoglobulin gene family rearrangement, although their gene targets are unknown. The echinoderm immune system has been characterized as unexpectedly complex, robust, and flexible. Many echinoderms have very long life-spans that correlate with an excellent capacity for cell damage repair. In many marine ecosystems, echinoderms are keystone predators and herbivores, and therefore are species that can serve as optimal sentinels of environmental health. Coelomocytes can be employed in sensor systems to test for the presence of marine pollutants. When Elie Metchnikoff inserted a rose prickle into a larval sea star and observed chemotaxis, phagocytosis, and encapsulation by the mesenchyme cells, he initiated not only the field of immunology but also that of comparative immunology, of which the echinoderms have been an important part