The economic burden of tuberculosis and latent tuberculosis in people living with HIV in Brazil: a cost study from the patient perspective.

OBJECTIVE: The objective of this study was to evaluate the direct and indirect costs of tuberculosis (TB) (active and latent TB [LTB]) and HIV co-infection from the patient perspective. STUDY DESIGN: Costing study conducted alongside a pragmatic clinical trial. METHODS: The study was conducted in Brazil in a referral service for HIV/AIDS. We applied a standardised questionnaire to collect data about out-of-pocket expenses and indirect cost. The questionnaire was applied at every patient's appointment in the referral service after TB or LTB diagnosis. We followed all patients' pathways during the prediagnosis period and treatment period. For patients on sickness benefit due to TB/HIV, income loss was calculated as the difference between an employee's wages forgone and the sickness benefit received. The monetary value of the time loss was calculated based on the Brazilian minimum wage/2015. RESULTS: Among 239 people living with HIV recruited in the first year of the trial, 31 patients were included into the costing study, 26 patients who were diagnosed and treated for TB/HIV and five patients who were diagnosed and treated for LTB/HIV. TB/HIV patients incurred higher total costs than LTB/HIV (US$1,429 vs US$ 166). The main cost component for TB/HIV was indirect costs, especially income loss (US$ 749). CONCLUSIONS: Public health policies may address ways to prevent high patients' costs through the introduction of more accurate algorithms for TB diagnosis to prevent delays in the diagnosis and treatment

Serum biomarkers associated with SARS-CoV-2 severity

Immunity with SARS-CoV-2 infection during the acute phase is not sufficiently well understood to differentiate mild from severe cases and identify prognostic markers. We evaluated the immune response profile using a total of 71 biomarkers in sera from patients with SARS-CoV-2 infection, confirmed by RT-PCR and controls. We correlated biological marker levels with negative control (C) asymptomatic (A), nonhospitalized (mild cases-M), and hospitalized (severe cases-S) groups. Among angiogenesis markers, we identified biomarkers that were more frequently elevated in severe cases when compared to the other groups (C, A, and M). Among cardiovascular diseases, there were biomarkers with differences between the groups, with D-dimer, GDF-15, and sICAM-1 higher in the S group. The levels of the biomarkers Myoglobin and P-Selectin were lower among patients in group M compared to those in groups S and A. Important differences in cytokines and chemokines according to the clinical course were identified. Severe cases presented altered levels when compared to group C. This study helps to characterize biological markers related to angiogenesis, growth factors, heart disease, and cytokine/chemokine production in individuals infected with SARS-CoV-2, offering prognostic signatures and a basis for understanding the biological factors in disease severity

The functional brain networks that underlie Early Stone Age tool manufacture

After 800,000 years of making simple Oldowan tools, early humans began manufacturing Acheulian handaxes around 1.75 million years ago. This advance is hypothesized to reflect an evolutionary change in hominin cognition and language abilities. We used a neuroarchaeology approach to investigate this hypothesis, recording brain activity using functional near-infrared spectroscopy as modern human participants learned to make Oldowan and Acheulian stone tools in either a verbal or nonverbal training context. Here we show that Acheulian tool production requires the integration of visual, auditory and sensorimotor information in the middle and superior temporal cortex, the guidance of visual working memory representations in the ventral precentral gyrus, and higher-order action planning via the supplementary motor area, activating a brain network that is also involved in modern piano playing. The right analogue to Broca’s area—which has linked tool manufacture and language in prior work1,2—was only engaged during verbal training. Acheulian toolmaking, therefore, may have more evolutionary ties to playing Mozart than quoting Shakespeare

Morphofunctional changes of phytoplankton community during pluvial anomaly in a tropical reservoir

AbstractThe present study focuses on the structure and function of phytoplankton community during periods of marked changes in hydrological traits, influenced by an atypical climatic event (La Niña) and its impact on Armando Ribeiro Gonçalves Reservoir of Rio Grande do Norte, situated in the Caatinga biome of northeastern Brazil. The main questions addressed were: What are the effects of environmental factors on the temporal variation of Morphologically Based Functional Group (MBFG) of phytoplankton community? How does the composition of cyanobacterial species shift in relation to high and low trends of phytoplankton diversity? The samples were collected monthly during 2008-2009 and analyzed for pH, temperature, electrical conductivity, dissolved oxygen content and the nutrients, such as, nitrate-nitrogen, ammoniacal nitrogen, total nitrogen and orthophosphate. Phytoplankton samples were collected for both qualitative and quantitative analyses to evaluate species richness index and species diversity index. The data was divided into two distinct hydrodynamic periods of instability and stability. The results demonstrate considerable changes in dissolved oxygen content, water transparency and nitrogen nutrients, which directly influenced the MBFG of phytoplankton community in space and time. The instability of reservoir water was caused by heavy rainfall, which exerts atypical external disturbances. The seasonal variation of MBFG demonstrates a change in cyanobacterial composition and their diversity during instability and stability periods. MBFG VII, composed by colonial cyanobacteria with mucilage, was associated with reduced values of electrical conductance and alterations in pH. The predominance of filamentous species with heterocyst (MBFG III) occurs only during the hydrodynamic stability period and did not show significant association with analyzed parameters. The co-dominance of MBGFs III, V and VII along with high species diversity of phytoplankton community occurred during the second hydrodynamic instability period which was associated with the reduction in water temperature. It is concluded that the decrease in cyanobacterial species dominance and the general increase in the diversity of phytoplankton community are influenced by pluvial anomaly. The higher water level during the period of pluvial anomaly resulted in nutrient pulse and the mixing of water column in the reservoir, which determined the MBPG phytoplankton community distribution

Morphofunctional changes of phytoplankton community during pluvial anomaly in a tropical reservoir

AbstractThe present study focuses on the structure and function of phytoplankton community during periods of marked changes in hydrological traits, influenced by an atypical climatic event (La Niña) and its impact on Armando Ribeiro Gonçalves Reservoir of Rio Grande do Norte, situated in the Caatinga biome of northeastern Brazil. The main questions addressed were: What are the effects of environmental factors on the temporal variation of Morphologically Based Functional Group (MBFG) of phytoplankton community? How does the composition of cyanobacterial species shift in relation to high and low trends of phytoplankton diversity? The samples were collected monthly during 2008-2009 and analyzed for pH, temperature, electrical conductivity, dissolved oxygen content and the nutrients, such as, nitrate-nitrogen, ammoniacal nitrogen, total nitrogen and orthophosphate. Phytoplankton samples were collected for both qualitative and quantitative analyses to evaluate species richness index and species diversity index. The data was divided into two distinct hydrodynamic periods of instability and stability. The results demonstrate considerable changes in dissolved oxygen content, water transparency and nitrogen nutrients, which directly influenced the MBFG of phytoplankton community in space and time. The instability of reservoir water was caused by heavy rainfall, which exerts atypical external disturbances. The seasonal variation of MBFG demonstrates a change in cyanobacterial composition and their diversity during instability and stability periods. MBFG VII, composed by colonial cyanobacteria with mucilage, was associated with reduced values of electrical conductance and alterations in pH. The predominance of filamentous species with heterocyst (MBFG III) occurs only during the hydrodynamic stability period and did not show significant association with analyzed parameters. The co-dominance of MBGFs III, V and VII along with high species diversity of phytoplankton community occurred during the second hydrodynamic instability period which was associated with the reduction in water temperature. It is concluded that the decrease in cyanobacterial species dominance and the general increase in the diversity of phytoplankton community are influenced by pluvial anomaly. The higher water level during the period of pluvial anomaly resulted in nutrient pulse and the mixing of water column in the reservoir, which determined the MBPG phytoplankton community distribution