Pneumocystis jirovecii pneumonia in tropical and low and middle income countries: a systematic review and meta-regression

Objective: Pneumocystis jirovecii pneumonia (PCP), the commonest opportunistic infection in HIV-infected patients in the developed world, is less commonly described in tropical and low and middle income countries (LMIC). We sought to investigate predictors of PCP in these settings. Design Systematic review and meta-regression. METHODS: Meta-regression of predictors of PCP diagnosis (33 studies). Qualitative and quantitative assessment of recorded CD4 counts, receipt of prophylaxis and antiretrovirals, sensitivity and specificity of clinical signs and symptoms for PCP, co-infection with other pathogens, and case fatality (117 studies). RESULTS: The most significant predictor of PCP was per capita Gross Domestic Product, which showed strong linear association with odds of PCP diagnosis (p30%; treatment was largely appropriate. Prophylaxis appeared to reduce the risk for development of PCP, however 24% of children with PCP were receiving prophylaxis. CD4 counts at presentation with PCP were usually <200×10 3/ ml. CONCLUSIONS: There is a positive relationship between GDP and risk of PCP diagnosis. Although failure to diagnose infection in poorer countries may contribute to this, we also hypothesise that poverty exposes at-risk patients to a wide range of infections and that the relatively non-pathogenic P. jirovecii is therefore under-represented. As LMIC develop economically they eliminate the conditions underlying transmission of virulent infection: P. jirovecii , ubiquitous in all settings, then becomes a greater relative threat

Drying kinetics of bananas by natural convection: Influence of temperature, shape, blanching and cultivar Cinética de secagem de bananas por convecção natural: Influência da temperatura, formato, branqueamento e cultivar

The influence of variables as temperature, solid shape, temperature, branching and cultivar on drying of bananas were studied. Bananas from cv. Prata and D'água, on disk and cylindrical shape, blanched or not, were dehydrated in a tray dryer in natural convection at 40 and 70ºC. Drying behavior was analyzed by using a mathematical model. The exponential model showed good agreement to experimental data (r² 0.93 - 0.99 and standard error: 0.01- 0.05). Temperature presented positive influence on drying rate in all the tested conditions. With respect to the sample shape, the disk shape carried out to significantly higher drying rates only for D'água cultivar without blanching. Blanching was significantly influent, with positive influence, on drying rate of banana cv. Prata at 40º C. The influence of the cultivar did not present a defined tendency.<br>No presente trabalho, estudou-se a influência de variáveis como temperatura, formato do sólido, branqueamento e cultivar na secagem de bananas. Bananas cultivares Prata e D'água, nos formatos disco e cilindro, branqueadas ou não, foram desidratadas em secador de bandejas com convecção natural nas temperaturas de 40 e 70ºC. O comportamento da secagem foi analisado utilizandose modelagem matemática. O modelo exponencial mostrou bom ajuste aos resultados experimentais (r²: 0,93 - 0,99 e erro de estimativa padrão: 0,01 - 0,04). A temperatura apresentou influência positiva na taxa de secagem em todas as condições testadas. Com relação ao formato das amostras, o formato disco conduziu a taxas de secagem significativamente maiores somente para o cultivar D'água e sem branqueamento. O branqueamento se mostrou significativamente influente, com influência positiva na taxa de secagem da banana Prata a 40º C. A influência da cultivar não apresentou uma tendência definida