Timing of antiretroviral therapy in Cambodian hospital after diagnosis of tuberculosis: impact of revised WHO guidelines

OBJECTIVE: To determine if implementation of 2010 World Health Organization (WHO) guidelines on antiretroviral therapy (ART) initiation reduced delay from tuberculosis diagnosis to initiation of ART in a Cambodian urban hospital. METHODS: A retrospective cohort study was conducted in a nongovernmental hospital in Phnom Penh that followed new WHO guidelines in patients with human immunodeficiency virus (HIV) and tuberculosis. All ART-naïve, HIV-positive patients initiated on antituberculosis treatment over the 18 months before and after guideline implementation were included. A competing risk regression model was used. FINDINGS: After implementation of the 2010 WHO guidelines, 190 HIV-positive patients with tuberculosis were identified: 53% males; median age, 38 years; median baseline CD4+ T-lymphocyte (CD4+ cell) count, 43 cells/µL. Before implementation, 262 patients were identified; 56% males; median age, 36 years; median baseline CD4+ cell count, 59 cells/µL. With baseline CD4+ cell counts ≤ 50 cells/µL, median delay to ART declined from 5.8 weeks (interquartile range, IQR: 3.7–9.0) before to 3.0 weeks (IQR: 2.1–4.4) after implementation (P < 0.001); with baseline CD4+ cell counts > 50 cells/µL, delay dropped from 7.0 (IQR: 5.3–11.3) to 3.6 (IQR: 2.9–5.3) weeks (P < 0.001). The probability of ART initiation within 4 and 8 weeks after tuberculosis diagnosis rose from 23% and 65%, respectively, before implementation, to 62% and 90% after implementation. A non-significant increase in 6-month retention and antiretroviral substitution was seen after implementation. CONCLUSION: Implementation of 2010 WHO recommendations in a routine clinical setting shortens delay to ART. Larger studies with longer follow-up are needed to assess impact on patient outcomes

The role of the lateral prefrontal cortex and anterior cingulate in stimulus–response association reversals

Many complex tasks require us to flexibly switch between behavioral rules, associations, and strategies. The prefrontal cerebral cortex is thought to be critical to the performance of such behaviors, although the relative contribution of different components of this structure and associated subcortical regions are not fully understood. We used functional magnetic resonance imaging to measure brain activity during a simple task which required repeated reversals of a rule linking a colored cue and a left/right motor response. Each trial comprised three discrete events separated by variable delay periods. A colored cue instructed which response was to be executed, followed by a go signal which told the subject to execute the response and a feedback instruction which indicated whether to ‘‘hold’’ or ‘‘f lip’’ the rule linking the colored cue and response. The design allowed us to determine which brain regions were recruited by the specific demands of preparing a rule contingent motor response, executing such a response, evaluating the significance of the feedback, and reconfiguring stimulus–response (SR) associations. The results indicate that an increase in neural activity occurs within the anterior cingulate gyrus under conditions in which SR associations are labile. In contrast, lateral frontal regions are activated by unlikely/unexpected perceptual events regardless of their significance for behavior. A network of subcortical structures, including the mediodorsal nucleus of the thalamus and striatum were the only regions showing activity that was exclusively correlated with the neurocognitive demands of reversing SR associations. We conclude that lateral frontal regions act to evaluate the behavioral significance of perceptual events, whereas medial frontal–thalamic circuits are involved in monitoring and reconfiguring SR associations when necessary

Effects of cooking on anthocyanin concentration and bioactive antioxidant capacity in glutinous and non-glutinous purple rice

Purple rice is a source of bioactive antioxidants for rice consumers. Loss of the major antioxidant compounds after a range of cooking processes was evaluated by measuring the change in anthocyanin concentration (ATC) and antioxidant capacity (DPPH activity) of four non-glutinous and four glutinous genotypes. However, soaking in water prior to cooking generally decreased ATC and DPPH activity more in non-glutinous than in glutinous genotypes. Wet cooking (WC) and soaking before wet cooking (S-WC) led to almost all the ATC and DPPH activity being lost with only slight variation between genotypes. In the glutinous genotype PES, which had the highest raw rice ATC, the highest ATC remained when cooked by the WC method. By contrast, almost no ATC remained after WC and S-WC in the low ATC genotypes such as KDK. Overall, the loss of ATC on cooking was greater in non-glutinous than glutinous genotypes for both WC and S-WC, but the reverse occurred for DPPH activity. Wet cooking using electric rice cooker retained higher ATC than the pressure cooking. Thus, for genotypes with high ATC and antioxidant capacity, the selection of cooking method is critical for retaining and stabilizing rice quality