Timing of Antiretroviral Therapy for HIV in the Setting of TB Treatment

The convergent human immunodeficiency virus (HIV) and tuberculosis (TB) pandemics continue to collectively exact significant morbidity and mortality worldwide. Highly active antiretroviral therapy (HAART) has been a critical component in combating the scourge of these two conditions as both a preemptive and therapeutic modality. However, concomitant administration of antiretroviral and antituberculous therapies poses significant challenges, including cumulative drug toxicities, drug-drug interactions, high pill burden, and the immune reconstitution inflammatory syndrome (IRIS), thus complicating the management of coinfected individuals. This paper will review data from recent studies regarding the optimal timing of HAART initiation relative to TB treatment, with the ultimate goal of improving coinfection-related morbidity and mortality while mitigating toxicity resulting from concurrent treatment of both infections

Improvement of Tuberculosis Laboratory Capacity on Pemba Island, Zanzibar: A Health Cooperation Project.

Low-income countries with high Tuberculosis burden have few reference laboratories able to perform TB culture. In 2006, the Zanzibar National TB Control Programme planned to decentralize TB diagnostics. The Italian Cooperation Agency with the scientific support of the "L. Spallanzani" National Institute for Infectious Diseases sustained the project through the implementation of a TB reference laboratory in a low-income country with a high prevalence of TB. The implementation steps were: 1) TB laboratory design according to the WHO standards; 2) laboratory equipment and reagent supplies for microscopy, cultures, and identification; 3) on-the-job training of the local staff; 4) web- and telemedicine-based supervision. From April 2007 to December 2010, 921 sputum samples were received from 40 peripheral laboratories: 120 TB cases were diagnosed. Of all the smear-positive cases, 74.2% were culture-positive. During the year 2010, the smear positive to culture positive rate increased up to 100%. In March 20, 2010 the Ministry of Health and Social Welfare of Zanzibar officially recognized the Public Health Laboratory- Ivo de Carneri as the National TB Reference Laboratory for the Zanzibar Archipelago. An advanced TB laboratory can represent a low cost solution to strengthen the TB diagnosis, to provide capacity building and mid-term sustainability

Development and implementation of a clinical pathway approach to simulation-based training for foregut surgery.

INTRODUCTION: Contemporary demands on resident education call for integration of simulation. We designed and implemented a simulation-based curriculum for Post Graduate Year 1 surgery residents to teach technical and nontechnical skills within a clinical pathway approach for a foregut surgery patient, from outpatient visit through surgery and postoperative follow-up. METHODS: The 3-day curriculum for groups of 6 residents comprises a combination of standardized patient encounters, didactic sessions, and hands-on training. The curriculum is underpinned by a summative simulation pathway repeated on days 1 and 3. The pathway is a series of simulated preoperative, intraoperative, and postoperative encounters in following up a single patient through a disease process. The resident sees a standardized patient in the clinic presenting with distal gastric cancer and then enters an operating room to perform a gastrojejunostomy on a porcine tissue model. Finally, the resident engages in a simulated postoperative visit. All encounters are rated by faculty members and the residents themselves, using standardized assessment forms endorsed by the American Board of Surgery. RESULTS: A total of 18 first-year residents underwent this curriculum. Faculty ratings of overall operative performance significantly improved following the 3-day module. Ratings of preoperative and postoperative performance were not significantly changed in 3 days. Resident self-ratings significantly improved for all encounters assessed, as did reported confidence in meeting the defined learning objectives. CONCLUSIONS: Conventional surgical simulation training focuses on technical skills in isolation. Our novel pathway curriculum targets an important gap in training methodologies by placing both technical and nontechnical skills in their clinical context as part of managing a surgical patient. Results indicate consistent improvements in assessments of performance as well as confidence and support its continued usage to educate surgery residents in foregut surgery

The Friedman-Eilber Resection Arthroplasty of the Pelvis

It has been argued that internal hemipelvectomy without reconstruction of the pelvic ring leads to poor ambulation and inferior patient acceptance. To determine the accuracy of this contention, we posed the following questions: First, how effectively does a typical patient ambulate following this procedure? Second, what is the typical functional capacity of a patient following internal hemipelvectomy? In the spring of 2006, we obtained video documentation of eight patients who had undergone resection arthroplasty of the hemipelvis seen in our clinic during routine clinical followup. The minimum followup in 2006 was 1.1 years (mean, 8.2 years; range, 1.1–22.7 years); at the time of last followup in 2008 the minimum followup was 2.9 years (mean, 9.8 years; range, 2.9–24.5 years). At last followup seven of the eight patients were without pain, and were able to walk without supports. The remaining patient used narcotic medication and a cane or crutch only occasionally. The mean MSTS score at the time of most recent followup was 73.3% of normal (range 53.3–80.0%; mean raw score was 22.0; range 16–24). All eight patients ultimately returned to gainful employment. These observations demonstrate independent painless ambulation and acceptable function is possible following resection arthroplasty of the hemipelvis

Η σημασία της γήρανσης των ηπατοκυττάρων στη φυσική ιστορία της χρόνιας λοίμωξης με ιό Ηπατίτιδας Β

Υπόβαθρο: Η χρόνια λοίμωξη με τον ιό της ηπατίτιδας Β αποτελεί ένα σοβαρό ιατρικό ζήτημα παγκοσμίως. Το ελεύθερο κυττάρου κυκλοφορούν DNA (cfDNA) και η ολική DNA μεθυλίωση, η οποία εκφράζεται με τα κυκλοφορούντα επίπεδα της 5-methyl-2’-deoxycytidine, εφαρμόζοντας την μέθοδο της υγρής βιοψίας, φαίνεται πως σχετίζονται ως τώρα με επιγενετικές μεταβολές και γήρανση. Αυτή η μελέτη στοχεύει στη διερεύνηση των επιπέδων του ελεύθερου κυττάρου κυκλοφορούντος DNA και των επιπέδων της 5-methyl-2’-deoxycytidine στους ορούς HBeAg-αρνητικών φορέων και ασθενών με χρόνια ηπατίτιδα Β, χωρίς θεραπεία, αλλά και μετά την εφαρμογή της. Μέθοδοι: Χρησιμοποιήθηκαν οροί από ένα σύνολο 61 ασθενών, μεταξύ των οποίων φορείς και ασθενείς με χρόνια ηπατίτιδα Β, χωρίς και μετά την εφαρμογή από του στόματος θεραπείας, με αντικειμενικό σκοπό την ποσοτικοποίηση των επιπέδων του ελεύθερου κυττάρου κυκλοφορούντος DNA και των επιπέδων της 5-methyl-2’-deoxycytidine. Αποτελέσματα: Η συγκέντρωση του ελεύθερου κυττάρου κυκλοφορούντος DNA αυξήθηκε στατιστικά σημαντικά μετά τη χορήγηση θεραπείας στους ασθενείς με χρόνια ηπατίτιδα Β σε σχέση με προ θεραπείας (15 vs 10 ng/mL, αντίστοιχα, p=0.022). Μία σημαντική τάση αυξημένων κυκλοφορούντων επιπέδων της 5-methyl-2’-deoxycytidine παρατηρήθηκε στους φορείς σε σχέση με τους ασθενείς με χρόνια ηπατίτιδα Β χωρίς θεραπεία (211 vs 176 ng/mL, αντίστοιχα, p=0.089), ενώ επιπλέον αυξημένη τάση των κυκλοφορούντων επιπέδων της 5-methyl-2’-deoxycytidine παρατηρήθηκε στους ασθενείς με χρόνια ηπατίτιδα Β μετά τη χορήγηση θεραπείας σε σχέση με πριν τη λήψη θεραπείας (215 vs 173 ng/mL, αντίστοιχα, p=0.079). Συμπεράσματα: Τόσο το ελεύθερο κυττάρου κυκλοφορούν DNA, όσο και τα κυκλοφορούντα επίπεδα της 5-methyl-2’-deoxycytidine, μπορούν να χρησιμοποιηθούν ως δείκτες της δραστηριότητας του ιού της ηπατίτιδας Β στα ηπατοκύτταρα σε επίπεδο επιγενετικής και της απάντησης στη θεραπεία των HBeAg-αρνητικών ασθενών, αλλά περαιτέρω μελέτες είναι απαραίτητες προς αυτήν την κατεύθυνση.Background: Chronic hepatitis B (CHB) virus infection is a serious medical issue, worldwide. Circulating cell-free DNA (cfDNA) and global DNA methylation, which is expressed as circulating levels of 5-methyl-2’-deoxycytidine, applying the liquid biopsy approach, seem to be linked to epigenetic changes and senescence. This study aims to investigate the levels of circulating cfDNA and 5-methyl-2’-deoxycytidine in HBeAg-negative carriers and CHB infected patients’ serums, without and after treatment administration. Methods: Serum samples from a total of 61 patients, including carriers and CHB patients without and after treatment, were studied in order to quantify the levels of circulating cf-DNA and 5-methyl-2’-deoxycytidine. Results: Circulating cfDNA concentration was significantly increased following the administration of oral antiviral treatment in CHB patients compared to pre-treatment levels (15 vs 10 ng/mL, respectively, p=0.022). A trend was demonstrated towards higher mean levels of circulating 5-methyl-2’-deoxycytidine in carriers as compared to CHB patients without treatment (211 vs 176 ng/mL, respectively, p=0.089) and additionally, a tendency for increased 5-methyl-2’-deoxycytidine levels in patients after in comparison to before treatment for CHB (215 vs 173 ng/mL, respectively, p=0.079). Conclusions: Both circulating cf-DNA and circulating levels of 5-methyl-2’-deoxycytidine might be used as markers in order to monitor disease activity in hepatocytes based on epigenetics and response to treatment of chronic HBeAg-negative patients, but further studies are needed towards that direction

Τεχνολογίες Ελέγχου των Συνόρων και (Βιο)πολιτικές Διαχείρισης της Μετανάστευσης

Η παρούσα εργασία επιχειρεί να προσεγγίσει τον τρόπο με τον οποίο έχει ιστορικά διαμορφωθεί η διαχείριση της μετανάστευσης και οι μεταναστευτικές πολιτικές εντός των ορίων του διακρατικού και υπερεθνικού χώρου «ελευθερίας και ασφάλειας» της Ευρωπαϊκής Ένωσης, ιδιαίτερα από τις αρχές της δεκαετίας του 1990 και τη συγκρότηση αυτού που σήμερα γνωρίζουμε ως ζώνη Schengen, καθώς και τη συνάρθρωση αυτού του καθεστώτος βιοπολιτικής μεταναστευτικής διαχείρισης με σύγχρονα τεχνοεπιστημονικά μέσα που μετασχηματίζουν τη λειτουργία των συνόρων. Ποιοι είναι οι μηχανισμοί και ποιες οι (βιο)πολιτικές που εφαρμόζονται για τη διοχέτευση της μεταναστευτικής κινητικότητας και την αναδοχή ή τον αποκλεισμό των ζωών των μεταναστών; Ποιοι μετασχηματισμοί έχουν επέλθει από το πέρασμα στις λεγόμενες κοινωνίες της μετανεωτερικότητας, τις παγκοσμιοποιημένες κοινωνίες του διεθνοποιημένου κεφαλαίου και των «κρυστάλλινων» συνόρων, όσον αφορά τους τρόπους, τα μέσα και τις πρακτικές μέσω των οποίων ρυθμίζεται η ανθρώπινη κυκλοφορία; Πώς συγκροτείται ο μετανάστης ως μια πολύμορφη απειλή για την ελευθερία και την ασφάλεια των «έμπιστων» πολιτών/ταξιδιωτών της Ευρώπης, και πώς γίνεται ταυτόχρονα αντικείμενο μιας βιοπολιτικής-ανθρωπιστικής διαχείρισης που κινείται συνεχώς στα όρια μεταξύ αποκλεισμού και ενσωμάτωσης, μέριμνας για τη ζωή και εγκατάλειψης στον θάνατο; Αυτά αποτελούν τα κεντρικά ερωτήματα της εργασίας γύρω από τα οποία θα χαραχθεί η ιστορικότητα των πολιτικών διαχείρισης της μετανάστευσης της Ευρωπαϊκής Ένωσης.This thesis attempts to trace the way in which migration management and immigration policies have historically been shaped within the limits of the transnational and supranational "freedom and security" space of the European Union, especially since the early 1990's and the formation of what is now widely known as the Schengen area, as well as the articulation of this biopolitical apparatus of migration management with (post)modern techno-scientific means which radically transform the operation of the border regime. What are the mechanisms, the devices and the (bio)politics that are put into practice in order to channel migrant mobility and to foster or exclude the lives of migrants? What transformations have taken place since the transition to the so-called postmodern societies, the globalized societies of international capital and "crystal frontiers", in terms of the ways, the means and the practices through which human circulation is regulated? In what ways is the migrant constructed as a multifaceted threat to the freedom and security of Europe's "trustworthy" citizens / travelers, while at the same time being subjected to a biopolitical-humanitarian apparatus which constantly shifts between exclusion or integration, care for life or abandonment to death? These are the main questions through which the historicity of the European Union's immigration management policies will be traced

Toxic reagents and expensive equipment: are they really necessary for the extraction of good quality fungal DNA?

The aim of this work was to evaluate a fungal DNA extraction procedure with the lowest inputs in terms of time as well as of expensive and toxic chemicals, but able to consistently produce genomic DNA of good quality for PCR purposes. Two types of fungal biological material were tested - mycelium and conidia - combined with two protocols for DNA extraction using Sodium Dodecyl Sulphate [SDS] and Cetyl Trimethyl Ammonium Bromide [CTAB] as extraction buffers and glass beads for mechanical disruption of cell walls. Our results showed that conidia and SDS buffer was the combination that lead to the best DNA quality and yield, with the lowest variation between samples. This study clearly demonstrates that it is possible to obtain high yield and pure DNA from pigmented conidia without the use of strong cell disrupting procedures and of toxic reagents.This work was supported by the Foundation for Science and Technology (FCT, Portugal) and the European Social Fund through the grant SFRH/BD/28332/2006; by Fundação para a Ciência e a Tecnologia and the Polytechnic Institute of Braganc a through the grant SFRH/PROTEC/49555/2009; and by the European Community’s Seventh Framework Program (FP7,2007/2013), Research Infrastructures Action, Under Grant Agreement Fp7 228310 (Embarc Project). The authors are also grateful to the Foundation for Science and Technology (FCT, Portugal) and FEDER under Programme PT2020 for financial support to CIMO (UID/AGR/00690/2013).info:eu-repo/semantics/publishedVersio

Laparoscopic Gastric Wedge Resection and Prophylactic Antireflux Surgery for a Submucosal Tumor of Gastroesophageal Junction

A laparoscopic wedge resection for a submucosal tumor, which is close to the gastroesophageal junction, is technically challenging. This can be a dilemma to both patients and surgeons when the tumor margin involves the gastroesophageal junction because a wedge resection in this situation might result in a deformity of the gastroesophageal junction or an injury to the lower esophageal sphincter, which ultimately results in lifelong gastroesophageal reflux disease. The patient was a 42 year-old male, whose preoperative endoscopic ultrasonographic finding did not rule out a gastrointestinal stromal tumor. He underwent a laparoscopic gastric wedge resection and prophylactic anterior partial fundoplication (Dor) and was discharged from hospital on the fifth postoperative day without any complications. There were no symptoms of reflux 5 months after surgery. A laparoscopic wedge resection and prophylactic anti-reflux surgery might be a good surgical option for a submucosal tumor at the gastroesophageal junction