Prevalence of intestinal microsporidiosis in Human Immunodeficiency Virus-infected patients with diarrhea in major United States cities

To determine the prevalence of intestinal microsporidiosis in HIV-infected patients, we performed a prospective study of HIV-infected patients with diarrheal illnesses in three US hospitals and examined an observational database of HIV-infected patients in 10 US cities. Among 737 specimens from the three hospitals, results were positive for 11 (prevalence 1.5%); seven (64%) acquired HIV through male-to-male sexual contact, two (18%) through male-to-male sexual contact and injection drug use, and one (9%) through heterosexual contact; one (9%) had an undetermined mode of transmission. Median CD4 count within six months of diagnosis of microsporidiosis was 33 cells/µL (range 3 to 319 cells/µL). For the national observational database (n = 24,098), the overall prevalence of microsporidiosis was 0.16%. Prevalence of microsporidiosis among HIV-infected patients with diarrheal disease is low, and microsporidiosis is most often diagnosed in patients with very low CD4+ cell counts. Testing for microsporidia appears to be indicated, especially for patients with very low CD4+ cell counts.

Tranexamic Acid for Major Spinal Surgery in Children. A Retrospective Study

Introduction: Paediatric patients who undergo posterior spinal fusion surgery to correct scoliosis often require multiple blood transfusions. Tranexamic acid is a synthetic antifibrinolytic drug that reduces transfusion requirements in scoliosis surgery (1),(2),(3). Methods: To evaluate the efficacy of prophylactic tranexamic acid (TA) (initial dose of 10mg/kg and infusion of 1mg.kg(-1).h(-1)) in reducing perioperative blood transfusion requirements, we reviewed patients files and compared the amount of blood lost and blood transfused in the perioperative period of 12 patients (54.5%) that received TA and 10 patients (45.5%) who did not received TA. T-Student test was applied. Results: The average difference of blood losses (2,67 +/- 6,06ml) and blood transfused (212,9 +/- 101,1ml) between the two groups was not statistically significant (p>0.05). No thrombotic complications were detected in either group. Discussion: Results of the current study showed that prophylactic low dose of TA did not have a significant effect in the management of intraoperative blood loss and transfusion requirements in children undergoing scoliosis surgery. It is important to emphasize that our study is retrospective and that the size of the sample is small. Further studies are needed to evaluate the efficacy and safety of TA on paediatric scoliosis surgery.

Subcutaneous immunization against Leishmania major - infection in mice: efficacy of formalin-killed promastigotes combined with adjuvants

Formalin-killed promastigotes (FKP) of Leishmania major, in combination with Montanide ISA 720 (MISA), BCG or alum were used in vaccination of an inbred murine model against cutaneous leishmaniasis (CL). Significant and specific increases in anti-FKP IgG responses were detected for both alum-FKP and BCG-FKP compared to MISA-FKP (p < 0.001). Significant increases in splenic lymphocyte recall proliferation was obtained in the MISA-FKP vaccinated mice compared to alum-FKP or BCG-FKP vaccinated groups (p < 0.01). The highest interferon-γ responses were observed in the BCG-FKP group followed by the MISA-FKP while the alum-FKP gave the least responses. Significantly reduced lesion sizes were obtained in the MISA-FKP group compared to the BCG/alum adjuvants-FKP vaccinated groups. Although the BCG-FKP group showed the highest IFN-γ responses, it failed to control cutaneous lesions. Significant reductions in parasite numbers were observed in the MISA-FKP and BCG-FKP vaccinated groups (p < 0.001). There was a good correlation between parasite burden and IFN-γ level indicating IFN-γ response as a sensitive parameter of the immune status. In conclusion, MISA-FKP is the most efficacious vaccine formulation against murine cutaneous leishmaniasis.

Neolithic transitions: can genetic data help us understand a major demographic event in human prehistory?

Dissertation presented to obtain the Ph.D degree in Biology

Bioengineering of Lactococcus lactis through modulation of its major glucose transporter

Dissertation to obtain the Master Degree in Biotechnology

Variation in Haemodynamic Monitoring for Major Surgery in European Nations: Secondary Analysis of the EuSOS Dataset

BACKGROUND: The use of cardiac output monitoring may improve patient outcomes after major surgery. However, little is known about the use of this technology across nations. METHODS: This is a secondary analysis of a previously published observational study. Patients aged 16 years and over undergoing major non-cardiac surgery in a 7-day period in April 2011 were included into this analysis. The objective is to describe prevalence and type of cardiac output monitoring used in major surgery in Europe. RESULTS: Included in the analysis were 12,170 patients from the surgical services of 426 hospitals in 28 European nations. One thousand four hundred and sixteen patients (11.6 %) were exposed to cardiac output monitoring, and 2343 patients (19.3 %) received a central venous catheter. Patients with higher American Society of Anesthesiologists (ASA) scores were more frequently exposed to cardiac output monitoring (ASA I and II, 643 patients [8.6 %]; ASA III-V, 768 patients [16.2 %]; p < 0.01) and central venous catheter (ASA I and II, 874 patients [11.8 %]; ASA III-V, 1463 patients [30.9 %]; p < 0.01). In elective surgery, 990 patients (10.8 %) were exposed to cardiac output monitoring, in urgent surgery 252 patients (11.7 %) and in emergency surgery 173 patients (19.8 %). A central venous catheter was used in 1514 patients (16.6 %) undergoing elective, in 480 patients (22.2 %) undergoing urgent and in 349 patients (39.9 %) undergoing emergency surgery. Nine hundred sixty patients (7.9 %) were monitored using arterial waveform analysis, 238 patients (2.0 %) using oesophageal Doppler ultrasound, 55 patients (0.5 %) using a pulmonary artery catheter and 44 patients (2.0 %) using other technologies. Across nations, cardiac output monitoring use varied from 0.0 % (0/249 patients) to 27.5 % (19/69 patients), whilst central venous catheter use varied from 5.6 % (7/125 patients) to 43.2 % (16/37 patients). CONCLUSIONS: One in ten patients undergoing major surgery is exposed to cardiac output monitoring whilst one in five receives a central venous catheter. The use of both technologies varies widely across Europe.

Mutations in the MECP2 Gene Are Not a Major Cause of Rett Syndrome-Like or Related Neurodevelopmental Phenotype in Male Patients

Rett syndrome is a genetic neurodevelopmental disorder that affects mainly girls, but mutations in the causative MECP2 gene have also been identified in boys with classic Rett syndrome and Rett syndrome-like phenotypes. We have studied a group of 28 boys with a neurodevelopmental disorder, 13 of which with a Rett syndrome-like phenotype; the patients had diverse clinical presentations that included perturbations of the autistic spectrum, microcephaly, mental retardation, manual stereotypies, and epilepsy. We analyzed the complete coding region of the MECP2 gene, including the detection of large rearrangements, and we did not detect any pathogenic mutations in the MECP2 gene in these patients, in whom the genetic basis of disease remained unidentified. Thus, additional genes should be screened in this group of patients.

O acesso ao tratamento em saúde Mental na microregião de Itajubá/MG-Brasil

RESUMO: A integração da saúde mental à atenção básica é a recomendação feita para facilitar o acesso ao tratamento. A pesquisa teve por objetivo mapear e analisar os facilitadores e as barreiras ao acesso ao tratamento em saúde mental da Microrregião de Itajubá, estado de Minas Gerais, Brasil, composta por 15 municípios. A metodologia pautou-se na triangulação dos métodos, combinando a abordagem quantitativa e qualitativa de pesquisa. Para tal foi feito o mapeamento da capacidade instalada dos recursos existentes e identificação das principais lacunas com base nos parâmetros da saúde pública, a partir de roteiros de entrevistas e grupos focais com os principais atores sociais implicados. Constatou-se que o maior facilitador ao acesso ao tratamento tem sido a atuação das equipes de PSF (Programa Saúde da Família), que atuam diretamente nas comunidades. Outros facilitadores foram: a atuação dos CRAS (Centro de Referência de Assistência Social); a existência de um CAPS (Centro de Atenção Psicossocial), embora não credenciado ao SUS (Sistema Único de Saúde); Colegiados de Saúde Mental que promovem discussões, informação, educação, e pressionam os municípios para a implantação de serviços de saúde mental. A falta de “vontade política”, isto é, uma intervenção mais clara da gestão pública da saúde, com estabelecimento de prioridades para prover a ampliação do acesso, foi identificada como a maior barreira a ser enfrentada na microrregião, especialmente por falta de organização e planejamento das ações em saúde mental. Serviços que trabalham de forma isolada, sem a construção de uma rede; pouca participação política dos usuários dos serviços de saúde mental; e falta de recursos humanos, e profissionais pouco preparados para a função compõem as outras barreiras de acesso. Vê-se que diante dos facilitadores e barreiras expostos é preciso que os municípios realizem um levantamento sistemático, a fim de criar um plano de ação em saúde mental para compartilhar informações, recursos, serviços, disponibilidade, disposição e ações em rede.-------------- ABSTRACT: Integrating mental health care in primary-care services is recommended in order to improve access to treatment. Access to mental health treatment has been a worldwide debated theme. In Brazil, with the Psychiatric Reform, there has been a change of paradigm in the way of treating persons with mental disorders. Various health devices were created, building a net of treatment and care that replaces the asylum system and where human rights are respected and defended and the offered treatment is the closest possible to their social space. The research aims to map and analyse the barriers and the facilitators to mental health treatment in the micro-region of Itajubá, state of Minas Gerais/Brazil, made up of 15 counties. The methodology was based on the triangulation of methods, combining quantitative and qualitative research. For that, a mapping of the installed capacity of the existent resource was carried out; identification of the main voids based on the parameters of public health through scripts of interviews and focus groups with the social actors involved. It was found that the main facilitator to treatment has been the performance of PSF, who act directly in the communities. Other facilitators also stand out: the work of CRAS; the existence of CAPS, although not accredited to SUS; Mental Health Collegiate, promoting discussions, information, education, and forcing pressure on the counties for the implantation of mental health services. The lack of political will was identified as the major barrier to be faced in the micro-region, especially due to lack of organization and planning in the actions towards mental health. The services working isolatedly, without a communication net, and the lack of human resources as well as poorly prepared professional, are the main difficulties faced by access to mental health treatment. Becomes clear that the counties need to undertake a systematic survey towards creating a plan of action in mental health, in order to share information, resources, services, availability, disposition and networking.

Characterization and regulation of a bacterial sugar phosphatase of the HAD superfamily, AraL, from Bacillus subtilis.

AraL from Bacillus subtilis is a member of the ubiquitous haloalkanoate dehalogenase, HAD, superfamily. The araL gene has been cloned, over-expressed in Escherichia coli and its product purified to homogeneity. The enzyme displays phosphatase activity, which is optimal at neutral pH (7.0) and 65 °C. Substrate screening and kinetic analysis showed AraL to have low specificity and catalytic activity towards several sugar phosphates, which are metabolic intermediates of the glycolytic and pentose phosphate pathways. Based on substrate specificity and gene context within the arabinose metabolic operon, a putative physiological role of AraL in detoxification of accidental accumulation of phosphorylated metabolites has been proposed. The ability of AraL to catabolise several related secondary metabolites requires regulation at the genetic level. Here, by site- directed mutagenesis, we show that AraL production is regulated by a structure in the translation initiation region of the mRNA, which most probably blocks access to the ribosome-binding site, preventing protein synthesis. Members of HAD subfamily IIA and IIB are characterised by a broad-range and overlapping specificity that anticipated the need for regulation at the genetic level. In this study we provide evidence for the existence of a genetic regulatory mechanism controlling AraL production.

Perfil de internamentos por Depressão Major no SNS português nos anos de 2008 e 2013 : variação em período de crise económica

RESUMO - O início da crise económica global colocou Portugal num contexto de restrição orçamental que gerou repercussões em várias áreas, especificamente na saúde mental das pessoas, evidenciadas a partir de 2009. O objetivo deste trabalho foi analisar o impacto da crise económica no perfil de internamentos por Depressão Major na população em idade ativa nos hospitais do SNS em Portugal Continental. Tratou-se de um estudo epidemiológico, observacional, descritivo e transversal. Foi efetuada uma análise individual, concretizada através da análise dos episódios de internamento; e ecológica, ao nível de distritos; nos anos de 2008 e 2013. Foram analisados dados relativos aos episódios de internamento, à população em idade ativa e às camas de internamento de psiquiatria. Os resultados permitem afirmar que os distritos com menores índices de urbanização e de densidade populacional apresentaram taxas de internamento por Depressão Major, na população em idade ativa, mais elevadas, e os seus habitantes apresentaram um risco de internamento superior, em ambos os períodos. Observou-se um aumento da taxa de internamentos e do risco de internamento por Depressão Major, na maioria dos distritos, no período de crise económica. Adicionalmente, verificou-se que a taxa de internamentos foi influenciada positivamente pelo número de camas disponíveis e ocorreu um aumento do número de internamentos por Depressão Major por cama de internamento disponível, no período de crise económica. Este estudo, de carater exploratório e com limitações identificadas, permitiu observar a variação geográfica e temporal do internamento por Depressão Major fomentando a necessidade de investigação futura neste âmbito.

The patent expiry as a major inflection point in a branded Rx drug's life and strategies to counter generic competition - exemplified at Pfizer's blockbuster drug Lipitor in the USA

A large number of expensive, but highly profitable branded prescription drugs will go off-patent in the USA between 2011 and 2015. Their revenues are crucial to fund the immense costs associated with the development of an innovative drug. The rising cost pressure on pharmaceutical stakeholders has increased the demand for more affordable medications, as provided by the branded drug's generic counterpart. Yet, research based incumbents are moving beyond the traditional late lifecycle strategies and deploy more aggressive tactics in order to protect their brands, as seen with Pfizer's Lipitor!. It is doubtful, whether these efforts will help the blockbuster business model to resist current market conditions.

Factors associated with a diagnosis of major depression among HIV-infected elderly patients

Introduction Acquired immunodeficiency syndrome (AIDS) is being increasingly reported among the elderly and major depression (MD) may be associated with suboptimal adherence to treatment. Methods Cross-sectional study on factors associated with MD among 72 HIV-infected elderly individuals. Results Twenty (27.7%) patients were found to have MD. The female gender (odds ratio [OR] = 10.65; p = 0.00586), a low CD4 count during the study (OR = 1.005247; p = 0.01539), and current smoking status (OR = 12.89; p = 0.01693) were independently associated with MD. Conclusions Our data underscore the need to attentively search and treat MD among HIV-infected elderly patients.

The existence of only one haplotype of Leishmania major in the main and potential reservoir hosts of zoonotic cutaneous leishmaniasis using different molecular markers in a focal area in Iran

IntroductionLeishmania major is the causative agent of zoonotic cutaneous leishmaniasis (ZCL), and great gerbils are the main reservoir hosts in Iran. Abarkouh in central Iran is an emerging focal point for which the reservoir hosts of ZCL are unclear. This research project was designed to detect any Leishmania parasites in different wild rodent species.MethodsAll rodents captured in 2011 and 2012 from Abarkouh district were identified based on morphological characteristics and by amplification of the rodent cytochrome b (Cyt b) gene. To detect Leishmania infection in rodents, deoxyribonucleic acid (DNA) of each ear was extracted. Internal transcribed spacer-ribosomal deoxyribonucleic acid (ITS-rDNA), microsatellites, kinetoplast deoxyribonucleic acid (kDNA) and cytochrome b genes of Leishmania parasites were amplified by polymerase chain reaction (PCR). Restriction fragment length polymorphism (RFLP) and sequencing were employed to confirm the Leishmania identification.ResultsOf 68 captured rodents in the region, 55 Rhombomys opimus were identified and nine Leishmaniainfections (9/55) were found. In addition, eight Meriones libycus and two Tatera indicawere sampled, and one of each was confirmed to be infected. Two Meriones persicus and one Mus musculuswere sampled with no infection.ConclusionsThe results showed that all 11 unambiguously positive Leishmania infections were Leishmania major. Only one haplotype of L. major(GenBank access No. EF413075) was found and at least three rodents R. opimus, M. libycus and T. indica—appear to be the main and potential reservoir hosts in this ZCL focus. The reservoir hosts are variable and versatile in small ZCL focal locations.

Entre a plasticidade do corpo e da imagem : contributos para uma viagem interactiva pelos territórios incertos da arte contemporânea

Este trabalho de investigação começou por ser estruturado em torno de quatro grandes capítulos (quatro grandes linhas de orientação temática), todos eles amplamente desenvolvidos no sentido de podermos cartografar alguns dos principais territórios e sintomas da arte contemporânea, sendo certo também, que cada um deles assenta precisamente nos princípios de uma estrutura maleável que, para todos os efeitos, se encontra em processo de construção (work in progress), neste caso, graças à plasticidade do corpo, do espaço, da imagem e do uso criativo das tecnologias digitais, no âmbito das quais, aliás, tudo se parece produzir, transformar e disseminar hoje em dia à nossa volta (quase como se de uma autêntica viagem interactiva se tratasse). Por isso, a partir daqui, todo o esforço que se segue procurará ensaiar uma hipótese de trabalho (desenvolver uma investigação) que, porventura, nos permita desbravar alguns caminhos em direcção aos intermináveis túneis do futuro, sempre na expectativa de podermos dar forma, função e sentido a um desejo irreprimível de liberdade criativa, pois, a arte contemporânea tem essa extraordinária capacidade de nos transportar para muitos outros lugares do mundo, tão reais e imaginários como a nossa própria vida. Assim sendo, há que sumariar algumas das principais etapas a desenvolver ao longo desta investigação. Ora, num primeiro momento, começaremos por reflectir sobre o conceito alargado de «crise» (a crise da modernidade), para logo de seguida podermos abordar a questão da crise das antigas categorias estéticas, questionando assim, para todos os efeitos, quer o conceito de «belo» (Platão) e de «gosto» (Kant), quer ainda o conceito de «forma» (Foccilon), não só no sentido de tentarmos compreender algumas das principais razões que terão estado na origem do chamado «fim da arte» (Hegel), mas também algumas daquelas que terão conduzido à estetização generalizada da experiência contemporânea e à sua respectiva disseminação pelas mais variadas plataformas digitais. Num segundo momento, procuraremos reflectir sobre alguns dos principais problemas da inquietante história das imagens, nomeadamente para tentarmos perceber como é que todas estas transformações técnicas (ligadas ao aparecimento da fotografia, do cinema, do vídeo, do computador e da internet) terão contribuído para o processo de instauração e respectivo alargamento daquilo que todos nós ficaríamos a conhecer como a nova «era da imagem», ou a imagem na «era da sua própria reprodutibilidade técnica» (Benjamin), pois, só assim é que conseguiremos interrogar este imparável processo de movimentação, fragmentação, disseminação, simulação e interacção das mais variadas «formas de vida» (Nietzsche, Agamben). Entretanto, chegados ao terceiro grande momento, interessa-nos percepcionar a arte contemporânea como uma espécie de plataforma interactiva que, por sua vez, nos levará a interpelar alguns dos principais dispositivos metafóricos e experimentais da viagem, neste caso, da viagem enquanto linha facilitadora de acesso à arte, à cultura e à vida contemporânea em geral, ou seja, todo um processo de reflexão que nos incitará a cartografar alguns dos mais atractivos sintomas provenientes da estética do flâneur (na perspectiva de Rimbaud, Baudelaire, Long e Benjamin) e, consequentemente, a convocar algumas das principais sensações decorrentes da experiência altamente sedutora daqueles que vivem mergulhados na órbita interactiva do ciberespaço (na condição de ciberflâneurs), quase como se o mundo inteiro, agora, fosse tão somente um espaço poético «inteiramente navegável» (Manovich). Por fim, no quarto e último momento, procuraremos fazer uma profunda reflexão sobre a inquietante história do corpo, principalmente com o objectivo de reforçar a ideia de que apesar das suas inúmeras fragilidades biológicas (um ser que adoece e morre), o corpo continua a ser uma das «categorias mais persistentes de toda a cultura ocidental» (Ieda Tucherman), não só porque ele resistiu a todas as transformações que lhe foram impostas historicamente, mas também porque ele se soube reinventar e readaptar pacientemente face a todas essas transformações históricas. Sinal evidente de que a sua plasticidade lhe iria conferir, principalmente a partir do século XX («o século do corpo») um estatuto teórico e performativo verdadeiramente especial. Tão especial, aliás, que basta termos uma noção, mesmo que breve, da sua inquietante história para percebermos imediatamente a extraordinária importância dalgumas das suas mais variadas transformações, atracções, ligações e exibições ao longo das últimas décadas, nomeadamente sob o efeito criativo das tecnologias digitais (no âmbito das quais se processam algumas das mais interessantes operações de dinamização cultural e artística do nosso tempo). Em suma, esperamos sinceramente que este trabalho de investigação possa vir a contribuir para o processo de alargamento das fronteiras cada vez mais incertas, dinâmicas e interactivas do conhecimento daquilo que parece constituir, hoje em dia, o jogo fundamental da nossa contemporaneidade.

Insider threats: the major challenge to security risk management

Security risk management is by definition, a subjective and complex exercise and it takes time to perform properly. Human resources are fundamental assets for any organization, and as any other asset, they have inherent vulnerabilities that need to be handled, i.e. managed and assessed. However, the nature that characterize the human behavior and the organizational environment where they develop their work turn these task extremely difficult, hard to accomplish and prone to errors. Assuming security as a cost, organizations are usually focused on the efficiency of the security mechanisms implemented that enable them to protect against external attacks, disregarding the insider risks, which are much more difficult to assess. All these demands an interdisciplinary approach in order to combine technical solutions with psychology approaches in order to understand the organizational staff and detect any changes in their behaviors and characteristics. This paper intends to discuss some methodological challenges to evaluate the insider threats and its impacts, and integrate them in a security risk framework, that was defined according to the security standard ISO/IEC_JTC1, to support the security risk management process.