Malnutrition, VIH et traitement antirétroviral dans les pays à ressources limitées

Introduction : Depuis les années 2000, la distribution du traitement antirétroviral hautement actif (TARVHA) dans les pays à bas et moyens revenus (PBMR) s’est accélérée. Dans ces milieux, l’épidémie du VIH s’est superposée à des conditions préexistantes de malnutrition. Le VIH et la malnutrition forment un cycle vicieux qui contribue à la détérioration des fonctions immunitaires et de l’état nutritionnel. Malgré l’accès au traitement, la malnutrition persiste comme déterminant de la progression de la maladie et de la mortalité chez les séropositifs. Par ailleurs, peu de données existent concernant les trajectoires et déterminants des statuts nutritionnels et immunologiques chez les patients débutant le TARVHA. Objectifs : Documenter les défis méthodologiques associés à la recherche nutritionnelle chez les personnes vivants avec le VIH (PVVIH) dans les PBMR. Investiguer les déterminants et trajectoires du statut nutritionnel à l’initiation et en cours du TARVHA. Investiguer l’association entre les fonctions immunologiques à l’initiation et au cours de la première année de TARVHA selon le statut nutritionnel. Méthodologie: Dans le cadre de la cohorte ATARAO (Mali), 250 PVVIH adultes naïfs au TARVHA ont été recrutés et suivis pendant 12 mois suite à l’initiation du traitement. Les données obtenues ont été jumelées à celles d’une étude prospective similaire provenant du Sénégal (n=372). Des analyses transversales et longitudinales ont été entreprises pour évaluer les covariables de la malnutrition à l’initiation et en cours de traitement. Parallèlement, la fiabilité des mesures anthropométriques collectées dans le cadre de la cohorte ATARAO a été documentée lors de deux sous-études. Finalement, une revue systématique de la littérature a été complétée pour investiguer la réponse immunologique selon le statut nutritionnel à l’initiation et en cours de traitement chez les PVVIH traités. Résultats: Seules les mesures de la taille et du poids se sont révélées fiables et ont pu être utilisées dans nos analyses prospectives. Le traitement a permis une amélioration initiale de l’état nutritionnel chez une majorité de patients. Par contre, ses effets ont atteint un plateau après 6 à 9 mois. Un an plus tard, la malnutrition persistait chez plusieurs patients vivants et actifs (entre 7 et 29 % selon la population et l’indicateur nutritionnel). Comme observé dans nos cohortes et revue systématique, l’attrition était fortement associée à la malnutrition. Par ailleurs, il n’existe pas de relation claire entre le statut immunologique et la malnutrition pré- ou post-HAART. La qualité et la quantité des évidences recensées ne nous permettent pas de tirer de conclusions définitives. Conclusions : Les évidences collectées suggèrent l’existence d’une association transversale et longitudinale entre les statuts nutritionnels et immunologiques chez les patients traités. Cependant, cette association ne fait pas consensus. L’état de la littérature ne nous permet pas de nous prononcer quant à l’impact de la malnutrition sur les fonctions immunologiques à l’initiation et eu cours de la première année de TARVHA. Les difficultés méthodologiques associées à la mesure de l’état nutritionnel ainsi que la forte attrition des patients malnutris suite à la mise sous traitement compliquent l’investigation de cette relation.

Virulence Potential And Antibiotic Susceptibility Pattern Of Motile Aeromonads Associated With Freshwater Ornamental Fish Culture Systems: A Possible Threat To public Health

Aeromonas spp. are ubiquitous aquatic organisms, associated with multitude of diseases in several species of animals, including fishes and humans. In the present study, water samples from two ornamental fish culture systems were analyzed for the presence of Aeromonas. Nutrient agar was used for Aeromonas isolation, and colonies (60 No) were identified through biochemical characterization. Seven clusters could be generated based on phenotypic characters, analyzed by the programme NTSYSpc, Version 2.02i, and identified as: Aeromonas caviae (33.3%), A. jandaei (38.3%) and A. veronii biovar sobria (28.3%). The strains isolated produced highly active hydrolytic enzymes, haemolytic activity and slime formation in varying proportions. The isolates were also tested for the enterotoxin genes (act, alt and ast), haemolytic toxins (hlyA and aerA), involved in type 3 secretion system (TTSS: ascV, aexT, aopP, aopO, ascF–ascG, and aopH), and glycerophospholipid-cholesterol acyltransferase (gcat). All isolates were found to be associated with at least one virulent gene. Moreover, they were resistant to frequently used antibiotics for human infections. The study demonstrates the pathogenic potential of Aeromonas, associated with ornamental fish culture systems suggesting the emerging threat to public health

Ansiedad, depresión y calidad de vida en personas adultas con VIH/SIDA y deterioro cognitivo leve

El Virus de la Inmunodeficiencia Humana (VIH) y el Síndrome de Inmunodeficiencia Adquirida (SIDA) han tenido a lo largo de los años un comportamiento epidemiológico que muestra la tendencia al aumento, de tal forma que ha llegado a considerarse como un problema de salud pública a nivel mundial. Sin embargo los tratamientos antiretrovirales han permitido que las personas con esta infección tengan una tasa de supervivencia mayor; pero ligado a esto, se han presentado efectos secundarios tales como problemas con la memoria y el funcionamiento cognitivo de estas personas. Además se ha encontrado que las personas con VIH/SIDA tienen algunas alteraciones en su área afectiva y generalmente ven afectada su calidad de vida. Este es un estudio exploratorio descriptivo que tuvo por objeto describir la ansiedad, depresión y percepción de calidad de vida en 35 pacientes con VIH/SIDA con deterioro cognitivo leve, seleccionados por conveniencia. Se aplicaron tres cuestionarios, el BDI-II para evaluar la sintomatología depresiva; el BAI para evaluar la sintomatología ansiosa y el MOS-SF30 para evaluar la calidad de vida. Además, se realizó una entrevista semiestructurada para profundizar en la evaluación de estas tres variables. Dentro de los resultados se evidenció que todos los paciente presentan algún nivel de ansiedad y de depresión, evalúan su calidad de vida en un punto medio; ni óptima ni baja. Se discuten estos y otros resultados.

Perfil neuropsicológico de personas adultas con VIH/SIDA

Los déficit neurológicos en el virus de inmunodeficiencia humana VIH, específicamente las alteraciones en el funcionamiento cognitivo, han estado presentes desde el inicio de su propagación y han sido una de las principales manifestaciones a lo largo de todas las etapas del virus. No obstante, gracias a los avances de la terapia antirretroviral se ha dado un aumento de la expectativa de vida de los pacientes, dándose de la misma manera un incremento en los déficits anteriormente mencionados. El objetivo del presente estudio es describir el perfil neuropsicológico de los pacientes con VIH y establecer si existen relaciones entre las funciones que se encuentren deterioradas, el tiempo de diagnóstico y la terapia antiretroviral. Para esto se llevo a cabo un estudio descriptivo de tipo exploratorio con el fin de medir las características de las funciones neuropsicológicas en un grupo de 24 pacientes pertenecientes al programa especial B24 del Hospital Universitario Mayor y Hospital de Barrios Unidos MÉDERI en Bogotá, Colombia. Para esto, se utilizó un protocolo de pruebas neuropsicológicas: Mini Mental StateExamination (MMSE), WAIS-III (sub-pruebas dígitos, letras y números, aritmética y semejanzas), Curva de aprendizaje auditivo verbal de Rey (RAVLT), WMS-III (sub-pruebas de recobro de historias y Localización), TMT A y B, Set Test de Isaacs, Figura Compleja de Rey y Test de Stroop. Dentro de los resultados se encontró que la medida de edad fue de 50 con un total de 19 hombres y 5 mujeres. Las funciones con mayor predominio de deterioro fueron la atención sostenida y alternante, la memoria declarativa, las funciones ejecutivas (específicamente en el control inhibitorio) y la velocidad de procesamiento, los pacientes presentan un rango de deterioro cognitivo leve (GDS 3). Se concluyó que el perfil de deterioro es mixto y que es necesario ampliar la muestra para obtener resultados más precisos en cuanto a las diferencias de acuerdo al tiempo de diagnóstico y la terapia antiretroviral.

Evidence of systematic approaches to innovation in facilities management

Purpose – This paper seeks to examine the nature of “service innovation” in the facilities management (FM) context. It reviews recent thinking on “service innovation” as distinct from “product innovation”. Applying these contemporary perspectives it describes UK case studies of 11 innovations in different FM organisations. These include both in-house client-based innovations and third-party innovations. Design/methodology/approach – The study described in the paper encompasses 11 different innovations that constitute a mix of process, product and practice innovations. All of the innovations stem from UK-based organisations that were subject to in-depth interviews regarding the identification, screening, commitment of resources and implementation of the selected innovations. Findings – The research suggested that service innovation is highly active in the UK FM sector. However, the process of innovation rarely followed a common formalized path. Generally, the innovations were one-shot commitments at the early stage. None of the innovations studied failed to proceed to full adoption stage. This was either due to the reluctance of participating organisations to volunteer “tested but unsuccessful” innovations or the absence of any trial methods that might have exposed an innovations shortcomings. Research limitations/implications – The selection of innovations was restricted to the UK context. Moreover, the choice of innovations was partly determined by the innovating organisation. This selection process appeared to emphasise “one-shot” high profile technological innovations, typically associated with software. This may have been at the expense of less resource intensive, bottom-up innovations. Practical implications – This paper suggests that there is a role for “research and innovation” teams within larger FM organisations, whether they are client-based or third-party. Central to this philosophy is an approach that is open to the possibility of failure. The innovations studied were risk averse with a firm commitment to proceed at the early stage. Originality/value – This paper introduces new thinking on the subject of “service innovation” to the context of FM. It presents research and development as a planned solution to innovation. This approach will enable service organisations to fully test and exploit service innovations.

An investigation and comparison of the bioactivity of selected essential oils on human lice and house dust mites

The insecticidal potency of some essential oils suggests that they may find an application in the control of house dust mites, but current in vitro assays for mites do not appear to give consistent results. A simple, novel, mite chamber assay was therefore developed to carry out testing. Different species of insects are susceptible to different essential oil components, so we compared the relative acaricidal and pediculicidal activity of three essential oils: tea tree, lavender and lemon, because the activity of their constituents on lice ranges from highly active to virtually inactive. The most effective essential oil against both lice and mites was tea tree oil; lavender was the second most effective, and lemon oil the least, although it did show activity against mites, unlike lice. The assay proved simple and effective and gave reproducible results. (c) 2007 Elsevier B.V. All rights reserved.

Nuclear fuel cycles: interfaces with the environment

The waste materials generated in the nuclear fuel cycle are very varied,ranging from the tailings arising from mining and processing uranium ore, depleted uranium in a range of chemical forms, to a range of process wastes of differing activities and properties. Indeed, the wastes generated are intimately linked to the options selected in operating the nuclear fuel cycle, most obviously to the management of spent fuel. An open fuel cycle implies the disposal of highly radioactive spent fuel, whereas a closed fuel cycle generates a complex array of waste streams. On the other hand, a closed fuel cycle offers options for waste management, for example reduction in highly active waste volume, decreased radiotoxicity, and removal of fissile material. Many technological options have been proposed or explored, and each brings its own particular mix of wastes and environmental challenges.

A survey of human motion analysis using depth imagery

Analysis of human behaviour through visual information has been a highly active research topic in the computer vision community. This was previously achieved via images from a conventional camera, but recently depth sensors have made a new type of data available. This survey starts by explaining the advantages of depth imagery, then describes the new sensors that are available to obtain it. In particular, the Microsoft Kinect has made high-resolution real-time depth cheaply available. The main published research on the use of depth imagery for analysing human activity is reviewed. Much of the existing work focuses on body part detection and pose estimation. A growing research area addresses the recognition of human actions. The publicly available datasets that include depth imagery are listed, as are the software libraries that can acquire it from a sensor. This survey concludes by summarising the current state of work on this topic, and pointing out promising future research directions.

Towards the computer-aided diagnosis of dementia based on the geometric and network connectivity of structural MRI data

We present an intuitive geometric approach for analysing the structure and fragility of T1-weighted structural MRI scans of human brains. Apart from computing characteristics like the surface area and volume of regions of the brain that consist of highly active voxels, we also employ Network Theory in order to test how close these regions are to breaking apart. This analysis is used in an attempt to automatically classify subjects into three categories: Alzheimer’s disease, mild cognitive impairment and healthy controls, for the CADDementia Challenge.

The Nutritional Status of Children and Adolescents with HIV/AIDS on Antiretroviral Therapy

The objective of this cross-sectional study was to assess the nutritional status of children and adolescents with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) receiving highly active antiretroviral therapy (HAART). One hundred and eighteen subjects aged 6-19 years attending an outpatient clinic in Sao Paulo city were involved in the study. The following anthropometric measurements were assessed: weight, height, waist circumference and triceps and subscapular skinfold thickness. One (0.9%) adolescent was diagnosed with abdominal obesity based on waist circumference measurement; three (2.5%) adolescents were obese based on subscapular skinfold thickness. According to the body mass index, the population studied was mainly eutrophic. The prevalence of fat redistribution, a characteristic of patients with HIV/AIDS under HAART, was low. We advise the development of further studies to assess the nutritional status of children and adolescents with HIV/AIDS using anthropometric measurements as well as computed tomography to detect fat redistribution.

Impact of a nutritional counseling program on prevention of HAART-related metabolic and morphologic abnormalities

The advent of highly active antiretroviral therapy (HAART) improved HIV infection prognosis. However, adverse metabolic and morphologic effects emerged, highlighting a lack of investigation into the role of nutritional interventions among this population. The present study evaluated the impact of a nutritional counseling program on prevention of morphologic and metabolic changes in patients living with HIV/AIDS receiving HAART. A 12-month randomized clinical trial was conducted with 53 adults of both genders in use of HAART. Subjects were allocated to either an intervention group (IG) or a control group (CG). Nutritional counseling was based on the promotion of a healthy diet pattern. Anthropometrical, biochemical, blood pressure, and food intake variables were assessed on four separate occasions. Sub scapular skin-fold results showed a significant tendency for increase between time 1 (Mean IG = 14.9 mm; CG = 13.6 mm), time 3 (Mean IG = 16.7 mm; CG = 18.2 mm), and time 4 (Mean IG = 16.4 mm; CG = 17.7 mm). Lipid percentage intake presented a greater increase among controls (time 1 mean = 26.3%, time 4 mean = 29.6%) than among IG subjects (time 1 mean = 29.1%, time 4 mean = 28.9%). Moreover, participants allocated to the IG presented an increase in dietetic fiber intake of almost 10 grams. The proposed nutritional counseling program proved to be effective in improving diet by reducing fat consumption and increasing fiber intake.

Self-reported Body Changes and Associated Factors in Persons Living with HIV

The study aimed at verifying the associated factors of self-perceived body changes in adults living with HIV in highly-active antiretroviral therapy (HAART) in the city of Sao Paulo, Brazil. This cross-sectional study was conducted among people living with HIV on HAART for at least three months. A standardized questionnaire was used for assessing self-perceived body changes. Associated factors relating to self-reported body changes in people living with HIV (PLHIV) were assessed with Student`s t-test and chi-square test. In total, 507 patients were evaluated. The mean time since diagnosis was 6.6 years [standard deviation (SD)+/-4.1], and the mean duration of HAART was 5.1 years (SD+/-3.3). Self-perceived body changes were reported by 79.5% of the participants and were associated with viral load and duration of HAART. Fibre intake was lower among males who gained in abdominal fat (p=0.035). HAART-related body changes were reported by the large majority of the population and were associated with demographic and clinical variables.

Rosiglitazone reverses tenofovir-induced nephrotoxicity

Tenofovir disoproxil fumarate (TDF) is a first-line drug used in patients with highly active retroviral disease; however, it can cause renal failure associated with many tubular anomalies that may be due to down regulation of a variety of ion transporters. Because rosiglitazone, a peroxisome proliferator-activated receptor-gamma agonist induces the expression of many of these same transporters, we tested if the nephrotoxicity can be ameliorated by its use. High doses of TDF caused severe renal failure in rats accompanied by a reduction in endothelial nitric-oxide synthase and intense renal vasoconstriction; all of which were significantly improved by rosiglitazone treatment. Low-dose TDF did not alter glomerular filtration rate but produced significant phosphaturia, proximal tubular acidosis, polyuria and a reduced urinary concentrating ability. These alterations were caused by specific downregulation of the sodium-phosphorus cotransporter, sodium/hydrogen exchanger 3 and aquaporin 2. A Fanconi`s-like syndrome was ruled out as there was no proteinuria or glycosuria. Rosiglitazone reversed TDF-induced tubular nephrotoxicity, normalized urinary biochemical parameters and membrane transporter protein expression. These studies suggest that rosiglitazone treatment might be useful in patients presenting with TFV-induced nephrotoxicity especially in those with hypophosphatemia or reduced glomerular filtration rate.

A new type of Brazilian propolis: Prenylated benzophenones in propolis from Amazon and effects against cariogenic bacteria

Ethanol extracts of four propolis samples (E1-E4) from Manaus (Brazilian Amazon) were analysed by HPLC/DAD/ESI-MS/MS and GC/EIMS. The major constituents of E2 and E4 were analysed by NMR ((1)H and (13)C) and ESI/MS/MS. The main constituents of E2 and E4 are polyprenylated benzophenones: 7-epi-nemorosone, 7-epi-clusianone (major E4 constituents), xanthochymol and gambogenone (major E2 constituents), making up a chemical profile so far unreported for Brazilian propolis. Aristhophenone, methyl insigninone, 18-ethyloxy-17-hydroxy-17,18-dihydroscrobiculatone B, and derivatives of dimethyl weddellianone A and B, propolones, and a scrobiculatone derivative, were detected as minor constituents. Triterpenoids (beta-amyrins, beta-amyrenone, lupeol and lupenone) were ubiquitous and predominant in El and E3. The extracts E2 and E4 were highly active against the cariogenic bacteria Streptococcus mitis, Streptococcus mutans and Streptococcus salivarius. E2 was more active than E4, probably due to a higher content of 2-epi-nemorosone, while the latter was richer in di-hydroxylated compounds. (C) 2010 Elsevier Ltd. All rights reserved.

Chronic action of association of zidovudine, lamivudine and ritonavir on pregnant rats. A biologic assay

Purpose: To evaluate at term the effects of a highly active antiretroviral (HAAR) drug association administered during the entire period of rat pregnancy. Methods: Three groups (n = 10 each) of adult pregnant rats were treated with an oral solution of HAAR (Exp 1 = 10/5/20 mg/kg b.w.; Exp 2 = 30/15/60 mg/kg b.w.; Exp 3 = 90/45/180 mg/kg b.w.) from day ""0"" up to the 20th day of pregnancy. A fourth group served as a control. At term (20th day) the rats were killed under deep anesthesia and the number of implantations, resorptions, living fetuses, placentae and intrauterine deaths were recorded. Results: The highest HAAR doses caused lower maternal weight gain, lower litter weights, and lower placental weights compared to the control group. Conclusions: HAAR during the entire period of rat pregnancy can reduce maternal body weight gain and lower term placental weight.