Rifapentine for latent tuberculosis infection treatment in the general population and human immunodeficiency virus-positive patients: summary of evidence

AbstractLatent tuberculosis infection (LTBI) and human immunodeficiency virus (HIV)-coinfection are challenges in the control of tuberculosis transmission. We aimed to assess and summarize evidence available in the literature regarding the treatment of LTBI in both the general and HIV-positive population, in order to support decision making by the Brazilian Tuberculosis Control Program for LTBI chemoprophylaxis. We searched MEDLINE, Cochrane Library, Centre for Reviews and Dissemination, Embase, LILACS, SciELO, Trip database, National Guideline Clearinghouse, and the Brazilian Theses Repository to identify systematic reviews, randomized clinical trials, clinical guidelines, evidence-based synopses, reports of health technology assessment agencies, and theses that investigated rifapentine and isoniazid combination compared to isoniazid monotherapy. We assessed the quality of evidence from randomized clinical trials using the Jadad Scale and recommendations from other evidence sources using the Grading of Recommendations, Assessment, Development, and Evaluations approach. The available evidence suggests that there are no differences between rifapentine + isoniazid short-course treatment and the standard 6-month isoniazid therapy in reducing active tuberculosis incidence or death. Adherence was better with directly observed rifapentine therapy compared to self-administered isoniazid. The quality of evidence obtained was moderate, and on the basis of this evidence, rifapentine is recommended by one guideline. Available evidence assessment considering the perspective of higher adherence rates, lower costs, and local peculiarity context might support rifapentine use for LTBI in the general or HIV-positive populations. Since novel trials are ongoing, further studies should include patients on antiretroviral therapy.

A historical overview of leprosy epidemiology and control activities in Amazonas, Brazil

Leprosy is an ancient infectious disease caused by Mycobacterium leprae. According to comparative genomics studies, this disease originated in Eastern Africa or the Near East and spread with successive human migrations. The Europeans and North Africans introduced leprosy into West Africa and the Americas within the past 500 years. In Brazil, this disease arrived with the colonizers who disembarked at the first colonies, Rio de Janeiro, Salvador and Recife, at the end of the sixteenth century, after which it was spread to the other states. In 1854, the first leprosy cases were identified in State of Amazonas in the north of Brazil. The increasing number of leprosy cases and the need for treatment and disease control led to the creation of places to isolate patients, known as leprosaria. One of them, Colonia Antônio Aleixo was built in Amazonas in 1956 according to the most advanced recommendations for isolation at that time and was deactivated in 1979. The history of the Alfredo da Matta Center (AMC), which was the first leprosy dispensary created in 1955, parallels the history of leprosy in the state. Over the years, the AMC has become one of the best training centers for leprosy, general dermatology and sexually transmitted diseases in Brazil. In addition to being responsible for leprosy control programs in the state, the AMC has carried out training programs on leprosy diagnosis and treatment for health professionals in Manaus and other municipalities of the state, aiming to increase the coverage of leprosy control activities. This paper provides a historical overview of leprosy in State of Amazonas, which is an endemic state in Brazil.

Human herpesvirus 8 (HHV-8) and the etiopathogenesis of Kaposi's sarcoma

OBJECTIVE: To review the current literature on human herpesvirus 8 with particular attention to the aspects related to the etiopathogenesis of Kaposi's sarcoma. MATERIALS AND METHODS: The authors searched original research and review articles on specific aspects of human herpesvirus 8 infection, including virology, epidemiology, transmission, diagnosis, natural history, therapy, and Kaposi's sarcoma etiopathogenesis. The relevant material was evaluated and reviewed. RESULTS: Human herpesvirus 8 is a recently discovered DNA virus that is present throughout the world but with major geographic variation. In the Western world, the virus, transmitted mainly by means of sexual contact, is strongly associated with Kaposi's sarcoma and body cavity-based lymphoma and more controversially with multiple myeloma and other non-proliferative disorders. There is no specific effective treatment, but HIV protease inhibitors may play an indirect role in the clearance of human herpesvirus 8 DNA from peripheral blood mononuclear cells of HIV-infected patients. Human herpesvirus 8 DNA is present in saliva, but there are as yet no documented cases of nosocomial transmission to health care workers. The prevalence of human herpesvirus 8 among health care workers is probably similar to that in the general population. CONCLUSION: Human herpesvirus 8 appears to be, at least in Western Europe and United States, restricted to a population at risk of developing Kaposi's sarcoma. Human herpesvirus 8 certainly has the means to overcome cellular control and immune responses and thus predispose carriers to malignancy, particularly Kaposi's sarcoma. The wide diffusion of Human herpesvirus 8 in classic Kaposi's sarcoma areas appears to represent an important factor in the high incidence of the disease. However, additional co-factors are likely to play a role in the development of Kaposi's sarcoma.

Involvement of C4 allotypes in the pathogenesis of human diseases

The complement system is an important humoral defense mechanism that plays a relevant role against microbial agents, inflammatory response control, and immunocomplex clearance. Classical complement pathway activation is antibody-dependent. The C4 component participates in the initial step of activation, and C4 expression is determined by 2 pairs of allotypes: C4A and C4B. Deficiencies in C4 allotypes have been associated with several diseases. The aim of the present review is evaluate the reported data in the literature regarding specific C4A and C4B deficiencies and characterize their clinical relevance. We searched the MEDLINE and LILACS databases. Papers referring to total C4 deficiency without allotype evaluation and case reports of primary C4 deficiency were not included. Deficiencies in C4 allotypes have been associated with Mycobacterium leprae infection, erythema nodosum, systemic sclerosis with anti-topoisomerase I antibodies, intermediate congenital adrenal hyperplasia with DR5 genotype, diabetes mellitus type 1 with DR3,4 genotype, and diabetes mellitus with antibodies against islet cells. C4 allotype deficiency is also related to C4B deficiency and autoimmune-associated diseases, such as systemic lupus erythematosus, or diseases with an autoimmune component, such as autism. Some reports associate C4A with thyroiditis after delivery as well as limited and systemic sclerosis without anti-topoisomerase I antibodies. However, the studies with C4A and C4B have been concentrated in isolated populations, and some of the studies could not be reproduced by other authors.

Development of human central nervous system 3D in vitro models for preclinical research

Neurological disorders are a major concern in modern societies, with increasing prevalence mainly related with the higher life expectancy. Most of the current available therapeutic options can only control and ameliorate the patients’ symptoms, often be-coming refractory over time. Therapeutic breakthroughs and advances have been hampered by the lack of accurate central nervous system (CNS) models. The develop-ment of these models allows the study of the disease onset/progression mechanisms and the preclinical evaluation of novel therapeutics. This has traditionally relied on genetically engineered animal models that often diverge considerably from the human phenotype (developmentally, anatomically and physiologically) and 2D in vitro cell models, which fail to recapitulate the characteristics of the target tissue (cell-cell and cell-matrix interactions, cell polarity). The in vitro recapitulation of CNS phenotypic and functional features requires the implementation of advanced culture strategies that enable to mimic the in vivo struc-tural and molecular complexity. Models based on differentiation of human neural stem cells (hNSC) in 3D cultures have great potential as complementary tools in preclinical research, bridging the gap between human clinical studies and animal models. This thesis aimed at the development of novel human 3D in vitro CNS models by integrat-ing agitation-based culture systems and a wide array of characterization tools. Neural differentiation of hNSC as 3D neurospheres was explored in Chapter 2. Here, it was demonstrated that human midbrain-derived neural progenitor cells from fetal origin (hmNPC) can generate complex tissue-like structures containing functional dopaminergic neurons, as well as astrocytes and oligodendrocytes. Chapter 3 focused on the development of cellular characterization assays for cell aggregates based on light-sheet fluorescence imaging systems, which resulted in increased spatial resolu-tion both for fixed samples or live imaging. The applicability of the developed human 3D cell model for preclinical research was explored in Chapter 4, evaluating the poten-tial of a viral vector candidate for gene therapy. The efficacy and safety of helper-dependent CAV-2 (hd-CAV-2) for gene delivery in human neurons was evaluated, demonstrating increased neuronal tropism, efficient transgene expression and minimal toxicity. The potential of human 3D in vitro CNS models to mimic brain functions was further addressed in Chapter 5. Exploring the use of 13C-labeled substrates and Nucle-ar Magnetic Resonance (NMR) spectroscopy tools, neural metabolic signatures were evaluated showing lineage-specific metabolic specialization and establishment of neu-ron-astrocytic shuttles upon differentiation. Chapter 6 focused on transferring the knowledge and strategies described in the previous chapters for the implementation of a scalable and robust process for the 3D differentiation of hNSC derived from human induced pluripotent stem cells (hiPSC). Here, software-controlled perfusion stirred-tank bioreactors were used as technological system to sustain cell aggregation and dif-ferentiation. The work developed in this thesis provides practical and versatile new in vitro ap-proaches to model the human brain. Furthermore, the culture strategies described herein can be further extended to other sources of neural phenotypes, including pa-tient-derived hiPSC. The combination of this 3D culture strategy with the implemented characterization methods represents a powerful complementary tool applicable in the drug discovery, toxicology and disease modeling.

Ontology-based representation and generation of workflows for micro-task human-machine computation

Doctoral Program in Computer Science

Hand gesture recognition for human computer interaction : a comparative study of different image features

Hand gesture recognition for human computer interaction, being a natural way of human computer interaction, is an area of active research in computer vision and machine learning. This is an area with many different possible applications, giving users a simpler and more natural way to communicate with robots/systems interfaces, without the need for extra devices. So, the primary goal of gesture recognition research is to create systems, which can identify specific human gestures and use them to convey information or for device control. For that, vision-based hand gesture interfaces require fast and extremely robust hand detection, and gesture recognition in real time. In this study we try to identify hand features that, isolated, respond better in various situations in human-computer interaction. The extracted features are used to train a set of classifiers with the help of RapidMiner in order to find the best learner. A dataset with our own gesture vocabulary consisted of 10 gestures, recorded from 20 users was created for later processing. Experimental results show that the radial signature and the centroid distance are the features that when used separately obtain better results, with an accuracy of 91% and 90,1% respectively obtained with a Neural Network classifier. These to methods have also the advantage of being simple in terms of computational complexity, which make them good candidates for real-time hand gesture recognition.

Rational manipulation of mRNA folding free energy allows rheostat control of pneumolysin production by Streptococcus pneumoniae

Rational manipulation of mRNA folding free energy allows rheostat control of pneumolysin production by Streptococcus pneumoniae

Osteogenic differentiation of human mesenchymal stem cells in the absence of osteogenic supplements: a surface-roughness gradient study

The use of biomaterials to direct osteogenic differentiation of human mesenchymal stem cells (hMSCs) in the absence of osteogenic supplements is thought to be part of the next generation of orthopedic implants. We previously engineered surface-roughness gradients of average roughness (Ra) varying from the sub-micron to the micrometer range ( 0.5–4.7 lm), and mean distance between peaks (RSm) gradually varying from 214 lm to 33 lm. Here we have screened the ability of such surface-gradients of polycaprolactone to influence the expression of alkaline phosphatase (ALP), collagen type 1 (COL1) and mineralization by hMSCs cultured in dexamethasone (Dex)-deprived osteogenic induction medium (OIM) and in basal growth medium (BGM). Ra 1.53 lm/RSm 79 lm in Dex-deprived OI medium, and Ra 0.93 lm/RSm 135 lm in BGM consistently showed higher effectiveness at supporting the expression of the osteogenic markers ALP, COL1 and mineralization, compared to the tissue culture polystyrene (TCP) control in complete OIM. The superior effectiveness of specific surface-roughness revealed that this strategy may be used as a compelling alternative to soluble osteogenic inducers in orthopedic applications featuring the clinically relevant biodegradable polymer polycaprolactone.

MMP-9/RECK imbalance: a mechanism associated with high-grade cervical lesions and genital infection by Human Papillomavirus (HPV) and Chlamydia trachomatis

"Manuscript"

Human papillomavirus (HPV) screening and cervical cancer burden. A Brazilian perspective

This review tackles the issues related to disease burden caused by cervical cancer (CC) and its precursor (CIN) lesions in Brazil. A special focus is given to new technologies with potential to interfere with the development of CC by reducing the high-risk human papillomavirus (hr-HPV)-induced lesions that remain a major public health burden in all developing countries where organized screening programs do not exist. Globally, 85 % of all incident CC and 50 % of CC deaths occur in the developing countries. Unfortunately, most regions of Brazil still demonstrate high mortality rates, ranking CC as the second most common cancer among Brazilian women. Recently, CC screening programs have been tailored in the country to enable early detection of CC precursor lesions and thereby reduce cancer mortality. A combination of HPV testing with liquid-based cytology (LBC) seems to be a promising new approach in CC screening, with high expectation to offer an adequate control of CC burden in this country.

Senescencia de celulas T humanas inducida por tumores: un nuevo mecanismo de evasión de la respuesta inmune. Senescence of human T cells iduced by tumors. A new mechanism of evasion of immune response.

La respuesta antitumoral en individuos con cáncer depende, en gran medida, de células del sistema inmune capaces de reconocer y eliminar las células tumorales. Sin embargo, los tumores tienen la capacidad de evadir la respuesta inmune a través de diversos mecanismos como por ejemplo inducir la muerte de células claves del sistema inmune [1-3]. Previamente nosotros demostramos mediante un modelo in vitro que dependiendo de las condiciones de interacción entre tumor y linfocitos (tiempo y relación numérica), los tumores pueden inducir apoptosis o senescencia de linfocitos T provenientes de donantes sanos. Nuestros resultados son los primeros en demostrar que células tumorales de diversos orígenes pueden inducir senescencia de células T a través de factor/s solubles. También demostramos que a diferencia con los que ocurre in vivo, tanto las células CD4 como las CD8 son susceptibles a adquirir fenotipo de senescencia. Estudiando las implicancias que puede tener la senescencia sobre la funcionalidad de la célula T, observamos que las células T CD4+ y CD8+ senescentes pueden suprimir una respuesta linfoproliferativa. Si bien las células CD8+CD28- han sido identificadas in vivo, nosotros demostramos que células CD4+ CD28- tiene capacidad supresora [4]. En base a estos resultados, nuestra hipótesis es que las células T senescentes inducida por tumores pueden regular nuestro sistema de defensa actuando sobre la respuesta inmune adaptativa y posiblemente sobre la innata y, por consiguiente, postulamos que la senescencia de células T puede ser considerada como otro de los mecanismos de evasión de la respuesta inmunePlanteamos así los siguientes objetivos específicos: -Evaluar como las células T senescentes inducidas por tumores pueden regular la respuesta inmune.-Evaluar la participación de mediadores solubles capaces de regular la senescencia de células T inducida por tumores. En la actualidad existen estrategias inmuno-terapéuticas que avizoran resultados promisorios. Sin embargo, el control de células T inmunosupresoras permanece como unos de los grandes desafíos. Nuestro proyecto proveerá conocimientos sobre un fenómeno muy poco estudiado y por consiguiente muy poco valorado a la hora de diseñar estrategias terapéuticas para la cura del cáncer.

Estudio de los modos de vida e historia biológica de las poblaciones humanas de la región central de argentina desde el registro bioarqueológico. Lifestyles and biological history of human populations of the central region of argentina from bioarchaeological record.

Se pretende aportar al estudio de la estructura, historia biológica y estilos de vida de las poblaciones que habitaron la región central de Argentina durante el Holoceno, desde una perspectiva que combina los aportes teóricos y metodológicos de la Genética del paisaje y la Bioarqueología. Interesa a) identificar barreras de diferenciación morfológica entre poblaciones, b) poner a prueba modelos poblacionales para explicar la variación observada e identificar las variables que contribuyan a dicha diferenciación, c) evaluar la congruencia de los resultados obtenidos, d) reconstruir los patrones de movilidad residencial de las poblaciones, e) estudiar sus patrones dietarios considerando diferencias temporales y espaciales, f) identificar indicadores de diversos tipos de estrés (nutricional, funcional), así como traumas, g) estudiar las historias tafonómicas del registro bioarqueológico regional, y h) proponer un modelo para explicar el poblamiento y la evolución local de las poblaciones que habitaron esta región, a partir de la información arqueológica y bioantropológica. Para el análisis de los patrones espaciales de variación biológica se trabajará a partir del registro de rasgos epigenéticos craneales, medidas lineales y datos obtenidos a partir de morfometría geométrica sobre fotografías en 2D sobre muestras arqueológicas procedentes de esta región y de otras regiones geográficas de la Argentina. Para el análisis de la estructura de la población se trabajará a partir del cálculo de la matriz R para datos morfológicos y sus estimaciones derivadas (distancia D², Fst, coordenadas principales) y la aplicación del modelo de Harpending y Ward. Desde la genética del paisaje, se realizarán análisis de autocorrelación espacial, barreras genéticas y análisis geoestadísticos (kriging). Para el estudio de los modos de vida a partir del registro bioarqueológico se relevarán patologías dento-alveolares y alteraciones vinculadas con la salud bucal tales como desgaste dental –a nivel micro y macroscópico- caries, abscesos, pérdidas dentales antemortem, cálculos, hipoplasias, marcadores esqueletales de salud y lesiones traumáticas. Se analizarán isótopos estables (δ13C, δ15N, 86Sr y 87Sr) en restos óseos humanos de diversos sitios arqueológicos con el objetivo de reconstruir patrones dietarios y analizar la movilidad residencial y migración de las poblaciones. Paralelamente, se establecerán procedimientos de control tafonómico de los restos óseos, y se harán análisis específicos para estudiar las historias tafonómicas y evaluar el grado de integridad de los contextos de depositación y de las colecciones en general. Estimamos que el análisis de los patrones espaciales y temporales de variabilidad morfológica craneofacial, así como el estudio de las dietas a partir de información isotópica y bioarqueológica, de las migraciones y la movilidad residencial de las poblaciones a partir de isótopos de estroncio, la reconstrucción de comportamientos y actividades cotidianas a partir de marcadores de estrés músculo-esqueletal, en un marco cronológico y espacial constituye un aporte novedoso y eficaz que permitirá incrementar de manera substancial la información sobre la evolución de las poblaciones originarias del centro del territorio argentino. The aim of this project is to study the structure, biological history and lifestyles of the people that inhabitated the central region of Argentina during the Holocene, from a perspective that combines theoretical and methodological contributions of Landscape Genetics and Bioarchaeology. To analyze the spatial patterns of biological variation we consider epigenetic cranial traits, linear measurements and data obtained from geometric morphometric on 2D photographs. Morphological variation will be focused on landscape genetics (autocorrelation, genetic barriers and geostatistical analysis –kriging-) and population structure (matrix R, D², Fst, principal coordinates, Harpendig and Ward model). For the study of lifestyles from bioarchaeological record we consider alveolar pathologies and disorders related to oral health such as tooth wear, micro and macroscopic level, caries, abscesses, antemortem tooth loss, hypoplasia, markers skeletal health and traumatic injuries, as well as taphonomic processes. Stable isotopes will be analyzed (δ13C, d15N, 86Sr and 87Sr) in human skeletal remains from various archaeological sites in order to reconstruct and analyze dietary patterns of residential mobility and migration of populations. It will be established procedures of taphonomic control on skeletal remains, analysis to study taphonomic histories and assess the degree of completeness of depositional context and collection, in general terms. We consider that analysis of spatial and temporal patterns of variability in craniofacial morphology and the study of health and diets from isotopic and bioarchaeological data, migration and residential mobility patterns from strontium isotopes, as well as activity patterns from stress markers is a novel and effective contribution that will substantially increase the information about the local evolution of populations that inhabitated the center of Argentina.

Odour nuisance in Ireland and the potential use of olfactometry for the control of odours

Odour nuisance in other European countries has led to the development of techniques which employ panels of human assessors for the determination of environmental odours. Odour measurement is not widely practised in Ireland, yet local authorities are frequently in receipt of odour derived public complaints. This dissertation examines the fundamentals of odour nuisance in terms of how we perceive odours, common sources of environmental odours, the principles of odour measurement (in particular the Sutch pre-standard on olfactometry) and the extent to which odour nuisance is a problem in Ireland. The intention is to provide a reference document for use by those interested parties in the country who may be variously involved in policy making, legislative development, enforcement of environmental law or any person who has an interest in odours and the public nuisance they can give rise to. In particular the aim was to provide previously undocumented information on the prevalence of odour nuisance in Ireland, the exercision of the available powers to control odours, and the possible value of odour measurement as part of a regulatory process. A questionnaire was circulated to all local authorities in the country and 82% responded with information on their experiences and views on the subject of odours. The results of the survey are presented in summary and detailed form.