Fatores preditores de abandono de tratamento de tuberculose: uma metanálise

A tuberculose (TB) é uma doença que foi declarada pela Organização Mundial de Saúde como emergência mundial em 1993. As ferramentas disponíveis hoje para controle da TB são: o diagnóstico precoce e o tratamento eficiente. Porém, o abandono do tratamento de TB é um problema enfrentado mundialmente em proporções que podem variar entre 3% a 80%. Por isso, a identificação dos fatores que são preditores do abandono do tratamento de TB pode ajudar a desenvolver melhores estratégias para o seu controle. O objetivo deste trabalho é, através de uma metanálise, fazer uma estimativa sumária da medida de associação entre cada um dos fatores (a) relacionados ao serviço de saúde, (b) relacionado ao quadro clínico e à terapia da TB e (c) relacionados aos indivíduos e o abandono do tratamento de TB. A estratégia de busca eletrônica remota para a recuperação de publicações relevantes foi desenvolvida de forma específica para as diferentes bases consideradas relevantes (MEDLINE [Pubmed] e LILCS). Buscas por referências cruzadas, além da consulta à base de revisões sistemáticas COCHRANE, também foram realizadas. Investigações foram incluídas se fossem trabalhos observacionais ou experimentais que estudem fatores de risco ou preditores do desfecho de interesse (abandono do tratamento de tuberculose) através de comparações de dois ou mais grupos e se seus dados pudessem ser extraídos. Dois revisores classificaram os trabalhos e extraíram dados de forma mascarada e as discordâncias resolvidas. Mais de 190 textos completos foram aptos à combinação de dados. Destes, foi possível extrair dados para combinação de 40 exposições. Destas, 19 foram demonstradas nesta investigação. Das 19 demonstradas, 13 exposições estudadas apresentaram associação e poderiam ser considerados preditores (sexo masculino, alcoolismo, infecção pelo HIV/SIDA, uso de drogas ilícitas, nacionalidade estrangeira, analfabetismo, retratamento, baciloscopia positiva, abandono prévio, tratamento de curta duração, acesso fácil à unidade de saúde, treinamento para adesão, tuberculose extrapulmonar) e seis não apresentaram associação (desemprego, efeitos adversos, tuberculose resistente, necessidade de hospitalização, demora para o início do tratamento, espera longa para a consulta). Porém, essas associações devem ser consideradas de forma conservadora devido à elevada heterogeneidade encontrada em todas as exposições. Apenas cinco exposições apresentaram explicação parcial e uma apresentou explicação total para a heterogeneidade. O viés de publicação foi detectado em apenas duas das 19 exposições.

LDLR and PCSK9 Are Associated with the Presence of Antiphospholipid Antibodies and the Development of Thrombosis in aPLA Carriers

Introduction The identification of the genetic risk factors that could discriminate non-thrombotic from thrombotic antiphospholipid antibodies (aPLA) carriers will improve prognosis of these patients. Several human studies have shown the presence of aPLAs associated with atherosclerotic plaque, which is a known risk factor for thrombosis. Hence, in order to determine the implication of atherosclerosis in the risk of developing thrombosis in aPLA positive patients, we performed a genetic association study with 3 candidate genes, APOH, LDLR and PCSK9. Material & Methods For genetic association study we analyzed 190 aPLA carriers -100 with non-thrombotic events and 90 with thrombotic events-and 557 healthy controls. Analyses were performed by chi(2) test and were corrected by false discovery rate. To evaluate the functional implication of the newly established susceptibility loci, we performed expression analyses in 86 aPLA carrier individuals (43 with thrombotic manifestations and 43 without it) and in 45 healthy controls. Results Our results revealed significant associations after correction in SNPs located in LDLR gene with aPLA carriers and thrombotic aPLA carriers, when compared with healthy controls. The most significant association in LDLR gene was found between SNP rs129083082 and aPLA carriers in recessive model (adjusted P-value = 2.55 x 10(-3); OR = 2.18; 95% CI = 1.49-3.21). Furthermore, our work detected significant allelic association after correction between thrombotic aPLA carriers and healthy controls in SNP rs562556 located in PCSK9 gene (adjusted P-value = 1.03 x 10(-2); OR = 1.60; 95% CI = 1.24-2.06). Expression level study showed significantly decreased expression level of LDLR gene in aPLA carriers (P-value < 0.0001; 95% CI 0.16-2.10; SE 0.38-1.27) in comparison to the control group. Discussion Our work has identified LDLR gene as a new susceptibility gene associated with the development of thrombosis in aPLA carriers, describing for the first time the deregulation of LDLR expression in individuals with aPLAs. Besides, thrombotic aPLA carriers also showed significant association with PCSK9 gene, a regulator of LDLR plasma levels. These results highlight the importance of atherosclerotic processes in the development of thrombosis in patients with aPLA.

Length at maturity in three pelagic sharks (Lamna nasus, Isurus oxyrinchus, and Prionace glauca) from New Zealand

Reproductive data collected from porbeagle, shortfin mako, and blue sharks caught around New Zealand were used to estimate the median length at maturity. Data on clasper development, presence or absence of spermatophores or spermatozeugmata, uterus width, and pregnancy were collected by observers aboard tuna longline vessels. Direct maturity estimates were made for smaller numbers of sharks sampled at recreational fishing competitions. Some data sets were sparse, particularly over the vital maturation length range, but the availability of multiple indicators of maturity made it possible to develop estimates for both sexes of all three species. Porbeagle shark males matured at 140–150 cm fork length and females at about 170–180 cm. New Zealand porbeagles therefore mature at shorter lengths than they do in the North Atlantic Ocean. Shortfin mako males matured at 180–185 cm and females at 275 –285 cm. Blue shark males matured at about 190 –195 cm and females at 170–190 cm; however these estimates were hampered by small sample sizes, difficulty obtaining representative samples from a population segregated by sex and maturity stage, and maturation that occurred over a wide length range. It is not yet clear whether regional differences in median maturity exist for shortfin mako and

The Bay Scallop, Argopecten irradians, Massachusetts Through North Carolina: Its Biology and the History of Its Habitats and Fisheries

This article covers the biology and the history of the bay scallop habitats and fishery from Massachusetts to North Carolina. The scallop species that ranges from Massachusetts to New York is Argopecten irradians irradians. In New Jersey, this species grades into A. i. concentricus, which then ranges from Maryland though North Carolina. Bay scallops inhabit broad, shallow bays usually containing eelgrass meadows, an important component in their habitat. Eelgrass appears to be a factor in the production of scallop larvae and also the protection of juveniles, especially, from predation. Bay scallops spawn during the warm months and live for 18–30 months. Only two generations of scallops are present at any time. The abundances of each vary widely among bays and years. Scallops were harvested along with other mollusks on a small scale by Native Americans. During most of the 1800’s, people of European descent gathered them at wading depths or from beaches where storms had washed them ashore. Scallop shells were also and continue to be commonly used in ornaments. Some fishing for bay scallops began in the 1850’s and 1860’s, when the A-frame dredge became available and markets were being developed for the large, white, tasty scallop adductor muscles, and by the 1870’s commercial-scale fishing was underway. This has always been a cold-season fishery: scallops achieve full size by late fall, and the eyes or hearts (adductor muscles) remain preserved in the cold weather while enroute by trains and trucks to city markets. The first boats used were sailing catboats and sloops in New England and New York. To a lesser extent, scallops probably were also harvested by using push nets, picking them up with scoop nets, and anchor-roading. In the 1910’s and 1920’s, the sails on catboats were replaced with gasoline engines. By the mid 1940’s, outboard motors became more available and with them the numbers of fishermen increased. The increases consisted of parttimers who took leaves of 2–4 weeks from their regular jobs to earn extra money. In the years when scallops were abundant on local beds, the fishery employed as many as 10–50% of the towns’ workforces for a month or two. As scallops are a higher-priced commodity, the fishery could bring a substantial amount of money into the local economies. Massachusetts was the leading state in scallop landings. In the early 1980’s, its annual landings averaged about 190,000 bu/yr, while New York and North Carolina each landed about 45,000 bu/yr. Landings in the other states in earlier years were much smaller than in these three states. Bay scallop landings from Massachusetts to New York have fallen sharply since 1985, when a picoplankton, termed “brown tide,” bloomed densely and killed most scallops as well as extensive meadows of eelgrass. The landings have remained low, large meadows of eelgrass have declined in size, apparently the species of phytoplankton the scallops use as food has changed in composition and in seasonal abundance, and the abundances of predators have increased. The North Carolina landings have fallen since cownose rays, Rhinoptera bonsais, became abundant and consumed most scallops every year before the fishermen could harvest them. The only areas where the scallop fishery remains consistently viable, though smaller by 60–70%, are Martha’s Vineyard, Nantucket, Mass., and inside the coastal inlets in southwestern Long Island, N.Y.