Hepatitis B virus genotyping among chronic hepatitis B patients with resistance to treatment with lamivudine in the City of Ribeirão Preto, State of São Paulo

INTRODUCTION: Lamivudine is a nucleoside analogue that is used clinically for treating chronic hepatitis B infection. However, the main problem with prolonged use of lamivudine is the development of viral resistance to the treatment. Mutations in the YMDD motif of the hepatitis B virus DNA polymerase gene have been associated with resistance to drug therapy. So far, there have not been many studies in Brazil reporting on genotype-dependent development of resistance to lamivudine. Thus, the aim of the present study was to determine the possible correlation between a certain genotype and increased development of resistance to lamivudine among chronic hepatitis B patients. METHODS: HBV DNA in samples from 50 patients under lamivudine treatment was amplified by means of conventional PCR. Samples were collected at Hospital das Clínicas, FMRP-USP. The products were then sequenced and phylogenetic analysis was performed. RESULTS: Phylogenetic analysis revealed that 29 (58%) patients were infected with genotype D, 20 (40%) with genotype A and one (2%) with genotype F. Mutations in the YMDD motif occurred in 20% of the patients with genotype A and 27.6% of the patients with genotype D. CONCLUSIONS: Despite the small number of samples, our results indicated that mutations in the YMDD motif were 1.38 times more frequent in genotype D than in genotype A.

Laparoscopic treatment of retroperitoneal fibrosis: report of two cases and review of the literature

OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.

Decision methods applied to solve a safety problem on a waste treatment facility

To solve a health and safety problem on a waste treatment facility, different multicriteria decision methods were used, including the PROV Exponential decision method. Four alternatives and ten attributes were considered. We found a congruent solution, validated by the different methods. The AHP and the PROV Exponential decision method led us to the same options ordering, but the last method reinforced one of the options as being the best performing one, and detached the least performing option. Also, the ELECTRE I method results led to the same ordering which allowed to point the best solution with reasonable confidence. This paper demonstrates the potential of using multicriteria decision methods to support decision making on complex problems such as risk control and accidents prevention.

Phage therapy: a step forward in the treatment of Pseudomonas aeruginosa infections

Antimicrobial resistance constitutes one of the major worldwide public health concerns. Bacteria are becoming resistant to the vast majority of antibiotics and nowadays, a common infection can be fatal. To revert this situation, the use of phages for the treatment of bacterial infections has been extensively studied as an alternative therapeutic strategy. Since P. aeruginosa is one of the most common causes of healthcare-associated infections, many studies have reported the in vitro and in vivo antibacterial efficacy of phage therapy against this bacterium. This review collects data of all the P. aeruginosa phages sequenced to date, providing a better understanding about their biodiversity. This review will further address the in vitro and in vivo results obtained by using phages to treat or prevent P. aeruginosa infections as well as the major hurdles associated with this therapy.

Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel.

CONTEXT: New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected adults in resource-rich settings. OBJECTIVE: To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society-USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus. DATA SYNTHESIS: Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered. CONCLUSION: New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.

Creació d'un consorci de microorganismes per l'eliminació de fòsfor a partir de fonts de carboni alternatives

L'existència d’una font de carboni adequada per l’eliminació biològica de fòsfor, és un factor decisiu per l'eliminació de fòsfor de les aigües residuals urbanes. Per a les aigües residuals amb baix contingut d'àcids grassos volàtils és necessària l’addició d’alguna font de carboni externa. El metanol és la font de carboni més utilitzada en processos a EDAR (p.ex. desnitrificació), degut al seu baix cost. Malgrat això, varis estudis proven que per l’eliminació biològica de fòsfor, aquest, no és una bona alternativa. En aquest estudi es desenvolupa un consorci amb la biomassa de digestió anaeròbia i biomassa acumuladora de polifosfat (PAO). El propòsit del consorci és la degradació de metanol en AGV, per obtenir l'activitat EBPR. A més, aquest estudi mostra la viabilitat de substituir en el consorci el metanol per altres fonts de carboni.

Postoperative delirium. Part 2: detection, prevention and treatment.

To target pharmacological prevention, instruments giving an approximation of an individual patient's risk of developing postoperative delirium are available. In view of the variable clinical presentation, identifying patients in whom prophylaxis has failed (that is, who develop delirium) remains a challenge. Several bedside instruments are available for the routine ward and ICU setting. Several have been shown to have a high specificity and sensitivity when compared with the standard definitions according to DSM-IV-TR and ICD-10. The Confusion Assessment Method (CAM) and a version specifically developed for the intensive care setting (CAM-ICU) have emerged as a standard. However, alternatives allowing grading of the severity of delirium are also available. In many units, the approach to delirium follows a three-step strategy. Initially, non-pharmacological multicomponent strategies are used for primary prevention. As a second step, pharmacological prophylaxis may be added. Perioperative administration of haloperidol has been shown to reduce the severity, but not the incidence, of delirium. Perioperative administration of atypical antipsychotics has been shown to reduce the incidence of delirium in specific groups of patients. In patients with delirium, both symptomatic and causal treatment of delirium need to be considered. So far symptomatic treatment of delirium is primarily based on antipsychotics. Currently, cholinesterase inhibitors cannot be recommended and the data on dexmedetomidine are inconclusive. With the exception of alcohol-withdrawal delirium, there is no role for benzodiazepines in the treatment of delirium. It is unclear whether treating delirium prevents long-term sequelae.

Roadway Alignments as Assets: Evaluating Alternatives for Valuing Major Highway Corridor Rights of Way Final Report December 2010 Sponsored

In most highway asset management exercises, real estate used in alignments is considered to be an asset class that does not depreciate. Although the treatment of right of way assets as non-depreciable real property may be appropriate as an accounting exercise, the fact is that the real estate contained in transportation corridors can in fact lose value from a traffic service point of view. Such facilities become functionally obsolete in that they no longer serve the purpose that was intended when they were planned, designed, and built. This report is intended to begin a discussion of the topic of how highway alignments ought be valued as assets as opposed to how they generally are valued, at either book value or replacement value, given it can be shown that some highway alignments do in fact depreciate in value.

Is use of nifurtimox for the treatment of Chagas disease compatible with breast feeding? A population pharmacokinetics analysis.

Introduction Women with Chagas disease receiving treatment with nifurtimox are discouraged from breast feeding. Many patients who would receive treatment with nifurtimox live in extreme poverty, have limited access to resources such as clean water and baby formula and may not have safe alternatives to breast milk. Aim We aimed to estimate, using limited available pharmacokinetics data, potential infant exposure to nifurtimox through breast milk. Methods Original nifurtimox plasma concentrations were obtained from published studies. Pharmacokinetic parameters were estimated using non-linear mixed-effect modelling with NONMEM V.VI. A total of 1000 nifurtimox plasma-concentration profiles were simulated and used to calculate the amount of drug that an infant would be exposed to, if breast fed 150 ml/kg/day. Results Breast milk concentrations on the basis of peak plasma levels (1361 ng/ml) and milk-plasma ratio were estimated. We calculated infant nifurtimox exposure of a breastfed infant of a mother treated with this drug to be below 10% of the maternal weight-adjusted dose, even if milk-plasma ratio were overestimated. Simulation led to similar estimates. Discussion Risk for significant infant exposure to nifurtimox through breast milk seems small and below the level of exposure of infants with Chagas disease receiving nifurtimox treatment. This potential degree of exposure may not justify discontinuation of breast feeding.

Tertiary treatment of pulp and paper mill effluents

Työn tavoitteena oli selvittää mitä käsittelyvaihtoehtoja on olemassa jäteveden puhdistamon tertiäärikäsittelyyn ja miten suuri tarve paperi- ja selluteollisuuden prosessivesien puhdistukseen on. Tarkoituksena oli saada käsitys koko tertiäärikäsittelystä eri näkökulmista. Lopuksi läpikäytiin tertiäärikäsittelymenetelmiä ja etsittiin mahdollisia uusia menetelmiä, joita voitaisiin käyttää jäteveden tertiääripuhdistukseen. Ensimmäisenä työssä on perehdytty jäteveden koostumukseen paperi- ja selluteollisuudessa ja puhdistukseen ilmastetulla aktiivilietemenetelmällä, jotta tertiäärikäsittely ymmärrettäisiin konseptina paremmin. Lisäksi työssä selvitettiin tertiäärikäsittelyn tarvetta ja vaihtoehtoja sen käyttämättä jättämiselle teollisuuden ja muun ympäristöä vahingoittavan toiminnan ympäristönäkökohdat huomioonottaen. Lyhyiden menetelmäesitysten jälkeen kiteytetään tertiäärikäsittelyn ympäristönäkökohdatja vaihtoehdot sen käytölle yhteenvetona, jossa otetaan huomioon myös viranomaisten, yrityksen ja BAT referenssien sisältämä tieto tertiäärikäsittelystä. Työn kokeellinen osa sisältää erään tertiäärikäsittelysovelluksenrakentamisen, koekäytön ja laboratorioanalyysien yhteenvedon. Lisäksi menetelmää verrataan kustannus-tehokkuudeltaan vastaavien menetelmien kanssa. Tarkoituksena oli löytää jäteveden tertiäärikäsittelyyn sopiva laitteisto, jonka toimintaanei sisältyisi kemikaalien annostelua ja sitä käytettäisiin lähinnä jätevedenpuhdistamon ongelmatilanteiden väliaikaiseksi ratkaisuksi. Mahdollisesti se voisi toimia myös jatkuvatoimisesti veden kirkastuksessa. Diplomityössä rakennettu laitteisto, jota käytettiin myös pilot koeajoissa, ei ollut paras mahdollinen laitteisto tertiäärikäsittelyn toteuttamiseksi paperi- ja selluteollisuudessa, mutta kilpailukykyinen muiden laitteistojen kanssa. Laitteiston toimintaperiaate on kuitenkin käyttökelpoinen tietyin varauksin ja sitä voidaan käyttää vedenpuhdistamiseen.

Estudi d'alternatives de gestió de la fracció orgànica generada al municipi de l'Esquirol

L'entrada en vigor de la Directiva 1999/31/CE limita l'entrada de residus biodegradables a l'abocador i promou la gestió d'aquests residus per altres vies. El compostatge és una alternativa a la deposició en abocador que respecta el cicle natural de la matèria. A Catalunya, aquesta tècnica s'ha vist potenciada pels plans de gestió de residus PRECAT201 i PINFRECAT202. L'objecte d'aquest estudi és avaluar l'eficiència de la recollida selectiva al municipi de l'Esquirol; i comparar i avaluar diferents alternatives de gestió de la FORM3 dins i fora del municipi. La metodologia de l'estudi ha consistit en analitzar les dades de la recollida selectiva de l'ARC4, tant del municipi de l'Esquirol com de la resta de municipis del Collsacabra, i calcular els costos econòmics de la gestió de la FORM en el supòsit de tractament mitjançant l'autocompostatge, una planta de compostatge a petita escala o el tractament en una planta de compostatge convencional. Els resultats de l'estudi indiquen que la recollida selectiva del municipi de l'Esquirol obté uns valors per sobre dels objectius del PROGREMIC5, amb l'excepció de la FORM. Per tal de millorar la qualitat i la quantitat de la FORM recollida, l'estudi proposa en una primera fase: implantar el sistema de recollida selectiva porta a porta d'aquesta fracció i de la fracció resta; i en una segona fase: tractar la FORM en una petita planta de compostatge amb el sistema de sitges amb ventilació forçada.

Treatment-related renal side-effects in pediatric cancer patients

Background: The long-term side-effects of cancer treatments are of growing importance, since the number of pediatric cancer survivors has considerably increased. Renal side-effects should be noted early to prevent further deterioration. Renal dysfunction may also develop long after cancer treatment. Easy and reliable methods for assessing renal function are needed. Aims: The aims were to find the mechanisms behind methotrexate-induced renal damage by studying renal tubular cells (LLC-PK1cells), and to evaluate the usefulness of laboratory tests in assessing glomerular function in pediatric cancer patients by comparing an isotope clearance method with alternative methods. The aim was also to study the long-term effects of bone marrow transplantation (BMT) and high-dose methotrexate (HD-MTX) treatment in renal function. Results: Methotrexate induced time-dependent renal tubular cell swelling and cell death. In patients treated with HD-MTX a significant decrease in GFR was noted after a follow-up time of one to ten years. One year after BMTthe GFR was reduced, especially in patients treated with total body irradiation (TBI). GFR recovered slightly but remained stable thereafter. In glomerular function assessment the serum cystatin C (cysC) concentration showed a significant association with GFR measured by the isotope method. Conclusions: Methotrexate induced acute damage in renal tubular cells. In assessing GFR the isotope method still remains the method of choice, but the assay of cystatin C was the most reliable of other alternatives. Long-term follow-up of renal function is needed in BMT patients and patients treated with HD-MTX.

Electrocatalysis in wastewater treatment: recent mechanism advances

Over 50 years, several scientists and industries have developed new alternatives for wastewater treatment and remediation. Recently, electrochemical technology has been largely developed mainly because of its versatility and environmental compatibility. Scientific contributions about role of the electrode material have allowed determining that the influence of material in the selectivity is an important parameter. However, to interpret this behavior, comprehensive physical chemistry models for organics destruction, related to electrochemical phenomena and material surfaces, were proposed in the last decades. So, this paper presents a critical and comprehensive review about the principles and recent mechanism advances in electrocatalysis for wastewater treatment.

Swine manure post-treatment technologies for pathogenic organism inactivation

Swine manure agricultural use is a common practice in Brazil. Their physic-chemical characteristics favor its use as biofertilizer, but the presence of pathogens may become a risk to human health. This research presents a qualitative study of the main alternatives of pig manure disinfection, analyzing efficiency, advantages and limitations of each procedure. The disinfection studies reported in literature are based on the following treatments: alkaline, thermal, biological, chemical, and physical. The greater efficiencies are in thermal treatment (> 4 log: 60 °C), chemical treatment (3 to 4 log: 30mg Cl- L-1; 3 to 4 log: 40 mg O3 L-1) and physical treatment (3 a 4 log: 220 mJ UV radiation cm-2). The biological treatment (anaerobiosis) also promotes the pathogen reduction of swine manure, however with lower efficiency (1 to 2 log). The selection of the treatment should consider: implementation and operation cost, necessity of preliminary treatment, efficiency obtained and destination of the treated manure (agricultural use, water reuse). Brazilian regulation does not have specific guidelines for the microbiological quality of animal production effluents that is very important to be considered due to confined animal feeding operation transformation in the last years in the country.