Identification of patients at risk of cardiovascular disease in Greater Manchester in the VICTORION-Spirit study

Background:Inclisiran is a cholesterol-lowering small interfering RNA treatment licensed in the UK for lowering low-density lipoprotein cholesterol (LDL-C). VICTORION-Spirit (NCT04807400) is an implementation science study designed to provide evidence for inclisiran implementation within the National Health Service. The aim was to describe the process of patient identification employed in VICTORION-Spirit.Methods:A Phase IIIb, multicentre, randomisedcontrolled study, VICTORION-Spirit is evaluating inclisiran implementation in participants with atherosclerotic cardiovascular disease (ASCVD) or ASCVD-risk equivalents and elevated LDL-C. Feasibility Assessment and Recruitment System for Improving Trial Efficiency (FARSITE) software utilising natural language search functions identified patients who may benefit from inclisiran. FARSITE searches were performed within Salford, Manchester, Trafford and Bury Clinical Commissioning Groups to identify individuals with elevated LDL-C or total cholesterol and pre-existing cardiovascular disease (CVD) or at risk of ASCVD.Results:FARSITE used ‘total cholesterol >4 mmol/l’ terminology rather than ‘LDL-C’; the former yielded >3 times the number of eligible patients. The search for individuals with pre-existing CVD identified 24,196 people in a population of 560,969 (4.3%); including ‘total cholesterol >4 mmol/l’ identified 10,431 individuals with pre-existing CVD and elevated total cholesterol. Searches for individuals at risk of ASCVD identified 65,457 people, narrowing to 26,580 at risk of ASCVD plus elevated total cholesterol. The most discriminatory SNOMED concept codes and their prevalence within the dataset can inform national approaches to develop similar searches. Conclusions: FARSITE searches employed in VICTORION-Spirit identified a population at risk of ASCVD in Greater Manchester, England, who may benefit from a cholesterol-lowering medication such as inclisiran.

The clinicopathological spectrum and driver mutation profile in classic BCR-ABL1 negative myeloproliferative neoplasms: a three-year study from a tertiary care center in Kerala, South India

Background: Myeloproliferative neoplasms (MPNs) are clonal hematopoietic stem cell disorders primarily of the adults. The 2016 World Health Organization (WHO) classification of MPNs include the molecular landscape as one of the diagnostic criteria. JAK2 exon14 (JAK2 V617F), JAK2 exon12, Myeloproliferative leukemia virus oncogene exon 10 (MPL 515), and calreticulin exon 9 (CALR) mutations are the main somatic driver mutations detected in classic BCR-ABL1 negative MPNs. Methods: A retrospective, cross-sectional study was conducted including 99 patients diagnosed with classic BCR-ABL1 negative MPNs during a 3-year time period, from March 2018 to February 2021 in the departments of pathology and clinical haematology- haemato oncology of a tertiary care teaching hospital. Clinical, haematological and morphological features were analysed and correlated with MPN associated mutation studies done in blood/bone marrow samples. Results: The prevalence of polycythaemia vera (PV) was found to be higher than other MPN, two third of which were JAK2 positive. More than half of the cases of primary myelofibrosis (PMF) and essential thrombocythemia (ET) also showed JAK2 mutation. CALR was positive in 17.4% of ET and 31.3% of PMF; MPL in 4.4% of ET and 3.1% of PMF. Conclusions: The prevalence of triple-negative MPN point towards the need for whole-exome sequencing of triple-negative MPN.

Accelerating the development of healthy and climate-smart hospitals in the Southeast Asian Region

@#The Sixth Environmental and Occupational Health Forum, conducted virtually on November 23 to 24, 2023, focused on "Accelerating the Development of Healthy and climate-smart Hospitals in the Southeast Asian Region." This forum, a collaborative effort of the University of the Philippines Manila and Health Care Without Harm Southeast Asia, aimed to explore and exchange strategies, challenges, and innovative practices for integrating environmental sustainability in healthcare settings across Southeast Asia. The event gathered healthcare professionals, policymakers, and environmental experts to discuss the transformation of hospitals into health and climate-smart institutions. Keynote speakers from various countries presented case studies and research findings, emphasizing the need for holistic approaches that include policy development, stakeholder engagement, and continuous education. Significant outcomes highlighted were the identification of effective policies for sustainable hospitals, understanding the impact of healthcare facilities on climate change, and the necessity for political acumen in promoting environmental stewardship in healthcare. The forum concluded with a consensus on the critical need for ongoing collaboration and innovation in environmental and occupational health, underscoring the importance of transforming healthcare facilities into entities that prioritize both patient care and planetary health.

Implementation of inclisiran in UK primary care for patients with atherosclerotic cardiovascular disease (ASCVD) or ASCVD-risk equivalents: rationale and design of VICTORION-Spirit, a pragmatic phase IIIb, randomised controlled study

Background: Translational gaps exist in implementing health innovations rapidly in clinical practice. Pragmatic effectiveness and implementation studies, therefore, play a pivotal role in understanding how high-value health innovations could be deployed and delivered in healthcare systems to reduce barriers to adoption and provide more rapid patient benefit. VICTORION-Spirit is an ongoing pragmatic, 9-month, phase IIIb, open-label, multicentre, randomised controlled study evaluating the implementation, patient experience, and delivery of the subcutaneous lipid-lowering therapy, inclisiran sodium 300 mg, in participants with elevated low-density lipoprotein cholesterol (LDL-C) who are on established lipid-lowering medication, or have been recommended lipid-lowering therapy but are unable to tolerate treatment. Methods: VICTORION-Spirit utilises a type 1 hybrid effectiveness-implementation design, where the primary objective is to demonstrate superiority of inclisiran with or without (±) behavioural support versus standard of care (SOC; e.g., statin and/or other lipid-lowering therapies) + behavioural support in terms of percentage reduction in LDL-C from baseline to Day 270 in a primary care setting. Secondary objectives will evaluate implementation of inclisiran ± behavioural support versus SOC + behavioural support through assessment of: patient satisfaction and patient activation/empowerment after treatment at Day 90; adherence to cardiovascular disease self-management; and serious adverse event profile. Additionally, a process evaluation ascertaining the views of: patients, providers, and National Health Service (NHS) commissioners will explore barriers and enablers to integrating inclisiran within primary care. Conclusions: The results of VICTORION-Spirit have potential to change our approach to lipid management and inform further implementation efforts in healthcare systems, such as the NHS. Trial registration: ClinicalTrials.gov NCT04807400.

"Proximal to distal" sequence of the release of the upper extremity post-burn contracture: Rule or case-based approach? / 中华创伤杂志(英文版)

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.

Building back better: resilient environmental and occupational health systems for the next global crisis

@#Even after two years, the COVID-19 pandemic still disrupts public activities and services as it exposes vulnerabilities among the population and negatively impacts environmental conditions. The crisis also impeded global progress toward achieving Sustainable Development Goals (SDG). The Fourth Environmental and Occupational Health (EOH) Forum held virtually on November 25 to 26, 2021 provided a venue for learning about local and international COVID-19 responses to help prepare for the next global crisis. Through the systems thinking approach, the discussions prioritized analyses of leadership and governance, financing, human resource, technologies, information management, and service delivery. These analyses focused on community and/or workplace programs and services linked to air quality, waste management, psychosocial wellness, and COVID-19 vaccination. The forum amplified calls for climate actions and public health improvement and emphasized the significance of a collaborative, evidence-based, integrated public health response to a crisis underscoring the apparent interdependence of the SDGs.

Exploring factors influencing Essential Intrapartum and Newborn Care (EINC) practice amongst Covid-19 suspected mothers: a qualitative study

BACKGROUND@#The practice of Unang Yakap or Essential Intrapartum and Newborn Care (EINC) during the COVID-19 pandemic poses a safety concern with regards to a newborn’s exposure to their COVID-19 suspected mother. @*OBJECTIVES@#This study aims to describe the experiences of COVID-19-suspected mothers and explore the factors influencing their decision to allow healthcare professionals to practice full EINC. Specifically, it aims to: 1) describe the experiences of mothers prior to, during, and immediately after delivery, and during postpartum care leading to their decision; and 2) explore the factors that influence the participant’s decision to practice EINC amidst the pandemic.@*METHODOLOGY@#For this phenomenological case study, online interviews with nine (9) participants were conducted using a 13-item questionnaire describing their experience. Thematic analysis using the inductive and semantic approach was conducted to identify the common themes or factors. @*RESULTS@#Of the nine (9) participants, five (5) experienced EINC, while four (4) did not. The COVID-19 status and the choice to undergo Unang Yakap were not a causal relationship. Two main influences, mother-related factors, and hospital-related factors, were identified and were found to have weight in decision-making. The mother-related factors include prior knowledge and perception towards EINC, COVID-19 status, personal beliefs, and information from social media; while the hospital-related factors are hospital facilities, hospital protocols, and HCW-patient relationship. @*CONCLUSION@#By delineating the different factors that influence mothers’ decisions, this study allows for the identification of possible bottlenecks in the practice of EINC, as well as effective and efficient means to encourage its practice.

Percepción de estudiantes de la salud sobre educación a distancia en una universidad privada en Perú

Objetivo Determinar la percepción de estudiantes de la Salud sobre la educación a distancia en una universidad privada en Piura, Perú durante el 2020. Metodología La investigación fue de tipo descriptivo y transversal. El instrumento utilizado fue un cuestionario elaborado con una escala de Likert, aplicado mediante la plataforma de Google Formularios y constó de 25 preguntas, validadas por juicio de expertos. La confiabilidad obtenida fue 0,92; la muestra estuvo conformada por 555 estudiantes de Ciencias de la Salud entre Medicina, Estomatología y Enfermería, y el muestreo fue por conveniencia. Resultados La percepción de los estudiantes fue buena con 36,2%; se determinó por sexo, siendo buena para el femenino con 36,6% y para masculino, el 35,4%; y según escuela, Estomatología y Enfermería tuvieron percepción buena con 45,2% y 37,5%, respectivamente, mientras que Medicina obtuvo percepción mala con 40%. Conclusión El 36,2% de los estudiantes de la salud perciben la educación a distancia como buena.

Objective To determine the perception of Health Sciences students about distance education in a private university in Piura, Peru during 2020. Methodology The research was descriptive and cross-sectional. The instrument used was a questionnaire made with a scale of Likert, applied through the Google Forms platform, and consisted of 25 questions, which were validated by expert judgment. The reliability obtained was 0.92; The sample consisted of 555 students of Health Sciences between Medicine, Stomatology and Nursing, and the sampling was for convenience. Results The perception of the students was good with 36.2%; It was determined by sex, being good for females with 36.6%, and for males, it was 35.4%; and according to school, Stomatology and Nursing had a good perception with 45.2% and 37.5% respectively, while Medicine obtained a bad perception with 40%. Conclusion 36.2% of Health Sciences students perceive distance education as good.

Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association?

Background: Human papillomavirus (HPV) is an evolving important risk factor for head and neck cancer (HNC) especially for individuals who do not smoke and drink alcohol. The aim of this study was to establish the prevalence of HPV infection and elucidate its association with head and neck squamous cell carcinoma (HNSCC) patients in UK population. Methods: The presence and association of HPV was investigated in HNSCC patients in this retrospective clinical study. Samples were obtained from archived biopsies and resections. HPV screening was performed by the use of polymerase chain reaction (PCR) using the GP5+/GP6+ and the SPF1/2 consensus as primers and by immunohistochemistry (IHC). Samples of viral warts that were IHC positive for HPV and fibroepethelial polyps (FEP) were used as positive and negative controls respectively. Results: The cohort included 124 patients with HNSCC with an age range of 27–97 years (median 60 years) and a male to female ratio of 2:1. Among the 124 HNSCC 43/124 (34.7%) were from the tongue 74/124 (60%) presented with advanced stage III or IV disease 112/124 (90%) had a conventional phenotype 84/124 (68%) were moderately differentiated and 89/124 (72%) had bands or cords at the invasive front. Of the 124 patients with HNSCC 84/124 (68%) demonstrated the presence of HPV 0/124 (0%) was for oral squamous cell carcinomas (OSCC). HPV16 was the associated virus type in all positive samples. However no significant association was observed between HPV positivity and other clinico-pathological variables including age and gender of the patients stage and malignancy differentiation. Conclusion: The results we provide suggest that HPV infection is low in HNSCC in general and absent in OSCC specifically in this UK population during this time period. This implies that HPV infection may not play an important role in HNSCC carcinogenesis compared to other risk factors in UK population. This information can aid in more effective treatment approaches for treating UK cases of HNSCC.

Les indicateurs de l'alimentation du nourrisson et du jeune enfant prédicteurs de la malnutrition chez les enfants 6-23 mois dans la zone de santé de Kapolowe, Haut-Katanga, R D Congo / NA

Introduction. L'étude visait évaluer les indicateurs de l'alimentation du nourrisson et du jeune enfant liés à l'état nutritionnel dans la zone de santé de Kapolowe, province du Haut Katanga avant les essais cliniques. Matériel et méthodes. Nous avons conduit une étude descriptive transversale dans la communauté auprès des 568 couples mère-enfant 6-23 mois évalués sur les indicateurs nutritionnels associés à la malnutrition. Résultats. L'allaitement maternel optimal était observé chez 10,7% des couples mère-enfant et l'alimentation complémentaire adéquate bénéficiée par 5,5% des enfants. Presque 25,6% des ménages utilisaient des toilettes améliorées, 98,8% des ménages buvaient l'eau des sources protégées et 12,1% des mères pratiquaient un minimum de lavage de mains. Le premier aliment complémentaire donné à la moitié des enfants (46%) était importé, mais 60,3 % des mères utilisaient le mélange farine de maïs + huile + sucre comme aliment de complément. La prévalence de la malnutrition aiguë, de la malnutrition chronique et de l'insuffisance pondérale était respectivement de 11,9%, 37% et 26,8%. La malnutrition aiguë était associée à l'occupation de la mère, au niveau socio-économique du ménage, à la Religion de la mère, à la consultation prénatale suivie par la mère, au Minimum de Diversité Alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. L'insuffisance pondérale était associée au sexe, à l'occupation de la mère, au niveau socio-économique, à la religion de la mère, au minimum de diversité alimentaire, à l'allaitement maternel non optimal, aux infections récurrentes et au faible poids de naissance. La malnutrition chronique était associée au sexe, au niveau socio-économique,

Introduction. The aim of the study was to assess infant and young child feeding indicators related to nutritional status in the Kapolowe health zone, Haut Katanga province prior to the clinical trials. Material and methods. We conducted a descriptive cross-sectional study in the community among568 mother-child pairs 6-23 months of age assessed on nutritional indicators associated with malnutrition. Results. Optimal breastfeeding was observed in 10.7% of the mother-child pairs and adequate complementary feeding in 5.5%. Almost 25.6% of households used improved toilets, 98.8% of households drank water from protected springs and 12.1% of mothers practiced minimal hand washing,12.1% of mothers practiced minimal handwashing. The first supplementary food given to half of the children (46%) was imported food, but 60.3% of mothers used maize flour + oil + sugar as a complementary food. The prevalence of acute malnutrition, chronic malnutrition and under weight were 11.9%, 37% and26.8% respectively. Acute malnutrition was associated with the mother's occupation, household socio-economic level, mother's religion, prenatal consultation attended by the mother, minimum dietary diversity, non-optimal breastfeeding, recurrent infections, and low birth weigh. Underweight was associated with gender, maternal occupation, socio-economic level, maternal religion, minimum dietary diversity, non-optimal breastfeeding, recurrent infections and low birth weight. Chronic malnutrition was associated with gender, socio-economic level, minimum meal frequency, type of toilet used, non-optimal breastfeeding, recurrent infections, and low birth weight. Conclusion. The prevalence of malnutrition, in all its forms, is still very high and worrying among children aged 6-23 months. The feeding practices are predictors of it.

From Vietnamese plants to a biflavonoid that relieves inflammation by triggering the lipid mediator class switch to resolution

Chronic inflammation results from excessive pro-inflammatory signaling and the failure to resolve the inflammatory reaction. Lipid mediators orchestrate both the initiation and resolution of inflammation. Switching from pro-inflammatory to pro-resolving lipid mediator biosynthesis is considered as efficient strategy to relieve chronic inflammation, though drug candidates exhibiting such features are unknown. Starting from a library of Vietnamese medical plant extracts, we identified isomers of the biflavanoid 8-methylsocotrin-4'-ol from

Prevalence of Defecation Disorders and their Symptoms is Comparable in Children and Young Adults:Cross-Sectional Study / 대한소아소화기영양학회지

Purpose@#We aimed to compare the prevalence rates and associated symptoms of constipation and fecal incontinence in children and young adults and evaluate how these patient groups cope with these disorders. @*Methods@#A cross-sectional study was performed in which 212 children (8–17 years) and 149 young adults (18–29 years) from the general Dutch population completed a questionnaire about defecation disorders. @*Results@#Constipation occurred in 15.6% of children and 22.8% of young adults (p=0.55), while the prevalence of fecal incontinence was comparable between groups (7%,p=0.91). The symptoms associated with constipation occurred as often in children as in young adults, while most fecal incontinence symptoms occurred more often in young adults.Approximately 43% of children had constipation for more than 5 years, while 26% of young adults experienced constipation since childhood. Only 27% of constipated children and 21% of constipated young adults received treatment (mostly laxatives). For fecal incontinence, 13% of children and 36% of young adults received treatment (mostly antidiarrheal medications or incontinence pads). @*Conclusion@#In contrast to the general belief, the prevalence of defecation disorders and associated symptoms seem to be comparable in children and young adults. Only a few people with defecation disorders receive adequate treatment.

Prevalence of Defecation Disorders and their Symptoms is Comparable in Children and Young Adults:Cross-Sectional Study / 대한소아소화기영양학회지

Purpose@#We aimed to compare the prevalence rates and associated symptoms of constipation and fecal incontinence in children and young adults and evaluate how these patient groups cope with these disorders. @*Methods@#A cross-sectional study was performed in which 212 children (8–17 years) and 149 young adults (18–29 years) from the general Dutch population completed a questionnaire about defecation disorders. @*Results@#Constipation occurred in 15.6% of children and 22.8% of young adults (p=0.55), while the prevalence of fecal incontinence was comparable between groups (7%,p=0.91). The symptoms associated with constipation occurred as often in children as in young adults, while most fecal incontinence symptoms occurred more often in young adults.Approximately 43% of children had constipation for more than 5 years, while 26% of young adults experienced constipation since childhood. Only 27% of constipated children and 21% of constipated young adults received treatment (mostly laxatives). For fecal incontinence, 13% of children and 36% of young adults received treatment (mostly antidiarrheal medications or incontinence pads). @*Conclusion@#In contrast to the general belief, the prevalence of defecation disorders and associated symptoms seem to be comparable in children and young adults. Only a few people with defecation disorders receive adequate treatment.

Riesgos, contaminación y prevención frente al COVID-19 en el quehacer odontológico: una revisión / Risks, contamination and prevention against COVID-19 in dental work: a review

RESUMEN Introducción En abril del 2020, la pandemia del COVID-19 ha causado más de un millón de contagios y 54 600 muertes a nivel mundial. El contagio del SARS-CoV-2 es rápido y su transmisión se da a través de gotas de saliva. De allí su importancia en la odontología. Objetivo Identificar los principales riesgos, vías de transmisión y medidas de prevención frente al COVID-19. Métodos Se realizó una revisión de literatura científica de los últimos dos años sobre el tema, en las bases de datos PubMed, ScienceDirect, Google Scholar y Research Gate. Los descriptores utilizados fueron los siguientes: "coronavirus", "COVID-19", "dental", "dentistry", "oral", "stomatology" y "aerosol". Se encontraron 350 artículos, de lo que se seleccionaron 50 por su actualidad, relación y enfoque. La transmisión del COVID-19 se da principalmente a través de gotas de saliva, aerosoles y fómites. El virus puede subsistir por un tiempo en el ambiente y en las superficies. Los odontólogos son trabajadores de la salud con peligro de contagiarse debido que varios de sus procedimientos liberan aerosoles. La bioseguridad en el ejercicio de esta profesión debe ser estricta y extrema, también la limpieza y desinfección del ambiente y superficies de contacto. Conclusiones En la profesión odontológica el riesgo potencial de contaminación entre operados, asistentes y pacientes es alto. El conocimiento del agente causal y de la enfermedad permitirá reducir la posibilidad de contagio. El odontólogo debe considerar a los pacientes como sospechosos de COVID-19 y aplicar la bioseguridad a todo nivel.

ABSTRACT Introduction In April 2020 The COVID-19 pandemic caused more than one million infections and 54 600 deaths to date around the world. The spread of SARS-CoV-2 is rapid, and its transmission is through droplets of saliva, hence its importance in dentistry. Objective Identify the main risks, transmission routes and prevention measures against COVID-19. Methods A review of the scientific literature of the last two years on the subject was carried out in the PubMed, ScienceDirect, Google Scholar and Research Gate databases. The descriptors used were: "coronavirus", "COVID-19", "dental", "dentistry", "oral", "stomatology", and "aerosol". 350 articles were found, but 50 were selected for their topicality, relationship, and focus. The transmission of the COVID-19 is carried out mainly through saliva drops, aerosols and fomites. The virus can subsist for a time on the environment and surfaces. Dentists are health workers who are at risk of contagion because several of their procedures release aerosols. The biosecurity in the exercise of this profession must be strict and extreme, also the cleaning and disinfection of the environment and contact surfaces. Conclusions In the dental profession the potential risk of contamination among operators, assistants and patients is high. Knowing the causative agent and the disease allows you to reduce the possibility of contagion. The dentist must consider patients as suspects to COVID-19 and apply biosecurity at all levels.

Effects of Highly Active Antiretroviral Treatment on Liver and Kidney Functions

Aim:This study assesses the effects of HAART on liver and renal functions in HIV infected individuals on HAART.Study Design:Cross sectional study.Place and Methods:This study was conducted in Tamale, Ghana from August, 2015 to November 2017. Original Research Article Methodology:A total of 300 HIV infected participants with ages ranging from 19 to 79 years who have been administered with HAART for at least 6 months were recruited. Pre-HAART administration (baseline) demographic and clinical information, with initial liver and renal function test results were retrieved from the medical records of the participants present at the ART center. Post HAART administration blood sample (5mLs) was taken from each participant into a gel separated vacutainer tube, allowed to clot and spun at 3000rpm for 3 minutes to produce serum. The product (serum) was used for liver and renal function test analysis using a fully automated chemistry analyser (Vital Scientific Selectra Flexor XL). Results: Of the study population, 72% were administered with AZT/3TC/EFV, 13% with AZT/3TC/NVP, 6.7% with TDF/3TC/LPV/r and TDF/3TC/NVP, 1% with AZT/3TC/EFV while 0.7% were administered with TDF/FTC/EFV. The following parameters were significantly increased post HAART administration; ALT (25.53 ± 16.90 to 30.87 ± 19.28 U/L), ALP (163.7 ± 141.0 to 215.2 ± 143.4 U/L), GGT (37.27 ± 25.21 to 53.19 ± 41.71 U/L), Total protein (73.97 ± 17.08 to 82.31 ± 11.62 g/L), Albumin (38.02 ±9.331 to 41.01 ± 7.471 g/L), Globulin 38.02 ± 15.71 to 42.79 ± 25.20 (g/L). There were however significant reductions in Total bilirubin (12.13 ± 10.85 to 9.434 ± 4.560 μmol/L), Direct bilirubin (6.616 ± 5.770 to 4.184 ± 2.806 μmol/L), (Creatinine 73.19 ±36.13 to 63.14 ± 27.14 μmol/L) and Urea (3.515 ± 2.552 to 3.011±1.274 mmol/L).Conclusion: HAART improves renal function, induces elevation in liver enzymes, stimulates the production of plasma proteins and reduces serum bilirubin concentration

Physiognomic responses of páramo tussock grass to time since fire in northern Ecuador / Respuestas fisionómicas de las macollas de gramínea del páramo posteriores a incendios en el norte del Ecuador

Abstract Ecologically-sound management plans for high-altitude grasslands of the Andes depend on an understanding the responses of plants to fire, especially the dominant tussock grasses. This study considers physiognomic responses of tussock grass in 13 sites in northern Ecuador with a known fire history, with time since fire 0.5-10 y, and a control site which had not been burned for at least 40 y. At each site, we assessed vegetation height, basal cover of the tussocks, and the ratio of dead:live leaves in tussocks. We also measured light at ground level. As recovery time increased, tussock cover and number decreased, while tussock height increased. Light levels fell sharply below the tussock canopies as recovery took place, and dead leaves accumulated quickly, reaching 60 - 70% by just two years after fire. The modification of physical tussock structure is likely to influence a much wider ecosystem response to fire, and determines directly the fuel load for future fires. Despite these clear changes in tussock characteristics, they were too variable to be used as a reliable bioindicator of time since fire. However, a better understanding of the responses of tussock grasses to fire and particularly its impact on other species should become the focus of further attention in future.

Resumen Los planes de manejo ecológicamente sólidos para los pastizales de gran altura en los Andes dependen del entendimiento de las respuestas de las plantas al fuego, en especial las respuestas de los pastos dominantes. Este estudio considera las respuestas fisionómicas de pastos en 13 sitios en el norte del Ecuador con un historial de incendios conocido, con tiempo entre 0.5 y 10 años después del incendio, más un sitio control donde al menos durante 40 años no se había producido incendio. En cada sitio, evaluamos la altura de la vegetación, la cobertura basal de las macollas y la proporción de hojas muertas:vivas en las macollas. También, medimos la luz a nivel del suelo. A medida que aumentó el tiempo de recuperación, la cobertura y el número de macollas disminuyeron, mientras que la altura de las macollas aumentó. Los niveles de luz cayeron fuertemente debajo de las copas de las macollas durante la recuperación, y las hojas muertas se acumularon rápidamente, alcanzando 60 - 70% solo dos años después del incendio. Es probable que las modificaciones en la estructura física de las macollas influyen en una respuesta mucho más amplia del ecosistema al fuego, y determinen directamente la carga de combustible para futuros incendios. A pesar de que se observaron cambios claros en las características de las macollas, estas eran demasiado variables para ser consideradas como un bioindicador confiable del tiempo transcurrido después del incendio. Sin embargo, una mejor comprensión de las respuestas de las macollas al fuego y, en particular, el impacto de esas respuestas en otras especies debería ser el enfoque de mayor atención en el futuro.

Effects of Highly Active Antiretroviral Treatment on Complete Blood Count Parameters

Aim:This study assesses the effects of HAART on complete blood count parameters among HIV infected participants.Study Design:Case control study. Place and Methods:This study was conducted inTamale, Ghana from August, 2016to December,2017. Methodology:A total of 300 HIV infected participants with ages ranging from 19–79 years, administered with HAART for at least 6 months were recruited. Pre-HAART administration (baseline) demographic andclinical information, with initial full blood count results were retrieved from the medical records of the participants. Post HAART administration blood sample (5mLs) was taken from each participant into an EDTA vacutainer tube andcomplete blood count (CBC) performed usingURIT 5250 haematology analyser.Participants transfused with blood overthe last 4 months were excluded from the study.Results: The study recorded significant decreases in WBCand Neutrophil (%)post HAART administration. Lymphocyte (%),Haemoglobin, Haematocrit, MCV, MCHC, RDW-SD were all significantly higher post HAART administration. Total Platelets count, MPV, PDW-SD, PCT and P-LCR were significantly lower post-HAART administration.A comparison of the effects of EFV and NVP administered with AZT/3TC backbone yielded the following results. The NVP group recorded a significantly higher HCT compared with the EFV group (p-0.0073). A significantly higher mean PCT, MPV, P-LCR,PLCC, PDW-SD were recorded in the EFV group comparedto the NVP group respectively.Conclusion: The administration of HAART is associated with significant improvements in erythroid and lymphoid lineages, reduce anaemia, improves immunity and general patient well-being. NVP improve erythroid cell indices while EFV ameliorate platelet indices. HAART regimen should be chosen based on the pre-HAART laboratory tests conducted on the individual

HIV-2 Treatment in Mali and Drug Resistance Antiretroviral Profile

Aims:We evaluated different treatment regimens administered to patients infected with HIV-2 in Mali, and studied pol polymorphisms that may influence susceptibility to antiretrovirals.Methodology:We collected 57 blood samples from HIV -2 seropositive patients in health centers in Mali (Bamako, Segou and Sikasso), including 21 treated patients and 36 untreated patients. The confirmation of the serological status and the measurement of the viral load were carried out in Brussels. Genotypic analysis of protease, reverse transcriptase and integrase was then performed on specimens with detectable viral load. The search for ARV resistance mutations and polymorphism positions was performed in comparison with reference sequences.Results:The most used treatment regimen was ZDV-3TC-LPV/ r. Genotypic analysis of protease, reverse transcriptase and integrase was performed on 20 samples from patients with detectable viral load: 16 untreated patients and 4 treated patients. Seventy-five percent of the strains analyzed correspond to group A of HIV-2. In 2cas, mutations associated with resistance to the administered molecules were found. Three viral strains from untreated patients had NRTI or PI resistance mutations. In integrase, no mutation associated with resistance was observed.Conclusion:The circulation of strains carrying resistance mutations to NRTIs and PIs has been observed in Mali

Antiretroviral-induced adverse drug reactions in HIV-infected patients in Mali: a resource-limited setting experience

Background: There are few reports in the literature from sub-Saharan Africa (SSA) regarding antiretroviral-induced adverse drug reactions (ADRs). Antiretroviral therapy (ART) is now widely available in SSA, and ADRs during HIV infection are also frequent. In this study, we reported the frequency and risk factors of ART-induced ADRs in a Malian population.Methods: This prospective cohort study was performed in the HIV Care and Counseling Centre (CESAC) of Mali from 2011 to 2012. Adult patients infected with HIV and who had recently started ART were included and followed-up clinically Were included in this study, adult patients living with HIV and had recently started ART who were followed up for at least 6 months to determine the incidence of ADRs using Naranjo’s classification scale.Results: During this study, 357 (42.3%) patients presented ADRs (40.1% of our patients (n=338) experienced at least one ADR, and 2.2% (n=19) experienced at least two ADRs). The prevalence of ADRs by organ system was: 45.9% neurological (n=164); 29.4% metabolic (blood chemistry) (n=105); 15.4% hematological (n=55). High probable rate of ADR was observed as indicated by the Naranjo score in 83.7% of the cases. Zidovudine (AZT) and stavudine (d4T) use was identified as a risk factor for either anaemia or peripheral neuropathy whereas nevirapine (NVP) and female gender were risk factors for skin reactions. Patients with advance disease had the highest rate of ADRs compared to the others.Conclusions: Based on the Naranjo probability scale, our data show that ADRs such as peripheral neuropathy and anemia are very frequent. These ADR was linked to AZT and D4T. Our findings highlight the need for active monitoring, continuous pharmacovigilance of ART and change of some ART drug in this population.