Perceived Susceptibility and Severity of COVID-19 on Prevention Practices, Early in the Pandemic in the State of Florida.

Early in the pandemic and prior to the development of the COVID-19 vaccine, prevention measures were promoted to help inhibit the spread of the virus. To optimize adherence to prevention practices, it's important to understand factors that may influence adherence. A study was conducted in the month of April, 2020, to explore the influence of perceptions of COVID-19 on prevention practices. The sample included members of a public social-media group focused on providing updates and information on COVID-19. A total of 719 individuals completed an online survey that assessed various aspects of COVID-19 which included experience, perceptions, and prevention practices. The perceptions of COVID-19 included perceived susceptibility of contracting the virus, and perceived potential severity if contracted COVID-19. To assess prevention practices, the survey included a 10-item prevention practices questionnaire that included items such as wearing a mask, and social distancing. Results revealed that perceived susceptibility of contracting COVID-19, and potential severity of COVID-19 were significant in predicting prevention practices. Further, results suggest that perceived potential severity predicts a greater proportion of the variance in prevention practices than susceptibility of contracting COVID-19. In addition, a moderation analysis revealed no interaction between perceived susceptibility and severity, which provides evidence that the variables do not influence one another. Theoretical and practical implications are discussed.

The attrition rate of patients in the antiretroviral therapy program in two outpatient treatment centers in Bangui.

To determine the rate of attrition of patients in the antiretroviral treatment program in Bangui and factors associated with this loss to follow-up. This was a retrospective descriptive, analytical cohort study from January 1, 2014 to March 31, 2017 in two large outpatient treatment centers in Bangui. Data were entered in and analyzed with Epi info version 3.5.4 software. Survival probability was calculated by a Kaplan Meier curve. The Cox model and logistic regression were used to determine the association between attrition and risk factors. A total of 292 patients were registered. Attrition rates at 6, 12, and 24 months were 14%, 20% and 31%, respectively. Factors associated with attrition were patients' age (young), living alone (compared to living with a partner), distance between place of residence and treatment center, presence of opportunistic infections, low hemoglobin levels, and lack of therapeutic education. This study identified the main risk factors for patients leaving the care system. Innovative strategies including differentiated approaches must be implemented to improve quality of screening, early start of treatment, and geographical access to care. Particular emphasis should be placed on therapeutic education to train and educate patients about their illness and how to manage it.

Epidémie de rougeole en période post-conflit dans une zone rurale centrafricaine

Introduction : La rougeole est une maladie infectieuse très contagieuse. Les situations de conflit telles que le cas de la République centrafricaine (RCA), peuvent favoriser la survenue des épidémies. L'objectif de ce travail était de décrire l'épidémie de rougeole survenue dans la préfecture sanitaire de Sangha-Mbaéré en termes de temps, lieu et personnes. Patients et méthodes : Il s'agissait d'une étude rétrospective réalisée lors de l'investigation des cas de rougeole survenus à Nola, dans le sud-ouest de la RCA qui a couvert la période du 30 décembre 2015 au 20 avril 2016. La population cible était constituée d'enfants de moins de 15 ans. Nous avons inclus dans l'étude, après consentement éclairé des parents, tout enfant chez qui un agent de santé a suspecté la rougeole avec une fièvre supérieure ou égale à 38°C, une éruption maculo-papulaire généralisée (non vésiculaire) et un des signes suivants : toux, rhinorrhée ou conjonctivite. Les caractéristiques sociodémographiques et cliniques ont été recueillies à l'aide d'un questionnaire anonyme. La saisie et l'analyse des données ont été faites au logiciel Epi Info 7. Résultats : Au total, 31 malades ont été inclus dont 58% de sexe féminin soit un sex-ratio (F/H) de 1,38. L'âge moyen était de 1,9 ± 1,2 ans. Les enfants âgés entre 1 et 4 ans représentaient 74,19% des cas. Tous les enfants (100%) n'étaient pas vaccinés contre la rougeole. Ils provenaient de la commune de Salo dans 51,61% des cas et de Nola dans 48,39%. Le taux d'attaque était de 0,82‰. Dans la commune de Salo, le taux d'attaque était de 2,97‰ (16/5392) et de 0,46‰ (15/32401) à Nola. Le taux de létalité était de 9,68% (3/31). Ce taux était de 33,33% (1/3) avant l'âge d'un an, de 8,70% chez les enfants de 1 à 5 ans. Conclusion : L'épidémie de rougeole survenue à Nola serait liée à une faible couverture vaccinale. Le renforcement de la vaccination et de la surveillance épidémiologique pourrait contribuer au contrôle et à une prévention efficace de la rougeole ainsi que d'autres maladies à potentiel épidémique

Attitude of men who have sex with men toward condom use in Bangui, Central African Republic (CAR).

to understand the attitude of men who have sex with men (MSM) towards the use of condoms, to identify potential barriers to their use, environmental factors that facilitate or on the contrary, prevent this use, beliefs about contracting HIV, and priority needs of MSM for general prevention of sexually transmitted infections (STI). Individual interviews conducted in private with 20 MSM. In general, MSM recognize that condoms protect against STI as well as preventing unwanted pregnancies (although this is not our purpose here). The disadvantages of condom use that they reported included the potential for them to break and their reduction of pleasure. Barriers to their use include the belief that the partner is not HIV-positive, the shame of buying condoms, inability to wear them, and lack of financial resources, as well as social norms and false beliefs. MSM are aware of the positive role of condoms against STIs, including HIV. They perceive the dangerousness of the HIV, but do not feel vulnerable to this disease. They have identified obstacles to condom use, and their lists of perceived needs suggest solutions to them. Implementing these solutions in interventions should improve the frequency of condom use.

SERS Investigation of Cancer Cells Treated with PDT: Quantification of Cell Survival and Follow-up.

In this study Surface Enhanced Raman Spectroscopy (SERS) data recorded from mouse mammary glands cancer cells (4T1 cell line) was used to assess information regarding differences between control, death and viable cells after Photodynamic Therapy (PDT) treatment. The treatment used nanoemulsions (NE/PS) loaded with different chloroaluminumphthalocyanine (ClAlP) photosensitizer (PS) contents (5 and 10 µmol × L-1) and illumination (660 nm wavelength) at 10 J × cm-2 (10 minutes). The SERS data revealed significant molecular alterations in proteins and lipids due to the PDT treatment. Principal Component Analysis (PCA) was applied to analyze the data recorded. Three-dimensional and well reproductive PCA scatter plots were obtained, revealing that two clusters of dead cells were well separated from one another and from control cluster. Overlap between two clusters of viable cells was observed, though well separated from control cluster. Moreover, the data analysis also pointed out necrosis as the main cell death mechanism induced by the PDT, in agreement with the literature. Finally, Raman modes peaking at 608 cm-1 (proteins) and 1231 cm-1 (lipids) can be selected for follow up of survival rate of neoplastic cells after PDT. We envisage that this finding is key to contribute to a quick development of quantitative infrared thermography imaging.

Risk factors for transmission of HIV from mother to child in Bangui.

the prevalence of human immunodeficiency virus infection (HIV) in pregnant women in Central Africa is 4.5%. Although a program to prevent mother-child transmission of HIV has been implemented throughout the country, the number of infected infants continues to increase. In this context, our study sought to determine the rate of mother-child transmission of HIV and to identify the main risk factors. this prospective cross-sectional study took place from November 1, 2014, to November 1, 2015, in all 16 maternal and child health centers in Bangui. The study population comprised the infants born to HIV-positive mothers and seen at these centers for HIV testing 6 weeks after birth. The mothers were interviewed and their files examined to identify the risk factors of HIV transmission to their babies. the study included 656 infants. The maternal-fetal transmission rate of HIV was 7%. The main risk factors were the absence of antiretroviral prophylaxis for mothers or children and rupture of the membranes more than 24 hours before labor. HIV transmission from mother to child is a public health problem in Bangui. Vigorous action, such as interventions with antiretroviral medication, good obstetric practices, and especially the implementation of the 2013 WHO recommendations, should certainly reduce the number of new infections among newborns in Bangui.

Comparing organ-at-risk doses for high-dose-rate vaginal brachytherapy between three different planning workflows.

PURPOSE: The aim of this study was to compare the organ-at-risk doses to the rectum and the bladder in postoperative endometrial cancer patients who receive high-dose-rate vaginal brachytherapy (HDR-VB), when using three different methods of treatment planning: (Workflow A) individualized treatment planning before every fraction, (Workflow B) individualized treatment planning for first fraction only), and (Workflow C) using a template plan based on applicator choice and prescription specifics without patient-specific imaging or planning (standardized template approach). METHODS AND MATERIALS: Alternative plans were retrospectively created using workflows B and C for 22 patients who previously received postoperative HDR-VB using a vaginal cylinder and planned using Workflow A for endometrial cancer. The rectum and bladder were contoured on the CTs used for each fraction for dose comparison between the three methods. D50, D2cc, D1cc, D0.1cc, and V100 of the bladder and the rectum were compared using the two-sided Wilcoxon signed-rank test. RESULTS: A total of 123 fractions were available for comparison. For Workflow A vs. Workflow B, there was no significant difference for any rectal or bladder dosimetric parameter. For Workflow A vs. Workflow C, Workflow A delivered a significantly higher median dose to the rectum than Workflow C for D50, D2cc, D1cc, and V100. Workflow C delivered a significantly higher dose to the bladder than Workflow A: D2cc, D1cc, D0.1cc, and V100. However, the magnitudes of the differences were small; the dose index difference was >75 cGy for only two fractions. CONCLUSION: Plan standardization in HDR-VB may result in considerable time and cost savings with minimal organ-at-risk dose differences.

Mobilising Expertise and Resources to Close the Radiotherapy Gap in Cancer Care.

Closing the gap in cancer care within low- and middle-income countries and in indigenous and geographically isolated populations in high-income countries requires investment and innovation. This is particularly true for radiotherapy, for which the global disparity is one of the largest in healthcare today. New models and paradigms and non-traditional collaborations have been proposed to improve global equity in cancer control. We describe recent initiatives from within the radiation oncology community to increase access to treatment, build the low- and middle-income countries' radiation oncology workforce, mobilise more professionals from within high-income countries and raise awareness of the global need for equitable cancer care.

Les accidents d'exposition au sang dans les maternités de Bangui

Introduction : Les accidents d'exposition au sang constituent une hantise pour les agents de santé travaillant en contact du sang et de ses dérivés. Leur prise en charge constitue un défi pour la réduction de l'infection à VIH parmi le personnel de santé. L'objectif de notre étude est de déterminer la prévalence des accidents d'exposition au sang dans les maternités de Bangui, d'identifier les circonstances de survenue, les attitudes et les pratiques des agents de santé après ces accidents. Patients et méthodes : Nous avons mené une étude transversale à visée descriptive et analytique allant du 1er novembre au 31 décembre 2013. La population d'étude était représentée par le personnel de santé et techniciens de surface exerçant dans toutes les maternités publiques de Bangui. Résultats : Nous avions interrogé 260 personnes. La prévalence des accidents d'exposition au sang était de 60%. Les victimes étaient majoritairement des femmes (71,2%) avec un âge moyen de 37 ans. La plupart du personnel (91,2%) n'était pas immunisée contre l'hépatite B et 58,5% ont déclaré avoir été sensibilisés sur les accidents d'exposition au sang. Les accidents par projection de liquide biologique (63,5%) étaient les plus représentés suivis de piqures par une aiguille (53,2%). La principale réaction des victimes après l'accident était le lavage de la lésion (87,8%), suivi d'une application d'antiseptique (35,2%). Conclusion : Les accidents d'exposition au sang par leur ampleur demeurent encore un problème de santé publique dans nos milieux de soins. L'insuffisance en matériels de protection, la sous- déclaration des cas et la faible couverture vaccinale contre l'hépatite B du personnel de santé sont autant de facteurs de risque. La prise en compte des problèmes identifiés contribuerait à la réduction de la propagation de l'infection à VIH et des hépatites dans nos milieux de soins

Foraging of Great Kiskadees (Pitangus sulphuratus) and food items offered to nestlings in the Pantanal.

Feeding of Pitangus sulphuratus (Tyrannidae) nestlings have been poorly studied. Here we describe the foraging behavior of a P. sulphuratus pair and the searching and offering time of food items to nestlings in the Pantanal, Brazil. Data collection was carried out over 25 days on the outskirts of the Base de Estudos do Pantanal building, inhabited by insectivorous bats. Records were based on direct observations with the help of binocular. The pair required little time for searching for small insects and fruits, but these items comprised a little amount of food per event of capture. Some large prey was more time-costly for searching, but the long period that these food items were offered to nestlings overcompensated the searching time. Considering the time of feeding nestlings (benefit) in relation to the searching time by the parents (cost), bats and snails are the most advantageous items for P. sulphuratus parents feeding nestlings at the study site.

Liposomal photosensitizers: potential platforms for anticancer photodynamic therapy.

Photodynamic therapy is a well-established and clinically approved treatment for several types of cancer. Antineoplastic photodynamic therapy is based on photosensitizers, i.e., drugs that absorb photons translating light energy into a chemical potential that damages tumor tissues. Despite the encouraging clinical results with the approved photosensitizers available today, the prolonged skin phototoxicity, poor selectivity for diseased tissues, hydrophobic nature, and extended retention in the host organism shown by these drugs have stimulated researchers to develop new formulations for photodynamic therapy. In this context, due to their amphiphilic characteristic (compatibility with both hydrophobic and hydrophilic substances), liposomes have proven to be suitable carriers for photosensitizers, improving the photophysical properties of the photosensitizers. Moreover, as nanostructured drug delivery systems, liposomes improve the efficiency and safety of antineoplastic photodynamic therapy, mainly by the classical phenomenon of extended permeation and retention. Therefore, the association of photosensitizers with liposomes has been extensively studied. In this review, both current knowledge and future perspectives on liposomal carriers for antineoplastic photodynamic therapy are critically discussed.

Liposomal photosensitizers: potential platforms for anticancer photodynamic therapy

Photodynamic therapy is a well-established and clinically approved treatment for several types of cancer. Antineoplastic photodynamic therapy is based on photosensitizers, i.e., drugs that absorb photons translating light energy into a chemical potential that damages tumor tissues. Despite the encouraging clinical results with the approved photosensitizers available today, the prolonged skin phototoxicity, poor selectivity for diseased tissues, hydrophobic nature, and extended retention in the host organism shown by these drugs have stimulated researchers to develop new formulations for photodynamic therapy. In this context, due to their amphiphilic characteristic (compatibility with both hydrophobic and hydrophilic substances), liposomes have proven to be suitable carriers for photosensitizers, improving the photophysical properties of the photosensitizers. Moreover, as nanostructured drug delivery systems, liposomes improve the efficiency and safety of antineoplastic photodynamic therapy, mainly by the classical phenomenon of extended permeation and retention. Therefore, the association of photosensitizers with liposomes has been extensively studied. In this review, both current knowledge and future perspectives on liposomal carriers for antineoplastic photodynamic therapy are critically discussed.

Cognitive dysfunction in systemic lupus erythematosus: prevalence and correlates.

Little is known about the mechanisms and relevance of cognitive dysfunction in systemic lupus erythematosus (SLE) patients who never displayed major neuropsychiatric manifestations (nSLE). Thirty-one nSLE female patients and 31 cognitively healthy control women were recruited. Sociodemographic, clinical, neuropsychological and SLE-related markers were collected including cerebral perfusion by single-photon emission computed tomography. Prevalences of cognitive complaints were 22.6% in nSLE versus 6.5% in the control group (p = 0.147); respective prevalences of cognitive dysfunction were 32.3 versus 6.5% (p = 0.01). Within the nSLE group, all cognitive domains appeared similarly affected, and correlations were found between cognitive dysfunction and less skilled occupation (r = -0.41, p = 0.02) and between cognitive complaints and depressive symptoms (r = 0.35, p = 0.05). Cognitive dysfunction is rather frequent in nSLE and seems to negatively impinge on social functioning.

Genetic variation in the nuclear factor kappaB pathway in relation to susceptibility to rheumatoid arthritis.

OBJECTIVE: To examine genetic association between rheumatoid arthritis (RA) and known polymorphisms in core genes of the nuclear factor (NF)kappaB pathway, the major intracellular pathway in RA pathogenesis. METHODS: Discovery and replication sample sets of Spanish patients with RA and controls were studied. A total of 181 single nucleotide polymorphisms (SNPs) uniformly spaced along the genomic sequences of 17 core genes of the NFkappaB pathway (REL, RELA, RELB, NFKB1, NFKB2, NFKBIA, NFKBIB, NFKBIE, IKBKA, IKBKB, IKBKE, IKBKAP, KBRAS1, KBRAS2, MAP3K1, MAP3K14, TAX1BP1) were studied by mass spectrometry analysis complemented with 5'-nuclease fluorescence assays in the discovery set, 458 patients with RA and 657 controls. SNPs showing nominal significant differences were further investigated in the replication set of 1189 patients with RA and 1092 controls. RESULTS: No clear reproducible association was found, although 12 SNPs in IKBKB, IKBKE and REL genes showed significant association in the discovery set. Interestingly, two of the SNPs in the IKBKE gene, weakly associated in the discovery phase, showed a trend to significant association in the replication phase. Pooling both sample sets together, the association with these two SNPs was significant. CONCLUSION: We did not find any major effect among the explored members of the NFkappaB pathway in RA susceptibility. However, it is possible that variation in the IKBKE gene could have a small effect that requires replication in additional studies.

In vitro photodynamic therapy on human oral keratinocytes using chloroaluminum-phthalocyanine.

In this study, oral carcinoma cells were used to evaluate chloroaluminum-phthalocyanine encapsulated in liposomes as the photosensitizer agent in support of photodynamic therapy (PDT). The genotoxicity and cytotoxicity behavior of the encapsulated photosensitizer in both dark and under irradiation using the 670-nm laser were investigated with the classical trypan blue cell viability test, the acridine orange/ethidium bromide staining organelles test, micronucleus formation frequency, DNA fragmentation, and cell morphology. The cell morphology investigation was carried out using light and electronic microscopes. Our findings after PDT include reduction in cell viability (95%) associated with morphologic alterations. The neoplastic cell destruction was predominantly started by a necrotic process, according to the assay with acridine orange and ethidium bromide, and this was confirmed by electronic microscopy analysis. Neither the PDT agent nor laser irradiation alone showed cytotoxicity, genotoxicity, or even morphologic alterations. Our results reinforce the efficiency of light-irradiated chloroaluminum-phthalocyanine in inducing a positive effect of PDT.

A double-blind placebo controlled trial of etanercept in patients with giant cell arteritis and corticosteroid side effects.

OBJECTIVE: Open label studies have suggested that tumour necrosis factor (TNF) antagonists led to sustained improvement and corticosteroid sparing effect in patients with giant cell arteritis (GCA). To confirm these observations, we conducted a randomised, double-blind, placebo controlled trial with etanercept in patients with biopsy-proven GCA with side effects secondary to corticosteroids. METHODS: We randomly assigned patients with GCA to receive etanercept (n = 8) or placebo (n = 9) over 1 year together with corticosteroids that were reduced according to a predefined schedule. The primary outcome was the ability to withdraw the corticosteroid therapy and control the disease activity at 12 months. RESULTS: Baseline characteristics were similar in the two groups, although patients in the etanercept group showed higher levels of basal glycaemia (p = 0.02) and a higher erythrocyte sedimentation rate (ESR) (p = 0.01). After 12 months, 50% of the patients in the etanercept group and 22.2% in the placebo group were able to control the disease without corticosteroid therapy (p value not significant). Patients in the etanercept group had a significant lower dose of accumulated prednisone during the first year of treatment (p = 0.03). There were no differences in the number and type of adverse events. CONCLUSION: The limited number of patients included in this study does not allow us to draw definitive conclusions. Etanercept therapy was well tolerated in this aged population. The therapeutic role of etanercept in patients with GCA should be evaluated in studies with a larger number of patients.

[An update on severe pediatric malaria in Central Africa hospital units]. / Les aspects actuels du paludisme grave de l'enfant en milieu hospitalier pédiatrique centrafricain.

OBJECTIVE: The authors had for aim, to determine the frequency and the main clinical forms of severe malaria and to evaluate its management. PATIENTS AND METHODS: A cross-sectional investigation was made in the "Complexe Pediatrique" of Bangui, the only children hospital of the CAR capital, from 12 January to 12 September 1998. The survey included children 6 months to 15 years of age presenting on admission with a positive thick drop examination, and at least one of the clinical symptoms of severe malaria as defined by the World Organization of Health (WHO). RESULTS: Four hundred and thirty-two children were included. Those from 6 months to 4 years of age accounted for 89.35% of the studied population. The most frequent clinical forms were neurological 31% and anemic 22.2%; the other forms were combined in 42.8%. Managing patients consisted of an etiologic treatment by quinine (91.7%) or sulfadoxine pyrimethamine (3.2%) and symptomatic treatment in the following proportions: rehydration: 49.3%; blood transfusion: 36.3%; preventing seizure: 72.9%; oxygen therapy: 77.5%; use of antipyretics: 96.7%, and correction of hypoglycemia: 9%. The death rate remained high with 62 deaths (14.35%). It was higher in combined forms (48 deaths out of 62). CONCLUSION: Severe malaria and its various clinical forms remain a major problem for our pediatric intensive care unit. Updated technical means and human resources could improve the management of severe pediatric malaria.

Chronic clonal proliferative disease of gamma-delta (gammadelta) T-cells in a patient with rheumatoid arthritis and neutropenia: lack of the morphology and the immunophenotype of large granular lymphocytes.

Normal gammadelta T-lymphocytes have the morphology of large granular lymphocytes (LGL) and, as the LGL of alphabeta T-cells, they express pan-T antigens, NK-associated antigens and the cytotoxic molecules, perforin and granzime B. In this report we describe an unusual patient with rheumatoid arthritis and neutropenia who has a chronic gammadelta T-cell proliferation with a chronic, indolent clinical course and atypical lymphocytes, lacking the classical LGL morphology, not expressing NK-associated antigens, and not expressing perforin or granzyme B. In spite of the atypical morphological features of the clonal cells, which were suggestive of a more malignant process, the patient has been followed for 4 years without aggressive therapy. It is important to recognize this entity and to distinguish it from other gammadelta T proliferations such as the hepatosplenic gammadelta T-cell lymphoma.

Tromboembolia pulmonar masiva de repetición tratada con 2 fibrinolisis consecutivas / Recurrent massive pulmonary thromboembolism treated with two consecutive administrations of a fibrinolytic agent

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International monitoring for environmental health surveillance.

This paper offers an overview of existing international monitoring systems with relevance for environmental health surveillance. Representative monitoring systems are described that: address areas of chronic and acute exposure, and diseases and behavioural effects resulting from human-environment interactions; have an ecosystem focus with perhaps a secondary motivation of ascertaining human health impacts that may result from ecosystem conditions; and that incorporate socio-demographic and economic data that may reflect population health determinants. General conclusions on the state of environmental surveillance systems and suites of indicators reviewed are provided in relation to their utility for the development of a generic environmental health surveillance system. This review indicates, among other things, that no obvious short list of core indicators exists which spans "environmental health" to provide a sufficient set applicable in a global context. Through a summary of challenges and limitations in existing systems and indicator sets, recommendations are provided for the discussion of indicator selection and organization, and of developing general and widely applicable environmental health monitoring and surveillance systems.