Exploring resilience in sports. Coach's autonomy support and athletes engagement -A contribute to literature / Explorando la resiliencia en deporte. Apoyo del entrenador a la autonomía y compromiso del Atleta - Una contribución a la literatura / Explorando a resiliência no desporto. O apoio do treinador à autonomia e o compromisso do atleta - Uma contribuição para a literatura

Resilience study as a critical psychological factor in competitive sports setting has been growing widely in sports psychology field. Nonetheless, few are the studies that consider its interaction with personal and contextual factors and how they may enhance or promote its construction. Tis paper explores within Self-Determination Theory framework, coaches'autonomy support and athletes' engagement and their relationship and contribute towards resilience. A whole of 177 athletes were examined (78 ♀), with ages between 12 and 31. Results indicate that coaches' autonomy support and athletes' engagement are positively associated with resilience and that some engagement dimensions are more important than others to resilience development. A line of discussion is uncluttered about athletes' resilience development and how coaches' autonomy support and athletes' engagement interaction may impact protective and promotive dynamics (AU)

La resiliencia como un factor crítico en el deporte competitivo tiene ganado cada vez más relevo en la investigación. Todavía, pocos san los estudios que consideran la interacción de la resiliencia con otros factores personales o contextuales, y la forma que estés incrementan o promueven su construcción. Adentro de lo paradigma de La Autodeterminación, exploramos lo Apoyo de lo Entrenador a la Autonomía y lo Compromiso de lo Atleta y su relación con la Resiliencia. Un total de 177 atletas (78 ♀), comidades entre los 12 y 31 han sido submetidos a estudio. Los resultados indican que lo Apoyo de lo Entrenador a la Autonomía y lo Compromiso de lo Atleta se asocian positivamente con la Resiliencia, y que algunas dimensiones de lo Compromiso san más importantes que otras para desarrollar la resiliencia. Por fin, abrimos una línea de discusión sobre como lo desarrollo da resiliencia y lo Apoyo de lo Entrenador a la Autonomía y lo Compromiso de lo Atleta interactúan en dinámicas de protección y promoción (AU)

A resiliência como fator psicológico crítico no desporto competitivo tem vindo a ganhar cada vez maior relevo na investigação. Contudo, poucos são os estudos que consideram a interação da resiliência com outros fatores pessoais e contextuais, e a forma que estes aumentam ou promovem a sua construção. Dentro do paradigma da Teoria da Autodeterminação, exploramos o Comportamento de Suporte à Autonomia do Treinador e o Empenhamento do Atleta e a sua relação com a Resiliência. Um total de 177 atletas (78 ♀), com idades compreendidas entre os 12 e 31 anos de idade, foram submetidos a estudo. Os resultados indicam que o suporte à autonomia por parte do treinador e o empenhamento do atleta, associam-se positivamente à resiliência, e que algumas dimensões do empenhamento são mais importantes que outras para o desenvolvimento da resiliência. Por sim, abrimos uma linha de discussão sobre como o desenvolvimento da resiliência e como o comportamento de suporte à autonomia e o empenhamento do atleta interagem nas dinâmicas de proteção e promoção (AU)

Boceprevir plus pegylated interferon/ribavirin to re-treat hepatitis C virus genotype 1 in HIV-HCV co-infected patients: final results of the Spanish BOC HIV-HCV Study.

INTRODUCTION: Boceprevir (BOC) was one of the first oral inhibitors of hepatitis C virus (HCV) NS3 protease to be developed. This study assessed the safety and efficacy of BOC+pegylated interferon-α2a/ribavirin (PEG-IFN/RBV) in the retreatment of HIV-HCV co-infected patients with HCV genotype 1. METHODS: This was a phase III prospective trial. HIV-HCV (genotype 1) co-infected patients from 16 hospitals in Spain were included. These patients received 4 weeks of PEG-IFN/RBV (lead-in), followed by response-guided therapy with PEG-IFN/RBV plus BOC (a fixed 44 weeks was indicated in the case of cirrhosis). The primary endpoint was the sustained virological response (SVR) rate at 24 weeks post-treatment. Efficacy and safety were evaluated in all patients who received at least one dose of the study drug. RESULTS: From June 2013 to April 2014, 102 patients were enrolled, 98 of whom received at least one treatment dose. Seventy-three percent were male, 34% were cirrhotic, 23% had IL28b CC, 65% had genotype 1a, and 41% were previous null responders. The overall SVR rate was 67%. Previous null-responders and cirrhotic patients had lower SVR rates (57% and 51%, respectively). Seventy-six patients (78%) completed the therapy scheme; the most common reasons for discontinuation were lack of response at week 12 (12 patients) and adverse events (six patients). CONCLUSIONS: Response-guided therapy with BOC in combination with PEG-IFN/RBV led to an overall SVR rate of 67%, but an SVR rate of only 51% in patients with cirrhosis. The therapy was generally well tolerated. Although the current standards of care do not include BOC+PEG-IFN/RBV, the authors believe that this combination can be beneficial in situations where new HCV direct antiviral agent interferon-free therapies are not available yet.

HIV/antiretroviral therapy-related lipodystrophy syndrome (HALS) is associated with higher RBP4 and lower omentin in plasma.

Very little information is available on the involvement of newly characterized adipokines in human immunodeficiency virus (HIV)/antiretroviral therapy (ART)-associated lipodystrophy syndrome (HALS). Our aim was to determine whether apelin, apelin receptor, omentin, RBP4, vaspin and visfatin genetic variants and plasma levels are associated with HALS. We performed a cross-sectional multicentre study that involved 558 HIV type 1-infected patients treated with a stable highly active ART regimen, 240 of which had overt HALS and 318 who did not have HALS. Epidemiologic and clinical variables were determined. Polymorphisms in the apelin, omentin, RBP4, vaspin and visfatin genes were assessed by genotyping. Plasma apelin, apelin receptor, omentin, RBP4, vaspin and visfatin levels were determined by enzyme-linked immunosorbent assay in 163 patients (81 with HALS and 82 without HALS) from whom stored plasma samples were available. Student's t test, one-way ANOVA, chi-square test, Pearson and Spearman correlations and linear regression analysis were used for statistical analyses. There were no associations between the different polymorphisms assessed and the HALS phenotype. Circulating RBP4 was significantly higher (p < 0.001) and plasma omentin was significantly lower (p 0.001) in patients with HALS compared to those without HALS; differences in plasma levels of the remaining adipokines were nonsignificant between groups. Circulating RBP4 concentration was predicted independently by the presence of HALS. Apelin and apelin receptor levels were independently predicted by body mass index. Visfatin concentration was predicted independently by the presence of acquired immunodeficiency syndrome. HALS is associated with higher RBP4 and lower omentin in plasma. These two adipokines, particularly RBP4, may be a link between HIV/ART and fat redistribution syndromes.

A study of fatty acid binding protein 4 in HIV-1 infection and in combination antiretroviral therapy-related metabolic disturbances and lipodystrophy.

OBJECTIVE: The aim of the study was to determine circulating levels of fatty acid binding protein 4 (FABP-4) in a cohort of HIV-1-infected patients treated with combination antiretroviral therapy (cART) and to investigate the relationships between FABP-4 levels and insulin resistance, dyslipidaemia, lipodystrophy and levels of proinflammatory adipocytokines in these patients. METHODS: A total of 282 HIV-1-infected patients treated with stable cART for at least 1 year (132 with lipodystrophy and 150 without) and 185 uninfected controls (UCs) were included in the study. Anthropometric parameters were determined. Plasma levels of FABP-4, soluble tumour necrosis factor receptors 1 and 2 (sTNF-R1 and sTNF-R2), interleukin-18 (IL-18), IL-6, adiponectin and leptin were also analysed. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR). Subcutaneous adipose tissue mRNA expression of proinflammatory cytokines was assessed in 38 patients (25 with lipodystrophy and 13 without) by real-time polymerase chain reaction (PCR). RESULTS: The plasma FABP-4 concentration was significantly higher in patients with lipodystrophy than in those without (P=0.012). FABP-4 concentration was positively correlated with body mass index (BMI), HOMA-IR, and the concentrations of insulin, total cholesterol, triglycerides, sTNF-R1, leptin and IL-18, but showed a negative correlation with high-density lipoprotein (HDL) cholesterol and adiponectin concentrations. After adjusting for age, sex and BMI, the odds ratio (OR) for risk of lipodystrophy was found to be significantly increased for those with the highest levels of FABP-4 [OR 0.838, 95% confidence interval (CI) 0.435-1.616 for medium FABP-4 vs. OR 2.281, 95% CI 1.163-4.475 for high FABP-4]. In a stepwise regression model, FABP-4 was independently associated with HOMA-IR after controlling for clinical and inflammatory parameters (P=0.004). Moreover, a positive relationship was observed in patients with lipodystrophy between subcutaneous adipose tissue CD68 expression and FABP-4 plasma levels (r=0.525; P=0.031). CONCLUSIONS: cART-treated HIV-1-infected patients with lipodystrophy have a systemic overproduction of FABP-4, which is closely linked to insulin resistance and inflammatory markers in subcutaneous adipose tissue.

Tumour necrosis factor alpha in fat redistribution syndromes associated with combination antiretroviral therapy in HIV-1-infected patients: potential role in subcutaneous adipocyte apoptosis.

BACKGROUND: The pathogenesis of fat redistribution syndromes (FRS) observed in the setting of highly active antiretroviral therapy (HAART) for the treatment of HIV-1-infection remains elusive. A dysregulation of the tumour necrosis factor alpha (TNF-alpha) system occurs in HIV-infected patients with FRS. MATERIALS AND METHODS: The study looked at both the in vivo and in vitro relationship between TNF-alpha and the degree of subcutaneous adipocyte apoptosis in 60 HIV-1-infected patients on HAART with FRS, another 60 HIV-1-infected patients on HAART without FRS and 60 uninfected control patients. Apoptosis was assessed by the terminal deoxynucleotidyl transferase dUTP (deoxyuridine 5'-triphosphate)-digoxigenin Nick End Labelling (TUNEL) method. Soluble receptors of TNF-alpha were determined by the sandwich enzyme immunoassay technique. The in vitro viability was assessed by staining with 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium bromide (MTT) and apoptosis by TUNEL. RESULTS: HIV-1-infected patients with FRS had significantly higher degrees of subcutaneous adipocyte apoptosis than those without FRS (P = 0.0001) and uninfected controls (P < 0.0001). There was a statistically significant association between serum levels of soluble TNF-alpha receptors #1 and #2 and the degree of subcutaneous adipocyte apoptosis in patients with and without FRS (P < 0.0001 for both receptors). In vitro, the addition of TNF-alpha (10 ng mL(-1)) to an adipocyte culture embedded with indinavir, either alone or in clinically relevant combinations with stavudine (d4T) and lamivudine (3TC), significantly decreased adipocyte viability (P = 0.0001) and increased adipocyte apoptosis (P < 0.0001) with respect to that observed with the addition of antiretrovirals alone. CONCLUSIONS: TNF-alpha plays a significant role in subcutaneous adipocyte apoptosis, which occurs in the setting of FRS in HIV-1-infected patients on highly active antiretroviral therapy.

[PiSZ-phenotype alpha 1-antitrypsin deficiency: a rare cause of bronchiectasis]. / Déficit de alpha-1-antitripsina PiSZ. Una rara causa de bronquiectasias.

Panacinar emphysema is the most characteristic pulmonary disease in patients with alpha1-antitrypsin deficiency (AAT). Bronchiectasis can also arise with AAT deficiency, although the association is much less common and no clear cause-effect relationship has yet been established. We report the case of a woman who presented with bronchiectasis and PiSZ-phenotype ATT deficiency, without emphysema. A review of the literature showed that the case is exceptional.

Déficit de -1-antitripsina pisz. Una rara causa de bronquiectasias / Pisz-phenotype alpha 1-antitrypsin deficiency: a rare cause of bronchiectasis

La patología pulmonar más representativa del déficit congénito de -1-antitripsina (AAT) es el enfisema pulmonar panacinar. Las bronquiectasias (BS) también pueden derivarse de dicho déficit, aunque es mucho menos frecuente y la relación causa-efecto es más controvertida1. Presentamos una paciente con BS debidas a un déficit de AAT fenotipo PiSZ, sin enfisema asociado, que representa una observación clínica excepcional al revisar la correspondiente bibliografía médica. (AU)

Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes.

BACKGROUND: Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses. OBJECTIVES: Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non-comparative and multicentric investigation. Patients and methods The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0-5.9 mm; and Group 2: more than 6 mm. RESULTS: Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments of the study: pre-treatment, end of therapy (fourth month) and follow-up (ninth month) in both groups. CONCLUSIONS: Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.

The National Population Program: how cost-effective is it?

PIP: The results of a cost effective analysis of the Philippine Population Program from 1971 to 1977 are summarized and discussed. Data is presented in tables and graphs in terms of cost per acceptor, cost per couple-year of protection, cost per year of effective protection, cost per future birth averted, cost of various contraceptive methods, and direct and indirect family planning expenditures. Major findings were that the indirect costs (information-education-communication, research and evaluation, and administration) have gone up considerably, presumably because of the difficulty in motivating acceptors and discontinuers, and that cost-effectiveness varied greatly between regions, and is positively related to educational levels. The author recommends that promotion of the small family norm be emphasized, and the quality of contraceptive practice rather than just the quantity.^ieng