ABSTRACT
Resumen Objetivo: Determinar el impacto del uso de la prueba genotípica de resistencia en la respuesta y supervivencia a largo plazo de los pacientes infectados con el VIH-1 que presentaron fracaso a la terapia antirretroviral. Métodos: Se realizó un estudio de cohorte, retrospectivo, se definieron dos grupos basados en la forma de selección de la terapia de rescate utilizada: en base al resultado de la prueba genotípica de resistencia (grupo A) y en base al criterio de expertos (grupo B). Los pacientes fueron evaluados antes del cambio de la terapia de rescate según variables demográficas, clínicas y de laboratorio y evaluados a los 6, 12, 18, y 24 meses del cambio de tratamiento según respuesta virológica, respuesta de células CD4+, incidencia de enfermedades oportunistas y supervivencia. La información fue obtenida de las actas de la Comisión Nacional de Terapia Antirretroviral, la base de datos del IPK y las Historias Clínicas. Se utilizaron números absolutos y porcentajes, media y mediana, con sus respectivas desviaciones estándares (DE), Chi2, se aplicó el Riesgo Relativo (RR), prueba U de Mann-Whitney, y el método de Kaplan-Meier. Resultados: Los pacientes de grupo A tuvieron 1,44 veces mayor probabilidad de alcanzar supresión virológica completa que los pacientes del grupo B a los 6 meses, RR 1,44 (1,046- 2,054) p=0,017. El incremento promedio de Linfocitos T CD4+ fue de 117,40 células/mm3 en pacientes del grupo A y de 30,04 células/mm3 en pacientes del grupo B, p<0,005 a los 12 meses de iniciado el tratamiento. La incidencia de enfermedades oportunistas fue de 25,7% en el grupo B y de 5,6% en grupo A. El mayor porcentaje de sobrevida acumulada se observó en el grupo el grupo A (98,1%), en comparación con el grupo B (79%). Conclusiones: Los pacientes en los cuales el tratamiento de rescate se escogió basado en una prueba genotípica de resistencia tuvieron una mejor respuesta virológica, un mayor incremento de Linfocitos T CD4+ y una mayor supervivencia que aquellos en los que el tratamiento se eligió basado en el criterio de expertos.
Abstract Objective: To determine the impact of the use of genotypic resistance testing on the response and long-term survival of HIV-1 infected patients who have failed antiretroviral therapy. Methods: A retrospective cohort study was carried out; two groups were defined based on the method of selection of the rescue therapy used: based on the result of the genotypic resistance test (group A) and based on the criteria of experts (group B). The patients were evaluated before the change of rescue therapy according to demographic, clinical and laboratory variables and evaluated at 6, 12, 18, and 24 months after the change of treatment according to virological response, CD4 + cell response, incidence of opportunistic diseases. and survival. The information was obtained from the minutes of the National Commission for Antiretroviral Therapy, the IPK database and the Medical Records. Absolute numbers and percentages, mean and median, with their respective standard deviations (SD), Chi2, were used, the Relative Risk (RR), the Mann-Whitney U test, and the Kaplan-Meier method were applied. Results: Group A patients were 1.44 times more likely to achieve complete virological suppression than group B patients at 6 months, RR 1.44 (1.046-2.054) p = 0.017. The average increase in CD4 + T lymphocytes was 117.40 cells / mm3 in group A patients and 30.04 cells / mm3 in group B patients, p <0.005 12 months after startin treatment. The incidence of opportunistic diseases was 25.7% in group B and 5.6% in group A. The highest percentage of cumulative survival was observed in group A (98.1%), compared to the group B (79%). Conclusions: Patients in whom salvage treatment was chosen based on a genotypic resistance test had a better virological response, a greater increase in CD4 + T lymphocytes, and a longer survival than those in whom treatment was chosen based on expert judgment.
Subject(s)
Humans , Male , Female , HIV-1 , Antiretroviral Therapy, Highly Active/methods , CubaABSTRACT
Drug resistance mutations (DRMs) can affect the success of the therapy and compromise new prevention strategies. Increasing rates of resistance to antiretroviral (ARV) drugs have been reported in some areas. This study evaluated the DRMs prevalence among patients at Hospital das Clínicas (São Paulo). Among treatment-naive patients, the prevalence of transmitted DRMs (Stanford Calibrated Population Resistance) was 8.4% (21/249), with 69% (75/109) of acquired resistance among treatment-experienced patients. Rates of transmitted DRM showed an increase (6.6% in 2002-2009 vs. 15.1% in 2010-2015, p = .05), from the first to the second decade, mainly due to mutations to the NNRTI (non-nucleoside reverse transcriptase inhibitor) class. Among treatment-experienced cases, a nonsignificant decrease overall, significant for the protease inhibitors (PIs) class, was documented. Subtype B predominated in both groups (78%), followed by subtype F, BF recombinants, and subtype C. Our results add to the growing evidence of an increase in transmitted DRM, document extensive DRM among experienced patients, and a decrease in resistance to PIs class that may reflect the increased use of boosted PIs and newer ARV classes in more recent years.
Subject(s)
Anti-Retroviral Agents/therapeutic use , Drug Resistance, Viral/genetics , HIV Infections/drug therapy , HIV-1/genetics , Mutation , Adult , Ambulatory Care Facilities , Anti-Retroviral Agents/pharmacology , Brazil/epidemiology , Female , Genotype , HIV Infections/virology , HIV-1/drug effects , Hospitals, University , Humans , Male , Prevalence , Protease Inhibitors/therapeutic use , Retrospective Studies , Reverse Transcriptase Inhibitors/therapeutic useABSTRACT
Resumen Introducción: A nivel mundial, la tasa global de resistencia primaria y secundaria a los anti-retrovirales (ARV) es de 15 y 40%, respectivamente. Se desconoce su prevalencia en Uruguay. Objetivo: Conocer la prevalencia de resistencia a los ARV en niños y adolescentes uruguayos bajo 15 años de edad infectados con VIH que se controlan en el Centro Hospitalario Pereira Rossell entre 2008 y 2016. Objetivos específicos: Cuantificar mutaciones de resistencia primarias y secundarias e identificar variables asociadas a resistencias; describir si el resultado del test de resistencia contribuyó a lograr una carga viral (CV) indetectable. Metodología: Descriptivo observacional, seguimiento longitudinal. Se incluyeron menores de 15 años con test de resistencia entre 1 de enero de 2008 y 15 de diciembre de 2016. Variables maternas y del niño. Resultados: Se incluyeron 56 niños. Tenían test de resistencia previo al inicio TARV 36 niños (64%) y por fallo terapéutico 20 (36%). La resistencia total fue 28,6% (16 niños): cuatro (11,1%) con mutaciones primarias y 12 (60%) secundarias. El test modificó el plan ARV en 15 (26,7%) de los 56 niños. El cambio logró CV indetectable a los seis meses en ocho casos. El cambio de TARV no se asoció con sida o muerte. Discusión: Los estudios de prevalencia son útiles para la toma de decisiones sobre la selección inicial de ARV. La prevalencia de mutaciones primarias fue similar a la publicada, mientras que la secundaria fue mayor.
Background: Primary and secondary antiretroviral (ARV) resistance rates of 15 and 40% respectively have been reported in worldwide. Its prevalence in Uruguay is unknown. Aim: To know the prevalence of ARV resistance in Uruguayan children under 15 years old infected with HIV that are controlled in the Centro Hospitalario Pereira Rossell between 2008 and 2016. Specific objectives: Quantify primary and secondary mutations, to identify variables associated with resistance; to describe if the result of the resistance test contributed to achieve undetectable viral load (VL). Methodos: Observational descriptive, longitudinal follow-up. Only children under 15 years with resistance test done between January first 2008 and December 31th 2016 were included in the study. Maternal and child variables. Results: Fifty six children were included. 36 children (64%) had resistance tests prior to the initiation of ART and the other 20 children (36%) due to therapeutic failure. Total resistance: 28.6% (16 children); 4 (11.1%) children with primary mutations and 12 (60%) secondary mutations. The test result changed the ARV plan in 15 (26.7%) of the 56 children. The change achieved undetectable CV in 8 children at month 6. The ART change was not associated with AIDS or death. Discussion: Prevalence studies are useful in making decisions about initial ARV treatment. The prevalence of primary mutations was similar to that published, while secondary prevalence was higher.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , HIV Infections/drug therapy , HIV Infections/virology , Anti-HIV Agents/therapeutic use , Drug Resistance, Viral/genetics , Mutation/genetics , Uruguay , Prevalence , Longitudinal Studies , Drug Resistance, Viral/drug effectsABSTRACT
BACKGROUND: Information on fracture biomechanics has implications in materials research and clinical practice. The aim of this study was to analyse the influence of non-carious cervical lesion (NCCL) size, restorative status and direction of occlusal loading on the biomechanical behaviour of mandibular premolars, using finite element analysis (FEA), strain gauge tests and fracture resistance tests. METHODS: Ten buccal cusps were loaded on the outer and inner slopes to calculate the strain generated cervically. Data were collected for healthy teeth at baseline and progressively at three lesion depths (0.5 mm, 1.0 mm and 1.5 mm), followed by restoration with resin composite. The magnitude and distribution of von Mises stress and maximum principal stress were simulated at all stages using FEA, and fracture strength was also determined (n = 7 per group). RESULTS: There were significant effects of the lesion size and loading directions on stress, strain and fracture resistance (p < 0.05). Fracture resistance values decreased with increase in lesion size, but returned to baseline with restorations. CONCLUSIONS: Combined assessment of computer-based and experimental techniques provide an holistic approach to characterize the biomechanical behaviour of teeth with both unrestored and restored NCCLs.
Subject(s)
Bicuspid/physiology , Mandible , Tooth Cervix/physiology , Tooth Fractures/surgery , Adult , Biomechanical Phenomena , Composite Resins , Dental Restoration, Permanent/methods , Dental Stress Analysis/methods , Finite Element Analysis , HumansABSTRACT
Bragança is one of the largest fishing centers in the state of Pará, northern Brazil. In the city, there are several environmental and socio-economic problems such as lack of waste management and contamination of water sources that supply to the city and the Caeté river estuary. The social and economic problems are mainly caused by social inequality, which usually occurs in communities where the population depends mainly on fishing. Fish waste forms a part of the waste disposed in the region. Fish skin represents a significant portion of this waste and may be used for manufacturing leather by the tanning process, thereby generating income for the community and reducing environmental impacts. The acoupa weakfish (Cynoscion acoupa) has a high potential for tanning because of its large size and high yield of skin. The aim of this study was to develop a methodology for artisanal skin tanning of acoupa weakfish and the subsequent transfer of this methodology to a fishing community through a workshop. The methodology developed in the laboratory is more streamlined than traditional methods and is based on tanning methods cited in the literature and techniques applied in regional tanneries. To assess the quality of acoupa weakfish leather, resistance tests were performed, which proved its potential for manufacturing clothing and footwear. An economic analysis of the hypothetical...(AU)
Bragança é um dos maiores polos pesqueiros do estado do Pará, norte do Brasil. No município há problemas de ordem sócio-ambiental e econômica como: falta de gerenciamento dos resíduos, contaminação dos mananciais que abastecem a cidade e do estuário do rio Caeté. Os problemas sociais e econômicos são ocasionados principalmente pela desigualdade social, que ocorre geralmente nas comunidades onde a população sobrevive principalmente da pesca. Dentre os rejeitos descartados na região podem-se citar os resíduos do pescado. A pele do peixe corresponde a uma parte significativa desses resíduos e pode ser destinada ao curtimento, para obtenção de couro, gerando renda para comunidade e reduzindo impactos ambientais. Dentre os peixes com potencial para o curtimento, pode-se citar a pescada amarela (Cynoscion acoupa) pelo grande porte a alto rendimento em pele. O objetivo deste estudo foi desenvolver uma metodologia de curtimento artesanal da pele da pescada amarela e sua posterior transferência a uma comunidade pesqueira, sob forma de oficina. A metodologia desenvolvida em laboratório é mais simplificada que as tradicionais e foi baseada em métodos de curtimento citados na literatura e técnicas aplicadas em curtumes regionais. Para avaliar a qualidade do couro da pescada amarela, foram feitos testes de resistência, que comprovaram seu potencial para confecção em vestuários e calçados...(AU)
Subject(s)
Animals , Fishing Industry , Tanning , Fishes , Garbage , TanninsABSTRACT
Bragança is one of the largest fishing centers in the state of Pará, northern Brazil. In the city, there are several environmental and socio-economic problems such as lack of waste management and contamination of water sources that supply to the city and the Caeté river estuary. The social and economic problems are mainly caused by social inequality, which usually occurs in communities where the population depends mainly on fishing. Fish waste forms a part of the waste disposed in the region. Fish skin represents a significant portion of this waste and may be used for manufacturing leather by the tanning process, thereby generating income for the community and reducing environmental impacts. The acoupa weakfish (Cynoscion acoupa) has a high potential for tanning because of its large size and high yield of skin. The aim of this study was to develop a methodology for artisanal skin tanning of acoupa weakfish and the subsequent transfer of this methodology to a fishing community through a workshop. The methodology developed in the laboratory is more streamlined than traditional methods and is based on tanning methods cited in the literature and techniques applied in regional tanneries. To assess the quality of acoupa weakfish leather, resistance tests were performed, which proved its potential for manufacturing clothing and footwear. An economic analysis of the hypothetical...
Bragança é um dos maiores polos pesqueiros do estado do Pará, norte do Brasil. No município há problemas de ordem sócio-ambiental e econômica como: falta de gerenciamento dos resíduos, contaminação dos mananciais que abastecem a cidade e do estuário do rio Caeté. Os problemas sociais e econômicos são ocasionados principalmente pela desigualdade social, que ocorre geralmente nas comunidades onde a população sobrevive principalmente da pesca. Dentre os rejeitos descartados na região podem-se citar os resíduos do pescado. A pele do peixe corresponde a uma parte significativa desses resíduos e pode ser destinada ao curtimento, para obtenção de couro, gerando renda para comunidade e reduzindo impactos ambientais. Dentre os peixes com potencial para o curtimento, pode-se citar a pescada amarela (Cynoscion acoupa) pelo grande porte a alto rendimento em pele. O objetivo deste estudo foi desenvolver uma metodologia de curtimento artesanal da pele da pescada amarela e sua posterior transferência a uma comunidade pesqueira, sob forma de oficina. A metodologia desenvolvida em laboratório é mais simplificada que as tradicionais e foi baseada em métodos de curtimento citados na literatura e técnicas aplicadas em curtumes regionais. Para avaliar a qualidade do couro da pescada amarela, foram feitos testes de resistência, que comprovaram seu potencial para confecção em vestuários e calçados...
Subject(s)
Animals , Tanning , Fishing Industry , Fishes , Garbage , TanninsABSTRACT
As Aeromonas são bactérias distribuídas predominantemente em meio aquático. São consideradas patógeno emergente, podendo causar doenças em peixes como também no homem. Os problemas mais comuns são a gastrenterite no homem e morte em peixes. OBJETIVO: Este estudo foi desenvolvido para comparar a identificação fenotípica com a genotípica, e também para conhecer o perfil de resistência aos antibióticos em Aeromonas caviae, A. aquariorum, e A. sanarellii isoladas do ambiente aquático e a presença de genes de virulência e resistência. MATERIAL E MÉTODOS: O DNA das 24 cepas em estudo foi extraído por choque térmico e purificado utilizando CTAB. Foram realizadas as PCRs para a detecção dos genes de virulência e dos genes de resistência, após a realização do antibiograma. RESULTADOS: Foram identificadas 4 A. caviae das quais 3(75,0 por cento) apresentaram pelo menos um dos genes act, ast ou alt. Das 3 A. aquariorum, 1(33,3 por cento) apresentaram positividade para os genes act e ast. Entre os 5 isolados de A. sanarellii 1(50,0 por cento) possuíam os genes alt e ast. Seis isolados não foram posicionados taxonomicamente entre as espécies descritas de Aeromonas, e dentre essas um exemplar apresentou o gene alt. Em relação às enzimas MBL e AmpC foram obtidos respectivamente: 3(100 por cento) e 3(100 por cento) em A. aquariorum; 2(50,0 por cento) e 4(100 por cento) em A. caviae; 3(75,0 por cento) e 5(100 por cento) em Aeromonas spp.; 1(20 por cento) e 5(100 por cento) A. sanarellii; Nenhum isolado apresentou resultado positivo, no teste fenotípico, para a produção de ESBL. Com a realização da PCR foi detectada a presença de 5 amostras com gene tipo blaMOX, 21blaCPHA , 17 tipo blaTEM e 2 cepH. CONCLUSÃO: Os resultados sugerem que os isolados podem servir potencialmente como reservatórios de resistência aos antimicrobianos e ainda, que os isolados podem ser considerados patógeno emergentes e significativos para a saúde pública.
Aeromonas spp. is predominantly distributed in the aquatic environment. They are regarded as emerging pathogen, causing disease in fish but also in man. The most common problems are gastroenteritis in humans and death in fish. OBJECTIVE: This study was designed to compare phenotypic with genotypic identification, and also to know the profile of antibiotic resistance in Aeromonas caviae, A. aquariorum, and A. sanarellii isolated from aquatic environment and the presence of virulence genes and resistance. MATERIAL AND METHODS: DNA from 24 strains under study was extracted by thermal shock and purified using CTAB. PCR reactions were performed for the detection of virulence and resistance genes, after the completion of the antibiotic resistance test. RESULTS: We identified four A. caviae from which 3(75.0per cent) had at least one of the genes act, ast or alt. From 3 A. aquariorum, 1(33.3per cent) was positive for the genes act and ast. Among the five isolated A. sanarellii, 1(50.0per cent) had the alt and ast genes Six isolates were not positioned within taxonomically described species of Aeromonas, and among these only one strain presented the alt gene. Regarding the MBL and AmpC it was obtained respectively: 3(100per cent) and 3(100per cent) isolates from A. aquariorum; 2(50.0per cent) and 4(100per cent) isolates from A. caviae; 4(66.7per cent) and 3(50.0per cent) isolates from Aeromonas spp.; and 1(20per cent) and 5 (100per cent) isolates from A. sanarellii. None of the isolates showed positive results in the phenotypic test for ESBL production. The PCR reaction detected the presence of 5 strains with blaMOX-like gene; 21 with blaCPHA gene; 17 with blaTEM-like gene and 2 with cepH gene. CONCLUSION: These findings suggest that the isolates may serve as potential reservoirs of antimicrobial resistance and also that the isolates could be considered emerging pathogens of public health significance.
Subject(s)
Aeromonas/genetics , Aeromonas/isolation & purification , Virulence Factors/genetics , Virulence Factors/isolation & purification , Drug Resistance/genetics , Genotype , Phenotype , VirulenceABSTRACT
Samples of frozen semen (N = 139) from four water buffaloes (Jafarabadi and Murrah crossbred), with three years of age, were collected from January to November of 1990, were used. Semen was collected weekly and evaluated by microscope for physical characteristics of turbulence; concentration; motility and vigor. Fresh semen was diluted in solution prepared with seven extenders: yolk-lactose; TRIS-I; TRIS-II; TRIS-III; yolk-cytrate; TES-TRIS and MEN-Eagle medium. Concentrations of glycerol (7%); egg-yolk (20%) and distilled water to complete 100ml were constant for all extenders. The Thermo-Resistance Test (TRT) was used to achieve motility and vigor in frozen-thawed semen at zero and five hours of incubation. There was no difference among extenders (P>0.01) for motility and vigor at zero hour of incubation; but at five hours there were differences (P 0.01) among semen frozen with yolk-lactose; TRIS-I and TES-TRIS. TES-TRIS showed higher motility and vigor than the TRIS-I. Based on these results it is possible to freeze-thaw buffalo semen with these extenders. An appropriate concentration of sugar in the solution could improve motility of thawed buffalo semen.
Foram analisadas 139 amostras de sêmen congelado, obtidas de quatro touros bubalinos mestiços Jafarabadi x Murrah, com três anos de idade, durante os meses de janeiro a novembro de 1990. O sêmen foi colhido semanalmente e avaliado microscopicamente, quanto às características físicas de turbilhonamento, concentração, motilidade e vigor. Os ejaculados foram diluídos a fresco em combinações preparadas com sete diluidores: Lactose-gema, TRIS-I, TRIS-II, TRIS-III, Citratogema, TES-TRIS e Meio de Mem-Eagle. As concentrações de glicerol (7%), gema de ovo (20%) e água destilada (veículo), foram constantes em todos os diluidores. O Teste de Termo-Resistência (TTR) foi utilizado para a avaliação pós-descongelação das características motilidade e vigor, às zero e 5 horas de incubação. Não houve diferença (P > 0,01) das características motilidade e vigor pós-descongelação entre os diluidores à zero hora, porém houve diferença (P 0,01) às 5 horas de incubação, entre os diluidores Lactose-gema, TRIS-I e TES-TRIS, sendo que o TES-TRIS superou o TRIS-I nas duas características avaliadas. Com base nos resultados do presente estudo, é possível a congelação de sêmen de búfalos com estes diluidores, sendo que concentrações adequadas de açúcares nas soluções tampões, podem melhorar a motilidade pós-descongelação.
ABSTRACT
Samples of frozen semen (N = 139) from four water buffaloes (Jafarabadi and Murrah crossbred), with three years of age, were collected from January to November of 1990, were used. Semen was collected weekly and evaluated by microscope for physical characteristics of turbulence; concentration; motility and vigor. Fresh semen was diluted in solution prepared with seven extenders: yolk-lactose; TRIS-I; TRIS-II; TRIS-III; yolk-cytrate; TES-TRIS and MEN-Eagle medium. Concentrations of glycerol (7%); egg-yolk (20%) and distilled water to complete 100ml were constant for all extenders. The Thermo-Resistance Test (TRT) was used to achieve motility and vigor in frozen-thawed semen at zero and five hours of incubation. There was no difference among extenders (P>0.01) for motility and vigor at zero hour of incubation; but at five hours there were differences (P 0.01) among semen frozen with yolk-lactose; TRIS-I and TES-TRIS. TES-TRIS showed higher motility and vigor than the TRIS-I. Based on these results it is possible to freeze-thaw buffalo semen with these extenders. An appropriate concentration of sugar in the solution could improve motility of thawed buffalo semen.
Foram analisadas 139 amostras de sêmen congelado, obtidas de quatro touros bubalinos mestiços Jafarabadi x Murrah, com três anos de idade, durante os meses de janeiro a novembro de 1990. O sêmen foi colhido semanalmente e avaliado microscopicamente, quanto às características físicas de turbilhonamento, concentração, motilidade e vigor. Os ejaculados foram diluídos a fresco em combinações preparadas com sete diluidores: Lactose-gema, TRIS-I, TRIS-II, TRIS-III, Citratogema, TES-TRIS e Meio de Mem-Eagle. As concentrações de glicerol (7%), gema de ovo (20%) e água destilada (veículo), foram constantes em todos os diluidores. O Teste de Termo-Resistência (TTR) foi utilizado para a avaliação pós-descongelação das características motilidade e vigor, às zero e 5 horas de incubação. Não houve diferença (P > 0,01) das características motilidade e vigor pós-descongelação entre os diluidores à zero hora, porém houve diferença (P 0,01) às 5 horas de incubação, entre os diluidores Lactose-gema, TRIS-I e TES-TRIS, sendo que o TES-TRIS superou o TRIS-I nas duas características avaliadas. Com base nos resultados do presente estudo, é possível a congelação de sêmen de búfalos com estes diluidores, sendo que concentrações adequadas de açúcares nas soluções tampões, podem melhorar a motilidade pós-descongelação.