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BACKGROUND: ABO1020 is a monovalent COVID-19 mRNA vaccine. Results from a phase 1 trial showed ABO1020 was safe and well tolerated, and phase 3 trials to evaluate the efficacy, immunogenicity, and safety of ABO1020 in healthy adults are urgently needed. METHODS: We conducted a multinational, randomized, placebo-controlled, double-blind, phase 3 trial among healthy adults (ClinicalTrials.gov: NCT05636319). Participants were randomly assigned (1:1) to receive either 2 doses of ABO1020 (15 µg per dose) or placebo, administered 28 days apart. The primary endpoint was the vaccine efficacy in preventing symptomatic COVID-19 cases that occurred at least 14 days post-full vaccination. The second endpoint included the neutralizing antibody titers against Omicron BA.5 and XBB and safety assessments. FINDINGS: A total of 14,138 participants were randomly assigned to receive either vaccine or placebo (7,069 participants in each group). A total of 366 symptomatic COVID-19 cases were confirmed 14 days after the second dose among 93 participants in the ABO1020 group and 273 participants in the placebo group, yielding a vaccine efficacy of 66.18% (95% confidence interval: 57.21-73.27, p < 0.0001). A single dose or two doses of ABO1020 elicited potent neutralizing antibodies against both BA.5 and XBB.1.5. The safety profile of ABO1020 was characterized by transient, mild-to-moderate fever, pain at the injection site, and headache. CONCLUSION: ABO1020 was well tolerated and conferred 66.18% protection against symptomatic COVID-19 in adults. FUNDING: National Key Research and Development Project of China, Innovation Fund for Medical Sciences from the CAMS, National Natural Science Foundation of China.
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In this manuscript, we undertake an examination of a classical plasma deployed on two finite co-planar surfaces: a circular regionΩininto an annular regionΩoutwith a gap in between. It is studied both from the point of view of statistical mechanics and the electrostatics of continua media. We employ a dual perspective: the first one is by using molecular dynamics (MD) simulations to find the system's positional correlation functions and velocity distributions. That by modeling the system as a classical two-dimensional Coulomb plasma of point-like charged particlesq1andq2on the layersΩinandΩoutrespectively with no background density. The second one corresponds to a finite Surface Electrode (SE) composed of planar metallic layers displayed on the regionsΩin,Ωoutat constant voltagesVin,Voutconsidering axial symmetry. The surface charge density is calculated by the Method of Moments (MoM) under the electrostatic approximation. Point-like and differential charges elements interact via a1/r-electric potential in both cases. The thermodynamic averages of the number density, and electric potential due to the plasma depend on the coupling and the charge ratioξ=q1/q2once the geometry of the layers is fixed. On the other hand, the fields due to the SE depend on the layer's geometry and their voltage. In the document, is defined a protocol to properly compare the systems. We show that there are values of the coupling parameter, where the thermodynamic averages computed via MD agree with the results of MoM for attractiveξ=-1and repulsive layersξ = 1.
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BACKGROUND: SYN023 is an anti-rabies monoclonal antibody mixture administered as part of post-exposure prophylaxis regimens. The rabies virus neutralizing antibody (RVNA) concentration generally accepted as an adequate immune response to vaccination is ≥ 0.5 IU/mL. METHODS: Within 54 h of potential rabies exposure, 448 patients in two risk substrata of WHO Category III exposure were randomized to receive either 0.3 mg/kg SYN023 or 0.133 mL/kg human rabies immunoglobulin (HRIG) injected in and around the wound site(s) plus a course of rabies vaccination. Patients were followed for safety and absence of rabies for ≥ 365 days. RESULTS: GMT RVNA was higher with SYN023 throughout the 2-week post-treatment period. In the primary analysis group (n = 368), 99.4 % of SYN023 recipients versus 4.5 % of HRIG recipients had protective RVNA levels on Day 4. On Day 8, 98.1 % SYN023 versus 12.2 % HRIG recipients were protected. The SYN023:HRIG ratio of geometric mean titer of RVNA (RVNA GMTs) on Day 8 (19.42) exceeded the 10 % superiority margin (P < 0.0001) indicating higher Day 8 RVNA with SYN023. On Day 99, the SYN023:HRIG RVNA GMT ratio (0.66) was below the non-inferiority margin of 20 % (P = 0.9485) suggesting some moderation of vaccine immune response by SYN023 relative to HRIG. The ratio of percent SYN023:HRIG recipients achieving RVNA ≥ 0.5 IU/mL on Day 99 (0.98) met the non-inferiority margin of 20 % (P = 0.013) indicating anti-rabies immune response with SYN023 was non-inferior to HRIG despite this effect. There were no probable/confirmed rabies cases in any patient. Study regimens were well tolerated. CONCLUSIONS: SYN023 provided higher RVNA than HRIG soon after rabies exposure. By Day 99 post-treatment, GM RVNA with SYN023 was lower than HRIG, however, the percent of SYN023 recipients with a protective response was not inferior at this time point. No rabies cases were reported in the study. The SYN023 safety profile was acceptable. CLINICALTRIALS: gov ID: NCT03961555.
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We assessed the non-inferiority of homologous boosting compared with heterologous boosting with the recombinant protein vaccine, SCB-2019, in adults previously immunized with different COVID-19 vaccines. Three equal cohorts (N ~ 420) of Philippino adults (18-80 years) previously immunized with Comirnaty, CoronaVac or Vaxzevria COVID-19 vaccines were randomized 1:1 to receive homologous or heterologous (SCB-2019) boosters. Neutralizing antibodies against prototype SARS-CoV-2 (Wuhan-Hu-1) were measured in all participants and against Delta variant and Omicron sub-lineages in subsets (30â50 per arm) 15 days after boosting. Participants recorded solicited adverse events for 7 days and unsolicited and serious adverse events until Day 60. Prototype SARS-CoV-2 neutralizing responses on Day 15 after SCB-2019 were statistically non-inferior to homologous Vaxzevria boosters, superior to CoronaVac, but lower than homologous Comirnaty. Neutralizing responses against Delta and Omicron BA.1, BA.2, BA.4 and BA.5 variants after heterologous SCB-2019 were higher than homologous CoronaVac or Vaxzevria, but lower than homologous Comirnaty. Responses against Omicron BF.7, BQ.1.1.3, and XBB1.5 following heterologous SCB-2019 were lower than after homologous Comirnaty booster but significantly higher than after Vaxzevria booster. SCB-2019 reactogenicity was similar to CoronaVac or Vaxzevria, but lower than Comirnaty; most frequent events were mild/moderate injection site pain, headache and fatigue. No vaccine-related serious adverse events were reported. Heterologous SCB-2019 boosting was well tolerated and elicited neutralizing responses against all tested SARS-COV-2 viruses including Omicron BA.1, BA.2, BA.4, BA.5, BF.7, BQ.1.1.3, and XBB1.5 sub-lineages that were non-inferior to homologous boosting with CoronaVac or Vaxzevria, but not homologous Comirnaty booster.
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COVID-19 , SARS-CoV-2 , Vacinas de Subunidades Antigênicas , Adulto , Humanos , Vacina BNT162 , ChAdOx1 nCoV-19 , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , ImunizaçãoRESUMO
BACKGROUND: We compared homologous and heterologous boosting in adults in the Philippines primed with 2 or 3 doses of CoronaVac, with recombinant protein vaccine, SCB-2019. METHODS: CoronaVac-immunized adults (18-72 years) received a homologous or heterologous full or half dose SCB-2019 booster. We assessed all neutralizing antibody (NAb) responses against prototype SARS-CoV-2 after 15 days and NAb against SARS-CoV-2 Delta and Omicron variants in subsets (30â50 per arm). Participants recorded adverse events. RESULTS: In 2-dose CoronaVac-primed adults prototype NAb geometric mean titers (GMT) were 203 IU/mL (95% confidence interval [CI], 182-227) and 939 IU/mL (95% CI, 841-1049) after CoronaVac and SCB-2019 boosters; the GMT ratio (4.63; 95% CI, 3.95-5.41) met predefined noninferiority and post-hoc superiority criteria. After 3-dose CoronaVac-priming prototype NAb GMTs were 279 IU/mL (95% CI, 240-325), 1044 IU/mL (95% CI, 898-1213), and 668 IU/mL (95% CI, 520-829) following CoronaVac, full and half-dose SCB-2019 boosters, respectively. NAb GMT ratios against Delta and Omicron comparing SCB-2019 with CoronaVac were all greater than 2. Mild to moderate reactogenicity was evenly balanced between groups. No vaccine-related serious adverse events were reported. CONCLUSIONS: Full or half dose SCB-2019 boosters were well tolerated with superior immunogenicity than homologous CoronaVac, particularly against newly emerged variants. Clinical Trials Registration. NCT05188677.
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COVID-19 , Humanos , Adulto , COVID-19/prevenção & controle , SARS-CoV-2 , Anticorpos Neutralizantes , Anticorpos Antivirais , Imunogenicidade da VacinaRESUMO
Commercially available broadband echosounders have the potential to classify acoustic targets based on their scattering responses, which are a function of their species-specific morphological and physiological properties. This is particularly important in complex environments with biologically diverse fish assemblages. Using theoretical acoustic scattering models among 130 fishes across six species, we examine the potential to classify reef fish based on the fine-scale gas-bearing swim bladder morphology quantified from three-dimensional computed-tomography models. Modeled echoes of the swim bladder for an incident broadband sound source (30-200 kHz) and across a range of orientation angles (±44°) are acoustically simulated using the boundary element method. Backscatter models present characteristics that are consistent within species and distinguishable among them. Broadband and multifrequency echoes are classified and compared with Bayesian, support vector machine, k-nearest neighbor, and convolutional neural network estimators. Classifiers have higher accuracies (>70%) when noise is not present and perform better when applied to broadband spectra than multifrequency data (42, 70, 100, 132, 160, 184 kHz). The modeling and classification approaches presented indicate that a taxonomic distinction based on morphologically dependent scattering responses is possible and may provide the capacity to acoustically discriminate among fish species.
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Acústica , Som , Animais , Teorema de Bayes , Peixes/fisiologia , Máquina de Vetores de SuporteRESUMO
In this work, we study the gapped surface electrode (SE), a planar system composed of two-conductor flat regions at different potentials with a gapGbetween both sheets. The computation of the electric field and the surface charge density requires solving Laplace's equation subjected to Dirichlet conditions (on the electrodes) and Neumann boundary conditions over the gap. In this document, the gapless surface electrode is modeled as a two-dimensional classical Coulomb gas having punctual charges +qand -qon the inner and outer electrodes, respectively, interacting with an inverse power law 1/r-potential. The coupling parameter Γ between particles inversely depends on temperature and is proportional toq2. Precisely, the density charge arises from the equilibrium states via Monte Carlo (MC) simulations. We focus on the coupling and the gap geometry effect. Mainly on the distribution of particles in the circular and the harmonically-deformed gapped SE. MC simulations differ from electrostatics in the strong coupling regime. The electrostatic approximation and the MC simulations agree in the weak coupling regime where the system behaves as two interacting ionic fluids. That means that temperature is crucial in finite-size versions of the gapped SE where the density charge cannot be assumed fully continuous as the coupling among particles increases. Numerical comparisons are addressed against analytical descriptions based on an electric vector potential approach, finding good agreement.
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BACKGROUND: A range of safe and effective vaccines against SARS CoV 2 are needed to address the COVID 19 pandemic. We aimed to assess the safety and efficacy of the COVID-19 vaccine SCB-2019. METHODS: This ongoing phase 2 and 3 double-blind, placebo-controlled trial was done in adults aged 18 years and older who were in good health or with a stable chronic health condition, at 31 sites in five countries (Belgium, Brazil, Colombia, Philippines, and South Africa). The participants were randomly assigned 1:1 using a centralised internet randomisation system to receive two 0·5 mL intramuscular doses of SCB-2019 (30 µg, adjuvanted with 1·50 mg CpG-1018 and 0·75 mg alum) or placebo (0·9% sodium chloride for injection supplied in 10 mL ampoules) 21 days apart. All study staff and participants were masked, but vaccine administrators were not. Primary endpoints were vaccine efficacy, measured by RT-PCR-confirmed COVID-19 of any severity with onset from 14 days after the second dose in baseline SARS-CoV-2 seronegative participants (the per-protocol population), and the safety and solicited local and systemic adverse events in the phase 2 subset. This study is registered on EudraCT (2020-004272-17) and ClinicalTrials.gov (NCT04672395). FINDINGS: 30 174 participants were enrolled from March 24, 2021, until the cutoff date of Aug 10, 2021, of whom 30 128 received their first assigned vaccine (n=15 064) or a placebo injection (n=15 064). The per-protocol population consisted of 12 355 baseline SARS-CoV-2-naive participants (6251 vaccinees and 6104 placebo recipients). Most exclusions (13 389 [44·4%]) were because of seropositivity at baseline. There were 207 confirmed per-protocol cases of COVID-19 at 14 days after the second dose, 52 vaccinees versus 155 placebo recipients, and an overall vaccine efficacy against any severity COVID-19 of 67·2% (95·72% CI 54·3-76·8), 83·7% (97·86% CI 55·9-95·4) against moderate-to-severe COVID-19, and 100% (97·86% CI 25·3-100·0) against severe COVID-19. All COVID-19 cases were due to virus variants; vaccine efficacy against any severity COVID-19 due to the three predominant variants was 78·7% (95% CI 57·3-90·4) for delta, 91·8% (44·9-99·8) for gamma, and 58·6% (13·3-81·5) for mu. No safety issues emerged in the follow-up period for the efficacy analysis (median of 82 days [IQR 63-103]). The vaccine elicited higher rates of mainly mild-to-moderate injection site pain than the placebo after the first (35·7% [287 of 803] vs 10·3% [81 of 786]) and second (26·9% [189 of 702] vs 7·4% [52 of 699]) doses, but the rates of other solicited local and systemic adverse events were similar between the groups. INTERPRETATION: Two doses of SCB-2019 vaccine plus CpG and alum provides notable protection against the entire severity spectrum of COVID-19 caused by circulating SAR-CoV-2 viruses, including the predominating delta variant. FUNDING: Clover Biopharmaceuticals and the Coalition for Epidemic Preparedness Innovations.
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Adjuvantes Imunológicos/uso terapêutico , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Glicoproteína da Espícula de Coronavírus/uso terapêutico , Adolescente , Adulto , Idoso , Compostos de Alúmen/uso terapêutico , Bélgica , Brasil , Colômbia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oligodesoxirribonucleotídeos/uso terapêutico , Filipinas , Multimerização Proteica , Proteínas Recombinantes/uso terapêutico , Risco , SARS-CoV-2 , África do Sul , Eficácia de Vacinas , Adulto JovemRESUMO
We propose an approach for discriminating fibrillar collagen fibers from elastic fibers in the mouse cervix in Mueller matrix microscopy using convolutional neural networks (CNN) and K-nearest neighbor (K-NN) for classification. Second harmonic generation (SHG), two-photon excitation fluorescence (TPEF), and Mueller matrix polarimetry images of the mice cervix were collected with a self-validating Mueller matrix micro-mesoscope (SAMMM) system. The components and decompositions of each Mueller matrix were arranged as individual channels of information, forming one 3-D voxel per cervical slice. The classification algorithms analyzed each voxel and determined the amount of collagen and elastin, pixel by pixel, on each slice. SHG and TPEF were used as ground truths. To assess the accuracy of the results, mean-square error (MSE), peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) were used. Although the training and testing is limited to 11 and 5 cervical slices, respectively, MSE accuracy was above 85%, SNR was greater than 40 dB, and SSIM was larger than 90%.
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REALISE Asia-an online questionnaire-based study of Asian asthma patients-identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: 'Well-adjusted and at least partly controlled'; 'In denial about symptoms'; 'Tolerating with poor control'; 'Adrift and poorly controlled'; 'Worried with multiple symptoms'). We developed consensus recommendations for tailoring management of these attitudinal-control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal-control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster's attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal-control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.
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Asma/terapia , Atitude Frente a Saúde , Educação de Pacientes como Assunto , Ásia , Análise por Conglomerados , Consenso , Técnica Delphi , Gerenciamento Clínico , Hong Kong , Humanos , Malásia , Países Baixos , Filipinas , Guias de Prática Clínica como Assunto , República da Coreia , Singapura , Reino UnidoRESUMO
BACKGROUND AND OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. We evaluated the characteristics of stable COPD patients in the pulmonology clinics of seven Asian cities and also evaluated whether the exposure to biomass fuels and dusty jobs were related to respiratory symptoms, airflow limitation, and quality of life in the COPD patients. METHODS: This cross-sectional observational study recruited 922 COPD patients from seven cities of Asia. The patients underwent spirometry and were administered questionnaires about their exposure to cigarette smoking, biomass fuels, and dusty jobs in addition to respiratory symptoms and health related quality of life. RESULTS: Of the patients, there appeared to be variations from city to city in the history of exposure to biomass fuels and dusty jobs and also in respiratory symptoms of cough, phlegm, wheeze, and dyspnea. These symptoms were more frequent in those COPD patients with a history of exposure to biomass fuels than without and those with a history of exposure to dusty jobs than without (P < 0.01 for all comparisons). Airflow limitation was more severe in those COPD patients with a history of exposure to biomass fuels than without (52.2% predicted versus 55.9% of post-bronchodilator forced expiratory volume in 1 second [FEV(1)], P = 0.009); quality of life was poorer in those with exposure to biomass fuels than without (40.4 versus 36.2 of the St George's Respiratory Questionnaire [SGRQ] total score, P = 0.001). Airflow limitation was more severe in those COPD patients with a history of exposure to dusty jobs than without (51.2% predicted versus 57.3% of post-bronchodilator FEV(1), P < 0.001); quality of life was poorer in those with dusty jobs than without (41.0 versus 34.6 of SGRQ score, P = 0.006). CONCLUSION: In Asian cities, the characteristics of COPD patients vary and the history of exposure to biomass fuels or dusty jobs was related to frequency of symptoms, severe airflow limitation, and poor quality of life.
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Doença Pulmonar Obstrutiva Crônica/epidemiologia , Idoso , Resistência das Vias Respiratórias , Instituições de Assistência Ambulatorial , Ásia/epidemiologia , Tosse/epidemiologia , Estudos Transversais , Poeira , Dispneia/epidemiologia , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Análise Multivariada , Exposição Ocupacional/estatística & dados numéricos , Qualidade de Vida , Sons Respiratórios , Índice de Gravidade de Doença , Fumar/epidemiologia , Inquéritos e Questionários , Emissões de VeículosRESUMO
To establish reference values for lung function test in Filipinos, 283 (130 males and 153 females) normal non-smoking ( Multiple linear regressions with backward elimination was done. The data obtained was regressed against independent variables of age height, weight, and body surface area for each sex. Analysis of variance (ANOVA) of the regression equations for most parameters were significant at = 0.01. In a few parameters were significance was = 0.05. Only in Raw was the regression model not significant. The coefficient of determination (R) of our regression equations were low (
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Humanos , Masculino , Feminino , Fumar , Pulmão , Análise de Variância , PopulaçãoRESUMO
BACKGROUND AND OBJECTIVE: Roflumilast, an oral, selective phosphodiesterase 4 inhibitor, has been shown to reduce exacerbations and improve pulmonary function in patients with COPD. This study examined the efficacy, safety and tolerability of roflumilast in Asian patients with COPD. METHODS: Patients with COPD were randomized 1:1 to enter a 12-week treatment period and receive either oral roflumilast, 500 µg once daily, or placebo, following a single-blind, 4-week baseline period in which all patients received placebo. The primary end point was mean change in FEV1 from baseline to each postrandomization visit during the treatment period. Other spirometric lung function measurements were evaluated as secondary end points. COPD exacerbations were monitored. Safety was assessed from clinical laboratory tests, vital signs, physical examination (including electrocardiogram) and monitoring of adverse events (AEs). RESULTS: Of 551 patients recruited, 410 were randomized and received at least one dose of study medication (roflumilast, n = 203; placebo, n = 207). Superiority of roflumilast over placebo was demonstrated by a statistically significant difference in postbronchodilator FEV1 (79 mL, P < 0.0001). Other spirometry end points, including prebronchodilator FEV1, pre-and postbronchodilator FEV6, forced vital capacity and peak expiratory flow significantly favoured roflumilast over placebo. AEs were more common with roflumilast than with placebo, but were comparable with those reported in previous studies. CONCLUSIONS: Roflumilast, 500 µg once daily, improves pulmonary function in Asian patients with COPD. The safety and tolerability of roflumilast in this population was similar to that in a Caucasian population.
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Aminopiridinas/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Povo Asiático , Benzamidas/uso terapêutico , Volume Expiratório Forçado/efeitos dos fármacos , Inibidores da Fosfodiesterase 4/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Capacidade Vital/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ciclopropanos/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/etnologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVE: The aim of this study was to determine the prevalence of and risk factors associated with COPD in a rural setting in the Philippines. METHODS: The study was conducted in two municipalities in Nueva Ecija province in the Philippines. Using the Burden of Obstructive Lung Disease (BOLD) protocol and study design, non-hospitalized men or women, aged 40years or older, were recruited by multi-stage random sampling procedures. Participants completed questionnaires on respiratory symptoms and exposure to potential risk factors for COPD, including smoking, occupation and exposure to burning of biomass fuel. Spirometry was performed according to American Thoracic Society criteria. RESULTS: Of the 1188 individuals selected for recruitment, 722 had acceptable post-bronchodilator spirometry and were classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. The overall prevalence of COPD for all stages was 20.8%. The prevalence of COPD at GOLD Stage I or higher was greater in men compared with women (26.5% vs 15.3%), and increased between the ages of 40 to >70years. Logistic regression analysis showed a significant association between all stages of COPD and farming for >40years (odds ratio (OR) 2.48, 95% confidence interval (CI): 1.43-4.30), use of firewood for cooking for >60years (OR 3.48, 95% CI: 1.57-7.71), a smoking history of ≥20 pack-years (OR 2.86; 95% CI: 1.78-4.60), and a history of tuberculosis (OR 6.31, 95% CI: 2.67-15.0). CONCLUSIONS: The prevalence COPD in a rural community in Nueva Ecija, Philippines was 20.8% for GOLD Stage I or higher, and 16.7% for GOLD Stage II or higher. In addition to smoking history, the use of firewood for cooking, working on a farm and a history of tuberculosis were significantly associated with fixed airflow obstruction, as assessed by spirometry.
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Efeitos Psicossociais da Doença , Exposição Ambiental/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , População Rural/estatística & dados numéricos , Fumar/epidemiologia , Tuberculose/epidemiologia , Adulto , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Filipinas/epidemiologia , Prevalência , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Fatores de Risco , Fumar/efeitos adversos , Fumar/fisiopatologia , Espirometria , Inquéritos e Questionários , Tuberculose/complicações , Tuberculose/fisiopatologiaRESUMO
BACKGROUND AND OBJECTIVE: Antimicrobial resistance is a global problem and the prevalence is high in many Asian countries. METHODS: A prospective observational study of the prevalence of bacterial pathogens and their antimicrobial susceptibilities in patients with acute exacerbations of chronic bronchitis (AECB) was conducted in Indonesia, Philippines, Korea, Thailand, Malaysia, Taiwan and Hong Kong from August 2006 to April 2008. The diagnosis of AECB was based on increased cough and worsening of two of following: dyspnoea, increased sputum volume or purulence. Patients who had taken antibiotics within 72 h of presentation were excluded. All bacterial strains were submitted to a central laboratory for re-identification and antimicrobial susceptibility testing to 16 antimicrobial agents according to Clinical and Laboratory Standards Institute. RESULTS: Four hundred and seven isolates were identified among 447 patients of AECB. The most frequent organisms isolated were Klebsiella pneumoniae and associated species (n = 91 + 17), Haemophilus influenzae (n = 71), Pseudomonas aeruginosa (n = 63), Streptococcus pneumoniae (n = 32), Acinetobacter baumannii (n = 22) and Moraxella catarrhalis (n = 21). According to Clinical and Laboratory Standards Institute susceptibility breakpoints, 85.7% and >90% of these pathogens were susceptible to levofloxacin and cefepime respectively. Other options with overall lower susceptibilities include imipenem, ceftazidime, ceftriaxone and amoxicillin/clavulanate. CONCLUSIONS: Gram-negative bacteria including Klebsiella spp., P. aeruginosa and Acinetobacter spp. constitute a large proportion of pathogens identified in patients with AECB in some Asian countries. Surveillance on the local prevalence and antibiotic resistance of these organisms is important in guiding appropriate choice of antimicrobials in the management of AECB.
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Antibacterianos/uso terapêutico , Bronquite Crônica/tratamento farmacológico , Bronquite Crônica/microbiologia , Progressão da Doença , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Ásia , Bronquite Crônica/epidemiologia , Comorbidade , Farmacorresistência Bacteriana , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fumar/efeitos adversos , Fumar/epidemiologia , Escarro/microbiologiaRESUMO
INTRODUCTION: As of 2001, the Philippines ranks 7th among the world's 22 countries with a heavy tuberculosis (TB) burden. As the country accelerates its campaign to control the global epidemic, the Philippine Tuberculosis Initiatives for the Private Sector (PhilTIPS) joined the efforts to combat it through the Directly Observed Treatment Short-course (DOTS) strategy and brought it to the level of medical schools. PhilTIPS commissioned this work to develop an evidence-based medical curriculum with strong and conscious integration of TB-DOTS. MATERIALS AND METHODS: In the needs assessment, curricula, sample tests, and syllabi were reviewed. Deans and curriculum committee chairs were also asked to answer a questionnaire dealing with how TB, TB control and DOTS were taught. Based on the needs assessment, the TB control-DOTS core curriculum was developed. Ten months after its implementation, a monitoring evaluation was conducted through questionnaires, review of records and key informant interviews. DISCUSSION: Representative samples of 18 out of 32 schools participated in the needs assessment and monitoring phase. Data revealed that the biomedical and clinical aspects of TB are emphasised in all schools. But only 7 out of 18 (38.89%) actually dealt with DOTS. A competency-based, integrated, and interactive TB-DOTS curriculum was then developed. The competencies around which the curriculum was designed were: (1) a thorough understanding of TB as a biomedical and social phenomenon; (2) the management of TB patients; and (3) an adherence to DOTS in managing TB patients. The curriculum was reviewed by local and international panelists, and implemented in 2003 to 2004. Monitoring evaluation 10 months later revealed that this curriculum was minimally to moderately integrated by medical schools. The study exhorts all medical schools to empower their graduates with competence in TB-DOTS.
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Currículo , Desenvolvimento de Programas , Faculdades de Medicina , Tuberculose/prevenção & controle , Terapia Diretamente Observada , Humanos , Filipinas , Vigilância da População , Saúde Pública , Inquéritos e QuestionáriosRESUMO
The gastroprotective effect of quantified tannins (13.4%) from Syzygium cumini was determined. Gastric mucosal damage was induced in sixty eight rats by oral gavage administration of HCl/ethanol solution. For macroscopic and microscopic studies, 30 rats were divided into three groups consisting of a negative control, an Omeprazole group and a Tannins group. There was no significant difference in the number, size and surface area of macroscopic lesions between the three groups. Microscopic examination using Best's Ulcer Staging Index showed that Tannins had a very significant decrease in gastric mucosal damage with p<0.01. Average lymphocyte populations in the three groups showed no significant difference, although both the Tannins and Omeprazole group had fewer lymphocytes. Thirty-eight rats were studied for the amount of free radicals present after induction of gastric damage. A dose which consisted of 20.0 g tannins/kg rat weight showed significantly lower stomach free radical concentrations. These findings suggest that tannins extracted from S. cumini have gastroprotective and anti-ulcerogenic effects.