Four-Year Treatment Outcomes of Adult Patients Enrolled in Mozambique's Rapidly Expanding Antiretroviral Therapy Program

BACKGROUND: In Mozambique during 2004-2007 numbers of adult patients (≥15 years old) enrolled on antiretroviral therapy (ART) increased about 16-fold, from <5,000 to 79,500. All ART patients were eligible for co-trimoxazole. ART program outcomes, and determinants of outcomes, have not yet been reported. METHODOLOGY/PRINCIPAL FINDINGS: In a retrospective cohort study, we investigated rates of mortality, attrition (death, loss to follow-up, or treatment cessation), immunologic treatment failure, and regimen-switch, as well as determinants of selected outcomes, among a nationally representative sample of 2,596 adults initiating ART during 2004-2007. At ART initiation, median age of patients was 34 and 62% were female. Malnutrition and advanced disease were common; 18% of patients weighed <45 kilograms, and 15% were WHO stage IV. Median baseline CD4(+) T-cell count was 153/µL and was lower for males than females (139/µL vs. 159/µL, p<0.01). Stavudine, lamivudine, and nevirapine or efavirenz were prescribed to 88% of patients; only 31% were prescribed co-trimoxazole. Mortality and attrition rates were 3.4 deaths and 19.8 attritions per 100 patient-years overall, and 12.9 deaths and 57.2 attritions per 100 patient-years in the first 90 days. Predictors of attrition included male sex [adjusted hazard ratio (AHR) 1.5; 95% confidence interval (CI), 1.3-1.8], weight <45 kg (AHR 2.1; 95% CI, 1.6-2.9, reference group >60 kg), WHO stage IV (AHR 1.7; 95% CI, 1.3-2.4, reference group WHO stage I/II), lack of co-trimoxazole prescription (AHR 1.4; 95% CI, 1.0-1.8), and later calendar year of ART initiation (AHR 1.5; 95% CI, 1.2-1.8). Rates of immunologic treatment failure and regimen-switch were 14.0 and 0.6 events per 100-patient years, respectively. CONCLUSIONS: ART initiation at earlier disease stages and scale-up of co-trimoxazole among ART patients could improve outcomes. Research to determine reasons for low regimen-switch rates and increasing rates of attrition during program expansion is needed

Changes in stature during and after spinal traction in young male subjects Alterações na estatura antes e após a tração vertebral em homens jovens

BACKGROUND: Spinal traction is a relatively popular procedure for increasing the intervertebral space by applying separating forces. The parameters of time and magnitude of the traction forces may influence the outcomes from this procedure and need to be investigated. The duration of the benefits derived from traction is unknown and needs to be determined so that physiotherapists can provide better and more effective treatments. OBJECTIVE: This study analyzed the relationship between load magnitude and time during spinal traction in relation to stature variations. Traction effect duration was also analyzed. METHOD: Fifteen healthy male subjects (23.1 &plusmn; 5.77 years; 1.80 &plusmn; 0.17 m and 87.0 &plusmn; 9.6 kg) were assessed under three traction conditions (0, 30 and 60% of body weight, BW) of 42 minutes. Stature variation was used to determine intervertebral disc height variation. Stature was assessed every 7 minutes during traction of 42 minutes and every 5 minutes for 45 minutes after traction ceased. RESULTS: 0 and 30% BW traction produced similar gains (6.09 &plusmn; 1.89 mm, 5.70 &plusmn; 1.88 mm, respectively; p>0.05), while these were smaller (p<0.05) than at 60% BW (7.01 &plusmn; 1.98 mm). Significant differences (p<0.05) between 60% BW and the other conditions occurred only after the 21st minute. Stature loss after traction showed that the traction effects were transient and lasted for approximately one hour. This suggests that traction loads of 30% BW are insufficient to produce stature gains similar to those observed with 60% BW. CONCLUSION: Traction showed a short-duration transient effect. For this effect to be maintained, it must be repeated at one-hour intervals. Its use is questioned because of its transient nature.<br>CONTEXTUALIZAÇÃO: A tração sobre a coluna vertebral é um procedimento relativamente popular para aumentar o espaço inter-vertebral pela aplicação de forças de separação. Os parâmetros de tempo e magnitude da força aplicada podem influenciar os resultados desse procedimento e ainda precisam ser investigados. A duração dos benefícios derivados da tração não é conhecida e precisa ser determinada para que fisioterapeutas possam prover tratamentos melhores e mais eficientes. OBJETIVO: Este estudo analisou a relação entre a magnitude de carga e de tempo durante a tração vertebral sobre as variações de estatura, bem como a duração deste efeito. MÉTODOS: Quinze sujeitos saudáveis do sexo masculino (23,1 &plusmn; 5,77 anos; 1,80 &plusmn; 0,17 m e 87,0 &plusmn; 9,6 Kg) foram mensurados sob três condições (0, 30 e 60% PC) de 42 minutos. A variação de estatura foi utilizada para determinar a variação da altura dos discos intervertebrais. A estatura foi verificada a cada 7 min durante a tração de 42 min e a cada 5 min por 45 min após o término da tração. RESULTADOS: A tração com 0 e 30% do PC produziu ganhos similares (6,09 &plusmn; 1,89mm, 5,70 &plusmn; 1,88mm, respectivamente; p>0,05), que foram menores (p<0,05) que com 60% do PC (7,01 &plusmn; 1,98 mm). Diferenças significativas (p<0,05) entre 60% do PC e outras condições ocorreram apenas após o 21&deg; min. A perda de estatura após a tração demonstrou que os efeitos da tração vertebral são transientes e duram aproximadamente 1 hora. Isso sugere que a carga de tração de 30% PC não é suficiente para produzir ganhos de estatura similares aos observados com 60% PC. CONCLUSÃO: A tração demonstrou um efeito transiente e de curta duração, para esse efeito ser mantido ele deve ser repetido em intervalos de 1 hora. O uso da tração é questionado devido ao seu efeito transiente

Quality of life in children with OCD before and after treatment

Quality of life (QoL) is a well-established outcome measure. In contrast to adult obsessive-compulsive disorder (OCD), little is known about the effects of treatment on QoL in children with OCD. This study aimed to assess QoL after cognitive behavioural therapy (CBT) in children and adolescents with OCD compared with the general population and to explore factors associated with potential changes in QoL after treatment. QoL was assessed in 135 children and adolescents (ages 7-17; mean 13 [SD 2.7] years; 48.1 % female) before and after 14 CBT sessions, using self-report and a caregivers proxy report of the Questionnaire for Measuring Health-related Quality of Life in Children and Adolescents (KINDL-R). QoL was compared with an age- and gender-matched sample from the general population. Before treatment, QoL was markedly lower in children with OCD compared with the general population. QoL improved significantly in CBT responders (mean score change 7.4), to the same range as QoL in the general population. Non-responders reported no QoL changes after treatment, except for one patient. Comorbidity, family accommodation and psychosocial functioning were not associated with changes in QoL after treatment. To our knowledge, this is the first study of the changes in QoL after treatment of paediatric OCD. The assessment of QoL beyond symptoms and function in children with OCD has been shown to be reliable and informative. The results of this study support the application of QoL assessment as an additional measure of treatment outcome in children and adolescents with OCD

Cellular recovery from exposure to sub-optimal concentrations of AB toxins that inhibit protein synthesis

Abstract Ricin, Shiga toxin, exotoxin A, and diphtheria toxin are AB-type protein toxins that act within the host cytosol and kill the host cell through pathways involving the inhibition of protein synthesis. It is thought that a single molecule of cytosolic toxin is sufficient to kill the host cell. Intoxication is therefore viewed as an irreversible process. Using flow cytometry and a fluorescent reporter system to monitor protein synthesis, we show a single molecule of cytosolic toxin is not sufficient for complete inhibition of protein synthesis or cell death. Furthermore, cells can recover from intoxication: cells with a partial loss of protein synthesis will, upon removal of the toxin, increase the level of protein production and survive the toxin challenge. Thus, in contrast to the prevailing model, ongoing toxin delivery to the cytosol appears to be required for the death of cells exposed to sub-optimal toxin concentrations

Guidelines for the Management of HIV Infection in Pregnant Women and the Prevention of Mother-to-Child Transmission of HIV

The prevalence of HIV infection amongst women giving birth in England and Wales has increased every year since 1990. Results from the Unlinked Anonymous Surveys of infection in pregnancy, show that in 2003, the prevalence reached one in 180 (0.56%) in inner London, one in 271 in outer London (0.37%) and one in 1,282 (0.08%) in the rest of England [1]. The majority of these women are from sub-Saharan Africa. The Department of Health policy of recommending an HIV test to every pregnant woman [2] has resulted in an increase in the proportion of these women who are aware of their diagnosis prior to delivery (more than 80% in London in 2001) and a decrease in the absolute number of infants infected in the UK [3]