Failing a re-treatment regimen does not predict MDR/XDR tuberculosis: is "blind" treatment dangerous?

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PLoS One

Timely diagnosis of Pulmonary Tuberculosis (PTB) is associated with good prognosis, but remains difficult in primary healthcare facilities and particularly in children and patients living with HIV. The aim of this study was to compare the GeneXpert ® MTB/RIF assay (Xpert) performed using a stool sample (3-5 g) and using the first Respiratory Tract Sample (RTS; i.e., sputum, bronchoalveolar or gastric aspirate; as normally done) concomitantly collected from 119 patients with suspected PTB to improve PTB diagnosis in Burkina Faso, a high tuberculosis burden country with limited resources. Overall, microbiological, microscopic and molecular analysis of the 119 first RTS and 119 stool specimens led to Mycobacterium tuberculosis complex detection in 28 patients (23 positive RTS cultures and 5 negative RTS cultures-RTS Xpert positive). When using the 28 clinical confirmed cases as reference standard, the sensitivities of the stool-based and RTS-based Xpert assays were not different (24/28, 85.7%, versus 26/28, 92.86%; p > 0.30), and 22 results were fully concordant. Considering the first RTS culture as the gold standard, the sensitivities of the stool-based and RTS-based Xpert assays to detect PTB in patients with positive RTS culture were 100% (23/23) and 91.3% (21/23), respectively (p >0.05). The stool-based Xpert assay specificity for excluding PTB was 99% (95/96) (compared with 95%, 91/96, when using RTS) and its negative and positive predictive values were 100% (95/95) and 96% (23/24), respectively. Compared with the 23 positive RTS cultures, the incremental yield rates of the RTS-based and stool-based Xpert assays were 4.2% (5/119) and 0.84% (1/119), respectively. Overall, our findings support using the stool-based Xpert assay as an alternative method for earlier PTB diagnosis, when RTS are difficult to obtain

Multi-feature computational framework for combined signatures of dementia in underrepresented settings

PUBLISHED 25 August 2022Objective. The differential diagnosis of behavioral variant frontotemporal dementia (bvFTD) and Alzheimer’s disease (AD) remains challenging in underrepresented, underdiagnosed groups, including Latinos, as advanced biomarkers are rarely available. Recent guidelines for the study of dementia highlight the critical role of biomarkers. Thus, novel cost-effective complementary approaches are required in clinical settings. Approach. We developed a novel framework based on a gradient boosting machine learning classifier, tuned by Bayesian optimization, on a multi-feature multimodal approach (combining demographic, neuropsychological, magnetic resonance imaging (MRI), and electroencephalography/functional MRI connectivity data) to characterize neurodegeneration using site harmonization and sequential feature selection. We assessed 54 bvFTD and 76 AD patients and 152 healthy controls (HCs) from a Latin American consortium (ReDLat). Main results. The multimodal model yielded high area under the curve classification values (bvFTD patients vs HCs: 0.93 (±0.01); AD patients vs HCs: 0.95 (±0.01); bvFTD vs AD patients: 0.92 (±0.01)). The feature selection approach successfully filtered non-informative multimodal markers (from thousands to dozens). Results. Proved robust against multimodal heterogeneity, sociodemographic variability, and missing data. Significance. The model accurately identified dementia subtypes using measures readily available in underrepresented settings, with a similar performance than advanced biomarkers. This approach, if confirmed and replicated, may potentially complement clinical assessments in developing countries.Sebastian Moguilner, Agustina Birba, Sol Fittipaldi, Cecilia Gonzalez-Campo, Enzo Tagliazucchi, Pablo Reyes, Diana Matallana, Mario A Parra, Andrea Slachevsky, Gonzalo Farías, Josefina Cruzat, Adolfo García, Harris A Eyre, Renaud La Joie, Gil Rabinovici, Robert Whelan and Agustín Ibáñe

Brain clocks capture diversity and disparities in aging and dementia across geographically diverse populations

Brain clocks capture diversity and disparities in aging and dementia across geographically diverse populations Correction to: Nature Medicine https://doi.org/10.1038/s41591-024-03209-x, published online 26 August 2024. In the version of the article initially published, Brian Lawlor’s name appeared incorrectly (as Brain) and has now been amended in the HTML and PDF versions of the article.Peer reviewe

Brain clocks capture diversity and disparities in aging and dementia

Brain clocks, which quantify discrepancies between brain age and chronological age, hold promise for understanding brain health and disease. However, the impact of diversity (including geographical, socioeconomic, sociodemographic, sex and neurodegeneration) on the brain-age gap is unknown. We analyzed datasets from 5,306 participants across 15 countries (7 Latin American and Caribbean countries (LAC) and 8 non-LAC countries). Based on higher-order interactions, we developed a brain-age gap deep learning architecture for functional magnetic resonance imaging (2,953) and electroencephalography (2,353). The datasets comprised healthy controls and individuals with mild cognitive impairment, Alzheimer disease and behavioral variant frontotemporal dementia. LAC models evidenced older brain ages (functional magnetic resonance imaging: mean directional error = 5.60, root mean square error (r.m.s.e.) = 11.91; electroencephalography: mean directional error = 5.34, r.m.s.e. = 9.82) associated with frontoposterior networks compared with non-LAC models. Structural socioeconomic inequality, pollution and health disparities were influential predictors of increased brain-age gaps, especially in LAC (R² = 0.37, F² = 0.59, r.m.s.e. = 6.9). An ascending brain-age gap from healthy controls to mild cognitive impairment to Alzheimer disease was found. In LAC, we observed larger brain-age gaps in females in control and Alzheimer disease groups compared with the respective males. The results were not explained by variations in signal quality, demographics or acquisition methods. These findings provide a quantitative framework capturing the diversity of accelerated brain aging.</p

Essential Medicines at the National Level : The Global Asthma Network's Essential Asthma Medicines Survey 2014

Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013-2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013-2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.Peer reviewe

Etude de la dynamique de la macrofaune du sol en culture d’ognon sous usage de diverses pratiques agricoles

La dynamique de la macrofaune du sol en culture d’ognon (Alium cepa) a été étudiée huit semaines après le repiquage des plants. Les expérimentations ont été conduites en 2013 et 2014 au Centre de Recherches Environnementales et Agricoles et de Formation de Kamboinsé de l’Institut de l’Environnement et de Recherches Agricoles (INERA). L’objectif était d’étudier l’influence des différentes pratiques agricoles appliquées sur la faune du sol. La macrofaune a été échantillonnée par une méthode standard TSBF. Les termites ont été échantillonnés par la méthode des monolithes et par une fouille aléatoire sur un transect autour du monolithe. Les vers de terre et les autres groupes de la macrofaune du sol ont été échantillonnés uniquement par monolithes. Au total douze (12) espèces d’insectes et deux (02) espèces de vers de terre ont été enregistrées sous les dix (10) traitements appliqués sur le dispositif expérimental. Pour les insectes, ce sont : Cubitermes sp, Odontotermes akengeensis, Odontotermes silvaticus, Monomorium bicolor, Tetramorium sericciventre, Dorylus sp, Pachycondyla senaerensis, Componotus maculatus, Monomorium abyssinicum, Monomorium sp, Feronia sp, Nysius sp. Les vers de terre identifiés sont Milsonia inermis et Dichogaster affinis. Les traitements avec apport de fumure organique ont connu une macrofaune plus abondance en comparaison à ceux avec fumure minérale. L’application de l’herbicide de prélevé n’a pas eu d’effet sur les communautés de faune du sol étudiés. A l’intérieur des traitements, les groupes de faune du sol ont réagit différemment face aux traitements appliqués.Mots clés: ognon, macrofaune du sol, désherbage, pratiques agricolesEnglish Title: Study of the dynamics of soil macrofauna in onion by using various agricultural practicesEnglish AbstractThe dynamics of soil macrofauna in onion cultivation (Alium cepa) was studied eight weeks after transplanting the seedlings. The experiments were conducted in 2013 and 2014 at the Centre for Environmental and Agricultural Research and Training of the Institute of the Environment and Agricultural Research (INERA). The objective was to study the effect of different agricultural practices on soilfauna. Macrofauna was sampled by a standard method TSBF. Termites were sampled by monolith method and by a random search on a transect around the monolith. Earthworms and other soil macrofauna groups were sampled only by monoliths. In total eleven (12) and two species of insects (02) earthworm species have been recorded in the ten (10) treatments applied on experimental design. For insects, these are: Cubitermes sp, Odontotermes akengeensis, Odontotermes silvaticus, Monomorium bicolor, Tetramorium sericciventre, Dorylus sp Pachycondyla senaerensis, Componotus maculatus, Monomorium abyssinicum, Monomorium sp, Feronia sp, Nysius sp. Earthworms identified were Milsonia inermis and Dichogaster affinis. Treatments with organic manure were more abundant of soil macrofauna compared to those with added mineral fertilizers. The  application of herbicide removed had no effect on communities of soil fauna studied. Inside the treatment, soil fauna groups react differently to treatments applied.Keywords: onion, soil macrofauna, weeding, agricultural practice

Homotopy theory and Brouwer fix point theorem for the disc

100 σ.Η παρούσα εργασία αφορά στην παρουσίαση της Θεωρίας Ομοτοπιών και το Θεωρήμα του Brouwer του σταθερού σημείου για τον δίσκο. Σκοπός μας είναι μια έκθεση βασικών εννοιών της Θεωρίας Ομοτοπιών όπως η ομοτοπία, Θεμελιώδης ομάδα, απεικόνιση κάλυψης, χώρος κάλυψης και το Lifting απεικόνισης καθώς και συμπεράσματα που αφορούν την ταξινόμηση γνωστών τοπολογικών χώρων μέσω μιας αναλυτικής παράθεσης όλων των τεχνικών σημείων και υπολογιστικών λεπτομερειών που συνθέτουν τις σχετικές αποδείξεις. Περιλαμβάνονται, επίσης στοιχεία της Γενικής Τοπολογίας και βασικές αλγεβρικές έννοιες που θα χρησιμοποιηθούν στη Θεωρία Ομοτοπιών, καθώς και η παρουσίαση και δύο αποδείξεις του Θεωρήματος του Brouwer του σταθερού σημείου για τον δίσκο.The current work presents basic elements of Homotopy Theory and the Brouwer fixed point theorem for the disk. Our aim is to fully specify in high detail all the basic concepts of Homotopy Theory such as Fundamental group, covering space, covering map, Lifting of map and results, with relative proofs, which targets to classification of basic topological space. The paper includes elements of General topology and algebraic concepts which are useful for this work. After those results, we give two proofs of the Brouwer fixed point theorem for the disk.Παναγιώτα Δ. Μπίρμπ

Reference values for aerobic capacity estimated by cardiopulmonary exercise test on a cycle ergometer in a healthy Greek population

Objective: Aerobic capacity (AC) is inversely associated with a high risk of cardiovascular morbidity and mortality as well as all-cause mortality. Cardiopulmonary exercise testing (CPET) represents the gold standard for assessing exercise capacity based on maximum oxygen uptake (VO2max). The purpose of our study was to provide for the first time CPET-derived normative reference values in a Greek cohort of apparently healthy men and women on a cycle ergometer to evaluate their AC, and to compare our results with similar studies from other countries. Methods: A cohort of 194 apparently healthy subjects (118 males and 76 females, age range, 15-69 years) was submitted to CPET using a cycle ergometer. Mean ± SD values for several exercise parameters, VO2max included, were determined. We compared our results with existing data derived from USA and North Europe cohorts. Results: Male subjects achieved significantly higher levels of relative and absolute VO2max (p &amp;lt; 0.001) across all ages compared to female subjects. A decline in relative and absolute VO2max among older participants was observed in both sexes. Greek subjects had lower AC than the North Europe cohort and almost similar to the USA cohort. Conclusion: We provide the first reference data for AC in apparently healthy Greek subjects based on CPET using cycle ergometer. Our findings will allow for more accurate interpretation of CPET in several groups of healthy subjects or patients with CV diseases. The differences found between our reference values and those reported from the USA and northern European countries, underscore the need for individual countries to develop their own AC reference values. © 2019 Hellenic Society of Cardiolog