scholarly journals Poor retention and care-related sex disparities among youth living with HIV in rural Mozambique

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250921
Author(s):  
Aima A. Ahonkhai ◽  
Muktar H. Aliyu ◽  
Carolyn M. Audet ◽  
Magdalena Bravo ◽  
Melynda Simmons ◽  
...  
Keyword(s):  
Retention In Care ◽  
Young Males ◽  
Targeted Interventions ◽  
Art Initiation ◽  
Before And After ◽  
Cox Proportional Hazard Models ◽  
One Year ◽  
The One ◽  
Youth Living With Hiv ◽  
Living With Hiv

Background There are few studies that characterize sex-related differences in HIV outcomes among adolescents and young adults (AYA) 15–24 years of age. Methods We conducted a retrospective cohort study among AYA who enrolled in a comprehensive HIV program in Mozambique between 2012–2016. We assessed patients by sex and pregnancy/lactation status, comparing time to combination antiretroviral therapy (ART) initiation using Cox proportional hazard models. We employed multivariable logistic regression to investigate pre- and post-ART retention. Patients were defined as ‘retained pre-ART’ if they attended at least 3 of 4 required visits or started ART in the 6 months after enrollment, and ‘retained post-ART’ if they had any ART pickup or clinical visit during the last 90 days of the one-year follow-up period. Results Of 47,702 patients in the cohort, 81% (n = 38,511) were female and 19% (n = 9,191) were male. Of the females, 57% (n = 21,770) were non-pregnant and non-lactating (NPNL) and 43% (n = 16,741) were pregnant or lactating (PL). PL (aHR 2.64, 95%CI:2.47–2.81) and NPNL females (aHR 1.36, 95%CI:1.30–1.42) were more likely to initiate ART than males. PL females had higher odds of pre-ART retention in care (aOR 3.56, 95%CI: 3.30–3.84), as did NPNL females (aOR 1.71, 95%CI: 1.62–1.81), compared to males. This was also true for retention post-ART initiation, with higher odds for both PL (aOR 1.78, 95%CI:1.63–1.94) and NPNL females (aOR 1.50, 95%CI:1.35–1.65) compared to males. Conclusions PL females were most likely to initiate ART and remain in care post-ART in this AYA cohort, likely reflecting expansion of Option B+. Despite pregnancy and policy driven factors, we observed important sex-related disparities in this cohort. NPNL females were more likely to initiate ART and be retained in care before and after ART initiation than males. These data suggest that young males need targeted interventions to improve these important care continuum outcomes.

scholarly journals Real-World Experience of the One-Year Efficacy of Rifaximin Add-On to Lactulose Is Superior to Lactulose Alone in Patients with Cirrhosis Complicated with Recurrent Hepatic Encephalopathy in Taiwan

2021 ◽  
Vol 11 (6) ◽  
pp. 478
Author(s):  
Ching Chang ◽  
Chien-Hao Huang ◽  
Hsiao-Jung Tseng ◽  
Fang-Chen Yang ◽  
Rong-Nan Chien
Keyword(s):  
Hepatic Encephalopathy ◽  
Real World ◽  
Ammonia Level ◽  
Decompensated Cirrhosis ◽  
Control Group ◽  
Multivariable Logistic Regression Model ◽  
Before And After ◽  
One Year ◽  
The One ◽  
Serum Ammonia

Background: Hepatic encephalopathy (HE), a neuropsychiatric complication of decompensated cirrhosis, is associated with high mortality and high risk of recurrence. Rifaximin add-on to lactulose for 3 to 6 months is recommended for the prevention of recurrent episodes of HE after the second episode. However, whether the combination for more than 6 months is superior to lactulose alone in the maintenance of HE remission is less evident. Therefore, the aim of this study is to evaluate the one-year efficacy of rifaximin add-on to lactulose for the maintenance of HE remission in Taiwan. Methods: We conducted a real-world single-center retrospective cohort study to compare the long-term efficacy of rifaximin add-on to lactulose (group R + L) versus lactulose alone (group L, control group). Furthermore, the treatment efficacy before and after rifaximin add-on to lactulose was also analyzed. The primary endpoint of our study was time to first HE recurrence (Conn score ≥ 2). All patients were followed up every three months until death, and censored at one year if still alive. Results and Conclusions: 12 patients were enrolled in group R + L. Another 31 patients were stratified into group L. Sex, comorbidity, ammonia level, and ascites grade were matched while age, HE grade, and model for end-stage liver disease (MELD) score were adjusted in the multivariable logistic regression model. Compared with group L, significant improvement in the maintenance of HE remission and decreased episodes and days of HE-related hospitalizations were demonstrated in group R + L. The serum ammonia levels were significantly lower at the 3rd and 6th month in group 1. Concerning changes before and after rifaximin add-on in group R + L, mini-mental status examination (MMSE), episodes of hospitalization, and variceal bleeding also improved at 6 and 12 months. Days of hospitalization, serum ammonia levels also improved at 6th month. Except for concern over price, no patients discontinued rifaximin due to adverse events or complications. The above results provide evidence for the one-year use of rifaximin add-on to lactulose in reducing HE recurrence and HE-related hospitalization for patients with decompensated cirrhosis.

scholarly journals New wavelength calibration of the HARPS spectrograph

2019 ◽  
Vol 629 ◽  
pp. A27 ◽  
Author(s):  
A. Coffinet ◽  
C. Lovis ◽  
X. Dumusque ◽  
F. Pepe
Keyword(s):  
Radial Velocity ◽  
Frequency Comb ◽  
Light Emitting Diode ◽  
Laser Frequency ◽  
Wavelength Calibration ◽  
Light Emitting ◽  
Before And After ◽  
Doppler Spectroscopy ◽  
One Year ◽  
The One

Context. Doppler spectroscopy has been used in astronomy for more than 150 yr. In particular, it has permitted us to detect hundreds of exoplanets over the past 20 yr, and the goal today of detecting Earth-like planets requires a precision around 0.1 m s−1 or better. Doppler spectroscopy has also been and will be of major importance for other studies such as the variability of fundamental constants and cosmological studies. For all these applications, it is crucial to have the best possible wavelength calibration. Despite the fact that the HARPS spectrograph has been operational at the 3.6-m ESO telescope for more than 15 yr, and that it provides among the most precise Doppler measurements, improvements are still possible. One known problem, for instance, is the non-fully regular block-stitching of the charge-coupled devices (CCDs), which in some cases introduces one-year period parasitic signals in the measured radial velocity. Aims. The aim of the presented work is to improve the wavelength calibration of the HARPS spectrograph to push further its planet-detection capabilities. Methods. The properties of the CCD stitching-induced pixel-size anomalies were determined with light-emitting-diode (LED) flat-field frames, and then a physical, gap-corrected map of the CCDs is used for the fitting model of the spectral orders. We also used a new thorium line list, based on much higher-accuracy measurements than the one used up to now. We derive new wavelength solutions for the 15 yr of HARPS data, both before and after the fibre upgrade that took place in 2015. Results. We demonstrate that we do indeed correct the gap anomalies by computing the wavelength solutions of laser frequency comb exposures, known to have a very low dispersion, both with and without taking the gap correction into account. By comparing the rms of the most stable stars of the HARPS sample, we show that we globally decrease the radial velocity (RV) dispersion of the data, especially for the data acquired after the change of fibres of 2015. Finally, the comparative analysis of several individual systems shows that we manage to attenuate the periodogram power at one year in most cases. The analysis of the RVs derived from individual stellar lines also shows that we indeed correct the stitching-induced RV variation. Conclusions. This improved calibration of the HARPS spectrograph allows to go deeper in the search for low-amplitude radial-velocity signals. This new calibration process will be further improved by combining the thorium calibration spectra with laser frequency comb and Fabry–Perot calibration spectra, and this will not only be used for HARPS but notably also for HARPS-N and the new ESPRESSO spectrograph.

Robot-Asssisted Laparoscopic Radical Prostatectomy (Ralp). Oncological and Functional Findings after 90 Cases

2009 ◽  
Vol 76 (2) ◽  
pp. 87-89 ◽  
Author(s):  
C. Giberti ◽  
M. Schenone ◽  
P. Cortese ◽  
F. Gallo ◽  
E Gastaldi ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Functional Results ◽  
Modern Technology ◽  
Nerve Sparing ◽  
Number Of Patients ◽  
Before And After ◽  
Disease Free Survival Rate ◽  
One Year ◽  
The One

The RALP is the most modern technology available for the treatment of intracapsular prostate cancer (CaP), which can produce a shorter learning curve and better results than the traditional techniques. Methods Between March 2005 and March 2008, 90 patients (64.3 ys, range 52–71) with intracapsular CaP underwent RALP at our institute. Before surgery the patients underwent routine examinations and filled in IIEF, IPSS and EORTC-QLQC30/PR 25 questionnaires. Patients were followed up with PSA assay, physical examination and compilation of the questionnaires. Median follow-up was 12.5 months (range 1–35 months). Results Mean operative time was 230 min. Discharge and catheter removal were at day 7.4 and 8.2, respectively, after surgery. Pathological staging reported pT2 and pT3 in 57 (63%) and 33 patients (37%), respectively. Positive surgical margins were assessed in 30 patients (33%), particularly 8.7% in pT2 tumors. The one-year biochemical disease-free survival rate was 90%. Regarding the functional results, 81 patients (90%) were perfectly continent while a mild and a moderate incontinence were reported in 7 (8%) and 2 (2%) patients, respectively. Mean IPSS score decreased from 8 to 4; among the patients who underwent bilateral nerve sparing RALP and no adjuvant therapy, 31 (70.4%) reported satisfactory sexual intercourses. Concerning postoperative quality of life, mean EORTC-QLQC30/PR 25 questionnaires scores were very similar before and after RALP. Conclusions After 90 cases of RALP the oncological and functional results are definitely promising. However, a wider number of patients and a greater follow-up are needed to confirm these data particularly as regards the functional results.

Collagen metabolites in the prediction of response to GH therapy in short children

1997 ◽  
pp. 621-625 ◽  
Author(s):  
P Tapanainen ◽  
M Knip ◽  
L Risteli ◽  
L Kemppainen ◽  
ML Kaar ◽  
...  
Keyword(s):  
Bone Age ◽  
Type I ◽  
Gh Therapy ◽  
Gh Treatment ◽  
Type I Procollagen ◽  
Short Children ◽  
Before And After ◽  
The Absolute ◽  
One Year ◽  
The One

To evaluate the role of collagen metabolites in the prediction of the response to GH treatment we measured the serum concentrations of the C-terminal propeptide of type I procollagen (PICP) and the N-terminal propeptide of type III procollagen (PIIINP) with specific RIAs in 35 short children (16 boys) before and after 5 days, 5 weeks and 3 months of GH therapy. The mean age of the children was 10.3 years (range 1.9-16.4 years) and the bone age ranged from 1.2 to 12.5 years (mean 7.6 years). The initial mean relative height (RH) was -3.6 SDS (range -6.6 to -2.4 S.D.). Nineteen children were found to have GH deficiency (GHD; peak GH responses in two pharmacological tests < 10 micrograms/l), while the remaining 16 were considered to have undefined short stature (USS). The children were treated with recombinant human GH (0.1 U/kg given subcutaneously at bedtime 6-7 times/week). The increases in RHI over the first 6 and 12 months of therapy were used as response measures. There was already a significant increase (P < 0.001) in both the serum PICP and PIIINP levels at 5 days, and the concentrations continued to rise up to 3 months, PICP levels rising less than the PIIINP levels. In the whole group the RHI over 6 months correlated most strongly with the absolute PICP concentrations at 3 months (rS = 0.59; P < 0.05), while the absolute PIIINP concentrations at 3 months showed the strongest relation to the one year RHI (rS = 0.69; P < 0.001). In the GHD group the 6 month RHI was most strongly related to the absolute PICP concentration at 3 months (rS = 0.59; P < 0.05). In the USS group the absolute PICP concentrations at 3 months correlated most strongly with the one year RHI (rS = 0.82; P < 0.01). Significant correlations were also observed between the absolute PIIINP levels at 3 months and the 6 month RHI (rS = 0.60; P < 0.05) and 12 month RHI (rS = 0.76; P < 0.01) in this group. These results show that GH therapy results in an unequivocal increase in circulating concentrations of PICP and PIIINP. The serum PICP and PIIINP concentrations may be of value in the prediction of the long-term response to GH therapy.

scholarly journals A sub-group evaluation of the multi-month dispensing strategy for differentiated HIV care: is personalization of care guidelines warranted in Haiti?

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Canada Parrish ◽  
Anirban Basu ◽  
Paul Fishman ◽  
Jean Baptiste Koama ◽  
Ermane Robin ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Causal Effect ◽  
Care Delivery ◽  
Clinical Stage ◽  
Retention In Care ◽  
Individual Characteristics ◽  
Hiv Care ◽  
Marginal Effect ◽  
One Year ◽  
Living With Hiv

Abstract Background Differentiated care strategies are rapidly becoming the norm for HIV care delivery globally. Building upon an interest in tailoring antiretroviral therapy (ART) delivery for client-centered needs, the Ministry of Health and Population in Haiti formally endorsed multiple-month dispenses (MMD) in the 2016 national ART guidelines This study explores heterogeneity in retention in care with MMD for specific Haitian populations living with HIV and evaluates if a targeted algorithm for optimal ART prescription intervals is warranted in Haiti. Methods This study included ART-naïve individuals who started ART on or after January 1st, 2017 in Haiti. To identify subgroups in which to explore heterogeneity of retention, we implemented a double-lasso regression method to determine which individual characteristics would define the subgroups. Characteristics evaluated for potential subgroup definition included: sex, age category, WHO clinical stage, and body mass index category. We employed instrumental variable models to estimate the causal effect of increasing ART dispensing length on ART retention, by client subgroup. The outcome of interest was retention in care after one year in treatment. We then estimated the marginal effect of a 30-day increase to ART dispensing length to retention in care for each of these subgroups. Results There was evidence for heterogeneity in the effect of extending ART dispensing intervals on retention by WHO clinical stage. We observed significant improvements to retention in care at one year with a 30-day increase in ART dispense length for all subgroups defined by WHO clinical stages 1-4. The effects ranged from a 14.7% increase (95% CI: 12.4-17.0) to the likelihood of retention for people with HIV in WHO stage 1 to a 21.6% increase (95% CI: 18.7-24.5) to the likelihood of retention for those in WHO stage 3. Conclusions All the subgroups defined by WHO clinical stage experienced a benefit of extending ART intervals to retention in care at one year. Though the effect did differ slightly by WHO stage, the effects went in the same direction and were of similar magnitude. Therefore, a standardized recommendation for MMD among those living with HIV and new on ART is appropriate for Haiti treatment guidelines.

Gut Microbiota and Urine Metabonomics Alterations in Constitution after Chinese Medicine and Lifestyle Intervention

2021 ◽  
pp. 1-29
Author(s):  
Yuan Jing ◽  
Shuangshuang Han ◽  
Jieyu Chen ◽  
Yigui Lai ◽  
Jingru Cheng ◽  
...  
Keyword(s):  
Chinese Medicine ◽  
Gut Microbiota ◽  
Lifestyle Intervention ◽  
Intervention Group ◽  
Urinary Metabolites ◽  
Control Group ◽  
Human Beings ◽  
Before And After ◽  
One Year ◽  
The One

Traditional Chinese Medicine Constitution (TCMC) divides human beings into balanced (ping-he) constitution (PH) and unbalanced constitution. Yang-deficiency (yang-xu) constitution (YAX) is one of the most common unbalanced constitutions in Chinese general population, and it causes susceptibility to particular diseases. However, unbalanced constitutions can be regulated by Chinese medicine and lifestyle intervention in clinical practice. Gui-fu-di-huang-wan (GFDHW) is a well-known Chinese medicine with yang-invigorating activity and is regarded as improving YAX. In this study, 60 healthy YAX students selected from a prospective population of 5185 were enrolled in a randomized clinical trial and completed the study. We compared the gut microbiota and urinary metabolome between individuals with PH and those with YAX before and after one-month-intervention. Compared with the control group, the health status of the intervention group improved significantly, the YAX symptom score was reduced, and the efficacy remained high at the one-year follow-up. The gut microbiota of the healthy PH exhibited greater diversity, and significantly higher species were identified.[Formula: see text]Compared to PH group, YAX individuals showed increased abundance of Bacteroidetes and Bacteroides,also had higher levels of gut microbial-derived urinary metabolites. After one-month-intervention, both GFDHW treatment and lifestyle intervention enriched the diversity and modulated the structure in YAX. The intervention group also partially restored the microbiome and metabolome to healthy PH-like levels. Further, a microbiota co-occurrence network analysis showed that the metabolites enriched in YAX were correlated with microbial community structure. Taken together, our results suggest that Chinese medicine combined with lifestyle intervention benefits YAX individuals. Gut microbiota/metabolite crosstalk might be involved in the Chinese medicine-mediated effects.

scholarly journals Efficacy of bariatric surgery in a Colombian population

2020 ◽  
Author(s):  
Claudia Y. Obando León ◽  
William Otero Regino ◽  
HERNANDO MARULANDA FERNANDEZ ◽  
Hernán Ballén ◽  
Elder Otero
Keyword(s):  
Bariatric Surgery ◽  
Antihypertensive Drugs ◽  
Adjustable Gastric Band ◽  
Hypertensive Patients ◽  
Risk Of Mortality ◽  
Before And After ◽  
Excess Bmi Loss ◽  
One Year ◽  
The One

Abstract Background Obesity (OB) is defined as having a body mass index (BMI) of ≥ 30 kg/m2. It has a high risk of mortality due to its association with comorbidities. Bariatric surgery (BS) is indicated for a BMI of 40 kg/m2 or of 35 kg/m2 if concurrent with a metabolic disorder. Methods A retrospective observational study of patients subjected to BS, such as Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric band (AGB). A survey was applied to determine the BMI and patterns of comorbidities before and after BS. Results The study included 30 patients who underwent 25 RYGB, 4 SG and 1 AGB procedures. A total of 17 patients were evaluated at the one-year follow-up and all showed improvement in comorbidities and weight loss, with a mean excess BMI loss (%EBMIL) of 89.5% At the two-year follow-up, 3 patients reported a %EBMIL of 75%. At the three-year follow-up, 10 patients had a %EBMIL of 70.8%%, but 70% (7/10) still had a BMI > 30 kg/m2. Type 2 diabetes mellitus resolved in all (12/12) and the doses of antihypertensive drugs were reduced in 86.4% of hypertensive patients (11/13). Half of the patients followed a diet. Conclusion In our service, BS was effective one year after the procedure. After three years, BMI > 30 kg/m2 persisted in 70% of patients All diabetics were cured. The doses of antihypertensives were lowered in 86.4% of hypertensive patients. Ultrasound scan detected no fatty liver diseases at the one-year follow-up of 85.7% of patients.

scholarly journals Improving retention in care of HIV+ women through behavioural change interventions aimed at their male partners: A prospective, controlled before-and-after study protocol (WeMen) (Preprint)

2020 ◽  
Author(s):  
Stefano Orlando ◽  
Ilaria Palla ◽  
Fausto Ciccacci ◽  
Isotta Triulzi ◽  
Darlington Thole ◽  
...  
Keyword(s):  
Adult Population ◽  
Retention In Care ◽  
Hiv Positive ◽  
Male Partners ◽  
Post Intervention ◽  
Intervention Phase ◽  
The World ◽  
Before And After ◽  
Living With Hiv ◽  
Before And After Study

BACKGROUND According to the World Health Organization (WHO), in 2018, 37.9 million people were living with HIV (PLWHIV) worldwide. More than two-thirds of PLWHIV reside in Sub-Saharan Africa (SSA), where the HIV prevalence in the adult population (aged 15-49) is 3.9%. This includes 1.3 million pregnant women living with HIV, of whom 82% received Antiretroviral Therapy (ART) for Prevention of HIV Mother-To-Child Transmission (PMTCT). In these countries, one of the main challenges is an insufficient level of treatment adherence, particularly in HIV positive pregnant women. Among the causes, the lack of male partner involvement represents a significant contributor to the problem. This issue emerges strongly in Malawi, one of the countries with the highest HIV prevalence in the world: 9.2% of its adult population lived with HIV in 2018. OBJECTIVE The objective of the study is to assess three different interventions aimed at improving ART adherence and retention among HIV positive women through engagement with their male partners in four Malawian healthcare centres. METHODS The prospective, controlled before-and-after study is articulated in three phases (total duration of 24 months): pre-intervention, intervention and post-intervention analyses. The number of selected clusters (clinical centres) is limited to four, one for each intervention plus a cluster where no intervention will be performed (control arm). The interventions are 1) opening the facility on one Saturday per month, only for men, defined as a "special day"; 2) testing peer-to-peer counselling among men, "male champions"; 3) providing a non-economic incentive to all women who are accompanied by their partners to the facility, "nudge". The primary outcome of the study is to evaluate differences in retention in care and adherence among women to therapeutic protocols; the intermediate outcome is the assessment of differences in Male Involvement (MI). The level of MI in the health of their female partners (intermediate outcome) will be evaluated through a dedicated questionnaire administered at baseline and in the post-intervention phase. Data will be collected at the clinical centres and stored in two electronic databases managed through two different types of software. RESULTS Analysis of data collected in the four centres during the pre-intervention phase is ongoing as enrolment ceased on March 31, 2020. The total number of patients enrolled was 452 (Namandanje: 133, Kapeni: 78, Kapire: 75, Balaka: 166). Meanwhile several meetings have taken placeat the centres to organize the intervention phase. CONCLUSIONS The study will identify the best intervention which enhances involvement of male partners in womens health, using an approach that takes into consideration a broad spectrum of behaviours. An important aspect will the use of educational tools focused on messages initiating a reflective discussion of stereotypes and false beliefs related to the idea of masculinity present in Malawian culture. CLINICALTRIAL Clinicaltrials.gov NCT04356157 https://clinicaltrials.gov/show/NCT04356157

Safety Study of AAV hTert and Klotho Gene Transfer Therapy for Dementia

2021 ◽  
Author(s):  
Patrick E Sewell
Keyword(s):  
Gene Transfer ◽  
Randomized Study ◽  
Control Group ◽  
Response Data ◽  
Cognitive Improvement ◽  
Moderate Dementia ◽  
Before And After ◽  
Transfer Method ◽  
One Year ◽  
The One

A sponsored, interventional, non-randomized study without a control group using a novel and proprietary central nervous system gene transfer method to deliver AAV hTert and Klotho genes to five patients with mild or moderate dementia was performed to primarily evaluate safety. Clinical response data was gathered as a secondary interest. The therapy demonstrated a very high safety profile with no serious adverse effects identified. Clinical evaluation of the patients over the course of the one year follow up yielded significant findings with all five patients demonstrating evident reversal of Dementia symptoms such as sustained cognitive improvement as measured by the Folstein exam. Telomere analysis was performed before and after the therapy. A measurable elongation of the participants telomeres was identified, and biological age was reduced as chronological age increased.

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