Background. The optimal time to initiate antiretroviral therapy (ART) in human immunodeficiency virus (HIV)—associated tuberculous meningitis is unknown. Methods. We conducted a randomized, ...double-blind, placebo-controlled trial of immediate versus deferred ART in patients with HIV-associated tuberculous meningitis to determine whether immediate ART reduced the risk of death. Antiretroviral drugs (zidovudine, lamivudine, and efavirenz) were started either at study entry or 2 months after randomization. All patients were treated with standard antituberculosis treatment, adjunctive dexamethasone, and prophylactic co-trimoxazole and were followed up for 12 months. We conducted intention-to-treat, perprotocol, and prespecified subgroup analyses. Results. A total of 253 patients were randomized, 127 in the immediate ART group and 126 in the deferred ART group; 76 and 70 patients died within 9 months in the immediate and deferred ART groups, respectively. Immediate ART was not significantly associated with 9-month mortality (hazard ratio HR, 1.12; 95% confidence interval CI,.81-1.55; P = .50) or the time to new AIDS events or death (HR, 1.16; 95% CI,.87-1.55; P = .31). The percentage of patients with severe (grade 3 or 4) adverse events was high in both arms (90% in the immediate ART group and 89% in the deferred ART group; P = .84), but there were significantly more grade 4 adverse events in the immediate ART arm (102 in the immediate ART group vs 87 in the deferred ART group; P = .04). Conclusions. Immediate ART initiation does not improve outcome in patients presenting with HIV-associated tuberculous meningitis. There were significantly more grade 4 adverse events in the immediate ART arm, supporting delayed initiation of ART in HIV-associated tuberculous meningitis.
Even with antituberculosis therapy, tuberculous meningitis causes death or severe disability in more than half of affected adults. In this double-blind, placebo-controlled trial, conducted in ...Vietnam, dexamethasone treatment was associated with a reduced risk of death as compared with placebo (31.8 percent vs. 41.3 percent).
Dexamethasone treatment was associated with a reduced risk of death but the proportion of survivors with severe disability is not reduced.
Tuberculous meningitis is the severest form of infection with
Mycobacterium tuberculosis,
causing death or severe neurologic deficits in more than half of those affected in spite of antituberculosis chemotherapy.
1
,
2
Attenuation of the inflammatory response in bacterial and mycobacterial meningitis may improve outcome by reducing the likelihood or severity of neurologic complications. Early studies suggested that corticosteroids reduced cerebrospinal fluid inflammation and time to recovery in patients with tuberculous meningitis, but the studies were too small to confirm any effect on survival.
3
–
7
Concern remained that corticosteroids might reduce the case fatality rate but increase the number of disabled patients. . . .
The potential of green nanomaterials for environmental and agricultural fields is emerging due to their biocompatible, eco-friendly, and cost-effective performance. We report the use of Canna indica ...flowers extract as new capping and stabilizing source to bio-fabricate ZnO nanoparticles (ZnO NPs for dyes removal, seed germination. ZnO NPs was biosynthesized by ultrasound-assisted alkaline-free route to reach the critical green strategy. The physicochemical findings of ZnO revealed small crystallite size (27.82 nm), sufficient band-gap energy (3.08 eV), and diverse functional groups. Minimum‑run resolution IV approach found the most pivotal factors influencing on removal of Coomassie Brilliant Blue G-250. Uptake studies pointed out that pseudo second-order, and Langmuir were the best fitted models. Dye molecules behaved monolayer adsorption on ZnO surface layers, and controlled by chemisorption. Natural solar light was used as effective source for photocatalytic degradation of methylene blue (94.23% of removal and 31.09 mg/g of uptake capacity). Compared with H2O and ZnSO4, ZnO NPs positively affected the growth of shoot and root lengths (10.2–27.8%) of bean seedlings in most cases. ZnO acts an agrochemical for boosting weight gain, and germination ratio. This study may be promising for developing the recyclable, multifunctional ZnO nanoparticles for environmental and agricultural applications.
Display omitted
•ZnO nanoparticles were biosynthesized from Canna indica L. flowers.•Minimum–run resolution IV was used to screen and optimize the adsorption parameters.•Photodegradation of methylene blue was conducted under solar light illumination.•ZnO nanoparticles boosted shoot and root lengths of green and red bean seedlings.•Good recyclability and high removal efficiency were obtained.
Avian Influenza A (H5N1) in 10 Patients in Vietnam Hien, Tran Tinh; Liem, Nguyen Thanh; Dung, Nguyen Thi ...
New England journal of medicine/The New England journal of medicine,
03/2004, Letnik:
350, Številka:
12
Journal Article
Recenzirano
Odprti dostop
This report describes the clinical details of 10 patients who were shown to have been infected with an H5N1 influenzavirus, which normally does not affect humans. The patients had direct contact with ...fowl a median of three days before they presented with fever, respiratory symptoms, and an acute influenza syndrome, characterized by lymphopenia and marked pulmonary infiltrates on chest radiography. Eight of the patients died, even though none had preexisting medical conditions.
This report describes the clinical details of 10 patients who were shown to have been infected with an H5N1 influenzavirus. Eight of the patients died.
Influenza A virus infects a variety of animals, including humans and birds.
1
Although the natural reservoir for all known subtypes of influenza A (hemagglutinins H1 through H15 and neuraminidases N1 through N9) is wild waterfowl, only three subtypes are currently circulating among humans (H1N1, H1N2, and H3N2). However, during the past few years, several subtypes of avian influenza A have been shown to cross the species barrier and infect humans. During an outbreak of a highly pathogenic influenza A (H5N1) virus among poultry in Hong Kong in 1997, 6 of 18 people with confirmed infection died.
2
After this outbreak, prevention . . .
Talaromyces marneffei
is a dimorphic fungus that causes substantial disease in Asia, especially among persons infected with the human immunodeficiency virus. In this randomized, controlled trial, ...initial therapy with amphotericin B was found to be superior to itraconazole.
The dimorphic fungus
Talaromyces
(previously
Penicillium
)
marneffei
causes a life-threatening mycosis in immunocompromised persons living in or traveling to Southeast Asia, China, and India.
1
Talaromycosis (previously penicilliosis) is a major cause of human immunodeficiency virus (HIV)–related death; its prevalence is surpassed only by the prevalence of tuberculosis and cryptococcosis,
2
and it leads to 4 to 15% of HIV-related hospital admissions in regions in which the disease is endemic.
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–
7
Talaromycosis is increasingly diagnosed among patients who are not infected with HIV but who have other immunodeficiency conditions
8
and is reported to be the second most common cause of all . . .
BackgroundTuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to 1 or more antituberculosis drugs is an increasingly common clinical problem, although the impact on outcome is ...uncertain MethodsWe performed a prospective study of 180 Vietnamese adults admitted consecutively for TBM. M. tuberculosis was cultured from the cerebrospinal fluid (CSF) of all patients and was tested for susceptibility to first-line antituberculosis drugs. Presenting clinical features, time to CSF bacterial clearance, clinical response to treatment, and 9-month morbidity and mortality were compared between adults infected with susceptible and those infected with drug-resistant organisms ResultsOf 180 isolates, 72 (40.0%) were resistant to at least 1 antituberculosis drug, and 10 (5.6%) were resistant to at least isoniazid and rifampicin. Isoniazid and/or streptomycin resistance was associated with slower CSF bacterial clearance but not with any differences in clinical response or outcome. Combined isoniazid and rifampicin resistance was strongly predictive of death (relative risk of death, 11.63 95% confidence interval, 5.21–26.32) and was independently associated with human immunodeficiency virus infection ConclusionsIsoniazid and/or streptomycin resistance probably has no detrimental effect on the outcome of TBM when patients are treated with first-line antituberculosis drugs, but combined isoniazid and rifampicin resistance is strongly predictive of death
Summary
Bats and rodents are being increasingly recognized as reservoirs of emerging zoonotic viruses. Various studies have investigated bat viruses in tropical regions, but to date there are no data ...regarding viruses with zoonotic potential that circulate in bat and rat populations in Viet Nam. To address this paucity of data, we sampled three bat farms and three wet markets trading in rat meat in the Mekong Delta region of southern Viet Nam. Faecal and urine samples were screened for the presence of RNA from paramyxoviruses, coronaviruses and filoviruses. Paramyxovirus RNA was detected in 4 of 248 (1%) and 11 of 222 (4.9%) bat faecal and urine samples, respectively. Coronavirus RNA was detected in 55 of 248 (22%) of bat faecal samples; filovirus RNA was not detected in any of the bat samples. Further, coronavirus RNA was detected in 12 of 270 (4.4%) of rat faecal samples; all samples tested negative for paramyxovirus. Phylogenetic analysis revealed that the bat paramyxoviruses and bat and rat coronaviruses were related to viruses circulating in bat and rodent populations globally, but showed no cross‐species mixing of viruses between bat and rat populations within Viet Nam. Our study shows that potentially novel variants of paramyxoviruses and coronaviruses commonly circulate in bat and rat populations in Viet Nam. Further characterization of the viruses and additional human and animal surveillance is required to evaluate the likelihood of viral spillover and to assess whether these viruses pose a risk to human health.
Background. Streptococcus suis infection is an emerging zoonosis in Asia. We determined the detailed epidemiological, clinical, and microbiological characteristics of S. suis meningitis in adults. ...Methods. We prospectively studied 450 patients with suspected bacterial meningitis. Four hundred thirty-five (96.7%) of the patients participated in a trial to determine the effect of adjunctive dexamethasone treatment. For patients with S. suis infection, bacterial DNA load at hospital admission and during treatment was analyzed in cerebrospinal fluid specimens using quantitative real-time polymerase chain reaction. S. suis strains were characterized using pulsed-field gel electrophoresis and multilocus sequence typing. Putative virulence factors, including extracellular protein factor, suilysin, and muramidase released protein, were detected using polymerase chain reaction and Western blot assay. Predictors of outcome were identified using logistic regression analysis. Results. S. suis was the most common pathogen and was detected in 151 (33.6%) of the patients. Fifty (33.1%) of these 151 patients reported exposure to pigs or pork. Mortality was low (2.6%; 4 of 151 patients died), but mild to severe hearing loss occurred in 93 (66.4%) of 140 patients. Severe deafness at hospital discharge was associated with age >50 years (odds ratio, 3.65; 95% confidence interval, 1.15–11.6), a strain carrying the epf gene (odds ratio, 3.42; 95% confidence interval, 1.02–11.4), and dexamethasone therapy (odds ratio, 0.23; 95% confidence interval, 0.06–0.78) but was not associated with cerebrospinal fluid bacterial DNA load. Bacterial DNA was still detectable in 58 (63%) of 92 cerebrospinal fluid samples after 6–10 days of antimicrobial treatment. Ninety-one of 92 S. suis strains had serotype 2. Thirty-three (36%) of these epidemiologically unrelated strains belonged to 1 pulsed-field gel electrophoresis cluster of multilocus sequence type 1, indicating clonal spread. Conclusion. S. suis serotype 2 is the most frequent cause of bacterial meningitis in adults in southern Vietnam and is associated with substantial morbidity attributable to hearing loss.
Background
Porcine epidemic diarrhea (PED) is a highly contagious swine disease caused by the PED virus (PEDV), which is a member of the family Coronaviridae. Since the first outbreaks in Belgium and ...the United Kingdom were reported in 1971, PED has spread throughout many countries around the world and causing significant economic loss. This study was conducted to investigate the recent distribution of PEDV strains in Vietnam during the 2015–2016 seasons.
Methods
A total of 30 PED‐specific PCR‐positive intestinal and faecal samples were collected from unvaccinated piglets in Vietnam during the 2015–2016 seasons. The full length of the spike (S) gene of these PEDV strains were analysed to determine their phylogeny and genetic relationship with other available PEDV strains globally.
Results
Phylogenetic analysis of the complete S gene sequences revealed that the 28 Vietnamese PEDV strains collected in the northern and central regions clustered in the G2 group (both G2a and G2b sub‐groups), while the other 2 PEDV strains (HUA‐PED176 and HUA‐PED254) collected in the southern region were clustered in the G1/G1b group/sub‐group. The nucleotide (nt) and deduced amino acid (aa) analyses based on the complete S gene sequences showed that the Vietnamese PEDV strains were closely related to each other, sharing nt and aa homology of 93.2%–99.9% and 92.6%–99.9%, respectively. The N‐glycosylation patterns and mutations in the antigenic region were observed in Vietnamese PEDV strains.
Conclusions
This study provides, for the first time, up‐to‐date information on viral circulation and genetic distribution, as well as evidence to assist in the development of effective PEDV vaccines in Vietnam.
Porcine epidemic diarrhea viruses cause highly contagious swine disease in Vietnam. The circulating Vietnamese PEDV strains belonged to the G2/G2a and G2b group/sub‐groups and G1/G1b group/sub‐group.
Energy security and pollution are becoming critical issues in the context of climate change and the circular economy, calling for sustainable resources. Asteraceae species, commonly referred as ...the aster, daisy, composite, or sunflower family, are among the largest flowering plants with 23,000 species belonging to 1600 genera, and are a major source of biomass. Here we review botanical characteristics and applications of Asteraceae for bioenergy, remediation, nanotechnology, medicine, food and agriculture. Sunflower is the most used to produce bio-oils with a yearly production of 47 million tons. Sunflower is also used for phytoremediation of heavy metals such as cadmium, lead, uranium, and chromium. Artichoke, chicory, purple coneflower, and wormwood display medicinal potential with 27–103 bioactive compounds. Artemisia, calendula, and sunflower oil are precursors for cosmetic and perfume production. Asteraceae species exhibited high efficiencies of 90−96% for removal of remazol red, and reactive blue dyes. Asteraceae species are used for fabrication of nanoparticles, biochar, activated carbon and biocomposites.
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