By the middle of 2021, we are still immersed in the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The concurrence of this ...new pandemic in regions where human immunodeficiency virus (HIV) and tuberculosis (TB) infections possess the same epidemiological consideration, has arisen concerns about the prognosis, clinical management, symptomatology, and treatment of patients with triple infection. At the same time, healthcare services previously devoted to diagnosis and treatment of TB and HIV are being jeopardized by the urgent need of resources and attention for COVID-19 patients. The aim of this review was to collect any article considering the three conditions (HIV, TB, and SARS-CoV-2), included in PubMed/Medline and published in the English language since the beginning of the COVID-19 pandemic. We focused on detailed descriptions of the unusual cases describing the three co-infections. Eighty-four out of 184 publications retrieved met our inclusion criteria, but only three of them reported cases (five in total) with the three concomitant infections. The clinical evolution, management, and therapy of all of them were not different from mild/severe cases with exclusive COVID-19; the outcome was not worse either, with recovery for the five patients. Cases of patients with COVID-19 besides HIV and TB infections are scarce in literature, but studies deliberately embracing the triple infection as a priori inclusion criterion should be carried out in order to provide a complete understanding of joint influence.
Intratumoral expression of genes encoding Cytochrome P450 enzymes (CYP) might play a critical role not only in cancer development but also in the metabolism of anticancer drugs. The purpose of this ...study was to compare the mRNA expression patterns of seven representative CYPs in paired tumor and normal tissue of child patients with rabdomyosarcoma (RMS). Using real time quantitative RT-PCR, the gene expression pattern of CYP1A1, CYP1A2, CYP1B1, CYP2E1, CYP2W1, CYP3A4, and CYP3A5 were analyzed in tumor and adjacent non-tumor tissues from 13 child RMS patients. Protein concentration of CYPs was determined using Western blot. The expression levels were tested for correlation with the clinical and pathological data of the patients. Our data showed that the expression levels of CYP1A1 and CYP1A2 were negligible. Elevated expression of CYP1B1 mRNA and protein was detected in most RMS tumors and adjacent normal tissues. Most cancerous samples exhibit higher levels of both CYP3A4 and CYP3A5 compared with normal tissue samples. Expression of CYP2E1 mRNA was found to be significantly higher in tumor tissue, however no relation was found with protein levels. CYP2W1 mRNA and/or protein are mainly expressed in tumors. In conclusion, we defined the CYP gene expression profile in tumor and paired normal tissue of child patients with RMS. The overexpression of CYP2W1, CYP3A4 and CYP3A5 in tumor tissues suggests that they may be involved in RMS chemoresistance; furthermore, they may be exploited for the localized activation of anticancer prodrugs.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Este artículo discute la forma en que la política pública entiende el concepto de inclusión de los estudiantes con necesidades educativas especiales o discapacidad, lo traduce en normativa y lleva ...tales regulaciones a la práctica. A partir de una observación etnográfica, exploramos las variadas formas en que se implementan prácticas inclusivas en el marco de la política edu- cacional chilena. Nuestro hallazgo principal es que no existe un concepto de inclusión único y fijo en la actualización de la política pública, sino que se materializa en la práctica de formas dinámicas y múltiples, poniendo en contacto diversos actores, humanos y no-humanos, los cuales despliegan sus agencias. Esta situación hace difícil la puesta en marcha de una política nacional unívoca, pero a la vez abre paso a la posibilidad de territorializar situadamente ciertas prácticas y saberes.
RESUMEN Presentamos una revisión del estado de la legislación sobre educación especial en Chile y un análisis cualitativo de su aplicación en escuelas regulares con Programas de Integración Escolar. ...Exponemos que la normativa para la integración de niñas/os con Necesidades Educativas Especiales se enmarca en un contexto enfocado en la rendición de cuentas sin criterios comunes que faciliten su interpretación. Como consecuencia, los actores involucrados ponen en práctica las normas de diversas formas, lo que incluye el abordar la normativa respecto a asuntos administrativos y financieros para intentar que no obstaculice la inclusión de manera universal.
ABSTRACT We present a review of the state of legislation on special education in Chile and a qualitative analysis of the concrete application of this regulation in regular schools with School Integration Programs. We expose that the regulations governing the integration of children with Special Educational Needs into regular classes are part of a broader legal context characterized by dispersion and little systematization, focus on accountability and lack of common criteria to facilitate their interpretation. As a result, the actors involved program the standards in a variety of ways, including addressing regulations regarding administrative and financial matters to try not to hinder inclusion in a universal way.
Several European countries have established criteria for prioritising initiation of treatment in patients infected with the hepatitis C virus (HCV) by grouping patients according to clinical ...characteristics. Based on neural network techniques, our objective was to identify those factors for HIV/HCV co-infected patients (to which clinicians have given careful consideration before treatment uptake) that have not being included among the prioritisation criteria. This study was based on the Spanish HERACLES cohort (NCT02511496) (April-September 2015, 2940 patients) and involved application of different neural network models with different basis functions (product-unit, sigmoid unit and radial basis function neural networks) for automatic classification of patients for treatment. An evolutionary algorithm was used to determine the architecture and estimate the coefficients of the model. This machine learning methodology found that radial basis neural networks provided a very simple model in terms of the number of patient characteristics to be considered by the classifier (in this case, six), returning a good overall classification accuracy of 0.767 and a minimum sensitivity (for the classification of the minority class, untreated patients) of 0.550. Finally, the area under the ROC curve was 0.802, which proved to be exceptional. The parsimony of the model makes it especially attractive, using just eight connections. The independent variable "recent PWID" is compulsory due to its importance. The simplicity of the model means that it is possible to analyse the relationship between patient characteristics and the probability of belonging to the treated group.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
CRF19_cpx is a complex circulating recombination form (CRF) of HIV-1. We describe the characteristics of an outbreak of the CRF19_cpx variant among treatment-naïve patients in southern Spain.
The ...study was undertaken at the Virgen de la Victoria Hospital, a reference centre for the analysis of HIV-1 genotype in Malaga (Spain). Subtyping was performed through REGA v3.0 and the relationship of our CRF19_cpx sequences, among themselves and regarding other reference sequences from the same variant, was defined by phylogenetic analysis. We used PhyML program to perform a reconstruction of the phylogeny by Maximum Likelihood method as well as further confirmation of the transmission clusters by Bayesian inference. Additionally, we collected demographic, clinical and immunovirological data.
Between 2011 and 2016, we detected 57 treatment-naïve patients with the CRF19_cpx variant. Of these, 55 conformed a very well-defined transmission cluster, phylogenetically close to CRF19_cpx sequences from the United Kingdom. The origin of this subtype in Malaga was dated between 2007 and 2010. Over 50% of the patients presented the non-nucleoside reverse transcriptase inhibitor G190A resistance mutation. This variant was mostly represented by young adult Spanish men who had sex with men. Almost half of them were recent seroconverters, though a similar percentage was diagnosed at a late state of HIV infection. Five cases of AIDS and one non-AIDS defined death occurred during follow-up. The majority of patients treated with first-line combination antiretroviral therapy (ART) responded.
We report the largest HIV-1 CRF19_cpx cohort of treatment-naïve patients outside Cuba, almost all emerging as an outbreak in the South of Spain. Half the cases had the G190A resistance mutation. Unlike previous studies, the variant from Malaga seems less pathogenic, with few AIDS events and an excellent response to ART.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller ...population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015-2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling.
A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment among diagnosed PLWH of 10.5%/year from 2004 to 2014, and DAAs at 33%/year from 2015 with 94.8% SVR. We project the impact of current and scaled-up HCV treatment for PLWH on HCV prevalence and incidence among PLWH and overall.
Current treatment rates among PLWH (scaled-up since 2015) could substantially reduce the number of diagnosed coinfected individuals (mean 76% relative reduction from 2015 to 2030), but have little impact on new diagnosed coinfections (12% relative reduction). However, DAA scale-up to PWLH in 2015 would have minimal future impact on new diagnosed coinfections (mean 9% relative decrease from 2015 to 2030). Similarly, new cases of HCV would only reduce by a mean relative 29% among all PWID and MSM due to ongoing infection/reinfection. Diagnosing/treating all PLWH annually from 2020 would increase the number of new HCV infections among PWLH by 28% and reduce the number of new HCV infections by 39% among the broader population by 2030.
Targeted scale-up of HCV treatment to PLWH can dramatically reduce prevalence among this group but will likely have little impact on the annual number of newly diagnosed HIV/HCV coinfections. HCV microelimination efforts among PWLH in Andalusia and settings where a large proportion of PLWH have a history of injecting drug use will require scaled-up HCV diagnosis and treatment among PLWH and the broader population at risk.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Este artículo examina la forma en que la economía del trabajo flexible afecta a un grupo de trabajadoras de salones de belleza en Santiago, Chile. A este no se le da contrato laboral y se le paga ...como si brindara un servicio independiente, aunque en realidad dependa de las reglas que le imponen los jefes. Dicho tipo de empleo corresponde a un nuevo arreglo en el contexto de la informalidad urbana y tiene implicancias presentes y futuras respecto de la seguridad social y la incertidumbre. Con base en la observación etnográfica en cuatro salones de belleza, se describe cómo la creencia corporeizada de ser una trabajadora independiente ayuda a enactar muchos de los atributos requeridos por la economía del trabajo flexible.
Information about the retentive strength of luting agents for zirconium oxide–based crowns is limited. It is unknown if this type of high-strength ceramic restoration requires adhesive cementation to ...enhance retention.
The purpose of this in vitro study was to determine the ability of selected luting agents to retain a representative zirconium oxide ceramic crown under clinically simulated conditions.
Recently extracted human molars were prepared with a flat occlusal surface, 20-degree taper, and approximately 4-mm axial length. The axial and occlusal surface areas were determined, and specimens were distributed equally by total surface area into 3 cementation groups (n=12). Zirconium oxide ceramic copings (Procera AllZirkon) with an occlusal bar to facilitate removal were fabricated using computer-aided design/computer-assisted manufacturing (CAD/CAM) technology. All copings were airborne-particle abraded with 50-μm Al
2O
3 and then cleaned in an ultrasonic bath with isopropyl alcohol. Provisional cement was removed from the prepared teeth, followed by a pumice prophy. After trial insertion, the copings were cleaned with phosphoric acid, rinsed, dried, and dehydrated with isopropyl alcohol. They were then cemented with a seating force of 10 kg per tooth, using either a composite resin cement with adhesive agent (Panavia F 2.0 and ED Primer A & B PAN), a resin-modified glass ionomer cement (Rely X Luting RXL), or a self-adhesive modified composite resin (Rely X Unicem RXU). The cemented copings were thermal cycled at 5°C and 55°C for 5000 cycles with a 15 second dwell time, and then removed along the path of insertion using a universal testing machine at 0.5 mm/min. The removal force was recorded, and the stress of dislodgement was calculated using the surface area of each preparation. A 1-way analysis of variance was used to analyze the data (α=.05). The nature of failure was also recorded.
Mean dislodgement stresses were 5.1, 6.1, and 5.0 MPa for PAN, RXL, and RXU, respectively. The 1-way analysis of variance revealed no differences in mean crown removal stress among the 3 cementation groups. The predominant mode of failure was cement remaining principally on the zirconium oxide copings in 46% of the specimens, followed by cement found on the tooth in 25.7% of the specimens.
Within the limitations of this study, the 3 luting agents, with mean removal stresses ranging from 5.0 to 6.1 MPa were not significantly different. The use of a composite resin cement with a bonding agent did not yield higher coping retention compared to the other 2 cements tested.
OBJECTIVE:To assess the impact of HIV coinfection on the risk of developing liver-related complications in HCV-infected patients with advanced fibrosis treated with direct-acting antivirals (DAA) ...after sustained virological response (SVR).
DESIGN:Prospective cohort study.
SETTING:Multicenter.
SUBJECTS:Patients from the GEHEP and HEPAVIR cohorts were selected if they fulfilled the following criteriatreatment against HCV with all oral DAA combination; SVR achievement, defined as undetectable plasma HCV RNA 12 weeks after the end of therapy; pretreatment liver stiffness equal to or higher than 9.5 kPa; liver stiffness measurement at the time of SVR.
MAIN OUTCOME MEASURE(S):The primary variable was the time until the development of a liver complication or requiring liver transplant.
RESULTSSeven hundred and seventeen patients were included and 507 (71%) were coinfected with HIV. After a median follow-up time of 21 (14–25) months, 15 (2.1%) patients developed a liver complication and/or underwent a liver transplant and 15 (2.0%) died. The probability of remaining free of hepatic complications or transplant at 1 and 2 was, respectively, 99 and 96% in HCV-monoinfected patients and 99 and 98% in coinfected patients (P = 0.648). In a multivariate analysis, in which nonliver-related death was considered as a competing event, HIV coinfection was not associated with the appearance of hepatic complications or requiring liver transplant hazard ratio = 0.24; 95% CI (0.03–1.93), P = 0.181. Having presented hepatic decompensation prior to SVR hazard ratio = 29.06; 95% CI (3.91–216.16), P < 0.001 and the value of liver stiffness at the SVR time-point (hazard ratio = 1.12; 95% CI (1.07–1.18), P < 0.001 were associated with a higher probability of development of liver events.
CONCLUSION:HIV coinfection is not associated with a higher probability of developing liver complications in HCV-infected patients with advanced fibrosis, who achieved SVR with interferon-free regimens.
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