In Latin America, little is known about the involvement of private health-care providers in tuberculosis (TB) detection and management. We sought to gain a better understanding of current and ...potential roles of the private sector in delivering TB services in Peru. We conducted a mixed-methods study in North Lima, Peru. The quantitative component comprised a patient pathway analysis assessing the alignment of TB services with patient care-seeking behavior. The qualitative component comprised in-depth interviews with 18 private health-care providers and 5 key informants. We estimated that 77% of patients sought care initially at a facility with TB diagnostic capacity and 59% at a facility with TB treatment capacity. Among private facilities, 43% offered smear microscopy, 13% offered radiography, and none provided TB treatment. Among public-sector facilities, 100% offered smear microscopy, 26% offered radiography, and 99% provided TB treatment. Private providers believed they offered shorter wait times and a faster diagnosis, but they struggled with a lack of referral systems and communication with the public sector. Nonrecognition of private-sector tests by the public sector led to duplicate testing of referred patients. Although expressing willingness to collaborate with public-sector programs for diagnosis and referral, private providers had limited interest in treating TB. This study highlights the role of private providers in Peru as an entry point for TB care. Public-private collaboration is necessary to harness the potential of the private sector as an ally for early diagnosis.
Background. Globally, >30 000 children fall sick with multidrug-resistant (MDR) tuberculosis every year. Without robust pediatric data, clinical management follows international guidelines that are ...based on studies in adults and expert opinion. We aimed to identify baseline predictors of death, treatment failure, and loss to follow-up among children with MDR tuberculosis disease treated with regimens tailored to their drug susceptibility test (DST) result or to the DST result of a source case. Methods. This retrospective cohort study included all children ≤15 years old with confirmed and probable MDR tuberculosis disease who began tailored regimens in Lima, Peru, between 2005 and 2009. Using logistic regression, we examined associations between baseline patient and treatment characteristics and (1) death or treatment failure and (2) loss to follow-up. Results. Two hundred eleven of 232 (90.9%) children had known treatment outcomes, of whom 163 (77.2%) achieved cure or probable cure, 29 (13.7%) were lost to follow-up, 10 (4.7%) experienced treatment failure, and 9 (4.3%) died. Independent baseline predictors of death or treatment failure were the presence of severe disease (adjusted odds ratio aOR, 4.96; 95% confidence interval CI, 1.61–15.26) and z score ≤−1 (aOR, 3.39; 95% CI, 1.20–9.54). We did not identify any independent predictors of loss to follow-up. Conclusions. High cure rates can be achieved in children with MDR tuberculosis using tailored regimens containing second-line drugs. However, children faced significantly higher risk of death or treatment failure if they had severe disease or were underweight. These findings highlight the need for early interventions that can improve treatment outcomes for children with MDR tuberculosis.
The skin of fish is a physicochemical barrier that is characterized by being formed by cells that secrete molecules responsible for the first defense against pathogenic organisms. In this study, the ...biological activity of peptides from mucus of Seriola lalandi and Seriolella violacea were identified and characterized. To this purpose, peptide extraction was carried out from epidermal mucus samples of juveniles of both species, using chromatographic strategies for purification. Then, the peptide extracts were characterized to obtain the amino acid sequence by mass spectrometry. Using bioinformatics tools for predicting antimicrobial and antioxidant activity, 12 peptides were selected that were chemically produced by simultaneous synthesis using the Fmoc-Tbu strategy. The results revealed that the synthetic peptides presented a random coil or extended secondary structure. The analysis of antimicrobial activity allowed it to be discriminated that four peptides, named by their synthesis code 5065, 5069, 5070, and 5076, had the ability to inhibit the growth of Vibrio anguillarum and affected the copepodite stage of C. rogercresseyi. On the other hand, peptides 5066, 5067, 5070, and 5077 had the highest antioxidant capacity. Finally, peptides 5067, 5069, 5070, and 5076 were the most effective for inducing respiratory burst in fish leukocytes. The analysis of association between composition and biological function revealed that the antimicrobial activity depended on the presence of basic and aromatic amino acids, while the presence of cysteine residues increased the antioxidant activity of the peptides. Additionally, it was observed that those peptides that presented the highest antimicrobial capacity were those that also stimulated respiratory burst in leukocytes. This is the first work that demonstrates the presence of functional peptides in the epidermal mucus of Chilean marine fish, which provide different biological properties when the fish face opportunistic pathogens.
Resistance to isoniazid is the most common form of drug-resistance in tuberculosis. However only a tiny proportion of TB patients in the world have access to isoniazid drug susceptibility testing-the ...widely implemented Xpert MTB/RIF technology only tests for resistance to rifampicin. Patients with isoniazid mono resistance that is not identified at baseline are treated with a standard regimen that effectively results in rifampicin mono-therapy during the latter four months of the six month treatment course, exposing remaining viable organisms to a single agent and greatly increasing the risk of development of multi drug-resistant TB. Unusually, Peru has pioneered universal pre-treatment drug susceptibility testing with methods that identify isoniazid resistance and has thus identified a large number of individuals requiring tailored therapy. Since 2010, treatment in Peru for isoniazid-resistant tuberculosis without multidrug-resistant tuberculosis (Hr-TB) has been with a standardized nine-month regimen of levofloxacin, rifampicin, ethambutol and pyrazinamide. The objectives of this study were to evaluate the outcomes of treatment for patients with Hr-TB initiating treatment with this regimen between January 2012 and December 2014 and to determine factors affecting these outcomes.
Retrospective cross-sectional study; case data were obtained from the national registry of drug-resistant tuberculosis. Patients diagnosed with isoniazid resistant TB without resistance to rifampicin, pyrazinamide, ethambutol and quinolones as determined by either a rapid drug susceptibility testing (DST) (nitrate reductase test, MODS, Genotype MTBDRplus) or by the proportion method were included.
A total of 947 cases were evaluated (a further 403 without treatment end date were excluded), with treatment success in 77.2% (731 cases), loss to follow-up in 19.7% (186 cases), treatment failure in 1.2% (12 cases), and death in 1.9% (18 cases). Unfavorable outcomes were associated in multivariate analysis with male gender (OR 0.50, 95% CI 0.34-0.72, p<0.05), lack of rapid DST (OR 0.67, 95% CI 0.50-0.91, p = 0.01), additional use of an injectable second-line anti-tuberculous drug (OR 0.46, 95% CI 0.31-0.70, p<0.05), and treatment initiation in 2014 (OR 0.77, 95% CI 0.62-0.94, p = 0.01).
The treatment regimen implemented in Peru for isoniazid resistant TB is effective for TB cure and is not improved by addition of an injectable second-line agent. Access to rapid DST and treatment adherence need to be strengthened to increase favorable results.
Abstract
Co-digestion of thermally pretreated sewage sludge with food waste is an innovative strategy that could improve the balance and availability of nutrients needed to increase the efficiency of ...anaerobic digestion in terms of biogas production. In this context, the aim of this research was to evaluate the impact of different proportions of sewage sludge/food waste in laboratory- and pilot-scale reactors. Special focus was placed on the impact of the variability of food waste composition on the behaviour of the pilot digester. Our results show that by adding 40% of co-substrate, a higher biogas production was possible during laboratory operation. Interestingly, using a co-substrate of variable composition had no negative impact on the reactor's stability at pilot-scale, promoting an increase in biogas production through a more efficient use of organic matter. In both the lab and pilot experiences there was an impact on the amount of nitrogen in the digestate compared to digester operating in monodigestion. This impact is more significant as the proportion of co-substrate rises. Overall, our results show that co-digestion of thermally pretreated sewage sludge with food waste allows better management of food waste, especially when their composition is variable.
En el presente trabajo investigativo se identificó y analizó las formas y expresiones de la violencia simbólica, bajo el enfoque teórico y conceptual del sociólogo Pierre Bourdieu, las cuales suelen ...estar encubiertas en la sociedad. Éstas son ejercidas sobre mujeres que son docentes y autoridades universitarias que ocuparon u ocupan en la actualidad cargos jerárquicos en la Universidad Mayor de San Andrés (UMSA) en La Paz, Bolivia. Se constató la formación social de un menosprecio, discriminación y segregación contra la academia constituida por mujeres, la misma que influye, en la configuración de la estructura política de la citada universidad. Se encontró una reproducción social de las estructuras patriarcales que socavan las relaciones sociales e institucionales en la universidad. Para poder llegar a estos resultados, se utilizó un enfoque metodológico mixto, o lo que se ha denominado como metodología cuantitativa-cualitativa, concentrándose en lograr una mayor comprensión y explicación del estudio realizado. Con la metodología cuantitativa se pudo demostrar las diferencias numéricas de género con datos construidos con el apoyo del Departamento de Sistemas de Información Estadística (DSIE) de la UMSA y de ese modo se profundizó gracias a la aplicación de herramientas y técnicas de investigación de la metodología cualitativa, específicamente, se realizó una entrevista semi-estructurada a profundidad a 13 docente mujeres de todas las facultades de la universidad, se valoró la apertura de las entrevistadas para abordar un tema delicado y personal como el presentado en este trabajo investigativo.
The red cusk-eel (Genypterus chilensis, Guichenot 1848) is an iconic species in Chilean gastronomy, with a cultural significance that extends beyond its economic value, worthy of conservation. ...Despite the decline in fishery productivity across most of the distribution range for this species, little effort has been devoted to assessing stock management. In the present study, seven heterologous microsatellite loci (cmrGb3.8.1, cmrGb5.2B, cmrGb4.2A, cmrGb4.2B, cmrGb5.9, cmrGb4.11 and cmrGb2.6.1) were genotyped in a total of 153 individuals from four locations in central and southern Chile (30.5ºS–37.6ºS), comprising ~1000 km of coastline. Five microsatellite loci were consistently amplified with a low frequency of null alleles (<2.5%). These markers showed high average heterozygosity (HO=0.886 and HE=0.884) and PIC (0.869). Significant genetic differentiation among locations (global FST=0.043, global DJost=0.252) suggested the presence of at least three different genetic groups along the Chilean coast, with moderate levels of admixture between the two central populations (0.168 <Qmean<0.822). The southern population showed no admixture with the central populations (Qmean=0.985), less allelic richness and a small effective population size, indicating that urgent management measures must be developed for this fishery. The present study provides baseline information to assist fishery and aquaculture management, contribute to recovery of declining populations, promote sustainable fishing and aquaculture and avoid the collapse of red cusk-eel production.
Intermittent fasting for health care, a review Espinoza, Valentina; Alarcón, Carolina; Contreras, Yaroleth ...
Archivos latinoamericanos de nutrición,
03/2023, Letnik:
73, Številka:
1
Journal Article
Recenzirano
Odprti dostop
The incidence of obesity and overweight in the world has been increasing in recent years due to poor diet and lack of physical activity; people suffering obesity and overweight, related with ...malnutrition due to excess, often resort to calorie restriction diets that are usually not very effective. In this context, intermittent fasting (IF) has become popular due to the possibilities for weight loss that it offers. This diet consists of alternating periods of fasting with unrestricted eating; however, its effectiveness and consequences are unknown to most users. This narrative review analyzes whether intermittent fasting contributes to the improvement of body and metabolic composition. The purpose of the review was to examine the available data on the contribution of intermittent fasting to the improvement of body and metabolic composition, in order to provide information and to define the parameters that condition safe achievement of its benefits. IF dieting triggers adaptive cell responses that cause a decrease in lipid oxidative stress markers in individuals with obesity and prediabetes. Metabolic alterations have been found to go hand in hand with the alteration of circadian rhythms; if IF contributes to this effect, it may assist in treating and preventing obesity and associated diseases. However, there are also disadvantages, such as the loss of lean muscle mass by wasting, and increased hypoglycemia.
In the north of Chile, several projects propose to promote the diversification of national aquaculture with native fish species. However, one of the expected impacts of climate change on the Chilean ...coasts is an increase in the intensity and frequency of hypoxia events. Therefore, it can become one of the main problems for fish aquaculture in farming facilities. Two species of Chilean diversification programs are Seriola lalandi and Seriolella violacea, which have different habitats and may have different oxygen requirements. Thus, this work aimed to evaluate the variations in oxygen consumption rates in 10 month-old juveniles of both fish species and to determine the presence of tolerant and non-tolerant individuals at low dissolved oxygen (DO) availability. A simulation of an acute hypoxia event by loss-of-equilibrium (LOEhyp) experiments allowed us to classify tolerant and non-tolerant fish. Then, individual oxygen consumption rates were measured, and the resting metabolic rate (RMR) and the maximum metabolic rate (MMR) for hypoxia-tolerant and non-tolerant juveniles were obtained. The results reveal that S. lalandi juveniles have a higher oxygen demand than S. violacea, the first presenting a significantly higher metabolic rate and locomotor activity. Furthermore, the blood parameters suggest that triglyceride metabolism could be used as alternative energy sources by S. violacea during hypoxic-environments. The juveniles classified as tolerant from both species have a lower RMR than non-tolerant fish, which is associated with reduction in their locomotor activity evidenced by decreasing tail beat frequency. Furthermore, the hypoxia-tolerant juveniles also reached a significantly higher size than non-tolerant fish. This work provides valuable results for the future S. lalandi and S. violacea industries, considering the effects of low OD in the farms. Likewise, the first evidence of the hypoxia adaptive mechanism of native fish are presented, providing scientific support for their aquaculture in Chile.
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