Food insecurity can contribute to poor adherence to both tuberculosis treatment and HIV antiretroviral therapy (ART). Interventions that target food insecurity have the potential to increase ...treatment adherence, improve clinical outcomes, and decrease mortality. The goals of this study were to compare the feasibility, acceptability, and potential impact of implementing two different forms of nutrition support for HIV-TB co-infected adults in the Casamance region of Senegal.
We conducted a randomized pilot implementation study among HIV-TB co-infected adults initiating treatment for TB (ClinicalTrials.gov Identifier: NCT03711721). Subjects received nutrition support in the form of a local food basket or Ready-to-Use Therapeutic Food (RUTF), distributed on a monthly basis for six months.
A total of 178 monthly study encounters were completed by 26 HIV-TB co-infected adults; 14 received food baskets and 12 received RUTF. For both the food basket and RUTF, 100% of subjects obtained the supplement at every study encounter, transferred the supplement from the clinic to their household, and consumed the supplement. The food basket had greater acceptability and was more likely to be shared with members of the household. Adherence to TB treatment and ART exceeded 95%, and all outcomes, including CD4 cell count, hemoglobin, nutritional status, and food security, improved over the study period. All subjects completed TB treatment and were smear negative at treatment completion. The total cost of the local food basket was approximately $0.68 per day versus $0.99 for the RUTF.
The implementation of nutrition support for HIV-TB co-infected adults in Senegal is feasible and may provide an effective strategy to improve adherence, treatment completion, and clinical outcomes for less than 1 USD per day. Further studies to determine the impact of nutrition support among a larger population of HIV-TB co-infected individuals are indicated.
Understanding the impact of food insecurity on HIV outcomes is critical for the development and implementation of effective, evidence-based interventions to address food insecurity and improve the ...HIV care cascade. We conducted a prospective, longitudinal study to determine the impact of food insecurity on HIV outcomes in Senegal, West Africa.
HIV-infected individuals presenting for care and initiation of ART through the Senegalese National AIDS program in Dakar and Ziguinchor were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart review at enrollment, month 6, and month 12. Logistic regression was used to determine the association between food insecurity and HIV outcomes.
Among the 207 participants in this study, 70% were female and the median age was 37 years. The majority (69%) were food insecure at enrollment, 29% were severely food insecure, and 38% were undernourished. Nearly a third (32%) had no formal education, 23% practiced agriculture, and 40% owned livestock. The median daily food expenditure per person was $0.58. The median round trip transportation time to clinic was 90 min (IQR 30-240). The median cost of transportation to clinic was $1.74. At month 12, 69% were food insecure, 23% were severely food insecure, and 14% were undernourished. At month 12, 43% had not disclosed their HIV status; food insecurity was associated with non-disclosure of HIV-status due to fear of stigmatization and feelings of shame. Severe food insecurity was a strong predictor of loss to follow-up (OR 3.13 1.08-9.06) and persistent severe food insecurity was associated with virologic failure (OR 5.14 1.01-26.29) and poor adherence to ART 8.00 1.11-57.57. Poor nutritional status was associated with poor immunologic recovery (OR 4.24 1.56-11.47), virologic failure (OR 3.39 1.13-10.21), and death (OR 3.35 1.40-8.03).
Severity and duration of food insecurity are important factors in understanding the relationship between food insecurity and HIV outcomes. Our findings highlight the importance of nutritional status, socioeconomic opportunity, and self-stigmatization in the complex pathway between food insecurity and HIV outcomes. Interdisciplinary, multisectoral efforts are needed to develop and implement effective interventions to address food insecurity among people living with HIV.
Estimates of riparian vegetation water use are important for hydromorphological assessment, partitioning within human and natural environments, and informing environmental policy decisions. The ...objectives of this study were to calculate the actual evapotranspiration (ETa) (mm/day and mm/year) and derive riparian vegetation annual consumptive use (CU) in acre-feet (AF) for select riparian areas of the Little Colorado River watershed within the Navajo Nation, in northeastern Arizona, USA. This was accomplished by first estimating the riparian land cover area for trees and shrubs using a 2019 summer scene from National Agricultural Imagery Program (NAIP) (1 m resolution), and then fusing the riparian delineation with Landsat-8 OLI (30-m) to estimate ETa for 2014–2020. We used indirect remote sensing methods based on gridded weather data, Daymet (1 km) and PRISM (4 km), and Landsat measurements of vegetation activity using the two-band Enhanced Vegetation Index (EVI2). Estimates of potential ET were calculated using Blaney-Criddle. Riparian ETa was quantified using the Nagler ET(EVI2) approach. Using both vector and raster estimates of tree, shrub, and total riparian area, we produced the first CU measurements for this region. Our best estimate of annual CU is 36,983 AF with a range between 31,648–41,585 AF and refines earlier projections of 25,387–46,397 AF.
The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of ...tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive therapy (IPT), fluconazole pre-emptive therapy, and adherence support. The goals of this study were to determine the prevalence of advanced HIV disease among individuals initiating ART in Senegal, to identify predictors of advanced disease, and to evaluate adherence to the WHO guidelines.
This study was conducted among HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal. Clinical evaluations, laboratory analyses, questionnaires and chart review were conducted. Logistic regression was used to identify predictors of advanced disease.
A total of 198 subjects were enrolled; 70% were female. The majority of subjects (71%) had advanced HIV disease, defined by the WHO as a CD4 count < 200 cells/mm
or clinical stage 3 or 4. The median CD4 count was 185 cells/mm
. The strongest predictors of advanced disease were age ≥ 35 (OR 5.80, 95%CI 2.35-14.30) and having sought care from a traditional healer (OR 3.86, 95%CI 1.17-12.78). Approximately one third of subjects initiated ART within 7 days of diagnosis. Co-trimoxazole prophylaxis was provided to 65% of subjects with CD4 counts ≤350 cells/mm
or stage 3 or 4 disease. TB symptom screening was available for 166 subjects; 54% reported TB symptoms. Among those with TB symptoms, 39% underwent diagnostic evaluation. Among those eligible for IPT, one subject received isoniazid. No subjects underwent CrAg screening or received fluconazole to prevent cryptococcal meningitis.
This is the first study to report an association between seeking care from a traditional healer and presentation with WHO defined advanced disease in sub-Saharan Africa. Given the widespread use of traditional healers in sub-Saharan Africa, future studies to further explore this finding are indicated. Although the majority of individuals in this study presented with advanced disease and warranted management according to WHO guidelines, there were numerous missed opportunities to prevent HIV-associated morbidity and mortality. Programmatic evaluation is needed to identify barriers to implementation of the WHO guidelines and enhanced funding for operational research is indicated.
Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread ...resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons' compliance with best practices even more important.
Natural resource managers may utilize remotely sensed data to monitor vegetation within their decision-making frameworks for improving habitats. Under binational agreements between the United States ...and Mexico, seven reaches were targeted for riparian habitat enhancement. Monitoring was carried out using Landsat 8 16-day intervals of the two-band enhanced vegetation index 2 (EVI2) for greenness and actual evapotranspiration (ETa). In-channel water was delivered in 2021 and 2022 at four places in Reach 4. Three reaches (Reaches 4, 5 and 7) showed no discernable difference in EVI2 from reaches that did not receive in-channel water (Reaches 1, 2, 3 and 6). EVI2 in 2021 was higher than 2020 in all reaches except Reach 3, and EVI2 in 2022 was lower than 2021 in all reaches except Reach 7. ET(EVI2) was higher in 2020 than in 2021 and 2022 in all seven reaches; it was highest in Reach 4 (containing restoration sites) in all years. Excluding restoration sites, compared with 2020, unrestored reaches showed that EVI2 minimally increased in 2021 and 2022, while ET(EVI2) minimally decreased despite added water in 2021–2022. Difference maps comparing 2020 (no-flow year) to 2021 and 2022 (in-channel flows) reveal areas in Reaches 5 and 7 where the in-channel flows increased greenness and ET(EVI2).
Sigmoid volvulus is a common surgical emergency, especially in elderly patients. Patients can present with a wide range of clinical states: from asymptomatic, to frank peritonitis secondary to ...colonic perforation. These patients generally need urgent treatment, be it endoscopic decompression of the colon or an upfront colectomy. The World Society of Emergency Surgery united a worldwide group of international experts to review the current evidence and propose a consensus guidelines on the management of sigmoid volvulus.
Using a nested bivariate panel probit model, we quantify the perceived attribute values (PAV) that beef producers place on different information flows and alliance attributes. Our framework allows us ...to quantify the monetary value of individual rather than fixed sets of attributes. Results indicate that young producers are most likely to join an alliance, and high participation fees are a significant deterrent to joining an alliance. A PAV of $12.64/head is attached to an alliance that enforces restrictions on vaccinations and antibiotic use. For small producers, not having a required minimum number of animals has a PAV of $9.65/head.
Background:
In recent years, extracellular vesicles have been recognized as important mediators of intercellular communication through the transfer of active biomolecules (proteins, lipids, and ...nucleic acids) across the plant and animal kingdoms and have considerable roles in several physiological and pathological mechanisms, showing great promise as new therapeutic strategies for a variety of pathologies.
Methods:
In this study, we carefully reviewed the numerous articles published over the last few decades on the general knowledge of extracellular vesicles, their application in the therapy of various pathologies, and their prospects as an approach for the future.
Results:
The recent discovery and characterization of extracellular vesicles (EVs) of diverse origins and biogenesis have altered the current paradigm of intercellular communication, opening up new diagnostic and therapeutic perspectives. Research into these EVs released by plant and mammalian cells has revealed their involvement in a number of physiological and pathological mechanisms, such as embryonic development, immune response, tissue regeneration, and cancer. They are also being studied as potential biomarkers for disease diagnosis and vectors for drug delivery.
Conclusion:
Nanovesicles represent powerful tools for intercellular communication and the transfer of bioactive molecules. Their molecular composition and functions can vary according to their origin (plant and mammalian), so their formation, composition, and biological roles open the way to therapeutic applications in a variety of pathologies, which is arousing growing interest in the scientific community.
Clinical Trial Registration:
ClinicalTrials.gov
identifier: NCT03608631
This paper examines the environmental Kuznets curve (EKC) theory, augmenting the role of oil resources and energy consumption in carbon dioxide (CO2) emissions using the annual data of 11 African ...oil-producing countries from 1980 to 2014. We apply advanced panel cointegration and panel autoregressive distributive lag (ARDL) techniques coupled with Granger non-causality analysis to account for cross-sectional dependence and heterogeneity. The results of the augmented mean group (AMG) reveal that oil resources abundance degrades the environmental quality in Angola while abating CO2 emissions in Algeria, Gabon, Morocco, and Nigeria. Contrarily, energy consumption escalates pollution in the Congo Democratic Republic (COD), Côte d’Ivoire (CIV), Gabon, Morocco, and Tunisia. Our findings support the EKC hypothesis only in Cameroon, CIV, and Nigeria while exhibiting a U-shaped curve in Algeria and Morocco. Causality analysis unveils that oil resources Granger cause energy consumption, suggesting the balance between renewable and non-renewable energy sources. The current study has important policy implications for promoting green technology, economic diversification, service sector, and green investments.
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